Permit t CITY OF TIGARD MASTER PERMIT
" COMMUNITY DEVELOPMENT Permit#: MST2018-00192
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/25/2019
Parcel: 2S 110AC03900
Jurisdiction: Tigard
Site address: 11059 SW ANNAND HILL CT
Subdivision: ANNAND HEIGHTS Lot: 16
Project: Annand Heights, Lot 16
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 1040 sf Basement: 603 sf Left: 3 Parking Spaces: 0
Height: 34 Bathrooms: 4 Second: 741 sf Garage: 418 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2384 sf Value: $292,972.02 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 3 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: 6 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 add9 500 sf: 4 201-400 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
Other: N Other Description:
Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2384
Owner: Contractor:
ANNAND HILL LLC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 1 Geo Tech Required Prior To
12655 SW NORTH DAKOTA ST
Pour
TIGARD,OR 97223 2 Ersn Cntrl 503-639-4175
PHONE: 503-768-4375 PHONE:
FAX:
Total Fees: $30,584.61
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 0 R 952-001-0090. obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: e.---- ie mittee Signature: G
Call- ‘-7" 211.1 175 by 7:00 a.m.for the next available inspection date.
This permit ca an be kept In a-c3rTsp1-cuous place on the job site until-completion of the project.
Approved plans are required on the job site at the time of each inspection.
It '
Building Permit Application.
Residential t`
y�(y � FOR OFFICE USE ONLY
888 Received / If /t, Perm�1�3700.c T7 �/8..-(/)/ 2
City of Tigard DateBy: (,e ��( �T(/
NI 13125 SW Hall Blvd.,Tigard,OR 97 2 g Ol Plan Review (� /�� Other Per
•
' 0 Phone: 503.718.2439 Fax: 503.59 . 6 Date/By. 1 0- t L Or kc/0 t 'G.ej i 7?
TIGARD Inspection Line: 503.639.4175Tiv l;` ;R„ DateReadyBy: / luris: H See age2for
Internet: www.tigard-or.gov p�ki1l' '!n1� Iy�\►Y�'��� otified/Method 6 // �� Supplemental Information
ll
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
yNew 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.
Valuation: $ aha
and 2-family dwelling ❑Commercial/industrial _
❑Accessory building [3 Multi-family
Number of bedrooms: /1
❑Master builder 0 Other: Number of bathrooms: /
JOB SITE INFORMATION AND LOCATION Total number of floors: ' ) 0
•
Job site address: firUS C Jk) Alnand frilll 10 (04 '1 New dwelling area: ff square feet -)-)t-ii '
City/State/ZIP: 7--.4--a ii-ftp 0 21-.;-- 9 72. .-3 Garage/carport area: "quare feet /011-0
Suite/bldg./apt.no.: Project name: nn/)4nal 1-/Cr, A' Covered porch area: square feet (O3
Cross street/directions to job site: /0 f-a (� Deck area: ..2fistq /.7j square feet
Other structure area: r Y square feet
I
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: „Autie/ 1-/e0 A /5 Lot no.: e 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.
4/Ci'0 j'fy2. Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTYOWNER 0 TENANT Number of stories:
Name: it D e e504 co,(.S t-1 T 0it) pType of construction:
Address: /701-4 5 5w /11/2 D,14(661 f d'ciY-rt / Occupancy groups:
City/State/ZIP: 7A e,a✓ t Q'12_Z3 _ Existing:
Phone:(.5-03 70_L/ 7 c Fax:(t14_3) S'yo-7�e4 New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
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::( )
E-mail: lcj Wei 0/1145N a, ®&la a t o i Cc's PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
14)1 11 9/t�(tdCommercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Ij fmric'!1 dal&I-5 7._1-C... Submit two(2)sets of roof plan with connection details
� and fire department access,along with the 2010 Oregon
Address: A-G 5-5- j Ltd
� Nei- (f 4 /)&4d,4_ V+ -el Solar Installation Specialty Code checklist.
I City/State/ZIP: 7i en2 ,9-72-2--3 Permit Fee(includes plan review $180
and administrative fees):
Phone:(5". .60' -£ 75" Fax:( 6-03 6`90 -7aG C State surcharge(12%of permit fee): $'
CCB lic.: 6-0/96, Total fee due upon application: c
Authorized signature: ' - This permit application expires if a permit is not c
—. within 180 days after it has been accepted as cc
J S Date: / 'i *Fee methodology set by3 ri-County-Budding-Indy-- -
Print name:
-,; � Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
r
Building Permit Application Altecklist •
One- and Two-Family Dwelling / FOR OFFICE USE ONLY
City of Tigardtroot
Received
Permit No.:
.INI 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
Associated permits:
■ Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 ID Electrical 0 Plumbing ❑ Mechanical
1"IGARD 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. r ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. izr 0 0
3 Verification of approved plat/lot. .21El ❑
4 Fire district approval required. Name of district: g ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑
6 Sewer permit. 2 ❑ 0
7 Water district approval. 21` 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 ❑ Z
9 Erosion control ian ❑permit required. Include drainage-way protection,silt fence design and location of catch- Q 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 J ❑ ❑
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 Z ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 21 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- Ef 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 ❑
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- J' ❑ ❑
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 DP ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 W1
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 a ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 12t 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required re ❑ ❑
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 21 0 ❑
architect licensed in°relon and Shall be shown to be a.slica$Te 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. 17' ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 2 ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ 0
27 "Drawn to scale"indicates standard architect or engineer scale. 2' ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 2# ❑ ❑
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, El ❑ ❑
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)
Plumbing Permit Appbeatia
Building Fixtures ` E � i ,i FOR OFFICE USE ONLY
City of Tigard �� Received
2 8 2 01 t Permit No.:
1111 - a 13125 SW Hall Blvd.,Tigard,OR 97223 JUN 6a+ Plan :
Plan Review Other Permit No.:
Phone: 503.718.2439 Fax: 503.598.19{�Q t ti� !-,3 Date/By:
Inspection Line: 503.639.4175 '1...,11 I q u a {Ci.Nate Ready/By: Juris: El See Page 2 for
TIGARD Internet: www.tigard-or.gov BUILO N 1'1;,q... t N tified/Method: Supplemental Information
legl
ew construction ❑Demolition For special information use checklist.
Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
l-and 2-family dwellingSFR(2)bath 437.78
0 Commercial/industrial
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: c /t //1 i. r4 Catch basin or area drain 18.76
`l n� Fr 1/1/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tr6 O/L --- r-22-2--3Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: ,,pIa4c/d/<J A Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1® l 0 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: 1/1a/1i j/so /,2/5 1 Lot no.:/ Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
t.-) ��/L Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY'OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: p Idnd d'c,/ eajl S LT.- '� e•
Floor drain/floor sink/hub 25.02
Address: 5-5754D �(/�l/ // paid,__ � 4-G; Garbage disposal 25.02
City/State/ZIP: pc art" en � Hose bib 25.02
(4e73b
Phone:( -4(20 7 S Fax:(5 '3,5", -7 ,0t. Ice maker 12.51
CT APPLICANT ' ` ' 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: 56/
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
� � J �® � `` Urinal 25.02
E-mail: �� gtrc 6rdA. -",e5/l/G3 (9�/na i.4( Water closet 25.02
CONTRACTOR �/ 37.52
Water heater
Business name: �O!-Fk /ci,hL b I/y io Water piping/DWV 56.29
Address: /4,WO 5 64 `I iall ISI Other: 25.02
City/State/ZIP: ( 7//�an .04 �O ,5- Subtotal
Phone:(6Z3) �'70_3 ^�f9�� Fax:(5-e3) - ,5iG/ _ Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: ii0 .2 9 Plumbing Lic.no.: State surcharge(12%of permit fee)
Authorized signature: AZA/2_,..--- TOTAL PERMIT FEE
d Date: 1.7/1 This permit application expires if a permit is not obtained within 180 days
Lrint name: _%c vt f - after it has been accepted as complete.
