Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVEi•.n..mm •.•mn•••••••........_
LOPMENT . , „ !�'£,liii
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Permit#: MST2017-00107
T Eat1 t 13125 SW Hall Blvd.,Tigard OR 97223 503.718 24 b Date Issued: 04/20/2017
Parcel: 2S111CC19100
Site address: 10345 SW GREENLEAF TER Jurisdiction: Tigard
Subdivision: SUMMERFIELD NO.5
Project: CORNELIUS Lot: 250
Project Description: Extending roof over atrium next to adjoining townhouse wall. 1/2/18 REPRINTED to add(1)Tub/
Shower pan.
BUILDING
Floor Areas Required Setbacks
Stories: 1 Bedrooms: 0 Required
First: 20 sf Basement: 0 sf
Left 0 Parking Spaces: 0
Height: 24 Bathrooms. 0
Second: 0 sf Garage: 0 sf
Dwelling Units: 1 Front 0 Smoke
Third: 0 sf
Right 0 Detectors: Yes
Total: 20 sf Value: $15,000.00
Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0
Laundry Trays: 0 Rain Drain: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Urinals: 0
Tubs/Showers: 1 Sewer Lines: 0 SF Rain
Garbage Disp: 0 Water Heaters: p 0 Storm Sewer: 0
Water Lines: 0 Drains:
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Catch Basins: 0
Hose Bib: 0 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
Furn<100K: 0 Other Units: 0
Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders
1000 sf or less: 0 Branch Circuits
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
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 W/O SvGFdr: 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
Other: N Other Description: All
Ecompasing: N
BUILDING INFO
Class of Work: Type of Use:
ALT Type of Constr: Occupancy Group:
SF VB Square Feet:
R-3 20
Owner: Contractor:
CORNELIUS FAMILY TRUST IRON MOUNTAIN CONSTRUCTION INC Required Items and Reports(Conditions)
BY CORNELIUS,ARTHUR B& 6002 JEAN RD
MERILYN J LAKE OSWEGO,OR 97035
10345 SW GREENLEAF TER
TIGARD,OR 97224
PHONE: 503-579-3082 PHONE: 799-6312
FAX:
Total Fees: $575.88
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oreg r law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O .'952-0010. You :y obtai.,copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i //
9 ti
Issued By: . j/ Cal
Permittee Signature: &—:e_____l 503.639.4175 by 7:00 a.m.for the next available inspection date. i>"; -6_,,,,,71.1.--7
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applica 14 %!
Building Fixtures
FOR OFFICE USE oNLl
City of Tigard JAN r Received
ell 13125 SW Hall Blvd.,Tigard,O 97223 Date/By: �,/' #4 PermitNo.: _
' Phone: 503.718.2439 Fax: S .i89 ( b ¢ l Plan Review `� ����
Inspection Line: 503.639.41] a r� " Date/By: Other Permit T'
TIl ARD p v. vry DateRead/B
Internet: www.tigard-or.gov 1j IA R1 ( ( 1 Ready/By: tum: Supplemental See Page nf
���� � Noti�� -mod: I Information
: TYPE OF;'PORI{ t �FFI$EE* SCHEDULEn
❑New construction � � ' "
❑Demolition �a X i; �,I� For special information use checklist
Description
❑Addition/alteration/replacement ❑Other: � Qty. I Ea. � Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
%.CATEGORY:;OF CO?1STRUCTIOI SFR(1)bath 312.70
and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
r JOB,SITE INFORMATION AND LOCATIONSite utilities:
Job site address: /25 •,, �< ...s .6, C,,-&g l Catch basin or area drain 18.76
City/State/ZIP: 17 6.412%t/ Drywell,leach line,or trench drain 18.76
(�, �1�' -�f (/J Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: G
Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Subdivision: Water service(no.linear ft.: ) Page 2
I Lot no.: Fixture or item:
Tax map/parcel no Backflow preventer 31.27
k * r" 4 „ riESG ' '(ItKv, ` '' ,: *.„3-,,,,,,, `_4 ; Backwater valve 12.51
\ Clothes washer
/ ,/ / /il j .74ti/ - 25.02
_ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
rr' P oPLIRTY 11,'a ,
-y-' '� � "� ` [� NT 1 Expansion tank 12.51
Name: � 1 7:e.",tz Fixture/sewer cap�125.02
Address: 5 341 J 6 Jz .. 7- _ ,,,E Floor drain floor sink/hub
N Q /J , i 25.02
City/State/ZIP: -"-'�� Garbage disposal 25.02
Hose bib
Phone:(5t ' tom- `-')~7 / Fax:( ) .52
Ice maker 12.51
APP ,ICAN'i _I. , ,. a XONTACT,PERSON , %' Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address: Roof drain(commercial) 12.51
City/State/ZIP:
Sink/basin/lavatory 25.02
Solar units(potable water) 62.54
Phone:( ) I Fax::( ) Tub/shower/shower pan j12.51
E-mail: Urinal �� �
25.02
C NTRAC- - Water closet 25.02
w � N W Water heater
Business name: , /_;, , \ 37.52
f Water piping/DWV 56.29
Address: ``
0. 1tz� 5/_ . ' Other: 25.02
')
City/State/ZIP: I
Phone: � ir
c 70►.v'` Subtotal idr..57
ice-0 •-/19 _ Fax:( ) Minimum permit fee: $72.50
CCB Lic.: �!�E' � Plumbing Lic.no.: - (25%of pennit fee) 7�
,45, 34i� Plan reviewchrg
Authorized signature: ! .1)4.,----
17 State surcharge(12%of permit fee) g "�
�/� TOTAL PERMIT FEE 1,16-1
Print name: /1///�j 4 y j� D �j� j o a IJ,I Date: This permit application expires if a permit is not obtained within 180
v CC(///C/�w Jl I p� ��� days
1�.1 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-Permitgpp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
'ea Total �.: Ter f it '$e ,u
ate I7�ili�s�� fl� ,. a Qty. Fee� � �t�uar=e�'Qotage �
50.03 0 to 2,000 $121.90
Footing drain-l'100' 2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 ;Permit;Fee:
�Valuati�on - � ': r
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
'Qty., Fee d ° 1, and including$10,000.00.
(oth `
er Inspections ' ees` K e
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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*. , , F an*N;lew for PluMbing In tal,a eMs m
,. Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type forReplace/ Please check all that apply.
Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" A
-3" Isometric or`Kiser Diagram
4»
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Ref ig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDU5,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
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