Permit FOR OFFICE USE ONLY-SITE ADDRESS: ( o 0( 0 citl 6 ctVYet
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
li
>s Transmittal Letter
T i G 1!It D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: n I( lJ (J DATE RECEIVED:
DEPT: BUILDING DIVISION I REC
EIVED
EIVED
FROM: t pi JAN 2 2 2024
COMPANY: f rt.ck_ c)c, GI rY OF TIGAR
BU LDING DIVISI bt,.. .
PHONE: mil-?f 2ZZ^ g re
EMAIL: ou9i44-, . Gt4 urT Q S ram`1, cep,-,--
RE: tool° Se, (,r4+4,4-1 5f /IAST 7023•- Uo 3v 'tf
(Site Address) (Permit Number)
il ;s. G -
(Project n e or subdivisio name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description:! Copies: Description: .
Additional set(s) of plans. 3 Revisions:
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: j)Z.S`j - . at,scr;.n iv`,,,- o .w4, likausk .24,5;' .4,--
- h.-.4'It( S4t.,,_ ...A :::Ni cc,II,t.,c C.,.r 5 I frvJe-re4 ¢443,'.,.e.,-,e)j
FO OF CE USE ONLY
Routed to Pe � 2� Zy t Technician: Date: Initials: /"r'
Fees Due: [ Yes ❑No Fee Desc 'ption: Amount Due:
$
Special
Instructions:
Reprint Permit(per P ): ❑ Yes 'o, �n�, A ,�� ��(( ❑ Done
Applicant Notified: Date: I\ 1j1A)1JkS �,VALUu LLI ikAAIJXYL Initials: tbV
FOR OFFICE USE ONLY-SITE ADDRESS: to()\ SW G1 GY Y. %
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
III _ al Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: A1 — �.� - AUG 16 2023
COMPANY: CITY OF TIGARD
BUILDING DIVISI@N tog-
PHONE: I�( Z Zz- 6-{s Se n
EMAIL: ��`C�`a 1-r6t,, ,`-
RE: /c'O/a cc,/ (tea y� c,' Td193-0030
(Site Address) ( ermtt Number)
Pt-tot-0
( roject dune or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 3 Revisions:
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: ( ✓ 0(. _ jD,mot, ,ti tS Oc. 'l - cif)
FOR OFFICE USE ONLY
Routed to Permit Technic' : Date: Initials:
Fees Due: El Yes No Fee Description: Amount Due:
$$
1 $
Special
Instructions:
Reprint Permit(per PE):! El Yes ❑ No L Done
Applicant Notified: J Date: $;( �� Initials: ` —
I.\Building\Fonns\TransmittalLetter-Revisions_073120.doc
ry CITY OF TIGARD71
MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2023-00304
Date issued: 08/31/2023
T!CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102CB03600
Jurisdiction: Tigard
Site address: 10010 SW GARRETT ST
Subdivision: FREWING'S ORCHARD TRACTS Lot: 10
Project: HAUPT
Project Description: 900 sq.ft.detached garage with second story living space, bedroom and kitchen.Trade permits to
be separate.WATER METER UPSIZE TO 3/4"REQUIRED.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 35 Bathrooms: 1 Second: 900 sf Garage: 900 sf Front: 10 Smoke Yes
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors:
Total: 900 sf Value: $250,425.00 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0 Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 WI Svc or Fdr: 0
Ea add'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-800 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amplvolt: 0
ELECTRICAL-RESTRICTED ENERGY III
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 900
Owner: Contractor:
HAUPT,ROBERT ADAM OWNER Required Items and Reports(Conditions)
10010 SW GARRETT ST 1 Ersn Cntrl 503-639-4175
•
TIGARD,OR 97223
PHONE PHONE:
FAX:
Total Fees: $7,363.54
This permit is issued subject to t regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordan ith roved 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. ATTENT : Or On law requires u-1p follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
p52Minnin thrral (lap not-nnon V meran a nnne of}ha n doe nr rlir.nl nuaa}Inne}n(II aJr by',Minn a 9R lee,nr 1n ea,94d�
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspectio date.
his permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Application
Residential FOR ol'i'ici i'SE ONI.l
Received
City of Tigard Date/By: Permit No./{^11�, "`ad,f
III 13125 SW Hall Blvd.,Tigard,OR 97223R E C E I VE I) Received
Review Other Permit:
6'r� ffCJ 'I
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: filk
'i 1 ci A 1,I, Inspection Line: 503.639.4175 Date ReadyBy: lurir. F5 See Page 2 for
JULInternet: www.tigard-or.gov J„ 3 2023 Notified/Method: �� Supplemental Information
TYPE OF woRIC'TV OF TIGARD REQUIRED DATA:1-AND 2-FAMILY DWELLING
pli �11 N G D 1"r':b'i O d Permit fees*are based on the value of the work performed.
New construction ❑ �'t""`` Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and thepr,ofit for the io
CATEGORY OF CONSTRUCTION work indicated on this application.ZSQ 7Z —
31 1-and 2-family dwelling 0 Commercial/industrial Valuation: $
❑Accessory building El Multi-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: l-
ob site address: New dwelling area: 'Ice square feet
/� loofa SW C-4,,,, ,-44- !s�'
11 City/State/ZIP: -�'i l d I ?-7 2 Z 3 Garage/carport area: l�j square feet
V Suite/bldg./apt.no.: Project name: g*,.,,et Cr 4 Covered porch area:, square feet
Cross street/directions to job site: 1 Deck area: square feet
r/4.8, -4-4 eA.,,yk Q( ' N Other structure area: square feet
le ef .I LI,0A ( 'I, �:jgry43 (AJ 7rr/Yla-fc..r 7 j/„" REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 7/3/ 3 7 Lot no.: 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.
1UJ �Y � . (�1 mac.-si Valuation: $
✓/^ Existing building area: square feet
�ri/.l� i...c� s.( a.y,I ut -
/ New building area: square feet
tE PROPERTY OWNER 0 TENANT Number of stories:
AC//
Name: YtO4„. m A.,�� pr.rvt., c.II Type of construction:
Address: (c o p S LI CrCra*.rfs -1- C'1E• ▪ Cm rn Occupancy groups:
City/State/ZIP: i i 5ca/011, f)Q Q/ 7 L 2 'S Existing:
Phone:(C+7l) 2 2 i_4 g, " a'S Fax:( ) New:
I
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* I
(PleaBusiness name: 1' view refer to fee schedule)
G 5 ti�Al'{_. Structural plan review fee(or deposit):
Contact name: FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
n F_ Submit two(2)sets of roof plan with connection details
Business name: /T-�M _
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 lie.: p Total fee due upon application: $201.60
Authorized signature: /Z/�I�I _j This permit application expires if a permit is not obtained
( C(.��- within 180 days after it has been accepted as complete.
Print name: „,, M-i Date: Z_ 1- Z; *Fee methodology set by Tri-County Building Industry
Service Board.
I:\BuildinglPermits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR orrice usi: ovI.I
City of Tigard received Permit No.:
Date/By13125 SW Hall Blvd.,Tigard,OR 97223 Associated
� Associated permits:
IN Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 ❑ Electrical El Plumbing 0 Mechanical
Internet: www.tigard-or.gov
❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW \es No N/A •
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 • 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ 0
3 Verification of approved plat/lot. 0 ❑ 0
4 Fire district approval required. Name of district: 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 ❑
6 Sewer permit. ❑ ❑ 0
7 Water district approval. ❑ ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control ❑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-It.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 ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 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- ❑ 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. 0 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 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 0 ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 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 ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑ 0
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 . .sect under review.
