Permit CITY OF TIGARD MASTER PERMIT
■ Permit#: MST2022-00250
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/16/2022
Parcel: 2S103BB12000
Jurisdiction: Tigard
Site address: 12098 SW ANN PL
Subdivision: YE-OLDE WINDMILL Lot: 39
Project: Hunt
Project Description: 360 sq ft ADU and 98sf porch cover. Water Meter Upsize Required 3/4"
BUILDING
Floor Areas Required Setbacks Required
Stones: 1 Bedrooms: 1 First: 360 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 15 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 15 Smoke
DwellingUnits: 1 Yes
Third: 0 sf Right: 5 Detectors:
Total: 360 sf Value: $56,825.92 Rear 15
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer. 100
Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 1
Other Fixture Units: Bar sink
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Electricity Heat Pump: Y Hoods: 0 Other Units: 1
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 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:
ADD SF VB R-3 360
Owner: Contractor:
HUNT,JAKLIN OWNER Required Items and Reports(Conditions)
BRYAN,ZANE 1 Ersn Cntrl 503-639-4175
HUNT,DANA J ET AL
12100 SWANN PL
TIGARD,OR 97223
PHONE: PHONE:
FAX:
Total Fees: $12,829.93
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Slate 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 Noti cation Center. Tho a rules are set forth in OAR
OS9_nM-nnl n fhrn„nh. 1" p es7_nni.nnon Vnu : lMnin a rr�v of/hn n d<c nr dirnrf nnccfinnc/n rN IMC Yu,nallinn 6n 171100.7 nr1 An! '1 O'idd
Issued By: r�� Permittee Signature: ` AVIA\ --'\. ./0.2.-
I 03.639.4175 by 7:0 .m.for the next available inspection date.
This permit card shall be kept in a conspicu us place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
I
Building Permit Application
Residential E-GE\
\IED FOR OI'El('IC t SE ON I.1
City of Tigard p p Received 8 LQ L� Ua1eBY r .(:,'`� r) Permit No �S LdS L`_.
13125 SW Hall Blvd.,Tigard,OR 97223 }.L 2 C ✓/fL1�
aPlan Review A,,� �
Phone: 503.718.2439 Fax: 503.598.1960 FSiGARG Date/By: tVZZ A-A Other Permit:
1-i G It D Inspection Line: 503.639.4175 CON p1'jiS\01 Date Ready/By: / r 7uris, Ed See Page 2 for
Internet: www.tigard-or.gov G Notifiedm-tethoa: I L/1
* ��LQ�N r � Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
NI 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 0 Other: equipment,materials,labor,overhead,and the rofit for the
CATEGORY OF CONSTRUCTION wg[�fniicgte�4 n this application.
❑ 1-and 2-family dwelling 0 Commerciallindustrial •
aluyl n: 5 •rJ L $
1
gj Accessory building 0 Multi-family Number of bedrooms: '/� i
❑Master builder 0 Other: Number of bathrooms: t
JOB SITE INFORMATION AND LOCATION Total number of floors: I
Job site address: \2.0Ct6 7 Rf\flptilet New dwelling area: 31�0 square feet
City/State/ZIP: 1Q Garage/carport J
J t� q'�'Z' � g rport area: square feet
Suite/bldg./apt.no.: Project name: 1.:\ttpck Ne,15J 1 Covered porch area: square feet
Cross street/directions to job site: 1� �(yy 4 Deck area: square feet
' zr kt.f or g.J P1fr1.Pac _A- t..1 \t
, 6 AueAkt Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Q Lot no.: Permit fees'are based on the value of the work performed.
Tax map/parcel no.: 2510-6 ` e, -R`2 a� Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
[�DESCRIPTION OF WORK work indicated on this application.
C-�n 1 Sa- Cl(Lf C_f'h at.,)(1,l1 l A Valuation: $
,56 �►k ./r �il /- ILG`Gfi f {�%y,/�1ji/ Existing building area: square feet
pf 4 o l' �2 t s-‘4014 1'r New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: `\ek3tn p\Auld—
Type of construction:
Address: 12\CO � 1111,NA (y.a.` Occupancy y groups:
City/State/ZIP:l C)-d C2 Q�,
Existing:
Phone: b) 'dtli Fax:( )
New:
`Q4 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer rofee schedule)
Contact name: J Ul(.1zn
" I' Structural plan review fee(or deposit): '- -:, 5
Address: FLS plan review fee(if applicable):
�� ��tjut
Total fees due upon City/State/ZIP: p application:
Phone;( ) F . ;( ) Amount received:
Fax:
E-mail: "'. � \ qt_ C.o� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Jt COIN, 'ACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lic.:
\ E ^^^ Total fee due upon application: $201.60
Authorized signature: c. This permit application expires if a permit is not obtained
��� within 180 days after it has been accepted as complete-
Print name: 3 qyj e\ Date: II (2c�ZZ *Fee methodology set by Tr County Building Industry
tt Service Board.
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WE13)
,
Building Permit Application Checklist
One- and Two-Family Dwelling roll trait l_ t si crsiN
City of Tigard Rix ei.ca
III13125 SW Hall Blvd.,Tigard,OR 97223
Date/B : Permit No.
a Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 plumbic
g 0 Mechanical
TIGARD
Internet: www.tigard-ongov 0 Other.
TIIL? FOLLOWING ITEMS ARE REQI1IREl) FOR PLAN REVIEW 1cs No Ni.,
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. fg I E
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 t❑
3 Verification of approved plat/lot. 0 1
4 Fire district approval required. Name of district:
5 Septic system permit or authorization for remodel. Existing system capacity . i
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑
El
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ Q
basin protection,etc.
10 a.Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® 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 Cil 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 J 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, El 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross sectIon(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- Q] 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. gj 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 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 Dii 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 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 0 0
gl
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. p�
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 'L�9
for four or more appliances. i
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or fa CI
architect licensed in Ore ton and shall be shown to be :••licable to the •ro'ect under review.
.11ILISI)I( I ION,AI. SPL:('ll'l( S
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". �'4' N •
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. • 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 N
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 I
27 "Drawn to scale"indicates standard architect or engineer scale, Sil ■ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 I.
Q
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑
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, Z. ❑ ❑
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.
1:1Building1PennitslBUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
Mechanical Permit Application 1.0n 01.11( I: i ,i.:OyI ,
City of Tigard ' `) Received
Date/By: Permit No.:
• 13125 S W Hail Blvd.,Tigard,C�3
11111
Phone: 503.718.2439 Fax: 503.598.1 .0 o0g7 Date/By:PlanReew Other Permit:
Inspection Line: 503.639.4175 :`�
I If;,1 t:I) p Date Ready/By: hats: 61. See Page 2 for
Internet: www.tigardor.gov Notified/Method: Supplemental Information
CITY OF ri(,P.HU)
TYPE +-IA6RIC"'u\ilr -)'' COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
Ng
New constructionMechanical permit fees"are based on the value of the work
0 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/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial t Accessory building Far special information use checklist
0 Multi-family 0 Master builder 0 Other: Description
Qty. Ea. Total
JOB SITE INFORMATION ANb LOCATION Heating/cooling;
��% J A M f1 Air conditioning0 ,0 46.75
Job site address: 'ft 1" Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Ili( ,ra De (11222_ Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg/apL no.: 3 LI Project name: �(�, ` Heat pump 61.06 v,,W
W Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
�,,(� ,�+, .� (� (�OtC.� ^ Residential boiler(radiator or
q
V�+� Ur •CJi- .�W I' NA \ i- 12,E� J tt,)( 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: Lot no.: Other: 23.32
^ Other fuel appliances:
Ot
Tax map/parcel no.: s t 03 v,e, 12 O)O Water heater \ 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
L__ -nn Flue vent for water heater or gas
e.0(1`s4MC Oc aL[.t,`a rt-t a ` • t •A fireplace 23.32
-i r' c Lk Yt-tAZ - be `'"r ' 3
Log lighter(gas) 23.32
a r Wood/pellet stove 33.39
µ1/40.40,r... ►ACTf.1.J ,-, t� - Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
tA PROPERTY OWNER 0 TENANT Other: 23.32
� �^� Environmental exhaust and ventilation:
Name: tR L lrli Cs Range hood/other kitchen
Address: a.tors, .S> _ _ equipment 33.39
C� Clothes dryer exhaust 33.39
City/State/ZIP: �.► Single-duct exhaust(bathrooms,
1 e.12�l`�. q�22''� toilet compartments,utility rooms) 1 23.32 A.32
Phone:
(5:6) t► 01%1/4O5 Fax:( ) Attic/crawlspace fans 1 23.32
2a• Z
APPLICANT
0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: r Furnace,etc.
