HomeMy WebLinkAboutRES2025-0017 REV 1 APPLICATIONS PACKET Building Permit Application
Residential FOR OFFICE USE ONLY
City of Tigard Received
By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: a See Page 4 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
I]New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwelling ElCommercial/industrial Valuation: $ $431,302.29
❑Accessory building ❑Multi-family Number of bedrooms: 4
❑Master builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address:16663 SW RUBICON LANE New dwelling area: 2507 square feet
City/State/ZIP:TIGARD, OR 97224 Garage/carport area: 699 square feet
Suite/bldg./apt.no.: Project name:SOUTH RIVER TERRACE Covered porch area: 1 69 square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:SOUTH RIVER TERRACE Lot no.:81 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
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
NSFR-CAMDEN AMERICAN GL 3 CAR -
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name:LENNAR NW LLC Type of construction:
Address:11807 NE 99TH ST, STE 1170 Occupancy groups:
City/State/ZIP:VANCOUVER,WA 98682 Existing:
Phone:(360 )333-2513 Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:
LENNAR NW LLC (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:CAMERON NEWKIRK
FLS plan review fee(if applicable):
Address:SAME AS ABOVE
City/State/ZIP: Total fees due upon application:
Phone:(360 ) 333-2513 Fax: :( ) Amount received:
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:CAMERON.NEWKIRK@LENNAR.COM
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:LENNAR NW LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:SAME AS ABOVE Solar Installation Specialty Code checklist.
City/State/ZIP:VANCOUVER,WA 98682 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( 360 )333-2513 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:240462 Total fee due upon application: $201.60
N as M N +
Authorized signature: Cameron Newkirk �.r o;; w'",75=27mau-u""0V-'- 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
Date:7/10/2025 Print name:CAMERON NEWKIRK Service Board.
I:\Buildmg\Permits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
INDate/By:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
= Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 ❑ Electrical 12 Plumbing El Mechanical
TIGARD
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 Yes 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. ✓❑ ❑ ❑
3 Verification of approved plat/lot. n n ❑
4 Fire district approval required. Name of district: • n n ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ✓❑ ❑ ❑
6 Sewer permit. ❑ ❑
7 Water district approval. ✓ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 n ❑
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑✓ ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑✓ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or 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 ❑✓ U U
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 ❑✓ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 ❑ ❑
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- ❑✓ ❑ ❑
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. ❑✓ ❑ ❑
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- ❑✓ ❑ ❑
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 ❑✓ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 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 0 ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑✓ ❑ ❑
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 a I.licable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS 1 1
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑✓ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ✓❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ✓❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. El E El28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard
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-RESPermitApp.doc 01/25/2023 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G,i R l) Inspection Line: 503.639.4175 Date Ready/By: Juris: Ii3 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK mil COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
F CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
E Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 1 54.91
Heat pump 61.06
Suite/bldg./apt.no.: 1 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: 1 Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
MIIII DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
NSFR-MECHANICAL fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER ElTENANT Other: 23.32
Environmental exhaust and ventilation:
Name: LENNAR NW LLC Range hood/other kitchen
equipment 1 33.39
Address: 11807 NE 99TH ST,STE 1170 Clothes dryer exhaust 1 33.39
City/State/ZIP: VANCOUVER,WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( 360)601-1860 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ® CONTACT PERSON Other: 23.32
Business name: LENNAR NW LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:CAMERON NEWKIRK Furnace,etc.
Address: SAME AS ABOVE Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:(360 ) 333-2513 Fax: :( ) Fireplace
E-mail: CAMERON.NEWKIRK@LENNAR.COM Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:GG mechanical Inc Other:
' MECHANICAL PERMIT FEES*
Address: 1931 SE 176th ave Subtotal
City/State/ZIP:Portland,OR 97233 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 971)274-9266 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:223796 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: Ariel Salazar Date: 10/28/2024
I:\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_PermitApp_040113.doc 2
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/B
Eri
q 13125 SW Hall Blvd.,Tigard,OR 97223 Received
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B Permit#:: Related Permit#:
TIGARD Inspection Line: 503.639.4175 Ready Date/By: Juris: Ef See Page 2 for
e 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):
O Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 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 ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 1o01iP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: TIGARD,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 1 Project name: SOUTH RIVER TERRACE ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description Qty. Each Total *
New residential single-or multi-family dwelling unit.
Subdivision: SOUTH RIVER TERRACE 1 Lot#: Includes attached garage.
1,000 sq.ft.or less 1 168.54 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
NSFR-ELECTRICAL
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: LENNAR NW LLC 200 amps or less 100.70 2
Address: 11807 NE 99TH ST,STE 1170 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: VANCOUVER,WA 98682 601 amps to 1,000 amps 301.04 2
Phone:( 360 )601-1860 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: PERMITPORTLAND@LENNAR.COM 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: CAMERON NEWKIRK Date: 10/17/2024 401 amps to 599 amps 168.54 2
® APPLICANT .1.■ ® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: LENNAR NW LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: CAMERON NEWKIRK B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: SAME AS ABOVE branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: 360Miscellaneous(service or feeder not included)
( ) 333-2513 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:CAMERON.NEWKIRK@LENNAR.COM Reconnect only 67.84 2
M. M CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sunlight Electric Inc Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ID See Page 2 2
7524 N E 88th ST, panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
y Vancouver WA 98662 Additional inspection(1 hr min) 66.25/hr
Phone:(971 ) 222-5758 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Peter@sunlightelectricinc.com Inspections for which no fee is
CCB Lic.: 172549 Electrical Lic.: 230 Suprv. Lie.: 6652S
s ecificall listed('/z hr min) 90.00/hr
ELECTRICAL PERMIT FEES '
O
Suprv.Electrician signature,required. .--� Subtotal:
Print name: Yegor Shevchenko Date: 0 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 not obtained within 180
Print name: Peter Kozarez Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC PermitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
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
n 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 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:
I 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('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
SuI
Fee for each commercial system: $75.00 allowe al(EDter on rage 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
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.doc Rev 06/17/2015
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard NI 13125 SW Hall Blvd.,Tigard,OR 97223
Received Permit No.:
Date/By:
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date By:MI Other Permit No.:
T I GARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK Mr FEE* SCHEDULE i
®New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
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: Tigard,OR 97224
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
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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK MM Backwater valve _ 12.51
Clothes washer 25.02
NSFR-PLUMBING
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: LENNAR NW LLC
Floor drain/floor sink/hub 25.02
Address: 11807 NE 99TH ST,STE 1170
Garbage disposal 25.02
City/State/ZIP: VANCOUVER,WA 98682 Hose bib 25.02
Phone:(360 ) 333-2513 Fax:( ) Ice maker 12.51
® APPLICANT CONTACT PERSON Interceptor/grease trap 25.02
Business name: LENNAR NW LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:CAMERON NEWKIRK
Roof drain(commercial) 12.51
Address: SAME AS ABOVE Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(360 ) 333-2513 Fax: :( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: CAMERON.NEWKIRK@LENNAR.COM
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/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: TOTAL PERMIT FEE
i
Print name: Date: 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.
I:\Building\Permits\PLMU-PermitApp.doc 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 drain-each additional 100' 37.52 2,001 to 3,600 $169.69
_3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: _ Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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
Baptistry/Font ❑ Any new commercial building with water service 2"and
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
Drive 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.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4„ 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refit.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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2