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Permit • CITY OF TIGARD BUILDING PERMIT R! COMMUNITY DEVELOPMENT BUILDING MST2021-00177 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/19/2021 TIGARD Parcel: 1S136AA10800 Jurisdiction: Tigard Site address: 10186 SW 69TH AVE Project: CALDWELL Subdivision: OAK STREET ESTATES Lot: 3 Project Description: A new 312 sq.ft.in-ground swimming pool with 976 sq.ft.of impervious surface. Contractor: OWNER Owner: CALDWELL,TRICIA&RYAN MILLER, BRIDGET 10186 SW 69TH AVE TIGARD, OR 97223 • PHONE: PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: SF Class of Work: OTR Type of Const: VB DC Provision Review,SF-Ping 05/19/2021 $103.00 Occupancy Grp: R-3 Occupancy Load: Info Process/Archiving-Sm$0.50(up to 05/19/2021 $8.00 11x17) Dwelling Units: 0 Other,Heating/Cooling 05/19/2021 $23.32 Stories: 0 Height: 0 ft Fuel Piping 05/19/2021 $14.15 Bedrooms: 0 Bathrooms: 0 Erosion Control w/Development 05/19/2021 $107.60 Value: $50,000 12%State Surcharge-Mechanical 05/19/2021 $10.80 (manual) Minimum Fee Adjustment-Mechanical 05/19/2021 $52.53 Floor Areas: Ejectors/Sump 05/19/2021 $50.04 12%State Surcharge-Plumbing 05/19/2021 $8.70 Total Area: (manual) Accessory Struct: 0 Minimum Fee Adjustment-Plumbing 05/19/2021 $22.46 Basement: Carport: 0 Covered Porch: 0 Deck: Garage: Mezzanine: Total $400.60 Required: Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 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: Rermittee Signature: 47g ' 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. BIJildin2 Permit Application _` f rSrlte-4014 RECEIVE ' FOR OFFICE USE ONLY Cit of Tigard Received y g ' Date/By: S / Permit No.:pUrgod.'_ �o 77 NI 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review al C ' Phone: 503.718.2439 Fax 503.598.1960 APR 1 5 2021 �j 7/ol1 Other Permit: a��91_(1)iel7 Date/By: Inspection Line: 503.639.4175 Date Ready/By kris: T I G A R p �/ r, Y Y ® See Page 2 for Internet: www.tigard-or.gov JI 1 I OF TIGARL Notified/Method: `S `(l, �, T6r Supplemental Information TYPE OF woRclUILDING DIVISION: 6 .•.., J UIRED DATA:1-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 5-gj Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ El 1-and 2-family dwelling IIICommercial/industrial 50,000 ®Accessory building 0 Multi-family Number of bedrooms: \\I- ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: New dwelling area: square feet City/State/Z1P: 10186 SW 69th Ave Garage/carport area: square feet Suite/bldg./apt.no: Project name: Caldwell Pool Covered porch area: square feet Cross street/directions to job site: Between Locust and Oak on 69th Deck area: D I square feel Other st rcture area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Oak Crest Lot no.: 3 Permit fees*are based on the value of the work performed. Tax map/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. Digging hole for and installation of fiberglass swimming pool. Valuation: $ Jfi( 11 /V13) 4 1-1 On Existing building area: square feet 11P , -r{ �*r/�' ✓�4y ) ^.--'I'- New buildingq area: square feet IV PROPERTY OWNER ❑ TENANT Number of s ories: Na»"_ Ryan Caldwell Type of construction: Address: 10186 SW 69th Ave Occupancy groups: City/State/ZIP:Tigard, OR 97223 Existing: Phone:(503) 816-0062 Fax: ( ) New: [] APPLICANT ❑ CONTACT PERSON NOTICE Business name; All contractors and subcontractors are required to be Contact name: Ryan Caldwell licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 10186 SW 69th Ave jurisdiction in which work is being performed.If the City/State/ZIP: Tigard, OR 97223 applicant is exempt from licensing,the following reasons apply: Phone:(503) 816-0062 Fax: :( ) work to be performed by homeowner&family E-mail: rtcaldwell@gmail.com **412 sq ft for structure includes excavation CONTRACTOR digging and storage location Business name: (924/Aieve- BUILDING PERMIT FEES* Address: (Please refer to fee schedule) Structural plan review fee(or deposit): City/State/ZIP: Phone:( ) Fax:( ) FLS plan review fee(if applicable): Total fees due upon application: CCB lie.: Amount received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 040.112 Date: April 13, 2021 * Fee methodology set by Tri-County Building Industry Service Board. L\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(1 I/02/COM/WEB) • City of Tigard: Site Work Permit Checklist Page 2 -Supplemental Information Commercial,Multi-Family and One-and Two-Family Dwellings: No permit is required if fill is less than 50 yards(5 dump truck loads), or less than 3 feet deep and will not be supporting a structure. If a building will be constructed on the fill, it must be engineered fill. If fill is in a flood plain, drainage way,or wetland,the applicant must apply for a sensitive lands review (SLR). Please complete all items below,unless otherwise noted. Excavation Volume: 45 cu. yds. Grading Volume: (Soils report required for>5,000 cu. yds.) cu. yds. Fill Volume: (Fill exceeding 12" in depth shall be compacted to 90% of maximum density) 45 cu.yds. Retaining structure? (Check one) ❑x Rock ❑ CMU ❑ Concrete © Other: Fiberglass Pool *Total new impervious area including all buildings, sidewalks, and paving: sq. ft. Site Utilities Plumbing Work: Complete the Plumbing Permit Application for site utilities plumbing work. Plans Required: See"Site Work Permit Application-Plan Submittal Requirements"attached. The following must accompany this application: ❑ Site Plan with Vicinity Map showing ADA ❑ *Parking(including ADA)and Lighting compliance Plan ❑ Grading Plan and details ❑ *Landscaping Plan ❑ Erosion Control Plan and details ❑ Soils Report(if required) ❑ Retaining Structures *Does not apply to One-and Two-family dwellings. Plan Submittal: Permit Fee: TYPE OF SUBMITTAL #of Plans Valuation: Permit Fee: (New,Additions or Required at $.00 to$500.00 $51.09 minimum permit fee Alterations) Submittal $500.01 to$2,000.00 $51.09 for the first$500.00 and $2.69 for each additional$100 or fraction Commercial 3 thereof,to and including$2,000.00. S2,000.OI to$25,000.00 $91.44 for the first$2,000.00 and Multi-Family R-1 Occupancy 3 $10.76 for each additional$1,000 or fraction thereof,to and including $25,000.00. One-&Two-Family Dwelling 3 $25,000.01 to$50,000.00 $338.92 for the first$25,000.00 and $8.06 for each additional$1,000.00 or fraction thereof,to and including $50,000.00. $50,001.00 to$100,000.00 $540.42 for the first$50,000.00 and $5.38 for each additional$1,000.00 or fraction thereof,to and including $100,000.00. $100,000.01 and over $809.42 for the first$100,000.00 and $4.49 for each additional$1,000.00 or fraction thereof. 1:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2 Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard RECEIVE , Received IN ' 13125 SW Hall Blvd.,Tigard,OR 97223 Date By. V �I . 0 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 C p�By. Ocher Permit TIGARD Inspection Line: 503.639.4175 MAY - ) NZ' Date Ready/By: lrs Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OF TIGARD Typr or W'a,tt€i ql vi Sr'rkt2#' knrli s ' Alt lza �. Er st lIEetr ' aF2'-i _------ Mechanical permit fees*are based on the value of the work ❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: _mechanical materials,equipment,labor,overhead,and profit. r tONSTRU i ,= Value:$ 7i wash*"et('� .. 43!t' , -- { ' 4 s: -.r.,_.,.,,, h',.li: ❑ 1-and 2-family dwelling ❑Conunercial/industrial ®Accessory building For special information use checklist. ❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total n. .=N Heating/cooling: 46.75 Job site address: 10186 SW 69th Ave Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) illir 54.91 , 54.91 Duct pump 23.32 Suite/bldg./apt.no.: Project name: Caldwell Pool Ductwork 23.32 Cross street/directions to job site: Between Locust and Oak on 69th 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 Subdivision: Oak Crest Lot no.: 3 Other: Pa-6 k, VN X 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 , Gas fireplace/insert 33.39 Flue vent for water heater or gas Adding furnace equipment for pool and additional piping for future fireplace 23.32 outdoor expansion for BBQ and Fireplace; Homeowner to do the work. Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 738141Pm«e was p},rw+roe>^'n m'• .** -... a Other: 23.32 1, Pl&OPF i.TY OWT.d' ...itl _• , cna, -- Environmental exhaust and ventilation: Lame: Ryan Caldwell Range hood/other kitchen Address: 10186 SW 69th Ave equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: Tigard, OR 97223 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(503 )816-0062 Fax ( ) Attic/crawlspace fans 23.32 APPLxi;*"I Other: 23.32 ,�.,...aP.,.,,,,..,. r_ ,, .,.. Fuel piping: Business name. $14.15 for first four;S4.03 for each additional Contact name: Ryan Caldwell Furnace,etc. / JA.141 Address: 10186 SW 69th Ave Gas heat pump Wall/suspended/unit heater City/State/ZIP: Tigard, OR 97223 Water heater Phone:(503) 816-0062 Fax::( ) Fireplace 1 4.03 . Range E-mail: rtcaldwell@gmail.com Barbecue ,.. . .. 1 4.03 CONrnAC OR Clothes dryer(g Business name: Other: tC9-�� I l e (J j4V 'r MI'CBANICAI PFR6I1TFEFS'` Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE )J f tt) This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signs • • Fee methodology set by Tri-County Building Industry Service Board Print name: p1 Date: April 14, 2021 ]:tBuildwgtPennics\MEC_Pe m2App_0401 13.doc 440-0617r(t 1/02/cOM/WEB) Plumbing Permit Application - •Site Utilities RECEIVED FOR OFFICE USE ONLY CI of Ti and Received Date/ By:City Permit No 13125 SW Hall Blvd.,Tigard,OR 97223 ins ��(� , 7 Plan Review 2 Phone: 503.718.2439 Fax: 503.598.1960 ApR 1 5 zer Date/By: Other Permit No.: Inspection Line: 503.639 4175 T[GA R D Date Ready/By: 7u ® See mPage e 2 for m Internet: www.tigard-oLgov CI i�Y OF T�:+'-�'� Notified/Method. Supplental Inforation _ TYPE OF WORI( UILDING DIVISION FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. Total UZI Addition/alteration/replacement D 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 ElAccessory building El Multi-familySFR(3)bath 50032 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: 10186 SW 69th Ave Catch basin or area dra n 18.76 Drywell,leach line,or trench drain 18-76 City/State/ZIP: Tigard, OR 97223 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Caldwell Pool Manufactured home utilities 50.03 Cross street/directions to job site: Between Locust and Oak on 69th 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: Oak Crest I Lot no.: 3 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 • Clothes washer 25.02 Adding piping and plumbing for pool, pool pump, and possible Dishwasher 25.02 Future Expansion Drinking fountain 25.02 Ejectors/sump 2 25.02 50.04 N PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Ryan Caldwell Floor drain/floor sink/hub 25.02 Address: 10186 SW 69th Ave Garbage disposal 25.02 City/State/ZIP:Tigard, OR 97223 Hose bib 25.02 Phone:(503) 816-0062 Fax:( ) Ice maker 12.51 lz APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Ryan Caldwell Roof drain(commercial) 12.51 Address: 10186 SW 69th Ave Sink/basin/lavatory 25.02 City/State/ZIP: Tigard, OR 97223 Solar units(potable water) 62.54 Phone:(503) 816-0062 Fax: :( ) Tub/shower/shower pan 12.51 E-mail: rtcaldwell@gmail.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: /M - Water Pmg�1P WV 56.29 Address: Other: 25.02 City/Slate/ZIP: Subtotal 50.04 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: TOTAL PERMIT FEE '/171 }) Print name: ��� Date:April 13, 2021 This permit application expires if a permit is not obtained wit in 180 days after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. 1:1BuildinglPermits\PLMU-PennitAppdoe 10/01/09 440-4616T(10N2'COM/WF.e) 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-Is'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 S72.50 for the first$5,000.00 and$1.52 for Qty. Fee(ea) Total each additional$100.00 or fraction thereof;to Other Inspections or Fees 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$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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for any of the following. Work Performed: Capped Added Relocate Baptistry/Font Please check all that apply. Bath -Tub/Shower ❑ Any new commercial building with water service 2"and Jacuzzi Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: I:\Building\Permits\PLMU_PermitApp.doc 2 City of Tigard IN11 COMMUNITY DEVELOPMENT DEPARTMENT C T 1 c A R D Building Permit Review — Residential Building Permit #: 71v7 1- WI 7? Site Address: 10186 SW 69th Ave Project Name: Caldwell Lot #: Planning Review S L al : 4 i &-,( s de plo") Pr '.osal: Site work for new in-ground swimming/ pool S^o'w.w9 .witewt s,swsS•a, TA Verify address/suite #active in Accela. '� Ian River Terrace: No ❑ Yes, River Terrace Review Addendum Site Plan Elements: ` 1` ` erosion Control 0: copies of site plan on 8-1/2"x 11"or 11 x 17"paper ° et ed trees with drip line and tree protection measures 0Ifawn to scale(standard architect or engineer scale) O print of new structure(including decks)and FFE 0 oral arrow �Jtility locations&easements(required for new and additions) D.ite address,project or subdivision name and lot number ',d /driveway approach 0 pplicant information(name and phone number) ation of wells/septic systems 0 . . ensions and building setback dimensions street tree size,type and location O: are footage of buildings to be demolished street names 0 xi 3. g structures on site '1:timer elevations (2'contours if more than 4'differential b1).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? ui es o Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑Yes,applicant was notified Q No Received: 11 Yes ❑ No Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: ElYes,applicant was notified 0No Received: ❑Yes ❑ No SDC Exemption for ADU applied for: ❑Yes 0No Received: 11 Yes ❑ No Public Facilities Improvement (PFI) Permit: Required: ❑Yes,applicant was notified 0No Applied For: ❑ Yes 11 No,stop intake and Use Case#: ❑ Zoning: Required Setbacks: Front: N/A Rear: 5 Side: 5 Street Side: N/A Garage: N/A 111 :uilding Height: Max. Height: Actual Height: Lan. ..e Area: % ❑ Lot Coverage Max: Entrance ' -. .ack no more than 8'from street-facing wall 0 arallel to street or offset 45 degrees or less Windows I Minim 2%of area of all street-facing facades Garage III Gara e door is .-. d widest street-facing wall ElYes 11No,one of the following is met: ❑gDoor extends no -•.re than 5' fro I. • all and there is a covered porch extending beyond garage. uuDoor extends no more i ,I : rom wall and there is a 12 sq ft.window above garage on 2nd floor. ❑ Gara e door width is or les ❑ 50%or less of facade 60%or less and includes 7 of following: Covered pore• I Recessed entran ❑ Wall offset _ 1'Roof eave Roof offset Fires '-3 es Lap Siding El ch ❑ Gable,hi or gambrel roof Dormer cent siding I Window trim I Win.. . recess Window projection ❑ Balcony ❑ Visual Cle. ce ❑ Urban Forest Plan ❑ Se ...Ire Lands: ❑ Yes 11 No Type: onditions met prior to issuance of building permit Notes: �/� ❑ Approved By P1 ing: �:.�e Date: 5/5/21 Revisions (after B (ding Submittal only) Reviewer Revision 1: Approved El Not Approved Revision 2: ❑ Approved ❑ Not Approved 1:1Buildi ng\Form s\BldgPermitRvwRES_122419.docx Building Permit Submittal Original Submittal Date: L /0 ?) Site Plans: # Building Plans: # Building Permit#: to building ermit# above. Workflow Routing: anning ngineering r"-Coordinator Ly-suuding Workflow Sign-off: U�nn-off for Planning(include notes from planning review) ❑Route Application Documents: gngineering: (1) copy of permit application, (1) site plan, (1) building plan and original� plan review routing form. D.a t I ing: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: Date: 5f57 / Engineering Review ❑ Slope at building pad: ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments) per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑ Yes ❑ No • Final Plat Recorded: Cr NOT Approved by Engineering: •-riste7/ jefr,2fe. Date: `STA/ 2.4 ,Notes: New irnPdievipuS art eJt'Gd.ectS /POO 7 2 inv, ' 7frrJ Yvn, IAA< 1 A/pproved by Engineering: -7-;r,,"f es-tibe/y Date: (/ 'f2p2I Revisions (after Bu tl ng Submittal only) RA viewer Date Revision 1: I. Approved ❑ Not Approved Tj y y,,74 j7Z Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Of/..2. / Revision Notice 1: Date Sent to Applicant: �V"/7� ZI4-2 Revision Notice 2: Date Sent to Applicant: ❑ SDC Exemption: ❑ Received ❑ Does not ao ly ❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes I N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes ❑ N/A LIDA 0 Yes ❑ N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_RES_122419.docx Property Owner Statement RECEIVED Regarding Construction Responsibilities MAY 13 2021 Oregon Law requires residential construction permit applicants who are not licensed with OM OF TIGARD Construction Contractors Board to sign the following statement before a building permit gtiLIPING DIVISION 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 I 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. aV) C41dc J/ Print me of Permit Applicant 1 3/ / 3/ 2—®a 1 Sin re of PermitApplicant Date 9PP Permit#: fr'SY 2oa I - 0 J I -2 7 F ► 01 , _ SW Q Address: A 1ve ����� —7 +rurrr�: . p J NI: Z Issued by: /7 DDate: __ 5.7ZVJ] g This Copy for Permit Offices 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 !A z:N Transmittal Letter TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: alyson Armstron DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: Ryan Caldwell MAY 13 2021 COMPANY: Ryan Caldwell CITY OF TIGARD PHONE: 503.816.0062 BUILDING DIVISIOYBY: '41 EMAIL: rtcaldwell@gmail.com RE: 10186 SW 69th Ave MST2021-00177 (Site Address) (Permit Number) Caldwell pool (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. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. 2 Other(explain): TWO copies of Heater Owners/Install manual REMARKS: FO J OF 'ICE USE ONLY Routed to Permit Techni ian: Date: 6'/ 17/a f Initials: }-- Fees Due: ❑ Yes No Fee Description: Amount Due: // $ N $$ 0 Special Instructions: Reprint Permit(per PE): ❑Yes '1KNo ❑ Done Applicant Notified: S—/i l��ii Date: 5—/i et/a-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. IIIII City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter r E,,n tt r> 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: alyson Armstron DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: Ryan Caldwell NAY i 3 2029 COMPANY: Ryan Caldwell CITY OF TIGA D PHONE: 503.816.0062 BUILDING DIVI1I )l '4'7 EMAIL: rtcaldwell@gmail.com RE: 10186 SW 69th Ave MST2021-00177 (Site Address) (Permit Number) Caldwell pool (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. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. -t ,3 Other(explain): 3 no ph fc o f bark rl'j'C e- �j U iv'vv- REMARKS: $ 6ke)-0 -irIClt, c - f rj of lt6.e00., FOR OFFICE USE ONLY Routed to Permit Technic' n: Date: ( -1 'L ( Initials: 1A' Fees Due: ❑ Yes .No Fee Descriptio : Amount Due: \ iri N.__) E----- : ;(.e ... Special Instructions: Reprint Permit(per PE): ❑ Yes 1To ❑Done Applicant Notified: vk.,. Date: c—/i li, Initials: /2 .-,