Permit 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
i III ' ' Transmittal Letter
T I G A R[D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Allyson Armstrong DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVE':'
FROM: Meghan Ticknor DEC 2 0 2021
COMPANY: David Weekley Homes +IIlY OF YIGAHII
3UILDING DIVISION BY:
PHONE: 503.213.4409
EMAIL: mticknor@dwhomes.com
RE: 10774 Lady Marion Drive MST2021-00275
(Site Address) (Permit Number)
Trillium Hill Lot 5
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 3 Revisions: Trek Steps to rear deck Plan Change
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: Submitted plan set for rear deck revision.Trek steps to be added for access to the back yard.
t-C.k_ o rc` ; 1 1�( kAlkP "72 1 N.c.,s - -t+ ! 09.c_c-k- `/his
• : . :, ' It, = Zl3 cfr
FOR FFICE USE ONLY
Routed to Per � echnician: Date: I i 3 2 2— Initials: /
Fees Due: Yes ❑No Fee Descrip ion: Amount Due:
-
/7, �n (Lki1.� $
c,J $ �Sce„.
$
$
Special
Instructions:
Reprint Permit (per PE): ❑No ❑ Done
Applicant Notified: Date: //[ii/2-y Initials: 4 7-
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
114 Transmittal Letter
a i G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Allyson Armstrong DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Meghan Ticknor DEC 2 9 2021
COMPANY: David Weekley Homes CITY OF TIGARD
PHONE: 503.213.4409 3UILDING DIVISION -- ,
EMAIL: mticknor@dwhomes.com
RE: 10774 Lady Marion Drive. MST2021-00275
(Site Address) (Permit Number)
Trillium Hill Lot 5
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 3 Revisions: Plot Plan to show Trek steps
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: Revised plot plan to show trek steps leading off the deck to the back yard.
•
FO4 TICE USE ONLY
Routed to Permit Technici n: Date: I 3 2Z-- Initials:
Fees Due: ❑ Yes ✓❑No Fee Description: Amount Due:
Die $$
,-,-?5-
Special
Instructions:
Reprint Permit (per PE): ❑ Yes o ❑ Done
1 Applicant Notified: Date: Initials:
City of Tigard
IliCOMMUNITY DEVELOPMENT DEPARTMENT
■
I I 6 A l:I7 Building Permit Review — Residential
Building Permit #: MST 2.02-1- CDC)2-1 C
Site Address: 1 o11'y SiAl t4X' 1 M 14)121w Da .
Project Name: Ta 1L-IUM N►U1 Lot #: S"
Plannin: Review
�Jt-t - /i ver>ptMV .AN 4t)Sh«4 'EGG stem
Pro. • Sal: NUJ lielftt
■ Verify address/suite# active in Accela. In River Terrace: No 0 Yes,River Terrace Review_ Addendum
Sit lan Elements: IG onion Control
opies of site plan on 8-1/2"x 11"or 11 x 17"paper t: tained trees with drip line and tree protection measures
ilAi ipt,awn to scale(standard architect or engineer scale) '4 F otprint of new structure (including decks)and FFE
rth arrow IV -ty locations&easements(required for new and additions)
address,project or subdivision name and lot number L/ ewalk/driveway approach
AC licant information(name and phone number) Of I/cation of wells/septic systems
AALot dimensions and building setback dimensions I�OS et tree size,type and location
�r Square footage of buildings to be demolished [ICJ et names
Existing structures on site Comer elevations(2'contours if more than 4'diffffer ntial)
Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? I�'esO,N,
im ervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes L?No
LiJ Clean Water Services-Service Provider Lette of platted prior to 9/10/1995):
quired: ❑ Yes,applicant was notified L�J No Received: ❑ Yes ❑ No
Water Meter Fixture Unit Worksheet-Additi ,Remodels and ADUs
Required: ❑ Yes,applicant was notified 1a No Received: ❑ Yes ❑ No
03 C Exemption for ADU applied for: ❑ Yes ❑ No Received: 0 Yes ❑ No
ict
Public Facilities Improvement(PFI) Permit:
equired: ❑ Yes,applicant was notified No Ap ed For: ❑ Yes ❑ No,stop intake
and Use Case#: $�$ZO►b-O Q40 Zoning: r 4•S
quired Setbacks: Front: Z 0 Rear: I S" Side: S" Street Side:NA. Garage: ?,0►
"Kuilding Height: Max. Height: 5e, Actual Hex ht:
Al Landscape ea: f % El Lot Coverage Max: 1 %
Entrance Vet back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ,linimum 12%of area of all street-facing facades
Garage l Garage door is behind widest street-facing wall 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 w• and there is a 12 sq ft.window above garage on 2°d floor.
