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Permit „ CITY OF TIGARD MASTER PERMIT '`1 s • COMMUNITY DEVELOPMENT Permit#: MST2015-00190 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2015 Parcel: 1 S135AB03403 Jurisdiction: Tigard Site address: 9055 SW OAK ST Subdivision: ASHBROOK FARM Lot: 9 Project: Fahlman Project Description: Interior remodel: convert 2 bedrooms into master bedroom suite, remodel existing hall bathroom. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 2 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $10,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 3 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 2 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: 2 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea adds 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3 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 8.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 0 Owner: Contractor: FAHLMAN,DAVID M OWNER Required Items and Reports(Conditions) 9055 SW OAK ST DAVE FALMAN TIGARD,OR 97223 9055 SW OAK ST TIGARD,OR 97223 PHONE: PHONE: 503-799-2818 FAX: Total Fees: $729.17 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applica• . All work will be done in a • • • - with approved plans. This permit will expire if work is not started within 180 days of issuan -, o work ' susp: • or more the 180 days. A NTION: Oreg.• law requires you to follow the rules adopted by the Oregon Utility Notification -n Those rur• - set forth in OAR 952-0• -0010 through OAR 9 • :• 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 i.1•: or 1.800.33 >/ IS-ued By: �/ Permittee Signature: / _ . Call 503.639.4175 by 7:00 a.m.for the next available insp tion 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. I. Building Permit Application Commercial RECEIVEJ) FOR OFFICE t'SE ON'L\" % _ City of Tigard Received Cb1 • Permit No.: M % • 13125 SW Hall Blvd.,Tigard,OR 97�• Plan Review / X. /� �!S bD D Phone: 503-718-2439 Fax: 503-591.1- .�0 2 6 2015 Date/By: Jo) i Jir Related Permit: T I(,A R l) Inspection Line: 503-639-4175 `� Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov (.I1 Y Of 11(AHb Notified/Method: id 7-7 15-- Supplemental Information 4—ri .■, ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rotnded to the nearest dollar)of all Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the work indicated on this application. ® 1-and 2-family dwelling 1:1 Commercial/industrial Valuation: $ /0i CXp El Accessory building ❑Multi-family Number of bedrooms: El Master builder ❑Other: Number of bathrooms: Total number of floors: Job site address: 7z15,3 .5 © 1t-k_ 5 Ft New dwelling area: square feet �'&11-/--/a City/State/ZIP: 0 2 F7 2 2-3 Garage/carport area: square feet Suite/bldg./apt.#: Project name: h IM e,vti Covered porch area square feet Cross street/directions to job site: Ho Deck area: square feet Other structure area: square feet I ! 3i`ti 1 lit"t I (di i/3 i (4v 'I 1 �. -' t� ��s<-..n.T�"�e�xdktl"_3 x.e ... ie§s9� � f.,4..�SE�•�` 5�. Subdivision: 1 Lot#: Permit fees*are based on the value of the work performed. Tax map/parcel#: Indicate the value(rotnded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the '; work indicated on this application. Valuation: $ nl 0 9€.. LN T�ti t o 4- Ct�kcG-S Existing building area square feet New building area: square feet Number of stories: Name: D A-02 KLttt.. 0) Type of construction: Address: 7O - .. .c) 0,t_„_57-, Occupancy groups: City/State/ZIP: 'l i_o o ©tI_ 9 72. 2-i Existing: Phone:(� ) 7 -Zs-(2- Fax:( ) New: Business name: 0/1-0 Flt_tiLl ogt_p__, Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: 9053 S c-.)' 6 It-f-- / City/State/ZIP: Total fees due upon application: Phone: ) Z ( �' Fax::( ) Amount received: /�4•�7 �i.3 7?� r E-mail: c I cUC Gw. . /(-tiuU , Co 4,4ti Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: 0 it'k) E.2 Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB Lic.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained lifj(�t_ within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri-County Building Industry Service Board. I:Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB) Ati • City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT I • Accessibility: Barrier Removal Improvement Plan Commercial & Multi-Family - Additions or Alterations T I G A IZ D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov • REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241. (1) Every project for renovation,alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restroom, telephones and drinking fountains are readily accessible to individuals with disabilities unless such alterations are disproportionate to the overall alterations in terms of cost and scope. (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five