Permit Support Document (2) CITY OF TIGARD " ' MASTER PERMIT
ri 4 COMMUNITY DEVELOPMENT 7 ///2 °D Permit#: MST2019-00455
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2438 Date Issued: Jan 21 2020 12:00AM
Parcel: 2S103CA00309
Jurisdiction: Tigard
Site address: 13014 SW 121ST AVE
Subdivision: BIRCH MILL SUBDIVISION Lot:
Project: Birch Mill Estates, Lot 1
Project Description: New SF. 4/10/2020: REPRINT permit to add A/C. 7/10/2020: REPRINT permit to add irrigation
backflow.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 6 First: 1053 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1470 sf Garage: 399 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2523 sf Value: $328,409.85 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Tina's: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 1
Footing Drain: 0 Ice Maker. 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'l 500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2523
Owner: Contractor:
LF121 LLC JTSC LLC Required Items and Reports(Conditions)
5285 MEADOWS RD,STE 171 5285 MEADOWS RD,SUITE 171 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035
PHONE: PHONE: 503-308-7324
FAX: 503-684-0102
Total Fees: $34,146.73
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 952-001-00 0.
You may
obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _'� _1�/ !!/v",,-'�ad--- Permittee Signature: d.A./.. .04.1_/C.0'77 p"//
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.
Plumbine Permit Application ,37 ,-
Building Fixtures -'' FOR OFFICE USE ONLY
City of Tigard• 13125 SW H Received 7/ZG)/u% 42� P-it Nos 77-tI 19 -CO`1 SS
Hall Blvd.,Tigard,OR 97223
Plan Review
C ' Phone: 503.718.2439 Fax: 503.598.1960 pt,tugy_ Other Permit No.: ISS•t -CCI
T IGARD Inspection Line: 503.639.4175 pate Ready/By: 2,me 0 See Page 2for
Internet: www.tigard-or.gov PNotified/Method: Supplemental Information
:
v-:. a ;ice � ..,.
For sped al infornsadon use clieckiisc
®New construction ❑Demolition Description I Qty. ( Fa I Total
❑Addition/alteration/replacement ❑Other: New I-2-famUy dwellings(includes 100 ft.for each utilityconnection)
r '-' SFR(I)bath 312.70 I
SFR(2)bath 437.78
ID1-and 2-family dwelling 0 Commercial/industrialSFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bathtkitchen 25.02
❑Master builder ❑Other. Fire sprinkler(_sq.ft.) Page 2
�:. . , ., 'c y_fl' S it:. Site utilities:
+ I 1 \ .t Catch basin or area drain 18.76
Job site address:
r J( %� - )" Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.:___) Page 2
SSuite/bldg./aptno.: I Project names j 1 I-c )� \r\\ ,l}I Manufactured home utilities 50.03
Cross stteet/dinxtions to job site: 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: �_J_
�t-c.11 to �� ,Y�r� � i`�)1`i
Lot no.: Fixture or item:
;ll � i
Tax map/parcel no.: Backflow preventer 1 31.27 '� ,D�
e - 0r r a < :z . Backwater valve 12.51
e,-..rv;' iid" eati• ��YDk „(f'�*wy; t :, � Clothes washer 25.02
New home construction - I.a i\ C j n 1 l C .` ,( ( . _) Dishwasher 25.02
' )S ( V( )1 C i f L ' Y 1 ,7 1 ill c �)>'1 f Drinking fountain 25.02
Ejectors/sump 25.02
•"°` ' S a'=°t .k.',.. 'i 4f :?- Expansion tank 12.51
��� _����v^„ .. � ._ _..-.. -A a .. F -
Fixture/sewer cap 25.02
Name: F ] � L �.� Floor drain/floor sink/hub 25.02
Address:5285 Meadows Rd Ste 171 Garbage disposal 25.02
City/State/ZIP:Lake Oswego,OR 97035 Hose bib 25.02
Phone:(503)657-3402 Fax:( ) Ice maker 12.51
O- - •---17 M.,*--1rr ° +'rah? in- Interceptor/grease trap 25.02
�� .; 'tat '` r,.� X'" _..
Business name:JTSC,LLC Medical gas(value:S_) Page 2
Primer 12.51
Contact name:John Wy land Roof drain(commercial) 12.51
Address:5285 Meadows Rd Ste 171 Sink/basin/lavatory 25.02
City/State/ZIP:Lake Oswego,OR 97035 Solar units(potable water) 62.54
Phone:(503)209-7555 Fax::( ) Tub/shower/shower pan 12.51
E-mail:' land tsmithco.com Urinal 25.02
JwY @1
. Xa.� o , +,! Water closet 25.02
.I Water heater 37.52
Business name:Mullen Company Water piping/DW V 56.29
Address:1601 A SE River Road Other: 25.02
City/State/LIP:Hillsboro,OR 97123 Subtotal .3I.2.7 _
Phone:(503)640-0113 I Fax:( ) Minimum permit fee: S72.50
CCB Lie.:92689 Plumbing Lie.no.:34-260PB Plan review (25:.of permit foe)
State surcharge(12/e of permit fee) 3 75
oL:c)
Authorized sign re: TOTAL PERMIT FEE 3S,Q 7f
Date: The permit application expires if a permit is not obtained within 180 days
Print name:Jeremy ce j y).7� /. ) after It has been accepted as complete.
/ "Fee methodology set by in-County Building Industry Service Board.
11Buildis Pemits1PIA1U.PamltAp,.doc 10/01/09 4104616T(IWo2/COM1VWEB)