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
1 Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Amanda Loveridge
MAR 15 2022
COMPANY: D R. Horton al-Y OF TIUARU
PHONE: 503-522-9552 3UILDING DIVISIONBY
EMAIL: aloveridge@drhorton.com
RE: 14579 SW 78TH AVE MST2021-00494
(Site Address) (Permit Number)
Serenus Lot 17
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. Revisions: Site Plan Corrections
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: Approved site plan dimensions were measuring to the setback line and not the house footprint
FO OFFICE USE ONLY
Routed to Permit Techn ate: 3321 7iZ Initials: AIV
Fees Due: ❑ Yes No Fee Descriptio Amount Due:
,P
Special /
Instructions: �
Reprint Permit(per PE): ❑ Yes I, No ❑ Done
Applicant Notified: 3 J.v[ I,j Initials
City of Tigard
711 COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Residential
TIGARD
Building Permit #: M ST2O21-OQ4( 4
Site Address: (N 51-9 3W 8*IA A—v{,
Project Name: tnQ(AV 5 Lot #: 17,
Planning Review r(�_ �mif' .v.- S1 Rl G` 1) "Ore fn tf war
Proposal: t'Jt 11' Vl, GIe tAl\e, 111/15 % IG CPAC L.4NF l Verify address/suite# active in Accela. 0 In River Terrace:l/ No 0 Yes, River Terrace Review Addendum
Site Plan Elements: rosion Control AG[
013 copies of site plan on 8-1/2"x 11"or 11 x 17"paper laRetained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) la Footprint of new structure(including decks) and FFE
orth arrow 1 1Utility locations&easements(required for new and additions)
ri
ite address,projector subdivision name and lot number Sidewalk/driveway approach
RiApplicant information(name and phone number) P on- f ntJ1GJgapfiic„cy tnmc
pLot dimensions and building setback dimensions RStreet tree size,type and location
Ginuire-faursgraftuildtrgr fg±lStreet names
❑II.;°iing>t...e a ca en.,itc • INComer elevations(2'contours if more than 4'differential)
jitlLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? @Yes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes FINdo
Cad Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified iii.No Received: ❑ Yes 0 No
Ail Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified ,'No Received: ❑ Yes 0 No
xe Received: ❑ Yes 0 No
Required: 0 Yes,applicant was notified 0 No Applied For: 0 Yes 0 No,stop intake
RI Land Use Case#: 51i G So so "'Oood t ill Zoning. _ I Z
Required Setbacks: Front: 15 t Rear: 1 I Side: 5 a Street Side:_UV_ Garage: Zrll
liZl Building Height: Max. Height: ,�Jt^ iActual Height: 2-2-_5
cii Landscape Area: 26 % 1V2 Lot Coverage Max: €0
Entrance ri4 Set back no more than 8'from street-facing wall a Parallel to street or offset 45 degrees or less
Windows IP Minimum 12%of area of all street-facing facades
Garage door is behind widest street-facing wall 0 Yes ❑ No,o'o e following is met:
o Door nds no more than 5'from wall and there is a covered e'ttending beyond garage.
❑ Door extends re than 5'from wall and there is t.window above garage on 2" floor.
0 Garage door width is 0 1 ss 0 ° ess of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch 0 nt 0 Wall offset 0 1'Roof eave 0 Roof offset
❑ Fire shingles Lap Siding 0 Roo • ❑ Gable,hip,or gambrel roof 0 Dormer
❑ siding ❑ Window trim 0 Window reces Window projection 0 Balcony
® Visual Clearance A Urban Forestry Plan y 1
• Sensitive Lands: A Yes 0 No Type: GOm t 4/1• r'i LLg b t tw.1 Lew Va/112
Conditions met prior to issuance of building permit
Notes: f
tiqt Approved By Planning: Date: t l / e/'� —1
Revisions(after Building Submittal only) eviewer ( Date
1 Revision 1: p Approved 0 Not Approved kleam, I 3()'2-/7iD2/Z
Revision 2: 0 Approved 0 Not Approved
I:1Building\Fonns\BidgPennitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: ///91�ZC2/
Site Plans: # •��
Building Plans: #
Building Permit#: [ Enter building permit#above.
Workflow Routing. fly Planning O'Engineering [] 'Permit Coordinator [O.-Building
Workflow Sign-off: Q'Sign-off for Planning(include notes from planning review)
Route Application Documents: (WEngineering: (1) copy of permit application, (1) site plan, (1)building plan and
.original,plan review routing form.
( ' Uilding original pernvrapplication, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: / 2o2/
Engineering Review
Lr Slope at building pad: z4
• Conditions"Met"prior to issuance of building permit
[VEasements (encroachments)per engineering conditions of approval and plat
led Water Quality/Quantity Facility �,/
Assess Water Quality Fee in-lieu: 0 Yes Lu o
Assess Water Quantity Fee in-lieu: 0 Yes
,�,/ LIDA Facility on lot: 0 Yes LK No
L� Final Plat Recorded:
O NOT Approved by Engineering: Date:
Notes:
CVApproved by Engineering: Test fe - (/ji Date: )I/22/2p2
Revisions (after_Buuiilding Submittal only) Reviewer Date
Revision 1: Ya Approved 0 Not Approved 3/,x/„z>.7o2
Revision 2: 0 Approved 0 Not Approved
Permit Coordinator Review
VConditions "Met"prior to issuance of building permit
O Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant: hi- 1j/2q 22
Revision Notice 2: Date Sent to Applicant 1llf
/le SDC Exemption: 0 Received J7J Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ,E1 Yes 0 N/A
Tigard Trans SDC: V Yes 0 N/A
Parks SDC: 0 Yes 0 N/A
LIDA 0 Yes N/A
W OK to Issue Permit
Approved by Permit Coordinator. At\V4P\
Date: III 23 I ZO2,1
I:1BuildingFormslBldgPermitRvw RES I22419.docx
q CITY OF TIGARD MASTER PERMIT
s COMMUNITY DEVELOPMENT Permit#: MST2021-00494
Date Issued: 12/21/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112BD01000
Jurisdiction: Tigard
Site address: 14579 SW 78TH AVE
Subdivision: Serenus Subdivision Lot:
Project: Serenus, Lot 17
Project Description: New detached dwelling
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 951 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height 22.5 Bathrooms: 3 Second: 1327 sf Garage: 403 sf Front: 15 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 2278 sf Value: $318,127.08 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: 1 Water Lines: 100 Catch Basins: 0
gBckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr 0
Ea add''500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All
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 2278
Owner: Contractor:
BLUE PALOUSE PROPERTIES LLC DR HORTON INC PORTLAND Required Items and Reports(Conditions)
14630 SW 79TH AVE 4380 SW MACADAM AVE SUITE 100 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97224 PORTLAND,OR 97239
PHONE: PHONE: 503-222-4151
FAX: 503-222-1304
Total Fees: $40,483.23
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
oc7-nn1-nnl n thrnnnh nap oR7-nnl-nnon vnii mow nhfnin n nnn,i of}has ndac nr riirant n,ieeflnne in nI IN('by nnllinn cna 747 10R7 nr 1 ann'1'37 Tldd
Issued By: Hotly Wu, DE W�l% Permittee Signature: Ow Appti-c'0-ti..0- -,
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 lob site at the time of each inspection.
Building Permit Application -,-t 1/I I 2,1
Residential RECEIVED FOR OFFICE USE ONLY
Received ��� �
City of Tigard Date/By: ///p/2 2/ . i' Permit No.: �QZi-I�
. . 13125 SW Hall Blvd.,Tigard,OR 97223 NOV 0 1 2021 Plan Review 1 (�'
e Phone: 503.718.2439 Fax: 503.598.1960 y Date/By: 7 1?/ 7i other Permit�� 'O0 Z
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: .tur ® See Page 2 for
I IC AHD p BUILDING DIVISION N ed/Method: / ` (hij Supplemental Information
Internet: www.tigard-or.gov 7
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑Demolition Permit fees*are based on the value of the work performed.
[ New construction Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application. Ch
CATEGORY OF CONSTRUCTION n' I ou 1
�0
��
Valuation: 3321720 `()
❑ 1-and 2-family dwelling 0 Commercial/industrial
Number of bedrooms:4
ElAccessory building
0 Multi-family
Number of bathrooms S
0 Other:
❑Master builder it
JOB SITE INFORMATION AND LOCATION Total number of floors:2 lP
Job site address:14579 SW 78TH AVE New dwelling area: 2278 square feet 132,7
City/State/ZIP: Garage/carport area: 403 square feet C\51
Suite/bldg./apt.no.: Project name: Serenus Covered porch area:) square feet
Cross street/directions to job site: Deck area:0 square feet
Other structure area: 0 square feet Landing
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Serenus ( Lot no.:17 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.
NSFR Valuation: $
Existing building area: square feet
New building area: square feet
gi• e , `; :,.; •,FAER 0 TENANT Number of stories:2
Name:DR Horton Type of construction:
Address: 4380 SW Macadam Ave Ste 200 Occupancy groups:
City/State/ZIP: Portland OR 97239 Existing:
Phone:(503 ) 222-4151 Fax:( ) New:
0 APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: DR Horton Structural plan review fee(or deposit): 7 (.
Contact name: Emerald Weeks
FLS plan review fee(if applicable):
Address: 4380 SW Macadam Ave Ste 200
Total fees due upon application:
City/State/ZIP: Portland OR 97239
Amount received:
Phone:( 503 ) 222-4151 Fax::( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: esweeks@drhorton.com .
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name: DR llonon and fire department access,along with the 2010 Oregon
Address: 4380 SW Macadam Ave Ste 200 SolarInstallation Specialty Code checklist.
Portland OR 97239 Permit Fee(includes plan review $180.00
City/State/ZIP: and administrative fees):
Phone:( 503 ) 222-4151 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 4 13 Qi.6—e) 77 It 72-2__ Total fee due upon application: $201.60
Authorized signature: (/yL4i24G'Q' W 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
Print name: Emerald Weeks Date: 6/3/2021 Service Board.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
- One- and Two-Family Dwelling FOR ()Hitt:ltl: t oNIA
Received
City of Tigard Received
Permit No.:
III 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
■ 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 ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. x 0 ■ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. x❑ 0 0
3 Verification of approved plat/lot. x 0 0 0
4 Fire district approval required. Name of district: . x 0 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacity X❑ ❑❑ ❑❑
6 Sewer permit.
7 Water district approval. x❑ 0 ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. x❑ 0 ❑
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- x❑ ❑ 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state x❑ ❑ ❑
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 x❑ ❑ ❑
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 x0 ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, x❑ ❑ ❑
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- x 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. x 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- x❑ ❑ ❑
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 x❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered x❑ 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 x0 0 ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. x❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required x 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 x 0 0 ❑
architect licensed in Ore:on and shall be shown to be applicable to the iroject 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 ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not he accepted. 0 0 ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 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 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 0 ❑
and protection measures must be drawn to scale and must include the project arhorist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Pennits\BUP-RESPernitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB)
5. ..: .
