Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAR 2 2020
'PI .
CITY CoFETIGARIVEDD
Request for Permit Action 3uILDINGDiV a ,
T I c;A R f) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARDN.i r) 1
Building Division 4 ,
13125 SW Hall Blvd.,Tigard,OR 97223 3 h/ :LC) . --
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) 2 v._ ) \-\v,,-.!S \\L
Mailing Address: ri S 33 N ro..,./5„.„,„ 1Zz(t.....�.74 5,z ,
City/State/Zip: t`2e4.-..1-v\o-Y\ c — cI .-i c,v 3 -?
Phone No.: S o S — 515— 09 7c(:,
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
E3 CANCEL/VOID PERMIT APPLICATION.
E REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE at le and provide explanation below).
Permit#: r•Sa ?go 11- docit..
Site Address or Parcel#: -7- V 7 5,..,s k.--ls.,.-y, L_I
Project Name: el c�l- ,ris '(Z, �e_
Subdivision Name: Lot#: 2...1
EXPLANATION:
Signature: Date: 3/2.../2a
Print Name: r,t J /4-0.1 •
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date By Route to Records: Date 3 7 7 )
Refund Processed: Date'AI/9- B Invoice Processed: Date By
Permit Canceled: Date3/-i/ , B Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_4j20y(8.doc
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Building Permit Applicatio ECEI VED ; /7 mot
Residential uoR OFF 1"SE O\I.l'
City of Tigard NOV 2 5 2019 Received �; �.
14 . 11 13125 SW Hall Blvd.,Tigard,OR 97223 Date By: ll pZ� / /� �'' Tjj�� ��y �
Phone: 503.718.2439 Fax: 503.598.1 TY OF (IGARD Plan Review (%,
TIGARU Inspection Line: 503.639.4175 BUILDING DIVISION Date/By: 12,, (240 9 Juris: P t. 1 5-
/ ® See Page 2 for
Internet: www.tigard-or.gov � �6 �� Supplemental Information
TYPE OF WORK / REQUIRED DATA:1-AND 2-FAMILY DWELLING
El New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead 44hg profit for
CATEGORY OF CONSTRUCTION work indicated on this application.
❑✓ 1-and 2-famil dwellin Valuation: $ ^r.ai+Rtiv
y g ❑Commercial/industrial )
ElAccessory building El Multi-familyNumber of bedrooms: 3
❑Master builder ❑Other: Number of bathrooms: f 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 2S 9 )-__
Job site address: 7749 SW HANSEN LN New dwelling area: 2222 square feet 1255
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 370 square feet Ci(el
Suite/bldg./apt.no.: Project name: Elderberry Ridge Covered porch area square feet
Cross street/directions to job site: SW Bonita Rd &SW 76th Ave Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Elderberry Ridge Lot no.: 28 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.
Construction of SFR Valuation: $
Existing building area: square feet
New building area: square feet
El PROPERTY OWNER ❑ 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 APPLICANT CONTACT PERSON BUILDING PERMIT FEES*
Business name: Riverside Homes, LLC (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: Amo Avgi
FLS plan review fee(if applicable):
Address: 17933 NW Evergreen Pl., Ste 370
Total fees due upon application:
City/State/ZIP: Beaverton, OR 97007
Amount received:
Phone:(503)645-0986 Fax::( )
E-mail: aavgi@riversidehome.com PHOTOVOLTAIC SOLAR PANEL SYSEM 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 97007 Permit Fee(includes plan review $180.00
• and administrative fees):
Phone:(503)645-0986 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 189148 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Nikki Pruett Date: 11/21/19 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
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Mechanical Permit AuklisagtEIVED FOR OFFICE USF.OM.v
City of Tigard Received
Date/By: Permit No. qq�, '-.CV z?
