Permit v CITY OF TIGARD MASTER PERMIT
�'1 COMMUNITY DEVELOPMENT Permit#: MST2015-00065
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/12/2015
Parcel: 2S111DB12900
Jurisdiction: Tigard
Site address: 15070 SW 96TH AVE
Subdivision: 1991-034 PARTITION PLAT Lot: 1
Project: ROBERTS
Project Description: Attic space converted to habitable space.
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:
Total: 0 sf Value: $56,000.00 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
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 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 0
Owner: Contractor:
ROBERTS,JOHN C HUGHES STRUCTURES LLC Required Items and Reports(Conditions)
14340 SW 114TH AVE 47525 SW CARPENTER CR RD
TIGARD,OR 97224 FOREST GROVE,OR 97116
PHONE: PHONE: 503-349-2042
FAX:
Total Fees: $1,658.38
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 et forth in OAR
952-001-0010 through OAR 952-001-0090. You may ob-'. - •• of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 • . 34;//
Issued By: ��'�.�_' %r��••:rmittee Signature:
Call 50 TC7!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 I ()1; „1 i I( I I ■I O.I
' City of Tigard Received
• Date/By: y/.3.1//3— Permit No.: ST�1 ziexp,_
1114
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / W
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: �j�'` L Other Permit:
T I G A F D InsPection Line: 503.639.4175 1v°) Date Ready/By. v kris: ® See Page 2 for
Internet: www.tigard-or.gov Re 6 Notifed/Method: • Supplemental information
1M1, �Q15
TYPE OF WOIVik 3 4 ii3O REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Deln itie*- 0 v�C 00 Indicate the value(rounded to the of
earest dollar)performed.all
14 Addition/alteration/replacement ❑ i..104— equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CO a UCTION work indicated on this application.
te 1-and 2-family dwelling ❑Commercial/industrial
Valuation: $ 5 6,CCO
❑Accessory building ID Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms: j
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: (5p1 0 5 t,J 9 to a i.e. New dwelling area: 7 5v square feet
City/State/ZIP: 7, (3 k Q1 , b E. Garage/carport area: square feet
Suite/bldgJapt.no.: Project name: Co r/e-iul4-I to 4 - (70 Covered porch area: square feet
Cross street/directions to job site: f 4 i L-0-1- Deck area: square feet
Other structure area: square feet
b REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I 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.
k rIC_ s P*� TvEaecL (u 1 / './2i4 LI theo ce Valuation: S
+s ZO t 1 f rk�`� A9b �"ee,1 S p4 p� Existing building area: square feet
`1 New building area: square feet
CILPROPERTY OWNER I 0 TENANT Number of stories:
Name: iN 6neez F5 Type of construction:
Q Address: I Li 340 �j ( I � +A Occupancy groups:
}v1 City/State/ZIP: (�} 2.c� C i2 _ • Existing:
V p J t, //t g
Phone:(5 D 71 ✓-6[t 6 Fax:( ' ) New:
4 APPLICANT CONTACT PERSON BUILDING PERMIT FEES*
Business name: i--) 1J- L e S S I-eiX./-A£5 L.L.L / refer f� �
�N Structural plan review fee(or deposit):
Contact name: ! ik K 0 o3 ke 5
FLS plan review fee(if applicable):
Address: `-75Z - . LA) C A to P�Ni-,P,e ee ' ed_ Total fees due upon application:
City/State/ZIP: i S- - 6 Leo l/e f D W ire.. 3 !
Phone:( 033) -3 LI 9 - 2(.2/j-a Fax::( ) Amount received:
E-mail: tit/9 N e s s+e)�� -e s ei 1,44,L , C D M PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 544449 11/1-g-k J 1 e 4t�i S Submit two(2)sets of roof plan with connection details
V and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review 5180.00
- and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: ./q/OU ,
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.
,l,A,z 14 1 � /!Z Qr'5- *Fee methodology set by TO-County Building Industry
Print name:/"t li Die Ted Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Application �i� FOR OFFICE USE ONLY
- Ci o Ti and
G�,\ y Received pmt#:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.598.19 4� a '.\15 Date/By:
Inspection Line: 503.639.4175 Q� �7 early Date/By: luris ® See Page 2 for
TIGARD Internet: www.tigard-or.Qov Supplemental Information
,-.[". ,,}tom
TYPE OF WORK S^ -cN( `.'",�_r..ON\I PLAN REVIEW
❑New construction ddition/alteration/fspil cement Please check all that apply(submit/sets of plans w/items checked):
L ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY,OF CONSTRUCTION ,, , exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1l-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: ❑Addition of new motor load of system.
