Permit Support Document (2) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED
IN
Request for Permit Action MAR 9 20R
q CITY OF TIGARD
TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • �c����.tigard or. c ILDING DIVISI0ON
TO: CITY OF TIGARD t
Building Division 3/26/2
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: Owner ® Applicant ErContractor n City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or individual) JW GLISSON CONSTRUCTION LLC
Mailing Address: PO BOX 1057
City/State/Zip: GRESHAM, OR 97030
Phone No.: 503-519-6500 503-957-6174 OFFICE
PLEASE TAKE ACTION FOR THE ITEM(S) CHECK},D (1):
(Xi CANCEL/VOID PERMIT APPLICATION.
Q REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
[ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: MST2020-O98e- QOCgO
Site Address or Parcel#: 8827 SW THORN ST. TIGARD OR
Project Name: LOT 1 ROW HOUSE
Subdivision Name: THORNWOOD MEADOWS Lot#: 1
EXPLANATION: PURCHASE TRANSACTION DID NOT GO THROUGH
Signature: CA 9L c'�C)/1/ Date: 3/9/2020
Print Name: f JACK G SSON
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date vo i.-/ By .(11/1
Refund Processed: Date 3/4c/Zv 110 Invoice Processed: Date By
Permit Canceled: Date e3/4/2e1 By Parcel Tag Added: Date By
I:\Building\Forms\RegPemutAction_120518.doe
r �
Building Permit Application
0 ! S,7/11t .
Residential FOR OFFICE ISI. OyL)
IN 0 City of Tigard EC VE Dat/B :-d 3 -kl Permit N i�w'l101,�, G�
13125 SW Hall Blvd.,Tigard,OR 97223 MAR
pp Plan Review
Phone: 503.718.2439 Fax: 503.598.1960IYIH1� 5 2020 Date/B : Other Perm y `i i
TIGARD
Inspection Line: 503.639.4175 Date Ready/By: Juris: Fa See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
i
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
ANew construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
I-and 2-family dwelling ElCommercial/industrial Valuation: $
ElAccessory building El Multi-familyNumber of bedrooms: 3
❑Master builder 0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors:3
Job site address: Ti32'i S -1 .1i2 — New dwelling area: I'1%8' square feet
City/State/ZIP:11 n 0)2 9-13 Garage/carport area:2'2�^, square feet
Suite/bldg./apt.no.: "1 Project name:-He btLi0 Lxicklo rA614 cco Covered porch area: 1.1.0 square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: J Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTIONI OF WORK work indicated on this application.
4 I N Y-14 M I 1 ' �aQ� Valuation: $
Existing building area: square feet
New building area: square feet
APROPERTY OWNER 0 TENANT Number of stories:
NameJ,C i G tIt%Qii Type of construction:
Address: -- t2[_ 5c &przccJk.. LA_IA� Occupancy groups:
City/State/ZIP:G2D e IAA in,, Q/L O`1 O e) Existing:
1,v A Phone:) 5 1'1 6500 Fax:563) 1 ! S39 New:
� // PLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application:
Amount received:
Phone:( ) Fax: :( )
E-mail:gL;S.'S. n L(' n-i mil �-c c� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: SA.V) c G.o Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: I b I St^�
' Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:��r Q `ig5tj 0 Date:3 5^ 7.,. *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\P '• . •-: ' ,peAgc /2011 440-4613T(11/02/COM/WEB)
,`
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFIcI. I Si. OyI.1
City Tigard Ti d Received
Permit No.:
I Phone: 503.718.2439 Fax: 503.598.1960
ig
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
Associated permits:
TI(.AKD
24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov ❑ Other:
"I11E FOLLOWING ITEm'IS ARE REQUIRED FOR PLAN REVIEW 1c y0 •
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 ❑
4 Fire district approval required. Name of district: •
0 ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 ❑
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control IDplan ❑permit required. Include drainage-way protection,silt fence design and location of catch- El El
basin protection,etc.
10 3 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
3 COSite/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ 0 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
0,_ e Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0
systems,see item 22,"Engineer's calculations."
01.. 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
( l2 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances.
0 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0
architect licensed in Ore.on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 ❑
4l4 j Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
5 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ 0 ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
t
Mechanical Permit Application_ EDFOR OFFICE USE ONLY
CI of Tigard
�Vf Y`� Received Permit
Date/By: f/.,� `4� 3 ea,
13125 g SW Hall Blvd.,Tigard,OR 97223 MAR 5 2020
Plan Review
= Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BU'LD NOD OF 'VASION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
ANew construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
S-+-Air conditioning 46.75
Job site address: g � '
� ,'�6 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:'th 0(z 4 Duct work 23.32
Cross street/directions to job site: r�ccas. ��/°� Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
_Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
"7 ' + Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39 _
Flue vent for water heater or gas
b ilk) lifs 44 U i , fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Mil PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: ' Range hood/other kitchen
4 ,
Address: "3/ equipment 33.39
e Clothes dryer exhaust 33.39
City/State/ZIPG/ k4o C5 Z. CI o 1,) Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(C;,-,a,)c7'CI)&e50 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump _
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: --J- 6 D Other:
MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 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-County Building Industry Service Board
Print name,J 4,Go. G (,.. ..6
• Date:
I:)Building sr4qA 440-46 ITT(1 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.
$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\Pernuts\MEC_PermitApp_040113.doc 2
Electrical Permit Applicatio1f ECEIVED roil Orri( r. 1 SI. O\l.\
City ofTigard Received
g MAR 5 2020 Date/B : riff10 ....Mg.. WPM
i II
IN 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 r�/ Date/B : Related Permit#:
Email: TigardBuildingPetmits@Tigard-tc�bN OF TIGARD Ready Date/By: Juris: ® See Page 2 for
1 v A It 1 J Inspection Line: 503.639.4175 Intelcil_ I.trtg lI§bpN Notified/Method: Supplemental information
TYPE OF WORK PLAN REVIEW
cpNew construction ❑ Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked).
����`"" 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Q ❑Addition of new motor load of system.
Job#: Job site address: °� c 1 Lk' ) k ZO ND 100HP or more. ❑"A„ «E„ `<t_2„ 1.3>
City/State/ZIP: V ❑Six or more residential units. occupancy.
0 Health-care facilities. El Recreational vehicle parks.
Suite/bldg./apt.#: Project name hepe_l)L (0' '( 'r�p 7 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SPCc11/4) !' G es FEE SCHEDULE
�^-' Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I kOQ,0 w tar ) 'rn*„W S Lot#: 1 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
I j,tl e '1� Yrl tl (� �,• Limited energy,multi-family
J='� residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
01 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: '> I";j 1 i sso L.) 200 amps or less 100.70 2
Address: a L 5 c , DC ce_C vsk k w A 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: G Q Q_,,114o-'VY ) O 9"1 D C) 601 amps to 1,000 amps 301.04 2
Phone:5b3) Si ci L,so 0 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: GI_J $c)00 ,_,.L. @ i*ns m a Co'v-n relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: t C•9 ' I', 6 (75.0 above service or feeder fee, 7.42 2
each branch circuit
Contact name: 4 cI, G ( i
Ji , ^) B.Fee for branch circuits without
Address: ,V service or feeder fee,first 56.18 2
SA nA Q branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: i' ' D Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy El See Page 2 2
Address: panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed(%z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name. G��,1 Sst yj Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
(:\Building\Pertnrt LC P A doc Rev 10/26/2017 440-4615T(l l/05/COM/WEB
w' I
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description Q
Fee for all residential systems combined: $75.00 Each Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
$75.00 Fee for each commercial system: * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLI
City of Tigard e 2020 ReceivedDate/By:
Permit 1 i1sr'�eae, .avec)
i1
u 13125 SW Hall Blvd.,Tigard,OR 97223 MAR Plan Review
I Phone: 503.718.2439 Fax: 503.598.laityOther Permit No.:
OF 7tGARD Date/By:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: HI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental information
TYPE OF WORK FEE* SCHEDULE
Q New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath /` 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SI7' INFORMATION AND LOCATION Site utilities:
Job site address: 18.76
Catch basin or area dram
(" '"" Drywell,leach line,or trench drain 18.76
City/State/ZIP: 277 S -- 012-K) Sac
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
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" 1.4.)00i - I Lot no.: f. Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
--8V I to 2.. _16t, Y, Dishwasher 25.02
S J 14 Drinking fountain 25.02
Ejectors/sump 25.02
J2 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: e. go, I Fixture/sewer cap 25.02
�6� `�''� Floor drain/floor sink/hub 25.02
Address: ' .G:f�? ` � -' (" Garbage disposal 25.02
City/State/ZIP %. LI 10•40 Hose bib 25.02
Phone:( )' Fax:(--' ) ' Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
�-)�r I S oho Primer 12.51
Contact name: '7 I' (commercial)1 ` "' Roof drain 12.51
Address: fi t " Sink/basin/lavatory 25.02
City/State/ZIP: -, (Al Solar units(potable water) 62.54
Phone:(' ) Fax: :( ) � Tub/shower/shower pan 12.51
•E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: 1-43,06 Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print namei jQ,G( ( i`sst pJ Date -,‹...-..2tD
This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Bu its\PLMU-PermitAp•a l0/01/09 440-4616T(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- 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
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 SI.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 ❑ Any new commercial building with water service 2"and
-- greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
Jacuzzi/Whirlpool engineer.
CICar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El 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
4 ❑ 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: -Iav/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:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard N I ( .--:
COMMUNITY DEVELOPMENT DEPARTMENT t;
I 1 1
TIGARD Building Permit Review — Residential
co
Building Permit #: /�c wzd —come)
Site Address: E382-i Svw The in S e.d-
Project Name: o A U.U d M eacta.NrS Lot #: I
Planning Review
Proposal: Ne(A/SW
i
,O Verify address/suite# active in Accela. 0-...In River Terrace: No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: XFrosioif ontrol
C SIG. copies of site plan on 8-1/2"x 11"or 11 x 17"paper Nketained trees with drip line and tree protection measures
t)rawn to scale(standard architect or engineer scale) sfIlFootprint of new structure(including decks) and FFE
.. forth arrow KUtility locations&easements(required for new and additions)
! •ite address,project or subdivision name and lot number Sidewalk/driveway approach
pplicant information(name and phone number) A s%iffik c iV ocation of wells/septic systems
e=' .t dimensions and building setback dimensions r-J.treet tree size,type and location
Nfquare footage of buildings to be demolished Street names
/Ai -xisting structures on site 1orner elevations(2'contours if more than 4'differential)
►: -ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ; ,e.Ail No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? I■ /e. 11 No
2'Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified �No Received: ❑ Yes ) 1'No
itK Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified ,1 No Received: ❑ Yes ❑ No
SDC Exemption for ADU applied for: ❑ Yes No Received: ❑ Yes ❑ No
' Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified )K-No Applied For: ❑ Yes ❑ No,stop intake
R-Land Use Case#: PD 2olco 'ccO ( 0 14 Zoning: g t 2--
Required Setbacks: Front: 37-5 Rear: IS Side: 5' Street Side: 141 k Garage: 2-V
Building Height: Max. Height: Actual Height: 31
gLandscape Area: C7 % g Lot Coverage Max: `CEN) 0/0
Entrance Set ba k no m re than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ' um 12°o of area of all street-facing facades
Garage Gara e door s be . d widest street-facing wall ❑ Yes ❑ No,one of the following is met:
❑ Door xtends►o more than 5'from wall and there is a covered porch extending beyond garage.
Door xtend more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor.
Garage do r wid I ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Cov red po ch • Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fir shingles • Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
Visual Clearance Urban Forestry Plan
Sensitive Lands: ❑ Yes X No Type:
Conditions met prior to issuance of building permit
otes: pO y104- 1SG' - VAC f i-t.z- DN-fec , •
r Approved By Planning: 4-10-)j" -- Date: 315 J319
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPennitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: Wth--0
Site Plans: # '�
Building Plans:
Building Permit#: Enter building permit#above.
Workflow Routing: 12--15Fanning El-Engineering [ —Prrrnit Coordinator iilding
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: g—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: ��i,��.r_.c--J Date: 3/ j
Engineering Review
❑ Slope at building pad:
❑ Conditions"Met"prior to issuance of building permit
❑ Easements (encroachments) per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
❑ Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: Cl 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 apply
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
LIDA ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\B1dgPermitRvw_RES_122419.docx
1
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, (NOT INCLUDING OVER-IANGS)
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CONNECT WITH tt�'L'f� j �' 'P
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LEGAL DESCRIPTION -�
SUNTEL DESIGN, INC. IS NOT 'fl4SV� ZONE 1 `
LIABLE FOR THE ACCURACY OF THE -- L.OT 1� '�0f' �'wOOD MEADOWS
TOPOGRAPHY INFORMATION. IT IS PUD R-12 likelaMIMIIMPI1411101.111111110
a lk THE SOLE RESPONSIBILITY OF THE TIGARD, OREGON
BUILDER TONS VERIFYD ALL SITE „
CONDITIONS, INCLUDING ANY FILL "PDR 2,a1fo-mmPim
DOWNERS OAF ANY POTEN AND INFORM
FIELD TAX MAP: 15 3DAD.
MODIFICATIONS.
` •
FLANmme LOGM1 PACIFIC EVERGREEN LOTS 1&2,THORNWOOD MEADOWS
DATE'WON KA Oft
S 1.1 rit it t o I P1V I IV C SITE PLAN
O E 5 1 6
16865 Boones Ferry Road.Snit*201.Like Oven°,Oteyon 97035
Tel(5031624 0555✓Fax 150 31 624 01 55 L O GA N •ySCyALyE:: 1"-20'-0"
•: .° II
■uncrinrrlon . com on( or GARD
approved y Planning
Date: 315p
Initials: ; .
1/8/2020, 9:22 AD
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--reitszJ P(ko Gi'rlcti.t 1_,
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t ``E 0-A LOT AREA i 445 5Q FT 2.003 5Q =T
5-il 36-® 5
IMPERVIOUS AREA
/ — DRIVEWAY iSIDEJJALK/CONC 504 5Q.FT 598 5Q. F-
I8'-0' ;r-0. REAR PAT'0 ?8 SQ.FT !a 5Q. F-
f /._-...... RACT TOTAL522 5Q.FT 6 i6 5Q. c-
(E)6'-0' WOOD I OPEN BUILDING COVERAG=E
FENCE TO REMAIN I SPACE/PARC
BUILDING FOOTPRINT 715 SQ.FT 115 SQ. F-
♦ 2313 • T (INCLUDES COVERED PORCH)
(NOT INCLUDING OVERHANGS)
� tit �. � •�
�►
1 I h LOT COVERAGE
{/ i A: ' W 44. 1 (MAX CCVERAG,E: SO a) 50.5% 66.490
n ''� °F Ig 2 3. ,a' 11'1$
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(E)TREES TO :- ,,- FP ELLEv3: 50' PR4 • ' S'
'Hla . . (E)TREE .`�j�Gt ' f 'J�' 1
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CONNECT WITH -t9'd. ,-
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LEGA_ DESCRPTON
SUNTEL DESIGN, INC. 15 NOT ZONE T�?ORNi,�OCC ME:aDOW�� s�-`
LIABLE FOR THE ACCURACY OF THE LOT '
TOPOGRAPHY INFORMATION. IT I5 PUD R-I2 l 46 ,THE SOLE RESPONSIBILITY OF THE TICzARD, OREGON
BUILDER VERIU ALL SITE 4111
CONDITIONS, INCLUDING ANYD FILL "? R 2@16-@@@I@
PLACED ON THE SITE, AND INFORM TAX "'AP: 1Si35AD.
OWNERS OF ANY POTENTIAL FIELD
MODIFICATIONS.
`KANIwo&LOB PACIFIC EVERGREEN LOTS 1&2,THORNW00D MEADOWS
Aillei
aT� Surattel SITE PLAN
P D E S I B N I N C .
16865 Sonnies Forty Road,Suite 201,Lotto Oawogo,Oregon 97035
Tot:1503)624 0555.Fax:15031624 0155 L O GA N SCALE: 1"-20'-0"
• , aunt•i d.•1 On . c0m TIGARD
CITY OF 1 IGARD
:-.pprove byPlanning
Date: 3 5 Zo
Initials: Al �.
1/8/2020, 9:22 AT