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Permit CITY OF TI MASTER PERMIT PERMIT #: MST2005 -00334 Ail DEVELOPMENT SERVICES DATE ISSUED: 10/13/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135DA -02401 SITE ADDRESS: 11075 SW HALL BLVD ZONING: R -12 SUBDIVISION: METZGER ACRE TRACTS LOT: 010 JURISDICTION: TIG Project Description: Addition /remodel. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 391 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: 5 VALUE: 13 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 391 sf REAR: 15 • PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 3 0 - 200 amp: W /SVC OR FDR: 18 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAL /PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes MARIA LEMUS AVN CONSTRUCTION and all other applicable laws. All work will be done in 11075 SW HALL BLVD 5819 SE 104TH AVE accordance with approved plans. This permit will expire TIGARD, OR 97223 PORTLAND, OR 97266 if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. . ATTENTION: Oregon law requires you to follow rules Phone: 503 620 - 9664 Phone: 503 784 - 8150 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: LIC 141811 direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 853.48 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS Issued By : _4116., . _ _a - Permittee SignatureA- 11 I .. . . _ A Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 02/05/2011 23:51 5037771861 AVNCQ PAGE 01/01 A-TT 1� Pages / "1141 r`+ L- f� — P. Mechanical Permit Aaalication lint 1 ti• i• 1('I-: 1 •x1.1)11,1 City of ' and aeoevzc AI 13125 5W Hall Blvd, Tigard, OR 97223 Re Date/Br ve Permit No Mf T ag S- 33 Plea Review Phone: 503.639.4171 Fax 503.598.1960 /„,4, i DateDY Other Permit: Inspection Line: 501639.4175 Internet: www.ci-tigard.or.us = „al ' ' 1 -- Dote M /s lariy See i ma No$fied/d/Metho d Sup k xaforraation YPE OF WORK COMMERCIAL 1F E° SCHEDULE — USE CHECKI 9f Now construction ❑ Addition/alteration/replacement lbtechanical permit fzes° are based on the value of the work performed, Indicate the value (rounded to the nearest dollar) of all El Demolition I: Other: • mechanical materialse9uipment, labor, overhead, and profit CATEGORY OF CONSTRUCTION Value: S360. Iia DE 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building IENTIALIEQUIP117 lvrr / SYSTEMS FEES' ❑ Multi- family 0 Master builder ❑ Other: For special bformatton use cheek!isL Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/tooling Job site address: ` LO 175 5 c o iJ A �D \� Air conditioning or heat pump 4444 ���, ► + (requites site plan showing placement) 14.00 City /State/ZIP: Ti G A, R D 0 R ( C �� Furnace 100,000 BTU (dadaMvents) 14.00 ' l j Furnace 100,000+ BTU (ducts/vents) ts) 17.90 Suite /bldg. /apt. no.: Project name: / � g,.R�l C f J Gas beat pump 14,00 Cross street/directions to job site: Duct work _ 14.00 Ilydronio hot water system 14,00 •Residential boiler (radiator or • hydronio ) 14,00 Unit beaters (fuel -type, not electric), in-wall, in -duct, suspended, etc. 10.00 Subdivis ion: l Lot no.: Flue/vent for any of above 10.00 Other: _ 10.00 Tax map /parcel zap -: Other fuel appliances DESCRIPTION of WORK wafer truer 1 10.00 . C � Gas fireplace 10.00 G 0 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 • ' *: PROPERTY °W INTER . 0 roan Chitxxney /liuerlfiue ✓ ve 10.00 Other 10.00 Name: IA t t 6 t L.. M u , Environmental exhaust and ventilation Address: S w � � Range hood/other kitchen eon”' meat 10.00 city /Stat `'i 7 - 2 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, �t Q� Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 1 6.80 ,fAr° El APPLICANT Li CONTACT 'PERSON Attic/srawl pace fans 10.00 Business name; Other _ 10.00 Fuel piping Contact name; J-- $5.40 for first four; 51.00 for each additional Address; Film : Gas heat pump , Ciry /State/ZIk: Wall/suspended/unit heater ' Phone: ( ) . Fax: : ( ) Water heater E-mail: - Range CONTRACTOR Barbecue Business name: ... J /1i - e. t' i f-� aerz. e_ d O C4- Clothes dryer (gas) • Address: S5/ 1 S,>G► / 0 V 1- N .Ve other MECIATIICALPEBM}i FEES* CitY/State/ZIP: 'P j ` 1, el AtA er K /7 264 Subtotal Minimum ermit fee ($72.50) ( ) 7614, .. 8 / $ Q Fax: ($e3) 7 "7 7 ^ igh i P ) Plan review (25% of permit fee) CCB lie.: !41'Z ' j ry State s (8% of permit fee) z . TOTAL PERMIT FEE Authorized signature: ' 'Phis permit application expires if a permit Le pet obtained grit io 180 ,.'/62.......j,.... days after It hats bens accepted as complete. Print name: /l r ey 17 r r/5 1 I Date: i l(; /0 0,5 • Fee mcthodoloj' set by 7ri- County Building industry Service Board i:ustuldingwerouta� rec- p�itApp.dao I7103 440 4617T(1002/Cps?/Wsa) Building Permit Application FOR OFFICE USE ()NLN' " City of Tigard le. D�er6 `_ ,!` Permit No. :' ( - ••33 I" 13125 SW Hall Blvd., Tigard, OR 'u w 2' Plan Review Phone: 503.639.4171 Fax: 503.598.1960 %o� Atli. � * -. Received - ' ' Date /By r i : V _ r, - o S O her Permit: Ins p ection Line: 503.639.4175 SEA L Date Ready/By: Eg See Attached Checklist for Internet: . www. ci. tigard.or. us Notified/Method: Supplemental Information • t3Tl'iect Q � ®� 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. 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 3/ /S 3 8 ❑ Accessory building El Multi-family Number of bedrooms: 4 ❑ Master builder ❑ Other: Number of bathrooms: L} y "JOB SITE INFORMATION AND LOCATION Total number of floors: • A Job site address: / / 0 75 S iJ I-) A) / 6 L l o ak b New dwelling area: square feet • City /State /ZIP: -7- t 6 a OR_ Gi -7 2 3 Garage /carport area: square feet 3 9 / Suite/bldg. /apt. no.: Project name: L . M (1 S . Covered porch area: square feet yb C street /directions to job site: L,1-14 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 `' D•ESCRIPTION •OF WORK work indicated on this application. P14k4 r r m 0 0 . 17 Iy ko D c L ' ST A- / /Z5 Valuation: $ bole we 40 A-0 - R - - /-i"2an fi/ Existing building area: square feet New building area: square feet ® PROPERTY OWNER ' ❑ TENANT ' Number of stories: Name: IA a I A N 1,_C M.. us Type of construction: Address: `.t C7 of go! A if • Occupancy groups: City /State /ZIP: T t Ga 9....D O L Existing: Phone: (503) 6 , a 0 - 9' 6y' Fax: ( ) New: • ❑ APPLICANT ❑ CONTACT PERSON NOTICE. Business name: J Ntittf Ifr at 4 L6Mc1& All contractors and subcontractors are required to be • Contact name: - L,r.:-/Z.,,a-(i 0 'V (SL /4-5 71.1 2- licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: // i 75 / e L I jurisdiction in which work is being performed. If the City /State /ZIP: - / �� R....6 O r\ 3 applicant is exempt from licensing, the following reasons p apply: Phone: ( 5'03) 7z/ - Si 50 Fax:: ( j a i ) 777 - /O E -mail; 4/ i(0 C__„0 NS7, 05 , Ca,44 • CONTRACTOR ' Business name: p - to 0 t 2cE# 1y /g r ,` BUILDING PERMIT FEES* Address: L) 8,- r y ' .t E, joy t/ ? f-„ / Please refer to fee schedule. City /State /ZIP: 7 & ,1 -r -4 4 /b ®i� 9'2,� 6 .6 � Fees due upon application I 4 �,J Phone: ( 5.03) 74(0 - VS c) Fax: (9 777 /R6/ r /g / l 3 / 0 14 Amount received CCB lie.: 7 66 Date received: Authorized signature: g /% This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: A- L Ff�.L 0 t/&Z./1- Sii/ -0 r Date: (y/,-� f ,_d0,5 * Fee methodology set by Tri- County Building Industry / Service Board. i:\ Building \Permits\BUP- PermitApp.doc 12/03 440-46I3T(I1/02 /COM/WEB) • One- and Two - Family Dwelling ... Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Daze /By. Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 /heJ Orr,p i 1 i $• 24- Hour Inspection Line: 503.639.4175 i ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us ❑ 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. ❑ ❑ ❑ 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 twoelevations 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. j 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 ❑ ❑ 0 over 10 feet long and/or any beam /joist carrying a non - uniform load. 1 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. l'%, 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 ...livable to the .ro'ect under review. ,TURISDICTIONAL SPECIFICS c �; ° ` '`� `t ,; n, 23 Five (5) 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. ❑ ❑ 0 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 tree protection measures as required by conditions 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-RES-PermitApp.doc 2 • • Electrical Permit App . � , ( ! 