100HP or more. ❑ A","E","l-2","l-3",
City/State/ZIP: /5—CrILD LA.) "t z- �� 4� ❑Six or more residential units. occupancy.
1 I 1 I ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: iV+`I-1 oc:g_ N C 1 P,�(R .c:6) ❑Hazardous locations. ❑Supply voltage for more than
Z 600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site 1 1 /..j,71- ,,-'FEE SCHEDULE
Al 1`J( 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#:
t .. Ea.add'1500 sq.ft.or portion 33.92 1
x g 4 _x :, � DESCRIPTION OF WORK ' ' = 75.00
Iti .,� ., ,-•� Limited energy,residential
}� ' with above. ft.
` � O � � 1 + f�2 f �(co62 Limited energy, ulti-family 2
residential(with above sq.ft.) 75.00
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER -'` -''I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: TC)k 6e-r-A-5 200 amps or less 100.70 2
Address: Hi -346; . W /1/L 1� it*-e. 201 amps to 400 amps 133.56 2
1 401 amps to 600 amps 200.34 2
City/State/ZIP: �--1 p 2 e 0 601 amps to 1,000 amps 301.04 2
Phone:(y 3 h 7-7 ,5 ,Tz Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation i• r- _made on perry that I own which is not 200 amps or less 59.36 1
intended for sale,leas- `, t sing to ii, 447,449,670, d 701. 201 amps to 400 amps 125.08 2
dig Owner signature: b k Date: (t(f /\ 401 amps to 599 amps 168.54 2
.- Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT ❑ CONTACT PE ON A.Fee for branch circuits with
Business name: 4 u .5 �jI 72.L. w y(� above service or feeder fee,
7.42 2
Contact name: / l,4-42 )842_5 , Fee branch branch circuit
- B.Fee for branch circuits without
tr+ Q.�I e).1+-C service or feeder fee,first 56.18 2
Address: �7�7�� G� C,O�O�O �� branch circuit
Each add'I branch circuit 7.42 2
City/State/ZIP: ��— G,(� C �' ( ,
/� Miscellaneous(service or feeder not included)
Phone: J) Z Fax::( ) Each manufactured or modular
r 5 $ 4-q ie . ` / - dwelling,service and/or feeder 67.84 2
Email stir j�,(J- C� Reconnect only 67.84 2
_- . , SCONTRA _1,1._ __ �z .:.:,,, Pump or irrigation circle 67.84 2
Business name: ;• 1 Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: g
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90 00/hr
CCB Lie.: Electrical Lie.: Suprv.Lic.: s ecificall listed Y hr mm)
)LECTRICAL PER,
Suprv.Electrician signature,required: 6 N)ive,_ Subtotal:
Print name: Date: ❑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
Print name:f ` /-f-k /` , , Date: 3 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\BuildinglPermiu\ELC_PermitApp ELR_ERE.doc '- 04/21/2014 440-4615T(11/05/COM/WEB
Mechanical Permit Application FOR OFFICE USE ONIA'
Received
City of Tigard O Date/By: Permit No: `/ /S -
'a 13125 SW Hall Blvd.,Tigazd,OR 97223 .j Plan Review J J-k a a Phone: 503.718.2439 Fax: 503.598.11 ..`V Date/13y: Other Permit:
I I G A R D Inspection Line: 503.639.4175 n V�J ^ 1� Date Ready/By: lens. HI See Page 2 for
Internet: www.tigard-or.gov "VV Q O I.Q Notified/Method: Supplemental Information
Mechanical permit fees*are based on the value of the work
❑New construction / Addition/alte ii. \7, ent performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: ,e,■ mechanical materials,equipment,labor,overhead,and profit.
Value:$
2-1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For speda[information use checklist
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
Heating/cooling:
Air conditioning _ 46.75 _
Job site address: iete /507 O s'1q/ G4- 1--Q V-&. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: rij a e-er i 0/2- Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name: Colt.c,I M'1q iM 21,E r iotr Duct work 3 23.32
Cross street/directions to job site: p I aq Lo Hydronic hot water system 23.32
J 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: I Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
i ESCRIPTION OF WORK IIMIII Gas fireplace/insert 33.39 _
Flue vent for water heater or gas
1441/6 S 9a-ce- Iv S 7Ikriled Gn G MA r r o'z"- fireplace 23.32
44'L /a ,% Log lighter(gas) 23.32
r /J 1 K Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
■ PROPERTY OWNE'
=�_ Environmental exhaust and ventilation:
Name: J O(,.‘ Range hood/other kitchen
�( L/' equipment 33.39
Address: 3 y0 f'7 � .ti/ - Clothes dryer exhaust . 33.39
City/State/ZIP: -7- / 0 Single-duct exhaust(bathrooms,
/ ia Yom/ toilet compartments,utility rooms) , r 23.32
Phone:(5o3 ) ai- ,i./G Fax:( ) Attic/crawlspace fans . 23.32
Other: 23.32
Business name: 1.� r5, 1 Fuel piping:
"�I Iles S-1-rux._- ,�reS I Li_C $14.15 for first four;$4.03 for each additional
Contact name: 1' !a V-k �QS Furnace,etc.
Address: 17 5�5 3,w, fr�4 r (rte /K-j Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: FCi CS f &rove. i ox ( 7//4 Water heater ,
Phone:(5o3) 3 L1.C1 _;: 1e/?_ I Fax::( ) Fireplace
E-mail: Range• e S r lK-#U 1res Ts tM o,,` .cxne•∎ Barbecue
I"
Clothes dryer(gas)
Business name: �"`tja _
Other:
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lic.: %t1(Ud Co 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: M ate`v_s &% i, C I Date: ..zio--(:)-1
1:1BuildineemiteVMEC_Prnnitppp_040113.doc
440-4617r(I1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Famil Fee Schedule:
$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\Penmits\MEC_PermitApp_040113.doc 2
Plumbing Permit Application
Building Fixtures FOR OFFICE I ■l: ONE)
. „ c, City of Tigard O`V e Received Permit No.: S )/L S
■ 13125 SW Hall Blvd.,Tigard, Plan Review
Phone: 503.718.2439 Fax: 5 960 �01� DateBy: Other Permit No.:
T t G A R D Inspection Line: 503.639.4175 Vk%Q Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov PQ �� Notified/Method: Su plemental Information
❑New construction IVA n For special information use checklist
Description I Qty. I Ea. I Total
. Addition/alteration/replacement Other: I New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
Site utilities:
Job site address: /5'0r/0 SG/ 94'4'Q Ue- Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: T9arc' e
/ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:�NA rI+,4.4 vn 2``wpaa✓ Manufactured home utilities 50.03
Cross street/directions to job site: 04.9 /0/ 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: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
PPP- / / Clothes washer 25.02
PT1L Spat was rnea ln10 Iti/Shed I'C 1ltJ Dishwasher 25.02
C c_ tLII!It ba)tA/70i�, /S'.2Dtirr tte Drinking fountain 25.02
/ v Ejectors/sump 25.02
P'PROPERTY OWNER ❑ TENA . Expansion tank 12.51
Fixture/sewer cap 25.02
Name: ,o(,1,‘ Zober.4s
Floor drain/floor sink/hub 25.02
Address:14 3L0 SW. //90,0;vt
Garbage disposal 25.02
City/State/ZIP: T:54,L✓, t'e Hose bib 25.02
Phone:(5503 ) 077- 56 4/4 Fax:( ) Ice maker 12.51
❑ CONTACT PERSON interceptor/grease trap 25.02
Business name: 6/4,(g Aes Siru c/u/..ec / (L C
Medical gas(value:$ ) Page 2
y� J Primer 12.51
Contact name:
mark k pi U /'1 es Roof drain(commercial) 12.51
Address:9 75).5' s,a e;„Pem 74{r (1 eA IJ Sink/basin/lavatory a 25.02
City/State/ZIP: poresI (r'✓,_, 0/2 97//4 Solar units(potable water) 62.54
Phone:(5 03 ) 3/4,i _ 01.1.)._ Fax::( ) Tub/shower/shower pan i 12.51
E-mail: hu_i.-,e _I r u G U r e S • e 11-1..;\ r cove-. Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: p.P
/�q Lt'kJo�e �,q/�ft°.r' Water 1 in WV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
Authorized signature: -`:��L ,,,' State surcharge(12%of permit fee)
/77t/�/' TOTAL PERMIT FEE l
Print name: pJ , n Date: This permit application expires if a permit is not obtained within 180 days
iW after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildinePermits\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 Sup ression 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 S stems:
Water Service-each additional 100' 37.52
$1
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
is eC 0 i each additional$100.00 or fraction thereof,to
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 is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
ant 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
-Jacuzzi/Whirlpool engineer.
Car F,ach Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
-3"
• Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the •ualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar 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:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
{ I Building Permit Review — Residential
Building Permit #: p7JlapiS---fJkX,5`
Site Address: 1CbW) 3k) c7 Ate .
Project Name: kGr/f 73 47)1-E,nt'v- i4117efisah0 r>..., Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review /
Proposal: klec7c: ' A.:0r--k 04 li,.
gf Verify site address/suite#exists and active in permit syst .
0 ver Terrace Plan District: ❑ Yes ENo
Si Plan Elements:
ree(3)copies of site plan [xisting structures on site
Dite plan must k on 8-1/2"x 11"or 11 x 17"paper KJFootprint of new structure(including decks)with finished
raven to scale(standard architect or engineer scale) a oor elevations
•
orth arrow ��'utility locations(required for new,may apply for additions)
to address,project or subdivision name and lot number 111 ,,,,1 cation of wells/septic systems
pplicant information(name and phone number) 11 rosion control(including drainage-way protection,silt fence
t dimensions and building setback dimensions sign,location of catch basin,etc.)
Lot area,building coverage area,percentage of coverage and I'treet names F/ /H-
i i pervious area(applicable if R-7,R-12,R-25&R-40) 1, eet tree size,typ d location
*Pfoperty corner elevations(2 foot contour lines if more than t': sting trees to be retained with drip line,and tree
4 foot differential) protection measures
felean Water Services-Service Provider Lette (lot platted prior to 9/10/1995):
(equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
1 Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified [No Applied For: ❑ Yes ❑ No,stop intake
0 and Use Case#:
Zoning: P- 4- s--
a Setbacks: Front cQO Rear 1 Side 5- Street Side +-____-~ Garage p?0
II l andscape Requirement: %
II •t Coverage Maximum:
0 Building Height: Maximum Height 30 Actual Height
Tisual Clearance
Orliasements
ensitive Lands: ❑ Yes dNo Type
IS,r,(�trrban Forestry Plan
14 fConditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: ars•Nms, Date: C:2 ,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
l:l Building\Forms\BldgPermitRvw_RES_031015.docx
Building Permit Submittal
Original Submittal Date: I S
Site Plans: # ,
Building Plans: #
Building Permit#: E nter building permit#above.
Workflow Routing: Ca ni g ❑ Engineering ❑ Permit Coordinator L`�'Butlding
Workflow Sign-off: 444- ❑ Sign-off for Planning(include notes from planning review)
Route Application Documents4/O Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
on Ian review routing form.
uilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: _� Date: 4,/,995-
c �
Engineering Review
❑ Slope at building pad:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
1:\Building\Forms\BldgPermitRvw_RES_031015.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15070 SW 96TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2015-00065
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS
Comments:
Per mechanical final
Damp location trim to be installed on fan in shower
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15070 SW 96TH AVE, TIGARD, OR, 97224
Residential - Master Permit
299 Final inspection
PASS - No C of O
MST2015-00065
David Young
Work covered prior to inspections for upper level addition appear to be code compliant
for time of installation.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15070 SW 96TH AVE, TIGARD, OR, 97224
Residential - Master Permit
699 Mechanical final
FAIL
MST2015-00065
David Young
Provide fan cover rated for damp location per electrical inspection for fan light in shower
compartment.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15070 SW 96TH AVE, TIGARD, OR, 97224
Residential - Master Permit
299 Final inspection
FAIL
MST2015-00065
David Young
Provide approved mechanical final inspection.
All else appears code compliant per non invasive inspection.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15070 SW 96TH AVE, TIGARD, OR, 97224
Residential - Master Permit
699 Mechanical final
PASS
MST2015-00065
David Young
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15070 SW 96TH AVE, TIGARD, OR, 97224
Residential - Master Permit
399 Plumbing final
PASS
May 13, 2015 at 9:34:28 AM
MST2015-00065
David Young
Plumbing installed and covered prior to permits. Thru non invasive inspection, appears
to be code compliant.
Contractor securing shower valve.
Violation Summary:
Inspector Contractor