Permit Support Document (147) RE
C . _. -
.1111 City of Tigard • COMMUNITY DEVELOPMENDEP MERIT !, ,
Request for Permit Action ✓ C If''O . I IGAIO
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigarVTG DIVISION
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ® Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(/)one
REFUND OR Name: Riverside Homes,LLC
INVOICE TO: (Business or Individual)
Mailing Address: 17933 NW Evergreen Parkway, Ste 370
City/State/Zip: Hillsboro, OR 97006
Phone No.: 503-645-0986
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
r CANCEL;/VOID PERMIT APPLICATION.
El_...._�D PERMIT FEES (attach copy of original receipt and provide explanation below).
F ' INVOICE R FEES DUE (attach case fee schedule and provide explanation below).
r E/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: MST2016-00305 /J&,f2oi ,
" evA6 7
Site Address or Parcel #: 12805 SW 133"'Ave.
Project Name: Walnut Ridge
Subdivision Name: Walnut Ridge Lot#: 002
EXPLANATION: Reapplying for a revised floor plan of the original submission for this site.
cc,E. /(7-C' c20iC •--,0a 5-6,f/Sc j )i e5z95r77
Signature: Date: 12/8/2016
Print Name: Nikki Pruett
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date By Route to Records: Date /2/25/ /A, By,411.
Refund Processed: Date/v//9 B 44 Invoice Processed: Date /W„,.eit'f., By > i'
Permit Canceled: Date /2./2f//�, By ���'" . Parcel Tag Added: Date / By
I:\Building\Forms\RegPermitAction_09.f314. oc
�! CITY OF TIGARD FEE AND PAYMENT HISTORY
II i 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
MST2016-00305 - 12805 SW 133RD AVE, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Plan Review 230-0000-43106 $751.34 $751.34 $750.00 8/1/16 Check 405257 $1.34
DC Provision Review, SF-Ping 100-0000-43112 $90.00 $90.00 $90.00
Plan Review 230-0000-43106 $427.38 $427.38 $427.38
Totals for Fees $1,268.72 $1,268.72 $750.00 $518.72
Receipt# Payment Method Check# Pavor: Receipt Date Receipt Amount
405257 Check 34798 Riverside Homes LLC 08/01/2016 $750.00
Total Payments: $750.00
Balance Due: $518.72
IIIq City of Tigard i COMMUNITY DEVELOPMENT
= Building Division
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TIGARD
INVOICE
TO: Riverside Homes,LLC Customer ID: 189148
Atm: Nikki Pruett Invoice No.: INV2016-00017
17933 NW Evergreen Pkwy, Ste 370 Invoice Date: 12/29/2016
Hillsboro, OR 97006 Date Due: 1/29/2016
Case No. Site Address Subdivision-Lot#or Project Name Amount Due
MST2016-00305 12805 SW 133rd Ave. Walnut Ridge,Lot 2 $518.72
Fees due for plan review completed
prior to request to void permit.
Invoice Total: $518.72
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MST2016-00305 Customer ID: 189148
Site Address: 12805 SW 133rd Ave. Invoice No.: INV2016-00017
Project: Walnut Ridge,Lot 6 Invoice Date: 12/29/2016
Date Due: 1/29/2016
Invoice Total: $518.72
Amount Paid: $
Office Note: Route copy of receipt to Dianna Howse.
Please mail payment to:
City of Tigard, Building Division
Atm: Dianna Howse
13125 SW Hall Blvd.
Tigard, OR 97223
I:\Building\Accounting\Invoice.doc 01/14/2011
•. v 0 I .
Building Permit Application s'
Residential FOR OFFICE:USE OM
Ci of Tigardrir
Received 71 44/
g Date/By: 7 ' ' Permit No.
' ,1u 13125 SW Hall Blvd.,Tigard,OR 97223 ,, tI tt; Plan Review �� �6�D� 1�
s Phone: 503.718.2439 Fax: 503.598.19601 G 1 (11 Date By: �— I�j Other Permit. 4/2 j6--QC7e2 77
T I G:1 fi D Inspection Line: 503.639.4175 Date Ready/By: et'' Iur s: I See Page 2 for
Internet: www.tigard-or.gov z, Notified/Method: 0 Supplemental Information
�' n '' e t t aµt a 1.,1 �a d ,. .per rd
®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 0 Other: equipment,materials,labor,overhead,and the profit for the
r , •u work indicated on this application G
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 3 j 7
0 Accessory building
0 Multi-family Number of bedrooms: 4
0 Master builderOther: Number of bathrooms: 3
,, ..;. Total number of floors: 2 3 Q Q
tttrt ' g ❑ot t to t
Job site address:12805 SW 133rd Ave New dwelling area: 2626 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 379 square feet p
Suite/bldg./apt.no.: Project name:Walnut Ridge Covered porch area: 33 square feet 1 ►1 ►1-7 .S3
? ,
Cross street/directions to job site:SW Walnut and SW 133rd Ave Deck area: square feet J) 7 9
Other structure area: square feet
:. ,,.s" per " l �'�
Subdivision:Walnut Ridge Lot no.:002 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
'44'%''•:'''''''''':**"'' o E' rt i a � p�r tom. work indicated on this application.
Construction of SFR Home Valuation: $
Existing building area: square feet
New building area: square feet
a+ 14it e e . , - ,.,f Y< � ` Number of stories:
Name:Riverside Homes,LLC Type of construction:
Address:17933 NW Evergreen Parkway,Suite 370
Occupancy groups:
City/State/ZIP:Beaverton,OR 97006 Existing:
Fax:( ) New:
'
swar4i 11 ; ii ,N 0,Phone:(503)645-0986 ` tii t ,,Jlk. ' ' •, Il.rf [ . ,7.--,:1-1,-...,,v ' z p }
Business name:Same as Above
Structural plan review fee(or deposit):
Contact name:Wes Boisvert
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
E-mail:wboisvert@riversidehome.com # }'
% :4''Z.--.:'''''
; Commercial and residential prescriptive installation of
�t y roof-top mounted Photovoltaic Solar Panel System.
Business name:Riverside Homes,LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:17933 NW Evergreen Parkway,Suite 370
Solar Installation Specialty Code checklist.
City/State/ZIP:Beaverton,OR 97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)645-0986 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:189148
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Wes Boisvert Date:07/12/2016 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application VOL "`. 1,OR OFFICE I;SE°NI.,
Cl of Tigard :' Received
`� g Date/By: Permit No.
11111 1 13125 SW Hall Blvd.,Tigard,OR 97223 5 �6...00 3AB
Phone: 503.718.2439 Fax: 503.598.1960 I' " t t1 Plan Review Other Permit:
Inspection Line: 503.639.4175 CIL �° t l) Date Ready/By:I<.; R T7 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov t Notified/Method: Supplemental Information
Y` 5 ..,, .d' # • ,c :k s 4 „ ' l igtfl"l Bali -': * `• i' a +�
> " ,"� _" - -' Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:
'fir V 6* EG60, BTI iJCil°14 -.,i 5
v Ftl-° tail ;- ISig1`EMS-' " '�
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
h ,; , ,' . ' , e ' ' =t r Y Heating/cooling:B F tu
Air conditioning 46.75
Job site address: 12817 SW 133rd Ave Furnace 100,000 BTU(ducts/vents) 1 46.75 46 75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name: Walnut Ridge Duct work 1 23.32
23 32
Cross street/directions to job site: SW Walnut&SW 133rd Ave. 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 1 23.32 23.32
Subdivision: Walnut Ridge I Lot no.: 002 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23 32
5 ' Ix Ns'i- 4. t RKY , ,' t Gas fireplace/insert 1 33.39 33 39
Flue vent for water heater or gas
Construction of SFR fireplace 1 23.32 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ar Other: 23.32
;' _ � - t �.ERTY,mss i
J_. ` ti.
n Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Rangehood/otherkitchen
equipment 1 33.39 33.39
Address: 17933 NW Evergreen Parkway, Suite 370 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Beaverton, OR 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32 93.28
Phone:( 503) 645-0986 Fax:( ) Attic/crawlspace fans 23.32
' CLIC t % .., i Cs "3 cr ' '#'N'717' Other: 23.32
Fuel piping:
Business name: Same as above
$14.15 for first four;$4.03 for each additional
Contact name: Wesley Boisvert Furnace,etc. 1 14 15
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace 1 14 15
Range 1 14 15
E-mail: wboisvert@riversidehome.com Barbecue
''''''''".4.t7:4• s Clothes dryer(gas)
Other:
Business name:
Pyramid Heating &Cooling
' Mi i y k• 'i 4. e'''':1.- 'I''.' :;.4;,. .";t
ttf
Address: 9409 NE Colfax St. subtotal 375 93
City/State/ZIP: Portland, OR 97220 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 503) 786-9522 Fax:(503)786-3432 State surcharge(12%ofpetmit fee)
CCB lie.: 59382 TOTAL PERMIT FEE
jJ This permit application expires if a permit is not obtained within 180
l V S v ar days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: Wesley Boisvert Date: 7/10/2016
1:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1I/02/COM/WEB)
Electrical Permit Applicatio I t I:oR OFFI(E USE OM.v
Cl O Tl and ,• yY�} 0 �'eceived �t
`'J f g �j�.1 `1 V DateB : Permit#:i C5% e/bj- 0• a
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 ': EffillMIM Related Permit#:
Inspection Line: 503.639.4175 +. "
T I G A K D p _ j � 'heady Date/By: 7uds: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
, , ii. � 'P'' ,t W
r
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
:
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other
l - where the available faultcurrent Marinas and boatyards.
tyar
„,,,.,a„ el*'t i ' ...6 CO (l�,. e, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
dwelling 0Commercial/industrial 0Accessory building
® 1-and 2-familyless to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
"�. .TOE 'I 1114
��*� w.,� e. , 4I0N' .'i)i,EI,•x0 iN f 0 Emergency system. larger separately derived
Job#: Job site address: 12817 SW 133rd Ave ❑Addition of new motor load of system
100HP or more. ❑"A","E", 'l-2",'l-3",
City/State/ZIP: Tigard, OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: Walnut Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Walnut&SW 133rd Ave. 1;"' ' y,tE ; t tris : '
DescdEao I Qty. I Each I Total_ I
New residential single-or multi-family dwelling unit.
Subdivision: Walnut Ridge J Lot#: 002 Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: 1 Ea.add'l 500 sq.ft.or portion 9- 33.92 1
e t .. t t i:".4 IN 0 ': rt 4 719'"s,r Limited energy,residential J 75.00 2
Construction of SFR (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
i r• 2
PRERTY 0� t3 : ., ` Et Services orRenewable feedersEnergy installation,alteration,❑ SeePage and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen Parkway, Suite 370 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( 503) 645-0986 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: wboisvert@riversidehome.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,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
„acofBranch circuits—new,alteration,or extension, er panel
0 -.,„' CANS ' ` , ,, �ti AV 4A -, A.Fee for branch circuits with
Business name: Same as above above service or feeder fee,
7.42 2
each branch circuit
Contact name: Wesley Boisvert B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Wboisvert perlversidehome com Reconnect only 67.84 2
z. . 6sj:i ' --. ir? Pump or irrigation circle 67.84 2
Business name: Garner Electric Sign or outline lighting 67.84 2
Address: 2920 SE Brookwood Ave#1 Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 503) 6484552 Fax:( 503)642-7925 Investigation(1 hr min) 90.00/hr
Email: ge@garnerelectric.com
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 121159 Electrical Lic.: 37075 Suprv.Lie.: specifically listed(%hr min) 90.00/hr
Suprv.Electrician signature,required: aim „ " *'777g Subtotal:
Print name: Chuck Garner I Date: 07/12/2016 0 Plan Review Required(25%of permit fee):
a , imState surcharge(12%of pennit fee):
Authorized signature: ttiookB '`c TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Wesley Boisvert Date: 7/12/2016 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDWJAL 'FRKEs ,
Fee for all residential systems combined: $75.00 Description
r"-Qt;. I Each I Total I *
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑X Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑X Heating,Ventilation and Air Conditioning
Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s cificall listed %hr min
COM
* Number of inspections Subtotal peter n P.
ro
allowed
p
Fee for each commercial system: $75.00o a e l):
(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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
[:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application \ / 0 ,., 1 5:4 ,, '
* Building Fixtures FOR orl�lcl. I:sl: ON El
City of Tigard t '
��\(Q Received
Date/By:Pemit No.s/S/' ��r9
Q3C�u 13125 SW Hall Blvd.,Tigard,OR 9722 \�" " Plan Review ether Penut No.:IN I Phone: 503.718.2439 Fax: 503.598.13\
Date By:
Inspection Line: 503.639.4175
t I G A I.l) Internet: www.ti and-or. ov i. Date Ready/Bed/Metho Juris: Supplemental0 See Pagefor
g g NotiSed/Method: Information
tit ,.
&, 'tea+ . .. ,,,..
®New construction 0 Demolition For special information use checkdist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other:, , ,,„. , New 1-2-family dwellings(includes 100 ft.for each utility connection)
At t { sia ,,,,,:ill: SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder
0 Other:
Fire sprinkler(_sq.ft.) Page 2
: I' ,tf? r5$ 1 is A e J Site utilities:
Job site address: 12805 SW 133rd Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Walnut Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Walnut&SW 133rd Ave. Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_I Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Walnut Ridge I Lot no.: 002 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve
I„,;,„ DE \ Ott t ' at 12.51
` Clothes washer 25.02
Construction of SFR Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r l pgop owM Rw • . I It` Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sinlc/hub 25.02
Address: 17933 NW Evergreen Parkway, Suite 370 Garbage disposal 25.02
City/State/ZIP: Beaverton, OR 97006 Hose bib 25.02
Phone:(503) 645-0986 Fax:( ) Ice maker 12.51
Interceptor/grease
,�:-,. r rLi • . • . .. trap 25.02
Business name: Same as above Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Wesley Boisvert
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: wboisvert@riversidehome.com Urinal 25.02
c .s: Water closet 25.02
>" :*°:i1,-.••41, 4
mss- .. ' Water heater 37.52
Business name: H & H Mechanical
Waterpp r m WV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Phone:(503) 975-9787 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 178122 Plumbing Lic.no.: PB414
q State surcharge(12%of permit fee)
Authorized signature: w 3 ""24
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: Wesley Boisvert Date: 7/12/2016
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Pennits\PLMU-PesmitApp.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:
'SWUM
Footing drain-l't 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 v
Storm&Rain Drain-1st 100' 62.54 " : "' + � g • f,'
$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
�,,A .� e TM $.., t"of"Y. ea)� , each additional$100.00 or fraction thereof,to
Wither In`f 4'1 .t B!9 s or
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 char:e-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 char:e-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*.
Fixture Type
Fixture Type for Quant1 by elace?
Work Performed: Capped Added Reloc .; Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font pp y'
Bath Tub/Shower
0 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 Tluu 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 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"
Car Wash Drain
0 Isometric or risers
diagram is required for new buildings
�ryY"
Garbage -Domestic-non-food g
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.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 thisermit results in an
Washer-Clothes p
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\npruett\Downloads\PLMF_PetmitApp(1).doc 2