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
1111 _ Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.71 8.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Amanda Loveridge MAR 15 2022
COMPANY: D.R. Horton vl Y OF fIGARD
PHONE: 503-522-9552 3UILDING DIVISION By:
EMAIL: aloveridge@drhorton.com
RE: 14639 SW 78TH AVE MST2021-00491
(Site Address) (Permit Number)
Serenus Lot 14
(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 Technic' 3�Z?Jp�i�-- Initials: IQ
Fees Due: ❑ Yes N Fee Descriptio Amount Due:
Special
Instructions:
Reprint Permit(per PE : ❑ Yes / No ❑ Done
/A
Applicant Notified: C�f� Date: 3/2 S f/2 ) Initials:
City of Tigard
COMMUNITY DEVEI OPMENT DEPARTMENT
Building Permit Review — Residential
TIGARD 1
Building Permit #: MST2o2l //
Site Address: i 6 I 3L" kl,
Project Name: CeefirtAn US Lot #: (`I
Planning Review i . I- 5lre?MO Pve rtskszt WeR 17)The 211911a3sPlael.4-4v
14015 Recfcritaw.
Proposal ew NisT ster64c_u_NW ,
WI Verify address/suite#active in Accela. 0 In River Terrace: p o ❑ Yes, River Terrace Review Addendum
Site Plan Elements: arosion Control
go copies of site plan on 8-1/2"x 11"or 11 x 17"paper ?Retained trees with drip line and tree protection measures
tlglOrawn to scale(standard architect or engineer scale) l7''ootprint of new structure(mcluding decks) and FFE
North arrow lZlUtility locations&easements(required for new and additions)
ire address,project or subdivision name and lot number �idewalk/driveway approach
_ pplicant information(name and phone number)
(�I ocadon of wells/septic systems
of dimensions and building setback dimensions Street tree size,type and location
Street names
nT . sits., ential)
?lint area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced?1Yes No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Yes�?No
rClean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified p No Received: ❑ Yes 0 No
emo
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes 0 No
o Received: ❑ Yes 0 No
[Public Facilities Improvement(PF1)Permit:
Required: ❑ Yes,applicant was notified L7 No Applied For: Yes El No,stop intake
Y$ Land Use Case#:�UBZf� I 75 Zoning: /'Z, —a-
WI) Required Setbacks: Front: 15 1 Rear: 1 tt Side: 5 t Street Side: `O t Garage: yd
Building Height: ��l Max. Height. 3 Actual Height: 2
PLandscape Area: G(.J % C� Lot Coverage Max:
Entrance �p) 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 pa Garage door is behind widest street-facing wall 7, Yes 0 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.
RP Garage door width is 0 12'or less '50%or less of facade 0 60%or less and includes 7 of following:
C ❑ Covered porch 0 Recessed entrance 0 Wall offset 0 1'Roof cave ❑ Roof offset
❑ Fire shingles 0 Lap Siding 0 Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding 0 Window trim ❑ Window recess ❑ Window projection ❑ Balcony
(P Visual Clearance Ig Urban Forestry Plan �oa !�/ ' ��
r� Sensitive Lands: ill Yes 0 No Type: 1 Low
OD Conditions met prior to issuance of building permit
Notes:
OP Approved By Planning: 4. Date: G I 7/ cg/Ze Z-
Revisions(after Building Submittal only) eviewer_ Date
Revision 1: rip Approved 0 Not Approved 965/ZOZ-2-
Revision 2: ❑ Approved 0 Not Approved
6\Building\Fonns\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: VOSt�102/
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing. ((Planning E Engineering E'rermit Coordinator ®Building
Workflow Sign-off: (Sign-off for Planning(include notes from planning review)
Route Application Documents: LL7'Engineering: (1)copy of permit application,(1) site plan, (1) building plan and
original plan review routing form.
Er-Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: '
Date: //0 (_,OZ/
By Permit Technician: �t i / `//�
Engineering Review
L_�Y/Slope at building pad: 2%
L—� Conditions"Met"prior to issuance of building permit
2'l asements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes ' o
Assess Water Quantity Fee in-lieu: ❑ Yes L7 No
LIDA Facility on lot: 0 Yes EYNo
GYFinal Plat Recorded:
El NOT Approved by Engineering: Date:
Notes:
[J Approved by Engineering: 77wi-,>`/6.- 7 e-,-, Date: " "/2z/Zoz i
Revisions (after B)lding Submittal only) Reviewer Date
Revision 1: Approved 0 Not Approved - ,f A ri X,� 3 its-12,
Revision 2: 0 Approved 0 Not Approved
Permit Coordinator Review
)Z 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: 1\1. '3 11i IZUZZ — P(V9VO\'Cr,{ .
Revision Notice 2: Date Sent to Applicant:
gr SDC Exemption: 0 Received Does not apply
4 SDC Fees Entered: Wash Co Trans Dev Tax: ,f Yes 0 N/A
Tigard Trans SDC: 'Yes ❑ N/A
Parks SDC: fa' Yes 0 N/A
T.TDA 0 Yes SZIN/A
V OK to Issue Permit
Approved by Permit Coordinator: Date: (` 27,12 21
1:\Building\Forms\BldgPwmitRvw_RES_1224 19,docx
CITY OF TIGARD MASTER PERMIT
IN -:T . COMMUNITY DEVELOPMENT Permit#: MST2021-00491
T[1:-.A f,F) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2022
Parcel: 2S112BD01100
Jurisdiction: Tigard
Site address: 14639 SW 78TH AVE
Subdivision: Serenus Subdivision Lot:
Project: Serenus, Lot 14
Project Description: New detached dwelling
BUILDING
Floor Areas Required Setbacks Reauired
Stories: 2 Bedrooms: 4 First: 872 sf Basement: 0 sf Left 5 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1153 sf Garage: 403 sf Front: 15 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 2025 sf Value: $285,090.34 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 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 Than Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvcfFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!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 2025
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: $37,808.18
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
Q59-M1_Ant n fhrnmh nAP oc ..nn111non Vnu TM/nhfein a rnnv nf+ha nine nr dlrarl nuaeanne in fll iNr:hn rallinn Sn'1 9'19 1QA7 nr I Finn'1'19 9A44.
�
IOIC^n , 11!] 1
�rG Issued By: JIAI{(l�.J �]� On Permittee Signature: �tMla t U�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 lob site at the time of each inspection.
Building Permit Application ( • Z 1
Residential RECEIVE FOR OFFICE ( SE OM 1.
�r Received �/� Permit No.:
City of Tigard Date/By: I �q ZOIJ i 1AST 2021 nl
• 13125 SW Hall Blvd.,Tigard,OR 97223 N O V 04 2021 Plan Review, �; Other Permil7ytf ��-�Z�3
' I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: til
TIG RI) Inspection Line: 503.639.4175 CITY OF )I(aHHj_1 ,Date Ready/By: OA' 1' i ^ 61 See Page 2 for
Internet: www.tigard-or.gov BUILDING DI�IIc t r�°!i,fi7 method: �j{fl. t 74-- Supplemental Information
TYPE OF WORK REQUIRED DATA: I-AND 2-FAMILY DWELLING
[,New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. L `5i
❑ I-and 2-family dwelling IDCommercial/industrial Valuation: 11 2� 7� �I
ElAccessory building 0 Multi-family Number of bedrooms:4
❑Master builder ❑Other: Number of bathrooms:XS j
JOB SITE INFORMATION AND LOCATION Total number of floors:2 2tiZp
Job site address:14639 SW 78TH AVE New dwelling area: 2025 square feet t 1S 3
City/State/ZIP: Garage/carport area: 403 square feet (6-1 a,
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.:14 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
❑ PROPERTY OWNER 0 TENANT Number ofstories: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:
❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
- - ;(Please refer:to.feeschedu✓f) . .
Business name: DR Horton
Structural plan review fee(or deposit): 7,1
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 ) 222-0151 Fax::( )
E-mail: estveeks n drhorton.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
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
and administrative fees):
Phone:( 503 ) 222-4151 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 1.303S" 'so g segi 0i/.2-2_- Total fee due upon application: $201.60
Authorized signature: ("T.,1„e We 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./2 210 *Fee methodology set by Tri-County Building Industry
r Service Board.
I:1 Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440:161 3T(1 1/02/COM/WEB)
-r
Building Permit Application Checklist
One— and Two—Family Dwelling FOR OFFICE USE ONLY
City of Tigard ReceivedDate/By: Permit No..
IIIII • 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
a Phone: 503.718.2439 Fax: 503.598.1960
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 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
3 Verification of approved plat/lot. x 0 0 0
4 Fire district approval required. Name of district: . x 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity x❑ 0 0
6 Sewer permit. x❑ 0 ❑
7 Water district approval. x❑ 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. x 0 0 0
9 Erosion control 0 plan ❑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 )0 ❑ ❑
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 ❑ ❑
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
(P P Y
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 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 x❑ ❑ ❑
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 pathror provide calculations. A gas-piping schematic is required x❑ ❑ 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 a r rlicable 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". 0 ❑ 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 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 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
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/t2/COM/WEB)
f>
Mechanical Permit Applicat' IOR OIPR l I St ()NI.)
City of Tigard CEIvED Date : ISTZOZI.00N9(
Permit No.:
- • 13125 SW Hall Blvd.,Tigard,OR 97223 r7 Plan Review
NOV O Phone: 503.718.2439 4 2Ot' Date/By: Other Permit.
't 1 c 1 n 11 1) Inspection Line: 503.639.4175 _ Date Ready/By: luric: Fd See Page 2 for
Internet: www.tigard-or.gov CITY OF I IGAHL 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 ❑Commercial/industrial 0 Accessory building For specks!fpformatbn use checklist.
❑ Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 14639 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: Hvdronic 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.: 14 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 I 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 $14.15 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 I
Phone:( 503 ) 222-4151 Fax: :( ) Fireplace
E-mail: esweekst✓drhorton.com Range 1
Barbecue
CONTRACTOR Clothes dryer(has)
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 180
U'J /�/// days after it has been accepteda di as campkte.
Authorized signature:
Fee methodology set by Tri-County Building Industry Service Board
Print name: Andrew Darland Date: mini
t:\BuildingTennialhMEC PennitApp 092520.doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED RReeceved ►STZDZI 00
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 N O V O 4 2021 Date/B : Related Permit 6:
Inspection Line: 503.639.4175 Ready Date/By: lurk: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF WOR1 . ,.,<>v r+ .,..'`r :..:PLAN REVIEW
111 New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ i-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground.or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑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:14639 SW 78TH AVE 10OHP or more. ❑"A 'E","I-2","I-3",
City/Stflte'ZiP' 0 Six or more residential units. occupancy.
0 Healthcare facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Serenus 0 Hazardous locations. 0 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 Ott. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Serenus Lot#:14 includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#:
Ea.add'1500 sq,ft.or portion 3 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
NSFR (with above sq.&)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER ❑ 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 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
i - . ;, t Branch circuits—new,alteration,or extension,per panel
-- - "" 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
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'I branch circuit 7.42 2
222-4151Miscellaneous(service or feeder not included)
Phone:( 503 ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: esweeks(r)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 ❑ See Page 2 2
Address:2890 SE Brookwood Ave. panel,alteration,or extension.
city/sate/ZIP:Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503-848-4552 Fax:( ) Investigation(I hr min) 90.00/hr
Email: permits@garnerelectric.com Industrial plant(1 hr 78.1e/hr •
p @9 Inspections for which no fee is 90.00/hr
CCB Lie.: 121159 Electrical Lic.: 4- 5C Suprv. Lie.:3707-S specifically listed(.,hr min)
FEE
Suprv.Electrician signature,required: ELECTRICAL PERMITSubtotal: S
Print name: Charles Garner I. Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): _
Authorized signature:Cy 1.44-all 0//2-42,i-4- TOTAL PERMIT FEE:
This permit application expires If a permit is not obtained within 1 all
Print name: Emerald Weeks Date: 6/3/2021 days after it has been accepted as complete.
* Number of inspections allowed per pennit.
I:lBuildineermits6ELC_PermitApp_ELR ERE.dor Rev 06.t17/2015 440-4615T(11/05!COM'WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: •.a .; FEE SCHEDULE
Description I Qt). I Each Total i
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less I 00.702
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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
552.26
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(I hr min) -
Inspections Tor which no fee is 90.00/hr
specifically listed('/r hr min)
COMMERCIAL WORK ONLY: ELECTRICAL rE,Rna .JES
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:
❑ 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
ho8uilding'Permits‘ELC_PermeApp_ELR_ERE.doc Rev 06/172015
. Plumbing Permit Application
*Building Fixtures RECEIVED FOR OFFICE USE ONLY
Received ' / U
Cityof Tigardermit No.: 2 r t4
:� i ■ 131SWHa➢Blvd.,Tigard,OR 97223 NOVN�� �4 2021 Date/By: s fldrVt
Phone: 503.718.2439 Fax: 503.598.19 Plan Review
�ITY OF i`lUHHG
Date/By: Other Permit No.:
Inspection Line: 503.639.4175 BUILDING DIVISION Date Read /B orris. ® SeePA e2for
l IGA17p Y Y 8
Intemel: www.[igafd-Ot.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑x New construction ❑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
0 1-and 2-family dwelling D Commercial/industrial .... SFR(2)bath 437.78
SFR(3)bath 1 500.32
O Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
O Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Slte utilities:
Job site address:14639 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 II.:_) Page 2
Subdivision: Serenus I Lot no.:14 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 1 25.02
NSI•R
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 Floor drain/floor sink/hub 25.02
Address: 4380 SW Macadam Ave Ste 200
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:S_) 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 Water closet 3 25.02
. Water heater 1 37.52
Business name: Alliance Plumbing,LLC Water piping/DWY 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 Lie.: 184601 Plumbing Lic.no.: Pg732 State surcharge(12%s of permit fee)
Authorized signature: �-7� TOTAL PERMIT FEE
Print name: Gavin Thomes Date: 7.01.2021 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Pee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permhs\PLMU•PenoitApp.doc 10,01,09 440-4616T(I0i02tcOM'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-1e 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2.001 to 3,600 $169.59
3,601 to 7,200 S233.20
Sewer-1st 100' 62.54 7,201 and greater S327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' • 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Ins ections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
p 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 cheek 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
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water
Asirator-Commercial ❑ Any multipurpose fire sprinkler system.
D ❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
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 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: -Lay/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:
l:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
Ili ■ COMMUNITY DEVELOPMENT DEPARTMENT
r I c n R D Building Permit Review — Residential
Building Permit #: MS T 202t-OO14ql
Site Address: j`I631 5(A 11i k(,
Project Name: certitnUS Lot #: ` Li
Planning Review. ,
Proposal: krew olaax/hat
Vl Verify address/suite# active in Accela. E In River Terrace: A o ❑ Yes,River Terrace Review Addendum
Site Plan Elements: arosion Control
lya3 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) pootprint of new structure (including decks)and FFE
vi North arrow 4-Utility locations&easements(required for new and additions)
!j.ite address,project or subdivision name and lot number idewalk/driveway approach
ry pplicant information(name and phone number) ❑Location of-wells/septic systems
t'Li t dimensions and building setback dimensions ig1Street tree size,type and location
QrT�rrfeatagrcrFb F2Street names
ZLF. site etmteorrxf-if —t .m4'-""sential)
? of 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' ?No
rClean Water Services-Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified p No Received: ❑ Yes ❑ No
CI WI T,T t T:' TT T 1 lr A + r . -
uuns,reemoaeis arr�rpos•
'Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
. o Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified PS No Applied For: Yes ❑ No,stop intake
J Land Use Case #:SU f32320 .1006$0 i f7,2 Zoning: K.—
®Required Setbacks: Front: N5 1 Rear: I t Side: 5 Street Side: I t Garage: ZO f
t c
p Building Height: �`} Max. Height: 3 Actual Height: 7�gj
Landscape Area: -6 % Lot Coverage Max:
Entrance J l Set back no more than 8'from street-facing wall p Parallel to street or offset 45 degrees or less
Windows El Minimum 12%of area of all street-facing facades
Garage fd Garage door is behind widest street-facing wall A 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 2nd floor.
IXP Garage door width is El 12'or less 50%or less of facade ID 60%or less and includes 7 of following:
` ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ I'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
Visual Clearance L� Urban Forestry Plan r � r A /
Sensitive Lands: b�
Yes 0 No Type: I Loco V c6 ev
14)Conditions met prior to issuance of building permit
Notes:
44g Approved By Planning: AWL Date: i I / 4/2e 1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: / O f/10Z/
Site Plans: #
Building Plans: #
Building Permit#: Er-Enter building permit# above.
Workflow Routing. ErPlanning [ Engineering Errermit Coordinator Cl�Building
Workflow Sign-off: L '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.
[-Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: -4711044 Date: ///0q202/
Engineering Review
LAY Slope at building pad: 2.%
Conditions "Met"prior to issuance of building permit
asements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility: ll
Assess Water Quality Fee in-lieu: ❑ Yes E" o
Assess Water Quantity Fee in-lieu: ❑ Yes L7 No
LIDA Facility on lot: ❑ Yes ErrNo
C'Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
e Approved by Engineering: 7 -vy,7` Date: I-)12.Z1207
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
fvf 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: X Yes ❑ N/A
LIDA ❑ Yes /N/A
1Z OK to Issue Permit
Approved by Permit Coordinator: Date: I� 2�712111A
I:\BuildinglForms\B1dgPermitRvw_RES_122419.docx
Plan# SAA 011 2 5'�
Floors Z Large 1 R3 2025 1 J0 5� t 1 y Z®�
Bed rooms Small �j a 1� 5 J �"�
we _ c-(03X 1 28 � 2,0i 3`k
TubLAV 3 ID-��� _ f °96 '
Tub ?J' Basement `� 2�
Vent S 1st Floor c37),
Water Heater 1 2nd Floor 1 1S3
AC t•--r3 3rd Floor
School 1-y R-3 Total ZaZS
Garage C.tty-j
3 4A kblAS Total ZgZ$
2 y`'Sr`" U Nk
#for Elec 3