Garage door width is ❑ 12'or less 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ 'indow trim ❑ Window recess ❑ Window projection ❑ Balcony
Visual Clearance rban Forestry P
sitive Lands: ❑ Yes No Type:
Conditions met prior to issuance of bu.di g permit
/ pproved
By Planning: Date: 2 I _
Revisions (after Building Submittal o ly R •ver Date
Revision 1: Approved ❑ Not Approved I/3/
Revision 2: ❑ Approved 0 Not Approved
i:\Building\Forms\BldgPermitRvw_RES_1224 I9.docx
Building Permit Submittal
Original Submittal Date: C0 2.4:1\21
Site Plans: # M
Building Plans: # 3
Building Permit#: Q'Enter building permit#above.
Workflow Routing: [Planning Engineering Permit Coordinator ❑ Building
Workflow Sign-off: E� j�tgn-off for Planning(include notes from planning review)
Route Application Documents: LY Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
riginal plan review muting form.
�� * Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: \ \J Cr t\ ewe Date: 1\ ,2--1
Engineering Review
Slope at building pad: ,,,
Eonditions "Met"prior to issuance of building permit
2-"Easements (encroachments) per engineering conditions of approval and plat
2/Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes EY-No
Assess Water Quantity Fee in-lieu: ❑ Yes ['-No
LIDA Facility on lot: ❑ Yes ff/No
2 Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Cklipproved by Engineering: K. 45 Date: '1— 1 C'--zeoz,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Permit Coordinator Review
7 Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption:0
0 Received Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: /Yes 0 N/A
Tigard Trans SDC: /" Yes 0 N/A
Parks SDC: /Yes 0 N/A
LIDA ///❑ Yes / N/A
/ OK to Issue Permit
Approved by Permit Coordinator: ty.,s/e-s --- Date: 1 i is(2.0/1.4
I•\Building\Forms\BldgPennitRvw_RES_122419.docx
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
4 Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Allyson Armstrong DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Meghan Ticknor OCT 13 2021
COMPANY: David Weekley Homes CITY OF TIGARD
3UILDING DIVISION B:: s4-.
PHONE: 503.213.4409
EMAIL: mticknor@dwhomes.com
RE: 10774 SW Lady Marion Drive MST2021-00275
(Site Address) (Permit Number)
Trillium Hills Lot 5
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Descriptions A
Additional set(s)of plans. 3 each Revisions: FRM-2/FS-1
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):
Ili MARKS: Revised FRM-2,was bearing the wrong state stamp.Revised FS-1 -venting calculation/plan for new underfloor area.
$i :'5 : , FOR FFIC USE ONLY ,. ,t �. *'
Routed to Permi c�'cian: Date: 1,Cp� , 2 1 Initials: '
Fees Due: el L I No Fee Description: Amount Due:
11.4 T „,.. ; - $ l- p .
p\.. r A v t .t-v►.S $
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes o ❑Done,,,
Applicant Notified: ate: `p �,�.,� ,)--( Initials:
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
.1111 II
_ Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Allyson Armstrong DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Meghan Ticknor
SEP 2 2 2021
COMPANY: David Weekley Homes CITY OF TIGA
PHONE: 503.213.4409 BUILDING DIVISI f
EMAIL: Mticknor@dwhomes.com
RE:
10774 SW Lady Marion Drive MST2021-00275
(Site Address) (Permit Number)
Trillium Hill Lot 5
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: . Copies:' Description:' , ,..) �,f" }. " t ,'.`,;"
Additional set(s) of plans. 2 Revisions: Structural Set-Framing/location
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: Garage access panel location is needing changed-please see the attached with adjustments.Note added to Structural Set for framing and location
FOR FFI E USE ONLY M
Routed to Permit Technici ate: 20 24 Initials: /b'fi
Fees Due: n Yes No 1 Fee Descr tion Amount Due:
$ ar....----
N..) b 1`.--) €
v
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes No ❑ Done
Applicant Notified: Date: l//J.LS 2/ Initials:
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
INle
11 Transmittal Letter
Tic,,,E t, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
TO: j'C I l06( Y 1 AP r3 DATE RECEIVED:
V
DEPT: BUILDING DIVISION
FROM: I4 V \ i iC�� RECEIVED
\-\--imb SEF �. � �Cs2�
COMPANY:DD\ (t \NL€,,v..i_e�
�.Zi�, `' oq` CITY NOF GTIGARU
PHONE: a J �{''f BUILDING OlillSinAPY
I EMAIL:�,y Y_L'Y� �' O(n
RE: 1 n-f.4 Lad Maki u(1 . V6T2.02-I— 0 621
(Site Address) (Permit Number)
1 (in7 i I l c VVV ff l i(da o+!
ject name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 6taCV) Revisions:
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:OprtY\Cie N-Q4A-Vin \R( cP1cu1 , U a
\oe\ow-ou �v� d.c. fr CDic�v tare
v( �s &d� _ °' ► cA it e
W e �� � i °�
Wl Una �Y �J-21C�r )lCq� ,
FOR E USE ONLY
Routed to Permit Technic' ate: t'D 20 �j( Initials:
Fees Due: El Yes I No Fee Descri tion. Amount Due:
VC5 ''G ✓ $
Special
Instructions:
Reprint Permit(per PE : [] Yes No ------ ❑Done�J
Applicant Notified: Date: 7,yILL �L( Initials: ,'
i
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
tE ; V Transmittal Letter
,,,,..1 r I c;,� n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
tr-
TO: RECEIVED
44Vq&D TO: flrdaY DATE RECEIVED:
DEPT: BUILDING DIVISION
1 FROM: von- 1 C • C'V AUG 2 3 till
y
tCOMPANY: David Weekley Homes CTY OF TIGARL
PHONE: (503)213-4409 BUILDING DIVISIQ I
EMAIL: mticknor@dwhomes.com
RE: \ V -14- L_ k4 (OXtve• MST2b21- 66Z V )
(Site Address) (Permit Number)
TYI kll v v\ ti11 12D±-.
yy (Project name or subdivision name and lot number)
orie S
ATTACHED ARE THE FOLLOWING ITEMS
'Z. 1 Copies. ° Descnplion x. , :4, , -taro,,, �' ,�
-P Additional set(s)of plans. Revisions: a\C 3 I Pt, Y 1
Cross section(s)and details. Wall bracing and/or lateral analysis.
-?,
Floor/roof framing. Basement and retaining walls.
cl Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: ��V 1 S i i 1 )\e�se see
=� aPV of.-F`giDY ?\3vc\ r--eNri cA \cv a-- o\ \
ppc_k_ oye -
FO 0111 CE USE ONLY
Routed to Permit Technic' ate: 1,0 2/0 7i Initials: A-A—
Fees Due: ❑ Yes Fee Descri tion. Amount Due:
$
c .....)Ci' ,,P
Special
Instructions:
Reprint Permit(per PE : fp Yes o ❑Done
Applicant Notified: te: IIJI) Initials:
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021-00275
T f GAP.T3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/02/2021
Parcel: 2S 11 ODA 10500
Jurisdiction: Tigard
Site address: 10774 SW LADY MARION DR
Subdivision: TRILLIUM HILL Lot: 5
Project: Trillium Hill, Lot 5
Project Description: New detached dwelling unit with covered deck
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1392 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 3 Second: 1746 sf Garage: 395 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 3138 sf Value: $407,644.85 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 3 Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Bckflw Prevntr: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 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 addi 500 sf: 6 201-400 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 Y
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3138
Owner: Contractor:
WEEKLEY HOMES LLC WEEKLEY HOMES Required Items and Reports(Conditions)
1111 N POST OAK RD 1905 NW 169TH PLACE SUITE 102 1 Ersn Cntrl 503-639-4175
HOUSTON,TX 77055 BEAVERTON,OR 97006 2 Geo Tech Report Required
Prior To Pour
PHONE: PHONE: 503-213-4415
FAX:
Total Fees: $40,923.06
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
QF)-nnl-nnin thrnnnnhhrise QS9-nnl-nnon Vn,,n, ,i nhtoin o nnmi of tho niloe nr riin,-t n,,oetinne 4n r i min by rnllinn Fr1'3 94)10S7 nr 1 MO'2Z)94AA
Issued By: Holly VcvniDe/Wece Permittee Signature: 0niApplecaticrv►
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.
Building Permit Application /2 4 1 6
- Residential FOR OFFICE USE ONLY
City of Tigard RECEIVED lla�et3y�, \3 Z, Nv Permit No.AST21-OO2:1S-
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' • Phone: 503.718.2439 Fax: 503.598.1960 juN 2 t MI Date/By: T�� it
Other PermiI:S Q .OZ.I—OOP°�
1 t;Alt 0Inspection Line: 503.639.4175 Date Ready/By: kris 0 See Page 2 for
www.tigard-or.gov CITY OF TIGARD ified/Meth ! Supplemental Information
'I V`Pt OF W( tEQt:IRED DATA: I-ANI)2-FAMILY DWEl.1.ING
®New construction ❑ Demolition Permit tees'are based on the value(tithe work performed.
— Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONS(RUCTION work indicated on this ap lication. �
® I-and 2-family dwelling 0 Commercial/industrial Valuation: $3 o7/ 11f7
❑Accessory building 0 Multi-family Number of bedroom 4
❑ Master builder 0 Other Number of bathrooms: X
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: 10774 Lady Marion Drive New dwelling are9. square feet -5533
City/State/ZIP:Tigard/OR/97224 )arage/carpRrt area: Ssquare feet (271 W
Suite/bldg./apt.no.: Project name:Trillium Hill ov�orch area: square feet t 7 Z
Cross street/directions to job site:SW 1119" AVE AND SW Lady Marion Dr Deck area: 12_1 square feet
Other structure area: / ti square feet
REQUIRED DATA:C ONIMERCIA I.-USE CIIICKLISI
Subdivision:Trillium hill Lot no.:5 Permit Ices*are based on the value of the work performed.
1'a nutp�p�n rcl no: 2S 1 101):1 11400 Indicate the value(rounded to the nearest dollar)of all
_ equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New Single Family Home to be built-3138 SQFT 4 Bedroom,2.5 bath with 412 SQ Valuation: $
FT 2 car garage with a 121 SQFT covered rear porch and 152 SQFT front porch. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 '1 CN'AN I Number of stories:
Name:David Weekley Homes Type of construction:
Address:1905 NW 169th Place Suite 102 Occupancy groups:
City/State/ZIP:Beaverton,OR 97006 Existing:
Phone:(5113)213-4415 I� '. t I New,:
0 APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:David Weekley Homes
Structural plan review fee(or deposit):
Contact name:Meghan Ticknor
FLS plan review fee(if applicable):
Address:1905 NW 169th Place,Suite 102
City/State/ZIP:Beaverton/OR/97006 Total fees due upon application:
Amount recei‘ed:
Phone:(503)213-441)9 Fax: :( )
I -mail:mticknoru'dwhomes.com l'HOTON'OLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR
RAC 1013 roof-top mounted PhotoVoltaic Solar Panel System.
Business name:David Wcekles I tomes Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:1905 NW 169th Place,Suite 102 Solar Installation Specialty Code checklist.
City/State/ZIP:Beaverton/OR/97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)213-4415 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.:213653
Total fee due upon application: $201.60
Authorized signature: ."�7�� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Meghan Ticknor Date: Li(.O 12 I *Fee methodology set by Tri-County Building Industry
I Service Board.
l:\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 USE ONLY
City of Tigard Received
2 ll DateBy: Permit No
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
>11 Phone: 503.718.2439 Fax: 503,598.1960
1GAttD -Hour Inspection Line: 503.639.4175 24 181 Electrical ® Plumbing El Mechanical
T
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQI!IRI:D FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ® ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ® ❑ ❑
3 Verification of approved plat/lot. ® ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ® ❑ ❑
9 Erosion control ®plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ® ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ® 0 ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area:percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ® 0 0
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. ® ❑ 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- A ❑ 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ►/ 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 El
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. ® 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ® 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ® 0 0
architect licensed in Ore.on and shall he shown to be a ilicable to the ,ro'ect under review.
JURISDICTIONAL SPECIFICS
23 I hree(3)site plans are required for Item II above. Site plans must he 8-1/2"x 11"or 11"x 17-. ® ❑ ❑
24 Iwo(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. ® ❑ ❑
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 ® ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ 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 ❑
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.
L\Building\PemuCs\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
i
Mechanical Permit APnlicati ("' �/ 1 FOR OFFICE USE ONLY
City of Tigard �✓ I '" Date/By:ReceivedED 1`3`2� �V Permit No.:MST�Z, Ot 2.,S
41 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JUR 2( 2O2 Date/By: Other Permit:
!AGAR D Inspection Line: 503.639.4175 Date Ready/Br luris: 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Meils i Supplemental Information
TYPE OF \y()Itli C:OMMERC"I 1L FEE'' SC[1EDt.LE - USE CHECKI.ISI
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
.. ...„ .,., .,.,.. Value:S
CATEGORY OF CONSTRUCTION
C'TION RESIDENT(Ai,EQUIPMENT I SYSTEMS FEES'*
® 1-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building fir special infurmution 10E'sizes
❑ Multi-family ElMaster builder ❑Other: Description 1 t i Ea. Total
.., Heating/cooling:
JOB SITE INFORMATION AND LOCATION
Air conditioning I 46.75 46.75
Job site address: 10774 Lady Marion Drive Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard/OR/97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Trillium Hill Duct work 23.32
Cross street/directions to job site:SW l096 Ave and SW Lady Marion Dr 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:Trillium !till I I of no.:5
Other: 23.32
Other fuel appliances:
"fax map/parcel no.: 251 I III)11 I4110 Water heater I 23.32
DESCRIPTION OF WORE Gas lireplace/insert I 33.39
Flue sent lbr water heater or gas
New single family home to be built-3138 sqft,4 bedroom 2.5 bath home with fireplace 23.32
412 sqft 2 car garage and a 121 sq ft covered deck patio and 152 sq ft front po. Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32 ,
Chimney/liner/flue/vent 23.32
Other: 23.32
® PROPERTY OWNER 0 TENANT
Environmental exhaust and ventilation:
Name:David Weekley Homes Range hood/other kitchen
equipment 1 33.39
Address:1905 NW 169th Place,Suite 102 Clothes dryer exhaust 1 33.39
City/State/ZIP:Beaverton/OR/97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 3 23.32
Phone:(503)213-4415 Iax.I ) Attic/crawlspace fans 23.32
1;4 APPLICANT ® CONTACT PERSON Other: 23.32
Fuel piping:
Ilu,lnes-,nante: David Wecklcy [tomes
$14.15 for first four;$4.03 for each additional
Contact name:Meghan Ticknor Furnace,etc.
Address: 1905 NW 169t'Place,Suite 102 Gas heat pump
— Wall/suspended/unit heater ,
City/State/ZIP:Beaverton/OR/97006 Water heater
k
Phone:(503)213-4408 Fax: :( ) Fireplace (
Range
F-mail: mticknorra�dwhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: David N\eeklev homes Other:
r MECHANICAL PERMIT FEES"
Address: 1905 NW 169'h Place Suite 102 Subtotal
City/State/ZIP: Beaverton/OR/97006 Minimum permit fee($90.00)
ri %Plan review(25ofpermit fee)
Phone:(503)213-4415 Fax:( )
State surcharge(12%of permit fee)
i
CCB lic.:213653 TOTAL PERMIT FEE
f This permit application expires if a permit is not obtained within 180
�� days after it has been accepted as complete.
Authorized signature: / * Fee methodology set by Tri-Canty Building Industry Service Board
Print name: Ken Pu man Date: Del/2,I
I.\Building\Permits\MEC_PertnitApp_040113.doc 440-4617T(I`I/02/COM/WEB)
Mechanical Permit Application - City of Tigard
'Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
L•\Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit Applicatio ECEIVED FOR OFFICE USE ONLY
Received
City of Tigard —7 V3 "Lk U Peoria_, MST2OZ1- O 21S
q Date/Bv:
IIIr 13125 SW Ilall Blvd.,Tigard,OR 97223 JUN t� 2�LS Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 G DateiP3 : Related Permit#:
Inspection Line: 503.639.4175 y Ready DateBy: tuns EI Sew:Page 2 for
1 I(i A It ll Internet: wWW.tigard-or.gov U� OFTIGARD Supplemental Information
TYPE OF w dhi '.i1 ~Et.3 V,,71,0 PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
Demolition IDOther where the available fault current D Marinas and boatyards.
CATE(.OR\ OI' CC)-VS1 RTC! exceeds 10,000 amps at 150 volts or ❑Floating buildings.
i ® _ , - r-� less to ground,or exceeds 14,000 ❑Commercial-use agricultural
u,�l _-,nail, ,1„,"il�i;;' 0 t unl„n.r.i:,iiin,iu•„.,,il \,.rc,;�rr, hinhimg
amps for all other installations. buildings.
j ❑ \lolti-!:irttil, ❑ \Ltstcr huil,let ❑Other ❑Fire pump. ❑installation of150KVAor
JOB yl(I INFORMATION AND LOCATION 0 Emergency system larger separately derived
❑Addition of new motor load of system.
Job#:68160005 Job site addres'- 10774 Lady Marion Drive 100HPor»more. ❑"V', E", 1-2 . '1-3 .
City/State/ZIP:Tigard/OR/97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
❑Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: Project name:Trillium Hill ❑tirrc ice on (ceder 600 amps or more. 600 volts non»nal.
Cross street/directions to job site:SW 1(19''AVE AND SW Lady Marion dr FEE SCHEDI7.E
Description I On. I Each I fora] I
New residential single-or multi-family dwelling unit.
Subdivision:Trillium Hill Lot#:5 Includes attached garage.
1,000 sq.It or less I 168.54 168.54 4
Pax map/parcel#k:2SI 111DA1 I4( ) Ea.add'l 500 sq.ft.or portion 4 33.92 107.76 1
DESCRIPTION OF WORK Limited energy,residential
New Single family home to be built-3138sgft 4 bedroom, 2.5 bath with 412sqft 2
(with above sq.ft.) 75.00 2
Limited energy.multi-family 75.00
car garage with a 121 sgft covered rear porch and 152sqft front porch. residential(with above sq.ft.)
Renewable Energy 0 See Page 2
15 PROPER FA OWNER ❑ TEN.-1ST i Services or feeders installation,alteration,and/or relocation
Name. David\\eckley !Ionics i 200 amps or less 100.70 2
Address:1905 SW 1690 Place Suite 102 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Beaverton/OR/97006 601 amps to 1,000 amps 301_04 ''
Phone:(5(13)213-4415 Fax:( ) Over 1,18)0 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:mschiedler@dwhomes.com 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: Dale: 401 amps to 599 amps 16854 2
Branch circuits—new,alteration,or extension,Per panel
® APPLICANT ►t CONTACT PERSON A.Fee for branch circuits with
Business name: David Wcekley !Ionics above service or feeder fee, 7.42
each branch circuit
Contact name:Meghan Ticknor B.Fee for branch circuits without
Address: 1905 NW 169ih Place Suite l02 service or feeder fee.first 56 18 2
branch circuit
City/State/ZIP: Beaverton/OR/97006 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)213-4409 Fax: :( ) Each manufactured or modular 67.84
dwelling,service and/or feeder
Email: mticknor*dwhones.com Reconnect only 67.84 0
CONTRA CI OR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Address:2890 SE Brookwood Ave Signal enemas)or limited-energy 0 See Page 2 2
panel,allteration,or extension.
City/State/Z,I P:Hillsboro,OR.97123 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25.'hr
Phone:(503)648-4552 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:permits@garnerelectric.com Indust ial plant(I hr min) 78.18,'hr
Insprruons for which no t``t. an i si hr
CCB Lie.:121159 Electrical Lie.. 4-305C Suprv,Lie.:3707S ,,I,ac'iicall, tried t';hi.n��,i 1
ELECTRICAL PERMIT FIGS
Suprv.Electrician signature,require Subtotal:
Print name:Charles Garner Date: ❑Plan Rev ie„ Required(25%ofpermrtfee):
State surcharge(12%of permit fee):
Authorized signature: gQ.d:t! gG�/Ll-Ch�L TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name:Brittany Burlan Date:6/29/21 days after it has been accepted as complete.
* Number of inspections allowed per permit_
l:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-461 Sr(I I/05/('OM/WEB
i Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FFE SCHEDULE
Fee for all residential systems combined: $75.00 DRenewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70
5.01 to 15 kva 133.56
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 _
Wind generation systems in excess of 25 kva:
0 Burglar Alarm 25.01 to 50 kva 301.04 2
5001 to 100 kva 552.26
Garage Door Opener*
loll kva(fee in accordance
2
with OAR 918-309-0040) 552.26
® 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 0.0 3
Each additional inspection over allowable in any of the above:
Other: Each additional inspection is ,,
charged at an hourly(l hr min) 66._5/hr
inspections for which no lee Is 90,00/hr
specifically listed('=z hr milli
COMMERCIAL WORK ONLY: ELECTRICAL. PERMIT FEES
Subtotal(I nteronPage I):
Fee for each commercial system: $75.00 Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
Fl Boiler Controls
Clock Systems
Data Telecommunication Installation
- Fire Alarm Installation
1-IVAC
- 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
IaBuilding\Permits\ELC1_PermitApp_ELR_ERE.doc Rev 06/17/2015
ill
g
Plumbing Permit APnlicatiaiglECEIVEC
Building Fixtures
•
City of Tigard JUN r�pq tteeal46<1 `�\
11111 13125 SW Hall Blvd.,Tigard,OR 97223 2 GUL t Dnw(Dy: '7 k3 2i \J Pemth No,;M ST2QZ,-0021 S
Phone: 503.718.2439 Fax: 503.598.146p,, Pear Review
vI I T O IGAR L to
Otheri'crn
ritN .
sIli Inspection Line: 503.639.4175
Internet: wwwnatt or,govy I11 t7 ( 7 Date Retdy/DY )arm ) lid See
e fine 2 forNotMittedMleand Supplemental Information. , �i t r v iltii3O O t1;t' ti. .t ti ip ykT0. 60
,
}®New construction ❑Demolition For special try/ormadon use checklist
❑Addition/alteration/replacement emeDt Description j Qty. ( Ea ,1 Total❑Oilier New I-24anify dwellings(includes 1(N)It,for each utility connection)
y. 'y,�; ,.zt 4?A v � } i x`Yty rt tt ,,.,
r t_Ci0 ,��.<, 47 a•ti, . :`st,.�'4!d�`a x ,`! t3S/ t;(• SFR(I)bath 312.70
®1-and 2-family dwelling Q Commercial/industrial SFR(2)bath
437.78
❑Accessory building 0 Multi-flintily SFR(3)bath 500.32 500.32
❑Master builder OtherEach additional bath/kitchen 1 25.02 25.02'
"'€i't st q , 'ir, r +s r,rrr tr t` q Fire sprinkler(,�- ft.) Page I
,t .i"xt.,Y�i 43 s R �iw+,-k}+ {. sq. )
#'t v;;.R K S,,.ltt `I't ttitri .5� ,"�:"z" ^#+r Ores i,'S'�3k i�ffe w 4+�v;. y•07eart: Site utilities; 2
Job site address: 10774 Lady Marion Drive Catch basin or area drain I 8.76
City/State/ZIP:Tigard/OR/97224 Drywall,leach line,or trench drain 18,76
Suite/bldg./apt•no,: 1 Project name:Trillium Hill tooting drain(no.linear ft.: 311 Page 2 87.55
Montt hectored home utilities 50,03
Cross street/directions to job site:SW 109th AVE AND SW Lady Marion Dr Manholes
18,76
Rain drain connector 18,76
Sanitary sewer(no.linear 11,: ) Page 2
Storm sewer(no,Linear ft.: ) _ Page 2
Subdivision:Trllllum hill Water service(no,linear It,: ) I Page 2
Lot no.:5 Fixture or beat;
Tax mttp/purcelno 281IODA11400 Backtlow preventer 1 31.27 31.27
L' tr5^ � Y1 5�,r �'r�'�7 �m.t .F a,�v 'rt z� 7rY a
r ' '"i',EA ,1;�'�• �!u; F�, ) ¢a!'jr 't��i dyt� I SFti�- ti.S. Backwater vat ve
�t di .4....,.��� �+�i"�����"t 'rt"�tk ' *�''�hM1f��t�aZ�i� � 12,5I
New Single Family Home to be built-3138sgft 4 bedroom,2.5 bath with Clothes washer t 25.02 25.02
412sqft 2 car garage with a 121sgft covered rear porch and 152sgft front porch. Dishwasher 1 25.02, 25,U2
Drinking fountain
25,02
Ejectors/sump 25.02
irM" R (# � F Fdt���$�� � �_trs?+dui�fi� Irl
Fri f lir 1 TF �'� gt ra e �F'rS52,4 L;fpansi°n lank
+ � r,,,, (i 12.51
Name:David Weekley Homes Fixture/sewer cap �5 02
Address:1905 NW 169'it Place Suite 102 Flour drain/floor sink/hub 25.02
City/State/ZIP;Beaverton,OR 97006 Garbage disposal t 25,02 25.02
Hose bib 2 25.02 50,04
Phone (503)213.4415 Fax:( ) Ice
maker
1 12.51 12.51La -t{ s tt r ,f r xr�,. , sea ftt k r{r .� � !a ° • , � S l y Uft Interceptor/grease trap 25.03
Ausiness name: David Weekley Hanes Medical gas(value:$ ) Page2
Contact name: Meg Min Ticknor Primer 12,51
Address: 1905 NW 169th Place,Suite 102 Roof drain(commercial) 12.51
Sink/basin/lavatory b 25.02 10008
City/State/ZIP:Beaverton/OR/97006 Solar units(potable water)
62,54
Phone:(503)213-4409 i Fax:: r
( ) Tub/shower/shower pan 2.. 12,51 25.02
E-mail;ntschiedler@dwhomes.cont Urinal 25.02
,Tr ,� rN-rt y+Se fr.t, sf[( f� .N.;#; a r:r Water Closet
tl #' . -3 t i : tthr lwc,tft .a.lT�uc3.;4s?rt it F Y,: � �5r1� � 3 37.52 I OU,08
Business name:Malmedal Plumbing Water hearer 1 37.52 37.52
Water piping/DWV 56.29
Address:PO Box 207
Other: 25.02
City/State/ZIP:Banks/OR/97106
Subtotal
Phone:(503)324-0759 Fax:( Minimum permit tee: $72 50
CCII Lie.:102535 Plumbing 1.1c.no,:34-276PB Plan review (25%of permit tee)
Authorized signature: Carolina Malmedat l o •- -•- State surcharge(12%ot'permit Ice)
..� TO'1'Al.,PERMIT FEE
Print name:Carolina Malmedai Date: 61' MI This permit nppltewnonexpires If printbIs not obtained within 18Uchip;
After it hits been accepted its complete,
"Foe nrolhodology sat by Tri-County Building rndasiry Serving Dowd.
I.tBua&ieniaenniinoLMU-Pemitatioduc I0/01'09 +104616T(!0/02/COM/WE9)
1
v,
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
4. Fee Schedule: Residential Fire Suppression Systems:
c . � r�.`0A3,, , r r , A.'. FYI M �I �y ii.� � +� ,{, rq.., yy�ti�tl{f Y i -tpCr h rm
a r , r :qi°V t ,.b :t3� �,.. t7 c\' i et ''?Q wv;;f Ifi ..:,, i 4; tk.N. a` i ,5{5,5,:;,1 s y,'t.
Footingdrain-I t00 50.03 0 to 2,000 $121,90
Footing drain-each additional 100' 37,52 2,001 to 3,600 $169.69
-Sewer-1st 100' 62,54 3�601 to 7,200 $233.20
Sewer-each additional 100' 7,201 and greater S327.54
37.5..
Water Service-1st 100' 62.54
Water Service-each additional too' 37,52 Medical Gas Systems
Storm&Rain Grain-1st 100' 62.54
$1.00 to$5,000,00 Minimum tee$72,50fllgtii''� aa{...,s �rmi ' 3f�a rr,? irtk`},
{
Storm&Rain Drain each additional 100 57.52 $5,00(.00 to$10,000.00 $72.50 for the first$5,000.00 and$1,52 for -p M r+� e h. nu � e'f:r art '�,�,,�,t ^. ) s
Oit 1, n ( ettf� : : r - ,t; r�; � elrr5t4. FA r?,,,ch each additional$100.00 or fraction thereof;to
Inspection of existing plumbing or for and lncluding$LO,OW.VU.
which no fee is specifically indicated 90.00/hr $10,04)1.00 to$25,000.00 $148,50 for the fist$10,000.00 and$1.54 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof;to
Inspections outside of normal business 90 U0lhr and including$25,000.00,
hours(minimum charge-2 hours) $25,001.0(7 to$50,000,00 $379.50 for theefirst
rst$25,000.00 and$1,45 for
Reinspect ion Fees 90 00/hr each additional$100,00 or traction thereof;to
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 traction 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*. ,y
t>< F'R,, (at' , L -� •
t?uariliy l kriXtard rYt e %, ��z:x iiii kiiii 7tdk` iki sH Y T 4 r t�-•
to . yp� . i rIv ui'r �` tc l*a .1f11lirtlz� tcf'nS
;��'OACIie1'fot`iieil r.,,. C.ppld yTAdJty, .:its) Plan review is required for any of the following,
Baptistry/Pont Please check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
Jacuzzi/Whiriprxri 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 0 Medical gas and vacuum systems for health care facilities,
-Domestic - 0 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.
-4" S3: r F b ; f rr s
Car Wash Drain _,a't'ki YAW41 r,�#`Y V0s 10WOM z R r 1�ki
Garbage -Domestic-non-food
❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-ford related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
11 Ice Mach./Refrig,Drains
Oil Separator(Ow SURE) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall '
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
{ Swimming fool Filter
Washer Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer l;Diis,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 1MulmedaliAppDutali,Deal\MicrosolI\Windows1INetCache1Conigt.Outlookt3Fl2CXR48\Plumbing Persnit.doc
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COMMUNITY DEVELOPMENT DEPARTMENT
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T 1 G A R D Building Permit Review — Residential
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Building Permit #: MST 2OL1` Cab 2-1 c
Site Address: I 6111 SiAl td PY (V►A Pioki DP- •
Project Name: TRILLIUM 011.LS Lot #: S—
Plannin Review
Prop al: Nit 1ti
Verify Alddress/suite#active in Accela. In River Terrace: No El Yes,River Terrace Review Addendum
Sililan Elements: Erosion Control
4copies of site plan on 8-1/2"x 11"or 11 x 17"paper t: tained trees with drip line and tree protection measures
awn to scale(standard architect or engineer scale) 'A F otprint of new structure(including decks)and FFE
vprth arrow ty locations&easements(required for new and additions)
IQS address,project or subdivision name and lot number II ewalk/driveway approach
ZJ plicant information(name and phone number) Of ation of wells/septic systems
Lot dimensions and building setback dimensions IaS et tree size,type and location
�� Square footage of buildings to be demolished
et names
Existing structures on site [Corner elevations(2'contours if more than 4'differ,trial)
Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? EQYes ❑�N9
im ervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes L�J'No
LJ Clean Water Services—Service Provider Lette of platted prior to 9/10/1995):
Wequired: ❑ Yes,applicant was notified L�J No Received: ❑ Yes ❑ No
ater Meter Fixture Unit Worksheet—Addiit ,Remodels and ADUs
Required: ❑ Yes,applicant was notified air No Received: ❑ Yes ❑ No
OPS C Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No
IV Public Facilities Improvement(PFI)Permit:
equired. ❑ Yes,applicant was notified No Ap ed For: ❑ Yes ❑ No,stop intake
and Use Case#: SU8201d 0000 Zoning: PA`S
.equired Setbacks: Front: 2 0 Rear: I C Side: S'' Street Side: (l)Ar Garage:
uilding Height: Max. Height: Actual Hei ht:
ICJ Landscape ea: % El Lot Coverage Max:_
Entrance 7 et back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ( um 12%of area of all street-facing facades
Garage Garage door is behind widest street-facing wall 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 w and there is a 12 sq ft.window above garage on 2nd floor.
/
Garage door width is ❑ 12'or less 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ indow trim CI xi Window recess ❑ Window projection ❑ Balcony
Visual Clearance rban Forestry P
sitive Lands: ❑ Yes IIVNo Type:
Conditions met prior to issuance of bu. •• g permit
;joys:
Approved By Planning: Date: 2
Revisions (after Building Submittal o ly Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPermitRvw_RES_122419.docx
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Building Permit Submittal
Original Submittal Date: (o\ Zc1\-2-1
Site Plans: # 3
Building Plans: # 3
Building Permit#: I'l Enter building permit# above.
Workflow Routing: Planning Engineering 2/Permit Coordinator ❑ Building
Workflow Sign-off: D,�/}�ign-off for Planning(include notes from planning review)
Route Application Documents: LsY Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
9riginal 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: \--\--a\ v C1^� t- -)e Date: 1''M\2.1
Engineering Review
Err- c--)pe at building pad: �p
L'onditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat
IQ/Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [No
Assess Water Quantity Fee in-lieu: ❑ Yes 1:r-No
LIDA Facility on lot: ❑ Yes QjNo
2 Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
L1pproved by Engineering: K.. 45 14- Date: 7-- / T -�,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption: ❑ Received / Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: )if Yes ❑ N/A
Parks SDC: f�Yes ❑ N/A
LIDA /❑ Yes / N/A
/ OK to Issue Permit
Approved by Permit Coordinator: ty,,)1 ,--- Date: 1 f t5(2021
1:\Bui]ding\Fonns\B1dgPermitRvw_RES_122419.docx