Permit itt CITY OF TIGARD MASTER PERMIT
1111 a • COMMUNITY DEVELOPMENT Permit#: MST2015-00167
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/06/2015
Parcel: 2S112CA01800
Jurisdiction: Tigard
Site address: 7715 SW GENTLE WOODS DR
Subdivision: GENTLE WOODS Lot: 10
Project: Eykelbosch
Project Description: Finish crawl space and remodel lower level. Adding(1)bedroom.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms. 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors. Yes
Total: 147 sf Value: $16,559.55 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 1 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
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 1
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add9 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3
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:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 147
Owner: Contractor:
EYKELBOSCH,EVAN MCEWEN&CHRISOWNER Required Items and Reports(Conditions)
7715 SW GENTLE WOODS DR EVAN EYKELBOSCH
TIGARD,OR 97224 7715 SW GENTLE WOODS DR
TIGARD,OR 97224
PHONE: 541-908-0798 PHONE: 541-908-0798
FAX:
Total Fees: $1,161.89
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a c•• • -s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Ca' •175 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.
' Bdildin Permit A Heat'
Residential CEIVED FOR OI:I-I( E I tiL:()NI.)
p Received
City of Tigard Et 17 2015 DateB : 9 1 Permit No.: r a. L�to IV
13125 SW Hall Blvd.,Tigard, 223 2015 Plan Revie / ,
' I Phone: 503.718.2439 Fax P-p3 113 TIGAP Date/By: J JZy ) I Other Permit:
Inspection Line: 503.639.4ou D Date Ready/By: Juris ® See Page 2 for
1-IGARI) p IL.
Internet: www.tigard-or.gov SING DIVISION Notified/Method:9/p/17 Supplemental Information
0 49d V-c ilL k,uaw
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: $ �� r�p�h+ ss S
y g ❑Commercial/industrial i
❑Accessory building ❑Multi-family Number of bedrooms: `
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 7 7(5 $t,.,7 Cren-i-1•e (:�ocx 5 "V/^ New dwelling area: 147 square feet
City/State/ZIP: TIGk�, O2 q 7Z-Z(4 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: n.1FL 3a5 CM Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
&• vk{, (,a)%oc S Vr i Creel)-e— (,J % Ct Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
Z S 1/ Z GA O 14800 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
PWISh Gea...1 Srfccc, r Aetl�QY`. rGw►.o). -I Valuation: $
Existing building area square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: EVAAd 6-Yif E4,13o$cs.4 Type of construction:
Address: 77(5 6 eii fl,-... casct s 1 r- Occupancy groups:
City/State/ZIP: --c--1 4.LRD OR, i7 Z 4 Existing:
Phone:(5c1( ) ?oz..O? $ Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application:
Phone:( ) Fax::( )
Amount received: 46,0
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR --r-p)1) roof :. mounted Photo Voltaic Solar Panel S. • em.
Business name: GiLt/vt Submit t v 2)sets of roof plan with con - tion details
and fire dep. •rent access,along wit. . e 2010 Oregon
Address: Solar Installation..ecialty Code • ecklist.
Permit Fee(inc ..es • .� review
City/State/ZIP: and admix five fees): $180.00
Phone:
( ) Fax:( ) State surcharge %of pe ' fee): $21.60
CCB lic.: Tot. ee due upon application. $201.60
Authorized signature: !� This permit application expires if a permit not obtained
C______ __ within 180 days after it has been accepted as complete.
Print name: Van */CG.I6e J Date: rf(7/5- *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WE$)
i
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Received
ipq City of Tigard DateBy: Permit No
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
• Phone: 503.718.2439 Fax: 503.598.1960
TIGARD
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 es No N/:1
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity CI CI CI
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑
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. ❑ ❑ ❑
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- ❑ ❑ ❑
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 ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
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 ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑
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 t on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
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, ❑ ❑ ❑
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(11/02/COM/WEB)
I
Elzctrical Permit Applies r FOR OFFICE USE ONLY
V�I Y``�D Received
71 - City of Tigard Date/By: 7/7/ ( f) Permit s: l7Di �1�r 6'0167
13125 SW Hall Blvd.,Tigard,OR 97++r a 1 7 2015 Plan Review vv
Phone: 503.718.2439 Fax: 503.598. •.1 Date/By:
Related Permit#:
TI c;A R D Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: luris: El See Page 2 for
Internet: www.tigard-or.gov ION Notified/Method: Supplemental Information
TYPE O WORK 1`I PLAN REVIEW
❑ New construction ❑Addition/alteration/replacement Please check all that apply(submit 2,sets of plans w/items checked):
❑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.
El I-and 2-family dwelling El 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
q ❑Addition of new motor load of system.
Job#: Job site address: 7 7/ 5 5 2 )o
Gerllit o.N R 100HP or more. ❑"A ,"E", t-2","l-3",
❑Six or more residential units. occupancy.
City/State/ZIP: ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: E✓ ❑Hazardous locations. 0 Supply voltage for more than
/K�L Cir�S ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qtv. I Each 1 'I otal 1 '
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00
(with above sq.ft.)
