Permit CITY OF TIGAR711D MASTER PERMIT
1 COMMUNITY DEVELOPMENT
Permit#: MST2016-00219
T/ A t. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 s: `
t t Date Issued: 06/09/2016
Ailim
�' ,,�� Parcel: 2S103DC06300
/reit i
s Jurisdiction: Tigard
Site address: 11210 SW FAIRHAVEN ST
Subdivision: EXODUS Lot: 4
Project: WALTERS
Project Description: Kitchen Remodel: Moving door and(2)windows. 6/16/16: REPRINTED permit to show change
of contractor from owner to Power Plus Electric and added (1)branch circuit, (1)garbage
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: No
Total: 0 sf Value: $8,000.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Drains: 0
Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 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: 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: 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&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:
WALTERS,LORRETTA J ALLAWAY CONSTRUCTION LLC Required Items and Reports(Conditions)
11210 SW FAIRHAVEN ST 901 BRUTSHER ST,STE D#101
TIGARD,OR 97223 NEWBERG,OR 97132
PHONE: PHONE: 503-217-4243
FAX:
Total Fees: $670.75
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through R 952-001-0090. Y• • - .- -in a • e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �` ill b. Permittee Signature: C....2se',_ Q
10/ 03.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFF1CF t SF Oy 1.1
4, *, ; '
City of Tigard `. ' Received
UPIu Date/By: Permit#: /1s7 jb�11
. - 13125 SW Hall Blvd.,Tigard,OR 97223 G Plan Review / ,
Phone: 503.718.2439 Fax: 503.598.1960r �'�`' Date/By: Related Permit#:
Inspection Line: 503.639.4175 \:‘,\\' % ady Date/By: Juris: ® See Page 2 for
7 I GA R D Internet: www.tigard-or.gov ,:,'iotified/Method: I Supplemental Information
TYPE OF WORK ' .tib"1 f piliVIS10 PLAN REVIEW
❑New construction ErKddition/alteration/Zelp14ettheht'` Please check all that apply(submit 2 sets of plans w/items checked):
El Demolition ❑Other: r 0 Service or feeder 400 amps or more
p 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
t.CATEGORY OF CONSTRUCTION •Y exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Ikr:and 2-family dwelling 0Commercial/industrial 0 AcSOry ` less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builderg
0 Oth- : ' 0Fire pump. 0Installation of 150 KVA or
JOB SITE INFORMATIONN AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: I ❑Addition of new motor load of system.
I a/G^C S'('(' '"'n.t: 144144‘ -C.+ 100HP or more. ❑«A„ "E,> `.1 2„ «1.3»
City/State/ZIP: T t<j et rd o / 9 7 Z`3 Z ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORKLimitedLimited energy,residential
R 1-,(- I c i'', /2--‘11-c—ka-v Q`-vvsl raP 1qC i/ or
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
all Z —C I r C.C.-t.t 7--c i,1. 7-4‹. A t h 0.44 w% residential(with above sq.ft.)
/ ';,J Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: ,r%,oa't l.A.ci L"p --f" 200 amps or less 100.70 2
1' r t i-q t-e_ -\ -CD' 201 amps to 400 amps 133.56 2
Address: I 1 Z I 0 __c(.&'
-^�.� 401 amps to 600 amps 200.34 2
City/State/ZIP: / () 4,---4 (`o 7 7 2 Z 601 amps to 1,000 amps 301.04 2
Phone:(.t`P3 6 ao ! I3 9 Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own hich is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,67r,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT 0 CONTAC ' 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
each branch circuit
Contact name: /� 4 B.Fee for branch circuits without
/ / ,/J 4 l/� { service or feeder fee,first 56.18 2
Address: (�H/%1 j /6//)- branch circuit VVV
City/State/ZIP: L1V l j I i lr/ Each add'l branch circuit 7.42 'di. 2
Miscellaneous(service or feeder not included)
Phone:( ) ir,(L/`rv-t ax: :( ) Each manufactured or modular 67.84 2
Email:
dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Pek./...e_r {3Z-Li� 4. ---e..43 t`-- Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:/'76 7...c— --c(--4)1 rvy-,5 4F Zs-‘ panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:/ [zJ /6� ( ?op Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:
( �l) �p (q
o J � Fax:( ) Investigation(1 hr min) 90.00/hr
Email6 rekK I-6)L, fZ f p e s c(? Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: lt'8ei 7 ELECTRICAL PERMIT FEES
Electrical Lic.: /17) I Suprv.Lic.: c' '" 5`s specifically listed('/2 hr min)
/}i 6 It
Suprv.Electricians tore, •requiredt �/ 1C1IId >a Subtotal. _ 7,,,dit
Print name:I)X4.11 C0.[_F Date: 0 Plan Review Required(25%of permit fee): _
State surcharge(12%of permit fee): 594
Authorized Authorized signature: TOTAL PERMIT FEE: 7,7,
This permit application expires if a permit is not obtained within 110
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015 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
Description I Qty. I Each I Total
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(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
COMMERCIAL WORK ONLY:' ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Pernits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
Plumbing Permit Application
Building Fixtures
]
City of Tigardlit- + Received
Date/By: Permit No.:
11111 II r 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 v, 2 5 2b16 Date/By: Other Permit No.:
Inspection Line 503.639.4175 P`
i 1 t. \RI) M Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov AA Notified/Method: S
t, Supplemental Information
r ,,��"°
r
.,roa3 .f e t '•:R:4 p p ;, -, k'':',, .i ,' t 4.' ,
0 New construction 0
',� ' For special information use checklist.
j�� Description I Qty. I Ea. 1 Total
,12f Addition/alteration/replacement ❑Other: New -2-family
dwellings(includes 100 ft.for each utility connection)
a 4 . �a 2yv ,,,:s;. ..t6r@... 5� '7th. f,,fje is, T
,,-..',-4.4,, ; 1,y'-- -40$4: � 1w, ,t , n,°,1m SFR(I)bath 312 70
F1 1-and 2-family dwelling ❑Commerce �� SFR(2)bath 437.78
❑Accessory building ❑Multi-famil , SFR(3)bath 00.32
ID Master builder C Each additional bath/kitchen t
, ❑Other Fire sprinkler( sq.ft.) Page 2
f
I 'iSi . : k i w it ` Site utilities:
Job site address: //,,7/12 _ ),(/' f" f 1 Catch basin or area drain 18.76
z ( 1,,,,1„,P n S Drywell,leach line,or trench drain 18.76
City/State/ZIP: '-�et pe 6,7A26,7A29'7aa
Footing drain(no.linear It: ) Page 2
Suite/bldg./apt.no.: j Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
C)a 0,.... r, Le P Os n PP /lam Rain drain connector 18.76
�^ Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
� ,y< .....- 141)RK:.: , ;, r Backwater valve 12.51
25.02
u. . . .}: I t '°~ Clothes washer
./-7C7/ v/-L-- --S'i n 44.,--7,e Ar dl'/ 5'h I, D )LI7 q (- Dishwasher j 25.02 ol5- � y,
-6 -Fe t' A i'✓'o X , Drinking fountain 25.02
I ' /kr_ 4, i--,,a aid /J�� e(,t,✓ Ejectors./sump 25.02
r:4'. v rx��'rr at
14...,+7,11:, L ffia t; ,: i0 : ' `;'i..,:,91-4.7 Expansion tank 12.51
Name: Fixture/sewer cap 25.02
D r r p � �� ��r C Floor drain/floor sink/hub
Address: i',/,r: /(27 ) 25.02
C 5-4/ �OS J r�'1�l v !?/1 _5---7----
Garbage disposal 25.025•'•,4-...0.. X
City/State/ZIP:
T 2. A S(� oma' 9 7a�_s Hose bib
25.02
Phone:•Ur-i79) k 0 - 4 Fax ( ) Ice maker r 12.51 /4.51
1
n°- r i , 1' ` Interceptor/grease
,�'." �:� �'�` •����� " �� trap 25.02
Business name: )_��`/ f S Medical gas(value:$ ) Page 2
�a f r C-- " !,� g
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address: 0.S, �pi 1 2-5.,u1-,
5:0-4Sink/basin/lavatory 25.02
City/State/ZIP Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
ba s ,:�k ?. a -?,0 ,.G d ar ,,.-s.: +^ 'y4'Yv., ecu-,'e.a'". e.. , Water closet
,, ,,.c., .:3 g,,'4 et4 s•y L.-4;,t.. ' "44.1, Aldir t ', .� 0 ��".4.^ Water heater 25.02
�r 37.52
Business name: /..LA,iii�" p/N�`L_,..7.5 Water piping/DWV 56.29
Address: Po 0� o? 3 ! a Other: 25.02
City/State/ZIP: 77 62z 0,e-- ?7,2e/ Subtotal 8-7,,5-7
' /Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing o./6_yys Plan review (25%of permit fee)
►/
���� 7 Lic.no.:
�;�7� r •- State surcharge(12%of permit fee) to•..)'7
Authorized signature: c-�j7y-_- 1
TOTAL PERMIT FEfe.f v r
Print name:4,r-,r.z---Ilk // e 1":5 Date,,u7 j-1/- This permit application expires if a permit is not obtained within 180 days
T7 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:-Buiiding'Permirs PLMU-PermilApp,doc 1001 09 440-4616T(1002d-OM WEB)
i
CITY OF TIGARD MASTER PERMIT
li . COMMUNITY DEVELOPMENT Permit#: MST2016-00219
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2016
T[i;;1 r D 9 Parcel: 2S103DC06300
Jurisdiction: Tigard
Site address: 11210 SW FAIRHAVEN ST
Subdivision: EXODUS Lot: 4
Project: WALTERS
Project Description: Kitchen Remodel: Moving door and(2)windows.
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: No
Total: 0 sf Value: $8,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 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: 0 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 Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea addl 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:
ALT SF VB R-3 0
Owner: Contractor:
WALTERS,LORRETTA J ALLAWAY CONSTRUCTION LLC Required Items and Reports(Conditions)
11210 SW FAIRHAVEN ST 901 BRUTSHER ST,STE D#101
TIGARD,OR 97223 NEWBERG,OR 97132
PHONE: PHONE: 503-217-4243
FAX:
Total Fees: $347.33
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 .2344.
Issued By: Permittee Signature: , ::: ::. 7 LiziX.„..=_____,,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential 1 (>R ()FFI( I. l SI•: ONI.1
I
Received
City of Tigard OiSIAIQ 9� Qui Permit No.: /,,�y /y
Date/By: p2Gj nip 7
• 13125 SW Hall Blvd.,Tigard,OR 972 I ii Plan Revie
II Phone: 503.718.2439 Fax: 503.598.196 T !�� Date/By: Other Permit:
I I t .n!:I Inspection Line: 503.639.4175 Date Ready/By: orris: ® See Page 2 for
Internet: www.tigard-or.gov 9�QZ n f ��W Notified/Method: tiP SA0 •44.44 ''r'�/I Supplemental Information
y `, V / L-0 �`V
TYPE OF WORK - // REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑li ,13311 Permit fees*are based on the value of the work performed.
i� Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ �� ea.,
FLI-and 2-family dwelling 0 Commercial/industrial U y(YOS .v
❑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: 7/ 7/t7 s si ,4 J e_n --5-1f— New dwelling area: square feet
City/State/ZIP: ----r, Q� r c O� 92,2,7...F Garage/carport area: square feet
Suite/bldg./apt.no.: / Project name: Covered porch area: square feet
Cross street/directions to job site: fit_ r oe, ,,,(' J��JA Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
AValuation: $
Existing building area: square feet
New building area: square feet
j2NPROPERTY OWNER 0 TENANT Number of stories:
Name: prr- e if ,V J/ f. Type of construction:
Address: //,„ /D S-' /,,.A, ve_n 5-.7— Occupancy groups:
City/State/ZIP: 7::7„,,1/4,.,pR , 97-7,7_j Existing:
Phone:c_5-92 ,dam `y� 4 Fax:( ) New: 1
O.APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
� � 1� (Please refer to fee schedule)
Business name: /p
r^it rit J // . e_f Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address: x.t
,4 ,e_ us O V `� Total fees due upon application: 7City/State/ZIP:
Phone:( ) Fax: :( ) Amount received:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTORroof-top mounted PhotoVoltaic Solar Panel System.
Business name: .579--Soij i4-GL��� � NS-T�4 C77O� Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: l DOL/ fe 77.V 4 q 77 . _ 'C C O AA Solar Installation Specialty Code checklist.
City/State/ZIP: t)OO4 O 2 9 7 yo /y Permit Fee(includes plan review
"' and administrative fees): 5180.00
Phone: . ) 3 29 .3.5 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: /4,p20--e)
$201.60
Total feeapplication due upon application:ifpe
Authorized signature: // This permit expires aipermit is not obtained
=CC rJ within 180 days after it has been accepted as complete.
/ (��T Date: *Fee methodology set by Tri-County Building Industry
Print name:
hp „' eGC 'it/� / S— �- �� Service Board.
1:ABuilding\Pennits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR O1'FI( t. 1SF ()NIA •
City of Tigard Received Permit No.:
Associated permits:
I Phone: 503.718.2439 Fax: 503.598.1960 Date
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
i IC;AItI)
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No N/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 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 tloors/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 licable to the ro'ect under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17".
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 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:A Building\Pennits\BUP-RESPernitApp.doc 02/24,201I 440-4613T(II/02/COM/WEB)
Mechanical Permit Application FOR 0111(1: U. ()NIA
City of Tigard g tlik'NS ! ICW
Permit No.1,11:,.. OR 97
Phone: 503.718.2439 Fax: 503.1W Date/By: Other Permit:
I I G n 1:l) Inspection Line: 503.639.4175 Date Ready/By: lir s: ® See Page 2 for
Internet: www.tigard-or.gov r7-Q1l? Notified/Method: Supplemental Information
s Nw s Y.' s ^. O �.i f ! "w4, s ,'.: as 'd are
a ;ed , hi & 3 :. 4 t*
.. i -: :�- a1 )4; saw '''''/'-'2'''
,� _.: .w, -� .,, ..,,�.w
a Mechanical permit fees*abased on the value of the work
❑New construction ,® Addition/alter oitt/i performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: t- mechanical materials,equipment,labor,overhead,and profit.
41 Value $, ft ` " ` ` 1-*. : # a;
';,',''''''''''?-:';';'7'
a, _
_7 a : µ xY - W .,e e. { !e_ t✓ t , . r., t,..„,,,., .„ x ' x mrze.r«, , A,.�.1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
17: :'74,3::184-"F70'.1157;,,,,.,-:8? .. % `1 "!'ll) �" r 0. 1 a 1 i" Heating/cooling:
.n_ .,..'''r ;tom .-- -�t''''''' '''4"I''''''''''''''''""- .,r.. �''''',,..'s'""-.1uat,Tt ,«.'; -.. , `.�W
p __/-- Air conditioning 46.75
Job site address: / ��� �� �- /-h�V�� S/ Furnace 100,000 BTU(ducts/vents) 46.75
7,:;.?„.?,_ Furnace 100,000+BTU(ducts/vents) 54.91
City/State/ZIP: 1/ A r i og 9
I Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: C a r e_ n i l/S/X Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
,- fire e/insert
�`1�5�11PTI4�N f3F!WbRK"";' £, �: p
FlueGas ventlacfor w 33.39
ater heater or gas
it 0 Y/ !J q GL St70!` Gtrl GP 17,,,PL✓//)40OLk,-� fireplace 23.32
J Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
s 1+1 Other: 23.32
� �"�-' °"� - .w � Environmental exhaust and ventilation:
Name: 4 D rt.e_ / ir---_.S- Range hood/other kitchen
L/ �j V -
equipment 33.39
Address: //e+„7/7 ___D-11/cp., -.'•�`
r D.JJ� C1 Clothes dryer exhaust 33.39
City/State/ZIP: 7-7-- 0„ r„
(;)) 9'7-?.... __F Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(•5O.f 6. ...2:Z; / q3 9' Fax:( ) Attic/crawlspace fans 23.32
r lI IT ❑`ai•iii ` N Other: 23.32
Business name: {{��� c �f ,,t Fuel piping:
C � cv.J' Q TL/l t_- $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
` rx4t4 4 'It, r t ` Clothes dryer(gas)
Business name: �/v,,sD/J 4/-4, rl/Ay �,1 Other:
Address: -�- / nn ;Lel ., .1....,,,L...-.v,,,,,,,.,,..,,,,,,,,,.
) L p o y 5 0/ 7�0. l,t7i,,--5, e,,,v, K '-y7 Subtotal
City/State/ZIP: �' e r��4p A2 OR' Y'7 y� Minimum permit fee($90.00)
Plan review(25%of permit fee)
hone:( 3,-,z q_3��� Fax:(t� �y a.2a' _ 7.....c
/ // State surcharge(12%of permit fee)
V
CCB lie.: / 6,3 P 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: ��, iir/Z'.,t,..,,,,c....-
Print
* FeemethodologysetbyTri-CountyBuildingIndustryServiceBoard name: Lor- C e /t/a 17 -5-- Date: c - /h
I:�Building,.Permits,MEC_PermitApp_040113.doc " 440-4617T(11,02 COMWEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Famq Fee Schedule:
', .. ` 1 , ol Feed
$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\M EC_PennitApp_040113.doc 2
Electrical Permit ApplicationVSKY.XN Received
Plan r<)IZ c)l h l c, I SI.0\1.1
d City of Tigard
Date/By:
RevPermit#:
U 13125 SW Hall Blvd.,Tigard,OR 97223 ` iew
Q. I Phone: 503.718.2439 Fax: 503.598.1960 5 �� Related Permit#:
rt Dale/By:
Inspection Line: 503.639.4175 MAy Ready Date/By: loris: 0 See Page 2 for
I I( \R I) Internet: www.tigard-or.gov r/V,TAGivt. Notified/Method: Supplemental Information
_. TYPE OF WORk i ? /I 131 I P .All REVIEW
0 New construction laAddition/alteratiettia0M Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
' CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings,
.,,g 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORI IATIONAND LOCATION ❑Emergency system. larger separately derived
/7�p . r j) ❑Addition Hof new motor load of system.
Job#: Job site address:/
.v i OL"-Li P✓1 �7 IO0HP or more. ❑"A_ ..E.. ..1_2„ ..I_�„
7 9 ❑Six or more residential units. occupancy,
City/State/ZIP:
i ¢ a-r oP �� 7,2-2 3 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: �J Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Ga_ r 2 e u„cP /i5 FEE SCHEDULE
Description I QB. 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 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
�
/ / n / D (with above sq.ft.)
/ /D v '� e. P r- A.rl f � A/-](X h o C'.4)1
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER Li TENANT' Services or feeders installation,alteration,and/or relocation
Name: 4 6 rr k/ ,/J d—_, 200 amps or less 100.70 2
Address: 7/....2/O yk/ 201 amps to 400 amps 133.56 2
ui a 2� 401 amps to 600 amps 200.34 2
City/State/ZIP: .77 i--, O� 9'l?__7 601 amps to 1,000 amps 301.04 2
Phone: p Fax: Over 1,000 amps or volts 552.26 2
(��) 602 9� ( ) 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.exch• ge,acc tr tto ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
a /t, 401 amps to 599 amps 168.54 2
Owner signature:ar�,- - i� / /,- i�4. Date:,�j y—
0 APPLICANT I I 0 CONTACT 'ERSt N Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with 1
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 1
56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit I 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
-
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) 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 Lic.: Electrical Lie.: Suprv. Lie.: specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature �y c..4e:.,_ di
TOTAL PERMIT FEE:
/ / (/� This permit application expires if a permit is not obtained within 180
Print name: h D r. � - G /�l rs Date:Li �_ /f j� days after it has been accepted as complete.
/NNN' ! * Number of inspections allowed per permit.
I:Building Permits''.ELC Permit App_ELR_ERE.doe Rev 06 172015 440-46151(11 05 COM,WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information 1.4
Limited Energy Permit Fees: Renewable Energy Permit Fees:
f tD'+3M 445 .^, �, �■+ » £ �,. "" lE n P ' h w�� t°y iJ"$$ I. «..�> ✓ H" x 'xt.�K'..;3
Fee for all residential systems combined: $75.00 Description Qty. Each Y Total
y 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
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
COMMERCIAL WORK ONLY: ,EttanICAL,nsioUT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
* Number of inspections allowed per pent.
(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
1.nodding Permits El CPermitAppELRERE.doc Rey 00 17 2015
Plumbing Permit Application
Building Fixtures -si_AV
-0CFOR OFF ICl': l sl': t)\I.l
Cityof Tigard Received
ganDate/By: Permit No.:
u 13125 SW Hall Blvd.,Tigard,OR 972
I Phone: 503.718.2439 Fax: 503.598.1960 2Plan Review
2416 Plan
Other Permit No.:
Inspection Line: 503.639.4175 \‘10
Date Read /Bo Rids: El See Page 2 forII( \Rl) Internet: www.ti and-or. ov n k► Notified/Method:
Supplemental Information
'P
d-t ',1, a.megN. a ! t. ;;, $ L n1 1 'te _ w 9rrY r r3 1.
0 New construction 0
wvk '. t For special information use checklist.
Description Qty. I Ea. I Total
,121 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
F ( , m ,r"i' r ,,z'' `i 7t T 1s SFR(1)bath 312.70{ ar'::-.44,,,,,,,4,
1
Q 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
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
4 i {tt re.,. g, *.. N Lriik N.. ' . Site utilities
Catch basin or area drain 18.76
Job site address: J/�/2 , y� /; r Ii 4.d e n -sem
Drywell,leach line,or trench drain 18.76
City/State/ZIP: moi" 2./1:75'70Z0,7� 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
p Rain drain connector 18.76
0. .
