Loading...
Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2005 -00012 ° II''ll DEVELOPMENT H ME d , SERVICES 5039 -4171 DATE ISSUED: 2/24/2005 SITE ADDRESS: 11486 SW FONNER ST PARCEL: 2S103AC -09300 SUBDIVISION: GERTZ PARTITION ZONING: R -4.5 BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE. MS2463 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 22 FIRST: 1,101 sf BASEMENT: sf LEFT. 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD. 40 SECOND: 1,362 sf GARAGE: 484 sf FRONT: 20 PARKING SPACES . 2 TYPE OF CONST: 5N DWELLING UNITS' 1 THRD sf RIGHT. 5 VALUE: 242,396 80 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,463 sf REAR 15 PLUMBING SINKS* 1 WATER CLOSETS: 3 WASHING MACH' 1 LAUNDRY TRAYS. 1 RAIN DRAIN. 100 TRAPS: LAVATORIES: 4 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• BOIUCMP < 3HP. VENT FANS. 4 CLOTHES DRYER: 1 GAS 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' 4 201 - 400 amp. 201 - 400 amp: 1st W/O SVC/FOR: 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 -ENCOM BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL. GARAGE OPENER' CLOCK: INSTRUMENTATION. MEDICAL: OTHR: HVAC' DATA/TELE COMM' NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 10,299.37 This permit Is subject to the regulations contained In the GERTZ CONSTRUCTION GERTZ CONSTRUCTION Tigard Muniapal Code, State of OR. Specialty Codes 19200 SW 46TH 19200 SW 46TH and all other applicable laws. All work will be done in TUALATIN, OR 97062 TUALATIN, OR 97062 accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days Phone: 503 638 - 3390 Phone: 503 692 - 3390 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through Reg #: LIC 34350 952 - 001 -0080 You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699 REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 M Issued B : .41, — //./A/ . Permittee Signature : r' Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the n � business day ._. �' CLL. ,, Building Perm L I. I oR o"FFICE USE ONI Y • • • -.c _. Vii'•'_ _ City of Tigard 2°6 Date/By — 1 1 - 0 3B Permit No, (S , �0r�. 13125 SW Hall Blvd., Tigard, OR Plan R ev i ew Phone: 503.639.4171 Fax: 503.598.1960 T� T� 4,,, t h' a wj l j(;o I " � Date/By j _ '2- �.) -o Other Permit: :1 �� __ re l 1, Inspection Line: 503 639.417C9I'I j 1 OF TI� T Ai�i� A , � '�' ; . Date Ready/By: p � q ^ �,!J �9S See Attached Checklist for Internet: www.ci.tigard.or.us BU ILDING T� T1I V ISIOl x Notified/ --,G � (J> },(�� , i/4 Supplemental Information , 1� iJ 1 ", 1 •Q., x.1'0 -e, T YPE OF WORK REQUiR 'D DATA: 1- •AND,2- FAMILY DWELLING - X 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. 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ p .0 0 t- • 00 ❑ Accessory building ❑ Multi - family Number of bedrooms: .5 ❑ Master builder ❑ Other: Number of bathrooms: ZI� JOB SITE ,INFORMATION AND LOCATION • - ' Total number of floors: Z Job site address: j 1 44 l) (p / ''''Fo tJ ,,j c ,, r New dwelling area: �‘.4 S square feet City /State /ZIP: T I Ci " --(e — P i l o ` Oj I - 2 Garage /carport area: It 1 6 t-t• square feet Suite/bldg. /apt. no.: Project name: Covered porch area: -- square feet Cross street /directions to job site: Deck area: square feet 1 IS 17 " °i f N iJ Other structure area: square feet L — k - TZ �kfi r IT l GN - REQUIRED.DATA: COMMERCIAL - USE CHECKLIST Subdivision: Lot no.: 2_ 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: $ Existing building area square feet New building area: square feet PROP ERTY OWNER Li TENANT Number of stories. Name: Type of construction: Address: Occupancy groups: City /State /ZIP. Existing: Phone: ( ) Fax: ( ) New: 0 ' APPLICANT - • . ❑ CONTACT PERSON NOTICE • Business name: 6 024 6,. r4 c a — ' All contractors and subcontractors are required to be Contact name: �����, licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: •- 1 q'cyc 5A,u 4 L - jurisdiction in which work is being performed. If the City/State/ZIP: applicant is exempt from licensing, the following reasons Cit y -- TV AZ ,Pt'i"l NJ 0 ,(g, --) q ova apply: Phone: (9;3 ) Log j - 0 Fax: : (� LoGfi 2, - 6 E -mail: CONTRACTOR • Business name: BUILDING PERMIT FEES*. - • Address: Please refer to fee schedule. City /State /ZIP: • Fees due upon application Phone:( ) Fax:( ) 1L Amount received CCB lic.: '3 � ? SCE Date received: Authorized signature: This permit application expires if a permit is not obtained r __1...--- - within 180 days after it has been accepted as complete. Print name: ` Date: " " ab * Fee methodology set by Tri- County Building Industry Service Board. I \Building\Permiis\BUP -TI- PermitApp doc 12/03 440 I /O2JCOM/WEB) Building Division 4111111,,,, Building Plan Submittal Requirement Matrix Commercial & Multi- Family - New, Additions or Alterations City of Tigard Type of Submittal '# of Plans (Includes new, additions and alterations.) Required at Submittal Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 1* Fire Protection System 3** Mechanical 2 Plumbing (building fixtures) 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over - the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i \Bwldmg\Permits\BUP- TI- PennnApp doe 12/03 440- 4613T(I I /02/COM/WEB) Electrical Per `I�� r t(,1 '.EIVED FOR OFFICE ICE USE ONL . Ci of Tigard Received ved Permit No, 13125 SW Hall Blvd., Tigard, OR 22 -360 Plan Review �, 5 U I Phone: 503.639.4171 Fax: 5031 1�6 i I 2005 ' ��'i w?iI Date/B , Other Permit - Inspection Line: 503.639.4175 � 6 _ Date Ready/By: laiig ® See Page 2 for Internet: www.ci.tigard.or.ug/g/ TT u ® F1 t� T l CT A p� D Notified/Method• Supplemental Information ‘,.....1 ...t B TILT'CYPE OkY +®T"Ni PLAN REVIEW ki(New construction tJl 3 A l d l diitiion /allterattion/rreplacement P lease check all that apply: 0 Service over 225 amps, comm'l ❑Hazardous location ❑ Demolition El Other: 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 V 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building El System over 600 volts nominal units in one structure DI Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more DOccupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: 1 1 t..}. C (O l,I,,,) C '� ❑Health -care facility fp ay ❑ Submit 2 sets of plans with any of the above. City /State /ZiP: &A-(2-0 - of__ cti 1.4.3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Total I ** Cross street/directions to job site: New residential single- or multi - family dwelling unit. i Includes attached garage. l 1 S 1 4 t' N e1Z, 1,000 sq. ft. or less 1 145.15 4 Subdivision: Lot no.: °L.. Ea. add'l 500 sq. ft. or portion 1 33.40 I Tax map /parcel no.: Limited energy, residential i 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 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 .. 94 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps i 106.85 2 401 amps to 600 amps 160.60 2 Name: c 601 amps to 1,000 amps 240.60 2 Address: "'CS Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 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, 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 ' IS APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with II service or feeder fee, each Business name: ( 6.00, 5 C.: , & branch circuit 6.65 2 B. Fee for branch circuits Contact name: s1■1 6 0 without service or feeder fee, 46.85 2 Address: A R 0 5 `t'�' each branch circuit it Each add'1 branch circuit 6.65 2 City /State /ZIP: i \Pl(.,j.1er(N CA. g1o(p`'2- Miscellaneous (service or feeder not included) Phone: ( ) Cwt Z_ 50 Fax :: ( ) vi s _ 5433 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, G or ' extension. Describe: Page 2 2 Business name: E, �.c..� C1 evki c Address: 4Q40 Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZIP: `F i o 0 4 c7 2 j t Investigation per hour (I hr min) 62.50 Phone ( ) Li' l ' - SCZy Fax: ( ) �52 oil ,1 - o Industrial plant per hour 73.75 66 ELECTRICAL PERMIT FEES*' CCB Lic.: 17).4 Electrical Lic.: IV t i gQ 1. Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: L( 1J 0 i,(� �sj—A� -1, Date: State surcharge (8 %ofpermit fee) TOTAL PERMIT FEE Authorized signature: ti This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * 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/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: P RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: Audio and Stereo Systems* [ Burglar Alarm Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: �� 4 Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) 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 is \Budding\Permits\ELC- PerrnitApp doe 04/03 • Mechanical Pe litll i roii OFFICE' USE . t. tt Its+. ' t • , z City of T " .. D eiB Permit No 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /2.' ©O/ Phone: 503.639.4171 Fax: 503.519 n 60 AA: ; � , Date /By Other Permit: Inspection Line: 503.639.4175 1 ji— j 1 2005 f �'� • Date Ready/By: * Juns = ' El See Page 2 for Internet www.ci.tigard.or.us Notified/Method: Supplemental Information +i ') ;••v ,, "){ Ti(:, .A 1.0 , q TYPE OF 'WORK, ' ' COMMERCIAL FEE* SCHEDULE — USE CHECKLIST' ❑ New construction 1:1 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 $ El I- and 2- family dwelling 1:1 Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYSTEMS FEES* ❑ For special information use checklist. ❑ Multi - family ❑ Master builde Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating /cooling Job site address: 148 - ivNANN ail- Ai p heat lac a em (requires site plan showing 14 00 Furnace 100,000 BTU (ducts/vents) 14.00 Suite/bldg./apt no.: Project name: Furnace 100,000+ BTU (ducts/vents) I 17.90 Gas heat pump 14.00 Cross street /directions to job site: Duct work 14.00 1 el-- Hydronic hot water system 14.00 y - Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: Lot no.: Flue /vent for any of above I 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 1 10.00 Gas fireplace 1 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 PROPERTY OWNER - ❑ TENANT Other: 10.00 Name: Environmental exhaust and ventilation Address. Jrr,, Range hood/other kitchen " '`h' equipment i 10.00 City /State /ZIP: Clothes dryer exhaust 1 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 g. APPLICANT . ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Business name: G,rI CO , Other: 10.00 Fuel piping Contact name: ° N & �.z--z., $5.40 for first four; $1.00 for each additional r Furnace, etc. 1 Address: q ZUO �Qt,> l (p Gas heat pump City /State /ZIP: --- 10 -L, ti t N i Cr 49 i - 1O ioZ Wall /suspended/unit heater Phone' ( ) tpG 1---'5541,0 Fax • ( ) Lo 2_ 51-433 Water heater ) Fireplace 1' E -mail: Range I . . ' CONTRACTOR , Barbecue Business name: new o-i � -=c / L , �� Clothes dryer (gas) � m h' `� ` Other: Address: - po f D 3S • MECHANICAL PERMIT FEES* City /State /ZIP: te Cas -K_ , of . �•� Subtotal Minimum permit fee ($72.50) Phone: ( ) ta5" 022-1 Fax ( ) 2-0t13 Plan review (25% of permit fee) CCB lie.: i 7-5 ) State surcharge (8% of permit fee) / !! TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:, is Date: • Fee methodology set by Tn - County Building Industry Service Board I \Building\Permiis\MEC- PennitApp doe 12/03 440- 4617T(11 /02/COM/WEB) Mechanical Permit Application - City of Tigard - t Page 2 - Supplemental Information Commercial Fee Schedule: ' 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. $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 $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. is\ Building \Permits\MEC- PermtApp.doc 12/03 2 Pg'umbing Per a > FOR OF F l I IJSE ONLY . r. -. • . Received City of Tigard Permit No IIig23" Date /By. l jT (JO 000))....... 13125 SW Hall Blvd., Tigard, OR 9oY 2005 Plan Review Phone: 503.639.4171 Fax: 50j.5 8 1 /Mri ,,:Or� N '!s I" Dat e/By. 24- Hour Inspection Line: 503.639.4175 Other Permit No -.` � r ard.o 3 OF YGA " "�' Date Ready/By See Page 2 for Internet: www.ci.ti g Notified/Method. Supplemental Information RIB L, D1ti4.1 O$ION 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 249.20 .0 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath j 350.00 ❑ Accessory building CI Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other. Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: I 1 (43(,p c t. - Fol.) rJC'Q. Catch basin or area drain 16.60 City /State /ZIP: i 6 , O-_ 9 y23 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: �- Manholes 16.60 p f 1 ` 5 4 " N &. Rain drain connector I 16.60 Sanitary sewer (no. linear ft.: ) I Page 2 Storm sewer (no. linear ft.: ) ` Page 2 Subdivision: l Lot no.: Z Water service (no. linear ft.: ) 1 Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 1 16.60 Dishwasher 16.60 PROPERTY OWNER- ' ❑ TENANT Drinking fountain 16.60 I Ejectors /sump 16 60 Name: Expansion tank 16.60 Address: 5INV Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 • Phone: ( ) "`II0 Fax: ( ) Garbage disposal ) 16.60 Hose bib i 16.60 _ • I4 APPLICANT ❑ CONTACT PERSON Business name: ��aa��� +.l Ice maker i 16.60 ��� (ff3►'L cYTI�`A1C� O Interceptor /grease trap 16.60 Contact name: lC rz-N 61,0M-1 Medical gas (value $ ) Page 2 Address: 1 120 x0 5-W (.44 Primer 16.60 City /State /ZIP: `■PQ_A•fl (.)