Permit CITY OF TIGARD MASTER PERMIT
"�! 2= COMMUNITY DEVELOPMENT Permit#: MST2016-00072
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/14/2016
TIGARD Parcel: 2S104DC00400
Jurisdiction: Tigard
Site address: 13376 SW BENCHVIEW TER
Subdivision: BENCHVIEW ESTATES Lot: 4
Project: New Century Holdings, Lot 4
Project Description: Convert 527 square feet of mechanical room into habitable space. Which adds(1)bathroom with
sauna,theater room and bar area.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First 589 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: 589 sf Value: $10,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0
Drains: 0
Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 3 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 0
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: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF 589
Owner: Contractor:
NEW CENTURY HOLDINGS LLC VP CUSTOM CONSTRUCTION LLC Required Items and Reports(Conditions)
13815 SW CAROLINA CT 8613 NE 97TH CT
PORTLAND,OR 97224 VANCOUVER,WA 98662
PHONE: 503-481-6781 PHONE: 360-521-6494
FAX:
Total Fees: $1,209.27
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. • • • : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 -001-0010 throug OA' - 2-101-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.V or 1.800.332.2344
/ , /11J r I_I . /
I_ ued By: Permittee Signature: -
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. IF
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential HC E i
City of Tigard MAR 7 2016 Received 2 ,� Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ofli
��Q��Q �
S g ,�q�y _ Plan Review 4 iii
Phone: 503.718.2439 Fax: 50301" '401'" a t.ifPic'RD Date/By: 3i/p/ j Other Permit: tyyveyV Gaa!JC'
I ,, \I:I, Inspection Line: 503.639.417 ti}Y!w�l Date Ready/By: orris: ® See Page 2 for
Internet: www.ti ard-or. ov �I�- I 1 {, I Notified/Method:
g g �/ /� 15upplementallnformation
� TYPE OF ! RTS ' . .* 41.114ADA"PA•I4 AND 4,ThiN H'4LI.1(/46
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ElCommercial/industrial Valuation: $ v U
t
❑Accessory building ❑Multi-family Number of bedrooms:
/
❑Master builder ❑Other: Number of bathrooms: 1
0. SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ( ,3 3 TS W 414--A al ek .i/ e w 't'e New dwelling area:S'2. 7 square feet
City/State/ZIP: •1", / [0 et./--a/ Garage/carport area: square feet
Suite/bldg./apt.no.: ,J Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
-
REQUIRED`DATA:COMMERCIAL-TSE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax ma / arcel no.: Indicate the value(rounded to the nearest dollar)of all
P P equipment,materials,labor,overhead,and theP rofit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
6A)JP ig 7— /-&& ,s }1 i1( V ,CODlt-/ /j✓r' Existing building area: square feet
rJ(rI476L f /.6i/i-eE New building area: square feet
Ci PROPERTY OWNER 13"'TENANT Number of stories:
Name: f)e w s Q l 1 V Type of construction:
Address: / 3 3 7 6 S t.RJ (3e (; C I! V / € LU `1--cer Occupancy groups:
City/State/ZIP: "1- 1 Cp 0 iCil Existing:
Phone:( ) . Fax:( )
New:
0 AP JCANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:
(Please refer to feesehetlntr}
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Z�/�y
Phone:6ip(J l�,249 /(,� Fax::( ) Amount received:
PHOTOVOLTAIC:SOLAR PANEL SYSTEM FEI
E-mail•
CONTRACTOR Commercial and residential prescriptive installation of
, _ . roof-top mounted PhotoVoltaic Solar Panel System.
Business name: U C ( , c;1_S i 0 /,1( L° c. ) s f L L e Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: / 33 7 tS 4J 1 I c7 et Y C&/ Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
�� C'7r/ and administrative fees):
Phone:(3 ) S Z I 6 y 67 l/ Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lic.: l gg335 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
/ 6 within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
(� `f
Print name: Date: /7 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR 01:FICF SE ON IA
City of Tigard Received
Permit No.:
61 13125 SW Hall Blvd.,Tigard,OR 97223 Associ t
S Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
I I(iAl D
24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW acs y0 y/k
I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 • ■
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 ❑
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: . 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
1 1 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0
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 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
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- 0 0 0
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. 0 0 0
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- 0 0 0
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 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
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 0 0 0
architect licensed in Oreton and shall be shown to be a..licable to the Iro'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". • • 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ 0 0
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, 0 0 ❑
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:ABuilding\Pennits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB)
Mechanical Permit Application FOR OFFI( t: FSE ON 1.1
City of Tigard @ t Date/By Permit No.: 0,�,
` D
:, 13125 SW Hall Blvd.,Tigard,OR 97223 ��' y , —
• Plan Review
Phone: 503.718.2439 Fax: 503.59i� '� 2 6 Date/By: Other Permit:
I I t,,�is 1) Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov .-. i- ((Y t,Ht• Notified/Method: Supplemental Information
V i i�"� .. ��is:..i, t t-.,
1I 1\'r t t
1cis _
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4,'ofi ''''''.'-;:i.---
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Mechanical permit fees*are based on the value of the work
0 New construction 0 Addition/alteration/replacement performed.indicate the value(rounded to the nearest dollar)of all
❑ Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Otta Value:$
�1 �.b5 e t ' 41,10',71VIV 7,44 4:','''r-Try.,
,in 9 4F ,jy� y}j �,C y � �Rry�Y 'JW a-
!,,r,
a.�t K..'��t:1477 . ..a 1., ma ...,iiiiiiitigitifitviott X` -,'3, ,..la/ 6', -*'.It,4i?y, [2 _,�..._ i? 1�„TZ „a t T4 ...�. 3,. %1..,.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
O Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
t r .` "� x 6" t ., `� `ISt r rt' , r .. ,„,,:',.',1'1!",,,,:,,t1
x Heating/cooling:
a 7,”. .�. ,:r°,.,�.d 6rr` , *a Alr COndltlOming 46.75
Job site address: r 3 376 . 'iv Li c iuc/ U ( et-L .f-e ec Furnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP: -1- c.fillci 1 aFurnace 100,000+BTU(ducts'vents) 54.91
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
Other: 23.32
Subdivision: Lot no.:
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
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
�;❑ PROPERTY OWNER [ TENAN#
- 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) 3 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
,APPLICANT._ , 0 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
' Clothes dryer(gas)
.> ag.: .; ..—,-,-,::-.I1,-,. , < ,. . „ other:
name: JP LbTOC17��7T��1LTD/V `,r�
" i r . '�� �t
.'
iCk "s bb, ,,,' .-, .>.. ,, , d
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 lie.: /q 9 3 3 5' 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 doe 440-4617T(11 02 COM WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
�
Valuation: J n
$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_PennitApp_040113.doc 2
J
Plumbing Permit Application
• Building Fixtures yz )_.`
FOR OhFI(-I: Ctil': ON 1.l
City of Tigard ReceivedDate37 / / /� PennitNo.: i'/ /-06V6 7r
;� 13125 SW Hall Blvd.,Tigard,OR 9722,3 201, Plan RevBy:iew (jJ `,L�,/J
Plan Review
1 Phone: 503.718.2439 Fax: 503.�t � 60 Date/By: Other Permit No.:
Inspection Line: 503.639.4175
I I(,ARI) �,n"---,:„. t Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov4` Notified/Method: Supplemental Information
'''"''''r)::):,
j,� , '.. t :E Ta, _ : - x Ys'.; x.�� iC r.
n ., �,n < ,�`a ,mt ,nr[;.� ..,5 �§v �.�.��.�,�.���?. �'r�lq �`,.,'; ,:,, ?'.wi���litisk ��fi�°� ate. A3y �(��. d
El construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ,I=1_Other:
New 1-2-family dwellings(includes 100 ft.for each utility connection)
''' )
:-Year r �� il ), . f f ' SFR(1)bath 312.70
ID1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
0 Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
� � ��ff,�� , xi 4 r R �, F, „� Fire sprinkler( sq.ft.) Page 2
r
.,� r it , )) , Site utilities:
Job site address: 3 3 �� (fj f % k i I e w 1t eek-
Job Catch basin or area drain 18.76
1,2 Drywell,leach line,or trench drain 18.76
City/State/ZIP: `�' I a Q(2 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
t.)l DESCRIPTION OF WORK '." Backwater valve 12.51
...x=« ,,.»,.,N))))' ;.e-e . �.. .:s,'.xy, mi),,r..),,,,,.._,�.. , ....k..,,., u... .. ,,,. Sao ,. .r'`.. �-
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
12.51) ,� § ' Expansion tank" ` O F ' Y � .Es; v „ M .- - - -µ „
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
4puO Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name:
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 1 12.51
E-mail: Urinal 25.02
t* . Water closet ' 25.02
''' .. t,rl''y yuLy
1;t7:u . 1,,1 ita 41.4- r Water heater 37.52
Business name: �I f i-u�g Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone:( ) Fax:( )
CCB Lic.: 137 sO Plumbing Lic.no.: Plan review (25%of permit fee)
/ State surcharge(12%of permit fee)
' Authorized signature: TOTAL PERMIT FEE
Date: after it has been accepted as complete.
This permit application expires if a permit is not obtained within 180 days
Print name:
*Fee methodology set by Tri-County Building Industry Service Board.
1:rBuilding`,Permits P1.MU-PermitApp.doc 10 0!09 440-4616T(10i02r COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su s •ression S stems:
( 4 F
�'C a� a
. �,y ,,, .d. •,�, .,.Vie... mmranT
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54
.= ."• „(:rd. - .. .. � f.. ,,:
$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
lv, t 3,F t § - 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 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*. llltr A' rfl ' m 'Jlg it ltaUat1ous,
Quantitj by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
IDCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
IDCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ID Any multipurpose fire sprinkler system.
Domestic 0 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"
4'
El Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2
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
13376 SW BENCHVIEW TER, TIGARD, OR,
97223
Residential - Master Permit
299 Final inspection
PASS - No C of O
MST2016-00072
David Young
Rough in inspections and final inspection ok.
Violation Summary:
Inspector Contractor