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Permit
CITY OF TIGARD MASTER PERMIT 14 III. COMMUNITY DEVELOPMENT P ermit #: MST2011 -00029 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/02/2011 Parcel: 2S 111 BA09500 Jurisdiction: Tigard Site address: 9759 SW ELROSE ST Subdivision: Lot: 0 Project: MORSE FAMILY TRUST Project Description: Finishing basement. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $2,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 Fum<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: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 3 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1 D00 +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: ALT SF VB R -3 0 Owner: Contractor: MORSE FAMILY TRUST OWNER Required Items and Reports (Conditions) BY PAUL W /MEREDITH M MORSE TRS 9759 SW ELROSE ST TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $463.71 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 • , ' 952- 001 -0090. You r• - • - • • • the - - •• -ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: --.....4 . -../ ■oll ....• 41111°. — - Permittee Signature: _ g.../�l h/ i ) Call : T by 7:00 a.m. for the next available inspection date. This permit card • . • 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. Building Permit Application !_ �-�C ; _e111 'h Sr - Residential OCEIN FOR OFFICE USE ONLY C1 of Ti and 1 Received 131 B SW Hall Blvd., Tigard, OR 97223 F E A a ' f ; , l Permit No mg ` /ram Plan Review v . a Phone: 503.639.4171 Fax: 503.598.1960 . 1 DatelB : Js� Other Permit: I I C; A R D Inspection Line: 503.639.4175 ric ik3 A % � , e Ready : y: H See Page 2 for Internet: www.tigard- or.gov CM 1N Ct � I V IS1 � cC � t „ i .o � d ' : � � � � / Supplemental Information 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 Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ `Z , 14,1- and 2- family dwelling ❑ Commercial/industrial / ❑ 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: Cr 7s t .5; (,J, £LR ose ,s' T— New dwelling area: square feet City /State /ZIP: r( 6 r d t ) 8 .772 x q Garage/carport area: square feet Suite/bldg. /apt. no.: (/ Project name: pa k f j(4 0 rnse___ Covered porch area square feet Cross street/directions to job site: )0Q- DhI?La f p 1 .. <-63, �f r D$e_- Deck area: square feet 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. '/ Valuation: $ -�iTT�"^�' - ' Q d A rti r w s to wa fi e ppiety t I'D b lu /w iO.flIT - Q dd 0. 1 . 0l / 5 '�/ e r`/ 11-- L�a w�. d' It . -r/A ii .6 6r11 Existing building area: square feet a ci Q J , i --e.5 `J / J .5 , A T y Vg . . 5- New building area: square feet ❑ I OWNER F ❑ TENANT Number of stories: Name: 1 7 . ( . per,' L J 0 r se---- Type of construction: Address: 17 s 4. ,, F L ace Occupancy groups: City/State /ZIP: -5 l ` O 2 9 7 2 2 7 Existing: Phone: (503) 7 / 0 73 Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State/ZIP: apply: Phone: ( ) Fax:: ( ) E -mail: CONTRACTOR Business name: ("J AJei BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City/State/ZIP: Structural plan review fee (or deposit): FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) CCB lic.: Total fees due upon application: *7 he Amount received: Authorized signature: 4 Gj . W6V\.4 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: P414( J1.J. /" //� L 0 Ace- Date: 2 S ) 6 _ii l * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP -RES PermitApp.doc 10 /01/09 440- 4613T(I1 /02/COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No.: • 13 125 SW Hall Blvd., Ti gard, OR 97223 Date/By: Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: T I GA R D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing El Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. El ❑ El 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if 0 ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. _ 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ El ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ El ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore Ion and shall be shown to be at tlicable to the •ro'ect under review. it RISUIC I ZONAL SPECIFICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. El ❑ El 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:I Building \Permits\BUP- RES- PermitApp.doc 03 /21/06 440- 4613T(11 /02/COM/WEB) Electrical Permit Application FOR OFFICE USE ONLY City Tigard Ti aril Received Permit No.: DaterB : - 7'U /!