percent(25%). VALUATION: Total of all renovation,alteration or modification being done, excluding painting and wallpapering: [1] $ MULTIPLIER(25%barrier removal requirement): x .25 TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ ELEMENTS: In choosing which accessible elements to provide under this section,priority shall be given to those elements that will provide the greatest access. Elements shall be provided in the following order: (a) Parking $ (b) An accessible entrance: $ (c) An accessible route to the altered area: $ (d) At least one accessible restroom for each sex or a single unisex restroom: $ (e) Accessible telephones: $ (f) Accessible drinking fountains:and, $ (g) When possible,additional accessible elements such as storage and alarms: $ TOTAL(shall equal line [2] of Valuation Computation): $ I:\Building\Permits\BUP_COM_PermitApp.doc Rev.12/18/2014 RECEIVE!) Electrical City Application FOR OFFICE USE ONLY `J f g OCT 2 6 2015 Received : Ci of Tigard Permit 5: • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598 1 Related Permit#: / Y/IL 111 ARD Date/B T 1 G A R I inspection Line: 503.639.4175 1, 1 Of 1 lUfil`V Ready Date/By: Juris: 0 See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑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. I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: f (�_ ❑Addition of new motor load of system. 7�5� S,r.. ) ' ©k f-S l , I OOHP or more. ❑.,A,. ..E„ ..1.2„ ..1 3„ City/State/ZIP: kIL ©/` 9 7 Z ❑Six or more residential units. occupancy. [[ 3 ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Pro Project name: ?f 'L5 0,0,4-- El Hazardous locations. ❑Supply voltage for more than J £5 t� , ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: f4ltra_ 6Lewouitej-- FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited ener bry,residential 75.00 2 kF-�t 6 4` ©rn c_� (with above sq.ft.) O Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 PROPERTY' OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: [24 }•_, M. FA t„1 L 4t-u.) 200 amps or less 100.70 2 Address: 9e s,LA", D A.r` <— 201 amps to 400 amps 133.56 2 1 , 401 amps to 600 amps 200.34 2 City/State/ZIP: j. r� /� 9,7 T �J (i)Fax:/�_ ( 2 Z 601 amps to 1,000 amps 301.04 2 Phone:(S�3 �`7 �"9-Z ( Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: t Ati6..p,„,,__5 @ Yk,_ro„_ �a4- - — relocation Owner installation:This install.tion is being made o roperty that I own which is not 200 amps or less 59.36 1 intended for sale,lease,re • -xAcf ge,ac.. ' s a RS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 401 amps to 599 amps 168.54 2 Owner signature: , „'°` ate: p P Vi. APPLICANT I�CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: D (o t-AKLi44..A--tA.) B.Fee for branch circuits without Address: gars- S ©k/r- 5; service or feeder fee,first / 56.18 2 f branch circuit City/State/ZIP: Tt © 2 cl 7 2_2_3 Each add'l branch circuit 7.42 2 Phone: - L Miscellaneous(service or feeder not included) 7 i Fax: ( ) Each manufactured or modular t✓ dwelling,service and/or feeder 67.84 2 Email: 1 ., ,..+.t4,,S c.p /Are o0 . <6 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Q 1/ , ♦lam!' t2 Sign or outline lighting 67.84 2 Address: • Signal circuit(s)or limited-energy ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lie.: Supra. Lie.: specifically listed('//hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature,r fired. Subtotal: Print name: Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building'Permits,ELC_PermitApp_ELR_ERE.doc Rev 06/I7,2015 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE * Fee for all residential systems combined: $75.00 Description Qt,. Each j Total j 3' Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: U Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allow_able in any of the above: Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specificall■ listed('S hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 _ Subtotal(Enter on Page I): (SEE OAR 918-309-0000) " Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems IT Landscape Irrigation Control* Medical Nurse Calls Outdoor Landscape Lighting* Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Mechanical Permit Appli glpE1 rE FOR OFFICE LSE ONLY �I Received City of Tigard Date/By: Permit No.: 1114 " 13125 SW Hall Blvd.,Tigard,OR 97223 :t Phone: 503.718.2439 Fax: 503.598.1960 Plan Review D Other Permit: Date/By: TI G A R D Inspection Line: 503.639.4175 fl',,T 2 6 7 015 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CI I Y OF 1 I(JAIL) TYPI Q i `DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST * 1�!� DIVISION 1 Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* g1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: ek_5-5- 5' Cl) L�!0 /—�...5 Furnace 100,000 BTU(ducts/vents) 46.75 ( City/State/ZIP: T7 W Q it- 4j�'7 Z Z_3 Furnace 100,000+BTU(ducts/vents) 54.91 1 ( Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work r 23.32 Cross street/directions to job site: 6-4-5` �4- B u'4-G-- Hydronic hot water system 23.32 l ��/ 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 tL'c ( it,6 fireplace 23.32 {� t/ Log lighter(gas) 23.32 ll / 4 •) Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation: Name: Range hood/other kitchen A 'tiJ f"fFo (LUG vr' equipment 33.39 Address: qO-� 5 r (,1,)_ DA-tc- ST- Clothes dryer exhaust 33.39 City/State/ZIP: / 77 —4.4 0 9 7 2Z3 Single-duct exhaust(bathrooms, / toilet compartments,utility rooms) 23.32 Phone:( (J3) -71 5' Z.2. (w Fax:( ) Attic/crawlspace fans 23.32 ID APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: jP/t v 0 / /wt./44_01.—I--. Furnace,etc. Address: 70-5Zr C (0i �� S'l. Gas heat pump q ,e Wall/suspended/unit heater City/State/ZIP: r &..r i t�� 0 it 9 7 2 Z3 Water heater . 3) 9^ Fireplace Phone:(� / ( ( Z�( /� Fax: :( ) f ( y Range E-mail: f 1 ...t ko4.-r'-5 Q rl l?V . CO«-`- Barbecue CONTRACTOR Clothes dryer(gas) `1 Business name: v --1/2-- 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 signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: Date: I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/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_040113.doc 2 - Plumbing Permit Application -1 Building Fixtures e HOR OFFI(l'. USE ONLY y� City of Tigard Received y g Date/By: Permit No.: •III 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review E Phone: 503.718.2439 Fa �'Sp3296.1 b Date/By: Other Permit No.: T I G A R D Inspection Line: 503.639.4 7� Date Ready/By: turis: ® See Page 2 for Internet: www.tigard-or.g m a i t Notified/Method: Supplemental Information 11 �;1� �7.CIa-. TY�Illil � FEE* SCHEDULE ❑New construction *) -1 `- ❑Demolition For special information use checklist. Description I Qty. I Ea. 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 tiO 1-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: cis s, t 6 f}-� S 7 Catch basin or area drain 1 8.76 City/State/ZIP: '--/ 0 L? a3 Drywell,leach line,or trench drain 18.76 V ( Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 f7/ __j 4C€40 v 04.6- • Rain drain connector 18.76 l 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 TAO 8 � / Clothes washer 25.02 ,7"'� Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 kiA PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: PAC,;D C/�tiLlh re-A.) Fixture/sewer cap 25.02 9b 5. ` , '` ®�� ff Floor drain/floor sink hub 25.02 Address: W ` O� Garbage disposal 25.02 City/State/ZIP: T � Hose bib 25.02 Phone:(3) 75,F 2g ( 7- Fax:( ) Ice maker 12.51 APPLICANT [CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: RA., 4 FA_t1L _,3 Roof drain(commercial) 12.51 Address: 7 S, (,o. V4►c--- 57- Sink/basin,/lavatory 25.02 City/State/ZIP: `�y ( ( 64- ?7 2- �3 Solar units(potable water) 62.54 Phone: l 7 (Q 2 d (- Fax: :( ) Tub/shower/shower pan . 12.51 E-mail: CC,A,L. 1, '` Urinal 25.02 CONTRACTOR Water closet '?j 25.02 Water heater 37.52 Business name: 42 t-f ,4 vi_f� f��c,t ti�t�z«e,'-- Water piping/DWV 56.29 Address: ( Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: /\ Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:'Building 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- I'' 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 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $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 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 nonnal 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: tipped 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 tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ial ❑ 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 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: -Lay/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: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Property Owner Statement Regarding Construction Responsibilities 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. r a 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. PA-0 /71-141u■4b ,-) Print Na e of Permit Applica /OOt/c— ignature of Permit Applicant Date Permit#: H c90(5 —D0 / ?0 Address: 90 SS Odk - �!•-, "„.- •/ --ir �D D/- 97a.0 S�. :;nu. Issued y: ate: /D a r /( l-1-1: This Copy for Permit Offices 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 9055 SW OAK ST, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2015-00190 David Young Violation Summary: Inspector Contractor 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 9055 SW OAK ST, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS MST2015-00190 David Young Violation Summary: Inspector Contractor