Permit CITY OF TIGARD MASTER PERMIT
C • COMMUNITY DEVELOPMENT Permit #: MST2012 -00064
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012
Parcel: 2S103DA05400
Jurisdiction: Tigard
Site address: 13395 SW 107TH AVE
Subdivision: FANTASY HILL Lot: 6
Project: Tabert
Project Description: Addition of 400 sq ft of living space and 380 sq ft of garage.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 400 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 17 Bathrooms: 1 Second: 0 sf Garage: 380 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 400 sf Value: $59,513.20 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 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: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =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 addl 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 2
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing. N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R - 3 400
Owner: Contractor:
TABERT, DEAN J OWNER Required Items and Reports (Conditions)
13395 SW 107TH AVE 1 Ersn Cntrl 503 - 681 -4444
TIGARD, OR 97223
PHONE: 503- 347 -0853 PHONE:
FAX:
Total Fees: $2,252.14
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
bee - in acco • - > 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
d: 's. ATTENTION: 0 = :o - - quires you to follow the rules adopted by the Oregon Utility Notification Ce ter. Those rules are set forth in OAR
9.2- 001 -001 • through OA -A:52 -• • -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 .19: or 1.800.332.2344.
Is ued By: - 4 Permittee Signature: -c. %. -!
C all 503.839.4175 by 7:00 a.m. for the next available inspe on da e.
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.
Building Permit Application
Residential RECENED FOR OFFICE USE ONLY
City of Tigard 2012 Date /Bea a9 19 Permit No.: "o�o�a — 'r' '
NI •
13125 SW Hall Blvd., Tigard, OR 97223 MAR Plan Review M.
C Phone: 503.718.2439 Fax: 503.598.1960 ,or.r ii 1 � Oth Permit �, 1
1I C. n t: Il Inspection Line: 503.639.4175 CI O TIG A� Date /B : / 1 Date Ready /: Jura: ® See Page 2 for
Internet: www .tigard - or BUIL D1NG DIVISION Notified /Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: I- 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
�ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
dwelling ❑ Commercial /industrial Valuation:
and 2 -famil dwellin $ 15ct 3; -
ID 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: I 3'395 5,,, /0"71! ,6A1 New dwelling area: 4 square feet
City/State /ZIP: rld p. , 6 R 97 Z23 Garage /carport area: 3• square feet
Suite/bldg. /apt. no.: I Project name: 'AA4302T p1§5(DeNc Covered porch area: 1 5 ) square feet
Cross street/directions to job site: Deck area: square feet
P /-Ek 5nZZET TO /O7 ' AVE Other structure area: square feet (7
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: I 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.
I—NI i56 SPACE Ai5D(TtoN cl` Grcke4c- — E lei IL) Valuation: $
Existing build' area: s eet
,,��,,
New building area. square feet
laf OPERTY OWNER ❑ TENANT Number of stori .
Name: DE/No • C ERst Type of co truction:
Address: 13395 S tJ /O7 Au E Occupancy groups:
City/State /ZIP: 7/6.hej) I cD (Z 973 Existing:
Phone: (5o3) 34- 7 -01$53 Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: ('�W I ! (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: DAN TF~Pe'
FLS plan review fee (if applicable):
Address:
Total fees due upon application:
City/State /ZIP:
Phone: ( ) I Fax: : ( ) Amount received: Og . zr5
E - mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel stem.
Business name: CiwIJ elt_ Submit two (2 ets of roof plan wi • onnection details
and fire departm- • access, alo. _ with the 2010 Oregon
Address: Solar Installation S.. laity 'ode checklist.
City /State /ZIP: Permit Fee (inclu.' .Ian review $180.00
and a. - inistrative - •
Phone: ( ) I Fax: ( )
State surchar. (12% of permit fee): $21.60
CCB lie.:
/ 7 To : fee due upon application: $201.60
Authorized signature: / This , • rmit application expires if a permit is not obtained
�l ii ��ccc --- ' hin 180 days after it has been accepted as complete.
Print name: ®FAI.I A6e-a Date: 3/z, / ( I * Fee methodology set by Tn -County Building Industry
Service Board.
I:\ Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440.4613T(I 1 /02 /COM /WEB)
Building Permit Application Checklist ,
One- and Two - Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
`' Date/By: Received Permit No.:
;� 1 3125 SW H all Blvd., Tigard, OR 97223 Associated permits: Ill Phone: 503.718.2439 Fax: 503.598.1960
l I l A I: 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 Yes No N/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 ❑ ❑ ❑
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.
1 1 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 ap to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
4 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or I I" x 17 ". ❑ ❑ ❑
7 - 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- RESPennitApp.doc 02/24/2011 440- 4613T(I I /02 /COM /WEB)
• Electrical Permit Application
t�
City of Tigard JECEIVED Date/By: Received ? ! Q /) Permit No. : 5��Of O 61r
° 13125 SW Hall Blvd., Tigard, OR 97 Plan Review
' C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G n R u Inspection Line: 503.639.4175 MAR 2 9 2012 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov ( Notified/Method: Supplemental Information
TYPE OF viki ' z �/ OF PLAN REVIEW
❑ New construction [ lcddition/altahtldtCf���ct�menf
TTa�ii� {{;; IViSIGN Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory buildng 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 ", "I -2 ", "I -3 ",
Job no.: Job site address: 13395 5 W (0 7�!'- !'C�� o I or more. occupancy.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 'T(,G p .p o R- 9 7 u3 ❑ Health facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: n (2ET ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
{� New residential single- or multi - family dwelling unit.
TICK 5'7 ;' `tc /07. MC Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less - 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
• Limited energy, multi- family 75.00 2
Li VI r sfokcr />.AI rta/0 -- t51DAJ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
[ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: QEFkr,! "�/% -ems- 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 3? c s I.) /07`iss, A ve Over 1,000 amps or volts 552.26 2
City/State /ZIP: `l Ga-� d 7Z Temporary services or feeders installation, alteration, and/or
t relocation
Phone: ( . (33) 7- Q SS3 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
LICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: ( .)ell-- B. Fee for branch circuits without
service or feeder fee, first r 56.18 2
Contact name: p E1vJ "('J°a6star branch circuit
Each add'I branch circuit y 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: 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: 00..511/4)&12 panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (I 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
• Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
&.67e7..413.----- TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
Print name:
ptel4 3 /( Z • N um b er o inspections allowed per permit.
I :\ Building \Permits\ELC- PerrnitApp.doc 07/01/10 4404615T(I1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
j RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
•
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
•
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \ BuildingWermitAELC- PermitApp.doc 07/01/10
Mechanical Permit Application ONI_V
I OIZ curer: liSl�:
RECEIVE �� • ec eived ipr
City of Tigard Date c5 � PermitNo.: I •
C ° 13125 SW Hall Blvd., Tigard, OR 97223 MAR 2 9 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 2 2 Date/By: Other Permit:
. 1 . 1 G A K D Inspection Line: 5013.639.4175 Date Read kris: ® See Page 2 for
w
Internet: ww.tigard -0 C ITY OF TIGAR r.goV Notifie Supplemental Information
RI III .f IN(1 i)IVI.CI . -
TYPE -OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
ID +��
New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
d 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For spedal information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: i 3 3 / 5 5 LA) /0 7 AARF (requires site plan showing placement) 46.75
(G �(2 (� 7? 7 Furnace 100,000 BTU ( ducts/vents) 46.75
City/ State/ZIP:
T r C D 3 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: 't P_E512,d1N - Heat pump
(requires site plan showing placement) 61.06
Cross street/diredions to job site: Duct work ( 23.32
P � 5 . - I U7 �, AVE 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
L! ti/ A-)6 5P/tCE /r17Dt 11O J Gas fireplace vent 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
Chimney /liner /flue /vent 23.32
Erf OPERTY OWNER ❑ TENANT
Other: _ 23.32
Name: DAN ` -f elegy Environmental exhaust and ventilation:
Address: 1.33tis -54_,J / - 7 h� Range hood/other kitchen
equipment 33.39
City /State /ZIP: 176 / a., , O g. c77 Z2-3 Clothes dryer exhaust 33.39
4:7 — (! 8 S3 Fax: ( )
Single compartments, exhaust (bathrooms, utility rooms)
Phone: (563) 3
�,/ toilet compartments, utility roo ( 23.32
( tPPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: 0 W - t� Ayg Other: 23.32
Fuel piping:
Contact name: O rp.t...5 'v i T $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: Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal 4. (,•
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) 43.'51..,
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) (o . g
TOTAL PERMIT FEE 'I W
Authorized signature: e� z This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 1Ep.t. 'S /`.eR'r I Date: * Fee methodology set by Tn County Building Industry Service Board
1:\ Building \Permits'MEC- PermilApp.doc 09/09/10 440-4617T(II /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 $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC- PermitApp.doc 09/09/10 2
Plumbing Permit Application
Building Fixtures RECEIVED
City of Tigard A 9 /a, Permit No.: ) -erred/
a
:74 V 1 SW Hall Blvd., Tigard, OR, ?72.?
3 cc�� Plate y:
C Phone: 503.718.2439 Fax: 50 9d0 9 2 U 1 Z Plan Review
Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639 Date Ready/By: luris: El See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE ttJit llkIG DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist .
Description I Qty. I Ea. I Total
ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 1 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 3395 .51.,,, /o7 '- Aver' Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP:
`TlG1tP� ! O g,_ 9722.3 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
P 517 •J /07 `.fNJEv Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
j_kl. •3G sr &cir ADO 117010 Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
ID ROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: p J.) 'T?r$trIast- Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: / 339 5 5c..a.) 107 /V > Garbage disposal 25.02
City/State /ZIP: - 6Rr2.0 t 0 g... 9 777 ' 3 Hose bib 25.02
Phone: (Spy) 3 4-7 853 Fax: ( ) Ice maker 12.51
PPLICANT ❑ CONTACT PERSON Interceptor /grease trap • 25.02
Business name: w tl l Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Dt¢ ► ' rAe.6��- Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory I 25.02 25 ,02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 1 12.51 12.
E -mail: Urinal 25.02
CONTRACTOR Water closet I 25.02 26.02
Water heater 37.52
Business name: OW fra tLsIP` Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal (07.55
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 a /a c
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) I •7
Authorized signature: De......-
TOTAL PERMIT FEE
Print name: 1) ef4t4 T -rA1gegsr Date: 3 (2_9 / / Z 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:\ Build ing \Permits\PLMU•PermitApp.doc 10/01/09 440- 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 - 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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font • ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" Isometric or Riser Diagram
- 4.. ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach/Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang ,
-Stall
Sink: - Lav/Bar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1: \Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
RECEIVED
MAR 2 9 2012
i e ° Building Division CITY OF TIGARD
Development Code Provision Review BUILDING DIVISION
TIGARD Residential Projects
Building Permit No: 1 r ��Ab i a Dal 42 ���Q
CWS Service Provider Letter Received: Yes ❑ No F N/A ❑ e
0-1-4.1_ L.T,
Routed Plans:
Original Plan Submittal Date: W 9 /4 2
1st Revision Submittal Date: ❑ Site Plan Only //��, n /�
2nd Revision Submittal Date: ❑ S ite Plan Only rl2 e"
To the Applicant: .6
` r V''
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (■) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.,
Staff: please check items alon left only 'f approved.
r
Planning Review (contact S h e.e, r at 503 -718 y5Z or @ tigard- or.gov)
Land Use Case No. — Name "'
I!D oning if. 5+ 5
Of Setbacks:
Front 2_4 Rear I S Side Street Side )0 Garage
❑ Maximum Building Height 3 Actual Building Height 1
GY isual Clearance
[ asements
lid Sensitive Lands Type: dliil'
Notes:
Original Plan: Approved Not Approved ❑ Date: et 2
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov)
Actual Slope: 4
Notes:
Original Plan: Approved Not Approved ❑ Date: i / (
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date: '
•
• (Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
L" treet Trees
Dr Protected Trees
Notes:
Original Plan: Approved Not Approved ❑ Date: 14/0
Revision 1: Approved ❑ r Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applica
Okay to Issue Permit: Yes No ❑
Date Routed to Building:
Page 2 of 2
RECEIVED
Property Owner Statement MAR 2 9 2012
Regarding Construction Res onsibilitie GI T N OF TI GARD
g g p �C7 II.DING D IVISION
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 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
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 a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
V I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
• 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.
EN.) TA
Print Name of Permit Applicant
-4
3 ( 2 -7 7/
Signature of rmi pplicant Date
Permit #: Y1 — O06)&4
Address: / 339 ••,w 107 /tU ,, v • im ;,;, %:• �?i
1 #127 j c Q. _ 9 '7 a)-3 .�.;��, : :
•
Issue by: I' _ - Da 4 Aid/" �`
1 -
This Copy for Permit Offices
f _ RECEIVED
APR ?012
CITY OF TgAn ater Services File Number
ClcanWater \ Servi3 DiNG yviSg2No00708
Sensitive Area Pre - Screening Site Assessment
1. Jurisdiction: Washington County
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Dean Tabert
Company:
Address: 13395 sw 107th Ave
Site Address: 13395 SW 107th Ave City, State, Zip: Tigard, OR 97223
City, State, Zip: Tigard, OR 97223 Phone /Fax: 503-684-6401 fax 503 -684 -6401
Nearest Cross Street: Cook I_n. E - Mail: deanii)dt.abertdesign.corn
4. Development Activity (check all that apply) 5. Applicant Information
• Addition to Single Family Residence (rooms. deck, garage) Name: Dean Tabert
❑ Lot Line Adjustment J Minor Land Partition Company:
ID Residential Condominium ❑ Commercial Condominium Address:
• Residential Subdivision ❑ Commercial Subdivision
❑ Single Lot Commercial t] Multi Lot Commercial City, State. Zip:
Other Phone /Fax: 503- 684 -6401 Fax 503 -684 -6401
E dean @dtabertdesign.com
6. Will the project involve any off -site work? ❑ Yes $1 No ❑ Unknown
Location and description of off -site work
7. Additional comments or information that may be needed to understand your project
Please review the attached drawing (DT2012 - 00 R1.) and get back to me with any comments or questions.
This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ
1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army
COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify
that I am familiar with the information contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate.
Print/Type Name Dean Tabert Print/lype Title
ONLINE SUBMITTAL Date 3/29 /2012
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report
may also be required.
• Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site. This
Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently
discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local, State, and federal law.
• Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially
sensitive area(s) found near the site. This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water
quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order
07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law.
❑ This Service Provider Letter is not valid unless CWS approved site plan(s) are attached.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9)9/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED_ APPROVED
� /
y� ( - J �s� 2,• ( r f:11 pra, Apr 0, 2011
Reviewed by Ci � r f Date By Laurie Harris a
.._. .._ 7 ___.,
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • www.cleanwaterservices.org