Permit (11) INCITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT Permit#: MST2017 00104
T[(7,ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2017
Parcel: 2S 102 BA02300
Jurisdiction: Tigard
Site address: 10005 SW JOHNSON ST B
Subdivision: NORTH TIGARDVILLE ADDITION,AMENDE Lot: 15
Project: YOUNG
Project Description: Foundation and structural repairs to farm house.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 2 First: 700 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 24 Bathrooms: 1 Second: 0 sf Garage: 300 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 700 sf Value: $25,000.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
0
Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 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: N Vent Fans: 1 Clothes Dryers: 1
Natural Gas Heat Pump: Y Hoods: 1 Other Units: 0
Furn<100K: 0 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: 0 0-200 amp: 0 W/Svc or Fdr: 10
Ea add'I 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-3 700
Owner: Contractor:
YOUNG,BRADLEY RONALD&REBECC/EMPIRE PLUMBING LLC Required Items and Reports(Conditions)
10005 SW JOHNSON ST 19572 SW TREEHOUSE LN
TIGARD,OR 97223 BEAVERTON,OR 97007
PHONE: PHONE: 971-506-6354
FAX:
Total Fees: $1,464.20
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 throu OAR 952-001-0090. You may•• :' - •• .•f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332. 344.
/`
Issued By L� Permittee Signature: - � � -"1(l/
all 603.639.4175 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 rojec
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Res,,entlal IOROiII( lttil_ OvI1
City of Tigard _, s ` Received a /
-1 .i• s Date/By: > /3 i) --- Permit No.:/V) I D 7-- lC
1. 13125 SW Hall Blvd.,Tigard,OR t Plan Review �1--■ Phone: 503.718.2439 Fax: 503. '. .1 Date/By: 3'3,..,F a 1? ` Other Permit:
I i _ l; Inspection Line: 503.639.4175 s Date ReadyBy: I Juris: See Page 2 for
Internet: www ttgard or gov t, '� ° Notified/Method: D/� /17 �y Supplemental Information
M tv `� ° ~4)/ ete4ey °!'"' Vic'^)
T O ` '" i ' R F3 DATAt 1- 2-FAMILYD!P �
1N �.G Permit fees*are based on the value of the work performed.
❑New construction � ! °° �j ,= pe
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement a Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION ION work indicated on this application.
1-and 2-family dwellingValuation: $25,000
❑ y 0 Commercial/industrial
®Accessory building 0 Multi-family Number of bedrooms: 2
❑Master builder 0 Other: Number of bathrooms: 1
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address:10005-B SW Johnson Street New dwelling area: 700 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 300 square feet
Suite/bldg./apt.no.: 5 Project name: `l J Covered porch area: square feet
Cross street/directions to job site:Grant Ave. Deck area: square feet
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.:25102BA Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
ossa I'I'ION OF WO work indicated on this application.
Repair and maintain property's original 1920's farm house Valuation: $
Existing building area: square feet
New building area: square feet
=' PROPERTY OWNER ❑ 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 New:
�" APPLICANT ❑`CONTACT PERSON BUILDING PERMITFEES*
Business name: _ f� to e•se*reiu1f).
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: `L_
City/State/ZIP:Tigard,Oregon 97223 .- /1 .
Amount received.
Phone:(503)8076953 Fax::(503)928-4779 •
E-mail brad.young2graceclinic.org
PHOTOVOLTAIC SO R'PANEL SYSTEM 1 ES*
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:______:_m iii6
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Brad Young ate:3/13/2017 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPe ' p.doc 02/24/2011 440-46131(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR 011 II t SF 0\1.\
City of Tigard Received DatePermit No.:
IIIu 13125 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 [c.:\RI) Internet: www.tigard-or.gov ❑ Other:
IE, FOLLOWING ITEMS :ARF REQUIRE]) FOR PL.-\\ RF\ IEWheti No y-
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ • •
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: •
00 0 0
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit. 0 0 0
7 Water district approval. ❑ ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 ❑ 0
9 Erosion control 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- 0 u 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator,lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all 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 licable to theproject under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17".
24 Two(2)sets each are required for Items 16,19,20 and 22 above. 0 0 H
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑
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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Amin
Mechanical Permit Application r 1(m O I"► ►( 1. 1 s 1 O y► ,
Cityof Tigard -,1 Received
131SW Hall Blvd.,Tigard,OR 97223 ., < R Plan 7
Permit No.: d
Phone: 503.718.2439 Fax: 503.598.1960IN
Plan Review Other Permit.
1 Date/By:
I i�;;�l',1) Inspection Line: 503.639.4175 P t� s) ._�
Internet: www.tigard-or.gov 1 f'is Date Ready/By: Juris: Q1 See Pagel for
r; 1,�>i tified/Method: Supplemental Information
() ry.s ,
TYPE,OF WORK `' I ' cow. * SCIIEAUi -U MOWN'
'
®Addition/alteration/ acem�e�
� � Mechanical permit fees*are based on the value of the work
❑New construction performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
RESIDCATEGORY,t F"CONDUCTION f
ENTI►AI.) UIPMENT/SYSTEM FEES"
❑ 1-and 2-family dwelling 0 Commercial/industrial ►1 Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. [ Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:10005-B SW Johnson Street Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: j Project name:10005-B SW Johnson Heat Pip 1 61.06
Duct work 23.32
Cross street/directions to job site:Grant 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. 1 46.75
Flue/vent for any of above 23.32
Subdivision: l Lot no.:2300 23.32
Other fuel appliances:
Tax map/parcel no.:25102BA Water heater 1 23.32
+
DESCRIPTION OF WORD Gas fireplace/insert 33.39
Flue vent for water heater or gas
Repair and maintain property's original 1920's farm house. fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
r. li 'ERlY OWNE t 0 TENANT
Other: 23.32
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,
toilet compartments,utility rooms) 1 23.32
Phone:(503)807-6953 Fax:( ) Attic%rawlspaee fans 23.32 -
.+ 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
CONI' OH Clothes dryer(gas)
Business name:All Time Heating Other:
MECHANICAL PERMIT TEES*
Address:10592 SW 63rd Drive Subtotal
City/State/ZIP:Portland,OR 97219 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)208-2276 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: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 Date:3/1 /17
I:\Buildiag\Permits\MEC PermitApp_040113.doc - 440-4617T(11/02JCOM/WEB)
Mechanical Permit Application City of Tigard
Page 2 Supplemental Information
Commercial& Multi-Family Fee Schedule: •
Total)44-nation:: . Penult 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
Electrical Permit Application , OIL �,, , ,� , �, (,�, ,
City of Tigard �„;" , ,# Received
13125 SW Hall Blvd.,Tigard,OR 97223 sf„,
n Date/13
. X e Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
Inspection Line: 503.639.4175 1 2E Ready /B
Inspection
Permit#:Jude: (;Z See Page 2 for
Internet: www.tigard-or.gov O,!1. Notified/Method: Supplemental Information
t1
❑New construction Addition/alteration/rep a tca4t r 17i 1'V'4 4' Please check all that apply(submit 2 sets of plans w/items checked):
# 'v, 'a
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: I-1 a
. ;� �.� where the available fault current 0 Marinas and boatyards-
AT GORY CONSTRIICTIO1 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ❑Commercial/industrial [Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 Multi-family 0 Master builder ❑Other: 0 amps forumall other installations. buildings.
Pump- 0 Installation of 150 KVA or
4.0B sin:l ? TIC11V;*NO L4411061/ ❑Emergency system. larger separately derived
��a AI ❑Addition of new motor load of system
Job#: ( Job site address: .�- �l✓ 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: 711 A/g� C./
❑Six or more residential units. eecupancy-
fr l 2 t' l7.:-.2.•-•
0 Health-care facilities. 0 Recreational vehicle parks.
I j .//i0'S.2 J? fedi//+, ;a,� / ❑Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Pro ect name: `�L -4+ sl� �"'Tr`5�� '. 600 volts nominal-
❑Service or feeder 600 amps or more.
Cross street/directions to job site: T
:: .� nit utt
Description I Qty. 1 Each 1 Total 1 *
New residential single-or multi-family dwelling unit.
Subdivision: ( Lot#Zpo t? Includes attached garage.
Tax map/parcel# 2 /e,2,6; 1,000 sq.ft.or less 168.54 4
t` Ea.add'l 500 sq.ft.or portion 33.92 1
," DESC*IETTON lam'WORK Limited energy,residential
75.00 2
�
i�J"'- ,� r (with above sq.ft.)
d � X `
, 40 r " /6 Limited energy,multi-family
:7•, ,e),""4 y 9 ,.(9.. -017 �jV�� residential(with above sq.ft.) 75.00 2
i r" Renewable Energy 0 See Page 2
- , I'RO *TYlWIER 0-TE1tIA17T', Services or feeders installation,alteration,and/or relocation
Name: . ege4e N7 > //t/ 7�' 200 amps or less 100.70 2
/ /y� 201 ams to 400 ams 133.56 2
Address/4004>S— 5 , P P
9 .� 401 amps to 600 amps 200.34 2
City/State/ZIP: 7 y� ) 7 'a
����! �� /" �--"✓� 601 amps to 1,000 amps 301.04 2
Phone ) f'--,4v5-5 I Fax:( ) Over 1,000 amps or volts 552.26 2
7 /34 GL//`�e.0/0(.7 Temporary services or feeders installation,alteration,and/or
�
Email: A , 0 / / relocation
Owner installation:This'installation iS'being mane on property that I own which is not 200 amps or less 1 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
APALICI�I' F. . Branch circuits—new,alteration,or extension,per panel
Business
' PIt5i3 A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
Contact name: /'� "� eacheebranch circuit
/�y�'cQ Jv�� B.Fee for branch circuits without
_-_ ,ervir.c w'feeder fee,first
- ss: �7, pj1/ > branch circuit 1
re56.18 2
r �G%
City/State/ZIP: 9 !7 s7 13 Each add'l branch circuit qr 7.42 2
.� �� ../.../. Miscellaneous(service or feeder n t included)
Phone:� ) 1c5-. Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: .,Et y4, g,c.:$45..., ,,7-' I7 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: Viel.,3 Sign or outline lighting 67.84 2
C'- `, Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 00 YG gC/-- a¢ 4 576 S panel,alteration,or extension.
City/State/ZIP' l /�0 ✓�Q Cy' Each additional inspection over allowable in any of the above
' t '�`f t `''--+ ( ' .. / 71-1 é Additional inspection(1 hr min) 66.25/hr
Phone:(51)3) f Fax;_( ) Investigation(1 hr min) 90.00/hr
rr ( 7'�®.rl
Email��/2 , / ;t ,jeer/� e/,ce /7� Industrial plant(1 hr min) 78.18/hr `
�' ���jjj �/y tfti Inspections for which no fee is 90.00/hr
CCB Lic.:)15/p7 J Electrical Lic.: Suprv.Lie.: �/ J S specifically listed(V2 hr.min)
` ICELECTRICAL PERMIT FEES"
Suprv.Electrician signature, J/required: Subtotal:
Print name: 4-11/1/1 t icy ceif - of A Date: 'dots Il f❑Plan Review Required(25%of permit fee): -
^1 / / State surcharge(12%of permit fee):
Authorized signature J TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name:•'7f 0�),� („) Date:
*.;2,...,s
�� days after it hes teenaccepted as complete,
( 1� (� L ( ! Number of inspections allowed per permit.
I:\Building\Permits\ELC PermitApp ELR_ERE. c Rev 06/17/2015 440-4615T(11/05/CO
Plumbing Permit Application
Building Fixtures ATCV �v..� ° I O lz O l I I( c I 'NI ()NI.
City of Tigard i , Received ]�
Date/By: PermitNo.:/'Msrao7-60toil.
i 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review•
Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit No.:
Inspection Line: 503.639.4175 ?,
I I c n K D t,A A\ Date Ready/By: Auris_ 0 See Page 2 for
Internet: www.tigard-or.gov IVt Notified/Method: Supplemental Information
WORK Woi O11
❑New construction f,INA � i,)1For tial information use checklist
®Addition/alteration/r Addition/alteration/replacement Description Qty. I Ea. � Total
eP 0 "'er: 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 0 Commercial/industrial SFR(2)bath 437.78
Accesso buildinSFR(3)bath 500.32
® rY g 0Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB.SITE INFORMATION ANLOCATION Site utilities:
Job site address:10005-B SW Johnson Street Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,Oregon 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:10005-B SW Johnson 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: I 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
Repair and maintain property's original 1920's farm house Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r 4 titotwary OWNER I 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
City/State/ZIP:Tigard,Oregon 97223 Garbage disposal 1 25.02
Hose bib 2 25.02
Phone:(503)807-6953 Fax:(503)928-4779 Ice maker 1 12.51
A i LIU N f`. Li 111 1` ACA` PERSON ` Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Brad and Becky Young
Roof drain(commercial) 12.51
Address:13430 SW HiUshire Drive Sink/basin/lavatory �N.• 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 1 12.51
E-mail:brad.young@graceclinic.org Urinal 25.02
Water closet t• 25.02
Business name:Empire Plumbing Water heater 1 37.52
Water piping/DWV 56.29
Address:1509 NE 24"' Other: 25.02
City/State/ZIP:Portland,Oregon 97232 Subtotal
Phone:(971)506-6354 Fax:(503) Minimum permit fee: $72.50
CCB Lie.:197214 Plumbing Lic.no.: /16/20.1 f Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signa i.
TOTAL PERMIT FEE
Print name:Brad Young ate:•3/13/2017 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:lBuilding\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 UteQty Fee(ea)iisSquare Footage: Permit Fee:
Footing drain-14 100' 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° ;
Perin='Fri.
Stone&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
QtY• "w( a1=
each additional$100.00 or fraction thereof,to
Cltlter` lne >rl< or 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*.
Quantity by Fixture Type * Review for Plumbing last
Fixture Type faaper Relocate
Plan review is required for any of the following.
Work Performed: Please check all that apply.
Baptistry/Font
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 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.
-3,'
4„
Car Wash Drain _ IsometricorRiserDiagram .: '"
Garbage -Domestic-non-food L7 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 this permit results in an
Washer-Clothes
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\10005B PLMF PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10005 SW JOHNSON ST B, TIGARD, OR, 97223 July 11 , 2017 at 3:34:57 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00104
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Gfci at front of garage not resetting.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10005 SW JOHNSON ST B, TIGARD, OR, 97223 July 11 , 2017 at 3:08:40 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00104
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10005 SW JOHNSON ST B, TIGARD, OR, 97223 July 11 , 2017 at 3:09:11 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00104
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10005 SW JOHNSON ST B, TIGARD, OR, 97223 August 1 , 2017 at 10:18:45
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00104
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10005 SW JOHNSON ST B, TIGARD, OR, 97223 August 10, 2017 at 11 :13:30
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00104
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Corrections completed
Violation Summary:
Inspector Contractor