C. t^ �P_ oln.0 //�
41
Sanitary sewer(no.linear It:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear It.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
11 " - Backwater valve 12.51
n }} Clothes washer 25.02
/lC7 t/ .S'/ r)A- Gk/1 eQ OC/ S'h IA,LA.S)(Z r- Dishwasher 25.02 y,
-6 -'Fe. e_1-- 0,./217r-r >( , Drinking fountain 25.02
Ejectors/sump 25.02
,; r4 * i Expansion tank
12.51
Name: J / VOL. ixture/sewer cap 25.02
AO('D( /` e 7/tt../W �2) <•c Floor drain/floor sink/hub 25.02
Address: //c /r2 _5-N/ � t f i') _V'en S'
0. Garbage disposal 25.02 X
City/State/ZIP: ')-----,...3,- e -7, ?2_
al r- 9/ Hose bib 25.02
p� Phone:(j5" ' 47., p .-/-.93 f Fax ( ) Ice maker 12.51
�y Interceptor/grease 25.02
��5 �!" '�` ' {� COIF ' �}� trap
�� Medical gas(value:$ ) Page 2
Business name: 1.0 r ,-e_ e r S
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: ��,1 as �pv e__ Sink/basin/lavatory 25.02
City/State/ZIP` Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
� 25.021. !p y l iw r,'s1 ' x n 4 ,Ti, Water closet
Ff � v.,rua - . . z-gg; L �R
Water heater 37.52
Business name: N/7/7 .e.._/,-- ju i,�� Water piping/DWV 56.29
Address: Po 4 e, o? 3 9s Other: 25.02
City/State/ZIP: 776�E� 0 ';; :2da/ Subtotal
Phone:( ) Fax:( ) C Minimum permit fee: $72.50
/CCB Lie.: e-/f37 Plumbing Lic.no.: ,/6'yyJ Plan review (25%of permit fee)
11),,,, ,,...,,„ State surcharge(12%of permit tee)
Authorized signature:G- TOTAL PERMIT FEE
Print name: , l Date: c / This permit application expires if a permit is not obtained within 180 days
4c7!-'rcz--77GC- k of/! C ,.. l-1 P 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:
p a a � s
I +may "
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- I st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 /4�' '
Storm&Rain Drain 1st 100' 62.54 °..�.`,„ ,."rh" ��, , ) ".,� x. ,Ad , ., tar,40"�, ...S.M,
_ $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
7,, e7w each additional$100.00 or fraction thereof,to
%fine* .:` .f 5 _ - _ n 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*.
Quanti,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
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial El Any multipurpose fire sprinkler system.
Domestic 111 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
-Com/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:
I:ABuilding\Permits\PLMF_PernitApp.doc 08/04/2011 2
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit q e mit Action
71
, ;,-, ,,;,, 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
FitGEIVED
TO: CITY OF TIGARD i X016
Building Division JUN
13125 SW Hall Blvd.,Tigard,OR 97223 CIT OF-FIG, ARg
im
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingP ^.+r'.
FROM: wnex ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: , .}
INVOICE TO: (Business or Individual) kD ) hitt.//; r_s
Mailing Address: //..?/D .-5-14/ A;;.,,s- 4,t✓e ,1
City/State/Zip: j A e% 9 27A7 g 7-?.?3
Phone No.: A7— 4=26 9...3 ?
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ I CE FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: /15 7—o7 p/b .- 0 0
c
Site Address or Parcel#: /100.40 .5 f4 �/' lja v e i
Project Name:
Subdivision Name: Lot#:
EXPLANATION: - � �
_nn ai ...� —�
/ �i 1 /..
L
Signature: Date: --
Print Name: I'r Q/7-e r s
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By A 41. Route to Records: Date 6 ) 40 By 5
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPernutAction_092314.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11210 SW FAIRHAVEN ST, TIGARD, OR, 97223 February 6, 2019 at
10:30:48 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00219
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11210 SW FAIRHAVEN ST, TIGARD, OR, 97223 February 6, 2019 at
10:36:34 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00219
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11210 SW FAIRHAVEN ST, TIGARD, OR, 97223 February 6, 2019 at
10:34:53 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00219
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11210 SW FAIRHAVEN ST, TIGARD, OR, 97223 February 6, 2019 at
10:29:41 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00219
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor