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Permit Support Document •`Y e v t-i\t311z- Electrical Permit A licatioRECEtMt) Stilt lli fit I.I NI ti\i," City W TigardIli a AU CI 0 3 2020 Received /� w • 13I25 SW Hall Blvd.,Tigard,OR 97223 r, nate N : vtill , i Phone: 503.718.2439 Fax: 503.598.1 '(OF TIGARD plan Review �� Inspection Line: 503.639.4175 Uate/ny: Related Permit ill 1IGApall {'. �l ��� ReadyDate�ny; tarn Internet: wwtv.hgard-or.gov l�!1 I 1��.., Notified/Method' 0 P�Re2f°r ----- --- -- Supplemental lnfarmMlon _ _TYPE OF WORK ----I— PLAN REVIEW ❑New construction ^❑Addttionialtcrati niteplaccment Pic,sr cbecl aiiihat apply(submit 2 set,01 ytans„ditems c u ctedt. ❑Demolition El Other: ❑Service or feeder 4(N)amps or more ❑nudd,,, over three stories. - — --- _ where the available fault current ❑Marinas and huaryurds. JCATLCrOR1 OF CONSTRUCTION exceeds in,(NNtnmpsor lSUvMtsnr ❑flnannghuildings. ❑ I-and 2-I rniily dwelling ❑Cotntnui t l/industrial []Acccssedy hutldutg ---. less to ground.or exceeds t4,tx)fr ❑Commercial-use agrieuhural ❑Multi-faintly amps for all other installations. buiMulti-faintly -I h11%Icr builder (_]OIhcr: ❑Fire pump. ID Installation of lSU KVA or J()R SITE INFORMATION AND LOCATION ❑Ifltergency system. larger separately derived ,�--^ c. )'r—""- ❑Addition of new motor load of system. Job 4: loh sttc adtitc%s. ( �4' ..S t.c ItxlHP or ore. ❑"A","t ^62".'1-3, City/State/ZIP: �� ❑Six or more residential units. occupancy. __ _ El Health-cure facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Lroject name: `� ❑hazardous locations 0 Supply voltage for more than 0 Service or feeder b(N)amps or more fNNI volts nominal. Cross street/directions to jobsite: FEE SCHEDULE_____-- Description ___I_t&_1_e,o, I Total • New residential single-or multi-family dwelling unit. Subdivision: Lot tt: Includes attached garage. ..-— 1.000 sq.0.or less 166.54 4 Tax map:parcel 4: Fa.add'I 500 sq.0.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 I -- r -if i 'y t k.- 't with above.•.0. _ __ ' ,'f __ _ ` f . .71- Limited energy,multi-family 75.00 residential(with above sq.ft) Renewable Energ• 0 See Pa:e 2 ■� 0 PROPERTY OWNER 1 ❑ TENANT Services or feeders installation alteration,and/or relocation t^ 200 amps or less 100.70 2 Name: r/ '( a J. o C.)At r. 201 amps to 400 amps 133.56 2 1\ Address: Iy� +° ft% - ) 401 amps to 600 amps 200.34 2 City'State/ZIP:_ I t r ir-` v,,. Off,. J Cr ! 601 amps to 1,000 amps 301.04 2 41. Over 1,000 amps or volts 552.26 2 Phone:(�{ ) "" " Fax:( ) Temporary services or feeders installation,alteration,and/or ,t '�/a(f'�OD , 0.rJ`y"'Y'3 relocation Email: P)I .1 x ,� 7 59.36 1 Owner installation:This installation is being made on property that I own which is not 200 amps or less intended for sale,lease eat,or exchange,ac ording to ORS 447,449,670,and 701. 201 amps to 400 r�` b5.08 \2 2 leas;lent, ,t .t p5 Owner signature: _.... /fo i Branch circuits—new,alteration,or extension,ter panel 0 APPEIC/NT I ❑ CONTACT PERSON A.Fee for branch circuits with r above service or feeder fee, 7.42 2 Business name: f y0et\O 0 cT a b 0V r _---------- each branch circuit B.Fee for branch circuits without pp Contact name: i service or feeder fee,first 56.18 'j(j,(tS 2 —" branch circuit 2 Address: Each add'1 branch circuit 7.42 City/State/ZIP: Miscellaneous service or feeder Phone:( ) notincluded) Each manufactured or modular Fax::( ) dwellin•,service and/or feeder =�� Reconnect only 113 Email: 67.84las CONTRACTOR Pump or irr gallon circle - Sign or outline lighting 67.84 Signal circuit(s)or limited-energy ❑ See Page 2 111 Business name:name: .and,alteration,or extension. Address:City/State/ZIP: EachAdditiona additionallinsp ins,eehrdomin nover) all ble66.2 in 5!anhrEllifilill of�the above ■ ect® 90.00/hr _ Fax:( ) IIME=SIMINININIEUMNIIMIS Phone:( ) . 'hr - ^_____- Inspections for which no fee isIII 90 00 Email: s eciflcall listed t"hr min) Electrical Lic.: Suprv.Lie.: Subtotal: �. I CCB Lic.: arm CI Plan Review Required(25°/a of permit fee): IIM Suprv.Electrician signature,required: Date: State surcharge(12°l0 of permit fee): Print name: TOTAL PBRMIT Fit:: r' This permit application expires if a permit is not obtained within 1B0 days after it has been accepted as complete. Authorized signature: Date * permit Number of inspections allowed per pe Print name: aao-a615r(nrosrcoMiwen lanuilding\Permits\ELC_PermitApp_ELR ERE.doc Rev Mil 7/2015 .. .. . . , Plumbing Permit Application Building Fixturel:KfervitA .-fc (>f, ( oct FOR OFFICE USE ONLY to 4,?„„Xilf21,121-xl 11$4 City of Tigard pLA 3,0 irtdoM)$ Received Permit No.:if0/4/17A)/(1.... .itrckti 0 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By 4 ,.0 h... ) Plan Review ll Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No,: Date/By. Inspection Line: 503.639.4175 ricLARD Date Ready/By Adis: 61 See Page 2 for Internet: www.tigard-orgov Notified/Method So lemental Information ,',,,,.,,,“. ",''',,'!,t7..TIRIt. '''' ''''..'q',,'''. .'`','41-.'-',,°7,II.,„1 , •-:•---,all19:41441li'' Et New construction [2]Demolition For s cial in ormation use checklist. Description - Ea".--1 Total XAddition/alteration/replacement CI Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) SFR(1)bath 312.70 _ _........_.....,__ ...._ I-and 2-family dwelling 0 Commerciallindustrial SFR(2)bath 437.78 SFR(3)bath 500.32 Li Accessory building El Multi-family Each additional bath/kitchen 25.02 Li Master builder Li Other: Fire sprinkler( sq.ft.) Page 2 , • .•- -,-- ,' -)Q$ SITE:,IN,FORMATION',ANP1,0,026.110N - '-.,'.,":"'"•-•'"' - Site utilities: Job site address: P101;(5 , SIX f-Ai t ti)--ru, Catch basin or area drain i 8.76 _________ - • Drywell,leach line,or trench drain 18.76 City/State/ 'I ZIP: i . r--0 9 r, ,P)- Footing drain(no.linear ft.: ) Page 2 Suite/bldg./ant no,: 4.- Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 .p..._ kbei--rcr-__./--1 L-7-7--E72-- (A) 0 12-pcsi-tch---i- Rain Man connector i 18.76 At---0--hr Pe:---)2- 1;11_4-7•1 0 I.-.. 1 i 0/1/2-b Sanitary sewer(no.linear ft.: __„) Page 2 Storm sewer(no linear ft.: ) Page 2 r.I0 k-E: rowsc Water service(no.linear ft.: ) Page 2 Subdivision: FLO.no.: Fixture or itenr Tax map/parcel no.: i I i elt,4400 300 Backflow presenter 31.27 - :• - : : : ': ',-g-rc,„-,:----::.na t -7-7----, - ---1"--------7- Backwater valve 12.51 ','''';''''::1'''''s,rt--:'',•:;:,:(;:%!ji; :;•16,. W01140141'OF::-.WORK -'- -'.''' --,• - :-- 25.02 e_x ty7riv.7,7 fr-rrvl,7.la4 424:9‘,1/47-C-a?..gDishwasher 25.02 .. -'4;c'f-- C-'(l-C*T24:71-el. ItiViifiVi-e77.-, ,/X--41-12-. Drinking fountain 25.02 - .,b e C. 20/1--- 00696 S 47,1) Ejectors/sump ----------"----- ___..............._..............................._............_________ ii4opEo .aiivisviit-r; .,,', 0 IFNI:NT' ' Expansion tank 12 51 , Fixture/sewer cap 25.02 Name: : -rari., /..)4t1}vni.z,,.,/ Floor drain/floor sink/hub 25.02 Address: /11-10 --5- Sti,,k) 14,1.1 B IA Garbage disposal 25 02 City/State/ZIP: -21:71:4-kvn-ht OK ciln-cl Hose bib 25.02 _. Phone:er,,, ) _q-...:9 ,, Fax:( ) Ice maker 12 51 :31,5Liiki, EletitiiAtt PERSON '::. Interceptor/grease trap 25.02 Business name: , Medical gas(value:S ) Page 2 Pruner 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: ''b'-''AI'- :I14t:„:II:':)-1°• :6-,, ' ,,COrall ACTOR Water elr'ser 25,02 -- - - ',' Water heater 37.52 Business name: ft)J,19.,/"----- Water piping/DWV 56.29 _Address:111011",,5-- S tdj lid I .E.Lily:, Other: 25.02 City/State/ZIP:"-Thaex,,,---44 OK 1'7 i Subtotal .4te ca, Phone:P7.17 4 ) ,r. ..4 ''' -s - 6... 