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Permit me CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2010-00011 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/14/2010 Parcel: 25111 CD03100 Jurisdiction: Tigard Site address: 9645 SW BRENTWOOD PL Subdivision: SUMMERFIELD NO.9 Lot: 520 Project: Jensen Project Description: Fire repair. 1/28/10 ADDED furnace to scope of work. BUILDING Floor Areas Required Setbacks Required Stories: Bedrooms: First: sf Basement: sf Left: Parking Spaces: Height: Bathrooms: Second: sf Garage: sf Front: Smoke Dwelling Units: Third: sf Right: Detectors: Total: sf Value: $140,000.00 Rear: PLUMBING Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: 2 Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs/Showers: 2 Garbage Disp: Water Heaters: 1 Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Tvpes Air Conditioning: N Vent Fans: Clothes Dryers: Heat Pump: N Hoods: Other Units: Furn<100K: 1 Vents: Woodstoves: Gas Outlets: Furn>=100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0-200 amp: 0-200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 20 1-400 amp: 201-400 amp: 1st W/O Svc/Fdr: Limited Energy: 401-600 amp: 401-600 amp: Ea add'I Br Cir: 601-1000 amp: 601+amp-1000v: 1000+amp/volt: ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) JENSEN 9645 SW BRENTWOOD PL TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $2,758.09 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 t ough OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.16699 or 1 800.332.2344. Issued By: Permittee Signature: Q i AQQ k ..- CITY OF TIGARD MASTER PERMIT '� '-- COMMUNITY DEVELOPMENT Permit #: MST2010 -00011 .TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/14/2010 e Parcel: 25111 CD03100 Jurisdiction: Tigard Site address: 9645 SW BRENTWOOD PL Subdivision: SUMMERFIELD NO.9 Lot: 520 Project: Jensen Project Description: Fire repair. BUILDING Floor Areas Required Setbacks Required Stories: Bedrooms: First: sf Basement: sf Left: Parking Spaces: Height' Bathrooms: Second: sf Garage: sf Front: Smoke Dwelling Units' Third: sf Right: Detectors: Total: sf Value: $140,000.00 Rear: PLUMBING Sinks. Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: 2 Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs /Showers: 2 Garbage Disp: Water Heaters: 1 Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers: Heat Pump: N Hoods: Other Units: Fum <100K Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr. Ea add'I 500 sf: 20 1-400 amp: 201 -400 amp: 1st W/O Svc/Fdr Limited Energy: 401 -600 amp: 401 -600 amp: Ea add! Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) JENSEN 9645 SW BRENTWOOD PL TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $2,657.29 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 - in accor.a - , ith 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 • -. ys. ATTENTION: Oregon -w = •uires 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 -: 3 1 -01 80 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246.669• or 1.800.332.2344. /jl r ssued By: , ___■ - A �, Permittee Signature: a<- /, •Bu _ ermit Application Residential FOR OFFICE .USE O \Ll 5 Received i �ermitNo.: 71 City of Tigard Date/By: �` V 1.100// a 131 25 SW Hall Blvd., Tigard, OR 97223 JAN 14 2 01 0 Plan Review B : � �. Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 Date C ites -- — 'TIGARD Inspection Line: 503.639.4175 Date Read B Juris: 0 See Page 2 for Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION • ' TYPE OF WORK REQUIRED DATA': -1- AND 2 -FAMRY DWELLING El New construction ❑Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all El Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ` CATEGORY OF CONSTRUCTION work indicated on this application. -- I� 1 - and 2- family dwelling ❑ Commercial/industrial Valuation: $ v _ / � ❑ Accessory building ❑ Multi - family Number of bedrooms: E] Master builder Cl Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION' Total nu of floors: Job site address: L New dwelling area: square feet c•e City/State /ZIP: c, rJ E c\ ,--i q'--1 Gara /carport area: square feet Suite/bldg. /apt. no.: J Project name: t, �� c , Covered porch area: square feet Cross street/directions to job site: n ,,..,�.,, r Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: r. 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) o, ail equipment, materials, labor, overhead, and the pro it for the DESCRIPTION OF, W ORK - ' work indicated on this application. 44 (� Valuation: $ - In ., $ ' , 1 l r;,_-)- : L , c[ �r\ !?l {-� i ,, (, ` - ' ^ P 1 Existing building area: square feet New building area: square feet . PROPE OWNER 1 ❑ TENANT Number of stories: Name: ( c, ` c„, v, 7 t , eye Type of construction: Address: C\ �� Li c) S L3 R,.F --n-+ 4; e -: 0 i ' L - Occupancy groups: City/State/ZIP: ty 7 J can A , L' C I r,) a t-{ Existing: ---- - - - - -- Phone: (C) U (,..„ :-_,4 ('.a -- i 1 „2 Fax: ( ) New: • ® APPLICANT 0 CONTACT ,PERSON NOTICE Business name: i, ` L` -, , S i t { � i rt ,_\ All contractors and subcontractors are requ to be Contact name: nn licensed with the Oregon Construction Contractors Board .� c i •S t'., c-.. e; 5 - under ORS 701 and may be required to be licensed in the Address: `7 '7'1,, () L `. r• r -1 ; .., i r jurisdiction in which work is being performed. If the City/State /ZIP: 7 Q. applicant is exempt from licensing, the following reasons c : C 4 _ (c'. r� r t` , 4. y� ` apply: — Phone: ( _ f i 3 ) 6 . ; C: g 0 c., Fax:: ( ' ) 6 .-`1 Li - C . 'r) 'z, E -mail: • CONTRACTOR, Business name: /()) BUILDING PERMIT FEES* Address: —7 t ,' . c (Please refer to fee schedule) City/State /ZIP: _ r � Structural plan review fee (or deposit): G d c : 1 1 ~7 : FLS plan review fee (if applicable): Phone: OD-9 (r '). c Fax: (5c3) <_,.:1) ci — c C, ".t '?. CCB lic.: ` Total fees due upon application: '^i � , Amount received: Authorized signature: •lam This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: n c Date: 1 / 1 ( / (L} * Fee methodology set by Tri- County Building industry Service Board. .10 09:30a Columbia Heating /Cooling 503 - 598 -0270 p.2 Mechanical Permit Applica ii i h,CEIVED 1 Of, ohl 1(l. I S! O \1,1 City of Tigard Received C u ♦ i . ,.I i • 13125 SW Hall Blvd., Tigard, OR 97223j AN 2 8 2010 Date By: i''� M Phone: 503.639.4171 Fax: 503.598.1960 Plan Review TIGARD Inspection Lin:: 503.639.4175 Date/By: Other Permit: Internet: www.tig2rd ocgev CITY OF TIGARD Date Ready /By: t:r : El Sec Page 2 for • BUILDING DIVISION Notifed/Mcthod: i sq, Supplemental Information TYPE OF WORK • . • • •COMMERCIAL FEE* SCHEDULE -- USE CHECKLIST ID Ncw• construction Addit ion/alterationireplacement Mechanical permit fees' arc based on the value of the work ❑ Demolition performed. Indicate the value (rounded to the nearest dollar) of all ❑ O ther: mcchanica: materials, equipment, labor, overhead. and profit. ■ CATEGORY OF:•CONSTRUCTION . value: S --and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES* For special injormounn tine checklist ❑ Multi- family 0 Master builder ❑ Other: Descr :ption Qty. . Ea. I total JOB SITE INFORMATION AND LOCATION . fleating/cooling !nh site addrt s: Ci / ► L - *. Air conditioning � • S (requires site plan sltorir.g placement: 46. 75 t :v/Stetc /ZIP: ! I a Al i - � Furnace 100,0`00 BTU (duc:s+vents) i 46. V1 Furnace 100.000+ BTU SU itc•'bldelapt. no.: Project name: BTU (decsven) 54.91 Heat pump 61.06 Cross strcetidirecti to job site: Duct work 1 23.32 Hydron is hot water system i 23.32 • Residential bailer (radiator or hydronic) 23.32 Unit heaters (fuel - type, not electric), in -wall, in -duct, suspended, etc. 46.75 Stthci v i s intt: . Flue /vent for ar.y of above 1 23.32 j Lot no.: Other: - 23.32 a' map/parcel no.. Other fuel appliances DESCRIPTION OF W RK..:. Water heater 23.32 � _ _I `•mi � Ir, ", -,_ i Fluev vent 33.39 - -1 I .9t0_ y�-t��� ___,/ Flue vent for water heater or gat fireplace 23.32 t Log lighter (gas) 23 Wood/pellet stout 33.39 • Wood fireplace:insert 23.32 ❑ PROPERTY OWNER Chimney.9iner /flue vent 23.32 ❑ TENANT Other 23.32 I Name: Environmental exhaust and ventilation : \ ddr�ss: f' /1 1 .I � Range hood/other kitcnen �.�' 11 /e! _ - � / equipment 33.39 is i :!State ZlP: 7 / ! Clothes dryer exhaust 33.39 I Single -duct exhaust .;bathrooms. Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT :.❑ CONTACT PERSON Atticicrawlspace fans 23.32 Business name: Other: 23.32 Fuel piping (.c'ntac: name: r / 2 K /- i a , f }71 eeC �! f 1! / f � / � 514.15 for first four; 54.03 for each additional Address: Furnace. etc. • Gas neat pump 1 j CitS : :ti :atc71P: , , p ,s� WalUsuspendcd/unit hca :cr • Ph. n=: ,.3i ( ,, a -.a i Fax:: )3 G q t , - ) 7Q Water heater F. - mail: Fireplace I Range CONTRACTOR:. . Barbecue Business name: CO� f m /� /� t Clothes dryer (gas) -_ : \tldrMsc: 7� p - ` X - IF )� Other: l p L � �` ��� / / • MECHANICAL PERMIT FEES`.. ' City; ,atc7.IP: 7 j n r) O G' p) Subtotal Phone. ) /p , ^ 1 Fa x: D ( / �C� _ Minimum permit fee permit f e e ) i -col_ �� Plan review (25 % of permit fee) -3 CCA lic.: 7<ntasy State surcharge (12% of permit fee) f ' / TOTAL PERMIT FEE 160 . P0 Authorized s�tatur�f ,(1 p�� This permit application expires if a permit is not obtained within ` ' v ` day's after it has been accepted a$ complete. I Print name: - (y,^ e a / 7)) Date: ' Fee methodology set try 'ri County Building industry Service Board I - .: 1. .!.i.na•PntriiA.i5C.Permit.np dm INftl17) 445.46iT7 (ttlO2/COM/.y'tB) blu, v oiu .4i 4 Coakn9 Electrical Permit A Licari �. - - - 1'OR OFFYt i O' LY City of Tigard g R«;r:ived PCtQ1tI �a?O(O - l " t 13125 SW Mall Blvd.. Tigard, OR 972.x} "sA �� y • DateJB : No.: v Gai Phone: 503.639.4171 Fax: 5O359& !4d � 1 L U I U Ptah xcv'ew _ Date%6 • C7thcr Pcrmil: T lnspcctionLinc 503.639.4175 DateReady /By: luri3: SetPagc. for • lntcrnet: www ^tigard or.gov C {Ty OF TIGARD Notificd/Mcthod; Supp(ement 1 Jpforw9tion � m B " . T ii � iV' h"Rkv'+r ,I r � �'Ig r J6W$ prr °w i * p N r!m I ', '�,W+r i� ' ° ', "t "�'Lw�iai�1'- ,G�'Y ..^?i " ;�1� Pj� ,� �' y""7h�� i "g� ��. m�''� i�14'�Sn }, Y"' -. Y �r^nr•�,� ro s ❑ New construction 1.'d Addition /alteration/replacement Ploasc check all that apply (sutmlit a seta of phms w /items checked below): ❑ Dcrn01 1t10n • Oilier: ❑ Serviee or feeder 400 amps or more fl building over throe stories. " r �� g , p � ! �J`'•' M db7i6. n ,»w *.,� where the available fault current Cl Marinas and boatyzRds. uu1�lW" F^ r -?' kw a 3 R'R'6'@ m : R� 'ir . r, iV >; lom .tin •. , , ., a , ,... �� 1 'i� �'• II „ g� ar �..I� c__,., ., .1 exceeds [0,000 am F s at 150 volts or ❑• Kbniidinga. 1 - and 2 - family dwelling ❑ Commercia1/industrial ❑ Accessor ii Idin amps to r t of or cacaeds 14,000 © C:ommcrcisl -use agi'iculwral ry g amps for all other instaliations. buildings. ❑ Multi - family ❑ Master builder ❑ Other Cl Xirn pump- Cl Installation of 75 KVI\ or r t+ a °. "'!I'`W �ad4 awausacli ^ t ' ; ° m rr {RII bwWp ,.I d F.mCigcncysy5iem. t argCf 42NePalely derived 5Y5tem. ❑Addition of new motor load of ❑ `A" ");° `1 2" "I 3° Job no.; _ Job site address �rF 11(� I . � (ooFll' or mom. occupancy. Cl Six or atnre nsideutia3 units. ❑ Recreativnal vehicle parks. City /State/ZIP: � � ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldgJapt. no.: Proj nam e: c,y / G -.._.- ❑ Service or feeder 600 amps or more. Cross street/directions to job site: F � t 6 rt'wt ncscriprien • Fcf New residential single- or multi- family dwelling unit_ Includes attached garage. • Subdivision_ Lot no.; 1,000 sq. ft or less I 165.54 4 T map /parcel no.; Ea. sdd'1 - 500 sq. ft. or portion 33.92 1 l Limited enerbry, residential �,G, � y i uaw��,,�. �, t F (with above sq. it ) 67.84 2 40 I l.iruited energy, multi - family • I4 / ' / jO ! �'� residential (with above sq. ft.) 67.84 2 Services or feeders installation, alteration, and/or relocation w �, � 200 amps or less 100.70 2 t r `t' ' ' e P' h ^� IVry:I J , 1'S �P; N k g" ` � gg � 201 amps to 400 amps 133.56 2 Name: • 401 amps to 600 amps 200.34 2 601 amps to 1.000 amps 301.04 • 2 Address_ _ Ovcr 1.000 amps or volts _ 552.26 2 City /State/71P - Temporary services or feeders installation, alteration, and /or relocation _ Phone; ( ) Fax: ( ) 200 amps or less 5936 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange according to ORS 447, 449, 670, and 701. 401 tamps to 599 amps 168.54 2 Owner signature: Date: Branch circuits - new, alteration, or extension, l tr panel a e r s t �I t _ A. Fee fvr branch circuits with $,Jwr ,� r 6 ",Y•�r� r 4 '�' +I U�,, EZ¢�, ,i,�', I Ana tiv'!r; rr r "' Ala „ru ( i I- I ,, , above Service or feeder fee, 9 each branch circuit 7.43 2 Business name: \ - B. Fee for branch circuits Contact name: - without service or fader fed E 56.18 ) / 2 first branch circuit Address= • Each add'I branch circuit 7Z) 7.42 74 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manutactured or modular Phone :( ) Fax ::( ) dwcllina, service and/or feeder b7,84 2 _ Reconnect only 67.54 2 E -mail: Pump or irrigation circle 67.84 2 ll nli.i i �'�' � �� up � 'm v „ry�ry �-- I .16I 6:4ps, a' to �l h„ YIN'Iw ' p�`... 'a Illty i! iri �ir' 1 �4.' �0 Signor outline llghtmg 67.84 2 Business name: 3 LL! r'e.5 Par" ' S {final circuits) Or limied - ;7� r energy panel, alteration , or Address: (� X / '6./ extension. Describe: Page 2 2 _ Each additlonsl inspection over allowable in any of the above _ Fer inspection Phone: r / D Fax: ( 66.25 l �' �J / Investigation per hour (1 hr min) 66.25 CCB Lie.; i 3 dJ5 Electrical Lic -///( Suprv. Lie.; Industrial plant per hour 78.18 . Electrician Si�taturc r - _ 'I •,�w Y „,,.rr ; �, „� ;,- a, ,� equ ht 1 t Supry El ` . ; �" • Date: + Subtotal: /# 7 - Print na . me Plan review (25 %of permit fcc): ��/ Y � i / State surch e I2 %of erg ( Permit fnc): I � - 1 Authorized signature: TOTAL PERMIT 1 EE: r'= Print name- : Date. permit application expires tra permit is not obtained wit to 80 days after it has been accepted as COmprete 1:'Buir PcrmiteP.C-reuit.4pp.doc 10/01/09 440.aGi1T(tt /05 /COM/WPB Number of u>Sr>ectipn5 allowed per permit. Z00 /Z00 d LLbtr# 8Ia18313 S]HIfllJS LE8�E93EO9 LOS IL OIOZ /VL /LO Plumbing Permit A t 'ilea ; , I )k jj`}`� ; `•..i • it , Building Fixtures ` ' 1 t)11 It l: 1'SF. 011,1• City of Tigard Received Permit No ": q 13125 SW Hall Blvd., Tigard, OR 972 N 1 4 2010 DateB . /D N�a O �/ P Itevicw o Phone. 503.639.4171 Pant: 503.598.1960 Date/By; Other Permit No " ": '1• I C i A it i) inspection Line: 503.6394175 CITY OF TIGARD Date Ready/By: Suds: El See Page 2 for Internet www.tigard-or.gov Notifed/Method: supplemental Information � . 'WPC-CM lCXPE..OF ` 1 m • F SC133;AULE ❑ New construction ❑ Demolition • Far special lr ormatton use checklist Description I OW. I Ea. I Total - i' 1 • ition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) - CATEGO,RY OP CONSTRUCTION .:. SFR (1) bath - 312.70 1 and 2 -fimil dwelling SFR (2) bath 43738 y g � Commercial/industrial SFR (3) bath 500.32 0 Accessory building 0 Multi - family . Each additional batb/kitchcn 25.02 ❑ Master builder 0 Other: Fire sprinkler ( ... „sq. ft) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 91,45 s u 7 T: 34 .- cn t wert d IpL. Catch basin or area drain 18.76 Drywall, leach line, or trench drain 18.76 City/ State/ZIP: ti ( y Q 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 Plain drain connector I8,76 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no, linear ft.: ) Page 2 A "� Water service (no. linear ft.: ) Page 2 Subdivision: 1 Lot no,: , Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 _ DESCRIPTION' OF 'WORT[: Backwater valve 12.51 Sin Clothes washer 25.02 1* ' -� - i l -e„.4-- Yl STt �� Dishwasher 25.02 / O 1-) rr • II " V1 Drinking fountain 25.02 W Ejectors/sump 25.02 • 0 PROPERTY OWNER- .. • • ` Li' TENAINT - Expansion tank - 12.51 • Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: • Garbage disposal 25.02 City /State/ZIP: Hose bib 25.02 - Phone: ( ) Fax: ( ) Ice maker 12.51 • ❑ APPLICANT • ; ..' , ..'. ," :. ;. • .:,; ` • ,:0 OON`I'ACJ('• PERSON . . Interceptor /grease trap 25.02 Medical gas (value: $ ) Page 2 Business name: __ . Primer • 12.51 Contact name: Roof drain (commercial) 12.51 Address- T 51).04 Sirlk/basin/laVatory 25 .02 City/ State/ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub / shower /shower pan 2 12.51 0 S . 0 E -mail: Urinal 25.02 CONTRACTOR " Water closet 25.02 n= Water heater I 37.52 -7, 52_ J3usiness name: v : w [� */� am At to - W , Water piping/DWV 56.29 Address: . ( ),3 . _.y do ' Q.. f � t i Other: 25,02 mi. - City / State/ZIP. k)1 J 1 j A 0 0 AP _ Subtotal / f ,r! Phone: (0,O j 0' -269s- F ax: t t a 5- f Minimum permit fee: $72.50 CCE Lie.: ) 2,D% Plumbing Lic_ no.: 51.4_ Plan review (25% of permit fee) State surcharge (12% of permit fee) _ ! - , 5 Authorized signature: v . I TOTAL PERMIT FEE I, 2./..., o) s t- e . ir Date: This permit application expires if a permit is not Obtained within 180 days . �, after it has been accepted as complete. ' r , 1 � � "pee methodology sot by Tn -County Building Industry See vice Board I: 1I3u�ld pp.doc MI +9 44o.4616T(Ic/02/COMAVE13) 7171/Tl - 4)t�'i--1 fTt.nst?7 bTgRPR7RI 7T:7T pTl7 /bT /Tl PlumbilnE Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire ression stems; . .._ ,:,y, >r ""-, u�n. 5 �:. ,. ��,.. .�,..�. ti y , q j + y e r N4;. 1 "� l :"�� c, tM °� sd ha eSur rr n se } �7 � x � S'• �J�� �`t iy j( � { /� f '91 '''� I { ; �s i,( U f t I, Vi } � j '��C {y [ 1�1�(y ' ( 'Y, 7, S - ^ 1 t 7 '''' "Fzu�� ' x ' , '., R ✓C,'�A L . -'' I; � }y., ;;; Se. V.f "g•-*r �i4t,'J =.: w1.�.1,.ar..,L: . 115.00 'Footing drain -1" 100' 55.00 0 to 2 000 2001w3600 $160.00 Footing drain •each additional 100' 46.40 ME 3,601 to 7 200 $220.00 Sewer - 1st 100' -. 55.00 7 201 and : ater $309.00 Sewer - each additional 100' 40.40 Water Service - 1st 100' MI 55.00 allil Medical Gas S stems: each additional 100' " _ ,� ^. A n "'e .. y, wT' 3 1 i � + �' Water Service 1 0' 46.40 , i7 D?`C'n' � . � I , '�., ` ' r, -?) }K •.fie.: �,� • u'r.i ae 3,Sr .t� �.CM1:� ;s�� l .„7, - ; ,, .n, ,¢YJ vI i L - Storm &Rain Drain -1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 51.52 for each �,7, �... 1 , ,.�., Rr: '•1�..•;1'x .....:,..,4,,v. ryi T'• �4n h ,- y i 7755 n.' t' : �. i.7. : ` 1 � / additional $ 100 -00 or fraction thereof, to and ncludin $10,000.00. j: " i.,~ ..,•.:... + , ' •• , � ~ . 'r ... . ...,.'�,: � , R� :� i,. .,VA43k .ueY�'1]( t Commercial Back Flow Prevention Device 46.40 NM $10.001.00 to $25,000.00 $148,50 for the first $10,000.00 and $1. for Residential Backflow Prevention Device IIII each additional $100.00 or fraction thereof, to minimum .:..'t fee $36.25 2735 and including $25,00040. Rain Drain, single family dwelling MINK= $25.001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and includin . $50 000.00 s. ciall • ested ins•eetions - 'sr hour IN 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: MINIM each additional $100.00 or fraction thereof. „ y c r.-r ..., r ` }- ,0, r vg.,- , i° 1 Eixture Work: e E -Y `F , : J z , . . . .: � .: . 1,: i f! ;% - ;�Yx, t,:•�3 �. ...�s , Cl }Y ?..r i if 3 ti ,- � bin; , Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accuri tel re , r rt fixtures could result in increased sewer fees*. 0 Any new commercial building with water service 2" and �� . ,��,.,. .. , , �. ,, , , greater, except systems designed and stamped by licensed aq :? ?l , ;, iti it y' . il `s }, ? % : - . - ;`1 6,.' : ":.1.i=.i � ^f�1. :i r. t4 G tiYzle, , ,.r j � jf�,. �� ,� l t , ` , a >� ,; " }� t` �t '"" " r i "$ ❑ Any n w exterior plumbing site utilities. U „ , ,,,.;,- ,• , s _ a s, ,.,: <i :1 �. _6. # _.� .. r � .� •�• ` 0 Medical gas and vacuum systems for health care facilities. B; t Bath /Font � � � 0 Any multipurpose fire sprinkler system. Bath : acu.7 how - ,lacuzeilVlihid + +•1 (] Any complex structure as defined in OAR918- 784 - 1 3040. Car Wash -Each Stall a -Drive tall Submit 2 sets of plans with any of the above. tdor/Water.As nrato � �:� � - ,,..,„.,... , ,: � t , • �•:&R�z�3=:k,^. • �'�U,Wa 7 . ���''x €�`.y. �a�. >, ;• �, as :�,, Dishwasher - Commercial '•' '.� . 1 �k. `� rcly :} $ a 1 tS ; 'i S : 4C �i b � .... - Domestic �� r Isometric or riser diagram is required for new buildings D rirnkin Fountain e ,WashENIEM. that meet the ualifiea a bove . Floor Drain/sink - 2" 1I -3 " Comments regarding fixture work: -4" Car Wash Drain Garbage - Domestic - Disposal - Commercial -Industrial Ice Mach./Refri Drains • n 'castor as canon 111111.11111.11111M1 I Rcc. Vehicle Dum. Station Milli Shower - Gang M*Note: If the fixture work under this permit results in an - Stall increase of sewer ED'Us, a sewer permit will be issued and Sink - Bar/Lavatory fees assessed for the sewer increase must be paid before the - Bradley plumbing permit can be issued. - Commercial -Service Swimming - Pool Filter W a Washer Clothes s Water Extractor _ W 1.111 1.11M11111"1 ater Closet - Toilet � Urinal Other Fixtures: - ,na.,:ur- .ao.w1.1PT ,A.MrmrtAne.dac 09)22/06 7A/7A n17- -I frv: -- )n bTgf,F .PAq 7T:7T nTta' /t'TITn ' Main Level I , I f I 122' 162' t_ JL-4 , 1, r 87-- ■ I EattilReol. n ' 1 1 . n . l\ C.:‘,...\- - Ce" ' • . .,, 1;.)) ) ( 1 - 2... "--- 3 C 3 t.-. e3 C ,, SC-: r I Ile t;_ , , Meotln Ord ..C ZD 1., Ll_ •- ___..... , -II •" ( (1 . 4 14 1 II ' I ' \ T 3 1(., 1" 4 \ -.:.. t.- N ia 0 .i L.:...-.0,.. \\ es.Kk- . — \ v• k , , -DC..k..\\<1 .,t ■; '...- r±i -9 , i'6,,. .., . ... ,, N ..\\......... .. ,N,._, .t,!r ,.. Anrc--1,.„,-::: > .., I— 4 - ---• _W- ' 1: ' I 1.: 1 . (BO - 5 ) PC. ,--•- .'",'--) \,&:. \ Co....., '‘,1 ( c 5, 0.. -,,- --, " ic li-e 2 (ISO) it ir-k. % P 11 1.-E l' '''S fe• - M4Z1re Flev1h 1 ' ,j, Ti J 1 C-'.."s r(i Fri -- if$ - , ._ .. ',.....` 7..i• t,.., 417_ 1 1t011 1 . .1.11L ,... 1 . 5.1 " . i_ ;:, 1:— .----------------- 0 ',. ;-.. sutti, II i' E - 1 4 - V I ii • ur..• Co) 941-&te \ t C D/ c:A.- e,c A. ,, ,.....:\X I _i_ 0 ,. _i_.,1 , , , ,-. . ._ , i 1 I _ _ \.....) e ..... 'C.,- c: J, c...• ... N. / a S'A c ,..c 4? ( fi:':•ei,'1. Fir stated In watt heatet closet II. _ t— 5 7,31 4,11- 1 10 r — • q. - - t ‘4 - . ii T ,,,T \ , . West Bath 1 ' ll° - 7) 2 - (5 c._.A— Pc-, c k•- (.....:D4 V k, (_.> I Hay Ripi ? ■ '1, .51V ,' • , .." ,,-- : :i - 1. 1 „..,.. j'a ;7. t—li k, . ■ P ., •;,‘ , 1 I t., West. Elet990■11 1FF 1 1 1 , ii: i A) LIvInylillarri 1 .‘ / ...1 ) — _ 163 __. 1 I i • 1-2•311•1 15 t • 5 3 9 --, _ ' :-. 661666 Main Level 16940-P0 11/22/2009 Page: 10 i) 1