Permit 7
r
r,' CITY OF TIGARD MASTER PERMIT
c n
:y. COMMUNITY DEVELOPMENT Permit #: MST2009-00192
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2009
TIGARD Parcel: 1S136CA04600
Jurisdiction: Tigard
Site address: 10990 SW 79TH AVE
Subdivision: FRIENDLY ACRES Lot: 2
Project: Combs
Project Description: Inspect as built bedroom and bathroom.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 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:
Total: sf Value: $2,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add! 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc /Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add! Br Cir:
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
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)
COMBS, TYLER OWNER
10990 SW 79TH
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Total Fees: $280.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling Ynnifu 503.2 or 1.800 2.2344.
�j ; Issued By: A Permittee Signature: 111
rC ra�it Application RECEIVE"' , .
FOR OFFICE USE ONLY
elty'of Tigard Date/By: 1 Permit No.: T •
IN
" 13125 SW Hall Blvd., Tigard, OR 97223 SEP 2 3 2009 = G Z
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
'TIGARD Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: INEI ® See Page 2 for
Internet: www.tigard - ocgov BiJLLDIN DIVISII 1. �p otified/Method: Supplemental Information
Y:,'3 , ,„« �5 ' r et •Y� T E'..f® . -5 ORK- -r3't l'r�„"�; `�, '� ., ' ., ,``M�" ,a c�x , ^, ,* tt^er d s r . �;., z z*w .aim wra-' ,
- e�A� 'ir W �x , COMMERCIAL' -FEE SCAED>JLE ' LI SE HECKusr.
i;,..'.ide<kf#sm:.;'t 4 t ,,,. - 4a..w, X,zt,. a,.$ oxxr.e R,,,.., , v._n. ,24:,ai=3„b", irb.. ,, "�: ..4,s,m :1", k 2--.. ,::,x> - ,. n.t .5+,, , :x .,.454,,,„,,..,.., :✓.s,!w*a .k�+U: '.4
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.
` 4 4 t' TGATEGORY OF COisrs4V CTTONz =E ' ; f Value $
, RESIDEN SYSTEMS y} , p
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder . ❑ Other: Description Qty. Ea. Total
P ,n r � -„ a .x»smu^ tia'..��� .wxa�. :a:.�.re -u+� yx -r � - s`' � 3'x ' ��.
f -Ii x ` .. �? JOB, S INFO�RMA� LOCATION 4.:r '_ - � f " ..:.:' Heating /cooling
X Job site address: [ C) tt C. O CZ �h k
Air conditioning
Tres s to plan ho in g p pump )
(requires site Ian showin placement) 14.00
Cit /State /ZIP: "r I , 7 2_2_
` � Fumace 100,000 BTU (ducts /vents) 14.00
y c l �� �� Fuace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. f ' m
e/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other 10.00
Tax map /parcel no.: Other fuel appliances
s �, . . - �3, z x v z x -5 'v„ - * ,z. sh r R �` ,V
m 1 DESn CI I.P WORK m'> r r
� ater hea
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) . 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
&, G Chimney /liner /flue /vent 10.00
0 E PR T IO , ERi , .. k r . , . _ - AI xmit , 5 b . - Other: 10.00
Name: Environmental exhaust and ventilation
Range hood /other kitchen
Address: equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6,80
. " '>` " °aS " ° ` "� 4 cif Attic /crawlspace fans 10.00
o APPLICA , i t. . °� r Lmw C T 1.= P RSON ,
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Fumace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
-1s9, y ri-eia ca ? iaiar" ` s _� �' . "` ^^eel Barbecue
r �ii `�, , � ONIRACTOR Na��
. a s �. M... a. <x�a rra�ar.,,ary -.ns, ,.. w, taR.kx,s .._ } r.,`5.��'u >,. fin, ...aR -.� _,x< ,.,.
Business name: Clothes dryer (gas)
�r Othe
Address: � `� � � r �,j MEC `4,, `i
e!/" a <rs,,..,. .., „.r ...e«..r a „ms-.ce„ax8,n..„. . „: vim,, ..., . ,r x z:.
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: Date:
• Fee methodology set by Tri- County Building Industry Service Board
I: \Building \Permits \MEC- PermitApp.doc 01/19/07 440 -4617T (I 1/02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total��?aluat><on $ Permit. F
$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.
$50,001.00 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.
L\ Building \Permits\MEC - PermitApp.doc 01/19/07 2
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
• City of Tigard Date/By: Iy 09 Permit No.: • 0..... .
'n 13125 SW Hall Blvd., Tigard, OR 97223DEC U 2 2009 Plan Review
-. C Phone: 503.639.4171 Fax: 503.598.1960 .. Other Permit No.:
atey:
f; I C A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: EI See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I 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 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: /0 9e a . Iv C 7 a- c -e___ Catch basin or area drain 18.76
t Drywell, leach line, or trench drain 18.76
City /State /ZIP: j / as g - Q 9 722 3 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: 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: 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
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name:
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 ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
/ Water heater 36.29
Business name: 44„A q /� / ,s-c Water piping/DWV 56.29
Address: Z j 7/ 3 5 /3e et ," eieeie _e_e �� g /�l Other: 25.02
City /State /ZIP: z z a e.e -- C11/.7- Q2 9 7 ST- Subtotal
Phone: ( . ) j (?6q,- 6 0i Fax: (5 Q) $ ? 6 z yd Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: /56 59 Plumbing Lic. no.: a6 7 SP State surcharge (12% of permit fee)
Authorized signature: / y am. -,,._ " - - - --_ TOTAL PERMIT FEE
Print name: Gl i yu K Date: 6Z , Q Z , ► + r ., 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)
I
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 ", 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 Thru ❑ 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
that meet the qualifications above.
-4"
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 plumbing permit can be issued.
Water Extractor p g p
Water Closet - Toilet
Urinal
Other Fixtures:
I:\Building \Permits \PLMF - PermitApp.doc 2
Plumbing Permit Application
RECEIV I FOR OFFICE • USE ONLY
City of Tigard Received
Permit No.: y �
II Date/By: P/1.0 2c -GOP
a 13125 SW Hall Blvd., Tigard, OR 97223 S •� P 2 3 ?O Ilan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
Inspection Line: 503.639.4175 C ITY OF TIG fi to Ready/By: Juris: I l See Pa e 2 for
TI.GARD ' ' Y Y g
Internet: www.tigard-or.gov otified/Method Supplemental Information
_..h ���a � I , � �F.„ -� �� I�iILI)IN�G�HNI IO 4� - -�' � ..�_ �. � -,�� , , �
2 � r z r MOO OF' WOR t� .� 1 '' t � 9 E *'` SC HE DU LE ^ a
,.. � a...T .�-�,� �u . �. � � .,. �; »�_.��� �.us s��a� a.x.� _ , :*.. n� -.� -.. 'way.�- ,.,�t _ K:� �..-� d «� .,.«,x �`.�r „ .�+e'` . ,. a�;3w a*� ,+ - ,.�x,,�i�' � '::� � .. ., .� _ ,.� ,.tr.
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
•
r_A hp`s°% .° i ' %,t ^.z*^. i ' .,., 11. .a^.x hbr a -_ r , 5r
N k CATEG®R OP' CUNS'I TYO_ I�i i t f � a g taA SFR (1) bath 249.20
K1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
hr x Fire sprinkler ( , sq. ft.) Page 2
;t ^A � JO$ ..: INFORMATIOiV LOCATION 4 y _" .. �' Site utilities
lob site address: 2 �2 gi 7/ A i e Catch basin or area drain 16.60
City/State/ZIP: '77 aJ 1 it q 0� 6 Y7 22=3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: .
u " � Absorption valve 16.60
' . I'ON`t'OF WORK ``
.'9.. { .� -* 'DESCRIPT
:gt.z. m.b ,4i rt-i ..`.s'1vat.,:! ,> m ? ,-., ae•''. ...a '_•. - , - 1 r, .i , *':. t 4...,,niat :11414 Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
tiN .t �. ?,, s ,xe -✓r it vz�,za' * s noun eg Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
r� c. a t s a x , . Hose bib 16.60
a . ,' � � APPL ICA '„I`a 4 ;' . _ `CON PERSON j a t 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
'v r $t `' r 13 ti F ` �../ d �rz r H '� : *,#
-dal . t _ . <: � u t .* gi .k." `.� ,...t -4; Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
- State surcharge (12% of permit fee)
Authorized signature:
TOTAL PERMIT FEE
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.
1:\Building\Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
.;..� . .u s•ro-�'. �� s. �y " «. -;�,`- -"� w�'ti,x - "" =s '� A - -s�
i Site tfild 1PS Q Te (ea) , Total .s Scluraref'Faotage �el'Illlt FOe � r
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 :... Y , :t..
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 teni` ' Qty t Feel(ea) I 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
and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", w 1 ` A* sI ° '' ffi
��PlannRevew fo�al' umb><ng� ion
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.
��~ �zQuantiby�Fixture )Work�Performed� Any new commercial building with water service 2" and
Fixturctype r r - 1 v i *two*, " greater, except s desi and stamped by licensed
,._ . ..a3,, g..IMgft" '" .,.P,revtous appe1 t agkoigagii Existuig., engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
Jacuzzi/Whirlpool as defined in OAR918 780 - 0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ 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 e.,11 t. 4 )(SOTII etriel �P Riser ] agI ap .,
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory *Note: If the fixture work under this permit results in an
-Bradley
p
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Building\Permits\PLM- PermitApp.doc 12/27/06
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
City of Tigard Date /B : Permit No.: �^
° 13125 SW Hall Blvd., Tigard, OR 97223 S E V V `�2 �G 2
g
I Phone: 503.639.4171 Fax: 503.598.1960 2 3 7.0 09 P lan Review
Date /B : Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: Supplemental lnformation
TYPE OF
B UILDING DIVISION
PLAN REVIEW
• ❑ New construction ❑ Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
. 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
x Job site address: /0 Of �l Six or or more. occupancy.
Job no.:
v _ U'r I }� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: - ❑ Health -care facilities. ❑ Supply voltage for more than
y °�' ` -� ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
•
Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 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, leas re or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
�1 / /�, Branch circuits — new, alteration, or extension, per panel
/� ,/ �,/- -- ,4 .�''
Owner signature: ( ' `Y Date: A. Fee for branch circuits with
❑ PLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (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: Date: days after it has been accepted as complete.
• • Number of inspections allowed per permit.
I:\Building'Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1 I /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
PI Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
t'BuildingWermits\ELC- PermitApp.doc 03/23/06
Mechanical Permit Application RECE, FOR OFFICE USE .ONLY -
Received ` �
t ,00(
C of Tigard Permit . ; ' V l n�2 -OJ-
IN q 13125 SW Hall Blvd., Tigard, OR 972 SEE' 2 3 Ali,' ? Y
eview
C ' Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date/By:
Inspection Line: 503.639.4175 CITY O F T ' •A '' ad B Juris: ®S Pa e 2 for
'TIGARD II � Y y g
Internet: www.tigard ocgov FUILDIN � ` � ethod: Supplemental Information
G DI
r : � r v. ; I;s ",}�.�' " v COMIVIERCIAL e CIIEDTJ ,ra I gre = IST
t y� ° a 4 " s ` c 4At TcYPE O - OI2K . 'z 4 ,: x .,sm,ai .,.a* g k,
_ „'!�'k Y �� n'�. ff a �` i a ""_� .. 9R .�e { :.'',�Scir�,?sar_ : -;.:. 3,�ea�e Csot+'N” ,• -, r- �. ::_ .�' ,aL':..:a 8 ;:,'.:t:
❑ 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.
,:.,^ �' z ,{;• '< w.�y. - ° ..vas .. _ + ,,. x a' °v �'� s ,. '�Y - `, Value $
:sa m21 &.. a tw " -,' CA'pEGOT OF G®NS U ^ mt~g; � t 'v es , ,y r t ,
�.,.�_.�,,t. ..,a ,_� N..z. . -, .,,r.,�.. �� RESIDEN T eSYS'I
4. a=+.. z! re.: mr. l.. n` 7�..<£ m ve :b".� a"d»r�'?Ri`.A..uwx'lti',�,' ..TV'.> f .v4 : <.Y »: 3.':5'ANTIfi+
l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
; t rk , ° M J,OB ; S fTETIN X N D LOC � A r , ' ` Heating /cooling
{� , Air conditioning or heat pump
/" Job site address: w [ �( p ia •514/ 77741 iei tie__ , (requires site plan showing placement) 14.00
City /State /ZIP: • 7 a Ur -� 7 Z7 3 j Furnace 100,000 BTU (ducts /vents) 14.00
1 Furnace 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 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances '
t P az `' it L _ DESCRIP t OFTWOIiK' t , t r r Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
._�„ Chimney /liner /flue /vent 10.00
T
N A . O zPRO RTYh OWIZVVI .., t � �, �K . a� `1 r. ili/4 'ry ... 14,1 , , ,,
. k . - - Other: 10.00
Name: Environmental exhaust and ventilation
- Range hood/other kitchen
Address: equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
_"1 ft"' APPLI CA NT�' Z r a !,- a9ONTACT y f ti Attic/crawlspace fans 10.00
, , 4 itiiTira ., ., " c. ,, .a.r.�_ ....,- x, Aagta, -' "' z � � .;a , ., , ,,,6, ..x 1,,A , k i .,.a, t aste . .. 3': ;. ;
Other: 10.00
Business name: Fuel I in
P�P g
Contact name: 85.40 for first four; 81.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
43 , :CO14f AC15 A., ,,, ..'''AIIV.WWU %" . €' 5 T Barbecue
Business name: Clothes dryer (gas)
Other:
Address: (?� , t N, ;, ° ME CII A NI' CAL P F z
w : .
City /State /ZIP: 1 Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
• Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board
I:\Building\ Permits\MEC -Perm it App. doc 01/19/07 440 -4617T (1 I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total �?alaatron� ., Per i' Fee l k s£
$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.
$50,001.00 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.
1: \Building \Permits \MEC- PermitApp.doc 01/19/07 2
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Back Porch
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floor CD planner
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Toilet has the back wall 18" from side 3'8"
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