Permit (100) CITY OF TIGARD MASTER PERMIT
II
.: COMMUNITY DEVELOPMENT Permit#: MST2018-00057
T 1(HARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/07/2018
Parcel: 1S135BD01900
Jurisdiction: Tigard
Site address: 9525 SW ANNA BELLE CT
Subdivision: ASH CREEK VILLAGE Lot: 5
Project: Ash Creek Village, Lot 5
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 446 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 4 Second: 841 sf Garage: 360 sf Front: 15 Smoke
Dwelling Units: 1 Third: 892 sf Right: 3
Detectors: Yes
Total: 2179 sf Value: $264,875.30 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
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: V
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2179
Owner: Contractor:
SAGE BUILT HOMES LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1815 NW 169TH PL STE 1040 1815 NW 168TH PLACE 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 971-221-4597 PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $30,089.99
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow t - -•opted by the Oregon Utility Notification Center. Those rules ar set forth in OAR
952-001-0010 thro 952-001-0090 .. ay o. - opy of the rule or direct questions to OUNC by calling 503.232.1987 or 1.800.3 -
Issued By: ! Permittee Signature: Aft..ar' _
. 39.4175 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 Application
Residential � FOR OFFICE GSE ONLV
�y
City of TigardDateBed p� (i-,'-1.40'
O j PermitNo. --��` ��
INDate/13y. sl
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Other Permit:
II Phone: 503.718.2439 Fax: 503.598.1960 c {)'',; Date/By: �-� 3—� �Lt. ��0 7
-r
flu,A R D Inspection Line: 503.639.4175 { Date Ready/By: n _ Juris: See Page 2 for
Internet: www.tigard-or.gov ;- Notified/Method: 51t'-71� Supplemental Information
TYPE'OF W 1RIs Uk t f"' ' 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION, work indicated on this application.
Valuation:
® $1-and 2-family dwelling 0 Commercial/industrial I t
❑Accessory building 0 Multi-family Number of bedrooms: , $ 1/. $'7S— -I"
❑Master builder 0 Other: Number of bathrooms , 3 9 f
108 SITE INFORMATION AND LOCATION . ; Total number of floors: 3
Job site address:9525 SW Anna Belle Ct New dwelling area: 2179 square feet
City/State/ZIP:Tigard Oregon Garage/carport area: 360 square feet$qa
Suite/bldg./apt.no.: Project name:Ash Creek Covered porch area: X square feet $ 14 ,
Cross street/directions to job site: Deck area: 25 square feet Li 14
6
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Ash Creek Lot no.:5 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.
New Residential Construction Valuation: $
Existing building area: square feet
New building area: square feet
li PROPERTY OWNER ❑ TENANT - Number of stories:
Name:Sage Built Homes Type of construction:
Address:1815 NW 169v'Place Occupancy groups:
City/State/ZIP:Beaverton Oregon 97006 Existing:
Phone:(971)221-4597 Fax:( ) New:
`+ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Mate refrtojeeschedule)
Business name:Same As Above
Structural plan review fee(or deposit):
Contact name:Alex Rodriguez
FLS plan review fee(if applicable):
Address:Same As Above
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:(971)336-6911 Fax: :( )
E-mail:Planning@sagebuilthomesllc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: '514,, c Submit two(2)sets of roof plan with connection details
e�i> �/ I and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
y and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: ,
Total fee due upon application: $201.60
Authorized signature: &•"*Ni.„..41This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Alex Rodriguez Date:2/1/2018 *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)
r
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE I.SE ONI.v
City of Tigard Received
III - Permit No.:
n 13125 SW Hall Blvd.,Tigard,OR 97223
Associated
ated Associatt ed permits:
Phone: 503.718.2439 Fax: 503.598.1960
i'1 G A R D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: 0 El El
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ 0
6 Sewer permit. ' ❑ 0 0
7 Water district approval. ❑ El 0
8 Soils,report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 El
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ 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 El El ❑
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 El El ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ . ❑
N. 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- ❑ ❑ El
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. El El ❑
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 El ❑ El
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 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 El El ❑
over 10-feet long and/or any beam/joist carrying load.
20 Manufactured floor/roof truss design details. El ❑ ❑
21 Energy Cbde compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ El El
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 applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ 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. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ 0
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ 0 El
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, El El 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, ❑ El El
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)
S
plumbing Permit Application
Building Fixtures 4i i FOR OFFICE LSE ONLv
Received ��y�
- City of Tigard Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223B 1 Date/By: /r/t� �(�'L(i(ic�7
Phone: 503.718.2439 Fax: 503.598.1960 ( ititan Review
Date/By: Other Permit No.:
T I G n R D Inspection Line: 503.639.4175 f rPO_ Y Y Tad/B : mri:: ® See Page 2 for
Internet: www.tigard-or.gov _ �.x t ' ••'1 i1 til/Method: Supplemental Information
TYPE of WORx IIIII1:TJIIG DIVIS1QJ' FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description Qty. I Ea. Total
El Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION • SFR(1)bath 312.70
® 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
SFR(3)bath x 500.32 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 1 25.02 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION s Site utilities:
Job site address:9525 SW Anna Belle Ct Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard Oregon
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Ash Creek 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:Ash Creek 1 Lot no.:5 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK •
Backwater valve 12.51
Clothes washer 1 25.02 25.02
Dishwasher 1 25.02 25.02
New Residential Construction Drinking fountain 25.02
Ejectors/sump 25.02
►'i PROPERTY OWNER El TENANT Expansion tank 12.51
Name:Sage Built Homes LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1815 NW 169th Place
Garbage disposal 1 25.02 25.02
City/State/ZIP:Beaverton Oregon 97006 Hose bib 2 25.02 25.02
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
i...7,..1 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Same As Above Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Alex Rodriguez
Roof drain(commercial) 12.51
Address:Same As Above Sink/basin/lavatory 6 25.02 150.12
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)336-6911 Fax: :( ) Tub/shower/shower pan 3 12.51 37.53
E-mail:Planning@sagebuilthomesllc.com Urinal 25.02
Water closet 25.02
CONTRACTOR.
Water heater 1 37.52 37.52
Business name:Edwards Mullen Plumbing Water piping/DWV 56.29
Address:1601 A Se River Rd Other: 25.02
City/State/ZIP:Hillsboro Oregon 97123 Subtotal
Phone:(503)628-3560 Fax:( ) 7/'fw Minimum permit fee: $72.50
CCB Lic.:92689 Plumbing Lic.no.: La(C kS Plan review (25%of permit fee)
RState surcharge(12%of permit fee)
Authorized signature TOTAL PERMIT FEE
Print name:Alex Rodriguez /// Date:2/1/2018 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)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee( ) Total Square Footage: Permit Fee:
Y 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 Valuation: 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
, ) Total 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) 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
accurately report fixtures could result in increased sewer fees*.
Quantity by FixtureType Plan Review forPlumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate 9
Baptistry/Font Please check all that apply.
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 Thru 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 ❑ 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.
m
Car Wash Drain ❑ Isometric or riser diagramis required for new buildings
Garbage -Domestic-non-food q 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 this permit results in an
Washer-Clothes
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\alejandra\Desktop\Templates\City of Tigard\Plumbing.doc 2
Mechanical Permit Application FOR OFFICE USE O' 1.1
CityofTigard < < ! ' L1 •, eceived Permit No.
= z4 4 �' i t
'Date/By: i 0 rA
1111 . 11 13125 SW Hall Blvd.,Tigard,OR 97223 °`,L r
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G n R D Inspection Line: 503.639.4175 { t 9 Date Ready
By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov 1-t.5 Notified/Method: Supplemental Information
R lf
TYPE OF W , COMMERCIAL FEE*,SCHEDULE- USE CHECKLIST
''` TJ'r ';',41,7,!. .1.(1,N Mechanical permit fees*are based on the value of the work
New construction 0 Addition/alterat) h►/iiepIbi tient performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSI'RIJCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑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:
Air conditioning 1 46.75 46.75
Job site address:9525 SW Anna Belle Ct Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP:Tigard Oregon Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Ash Creek 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:Ash Creek Lot no.:5 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 33.39
Flue vent for water heater or gas
New Residential Construction fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
►s PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name:Sage Built Homes Range hood/other kitchen
equipment 1 33.39 33.39
Address: 1815 NW 169th Place Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP:Beaverton Oregon 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32 116.60
Phone:(971)221-4597 Fax:( ) Attic/crawlspace fans 1 23.32 23.32
,n1 APPLICANT CI CONTACT PERSON Other: 23.32
Business name:Same As Above Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Alex Rodriguez Furnace,etc.
Address:Same As Above Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:(971)336-6911 Fax::( ) Fireplace
Range
E-mail:Planning@sagebuilthomesllc.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:All Time Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address:PO Box 1341 Subtotal
City/State/ZIP:Lake Oswego,OR 97035 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)208-2276 Fax:( ) State surcharge(12%of permit fee)
CCB tic..1845.75T (IC 7 IL(i 1 l/ f TOTAL PERMIT FEE
!!!! ! This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signator * Fee methodology set by Tri-County Building Industry Service Board
Print name:Alex Rodriguez Date:2/1/2018
1:\Building\Permits\MEC_PermitApp_040113.doc 440-461TT(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
$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
.Y
Electrical Permit Application FOR of i 1ct. L SF 0N1.1
City of Tigard 41 <;' 1 '' � e
.� /'�/. `
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• ' Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175Ready Date/By: Juris: ® See Page 2 for
T lc;.\R I) Internet: www.tigard-or.gov L'C i 1 ` Notified/Method: Supplemental Information
y� �r ,
t, of';,07:,T,, ,ro ,; '
.{. s; r; 'Il. ��t*0*( , - P JF ,&,,,1'�,.f1 ,"i,r � f:`.
®New construction 0 Addition/alteration/rgpl etitc4lt --%.' Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps
❑Demolition 0 Other: i���•`' °''' �� '' � ' `� � or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGOR`Y,OFC ilioloO NC 2' „, , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
ngs.
❑Multi-family 0 Master builder 0 Other: 0 ampsireforumall other installations. Inbustallation
pump. Installation of 150 KVA or
`" -Ak�lW,LOCATION 0 Emergency system. larger separately derived
Job#: Job site address�5 SW Anna Belle Ct 0 Addition of new motor load of system.
I OOHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard Oregon ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Ash Creek 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 ScH DU ,
Description I Qty. I Each 1 Total I •
New residential single-or multi-family dwelling unit.
Subdivision:Ash Creek Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
''." , , . O , O Limited energy,residential 75.00 2
New Residential Construction (with above sq.ft.)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy
0 See Page 2
, ON - - 1�1 @!IAt9T Services or feeders installation,alteration,and/or relocation
Name:Sage Built Homes LLC 200 amps or less 1 100.70 100.70 2
Address: 1815 nw 169TH Place Suite 1040 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Beaverton Oregon 97006 601 amps to 1,000 amps 301.04 2
Phone:(971)221-4597 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 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
�, ,pN 1Branch circuits—new,alteration,or extension, per panel
0.C°AiTA' r. N A.Fee for branch circuits with
Business name:Same As Above above service or feeder fee,
7.42 2
eacContact name:Alex Rodriguez Feehorbranh circi c
g 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
Miscellaneous(service or feeder not included)
Phone:(971)336-6911 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Planning@sagebuilthomesllc.com Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name:Ross Electric Sign or outline lighting 67.84 2
Address:2870 SE 75th Ave 203 Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Hillsboro Oregon 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)642-2800 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
0%/t' Inspections for which no fee is 90.00/hr
CCB Lic.: 157891 Electrical Lic.: 34-436C Suprv.Lic.: 6(2;Z S , specifically listed(/Z hr mm)
Suprv. Electrician signature,required: '� >
Alte- ( � �'7_ Subtotal: (
Print name: Stephen Ross 5 , .4,,, / s$f Date: 0 Plan Review Required(25%of permit fee):
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: Alex Rodriguez Date: 2/1/2018 days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitAppELR_ERE.doc Rev 06/17/2015 440-4615T(I 1/05/COM/WEB
ECE1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
110111MAY222018
Request for Permit Action C TY s ,
T 1 Ci A It f) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.ttgard � � ��� �$ ��
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 Q Applicant ❑ Contractor ❑ City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Sage Built Home
g
Mailing Address: 1815 NW 169th Place Suite#1040
City/State/Zip: Beaverton,OR 97006
Phone No.: 503-533-5167
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: MST2018-00057
Site Address or Parcel#: 9525 SW Anna Belle Ct
Project Name: Ash Creek Village
Subdivision Name: Ash Creek Lot#: 5
EXPLANATION: Requesting to remove A/C from permit and a refund
Signature: th41.• C?.. per,
!!// Date: -�,/ Z-2//el
Print Name: Ben Cooper
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.
Ne 7 /SSi1 E- " 7,-:?it,4/c e/e- ‘ ,e-c---//0-4 /e /Z /F "*.--
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date 1V/4 B Invoice Processed: Date By
Permit Canceled: Date /1.3/4" BytWV Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
City of Tigard
11111 COMMUNITY DEVELOPMENT DEPARTMENT
T i c a R o Building Permit Review — Residential
Building Permit #: /I25% <F-6i xj 5-7
Site Address: 9 SLS S vJ A Ni nen ReAiLL C-t--
Project Name: A .C11 Cree k.. j i I 1 of y e Lot #: 5
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review Proposal: NeAAJ E F 7fJ Sjz i U ,S/k fl/4bi
7 Verify site address/suite# exists and active in permit system.
4 River Terrace Neighborhood: 75 No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
/Three(3)copies of site plan (Existing structures on site
Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
/Drawn to scale(standard architect or engineer scale) floor elevations
///North arrowlUtility locations&easements(required for new and additions)
ZSite address,project or subdivision name and lot number ASidewalk/driveway approach
Applicant information(name and phone number) of wells/septic systems
Lot dimensions and building setback dimensions 7F,ricting trees to be retained with drip line,and tree
❑Square footage of buildings to be demolished rotection measures
,leLot area,building coverage area,percentage of coverage and t treet tree size,type and location
impervious area(applicable if R-7,R 12 R-25&R-40) Street names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? Yes ❑No
4 foot differential) If yes,is a storm water quality facility shown? J'Yes ❑No U.6
71 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
'Public Facilities Improvement(PH) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
76Land Use Case#: PD1 '2C 1S-00001 /. SVQ2,0kS- 000o3
A Zoning: R It
Ai Required Setbacks: Front i S Rear -I S Side 3 Street Side l e Garage `g '2-0
0 Landscape Requirement: Z,0
Lot Coverage Maximum: 0/0
o 0% /!
Building Height: Maximum Height ' s Actual Height
0 Visual Clearance
jZi Sensitive Lands: ❑ Yes A No Type
Fl I Trban Forestry Plan
iCit'.nditions "Met"prior to issuance of building permit
1 otes: t7 Ut-S'frit n clAir1 c.) (-O n CJC.A•hb () S
Approved By Planning: ill 4 cry,_ (/N_ Date: 2/ i / 1 `c',
Revisions (after~Building Submittal only) viewer Date
Revision 1: , Approved ❑ Not Approved VII*
Revision 2: El Approved CI Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES_061417.docx
I
Building Permit Submittal
Original Submittal Date: /Pi(
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planning 9IPEngineering pi.liermit Coordinator Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: , Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
460 Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: A !A / tiL Date: ,?4, 7
Engineering Review
Slope at building pad: a,
4 Conditions "Met"prior to issuance of building permit
4 Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes d No
Assess Water Quantity Fee in-lieu: ❑ Yes Q No
LIDA Facility on lot: ❑ Yes A No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Ar Approved by Engineering: illZ 17 Date: _,2,- 7-,e
Revisions (after Building Submittal only) �Reti
wer Date
Revision 1: it Approved 1=1 Not Approved
,i4tN_LAsjil
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Condition'—s`Met"prior to issuance of building permit
Approved,NOT Released: xyla, ,w 1127 Date: 3)224 LX
Notes: GOS10Y r V rc h Izd L H-(o lae6►-c LotS.S. — op ►ia -D0 o1-(--riCu.- •
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
E ...11 C Fees Entered: Wash Co Trans Dev Tax: es ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA (❑ Yes N/A
I'!�i OK to Issue Permit C
Approved by Permit Coordinator: �' • IA�. - , t4A4
I:\Building\Forms\BldgPermitRvw_RES_010118.docx r 1
5
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
Iii City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
2 Transmittal Letter
i ., , € ,, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION -. ® ,
FROM: i3eit\ Cf)019er
UN 11. 2018
COMPANY: J e - SA;„ (V- kY"\LE,":;/, .....::::N
— c)� �5 By.
PHONE: � Z< '- tD�cjAC,
RE: 152 Sc j AMS Bei 1e- CA- Abh7,01Z ` X51
(Site Address) (Permit Number)
451A (xed- Ecy— )
(Project
name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:!la I c \-00 Slit Pl 3
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
FOO CE USE ONLY
Routed to Permit 'cian: Date: k tq. COO Initials:
Fees Due: E No Fee Descriptio : Amount Due:
$ p
$ L1S�
./.....- Lcw�. 1--9.4 �ei $s
Q $
Special
Instructions:
Reprint Permit(per PE): ` No E Done
Applicant Notified: Date: Cis(<c, l Initials:
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
Loi-
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
etter
i i r) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION O .
rkIFD
FROM: 13x Cno?er- JUN 1 1 2018
COMPANY: , U�1 � -�
PHONE• — g-- By:AL
RE: -I� Ls c>LJ AINIALL 13'ii c M i 2v10 - WoS1
(Site Address) (Permit Number)
45)A Cxed 1c —
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: ' Description: Copies: , Description:
Additional set(s)of plans. Revisions%t o l -'I� }U® s'fie... platA3
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: [ Yes ❑No Fee Description: Amount Due:
Special
Instructions:
Reprint Permit(per PE): ❑ Yes ❑No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9525 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00057
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
No ac installed at this time.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9525 SW ANNA BELLE CT, TIGARD, OR, 97223 April 11 , 2019 at 2:27:00 PM
Record Type: Record ID:
Residential - Master Permit MST2018-00057
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Water pressure = 75 psi.
Previous corrections completed.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9525 SW ANNA BELLE CT, TIGARD, OR, 97223 April 22, 2019 at 11 :00:24 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00057
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS
Comments:
Corrections completed
No A/C
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9525 SW ANNA BELLE CT, TIGARD, OR, 97223 May 3, 2019 at 9:02:11 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00057
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Final erosion control passed
Moisture content form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor
Plumbing Permit Applicati ,,
Building Fixtures ,
City of Tigard JUL 3 ,.0:r5 Dat/B d 7/Ac/�j Permit S�U1 '�S7
`� t.� L. i
• 13125 SW Hall Blvd.,Tigard,OR 97223 y'
Plan Review
1111 I
Phone: 503.718.2439 Fax 503.5986-0.. Date/By: Other Permit No.:
Inspection Line: 503.639.4175 bL,1 „1
I 1.,A I i t Date'¢ :�By: Juris: See Page 2 for
Internet www.tigard-or.gov '' ,-;e.,---1,thod: Supplemental Information
s wn
U"ac i iha .>>�, .w r ;,: ,,e .�:x... x� Y� 0it...r,?„,, .,_ ,,r s.-.-.? ,M.t °N.an ,L ,. n-e. ,„ m,ra
®New construction ❑Demolition + '' 11� For special information use checklist
hl� Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
1 ii,:;:. SFR 1 bath
�.' a {fit " ,F�t �l'r t �` '}: �`�`- � ( ) 312.70
1-and 2-familydwellingSFR(2)bath 437.78
® 0Commercial/industrial
0 Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
4 Fire sprinkler( sq.ft.) Page 2
..'. ;•� t ,TIt1N tx:A! tr'-'f%1:-.V1,,eSite utilities:
Job site address:9525 SW Anna Belle Ct Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,Oregon Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Ash Creek Village Manufactured home utilities 50.03
Cross street/directions to job site:SW 95th Avenue 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:Ash Creek Village J Lot:5 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
r 3 a1- I t t';, t 'r • Backwater valve 12.51
"' '' "' Clothes washer 25.02
New residential construction/Plumbing contractor revision Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
iiRQPE*owNii:,01P14 t (�''( � ': Expansion tank 12.51
Name:Sage Built Homes,LLC. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1815 NW 169th Place,Suite 1040
Garbage disposal 25.02
City/State/ZIP:Beaverton,Oregon Hose bib 25.02
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
1-1'1 ;411..,,4 w'. 'i 'APi1-I sX ru - - 0 CONTACT F I N Interceptor/grease trap 25.02
Business name:Sage Built Homes,LLC. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Ben Cooper
Roof drain(commercial) 12.51
Address:Same as above Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)258-6658 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:planning@sagebuilthomesllc.com Urinal 25.02
"` CONTRACTOR Water closet 25.02
'',.
Water heater 37.52
Business name:Max Plumbing Service Inc Water piping/DWV 56.29
Address:PO BOX 230674 97281 Other: 25.02
City/State/ZIP: Tigard,OR 97281 Subtotal
Phone:(971)-275-0198 Fax:( ) Minimum permit fee $72.50
Plan review (25%of permit fee)
CCB Lie.: 205392 Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Ben Cooper Date:7/23/2018 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)
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fire Su t i ression S stems:
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 S stems:
Water Service-each additional 100' 37.52 �° �.; r s
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
;:.:,- , tlila each additional$100.00 or fraction thereof,to
6 ' 1 o 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 char_•e-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*.
Quantity'by Fixture Typea CW, or Y
Fixture Type for Replace/ - Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ 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 Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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.
4„ .omel is or Ise '✓gr
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
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/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
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\kylie\Downloads\PLMF_PermitApp.doc 2