Permit CITY OF TIGARD MASTER PERMIT
III
■.,': COMMUNITY DEVELOPMENT Permit#: MST2019-00431
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03l02/2020
'I[ '.rl t2 r' g Parcel: 1 S134CB05600
Jurisdiction: Tigard
Site address: 11130 SW TONY CT
Subdivision: ANTON PARK Lot: 18
Project: BISWAS
Project Description: Removing load bearing wall, installing GLB, and framing for new kitchen walls, relocating
bathroom and laundry room.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $5,000.00 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
Drains: 0
Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywall-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 1 Other Units: 1
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:
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 10
Mfd Home/Feeder/Svc: 0 401-800 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 0
Owner: Contractor:
BISWAS,BIJOU M FREEMAN REMODEL Required Items and Reports(Conditions)
11130 SW TONY CT 1129 29TH PLACE
TIGARD,OR 97223 SALEM,OR 97304
PHONE: PHONE: 503-932-4248
FAX:
Total Fees: $694.23
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a c the rules or direct questions to OUNC by calling 503.232.19872.�or 1.600.332,2344.
c
Issued By: /t-� i v--r/r' rmittee Signatur
a 3.639.4175 by 7:00 a.m.for the next available inspectl�iL(�`�L
ate.
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 il t 4 ii m
1 ei
City of Tigard DatReceBy:ved /02-!/
fry 4 ,2°9-z Y-f3/
iCi
• 13125 SW Hall Blvd.,Tigard,OR 97223 n� 43 Z D I.. Plan Review n
■ C -+ Q illy- Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: (2. 3 ( ( /!'J
TIGARD Inspection Line: 503.639.4175 ,� 1 .-;•Ir +°1' . Date Ready/By: Iuriv: See for
Information
www.tigard-or.gov u�-� ° .J,•. w r No d/Method' f 7 Supplemental Information
FI
TYPE OF WORK QULRED DATA:1-AND 2-FAMILY 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
,xs Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling Valuation: $ �O�d, PG,Commercial/industrial
ElAccessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /%/3 2 s(x../ r�T New dwelling area: square feet
City/State/ZIP:,.- Q ,97a fiti.3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: �j j p!j Covered porch area: square feet
Cross street/directions to job site: / 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.
Valuation: $
/ //Ge tr�� � � f. Existing building area: square feet
�� New building area: square feet
...1!J riOPERTY OWNER ❑ TENANT Number of stories:
Name: �j Ie2/ �,3' J- Type of construction:
Address: . jyy� oar (.3:4 / Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
APPLICAAN� IT}� 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: `�.///� AI /4 /7 /O.-.1/G (Please refer to fee schedul)
Structural plan review fee(or deposit):
Contact name: p FLS plan review fee(if applicable):
Address://e/t "/ � 1;4 �� �1
City/State/ZIP: f�1n e� 9710 Total fees due upon application:
(97G) n 6 J e/�� Amount received:
Phone: �f Fax: :( )
E-mail:jot-14 a �� / ia,6,p PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR /� roof-top mounted PhotoVoltaic Solar Panel System.
Business name:f�I2� 6// ��,tililr,G LlG Submit two(2)sets of roof plan with connection details
a//�,, 7 e,v / od fir Idepartment
calla t on S access,iSpecialty
along wchecklist.
the. Oregon
Address: Off (.f�i j� • Solar
Installation Specia(ry Code checklist.
ty U/t %✓✓ Y Permit Fee(includes plan review
City/State/ZIP: D $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: t ,7 7 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:_ Date: f✓
�//1,7/9 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pennits\BUP-RESPetmitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1—
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY - a
Cityof Tigard Received
'� Date/B : P:nnn No,:
• 13125 SW Hall Blvd.,Tigard,OR 97223
_; Phone: 503.718.2439 Fax: 503.598.1960 Associated permit
TIGARD 24-HourInspectionLine: 503.639.4175 0 Electrical ❑ °',un1bhig ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I 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
4 Fire district approval required. Name of district: ❑ 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. ❑ 0 0
7 Water district approval. ❑ 0 0
8 Soils report. Must catty original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control ❑plan ❑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 ❑
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 ❑ ❑ ❑
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
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑
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 ❑ ❑
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 uoss references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ 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
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 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 ❑ El ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑ 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 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 ❑ ❑ ❑
architect licensed in Ore:on and shall be shown to be aui licable to the .ro'ect under review.
JURISDICTIO\Al, 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". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. 0 0 ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. 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
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 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 ❑ ❑
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\Pemuts\BUP-RESPernutApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
r r t c s i eceived
City of Tigard e
i ' 13125 SW Hall Blvd.,Tigard,OR 97223 x
= g Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 4 2 1.: Date/By: Other Permit:T I G A R D Inspection Line: 503.639.417511 "� `( Date Ready/13y: runs: ® See Page 2 for
Internet www.tigard-or.gov It _ Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Ad dition/altcration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: ///5Q SW; er' Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: �� / (9,49 (�'Jrg_f Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 1 23.32
Cross street/directions to job site: 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: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert , _33.39
_s Flue vent for water heater or gas
A7GYfi O fireplace 23.32
//p/i i_,./7 �' Log lighter(gas) 23.32
/(/f Wood pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32 .
Oth
rerPROPERTY OWNER 0 TENANTS' 23.32
Environmental exhaust and ventilation:
Name: ij`/; ,`���� Range hood/other kitchen
1///2 5��� ,�7 equipment 33.39
Address`
Clothes dryer exhaust 33.39
City/State/ZIP: '4 j eA (J.7wg- Singleductexhaust(bathrooms,
+, toilet compartments,utility rooms) / 23.32
Phone:(97/ )kg q/$/ Fax:( I Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump ___
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:
l/H C MECHANICAL PERMIT FEES*
.
Address: N,a}rr y C1 l cI-1 Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 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: i per `
(� ,% Date: t( OS 1 Io D�
I:\Buldmg'Permits1 MEC_PermitA— p_1C040113.doc 440-46170(I 1/0/vC0 B) °,
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information .
4.
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: MI new commercial buildings require 2 sets of plans.
I:\Building\Pemtits\MEC_PemiltApp_040113.doc 2
Electrical Permit Application ,....., FOR OFFICE USE Qv1 1
. CityofTigard Received
g DateB : /7jt�.
, 11111
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 t l i i Date/B
Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: Jerk: ® See Page 2 fur
I I L'A R I) Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
)'YPE OF WORK PLAN REVIEW
❑New construction Addition/alteration/rcplaccmcnt Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑ Other: CIService or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
,-// CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
ill l-and 2-famil dwellin less to ground,or exceeds 14,000 0 Commercial-use agricultural
y g ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
!//jD d�.t/ IOOH 7M� Gl El100 Addition of new motor load of system.
Job#: Job site address: P or more. ❑"A","E","1-2",`1-3",
ElSix or more residential units. occupancy.
City/State/ZIP:
,�orlgs 63.9 9703 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
��/ ��// ,,,,,,��AA ��// (with above sq.ft.) 75.00 2
a ��/�i�.f 'lf�tf/(�i t/t�Gr/ Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
❑ TENANT Renewable Energy 0 See Page 2
El PROPERTY OWNER Services or feeders installation,alteration,and/or relocation
Name: 4/j . , �
�/' ..„, 200 amps or less 100.70 2
Address:V/��0 JA.f�' �+ 201 amps to 400 amps 133.56 2
< G7 401 amps to 600 amps 200.34 2
City/State/ZIP:4/c/4r//u/ eq f7sR5 601 amps to 1,000 amps 301.04 2
Phone:(97/ )10- 9/3/ Over 1,000 amps or volts 552.26 2
�l
Temporary services or feeders installation,alteration,and/or
Email: bit lob— bli ia_s e r.t�-te.n.kiaror( .J relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,I e,rent,or ea c nge,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: (k f t g ( i Q 1 401 amps to 599 amps 168.54 2
❑ APPLICANT El CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit Vv 7.42 59 J� 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:
branch circuit ���.3�
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
- - Signal circuit(s)or limited-energy See Page 2 2
Address: panel,alteration,or extension.
CitylStatelZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
. Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv. Lic.: specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
' days after it has been accepted as complete.
Print name: `Q t'_ C �`C'pret Date: i (g ( �Q r p p
_Ptx� 1 • Number of inspections allowed per permit.
I:\Bai:Int a l:mits1ELC_PermitA LR ERE.doc Rev 10/26/2017 440.4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information •
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description
Fee for all residential systems combined: $75.00 Total
y Qty. Each Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page t):
(SEE OAR 918-309-0000) . Number of inspections allowed per permit
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
1 Intercom and Paging Systems
1 Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits ELC PmnitApp_ELR_ERE.doc Rev 10/26/2017
Plumbing Permit Application
Buildting Fixtures FOR OFFICE USE ONLY
City Of Tigard Received Perg17 `5-re/1Y
;� - • 13125 SW Hall Blvd.,
.,Tigard,OR 97223 l •' Date/By`Plan Review
! vJ
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: kris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist
Description I Qh'- I Ea. Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
,211 and 2-family g dwellin SFR(2)bath 437.78
❑Commercial/industrial
❑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
JOB SITE INFORMATION AND./ LOCATION Site utilities:
Job site address: ///3O 5 j/®/1 G/ Catch basin or area drain 18.76
City/State/ZIP: i®I/W 44 7 2f Footing drain
(line,noe trench drain 1 Page 2
Footing drain(no.linear ft.: ) 2
Suite/bldg./apt.no.: I Project name: 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
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes 25.02
�/ '�� /'J! -G - - o`y - �! .. j� Dishwasher / 25.02 Drinking fountain 25.02
Ejectors/sump 25.02
2 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: 4u`D/5'prfWad Fixture sewer cap 25.02
Address: ✓ilj ow „Us-, Floor drain floor sink hub 25.02
Garbage disposal / 25.02
City/State/ZIP: Hose bib 25.02
Phone:(97/ )a/9 y/37 Fax:( ) Ice maker / 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory a 25.02 56_5/
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet Arm' .tk 1 25.02
CONTRACTOR
Water heater 37.52
Business name: /
{/' l T Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.:
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: lO �„ ��' .a Date:1, I 1 /t C This permit application expires If a permit is not obtained within 180 days
- o ` ( ` after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I;1Building\Permits'PLMU-PermilApp.doc 10/01/09 440-4616T(10/02COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information - ,
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1" 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 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
(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*. Plan Review for Plumbing Installations
Quantity 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thr
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial al ❑ Any multipurpose fire sprinkler system.
Commer ❑ Any complex structure as defined in OAR918-780-0040.
-DDrinking Fountain
Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" Isometric or Riser 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
IceMachiRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
L\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2