Permit (170) CITY OF TIGARD MASTER PERMIT
` J : COMMUNITY DEVELOPMENT Permit#: MST2018-00214
Date Issued: 08/20/2018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135DC01200
Jurisdiction: Tigard
Site address: 11835 SW LINCOLN AVE
Subdivision: TIGARDVILLE PARK Lot: 9
Project: Pollock
Project Description: Adding (1)bedroom and(1)bathroom to primary structure.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 285 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 12 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors:
Total: 285 sf Value: $33,758.00 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 30 SF Rain Storm Sewer: 0
0
Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 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: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 1
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 W/Svc or Fdr:
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 4
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
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 285
Owner: Contractor:
POLLOCK,ZACHARY&KATIE WOODS GENERAL Required Items and Reports(Conditions)
11835 SW LINCOLN AVE 8557 SE HARNEY ST
TIGARD,OR 97223 PORTLAND,97266
PHONE: 503-805-3663 PHONE: 971-678-4277
FAX:
Total Fees: $1,804.71
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy- - .- _ ••rect questions to OUNC by calling 503.232.1987 or 1.8 .332.2344.
Issued By:
{-e------ !c .,gosr _- .- •'tee Signature:
Call 50 .•39! 5 by 7:00 a.m.for the next available inspection e.
This permit card shall be kept in a conspicuous place on the job site until completi• •f • proje
Approved plans are required on the job site at the time of each inspection
•
Building Permit Application
Residential ,.,,,� 4 ,, FOR OFFICE USE ONLY
Cityof Tigard q Received /A �-) _
g AUG 2 20 12 Date/By: r/ /i f Perms/ Ir Oc71 y
1111 13125 SW Hall Blvd.,Tigard,OR 97223
_ g Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 c o DateBy: (' Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 ( 1 r i' d t '+ D ReadyBy: ns: ® See Page 2 for
Internet: www.tigard-or.gov B(.J!(_D °E i l\tt v Afied/Methood: !�" / 1 9 Supplemental Information
TYPE OF WORK REQUIRED DA: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.
1-and 2-family dwelling ❑Commercial/industrial Valuation: $ -2., 7 S
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms: (
JOB SITE INFORMATION AND LOCATION Total number of floors: (
Job site address: 1 8 3S" sl„� L;/..0 O,^ p\r-e... , New dwelling area: 2,ed square feet 28s--
-•
City/State/ZIP: eA D h- 3-z 3' z Garage/carport area: ch square feet
Suite/bldg./apt.no.: 1 Project name: Pat l-o LV_- K-_tS AMC. e_ Covered porch area: CA square feet
Cross street/directions to job site: 5� G(2 QN(Qv1/4(A ay..el S w L;ILO\A , Deck area: 0 square feet
w e 5* on S W G(E-«kk C `So �+'- b n 51 L�A co In 1Other structure area: 0square feet
Pi t(144 idl vt5„ e0 /Y tj( Ill-)tJ4 t47'c-sZ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
KeIiiA6reef idyv( /v (ss GIA k ee...-- Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.. j S�3 Sp G(� Z � 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.
Valuation: $
I �� ll 3c.�� 4�c� ti ion -Eo Qr'.w-.c.r�' S-�r.,c �( C
':�; Sc.1�v�GG /6:e 62 V d- ' IA"� -✓. Y,e5ete vt� Existing building area: square feet
. -4— 1 ,. ,v, ,1---- r'!e ! ,.* r New building area: square feet
G PROPEIITY OWNER ❑ TENANT Number of stories:
Name: - ..6._L kac yQa(l O C, Type of construction:
Address: \L%3 S s 1... 1_,...;‘\-C a`A ( 5-J t• Occupancy groups:
City/State/ZIP: q,.04.--0 ( 0 ct Y-7.-7-3 Existing:
Phone:O ) S 054-1 CO(p 3 Fax:( )
New:
i
1 EI APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: ii0 1 A
Structural plan review fee(or deposit): 5--L( Z• t I
Contact name: ZaLcko i Pa I to cL
y FLS plan review fee(if applicable): N/A
Address: l S 5t-
L�COI . A..J•e_ •
City/State/ZIP: \' (� a Gt R-Z Z Total fees due upon application: 5-1z • l
Amount received:
Phone:(s-OD 8 os-u— -. (.O (O I Fax: :( )
E-mail: '-0.c..kc / J(OL�(4 y(..c D(). COM PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR 1 (( ..e� roof-top mounted Photo Voltaic Solar Panel System.
Business name: oo� $ C-t{,.
, .e r`1 (0,• crc..c`►'I• Submit two(2)sets of roof plan with connection details
/ and fire department access,along with the 2010 Oregon
Address: GS r 7 t>E 1-4G r,1 e y 94 Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
City/State/ZIP: kc lie(4,J p a_ r17.L 6 6 and administrative fees): $180.00
Phone:(cri I ) 6 755 • 4.7_77 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: -2_0 l3 3 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days it has been accepted as complete.
Print name: ��,A�`/ l OL Date: R—)'31 /C *Fee methodology set after Tri-County Building Industry
by
Service Board.
`\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02OM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Received
City of Tigard Permit No.:
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B
_ Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
t t G A R D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes 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. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . CI CI
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ CI
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control 0 plan 0 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 ❑ ❑ ❑
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 El ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ Cl
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- ❑ ❑ ❑
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. ❑ ❑ ❑
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- ❑ ❑ ❑
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 ❑ ❑ ❑
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. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 Cl
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.,slicable 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". ❑ ❑ ❑
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. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. Cl ❑ ❑
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, ❑ ❑ ❑
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 Applicati L ¢ FOR OFFICE USE ONLY
�1 , .
Received
kJ
City of Tigard
Date/By: Permit No.:
,74
■ 4 13125 SW Hall Blvd.,Tigard,OR 97223
AUG 2 2018 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 U Date/By: Other Permit:
1 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: Jur s: SeePae 2 for
Internet: www.tigard-or.gov CITY ) M(. ® g
,, h, .,.1 ' e ,; Notified Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ,
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: M S S 5(J b (\COI/1 Y U e._- - Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7 �` ,r d O 4. - Z > Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: U Project name: O \c Heat pump 61.06
0 I` C�' t Duct work I 23.32 2-3.3 Z
Cross street/directions to job site: S v.) (_ t\[a.( me,(SlA) (CC esti Hydronic hot water system 23.32
F� � (� ttitO((� J Residential boiler(radiator or
V�eSJ l�
O(\ ( LPtA(to n sb0,+IA 0/\ LN\{plA 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:
Tax map/parcel no.: )S' ) 3 5 0 G�J a 0 0 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
(� ^(� Flue vent for water heater or gas
I.,S�c A\ lfl too,_ i;,,` c..�c� cX..�c�-3o r -lo ,,..e t,� fireplace 23.32
\ Log lighter(gas) 23.32
G`c)�'_k;o K `~ ,
c, t-tooS Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
13:141VIOPERTY OWNER ❑ TENANT
(� Environmental exhaust and ventilation:
Name: 0..LV Lor` POI (0 Range hood/other kitchen
eqAddress: 1 3 S S/l,0 L (\C 0 `� Av e . Clothes dr 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: --\--; �J/ O g_ �' �' 1 Z 3 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 1 23.32 Z5.5 2-
Phone:(S)3) X35 (0(03 Fax:( ) Attic/crawlspace fans 23.32
Er-APPLICANT 0 CONTACT PERSON fie': 23.32
' Fuel piping:
Business name: N 1I $14.15 for first four;$4.03 for each additional
Contact name: .0 k.0.` Q o C.� Furnace,etc.
Address: 1( W�S S(,J (�Z�O a 11,/\ l.� , Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: -1-4.6cA r () g TZZ 3 Water heater
Phone:(p3)&C) 3(0(0/ Fax::( ) Fireplace
/, Range
E-mail: .a .kcE.y-- pc.1 L c ( �ta.�'w0 .C-a " Barbecue
J CONTRACTOR / Clothes dryer(gas)
Other:
Business name: l.,.l 00,D S (-z,„.e rte' co c..jc f rt L ticI MECHANICAL PERMIT FEES*
Address: 5 5`7 5 E +\,....e,./ S-4 Subtotal -I b.6 y
City/State/ZIP: po 4tc.-.cQ 0 2 1-7 Z i,6 Minimum permit fee($90.00) O.o O
Plan review(25%of permit fee) ZZ,
Phone:(17 I )67e6 . 4/11 Fax:( ) SD
State surcharge(12%of permit fee) /0.i60
CCB lic.: 'ZpZ (33 TOTAL PERMIT FEE I .. 30
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: -i�C Y U)d I(O c r_ Date: -q- 1/1 C
I:\Building\Permits\MEC_PermitApp_0401 16.doc 440-4617T(11/02/COM/WEB)
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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
1 ;a
, Electrical Permit Application a . 5!E; FOR OFFICE USE ONLY
City of Tigard to L 2018 Received
Dateiv : Permit#:
IR 111 13125 SW Hall Blvd.,Tigard,OR 97223 AUGU Plan Review
B Phone: 503.718.2439 Fax: 503.598.1960 -r DateB : Related Permit 4:
Inspection Line: 503.639.4175 GP ' Y o I' i I'7tReady Date/By: Sufis: El See Page 2 for
Tll, ARI) Internet: www.tigard-or.gov ( )1 NIP, r \nsNotified/Method: Supplemental Information
TYPE OF WORK_w -.. .. .., _.._ PLAN REVIEW
❑New construction ® Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® I-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 11835 SW Lincoln Ave 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97212 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Pollock Residence 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Lincoln&Greenburg FEE SCHEDULE
W on Greenburg,S on Lincoln. Description I Qty. Each Total
New residential single-or multi-family dwelling unit.
Subdivision:N/A Lot#:N/A Includes attached garage.
Tax map/parcel#: 1S135DC01200 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
3 ceiling lights,1 exterior light,7 120 sockets in new addition
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alter 'on,and/or relocation
Name:Zachary Pollock 200 amps or less 100.70 t.o.'10 2
Address: 11835 SW Lincoln Ave 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:(503)805-3663 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services 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, r exc ge, . ord., p,to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: —7/31/(� 401 amps to 599 amps 168.54 2
® APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: N/A above service or feeder fee, Li7.42 2
each branch circuit
Contact name:Zachary Pollock B.Fee for branch circuits without
Address: 11835 SW Lincoln Ave service t ffee,first
branch circuuitit 56.18 2
City/State/ZIP:Tigard,OR 97223 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)805-3663 Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:zachary_pollock@yahoo.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lic.: Suprv.Lic.: specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: I oo . 7 0
Print name: Date: 0 Plan Review Required(25%of permit fee): Z S, I e
State surcharge(12%of permit fee): [2 , a
Authorized signature: TOTAL PERMIT FEE: t 3-7, 9 6
t This permit application expires if a permit is not obtained within 180
Print name: Zachary Poll: , / ()AX---- Date: 07/30/18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1\Building\Permits\ELC_PermitAppELRERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
, w
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
De
Fee for all residential systems combined: $75.00 neon I Qty. Each I Total
3' Renewable
wable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n 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:
Each additional inspection is
Other: 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(S_hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Paget):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
U HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
\Building\Permits\ELC_PernitApp_ELRERE.doe Rev 06/17/2015
" Plumbing Permit ApplicationCFF.�„A.
Building Fixtures AUGFOR OFFICE USE ONLY
AUG 2 201'. Received
City of Tigard Permit No.:
DateBy:
13125 SW Hall Blvd.,Tigard,OR 97223 t " pian Review
Phone: 503.718.2439 Fax: 503.598.19 ��" kF d "`
II �y ^�1111
Other Permit No.:
u l i` � ' r, o r
Date/By:
I GAR D Inspection Line: 503.639.4175 w Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑ Demolition For special information use checklist.
Description Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11835 SW Lincoln Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name:Pollock Residence Manufactured home utilities 50.03
Cross street/directions to job site:Greenburg&Lincoln Manholes 18.76
West on Greenburg from 99.South on Lincoln. Rain drain connector 18.76
Sanitary sewer(no.linear ft.:30) 1 Page 2 62.54
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: 1 S135DC01200 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Addition of 1 bedroom,1 bathroom.Will require an additional 30 feet Dishwasher 25.02
of sanitary line. Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Zachary Pollock Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:11835 SW Lincoln Ave
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)805-3663 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:N/A Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Zachary Pollock
Roof drain(commercial) 12.51
Address:11835 SW Lincoln Ave Sink/basin/lavatory 2 25.02 50.04
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)805-3663 Fax: :( ) Tub/shower/shower pan 1 12.51 12.51
E-mail: zachary_pollock@yahoo.com Urinal 25.02
CONTRACTOR Water closet 1 25.02 12.51
Water heater 37.52
Business name:Woods General Contracting I. Water piping/DWV 56.29
Address:8557 SE Harney St Other: 25.02
City/State/ZIP:Portland,OR 97266 Subtotal 137.60
Phone:(971)678-4277 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:202133 Plumbing Lic.no.: Plan review (25%of permit fee) 34.40
State surcharge(12%of permit fee) 16.51
Authorized signature: cW/V\--,.,,Z
TOTAL PERMIT FEE 188.51
Print name:Zachary Pollock Date:08/01/18 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
C\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
• Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain- l'' 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 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-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other 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
(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 forof the following.
Work Performed: Capped Added Relocate q any owg'
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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 ❑ Isometric or riser diagramis required for new buildings
Garbage -Domestic-non-food q g
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
_Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
/Users/zpollock/Desktop/House Permits/PLMF_PermitApp.doc 2
City of Tigard
IIIa COMMUNITY DEVELOPMENT DEPARTMENT
0
T 1 G A R D Building Permit Review — Residential
Building Permit #: til S7—� , r-ooz I y
Site Address: \1 '3S S i✓ c,;,\4).1 Av-e_
Project Name: V01la r.-r,,, Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review Lt
l
Proposal: 1 Q �/ 1 at�1 ctlotiAll 1U r r'ir,a 7 S--,NLjrf
I/ erify site address/suite#exists and activ9/rn permit s stem.
viT
River Terrace Neighborhood: E No 0 Yes,See River Terrace Review Addendum Attached
IIlite "lan Elements:
- ee(3)copies of site plan 4 :sting structures on site
15 •te plan must be on 8-1/2"x 11"or 11 x 17"paper 11 ootprint of new structure(including decks)with finished
`7 R awn to scale(standard architect or engineer scale) 3 or elevations
So.rth arrow I►,i a'ty locations&easements (required for new and additions) (
M. - address,project or subdivision name and lot number L �S�+idewalk/driveway approach L1 pr id &) '^ Et
(Iplicant information(name and phone number) ,I1 . ation of wells/septic systems I u
DVLot dimensions and building setback dimensions 2xisting trees to be retained with drip line,and tree
ltivi
VA Oiquare footage of buildings to be demolished n `rotection measures
64Jfot area,building coverage area,percentage of coverage and�l/14'Z4 eet tree size,type and location
fipervious area(applicable if R-7,R-12,R-25&R-40) GO treet names
Property corner elevations(2 foot contour lines if more than ,000 sf of impervious area created or replaced? ❑Yes 1P o
t differential) If yes,is a storm water quality facility shown? ❑ -. II No
AV Clean Wate�r.S�'ces—Service Provider Letter(lot platted prior to 9/10/1995):
IX 'equired: L�" Yes,applicant was notified ❑ No Received: Yes ❑ No
, Public Facilities Improvement(PFI) Permit: /
Required: ❑ Yes,applicanted ❑ No Applied For: CIYes ❑ No,stop intake
ylirand Use Case#:
onin : C
�1 'equired Setbacks: Front a Rear IS Side E Street Side Garage
Ldscape Requirement:
Lb cy.
��of Coverage Maximum: 86
ly Building Height: Maximum Height 3° Actual Height 12-
14;
J' 11, isual Clearance
1e Sensitive Lands: ❑ Yes +L< No Type
Z� -rban Forestry Plan
IP Conditions "Met"prior to issuance of building permit
Not's:
Approved By Planning: ,,10^'J 1.i/ Date: g'.--1.--i I
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPennitRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: V 2 `11
Site Plans: # 3
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing: Planning il. Engineering 17`Permit Coordinator [jBuilding
Workflow Sign-off: 7 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.
Ed Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: /44 iii,Ve(*(7 Date: V2/I r—
Engineering Review
Slope at building pad: ‘7
a Conditions "Met"prior to issuance of building permit
al—Easements (encroachments)per engineering conditions of approval and plat
a Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Er No
Assess Water Quantity Fee in-lieu: ❑ Yes Er No
LIDA Facility on lot: ❑ Yes 11 -No
Er Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
[Approved by Engineering: EL to 6.5 r}. Date: e -7-/5
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: CI Yes N/A
Parks SDC: ❑ Yes N/A
LIDA ❑ Yes N/A
rK to Issue Permit
1/ /�
oved Permit Coordinator: Date: v by
I:\Building\Forms\BldgPermitRvw RES_010118.docx
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
!PI Transmitt l Letter
a
T 1 G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.go
TO: DATE RECEI D:
DEPT: BUILDING DIVISION R , E I VE
D
JUL 1 6 20199
FROM: Z (A0 1 ` �`` ()1) 1,1Q C. CITY OF TIGARD
/ BUILDING DIVISION
COMPANY: çn Q.�k�� OSE'
PHONE:
RE: l� 5 ltd / mS 1 Jl q -0CC/
(Site Address) S e `( (Permit Number)
✓U ;mss i• 4A U 1,'L _k_
(Project name or subdivision name and lot numb,
ATTACHED ARE THE FOLLO NG I ' 1' :
Copies: Description: Copies: Description:
Additional set(s) of plans. Ai• X Revisions: '!Z A31101 . 3
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): J d
REMARKS: I C& J '4 ) U I .3 iS(V a(,I j `-p amitie
FORpFFICE USE ONLY
Routed to Pe s'it Techni ian: Date: 7 (co ( v' Initials:
Fees Due: Yes F2 Nor Fee Description:( Amount Due:
$ ifez5,0'
r\--) \''(')
S., cial
Instructions:
Reprint Permit(per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: 7(/ 7/?'='? Initials:
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc