Permit Support Document w
\I /4/1) ;;*1 MAY 2 4 2020
IN City of Tigard • COMMUNITY DEVELOPMENq DEPARTMENT ,, i:i r , fir! AP
Re uest for Permit Action
I, 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: El Owner lg Applicant El Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: ,�� ``
INVOICE TO: (Business or Individual) P.; v +cJj, H c" e
Mailing Address: )7Cj, ) /iv) it.2,,,e,L. pi,,,,,, -4.137o
City/State/Zip: Secit,e440,-L ( UK 9 i
Phone No.: �G 3 '' 1 u —Gcf g-i,
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
J. INVOICE FOR FEES DUE(attach case fee schedule and provide explanation below).
Permit#: M 5-7 0/-C'1 C/ -- OC/3 8. 1
Site Address or Parcel#: 75-4 G SW. lia 1, 2vt i,
Project Name: klt er' P..)S3 .
l°Subdivision Name: El1 49 ✓✓P,ve:i 6 i t . Lot#: ) Ci
EXPLANATION: !1 t"s t,►I�c�rl i j--} Gl C M r. 0t7.,f Cr'Ps--,t` c tccv—p LC,c.-
Signature: -- Date: l 1
Print Name: "elle-r i OCii
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
I i tl! t tI I IC I. I '^l ()'\I.ti
koute to Sys Adman: bate By Route to Records: mate 9 K '7�/ •,,i
Refund Processed: Date /1/f, " By` () Invoice Processed: Date By
Permit Canceled: Date li/yJ� By 4j) Parcel Tag Added: Date By t
(2{j g'� J
I:\Building\Forms\RcgPeanitAction, l 5I .doc
Building Permit Application \‘'' 0 I
Residential RECEIVEr FOR OFFI( l_ l SI. O\► l
City of Tigard ReceivedDateBy: C1' 1.,�� Permit No.:hnS-N _(1: l
4 13125 SW Hall Blvd.,Tigard,OR 97223 S E P 2 6 2019 Plan Review QQ ,``
503.598.1960 Date/By: �('�dJ 4 S�' Other PermitC ‘ _ �
Phone: 503.71 R.2439 Fax: L��p
t tt i Inspection Line: 503.639.4175 �..j.V t- 1 Atl i f TA
Date Ready/By: ) Juris: 65 See Page 2 for
Interne[: www.tigard-or.gov 3UIL I1�1�z DIVISION
IViS1 p Noti- /Method: 0/ Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
ElNew construction 0 Demolition Permit fees*are based on the value of the work performed.
indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling ❑Comm Valuation: $ 167 1 -m
❑Accessory building 0 Multi-family Number of bedrooms: 5
❑Master builder 0 Other: Number of bathrooms: 4
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 ,5/ !�
Job site address: 7540 SW Hansen Ln New dwelling area: 3137 square feet (I OS
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 383 square feet l'6.1
Suite/bldg./apt.no.: 1 Project name: Elderberry Ridge Covered porch area: 158 square feet e
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave Deck area:
.4'J 10� square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Elderberry Ridge Lot no.: 19 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. _ _
Valuation: $
Construction of SFR
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories:
Name: Riverside Homes, LLC Type of construction:
Address: 17933 NW Evergreen Pl., Ste 370 Occupancy groups:
City/State/ZIP: Beaverton, OR 97007 Existing:
Phone:( 503)645-0986 Fax:( ) New:
❑ APPLICANT CONTACT PERSON BUILDING PERMIT FEES*
Business name: Riverside Homes, LLC (Please refer ro fee schedule)
Structural plan review fee(or deposit):
Contact name: Nikki Pruett
Address: 17933 NW Evergreen Pl., Ste 370 FLS plan review fee(if applicable):
City/State/ZIP: Beaverton, OR 97007 Total fees due upon application:
Amount received:
Phone:(503)645-0986 Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: npruett@riversidehome.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: Riverside Homes, LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 17933 NW Evergreen Pl., Ste 370 Solar Installation Specialty Code checklist.
city/State/zIP: Beaverton, OR 97007 Permit Fee(includes plan review
$180.00
and administrative fees):
Phone:( 503)645-0986 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 189148 Total fee due upon application: $201.60
Authorized signature: /2 This permit application expires if a permit is not obtained
fi within 180 days after it has been accepted as complete.
Print name: Nikki Pruett Date: 9/30/19 *Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP-RESPernitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
•
Building Permit Application Checklist
One- and Two-Family Dwelling FOIL ()FIR F 1 sE O\l.l'
City of Tigard ReceivedAssoci t Permit No." . ♦`ci.
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
0 Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical
TIGARD
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEIIS ARE REQUIRED FOR PLAN REVIEW )e, No y A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: . 0 ❑ 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 carry original applicable stamp and signature on file or with application. ❑ 0 0
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 ❑ ❑
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 0 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 ❑ ❑
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 0 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- ❑ 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 ❑ ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
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 0 0
architect licensed in Ore.on and shall be shown to be a'ilicable to the •ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
1 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. El ❑
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
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 El 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
i
Mechanical Permit Applicat CE F � FOR OFFICE I sF:o i.v
City of Tigard Received
Permit No.ir .Duck_ Qji
III ll u 13125 SW Hall Blvd.,Tigard,OR 97223 S E P 2 6 2019 Plan Review ��\\11 u j 1-`
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R n Inspection Line: 503.639.4175 err( OF F T!GAR D Date Ready/By: Juris: Page
Internet: www.ti and-or. ov f 19.6 Supplemental See 2 nr
g g Notified Method: Information
?l Ill I I`I41� t"'t1J°ff`'?: �3R,9
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
Q New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
El 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address: 7540 SW Hansen Ln Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP: Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 _
Heat pump 1 61.06 61.06
Suite/bldg./apt.no.: Project name: Elderberry Ridge Duct work 23.32 _
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave 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. 2 46.75
Flue/vent for any of above 23.32
Subdivision: Elderberry Ridge Lot no.: 19 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 . 33.39 _ 33.39
Flue vent for water heater or gas
Construction of SFR fireplace 1 23.32
Log lighter(gas) , 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Range hood/other kitchen
equipment 1 33.39 33.39
Address: 17933 NW Evergreen PI., Ste 370 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Beaverton, OR 97007 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32 116.60
Phone:(503 )645-0986 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑✓ CONTACT PERSON Other: 23.32
Business name: Riverside Homes, LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Nikki Pruett Furnace,etc. 1 14.15
Address: 17933 NW Evergreen Pl., Ste 370 Gas heat pump 14.15
Wall/suspended/unit heater
City/State/ZIP: Beaverton, OR 97007 Water heater 1 14.15
Phone:(503 1645-0986 Fax::( ) Fireplace 1 14.15
Range 1 , 14.15
E-mail: npruett@riversidehome.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Pro Heating & Cooling Other:
MECHANICAL PERMIT FEES*
Address: 2095 NW Alocleck Rd.#1103 Subtotal
City/State/ZIP: Hillsboro, OR 97124 Minimum permit fee($90.00)
t Plan review(25%of permit fee)
Phone:( 971) 205-4989 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: . , „, * Fee methodology set by Tri-County Building Industry Service Board
Print name: Nikki Pruett Date: g/30/19
I:\Building\Permits\MEC_PermitApp_0401 I 3.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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit Application ,a I C J FOR OFFICE USE ONLY
CityofTigard 2019Received
IIIM 1315 S Hal Blvd.,Tigard,OR 97223 SEP2 6Plan Review
°' R Phone: 503.718.2439 Fax: 503.598.1Q60 f y DateB Related Permit k:
Inspection Line: 503.639.4175 �IA1 Y OF TIEr iJ Ready Date/By: turfs ® See Page 2 for
l lt'nitD. Internet: www.tigard-or.gov " uI1-f!Nr D V ,9101v Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition El Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
✓ 1-and 2-familydwellingCommercial/industrial less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ ❑ ['Accessory building
amps for all other installations. buildings.
0 Multi-family ❑Master builder D Other: 0 Fire pump. 0 Installation of 150 KVA or
-
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: lob Site address:
7540 SW Hansen Ln 100HPormore. ❑"A "E","1-2'."1-3
City/State/ZIP: Tigard, OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Elderberry Ridge ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Bonita Rd &SW 76th Ave FEE SCHEDULE
Description I Qty. I Each I Total i
New residential single-or multi-family dwelling unit.
Subdivision: Elderberry Ridge Lot#: 19 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Construction of SFR Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
✓❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen PI., Ste 370 201 amps to400amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Beaverton, OR 97007 601 amps to 1,000 amps 301.04 2
Phone:( 503)645-0986 Fax:( ) Over 1,000 amps or volts 552.26 . 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: __ 401 amps to 599 amps 168.54 2
APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Riverside Homes, LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: Nikki Pruett B.Fee for branch circuits without
seAddress: 17933 NW Evergreen PI., Ste 370 branche circuit
fee,first 56.18 2
•
g branch circuit
City/state/ZiP: Beaverton, OR 97007 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)645-0986 Fax: :( ) Each manufactured or modular 67.84 2
dwelEmail: npruett@riversidehome.com
n service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sunlight Electric Inc Sign or outline lighting 67.84 2
Address: 2804 NE 65th Ave. St. D Signalalteration,
or limited-energyxsi 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
y Vancouver, WA 98661 Additional inspection(1 hr min) 66.25/hr
Phone:(360) 518-7589 Fax:( ) Investigation(1 hr min) 90.00/hr
industrial plant(1 hr min) 78.18/hr
Email:
�� inspections for which no fee is 90.00/hr
CCB Lic.: 1 72549 Electrical Lie.: C230 I Suprv.Lie.: I7 e , 2 specifically listed(Ya hr min)
t ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _1,4 Subtotal:
Print name: Chester Garrett Date: 9/30/19 0 Plan Review Required(25%of pennit fee):
/ State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: ,
This permit application expires if a permit is not obtained within 180
Print name: Nikki Pruett Date: 9/30/19 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ 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 552.26 2
with OAR 918-309-0040)
VI 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 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s ecificall listed Mir min)
COMMERCIAL WORK ONLY: 1r
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
'
(SEE OAR 918 309 0000) Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ B• oiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n F• ire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ O• ther:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I.\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015
Plumbing Permit Applicatio r
A/ J . L
Building Fixtures 2 1.0R 014IL . l SI. 0y1 1
C P 6 Received �S�(A�'l-(5G
City of TigardDate/By:cePermit No.:
il 13125 SW Hall Blvd.,Tigard,OR 9 2�.�, Plan Review
: I Phone: 503.718.2439 Fax: 503.42211B41 Of' I l t AH Date/By: Other Permit No.:
Inspection Line: 503.639.4175 $UILDING DIVISION' Ready/By: ® See Page 2for
1 I U A R I) Date Read/B : luris:
Internet: www.tigard-or.gov Notified/Method: Supplemental information
TYPE OF WORK FEE* SCHEDULE
Q New construction ❑Demolition _ For s ecial in ormation use checklist.
Description �� Qty. ( Ea. 1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ig 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building 0 Multi-family
-
Each additional bath/kitchen 1 25.02 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 7540 SW Hansen Ln
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Elderberry Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave Manholes 18.76
Rain drain connector 1 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Elderberry Ridge Lot no.: 19 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Construction of SFR Clothes washer 1 25.02
Dishwasher 1 25.02
_ Drinking fountain 25.02
Ejectors/sump 25.02
ID PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Riverside Homes, LLC
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Pl., Ste 370 Garbage disposal 1 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 2 25.02
Phone:(503)645-0986 Fax:( ) Ice maker 1 12.51
0 APPLICANT Q✓ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Riverside Homes, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Nikki Pruett
Roof drain(commercial) 12.51
Address: 17933 NW Evergreen Pl., Ste 370 Sink/basin/lavatory 7 25.02
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax::( ) Tub/shower/shower pan 5 12.51
Urinal 25.02
E-mail: npruett@riversidehome.com
Water closet 4 25.02
CONTRACTOR
Water heater 1 37.52
Business name: H & H Mecanical
Water piping/DWV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Phone:( 503 975-9787
Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 178122 Plumbing Lie.no.: PB414 Plan review (25%of permit fee)
�, J State surcharge(12%of permit fee)
Authorized signature: �,�le& �r / 4 TOTAL PERMIT FEE
Print name: Nikki Pruett ' Date: 9/30/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fce methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food Li Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\npruett\Downloads\PLMF_PermitApp.doc 2
Plumbing Permit Application #" ,.' ��V�:.r
Building Fixtures
S E P 2 6 2019 Received
City of Tigard Permit No. y ^
• 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: `y �' ,�`i-� t
I a .1iY (��- II��ARDPlanReview
Phone: 503.718.2439 Fax: 503.59R.196(N p teBy: Other Permit No.:
Inspection Line: 503.639.4175 :WILDING Dl\/ SIO to Read/ ® See Page 2 for
11GAItl) yBy: ]uric:
Internet: www.tigard-or.gov Notified/Method: Supplemental information
TYPE OF WORK FEE* SCHEDULE
2 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
p I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7540 SW Hansen Ln 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.: Project name: Elderberry Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave 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: Elderberry Ridge Lot no.: 19 _ Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Construction of SFR Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Riverside Homes, LLC
- Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Pl., Ste 370
Garbage disposal 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 25.02
Phone:(503)645-0986 Fax:( ) Ice maker 12.51
Q✓ APPLICANT ✓Q CONTACT PERSON Interceptor/grease trap 25.02
Business name: Riverside Homes, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Nikki Pruett
Roof drain(commercial) 12.51
Address: 17933 NW Evergreen Pl., Ste 370 Sink/basin/lavatory 25.02
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: npruett@riversidehome.com --- _ -.
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: TruScapes Water piping/DWV 56.29
Address: 21600 NW Amberwood Dr. Other: 25.02
City/State/ZIP: Hillsboro, OR 97124 subtotal
Phone:( 503 531-8216
Fax:( ) Minimum permit fee: $72.50
CCB Lie.: LCB#7962 Plumbing Lie.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: 4 z.AC` TOTAL PERMIT FEE
Print name: Nikki Pruett Date: 9/30/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-I' 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower 0 Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
-4" Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\npruett\Downloads\PLMF_PermitApp.doc 2
City of Tigard
.1114 " COMMUNITY DEVELOPMENT DEPARTMENT
■
r l c A u D Building Permit Review — Residential
Building Permit #: 1S-Cj►,C3t- 1
Site Address: 7,c-- o c/) /72-7n /7 LOA-C._
Project Name: E1derl.P �� Lot #: /
C)
(New dwelling=su ivision name; dition or Alteration=last name of owner)
Planning Review
Pro. +sal: A) (,V ,qFj_
Ipi Verify address/suite# active in Accela. o In River Terr e: LId No ❑ Yes,River Terrace Review Addendum
1
Site Plan Elements: Er.sion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper 'AV tained trees with drip line and tree protection measures
W• awn to scale(standard architect or engineer scale) i• .otprint of new structure(including decks)and FFE
.rth arrow X ytility locations&easements(required for new and additions)
►i jte address,project or subdivision name and lot number Si.-walk/driveway approach
.plicant information(name and phone number) Vi0.cation of wells/septic systems
X Lo dimensions and building setback dimensions ~ eet tree size,type and location
4,, 4cS+uare footage of buildings to be demolished et names
�''f':f sting structures on site Corner elevations(2'contours if more than 4'diff ntial)
X Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replace ? ' Yes I
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shownk)Yes Ltd' o
01 lean Water Services—Service Provider Lett r(lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified No Received: CI Yes ❑ No
Public Faciliti9eImprovement(PFI) Permit:
equired: Yes,applicant was notified ❑ No Appliie For: Yes ❑ No op intake
and Use Case#: ' �l Occoci
�J Zoning: (P2)
Uequired Setbacks: Front: Rear: Side: Street Side: l Garage:
tler uilding Height: /�`� Max. Height: �� Actual He' ht: /
12 Landscape Area: c (/ % Lot Coverage Max: /
cyo
Entrance back no more than 8'from street-facing wall ❑ Parallel to stre offset 45 degrees or less
Windows ❑ Minimu °o of area of all street-facing facades
Garage CI Garage door is be 'dest street-facing wall es ❑ No,one of the following is met:
❑ Door extends no more 'from wall a ere is a covered porch extending beyond garage.
❑ Door extends no more than 5'fr and there is a 12 sq ft.window above garage on 2'd floor.
❑ Garage door width is ❑ 1 ' ess ❑ 50%or of facade ❑ 60%or less and includes 7 of following:
❑ Covered por Recessed entrance ❑ Wall o s ❑ 1'Roof eave El Roof offset
❑ Fir • gles El Lap Siding Cl Roof pitch ❑ Gable, • ambrel roof ❑ Dormer
Accent siding A Window trim ❑ Window recess El Window ' ction ❑ Balcony
la isual Clearance lT rban Forestry Plan /
►A Sensitive Lands: Yes ❑ No Type: S2k1 S/oees
❑ Condi s metprior to issuance of building perms
NItes: UNtirh3hA 1UQ X-P m• -r , , _
Approved By Planning: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
l:\Building\Forms\BldgPermitRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning Engineering Permit Coordinator C Building
Workflow Sign-off: Sign-off for lanning(include not s from planning review) ((
Route Application Documents: 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
am calculations and trust details,if applicable, etc.
Notes: /4erifi/ii
/. 4 .
By Permit echnician: Date: (of i/"
En_ineering Review
I/ Slope at building pad:
12(Conditions "Met"prior to issuance of building permit
[YEasements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes V No
Assess Water Quantity Fee in-lieu: ❑ Yes rNo
LIDA Facility on lot: ❑ Yes t/No
Final Plat Recorded:
Cl NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: / '
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ 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:
Revision Notice 3: Date Sent to Applicant:
0(DC Fees Entered: Wash Co Trans Dev Tax: es ❑ N/A
Tigard Trans SDC: ❑ N/A
/ Parks SDC: L7 Yes ❑
LIDA ❑ Yes f N/A
OK to Issue Permit l
/97/
Approved by Permit Coordinator: Date: tv! J���
I:\Building\Forms\BldgPermitRvw_RES_022819.docx