Permit BACKFLOW EXISTING REMOVED
PREVENTER REPORT NEW REPLACED
REPAIRED OLD SIN:
PROPERTY NAME DR Horton Serenus Lot 18 PHONE
CONTACT NAME PHONE
MAILING ADDRESS 14553 SW 78th Ave
crrY Tigard STATE OR 'LIP 97224
PRE VENTER ADDRESS 14553 SW 78th Ave Tigard, OR 97224
WATER SUPPLIER City of Tigard, Oregon SERIAL# HF 57084
LOCATION Front lawn, SE corner
MAKE Febco MODEL 850 SIZE 3/4"
TYPE El RP n RPDA ❑ RPDA-II [Xi DC n DCDA Li IXX/A-11 n PVB I J SVB n AVE n AG
HAZARD PROTECTED ❑ PREMISES ISOLATION LA IRRIGATION J J FIRE SYSTEM Ll BOILER I I OTHER
APPROVED: lSl ASSEMBLY El INSTALLATION IXI7 ORIENTATION n AIROAP PIPE SIZE in PHYSICALP"YS ^,
BP.PARATON la
REDUCED PRESSURE ASSEMBLY PVRA/SVBA INrum,TEST
DOUBLE CHECK MR INLET CHECK VALVE PASSED X
CHECK#1 CHECK#1 TYPE II OPPSEDAT: vans neon i�I
PROS Ti(,HT IXI I I
pnas FAILED
INITIAL PAN S,SID 1 .3
TEST RELIEF VALVE LEAKED n MN I t'5ID MIN MUD tatty 1 PSID DATE 09-10-22
RESULTS OPENED AT: OPENED
MIN 2 no CHECK#2 FULLY r 1 FAILED SYSTEM PSI 105
RELIEF VALVE: TIG11T DID NOT (l DETECTOR METER
.R
PASSED 1 FARD n ( 1 .6 OPEN n READING:
IJ
LEAKED Mot I PS D
NOTES
REPAIRS
PARTS
REDUCED PRESSURE ASSEMBLY A TEST
CHECK#1 DOUBLE CHECK PYRA/SVBA
AFTER REPAIRS
PRESS
DROP: CHECK#1 TYPE U AIR INLET CHECK VALVE
REPAIR MIN}PsID TIGHT I I OPINED AT: PROS DROP:
RESULTS RELIEF VALVE DATE
OPPI5!D Al: _ CHECK IR MN I PIED MN I MD FAIN I MID
aRr.IIVYALVa MIN2P$n TIGHT I I wry nPASSED I
PASSED r1 FAMED n PAN'Pam
GAUGE S/N 04141250 MAKE/MI ODEL Mid-west Instruments 845 CALIBRATION DATE 1 1-12-2021
In completing and submitting this test report,the tester certifies that the assembly was tested and maintained in accordance with all applicable
rules,laws,codes and regulationsp
of the slate and water system using a�Ipmval testing equipment and approved testing procedures.
INITIAL TEST TEST AFTER REPAIRS _
T'� 066108
TESTBRIGNATURE' TESTER SIGNATURE TESTER CERT#
Jordan A 503-849-0237
TESTER NAME(PRINTED) /usr lilt NAME(PRINTED) PHONE#
2153 Molalla Rd Woodburn, OR 97071 Jordan@ablandscapes.net
TESTER ADDRESS TESTER ADDRESS EMAIL
Ashland Brothers Backflow Testing, Repair&Install
COMPANY NAME COMPANY NAME I X I WATER RESTORED?
REPORT RECEIVED BYOWNER) ED FOUND OFF,LEFT OFF
(IO PRMENTATIVE OF REPORTRRCNVED 11Y(REPRESENTATIVE OF OWNER)
ICITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021-00495
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/30/2021
Parcel: 2S112BD01000
Jurisdiction: Tigard
Site address: 14553 SW 78TH AVE
Subdivision: Serenus Subdivision Lot:
Project: Serenus, Lot 18
Project Description: New detached dwelling
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 635 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: Bathrooms: 3 Second: 987 sf Garage: 390 sf Front: 15 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 1622 sf Value: $231,799.96 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: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 4 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'I 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All 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 1622
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: $36,179.73
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
Q99-nn1_nnin thrn,inh( P Qc9_nn1_nnon )(nil may nhfnfn a rnnv of fho niloc nr rtirorf ni,cctinnc fn( i;Air by Tallinn SM 919 10R7 nr 1 RCM'Y29 73d4
Issued By: HoU y Va v�Pe,�n/I ge Permittee Signature: t t' A
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the iob site at the time of each inspection.
•
Building Permit Application - 1 it !21
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard NOVt?021 Received ,/ Oa 2d2/ 0'//Date/By: Permit Na:MsTzOZI-po1/95
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGARU Date/By: tz `I ZI ' ' Other Permitna2t2/'06Z f 7
Inspection Line: 503.639.4175 SI Date Ready/By: ��jL luris_ ® See Page 2 for
I IC,ARU Internet: www.tigard-or.gov BDILDING DIVI .�J Notified/Met �: ��/� ' Ile Supplemental Information
� r
/f i
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
121 New construction ❑ 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 0 Other: equipment,materials,labor,overhead,and the profit for the Q �
CATEGORY OF CONSTRUCTION work indicated on this application. 1M� f
Valuation: c`*9464Q 1 ' ( /�,
❑ 1-and 2-family dwelling 0 Commercial/industrial 1
❑Accessory building ❑ Multi-family Number of bedrooms:3
❑Master builder 0 Other: Number of bathrooms'
JOB SITE INFORMATION AND LOCATION Total number of floors:2 0 l-
Job site address:14553 SW 78TH AVE New dwelling area: 1622 square feet 9 6-7
City/State/ZIP: Garage/carport area: 390 square feet (4,55
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.:18 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.
NSI R Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 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 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: DR I lorton
Structural plan review fee(or deposit):
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.
Business name: DR Horton Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4380 SW Macadam Ave Ste 200 Solar Installation Specialty Code checklist.
City/State/ZIP: Portland OR 97239 Permit Fee(includes plan review $180.00
tY and administrative fees):
Phone:( 503 ) 222-4151 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: ill/59 I 36F5 ? � f0`/7Z.2 - Total fee due upon application: $201.60
Authorized signature: c. *) 4'r2�GLh? W This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Emerald Weeks Date: 6/3/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pennits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
Building Permit Application Checklist
. One- and Two-Family Dwelling FOR OFFICE i; LSI: o\l.l
City of Tigard Receiv eived Permit No.:
■ 13125 S W Hall Blvd.,Tigard,OR 97223 y
I Phone: 503.718.2439 Fax: 503.598.1960 Da
Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
T I G A R D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 es 10 1v/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. x ' 0 •
II
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❑ 0 0
6 Sewer permit. xD 0 0
7 Water district approval. x❑ ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. x❑ 0 0
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- x❑ 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state x❑ 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if x❑ 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 CI 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, x 0 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- 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 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❑ 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 x❑ ❑ 0
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 xD 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. x❑ 0 ❑
21 Energy Code compliance. identify the prescriptive path or provide calculations. A gas-piping schematic is required x 0 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 ❑
architect licensed in Ore.on and shall be shown to be applicable to the .roject under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item I 1 above. Site plans must be 8-1/2"x 11-or 11"x 17". 0 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 be accepted. 0 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 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 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 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-46I 3T(1 I/02/COM/WEB)
Mechanical Permit Applicati alECEIVE� i c)li c)hrlc I: rtiI c1�l.l
City of Tigard Received
Date/By: Permit No.: F..lgr W2( 'OP 49 S
IIIII13125 SW Hall Blvd.,Tigard,OR 97223 t 4 Plan Review
8 Phone: 503.718.2439 N 0 V 0 1 2 Q 2 1 Date/By: Other Permit:
I l t It I y Inspection Line: 503.639.4175 Date Ready/By: Inds ( Eif See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: 1 Supplemental Information
BUILDING DIVISION
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
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
❑ Multi-family ❑Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 14553 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.: 18 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
Address: 4380 SW Macadam Ave Ste 200 equipment 1 33.39
Clothes dryer exhaust I 33.39
City/State/ZIP: Portland OR 97239 Single-duct exhaust(bathrooms, 4
Phone:( 503 ) 222-4151 Fax:( ) toilet compartments,utility rooms) 23.32
Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: DR Horton
Fuel piping:
Emerald Weeks S14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: 4380 SW Macadam Ave Ste 200 Gas heat pump
City/State/ZIP: Portland OR 97239 Wall/suspended/unit heater
Water heater 1
Phone:( 503 ) 222-4151 Fax: :( ) Fireplace
E-mail: esweeks@drhorton.com Range 1
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 lic.: 112220 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has accepted as complete.
' Authorized signature: /�Z��i -
g Fee methodology set ity has beenuna Building Industry Service Board
Print name: Andrew Darland Date: Io/2inl
1:\Buildinglpermits'\MEC_PermtApp_082520.doc 440-46I 7T(II/02/COM/WEB)
Electrical Permit Application RECEIVE I FOR OFFICE USE ONLY
City Ofgan Tigard Received Permit 1: MST 2Q 2( -0044.5
! PlanR v
III 13125 SW Hall Blvd.,Tigard,OR 97223 NOV o 1 �OZ{ Plan Review
1111 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit ti:
Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: Juris: ® See Page 2 for
TIGARDBUILDING DIVISION Notified'Method: Supplemental Information
Internet: www.tigard-or.gov
TYPE OF WORK PLAN REVIEW
® New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans s'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
❑ i-and 2-family dwelling 0 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑ Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:14553 SW 78TH AVE 100HP or more. ❑"A","E "I-2',"I-?
0 Six or more residential units. occupancy.
City/State/ZiP: ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Serenus ❑Hazardous locations. ❑Supply voltage for more than
600 volts nominal_
0 Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qtv. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Serenus Lot#:18 Includes attached garage.
1,000 sq.fl.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
NSFR (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.f1.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: DR Horton 200 amps or less 100.70 2
Address: 4380 SW Macadam Ave Ste 200 201 amps to 400 amps 133.56 2
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: esweeks@drhorton.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
0 APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
Business name: DR Horton above service or feeder tee, 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
City/State/ZiP: Portland OR 97239 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503 ) 222-4151 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: esweeks drhorton.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Co Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 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
CCB Lic.: 121159 Electrical Lic.: —.05C� Suprv. Lie.:3707-S
specifically listed((1/2hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ;•J / '' Subtotal:
Print name: Charles Garner Date: 0 Plan Review Required(25%of permit fee):
Q� ,'0.l State surcharge(12%of.permit fee):
Authorized signature:rht.tLGk TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Emerald Weeks Date: 6/3/202 I days after it has been accepted as complete.
* Number of inspections allowed per pennit.
1:`BuildingTennitskELC_PermitApp_ELR_ERE.doc Rev06i17,2015 440-4615T(It/05iCOM'WEB
Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEE SCHEDULE " :..
REiTiE1�ITTAL WORK ONLY:
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
LI 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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
specifically listed(A hr min)
COMMERCIAL WORK ONLY: - .PEEtM! ;FE> -tr ' .°'Subt '`
Fee for each commercial system: $75.00 allowed
per permitter .
Page 1).
�' • Number of inspections allowed per permit.
(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
I:\Building\PermitsnELC_PennitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application
Building Fixtures RECEIVE I FOR OFFICE USE ONLY
City of Tigard Received PI 5T 20Z(-oo�9 Gj
i NOV 01 2021 Date/By: PennitNO.:
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 CITY OF i IUHHG Date Ready/By: Juris: ® See Page 2 for
T I G A R D Y 1 r� r� y y'
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
x❑New construction ❑Demolition For special information use checklist.
Description I Qty. I 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
❑ 1-and 2-family dwelling IDCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:14553 SW 78TH AVE Catch basin or area drain 18.76
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.:18 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 1 25.02
NSFR
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
Address:
4380 SW Macadam Ave Ste 200 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Portland OR 97239 Hose bib 2 25.02
Phone:( 503 ) 222-4151 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: DR Horton Medical gas(value:$ ) Page 2
Primer 12.51
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 3 25.02
Water closet
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
Phone:( 503)492-3490 Fax:( 503 ) 912-6438 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 184601 Plumbing Lic.no.: PB732
State surcharge(12%of permit fee)
Authorized signature: / " --�/.> 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.
t:Building,PermitsPLMU-PennitApp.doc 10,01/09 440-46161(100'-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 s i.110 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool, ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
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
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.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_PennitApp.doc 08/04/2011 2
r COMMUNITY DEVELOPMENT DEPARTMENT
• i City of Tigard
T l A R o Building Permit Review — Residential
MST OZ
Building Permit #: 2, I-004
Site Address: t `-j 3 SJ q' �► A-
‘pc
B ‘pe
1 Project Name: S'Cii ,J K S Lot #: Jo
Planning Review G
r
Proposal: of we 1 v j
0 Verify address/suite# active in Accela. ❑ In River Terrace: 3/No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: Wrosion Control 64.
A copies of site plan on 8-1/2"x 11"or 11 x 17"paper RRetained trees with drip line and tree protection measuresatC
[)rawn to scale(standard architect or engineer scale) j'Footprint of new structure(including decks)and FFE
jSiNorth arrow igUtility locations&easements(required for new and additions)
j4Site address,project or subdivision name and lot number ASidewalk/driveway approach
Applicant information(name and phone number) I—IT ocation-of-Arzp rss$tis' �.T texts:.
MLot dimensions and building setback dimensions RStreet tree size,type and location
s clSauarr footage of b OStreet names
4 Corner elevations (2'contours if more than 4'differential)
pLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? EYes ❑No
area
impervious
(applicable if R-7,R-12,R-25&
R-40) If yes,is a storm water quality facility shown? ❑Yes KiNo
01 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified p No Received: ❑ Yes ❑ No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified XI No Received: ❑ Yes ❑ No
- --SD t . for AD;3-applk,dfV,.. ❑ Ycs -0 NT, Received: ❑ Yes ❑ No
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
�1 Land Use Case#: S O 6'�Z-O " Q 0 bD 1 gi Zoning: �rlifti
g Required Setbacks: Front: (S L Rear: ( l Side: 5 t eet Side: t O Garage: 2 >'
Building Height: Max.Height: S 1 Actual He .ht:
Landscape Area: W % (vy Lot Coverage Max: 0 %
Entrance sE Set back no more than 8'from street-facing wall Aii Parallel to . o fset 45 degrees or less
Windows A Minimum 12%of area of all street-facing facades
Garage oor is behind widest street-facing wall ,] Yes o,one of the following is met:
❑ Door ex e more than 5'from wall and ' a covered porch extending beyond garage.
❑ Door extends no more and there is a 12 sq ft.window above garage on 2"floor.
❑ Garage door width is ❑ 12' ss ❑ 50 0 o facade El 60%or less and includes 7 of following:
❑ Covered por Recessed entrance ❑ Wall offset f eave ❑ Roof offset
❑ Fir gles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gam r El Dormer
Accent siding ❑ Window trim ❑ Window recess ❑ Window projection alcony
gi Visual Clearance Urban Forestry Plan I (1'üt&i
l Sensitive Lands: ElYes No Type: &^I 4ti £s' • t.su ds lAZ iti-e>
Conditio5s met prior to issuance of building permit
Notes: "V' -2' ' 1 Y1 rest►-
[ l Approved By Planning: ,4-e.AVl. Date: Z
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved El Not Approved
i
i
1:\Building\Forms\BldgPermitRvw_RES_122419.docx
ansii► Ni
Building Permit Submittal
Original Submittal Date: 0//102/
Site Plans: # ..,
Building Plans: #
Building Permit#: [ Enter building permit# above.
Workflow Routing: Tr-Planning It/Engineering (ti Permit Coordinator El/Building
Workflow Sign-off: C' Sign-off for Planning(include notes from planning review)
Route Application Documents: IR"Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: �- b Date: / 0 2 /
Engineering Review
[Slope at building pad: L70
Y/Conditions "Met"prior to issuance of building permit
2/Easements Easements (encroachments) per engineering conditions of approval and plat
d Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 15 No
Assess Water Quantity Fee in-lieu: ❑ Yes D No
LIDA Facility on lot: ❑ Yes D/No
(Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
All Approved by Engineering: -4 w 0 ce ,,, Date: t(a Z 3 l L az(
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
11 1 I I I
Permit Coordinator Review
vi 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: Yes ❑ N/A
Parks SDC: 4 Yes ❑ N/A
LIDA ❑ Yes ,21 N/A
/
l� OK to Issue Permit
Approved by Permit Coordinator: Date: II I2,3 l/42(
1•\Building\Forms\BldgPennitRvw_RES_122419.docx