Permit Support Document 4.
Building Permit Application
Residential II `.6
RECEIVE , FOR OFFICE USE ONLY
Cityof Tigard Received - 7 .—I '7 (J)�Q
g q +C f 7i lj 5�� Permit No.:04 t Z-a7.-VW Ud
NAR 17 2022 Date/By: ,
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review n u
Phone: 503.718.2439 Fax: 503.598.1960 '1 n ' Other Permit:5 K.0.l 2 moLi1
Date/By: Z(/ i1�
-1 I A R.D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: //,Juris: H See Page 2 for
Internet: www.tigard-or.gov ed/Method: / 1Z /� Supplemental Information
BUILDING TIIUISIOr'1
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®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 profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. b
® 1-and 2-family dwellingValuation: 0/""W—' '�51'-/1 O
ElCommercial/industrial
❑Accessory building El Multi-familyNumber of bedrooms: 4
El Master builder ID Other:
Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 3 f 67
Job site address: 15609 SW Peace AVE New dwelling area: 2527 square feet 1323
City/State/ZIP:Portland,OR 97224 Garage/carport area: p Sao square feet t ad `
Suite/bldg./apt.no.: Project name:River Terrace Covered porch area: square feet 4
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:River Terrace Lot no.:23 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.
New SFR 4 bedrooms and 3 baths with a sales office where the garage will be. Valuation: $
vered entryway and covered deck Existing building area: square feet
r.
Ld` .- ,/er � f New building area: square feet
® PROPERTY OWNER
1 ❑ TENANT Number of stories:
Name:Pacific Lifestyle Homes Type of construction:
Address:11815 NE 99th Street,Suite 1200 Occupancy groups:
City/State/ZIP:Vancouver,WA 98682 Existing:
Phone:(360)573-8081 Fax:(360)574-6401 New:
1.1 APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:Pacific Lifestyle Homes
(Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Permit Coordinator
FLS plan review fee(if applicable):
Address:11815 NE 99th Street,Suite 1200
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98682
Phone:(360)573-8081 Fax::(360)574-6401 Amount received: ,
E-mail:permits@,buildplh.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Same Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:Same Solar Installation Specialty Code checklist.
City/State/ZIP:Same Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.:173524
Total fee due upon application: $201.60
Authorized signature: _)&._ 0-74) This permit application expires if a permit is not obtained
� within 180 days after it has been accepted as complete.
Print name:Summer Dowell Date: 11/16/20 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard ReceDate/By:
Permit No.:
IIII13125 SW Hall Blvd.,Ti ard,OR 97223 y
g Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical
I WARD
Internet: www.tigard-or.gov ❑ other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l e.• "O yi,k
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ® 0 ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. Cl ❑ ❑
3 Verification of approved plat/lot. ® ❑ ❑
4 Fire district approval required. Name of district: • 0 ® ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑
El
6 Sewer permit. ❑ ® ❑
7 Water district approval. ❑ ❑ El
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ® 0
9 Erosion control 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ® ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ® 0 ❑
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, ® ❑ ❑
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- ® El El
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. ® ❑ El
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- El 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 ® El ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 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 ® ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ® El ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ® ❑ ❑
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 ® ❑ ❑
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 11"or 11"x 17". ® 0 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. ® ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ® El
27 "Drawn to scale"indicates standard architect or engineer scale. ® ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ El
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ 0
El
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(11/02/COM/WEB)
Mechanical Permit ApplicatinE EIVE FOR OFFICE USE ONLY
IIICity of Tigard Received �/ 7
Date/By: /2 l l)j. Permit No.: L �n0
" 13125 SW Hall Blvd.,Tigard,OR 97223 �[ L Z Qoo�
= 7 y0 g Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 � 1 t `u�t Date/By: Other Permit: IQ jai.-000(,,,(.�
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: Jur s: 1
Internet: www.tigard-or.gov CITY OF TIGARp H See Page 2 for
tty y Notified/Method: Supplemental Information
El 1.r
TYPE OF WORK ffiMMERCIAL FEE* SCHEDULE -USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT 1 SYSTEMS FEES*
® I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder
0 Other: Description Qty.y. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 15609 SW Peace AVE Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Portland,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:River Terrace Heat pump 1 61.06
Duct work 1 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:River Terrace Lot no.:23 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 2 33.39
Flue vent for water heater or gas
New SFR fireplace 2 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Pacific Lifestyle Homes Range hood/other kitchen
Address:11815 NE 99thSt.Suite 1200 equipment 1 33.39
Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 6 23.32
Phone:(360)573-8081 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT El CONTACT PERSON 23.32
Other:
Business name:Pacific Lifestyle Homes Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Permit Coordinator Furnace,etc.
