Permit CITY OF TIGARD MASTER PERMIT
11 Permit#: MST2014-00017
• COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/18/2014
TIGARD p 1 Parcel: 1S125DB09600
WAWAJurisdiction: Tigard
Site address: 7080 SW LOLA LN
Subdivision: RAZBERRY PATCH, THE Lot: 16
Project: KELLY
Project Description: 320 sf. addition. 6/2/2014: REPRINT permit to add furnace,A/C and gas piping for range and ,
barbecue. A/C unit must be installed and placement per manufacturers requirements.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First 160 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 160 sf Garage: 0 sf Front: 20 Smoke
Yes
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors:
Total: 320 sf Value: $60,000.00 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 1 Floor Drains. 0 Sewer Lines: 0 SF Rain 0 Storm Sewer: 0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters 0 Water Lines'. 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain. 0 Ice Maker 0 Hose Bib. 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvpes Air Conditioning: Y Vent Fans. 1 Clothes Dryers: 0
Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 1
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O SvciFdr: 4
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:
ALT SF VB R-3 320
Owner: Contractor:
KELLY,JOHN R&ELIZABETH A ERIC WILLIAMS QUALITY REMODELING Required Items and Reports(Conditions)
7080 SW LOLA LN 22805 SW BALD PEAK RD
TIGARD,OR 97223 HILLSBORO,OR 97123
PHONE: PHONE: 503-516-5674
FAX:
Total Fees: $2,115.98
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. ••.- r les are set forth in OAR
952-001-0010 throe AR• 2-Os1-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 •: or 7:oss .2344.
Issued By: rZC._— Permittee Signature: �f - 7
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE IISE ONLY
Received �
City of Tigard Da<eBy: /;i Permit NcVW7aO//,�f O0/7
• 13125 SW Hall Blvd.,Tigard,OR 972 EcEi vF ) Plan Review
ET1111
Phone: 503.718.2439 Fax: 503.598.1 111 Date/By: Other Permit:
T I c;A R l) Inspection Line: 503.639.4175 JUN - 2 2014 Date Ready/By: ® See Page 2 for
lulls
Internet: www.tigard-or.gov ((�� `jt Notified/Method: Supplemental Information
Vt 1 tVf1�u COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
TYPE OF WO nN,^no
"' tttKtt ft'+ ' Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: 176 e) ,' L/9-- Furnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
�L.ELL y Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater , 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
(9,2— 71S i/1/C /Q X /S 77/N/ fireplace 23.32
/9&-72 / Log lighter(gas) , 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. .
Address: Gas heat pump
•
Wall/suspended/unit heater _
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range /
E-mail: Barbecue /
CONTRACTOR Clothes dryer(gas)
Business name: Other:
MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signat • Fee methodology set by Tri-County Building Industry Service Board
Print name- „ 7 — ` Date:S 7.2� e
1
I:\Buitdingl Permits\MEC_PermitApp_040113.doc 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.
l:\BuildingWenni ts\MEC_PermitApp_040113.doc 2
CITY OF TIGARD MASTER PERMIT
• q COMMUNITY DEVELOPMENT Permit#: MST2014-00017
Date Issued: 03/18/2014
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503 718.2439 Parcel: 1 S125DB09600
Jurisdiction: Tigard
Site address: 7080 SW LOLA LN
Subdivision: RAZBERRY PATCH. THE Lot: 16
Project; KELLY
Project Description: 320 sf. addition
BUILDING
Floor Areas Required Setbacks Required _
Stories. 0 Bedrooms 0 First 160 sf Basement 0 sf Left 5 Parking Spaces 0
Height 0 Bathrooms. 0 Second 160 sf Garage 0 sf Front 2C Smoke
Dwelling Units: 0 Third 0 sf Right 5
Detectors Yes
Total 320 sf Value $60.000 00 Rear 15
PLUMBING
Sinks 0 Water Closets 0 Washing Mach. 0 Laundry Trays 0 Rain Drain 0 Urinals 0
Lavatories 0 Dishwashers 1 Floor Drains 0 Sewer Lines 0 SF Rain Storm Sewer 0
Drains 0
Tubs/Showers- 2 Garbage Disp 1 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 1 Other Units 0
FurnclOOK 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 add'I 500 sf 0 201-400 amp: 0 201-400 amp 0 W/O Svc/Fdr 4
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:
ALT sr VB R-3 320
Owner: Contractor:
KELLY,JOHN R&ELIZABETH A ERIC WILLIAMS QUALITY REMODELING Required Items and Reports(Conditions)
7080 SW LOLA LN 22805 SW BALD PEAK RD
TIGARD,OR 97223 HILLSBORO,OR 97123
PHONE PHONE 503-516-5674
FAX:
Total Fees: $2.032.70
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. -a--a are set forth in OAR
952-001-0010 through OA 952-001-0090 You may obtain a cony o ft questions to OUNC by calling 503 232 1•' or -:. 3 •
a
Issued By: �� C Permittee Signature: .�
CalI(50344Q; 7S,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 project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Number: tx5 - /Li-Gr-i)/ 7
III Building Permit Review
Residential Projects
I I GARD
Site Address: 77 h/c., -/-611/7-E
❑Venfv site address is valid.
Project Name & Lot #:
Clean Water Services — rvice Provider Letter: (lot platted prior to 9/10/1995)
Required: Yes L'J No ❑ Received: Yes ❑ No Rjv, # /4./77
Site Plan Elements:
pSite plan must be on 8-1/2"x 11"or 11"x 17"paper (3)copies of site plan
If Drawn to scale(standard architect or engineer scale) North arrow
)2fMap and tax lot number,site address,project or subdivision pFootprint of new structure(including decks)with finished
,name,lot number,and zoning floor elevations
pApplicant information(name and phone number) pf,ot and building setback dimensions
❑Property corner elevations(2 foot contour lines if more than ❑Lot area,building coverage area,percentage of coverage and
4 foot differential) .impervious area.
❑Utility locations OLocation of wells/septic systems.
Existing structures on site ,QSurface drainage
,QStreet names ❑Street tree size,type and location
❑Erosion control(including drainage-way protection,silt fence ❑Existing trees to be retained with drip line,and tree
design,location of catch basin,etc.) protection measures
Planning Review
❑ Land Use Case Number:
❑ Zoning: R/(}
L,S'
❑ Setbacks: (
Front :" (,0 Rear / >' Side Street Side Garage 26
❑ Landscape Requirement: r
❑ Lot Coverage Maximum:
❑ Building Height: Maximum Height 3 0 Actual Height
❑ Visual Clearance
❑ Easements
❑ Sensitive Lands: ❑ Yes Type
❑ Urban Forestry Plan
❑ Conditions Satisfied a
Approved by: Date: j �-� / ��
Notes:
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
I\Building\Forms\BIdgPermitRvw_RES_I23013.docx
4 • , .r
Building Permit Submittal
Original Plan Submittal: Date: 3//V is/ By: 97.
Site Plans: #
Building Plans: #
Create Case Record#: [^ n case #above for Building Permit Number.
Workflow Routing L 'I' g Le>figineering 't Coordinator Ceding
Workflow Sign-off: Sf,�".�i f for Planning staff,including notes from planning review(page 1)
Route Application Documents: [3'Engineering (1) copy of permit application, (1) site plan, (1) building plan and
o�.ial plan review routing form.
L{J"Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Reviewed By: Date: ? t
Notes:
Engineering Review—reviewed by 4
Actual Slope:
❑ Conditions S Notes:
Approved by: , _ . = Date: Z,, /q)/
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
Permit Coordinator Review
£nditions Met-Prior to Issuance of Building Permit
Notes:
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applican
Revision Notice 3: Date Sent to Ap. '1.nt
111"
Okay to Issue Permit- V Date: /9 / "
1:\Building\Forms\BIdgPermitRvw_RES_123013.docx
� Clean Water Services File Number
C1eanWater` Services 14-000463
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: ( ((5,4
2. Property Information (example 15234A801400) 3. Owner Information
Tax lot ID(s): Name: , Q0 4)...f )..( k
Company:
'' tt Address:
Site Address: 1 0 °pO (� (,OVA (�/-i 1 City, State, Zip:' 0‘d4 6710%-) L�.VJ 1,34 i
City, State,Zip: -"( tj'Lf7 ' ( (i t2 • Phone/Fax: T\ (,ati)
Nearest Cross Street: E-Mail:
4. Development Activity (check all that apply) 5. Applicant Information
® Addition to Single Family Residence(rooms,deck,garage) Name: ,k() % it.N 1GI)4 4
❑ Lot Line Adjustment ❑ Minor Land Partition Company: t 1 V 0
❑ Residential Condominium ❑ Commercial Condominium Address: ,fj �Q t 1L.
❑ Residential Subdivision ] Commercial Subdivision
❑ Single Lot Commercial ] Multi Lot Commercial City, State,Zip. 41 (1' 3
Other Phone/Fax: c-0 7 '5 o , 1 115
E-Mail: CI 111♦ d eS ' • °4 .DGLI/ .A L.
•
6. Will the project involve any off-site work? ❑Yes El No a Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project (`'J� I
p t PO5M- IS 4 V 67 VIid/(i M >~I al- -rte �r1
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 b L V I1' J '
N U 1 5 Print/Type Title
ONLINE SUBMITTAL Date 2- '14 • to(4.
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
XI 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. Drainage appears to be piped.
❑ 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.
Reviewed by _/a et art x A."t Date 02/24/14
2550 SW Hillsboro Highway • Hillsboro Oregon 97123 • Phone (503)681-5100 • Fax (503)681-4439 • www cleanwaterservices org
Building Permit Application
Residential Crooll FOR OFFICt: t 'NI 4ANI 1
City of Tigard \bc Received Permit No.:
Date/B• 13125 SW Hall Blvd.,Tigard, Plan . .. �a
Phone: 503.718.2439 Fax: 503.598.1 1 ��Q Datem 'i . RIM Other Permit:
TI ei A R I a Inspection Line: 503.639.4175 ` S'`," c `04 Date R •.• • hrir. ® See Page 2 for
Internet: www.tigard-or.gov �OC ���\� Notified/Method:ipy�ich y 6J 7� Supplemental Information
G\ ,..', � ; (4.,h L) L.0._,' -F- -,K ,T Lt 1nLJ
TYPE OF WOkK ' REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑N 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,
an
Er/d 2-family dwelling El CATEGORY
$ (e O l
❑Accessory building El Multi-family Number of bedrooms:
❑Master builder ❑Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: "10 19 d Clikkj LL LIJ• New dwelling area: square feet
City/State/ZIP: 11.V,4 MI'. Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: V/014„011 iv Is ,u)jo` J 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(rounded to the nearest dollar)of all
, equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
16 rr/, j,1 f- 4!�I`x P.1..114 F4-1 VI.V/frkii ; Valuation: $
320 S f
Existing building area square feet
New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: J P).. Lif !M !, !v" Type of construction:
Address:10 47'01 GTCO 14(/. 144 ' Occupancy groups:
City/State/ZIP: -71 10isi Y 0(a t _ Existing:
Phone:( ) Fax:( )
New:
PPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name; V t7 (Please refer to fee schedule)
Structural plan review fee(or deposit);
Contact name: f j U 0
FLS plan review fee(if applicable):
Address;1j4 50 i3.L4 ) I• • ,
City/State/ZIP:44 V1'- " -Ojz oz r eV n1")
Total fees due upon application: 5-,), t J 7
,j, Amount received;
Phone: I `-j I-1
3 Fax: :( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: 6, 1 v 0 d Z C ,. h eD Qc.t, ( (n 1� . h„e,t/
Commercial and residential prescriptive installation of
CONTRACTOR
roof-top mounted PhotoVoltaic Solar Panel System.
Business[tame: 0,,rut. U(M,4M s QV 4t' V ty4,M 4, f Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: P A I/ )y tz` IA>. Solar Installation Specialty Code checklist.
City/State/ZIP: i L r) 0tso ea- 4 .1 (23 Permit Fee(includes plan review S180.00
and administrative fees):
Phone:,lO S) , -) le 541+ Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: -1 1 /i-7/i,--- Total fee due upon appication: $201.60
Authorized signature: 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
Print name: 1r�/ J l 1 [ Date: Service Board
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/YEB)
1
Building Permit Application Checklist .
•
One- and Two-Family Dwelling FOR OFFICE USE O1
City of Tigard Received
III13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
Phone: 503.718.2439 Fax: 503.598.1960 Associated permit,
t WARD 24-Hour Inspection Line: 503.639.4175 13 Electrical ❑ Plmmbm_ ❑ Me,han cal
Internet: www.tigard-or.gov ❑ Other
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 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 Fluor 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 g • ❑ ❑
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 a licable to the ro'ect under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x I I"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"buildingplans 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, ❑ ❑ ❑
L 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.
l:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440 4613T(11/02/COM/WEB)
Electrical Permit Application FOR OFFICE USE ONLY
•
City of Tigard RPleaCteei1Bved y: 1d/f I" Permit No 1}7 L i
/ `Z ( Y)( 7
" 13125 SW Hall Blvd.,Tigard, IR 97223 Plan Review
■ Phone: 503.718.2439 Fax: ,'x{ 398.4960 Date/By Other Permit:
7 lGAR1) Inspection Line: 503.639.411 ,�_ ' Date ReadyiUy Juris ® See Page 2 for
Internet: www.tigard-or.go�v `` Notified/Method: Supplemental Information
E OF WORK PLAN REVIEW
' ❑ New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑ Demolition El Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
exceeds 10.000 amps at 150 volts or Floating buildings.
CATEGORY OF CONSTRUCTION P ❑Floatin buildin
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
1 and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3°,
%,a 1,O (/4 100HP or more. occupancy.
Job no.: Job site address: C/ I
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 111,.)„471).y),a71). Ors • ❑Health-care facilities.
0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: FAY "l f1 1 s _ ❑Service or feeder 600 amps or more.
�jf�,'�T�r FEE SCHEDULE
Cross street/directions to job site: 2,,),/,,,..s. �r„", f�J/I� y? Description I Qty. 1 Fee. I Total I
�/J ����GRR� / New residential single-or multi-family dwelling unit.
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 I
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.)
75.00 2
I, �1� y r` rLimited energy,multi-family
75.00'MN(G t(�l H i+j� J� &,1(4. oM> , residential(with above sq.ft.)
i
/ / Renewable Energy _ ❑ See Page 2
5 Services or feeders installation,alteration,and/or relocation
e'VROPERTY OWNER 1 0 TENANT 200 amps or less 100.70 2
/ ' , 201 amps to 400 amps 133.56 2
Name: j ( L / ,,) P (/11 401 amps to 600 amps 200.34 2
■Address: L Q 4rt, ((/,. 1,44 r' 601 amps to 1,000 amps 301.04 2
�� n
Over 1,000 amps or volts 552.26 2
City/State/ZIP:
V/` /nn"Y. a r Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. .401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
£YAPPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: D 1' G each branch circuit
B. Fee for branch circuits without
Contact name: b, l V p service or feeder fee,first / 56.18 2
branch circuit if
Address:44_. - .A.1�,1y) *14.. Each add'I branch circuit 67 7 42 �K_SA 2
City/State/ZIP: 4...4 5 5 Q J a g-- ' 1l (IL 3 Miscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
go c2 oO 1 1 1 ( ) dwelling,service and/or feeder
Phone: 77 Fax:,,: ]� t Reconnect only 67.84 2
E-mail: Cie IV 0 d LS I A� a) eA t 44 1 4 h - 0 Z. Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name- .. ' r / '>(,c3 1 (_�C • '"a Signal circuit(s)or limited energy See
panel,alteration,or extension. Page 2 2
Address: / 5//8 S -4,Jood jle� Each additional inspection over allowable in any of the above
f o (� Additional inspection(I hr min) 66.25/hr
City/State/ZIP
1 ei ( `I !0 Investigation(1 hr min) 66.25/hr
Phone:(5 ) 5b41 -3095- ( ) Industrial plant(1 hr min) 78.18/hr
•
Inspections for which no fee is
CCB Lie.: /2519y/?/�4 Electrical Lic.: C 57, Suprv. Lic.: 3Rs 3 S specifically listed(%,hr min)
90.00/hr
C,-� • ELECTRICAL PERNIIT FEES
Suprv.Electrician signature,requireuire== ` Subtotal t/o��e��
Print name: '7 Plan review(25%of permit fee): w..- TQ
���V� L- /-1 O fZ!Z�S Date: ���y
State surcharge(12%of permit fee): t3 0
Authorized signature: TOTAL PERMIT FEE: ID_ v
. Zg
.---- This permit application expires if a permit is not obtained within t80
Print name: ciaS°� 4 Date: -y/e//`j days after it has been accepted as complete.
• Number of inspections allowed per permit
1:1BuildingiPermits\ELC_PermitApp_ELR_EREdoc Rev 05/21/2013 440-4615T(Ii/OS/COM/WEB
Plumbing Permit Application
• ,Building Fixtures FOR OFFICE USE ONLY
of Tigard Received
City g q�{ l Permit No
13125 SW Hall Blvd.,Tigard,OR 97223 , Plate/By. p/ 7 `J�' /1-63-010/ `1 - Gr.„.4„)1�j
Phone: 503.718.2439 Fax: 503.598.1960 .. Date/By Review Other Permit No..
Inspection Line: 503.639.4175 '.
1 I G A R D Date Ready/By: turfs ® See Page 2 for
Internet: w tigard-or.gov
ww Notified/Method: `c Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑Npw construction ❑Demolition lai°' 1 For special information use checklist
L�'/ ^'��`' Description Qty. 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
Iff(-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
E] Accessory building SFR(3)bath 500.32
g ❑Multi-Family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other: Fire sprinkler( sq.ft.) I- Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10 t) 0 4r 0 LI V. . t4 ) Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: ) VA. 141 J , - -
Footing drain(no.linear ft.:J4 ) ' if Page 2 _50 ed 3.
Suite/bldg./apt.no.: Project name: ii.4 Lv V1 Manufactured home utilities 50.03
�i
Cross street/directions to job site: Manholes 18.76
• fix /-� / 7,r _ Rain drain connector - , 18.76 g.-7G
/Y Sanitary sewer(no. linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear It.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
y��� Clothes washer 25.02
I& ii-c. td, c F' ra lt11 . .4 I V -i- 1 4 Dishwasher f! j 25.02 )_5.,-:,4
3'Y0 c7 F Drinking fountain 25.02
Ejectors/sump 25.02
LROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: to)4 U. AiLsAl iptAnArt Fixture/sewer cap 25.02
!
Address: /4,C V,(G Floor drain/floor side/hub 25.02
v ' Garbage disposal
City/State/ZIP: -}�- L b P , � � 25.02 '-,�:C3 i.
I (,Li Hose bib 25.02
Phone:( ) Fax:( ) Ice maker C 12.51 «-
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: `a t V O 8
Contact name: 1> I J to Primer 12 51
Roof drain(commercial) 12.51
Address://I, 0 [ �) •4-, �,
�, Sinkibasin/lavatory 3 25.02 7s--.04:,,
City/State/ZIP:44 friA, 0 - Ov., Gj 1 Solar units(potable water) 62.54
Phone:(93) c-3 4e) '. 1 7 3 Fax::( ) Tub/shower/shower pan ✓ A.. 12.51 )5 0?
E-mail: (� I+s! n d t e WC 14 4 - , 4:6" Urinal 25.02
j CONTRALTO Water closet 1 25.02 it 5-.0}
1 I � f' Water heater 37.52 LL Business name's
L Water piping/DWV 56.29
Address: (Q 4 S Z i-f- Adi - / - Other: - 25.02
City/State/ZIP: L m. ,. Subtotal ,jC), Sly
c • 1 Minimum permit fee: $72.50•Phone: r✓3 b o� A Fax: r t I
y r Z 7 T� Plan review (25%of permit fee)
CCB Lic.: I Plumbing ic.no.: 2.4 -- D
State surcharge(l2%of permit fee) 3i 7
Authorized si: I 1/1 2,n TOTAL PERMIT FE De'Print name: ' r-r V� Date: 3 I s-� 1 1 This permit application expires if a permit is not obtained w in 180 days
1` after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
I'%Building'Permits\PLML'-f ermi tApp d. 10/01/09 44O-4616T(10/02/COMIW EB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
_Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total 1 Square Footage: Permit Fee:
Footing drain•lu 100' j 50.03 7 .4�I 0 to 2,000 $121.90
Footing drain-each additional 100' J 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- I st 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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
El Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
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"
Isometric or Riser Diagram
❑ 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 Filer 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
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: I
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Mechanical Permit Application FOR OFFICE USE ONLY
' City of Tigard Date/By.
t g j ii ,gj� permit No.
�' TTnE/ 1 cJL7 1 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
ll Phone: 503.718.2439 Fax: 503.598.196 `I l ,y ? Date/By: Other Permit:
FIG A K U Inspection Line. 503.639.4175 14°' 2��� Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov Notified/Metlrod: Supplemental Information
E OF WORK "` / ^','%7 COMMERCIAL F'EE' SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑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:S
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. f Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 1 0 0D O CyW kVV.4 1,00• Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: `ti V A,pt> OR— Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: IC,Vo (/J .0,5 JJ L� Duct work 23.32
Cross street/diretxions to job site: 1"v Hydronic hot water system 23.32
� // G Residential boiler(radiator or■70/7#r / /C/I/ / a hydronic) 23.32
// Unit heaters(fuel-type,not electric),
, in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: 1 Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater I 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
''ff� !� q �j Flue vent for water heater or gas
IC OTA{WA/ .1,1)tisi • / A,.`-1 f)-4(//(r{/ '4tIv„rr fireplace 23.32
Log lighter(gas) 23.32
1l Sim • Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
PROPERTY OWNER 0 TENANT _ Environmental exhaust and ventilation:
Name: J 0 ), )4 0/�l/l Range hood/other kitchen
Address: J ) Id 0 9 ) VO`/44 (l 141 equipment 33.39 3-3"'"t ' Clothes dryer exhaust 33.39
City/State/ZIP: (Qt�rf, 0 m - Single-duct exhaust(bathrooms, ry' 7
toilet compartments,utility rooms) / 23.32 A'3 3f
Phone:( )_, Fax:( ) Attic/crawlspace fans 23.32
LVC PLICANT ❑ CONTACT PERSON Other: , 23.32
Business name: ' V 0 Fuel piping:
I>
514.15 for first four;84.03 for each additional
Contact name: ita IV la Furnace,etc. .
cc° 144e1`, p 14` . , . Gas heat pump
Address: �i I �"1J Wall/suspended/unit heater _
City/State/ZIP:44 ,9 3 fDtt, OIL ' ei 1-1L 3 Water heater
Phone:(9-D-; 5-3 0a t1'-i Fax::( ) Fireplace _
^` Range
E-mail:
L () C/S ( a) QGt'Ali) y 11 Lc - vi _CU Barbecue
"CONTRACTOR Clothes dryer(gas)
Other:
Business name:,/C �"k,ti- dry y.c"TX'' /nc/e;: i!//1.� MECHANICAL PERMIT FEES*
Address: Z s". ' S !Y, 60,6/ A% "'s Subtotal 5r'--7/
City/State/ZIP: '� ` t7� ?71�, Minimum permit fee($90.00) cit) ,
� f/f.o r'� r
Phone: 3 l Plan review(25%of permit fee)
/' - c) y Fax.( -} State surcharge(12%of permit fee) 0,1X)
CCB lie.: 977 ' Y C TOTAL PERMIT FEE is;C),. p
This permit application expires if a permit is not obtain wunin 180
days after it has been accepted as complete.
Authorized signature/' ��� • Fee methodology set by Tri-County Building Industry Service Board
Print name: irk. '/v//,../so- S Date: ���//,/
L.
I`Building'Permilsl,MEC_PennitApp_0401 13 doe 440-4617r(I 1/02/CO.N/WEB)
Plumbing Permit Application p67141-;+ g Y ►i S-2-O 1`I ` 000 - 1 .
Building Fixtures f pc_ c4g f t.►ttlt I: I �1: t.►\1.1
City of Tigard E �°�Z V Received �'`Ca / ( A Permit No./ - i /y'e)00/7
IN 13125 SW Hall BIv1,Tigard,OR 97223 t Plan Review
Phone: 503118.2439 Fax: 503.598.1960 , Day: Other Permit No.: •
Inspection Line: 503.639,4175 ' I Datc Rcarly/By. 7w;s. ® Sec Page 2 for
Internet: wwrv.tigArd-Ot'.gDN � .:.�/Njetll�; Sn.dements!Iaformrtioo
❑New construction ❑DeMOlition 1 For special information use checklist
Descri•tion •V, Ea_ Total
F'Addition/alteration/replacement ❑Other: New 1-2-thm4 dwellings(includes 100 ft-for each utility connectiorl.
!f-and 2-family dwelling ❑Commercial/industrial i SFR(2)bath 437.78
SFR(3)bath 500.32 Mill
■ Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder Q Other Fire sprinkler(_sq.R)
-: ;• -' �: Site utilities:
Job site address: - -Q Q S()J COL A L A IV E Catch basin or area drain j 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIPiI
Footing drain(no.linear ft.: Page(,...
Suite/bldg./N:44" 0.: I Project name: V E Manufactured home utilities 543
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
•i
Sanitary sewer(no.linear ft_:_j; Page 2
• - Storm sewer(no.linear ft.:.) ! Page 2
Water service(no linear ft.:_____) j Page 2
Subdivision: Lot no.: Fixture or item:
I Tax map/Tweet no.:
Back flow prcventer 31,27
I
r•y :. :, Backwater valve 12.54
Clothes w 25:02
Dishwasher 25.02
Drinlang fountain 25.02 !
s
. 25.02
Ejectors/sump I S
4.
Expansion tank 12.51
'y Fixture/sewer cap ' 25 02
Name:
�/�" `` / Floor drain/floor sink/hub 25.02
Address: I 1
Garbage disposal 25,02
City/State/ZIPr' 3+ n r Hose bib 11111111_
P1to ie ( . . )•!.; Fax:( ) Ice maker _KEttl
Interceptor/grease trap 111.1111 25-02
Business name: Medical gas(value.1 ) _ Page 2
Primer 12.51
Contact masse:
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
Urinal
! 25.02
E-mail: Water closet ! 25.02
Water heater
Business name;: A C L. / la t x/I NtG Waterptping/DWV 56.29
Address: ,& a CC lit) e-4 Co r I. Other: ! 25:02
City/State/ZIP: 1 j,,,Val%)A✓ DR. 1900(e, Subtotal
^ •
Phone:(9') (p f i- I_32-3 Fax:(,5s 2,f T•7 Minimum pcm it fee
,2_ l I ' g Z(—/62,pQ� Plan review (25%of permit fee)
CCB Lic.: "T Piumbin Li no.: l�
State surcharge(12%of permit fee)
Authorized signature: r r.------: _ TOTAL PERMIT FEE
i /_/I 7i- 6--/_`i/� This permit Application expires If a permit is not ebtsiaed witinn 8e days
Print name: IA-4: fY] /VC L Date: t(J 'I
after if has been accepted as complete.
"Fee methodology set by•1•ri-County Building Industry Service Board.
1'1Bufidina uinimkPLMU•PermitApp.doe 10/01/09 440-4616T(10/03/CO:Y1 WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7080 SW LOLA LN, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
PASS
MST2014-00017
Jeff Grove
Violation Summary:
Inspector Contractor