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Permit q CITY OF TIGARD MASTER PERMIT 111111 * COMMUNITY DEVELOPMENT Permit#: MST2021-00445 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/02/2022 Parcel: 1 S 136CB09000 Jurisdiction: Tigard Site address: 11136 SW 81 ST AVE Subdivision: HERB AND PEGGIE'S PLACE Lot: 24 Project: Afsharialiabad Project Description: 880 sq ft addition to the back of the house. Relocate kitchen and add a bedroom. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 880 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 15 Smoke Yes Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Total: 880 sf Value: $114,910.40 Rear: 15 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer. 0 Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker 1 Hose Bib 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 1 Other Fixture Units: DWV MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 1 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All N Other N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 880 Owner: Contractor: AFSHARIALIABAD,FARSHAD OWNER Required Items and Reports(Conditions) 11136 SW 81ST AVE 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 PHONE: PHONE: FAX: Total Fees: $5,477.68 This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 0c7ji ijln In fhrni,nh r1CR oc ,.nnl-noon Vrai m,u nhrain m rnnv of the rnloc nr rlirprf ni.efinne to rlI INC hu rollinn St l 9'1/1027 nr 1 Ann 119 7'14 Issued By: Ed9a f dO M y Permittee Signature: S�a f 1 U� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the lob site at the time of each inspection. J3uildin2 Permit Application $-8161 at Residential RECEIVE® City of Tigard Received///is/ 21 �y �sr ui� Date/B F/ l/ iCry Permit No.: MI " 13125 SW Hall Blvd.,Tigard,OR 97223 h,AUG J 2021 Plan Review ��y�_ 11 Phone: 503.718.2439 Fax 503.598.1960 Date/By: 2 2 A-4 �`e`Permit. T I GARD Inspection Line: 503.639.4175 CITY OF I GARD Date Ready/ay: /JJ ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION ifi.efh / Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all KEI Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for drip CATEGORY OF CONSTRUCTION work indicated on this application. ! V 4 Thpi Valuation: ® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building 0 Multi-family Number of bedrooms: r ❑Master builder 0 Other: Number of bathrooms: JOB SITE \�IN FORMATION/AND LOCATION Total number of floors: Job site address: ‘113( cS/ Y t'J tg'S.f A y 6. New dwelling area: get, square feet � bT d CMG City/State/ZIP: Ti�l 0-Y. , ,0 R , 9 7"223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directio�nsvto job site: ge,,f Y'ra,tss7� iv 6� [,.. .f f 1�1- ,I�� Deck area: square feet 6 SSic GK CG : Seficit z ProM sirc-t L[� f et[ nepe Z 'otA.K. Other structure area: square feet ill artl i Q s 15 It t dd.fr. et'L'G'�t?,1 R I 1 fII1+ 5I1 Ii REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: / no.: Permit fees*are based on the value of the work performed. / %(tlH6 � a'�✓�Nt�G[k� Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK / L work indicated on this application. gt/ /'6 _fJ ' C i�__ _ e 7�,7 E_ (� se Valuation: $ R.E D 4`T( _ (r, 64 �i�C Existing building area: square feet L j.[7�1�''r '1� New building area: square feet ® PROPERTY OWNER 0 TENANT Number of stories: Name: A R tS 1' V A F S }-I I\ V 1 l�Lt kV A(7 Type of construction: 3h Address: 11 1 k rS f / ,J Occupancy groups:City/State/ZIP:7l 6.,f GL ,/ 0 R 1 9 . 24 3 Existing: Phone:(9 W`�) ''1 4 9-6 iZ 5 6 Fax:( ) New: 0 APPLICANT 0 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: Total fees due upon application: City/State/ZIP: Amount received: Phone:( ) Fax::( ) E-mail: F fkfiti 80 0 9 ( Gy M�`(t �' AN PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* 1 J Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: N t7A F l' i "4/f R Submit two(2)sets of roof plan with connection details / `/� and fire department access,along with the 2010 Oregon Address: \117 B 6 \N+ g I s t A 1'Ci Solar Installation Specialty Code checklist. City/State/ZIP: •y�^ ,�� R/ +� .,/`'� Permit Fee(includes plan review $180.00 q / / and administrative fees): Phone:(�'�9)� /.... (j `�K 6, Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: 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: Date: *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) • Building Permit Application Checklist One- and Two-Family Dwelling rOR Orrl( I. t i.: Oyl.l City of Tigard Received Permit No.: [i Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: r. Phone: 503.718.2439 Fax: 503.598.1960 T 1 G A R D 24-Hour Inspection Line: 503.639.4175 a 0 Electrical 0 Plumbing 0 Mechanical Internet: www.tigard-or.gov 0 Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 . NU %.k 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. • II III 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ 0 3 Verification of approved plat/lot. ❑ 4 Fire district approval required. Name of district: 5 Septic system permit or authorization for remodel. Existing system capacity . 6 Sewer permit. ❑ 0 0 7 Water district approval. ❑ 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 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 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 ❑ there is more than a 4-f1.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 ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 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 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,roofmg,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 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 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 ❑ 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 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 0 ❑ architect licensed in Ore!on and shall be shown to be a 8 i licable to the .ro'ect under review. JURISDICTIONAL SPECIFIC'S 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. _ _ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ 0 0 27 "Drawn to scale"indicates standard architect or engineer scale. 8 A A 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 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 ❑ 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 Applicatti CEIVED FOR OFFICE USE ONLY ' City of Tigard ��11C Date/By: /O/( ' ) / Permit No. S 21—01 kiy 13125 SW Hall Blvd.,Tigard,OR 97223 A I I u 0 r 2021 Plan Review "� II Phone: 503.718.2439 FA 11 L Date/By: Other Permit: T 1 G A R D Inspection Line: 503.639.4175 CITY OFT I GARD Date Ready/By: Juris: la See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information l 111 fI\lr nI\Il J()N TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST ❑New construction g Addition/alteration/replacement Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* lil 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: Job site address: + f•»'�� - Air conditioning 46.75 � %." �� Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: / `�a1 1 Q , 9 7Z- 2-_3Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: Heat pump 61.06 Cross street/directions to job site: Duct work ' 23.32 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 Tax map/parcel no.: Other fuel appliances: Water heater _ t 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 14V (a L(J r- Y Q Q mE, 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 E PROPERTY OWNER 0 TENANT Other: 23.32 C Environmental exhaust and ventilation: Name: � �� \ i�Val �` IA }� 1 / Range hood/other kitchen Address: M 3 6 S \ C� 1st Ve, i l/ equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: 779 A,'0(_,5 0 ) 9F 2_23 Single-duct exhaust(bathrooms, Phone:(, i9) 11 W 9 6 6 Fax:( ) toilet compartments,utility rooms) 23.32 Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: Contact name: $14.15 for first four;$4.03 for each additional Furnace,etc. Address: Gas heat pump • City/State/ZIP: Wall/suspended/unit heater Water heater Phone:( ) Fax::( ) Fireplace E-mail: Range 1 CONTRACTOR Barbecue Clothes dryer(gas) Business name: 0 \\J I\(2_r Other: Address: MECHANICAL PERMIT FEES* 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 Authorized signature: days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board Print name: Date: I:\Building\Permits\MEC_PetmitApp_082520.doc 440-4617T(I 1/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Submittal Requirements: • (2) sets of plans, drawn to scale. • (2) sets of equipment cut sheets. • (2) copies of site plan for ground and roof top equipment location and screening per Tigard development code. 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. I:\Building\Pennits\MEC_PennitApp_082520.doc 2 e Electrical Permit Application rOR orrl( r: i sl..Oy1.1 City of Tigard ECEIVED De /B : Permit#: w 13125 SW Hall Blvd.,Tigard,OR 972 3 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 JA;y 0 L. fen Read Date/B Ions: @ See Pa 2 for II( AkI) ULt y y Internet: www.tlgazd-oi.gov Notified/Method: Supplemental Information TYPE OF WOIT OF TKO PLAN REVIEW ❑New construction Addition/alteratWINCIDIVISION Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: MS S g '+ c. ve 100HP or more. ❑"A","E","1-2","1-3", t; ❑Six or more residential units. occupancy. City/State/ZIP:'f��q ) �� 3 ❑Health-care facilities. ElRecreational vehicle parks. Suite/bldg./apt.#: tJ Project name: ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 ode? 1� -c h� Yi �rkat V P o►�c: eat v t;o M l Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 [ PROPERTY OWNER i 0 TENANT Services or feeders installation,alteration,and/or relocation �Name: 'A tQ,c iA 1k v CS 1� (M Al A O A 0 200 amps or less 100.70 2 Address: ((\ 3\ e l vg Stl- A.v e, 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 77 d l 1 9722 3 601 amps to 1,000 amps 301.04 2 Phone: ) t3) /A"1 9 5 Fax:( ) Over 1,000 amps or volts 552.26 2 t�/ Temporary services or feeders installation,alteration,and/or Email: F �p (' , G /114�1 X �,�vtj 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: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first , 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) 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: abiyi,.11/ Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) 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.Lic.: specifically listed(Y2 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: t This permit application expires if a permit is not obtained within 180 Print name: 1 /� 0 t A q days after it has been accepted as complete. *�� N SITY��(?1L� Date: ��� ��/ ZZ y P P Number of inspections allowed per permit. I:\Building\Permits\ELC_PemfitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB "Electrical Permit Application—City of Tigard Page 2-Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description j Qty. ] Each I Total 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 0 V• acuum 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 00/hr specifically listed(%s hr min) COtt WORK ONLY: ELECIRICAL lE> 4fr n... Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): y + Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems 0 B• oiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation 0 HVAC ❑ Instrumentation 0 Intercom and Paging Systems 0 L• andscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* 0 Protective Signaling ❑ 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 06/17/2015 Pl`%mbin2 Permit Application Building Fixtures RECE Cityof Tigard �e eceived Permit No.: le 13125 SW Hall Blvd.,Tigard,OR 97223 c Date By: 0 4 14 ■ Phone: 503.718.2439 Fax: 503.598.1960 `)�'� QLt Plan Review DateBy: Other Permit No.: Inspection Line: 503.639.4175 TIGARD Vrry of Tate ReadyBy: Juris: See Page 2 for Internet: www.tigard-or.gov otified/Method: Supplemental Information TYPE OF WORK -( Q DM`` FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. Ea. 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 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(-sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:VA-3 U 5 ,. ) t rc l A Je Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:"T/ r.vct23, 0� l � 2 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: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK t 7 'J Clothes washer 25.02 A 0 vL l� �^, 1`,�. Qi\a-vl c.L !/Y Q Ne Dedev-Q0Al Dishwasher ( 25.02 C�e L 0 Cam^ -(Je ._1 f he-4 Drinking fountain 25.02 '` Ejectors/sump 25.02 IA PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: F A R k AO A F(c kk /k R, N. t\Y ik Q Fixture/sewer cap 25.02 Floor drain floor sink/hub 25.02 Address: I t 6 S\AI I S t A V e Garbage disposal t 25.02 City/State/ZIP: ri NY 7 (2 , 9 7-2-2-3 Hose bib 25.02 Phone:(<�\ �9) P9 g -5 6 Fax:( ) Ice maker t 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory t 25.02 City/State/ZIP: 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 I 37.52 Business name: 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 na Print name: ( A-kc\N a /,r'S 0 Mk i k Li AO A)Date:`Z./ 3 t�20 2` 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:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) .Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1s`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 P 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 ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -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.dac 08/04/2011 2 City of Tigard .114 a COMMUNITY DEVELOPMENT DEPARTMENT I TIGARD Building Permit Review — Residential (, Building Permit #: 14Er2.02P-t> P M S; Site Address: (\ \ -36o S1k) Si S'(" MN, Project Name: f 1r On IAA CAO Lot #: Planning Review Prop sal: ApkvrioN ld' Verify address/suite#active in Accela. Z In River Terrace: EiNo ❑ Yes,River Terrace Review Addendum Sits/Plan Elements: C‹s sion Control 3,opies of site plan on 8-1/2"x 11"or 11 x 17"paper Ir t -tained trees with drip line and tree protection measures awn to scale(standard architect or engineer scale) "4 F..tprint of new structure(including decks)and FFE rth arrow I. a1'ty locations&easements(required for new and additions) S• ite address,project or subdivision name and lot number 4 Sidewalk/driveway approach A licant information(name and phone number) Location of wells/septic systems ,ot dimensions and building setback dimensions ]SA.t.et tree size,type and location ON I1 S.ware footage of buildings to be demolished S eet names FA Existing structures on site Comer elevations(2'contours if more than 4'differential)�, [ l 11 lY Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes 1d1Vo impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes J2No Jr.-Clean Water Se, ices—Service Provider Letter(lot platted prior to 9/10/1995): quired: 2'Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No Water Meter F)iitare Unit Worksheet—Additions,Remodels and ADUs „equired: Yes,applicant was notified ❑ No / Received: ❑ Yes ❑ No Z ;DC Exemption for ADU applied for: ❑ Yes EYNo Received: ❑ Yes ❑ No Fr Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified (a No Ap lied For: ❑ Yes ❑ No,stop intake Land Use Case#: Zoning: T aired Setbacks: Front: /`S Rear: IC Side: Street Side: Garage: 2� q g Building Height: A./A-Max. Height: ��- Actual Height: Or ❑ Landscape Area: OA— % ❑ Lot Coverage Max: NA rance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset ees or less Windows 'nimurn 12%of area of all street-facing facades Garage ❑ Garage o hind widest street-facing wall ❑ No,one of the following is met: ❑ Door extends no mo 'from wall and ' a covered porch extending beyond garage. Cl Door extends no more than 5'fr ere is a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is or less ❑ 50%or less o a ❑ 60%or less and includes 7 of following: ❑ Cover c ❑ Recessed entrance ❑ Wall offset ❑ 1' o ❑ Roof offset ire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roo Dormer ❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ a [, E3 Visual Clearance p Urban Forestry,Plan Itl Sensitive Lands: ❑ Yes Igo Type: I ❑ Conditions met prior to issuance of building permit NNoter © er.oh C Act) t&AYIr t-L ile Movin(0 0. Kin-ten Approved By Planning:R' Date: 0 r /2/ Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved 0 Not Approved : i s I:\Building\Forms\BldgPermitRvw_RES_122419.docx { veinowimmoommurim Building Permit Submittal Original Submittal Date: D61/4$7?.62/ Site Plans: # ,3 Building Plans: # 3 Building Permit#: Pr Enter building permit#above. Workflow Routing: 'Planning 12' Engineering Ea-Permit Coordinator LkBuilding Workflow Sign-off: 52-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. 1Building: original permit application, site plans,building plans,engineer and beam calculations an. .t details,if applicable,etc. Notes: By Permit Technician: Date: /61/8/jal Engineering Review }� Slope at building pad: 'J Brtonditions "Met"prior to issuance of building permit 2-"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 [ o LIDA Facility on lot: ❑ Yes - o .al Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: proved by Engineering: ) • h St•k trt,., Date: /o-2/•Zo2,( Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved E 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: E Yes )?1 N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes 6— N/A LIDA ❑ Yes N/A OK to Issue Permit Approved by Permit Coordinator: Date: t01 Z*024 1:\Building\Forms\BldgPermitRvw_RES_122419.docx FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT = i Transmittal Letter i f G,n R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: DATE RECEIVED: DEPT: BUILDING DIVISION DECEIVED ' n FROM: DEC 13 2O21 COMPANY: �t o IIL(')I �F OI G S(>>�: PHONE: 9 qz tj "t 9.—6 756 EMAIL: lJ /!/Q,� ' C RE: .I 't, et \-AST202t - 0044 5 (Site Address) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: 3 Additional set(s)of plans. Revisions: Cross section(s)and details. Wall bracing and/or lateral analysis. 5 Floor/roof framing. Basement and retaining walls. Beam calculations. ) Engineer's calculations. Other(explain): REMARKS: 3 a,A S 7;6, S i4 q cacct_1604-ht,,,3 n n dLe-esct Y111UV . ( eo ) \ iCer FOR FFIC USE ONLY Routed to Permit Technic' gate: Z�v 2' Initials: MY Fees Due: ❑ Yes (�Not/ Fee Descrip ion: Amount Due: f 1.) "JD Special j Instructions: Reprint Permit(per PE): Yes No [ Done i . Applicant Notified: Date: /���.� Z Initials: OF RECEIVED Information Notice to Owners About AUG 05 F Construction Responsibilities i2AR " .�., ' ' 'Z p CITY OF s IGARD (ORS 701.325 (3)) BUILDING DIVISION Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number(BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business Registry. For questions, call 503-945-8091. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 800-452-0288. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, go online to www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance:As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD PO Box 14140,Salem,OR 97309-5052 Telephone:503-378-4621 —Fax:503-373-2007 Website Address:www.oregon.gov/ccb f/property_owner adopted 9-2016 This Copy for Permit RECEIVED Property Owner Statement AUG 05 2021 Regarding Construction Responsibilities CITY OF i"IGARD Oregon Law requires residential construction permit applicants who are not licensed witlDING DIVISION Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: rA & NAB 4--FSNA ( >4\ nt7 Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. /1/2/ Print rm e of Nam Peit plic i s � P\ � � ►�A� � 1:4c Signature of Permit Applicant Date Permit#: o F Address: t '' Issued by: Date: 5e This Copy for Permit Offices