Permit (102) CITY OF TIGARD MASTER PERMIT
IN2 '> COMMUNITY DEVELOPMENT Permit#: MST2018-00269
1.G� .o 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14/2018
-�-
Parcel: 2S 110AD 10600
Jurisdiction: Tigard
Site address: 10953 SW ANNAND HILL CT
Subdivision: ANNAND HEIGHTS Lot: 8
Project: Annand Heights, Lot 8
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 770 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1114 sf Garage: 392 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 1884 sf Value: $243,068.50 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=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: 3 201-400 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
asin Y
Other: N Other Description: Ecom P 9
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF 1884
Owner: Contractor:
ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
12655 SW NORTH DAKOTA ST TIGARD,OR 97223 2 Geo Tech Report Required
TIGARD,OR 97223 Prior To Pour
PHONE: 503-780-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $30,256.18
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 =. by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. Y•• ay obtain a •.'y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By• -,e-' _ Permittee Signature:
Call 5' jat by 7:00 a.m.for the next available inspection .
This permit card shal •e 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.
0
Building Permit Application', 11
Residential RECEIES-{ FOR OFFICE USE ONLY
City of Tigard O C I $ ! 'ew
// I /) Pe , �05r 13125 SW Hall Blvd,Tigard,OR 97223 i�/07/ /I//((//,;` a UG 22 v1
Phone: 503.718.2439 Fax: 503.598.196 ITY OF TI a DateBy:
Inspection Line: 503.639.4175 q� Date ReadyBy: )oris: 0 See Page 2 for
TIGARD Internet: www.tigard-or.gov �IL` �ING DIVISION ified/Method: �� Q r� Supplemental Information
Xit/t/tres
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
XNew 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 profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
and 2-family dwelling 0 Commercial/industrial Valuation: $ �14 / b��
—0:
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms: 3 1'"3
JOB SITE INFORMATION AND LOCATION Total number of floors: ZZ'](Q
Job site address: /0 9 c5itu 4A1anC Hi// (o4 r'- /
New dwelling area: I4•c II square feet `‘` 4
City/State/ZIP: F _7�6/-2p 0 A-Z,-- 9 7a --3 Garage/carport area/7449.3' 1 .square feet -71D
Suite/bldg./apt.no.: Project name: nn fl4nd �Ct:, h Covered porch area: square feet
Cross street/directions to job site: /a G 7_l Deck area: 4-11 square feet
/ Other structure area: square feet
REQUIRED DATA.COMMERCIAL-USE CHECKLIST
Subdivision: n Iva A 4' j.�...�y A Lot no.: �i't Permit fees*are based on the value of the work performed.
Tax map/parcel no.: v V G/ 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.
/ ` j'1P, Valuation: $
�"t/ 'G Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: bo.p JJ) ® j/1L Type of construction:
�u®off ��asrp-�GT.� �u' �
Address: /o2- S-5- 5&) /110/ 7-it Dake f 6°V1Prd Occupancy groups:
City/State/ZIP: �� a i-7,,/ 223 Existing:
Phone:(4r/-41) 06 7 L/376- Fax:(3) 5-90-6fid4 New:
0 :APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: cirje (Please,refer tofee schedule)
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fax::( ) Amount received:
E-mail: �/n 640-1CMG/101 OA4-5,114" ID t �ail i Co" PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
V Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: t<lJ/I2{�a"0d,1 acs L Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 46 5-5- S° hVier 14 )04.1 Ci//Z (5' -el- Solar Installation Specialty Code checklist.
City/State/ZIP: 7t.i tn7 �23 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(5' 3) &0 _L 75- Fax:( 67/3 6-47 -Zae)G State surcharge(12%of permit fee): $21.60
CCB lic.: 6-0/960.
Total fee due upon application: $201.60
Authorized signature: --__ --- — This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ✓,,, _, , /Ws-
, Date: 71/6,/,/ i/ *Fee methodology set by Tri-County Building Industry
Service Board.
,---
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
4
E ,
Building Permit Application Sck1ist 0
One- and Two-Family Dwelling RECEIVE0 FOR OFFICE USE ONLY
City of Tigard Received
v 13125 SW Hall Blvd.,Tigard,OR 97223 OCT 2018 Date/By:rPermit No.:
• Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD
24-Hour Inspection Line: 503.639.4175 CITY OF I lGARD
0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov BUILDING ( luso 0 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. Z 0 0
3 Verification of approved plat/lot. Zr 0 0
4 Fire district approval required. Name of district: . Z 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 R'
6 Sewer permit. ®` 0 0
7 Water district approval. 21` ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ la
9 Erosion control Errylan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ®" 0 0
basin protection,etc.
10 3 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 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 Ice ❑ 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, Zr ❑ ❑
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- [d�' 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. g 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- Z 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 Er ❑ 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 21
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 2' 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ® 0 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 2' 0 0
architect licensed in Oregon and shall be shown to be a..licable to the .roject 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. a 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. J 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ IZI
27 "Drawn to scale"indicates standard architect or engineer scale. L2 ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard [ff ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 2` ❑ ❑
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, Ef p 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicatio• Ft ,)FFICE USE ONLY
�� �..
Cl of Tigard l Received
Date/By:
No.:
IIII ■ 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960OCT 1 pp Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 1t1 Date Ready/By: lu s: H See Page 2 for
Internet: www.tigard-or.gov CITY, _ GAR Notified/Method: Supplemental Information
BUILDING f`�IV.S1Ot
" "' COMMERCIAL FEE*.SCHEDULE — USE CHECKLIST
J')CYPE.'OF WflR1�
Mechanical permit fees*are based on the value of the work
w construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
` CATEGORY OF CONSTRUCTION ;" '
Value:
,Zr- ,-; RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1and 2-family dwelling 0 CommerciaUindustrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
}$ SITE.TI iiiiiitk.TION APID'LOCATION Heating/cooling:
� 1 Air conditioning 46.75
Job site address: `d '515j 19---44,,,,a/ /74`1 �'i f-� Furnace 100,000 BTU(ducts/vents) .. 46.75
City/State/ZIP: Tc-,-_,a� ®' Q�23 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: / �/A. Heat pump 61.06
�/I/ /t L/ dPC0 47 Duct work 23.32
Cross street/directions to job site: /oi r V Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: /9/1/14/Ld /r (/-e0 ALot no.: / Other: 23.32
y Other fuel appliances:
Tax map/parcel no.: Water heater ..® 23.32
DESawRIIoN 0*--fwoRIC.' Gas fireplace/insert .� 33.39
` P �r Flue vent for water heater or gas
��(,� �'//�- fireplace / 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
. ROPERTY;OWNER•- 0 TENANT
Environmental exhaust and ventilation:
Name: ®g�1 pittJ&)�� ),e5L C Range hood/other kitchen
fi/ /5 � d '� � 1 A S equipment 33.39
Address: f0 � '"lr 'f ti1 Clothes dryer exhaust ..," 33.39
City/State/ZIP: 3 Single-duct exhaust(bathrooms,
�( �jG �'Z q---). ..2,3
��/�2 toilet compartments,utility rooms) 5 23.32
Phone:( 73 6 d .-/../37c" Fax:9 3) 1y'0 _:.76t9t Attic/crawlspace fans 23.32
PLICANI ',❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
0Ise $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
,/ /L J Range
E-mail: �!ti (.P UJ`d dl,�kom es 1vG�(} flt/® r (aril
CONTRACTOR,- Clothes dryer(gas)
Business name: -F,r5/ c4-pOther:
/� MECHANICAL PERMIT FEES*
Address: /3/5v //4y jtw5 (121,„„,., /2
Subtotal
City/State/ZIP: zik 6S Bn y z J Minimum permit fee($90.00)
v Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: —726;3TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: pra q/ 13.d / ) Date://JO
1\Ruildine\Permits\MEC PermitAoo 040 oc 440-4617T(11/02/COM/WEB)
Electrical Permit Applications R. JFFICE USE ONLY
RECENT:''
City of Tigard I .p DateBeceived
Permit#:
114
Ill 13125 SW Hall Blvd.,Tigard,OR 97223 OCT
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 U C Ir 2018 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready DateBy: June: 0 See Page 2 for
TIGARD Internet: www.tigard-or.gov CITY OF E ii -;:iID Notified/Method: Supplemental Information
R3C{�UILD{NG DIViCiaN4 PLAN REVIEW
TYPE OF WO
New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB;$ITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
0 Addition of new motor load of system
Job#: Job site addres (� �^n 4,16/M�� � //�/ I OOHP or more. ❑"A","E","1-2"."1-3"•
❑Six or more residential units. occupancy.
City/State/ZIP: / , (�n�3 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: `f Project name: Aita Ad '4 0 locations. 0 Supply voltage for more than
V ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: /AO V f� FEE SCHEDULE
Description I Qty. 1 Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: nitnq,nc1 /f9 x g15 Lot#: Includes attached garage.
y V 1,000 sq.ft.or less / 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential A
(with above sq.ft.) J 75.00 2
Iva.) d � Limited energy,multi-family
_residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
-PrROPERTY OWNER ' 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: to atcl iwzydcl at t od/A pi__ 200 amps or less 100.70 2
Address: ig6,5`5• CO A.Afe-1 1 pL�
Pc/A 6 lirce.-4 201 amps to 400 amps 133.56 2
^� 401 amps to 600 amps 200.34 2
City/State/ZIP: d'5 (tie,/ 0-c._ Q72...2-3 601 amps to 1,000 amps 301.04 2
Phone:( . 76tr)—1/3 7 Fax:(5D3 )5y0 7 , 4Over 1,000 amps or volts 552.26 2
Email: oa-tetcjZS MA.) 6, 1_64 j gra Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
ICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: troe. above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: za ir,40,5c friY�Tli L Sign or outline lighting 67.84 2
/ Signal circuit(s)or limited-energy
.2,00.-Address: .2,00.-! ' � Ddn panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: �... .�4, ®� "7'2,1-63-5 Additional
additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:�3) 57`q y 71,C Fax:( (/3) ‘5ib —97?-3 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.:/qG 7,2_4 Electrical Lic.4—evb Suprv.Lic.:4/Z.OS specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name /Vii 5 4, 1 s Date: ?//9/6 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
— ___..a 2 TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: C Ari, /, la ,4- .e. Date: Filo /0days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/1*- 5 440-4615T(11/05/COM/WEB
•
Electrical Permit Application—City ofTigard
RECEIVED
Page 2—Supplemental Information OCT 1 2018
Limited Energy Permit Fees: CITY OF TIGARD
Renewable EnergyPermit Fees:
Bull DING lDIVISION
RESIDENTIAL WORK ONLY: FEE SCHEDULE
combined: $75.00 DescriptionenwaQty. Each Total
Fee for all residential systems
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
D Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n 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
H V• acuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr i
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
H Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ F• ire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
E Landscape Irrigation Control*
n M• edical •
n Nurse Calls
E Outdoor Landscape Lighting*
n P• rotective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
Plumbing Permit Applicatio.
Building Fixtures4 I\ 1 FOR OFFICE USE ONLY
City of Tigard Receivedy Permit No.:
III n 13125 SW Hall Blvd.,Tigard,OR 97223Date/By:
Phone: 503.718.2439 Fax: 503.598.1960 OCTO C 2018 Plan Review
Date/By. Other Permit No.:
_ Y
Inspection Line: 503.639.4175
TIGARD CITY OF TIGARD DateReady/By: Juris 0 See Page 2 for
Internet: www.tigard-or.gov BU ( nSNG Dl\lSl� Notified/Method: Supplemental Information
TYPE OF WORK` FEE!'-'SCHEDULE
_.,�/" ew construction 0 Demolition For special information use checklist.
Description Qty. Ea. 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
S'1-and 2-family dwelling E]Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:///'Vt 953 0 4{/ nA AgAgit' II/I(auCatch basin or area drain 18.76
`
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7y 'j„� --,-�
��to�,� � n�G���� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:/9e!` A, • Manufactured home utilities 50.03
Cross street/directions to job site: V Manholes 18.76
10 9 . Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: M/lk/1-ds lito k/5 1 Lot no.: 6 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
``"'. DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
NTJ.J 5J72- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY•OWNER- I 0 TENANT Expansion tank 12.51
Name: puindk'c'o f / �a-s$-p, (_, Fixture/sewer cap 25.02
Address: /(9-4 5- Nr/5 5'' ,A9,4`Z 3.--./ Floor drain/floor sink/hub 25.02
77 Q7�
Garbage disposal 25.02
City/State/ZIP: Q_ Hosee bib 25.02
Phone:( .-2 "b--/-(20 7S Fax:(fe,3 54-, -7 011 Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ,50/n Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: //A./1,`i./i aro,et/ / , S/V14.7 t7V r''/ltll/,6/C,Gd,„ Urinal 25.02
CONTRACTOR
Water closet 25.02
Water heater 37.52
Business name: per- / fA!_M. 6%/y 6 Water piping/DWV 56.29
Address: /; // ) 5 61! 61 i PI Other: 25.02 ii
City/State/ZIP: O/ycoi► fi- I Dpi f795- Subtotal
Phone:(6-G3) 7g.:3 - / Fax:493) -7,,,36 ,e/ Minimum permit fee: $72.50
CCB Lic.: /!s� /3 9 Plumbing Lic.no.: Z C N� Plan review (25%of permit fee)
/ State surcharge(12%of permit fee)
Authorized signature: 7 1 `1-0 TOTAL PERMIT FEE
Print name: u )A 6.i kL'E' �/�f Date: J// 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.
I:\Building\Permits\PLMU-PermitApp.dos 10/01/09 440-4616T(10/02/COM/WEB)
ty ®,fTigard
COMCiMUNITYTigDEVELOPMENT DEPARTMENT
1111 I
T l c A R l) Building Permit Review — Residential
Building �n,STA0/,� �' _,.�.......:�-..tr�_ui�,�, -,-.71.,,..-::-._._.. _ _�_.JT-L.,' .-.
Permit #: / " '-O ,o?-
,o? 7 , ,�
Site Address: 10133 Ski AnNtmt rd) CL
Project Name: Annan clUe; h+s
(New dwelling=subdivision name;Addition or Alteration=last name of owner) Lot #:
Planning Review
Proposal: iv Cts/ S F
erify site address/suite#exists and active permit system.
Off River Terrace Neighborhood: Lid' No ❑ Yes,See River Terrace Review Addendum Attached
Sit Ian Elements:
ee(3)copies of site plan y►�,,
ire plan must be on 8-1/2"x 11"or 11 x 17"paper h sting structures on site
awn to scale(standard architect or engineer scale) ,i oorprint of elevationsw structure(including decks)with finished
111 a rth arrow PI
A Si a address,project or subdivision name and lot number ty locations&easements (required for new and additions)
plicant information(name and phone number) idewaln driveway approach
uLot dimensions and buildingsetback dimensions ���I' •cation of wells/septic systems 1;Existing trees to be retained with drip line,and tree
" uare footage of buildings to be demolished
p:y6tection measures
Letot area,building coverage area,percentage of coverage and [ eet tree size,type and location
isnpervious area(applicable if R-7,R-12,R-25&R-40) 1S Street names ��
roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? It es No
4 .of differential)
If es,is a storm water .uali facili shown? ❑Yes ❑No
0: Clean Water Services—Service Provider LetteyOot platted prior to 9/10/1995): '�f'"11 �,
quired: ❑ yes,applicant was notified No Received: �'"
Public Facilitie provement(PFI)Permit: ❑ Yes 0 No l� a Jyt
equired: Yes,applicant was notified 0 No Applied For:
C7 Yes 0 No,stop intake
,Land Use Case#: PD ZM —00008
litroning: k_12 (f 1))
ff Required Setbacks: Front I S Rear
1,S Side Street Side iI//f Garage le
Prj.andscape Requirement:
rne Lot Coverage Maximum: go %
(!d Building Height: Maximum Height
F,! J✓ Actual Height
isual Clearance
lei L
iti
Sensve ands: ❑ Yes
IK:� /No Type
Jrban Forestry Plan
EtY Conditions "Met"prior to issuance of building permit
Not :
Cid Approved By Planning: ieteinAAAL
(Or/P — Date: 1 6--t-18
Revisions (after Building Submittal only)
Revision 1: 0 Approved 0 Not Approved •
Reviewer Date
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
IABuildingTorms\BldgPernvtRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: / r le- -
Site Plans: #
Building Plans: #
Building Permit#: 'Enter building permit#above.
Workflow Routing: Vf.Planning Engineering Permit Coordinator liBuilding
WorkflowSign-off:S' -off: Sign-off for Planning(include notgs from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1)site plan, (1)building plan and
original plan review routing form.
f4'Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: r
�/ �� /J,�� , Date:
' L L.rL/ '
By Permit Technician:
E gineering Review
si--//Slope at building pad: 5 /0
lit onditions"Met"prior to issuance of building permit
£ Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes No
Assess Water Quantity Fee in-lieu: 0 Yes No
LIDA Facility on lot: 0 Yes No
[i Final Plat Recorded:
Date:
0 NOT Approved by Engineering:
Notes:
Er ��% la • Z-/8
Approved by Engineering: ���?f�t i--j . Date:
Revisions(after Building Submittal only)
Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
essassommonsongstsisesisooffilmamitommis
Permit Coordinator Review
0 Conditions "Met"prior to issuance of building Permit
0 Approved,NOT Releasee
-- Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant
Revision Notice 2: Date Sent to Applicant:
e.Iision Notice 3: Date Sent to Applicant:
ad SDC Fees Entered: Wash Co Trans Dev Tax: tel-Yes 0 N/A
Tigard Trans SDC: Yes 0 N/A
Parks SDC: FrYes 0
LIDA 0 Yes N/A
OK to Issue Permit /v /2.//2/S
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvvv_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
III Transmittal Letter
1 ;(IA it n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: �/yen DATE RIV ,,
DEPT: BUILDING DIVISION +' 2 2018
g} Y ii* I U$AR
FROM: ��M«.c1.�(1).+1. F= (Z—LCE�6 S.
COMPANY: iw:',J o w,.. s, .0 CA: :.i s `7`/^& c--(\o")
PHONE: 5b 3 78,)- Id 3 7 5 By "
RE: j00/3-3 s— Arm � O c-(t-i ZIer—06 a 0
(Site Address) (Permit Number)
p
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: 1 Copies: Description:
Additional set(s) of plans. (5 ' X Revisions:
Cross section(s) and details. 1� Wall bracing and/or lateral analysis.
Floor/roof framing. 1 ,)k)d)
I) Basement and retaining walls.
Beam calculations. (1v \f) Engineer's calculations.
Other(explain): l'd
P
REMARKS: p LAS (Lcv , o^J• S' 5 P(. D s„A...6 -F-_b�,4_
r
T-4,,,,- ,,-06- (. 2)--i 2 ( ST.
FO OFF CE USE ONLY
Routed to P- 1 it Tei "cian: Date: ti Z$ ( (b Initials: /4141-
Fees Due: a Ye D No Fee Desc iptio : Amount Due:
$ 1 — 6
I2 CtAin r.-er e.W $ C6�'
Specia
Ins .ctions:
' - .rint Permit(per PE): ❑Yes , o ❑ Done
Applicant Notified: , Date: `//i-"JI r Initials: j
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
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
=