Permit CITY OF TIGARD MASTER PERMIT
" COMMUNITY DEVELOPMENT Permit#: MST2016 00116
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2016
Parcel: 1 S136AD00100
Jurisdiction: Tigard
Site address: 11205 SW 65TH AVE
Subdivision: VILLA RIDGE NO.2 Lot: 1
Project: ELLIOTT
Project Description: Basement remodel: Relocating wall for new bathroom and completing the work for the
mechanical, electrical, and plumbing rough-in inspections only. Homeowner will pull a separate
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $5,000.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 1 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: 1
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 Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add.'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 5
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 0
Owner: Contractor:
ELLIOTT,KELSEY STRAIGHT LINE DESIGN&REMODELING LL Required Items and Reports(Conditions)
11205 SW 65TH AVE 4640 SW BEAVERTON HILLSDALE
PORTLAND,OR 97219 HWY
PORTLAND,OR 97221
PHONE: PHONE: 503-244-5463
FAX:
Total Fees: $672.68
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable la . All work will
be done in a - =:• - with approved •ans. This permit will expire if work is not started within 180 days of issuance, r if work is suspended or more the 180
days. • NTION: Orego law •uir-s you to follow the rules adopted by the Oregon Utility Notification C=der. Those rul-s ar- sed forth n OAR
952-0• -0010 through OAR 95:-..1-0090. oo40, ay obtain a copy of the rules or direct questions to OUNC by calling 503.23, •87 or 1.800.3 j 344.
Pr",
Iss ed By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspecti. :ate.
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 Ful(011.1( F: I til: ON Ll
Received
City of TigardCEINV
Date/By: 3 /`6 Permit No.: M(-}2Dl(o !l cp
1„,1 4 13125 SW Hall Blvd.,Tigard,OR Plan Review /I / 1,151_02
'J/
Phone: 503.718.2439 Fax: 503.5'.,`1[ Date/By: l C Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: q I, Juris: See Page 2 for
Internet: www.tigard-or.gov 2016 Notified/Method;W47/1 7 Supplemental Information
A
OR t
TYPE OF WO AU Aj REQUIRED DATA:1-AND 2-FAMILY DWELLING
El New construction illi
j Permit fees*are based on the value of the work performed.
ii � � Indicate the value(rounded to the nearest dollar)of all
.kkidition/alteration/replacement tH equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
jTand 2-family dwelling ElCommercial/industrial Valuation: $ 5C/00
❑Accessory building ElMulti-familyNumber of bedrooms: a
❑Master builder ❑Other: Number of bathrooms: /
JOB SITE INFORMATION ANDja
LOCA ON Total number of floors:
Job site address: , ' ti 0 5 S W 6 51-k New dwelling area: square feet
City/State/ZIP: `/`r.{±( 1,?! Q/ °17A!7 Garage/carport area: square feet
Suite/bldg./apt.no.: l 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-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
J DESCRIPTION OF WORK work indicated on this application.
g(L°N`E Pe.i 4G�C.( .— 4iW (r 4ZICCJW1 Valuation: $
kL/UL I cY Existing building area square feet
((��CC�jj((__;;%hl 14 1y 1New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
(/,.o
Name: /<T S T�t ,ff _
Type of construction:
Address: )flfA�i�p ti'0 ll s * Occupancy groups:
City/State/ZIP: C44402 // Existing:
Phone:( ) Fax:( ) New:
APPLICANT Nyi CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule) .
Business nam:
41044.
{a� ; / ,� Structural plan review fee(or deposit):
't Contact name: Lo I 1/a yaA S FLS plan review fee(if applicable):
Address: -
Total fees due upon application: Q73
City/State/ZIP:
Phone:(56 j) 6/czJ 'S9'A Fax: :( ) Amount received:
•
E-mail: Itil( KYlt riPN>°dr
a c'0111
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTORCommercial and residential prescriptive installation of
/� ( roof-top mounted PhotoVoltaic Solar Panel System.
Business name: �j� ki L I m U f s-1 r , Zz� Submit two(2)sets of roof plan with connection details
✓/ , and fire department access,along with the 2010 Oregon
Address: H6C' ,'
46/ 8 erw , Sap `r.U� Solar Installation Specialty Code checklist.
/! Permit Fee(includes plan review
City/State/ZIP: � -/01 u 0 9 ?p� and administrative fees): $180.00
Phone:(SO 3) a L/4(_sit 6 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: / ! l8 10 Total fee due upon appbcation: $201.60
Authorized signature ,� This permit application expires if a permit is not obtained
i"; within 180 days after it has been accepted as complete.
Print name: //r Date: ///,, *Fee methodology set by Tri-County Building Industry
Li///(i Ct/l4S / `�' �� Service Board
` I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(l1/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE Fsl, O\I.1 i
City of Tigard Received Permit No.:
ul 13125 SW Hall Blvd.,Tigard,OR 97223 Associat
;.
• Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
IIti,1Pl)
Internet: www.tigard-or.gov CIOther:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No N/k
1 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 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 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.
11 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 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 Ore.on and shall be shown to be a'Ilicable to the .ro'ect under review.
JURISDICTIONAL SPECIFIC'S
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 0 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
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 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 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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I l/02/COM/WEB)
Mechanical Permit Application 1.(m ouTiti.: t su:()NIA
City of Tigard viiiirkvirk RDeactee/iBveyd:
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97tiVIVA LI!
Plan Review
' . Phone: 503.718.2439 Fax: 503.598 , Date/By: Other Permit:
Inspection Line: 503.639.4175 Juris:
I 1 t i \K 1) Date Ready/By: 171 See Page 2 for
Internet: www.tigard-or.govNotified/Method: Supplemental Information
1'
1r: ‘W' f,.."*:'''Ti 6,...111,4,t1'''islis.t,''':tk t; ".‘",'"- ""'","
.,.. .4ttil ',"•._ ....Z121757/4,.. Ct'olfil3tr):11701.5:.-„Ir.otterT::'
"' Mechanical permit fees*are based on the value of the work
0 New construction 1.- Addition/altera t. /ealmc(VAN I performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: 0311113 mechanical materials,equipment,labor,overhead,and profit.
Value:$ 5Cit.)
.-; t27.1;',./;:s'-',W;',.1.',47esir•s-7,;';$'441:'s:..'il".- t7,..- , -:, 7t--.% . '-,---,17,, ;'-'7. : :: --.: ,.: -- ,-, :- 111- . -.,,i:.--:2-,--,r-,7:0- ...k,--feasoe.,,_,-..1-,-
'41--and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
El Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
'. " ' s-''s Heating/cooling:
46.75
Job site address: 1 A.CIS 5- to & 5,.....t.... v.A._
Furnace 100,000 BTU(ductsvents) 46.75
City/State/ZIP: 101. 0 ps. cl --7,A (,
Furnace!00,000+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: 1 Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
4iitt '<
ik.toinoit-4.w: ric . ;-, '‘2, ' - - - , Gas fireplace/insert 33.39
-'."-`-=''•"'S-''''' ' '':'' 1'. Add -4 4: _ Flue vent for water heater or gas
ts-f Mi"f WRI/I/mak, - ict_ teey-rvk fireplace 23.32
(gas) 23.32
k - t,. Cdvy Log lighter
Wood pellet stove
33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
,,,. .1„ , 23.32
1:'''':''' ''' '' CI:jj-!°"1.'''''411 ' ' '1 '. Environmental exhaust and ventilation:
Name: p k .z, ,3 A ict(--
L. 1 y Range hood/other kitchen
equipment
Address: ft?5Q "'54) 6_3--3:6--/47/. _ Clothes dryer exhaust . 33.39
4
i 33.39 33,i CI
City/State/ZIP: PC,r-k--LiztLei? OR 997a I 9 Single-duct exhaust(bathrooms, ..,
toilet compartments,utility rooms) I . 23.32 A 3 i 52,
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
. '
. , NTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;54.03 for each additional
Contact name: Ala ff a) il I (Ck 04_5 Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:c. 3) 6(c..- ,c ?s yl I Fax: :( ) Fireplace
Range
E-mail: v f-t,r; < Ott\ 1,44 l'pq d,. ,,yo Barbecue
f.s; '''',- Z,.--;. ...17"."." ,.. ,' s7''' - ,;, ,-"" rl.;. .,„. . Clothes dryer(gas)
- -,-; ,..44, ,, --itr. ,,...t 444404i. -.r, , _.,. . ,., -,_P ,, _ , -..,,,,-,,,;
t 1 ,j_ I i it,_ l ,,.„,,
Business name: 41.-Cct rei it I- /..._16,4,c r vi I, IA / i Ca owAitw000,r,, ,::,. ii;,„,:
/, ._./ ,. 4 4,11-
Address: 2.71k 471, <--te ivr,,,ti._ #5.1)1_ II(i i r Subtotal I (
City/State/ZIP: ort-Ict bo., c7k 9'7 A A I minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(3'-73) 62/ 6 - *. 5 7A Fax:( ) State surcharge(12%of permit fee)
CCB lie.: (G 5 A 1 0 / TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
• i
days after it has been accepted as complete.