-(Z__ 41 OWL Roof drain (commercial) 16.60 Phone: ( ) 6O - z� -�� O Fax: : ( ) (all- 6 3 Sink /basin/lavatory 4 16.60 Tub /shower /shower pan Z 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet V 16.60 Business name: �t"� Y 4 owl, (ji 1 „,.4 :1 Water heater 1 16.60 • Address: 7© 21 I Other: City /State /ZIP: ( . ( _,i - OR- c - (toe Subtotal Minimum permit fee: $72 50 Phone. ( ) Gt - 59- Z3 i3 4 Fax: ( ) (l3- ell 2_ Residential backflow minimum permit fee: $36.25 CCB Lic.: 1 b - S1 q i 4 Plumbing Lie. no.: 5--2.5 b. Plan review (25% of permit fee) 67% State surcharge (8% of permit fee) Authorized signature�A 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. i \ Building \Perrnits\PLM- PennitApp doe 12/03 440- 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 - I' 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' i 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' i 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. $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. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by (Fixture) Work Performed Fixture Type: Replace New Moved ' Eidsting Capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink -2" - 3" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach. /Refng. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i \BuildmglPeimrts\PLM- PermitApp doc 3/03 CITY OF TIGARD r BUILDING DIVISION PERMIT #: MST200&00012 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2124/2005 Phone: (503) 639 -4171 #I#411 . Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/16/2005 TIME: 7:01AM PAGE: 82 SITE ADDRESS: 11486 SW FONNER ST CLASS OF WORK: SUBDIVISION: GERTZ PARTITION LOT #: 002 TYPE OF USE: PROJECT NAME: GERTZ PARTITION DESCRIPTION: New SF detached OWNER: GERTZ CONSTRUCTION, PHONE #: 503 -63B -3390 CONTRACTOR: GERTZ CONSTRUCTION PHONE #: 503- 692 -3390 Inspection Request Scheduled For: Date: 91/6/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 0155866 -01 503.780 -7793 Y 0 Arli f '/5 Corrections/Comments/Instructions: ` / 3 4/1 0. _, .l r...IA /.� PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS I FAIL / ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1 1 t Date: ( ' hone #: (503) 718- F -,-' CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005- 00012 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/24/0006 Phone: (503) 639 -4171 a a +ahppgi I l In Requests (24 Hrs.): (503) 639 -4175 -... INSPECTION WORKSHEET FOR DATE: 9114/2005 TIME: 7 :O9AM s PAGE: 97 SITE ADDRESS: 11486 SW FONNER ST CLASS OF WORK: SUBDIVISION: GERTZ PARTITION LOT #: 002 TYPE OF USE: PROJECT NAME: GERTZ PARTITION DESCRIPTION: New SF detached OWNER: GERTZ CONSTRUCTION, PHONE #: 503.638 -3390 CONTRACTOR: GERTZ CONSTRUCTION PHONE #: 503.692 -3390 Inspection Request Scheduled For: Date: 9/14/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 015573 -01 503-780-7793 Y Corrections /Comments /Instructions: ( 9/ Plift- O 1 I ❑ PARTIAL APPROVAL n CANCEL _ NO ACCESS FAIL ❑ a L FeR • SP' CTION n ADDITIONAL FEES SSESSED Inspector: AWA1A Ate. Date: / ! ' d 7 1 5 #: (503) 718- -a-"°,7" CITY OF TIGARD BUILDING DIVISION .. PERMIT #: MST200&00012 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/24/2005 Phone: (503) 639-4171 :04 t Inspection Requests (24 Hrs.): (503) 639-4175 ..,...., '-. 1 ... INSPECTION WORKSHEET FOR DATE: 9/14/2005 TIME: 7 PAGE: 23 SITE ADDRESS: 11486 SW FONNER ST CLASS OF WORK: SUBDIVISION: GERTZ PARTITION LOT #: 002 TYPE OF USE: PROJECT NAME: GERTZ PARTITION DESCRIPTION: Now SF detached OWNER: GERTZ CONSTRUCTION, PHONE #: 503-638-3390 CONTRACTOR: GERTZ CONSTRUCTION PHONE #: 503-692-3390 Inspection Request Scheduled For: Date: 9/14/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 016665-01 603-780-7893 N Corrections/Comments/Instructions: CW4z-CK-■ e__06-y 9(s /)--....„ T y .. • • SS - 0 PARTIAL APPROVAL 0 CANCEL NO ACCESS I I FAIL 0 CALL FOR INSPE ION 0 ADDITIONAL FEES ASSESSED ' / \ Inspector: -/:(" Date: Phone #: (503) 718- 2-7/Yc:.