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Permit Support Document (2) RECEIVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAR 9 2020 CITY OF TIGARD Request for Permit Action BUILDING DIVISION T I.;A R E) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • tV1tW.tigard-or.gov TO: CITY OF TIGARD n I D. Building Division 3/2e)/2 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner 2 Applicant Q Contractor ❑ 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) CHECKED (✓): U CANCEL/VOID PERMIT APPLICATION. • REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). n INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: MST2020-9084- d 0 0 g/ Site Address or Parcel#: 8821 SW THORN ST. TIGARD OR Project Name: LOT 2 ROW HOUSE Subdivision Name: THORNWOOD MEADOWS Lot#: 2 EXPLANATION: PURCHASE TRANSACTION DID NOT GO THROUGH Signature: � ��/ �CV c�,Q/(/ Date: 3/9/2020 Print Name: 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 '1,3/7N B3,6 C Refund Processed: Date 3/2/7_,, 4e%44 Invoice Processed: Date By Permit Canceled: Date 2,- /24 By 4W Parcel Tag Added: Date By I:\Building\Forms\KegPemutAction_120518.doc \ / n 1 :, Building Permit Application « ,;_i; Residential RECEIVE FO12 OFFICE USE ONLY g �/ Dateived3 s- ,tijSiao a DODer/ CityIII of Tigard / Permit No Date/By: • 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 5 2020 Plan Review= Phone: 503.718.2439 Fax: 503.598.1960 Date/By: OtherPeruidg� ^�?©a`5r/z�% TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for VV Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING wNew 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 the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Y] 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ ❑Accessory building 0 Multi-family Number of bedrooms: 3 ❑Master builder El Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 3 Job site address: 'Z Q ( S1,i3 ore y`} S 4- New dwelling area: 1-1 M square feet City/State/ZIP:._.},Icpitc` CIA, � r�C4' Garage/carport area: Z.3 to square feet 1 Suite/bldg./apt.no.: Project namel t'ho L jvc1Z0 11\01410001 Covered porch area: square feet Cross street/directions to job site: Deck area: 1 — square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:—fi4-Np,2O LAI Q00 rA 4 Douj Lot no. 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 /IN DESCRIPTION OF WORK work indicated on this application. .S‘ (VZ. clarr11 Valuation: $ Existing building area: square feet New building area: square feet Si gPROPERTY OWNER 0 TENANT Number of stories: Name: c__44._ G t Itch,0 Type of construction: Address: 3 7,2 4, S """y___6„.. E-E LOy Occupancy groups: (< i_Z.A City/State/ZIP: 3 -% r j /1 70 0 Existing: Phone:(6'(. 3) 5 11 4, Sir 2' Fax:( ) New: " PPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: I 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: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* j I;S.0" — L 6, tw.S►1. I. Lc ,v--- Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: S,0 mG cA cn .,,, 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 lie.: i 1p3I Total fee due upon application: $201.60 Authorized signature: 1 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print n �� • *Fee methodology set by Tri-County Building Industry t Gfs d /�,� Date:3^S� � Service Board. I:\Build' -R m• fr41 02/24(2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling 1 O It Oilk !. I s i (I\l City of Tigard Received Permit No.: , U 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical TIGARD Internet: www.tigard-or.gov 0 Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l es yo ` .' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 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 0 El 5 Septic system permit or authorization for remodel. Existing system capacity 0 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 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0 basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 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. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 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. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 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." 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. 20 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. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ 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 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0 25 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 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 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) Mechanical Permit Application ` , FOR OFFICE USE ONLY City of Tigard []C��'V �y ceived f RECEIVE •te/By: Permit No. T� n�:D�0�// 111 "I 13125 SW Hall Blvd.,Tigard,OR 97223 ■ Plan Review Phone: 503.718.2439 Fax: 503.598.1960 2020 Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 MAR Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified Method: Supplemental Information TYPE OF WORK BUILDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work AN 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* 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: /'y Air conditioning 46.75 Job site address: I p :,, l a IBC-4 }cy Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 0 0 ZI S v3 -1-).10( ) Furnace 100,000+BTU(ducts/vents) 54.91 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 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 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 fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 't I PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. 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: t Q Y1 Other: JJ MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.: 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`�pc&. ( SSW Date: I:\Building\PermitsArti5 pitAu 2r5e. _ 440-4617T(11/02/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\Permits\MEC_PennitApp_040113.doc 2 Electrical Permit Applicati I OR t)F1 1(i t S1: t)�►.� {...� ���� Received p l f T ?,o o City of TigardDate Permit ■ 13125 SW Hall Blvd.,Tigard,OR 972 n Plan Review: Q� 1 I Phone: 503.718.2439 ~� 2U20 Date B Related Permit#: I I G A R D Email: TigardBuildingPermits@Tig F TIGARD Ready Date/By: Juris ® See Page 2 for Inspection Line: 503.639.4175 Ijnt�etitt �Wt@Ilglf g� Notified Method: Supplemental Information TYPE OF'WORK L�IVtvt•+ PLAN REVIEW 10 ;5New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ElService or feeder 400 amps or more ElBuilding over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. I CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ElFloating buildings. 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural Multi-familyMaster builder Other: amps for all other installations. buildings. ❑ 0 ❑ ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived 0 Addition of new motor load of system. Job#: Job site address: d . -6<i(✓ S W O 100HP or more. ❑„A„ .<E» ..1 2„ ..1 3„ 1t ,�"� i+► ❑Six or more residential units. occupancy. City/State/ZIP: �; CA,t r:') ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name D t A y-1 0 Hazardous locations. ❑Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Sk)C;,,;�„t{j,. FEE SCHEDULE Description I Qty. I Each I Total I New residential single-or multi-family dwelling unit. Subdivision 4r Includes attachedgarage. �`l�� Lot# 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.addl 500 sq.ft.or portion 33.92 1 pis, ,,, ,.. . , ' _„. CRW rI OF WORiL, Limited energy,residential +I -}' (with above sq.ft.)�(� 75.00 2 TJ !i t J L4 W i ► Limited energy,multi-family 75.00 2 541 T(1 e6 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 /DA.I��I#P RTSi OW 1> R, , - 1 - - Q TENANT.. Services or feeders installation,alteration,and/or relocation Name: j o� �� /� 1 i ,,..„,�) 200 amps or less 100.70 2 Address: t� "" 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:, 4 l,,1 f m) 0 e 0 ( - 601 amps to 1,000 amps 301.04 2 Phone:'("7:; ) t I1300 Over 1,000 amps or volts 552.26 2 ,� Temporary services or feeders installation,alteration,and/or Email:(..1, 1 e,' s ,� +L6 I '<'ar t• t ,-, r. 1, 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 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel - A.Fee for branch circuits with Business name:_1 flc.k, (1,55ayj above service or feeder fee, 7.42 2 each branch circuit Contact name: 3-1 Z 4 S'C 0 cEp_ C egck B.Fee for branch circuits without Address: � (, 1 t SSo '( service or feeder fee,first 56.18 2 �-t!� 1>J branch circuit City/State/ZIP: G2.�.5 h,A>rv-s U I q og,eD Each addl branch circuit 7.42 2 Phone:603) S I I S(� Miscellaneous(service feeder not included) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: C Li 5S O ij---L "Y 5 N• cf3 yvN Reconnect only 67.84 2 CONTRACTOR1 Pump or irrigation circle 67.84 2 Business name: t3 ft----) Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. 0 See Page 2 2 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 Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed('/A 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): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name:,.]4. `c.le__G 1 ISsr kJ Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Pemits\E C_ 'tApp 7 Itic ev 1 7 440-4615T(11/05/COM/WEB CC S Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Each I Total I * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01to15kva 133.56 2 ❑ 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 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ 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 1 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 Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems El Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ 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 Cityof Tigard Received illi 131 SW Hall Blvd.,Tigard,OR 97 4(pp 5 2on PlanDate/By: Permit N9f/1�(T �,/JD�I C Phone: 503.718.2439 Fax: 503.59 Date/By:Review Other Permit No.: Inspection Line: 503.639.4175 T I G A R D Internet: www.ti and-or, ov CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for g g l I�D1NG DIVISIC?N Notified Method: Supplemental Information TYPE OF FEE* SCHEDULE psNew construction ❑ Demolition For special information use checklist Description I Qty. I En. Total D Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 V 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ElAccessory building 0 Multi-family SFR(3)bath x 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: b 1 G.,. t s E Catch basin or area drain 18.76 Dr City/State/ZIP: ��Z' J t)3 S( Footing drain line,noe trench drain 1 Page 2 6��� Footing drain(no.linear ft.:_) 2 Suite/bldg./apt.no.: I Project name-~ C)lug_) L 1),Cy*,°e ) Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 k 7 Lem Rain drain connector 18.76 t Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: - t h LA. ..:c Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 km, n .:.1 l L. rl c =1' Dishwasher 25.02 s Drinking fountain 25.02 Ejectors/sump 25.02 ISI PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name:. i.7 `�y„c1u,_., 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 [0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name:-I- Medical gas(value:$ ) Page 2 - Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: -' "13J:D Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE \ c+ G a t c�b„ \ '„ ^1(- This permit application expires if a permit is not obtained within 180 days Print name:_,] q `/V 1 Y`J Date: G�J after it has been accepted as complete. . , ' orG..I *Fee methodology set by Tri-County Building Industry Service Board. I:\Buil''(\\Permits LMU-PermitApp.do.411/09 440-4616T(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-15`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 I� 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$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font El Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. Jacuzzi/Whirlpool Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 4„ ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 City of Tigard r COMMUNITY DEVELOPMENT DEPARTMENT i. TIGARD Building Permit Review - Residential V dt Building Permit #: M$ 7"020-O - 6QQ',/ Site Address: g4.32-1 SW morn wuL Project Name: 'MOM kNaDdi IA GvKS Lot #: Planning Review Proposal: Pkliv SF AVerify address/suite# active in Accela. In River Terrac • A No Yes,River Terrace Review Addendum Site Plan Elements: 1' rosi of frit copies of site plan on 8-1/2"x 11"or 11 x 17"paper ►: 'etained trees with drip line and tree protection measures aisrawn to scale(standard architect or engineer scale) sZFootprint of new structure(including decks) and FFE ,Llorth arrow XUtility locations&easements(required for new and additions) r►i.ite address,project or subdivision name and lot number Sidewalk/driveway approach AO pplicant information(name and phone number) Y1�1e8.m in .cation of wells/septic systems CO.t dimensions and building setback dimensions ej.treet tree size,type and location Nquare footage of buildings to be demolished Street names 61 xisting structures on site Corner elevations(2'contours if more than 4'differential) 1: _.t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? o impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Ye o X Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified lEt-No Received: ❑ Yes A'No X Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: ❑ Yes,applicant was notified KNo Received: ❑ Yes ❑ No TSDC Exemption for ADU applied for: ❑ Yes SNo Received: ❑ Yes ❑ No *IR'Public Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified i-.-No Applied For: ❑ Yes ❑ No,stop intake R'Land Use Case#: PDR 20(0 -COO t 0 14 Zoning: R-1 Z- ,S Required Setbacks: Front: t5 Rear: is Side: 5 ' Street Side: NI Pr Garage: 2.0 Building Height: Max. Height: Actual Height: 302. . Landscape Area: W % 0 Lot Coverage Max: `a 0 % Entrance IN Set ba k no m re than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows II ' . urn 12° of area of all street-facing facades Garage I■ Gara - door s be ' d widest street-facing wall ❑ Yes ❑ No,one of the following is met: ❑ Door xtends'. more than 5'from wall and there is a covered porch extending beyond garage. • Door xtendIiii more than 5'from wall and there is a 12 sq ft.window above garage on 2°a floor. i■ Garage do r wid . ❑ 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 El Roof offset ❑ Fir shingles • Lap Siding El Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer ❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony IR"Visual Clearance lEt Urban Forestry Plan Sensitive Lands: 0 Yes lErNo Type: Conditions met prior to issuance of boil •dill g permit otes: NQQO ammo- rr,p0-4' 0, k & pl e. .. ❑ Approved By Planning: }16S-V.,oe—A-- Date: .. 315/2a Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: `3/5/2 0 Site Plans: # Building Plans: # Building Permit#: [Th Enter building permit#above. Workflow Routing: [ -Planning EtEngineering rmit Coordinator —Et—Building Workflow Sign-off: Q. 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. D uilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: <IJ ) te-44-uf_ Date: .3/(0,/2.c.) 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: ❑ 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\BldgPermitRvw RES_122419.docx