Permit k)., ' � �� �� MASTER PERMIT
PERMIT #: MST2005 -00396
. DEVELOPMENT SERVICES DATE ISSUED: 1/23/2006
'" - - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103RD -11000
SITE ADDRESS: 11695 SW ERROL ST ZONING: R - 4.5
SUBDIVISION: CAPPOEN ESTATES LOT: 001 JURISDICTION: TIG
Project Description: New SF.
BUILDING
REISSUE: PH2197D STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,269 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 1,536 sf GARAGE: 726 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THR sf RIGHT: 10
VALUE: 279
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,805 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
NAT FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
......--------
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
FOUR D CONSTRUCTION CO. FOUR D CONSTRUCTION and all other applicable laws. All work will be done in
PO BOX 1577 PO BOX 1577 accordance with approved plans. This permit will expire
BEAVERTON, OR 97075 BEAVERTON, OR 97075 if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules
Phone: 503 -590 -0805 Contact #: PRI 503 -590 -0805 adopted by the Oregon Utility Notification Center. Those
FAX 503 -590 -1751 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
Reg #: LIC 71037 direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 9,809.99 1 -800- 332 -2344.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
�`., //, �i /�,
Issu. d By • ,, rte_ '% / P e rm ittee Signature : i r � /�►!.
Call 503- 6394175 by 7:00 a.m. for an inspection that business day.
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.
;, ub plod
Buildin2'Permit Application FOR OFFICE USl ONLY
City of Tigard ived �. 4:21.105..-80 a 7 •
Date . ���1��V Permit No
13125 SW Hall Blvd., Tigard, OR 972 3ECEVED4 Plan Reiew
Phone: 503.639.4171 Fax: 503.5981960 � p µ Received
Other Permit. �- b
l0 Plan
i� ' Date/B . -o . _ �/ l
Inspection Line: 503.639.4175 (� 4.
P ` ? O0 ,,,,_ Date Ready/By: ��"" / %' /C/ / See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method / C C,(Ii S S upplemental Information
t T u OF TiGAti
iii ra'Mida #:i#:D u
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
❑ Addition /alteration/replacement ❑Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ , Cs
N 1- and 2- family dwelling ❑ Commercial /industrial �� Dd
❑ Accessory building ❑ Multi- family Number of bedrooms: 3
ig Master builder ❑ Other: Number of bathrooms: 2 /2
JOB SITE INFORMATION AND LOCATION Total number of floors:
,lob site address: /X 7S S' to 6gto 7"-- New dwelling area: 2 square feet
City /State /ZIP: 7 ,9 / OA- G7223 Garage /carport area: 72 4 square feet
Suite/bldg. /apt. no.: /� Project name: Covered porch area: /a:02 square feet
Cross street /directions to job site: /NQ�/V� -! �; ..
Deck area: e- square feet
��`"' Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: C"b, , �„�, Lot no.: J 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.
2? N , / _' Valuation: $
13 /�r� Existing building area: square feet
New building area: square feet
($f PROPERTY OWNER ❑ TENANT • Number of stories:
Name: p f U s /x.ejG� 04) & Type of construction:
Address: 2 ry � S 9 7 Occupancy groups:
City /State/ZIP: E p % i l , 0 9 7o75 Existing:
Phone:S1S3 )S90 —00 Fax: LSD ) S, 4) 1 75/ New:
r APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ....PA-3*u. 4ef �� D 0.A/ All contractors and subcontractors are required to be
Contact name: `�� � licensed with the Oregon Construction Contractors Board
i ! under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail:
CONTRACTOR
Business name: S4, -yn,,e_ S Ail n U.e...„ BUILDING PERM FEES"
Address:
Please refer to fee sc hedule
City /State /ZIP: Fees due upon application
Phone:( ) Fax:( )
c� Amount received
CCB lic.: 7/O J7
Date received:
Authorized signature: This permit application expire
within 180 days after it has b,
Print name:)ig " , kpp o er Date: / c) — 23 — oS * Fee methodology set by Tri -Cou
Service Board.
i:\ Building \Penults\BUP- T1- PermitApp.doc 12/03 440-46I3T(11 /02/COM/WEB)
Mechanical Permit Application " J )..;e"',' ,. a ;'_ 1.0R o[ F l c - 1 tit iii � ; : , , t, , r %
City of Tigard Received Permit No. ()' �)
13125 SW Hall Blvd., Tigard, OR 97223
Date/By. ' ' .IA 0 0 D I C
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �, "r ,n patelBy. Other Permit:
Inspection Line: 503.639.4175 44►.'11
Internet: www.ci.tigard.or.us wry__ . Date ed/Met y: 3uris: Supplemental See Page for
Ba NNotified/Method: Supplemental l Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE – . USE CHECKLIST
N New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
Tij 1- and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family Master builder ❑ Other:
Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
/ ' •' may.. Air conditioning or heat pump
Job site address:
/ /lp 7s � „ [N , 2 2 0Z. .' / (requires site plan showing placement) 14.00
City /State /ZIP: ^-779 4 i G 0,.... 9 722 °3 Furnace 100,000 BTU ( ducts/vents) 14.00
Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
�,t Hydronic hot water system 14.00
W .A/A-i ,c7 Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision:CA,�yjo ,5 �.Q j Lot no.:
/ Flue /vent for any of above 10.00
// �� r Other: 10.00
Tax map /parcel no.: Other fuel appliances
. .. DESCRIPTION OF WORK Water heater 10.00
g 1 _ 4 t 4 st4.� Gas fireplace vent 10.00
Flue vent foor water heater or gas
fireplace 10.00
Log Tighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
PROPERTY OWNER 1 ❑TENANT
Other: 10.00
Name: U. K, ,s x.Gc-L ON dr---' Environmental exhaust and ventilation
Address: 9 b- ( /S 77 Range hood other kitchen
equipment 10.00
City /State /ZIP: V - , c»t- F2' 7 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (3\63) S70— o Fax: L 3 ) S9p -2 7 s-' toilet compartments, utility rooms) 6.80
Mu APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: S> , Agot." Fuel tin
P�P g
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
•
Business name: �[ / / Clothes dryer (gas)
���� �C �/J� ��// Other:
Address: /6 a / S E / / ,Z/ LLU- got MECHANICAL PERMIT FEES*
City/State/ZIP: la_j�jd�j I F7Z 3 Subtotal
` ( Fa x: ( ) Minimum permit fee ($72.50)
Phone: 3)
✓� 3 Plan review (25% of permit fee)
CCB lic.: Cv C.. L" State surcharge (8% of permit fee)
/�j
TOTAL PERMIT FEE
Authorized signature: 06 .,�-- / a�� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name:A4--/Pj(,C M. di-Vile, K.-S Date: `O ._.. 2L S" • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- PennitApp.doc 12/03 440-4617T ( I I/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00. •
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or ..
fraction thereof, to and including
$50,000.00. -
850,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
•
Note: All new commercial buildings require 2 sets of plans.
•
•
i: \Building\Permits\MEC- PermitApp.doc 12/03 2.
t 5 - � .c,,� o' j 5i'p+ '" F: �= i�d�7� •z'°#�,fi�x'r�u�+„t-'':�'� .kI�N�� w
Electrical Permit Application .,, i � � , l o i OFI GE 1 , a , t
City of Tigard Received Permit NS` \ S 6,0 ofd 3476
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
/4,,�,d' c • , �j Dat Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 , t +� . , � e B y.
Inspection Line: 503.639.4175 „ A., _ •_ D ate Ready/By: tuns: 10 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK • .,PLAN REVIEW , .,
V New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION - of 1 and 2 family dwellings 4 or more new residential
I and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure Ig
Multi - family Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
' . JOB SITE INFORMATION AND LOCATION. ❑Egress/h ghtingplan RV park
Job no.: Job site address: //‘, 9 ,S',W ! RRo Z ST ❑Health care facility ❑ �
.S Submit 2 sets of plans with any of the above.
City/ State/ZIP: - O � nit ' 7 2�,, The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: J Project name: FEE* . SCHEDULE .
Description I Qty. I Fee' I Total 1 ..
Cross street/directions to job site: lofK-A/ New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: l#tl e ta Lot no.: / Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder _ _ 90.90 2
44_4 y C / ■ pu -Q. Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
- A PROPERTY OWNER '1 ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: . �p,t x ci -eRz-C.c ' ". 601 amps to 1,000 amps 240.60 2
Address: D 7 /S7 7 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: _F V , t 97 373 Temporary services or feeders installation, alteration, and /or
l relocation
Phone: (Si) 3) ,S9a Dd>a,c Fax: ica ) S7e ..-./ 7 S'/
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
g` APPLICANT ' 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: - S,•y,... e ) Z 0 0 branch circuit
/� B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 _ 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
. CONTRACTOR energy panel, alteration, or
, extension. Describe: Page 2 2
Business name: ?- b _ jL p
Address: s 7 ., e , v-�- Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: 7c, R - - L q.mil OA 9722/ Investigation per hour (1 hr min) 62.50
Phone: �U�) 77sf Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: g Electrical Lic. ,4/ - 23t Suprv. Lic�' BS Subtotal
Suprv. Electrician signature, required: l4' c,f_... Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: (.4.e,, 7 Aitc G?GQ I Date: / ( OS
-
TOTAL PERMIT FEE
Authorized signature: �� ,A _ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: .)// p ,r- .. e4 / 44R_ •, •,ie.:7 Date: / U _22......5 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i.\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM/WFB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined .. $75.00 • •
Check Type of Work Involved:
Audio and Stereo Systems* •
El Burglar Alarm
_ • . .
El Garage Door Opener* •
. „
1: Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
0 Other:
rCOMMERCIAL WORK.ONLY: :
•
. .
Fee for each commercial system $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved: •
, .
El Audio and Stereo Systems
•
El Boiler Controls =
fl
•
0 Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
. .
HVAC
O Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control*
0 Medical
. - .
El Nurse Calls
El Outdoor Landscape Lighting* •
El Protective Signaling
O Other
Total number of commercial systems: •
. ,
. ,
*No licenses are required. Licenses are required
for all other installations
\Building\Permits \ELC-PermitApp.doc 04/03
Building Fixtures 1.\1 4
Plumbing Permit Application , t � " ` pl, iFOR is lcl 'c)� �'",;. `'''
rw +i . t~ If t F ., C 3 t�Cx _ I� I 1 °' il: �,{, . .
r.k u
City of Tigard Received Permit N
13125 SW Hall Blvd., Tigard, OR 97223 Date/By tiY2l�OS 7 n
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
k Dt/By Other Permit No.:
24 -Hour Inspection Line: 503.639.4175 i Date Ready/By: Jt ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK ' FEE* SCHEDULE
IX New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
p I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: J J6 7, S 6 J, `R R f -, 2 s7:' Catch basin or area drain 16.60
City /State /ZIP: / - 'l4� OR. 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: / oz4 i t i k i-
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: ��pp0+� , �+s7, ,T� I Lot no.: Water service (no. linear ft.: ) I Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
V "-t- 46 0 1 /LJ4-1.4) /./6)a Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
. is PROPERTY OWNER I � ❑ TENANT Drinking fountain 16.60
n Ejectors/sump 16.60
,,�
Name: ‘,,L ` a.5..,„ s - T2.GC -7 c ,t/ �-4
Expansion tank 16.60
Address: V, 2sx A 7 7 Fixture /sewer cap 16.60
City /State /ZIP: �,.g„,,,.. ,.:)/C- '77 0 7S Floor drain/floor sink/hub 16.60
Phone: (s S9p /73/ Fax: (.SaS ) t.S 90 / 7S/ Garbage disposal 16.60
• IN APPLICANT ❑ CONTACT PERSON Hose bib 16.60
,Q i X41 O €/ Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone:( ) Fax::( )
Tub /shower /shower pan 16.60
E -mail: • Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: C'-i_ 2? c- P2Ch ff i /N Water heater 16.60
Address: /5 S' mil- 4 0-4-- Other:
City /State /ZIP: /,l /CZ_ 6 f 6 / (... /L- 9 7/ 2 3 Subtotal
Minimum permit fee: $72.50
Phone:4S ) (o c/,-2.3 // Fax: ( ) Residential backflow minimum permit fee: $36.25
q7 7 Plan review (25 %ofpermit fee)
CCB Lic.: / / p Plumbing Lic. no.:3L� � 10 Plan
� l-s %4 JL J Ci State surcharge (8 %ofpermit fee)
Authorized signature:
TOTAL PERMIT FEE
Print name: // , c w L 4.1 Date: /0 -�. c1 ' 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.
is \Building\ Permits\ PLMF- PermitApp.doc 06/05 440-4616T(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 - l' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
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 $1.52 for each
Fixture or Item . Qty. Fee (ea) • � Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50;000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial.building
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area. • '
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic , dwelling units.
Drinking Fountain ' ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
, .
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall .
Sink - Bar/Lavatory . - •-
- Bradley • _
- Commercial -
- Service • . •
• Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor P
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: . plumbing permit can be issued.. -
i:\ Building \Pennits\PLM- PertnitApp.doc 07/06/05
RECEdVEC) , R , i�,� i � N �1
NOV A 0 2005 CI ' TG; ''` D
CITY OF TIGARD
RESIDENTIAL PERMIT APPLICATION RILDWG DIVISION ®EG®N
A Pj,ermit Num�6:61; i. _Iaoes -- 0039
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Y,• r,Subd visanjn` 1 �i� .
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� � Busness1 o t .► L S 1 C I CO .
�sr 4,� �1WS�'rrk t V,,,,'611
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VW ,P.0 . .t .x 1S-7) 1S-7) ! : .:i State 0! Zip 4 170
As required by the 1999 Legislative action (Senate Bill 587), your residential permit
application and plans have been reviewed to determine if it is complete and if the plans are
deemed "simple" or "complex" as defined in ORS 455.467 and 455.469.
X The application is complete.
The application is incomplete for the following reason:
The submitted plans will be reviewed; however, a permit cannot be issued until the
above information is reviewed and /or approved.
The submitted plans cannot be reviewed until the above information has been
submitted and/or approved.
The plans are deemed "simple ". n The plans are deemed "complex ".
If you have any questions lease call Chad Williams at (503) 718 -2708.
ck(441AAAJ 1, 0 O
Name of Plans Reviewer Date
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772