Permit .(•
• f_c
CITY OF TIGARD ,+ r ' MASTER PERMIT
a COMMUNITY DEVELOPMENT �® Permit#: MST2012-00224
Date Issued: 08/29/2012
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114BB04800
Jurisdiction: Tigard
Site address: 10080 SW PICKS CT
Subdivision: PICK'S LANDING NO.1 Lot: 25
Project: Pitkin
Project Description: Alteration for 780 sq ft accessory residential unit. 1/24/13(a), reprinted to reflect original scope of
work in body of permit. 1/24/13(b), reprinted to add to scope of work for"Phase 2".
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: 2 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $9,600.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 0 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: 1 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 1
Other Fixture Units: Extend hot&cold water supply lines
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans:. 1 Clothes Dryers: 0
Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 0 . Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 5
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:
MARCHANT,DEBORAH DEWIT MAJO AHRENS CONSTRUCTION Required Items and Reports(Conditions)
PO BOX 152 1170 SE RIVER FOREST RD
WHEELER,OR 97147 MILWAUKIE,OR 97267
PHONE: PHONE: 503-201-2489
FAX:
Total Fees: $873.98
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 acrdance 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. • NTION: • -!•n law equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0%1-0010 through OAR 9 ■81-009 r You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
0
Issue. =y: Permittee Signature: A. 67414.-15fre
Call 503.639.4175 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.
CITY OF TIGARD MASTER PERMIT
3 COMMUNITY DEVELOPMENT I Permit#: MST2012-00224
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �� Date Issued: 08/29/2012
Parcel: 2S114BB04800
Jurisdiction: Tigard
Site address: 10080 SW PICKS CT
Subdivision: PICK'S LANDING NO.1 Lot: 25
Project: Pitkin
Project Description: Alteration for 780 sq ft accessory residential unit. 1/24/13(a), reprinted to reflect original scope of
work in body of permit.
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: 2 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $9,600.00 Rear: 0
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
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckfl Pr vnt: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 1
Other Fixture Units: Extend hot&cold water supply lines
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: 1 0-200 amp: 0 W/Svc or Fdr: 5
Ea add'I 500 sf: 0 201-400 a •. • 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 8 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:
MARCHANT,DEBORAH DEWIT MAJO AHRENS CONSTRUCTION Required Items and Reports(Conditions)
PO BOX 152 1170 SE RIVER FOREST RD
WHEELER,OR 97147 MILWAUKIE,OR 97267
PHONE: PHONE: 503-201-2489
FAX:
Total Fees: $637.21
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 . •r•ance 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. • TENTION: Oregon =w • i -s ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-•01-0010 ••ugh OAR 952-0.1-0090./ ay obtain a copy of the rules or direct questions to OUNC by cal'•: '• . . 987 or 1.800.332.2344.
Iss -d By: -_�4 _■ _- - Permittee Sign- •l'=_s!
�� r
i
Call 503.639.4175 by 7:00 a.m.for the next available
This permit card shall be kept in a conspicuous place on the job site until com•at•' • the project.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Application
Receiv Residential rolz OFFICE USE ONLY
of Tigard RECEIVED Date
Bed Permit No.: $x9049--xv,
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C.: Phone: 503.718.2439 Fax: 503.598.1960 A N 2 4 Z Q 3 Date/B : Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: huffs: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION
work indicated on this application.
® 1-and 2-family dwelling Valuation: y""
❑Commereial/industrial
❑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:10080 SW Picks Ct. New dwelling area: 0 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 0 square feet
Suite/bldg./apt.no.: I Project name:ARU 2012-00003—Phase 2 Covered porch area: 0 square feet
Cross street/directions to job site:SE corner of Picks CL and Serena Way Deck area: 0 square feet
•
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Picks Landing#1 I Lot no.:25 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.:2S114BB04800 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK `DT) To HSTao t?' work indicated on this application.