JIJRISI)ICTIONAL 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 ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0
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 ❑ ❑ ❑
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, ❑ 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:1Building\PennitslBUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
•III ' COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
1lt,ARD
Building Permit #: mbraza-3 — C0�4 ,,,b 4
Site Address: �OO1O SW n . `f el' _,1eriifiied in Accela
Kn'a�
Project Name: - l eiara . L ( zrd go, ACCPSS d Lot/Unit #: P +�-p
Proposal: AC, M) cAf*'d Ni( Acc- W1.Gt \. Zone: W
Housing Type: FR(❑ Single Detached ❑ Duplex❑Triplex 0 ADU) ❑ Rowhouse❑Cottage Cluster❑CYU ❑Quadp'Other
Required Site Plan Elements:
73 ies of site plan on max 11x17"
Nrawn to standard scale -1E-Retairred trees, drip line/tree protection
orth arrow ®-Street and site trees shown / labeled
Site address, project name, lot # 0 Tabl calculating tree canopy at maturity
treet names (N/A for SFR)
7Applicant name and phone # ❑ Cum[yard rectangle dimensioned (if applicable)
Z(Lot and setback dimensions ❑ Vision,clearance triangle
9Q-Existing structures &square footage if Utility locations &easements
Footprint of new structure and FFE /Property corner elevations
+7 Sidewalk/driveway dimensioned L7 LIDA (>1,000 sf disturbance)
/Lot area and lot coverage percentage -Erosion control
Required Elevation Plan ments:
(F FR: calcs needed o y on street-facing) Summary table with calculations for:
❑ wn to stands scale ❑ Total f a
❑ Buil heig dimensioned al window and door area
❑ Facade nsioned
❑ Window n oors dimensioned
0 Garag doors di nsioned
Requi Floor Plan Elements:
(Not r quired for SFR) 0 Summary table that includes
Each story dimensioned ❑ Total floor area
❑ Each story floor area calculated ❑ Floor area per story
Planning Review
The following standards have been met:
Setbacks/Eront: (O Rear: 1S Side: J Min/Max Street Side: (D / Garage:
Height ,'Max. Height: 25 Proposed Height: 3 5
JKYes ❑ N/A Landscape * pip)
❑ Yes "N/A Screening (Quad only) ✓TT -�
❑ Yes N/A % Window Coverage N/A ,nrt p:c: )
gYes 0 N/A Garage (SFR Only) Parking (Other Res)
O Yes p'N/A Entrance (SFR, Rowhouse, Quad only)
0 Yes ZN/A Other building design standards (Rowhouse only)
1 es ❑ N/A Accessory Structure Standards
❑ Yes 7No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses,and Quads:
❑ Yes ❑ N/A Unit Count:
El Yes 0 N/A Lot Width and Size
❑ Yes ❑ N/A Pathway
Additional standards for Courtyard Units and Cottage Clusters only:
❑ Yes ❑ N/A Unit Area:
❑ Yes ❑ N/A Floor Area (per story)
0 Yes 0 N/A Courtyard
0 Yes ❑ N/A Fence
❑ Yesko ❑N/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ NoV/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes ❑ No, stop intake
)ensitive Lands: ❑ Yes E'1 o
ilfrMain Land Use Case #s: /,DV2A?'b- 0000, , /'f XConditions met
Applicant notified of land a expiration date:
Approved By Planning: Date: V(2°t. (23•
Notes VA.:S is vlG j Ate. AOt/ t7 I c i'f CiatSvi} tw✓t {i,/N rFftc/in•fM
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date:
Site Plans #:
Building Plans #:
Building Permit #: 0 Building permit # entered on page 1
Workflow Routing: ❑ Planning ❑ Engineering ❑ Permit Coordinator ❑ Building
Workflow Sign-off: ❑ Sign-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.
0 Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc. •
Permit Technician: Date:
Notes:
Engineering Review
❑ PFI Permit:
a
lope at building pad: 2.2
onditions met prior to issuance of permit
�// (..,11
asements (encroachments) per engineering conditions of approval and plat
ater Quality/Quantity Facility:AssessWaterQualityFee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No Add Fee: ❑ Yes ❑ No
inal Plat Recorded
❑ NOT Approved: Date:
Notes: ____.---,
i
Approved By Engineering: pro _ Date: //�//�"S
Revision 1: El Approved N Approved o Apved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
ermit Coordinator Review
❑ Conditions met prior to permit issuance
Approved, NOT Released: Date notified applicant:
ENG Revisions Required: Date notified applicant:
SDC Exemption: ❑ Applied for 0 Received Does not apply nb coVit/v
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A ❑ Deferred U r a
Parks SDC: ❑ Yes d] N/A ❑ Deferred
LIDA ❑ Yes 1f(0 N/A•
//r, T` 1 (
�/
OK to Issue/Approved by Permit Coordinator: OD \
�p Date: 1\
Revision 1: ❑ Approved CINot Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
4C I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Name of Permit Applic nt
07,; Z 3
ignature of Permit Applicant Date
Permit#: MS 1 1 CO
Address: Sk �rvolI
Issued by: to Date: ) I31 IVY fl
This Copy for Permit Offices
4:r> ,;)- L -4•D D u.,,- 7/f 7 /2-3
Water Meter Fixture Unit Worksheet for Additions Reemodeel,/AD s
RECEI
Please complete the following information: �J
,+,,� 3 2023
Customer Name: {kAu-w ltrAJ • t
Service Address: Street/Suite#: Sou (c 51j+ fr+a"Ll-� , �'��F jl �� �
9 JIN3 CIV;S,Ji'�
City: T:5 c,rd, State: of. Zip: 3 7 Z 2 3
Phone Number: (hi - 222- N,5�r8 Email: c.,t,c�,... , Liu,p r 7g.rj i+Aw (. cam,-.
Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add.
Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at
total. the proposed total.
Fixture Unit Current Point Current Proposed Point Proposed
Quantity Value Total Addition Value Total
Bar sink x 1 = x 1 =
Bidet x 1 = x 1 =
Clothes washer 1 x 4 = N x 4 =
Dishwasher I x 1.5 = 1,S 1 x 1.5 = \,5
1"Outside Water Spigot 1 x 2.5 = 2.S x 2.5 =
Water Spigot,each add'I ` x 1 = 1 x 1 =
Kitchen sink 1 x 1.5 = 1.S 1 x 1.5 = j. c
Laundry sink 1 x 1.5 = 1.V x 1.5 =
Lavatory(bathroom sink) Z X 1 = 1 1 x 1 =
Water closet,1.6 GPF(toilet) 2 X 2.5 = Z,,i- t x 2.5 = 2.5
Bathtub/whirlpool 1 x 4 = r.4 ` x 4 =
Shower stall 1 x 2 = 2 x 2 =
Bath/shower combo x 4 = I x 4 = N
Current Points:
� 2l-c Proposed Increase:
Current Points+Proposed Increase _2 0: r =New Total Points =Required Meter Size 3
Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points='/<" 37.5 and over points= 1"
New Meter Size Needed for New Total Points: , Cost: $ t r" (see page 1)
0. cc)Current Meter Size per Utility Billing: I31os. Cost: $ jt. 2; c, (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $ �( qs3(e•�
(This is Your Cost to Increase Meter Size Due to Additional Fixtu Units)
FOR OFFICE USE ONLY
Current Meter Size Confirmed with UB
Signature of UB Representative Date
1:/Building/Forms/WaterMeters_070121_Add.dOCX Page 2
vo EMGileaf ID (A. b, '7131.13 . 8:
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Water Meter Fixture Unit Worksheet
i t,;\I. J 1 For Additions /Remodels /ADUs
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
LOCATION: City of Tigard—City Hall WATER METER SALES:
Utility Billing By Email Only. Please contact
13125 SW Hall Blvd. ubonlinepay@tigard-or.gov
Tigard, OR 97223 to discuss sending documents and payment
METER: SIZE: FEE: Pricing effective 07/01/2022
5/8" $11,258.00 Fee includes:
3/4" $16.094.00 water system development charge,
1" $29,588.00 water meter, and
1-1/2" $87,787.00 meter installation fee.
2" $142,227.00
DETERMINING METER SIZE FOR RESIDENTIAL CUSTOMERS
City of Tigard Water Service Area uses the American Water Works Association Manual and the Oregon
Plumbing Specialty Code to determine the size of meter needed to adequately serve buildings. Due to the
variety of home sizes built in the Tigard area, we count the fixture units of all homes to determine the
appropriate meter size.
Use the worksheet on Page 2 to calculate the current number of fixture units compared to the proposed
increased number of fixture units,which will determine whether an increased meter size will be required.
Submit this signed worksheet with your building or plumbing permit application submittal.
DOCUMENTATION
Once you are ready to purchase the new meter, please provide the following items to the Utility Billing
counter:
• Completed water meter fixture unit worksheet for additions, remodels,ADUs, etc. (on back page).
• Copy of building or plumbing permit application date-stamped by building division.
• Copy of issued building or plumbing permit.
Your fixture count will be verified and your request will be processed upon receipt of these documents.
No exceptions.
INSTALLATION TIME
Once the upgraded meter size has been purchased, most meters are installed within 10-14 business days.
I:/Building/Fnrms/WaterMeters_070121_Add.doCx Page 1
CleanWateY �`'Services
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT
Clean Water Services File Number 123-001270
1. Jurisdiction:Washington County 2. Property Information(example: 15234AB01400) 3. Owner Information RECEIVED
Tax lot ID(s):
Name: Adam Haupt
2s102cb03600 Company: JUL
Address: 10010 SW Garrett St
10010 SW Garrett St City,State,Zip: Tigard,Oregon,97223 CITY OF Tla
OR Site Address: Pity,State,
BUiLDINU D1VI LION
City,State,Zip: Tigard,Oregon,97223
Nearest cross street: Email:
4. Applicant Information
4. Development Activity(check all that apply) Name:
I] Addition to single family residence(rooms,deck, garage) Adam Haupt
Company:
❑ Lot line adjustment ❑ Minor land partition Address:
tom SW Garrett St
❑ Residential condominium x❑ Commercial condominium City, State,Zip: Tigard,Oregon,97223
❑ Residential subdivision ❑ Commercial subdivision
❑ Single lot commercial 0 Multi lot commercial
Phone/fax: 971-222-898
Other Email: adam.haupt7@gmaii.com
6. Will the project involve any off-site work? ['Yes 0 No ❑Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project
this is a 30.30 Garage
This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site
Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality,
Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and
completed under applicable local,state,and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water
Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering
information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my
knowledge and belief,this information is true, complete,and accurate.
Print/type name
Adam Haupt Print/type title
Signature
ONLINE SUBMITTAL Date 4/25/2023
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO
ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural
Resources Assessment Report may also be required.
❑ Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the
site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if
they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section
3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable
local,State and federal law.
® Based on review of the submitted materials and best available information the above referenced project will not significantly impact the
existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to
evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service
Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22. All required permits and
approvals must be obtained and completed under applicable local,state and federal law.
❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2).NO SITE ASSESSMENT
OR SERVICE PROVIDER LETTER ISDD,R,EQUIRED. /
Reviewed by
�� jW�tees4 Date 4/26/2023
Once c plete,email to: SPLReview@cleanwaterseinrices.org • Fax:(503)681-4439
OR mail to: SPL Review,Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro,Oregon 97123 Revised zrzozo
Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p:503.681.3600 f:503.681.3603 • cleanwaterservices.org