03-March (2) CITY OF TIGARD MASTER PERMIT
11II-1 . COMMUNITY DEVELOPMENT Permit#: MST2017-00032
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2017
r ti l: 5 g Parcel: 2S102BA02300
Jurisdiction: Tigard
Site address: 10025 SW JOHNSON ST
Subdivision: NORTH TIGARDVILLE ADDITION,AMENDE Lot: 15
Project: YOUNG
Project Description: Remodeling existing single family home and adding a second story.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 31 Bathrooms: 3 Second: 759 sf Garage: 0 sf Front: 15 Smoke
Dwelling Units: 1 Third: 559 sf Right: 5
Detectors: Yes
Total: 1318 sf Value: $148,472.70 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
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: 30
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:
ALT SF VB R-3 1318
Owner: Contractor:
YOUNG,BRADLEY RONALD&REBECC/JOSH JONES CONSTRUCTION LLC Required Items and Reports(Conditions)
10005 SW JOHNSON ST PO BOX 5777 1 Special inspection
TIGARD,OR 97223 ALOHA,OR 97007 required...Epoxy bolts
PHONE: PHONE: 503-568-3937
FAX:
Total Fees: $5,725.61
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 0A- 952-001-0090. You may obtaina�e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �. ./i/- /r - ittee Signature: -� ' " %� -
--°!.. f 3.639.4175 by 7:00 a.m.for the next available inspection date. 7
This permit card shall be kept in a conspicuous place on the job site until completion of, e proje \
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
,nom
City of Tigard I Received ! 3
Permit No.:
lig 13125 SW Hall Blvd.,Tigard,OR 9 ° Plan Re: v'/ /1/57)6/7'
� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960' N � ')t1 I i Date/By: 3 - . j 7 Other Permit:
Inspection Line: 503.639.4175 s �/
7 1 G�R p Date Ready/By: ` Juris I 21 See Page 2 for
Internet www.tigard-or.gov ' Notified/Method /7 ,7 - ." Supplemental Information
CITY °F 1v (t✓.(/
TYPE OF ING DIVISI� erpo,i
REQU) D IIATA:1-AND 2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
[]Addition/alteration/ lacement - Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement ,®Other:Remodel equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1-and 2-familydwellingValuation: + (� p 11
® 0 Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms: 4 j 7 D J it 7
❑Master builder 0 Other: Number of bathrooms: '�,k3 t r I
JOB SITE INFORMATION AND LOCATION 3'5
Total number of floors: 5` J 3 1 $
Job site address:10025 SW Johnson Street New dwelling area: " 64square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet 4T 9
Suite/bldg./apt.no.: Project name14002n-3onnsori 'li st Covered porch area: 7.9 square feet' s
NaL
Cross street/directions to job site:Grant Ave. Deck area: square fee{ 0
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.:2300 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:25102$A 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.
Remodel existing single family home and add second story. Valuation: $
.....` Existing building area: square feet
New building area: square feet
rr PROPERTY OWNER 0 TENANT Number of stories:
Name:Brad and Becky Young Type of construction:
Address:13430 SW Hillshire Drive Occupancy groups:
City/State/ZIP:Tigard,Oregon 97223 Existing:
Phone:(503)807-6953 - —- Fax:_(503)928-4779 L
G APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:
(Pkase a m sekedul f)
Structural plan review fee(or deposit):
Contact name:Brad and Becky Young
FLS plan review fee(if applicable):
Address:13430 SW Hillshire Drive
Total fees due upon application:
City/State/ZIP:Tigard,Oregon 97223
Amount received: �� Y7
Phone:(503)807-6953 Fax::(503)928-4779 /�
E-mail:brad.young2graceclinic.org PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Josh Jones Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:P.O.Box 5777 Solar Installation Specialty Code checklist.
