Permit I _ CITY OF TIGARD MASTER PERMIT
II -I''- COMMUNITY DEVELOPMENT Permit#: MST2015-00183
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2015
Parcel: 1S125DC01900
Jurisdiction: Tigard
Site address: 7065 SW VENTURA DR
Subdivision: WASHINGTON SQUARE ESTATES Lot: 9
Project: BURKE
Project Description: Adding (2)kitchen windows for remodel.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $15,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 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
Furn<100K: 0 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 Svc/Fdr: 8
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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
BURKE,LAURIE NEIL KELLY CO INC Required Items and Reports(Conditions)
7065 SW VENTURA DR 804 N ALBERTA ST
TIGARD,OR 97223 PORTLAND,OR 97217
PHONE: PHONE: 503-335-9240
FAX:
Total Fees: $858.74
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. AT ■ ON: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth,in •OAR
95 :11-0010 throu• OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 32.1987 or 1.800.332.2344.
Is-ued By: / /. 0, Lam! Permittee Signature: JICI
f '_
Call 503.639.4175 by 7:00 a.m.for the next available inspect ate.
This permit card shall be kept in a conspicuous place on the job site until corn lotion of the oject.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
!Residential j`R FOR OFFICE USE ONLY
City of Tigard Received Permit No.
`J g s����� Date/B � (� 1 � ._ � )5--„. C7 ,
III ■ 13125 SW Hall Blvd.,Tigard,0 �11L23" Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 1G Date/B : O f�� Other Permit:
TIGARD
Inspection Line: 503.639.4175 1 3 2� J Date Ready/By: / �l�/ 0 See Page 2 for
Internet: www.tigard-or.gov OC1 1 Notified/Method: 0 a �� �I t, Supplemental Information
TYPE OF � �� N 107, REQUIRED DATA:1-AND 2-FAMILY DWELLING
"�1O�j ti n Permit fees*are based on the value of the work performed.
❑New construction � rtion P
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: $15,000
❑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:7065 SW Ventura Drive New dwelling area: square feet
City/State/ZIP:Tigard OR,97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Oar-- l- Covered porch area: square feet
Cross street/directions to job site:SW 72nd Deck area: square feet
`\�
eel `. Other structure area: square feet
^ I S ;,r" 0 f 06,,.. REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I t;f4 Lot no.: g Permit fees*are based on the value of the work performed.
�` Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
The remodel of the residence kitchen with the addition of two 2'x4'windows in Valuation: $
the west elevation.See drawing Attached /, Existing building area: square feet
g C�YI� x 4 v i'rx�v4Y
®i'1 a c- T e,) f New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Laurie Burke Type of construction:
Address:7065 SW Ventura Drive Occupancy groups:
City/State/ZIP:Tigard OR,97223 Existing:
Phone:( ) Fax:( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:Neil Kelly (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Doug Kensil
Address:804 N.Alberta FLS plan review fee(if applicable):
City/State/ZIP:Portland OR 97217 Total fees due upon application:It/qcp, j
Phone:(503)331-9410 Fax::(503)288-7464 Amount received:
E-mail:DougKensil @neilkelly.com / r
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
L.,Et1r fS L.� 1�[ :^G( ✓ice✓r c°E � Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Neil Kelly Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:804 N.Alberta Solar Installation Specialty Code checklist.
City/State/ZIP:Portland OR 97217 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)335-9260 Fax:(503)288-7464 State surcharge(12%of permit fee): $21.60
CCB lic.:001663
� ,/ Total fee due upon application: $201.60
ce%
Authorized signature: in, K U 6 g"�l�7 This permit application expires if a permit is not obtained
1 within 180 days after it has been accepted as complete.
Print name: / _ Date: //J /
*Fee methodology set by Tri-County Building Industry
__ —,_ C Service Board.
I:\Building\Permits\BUP-RESPe it-p.doc 02/24/2011 440-4 13T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY. t
1111 City of Tigard Received
g Date/By.
Permit No.:
a 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
I IGAKll 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.
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 . ❑ ❑ CI
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ El ❑
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 El El ❑
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 ❑ El ❑
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 a',licable to the •ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)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. ❑ ❑ ❑
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, El ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 1/02/COM/WEB)
•
‘Electrical Permit Application `} i tilit04 `di d h Cis oi r s `
; .; City of Tigard ved
t7. ° RECEIV PcrtmtNn.: M �,Z
13125 SW Hall Blvd.,Tigard,OR 97223 •an Review
1� : Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
9 atelBy:
m'i"XGA ∎; Inspection Line. 503.639.4115 0 C T 1 9 20 Tate Ready/By: Iuris: IA See Page 2 for•t . . Internet: wWw.tigatd-or.gov Notiticd/Method: Supplemental Information
°'k r-...,
4 gil{. ini.'rfi.. r4i'Ite._ Oi'y WO.._.. '*, , t �5"a-l „�1 rt V k 4r..+�J , ` i k x?P t i'kR.._ia V,. l 1,. t;t 3C ?c „t' ( 4.
:
New construction Addition/alteratio'.' • Please check all that apply(submit 2 sets of plans w/itcms checked below):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current
,,.,,z�� . r-� �s r� � ❑Marinas and boatyards.
f . 0vs .Mti S, etA oreb ' >r 0&: F,!, s. x ,u, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
' �` `s;� ' � T.E.-. _N.!:�`? � B gs.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building amps for all other installations. buildings.
Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 75 KVA or
t� T �`' x ❑Emergency system. larger separately derived system.
4 Q-k ti 1; 0 .in'WP. 7 f,4N, e1-.41- -ri q { lit: ❑Addition of new motor load of ❑"A""E","1-2","1-3",
Job no.: Job site address:"�� y= t loop or more. occupancy.
V 'tvr 1 t �.-- 0 Six or more residential units.
" ❑Recreational vehicle parks.
City/State/ZIP: —' Y,a (�� c\--i^bS.� ❑Health-care facilities_ ❑Supply voltage for more than
❑Hazardous locations 600 volts nominal.
Suite/bldg./apt.no.: Project name: B ... 0 Service or feeder 600 amps or more.
Cross street/directions to job site: Description is? 'a ''".. t�'E;�: gD k { "` ' "
Description r Qtv I Fea I Taint 1
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea add'l 500 sq.ft.or portion 33.92 1
s Limited energy,residential
idential
ki�`� ; h u i}. b ti . A*��4f�N ` (with above s q.ft-)
67.84
2
t �, t C c t c t �c n R cl.ppiA G,n(.-- 1 Limited energy,multi-family
residential(with above sg ft.) 67.84 2
�1 � Services or feeders installation,alteration,and/or relocation
y cam-. +'�-`"s _ 200 amps or less 1 .1 100.70 2
�.1'iM 'iFt ';( / t ; r 1 wJ �, i_. 'it rl'."
" .. . ,�ROl' ;'Yr .t:714-t,: *a?riz k1'a iii ; ,}�:'# .'t�' 'x.-ff dit1 201 amps to 400 amps 133.56 2
Name: au.r'r -,,-- 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Q � Over 1,000 amps or volts 552.26 2
City/Statc/ZIP; Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 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
A.Fee for branch circuits with
2aisl -r ;A'P.PI.IG`13'T._la`4 ;.>,__,f.4_:, w u�l c 6l rE VhNf3a ,,} II above service or feeder fee,
each branch circuit 742 2
Business name: B.Fee for branch circuits
Contact name: without service or feeder fee, I.. 56.18 sk4.t% 2
first branch circuit
Address: Each add'I branch circuit -1 7.42 .51 ,' 4 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 67.54 2
Phone:( ) Fax::( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
u il j'::34.'x , i<,`. :.,,t lM rP J,.„. : 0W12A`e.kii 6. : o,. _r'''tit lf'' ; Sign or outline lighting 67.84 2
Signal circuit(s)or limited-
Business name: (7.14:36z., n
l'cG 1(, ?- c.. energy panel,alteration,or
Address: Pb �K , t extension.Describe: Page 2 2
City/State/ZIP: 1,s_O i\c c-_v,\ `C. V �"1 (3^7 Each additional inspection over allowable in anyof the above
!I I V ` Per inspection 66.25
Phone:(5 ) sue" e, _` .—)-I'1 Fax:( ) 5 Q -- 't t 4(3 Investigation per hour(1 hr min) 66.25
CCB Lic.: \5`1 t lock Electrical Lie.: 'u•- -15c., Suprv.Lic.: 5 ct.( Industrial plant per hour 78.18
Ti lg/
Suprv.Electrician signature,1�q ' �` � 'tt.:'�l'"�7::�1ntt,k.Q'>t[Cti,L�PE�t'�1rT.�i'EEo€- . Al
required: ;'� ���/�� Subtotal: "t b� \��
•
`Date. Plan review 25%of permit fee
Print name: ���77 ( p )-
��C i��� ��U t21 �1�-1G� �- 1�J- State surcharge(12%of permit fee): st, .Cn i
Authorized signature: ' i ,� �,
1 / TOTAL PERMIT FEE: 1 a 1 �C`
Print name: �' � K Date: �� r\C This permit application expires if a permit is not obtained within ISO
}\1 �r ✓ days after it has been accepted as complete.
• Number of inspections allowed per permit.
\Building\Permits\ELC•PermitApp.don 10ro1ro9 440-46157t11ro5/CW4/WEB
•
Mechanical Permit Application FOR OFFICE USE ONLY
y Received
INI D- City of Tigard Permit No.: A. —A.7
ate/By:
13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 `f Other Permit:
DateBy:
TIGARD Inspection Line: 503.639.4175 (► Date Read/B Juris•
Internet: www.ti and-or. ov v Ready/By. BI Sce Page 2 for
g g �� �Q�� Notified/Method: Supplementallnformation
n 9 QQ w,
TYPE OF WOR161�� PZ`� lv COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
` ,...,c1\---., ` O Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteratc® performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: ���\� mechanical materials,equipment,labor,overhead,and profit.Value:$
CATEGORY OF CON'STI2UCTION 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. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:7065 SW Ventura Drive Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Burke Residence Duct work 23.32
Cross street/directions to job site:72"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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other:Air Handeler I 23.32 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
Kitchen remodel, fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
-
❑ PROPERTY OWNER Other: 23.32
❑ "fENAN'f Environmental exhaust and ventilation: _
Name:Laurie Burke Range hood/other kitchen
equipment . I 33.39
Address:7065 SW Ventura Drive Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:Nelly Kelly Fuel piping:
$14.15 for first four;$4.03 for each additional_
Contact name:Doug Kensil Furnace,etc.
Address:804 N.Alberta Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Portland,OR 97217 Water heater
Phone:(503)331-9410 Fax: :( ) Fireplace
Range
E-mail: DougKensil @ncilkelly.com Barbecue
1 CONTRACTOR Clothes dryer(gas)
Other
Business name:Neil Kelly uc,. .
,, MECHANICAL PERMIT FEES
Address:804 N.Alberta Subtotal 23.32
City/State/ZIP: Portland,OR 97217 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)331-9410 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:001663 TOTAL PERMIT FEE 26.12
This permit application expires if a permit is not ohtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Doug Kensil Date:
I\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(I1/02/COM/WEB)
- ., Plumbing Permit Application
13ttilding Fixtures EQ ? j1. FoRIOFJriOE U2> av�i,:f
v .
C City of'Cigar(' Permit No.: p
y > Date/By: - I�l D. -G�7tp 3
't 13125 SW Hall Blvd.,Tigard,
t-f 15 Plan Review
,.. a .;-- Phone: 503.718 2439 Fax: 53. 98.1960 19 '�� Date/By: Other Permit No.:
Inspection Line: 503 639:1175 C� U Read/0 tuns FA See Page 2 for
r, ate Ready/By:£I 1GA,RTJ. Internet: vvw tignrrl or gov O ��,�P`;O Notified+?[ethod Supplemental Information
1.11'6 01'.11' ' 4� I?FE' SCIIFDI1LE'
❑New construction ri1j A t ion For special inform ation use checklist.
OM Description Qty. I En. 1 Total
®Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 10011.for each utility connection)
CATEGORY 04 CONSTRUCTION SFR(I)b;th 312.70
® 1-and 2-family dwelling ❑Conunercial/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.) Pnge 2
JOB SUII: IM'ORAIA'I'ION Ar'D LOCA1 ION.is Site utilities:
Job site address:7065 S\\+\'cnlura Drive Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR
Footing drain(no.linear R.: ) Page 2
Suite/bldg./apt.no.: I Project name:Burke Mmmfactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Stone sewer(no.linear I).:_) Page 2
• Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION.OF:11'ORK Backwater valve 12.51
Clothes washer 25.02
Kitchen remodel
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0.11101.ER1-v O1YNL12 ';[]TFNAINT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
- - Floor drain/floor sink/hub 25.02
Address:
Garbage disposal , ✓ 25.02 ✓
City/State/ZIP: }lose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 ✓ 12.51 ✓7
❑ APPLICANT 0 CONTACT I'F.RSON . Interceptor/grease trap 25.02
Business name; Medical gas(value:S^) Page 2
Printer 12.51
Contact name:
Roof dram(commercial) 12.51
Address: _ Sink/basin/lavatory I ✓ 25.02 ✓
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONT12AC1'QI2 1Ynlcr closet 25.02
Water heater 37.52
Business name:Modern Plumbing Co. Water piping/DWV 56.29
Address: 11120 SW Industrial Way,Bldg.9-3 Other: 25.02 5). /)
p /•5/
City/StntclZlP:'1'ualaltht,OR 97062 Subtotal , 0 •
Phone:(503)691-6166 Fax:(503)691-6771 Minimum permit fee: $72.50
CCII Lie.:87906 Plumbing Lic.no.:34-250-Pg Plan review (25%of penuit fee) L I
State surcharge(12%of permit fee) Lt 6 to •J
Authorized signature:44/,,a/L..- �� TOTAL PERMIT FEE A'2._
rPrintThis permit application expires if u permit is not obtained within 186 days
l rat name:Deborah George Date: 10/19/2015 after it has been accepted AS complete. `
"Fee methodology set by Tri•County Building Industry Service Board.
IA-Wilding\Permits,PL\IU•Pcmrit App.dos: 10.'01.09 440.4616T(1O'O1C0\0\Pfla)