Gr1�r3t/ Valuation: $
Rough opening and install of 36w x 48h window in bathroom,new 4x8 header. New
. 76"h short partition wall to enclose shower stall. Vent new bathroom fan to Existing building area: square feet
exterior. Install new stove and range hood and vent hood to exterior. New building area: square feet
® PROPERTY OWNER I 0 TENANT Number of stories:
Name:Carol and Edward Pitkin Type of construction:
Address: 10080 SW Picks CL Occupancy groups:
City/State/ZIP:Tigard;OR 97224 Existing:
Phone:(503)358-8172 Fax:(971)245-6273 New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:Carol and Edward Pitkin -
FLS plan review fee(if applicable):
Address: 10080 SW Picks CL
City/State/ZIP:Tigard,OR 97224 Total fees due upon application:
Phone:(503)358-8172 I Fax::(971)245-6273 Amount received:
E-mail:spinynorman @comcast.net PHOTOVOLTAIC SOLAR PANEL,SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photovoltaic Solar Panel System.
Business name:Majo Ahrens Construction Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:1170 SE River Forest Road Solar Installation Specialty Code checklist.
City/State/ZIP:Milwaukie,OR 97267 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)201-2489 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 189049 Total fee due upon application: $201.60
Authorized signature: diew671.----- . This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Carol Pitkin Date:Jan 24,2013 *Fee methodology set by Tri-County Building Industry
Service Board. .
I:\Building\Pernits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: Permit No.: 114:1-4,7%/?...00,09 i
13125 SW Hall Blvd.,Tigard,OR ' CEI`�ED
C '4 �i Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.59:. 1 Plan Review
'f I G n It U Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method:
JAN4 ^ Notified/Method: Supplemental Information
H V 23
TYPE OC1°?FTIGARD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ � ���rr��N Mechanical permit fees*are based on the value of the work
❑New construction Additio ayl+uu�I performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description 1 Qty. I Ea. I Total _
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: / 07,8o 5 w f f-Z/GS G . (requires site plan showing placement) 46.75
Cit /State/ZIP: Furnace 100,000 BTU(ducts/vents) 46.75
Y 1 r cs- -cj 0 2 °1 71,3-4/ Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: /IRO o?or — C o"° Heat pump
(requires site plan showing placement) 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
�4 �w,p--6D _ _ / Gas fireplace/insert et ot 33.39
-/Q Ov J'-�fL 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
❑PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: (a,,yDJ Ai-t-k f,-, Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment / 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Phone: Fax: Single-duct exhaust(bathrooms,
( ) ( ) toilet compartments,utility rooms) ,/ 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Address: Furnace,etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater ,
Phone:( ) Fax::( ) Water heater
Fireplace
E-mail:
Range
CONTRACTOR Barbecue
•Business name: v Clothes dryer(gas)
24.- _e__,,,_< Other:
Address: /1-7 o Sc Rn.>e-5/- �,-Q s t MECHANICAL PERMIT FEES*
City/State/ZIP: p/2. q-71•G Subtotal
Phone:( 03) �p/ _ y Fax:( ) Minimum permit fee($90.00)
Plan review(25%of permit fee)
CCB lic.: /g'0 44? State surcharge(12%of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: C a.ry / 17 t`i p✓J I Date: /—.2 q-oto/ s • Fee methodology set by Tri-County Building Industry Service Board
.1:\Building\PerrnitsVMEC-PermitApp.doc 03/07/12 4404617T(II/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\PermitsUv1EC-PermitApp.doc 03/07/12 2
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard IVED Date/By: Permit No.: f 90 I 9,00 -9e./
a 13125 SW Hall Blvd.,Tigard,-OR 2 Plan Review
a . Phone: 503.718.2439 Fax: 503. R�l9 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 JH IV 2`S 2013 Date R B Iwis: la See Page 2 for
T I G A R D Internet: www.ti ard-0r. ov o g
g g r Notified/Method: Supplemental Information
TYPE 01Clt&FTIGARD FEE* SCHEDULE
ID
construction BUILT'URIISION For special information use checklist
Description I Qty. I Ea. I 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
SFR(2)bath 437.78
® 1-and 2-family dwelling ❑Commercial/industrial .
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
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: 10080 SW Picks CL Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
-
Footing drain(no.linear IL: ) Page 2
Suite/bldg./apt.no.: I Project name:ARU 2012-00003-Phase 2 Manufactured home utilities 50.03
Cross street/directions to job site:SE corner of Picks CL and Serena Way Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:50) Page 2 .42.54 .