City/State/ZIP:Aloha,Oregon 97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)568-3937 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:205832
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Brad Young Date:1/23/2017 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
N
Mechanical Permit Application 1 )ri or rr( i r 1.0\1 1
City of Tigard i " Rives Permit No.: S etiosal
71 13125 SW Hall Bivd.,Tigard,OR 97223 ^. DateBy: ,� o7-
e
Plan Review
Phone: 503.718.2439 Fax: 503.598.19 .0 "..7-
03.598.1 ,4 Other Permit:
DateJBy:
T I t,A a D Inspection Line: 503.639.4175 to\' Date Ready/By: runs. 2
Internet: www_ti and-or. ov 4s �' Supplemental See Page for
g g ��� � „yr?,Notified/Method: Information
Alkil>t
14
TYPE OF WORKS 0%0'j\ COMMERCIAL FEE* SCHEDULE -USE CHECKLIST
;\ Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alterati i v.:91 : ment performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition .1 Other:Remodel mechanical materials,equipment,labor,overhead,and profit
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 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:
Air conditioning 1 46.75 r
Job site address:10025 SW Johnson Street Furnace 100,000 BTU(ducts/vents) 1 46.75
City/Stats/ZIP:Tigard OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name:10025 SW Johnson Heat pump . 61.06
Duct work 23.32
Cross street/directions to job site:Grant Ave. Hydronic hot water system 2332
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: 1 Lot no.:2300 Other: 23.32
Other fuel appliances:
Tax map/parcel no.:25102BA Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Remodle existing single family home and add second story fireplace 23.32 ,
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
►.� PROPERTY OWNER I 0 TENANT Environmental exhaust and ventilation:
Name:Brad and Becky Young Range hood/other kitchen
- equipment 1 33.39
Address:13430 SW Hillshire Drive Clothes dryer exhaust 1 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms, u
toilet compartments,utility rooms) -J' 23.32
>u:
- Adi..laawl.paa.Erns 13.32 - - _
C. APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Brad and Becky Young Furnace,etc.
Address:13430 SW Hillshire Drive Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Tigard,OR 97223 Water heater
Phone:(503)807-6953 Fax::( ) Fireplace
Range
E-mail:brad.young@graceclinic.org Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:All Time Heating Other:
MECHANICAL PERMIT FEES*
Address:10592 SW 63r"Drive Subtotal
City/State/ZIP:Portland,OR 97219 Minimum permit fee($90.00)
Phone:(503)208-2276 Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.:184575 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: '\ * Fee methodology set by Tri-County Building Industry Service Board
Print name:Brad Young / ate:1/23/17
I:\Building\Permits\MEC_PermitApp_0401133 d✓✓oc 4404617T(11/02/COM/WEB)
Electrical Permit Application I
,,, 0,. -,- I
-....,...., .. ,
City of Tigard -" 'i _.,--' 1'--- ),c, 1 :i111,111i11211M01111111MMENIM
111„,• 13125 SW Hall Blvd.,Tigard,OR 9)kbwr- r.
ll Phone: 503.7182439 Fax: 503.598. 960 „..,.., 1,4 i .,,,i.,,FRIIIIIIIMMII Related Permit#
Inspection Line: 503.639.4175 \-- greedy Date/By:
Internet: www.tigard-or.gov -., .,\-..' -' ' *WOWSupplemental Page2 for/Method: Information
Mill IS
,,,W00.;11/01.0Z;N:TT.;0:,,,,n-.:.:,,-r ,:..4 ,,,.„..,.:,: :.-„,,,,, ,;.- , .,:,,,.;.tultoolow,„5-',._::,:,,i-fe ,,,,,:,-;::::::,:,':if,
0 New construction 0 Addition/alteratio9iindiment Please duck all that apply(submit 2 sets of plans wfitems checked):
0 Service or feeder 400 amps or mom 0 Building over three stories.
0 Demolition ISI Other:Remodel where the available fault current 0 Mminas and boatyards.
( #IntOtAlitte*:,3S0)11k0zWitOV„,:r,j-,-.i.;-,. ,.4:„ -'...,: ,..: :::: ,% exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
turps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0Fire pump. 0 Install/Pion of 150 KVA or
2.:::-.<'1?--2-.'.4:':•I';-:::-::.' ;*1:;Sitigt0~04400..Witilitik.:;:.;:':.1-:. :--'''':'.. DEmergencY sYstemlarger Wargo*derived
13 Addition of new motor load of system.
Job#: Job site address:10025 SW Johnson Street 10011P or mom. 0"A",`S","1-r,"1-3",
City/State/ZIP:'Tigard, OR 97223 Cl Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle paths.
Suite/bldg./apt#: I Project name:10025 Jobnsong 0 Hazardous locations. Ii Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site:Grant Ave. "1447M7627g,L11!--Sti:-`;:''.**1--• . ';,:'''';--:''ff W1:514.q.';-,::,,ifi;
nemajoi.. - 1 cit. -Zech 1 isiut i •
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#:2300 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:25102BA Ea.addi 500 sq.I or portion 3192 1
11''':g2:;::k&ZZ:-:-5::,....-,-,1fW.;51f.4:71'11).4.1 — ....4•':,:''';:=:''-'.:.:.:::',::'''i'-%:,.'!"1.:','-':-''':1';`,?,A
Limited energy,residential
75.00 2
Rewire existing single family structure and new second story - (widi above SQ.ft.) .
