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Permit (32) III CITY OF TIGARDMASTER PERMIT COMMUNITY DEVELOPMENT lli Permit#: MST2016-00216 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2016 F I(;A R.f r 9 Parcel: 2S103BD11800 Jurisdiction: Tigard Site address: 12610 SW 121ST AVE - Subdivision: 2008-056 PARTITION PLAT Lot: 2 Project: Nix Project Description: New SF. 7/5/16, Changed plumbing contractor. 1/25/17, REPRINTED to add washer and dryer vent. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 2926 sf Basement: 0 sf Left 5 Parking Spaces: 0 Height 26 Bathrooms: 4 Second: 900 sf Garage: 812 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3826 sf Value: $475,847.68 Rear: 15 PLUMBING Sinks: 2 Water Closets: 4 Washing Mach: 2 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 5 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 2 Natural Gas Heat Pump: Y Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sl' 7 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Ecompasing: Y Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 3826 Owner: Contractor: NIX,DAVID C OWNER Required Items and Reports(Conditions) NIX,JULIA A DAVID&JULIA NIX 1 Ersn Cntrl 503-639-4175 12630 SW 121ST AVE 12610 SW 121ST AVE TIGARD,OR 97223 TIGARD,OR 97223 PHONE: 503-314-0798 PHONE: 503-314-0798 FAX: Total Fees: $32,690.56 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 d- E •'. -•regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR -"952-001-0010 through OA' • i i 0190. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 4 0 ) Issued By: i / 4_ Permittee Signature: Call 503.639.4176 by 7:00 a.m.for the next available inspectio date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE CSE O\E\ City of Tigard t nate/By Permit No.: I ty'a pf�—(�a( 13125 SW Hall Blvd.,Tigard,OR E , ` j7 „.„ Plan Review Phone: 503.718.2439 Fax: 503. Date/By: Other Permit: T I G A R U Inspection Line: 503.639.4175 JAN Q 1r Date Ready/By: kris: ® See Page 2 for Internet: www.tigard-or.gov 2 Notified/Method: Supplemental Information g C TYPEL141"�c DIVISION COMMERCIAL FEE* SCHEDULE USE CHECKLIST Mechanical permit fees*are based on the value of the work lEr New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* a 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: '/O /,,i 1./,/1 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: -.7—i:76,02,...../ Oer . Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions toob site: / `` Hydronic hot water system 23.32 J ` T_ Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK,' Gas fireplace/insert 33.39 Flue vent for water heater or gas A-D 1- p,Y __9 fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 381 PROPERTY•OWNER 0 TENANT Environmental exhaust and ventilation: Name: "4jj/f��/' q/ . y. Range hood/other kitchen v vvJJ �`J�!/1 equipment 33.39 Address: �,Z i/ ..c‘e...2 ..1- 4,,,„9‘,/,..‹.. Clothes dryer exhaust / 33.39 City/State/ZIP: T�✓/�►r� Single-duct exhaust(bathrooms, / � toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 0 APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Allir 6,32_44,44_ 6 A.14.4other: Business name: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. ul ,..i.,„„dio Print name: Cw L d i Date: / /2,5//i I:\Building\Permits\MEC_PermitApp_040113.doc 440-461TT(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_0401 I3.doc 2 Plumbing Permit Application Building FixturesFOR OFFICI. USF. ONLI' REC;F` Received City of Tigard PermitNo.: /1/1(p/01/7-000-it DaBy: 5,1 . 13125 SW Hall Blvd.,Tigard,OR 9J 2 1 Plan Re Phone: 503.718.2439 Fax: 503.5 96 J Q Plan Review Date/By: Other Permit No.: Inspection Line: 503.639.4175 , Date Read/B runs: ® See Page 2 for TI GA RD }i'� Ready/By: S Internet: www.tigard-or.gov CITY r i I'-2" Note ee/ ethod: Supplemental Information FEE* SCHEDULE New construction 0 Demolition For special information use checklist Description Qty. Ea. I Total 0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 j..1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 0 Accessory buildingMulti-family SFR(3)bath 500.32 0 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: �,� '/O,r� /i/ r �,�,� Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: �7/^ �� / • r Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: "40"/x Manufactured home utilities 50.03 Cross street/directions to job site: /_ f ' __CIA. Manholes 18.76 �'�/ ! Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF`WORK Backwater valve 12.51 Clothes washer / 25.02 A--15-1) (f) a‘6------V(1..0 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PR TY OWNER 0 TENANT Expansion tank 12.51 Name: ,a(/7 /,j��� Fixture/sewer cap 25.02 6"cP j--a,2 /1�wFloor drain/floor sink/hub 25.02 Address: (2 ,,,,,7‘,„.... .._ Garbage disposal 25.02 City/State/ZIP: 9®� Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 APPLICANTInterceptor/grease 25.02 .. _ ..7 ! 0GONTACT *EitSONtrap Medical gas(value:$ ) Page 2 Business name: Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 _ CONTRACTOR Water closet 25.02 . s"' Water heater 37.52 Business name: a- - Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) �1 State surcharge(12%of permit fee) ,,„ Authorized signature:1 \ ,, ,,_/ / 6 / _, TOTAL PERMIT FEE Print name: I)a L/Id e. n-)Lx Date: /l/5/11 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1st 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit=l'ee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accuratelyreport fixtures could result in increased sewer fees* all- i p ?an I2ev><ew ft�r Pi 13* Installations " Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure -Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator Q Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR9J 8-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" solk , ? tric or Riser Diagram 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Sery/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 CITY OF TIGARD MASTER PERMIT ItIII Permit#: MST2016-00216 I COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2016 TIGARD Parcel: 2S103BD11800 Jurisdiction: Tigard Site address: 12610 SW 121ST AVE Subdivision: 2008-056 PARTITION PLAT Lot 2 Project: Nix Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 2926 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 26 Bathrooms: 4 Second: 900 sf Garage: 812 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3826 sf Value: $475,847.68 Rear: 15 PLUMBING Sinks: 2 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 5 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: Y Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder TIMID Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add!500 sf: 7 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 3826 Owner: Contractor: NIX,DAVID C OWNER Required Items and Reports(Conditions) NIX,JULIA A DAVID&JULIA NIX 1 Ersn Cntrl 503-639-4175 12630 SW 121ST AVE 12610 SW 121STAVE TIGARD,OR 97223 TIGARD,OR 97223 PHONE: 503-314-0798 PHONE: 503-314-0798 FAX: Total Fees: $32,535.14 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OA - 2-001-0090. Y•u may obtain a copy of the rules or direct questions to OUNC by calli 3.232.1987 or 1. .332.2344. I Ln Issued By: ll N / 74-CPermittee Signature: Callki/— 503.639.4176 by 7:00 a.m.for the next available inspection date. This permit card shall be kept In a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Buiklin2 Permit Application x/29,12 Residential RECEIVE' hOl2 OfFl( i l tih: ()NI 1 City of Tigard Received y �G ii l o(6 (p Date/By: K Permit No.: ���� :� s 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 4 2016 Plan Review / Phone: 501718.2439 Fax: 503.598.1960 Date/By: C/i j j c Other Permit: Q•�((Q t 7� Inspection Line: 503.639.4175 OF T�UARD Date Ready/By: fur s: ® See Page 2 for 1I<, ' I:I) CITY I S Internet: www.tigard-or.gov �,I'1 1 D'"��tO Notified/Method:Gl 9//� Supplemental Information BUILDING V 1 4 n l<<l� �( /V%r TYPE OF WORK REQUIRED DATA:I.AND'2-FAMILY DWELLII '; yj New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this applicati 0.1-and 2-family dwelling ❑Commercial/industrial Valuation:Lac/ a(�47$ 3 a•S---.0 / ii- ❑Accessory building ❑Multi-family Number of bedrooms: V ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND.LOCATION Total number of floors: i+601 g Job site address:AZ 610 J� `z/r/Alize New dwelling area: 3.7,7 06' square feet City/State/ZIP: Tff,.,4 Oj�, 9,7223 Garage/carport area: jA.' square feet Suite/bldg./apt.no.: J Project name: ,K f Covered porch area: 6/5/1square feet 903 Cross street/directions to job site: a,,,00/� _s-77,4*, Deck area: _.42_ square feet a9 a.c. Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. �j�-/p3 /�/1 // p Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: f. !'.v O O� equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. <V'/eG, ?/ c 7,0r-c Valuation: $ Existing building area: square feet New building area: square feet gl PROPERTY OWNER 0 TENANT" Number of stories: Name: Davit!and JO in,A. JNII)c Type of construction: Address: ilio 5V✓ G)S;-I lu1'U Occupancy groups: City/State/ZIP: 11 a t C . Q7 , 3 Existing: Phone:(503)3/ 07gg Fax:( ) New: dKAPPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: �.— „, Meese refer Wise schedule) Structural plan review fee(or deposit): Contact name: d0 a rld C ni1x ` FLS plan review fee(if applicable): Address: /6149/Q sir i2/S+ J Total fees due upon application: City/State/ZIP: 10( (� 9 3 (r./_0•�1gPhone: ) '] ?AP-3 Fax: :( ) Amount received: E-mail: da✓e , Q�QI�ja I),�y� PHOTOVOLTAIC SOLAR PA L SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: — ©€4-f;- Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature:.-- -A (f. This permit application expires if a permit is not obtained J !`,i„/�-CJ/ within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry "UM Print name: j ai1X Date: 3/ 162Service Board. I:ABuilding\PertnitsBU\BP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB) • Building Permit Application Checklist • One- and Two-Family Dwelling Folz 011.1( i. f sf: o\1.1 City of Tigard Received Date/By: Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: I Phone: 503.718.2439 Fax: 503.598.1960 I I c K I) 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov 0 Other: �'� 11-IE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ,es No N k 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ ■ ■ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 0 3 Verification of approved plat/lot. 0 0 0 4 Fire district approval required. Name of district: . 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0 6 Sewer permit. 0 ❑ 0 7 Water district approval. 0 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0 9 Erosion control 0 plan 0 permit required. include drainage-way protection,silt fence design and location of catch- 0 0 0 basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0 building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0 there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0 ___ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0 floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0 Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0 prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0 systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 0 0 21 Energy Code compliance. identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0 for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0 architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review. 23 Three(3)site plans are required for item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0 27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0 and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0 including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:A Building\Permits\BUP-R ESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) , Electrical Permit ApplicalRcCEIVED l 0,,, °Hi, I I St c)\l l Received �ma t —66 City SW Tigard 2 4 Date/B : Permit t1' �- iir / 13125 Hall Blvd.,Tigard,OR 971/64Y ZQ16 Plan Review ■ Phone: 503.718.2439 Fax: 50 60 Date/B : Related Permit 4: Inspection Line: 503.639.4175 LA 1 i OF I 1GARD Ready Date By: tuns: See Page 2 for I I t,,A R I) Internet: www.tigard-or.gov BUILDING DIVISION Ready Supplemental Information TYPE OF WORK PLAN REVIEW New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. g I_and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground.or exceeds 14.000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: I Job site address: /246/4/, fa r2/lff"l/`C ❑Addition of new motor load of system. J IOOHP or more. ❑"A","E","I-2","I-3". City/State/ZIP: �� t�J ❑Six or more residential units. occupancy. �/' 9�1230 Recreational vehicle parks. 0Health-care facilities. Suite/bldg./apt.#: Project name: /1//,(A-e 0 Hazardous locations. 0 Supply voltage for more than J' ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: ,fixefa �� FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot#: g g • 1 A40/9/474561 a sq. or less 168.54 4 f°'/0 /Y� Tax map/parcel#: 3Ea. dd'I 500 sq.ft.or portion 7 33.92 1 DESCRLPT'ION-OF WORK Limited energy,residential %./e41 �© (with above sq.ft.) 75.00 2 Limited energy,,multi-family mullti-family 75.00 2 residential(with above sq.II.) Renewable Energy 0 See Page 2 iirPROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation Name: Aa r0V4jl�l3ke/ia 04 200 amps or less 100.70 2 Address: /2‘,„ ,fug �2/f‹�,� 201 amps to 400 amps 133.56 2 - 401 amps to 600 amps 200.34 2 City/State/ZIP: �f�f/`? 497/9ve, �/9Q 601 amps to 1,000 amps 301.04 2 Phone:'7.% „7/y-- Qger I Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: - Date: 401 amps to 599 amps 168.54 2 0 APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits wit/i Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first branch circuit 56.18 2 City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Small: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business nam ' Sign or outline lighting 67.84 2 � P_ t! cst.� 1 rL 1/tA�/G,-�1 04.s ��l,C Address: IZ S6 3 2 .,e Signal circuit(s)or limited-energyxesi0 See Page 2 2 .___ `r � panel,alteration,or extension. City/State/ZIPQ,j e ? -i 2 a �i 9 Each additional inspection over allowable in any of the above J N OL_ Additional inspection(1 hr min) 66.25/hr Phone:( ) 35-2- 6 9,k-2 Fax:( ) Investigation(I hr min) 90.00/hr n 77 IO /6-IT 0 p ) 0 ` coIndustrial plant(I hr min) 78.18/hr Email:' /�„ /� (j `t G Inspections for which no fee is CCB Lickfel/L Electrical .'� - �� Suprv. Lic.:3 d2 s chic•, listed('/_hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv. Electrician signature,required ,,____ - , - Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: ` b/zzi'1(Q This permit applicationsr hexpires if na permit is noto plot e. within 180 Print name: e, A 1�`, Date: days after it has been accepted as complete. v X * Number of inspections allowed per permit. T Building Permits ETC PermitApp EI.R_ERE.doc Rev 06 1 7^_015 440-4615TH 105 COx1 WEB 4 Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENT AL +(" R M x YEE SCHEDULE -`;, _, Description Qty. Each Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance ith OAR 918-309-0040) 552.26 2 w ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100kva-noadditional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed CA hr min) COMMER IAL WORK ONLY: ELECTRICAL PERMIT FEES Subtotal(Enter on Page I): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n C• lock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ P• rotective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i nuilding Permits I I C PermitApp ELR_FRIi.do, Rec 06 I—2015 1 Mechanical Permit Applic E I VE D FOR OFFICE 1 SE ON 1.1 City of Tigard Date/By: 5�� . �� ;,71 . 13125 SW Hall Blvd.,Tigard,OR 972.1 ,Y 2 4 2016 Received Plan Review Permit No.: ����- ,�( / ^ Phone: 503.718.2439 Fax: 503.598.1 1 Date/By: Other Permit: I I c, \I:It Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Auris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information b.. ''':''74,'3,' -;. .A . - s ar^' S •# y.tr,, r Ir`. 4 .€:t-' ��fJ+ aat . 'w „. , .,,. n ,k ,,.,,,5,$�f, x t Mechanical ermrt fees*are based �t°'� �. � �s: sr u„ w,.=',,, tea, i. t a^, m l,a abi a.2:"'..aut °.ws6 > ,,,. ,'s�i`''''''''''''''''''''4 w"'%*s... ,�,5 ., r p h on the value of the work 121 New construction ❑ Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all mechanical materials,equipment,labor,overhead,and profit. 0 Demolition ❑Other: Z,4 Value:5 V ,� ,�i�� 0 ' 'c'1t.. ask eL r4ns. 1 t. �71.; $1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑ Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total a � .. Heating/cooling: =a � :.g .W f' ..e4.i: .p�, '....Z.,i.,..', d i't,IP, w r ..,.u„, ,dresa, . 4,. .. Air conditioning 46.75 Job site address: /46i0 J2 `'f lf,'-C Furnace 100,000 BTU(ducts/vents) _ 46.75 City/State/ZIP: 77,-.00,:, ./ , 9712 Furnace 100,000+BTU(ducts/vents) 54.91 ( - i Heat pump 61.06 Suite/bldg./apt.no.: Project name: �k f Duct work ' ' 23.32 Cross street/directions to job site: ���s LrA Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: 1 Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: ,e S/Oa 4AO/18OD Water heater 23.32 !1- ; `�"" O Gas fireplace/insert .. 33.39 r"` .. ".... .. " .. .` ;'.... Flue vent for water heater or gas 0f/e0/Veto0,-G fireplace 23.32 . Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 X - 23.32 /y�{�(lOther: �- • a Environmental exhaust and ventilation: Name: laQ`/,/j/ s,,�/ 7i,/,er mX Range hood/other kitchen /,246./.0 V ��' equipment 33.39 Address: ��6� �, l�� � Clothes dryer exhaust 33.39 City/State/ZIP: �s� O� .2 ? Single-duct exhaust(bathrooms, 4 V toilet compartments,utility rooms) 23.32 Phone:iCo1) 3/f/�D 9' Fax:( ) Attic/crawlspace fans 23.32 „. 4 4 C� . . 41w r cr Al"'" • Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) I Fax::( ) Fireplace Range E-mail: Barbecue 4.44;47;.. ���, � -mea n�� � { � � . , - ipl i� 1° „1� tf '7';' ,1'r'/,',4-`1'71 '' Clothes dryer(gas) 4 �3fit �'. � wa...c..., ,,..,•.�..... o..,s....�.��. Business name: e LC-0"c �Q2.6 /1f /' ,�(� Other: r ,, p Address• �7 n �i C-. I.4ii,,,...i.�,^,v,«.*.u, .., 1..- di '-�lAkV.: :�. x, tri . -, ,.�,.:;zx .,..,';,;,,,;:',- Address: / lgiUO/c5'L4 xis // Subtotal City/State/ZIP: S9-4,,E7-1/ 0/2- '7 3 Minimum permit fee(S90.00) fee) Plan review(25%of permit fee) Phone:) Pte2.---_c7c,22 Fax:( ) State surcharge(12%of permit fee) CCB lic.: / 91206 y 47344//17 TOTAL PERMIT FEE f This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized si l nature: * Fee methodology set by Tri-County Building Industry Service Board Print name: I ` .. Date: 5/2_/..) /(6, I:Building Permits MEC_PermitApp 040113 doc 440-4617T(11 022,COM WEB) 1 Mechanical Permit Application - City of Tigard c ., Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Va1 +�a ;' .dt $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:ABuilding\Permits\M EC_PennitApp_040113.doc 2 • Plumbing Permit Application Building Fixtures RECEIVED Ci of Ti d Received `� ganDate/B 94 Permit No.: _ IN II 13125 SW Hall Blvd.,Tigard,OR 97MAY 2 4 2016 Plan Review � � I Phone: 503.718.2439 Fax: 503.598.1960Other Permit No.: Inspection Line: 503.639.4175 CITY OF TIGARD DateBy: 1 I e i A I:l) Date Ready/By: Juris: la See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE sNew construction ❑ Demolition For special information use checklist. Description Qty. Ea. Total ❑Addition/alteration/replacement El Other: New I-2-family dwellings(includes 100 ft.for each utility connection) _ CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 91 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78 El Accessory building ElMulti-family SFR(3)bath 500.32 Each additional bath/kitchen J 25.02 El Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 42g/e2 .,rte /2/ t�/y'a� Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: rifdr, tf- 9' 22 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: ,�// y/ X f Manufactured home utilities 50.03 Cross street/directions to job site: 4.. / '& i Manholes 18.76 / ,,� � Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map/parcel no.: 5-/03 ee&&rte Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 ,ier/de.2 d'D� Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 � � A/A1 �a / Fixture/sewer cap 25.02 Name: (/�J f(� ,//Q // Floor drain/floor sink/hub 25.02 Address: /..Z5/4 ' ‘cee) /2`/ft,9"-c- Garbage disposal 25.02 City/State/ZIP: 7"1/17: G ., :22 3 Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:S ) Page 2 Contact name: /���r Primer 12.51 "94", �/` Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:(fQ/ 3 /L. 0 �� Fax::( ) Tub/shower/shower pan 12.51 `/1., �� 4 65m� . ek -t Ware] 25.02 E-mail: G , CONTRACTOR Water closet 25.02 Water heater 37.52 Business name:„.1-&--7--- jA/46_e(s7 rc Water piping/DWV 56.29 Address: /9'35` 5/L4/L--7&7/ Other: 25.02 City/State/ZIP: �r¢LE- 15-7Z. ?7,'o_ Subtotal Phone:_ ) ..g43 -,R32;f' Fax:( ) Minimum permit fee: $72.50 / Plan review (25%of permit fee) CCB Lie.:.3qy� Plumbing Lic.no it y / State surcharge(12%of permit fee) Authorized si naturef;� � / /// TOTAL PERMIT FEE Print name: ' CIO`/. /\;‘,....t( i J ' IZLI // This permit application expires if a permitpis not obtainedpwithin IRO days «<VVV LP Date: I �n after it has been accepted as complete. `� *Fee methodology set by Tri-County Building Industry Service Board. 1:Building Permits PLML-PermitApp.doe 10 01 09 440-4610T(10 02 COM WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1" 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer- 1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service- I st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to S25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge 1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2-and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918-780-0040. ElCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial El Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2- Isometric or Riser Diagram 4„ ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above, Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:ABuilding\Permits\PLMF_PennitApp.doc 08/04/2011 2 City of Tigard 74 COMMUNITY DEVELOPMENT DEPARTMENT • T I G A R D Building Permit Review - Residential Building Permit #: M ares/lam-Goa/ 4, Site Address: 12 c, I o S of 121 c t o,.t. __ Project Name: N.J X Lot #: 2— (New(New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N-e/VI E R kr Verify site address/suite# exists and active in permit system. l" River Terrace Neighborhood: g No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: )241hree (3)copies of site plan -Ft-Existing structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper grFootprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations )2:1North arrow Utility locations(required for new,may apply for additions) ,'Site address,project or subdivision name and lot number `B+ocation of wells/septic systems pplicant information(name and phone number)90 ,P1Erosion control(including drainage-way protection,silt fence t dimensions and building setback dimensions design,location of catch basin,etc.) Bot area,building coverage area,percentage of coverage and Street names impervious area(applicable if R-7,R-12,R-25&R-40) Street tree size,type and location et roperty corner elevations(2 foot contour lines if more than BExisting trees to be retained with drip line,and tree 4 foot differential) protection measures 7 Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No g Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake Land Use Case#: M LP200S- 00013 ,Z1 Zoning: 4. c Setbacks: Front Z Rear jS Side 5 Street Side f S Garage Ze7 -E-Landscape Requirement: -- -Lot Coverage Maximum: — 0 Building Height: Maximum Height 3 S Actual Height Zc- - Visual Clearance Easements - -sensitive Lands: ❑ Yes ❑ No Type -$Urban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: til/O 41 - G ,(o L ^- Date: S/z ti / I b Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\Building\Forms\BldgPermitRvw_RES_012116.docx Building Permit Submittal / Original Submittal Date: S/a4 /fr Site Plans: # Building Plans: # Building Permit#: Enter building permit#above. —/ Workflow Routing: K Planning L Engineering [4ermit Coordinator 2 Building Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: JCrEngineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application,site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: /1...e/A__.! _ Date: 5 - Engineering Review o/ [ '' lope at building pad: 4 !D JAS Conditions "Met"prior to issuance of building permit Easements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: KYes ❑ No Assess Water Quantity Fee in-lieu: 1Yes ❑ No LIDA Facility on lot: ❑ Yes ...2r--No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 1L„o,,__ Date: .6 ZL -/(P Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: :ISDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: Yes El N/A Parks SDC: Yes ❑ N/A YOK to Issue Permit Approved by Permit Coordinator: Date: S fl" l:\Building\Forms\BldgPermitRvw_RES_012116.docx RECEIVED Property Owner Statement JUN 9 2016 Regarding Construction Responsibilitiegln OF TIGARD Oregon Law requires residential construction permit applicants who are not licenBELIIIMINQ DIVISION Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or ki I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. • I f Print Name of Permit Applicant cis • 6/C1 12°K2 Signature of Permit Applicant Date Permit#: /47S7-020/ X o,2/,0 •lam. Address: /"26/0 — o /02/ •t/E- ry • Issued by: Date: 679// =:7 \14-1-i• This Copy for Permit Offices 2r City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENTJU/ Ili , Request for Permit ActiCl on I.;A 1, 13125 SW Hall Blvd. •Tigard,Oregon 97223.503-718-2439•www.tig4atd. , �rt ,,Y '' RI) 3 TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBtWdingPermits@tigard-or.gov FROM: LK Owner Ja.Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: /! / INVOICE TO: (Business or Individual) )\)/114--- Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED(1): ❑ CANCEL/VOID PERMIT APPLICATION. 0 REFUND PERMIT FEES(attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE(attach case fee schedule and provide explanation below). ii, REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: /7/,57— 2o/,6 --AC,'./.{ Site Address or Parcel#: /64‘7;e2 ,5"a.) 7.2/' r7`9 Project Name: 4//k Subdivision Name: Lot#: EXPLANATION:I ( C4 ' 0 :P� — _` . 0. (f r}>MA. lam. . YEA ,, �`tr l, to--1 tb c w r. 4 Signature: a,< ( Z��-'�y Date: 6--3 e9 —/-,6"-- Print Name: id e' 47/ Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. rott OFFICE USE ONLY Route to Sys Admin: Date 7,,/0 B & • y Route to Records: Date By Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date B. Parcel Ta:Added: Date B L:\Building\Fomss\RegPermitAction_092314.doc flAT 31 it, p-.luxnbn Perpp mit Ali Building Fixtures Cl of TigardReceived Permit No.: f.,� / City 40 Date/Dy:II ' l 4 f c �p�� !E a 13125 SW Hall Blvd.,Tigard,OR 97223 t - -t e`i', Plan Review Other permit No.: Phone: 503.718.2439 Fax: 5ll .*198.I9�1 Datc/By T I G A R D Inspection Line: 503.639.41_7,$i %•; s t )ft`d+.,, Date Ready/By: tutu: 0 See Page 2 for Internet: www.tigard-or.go ¢ _ r,, , .. 1 s - j Notifed/Metlwd: Supplemental Information FEES' SCHEDULE r' . 41 3 _ ...... ,, TYPE _ om„ 0 Demolition ''' New constructionFor special information use checklist Description Qty, Ea. Total ❑Addition/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION r SFR(I)bath 312.70 u fir 437.78 0.1-and 2-family dwelling SFR(2)ba 0Commercial/industrial SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 - ❑Master builder 0 Other: Fire sprinkler(,sq.ft.) Page 2 '274:;:. JOB SITE INFORMATION AND LOCATION,: Site utilities: Job site address: !e,g d"/Q f', /27 s'c/ifil-1 Catch basin or area drain 18.76 City/State/ZIP -7+7��d� Frohn t,leach line,or trench drain 18.76 _Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: a7,07/,,;(„el J' Manholes 18.76 Rain drain connector 18.76 - Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft::_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 D>SCRIh„TIirt UI0,4 1 .0 ;` Backwater valve 12.51 Clothes washer 25.02 ��� AfOff-C Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 -'-.1 -;-4,-`4"-0 Expansion tank0 ROPERTXO R' r 12.51 Fixture/sewer cap 25.02 Name Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker _ 12.51 ❑'m,4„ir<C -, .e o ACTT.-Ro '' ,- Interceptor/grease trap 25.02 Medical gas(value:$, ) Page 2 Business name: Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/Iavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax:':( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: 4 z f. vn s Watercloset 25.02 /_ 'SV Water heater 37.52 Business name: /,y///, �T2r /�j�� Waterpiping/DWV 56.29 -Address: ��r� , 7 S'�) C/'/4 ✓ Other 25.02 City/State/ZIP. `i/ V Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lie.: /)'' �� Plumbing Lie.no.:,,y�2 ,f Plan review (25%of permit fee) �/ "- State surcharge(12%of permit fee) Authorized signature TOTAL PERMIT FEE Print name: Date: •-,e7 Tis permit application expires if a permit isnot obtained within 120 days - atter is us been accepted as complete. •Fee methodology set by Tri-County Building Industry Service Board. I:•Tiuildin8'Permits':PLMU•Perm6App:doe ta01'09 440-4616T(10,021COM'WEB) City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12610 SW 121ST AVE, TIGARD, OR, 97223 June 14, 2017 at 12:13:08 PM Record Type: Record ID: Residential - Master Permit MST2016-00216 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Fire separation for ARU with self closing door ok. Approved deck plans required for final inspection approval. All else ok. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12610 SW 121ST AVE, TIGARD, OR, 97223 September 18, 2017 at 8:30:10 AM Record Type: Record ID: Residential - Master Permit MST2016-00216 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Deck revisions not issued at this time. Re schedule inspection after revisions have been reviewed and issued. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12610 SW 121ST AVE, TIGARD, OR, 97223 September 26, 2017 at 1 :01 :31 PM Record Type: Record ID: Residential - Master Permit MST2016-00216 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Corrections complete as Noted on previous inspection. Street tree certification received. Moisture content form received. High efficiency lighting form received. Insulation certification received. C of 0 to be delivered on site to owner. Violation Summary: Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 12610 SW 121 STAVE, TIGARD, OR, 97223 Record Type: Residential - Master Permit Inspection Type: 199 Electrical final Result: PASS Comments: Tel: 503.718.2439 Inspection Date: February 2, 2017 at 11:26:28 AM Record ID: MST2016-00216 Inspector: David Young Provide breakerlock for kitchen dishwasher not plug and cord connected. 422.30 Will check at building final inspection. Provide permit for heat pump connected without permit. Separate electrical permit for mini split required. No hot tub installed at this time. Violation Summary: Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 Location: City of Tigard 12610 SW 121 STAVE, TIGARD, OR, 97223 Record Type: Residential - Master Permit Inspection Type: 299 Final inspection Result: FA I L Comments: Tel: 503.718.2439 Inspection Date: February 2, 2017 at 12:01:19 PM Record ID: MST2016-00216 Inspector: David Young Provide address on site for inspection. R319.1 Provide approved final inspections to close open permits, FPS 2016-00156 and ELC 2016-00368. Provide permit for deck and stairs for bonus room above garage. Provide lateral bracing detail, remove non pt wood exposed to the weather. Provide permit for mini split to permit for bonus room above garage. Provide permit for second water heater. Provide steps to code at all exterior doors. Main egress only ok. Plumbing for bonus room has approved rough in only, permits required at finish. Provide city required documents for final inspection. Owner in process of converting bonus room above garage to legal ADU. Violation Summary: Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 12610 SW 121 STAVE, TIGARD, OR, 97223 Record Type: Residential - Master Permit Inspection Type: 699 Mechanical final Result: PASS Comments: Tel: 503.718.2439 Inspection Date: February 2, 2017 at 11:41:26 AM Record ID: MST2016-00216 Inspector: David Young Provide new permit for mini split installed without permit at bonus room. Provide permit for microwave venting in bonus room. Mechanical final for house only ok. Violation Summary: Inspector Contractor