Mechanical Permit Applicatiiti ECEl\ ED ,,OROI I I( I: I si.:O\I.1
Cityof Tigard �( L� DateiBy: Permit No.: ST2021-OO'4�
g Dan Review
SW Hall Blvd.,Tigard,OR 97223 N O U 1 02 Plan Review
Phone: 503.718.2439 Date/By: Other Permit:
I I n t;a Inspection Line: 503.639.4175 CITY OF TIGARU Date Ready/By: ions E3 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE*SCHEDULE—USE CHECKLIST
®New construction 0 Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi-family 0 Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 14579 SW 78TH AVE Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) I 54.91
Suite/bldg./apt.no.: Project name: Serenus Heat pump 61.06
Duct work I , 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Serenus Lot no.: 17 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
NSFR Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent , 23.32
0 PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: DR Horton Range hood/other kitchen I
Address: 4380 SW Macadam Ave Ste 200
equipment 33.39
Clothes dryer exhaust 1 33.39
City/State/ZIP: Portland OR 97239 Single-duct exhaust(bathrooms, 4
toilet compartments,utility rooms) 23.32
Phone:( 503 ) 222-4151 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: DR Horton Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Emerald Weeks Furnace,etc. I
Address: 4380 SW Macadam Ave Ste 200 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Portland OR 97239 Water heater 1
Phone:( 503 ) 222-4151 Fax: :( ) Fireplace 1
E-mail: esweeks@drhorton.com Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Development Northwest Inc.,dba Wolcott HVAC Other:
MECHANICAL PERMIT FEES*
Address: 1075 W Historic Columbia River Hwy Subtotal
City/State/ZIP: Troutdale,OR,97060 Minimum permit fee($90.00)
Phone:( 503 ) 667-1781 Fax:( 503 ) 667-9891 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie: 112220 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
�� days after it has beeno accepted as complete.
Authorized signature: Fee methodology set by Tri-County Building Industry Service Board
Print name: Andrew Darland Date: 10/21n1
I-.\Building\Permits\MEC_PermIApp_082520.doc 440-4617T(11/02/COM/W EB)
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
Received Permit Th ST ZQu- Li
111 City of Tigard i Daleive 0041
• 13125 SW Hall Blvd.,Tigard,OR 97223 N O V o 1 202 l Plan Review Related Permit#:
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: Juris: ® See Page 2 for
T 1 ti A K I) Notified,Method: Supplemental Information
Internet: www.tigard-or.gov BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement
Please check all that apply(submit 2 sets ufplans w items checked).
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling 0 Commercial/industrial D Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
0 Emergency system. larger separately derived
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of system.
Job#: Job site address:14579 SW 78TH AVE 100HP or more. ❑"A "E "1-2","I-3
❑Six or more residential units.
occupancy.
C1ty/State/ZiP: 0 Health-care facilities, 0 Recreational vehicle parks.
0 Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name: Serenus ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
Description Qty. Each Total
New residential single-or multi-family dwelling unit.
Subdivision: Serenus
Lot#:17 Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: Ea.add'I 500 sq ft or portion 3 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
NSFR Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: DR Horton 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 4380 SW Macadam Ave Ste 200 401 amps to 600 amps 200.34 2
City/State/ZIP: Portland OR 97239 601 amps to 1,000 amps 301.04 2
Phone:(503 ) 222-4151 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: es‘veeks@drhorton.com relocation
Owner installation:This installation is being made on property that 1 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
Branch circuits—new,alteration,or extension, er panel
�, 31'. ti) `4#'m)LTCANT I El CONTACT PERSON A.Fee for branch circuits with
Business name: DR Horton above service or feeder fee, 7 42 2
each branch circuit
Contact name:Emerald Weeks B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 4380 SW Macadam Ave Ste 200 branch circuit
Each add'1 branch circuit 7.42 2
City/State/ZIP: Portland OR 97239 Miscellaneous(service or feeder not included)
Phone:( 503 ) 222-4151 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: esweeksadrhorton.com Reconnect only 67.84 2
y w t "�Jy0 4r 4 ') 8 ` Pumpor irrigation circle 67.84 2
as ez�-�'tl.� 4� �y,`1� *P�''. r'• _ �� KA 1_Q��;�'3"�+s,ts���� .f' d�lr,fit�.. . b
Business name:Garner Electric Co Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2890 SE Brookwood Ave. panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Hillsboro, OR 97123 Additional inspection(1 hr min) 66.25/hr
Phone:(503-848-4552 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: permits@garnerelectric.com Inspections for which no fee is 90.00/hr
Su rv. Lie.:3707-S specifically listed(%:hr min)
CCB Lic.: 121159 Electrical Lic.: 4- 05C P ti ,'�. '7` "'
t~ gtt
Suprv. Electrician signature,required: Subtotal:
•
Print name: Charles Garner Date: 0 Plan Review Required(25%of permit lee):
State surcharge(12%of permit fee):
�fyL4i ..zi W TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Emerald Weeks Date: 6/3/2021 days after it has been accepted as complete.
* Number of inspections allowed per pennit.
1:,.Building,Permits\ETC_PennitApp_ELR_ERE.doc Rev 0617'2015 440-4615T(I1'05tCOM'WEB
Electrical Permit Application—City of Tigard
. Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
;" FEE SCHEDULE
RESIDENTIAL WOI '�DN�.gY.`'. •
Description I Qty. 1 Each I Total I *
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
❑ Audio 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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s clttcall listed(/hr min)
t i,,; 7^:t , z,' a; ;1ck °, 'A'ArtagitftiOr EE>
Subtotal(Enter
Fee for each commercial system: $75.00
y " Number of inspections allowed per permit.
Page I>:
t.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
1:'Building Permits ELC_PermitApp_ELR_ERE.doc Rev 06,17,2015
'Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
14
City of Tigard Received Pennit No.: 21-00 C.p
r 13125 SW Hall Blvd.,Tigard,OR 97223 N O V O 1 Z�2� p atn Review Other Pennit No.:
■ Phone: 503.718.2439 Fax: 503.598.1�}4 Date/By:
Inspection Line: 503.639.4175 v Y OF TIGARD D Kris: ® see Page 2 for
T I G A K D p Date Ready/By: g
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
x❑New construction 0 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)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
SFR(2)bath 437.78
1 ❑ I-and 2-family dwelling ElCommercial/industrial SFR(3)bath 1 500.32
0 Accessory building ❑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:
Catch basin or area drain 18.76
Job site address:14579 SW 78TH AVE
Drywell,leach line,or trench drain 18.76
City/State/ZiP: Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Serenus 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: Serenus I Lot no.:17 Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
Backwater valve 12.51
DESCRIPTION OF WORK 25.02
Clothes washer 1
N S f It Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: DR Horton 25.02
Floor drain/floor sink/hub
Address: 4380 SW Macadam Ave Ste 200 25.02
Garbage disposal
City/State/ZiP: Portland OR 97239 Hose bib 2 25.02
Phone:( 503 ) 222-4151 Fax:( )
Ice maker 12.51
Interceptor/grease trap25.02
❑ APPLICANT El CONTACT PERSON
Medical gas(value:$ ) Page 2
Business name: DR Horton 12 51
Primer
Contact name: Emerald Weeks Roof drain(commercial) 12.51
Address: 4380 SW Macadam Ave Ste 200 Sink/basin/lavatory 4 25.02
City/State/ZIP: Portland,OR 97239 Solar units(potable water) 62.54
Phone:( 503 ) 222-4151 Fax::( ) Tub/shower/shower pan 2 12.51
Urinal 25.02
E-mail: esweeks@drhorton.com Water closet 3 25.02
CONTRACTOR Water heater 1 37.52
Business name: Alliance Plumbing, LLC Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP: Troutdale,OR 97060 Subtotal
Minimum permit fee: $72.50
Phone:( 503)492-3490 Fax:
( 503 ) 912-6438
Plan review (25%of permit fee)
CCB Lic.: 184601 Plumbing Lic.no.: PB732 State surcharge(12%of pennit fee)
Authorized signature: ��L, TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: Gavin Thomes Date: 7.01.2021 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:,Building:Perm;ts,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:
Foisting 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
Sto ni&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
A 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Relit.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
IIIq COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D Building Permit Review — Residential
Building Permit #: M ST2O2(-00494
Site Address: l(-(511 5 car "-18 4-t A-
Project Name: Vb lI 5 Lot #: l
Planning Review ((Lek
,� _,� ,Q
Proposal: I` ` kilt(V I,aL 11 iCl 6
Verify address/suite# active in Accela. ❑ In River Terrace: p No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: ►: rosion Control 4014,
0iI 3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper ''.Retained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) Footprint of new structure(including decks)and FFE
7I4North arrow eUtility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number 71Sidewalk/driveway approach
'4Applicant information(name and phone number) IIi nr-e*�^ �_•=TPli /sept c Systems
ylLot dimensions and building setback dimensions gStreet tree size,type and location
gs o lib6treet names
❑Eubtu1g at..ett tLa arr„itc • Corner elevations (2'contours if more than 4'differential)
,RI Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? M'es ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes 61:No
Cja Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified ,e)No Received: ❑ Yes ❑ No
xe • Received: ❑ Yes ❑ No
vemeiat(PFPy-Fermat-'
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
C Land Use Case#: 5(f 2-0 iO --OQO ( id Zoning: j r Z
lcz Required Setbacks: Front: I S g Rear: L 5 Side: 5 ` Street Side: 10 I Garage: 201
I
g Building Height: Max.Height: X 5 Actual Height: 2.55 A
�$ Landscape Area: 2.0 % C�3 Lot Coverage Max: eQ
Entrance Cg Set back no more than 8'from street-facing wall Parallel to street or offset 45 degrees or less
Windows Minimum 12%of area of all street-facing facades
Garage e door is behind widest street-facing wall ❑ Yes ❑ No,o e following is met:
❑ Door nds no more than 5'from wall and there is a covered o tending beyond garage.
❑ Door extends re than 5'from wall and there is t.window above garage on 2nd floor.
❑ Garage door width is ❑ 1 ss ❑ 5 ° ess of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Rec ntr ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles Lap Siding ❑ Roo E Gable,hip,or gambrel roof ❑ Dormer
❑ siding ❑ Window trim E Window reces Window projection ❑ Balcony
O Visual Clearance A Urban Forestry Plan r ((
• Sensitive Lands: ig Yes ❑ No Type: 17041 5 9kl • a,b �y.-= Low IU2
..Conditions met prior to issuance of building permit
Notes: &GArcli,(, in f'`'LGe.r
Approved By Planning: Date: `( / d/'Ze 2"
Revisions (after Building Submittal only) Reviewer (( Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
iI
I:\Building\Forms\BldgPermitRvw RES 122419.docx
Building Permit Submittal
Original Submittal Date: /74/ 202f
Site Plans:
Building Plans: # 3
Building Permit#: [ Inter building permit#above.
Workflow Routing: L' Planning ®'Engineering [Permit Coordinator C�Building
Workflow Sign-off: [g'Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Pr/Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: 'Cir
Date: // 202/
Engineering Review
Slope at building pad: Z%
g/Conditions "Met"prior to issuance of building permit
C^�Easements (encroachments) per engineering conditions of approval and plat
L.d"/Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Di No
Assess Water Quantity Fee in-lieu: ❑ Yes [[r"/No
LIDA Facility on lot: ❑ Yes L/ No
dFinal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
R"Approved by Engineering: T,nP� (1 �/�,l„7 Date: f 1 I22/2.0?I
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: ,I Yes ❑ N/A
Tigard Trans SDC: Wr Yes ❑ N/A
Parks SDC: gr Yes ❑ N/A
LIDA ❑ Yes / N/A
OK to Issue Permit
Approved by Permit Coordinator: k0\ 14N1
Date: l' 23Ito2�
I:\Building\Fonns\BldgPennitRvw_RES_t 22419.docx