Permit (44) CITY OF TIGARD MASTER PERMIT
'` Permit#: MST2016-00585
COMMUNITY DEVELOPMENT
R Date Issued: 03/27/2017
T t G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S111DA22300
Jurisdiction: Tigard
Site address: 15429 SW APPLEWOOD LN
Subdivision: HERITAGE CROSSING Lot: 42
Project: Heritage Crossing, Lot 42
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 714 sf Basement: 0 sf Left: 4 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1025 sf Garage: 330 sf Front: 15 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 4
Detectors;
Total: 1739 sf Value: $211,184.25 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain0 Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add9 500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description:
Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1739
Owner: Contractor:
DR HORTON INC. DR HORTON INC PORTLAND Required Items and Reports(Conditions)
4380 SW MACADAM AVE STE 100 4380 SW MACADAM AVE SUITE 100 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97239 PORTLAND,OR 97239
PHONE: 503-222-4151 PHONE: 503-222-4151
FAX: 503-222-1304
Total Fees: $27,736.29
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987`/ or 1.800.332.2344.��� ���111
Issued By: L✓. . .�l`i L//.-� / Permittee Signature: .c Z a��//-(oet oI7
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
-
- , Bualdin2 Permit Application 7/1-/ GL �� ll
•
Residential , lett (�rr►c I I •► 0\1_
Recired /�S , G,t ,
Yern�it Nn
III 4
City of Tigard paid;: « . /.I
13125 SW Halt Blvd.,Tigard,OR 9722 (�1J z Q 6 Plan Iter ica ,_ - - ,7 - Other Perini zwe--LYS e/9L(
■ Phone: 503.718 2439 Fax: 503.598.19(+0
Date By. 0th ��/$le�c Pape 2 for
Inspection Line. 503.639.4175 CITY01: r D Date Ready R., 1, Juris_4
I i •I I i rIY jr ISI NotifiedMeil od:t� � -Tyr Supplemeotal Information
Inland: www.tigard�r.gm FI�It_LIIi�i `)d11�L`+ h) • /// d
�r
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
Permit fees'arc based on the value of the work performed.
New construction 0 Demolition Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application. _ �,F
CATEGORY OF CONSTRUCTION Valuation: S �) I , '1 �7►
Q I-and 2-family dwelling 0 Commercial/industrial �/
Number of bedroo s:
❑ Accessory building 0 Multi-family
Number of bathrooms:
❑ Master builder ❑ r' -
JOB SITE INFORMATION AND LOCATION Total number of floors: ao 4 9
G �� A Nev dwelling arca: 17 3C( square feet _
Job site address: t ci f geA AFF
)1 -
97223 / Garage,carport arca: 33('j square feet
City/State/ZIP:Tigard, _
Project name - C 'C 6'y Cohered porch area: ./.,), square feet I 0 a5
Suite/bldg./apt.no.: J ��fi�n lf/l� lJY V I1
Cross street/directions to job site:
Deck area: square feet 7 /1 1
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE.CHECKLIST
Subdivision: 1 Lot no.: V Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no,: equipment,materials,labor.overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
NeWI'R —
Existing building area: square feet
New building area: square feet
It PROPERTY OWNER
I
El TENANT Number of stories:
Name: DR Horton Inc. Type of construction:
Address: 4380 SW Macadam Ave Suite 100
City/stateiZIP: Portland, OR 97239 Existing:
Phone:( 503) 222-4151 Fax:( ) New __
0 APPLICANT I CONTACT PERSON BUILDING PERMIT FEES"
(Please refer to lee starer/WO
Business name: DR Horton Inc. Structural plan review fee(or deposit):
Contact name: Emerald Weeks - FLS plan review fee(if applicable):
Address: 4380 SW Macadam Ave Suite 100 Total fees due upon application:
City/State/ZIP: Portland, OR 97239 Amount received;
Phone:(503 )222-4151 x1107 I Fax: :( ) PHOTOVOL rAIC SOLAR PANEL SN STEM FEES°
E-mail: esweeks@drhorton.com Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVollaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name: DR Horton Inc, and fire department access,along with the 2010 Oregon
Address:4380 SW Macadam Ave Suite 100 Solo"lnswllarion Specialty Code checklist.
—
Permit Fee(includes plan review S 180.00
CitylStatelZlP: Portland, OR 97239 and administrative fees): I
Phone:(503 )222-4151 f Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 130859 Total fee due upon application: $201.60
This permit application expires if a permit is not obta°
;,
Authorized signature: / within 180 days after it has been accepted as comp'
`Fee methodology set by Tri-County Building lndustr
LPrint name: t '• t' I '•t li 1 it { ci A. . t; I Date:2016 I Service Board.
I:Building,Perrnits13UP-RESPennitApp.doc: (12 24 211 I 44U-4 l3T(I I 02 COM'WEB,
Building Permit Application Checklist
One- and Two-Family Dwelling
1•or? mulct: I SI: ONLY
City of Tigard
iti 13125 S . Hall Blvd.,Tigard,OR 97223 Received
I Phone: 503.718.2439 Fax: 503.598:196(1 Date By: Yermii No.:
Associated permits:
i i t;A,,I 24-Hour Inspection Line: 503.639.4175
Internet; www.tigard-or.gov 0 Elco ricyl 0 Plumbing
ID Aturhanical
0 Oilier:
TIAL FOI_LOW1\'(; ITEMS ARE REQUIRED FOR PLAN REVIEW
I Land use actions corn.leted. See•urisdiction criteria for concurrent reviews. s o N'";
2 Zonin_. Flood .lain,solar balance oints,seismic soils desig ,etc.
nation,historic district � �,
3 Verification of a. .roved .lat/lot, 0 0
In
4 Fire districts. 'royal re Tua Name of district: atm Va e �� 0
1.111
5 Se.tic system .ermit or authorization for remodel, Existin s stem ca acit),
6 Sewer r �� a
alit. ■
•
7 Water district a. .royal.
8 Soils re i ort. Must ca ori.inal a, livable stam and si nature on file or with a. lication
9 Erosion control 0 plan 0 permit required. Include drainage-way protection, silt fence design and location of catch-
-___
basin .rotection,etc. I
10 3` Complete sets of legible plans. Must be drawn to scale,showing conformance to applicableand state '
building codes. Lateral design details and connections must he incorporated into the plans or on a separate full-size ❑ 1
sheet attached to the plans with cross references between plan location and details. Plan review cannot he cont/,leted if I'
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2-ft.intervals); location of easements gp 0 1 0
and driveway; footprint of structure(including decks); location of wells septic systems;utilit) locations:direction
indicator; lot area; building coverage area;percentage of coverage; impervious area;existing structures on site:and
surface draina•e.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details, vent size 7
and location. 0 I 0
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors.water heater,
furnace,ventilation fans. .lumbin• fixtures,balconies and decks 30 inches above •rade,etc. 1 • ❑
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 he required to clearly portray 0
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fires lace 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 int �] 0 0
Full-size sheet addenduins showin_ foundation elevations with crosareferrences arc accan e table at building envelope,
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non-
.rescri five .ath anal sis rovide seecifications and calculations to en•ineerin- standards. 0 ❑
17 Floor/roof framing. Provide plans for all floorsiroof assemblies,indicating member sizing,spacing,and hearing
locations. Show attic ventilation. ❑
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems,see item 22."En ineer's calculations."
19 Beam calculations. Provide twoJ 0 ❑
sets of calculations using current code design values for all beams and multiple joists
over 10 feet Ion.and.'or an beatn"oist ca 'in: a non-uniform load. 0 0
20 Manufactured floor/roof truss des',n details.
p --- --._1-- LLQ 0 0
21 Energy Code compliance. Identify the prescriptive ath or provide calculations•1 gas-piping schematic is required
. iifor four or more a .fiances. ❑ 0
22 Engineer's calculations, When required or provided.(i.e.,shear wall,roof truss)shall he stamped by an engineer or
architect licensed in Ore,on and shall be shown to be a..licable to the roject under review. 0 El 0
.Jt RJSDICTiONAL SPECIFICS
23 Three(3)site lans are resulted for Item I I above. Site dans must be 8-1/2"x 11"or I I"x 17".
24 Two(2)sets each are r •uircd for Items 16, 19,20 and 22 above. I_1 0 0
25 Buildin lans shall not contain red lines or to c-ens. "Mirrored"buildin .tans will not be acee ted.
26 -Reversed"buildin• .tans must meet criteria outlined in the Permit cQt System Devdo.ment Fees document.