FI N tSH Gi QA L,A,5 i i .E i 2 fl c.Af 8 4r vsoc;.A 4 G 4.0 I,APY , Limited energy,multi-family
- . IA, AV cAA) N(rMfl ik, FA-A-4u1. . 0:-..--k. EV1ZQ'. residential(with abovesq.ft.) 75.00
Renewable Energy ❑ See Page 2
a PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: E1 f AA) ElVeLikoS C F{ 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( t( )Toe-.c, 7' 5 I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that i own which is not 200 amps or less 59.36 l
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON ' Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit Z 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR
7-3-p Pump or irrigation circle 67.84 2
Business name: �L1//�r Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension. g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax: ( 1 Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Supry. Lie.: specifically listed(1/4 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: ei,i llQ1bseli TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: c....„.... .--- Date: Qi/ii f ic days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46 15T(11,05,COM-WEB
4
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Renewable I a. I Each I Total I
Renewwaa Q
ble electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040) _
I I Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
f 1 Other: Each additional inspection is 66.25/hr 1
LJ charged at an hourly(1 hr min)
Inspections for which no fee is 90 09/hr
specifically listed('.hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter
Page I).
* Number of inspections allowed per permit.t.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
I I Instrumentation
I Intercom and Paging Systems
Landscape Irrigation Control*
Medical
I Nurse Calls
Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:Building\Permits\ELC_PcnnitApp_ELR_ERE.doc Rev 06/17/2015
Mechanical Permit Application FOR OFFICE USE ONLY
RECEIVED Dace/Bed ,
City of Tigard Date/By: 7/5 y�... , Permit No.: ihT /5-......ex /c� 7
III • 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
r�
I I( A R I Inspection Line: 503.639.4175 S E P / 2 Q Date Ready/By: Juris 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
ETI7iCillF §MOINGD1VISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the v.ork
❑ 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.
Value:S
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 I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
''"• '' {� Air conditioning 46.75
Job site address: 77/5 .y,� t)- 7Ne. Wt S �f" Furnace 100,000 BTU(ducts/vents) _ 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: e yKCL6e5 C H Duct work I 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) . 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. , 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert , 33.39
Flue vent for water heater or gas
.RE-(pe,ATE '�e.TS i- GAS t Ai cCLAw,5 PAS. APi) fireplace 23.32
4 Log lighter(gas) 23.32
\ie/V I5 11J RATH WO-mot `t Glu`'JiZ i Rc-x`" mot' Wood/pellet stove . 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: AJAA) GY4,CC4...(3o5 ett Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust ( . 33.39
City/State/ZIP: Single-duct exhaust(bathrooms, n
toilet compartments,utility rooms) a" . 23.32
Phone:(51k ) ?0$-0 8 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: _ 2332 _
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address:
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR liM" Clothes dryer(gas)
Business name:
Other:
e./2n//t/r-/ r `MECHANICAL PERM_ IT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee) _
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: fV424 t.(.I k` ese-k Date: 911/15
1:\Building\.Permits\MEC_PermitApp_040113.do 440-4617r(I 1/02,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:A Building\Pennits\MEC_PcnnitApp_040I I3.doc 2
Plumbing Permit ApplicatRCEIVED
Building Fixtures SEP 17 2015 FOR OFFICE USE ONLY /f
III City of Tigard Received 0 1 /L Permit No 17 16 }Z/�`47
- • 13125 SW Hall Blvd.,Tigard,OR O'er OF TIGARD Date/By: l7. S ,� )./J
Phone: 503.718.2439 Fax: SButioNG DIVISION Plan Review
Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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
❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
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: 77(5 5,..) G.�tr/rt.E L p�S i>Q Catch basin or area drain 18.76
a Drywell,leach line,or trench drain 18.76
City/State/ZIP:
�`4.�'�t Q'�' i TZz4 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer / 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
1ROPERTY OWNER ❑ TENANT Expansion tank 12.51
��
ail t} fit. dLG� Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:(4n ) 70$-one Fax:( ) Ice maker 12.51
❑ 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/basi avatoryy) / 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower hower pan , 12.51
E-mail: nna 25.02
Water closet J 25.02
CONTRACTOR
Water heater 37.52
Business name:
!_j),i/Af C,/- Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( )
Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: _ TOTAL PERMIT FEE
Print name: eu4h G4 kel�s� Date: f/l7/(S This permit application expires if a permit is not obtained within 180 days
VV / after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Buil ding\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- I" 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
51.00 to 55.000.00 Minimum fee S72.50
Storm&Rain Drain-each additional 100' 37.5'- $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
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 nonnal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall 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 El 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
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extra
ctor plumbing permit can be issued.
Water Clooseet-Toilet p g p
Urinal
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
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
7715 SW GENTLE WOODS DR, TIGARD, OR,
97224
Residential - Master Permit
699 Mechanical final
PASS
MST2015-00167
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
7715 SW GENTLE WOODS DR, TIGARD, OR,
97224
Residential - Master Permit
399 Plumbing final
PASS
MST2015-00167
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
7715 SW GENTLE WOODS DR, TIGARD, OR,
97224
Residential - Master Permit
199 Electrical final
PASS
MST2015-00167
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
7715 SW GENTLE WOODS DR, TIGARD, OR,
97224
Residential - Master Permit
299 Final inspection
FAIL
MST2015-00167
David Young
Window by tub to be tempered if within 5' horizontal and less than 60" off floor. R308.4(5)
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
7715 SW GENTLE WOODS DR, TIGARD, OR,
97224
Residential - Master Permit
299 Final inspection
PASS - No C of O
MST2015-00167
Jeff Grove
Violation Summary:
Inspector Contractor