Permit (3) CITY OF TIGARD MASTER PERMIT
IIII.00- 4.1 COMMUNITY DEVELOPMENT Permit#: MST2018-00355
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2019
Parcel: 2S112BD12900
Jurisdiction: Tigard
Site address: 7691 SW HANSEN LN
Subdivision: ELDERBERRY RIDGE Lot: 25
Project: Elderberry Ridge, Lot 25
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 1063 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1290 sf Garage: 378 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2353 sf Value: $296,781.25 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 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: Y 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: 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 2353
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PL STE 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
370 BEAVERTON,OR 97006 2 1 Hour Fire Rated Eaves
BEAVERTON,OR 97006
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $31,522.25
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes :nd all •her 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 w'-rk is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce er. hose rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a c••y of the rut -er direct questions to OUNC by calling 503.232.1*:7 o :00.332.2344.
Issued By: 26.- ---e7--,--1.:.-d--, l :�— •- mittee Signature:
'639.4175 by 7:00 a.m.for the next avai able inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential RECEIVE;. 1.__O-v ,,7-:)
FOR OFFICE USE ONLY
Cityof Tigard DEC 2 0 2 018 Received y: � �k l Permit No. �� f._( t
g 0 eBy: , �
II 2 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1/
Phone: 503.718.2439 Fax: 503.598.196 y; / y Date/B { y i9 Other Permi � �j�
TI GA RD Inspection Line: 503.639.4175 CITY OF .l�UtAR Date Ready/By: 7uris: 0 See Page 2 for
Internet: www.tigard-or.gov 1�IjIIa�jI1\� DIVI�7I Not d/Method: Supplemental Information
Pa J !U l _,(( k7
TYPE OF WORK REQUIRED DATA: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
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑✓ 1-and 2-family dwelling ❑Comrnercial/industrial Valuation: $ 2‘j(19/ 75 /
❑Accessory building IIIMulti-familyNumber of bedrooms: ,¢�
❑Master builder ❑Other: Number of bathrooms/...2;4i -3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Z771/
/
Job site address: 7691 SW HANSEN LN New dwelling area: 2353 square feet (a9a
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 378 square feet I ok,a
Suite/bldg./apt.no.: Project name: Elderberry Ridge Covered porch area:X square feet
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave Deck area: square feet
Other structure area: square feet
1t UIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Elderberry Ridge Lot no.: 025 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 2S112BDO0300 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.
Construction of SFR — 2353 A l..- Valuation: $
Existing building area: square feet
New building area: square feet
Q PROPERTY OWNER 0 TENANT Number of stories:
Name: Riverside Homes, LLC Type of construction:
Address: 17933 NW Evergreen Pl., Ste 370 Occupancy groups:
City/State/ZIP: Beaverton, OR 97007 Existing:
Phone:( 503)645-0986 Fax:( ) New:
0 AP?LICANT ElCONTACT PERSON BUILDING PERMIT FEES*
Business name: Riverside Homes, LLC (Please refer tofee schedule)
Structural plan review fee(or deposit):
Contact name: Wes Boisvert NJ ' PfV Xi
FLS plan review fee(if applicable):
Address: 17933 NW Evergreen Pl., Ste 370 Total fees due upon application:
City/State/ZIP: Beaverton, OR 97007
Phone:(503)645-0986 Fax: :( ) Amount received:
E-mail: wboisvert@riversidehome.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: Riverside Homes, LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 17933 NW Evergreen Pl., Ste 370 Solar Installation Specialty Code checklist.
City/State/ZIP: Beaverton, OR 97007Permit Fee(includes plan review $180.00
and administrative fees):
4,,,
Phone:( 503)645-0986 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lic.: 189148 Total fee due upon application: $201.60
Authorized signature: (..;&("6This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Nikki Pruett Date: 12/18/18 *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)
i
' Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received114 Permit No.:
- II 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
I Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
T I GA R D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l'es No N/.1
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ 0
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. ❑ 0 0
7 Water district approval. ❑ 0 0
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- ❑ ❑ 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 ❑ ❑ ❑
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 ❑ 0 ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 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- 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. ❑ ❑ ❑
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 ❑ ❑ ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 ❑ ❑
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 0 ❑ ❑
architect licensed in Ore.on and shall be shown to be a..licable 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. 0 ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. 0 ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9,1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit AnnlicattrECEIVED
FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit No.:
111 l' 14 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �®��
Phone: 503.718.2439 Fax: 503.598.1960 DF c ® 2 Q Date/By: Other Permit..MS O g...W JS.5
I'I GAR D Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE O> ING I 'ISI®IV COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
✓❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTT.N 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 ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address: 7691 SW HANSEN LN Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP: Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Elderberry Ridge Duct work 23.32
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave 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: Elderberry Ridge Lot no.: 025 Other 23.32
Other fuel appliances:
Tax map/parcel no.: 2S112BD00300 Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 33.39
Flue vent for water heater or gas
Construction of SFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0PROPERTY OWNER IDTENANT Other 23.32
Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Range hood/other kitchen
equipment 1 33.39 33.39
Address: 17933 NW Evergreen PI., Ste 370 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Beaverton, OR 97007 Single-duct exhaust(bathrooms, 11�
toilet compartments,utility rooms) 5 23.32
Phone:(503 )645-0986 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT ❑✓ CONTACT PERSON Other: 23.32
Business name: Riverside Homes, LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Wes Boisvert Furnace,etc. 1 14.15
Gas heat pump
Address: 17933 NW Evergreen PI., Ste 370 Wall/suspended/unitheater
City/State/ZIP: Beaverton, OR 97007 Water heater 1 14.15
Phone:(503 )645-0986 Fax::( ) Fireplace 1 14.15
Range 1 14.15
E-mail: wboisvert@riversidehome.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Pro Heating & Cooling Other: *
MECHANICAL PERMIT FEES
Address: 2095 NW Alocleck Rd.#1103 Subtotal
City/State/ZIP: Hillsboro, OR 97124 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 971) 205-4989 Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 209001 TOTAL 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: Nikki Pruett Date: 1 2/1 8/1 8
I:\Building\Permits\MEC_PermitApp_040113.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
Electrical Permit ApplicatioRECEIVEP FOR OFFICE USE ONLY
City of Tigard Received�y Date/BPermit#:
INa 13125 SW Hall Blvd.,Tigard,OR 97223 fl E C 2 0 2018 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 py Date/B : Related Permit# STS '�3`� ,
Inspection Line: 503.639.4175 CITY OFTIGARD Ready Date/By: .ruris: 2 See Page 2 for
T I C A lZ D Internet: www.tigard-or.gov (� Notified/Method: Supplemental Information
TYPE O>-w P1N 3' .. PLAN REVIEW
❑✓ New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑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.
❑✓ 1-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.
0 Multi-family 0 Master builder 0 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: 7691 SW HANSEN LN 100E2 or more. ❑"A","E","1-2",`°t-3",
City/State/ZIP: Tigard, OR 97224 13 Six or more residential units. occupancy.
g ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Elderberry Ridge 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: SW Bonita Rd & SW 76th Ave L. FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Elderberry Ridge Lot#: 025 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 2S112BD00300
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Construction of SFR
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑✓ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen PI., Ste 370 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Beaverton, OR 97007 601 amps to 1,000 amps 301.04 2
Phone:(503)645-0986 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,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
Branch circuits—new,alteration,or extension,per panel
EI APPLICANT ❑✓ CONTACT PERSON
A.Fee for branch circuits with
Business name: Riverside Homes, LLC above service or feeder fee,
7.42 2
each branch circuit
Contact name: Wes Boisvert B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 17933 NW Evergreen PI., Ste 370 branch circuit
City/State/ZIP: Beaverton, OR 97007 Each add'lbranch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)645-0986 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: wboisvert@riversidehome.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sunlight Electric Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 2804 NE 65th Ave. St. D panel,alteration,or extension.
City/State/ZIP: Vancouver, WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360) 518-7589 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 lirmin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 172549 Electrical Lic.: C230 Suprv.Lic.: specifically listed('/�hr min)
/ �� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Chester Garrett Date: 12/18/18 ❑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 is not obtained within 180
Print name: Nikki Pruett Date: 12/18/18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PemutApp_ELR_ERE.doc Rev 06/17/2015 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
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable 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
❑ 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:
n Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
r
COMMERCIAL WORK ONLY:
— ELECTRICAL PERMIT FEES
Su
Fee for each commercial system: $75.00 allowetal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n 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
, Plumbing Permit Application ECEIVEP
Building Fixtures FOR OFFICE USE ONLY
Received
City of Tigard F C 0 2018 Date/By: Permit No.:
41 lit13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.rrn
O/� TIGARD
I G qq��qqp� Other Permit No.
if 1yl�tkit�Iil Date/By:
Inspection Line: 503.639.4175 Date Ready/By: kris: 0 See Page 2 for
TIGARD pg } y'
Internet: www.tigard-or.gov 'UTtl mrivr: 'Qt11A'IJ!t"1( TV Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist
Description I Qty. Ea. I Total
0 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
I l 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION j Site utilities:
Job site address: 7691 SW HANSEN LN Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97224 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Elderberry Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave Manholes 18.76
Rain drain connector 1 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Elderberry Ridge I Lot no.: 025 Fixture or item:
Tax map/parcel no.: 2S112BD00300 Backflow preventer no backflow for this home. 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Construction of SFR Clothes washer 1 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
pr PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Riverside Homes, LLC Floor drain/floor sinlc/hub 25.02
Address: 17933 NW Evergreen Pl., Ste 370 Garbage disposal 1 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 2 25.02
Phone:(503)645-0986 Fax:( ) Ice maker 1 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Riverside Homes, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Wes Boisvert
Roof drain(commercial) 12.51
Address: 17933 NW Evergreen Pl., Ste 370 Sink/basin/lavatory _ (Q 25.02
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax::( ) Tub/shower/shower pan _ S 12.51
E-mail: wboisvert@riversidehome.com Urinal 25.02
Water closet 3 25.02
CONTRACTOR -
Water heater 1 37.52
Business name: H & H Mecanical Water piping/DWV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Minimum permit fee: $72.50
Phone:( 503 975-978 •• Fax:( )
CCB Lic.: 178122 g Plan review (25%of permit fee)
Plumb' Lic.no.: PB414
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Nikki Pruett Date: 12/18/18 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.
L:\Buildng\Pemtits\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-1'100' 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' 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/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower 1=1 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 0 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.
-3"
Car Wash Drain Isometric or Riser Diagram
`
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
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/Lav -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:
C:\Users\npruett\Downloads\PLMF_PermitApp.doc 2
Rtvi
41 City of TigardIzejtui,
COMMUNITY DEVELOPMENT DEPARTMENT
T GARB Building Permit Review — Residential
Building Permit #: me i aC1-(jj'=f-j
Site Address: Wil S W {-dNu„ Lel
Project Name: 0U rb(r lgic Lot #: ZS-
(New dwellingsubdivision name;Addition or Alteration=last name of owner)
Planning Review n 1
Proposal: �Jt J SF-g, —2.3S3 AL //e f i ? yl.ek) tel}- /7,64 / Neto --fixes
LJ Verify site address/suite# exists and active permit system.
River Terrace Neighborhood: Lit" No 0 Yes,See River Terrace Review Addendum Attached
SiX Plan Elements:
if Three(3)copies of site plan �i9dsting structures on site
eidewC • e plan must be on 8-1/2"x 11"or 11 x 17"paper L�11~'ootprint of new structure(including decks)with finished
yawn to scale(standard architect or engineer scale) flyor elevations
orth arrow ty locations&easements(required for new and additions)
e address,project or subdivision name and lot number
alk/driveway approach
.plicant information(name and phone number) cation of wells/septic systems
6 o dimensions and building setback dimensions LTrxisting trees to be retained with drip line,and tree
1/ ffliare footage of buildings to be demolished r tection measures
Riot area,building coverage area,percentage of coverage and et tree size,type and location
IL(JSpervious area(applicable if R-7,R-12,R-25&R-40)
treet names
R roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? L1'(es No
4 foot differential) If yes,is a storm water quality facility shown? Ote440No
Ln` Clean Water Services—Service Provider Letter/(lot platted prior to 9/10/1995): L4,('ktvt, L4.4/rL�3
equired: 0 Yes,applicant was notified " No Received: ❑ Yes 0 No ( I "'"4
Lam" Public Facilittie mprovement(PFI) Permit: 0�
equired: (g" Yes,applicant was notified 0 No Applied For: [ s 0 No,stop intake
El and Use Case#: PV�2,016-0006q
[�7//Zoning: g- -( po)
L� Required Setbacks: Front IS Rear I,$ Side 7 Street Side Pli- Garage Ze..)
Er andscape Requirement: 2.r)
of Coverage Maximum: go %
lier Height: Maximum Height K.C. Actual Height 2.1S
0-Visual Clearance
ensitive Lands: El Yes [u No Type
V Urban Forestry Plan
® Conditions "Met"pror o issuance of building permit
Notes: Cajit.0..1 r..J r r- b.,;th,j .— idduw,u.
I
Lif
Approved By Planning: -lid— Date: 12--lA-1
Revisions (after Building Submittal only) z Reviewer Date
t
Revision 1: E'Approved ❑ Not Approved •,,!�y2H ( f I- g—lq
Revision 2: 0 Approved ❑ Not Approved 1
Revision 3: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES 061417.docx
Building Permit Submittal
Original Submittal Date: a 1. l t�
Site Plans: # 3
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing 2/Planning Er/Engineering [ 'Permit Coordinator ['Building
Workflow Sign-off: ['Sign-off for Planning(include notes from planning review)
Route Application Documents: R'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: '\ ut �. Date: \'x, &
En:ineering Review
r Siope at building pad: 4
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 ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: ..011...._ Date: Z
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
Cl Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
.sion Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: [� CI N/A
Parks SDC: Yes /N/A/A
LIDA El Yes
OK to Issue Permit
Approvedby Permit Coordinator: 4 Date: /17
I:\Building\Forms\BldgPennitRvw_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
al
Transmittal Letter
$11
T 1 G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Jll 1 DATE RECEIVED:
DEPT: BUIL INGDIVISION
RECEIVED
FROM: %/ K/(i / Z77- JAN 3 20119
�
/ CITY OF WARD
COMPANY: i,v7-,c j �4
/, I
' '-1 5 BUILDING DIVISION
PHONE: c 4-7 S , 0 / BY:,,I
,�
RE: 14, 01 ( s HaN E \ ,i/57 -07- C 3,5 j
(Site Address) // (Permit Number)
0- 6c bN- j' ho1 5
(Project name or subdivision name and number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. X Revisions: P3 'F(A,M P Pr-10 (1 )
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls. f 4,
Beam calculations. Engineer's calculations. A �(� �� �'
Other(explain): \A
PO-A
CI�..v ke -A9 a�`2 �
REMARKS: e LG�Le �.
i. pLce w R( \ puUlecl ane )ft.-eQ- O . C . y'A
V7 &-5t5 Y: 3 / Y - 4
FO TICE USE ONLY
Routed to Permit Technician: pace: 1 ( 1 Initials:Fees Due: ❑ YesN� Fee De cripAmount Due:
QO _). - -' $
$ 7:;. .._ ______
$
Special
Instructions: 7"
Reprint Permit(per PE): ❑ Yes I M, o ❑ Done
Applicant Notified: V..,v_ Date: g/1//4 Initials:
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.
IIII City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
4 •
Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: MiLl 5a \ 4 r9, DATA c .E AL,
DEPT: BUILDING DIVISION
t�
F684 2019
FROM: I ( 1'eAt e h CITY OF TIGARD
8UILDING DIVISION
COMPANY: A Verb d( Hume S
PHONE: SD? b L/S d ci V70° By:67/e
RE: 1(6'671 SU) 14401seli LI) ps-i- Zvi - Ula SSS
(Site Address) (Permit Number)
'ridge- Y1e,—tt Ciame
(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. -X Engineer's calculations.
Other(explain):
REMARKS: .Ti®--12 sS L j 00 5 4 er �0ee� G i o 6e S C ( t 1 &ieP-a '
G4PI a-?na I
FO F ICE USE ONLY
Routed to Pe •' Tec : Date: V / 1 Initials: APT--
Fees Due: Yes Fee Des 'ptiion: Amount Due:
Special
Instructions:
Reprint Permit(per PE): ❑YesNo ❑ Done
Applicant Notified: V/ 7______
Date: g 1( <y Initials:
I:\Building\Forms\TransmittalLetter-Revisions o61316.doc