Permit (35) CITY OF TIGARD MASTER PERMIT
Ill jC .?. COMMUNITY DEVELOPMENT Permit#: MST2016-00235
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2016
Parcel: 2S112CA03400
Jurisdiction: Tigard
Site address: 15270 SW 79TH AVE
Subdivision: DURHAM ACRES Lot: 30
Project: Trevor
Project Description: Add an additional garage bay with 2nd story living space over new bay. Bump out front of existing
garage 2',extend existing deck across entire rear of house, including the new addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 20 Bathrooms: 1 Second: 312 sf Garage: 444 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 312 sf Value: $63,920.00 Rear: 15
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: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0
Natural Gas Heat Pump: Y Hoods: 0 Other Units: 0
Furn<100K: Vents: 0 Woodstoves: 0 Gas Outlets: 2
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: 6
Ea add!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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 312
Owner: Contractor:
TREVOR,BRETT&AMY JO OWNER Required Items and Reports(Conditions)
15270 SW 79TH AVE BRETT TREVOR 1 Needs to submit truss
TIGARD,OR 97224 15270 SW 79TH AVE engineering before calling
TIGARD,OR 97224
PHONE: PHONE: 541-350-0383
FAX:
Total Fees: $2,535.75
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. ATTEN an Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0/ I through••R 9 '01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33�2.23�474.
Issuer By: L. _ I Permittee Signature: y //`y tf l/ 1.l,
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 � i, ' FOR OFFICE USE ONLY
City of Tigard Received i_ // /m IP' ' Permit No.:�ly��/(p co;3 S
Illq w 13125 SW Hall Blvd.,Tigard,OR 9720 ., 'i i c, Plan Review
Phone: 503.718.2439 Fax: 503.598119601 601- = '
' '�'' Date/By: •/a3/i G 41 Other Permit:
t R t Inspection Line: 503.639.4175 Date Ready/By: Juris: Vi See Page 2 for
Internet: www.tigard-or.gov > s Notified/Method: Supplemental Information
TYI ' OA REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $63920
®1-and 2-family dwelling ❑Commercial/industrial
❑Accessory building 0 Multi-family
Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms: 1
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:15270 SW 79th Ave New dwelling area: 312 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 444 square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: 440 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.
Add one additional garage port and extend the second floor above it. Valuation: $
Extend the existing deck across the entire back of the house,including addition Existing building area: square feet
Bump out existing garage 2'to the front of the house,flush with the 2nd floor. New building area: square feet
® PROPERTY OWNER ��
❑ TENANT Number of stories:
Name:Brett Trevor Type of construction:
Address:Same as site Occupancy groups:
City/State/ZIP: Existing:
Phone:(541 ) ;5b —o363 ''fix.(S03 ) 62,7— +- New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fax::( ) Amount received: �T a.{AZ
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:
CONTRACTOR Commercial and residential prescriptive installation of
ro -top mounted PhotoVoltaic Solar Panel Syste
Business name: 0 i- f be-- Subnn o(2)sets of roof plan with connec . details
and fire dep�az rnent access,along wit the"2010 Oregon
Address: Solar Installation S Tial 'Code ecklist.
City/State/ZIP: Permit hee(includes 1 review $180.00
and admiristrativelee
Phone:( ) Fax:( ) State surcha (12%of permit fee): $21.60
CCB lis.: Total fee due upon application: $201.60
Authorized signature:ytNyoThis permit application expires if a permit is not obtained
+/� within 180 days after it has been accepted as complete.
Print name: Date: *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Cityof Tigard Received Permit No.:
11‘ il 131 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
■ Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
I [onto-) Other:
Internet: www.tigard-or.gov ❑
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
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
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
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 Oregon and shall be shown to be a I I licable to the iroject 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
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(11/02/COM/WEB)
Electrical Permit AppllCatioir FOR OFFICE USE ONLY
City of Tigard Received
1 �'i, / Permit#: it---,9.e.,/6_6,601_
e r C' i' Date/B i
R 13125 SW Hall Blvd.,Tigard,OR23 Plan Review
et Phone: 503.718.2439 Fax: 50 598.19,60 Date/B : Related Permit#:
Inspection Line: 503.639.417 Ready Date/By: Juris: Fa See Page 2 for
11 G A Il D Internet: www.tigard-or.gmi Notified/Method: Supplemental Information
', Lei rA A iv-,,
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement 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.
❑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.
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 15270 SW 79th Ave. ❑Add
100HPHP o of new motor load of system.
or more. ❑"A" "E" "1-2" "1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Thurston and 79th Ave. 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'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Add heat pump,hot tub,and lights and plugs for master suite addition. Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
PROPERTY OWNERRenewable Energy 0 See Page 2
0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Brett Trevor 200 amps or less 100.70 2
Address:Same as above 201 amps to 400 amps - 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 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 1 59.36 59.36 1
intended for sale,lease,rent,orI ..' hange,according to ORS 447,449,670 and 701. l 201 amps to 400 amps 125.08 2
C2Owner signature: 2/t ex ( Date: ( ¢—t6 401 amps to 599 amps 168.54 2
0 APPLICANT' ❑ CONTACT PERSON Branch circuits–new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 6
7.42 44.52 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'1 branch circuit 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: d l4) N E (2— Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: panel,alteration,or extension. g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/In
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed(th hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 103.88
Print name: Date: ❑Plan Review Required(25%of permit fee): 25.97
State surcharge(12%of permit fee): 12.46
Authorized signature TOTAL PERMIT FEE: 142.31
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 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
Fee for all residential systems combined: $75.00 Description Qty. Each Total
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ 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
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
El 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('h hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I:\Building\Pernilts'ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Mechanical Permit Applichtja '" `° FOR OFFICE USE ONLY
Citof Tigard Received //�
y g Date/By: CPAinia / Permit No.: /1/415-F,90//,,,...60,_3
III13125 SW Ha11 Blvd.,Tigard,OR 97223 ,, 01,.
Plan Review
Phone: 503.718.2439 Fax: 503.598.i9�b! -s. . ' Date/By: Other Permit:
7 I G NIL D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-Or.govNotified/Method: Supplemental Information
TYPE OF WORK s COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
►1 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
to Air conditioning 46.75
Job site address: 15270 SW 79 Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 1 61.06 61.06
Suite/bldg./apt.no.: Project name:Addition Duct work 23.32
Cross street/directions to job site:Thurston and 79th Ave. 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
DESCRIPTION OF WORK Gas fireplace/insert 1.F 33.39 66.78
Flue vent for water heater or gas
One gas fireplace in master suite,one outdoor firepit,two bathroom fans fireplace 1 23.32 23.32
New heat pump Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
r.. PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Brett Trevor Range hood/other kitchen
equipment 33.39
Address:Same as above
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 2 23.32 46.64
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:
Fuel piping:
$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 2 14.15 14.15
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: O 1.13 C 2 Other:
MECHANICAL PERMIT FEES*
Address: Subtotal 211.95
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee) 52.99
Phone:( ) Fax:( ) State surcharge(12%of permit fee) 25.43
CCB lie.: TOTAL PERMIT FEE 290.37
This permit application expires if a permit is not obtained within 180
g ,Q � * days after t has been y as complete.
Authorized si nature: JIU\�CJX/i Fee methodology set by Tri-County Building Industry Service Board
Print name: Date:
I:\Building\PermitslMEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial &Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Plumbing Permit Application
Building Fixtures a i ; FOR OFFICE USE ONLY
Received
Cityof Tigard -/ (3-1,17
r, Permit No.:
a 13125 SW Hall Blvd.,Tigard,OR 9742 t. PlanRe Date/By: �Q /`I l �ST�mc_60,2_35-
a
Q�� 3
a Phone: 503.718.2439 Fax: 503.5W1060' ' '' Date/By:an Review Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Juris: Ea See Page 2 for
1 I G A it 1) Internet: www.ti and-or. ov
g g Notified/Method: Supplemental Information
i
TYPE i g, a' ��` 4 I ( FEE* SCHEDULE
� . 1���
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. l Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:15270 SW 79th Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
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:Thurston and 79th Ave. 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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Add one bathroom in the master bedroom
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
E PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Brett Trevor Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:Same as above
Garbage disposal 25.02
City/State/ZIP: Hose bib 1 25.02 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 2 25.02 50.04
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 1 12.51 12.51
E-mail: Urinal 25.02
Water closet 1 25.02 25.02
CONTRACTOR
n Water heater 37.52
Business name: Q L N f!` Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 112.59
Minimum permit fee: $72.50
Phone:( ) Fax:( )
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) 28.15
State surcharge(12%0 of permit fee) 13.51
Authorized signature: X6;20 TOTAL PERMIT FEE 154.25
Print name: Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1st 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thea El New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
4„ Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food El Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under thisermit results in an
Washer-Clothes p
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Documents and Settings\Amis21\Desktop\PLMF_PermitApp.doc 2
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing 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.
E re, ( Tre,vo
Print Name of Permit Applicant
'?Z4Or— 45Z7117 6— — 6
Signature of Permit Applicant Date
Permit#: M`DT-c of 0.)\
I52.?o �t) `' ` °�`
Address: 7� v ti
it•
Ir&A/Lb oil 7?-9, rdvF
Issued b : _ Date: 44614%
This Copy for Permit Offices
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c n�o Building Permit Review — Residential
Building Permit #: H 1-f 40 j (' -OO a3
Site Address: t S 2.10 Svv •7 +tet.,
Project Name: Tievo H-0 04.e. Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: { M Q 01 d .i'i10 r ck 4? f e,r1 A cbt.C (A-
0
❑ Verify site address/suite# exists and active in permit system.
❑ River Terrace Neighborhood: ❑ No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
.Three(3)copies of site plan /Existing structures on site
A Site plan must be on 8-1/2"x 11"or 11 x 17"paper ,J Footprint of new structure (including decks)with finished
CODrawnto scale(standard architect or engineer scale) 1Gwwl,f, fk, oor elevations
%North arrow / Utility locations (required for new,may apply for additions)
Site address,project or subdivision name and lot number / Q .e :.. • .. .. s
Applicant information(name and phone number) Erosion control(including drainage-way protection,silt fence
Lot dimensions and building setback dimensions design,location of catch basin,etc.) 1,.Q,+.0"tre-v--S0O6F
• • , .- - .•• • _e - - .nd ,. Street names 4A0"
-i' •- • •us area ...1 .• - "- - ' • '- 1 C -e size,ty.- :-_ _ .tion
/Property corner elevations (2 foot contour lines if more than G - : - . .- - .i, -. .• . . t -, .n. tree
4 foot differential)
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ❑ No Received: r es ❑ No
'—Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
.-E;1---Land Use Case#: f\i/A
:1rs
--_ A Setbacks: Front 1 S Rear \ S Side S Street Side S Garage -2. 0
A Building Height: Maximum Height O Actual Height 1 0
/g
r,
Easements
►' Sensitive Lands: ❑ Yes ❑ No Type
Urban'Forestry Plan--
" rior to issuance of building permit
Notes:
Approved By Planning: VI 0.-e& () n c - Date: J 1l / 110
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPennitRvw_RES_012116.docx
I
Building Permit Submittal
Original Submittal Date: 6211q(1°
Site Plans: # 3
Building Plans: # 3
Building Permit#: D.-Enter building permit# above.
Workflow Routing: rkPlanning JJ- Engineering JPermit Coordinator 213uilding
Workflow Sign-off: 21--Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original 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: Ck)(-40,4„,,,,,L, Date: 6//i1/16`
Engineering Review
Slope at building pad: i�
Conditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 1211/1Date: ♦ (MIA"
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ 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:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ' /A
Tigard Trans SDC: ❑ Yes 1 1/A
Parks SDC: ❑ Yes 7N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: O/t/�
I:\Building\Forms\B1dgPennitRvw RES 012116.docx