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Permit
YES ____9\ 7_7-kzi tk4 CITY OF TIGARD MASTER PERMIT 11 I. COMMUNITY DEVELOPMENT Permit#: MST2021-00143 Date Issued: 05/25/2021 T r r A.R.r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 BA02500 Jurisdiction: Tigard Site address: 14470 SW 100TH AVE Subdivision: TIGARDVILLE HEIGHTS Lot: 30 Project: White Project Description: Master bedroom&bathroom relocation(addition). Remove walls in living area&add load bearing beams. 9/15/2021: REPRINT to add 38 If of water service, irrigation backflow and backwater valve. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 496 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 13 Bathrooms: 0 Second: 0 sf Garage: 0 sf FrOnt: 20 Smoke Yes Dwelling Units: 0 Third: 0 sf Right 5 Detectors: Total: 496 sf Value: $60,740.16 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 4 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0 Tubs/Showers: 3 Garbage Disp: 0 Water Heaters: 1 Water Lines: 38 Catch Basins: 0 Botchy Prevnlr: 1 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 1 Other Fixtures: 0 Drywall-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 1 Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 3 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 WIO 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/vgh: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All N Ecompasing. Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 496 Owner: Contractor: WHITE,SHANA L&WILLIAM A OWNER Required Items and Reports(Conditions) 14470 SW 100TH AVE 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $3,847.02 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 0 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 oc9-nM-noin thrnnnn nAP owx.not_onon vnn ma.,nbrnin a rnna of the nip nr dir<M n,,e'unnc rn nt IAIC b.,reIlinn SM 919 10R7 nr 1 Rnn 119 7i11e Issued By: 1-itrajj Va.tr.,L . Wtoe Permittee Signature: O r.'A� Call 503.639.4176 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 lob site at the time of each inspection. Plumbing Permit Apulication site UtilitiesRECEIVED l•(►R OFFICE USE ONLY City Received � Cl of Tigard ,�y Permit Not-1 -M 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 1 Q e�12? Plan Review 1 S•J?// t4l D STzf7 2_,1-00I `f '� 11 Phone: 503.718.2439 Fax: 503.598.19�6 other Permit No.: 11 Y OF TIGARD DateBy: 1 I GA R Ll Inspection Line: 503b39.4175 Date Ready/BY: c7 /t s/71 „di t) Jypsta H See Page 2 for Internet: www.tigard-or.gov ;UILDING DIVISION Notified/Method: ( /9t Supplemental Informwnon TYPE OF WORK (i-f- q-(I s, 7f4-' FEE* SCHEDULE For special information use checklist, 0 New construction ❑Demolition Description I Qty, I Ea. I Total Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312,70 ❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500,32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: /I-/4`70 SW /co7,1 t:1VE Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: ` ppr, O e 97Z24 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt,no.: (Project name: &Ai/78 Manufactured home utilities 50.03 Cross street/directions to job site: /00 Z p.a,g i //.JE 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.:r`y ! Page 2 4 2, 5 f Subdivision: J Lot no.: Fixture or item: ''. b Tax map/parcel no.: Backflowpreventer I 31.27 3 Lz7 DESCRIPTION OF WORK Backwater valve 1 12.51 12.SI Clothes washer 25.02 eRAC-e GOA')e14 Nall-1 ♦- ADD BACLF{O(A) FOrt, Dishwasher 25.02 I e.J An O IJ Drinking fountain 25.02 /SAD Its 1S i Nei 1081-207_,F 0043 Ejectors/sump 25.02 I$ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: WI LUAMa SI1A4Jin 6014/Te Floor drain/floor sink/hub 25.02 Address: 1 U N 7 D s(A) t p0 77J a Garbage disposal 25.02 City/State/ZIP:716440n oe q-7 .Z(a Hose bib 25.02 Phone:(SO3 S N CI-Sort 5 Fax:( ) lee maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON interceptor/grease trap 25.02 Medical gas(value:$_) Page 2 Business name: 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:( ) Fax::( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: Water piping/D W V 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal lg. 3?fr Phone:( ) Fax:( ) Minimum permit fee: $72.50 /0,, t .2- Plan review (25%of permit fee) CCB Lie.: ; Plumbing Lic.no.: State surcharge(12%of permit fee) I i• '7(49 Authorized signature: t/� r rl'� TOTAL PERMIT FEF. II . 