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Picks Landing#1 I Lot no.:25 Fixture or item:
Tax map/parcel no.:2S114BB04800 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Plumb and install kitchen and bathroom fixtures for accessory residential unit: Dishwasher I 25.02 25.02
Shower,toilet,sink in BA. Sink,dishwasher,garbage disposal in kitchen. Drinking fountain 25.02
(ARU2012-00003) 4b', Td M g ao/2---Z)03-24-/- _Ejectors/sump 25.02 I
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Carol and Edward Pitkin • Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:10080 SW Picks Ct.
Garbage disposal 1 25.02 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:(503)358-8172 Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Carol and Edward Pitkin
Roof drain(commercial) 12.51
Address: 10080 SW Picks Ct. c Sink/basin/lavatory 2 25.02 50.04
City/State/ZIP:Tigard,OR 97224 Solar units(potable water) 62.54
Phone:(503) 358-8172 Fax::(971)245-6273 Tub/shower/shower pan I 12.51 12.51
E-mail:spinynorman @comcast.net Urinal 25.02
'Water closet 1 25.02 25.02
CONTRACTOR
Water heater 37.52
Business name: (J/��' '1 t12. Water piping/DWV 56.29 5549-
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:Carol Pitkin Date:1/24/2013 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.
1:\BuildingWermits\PLMU-PennitApp.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-19 100' 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' I 62.54 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
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate '
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thar ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4" Isometric or Riser Diagram
_ Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food q g
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice MachfRefrig.Drains
Oil Separator(Gas Station) _ _ Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall -
Sink/Lav -Non-food related -- -_
-Bradley
-Commercial-food related
-Service -- -
Swimming Pool Filter *Note: lithe fixture work under this permit results in an
Washer-Clothes
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\Pitkin\Documents\Documents\Finances\Picks Ct\Plumbing Pernt Form phase 2.doc
CITY OF TIGARD MASTER PERMIT
• 3. COMMUNITY DEVELOPMENT Permit# MST2012 -00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/29/2012
Parcel: 2S114BB04800
Jurisdiction: Tigard
Site address: 10080 SW PICKS CT
Subdivision: PICK'S LANDING NO.1 Lot: 25
Project: Pitkin
Project Description: Alteration for 780 sq ft accessory residential unit.
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: 2 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $9,600.00 Rear: 0
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 Catch Basins: 0
Bckflw Prevntr: D
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: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders 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
Ecompasing: N
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
MARCHANT, DEBORAH DEWT MAJO AHRENS CONSTRUCTION Required Items and Reports (Conditions)
PO BOX 152 1170 SE RIVER FOREST RD
WHEELER, OR 97147 MILWAUKIE, OR 97267
PHONE: PHONE: 503- 201 -2489
FAX:
Total Fees: $637.21
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 •A 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. 87 or 1.800.332.2344. t,/f�
A 7
Issued By: / � Permittee Signature:
Call 503.639.4175 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 RECD
City of Tigard P2 / A 4 h W . 7 - 0 0 . 2 , 2
.
Ayr) r 2 7 2012
. ° 13125 SW Hall Blvd., Tigard, OR 97223 A P lan Review
Phone: 503.718.2439 Fax: 503.598.1960
Date/By: M9l/ /aZ 7 /i�-
Other Permit:
TI G A RD Inspection Line: 503.639 CITY OF TIG A D n Date Ready/By: 1 See Page 2 for
Internet: www.tigard- or.gov tiRi! Notit;ed/Method�7 /04 (6.--1 � Supplemental Information
BUILDING DIVISION s-,o, - W 8
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ 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/altcration/replaccment ❑ Other equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® I- and 2- family dwelling ❑ Commercial/industrial
Valuation: $9,600
❑ 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: 10080 SW Picks CL New dwelling area: 0 square feet
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 0 square feet
Suite/bldgiapt. no.: I Project name: ARU 2012-00003 — Phase 1 Covered porch area: 0 square feet
Cross street/directions to job site: SE corner of Picks Ct. and Serena Way Deck area: 0 square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Picks Landing #1 I Lot no.: 25 Permit foes* are based on the value of the work performed.
Tax map /parcel no.: 2S114BB04800 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.
Move existing interior wall 14" & add new 4x10 header; Remove garage door & Valuation: $
install new window within opening; Install 1 hr rated firewall & prepare opening Existing building area: square feet
for fire rated door; Install new subpanel; Run water supply to south wall; New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Carol and Edward Pitkin Type of construction:
Address: 10080 SW Picks CL Occupancy groups:
City / State/Z1P: Tigard, OR 97224 Existing:
Phone: (503) 358 -8172 Fax: (503) 231 -1976 New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: Carol and Edward Pitkin
FLS plan review fee (if applicable):
Address: 10080 SW Picks Ct.
City/ State/Z1P: Tigard, OR 97224 Total fees due upon application:
Phone: (503) 358 -8172 I Fax: : (503) 231 -1976 Amount received:
E -mail: spinynorman @comcast.net
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted Photo Voltaic Solar Panel System.
Business name: Majo Ahrens Construction Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 1170 SE River Forest Road Solar Installation Specialty Code checklist.
City/ State/Z1P: Mitwaukie, OR 97267 Permit Fee (includes plan review $ 180.00
and administrative fees):
Phone: (503) 201 -2489 I Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: 189049 /A1/1/3 . _ Total fee due upon application: $201.60
Authorized signature: / /4119 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Carol Pitkin I Date: Aug 22, 2012 " Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \Permits\BUP- RESPerrnitApp.doc 02 /24/2011 4404613T(I I /02/COM/WEB)
•
Building Permit Application Checklist
One- and Two- Family Dwelling FOR OFFICE usE ONLY
City of Tigard Received Date/By: Permit No.:
a 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
C Phone: 503.718.2439 Fax: 501598.1960
24- Hour Inspection Line: 503.639.4175 0 Electrical ❑ Plumbing 0 Mechanical
TIGARD
Internet: www.tigard -or.gov ❑ Other.
THE FOLLOWING, ITEMS ARE REQUIRED FOR PLAN REVIEW Y« No Ni.-".
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ El
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ EI
4 Fire district approval required. Name of district: ❑ El El
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ El
6 Sewer permit. ❑ ❑ El
7 Water district approval. ❑ ❑ El
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ El
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ Ej
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ El
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 ❑ El
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 ❑ El
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ® El El
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- ❑ ❑ El
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. ❑ ❑ El
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- El ❑ El
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 El ❑ El
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered El El EJ
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. ❑ ❑ IZI
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ El
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 van on and shall be shown to be ...licable to the s ro 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 ". ❑ ❑ El
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. El El El
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ Cl
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ El
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ El
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ El
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ El
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, ❑ ❑ El
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(I 1 /02 /COM/WEB)
. • Aug 28 12 07:44a B &H ELECTRIC INC. 503-254-8553 p.1
• M OJT ao c x -do S a e(
I9euw alas* an r h o apply l ubmit 2 acts of maul w /aama chocked below);
'TYPE op WORK Servir+e (IT f '400coups building aver thanAngina
where the avnilehle flail currant maims and htarynrvtw.
New construct inn Ad dill on lnitoratinn /rcplacement�"
esmeda 10,0011 amps at 150 vu1Ls ur lloulmg hatpin &s.
Demolition Other loss to guund, excucda 14,010 Commercial-use ugricuhurat
CAI'l;(;OKY OF CONSTRUCTION mnp. for all mho installations burldi ep.
• - For. pump. UU1rll.ii.m 475 KVA or
1 - and 2- family dwellint ✓ Comtnemciul/indus(rial Accessory building Emergency system. Tarter sego aid). dcn.edsysa ern .
Multi - family Master builder Other. Addition ofnuw Motor load of ° A` " ° "1.7
- 100HP or mute. Ib rcrrnIrrmnt vehicle pale.
JOB SITE INF'OI4MictiON AND LOCATION SIX UT more residential (nits. Supply voltage Icr more than
fob no.: Ob site address: / 6 cQ 0 5 LL' f Ice 5: 110111h-we localities. GOO vats ownin�.l.
f > .� Hararttmialrcmtems.
City/State/ZIP: "71 C llq ti> Service ua Iccda (stn a t ex more
IiK1E: SCHEDULE
Suite /bldgJapt. no Project name: nereripuo. Wr F� I bW
Cross street/directions to, job site: New residential single or multi family dwelling unit
Includes attached Ramat- ,
1.000 se.. ft or l - 168.54
Subdivision: Lot n0.: 1a. odd'I S11(1 sq. 0. or portion 33.92
. , Limited enerr, rwtedenrial 75.00
Tax m
Ti ap/parcel no.: (worth abuou raL11.)
I.imitod energy, multi thmily
DESCRIPTION Of WORK residential (with above sy 0.1 75,00 .
