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Permit CITY OF TIGARD MASTER PERMIT •' COMMUNITY DEVELOPMENT Permit#: MST2017-00034 13125 SW Hall Blvd.,Ti Date Issued: 02/23/2017 Tlt;,hKf) and OR 97223 503.718.2439 g Parcel: 2S104DA14200 Jurisdiction: Tigard Site address: 13030 SW CADDY PL Subdivision: QUAIL HOLLOW-WEST Lot: 128 Project: Lewis Project Description: Convert portion of garage to bedroom&bathroom. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 240 sf Basement 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front 0 Smoke Dwelling Units: 0 Third: 0 sf Right 0 Detectors: Yes Total: 240 sf Value: $25,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Drains: 0 Water Lines: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas 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 add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 2 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-3 240 Owner: Contractor: LEWIS,ALEXA HARDLINE DESIGN AND CONSTRUCTION IN Required Items and Reports(Conditions) 13030 SW CADDY PL 8480 SE STRAWBERRY LN TIGARD,OR 97223 MILWAUKIE,OR 97267 PHONE: PHONE: 503-703-3775 FAX: Total Fees: $1,352.92 ' This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spe '7. odes -' -I other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 day, of is ance o ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility otifi do C= to Those rules are set forth in OAR 952- -0010 thro.•h OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC b calling '.3.•3 .198 • 1.800.332.2344. Iss ed By: _. . IU �1.......:—.AL . 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 Applicati f 3Y Residential JAN 2620'7 City of Tigard Received �y APT Date/By: I �� �7 Permit No.: �5f 9, /7-39 13125 SW Hall Blvd.,Tigard OR 9 p� , twat' ;,�1",,, €i.• II C e3 t ,«», Plan Review Phone: 503.718.2439 Fax 503.59, t 06.9y,i ) r 1 �,�'. s i 1..=s< Date/By: -4 Other Permit: Inspection Line: 503.639.4175 -,,'"-- �''' �-30 Ti G A R D p Date Ready/By: kris H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Ala l7 l I Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction 0 Demolition Permit fees*are based on the value of the work performed. XrAddition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. VI-and 2-family dwelling 0 Commercial/industrial Valuation: $ 25 ,K /( ❑Accessory building 0 Multi-family Number of bedrooms: I 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: I'30 4,e, Sk cAbis.Y iNtakcE, New dwelling area: square feet City/State/ZIP: -si‘=,,,,,Ek. ovazot -l_ZZa4 s. Garage/carport area: o square feet Suite/bldg./apt.no.: Project name: _l —1 (_.E��S• Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: vAl L., tiou.,o ? kg.ieST I Lot no.: lZs Permit fees*are based on the value of the work performed. Tax map/parcel no.: 2 s O spA'q RZ��2 141 equipment, 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. AWN, C (ionM PW 1 iZ trr Valuation: $ EA 06 �if,N (fit,,_ �� k<. �n Existing building area: square feet '�C�' New building area: square feet CR PROPERTY OWNER 0 TENANT Number of stories: Name: A L-E�t/IC Lew is Type of construction: Address: (2c• ,D S(� cAiscrT. i->Liocce, Occupancy groups: City/State/ZIP:^ri`,k��j OR.—eb0 N "1'72-'z 3 Existing: Phone:( ) Fax:( ) New: PLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: t.,V^ ( E S`biki � /�„_�n_ � ,N`r (Please refer to fee schedule) Contact name: kp AM ~' , `= s CJt.�VaT Structural plan review fee(or deposit): Address: eal-s SIG -r+ Q.� FLS plan review fee(if applicable): City/State/ZIP: M �� s Uk.t.- D �D� ' ° 7 Total fees due upon application: Phone: 53 -70-s -s.-7—m. Fax::( ) Amount received: 2q� 7 E-mail: ( :06, 1.=_ No rd►0 nec1¢S' ` . i1 Q•li PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: lifektA A\...,Slots 46 p b* D ) Submit two(2)sets of roof plan with connection details Address: 2nd fire department access,along with the 2010 Oregon Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 Phone:(`03. e'-'s ( ) and administrative fees): CCB lic.: 1`1$— .S„ i — State surcharge(12%of permit fee): $21.60 / '��1 7 Total fee due upon application: $201.60 Authorized signature: 40 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. /&f A 4 �l�I:S Date: *Fee methodology set by Tri-County Building Industry Print name: I �" ( \�m �� Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE l SI. Ov.\ Received permit No.: City of Tigard Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: = Phone: 503.718.2439 Fax: 503.598.1960 ❑ Electrical ❑ Plumbing ❑ Mechanical 24-Hour Inspection Line: 503.639.4175 TIC A R D Internet: www.tigard-or.gov ❑ other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l`s No '[' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. • U • 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. 0 0 4 Fire district approval required. Name of district: • 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0 6 Sewer permit. 0 0 0 7 Water district approval. 0 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0 basin protection,etc. 0 0 0 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 0 0 0 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. 0 0 0 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 0 0 0 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- 0 0 0 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. 0 0 0 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. 0 0 0 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. 0 0 0 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 0 0 0 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 0 0 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 0 0 0 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0 for four or more appliances. 0 0 0 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 on and shall be shown to be a licable to the ro'ect under review. 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0 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"building plans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0 27"Drawn to scale"indicates standard architect or engineer scale. 28 Site planto include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0 and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0 0 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) Electrical Permit Application �r �'{4 /e (J ((""�j 1 (w t)1 1 14 I I .-I tA 1 1 City W Tigard a •EC E I N E i< r / —7 Perm,t lr: 13125 SW Hall Blvd.,Tigard,4R 97223 Date/By: lJ J ,j ff 7–{ ,3 I Phone: 503.718.2439 Fax: 503.598 I9(�pp r ' 7 Plan Review `a� 2 DaterBy: Retried Permit : Inspection Line: 503.639.4/75 Ready t tdsy: Internet: www.tigard-or.gov fI1 Sex Page 2 far CITY (it- !ttatitft? Noafied Mettnod sappietnestallafbrmatdoa ❑New construction Addition/alte.ration/replac meat e� P ~� Its ofpl = bee Please check all that apply(submit�sets pleas w/itetffi checked). ❑Demolition 0 Service or feeder 400 snaps or more [3 Building over three stories where the available fault current 0 Marinas and boatyards. r� exceeds 10,000 amps at 150 volts or C]Floating buildings. `�L! i-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 Q commercial-use agricultural ❑Multi-family ❑Minster builder 0 Other amps for all other instalLtions_ buildings. - Q Fire purmp_ []Installation of 150 KVA or < g 3 .. 0 P-mergency system. leaner separately derived Job II: I Job jsite address: I%3Q?�j :si - f ©10011 Addition afore motor load of system C _t'-,�J'�s �L. I�HP or more. City/State/ZIP: tea(? fi ')2 ---e- ❑Su or more residential units, occulxsncy- [ t ❑Health care facilities. ©Recreational vehicle panes. Suite/bldg./apt.#: Project name: b ryy S 0 Hazardous locations. 0 Supply voltage for more than Cross street/directions to job site: ©service or feeder 600 atmos or more, 600 volts nominal. al� j New residentialBaN row Subdivision: Qt U.- single-or multi-family dwelling unit. .ifdg. 1/(,,, I Lot#: 1 2� Includes attached garage. Tax map/parcel#: 2 s)c:,-4 1.000 sq.ft.or less l 68.54 4 f w�, 1122-1/ Ea.add'l 500 „,sz .. riti _,til; ' ..s Y£ ... = ,a� ' s s;:„1 y5 j" l.i... '` s,residential portion 33.92 l /p,�1���J�, `� �r ,.�,,,t p Limited energy,residential 'r :,c: C") T� _�\ /cam ( ") talo— ( (with above sq.ft.) 75.aA 2 Limited energy,multi-family residential(with above sq.ft.) 75.44 ' * ergy ❑ See P Name: � ' r � Renewable Services or Enfeeders iestalLtfa►n,a tion,and2/or relocation Address: 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 City/State/ZIP: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 30104 2 Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less intended for sale,lease,rent,or exchange,according tel ORS 447,449,670,and 701. 59 ' , 1 Owner signature: 201 amps to 400 amps 125.08 , 2 Date: 401 amps to 599 amps 168.54 2 T:13**c. p�' 1 t s"' Branch circuits—new,alteration,or extension,per panel Ake, A kt i 6 A.Fee far branch deeds fee, Business name; 4 !.,, .*.�., �N� above service o-feeder fees Contact name: ,�1 , �t n L� each branch circuit 7.42 7`�`� t Pc", q B.Fee for branch circuits without Address: QV) �. �,4�n„ j I,,,,A j service or funder fee first 56.18 2 l LJ I' blanch circuit City/State/ZIP: 1, A i wit/11.4(66E_ , 9'72_627 07 Each add'I branch circuit j 7.42 2 Phare: '� � � LF�npf:az :( —� Miscellaneous(service or feeder not included) —..,, Each manufactured or modular dwelling,service and/or feeder2 Lmail: 67.84 c a e. ko-f tt d�.e. dei( . Reconnect only 67.84 2 'CON`i[RACro ' l Pump or irrigation cock 67.84 2 Business name y�,' „ i..0`re.'pp / F t.,., � .t„:,_ Sign or outline lighting 67.84 2 Address: # t r , , ,-,€ , Signal circuit(s)or limited energy0see Page 2 „ parol,aliexation or extension. City>'State,'ZIP: (- ' Each additional inspection over allowable in any of the above x 5 k. '`�„J't LAR Phone:(-y - Additional inspection(1 lir into/ 66.25/hr ) -7e-/ 7 j ' / Fax:( ) Mvestigtuitvn{1 hr min) 90.00/hr I Emdii: -- t r I Industrial plant(I hr min) 78.181 hr I CCB Lie.:/ 7 j ��• ltx tical Lie_T.' Inspections for which no fee is ( Y Sulky.Lic.: ey '--u,� specifically listed('.�In min} 1 90.001 / I -FEE hr uprv. Electrician si mire, aired / f ELECT; �liL PERMT f iS . i Subtotal: Print name t l �'- ,e t e9 ( permit fee). * i! f u 3 Date_ Q Platt Review R aired 2S°fo of (( State surcharge(12%of permit fee): Authorized signature: r iF TOTAL PERMIT FEE Thispermit a pi permit is not obtained within ISO Print name: �._ Date: application expires if a days atter it has been accepted as complete. ' Number of inspections allowed per permit Mechanical Permit Appiition FOR OF lct. ; City of Tigard IAN 201 sL ^11 Received Date/By: Permit No.: 13125 SW Hall Blvd.,Tigard,OR 9 23 . r igni . % % ar!jl7-�L7�� g � A I Phone: 503.718.2439 Fax: 50 $48t ) l Plan Review i n I®;a, F A Date/By: ) Other Permit: T t G A R D Inspection Line: 503.639.417p,i t Internet: www.tigard-or.gov ° Date Ready/By: Allis' ® See Page 2 for Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑New construction Addition/alteration replacement Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* Nr.,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 JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address:CSd�0 � Air conditioning 46.75 • Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:-lib D via cilsz3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: Heat pump 61.06 Duct work Cross street/directions to job site: 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 Flue/vent for any of above 23.32 Subdivision: ks►p%(,4- F{_. - _ , I Lot no.: ' Other: 23.32 p Other fuel appliances: Tax map/parcel no.: l A�L DI�� ism 4}O/A vct22a0 ZO { (02+i Water heater 23.32 DESCRIPTION'OF WORK h Gas fireplace/insert 1 33.39 (� - . ,t)AA t t b4, 6.,_. Fest).• 1 Fluerevent for water heater or gas this, CX'�,11�'IGt}/ L x �`l INAI S'�iV fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 x.PROPERTY OWASIFR.. Other: 0TENANT ' 23.32 Name: Environmental exhaust and ventilation: Range hood/other kitchen Address: equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, Phone:( ) toilet compartments,utility rooms) 23.32 Fax ( ) Attic/crawlspace fans 23.32 APPLICANT }`x 0 COTCT PERSON Other: NA �-�,u 23.32 Business name: A, INEru&kl /1,yvFuel piping: '�' � ( $14.15 for first four;$4.03 for each additional Contact name: itlobilhvv. wag Furnace,etc. Gas heat pump aiw..pl _ Cip)'C "‘. Wall/suspended/unit /unit heaterCity/State/ZIP: NA OQ ' 9 i C°-7 Water heater Phone:(�"2j, b 3 `7?S-- I Fax::( Fireplace ( E-mail: 1�.A.0 Range �� � n Barbecue CO` 7 OR Clothes dryer(gas) Business name: n 4% p J dL ! -tom J Other: l./�b 61.0 � c.�� . MECHANICAL PERMIT FEES* Address: g Subtotal City/State/ZIP: IAD ? � � Minimum permit fee($90.00) Phone:(pJ� ' Plan review(25%of permit fee) 70 3. 37754-, Fax:( ) State surcharge(12%of permit fee) CCB lie.: 793 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. * Fee methodology set by Tri-County Building Industry Service Board Print name: I Date: I:ABuildingA Permits\MEC_PermitApp_040113.doc 440-4617T(1 I/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial&Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PernutApp_040113.doc 2 Plumbing Permit ' . Building Fixtures Applic _ City of Tigard J/N 2 to 2017 Received IN • 13125 SW Hall Blvd.,Tigard, X223 Date By: / / Permit No.: y�4/)/7 � Phone: 503.718.2439 Fax: s�a 151 1 Plan Review /�! i `f ��� � Other Permit No.: T I G A R D Inspection Line: 503.639.419M M� i N (. UJ /5:,RD Date/By: Internet: www.tigard-or.gov s`` 3 Dale Ready/By: Juris: I See page 2 for Notified/Method: Supplemental Information TYPE OF.WORK FEE* SCHEDULE 0 New construction ❑Demolition For special information use checklist *ddition/alteration/replacement 0 Other: Description Qty. Ea. Total New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath � w1-17-ZOL - '~10-and 2-family dwelling 0Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builder Each additional bath/kitchen 25.02 ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1 Gw / P t - _ Catch basin or area drain 18.76 City/State/ZIP: b , Ol 7(2�z LDrywell,leach line,or trench drain 18.76 t l Suite/bldg./apt.no.: I Project name: Footing drain(no.linear ft.: ) Page 2 � )� 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 Subdivision: �J,L� Water service(no.linear ft.:_) Page 2 �, I Lot no.: re e6 Fixture or item: Tax map/parcel no.: 2-CJ1( 1 A 1 i 21,21) Backflow preventer 31.27 DESCRONF WORT Backwater valve 12.51 to �� 1 � Clothes washer 25.02 I al-- , �V" " - 1 V`'�i Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ©-PROPERTY'OWNER 1 ❑ TENAN I Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 City/State/ZIP: Garbage disposal 25.02 Hose bib 25.02 Phone:( )- ( ) Fax: Ice maker y. 12.51 PLICANT':..' , • 0.CONTACT PERSON Interceptor/grease trap 25.02 Business name: lQ p,ALe Q S-(1 „ �, j„�, ,,1 p_ � .,_ab 1 _Medical gas(value:$ ) Page 2 Contact name: A L 0/402_ Primer 12.51 Address: S-44c�Pln ri� Roof drain(commercial) 12.51 J Sink/basin/lavatory 25.02 City/State/ZIP: it'A (Lr,gyp., 1'4 F ,gyp - e 7-�(D� KA w''11J� V�--- Solar units(potable water) 62.54 Phone:(C....1. -l 7 3 j � I Fax::( ) Tub/shower/shower ower/shower pan 12.51 E-mail: Y--1ltv �Cc l y43-t- Urinal 25.02 CONTRACTOR Water closet 25.02 j Business name: C� �"lOt.e_1JT -113 Plu►t.-! /JU Water heater 37.52W 6 �s Water piping/DV 56.29 Address: D Poo x y Other: 25.02 City/State/ZIP:�i� y J ()2 7 7e5 Sc Subtotal Phone: Fax:&56! Q'i a S �Q(,Q�I �. ( ) Q Minimum permit fee: $72.50 CCB Lie.: 1 .5 5 obi,7 Plumbing Lic.no.: pe, 3 9 Plan review (25%of permit fee) Authorized fgnature: 7/11/7 State surcharge(12%of permit fee) ��'' f TOTAL PERMIT FEE Print name: I Date: I 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. I:\Building\Permits\PLMO-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: 50.03 Oto 2,000 $121.90 Footing drain-l'100' 2,001 to 3,600 $169.69 Footing drain-each additional 100' 37.52 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 0 and$1.52 for each additional$1 0 02.50 for the first OorOfraction thereof,to Other Inspections or Fees Qty. Fee(ea) Total 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. 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimumAd nal plan review for revisions each additional$100.00 or fraction thereof.charge-1/2 hour) 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 ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" $el Ihatgra Isometric or , 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Comments regarding fixture work: Ice Mach./Ref ig.Drains 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 Extractor plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13030 SW CADDY PL, TIGARD, OR, 97223 July 6, 2017 at 12:10:42 PM Record Type: Record ID: Residential - Master Permit MST2017-00034 Inspection Type: Inspector: 399 Plumbing final David Young Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13030 SW CADDY PL, TIGARD, OR, 97223 July 6, 2017 at 12:14:36 PM Record Type: Record ID: Residential - Master Permit MST2017-00034 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Gas FP installation ok. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13030 SW CADDY PL, TIGARD, OR, 97223 July 6, 2017 at 2:20:00 PM Record Type: Record ID: Residential - Master Permit MST2017-00034 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13030 SW CADDY PL, TIGARD, OR, 97223 July 6, 2017 at 2:22:21 PM Record Type: Record ID: Residential - Master Permit MST2017-00034 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - NoCofO Comments: Note: C of 0 only issued for new residence. Building final approved. Violation Summary: Inspector Contractor