Permit (2) CITY OF TIGARD BUILDING PERMIT
= COMMUNITY DEVELOPMENT Permit#: MST2007-00042
Date Issued: 4/5/2007
T I CI A 0:T7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S111CA13700
Jurisdiction: TIG
Site address: 9685 SW SATTLER ST i
Project: FURLOTT Subdivision: Lot:
1
Project Description: 935 sq ft addition.4/3/08 added(12)additional branch circuits,(2)A/C's,(1)gas water heater,(3)bath fans and(1) '
air handler. 11/02/20 Reinstate permit for final inspection.
Contractor: Owner: ROD FURLOTT
9685 SW SATTLER ST
TIGARD, OR 97224
PHONE:
PHONE: 503-624-9439
FAX:
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: ADD Type of Const: 5N [BUPPLN]Pln Rv Deposit 02/22/2007 $250.00
Occupancy Grp: R3 Occupancy Load: [CDCPLN]CDC Pln Rev 04/05/2007 $45.00
Dwelling Units: 1 [LRPF] LR Planning Surcharge 04/05/2007 $6.00
[BUPPLN]Pln Rv Balance 04/05/2007 $198.24
Stories: 1 Height;. i ft [BUILD]Bldg Permit 04/05/2007 $689.60
Bedrooms: Bathrooms: [TAX] Build 8%State Surchrg 04/05/2007 $55.17
Value: $89,140 [MECH]MEC Permit 04/05/2007 $72.50
[TAX] MEC 8%State Surcharge 04/05/2007 $5.80
[PLUMB]PLM Permit 04/05/2007 $164.85
Floor Areas: [TAX]PLM 8%State Surcharge 04/05/2007 $13.20
Total Area: [ELPRMT]ELC Permit 04/05/2007 $66.80
Accessory Struct: [TAX]ELC 8%State Surcharge 04/05/2007 $5.34
Basement: [ERPRMT]Erosion Control 04/05/2007 $40.00
Carport: [ERPLN]Erosn Pln Rv CWS 04/05/2007 $13.00
Covered Porch: [EROSN]Erosn Pln Rv COT 04/05/2007 $13.00
Deck: [MECH]Addl MEC Permit 04/03/2008 $4.90
[TAX]MEC 12%State Surcharge 04/03/2008 $0.59
Garage: [ELPRMT]Addl ELC Permit 04/03/2008 $79.80
Mezzanine: [TAX]ELC 12%State Surcharge 04/03/2008 $9.58
Total $2,136.57
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 ygito 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. Yo/rney}obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1,800,332.2344.
Issued By: 'A'J�'' Permittee Signature: Al /PM///61
,0j
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.
-11
Building Permit Application B
Residential a EC E V 1 FOR OFFICE 1 s1:OA LF
City of Tigard 2 Received
OCT3 2021 nate•
Permit No
13125 SW Hall Blvd.,Tigard,OR 97223
ii
iiiill
' ■ Phone: 503.7182439 Fax: 503.598.1960 r, Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF fIGA^fit- - • June H See Page 2for
Internet: www.tigard-orgov BUILDING DIVISi:al. Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees'are based on the value of the work performed.
Addiaon/alte ration/replac�ent El Other: Indicate value(rounded to the nearest dollar)of all
Eitequipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
l-and 2-family dwelling 0 Commercial/industrialValuation: _
❑Accessory but?ding ❑Mrlti-family Number of bedrooms: 3
['Master builder 0 Other. Number of bathrooms: ri'
JOB SITE INFORMATION AND LOCATION Total number of floors,:
lob site address: ✓ ( 64 6} .z J-i{ New dwelling area: 9 3 s square feet
—�City/State/ZIP: t 5'Q�' 04. ei n a t Garage/carport area: square feet
� 1
Suite/bldgJapL no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
1_4-A4 1%L s/ej/ c/4 f 4'(-/ — 1W Q eel Cite `l q le Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:-DA..Q_vv'vG t Lot no.: `t')_ Permit fees*are based on the value of the work performed.
Tax map/parcel no.: S 4 l 4 C.,�} _ 13 a(? 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.
Valuation: S
6:-';#3 ,I S`I-1=Yk� . Z- -Gina'
( 'Inspector-)
e. e -{t tea-) Existing building area square feet
1 '' '1� -t-� ` New building area: square feet
'PROPERTY OWNER 0 TENANT Number of stories:
Name: tR od,„ e G 4f-z-tbexin kve214;i—lr Type of construction:
Address: (p£1 SFl-++( >t Si... Occupancy groups:
City/State/ZIP:-1-- rr ii L(el i - -'i Existing:
Phone: )3)MO-9 o)-g IP Fax:( ) New.
aAPPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedw(e)
, Structural plan review fee(or deposit):
Contact name: i(4,e-Y� CIS C(Jvt;LTC,
Address: FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP:
Phone:( 3) c g 0-il a. D o Fax::( )
Amount received:
E-mail: a.CA-LAA�- -} COev\ a-E-t y\�- PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: f' , yk't 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.
CityfState/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB ltc.. Total fee due
n 7 upon application: 5201.60
Authorized signature: f 2s... , / _ _ nT Tins permit application aspires Ka permit is not obtained
rrr ���///T_ 77//"�' within 180 days after it has been accepted as complete.
odr�e� C �. Date: •Fee methodology set by Tri-County Building Industry
Print name:
.� l 4 /OM et-) Service Board.
I:1BuildinglPennits\BUP-RESPermitApp.doc 02/24/2011 440 4613T(I I/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling Fos o1TIt 1_ I Sl_ (pl.)
City of Tigard Received
Date/B Permit No.:
13125 S W Hall Blvd,Tigard,OR 97223 Associated
IIPhone: 503.7182439 Fax: 503.598.1960permits.
TIGARD 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gnv 0 Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ' "„ s-S.
I Land use actions completed. See jurisdiction criteria for concurrent reviews. 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
4 Fire district approval required. Name of district 0 ❑ 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0
6 Sewer permit. _ 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
9 Erosion control 0 plan ❑permit requited. 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 ❑
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 ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ El ❑
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
floor,wall construction,roof construction. More than one cross section may bc 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- D 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
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
2I Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ 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 El 0
architect licensed in Ore on and shall be shown to be licable to theproject under review.
23 Three(3)site plans are required for Item I I above. Site plans must be 8-1/2"x 11"or 11"x 1T'. ❑ ❑ —
24 Two 2 sets each are ❑ ❑ o
( ) required for hems 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 ❑
27 "Drawn to scale"indicates standard architect or engineer scale. 0 ❑ 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard El ❑ 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 theproject 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\Pennits\8UP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application RECEIV
City of Tigard natem Permit No.:
; .- 13125 SW Hall Blvd.,Tigard,OR 97223 0 C T 2 6 2020 Plan Renew Other Permit:
■ Phone: 503.718.2439. Fax: 503.598.1960 Daterey:
Inspection Line: 503.639.4175 pate Ready/By: Juts H See Page 2 for
c n i r' �" CITY OF TIGARD Notified/Method:!roamer wWW.tlgSld-Of.gOY Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction ;la-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*
•gli 1-and 2-family dwelling ❑Conunercial/industrial ❑Accessory building For special Information toe chezldkt
❑Multi-Gamily ❑Master builder ❑Other:
Description I Qty. I Ea. Total
Hcatiug/cooliag:
JOB SITE INFORMATION AND LOCATION Air conditioning 46.75
Job site address: o b&S ) sf-t*-Cf5 . Furnace 100,000 BTU(duetstvems) 46.75
City/State/ZIP: —T.t ir( ra..61 7�‘4 F»mace 100,000+BTU(duastvents) 54.91
61.06
Heat pump
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
14 ry-1 1 fill Wrt/ -t+k," —hb fi,.)CGn c i(o 4A-C'l g`a- h dronie Unit heaters( not electric), 23.32
is-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
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
l �` �`�^"^)_ Log lighter(gas) 23.32
1(0 -1/l s t i' \IN 'I41�_:Co 5pe cre` Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other 23.32
PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name: 0(I,Y\t/ 4 G k z4 . .62J/0 Range hood/other kitchen
equipment 33.39
Address: CI W if-S-- 5 44-(eft...S Clothes dryer exhaust 33.39
Single-duet exhaust(bathrooms,
City/State/ZIP: - (� 7a ff toilet compartments,utility rooms) 23.32
Phone:(`jf)J2)87 f)--1. --D i. Fax:( ) AtticiCrawtspace fans 23.32
O Other 23.32
0 APPI,ICA.R*I' ❑ CONTACT PERSON Fuel piping:
Business name: $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address: Wall/suspended/unit beater
City/State/LIP: Water heater
Fireplace
Phone:( ) Fax::( ) Range
E-mail: _Barbecue
CONTRACTOR Clothes dryer(gas)
Other
Business name: t"1�/I }1e� MECHANICAL PERMIT FEES*
Address: lJ " Subtotal
Minimum permit fee($90.00)
City/State/ZIP: Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)CCB lie.:
TOTAL PERMIT FEE
Thispermit application expires if a permit m net obtained within 1tl0
ej^_Jdays after it has been accepted as complete.
Authorized signature: • t=f f'� — l 4\ t Fee methodology set by Tri-Coemty Building Industry Service Board
Print name: Q—f)ft/U., (.F•SLQ.(,(Jt'1� Date: /81131du
l:.Bsildrng'Pee nil atEC PetmaApp..04011idot 4404617f(II a7VICOMlYEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
S0.00 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$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:1BuildingV'ennits1MEC_Pern1 itApp_0401 IAdoc 2
Electrical Permit Avalicatio"RECEIVE i FOR OFFI(F I .1 t 1N I ti City of Tigard ReceivedDate/BY: Permit a:
1111 13125 SW Hall Blvd.,Tigard,OR 97223 0 C T 2 6 2020 Plan Review
® Phone: 503.718.2439 Fax: 503.598.1960 Data/By: Related Permit k:
Inspection Line: 503.639.4175 Ready Date/By: rues ®See Page 2 far
TIGARD a Internet wwwtigard-orgov CITY OF TIGARD Noti0ed/Method: Supplemental Information
TYPE OF W
ttIFEILDING DIVISION PLAN REVIEW
0 New construction /$Addition/alteration/replacement Please check all that apply(submit isms of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stones.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 vohs or ❑Floating buildings.
`2 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building lass to ground,or exceeds 14,000 0 Commercial-use agriudtursl
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
['Addition of new motor load of syystetlt
Job if: Job site address: 9k,i Sv 5 A'-' 'k,5 f 100HP or more. ❑"A","E',"1-2","1-3',
City/State/ZIP: - 1 l { (/ 01'7 aa� o Six or more residential units. occupancy.
J Heahhaatre Facilities. ❑Recreational vehicle parks.
Suite/bldgiapt.#: res....
Project name: ❑Hazardous locations. ❑Supply voltage for more than
(3 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
RAAA 31 vd 15 f} ;4 Cr 1)t* 'CC-n `i(pia-4: ci'g Description
esci" I ors- 1 Each1 Tad 1 *
New residential single-or multi-family dwelling unit.
Subdivision: '-1),pj.z.,,..le i Lot#: C)l -- includes attached garage.
1,0Tax map/parcel#: as 1„ Cp- - k 3 r)e)0 En.w0 TIsq It 500or less 168.54 4
Fa.trdd'1 sq.R or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
�y p �+ Limited energy,multi-family 75.00 2
res61 R,.t,4 S I.u° r.— GSZ '' K2 i v WIS e�t Renewable
(with above sq.R.}
1�cs-yr�ROPERTY OWNER ❑ TENANT Renewable Energy El See Page 2
yrP Services or feeders installation,alteration,and/or relocation
Name: N.04A1-41 4 e i\ a 4.`t'i° c 2.1R-I-4- 200 amps or less 100.70 2
Address: 61 jogs 6,vt) 5 E}' 1 ti eta_ j-' 201 amps to400 amps 133.56 2
u 401 amps to 600 amps 20034 2
City/State/ZIP: �- a!?i 040- C r!1 a D I 601 amps to 1,000 amps 301.04 2
Phone:( �?) i 1 Fax:( ) Over 1,000 amps or volts 552 26_ 2
` Temporary services or feeders installation,alteration,anti/or
Email: (Z d It (I tpi-'1-@•('�a/Vt pPr5 I--. I le T relocation
Owner installation:This installation is being made on property that 1 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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
above service or feeder fee.
Business name: each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each addl branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: f
Sign or outline lighting 67.84 2
tJ Signal
is)or)exiension. 0 �Page2 2
Address: panel,alteration,or extension.
Each additional inspection over allowable in nay of the above
City/State/ZIP: Additional inspection(I hr rain) 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 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(Vt hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of pemnit fee):
�� Slate surcharge T(12%L Ef RMIT fee):
Authorized signature: fit TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: cfsi C. (_'t i/2,�'1-f Date: j u I,7 211) days after it has been accepted as complete.
N nailer of iusprctions allowed per permit.
1:114ildsgParreks1ELC_Pm.etApp_ELR ERHdoc Rev 06/17/2015 440-4615TO 1/05/COWWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCueDULE
Fee for all residential systems combined: $75.00 °an °° QmtY• E.ra I Total t
y Renewable electrical energy systems::
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 13356 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25 01 to 50 kva 301.04 2
50 01 to 100 kva 552.26 2
❑ 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 2S Ion
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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(h hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75A0 Subtotal(Enter on Page I)
y • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
nOther:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
KlitnldinglPermns0tlC PemlitApp_ELR ERE.dot;Res 0617/2015
Plumbing Permit Application
1VEp
Building Fixtures R Fr1R OFPI( I 1 SI. ON1.1
City of Tigard OCT Z 6 MO Received Parma No.:
;� - u 13125 SW Ilan Blvd.,Tigard,OR 97223 m�Date/By:
Phone: 503.7182439 Fax: 503.598.1 P
y OF TIGARD Plate/By. oleapennalao_'
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Dane ReadylBy. lira: ® See Page t for
Internet: www.tigard-or.gov Notified/Medrod: Sappkmeotal lnformatiaa
TYPE OF WORK FEE' SCHEDULE
0 New construction 0 Demolition For speak!information use checklist
Description I Qty. I En. I Total
addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
SFR(2)bath 437.78
-and 2-family dwelling Commercial/industrialSFR 3
( )bath 500.32
0 Accessory building 0 Multi-family Each additional bathilcitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
b 15�� f t Catch basin or area drain 18.76
Job site address: )A t1 (e si_ �1
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -Iry Q ,tf t2/� q 9.--.)-4 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: J I Project Creme: Ct 3s' sm (-4. Q Xit 1-7 Manufactloed home utilities 50.03
Cross street/directionsLtoijob site: .T y rJr� Manholes 18.76
F'r.0.1 V`uti 4 5 r L „,.. r h . ,I', 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: --opiCLNI-Ne.k I Lot no.: 01 Fixture or item:
Tax map/parcel no.: �S 11\ c+4 - 131100 Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK 25
gCkKhes washer,'"'`� Scn t-d- �,{-1v, Dishwasher25.02
_ � _ • i r 11�C' (r t ff'^+ Drinking fountain 25.02
••�C��� `1 _ Ejectors/sump 25.02
'®`PROPERTY OWNER I 0 TENANT Expansion lank 12.51
Fixture/sewer cap 25.02
Name: 4-2.11Ayit y f� �za
� �'! LDI f
�}s 1 2 Floor drain/floor sink/hub 25.02
0 Address: el ✓ S i.-.) irr..(-.�`1�Z. c 1- Garbage disposal 25.02
City/State/ZIP: 'T tq-Q uc3 OIL C. 7 2 Jy Hose bib 25.02
Phone:( 3)Ves o-')a a I Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal • 25.02
E-mail:
Water closet 25.02
�/�ON CONTRACTOR Water heater 37.52
Business name: { e Water piping/DWV 56.29
Address: Other: 25.02
Ctty/Stete/ZIP: Subtotal
Phone:( )
Fax( ) Minimum permit fee. 572.50
Plan review (25%of permit fee)
CCB Lie.: Plumbing Lic.no.: Sethh (12%of permit fee)
Authorized signature: e „..Cy - TOTAL PERMIT FEE
Print name: Y
a ci {� -W2- ULv Date: !/0 II P�0 This permit application expires if a permit a not obtained within 180 days
L C' after it has been accepted as compkte.
*Fee methodology set by 7it-County Building Industry Servhx Board.
r.gauildinOevratillAMMU--PrnneAPP_doe 10/01/09 0t0.4al6l(r11/02/COM/WEIS)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1°'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-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 S5.000.00 and$152 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for S 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 S50,000.00.
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—12 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees". Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace( Please check all that apply.
Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3' Isometric or Riser Diagram
4� O Isometric or riser diagram is required for new buildings
-Car Wash Dratrt that meet the qualifications above.
Garbage -Domestic non-food q
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach/Refiig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall _
Sink: -d.av/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 Extractorfees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
UrinalOther Fixtures:
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