Permit Plumbing Permit Application
Building Fixtures J3009 FOR OFFICE USE ONLY
City of Tigard FH 13 Received (^T _��
���tttcci''' ` Date/By: Permit No.:M l W�
• 13125 SW Hall Blvd.,Tigard,OR ,'t Plan Review
Phone: 503.718.2439 Fax: 503:. ",1 Other Permit No.:
Date/By:
Ti G A R U Inspection Line: 503.639.4175 ) Date Ready/By: Juris El See Page 2 for
Internet: www.tigard-or. -- Notified/Method: Supplemental Information
nv ,,. TYPE OF WORK -�` - FEE" SCIIEDULE
IE New construction ❑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)
IIMCATEGORY OF CONSTRUCTION SFR(1)bath 312.70
l 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 1 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder D Other: Fire sprinkler(_sq.ft.) Page 2
MP JOB SITE INFORMATION AND LOCATION AM
Site utilities:
Job site address: 13094 SW Foran Hills Ct. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Foran Hills 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: Foran Hills I Lot no.: 13 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
New, single family residence Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Stone Bridge Homes NW, LLC Fixturelsewercap 25.02
Floor drain/floor sink/hub 25.02
Address: 4230 Galewood St. Suite#100 Garbage disposal 1 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hose bib 2 25.02
Phone:(503)387-7577 Fax:( ) Ice maker 12.51
lJ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: Stone Bridge Homes NW, LLC
Primer 12.51
Contact name: Permit Tech Roof drain(commercial) 12.51
Address: 4230 Galewood St. Suite#100 Sink/basin/lavatory 5 25.02
City/State/ZIP: Lake Oswego, OR 97035 Solar units(potable water) 62.54
Phone:(503 )387-7577 Fax::( ) Tub/shower/shower pan 3 12.51
E-mail: portlandpermits@stonebridgehomesnw.com Urinal 25.02
Water closet 2 25.02
CONTRACTOR
Water heater 1 37.52
Business name:Jardine Plumbing Water piping/DWV 56.29
Address: PO Box 186 Other: 25.02
City/State/ZIP: Estacada, OR 97023 Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 108747 Plumbing Lic.no.: 3-320PB Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:jay jar l,vt e TOTAL PERMIT FEE
Print name: JayJardine Date: 5-14-2021 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Yee methodology set by Tn-County Building Industry Service Board.
IiBuilding\Permits\PLMU-PermitAppdoc 10/01/09 440-4616T(10/02tCOM/WEB)
IN CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit*: MST2021-00060
T 1 GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2021
Parcel: 2S109ACO2200
Jurisdiction: Tigard
Site address: 13094 SW FORAN HILLS CT
Subdivision: 1992-057 PARTITION PLAT Lot: 13
Project: Foran Hills, 13
Project Description: New detached dwelling unit
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1942 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 17 Bathrooms: 2 Second: 0 sf Garage: 550 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 1942 sf Value: $264,618.82 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 2 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
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
BckOW 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 Tvoes Air Conditioning: N Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add''500 sf: 3 201-400 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 1942
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: $36,078.99
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 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.
Issued By: HO1I'Van/De.Wege Permittee Signature: 0w1pp
UCarLOVI
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.
• .
J30o9
FHt3
Building Permit Application
Residential
RECEIVED
City of Tigard Received
` N N15(Z0U .006Co 0
Z L{„ �. Permit No.:
Illi13125 SW Hall Blvd.,Tigard,OR 97223 FEB 1 1 2021 Plan Review s(
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: �zj��'�j 21 Mom,jod,erPe t:5#. gz z(_OO
i,r; Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Ill ( /yam Ct Supplemental See Pone 2 for
Information
Internet: www.tigardor.gov L' Not— Method: �j�,1 �T,
J
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
Sl'New construction ❑Demolition Permit fees'are based on the value of the work performed.
❑Addition/alteration/replacement ❑Other: indicate a value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,atO t prpfit he tZ
CATEGORY OF CONSTRUCTION work ibeicaled on this application Z I Li
1 lia)1-and 2-family dwelling ❑Commercial/industrial Valuation: $
Accessory -2111311441--
buildin umber •
of bedrooms: `N
El g ❑Multi-family 3
❑Master builder 0 Other: Number of bathrooms: eL a y A
JOB SITE INFORMATION AND LOCATION
Total number of floors: Li
lob site address: 1 50 1l"( S J ` Y—orN -Yt1 Gt. New dwelling area: 1 a91 2. square feet
City/State/ZIP: T((,Att.D,bit Garage/carport area: 550 square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
er structure area: square feet
REQ DATA:COMMERCIAL-USE CHECKLIST
Subdivision: F R.,.., films- I Lot no.: 1". 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.
;'•lk.1,Sti-AA 19LMIvi let SIGENOE Valuation: $
Existing building area: square feet
New building area: square feet
I5bPROPERTY OWNER 0 TENANT Number of stories:
Name: STL 4 E 59--1 DbE HOMbS 14 W r tAL Type of construction:
Address: 41.7 bmtv1000 coat I� Occupancy groups:
City/State/ZIP: Line OS� �� 1 . �t`(035 Existing:
Phone:(,)3) 3b115-n Fax:(5)3) 3(j7111,D15 New:
rb APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES`
Business name: St'CNe, FSQ-11x �, H ONES i`IW;ILL,
(Pteore referwjee schedule)
Structural plan review fee(or deposit):
Contact name: -va{()(ig B t-
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
E-mail: DB2-.17 j ce. S-fOtlEv3R-1C H 0t AE.SntW.COP-A
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES'
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: STb1,e i D V e (.1 C)M c t,t'V);(AL, Submit two(2)sets of roof plan with connection details
e,' and fire department access,along with the 2010 Oregon
Address: 4z3(j ( 4 J()OP SI, Uilt- I Oe Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review
(1>i bSV JU, UQ, "(035 SI80.00
and administrative fees):
Phone:(tip-5)3E6-115-1 1 Fax:( %)3V1-1 LDI 55 State surcharge(L2%of permit fee): $21.60
CCB lie.: 113�i l$ Total fee due upon application: $201.60
Authorized signature: . _;:tt 5 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1lo PA24 1 Date:2..— 1 I`-2.O2 1 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pesmits\BUP-RESPesmitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family DwellingiiE 'L.EIVE® luu ul Fl( 1; l .F „0,l ,
City of Tigard Wired 2 Z. = /' _ , 1
• 13125 SW Hall Blvd.,Tiganl,OR 97223 FEB 1 1 2021 Acts/B : ptcmite:
' Phone: 503.7182439 Fax: 503.598.1960
i t C;h R tJ 24-Hour Inspection Line: 503.639.4175 0 Ekcaicel 0 Plumbing ❑ Mechanical
Internet: www.tigardor.gov CITY OF TIGARD 0 other
II . a a a.
'['HE 1-01 1,01VINC ITEt1Iti -ARF. RIQl'112FI) FOR 1'1 ;1\ RE1'IF11 )r' 'so
I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 i 0
2 inning. 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: , —❑" [l 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0
6 Sewer permit. 0 0
7 Water district approval. ❑ 0 0
8 Soils report. Must catty original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state pzi ❑ 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
cop}rtgbt violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property comer elevations(if pll ❑ ❑
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 is ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details, Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 ❑
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. U 0 ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 00 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 tu ❑ ❑
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 ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0
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 'ect under review.
23 Three(3)site plans are required for Item I 1 above. Site plans must be 8-1/2"x 11"or II"x 17".
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 0 ❑
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
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard R 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,(hiplines, ❑ 0 ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9,1995.
I:1Buitding\Pemtits\BUP-RESPetmitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit AnnlicataECEIVED FOR OFFICE 1.'.SF1 ONLY
City of Tigard FEB 1 "`r "` 2`
9 qq Da v 22tZ1 It 'Y151 2011-DOC�D6
.1111 r 13125 SW Had Blvd„'Figard,OR 97223 1 ZUL�
■ Phone: 503.718.2439 Fax: 503.598.196
'f 1 L A It p Inspection Line: 503.639.4175 CITY OF TIGARD RD Dote t u.• -o ES See Page 2 fur
Internet: www.tigurd-or.gov BUILDING DI Nati lie,t,letbnd Supplemental information fl
VISION
TYPE OF WORK COMMERCIAL FEE- SCHEDULE-USE CHECKLIST
Mechanical permit fees*are based on the value of the work
L. New construction ❑Addition/alteration/replacement performed.Indicate the value(rminded to the nearest dollar)of all
❑Demolition ❑Other: nlechanieul materials.equipment.labor.overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT.0 SYSTEMS FEES'
® I-and 2-family dwelling ❑Comtnerciallindustrial 0 Accessory building For special information use checklist.
❑Multi-faintly ❑ Master builder ❑Other: Description Qty. Ea. Total
JOE SITE INFORMATION AND LOCATION Heating/cooling:
ail./ `y C p FoY'� , r14t S C• Airconditioning
ace I i L000 46.75
Job site address t t7 y ` Funtace 100.000 BTU nicirnemsi I 46.75
City/State/ZIP:Tigard,OR Furnace 1(10,000- II'l't rtlucr._corn �� 54.9I
Heat pump .._.._._.__.,. 61.,o .
Suiterbtdg/apt.no.. Project name: Duct work 23.32
Cross street/directions to job site: Hvdronic hot water system 23.32
Residential boiler(radiator or
_ hvdronic) 23.32
Unit heaters(fuel-type,not electric),
.. _..-._...._ -.._________._. in-wall.in-duel.suspended etc.. 46.75
Flue vent for any of above 1 23.32
Subdivision:i A*J HILLS Lotno.: 1-3 Other23.32
1g
Other fuel appliances:
Tax map/parcel no.: Water healer I 23.32
DESCRIPTION OF WORK Gas fireplace/insert I 33.39
Flue vent for water heater or gas
new,single family residence
Fireplace 2 23.32
Log lighter(Fast 23.32
Wood/pellet stove 33.39
_._._. Wood fireplace/insert - 23.32
Chisnleviliner/tluelvcnt 23.32
ElPROPERTY OWNER 0 TENANT Other: _ _ 23.32
Envirorinlental exhaust and ventilation:
Name:Stone Bridge Homes NW,LLC Range hood/other kitchen
equipment 1 33.39
Address:4230 Calewood St,Suite 100 Clothes d yes exhaust I 33.39
City/State/!II':Lake Oswego,OR 97035 Single-duct exhaust(bathroom+, u
toilet compartments.utility rooms) "1 23 32
Phone:(503)387.7577 Fax:(503)387.7615 ^Altic.`erawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other__...._._. 23.32
Business name:same as above Fuel piping:
----- ----- $14.15 for first four:$4.03 for each additional
Contact name:Deirdre Britt Furnace.etc. 1
Address: Gas heat pump
Wall/suspended/unit heater
City/State/LIP: Water heater _ I
Phone:( ) f F:ix: :( ) Fireplace I
{{{
Range 1
E-mail:dbrittTstvnebridge hamesnw.com Barbecue
•CONTRACTOR Clothes drra(gasl ,- I
Business name:Comfort Zone Other;
MECHANICAL PERMIT FEES'
Address:1032 NW Corporate Dr. Subtotal
City/StateJZJP:Troutdale,OR 97060 Minimum permit fee(S90.00)
Plan review(25%of permit tee)
Phone:(503)667.5595_-_ Fax:(503)491.8252 State surcharge(12%of permit fee)
CCB he:110091 TOTAL PERMIT FEE
,..�._..�.._ This permit application expires if a permit is not obtained within 180
l 1� '-... days after it has been accepted as complete.
Authorized signature�_-, _ .
' Fce methodology set by 1'ri-County Building Industry Service Bn,Ird
Priitt name David Hehtstah Date Z I '20Z,1
I-PotLigVPcrmil it rC 0.;nnl'u 9 c fnI Udoc
•
Electrical Permit Applicatia CEIVED ,,,it tiFFICF. ('SF 0'l.1
City of Tigard Received
ap- 13125 SW Hall Blvd.,Tigard,OR 972SEB 1 °e"� ' Z 2 2 J�J Penult u: - 000 Op 0
Phone: 503.718.2439 Pax: 503.598.1960 1 10Z1 Da, : . w Related Permit s:
Inspection Line: 503.639.4175 CITY OF TIGARD ReayDatethad: iota_ Fa See
e Page
2for fornattoa
T I fi A R . interne: www.tigard-or.gov ��� n�,'
TYPE DIVISION PLAN REVIEW
)New construction ❑Addition/alteration/replacement Please cheek all the apply(submit 2 eels of plans w/items checked):
El Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition El Other:
where the available fault ascent 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Ep 1-and 2-family dwelling 0 Commercial/industrial El Accessory building ua less to ground,or exceeds 14.000 0 Commercial-use agriculnt
amps Multi-familybu
❑ Master builderOther: for . otherinstallations. Installation
❑ 0 ❑Fim pump. ❑Iranlletan of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
lob#:3o0R lob site address: 130114 SW 55YaYt +1i 6 Ct. Ifg liP❑Additpoofoewmotorloadof ❑e}'1emE
11 or mare.
City/State/ZfP• Q- ' 11,,� 0 Six or more residential units. occupancy.
�' " )t V ❑Health-care facilities. 0 Recreational vehicle perks.
Suite/bldgJapt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or mote. 600 volts nominal
Cross street/directions to job site: FEE SCHEDULE
Desolation I 00'. I each I Twat I •
New residential single-or multi-family dwelling unit
Subdivision: f0r2..A41 N I U S` Lot#: 1`a includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less l 168.54 4
Ea.add'1500 sq.ft.or portion 2. 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
t4?-,W 1 FRI A 0 ss i7ENCE (with above sq.ft.)
IYvW:S NEE r r"Yt t'7 Y 1/L.`- Limited energy,mufti-family 75.00 2
residential(with above sq.ft.)
® OWNER - Renewable Energy 0 See Page 2
1O,PROPERTY j El Services or feeders installation,alteration,and/or relocation
Name: S�oF1 ,D l�ME3 4'1 fL 200 amps or less 100.70 2
Address: 4i2 0 V V V x-A..+ Sir SUITE 100 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/IIP: QSW QUO i op. 91035- 601 amps to 1,000 amps 301.04 2
Phone:(St 3(j"11 1 Fax:(5D3)3cbi l u i 5 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 1 own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.06 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
i51 APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension, . r mid
A.Fee for branch circuits with
Business name: s1Qis,1 F,gl17bE 1.{OMC , NW i u.L.› above service or feeder fee, 7.42 2
each branch circuit
Contact name:"1 at (t,E 24 T B.Fee for branch circuits without
service or feeder fee,first
Address: 56.18 2
branch circuit
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Dg12477 e Szot i:5 W oL H ornEsts.s.u).Cohn
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: E1.6.Lflt ICpr4. I r1 N tyV p,-(I Col S Sign or outline lighting 67.84 2
I!p9'S3 23-U.1D b Signal circuit(s)or limitcd.cncrgy .
Address: S E {Z. panel,alteration.or extension. 0 See Page 2 2
City/State/ZIP: VprN)A SC U S, OP-• 91 01)-)9 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(5>3)3S17 G94b9 Fax:( ) Investigation(I hr min) 90.00/hr
Email: // /� /L� Industrial plant(1 hr min) 78.18f hr
(U l Intspections for which no fee is
CCBLie.: 4242412 Electrical Lic.: qgL. Suprv.Lic.�2f s specifically listed(X hr min) 90.00 hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
, Subtotal:
Print name:-feiviM11.10M A S [Date: / 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
1�(- TOTAL PERMIT FEE:
Authorized signature: 1, - ' g 'IV*
C�N� O� 2-It—2021 This permit appika ter aspires H a prmil is eat obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of impactions allowed per permit,
Mauildir\PermitACLQ PmmilApp t.R_tlr.doc Rea 06/172015 \ 440-4615T(I IN5/COMMTa
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 Re,ew° i Q ' i etle° r"r''
Reaewahle electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.20 2
5.01toISkva 133.56 2
C Audio and Stereo Systems* :5.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
C Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
j Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge (LO 3
Each additional inspection over allowable in annof the above:
❑ Other: Each additional inspection is 66 25i hr
charged at an hourly(1 hr min)
inspections for which no fee is 90 007 hr
specifically listed(Ys hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
" Number of inspcc[ions allowed per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
O Audio and Stereo Systems
0 Boiler Controls
❑ Clock Systems
O Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
C Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
Medical
I Nurse Calls
O Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
:'Auild�ng\PenniuELc Permit App r.LR_rxr:.dac Rev 0601 72 0 1 5
Plumbing Permit ApplicutPECEIVED
Building Fixtures I (rI 1 l 1 1( 1 I .1 1)v I 1
City of Tigard FEB 1 1 2021 Received Z 2 Permit No.:
13125 SW Hall Blvd„Tigard,OR °"�" 1 Zl '('f1S1 ZoZI -6�">(C6
Plan Review
- Phone: 503.718.2439 Fax: 5113.54 OF TIGARD r Other PermitNo.:
TI(;:,is D I www: Sat-or.g4175 gUILDIMG DIVISION , 'tea: kris: Supplemental Page 2 for Information
Internet: www.tigard-or.gov
TYPE OF WORK FEE* SCHEDULE
New construction ❑ Demolition For specie(information use checklist
r
❑Addition/alteration/replacement ❑Other Ne
NewI Qty. I Ea. I Total I-ton 2-family dwdlingg(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(t)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/ititchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.fl,) Page 2
JOB SITE INFORMATION" AND LOCATION Site utilitie
TI s.
Job site address: 130Cl SY%) k O aion -{WASC � Catch basin orarea drain 18.76
City/State/ZIP: �i�? Q 012. Drywell,teach line,or trench drain 18.76
1Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I 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.: 1 Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: 1p_411 Hi us' I Lot no.: 13 nature errBeau
Tax map/parcel no.: Baekftow preventer 31.27
DESCRDESCRIPTIONOF WORK
WO Backwater valve 12.51
N t1J, SII,lL FYM$L'I i ,ION sipme� Clothes washer1 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER i 0 TENANT Expansion tank 12.51
Name: STOist P i1)1) 1--icr/1ES 1.4U)k (L Fixturelscwercap 25.02
Floor drain/floor sink/hub 25.02
Address: 4130 (2P‘taViDOD Sit SO11C ICC' Garbage disposal 1 25.02
City/State/ZIP: tfil-te CJ(7o/ 00, 9103C Hose bib 2- 25.02
Phone:(5L) )3Y,1151? Fax:0-t3)3,2511(p 15 Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Slows $p..(pbE H UIV11rS hl W i (,LC. Medical gas(value:$_) Page 2
Contact name: (Z,rQ �p�7-7 Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 525.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 3 12.51
E-mail: pP1ZZ e Sloide 81u p(�E HomtSN L W. .C.KA Urinal 25.02
13
Water closet Z„ 25.02
CONTRACTOR
Water heater i 37.52
Business name: E:DNf O M014.61..I "VW NV?,i1,1(" WaterpipingfDWV 56.29
Address: S 12,1\ L�. Other. 25.02
City/State/ZiP: I U S$mof OR Alt L-5 Subtotal
Phone:(�.)))1 4,-D O 113 Fax:( ) Minimum permit fee: 572.50
CCB Lie.: 9,4051 - Plumbing Lic,no.: 34-100pl; Plan review (25%of permit fcc)
State surcharge(12%of permit fee)
Authorized signature:
TOTAL PERMIT FEE
Print name: Ply Date:'L- -2021 This permit appnmdon exp(ree ifs permit is not obtained within 180 days
after i[has been accepted as complete.
*Fee methodology set by Tri-County Huitdios Indu.sity Service Board.
t:dlaildag)Pernitathilu-➢ennilApp.doc tor01N9 4/0-1616T(10/02'COM/wrn)
Plan # Liao MQD
Floors I Large
Bed rooms 3 Small oZ
WC 2.
Tub 3 Basement 3 'LAV 3 122 y 4 X )94 2 ZY71`b l7 .
3Z
Vent 4 1st Floor VI LA 2- I 1 (�c� ��j `/ 5jrj b Z�D, '36
Water Heater 2nd Floor V l�
AC � 3rd Floor �01 2Cp({/ tcp SZ
R 3 Total School �& «�Z
Garage 52-1S�b1
Total 2,
I „ , y „y `c) #forElec 4
City of Tigard
N COMMUNITY DEVELOPMENT DEPARTMENT 2/i 1 /2-(
IPIIC
T I G A R D Building Permit Review — Residential
Building Permit #: l y►S1 Z. C Z\ — oe,(Co d
Site Address: 13094 SW Foran Hills Ct
Project Name: Foran Hills Lot #: 13
Planning Review
Proposal: New house
® Verify address/suite # active in Accela. E1 In River Terrace: ® No ❑ Yes, River Terrace Review Addendum
Site Plan Elements: $]Erosion Control
]3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper IlalRetained trees with drip line and tree protection measures
®Drawn to scale (standard architect or engineer scale) EFootprint of new structure(including decks)and FFE
®North arrow nUtility locations&easements(required for new and additions)
®Site address,project or subdivision name and lot number ®Sidewalk/driveway approach
®Applicant information(name and phone number) na Location of wells/septic systems
XlLot dimensions and building setback dimensions E Street tree size,type and location
IlaSquare footage of buildings to be demolished $]Street names
n$]Existing structures on site %]Corner elevations(2'contours if more than 4'differential)
XLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? E Yes No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? [ Yes ❑No
K7 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: E Yes,applicant was notified la No Received: ❑ Yes ❑ No
K] Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified g No Received: ❑ Yes ❑ No
!] SDC Exemption for ADU applied for: ❑ Yes l'KI No Received: ❑ Yes ❑ No
N Public Facilities Improvement (PFI) Permit
Required: ❑ Yes,applicant was notified 1`}' No Applied For: ❑ Yes ❑ No,stop intake
E Land Use Case#: SUB2017-00005 K] Zoning: R-7
Cl Required Setbacks: Front: 15 Rear: 15 Side: 5 Street Side: na Garage: 20
N Building Height Max.Height: 35 Actual Height: 17
® Landscape Area: 80 % E Lot Coverage Max: 20
Entrance ® Set back no more than 8' from street-facing wall $l Parallel to street or offset 45 degrees or less
Windows & Minimum 12%of area of all street-facing facades 14%
Garage R] Garage door is behind widest street-facing wall A Yes ❑ No,one of the following is met:
❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2"d floor.
hl Garage door width is ❑ 12'or less E 50%or less of facade ❑ 60%or less and includes 7 of following:
X] Covered porch Pill Recessed entrance ❑ Wall offset 2 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch X Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ® Window trim ❑ Window recess ❑ Window projection ❑ Balcony
® Visual Clearance 29 Urban Forestry Plan
K] Sensitive Lands: ❑ Yes Kl No Type:
® Conditions met prior to issuance of building permit
Notes:
J Approved By Planning: 1 &mak/ Date: 2/16/2021
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
1:1B uil di ng\Form s\BI dgPerm itRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: Z 1 1%
Site Plans: # 3
Building Plans: #C+ _ _
Building Permit#: � Enter building permit#above.
Workflow Routing: 2/Planning R.Engineering l'Pernut Coordinator ' Building
Workflow Sign-off: V Sign-off for Planning(include notes from planning review)
Route Application Documents: t_Iv Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: 1 y,•,`t- 'Gnp ",f Date: 2-`Q2 \ 2
Engineering Review 1 "
2lope at building pad:
Conditions "Met"prior to issuance of building permit
C9E ements (encroachments)per engineering conditions of approval and plat
Di Water Quality/Quantity Facility: ��
Assess Water Quality Fee in-lieu: E Yes Id lyo
Assess Water Quantity Fee in-lieu: E Yes No
LIDA Facility on lot E Yes Id No
Id Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
L� Approved by Engineering: 14 . A S i f% Date: g•,74-so a••
Revisions (after Building Submittal only) Reviewer Date
Revision 1: E Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
P,�rmit Coordinator Review
\ j C.nditions"Met" prior to issuance of building permit
a Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
IA> SDC Exemption: ❑ Received //Does not apply
7 SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: ® Yes ❑ N/A
Parks SDC: Yes ❑ /A
LIDA ❑ Yes 1td N/A
OK to Issue Permit
Approved by Permit Coordinator: _ Date: 2/2Y/2/
1:\Building\Forms\BI dgPcrtnitRvw_RES_122419.docx