J- '`$L7$ i e. I e --�L` ITS S A '1'.) 'A- cd
Services or feer� installation. allerarioo, and/or relocation
� r 49 � � 200 amps CT lea 1110,70
1 �1 ' 1 2- QJ 701 amps to 400 amps 133.56
PROPERTY OWNER TENANT . urrlp3lob ' 200.34
Name: 501 ;Imps in 1 000 amps 301.04
Over 1.000 amps or volts SS2.2l
Address: _ Temporary services or feeders installation, alteration. and/or
City/StateJZIP: relocation
700 amper or levy 59.36
Phone: ( ) Fax: ( ) :01 amps to40(►Innps 125.0R .
Owner installation: This installation is being made on property that I own which is not 101 amps to 599 amps 168.54
intended for sale. lease, rent, or exchange, according to ORS 447. 449, 670. and 701. Branch circuits- new, alteration, or extension, per panel
Owner signature: A. Fee for branch circa Ls with
•
above service ur io adcr fee. each
Date: - branch circuit 7
APPLICANT I CONTACT PERSON B. lace for branch an without
sesvioe or feeder fee, fast hearth
56,18
Business mane: circuit
Pitch add' I branch circuit 7.42
Contact name:
*fiscal aeons (serv or f eeder not included) -
Addn:ss: !Lich manufactured or modulur 67.84
dwelling. service and /or loader
City/Stale/ZIP: 10.Nonnxt only 67.84
Thane ( )
N.:: ( r ) Pump or irrigation circle ('7.84 •
Sin or outline lighting 67.84
1 !lei I: signal errcuios) or limited -enemy
CONTRACTOR pand altcratir.I or caycrmon. Pagc 2
11u.iness name: %7r
r f C �I ✓t' r Each additional Ins Ic
thin over allowable in y of the above
, s
/� !' � C' Addmonul ,nsprepon ( I hr min) 66..25/ hr
Adlbcst: 6 .5 3 0 *`" InvoaGt aL at ( I hr inm) Afi.; 5/ ht -
City/Sone/ZIP: e in...AN1 t�'� 977- is-- industrial plant (I hr min) 78.18 / hr
.} Inspections for which no ice is
Phone: (0 ) ?.70 s --73 J lax: ($0 � 3) .2.5 .2.5 `/ S 3 slocilirally lasted ('fi hr min) 90.00/ hr
'Chi Lie.: ! y Z• {Electrical Lie.: , ..Suprv. Lie.: 5
EL1x.T l(,:AI. l'I KMIT FEES
f a �, StdslMpl:
Suprv, k:'Ice a n attire, required! 34 ��' MA /- 19an review (25°`a Ofpennl[ rec):
Print name: M ) C4- Pi 5 e. 7Eitc pale: ,?/ 2. 7 ( State surcharge (12%ofpermh fee):
f TOTAL PF:'kMTf FEE
Aulhuri'ed signature: 'l'hie permit applicetioo empire; if ■ permit o not o twiwed within IR0
' days .tire it has been accepted w complete.
Print name: 'Date: • Number or inet /l
ctiont wlllmoud per pamil.
r.---- - ..._ pi .AN RFVIVW 1 ,� /L. i/ ---
f/A.P.//01'-- 04#)171-
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard RECEIVED �• Received 6-i�7/�- .i ;ice/ Permit No/LJ-S�o2d /o2- Gao2V
11 2 V 13125 SW Hall Blvd., Tigard, 0 723 Pla.
Phone: 503.718.2439 Fax: 50 . j I 7 2 Q Plan /Byyn Review
Date/By: Other Permit No.:
TI G A li D Inspection Line: 503.639.4175 Date Ready/By: see Page 2 for
Internet: www.tigard -or.gov CITyOFTIGARD Notified/Method: Supplemental Information
TYPE BLAMING DIV ISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I 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
® 1- and 2- family dwelling ❑ Commercial/industrial
SFR (2) bath 437.78
ID Accessory building SFR (3) bath 500.32
ry g ❑Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. [L) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10080 SW Picks Ct Catch basin or area drain 18.76
City/State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft: ) Page 2
Suite/bldg./apt. no.: I Project name: ARU 2012 -00003 - Phase 1 Manufactured home utilities 50.03
Cross street/directions to job site: SE corner of Picks Ct. and Serena Way 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: Picks Landing #1 I Lot no.: 25 Fixture or item:
Tax map /parcel no.: 25114BB04800 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Run hot and cold water supply lines from the water heater to the south wall in Dishwasher 25.02
preparation for future ARU kitchen and bath. No fixtures will be installed at Drinking fountain 25.02
this time. (ARU2012-00003) Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Carol and Edward Pitkin Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 10080 SW Picks Ct.
Garbage disposal 25.02
City /State/ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503) 358 -8172 Fax: (503) 231 -1976 Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Carol and Edward Pitkin
Roof drain (commercial) 12.51
Address: 10080 SW Picks CL Sink/basin/lavatory 25.02
City/State/Z1P: Tigard, OR 97224 Solar units (potable water) 62.54
Phone: (503) 358 -8172 I Fax: : (503) 231 -1976 Tub /shower /shower pan 12.51
E -mail: spinynorman @comcast.net Urinal 25.02
Water closet 25.02
CO CTOR
60 't Water heater 37.52
Business name: Water piping/DWV 1 56.29 56.29
Address: Other. 25.02
City/StateJZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7A , 510
Plan review (25% of permit fee)
CCB Lic.: Plumbing Lic. no.:
r State surcharge (12% of permit fee) 9, 70
Authorized signature: D p_____ TOTAL PERMIT FEE f / ,,2.0
Print name: Carol Pitkin I Date: 8/22(2012 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.
11 Building \Pennits\PLMU- PennitApp.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 - l 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
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",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace) Plan review is uired for any of the following. Performed: Capped Added Relocate y g
•
Baptistry/Font Please check all that apply.
Bath - Tub /Shower El Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain El Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
- 4" Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic - non - food agra s
q g
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice MachfRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
-Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
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\Pitkin\ Documents \Documents\Finances\Picks Ct\Plumbing Permit Form.doc
114 _ ° Building Division
Development Code Provision Review
T I G n R D Residential Projects
Building Permit No: MST'o?O /oZ — Q 0 a
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A 0
Routed Plans:
de i.
Original Plan Submittal Date: 0 7 / /0 e'/ '
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked ( items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved. , /,,/
ti
Planning Review (contact at 503 -718 �` Y 7 U or @tigard or.gov)
r pUse Cash No. i 9IW .2.4/62 -•penill Name
Zoning ''7 S
0 Setback .
Fron Rear Side Street Side Garage
❑ . urn Building Height Actual Building Height
❑ i . al Clearance
❑ Ease ents
'4 Sensiti - Lands Type:
Notes: r i
Q , /
Original Plan: Approved / Not Approved ❑ Date: Ol�, 7 l I D Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope:
Notes:
( 1 (/ ****----
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
(1\1
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503-718-2426 or abert@tigard-or.gov)
❑ Conditions of Approval Prior to Issuance of Building Pe 't
Notes :
I i1 V WWI
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
•
Page 2 of 2
CITY OF TIGARD MASTER PERMIT
• 3. COMMUNITY DEVELOPMENT Permit# MST2012 -00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/29/2012
Parcel: 2S114BB04800
Jurisdiction: Tigard
Site address: 10080 SW PICKS CT
Subdivision: PICK'S LANDING NO.1 Lot: 25
Project: Pitkin
Project Description: Alteration for 780 sq ft accessory residential unit.
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: 2 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $9,600.00 Rear: 0
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 Catch Basins: 0
Bckflw Prevntr: D
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: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders 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
Ecompasing: N
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
MARCHANT, DEBORAH DEWT MAJO AHRENS CONSTRUCTION Required Items and Reports (Conditions)
PO BOX 152 1170 SE RIVER FOREST RD
WHEELER, OR 97147 MILWAUKIE, OR 97267
PHONE: PHONE: 503- 201 -2489
FAX:
Total Fees: $637.21
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 •A 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. 87 or 1.800.332.2344. t,/f�
A 7
Issued By: / � Permittee Signature:
Call 503.639.4175 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.
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10080 SW PICKS CT, TIGARD, OR, 97224
Residential - Master Permit
615 Mechanical rough-in
02/19/2013
MST2012-00224
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10080 SW PICKS CT, TIGARD, OR, 97224
Residential - Master Permit
280 Insulation
02/19/2013
MST2012-00224
PASS
Violation Summary:
Inspector Contractor