!PI II 13125 SW Hall Blvd.,Tigard,OR 97 flV 2 5 2019
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 CITY OF TI GAR D Date Ready/By: Juris: WI See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition D Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family ❑Master builder D Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address: 7749 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.: 28 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: 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
Other: 23.32
ElPROPERTY OWNER ❑ TENANT
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,
toilet compartments,utility rooms) 5 23.32 116.60
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: Amo Avgi Furnace,etc. 1 14.15
Address: 17933 NW Evergreen Pl., Ste 370 Gas heat pump
Wall/suspended/unit heater
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: aavgi@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)
Phone:( 971)205-4989 Fax:( ) Plan review(25%of permit fee)
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 signatureIL
�,l ti,G * Fee methodology set by Tri-County Building Industry Service Board
Print name: Nikki Pruett 17-
Date: 11/21/19
1-\Building\Permits\MEC_PemvtApp_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
RECEIVED c---,,v
Electrical Permit Application NOV 2 5 2019 I OR()um I. I SF ()NIA
Received // f /27
City of Tigard Permit#: (`� `//
T OF IGAR.
13125 SW Hall Blvd.,Tigard,OR 97223 CITYIanateB Revy:iew
Phone: 503.718.2439 Fax: 503.598.1960BUILDING DIVISI• ate/By: Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: ions: 1 ® See Page 2 for
T I G AR D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
ElNew construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
✓ 1-and 2-familydwellingE Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ ❑Commercial/industrial
❑Multi-family ❑Master builderOther: ampsrefor all other installations. butngs.
0 0Fire pump. Installation❑ of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 7749 SW HANSEN LN 0 Add o of new motor load of system.
or more. ❑"A","E","1-2","1-3",
City/State/ZIP: Tigard, OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Elderberry Ridge 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: SW Bonita Rd &SW 76th Ave FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Elderberry Ridge Lot#: 28 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
OI?SCRI TION OF' WORK .y Limited energy,residential
Construction of SFR 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPF,R'0 „. ,1• .1 ..„-;4,-, Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen Pl., 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
0 APPLICANT; ❑✓ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
J
A.Fee for branch circuits with
Business name: Riverside Homes, LLC above service or feeder fee,
each branch circuit 7.42 2
Contact name: Amo Avgi B.Fee for branch circuits without
service or feeder fee,first Address: 17933 NW Evergreen PI., Ste 370 branch circuit 56.18 2
City/State/ZIP: Beaverton, OR 97007 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)645-0986 Fax: :( ) Each manufactured or modular 67.84 2
Email: aavgi@riversidehome.com dwelling,service and/or feeder
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
Address: Signal circuit(s)or limited-energy El See Page 2 2
2804 N E 65th Ave. St. D panel,alteration,or extension.
' Each additional inspection over allowable in any of the above
city/state/ZIP: Vancouver, WA 98661
Additional inspection(1 hr min) 66.25/hr
Phone:(360) 518-7589 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
((.*it/ZZ Inspections for which no fee is 90.00/hr
CCB Lic.: 172549 Electrical Lic.: C230 Suprv.Lic.: IA h specifically listed( r min)
��•� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 7 ��..,_ ...,4; ....,1,4 Subtotal:
Print name: Chester Garrett Date: 11/21/19 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:, . TOTAL PERMIT FEE:
t'
This permit application expires if a permit is not obtained within 180
Print name: Nikki Pruett Date: 11/21/19 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PerniiApp_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. ( 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:
❑ 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
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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ 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(`2 hr min)
COMMERCIAL WORK ONLY: ° ' ' `*WIT*ry ;'
Subtotal(Enter on Page 1):
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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application RECEIVE
Building Fixtures
City of Tigard NOV 2 5 2019 Received ' T2O/9t..0)cC2 7
Date/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGARD
Plan Review
Phone: 503.718.2439 Fax: 503.598.19fi(IUILDING DIVISION Other Permit No.:
Inspection Line: 503.639.4175
1 I L A R D ig See Page 2 for
Internet: www.tigard-or.gov Notatif eed/Me hod: Duna. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Q New construction ❑Demolition For special information use checklist.
Description I Qty. [ Ea. I 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
El1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7749 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 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 Lot no.: 28 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
Construction of SFR
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
rQ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor Address: 17933 NW Evergreen Pl., Ste 370 Garbage oor sink/hub 25.02
Garbage disposal 1 25.02 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 2 25.02 50.04
Phone:(503)645-0986 Fax:( ) Ice maker 1 12.51 12.51
❑ APPLICANT ✓0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: Riverside Homes, LLC g
Primer 12.51
Contact name: Amo Avgi
Roof drain(commercial) 12.51
Address: 17933 NW Evergreen PI., Ste 370 Sink/basin/lavatory 6 25.02 150.12
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax::( ) Tub/shower/shower pan 2 12.51 25.02
E-mail: aavgi@riversidehome.com Urinal 25.02
Water closet 3 25.02 75.06
CONTRACTOR
Water heater 1 37.52 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
Phone:( 503 975-9787 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 178122 Plumbing Lie.no.: PB414 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Nikki Pruett Date: 11/21/19 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.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-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 ❑ 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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
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
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Plumbing Permit Applicat 1'lG C E IVE D �,, ii r
Building Fixtures rt,lz orrlci.. t Si. 0y1 l
Cityof Tigard N O V 2 5 2 019 Received
ll Permit No.:�syzeikr' 7
. 13125 SW Hall Blvd.,Tigard,OR 9 Date/By:
TIGARD Plan Review
Phone: 503.718.2439 Fax: 503 Other Permit No.:
Inspection Line: 503.639.4175 ING DIVISION Date/By:
T I G A P.D Internet: www.ti and-or. ov Date Ready/By: Jens: ® See Page 2 for
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Q New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ll 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
0 Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
El Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7749 SW HANSEN LN Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR 97224 Drywell,leach line,or trench drain 18.76
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 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.: 28 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
k31 "7 : .o, " ":7- " Backwater valve 12.51
i`(,``: •Wi",. `,s it«V., .F.. , t° 'f .n-',,,y� 1,t,'�� ,` ':x
Clothes washer 25.02
Construction of SFR
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Q✓ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen PI., Ste 370
Garbage disposal 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 25.02
Phone:(503)645-0986 Fax:( ) Ice maker 12.51
0 APPLICANT ✓❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Riverside Homes, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Amo Avgi
Roof drain(commercial) 12.51
Address: 17933 NW Evergreen Pl., Ste 370 Sink/basin/lavatory 25.02
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: aavgi@riversidehome.com
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: TruScapes Water piping/DWV 56.29
Address: 21600 NW Amberwood Dr. Other: 25.02
City/State/ZIP: Hillsboro, OR 97124 Subtotal 31.27
Phone:( 503 531-8216 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: LCB#7962 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: iyl TOTAL PERMIT FEE
�:r�C � «� 31.27
Print name: Nikki Pruett Date: 11/21/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:'Building\Permits\PLMU-PermitApp.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/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate 9
Baptistry/Font Please check all that apply.
Bath Tub/Shower El 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 0 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"
Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food ❑ 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
City of Tigard
■ r COMMUNITY DEVELOPMENT DEPARTMENT
11111
T1cARD Building Permit Review — Residential
Building Permit #: 1-S i 2O 1 of --O . -
Site Address: -1 I Sw lin rEeArl La i&
Project Name: l(At'Y oemil R tGt« Lot #: 2
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: we t}uk'
• Verify address/suite#active in Accela. 5 In River Terrace: No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: IErosion Control
..K.copies of site plan on 8-1/2"x 11"or 11 x 17"paper keRetained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) ,Footprint of new structure(including decks)and FFE
• Torth arrow n Utility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number n Sidewalk/driveway approach
Applicant information(name and phone number) rlocation of wells/septic systems
Lot dimensions and building setback dimensions �l�treet tree size,type and location
1Vlquare footage of buildings to be demolished , Street names
Nxisting structures on site Comer elevations(2'contours if more than 4'differential)
X.,ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? I; ' e I .
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? IN s A o
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified X No Received: ❑ Yes ❑ No
XPublic Facilities Improvement (PFI)Permit:
Required: ❑ Yes,applicant was notified g No Applied For: ❑ Yes ❑ No,stop intake
U, Land Use Case#: PD 2-0 iv"O000c2I 0 Zonin : 'R ` 7 C P D
jzt Required Setbacks: Front: 1 S Rear: t S Side:3(e 4)Y'' street Side:N/ A— Garage: 20
.Building Height: Max. Height: '3� i Actual Height: t 2.4
Landscape Area: Lot Coverage Max: c (f) cYo
Entrance Set ack no l ore than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows urn 1 %of area of all street-facing facades
Garage ge doo is be i' d widest street-facing wall El Yes ❑ No,one of the following is met:
i Doo exten . more than 5'from wall and there is a covered porch extending beyond garage.
❑ Doo exte..s no more than 5'from wall and there is a 12 sq ft.window above garage on 2'd floor.
El Garage d or wie is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
Cl Co ered porch El Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
El F. e shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection El Balcony
ttkVisual Clearance JEC Urban Forestry Plan
Sensitive Lands: ❑ Yes 21 No Type:
e❑ Conditions met prior to issuance of building permit
otes: Me& Civic{ 11-1vY pvl \' -V \SS i1.VkC-Fi
IN'Approved By Planning: L- Date: 1 I ZS '
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BIdgPermitRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: /f(,2 7 '
Site Plans: #
Building Plans:
Building Permit#: nter building permit# above.
Workflow Routing: Planning Engineering ] ermit Coordinator ding
Workflow Sign-off: Sign-off for P nning(include note 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 cal ulations and st details,if applicable,etc.
Notes:
By Permit Technician: Date:
Engineering Review
Er Slope at building pad: 2'1
C/7 Conditions "Met"prior to issuance of building permit
[3'Easements (encroachments)per engineering conditions of approval and plat
ErWater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Q No
Assess Water Quantity Fee in-lieu: ❑ Yes CTNo
LIDA Facility on lot: ❑ Yes a No
❑Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Ls'Approved by Engineering: Date: ///i(,l20/
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:
E SDC Fees Entered: Wash Co Trans Dev Tax: 'Y s ❑ N/A
Tigard Trans SDC: [�I�s ❑ N/A
Parks SDC: [ Yes ❑ NyA
LIDA ❑ Yes Ld'N/A
Er-OK to Issue Permit
Approved by Permit Coordinator: ///1/" ;--ate:
1:\Building\Forms\BldgPermitRvw_RES_022819.docx
tit ST2.o19-op 427
Id 776N I-f4-C\i S t N
0 10' 20' " OF (Pnnin ECEIVED
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SCALE: 1"-20I Date: NOV 2 5 2019
.... -Al.--
initials: CITY OF TIGARD
BUILDING DIVISION
170 169 168 167 166 165
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N I I I I _1 ED _ _ -- — — —
Lot Area: 6348 SF a 'b' ' N'
E Bldg Coverage:2222 SF ' :cr) a _.--1^ ' ‘
Total Impervious: 2613 SF a I a --if— a
Coverage: 33% / 434 Total a I -- I 1 —
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6 DATE
08/15/2018 ELDERBERRY RIDGE WESTLAKE
REVISION
7 DRAWN BY
1 TIGARD, OREGON I' CONSULTANTS u+c.
DAB 7749 SW HANSEN LN ENGINEERING • SURVEYING • PLANNING
CHECKED BY
z JAB LOT SETBACKS PACIFIC CORPORATE CENTER
15115 S.B. SEQUOIA PARKWAY. SUITE 150 503 684-0652
a JOB NO. LOT 28, 6348 SF TIGARD, OREGON 97224 FAX�(503)) 624-0157
1306-006