Address: ' I a...- o t,l,e-r Gas heat pump
�JJ `' Wall/suspended/unit heater
City/State/ZIP:
Water heater
Phone:( ) Fax::( ) Fireplace
E-mail:
- Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: yh ), a r Other:
Address:
`�'�1 l� "� MECHANICAL PERMIT FEES*
Subtotal t '•>1p
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee) 2A0.1212,
State surcharge(12%of permit fee) 17, •417.
CCB lic.: TOTAL PERMIT FEE 11.1.,514,
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 Tn-County Building Industry Service Board
Print name: Date:
I:1Building'Permite\MEC_PermitApp_040I I3.doc 440-4617T(I1/02/COM/WE.B)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: 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.
•
1:\Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVE .•ceived
,� - DateBy: Permit N:
• SW Hall Blvd.,Tigard,OR 97223 J U 8 202
Phonehone: 503.718.2439 � plan Date/By:Review Related Permit k:
TIGARD Email: TigardBuildingPermits@Tigard-or.govWrl.lrT nR Ready Date/By: Juris: HI See Page 2 for
Inspection Line: 503.639.4175 Internet: wl a C r.���A ' Notified/Method: Supplemental Information
TYPE OF WORK BUILDING DIVISI• PLAN REVIEW
New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
D Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ❑Commercial/industrial 14 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
I2�G . , RCS ❑Addition of new motor load of system.
Job#: Job site address: O W 100HP or more. ❑"A","E",'y-z","t-3',
City/State/ZIP: 7��.1A L V` a'%2.Z3 ❑Six or more residential units. occupancy.
0 Health-care facilities. El Recreational vehicle parks.
Suite/bldg./apt.#: Project name: .,- A ) 0 Hazardous locations. ❑Supply voltage for more than
t✓� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 1 FEE SCHEDULE
�t\/ Nu-oC co )'M Rau-
_ i G' ` i21�4r _, a Description I Qty. Each Total
WJ ��(�i -f �7V,.J tW`' New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
P P 2 l 03 P�S3 1,000 s ft.or less II�S elf
Tax ma / arcel#: �j `� 12� q I 168.54 1 4
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
cJn I,�- p l^m( Sort cl�¢a1,x� us"..)-- (with above sq.R.)
�` —ILimited energy,multi-family
ROPERTY OWNER
residential(with above sq.ft.) ) 75.00 Y, 2
Renewable Energy 0 See Page 2 �J
❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: k.<<n l w Vt 200 amps or less t 100.70 10.), 0 2
Address: 12k(Z�� fj,,,,x` � 201 amps to 400 amps 133.56 2
`''r" 401 amps to 600 amps 200.34 2
City/State/ZIP:eft &t ( 1 7 L 3 601 amps to 1,000 amps 301.04 2
Phone:( ) a 0.05 [J Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: '( j UA,�. @ a C crti relocation
Owner-ilastallation: is installatiodis being made on property that I own which is not 200 amps or less 59.36 I
intended fbr sale,le e,rent,or excha e,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
0 ,rI►g� ��� -t YI/
Owner signature: ` I�l!V' Date: - 2q12.1, 401 amps to 599 amps 168.54 2
Ni
APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 P•iD 2
1 each branch circuit
Contact name: 1(��(� e
LJLVJJ B.Fee for branch circuits without
serS Gh�re. it feederitfee,first 56.18 2
Address: /�
�'S.t-0. branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
Email:
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR
Pump or irrigation circle 67.84 2
Business name: ?xi a.r /ylixo ^' t1 0, t -ri` Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) hr min Investigation(1
g ) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(%hr min) 90.00/hr
ELECTRICAL PERMIT FEES
It Suprv.Electrician signature,required: Subtotal: 9•A\•31-{
Print name: Date: lei Plan Review Required(25%of permit fee): a5.3y
State surcharge(12%of permit fee): Li5i .
Authorized signature: VIi A TOTAL PERMIT FEE: C�t2.'1`i
1 �� 1 � / This permit application expires if a permit is not obtained within 180
Print name: 3 (n Ic RMX Date: -41 Z%J 21. days after It has been accepted as complete.
* Number of inspections allowed per permit.
IABuilding'Rermits1ELC_PernitApp_ELR ERE.doc Rev 10/26/2017 440-4615T(1 t/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
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 I5 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
n 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:
Each additional inspection is 66.25/hr 1
• Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
ELECTRICAL PERMIT FEES
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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems •
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:13uilding`YermitseFLC PermitApp ELR_ERE.doc Rev 10,26/2017
Plumbing Permit Application RECEIVE
Building Fixtures �l FOR OFFICE USE ONLY
City of Tigard JUL 28 2022 Received
i 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Permit No.:
e Phone: 503.7182439 Fax: 503.598.1960CITYOFTIGAR• Plan Review
ateBy:eay ms Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISIOPdateRdy/B
Internet: www.tigard-or.gov See page 2 for
NNotified/Method: S Supplemental Information
TYPE OF WORK FEE* SCHEDULE
VI New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. Total
0 Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath I 312.70 Bi2,.`}p
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
rii Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ,2�cb .. AM Rack,
Catch basin or area drain 18.76
City/State/ZIP: �' ,Q a l(it_ A T ZcZ� Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 4 AN- Ala.) Manufactured home utilities
50.03
Cross street/directions to job site: � Manholes 18.76
WC-(fir CC' a� �u-,F , 1 2i ll1 Rain drain connector 18.76
Sanitary sewer(no.linear ft.:,ILt % Page 2 kn,F,y
Storm sewer(no.linear ft.:AU)) ` Page 2 (12,51{
Water service(no.linear ft.:. )4)) l Page 2 (3 Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no. G. 162)`-C tZ 12(1,6) Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12 51
Clothes washer 25.02
tiorip' Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,. .,PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: \ �^ ILA
- Fixture/sewer cap 25.02
Address: 11,I0D C (L__ � Floor drain/floor sink hub 25.02
�.r nY� Garbage disposal 25.02 2G•07-.
City/State/ZIP: /(�` n),a t ca.- (r+ 2.-3 Hose bib 25.02
Phone:( )Qi ,VV Fax:( ) Ice maker 12.51
lit_APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Contact name: iokte th.>,pi Primer 12.51
Roof drain(commercial) 12.51
Address:
h--4 • a`7 uK- Sink/basin/lavatory 25.02 •0k,
City/State/ZIP:
Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 \2,.j I
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02 2G.o2
Water heater 37.52
Business name: �J4�Z'
Water pipingDWV 56.29 5102q
Address:
Other: 25.02
City/State/ZIP: Subtotal -4?�1•
Minimum permit fee: $72.50
Phone:( ) Fax:( )
Plan review (25%of permit fee) I�'�•�{
CCB Lie.: Plumbing Lic.no.:
State surcharge(12%of permit fee) er+Al
Authorized signature - TOTAL PERMIT FEE KQ
r��� Ig02•
Print name: r�F-✓L.f� i Date: 4j2eS This permit application expires it a permit is not obtained within ISO days
2i12, after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Permits\PLMU-PernitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
•Plumbing Permit Application - City of Tigard v
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain- I"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 1 62.54 tfjl..l 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' I 62.54 (,Q26,01 Medical Gas Systems:
Water Service-each additional 100' 37.52 'Valuation• Permit Fee:
Storm&Rain Drain-1st 100' ( 62.54 Lot - si.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 Inspections or Fees
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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
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/Pont greater,except systems designed and stamped by licensed
Bath. -Tub/Shower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any 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
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal •
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
1111 COMMUNITY DEVELOPMENT DEPARTMENT
C
TIGARD Small Form Residential Supplemental (Non-RT)
Building Permit #: (Y\Staoa1- Project Name: `W'izYAN)
Site Address: 12oc& cu.) AN►) 17c:,jc�
Lot #: Total Existing Units: 2-One ❑ Two 0 Three
New Configuration: 0 Single Detached 0 Duplex ❑ Triplex __ID--i-ADU
Small Form Residential Standards
Setbacks ❑ Front: jC Rear: (T Side: S Street Side: 11— Garage: 2-0
Height 0 Max. Height: 2C Actual Height: IN ' ION
Landscape ❑ Landscape Area: % Lot Coverage Max:
j
Entrance P1 5 t back no more than 8' from street-facing wall
Parallel to street or offset 45 degrees or less
Windows linimum 12% of area of all street-facing facades
Garage arage door is behind widest street-facing wall
RI Yes
O "• and one of the following is met:
❑ Do• extends no more than 5' from wall and there is a covered porch
extending , -yond garage.
❑ Door exten• no more than 5' from wall and there is a 12 sq ft.
window above ga - •e on 2nd floor.
Garage door width is:
O 12' or less
❑ 50% or less of facade
❑ 60% or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset
❑ 1' Roof eave ❑ Roof offset N, 0 Fire shingles
❑ Lap Siding ❑ Gable, hip, gambrerropf ❑ Dormer
❑ Roof pitch ❑ Accent siding '' ❑ Window trim
❑ Window recess ❑ Window projection LN Balcony
Approved By Planning: Date: -7/Z1
L\Building\Fanm\BldgPennitRvx_SFR Supplemental 070722
City of Tigard
° COMMUNITY DEVELOPMENT DEPARTMENT
11
TIGARD Building Permit Review - Residential
Building Permit #: Yti t 2,oaa-0Qa Sd
Site Address: (2048 St,S ANC Pe-ACE
Project Name: g12'/ 4J Lot #:
Proposal: vtAc.t4-e-'o Apo
Land Use Case: Zone: -.es- a
Required Submittal Elements
copies of site plan Lp Square footage of buildings to be demolished
Drawn to standard scale Footprint of new structure and FFE
•IfrNorth arrow Retained trees, drip line / tree protection
Site address, project name, lot #t Aewalk
eet trees shown / labelled
❑'Street names / driveway shown and dimensioned
plicant name and phone # )a L tility locations & easements (new / additions)
t and setback dimensions ifi ]ycation of wells / septic systems
Existing structures on site L t area and lot coverage percentage
'rosion control l Corner elevations (2' contours if > 4' differential)
IVision clearance triangle shown pkLJ Ground slope at building pad calculated / shown
Planning Review
p4:yrrify address / suite # active in Accela.
BClean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
Required: ❑ Yes 21 o
Received: ❑ Yes 0 No
i P lic Facilities Improvement (PFI) Per
Required: ❑ Yes A No
Applied For: ❑ Yes ❑ NN , stop intake
SSensitive Lands: ❑ Yes AtiNo
Type:
Musing Supplemental Sheets Completed
O Cottage Cluster C&O (1 site, 1 per unit) ❑ Quad
O Courtyard Units C&O (1 site, 1 per building) ❑ Rowhouse
❑ Cottage Cluster Type II (1 per unit) 2--Small Form Residential / ADU
❑ Courtyard Units Type II (1 per building) ❑ River Terrace Addendum
❑ Conditions met prior to issuance of buil ' bay-0 V'g permit bay Cotu —
Approved By Planning: Date: ? /Z2
Notes ,,{{
� Revision 1: Approved ❑ Not Approved Rt\(�YIJ Date: " L7 ZZ-
5
LNS Revision 2: Approved ❑ Not Approved Date:
f 0kC 1 C� C �'N \ Ono is ("fro,,,
4:\Building\Forms\BldgPermitRvw_Ra_07072) C� � U- �/)
Building Permit Submittal
Original Submittal Date: 'I,/ s.iL)
Site Plans #:
Building Plans #:
Building Permit #: 2-Building permit # entered on page 1
Workflow Routing: It Planning 0 Engineering 0 Permit Coordinator Ig Building
Workflow Sign-off: _IV Sign-off for Planning (include notes from planning review)
Route Documents: L$Engineering: (1) copy of permit application, (1) site plan,
(1) building plan and original plan review routing form.
0 Building: original permit application, site plans, building
plans, engineer and beam calculations and trust details, if
applicable, etc.Permit Technician: 41(`-Pv1 i I\A\ 1) Date: 7 A I oa
Notes
Engineering Review
It Slope at building pad verified Slope: 73/
Conditions met prior to issuance of permit
❑ Easements (encroachments) per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No Add Fee: ❑ Yes ❑ No
❑ Final Plat Recorded
❑ NOT Approved Date:
Notes
Approved By Engin Bring: - Date: 2Z
Revision 1: I 'Approved ❑ Not Approved -- ' Date: 2z
Revision 2: ❑ Approved El Not Approved Date:
Permit Coordinator Review
Conditions met prior to issuance of permit
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
„: Sep' 0. L ..turf
'b SDC Exemption: p' Received CI Does not apply 'ceC 'l C
CAykil
❑ SDC Fees Entered: Wash Co Trans Dev Tax: y Yes ❑ N/A
Tigard Trans SDC: 2 Yes 0 N/A h a
Parks SDC: ❑ Yes ❑ N/A (Vc'r -VPGrn4, 01(-
LIDA ❑ Yes J N/A wl1' '0.�►^ {cw">
III OK to Issue/Approved by Permit Coordinator: 4 ,A\,,�� t\ Date: i.L
Revision 1:4 Approved ❑ Not Approved Al— Date: g
Revision 2: 0 Approved 0 Not Approved Date: