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Permit
iv1V1202(-40452 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Water Meter Fixture Unit Worksheet TIGARD For Additions /Remodels /ADUs 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503.718.2439 •www.tinard-or.nov LOCATION: City of Tigard—City Hall WATER METER SALES: Utility Billing By Appointment Only: 503-718-2460 13125 SW Hall Blvd. Tigard,OR 97223 METER: SIZE: FEE: Pricing effective 01/01/2021 5/8" $9,495.00 — Fee includes: 3/4" $13,554.00 water system development charge, 1" $24,886.00 - water meter,and 1-1/2" $73,689.00 meter installation fee. 2" $119,333.00 DETERMINING METER SIZE FOR RESIDENTIAL CUSTOMERS City of Tigard Water Service Area uses the American Water Works Association Manual and the Oregon Plumbing Specialty Code to determine the size of meter needed to adequately serve buildings. Due to the variety of home sizes built in the Tigard area, we count the fixture units of all homes to determine the appropriate meter size. Use the worksheet on Page 2 to calculate the current number of fixture units compared to the proposed increased number of fixture units,which will determine whether an increased meter size will be required. Submit this signed worksheet with your building or plumbing permit application submittal. DOCUMENTATION Once you are ready to purchase the new meter, please provide the following items to the Utility Billing counter: • Completed water meter fixture unit worksheet for additions,remodels, ADUs,etc. (on back page). • Copy of building or plumbing permit application date-stamped by building division. • Copy of issued building or plumbing permit. Your fixture count will be verified and your request will be processed upon receipt of these documents. No exceptions. INSTALLATION TIME Once the upgraded meter size has been purchased,please contact Public Works for installation. Their number is 503-718-2591. Most meters are installed within 10-14 business days. I:/Building/Forms/WaterMeters_070120_Add.docX Page 1 Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs Please complete the following information: Customer Name: . Pr6u-N N1/- f) Service Address: Street/Suite#: 122,-3 0 Svd 5‘..4-4401 Efe_ ST City: T/ State: CrYL Zip: 411 iZ3 Phone Number: Email: kA2e,n CI +Art Act.o qyrtuiJ.4lwl Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = x 1 = Bidet x 1 = x 1 = Clothes washer x 4 = y x 4 =- Dishwasher Dishwasher j x 1.5 = j ,ca x 1.5 = 15'Outside Water Spigot j x 2.5 = 2 .5 x 2.5 = Water Spigot,each add'i 3 x 1 = 3 x 1 = Kitchen sink j x 1.5 = 1 . S x 1.5 = Laundry sink x 1.5 = i.J x 1.5 = Lavatory(bathroom sink) x 1 = z l x 1 = Water closet,1.6 GPF(toilet) Z x 2.5 = 5 x 2.5 = Bathtub/whirlpool 4 x 4 = I x 4 = Shower stall j x 2 = Z x 2 = Bath/shower combo 1 x 4 = 4 x 4 = Current Points: Z'] Proposed Increase: 2... Current Points+Proposed Increase= =New Total Points =Required Meter Sizers 1$1/ Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points='/4" 37.5 and over points= 1" New Meter Size Needed for New Total Points: Si 2? Cost: $ W q$ .t— (see page 1) Current Meter Size per Utility Billing: S i g Cost: $ q °I 9 S• 01) (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY Current Meter Size Confirmed with us Bentley (no upsize required) 5/26/21 Signature of UB Representative Date I:/Building/Forms/WaterMeters_070120_Add.d ocx Page 2 CITY OF TIGARD MASTER PERMIT 1111 11: ' COMMUNITY DEVELOPMENT Permit#: MST2021-00052 TIGAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/20/2021 Parcel: 1 S 134CB01300 Jurisdiction: Tigard Site address: 12280 SW SUMMER ST Subdivision: SUMMER HILLS PARK Lot: 12 Project: Abunnadi Project Description: Interior/Exterior Remodel.Vaulting ceiling,demo chimney, re-piping, re-wiring and replacing drywall. Going from 3 bdrm to 2 bdrm,adding 280sf cover over exempt deck, and adding BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 0 sf Value: $40,000.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sower Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 20 Drains: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 0 Bckflw Prevntr: 0 Drywall-Trench Drain: 0 Other Fixtures: 1 Other Fixture Units: Re-piping/DWV MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 3 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 0 201-400 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF ye R-3 0 Owner: Contractor: ABUNNADI,KAZEM M OROPEZA CONSTRUCTION Required Items and Reports(Conditions) 12280 SW SUMMER ST 10405 SW DENNEY RD TIGARD,OR 97223 BEAVERTON,OR 97008 PHONE: PHONE: 360-949-9946 FAX: Total Fees: $1,838.12 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 1.8000,. .33322..23344. ,{Issued By: . (0J Q Q j .A Permittee Signature: n a t x•( c-v t 1 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. b a Building Permit Application _ Z//(o/2l Residential RECEIVED ,Y)It t,l1l( 1 I SF.ONLY III City of Tigard DatRece/By: 0 /ry / '7 �C-f �I2/D(.Y FEB 16 2021 p ,Rev' Permit No 13125 S W Hall Blvd.,Tigard,OR 97223 Plan A� 52. Phone: 503.718.2439 Fax: 503.598.19�d1 r,,OF TIGARD ��y: I Z I 41 O her Permit: .l. t .,�;n Inspection Line: 503.639.4175 Date ReadyBy: _agar ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION i0 / /0( a Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction 0 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 51 Other:Re ny.J cl t_t, !,k ,t. equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. / Valuation: $ / �L7r CZ3J V 121,I.and 2-family dwelling 0 Commercial/industrial `t ❑Accessory building 0 Multi-family Number of bedrooms 3 ❑Master builder 0 Other: Number of bathrooms It i JOB SITE INFORMATION AND LOCATION Total number of floors:�� o1`� 1 Job site address: i' Z2? New dwelling aretr n�hf"'15`'`s�uare feet City/State/ZIP: 7J L✓9.4„, r tJYL / 7 Z.Z-t-, tr����, area t f" `-asquare feet v� 10 Suite/bldg./apt.no.: Project name: Covered pore area: p I ede,,f square fe u �2.,g V J Cross street/directions to job site: Deck area:gee I qr,...J square feee_!'� 'e ,j tn) I 2.1 S 4-' / WE S T (-r+..) S t--e---,"?'"1 i-'( Sr Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: Permit fees"are based on The value of the work performed. * y(l indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: p A t\t9, equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK "D {`r�11 work indicated on this application. �5 Valuation: $ CR...; li1V . Ite_net/i.42 If- iee_,.vlrinA , (,..pi,.,.a },, 2 Existing building area: square feet 13e d ru',,,1 J7yv s 3 RQP Igtti..,a ,1-4 Id-eH.A.i:AJA , New building area: square feet Elk PROPERTY OWNER 0 TENANT Nut ber of stories: Name: 1.4 p T...+A IA. AO•,.+--ry Al 4-1)i Type of construction: Address: I22'30 , -.) ,st.t srrr i&Tit S.i Occupancy groups: City/State1ZlP: 1--/ (_i-pC.. c: 9--7 z2,3 Existing: Phone:(j ) 3 v-1 5yy y Fax:( ) New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES' Business name: ©,,.v e./1.� (Please rejerrofee schedule.) Structural plan review fee(or deposit): Pr 6/ Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Phone:(5'r/3 ) '3v -'I 5 `I 61 Fax::( ) Amount received: E-mail: V ck'�Q,,,1r1 a 5 may)y1 n ra..+ p L�im1 N r I. c,.iv^ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES' Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: ' �„.,�_ LOr -4� _.�'�j Submit two(2)sets of roof plan with connection details' 7GI�� �-� and fire department access,along with the 2010 Oregon Address: /0 L� 5 SGrJ �Li e n r jieeze y� ,7 Solar Installation Specialty Code checklist. City/State/ZIP: ix4VC �.. �/(� / �U� Permit Fee(includes plan review $180.00 and administrative fees): Phone:(3l,0) 9 el g 914/L Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: 02,4 sus— /Attu Total fee due upon application: $201.60 _ Authorized signature /J7 . C'(, / � This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Dare' 'Fee methodology set by Tri-County Building Industry Print name: K!q-2�Gt"l N1{ - �Anth 61 2 l f 7 / a-) Service Board. (:\Building\Permits\BUP-RESPermilApp.doc 02/24/2011 440-46I3T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OrFICE LSE ov a City of Tigard Received : Permit No.: 411 13125 SW Hall Blvd..Tigard,OR 97223 I Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical 14..,Ato Internet: www.tigard-or.gov ❑ Other: llli FO> F,ONv me I'll NIS ,tR1. RRFQI'112F.D FOR rl..vy lu•:N'llAN NeC N° Ni N I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ it 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 [' 3 Verification of approved plat/lot 0 ❑ El 4 Fire district approval required. Name of district: . 0 0 21 5 Septic system permit or authorization for remodel. Existing system capacity 0 ❑ 6 Sewer permit. ❑ 0 El 7 Water district approval. ❑ ❑ I 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ■ 9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ■ ,� basin protection,etc. 10 _A,Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state M ❑ ❑ 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. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ® 0 ❑ 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 LEI 0 ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® 0 0 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- g 0 0 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. m 0 ❑ 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- 1E1 ❑ 0 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 A, 0 ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ [F 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 IN ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof Muss design details. ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 for four or more appliances. ,,�t 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or r5l ❑ ❑ architect licensed in Ore on and shall be shown to be a licable to theproject under review. 23 Three(3)site plans are required for Item II above. Site plans must be 8.1/2"x 11"or 11"x IT'. ❑ 24 Two(2)sets each are required for Items 16,19,20 and 22 above. 0 ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document, ❑ ❑ u[� 27 "Drawn to scale"indicates standard architect or engineer scale. 5 0 0 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, ❑ ❑ IN and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ 0 29, 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 0224/2011 440-4613T(11/02/COM/WEB) DECEIVED Mechanical Permit Application FoR OFFICI,USE 051.1 City g ofTi and FEB 16 ZOZI Received Datei Permit ro. a��^UCr15Z 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.10TV OF TIGARD DatetS Other Permit: InspectioI-I G:11:n Internet:nwww.tigardbor.gov 5 BUILDING DIVISION Date Ready/By: Jens. VI See Par Afar Notified/Method: Suppler .ntal Information TYPE OF WORK COMMERCIAL FEE"SCP-D'..E- USE CHECKLIST Mechanical permit fees* v 1-sr on the value of the work ❑New construction ❑Addition/alteration/replacement performed.Indicat the t i',unded to the nearest dollar)of all 0 Demolition 21 Other: gE- /Y!O l]4L mechanical meter' '_ ir •,r .nt,labor,overhead,and profit. CATEGORY OF CONSTRUCTION RESIT " At .QUIPMENT/SYSTEMS FEES* *1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building s .clot information use ckecktisr. ❑Multi-family 0 Master builder ❑Other: Descrip. = 1 Qty. Ea. Total JOB SITE INFORMATION AND LOCATION F.eatior 441ir it e - .ng 46.75 Job site S address: i Z,2 U •...) .G/Y/MEr/CC 5C - J, m Euro /1,0,000 BTU(duetaives) 46.75 City/State/ZIP: 77 A �L q 1 az 3 Fumac 100,000+BTU(duets/vents) 54.91 •r`a,i p 61.06 Suite/bldg./apt.no.: Project name: D,twork 23.32 Cross street/directions to job site: r .) .ydronic hot water system 23.32 • Residential boiler(radiator or Skis./ /7,./SPL / MJ S i ,ci:A... y►i'7. ' J . hydronic) 23.32 i' Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 — — Other: 23.32 Subdivision: Lot ko;' , Other fuel appliances: Tax map/parcel no.: Water heater 23.32 geit DESCRIPTION OF WORK - Gas fireplace/insert 33.39 ( ZikCS f � Y� fireplace ace for water heater or gas _ DS Q — ,I,sw"1'_') fire lace 23.32 l hter �Y\ I v`."' Log d/pelletsto) 23.329 41 �e�CA) �l, Wood/pellet stove 33.39 t ,v �, Wood fireplace/insert 23.32 f Chimney/liner/flue/vent 23.32 Other: 23.32 jar PROPERTY OWNER E_r TENT Environmental exhaust and ventilation: Name: k Pt'Z.&+�1 t.,, , fl' t LA./N IVIzli Range hood/other kitchen l 33.39 _ equipment Address: ).ZZe C si tirf,Y111 •� I Clothes dryer exhaust 33.39 City/State/ZIP: T1 1`"LZ3 Single-duct exhaust(bathrooms, / �r�f� / / toilet compartments,utility rooms) 3 23.32 Phone:(.53) 0-1 5 /%1 y , 'x: ) Attic/crawlspace fans 23.32 An APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: o(A//✓EjC _ $t4.IS for first four;54.03 for each additional Contact name: Furnace,etc. Gas heat pump Address: h(q/CC. b F.,„...- 1 Wall/suspended/unit heater City/State/ZIP: 14 4}T j /C.G D 9 1 1 • C i 4 1 'Yt,(,i) Water heater Phone:( ) l4 Ed. Fk'( 04.1.-c1 Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) ii Other: Business name: Tr1- L✓er��c,, / 2 z '2 MECHANICAL PERMIT FEES* Address: j3 `co t°/ �,,-At a., e'vr," 6,..,i[_ Subtotal •• "" G 2 o 4� Minimum permit fee($90.00) City/State/ZIP:ar��A� / / y t f Plan review(25%of permit fee) Phone:��)e �7..'-2 0 - '1(Fax:( ) State surcharge(12%of permit fee) CCB lic.: 3 4Z) TOTAL PERMIT FEE 2460.23 / This permit application expired Ira permit is not obtained within 180 days after it has been accepted as le. Authorized signature 7') 44.L......017 * Fee methodology art by Tri-County Building Industry duslry Service Board : / •. Print name:g' sy-y4 Ai, no ZA f/J/ Date: ? /j 7/Z/ Lddatdina&Pernrits\MEC Pernilnpp.040113.doc 4e0-1617i'(I lroucOMM'EB) J 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 nesv commercial buildings require 2 sets of plans. I:IBuild ingV'cmits\MEC_PermitApp_0401 I 3.doc 2 Electrical Permit ArmlicatRECEIVED 1 OR(>FFI( 1( t sli t>M1I.1 City of Tigard rr Received Permit#fit-frsr2(J2 f-Cla)S2 II • 13125 SW Hall Blvd.,Tigard,OR 9722T EB 1 6 2021 Plan Review = Phone: 503.718.2439 Fax: 503.598.1960 Date/13y: Related Permit k: , Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: lure: s 'ee Page 2 for T It-'A h U Internet: www.tigard-or.gov Notified/Method: upplemeatal Information Run nwr njvGm TYPE OF WORK PLAN ' ' IEW ❑New construction ❑Addition/alteratio a lacemegt7 Please check all that apply(submit sets of plans w/items checked): 0 Service or feeder 400 amps... More 0 Building over three stories. ❑Demolition 0 Other: where the avaii'sble fault c eat 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,001 amps 5' r.Its or 0 Floating buildings. 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to s quad,5 ex•" 14,000 0 Commercial-use agriculturalamps for 1 I. miens buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire p ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emer_y'y��iat)r larger separately derived ❑Addi SIt�'new otor load of system. Job#: I Job site address: j Z Z.1s'v S,.,J su.ri mGG, s i t s !more. ❑`A","E', 'I-z "I-3", City/State/ZIP: j t G.AtiC t7 ❑i� 'more residential units. ocen�"ey. / (J� 9 1 Z 7.-3 CD.!i.• th-care facilities. 0 Recreational vehicle parks. Suite/bld /a t.#: I Project name: t pus locations. ❑Supply voltage for more than g' P JAt S.. ice or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: S,•J j Zi 5 4-, INr S r uy't FEE SCHEDULE Description I Qty. I Each I Total I • St..G-in)N 7 F-/'. 5 T 1 , New residential single-or multi-family dwelling unit. Subdivision: I L of#: \ • Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK >; Limited energy,residential• 75.00 2 (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 (lg PROPERTY OWNER I ■ 1 Services or feeders installation,alteration,and/or relocation k'Name: , z i�,f.q M , A.Q 0,4%.1ta/ -/:+ 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Address: I LZ)y'v :<.J L.f_i'1'1 q'iC-1'' S T �` 401 amps to 600 amps 200.34 2 City/State/ZIP: T ti A-rt.1> / UYL- el -1 Z'• 601 amps toI,000amps 301.04 2 Phone:(5O 3 01 54%4 17 Fax:( Over 1,000 amps or volts 552.26 2 n Temporary services or feeders installation,alteration,and/or Email: i<(tvZe vv\ 4�j(-4rrn fi 44 e lg 3 1‘ipr a 1 , C ") relocation Owner installation:This installation is being mad . .;,petty that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,ac t . t RS 447,449,670,and/ 701. 201 amps to 400 amps 125.08 2 Owner signature �'j'J ' °�� Date:a / ,� 401 amps to 599 amps 168.54 2 0 APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with oa p, above service or feeder fee, Business name:�P� Il L �st r vY1 pPf�//Ylr �S zOa each branch circuit 7.42 2 Contact name:LA);II S 7,.4L 4'� 13 f--AY B.Fee for branch circuits without L�� L. � e. service or feeder fee,first 56.18 2 Address: )- "ne I 't)r�t C branch circuit Each add'I branch circuit 7.42 2 City/State/ZIP: Miscellaneous(service or feeder not included) Phone:( ) I Fax::( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Vki, Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: de , e ,t G.-r,e 1 t.- Sign or outline lighting 67,84 2 Signal circuit(s)or limited-energy 0 See Page 2 2 Address: ZO 9 K 5 'ic& au F{e ;./l 1/ C j 2 JJ apanel,alteration,or extension. Cit /State/ZIP: b e a I (JYZ- �')'1 O L,..7 Each additional inspection over allowable In any of the above Y / Additional inspection(I hr min) 66.25/hr Phone:(501) —1 ' 3 ci 01-1 3 I Fax:( ) Investigation(I hr min) _ 90.00/hr @@@ Industrial plant(1 hr min) 78.18/hr Email: m K, 0 1 :,.. b2..Ct l eAe L L - ca3^^'% Inspections for which no fee is CCB Lic.: .9 1 Electrical Lic.: I Suprv.Lic.: specifically listed('h hr min) 90.00/hr t ELECTRICAL PERMIT FEES Suprv.Elect,clan signature,required: �1ce.✓k. 1�\, ,' Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): .� I� TOTAL PERMIT FEE: Authorized signature �✓l�f ��./f Y,- �t �, ' This permit application expires if a permit is not obtained within 180 Print name:iA 7 M . /h-1-/t„(0t/�A-j). Date: 'Z I/1 I Z i days after it has been accepted as complete. /'�_ _. . Number of inspections allowed per permit. I:\Buildingrarmiu,ELC_PermitApp_ELR ERE.doc Root16/172015 4404615r(11/05/COM/WEB A Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Deaeriptinn I Qtr. I Elide I Total I • Fee for an residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: s kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 [] Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in an of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(%hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Subtotal Fee for each commercial system: $75.00 • Number of inspections allowed r En permlon Paget}; t. (SEE OAR 9l 8-309-0000) Check Type of Work Involved: El Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations l:huildingTermitsELC v,mkApp_ELR ERE.doc Rev 06/172015 t PI mbing Permit Application Building Fixtures RECEIVED FOR Of n( L 1'SIC 0�1.1 City of Tigard Received Permit No.:.j��r��/� , 13125 SW Hall Blvd.,Tigard,OR 97��p Dan Re �(ry L V2� S� Phone: 503.718.2439 Fax: 503.598r1%0 6 2021 P1en Review Date/By: Other Permit No.: n Inspection Line: 503.639.4175 CITY OF TIGARD Dan Rey/By: kris.. 0 See Page 2 for Internet: www.tigard-or.gov Notified/'Method: Supplemental Information TYPE OF SING DIVISION FEE* SCHEDULE ❑New construction ❑Demolition For special in orrrarlion use checklist Description I Qty. I Ea. I Total ❑Addition/alteratiaiireplacemeiit) ❑Other: New 1-2-family dwellings(includes 100 It for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath j 312.70 B(I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath y 437.78 SFR(3)bath \ 50032 ❑Accessory building ❑ Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.fl.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1 t2 O 54j S(j_ ihM ,S.-3- Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 7 I‘..1€)1C t , (-(YC ' "I Z Z,_2 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: SJ IV S 4" , u rtS i CryJ Manholes 18.76 Rain drain connector 18.76 $c(-7n/✓1 ars2- ST Sanitary sewer(no.linear ft. Page 2 Storm sewer(no.linear ti.: ) Page 2 Water service(no linear ft.: ZJ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow prevcnlcr 31.27 DESCRIPTION OF WORK Backwater valve 12.51 _ - Clothes washer I 25.02 f�F'1ALi *I(3 e.. I5i-'1rvri (- Z p1ed4 Dishwasher ( 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 Ig PROPERTY OWNER } 0 TENANT Expansion tank 12.51 Name: KAz.r-tA IA • A�3,-(3, -r7la Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: r'Lz-'v Q s,,,) -S`tarlN9 crG '$f Garbage disposal I 25.02 City/State/ZIP: Tl (,- -st.i) / ult. 91 Z 2..3 Hose bib 'y 25.02 Phone:(Stg )3t3, .s-14 g Fax:( ) Ice maker j 12.51 IX APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: ry„i 4,1 Medical gas(value:$_) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:(3Jj) 3tst 54y1' Fax: :( ) Tub/shower/showerpan Z 12.51 E mail. sy7 . eL Urinal 25.02 Water closet ?+ 25.02 CONTRACTOR Water heater I 37.52 Business name: /,(.onc✓1 Water piping/DWV 1 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax;( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.: Plumbing Lie.no.: State surcharge(12%of permit fee) Authorized signature:../.01.0":040.' - /'. TOTAL PERMIT FEB "� This permit application expires if a permit is not obtained within ISO days Print name:kkaZA*' M - ,.(,/�41) Dale:/ Z,/1-71 2 / after it has been accepted as complete. *Fee methodology set by Tti-County Building Industry Service Board. I:\Building\Permits\PLMti-PermitApp.doc 10/O1/09 440.4616T(10/O2/COMIWEB) Plumbing Permit Application - City of Tigard t Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-la 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 p and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first 525,000.00 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 fix 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*. 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 Baptistry/Font ❑ Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall ElNNewew exterior plumbing site utilities for any complex structure Dve Tam as defined in OAR918-780-0040. - Cuspidor/Waterriirator ElMedical gas and vacuum systems for health care facilities. Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit a sets of plans with any of the above. Floor Drain/sink: -2" -3" Isometric or Riser Diagram -4" 0 Isometric or riser diagram is required for new buildings -Car Wash Dram that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach/Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lay/Bar non-food related -Bradley -CmNServ/Util food related -Service *Note: lithe fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: L:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 ? Ain,r-\.i r s A SlSr - Off— , Plan # 7e2vllSi`on g-ti 1/-4-6‘C-ti Floors Large Bed rooms Small 2 I ( i 2---( WCLAV ,Tub v I Basement �/[� 1 ��" V J Vent 1st Floor fDu VY ,(� Q��� �1'►�u a" I Water Heater 2nd Floor AC 3rd Floor ` 4-tb� Gvt School R-3 Total * �• �(��- d��� f -L- Garage J r I h�,� a�0 V 1) c Total D I (xJ✓� t-' kiNsio #for Elec 1 DW 1) r-D ,- I r t7•t� 2�sv5� 2-) L, 1 ✓>✓SU V''-) — 3) - - = -- _ LI ` 1 S.) , k 12_-V\--Q YVyk,-rtiA -(__. y Vas t — 1,-� t5 '( rv-\ 7-eak. — Os., :C?E`K Lb,( rA t A Ati Its S 0 1(1 / e'O° (.- OF City of Tigard q COMMUNITY DEVELOPMENT DEPARTMENT 0 TIGARD Building Permit Review — Residential Building Permit #: MST2021-00052 Site Address: 12280 SW Summer St Project Name: Abunnadi Lot #: Planning Review dPr posal: Interior/exterior remodel Verify address/suite#active in Accela. River Terrace: No ❑ Yes, River Terrace Review Addendum Sit- lan Elements: _,,Erosion Control opies of site plan on 8-1/2"x 11"or 11 x 17"paper _Retained trees with drip line and tree protection measures A P rawn to scale (standard architect or engineer scale) ootprint of new structure(including decks) and FFE •'orth arrow tility locations&easements(required for new and additions) e address,project or subdivision name and lot number sidewalk/driveway approach .plicant information(name and phone number) location of wells/septic systems • .' ensions and building setback dimensions _Xeet tree size,type and location F.i.uare footage of buildings to be demolished V t et names RI '.ring structures on site rner elevations (2'contours if more than 4'differential__ ;'.•t area,building coverage area,percentage of coverage and 4>1,000 sf of impervious area created or replaced? es o pervious area(ap licable if R-7,R-12,R-25&R-40) If yes,is a storm water quality fac- ity shown? es o 9 Clean Water rvices—Service Provider Letter (lot platted prior to 9/10/1995): Required: Yes,applicant was notified ❑ No Received: Yes — No II Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: ❑Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No II SDC Exemption for ADU applied for: ❑Yes ❑No Received: ❑Yes ❑ No :I Public Facilities Improvement (PFI) Permit: Required: ❑Yes,applicant was notified ❑ No ,)pplied For: ❑ � es ❑ No,stop intake I� and Use Case#: _ Zoning: £7 C e. equired Setbacks: Front: Rear: / SiSide: Street Side: ADM- Garage: 2O 1(J Building Heir ht: Max. Height: -�C..) Actual Height: h andscape rea: % t Coverage Max: Entrance J :et back no more than 8'from street-facing wall Parallel to street or offset 45 degrees or less Windows 7 ,- . urn 12%of area of all street-facing facades Garage Li Gara door is behind widest street-facing wall ❑Yes No,one of the following is met: Door extends no more than 5'from wall and there is a covered porch extending beyond garage. E. Door extends no more than 5' from w and there is a 12 sq ft.window above garage on 2nd floor. OL Gaxa e door width is 12'or less 50%or less of facade 60%or less and includes 7 of following: Covered porch 1 Recessed entrance ❑ Wall offset 1'Roof eave Roof offset Fire shingles Lap Siding ❑ Roof itch 0Gable,hi ,or gambrel roof ❑ Dormer Accent siding �mdow trim Window recess Window projection ❑ Balcony Visual Clearance , LIB rban Fores P n `�}\ Sensiti e Lands: ❑ Yes No Type: C. •itions met prior to issuance of building permit o -s:Pi Approved By Planning: �_ `-V� 1/7�-- �- Date: /1�-4/ Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\B I dgPermitRvw_RES_122419.do ex Building Permit Submittal Original Submittal Date: 0��il,2./ Site Plans: # 3 Building Plans: # .3 Building Permit#: &&�Enter building}permit# above. n Workflow Routing: Planning LJ Engineering [ -Permit Coordinator Building Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: ©.'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application, site plans,building plans,engineer and beam calculations and . t details,if applicable,etc. Notes: yaw i By Permit Technician: //�� Date: Dy—d/--ZOZ( Engineering Review `Slope at building pad: /f Conditions "Met"prior to issuance of building permit h/A.- asements (encroachments) per engineering conditions of approval and plat HA- IL7YWater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Et-No Assess Water Quantity Fee in-lieu: ❑ Yes L7 No LIDA Facility on lot: ❑ Yes &No Br Final Plat Recorded:vi/°" ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: �y> et-;> e-.1 Date: f/i IN Z 1 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review Conditions "Met"prior to issuance of building permit `1 Y Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: 0 i SDC Exemption: 0 Received LY] Does not a5pl SDC Fees Entered: Wash Co Trans Dev Tax: El 1y /A Tigard Trans SDC: ❑ Yes /t Parks SDC: ❑ Yes '/A LIDA ❑ Yes Pi N/A OK to Issue Permit Approved by Permit Coordinator: C dOe Date: 2"//Z1 I:\Building\Fomis\BI dgPertnitRvw_RES_122419.docx RECEIVED Clean Water Services -Service Provider Letter 2021 CITY Or i iGA=1D BUILDING DIVISION Submission Date: 4/1/2021 Confirmation#: 523 Applicant Name: Kazem Abunnadi Review Type: Partner City Plan Review Contact Email: kazemabunnadi@gmail.com Ground Disturbance: 100 Sq. Ft. Contact Phone: 503-307-5448 New Impervious Area: 0 Sq. Ft. Primary Address: 12280 SW SUMMER ST Mod. Impervious Area: 280 Sq.Ft. Primary Jurisdiction: Tigard Development Activity: Single-Family Dwelling Addition Affected Tax Lots: 15134CB01300 INSTRUCTIONS:This pre-screening report is the Service Provider Letter(SPL)as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22. PROVIDE A COPY OF THIS SPL TO THE JURISDICTION RESPONSIBLE FOR LAND USE REVIEW AND PERMIT ISSUANCE.This pre-screening review does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered and this review does NOT eliminate the need to obtain additional CWS permits or reviews if project changes in scope or location.All required permits and approvals must be obtained and completed under applicable local,State and federal law. Permit or Review Required Next Steps Environmental Site Assessment No Review Water Quality Treatment Review TBD Contact city(primary jurisdiction)responsible for land use review and permit and Stormwater Inspection issuance. Erosion Control Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Erosion Control Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit with Site Plan issuance. Line Tap Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Disconnection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Connection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Connection Permit with Plumbing TBD Contact city(primary jurisdiction)responsible for land use review and permit Plan issuance. Easement Review TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the Tualatin River Watershed.Our partners include municipalities,environmental organizations,and developers large and small. Contact Us*2550 SW Hillsboro Highway*Hillsboro,Oregon 97123 phone:503-681-5100*email:splreview@cleanwaterservices.org*website:www.cleanwaterservices.org/permits-development CleanWate"� Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number 1. Jurisdiction: Tigard 2. Property Information(example: 1 S234AB01400) 3. Owner Information Tax lot ID(s): Name: Kazem Abunnadi Company: Address: 12280 SW Summer St OR Site Address: 12280 SW Summer St City,State,Zip: Tigard, OR, 97223 City,State,Zip: Tigard, Oregon, 97223 Phone/fax: 5033075448 Nearest cross street: SW 121st Email: kazemabunnadi@gmail.com 4. Development Activity(check all that apply) 4. Applicant Information ® Addition to single family residence(rooms,deck,garage) Name: Kazem Abunnadi ❑ Lot line adjustment 0 Minor land partition Company: ❑ Residential condominium ❑ Commercial condominium Address: 12280 SW Summer St ❑ Residential subdivision IDCommercial subdivision City, State,Zip: Tigard, OR, 97223 ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 5033075448 Other Site plan is sent via email Email: kazemabunnadi@gmail.com 6. Will the project involve any off-site work? ❑Yes ❑ No ❑Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: Renovation to an existing home.Added a back covered area. 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 and/or 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 Kazem Abunnadi Print/type title Signature ONLINE SUBMITTAL Date 4/1/2021 FOR DISTRICT USE ONLY ❑ 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. ❑ 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 Date Once complete,email to:SPLReview@cleanwaterservices.org • Fax: (503) 681-4439 OR mail to: SPL Review, Clean Water Services, 255C SW Hillsboro Highway, Hillsboro, Oregon 97123 Rev.s,d 2rzoz: ssr,. 3 Main Office • 2550 SW Hillsboro Highway • Hillsboro.Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cleanwaterservices.org 31I S NVId 3115 € m N Oa 6, -; sig -�� — '1S 213W/]WITS MS 21 2 F van?/ ////�� s I Ws x 4 N0 a am p I T D m M /y O II 0 m r V Y t 1 IIIF N. COVERED DECK k DECK C DECK J W . +.a.+ x K 5 w.usi- Av.../ BEDROOM eGReas x X li L Q MUD/ OR I 10 N W MASTER BEDROOM fY 1( t _ ce S GARAGE ® IA KITCHEN LIVING ROOM e 0 7 _ 0 +moia Encziaa BTH. 0 N K a O MSTRR S� MASTER YIIC CO ` _ .o..A DM ...:CM ._ COVERED -K ._ _— + /i/ ' ENTRY L1� i Y AA Ay ea i z.+++m 1. MOMMIKCIR KM ®MAIN FLOOR PLAN /n a ecMISCM: ISM`� exars Eo6EE +roc'" uwu.o.F..+c.mxsos+c.cs. 0 ww.uwo....wa+. K O E vm D2 1 II 1 � I mnou ..cwx.ws,u. q 9 5 = I - /E .m•so % J CC II pnevro.Lever r__ a � ck W 5t II II [�` K Cr TBEt. e Flynt,. .as,US J N /. y rv!t',,, ov.sa..w III It PoNg fip 4- I II W N 1[ Q V j 1 f CO I LLB —J1 ., W 1iF.Oe,tc. 1 —— 1 POST GP ir.0.4 CAP 7:1:131TZEP Ai ALL EXTERIOR OPENINGS II Ai 0 "`777 `hJ DOE i a 0 ROOF FRAMING PLAN co N D4 1oi1 Property Owner Statement '6 �`Gp8D NRegarding Construction Responsibilities G1 • -� ��vv requires residential construction permit applicants who are not licensed with the .nstruction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325(2)) This statement is required for residential building,electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or XI will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. A z-� I I4 • , ,"-1>,J Print Name of Permit Applicant Signature of Permit Applicant Date Permit#: =mil r Address: Issued by: Date: This Copy for Permit Offices Lina Smith From: Planner on Duty Sent: Thursday, April 1, 2021 12:16 PM To: kazemabunnadi@gmail.com Cc: Allyson Armstrong; #Building Permit Technicians; Planner on Duty Subject: RE: Summer St. MST 2021=0052 Hi Kazem, I finished the Planning/Zoning check for your building permit.You will need to obtain a service provider letter from Clean Water Services in order for Building to issue your permit. Please upload your site plan and fill out this form to obtain the letter: https://www.cleanwaterservices.org/documents-forms/pre-screen-form/. Once you receive a response from Clean Water Services, please send it to tigardbuildingpermits@tigard-or.gov. Thank you, Lina Smith Assistant Planner City of Tigard Planning Division 13125 SW Hall Blvd. Tigard, OR 97223 Phone: (503) 718-2421 E-mail: tigardplanneronduty@tigard-or.gov From: Kazem Abunnadi<kazemabunnadi@gmail.com> Sent: Friday, March 19, 2021 2:38 PM To:Allyson Armstrong<AllysonA@tigard-or.gov> Subject: Fwd: Summer St. MST 2021=0052 Caution! This message was sent from outside your organization. Allow sender I Block sender Allyson, Please see attached... Thank you, Kazem 503-307-5448 Begin forwarded message: From: "geoff@utfconsulting.com" <geoff@utfconsulting.com> Subject: Summer St. Date: March 19, 2021 at 2:22:57 PM PDT To: Kazem Abunnadi <kazemabunnadi@gmail.com> i 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 IIN _ " Transmittal Letter l i ,A p r, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Ailtartmn / y rr159y- r DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: ,WW) !t4 . Nnunn G 8.4 MAR 0 2021 COMPANY: CITY OF TIGARD RIMING D1V1S10 " Y �! �l: PHONE: S 3 Cr/ 5 4 4 j? I EMAIL: VCkten1 A L In A & 0 a I • 4!wI RE: t Z2 0 sin l 5L2 i Sr HT?" 2x0Z1 — oOD57 py, Z (Site Address) Z3 (Permit umber) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Z Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. "L — Engineer's calculations. Other(explain): REMARKS: • FO OF CE USE ONLY V Routed to Pe • Tec ician: Date: / Initials: a lk— Fees Due: Yes ❑No Fee Description: Amount Due: $ Ili- ?Uil roic $ q.. $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes No ❑ Done Applicant Notified: ,- Date: 4f/'7 t / Initials: �4 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 al ' Transmittal Letter i i,„\a n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov , TO: I I I si S crv-\ !"r rn 5 .c�7-n.ei DATE RECEIVED: DEPT: BUILDING DIVISION d— RECEIVED FROM: K Z A'ILA IA Ack A4 MAR 2 2 2021 COMPANY: CITY OF TIGARD PHONE: .503 3 c71 5 y y BUILDING DIV�QI� '`� EMAIL: K ck Ze-wh L v1v\G ck i 0 C rule{; /• c-covNA RE: MST 7L=L 1 — 0 G S 7 it262.1'00052 (Site Address) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: 1, Additional set(s)of plans. 3 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: 1 FO OF CE USE ONLY Routed to Permit Tec i 'an: i te: �j ?j/ Initials: a-i' Fees Due: Yes o l/ Fee Des i tion: Amount Due: / $ J`----S b N3: (--;)- ss iz ,.....----- Special Instructions: v Reprint Permit(per PE): ❑ Yes ►: o ❑ Done )` Applicant Notified: Date: r—/) 7/2/ Initials: r 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 7111 l ,c A 1: i i 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.Qov TO: A I I tSt.rsn lam s-1yLrel0 DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: k z �..t., A w� (� Y�v\a c� , MAR 2 � 2021 COMPANY: CITY OF TIc.\RD BUILDING DI' ' t• 'f- PHONE: gL,3 3 01 Sti N? EMAIL: K0.Ze.w1 A i..L"I G Ivr 0 5 m u,I . Germ RE: I2,-Z RO SJ 5-Gcmoi Sr MS 7,-)21 — O )OS"z (Site Address) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. 3 Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. 02 Engineer's calculations. 'eL Other(explain): R ejj ( 14.{�,/ REMARKS: FOR{O FIE USE ONLY Routed to Pe Tech ician: Date: * 1' I Z Initials: Fees Due: Y ❑No Fee Description: Amount Due: $ _Ov 1 tk Qw 0,0\-)Lio 1- $ LtS ./ - Special Instructions: Reprint Permit(per PE): ❑ Yes ❑No ❑ Done Applicant Notified: ` .0L Date: y/27,4 / Initials: 2