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Permit
CITY OF TIGARD MASTER PERMIT Permit i, ' COMMUNITY DEVELOPMENT R #: MST2016 00312 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2016 TIGARD IFF/ Parcel: 1S134DA06500 �� Jurisdiction: Tigard Site address: 10700 SW NORTH DAKOTA ST Subdivision: 1995-023 PARTITION PLAT Lot: 1 Project: Boberg Project Description: Add 360 sq ft for new bedroom and bathroom. 4/30/18: REPRINTED permit to include(1)gas fireplace and (1)bathroom exhaust fan. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 360 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 360 sf Value: $40,554.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 8 Ea add9 500 sf: 0 201-400 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: N Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 360 Owner: Contractor: BOBERG,RICHARD OWNER Required Items and Reports(Conditions) 12480 SW FIRST RICHARD BOBERG BEAVERTON,OR 97005 10700 SW NORTH DAKOTA ST TIGARD,OR 97223 PHONE: 971-732-2676 PHONE: 971-732-2676 FAX: Total Fees: $2,152.41 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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 .232.1987 or . 0 .332.2344. Issued By: ! ermittee Signature: C 3 .4175 by 7:00 a.m.for the nit Prftable in 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. Plumbing Permit Applica. s :, 7 CIVEP Building Fixtures ` " _ FOR OFFICE I_SE ONLY City of Tigard II'' Received c( Permit J /_ 1 t 1114 ■ 13125 SW Hall Blvd.,Tigard,OR 37P7Z� 3 2016 Dace/By. " 3 4 t i%•TC/(o- �`r, Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.: Date/By: Inspection Line: 503.639.4175CITV(3 }i r Date Ready/By: Jurs: H See Page 2 for TiGARU 4 7flI1 / Internet: www.tigard-or.gov Notified/Method: Supplemental Information P NG DIVISION TYPE FEE SCHEDULE ❑New construction ❑Demolition For special information use checklist Description Qty. I Ea. I Total dition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY,OF CONSTRUCTION SFR(1)bath 312.70 and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ' ') .,D o j 4 tro r Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: T / I �A•i/QC� ,✓ q 7 L L` � Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: O 'Z j> Manufactured home utilities 50.03 Cross street/directions to job site: 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: ( Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 1)ESCRI Q 4&WORK' .� - Backwater valve 12.51 � �' Clothes washer 25.02 i-D g-oo -' ,�/-1`7biT/tt "i - Dishwasher 25.02 cam'/--?/�•'1 43'('"['ep �-'t s�47L�,r �„ -airi,- Drinking fountain 25.02 ( ✓'- t Ejectors/sump 25.02 ta ' 0Fi 4ONYNtER ' ElTENANT ' }"z. Expansion tank ` 12.51 Name: pi (i),4,4-a,6 • d B Qom-- Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: l D70 p I be) D l(irr AGarbage disposal 25.02 City/State/ZIP: 1--- I CrArQ i7 7 Z-L 3 Hose bib 25.02 Phone:((17/ ) j y Lo Fax:( ) Ice maker 12.51 Interceptor/grease 25.02 APPLICANT 0CdNTA�T PERSONtrap Business name: Medical gas(value:$ ) Page 2 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 I 12.51 Urinal 25.02 E-mail: Water closet / 25.02 CONTRAQR -, -, Water heater / 37.52 Business name: + Water piping/DWV 56.29 Address: 5�t'- r= Other: 25.02 City/State/ZIP: Subtotal t i Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: /' State surcharge(12%of permit fee) i-( Authorized signature:A/Lci Gam(�� TOTAL PERMIT FEE kit., G)., te: r This permit application expires if a permit is not obtained within 180 days Print name: (2 i(>,`�(,-iy b W .0 BGj/ . � 3 G�-'•y. ZL1/J„ after it has been accepted as complete. ® *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46I6T(10/02/COM/WEB) CITY OF TIGARD MASTER PERMIT ' COMMUNITY DEVELOPMENT Permit#: MST2016 00312 �°� �,x Date Issued: 09/28/2016 -4 a t�Ed L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 `, wr Worn , parcel: 1S18/2016 500 Jurisdiction: Tigard Site address: 10700 SW NORTH DAKOTA ST Subdivision: 1995-023 PARTITION PLAT Lot: 1 Project: Boberg Project Description: Add 360 sq ft for new bedroom and bathroom. 4/30/18: REPRINTED permit to include(1)gas fireplace and(1)bathroom exhaust fan. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 360 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 360 sf Value: $40,554.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF RainStorm Sewer: 0 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 8 Ea add'I 500 sf: 0 201-400 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 N Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 360 Owner: Contractor: BOBERG,RICHARD OWNER Required Items and Reports(Conditions) 12480 SW FIRST RICHARD BOBERG BEAVERTON,OR 97005 10700 SW NORTH DAKOTA ST TIGARD,OR 97223 PHONE: 971-732-2676 PHONE: 971-732-2676 FAX: Total Fees: $2,071.85 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. • .... obt- -copy of the rule or direct questions to OUNC by callin• 03.2 .198 1.800.332.2344. Issued B • ,i_t -er .. ••• '-i°. /i0.,--- _____ C. 39.4175 by 7:00 a.m.for the next available inspection•''te. f This permit card shall be kept in a conspicuous place on the job site until coin.letion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit A lic � 'j FOR OFFIC'I l SI:0 N I 1" City of Tigard Received p 13125 S W Hall Blvd.,Tigard,OR 972 7 Date/By: O 3 I e "401 Permit No.:y 5 • C 016 Plan Review 04,Phone: 503.718.2439 Fax: 503.598.1 r 3 Date/By: Other Permit: T I G A R I) Inspection Line: 503.639.4175 Date Ready/By: Juris: Internet: www.tigard-or.gov CIT1 OF IG.y I} .pSeePageZfor ttylq� ESEt'� Notified/Method: Supplemental information T>p I3o INDII G DIVISION , OM117ERCh ``FEE* SCHEDULE- USE CIHECIL.IST!'.;, Mechanical permit fees*are based on the value of the work ❑New construction ❑Addition/alteration/replacement ❑Demolition 3 Performed.Indicate the value(rounded to the nearest dollar)of all ❑Other: 4 mechanical materials,equipment,labor,overhead,and profit. V `, Value:$ ID1-and 2-family dwelling 0 CommerciaUindu �: �"",+Ia'c -ssorybuilding DEMET I SYSTEMS FEES ❑Multi-family 0 Master builder For special information use checklist.❑Other. Description I Qty. I Ea. I Total JOB SITE INFORM4 tft)$.AND t OCAtION 114114140111-01 Heating/cooling: Job site address: /6 7e5(;) �(' � r Air conditioning 46.75 `"' "(� ��//�'' L Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: j ty 1 &'`'Lk / 0 r--... c 0 Z ��.2 Furnace 100,000+BTU(ducts/vents 5 .91 Suite/bldg./apt.no.: I Project name: }� , J Heat pump .06 c�c� Duct work Cross street/directions to job site: �J 23.32 Hydropic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), I in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: I Lot no.: Other: 23.32 Tax map/parcel no.: Other fuel appliances: Water heater 23.32 DESCR r t)¢'Did. , h: Gas fireplace/insert 1 33.39 37, °39 •-� 3C� �, �� /, /� Flue vent for water heater or gas L1 G��.1...f j. 7-% fireplace 23.32 __r 6/ .. iti itLog lighter(gas) 23.32 5. s Wood/pellet stove 33.39 �-'` i. s itWood fireplace/insert 23.32 r Chinmey/liner/fluelvent 23.32 i a �i* a _ ` t ,t�^� i 1R(t ;' '.. ❑;rEN1 Other: 23.32 } I_ T5:'•4,4 "' " '�" Environmental exhaust and ventilation: Name: % cure( .O ic)v YJ Range hood/other kitchen Address: j D 0() SSW r p, L kGItC� 5-t-- equipment 33.39 City/State/ZIP; ""` � /� Clothes dryer exhaust 33.39 ( cj c�Gz r 0(�' i 7 aZ �j Single-duct exhaust(bathrooms, (,)Phone (lit) � 0 toilet compartments,utility rooms) 23.32 i/(p.(pil ,,(., .. 7.10 76 Fax ( ) Attic/crawlspace fans 23.32 A.r,Pt.ICA r .... Q: 11.440� ONa,;:` Other: 23.32 Fuel piping: Business name: Contact name: $14.15 for first four;$4.03 for each additional Furnace,etc. Address: Gas heat pump City/State/ZIP: WalUsuspended/unit heater Water heater Phone:( ) ) Fax::( ) Fireplace Range E-mail: yl.�1 Z_l / r ,,.��,y,O TRAC RMW,/,f-Eif'vl Barbecue Clothes dryer(gas) Business name: d lki E1t Other: Address: '`ME<HANICAL PERMIT FEES* City/State/ZIP: Subtotal A,` _ Minimum permit fee($90100) Plan review(25%of permit fee) Phone:( ) I Fax:( ) CCB lic.: State surcharge(12%of permit fee) j i Jo TOTAL PERMIT FEE CJ I f ��, /) This permit application expires if a permit is not obtained within no J Authorized s/%4134-1‘a--/-- * days atter it has been accepted as complete. Fee methodology set by Tri-County Building,Industry Service Board Print nartl/2_f 4_44*i o :.{.7 8 i DWin,/- f Dates G,,,,, 1l3 i le,t:\Building\Permits\MEC_PermuApp_040113.doc 6^ - 440-4617T g1/02/COM/WEB) . CITY OF TIGARD MASTER PERMIT ' COMMUNITY DEVELOPMENT =' K �� Permit u: MST2016-00312 T t G.i u,D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Egli Date Issued: 09/28/2016 l Parcel: 1S134DA06500 Jurisdiction: Tigard Site address: 10700 SW NORTH DAKOTA ST Subdivision: 1995-023 PARTITION PLAT Lot: 1 Project: Boberg Project Description: Add 360 sq ft for new bedroom and bathroom. 4/30/18: REPRINTED permit to include(1)gas fireplace and(1)bathroom exhaust fan. BUILDING Floor Areas Required Setbacks Required Stones: 1 Bedrooms: 1 First: 360 sf Basement: 0 sf Left 5 Parking Spaces: 0 Height: 24 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right 5 Detectors: Yes Total: 360 sf Value: $40,554.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Drains: 0 gWater Lines: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 8 Ea add.'500 sf: 0 201-400 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 360 Owner: Contractor: BOBERG,RICHARD OWNER Required Items and Reports(Conditions) 12480 SW FIRST RICHARD BOBERG BEAVERTON,OR 97005 10700 SW NORTH DAKOTA ST TIGARD,OR 97223 PHONE: 971-732-2676 PHONE: 971-732-2676 FAX: Total Fees: $2,071.85 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a c e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: ` 03.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit A licjJ) FOR OFFICE: I si:0\1.1 City of Tigard Received Date/By: 8 3 1(0 Permit No.: 13125 SW Hall Blvd.,Tigard,OR 972231 I -� ` �J ,/, r/I ' I Phone: 503.718.2439 Fax: 503.598.1996 G 3 20 16 Plan Review 1 I G n R U Inspection Line: 503.639.4175 Date/Rea Other Permit: Internet: www.tigard-or.gov OF ° !� g)t)j Date Ready/By: Ions: S See Page 2 for l '"45't.t Notified/Method: Supplemental Information TYP BUILDING'DIVISIONR ' " COMMERCII FEE* SCHEDULE USE CIIECKLIST'``''" ID New construction - Mechanical permit fees*are based on the value of the work 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: ` ;. i mechanical materials,equipment,labor,overhead,and profit. ?'TE( Yt~6F CON a ® h Value:$ A, " , RESIDEN 1IAI, UIPMENT/SYSTEMS FEES. ❑ 1-and 2-family dwelling 0 Commercial/indu W .c essory building For special information use checklist ❑Multi-family 0 Master builder 0 Other Description Qty. Ea. Total JOB SITE INFORMATI01+!i'AND �. '+! Heating/cooling: Job site address: / r7 Y (may Air conditioning 46.75 ( (3 ( f:�t� s�`1' )v' b 1 t�` .. // / Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: j t et,(,-Ck / 0 c '7 Z• .2 Furnace 100,000+BTU(ducts/vents 5 .91 Suite/bldg./apt.no.: Project name: l (, J Heat pump Are .06 (6 C::1^`j Duct work23.32 Cross street/directions to job site: C Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), I in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 I Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DE� ;yWO -.14!,, Gas fireplace/insert 1 33.39 37.3 Y Flue vent for water heater or gas �/j��/��' &> �il4,�..1 j, .J fireplace 23.32 Log lighter(gas) 23.32 _ i ) -.r --rS>� tfr _ Wood/pellet stve 33.39 5( /r ` a) L7i !rh.C- 74r 7SWood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 i , ,,.4 '� R , '. 0 'TEN ) .4,10•407-• . Other: 23.32 I �' "w i,-' Environmental exhaust and ventilation: Name: R"'at . ` O bcr Range hood/other kitchen Address: 1 •y� VJ equipment 33.39 0 7 0�� 5(/..J 14 , L.K etc, 5-C . Clothes dryer exhaust 33.39 City/State/ZIP: `L G�Z4.f V R-,_ 1' 7 Z Z. Single duct exhaust(bathrooms, l toilet compartments,utility rooms)C ^ 23.32 1.((p: Phone:(4 7 O 7 ��7� Fax:( ) Attic/crawispace fans 23.32 ?t :i',4,1 APPLICANT Q TA ii* N, Other: 23.32 Business name: Fuel piping: $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 I ll- " "J Range E-mail: rr,`f� � ti. lAi-C rr/ gML4( ,� Cf4'v'1 ; � �j J Barbecue i CONTRA R Clothes dryer(gas) Business name: d �� f� Other: (�} Address: MECHANICAL PERMIT FEES* Subtotal Cr%(,1K City/State/ZIP: Minimum permit fee($900) Phone: Plan review(25%of permit fee) ( ) Fax: ( ) State surcharge(12%of permit fee) ji `'�l CCB lic.: TOTAL PERMIT FEE &Sill j This permit application expires if a permit is not obtained within ill tot./ / � dayg aster y has boun yccepted I complete. Authorized 5�� (.(,/ • Fee methodology set by Tri-County Building Industry Service Board Print nam/2„.14_44 All ,?..) RI I Cn4.. Date G,Y kj 11 1:'Building\Permits\MEC_PermitApp_0401I3.doc 440-4617T f11/02/COM/WEB) . CITY OF TIGARD MASTER PERMIT 'F'! '' COMMUNITY DEVELOPMENT Permit#: MST2016-00312 T[C ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2016 Parcel: 1 S 134 DA06500 Jurisdiction: Tigard Site address: 10700 SW NORTH DAKOTA ST Subdivision: 1995-023 PARTITION PLAT Lot: 1 Project: Boberg Project Description: Add 360 sq ft for new bedroom and bathroom BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 360 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 360 sf Value: $40,554.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: Y Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 8 Ea addl 500 sf: 0 201-400 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 360 Owner: Contractor: BOBERG,RICHARD OWNER Required Items and Reports(Conditions) 12480 SW FIRST RICHARD BOBERG BEAVERTON,OR 97005 10700 SW NORTH DAKOTA ST TIGARD,OR 97223 PHONE: 971-732-2676 PHONE: 971-732-2676 FAX: Total Fees: $2,020.56 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 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 OAR 952-001-0090. You fiat'o�RZ eepK f t e rules or direc uestions to OUNC by calling 03.232.1987 or 1.800.332.23 Issued By: vouPermittee Si nature: 9 Call 503.63 . :00 a.m.for the next available inspect':n 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. • Building Permit Application L. e5 3 ) / Residential t' E !' Received FOR OFFICE USE ONLY City of Tigard 3 to , t Permit No.:il5r�t 312., Date/By: , 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �� ' _ : Phone: 503.718.2439 Fax 503.598.1 15 Date/By. �z" C Other Permit �9C 3 1-U U TI GA RD Inspection Line: 503.639.4175 Date Ready/By: G� loris See Page 2 for Internet: www.tigard-or.gov Notified/Method: �� ,� 7 Supplemental Information CITY OF IGAR ( a3A...t ' TYPE, U :ING DW p " REQUIRED DATA 1 AIVD 2 FAMIIL„"' DWELLING ❑New construction ❑ Demolition Permit fees* are based on the value of the work performed. I Indicate the value(rounded to the nearest dollar)of all ,edition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the Q 66ii OF GOND Rt OI work indicated on this applicat . 1-and 2-family dwelling 1:1Commercial/industrial Valuation: $ 651/ D Accessory building ElMulti-familyNumber of bedrooms: 1/ ['Master builder ❑Other: Number of bathrooms: % 7Total number of floors: . O T IFORTrON AND Lo,O 10.9N Job site address: /p 7 L1(o 5 L.,0 iv T)A...1D'T,4 New dwelling area: 14' (, square feet City/State/ZIP: T/g.../A-0, -0 E) c7 `7 L y ?a Garage/carport area: square feet Suite/bldg./apt.no.: Project name: i e,re Covered porch area: square feet Cross street/directions to job site: • t ' s 73. Deck area: square feet Other structure area: square feet R Q.TIRED DMIlkii;-C6M1V.ICROIAOSIISSETifteRUIFItEN Subdivision: !.5rt16.:3 L)D4 C,t,jc%f-Permit fees* are based on the value of the work performed. 1 Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no equipment,materials,labor,overhead,and the profit for the y t�.a''� LH KQRII"TIOtN U W 14It il work indicated on this application. /n- -sem ,.,,-... _.' v -/b 0 0 il- a-D R.,00/,i +`. ."1j-1- A Valuation: $ Existing building area: square feet Ne TNumber building area: square feet � OPEiiiii� WER ❑ TEANIof stories: Name: /2._ )c.. /A-a.„ D ii1.) -Ba E 2G Type of construction: Address: / l t D 7 o v ' ' N DA-k b/--At- Occupancy groups: City/State/ZIP: 1 /t,.._4-I —P © I 7 L L .), Existing: Phone:(7)' 7 3 L. )_t, 7 4, Fax:( ) PLICANT [] CONTACT PERSON..:" BUILDING PERMIT FEES* (Please referto fee scliedrele) Business name: Structural plan review fee(or deposit): Contact name: '4--t1 /r. FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application: Phone: Amount received: 6S ( ) Fax: :( ) .. E-mail: (Y („, tea.,/ � i C.='''.-1-- I0-�1k aiii ? • 1Nal* .fg E * : ,AY pc ' Oh#RCTOR n � Commercialand residential prescriptive installation of -• : �� __i, :: roof-top mounted Pho'oVoltaic Solar Panel System Business name: /, 'j 4..--. Sulu • two(2)sets: oof plan with conned details J f� and fire depa -•It access,along with,t1.1e2010 Oregon Address: Solar Installation Spe 4.._-ode c 2cklist. City/State/ZIP: Permit Fee(includes p ,review• $180.00 and adminis-trative Phone:( ) Fax( ) State surcharge,(12%of r:rmit fee): $21.60 CCB lic.: Total-fee due upon application: $201.60 Authorized signaturet���✓✓� f�C J� This pmit application expires if a permit is not o` within 180 days after it has been accepted- Print name:Z)e._H��D w pe, $��G-- Da e:`J -,Y id it, Fee methodology set by Tri-County Buildi� Service Board. I:ABuilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(II/02/COM/WEB) Electrical Permit Application -1- 11-11/1141 1 holt ohhlcl. t SI 0y1.1 " Received City of Tigard Permit#: p-f 't?a pd , -CO - Date/13 III13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review TT Phone: 503.718.2439 Fax: 503.598.1960 4 U G 3 J 016 Date/B : Related Permit#: Inspection Line: 503.639.4175 G Ready Date/By: tors: ® See Page 2 for 7 1 G A R D Internet: www.tigard-or.gov it I Notified/Method: Supplemental Information OF TIGARD TYPE OF itr PLAN REVIEW /rel ❑New construction 0 Addition/alteration �l�tt-/,3 SP1 ' 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. 0 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. ❑Multi-family 0 Master builder El Other: Installation 0 Fire buildings. pump. 0 of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived h ❑Addition of new motor load of system. Job#: Job site address: 61.? , ,,,,,Ii, of . 100HP or more. ❑«A» «E» «I_Z»«1 3» City/State/ZIP: �L 3 ❑Six or more residential units. occupancy. l �� �' r `i 7 2 ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I 9 Project name: Brj C 0 Hazardous locations. 0 Supply voltage for more than �� 600 volts nominal. Cross street/directions to job site: ❑Service or feeder 600 amps or more. FEE SCHEDULE Description I Qty. Each I Total New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: K t G.h cu Lk &o c rc) 200 amps or less I 100.70 2 201 amps to 400 amps 133.56 2 Address: Q 1700 5(r.), N, 1` .-KtrciA-s- , 401 amps to 600 amps 200.34 2 City/State/ZIP: 1--;:,ci eLI 012- l .7 2-2-3 601 amps to 1,000 amps 301.04 2 Phone:(47 1p 7 3S— 76 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: V,tp 6 c[ (Q,v't i1 flit —i ( , C;O yYJ relocation Owner installation:This installation is berg 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 ❑ CONTACT PE Branch circuits—.new,alteration,or extension,per panel / A.Fee for branch circuits with usiness 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 56.18 2 branch circuit City/State/ZIP: Each add'I 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 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: a I( 9 ,k 1 r2--- Sign or outline lighting 67.84 2 `' Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. g City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('/hr min) 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): Authorize/i t TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name-/4.44 1 - t,P l L 3 i....42.4._-U Date: /�idays after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PertnitApp_ELR_ERE.doc Rev 06/17/2015 440-461510 1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE I * Fee for all residential systems combined: $75.00 DescriptionwQty' Each Total Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 n Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional 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(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('A hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015 Mechanical Permit A 1 i lic ,. - ? t FOR OOFFICE I SE()NEI City of Tigard Received g 3/100` Permit No.: Date/By: �� 5 i ,�c"e, III 13125 SW Hall Blvd.,Tigard,OR 972 r s� 11 n Plan Review C Phone: 503.718.2439 Fax: 503.598.1 G 3 C tJ 16 Other Permit: Date/By: 1 1 G ARD Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for Internet: www.tigard-or.gov tJ CITY OFygT!GARD R ) Notified/Method: Supplemental Information BUILDING DIVISION FEE* SCHEDULE — USE CHECKLIST TYPE OF WORK Mechanical permit fees*are based on the value of the work ❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. CATEGC RY"OF CONSTRUCTION w.;„.. . Value:$ _ ' RESIDEN'T'IAL EQUH'MENT/SYSTEMS FEE'S* O 1-and 2-family dwelling ❑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: ,. j�i9 Air conditioning 46.75 Job site address: 7 0(1 5(2 )t ,L,k o ST, Furnace 100,000 BTU(ducts/vents) 46.75 0 2'Z,3 Furnace 100,000+BTU(ducts/vents) 54.91 City/State/ZIP: �`ck ( I 61.06 Heat pump Suite/bldg./apt.no.: Project name: , .)6 C Y'y( Duct work lt, 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), 1 in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRWI 'Wo 1:7;t:' Gas fireplace/insert 33.39 '' ,,. ' �' - Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 23.32 • O `�XVEIt l 0 TENANT $; Other: - 11°, ' m. y Environmental exhaust and ventilation: Name: R:441 a VC( 30 to r Range hood/other kitchen equipment 33.39 Address: 101 0() 5v✓ g :(...K etc, 51' . Clothes dryer exhaust 33.39 City/State/Z1P: ' ' Single-duct exhaust(bathrooms, ( �' ft toilet compartments,utility rooms) 1 23.32 Phone:(q 70 7.a -lb Fax:( ) Attic/crawlspace fans 23.32 :APPLICANT 4 ❑: ITA " ? R oN,` Other: 23.32 Business name: Fuel piping: $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) Business name: O!y-1 w Eit Other: 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. Authorized s� * Fee methodology set by Tri-County Building Industry Service Board Print nan> (4_,4 432,6 ,,t) 8 Q D� Date 6y,,,. _.)/ I:\Building\Permits\MEC_PermitApp_040113.doc 440-46 ITT 1/02/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_PennitApp_040113.doc 2 Plumbing Permit Applica ;1 i:., 1 Building Fixtures -�C FOR OFFICE ISE O\L.l City of Tigard Received g r1 r Date/By: y 3 16, Permit No.:i\--i• Tao/&P-60 31 514 ill 13125 SW Hall Blvd.,Tigard,OR 9'i tl 3 2016 Plan Review 1 Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit No.: I I G ARD Inspection Line: 503.639.4175CI T /()F Tit,yil f Date Ready/By: Jars: H See Page 2 for Internet: www.tigard-or.gova r Notified/Method: Supplemental Information TYPE .P P•f lI'ii t ► � I.. � � FEE* SCHEDULE 0 New construction 0 Demolition For special information use checklist Description Qty. I Ea. I Total 2dition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 500.32 ❑Accessory 0 Multi-family 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: ! ') .,0D j Lc) ire, 7- Drywell,leach line,or trench drain 18.76 Catch basin or area drain 18.76 City/State/ZIP: V -Ty/4_,/pc.0, \--- e 7 L-1, '5 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: V 'B,C-f• Manufactured home utilities 50.03 Cross street/directions to job site: 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 tikscRIP `/ ORK :' . Backwater valve 12.51 ` ;..nr;. W '`�` Clothes washer 25.02 E_D I-00 l.iy A---o b)T/cut) Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 '- t PE <'... o R J 0 TENANT ;"y. Expansion tank 12.51 Name: T / C4i,1 4-12‘C .e d 0 Fixture/sewer cap 25.02 A) Floor drain/floor sink/hub 25.02 Address: /070 0 1(J)' ,DA-k'at Garbage disposal 25.02 City/State/ZIP: 7 /l '/i'Q} C:i7 L L 3 Hose bib 25.02 Phone:( • ) Fax: G)7� � y �-{, � �, ( ) Ice maker 12.51 OPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: Contact name: Primer 12.51 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 I 12.51 E-mail: Urinal 25.02 Water closet / 25.02 CONTR TOR Water heater () 37.52 Business name: Water piping/DWV � 56.29 J` (r 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) hK State surcharge(12%of permit fee) Authorized signature:�� td +`�c��L�. TOTAL PERMIT FEE (2 10i`1 , lb „-B4, � w` This permit application expires if a permit is not obtained within 180 days Print name: F�-(ri l� ���te: �, after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PernmApp.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 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $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 err° Fee(ea) Total each additional$100.00 or fraction thereof,to 1� 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 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 0 Any new commercial building with water service 2"and Baptistry/Font 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 as defined in OAR918-780-0040. -Drive Tani Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic 0 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" 3" Isometric or Riser Diagram 4„ 0 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:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Building Permit Application kS 4 3 / Residential ] FOR OFFICE USE ONLY City of Tigard ��J11 Y Date/BReceived ei 3 i(o Permit No.:r L J� G�-�/ 3C� a 13125 SW Hall Blvd.,Tigard,OR 97223 y ED g Plan Review ' to Phone: 503.718.2439 Fax: 503.598.1A �f q Date/By: Other Permit A T1G RI) Inspection Line: 503.639.4175 ^v U 3 2016 Date Ready/By: 1uris: I FZf See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OF TIGARD TYPE B[II}NG DIVISION REQUIRED DATA:1-AND 2 FAMILY rk'ii<AJNG' .' ❑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 dition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the _ iz, 14110QRY:o, cQNSTIOICrjoN.. workindicated on this p t d a pl ratio . I-and 2-family dwelling 0 Commercial/industrial Valuation: $ �` 55 ❑Accessory building ❑Multi-family Number of bedrooms: f ❑Master builder 0 Other: Number of bathrooms. / A � '" Total number of floors: 2 f�1ll�'IN €�t15�IATIt>1S1 AND LOCAT)I(3I�, ' Job site address: /fl 7 o Q 5 t_i NJ P/4-,1 v r ,4 New dwelling area: '3& C/ square feet City/State/ZIP: T/4,A-0. b © 0- '7 Z),3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: M 6 _i___ 'v w / D /4-k-0-7--4- Deck area: square feet v Other structure area: square feet REQUIRED DATA:COMMERCIAL USE CUECKLIST' Subdivision: /6-it.:3 L)DA.t ,j)t)ermit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: the materials,labor,overhead,and profu for the DESCRIPTION ( WORK S work indicated on this application. /4—VD r sri o k O P T) a-0 i2-©aM -1— ---1--11-1, Valuation: $ Existing building area: square feet New building area: square feet PRTPERTYF OWN R - -0 TENANT ' Number of stories: Name: 12. )C./4, -(L b W 'Ba 2 ' Type of construction: Address: /0 )0 0 Cj LL) N I Ark DI-At Occupancy groups: • City/State/ZIP: '7` 16 A—d--D GP I-1ei ? L L 'S Existing: Phone:( '7/ 7 3 Z 2,....6, 7,6 Fax:( ) New: �, `Vr'ICANT" 0 CONTACT PERSON 'BUILDING PERI4IT'FEES* (Please refer to fee schedule Business name: Structural plan review tee(or deposit): Contact name: /1-- FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application •. g•- Amount received: 6ap Phone:( ) Fax :( ) ARAQTflf A� P3E-mail: 1.--(4..) /Y. /V61v/ir Ai 2 TO 16.-,e......16.-,e........1.—D-': G�—`— Commercial and residential prescriptive installation of - CONTRACTOR roof-top mounted Pho'oVoltaic Solar Panel System Business name: ' / �— Subt two(2)sets oof plan with connec details and fire depa --It access,along with • 010 Oregon Address: Solar Installation Spe '- .1:,'ode •-cklist. City/State/ZIP: . Permit Fee(includes p •• review $180.00 and admi rative Phone:( ) Fax:( ) _ State surcharge %of r-rmit fee): , $21.60 CCB lic.: , Tot. ee due upon application: $201.60 Authorized signature W) This p• mit application expires if a permit is no obtained tttt�e�i�eee��iwithin 180 days after it has been accepted as complete. Print name:]jC HA-(2,D 1,<_) p 0 $ 26.- Da e:7 1d j Fee methodology set by Tri-County Building Industry l Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT ill I T 1 G A R D Building Permit Review — Residential Building Permit #: H- -2 l 9-e I Cc—0Q ( 7. Site Address: f0 960 C A10,444 k© 97 Project Name: /3a4ZQ/bn Lot #: (New dwe subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: SIPL9" 111.2.--, -Lit cQJ c 7b 'A'/,s7 �i�i� /Verify site address/suite# exists and actio in permit system. Liver Terrace Neighborhood: IQ No ❑ Yes,See River Terrace Review Addendum Attached Sit/Plan Elements: ree(3)copies of site plan [ ' 'sting structures on site e plan must be on 8 1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished vtif awn to scale(standard architect or engineer scale) floor elevations orth arrow locations (required for new,may apply for additions) e address,project or subdivision name and lot number 0 cation of wells/septic systems /or plicant information(name and phone number) sting trees to be retained with drip line,and tree TAli,Aoit dimensions and building setback dimensions rotection measures t area,building coverage area,percentage of coverage and eet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) Street names 1perty corner elevations(2 foot contour lines if more than 4 foot differential) lean Water S ces—Service Provider Letter (lot platted prior to 9/10/1995): Required: rer Yes,applicant was notified ❑ No Received: ❑ Yes(1411P15ublic Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake ,„and Use Case#: /Zoning: le- .5-s-: g Setbacks: - etbacks: Front v)ip- Rear /S" Side l Street Side AV/ Garage tQO fes' .andscape Requirement: cyo it ► of Coverage Maximum: 0/0 U Building Height: Maximum Height Actual Height �Sl(49 // I IL 0 u isual Clearance 0 Prasements 'ensitive Lands: ❑ Yes El No Type Jrban Forestry Plan ondition "Met"prior to issu ce o Building permit Notes: ,- 1 :, er: ,Al j ' !lrt1u ' �- el! ,-er�.op( o2-1 -71---bis Approved By Planning: _ _` Date: j® ,, Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_060116.docx Building Permit Submittal Original Submittal Date: 71z It Site Plans: # Building Plans: Building Permit#: a Enter building permit# above. Workflow Routing: a Planning atngineering ermit Coordinator wilding Workflow Sign-off: a Sign-off for Planning(include notes from planning review) Route Application Documents: [i]" Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Or Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: � C Date: cs13/1,6 Engineering Review 'Slope at building pad: ogg. "'Slope "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: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes Cl No LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: Date: - Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: El Approved ❑ Not Approved Revision 3: ❑ Approved El 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: SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: El Yes N/A Parks SDC: Cl Yes N/A N(oOK to Issue Permit / - Approved by Permit Coordinator: Date: 371Ar `� I:\Building\Forms\BldgPennitRvw_RES_060116.docx RF CavED Property Owner Statement p Y Regarding Construction ResponsibilitiF AuG 3 2016 Oregon Law requires residential construction permit applicants who are not lic -• i� � � Construction Contractors Board to sign the following statement before a build'a. i f6 . issued. (ORS 701.325 (2)) '�'' Of ' 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 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. (2- INtkab wt Print Name of Permit Applicant .Kth-4-d t ) -3 z 1(0 Signature of Permit Applicant Date Permit#: N 'JTo2U 16 Oo �Jl�• Address: /(5700 61-4D Cs ��wun�s vt_A£ ci 7 a..3 ti . Issued by: d7-; Date: /////l6 This Copy for Permit Offices -i- FOR OFFICE USE ONLY—SITE ADDRESS: /0 200 SiV Al~ 0Llik_o This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. 11;11City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT = Transmittal Letter 1 :c,,A R n 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503.718.2439 • www.tigar r.gov TO: Till DA -a 1 4 f01 k VELD DEPT: BUILDING DIVISION APR 302018 CITY OF TI GAr D FROM: 12 )CI A-ArD D75£i 11.Z - BUILDING DIVISION COMPANY: PHONE: q71 - 73 )- - 7 b - _ By:07, RE: M 7 ??9/6 "—' OO-'J + 2-- /h¢ To2o)(.,-o0 31 a (Site Address) (Permit Number) / O .7 v9 CCJ 0 V ' 6-74- (Project name or subdivision name and lot numb- ATTACHED ARE THE FOLLOWING ITE .: Copies: Description: Copies: Description: � / t.< / Additional set(s) of plans. t Revisions: - .�-t cam' Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. \i , Basement and retaining walls. Beam calculations. V Engineer's calculations. Other(explain): 1 REMARKS: \ FOR F CE USE ONLY Routed to P it Te ician: Date: Initials: Alt Fees Due: • • No Fee Description: Amount Due: $ 14, cl $ 1 s-. z. -$ $ Special Instructio s: Reprin 'emit(per PE): ❑ Yes No l / ❑ Done Appl. ant Notified: J.- Date: clokr Initials: l %f I:\Building\Forms\TransmittalLetter-Revisions_061316.doc