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Permit (44) q CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2017-00177 T r GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2017 Parcel: 1 S 133AD06500 Jurisdiction: Tigard Site address: 10905 SW SUMMER LAKE DR Subdivision: AMART SUMMER LAKE Lot: 109 Project: Jaquith Project Description: Add 566 sf addition to west side of dwelling. Adding(2)bedrooms. BUILDING Floor Areas Required Setbacks Required Stones: 1 Bedrooms: 2 First: 566 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right 5 Detectors: Yes Total: 566 sf Value: $63,759.90 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 Catch Basins: 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: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 1 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL•RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 566 Owner: Contractor: JAQUITH,KERRY B&DIANA D B DUTTON CONSTRUCTION INC Required Items and Reports(Conditions) 10905 SW SUMMER LAKE DR 11965 SW LYNN ST 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-572-7392 FAX: Total Fees: $2,382.46 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done i. - . ._ -- with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days.,-ATTENTION: Oreo on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 601-0010 through OAR 9 :61-00•0. You may obtain a copy of the rules or direct questions to OUNC by calling 503. .1987 or 1.800.332.2344. / Iss ed By: _ 411e/j/P-4--k,/e Permittee Signature: A-- E---,.��, (, � Call 603.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential FOR OFFICE l SE()NEI RECE$ -1 Received City of Tigard " k '' i Permit No.: -7 Plan Re: 5 i S. l 7 (1.R.� �/o�j/7'-001 /7 13125 SW Hall Blvd.,Tigard,OR 97223 , Plan Review ti Phone: 503.718.2439 Fax: 503.598.1960 MAY 1 8 2017 Date/By: 72 Ocher Permit: 1-1 G A R D Inspection Line: 503.639.4175 Date Ready/13y: Juris: ® See Page 2 for Internet: www.tigard-or.gov CITY'tO Notified/Method:5 V�`. � .�����.:��, J/?e /"7 19)27-- Supplemental Information VI I ❑New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all f•1 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the work indicated on this application.( orf 175 PI1-and 2-familY dllinweValuation: $ urs g ❑Commercial/industrial ❑Accessory building ❑Multi-family Number of bedrooms: 2, ❑Master builder ❑Other: Number of bathrooms: Total number of floors: ( Job site address: 0 . u ly1 ( . , , _ New dwelling area: square feet City/State/ZIP: l G R L d , ` 7 223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: A 0,(3-T Covered porch area: square feet Cross street/directions to job site: G b LL. c ,. / Deck area: square feet Other structure area: square feet 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 work indicated onth this application. Valuation: $ Existing building area: square feet New building area: square feet Number of stories: Type of construction: Address: © OS - v v\Yrl&IZ L- - '-1)i Occupancy groups: City/State/ZIP: ( . , C' s ' 22.3 Existing: Phone:( ) Fax: New: Business name: s l V l d C6tJ IRt3C l lot" '1 1, Structural plan review fee(or deposit): Contact name: , v II dfJ FLS plan review fee(if applicable): Address: b S , 5 City/State/ZIP: -[ ( �(1-(2, Total fees due upon application: Phone:( ��) z 9 Fax :( ) Amount received: / '7C) E-mail: b IC etkd) 6c- H- oto Go %> s Commercial and residential prescriptive installation of ',:'•'' • - roof-top mounted PhotoVoltaic Solar Panel n. Business name: / Submit sets of roof plan with ection details �b� C� and fire departm ccess,alo ith the 2010 Oregon Address: ( ' 5 L� k L 1 Solar Installation Specz de checklist. City/State/ZIP: --1(c Permit Fee(i des plan re ' $180.00 anadministrative fees): Phone:(5) 5 7 Z 7 3 2_ Fax:( ) State Burch ° .60 CCB lic.: l — i 0 -� / Total fee due upon application: $201.60 Authorized signature:6 zi/J This permit application expires if a permit is not obtained lll, [1/ (�)v Gvl within 180 days after it has been accepted as complete. Date: *Fee methodology set by Tri-County Building Industry Print name: L es`A t,.. �iJ-CA--C3 tj �Z /7 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 CSE ONE) City of Tigard Date/BReceived Permit No.: - • 13125 SW Hall Blvd.,Ti ard,OR 97223 a g Associated permits: Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical T I G A It D Internet: www.tigard-or.gov 0 Other. THE FOLLOW INC ITEMS ARE REQUIRED FOR PLAN REVIEW les No N/:k 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. 0 0 0 4 Fii e#listrict 1pproval 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 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 Oreton and shall be shown to be a..licable to the .r&ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0 27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0 and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0 including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Applic Et Y ED FOR OFFICE FSE ONL1 Cityof Tigard Y G Received g Date/By: Permit No.: �/ lig .. 13125 SW Hall Blvd.,Tigard,OR 97223 8 I c 5��t 7-�!77 _ Phone: 503.718.2439 Fax: 503.598.196MAY 1 2017 Date/By: view Other Permit: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov CITY OF TIGHt-1D Notified/Method: Supplemental Information ILDING DIVISION Mechanical permit fees*are based on the value of the work ❑New construction I 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:$ 1-and 2-family dwellin g 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. I Ea. I Total Heating/cooling: Air conditioning 46.75 Job site address: (O IC C 5(,'J LI Nt M EP\Lk K C "k Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: i-r Furnace 100,000+BTU(ducts/vents) 54.91 y -rjC`*'��.� c�,�C!-�� � 67iZ3 Heat pump 61.06 Suite/bldg./apt.no.: I Project name: t-d`u t.r-14 Duct work 23.32 Cross street/directions to job site: S'Ctoits ezey 6 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: Other: 23.32 Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 Gas fireplace/insert 33.39 ' Flue vent for water heater or gas EX-M.06 X l5 i tivi. UCTS Td NO fireplace 23.32 ek -R et Roo PIS Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 Environmental exhaust and ventilation: Name: .K t=RRY -1-43cao 1'TH Range hood/other kitchen equipment 33.39 Address: l 0 qo 5‘3 utAmt c-Q t,Ar fC U ►� Clothes dryer exhaust 33.39 City/State/ZIP: Tl 6 A • 7 Z23 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 Other: 23.32 p Fuel piping: >O Business name: U dN C dr S j t.C_T/0lJ �,,Q $14.15 for first four;$4.03 for each additional Contact name: K t i�� cb u.- N3 Furnace,etc. Gas heat pump Address: I l c é 5 L,0 L_Y& Wall/suspended/unit heater City/State/ZIP: -T,i (k..ft d R( 1?Za,3 Water heater Phone:( ) I Fax::( ) Fireplace Range E-mail: Barbecue es ,.i,,.,.%, ,,.. ,.... , ,. „ r dryer(gas) °; Cloth Business name: I�. Other u tzo I.\ COLDS Z,UCTION 1-00 ., Address: I tct& s 0 L yiON SC Subtotal City/State/ZIP: ,-1.6 itQa O R z ci ?Z Z 3 Minimum permit fee($90.00) �-^�) Fax: Plan review(25%of permit fee) Phone:( .X1V 7 Z 7 3C Z ( ) State surcharge(12%of permit fee) CCB lic.: / q s'L gQ 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: ��M (d.,/,_ ; Fee methodology set by Tri-County Building Industry Service Board Print name: Kiipew /4 u rapes Date: s_IT._t 7 I.\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Famil Fee Schedule: as $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1:\Building\Permits\MEC_PermitApp_040113.doc 2 Electrical Permit Application RECEIVE1 FOR OFFICE t SE O"L' y City of Tigard Received 1111 - Permit#: 1-106/ a0 17 4 'I 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 1 8 2017 PlanDateB Review Phone: 503.718.2439 Fax: 503.598.1960n Date/B : Related Permit#: T I G n R u Inspection Line: 503.639.4175 CI"f Y OF�� t1��'Ready Date/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISI 0 4tified/Method: Supplemental Information ❑New construction I 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. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. exceeds 10,000 amps at 150 volts or 0 Floating buildings. 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: 0 Fireum . p P 0 Installation of 150 KVA or ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 1 0c,6S nz So(vrVt utee,6-2)2 100HP or more. ❑"A","E","1-2","l-3", City/State/ZIP7--r ��� bf� ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: =A. 0'11-44 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: Description Qty. Each Total New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'1500 sq.ft.or portion 33.92 1 // t: . Limited energy,residential A S4,, 69 Fit Z €�2 TOM. Pt"n(,b N (withd above smmulti-family ft.) 75.00 2 t Limited energy,ml75.00 2 -... (,30:7,,/,,, N 6 . 1'`4.7 - 2 Ckt c 1 residential(with above sq.ft.) Renewable Energy 0 See Page 2 ., ". Services or feeders installation,alteration,and/or relocation Name: .6 -' Qy -- L3.- —A 200 amps or less 100.70 2 Address: (09 b S 5 LYNN S 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: -T- I G k.<6 c,R P ...bl� C(-222,-3 601 amps to 1,000 amps 301.04 2 Phone:(s ' ) I Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This sta .tion is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease, nt exchange,according to ORS 447,449,670, . d 701. 201 amps to 400 amps 125.08 2 Owner signature: :iiie ' Date: .7/8/7 401 amps to 599 amps 168.54 2 - tion,or extension,per panel •, � Branch circuits new,alteration A.Fee for branch circuits with Business name: t b L-v-To f,. Co x S?,Ku c,lDN 2 oc above service or feeder fee, 7.42 2 each branch circuit Contact name: '6 Ic„I F'S IJ -b o 1.-CC,I B.Fee for branch circuits without service or feeder fee,first I 56.18 2 Address: ( t Cl b 5 ' L Y N N. .� branch circuit City/State/ZIP: --(- t 6-/k-R' tD R e Gj 7 ZZ 3 Each add'l branch circuit 7.42 2 �t Miscellaneous(service or feeder not included) Phone:(St 3) sS 71 *73 c Z I Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: --Z Is R OBJribfU 0 coo-k Reconnect only 67.84 2 .; ,, ,. ,:,.. ,. _,; , Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 — Signal circuit(s)or limited-energy Address: panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone: I Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: s cificall listed %z hr min q; i ivs ? i r , i i y l,'< Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): 1�/I (1617L State surcharge(12%of permit fee): Authorized signature: 6/a,,,t /' / TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: e,,,.,„, /lit L7 rid"j Date: ,5_J2.17 days after it has been accepted as complete. ''1 * Number of inspections allowed per permit. I:\Building\Permits\ELCPermitApp_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: A/�/i i fni�i�o�i ,Ji�ir�si!�� J?��� �n�irrii���/Jo �,"• D Fee for all residential systems combined: $75.00 eserewa Cams: Renewable electrical energy systems. Check Type of Work Involved: 5 kva or less 100.70 _© 5.01 to 15 kva 133.56 _© ❑ Audio and Stereo Systems* 15.01 to 25 kva - 200.34 _© Wind eneration s stems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva - 301.04 _© 50.01 to 100 kva 552.26 _© ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) III 552.26 —© ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 _© ❑ Vacuum Systems* >100 kva—no additional charge - 0.0 _© Each additional ins section over allowable in any of the above: ❑ Other. Each additional inspection is ■ 66.25/hr —111 char•ed at an hourly 1 hr mm) Inspections for which no fee is ■ 90.00/hr —. s secifically listed('/:hr min) o Jam i. i�Joi� Sui end Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 • 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_ELRERE.doc Rev 06/17/2015 Plumbing Permit Application RECEIVED Building Fixtures FOR OFFICE I SE O\LI of Tigard MAY 1 8 2017 Received CityPermit No.: TMST i -cot IN 't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review: aQ 7 77 _ 1giT1({�FTtH�i�, P1an Phone: 503.718.2439 Fax: 503.598. llYUJ�I Other Permit No.: Inspection Line: 503.639.4175 ILDING Divisfr�vgate/By: T I G A R D eJ !G ' ate Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information 0 New construction ❑Demolition For special information use checklist Description Qty. I Ea. Total IA Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) SFR(1)bath 312.70 13/1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 0 Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 ' Site utilities: Job site address: e,ECatch basin or area drain 18.76 5 �� �� Drywell,leach line,or trench drain 18.76 City/State/ZIP: T 6 pc IQ 6 �QN) C("--7 Z 7 3Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: 'SAct)1 T1-k Manufactured home utilities 50.03 Cross street/directions to job site: 5C,146(L5 ts R ey 'N 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.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 - . Backwater valve 12.51 c Clothes washer 25.02 ->c 1' lel oht L •LL-) 4' (r'lt Dishwasher 25.02 sb UE- 'Z A:WTTro g Drinking fountain 25.02 Ejectors/sump 25.02 Expansion tank 12.51 Fixture/sewer cap 25.02 Name: l< ep K y A CI) Floor drain/floor sink/hub 25.02 Address: \ O0 S S(,3 �1y�1��& - Garbage disposal 25.02 City/State/ZIP: '^j'"-(� �b c KE q 7 Z'L3 Hose bib f 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ;,,. trap 25.02 Interceptor/grease Business name: Medical gas(value:$ ) Page 2 0-r-co lIJ C Or rs I l o CiSt51y 'Z1,.0 Primer 12.51 Contact name: j3 is._ l't �D T c CJ �rC Roof drain(commercial) 12.51 Address: ' ! 5 5 Ly l>,1 + Sink/basin/lavatory 25.02 City/State/ZIP: --r l G c R b O. ��1 ,7 Zz,3 Solar units(potable water) 62.54 Phone:(SQ3) S"7 ? 39 Z Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 s w , , :� ,, Water closet 25.02 Water eater 37.52 h Business name: ,r p,.e-A✓ _ Water piping/DWV 56.29 Address: Mrie).S- S. s J e-/4' R-- Other: 25.02 City/State/ZIP: /, '4 t2€ 97/75 Subtotal Phone:(,gyp y), s7 -3268 Fax:( ) Minimum permit fee: $72.50 CCB Lic.: /4"„ole4e� Plumbing Lic.no.: /� Plan review (25%of permit fee) ,/t. '���"���� State surcharge(12%of permit fee) Authorized signature: `/�_ . n✓1 0u-it, TOTAL PERMIT FEE !�R //1"N 1 t /U rO� This permit application expires if a permit is not obtained within 180 days Print name: {� /, l Date: after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/C0M/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Sc�h�edule: Residential Fire Su ression S stems: iveiiiuinni o�Fi .� . ....:. :...� r. ys�r.� .�. ...... Footing drain-Pt 100' 50.03 0 to 2,000 $1261.90 2,001 to 3,600 Footing drain-each additional 100' 37.52 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and_reater $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 '"" Storm&Rain Drain-1st 100' 62.54 /y" a,' a $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 � ' ice" 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_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 $50,001.00 and up for the first$ , and (minimum char_•e-1/2 hour) each$742.00 additional$100.00 50or000.00 fraction thereo$1.20f.for 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". Planreview is required for any of the following. BaItis /Font Please check all that apply. Bath -Tub/Shower --- 0 Any new commercial building with water service 2"and -Jacuzzi/Whirlpool -_-_- greater,except systems designed and stamped by licensed engineer. Car Wash -Each Stall -Drive Thru -_- 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water As•irator --- 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. E e Wash --- Floor Drain/sink -2" --- Submit 2 sets of plans with any of the above. -3" --- --- a`•a,� t �, 1/• d Car Wash Drain e< � a�"�lou�/� r�� .,aoiiih Garbage -Domestic-non-food --- ❑ Isometrtc 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./Refri•.Drains --- Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Duni, Station --- Shower -Gang --- -Stall --- Sink/Lav -Non-food related --- -Bradley --- -Commercial-food related --- -Service --- Swimmin_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\bdutton\Downloads\PLMF PermitApp(1).doc 2 IIi City of Tigard q COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Residential Building Permit #: He,r,„10 1i-to 177 Site Address: i a cia5 , 5uwtwt.-ec\Q .h,( Project Name: iac u,4 12--e5, � tol-da, ov\ Lot #: (Ne welling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: 14,2,v3 a�,-►-kcvl ,f-r..) e_X 1 -;vt a Cup (€.--A d,,/Verify site address/suite#exists and active in permit system. Lia River Terrace Neighborhood: Lif No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: ree(3)copies of site plan 4 ••sting structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper h 'Footprint of new structure(including decks)with finished CIDrawn to scale(standard architect or engineer scale) or elevations EI North arrow tility locations(required for new,may apply for additions) [ Site address,project or subdivision name and lot number Applicant information(name and phone number) 1• • ;., - Lot dimensions and building setback dimensions vf.of area,building coverage area,percentage of coverage anda i >- y.++w�a uOri impervious area(applicable if R-7,R-12,R-25&R-40) greet names Property corner elevations(2 foot contour lines if more than C . - _ • I I i _ • 0 t� (10 4 foot differential) �� �� e � :' - ' '• �iv Di Clean Water ervices—Service Provider Letter(lot platted prior to 9/10/1995): Required: [f Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified 'No Applied For: ❑ Yes ❑ No,stop intake El Land Use Case#: j (ani vtc-e ec ie ❑ Zoning: 12. -7 ❑ Required Setbacks: Front t'5 Rear ( 5 Side 5 Street Side iC) Garage j) ❑ Landscape Requirement: 2. % El Lot Coverage Maximum: e,) ❑ Building Height: Maximum Height 3 5 Actual Height g--TeiSiratCTearance C1E e ts n censiti re T anrls: ❑ Yes ❑ No Type IP -- ••:•• "14 : " •:. Notes: Approved By Planning: %,47/i6,. 'Fere Date: 5(IS Revisions (after Building Submittal only) Reviewer Date Revision 1: El Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw RES 042017.docx Building Permit Submittal Original Submittal Date: 511 $( i 7 Site Plans: # 3 Building Plans: # 3 Building Permit#: [ Enter building permit#above. Workflow Routing: B" Planning ❑engineering Permit Coordinator .B'fluilding Workflow Sign-off: a Sign-off for Planning(include notes from planning review) Route Application Documents: f Engineering: (1) copy of permit application, (1) site plan, (1) building plan and ,p riginal plan review routing form. Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: �, Date: 5/( /i7 Engineering Review ❑ Slope at building pad: ❑ 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: G Date: A 5r j 7 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 CpjN/A Tigard Trans SDC: ❑ Yes (t ' N/A Parks SDC: ❑ Yes ipN/A LIDA ❑ Yes N/A OK to Issue Permit J 3 I -' Approved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_RES_091216.docx