Permit Support Document (158) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECflT
}
~ NOVj � 'r�1F�
_ Request for Permit Actioncrrt
F I G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 + and 'It
5 II"rg'
In
TO: CITY OF TIGARD V
Building Division /../- s 7- / P id--,/---
13125
, i---
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fa • 503-598-1960 TigardBuildingPerrnits@tigard-or.gov
FROM: ❑ Owner Applicant 0 Contractor
Check(✓)one ❑ City Staff
REFUND OR Name:
INVOICE TO: (Business or Individual) °"---r- _,IL , t ' J 1,6(,P 1 �L
•
Mailing Address: �-� 7O &e, (�
City/State/Zip: 1 t(2.7i- t b Og
9-2-) .5
Phone No.: . 7 06- 06,24„
PLEASE TACTION FOR THE ITEM(S) CHECKED (1):
d CANCE I OID PERMIT APPLICATION.
DP"'. "N 1 RMIT FEES (attach copy of original receipt and provide explanation below).
1/2 INVOWbR FEES DUE (attach case fee schedule and provide explanation below).
• 'REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: H 6/-0-c l(f) on 3 (9,9/SAW /, —oeA<Pci
C
Site Address or Parcel#: 1 C 0 2,---7,- (-- j a (Agee/di 1
Project Name: (' a k)
Subdivision Name: r` j (_ !>✓'�' Lot#: ( O
EXPLANATION: . 1' ' 'P ,,,,6 / • r
—1T_j —Jr - _ j e) .. t -r'.. ' ..
Signature: Date: I 1 , (7 ' le,
Print Name: G •--•v�1y-� 1
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date it /6: ley . ' Route to Records: Date ,fa-..2. / ; �
Refund Processed: Date ^//' By ,^. Invoice Processed: Date /�/ //�- B ..
Permit Canceled: Date / ,7.7j/p. B /� Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_0' 314. oc
City of Tigard • COMMUNITY DEVELOPMENT
1111 q
Building Division
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
INVOICE
TO: Westland Industries, Inc. Customer ID: 30235
Attu: Jim Standring Invoice No.: INV2016-00018
12670 SW 68th Pkwy, #400 Invoice Date: 12/29/2016
Tigard, OR 97223 Date Due: 1/29/2016
Case No. Site Address Subdivision-Lot#or Project Name Amount Due
MST2016-00329 15022 SW Corbin St. Corbin Estates,Lot 10 $1,024.37
Fees due for plan review completed
prior to request to void permit.
Invoice Total: $1,024.37
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment)
Case No.: MST2016-00329 Customer ID: 30235
Site Address: 15022 SW Corbin St. Invoice No.: INV2016-00018
Project: Corbin Estates,Lot 10 Invoice Date: 12/29/2016
Date Due: 1/29/2016
Invoice Total: $1,024.37
Amount Paid: $
Office Note: Route copy of receipt to Dianna Howse.
Please mail payment to:
City of Tigard,Building Division
Attn: Dianna Howse
13125 SW Hall Blvd.
Tigard, OR 97223
I:\Building\Accounting\Invoice.doc 01/14/2011
CITY OF TIGARD FEE AND PAYMENT HISTORY
II
11111 it 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TEGARD
MST2016-00329 - 15022 SW CORBIN ST, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Plan Review 230-0000-43106 $751.34 $751.34 $750.00 8/16/16 Check 405669 $1.34
DC Provision Review, SF-Ping 100-0000-43112 $90.00 $90.00 $90.00
Plan Review 230-0000-43106 $933.03 $933.03 $933.03
Totals for Fees $1,774.37 $1,774.37 $750.00 $1,024.37
Receipt# Payment Method Check# Pa or: Receipt Date Receipt Amount
405669 Check 1181 Westland Custom 08/16/2016 $750.00
Homes LLC
Total Payments: $750.00
Balance Due: $1,024.37
t ..
1 0
Building Permit Application V:
f:\li §
Residential i;12-`i/ FOR OFFICE i SF OM 1
City of Ti and RECEIVED Received Ise �� H 1 !o—ao
g Date/By: I Permit No.: �� 3,2,1
13125 S W Hall Blvd.,Tigard,OR 97223 Plan Review
= Phone: 503.718.2439 Fax: 503.598.1960
AUG 1 � Other Permit:�W ter-4Z)49"3?
U 1 2 016 Date/By:
T t G ARD Inspection Line: 503.639.4175 Date Ready/By: v -, I , kris IBJ See Page 2 Tor
Internet: www.tigard-or.gov CITY Notified/Method: / �/ Supplemental Information
C OF T'IGARD „cil c' /nr-► S.
SUIIpiR1G DIVISION' REQUIRED DATA:1-AND 2-FAMILY DWELLING
TYPE OF VVO
New construction 0 Demolition' Permit fees*are based on the value of the work performed.
❑\A Indicate the value(rounded to the nearest dollar)of all
ddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1and 2-fami]Y dwelling Valuation: $ 9.. J Js C )1
0Commercial/industrial 1
❑Accessory building ElMulti-familyNumber of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: L.6D.7
Job site address: I SO y..2,,, �3, �,rr^'
�1 New dwelling area: . 09g4 square feet
City/State/ZIP: 'IAC.) O `'[7.2-7-77Garage/carport area: 6 93, square feet
Suite/bldg./apt.no.: Project name: /'/A Q ,k) 691-14- Covered porch area: square feet CLI 3
c
Cross street/directions to job site: / T (-oft t (ern aet: C`f- square feet j 8 M-
r- Other structure area: - 8 square feet/S3'
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: coe1 0 es -i- -• Lot no.: ',0 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
S` 1_ Valuation: $
Existing building area: square feet
New building area: square feet
..71-PROPERTY OWNER 0 TENANT Number of stories:
Name: e --c.'1--1 g/� i-/— tType of construction:
Address: I) -�O f6 'SLiu .--2?„ 10,5 �F2D Occupancy groups:
City/State/ZIP: (..A.�,a op 7--1
f")-2,e �F-' � / q Existing:
Phone:( _ — 1 �O 2-1 Fax:(S?) (c�1f 62;39 New:
`APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: W f r.z .4 l �j X71_15•a-�/J t .�,\v /Please refer Io fee schedule
Contact name: l `4�`�" 1 ( 1� --�J�L. Structural plan review fee(or deposit):
� ( FLS plan review fee(if applicable):
Address: ( �•�,7 ) c ( / _ p) *{ .i,fl
City/State/ZIP: (."7211 b� q�Z� Total fees due upon application:
Q/�
Amount received:
Phone: '�
( ,?86 -cGZ(� Fax::( � 5ge- _ `08 \
E-mail: TS C �(Z e.,. A-e ` (CY\ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR
c� Commercial and residential prescriptive installation of
�,�zc�. /� .,,0 roof-top mounted PhotoVoltaic Solar Panel System.
Business name: ��`�'''�C.A,yr `Tax/j c ie,1 ...13(___. • Submit two(2)sets of roof plan with connection details
Address: Sc).. and fire department access,along with the 2010 Oregon
�,,7 Sx1 �p[ems ()63 Solar Installation Specialty Code checklist.
City/State/ZIP: �( -) c ?yy., Permit Fee(includes plan review $180.00
— and administrative fees):
Phone:(42:, '7¢1'3 .. V 47.4. Fax:( S 5% --cf0g ( State surcharge(12%of permit fee): $21.60
CCB lic.: -302. _ Total fee due upon application: $201.60
Authorized signature. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:�i i -( rf' Date: p_f• ��
*Fee methodology set by Tri-County Building Industry
Service Board.
I ,
Building Permit Application Checklist
One- and Two-Family Dwelling FOR 011 1( L. LSI: 0\1.1
City of Tigard Received
INrDate/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223
C Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
T I G A R D 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No y1;1
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. r; • U
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0
3 Verification of approved plat/lot. 0 0
4 Fire district approval required. Name of district: •
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 ICJ
6 Sewer permit.
E A H
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application. ik- 0 7 0
9 Erosion control,❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑, 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
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 42' 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 Q 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 2 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- 12' 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. re 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- r CO ' 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 of ❑ . 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 p 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. fla0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required lir 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 Elp/ 0 0
architect licensed in Ore:on and shall be shown to be a.•licable to the •roject under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". [l]/ I U
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. (j - 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. t T
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document.
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
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, V 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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Application ,../
FOR OFFICE 1JSE ONLY
City of Tigard ECEI VED Received:
•
n 13125 SW Hall Blvd.,Tigard,OR 9711
223
C' Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/B : Related Permit#:
'T I GA RD Inspection Line: 503.639.4175 AUGH1 6 2016 Ready Date/By: loris: 0 See Page 2 for
Internet: www.tigard-or.gov V Notified/Method: Supplemental Information
TYPE OF 60- �pOt��Fs TIGAHD PLAN REVIEW
'New construction 0 Addition/altera Ion/ 12( i A ON Please check all that apply(submit 2 sets of plans w/items checked):
0Service or feeder 400 amps or more 0Building over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or
0 Floating buildings.
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-family0 amps for all other installations. buildings.
0 Master builderOther: 0 Fire pump. 0 InstaAl
llation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: 1607:2,... c��'g 113 -- ❑Addition moew motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: Ti�:.1` O(2 > , 0 Six or more residential units. occupancy.
"?
Suite/bldg./apt#; �""t' ❑Health-care facilities. 0 Recreational vehicle parks.
Project name: 0 Hazardous locations.
❑Service or feeder 600 amps or more. ❑Supply voltage for more than
Cross street/directions to job site: Si 4Tbk, �,p�� �
600 volts nominal.
���i�ruLr� FEE SCHEDULE
Description I Qty. f Each 1 Total
• � New residential single-or multi-family dwelling unit.
Subdivision: � I1N i`-iet ,-¢4/ I Lot#: )6 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4
DESCRIPTION OF WORK )
Ea.add'I 500 sq.ft or portion 33.92 1
„ t Limited energy,residential 75.00 2
N G14,-) cc =- (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
p--PROPERTY OWNER I 0 TENANT ServRenewable Energy ❑ See Page 2
n y, 200 amps or feeders installation,alteration,and/or relocation
Name: , v�-]�1- „ 200 amps or less 100.70 2
Address: ‘2,4 0 0 77�e } .12,"31, 44-,�6 201 amps to 400 amps 133.56 2
City/State/ZIP: r �/�' f� __ Q 401 amps to 600 amps 200.34 2
g� sem' ` 2,?..?„, 601 amps to 1,000 amps 301.04 2
Phone:SZ 1o3 '.2,4 7.... I Fax:( � 6 2`r ^o Over 1,000 amps or volts 552.26 2
Email: 7 / `1 Temporary services or feeders installation,alteration,and/or
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
PLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
. , `e - A ._� A.Feo forbranch circuitsee fee,
th
Business name: ,w (�'� s�./�.��' �y above service or feeder fee,
bpi is+�tJ each branch circuit 7.42 2
Contact name: �J at 50411T° � B.Fee for branch circuits without
Address: �'�L�Yv�t service or feeder fee,first
t 2.16,70s branch circuit 56.18 2
City/State/ZIP: Q�/IIJJ off. ?; -/g Each add'l branch circuit 7.42 2
Phone: l �j ()6 I q Miscellaneous(service or feeder not included)
(9 IN _ .21..21. I Fax::�aol .0 Each manufactured or modular
Email: �� e,.11--ac. dwelling service and/or feeder 67.84 2
,.? ' cowlReconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: g 6..,3D(AD � p I G Sign or outline lighting 67.84 2
Address: ^ Signal circuit(s)or limited-energy
v1panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: u_'f .^tA Each additional inspection over allowable in any of the above
M �JNi Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:
Z.. 57...' Investigation(1 hr min) 90.00/hr
��
Email: /� Industrial plant(1 hr min) 78.18/hr
�� '' `- Inspections for which no fee is
CCB Lic.: 100 y.- Electrical Lic.: Z ,,3" ipii rv.Lic51 DO 5 specifically listed(%z hr min) 90.00/hr
Suprv.Electrician signa r ui d• A. ELECTRICAL PERMIT FEES
Subtotal:
Print name: 'fiT�'�Q si._ T l Date: i C(Jib 0 Plan Review Required(25%of permit fee):
Y III I State surcharge(12%of pennit fee):
Authorized signature: TOTAL PERMIT FEE:
f This permit application expires if a permit is not obtained within 180
Print name: Date:C' 1 f( o days after it has been accepted as complete.
tl * Number of inspections allowed per permit.
I:\Building\Pennits\ELC PetmitApp ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
4
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description I Qty. I Each I Total I
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
V.-Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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
CEach 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
specifically listed(Y=hr min) 90.00/hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
*
(SEE OAR.918-309-0000) Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:1Duilding\Permits\ELC_PermitApp ELR_ERE.de ,R elk 06/I 7/1015
'Meclianical Permit Appiic iFI ® FOR OFFICE USE ONLY
City of Tigard A U IA 6 t _�� Permit No.: � (y�i //-1003A9`
I .1 13125 SW Hall Blvd.,Tigard,OR 97223 r!
Phone: 503.718.2439 Fax: 503.5gry}�� Pian Review
C�P OF TIGARD Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Read/B Saris:
Internet: www.tigard-or.gov BUILDINGDIVISION y y Id See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
New constructionMechanical permit fees*are based on the value of the work
0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Al-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:
Job site address: K 0302. Air conditioning / 46.75
(/�- Chi+lam ,7i Furnace 100,000 BTU(ducts/vents) t/ ( 46.75
City/State/ZIP: 1`�O, , r-'> 0o Q2
, � Furnace 100,000+BTU(ducts/vents) _ 54.91
Suite/bldg./apt.no.: , Project name:," -1 Heat pump 61.06
Duct work l 23.32
Cross street/directions to job site: e� -k"• k .�1n Hydmnic 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.: W Other: 23.32
C..,6(4.-aC..,6(4.-at.„
Other fuel appliances:
Tax map/parcel no.: Water heater ../, C 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
' t e,, ` i.,.�-„ig --
Flue vent for water heater or gas
NI� W ,� �- fireplace 23.32
Log lighter(gas) _ 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER 0 TENANT Other 23.32
Name: �� Environmental exhaust and ventilation:
Range hood/other kitchen
tlJ
Address: (ADO ,_` 1) I,266
equipment /� 33.39
� � .�2.X1Clothes dryer exhaust t/1 33.39
City/State/ZIP: ''V..-,CD CSF- •7�, Single-duct exhaust(bathrooms, /e
Q ` toilet compartments,utility rooms) `t' 23.32
Phone:(1J3- tosc Fax:
SG5 6)Z4- 62-39 Attic%rawlspace fans 23.32
II-APPLICANT 0 CONTACT PERSON Other 23.32
Business name: �'/1/41[ C�•�j Fuel piping:
g ` ` J^r '��� ' $14.15 for first four;$4.03 fo ach additional
Contact name: ?{ ,�/► S.fA gr)12,4 Ak Furnace,etc.
Address: `2 !_,170 c, ,1 /_I 1 Gas heat pump
�►lO so.1
to
WalUsuspended/unit heater
City/State/ZIP: t't&M > a"7 Water heater / 1
Phone:( 9)3 +.�...lb() .3Q/,0t�(/_ 4 Fax::(�'3 g(, (fag I -Fireplace ✓ 1
E-mail: W t.a 'Ai i) G 0,, Range
'✓ �L` �v>r► \ Barbecue �
1;)
CONTRACTOR Clothes dryer(gas)
Business name: (j ,Q.Qe .rU rrm 4L.t . 1& Other:
564 �+t )114(r fV E MECHANICAL PERMIT FEES*
Address: 51
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:(SO , 4 3g 0 Q f) Fax:( ) Plan review(25%of permit fee)
Q t+'1 State surcharge(12%of permit fee)
CCB lic.: 2.0 3 Sq Qs . TOTAL PERMIT FEE
tJ�y , This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: e> �' ( / ate:
X:'Buildin¢\Permits\MEC Permit/km 040113.doc 440-4617T(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 forthe 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.
eNote: All new commercial buildings require 2 sets of plans. •
•
•
1:\Building\Permits\MEC_PermitApp_040113.doc 2
a 1 ,
' plumbing Permit Application
Building Fixtures FtEla] NUR of 1:1( I. ISE ONI.I
City Tigard of Ti d Received 13125 SW Hall Blvd.,Tigard OR 972?Q U G 1 6 2O 6 Pla Re
PermitNo.:1r /6,_ o30?9
I Phone: 503.718.2439 Fax: 503.598.1960 n Review
Daate/By: Other Permit No.:
D
T I t,ARD 503.63 4175 CITY 1(OF TI OAR Date Ready/By: Juris: H See Page 2 for
Inspection Line: .4
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
( - TYPE!;,OF WORK >1 EE* SCHEDULE
Vr-New construction ❑Demolition Description For special information use checklist
Qty. I Ea. I Total
❑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
-and 2-famil y dwellingSFR(2)bath 437.78
0 Commercial/industrial
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 1 25.02
0 Master builder 0 Other: -
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION,AND-LOCATION Site utilities:
Job site address: I S on, « t, cm°� �l,6 �! Catch basin or area drain 18.76
_n �( Drywell,leach line,or trench drain 18.76
City/State/ZIP: -1 Q(G+ �7�
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
0 t ST t -U[YJCA.VY Rain drain connector 18.76
Sanitary sewer(no.linear ft.: )✓ I Page 2
Storm sewer(no.linear ft.: ) ✓// I Page 2
Water service(no.linear ft.: ) 1 Page 2
Subdivision: ilk.) I Lot no.: a
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
y i < ' "'i4 4 z' --lam;, s;•, - Backwater valve 12.51
C.� Clothes washer 25.02
Dishwasher ✓t 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
"ROPERTY OWNER 1 ❑ TEA(AIV[ry ` Expansion tank 12.51
Name: 31"
I 1 t ") 6 _ Fixture/sewer cap 25.02
Address: tV ,(06n ',5,,-^N`'�✓JZ Ow� Floor drge osink/hub 25.02
City/State/ZIP �W 1 Garbage disposal I/1 25.02
�, 4 4 OR- Q?ZZ, Hose bib ��/ 25.02
Phone:�',� �? .r 2(A,�j�Q Fax:( }4-d Y Ice maker s// 12.51
• ', "'LICA?" 11 ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Z- INT Medical gas(value:$ ) Page 2
�ijV Primer 12.51
Contact name i ten ' T idXb^1,3‘ .... Roof drain(commercial) 12.51
Address: ( ! >_7v C� (is et
pG Sink/basin/lavatory ri; 25.02
City/State/ZIP: ( , L C5
Z. Solar units(potable water) 62.54
Phone:(552> /1 D4 06 2 Fax::(9/r gili , CP‘ Tub/shower/shower pan (5),./y 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater ( 37.52
Business name: 2011E f j s ede'01,_ (" G Water piping/DWV 56.29
Address: I17AAvS. wQi""�N RI) Other: 25.02
J
City/State/ZIP: � �' ` Q� ^(�'7'1 0 Subtotal
Phone:( ) Fax:( )` 'TiJ Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: CROS Plum Lic.no.: S44,..-S44,..-AK C P95
State surcharge(12%of permit fee)
Authorized lisignature: ` TOTAL PERMIT FEE
E II,, ` , Date: This permit application expires if a permit is not obtained within 180 days
Print name:
pK 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. 'Fite(ea) Total Square Footage: PPjit 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-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation:
Storm&Rain Drain-1st 100' 62.54 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
.' Fee(ea Total and including$10,000.00.each additional$100.00 or fraction thereof,to
Other inspections or rips 41t).,§;,' .
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 fust$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*. ' Rpt ew foiljumbing,staltations
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 0 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 Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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"
-3„ M,, Vic, r �rro., {�
•
. r �.Iaitnetr+ ,Riser Ditigram
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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
IIIe COMMUNITY DEVELOPMENT DEPARTMENT
■
T I G A R D Building Permit Review — Residential
Building Permit #: M hf go/lp- 00 3.2-6/
Site Address: 150,,;z S Lk) (.,t>.-b',n ,S -
Project Name: C 0,-ko'1 v ' .y 4-o—k.J Lot #: / b
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: N-e<-.f S.F(Z
le Verify site address/suite#exists and active in permit system.
El River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
11Three(3)copies of site plan ,Existing structures on site
(Site plan must be on 8-1/2"x 11"or 11 x 17"paper l Footprint of new structure(induding decks)with finished
Vbrawn to scale(standard architect or engineer scale) floor elevations
R'North arrow ROtility locations (required for new,may apply for additions)
IXISite address,project or subdivision name and lot number Location of wells/septic systems
)Applicant information(name and phone number) xisting trees to be retained with drip line,and tree
. Lot dimensions and building setback dimensions protection measures
Jot area,building coverage area,percentage of coverage and ❑Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) Street names
,'Property corner elevations(2 foot contour lines if more than
4 foot differential)
(Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified k''No Received: ❑ Yes ❑ No
Public Facilities Improvement(PFI) Permit:
Required: [r Yes,applicant was notified ❑ No Applied For: Xi-Yes ❑ No,stop intake
ZrLand Use Case#: 6C ' a , 1 L4 — C c7 0 e/ U A 2 , 0i(4, -(...,,,, ,,,A._
„Er-Zoning. {Z - 4 - 5
0 Setbacks: Front 0 Rear j 5 Side ,j Street Side — Garage LD..
Landscape Requirement:
,ErLot Coverage Maximum:
2$ Building Height: Maximum Height 30 Actual Height „2(a
f)-4' Visual Clearance
LN Easements
Sensitive Lands: ❑ Yes No Type
Nr Urban Forestry Plan
i --Conditions "Met"prior to issuance of building permit
Notes: w j4-e).c 1ln f - vY0.J''- rc..i r~. /. e.y 1- pu A-I- p(�<J 1 0 1
b e c a.Lt.) c 1 a e,31-- i v c,...1 -e. (3 t'-N-k li-L..i._ t1/ 4.;1..1 i 0 fit_i- - b el.
Approved By Planning: au. Ct jC,,,..s.----- Date: @@' - I .-1 tF:
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: il/d/O
Site Plans: # JI
Building Plans: # f
Building Permit#: ErEnter building peimit#above. LL
Workflow Routing: 2'Planning Engineering [;1/I5ermit Coordinator Id'tiuilding
Workflow Sign-off: Q" Sign-off for Planning(include notes from planning review)
Route Application Documents: la' Engineering: (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: 4,..Ic2sa.„0„..41_44,
Date: /4/42
Engineering Review
Slope at building pad: Rg
Conditions "Met"prior to issuance of building permit
J'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 No
LIDA Facility on lot: ❑ Yes Q No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: W/4_12_
Date: de51"—
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
Cl Conditions "Met"prior to issuance of building permit
El 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: •.Yes ❑ N/A
Parks SDC: !— es ❑ N/A
' DOK to :;: orthnator:
Permit /,,
Approved Date: ?Z t `4
I:\Building\Forms\BldgPermitRvw_RES_060116.docx