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Permit (2) CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2020-00060 T"I(;A R.ft) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/10/2020 Parcel: 25109BB02903 Jurisdiction: Tigard Site address: 14305 SW HIGH TOR DR Subdivision: HIGH TOR WEST Lot: 29 Project: HASHIMA Project Description: 528 sq. ft. detached accessory structure for recreation room including sauna,bathroom and storage room. WATER METER FIXTURE WORKSHEET REQUIRED PRIOR TO ISSUANCE. BUILDING Floor Areas Required Setbacks Required Stones: 1 Bedrooms: 0 First: 528 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 11 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 528 sf Value: $64,658.88 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 1 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Electricity Heat Pump: Y Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 4 Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr. 0 Mfd Home/Feeder/Svc: 0 401-800 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm. N Vaccuum System. N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 528 Owner: Contractor: HASHIMA FAMILY TRUST PINEHURST HOMES Required Items and Reports(Conditions) BY HASHIMA,JASON N&LISA K P.O.BOX 3665 1 Ersn Cntrl 503-639-4175 TRS TUALATIN,OR 97062 14305 SW HIGH TOR DR TIGARD,OR 97224 PHONE: PHONE: 503-407-1102 FAX: 503-336-0437 Total Fees: $3,856.74 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. Thi permit will pire if work is not started within 180 days o . , or if work is suspende for mo e 180 days. ATTENTION: e-..-t law requires you follow rules pted by the Oregon Utility i icati$n Ce er. Those rules set rth in OAR 952-001-0010 throu• OA- •52-001-00-' 'ou obtain a of th les or direct questions to OUNC by (ling 509.2 .1987 or 1.800.33 Issued By: Permittee Signature: Call 503.639. 5 by 7:00 a.m.for the next available inspectiomd This permit card shall be kept in a conspicuous place on the job site until co e ion of the project Approved plans are required on the job site at the time of each inspection. Building Permit Application • Residential FOR OFFICE CSF,o11.Y City of Tigard y Received .., .i.... Date/B : i t. » �. ./// , .� r ;� 13125 SW Hall Blvd.,Tigard,OR 97223s $ /,� ti / e g <,r� a ' Plan Rcv�cw I / Iu., Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 Date,B 1 1 ci A RI, Inspection Line: 5503.63..4175 FEB 13 202:; Date Ready/By- 0 See Page 2 for liri Internet: www.tir d-or. ov No[ified�'Method: ` Supplemental Information TYPE OF WOR,IC "; = REQUIRED DATA:I-AND 2-FAMILY DWELLING ID New construction ['DemolitionPermit 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,f and�� the f the CATEGORY OF CONSTRUCTION work indicated on this application. l c9 l!t VI-and 2-family dwelling ❑Commercial/industrial Valuation: ❑Accessory building El Multi-familyNumber of bedrooms: p El Master builder ❑Other: Number of bathrooms: t/Z JOB SITE INFORMATION AND LOCATION Total number of floors: ' Job site address: / li3 O s S Gt.,/ t(,/I L.d./ rod Ma. New dwelling area: S 2 t square feet City/State/ZIP: Ti V a,z p co Garage/carport area: gc square feet Suite/bldg./apt.no.: 1 Project name: AI A SNr . A Covered porch area: f square feet Cross street/directions to job site: Deck area: if square feet tej, /4,.-c�I Ij,�/� ��/Y f Other structure area: square feet f f1 . . t Pi • c,to- .Sb`5, • �f.0 REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: l/ / Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: 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. 1)Cr L R e C 0SSC,77f S�"7� UCa'2Lf'_5. Valuation: $ ADQIUL flEc. 2sb-, !Ai C ,_ult ,r.1e Existing building area: square feet Sslzc: /LCL57-4 S Ia 1"C=E: /'.t.'1-A0 . 46/4-77".7.27 6, - F t'+r T,te_r_ /,,1 c^$re,c1.,, ,_ fzemze l Itigrizt New building area: square feet ❑ PROPERTY OWNER 0 TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: Ig APPLICANT X CONTACT PERSON BUILDING PERMIT FEES* ?/ ,TC/t-tu/2S:' /laMu-c (Please referrojeeosit): t� Business name: Structural plan review fee(or deposit): Contact name: Z p,J j, Aij GkA/..� Y FLS plan review fee(if applicable): Address: I ,f .. y 5 w c. S Aux- 461 / 9 / Ci /State/ZIP: Total fees due upon application: ty CA osc,, sC0 / o 2 t} 7035" Phone:(So, l L1U7 1 l e -2... Fax: :( ) Amount received: �� �1 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: v q,J n7 r r/V EFlU/t 57<Io+rITS. U S Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: Submit two(2)sets of roof plan with connection details //sa 1-tLl u/L s 7 r�0 iY.er 5 and fire department access,along with the 2010 Oregon Address: L( C./ (, G-0, A.. 6— .Is i qi / Solar Installation Specialty Code checklist. City/State/ZIP: ,,Hk S C S W b (.0 r 0,4 9- 70 3. Permit Fee administrativenes plan review $180.00 l and fees Phone:(5-03 vo 7—// 0 L Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: /8 y r. 4 L /(!/(O 724) Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained 0� Ai."C.Atha ....__,,.� within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name: Date:Z /3 l f0 Service Board. I:\Building ermits\BUP-RESPermitApp.doc 02/24/201I 440-4613T(Il/02/COM/WEB) Building Permit Application Checklist • kf One- and Two-Family Dwelling FOR OFFICE ESE OM ° Cityof Tigard Received . g ADate/Bssociated : Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 • Phone: 503.7182439 Fax: 503.598.1960 Associatedpennits: T 1 G It 1 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov 0 Other: TII I: FOI.FOW'ING ITEMS ARE REQUIRED FOR PLAN REVIEW No, No N%‘. 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 ❑ 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ ❑ 3 Verification of approved plat/lot. ❑ 0 ❑ 4 Fire district approval required. Name of district: . 0 ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity 0 0 El 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. 0 0 0 9 Erosion control 0 plan El 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 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 0 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ 0 0 floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0 Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ 0 0 prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 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 0 0 ❑ architect licensed in Ore•on and shall be shown to be a.I licable to the ,rdect under review. JURISDICTION:kl. SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ 0 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 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 and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:Building Permits\BUP-RESPernutApp.doc 02/24/2011 440-613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLI City of Tigard v,- Received g i Q t, Date/By: PernlhNo.: 7�ap '000(ofl • 13125 SW Hall Blvd.,Tigard,OR 97223 "'!„*9s" '. Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: T I G A R U Inspection Line: 503.639.4175 FEB 1 3 2020 Date Ready/By: Jude ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF W t 1,NI G L i t l i fy`10 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑ New construction 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 CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* k] 1-and 2-family dwelling ❑Commercial/industrial ❑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 46.75 !Job site address: 1 3 ps S W ,y A( � 7 04 f J\\R, Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 1-1 L.A ecn, O 2, Gicssit.3Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump I 61.06 Suite/bldg./apt.no.: Project name: 4.4 c ' i„', Duct work 23.32 Cross street/directions to job site: 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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas Pr I)to #1-•14.11 — SA'1--2-7' , 73 A-7..4 F-0e1,j fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Oth 0 PROPERTY OWNER El TENANT S' 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen Address: equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 • g APPLICANT IV CONTACT PERSON Other: 23.32 Fuel piping: Business name: 2 /ha e" Z S 7 4 vJoD S $14.15 for first four;$4.03 for each additional Contact name: RYwaa) Ci1nN,6rtl.Q .- ` Furnace,etc. Gas heat pump Address: i (a 6 6 7 s (-,/ 5 A u 3- L-4 ! 5 - Wall/suspended/unit unit heater City/State/ZIP: Lot Fm S- 0 S W v G O 02 1-2 O ?3 Water heater Phone:(See)4 U 7_ Ito Z Fax::( ) Fireplace Range E-mail: gy , jZ) I p , EM l,2S--7 alto rvttTS. L S Barbecue CONTRACTOR Clothes dryer(gas) Other: Business name: ''A co as 14.4 tIits-7,, i C. -'LAICAL PERMIT FEES* Address: Li Li--7 y S e lvi I L t.lt,A vic-,cr A u is Subtotal City/State/ZIP: ?p a 9 Lim., A , 0/t q'-72 U Minimum permit fee($90.00) Z Plan review(25%of permit fee) Phone:(51 1 2.3 y _--)3 3 1 Fax:( ) State surcharge(12%of permit fee) CCB lic.: / Li y 1 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signat • * Fee methodology set by Tri-County Building Industry Service Board Print name ���—� Date: ?//62/25 1 B I: uilding1Permn\M sEC_PermilApp_040 113.doc 440-4617T(11/02/cOM/WES) 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 Application 0.0.:.,1+ r Cit-. ofTigard :Doe 1,45 Perrade, a Etafl 13h4 figard.OR 17L'2,1 ram an*. f-o44, ‘14 7 $.1419 Law* [ ado*Pomo s i Una 11 1)pardlitaldmnem4iN14 repard-er pa weary Moe., 4e4 I 111144Pme2for hapealo•L . 601 OW 4 175 Ware* ...no opod-or ro PdadAr115M1411•11 I I liappiemmal bkruSen TOTE 06 WORK PLAN IIIVW - pi...th,,,4.4,a4,.2.26,04444o,a ou er pm 4 wee.Maim r .ft IVE 0 New curistrumon Addukm'shmuintOmpliscomm D„..,,,-...,...,..u.0 u,c,usu..rsuu 0 itussme 0.,au, 0 Demolatoo o.,.... ..„,..,.,,,...*IMO(,Yrrn1 CI ,61.8.1.0•aaa tce1,444, CATEGORY Of CONSTRIA_I PUN r 44,46,,,,,,,.4f.,or..o 1S7.-44,4 0 1-10R47117.6177'716 1 0 2020 t_sad 2-Bally dwelling El c,..,,ncrcsat inuu.mat El Acur,sorr Wilting{-F Multi-family D Niactcr 14441t4 0 Coheir: 4.,k,puv.e or f 1-.404;4 455 0(cgmaerrel ums 4,,' ars*.,a,01 mac,44141,42,,os E,4',1"444, ,.,..uut-• 0 aaallarWal 0 1.55 11,7 Ay, F FIGARO JOS SITE INFORMAT1061 APS LOCATION C 7 44 woe, 11..,4 11'7 C 44114.,.4..,-4.4.i.e.,o ki,P' RAI Sit adorns:/61, 66/ / -ro A DA Kum 4 Ice it, Elsa a 11...lr 11.7611.1.114 VW. '":'::: IN G DIVISION! CiW'SweIZIF% 7/1..".40, 0.4 014•410-we WII•Lax ID Itarrons.5,4 5 vd4c5r poks SanldhlaglIpt it P i t a all= 404 CO-11 boa 44 011aaarano wow 0 afRoph,4444r in rat ilma D6orm..no innor ila won a eiSaPt Cme.s tamtudiamisms m Oh iliac PSI 01C1IMPULA -r - larailoan 1 On.1 lea 1 tan I• non nallarial nag*or im111-11anily Swans malt 1' Subdivision, i Us a: INalloaa allaaboll wasp., - 14106 ma a ra kw , 16E64 4 Tax R*6716afae4 ft __ _ DESCRIPTION OF WORE land ant!,raufloaal - 11110 - Wulf&Noe* 114 A 0.0 12 r c_ 1)*C...... l.maced man,enalo-heilit. . 1100 : 2 omalaterfa114.146*ow*II 0 Peoporn moms I 0-retort Renal*Elam 0 tior Pow 3 Santini o;liesion rirroge,limos raft,rebeedso Nam: ,X.rapt cr kw 1 , 100.10 2 301 mos ft*OD nan 1106 2 Address. , ' *I apt NIDIONIps 10034 2 CSisiteMP: 0I use.an OM sop 301.04 2 non=1 i (Ter LOY/=pia oohs 552,26 2 ^--- Temporary nerriess se Irina Imallaisra,altannion.BMW, Email: mho** Owner installation;This inanlon is being nada in properly diet I olio which is nes MI swam less aftencial for oak,Moe.rum,at essthumic,Rico:Naas to ORS 447.449,PN 0141 )I. , 201 Nora ia*V ear 123,041 2 (Po rual.447•4711164' Dow 401 far.,14 55#',an". 166 54 2 , Smack dreaiss-ma,MasdaoN or egoist.tor Iasi -it APPLiCANT (1'CONTACT MOON A,froc for Mad,roma on% BL61,14,5,r*** ?!ad 6rAtv C V. 49.,X S dao.is.,KE,Reda for_ q 142 444-11 Oran.,iassa o , Carat,mow p ,,,,„, . L o 4 O we 44.161.••-•••••.. 8 Fee tot brim.*canvas.rralreao coo4ce or Sato fee,fee Adar, a tt1 !L. 6 6 1 _ . ..44 1Eo if 1 bh a , W7 4II 2 CltStZW 2: Illisallonoin nanny or NMI*904 1;*111111140 SO 3-4or 67—i I o 2, • 67.14 1 1 i dm.canal.SU ote video.knew Email: Ry ia...ir .'1/4, it4 ya4S-7 Ai co-t.S.e... 5 Ney 6714 2 1, CON'IltACTOIR Pomp a 4,1pasm rade 6706 2 1 likankciar oakum 2,c,... E L. F4721/L-4.4 1 ittr,4,,,c Foe ararra* 61 II 1 1 S%To;..4.4m1.1‘.7.47.0-catalp 0 hop paw 2 2, Add.r%- 2 8-,o s E -2 3 A vr -02.63 p4oe,444.o."A ••=4...st Lat6 sciatica.,imperils.inn.alloonlas In say M'Nos Mom ' Ciry-Sam2IP ).4,4,1_,s gairi n, n< Miroasau,revrzaT3....I 1 I.MO I biZ-kr • Pti'4" ca 1- (...i 2.- 2 b 6 0 kwelpganc.,l re n",1 90.00 a ' lodwarai per(1 or 11:41111i , Til 1 Ft k Rozekar;ler-Or-IC.4'ff:- bapwam .,, o for o NO a...ice a. *00 Or CCB Lir..)5 714:11 allixtrual LIC ii....93‘C , Stjpry lic_:ti.23.1. c ..paulfrziA7 hoof CA ts EOM) ladECIEICAL BMW 1,613 S .Eluctrician. uranium.MIltarud" esr7" Seristrok Prins amne...Sie rhe, 2/1/41 c 0 1 0pun 11,...r.r..p...0 121%alf pima flikt Sine OINEIM4,4 I..I 216 a peak Ark Alfaloonted etanallim'-'-'e-2- ----- -- h/ TOTAL PERMIT FEE laN lorrnla aosonia @spin.if•permk Is MN eiarlamluiell•Oa PM ---exafnc 40.42--"-f , 211,...JC A4,4 -- Bac 22,) aim OW is We Iwo imprl Is naqam. • 14•0444 a r...r.v ium 9.1.7.44 per pr.., kis famos...kill Rai a on go N.an* aa.-5141,1515 0 tILArvell Electrical Permit Application it),)," ' , FOR OFFICE USE ONI , City of Tigard - 1 3 20`• DatNBReceived Permit#/ys p�Q. QI g 41 13125 SW Hall Blvd.,Tigard,OR 97223'Pi Plan Review Phone: 503.718.2439 ",r Date/B : Related Penn it#: Email: TigardBuildingPermits@Tigardor.gov ,',_ Ready Date/By: Inns; RI See Page 2 for T I G A R D Inspection Line: 503.639.4175 Internet:www.tigard-or.gov 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): ['Demolition Other: 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current ❑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 Multi-family El Master builder El Other: less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AM) LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: / 100HP or more. ❑"A","E"."I-z ,"ta", Ci /$tate/ZIP: ❑Six or more residential units. occupancy. n' r I` ,/i A /Z, 0 4 ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 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 (with above sq.IL) 75.00 2 1((! =0 -•I0�(J A.wP <t 1R (:).4AK.F•,- L Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less / 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) 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 I 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 tp APPLICANT I IXCONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 „L., E l.d t r? C7 AI 0,,,,,, S each branch circuit Contact name: I> B.Fee for branch circuits without r' service or feeder fee,first 56.18 2 >rwJ Aes-IG1.asa Address: I (, D (9 5' S G,J (o S A.., S f c I branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 1.6..,c 3 b S Cv S G U, a Q Miscellaneous(service or feeder not included) Phone:( )°c 7 —c i 0-7 1( 0 7 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: 12 O S S L�L7� i f 64` Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: 2ef-20 S C -73.t CI A u 7- .dL 7 o 2 panel,alteration,or extension. 0 See Page 2 2 Each additional inspection over allowable in any of the above City/State/ZIP: k/ (, t, 5 r3 04 t l ( 0,4Additional inspection(1 hr min) 66.25/hr Phone:( ) SG 3 „ G. e1 2— 2 A O0 Investigation(1 hrmin) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: ' Electrical Lic.: Suprv.Lic.: specifically listed('h hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized si I TOTAL PERMIT FEE: ` .si A u 1 L/�I i 6' r4,q` "�� This permit application expires if a permit is not obtained within 180 Print name: Date:'Z—..I _ 20 days after it has been accepted as complete. Number of inspections allowed per permit. I:\Building\P _PermitApp_ELR_ERE.doc ev 62017 440-461 S1O 1/05/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 Desc Qty. Each ratal Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01to15kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: 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 Fee for each commercial system: $75.00 Subtotal(Enter on Pagel): * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\BuildinglPermits'ELC_PermilApp_ELR_ERE.doc Rev 1 0/2612 01 7 Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard 6 it Received '' Perini(No.MJ� /D 1111 • 13125 SW Hall Blvd.,Tigard,OR 972 � A, �� Plato Reviewa0 = Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit No.: Inspection Line: 503.639.4175 r i p 1 n 2 n n Re T 1 G A R D ._ tt /° �� Date Ready/By: kris: E See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORICA f+1 Jrr h(-.'Af.!-J FEE* SCHEDULE 0 New construction ID Demolition For special information use checklist. Description Qty. Ea. Total XAddition/alteration/replacement ❑Other. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 Ng 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78 ❑Accessory buildingSFR(3)bath 500.32 ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder El Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Catch basin or area drain 18.76 Job site address: it43bS 5 t4.J f /bK "TOG PQ, Drywell,leach line,or trench drain 18.76 City/State/ZIP: T! 60.Ara Oi{ ! Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector I 18.76 Sanitary sewer(no.linear ft.:_) i} Page 2 Storm sewer(no.linear ft.: ) t Page 2 Water service(no.linear ft.: ) I Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 A 0 c 1/p A71 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax: ( ) Ice maker 12.51 1/4 APPLICANT 5° CONTACT PERSON Interceptor/grease trap 25.02 Business name: -Pi A...,1SHu 4 5,7 I-1 p ryr.6 c Medical gas(value:$_) Page 2 Contact name: I _ Primer 12.51 ��lANGHAt inn, Roof drain(commercial) 12.51 Address: j (a CB 6 9 5(.0 (e S 1i A u r i t Sink/basin/lavatory j 25.02 City/State/ZIP: Lp.,cg. 0SLI15 (no o a 9 •703. Solarunits(potablewater) 62.54 Phone:($ t03- 4 a-7_ 1 i 02. Fax: :( ) Tub/shower/shower pan 12.51 E-mail: 2.t-,..."1 P i AJ sk U4.5'i/•l 0..i.15 S• 0 S Urinal 25.02 CONTRACTOR Water closet I25.02 Water heater I 37.52 Business name: G./j Au i.704 2 L.If i„, $t AJ L Water piping/DWV 56.29 Address: /'i tj 3'{ S• 67!Mr 10-rasa- IDA% Other: 25.02 City/State/ZIP: 0 q,, cm,...1 GI•r.,/ r 2 C)-loci S` Subtotal Phone:(Sod 6/GI O -b's(o Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: 1 d) if 5`0 S 71.(S L l Plumbing Lic.no.: /0 `XS State surcharge(12%of permit fee) Authorized signature: / TOTAL PERMIT FEE Print name:/� ��� Date:Zia.gg/21) This permit appllcatton 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. 19Building\Permits‘PLMU-PermitApp.doc l0/01/09 440-4616T(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- I"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*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate El Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thnt ❑ Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram -4" ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lay/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: l:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard 44 i li COMMUNITY DEVELOPMENT DEPARTMENT C T I G ARD Building Permit Review — Residential Building Permit #: /t9 S 7 0 20 —eV(2(0 Site Address: /Z7i,g0 - `QJ,() /-7I 7 Project Name: /�S�i�� c Lot #: Planning Review p PJrq#osal: dl/-oo aces, �,P ��'7 zf(7/ure . �p S a_ �r 1L�I Verify address/suite#active in Accela. IF;O n River Terra No 0 Yes,River Terrace Review Addendum Sit lan Elements: rosion Control )opies of site plan on 8-1/2"x 11"or 11 x 17"paper W' ained trees with drip line and tree protection measures wn to scale(standard architect or engineer scale) t/ ootprint of new structure(including decks)and FFE 'th arrow \ '11 ;,'ty locations&easements (required for new and additions) IQ,Sife address,project or subdivision name and lot number„Afk IE id walk/driveway approach plicant information(name and phone number) fation of wells/septic systems t dimensions and building setback dimensions ii..,eet tree size,type and location are footage of buildings to be demolished Vet names sting structures on site orner elevations(2'contours if more than 4'differential) t�Lot tt area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes aiN/o 2Ifapervious area (applicable if R-7,R-12,R-25&R-40) yes,is a storm water quality facility shown? Yes O21 o 14 Clean Water Sces—Service Provider Letter (lot platted prior to 9/10/1995): Required: 11G Yes,applicant was notified ❑ No Received: �t'es ❑ No kt ( Vater Meter Fixture Unit Worksheet—Ad i o is,Remodels and ADUs ` Required: ❑ Yes,applicant was notified �( No �� Received: 0 Yes ❑ No SDC Exemption for ADU applied for: ❑ Yes 6G No Received: ❑ Yes ❑ No ublic Facilities Improvement(PH) Permit: Required: ❑ Yes,applicant was notified V No A lied For: ❑'l)Yes El No,stop intake 10 and Use Case#: ll3 Zoning: K--°e ^�- L. II quired Setbacks: Front: /S Rear: / Side: c P�Street Side: Garage: i3lj "' 'ding Height: Max. Height: Actual H . t: /O> S Landscape Area: `-�O % Lot Coverage Max: e1 Entrance t back no more than 8'from street-facing wall ❑ Parallel to street o et 45 degrees or less Windows ❑ Minim %of area of all street-facing facades Garage ❑ Garage door is e ' widest street-facing wall �� es ❑ No,one of the following is met: ❑ Door extends no mor n 5'from wall and is a covered porch extending beyond garage. ❑ Door extends no more than 5 and there is a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is 0 12' ss ❑ less of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch Recessed entrance ❑ a set ❑ 1'Roof eave 0 Roof offset ❑ Fire es ❑ Lap Siding ❑ Roof pitch ❑ hip,or gambrel roof ❑ Dormer ccent siding ❑ Window trim 0 Window recess ❑ w projection ❑ Balcony Visual ClearanceJrban Forestryyan AV Sensitive Lands: 0 Yes Ild No Type: WO onditions met prior to issuance of building permit N ,Approved By Planning: Date: --2 _ D2--e) Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved I:\Building\Forms\BIdgPermitRvwRES_122419.docx Building Permit Submittal Original Submittal Date: p2//3/mo61 Site Plans: # Building Plans: # Building Permit#: Et-Enter building permit#above. Workflow Routing: [Planning Eringineering l --PEfiut Coordinator n Being Workflow Sign-off: D.-Sign-off for Planning(include notes from planning review) Route Application Documents: Engineering. (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building. original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: a��/.�) Engineering Review Er-Slope at building pad: ,2,J/ ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat a Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes CKNo Assess Water Quantity Fee in-lieu: 0 Yes ErNo LIDA Facility on lot: 0 Yes Er No ❑ Final Plat Recorded: O NOT Approved by Engineering: Date: Notes: [Approved by Engineering: jam,r.,�� Date: 2/t 1/2oto Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved El Not Approved Permit Coordinator Review t'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: .rfg SDC Exemption: ❑ Received Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes N/A Tigard Trans SDC: 0 Yes R N/A Parks SDC: 0 Yes 3St N/A LIDA 0 Yes N/A X OK to Issue Permit Approved by Permit Coordinator: URA'"- Date: 21 [1 12,0 I:\Bui Iding\Fomis\BldgPernutRvw_RES_122419.doc x 1 RECEIVED MAR 1 0 2020 GITY OF- fbGARD�IeanWater Services SENSITIVE AREA PRE-SCREENING SITE ASSESfIvisinNl Clean Water Services File Number 20_000719 1. Jurisdiction: Tigard 2. Property Information(example: 1 S234AB01400) 3. Owner Information Tax lot ID(s): Name: Jason and Lisa Hashima 2S109BB02903 Company: Address: 14305 SW High Tor Dr OR Site Address: 14305 SW High Tor Dr City, State,Zip: Tigard, OR, 97224 City, State,Zip: Tigard,OR, 97224 Phone/fax: Nearest cross street: SW Benchview Ter Email: 4. Applicant Information 4. Development Activity(check all that apply) ❑x Addition to single family residence(rooms,deck, garage) Name. Ryan Langhaim ❑ Lot line adjustment 0 Minor land partition Company: Pinehurst Homes ElResidential condominium ❑ Commercial condominium Address: 16869 SW 65th Ave#191 ❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Lake Oswego, OR, 97035 0 Single lot commercial ❑ Multi lot commercial Phone/fax: 503-407-1102 fax 503-715-0406 Other Email: Ryan@pinehursthomes.us 6. Will the project involve any off-site work? Dyes ❑ No ❑ Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits,Site Development Permits, DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief, this information is true,complete, and accurate. Print/type name Ryan Langhaim Print/type title President Signature ONLINE SUBMITTAL Date 2/25/2020 FOR DISTRICT USE ONLY O Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. X Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,State and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5, Section 3.02.1, as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local, state and federal law. THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS 1 CWS APPROVED SITE PLAN(S)ARE ATTACHED. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2).NO SITE ASSESSMENT OR SERVICE PROVIDER IS REQUIRED. Reviewed by ���a c ,,o„'eRL 4.w ..w4_ Date 3/5/2020 Once complete,email to: SPLReview@cleanwaterservices.org • Fax: (503)681-4439 OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway, Hillsboro, Oregon 97123 aea:;eo z�ozo Main Office • 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cleanwaterservices.org /-i _S i, p p -- U00 G-, r Water Meter Fixture Unit Worksheet for Additions/Remodels/AQ EJVED Please complete the following information: FEB 2 4 2020 CITY OF TIGARD Service Customer Name: Piti c�l u 2 s 7 �0 o S „ Yea AN 4' I HEWING DIVISION Service Address: Strect/Suite #: /'? 30..0 S. AI/to'-! '%U2 ra.7. City: '7 7Gr/a - State: D 2 Zip: Phone Number: _Soy - k v 7 ^l/ uZ Email: /a yo4,..i Cu' Peru F 4v-c3>uoniSS. v Please till in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = x 1 = Bidet x 1 = x 1 = Clothes washer / x 4 = y x 4 = Dishwasher / x 1.5 = I5 x 1.5 = Hose bib I x 2.5 = .2,S x 2.5 = Hose bib, each 'E,< < x I = '$ i . x I = Kitchen sink ( x 1.5 = I. 5 x 1.5 = Laundry sink 45 x 1.5 = x 1.5 = Lavatory 2. x I = Z I x 1 = I Water closet, 1.6 GPF Z. x 2.5 = s I x 2.5 = 2 5- Bathtub/whirlpool x 4 = x 4 Shower stall I x 2 = Z x 2 = Bath/shower combo / x 4 = q x 4 = Current Points: 3. Proposed Increase: ? .S C> 5 Current Points 4 Proposed Increase= 2 " — = cw Total Points = Required Meter Size �S Meter Sizes: I to 30 points=5/8" 30.5 to 37 points ='/a" 37.5 and over points= I" New Meter Size Needed for New Total Points: Cost: $ (sec page I) Current Meter Size per Utility Billing: Cost: $ (see page I) New Meter Size Cost minus Current Meter Sizc Cost= $ (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) FOR OFFICE USE ONLY Current Meter Size Confirmed with UB �. ©� ?14c7Cial0 Signature of R Represe tativc Date — —a I:/Building/Forms/WaterMeters 07(11 19_Add.dOCX Page 2