Permit Support Document CITY OF TIGARD i ( MASTER PERMIT
Elk v z\.
' COMMUNITY DEVELOPMENT Permit#: MST2021-00026
T I G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/05/2021
Parcel: 2S109AC09100
Jurisdiction: Tigard
Site address: 13080 SW FORAN HILLS CT
Subdivision: None Lot: None
Project: Foran Hills, Lot 12
Project Description: New detached dwelling, 158sf deck, 120sf deck cover
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1740 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24.5 Bathrooms: 3 Second: 1073 sf Garage: 453 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2813 sf Value: $373,329.53 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bcklw Prevntr: 0
Footing Drain: 0 Ice Maker. 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
-- MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=10OK: 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: 5 201-400 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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2813
Owner: Contractor:
BULL MOUNTAIN LLC STONE BRIDGE HOMES NW LLC Required Items and Reports(Conditions)
3115 SW STEPHENSON ST 4230 GALEWOOD STREET#100 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97219 LAKE OSWEGO,OR 97035
PHONE: PHONE: 503-387-7577
FAX: 503-387-7615
Total Fees: $39,637.12
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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
vicarv\tee P
Issued By: Permittee Signature: CA PP\(.._a
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
it 3405
Building Permit Application C -j- 2(1 2i
Residential RECEIVE TOR°Fri(CU EO'L.VV
City of Tigard Received 2/ - 11 ..ar20�0024
w 13125 SW Flail Blvd.,Tigard,OR 97223 FEB 0 1 1021 DatrlBcv w -�4 Permit No VIII
lik
iPlan Roviow ���+1�/,
Phone: 503.7182439 Fax: 503.598.196(1 DatdEy: 2l i I Other Yeri W/ �-OOO�7
Inspection Line: 503.639.4175 CITY OF TIGARD -Date Read/a Tli3ARD _ Y Y: `' �See Page2for
Internet: www.tigardor.gov N ed/Method: i. Supplemental Information
BUILDING DNIS!C?r �'" t�
TYPE OF WORK REQUIRED DATAt1-AND 2-FAMILY DWELLING
r?New construction ❑Demolition Permit fees*arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and profit fgr t e.,I,
CATEGORY OF CONSTRUCTION .work indicated on this application. '5 1-t�
Valuation: $ '
pi-and 2-family dwelling ❑Commercial/industrialTI I 1
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder 0 Other; ' Number of bathrooms: ,3
JOB SITE INFORMATION AND LOCATION Total number of floors:: Z. '2,2Ce Le
Job site address: 130'bo SiA) z-, .i H(N,S• cz New dwelling area: 2R)i 3 square feet ` 01--.
City/State/ZIP' Tic/Ay-tit oR. Garage/carport area: 453 square feet `l y jl
Suite/bldg./apt.no.: Project name: Covered porch area: square feet u�
Cross street/directions to job site Deck area: ('S square feet
ze,
Other structure area: ' square fact
REQUIRED DATA:COMMERCL&I.USE CHECKLIST
Subdivision: fuLpij }..O uS' Lot no.: 1 Z Permit fees'are based on the value of the work performed.
Tax neap/parcel no.: Indicate the value(rounded to the nearest dollar)of all
- -. equipment,materials,labor,overhead,and the profit for the
tt DESCRIPTION OF WORK work indicated on this application.
