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Permit (149)
CITY OF TIGARD MASTER PERMIT ' I . COMMUNITY DEVELOPMENT Permit#: MST2019-00369 Date Issued: 09/23/2019 T i(1 ARID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103DA04300 Jurisdiction: Tigard Site address: 10660 SW PARK ST Subdivision: FANTASY HILL Lot: 4 Project: ARREOLA Project Description: Garage conversion to a bedroom; Moving washer and dryer into garage; Making current half bath into a full bathroom. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 482 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Yes Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Total: 482 sf Value: $59,025.72 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 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: 6 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: ALT SF VB R-3 482 Owner: Contractor: ROSALES,LUIS ARREOLA OWNER Required Items and Reports(Conditions) _ ARREOLA,JESSICA -LUIS ARREOLA 10660 SW PARK ST 10660 SW PARK STREET TIGARD,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-475-0892 FAX: 1 Total Fees: $2,435.76 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable - All work will be done in accordance with approved plans. This •-}mit will ex.'e if work is not started within 180 days of issuance, or if work is susp= .ed for more the 180 days. ATTENTION: Oregon law requires you to f.11ow the ules adopted by the Oregon Utility Notificati enter. Those ru are set forth in OAR 952-001-0010 through 0 - •001-0090./ ay 0, :in a cop •f t les or direct questions to OUNC by callin 3.232.1987 r 1 =00.3 .2344. Issued By: ./teL! ,.,,♦L AiI/ Permittee Signature: - / /� -. ' "-r te ..1503.639.4175 by 7:00 a.m.for the next available inspection da 7 , / y This permit card shall be kept in a conspicuous place on the job site until comp ion of the pr•ject. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential POR 01 1 1( 1 1 S l.OM.l Cityof Tigard C D RDeactee/iBveyd: y G /t �� y� Permit No.:/11,57-4201 11�T�0 1— 0y 31 05 11 III 13125 SW Hall Blvd.,Tigard,OR 9722QCrEvGPlan Review I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: A A dth- Other Permit: Inspection Line: 503.639.4175 SEP 1 6 2019 Date Ready/By: // / Juisl ® See Page 2 for TiGnKDInternet: www.tigard-or.gov N d/M od: Supplemental Information CITY OF TIGARD A-742-' TYPE oF W( LING UIV4bION i RE'Q 17 2ED DATA:1-AND 2=FAMTLY DWELLING 0 New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. i and 2-family dwelling ❑ Valuation: $ '3e5- ''5 Q1� Commercial/industrial I ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: loco 410 S W pMg VST. New dwelling area: 4--[(56. _ square feet City/State/ZIP: T l&vA I on7 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: -ag,c 1,Corrvtarsi 01\ Covered porch area: square feet Cross street/directions to job site: vary_st AWck. 'L nS Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST 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 DESCRIPTION OF WORK work indicated on this application. Canvertltn garait in-h) bedroom. kkov t n wasinerr Valuation: $ drt4er 11\10 gar-a c. kka,,Vi in r.0 rroki- tt bc14 4, Existing building area: square feet `n1„ 0. , `l ban New building area: square feet IBPROPERTY OWNER 0 TENANT Number of stories: Name: Lul S LA- Type of construction: Address: \Olio WI) )P1- Sr Occupancy groups: City/State/ZIP:^-'v-rb, _ 91M Existing: Phone:(Th'j) 415--ot12- Fax:( ) New: [APPLICANT0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule Business name: . Structural plan review fee(or deposit): Contact name:(� A-5 IbVe) FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application: $f 7, ' - a4,.._�ne.7— __� _ -. — — _—_! _.___ _ Amount mewed:: s Phoe:( ) Fax::( ) E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: Q�JNcv' Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Addres . Solar Installation Specialty Code checklist. City/State/ZIP: -------------- Permit Fee(includes plan review $180.00 and administrative fees): , Phone:( ) �� L ) State surcharge(12%of permit fee): $21.60 CCB lic.: ...eV- ------1Total fee due upon application: $201.60 Authorized signatur-• „.1.4111r - This permit application expires if a permit is not obtained CJ. within 180 days after it has been accepted as complete. Print name: /i i #41,redo tDate: q--/�.- (q,, *Fee methodology set by Tri-County Building Industry V Service Board. I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist , One- and Two-Family Dwelling i cm o i i u i. I s i. 0 v I 1 City of ed d Received Ti anv g Date/B Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: I Phone: 503.718.2439 Fax: 503.598.1960 T 1 c ARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other: 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 3 Verification of approved plat/lot. , ❑ 0 4 Fire district approval required. Name of district: 0 5 Septic system permit or authorization for remodel. Existing system capacity . 0 6 Sewer permit. 0 7 Water district approval. 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. CI __ 0 0-_r____ 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 a..licable to the .ro'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. A ❑ •■ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 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. ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 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 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-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE LSF Oy1.v City of Tigard ReceiDate/By:ed Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 = g an Review Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 Date/By: T I c,ARI) Inspection Line: 503.639.4175 Date Ready/By: Juris: III See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information : WORK T COMMERCIAL FEE* SCHEDULE-USE CHECKLIST « tPF.OF _ Mechanical permit fees*are based on the value of the work o New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ 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 46.75 Job site address: 4 U(i(j 0 (5W ?`2.1 - Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: I /' ` Furnace 100,000+BTU(ducts/vents) 54.91 t s t Heat pump 61.06 Suite/bldg./apt.no.: ' Project name: Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) Unit heaters(fuel-type,no electric m-wal -duct,suspend 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 D> SCRTFTION`I3F WORK ': / Gas fireplace/insert 33.39 Flue vent for water heater or gas 14c-ta.lti rv)..+a niz 1gs Loak r he ak fireplace 23.32 J Log lighter(gas) 23.32 CA CA-Lt3 dl j er P ka-ut S'1y Wood/pellet stove 33.39 - Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 23.32 -PR "I t- „ r {� IIIA tT Other: • • Environmental exhaust and ventilation: Name: Luka fir?ot� Range hood/other kitchen 5 equipment 33.39 Address: O(c(n o S V.-) ,�i'- c-\-, Clothes dryer exhaust f 33.39 City/State/ZIP: ‘ �C( (J2 c fl 7 -j Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 L t1-06---(711,_ Phone:( ) Fax ( ) Attic/crawlspace fans 23.32 IGANT ;13 CONTrWF PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: 1 S Pr 'D 1,C` Furnace,etc. Gas heat pump Address: Wall/suspended/unit heater -City/State/ZIP: Water beak' —.. _. Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue CONT 'OR Clothes dryer(gas) { Business name: Other: W-^.- I� Q��r r MEAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authoriz -'gnature: * Fee methodology set by Tri-County Building Industry Service Board Print name: tat r\Y r Lo t& Date: 6;I 11 ii I:\Building\Permits\MEC_PenuitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit 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\Pemuts\MEC_PermitApp_040113.doc 2 Electrical Permit Application of E C E i yr E Received City I O K O F F I( I l .�f O\I.1 13125 SW HallTigard Blvd.,Tigard,OR 97223 Date/B : Phone: 503.718.2439 SEP 1 2019 Plan Review Email: TigardBuildingPermits@Tigard-o.:a Date/B : Related Permit#: T I G A R ll • r4 Ready Date/By: kris: Inspection Line: 503.639.4175 Int-n- : :• If; See Page 2 for Notified/Method: 1 ll k II •► Supplemental Information TYPE OF WORK 0 New constructionPLAN REVIEW 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 DemolitionOther: 0 Service or feeder 400 amps or more where the available fault current la Building overb tboatyards.stories. CATEGORY OF CONSTRUCTION ❑Marinas and boatyards. dwelling exceeds 10,000 amps at 150 volts or 0 Floating buildings. El 1-and 2-famil Y g 0 Commercial/industrial 0 Accessory buildingless to ground,or exceeds 14,000 0 Commercial-use agricultural ❑Multi-family ❑Master builder amps for all other installations. buildings. ❑Other: 0 Fire pump. JOB SITE INFORMATION AND LOCATION ❑Installation larger separately drive or 0Emergency system. derived Job#: I Job site address: 0(0(0 ``,�' /t_y� 0 Addition of new motor load of system. City/State/ZIP: -+V V TCt` sr. 100HP or more. ❑"A","E","1-2","1-3", TI6P'RD r OP- 912 r7 0 Six or more residential units. occupancy. Suite/bldg./apt.#: J Project name: L 0 Health-care facilities. 0 Recreational vehicle parks- ❑Hazardous locations. 0 Supply voltage for more than Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal. FEE SCHEDULE Description I QtyI j Subdivision: New residential single-or multi-family dwellingEach unit.Total I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 DESCRIPTION OF WORK Ea.add'l 500 sq.ft.or portion 33.92 1 Addi j I U S dr r Limited energy,residential Li q q 1' ki� L nsi-alli n9 au.i-1etc (with above sq.ft.) 75.00 2 4411(0111.0J USI_ � Q '. �� Limited energy,multi-family TT g C -� t 9 fix-ha-6 • residential(with above sq.ft.) 75.00 2 — Renewable Energy 0See Page 2 PROPERTY OWNER , 0 TENANT Services or feeders installation alteration,and/or relocation Name: LV 1S Qt-12(Z7�(��. Address: 200 amps or less 100.70 2 l0(ob0 SW }7,oc R(e_ 201 amps to 400 amps 133.56 2 City/State/ZIP: Te. �f 1 .0%2_ cl..vis 401 amps to 600 amps 200.34 2 Phone:(953) y^'i 601 amps to 1,000 amps 301.04 2 S..-08g2 Over 1,000 amps or volts , 552.26 2 Email: err COO ICI 8(p hbfMa• Temporary services or feeders installation,alteration,and/or Owner installation:This' Est ( I•�� relocation intended for sale,lease s being made on property that I own which is not 200 amps or less /� ueTa ording to ORS 447,449,670,and 701. 201 amps to 400 amps 59.36 1 Owner signature:de --�c� _ 125.08 2 Date: 5-14^/q• 401 amps to 599 amps , 168.54 2 lie PPLICANT -0CONTACT PERSON Branch circuits-new,alteration,or extension,per panel I Business name: A.Fee for branch circuits with above service or feeder fee, Contact name: Lulc, Q`�,z o each branch circuit 7.42 2 r B.Fee for branch circuits without Address: e 1 v�\ service or feeder fee,first City/State/Z �W J\ branch circuit 56.18 2 Each add'l branch circuit 7.42 2 Phone:( Miscellaneous(service or feeder not included) Each manufactured or modular Email: dwelling,service and/or feeder 67.84 2 CONTRACTOR Reconnect only 67.84 2 • mess name: -- 4 r Pump or irrigation circle 67.84 $lgrtarouillneiTing _ 67.84 2 -�Address: 2 Signal circuit(s)or limited-energy panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Phone:( _ Additional inspection(1 hr min) 66.25/hr Investigation(1 hr min) 90.00/hr Email: - Industrial plant(1 hr min) 78.18/hr CCB Lie.: Inspections for which no fee is Electrical L . Suprv.Lic.: specifically listed(%hr min) 90.00/hr Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES Print name: Subtotal: Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: This permit application expires if a permit is not obtained within 180 II Date: days after it has been accepted as complete. I:0Building�Peru,ics\ELC_Pertui[App_ELR_ERE.doc Rev 10/26/2017 * Number of inspections allowed per permit. 440-4615 T(11/05/C OM/W Eg Electrical Permit Application—City of Tigard K �.. Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: FEE SCHEDULE Total ( Qty. EachI * ' .10 ►:; _,A. �. !�. �ONLY* . ,, Description Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 100.70 2 5 kva or less Check Type of Work Involved 2 5.01 tol5kva ❑ 15.01 to 25 kva 200.34 2 Audio and Stereo Systems* Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 Burglar Alarm 552.26 2 50.01 to 100 kva 0 Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Solar generation systems in excess of 25 kva: Heating,Ventilation and Air Conditioning 42 3 System* Each additional kva over 25 7.42 >100 kva—no additional charge 0.0 3 Vacuum Systems* Each additional inspection over allowable in any of the above: Each additional inspection is 66.25/hr 1 Other: charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr s.-cificall listed '/z hr min ELECTRIC *ES: s 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 O Boiler Controls O Clock Systems O Data Telecommunication Installation O Fire Mann Installation • HVAC 0 Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* O Medical O Nurse Calls [] Outdoor Landscape Lighting* 0 Protective Signaling [] Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 Plumbing Permit Application Building Fixtures / FOR OFF ICG uSE ("IA City of Tigard RECE I �/ E D Received 13125 SW Hall Blvd.,Tigard,OR 97223114 p 6 r��}{ Date/By: Permit No.:�Sr1Q'q „�;3r s,/ ■ Phone: 503.718.2439 Fax: 503.598.1960}E(- 1 t u 19 Plan Review J Ins ection Line: 503.639.4175 Date/By: Other Permit No.: T 1 ARU p Date Ready/By: Juris: VI See Pae 2 for Internet: www.tigard-or.gov u;IT ' OF TIGARD I g Notified/Method: ylJlL1 aceta Supplemental Information ❑New construction ❑Demolition For special information use checklist ❑Addition/alteration/replacementDescription I Qty. Ea. I Total 0 Other: 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 ❑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 JOB SITE INFORMA'T'ION"AND LOCATION Site utilities: Job site address: 11:140 b o SvJ peke y_ Catch basin or area drain 18.76 City/State/ZIP: T\ -1 b, op_ cn-t�� Drywell,leach line,or trench drain I 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: l t C` 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 DESCRIPTION'OF'WORK r Backwater valve 12.51 "' Diswasher ' 25.02flCN1v3 wasliedicirTr from YZ 641t IntUaage+ Dishwasher 25.02 adding drain -Fur shower 1-rU6uhvij &rain Drinking fountain 25.02 S\11V--- • 14,914.61/ (A)a4rcr. he Q•�-Pr 4 j d, 35 �,1� Ejectors/sump 25.02 SKI" )PE* OIiV+TER alti �/ 0141' ' Expansion tank 12.51 Name: Lots i.agEOI /� Fixture/sewer cap 25.02 Address: 10 b�O� S\A/ P4�K Floor drain floor sink/hub 25.02 City/State/ZIP: �1�� - Garbage disposal 25.02 Tie l 0� Hose bib 25.02 Phone:(15t%) 1.4ls-013q2, Fax:( ) Ice maker 12.51 tn^°APPI,dXANT rv, CO °© CONTACT ARSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Contact name: (56ct.i ' A3 A_„lTJ ),E\ Primer 12.51 Address: ��7 - Roof drain(commercial) 12.51 City/State/ZIP: Sink/basin/lavatory t 25.02 Solar units(potable water) 42.54 ,unc.( ) Fax::( ) Tub/shower/shower pan t 12.51 E-mail: Urinal 25.02 Water closet CONTRACTOR 25.02 Busin e: c�✓ � Water heater ' 37.52 Water piping/DW V 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax: ( Minimum permit fee: $72.50 CCB Lic.: , r'lumbing Lic.no.:AP Plan review (25%of permit fee) Authorized signature: - '..a State surcharge(12%of permit fee) TOTAL PERMIT FEE Print name: i( r ,(Yea(4 Date: a�> �‘',..-/lY 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:\Building\Permits\PLMU-pemtitApp.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: Qty. Fee(ea) Total Square Footage: Permit Fee: Site Utilities Footing drain-1' 100' 50.03 0 to 2,000 $121.90 37.52 2,001 to 3,600 $169.69 Footing drain-each additional 100' 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 Valuation: Permit Fee: 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 Qty, Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Fees 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 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*. Plan Review for P'umbing'Installatons , Quaintly by Fixture Type Plan review is required for any of the following. Fixture Type for Replace! Please check all that apply. Work Performed: Capped Added Relocate ❑ 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 ❑ 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" , " TS -3O!i!tris of Riser)iaP,ram -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./Refrig.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 EDUs,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: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2