Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2022-00128
Date Issued: 05/23/2022
TIGARD 13125 SW Hat Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S 111 AB07700
Jurisdiction: Tigard
Site address: 9425 SW INEZ ST
Subdivision: PENROSE TERRACE Lot: 22
Project: Kling
Project Description: Interior kitchen remodel and window replacement and relocation.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms 0 Second 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third. 0 sf Right: 0 Detectors:
Total 0 sf Value: $15.000.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 0 Washing Mach, 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker 1 Hose Bib: 0 Backwater Value: 0
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K. 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
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 1
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 N
Other. N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
KLING,CONNIE B OWNER Required Items and Reports(Conditions)
9425 INEZ ST
TIGARD.OR 97224
PHONE: PHONE:
FAX:
Total Fees: $803.07
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
aco_nn1-nnin fhrni npp ac9-nnl-nnan Ynu fain a rnn„of fhc n iI nr d rcrf niioefinnc fn nl IAIr by nnllinn 601 OZ.)10a7 nn'110 91dd
Issued By: - `Xe-✓U- Permittee Signature:
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 pro
Approved plans are required on the job site at the time of each inspection.
•
l3uildin2 Permit Application RECEIVED
Residential MAY _ 9 2022 FOR OFFICE USE ONLY
CIt Of Z 1 $I(� i _ 4�
13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGA b Rece Dam/Bved: 'i j sip — i
�4l)ILDING DIViS101 Plan Review `DI / Other Permit:
Phone: 503.718.2439 Fax: 503.595.19 Dam/B : r Auli
7-l I. R t> Inspection Line: 503.639.4175 Date Ready/By: Suns: 0See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYI F W REQC R' t;t AATA,I-AND 2.FAMILY DWELLING
❑New construction ❑Demolition Pennit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
f$Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF'CONSTRUCTION
work indicated on this application.
I-and 2-family dwelling ❑Commercial/industrial Valuation: $ trj t Odd
Number of bedrooms: ,B-
❑Accessory building ❑Multi-family
❑Master builder ❑Other: Number of bathrooms:
Total number of floors:
JOB!St'�l� t�#I��'I�r.N OR�;rCAT101+l 1_
Job site address: c t/ ,S 51rS ((��• Sr New dwelling area: ,Br- square feet
City'State/ZIP: T\(o/t•IZtp (JI2-.. C{--) 2-2-Ifr Garage/carport area: e- square feet
` \ Suite/bldg./apt.no.: Project name: �L i 0 6. t_{TC-(#„J Covered porch area: square feet
Cross street/directions to job site: .5t,,,) C(3 A`,,IE Deck area: 4;>-- square feet
j] / Other structure area: square feet
fir- --A >REQIJIREI DATA:Ctk11fi11IICTA = ) ,'��,. ki5
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
t P'H N g, work indicated on this application.
Valuation: $
1 N rc e-(D E-- r-(Zee-eNs Rt''- GL
w I Math VJ 0.40 / bow IQ S 1'G Existing building area: square feet
r4 re l4 e i 1 r ( 14sC V, �r New building area: square feet
-'• t4 PROPERTYO (ER ❑ TENANT (ok
Number of stories:
Name: C 4,N 1..1(E klA.N lei Type of construction:
Address: I I�2 S t✓.I (NG--.4" 6'r., Occupancy groups:
City/State/ZIP: ``G ,40-p GyQ- 4t12.2- . Existing:
Phone:(So3) -73if 67 So Fax:( ) New:
APPLICANT 0 CONTACT'PERSON BUILDING P�IIT FEES` .
(6.1,1 s
Business name: GFec1„_sr,, i r>C c I!!leptetwJ ecb ldnl}.
Structural plan review tee(or deposit):
Contact name: ►J M/,e FLS plan review fee(if applicable):
Address: -7-(Oo t;W E}11,4\./N(rrjh) $ 2-1
City/State/ZIP: 116, b 0g- 4-?'�-2-3 Total fees due upon application:
Phone:(563 ).. < 4 77( Fax::( ) Amount received:
E-maiI: II11✓1. e C'vre k 5:4- ,2,dee Sl n S•Cd ;FOOT VO AIC S 1 AI!PAWL SYSTEM FE1 t
t~? * Commercial and residential prescriptive installation of
O1 RAC 01., roof-top mounted PhotoVoltaic Solar Panel System.
Business name' A C S 4.,IO'f�c 1• Submit two(2)sets of roof plan with connection details
Sochand 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 pennit fee): $21.60
('CB lic.: t-4 5 q
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:
Date:�/( Date: 2 *Fee methodology set by Tri-County Building Industry
W �� -y k '4A-1
Service Board.
I:ABuildingAPermits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1I/02/COM/WEB)
. Mechanical Permit ApplicatBiECElVEL) FOR 0FF10E I SE ONl,Y,
City of Tigard MAY — 9 2022 ReceiveDate/Bed
Permit No.:
p 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 '//��`�y 66 � Other Permit I
CITY OF TIUr1f 1-b Date/By:
TIGARD Inspection Line: 503.639.4175 V `/�+ f� Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
❑New construction tg Addition/alteration/replacement
p ement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
,w, ai- ,,,,,,,CATEGORYOr CONSTRUCTION " . Value•
a '+ IRI +;TO T & EIS :'.'111
I-and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other:
Description 1 Otv I 1.d , Ioid1
Heating/cooling:
Job site address: 0 NZ-5j (d•S I, h s-(' Air conditioning 46.75
�6,1 "0 OP- 2_"2--+ Furnace 100,000 BTUT (ducts vents) 46 91
City/State/ZIP:
�� Furnace 100,000+BTU(duns/vents) 54 91
Suite/bldg./apt.no.: Project name: K-L,,.I^J es Heat pump 61 06
Duct work 23 32
Cross street/directions to job site: 5-is dl 3 A 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.:
qt q Water heater 23.32
_. A ..w u��s-J ) � t��tr=-c r1. Nxiklm,ir� Gas fireplace/insert 33.39
I RI-eV-AO 0" 14"Vic'" Free vent for water heater or gas
p 23.32
IN`:>rtArLe..- 15. .,.1"ty...0 t'1/413eAD t VEN'T C)LT Log lighter(gas) 23.32
oc , FAO UIJn 4 UO �F� Wood/pellet stove 23 32
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other:
23.32
Environmental exhaust and ventilation:
Name:
CO tJ P 11 C- ‘e---l-A p.1 b Range hood/other kitchen 1 1 1
Address: Sikt.x AS COTS' equipment I 33,39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments,utility rooms) 23.32
Attic/crawlspace fans 23.32
a ., ❑ CONTACT PERSON Other: 23.32
Business name: G r„.- -Cirs.6 ()Via 6")S Fuel piping:
Contact name: , ,fp ffr....) ri $14.15 for first four;$4.03 for each additional
rn
, . �jl Furnace,etc.
Address: woo SW .Hy /ie Ai ST 2 Gas heat pump
Tt G�4 0 61,-- e / �Z 3 Wall/suspended/unit heater
City/State/ZIP:
Water heater
Phone:(5 e2)) "f '2..y 7 Fax: :( ) Fireplace
E-mail: - eh y C 4e lee le t744 oet CI ,4I+F" CrAr✓1 Ranee
�,: � Barbecue
Clothes dryer(gas)
Business name: T 9— C,c U�tJ`r'-1 f•-t v+lc L Other: (01
Address: / MECHANICAL PERMIT FEES*' . e
�V ( ��t Subtotal
City/State/ZIP: -Cc_,--rocc, O,cv. clv2 01-1623 Minimum permit ICC($')(,OH
Phone:(5u)) /l Li 1 ")) .. Fax:( ) Plan review(25%of permit fee)
State surcharge(12n/o of permit fee)
CCB lie.: I so 321 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signatur days after it has been accepted as complete.
Pee ieih dolour ;et 6 I n-(. ini liiia;li , li.l .i, ..,.r•
Print name: V /•‘ Mk Date: S7T 1(2
I.\Building\Permits\MEC PermitApp_082520.doc 440-46 (II/02/COM/WEB)
Mechanical Permit Application - City of Tigard -
Page 2 - Supplemental Information
Commercial Submittal Requirements:
• (2) sets of plans, drawn to scale.
• (2) sets of equipment cut sheets.
• (2) copies of site plan for ground and roof top equipment
location and screening per Tigard development code.
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.
$I00,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
I:ABuilding\PermitsVMEC_PermitAPP_082520.doc 2
Electrical Permit Application RECEIVED roil OFFICE I_SE ONE l'
City of Tigard MAY- 92022 Received Permit#:
n
13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGARD Date/B Plan Review" ill Related Permit#:
Phone: 503.718.2439 Date/B
Email: TigardBuildingPerinits@TigardtvDJNG DIVISION Ready Date/By: 1uris: ® See Page 2 for
T 1 L A R U Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ,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 ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
f 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: et t1 c, 5w f A�- ,�1' 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: "L-(t O ' -1 Z.y.4' El Six t more residentialunits. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: pt.(N‘:1 0 Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Sc,.....) /*3/230 14Ve FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
�/� iy^) e J (with above sq.ft.) 75.00 2
l�(7G(-(fin) 1-t-m L , AJ t W(-G"(fc/ Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
P tA�C�S .�Mt7 e i (Z C.-v 1 T
Renewable Energy 0 See Page 2
PROPERTY OWNER 0 TENANT Services or feeders installation alteration,and/or relocation
Name: CON N(E K(..( rJ 6 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: S A ill e Ac ( 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:(T,12) "?1J i 401 SU Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: may)el i e (. )co 9#11 et ji °e 044 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,lea rent,or e}t�h ge,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature:� � 2c C,
Date: Gr l/ZZ 401 amps to 599 amps 168.54 2
WAPPLICANT El CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: /� Veye S 4 tj above service or feeder fee,
(� tvr7p�i�✓T(/n.�i C"i Ai 7.42 2
each branch circuit
Contact name: U 11-1NJ 0141Ar B.Fee for branch circuits without
servAddress: T branche or feederitfee,first
�� (� GN S �Z�? I branch circuit 56.18 2
City/State/ZIP: -"("-( 6,pc.,e.0 y'-7 22_1 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(5 D 3) (q q Cj.l`f 7 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: ,e in e✓,i 4 ,�f 91-1 �t(54'j 0.f• Ce447
'/ Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: "PRO( .4 Te,u..;a'"1V.- Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 1 .q-e/ 3'-4 5t". MC- ' wM N at-2- 4 A-- panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:,y , ,s. ci►'72�4 Each additional inspection over allowable in any of the above
rod� ��► V� Additional inspection(1 hr min) 66.25/hr
Phone:(.1 (/'22) 7 6 6,j.4'1 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: O A ce g D 0./e.c_O ~, C. ‘,444LQ iC 4—, Inspections for which no fee is
CCB Lic.: //t r)e Electrical Lic.:GW`� Suprv.Lie.:6V2c— specifically listed(A hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: 54-J ,) f'�'Al/ j�(, y.,� " Date: ❑Plan Review Required(25%of permit fee):
�Qr,�TEt_- State surcharge(12%of permit fee):
Authorized signature: t abv TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per pennit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(I1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information A
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Q1). I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70
5.01 to 15 kva 133.56 2 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
n 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('/s hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
`` ' ❑ Audio and Stereo Systems
1 t
F, n Boiler Controls
n Clock Systems
04 n Data Telecommunication Installation
n Fire Alarm Installation
k.
ttvlkt n HVAC
A n Instrumentation
t
41.
n Intercom and Paging Systems
r
❑ Landscape Irrigation Control*
:
❑ Medical
n Nurse Calls
t : ❑ Outdoor Landscape Lighting*
s ❑ Protective Signaling
AV
kh:
n Other:
i-k, Total number of commercial systems:
,: *No licenses are required. Licenses are required for all
t other installations
�� I:\Bui1din5\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017
Plumbing Permit Application
RECEIVE :
Building Fixtures Ft1Iz ()Hi( 1 t si: ()NIA
MAY _ 9 2022 Received
City of Tigard Date/By: Permit No.:
4 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGAR Li Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Other Permit No.:
I �JI�.DING DIVISIG Date/By:
Inspection Line: 503.639.4175 Date Read /B Juris: ® See Page 2 for
T I G A R D Internet: www.ti and-or. ov y Yg
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
q� Description Qty. Ea. Total
'Y--'.Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
EA 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: q(/ Z£j ( i, S Catch basin or area drain 18.76
6
City/State/ZIP: -- ((t /j0 V/L Cl'7-Z2 t. FooDryting
1,leach line,or trench drain 18. 2
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: L- l-t0 Manufactured home utilities 50.03
-
Cross street/directions to job site: 5 w 01 / 2() Ate- 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
€' ^ 711 Backwater valve 12.51
'A'';', t- <;. ;:,,�\ A �`° "� 1: t' ION OF WORK
Clothes washer 25.02
1G(TG xi ixv-w.GVl9 MGA 5iiv - 'L S' Dishwasher I 25.02
C IJ ljf�` IA/Au Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER 1 0 TENANT Expansion tank 12.51
Name: N NW1 k N Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: lt'ellie. l Cam./
Garbage disposal I 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker ( 12.51
[7.APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: C ri- K-57-G A/f' jj 7�sf 4J 7
ylty/ Primer 12.51
Contact name:
c.(d ffN r�� � ( Roof drain(commercial) 12.51
Address: -706 kU "Om pro"' (-r 0431 Sink/basin/lavatory I 25.02
City/State/ZIP: 'n6041,40.0 C 2_ 47 ZZ_z' Solar units(potable water) 62.54
Phone:(57,2> ) 1'4 S L c/"'( Fax: :( ) Tub/shower/shower pan 12.51
h N & e4. S di 2/7n S_Cowl
-
/
Urinal 25.02
E-mail: v
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: T7 *6 --A - . -pW o el 14 coWater piping/DWV 56.29
Address: It 5-5 53 NGQ wf.c,-7 4 97 Other: 25.02
City/State/ZIP: 77 U i'Z 472-2-3 Subtotal
Phone:(5p?J) c f+s( /cc.3 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Z 3 2 So Plumbing Lic.no.: pa 2;ft7Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: m fGeL �yjl L4 N/: Date: 0/!9/Z This permit applicationexpires 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.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
4t
503- 9I _ z4( i'
r Plumbing Permit Application - City of Tigard t .
c Page 2 - Supplemental Information ,
t,�; Fee Schedule: Residential Fire Suppression Systems:
s Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
t� 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
s
Sewer-each additional 100' 37.52
kf� Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
s Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54
A.t $1.00 to$5,000.00 Minimum fee$72.50
;.
'4i' 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
1' E' Qty. Fee(ea) w Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
iqi, 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
:‘,1`` 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)g each additional$100.00 or fraction thereof,to
r Reinspection Fees 90.00/hr and including$50,000.00.
4r 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
+, each additional$100.00 or fraction thereof.
9 (minimum charge-1/2 hour)
Al,
iSubtotal:
4 Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
` please indicate work performed by fixture. Failure to
4.. 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/
i YP Please check all that apply.
Work Performed: Capped Added Relocate
tY` Baptistry/Font _ ❑ Any new commercial building with water service 2"and
x��`` greater,except systems designed and stamped by licensed
Wit- Bath: -Tub/Shower
'Ai' -Jacuzzi/Whirlpool engineer.
El+ y Car Wash: Each Stall New exterior plumbing site utilities for any complex structure
a Drive tall 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.
a : Drinking Fountain
4 Eye Wash Submit 2 sets of plans with any of the above.
��� Floor Drain/sink: -2"
t .' -3" Isometric or Riser Diagram
' CIIsometric or riser diagram is required for new buildings
-Car Wash Drain
'15 Garbage -Domestic non-food that meet the qualifications above.
i
' Disposal: -Domestic food related
i -Commercial food related
% .` -Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains g g
A i'_
Oil Separator(Gas Station)
`' :> Rec.Vehicle Dump Station
t't
0,1, Shower: -Gang
4 -Stall
" Sink: -Iav/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
flOther Fixtures:
Vt I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
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