41/ `�` *Fee methodology set by Tri-County Building Industry Service Board.
uilding\Permits\PLMU-PermitApp.doe 10/01/09 440-46t6T(10/02/COM/WEB)
Mechanical Permit Applicati "".( ''Li l`
g l , t.- r Ft JFFICE USE ONLY
-
City of Tigard Received
■ Date/By:
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 I{� + 4.��1
Phone: 503.718.2439 Fax: 503.598.1960 " `�' Plan Review
Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175
Internet: www.tigard-or.gova e' t, E" .Date Ready/13y: Jur s: H See Page 2 for
,NA ` f'Ilk r7 ¢i �ified/Method: Supplemental Information
� �
r .$ i , .;.. �,"%s "„* >'1GY)PE OF.,FVORK :, ..COMMERCIAL'FEE*:'SCHEDULE-;USE CHECKLIST
ew construction ❑Addition/alteration/replacement
Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
', '.:..:•.,CATE-GORX.OF CONSTRUCTION
� RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
J31::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
3
dO 3•SITIE INFOR317ATIOINi,AND LOCATION Heating/cooling:
/77 1/fT4 .�Air conditioning 46.75
��
Job site address:/A/57 .5-4.1- ASG Furnace 100,000 BTU(ducts/vents) ' 46.75
City/State/ZIP: 7---,,i,�a� J • n 2_-3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:`7 ` Heat pump 61.06
�� � 0/4 Duct work 23.32
Cross street/directions to job site: /of /4 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: /3-41,14 //O h b Lot no.:/6 Other: 23.32
y Other fuel appliances:
Tax map/parcel no.: Water heater ,/ 23.32
•.:4,4::-J--,---4'::(f:24,.:. DESCRIP'T'ION Olt WORK->. Gas fireplace/insert ,,'".- 33.39
�/ Flue vent for water heater or gas
/��� g/� fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ROPERT DOWNER ,, . 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 6 4)iit/1�� �t 51 T�. Range hood/other kitchen
Address: CdA(O,— 5c.. /Uiro6'h ,PG.�eiA S 6rel
equipment "� 33.39
V fT Clothes dryer exhaust 33.39
City/State/ZIP: 7-,, ,,,,„/
� ®e, .7.-22.2.3 Single-duct exhaust(bathrooms,
Phone:( �� 7G�( .L/ Fax: 3) toilet compartments,utility rooms) 0 23.32
-1-1
�6 vJ f U -:7‘UG Attic/crawlspace fans 23.32
PLICANT' 0 CONTACT PERSON Other:
`' �� -; � , � �, 23.32
Business name: t�0m� Fuel piping:
$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
�
I, Range
E-mail:
LV!/f (�dU Od JW"es lvc,_)d9�e3 1.114., 'Z (7 Barbecue
CONTRACTOR= Clothes dryer ry (gas)
Business name: -F rr Y /ti/ Other:
�3/5z) !' /ac L e#143 �
Address: `,z� Dr• MECHANICAL PERMIT FEES*
Subtotal
City/State/ZIP: 7,..„,,,,,A_ 4 0 d/i J a- < J Minimum permit fee($90.00)
Phone: Plan review(25%of permit fee)
( ) Fax:( )
State surcharge(12%of permit fee)
CCB lic.: "7Z6v13 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signaturel
_
1 Fee methodology set by Tri-County Building Industry Service Board
Print name: /143r-a. /�) Date /AA
\Ruildinv\Permits\MEC PermitAoo 040 13.doc 440-4617T(11/02/COM/WEB)
Electrical Permit Applicatiol i i - T . F. OFFICE USE ONLY
R
. City of Tigard Received
Date/B Permit#:
II r 13125 SW Hall Blvd.,Tigard,OR 97223 )1,N 2 8 7_01 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960' Date/By: Related Permit#:
Inspection Line: 503.639.4175 Cir ):. e�t, sem,l`t Ready Date/By: Juris: El See Page 2 for
T 1 G A R D
Internet: www.tigard-or.gov t�) l.1yl t G t &y i,�et �i,i Notified/Method: Supplemental Information
TYPE OF WORK 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.
0 Demolition 0 Other:
where the available fault current ❑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 ❑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: 0 Fireum
p p. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 1 0 Emergency system. larger separately derived
11^n Q� 11 / El Addition of new motor load of system
Job#: Job site address//05-5
r�/�G 4� 100HPormore. ❑"A" "E" "1-2" "1-3"
City/State/ZIP: /�� 9,-)22.3 ❑Six or more residential units. occupancy.
5 L f` ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: J Project name: M �a 'L ❑Hazardous locations. El Supply voltage for more than
F ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: bo th FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: /Lj,ia/I4/ flee),15 Lot#: 1� Includes attached garage.
V l 1,000 sq.ft.or less / 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
fr� 5F, (with above sq.ft.)
�G- Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
'PIWOPERTY'OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 1 '(A` t :9dd 6",s oi 200 amps or less 100.70 2
Address:
42G5–s' 6"CO N6e-Y ii pa /..,i U' -/ 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 7 ,, 't./� 6, f-72_...23 601 amps to 1,000 amps 301.04 2
Phone: (Irt3 • 7ha"i/3 ,s- Fax:(Cr3 )10 7 , Over 1,000 amps or volts 552.26 2
1, ! �et /1 s O At� J ldot Temporary services or feeders installation,alteration,and/or
Email: � b,r- fFJ c 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
LICANT ❑ CONTACT PERSON Branch circuits–new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Va ',e 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'l 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
,: .L ;. 4/.-cairrOu5C
,. ., .CONTRACTo12_;..,, . '. Pump or irrigation circle 67.84 2
Business name: ikiZ,(Tl/L Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: ��/ ' Ct.--, jinOdi I,fy / /7/ panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: `._ Z Gf )-5
Additional inspection(1 hr min) 66.25/hr
Phone: --.�j'3) 3-/'7 ....J,•7(11 Fax:(�(/3) 4Yb—97)-3 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is
CCB Lic.:/ l v7o . Electrical Lic.:6,— e Suprv.Lic.: OS specifically listed(%2 hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name iyez:5 4)4A Date: 6f,
/� 0 Plan Review Required(25%of permit fee):
�(, State surcharge(12%of permit fee):
Authorized signature:^ TOTAL PERMIT FEE:
, , This_permit application expires if a permit isnot obtainer)within 180
Print name: ClT'I'.y mc, -ADate: 7 days after it has been accepted as complete.
J * 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 of'Tigard •
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL.WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Renewable
Description Qty. EEachTote, *
Ren
y electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ 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
0 Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n Vacuum 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 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
E Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE-doc Rev 06/17/2015
City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: c-7-.),c17;"6 l Z
Site Address: I I 5C1 SVV A iris nd N! l I Cf-
Project
"Project Name: 1'iiV :I'ld t 11 Lot #: I L.e
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: N eV G
Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: VI No -%GA Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
;Three(3)copies of site plan 1/d xisting structures on site
%lite plan must be on 8-1/2"x 11"or 11 x 17"paper ►20 ootprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
;Worth arrow [Jtility locations&easements(required for new and additions)
jct.S. ite address,project or subdivision name and lot number lidewalk/driveway approach
Applicant information(name and phone number) �! ocation of wells/septic systems
..&,ot dimensions and building setback dimensions IE xisting trees to be retained with drip line,and tree
n quare footage of buildings to be demolished .rotection measures
1 et area,building coverage area,percentage of coverage and Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) lStreet names
Property corner elevations (2 foot contour lines if more than >1,000 sf of impervious area created or replaced? N j f No
4 foot differential) If yes,is a storm water quality facility shown? 04
eMI No
q Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified .g No Received: ❑ Yes ❑ No
121 Public Facilities Improvement(PFI)Permit:
Required: E Yes,applicant was notified •k No Applied For: E Yes ❑ No,stop intake
XLand Use Case#: PDI220N—U (
V. Zoning: (2-k;)( Pa),
Required Setbacks: Front \5 Rear tc Side -97 Street Side Garage 20
i:g.Landscape Requirement: 2 f_)
a.Lot Coverage Maximum: po
Building Height: .Maximum Height Actual Height 17314
Visual Clearance
Sensitive Lands: .tel Yes ❑ No Typer-,
1--) 5 1 01..
'LK Urban Forestry Plan e
_X Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: �;to Q 'L. Date: (.E1
Revisions (after Building Submi only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES 061417.docx
Building Permit Submittal _
Original Submittal Date: 11)-12(-�—
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning J'Engineering P1=Termit Coordinator L -Building
Workflow Sign-off: P Sign-off for Planning(include notes from planning review)
Route Application Documents: pl7 Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: AX:
G /I-641 iv Date: (,)-1-7-5-1/1
Engineering Review 74)
j2rSlope at building pad:
Conditions "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: ❑ Yes 'No
Assess Water Quantity Fee in-lieu: ❑ Yes Z No
LIDA Facility on lot: ❑ Yes ,No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 44 6 w e Date:7f/VAS
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:
C Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: 0 Yes ❑ N/A
LIDA ❑ Yes '®'N/A
OK to Issue Permit
WIl(
pproved byPermit Coordinator: )ate:
I:\Building\Forms\BldgPermitRvw_RES_061417.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
i i t;A k t) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: --l60SOlil. DATE RECEIVED: _
DEPT: BUILDIING DIVISION RE:CF > '
® JUL 1 2 2013
FROM: c,/c f�GL.c.- C ;a # 0
COMPANY: W (/\ /&A0..4.1
PHONE: 6-03- 7ria- '13 7c By:
RE: 00 4--f /97I h urs./ /,l, i /lt s7)ag- 9)—
(Site
(Site Address) (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 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 (-- C5 r t
Routed to Permit Technici. : Date: '7 (cQ `66 Initials: '11
Fees Due: ❑Yes E o Fee Desc olio : Amount Due:
$
p r‘f\) -- $
fi
Special
Instructions:
Reprint Permit(per PE): ❑YesNo ❑ Done
Applicant Notified: Date: T/2 7(a-- Initials: . 4-
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
_IN Transmittal Letter
r i 6 A ct n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: -1.•1\yspn DATE RECEIVED:
DEPT: BUILDING DIVISION A l I '``
AUG 1 6 2018
FROM: kA0C. 1`/ab CM'l'O .. i k( 't,e.;
COMPANY: 1)0tQ -r ,n
�c � 9 Cr ciAA,14;e41
SLI.
PHONE: -..n 'M– eiaKi i criAr
RE: .lc44„QQ iAti( C_`f' -5T-v2p/d —e0/9�,
(Site Address (Permit Number)
hillrYild
(Project name or subd' sion name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. )C Revisions: cticu0"(
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:
Routed to Permit _111 .j.an: Date: 4g j / , Initials: 1"
Fees Due: es�No Fee Desc 'pti s : Amount Due:
lb, ,(--�.6v�' c,4) $ c,f cz°1:21.0„
$
$
Special
Instructions:
Reprint Permit(per PE): ❑Yeso 0 Done
/x..
Applicant Notified:) � 1 Date: , ?,Z, (CT Initials:
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc