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Permit (66) CITY OF TIGARD MASTER PERMIT 1,11 ,u I ' COMMUNITY DEVELOPMENT Permit#: MST2016-00233 T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2016 Parcel: 2S112CD02000 Jurisdiction: Tigard Site address: 15630 SW 79TH AVE Subdivision: DURHAM ACRES Lot: 14 Project: LAYTON Project Description: 1,600 sq.ft. addition: New living room, master bedroom, bathroom, and garage. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 1600 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 1 Second: 0 sf Garage: 600 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 1600 sf Value: $100,000.00 Rear: 10 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 60 SF Rain Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 1 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 1 Clothes Dryers: 1 Natural Gas 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: 1 0-200 amp: 0 W/Svc or Fdr: 8 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: ADD SF VB R-3 1600 Owner: Contractor: LAYTON,RONALD J OWNER Required Items and Reports(Conditions) 15630 SW 79TH AVE RONALD LAYTON 1 Needs Truss engineering TIGARD,OR 97224 15630 SW 79TH AVE submitted before framing TIGARD,OR 97224 PHONE: PHONE: 909-568-8335 FAX: Total Fees: $4,731.30 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 t - 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification --nr r. Those rules . e set r- • OAR 952-001-0010 through OAR 952-001-0090. You ..- -• .in a co• of the rules or direct questions to OUNC by calling 5• .232. -87 or 1.800.332.23 '�b By: _ Permittee Signature: 7 /00,7"."--- Issued Cal'��.4175 by 7:00 a.m.for the next available ins a on date. This permit card shall be kept in a conspicuous place on the job site , it completion of the prof,,/ Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential Cl Of Tigard FIEC�r ! iec " ' _ 3 PennitNo.:rw �13125 SW Hall Blvd.,Tigard,OR 1 a Phone: 503.718.2439 Fax 503.598.1960 6 Date/By: �� l I') Other Permit: I I C A i D Inspection Line: 503.639.4175 � � � 1 Date Ready/By: rods: ® See Page 2 for Internet: www.tigard-or.gov rq Notified/Method IIlPZ I Supplemental Information CITY OF TIGP813 $5 i d TYPE O ING►0IVI REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all FAddition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION O(�/ (i work indicated on this application. I Jt�`�(i0,, Valuation: $ 1 ❑ 1-and 2-family dwelling 0 Commercial/industrial J ❑Accessory building ❑Multi-family Number of bedrooms: /[ 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: i 5- 30 5 n'-7 .7 pi /,/- New dwelling area: �l j, square feet gr//34- City/State/ZIP: p`j 7 (2/2 5 ?�� { Garage/carport area: /„(� square feet Suite/bldg./apt.no.: Project name: ‘44--171,71#4,) A-0,0/1207"1Covered porch area: .2 D p 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. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. /+.010 L/LJ%/i.3L / MA-5A91i /3/17)1/ 6,1/%77,164f,:, ,1 Valuation: $ Existing building area: square feet New building area: square feet 0 PROPERTY OWNER, 0 TENANT Number of stories: Name: R4 t /t-i i9 j Lk-I/VA) Type of construction: Address: j 5'6 5 ? iiez> 2`3 Az/ Occupancy groups: City/State/ZIP: 1 VA-72,0 €4- 9?2-21 Existing: Phone:('7Q9 55iJ _ -3.ys-- Fax:( ) New: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule Business name: y✓Y) q, "b171,7(_.. Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: ?fr. f(7 City/State/ZIP: Amount received: Phone:( ) Fax::( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: Submit two(2)sets of roof plan with connection details Jar and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: � ,+� This permit application expires if a permit is not obtained L� within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name: N *9 j • Date: 1V / Service Board. 1:ABuilding\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613 T(l11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling mit oFFlcf: t si: ONFv City of Tigard Received Date/By: Permit No.: • 13125 SW Hall Blvd.,Tigard,OR 97223 e Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: I. C ^R D 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical IInternet: www.tigard-or.gov 0 Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1'cs No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 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 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 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 as,licable to the sro'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 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 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\Permits\BUP-RESPernitApp.doc 02/24/2011 440-4613T(1l/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE()NEN' Received Permit No.: V r City Tigard EI VQED Date/By: 13125 SWW Hall Blvd.,Tigard,OR 972 Plan Review Other Permit: Phone: 503.718.2439 Fax: 503.598.1 6 Date/By: ��{C Date Read /B Juris: ® See Page 2 for InspectionLine: 503.639.4175 ff''1i tU y y' Supplemental Information T I C;n ftU Internet: www.tigard-or.gov J U 14. Notified/Method: 11 a * 4 t 'v* "s are based on thevaline of the work x �� ' , s"s t l- 1', t J,. „ham. ",, Mechanical permit fee ❑New construction % -ddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all mechanical materials,equipment,labor,overhead,and profit. rliii emolition MI Other: Value:$ �, ., � ;.4 'fir; ,. . : a ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. Multt famil 0 Master builder 0 Other: Description I Qty. I Ea. Total ❑ y . . *, Heating/cooling: t , 0 fir.:g , 1 ' ii r1 4 . . '' - f Air conditioning 46.75 �. ,�_, :+ � .a"°`tom :,,. - '/7 Furnace 100,000 BTU(ducts/vents) 46.75 Job site address: ,�1�j 30 5�.<<; 54.91 Furnace]00,000+BTU(ducts/vents) City/State/ZIP: s+2- ^?. ..7-'7' Heat pump t 61.06 Pro Project name: 4-#4/1"*"' A XTZ�7 f �y Duct work / 23.32 Suite/bldg./apt.no.: J vf�! /� Hydronic hot water system 23.32 Cross street/directions to job site: 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 Lot no.: Other fuel appliances: Subdivision: 23 32 Water heater Tax map/parcel no.: Gas fireplace/insert 33.39 '" ` s4 = � F •K '' '- ..a:--r, Flue vent for water heater or gas AVO fireplace 23.32 / Alt)/A)�%./ ,MA( /34Plie605P2Loglighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 . `' #f Other: 23.32 , `t1 t I ' s I,4 ' s, : r l t �1., P.: - Environmental exhaust and ventilation: ::111;4707,.. ''" """ Range hood/other kitchen Name: / /V � equipment 33.39 i+ �j 33.39 Address: I .57 j�j L) 5'.....) 77,-(,42,e...--; #/ 2 Clothes dryer exhaust Single-duct exhaust(bathrooms, City/State/ZIP: ')7 1/ 014-- ,?��1 toilet compartments,utility rooms) 23.32 QC( ) 3S� Fax ( ) Attic/crawlspace fans 23.32 t/{ ', A� C1 i 'Iv 010*F.: .*'' •Other: 23.32 �Mre��: '.. . -,: , rt.+T. a Fuel piping: Business name: 'C &3 4%c/ft- $14.15 for first four;$4.03 for each additional 1% Furnace,etc. Contact name: Gas heat pump Address: Wall/suspended/unit heater City/State/ZIP: Water heater ` Fireplace Phone:( ) Fax: :( ) Range E-mail: Barbecue ` r; , - t t r . � , Clothes d ryer(gas) Other: Business name: GiAd/e✓ Int . - ` til Subtotal Address: Minimum permit fee($90.00) City/State/ZIP: Plan review(25%of permit fee) Phone:( ) I Fax:( ) State surcharge(12%of permit fee) TOTAL PERMIT FEE CCB liC.: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. II( 1'/ � * Fee methodology set by Tri-County Building Industry Service Board Authorized signature: J/ Print name: ;$2,01....1-0 I Date: 61,/e 1 I:\Building\Permits\MECPermitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Famil Fee Schedule: $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:\Building\Permits\MEC_PermitApp_040l 13.doc 2 Electrical Permit Application Qlz Orrlci: SI:0y1.1 �������� r �`'eceived City of Tigard Date/By: Permit#:/11527,71/(0 ,60.933 . " 13125 SW Hall Blvd.,Tigard,OR 97223 JUN 8 2016 Plan Review � Phone: 503.718.2439 Fax: 503.598.1960 lJ Date/By: Related Permit#: Inspection Line: 503.639.4175 ReaCITY OF TIG it R 1j Nota ed/Method:y Date/By: 1uris: ®See lemental Information I I(;A It D Internet: www.tigard-or.gov Ctrl PP BUILDING DIVISI® t1 TYPE OF WORK PLAN REVIEW ❑New construction (ErAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ElService or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amp❑Multi-family 0 Master builder 0 Other: 0 Fire buildings. Fire for all other installations.pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: ❑Addition of new motor load of system. 100HP or more. ❑"A" "E» "1-2» "1-3» 0 Six or more residential units. occupancy. City/State/ZIP: ❑Health-care facilities. 0 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'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential / 75.00 2 e��'' 6t7 E J( .3 (with above sq.ft.) CC// Limited energy,multi-family /�..e(/`) residential(with above sq.ft.) 75.00 2 /' `f ,11? -)C?"--- Renewable Energy 0 See Page 2 ^PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less f 100.70 2 Address: `j.6.-, 0 moi..;% -�j /11-2 _ 201 amps to 400 amps 133.56 2 }� 401 amps to 600 amps 200.34 2 City/State/ZIP: 776~ ~ 9 7 22( 601 amps to 1,000 amps 301.04 2 Phone:Oh ) 56 ' v$,/r- Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: ()©`ya (/7 r‘7/3'7 , 6a/r7(--- relocation Owner installation::'This installation is being mad on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease, t or exchanacco ORS 447,449,67700, 7 . 201 amps to 400 amps 125.08 2 Owner signature: d. Date:(O c 401 amps to 599 amps 168.54 2 0 APPLICANT Q CONTACT PERSONBranch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 5(L YGie��� = � Sign or outline lighting 67.84 2 A�. s: / Signal circuit(s)or limited-energy ❑ See Page 2 2 panel,alteration,or extension. City/State/ZI': i:/ -" �>7.! _ Each additional inspection over allowable in any of the above i 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.: Elec.- al Lic.: Suprv.Lic.: specifically listed('/2 hr mm) ELECTRICAL PERMIT FEES Suprv.Electrician signatu required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PennitApp_ELRERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined: $75.00 Renewable Description I Qty. I Each I Total R 3' Renelectrical energy systems: 2 Check Type of Work Involved: 5 kva or less 133. 5.01 to 15 kva 133.5656 2 2 n 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 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over 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(1/2 hr min) C MMERCIAL WORK ONLY; ELECTRICAL(EnterV on FEES Fee for each commercial system:stem: $75.00 Subtotal(Enter Page 1): y * 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 n HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Plumbing Permit Application Building Fixtures RECEIVED Folz orrlcl: usr. ()Nil Cit of Ti and DateiBy: y ll Date/B Permit No.:"5 )�,6 -t:100-133 el 13125 SW Hall Blvd.,Tigard,OR 97223 y 111111 �``N�{ Plan Review II Phone: 503.718.2439 Fax: 503.598.1960 VIV2��� Date/By: Other Permit No.: Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for T I G A R I) Internet: Line:www.tigard-or.gov t OF TIGARD Notified/Method: Supplemental Information .. Y 1 1, r t. t rF 15..t ux 61 "' ' '"ic `;',+,0,,„;'''. .�,is r1,..,14,-.'?4,T110;/;:4,441404. ,a ... 'i'. oNew construction 0 Demolition For special•information use checklist Description Qty. Ea. Total 2 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 0 ft.for each utility connection) , a s * ,:;,,,:,1; - 1 "<.a: g Ursa „ : ;:14;::::241:;:';'41:"1" ry .- � °..�,^�..• r�„ d t t t "��o n' a(�s , � +;"�i� � SFR(1)bath 312.70 ❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02 0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 �n k.'3 ,,erg , tt., i. „b... .-', . Site utilities: Job site address: ('i,_... bis C:3 .....5„,._, '5' Catch basin or area drain 18.76 City/State/ZIP: �� 7 ) �� 9'7•Z 2-r Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: 1i7c 1� Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 - Sanitary sewer(no. ft.:O / Page 2 6, Storm sewer(no.linearlinear ft.:_) Page 2 3-7 Water service(no.linear ft.:_) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 + Backwater valve 12.51 / ,�s �,/ fClothes washer 25.02 9 /('� � � � I�J/!, w Dishwasher 25.02 Drinking fountain 25.02 � -nider�t� 2 ...5q,(1L1 Ejectors/sump 25.02 �,,, ,,, ,/ �, .;e✓ s" a skrt * rrf�'t e r a, S Fy �' P Peak' Expansion tank 12.51 Name: /20/Ll -f9 � " Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: �� 7��' � ,,/ Garbage disposal 25.02 City/State/ZIP: 72&0477-1;f l� 92 2--2 / Hose bib / 25.02 Phone ((C(j) 5 �'3J Fax ( ) Ice maker 12.51 r z r , .�,.F l? .. t.,a ",,,,0,4,:,--, . . 1 ,„ .. R-.-9 .3!t'+ Interceptor/grease trap 2 2 Business name: L/- Medical gas(value:$ ) Page 2 �'���v S �✓V C- Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory .2.- 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan / 12.51 E-mail Urinal 25.02 ' a' r, Water closet / 25.02 �' :fix. .� 'Z''',1!"'r �''A.1410,', Water*11 heater 37.52 Business name: � ��- Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( Minimum permit fee: $72.50 CCB Lic.: um � .: Plan review (25%of permit fee) �� State surcharge(12%of permit fee) Authorized signaturey /AIR� TOTAL PERMIT FEE t /�/ This permit application expires if a permit is not obtained within 180 days Print name: ry/J' f ""C Date:/L after it has been accepted as complete. - r` *Fee methodology set by Tri-County Building Industry Service Board. I440-4616T(10 Building\Permits,PLMU-PermitApp.doc 10,01/09 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su. s ression S stems: 4:1dpi ".G,;r'« @ F e i r ;s 8 ' ;, Fa y ,�7 ."bra 4 J . n,e s„-�' n ,� tl y °:§ w '+ p a^ E t ' 'vii �/e 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' i. 62.54 NMI 7,201 and greater $327.54 Sewer-each additional 100' Water Service-1st 100' 62.54 Medical Gas Systems: 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 fre ..i. ” .fin.` 't; each additional$100.00 or fraction thereof,to - _ .9,. -i, > 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 char_e—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 char_e-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*. ' "" Qtt ntrty y to � Plan review is required for any of the following. Fixtur elormace! Please check all that apply. Work [ormed< O Pe4 :. Added Rel _ Baptistry/Font LIAny new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic 1:1 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" tih �t -3" ;: v � - a �' -- � a 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food 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\Permits\PLMF_PermitApp.doc 08/04/2011 2 A Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Prlht Nam- : • rmitApplicant 1 -.0, 6A-2-A> i ture of Permit Applt / Date Permit#: ,.„ , r x Z 3 � °, Address: /5-Z730 S-� 77 >9v'- .* i\��s^ //7er,�� : Issued by: Date:CA.)//c off=1- This Copy for Permit Offices City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT i Building Permit Review — Residential TIGARD Building Permit #: /'7S7J14,—t " Site Address: I G 6 3 0 7g -e-t-1 Are Project Name: 1-GV-t-o a Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: g F 2 f)dld,i'hi) in 1/ Verify site address/suite# exists and active in permit system. XRiver Terrace Neighborhood: f2"No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: "Three(3)copies of site plan Existing structures on site n Site plan must be on 8-1/2"x 11"or 11 x 17"paper lFootprint of new structure(including decks)with finished Prawn to scale(standard architect or engineer scale) floor elevations %North arrowUtility locations(required for new,may apply for additions) '[.J ite address,project or subdivision name and lot number ocation of wells/septic systems plicant information(name and phone number) .O'Existing trees to be retained with drip line,and tree ■ ot dimensions and building setback dimensions protection measures 1.t area,building coverage area,perc I. tage of coverage and EiStreet tree size,type and location impervious area(applicable if R-7, -12 R-25&R-40) /Street names Property corner elevations (2 foot contour lines if more than 4 foot differential) 2"-Clears Water Services—Service Provider Let - ot platted prior to 9/10/1995): Required: CI No ❑ Yes,applicant was notified � No Received: ❑ Yes [ Public Facilities Improvement(PFI) Permi Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake IIV.Land Use Case#: LLA to S (9 -0 000 C: VW-Zoning: (l- ( 'l- Setbacks: Front ( S Rear 1 S' Side S Street Side ( c7 Garage 7,0 Landscape Requirement: e-0 Lot Coverage Maximum: S 0 % 7 Building Height: Maximum Height 3 s Actual Height 1 S rygArisual Clearance a—Easements B--Sensitive Lands: ❑ Yes ❑ No Type 'Urban Forestry Plan 4 Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: M 0 t1, (3'1(9 Date: G/g/ / (o Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_060116.docx Building Permit Submittal Original Submittal Date: 67TA0 Site Plans: # Building Plans: # Building Permit#: nterbuilding permit above. _� Workflow Routing: a n ig engineering [rm - tt Coordinator wig Workflow Sign-off: 1E,�- �ig,�n-o-gr for Planning(include notes from planning review) Route Application Documents: 4cYEngineering: (1) copy of permit application, (1) site plan, (1) building plan and orijial plan review routing form. Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: 1i l Engineering Review ❑ Slope at building pad: ❑ Conditions "Met"prior to issuance of building permit El Easements (encroachments) per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: El Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes El No LIDA Facility on lot: ❑ Yes ❑ No El NOT Approved by Engineering: Date: Notes: - 1- ,_ _Arsem D. Approved by Engineering: LL 7 I ate: A...9.,._.� Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: El Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: i ,GSDC Fees Entered: Wash Co Trans Dev Tax: ElYes 'LtI N/A Tigard Trans SDC: El Yes N/A Parks SDC: ❑ Yes N/A T2' OK to Issue Permit Approved by Permit Coordinator: 4( Date: 6/4/i I:\Building\Forms\BldgPemiitRvw_RES_060116.docx