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Permit CITY OF TIGARD MASTER PERMIT II 2 COMMUNITY DEVELOPMENT Permit#: MST2017-00047 T[€ ,r R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/27/2017 Parcel: 2S103BD03800 Jurisdiction: Tigard Site address: 11865 SW FONNER ST Subdivision: None Lot: None Project: Baker Project Description: Interior remodel to include creation of ARU. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 3 First: 96 sf Basement: sf Left: 5 Parking Spaces: Height: 24 Bathrooms: 2 Second: sf Garage: sf Front: 20 Smoke Dwelling Units: 2 Third: sf Yes Right: 5 Detectors; Total: 96 sf Value: $46,375.00 Rear: 15 PLUMBING Sinks: 2 Water Closets: 2 Washing Mach: 2 LaundryTrays: 0 Y Rain Drain: 0 Urinals: 0 Lavatories: 3 Dishwashers: 2 Floor Drains: 0 Sewer Lines: 0 SF Rain 0 Storm Sewer 0 Tubs/Showers: 2 Garbage Disp: 2 Water Heaters: 1 Water Lines: 0 Drains: Bckflw Prevntr: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 2 Natural Gas Heat Pump: N Hoods: 2 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 1 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 2 0-200 amp: 0 W/Svc or Fdr: 16 Ea add',500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: ALTP y Square Feet: SF VB R-3 96 Owner: Contractor: BAKER,JENNIFER MAY&SHAWN OWNER Required Items and Reports(Conditions) 11865 SW FONNER ST SHAWN BAKER TIGARD,OR 97223 11865 SW FONNER ST TIGARD,OR 97223 PHONE: PHONE: 541-281-3096 FAX: Total Fees: $2,565.38 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 throu•• s•R 952-001-0090. You may obta. a copy. he rules or direct questions to OUNC by calling 503.232 7 1.800. �2.2t Issued By: �� - �/ Permittee Signature: 503.639.4175 by 7:00 a.m.for the next available inspecti n,d . This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application L :2/i . Residential • -,1 1'012 O 1'1'1(1'. l I. O\1.1 City of Tigard :°j 1 ` r Received et ." 4 `""k Date/By: / j 7 Permit No.: �/ /� 13125 SW Hall Blvd.,Tigard,OR 97 /� 1-1 6rcpx)f 7 04 _ Phone: 503.718.2439 Fax: 503.598 Qy@1Plan Review lJ 17 Date/By: -* 6- )1 Other Permit:4,24a€,/1, TI C A R D Inspection Line: 503.639.4175 Date Ready/By: J Internet: www.ti and-or. ov 1 R S la See Page 2 for g g (.gIp r t 1 ,. Notified/Method: a- ;.3/17 • Supplemental Information TYPE OF WORK ! REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. EREAddition/alteration/replacementIndicate the value(rounded to the nearest dollar)of all 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 0 1-and 2-family dwelling 0 Commercial/industrial i. Valuation: $ I103-7s- r ❑Accessory building 0 Multi-family Number of bedrooms: 1 2'- - Number of bathrooms: -Z'� ❑Master builder 0 Other: JOB SITE INFORMATION AND LOCATION Total number of floors: A- Job site address: It 8 S 5W F0t�11/4,3 New dwellingL square area: � � s uare feet City/State/ZIP: -ti GAgp b 7.Z3 Garage/carport area: square feet Suite/bldg./apt.no.: I Project name: s N.v1/4^4BAKi/Z Covered porch area: square feet Cross street/directions to job site: i3,6.r te ST 'T�i S +- `2A Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. i 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. `ATICIZi 0 R c.beL_. '� 1,f4 .1.,.0 3)6 A i'l i Valuation: $ Existing building area: square feet New building area: square feet tit PROPERTY OWNER i 0 TENANT Number of stories: Name: 5 Vi i iJ (3 Atm 42„ Type of construction: Address: k(Sus c E f f S -na.(r-r- Occupancy groups: City/State/ZIP: 1161 <DJ O R.. 4T 7223 Existing: Phone:(94 k ) •2$\- 0°) Fax:( ) New: CONTACT PERSON BUILDING PERMIT FEES* Business name: lv y c A s.�,o c 1 6 T'E S (Please refer to fee schedule) Contact name: 5 1 NJ S Structural plan review fee(or deposit): Address: i kg�S 5,0 ��rIN S"'L 461- FLS plan review fee(if applicable): City/State/ZIP: .. 1 GA.e.tv/ O(L 9,72-3 Total fees due upon application: Phone: t� ) 2.,411.;-: m121 Fax::( ) Amount received: it V6A.4'S E-mail: 5ab 2S 1A0' i�1A�t‘ . Co M PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: 5- l`/6tJ<-2,..... Submit o(2)sets of roof plan with connection details Address: and fire dep.1 .4 ent access,along with the 2010�regon �`� AS AOeq',. Solar Installation ':-cialty Code chec City/State/ZIP: Permit Fee(inclus- -view Phone:( ) I and. ' istrativ- --s : $180.00 Fax:( ) � Stat-,:. c arge(12%of permit fee): $21.60 � CCB lic.: A Total fee due upon application: $201.60 Authorized signature: C........._ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 5( W:� 8A &. Date: -=c2_4,1-71 * methodology set byTri-Coon BuildingIndus -1 -� Fee Tri-County Industry Service Board. I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) Y Building Permit Application Checklist One— and Two—Family Dwelling FOR OFFICI. I:SE Oy1.v 4 Permit No.: City of Tigard III u Date/By: SW Hall Blvd.,Tigard,OR 97223 Associated permits: C Received Phone: 503.718.2439 Fax: 503.598.1960 ❑ Electrical ❑ Plumbing ❑ Mechanical 24-Hour Inspection Line: 503.639.4175 ❑ Other: TIGARD Internet: www.tigard-or.gov : THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les \0 1/k❑ 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. ❑ 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 6 Sewer permit. 00 0 0 ❑ 7 Water district approval. 0 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 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 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, nd surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size0 0 0 and location. 0 0 0 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, • 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. 0 0 0 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 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. 0 0 0 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- prescriptive path analysis provide specifications and calculations to engineering standards. 0 0 0 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 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 over 10 feet long and/or any beam/joist carrying a non-uniform load. 0 0 0 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0 architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review. 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0 24 Two(2)sets each are required for Items 16,19,20 and 22 above. 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. 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. 0 0 0 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 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.doe 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application LA ,2/i , ResidentialRrtl►i t�rr►c F l s►. tl\►.1 City of Tigard Eta I Received 6_e„,„,1-#.=,„,„„,,,a `J g DateB e�. Ar 'errant`o.: M 4 13125 SW Hall Blvd.,Tigard,OR 97 1 Plan Review Phone: 503.718.2439 Fax: 503.598111 1 Date/B : Other Permit 2017 4.40.0/114 1 i G A r 1 1 Inspection Line: 503.639.4175Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov Cl Y OF ;iiD Notified/Method: supplemental Informa tion ,4-4 '`e's , R PPOSIGIN '* - : -` - z.c ,,z -i ; yfi . ga ,- PE O .. .. - 44 4. REQS 2Y 4 Permit fees*are based on the value of the work performed. 0 New construction 0 Demolition Indicate the value(rounded to the nearest dollar)of all ba Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the ' , t � J) *t � � work indicated on this application.cation. ij• Valuation: $ LI-and 2-familydwelling ❑Commercial/industral ❑Accessory building 0 Multi-family Number of bedrooms: .6 ❑Master builder 0 Other: Number of bathrooms: . j 41.1;•:-..f7''''' gO !; ` A' ' t Total number of floors: i;;;,,,„1.;,,,-, ,,i-7 ,,- -----7'.'4-7:-7- "14'1'',';''':: � :t o,, 4r 1, ��.. . ,_ _M. .� . 4 . ,ar> Job site address: t r 8(,,c Sw Fde.:,N)e� s. ker- New dwelling area: C) square feet City/State/ZIP: "''fl GgD/ b p 11 7:7-3 Garage/caiport area: I square feet Suite/bldg./apt.no.: Project name: S Nva (j,4602... Covered porch area: square feet Cross street/directions to job site: le..4 itja..(cij t i SSW 4- ‘Zk ST Deck area: square feet Other structure area: square feet 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 «, n- .- .-4,•,,,,;•4:7,,,--1,.^-,r1;7.:x �� ; . ; � 0, work indicated on this application. 1 1�`raikt oR � 03 (,0(..4_0»6A iS3 r Valuation: $ Existing building area: square feet _ New building area: square feet --: ,,,,t,';'4;.; _..�,••: .� , . .0 Number of stories: Name: 5 FthW1.1 (3 A ��R., Type of construction: Address: k i$c,,s- c1/40, E NAL_ S'r T Occupancy groups: City/State/ZIP: -r'' D / 0 2 u 3 Existing: Phone:(Sy( ) 2S t- 09(o Fax:( ) g rx New: Business name: _ N Y f =rer _ . A S C 1 S Structural plan review fee(or deposit): Contact name: 51">E V e. S FLS plan review fee(if applicable): Address: IkstAs Std .„,c1f.Jisr-4_ 5-1.4. ,r- Total fees due upon application: City/State/ZIP: GAkz41 O a. 972.23 /5�'4S Phone: Amount received: 4/ �r03) z� 5s- - 2 I Fax::( ) — PHOTOVOLTAIC SOLA I-rAN4-,sYS i t M FEES*` E-mail: *.gab 2$CL.)-‘^o4-iM�‘r I . Go M w Commercial and residential prescriptive installation of CONTRACTOR _ roof-top mounted Photo Voltaic Solar Panel System. Business name: s.` E-' r6 tZ Submit o(2)sets of roof plan with connection details / and fire dep.� ent access,along with the 2010 egon Address: SAM€ q,S pteos Solar Installation -: ialty Code cher City/State/ZIP: Permit Fee(inclu� view $180.00 and ..- strativ- - s : Phone:( ) Fax:( ) Stat-.:.r arge(12%of permit fee): $21.60 CCB lic.: Ori 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: r>'(-AwY1 8A-K- 4 .. Date: *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPemritApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) - Electrical Permit Application FoR OF I11( 1. FSI. 0y1.1 City of Tigard 4,11'F'' 1 t"� t"1 1" Received z IMEMillingli • 13125 SW Hall Blvd.,Tigard,OR , 3 Date/B : �� 0 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/B Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Juris: H See Page 2 for I !CARD Internet: www.ti and-or. ov t ? i g g � Notified/Method: Supplemental Information TYPE OF, RRi5 f; )'I s A 1<1 PLAN REVIEW 0 New construction Addition/4ltAl�troiif epliaCt�,ritefii''2 Please check all that apply(submit 2 sets of plans w/items checked): 1 1)1' r t 1 1 ;' 0 Service or feeder 400 amps or more 0 Building over three stories. EJ 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. FA 1-and 2-family dwelling D Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. Multi-family 0 Master builder 0 Other: 0 Fireum P P• 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived � t.J ❑Addition of new motor load of system. Job#: Job site address: ,rj S t,i 0 L�Z 5 100HP or more. ❑"A","E","I-2","I-3", City/State/ZIP: -t"fj � � .�Z Z3 ❑Six or more residential units. occupancy. / 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: s $A.V„C(� 0 Hazardous locations. 0 Supply voltage for more than mss• ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE 6360'(,4Sk,.) 1150' Sy Description I Qtv. I Each I Total � �� Z, 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'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 1,011.64(1 oo V--C.-t D 1)Et- "Vali I r4tL,.3bE 'A`ilk 0 . Limited energy,multi-family 75.00 2 residential(with above sq.ft.) gi PROPERTY OWNER ❑,TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: S koly ill Q A te. 200 amps or less leo. 100.70 2 Address: ‘k 564,,,5" csrJLV� C � 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: -n 6�41,„ / ©,,, c)1 2:v3. 601 amps to 1,000 amps 301.04 2 Phone:(S..(( ) 2 g(- 3©q(d Fax:( ) Over 1,000 amps or volts 552.26 2 Email: t' Temporary services or feeders installation,alteration,and/or 6..- 2.6 € 04 M Ql 1. form 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,r t or exc ane,a ording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 / Owner signature: A Date: 401 amps to 599 amps 168.54 2 no • 'LICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: S C.--lt above service or feeder fee, 14! each branch circuit f fl 7.42 2 Contact name: 5 U 54Y-4.-(-42. 13.Fee for branch circuits without Address: Q service or feeder fee,first 1 i (2 5'.1 at P.- S branch circuit 56.18 2 City/State/ZIP: Each add'l branch circuit 7.42 2 ( 2� / c 97213 Miscellaneous(service or feeder not included) Phone:(57.J() 281.- 3,q Fax: :( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder r Z� ( �,,t,m c1/4 t `. (9.!'^ Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: C-L.1'/�Q t...14 61?.....61?..... Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy SA`k t�S 151- Of L 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(I 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 'A hr min) 90.00/hr Suprv.Lic.: I Y ( Su rv.Electrician si ELECTRICAL PERMIT FEES p gnature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): } State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: 5 . 0 (A 4s..(` Date: 2:7 F Z' °�i--7daysafter it has been accepted as complete. t l * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(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 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: 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('/hr min) COMMERCIAL'WORK ONLY: ELECTRICAL'PERMITeron FEES °' Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Fl Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC III Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* El M• edical In N• urse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Budding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 'Mechanical Permit Appli .' ) FOR OFFICE I. ONE) City of Tigard Received Date/By: Permit No.: / _c_..)0)O I' , a . 13125 SW Hall Blvd.,Tigard,OR 97223_; i. Plan Review V I Phone: 503.718.2439 Fax: 503.598;1160` Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Iur s: ® See Page 2 for Internet: www.tigard-or.gov d, • A Notified/Method: Supplemental Information WORK`. TYP COMMERCIAL FEE* SCHEDULE -USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction El Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* C 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building Forspecial information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION ANI)LOCATION Heating/cooling: Air conditioning 46.75 Job site address: i i.g(c,5 S't,. c0 4 5-rize l Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: Furnace 100,000+BTU(ducts/vents) ducts/vents) 54.91 � ©� 91-7-1-3 Heat pump 61.06 Suite/bldg./apt.no.: I Project name: Si^Ain1sJ V/j(Z Duct work 23.32 Cross street/directions to job site: .3 6'rl�3R� `r 5 A-.. 12 i ST Hydronic hot water system 23.32 9 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: Other: 23.32 Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 4 23.32 2 s,' DESCRIPTION OF V4'ORK Gas fireplace/insert I . 33.39 3'3.(.4 Flue vent for water heater or gas M Cf \Q(Z C41/1P Q K i fJ CL.'J XRV+ fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 1 23.32 23,31. Chimney/liner/flue/vent 23.32 SilthOlier 151 PROPERTY OWNE Other: 23.321. R TENANT;• Environmental exhaust and ventilation: Name: CJkv.ir 4 13A KAP Range hood/other kitchen Address: equipment 2 33.39 (:(0..7$ % 8(o5 S't (--0001 ST(�Z-eor Clothes dryer exhaust Z. 33.39 64.-7Y5 City/State/ZIP: ,Ti 9 ©2 /27-3 Single-duct exhaust(bathrooms, / toilet compartments,utility rooms) `Z... 23.32 1{4.61 Phone:(541) 7._42)‘ - 3 at/(p Fax:( ) Attic/crawlspace fans 23.32 5 APPLICANT ❑ CONTACT PERSON ' Other: 23.32 Fuel piping: Business name: 5 e(-ir $14.15 for first four;$4.03 for each additional Contact name: S 40 (SA K Furnace,etc. heat Address: i( r4 tJSI-'42.6-6rg. S, I Gas ump Wall//suscusp penddee d/unit heater City/State/ZIP: --n GnoWei) I Og... 3 91y Water heater 1 14 ,5 i1 s Phone:(5t () Z'.1 A 30 91 Fax::( ) Fireplace E-mail: + �P , y Range 1. • Sqb-. 2'$ o� w1 CAA 1 �9�`^ Barbecue CONTRACTOR Clothes dryer(gas) Business name: SL4j /0 WrJ Other: MECHANICAL PERMIT FEES* Address: S Ar#A t. A-$ A 6•X 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.: rN f A TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 it e. Authorized signature: * Fee methodologydays after set by Tri-Counhasbeenty Buildingacceptedas IndustrycompletService Board ,,,,........41X______ Print name: C3A �(� Date: 77 r\-7-13 • -i I:Building\Permits\MEC_PemtitApp_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 Plumbing Permit Appji`ci, Building Fixtures :,- FOR OFFICE USE O Lv Cl of Tigard Received 'J gan4PermitNo.: IN w 13125 SW Hall Blvd.,Tigard,Qk'97223 Date By: in S� z�l -1,304_ Plan Review Phone: 503.718.2439 Fax: 503 598.1960 ., Date/By: Other Permit No.: Inspection Line: 503.639.4173 TI G A R D Internet: www.ti and-or. ov' Date Ready/By: Juris: Supplemental See Page 2 for g g 4{ z Notified/Method: Information TYP �I& ).Z`L_;''.'. FEt+;"'"lSCHEDULE For special information use checklist 0 New construction ❑Demolition Description I Qty. Ea. Total .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-famil y dwellin SFR(2)bath 437.78 g ❑Commercial/indusMal _ 0 Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: Catch basin or area drain 18.76 Fj�S0 "`I��� 5� �' Drywell,leach line,or trench drain 18.76 City/State/ZIP: .716447 Oz. 9122 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: S 1f4t i ) aAKEQL Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 66-rcutl;E-1.3 50 1 15.E A-141 Sc,-ii V2-1 s,vr Rain drain connector 18.76 unitary sewer(no.linear ft.: t Page 2 t. Storm sewer(no.linear ft.: ) Page 2 Subdivision: Lot no.: Water service(no.linear ft.: ) Page 2 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF'WORK Backwater valve 12.51 Clothes washer Z. 25.02 it4`RLI Clit, rlk.Lcivteso1L Tz i i CWT* iaR O. Dishwasher 'Z 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 i! PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: 5 13�1t. Z Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 1,i Aij 4,5" Std t--o la tJ;SA- 6. -rt..0 f„I- City/State/ZIP: &n AAA> 22 Garbage disposal 2 25.02 / O `� Hose bib 25.02 Phone:(55q j ) 2_bl-309(a Fax:( ) Ice maker I 12.51 51 APPLICANT" ' 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: $ G Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: S ,J R Q AZ Roof drain(commercial) 12.51 Address: t i I P s SW t•itJ 4111-6-61" Sink/basin/lavatory 9-5 1,.L 4 25.02 City/State/ZIP: -1 c) / p R t 1-2.2.3 Solar units(potable water) 62.54 Phone:(sq,) Z36,3 - 3 0(49 Fax::( ) Tub/shower/shower pan i Its I-$ Z. 12.51 t Urinal 25.02 E-mail: 5G.b_ 2sC� v.o©i-Mcxi 1` c Water closet 2, 25.02 CONTRACTOR Water heater I 37.52 Business name: st..4_r / O t,..14€-(4... Water piping/DWV 56.29 Address: CAM 6' kc AlacA/E Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: j Plumbing Lie,no.: Plan review (25%of permit fee) (...-....015( 1 State surcharge(12%of permit fee) Authorized signature: __ TOTAL PERMIT FEE Print name: $ 5� � Date: 2 7 � ,(-- 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\Pennits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-151 100' 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 (p ,5q 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 Other Inspections or Fees Qt. Fee(ea) Total each additional$100.00 or fraction thereof,to h and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations.. Quantity by Fixture Type Plan review is required for any of the following. Fixture Type forRenu Please check all that apply. Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic 0 Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 4„ 0 Isometric or riser diagram is required for new buildings -Car Wash Drain 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 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 III s , II City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT Building Permit Review — Residential TIGARD Building Permit #: H'T,9<oi-7- bd a q- Site Address: Ile& ) » r ...Sire' �� ,2 U Lot #: Project Name: � (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review , Proposal: 6640- c���._ ' -) �.�.�... c �G /hrn 4..) -e--)c-i::. Verify site addrek suite#exists activ in permit system. Attached Iver Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Si Plan Elements: ree(3)copies of site plan Existing structures on site I4 Site plan must be on 8-1/2"x 11"or 11 x 17"paper ❑Footprint of new structure(including decks)with finished IP awn to scale(standard architect or engineer scale) floor elevations Pi I �,'ty locations(required for new,may apply for additions) II orth arrow l 0_ 1, ation of wells/septic systems ite address,project or subdivision name and lot number , �� stirs trees to be retained with drip line,and tree JXpplicant information(name and phone number) g 4r�,( measures Lot dimensions and building setback dimensions `•protection eet tree type and location <1 I,,t area,building coverage area,percentage of coverage and 13size, impervious area(applicable if R-7,R-12,R-25&R-40) VA Street names Opperty comer elevations(2 foot contour lines if more than foot differential) ❑ Clean Water ervices—Service Provider Letter (lot platted prior tRoceived/1995): ❑ Yes No Required: [ J Yes,applicant was notified ❑ No gePublic Facilities Improvement(PFI)Permit: equired: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake iR VrkL and Use Case#: ("L'k- < onin : rivir Garage g P Rear �--� Side _ Street Side O A- _ Required Setbacks: Front (J �ti7 e� la 4.andscape Requirement: 0/0 IP,.°, of Coverage Maximum: % / �, Building Height: Maximum Height Actual Height w ''isual Clearance \I i asements I1., ensitive Lands: ❑ Yes i No Type •J' Urban Forestry Plan OKonditions"Met"prior to issuance of building permit Notes: `-____,_.�,..�- `~ Date: Q i/l//74- Revisions Approved By Planning: _ �'(after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\B1dgPermitRvw_RES_091216.docx Building Permit Submittal / Original Submittal Date: ,.,�f//17 Site Plans: #_ // Building Plans: # 3 Building Permit#: 2/Enter building permit#above. Workflow Routing: 2'Planning ( Engineering ['Permit Coordinator .Building Workflow Sign-off: ❑- Sign-off for Planning(include notes from planning review) Route Application Documents: ca 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: 4 0_vt By Permit Technician: 0_ �'��_. Date: 17 Engineering Review !!! Slope at building pad: ZL Conditions "Met"prior to issuance of building permit Easements (encroachments)per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: El Yes No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: ,feiZ b .,� Date: 7i �-3--47 Revisions (after Building Submittal only) Reviewer Revision 1: 11=1 Approved ❑ Not Approved Date Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved, NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: DC Fees Entered: Wash Co Trans Dev Tax: ii Yes ��, /A // Tigard Trans SDC: ❑ Yes ►` N/A Parks SDC: ❑ Yes El-N/A OK to Issue Permit Approved by Permit Coordinator: a� �" Date: I:\BuildingTorms\BldgPermitRvw RES 091216.docx Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325(2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Print Name of Permit •p• ' .nt nature of Permit Applicant Date Permit#: "252—.201 7—(JaPt 7 • Address: 1)1 Vif 04- 7I? ! e • Issued by: I/ Date: )/277/7 This Copy for Permit Offices