Permit ,
foi CITY OF TIGARD MASTER PERMIT
i
is ' COMMUNITY DEVELOPMENT Permit#: MST2022-00162
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued:
Parcel: 2S104AA13800
Jurisdiction: Tigard
Site address: 12270 SW 128TH AVE
Subdivision: BELLWOOD NO.3 Lot: 157
Project: Sotelo
Project Description: Converting exiting shop to bedroom and bathroom.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 188 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Yes
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 188 sf Value: $24,549.04 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 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: 2
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-3 188
Owner: Contractor:
DE LOS SANTOS,MERCED SOTELO OWNER Required Items and Reports(Conditions)
DE LA O,OYUKI GARCIA
12270 SW 128TH AVE
TIGARD,OR 97223
PHONE: PHONE:
FAX:
Total Fees: $1,312.66
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 require you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oc9-nnl_nnln thrn,inh ntkp rig-nnl-nno Vn„ r htain a rnrn f tha rnla r rlirart ni iactinne fn(i INR by raninn 919 10R7 nr 1 Ann 119 91 d
Issued By: ...e.1 Permittee Signature: 2// / (2°C17
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 lob site at the time of each inspection.
Building Permit Application
Residential FOR OFFICE USE ONLY
,.. ,
City of Tigard Received dr 1
Date/By: / A.'� Permit No.: �5+ •10 c ]/;bey
„"'�
III . 13125 SW Hall Blvd.,Tigard,OR 97223' i , z2. Plan Review ! a d7\,�w�
Phone: 503.718.2439 Fax: 503.598.1960 \ f1 J Date/By: (g (aiv/ ,I ,' Other Permit:
1 1 C;1!Z I) Inspection Line: 503.639.4175 �i�AR)7 Date Ready/By: )ur s. ® See Page 2 for
Internet: www.tigard-or.gov Gk-{ �±
CY 0 [Iw1�7,Q� Notified/Method: 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.
Indicate the value(rounded to the nearest dollar)of all
1YrAddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for MI,'
���/ CATEGORY OF CONSTRUCTION work indicated on this application. Zeal cyq C`�
LJd'1-and 2-familydwellingValuation: $
❑Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms: t
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 L2_To ,.i', 1 9 v 1.k IN,.1 New dwelling area: l gt6 square feet I S
City/State/ZIP: - •34v,A D R-. -q 2 Z 3 Garage/carport area: square feet
ASuite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross stree directions to job site: U(� V Deck area: square feet
4. /Q �Wu ✓ lsep y?"c ("14,. `4,5/�.y� _ /uS-�--/ee ll.Z, Other structure area: square feet
erA.1 a i Gt V , o-ta /a/ m S/ 4 c_ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: /�/W`�r�l Lot no.: Permit fees*are based on the value of the work performed.
/" Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
1 j�DEESCRIIPTI�ON OF WORK (t ` [� p work indicated on this application.
b - Le-VYV �1)3 `'�141:."t(,' 't- ! 4VCAO 6J Gae l(:C1 Valuation: $
1\ &r Cex.��`'�, Existing building area: square feet
J New building area: square feet
[PROPERTY OWNER ❑ TENANT Number of stories:
Name: 1 Z41.-0 s i,.) 1 2 ia 4.k p V e"�., Type of construction:
Address:
'-r',Cj cilf" U R--- et� Z Z3 Occupancy groups: ,
City/State/ZIP:
Existing:
Phone:(,y 03) ?2.7 _ U 7 L}Gr Fax:( ) New:
e��
❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to r.'schedule)
e � _ a.�, ..-- —Structural
—Business name: St plan review fee(or deposit): cf 30
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fax::( )
Amount received:
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:linvile- W1$S 0 Grvvy;1 „cow Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: ;4 2 CE D M SS @, C1 14 iL,•COM Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: / Solar Installation Specialty Code checklist.
City/State/ZIP: O Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:
Total fee due upon application: $201.60
Authorized signature: 2ti"
/� This permit application expires if a permit is not obtained
,, yr'vf3 within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: t/� e..rc.,.,1 5 c it j 0 Date: (h /i 2 Service Board.
\ \I:\BuildingPermitsBUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
,w ,. — .
Building Permit Application Checklist '
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Received Permit No.:
City of Tigard Recei
Dateve
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
I Phone: 503.718.2439 Fax: 503.598.1960
❑ Electrical ❑ Plumbing ❑ Mechanical
24-Hour Inspection Line: 503.639.4175
1 OAR')
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW \'es No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ El ❑
_ 3 Verification of approved plat/lot. ❑ El
4 Fire district approval required. Name of district: El ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . El ❑ ❑
6 Sewer permit. ❑ El ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ El
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state El ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans cr 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 ❑ ❑ ❑
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 ❑ El ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, El 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- ❑ El ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ El
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- El ❑ ❑
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 ❑ El El
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered El ❑ El
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 ❑ El El
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ El ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑
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 ❑ El ❑
architect licensed in Ore!on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ El
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. El ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ El
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ El ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ El
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ El ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
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-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By:ed Permit No.:
ill 13125 SW Hall Blvd.,Tigard,OR 97223 Pl
an ReviewINI: ll Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
T I G A P.1) Inspection Line: 503.639.4175 Date Ready/By: ]uris: m See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
�� Mechanical permit fees*are based on the value of the work
Ad❑New construction dition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: II:LT U 3 w i 2,9411 w E;- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 17 yuYS- OIL CS7.- 2--2-3 Furnace 100,000+BTU(ducts/vents) 54.91
I Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
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
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
Er/PROPERTY OWNER ❑ TENANT
Environmental exhaust and ventilation:
Name: rCe- 5 0A-c.to 9e. I as.3 5u44--o$ Range hood/other kitchen
r
equipment 33.39
Address: 12 4 0 3. w 12o.�hA
ri v e7 Clothes dryer exhaust 33.39
City/State/ZIP: t �y �Z q ZZ 3 Single-ductexhaust(bathrooms,
toilett compartments,
ameents,utility rooms) I 23.32
Phone:(y`p ) 9'4.7_.4?-2_0 C1 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: : --i. lll'4?, ..c-_,) C. $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail:
►t( C r ce..S. YV S 6 VtAa:i t' t^O W Barbecue
' CONTRACTOR Clothes dryer(gas)
Other:
Business name: ‘,Iy,^ �/
v l (LA-) '- MECHANICAL PERMIT FEES* k1q)
Address: Subtotal �,�4
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: ' . * Fee methodology set by Tri-County Building Industry Service Board
Print name: ✓✓✓
tM�r��� s o.kdo Date: a3 13l l Z2,
1:\Building\Permits\MEC_PermitApp_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_PennitApp_040113.doc 2
•
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/B : Permit#:
w 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
1e: Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: kris: ll See Page 2 for
T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction 19111 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
O Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
ruir and 2-family dwelling ❑Commercial/industrial IIIAccessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: 1 Job site address: I'2.--2- f} a;w i L I't k j}v C 100HP or more. ❑"A","E","1-2","1-3",
O Six or more residential units. occupancy.
City/State/ZIP:
1---C3cLy-A- q i'Z 2_3 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
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
(with above sq.ft.) 75.00 2
A pOX-r -C'N` Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
.PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: t
i(3. 4,<- Ctvtkr. S 200 amps or less 100.70 2
MQrCQa ... &Ta ° DC.- L
201 amps to 400 amps 133.56 2
Address: i.
2_7_3--0 S W 12 (SA.K. !1 or 401 amps to 600 amps 200.34 2
City/State/ZIP: -1";G cur oft_`0 (i -/2 2.3 601 amps to 1,000 amps 301.04 2
Phone:(5 03) el 2,7- _4?r? G G Fax:( ) Over 1,000 amps or volts 552.26 2
v Temporary services or feeders installation,alteration,and/or
Email: M ey-c_a-A m�� a G Ott,`I r CQi relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent, r exc n e,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
401 amps to 599
Owner signature:� /, Date: amps 168.54 2 P
Branch circuits—new,alteration,or extension,per panel
0 APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
Business name: ckS 0 Aj N " above service or feeder fee, 7 42 2
each branch circuit
Contact name: P B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I 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 C //� Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(1 hr min) 66.25/hr
Phone:(.5 63) ?�fC� ..-02 6 Cr Fax:( ) Investigation(1 hr min) 90.00/hr
(( 1 Industrial plant(1 hr min) 78.18/hr
Email: /r l e r C GGt- S Q ice-i . -cis wv Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(''/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
� � State surcharge T %L of pM T fEE:
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Yv`cV coS -o -o'to Date:03 1.9` / 2 1, days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
+aurrlrr► ..
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:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
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
with OAR 918-309-0040) 552.26 2
❑ 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 PERMIT FEES
Fee for each commercial system: $75.00 per
Subtotal(Enter on Page 1):
y * Number of inspections allowed pe permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
I I Audio and Stereo Systems
(l Boiler Controls
Clock Systems
Data Telecommunication Installation
I Fire Alarm Installation
IHVAC
Instrumentation
Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
I I Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/I7/2015
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223
Date/By: Permit No.:
Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960
Date/By: Other Permit No.:
T I G A It I) Inspection Line: 503.639.4175 Date Ready/By: huffs: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description Qty. Ea. Total
IV/Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ID-1-and 2-family dwelling I]Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: j 7,1-0 v% 1 zS 41 4 (\ G. "C. o'ri 112-Z
J Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Pc.4\01A-. 0 A v W n tX A-h rO tM Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Stone sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: �q� A_ Fixture/sewer cap 25.02
1"l Ql'f'(C ut OS v{✓ 3r b Floor drain/floor sink/hub 25.02
Address: tip
�''L}0 `�t� roc- Garbage disposal 25.02
City/State/ZIP: --1-;G CAY 1- R 3-2-Z 3 Hose bib
.l 25.02
Phone:(Lc,-'3) 5 A 7.. _ ?,... ,t i Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: f Medical gas(value:$___,_) Page 2
��M t- C,�t Ct.() 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:(-SO3) 924 ,-9� pi Fax::( ) Tub/shower/shower pan f 12.51
E-mail: ( Urinal 25.02
}�G� -- C7 ruff c�(i I .. C,e,Yv1
Water closet ' 25.02
CONTRACTOR
Water heater 37.52
Business name: 6 Water 1 in DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.:
Plan review (25%of permit fee)
State surcharge(12%of permit fee)\
Authorized signature: Ile/ TOTAL PERMIT FEE
Print name: / Date: 3 �? �
l This permit application expires if a permit is not obtained within 180 days
Q -t;1 ,, D d ll after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Budding\Permits\PLMU-PermitApp.doe 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-1"100' 50.03 0 to 2,000 $121.90
Footing dram-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Othef Ins eCt s or-tee-S :, aee(ea3,' dotal
each additional$100.00 or fraction thereof,to
p 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 for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ID 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
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
l:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Water Meter Fixture Unit Worksheet for Additions/Remgige (
Please complete the following information: MAY 31 2022
Customer Name: e r ` " 10 1)C Lc S 5 CITY OF TIGARC
Service Address: Street/Suite#: 12_7— -Q Si.- 12-9 A\ Avg BUILDING DIVISION
City: '`A—i.rct+f .- State: o R. - Zip: q 7 2 Z
Phone Number: .503 -7 2 3--- S2_0' Email: n?orcz r, (4 6 ,,,,,A • Cv i -t
Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add.
Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at
total. the proposed total.
Fixture Unit Current Point Current Proposed Point Proposed
Quantity Value Total Addition Value Total
Bar sink x 1 = x 1 =
Bidet x 1 = x l =
Clothes washer j x 4 x 4 =
Dishwasher x 1.5 = x 1.5 =
l sl Outside Water Spigot x 2.5 =IN
x 2.5 =
Water Spigot,each add'l 1 x 1 = ( x 1 =
Kitchen sink i x 1.5 =—I' x 1.5 =
Laundry sink x 1.5 = x 1.5 =
Lavatory(bathroom sink) 2,, X 1 =
Water closet,1.6 GPF(toilet) 9... x 2.5 = 5 A x 2.5 = `L,c-
Bathtub/whirlpool x 4 = x 4 =
Shower stall 1 x 2 = 'A x 2 = '3„
Bath/shower combo 2 x 4 = x 4 = -_
Current Points: 23, 5 Proposed Increase: 5 .i 5
Current Points+Proposed Increase= ILCI =New Total Points =Required Meter Size
Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=3/4" 37.5 and over points= 1"
New Meter Size Needed for New Total Points: 5/8 Cost: $ (see page 1)
5/8"
Current Meter Size per Utility Billing: Cost: $ (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $0.00
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
*************************************************************************************
FOR OFFICE USE ONLY Meter does not need to be increased in size.
J Bentley 06/01/22
Current Meter Size Confirmed with UB
Signature of UB Representative Date
[:/Building/Forms/WaterMeters_070121_Add.docx Page 2
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
It Water Meter Fixture Unit Worksheet
!GAR l-) For Additions /Remodels /ADUs
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tiiard-or.gov
LOCATION: City of Tigard—City Hall WATER METER SALES:
Utility Billing By Email Only. Please contact
13125 SW Hall Blvd. ubonlinepay@tigard-or.gov
Tigard, OR 97223 to discuss sending documents and payment
METER: SIZE: FEE: Pricing effective 07/01/2021
5/8" $10,095.00 Fee includes:
3/4" $14,418.00 water system development charge,
1" $26,487.00 - water meter,and
1-1/2" $78,488.00 meter installation fee.
2" $127,125.00
DETERMINING METER SIZE FOR RESIDENTIAL CUSTOMERS
City of Tigard Water Service Area uses the American Water Works Association Manual and the Oregon
Plumbing Specialty Code to determine the size of meter needed to adequately serve buildings. Due to the
variety of home sizes built in the Tigard area, we count the fixture units of all homes to determine the
appropriate meter size.
Use the worksheet on Page 2 to calculate the current number of fixture units compared to the proposed
increased number of fixture units,which will determine whether an increased meter size will be required.
Submit this signed worksheet with your building or plumbing permit application submittal.
DOCUMENTATION
Once you are ready to purchase the new meter,please provide the following items to the Utility Billing
counter:
• Completed water meter fixture unit worksheet for additions,remodels,ADUs, etc. (on back page).
• Copy of building or plumbing permit application date-stamped by building division.
• Copy of issued building or plumbing permit.
Your fixture count will be verified and your request will be processed upon receipt of these documents.
No exceptions.
INSTALLATION TIME
Once the upgraded meter size has been purchased, most meters are installed within 10-14 business days.
1:/Building/Forms/WaterMeters_070121_Add.dOCx Page 1
Property Owner Statement
Regarding Construction 7 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 plumbi igiSCEDIE
Licensed architect and engineer applicants, exempt from licensing under ORS 701.01 .
submit this statement. This statement will be filed with the permit. 3 1 7112
Please check the appropriate box:
CITY OF TIGARL)
BUILDING DIVISION
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 ! 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.
MarceA,
Print Name of Permit Applicant
Signature of Permit Applicant Date
Permit#: `4 a,& , —G01 (4� , F
Address: (').?K'7 0 ` g . .A,
Issued by: Date:
This Copy for Permit Offices
,.a Information Notice to Owners About
�: . N�.r.: Construction Responsibilities
"'• /
(ORS 701.325 (3))Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 97309-5052
Telephone: 503-378-4621 —Fax: 503-373-2007
Website Address:www.oregon.aov/ccb
f/property_owner adopted 9-2016 This Copy for Permit