1 ' _ WE. F ' FOR orFic c I SI oN tY • City of Tigard Date/By: Received Permit N °: 115 rg_a.9 Uo 3 3 `/ 2 2 2005 ' 13125 SW Hall Blvd, Tigard, OR 97223 �Cf plan Review ' Phone: 503.639.4171 Fax: 503.598.1960 l ?. By ,_ Other Permit: Inspection Line: 503.639.4175 : = -ILL Inter www.ciligard.or.us us _ - Date RO (MCth O d: runs: la See Page 2 for C ITY OF TLGA "- NatiSed/MmboSupplemental Information b VISIO PLAN REVIEW ❑ New construction r0 ' Please check all that apply: ❑ Demolition Other ['Service over 225 amps, comn'I ['Hazardous location ['Service over 320 amps- rating ❑Burldng over 10,000 sq. ft, � CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential Eli - and 2- family dwelling ❑ Commer'ciai mdtstrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi -family ❑ Master builder ❑ Other OBIS over stories [Weeders, 400 amps or more ❑Occupant load over 99 persons ❑Marmfact red structures or JOB STYE • INFORMATION AND LOCATION ❑Egressllighting plan RV park Job Job site address: ❑Reatth-care facility ❑Other. no.: • W S �' 7 l � S �V Submit 2 sets of plans with any of the above. City/State/ZIP: t / N s ©4 q 7 0 3 The above are not applicable to temporary construction service. Suite/bidgJapt. no.: Project name: e 1. u y'. FEE' SCHEDULE DertrIption I Qty. I Fee. 1 Total I .. Cross street/directions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft or less 145.15 4 Subdivision: 1 Lot no.: Ea. add'l 500 sq. ft or portion 33.40 1 Tax map/parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or Seeder 90.90 2 R Q. 100. �� `s` ,p � c . j �` . ` -, xti�. '�� Services or feeders installation, alteration, and/or relocation 200 amps or less 3 80.30 . 4k)' U 2 1, 4 --- it,--1-,. %1 0 . I l'C ct. c k Lv "PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106.85 2 Name: M<_ ✓ '�� a it (2-3 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: , a gj ``I y .. .1// ti ez„.# .l31 v t.= Over 1,000 amps or volts 454.65 2 ry Reconnect only 66.85 2 ' City/State/ZIP: '71 G t' G p i 01,). 3 Temporary services or feeders installation, alteration, and/or relocation Phone: (.�d3 ) (� o — 9'6 4'1 Fax: ( ) 200 amps or less 66.83 d ' Owner installation: : This installation is being made on property that I own which is not 201 am 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 dfr dta - new, alteration, or extension, per panel ❑ APPLICANT ( ❑ CONTACT PERSON A. Fee for branch circuits with service Business name: c ' each r y 6.65 1,3._ 2 Contact B. Fee for branch circuits without service or feeder fee, 46.85 2 each branch circuit • Address: I Each add'( branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) _ Pim Phone: (' ) Fax :: ( ) Pimp or irrigation circle 53.40 2 • E - mail. Sign or outline lighting 53.40 2 Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or / extension. Describe: Page 2 2 Business name: V e2 ie cL e v . /o u-e 1 /�r /... /-t- -t Address: Each additional inspection over allowable in any of the above .. Per inspection 62.50 City/State/ZIP: �y Investigation per hour (1 hr min) _ 62.50 j , / gg 3d�" p Fes: ( O) Industrial plant per hoar 73.75 Phone: ( I loo �O EI.ECPRICAL P'ERMIP FEES* CCB Lie.: I fiQ j 6 '7 , Electrical Lic.: a e ,.. f o3d I Suprv. Lie.: Q f $ Subtotal / � 3 '73'Y 0 Suprv. Electrician signature, required:09�Q4,4 0- / G�' Plan review (25% of permit foe) (/ q State surcharge (8% of permit fee) , ? , `f / Print name: 201,4_40.44,,e, /r cn cell -- : 7— l l '� oo b� TOTAL PERMIT FEE /183 • €-/ Authorized signature: nib permit applicadaion aspires ifs permit is net obtained wilhla ISO Print name: Date: • Fee methodology Tnn - County Building Industry Service Board " Number of msoections °er permit allowed Building Fixtures t. Plumbing Permit Application 1' FOR OFFICE 'LSE ONLY City of Tigard Received /l L 7- -��_ 339 Received Permit No.: / l� 13125 SW Hall Blvd., Tigard, OR 97223• r � P Plan hone: 503.639.4171 Fax: 503.598.1960 s` ) 2, 1 o �r n �:/it , \ p � � Other Permit No.: ! 24- Hour Inspection Line: 503.639.4175 NE - I i I i l ' i y p Date Ready/By: Juns: ® See Page 2 for Internet: www.ci.tigard.or.us • Notified/Method: Supplemental Information TYPE OF 1<{, ' FEE*` SCHEDULE $ui� For special information use checklist. ❑ New construction Demolition P Description I Qty. I Ea. I Total q Addition /alteration/replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 .41 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: • Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION ,AND LOCATION, Site utilities Job site address: 7f b '15 5 /,J /4 . SL// Catch basin or area drain 16.60 City /State /ZIP: 77 (' &to d jL 7 ,z,7, 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: l-6 liu , 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.: • Absorption valve 16.60 • .DESCRIPTION OF WORK Back flow preventer Paget A- I j / L u) � E9M '� I J 7 (Lim r 'I . f/t//< Backwater valve 16.60 / / S / G%/L - ,"1 �,-/ / c 04 a �OOf - T v4 i �'L Clothes washer 16.60 /6 6 6 i Dishwasher 16.60 3 I i/t/E /z Grp &� �� TO )1 /2 flrri•1��s ❑ PROPERTY OWNER I . ❑ TENANT 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 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 i/� 14 , _ ., � � ' Ice maker 16.60 Business name: / � /U • Interceptor /grease trap 16.60 Contact name: Rigs 6- 7 -in Medical gas (value: $ ) Page 2 Address: 4 ' 7 2 ,,4,& /i( 4U/ 64 A 57 Primer 16.60 City /State /ZIP: /q /4 L5go G 2 q 7 (2Y Roof drain (commercial) 16.60 / Sink/basin/lavatory 16.60 / 6. 66 Phone: (5,3) t . J F G '' - 1 / 2- 9 0 I Fax:: ( ) - / Tub /shower /shower pan 16.60 ' ( ' E-mail: Urinal 16.60 ' CONTRACTOR Water closet 16.60 Business name: / �� pA, 5 Water heater 16.60 Address: c,/ c2_ �J Other: 7 J s-T Subtotal City /State /ZIP: i:74.1,//. ^60_G C2 3•. C' 7/ 2y Minimum permit fee: $72.50 Phone: (5'07) Oq, wj�� Fax: ( ) _ Residential backflow minimum permit fee: $36.25 G- CCB Lie.: / s . . . Plumbing Lic. no.:. - _ E. t . / Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature --� c.-- TOTAL PERMIT FEE Print name: j Qe,y Le -Tp_I(� 2a Date: �12Q`Q,5 This permit application expires if a permit is not obtained within / 1 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. is \Building\Permits\PLMF - PermitApp.doc 06/05 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard . Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: "Site.,Utilities,. ' . . , , Qty.. Fee (ea) _ "Total Square Footage: ' ,' ' _Per>inif,F,ee , , , Footing drain - 1 100' 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 ,Vahlation: - . . 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 Future 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 Back flow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • Fixture Work: Plan -Review for,Complex Structures Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. .accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. .. Previous -- Capped ' Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi /Whirlpool providing services to human beings. Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service -Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor /Water Aspirator are being installed for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 - multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" 4" . Car Wash Drain , . Isometric or Riser Diagram ' Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley _ - Commercial - Service • Swimming Pool Filter Washer - Clothes Water Extractor *Note: If the fixture work under this permit results in an Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. i \ Building \Permits\PLM- PermitApp.doc 07/06/05 CITY OF TIGARD 7, . • BUILDINIVISION PERMIT #: MST200fr00334 13125 SW Hall Blvd., Tigard, OR 97223 \ DATE ISSUED: 10/13/2005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/25/2005 TIME: 7:10AM PAGE: 6 SITE ADDRESS: 11075 SW HALL BLVD CLASS OF WORK: SUBDIVISION: METZGER ACRE TRACTS LOT #: 010 TYPE OF USE: PROJECT NAME: WORK WITHOUT PERMIT DESCRIPTION: Addition /remodel. OWNER: LEMUS, MARIA PHONE #: 503-620-9664 CONTRACTOR: AVN CONSTRUCTION PHONE #: 503-784-8150 Inspection Request Scheduled For: Date: 10/25/2005 Pour Time: Code # Inspection cription Confirm # Contact # Message 115 =al rical- 019286 -01 360-798-3039 Corrections /Comments/ Instructions: cAA Cr12. 1sV N,D wic4E a X5 . •4. Ci ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I l FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: ) a5 Phone #: (503) 718- 1