— C 1; 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie III a Phone: 503.639.4171 Fax: 503.598.1960VIV,Va Date/B : Other Permit: I it . ;1 h l Inspection Line: 503.639.4175 Date Ready/By: Jris: ® See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information TYPE OF WORK - PLAN REVIEW ❑ New construction ErAddition/alteration/replac tt LiN ) Please check all that apply (submit ]/ sets of plans w /items checked below): v t M ❑ Service or feeder 400 amps or more ❑ Building over three stories. El Demolition ❑ Other: Tj G1)1 where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSi'l exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural WI 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 ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: 4 Psi $ t2 EL ��P Cr Six or or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: {q 9 ❑ Health-care facilities. ❑ Supply voltage for more than 1 Q f I ` ` 7 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: J Project name: r K ( b c ❑ Service or feeder 600 amps or more. ) J FEE SCHEDULE Cross street/directions to job site: Mc do xa di -.... Q 7 0 _ 'Z ' o3'e Description I Qtr. I Fee. 1 Total New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 I Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 � `� Limited energy, multi - family 7500 2 "att 71-- / o x S I yl f e Q t residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 [-PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 / 401 amps to 600 amps 200.34 2 Name: p 1 4 y1 � , e r e d . f - I D r s Q 601 snips to 1,000 amps 301.04 2 Address: 7 7 s y �,L , / L 8..e S 7 - Over 1,000 amps or volts 552.26 2 ! , 3 a r� 1 n K y n� z Temporary services or feeders installation, alteration, and /or Ti City /State/ZIP: 2.,[f relocation Phone: (. )3) � Z y 6 0 7 3 Fax: ( ) r-- 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: Is installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. / Branch circuits - new, alteration, or extension, per panel / Owner signature: 77/0")....2..e.- Date: _2 -it - /1 A. Fee for branch circuits with JZ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without Q-� # o l service or feeder fee, first Contact name: branch circuit 56.18 2 Each add'l branch circuit 2j 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 ty dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: panel, alteration, or extension. Page 2 2 L Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ ltr City/State/ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed ( hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: o Subtotal: Plan review (25% of permit fee): Print name: 5_ ( V, A4 L 0 es Date: . (b `// State surcharge (12% IA permit fee): Authorized signatur / �/ TOTAL PERMIT FEE: ���� V J/ •2.- This permit application expires if a permit is not obtained within 180 Print name: Date: i days after it has been accepted as complete. Number of inspections allowed per permit. I:\ BuildinePermits \ELC- PermitApp.doc 07/01/10 440- 4615T(1 V35/COM/WF.B 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: n Audio and Stereo Systems ❑ B oiler Controls O Clock Systems ❑ Data Telecommunication Installation O Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical O Nurse Calls n Outdoor Landscape Lighting* n P rotective Signaling n O ther Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: \ Building \Permits\ELC- PermitApp.doc 07/01/10 Mechanical Permit Application FOR OFFICE: USE ONLY City of Tigard ��i r �� Received • 13125 SW Hall Blvd Tigard, OR 97223 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Permit No.: 1 Date/By: Other Permit: A 1 ( l 1 . l J `It l) Inspection Line: 503.639 FEB Date Ready/By: furls: H See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information (IV OF TIG ARI) TYPE OF WOalL LI( is COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction 0-Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* -t- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use check list. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: q 75--- 5,Y, y - L fi 5 (requires site plan showing placement) 46.75 City/State/ZIP: t n O J' T Furnace 100,000 BTU (ducts /vents) 46.75 Cit y T (1 el r d , O 11 , 17.22 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: r4 k / /4 D rs e----- Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work I 23.32 2-37.- — - y, C / Hydronic hot water system 23.32 /K o Yt a r' - q / r� �� Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 Gas fireplace 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: Pa „ i M er.o eif `7J, NI U rs� Environmental exhaust and ventilation: Address: 4 7 c 7 S RDce Range hood /other kitchen equipment 33.39 City /State /ZIP: " a g r d © e f' ,2, 2 y Clothes dryer exhaust 33.39 �`� I Single -duct exhaust (bathrooms, (s 0 Phone: ) ) 7 41 4 0 ?.3 3 Fax: ( ) _ toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Other: 23.32 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: WalUsuspended/unit heater Phone: ( ) Fax: : ( ) Water heater E -mail: Fireplace Range CONTRACTOR Barbecue Business name: //1, , x e r Clothes dryer (gas) . caw Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal 7:3, ' / Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) Cj b, Plan review (25% of permit fee) CCB lie.: State surcharge (12% of permit fee) I G J �j /f days after it has been accepted as complete. PERMIT FEE I � , PO Authorized signature: ii/ ii/ This permit application expires if a permit is not obtained within 180 f omplete. Print name: PT - t Gil/ A/1 0 rS e- Date: Z fib— /( • Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits\MEC- PermitApp.doc 09 /09/10 440 -4617T (1l /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi - Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2,92 for each additional $1 00.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\ Building \Permits\MEC- PermitApp.doc 09/09/10 2 W 1 Permit Application I Site Utilities FOR OFFICE USE ONLY City of Tigard 1 V 1J Received ���// Date/By: - r (� / if 47r Penult No.: in (r'],l 1 (1 i _r y H O 1 111111 • 13125 SW Hall Blvd., Tigard, OR 97223 u w 'W )' ZO Date/By: Plan Review Phone: 503.639.4171 Fax: 503.598.1960 F E g 16 1� Other Permit No.: FIG A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for Internet: www.tigard- or.gov Cr OFTLC,AR Notified/Method: Supplemental Information TYPE OF WORK alltij' lNG DIV.SIO FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I 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: f'S 9 5 L/, E'L / ?t 5 ° Catch basin or area drain 18.76 City /State /ZIP: .JI" t 411 _4 9/ ' '7 2 2. q Footing drain line, lior near trench drain 18.76 e v / Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: M p � 1 (tea ,t. ( Manufactured home utilities 50.03 Cross street/directions to job site: 1 / / Manholes 18.76 1 " M,1 Ned J k 17 1 ! (" DSO- 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: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 -.2.. 0 ` Dishwasher t 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 a PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: e u / it pi e red 1 rti Al or-3"-e-- Fixture /sewer cap 25.02 Q �j Q Floor drain/floor sink/hub 25.02 Address: �� `"` 1 ! s'.1./.. gL 1- e s� cT Garbage disposal 25.02 City /State /ZIP: '*'r 4 4 I- 4 , (9 t , ' 11. Z r/ Hose bib 25.02 Phone: (5-63) 7Y b , ^� '3 Fax: ( T om-- - 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 i 25.02 z�,az, City/State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan I 12.51 ('2,.5 ( E -mail: Urinal 25.02 CONTRACTOR - Water closet ( 25.02 `) , (72... Water heater 37.52 Business name: d p� �� e ( Water piping/DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal ,7, . j7 Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) i 0 , - Authorized signature: Oz 1 V�4. TOTAL PERMIT FEE 4 16 , 0 e5 Print name: 1 A-ut ( w, / 1 O ( Z S 6 ' I Date: A _ ! - i i 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\PLMU- PermitApp.doc 10/01/09 440- 4616T00 /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 - ls` 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 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. Quanti 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. 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: I: \Building\Permits\PLMU- PermitApp.doc 2 • Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. I or will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction • Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. i7A0( iv, rse Print Name of Permit Applicant )11eAd .911 Signature of Permit Applicant Date Permit #: )C721 Address: 67 75 / Sq/ r /eraf iiLLtW '. Issued by: - Date: 3//// This Copy for Permit Offices