. .
Authorized signature: AP,• * Fee methodology set by Tri-County Building Industry Service Board
Print name: A f..(..... k) 1i 'i,cx/113.
et Date: :_,/ v/4
I: M
Building Permits EC PermitApp 040113 doc 4 -46171 11 02 COM WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family
Total
Schedule:
' Valuation: p,rarmiXtoer
$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.
1:A BuildingPermitsyM EC_PennitApp_040113.doc 2
Plumbing Permit Application Building Fixtures Receivedg RECEINE1
I.OR ()1F1 1( 1•: I SE ()\I.)
CityOf Tigard Permit N
11111110 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By. /'�Sj�p�(p (,Xjili(Q
Plan Review
Phone: 503.718.2439 Fax: 503.598.190,8 2 2 2016 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 �1 Date Ready/By: Juris: ® See Page 2 for
I 1(p:A I:U Internet: www.ti and-or. ov o
g g � Notified/Method: Supplemental Information
❑New construction .t, !Air ., 7 i For special information use checklist.
Description I Qty. I Ea. I Total
AC-Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
" o-"' " 7"' ' SFR I bath 312.70
I-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
�"'t
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
M � fs* 5 : .t 1 a `1i141 Site utilities:
. .
' 5 51
,' 6 S1 /�` & Catch basin or area drain 18.76
Job site address: W lC l`t
City/State/ZIP: _I h q A ( Dt Drywell,leach line,or trench drain 18.76
G'(� L�(7l 0 R. 1 1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: j 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
s '...,-,",,-.4j n Backwater valve 12.51
Act - Clothes washeri 25.02 ... 5-',aA
CSQrnt/tib ��n0 CZ i� `GB�h i Dishwasher 25.02
4,13h - T'y, C 1✓. J{/ Drinking fountain 25.02
/ Ejectors/sump i 25.02 a5.0
'•',.;7'.`:' -V + r --'" 3• . , r ,...,,i,.=,,': Expansion tank 12.51
Name: L,t k-t i TCih� // t` �1L Fixture/sewer cap 25.02
Address: N I/�� .5 (� �js ^* GFarbage
drain/flooresink hub 25.02
///"TTT��� Garbage disposal 25.02
City/State/ZIP: Pc({--tot Ftof Q i l 7.01 I l Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
�_ ,k7: CANT r,` 4 a CONTAC N Interceptor/grease trap 25.02
,. . Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name: .4,6+4- ()) t/1; Roof
IR S
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory t.,Z. 25.02 2150,O /
City/State/ZIP: Solar units(potable water) 62.54
Phone:(.. ',3 ) 62/6 0,5-7,A Fax::( ) Tub/shower/shower pan 12.51 , 0a
E-mail: S co�� Urinal 25.02
r�ret 0 '4) '''':01,..!`Y"'1* ' l'''," 7t�.fic + r 8 I Water closet I 25.02 X15,CA
., ,,A .r. +�1:',A.,%k ,, :„ i,� , .,r 41...4�. " =, :: Water heater 37.52
Business name: T� //,c 8'1-f- um ,f bi p� Water piping/DW V 56.29
Address: 1P j 1 leis 8 J Other: 25.02
City/State/ZIP: k++ t k t(V5 oP Of 7/- 3 Subtotal /50,L)
Phone:(') 307 - 5 7 5o Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 1Jq 130 PI mbingLic.no.:3 y_41001PR
l State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: / I Date: / This permit application expires if a permit is not obtained ssithin 180 days
l L`t `�i1 (� � 3 ���� pp after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
1:Building Permits PLMU-PermiiApp.doe 1001.09 440-4616T(1002 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su a a ression S stems:
Fee'{ei) TOtal
t �eeFF� ..}} r-- 7 p 4!e76,4-.7•A
; q x
� .e � a.- � bA �'%C-ms'A�11t�a+h >,. 4.,. C M o:iF^Mmm^vh.4!e76+ak re =
Footing drain-1'1100' 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
$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
r{
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*. aI .Revle "°.fof Fiun*hIng I Hat ,
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
ID Any new commercial building with NN ater 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 Aspietor 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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
0 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
-Coin/Sery/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
• Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:ABuilding\Permits\PLMF_PermitApp.doc 08/04/2011 2
Electrical Permit Application t�, 1.012 01.1.1( I I S1. t)Nl 1
City ofTigard i Received Permit#:
13125 S Hal Blvd.,Tigard,OR 97223 " Date/By: /►�7�}�!!o-001162
;� gPlan Review Related Permit#:
• Phone: 503.718.2439 Fax: 503.598.196 Date/By:
Inspection Line: 503.639.4175 A 2 0�6 Ready Date/By: Juris: ® See Page 2 for
I t 1 I.I) Internet: www.tigard-or.gov AR. D %Notified/Method: Supplemental Information
TYPE OF WORK `tv 1 OV 11 ,ni ica )n, PLAN REVIEW
0 New construction Addition/alteration/rpl C� A ' ` \J Please check all that apply(submit 2 sets of plans w,�items checked):
U"'� 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: �T��� where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
4.< and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground.or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: / d 0 Addition of new motor load of system.
f fp��5 r!� 4� �1��- IOOHP or more. ❑
City/State/ZIP: 0 Six or more residential units. occupancy.
Y (� '] Recreational vehicle parks.
�`���� 1 [ ❑Health-care facilities. 0
Suite/bldg./apt.#: Project name: 0 Hazardous locations. ❑supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 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'I 500 sqft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Q ,^A pp �^,w���j'// ,,J �^ (with above sq.ft.) 75.00 2
`�] �� ��� �lw`^ ( — � � iL�C�)"� Limited energy,multi-family 2
Za���
ir residential(with above sq.ft.) 75.00-1--V1 �' RenewableEnergy ❑ SeePage2PROPERLY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
v /
Name: 1._(c. 4, 1- 4‘ E// "
1 200 amps or less 100.70 2
Address: 1l\6 5 5 LO & A v—t 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: (c -1 .1, / op_ 9 701 // 9 601 amps to 1,000 amps 301.04 - 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps _ 125.08 _ 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
eacA,a i 1( i N,�� Fee fbor
anh circuit
Contact name: /� 5 B.Fee for branch circuits without
service or feeder fee,first
i56.18 // 1
Address: branch circuit 51s%I
City/State/ZIP: Each add'I branch circuit 4' 7.42 d/t4A' 2
Miscellaneous(service or feeder not included)
Phone:603 ) p S Fax: :( ) Each manufactured or modular
l d) 67.84 2
4-4-;t7) dwellin service and/or feeder
Email:
✓14C,L S4'�l h- H( vq. r ' co), -1 Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: frGlli3 E f t Lf( I'L _ Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: l0 3.SS 5' W ' c (!kj`n panel,alteration,or extension.
City/State/ZIP: (� I I `0 d �/(t- 0 . q 70 TO
Each additional
nal inspection
inspection over allowable in2 any of the above
V" Additional inspection(I hr min) 66.25/hr
Phone:( c3) 57 A -3Gf g , Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.:1 l T ?g 7 Electrical Lie.:G.7 e 7 Suprv. Lic.: 5-7 ( 7$ specifically listed(Y:hr min)
� �_ , ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: , . i. 7 Subtotal: Kt g 6
Print name: 70 s h 110 q h L Date: 3 " i 6 - !G 0 Plan Review Required(25%of permit fee):
J State surcharge T(12%Lofpermitfee):E
Authorized signature: // TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: 4 q.f f' w /! 1 :el s Date: . 6 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:,Building.Permits ELC_PermitApp_ELR_ERE.doc Rev 06 17 2015 440-461555 COMWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WO .ONLY E Description scIU )Qty. I Each I Total[)LE
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ 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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WOiiK ONLY: ELECTRICAL PERMIT FEES -
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:Building Permits FIX PerntitApp ELR_ERE.doe Re c(15 1-2015