Limited energy,multi-family 75.00 2
residential(with above sq.it)
Renewable Energy Cl See Page 2
gilifiliMMOVVOU 'I-- ''''"''' "'04144100 ' -- - '
-..,•-'-:,---, i.':),-',,, '...-",-“r'-,' 4 ' ' '''' '-':"..' ''' ' '' ' Services or feeders installadon,alteration,and/or relocation
Name:Brad and Becky Young 200 amps or RISS f 100.70 2
Address:13430 SW Hillshire Drive 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)807-6953 Fax:(503)928-4779 Over 1,000 amps or volts I 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
:::,,,e,:mimitowf....1 . . '1 ,,-, .- _,E3 corriterlevitioN, , . .,, A.
Feenforbonds ci Branch circuits-new,alteration,or extension,per panel
,_
Business name: above service or feeder fee, .317 7.42 2
each branch circuit
Contact name:Brad and Becky Young B.Fee for branch circuits without
.----
Address:13430 SW Hillshire Drive branch circuit
City/State/ZIP:Tigard,Oregon 97223 Each add'l branch circuit 7.42 , 2
Miscellaneous(service or feeder not included)
Phone:(503)807-6953 Fax::(503)928-4779 Each manufixtured or modular
67.84 2
dwelling,service and/or feeder
Email: ,—. Reconnect only 67.84 2
fatiliWilliatiit 67.84 2
\ilBusiness name: 51 e--/E-c-77-2.,1 (k' Sign or outline lighting 67.84 2
Signal circuilis)or limited-energy
Address: ,Z.VC-5- ç &2,111--- 1 I i k i 1 E c '1.-e-C- panel,alteration,or extension. 0 See Page 2 2
Each addiiional inspection over allowable in any of the above
City/State/ZIP; ?OAT L,Isliu T.) f.-)R___, 17.2_/je, Additional inspection(1 hr min) 6625/hr
Phone:( j) 7 7 g b-pc>7 / Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.. i 7 5.5‘3. 1 I Electrical Lie.. 'ASPD I Suprv.Lie.: if 2 6 0 S , sP!cificullY listed ch,hr ldrn),. .,
,IMPErix Elotiriciatsigesture.requiltd: Olo, • " ' . '• ItLECTINICAL Pirient
iwill I' ' ' - . - - - - Subtotal:
—
Print name: /fp/ gi,/2 •er ,,,e") Date: 0.2/44 ji / y 0 Plan Review Required(25%of permit fee):
/ l State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized si : i,,t5.7 .. < TOTAL
name: 'Tr / ... Date: 0 1,7
,a‘:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspectMas allowed per permit
1:1BuildingiPermitekELC_PermitApp_ELR JERE Rev 06/17/2015 440-4615TO 1/0/C014/Wim
Plumbing Permit Application , 0
Building Fixtures E 10R OFI R F lel c)\1.1
City of Tigard ` 4.'
-N ( Received
10 Permit No.: 3)1
li a 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ry l It r-.�s�J - t
a Phone: 503.718.2439 Fax 503.598.1960 'G,N kt'`$e/B view / : ��-'
�^' t � Other Permit No.:
1 �,;�ft 1 Inspection Line: 503.639.4175 (-,,k r( O\IISI Y.
Internet: www.tigard-or.gov 1� D�Ready/By: kris H See Page 2 for
0� Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description Qty. Ea. 1 Total
❑Addition/alteration/replacement ®Other:Remodel New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
►Z/ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATIONAM) LOCATION Site utilities:
Job site address:10025 SW Johnson Street Catch basin or area drain 18.76
City/State/ZIP:Tigard,Oregon 97223 Drywell,leach line,or trench drain 18.76
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:Grant 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: Lot no.:2300 Fixture or item:
Tax map/parcel no.:2510BA Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
Remodel existing single story home and add second floor
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
C PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Brad and Becky Young Fixture/sewer cap 25.02
Address:13430 SW Hillshire Drive
Floor drain/floor sink/hub 25.02
Garbage disposal 1 25.02
City/State/ZIP:Tigard,Oregon 97223 Hose bib 2 25.02
Phone:(503)807-6953 Fax:(503)928-4779 Ice maker _ 1 12 51
fAPP'LICANT I 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:Brad and Becky Young Primer 12.51
Roof drain(commercial) 12.51
Address:13430 SW Hillshire Drive Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,Oregon 97223 Solar units(potable water) 62.54
Phone:(503)807-6953 Fax::(503)928-4779 Tub/shower/shower pan 2 12.51
E-mail:brad.young@graceclinic.org Urinal 25.02
CONTRACTOR Water closet ,3 25.02
Business name:Empire Plumbing Water heater 1 37.52
Water piping/DWV 56.29
Address:1509 NE 24th
Other: 25.02
City/State/ZIP:Portland,Oregon 97232 Subtotal
Phone:(971)506-6354 Fax:(503) Minimum permit fee: $72.50
CCB Lic.:197214 Plumb'i g Lic.no.: 4 Plan review (25%of permit fee)
I f1��
��� State surcharge(12%of permit fee)
Authorized signature: - .
