Permit 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$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\Building\Pwmits\MEC_PermitApp_040113.doc 2
Electrical Permit Application _��'++C `, {''� 1.0K 0H I.:1:usI oNI.1
City of Tigard Yee-.,C t V E 4' Re.e';°a Peron r: -t
I' : a 13125 SW Hall Blvd.,Tigard,OR 97223 plan Raviewrfrzosisiiiiiiimmis
Phone: 503.718.2439 Fax: 503.598.1960 Zen Oslo :
AAuu LWd.
Inspection Line: 503.639.4175 JF11a Randy Dam eons
"1'I GA sot n Notified/Method: .• "'•.' ..
Internet: www.tigafdror.gov
II
,r-,..M . .. .. .,t • ' ..r;�,.3']T.E F ORala eta -�-7� ''i0" '.1`[-''' .'.JI ..t.'i::� _^:,r"..r.Y.'.'..'V 1.akdkA+ t��a.'tom' ageAl a�}:
igNew
a:•..:..tr ion �. ' 1i4� .Mose check ea that apply(Womb I acts ofptam wfew&checked}
consfruction ❑Additi0a/altOrdj T V����•` ❑Sevieeorfeeder400 amps ormore ❑lladkB over thteaetmier.
Demolition 0 Other: 7 v v when the available fault oatmeal ❑Merinos and boatyards.
rg'.4,0 a=' ' ':',w�;a-',,'x' { �Q, CrOR1'.ijj!?epN,4„1.'1(UQIO14 _fit :;E.44t. ' le..4.er t r.,:•:� axcud 10,000 amps at 150 volts or ❑[tooling buildings.
1-and 2-family dwelling 0 Commerci al/industrial ❑Accessory building to ground Of exceeds u,eao ❑can mertm me agricultural
amps for as other katallations. hmldhYs.
❑ -fly ❑Master builder ❑Other. Mho ❑Installation oflsottvAor
:v::;v.'! .der r ..-.$-t B;:4#13']ikl 'PRtF �.✓ /??rOOA !OH ...,45' .w• <.+,'(('"r 'r', (3 ey aystem. larger sepauelydaived
/ZJ 97 `-'-'� /2/4 1d, ` DAttdleormom anew rmlmlwd of t
Job#: Job site address: Maid n meet. ❑'A
• ( ❑Six a teote inglantW miu. ❑Resamdotul vehicle perks
City/State ZIP: ®� Q77'aK p Ba,bh are a elitim.
J ❑Huedooslocatiom ['Supply voltage Srmae than
SuittslbldgJapt#: Project name: 600 vows®mtoat
[]Service or feeder 600 amps ormane.
Crass street/directions to job site: ��„/4.r��� ,.. r•: s _ S' t :.:a
i5aser¢aee "i oar. f" awn 1 rent I •
!-` New maddened shank-or multi-family dwelling unit
'!
I'` Subdivision: Lot 1: / Includesattached garage.
1,000 sq.ft or leap i 16134 4
Tai6 taap/p*T'Cel#: Fa add'1500 sq.f.or portion I/ 33.92 I
.Y.l••!'4"y_'o":;..a '..I: .40)19 il!P_1Q)1Vk '..,• y!:`S1':•-•'.'1 '.M14q, Limited mew,residential 75.00 1
(with above tq.ft)
Limited energy,multi-family 75.00 1
residential(with above sq.ft.)
ay.r>-,N•t, Renewable Energy Q See Page 2
r 'r•:: bP- T '- 'i'i: c 4,:. �' Iyt_,,:y, Services or feeders instalation,alteration,end/or rebution
.s.G#n•;�+ 'if"�! ,F),I�'.'�'-;ti0��'� -... ../, � ^t"#/':�:...c^.dt•�-cam,
Name: � eoloro �! r / 200 amps or tea 100.70 2
v "t/ V 201ampam400atnps / 133.56 2
Address/Aj./Q S� / 401 amps to 600 amps 200.34- 2
City/StatefLIP: '7l ee dele '1 601 amps to 1,000 amps 301.04 2
Phone:(�y, s'3 - 7co� Fax:( --3-' Over 1,000 amps or volts 552.26 2
.XJJ Temporary urvtces or feeders Installation,alteration,and/or
Email: 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. 20I snipe to 400 sups 125.08 2
Owner signature: Date:
401 amps to 599 snips 168.54 2
Bnrxh eircdte-nerR alteration,or extension,ter pared
`. ._'-f �' ;v 4:8.0.6A1V'''"r c,,�l1', 7: .C,.a: X'❑! OAtigCgiftiRSOIVI:" `.' AF„1-minatchtacuiuwith
�. �,-. , above service or feeder sae, 7.42 2
Business nanla:�.zl( 'G U>D ` �J! ' men branch shalt ,
Contact name: LL // B.Fee for branch circuits wkhout
��'T service or feeder fee,fist 56.11 2
Address: /D - S f 2,-s?, j �J /� ,much Windt
City/State/ZIP: �/' 77'/fl,,or'3 /9IC C7, 74 t� %`ha�neaus(serach iceuit 7.) 2
q� /�y�� Miudla¢earu(service or feeder not l¢cladedl
Pbone:�"�i r.C-.e� 2� c.�C.! Fax::( ) Eachnieaufacturedormodtila 67.84 2
dwelling,service and/or feeder
Email: Resonant only 67.14 2
�,i. ..'',;.vat-.i,1 r:3v'X:.. 7.0001i'X0ORk.,,4 •j,.., �:x-%"`."v1;.i. ,,...`.:..J Pump or inigatioecbek 67.14 2_
Business name: 04".".,_ _„N, IQa:{1(tn,,,r.c,S�,lr Siporattlinglighting 67.14 2
,1"`+r Signal chcuit(s)or limited-energy ❑sce Poe 2 2
Address: 1OIS V•1 4,15Foce. C.ut.d.rt.•trleb, ftrr. peon sheration.oreaaaelm.
Each additional Inspection over allowable in any of the above
CltylStalrPLIP'
tsvl-Vs _ , oft / TIO( 0 + Additional Inspection(I hr min) 6625/be
Pam:(
Fax:( ) !�t� Investigation(1 lu min) 90A0!br
3) $'S3 `.°'('"LC) Indus-old pleat(Ibrmin) 71.111/hr
Email: iv)v.t 01,C.0 tk Q, W olx- -. t-O Inspections for which no foe is 90,00/lir
CCBLic.: I/Z2Z() ElectricalLic.:CA..2.17Z. Suprv.Lia: `jtj.2It.5 sveeisallv listed ehhrmin) sob
::;:: '-r.i. 'CliI,1S6T 1. 1; ItIE 9.,'" .:,.,i.
Suprv.Electrician signature,required: 1„u„.; Li Subtotal:
Print name' 1..,.60;„ W e"J(MZ, Date: )jt ! n ❑Plan Review Required(25%of permit foe):
State surcharge(12%of permit fee):
/� 4`' , TOTAL PERMIT FEB:
Authorized signature:s: 6 " 1 p b permit Appnutiea expires H e parson h net chinned ratan 1St
Print name: m r,v(o.-C..A., ` J 0(- It- I pat! ) I 6 i Z '4' days Nusn6crot a l accepted m complete.
• mopes/�allowed pa permit
UlleildBglrennfinE.CJemitAPP,61.It-Epodes Rot 060 inois 440.461fT(Itro5I:oMfWEB
/15T?O l-c0 3.3 1
FIXTURE UNIT WORKSHEET - WATER METER
Contractor Name Ze."4'�49 oc 6 S� _ Z C.
g
Billin Address 00- 0 &9k 297
/J
Sk�7.-,, �oc� . %° 9.71
/
Address of New Meter ` ? s ) 7/713P`v, -eg' RECEIVED
Lot # 3 Subdivision ? o .r 2 u 7r'
CITY OF TIGARD
Please fill in the number of each fixture as detailed on the plans, then multiplI ItV*0 DIVISION
by the point value given to arrive at the point total. Add all point totals together for total
fixture unit points.
Fixture Unit Quantity Point Value Point Total
Bar Sink f? _ X 1 = / _
Bidet Q X 1 = 60
Clotheswasher / X 4 _ '
Dishwasher / X 1.5 = A
Hose Bib 1 X 2.5 = 2.5
Hose Bib, each Adt'l / X I =
/
Kitchen Sink I X 1.5 =
Laundry Sink o X 1.5 =
+'
Lavatories % X 1 V
Water Closet, 1.6 GPF i X 2.5 -
Bathtub/Whirlpool 0 X 4 = 0- _
Shower Stalls i X 2 = _ Z
Bath/Shower Combo .2 X 4 = E
Irrigation /
(# of heads in largest zone)_ _ X 1
Up to 34 = 5/8 X 3/4" . Over 34 = 1" Total Fixture Points
Meter Size �/y `/ Meter Cost
*************************************************************************
FOR OFFICE USE ONLY
Fixture Count Verified with Plumbing Permit
Meter#
Receipt #
Emp. Name
I:\Building\Forms\W ate rM e tens_020111.do c x
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
IN
c Small Form Residential Supplemental (Non -RT)
TIGARD
Building Permit #: /1157).0.22--C43S1 Project Name:
Site Address: 1 "!i5C11 45W \ Z l -
Lot #: -5 Total Existing Units: Two ❑
New Configuration: Tg Single Detached ❑ Duplex ❑ Triplex ❑ +ADU
Y'f '
Small Form Residential Standards O
Setbacks Cd Front: . Rear: `G� Side: 5 Street Side: 1S arage: f9
Height j Max. Height: .mow Actual Height: 1-fQ'(12 kt
Landscape a dscape Area: "1/0 % Lot Coverage Max:
Entrance Kt Set back no more than 8' from street-facing wall
Parallel to street or offset 45 degrees or less
cis
Windows Minimum 12% of area of all street-facing facades . \ ea\
Garage Garage door is behind widest street-facing wall ca\C,S 0.re u-WX\
❑ Yes
i No, and 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: �\y-y12O`!\5o� 0C0.\C?(� OttY--'"
❑ 12' or less o'n 00\Y1 ''5
650% 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 ❑ Gable, hip, gambrel roof ❑ Dormer
❑ Roof pitch ❑ Accent siding ❑ Window trim
❑ Window recess ❑ Window projection ❑ Balcony
Approved By Planning: (—\--- 1\ Date: -1 C.Q �Z-"-e___
11Building\Forno\BldgPermitRvw_SFR Supplemental 070722
i
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
1111111
TIGARD Building Permit Review - Residential
Building Permit #: /47,Srdju&C13
Site Address: g ^S-9Z' SW t
Project Name: l\ ( 9 QX\(J, Lot #:
Land Use Case: A l,ew- 00001 Zone: PS—Pj
Required Submittal Elements
It copies of site plan ` •uare footage of buildings to be demolished
@ Drawn to standard scale m Footprint of new structure and FFE
O North arrow Fi Retained trees, drip line / tree protection
/I Site address, project name, lot # ` Street trees shown / labelled p4i
Z' Street names E Sidewalk / driveway shown and dimensioned
W Applicant name and phone # C.l'Utility locations & easements (new / additions)
Ka Lot and setback dimensions ❑ Location of wells / septic systems
10 Existing structures on site l/ot area and lot coverage percentage
u3 Erosion control Horner elevations (2' contours if > 4' differential)
Vision clearance triangle shown ❑ Ground slope at building pad calculated / shown
PIrning Review
Verify address / suite # active in Accela.
Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
Required: ❑ Yes El No
Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI) Permit: \Yl S.:13
Required: "IgL.Yes ❑ No PF
Applied For: ;Yes ❑ No, stop intake
OP5ensitive Lands: ❑ Yes ❑ No
Type:
It Housing Supplemental Sheets Completed
❑ Cottage Cluster C&O (1 site, 1 per unit) ❑ Quad
❑ Courtyard Units C&O (1 site, 1 per building) El Rowhouse
❑ Cottage Cluster Type II (1 per unit) C 'Small Form Residential / ADU
❑ Courtyard Units Type II (1 per building) ❑ River Terrace Addendum ,mot
o❑o Conditions met prior to issuance of building permit T` tE. t .c t)) A ?Ft , c 1 d
itb1CW t01SSu c v
Approved By Planning: . `V WCY Date: q- zyci; 7-7
Notes
Revision 1: ❑ Approved El Not Approved Date:
Revision 2: ❑ Approved 0 Not Approved Date:
I.\Building\Form\BldgPernutRvw R s 070722 docx
Building Permit Submittal
Original Submittal Date: 77 7,2 1-
Site Plans #:
Building Plans #: 5
Building Permit #: "1SBuilding permit # entered on page 1
Workflow Routing: 1 1anning _-Erfgineering---LrPermit Coordinate -1 -Building
Workflow Sign-off: 1ign-off for Planning (include notes from planning review)
Route Documents: Engineering: (1) copy of permit application, (1) site plan,
(1 _building plan and original plan review routing form. 1
❑ Building: original permit application, site plans, building
plans, engineer and beam calculations and trust details, if
applicab, , etc.
Permit Technician: `�5�� Date:
Notes
Engineering Review
0-Slope at building pad verified Slope: 2-7
®`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 E1No
Assess Water Quantity Fee in-lieu: ❑ Yes C'No
LIDA Facility on lot: IE-Yes ❑ No Add Fee: ❑ Yes Er No
Final Plat Recorded
❑ NOT Approved Date:
Notes
Approved By Engineering: n-4, f . &i4 Date: 1 Z ' 3 " 2- ?-
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ 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:
?'SDC Exemption: ❑ Received 71 Does not apply
OSDC Fees Entered: Wash Co Trans Dev Tax: 7'Yes ❑ N/A
Tigard Trans SDC: /Yes ❑ N/A
Parks SDC: %Yes ❑ N/A
LIDA ❑ Yes / N/A
,)ZrOK to Issue/Approved by Permit Coordinator: Date: 12l( 2'l-1111)2
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date: