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Permit (124) CITY OF TIGARD MASTER PERMIT III 2 '- COMMUNITY DEVELOPMENT Permit#: MST2017-00326 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/23/2017 " '� Parcel: 1S 136AD01500 Jurisdiction: Tigard Site address: 10530 SW 69TH AVE Subdivision: VILLA RIDGE Lot: 2 Project: Ray Project Description: Relocate laundry room to create additional bathroom. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left 0 Parking Spaces: 0 Height: 0 Bathrooms: 2 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $8,000.00 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 Rain0 Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 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: 1 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 add!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 0 Owner: Contractor: RAY,CODY VGP CONSTRUCTION LLC Required Items and Reports(Conditions) 10530 SW 69TH AVE 13049 SE MILL ST TIGARD,OR 97223 PORTLAND,OR 97233 PHONE: 503-369-8628 PHONE: 503-705-0134 FAX: Total Fees: $616.94 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: Ore n law requ'es you to •Ilowd e rules adopted by the Oregon Utility Notification Center. ose rules are set forth in OAR 952-001-0010 through 0 952 1-009 . You may• '• - Apy of the rules or direct questions to OUNC by ailing 503.232.1987• :'0.332.2344. Issued By: 8 .G/j /'4. / Permittee Signature: A Call 503.639.4175 by 7:00 a.m.for the next available inspection d . N L V This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. ' ' Building Permit Application Residential RECEIVED Received ,r 3 7 e 03„2 City of Tigard y c /,‘, ./7 Permit No % S�, 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 1 [1 2017 Date/By: i g Plan Revie ,... j7 Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 t, Date/By: .1 ( TIC A R D Inspection Line: 503.639.4175 CITY OF I I€aARD Date Read /B //�/ Juris: H See Pa e 2 for Internet: www.tigard-or.gov BUILDING DIVISION ^Notifiedimethode//`��j j/� I Supplemental Information l to t .f V46/( G/'�" TYPE OF WORK REtUIRED DATA:1-AND 2-FAMILY DWELLING 0 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. IV1-and 2-family dwelling 12Commercial/industrial Valuation: $ g, QQo .•40P ElAccessory building ❑Multi-family Number of bedrooms: 12 Master builder 0 Other: Number of bathrooms: I JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /0S-30 .5 C 6 q' 7 h 14157: New dwelling area: square feet City/State/ZIP: 77 6,44x0(g"^"'( Q� q'7`Z Z,3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Kan/ 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. Tax map/parcel no.: Indicate 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. Co e4z e .. l j _ (-IA v/Ay Valuation: $ Z00 /_6 A'E CL S r�Kr l/( - - Existing building area: square feet - %tom`"f• New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: (2Qdy Jet.ine5 ' ~/-r Type of construction: Address: /QS 3 O s G. 6e Th. Ape - Occupancy groups: City/State/ZIP: T,.pilot,CC 912-Z- 3 Existing: Phone:(5 ) 2>6 q.. e6 2...e, Fax:( ) New: ri APPPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: V �R '/4-i on (Please refer m,jee sehedul0 Structural plan review fee(or deposit): /2 7. tril Contact name: l / �ips l i t r s ea.' FLS plan review fee(if applicable): Address: 1349 L 1"9 SE Miff ,,e--, City/State/ZIP: p�,a 1, 4,,,,„,r Qt 9r72 2J 3 Total fees due upon application: Phone:(55'3) -2196 i 013 y Fax::( ) Amount received: /2 7. E-mail: // PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: v CP ca pl s r O Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: (3 0 tef S j IV l ;It c Solar Installation Specialty Code checklist. City/State/ZIP: PQ Permit Fee(includes plan review Q¢C+�,ho� 9 �. 3 3 and administrative fees): $180.00 Phone:(5c7 -r 05-„ m/ 3 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: 2,Q j,:/Li3" Total fee due upon application: $201.60 Authorized signature: %,...p.&_ 4 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: AS f l *Fee methodology set by Tri-County Building Industry U V S(� C Date: 8. (� Q f 7 Service Board. I:\Building\Permits\BUP-RESPPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist r ` One- and Two-Family Dwelling l OR order 1 sl: Oyl.l Received City of Tigard Permit No.: II/ M 13125 SW Hall Blvd.,Tigard,OR 97223 AssociDate/Bated permits: II Phone: 503.718.2439 Fax: 503.598.1960 i'I G n K D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIENN les yo y/.' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ■ ■ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ 0 3 Verification of approved plat/lot. 0 0 ❑ 4 Fire district approval required. Name of district: • ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ 0 6 Sewer permit. 0 0 ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ CI Li 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 1:1 Li basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 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 [30 ❑ 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 ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 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 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. CI ❑ 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 ❑ 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 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. CI ❑ 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 ❑ ❑ 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 ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 CI ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. CI ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. 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 ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ 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 ❑ 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 Applicati FOR OFFICE USE ONE) City of TigardRece DateREUEIVED /By: Permit No. S 11111 • 13125 SW Hall Blvd.,Tigard,OR 97223 AUG1 6 , l r / +�© IH U 2017 Plan Review Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 Date/By: TI G A It D Inspection Line: 503.639.4175 CITY q Date Ready/By: Juris: 10 See Page 2 for Internet: www.tigard-or.gov �I! `' Ir �� Notified Method: Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE -USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction ❑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:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 104-10 S G7 6 f.f4 A je. Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: r(D pd0 k q 7 '- Z 3 Furnace 100,000+BTU(ducts/vents) 54.91 d' Pay ay Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 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 .,r: ,:q, i "DE CRllTION OF WORK : k Gas fireplace/insert 33.39 Re--C /_ Q � Fluep vent for water heater or gas 101 W`�'�.,,t[ aQ",Y, n r1r,+1 fireplace 23.32 I MC _/,,,1: kt &' Si S1 (w' 42 w� Log lighter(gas) 23.32 P"' ,N l n,Q "1` Wood/pellet stove 33.39 --nal`14 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 t Other: 23.32 0 PROF `' lti _ '!',14::,.,..,,.., Ll '-N rs Environmental exhaust and ventilation: Name: adv cS n,,,,7, Range hood/other kitchen �' equipment 33.39 Address: 105 30 5 w, 66 q lb ilv Clothes dryer exhaust 1 33.39 City/State/ZIP: Tl'1pa�/ QR `7 7 22. 3 Single-duct exhaust(bathrooms, �"�`} toilet compartments,utility rooms) i 23.32 Phone:(503) / 9 6 Z6 Fax:( ) Attic/crawlspace fans 23.32 ;APP.', r ` A 1 0,,--p.' ,:..t.? ° 44 Other: 23.32^'. 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 1„. ,'CONTRACTOR Clothes dryer(gas) Business name: on S 4424444 R4 f`T'V P con Y L con ' 4 MECHANICAL;PER` 'FEES* Address: oI jq r`( Subtotal City/State/ZIP: g tam' OR 972-33 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(623) 70,-.5- r m t 2 �/ Fax:( ) State surcharge(12%of permit fee) CCB lic.: E 2j/ L('1 6' 3 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: '' t QA,L Date: 0 15, 2.o(7 ��•Si l Y '�-S t� • I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Feer $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 c-t $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\Pemuts\MEC_PennitApp_040113.doc 2 • , Electrical Permit Applicatio> FOR 0111( 11 I SF ()Nl.v City of Tigard I E Received .1111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B y Plan Review I Phone: 503.718.2439 Fax: 503.598.1964,U G 1 6 2017 Date/B : Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Juris: H See Page 2 for I I C;A R I) Internet: www.tigard-or.gov CITY OF rIG: RD Notified/Method: Supplemental Information TYPE OA `` TNG DIVISION PLAN REVIEW 0 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): I:1 Demolition ID Other: ❑Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑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 Job#: Job site address: ADE 30 $(.3 / i4j ❑Addition of new motor load of system. (p4, ,�T�. 100HP or more. ❑"A","E","I-2","1-3", City/State/ZIP: j q 0 Six or more residential units. occupancy. �,�A/ �"• • 72 2 3 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: /�,�/ 0 Hazardous locations. 0 Supply voltage for more than "`11I'""���! 0 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. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential -Ike � /� a/ `*s�{1 deo (with above sq.ft.) 75.00 2 lI - I t J Limited energy,multi-family 75.00 2 ,/k � 1 1 .t � io�tG�• residential(with above sq.ft.) PROPERTY OWNER ❑ TENANT Renewable Energy ❑ See Page 2 y Services or feeders installation,alteration,and/or relocation Name: Tomo- 200 amps or less 100.70 2 Address: 05 ( 201 amps to 400 amps 133.56 2 ���`y� S� 401 amps to 600 amps 200.34 2 City/State/ZIP: Thai ori, OTR.°(7223 601 amps to 1,000 amps 301.04 2 Phone:0) ) 311,i 016Z( Fax:( ) Over 1,000 amps or volts 552.26 2 Email: ray /6Z3 e,9A( cM Temporary services or feeders installation,alteration,and/or `{ • relocation Owner installation:This installs ion is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease t,o ex ange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: • Date: S-/s-t 7 401 amps to 599 amps 168.54 2 0 ICANT 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: 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 / 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular Email: dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 7/` 1 t / e/2- Sign or outline lighting 67.84 2 vv !v Signal circuit(s)or limited-energy Address: panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) hr min Investigation(1 g ) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(/z hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): id----------- State surcharge(12%of permit fee):Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: /_ Date: 6!/s/(7 days after it has been accepted as complete. ('� ' •, * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp ELR_E .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: i SI s `. Description 1 Qty. 1 Each I„i Total T I'* Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 5.01 to 15 kva 133.56 2 H Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm k .."„q,• ,*.� 25.01 to 0 kya 301.04 2 ...i, k‘ t t't +: . 4I1{. 50.'0P4oi0'kva q, .552.26 2 ❑ Garage Door Opener* loo cve<tgainiac olaaee'' ,. `,►t:41.4 {1 with OAR 918-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning , lr' ` i54 wit generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >lMO 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(I hr min) Inspections for which no fee is 90.00/hi •y e spec fi lis ,('/hr mm to iir C " C�#3 .. w, � �11,*": '�"ca ry::� k. .. 4n P epi , '� �� .: .� },145 • a;r>4 '�� raP+. r�i ". Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) ,Ail. ..*At ',,'*,.4 Check Type of Work Involved: ,y;`.- f'.'! • ..!`<' .. ?+,!': n Audio and Stereo Systems 1:,, \ t. „AIL. 'i I**` '. ❑ Boiler Controls *„ ,.,..yo,� rac. ‘ii,.._',•;, •,,-, :t ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ M• edical ❑ Nurse Calls n O• utdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations %' < {, r I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 - Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONE) City of Tigard �. Received + AUGDate/By: Permit No. �'r �/7,,,190;+"/G, 11 • 13125 SW Hall Blvd.,Tigard,OR 97223 G 16 III Phone: 503.718.2439 Fax: 503.598.1960 O C Plan Review Date/By: Other Permit No.: 1 I G A R O Inspection Line: 503.639.4175 CITY OF °fl( AR Date Read/B Juris: 0 See Page 2 for Internet: www.tigard-or.gov t l Ready/By: Su 1 111 y' IN DIVISION Notified Method: n IJILLJlIVk� LJ Y 1� Supplemental TYPE OF WORK' �-r fix.� s. FEE* SCHEDULE _r ❑New construction 0 Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) 4 C4E ' OF tONSIR CTIO 1 ''<"; SFR(1)bath 312.70 ❑ 1-and 2-famil y dwellin SFR(2)bath 437.78 g ❑Commercial/industrial ❑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 J(A SITE INFORMATION AND,LOCATION Site utilities: Job site address: 10 530 5W C7 Catch basin or area drain 18.76 T' Op. R�j �'f ��^ Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: ROI 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 Stone sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 '' Backwater valve 12.51 ONF wank _; "{ 154- '" �,- Clothes washer / 25.02 A Vitt. i Dishwasher 25.02 t It AU)) Stn n �$�. ct�d Drinking fountain 25.02 iit,4._ Ejectors/sump 25.02 I OPER? O R 0.4ENANT Expansion tank 12.51 Name: Tie' RAY Fixture/sewer cap 25.02 Sit) Floor drain/floor sink/hub 25.02 Address: 10 5 3 CO St t) > I' Garbage disposal 25.02 City/State/ZIP: 7 i Jars i q/ Hose bib 25.02 Phone:(y` ) 76,t-,.44 Fax:( ) Ice maker 12.51 i. ❑ AP C C411iTACT 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/bas ava'tory / 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan ( 12.51 E-mail: Urinal 25.02 RAG lR Water closet / 25.02 ,- ,, °p. Water heater 37.52 Business name: /�� U Waterpiping/DWV 56.29 Address: / / / 1 E_ w //�� Other: 25.02 City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone:( ) Fax:( ) Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: - State surcharge(12%of permit fee) Authorized signature)( TOTAL PERMIT FEE i N /1/414°---- Print name: 47 Date:005/1.7 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\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 4 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities r .Fee(ea) °t l Square Footage: P: rout .ee: Footing drain-1' 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 al>u atlon Permit==dee;, 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 Fee(ea) Toth each additional$100.00 or fraction thereof,to Other Inspections or Fees' 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$100.00 or fraction thereof,to (minimum charge—1/2 hour) Y .;`.t` 'hnd incl ding$Z5�e p. Inspections outside of normal business 90.00/hr $25,001.00;'.8.1 ,1,000.0'0 ,' $379`. Yfzorthe first$25,904.00 and$1.45 for hours(minimum charge—2 hours) va*+''t eachonat$,1,Q 00:dr"fraction thereof,to Reinspection Fees 90.00/hr °and c udiilg$50;0M.00: Additional plan review for revisions 90.00/hr $50,001.61tta 1 pp $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 forPfn Quantity by Fixture Type PtatF&view,is rS 11ir811%1 it any oilthe ollowin .. .'• ', Fixture Typefor Replace/ chCry tl t 1 Capped Added Relocate. ¢ pl!l Rg . �5 �,`" Work Performed: Any new coin r,tia'bunldin with water s2 ice. and Baptistry/Font greater,except systems designed and staraNdigrlicensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall 0 New exterior plumbiris site utilities tor any d�bmplex structure as defined in OAI it'8+780-ff018'. , -Drive Tluu Cuspidor/Water Aspirator 0 Medical and�Y?�cd�n sy �3 for ki�a�li Care`.facilities. Cuspidor/Water -Commercialirator ❑ Any multipttxpgse f(e sprinkler system. . D -Domestic -0, 0 Any compltx-gtracture as el1neI'14171b*1918-780-0040. Drinking Fountain x" .rt a r'a`R t Eye Wash Submit 2 sets of plans with any of the above: Floor Drain/sink: -2" -3" Isometric or Riser Diagram 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 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 Extractor Water Closet-Toiletplumbing permit can be iss,etI. Urinal •< ' • *A``.,, 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: 10530 SW 69TH AVE, TIGARD, OR, 97223 October 9, 2017 at 9:23:23 AM Record Type: Record ID: Residential - Master Permit MST2017-00326 Inspection Type: Inspector: 699 Mechanical 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: 10530 SW 69TH AVE, TIGARD, OR, 97223 October 9, 2017 at 9:17:07 AM Record Type: Record ID: Residential - Master Permit MST2017-00326 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: 10530 SW 69TH AVE, TIGARD, OR, 97223 October 9, 2017 at 9:27:39 AM Record Type: Record ID: Residential - Master Permit MST2017-00326 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: 2 gfci' s in bath show bad grounds after trip. Gfci by water closet trips when tester is plugged in. Power to gfci' does not appear to come from bath circuit. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10530 SW 69TH AVE, TIGARD, OR, 97223 October 9, 2017 at 9:29:15 AM Record Type: Record ID: Residential - Master Permit MST2017-00326 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Provide approved electrical final inspection. Re call with building final when corrections are complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10530 SW 69TH AVE, TIGARD, OR, 97223 October 17, 2017 at 9:01 :36 AM Record Type: Record ID: Residential - Master Permit MST2017-00326 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - NoCofO Comments: Corrections from previous inspection complete. Owner to re install switch plate prior to use. Smoke / carbon detectors ok. Violation Summary: Inspector Contractor