27 "Drawn to scale"indicates standard architect or en•Meer scale. 0 0
28 Site plan to include tree size,0,-pe and location per approved project street tree plan(if applicable),and City of Tigard ' i1 0 I
Street Tree List. 0
ll
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines,
and .rotection measures must be drawn to scale and must include the roject arborist's si•nature of a,'royal. 0
30 A Clean ater Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ 1
W
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings l • El
on a lot of record a.'roved •rior to S•.tember 9, 1995,
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Electrical Permit Application • IOlti�bi (fl�- 1 tilU\I 1•
NCity of Tigard RECEIVED RPlan Review panels t cSTX�1L.-tw rfS—' .
13126 SW Hall Siva.,T;gard OR 97223 Plan Review 001er Pecmir.
Phone: 503.7182439 Fax: 503.598.,1 6P ti 2 r i 6DReady//3y: +: 12I See Page 2 for
„`. Inspection Line: 503.639.4175 Iv U v N ethod: I Supplemental Information
Internet; www.tigard-ot.gov I .
', .F- r 1c.7I\ u.)
TYPE (' nrimsi oto Please check all that apply(submits sets of plans wfitems checked below):
®New construction 0 Addition/alteration/replacement p Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑Floating buil .
CATEGORY OF less to ground,or exceeds 14,000` ❑Codmtercial agricultural
0 1-and 2-family dwelling 0 Commercial/industrial- 0 Accessory building amps for all other installations. buildinp.
0 Install .on of 7s KVA or
❑Other: ❑Fire pump.
Multi-family 0 Master builder Cl Emergency system. lar , separately derived system.
JOB SITE INFORMATION AD LOCATION 0 Addition of new motor load of 0' ","E","1-2","1-3",
iQOHP or more. 00 �'
/ c• ' ❑Recreational vehicle parks.
Job no.: I Job site address: I `' o A�a 1 Gr(1?c 0 six or more residential l units.
0 Health-care facilities. 0 Supply voltage for more than
City/State/ZIP: O Hazardous locations. 600 volts nominal,
�. 0 Service err feeder 600..�,.or more.
Suite/bldg./apt no.: ' Project name: W-,i jt 7, .��j�i 1 - FEE SCHEDULE
street/directio•'-to job site: Dewlaps i QtY. I Esc i Tera) i
CrossNew resides' single-or multi=family dwelling unit.
Includes a+ chid garage.
Subdivision: I Lot no.: 7�u 1,000aq,..1(or less 168.54 4
. �/
Ea roma►500 sq.ft.or portion a, 33.92 1
Tax map/parcel no.: Laitted energy,residential 75.00 2
I)• .v• 1ON OF WORK ,, (with above en.ft.)
/ Limited energy,multi-family 75.00 2
,' residential(with above sq.f.)
/f— Services or feeders installation,alteration,and/or relocation
/ 200 amps or less 100.70 2
/�
❑ PROPERTY OWNER I TENANT 201 amps to 400 amps I33.36 2
200.34 2
401 amps to 600 amps
Name: i A
601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
/Address: Temporary services or feeders installation,alteration,and/or
City/$tatelZlP:
relocation
/ 1 59.36 I
200 amps or less Phone:( ) I Fax:( ) '`' 201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on prop that I o ' which is not 40I amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 47,449,670,., . 701. Branch circuits-new,alteration,or extension er_panel
Owner signature: Date: A.Fee for branch circuits with
i CONTACT PERSON above service er feeder fee' 7.42 2
0 ApYLICANT each branch circuit
DR Horton Inc ' B.Fee for branch circuits without
Business name: service or feeder fee,first 56.18 2
Emerald Weeks branch circuit
Contact name: 'add'l branch circuit 7.42 2
4380 SW macadam Ave i cenaneons(service or feeder not included)
Address: Each ufactured or modular
_ 69.84 2
City/State/ZIP: Portland OR 972 • ' dwellit_: ervice and/or feeder
503) Fax::( ) .,222-4151 l Reconnect' 67.84 2
Phone.( Pump or irrigati' ircle 67.84 2
E-mail: Sign or outliner: _ 67.84 2
I NTRACTOR 1 Signal circuit(s)or L' i rgy
t- j G/ j,, t panel,alteration,or extensiofi _ Page 2 2
0.
Business name: �`� r/ (/j'f (i( Ci 7 l f. Il_ Each additional inspection over allowable in any of the above
,( E /`'�,', Additional inspection(1 hr min) 6625!hr
-Address: go - tfJ /f/_�] �' C f r^/�
Investigation(1 hr ruin) 66.25/hr
City/State/Z/I,P,: /��0 C 0�7 6.0/...- t/". V -4, �, r9�g C/ Industrial plant(t hr min) 78.18/la
Phone:(361/1 ,7f 15 - .7scf✓ I Fax: 'CP} 3,G-c)"" r,7(�b bupectiuy lister( hr m)which no fee g 90.00/hr
p 2 r-y�9 I C Z 3 0 I Suprv.Lic.: 7 9.f s ELECTRICAL PERMIT FEES
CCB Lic.:1 ,7``ZZ Electrical Lic.:. P / .�
':`jti, Subtotal:
Suprv.Electrician signature,required: / / fes"" Pian review(25%of permit fee}:
(�� 1 ( Date: State surcharge(12%of permit far _
Print name:�� -S�b;/l, ,.t'7) 4 - TOTAL PERMIT FEE:
Authorized signature' �� This permit application expires ifs permit is not obtained within 180
days after it has been accepted as complete.
Print name: %,s4..... • I Date: * Number of inspections allowed per permit.
MuildingWermiMlII.GPermitAPP 4404615T(11/05/COM/WEB
• Electrical Permit Application • I t ,J: 01 I I( I I \I ()\ 1
City of Tigard RECEIVED R00Cxd7�/�!G-CYL S
13125 SW Hall Blvd,Tigard,OR 97223 Data/By: Penult ftl
Plan Review
Phone. 503.7182439 Fax: 503.598,
��Q� Date/BY: Other Permit
., Inspection Line: 508.639.4175 iv U V 2i 2 0 6
Internet: www.tigard-o�r.gov Ready/By:
Avis: B Sae Page for
TYPE C1 + ��r"i•O $aPFiearescW fafornaHoa
•
0 New construction 0 Addition/alteration/replacement nt Please check all that apply(submit1 sets of
❑Demolition 0 Other: ❑ ,�our>r « amps or more ❑
400 plans wi5tens checked blow):
Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY.OF CONST$ICTIUhT exceeds 10,000 amps at 150 volts or °Float ng buildings,
less 13I-and 2-family dwelling 0 Commerciai/mdustrial 0 Ace essory building bD grou or exc 14,000- ❑ agricultural
amps for aU ocher installations. buildings.
❑Multi-family 0 Master builder
Other: El Fife pump. ❑installation of
te75 KVA or
JOB arra INFORMATION AND LOCATION Hm rgencyAddition
o systnew m larger separately derived system.
/� ❑Additionofnewmotorload of 0"A, "I-2,X1.3",
Job no.: Job site address: U��i I /- ,� boor.HP."...7m:ore. occupancy.
�+f` D Six a more nesideatiid units. Ll Recreational vehicle parks.
City/State/ZIP: ❑liaalth.care facilities. ❑Supply voltage for more than
Suite/bldg./apt.no.: 6,...0 ❑Hazardous locations. 600 volts nominal.
I Project name: vto--KT_ c, v1•, ❑Service or feeder 600 amps or more.
Cross street/directions to job site: � FEE SCHEDULE
Drleriogea I Qtr. l Fee. I Taal 1
•
New residential single=or multi-family dwelling unit.
U Includes attached garage.