0 a Date: f This permit application expires if a permit is not obtained within 19a days Print name: sLlai.Ip ()ow,'T� 9/7 1 z, after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. i:\Building\Permits'PLMU-PermitApp.doc 10/01/99 440-461 ST(10/02/COM/WEB) CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2021-00143 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/25/2021 Parcel: 2S111 BA02500 Jurisdiction: Tigard Site address: 14470 SW 100TH AVE Subdivision: TIGARDVILLE HEIGHTS Lot: 30 Project: White Project Description: Master bedroom&bathroom relocation (addition) Remove walls in living area&add load bearing beams BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 496 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 13 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 496 sf Value: $60,740.16 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 4 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 3 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bcktlw Prevntr-. 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Tyres Air Conditioning: Y Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 1 Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL _Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less, 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 3 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 N Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 496 Owner: Contractor: WHITE.SHANA L&WILLIAM A Required Items and Reports(Conditions) 14470 SW 100TH AVE Ql vrl� 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $3,727.94 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: }{D IN VCt41,Ve'Wee Permittee Signature: 0 in/Ap7)UGatloft 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. ,e l:uildin2 Permit Application y _ Residential RECEIVED FOR OFFICE USE ONLY Received Permit No.: City of Tigard Date/By: > /� Z/ �i , mg 2lJZ'G-t70 14 II • 13125 SW Hall Blvd.,Tigard,OR 97223 ?'AR 2 1 ^UG Pla 0 n Review C Z/ / other permit: Phone: 503.718.2439 Fax: 503.598.1960 DatelBy: ✓ /J TIGARD Inspection Line: 503.639.4175 Date Ready/By: runs: 61 See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: / Z/ Supplemental Information BUILDING DIVISInN TYPE OF WORK REQUlREif)ATA:I.-AM)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 5(Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the t for the CATEGORY OF CONSTRUCTION work indicated on this application. (WW/llo r (se 1,1-and 2-family dwelling Valuation: $ ❑ Commercial/industrial ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: ( Job site address: /C/f./7 p $(tJ /0072J iQ UE New dwelling area: y y (P square feet City/State/ZIP: 776440,oe 97ZzLJ Garage/carport area: square feet Suite/bldg./apt.no.: Project name: W/1Ij g&- Opez.. Covered porch area: square feet Cross street/directions to job site: /OOW five d- -.Ee Deck area: square feet 964• e-- "1'`hrr-0 r Ic��Veit. &idl`'Vr...{ "11 1 ? j Other structure area: square feet Mtif I S kt PC h..tl S e r REQUIRED DATA:COMMERCIAL-USE CHECKLIST ubdivision: Lot no.: Permit fees*are based on the value of the work performed. ` '-� /// Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: -(/ / [-[/r�(r'4S 4 r G� equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. HAS7T-12. BE 2.00M 4- [3A-7Dir 4bH £ cp - of 0716123Valuation: $ -)% C Pori M E ow-U.. Can SA HE N.o H Bee OF et-0 rtoo M S r Existing building area: square feet e)'I -—13 - New building area: square feet 12FMOVE�rtuJA LA-4 tl.l L tflA 1 VW la A'CAM t- APO C0 S fL,A16 15e-Ail 1;~J PROPERTY OWNER ❑ TENANT Number of stories: Name: wicciatij.,S41/p/..J/3 co/ /TE Type of construction: Address: /4/t./1O Ser.) 100 h' &leOccupancy groups: City/State/ZIP:7—/b4E.Q,DR. C/'7Z2L./ -- Existing: Phone:(9)3 )3 LPG)-says' Fax:( ) New: ❑ APPLICANT D CONTACT PERSON BUILDING PERMIT FEES* (Please refer so fee schedule) Business name: Structural plan review fee(or deposit): Q��- Contact name: I FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Amount received: Phone:( ) Fax: :( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photovoltaic Solar Panel System. Business name: D(v/f_e Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: itv Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) 7'ax:( ) State surcharge(12%of permit fee): $21.60 CCB 1ic.: I Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained i`, VI__ within 180 days after it has been accepted as complete. Date. ���J / *Fee methodology set by Tri-County Building Industry Print name: L u tC(l Llez., Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB) Mechanical Permit AppliEI V E D FOR OFFICE USE ONLY Cityof Tigard Received permit No.: 74 13125 g MAY 3 2P2 Date/Ba '� SW Hall Blvd.,Tigard,OR 97223 Plan Review tS' Phone: 503.718.2439 Fax: 503.598af OF TIGARD Datc/By: Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: lurix: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION' Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE' SCHEDULE- USE CHECKLIST Mechanical permit fees`are based on the value of the work ❑New construction Addition/alteration(replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTTON RESIDEIOTIAL EQUIPMENT/SYSTEMS FEES* 01-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total Heating/cooling: JOB SITE.INFORMATION AND LOCATION Air conditioning ( 46.75 'IIo275 lob site address: i(i.f']o S(t) (Gbh' Ave Furnace 100,000 BTU(ducts/vents) I 46.75 Lib.2S City/State/ZIP: -6aQo 1 0 g, Cf'7 724 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: 1 Project name: 1,AV/TE 40D17 0141 1 120-109a-- Duct work 1 23.32 -Z 3.3 2 Cross street/directions to job site: (oo)13 a•ue 4 (IJ E 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.: 2 S1 i_E3A _0 Z g pv Water heater 23.32 2 3.37 DESCRIPTION OF WORK Gas fireplace/insert 33.39 33-39 Flue vent for water heater or gas "Re-tom-no Li OF FO 121J/SCE w LJ C T u.)/1TEL 1-1E741oQ- fireplace G 23.32 y(e(uLt Log lighter(gas) 23.32 7-1C1404901. I eigrn.W.COH r. NEU " ). C )H CFOOS) Wood/pelletstove 33.39 IQEIA) Call FIQ-EPLPC.-1✓ - Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 51 PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: l,)L11..na t i. 4-30AI.I4 (,()(.LIT Range hood/other kitchen equipment ( 33.39 33a 3 9 Address: t . t.i'7p 5co 10Cirg AuE Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, ' 1 •' `rJ(�p)Zpr QG G 72Z toilet compartments,utility rooms) 2, 23.32 ` L.L 14 Phone:(5)7OLd-L$t Z. Fax:( ) Atticicrawlspace fans 23.32 0 APPLICANT 0 CONTACT PERSON Other. 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. I 14.IS i q,/S Gas heat pump Address: - Wall/suspended/unit heater City/State/ZIP: Water heater I l4'1 S /4•IS Phone:( ) Fax: :( ) Fireplace I ILI„sl 1 y.t,S E-mail: Barbecue COl R ACTOR Clothes dryer(gas) Other: Business name: / 6 - MECHANICAL PERMIT FEES". Address: Subtotal i.4.:{,,y0 Minimum permit fee($90.00) t5 City/State/Z[P: Plan review(25%of permit fee) if 9.ZO Phone:( ) Fax:( ) State surcharge(12%of permit fee) t•l Z.8-Z CCB lie.: TOTAL PERMIT FEE L)W,4s•-2, This permit application expires if a permit is not obtained within 180 days after It has been accepted a,complete. Authorized signatu * Fee methodology set by Tri-County Building Industry Service Board Print name: Date:g7L.2/ 1:1Buiding\Permits\51EC_ itApp_040113.doe 440-4617T(I I/02/COM/WEB) •Mectranical 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\Pennits\MEC_PennitApp_040113.doc 2 Electrical Permit APPIICatIQ ECEIVED FOR OFFICE 1 SE OyIa , T .t Received City of Tigard Date/Hy:H Permit d: 13125 SW Han MA. ri and OR 972z3 Y % ~ $ , Plan Review Phone: 503.716 2459 Fax: 503.598,19 �- ��Z d Datediyt Related Per.„,i/: Inspection Line: 503.639.4175 Ready t)atediy: tarn: a See Page 2 tar t i(:AR i) Internet: www.tigard.-or.gov CITY OF MARL, Notified/Method; Supplemental Information TYPE. OF- t4PING DIVISIOr PLAN REVIEW TT 0 New construction ` Addition/alteration/replacement Please check all I hat apply(submit 2 sets ol'plans ve/Hems checked); ©Demolition Other: (1 Service or feeder 400 amps or more 0 building over three stones. LiY - _ where the available fault surreal Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 maps at ISO robe or CI(bating buildings. t��-py+I and 2-family dwelling ❑ Master builder ndustrial ❑ AccesOther: building lass to ground. ne' .oIi IS 000 C.)Commercial-use agri.utturaf �` amps for all other inetailationo. buildings. Multi-family ❑ M85t4'1'builder ❑Othen: 011ire pump, 0 Installation or 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency arum. larger separalaly derived Job#: Job site address: r e r ©Addition of new motor load of 55015m. IU O SL to( i • . -._. IOOHP or more. D A .ti,,...1-2 -I.7^, City/State/'LIP: y ❑Six or more residential Snits. occupancy. J ,i,Ag ok q-2 2-Zt'/.... 0 Health-care facilities. 0 Recreational vehicle parka. 'bi r ProjectHazardous locations. ❑Supply voltage for more than Surtu d�./apt.#: name: et l ll l� AOD/7xY t� iC Z ()°50IIa antntnal. Service or tcudcr 600 amps or more. Cross street/directions to job site: 106W a �L'4 111e.Z FEE SCHEDULE _. neaerapatm -- L !1: t VnIch I Toast I , __ New residential single-or multi-homily dwelling unit. Subdivision! IAA#: Includes attached garage. --. -_ - _. .- ___. t .— . - . _._.. 10(10 sq.id or less I68.54 4 Tax map/parcel#: 2 , 21--1,5 fa — 0-2.j DO Ea add'I SOOsq ti.nrlitmion 11.92 l .. -_.. DESCRIPTION OF WORK Limited energy,residential.. 1US7�4tLk- LCSbUdIpl�ryY j� t (with abovesq.tt.) 75.00 . T �' 3 13 < L1-1 eif2r, i7, , Limited energy,multi-)family residential(with above sq.ti) 73.f1f1 2 /ICJ0'TICS A-1 — Renewable RenewableEner$Y Q see rage PROPERTY OWNER 0 TENANT --- _ . . _ .... Sc.vnccs or feedera installation,alteration,and/or relocation Name: t1:)t�I,l pit-it ��uiai.l(h (,,CalTL 200 amps or ltxa Q{7.7o 1 't3 7fS 7 201 amps to 4t10 amps 33.56 1 Address: ItIll70 ,l.11 ICC�. II.t..,C• _-. --_ - - 4(11 stops to 400 amps 2(I0.34 2 City/State/ZIP:`77.60,ao 012, crl z7-1l�__ 60i am1a to i,ouii amps 301.04 2 . Phone:t tij) .34ct.5os� 5 Snood_ glob( 5c ) i q (s 8z-4;iCuaN1 Overl,01A1 amps orvolts 552.26 �2 _ ..`_.-. -- Temporary services or feeders installation,alteration,and/nr Email:4l(LJQINtint c zi.e0,HQ2.(Ut7 bola4110a;.Cu.ia M{AUkI/.11-11=.U719 relocation Owner installation: This installation is being made on property that I own which it not 200: aps or less 5')36 I intend d for sale,lease nti o ,r ORS 7,449, 0,and 01. 201 amps to Owner signature:APPLICANT exchange,according to ❑ CU4NTDate PERSON q- 7 I 13ranc401 ah circmtst"tnew,alteration,or extension,per panel 2 -- A.lee for branch circuits with Business name: abase sets-ice or feeder fee, 3 7 42 2 2 2 to 2 .-__ -_.„, each branch circuit Contact name: R.Pee for brunch circuit,without ; _ — service or feeder fee,first Sfi.I R 2 Address: branchcncmt City/State/ZIP: Each:ald'I branch circuit 7-42 7 - _.- - - Miscclianeous(service or feeder not included) Phone:( ) Fax: i( ) pach manufacmned or modular .. . . . __ _ -,.. .-.. _-.__ _ — .._.. _. _ dwelling,service and/or feeder 07-84 7 Email; Reconnect only G7.d4 7 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: ff ,� ), / Sign or outline lighting 67-84 2 _ �.ls.Nf✓_£ — _ Address: panel, Signal en-cants)or hroned-energy 0 1ec Pane 2 2 @anel,alteration,Or extension. , -. ._..___ _ _ __. _ _._ _n_..a. - - -_- _. Each additional inspection over allowable in any of the above. City/State/ZIP: _, -. _...__. - Additional inspection(1 hr min) I 00225'hr Phone:( ) i Fax:I ) .. - - Investigation 11 hr luinl Yt).00/hr Email: Industrial plant(I hr rain) 78.18/hr f 4. —... Inspections for which Mile.:as 90.00/iu. CC131.ic.: Electrical Lie.: Suprv.tic.: specifically listed(hhr min) - ELECTRICAL PERMIT FEES *Irv. Electrician signature,required: Subtotal: 17.'2 .4 to Print name: Date: CSI Plan Review Required(25%or penult fee): 3cn '7sI State surcharge(12%of permit fee): lc 71, _,_. . ..mom .. —_ _.... Authorized signature:i, '1`t)t At,PERMIT t FEE: i' y ., .—_ -^ _ Date: Z -_ r Num her u f dope t ions allowed cp r pe in IRO -- - --- permit is nut obtained within 180 This permit application ex trey if a Print name: +A ,L. ,. -71 accepted as complete. l:\Btlildwg\PermitantA_C_PertnitApp_EI.R_htlhi.4oe Reyna/171015 440-4615'r(II/O5/caM/win • Plumbing Permit Application ,r . Building Fixtures RECEIVE Received Cityof Tigard Permit xo.:1/,STZtn24-U 0143 2 g a 2 .l 7 ?? Date,'sy: 13125 SW Hall Blvd.,Tigard,OR 97223 {�iA * Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: r I c- It l� Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: turfs: la See Page 2 for Internet: www.ti and-or. ov Notified/Method: Supplemental Information g g BUILDING DIVISION PP TYPE OF WORK FEE* SCHEDULE For special information use checklist. 0 New construction 0 Demolition Description I Qty. I Ea. I Total Er Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) I. CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 01-and 2-family dwelling 0 Commerciallindustrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Catch basin or area drain 18.76 Job site address: /NL/70 Set, /00 ` Q.UE , Drywell,leach line,or trench drain 18.76 City/State/ZIP: -n 6,312,4 OR q7 zzy Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: /0072-1 Ave4 zije-z Manholes 18.76 l „' 149 OC r�)_#14 Rain drain connector 18.76 ski 0 COM £.EMO% all- IOK Sanitary sewer linear ft.:_) Page 2 Storm sewer(noo..linear ft.: ) Page 2 IJe-IP.J 1107 UJt YL J3E `/E . Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 !I Backwater valve 12.51 DESCRIPTION OF WORK f, I 'v CC g- 6•44✓-• Clothes washer 25.02 Dishwasher 25.02 iQ?Jq Drinking fountain 25.02 �3 m !�N tatZ.P'�e rf a NEyv 14.ar WA I,Z kl e11-rE Z- Ejectors/sump 25.02 54 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: f OCU/3M r• .Si.44420 ts-W1 TE Floor drain/floor sink/hub 25.02 Address: /yy70 SA' Keni ,we Garbage disposal 25.02 City/State/ZIP: 776420 i C7 C/72ZCJ Hose bib 25.02 Phone:($03 ).3419•50g 5 Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$_) Page 2 Business name: Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory LA 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pang, 12.51 Urinal 25.02 E-mail: Water closet ' 25.02 CONTRACTOR Water heater ' 37.52 Business name: 06,,,.,A,/1-/� Water piping/DW 56.29 Address: / V Other. 25.02 City/State/ZIP: Subtotal Phone ( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.: i Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: /, TOTAL PERMIT FEE Authorized name: fJ Y„���A This permit application expires if a permit is not obtained within 180 days Print ,/y 1 ksto.,, tit,1d`> Date.-3, (i "( after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:I Build mgYemtits\PLMIYPermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 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-1 n 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- I st 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 Il 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*. 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 Fon[ ❑ 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 ❑ New exterior plumbing site utilities for any complex structure Dr ve Thn as defined in DAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system. -Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 0 Isometric or riser diagram is required for new buildings -Car Wash Drain 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: -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 fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs Please complete the following information: Customer Name: eiIte.IAH +SNANA LOW TV Service Address: Street/Suite#: l(N70 Sto /Do a ur. C►ty: 776Ar¢D State: 0W. Zip: °722-14 Phone Number: 503-34(4-5085 Email: $1.1111JAW>JI'ry 9 ZL a 6HaIL. CAM ta)It.uart to WILLIAHAuwu)N176. Cori Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total• the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = 1 x 1 = 1 Bidet x I = x 1 = Clothes washer 1 x 4 = y x 4 = Dishwasher 1 x 1.5 = � S x 1.5 = 1"Outside Water Spigot 1 x 2.5 = Z rS x 2.5 = Water Spigot,each add'l 2 x 1 = 2 x 1 = Kitchen sink 1 x 1.5 = I, 5 x 1.5 = Laundry sink 1 x 1.5 = I, S x 1.5 = Lavatory(bathroom sink) 3 x I = 3 Z x 1 = 2 Water closet 1.6 OPF(toilet) 3 x 2.5 = 7.$ x 2.5 = Bathtub/whirlpool x 4 = ( x 4 = Shower stall 1 x 2 = a x 2 = Bath/shower combo x 4 x 4 = Current Points: 29.5 Proposed Increase: 7 Current Points+Proposed Increase= 36.5 =New Total Points =Required Meter Size 3/ 4-' �'r'ee warm Hare= I" 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: $ (see page 1) Current Meter Size per Utility Billing: Cost: $ (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ 1`..1/4 QDtttayrr MET7X IS 1 tt (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY . Current Meter Size Confirmed with UB J Bentley - no meter changes needed 5/25/21 Signature of UB Representative Date I:/Building/Forms/WaterMeters_oranktdd.docx Page 2 Information Notice to Owners About ` •may' Construction Responsibilities \lot14" (ORS 701.325 (3)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number(BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to httpJ/www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503-947-7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance:As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300, PO Box 14140, Salem,OR 97309-5052 Telephone:503-378-4621 —Fax:503-373-2007 Website Address:www.oreaon.00v/cch Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction 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 1 1 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. Print Na of Permit Applicant S Zy-zi Signatu ermit Applicant Date Permit#: MST- ZOZ! -OO/Li 3 >047D . LJ b0 r •�� Address: / /1l� ‘-ne8_ C,0e Issued by: Date: j c �- - • CleanWater Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number 21-0 0 11 50 1. Jurisdiction: Washington County 2. Property Information (example: 15234AB01400) 3. Owner Information Tax lot ID(s): Name: William and Shana White 2S111 BA-02500 Company: Address: 14470 SW 100th Ave OR Site Address: 14470 SW 100th Ave City, State,Zip: Tigard, Or,97224 City,State,Zip: Tigard, Or, 97224 Phone/fax: 503-349-5085 Nearest cross street: 14470 SW 100th Ave Email: shanawhite926@gmail.com 4. Development Activity(check all that apply) 4. Applicant Information ® Addition to single family residence(rooms,deck,garage) Name: William and Shana White ❑ Lot line adjustment ElMinor land partition Company: ❑ Residential condominium 0 Commercial condominium Address: 14470 SW 100th Ave ❑ Residential subdivision 0 Commercial subdivision City, State,Zip: Tigard, Or,97224 ❑ Single lot commercial 0 Multi lot commercial Phone/fax: 503-349-5085 Other Email: shanawhite926@gmail.com 6. Will the project involve any off-site work? ['Yes 0 No 0 Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: We have submitted plans for a house addition of less than 500 sq.ft and also a 288 sq. ft shed. 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 William and Shana White Print/type title Signature ONLINE SUBMITTAL Date 4/15/2021 FOR DISTRICT USE ONLY O 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 PROV DER LETT R IS REQUIRED. Reviewed by --- Date 5/6/21 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 R,:nF i 2n020 Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p:503.681.3600 f:503.681.3603 • cleanwaterservices.org City of Tigard 1 ~ COMMUNITY DEVELOPMENT DEPARTMENT e Building Permit Review — Residential TIGARD Building Permit #: MS Tznu-001A-3 Site Address: 14470 SW 100th Ave Project Name: White Lot #: Planning Review Proposal: Remodel and adding onto side of existing home ❑✓ Verify address/suite #active in Accela. River Ter ce: ❑✓ No ❑ Yes, River Terrace Review Addendum Site Plan Elements: YErosion Control II copies of site plan on 8-1/2"x 11"or 11 x 17"paper , Retained trees with drip line and tree protection measures prawn to scale(standard architect or engineer scale) Q-'``_ootprint of new structure(including decks)and FFE 111 Torch arrow :✓,.Jtility locations&easements(required for new and additions) CI.ite address,project or subdivision name and lot number ;sidewalk/driveway approach 12 pplicant information(name and phone number) -,o lion of wells/septic systems 0.o ,'m e n s i o n s and building setback dimensions et tree size,type and location l►.uare footage of buildings to be demolished street names CI,xi : g structures on site ✓Comer elevations(2'contours if more than 4'differential g:••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 ❑ Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Required: El Yes,applicant was notified ❑ No Received: ❑Yes El No ❑ Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: ❑✓ Yes,applicant was notified ❑No Received: ❑Yes ❑✓ No SDC Exemption for ADU applied for: ❑Yes El No Received: ❑ Yes ❑ No i\l Public Facilities Improvement (PH) Permit: Required: ❑Yes,applicant was notified El No Applied For: ❑Yes ❑ No,stop intake Land Use Case#: El Zoning: R-3.5 ElRequired Setbacks: Front: 20 Rear: 15 Side: 5 Street Side: 20 Garage: 20 El� I; ilding Height: Max. Height: 30 Actual Height: 13 „` 1 andsca.e -a: % t Coverage Max: % Entrance i��i et back no more than 8'from street-facing wall arallel to street or offset 45 degrees or less Windows 3 Minimum 12%of area of all street-facing facades Garage ara•- door is behind widest street-facing wall t 9 f 1 ❑Yes ❑ ► ., .ne of the following is met: 1 6.' extends no more than 5' from wall and s a cover-• ..rch extending beyond garage. IDoor exten. •• more than 5' from wall and ther- - sq ft.window above garage on 2nd floor. ❑ Gara e door width is i -' .r less El1°• or less of facade 60%or less and includes 7 of following: Covered porch I Recess •0"- ' ce ❑ Wall offset 1'Roof eave Fire shingles P ap Siding Roof offset I ' .: .itch ❑ Gable,kip,or gambrel roof Dormer Accent _ Window trim I Wm•. ecess Window projection 0 Balcony ❑ Visual Clearan : ❑ Urban Forestry Plan ❑ Sen •:'- ands: ❑ Yes 12:1 No Type: inditions met prior to issuance of building permit :pproved By Planning: Date: 2- Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved 1:1Bu ild ing\Forms\BI dgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: D3/24402,1 Site Plans: # Building Plans: # 3 Building Permit#: ❑ .Enter buildingermit#above. �� Workflow Routing: ►Planning ngineering L7 Permit Coordinator Building Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: a 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 d trust details,if applicable,etc. Notes: �/ �/ By Permit Technician: ,or"%// Date: VT/7/ Engineering Review R'Slope at building pad: '2 L�'-1�/Conditions "Met"prior to issuance of building permit M/"- Rsements (encroachments) per engineering conditions of approval and plat de / 1 Water Quality/Quantity Facility: y Assess Water Quality Fee in-lieu: ❑ Yes Lr N,o Assess Water Quantity Fee in-lieu: ❑ Yes g"-No � LIDA Facility on lot: 0 Yes LI Fyinal Plat Recorded: N tfo-- ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 7,ti„ ,c.7 Date: tf//c/tot( Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved ❑ Not Approved 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) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: SDC Exemption: ❑ Received 'Does not a SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes Er N/A LIDA ❑ Yes N/A ZOK to Issue Permit Approved by Permit Coordinator: Date: 41 t5(Zo u I:\Building\Forms\BIdgPerm itRvw_RE S_122419.docx 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 2 Transmittal Letter r ;G A k l> 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov TO: Al .,`(SONI A R-M S-reor,z, DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: 12AUe- GoI�E / WILLiArvi \HITI- MAY 32O2 COMPANY: 7Av� Co IasE Des 161,1 CITY OF TIGARD PHONE: go3 — (e6e, - I - BUILDING DIVISION By. '1-, EMAIL: 4:15Collil; @. h€TMAIL . CAW. RE: I4. -?o S.W. too AVE- MST 24,2 -- oo14-1' (Site Address) (Permit Number) WILL \MH ITE- A POI T1 or4 (UES..) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: 3 ) Additional set(s) of plans. ✓ Revisions: ' F ATTAI:H ED t t-1'Tv1= 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: Visit.NI AND e-EspONSE- 11FTT ATTALHel7 PLANS EXAMI IJE - 12.4.UE51r e_ATT/ H ) FOILf FFICE USE ONLY Routed to Pe t Tec ian: Date: 5Gj J?A Initials: 0/ Fees Due: Yes n No Fee Descriptjjjon: Amount Due: $ 1�� :`ii C $ fr .\:\_, p /--- Special Instructions: L Reprint Permit(per PE): ❑ Yes No ❑Donee Applicant Notified: 7-p�...---Date: ///j)-.( Initials: