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Permit Support Document (147) rt D LI ff // �J� .V r) ! j r . , II City of Tigard • COMMUNITY DEVELOPMENT DEPART'MFr2V/ Request for Permit Action TIGARD13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.ti a AIinViSiON TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ® Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: Riverside Homes,LLC INVOICE TO: (Business or Individual) Mailing Address: 17933 NW Evergreen Parkway, Ste 370 City/State/Zip: Hillsboro, OR 97006 Phone No.: 503-645-0986 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): (® CANCgL/AVOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). INVOICE FR FEES DUE (attach cas -- schedule and provide explanation below). (-Lf REMOVE/REPLACE CONT' %=="' i SN RMIT (do not cancel permit). Permit#: MST2016-00304 / �' Site Address or Parcel #: 12881 SW 133"'Ave Project Name: Walnut Ridge Subdivision Name: Walnut Ridge Lot#: 006 EXPLANATION: Reapplying for a revised floor plan of the original submission on this lot. S&6_. S7 i —eas 8/ . 'u'%gae1 , -Oe '/77 Signature: Date: 12/8/2016 Print Name: Nikki Pruett 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. Route to Sys Admin: Date By Route to Records: Date/2/a, By N/4-Refund Processed: Date �4- By t Invoice Processed: Date /. 174.2-4A-,/ B - Permit Canceled: Date AP-X2-05„,J„ By �.�.r- - Parcel Tag Added: Date By I:\Building\Forms\Req P ermitA c ti o n_09 5..314.d o c III City of Tigard • COMMUNITY DEVELOPMENT Building Division 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TIGARD INVOICE TO: Riverside Homes,LLC Customer ID: 189148 Attn: Nikki Pruett Invoice No.: INV2016-00016 17933 NW Evergreen Pkwy, Ste 370 Invoice Date: 12/29/2016 Hillsboro, OR 97006 Date Due: 1/29/2016 Case No. Site Address Subdivision-Lot#or Project Name Amount Due MST2016-00304 12881 SW 133rd Ave. Walnut Ridge,Lot 6 $516.72 Fees due for plan review completed prior to request to void permit. Invoice Total: $516.72 ® Please see attached fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: MST2016-00304 Customer ID: 189148 Site Address: 12881 SW 133rd Ave. Invoice No.: INV2016-00016 Project: Walnut Ridge,Lot 6 Invoice Date: 12/29/2016 Date Due: 1/29/2016 Invoice Total: $516.72 Amount Paid: $ Office Note: Route copy of receipt to Dianna Howse. Please mail payment to: City of Tigard,Building Division Attn: Dianna Howse 13125 SW Hall Blvd. Tigard, OR 97223 I:\Building\Accounting\Invoice.doc 01/14/2011 CITY OF TIGARD FEE AND PAYMENT HISTORY IN rII it 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD MST2016-00304 - 12881 SW 133RD AVE, TIGARD, OR 97223 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Plan Review 230-0000-43106 $751.34 $751.34 $750.00 8/1/16 Check 405256 $1.34 DC Provision Review, SF-Ping 100-0000-43112 $88.00 $88.00 $88.00 Plan Review 230-0000-43106 $427.38 $427.38 $427.38 Totals for Fees $1,266.72 $1,266.72 $750.00 $516.72 Receipt# Payment Method Check# Pavor: Receipt Date Receipt Amount 405256 Check 34799 Riverside Homes LLC 08/01/2016 $750.00 Total Payments: $750.00 Balance Due: $516.72 Building Permit Application \41 '7,.. I ,;t L a ti i Residential FOR OFFICE USE OyLv ., i Received s7/,, ,,e(�//-.�-7�, / E� City of Tigard Date/By: / GJ�I� ��� Permit NT%J /(P�`�025'D/ 13125 SW Hall Blvd.,Tigard,OR 97223 + r� i 1 1 2 L3 i'i an Review Other Pernut;� !IN . Phone: 503.718.2439 Fax: 503.598.196Qj �. Date/By: kl,_ 0'/,6 elo.26 a T t G n R n Inspection Line: 503.639.4175 Date Ready/By: Jurist H See Page 2 for Internet: www.tigard-or.gov a`t Notified/Method: I Supplemental Information L..r , s : ., fir' b p `rw ,i S ` i ? P= ii 8 a 1`. ®New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the rofit for the g Mt '` �� ,y' at s'. . ,a; b work indicated on this application. ?o/ '.J' ... a 3h. 'ma,t �#,i'f ill Valuation: $ .J. J ® 1-and 2-family dwelling 0 Commercial/industrial V.1 S r , 0 Accessory building 0 Multi-family Number of bedrooms: 4 0 Master builder 0 Other: Number of bathrooms: 3 CSB S: l`"_t,a. a at t a P r * Total number of floors: 2 " Job site address:12881 SW 133rd Ave New dwelling area: 2626 square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: 379 square feet Suite/bldg./apt.no.: I Project name:Walnut Ridge Covered porch area: 33 square feet 1 T Li 7 Cross street/directions to job site:SW Walnut and SW 133rd Ave Deck area: square feet 11-7 CI Other structure area: square feet ` "& ,f( e 4 i .i'; `.EtAtt..1,fit, !.`yam Subdivision:Walnut Ridge I Lot no.:006 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 y.1,..1,:„.„li tt °ft % s work indicated on this application. Construction of SFR Home Valuation: $ Existing building area: square feet New building area: square feet wr. , ' '. = wl . rr' ? '" . Number of stories: Name:Riverside Homes,LLC Type of construction: Address:17933 NW Evergreen Parkway,Suite 370 Occupancy groups: City/State/ZIP:Beaverton,OR 97006 Existing: Phone:(503)645-0986 Fax:( ) New: 7 �'r Y au .:. haus r.d = '�'Szl. .z• _ , Business name:Same as Above t Structural plan review fee(or deposit): Contact name:Wes Boisvert FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Phone:( ) Fax: :( ) Amount received: ' � s ` i E-mail:wboisvert@riversidehome.com i ? � Ir ;; , . Commercial and residential prescriptive installation of s ` s roof-top mounted Photovoltaic Solar Panel System. Business name:Riverside Homes,LLC Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:17933 NW Evergreen Parkway,Suite 370 Solar Installation Specialty Code checklist. City/State/ZIP:Beaverton,OR 97006 Permit Fee(includes plan review $180.00 and administrative fees): Phone:(503)645-0986 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.:189148 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Wes Boisvert Date:06/10/2016 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit ApplicationFOR OFFICE USF:ONI.1 City of Tigard '► Received ° Date/By: PermitNo./lj - ,7_ �, 20 13125 SW Hall Blvd.,Tigard,OR 97223' Plan Review ll//VV Phone: 503.718.2439 Fax: 503.598.1960 F4 ?T‘I ). Date/By: Other Permit: T i ;Am, Inspection Line: 503.639.4175 0`- 2 v Date Read B .runs: Internet: www.tigard-or.gov y See Page 2 nr Notified/Method: S Supplemental Information .r.y I. t. 1 .a i .• IN `fir, # 1 A .; SC '•)1 A "�*C:1:.'. °. Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ ' CAE li t °r or co's vOliox, ' .fior - , ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total [O$ i''' ? ATIOItral � �= Heating/cooling: ,r , ; b ,,. - Air conditioning 46.75 Job site address: 12881 SW 133rd Ave Furnace 100,000 BTU(ducts/vents) 1 46.75 4f 75 City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: I Project name: Walnut Ridge Duct work 1 23.32 93 39_ Cross street/directions to job site: SW Walnut&SW 133rd 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 1 23.32 23.32 Subdivision: Walnut Ridge I Lot no.: 006 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater i 23.32 23 37 k . DES .r, ON OF ''''''' Gas fireplace/insert 1 33.39 33 39 Flue vent for water heater or gas Consto lotion of SFR fireplace 1 23.32 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROPERTY OWNER �,. '14 Other: 23.32 , �' � ' Environmental exhaust and ventilation: Name: Riverside Homes, LLC Range hood/other kitchen equipment 1 33.39 33.39 Address: 17933 NW Evergreen Parkway, Suite 370 Clothes dryer exhaust 1 33.39 33.39 City/State/ZIP: Beaverton, OR 97006 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 4 23.32 93.28 Phone:( 503) 645-0986 Fax:( ) Attic/crawlspace fans 23.32 A PLICANT 'r, ' 000 ROtter: t TACT PESON i5 { 23.32 Business name: Fuel piping: Same as above $14.15 for first four;$4.03 for each additional Contact name: Wesley Boisvert Furnace,etc. 1 14 15 Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) I Fax::( ) Fireplace 1 14 15 Range 1 14 15 E-mail: wboisvert@riversidehome.com Barbecue ... �..„, 'COL,'. .R,_, _ / Clothes dryer(gas) Business name: Pyramid Heating&Cooling Other: ' a I.PE ES* A,, 47 Address: 9409 NE Colfax St. Subtotal 375 93 City/State/ZIP: Portland, OR 97220 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( 503) 786-9522 Fax:( 503)786-3432 State surcharge(12%of permit fee) CCB lic.: 59382 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 �t � 3ttth x4 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: Wesley Boisvert Date: 7/10/2016 I:\Building\Perinits1MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) 0 x:/ is I Electrical Permit Application ,z - -, ---, FOR OFFICE I. ONE City of Tigard t <Cr ` 5 ` Received �t7`-G'/ i, 311 d G Date/B Permit#: S 1111 •1 13125 SW Hall Blvd.,Tigard,OR 97223 iJ LI ll Phone: 503.718.2439 Fax: 503.598.1960 }`'`j' '.„.,„.,`Ei• Related Permit#: Inspection Line: 503.639.4175 -,.. '` ad Date/By: Anis: - Notified/Method: Supplemental See Pent 2 for I I GAR 1) Internet: www.tigard-or.gov Iuformadon ®New construction ❑Addition/alteration/replacem'ent Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition 0 Other: 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. � s ,C� OW lam' ' ",.� "' x CR exceeds 10,000 amps at 150 volts or 0 Floating buildings. E 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or ,1 r •-•''.-,--` - A,, 0 Emergency system.B l':::;:'‘ k ON i larger separately derived Job#: I Job site address: 12881 SW 133rd Ave ❑Addition of new motor load of system. 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP: Tigard, OR 97223 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: Walnut Ridge 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: SW Walnut&SW 133rd Ave. "� N'kR _s; 1 '' Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Walnut Ridge I Lot#: 006 Includes attached garage. 1 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 ,;. i i1 ,1 Limited energy,residential with above s ft. 75.00 2 Construction of SFR ( q� ) � Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 1't P t- .RTY t)")1 .2, : � ' Services or feeders installation,alteration,and/or relocation Name: Riverside Homes, LLC 200 amps or less 100.70 2 Address: 17933 NW Evergreen Parkway, Suite 370 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps 301.04 2 Phone:( 503) 645-0986 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: wboisvert@riversidehome.com relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 t pg z '''''''1.,,. C©TA . ;' Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: Same as above above service or feeder fee, 7.42 2 each branch circuit Contact name: Wesley Boisvert B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'l 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: wboisvert@riversidehome.com Reconnect only 67.84 2 CONTl*A EOR t^,'. a , Pump or irrigation circle 67.84 2 Business name: Garner Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: 2920 SE Brookwood Ave#1 panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( 503) 648-4552 Fax:( 503)642-7925 Investigation(1 hr min) 90.00/hr Email: ge@garnerelectric.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 121159 Electrical Lic.: 37075 Suprv.Lic.: specifically listed(/:hr min) 90.00/hr �j ' 'tt41„..iCAIi: / RMIt." 1' Suprv.Electrician signature,required: r� j!�1�-- Subtotal: Print name: Chuck Gamer I Date: 07/12/2016 0 Plan Review Required(25%of permit fee): �� ��a State surcharge(12%of permit fee): Authorized signature: "")`"'Q 3Is. s.°'e TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Wesley Boisvert Date: 7/12/2016 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 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: . SIDEN WQRK • Y., ,. r : E s Fee for all residential systems combined: $75.00 DescriptionQtr. Each I Total 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 to25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 ❑X Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑X 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 pct ca t % r min) s . Fee for each commercial system: $75.00 Subtotal(Enteron Page 1): * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Plumbing Permit Application ;ill_ 1 Building Fixtures ' FOR OFFICE LSE oyLl Cl of Tigard . *.. �Qv� ReceRy.i wNo.://57-0,20/6„.79036,7, g Ly S� Dateiv Permit Ili II III 13125 SW Hall Blvd.,Tigard OR 7223 ,,, U ,,PJan Review Phone: 503.718.2439 Fax: 503.598.196�w Date By: Other Permit No.: Inspection Line: 503 639.4175 4‘,.„."\ �. �� Ready/By: AIM: El See Page 2 for I I C A R[) Date Internet www ttgazd or gov Notified Method: Supplemental Information ..ciri New' 'con:::::: °8 .. , i - , , For special information use checklist Description I Qty. 1 Ea. I Total Addition/alteration/replacement New 1-2-family dwellings(includes 100 ft.for each utility connection) I= 312.70 x SFR(1)bathATEGORY$FCON: r ON 437.78 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath ❑Accessory building 0 Multi-family SFR(3)bath 00.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 'STfE tNF041tr '1,to , N0 l` A the a Job site address: 12881 SW 133rd Ave ' Drywell,leach hne,or trench dram 18.76 City/State/ZIP: Tigard, OR 97223 Footing Suite/bldg./apt.no.: I Project name: Walnut Ridge Manufacturedhome 1 1 Cross street/directions to job site: SW Walnut&SW 133rd Ave. Manhole , 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: Walnut Ridge I Lot no.: 006 Fixture Tax map/parcel no.: 'preventer 31.27 iia12.51 .x. . ~vy1,. CYN Clothes washer 1 Construction of SFR Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 t cio ER)t 3f e '°#; }L Eirt` �� Expansion tank 12.51 Name: Riverside Homes, LLC Fixture/sewer cap25.02 Floor drain/floor sink/hub t Address: 17933 NW Evergreen Parkway, Suite 370 Garbage disposal 25.02 City/State/ZIP: Beaverton, OR 97006 Hose bib 25.02 Phone:(503) 645-0986 Fax:( ) Ice maker12.51 '4*7 e Interceptor/grease trap■ ne ;■ 1 Business name: Same as above Medical gas(value:$ ) Page 2 Primer12.51 BoisvertContact name: wesley Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: wboisvert@riversidehome.com urinal 1 Water closet t ` , .,,k, . , it. . a . Water heater 37.52 Business name: H & H Mechanical Water piping/DWV 56.29 Address: 5757 SE Willow Ln Other: 25.02 City/State/ZIP: Milwaukie, OR 97267 Subtotal Phone:(503) 975-9787 Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: 178122 _ Plumbing Lic.no.: PB414 State surcharge(12%of permit fee) Authorized signature: ,U134t... ..441* TOTAL PERMIT FEE Print name: Wesley Boisvert Date: 7/12/2016 This permit application expires if a permit is not obtained within 180 days after e *Fee methodology setit byhas Trib-Countyenaccepted Buildingas Industrycomplete.Service Board. 440-4616TQ 0/02/COM/WEB) I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule:yResidential Fire Su s 1 ression S stems: Sit' 'till :i: i • u )rte ... .<� '_', ..:. '-• i l }E Y y , i. .it-: Footing drain-0 100' 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 $23320 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas S stems: Water Service-each additional 100' 37.52 i t , r'° , 4. , . 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 �.• each additional$100.00 or fraction thereof,to ()thee UI t,y 4 y i i s OP- • • ea 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 char l 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 fust$50,000.00 and$120 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 bi Fixture,Type,;• . ' ,,.,:;11,1*fp f i E ,bin° ._. ,, nl<° Fixture Type for e/ Plan review is required for any of the following. Work Performed: Capped Added Relocate Baptistry/Font Please check all that apply. 0 Any new commercial building with water service 2"and Bath -Tub/Shower Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain 0 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„ .ts+,i t` ;° R! Tii, 'itm, Car Wash Drain 0 Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food 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 this permit results in an Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and Water Extractor Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:\Users\npruett\Downloads\PLMF PermitApp(1).doc 2