L.__
TOTAL PERMIT FEE
Print name:Brad Young / Date:1/23/2017 This permit application expires if a permit is not obtained within 180 days
5 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:18uiIding\Pennits\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-1s`100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 3,601 to 7,200 $233.20
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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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 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*.
Fixture T for Quantity by Fixture Type Plan Review for Plumbing Installations
Type Replace/ review is required for anyg
Work Performed: Capped Added Relocate Plan q 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 Thm 0 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 0 Any multipurpose fire sprinkler system.
Eye Was
Floor Drain/sink -2" Submit 2 sets of plans with any of the above..
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food 0 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 MachlRefrig.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
Washer-Clothes *Note: If the fixture work under this permit results in an
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:\Users\brady\Documents\10025 PLMF_PermitApp.doc 2
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
■
T,cARo Building Permit Review — Residential
Building Permit #: 71)57:26/ --0( }3j
Site Address: /4) 5- sa, ,i ,70/—�,n/)e, SO,
Project Name: tRAA Lot #:
ew dwe g=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Ejc..Pu'.,d; ,,c) secuwid S'Ivc d- etcL 47 h5 a- 41-1-t r-ct -k -e Lr- .-1
Verify site address/suite#exists and active in permit system.
liVRiver Terrace Neighborhood: lSo'No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
/I, ree(3)copies of site plan Existing structures on site
(i i ite plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
0 Drawn to scale(standard architect or engineer scale) floor elevations
0 orth arrow
71 Utility locations(required for new,may apply for additions)
0 ite address,project or subdivision name and lot number N t ation of wells/septic systems
•
pplicant information(name and phone number) pOlting trees to be retained with drip line,and tree
FAlrk
: .t dimensions and building setback dimensions rotection measures
141 II 4 t area,building coverage area,percentage of coverage and treet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) Street names
r-tProperty corner elevations(2 foot contour lines if more than
4 foot differential)
0 Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: kYes,applicant was notified ❑ No Received: ❑ Yes ❑ No
rk-Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified No Applied For:
PP El Yes ❑ No,stop intake
,e_if'Land Use Case#: .67. 0/. - GSC 0c---
Ll- Zoning: R _ y. .5
il;—• -.ell •• .ac s: -- -rofit- Rear ---- Side
l S S Street Side — Garage as
S Landscape Requirement: _ %'
Lot Coverage Maximum: -
a Building Height: Maximum Height 3 .) Actual Height a
.2-Visual Clearance
-- Easements
la-Sensitive Lands: ❑ Yes , l- No Type
Urban Forestry Plan
,Conditions"Met"prioi o issuance of buildin t permit
Notes: .�, 1 f: 9 / L.,> iI ,
-e Ski f AMMINIESE
Approved By Pla .1 ' g:
�,,, Date: .
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved El Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES 091216.doex
Building Permit Submittal ,
Original Submittal Date: 2. J
Site Plans: # •
Building Plans: # _
Building Permit#: nter building permit#above.
Workflow Routing: arming ❑ Engineering ❑ Permit Coordinator udding
Workflow Sign-off -off for Planning(include notes from planning review)
Route Application Documents: [] ginee g: (1) c•• of•ermit application, (1) site plan, (1) building plan and
orifi;,,. pla• - '-w routing form.
C. :wilding: original permit application,tifellaS4,building plans,engineer and
beam calculations and trust details,if applicable,etc.
,,h.,, Y
Notes: �`„ � a - �i/ 4 ♦ , A _—, 4 /[� �� ',JAL, A.. . - //=i.� . � frtei,
By Permit Technician: 4111IDate: a� //7
—
Engineering Review
ALJ Slo uilding pad:
C ditions "Met"prior to issuance of building permit
ements (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:
r ��
Notes: �� �S --• /
Approved by Engineering: Date:
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:
)6DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ■'f /A
4
Tigard Trans SDC: ❑ Yes P /A
Parks SDC: ❑ Yes Mr N/A
OK to Issue Permit 0/1
Approved by Permit Coordinator: Date:
1:\Building\Forms\131dgPermitRvw_RES_091216.docx