Permit BACFLOW EXISTING -K REMOVED
PREVENTER REPORT X NEW REPLACED
REPAIRED OLD S/N:
PROPERTY NAME DR Horton Serenus Lot 9 PHONE
CONTACT NAME PHONE
MAILING ADDRESS 14569 SW 78th Ave
Cult Tigard STATE OR `LIP 97224
PREVENTER ADDRESS 14569 SW 78th Ave Tigard, OR 97224
WATER SUPPLIER City of Tigard, Oregon SERIAL# HF 57071
LOCATION SW corner driveway, lawn
MAKE Febco MODEL 850 _ SIZE 3/4"
TYPE n RP n RPDA n RPDA-II (X] DC n DCDA U DCDA-11 n PVB SVR Ell AVB n AG
HAZARD PROTECTED I PREMISES ISOLAr1ON ®7 IRRIGATION I( ' FIRE SYSTEM 1__1 BOILER n OTHERAPPROVED: IAASSEMBLY ® INSTALLATION Id ORIENTATION IA AIROAP PIPE SIZE in s "A`TIDN in
PHYSIC
REDUCED PRESSURE ASSEMBLY PVBA/SVBA INITIAL TEST
DOUBLE CHECK AMR INLET' CHECK VALVE PASSED X
CHECK#1 CHECK#1 TYPE II n OPENED AT: PRESS DROP:
PRESS TIGHT I^I FAILED n DROP:
INITIAL MIN S PAID 2.2
TEST RELIEF VALVE LEAKED 1j PAIN IPSID MNIMID MIN1P$ID DATE 09-21-22
RESULTS OPENED AT; OPENS
NON 2MID I:RECK#2( I I FOLLY FAILED SYSTEM PSI 105
l�l
RELIEF VALVE: TIGHT DID NOT I J DETECTOR METER
PAssED n FAILED n 2.2 OPm ❑ READING:
LEAKED n Mal I PSID
NOTES
REPAIRS
PARTS
REDUCED PRESSURE ASSEMBLY PVBA/SVBA TEST
CHECK#1 DOUBLE CHECK AFTER REPAIRS
PRESS _ CHECK#1
DROP TYPE R MR INLET CHECK VALVE
REPAIR MJN a sin TIGHT I 1 (W ED AT: PRESS DROP:
RESULTS RELIEF VALVE DATE
OPINED Al': (',HECK#2 MM I PSID MN 1 PSID MIN I PAID
RRL1EF VALVE SON 2 PSm TIGHT n OPENED I fl
PDU.V PASSED
PAsnul n PAWED O MINI raw
GAUGE S/N 04141250 MAKEIMODEL Mid-west Instruments 845 CALIBRATION DATE 11-12-2021
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 regulations of the slate and water system using Amroved testing equipment and approved testing procedures.
INITIAL TEST TEST AFTER REPAIRS _
066108
TESTER SIGNATURE TESTER SIGNATURE TESTER CERT#
Jordan A 503-849-0237
TE.STE.R.NAME(PRINTED) TESTER NAME(PRINTED) PHONE#
2153 Molalla Rd Woodburn, OR 97071 Jordan@ahlandscapes.net
TESTER ADDRESS TESTER ADDRESS EMAIL
Ashland Brothers Backflow Testing, Repair& Install
COMPANY NAME COMPANY NAME I X I WATER RESTORED?
n FOUND OFF,LEFT OFF
REPORT RECEIVED DY(REPRESENTATIVE OP OWNER) REPORT RECEIVED EY(RP.PRESENIATIVE OP OWNER)
74
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021 00486
T I G A It D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/18/2022
Parcel: 2S112BD01000
Jurisdiction: Tigard
Site address: 14560 SW 78TH AVE
Subdivision: Serenus Subdivision Lot:
Project: Serenus, Lot 9
Project Description: New detached dwelling
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 966 sf Basement: 0 sf Left 5 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 1390 sf Garage: 395 sf Front: 15 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 2356 sf Value: $328,517.44 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
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: 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 2356
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: $39,211.17
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
oc9-nn1-fain rhrniinh rlAp oF9-nn9_noon VniI may nhfnin n rnnv of fhn n ilac nr rilrcrf n,lccr{nnc fn fll INC'by ramnn rin'3 9Z9 10R7 nr 9 RCM 4'9 9'2AA
HO{,Ly Va.fti De,Wege,
Issued By: Permittee Signature: C?w Apr-Litr,a4-i.nv.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application e3_ i ( _
Residential RECEIVE a FOR OFFICE USE ONLY
1 �/ Received p/
City of Tigard Date/By: O f 20Z/ C.� Permit No.:M S r�u-Co 4. e,
13125 SW Hall Blvd.,Tigard,OR 97223 NOV 2021 Plan Review C�,/�� �7��
i ■ Alf Other PermwW L Phone: 503.718.2439 Fax: 503.598.1960 Date/By: j S 2I i !��
I l G A R I) Inspection Line: 503.639.4175 CITY OF TIGAiRD Date Ready/By: I fa See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION N ' cd/Method:f Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- ND 2-FAMILY DWELLING
21 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 ❑Other: equipment,materials,labor,overhead,and the rofit the
CATEGORY OF CONSTRUCTION 41
work indicated on this application. 3Z�Itt
�,
Valuation: y"" +.g0200
❑ 1-and 2-family dwelling ❑Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:4
❑Master builder 0 Other: Number of bathrooms:�
JOB SITE INFORMATION AND LOCATION Total number of floors:2_ ,-75
Job site address:14560 SW 78TH AVE New dwelling area:243.551,0quare feet 1390
City/State/ZiP: Garage/carport area: 395 square feet I(do
Suite/bldg./apt.no.: Project name: Serenus Covered p• areeK square feet
Cross street/directions to job site: Deck ar illt) square feet
Other structure area: square feet Landing
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Serenus Lot no.:9 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.
NSIR Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ 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*
Business name: DR Horton (Please refer to fee schedule
Structural plan review fee(or deposit): rj'/- /
Contact name: Emerald Weeks
FLS plan review fee(if applicable):
Address: 4380 SW Macadam Ave Ste 200
City/State/ZIP: Portland OR 97239 Total fees due upon application:
Phone:( 503 ) 222-4151 Fax::( ) Amount received:
E-mail: esweeks@drhorton.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic 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
and administrative fees):
Phone:( 503 ) 222-4 151 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 13059 i 3Or ' ' F`11
/� � ��
(Nf� � /� Total fee due upon application: $201.60
Authorized signature: CjytizA 'Q� 4et- 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\Permits\BUP-RESPennitApp.doc 02/24/201 I 440-4613T(I 1/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
I Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing ❑ 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 1 ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. x❑ ❑ El
3 Verification of approved plat/lot. x❑ El El
4 Fire district approval required. Name of district: - • x❑ 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacity . x0
0 El
❑
6 Sewer permit. x❑ El ❑
7 Water district approval. x❑ ❑ El8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- x❑ El El
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.
I 1 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if x❑ El El
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 x❑ ❑ ❑
and location. x❑ 0 0
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater,
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. CI El 0
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. x
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. x❑ 0 0
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non-
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 El
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists x❑ 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load. x❑ 0 0
20 Manufactured floor/roof truss design details.
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. ID El El22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or x
architect licensed in Ore:on and shall be shown to be applicable 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 II"or 11"x 17". Cl 0 ❑
24 Two(2)sets each are required for items 16,19,20 and 22 above.
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 00 0 0
27 "Drawn to scale"indicates standard architect or engineer scale.
El
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 El
and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0 0
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions,
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-RESPermitApp.doc 02/24/2011 440-46 I 3T(11/02/COM/WEB)
Mechanical Permit Application
RECEIVED Reeiv a pST2O2I_OO gg�
Cityof Tigard Permit No.
14 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■. Phone: 503.718.2439 Other Pennit:
NOU 0 22 DotelBy:
T I ri A It I) Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE*SCHEDULE—USE CHECKLIST
® New construction ❑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 ❑Accessory building
Fos special information use checklist.
0 Multi-family 0 Master builder 0 Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 14560 SW 78TH AVE Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 1 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.:9 Other: 23.32
Tax map/parcel no.: Other fuel appliances:
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 I 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:
S14.15 for first four;S4.03 for each additional
Contact name: Emerald Weeks
Furnace,etc. t
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 ) 2224151 Fax: :( ) Fireplace
E-mail: esweeks@drhorton.com Range I ,
CONTRACTOR Barbecue
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
Authorized signature: >� " (:::::2 � days after it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry Service Board
Print name: Andrew Datiand Date: t0/21/21
I\BuiIdinglpennits\MEC_PenmtApp_082520.doc 440-4617T(II/02/COM/WEB)
Electrical.Permit Application RECEIVE'""E I VE e� FOR OFFICE USE ONLY
Received
City of Tigard Permit#: I✓4Sr2021-60LF$6,
IPI . 13125 SW Hall Blvd.,Tigard,OR 97223 NOV 0 2 2021 Date/By:
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 Cl OF I IGA�B Ready Date/By: .tt�ris. I ® See Page 2 for
T[G A 1Z1) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
® 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.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground.or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑ Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:14560 SW 78TH AVE 100HP or more. ❑"A "E","l-z ,'1- ,
City/State/ZIP: 0 Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Serenus ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qiy. I Each I 'Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Serenus Lot#:9 Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: Ea.add'l 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.ft)
0 PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
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: esweeksndrhorton.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: DR Horton above service or feeder fee,
each branch circuit 7.42 2
Contact name:Emerald Weeks B.Fee for branch circuits without
Address: 4380 SW Macadam Ave Ste 200 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Portland OR 97239 Each add'l branch circuit 7.42 2
2224151 Miscellaneous(service or feeder not included)
-
Phone: ( 503 ) Fax: :( ) Each manufactured or modular
67.84 2
esweeks@drhorton.com
drhorton.Com dwelling,service and/or feeder
Email: 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 El See Page 2 2
Address:2890 SE Brookwood Ave. panel,alteration,or extension.
City/State/ZIP:Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503-648-4552 Fax: ( ) investigation(1 hr min) 90.00/hr
Email: permits@garnerelectric.com Industrial plant(1 hr min) 7s.1 s/hr
Inspections for which no fee is 90.00/hr
CCB Lie.:121159 Electrical Lie.: .4-.05C A Suprv. Lie.:3707-S specifically listed('L hr min)
/� ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: •_ Subtotal:
Print name: Charles Garner Date: 0 Plan Review Required(25%of pennit fee):
/' / State surcharge(12%of permit fee):
Authorized signature:�f W TOTAL PERMIT FEE:
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 permit.
I:;Building.Permits:.ELC_Permit App_ELR_ERE.doc Rev 06,17'2015 440-4615T(11 05-COM WEB
Electrical Permit Application—City of Tigard V
Page 2—Supplemental Information •
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I DIY. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n B• urglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n G• arage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
j Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n O• ther: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
sn.sgeciticall listed(Y hr min)
COMMERCIAL WORK ONLY: subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n A• udio and Stereo Systems
n B• oiler Controls
Clock Systems
n D• ata Telecommunication Installation
n F• ire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n M• edical
❑ N• urse Calls
n O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ O• ther:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:'BuildingtPermitsFLC_Permit App_FLR_FRE.doe Rev 06 t 72015
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY'
City of Tigard Received Permit No.: 51-2-4 -i r oQ tteG
■ 13125 SW Hall Blvd.,Tigard,OR 97223 NOV 2021 Date/By:
'� ■ Phone: 503.718.2439 Fax: 503.598.19Date/By:Plan
Review DOther Permit No.:
p
Ins ection Line: 503.639.4175 CITY OF TIGARD
T i G A R D ate/B :Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑ Demolition For special information 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
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:14560 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.: 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.:9 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
NSFR
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: DR Horton Fixture/sewer cap 25.02
4380 SW Macadam Ave Ste 200 Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Portland OR 97239 Hose bib 2 25.02
Phone:( 503 ) 222-4151 Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ 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�r drhorton.com 3 25.02
Water closet
CONTRACTOR
Water heater 1 37.52
Business name: Alliance Plumbing, 1.LC 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 pennit fee)
CCB Lic.: 184601 Plumbing Lic.no.: PB732 State surcharge(12%of pennit fee)
Authorized signature: ��/� TOTAL PERMIT FEE
Print name: Gavin Thomes Date: This permit application expires if a permit is not obtained within 180 days
7.01.2021 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:'•,Building Termits`.PLMU-PermitApp.doc 10/0I'09 440-4616T(I0,02'COM'WEB)
y
Plumbing Permit Application - City of Tigard '• .y , „
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
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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
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 90.00flv 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 Thtu 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
ElAny complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
;, 3 Isometric or Riser Diagram
-4" 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
l:\Building\Permits\PLMF_PennitApp.doc 08/04/2011 2
ea
City of Tigard
■
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 ul, Building Permit Review — Residential
Building Permit #: MST 202(-Ov L (o
Site Address: 14560 SW 78th Ave
Project Name: Serenus Subdivision Lot #: 9
Planning Review
Proposal: New detached dwelling
Verify address/suite#active in Accela. [N In River Terra CS1 No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: ;7•= .. •
[X3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper %i Retained trees with drip line and tree protection measures&<
[)rawn to scale(standard architect or engineer scale) NFootprint of new structure(including decks)and FFE
NINorth arrow NUtility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number aSidewalk/driveway approach
CitApplicant information(name and phone number) • s se tic systems
[XI.ot dimensions and building setback dimensions treet size,type anlocation
T
quare oo age molished NIStreet names
cinctures on site [KCorner elevations(2'contours if more than 4'differential)
N.Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? NYes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes [2:4No
® 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 a No Received: ❑ Yes ❑ No
® SDC Exemption for ADU applied for: ❑ Yes N No Received: ❑ Yes ❑ No
]] Public Facilities Improvement(PH) Permit:
Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake
® Land Use Case#: SUB2020-00001 a Zoning: R-12
® Required Setbacks: Front: 15 Rear: 15 Side: S Street Side: 10 Garage: 20
• Building Height: Max.Height: 35' Actual Height: 23'
IX] Landscape Area: 20 % EX Lot Coverage Max: 80
Entrance CSI Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows NI Minimum 12%of area of all street-facing facades
Garage [ Garage door is behind widest street-facing wall IX Yes ❑ No,one of the following is met:
❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2°d floor.
a Garage door width is ❑ 12'or less ❑ 50%or less of facade Di 60%or less and includes 7 of following:
X Covered porch ❑ Recessed entrance IN Wall offset IX 1'Roof eave D31 Roof offset
❑ Fire shingles Lap Siding ❑ Roof pitch II Gable,hip,or gambrel roof ❑ Dormer
• Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
N Visual Clearance ® Urban Forestry Plan
IX] Sensitive Lands: ❑ Yes a No Type:
❑ Conditions met prior to issuance of building permit
Notes:
[St Approved By Planning: Date: Z$
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal ' .
Original Submittal Date: //O2�202-/
Site Plans: # ��
Building Plans: # e
Building Permit#: IR/Enter building permit#above.
Workflow Routing: 12/Planning Engineering LYPermit Coordinator leBuilding
Workflow Sign-off: LE'Sign-off for Planning(include notes from planning review)
Route Application Documents: CI-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: Date: //.O%f-2p2/
Engineering Review
12 Slope at building pad: 2::),,)
Conditions"Met"prior to issuance of building permit
asements (encroachments) per engineering conditions of approval and plat
Er
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes E(No
Assess Water Quantity Fee in-lieu: ❑ YesEt/No
LIDA Facility on lot: ❑ Yes 12'No
air-Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
P"-Approved by Engineering: j rzty f /3 y? C -1 Date: I i lza/Zoz(
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
/211 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
KE'SDC Fees Entered: Wash Co Trans Dev Tax: ,E11 Yes ❑ N/A
Tigard Trans SDC: Xi Yes ❑ N/A
Parks SDC: g Yes ❑ N/A
LIDA ❑ Yes , N/A
Z OK to Issue Permit
Approved by Permit Coordinator: Date: II[1/1,/h01/1
I:\Building\Forms\BldgPermitRvw RES_122419.docx