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Permit (97) INICITY OF TIGARD MASTER PERMIT' `` COMMUNITY DEVELOPMENT Permit#: MST2017 00130 T-[GAP D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/17/2017 Parcel: 1 S 135DB03900 Jurisdiction: Tigard Site address: 11390 SW 92ND AVE Subdivision: DOGWOOD RIDGE Lot: 12 Project: Woodhouse Project Description: Remove existing bathroom, repurpose 2 bedrooms into bathroom and closet. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 3 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 24 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $4,500.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 2 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: 0 Heat Pump: N Hoods: 0 Other Units: 1 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'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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 0 Owner: Contractor: DUSTIN WOODHOUSE OWNER Required Items and Reports(Conditions) 11390 SW 92ND AVE DUSTIN WOODHOUSE TIGARD,OR 97223 11390 SW 92ND AVE TIGARD,OR 97223 PHONE: 503-830-5830 PHONE: 503-830-5830 FAX: Total Fees: $611.73 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 iss,- ce, or if work i suspended for more the 180 days. ATTEN •N: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati• enter. .s/ rules are set forth in OAR 952-001 '11.10 through o.R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5.c .1987 or :,,07.32.2344. Issue. By: ,- �L= / Permittee Signature: /; i►./.Aka. . . Call 503.639.4175 by 7:00 a.m.for the next available inspection d 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. Buildin Permit A lie ' IIVE i) Residential a rolz orrl1 l. tsl:0\1.1 City of Ti and n Received g H11 Date/B : �� Permit No.: r I - r 0 4 13125 SW Hall Blvd.,Tigard,O 7 3 Plan Review 1114 i Phone: 503.718.2439 Fax: TIGARD Date/B : I, Other Permit: I I K D Inspection Line: 503.639.41 I Il7•�Yl� Date Ready/By: r Juris: H See Page 2 for Internet: www.tigard-or.g UILDI {G DIVISION Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction 0 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. -and 2-family dwellingValuation: $ 4' ?PC 0 Commercial/industrial L ❑Accessory building 0 Multi-family Number of bedrooms: / Wir3 ❑Master builder 0 Other: Number of bathrooms: Q JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 13q 0 S(!� q2,1 .1C. A Ar-e New dwelling area: square feet City/State/ZIP: -T�xer, . b f q.Z-Z-33 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: f>j S e/N W 00-b 4.1:41..g" ITJLJ 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: 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. Ve UX/Sri 4� t O SC- Z izeyy fs Valuation: As tU p .(,tlQ r C/inS - Existing building area: square feet New building area: square feet PROPERTY OWNER 0 TENANT Number of stories: Name: PO71t4 WOW),f"J Type of construction: Address: _ciliu k, ja 7 S/T Occupancy groups: City/State/ZIP: Existing: Phone:(1,153) 8"30 `tea Fax:( ) New: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: yesepie (Please refer w fee schedule) *.5,,,,e__ Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Phone:( ) Fax::( ) Amount received: P 97, 3 E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Comme ial and residential prescriptive installation of CONTRACTOR roof-top unted PhotoVoltaic Solar Panel Syste u Business name: Q j t� Submit two ets of roof plan with co on details and fire departme .ccess,alon the 2010 Oregon Address: Solar Installation Speci... 'ode checklist. City/State/ZIP: Permit Fee udes p eview $180.00 and administrative : Phone:( ) Fax:( ) .te surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: �/ This permit application expires if a permit is not obtai •d te/f/17,„.4./L, v 1`� / within 180 days after it has been accepted as complete. Print name: Dors ' � -p - Date: G.1/ *Fee methodology set by Tri-County Building Industry CTty Service Board. I:\Building\Petmits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling rolz orrice: lsi oyl.v NCity of Tigard Date/By:Received Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: I Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical T I G A R I) Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les '° y/' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • II 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. ❑ ❑ 0 4 Fire district approval required. Name of district: • A 0 0 5 Septic system permit or authorization for remodel. Existing system capacity ❑ 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. 0 0 0 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. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0 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. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0 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. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0 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- 0 0 0 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 0 0 0 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. 20 Manufactured floor/roof truss design details. 0 0 ❑ 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. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0 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". 24 Two(2)sets each are required for Items 16,19,20 and 22 above. 0 0 0 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. 0 0 0 28 Site plan to 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. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0 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) Mechanical Permit Applicat' FOR OFFICE USE ONLY CEIVED City of Tigard Received Permit No.: `J g Date/By: l7Ti 7—e...:6,/ .I III13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960p f Date/By: Other Permit: TI G A R U Inspection Line: 503.639.4175 APR 17 Date Ready/By: Juns: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OFTIp GRD TYPE G DIVISION i COMMERCIAL FEE* SCHEDULE - USE CHECKLIST lJ L�6 1 j j� Mechanical permit fees*are based on the value of the work 0 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:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 12(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 1 JOB SITE INFORMATION`-AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: ( 1-- 610 cu.! el•v_,49 FIV�i Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: �1 (_4,, ©e- ci'. -.Z.?J Furnace 100,000+BTU(ducts/vents) 54.91 �1 Heat pump 61.06 Suite/bldg./apt.no.: Project name: DV8 itjtoD k. 5-6 Duct work 1 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 - DESCRIPTIONGas fireplace/insert 33.39 OF,W ItI ;- Flue vent for water heater or gas MOV Q 151/13 61 IM-fteeCtAA l Q o Z c fireplace 23.32 p M �� -) MI-ACIV r^`� (� Log lighter(gas) 23.32 11�$ f.� y 1 C1t- v"r,(. Wood/pellet stove . 33.39 CIAY4T- Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 BO'PROPERTY OWNER ' y .❑ TENANT Environmental exhaust and ventilation: Name: tV 5-0 N W rot> .c Range hood/other kitchen equipment ment 33.39 Address: v F�t.%; PS ,..bri.2 CITE Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, j� 14 toilet compartments,utility rooms) 23.32 ( !b Phone:((y')) g30 - c7 Fax:( ) Attic/crawlspace fans 23.32 ,d*R. ICA T wo, .0 ONTAC'#' ERSON. Other: 23.32 Business name: Fuel piping: S a �� A aJ $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Gas heat pump Address: Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue ' • .AV-t-,:, ''..: CONTRAG OR.,:r Clothes dryer(gas) 0 Ls fJ E/) Other. Business name: Uoic !C� q'7 1iI+iICAL PERMIT 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 lie.: 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: df 374,2, s Fee methodology set by Tri-County Building Industry Service Board Print name: 9Oc7r-,'iki Rib°©tler cC Date: /1 (I 7 \ I:\Building\PermitsMEC_PennitApp_040113.doc V440-4617T(11/02/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_PermitApp_040113.doc 2 Electrical Permit Application FOR 01:11( 1. t Se ()yI.1 illCity of Tigard RECEIVE �''naieise� Permit#: p y rao I _00/ C6 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 APR 1 1 2017 Ready Date/By: Juris: H See Page 2 for 1 i C,A R D Internet: www.tigard-or.gov pp'���ry*y err Notified/Method: Supplemental Information PE OF WOCII j I OF IGARD PLAN REVIEW ❑New construction Addition/altet WYE/HMI 'VISION 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. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 12 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: t I'.;ft Q Su-► (,,jam/ 100HP or more. ❑"A">"E">"1-2",`°l-3", Q,1 City/State/ZIP: , (4) y() CV23 0 Six or more residential units. occupancy. 0 1J1 ^ ✓ Health-care facilities. Recreational vehicle parks. Suite/bldg./apt.#: Project name: VGe3ri o � 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: FEE SCHEDULE Description I Qty. I Each I Total -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'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential r �,�1 p I - '�j (with above sq.ft.) 75.00 2 Y t:" -ADM 1 aki 4 -- i t'r)00-141 iC l�Cs� J t (5/[Mc Limited energy,multi-family residential(with above sq.ft.) 75.00 2 liROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2 PServices or feeders installation,alteration,and/or relocation Name: -c1 NI DOD PO o ce 200 amps or less 100.70 2 Address: smote A. v)g S tT 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:( ,--S) t) cV" V Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation: 's installation is i Bing made on property that I own which is not 200 amps or less 59.36 1 intended for sale,leas r� o)!exch. 1{ ccording to ORS 447,449,670,an 701. 201 amps to 400 amps 125.08 2 Owner signature: ��((ff / .,� Date: 401 amps to 599 amps 168.54 2 El APPLICANT 0 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 2 each branch circuit Contact name: c j .Z , ç Ai;6 V 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 a. 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 Pump or irrigation circle 67.84 2 Business name: O[AJ Ni £12,. Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy 0 See Page 2 2 Address: 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) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: IVTOTAL PERMIT FEE: r ¢ This permit application expires if a permit is not obtained within 180 Print name: 00s-7 kl jD p DR)ifrr Date: /�/ days after it has been accepted as complete. CC�v�� * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: SCHEDULE RESIDENTIAL WORK ONLY: FEE SCI Qty. I Each I Total I 3r Renewable for all residential systems combined: $75.00 enewDescription Renwable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 El 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) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 El 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 specifically listed('/Z hr min CO RCIAL WORK ONLY: '`1. ELECTRIC-AL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): y * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls El Clock Systems ❑ Data Telecommunication Installation El Fire Alarm Installation El HVAC ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* El Medical El Nurse Calls El Outdoor Landscape Lighting* ❑ Protective Signaling El Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Plumbing Permit Applica r Building Fixtures VECEI�+ED FOR OFFICE USE ONLY City of Tigard ,yy a Date/By:a PermitNo.: 1` P1jT�/7-00/30 lig ■ 13125 SW Hall Blvd.,Tigard,OR 9723 L Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.: Ti C A K D Inspection Line: 503.639.4175 CITY OF TIG,AR Date Ready/By: Jur s: fa See Page 2 for Internet: www.tigard-or.gov PJ Notified/Method: Supplemental Information TYPE oP n iNG`� Ii1'J1� FEE* SCHEDULE ❑New construction 0 Demolition For special information use checklist Description I Qty. Ea. Total [Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 Ed1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family Each additional badVicitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: t t"'" .10 cS(� 9,1_,..1,,, Catch basin or area drain 18.76 11&/ �� Oa- q��� Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: ( Project name: p05-11,3 wooDtjot. j 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: 1 Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 h w Backwater valve 12.51 _1 DESCRIPTION OF'� :;`' Clothes washer 25.02 r12, \1 )c(.c'11 ( �( 1N "� /l 1 n iil QOS rG Z- Dishwasher 25.02 5 ikS g L4 1 CIXS{ Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY(). * I y $ 0 TENANT4r ' Expansion tank 12.51 Name: D 0 5--nltd 0 Dip use- Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: S q Ci ASS ,pg S I- i Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 4:11''''''';4 0 APPLI{W a 44 Interceptor/grease trap 25.02 ,. .ri CONTAT PERSON Business name: � � Medical gas(value:$ ) Page 2 `Y`?a\ Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 'Z ' 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan j. ' 12.51 E-mail: Urinal 25.02 . r, 4 ',... ._ i., Water closet ( 25.02 CU1V I I2 Water heater 37.52 Business name: O LO /`-' f-J2- 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) V Authorized signature: ` TOTAL PERMIT FEE Print name: ws'p�yt, / This permit application expires if a permit is not obtained within 180 days �]� �a > Date: ems/( l r� after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\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-l' 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other;Inspections or Fees Qty. Fete(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 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 cgtiosio accurately report fixtures could result in increased sewer fees*. ` Review for Plumbing hi ul atto, Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: CaPtied- Added Relocate 0 Any new commercial building with water service 2"and Baptistry/Font BashTub/Shower greater,except systems designed and stamped by licensed engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic 0 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" 4„ 0 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 beaid before the Water Extractor p Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 4 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325(2)) This statement is required for residential building,electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCM Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or ✓pL'•I I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Print Name of Perx Cia/Ti mit Applicant 4//X7 '` Sign ure of Permi Applicant Date Permit#: 4 T O I`7 -6 C0 t 3O 1(390 �� �a, .�: . Address: ft"ifFV. • �— kr.r.11utisv� oe 7?-a3 Issued b Date: 41/17// This Copy for Permit Offices City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11390 SW 92ND AVE, TIGARD, OR, 97223 February 22, 2019 at 7:35:02 AM Record Type: Record ID: Residential - Master Permit MST2017-00130 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Provide approved electrical, plumbing and mechanical final inspections prior to building final inspection. R109.1 .6 No final inspection done at this time. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11390 SW 92ND AVE, TIGARD, OR, 97223 March 25, 2019 at 11 :45:18 AM Record Type: Record ID: Residential - Master Permit MST2017-00130 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11390 SW 92ND AVE, TIGARD, OR, 97223 March 25, 2019 at 11 :42:02 AM Record Type: Record ID: Residential - Master Permit MST2017-00130 Inspection Type: Inspector: 699 Mechanical final Aaron Cillo-Gobel Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11390 SW 92ND AVE, TIGARD, OR, 97223 March 25, 2019 at 11 :44:31 AM Record Type: Record ID: Residential - Master Permit MST2017-00130 Inspection Type: Inspector: 199 Electrical final Aaron Cillo-Gobel Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11390 SW 92ND AVE, TIGARD, OR, 97223 March 25, 2019 at 11 :45:55 AM Record Type: Record ID: Residential - Master Permit MST2017-00130 Inspection Type: Inspector: 299 Final inspection Aaron Cillo-Gobel Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor