Permit r n CITY OF TIGARD MASTER PERMIT
. - 2 COMMUNITY DEVELOPMENT Permit #: MST2010 -00199
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
Tlf,A • Parcel: 2S111DB02900
Jurisdiction: Tigard
Site address: 15375 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 488
Project: Demarinis
Project Description: Interior remodel.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 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: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $65,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 3 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
0 Tubs /Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 1 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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: 0
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
DEMARINIS, DELORES CARLSON ENTERPRISES LLC Required Items and Reports (Conditions)
15375 SW ALDERBROOK CIRCLE PO BOX 1311
TIGARD, OR 97224 BEAVERTON, OR 97075
PHONE: 503 -579 -8465 PHONE: 503 - 443 -5166
FAX:
Total Fees: $2,081.78
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 0 • r,:;- 2- 001 -0090. You may obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987, oL 1 •$9Q 22 332. ,44.
f� ' // /
Issued By: / � _ _ Permittee Signature: s ! / % /
C. 50 5 by 7 :00 a.m. for the next available inspection fa te. *--'--
This permit card s all 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 Application
Building Fixtures FOR OFFICE US ONLY
Received D
City of Tigard �� Date/By: l/ S/ /d Permit No.: rA)/024�1l
13125 SW Hall Blvd., Tigard, g OR " 97223 y
4 2 0� Plan Review
III C U Phone: 503.639.4171 Fax: 503.598. �� Date/By: Other Permit No.:
Inspection Line: 503.639.4175 TWO) Read /B furls: ®See Pa e 2 for
TIGARD SUG Ready /By: g
Internet: www.tigard- or.gov C, 1t 4F lo�� Notified/Method: � Supplemental Information
TYPE OF WO MW
❑ New construction C ❑ Demolition For special information use checklist
Description I Qty. 1 Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 It for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling El Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
i 5 375 5, u
Job site address: Mr brook C 1(C'L Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: --1-,.. r A 0 r ,„, ,,,,
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 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: S 0 IM Yh GAr F I i d J Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer i. 25.02 26/U2--
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
Er PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: D c c es b ev►.ar i. n I s
Fixture /sewer cap 25.02
Floor drain/floor sink/hub 1 25.02 25, OZ
Address: 15 37 S S•t2 AIdt(- b ro'k 01.(c-k Garbage disposal 25.02 -26, o z.
City /State /ZIP:77 aro( Ore 0 Hose bib 25.02
Phone: (503) 51q •-•- g 44 6,5 Fax: ( ) Ice maker ] 12.51 f a.. 51
❑ APPLICANT ❑ 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 3 25.02 " , 06
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan k 12.51 ( Lr5
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
f y" Water heater 1 37.52 '1,5--.7 Business name: / U � e z: tilt- n N . 1 �° 3 CO: Water piping/DWV / 56.29 &(0 W Address: t S' ; f .1 • , 1 , i 1 ,/ Other: 25.02
City /State /ZIP: ' 1 V 61 /6( I' 1 r i 1 0C f7 �� Subtotal 1'
Phone: (.5:= 3) Z '71 -L I L C-�
/ Fax: (5 ) 66 i 6, 2 7/ Minimum permit fee: $72.50
CCB Lic.: O 29 0 ( i1 Plumbing Lic. no.: 3E1 p - Plan review (25 (12/0 ° of permit fee)
j V State surcharge ofpennit fee) . ?Z, 2 . 7
Authorized signature S G TOTAL PERMIT FEI ( ., ‘Z 2,.
/ 1 7 / This permit application expires if a permit is not obtained within 180 days
Print name: % ' ° Date: / �f
1 - /� , _ / . ;67 after it has been accepted as complete.
�'�- �' p *Fee methodology set by Tri- County Building Industry Service Board.
/ 01 Gcr, /1 / ;
I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10/02/COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1s 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
Storm &Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
p 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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
Jacuzzi /Whirlpool as defined in OAR918- 780 -0040.
El Car Wash Each Stall Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator El Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I:\ Building \Permits\PLMF - PermitApp.doc 2
Mechanical Permit ApplicreCENED FOR OFFICE use oNl �-
City of Tigard Received
O DaDate/By: (r y /O A Permit No.: Ng'��o���/
° 13125 SW Hall Blvd., Tigard, OR 9722. 4 2 0\ 1
r) `' Plan Review
Phone: 503.639.4171 Fax: 503.598.1,'. I Other Permit:
Date/By:
- f 1 G A RD Inspection Line: 503.639.4175 OF 1�*M Date Ready /By: Juris: See Page 2 for
CIT.(
Internet: www.tigard-or.gov S''oN Notified/Method: Supplemental Information
BUILDING p1" V '
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: S' 3 S( ), e1 6 �� c 1 1--‹ Air conditioning -I
(requires site plan showing placement) 1' 46.75
Furnace 100,000 BTU (ducts/vents) "1„,V 46.75
City /State /ZIP: Tl ear f �/ 1 ( )
5 I Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg./apt. no.: Project name: /\ _� \N ,t3. Heat pump 61.06
Cross street/directions to job site: �� Duct work 23.32
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
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater / 23.32 .'3.?--
Gas fireplace 1 33.39 b?-
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
21. .PROPERTY OWNER ❑ TENANT
Other: 23.32
Name: Dc I O re S ' f- l'11aL1 I S Environmental exhaust and ventilation
j ((�� Range hood /other kitchen
Address: 1 50 A IAerbrooI\ CirL equipment 1 33.39 ..
City /State /ZIP: � on Clothes dryer exhaust '�
• Single -duct exhaust (bathrooms,
Phone: S G�-- �/1� c Fax 1 23.32 . 2-7 - /‘... - - ( 5 U� ( ) toilet compartments, utility rooms)
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Furnace, etc. 1 14,
Address:
Gas heat pump A L Q
City /State /ZIP: Wall /suspended/unit heater
1
Phone: ( ) Fax:: ( ) Water heater
Fireplace 1
E -mail: Range
CONTRACTOR , Barbecue
Business name: > l l Clothes dryer (gas) f
4 1CL l ( �'7 C�� "1 I 'v1 G� / Other:
Address: 6' q / ' 5'5 14 131'- J MECHANICAL PERMIT FEES*
City /State /ZIP: p/Ji/'tu.,. /1 04 9710-49 Subtotal '2 AR
1 Minimum permit fee ($90.00)
Phone:( ) Fax: )
�87 7� - ( >l Plan review (25% of permit fee)
. CCB lic.: q gi - State surcharge (12% of permit fee) (,, Q
TOTAL PERMIT FEE , 5(
/ This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: / • & (1567x'1 Date: 7/73//62 ` Fee methodology set by Tri- County Building Industry Service Board
I:\ BuildingWermits \MEC- PermitApp.doc 10 /01 /09 440 -4617T (1 l /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 \Permits\MEC - PermitApp.doc 10/01/09 2
' iSuildin2 Permit Application
Commercial , • FO R OFFICE USE ONLY
t
City of Tigard ECG Date/By: / ,/ 7 /a _ Permit No.: WS OIO .-�
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review IA, , 4 J J
li ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: � � /( I f - 1 £j r0 Other Permit:
T I GA R D Inspection Line: 503 NOV 2010 Date Ready /By: . g - J u ri !^ ® See Page 2 for
Internet: www.tigard- or.gov / Notified/Method: l, o l S upplemental Informati
I p t on
CM/ r/GAR ck e 1,.i, . 7 ) ,
TYPE OF Vverw U� y�JI R� REQUIRED DATA: 1-AND "2- FAMILY DWELLING
®t work of th
l
th
d * f
Permit fees* are based on the value oe wor performed.
❑ New construction ❑ Demolition p
Indicate the value (rounded to the nearest dollar) of all
X Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ (o 1 060. 0 0
❑ 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: ' 53 75 5 e t3 Al�l,er b roo t< Circle.. New dwelling area: square feet
City /State /ZIP: �j I q (1,. ) ()rcQ 6) (N Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 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: 5 Ulm e.:( c1 r 1A Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
.. , Valuation: $
Existing building area: square feet
New building area: square feet
sgc PROPERTY OWNER I ❑ TENANT Number of stories:
Name: (� e Lo ( r
0 e � a r
1 I Type of construction:
Address: 15 3 75 .S, La At d er brook ^ ti Occupancy groups:
City /State /ZIP: C _,t �
1
\ i on t l- Existing:
Phone: (503) S 7 s $L, 6,5 Fax: ( ) New:
g APPLICANT ❑ CONTACT PERSON NOTICE
Business name: — ∎ ( s o E e r s • G L. C., , All contractors and subcontractors are required to be
Contact name: (i`��� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: P+ 0 , B jurisdiction in which work is being performed. If the
City /State /ZIP: 6 cav etr f orG r> 1 q 170 7 5 a apply:
ant is exempt from licensing, the following reasons
Phone: (5 9 S / I b Fax:: )
E -mail: —rt. y � Carl5oiN en +err ri'sc5 L Lt.Corn
CONTRACTOR
Business name: C I So 11 ' n +mi n `5 c5 L . C . BUILDING PERMIT FEES* ,
Address: P 0, 3o I3 , to fee schedule)
City /State /ZIP: 1 6 J e I - 4-0r\ o r Gs5 o
�Q Structural plan review fee (or deposit):
t� 7 / ► FLS plan review fee (if applicable):
Phone: (503) - 7 J -- S i I, W Fax: ( ) f �/
CCB lic.: I ? 38 7 ?/// /I Total fees due upon application: [� 7 ' o
/ Amount received:
Authorized signal T his permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Z (f / Date: f//3 /6 * Fee methodology set by Tri- County Building Industry /41 Service Board.
I: \Building\Permits \BUP -COM PermitApp.doc 10/01/09 440- 4613T(11/02 /COM/WEB)
•
1111 111 Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
I: \Building \Permits \BUP -COM PermitApp.doc 06/25/08