Permit Support Document •
TIGARD
City of Tigard
October 18, 2012
Everett Custom Homes
735 SW 158 Ave., Ste. 180
Beaverton, OR 97006
Re: Permit No. MST2012 -00019 •
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11467 SW 96 Ave.
Project Name: Everett Terrace, Lot 12
Job No.:
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $428.98.
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of $
Comment(s): Lot purchased by another developer and new building plans were
submitted. Refund 80% of plan review paid for original plan review that was not completed.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
•
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
pr i City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request _Pr Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Everett Custom Homes DATE: 10/2/2012
735 SW 158 Ave., Ste. 180
Beaverton, OR 97006 REQUESTED BY: Dianna Howse
DEB
TRANSACTION INFORMATION:
Receipt #: 185554 Case #: MST2012 -00019
Date: 2/16/2012 Address /Parcel: 11467 S \V 96 Ave.
Pay Method: CreditCard Project Name: Everett Terrace, Lot 12
EXPLANATION: Lot purchased by another developer and new building plans were submitted. Refund
SO% of plan review paid for original plan review that was not completed.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. .Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount -
Plan Review Fee 230 0000 - 43106 $428.98
TOTAL REFUND: 5428.98
APPROVALS: - -- —
If under $5,000 Professional Staff
If under $12,500 Division Manager . -
If under $25,500 Department Manager '-‘5
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: /e//6 Az__ I By:
I. \Buddin \Refunds \RefundRe x 1)9/01/21111)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
•
Request Permit Action
.F i Gi A It I_) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor VO I
13125 SW Hall Blvd., Tigard, OR 97223 .42, Phone: 503.718.2430 Fax: 503.598.1960 www.dgard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 0 City Staff
(check one)
REFUND OR Name: 1
INVOICE TO: (Business or Individual) J G �� Lt 5 773/.../ f °0 }/g.
Mailing Address: 7 - 45 I 5 A}JE. t1 /g0
City /State /Zip: ')C,q-DLLTO 612_ 9 7CO(,
Phone No.: 5 - 7 5 - 10 ; uJJ
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
g • _.. • ID PERMIT APPLICATION.
1 .07 1 � REFUND ' RMIT FEES (attach copy of original receipt and provide explanation below).
' , I E FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). /
Permit #: H `DT 6101 2. - 000 1 9 4 O�tZ�aaf a - .. c
Site Address or Parcel #: f I t{ to 7 A..O 91i A u
Project Name: f- Qft2L I 1-OT (')-
Subdivision Name: E..3 ti/L€ 7 r /1. E Lot #: / --
EXPLANATION: („or Put C. H 11-5 b - 3v - DI f8./2_, Ow ,J so .
t•\ tu \ ) l-lt.. c ure-3M 1 rf a -f.-E. )1 a ooa. ' ..(3Q-49.0/9-- co/ 95:
Signature: CK 6.0.. e2_44,�..kr j Date: e;► / t /, 9-
Print Name: i / '. I�- . PC - yrrHs k,(
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fcc which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date 957&211117M Rte to Bld: Admin: Date /Q : �� i=
Refund Processed: Date / ATM / B ,A„,, Invoice Processed: Date B
Permit Canceled: Date to ,' e /2...— By 4: 'Parcel Tag Added: Date By
Receipt # Date Method Amount $
I: \Building \Forms \RegPerrtutAction.doc Rev 05/25/2012
/
f
• Building Permit Application V 0 I /o / Z
Residential R ECI I VIED FOR OFFICE USE ONLY
City of Tigard Received Date/B .1 Permit No.: MsrPoig —txrt •
to 13125 SW Hall Blvd., Tigard, OR 97223 _ T 1 2012 Plan Review
Il
C Phone. 503 718.2439 Fax • 503 598 1960 Date/B Other Permit a 494A G � ,
1.1 G RD Inspection Line. 503.639 �� TI(]AR® Date Ready /By Juris ® See Page 2 for
Internet www.tigard- or.gov CITY Notified/Method Supplemental Information
BUILDING DIVISION
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
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® I- and 2- family dwelling ❑ Commercial /industrial Valuation: $125,000
❑ Accessory building ❑ Multi- family Number of bedrooms: 3
El builder ❑ Other: Number of bathrooms: 1.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 3
Job site address: 1 4 1 SW 96th New dwelling area: 1851 square feet
City /State /ZIP: Tigard, OR 97224 Garage /carport area: 228 square feet
Suite/bldg. /apt. no.: Project name: Everett Terrace Covered porch area: square feet
Cross street/directions to job site: Greenburg and 96th Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Everett Terrace I Lot no.: 12-- 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.
new single family residence
Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Everett Custom Homes Type of construction:
Address: 735 SW 158 Ave Suite 180 Occupancy groups:
City / State/ZIP: Beaverton, OR 97006 Existing:
Phone: (503)750 -6268 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: Emerio Design (Please refer lo fee schedule)
Structural plan review fee (or deposit):
Contact name: Neil Fernando
Address: 6107 SW Murray Blvd #147 FLS plan review fee (if applicable):
Total fees due upon application:
City /State/ZIP: Beaverton, OR 97008 `�
Amount received: ' J !_
Phone: (503) 515-5528 I Fax::( )
E -mail: neil @emeriodesign.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted Photo Voltaic Solar Panel System.
Business name: Everett Custom Homes Submit two (2) sets of roof plan with connection details
and fire departme t access, alonl it the 2010 Oregon
Address: 735 SW 158 Suite 180 Solar Installation . •cinlry ,de checklist.
City / State/ZIP: Beaverton, OR 97006
Permit Fee (Intl . • e lan review $ 1 80.00
and adm' • sir a fees):
Phone: (503) 750 -6268 Fax: ( ) State surcharge (I % of permit - • $21.60
CCB lit.: 189447
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: N L � Dim I Date: Z I ` s([ 2 * Fee methodology set by Tri- County Building Industry
!( Service Board
I:\ Building \Permits\BUP -R ESPermitApp.doc 02/24/2011 4404613T(I 1 /02/COM/WEB)
t
' Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
II City of Tigard Received No.
q 1 3125 SW Hall Blvd , Tigard, OR 97223 Associated permits
0 Phone. 503.718.2439 Fax. 503.598.1960
24- Hour Inspection Line. 503 639.4175 El Electrical 0 Plumbing 0 Mechanical
TIGARD
Internet www.tigard- or.gov ❑ Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
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 . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
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.
I I 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 ❑ ❑ ❑
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- ❑ ❑ ❑
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. ❑ ❑ ❑
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 ❑ ❑ ❑
architect licensed in Ore•on and shall be shown to be as slicable 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 II" 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. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arbonst'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. _
1:\ Building \Permits\BUP - RESPermitApp doc 02/24/2011 440- 4613T(I I /02/COM /WEB)
Plumbing Permit Application RECFVED V 0 1 0
..
Building Fixtures FOR, OFFICE USE ONLY
City of Tigard FEB 2 012 Bet'l'nYd
DateBy: tie ( a / Pemtit No �f ''ODt7 (1
. - q 13125 SW Hall Blvd., Tigard. OR 972'. Ty O p�ir� /: p�, Plan Review \\ (�
Pitting: 50i 713 2139 Fax. 503. G�9a�lly DalelB Othe Permit No . ,L9∎ - 19002
T I G A It D a
Inspection Line 503.639 4175 1 ; p' d C 1� ,f l / y.
D ate R udy/Oy to i t See Page 2 for
Internet. www.tigard-or got � Naufied /Methnd Supplemental Information
' - _TYPE OF WORK FEE* SCHEDULE -
® New construction ❑ Demolition For special information use checklist.
Description l Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION" ' SFR (1) bath 312.70
Q 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Esch additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: \ ILL �W 96th Catch brim or area drain 18.76
Drywell, leach line, or trench drain 18 76
City /State/ZIP: Tigard, OR 97224
Tigard, Footing drain (no. linear ft : ) Page 2
Sin telbldgIapt. no.: I Project name: Everett Terrace
Manufactured home utilities 50.03
Cross street /directions to stie. Greenhurg and 96th Manholes 18.76
Rain drain connector 18 76
Sanitary sewer (no. linear ft.. _) Page 2
- Storm sewer (no. linear ft.: _) Page 2
it- Water service (no. linear ft • 1 Page 2
Subdivision: Everett Terrace I Lot no.: Fixture or Ilene
Tae map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
- - , DESCRIPTION OF WORK
Clothes washer 25.02
New single family residence Dishwasher 25 02
Dnnking fountain 25 02
Ejectors/sump 25 02
• El OWNER I - ❑ TENANT Expansion tank 12 51
Fixture/sewer cap 25 02
Name: Everett Custom Homes
Floor drain/floor siak/hub 25.02
Address: 735 SW 158 Suite 180
Garbage disposal 25.02
City / State/ZIP. Beaverton, OR 97006 Hose bib 25 02
Phone. (503)750 - 6268 Fax: ( ) Ice maker 12 51
® APPLICANT . ❑ CONTACT - PERSON • Interceptor/grease trap 25.02
Business name: Emerio Design Medical gas (value: S I I Page 2
Printer i 12.51
Contact name: Neil Fernando
Roof drain (commercial) 12.51
Address: 6107 SW Murray Blvd #147 Sink/basin/lavatory 25.02
City / State/ZIP: Beaverton, OR 97008 Solar units (potable water) 62.54
t I
Phone: (503) 515 - 5528 Fax: : ( ) Tub /shower /shower pan 12.51 I
E -mail: neil@emeriodesign.com Urinal 25.02 I
Water closet 25.02
CONTRACTOR
' Water heater 37.52
• Business name: Wolcott Plumbing Water piping/DWV 56.29
Address: 1075 W HistoricColumbia River Hwy Other 25 02
City /State/ZIP. Troutdale, OR 97060 Subtotal
Phone (503) 667 -1781 Fax. 1503) 667 -9891 Minimum permit fee: $72.50
CCB Lie.: 112220 Plumbing Lic. no.: 26- 824PB Plan review (25% of permit fee)
• State surcharge (12% of permit fee)
Authorized signature: / / 1 L� itrf� TOTAL PERMIT FEE '
Print name: DENNIS L DUNNING V Date: /0 1 ply This permit application
It ex if n a acc pe epted rmit is as not rn obtainempicte. d within 180 days
s bee
*Fee methodology set by To- County Building Industry Serv,cc Hoard
11ltuiidme \PrrnnuiPt.AtU- PcrmitApp.doa II /oiNi`r 4-10-161 6Tt IIWl21COtVWFBI
•
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 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*.
Quantiy by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate q y g'
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 ❑ 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 ❑ Isometric or riser diagram is re
i i dia required for new buildings
Garbage - Domestic— non -food b q g
Disposal - Domestic —food related that meet the qualifications above.
- Commercial —food related
- Industrial -food related
Ice MachJRefrig. Drains
Od 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
Washer - Clothes *Note: If the fixture work under this permit results in an
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:\Documents and Settings\Janelle\My Documents \Downloads\PLMF- PerlinitApp.doc
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City of Tigar f le, Pentit Nu. r90/ 2. _ coot .
,
1312s sw Hall Blvd., Tigani OR 97223
11 1 11 ' Phone: 503.718:2439 Fax: 503 598.106(EB 1 6 2012 r Pane ,54.)P
DaielB ; • . . , ,
inspection Line: 503.639.4175 Dare . ' '')". w' ' li allilliEEMMIIII
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Internet. www rigard-or.gov CITY OF riC3ARD mumI/method:
.:' . . • Y.. :::, ,, ,. , . ,. .TYrx oFEtifit*,3Cipikl•Som .. • • •rf:'•: •:. • ' ' : ::. 'FLAN •REvizc:':..4•:: • ' .:,...• ''....:•:
r:4 New rnnetruetion U Addition/alteration/replacement ehr...w gamy% 011 lira, pirrly OW. a na A mob IA pl.me I-W*4n. ..b..k. d beiewg
CI Serlive Or fader 400 amps Or InOte CI Building Ova glifIX ylfu ieS.
0 Demolition Ei Other'. where the available &oh current 0 Mannar and boatyards.
.. ''.'" . •' ' . 1.: ' -: TEGORY beto/iSTROCTION ,"' .`•';':,.:::;,,,,, ,.;, ,, :, ,. '• ' "nab 1°0° cars at 15° Y°14 cl I:I FI buildin
leas to ground, or exceeds 14,000 0 COTerflefe121-tlfie asncalkura.1
121 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building An for ell other installations. buildings.
1:1 Multi-family 1=1 Master builder 0 Other. 12Fire pump 0 Install ii of 75 KVA or
separately erid IYAc
dvem.
'..... 'rg JOB . §ii.E : •*.O.ORIV4ITION .:Ai ., • ‘.::,--.,-i%Q.,....: IS AM ' Of sner;*fil larger w mow llgui of EJ 'A", "r."1-T,"1-3".
Job no.: Job site address: ii SW 96" ICCIll? or runt occupancy.
0 Su or more residernhil uni is. 0 Recteaddlel veleele parts.
,...
Ci ty/Sunc/ZIP: Tigard, OR 97224 0 Kenith-We facilides 0 Supply voltage for more than
0 Hazazdous loot tinns. 600 volts nominal.
Suite/hlti a. /apt, no.: 1 Project name: Everett. Terrace Osernec or !mkt 600 imp or mum
'....'', ''.. .. • .... : • :, • '.... 'C. TEE 5013WVIA.
Cross street/directions to job site: Greenburg and 96th rie1211:R.
' New residential single- or multi-tamily dwelling unit.
Includes attached garage.
,
Subdivision: Everett Terrace Lot no.: 1-71 1,000 sq. ft. or kns 168.54 I 4
EL add'1500 sq. ft. or port= 33.92 I
Tax map/parcel no.: Limited energy, re:64615a) 75.00 1
'."::;',..:' ... • ' • *.• ".: • .•••.--..';'''.'::',-:'"" 'ThOESCRiiikri4 : ' • ) "....•' ; ',;,• .. ....... (with above eil 0 -)
Limited energy, multi•family 75.00
New single famliy residence residualal (with above sq. ft) - --
Services or feeders installation, a) teration, end/or relocation
200 amps or has 100.70 2
0 1 : 1 0ERTY 004, I . ..... .• anTI amps 131545 2
L 4 401 amp in 600 4111p7 200.34 2
Nome: Everett Custom Homes -
601 amps to 1,000 amps 301.04 2
Address: 735 SW 158 Ave over 1.000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/Stoic/ZIP: 15eaverton, OR 97006 relocation
Phone: (503)75A.4268 Fax: ( ) 200 amps or let S9.36 I
-- 201 amps to 400 amps II 0108 2
Owner Instillation: This installation is being made on property that I own which is not
e 2
i ntended for sale, leuxe, Tel or exchange, according to ORS 447, 449, 670, and 701. 401 ams to 599 turps $68.54
Branch circuits - new, alteration, or extension, . r panel
Owner signature: Date: k Fee for branch &auks with
PPI:T.0j41* ' I : ONTAer -PWON 3'.,:i.,•: eact , l abm6avic ei " r mui teder t fee 1.42 2
Business name: Enteric Design B. Fee to branch circuits without
seridot or feeder fee, lira! 56.18 2
Contact name: Nell Fernando branch circuit .
Each add') branch circuit • 7.42 2
Address: 6107 SW Murray Blvd #147 ATuicellancous (service or feeder not included)
_ .
Each manufactured or modular
City/State/ZIP:Beaverton, OR 97008 07.84 2
dwelling, service andkr fueder
PhOnc: (503) 515-5528 I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 1
E-mail: nell@emeriodesign.com
Sign or outline fighting 67.84 2
..., ',... : i. C ,' .''' .'" .:: ' " ' ' '''''_"' ' 'CONTRAtr,OR . " , -: .: ". ' .: . ,..;.::-.....i' '-' ...." .. .. • .• • - Signal eircuit(s) or Ilnated-enelgy
Business name: Wright 1 Electric panel, alteration. or extension. Page 2 2
, Each additional inspection over allowable in any of abov
Address: 5618 SE 135 Ave Additional insert:Suit (1 hr min) 6625/ hr
City/State/ZIP: Portland, OR 97236 _____,
iilVestigation (1 hr min) 66.25/ hr
Inclustnal plant (1 hr min) 78.18/ hr
Phone: (503) 760.8522 Fax: (503) 762.1823 Inspections for which no fee is
9040/ hr
steci6cany lined (1 hr rren)
CCB Lie.; 162368 I Electrical Lk.: 3-332C [ Suprv. Lic.: 33985 .LI: '. TLEC'rRICAL PERM:FEES' : ''
Subtotal:
Suprv. Electrician signature, required: ese4 it Egib, Plan review (25% of permit fee):
Print name: Dennis Welch Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEB:
Authorized signature: ,
Ibis permit application *vireo a a permit a not obtained within um
days after it leas been accepted as complete.
Print name: — {Date; t Hunter of amp:Lions °flowed per pemlit
liMildervAlk ,CAt nnaAjp.J.R: 1 17A1 MP 44a-0157f I linfAMWW1A) •
• •vaVlY
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
E l Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:'Bu1dmgWcrmits\ELC- PermuApp.doc 07/01/10
Mechanical Permit Application
RECFVE 1 "
: FOR OFFICE USE MIN
City of Tigard F EB Recched n
0 0F TI ARD Date Flea/ /B 1° 1?..- —API: 1) Penh r4°.. ff ° ° / '''
1
1 6 Daw/BY.
• 13125 SW Hall Blvd., Tigard, OR 972...n 2012
- Phone: 503.718.2439 Fax: 503.598.1960-,_ _ uTy ES111111.4111 Otter! e
cunic
r
...-..,
Inspection Une: 503.639.4175
Internet www.tigard-or.gov B UiLDMIn nvInvu,,,, Notified/PA :W1111/
ill 111li S upp lemental Page
i d
• • , . . Grata on
.
:::.*: •;::: .' %.. Z ' . ' .. ; '. f: 7! " 0 :; . i ? „ . ■ 1 , t .' 7 , : ;TYPE OF WORK .i .::::' '7. 7 .,:*•;f•t: . : !W,1..... ,,, •:•':,. :. - ' .w.: =..k/SBOIECKLXVI
Mechanical permit fees* are based on the value of the work
(33 New construction 0 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other mechanical materials. equipment, labor. overhead, and profit.
Value: S
.1,":,:';•;:.•:5 CATEGOilit*:,045TRUCTION . ...*.,'", ....' • ' ‘. . -.• ..:' ' ' ''' ''''''. , ----,--,:-• •'•'• • • • • • -
"." '' • - " ' .. PlIii" EQU/14100.$*:DIMS:Etitt
I- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description I Qty. L Ea. I Total
• - ' " ' Air conditioning
Job site address: 1A__451-W. 96 th unwires site Out shaming placement) 46.75
Furnace 100.000 BTU (ductdwors) I 46.75
City/State/ZIP: Tigard, OR 97224
Furnace 100.000+ BTU (ducts/venia) 54.91
Suite/bldg./apt. no.: [ Project name: Everett Terrace Lot Heat pump
- hetwires site plan showing placement) 61.06
Cross street/directions to job site: Greenburg and 96th Duct work 23.32 ,
Hydronic hot water system - 23
Residential boiler (radiator or
hydronic) 23.32
• Unit beaters (fuel-type, not electric).
in-wall. in-duct, suspended, etc. 46.75
Subdivision: Everett Terrace I Lot no.: 1.2"'" Flue/vent for any of above 2332
Other 23.32
Tax map/pastel no.: Other fuel appliances:
' '..:*.''' ' ."::''':".:•:= ' . • fr. "'' 5Vi`PF-scaWrI9r OF Nfigg:4•:',-;:i's:Vn:ri.::..E.::::‘,:i:,,,.::*,,, Water heater 2132
Gas fireplace 3339
new si ogle Eamtly residence Flue vent for water beater or gas
140V--• fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/men 2332
..: j [0.fi ',`..F-.'.'.....'1::.'';:::::;.!'?•'::.12:104,-Afe.M.K.:5,::la.;"::, e'/liner/flue/vent 23.32
Other: 2332
Name: Everett Custom Homes Environmental exhaust and ventilation:
Address: 735 SW 158 Ave Range hood/other kitchen
equipment 1 33.39
City/State/ZIP: Beaverton, OR 97006 Clothes dryer exhaust I 33.39
Single-duct exhaust (bathrooms,
Phone: (503)750-6268 Fax: ( ) rnu compartments, utility rooms) ' ' 23.32
',' I;trasOz4;;. ii-:.. AuktcrawisPaee fans 2132
Otha:
WI I 23.32
Business name: Enteric Design
Fuel Pining:
Contact name: Nell Fernando $14.15 for first four; 84.03 for each additional
Address: 6107 SW Murray Blvd #147 Furnace. etc.
Gas heat pump
City/State/ZIP: Beaverton, OR 97008 Wall/suspended/unit heater
Phone: ('503)515-5528 I Fax: : ( ) Water heater I
Fireplace I
E-mail: nen@erneriodesign.com Range 1
3.. ..f';',•''..;.M, ', .; . .:V:r.:;?•': 1 g.,..' ; '• -..• .•:-. i :••:' ' ,0).ft0.4 (4 0).*: :: ::- ' ' 1 ' -•.:' : • ! .."‹,11 ) -"? : ::•'7: : .•V:74: , i.?.:1 Barbecue
Business name: Pyramid Heating Clothes dryer (gas)
Other
Address: 9409 NE Colfax 1: ...".•';''
City/StatefZIP: Portland, OR 97220 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 786-9523 Fax: (Sin ) is, ?.432- Plan review (25% of permit fee)
CCB lic.: 59382 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
ApAd;j1 This pemdt application expires If a permit is not obtained within 180
at
Authorized signure: days after it has been accepted as complete.
I Print name: 6 \ 3ee I Date: 2_1 i (p) 12_ • Fee methodology sct by Tri-COunly Building Industry Service Semi
tstluildnyWcnahnteuC-HemitApp.doc UMW 10 44041117T II UMICUMIWER)
. . .
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.
1ABuiiding\Permits\MEC- PermitApp.doc 09/09/I0 2
6)Er €-- 6
i IN
Building Division r /z
Development Code Provision Review
TIGARD
Residential Projects
' '
Building Permit No: `55 19 9
- 000 t �l
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A F
Routed Plans:
Original Plan Submittal Date: 0 2-
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked ( ✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along eft only if approved.
Planning Review (contact ri.JI44 -ir/ht■y_ at 503 -718- Z Ynor /61,31-1.6 @ti - or.
Land Use Caseko. S4 6 Lel/ • ODUo( Name E. dt re # re r ea. c G
Er Zoning WIZ.'
Ee Setbacks: itV
Front 15 Rear t Side 7 Street Side / O Garage 2)4
(Maximum Building Height 3 5 Actual Building Height 31
ID /Visual Clearance
l.Easements f
G]/ Sensitive Lands Type: AOS
Notes: z' It41aY S . JAI SeJ- ho.c& /.4 — p44 A •1j....ar.r&1J 1Lo LlceIsr n,.,
L ! . ? k 2 l 2 . i s a - t 4a..e. l ' a .. et p e.4 Dahl 1' e s o k ..l i i la, las ale r d..,...-p a
b N A461 Sot - • 3' /1....0 en, (.J44 r r. AA "WC AI►p +4-+
Original Plan: Approved ❑ Not Approved Date: 2 ./t7//Z
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @ tigard - or.gov)
13' Actual Slope: 5
Notes:
Original Plan: Approved- Not Approved ❑ Date: 4 7 I Z
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
Citty / Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
I�dJtreet Trees
D .Protected Trees
Notes: 'ceJ (N- rf re, d- 14 c f r WJ 1n�•� Lidt s�n- �wcc h�c� „!+�`
Original Plan: Approved ❑ Not Approved Date: D "•a - I l
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @ tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
•
• Okay to Issue Permit: Yes ❑ No
•
Date Routed to Building. •
•
•
•
•
•
•
Page 2 of 2
FEB 1 G 2012
CITY Y GF T:a' "•
Bur ONGLid;i:-
VOID
1 -i r -- ■ PROPOSED 21' 0 335' { i� —; _ I x
I I 2U E TORY A EME TARY ' (7 THROUGH PLANTER 1 1I T• • ' -w I I • �'� EA� (79 LOT 11 I _
1 I, i PROPOSED TIT I
1 I I SED IMENT PROPOSED TREE PER 11 4 I I I Z
_ 1 i 135.59 FENCE ENGINEERING APPROVAL (TIP) i j 2 l• I ;i x
1 -11 — I - -X —x— rx =x x— x— x =x —x — x � II S poof Q
PROP OSED TREE 1 1 D 3STING �� -I 6tl 1=I `_'� [ W � �( • I I W I N �
PER ENgNEERDIC ER %
APPROVAL (TIP) 1 �S " I U PR LOT 12 PROPO�n .1 "'�� --� S� I x o`
V. I , 1 If, r DECK • CONNECTION 3,299 SF AWAY � E L I _ 1.• - • ;
o •� I c . a 1 PROPOSED I I 3 h VI u �E%ISTING TREE �� STORM IIII, � �i , r C 33'(YATCTi 1NTH LOT 11) i I�� rN % TO REMAIN (TYP) 1 49.62' n H_ L ∎.1 __� [ 1 II tilt I I S I
— r ?2 X I %— X —x— 4 — X— X —X —X —X _X— X— X— X —X — ` a PD ' '05m— asXa___.
TREE PROTECTIWT 1 COSTING STORM T 134.47 - I I ., I I
FENCE (TYP) 1 n N 1 SERVICE r 9 DSRNC I I
1 '0 1 PROPOSED i h m -:: III X-}MX in -x�7
I 3
I ./ 1
I FOOTING I �� I x E70STING I u
� 1 X 55 —'{ CONNECTION LOT 13 _
I i� I - •J � -, I `�Y T At�INOLE x
1 rn 1 1 .. r •�1 I I ��, I I I S
N
a 20'
SITE
SCALE I = 20'
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