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Permit 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 III Transmittal Letter T I A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: Klarissa Oh- Dave Horn LIAR 2 2022 COMPANY: LITY OF TIGARL PHONE: 503.890.1895 lUILDING DIVISION! By. +-IP— - EMAIL: kIarissa.oh@gmail.com RE: 11067 sw 79th ave. tigard or 97223 MST2021-00128 (Site Address) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. Revisions: s1.2, s2.2, s4.1 (revision#3) 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: FOR/OFF/ICE USE ONLY Routed to Pe Technician: Date: "jEZ2? Initials: Fees Due: L Yes ❑ No Fee Descrio Amount Due: $ Oc'� vi, etts.c, r-c `-c4, wt,5n $ • $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes o ❑ Done Applicant Notified: Date: Initials: . At, 11111 CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit#: MST2021-00128 T I(1 A II.i7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/9/2021 Parcel: 1 S 136CA02500 Jurisdiction: Tigard Site address: 11067 SW 79TH AVE Project: Gathering ADU Subdivision: FRIENDLY ACRES Lot: 23 Project Description: Converting 350 sf ft of existing space to an attached ADU. Contractor: TGK CONSTRUCTION Owner: RESIDE, GRAHAM 4533 NE 17TH AVE OH, KLARISSA PORTLAND, OR 97211 1706 LILLIAN ST NASHVILLE, TN 37206 PHONE: 5013-505-0928 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: ADU Class of Work: NEW Type of Const: VB Wash Co Trans Dev Tax- 07/22/2021 $5,544.00 Occupancy Grp: R-3 Occupancy Load: Condominium/Townhouse DC Provision Review,SF-Ping 07/22/2021 $103.00 Dwelling Units: 1 Services or Feeders-200 amps or less 07/22/2021 $100.70 Stories: 1 Height: 23.5 ft Branch Circuits w/Purchase Service or 07/22/2021 $37.10 Bedrooms: 1 Bathrooms: Feeder Value: $25,000 12%State Surcharge-Electrical 07/22/2021 $16.54 Water Heater 07/22/2021 $23.32 Range Hood/Other Kitchen 07/22/2021 $33.39 Floor Areas: Garbage Disposal 07/22/2021 $25.02 Total Area: Sink 07/22/2021 $25.02 Accessory Struct: 0 Tub/Shower/Shower Pan 07/22/2021 $12.51 Basement: Building Permit-Additions,Alterations, 07/22/2021 $453.95 Carport: 0 Demolition Covered Porch: 0 Plan Review 07/22/2021 $295.07 12%State Surcharge-Building 07/22/2021 $54.47 Deck: Minimum Fee Adjustment-Mechanical 07/22/2021 $33.29 12%State Surcharge-Mechanical 07/22/2021 $10.80 Garage: Minimum Fee Adjustment-Plumbing 07/22/2021 $9.95 Mezzanine: Total $6,786.83 Required: Required Items and Reports(Conditions) 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 952-001-00 O. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. e— Issued By: Permittee Signature: c�t r ��ne1--?5 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. Building Permit A plication, . , ;..:. " ,„ , , e.,,',_ Residential h(IR( l l(_I.usr.I)NI ) City of Tigard A P P 0 1 2 ?1 Received 4[i51z Nr Penn i Na'(y:St- 2_l'b012Y w 13125 SW Hall Blvd.,Tigard,OR 97223 `' " C I Plan Review( •tot n^� ' ,,,,�p7 111 Phone. 503.718.2439 Fax: 503.598.G�Y f J l` I!:.:N L, Dare/8, V( e"Permit' W( occi� Inspection Line: 503.639.4175 BUILDING �'+ e tI{,1tR11 B�'���t� �i f _itl� Dare u<' SeePa�2for Internet: www.tigard-or.gov L N ed/'Neth •, Supplemental Information , TYPE OF WORK REQUI D DATA:1-AND 2-FAMILY DWELLING ❑New construction E 0 Demolition Permit fees*are based on the value of the work performed. "Indicate the value(rounded to the nearest dollar)of all ®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. I-and 2-familydwelling1....LCo__ 4 Valuation: $ ;5, 0 0 0 ® ❑Commercial/industrial EEE Number '.1 ❑Accessory building El Multi-family of bedrooms: y_,.. _( LQ�i�T�Vv l7) 0 Master builder ❑Other: I Number of bathrooms: X cr14 Pi 0 Total number of floors. �+ SITE 1 :PtlltbfATll AND �h e1Cl.St house Job site address: ADDITION: ii 0627 60 jS New dwelling area: +59s- square feet City/State/ZiP: TIGARD,OR 97223 Garage/carport area: 464 square feet Suite/bldg./apt no.. Project name (74 k��� /Mk,. Covered porch area: . square feet Cross street/directions to job site: SW 79TH AVENUE BETWEEN SE' Deck area: CONC.PATIO:.�651} square feet PFAF I c " AND 5W S RUCE ST I_ .....__. . _.. ,_. y�'�� ��(, �� � ,//�i� — �t �� � i Other structure area. square feet 1 , __� ,. ....« REQUIRED DATA:COMMERCIAL-USE UD1CKLIST ......_... Subdivision: FRIENDLY ACRES C�je, I-et no.: 2500 I Permit fees*arc based on the value of the work performed. ""��✓ Indicate the value(rounded to the nearest dollar)of al; lax snap/parcel no 1S136CAO 2500Ere SfL equipment,materials,labor,overhead,and the profit for the DESCRIPTION WORK work indicated on this application. USE $ V,ahiafion: $ A NEW 350 SF ATTACHED .n w��� • STUDIO ADJ WITH ONE BATHROOM WILL BE CARVED OFF THE SOUTH SIDE OF THE EXIS PING HOUSE WHERE TWO Existing building area: square feet BEDROOMS AND A BATHROOM WERE PREVIOUSLY LOCATED.A NEW 1-HR FIRE SEPARATION WALL WILL BE -1 ADDED AND A NEW ENTRANCE DOOR TO THE ADU WILL BE.ADDED TO THE SOUTH SIDE OF THE EXISTING HOUSE. New building area: square feet f r PROPERTY OWNER 1 ❑ TENANT Number of stories Name: KLARISSA OH&GRAHAM RESIDE 1 Type of construction: Address: 11065 SW 79TH AVE ,/c -°- - ,^ e .-tom i/ V Occupancy groups: City/State/ZIP: TIGARD.OR 97223 Existing: Phone.( ) I Fax:( j ___ _,._„_..___ —. Now: I. APPLICANT 4 r CONTACT PERSON y BUILDING PERMIT FEES _. ._,......._._.__-.-. ... ._ ......_.,.,o...._. __. - ---- tP a/e /er i Le shadu(e( Business name: POLYPHON ARCHITECTURE&DESIGN,LLC. Structural plan review fee(or deposit): Contact name: SCHUYt ER SMITH A--T-• ---- _ _ -- FI,S plan review fee(if applicable): Address: 4103 NE TILLAMOOK STREET _._ _ _._. - _...._ ____, — � - - -- Total fees due upon application: City/State/ZIP: PORTLAND,OR 97212 —_— _.____.____I i'nonc ( ) 503 208 5678 i Fax: t } Amount received: _.......� •._-_._...__....._.__- ....-...._ i !,mail: Schuyler@polyphon.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* __,_.,,,.,,..,,... - „_ _-.._ -' Commercial and residential prescriptive installation of COl TRACTOB c. , tool-top mounted PhotoVoltaic Solar Panel System. Business name: TGK CONSTRUCTION,LLC. Submit two(2)sets of roof plan with connection details _._.a,., �_,_ ,...... —__ w_—_ �__ and tire department access,along with the 2010 Oregon Address: 5433 NE 17TH AVE. Solar Installation So ecialrt'Code checklist i IL City/State/ZIP: PORTLAND,OR 97211 "� PermitFee(includes plan review Phone: tnd administrative fees) _(_ -.._�. _i.Fax:(...__� ,., State surcharge(12'�o of permit fee): (CHlic.: 216236 _J t !oral fee due upon application:: This Authorized signature: r-•= 7 permit.application expires if a pernnit is not obtained within INtl days after it has been accepted as complete_ , Prnt n:ur e: (HUl DER SPA ITH r�tt f .) t 1 *F s nietnodolr}ey set by Tr:-County Building Industry. ..._-__.,. i Sc .___,._._ Sets/ice Board • " ildir.g`,Pennits\BtJP-RESPernitAppdoe 02/24i.':01! 44I-161 3T(Il/0'2/Coln/WEie) iiu s • mar .. Building Permit Application Ch �, k, One- and Two-Family Dwelling [� y ,� FOR OFFICE L t SI: OyLI APR 0 N [.0 21 Received City of Tigard nat� v: Permit No: +r 13125 SW Hall Blvd.,Tigard,OR 97223 .'Associated _._ CITY II`.tV-it^tL,_t i Associatedpennits: t PIlto e' 503- lour Line.2439 ax.503.639.417560 L�.igle.nINiPI 1)!k ON I ❑ Electrical 0 Plumbing Inspection ❑Mechanical 7l(;ARD Internet. www.tigard-Ur.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REViE1V Yes No NIA 1 1 Land use actions completed,See jurisdiction criteria for concurrent reviews. 01 ■ ■ 2 Zoning,. Flood plain,solar balance points,seismic soils designation,historic district,etc t•< ❑ 0 3 Verification of approved plat/lot _ ❑ ❑.... 4 Fire district approval required. Name of district: S Septic system permit or authorization for remodel. Existing system capacity •,y, •, _,,,_,_. D CI 6 Sewcrpermtt 0 0 7 Water district approval ❑ 9 Erosion control ❑plan ❑pennre required. Include S Soils report,.Must c u on Final applicable stampand signature on file or with application. a t ❑ q ' drainage-way protection,silt fence design and location of catch- 0 �� 3 n,etc. 1 I} b51(ompletn e sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state Er ❑ 1 i 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 1.__ ...__copvriphi violations exist i i I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ 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 r.� and location. 13 Floo r plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, t. 0 furnace ventilation fans,elunibintt fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all firaming-member sizes and spacing such as floor beams,headers,joists,sub- ►: ■ ] y I 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. ❑ 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 ❑ prescriptive path anabsisprovide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 121 CI t locations. Show attic ventilation, l _, 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑• Si stems,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 ; ❑ ❑ over 10 feet lone and/or are. beam/joist cam ins a non uniform load. ' 20 Manufactured floor/roof truss desk details. g 0 0 2 I Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required , ® ❑ ❑ litr four or more appliances.s 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or i :t t:1 El architect licensed in Ore' n and shall be shown to be a 5 slicable to the roiect under review. 1 ° JI.iRISDICTIONAL..SPECIF'ICSS 23 I hree(3)site plans are required for Item 11 above. Site plans must be S-1/2"x I I of II"x : _ 24 Two(2)sets each are required for items 16,19,20 and 22 above. E i 0 ❑ 25 IImidinp plans shall not contain red lines or tape-ens. "Mirrored"buildine plans will not be acoe led i_ 0 .0 26 `Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. _ ❑ 0 ®„ 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard Street free List. / ,_ w, 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree l cca attions dnpltnes 1 0 1-- . and protection measures must be drawn to scaleand must include the project arborist s signature of roval i I:lBuildinglPenritstBUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WIEB) I . Kyr- - PI F.(7/FIVF) ....2741,2,.............4./ 4 . , rm , ...-In ,,,r Mechanical Permit Application loft(n ut( I.i ,u.(ro N City of Tigard . - Rc,ceive,l Peimit NoLiM(rnitA,71, Categ' '11 , '1'; 13125 SW Hall Blvd.,TigardDow 51 2.1__01-- ,OR 97221 Piaci Review * -4-1---"e-4" — ----i 4 $ Phone: 503 713.2439 CITY OF TIGARD Dateilly" Other Permit:509Kit- ow V-2 • 1 T I 4.',, Inspection Line: 503.639.4175 - BUILO Internet: www.tigard-orgny NG 0/VIC ION Date Ready/Sy See Pa2 fr Notified/Method: Juns: iill ge o Supplemental information I — TYPE OF WORK I COADIERCIAL FEE*SCIIEDVI.E-USE CBE CKLIST El New construction ..11 Addition/alteration/replacement I Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all a Demolition 0 Other: nil.cehFlical illatet ,t,tN4l1Pglt lalt?t,overilollO and l'Iotil• CATEGORY OF CONSTRUCTION Value:$ I—---12KSIDENT.; TAL EQUIPMENT/SYSTEMS FEES* 4 I-and 2-family dwelling 0 Con'onerciallindustria1 0 Accessory building l Per special infamtation use checklist 0 Multi-famil y 0 Master builder Ea. 10E11 JOB SITE INFORMATION AND ON , ilea ring;cooling: ____. . .., Joh s in.address: ADDITIOc ADU: 11067 SW 79TH AVE. Aircdnditiontill ' 4b.",5 r Furnace,100,000 1.311.1(dads/vents) 46.75 CitviStatulliP: _ __ TIGARD,OR 97223 . Furnace 100.000+}ITU Maas/yews) , 54.91 , ....- Suitelbldg apt! .no., l'O'kti,ti name: i !feat nark . 1„ ', otJle 1-• A v i ,;Duct work I '3,32 Cross street/directions to job site:' SW 79TH AVENUE BETWEEN SW PFAFFLELST,AND SW SPRUCE SI P. .„,:ak li k dronic hot water system ' 23.32 ' • Residential boiler(radiator or - — -; ;-- ;Itydronicl._ _ ; 23.32 , I Unit heaters(fuel-type,not eleetite), Irt-wall lo.duct,:suspended etc. 46.75 1 „_„,„,..,... ,,,,,, ._,..„.... .. .— • Flue/vent for any of above 23 32 Subdri Ishii)," FRIENDLY ACRES Lot no.: 2500 Other: 23.3/ i,Other fueTappliarwest I ax map/parcel no.: 18136GA0 2500 Water heater 23.22 DESCRIPTION oF woRx , (lea fire;lace/insert 33.1V.... ...,.......,............., ,,„„ . . A NEW TWO STORY 1 505 SF ATTACHED ADDITION WILL BE ADDED TO THE EXISTING HOUSE.THE ADDITION Wti.L Flue vent for water heater or gas BE CONNECTED TO THE EXISTING HOUSE'S HVAC SYSTEM,AS WELL AS THE WATER HEATING SYSTEM.THE ; fireplace , ADDITION WILL HAVE A WOOD PELLET STOVE WI EXTERNAL COMBUSTION AIR AND THRU WALL.DIRECT VENTING .. 1,„fiz.hter Las) 23.32 A NEW 350 SF ATTACHED STUDIO ADU WEL BE CREATED VIA CONVERSION OF THE EXISTING HOUSE WHERE TWO . ' 4"1".-11 ""1-- i 323313392 BEDROOMS AND A BATHROOM WERE PREVIOUSLY LOCATED 'THE ADU WILL HAVE A NEW KITCHEN,AND THE 'Wood/pellet stove EXISTING BATHROOM WILL BE CONVERTED TO THE ADO.THE ADU WILL HAVE A NEW WATER HEATER,AND A NEW ' 'wood fir,,,,lacerinsen, WALL-MOUNTED ELECTRIC HEATER TO BE THERMCBTATICALLY CONTROLLED. , ...1.1...... ' ' Chinmeglineritliteivent 23.32 El PROPERTY OWNER 0 TENANT Other: . 23.32 Name: KLARISSA OH&GRAHAM RESIDE Envirotimeatal exiast and ventilation: Range hood/other kitchen ..,..,.„ . 3 3 3 41 Address' 11065 SW 79TH AVE, ei othment 1 33 39 Clothes d ,er exhaust ; 33.39 C itylStinth ZIP; TIGARD,OR 97223 Singie-duct exhaust(bathrooms, , toilercorriLartmettrs utility rooms) 41„... , 23.31 141 0.Vi Phone:( ) Idartssa.ohltgmaitoom Fax:i I . —a- An icltrawispace tans 2 A.3''' la APPLICANT a CONTACT PERSON Other. 23.12 Business name. y-x ,/,c ,,--r'N St' i4 i It '1,,Thr, O. .,.;,..R....1.i. k.....L',11.1,L,Ct„., a LEuel piplisig: i 1 4 St skis for first four;54.03 tor each sidditionsi, " I Contact name. f ILI,j "iii.1 1,,,.1C.A.ti-414 1:ei, • Furnace etc. Address: 2;');2_,:-.2 Ki( t,..k it< t ,4v, , "1-4::_,A, k2“. ,.1 , Gas heat kunji , t lisusoendeth'unit heater City/State/ZIP: rti '.; i : -- fit, e ii.oe, •••-1 ; 'i'll Wal 1 11.•I 5 Phone.(7<3;„ ;;;‘.,:3- ) LILA S•••• fj- 7 1 Fax :( ) , Fireoiace x • I E- Ran; 0 a mail: --,,k(Lx.\.. ...t.j....,.),-,,,,.,tAl.c. IC\ ....t, '. .,c•i.,,,,ois 41i. ; Barbecue CO ell) ; ;, •• -- 1,:c.19t13",dr,291'Q11, ' ,; , . ,. , ,. Rosiness name: I)y,") 1," -4-.!.e IQ rier 1 i r"ki C 1 I 14'.. Other: Address. D.2:7S INs3 1- Nt..);k 4 ‘ ‘ ' ;4:- 3 i r - 1 ,0(4 i i.,„ FMECHANICAL PERMIT EFS/ (- ''''''' ‘1,04 :.,......„.2.,X, ' , Subtotal itzgtetti,I.51 .5? City/State/ZIP; 1 i ,1 )(yr', (''''12 4-41-1k2t: - 't i Minimum permit fee($90.00) Phone:i Cti t 1 '2( 15 i-iciEct Fax:( ) Plan review(25%of-pen-rut fee) State surcharge(12%of permit feet 1 1,At, OAS lie.: 91 NI. :t , ' ----.----- TOTAL PERMIT FEE n _,...„............... . _...... .. __, ._„ ........ 'niii permit application expires Its permit is net obtained*Mum IRO ,„.K.L'...,'..,'-''' days after it has been accepted as complete. Authorized signature 'ogfr;-• /' --' /".„-,,, . i .4,,,,-'''"--,,, — -- 3 . Fee m.,,thodology set by'Fri-County Budding Industry Serowe Hoard Print name L.A ) i Date. L , k Lt. i' C,,t- 1,Sy( .,• - *,- L-_, &.„._ )i.64..ISCA_ t ...,... - t-- 1,11tolding.Pgrtmi,MtiC_Pcim,tAprt..02{2420 dee 440-4617T It 1/02KOMAVT.71) • 1 • • Y4iz1 NT— Electrical 1'lCAI Permit ApplicationFIECEP 1 t�l<(t l l I( 1. I 'D i'()v I 1 City of Tigard A P R 0 1 2 i 1 Permit tl: 31'2621`0012g 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Inspection Line: 503 639.at 75 0 CITY OF TIC, -i ,, Related Permit u 5(/aR2t)21-eta Phone: 503.718.2439 503. Fax: 503.59$.f 4b''. 1 j 1 t I'?I A P r r §t 1,r Ready bate/BY: turfs: El See Page 2 for l I :'i) Internet: www, -or. v ‘ �' " '� NotifiedlMetliod: i 1 Supplemental Information : TYPE OF WORK J PLAN REVIEW ❑New construction •:4 Addition/alteration/replacement Please°hoar all that apply(submit&sets of plans writes checked): Demolition ❑Other• ❑Santos or feeder 400 amps or more ❑Building over three stories. where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION { -- . ascends 10,000 amps at I50 volts or o Floating buildings. 0 Commercial/industrial "Accessory building less to ground,or exceeds 14,000 p Ceramic/al-use amicutttaa1 amps for❑Multi-family 0 Master builder ,Q Other: umpitaas�r;nstalaattana. InbudsIlatio rf,',"• Fin pump. Installation of S 50 KV A or JOB SITE INFORMATIQN AND ATIL? I`d'(ieL�. ❑Emergency system. larger separately derived L f / ❑Addition of new motor load of system Job#: 20020 Job site address: ( 11067 SW 79TH AVE. 100NP or more. ❑'°A" "E' `ldz..'i-3". City/State/ZIP: - TIGARD,OR 97223 Six or more residential units. occupancy. r❑}Health-care facilities. 0 Recreational vehicle parts. Suite/bldg.lapt.#: Project name: ' dlltlFiEFkNiB-- t�'j4 ADU ❑Hazardous locations. ©Supply voltage for more than I. Q Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: SW 79TH AVENUE BETWEEN SW~ --`� FEE SCHEDULE PFAFFLE ST.AND SW SPRUCE ST. ....„,., --T Teal 3 , New residential single-or multi-family dwelling unit. Subdivision: FRIENDLY ACRES Lot#: 2500 Includes attached garage. Tax map/parcel#: 1S136CA0 2500 1,000 sq.ft.or less 4 Ea.add'l 500 sq.ft.or portion 4= 321f 1 DESCRIPTION OF WORK . ' Limited energy,residential ' A NEW MVO-STOW),505 SF ATTACHEDAODmONWIL BEAD000 TOME exiSTINGiOUSE AHUCOtetECTEO TO THE EXISTING . (with above sq ft;) ?5.00 2 EIE(:T6r,CAL.A356SF ATTACHED ADU WU.SE CREATED NAtONHER3lONOFNEE0S11NGH�WHERE TWO MOSCONEANDA } y.. .. RANR0UIN WERE F'REW XtSLY LOCATED.THE Exi5TING BATHROOM Will BE COIF TO THE ACV,&A NEW KITCHEN WILL BE Limited energy,multi-family 75.00 '. . 2 AXED.THE ADU WILL BE HEATED BY AN ELECTRIC WALL.MOUNTED HEATER 1HE ADU WILL SEIZURE A NEW ELECTRICAL SUBPANEL residential(with above sq.ft. PROPERTY OWNER ❑ 5 Renewable Unarm, _ 0 See Page 2 L. TENANT Services or feeders installation,alteration,and/or relocation Name: '<ARISSA OH&GRAHAM RESIDE 200 amps or less 1 100.70 100.70 2 Address: 11065 SW 79TH AVE. 201 amps to 400 amps 133.56 2 . - ... , 401 amps to 600 amps 200.34 2 . City/State/ZIP: TIGARD,OR 97223 601 loops to 1,000 amps 301.04 : 2 Phone:( ) Fax:( ) Over 1,000 mops or volts 552.26 2 Temporary services or feeders Installation,alteration,and/or Email: klarlasa.oheonall.com 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: , ps amps 2 Branch ircuits—new, ❑ APPLICANT I. ❑ CONTACT PERSON s A F for branch circuits alwiteration,or extension,, r , net l Business nacre: above service or feeder fee, each branch circuit 7.42M Contact name: B.Fee orbranchcircuits without f : Address: service or feeder fee,first branch circuitIII 2 City/State/ZIP: Each add'}branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) I Fax::( ) Bach manufactured or modular 67.84 1 2 Email: dwellin, service and/or feeder CONTRACTOR Reconnect only II 67.84 Pump or irrigation circle 67.84 Ill Business name: TRI-STAR ELECTRIC,INC. Signor outline lighting 67.84 2 ( Signal circuit(s)or limited energy 0 Sea Page 2 2 Address:PO BOX 231175 mil,alteration.or extension. Eacbbia additional tional inspection over allowable in any of the above City/Stale/ZIP: TIGARD OR 97281 inspection(1 hr min) 66.25/hr 0 0/hr (503 >BGtI-383$ Fax:(503)590-2302 Investigation(l hr lain) '• Phone: 90. Email: Industrial plant(1 hr min) 78.18/hr debb 312 ahoo.com ,- Inspections far which no fee is 90.00/hr CCB Lic.: 153559 . Electrical Lic.: 34-620C sum.Lie.: 38325 sped keliy listed 4t,4 hr mini Suprv.Electrician signature, ELECTRICAL PERMIT FEES gym,required: r t"i►t Subtotal: mow. VOD•"71:1 if Print name: RICH METZLER Date: 12/21/20 0 Plan Review Required(25%ofpermit fee): State surcharge(12%of permit fee): ow _ TOTAL PERMIT FEE: Authorized signature: - application ovine;If a permit is not obtained within ISO Print name: Date: 1 This permit days after it has been ecceptsd as complete. ,._ ! r Number of inspections allowed per penult. l:\HuildingTe sent LC PetmeApp_StR ERE.doe Rev05d17t1015 44CW6151111/05/COM/WEa , .ii Electrical Permit Application-City of Tigard tt,ti, ED Page 2-Supplemental Information APR 0 1 2U21 Limited Energy Permit Fees: CITY OF TIGARD Renewable Energy Permit Fees: BUILDING DIVISICN - _ RESIDENTIAL WORK ONLY FEE SCHEDULE ......_,......,..1 Fee for all residential systems combined: $75.00 DescA99. I Renewable electrical energy ' - •I syist.Detin,•s Each i Tow j c_4 i 5 1 Check Type of Work Involved: kva or less 1 100.70 2--1 5.01 to 15 kva 133.56 2 Audio and Stereo Systems* I 15_01 to 25 Icva 1 200 34 12 1-- - Wind pnerationsystems in excess of25 kva: i 0 Burglar Alarm 25.01 to 50 kva • 301.04„I2 1 , 50 Otto 1001cva r + 552.26 21 n Garage Door Opener* i - I-->.100 kva(fee in accordance 1 1 cc, m-----1-1 2 with OAR 918-309.0040 1 I 26 ! 0 Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: . System* —1 Each additional kva over 25 7,42 3 • 0 Vacuum Systems* . WOO kva no additional charge ] 0.0_1_ 3 Each additional inarection over allowable in an of the abo4s11 1 1 . 0 Other: Each additional inspection is : , i 1 i 66.25/hr I 1 1 ,,,, charced at an hook.(1 hr min) 1 . — I Inspections for which no fee is ' i I ' s cca , listed, hr min) 1_....,a, ' 2 I i 90.00/hr ifill lid L I COMMERCIAL WORK ONLY: 1 ELECTRICAL PERMIT FEES Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 , I i * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n A• udio and Stereo Systems Boiler Controls I I Clock Systems ri D• ata Telecommunication Installation 0 Fire Alarm Installation ' • 0 HVAC 0 Instrumentation [ 0 intercom and Paging Systems El Landscape Irrigation Control* I I Medical ri N• urse Calls . 0 O• utdoor Landscape Lighting* n Protective Signaling Li Other: : Total number of commercial systems: . . i . *No licenses are required. Licenses are required for all other installations 1,‘Buildin0Permits‘ELC_PermitApp_ELR_ERE.doc Rev Mil 7/2015 . . ! . . . ti // /2‘ Pliimbin,0 Permit Application RECEIVE17, It u ild ing Fixtures APR 0 1 2021 i(8: (8 1 1( 1 1 ,1 ON I City of Tigard itecei,,ed a II k—r i - __ .Nfyz I Permit .rYNt zl,. 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TiGAH. D., ttl)Y A . 1 5- 71 I _ A S . /Ian Re le , = Phone: 503,718,2439 Fax: 503.598.11;1. 0 elliy{WING DIVic'l t* v Othcr Permit No.:$0911:52.1-6 00173 • Inspection I Ana: 503.639.4175 T t 6 AI:1) Date Readyfay ' hair lig See Page 1,for [Memel: www tigarii-or.gov ; Notified:Method: supplemental Information TYPE OF WORK FEE* SCHEDULE . For special information we rherklist. 0 New construction El Demolition - Description 1--Criy faml Total i4 A ditilion/alterationireplacoment 0 Other. New 1-2-funally dwellings(includes 100 IL for each utility connection) CATEGORY OF CONSTRUCTION SFR(i)1-nth. 1 312.70 1 irg . I I 0:16 1 J ,i,,..1 2 fisi•el„3.....I.Iiiig 0Conunercialiindustrial SFR(2)bath 437,78 SFR(3)bath t500 32 Ir ' A cc e ss ury building 0 Multi-family 1 Each additional badultitehen 1- 25.02 . ' 0 Master builder y - • —Xre_i•- 0 ----- ,'I fesprnkle: ... sq.a.) Page 2 JOB sr vNFORNION AND L VON Site utilties Catch basin or area drain 18 76 ' Job sits:address: ADDITION: 1 ADO: ‘14161143W-ffffil*I7T7- .._, ,A ....- / Drywall,leach line,or trench drain 18.76 : City/State/Zit': TIGARD,OR 97223 /' -i ... ...., Footing drain(no,linear 0.:____) Page 2 ; Suite/bldg./apt,no i'roject name: GATHE '0 ADDITION&ADO -- - Manufactured home utilities J 1 50 03 Cross street/directions to job smelt SW 79TH AVENUE BETWEEN SW !Manholes ; 18,76 ' ' - --------------'7-' PFAFFLE ST,AND SW SPRUCE ST. Rain drain connector - ; 18,76 ____ _ ,- ... „_. --- Sanitary sewer(no.linear 11:: ) " Page 2 I . .4- Storm sewer(no.linear IL: Page) 2 ; ! , . ' ___ Water service(cc.linear ft;____) Page 2 Subdivision: FRIENDLY ACRES Lot no.: 2500 Flzture.or Stem: ._.... , , ,.._, ,...........__________ _..... I Tax map/parcel no.: 1S136CA0 2500 Backilow preventer 31.27 I -i Backwater valve 12.51 r DESCRIPTION OF WOIUC ' - l. Clothes washer 25.02 4 NEW 1WO-SiCRY 1.500 SF ATTACHED AMARA WILL BE ADDED TO Tilt EXISTING HOUSE AND CODAIECTEDTD THE f MONTI WATER ANti SEINFR.THF.ADDITION Wilt HAVE Z NEW BA;Blooms sTOOMWATEll RUNOFF TROM THE AO .UITIUN Dishwasher 25.0? 1 I WILL BE HANDLED WA DOWNSPOUT TO SPIASHRLOCK.A NEw:IAD Sf ATTACHES ADU PALL St CREATED IAA CONVERSION OF ; . THE EXISTING fr c USF WHERE TWO BEDAORMS ANO A RATHAOOM WERE PREVIOUSLY LOCATED,THE EXISTING BATHROOM Drinking fountain 25.02 N1LL BE C CANER it 0 TO nit ADD(Atli.SHOWS ADDED).d A NEW KITCHEN MILL BE ADDED.Ifif ADT/Vial_BE CONNECTED TO'CBE DOSTIND HOUSES WATER AND SEWER. Ejectors/sump 25.02 --- 11.1 PROPERTY OWNER i 0 TEN,t,'N'T Expan5ion tank 1' .• 12.51 . „ -_1_, — Fixturelsewer cap 25.02 ; Name: KLARISSA OH&GRAHAM RESIDE . , Floor diilirilloor sink/hub 25.02 0.• Address: 11085 SW 791H AVE, i i2.5,...r)., Garbage disposal 1 25.02 City/State/LIP: TIGARD,OR 97223 Hose bib 25,02 __. Phone:( ) Idatissa.uhagmaileom i. Fax ( ) Ice maker 12.51 ,_____.._, _..............._ E3 APPLICANT 0 CONTACT PERSON iatereeptortgrease trap 25.02 I Business Medical gas(value:$ ) Page 2 name; --t Primer 12 51 ' Contact name: :I _„_,,........__,____.— ___ Roof drain(pairtmeicia 0 12,51 „...„. . Add _ — reaa: Sink:basin/lavatory , / 25.02 ----1 City/State/ZIP: Solar units(potable wawa) 62.54 : Phone:( ) I Fax::( ) Tub/showestshower pan , 12,51 r.—, i IA ., _ ' [Urinal 2 .51 E 5 02 •. -mail: --1 i Water closet , CONTRACTOR L. 2 02 1 / '5 . I Water healer 37 52 ; , -I-- . , Business name: B, c&1.3,s1;-R,4.:3 i \1..:k-s, ,i,s' '..: i 1,34- • Water pipingiDWV Address: ‘--/-1 7,-6 , - 1..„ I,A c 0 ST Other: 1 25,02 City/State/ZIP: .S--'0 c.7)--LA N.5'''`, 9- ; 4c1 1-3-s i Subtotal •' ' 137.53 --..... MinimtIm permit fee: $72.50 Phone:( ) ,T...;,. S-2_2- Fax:(51::',1) 73.,'2,7/OC,/,..i 2_L.1 _...... Plan revie-u; (25%of perrriit fix) I (7(13 Lie,: ‘s- i‘ LA 1 Piumbhig Lic.no.: _<..) ( S-- i Authorized signanti: . --;;"- _c7e-..47-.._. 1___g _41 Y. 4 a i L , State suit:hair;(12%of permit fee) 1„; TC)TA.I.PERMIT FEE ' Surprii,te A, ID - I ) i-, -, ,-, ' This'pertmt application expire:,if a permit is not obtained within NO days Print as . 4041,e'll romititA 4-0 uk- '- - •,,,-- after A baii barn accepted iiii complitte. Tee methodology set by Tri-Conitty Building 1J:dimity Set+.1.te Board, .. . 1\.1 iu,Id 1 il\Perrilit,411,14U-Famr1 App,c10,... 10,01'09 440-4618T(10rosICOMAVEB) . ' .. „ . .... _ . . k • EC V . Plumbing Permit Application - City of Tigard ',°° 01 2621 Page 2-Supplemental Information C.,FY Or r sq ARU U!L.t LNG DIVISION Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. F:r(ea) Total [S care Footage: I Permit Fee: Foo m_train 1'100' 50.93 l 0 to 2 901'093,6U0 0 �$i21.90 Footing drain-each additional 100' 37.52 $169.69 r 3 601 to 7,200 $233.20 Sewer-1st 1O0' 62.54 ? 7,201 and„Treater•' S327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 , 0Storm&Rain Drein-lit 100' . 62.54 al t-talon 1 Permit Fee: i 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 Qty. Fee(ea) Total 1 each additional$100.00 or fraction thereof,to Other Inspections or Fees I and tncludm $10,000 00 Inspection of existing plumbing or for $10,001.00 to$25,000.00"t$14&50 fnr the brat$1 QOOO.O0 and 51..54 far —1 which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum char;le-112 hoar, and includms $25 000 00 inspections 90.00/hr 5,"0` " ,0 0forh 00._ i. --___. pC $25,001.U0 to$50 009 UO $379a0 for the trial$25,0OO.OU and$t.45 flu hours entmtmum chart e_2hours) 1 each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and includizu $50.000.OD. 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 rminirnrun char a t/2 hours each additional$100.00 or fraction thereof. Subtotal: • Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work perforated by fixture. Failure to accurately report fixtures could result in increatv its sed Plan d seewer fees*. Parevien is requiredfor Review for Plumbing Installations u 1 the following. Fixture Type forReplaced IBM � Please check all that apply. Work Pcrfnrmed:. Capped ltew 0 Any new commercial building with water service 2"and 11a•tistr,/rom IIIIIIIIIIIII greater,except systems designed and stamped by licensed Bath; -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash -Each Stall 0 New exterior plumbing site utilities for any complex structure Drive Thr all as defined in OAR918-780-0040. • Cussidor/Water As;irator 0 Medical gas and vacuum systems for health care facilities. • Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system. Dnrnestic Mall 0 Any complex structure-as defined in OAR9l8-780-0040. Drinking Fountain E{a Wash Submit 2 sets of plans with any of the above. Floor Drain/sink' 2" Isometric or Riser Diagram _.__ l Isometric or riser diagram is required for new buildings • -Car Wash Drain c that meet the qualifications above Garbage -Domestic non-fend I Disposal: -Domestic food related -Commercial food related • -Industrial food related Ice Maeh.fRefria Drains Comments regarding fixture work: Oil Separator r.Gas Station: Rec.Vehicle Dump Station Shower: -Gang ' -Stall Sink: -LavBar non-food related -Bradley -Com/Serv/Util food related -S8rice *Note: If the fixture work under this permit results in an Swimmini•Pool Fitter increaseplumbing of serpermitver GDtis,be a iss sewered. permit will be issued and Washer-clothes Water Extractor fees assessed for the sewer increase must be paid before the Water Closet Toilet can u Urinal Other Fixtures I:\Building\Penaiis\PLMF;PermitApp.dae 08104/2011 Plumbing Permit ApplicatiotRECElVED Building Fixtures AUG 3 2021 FOR OFFICE I SE ONE). Received City of Tigard CO OF T� � Date/By: Peullir Sri //))i-lk 111 13125 SW Hall Blvd.,Tigard,OR 97223 h��� M DIVISION Plan Review O Lam'/ • Phone: 503.718.2439 Fax: 503.598.gout G Dt V I ION Date/By: Other Permit No.: Inspection Line: 503.639.4175 Date Read/B md5• ® see Page 2 for Ti G;1 R(7 Internet: www.ti rd-or. ov y Y S 1� g Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. I Total RI Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ I-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: ADU Fire sprinkler( sq.ft.) Page 2 Hoc 7 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 14 86 SW 79th St - Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Tigard,OR Q Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: �-Liri k5- /77 7i.( Manufactured home utilities 50.03 Cross street/directions to job site: �y"[ 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 lg.r APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: D &Sons Plumbing Primer 12.51 Contact name: Daniil Akimenko Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 2 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 1 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 1 25.02 Water heater 37.52 Business name: D &Sons Plumbing Water piping/DWV 56.29 Address: 16500 NE 199th St Other: 25.02 City/State/ZIP: Battle Ground, WA 98604 Subtotal Phone:( 971 ) 201-6148 Fax:( ) 7/iii f Minimum permit fee: $72.50 CCB Lic.199766 �'�2,�3 Plumbing Lic.no.: PB1342 7 Plan review (25%of permit fee) g � ��� ' State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name: Daniil Akimenko Date:July 30 2021 y after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp-doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qtr. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1" 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service- 1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to 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/Font CI Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure Drive Thr as defined in OAR918-780-0040. ID 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 ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. 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 City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT ■ TIGARD Building Permit Review — Residential Building Permit #: 1V 2o.2k ' OO1Zg Site Address: j I Q(o 1 StJ k AVE Project Name: V Lot #: Planning Review C741- I Proposal: �` A'DU Id' Verify address/suite#active in Accela. ❑ In River Terrace: ZNo ❑ Yes,River Terrace Review Addendum j Site Plan Elements: ErErosion Control Z3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper 11)11tRetained trees with drip line and tree protection measures /Drawn to scale(standard architect or engineer scale) ZFootprint of new structure(including decks)and FEE VJNorth arrow zUtility locations&easements(required for new and additions) eS'te address,project or subdivision name and lot number Ci7Sidewalk/driveway approach ?]Applicant information(name and phone number) - tt Location of wells/septic systems , M 4 rd'Lot dimensions and building setback dimensions ,�Street tree size,type and location 011t [t uare footage of buildings to be demolished YJStreet names IQ Existing structures on site [forcer elevations(2'contours if more than 4'differential) 4. lLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes Ro impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes G2Ko 'lean Water S vices—Service Provider Letter(lot platted prior to 9/10/1995): Required: ai Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs equired: ZYes,applicant was notified ❑ No Received: ❑ Yes ❑ No yJ SDC Exemption for ADU applied for: El Yes 'No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified El No Applied For: ❑ Yes ❑ No,stop intake ,Land Use Case#: ADU2oZo'CCO20 ' oning: R q •S .Required Setbacks: Front: 10 Rear: I S Side: c Street Side: /I Garage: LO 213uilding Height: Max.Height: 30 Actual Height: 23 •S LIJ Landscape Area: 13 % R:I Lot Coverage Max: N//%+ % Entrance Set back no more than 8'from street-facing wall ❑ Parallel to street o egrees or less Windows [Minimum 12%of area of all street-facing facades Garage e door is behind widest street-facing wall Yes ❑ No,one of the following is met: ❑ Door exten n 5'from nd there is a covered porch extending beyond garage. ❑ Door extends no more tha ' rom wa 's a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is 'or less ❑ 50%or less of facade ° r less and includes 7 of following: ❑ Covere c ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset ❑ ' e shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof er Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony 0 f P Visual Clearance a P t Urban Forestry Plan nsitive Lands: ❑ Yes ❑ No Type: Conditions met prior to issuance of building permit Not e : fri---- . „ 7 Approved By Planning: µ,a.4. — Date: V S/2 1 Revisions (after Building Submittal only) / Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved El Not Approved I:\Building\Forms\B1dgPermitRvw_RES_122419.docx n Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: Building Permit#: ❑ Enter building permit#above. Workflow Routing: ❑ Planning ❑ Engineering ❑ Permit Coordinator ❑ Building Workflow Sign-off: ❑ Sign-off for Planning(include notes from planning review) Route Application Documents: ❑ Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. ❑ Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: Engineering Review Q'Slope at building pad: 2 Conditions"Met"prior to issuance of building permit D lir-Easements (encroachments)per engineering conditions of approval and plat H/A Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes M'No Assess Water Quantity Fee in-lieu: ❑ Yes M".No LIDA Facility on lot: ❑ Yes C�'No Q'Final Plat Recorded: M/A- ❑ NOT Approved by Engineering: Date: Notes: Y.-Approved by Engineering: ,anji Date: 'f�/ ./?o2/ Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review Conditions"Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: • izr SDC Exemption: 'eceived ❑ Does not apply --want 1 � 'v gSDC Fees Entered: ��ash Co Trans Dev Tax: ,Zr Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: ie Yes ❑ N/A LIDA ❑ Yes N/A OK to Issue Permit Approved by Permit Coordinator: Date: 4 002J1 I:\Building\Forms\B1dgPennitRvw_RES_122419.docx