Subdivision:
I.Lot no.: !; 1,000 sq.ft,or less I 168.54 4
Tax map/parcel no.: i Ea.adds 500 sq.ft.or portion a 33.92 i 1
DESCRIPTION OF WORK Lr energy, al 75.00 2
(withAabove sq..It)
Ltmtted energy,multifamily 75.00
residential(with above sq.ft.) 2
Services or feeders instailatio alteration,and/or relocation
200 amps or less
100.70 2
❑ PROPERTY OWNER
' - J . ❑ TENANT 201 amps t4 400 amps 133.56 2
Nom: 401 amps to 600 amps 200.34 2
Address: 60I anus to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) I Fox:(: ) 200 amps or less 59.36 i 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 e to 599 amps i68 54 2
Owner signature: Branch circuits-new,alteration,or extension er panel
Date: v A.Fee for branch circuits with
0 APPLICANT . I .! 0 CONTACT PERSON above service or feeder fee,
DR Horton Inc each branch circuit 7.42 2
Business Warne: B.Fee for branch circuits widwM
Contact name: Emerald Weeks service or feeder fee,first
Manch circuit 56.18 I 2
Address: 4380 SW macadam Ave
Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Portland OR 97239 s Eacittna,rrnfacp,ndor,nadu>er
503 222-4151 dwellingservice arai/or feeder 67.84 l 2
Phone.( ) i Fax::( ) r Recotmec t only 67,84 2
E-mail' Pump or irrigation circle 67.84•
2
- CONTRAcroa , Sign or outline lighting 67.84 2
Business name: f 1 L �r Signal circuits)or limited energy I
`.�(4/4(I r0-174 C.,l Vii 'c panel,alteration,orexteneion. P�2 2
G/ C' Each additionalinspection
Address: Re LI/ �E /terelit �J d ft_ (Ihr over allowable in any of the above
� / r0 ?7�-2f /, Additional inspection(1 hr min) 66 hr
City/Statee//Z�IiP: V he C'tai V (i". t4'4, �O 6'b /
Investigation(1 hr min) 6625/hr
Phone:(J i ,57( .���J Fax:�J/` Industrial plant(1 hr min) 78.18/hr
SCO) 3Z� .9 Fj Q Inspections for which no fee is
CCB
Lie.: �2 "�9 I Eiectt can Lic.. CZ 3 r� 1 Suprv.Lie.: j specifcally listed(54 hr min) -001 hr
T9- $ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: � Subtotal:
� Plan review(25%of permit fee):
Print name:C4 t=Sih`/1. 6 grit
. I Date:
_ State surcharge(1296 of permit fee):Authorized signature:
/ i/ TOTAL PERMIT FEE:
Print name: r I Date: This permit application after has been isnot obtained within 180
daysaccepted as complete.
1:1Buildi * Number of inspections allowed per permit.
ngWamitatELGPe,mitApp
440a615n111ro5icoivwEa
Electrical Permit Application—City of Tigard RECEIVED
Page 2—Supplemental Information f.,
NOV 2 2016 ///t57-1-0/5--00S-FS-
Limited
Energy Permit Fees: Renewable Energy Permit Fees:
CITY Y OF �`�C�ii�?
RESIDENTIAL WORK ONLY: a � i)!V1S;(1l�I -
FEE SCHEDULE
Fee for all residential systems combined: $75.00
Description ql�. e,en
_T iorol
Renewable electrical energy systems:
Check Type of Work Involved: 5 1 or less ((;i ,;,
5.01 to 15 kva 56
Audio and Stereo Systems* — —
---
[1:] 133'" '1
15.01 to 25 kra 201.34 I
❑ Burglar Alarm
Wind generation systems in excess of 25 kva: 1
25.01 to 50 kra 301.04 2
Pi Garage Door Opener* 50,01 In IVO k,a 55,.,(, ,
'1od kra(fee in accordance I `
with OAR til ti-109-0040) 55�,r
NI Heating, Ventilation and Air Conditioning
System* ' Solar generation systems in excess of 25 kva;
Fach additional kva„vcr_5 7 4 -3 !
n Vacuum Systems* Ioi�kra—rio additional charge 0,0 3
Each additional inspection over allowable in any of the above:1
Other' Each additional inspection is t I
charged at an hourly(I hr min) (h'•` hr I —���
Inspection,lir which no fie is
spccrficallp listed(':hr mir,)— 00.00 hi
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
(SEE OAR 918-309-0000) ' Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
I-1 Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
I [ Instrumentation
I
I I Intercom and Paging Systems
Il Landscape Irrigation Control*
I—I Medical
FI Nurse Calls
fl Outdoor Landscape Lighting*
❑ Protective Signaling
C Other:
l Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
L.Buildinr'PermiT,LLC Pr:nirApp_LLR ERE.cit.: Rr.u.1'':0V
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtv. Fee(ea) Total Square Footage: Permit Fee:
Footing drain- I" IOU' 50.03 0 to 2,000 — $121.90
2,001 to 3,600 $1 69.69
Footing drain-each additional IUD' 37.52
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 IOU' 62.54 $1.00 to$5,000.00 Minimum fee 572.50
Storm&Rain Drain-each additional 100' 37,52 $5,001.110 to$10.000.00 57250 for the first$5,000.00 and$1.52 for
Qty, Fee(ea) Total each additional 5100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or for $10.001.00 to 525,000.00 S148.50 for the first$10,0((0.00 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 525.000.00.
Inspections outside of nonnal business 90.00.'hr 525,001.00 to S50,000.00 $379.50 for the first S25,000.(0 and SI,45 for
hours(minimum charge–2 hours) each additional 5100.00 or fraction thereof.to
Reinspection Fees 90.00 hr and including 550.000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and 51.20 for
Additional plan review for revisions 90.00rftr
each additional 5100.00 or ti action thereof.(minimum charge–1:2 hour)
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*.
Quamtih by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replacer Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
Baptistry/Font 0 My new commercial building with water service 2"and
Bath -Tub'Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash -Each Stall
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
Cus Water Aspirator
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-4 Isometric or Riser Diagram
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic–non-food
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:
Rix.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 increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet
Urinal plumbing permit can be issued.
Other Fixtures:
G:\Pians\Plats'"Summit RidgePPetmit Docs\PLMF_PennitApp.doc 2
Plumbing Permit Application
Building Fixtures
FOR OFFICE ICE t sl: ()NI.)
City of Tigard Received ��`
II__ 13125 SW Hall Blvd..Tigard.OR 97223
Date/13y: fYnmt No.: I�St W kc,_�
r �t
• = Phone: 503.718.2439 Fax: 503.598.1960 Ilan Review
Date/By: Other Permit No.:
Ins coon tine: 503.639.4175
r f C;:1 ki Date Ready/By: Jori. ® Sec Page 2 for
Internet: www.tigard-nr.gov
Notified/Method: I SappleaentalInformation
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition Far special information use checklist
❑Addition/alteration/replacementDescription 1 Qty. I Ea. i Total
0 Other: New 1-2-family dwellings(includes t(XI fl for each utility connection)
CATEGORY OF C'ONSTRU€TION SFR(I)bath 312.70
❑ I-and 2-family dwelling 0 Contrcial/indlulrial SFR(2)bath 437.78
mc
0 Accessory building 0 Multi-family SFR(3)bath 50032
Each additional bath/kitchen 25.02
0 Master builder ❑Other:
Fire sprinkler(,sq.hi Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: i'C(J_ 2, ci kv‘ ,VAi )6Ct Larl Catch basin or area drain 18.76
Li
City/State/71P: Drywell,leach line.or trench drain 18.76
Footing drain(no.linear fl.:_) Page 2
Suite/bldg./apt.no.: I Project name: race.
ri a� )¶
CS Manufactured hoax utilities 50,03
Cross Streel/directions to job site: Manholes
18.76
Rain drain connector 18 76
Sanitary sewer(no.linear ft.: ) Page 2
Storni sewer(no.linear ft.: ) Page 2
Subdivision:
Water service(no.linear fl.:_) Page 2
of no.: Et Z..,. Fixture or item:
fax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK - , Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
C_ f+71)Gt(-ft)r ('ho..fl Cie Iry fl'1 141.k1 V( Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank
12.51
Name: b ii? fro(-j"C� Fixture/scNzr cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
)hone:( ) Fax:( ) Ice maker
12.51
0 APPLICANT
0 CONTACT PERSON Interceptor/grease trap _ 25.02
Business name: r), e N-t t✓tr>t 1 Medical gas(value:S_) Page 2
Contact name: I Primer 12.51
�'1 v1 P Y� (r j w P f L� Roof drain(commercial) 12.51
Address: L_17 C\NNAafa(1(Aftt kVe
Sink/basin/lavatory 25.02
City/State/ZIP: PD v ei-7_ 3cI Solar units(potable water) 62.54
Phone:( ) 2,1,7,_.. Lj i `j i I Fax::
( ) Tub/shower/shower pan 12.31
E-mail: , _? xS d Y ‘100-on. C Urinal 25.02
CONTRACTOR -' Water closet 25.02
Business name:Wolcott Plumbing Water heater 37.52
Water piping/DWV 56.29
Address:1075 W.Historic Columbia River llwy
Other: 25.02
City/State/ZIP:Troutdale Or.9060 Subtotal
Phone:(503)667-1781 Fax:(503)667-9891 Minimum permit fee: $72.50
C'CB Lie.: 112220 ( hiiig Iie,no.:26-824PB Plan review (25°/a of permit fee)
Stale surcharge(12%1of permit fee)
Authoriicdsignature*--�( J�
vvv�rw` TOTAL PERMIT FEE
I, Print name;Mark Baleme Date:2/17/17 I This permit application expires if a permit is nut obtained eithin ISO days
after ii has berm accepted as Complete.
*Fee methodology set by Tri-Coumey Bmilding hmhtstn•Service Board.
t'•.auildmgMamib)Pt.x1U-P.-mitApp due ItrOl Ar) 44(14(.1*It 10C21('Oxt:H'F131
City of Tigard
IIIICOMMUNITY DEVELOPMENT DEPARTMENT
T I c A R D Building Permit Review — Residential
Building Permit #: /1A5 2.0/(c OUSTS"
Site Address: 15-:,,429 ' () i'�i'uz't. I-co/L/
Project Name: 4.n', ; r C ��� Lot #: /'7Q,
(New d 40 g=subdivision name ..r+.n or Alteration=last name of owner)
Planning Review
Proposal: itieio s/ /P
Verify site address/suite# exists and activ k permit system.
Iver Terrace Neighborhood: I Z No ❑ Yes,See River Terrace Review Addendum Attached
Sit/Plan Elements:
ihte
ree(3)copies of site plan t It ;, 'sting structures on site
plan must be on 8-1/2"x 11"or 11 x 17"paper II. ootprint of new structure(including decks)with finished
rawn to scale(standard architect or engineer scale) I.or elevations
orth arrow Ii tility locations(required for new,may apply for additions)
address,project or subdivision name and lot number
• cation of wells/septic systems
R
o.plicant information(name and phone number) •
'sting trees to be retained with drip line,and tree
l. .t dimensions and building setback dimensions .rotection measures
1 Lot area,building coverage area,percentage of coverage and YA street tree size,type and location
Ppervious area(applicable if R-7,R-12,R-25&R-40) V4 Street names
roperty corner elevations(2 foot contour lines if more than
4 foot differential)
Olean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
_,equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
ll,G Public Faciliti mprovement(PFI) Permit:
Wequired: VYes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
and Use Case#: i. ,
Roning: /'— -
equired Setbacks: Front Rear SideStreet Side Garage is �s 2/ g g a
andscape Requirement: Q
IC1 "ot Coverage Maximum: —OD-
ICJ uildin Height:
g g Maximum Height Actual Height
Y 0/Visual Clearance
Easements
/',ensitive Lands: ❑ Yes PKTo Type
II Urban Forestry Plan
❑ Condition " et" .rior to issuance ofbuilding permit
Notes: 7 Y1 / i -S'/. /` t /
Approved By Planning: C ,,y '� Date: __ZZA
Revisions (after Building Submittal only) Reviewer Dat
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPermitRvw REs 091216.docx
Building Permit Submittal
Original Submittal Date: 1i_/fQl
Site Plans: # 3
Building Plans: #
Building Permit#: \, nter building permit#above.
Workflow Routing: G Planning 'Engineering /54-Permit Coordinator �9.Building
Workflow Sign-off: , t' Sign-off for Planning(include notes from planning review)
Route Application Documents: 7 Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
40 Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician:
.�. .I0i.�i(..._. Date: 421),...,?//e,
Engineering Review
Slope at building pad: _„7.7
k
onditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes
t No
❑ NOT Approved by Engineering: Date:
Notes: ,�j�
Approved by Engineering: 6'4 Date: ,/ 2?a,
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:
SDC Fees Entered: Wash Co Trans Dev Tax:
' ,/Yes CI N/A
Tigard Trans SDC:
9 Yes ❑ N/A
Parks SDC: Yes ❑ N/A
OK to Issue Permit ��/�
Approved by Permit Coordinator: Date: i
I:\Building\Forms\B1dgPermitRvw_RES_091216.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15429 SW APPLEWOOD LN, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Master Permit MST2016-00585
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS
Comments:
No AC at this time
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15429 SW APPLEWOOD LN, TIGARD, OR, August 16, 2017 at 7:06:21
97224 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00585
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide approved final erosion control inspection prior to building final as noted on
approved plans.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15429 SW APPLEWOOD LN, TIGARD, OR, August 16, 2017 at 2:58:29
97224 PM
Record Type: Record ID:
Residential - Master Permit MST2016-00585
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed.
No A/C installed at this time
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15429 SW APPLEWOOD LN, TIGARD, OR, August 17, 2017 at 9:03:22
97224 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00585
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Final erosion control approved.
Street tree certification received.
High efficiency lighting form received.
Moisture content form received.
Blower door test report received.
Insulation certification checked.
C of 0 left on site with contractor.
Violation Summary:
Inspector Contractor