0i-i, Fax:( ) Minimum permit fee: $72 50 7) Plan review (25%of permit fee) CCB Lie.: c-t9....6, Plumbing Lie.no.: , State surcharge(12%of permit fee) Authorized signature: , „,„„,--it .te - : TOTAL PERMIT FEE 1..4.0 Print name: IZa,;1....f. L.44,1 i iNere''' Date:effW. :;,, t.;C,) This permit application expires If a permit is not obtained within 180 ttyi after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board I\iitulding,,Pernois111,MUTormOApp don I0/01/09 440-45 I6T(101072CONIAVEB) C ,2e),//9- d 0 d().2 Ck-1/6/12,4, /:::5 t-r Pi c711-17 0 r. 6FY2-/ j 0 /)2-17 2 0/ 0 / Li City of Tigard RECEIVED Re E^ 121 it 120 Datyy:d !Q71J 4. Permit No�lLi/ je Li,-I--©a � J 13125 SW Hall Blvd.,Tigard,OR 97223 s �FC 0 n ry0go Plan Review Phone: 503.718.2439 Fax: SU3.598.1967 L L Date/By: Other Permit Nog'00 G,24i 2 n..C/i el 7 I t�A R U Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD _ Notified/Method: Tier _ Supplemental Information TYPE OF WORgUILDING DIVISION FEE* SCHEDULE ❑New construction 0 Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑Addition/alteration/replacement 0 Other: City sewer hookup New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 IX I-and 2-family dwelling 0 CommerciaUindustrial SFR(2)bath 437.78 ❑Accessory buildingSFR(3)bath 500.32 0Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 15160 SW 81 St Ave Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Tigard, OR 97224 g Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I 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 Lotno.: Fixture or item: Tax map/parcel no.: 2S 1 12CB Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Connect the Existing House to the city Sewer and Dishwasher 25.02 abandon/remove the existing tank and drain field Drinking fountain 25.02 s(i' rrii'nr41,,-, ,,,-rt, k .�/3 an' Ejectors/sump 25.02 N PROPERTY OWNER 0 TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: Mark Vukanovich - Floor drain/floor sink/hub 25.02 Address: 4931 SW 76th Ave., #360 Garbage disposal 25.02 City/State/ZIP: Portland, OR 97225 Hose bib 25.02 Phone:(541)350-1060 Fax:( ) Ice maker 12.51 Rj APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Big-Vuk LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Mark Vukanovich Roof drain(commercial) 12.51 Address: 9790 SW Nimbus Ave Sink/basin/lavatory 25.02 City/State/ZIP: Beaverton, OR 97008 Solar units(potable water) 62.54 Phone:(541 )720-3734 Fax::( ) Tub/shower/shower pan 12.51 E-mail: MO Yr l S`� k S- c CO 'q`cI "E ''L'\ Urinal 25.02 - C . ) Water closet 25.02 CONTRACTOR ,a _ Water heater 37.52 Business name: (visor\ (3rus. ex(radC r. � ,1-Vt� Waterpiping/DWV 56.29 Address: L1 515 1v „ij 5,1 o t,t.`ef.,4 ur, Other: 25.02 City/State/ZIP: PCri-km,.,6 t QR. c izzci Subtotal tz, Si Minimum permit fee: $72.50 '72 S e) Phone:(S-oi) 5-3i- 052.1 Fax:(563) (r.`b-... kisg( CCB Lic.: tx,9 ,c05 Plumbing Lic.no.:3 t},LI s 7 1)13 Plan review (25%of permit fee) State surcharge(12%of permit fee) g',-it Authorized signature: .4.,e.._ ... ..- TOTAL PERMIT FEE J ,,2,0 This permit application expires if a permit is not obtained within 180 days Print name: �' �,S y t` Date: f L/5 r 2G?.� after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. r "� I'.\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) '+ Sk)1L `5;k:7S o`7v 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- I'' 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 $I.00 to$5,000.00 Minimum tee$72.50 Storm&Rain Drain-each additional 1 00- 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 Qty. 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 rex icyv is required for an) oldie. Follow ing. 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. ElCuspidor/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 ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: 1:ABuilding\Permits\PLMF PermitApp.doc 08/04/2011 2