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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1.• COMMUNITY DEVELOPMENT Permit#: MST2017-00035 T[G��RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243 f; Date Issued: 02/08/2017 ANIO9/ Parcel: 1S136AC00400 Jurisdiction: Tigard Site address: 10595 SW 71ST AVE Project: Anderson Subdivision: METZGER ACRE TRACTS Lot: 5 Project Description: Convert garage to habitable space adding 3 bedrooms to create foster care. 4/3/15:REPRINTED permit to include (1)water heater with gas piping,(20)branch circuits,(1)water heater for potable water,and replacing existing water piping throughout house. 12/19/17: REPRINTED to add low voltage. Contractor: OWNER Owner: ANDERSON, DENNISE DENISE ANDERSON 10595 SW 71ST AVE 10595 SW 71ST AVE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-884-0471 PHONE: 503-884-0471 FAX: FEES Description Date Amount Specifics: Building Permit-Additions,Alterations, 02/08/2017 $729.45 Demolition Plan Review 01/26/2017 $474.14 Type of Use: SF 12%State Surcharge-Building 02/08/2017 $87.53 Class of Work: ALT Info Process/Archiving-Lg$2.00(over 02/08/2017 $14.00 Total Number of Systems: 11x17) Tig-Tual School CET-Residential 02/08/2017 $730.62 Branch Circuits wo/Purchase Service or 02/08/2017 $71.02 Audio&Stereo: N Feeder Security Alarm: N 12%State Surcharge-Electrical 02/08/2017 $8.52 Duct Work 02/08/2017 $23.32 Garage Door Opener: N Gas Fireplace 02/08/2017 $33.39 HVAC: N Clothes Dryer Exhaust 02/08/2017 $33.39 Vacuum System: N Other: N Other Desc: Total $3,334.49 Required Items and Reports(Conditions) 1 Foster care guest must remain at 5 persons 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 ma btain •• •f the rules or direct questions to OUNC by calling 503.232.1987.'.- .800.332.2344. Issued By 7[/C c_., !r`ej Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 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. EElectrical Permit Applcati�E ,,, FOR OFFICE USE ONLY City of T1gardReceived D E C 19 2017 Date/B : %,IZIEMPle Ill IN 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 C:a t I' .,�af-''.R�) Date/B : Related Permit# IP" �� '' Email: TigardBuildingPermits@Tigs �a r� i ' I Ready Date/By: Juris: ® See Page 2 for TI GA RD s vgary o.gov Notified/Method: SupplementalInformation Inspection Line: 503.639.4175 Internet: www.hgard-or.gov w TYPE OF WORK PLAN REVIEW ❑New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. 0 Demolition 0 Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. Et 1-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 41' JOB SITE INFORMATION='AND;LOCATION ❑Emergency system. larger separately derived -7 1 ❑Addition of new motor load of system. Job#: Job site address: 76.5- :1-6,,,,,i-7( `J.t"_ A-J 100HP or more. ❑..A„ ..E„ a1.2„ ..1.3„ City/State/ZIP: 'PQ 12.}{t--E �Z� ❑Six or more residential units. occupancy. Z Z-- 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I....* New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK ','" Limited energy,residential 75.00 2 J o (with above sq.ft.) '' " k`��: Vi`^&` ' . , Limited energy,multi-family /614residential(with above sq.ft.) 75.00 0 See Page2 Renewable Energy 2 PROPER OWNER *r TENANT Services or feeders installation,alteration,and/or relocation Name: • .f 14 Al c6_ 'v'`113.-V e&, .- 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Address: i 0,,6-- 7 c8 , —7/ s4- fr V.k.- 401 amps to 600 amps 200.34 2 City/State/ZIP: 'f>e,2_,,6_0-01 601 amps to 1,000 amps 301.04 2 Phone:( ar6 ral-1 CC? '7 ( Over 1,000 amps or volts 552.26 2 7 Temporary services or feeders installation,alteration,and/or Email: � �( 3 ' / • � relocation Owner installation:This installation is beint-ttadd on property that I own which is not 200 amps or less 59.36 1 intended for sale,1 e,rent,or exchange,according to ORS 447,449,670,and f701. 201 amps to 400 amps 125.08 2 Owner signature: Date: (2 if--7 1/7 401 amps to 599 amps 168.54 2 0 APPLICANT, ICONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: i above service or feeder fee, 'ft yv�.L..C' l A!J'�.` ---r.. r"�,v ,J,,.* --((,� 7.42 2 /� , (� / each branch circuit Contact name: ' -t'-\-14 ,f5c 4 j( /� f-/A/"•.�2- �.-V% C//'-' B.Fee for branch circuits without W service or feeder fee,first Address: in (� 1./ - Wil- „1-Lsd .e,,g -64 branch circuit 56.18 2 City/State/ZIP: rc , a ��// e,/�'f/ c'� 7 Z."L Each add'I branch circuit 7.42 2 ( ) r_ ' A^^� ��� Miscellaneous(service or feeder not included) ( Phone: /? 0.'` 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: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy L(See Page 2 7c- co 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:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(Yhr 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): T.00 Authoriz i,l Si!nature: TOTAL PERMIT FEE: /16 r.) This permit application expires if a permit is not obtained within 180 Print nam; Date: J. I days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/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 Description Qty. I Each Total Fee for all residential systems combined: $75.00 ° 3' 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: FT 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 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: ri Other: 3 Each additional inspection is `t charged at an hourly(1 hr min) 66.25/hr 1 Inspections for which no fee is 90.00/hr specifically listed('/hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES c,. SubtotalEnteron Page 1): Fee for each commercial system: $75.00 y * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n 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 10/26/2017 CITY OF TIGARD /44„ MASTER PERMIT N.__ ; . 31., .._ COMMUNITY DEVELOPMENT Permit#: MST2017-00035 RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/08/2017 T E.G��` g Parcel: 1 S136AC00400 Jurisdiction: Tigard Site address: 10595 SW 71ST AVE Subdivision: METZGER ACRE TRACTS Lot: 5 Project: Anderson Project Description: Convert garage to habitable space adding 3 bedrooms to create foster care. 4/3/15: REPRINTED permit to include(1)water heater with gas piping, (20)branch circuits, (1)water heater for potable BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 7 First: 594 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 8 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 594 sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 5 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 7 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0 Drains: 0 Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 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: 8 Clothes Dryers: 2 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 �I ELECTRICAL a 5 A /LtPLfr1- >:4 Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add9 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 23 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: ALT SF VB R-3 594 Owner: Contractor: ANDERSON,DENNISE OWNER Required Items and Reports(Conditions) 10595 SW 71ST AVE DENISE ANDERSON 1 Foster care guest must TIGARD,OR 97223 10595 SW 71ST AVE remain at 5 persons TIGARD,OR 97223 / PHONE: 503-884-0471 PHONE: 503-884-0471 / FAX: / Total Fees: $3,250.49 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTE •L• Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0 0 through e'R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ��-it f Issued : Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspectio date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. IAF Mechanical Permit Appl " 1 - a_.. E-- - ` FOR OFFICE USE ONLI Iii City of Tigard Received Permit No.: / .' /0/� �� Date/By: / 01/ ♦� 13125 SW Hall Blvd.,Tigard,OR 9',1,11 l Plan Review Da111 te/By:503.718.2439 Fax: 503.598.1960Other Permit: Inspection Line: 503.639 4175 d ' T t G A R D t � � � � �, .,� Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information '''i1" ia�.r ;. i jtj J ,:I. TYPE OF WORK COMMERCIAL FEE* SCHEDULE -USE CHECKLIST Mechanical permit fees*are based on the value of the work 0 New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 0 1-and 2-family dwelling 0 Commercial/industrial ❑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: 105--q ,, 1 -7 . -///4--&_ Air conditioning 46.75 r) . • Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 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 to job site: 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 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 n DESCRurriW OF;WORK `k. ''`,w Gas fireplace/insert ! 33.39 Flue vent for water heater or gas (�_ ( J\\ pt�� 11-- �y , fireplace 23.32 \ J Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 AD R y s R 'TEN i= ' x Other: 23.32 - - °• '3. '`" -. ' Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 1 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 • I� PLICANT t Q 'COI °AC• P a Other: 23.32 ,. "- ,: -' FuelP tPing: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Gas heat pump Address: Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax: :( ) Fireplace Range E-mail: Barbecue I r CONTRACTOR ,; 4, , Clothes dryer(gas) Business name: 0 Lt D /0 f e------ Other: ¢ .: ; MECHANICAL PERMIT FEES* "'` 4 ". '" Address: Subtotal City/State/ZIP: Minimum pernrit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE 177.7 J`' 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: �- Date: I:\Building\Permits\MEC_PernutApp_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 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_040113.doc 2 CITY OF TIGARD MASTER PERMIT 7111 : COMMUNITY DEVELOPMENT Permit#: MST201700035 �` Date Issued: 02/08/2017 TI.GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 •. � // � Parcel: 1 S 136AC00400 Jurisdiction: Tigard Site address: 10595 SW 71ST AVE Subdivision: METZGER ACRE TRACTS Lot: 5 Project: Anderson Project Description: Convert garage to habitable space adding 3 bedrooms to create foster care. 4/3/15: REPRINTED permit to include(1)water heater with gas piping, (20)branch circuits, (1)water heater for potable BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 7 First: 594 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 8 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 594 sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 5 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 7 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs/Showers: 2 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: 8 Clothes Dryers: 1 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 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 23 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: ALT SF VB R-3 594 Owner: Contractor: ANDERSON,DENNISE OWNER Required Items and Reports(Conditions) 10595 SW 71ST AVE DENISE ANDERSON 1 Foster care guest must TIGARD,OR 97223 10595 SW 71ST AVE remain at 5 persons TIGARD,OR 97223 PHONE: 503-884-0471 PHONE: 503-884-0471 FAX: Total Fees: $3,175.70 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a c les or direct questions to OUNC by calling 503.232.1987��, .� or 1.800.332.2344. Issued By: Permittee Signature: ':�e ,j1J' 03.539.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • Mechanical Permit Applica , FOR OFFICE USE ONI.I City of Tigard t' 14 -, —1 IVET) Received Date/By: Permit No.: di ..— j5 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ■ Phone: 503.718.2439 Fax: 503.598.1960` !� Date/By:ate/By: Other Permit: t T I G A R U Inspection Line: 503.639.4175 Date Read/H Juris: 0 See Page 2 for an g g Internet: www.ti d-or. ov CITY Ready/By: OF yGARD Notified/method: Supplemental Information TYPE 0F'V (I 'G DIVlSIO(V COMMERCIAL FEE* SCHEDULE USE CHECKLIST 1\ Mechanical permit fees*are based on the value of the work ci. ❑New construction p Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 mechanical materials,equipment,labor,overhead,and profit. Demolition 0Other: Value:$ CATEGORY OF C$ ? a, '. RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling 0 Commercial/in ■ 'ssorybuilding n g For special information use checklist. ❑Multi-family 0 Master builder Other: Description Qty, Ea, Total JOB SITE' INFORMATION AND LOCATION Mr / r conditioning 46.75 Job site address: !Q S,5 Q.!-'7 f 5+- A .& Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP; "(i 6 a ?? 7 z Z- Furnace 100,000+BTU(ducts/vents) 54.91 A,�4 Heat pump 61.06 Suite/bldg./apt.no.: Project name: /V O ecj Duct work ' 23.32 Cross street/directions to job site: Hydmnic hot water system 23.32 1 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 '1/3/i i / 23.32 „,. r 'DES _ QN OF,WORK r Gas fireplace/insert f 33.39 P '�J � � /1 _ �'"F Flue vent for water heater or gas /�� V✓�f x l ' ! i2--Xil ' fireplace 23.32 t a' D VA� �r'� $ o\ Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 t` o f/3� 'V./Ile/leo'? le/le i j . ,r Chimney/liner/flue/vent 23.32 bi/ I /1 1�e'^`t�n ` r,: r '"J'' Apo," Other: 23.32 ROPERTY OWNER - " ��/ Environmental exhaust and ventilation: Name: sbG1V1�/ e- 'iTl l" Ls./ 0/ Range hood/other kitchen J'� equipment 33.39 Address: /o S-1 - ( ri., 1-tie- Clothes dryer exhaust 33.39 1 City/State/ZIP:2 IA47 k ©R— .172_2" Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 _ Phone:( ( Fax:( ) • Attic/c rawlspace fans 23.32 I M 0 APPLICANT Q CONTAC3,fERSON Other: _ 23.32 OA 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 j City/State/ZIP: Water heater j1/3/1 7 / Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue _ CONTRACTOR Clothes dryer(gas) . Business name: O Cel JO €*4- Other: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lie.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 , days after it has been accepted as complete. Authorized signature: t Fee methodology set by Tri-CountyBuilding IndustryService Board Print name: 11.-t V fl� .6 Date: f l ^ j� 7 I:\Building\Permits\MEC_PermitApp_04 113.doc 440-4617T(1 1/02/COM/WEB) 1 1ectrical Permit APPlicatio Ei I% Fc)IZ(1111( 1. I. til tl\l.l City of Tigard Received t l 7---,9,1 7-0003-6 1111 eil 13125 SW Hall Blvd.,Tigard,OR 97223I/� Plan/ Permit#:Review g Phone: 503.718.2439 Fax: 503.598.1263,6AMI 8 2 0�7 Date/B : Related Permit#: T 1 G A I:D Inspection Line: 503.639.4175 p Ready Date/By: coria: See Page 2 for Internet: www.tigard-or.gov CITY 01 11GAR) Notified/Method: Supplemental Information TYPE oBNtilING DIVISION 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 'Crl;_,r exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-familydwellingless to ground,or exceeds 14,000 0 Commercial-use agricultural 0 CommerciaUindustria �, ��...;�t .: :'dingeri ❑Multi-famil amps for all other installations. buildings. y ❑Master builder V . er: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND OCATIO 0 Emergency system. larger separately derived Job#: Job site address: i r�y: !�z� ,, ❑Addition of new motor load of system. t W 1 t J'- A"'t/' 100HP or more. ❑ `A„ '&" `i-2> 1-3„ City/State/ZIP: °a (j CI Six or more residential units. occupancy. �i/ — `�� ❑Health care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE - `1/3` r DperiPdon I Qty I Each I Toat ] ji�7/' t�4;4464 oV)G-,Af' '"1 /f -/7 _ New residential single-or multi-family dwelling unit. • Subdivision: /d7Z�.x 07: y'' Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq,ft.or less 168.54 4 Ea.add'l 500 sqft.or portion 33.92 1 - DESCRIPTION OF WORK . Limited energy,residential �,LJ {I ' 1 1 r� n (with above sq.ft.) 75.00 2 Tl v V Limited energy,multi-family 75.00 2 ; .TY o% 9rG1�s V residential(with above sq.R.) PROPERTY I< ❑ ""\ Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation Name: 61_,..4,4_4 pb.�,�/ 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 - 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: 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 ©APPLICANT 1 : EJ.CONTACT PERSON Branch circuits—new,alteration,or extension,per panel l A.Fee for branch circuits with 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,firs/n,11 I 56.18 2 branch circuit City/State/ZIP: 3 tY Each add'I branch circa' 17 �(, 7.42 2 Phone: Miscellaneous(service feed r not Included) ( ) , Fax: ( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: (/a.)1 ) tLR.- Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. ❑ See Page 2 2 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 Email: Industrial plant(1 hr min) 1 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed CA hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): _ i State surcharge(12%of permit fee): Authorized signature 1116.N. TOTAL PERMIT FEE: / This permit application expires If a permit is not obtained within 180 Print name: - \ ,�' 1 1 �\�°Vi ( iV/,-> / Date:0/ / 1 days after it has been accepted as complete. �( ( 1 * Number of inspections allowed per permit. I:\Building\Permits1ELC_PernitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(i l/05/COM/wEB Plumbing Permit Application Building Fixtures F,CJ P FOR orrlcl I Sr 0\1.1 City of Tigard Received Permit No.: 3 S r ;� . 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �� 1 /7 Q%�J Plan Review Phone: 503.718.2439 Fax: 503.510\1.1)622 7 Date/By: Other Permit No.: Inspection Line: 503.639.4175 T I G A R o Date Ready/By: Ions: id See Page 2 for Internet: www.ttgard-or.gov tf'11 y/NC Notified/Method. _ Supplemental Information TYPE '•�ri i� J.S FEE* SCHEDULE ❑New construction • Demoliti isi l For special information use checklist Description Qty. Ea. Total o Addition/alteration/replacement ❑Other: New 1-2-family ,- , dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builder Each additional bath/kitchen 25.02 ❑Other: : Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION-AND L s 4 tl r'' Site utilities: Job site address: to ),S.----��1 'rib V Catch basin or area drain 18.76 City/State/ZIP: PDrywell,leach line,or trench drain 18.76 -) 2 Z 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 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 DESCRIPTIO) )F;WOI IC p Backwater valve 12.51 ., h� ' dl. ,'V Clothes washer i 25.02 • ti� '( S\ .b r Dishwasher 25.02 'r ' i C��.•..N),...` 'q\f\-. 1 (�- -�cDrinking fountain 25.02 Itiii 0 /7 ✓ ,11‘.:yrIA..--c Au s . � )' Ejectors/sump25.02OP RTYmo . ,,-c," CI 'lt iAN'I' `i Expansion tank 12.51 Name: / O 1� � Fixture/sewer cap 25.02 /"/16v'�L Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) lce maker 12.51 pigs Interceptor/grease .�: ',.r D �'LIAl 'qt-- �t,;� yrs; t k ���'IG' TA� 151 �t' trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 7 \ 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 41 \ 12.51 E-mail: Urinal 25.02 C - Water closet S 25.02 "a Q Water heater . .� gr 37.52 37 5;2 name: n��O E/ ' �� �" Water piping/DWV 'f/a/I � � 56.29 5-6, ,j, Address: Other: 25.02 /'dl City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 1.CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE [� / ` wry j Print name: /'� d Date:Cil fL� I/ 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-PermilApp.doc 10/01/09 440.4616T(l0/02/COM/WF.B) CITY OF TIGARD MASTER PERMIT ', COMMUNITY DEVELOPMENT Permit#: MST2017-00035 13125 SW Hall Blvd.,Ti Date Issued: 02/08/2017 T E G, It.L and OR 97223 503.718.2439 9 Parcel: 1 S 136AC00400 Jurisdiction: Tigard Site address: 10595 SW 71ST AVE Subdivision: METZGER ACRE TRACTS Lot: 5 Project: Anderson Project Description: Convert garage to habitable space adding 3 bedrooms to create foster care. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 7 First: 594 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 8 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 594 sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 5 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 7 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0 Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 8 Clothes Dryers: 1 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 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3 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: ALT SF VB R-3 594 Owner: Contractor: ANDERSON,DENNISE OWNER Required Items and Reports(Conditions) 10595 SW 71ST AVE DENISE ANDERSON 1 Foster care guest must TIGARD,OR 97223 10595 SW 71ST AVE remain at 5 persons TIGARD,OR 97223 PHONE: 503-884-0471 PHONE: 503-884-0471 FAX: Total Fees: $2,833.30 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 obt ' of the rules or direct questions to OUNC by calling 503.t3f2.1987 or 1.800.332.2344. Issued By: _ - Permittee Signature: j// I 97.-vicr--Ori._ all 503.639.4175 by 7:00 a.m.for the next available inspection dat . 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. huilding Permit Application Residential ro►z orFR_i. I:SE O'l.l City of Tigard RECEIVFD DcevBy /447 /7 J Permit No.:)i7 i7-3c 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ��J �� ���/ III C Phone: 503.718.2439 Fax: 503.598.1960 a-h-, )7 Other Permit:dlQK•O,/l 7 J Date/By: T 1 G A R D Inspection Line: 503.639.4175 JAN 2 6 201? Date Ready/By: ,/ ' Juris: I H See Page 2 for Internet: www.tigard-or.gov Notified/Method:/ 9 l7 Supplemental Information CITY OF t`lGAkkb Vse 4.c. et TYPE DIVISION RE s UIRED DATA:1-AND 2-FAMILY DWELLING im li oNG Permit are based on the value of the work performed. ❑New construction � fees* Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1-and 2-family dwelling IDCommercial/industrial Valuation: $ r 6-0 12Accessory building ❑Multi-family Number of bedrooms: ‘5 ❑Master builder 0 Other: Number of bathrooms: ,-- , p t� ri f JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: le 5- 3. 0 '77 rj 4_ `c.;- New dwelling area: 3/C-f square feet City/State/ZIP: i � C5' -7'V2-- iI ''9Garage/carport area: square feet Suite/bldg./apt.no.: Project name: 4<9--/(/l t iSl Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQU)rtED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: 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. ' Zp.i 6 e L >--Xi`sidiv� Valuation: $ . ek,,, _ exo "! r/,_ ttip-i--17\ Existing building area: square feet -k04C kVLC--. New building area: square feet 0 PROPERTY OWNER 0 TENANT Number of stories: Name: ` 7i(l% ,<J&le-_S c vr/ Type of construction: Address: (03--/5£'fvt . .7C .i- "4.1,- - Occupancy groups: City/State/ZIP: /^ e q722 -5 Existing: Phone:( Fax; y 0V7/ ( ) New: a APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to schedule) Structural plan review fee(or deposit): Contact name: Address: FLS plan review fee(if applicable): City/State/ZIP: Total fees due upon application: Phone:( ) Fax::( ) � Amount received: 7 /7 � E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of , ) roof-top mounted Photo Voltaic Solar Panel System. f Business name: �/V EI 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 lie.: Total fee due upon application: $201.60 Authorized Signa This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: �'r±5c1�s. Date: ` *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Per its\BUP-RE etmitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFIC I t Oy1.1 City of Tigard Received Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 a g Associated permits: ■ Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical T 1 G A R D Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ' `s NO y/:' 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 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 0 6 Sewer permit. 0 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 applicable to theproject 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". 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"building plans 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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) • echanical Permit Applicat -, tReceived FOR OFFICE use o lti .j i eceveCI of Tigard Permit No.: I ....40140 1`Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 2Other Permit: / Date/By: TIGnRD Inspection Line: 503.639.4175 Date Ready/By: kris. H See Page 2 for Internet: www.tigard-or.gov CITY JlItAe Notified/Method: Supplemental Information TyPE 01PUURQING DIVISION COMMERCIAL FEE* SCHEDULE USE CHECKLIST Mechanical permit fees*are based on the value of the work 0 New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: �.,� Air conditioning 46.75 Job site address: ,SU k..7 j 94— i-1-U& Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: `/' t*O., O -17z-2_3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: , MdEI S0 " Heat pump 23.32 Duct work / 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), 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 1 33.39 fireFluepventlace for water heater or gas Ed *41 r l P-X/ •: -t� �e ,v�� ` 1 (ect5 � ��` 23.32 Log lighter(gas) 23.32 ''t` .ice Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 0 PROPERTY OWNEROther: 23.32 0TENANT �/ Environmental exhaust and ventilation: Name: boos(6-- i/f". w�!5 Range hood/other kitchen equipment 33.39 Address: 10 3 lr./... - Clothes dryer exhaust 33.39 City/State/ZIP: -r�3,_ © ei-7 22_-2) Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 123.32 Phone:( act 6( 7( 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 I Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Business name: /0 �� Other: (/ MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) 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 signature: 1 * Fee methodology set by Tri-County Building Industry Service Board Print name: / NI Z tel( Date: 0/ f l7 ME I:ABuildingAPermits\ C_PemiltApp_04 113.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 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 Electrical Permit ApplicatioRECEIVED FOR OFFICE t SI 0y,.1 City of Tigard Received47 7- O 3 Date/B : Permit#: t` 13125 SW Hall Blvd.,Tigard,OR 97223inPlan Review Phone: 503.718.2439 Fax: 503.598.19'6 N 2 6 2017 Date/B : Related Permit#: Inspection Line: 503.639.4175 $ Ready Date/By: Jur s: H See Page 2 for CITO1lGAR DIVISIONInternet: www.tigard-or.gov Notified/Method: Supplemental Info rmation TYPE Cid JN PLAN REVIEW ❑New construction ❑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. 0 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 ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: f 5 !5 CJ�J� ''1 i J +v ❑100H Addition of new motor load of system. e .� �{t t2 100HP or more. ❑"A» "E" "1-2" °`1-3" City/State/ZIP: -----1-43e0-?_p n 6� 9�1 '2 3 ❑Six or more residential units. occupancy. I mit- 1 ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total l * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 DESCRIPTION OF WORK Ea.add'1500 sq.ft.or portion 33.92 1 Limited energy,residential k R e.y./..,(- 4 a ( (with above sq.ft.) 75.00 2 t Limited energy,multi-family V^y S 75.00 2 �� Iry e�`�s residential Energybove sq.ft.) PROPERTY OV4jR ❑ TENANT Renewable ❑ See Page 2 Services or feeders installation,alteration,and/or relocation Name: �� "v 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 City/State/ZIP: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: 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 0 APPLICANT 1 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, Contact name: each branch circuit 7.42 2 B.Fee for branch circuits without Address: service or feeder fee,first 1. 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit // 7.42 2 Phone: Miscellaneous(service or feeder not included) ( ) Fax: :( ) Each manufactured or modular dwellin s 67.84 2 Email: g, ervice and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 01/U/ 3 t 'f a' Sign or outline lighting 67.84 2 Address: 1Signal circuit(s)or limited-energy panel,alteration,or extension. 0 See Page 2 2 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 Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: Electrical Lic.: specifically listed '/hr min 90.00/hr Suprv.Lic.: > y ( ) Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature 1\..A.1(\,........_ TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: \ �[tet /011-2( , / Date:(}C1days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PemiltApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application-o City of Tigard Page 2 Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Each I Total I * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 133.56 2 5.01 to 15 kva El 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 ❑ 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: El 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('h hr min) ELECTRICAL PERMIT FEES 'COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1): 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 ❑ Clock Systems ❑ Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* El Medical ❑ Nurse Calls F-1 Outdoor Landscape Lighting* ❑ Protective Signaling El Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 Plumbing Permit Application Building Fixtures ` 1 --1 FOR OFFICE 1 SF 011.1 City of Tigard Received Date/By: Permit No.: I (/ /7-6/C63 5-- III 111 13125 SW Hall Blvd.,Tigard,OR 97223 I Phone: 503.718.2439 Fax: 503.5A96(J 6 1[t i17 Plan Review i Date/By: Other Permit No.: TI G A R D Inspection Line: 503.639.4175 Date Read/B Internet: www.ti and-or. ov �� y y Ready/By: Ju is: 1i See Page 2 for g g CITY Ol f lG rt wy Notified/Method: Supplemental Information TYPE ; C r FEE* SCHEDULE ❑New construction ■ Demolition " For special information use checklist Description 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 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: tC)5 I S- Q • •7 Iv yf- fit-v- Catch basin or area drain 18.76 e.City/State/ZIP: t '- Drywell,leach line,or trench drain 18.76 - 2- Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: \� 2ject name: 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 DESCRIPTION OF WORK Backwater valve 12.51 'y5 i j(� Clothes washer 25.02 V - ` b Dishwasher 25.02 �1-V••N.�\�J(� \\..1N, L ..[i1 Drinkingfountain 25.02 Ejectors/sump 25.02 PROPERTY=OWNER , J ❑ TENANT Expansion tank 12.51 Name: "r l C�f _ ,Gam'.04"1, Fixture/sewer cap 25.02 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 A 'LICANT ,. Interc (� CONTACT PERSON eptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Contact name: Primer 12.51 Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 7 \ City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan a 12.51 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR , Business name: �/L9A) EWater heater 56.29 Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone:( ) Fax:( ) Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: Authorized signature: State surcharge(12%of permit fee) _ v ,(� TOTAL PERMIT FEE Print name: IC / �, I Date:60670 7 I 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.doe 10/01/09 440-4616T(l0/02/COM/WEB) f Plumbing Permit Application - City of Tigard ' , Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Qty. Fee(ea) Total Square Footage: Permit Fee: Site Utilities q g :- Footing drain-l'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 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 • (ea) Total Other In peC Ons or Feeseach 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. $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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 Mr 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 ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040. Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" -3" Isometric or Riser Diagram m ❑ 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/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 plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 FOR OFFICE USE ONLY-SITE ADDRESS: 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. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT III _ Transmittal tta Letter 1 i ,A ii n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: jdM DATE REC DEPT: BUILDING DIVISION RECEINED ,,,,, DEC 19 'ZQ1 . FROM: A//V( - 4-r\-'6 CI'T`Y OF GARD COMPANY: SIL► G MVI ® PHONE: cj0 ' 7c� Qt(7/ By•T7 RE: /'05- g tAj '7 i fi(-11-1/ ,''s../0-1T-E ( M * 2 C/7°#00c3,0— (Site Address) (Permit Number) 4AaiA/ tie)) 11' (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: ' ii Copies: Description: t,V o pies: Description: Additional set(s)of plans. Revisions: Cross section(s) and details. , \ Wall bracing and/or lateral analysis. Floor/roof framing. G ' Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: Cidnity/eft,` 614;p4,.) ,k-t (--- �v '(42.P FOR OFFICE USE ONLY Routed to Permit T; hnician: Date: )1- ' 7 Initials!lj Fees Due: j2ii Y; ❑No Fee Description:{� Amount Due: .S i- r PL�vI ✓c v,‘ ew $ LI' $ $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes L1 No E Donee.} � Applicant Notified] g1' E; Date: /Z/2�/ Initials:�:1 �- I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012