_lart%W; Soli 1\4114 R IQENeE- ..Valuation S
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑. TENANT Number of stories:
Name: STt7t4E 5 p 4IDNAL-S h1Wt.L,t Type of construction:
Address: ` l:3D t7tktW11OQD .11 coat (ob Occupancy groups:
City/State/ZIP: LAY,E,OSyJEbc,)/ op, cri O3 S Existing:
Phone:(533)3`2111511 Fax:(53) 3C6-11(D(5 New:
Il APPLICANT 0 CONTACT PERSON
" BUILDING PERMIT'FEES*
l
Business name S"rOFi� (➢kose refer ru fee schedule)
H C)M S (� 'Li,C' Structural plan review fee(or deposit): 77'i '/
Contact name: ' EA2V 13pAr
-� -' FLS plan review fee(if applicable}
Address:
City/State/ZIP: Total fees due upon application:
Phone:( ) Fax::( ) Amount received:
E-mail:'pj3\2(-r-T e SI DBE 13jl�C)L H Oti^E-S�w.GLMN,t PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES`
CONTRACTORCommercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Busmess name. S toi I(-, 1 2-1 D b-E.- H.C.S At.-C k4w:��. Submit two(2)sets of roof plan with connection details
`� and fire department access,along with the 2010 Oregon
Address: 4'L30 ( \ S tt Sk tb Io Solar Installation Specialty Code checklist.
City/State/ZIP: (nicet,tw7U oQ C11.035 Permit Fee(includes plan review $I80.00
Phone:( '�'3t j 1`icj"-("1 Fax: and administrative fees): F.,.
(,e-, 11 MI5 State surcharge(12%of permit fee): S21.60
CCB lie.: l"13"31$ —
Total fee due upon application: S201.60
Authorized signature: ; , _ x+l��"}-r This permit application expires if a permit is not obtained
�_r within 180 days after it has been accepted as complete.
Print name:1) ,p ). " ?t(�-T Date: i-Z�r� `Fce methodology set by 1'ri-County Building Industry
Service Board.
l:\Building\Permits\BtJP-RESPermitApp.doe 02/24/2011 440-4613T(1 l/02/COM/WEB)
Buildini Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE 1 NE ONLY
City of Tigard Receive ,
d
.. Permit No.: • •1 'r ' r
t 13125 SW Ball Blvd.,Tigard,OR 97223 Dae/Ra Associated
t 2 Phone: 503.7182439 Fax: 503.598.1960 permits: I
Tl ti.ie it t] 24-Hour Inspection Line: 503.639.4175 0 Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov 0 Other.
THE FOLI.OW1 ING ITEMS ARL RI:QIU IRE i) FOR PL;`,A REF iEN\ 1_es 'so '71
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ I 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ 0
3 Verification of approved plat/tot. . O 0 ❑
4 Fire district approval required. Name of district:
5 Septic system permit or authorization liar remodel. Existing system capacity 0 ❑ ❑
6 Sewer permit. ❑❑ 0 D
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application: 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 ie
El 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 p ❑ ❑
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, T/ 0 0
furnace,ventilation fins,'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. aP ❑ ❑—
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-" ld ❑ µ ❑
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 gli 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑— 0 gi
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
over 10 feet long and/or any beam/joist carryin a non-uniform load.
20 Manufactured floor/roof truss design details, la0 ❑
21 Energy Code compliance. identify the prescriptive path or provide calculations. A gas-piping schematic is required gp 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 0 ,,,,,,on and shall be shown to be au,ticableto the. ...ect under review,
JURISI)ICTIO'SAL 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 ❑
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 tapeons. "Mirrored"building plans will not be accepted_ ❑ 0
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. 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
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approvaL Tree locations,driplines, ❑ 0 El
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(I 1/02/COM WEtt)
Mechanical Permit AI)PIICatR CEIVED FOR OFFICE usrONLY
City of Tigard �Lv . MST2Z(-O O2 e
c mrl
tII aIf .a 13125 SW Hall Blvd.,Tigard,OR 97223 FEB 012021 t < °°.:•' - - -Phone. ---
503.718.2439 Fax. 503.5981960 ii,l l Fer Puts_,:
T lC;hit t3 Inspection Line: 503 639.4175
CITY OF TIGARD ` ` `'` S SeePane2 InfoInternet:
rmationwww.tigard-or.gov
BUD RING nIVISION
TYPE OF WORK COMMERCIAL FEE' SCHEDULE USE CHECKLIST
Mechanical permit fees*arc hascd on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials.ci ui.ntent,labor-overhead-and,rofit.
CATEGORY OF CONSTRUCTION -
., �axylnalaarlri�yrvn;latatatrr.�•�y��l '�x�
® 1-and 2-family dwelling 0 CormnerciaUindustrial 0 Accessory building For specie/information use checklist
❑Multi-fatuity ❑ Master builder ❑Other: Description IrIBIBEM Total
JOH SITESIn INFORMATION AND LOCATION - Heath-lcooIhi
13o lily 5�... !< Air condition ma-
aIIIIMEZIIIIIIIIM
Job site address; FOP-AN Tr
(L'I"r�1'1 Dana c¢100.000 BTU.fd,tctsJrcntsi IEMIIEIMIUMIIIIIIIS
City/State/ZIP:Tigard,OR Furnace 100,000 a 611 (duos re in 54 91
Suite'bldg'opt.on: Project name: Heat .um• 61 06
—.... .......-... Duct work 2332 111111.111
Cross street/directions to job site:I H [ironic hot water system
Residential boiler(radiator or
h5•droait)_.
Unit heaters(filcl-type,not electric), IIIIIIEIM
in-wall.in-duct,sus ended,etc:;
Flue;vent for any of above I 23.32
Subdivision:[ 1 HIA..S Lot no.. I2 '..
• Other fuel a..]lances:
Tax map/parcel no.:
EMEIIIIIMIMIMMIIMIIIIMIIRMIIIIIIIIII
DESCRIPTION OF WORK ESTIMMINIIIIIMMIMMEMIIIIIMI
Flue watt for water beater or gas
new,single family residencefir Flue yen _.
ce
l.o•II:Kier „as) 1111111.04111111111111
Woad/,•]let stove _ 33.39 Milli
Wood fire lace/insert 23.32 .an
Chinute 'liner/flue/vent 23.32:
El PROPERTY OWNER I 0 TENANT Other: Man
Environmental exhomsl and ventilation:
Name:Stone Bridge Homes NW,LLC Range hood/other kitchen
Address:4230 Galewood St,Suite 100 a ui merit
- - - - Clothes dryer exhaust
City/State/ZIP:Lake Oswego,OR 97035 Single-du t exhaust(bathrooms,
IIIMMIIII
---- toilet coon•artments.utility rooms)
Phone:(503)387.7577 1 Fax:(503)387.7615 Attic/crawls see LIM 23.32
® APPLICANT 0 CONTACT PERSON Other
2332..
Business came:same as above Fuel .i.in : _.
""" ..... - - ����314.15for first four:.S403 for each additional
Contact name:Deirdre Britt
y�t .hits (I
Address: - _._ rESIMMIIIIIIIIIIMIIIIIIMMIIIINININEI
-- - Wa0lsu winded/unit healer
City/State/ZIP
`�."`.
Phone:( ) .. Fos::(- - )
E-mail:dbriti6stonebridgehontesnw.com Barbecue
CONTRACTOR
CONTRACTOR IP11fH U �1;AII IItII�
Business name:Comfort Zone
MECHANICAL PERMIT FEES
Address:1032 NW Corporate Dr. ..
---- Subtotal
City/State/ZIP.Troutdale,OR 97060 Minimum permit fcc(S90 00)
Plan cevies (25°5 of permit fee)
Phone:(503)667.5595 _... Fax:(503)491.8252 rnr
•-- -4-.....-- State surcharge(12%of pmnit fee)
CCB tic.:110091 TOTAL PERMIT FEE
.
- '`""` "' This permit application expires if a permit is not obtained within ISO
tip., days after it has been accepted as complete.
Arithariz ;;n0.ed 5iture- '` * tee methodology set by Tri-County Building Industry Serv[ce Board
Print name:David Beldstab fate I.'IQ)r7- 1
I BnlldAieiCnnl.t ld:_Pcndll;,p 0 In i t3 die a .,17i iI, ,ern)
litre F 1itAu Beal CEIVEI I 1 21
i i i C ,r�i t� I I ,i ,I V l
City ojTigard ""clod rI®na;MST2021-aOOZG
I3125 SW Halt Blvd.,Tigard,OR 97223FEB 0 1 2021 Deter cvt.• •- . -
Phone: 503.718.2439 Fox 503.598.1960 1>>eriBy: Mated Pamir a:
leapentionLine 503.639.4175 CITY OF TIGARD
...�N I Itpdy nuWay' 1adV:r��., B See Page I far
Internet www.tigardorgov .,. .Netiiled/Met act: [1 •Sepplementat ldarnatioe
Tree osrEilileteD1NG DMVMSIOR
PLAN sfswe,Sv
Went construction ❑Addition/alteration/replacement Plum cheek ell tile apply(cubenitI say ofele leavens checked): .
0 Servers of feeder 400 emu be cobra ❑Radios over three notice.
❑Demolition ❑Other: where the avalabte Lott=rent ❑Madder and bratyads.
,cittliCeixii ex,.CdNS exceeds 10.000 amps et 150 vole or 0 pbaingbtnldings.
g- y hinge Q Commercial/industrial buildingjai
1-and 2-fermi! dwelling. ken m ground,r exceeds 14.000 0 Cammerul-see a
❑Multi-family ...-_❑Master builder , ❑Other: Fb for. other imu0mioaa. 'mildew.
nstil latio
- ❑Pka tastier• ❑bxhllation of 150 KVA or
JOB s fit itdoliziNiiii5t4 AI'do LO.imeN., I7 Emergency system layer separately derived `
°i b°'ernewmnmr!vealof mein.3008 kb 13080 SW Foran HiIIs Ct. 100HP or more ❑ A;-e ,-z .l_3- -
City/$tatr., ,t y7 IP-- ./.:.' 12. - .. ._ - .. ❑sic r anm rreidmtial wits. 3•
j D. . _ __ ❑Neehbyare Gcilities. 0 Rent-rime!vehicle parka.
Suite/bldg./apt# Project name: '.❑Rosadoas oeoi ons. ❑Supply wage for more than ,
._ .._- l ❑sir earfaeder 600 crops or more coo Pour mmoeL
Cross street/directions to job site ,, Pit -::
'fncacdaaaa
... _ _ .. ' ' i 4er ! 7eay.::,j
• p f1Yewreddeadals!single-or mdH-fam0y dwelling unit.
Subdivision: Fon-il*Fl H i(,l S' 1 Lai: Y ha m
12 I r !shades achedgusgtt
Tax map/parcel#:
1,000 ft.or lees 168.54 4
• I ,�+M,v:.,-,.� ...- . ea.add'1JOh sq.it.rc perm 4. -- 33.92 1
- a e e OF ♦ •+. Lirnibal ma8y,reside:did
�.,s' [ Y}E Cwlib.44aaeal.ft2 r 73A0 2 i.
•
Ankh,Sm-t tee 1 r mici fei.. � L mtaed rnerYN, v14-mmoy. •
.r., residential(with above a.ft.) i 7s,00 2
1 ....0_1'�IitANT .... : eaew.bleJPaesyy Cl.tfbx s..:.s.a.I3! e.`Pl[ Services�rfPdHf `� yf�- ad(bS1ta{Gl4tidD
Name `1t s omu-s e.kw I.t.L 300ampamless 10070 2 '
Address: 4213 Q , '&1; . -%�1- `F :EL 401 antes to60o otters 133.56 - 2
• ::-: q _. .- - -c r dot tang to fi00 ettrpa 20U34 2:
City/Stsie/ZiP: `A(T 60Iaug ii.I00Q®pa 301.04 2';
Phtme. .3t+a1-11Z I f�1Q3�7 Fax:(,,t-p3)3Cb-1-!_WIG . ovcrtuotf:iepso:vohi '352 d....
Email: _. - .. - Tearponzyi2tViets ul'4iiiaera f,1Wa11afloo;ell ypflAp-
i .
owner ins/sib-don:This installation is being made on property dial own which is not 'I ' 200 amps or ie® ;� ,...59:36 . . . .'.. L.
intended for sale,lease,real,or exchange,according to ORS 447,449,670,and 70I. , 201 Brain to 4 0 amps . 125.0a 2:.
Owner signature: Date: 401 amps to 599 amps_ v _ 103.54 _ .2,
uae� 1 . �,C°Ttrrke.,. ... . Breach elradis-1PMwal4prtiKaa,or comet.,),Rau'shrug- .
. - ... ..M.MSC*--.— A.Fm roc branch a inidh nit 1( .
Business name: VOW Fi9Ar7bu ii c knit ra NW 1 Ui above service or feeder fee, 742 2
n�-wsr ... - aaat tom,atcavii.. . ...
nPt' !bri !rt"C ;, 13.Pee for branch circuits withaat •
Address:
..- service err keder fa,Oast 56.18 2
__ -.::... •_.... . ! branch circuit_ --
City/StateJbIP: .. .... Each add'!branch tinuit 7.42 2
. M sedlaeetias(Service ar feeds not Fatladed)
Phone:( ) Feac::( ) each mat,factwed or modular
FaaaIl ]76'♦Z- "(' S-(t7F1�{5 W o f H Oi'4 U),CCM d vrllmR,service a�rot sae err 67.64
Remmtcd only.. 67.84 ' .2`;
• Pump a irtigelion circle '.. _. 67.84 .2
Business name: E et,...CT-1-4C..A•t_ Iea1,i CAI A- 'i Ot t$ Sign of aniline lighting 67.84 2
ib453 Sir 43-Z+.rt� 17(L. l(s)'ar`luurioaacigy. : ❑see Paget 2
Address: ° _._ rod,alb:ration,or=nmaon
City/Stat IP: 17L11JIA SC US'Sa {.` .. 9"1�9. Race additional Inspection ever allowable in airy of the above
q Ar),faional InsperAon(I •lie min) f. 66.21/fir
Phone:( �}jS�(09 YJ 1 I Fex:( ) Investigation(Ihrmin) 90.00/la
Email: `t�/, /) , industrial punt(I jinn 7s.18Jla -
. /IL
inspections for which no Poe is
Su Lic.: specifically listed(%limn) 9o.Oa br
CCB Lie.: �(0412 Electrical Lice �,lyyt.. � P^'• 3G-21 S seeq i<
i
Suprv.Electrician signature,required: �""" &1.8cW
'Print name:Tergisi 114C:04AS Date: l,Z):24 •- 0>haa Review Reebired(25%of permit fee):'
�el1.G//!.2 S2Gt,C." .. _ statesatdiarse(lzseorpamritree):
Authorized signature: TOTAL PERMIT FEE:
Inn penult alrp4eW ®cw h6a
a.repire.if a permit tekt [d aittkla--19!
Print name:__Deirdre Date:2/.t 1/21 days prier it has been accepted as complete.
yeirdre Britt ll • Namher of ifupe lions allowed pee permit.
I:iaalldglPemia113C PenekApp MRJltltdoc Rev OW ltlinn //0d4157(I1/0d1COM'W0a
Electrical Permit Application—City of Tigard
Page 2—Supplemental information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE_SCHEDULE
Fee for all residential systems combined: $75.00 Description / Div- ( End I Te si t '
Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to15kva 133.56 2
❑ Audio and Stereo Systems* ism to25kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301 04 2
Garage Door Opener* snot to 100 kva ss2se 2
>100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
(0 Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
0 Vacuum Systems* >100 kva-no additional charge 0.0 3
Earh additional inspection over allowable in any of the above:
❑ Other: cha h cd at an hou Eacadditional d a Ahrmin is
66.25/hr
--- - - -- -inspections for which no fee is
soecifical listed('/:hr min) 90.001 hr
COMMERCIAL WORK ONLY: r'!' Fa .L ELECTRICAL PERMIT PEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1)
(SEE OAR 918-309-0000) + Number nri inspections pc:pc nu.
Check Type of Work Involved:
Audio and Stereo Systems
• Boiler Controls
• Clock Systems
❑ Data Telecommunication Installation
Ej Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control*
• Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
Mnuildinga'ennils ELC Perm4ApP Ftn_1TRP,.doe Rev 06/170015
Plumbing Permit Application
Building Fixtures FiECEIVECummigismissimm
City of Tigard Receivdl
it 13125 SW Ilan Blvd.,Tigard,OR 97223
71
FEB 0 1 2021 Date/By: Permit No;N�Sr2021-QLn2G
Phone: 503.718.2439 Fax: 503.598.I960 Flan Review
�/ r-� Datdey: Other Permit No
T I G A R D Inspection Line: 503.639.4175 C I I 1 O F TIGARD Dare Ready/By. Jura: Sec Page 2 for
Internet: www.tigardor.gov is
I Notifixy_mcrhod Supplemental Information
TYPE OF WORK'. e,,;-z s,. 1l' FEE* SCHEDULE
VNew construction ❑Demolition For special information use checklist
❑Addition/alteration/replacement El Other: NDewI 1-LfaedlF siva:Inks(inehtdes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
fg I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)
❑Accessory building 0 Multi-family bath 1 500.32
Each additional bath/kitchen 25.02
0 Master builder ❑Other: Eire sprinkler( sq.It) Page 2
«r `& 'OB SITE INFORMATION AND LOCATION Site utirrties: l..
lob site address: 1 30060 S 14 F012.4kf.4 Hi t.ty- /x Catch basin or area drain 18.76
City/State/ZIP: 1[0r\d"° 0 : Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) _ Page 2
Suite/bldg./apt.no.: Project name: 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.: ) Page2
` - Water service(no.linear ft.: ) Page 2
Subdivision: Fc32,1344 Hi U '.Lot no.: 12, Filature or Item:Tax map/parcel no.: Backflow preventer _ 31.27
DESCRIPTION OF WORK Backwater valve 12.51
4 , slot e 1�=1 ' SSI� s� Dishwa waserher 25.02
Dishwasher her
25.02
Drinking fountain 25.02
..... Ejectors/son-1p 25.02
Et'.PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name' S'��".t,�L T'7r-1)}( k :& t(>{ _- Fixture/sewer cap 25.02
��r-���y.{ Floor drain/floor sink/hub 25.02
Address: 23 r^n.s�tle,`,1' CI Suite 1
Garbage disposal I 25.02
City/State/ZIP: , 00, ¶ C•35 Hose bib 2- 25.02
Phone:()3)' 115-11 Fax ( -3)3e5-1 Ito I5 Ice maker 12.51
'r APPLICANT ❑ CONTACT' PERSON Interceptor/grease trap 25.02
Business name S^ToIr.,11 13,i24 pbE F1oMu. 1si11.)i 1.1-C.. Medical gas(value:$ ) Page 2
Contact name:" �Rj Primer 12.51
Roof drain(commercial) 12.51
Address:
_. Sink/basin/lavatory J 25.02
City/State/Z1P: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 2 12.51
E-mail: Pep-4 7-1 Q Szoiy Be t r.bE iiit A t m.o.C C`N1 Urinal 25.02
Water closet 3 25.02
CONTRACTOR -
Water heater 1 37.52
Business name:"ruNk.f 1ztj MU utz1.4 171.,o M$1 t.41,
Water P1PNf/D 56.29
Address: se fZ,,,,t - . Other:
25.02
City/State/ZIP: HILAS6at .o1op,_en 12'j Subtotal
Phone:(5'2?)kiADOI13 Fax:( ) Minimum permit fee: $72.50
CCB Lic• 1 - 34- r.�al� Plan review (25%of permit fcc)
�()`(�� - Plumbing Lic.no.: -l-f-1-W rJ _ State surcharge(12%of permit fcc)
Authorized signature: TOTAL PERMIT FEE
Print name: J y ., A Date: 1.�,14 This MrmkappBeations'apireaHa permit is not obtained within 180days
- after it has been accepted as complete.
'Fee methodology set by TriCosaty Building Industry Service Board.
'Mudding\Permas\PLMU-PermilApp.doc 10,01/09 4404/16T(10/01+COM/WGA)