Permit RECEIVED
Llectrical Permit Application tom•ari t-lNItINI%
AUG 2 0 2020
l ON Ytj t igard usr2o2v-Q''21v3
71 , - CITY OF TIGARD
BUILDING DIVISION R r
TI6 Ro
TV'I•I rtp VMRK VIA?* RPVI7 4F
A ..
--f ATEGORY t tt- (r), i Rl f7Nih _. C
J(75 StT2 IN OR>(47IO% Alai LO ATR) -
- \p\87io 5 w ( )•va o 54, - • c ,
— per,
C tt, a. - -- ❑ .,y ..
\er rr+ld-.I I MN*.ur lnaiii tamlly AweKinC AM'.
Includes attacked Vararr-
DESCRIVI tO54 OF WORK 1
_-..-
1 14 1‘NC-r t ho4C, tom'\-ro,Z. A
,.. 0 PROPERTY OR'rs R ,. 0 TY.NA-VT Ktnt+<uht f.m*ry, ; 0 Set Pap'=�-
r - M nu-s-,,:r fredrn anKittcttoa,sheravon are/rx ref,AARGA
5
_ _. ..__ "
_.._-,- _..— Itmprx-�r±srn kc-.♦xfrxdcn iastaltatiun.nLtrrariaa.eMor
i.MI!' rtkrgtkm
()f+nrr tmUlilatioR: t nu r u,;e^:..r,: � .iz T..::a_ ,r -s�czr^„ .apt? ..,i ..r to ,.!. _, ,
p
i
'.:.i -•-.-k I„3 K.rt"t t,r- Y, _ S. . .C. r I,4 1,,(IRS 44".449.fi?Q_an4,-01 _
i.•.2tUiS 'J,a -, r-C
___.. _—. fir nrh c;rteitk.. nv' atttratYln.or rntasiw.far pullet
Q APPLICANT 0 covi 4C1 143114W
B Mre.., t t0
- 4 �Yr�x
} \l:v.el6ar e. +snxrrlrr'dCl tn>t+nelldrd.
CONTRACTOR
ti. F r_ CARToN r_EGTRIG Z►.lC.
I ,t /t:' rY�4 /� '0l_ Earl)arid htaWWI Impel tam over alkwabtr rn es;or Orr aMre
5o5 435—9_3gl_ _ '
1 C kg-To NELECT2ICeFRoNriER•coif _
jS97P3 -- - 34-t.2oc._ `_ .5075-S --- —ALE( ' __ Pegs(rrt
, i4,
a' •.� / )�\ l•;e,,per, rawrn r s prra.n s lag M Ynth,n'44
1�A _/n_ - 8—/g_ Lo ) M fte,-•run IY,."alrtw.r x rAmtNn..
,
Mechanism Permit Annlicati�ECEIVE a , , is .1 I (' , I ,I :,,I ,
City of Tigard may. Pamir,Na MrSrZOZO'G2 7
— 13125 SW Hall Blvd.,Tigard OR 97223 AUG 2 0 2020 Plan Aesiew thhee Ekrm.0!!!_ Phone: 503.718.2439 Fax: 503.598.1960 t teRty
i l c n h h Inspection Line: 503.639.4175 CITYOF TIGARD tMe rndy By: tom, lid See Sap 2 Por
Internet uuw.[igard-or.gov Nd,fie t"Alcthrd. 'R 6. swpi...td lyda...um,
BUILDING DIVISIC?i�____
TYPE OF WORK 1! 'e -IMICSECICLINT—
�""-- ��'��" -- -Mechanical permit fees'are based on the value nl the uork
Ness construction 1t1,4ddil iom'alteration/replacement performed Intimate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead.andpraiit.
Value S
\,,_, CATEGORY OF CONSTRUCTION R!{ti1UF:NflA1.RQU[l�l1RIY1/SYS'F'RMS FEFN"'
in1-and2-family dwelling ❑Commercial/industrial Accessory building t`nr special rnfmmntmnmedrerkIn$.
0 Multi-family ❑Master builder ❑Other: Description TCnyV Ea. "total
JOB SITE INFORMATION AND LOCATION HeadeglcooBMt.
lob site address: Air conditioning 4 46.75 �b
(t rj7 0 .t v .`C14,1-3o Furnace 100,000 BTU(duclWvena) 46.75 j
City/State/ZIP: Furnace 100,000+BTU lducwvena) 54.91
T��� a Heat pump61.
Suite/bldg./1pt.no.: Project name: I L.,iyel VI�
Duct work 1 23.32
Cross street/directions to job site: T Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
1. Unit heaters(hid-type,not electric),
in-wall,in-duct,suspended,etc. _ 46.75
Fludvent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Other fad appliance:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
f ' -- Flue vent for water heater or gas
, LL'W v LIN Ci(.F( -- '% A 4 j t r) if J 1 fireplace 23.32
AJ ( )r,�„ Log lighter(gas) _ }39
✓ Wood/pellet stove .
'„ 'L..t'I!‘e, Wood fireplace/insert 23.32
Chimney/liner/flue/venl 23.32
0 PROPERTY OWNER 0 Other:"TENANT 23.32
Environmental exhaust and ventilation: _
Name: Range hood/other kitchen
---._. equipment 33.39
Address:
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
._ toilet compartments,utility rooms) Z 23.32
Phone:( ) Pas.( ) Attirhrawlspace fans , 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23,32
Fuel piping:
Business name:
514.15 for Oast four;$4.03 for each additional
Contact name: Furnace,etc.
---- Gas heat pump
Address: Wall/suspended/unit heater
City/State/ZIP: Water heater
Fax::( ) Fireplace
Phone:( ) Range
E-mail' 0)O(11 1 ` Cp ti Z1` T`r , :"' 1 # I C•''., Barbecue
CONTRACTOR Clothes drver(-teas)
Other
Business name: - ' t s,.
�� i vd / ("`r MECHANICAL PERMIT FEES'
Address: I:'1(.0 i. ?�l Subtotal '
City/State/ZTP ` ..U1 a'[.2- el•7 I S.( Minimum permit fee(590.00)
f Plan review(25%of permit fee)
Phone:(011 j ) 2-,2-G t C1 So 1.1 Fax:( ) State surcharge(12%of permit tee)
CCB lie.: 2, 0' C (as"c?" TOTAL PERMIT FEE
This permit application expires Ira permit b not obtained within ISO
days after It has been accepted as complete.
Authorized signature: r • Fee methodology to,by Tri-County Budding Industry Service Board
Print name: Chi-1.. Date: •1`7 2„,f)
I lauiiding1Pera u'MEC_PmmUPp_0401 u]ece 44a46171(1I n2ICOM/WE61
, -
..,, - --Rk• :1k r....., .vv•\10 LAn.. r.„(2 VrYtt,..f--i-Ki.fr t(a4-lay .
a . ..... ........a., •....•6,6,11.•••1 Wlea4•4• I'
Building Fixtures RECEIVE '
......., ,.....)k .)1:1;R:E. Cs(' i)\1.;
City of Tigard ILI rarely. i_,...i 11113,5%111a1L, Blvd,Tigard.OK 9721396fP ti G 2 0 2020 litSr2,020-eV2a
if ..olit 109 Fax 512i.598.1 rancilisr: ullasOts nir.1.',
InKtaitirn f ins: 503.630 4175. Ain. 1,
CITY OF TIGARD '""r'34'''
Nontimim.th...1 II er r ..maihir....i...
_
!
—7-.7 F gr j{ .._...EL117.11150.ChrCriAr•_ ,
D 7,41ff lUilliOn
flaseriptitat 1.215 I Es. I Total
LpOthar: New 1-3-1- dirdliisifindadat 101:10..fur ant whiny ranrinagre)
L--- " "' ' ' ' STK 1 bath
CATEGOOrti t111 ..11,iitzt.a...-14.,t,.,,,,,,„.0:.;:t3,....::•v, - t ) A 70
SFR f2)00111 437 7B
-am i.,"ai i-1 r t CI CnrnTlitTuallindidstrial
• - SFR rill bath 50032
itootaisent laalam 0 El Misiti-fnmily -
addatitsad linthlirdn:bnn IIM 23.02
1 0 Mosier boil...kr D'.v.li:i \ Fire sprinkler C __ „„' ---PT1.) .1.111rj3
.....
... .„. . .
........ jos' oath basin ta sena dial 18.76 I
fob silo maim.: ' 6--' '-'I *N E` i 1\4. \ r. l',. 1_ , . ..--
CE=E211NM ' . ____ Dtsisit„gl.Ina&lima.l or mu*dui
, -
trating dram(nn inear IL____) t I.%
Papp 2 —
tilg.,biArt.lapt.ay.. Project nism _. ni, 1EZ fulansifacamed borne tarldes 50.03
Coop stroeVtlarmlies it to job sae. Marilvige 14%
—
, K11 49 drab 1 mango= 18.76
1 — ' Sarsiou I:wave(au.Isom fl.:,) Papp 2.
.--,
- -
• Maar solace(no.Boor 11, ) Pogo 2
Subtirrrsinn: I tin no..: Plaire sr item
—
bockfloror Fallow 21.27
Tan ninfr'rarcal nu
,7-_,".....--. -.:-...-..-,----,,,,,,i..------i,vt:viira?sTE:tritiiitisy 7.,• :- -.77-',--' - .:.'---,-,•-'':'.... naltkWalliflvihZ 12-ill
23.02
12 li 4 a IN: - ....." libIll -' ' ff.LI St" Onannurans 25.02 ,
.t Lt 111Vr) J:e.ikr-f-e-} 1-0 C-4."NA,--kiti e.)r( ,--__
___ Drinking fountain
(
' ''h ry-1*--,1) - , Ejcarersinump ZI)2
-ti rioritri+ owNrzt ..i ../.--- CITV,v,,x-r: '.-;1.-; Expauttion tank 12 41
Fultartiscuer call , 25.02
Nairn: Ybpoir drnientlins sirdabob 25.02
Addrasa. ' — u _
Ciartsson disposal , 25 Ca
,. IV'Stith'-1. Rope bt.b 2502
:<..v.-maks- I 2.51
, 25 ir2
0 2PPLIC 2'5'r ' El r 2 ATACT PI- ON , inicrWrtnrellooG tratt
t
Medical vaz(valuer 5,) Paga 2
_...
Priam WI
_ ,.- -
,--- Roof drain(conanarild) 12.51
Address: --
gtoicittoinlavatuty "2- 25.42
,--
citr'Stataig.11.: Solar ume3 Walk'mkt) 6154
nicer( ) 1,.,s:: ,, ,
I TohisholwrhytAxs pan I t25 1
(Irina 22322
h-ninil: 1
r ''---- ''.'' •-• '. 24,-"t2*Prit...artakf2;,..-,5L-4,, "":- - '''''' - - — - - i 25332 —
, 37 52
b=.., ..---;ntrnc. f t "t-CAart t,-/ttors rtf'-'t 0 1 rt0 _ Uttar pipisplAW 56.31
A dat..:,...-vp flio 551 ,) ,Other ' 2502
c LI.itysaaidZIP. ttA j „IA/ ) (44 I f-6').-- _SIAM ea
Maim ( ' i i Lc"LT bas.( ) .___. Minimum porton Ina 57230 —
rt 1.ic.: "2,4 txt, 0 Plumbing L ..ic nn.: - Thas(VViVile(25%of pannit foo)
7 Stale,sunisorec it 2%of vomit foe)
Authorissal iiipardona 'an Al P'F:RiMIT 1.11.
Prini name' Date' - 1 e75-17- Wit pima sosatanon tiOiss it permit so,na 441111106•NOEM IMO Alp
Wier li eat brew ases0ed is mompleir.
•Faii sreetlesdnirre id Dv I ri-t`mpt.Suitt:lug P..i4,I,:,Se3V6*.V.,,r.rd
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities (Ky. Fee tea) Taml> Square Footage: Permit Fee:
Footing drain-I°100' 5003 0 to 2.000 $121.90
2.001 to 3.600 $169.69
Footing drain-each additional 100' 37.52 3.601 to 7,200 $233.20
Sewer-1st 100' 62.54 7.201 and greater S327.54
Sewer-each additional 100' 37 S2
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 S1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain.each additional WO' 37.52 $5,001.00 to S10,000.00 $72 50 for the first$5.000.00 and S1.52 for
Other Inspections or Fees �'• Fee(a) Totaleach additionallding $100.00 or fraction thereof,to
l and including$10,000.00.
Inspection of existing plumbing or for S10,001.00 to$25,000,00 $148.50 for the first S10,000.00 and S1.54 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 90.00ihr and including$50,000.00-
Additional plan review for revisions 90 00/hr S50.001.00 and up $742.00 for the first$50,000.00 and$I 20 for
each additional$100.
00 or fraction 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
BaptistnlFont ❑ Any 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 ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thm
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher -Commercial 0 My multipurpose fire sprinkler system.
-Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink. -2"
Isometric or Riser Diagram
-4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain qu
alifications-Domestic non-food that meet the above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachiRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: - Gang
-Stall
Sink: -l.avBar non-food related
-Bradley
-Com/Serv/Util food related
-Service Swimming *Note: If the fixture work under this permit results in an
Pool Filter increase of sewer EDUs,Clothes a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures.
1:'Building\Permits1PLMF_PermitApp.doc 08/04/2011
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
Tlcli\lir7 13125 SW Hall Blvd.•Tigard,Oregon 97223 • 503.718.2439•www.tigard-or.eov
TO: BeardDr) f oir a DATE RECEIVED:
DEPT: BUILDING DIVISION ( / RECEIVED
FROM: tK I K) L
V
� NOV 10 2020
/
COMPANY: Cart-z",I,n2-Ir4 f2,CG1741,PlQ"&S S'CITY OF TIGARD
PHONE: SO 5(5 q 7Q5 BUILDING DIV SAON
EMAIL: T< ? h,,') - c/ `,3 i,,r75 C r dl Y11,7.-CT, /4,•(
RE: /l 8/O 5W V1Idc4WUct?f fVv _ 21-210 • eit 3
(Site Address) /� (Permit Number)
-1tbdv.e. Mai ' i11G -!'
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: C P Description; Copies; Description:
Additional set(s)of plans. Revisions:
Cross section(s)and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):REMARKS: ?'-E'( o(At 1)1,-W /7O S(o
FOR OF
FICE ICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Ch---re-Trj Yes ❑No Fee Description: Amount Due•
- $
Special
Instructions:
Reprint Permit (per PE) I Ycs in No ■ Done
Applicant Notified: Date: Initials:
1 Jiudding&mms17Y memo mall auer.Rcviions 071120dor
CleanWater Services
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT
Clean Water Services File Number 20-002570
1. Jurisdiction: Washington County
2. Property Information (example: 1 S234AB01400) 3. Owner Information
Tax lot ID(s): 2S110BD00700 Name: Jerry and karen Under
Company:
Address: 11870 SW Wildwood st
OR Site Address: 11870 SW Wildwood St City, State, Zip: tgard,Or,97224
City, State,Zip: Tigard,Or, 97224 Phone/fax: 503-515-4645
Nearest cross street: Bull Mountain Email: karen@klinteriordesigns.com
4. Development Activity(check all that apply) 4. Applicant Information
® Addition to single family residence(rooms,deck, garage) Name: karen Linder
❑ Lot line adjustment El Minor land partition Company: Karen Linder Interior Deisgns
❑ Residential condominium ❑ Commercial condominium Address: same a above
❑ Residential subdivision 0 Commercial subdivision City, State,Zip: ,
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 503-5154745
Other Email: karen@klinteriordesigns.com
6. Will the project involve any off-site work? Oyes ❑ No ❑ Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project:
This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits,Site
Development Permits, DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality,
Department of State Lands andtor Department of the Army COE. All required permits and approvals must be obtained and
completed under applicable local, state,and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water
Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering
information related to the project site. I certify that I am familiar with the information contained in this document, and to the best of my
knowledge and belief,this information is true,complete,and accurate.
Print/type name karen Linder Print/type title Principal Designer
Signature ONLINE SUBMITTAL Date 9/21/2020
FOR DISTRICT USE ONLY
0 Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO
ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural
Resources Assessment Report may also be required.
X Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the
site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if
they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5, Section
3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable
local,State and federal law.
❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the
existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to
evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service
Provider Letter as required by Resolution and Order 19-5, Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and
approvals must be obtained and completed under applicable local,state and federal law.
❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT
OR SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by � .14.4, ° Date 10/1/2020
Once complete,email to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway, Hillsboro,Oregon 97123
r,,,.;,ed zne2C,
Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p: 503.681.3600 f:503.681.3603 • cleanwaterservices.org