Permit CITY OF TIGARD BUILDING PERMIT
` • ' COMMUNITY DEVELOPMENT Permit#: MST2022-00225
Date Issued: 9/7/2022
T I GAR 1_0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S108DB05800
Jurisdiction: Tigard
Site address: 15364 SW SEINE DR
Project: WARREN Subdivision: POLYGON AT BULL MOUNTAIN Lot: 56
Project Description: Converting existing space to add 1 bdrm&1 bath. Current water meter adequate. No new meter required.
Contractor: ANVIL CUSTOM BUILDING LLC Owner: WARREN,CHRISTOPHER A&EMILY JL
6404 NE 139TH CT 15364 SW SEINE DR
VANCOUVER,WA 98682 TIGARD,OR 97224
PHONE: (971)533-6594 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: ADD Type of Const: VB Building Permit-Additions,Alterations, 09/07/2022 $619.25
Occupancy Grp: R-3 Occupancy Load: Demolition
Plan Review 07/14/2022 $402.51
Dwelling Units: 0 12%State Surcharge-Building 09/07/2022 $74.31
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 09/07/2022 $2.50
Bedrooms: 1 Bathrooms: 1 11x17)
Value: $40,000 Branch Circuits wo/Purchase Service or 09/07/2022 $78.44
Feeder
12%State Surcharge-Electrical 09/07/2022 $9.41
Floor Areas: Single Duct Exhaust(Bathrooms,Toilet, 09/07/2022 $23.32
Total Area: Utility Rooms)
Accessory Struct: 0 12%State Surcharge-Mechanical 09/07/2022 $10.80
Basement: Minimum Fee Adjustment-Mechanical 09/07/2022 $66.68
Carport: 0 Lavatories 09/07/2022 $25.02
Covered Porch: 0 Tub/Shower/Shower Pan 09/07/2022 $12.51
Water Closet 09/07/2022 $25.02
Deck: 12%State Surcharge-Plumbing 09/07/2022 $7.51
Garage:
Mezzanine:
Total 51,357.28
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 you to 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. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19887/or^1.800.332.2344.
Issued By: i�rl"1.,., . �I aidy Permittee Signature: �/v \
K/W r"I \ / 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.
Building Permit Application
kesidential FOR OFFICE USE ONLY
City of TigQard Received
Date/BY, '7 /4 — /krjrj-- Permit No.:�nr90*-lr,-�,�r15-
1 • 13125 SW Hall Blvd.,Tigard,OR 97223BEGEIVED Plan Review
� J� DV O� Vl/pVJ
Phone: 503.718.2439 Fax: 503.598.19 Date/By: 1 I 7/t/ Other Permit:
T I G A RD inspection Line: 503.639.4175 Date Ready/By: / - J. - Jurr 65 See Page 2 for
Internet: www.tigard-or.gov JUL. 14 2022 Notified/'Method UI KA /"Y`+ Supplemental Information
TYPE OF W i i G,nivisloN REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permil fens*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Addition/alteration replaceincnl 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
�/' Valuation: $ 14 Q 000
I-and 2-family dwelling ❑Commercial industrial ,
ElAccessory building ❑Multi-family Number of bedrooms: '
❑ Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 15.3(p 4 SW S e l n c.. b - New dwelling area: square feet
City/State/ZIP: -Ft V"c, 0 R 9-7y Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
I MMERCIAI USE CHECKLIST
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
I,IESCRIPTION OF Wow work indicated on this application.
�, _,,, ,•'.•t.: :�45/a.c.'.,:.rf.._/,.,;:.. 55f�P•..;;.,?:*rr"nr:.ir.,•.?ryiYad�' ';m; r °,"•:,"•.'.
Add1 �\-•1 Yl i Valuation: $
� bc, U�d eol Doom t�
0,'t/'�0`lAl - iy' is hed botSe MR' Existing building area: square feet
New building area: square feet
(+r PROPERTY OWNER I 0 TENANT Number of stories:
Name' ( 'i r i`\ ('And C Y7ti 1`,si1 �'1,1\Y V e (---_, Type of construction:
Address: 1 S3(p w Se1d f Occupancy groups:
City/State/ZIP: ...r-1 w ! l , r 017,2 j y Existing:
Phone: fJ ) (.
( . 13) 1{ (p �Cu a Fax ( 1New:
❑ APPLICANT 0 CONTACT PERSON BUI TIF PF` ICII"'E'LESa r'" x" 1
Business name ..(WQS�'"''r'Jv& +tc'Gude) a
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application:
Phone: Amount received:
( ) Fax: :( )
E-mail: . a( pouf lLP.1r' rrw,1 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR root top mounted PhotoVoltaic Solar Panel System.
Business name: t\kj I L -ran 41 LA( /11 Submit two(2)sets of roof plan with connection details
/ �o, �13ift, and fire department access,along with the 2010 Oregon
(Address: l "1/� z AV'e-- CT Solar Installation Specialty Code checklist.
City/State/ZIP: Jikr1Q,bvv( 7
1� 1� 9 9 C)9 2 Permit Fee(includes plan review $180.00
Phone: I 7h 5 33 Lp j I
Fax:( ) and administrative fees):
State surcharge(12%of permit fee): $21.60
CCB lie.: 2 23 tilt
"Ay/• //A��l��'J,./, Total fee due upon application: $201.60
Authorized signature: / /.. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 11'x t'`„ Il\AAV Y e in Date:7 / 1 C'J �Z "Fee methodology set by Tri-County Building Industry
JService Board.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard
il
• 13125SWHallBlvd.,Tigard,OR 97223 RECEIV' M� " " ' - �'Phone: 503.718.2439 Fax: 503.598.1960 . . Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov JUL 14 202, NIotified/Method: Supplemental Information
CITY OF TIGARn
TYPE OF WORK BUILDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
0 New construction Mechanical permit fees*are based on the value of the work
❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ❑ Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
y W S Q 1 Air conditioning 46.75
Job site address: 15 3 Y�{ I]tr t v(.. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: so,rd Q K C L 7 2 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: i^/Q r✓k
'V r 1 Duct work 23.32
Cross street/dileL.tions 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
ilk...,/ c"-,-tr61, }7 . l...d•/r 1.-4 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Oth
0 PROPERTY OWNER 0 TENANTS 23.32
Environmental exhaust and ventilation:
Name: I �- £v i(,4 c C�I 1% t.!QIpz r, Range hood/other kitchen
Address: '52(.0 11 S W \ YV equipment 33.39
St U Y^ 4 Clothes dryer exhaust 33.39
City/State/ZIP: Tj qQ\Y d I� 9 -7 Az Single-duct exhaust(bathrooms,
cJ toilet compartments,utility rooms) I 23.32
Phone:(6(3 ) Li(a 5- (1(:. i Fax:( ) Attic/crawlspace fans 23.32
APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: <_ Fuel piping:
rie�- 63 a '�.."-( $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:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: ( v 1'l C .\-&P l (l t'C I n Other:
( c, c \ J MECHANICAL PERMIT FEES*
(,
Address: L c)-\ n e I cl` Subtotal
City/State/ZIP: V 0.nC�v.44
r CM49 Minimum permit fee($90.00) l NI2* 1 ,�N)
, l 1\) S�� LoC,Gj 4Fax:( ) Plan review(25%of permit fee)
lf�
Phone: v
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: ../z„----' * Fee methodology set by Tri-County Building Industry Service Board
Print name: Err 1I YV(((. V) Date: 7 I I ('I / ZZ.
1:114uildingtPermha\MECPermitAA 040113.doc 440-4617T(11/02/COM/WES)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040I 13.doc 2
Electrical Permit Application FOR OFFICE USE ONLY
1,111 City of Tigard ReceivedPermit#::•;)-, .
y t J
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 Date/Br Related Permit#:
7 1�::�r,o Inspection Line: 503,639.4175 Ready Date/By: i a: ® See Page 2 for
Internet: www.tigard-or.gov g: Notified/Method: Supplemental Information
• .,. ',0-4# tL: ' s �,/17/,''! "' }*, r.'{rr`,'''`:,_' ?:' ,{,. A',j N .o-.
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit hers of plans w/itema checked):
D Demolition Service or feeder 400 amps or mare ❑Building over three stories.
❑Other: where the available fault current 0 Marinas and boatyards.
CA 6e+ :'a, 414 Y s,,ytry : . ,:, exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ElCommercial/industnal El Accessory building less to ground,or exceeds to oo0 ❑cores. glebe agricultural
❑Multi-family 0Master builder F for all other installations. buildings.
❑Other: ❑Fire pump. ❑installation of 150 KVA or
.�-. . . , : .., '.x.
�';?� t .f?tt��#2 r:.�y 7�, �#' x t:# �4 x... � �.,e. 0 Emergency system. larger separately derived
''�LL ❑Addition of new motor load of system.
Job#: Job site address: I Sat, SW Se t ylt b r IOoflP or more. ❑"A""E^"I-2^"I-3"
City/State/ZIP: Ti 9gyp,y'p( O Z. 972 .4 ❑Six or more residential units. occupancy.❑Recreational vehicle parka.❑Health-rare facilities.
Suite/bldg./apt#: Project name: Wes y let be‘ ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volta nominaL
Cross streeddirections to job site: V ...14v i- a a r)tl f '�r s"" :=}'
oe.r tpdo. . 1 I 'Qtr. 1 each I raw
New reaidendal single-or multi-family dwelling unit
Subdivision: Lot#: Includes attached garage. -
Tax map/parcel#: 1,000 sq.8.or less 168.54 4
-. '" ,.,,,,..!,„4'
s,� r_.,x_.n '�'+ r f'' �"' '` x%+F.« fie.ad/1'1500 sq.ft.or portion 33.92 1
-� , c" 'A A,ifia r.�.r'`."agir Limited energy,residential
(with above sq.ft 75.00 2
.)
Limited energy,multi-family 75,00 2
residential(with above sq.ft.)
f �. , .- ,,,.. ,v .- Renewable Energy ❑ See Page 2
," `,� Services or feeders installation,alteration,and/or relocation
Enn i 1 a r s�,�, On .S W g r ere... 200 amps or less , 100.70 2
Address: 1536 Li S W St‘ri v. Dr tot amps to 400 snips 133.56 2
City/State/ZIP: 01 amps to 600 amps 201.34 ' 2
tY TiTa bated c5 2 g 7 2 2 4 601 amps to 1,000 amps 301.04 2
Phone:(INS )y(05 —0006 Fax:( ) Over 1,000 amps or volts 552.26 2
j t fX Temporary services or feeders instillation,alteration,and/or
e
Email: P lee r" e g theses i t . Cei M 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,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: L .f. "'- Date: 1 Z7/ Z2 401 amps to 599 arms 168.54 2
}:: "; '.'a;•1'!a:# 524 : . ° •,4 . '' r,,,""; BA.an circ its circuits with
altteration,or extension,per panel
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits wi/Trout
service or feeder fee,fast
Address: branch circuit 56.18 2
City/State/ZIP: Each add'1 branch circuit a 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
- ,!.'1'4Y;.,,;*'�` , tie 'ii , . ' ,,At, tar , Pump or irrigation circle _ 67.84 2
Businessnatne: Mates Electric Inc Sign or outline lighting 67.84 2
St PMB 679 Signal cirouit(s)orhmited-enerST 0 SaePage2 2
Address: 11124 NE Halsey panel,alteration,or extension.
Each additional inspection over allowable in any of the above
cityfState/ZIP: Portland,Oregon 97230
Additional inspection(I hr min) 6625/hr
Plane:(503) 516-4142 Fax:( ) Investigation(1 hr min) 90.00✓hr
Email: joel@mateselectric.com Industrial plant(1 hem n) 76.18/hr
Inspections for which no fee is 90 00/hr
CCB Lic.: 159371 Electrical Lic.: 26-925C Suprv.Lie.: 3992S s, -fican fisted xbrrem
Suprv.Electrician signature,required: ..I..,/(� `v ` >
Subtotal:
Print name: Dan Mates Date: 07/26/22 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: �- TOTAL PERMIT FEE:
This permit application expires If a permit Is mat*Wadiwitbfa 180
Print name: F n't t 1 tj W a Ire<✓k Date:7/L7/22 Numberofdays after
it s b enpe accepted
permi as complete.
a
1auleotfPamiatELC_P•rossN9_Etn_Ea&doe Rev O6/17/2013 440a613r(I VOS/COM/WHH
. - 'Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit No.: /-1,s.r�
• 13125 SW Hall Blvd.,Tigard,OR 97 n�I9 f�® Plan Review J (/4
Phone: 503.718.2439 Fax: 503.59 v V Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 Date Ready/By
Internet: www.tigard-or.gov j i 2022 Notified/Method Method y Jura: See Page 2 for
II 1 4 : Supplemental Information
TYPE OF WORK FEE* SCHEDULE
,Ty
❑New construction ly�q �qO�ppF,TIGARDr1���� • For special information use checklist
-- tti �tli-rSION Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fires sprinkler
p (_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
J 6 4 Z7 v-I J e l Y\�, Catch basin or area drain 1g.76 Job site address: i J
t
City/State/ZIP: Ti 5 B„rd Or_ 9 1 2�y Drywell,leach line,or trench drain 18.76
Footing drain(no linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: 1(d 0.Y I
Q.n 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 if: ) Page 2
Water service(no linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
//�� Clothes washer 25.02
T'1D1d t Il (:) -- b&+h r 6 Q yyl rr ry bed Y 0 0YY\ Dishwasher 25.02
I J f 17 1 l 5 f I e d IOCK\--Q mit nt, Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TENANT Expansion tank 12.51
�. h ,. Fixture/sewer cap 25.02
Name:
C h a'1 J C YYI I( Cry Y vQ.Y(C 11 Floor drain/floor sink/hub
Address: 1 53(0 4 S h/ J`�Z] (� 25.02
1 h1Z Garbage disposal 25.02
City/State/ZIP: T 1 Q1(d pc_ 22_,4 Hose bib 25.02
Phone:(s ig ) Li(o - Q 0 L 5 Fax:( ) Ice maker 12.51
❑ APPLICANTS 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
s el..5C.ti
Contact name: - Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory i 25.02
City/State/ZIP:
Solar units(potable water) 62.54
Phone:( ) Fax::( ) ' Tub/shower/shower pan f 12.51
E-mail: Urinal 25.02
'7 1 CONTRACTOR Water closet 25.02
Business name. ?j{/ !� _ Water heater 37.52
C� , ) Water piping/DWV 56.29
-^_r
Address:
,,--) a Gve Other. 25.02
City/State/ZIP: (.ore`_'_ �- CR q"-7O Subtotal
Phone:i ,3) , 0 _ [C Fax:( ) 06
Minimum permit fee: $72.50
CCB Lie.: )0 9 5 //„/ /l PlumbingLic
a , .nos.: `v /c,, ti f Plan review (25%of permit fee)
wrla 3 State surcharge(12%of permit fee)
Authorized signature: 4, - -t TOTAL PERMIT FEE
Print name: FA,t(,,,i No./,l.e in Date: 1/i I/Z / This permit application expires if a permit is not obtained within 180 days
�► after it has been accepted as complete.
°Fee methodology set by Tri-County Building Industry Service Board.
I1 Budding\Paws 1PLMU-Perntl Appdoc 10/01/09 440-4616T(10/02/COM/WEB)
NNW
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
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other inspections or Fees 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
each additional$100.00 or fraction thereof
(minimum charge-1/2 hour)
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
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru D Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
Isometric or Riser Diagram
❑ 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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard /va ` '1✓' e_ "04.46
� as 646 i/l7s/ a1144a`//.ro7`Giwiz ecy
COMMUNITY DEVELOPMENT DEPARTMENT re -'1 t/r..! 10y-- Pie. -,vt/ 4f/ i>tfr iw
Wd/ti .
TIGARD Building Permit Review - Residential
Building Permit #: /Y1j}` ,---vv;,
Site Address: 153CoN Sw St►�1� <pCZ .
Project Name: tk.)bev Lot #:
Land Use Case: Zone: 1�-' C
Required Submittal Elements (t&ic aL _ _ )
copies of site plan ❑ Square footage of buildings to be demolished
O Draw standard scale ❑ Footprint of new structure and FFE
O North arrow ❑ Retained trees, drip line / tree protection
O Site address, project name, 0 Street trees shown / labelled
O Street names • alk / driveway shown and dimensioned
❑ Applicant name and phone # ❑ Utility loca ' & easements (new / additions)
❑ Lot and setback dimensions 0 Location of wells / se ' stems
O Existing structures on site 0 Lot area and lot coverage perce e
O Erosion control ❑ Corner elevations (2' contours if > 4' di tial)
O Vision clearance triangle shown 0 Ground slope at building pad calculated / shown
Planning Review
�r-i-fy address / suite # active in Accela.
Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
Required: ❑ Yes ENo
Received: 0 Yes 0 No
12rfu-'13lic Facilities Improvement (PFI) Permit:
Required: ❑ Yes No
Applied For: 0 Yes 0 N .., stop intake
Sensitive Lands: 0 Yes 'WM)
Type:
sing Supplemental Sheets Completed
e Cluster C&O (1 site, 1 per unit) uad
O Courtyard n 1 site uilding) ❑ Rowhouse
❑ Cottage Cluster (1 per 0 Small Form Residential / ADU
❑ r Units Type II (1 per building) 0 i e Addendum
ditions met prior to issuance of bu'Id' g permit
Approved By Planning: Date: 71 '/ Zz
Notes ALL IAJr wAL . OD sc/ppcet ovr t sxeer (ea-seep )
Revision 1: 0 Approved D Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
I IMolding\Forms lBldgPennitRow Res 070722.dot,
Building Permit Submittal
Original Submittal Date: 7 ,714.
Site Plans #:
Building Plans #:
Building Permit #: uilding permit # entered on page 1
Workflow Routing: 3-131anning El-Engineering E3`-Permit Coordinator ❑-B aging
Workflow Sign-off: n-off for Planning (include notes from planning review)
Route Documents: L-Engineering: (1) copy of permit application, (1) site plan,
(1) building plan and original plan review routing form.
uilding: original permit application, site plans, building
plans, engineer and beam calculations and trust details, if
applicable, etc.
-- `
Permit Technician: � -- .'--- -.- Date: -014)-
Notes
Engineering Review
CO Slope at building pad verified Slope:
APA ❑ Conditions met prior to issuance of permit
' ❑ Easements (encroachments) per engineering conditions of approval and plat
O Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 0 No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ElNo Add Fee: ❑ Yes ❑ No
❑ Final Plat Recorded
O NOT Approved Date:
Notes
Approved By Engineering: Date: T�zS/22
Revision 1: 0 Approved Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
Permit Coordinator Review
{conditions met prior to issuance of permit
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
,IZSDC Exemption: ❑ Received 7 Does not apply
,21'SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 7rN/A
Tigard Trans SDC: ❑ Yes g N/A
Parks SDC: ❑ Yes Jd N/A
LIDA ❑ Yes A N/A
/OK to Issue/Approved by Permit Coordinator: 'Au- Date: 7I Z1] ?"02v
Revision 1: ❑ Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Water Meter Fixture Unit Worksheet for Additions/ f s
Please complete the following information:
JUL 14 2022
Customer Name: 6 t t .. ON(f s✓y� CITY OF TIC�ARD
Service Address: Street/Suite#: I S3(4 4 S yJ S-e I y ar,BUILDING DIVISION
City: 11 a, J c State: 0( Zip: (I7R7.1-1
Phone Number: S I3— 445— OOU5 Email: C(1Jfarr ,n OIQ@ a1'nd+l is C'.a1'Yl
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 1 =
Clothes washer I x 4 = At x 4 =
Dishwasher I x 1.5 = f. S— x 1.5 =
1"Outside Water Spigot I x 2.5 = 2, S x 2.5 =
Water Spigot,each add'l 1 x 1 = f x I =
Kitchen sink i x 1.5 = I • 5 x 1.5 =
Laundry sink / x 1.5 = 1,5 x 1.5 =
Lavatory(bathroom sink) 3 x 1 = 3 I x 1 = 1
Water closet,1.6 GPF(toilet) 3 X 2.5 = 1,3" f x 2.5 = 2,5
Bathtub/whirlpool x 4 = x 4 =
Shower stall f x 2 = 2 i x 2 = 2
Bath/shower combo i x 4 = if x 4 = ;
Current Points: cZ.S' 5 Proposed Increase: 5', 5
Current Points+Proposed Increase= 5y =New Total Points =Required Meter Size 3 it
Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points='/a" 37.5 and over points= 1"
New Meter Size Needed for New Total Points: 3/4 Cost: $ (see page 1)
Current Meter Size per Utility Billing: 3/4 Cost: $ (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
*************************************************************************************
FOR OFFICE USE ONLY Property currently has appropriate meter size so no upsizing
needed.
Current Meter Size Confirmed with UB J Bentley 09/07/22
Signature o UB Representative Date
I:/Building/Forms/WaterMeters 070121 Add.dOcx Page 2