Permit ', . MASTER PERMIT
'' '"` CITY OF TIGARD
It` a - COMMUNITY DEVELOPMENT Permit #: MST2010 -00050
t D, GAA 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2010
4
ra.ti Parcel: 2S104CC06600
Jurisdiction: TIG
Site address: 13679 SW ASCENSION DR
Subdivision: Lot:
Project: SPOONER
Project Description: Converting 341 square feet of crawl space to habitable space.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 1 First: 0 sf Basement: 400 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes
Total: sf Value: $39,180.00 Rear: 0
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures:
Tubs /Showers: Garbage Disp: Water Heaters: 1 Water Lines: Drains:
Bckflw Prevntr:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers:
Natural Gas Heat Pump: N Hoods: Other Units:
Fum <100K: 1 Vents: Woodstoves: Gas Outlets: 1
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 addl 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 8 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)
DAVID SPOONER SHELBURNE DEVELOPMENT
13679 SW ASCENSION 7008 SW NYBERG RD
TIGARD, OR 97281 TUALATIN, OR 97062
PHONE: PHONE: 503 -692 -6383
FAX: 503- 692 -5760
Total Fees: $1,340.99
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
b ne in acco ce 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
ays. ATTENTION: r- eon I- requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA • 2-001-0 a I. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246. r 1.8 . 2.2344.
1 ssued By: — 0 ` / Permittee Signature: / s
r; .;`~ '5(9 7 (o - Z C.
Banding Permit Application
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Commercial , , `t 1 1 -_. f :wr, nth ,,,,-• ;ta"�� ne l ( YI i i',1 ',, ,() � ,i, ir Nos, t�i�G r i ; � lr , 1, , ,; 4:4Q "
City of Tigard u P , , I { , I Dat ve
lig '� � �„�' - ' ate 1 , Permit No. . _ 6• AS
'' ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review iii
Phone: 503.639.4171 Fax: 503.598.1960 APR p ®•6 /B DateB : � � ►�(�� Other Permit:
1. i / n it l i Inspection Line: 503.639.4175 Date Ready /By: A � ® See Page 2 for
Internet: www.tigard - or.gov AI Notified/Method. i c, __`■ Supplemental Information
r" "1 r"‘ ''-'5-‘: 1 ' c' :q 5 177., ✓
t I 1 -
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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
vi Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
• CATEGORY OF CONSTRUCTION• work indicated on this application.
•
ON 1- and 2- family dwelling ❑ Commercial /industrial Valuation:) 180 S
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION . - Total number of floors:
Job site address: 1367 514 JC er 10 kJ 12k. , New dwelling area: q§ uare feed
City /State /ZIP: '77 C,k() Q 1 9 7)-23 Garage /carport area: square feet
Suite/bldg. /apt. no.: ' Project name: 5' N e _ it Covered porch area: square feet
Cross street/directions to job site: Qe,NL v 1 . % , t ) `1-0 M (S-me -toe Deck area: square feet
I l S t L t ' TO e . `r() /- SC en) 5 ' 0 r . ) , Other structure area: square feet
REQUIRED DATA: COMMERCIAL -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
- DESCRIPTION OF WORK . . work indicated on this application.
FRAmt46 (d P-Cs X 95 Room (•V c L sPAe. App Valuation: $
3 'W e o ows, met_ et_ , S ke e?'-T R-c) C lC 4. A) 0 CGS ' o litoiti Existing building area: square feet
IZ O 0 M . - New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
r ame: O u e V-- K,,t �e (,) 6 (QO Ne ( Type of construction:
.ddress: 13 7 ? 4 q 4S C e J ( d /) D g Occupancy groups:
City /State /ZIP: 7 6 Alan t 0 k ' 3 Existing:
Phone: (-o 3) 307 7 920.5• Fax: ( ) New:
or APPLICANT ❑ CONTACT PERSON NOTICE .
Business name: S He L J3K g_n/ 2 Q C U co P me Arr All contractors and subcontractors are required to be
Contact name: " N e i N 2-e licensed with the Oregon Construction Contractors Board
�i n under ORS 701 and may be required to be licensed in the
I Address: 700 r� S ( �V xI a ek 6 A-0 - jurisdiction in which work is being performed. If the
City /State /ZiP: - g4-4-r(/s/ 0J. -70 6Z applicant is exempt from licensing, the following reasons
/ a p I
Phone: (503) (?2 63 3 1 Fax: : ( So3) C a / 2 5-760
0
4 E -mail: j hshet.[3412hie C ykkoo, COvl,
A , CONTRACTOR .
Business name: S YT C'Lgld (ANC Ole t) a..o p /Vienrr - • BUILDING PERMIT FEES*
Address: 700 g s- vO, API 13 c 12 G iQ 0 (Please refer to fee schedule)
•
City /State /ZIP: MA /..) O k Ct 7062 Structural plan review fee (or deposit):
p 1 FLS plan review fee (if applicable):
Phone: (503) 6! 2' 6 3 0 �i 3 Fax: ($o3) O T 57
p Q
ccv CCB lic.: 1123 gg (1 / kit Total fees due upon application: A / [ CQ .
Amount received: `
Authorized signature: . This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: .77e4 /4 (' 2.0 Date: Li-I,6 bp * Fee methodology set by Tri- County Building Industry
Service Board.
L: \Building\Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(I1 /02 /COM/WEB) '/l ill u 7q
$
Building .Division
Accessibility: Barrier Removal Improvement Plan
T I ri 11:1 4 .
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done, �x
excluding painting and wallpapering: [1] $ K000
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
•
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It ' . waived
'1 City of Tigard 0 . 6 2010 promo pir,...
....__. _______._ ._ .•
' API? Plea govrow
:,,,,,,.... ,' V",., 1 mum: S03.639.4171 Fax: 503.590.1960 , ..uld•_ji_i , 0ther Yoram:
„„ ,,' ; ei• ,,,41 !aspersion Line 503.09.4175 CITY OF TIGARD mato Roady/By. • ions --- Tsii 7 6 - ZileTw
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ir; ,:,, r '.■ 4 ';'' Istleastat: taw*. tigard• or StesifigatAteshed: an fialatolli infatrototrue 1
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Pleas* chock all Mai apply (rehash Z seas of plane v items attacked below)!
ID New exiastruction '7..: • dditiorlialtrrationfropincoment
0 Rapine or (coder 400 Burps or more ID 13014 op ova rime wont
Li Demolition 0 Other when: lea uwelabla fault anneal 0 Mw* g nod bratty/IPA.
%;:lagit.C.111477MttliTATI";;;;:;C:f.:::::'.:+.:';Y....1.;':!.:,;.:17.!";'.;175:i7..'''...5'ie.if(in',''''::?biatdA snoods 10.000 amps at 150 yoke or 0 llama a tiailalass
broom annual. or outworn 14.060 1:1 Cone, Istdal,se asrion It ... it
Z! 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building vow hi all uthrt Itarealltaioar. Huildi pl.
• Multi-fesnily 0 Muster bulhicr III Other: 0 Pin pomp. 0 WWI 11101I Of /5 KVA to.
. ■ ...,....., 0 Pmergoacy Aron bow separately dot lYed 'Mon
Witt,. .•,i'. l?T ' Vyr :':',' i ' . 1''s( " 7:':; ; :.4: i ' l .: ; * : °,‘ :: ',.. j: ': 47 '' ?;.. - '' ' ' '' . '-;1 1 11 itt. . wc= D Addgewnafraw rivor w 4
111M14Parmar. °Mal any.
lob no.: ica' 9 ite odd j,3 - 7 S.) /1 06 0 so, or mere iesleltn eat emits. CI NAN s or al vehicle fate.
. -......-
0 Ineallnowo facilitate 0 Supp • *novo for flaky . Ilastt
City/State/ZIP: Ti 6 4. 0 R
CI Wintstous Log:aliens. 61.41 Its 41C4nimot
t ........ _
CI Sergio° or haler 600 •• • • or wow.
Suite/bldg./apt. no.: Project namo:
— ' ' ----- ,1 :..41.5. '. Ifii
Cross street/directions to Job site: aeNclei, u 1 ei,,) To m( stte_t/) c. ).-
, ... -....._ ...„ .■ ...
New rosidearfal single or multi-fernlly dr. riling mill.
M L b ri- e.0 E - to A-sce
—. Includes attached ars e. ...... ... _... . , . ..
Subdivision: T Lot no.: , I,00n eq. II or loss 954 71
-. ----- -- • — -- "•— Re adn'l Soo , ft. or portion 31.02 1
LIM map/parcel no.:
Unntat meta", reeicksttial
r$ , 2 -
f.:„ , ■;.t.tt. , .4',■ • :.11", :•;'''5gifi . 7f IfT.,:7;?:''.7;1' (with above so. B. 7,84 .-., . ...... .—
Li otited energy. mulli-tiunily
0?./ 4
WU etil) R- 1 C_OOt (4N s-rA-Li- 5e-ea-PA-le residential twith obeys ii q ft -,
-
:
S es ervic or &oder& [Natalia alteration aaruor relocation
( L A. i.-F 12_ ... , 200 amps Or leur 00,70 2
„piste c_ e r
717, .;.,N.c,...!4 ';','''?'11k". "A;.3r.r.4"i'l\WW;SAW'rta ;•I'''''?r'fIrr"."..tflotit:::! Wrenn - 33.56 2
I: ' ........ 44 ,:., .t,i'l \ - ' — . _ . , _. — .-......
401 pimps to 600 amyl 911.34 2
Nantes Otiku e_ _ yk_eA) 5 .
601 °Sopa 10 1.000 arapt 01.04 — —
2
Addre 13 6 7 ? .LA) A-s c eN sic) A/ 19 R. ova 1,000 amps or _ . voila
- — —
1 t OR_ _ - lemporary **rakes or feeders Installerlo ., attsralion. andior
l:lty/Statc/ZIP: 6.,1240 _r_e_ipta 1110 II
„ .
Phone: ( 503) 3c.) 7 qp-05 J_Fax,( ) 200 umps or 1166
- 59,36 _
-I 1
Owner Installation: This installation is being made on properly that I own which is net °1 4V° "PI _
to
intended for tido, lease, rent, or exchange, according to ()RS 447, a4C, 670, and 701. 401 amps 599 anger 68.54
Stands tirade; - new.LalteratiOri, or 1R !i yct peol
Ownix signature:_ ,. . , Dee: — A. Pee tin brash ciroutta war - -
i l';iiiii-7".:,.;.• 7.'71.,....,■:::;'',:j.tr',rf;(::::4i,i-i,M%-,!'"'..7rfi,..:Pligqr":r.■r-'''':..•:'C''7•:'''.•4'..;•:';:i.'-''7itilt,r.,.51' above rorvica or fucker feu,
7
each brertch Oltverit . _
Business Dame: Ske(-1.340-ove 0 t.ie-i-oPmeA73"- B. Fee tor brood% erourite withoor ,
..-- . .
_
Contact nam ..,.. soviet, or finder fee. first . 1 SK ix r5r (8 2
e "1—e_...c... ketiV2-e bonen eireue
-
Address --- Each WWI brooch circuit 1 427 - 2
: 700 8' L_, Nyas (2_6 0_0 ,
Miscellaneous (service ur feeder apt ito
City/Stule/TIP. - (t PL All ".) i CO e..... 70 62- Each manufactured a/ modular
67 4 __:
H
,..
, dwelling, service milky feeder
Phone: (5() ) s/ -
lux ; • (503 ) 6 ?2_. 576' c) _
Reconncot only 6 1
__.._ - _
_ .._ 7 04 _ . _.
Pump or IM#11111.4) circle 6i4
Elnall: -
• he a — Al/100 CO ...___.. .. .._..-
: : :.... ASt;',:igqd :I uu • teliirolighlinl .— . nr.g4, 2
...,. _.. ..
1 or Min lted-energy
Bushman mune
' -
panel, olteratton, or oxturratore . Page 2 2
Rath addldnaallempecdonover aUci t in an Gault above:
Address: .• i ormr21471111I /
ip Atir4 , • 4, si Ai „rte i • . AdrUnnotil inspection (1 hr min) ,6.15/ of 1 ...
-- / 4 • IMF
• -... .... - ... ....,.
City/Suste/ZIP: _. • / 4 , 1 di I / if Invagligation (I hr min) • 4525, kr .
. ........ _ , ,....
•
Industrial pluut (1 hr rola) '8.18/ be
Phone: (SO - • ...- 55 W ' ) Pr I --- 4 2. ....
Lorpersluna bur where no &Tor
.--, • r
1 1.1,90/ Ile
— a • • ilictd1 Iletod lir lulu
cvn Lic.: i El :. , iv.. Li i er.,m-4r.,. Lic.: 37 TS c;:,,::: ,,,•:.:‘,...1.-[.:,....::. ,rj"..1_ „Hi:.
SlIP(v- Electriciaz rey ...: ir",. 'AK
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; D dal
Pri Subl
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9 1an . rev_lovrj25% orponnit
nt itanie: (.; h v ie.: • , ale: .-
q I Swat surdiarge (12% ofpormit ety 24" --
_. . .....__ _.._ ,...__ ....._ .
Authorized signature:
..._. 1 PERNI11' : ER, giCk- e2 / .
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, nail Plynill IIPPIltsllow =Om 11 8 !WIWI ii net obtahrod wIreer; tee
Print wine
I Dam: days atter Illataa bora aroopear 1 r romper.
.
• Number or rouvocirroar snowed par pciulit
• - -- -
•:0HIldingUrsi AHICHLI,C•HannhApp,doc lu/tri/01
440 . 4 • 11 T(Loomuouvwe0
_. .._......_........_.... _ .
I kg:ITS: T I 0I00 90 *.-lcild SE6LEP920S: ON XdA DI810213 63N30: WO6A
04/06/2010 TUE 13:29 FAX 503 786 3432 PYRAMID HEATING IA 001/001
Rp 06 2010 10:35RM SHELBURNE DEVELOPMENT 503- 692 -5760 p,1
_ f IP
City of Tigard '
Mechanical Permit Application j �� ._ c til. li I �c i t tie n � i ..,.. Permit No.:
1 114
• ] 3125 SW Hall B1vd., Tigard, OR 97223 ` - � " ;' ` Plan Review
• Phone: 503.639.4171 Fes 503.598.1960 Other Permit:
r , � i,': Inspection Line: 503.639.4175 APR 0 ' 6 20 10 D ate/By:
DataRandyBy: hair: l55 Ste Page 2for
IN Internet: www.tigatd Or.gov NotifiedMeQwd: Soppiemenlsllnformation
CITY Of: •TinA P
„ ^G f 'e' t ,�3�.0 -r 1 , J' .i, "4�4,i -t_ 'i',Ttt t �. T ,- YtJ�f'e ,:t"tF54 i-i' 1 SYi f �" .. .1.Ti ` aA. . •fri7 :.
z' `',.. 'ig 't _ ...� '}�^ { i .l 1 , le
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� '. Y '� rr� i �-�.7c'rt , �s}" r fi i 7 � , S a � t I � � I � r , . ? � 'l�.i'ai� . 2 2s.._. r �.-Ci � �i:naR�:�a�.'1.
:. M�z * ' it' .a &:w PIfi,,.E� • .+.,,/i^a.trl. _. t..,31.t , :._a I:.r._�. �f , �nt4.4 r. +rr L. ;. (rr ve = ,,. .a..:.es� �., .v
Mechanical permit fees• are based on the value of the work
❑ New construction la Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
f elk r ai h , n �1� , i s z + a + Value $
X
•hii,'fT .CA r'.. `,.„.. ;tis S�'<m'r:1%.'ail.k.44, r-I. . .. . i' v Y 3:.v , ,,l,r.' 4 ta. . . ' 3
: .?? j M•'`' r15' 0, •∎ . r , i t • %Fc
yrI and 2- family dwelling 0 Commercial/industrial ❑ Accessory building e` `�° '' " "" "'' '' + ?3 u n i x ' t ' d!� s . e' T'' ""�lti� &' °".
For sperm( information use .checklist.
❑ Multi-family
,° ❑ Master builder ❑ Other Description 1 Qty. .1 Ea. 1 Total
i Y 12SV Y '�.5'. n . x r, {.. 1 •r i l r � :97 l 'm4, + <' a : r Heating/ending
1
Job site address: l 3 6 7 C f,ij S ((} AI P12, Air conditioning (requires site plan ahowingplacement) 46.75
City/State/LIP: '1 6 4(2_0 ( ) t z, q 7 )_ 3 Furnace 100,000 BTU (ducts/vents) i 46.75 46175
f Furnace 100,000+ 13TU (ducts/venal) 54.91
Suite/bldg. /apt. no.: ' Project name: Heat pump 61.06
Cross street/directions to job site: j3 &act iii 'f- M ( S TteT-o ° Duct work 2332
SC N S (C, /�I Hydronic hot water system 2332
M ( s ri_e.Tp c to Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electrio),
in wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: I Lot no.:
Other: 23.32
Tax map/parcel no.: Other fuel appliances
n �, 1. e`�`' : �° " •mot q �u T 0' $ '�a.� fir" ' Water heater I 23.32 2.%,"-Z_- / Gas fireplace 33.39
l NS tA - N L(ik) Ft lzn/ACe- Flue vent for water heater or gas
move GAs 1-(Ne- TO pJet■J W fl - t'et2 f}e e LOC L og 23.32
Log lighter (gas) 2132
(N STki -L 6 Re PLY - To / U e_t.) RCO /vt . Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Y t II �, s j �r +ir w y r Chimney /liner /flue /vent 23.32
` c _ 4 . = Sli 7 .clit_ ' ttz.t. :G h :3; ... .. ! 7 ° . z, q . ' 1 ''^
_,.• ea A,c zxro-`7. .,it 1 s r8� �1 Other: 23.32
Name: ) IA) 4- tzAe -e n) 5 f W tJ C e_ Environmental exhaust and ventilation _
Address: 1. 367? SW ASCer)C. f U 0 p4,
Range pment hood/other kitchen
/ ` equipment 3139
City/5tate2JP: ( 6Ag49 ® 17 2`�3 Clothes dryer exhaust 33.39
) Single -duct exhaust (bathrooms,
Phone: 0 ) 307 9,2_0 Fax: ( ) toilet compartments, utility rooms) 23.32
ri�l , .7 , .true `1z� W4'i. '+o a' n. . .r. t•,r F a.F -.. .1 , .y�(_ 7 °�'- 'J Atnc/crewlspaee (unto 23.32
s u " 1 r 11 JT P�� . U t i >raa Y ")
r t ., cc
��,...*.;.1 . . . . �,Y; k r� s:. .:�5 �:yt,. x,�. ^� ,s, +i .i ,t�+.. >, .� ±';�
Business name: /ram.. 1 - 9/106" a• Cpl { l �� Fud 23.32
U Fed piping
Contact name: m. 4 . t> r - t , e , a l-.L 514.15 for first font; S4.03 for each additional
Address: SC�i°I C - - 1 ■� k.,,,--Q.,..., sk p _
Furnace, s heat etc. 1
A. dos heat pump
City/State/ZIP: t(1('1t,lL C. dy2- Ot - 1 2. 2'2 Wall /suspeadedVunitheater
Phone: j''( )1 (fl •-' 2 I Fax:: (51,3 ) .- 3t , l . Z Water heater (! , (4 as
Fireplace
E -mail: 1 b „ t c9 lea - t • G4DY Range
5 r - K � , t 'M ; 1 . n -1 ), f , r i, iY' , {i Frt ' ; '3• - 's a a 4 s 1pi : Barbecue
.._./S 5.t Xtt�7..:N: '1;.4.1 t. }•,r. e •, - �- r_d_.�... �' - ,v.. Ce.. f. t .- . N:.Sr�,��&_
Business name: P/ r ∎ �/► p'1e 1 q - . cam\ 1 8 /3 , 115 (In Clothes dryer (gas)
Other
Addttess: �y /q�qq e y,yt -
�1 ^�� . � 1 it rFe$t� �vA=r _ fr , hr � r a
'La _ L 1 SF lvti A 1 6m�'J W ' , vt`, ttt c'3F �� ,f f 1 ?:x + ..nom. i ,at
City/State/ZIP: (lt\l `w ter. tA,1c t e C::1Z c- --) t f � Subtotal 4 . '22
Minimum permit fee ($90.00) S ,
Phone: (Gjb�j)'7��� GtG 2 J Fax: (p - cj p Z Plan review (25% of permit fee)
CCD Ito.: 5- 3 .R2 3 11 Stec surcharge (12% of permit fee) ( � r eo
• TOTAL PERMIT FEE • 100 ,er)
Authorized signs , 1
This permit application empires it a permit b not obtained within 18t1
i dsys one It has bean aerepted ss wm � pte I Print name: mg Ih o ltd . �L� i� 1 Date: /� r `1 114 I - Foe methodology .al by Tri - Coumy Building Industry Serviw Boatel
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lumbing Permit Application
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City of Tigard as � , ti ' ' -z' 4 Received
Date/By: Permit No.:
11 1114 a 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 APR 0 201 Plan Review
Plan y:
® Other Permit No.:
Inspection Line: 503.639.4175
■•1'1 GA It I)' Ready/By: D Rd mr s: ®See Page 2 for
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Internet: www.tigard - or.gov CITY O � I IGARD Notified/Method: Supplemental Information
. ; TYPE OF WORK;)UILD1NG DIVISION . FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list
Descri•tion Q . Ea. 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
jo 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: ( 367 c SA) A sLeio S i o N V n Q , Catch basin or area drain 18.76
City /State /ZIP: -r V�.alo 0 q 79-13 Drywell, leach line, or trench drain 18.76
I Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: (14ut.c ) TU MtS fite. -to e Manholes 18.76
AA 15 ri- - e - rOtZi- To /{-S C-e NJ .S( 0 (■- t 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: 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
NI oU e. W ATe 2 l-E ekTe(Z Dishwasher 25.02
' Drinking fountain 25.02
Ejectors /sump 25.02
IV PRO OWNER ' I ❑ TENANT Expansion tank 12.51
Name: ort��L A.N0 K J ^ e(V S P (;)p�e2 ,/� Fixture)sewercap 25.02
Address: 1 3 679 5u) /TS iOA) 0 12- G rb drain/floor
edisposal 25.02
sink/hub 25.02
_ G-7 Garbage disposal
City /State /ZIP: 1 G Ark-(20 , O (Z ( / 2'Z3 Hose bib 25.02
Phone: ( SY) 307 0/'1.o S Fax: ( ) Ice maker 12.51
a APPLICANT ` • , ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: S V I e,(.E3u Nc_ 1 0 € V eLU 10/ A P (ST Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: J e-- ( Roof drain (commercial) 12.51
Address: 7 00 g Sv`) N aeQ-6 R,2• Sink/basin/lavatory 25.02
City /State /ZIP: -TV- k i_4T 4 ) U ( 7 70 6 2 Solar units (potable water) 62.54
Phone: ( - 03) 6,92- 63 V3 Fax: : (5.03) 6 5 7 60 Tub /shower /shower pan 12.51
E -mail: 3 h Ske�(juR(,l yAl . co M Urinal 25.02
Water closet 25.02
CONTRACTOR • 61-wspaciet Water heater 1 37.52 '?7, 452. -
Businessname: ,�(�IS Y n LU tGiA' 6 Waterpiping/DWV 56.29
Address: 1,3g0 S , Feie Ca 50 /J p n Other: 25.02
Cit y /State /ZIP: 0 P n -G 0 /N G( 1 ..- r 042_ ?701A- Subtotal 'j
Pt
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Phone: ( Sp 3 ) 7 4S c! 3C 13 F ax: ( o3) 6 ( 3 7 ?7 2 (3 --HT' Minimum permit fee: $72.50 . 1-k-,
Plan review (25% of permit fee)
CCB Lic.: 1 6 3 7 7 6 13 1 ) ) Plumbing Lic. no.: 3- 1 ' e (3 State surc (12% of permit fee) , (,
Authorized signature: ) TOTAL PERMIT FEE t Z 0
d o._-- --- C ' 1 I
Print name: mA_Qr A. LA Date: t} /6 / i o 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(I0 /02/COM/WEB)
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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
Storm &Rain Drain - 1st 100' 62.54 Valuation: - Permit Fee: ,
$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 Ins ections_ or Fees Qty. Fee (ea) Total 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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased' sewer fees *. Please check all that apply.
. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
. Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040:
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or.Riser.Diagram ';
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
•
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
1:\ Building \Permits \PLMF - PermitApp.doc 2