Permit (3) CITY OF TIGARD
I 4 ( MASTER PERMIT
main
Iii ■ ' COMMUNITY DEVELOPMENT Permit#: MST2020-00245
T I i;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/01/2020
Parcel: 1 S 134CA00535
Jurisdiction: Tigard
Site address: 11040 SW 119TH AVE
Subdivision: PANORAMA NO.2 Lot: 26
Project: Platt
Project Description: New 420 sf detached garage. 9/17/2021: REPRINT permit to add(1)rain drain connector.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 11 Bathrooms: 0 Second: 0 sf Garage: 420 sf Front: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No
Total: 420 sf Value: $20,466.60 Rear: 5
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 1 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 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: 0 Other Units: 0
Fum<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.'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
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:
NEW ACS VB R-3 420
Owner: Contractor:
PLATT,SCOTT D&JODI L OWNER Required Items and Reports(Conditions)
11040 SW 119TH AVE 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97223
PHONE: PHONE:
FAX:
Total Fees: $802.58
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. ATT ON: Oregon law re •es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
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Issued By t' /f Permittee Signature: \�w (ti?p withti1 1
all 503. 39.4175 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.
Plumbing_Permit Application
Site Utilities !3 �' \i ' E
City of Tigard Received
• 13125 SW Hall Blvd,Tigard,OR 97223� �BY r7�zi ! Permit No. S• 7,. r�e yS
' Phone: 503.718.2439 Fax: 503.598.1 e . ,. Date/By:
a Review �C
� a �/
Other Permit No,:
I I W ,f l Date Ready/By: /
Internet:
w. 503.639.4175
z 1 fi i l 1)I,W'<I DIVISION ate f�7IO N Notified/Method•�'I /�/ � ® Page2 Information www.figard-or.gov azd�r ov ,�
� �; ` � up men formanon
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XNew construction �El Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
r r , `mod ii,Ao { 7- r .. '
l..o �. :A� ,.,,, 7` :i. ,a .. ,. ,,s. ;% ..r �,•.•aA *� ..„% SFR(1)bath J 312.70
-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
El Master builder Each additional bath/kitchen 25.02
❑Other , �, Fire sprinkler( sq.ft.) Page 2
`" ..,.= &a w:i'�r ,, 'F,,,, .,s.„F.e �`.„_.;I.
,, d a: ., s�r.' J 4:4,1, I >�- Site utilities:
Job site address: 1104 o StJJ 1 (R•�mAle, Catch basin or area drain 18.76
City/State/ZIP: -C"1 J d OR q-�-2-23 Drywell,leach line,or trench drain 18.76
�(2, Footing drain(no.linear ft.: ) Page 2
Suite/bldg apt.no.: I Project name: t --cL ..he.f Gc'' V Manufactured home utilities
50.03
Cross street/directions to job site: Manholes 18.76
MA -r."1-u-. Si--- ..- t,Mail?.� Rain drain connector 1 18.76
Sanitary sewer(no,linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
I Water service(no.linear ft.: ) Page 2
Subdivision: �(^,, - 0 r- �� Lot no.: Fixture or item:
Tax map/parcel no.: I s M 34 CA 00 S-3 Ba kfl w c o venter pre 31.27
# a-u _T� �r✓a 4 ;t€ Backwater valve
T� 12.51
a '^'� d.d.. 1 ..,..,� S � 7 .:)%, T.P .� � �h'"�ah'� � s' �„$
(� toes washer 25.02
v1,C �o.r�S ishwasher 25.02
+'1�-. 6 Fx.1 Sya• 6-,r C12 117- {�,� Drinking fountain 25.02
l I 7�-Q �Y 0 4 i6 ` Ejectors/sump 25.02
��'E *, r ` ' r Expansion tank 12.51
Name: S,�-rc P(rA T Fixture/sewer cap 25.02
-• C-ue-- Floor drain/floor sink/hub 25.02
Address: l t b 4 O SW 119E-
Garbage disposal 25.02
City/State/ZIP: Ti ..,..„-a on_ q 7' -2_3 Hose bib
25.02
Phone:(S03) .7 2 0 1-7 3 Fax:( ) Ice maker 12.51
.
, �'.,. °�` � ', `��Q� � �x�� Interceptor/grease trap 25.02
Business name: a l t'1 Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
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
E-mail: S ►oci-i- te4 . CAvvt. Urinal 25.02
Water closet
CO t#1 25.02
Business name: t 1 Water heater 37.52
Water piping/DW V 56.29
Address:
Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 72,S'0
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%ofpermit fee) f 17
Authorized signature: �C�� d.
tl f TOTAL PERMIT FEE e„, �)
Print name: ogc. T �[_r�� Date: p 1 ��' u This permit application expires if a permit is not obtained within 180 days
111 after it has been accepted as complete.
*Fee methodology set by Tti-County Building Industry Service Board.
I:\Building\Permits\PLM1I-PermitApp.doc 10/01/09 440-4616I'(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
',Site ITlllti . .
Qty Fee(ea) Total ql , r* ll!0i . FLlr' t, eC
Footing drain-1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
_ - 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 g7 g
Storm&Rain Drain-1st 100' (to f 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
each additional$100.00 or fraction thereof,to
1� '± lS}ltl<QI<lSI" I<' " , .£ 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*.
Qu t3 y ype - ti *. m
anti b FixtareT` l � ' s'�' �'���U *4 � S ,
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
Baptistry/Font
El Any new commercial building with water service 2"and
Bath -Tub/Shower
--Jacuzzi/Whirlpool
greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
I 011iiiric;tfi''R:1er. graIll
Car Wash Drain
❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU PermitApp.doc 2