Address:11815 NE 99th Street,Suite 1200 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater
Phone:(360)573-8081 Fax::(360)574-6401 Fireplace 2
E-mail:permits@buildplh.com Range 1
Barbecue 1
CONTRACTOR Clothes dryer(gas)
Business name:Area Heating+Cooling Other:
MECHANICAL PERMIT FEES*
Address:2721 NE 65u'Ave
Subtotal
City/State/ZIP:Vancouver,WA Minimum permit fee($90.00)
Phone:(360)737-0811 Plan review(25%of permit fee)
Fax:(360)737-6946 State surcharge(12%of permit fee)
CCB lie.:64801 3 IIU(L TOTAL PERMIT FEE
I This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Summer Dowell Date:11/16/2021
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2- Supplemental Information
Commercial & Multi-Family Fee Schedule:
aluation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
L:\Building\Permits\MEC_PernitAPP_040113.doc 2
Electrical Permit Application RECEIVE
City of Tigard i' 5eg Permit#: A7l Received ���q � ,-20/1--C1000Q
111 Plan Rev iew
• 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 1 7 2022 Date/By: (ti
S Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:SWIM Z.t,1777-'Ct!O'1'j
T I GA R D Inspection Line: 503.639.4175 CITY OF�°'( ®�(� Ready Date/By: kris: H See Page 2 for
Internet: www.tigard-or.gov �+ Mrn ec+ Notified/Method: Supplemental Information
-. . r . I -
TYPE PLAN REVIEW
0 New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked)_
El Demolition ❑Service or feeder 400 amps or more 0 Building over three stories.
❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
[1 I-and 2-family dwelling ❑Commercial/industrial II]Accessory building less to ground,or exceeds 14,000 El Commercial-use agricultural
❑ Multi-family ❑Master builder amps for all other installations. buildings.
❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE 1NFOttMAT1ON ANC LOCATION ❑Emergency system. larger separately derived
Job#: Job site address:15609 SW Peace AVE ❑Addition of new motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Portland, OR 97224 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:River Terrace 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 Qty, I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#:23 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4
Ea.add'l 500 sq.ft.or portion 5 33.92 I
DESCRIPTION OF WORK Limited energy,residential
New SFR 4 bedrooms and 3 baths. (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
PROPERTY OWNERRenewable Energy 0 See Page 2
0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Pacific Lifestyle Homes 200 amps or less 100.70 2
Address:11815 NE 99th St Suite 1200 201 ampsto400amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver, WA 98682 601 amps to 1,000 amps 301.04 2
Phone:(360)573-8081 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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
Branch circuits-new,alteration,or extension,per panel
Ea APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name:Pacific Lifestyle Homes above service or feeder fee, 1-AC
each branch circuit 7.42 2
Contact name:Summer Dowell B.Fee for branch circuits without
Address:Same as owner service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 360)904-8130 Fax: :( ) Each manufactured or modular
Email:permits@buildplh.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Address:2890 SE Brookwood Ave. Signal circuit(s)or limited-energy El See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr
Email: permits@garnerelectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 121159 Electrical Lic.: 34-305C Suprv.Lie,: 3707-S specifically listed('.,hr min)
Suprv.Electrician signature,required: i.
ELECTRICAL PERMIT FEESSubtotal
Print name: Charles Garner Date:11/16/2021 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: 5z1,e,&7 ' TOTAL PERMIT FEE:
T This permit application expires if a permit is not obtained within 180
Print name: Brittany Burtan Date:11/16/2021 days after it has been accepted as complete.
