Permit CITY OF TIGARD MASTER PERMIT
II
S COMMUNITY DEVELOPMENT Permit #: MST2002-00309
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/10/2002
Parcel: 2S110BD01000
Jurisdiction: TIG
Site address: 11925 SW BULL MOUNTAIN RD
Subdivision: Lot:
Project: CHORUBY
Project Description: 459 square foot addition to rear of house.
3/17/2011: Reinstate expired permit to get final inspections for building, electrical, mechanical
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 2 First 459 sf Basement: sf Left: 12 Parking Spaces:
Height: 12 Bathrooms: 1 Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right: 74
Detectors. Yes
Total: sf Value: $41,585.40 Rear: 40
PLUMBING
Sinks: Water Closets: 1 Washing Mach: Laundry Trays: Rain Drain: Urinals:
Lavatories: 1 Dishwashers: Floor Drains: Sewer Lines: SF Rain Storm Sewer:
Drains: 1
Tubs /Showers: 2 Garbage Disp: Water Heaters: Water Lines: Catch Basins:
Bckflw Prevntr:
Footing Drain: Ice Maker: Hose Bib: Backwater Value:
Other Fixtures:
Drywell- Trench Drain:
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers:
GAS Heat Pump: N Hoods: Other Units:
Furn <100K: Vents: 3 Woodstoves: Gas Outlets:
Furn > =100K:
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr:
Ea add! 500 sf: 201 -400 amp: 201 -400 amp: W/O Svc/Fdr: 1
Mfd Home /Feeder /Svc: 401 -600 amp: 401 -600 amp:
601 -1000 amp: 601 +amp- 1000v:
1000 +amp /volt:
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description:
Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF 5N R3
Owner: Contractor:
CHORUBY, PATRICK S + LORI L Required Items and Reports (Conditions)
11925 SW BULL MTN RD
TIGARD, OR 97224
PHONE: PHONE:
FAX:
Total Fees: $1,439.32
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Code 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 issua e, 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 'Ce e-. Those roles are set forth in OAR
952- 001 -0010 through OAR 952 -001- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503. , '2.1= - or 1.800.332.2344.
Issued By: Permittee Signature: ^��
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. /
This permit card shall be kept in a conspicuous place on the job site until completion of the p oject.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application .(ECEIVED
Residential MAR 1 7 2011 FOR OFFICE USE ONLY
City of Tigard Received Permit No."1. 0704a -00309
• 13125 SW Hall Blvd., Tigard, OR 972 €ITY OF TIGARD Plan Review
1 Phone: 503.718.2439 Fax: 5°3.59 8tDING DIVISION Date/By: Other Permit:
I I GARD Inspection Line: 503.639.4175 Date Ready/By: Jyp9rj� 0 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: ////CC77 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
r ddition/alteration/replacement ❑ Other equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
p i and 2- family dwelling ❑ Commercial/industrial Valuation: $
-
0 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: %9 A5 Sk) 4.14» t , - fA j ,,t?, New dwelling area: square feet
City/State /ZIP: Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: en er U A (� / Covered porch area: square feet
Cross street/directions to job site: 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 ( rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
57 `7�" EXP /�2E� A��/`9/ . Valuation: $
RF V..
��7 _ /l/41-[„ / Ns I e- C 774 AT S • Existing building area square feet
New building area: square feet
/
PROPERTY OWNER ❑ TENANT Number of stories:
Name: / C-WvA a3 y Type of construction:
Address: / /9aS fst-) LL Aft A /1/4/71,"/A/ /{() , Occupancy groups:
City/State/ZIP: Existing:
Phone: .($ ) 7,42y- /7,,„.?y' Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
' Please r er to schedu
Business name: — • 7/011:1e 36 O
Contact name: AA e .c qty = r
Address: . „ - .. ., . � 2O
,
Total fees due upon application: L 1 / 0 .3. A
City/State /ZIP:
Phone: ( ) Fax: : ( ) Amount received:
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: D t [E ._ Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State /ZIP: Permit Fee (includes planreview $180.00
and administrative fees):
Phone: ( ) Fax: ( ) o
State surcharge (12% of permit fee): $21.60
CCB lic.: Total fee due upon appication: $201.60
V signature: This permit application expires if a permit is not obtained
l'- within 180 days after it has been accepted as complete.
L/1 Print name: a. Cjwn.-6 Date: . _ / 7- * Fee methodology set by Tri-County Building Industry
s - Service Board
I:\Building\Pennits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(11/02/COM/WEB)
Buildinss Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
5 Date/By:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
t [ G A R D 24- Hour Inspection Line: 503.639.4175 ❑Electrical ❑ Plumbing ❑Mechanical
Internet: www.tigard- or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l es N0 `' /A
I 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 ❑ ❑ CI
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
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 ❑ ❑ ❑
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. ❑ ❑ ❑
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. ❑ ❑ ❑
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. on and shall be shown to be as s licable to the •ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three (3) site plans are required for Item I 1 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. ❑ ❑ ❑
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: \ Building \Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(11 /02 /COM/WEB)
• Mechanical Permit Application FOR OFFICE USE ONLY
IVES
City of Tigard :CE Received Permit No
M • 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: itysrp2Q -0c, 3a
Phone: 503.718.2439 Fax: 503.598.1960 7 Plan Review
1 7 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov f.TTy npTIGARD Notified/Method: •i /�� Supplemental Information
fC
TYPE OF a COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ►:d ddition/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*
/ 1- and 2- family dwelling 1=1 Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: /9',,Z5 5 , { GL A hlAA/ . j, ./e/J (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
CitylState /ZIP: Furnace 100,000+ BTU (ducts/vents) 54.91
�n a � j Heat pump
Suite/bldg. /apt. no.: Project name: p
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
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
//��,, �_ A r—� Gas fireplace 33.39
/� /NS%1} %CC G/■ /lec % , ����`7'/ % Flue vent for water heater or gas
/2 c /N �� /N� p6—C7 /dN fireplace 23.32
/� le
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
ROPERTY OWNER l ❑ TENANT Chimney/liner /flue /vent 23.32
- Other: 23.32
Name: s'°61- q e& ?e 45 Environmental exhaust and ventilation:
�
E Range hood/other kitchen
Address: -1,
`�!9� E equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
� Single -duct exhaust (bathrooms,
Phone:.�S ) ) -/ j
y — l ,.2 4-)' 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: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
k)^./ Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signal This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: L' j" '• , w !� y I Date: 3 -- /7-// * Fee methodology set by Tri -County Building Industry Service Board
I\ \ \ ME.
Building PermitsC- PermitApp.doc 09 /09 /l0 440-4617T ( I 1/02/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 $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\ Building \Permits\MEC- PennitApp.doc 09/09/10 2
L
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED D e permitNo/IS7 O� �D3pq
M
13125 SW Hall Blvd., Tigard, OR 97223 11 r7 Plan Review
1
Phone: 503.7182439 Fax: 503.598.1960 MAR I ! 1: Date/By: Other Permit:
1 I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: ,T /C > Supplemental Information
TYPE OF WatIf4ILDINGDIVISIUN PLAN REVIEW
❑ New construction ddition/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.
�1 - and 2 dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
/ y g ❑ 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 ", "I -3 °,
// 9� J+ _ / / 1, 4. O � A /
Job no.: Job site address: / d 4r�K /dl/ 100HP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: d Qt4 4 ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description FEE SCHEDULE
.l Otv I Fee. I 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 1
Limited energy, residential 7500 2
DESCRIPTION OF WORK (with above sq. ft)
Limited energy, muki- family
f 7 — 9-7 EX/(3/4-E23 �✓ / _ residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
/Z7/L. /C / //SSC 7/C7/✓ 5 . 200 amps or less 100.70 2
JROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
ame:
�e-� r � C� aeu 8 y 601 amps to 1,000 amps 301.04 2
Address: 6', Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
�' relocation
Phone: ,2) 9 — ,. / 7,2 c f Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This 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
1✓ Owner signature: Dat : A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: 0 w "/Cite panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
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 ('/2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: - - ' - Date: State surcharge (12% of permit fee):
Authorized signature: j. TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
6/ ..--Print name: ,GC7s'vr7 f I Date: i / 3 - �� -�� + Number oinspections allowed per permit.
I:\ Building \Pennits\F,LC- PermitApp.doc 07/01/10 440- 4615T(11/05/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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ 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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
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
1QU LVCV
Plumbing Permit App,xa i _,: i
Building Fixtures FOR OFFICE USE ONLY
C i of Ti CITY OF ard TIG Received Permit No.yt r'
• 1 S W Hall B1�'9TlSIGN Date/By: r.S� v�O - 00
M
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.:
Date/By:
T l G A R D Inspection Line: 503.639.4175 Date Ready/By: Juri See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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
Alan - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
0 Accessory building SFR (3) bath 500.32
ry g ❑ 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: // FA 5 .S:40 LC L_(,,, Ate 6 /V /Ai 46 Catch basin or area drain 18.76
City/ State/ZIP: Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: C 7 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
7267/VS 7;9 �f (P /0e-6 / j Clothes her her 25.02
� Dishwasher 25.02
/ ( /L /� � A }L //1/s1'Ee 77o4/S' - Drinking fountain 25.02
Ejectors /sump 25.02
/
J2FPROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: /t9,--772-, e� ehze k it 6/
Floor drain/floor sink/hub 25.02
Address: c5 ey t- Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:.t5 7,9 - y7,,,2J 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
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: o A niE Water piping/DWV 56.29
Address: Other: 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
/ ,fir State surcharge (12% of permit fee)
Authorized signature: 'ell/
TOTAL PERMIT FEE
- f ` This permit application expires if a permit is not obtained within 180 days
' Print name: / v 'Lk. Cv/ ,, 1 i Date: /2 //
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 -4616r(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 - 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
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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whiripool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain El Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
4 " Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic - food s
g q g
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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