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Permit _ CITY OF TIGARD MASTER PERMIT ' COMMUNITY DEVELOPMENT Permit#: MST2021-00132 Date Issued: 08/24/2021 T I i; ' I?.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112CD16900 Jurisdiction: Tigard Site address: 15968 SW 76TH AVE Subdivision: DURHAM ACRES Lot: Project: HSU Subdivision, Lot 2 Project Description: New detached dwelling BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1116 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1419 sf Garage: 408 sf Front: 15 Smoke Yes Dwelling Units: 1 Third: 0 sf Right 5 Detectors: Total: 2535 sf Value: $330,867.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 9Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 4 201-400 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+ampNolt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Y Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2535 Owner: Contractor: TENHOUSE PROPERTY LLC EMPERIAL CONSTRUCTION Required Items and Reports(Conditions) 5978 SCHEEL TER PO BOX 86353 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97229 PORTLAND,OR 97286 PHONE: PHONE: 503-969-6160 FAX: Total Fees: $38,769.25 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with a proved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATT TION: Orego j w requires yo to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 0c2nn1-n(Nn fhrn, (1 9rnn1 on Ynu maw fain a rm.,/nf+h ileac nr rfiro t ni,eaefinne fn(ll INC hw r2Ilinn cI1 9't0]j�R7 nr 1 Ann 11771.1.1 Issued By: �. / Permittee Signature: (\/7CC 'r1 Vi/e1). �67/ L-` Call 503.639.4175 :00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application ; / . Residential RECEIVED roR OFFl(F 11,SF.OyI.N City of Tigard Received Pcunit No.: Datc/By: OG �1/ M SZOZIt' 13Z 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 2 3 !OZI Plan Review SW12ZQ 00 r7 e Phone: 503.718.2439 Fax: 503.598.1960 Date/By. 1 it. ( OherPem b$t t;D Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: 65 See Page 2 for Internet: www.tigard-or.gov N 'red/Method: / et Supplemental Information BUILDING DIVISION TYPE OF WORK REQUIRED DATA:i-AND 2,-FAMILY DWELLING. '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 0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and/eprofit_fo, rc ✓ CATEGORY OF CONSTRUCTION work indicated on this application. ` 7) (QDZ60. Valuation: $ ' " C il2rI-and 2-family dwelling 0 Commercial/industrial Number of bedrooms: ❑Accessory building 0 Multi-family ❑Master builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: z -2M 13 New dwelling area: 2 tJ«JS square feet y l l Job site address: '159 ea la 5� �6{�4t Me. New City/State/ZIP: 'Ti9ezrdl t (y'g Q7224. Garage/carport area: 14().43 square feet ILL(Q Suite/bldg./apt.no.: Project name: }}5,u StAdiViorz Lot Z Covered porch area: 38 square feet Cross street/directions to job site: Deck area: square feet Su..) Z6 t Awe. 4 btu nc r i Rd . Other structure area: . square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: H. .tA, subs' 'it9t0r1 I Lot no.: 2 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.: 25 112[C 0 t C.,400 equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK 1 work indicated on this application. ('QW COrt C'A<#IO('t —. strt3ke. -pIQl7')flt� ricbmQ Valuation: $ Existing building area: square feet New building area: square feet 0 PROPERTY OWNER ❑ TENANT Number of stories: Name: Teo(.{p l � PFLOPER.TY r LL C Type of construction: Address: ==i'78 NW rjc.rteel "Ter Occupancy groups: City/State/LIP: Q0 hAgyld, , O R. `I'(.2 Zq Existing: Phone:(503) µ ei -11 Q 4 Fax:( ) New: ❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer so fee schedule) Business name: Structural plan review fee(or deposit): 70.3 Contact name: DlAhlE HSU FLS plan review fee Of applicable): Address: A A — Aµ' YS J AtEekl t Total fees due upon application: Cityl5tate ZiP: Amount received: Phone:(q71) 5c,3-S 2)Q Fax::( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: , c1:1ina{Q6@ CCr*tCast.-net- Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: t M pER 1 AL CC51,1SZ FtaC110 N Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 41328 'l1E Sell to lox Sk. Solarfnsiallalion Specially Code checklist. City/State/ZIP: ��fl ©R �q^727n Permit Fee(includes plan review $180.00 tY �Or�lGlCle� r and administrative fees): Phone:(5O `Get-G I Go Fax:( ) State surcharge(12%of permit fee): S21.60 CCB lie.: 15J{ 4 Total fee due upon application: $201.60 Authorized signatuee: J iG. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. ( *Fee methodology set by Tri-County Building Industry Print name: ]�,1 A tJ E }}J L( Date: `j/�j ZC)Z) Service Board. B 1:' uildingWP \emtiisBUP-RESPermitApp.doc 02/24/2011 440-46/I3T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling City of Tigard p,- n<�,4 v sir u • 1 i 5 SW Hall tiled.,Tigard R `r"17 i Panne 503.'1S 439 rim rL.i :vi Idfan -4-their Inspection Line. 503.t:9.4175 0 Lict 0 niumoLnd 0 pt.<:rmdi.al TIGA[t t} Internet ua . r aril-or n I ❑ other. THE FOLLOWING ITEMS .Af{F. RLQI. ll{F.l) FOIL I'L \' RE\ IF:A\ "i'' "" 's it I Land use actions completed. Sec jurisdiction criteria for concurrent reviews. ■ • C 2 Zoning Flood plain.solar balance points,seismic soils designation.historic district.etc. 0 0 ©" 3 Verification of approved plati1ot. 0 0 2'' - 4 Fire district approval required. Name of district 5 Septic system permit or authorization for remodel. Existing system capacity _ o Sewer permit. ❑ d F ! 7 Water district approval. GcnCFtr mega vo 1 a4rc,rt '$i?rxh€ 0 Eir ! 0 R Soils report. SIust cant'original applicable;tamp anti signature on file or with application, i r 0 Er 9 Erosion control 0 plan ❑ permit required. Include drainage-way protection,silt fence design and location of catch- Sr 0 I ❑ basin protection.etc. 10 3 Complete sets of legible plans. Mast he drawn to scale,showing conformance to-applicable local and state [ ❑ 0 building codes. Lateral design details and connections must be incorporated into the plans or on a separate Mil-size sheet attached to the plans with cross references between plan location and details. Pion review cannot he completed if copyright violation;e.rr<t_ I I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if Err 0 i 0 there is more than a 4-tt.elevation differential,plan must show contour lines at 2-IL intervals); location of easements and driveway;footprint of structure(including decks):location of wells'septic systems:utility locations;direction indicator,lot arca;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 Er 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location or smoke detectors,water heater la- ❑ 0 tdrnaee,ventilation fans,plumbing fixtures.balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists.sub- Q- 0 ! 0 door,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing.rooting,roof slope ceiling height,siding material, footings and foundation.stairs.fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction:minimum tit two elevations for additions and remodels. a- 0 I ❑ 1, Exterior elevations rust reflect the actual grade if the change in grade is greater titan four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. lb Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;Mr non- a L] 0 prescriptive path analysis provide specifications and calculations to engineering standards. I7 Floor/roof framing Provide plans for ail floors rotif assemblies. indicating member siring.spacing,and bearing a ❑ 0 locations. Show attic s entilation. I S Basement and retaining walls. Provide cross sections and details showing placement of rehar. For engineered a- 0 0 systems.see item 22."Engineer's calculations." 19 Beam calculations. Provide Iwo sets of calculations using current code design values liar all beams and multiple joists [y}'' ❑ over 10 feet long antl.hor any beam/joist carrying a nun-uniform load. 20 Manufactured floor/roof Irons design details. a 0 0 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 for four or more appliances_ 22 Engineer's calculations. When required or provided.ti.c.,shear trail.roof truss)shall be stamped by an engineer or R}' ❑ 0 architect licensed in Ore inn and shall be shown to be a iicable to the ro'ect under renew. 23 Three(3)site plans are required for Item II above. Site plans must be 8-1-2"x I I"or II"x I T'. 24 Two(21 sets each are required for Items tfi. 19,20 and 22 above. 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ■ 0 220 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 ■ C+ 27 "Drawn to scale"indicates standard architect or engineer wale. a 0 0 1, 28 Site plan to include tree size.type and location per approt ed project street tree plan tip'applicable).and City of-Tigard 0 ❑ El, Street Tree List. 29 Site plan to include trees and free protection measures as required by conditions of approval. 'Tree locations.driplines, ❑ 0 amp protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Storririci 4rea Pre-Screening Sue assessment lure is required for all building additions, 0 0 Er-I including decks.patio covers(over non-ingervicws surface)and aces .sort'structures to existing residential dwellings s on a lot of record approved poor to September 9, I 995 cGetg cr v' co E 61uQG Bvsc4a1kt3, I:AoildingPenmas'AUP-RFSPermitApp.dot 02 24 2011 440-4613T(f i,02,COM-WIiR) Mechanical Permit A licati EC E IVE I FOR OFFICE USE ONLY ReceivedDat M Sr2^ �01.,3� City of Tigard Receive Permit No.: ( ((J V • 13125 SW Hall Blvd.,Tigard,OR 97223 MAR '� N . Phone: 503.718.2439 Fax: 503.598.1960 2 3 �7 4 Plan Review Date By: Other Permit: T I G A R D Inspection Line: 503.639.4175 CITY OF TI GAR D Date ReadyiBy: kris: 63 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WO III R 03MMFRCIAL FEE* SCHEDULE - USE CHECKLIST " ' " ( Mechanical permit fees*are based on the value of the work EX 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. Value'$ CATEGORY OF CONSTRUCTION _ - - -RESIDENTIAL EQUIPMENT/SYSTEMS FEES* d1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checkLN. 0 Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: I� q / ---- Air conditioning ( 46.75 46. 15 Job site address: b .. ;-,...0 76"1-k f IJ Furnace 100,000 BTU(ducts!vents) 46.75 City/State/ZIP: 7 i q q Pr 1 Q(� G�7ac2 .q- Furnace 100,000+BTU(ducts/vents) I 54.91 541:qt J Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or W '1(� /�t/R (� (n d. �'A. hydronic) 23.32 1 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: rrII Tax map/parcel no.: Water heater I 23.32 15151 DESCRIPTION OF WORK Gas fireplace/insert t 33.39 3$:- 01 Flue vent for water heater or gas 1. �{(0_ Tiel 5.fa it I(re i f , ', II c E e/L' A /C %G fireplace d 23.32 b f Log lighter(gas) 23.32 ---- Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 0 PROPERTY OWNER Other: 23.32 ❑ 'TENANT Environmental exhaust and ventilation: Name: ' L'-s. 1 a U`4.; (k�rl C:'jr i t_ .L.. Range hood/other kitchen equipment I. 33.39 3"i-s"1q�� Address: 5 q `1 F, MA) S e tit e e 11 1 t✓- Clothes dryer exhaust ( 33.39 33'. City/Stale/ZIP: 17 OK.“.... & ovc ( 0 2 Q Q Single-duct exhaust(bathrooms, G toilet compartments,utility rooms) 23.32 Phone:( •1)) k 1 - -1 I (e-1,. Fax:( ) Attic/crawlspace fans 23.32 0 APPLICANT 0 CONTACT PERSON Other: 23.32 /� Fuel piping: Business name: k peN j(,l/ C OK S.fa rrG.ji p✓7 / S14.15 for first four;$4.03 for each additional Contact name: S e KS e/y D e.to 9 (� . Furnace,etc. I n P c A.) Gas heat pump Address: 11 T 1g er Sc.i ,i i e-'2 Q} Wall/suspended'unit heater City/State/ZIP: POR 4ILtwte- OIe 07 '1 Q 2 O Water heater r ( z.) 969 -616 ( ) Fireplace Phone: 5Fax: Range I E-mail: _se,R S2/ (0,1i G iJ 6 e COJICed f k • 0-thpr- Barbecue CONTRACTOR Clothes dryer(gas) Other: Business name: E1.." Re , (sot/ co.it S,i K vO t'""011 MECHANICAL PERMIT FEES* Address: 113a S A) ( z).,4V L(Ly? IL Subtotal City/State/ZIP: P O tt. 1 1Ct,n I4 CV ! 9 a, ° Minimum permit fee(S90.00) Plan review(25%of permit fee) Phone:(Xr" 969 - 61 6 o Fax:( ) State surcharge(12%of permit fee) CCB lie.: / 5 `t 4 R it TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: • Fee methodology set by Tri-Courtly Building Industry Service Board Print name: 3QRgaft pe,t„ PTV U. Date: I.Building\Permits'.MEC_Permit App_0401 13.doc 440-4617T(I I/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 -Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. S10,000.01 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:\Buikling\Permits\MEC_PermitApp_040113.doc 2 Electrical Permit Application I OR Of I l( F I SI 1),I 1 �l crtsed City of Tigard RECEIVE Pr,,,,/x M512 2 t--GU 13Z a etc.Las • 13I 5 SW Hall Blvd agar vw OR 97"; Plan Rac . i Phone 503. I8 2439' 1 as 503 548 t7(xl MAR 2 3 zaz� Date B. t Related Perm= MAR Inspection Line 503 639 4175 Reads DataB. Raw i 63 See Page 2 for (I c).-1 P 13 Internet vtvut inrard-or gin Sot,fred Method. Supplemental Information CITY OF TIGAR u TYPE OF WORK p�IILDING DIVISION I PLAN RF:YIE11 ®New construction 0 Addition alteralion'r p acement Pleace ci k all that appls ciihrei/errs a(ptnn,w Item.checked, r—� 0 Ser,we a treater ues amp,or more 0 BunIdmp Deer three stones 0 DemolitionI„�Other: when[he xvnilank blue/:uneatt ❑ktannSS and bcm, ar3r CATEGORY OF CtYNS'1 R6(`I EQ!S ecaeds 1(W+1 amp at 45a wilts or ❑f lraung.buildings �----- less to attend.ore<cerds I Ms, 0(Crtnnters al-roe agncultural ® i-and 2-family dmselling 0 Commercial industrial 0 Accessory building amps for all other installations headings 0 Multi-family 0 Master builder ❑Other: ❑ p p Fin utn 0 Installation of"tSG KI`A or JOB SITE INFORMATION AND LOCATION ❑Emereeoes system larger mepamtels dented 0 addri,on oC new motor 144,1<4 to stein lobs: Job site address:15968 SVV 76th Ave luoliPormore ❑_a "L "I i ❑sim of more reitdenual urns. rw.uparn•. (.it State LI a:Tigard. OR 7 224 ❑lieeltbseare,,,dares ❑Reereanunal sehtele park. 'sune'bldg. apt.n: Project name: ❑i tarardorts I,xzron< 0 Suppls srltsite the motet-ban 0 Ser ice or feeder n^0 amps or mete (as)cons nominal. Cross street directions to job site: FEE SCHEDULE oesrriettee Qt1. Each l 1"otai I " New residential single-or multi-family dwelling unit. Subdivision: I,ot_. includes attached garage. Lfs'kt`,t ti or less 168.54 lee 54 4 lax map-parcel r: La add i 5till hi It u portion 33 9. '0.;.? 1 DESCRIPTION Or WORK i milted meter rz teen./ti xt New electrical service and wiring for new 3,135 SOFT SFR "11h''h "" " e ' - j Limited energs.multi-fain ity ,5 on res,dential ittnh atvtcc s4 fl.) 1 0 PROPERTY OWNER ( 0 TENANT - Renewable Energy _ _ I ❑ See Page 2 Sort ices or feeders installation,alteration.and/or relocation Name: t>h amps or it t 100 79 2 is 201 amps to 44£amps I I t:(h Address: sot amps to 600 amps 2 14 2 City StateL(P: l isot amps to 1C.14Y!amps 1 2 Phone I ) Fax:( ) Over i.s'O amps or cola 7.6 2 Temporary sersices or feeders installation.alteration.and/or Email: relocation Owner installation:This installation is being made on properly that I ovin s%hich k not ` 2o4 amps or less I 5936 intended for sale. lease-rent.or exchange.according to ORS 44'.449.670.and 701. I t amps to 4.5:amps 125 08 Owner signature: Date: 481 amps to Sac amps I 168.54 2 Branch circuits—new,alteration,or extension,per panel j ❑ APPLICANT0 CONTACT PERSON ,A.Fee for branch circuits is Business name: above service of feeder fee. 7 42 - each hranch circuit Contact name:Shalya Atex .._ li Fee for branch circuits u,ihrn,t I service or feeder fe1:..first i At-,Ili Address: ( blanch circuit - Cin stale/IP: 1-ach add t branch crcuit 7 42 1 2 Miscellaneous(service or feeder not included) Phone:I. 503)502-2699 I Fax: : 1 I wash manufactured or mctttulur t,,8J dwelling.service and or feeder I'nail: _ Reconnect onM 67 83 CONTRACTOR Pump or Irrigation suck 67 S-I I 1 Business nameI sign,n Sroutline lighting i h's1 - Portland Electric LLC t Signal circums:or luntted-enerdn ❑ See Page 2 Address: 1915 `~f l" Street,fl I panel alteration.mr eetensron - i Each additional inspection Deer allowable in any of the above (.115'State-l_t 1' I Additional'napes-Ron i hr run, ht 1 hrPhi etc , 5(}:', _. _ REx:I i 1 Investigation i I hr mini ( 90 oo hr Industrial plant,I hr min. 78 IS hr j Email:peal c oortlandelectric biz i lnsltrctmns for uhtGh no lee is IRi eN1.hr 1 1 CCB Lie.: 194066 I Electrical ic. g760 Suprv. I-ic.:4920S specrfically listed hr inn. I 1 1 El FA:Ti t XI,. PERMIT FEES �riprv. Electrician signature.required , "to ! subtotal r t ?a Print name:Alex Shalya lY Dale:3/i 6/2021 0 Plan Recrev. l s r ceL t :(1 permit fees -" N. Stale surchurgclt_ af potion tool PLRMII ter � �C)Lat Authoriied signature:`��b s.._ , ii Ian permit application empires if a permit is not obtained within ISO l Print Mune:Paul GruShevSKly Date:3,r'1,t},,( f days after it has been accepted as complete. • ,Somber of inspections allowed per permit I Dcdding terms.FL(: Perm,Set ELR ERE Cot Re' sr- ':17, 44:). •, •,.il\10.tn Plumbing Permit Application Building Fixtures RECEIVE FOR OFFICE USE ONLY Received City of TigardMAR ? Permit No. 13125 SW Hall Blvd..Tigard,OR 97223 �a2� Da Review T��"'�I Z- Phone: 503.718.2439 Fax: 503.598.196 Plan Review i S Other Permit No.: CITY OF TIGARD Date,Re TIGARC7 Inspection Line: 503-639.4175 Date Ready/By: kris: ® See Page 2 for Internet INww.ligard-or.gov qt 111 DING D!\/�SIntt'Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ,-0 New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. "I otal ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 El I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 1 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 15 9 6b Lk) -I 6.4-1I A L(% Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: I qCl 0 d- oK q.10,2 l Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 S`.i J .1 (, 4k t A v L i. D V h 1l G c-t K 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 1 25.02 N e-W f'7`I V WI ` (r O N OLi'i e Dishwasher I 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER ❑. TENANT Expansion tank 12.51 Fixture/sewer cap ( 25.02 Name: I E kJ H005,5 i O p r lz T 7 L-L C K / T Floor drain/floor sink7rub 25.02 5 9 1 1) ti u f 5 C kt e- e.L e✓` Garbage disposal I 25.02 City/State/ZIP: p 0 k 1.10 µ 1 O(Z q '[ 2 9 Hose bib 2. 25.02 Phone:( S0`j, 1 _ 1(49 Fax:( ) Ice maker ( 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: a 1,,,, I.,(.4.,,L an Co^SA s2 a fir I" O✓I Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: S,e,Q5 I g u '� (commercial)Roof drain 12.51 Address: ( (3 P Se-It-tJ V(e-n IL Sinkibasin/lavatory I O 25.02 City/State/ZIP: pQ(21+ 1C''-.e4 ©n G1 '7 2 .1 Solar units(potable water) 62.54 Phone:('S c97) q6 q 6(6 a Fax::( ) Tub/shower/shower pan 4 12.51 E-mail: `,. A cje.j Dee 9J 45 0- c0a.<Ca '3 4- - "LPir Urinal 25.02 Water closet 25.02 CONTRACTOR A) i_ / Water heater 37.52 Business name: /4 S C L: fit._b (Nt () I /I V t, Lt, Water piping'DWV 56.29 Address: l b (. 3 3 S w a n A y Other: 25.02 City/State/ZIP: 1DiZe 6+ Ot'l C .4'/ O - q1'0 9 S Subtotal Phone:(5 oj) 51 a._ 57_11 I Fax:( ) n Minimum permit fee: $72.50 CCB Lic.: '552 '�Z Plumbing Lic. 6 gS� Plan review (25%of permit fee) JJJ State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: ^, ' Date: This permit application expires if a permit is not obtained within 180 days V I r N�( 1 2 t 0 t( after it has been accepted as complete. *Pee methodology set by Tri-County Building Industry Service Board. i'Building"Permits,PLMC-PermitApp.doc 10/01/09 449-4616T110/02/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-I'100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuatiotl: 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 ec Ins tions or Fees Qty. tee(ea) dotal each additional$100.00 or fraction thereof,to p and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first S 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 S25,000.00 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,Mr $50,001.00 and up $742.00 for the first S50,000.00 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*. I Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replacer Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ElAny new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool ElCar Wash: -Each Stall New exterior plumbing site utilities for any complex structure Drive Thin defined in OAR918-780-0040. • ElCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system. Domestic El 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 4" ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domes c 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: -Lay/Bar 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\Pertnits)PLMF_PermitApp.doc 08/04/2011 2 City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT i IIe Building Permit Review — Residential TIGARD Building Permit #: M ST"ZO2 ( coot 3 Z Site Address: /S g ,20 7 / -e_ . Project Name: >' gt.d i✓i3/'C9rA-__ Lot #: Planning Review Prto osal: /J&ij l ld Verify address/suite#active in Accela. it n RiverT ce: 14 No ❑ Yes, River Terrace Review Addendum Sit Plan Elements: YJErosion Control /copies of site plan on 8-1/2"x 11" or 11 x 17"paper IV' -tained trees with drip line and tree protection measures VC?tawn to scale(standard architect or engineer scale) i� rootprint of new structure (including decks)and FFE fi rth arrow 9 . -ty locations&easements (required for new and additions) to address,project or subdivision name and lot number Sidewalk/driveway approach plicant information(name and phone number) III !.cation of wells/septic systems Lo ensions and building setback dimensions l reet tree size,type and location re footage of buildings to be demolished Corner elevations (2'contours if more than 4'diffe ntial) Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? s ❑No impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Ies ENo Clean Water Services—Service Provider Lett (lot platted prior to 9/10/1995): 7 Required: ❑ Yes,applicant was notified No Received: ❑ Yes No Water Meter Fixture Unit Worksheet—Additis,Remodels and ADUs Required: ❑ Yes,applicant was notified ��No �J Received: ❑ Yeso c2/5C Exemption r ADU applied for: ❑ Yes WI No Received: ❑ Ye No Public Faciliti mprovement(PFI) Permit: equired: Yes,applicant was notified ❑ No plied For: Yes ❑ No,stop intake and Use Case#: �� Jg '�f�0 ` ua Zoning: �C—10— equired Setbacks: Front:�S- Rear: Side: S Street Side: 0 Garage: O `ZC uilding Height: Max. Height: Actual Height:�g Landscape ea: -e0 % Lot Coverage Ma YID Entrance t back no more than 8' from street-facing wall Od Parallel to street or offset 45 degrees or less Windows ' um 12%of area of all street-facing facades Garage Garage door is behind widest street-facing wall 11CJ Yes ❑ No,one of the following is met: j� Door extends no more than 5'from wall and there is a covered porch extending beyond garage. Ll Door extends no more than 5'from wa and there is a 12 sq ft.window above garage on 2nd floor. Garage door width is ❑ 12'or less 50%or less of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer ❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony ` Visual Clearance ❑ Urban Forestay an C'����44�F1 sensitive Lands: ❑ Yes 1CJ No Type: i� Co 'bons met prior to issuance of building permit rc No s: Approved By Planning: 111111117 /d.d..._ Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved 1:\Building\Forms\B1dgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: /93/2.3/2.402/ Site Plans: # 8 Building Plans: # 3 Building Permit#: [ -Enter building permit#above. Workflow Routing: Planning [ Tngineering Er-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: ('171 0 b 242/ Engineering Review • llope at building pad: 02 2 'Conditions "Met"prior to issuance of building permit ', 'Easements (encroachments) per engineering conditions of approval and plat L'1 V(-'ater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes L'S No Assess Water Quantity Fee in-lieu: ❑ Yes C�No LIDA Facility on lot: C 'Yes ❑ No Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: Ik Approved by Engineering: �u, ,� � Date: 4/0l11121 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review gr 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 g Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: /Yes 0 N/A LIDA 12r Yes ❑ N/A OK to Issue Permit Approved by Permit Coordinator: Date: 4/(p 1202 I:\Building\Forms\BldgPermitRvw_RES_122419.docx