• Number of inspections allowed per pen nit
1:\Building\Permits\ELC_PermitApp.ELR_ORE.doc Rev 06/17/2015 440-46t5T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description Qty. Each 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 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 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
• Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other. Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s•-cificall listed 'Ye hr min
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
n Clock Systems
• Data Telecommunication Installation
Fire Alarm Installation
n HVAC
n 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\Permits\ELC_Perm0App_ELR_ERE.doe Rev 06/17/2015
Plumbing Permit Application RECEIVFfl
Building Fixtures
City of Tigard 14AR 1 '7 022 Received
13125 SW Halt Blvd.,Tigard,OR 97223 nC IN
Date/By: 1 /701'7' 5-PV Permit No.: Mi T701 z^avao
, IIPhone: 503.718.2439 Fax: 503.598.1960 IPlan Review n �Z
V I TInADI Date/By: Other Permit No.:5j 1,(;14 - ' ',0YH
l t,n R D Inspection Line: 503.639.4175 BUILDING DIVISI tuns. El See Page 2 for
Internet: www.tigard or.gov o fl eady/Bod:
Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition 1 For special information use checklist
Description I Otv. i Ea. I Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
❑Multi-family 1
Each additional bath/kitchen 25.02
❑Master builder i ❑Other:
Fire sprinkler( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15609 SW Peace AVE Catch basin or area drain 18.76
City/State/ZIP: � _ Portland, OR 97224 Drywell,leach line.or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name:River Terrace
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) 1 Page 2
Storm sewer(no.linear ft.: ) 1 Page 2
Water service(no.linear ft.:_) 1 Page 2
Subdivision: River Terrace I Lot no.: 23 Fixture or item:
Tax map/parcel no.: Parent Parcel Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 1 12.51
New SFR 4 bedrooms and 3 baths Clothes washer 1 25.oz
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
l(] PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Pacific Lifestyle Homes Fixture/sewer cap 25.02
Address: 11815 NE 99th St Suite 1200 Floor drain/floor sink/hub 25.02
Garbage disposal 1 25.02
City/State/ZIP:Vancouver, WA 98682 Hose bib 2 25.02
Phone:(360 ) 573-8081 I Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pacific Lifestyle Homes Medical gas(value:$ ) Page 2
Contact name:Permit Coordinator
Primer 12.51
Roof drain(commercial) 12.51
Address: 11815 NE 99t6 Street,Suite 1200 Sink/basin/lavatory 7 25.02
City/State/ZIP: Vancouver,WA 98682 Solar units(potable water) 62.54
Phone:(360)573-8081 Fax::(360)574-6401 Tub/shower/shower pan 4 12.51
E-mail:permits@buildplh.com Urinal 25.02
CONTRACTOR Water closet 3 25.02
Water heater 37.52
Business name: Alliance Plumbing Water piping/DWV 56.29
Address: 146 West Historic Columbia River Hwy. PO Box 386 Other 25.02
City/State/ZIP:Troutdale,Or 97060 Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: S72.50
CCB Lic.: 184601 Plumbing Lic.no.: PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ..^'L--^"'- TOTAL PERMIT FEE
Print name:Rya acDougall Date: 1 1/16/2021 This permit appticattrrn expires if a permit is not obtained within 180 days
.ief` after it baa been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Beard.
11Building\Permiu\PLM11.PMnitApp doc 10/01/09 440-7616T(10/02ICODUWEB)
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 S 121.90
Footing drain-each additional I00' 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-I st 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 S 10.000.00 $72.50 for the first$5.000.00 and$1.52 for
Qty. Fee teal 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 S100.00 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 S50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100,00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace) Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
4" Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food 0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach.fRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:`,Users\ryanm\AppData\Local\Microsott\Windows\INetCache\Content.girt look'\513 HZ.8 I C\PL B_PermitApp.doc
City of Tigard
N COMMUNITY DEVELOPMENT DEPARTMENT
11111
1 - l Building Permit Review — Residential
T ' _ ",.emu,uc-`.Stfls *1. -1«,*.r .., ^4' xa. ',',^,.. . .,,,, m tab�.,q�.��h2Te�+"��PdTF(+NiIk W'Jrrg`om9?ra GP,Fai
Building Permit #: M .0',7,,--( j
Site Address: 157&0qfie-ACE- NE
—
Project Name: g 1 u(Gp. �( t LOSS ANC Lot #: 23
Planning Review
Proposal: iVICP3, 114416 `'z, CAMS OFFt -_
Verify address/suite#active in Accela. [3 In River Terrace: ❑ No LE-- Yes,River Terrace Review Addendum
Si Plan Elements: ,I?Erosion Control
it>copies of site plan on 8-1/2"x 11"or 11 x 17"paper ,gl, 1 atned trees with drip line and tree protection measures
ZI9,awn to scale(standard architect or engineer scale) f' I_CJF•otprint of new structure(including decks) and FFE
rEd,,� orth arrow L% 'ty locations&easements(required for new and additions)
.LlSi--te address,project or subdivision name and lot number LJSidewalk/driveway approach
plicant information(name and phone number) l '. l ]L tion of wells/septic systems
t dimensions and building setback dimensions ,1? 1.21yeet tree size,type and location
[ Square footage of buildings to be demolished Z5.fteet names
lots [-t ring structures on site di Corner elevations (2'contours if more than 4'diffee ntial)
Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? I/JYes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes 121<o
Clean Water Services —Service Provider Letter platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified C�' j"o Received: ❑ Yes ❑ No
411 Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
ye6quired: ❑ Yes,applicant was notified air No / Received: ❑ Yes ❑ No
C Exemption for ADU applied for: ❑ Yes 2'No Received: ❑ Yes ❑ No
rr Public Facilities Improvement (PFI) Permit: 2".
Required: ❑ Yes,applicant was notified ❑ No Applied For [ Yes ❑ No,stop intake
Li Land Use Case#: PD R2ia. 0 000 ❑ oning R—
❑ Required Setbacks: Front /2- Rear: /'. Side: .2 S Street Side: /3 Garage: 20
ElBuilding Height: Max. Height: / Actual Height: 2/'
❑ Landscape tea: 2-0 % ❑ Lot Coverage Max:: C %
Entrance E et back no more than 8'from street-facing wall Parallel to street or offset 45 degrees or less
Windows 1 um 12%of area of all street-facing facades
Garage Garage door is behind widest street-facing wall jd''fYes ❑ 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.
Garage door width is ❑ 12'or less ,.2J 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'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
iLl:/Visual Clearance Z Urban Forestry plan
Zia Sensitive Lands: ❑ Yes Z No Type:
❑ Conditions met prior to issuance of building permit
Notes:
ApprovedBy Planning: - Date:
3/9/7 2_
Revisions (after Building Submittal only) Reviewer Date
Revision 1: Approved ❑ Not Approved N 1 3/nie
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPennitRvw RES_122419.docx
Building Permit Submittal
Original Submittal Date: 3/1 r/Z •ZZ
Site Plans: #
Building Plans: #
Building Permit#: p4 Enter building permit#above.
Workflow Routing: 8 Planning 1,8 Engineering /g Permit Coordinator (— Building
Workflow Sign-off: 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.
pBuilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: ' "1( t HoftitQ_. /
By Permit Technician:
,J `0 Q�- Date: 9/2q 2e z Z
Engineering Review
a
.,
,,,,_, SSl�lope at building pad: im�
Il.(onditions "Met"prior to issuance of building permit �,�
LP'Easements (encroachments)per engineering conditions of approval and plat
[Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [fr No
Assess Water Quantity Fee in-lieu: El Yes ['No
LIDA Facility on lot: ❑ Yes 'No Add Fee: ❑ Yes ❑ No
Iid' Final Plat Recorded: 4/41-
0 NOT Approved by Engineering: Date:
Notes: MCQ' fe 2 l/te-P re' epOe.- /'�/ j r4e&e7 ace- eaSeA009
t Approved by Engineering: Date: 4711/2.�
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
°Conditions "Met"prior to issuance of building permit
yr Approved,NOT Released: ici.. 5/2 /2i 72 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
„B'SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A SPi d�zt e - '"-1
Tigard Trans SDC: ,Yes ❑ N/A �^�
Parks SDC: �Yes ❑ N/A O I► '
A" ' Vircetr4
LIDA ❑ Yes N/A (Pitat.Refifidiar)eizte 4...
,VOK to Issue Permit '
Approved by Permit Coordinator: Dateq 7(2J' 11)r
T.\n,,.1A;,,,,\Fnrmc\11AoPermitRvw RF.S 120R021.docx
City of Tigard
Deferral Until Occupancy Request
T I G A R D Washington County Transportation Development Tax (TDT),Transportation and Parks System
Development Charges (SDCs)
This form is to be signed and submitted prior building permit issuance or,if no building permit is required, then
upon land use approval(TMC 3.24, as amended by Ordinance No.21-09).
Date: 6/22/2022 Site Address: 15609 SW Peace Ave
Project River Terrace Crossing Land Use Case or
Name: (Pacific Lifestyle Homes) Building Permit#: MST2022-00080
Tax Lot Lot 23 Total Parks $10,903.00
#: Amount*:
TDT N/A Total TSDC $10,348.00
Amount: Amount*:
*The total TSDC amount shown above is the sum of$6,690.00 for TSDC-Improvement,$ 386.00 for TSDC-
Reimbursement,and$3,272.00 for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of':!•,278.00 for Parks-Improvement, $ 1,739.00 for Parks-
Reimbursement,and either$ N/A for Parks-Neighborhood or$2,886.00 for Parks-Neighborhood River Terrace.
This constitutes my request to defer payment of the TDT, TSDC, and Parks SDCs, as provided above, to
prior to final inspection.
Payment of the TDT,TSDC, and Parks SDCs may be deferred until issuance of the occupancy permit. In
requesting this option, I understand that any deferred TDT,TSDC, and Parks SDCs must be paid prior to final
inspection.
TDT may only be deferred if the TDT is greater than the amount for a single-family residence. I further
understand that the amount of TDT due on deferred obligations shall be the amount in effect at the time of
issuance of the building permit.
For a deferral request to be acce _d both the Property Owner and the Developer must sign this request.
b /aikv
Property Owner: Date:
Developer: Date: -11
Permit Coordinator: ATVA AAA Date: 6/22/2022
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
i ill
INI Transmittal Letter.
1 !l IA I r) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •a_ww.tigard-or gtw_
TO: ,,A I I n/L DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: ( )JJW /� �YCt_(i�'�1 C�L%t�e LQ�Y� ( JUL 6 JUL
OF TIGA GARG
COMPANY: ,�447 BUILDING DIVISION
PHONE: 7711 6� 9 O`'t' -q U 12b By. rill
RE: t' Lb I Po « 0 //�vTp o -"-p cD
(Site Address) (Permit Number)
r't V e.V- Tom, c- -0--'2,
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
7.3 Additional set(s)of plans. al.-- Revisions+lAsC et.i C•S 1 t y - u i.,�l_
Cross section(s)and details. Wall bracing and/or later aysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
.�_ Other`(explain):-1' - c(& CS -I-- L t)kk..+ .
1-'l,
REMARKS: e.GI- — C,.Q.2 cAA -L1 Lt. —1 1,(utt---f-
--crY-
162,0cJaicAtcC fi 3 h . ��.a...rit V jerk
FOR O FICE USE ONLY
Routed to Permit Technician: Date: `7/-7 -2:Z Initials: ktr-
Fees Due: ❑Yes ❑No Fee Description: Amount Due:
Special $
Instructions:
Reprint Permit(per PE): ❑Yes [ No ❑Do
Applicant Notified: ate: >/f.,L1) -2.- Initia s•
I:\BuildingTorms\TransmittalLetter-Revisions 061316.doe