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Permit
III CITY OF TIGARD MASTER PERMIT ii' ' COMMUNITY DEVELOPMENT Permit#: MST2 02 1-001 2 2 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/17/2021 T r i; II,I't 9 Parcel: 2S103AD06200 Jurisdiction: Tigard Site address: 12655 SW 111TH PL Subdivision: WILDERNESS Lot: 8 Project: Nielsen Project Description: Build new master&master bath onto existing home(+561 sq ft) BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 561 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 13.75 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Yes Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Total: 561 sf Value: $68,700.06 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr. 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 2 Drywell-Trench Drain: 0 Other Fixture Units: Steam Generator and recirculation pump MECHANICAL Fuel Tvoes Air Conditioning: Y Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 6 Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-800 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 Ecompasing: NI Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 561 Owner: Contractor: NIELSEN,PAUL DAVID&STACEY MOUNTAINWOOD HOMES INC Required Items and Reports(Conditions) 12655 SW 111TH PL PO BOX 2257 1 Ersn Cntri 503-639-4175 TIGARD,OR 97223 BEAVERTON,OR 97075-2257 PHONE: PHONE: 503-746-7338 FAX: Total Fees: $3,876.75 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. Issued By: holly VI7.4LVe'Were Permittee Signature: {r)vv AppILczttIn-in 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. 1 ` Building Permit AiiNi►ca iun r Residential RECEIVED �� MA Received wen 2021 .tyq/ Pemut No.:M SrZOZI-CeD City of Tigard I9H� ? .II� DateBy:v7 III • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review��12 LI A /1_ Other Permit: Phone: 503.718.2439 Fax: 503.598.19¢01-I-Y OF TIGARD Date Ready By: 7 f�1� ru I See Page 2 Tic ',1,n Inspection Line: 503.639.4175 v D eeaMethod: Supplemental forInrorma[ion Internet: www.tigard-or.gov BUILDING DIVISION otA t!! TYPE OF WORK REQUIRED DATA.1-AND 2-FAMILY DWELLING ®New construction ['DemolitionPermit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the work indicated on this application. 010 CATEGORY OF CONSTRUCTION I _1,21�6 1Qa e Valuation: $ 3 (ju ( -and 2-family dwelling ❑Commercial/industrial Number of bedrooms: 1 ❑Accessory building 0 Multi-family Number of bathrooms: 0 Master builder ID Other: ` � \5 1 Total number of floors:JOB SITE INFORMATION AND LOCATION ✓s uazefeet q Job site address:12655 SW 111TH PL New dwelling area: +561 sq.ft. square feet CitylState/zIP:TIGARD, OR 97223 Garage/carport area: 9s square feet Project NIELSEN ADDITION Covered porch area: 4 Suite/bldg./apt.no.: 1 square feet Cross street/directions to job site: Deck area: r �_, k6/ J_1r.t fjejta`lt-W., Other structure area: square feet . I/1 h, i �i[L /Jr(' k'I 1 i a�p'�`g�fi� REQUIRED DATA:COMMERCIAL-USE CHECKLIST �ep%�I!�u �l�// I Lot no.: Permit fees*are based on the value of the work performed. Subdivision: v 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: MEW Existing building area: square feet BUILD A NEW MASTER&MASTER BATH New building area: MET square feet ® PROPERTY OWNER ® TENANT Number of stories: Name: PAUL & STACEY NIELSEN Type of construction: Address:12655 SW 111TH PL Occupancy groups: City/State/ZIP:TIGARD, OR 97223 Existing: Phone:( )951-751-7098 I Fax:( ) New: ® APPLICANT I CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name:MOUNTAINWOOD HOMES LLC Structural plan review fee(or deposit): Contact name:Kraig LeMay FLS plan review fee(if applicable): Address:8324 SW NIMBUS AVE Total fees due upon application: City/State/ZIP:BEAVERTON OR 97008 Amount received: Phone:( )503 703-9203 I Fax''( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail:klemay@mOuhtainw0odh0mes.com Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photovoltaic Solar Panel System. Submit two(2)sets of roof plan with connection details Business name:MOUNATINWOOD HOMES LLC and fire department access,along with the 2010 Oregon Address: 8324 SW NIMBUS AVE Solar Installation Specialty Code checklist. Permit Fee(includes plan review $1g0,00 City/State/ZIP:BEAVERTON OR 97008 and administrative fees): Phone:( )503 746-7338 I Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.:184317 Total fee due upon application: $201.60 �'/ 4c ( �� This permit application expires if a permit is not obtained Authorized signature: within 180 days after it has been accepted as complete. 02/08/2021 I *Fee methodology set by Tri-County Building Industry Print name: KRAIG LEMAY Date' Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) - , ` Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY I City ofTigard ReceDatived Pemut No.: a 13125 SW Hall Blvd.,Ti ard,OR 97223 y B Associated permits: Phone: 8.2439 Fax: 503.598.1960 0 Mechanical 24-Hourr Inspection Line: 503.639.4175 D Electrical D Plumbing TIGARD Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW \eS \o N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 n 2 Zoning. Flood plain,solar balance points,seismic soils desi• ation,historic district,etc. _ 0 0 Di 3 Verification of approved plat/lot. 0 0 4 Fire district approval required. Name of district: • 0 0 21 5 Septic system permit or authorization for remodel. Existing system capacity 0 GI 6 Sewer permit. 0 ,`y 0 7 Water district approval. 0 u 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 ❑ 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 0 ❑ 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- 0 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. 0 0 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- 0 0 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 0 0 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0 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 0 0 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 0 0 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0 architect licensed in Ore Ion and shall be shown to be a..licable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0 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 0 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. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) N. • Mechanical Permit Application FOR OFFICE USE ONLY tril Cl of Ti andDateBy: Permit No.: ty ged Date/By: ` 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review 2. Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit. T I G A P.D Inspection Line: 503.639.4175 Date Ready/By: lads: Fil See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE—USE CHECKLIST Mechanical permit fees*are based on the value of the work O New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition El Other: • mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® 1-and 2-family dwelling 0 CommerciaUindustrial ❑Accessory building For special information use checklist ❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION • Heating/cooling: Air conditioning t 46.75 Job site address:12655 SW 111TH PL Furnace 100,000 BTU(ducts/vents) 1 46.75 City/State/ZIP:TIGARD, OR 97223 NieiSCXI Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump _ 61.06 Suite Bldg./apt.no.: Project name:PAN ADDITION Duct work 1 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 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 no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas MASTER SUITE ADDITION fireplace 23.32 , Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 ® PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation: Name:PAUL & STACEY NIELSEN Range hood/other kitchen equipment 33.39 Address:12655 SW 111TH PL Clothes dryer exhaust 33.39 Ci /State/ZIP:TIGARD OR 97223 Single-duct exhaust(bathrooms, 2 23.32 t3 toilet compartments,utility rooms) Phone:(503 )505-2801 Fax:( ) Attic/crawlspace fans 23.32 ® APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name:MOUNTAINWOOD HOMES LLC S14.15 for first four;S4.03 for each additional Contact name:Kraig LeMay Furnace,etc. Address:8324 SW NIMBUS AVE Gas heat pump Wall/suspended/unit heater City/State/ZIP:BEAVERTON OR 97008 Water heater _ Phone:(503) 703-9203 Fax::( ) Fireplace _Range E-mail:klemay@mountainwoodhomes.com Barbecue CONTRACTOR Clothes dryer gas) • ABSOLUTE HEATING other: (� u e.txo(p'1 toi- Business name: MECHANICAL PERMIT FEES* Address:614 NE 105TH ST Subtotal City/State/ZIP:VANCOUVER, WA 98685 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( 360 721-2025 Fax:( ) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE 200568 This permit application expires if a permit is not obtained within 180 .j A, / Ti. y days after it has been accepted as complete. Authorized signature: /> (V — /`��(�(� * Fee methodology set by Tri-County Building Industry Service Board Print name:Kraig LeMay Date:04/13/2021 I:1Building\Peunns\MEC PermitApp_0401 I 3.doc 440-46 PT(I 1/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • I:\Building\Permits\MEC_PermitApp_040I 13.doc 2 • Electrical Permit ApplcationR E C E l V E 1 l t l u t l rl.i t.l' I s r t iv l ti City of Tigard Permit#: • 13125 SW Hall Blvd.,Tigard,OR 9722 1023 AY ! / i Plan Review Received Phone: 503.718.2439 Fax: 503.598.19600 IAtetg ; Related Permit#: Inspection Line: 503.639.4175 CITY TIGP, Ready natetay: Julia: 0 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORT( . PLAN REVIEW ❑New construction ®Addition/alteration/replacement Please check all that apply(submit j sets of plans w/items checked)• ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Uetnolilion El Other: where the available fault current 0 Mariana and boatyards. CATEGORY OF'CONSTRUCTION exceeds 10,000 amps at150 volts or ❑Floating buildings. 1-and2-famil dwellin CommcrciaVindustrial kssto ground,orexeocds14,000 ❑Commercial-use agriculuval ® y g ❑ ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: Mire pump. ❑Imtallation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Pone gamey system. larger separately derived n of Job#: Job site address:12655 SW 111TH PL ❑100HP or mrow motor load of system. 00FBr more. ❑"A""F" `ld""1 3" City/State/ZIP:TIGARD, OR 97223 0 s x or more residential units. ❑Recreanmyml vehicle parks. ❑Health-care facilities. Suite/bldg./apt.11: Project name:NEISEN ADDITION ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 rolls nominal. Cross street/directions to job site: FEE SCHEDULE Descrlpow I Ow. I Sari, I Total New residential single-or multi-family dwelling unit. Subdivision: Lot#: 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 (with above sq.ft.) MASTER SUITE ADDITION75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) , ® PROPERTY OWNER 0 TENANT - Renewable Energy ❑ See Page 2 _ Services or feeders installation,alteration,and/or relocation Name:PAUL& STACY NEILSEN 200 amps or less 1 100.70 100.7(t 2 Address:12655 SW 111TH PL 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:TIGARD, OR 97223 , 601 amps to 1,000 amps 301.04 2 Phone:(661 ) 505.2801 Fax:( ) Over 1,00D amps or volts 55226 2 Email: PAUWSTACEY711 OGMAILCOM Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ® APPLICANT • ) 0 CONTACT PERSON Branch circuits—new,alteration,or extension, , panel A.Fee for branch circuits with Business name:MOUNTAINWOODHOMES above service or feeder fee, 6 742 44.60 2 each branch circuit Contact name:KRAIG LEMAY B.Feefor breads circuits without servicAddress:8324 SW NIMBUS AVE bran circuior derfee,fitst 56.18 2 branch circuit City/State/ZIP:BEAVERTON OR 97008 Each add'l branch circuit 7.42 2 Phone:( 503 703-9203 Fax::( ) Each�uufa�(service or nodu feeder not included) lar dwelling,service and/or feeder 67.84 2 Email:klemay@mountainwoodhomes.com Reconnect only 6784 2' CONTRACTOR. Pump or irrigation circle 67.84 2 Business name: Whiskey Hill Electric Sign or outline lighting 67.84 2 Address: P.O. BOX 206 Signal circuit(s)or limited-energy See Page 2 2 petrel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above HUBBARD, OR 97032 Additional inspection(1hrmin) 66.25/lir Phone:(503)981.4640 Fax:( ) Investigation(1 hr min) 90.00/Iv Email: RON@WHE-INC.COM Industrial ) , 78.18/Ir / Inspections for which no fee is 90.00!Iv CCB Lie.:/62/f 5 Electrical Lic.: G j C Suprv.Lie.: 4#' ) S specifically listed('iohr min) /, ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: py„ c,_ Subtotal: 145.30 Print name: 'G N Vp67 T 5.5 e/ Date:se- 17- Z, ❑Plan Review Required(25%of permit fee): ��// State surcharge(12%of permit fee): 17.90 Authorized signature: gp.'t A.:.- �sys,sJ(/ TOTAL PERMIT bht: 162.80 � �/ This permit application expires if a permit is not obtained within 180 Print name:n � Y6sy As1a ( Date: '.-i7-2/ days after it has been accepted as complete. Number of inspections allowed per permit. I:tBuEdaglPereualELC_PermtApp_ELR_ERE.doc Rev 05/17t2015 440.4615T(11/05/COM/WSD 4 '• Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard R5ed D iv Permit No.. .r 13125 SW Hall Blvd.,Tigard,OR 97223 } g Plan Review Phone: 503.718.2439 Fax: 503.598.I960 Date By, Other Permit No.: TIGARD Inspection Line: 503.639.4175 Dale Ready/By: Juris: Ei See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total ®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:12655 SW 11TH PL Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:TIGARD, OR 97223 (Nile tS-e(i Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name:N@IE4Ce4J ADDITION Manufactured home utilities 50.03 Cross street/directions 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: l Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 MASTER SUITE ADDITION Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name:PAUL& STACEY NIELSEN Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:12655 SW 111TH PL Garbage disposal 25.02 City/State/ZIP:TIGARD, OR 97223 Hose bib 25.02 Phone:( 503 505-2801 Fax: ( ) Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name:MOUNTAINWOOD HOMES LLC Medical gas(value:$_) Paget Primer 12.51 Contact name:Kraig LeMay Roof drain(commercial) 12.51 Address:8324 SW NIMBUS AVE Sink/basin/lavatory 25.02 City/State/ZIP:BEAVERTON OR 97008 Solar units(potable water) 62.54 Phone:( 503) 703-9203 Fax::( ) Tub/shower/shower pan 2- 12.51 E-mail:klemay@mountainwoodhomes.com Urinal 25.02 Water closet ' 25.02 CONTRACTOR • Water heater 37.52 Business name:CRAFTWORK Water pi m Y 56.29 PP P�W Address:7733 SW CIRRUS DR Other:511.04,91 64,n f Yt_ ,)- 25.02 City/State/ZIP:BEAVERTON OR 97008 P�r'P Subtotal Phone:(5036448698 Fax:( ) 2 7//� Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.:79666 Plumbing Lic.no�-./r-1 6 a � a�<_--( Ney State surcharge T 2 PERMITf fee) Authorized signattlre: TOTAL FEE Print name:KraigLeMayDate:04/13/2021 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Perndts\PLMU-PermitApp.doc 10/01/09 440-4616r(10/02/COM/WEB) a. Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-I' 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 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37 52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$I.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 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. 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 Bath: Tub/Shower greater,except systems designed and stamped by licensed engineer. -Jacuzzi/Whirlpool ElCar Wash: -Each Stall New exterior plumbing site utilities for any complex structure Drive as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system. Domestic El Any complex structure as defined in OARS)8-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram -4 ❑ Isometric or riser s diagram is required for new buildings -Car Wash Drain g q g Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach/Refdg.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -LavBar non-food related -Bradley -Com/Serv/Util food related Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard :ligIN COMMUNITY DEVELOPMENT DEPARTMENT C Building Permit Review — Residential TIGARD 4,, Building Permit #: MSr2-.O21 -cc 122 Site Address: 12655 SW 111th PI Project Name: Nielsen Lot #: Planning Review Proposal: Add onto existing home ❑. Verify address/suite# active in Accela. n River Ter ce: ❑r No ❑ Yes, River Terrace Review Addendum Site Plan Elements: osion Control CI copies of site plan on 8-1/2"x 11"or 11 x 17"paper etained trees with drip line and tree protection measures rawn to scale(standard architect or engineer scale) _Footprint of new structure (including decks)and FFE IS orth arrow Y.Itility locations&easements(required for new and additions) D.ite address,project or subdivision name and lot number Sidewalk/driveway approach pplicant information(name and phone number) ` .ocation of wells/septic systems 12 . .' ensions and building setback dimensions N\ .treet tree size,type and location (.`% are footage of buildings to be demolished 'tr t names d� xi .. g structures on site rner elevations (2'contours if more than 4'differential IN k.t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es o impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es ° 'o 0 Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑° Yes,applicant was notified ❑ No Received: ❑Yes ❑ No ❑ Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: Q Yes,applicant was notified ❑ No Received: ❑Yes El No SDC Exemption for ADU applied for: El Yes ❑'' No Received: ❑Yes El No Public Facilities Improvement(PFI) Permit: Required: ❑Yes,applicant was notified ❑r No Applied For: ❑Yes ❑ No,stop intake Land Use Case #: ❑o Zoning: R-4.5 Required Setbacks: Front: 20 Rear: 15 Side: 5 Street Side: NSA Garage: 20 Q Building Height: Max. Height: 30 Actual Height: 13.75 i ndscape Area: % ❑ Lot Coverage Max: Entrance II Set back no more than 8' from street-facing wall 'arallel to street or offset 45 degrees or less Windows 111 IN.ii . urn... 12%of area of all street-facing facades t`)s* Garage I Gara e do. behind widest street-facing wall 0 Yes El No,one of the following is met: Door extends ore than 5' fro •a and there is a covered porch extending beyond garage. Door extends no more .- ' rom wall and there is a 12 sq ft.window above garage on 2.1d floor. ❑ Garage door width is or less 50%or less of facade 60%or less and includes 7 of following: Covered pore. / Recessed entrance I Wall offset 1'Roof eave Roof offset Fires •:es II Lap Siding ❑ Roofer 0 Gable,,or gambrel roof Dormer - cent siding Window trim ILI Window r--- s Window projection ❑ Balcony ❑ Visual Cle. ce ❑ Urban Forestry Plan 0 Se ive Lands: ❑ Yes ° No Type: C ditions met prior to issuance of building permit No s: Approved By Planning: — — ?� Date: J g Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:1Buil ding\Forms\BI dgPermitRvw_RE S_122419.docx Building Permit Submittal Original Submittal Date: 03/2qh?.011 Site Plans: # 3 Building Plans: # 3 Building Permit#: Q I-I�Enter building ermit#above. �� Workflow Routing: [ Planning ►.'Engineering Permit Coordinator Inn�Building I�7� Workflow Sign-off: I� 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 trus etails,if applicable,etc. Notes: By Permit Technician: Date: 0V/0002.1 Engineering Review IR lope at building pad: 2' L�I Conditions "Met"prior to issuance of building permit Pt/c- Ia-Easements (encroachments) per engineering conditions of approval and plat ^/t-- Et-Water Quality/Quantity Facility: I y Assess Water Quality Fee in-lieu: ❑ Yes 2-No Assess Water Quantity Fee in-lieu: ❑ Yes IL�I No ��/ LIDA Facility on lot: 0 Yes It No L7 Final Plat Recorded:„/" ❑ NOT Approved by Engineering: Date: Notes: [Approved by Engineering: 7 r-eHf drcaceti Date: 3///toz1 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved 4 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: I SDC Exemption: ElReceived 12 Doesa not 7 11 SDC Fees Entered: Wash Co Trans Dev Tax: ElYes /A Tigard Trans SDC: ❑ Yes /A Parks SDC: ❑ Yes LIDA ElYes B//;t1/A N/A OK to Issue Permit Approved by Permit Coordinator: ` �, Date: IA_/ 1:1Building\Forms\BIdgPennitRvw RES I22419.docx RECEIVED MAR 2 9 202 CITY OF TIGARD CleanWate Services SENSITIVE AREA PRE-SCREENING SITE ASSESSIMENTuvisioN Clean Water Services File Number 21-000535 1. Jurisdiction: Tigard 2. Property Information(example: 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Paul&Stacey Neilsen 2s103ad06200 Company: Address: 12665 sw 111th place OR Site Address: 12665 sw 111th place City, State,Zip: tigard, or, 97223 City, State,Zip: tigard,or,97223 Phone/fax: 951-751-7098 Nearest cross street Email: Paulnstacey711@gmail.com 4. Development Activity(check all that apply) 4. Applicant Information © Addition to single family residence(rooms,deck, garage) Name: kraig leMay ❑ Lot line adjustment 0 Minor land partition Company: Mountainwood Homes ❑ Residential condominium ❑ Commercial condominium Address. 8324 SW Nimbus LN ❑ Residential subdivision 0 Commercial subdivision City,State, Zip: Beaverton, OR, 97008 ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 5037039203 Other Email: klemay@mountainwoodhomes.com 6. Will the project involve any off-site work? ID yes ❑ 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 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 kraig leMay Print/type title Signature ONLINE SUBMITTAL Date 2/16/2021 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. O 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 P�VETTER IS REQUIRED. Reviewed by Date 2/26/21 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 Main Office • 2550 SW Hillsboro Highway • Hillsboro. Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cleanwaterservices.org • Building Permit Application '13— 3/ /2 Residential RECEIVED FOR OFFICE USE ONLY Received q or 2b21 Permit No.: tab M ST2b1J- l22- City of Tigard MAR 2 9 ZOZ� DateBy: ligi 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review • Phone: 8 3.598.199I OF TIGARD Date/By: Other Permit: TIGARD Inspection Line 503.639.4175 l a Ready/By: Jurfr ® See Paget for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING ®New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. "-and 2-family dwelling III Valuation: $ 30 000 `Y ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address:12655 SW 111TH PL New dwelling area: +561 sq.ft. square feet City/State/ZIP:TIGARD, OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name:NIELSEN ADDITION Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet QU1RED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax mad parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: MEMO BUILD A NEW MASTER& MASTER BATH Existing building area: square feet New building area: IMEESIT square feet ® PROPERTY OWNER ® TENANT Number of stories: Name: PAUL& STACEY NIELSEN Type of construction: Address:12655 SW 111TH PL Occupancy groups: City/State/ZIP:TIGARD, OR 97223 Existing: Phone:( )951-751-7098 Fax:( ) New: ® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* Business name:MOUNTAINWOOD HOMES LLC (Please refer ro fee schedale) Structural plan review fee(or deposit): Contact name:Kraig LeMay FLS plan review fee(if applicable): Address:8324 SW NIMBUS AVE Total fees due upon application: city/State/ZIP:BEAVERTON OR 97008 Amount received: Phone:( )503 703-9203 Fax::( ) E-mail:klerflay@mountainwoodhomes.coR1 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name:MOUNATINWOOD HOMES LLC Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:8324 SW NIMBUS AVE Solar Installation Specialty Code checklist. City/State/ZIP:BEAVERTON OR 97008 Permit Fee(includes plan review $180.00 and administrative fees): Phone:( )503 746-7338 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.:184317 Total fee due upon application: $201.60 Authorized signature: n/C 4 C-slG¢ This permit application expires if a permit is not obtained I1// within 180 days after it has been accepted as complete. Print name:KRAIG LEMAY Date:02/08/2021 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 4404613T(11/02/COM/WEB) Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs Please complete the following information: Customer Name: 1_ 1 STAce-I /WISE ) Service Address: Street/Suite#: / SS— ,c,,.> /i 1 Lb `AL. City: h A— > State: 62 Zip: 9.3 L2 Phone Number: I - ;o J - no i Email: �-,,,3 I n 540.ce;d et(y,.,o._;1.&' -, v 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 = co Qf x 1 = Bidet 6( x 1 = pf 0 x 1 = Clothes washer l I x 4 = y Al x 4 = Dishwasher / x - 1.5 = i S 95 x 1.5 = 1"Outside Water Spigot I x 2.5 = 27 /" x 2.5 = Water Spigot,each add'I 0 x 1 = 9f pJ x 1 = Kitchen sink ! x 1.5 = 1.7 x 1.5 = Laundry sink of x 1.5 = /0- pf x 1.5 = Lavatory(bathroom sink) a x 1 = 2 2 x 1 = a Water closet,L6 GPF(toilet) x 2.5 = � / x 2.5 = a,s- Bathtub/whirlpool 0 x 4 = 0- / x 4 = y Shower stall 1 x 2 = 2 / x 2 = a. Bath/shower combo )'' x 4 = . x 4 = Current Points: JB, s- Proposed Increase: /07 S Current Points+Proposed Increase= .2 1' =New Total Points =Required Meter Size /g Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=%" 37.5 and over points= 1" New Meter Size Needed for New Total Points: .' Cost: $ 9,495 n r, (see page 1) Current Meter Size per Utility Billing: Cost: $ 9,Li),5.•no (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ '0 (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY J Bentley 05/17/21 Current Meter Size Confirmed with UB Signature of UB Representative Date I:/Building/Forms/WaterMeters_070120 Add.doCx Page 2 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 lig Transmittal Letter , ,,,A,: „ 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov - I TO: Allyson Armstrong DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: Kim Hancock APR 212021 COMPANY: Mountainwood Homes CITY OF TIGARD PHONE: 971-269-5253 BUILDING DIVISION By' EMAIL: khancock@mountainwoodhomes.com RE: 12655 SW 111th PI.Tigard,OR 97223 MST2021-00122 (Site Address) (Permit Number) Nielsen Addition (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. 3 of each Revisions: Cover Sheet and Elevation Cross section(s)and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. 3 of each Other(explain):Electrical, Plumbing and Mechanical Permit Applications REMARKS: FOR OFFICE USE ONLY Routed to Pe it Tec clan: Date: Li 2`1 fJ`j_( Initials: Fees Due: Yes V❑No Fee Descri tion. Amount Due: $ b6/ th, ;i--)%0,--., 1 , , - $ LL s- - -,f-v_ y` .r,.a $ _ $ Special Instructions: Reprint Permit(per PE): ❑ Yes 71.,No `------/ ❑ Done - Applicant Notified: 0-7_--Date: v lL' Initials:G>