Permit CITY OF TIGARD BUILDING PERMIT
�`7 it COMMUNITY DEVELOPMENT Permit#: BUP2021-00284
Date Issued: 2/10/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD12300
Jurisdiction: Tigard
Site address: 10869 SW ANNAND HILL CT
Project: Annand Hill Partition,Lot 2,(1 of 2)ADUs Subdivision: ANNAND HILL CT PARTITION Lot: 2
Project Description: New multi-family dwelling on lower level.Trade permits to be obtained separately. NO FINAL INSP UNTIL
WATER METER UPSIZED.
Contractor: BLUE PALOUSE PROPERTIES Owner: BLUE PALOUSE PROPERTIES LLC
333 S STATE ST, SUITE V452 333 S STATE ST STE V452
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034
PHONE: 503-936-3212 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: MF
Class of Work: NEW Type of Const: VB Building Permit-New Construction 02/09/2022 $755.29
Occupancy Grp: R-2 Occupancy Load: 3 Plan Review 11/25/2021 $751.34
12%State Surcharge-Building 02/09/2022 $90.63
Dwelling Units: 1 Wash Co Trans Dev Tax- 02/09/2022 $5,756.00
Stories: 1 Height: 0 ft Condominium/Townhouse
Bedrooms: 1 Bathrooms: 1 Plan Review-Fire Life Safety 02/09/2022 $302.12
Value: $82,976 DC Provision Review,SF-Ping 02/09/2022 $110.00
Tig-Tual School CET-Residential 02/09/2022 $953.16
Plan Review 02/09/2022 $-260.40
Floor Areas:
Total Area: 676
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $8,458.14
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Yes Parapet: No
Fire Alarm: Yes Protected Corridors: No
Smoke Detectors: Yes Manual Pull Stations: No
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Edgardo-Ma-Ldavtado- Permittee Signature: ye,e,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
'
•
)Building Permit Application RECEIVED
,. , jell
Residential 1,4:i.)II'I( I I <1,,t), i. ,3 , 1:1
21 2021 i
on
Received 1 Q /, Perm No. ).
City
of TigardD,../lay: ID 271 G/ _ — L. 1>
.' :', Phone SW Hall.2439Blvd. Tigard,OR 98.19 CITY OF fiGARJ PlonReview� =y 1 puler ParnnC''/
Phone: 503.715. 439 Fax: 503.598.1ateBy: K .�V� � 27f7
.00TfiLQ1N�DIVISION t y. T t — —
}: Inspection Line: 503.639 4175 Date Read is / i i ec No 2 for
' ,: Internet: w•ww.tigard-or.gov tiled/Method: � {�- _iiupph:marrntlotormmricn
C S K'k C F, ,d.s, = t t ,rrs•"1-s�� c W -��t^fir-.��s— ,�q{— Tex-rrr� mr t ._-
i aft l } M f : ae ,61 lr lig -ry i 5 t���tr q"t 1t A u:it €��j = 1'r RE .a,7S .n xs:tl. YirY 1x�a�,x7��:. •`�I y� Ja�r.�.i. y.����„ '�F�..aV¢:CGS 4;dln�� �2t�.�tZ's.r:S�i#+,a.,s S s'..."S��sS- t ,^,"i �tx �v N� PRO 1
[ New construction ❑Demolition P nar fees*are based on th:;value 3f the w_rk performed.
Indicate the value(rounded.c the no arrsl tollarl of::d1
0 Addition/alteration/replacement 0 Other: equipment,materials,labor.overlie(d,and 11 profit a for the
1:1 rt�'1, • t4. , €,u ea r� 9 t"' ut '+tl s fa' aii _cri n; catcj on"is abplit r.tion.
.,..,Y(➢ " ,,tri r lea lit-/¢;tw t;.,;,,n.,.,,. ,,. l t% • 2.
- - - -ix I-I-and 2-family dwelling ❑Commercial/industrial _°lion: --- $ .1
O
[]Accessory building — 0 Multi-family Nutnbe r of bedroomsi • , `1
0 Master builder ❑Other. - t p Number of bathrooms:
i t t €e t 1 I, Total number of floors:
Job site address: /O v`r ApivA-Ri N/u. W New dwelling area: syuare 'eet
City,State/Z.tP: i1 77e7 O /}/f eg-7,vs Gat ageicarportare:a: / qua::reet
Suite/bldg./apt.no.: ``�� Project_ name a Ca"eyed porch area: • _--square reel
Cross street'directions to job site: CieosA/%�A 4_,A.oviiiti,fito y_ peck area: CO square i'cet
•
__ _.-_ Other sauct,tre area: / square reed
Subdivision: Lot no.: 2i Pervti:fees*are based on tht value Jf he wcrl< aerfonned
Tax map/parcel no 2.-S 1110 An 12300 Indicate the value(rounded to the no ar:sl dolls)of all
equipment,materials,labor.overlie(d,and the profit.Icor the
1101 4, :- t 1 t :u-. 't r r' t; Ii=4 l➢i '�° f a`l a` wc.rl: ndicated ontivs ja licetic�rr. _ _
to t <t tn.> tllI ,r- 6 a k , •.,;, x.:: -.. .. ..W .#7,. ,a i,,.t a ---- —__�.L--- - ---- -
- V�_j___ C W Vn- - -- - Valuation--- $
- ---------.- -------
4
/,�,�� 7� �4 !) ,Y� �� A �u� /� Exi;t.ng building area: ----syuare('eel
�/,[ `, !/I /' '�I New building area^ square'ieet
t
-a !.
:41rl:F r,. .., :,n ,, . ./., OW..,.:f .. , <'`�• ,:_� ski.,i 1 •, N tntber ot'ttories:
Name: Bugs'- Ayt-c ass• Asap 77 TYPeofconstruction;
+- --__-
i Address: 333 5: s ,./ sr://��-silz- 1/5 ---- On:upancy;;rotgts: ---- - -- —
City/State/ZIP: 4_,4-,f t EG 9 elf2. --- --- --_-Existing: ------- - -- - — -
I
( a36 3ZfZ Fact ) - --- -- -
Phone
RI!pprApr(2)
r t, �i g,Y .,< a 4t at tcg� tart q� t a j, r z r 4 I II t 7 ,..
�r i .'" ' r'Y� 5# �I 1 ,ts _ i—,1, Fr:-, zt tl rr t *c \ # a
>aM.r.. � 7�� ... s�::�t.n.:W.: t111tfi,'1,` '�I� I '#t tt.r', ; l'f � t � r
Business name: � � ifdrf x. ss'hs s:nto it. L tf .tt cam..- .:.
Struc_it ai plan review fee(ur dnpn:u)'
Contact name: -__—_ _ _-_--- ---_.—..----_—_.
Address: -`-- -FI S plan review fee(if appl.cab ie): - — -
---- Total fees duct upon appl cation.
City/State/Z:IP:
Phone:( ) Fax::( ) Elmo n t re tv ed
----- ] 4 s 1} EZ.f' rE rnaiL '•x :t . x 3G3ixs.� . irdai ,'""4-1 , F,Ttks la xrsc ;tea, 3y, r mtr g ^t" I•'r- •k l s� Comnte-cial and residential prescriFave installation of
af.t s-¢r l .i i l l .c i n py i x € ' ,° .,:i
;;3°e�'•��� ,„�ne�.>...�m:'�„ci�t.�:��� c��w�._i�y �lJ . .��ti,:: ,t.,.,s.� i�.a�f X�i roof-top mounted PilOtt7VV1ta,C ;Dist Panel System.
Business name: L/L.Iir- pffteu5e" /020.0 77 !-- Subnrt two(2)sets of roof plmstwitr connection details
and fire department access,alan t w th the 2010 Oregon
Address: 33 33' s. S7r7 Sr f v4-g-t- Solar Instalauon Specialty Cod?checklist. -- ____ _
City/State/Z iP: �,A-u--- aster (X Permit Fee(include,:plan rev ew� $180.00
andadn.inisttatro fe,$): ,
Phonc:(,)3) 9.76 Fax:( ) ^--__-_ State surcharge 112%<oof permit ft,e). : 521.60..
----.1 f 70�� - _-_.-_._---_ Total fee due upon app cat.sn: i361.60
Authorized signature; This permit application Expire.;Ifs permit Is not oottatined
- — within 180 days after It has been accepted as complete. '
*
` Print'name: _ �(,� Date: `v , Fee inethodrtlogy set.by Tri-C ou:ity 3ui)ding industry
Serva:Boas.
L\Building\Permits\BUP-RESPermitApp.doc 02/24/20 t 1 440.46I3T(11'02/COM/WEB!
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,. Rec,civol ,, ,, ,, . i!t,R 4 41;1(T 1,1!ir()N(,1
Mechanical Permit Applicatitia
EVE • '
II , City of Tigard
54 400427436:4101/.1 13125 SW Hall Blvd.,Tigard,OR 97223 _Date/By: Permit No
: 3 Phone: 503.7182439 Fax: 503.598.1960 OCT 2 1 2021 Plan Review
Daie/liv: Other Permit: r 1
.... ,
t 'i
I-t, Inspection Line: 503.639.4175
Jude: Si See Page 2 tar 0
Internet: www.tigard-or.gov CITY OF TIGARD De dy riEte,eavmeitiBL:
supp e
BUILDING DIVISION mental Information
i Afirtalitie iiiiilf •, igiii-WrvilKihrri.!iiiiiiiitillialiTiii Elirailit Mg '--'''''''''''1:-77:7-::4''.-• ':•. l•vuil:. .
..,
Meehan;cal permit fees*are based on the value of the work
W New construction 0 Addition/alteration/replacement perfonntid.Indicate the value(rounced to the nearest dollar of all
0 Demolition 0 Other: mechanical materials,equipment,latior,overhear.and profit
Value:$i
i Miiiiiii:M;,' Pit'tt,K.:.„.i„:::'.2;•:, ::117::::: ULM!! i• Irlit ilNtjld5ootjaiwt**wokr*oi*t,N.At 1
p -. and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
1
I 0 Multi-family 0 Master builder 0 Other: Descriptor -Dty. Ea. Total
lqi.1t,7'.!, 1414114:4492M11-i - 1; 'iiIA7-7.;,,,,r1N.,,,,;:..,,i,g.,..rfifiliksm—IRATTETE:mmirill _lleoil_t,... _ 1
—7
Air eoriditionint 46.75
r.: Job site address:
Furnace 100,000 BTU(ducts/venal 46.75
City/State/ZI?: 776440 Oft Furnace 100,0004 BTU(duets/vents) 54,91 1 Heat Ltop f 61.06 ]
Suite/bldg.'apt.no.: Project name: .
11 Ihict wo-k 23.52
1,I Cross streeUdirections to job site:
GAirire-1302.i 4 eigata-e,_ 2_,Q&Z....
Resalem ail boiler t radiator or
hydronicl
Unit hca:crs(fuel-type,not electric).
in-wall, n-duct,t suspended,etc. • 2:3.37
46.75
II Flue/vent for any of above 7 23.32 [
Subdivision:
Tax map/parcel no.: SS I(0 /ete) i 2.'70 0 Water, Lot no.: 1.....
Other:
Other fuel appliances:
nt ater 23.32
/ 23.32
immitatiREN-smirirgoiiiiiwirboxiottiTe.,,,,, riffr aitia;1,. Gas fireglace/insert 33.39 .
Flue ven:for water heater or gas
k0__V_ '-- I C 4 Ooveg- 4 / 7) fireplace / 23.32
Log ligh:er(gas.) 23.32
_
Wood/pellet stove 33.39
Wood Fireplace/insert 23.32 !II
Chimney/liner/flue/vent - 23.32
23.32
id'i11i'AITIII :Wit. I:• • 4;l1101101+,11110P-Mitrii#071747,WITF °tiler:
i,;,tiq,iai,`,tt,t ;iv,--Lot, --ril,,-t-;-,:g Atisotki-s,ii4crvAis,s4ii-o-t-rp. .,„,.,s, (s.,_,,,,,, ,Li,,t1.4,,,,,,,V,T1 Environmental exhaust and ventilating:
Name: 13.1-(/e- Oft-iNfSer-_,/1-6,6-ZrierS Range nand/other kitchen
equipme it / 3.3.59
Address: 33 r ...5".:: SMyr_sn_..5-0/7-6--- v4i-e_
Clothes dryer exhaust / 3.3.39
City/State/ZIP: 1,,4 4e- es-4 ,, evz Single-d ict exhaust(bathrooms,
toilet compartments,utility rooms) 2.3.32
Phone:(5-03) 9.36 30(2., Fax:( 1 Attic'era wlspace fans _ 2.1.32
.19411419$044135WA"I'!,!",' 'I, 18:gifititWItiRtMitti,EiFital'aiti,7("61741 ,4:1 other: 23.32
Dix-iiii,itirsIgLigirtest_i,,,,,,t-t., ' 0,111,4;m1m1P13013Vir.,te,3•13, ..:T,Ftrit,„;,,,,,,-ttt,--s,t-....,..MA 0.4.y.
Fuel piping: N
Business name: S,?4.otg_: &__.A2t2L/&v-
$14.15 for first four;$4.03 for each additional
Contact name: _Furnace,etc. 1. I
Address: ----
Gas heat pump I
Wallisusgended'unit heater
City/State/ZIP: Water Mater —1
_..., - ---- ------
Firepla e,
Phone:( ) Fax::( )
Range t- I
E-mail:
Barbecue ,
ININIRMA#1•0144•WE 4.4i24:4! 11/40:410110.11114litifERJ Clothes dryer(gas) _ •
Other:
Business name: A.Spiktep A.//2_ oip_r___ I7e6.1,Arjo- w, _
036:11,04,41034.1$4,40.41*.0,044114i;',144M.
Address:zoop c. H,InVizo Subtotal
City/State/ZIP: n(wri, 4 try 0_ 17.04.5-- Ivlinimum pemv1t fee($90.00) I.,
Plan review(25'S of permit fee)
Phone:( ' ) Fax:( )
State surcharge(12%of permit_______ fee)
CCB lic.: 4'34%+03 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within I NO 111
Authorized signature .040, Fee methodology set by Tri-County Building T ndiv.tr3 Service Board
t
{ Print name- NV:- i -“Wit./ Date: /0
pliuil;Iina Pernitti:MPC_PennitApp_0401 I 3.doc 440-46171(I I'02 COMAVE81 .
.H
I" I! I I
Electrical Permit Application trlt l rl HT► 1 t,1! �' '� : , I.
RECEIVE
I City of Tigard Received Permit �� � ��
I1ate/6v: Pe
6JK/ afgl .' 1
IN.- 13125 Si!Hall Blvd.,Tigard,OR 97223 O C T 21 2021 I Plan Rc\iew
Phone: 503.718.2439 Fax: 503.598.1960 1 Date/13v: Related Permit 4:
Inspection Line: 503.639.4175 �y Read}I)ate/By: Tans: RI See Page for
i 4(i A R;� C)TY V F TICAR otiticd/Mcthud: 'u
Internet: www.tigard-or,gov ---_ :i pplemeeteI Information
a ■ >$ 1•ti
finaftellft i I i : , e tJ E Ie It .1 ,= I. i r iii '-i..
I
R � (a L
►1 New construction ❑Addition/alteratiortireplacemeni
Plc a cht eh all that apply(submit;acts r:pl ins wtit-.nn ch ckad::
0 Service or feeder 400 amps or more ❑l:uildirg pvg three stories. 1
0 Demolition 0 Other: mere:he avniteblc fault current 0 1 tar nuts air b:Wya:d::.
1 ac e` { t `'t•�'g l t Gr7�[R 'rt1Ftt i'. i:i ;°•:t i.x..<f Kilt a u ,f,1�„ exoe:ds 10.000 a rips at 110 trots or ❑1 lcstint huild,nis.
t:.t. �. �� ti:,u_ 1� i1:��
1 and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14.ot10 0 t'nmm¢rut'-uac agricultural
sups t.r all otter installations. tutl,lints.
❑Multi-family 0 Master builder ❑Other: Ohre pump: ❑l13u:110mof150 It:vftor
o.. ,E rre...L., : ;wi__.e.> r .. ., ; .,,tu+ NI : `gL I ❑Emeg.meysysiem ltryur epa•.ttetyderived
Job#: Job site address: (086 Q oaf AtiNA�iD a�(, ❑Addition.of more
outer load of I.)(stun'.
City./State/ZIP: ❑>;:ornomresat:analunits. r'cecpanc}'•
❑Ilealh•c,tre facilities. ❑1.et:mammal%einele parks.
Suite/bldg./apt.#: Project name: 0 Hazen ouc locations. 0 c apply vol®g.,for more:Ilan
0 Service or Iteder 600 amps or more. t 011 volt'tx>rn net
Cross street/directions to job site: 7�- �r / 1 f rE I r I t17.117i �i j
GA�l�l3 9 �•(/L)Ant i ..a. ,1.I..>� , '?Ilia ; r`
txaaiot_ is:_ Gwk J. rota!
New residential single-ur malt i-farnilt d•.vellinl;unit.
Subdivision: - I Lot#: Z Include!:attached garage.
ZS l f 0 h9 I2300 __t 1 UO`I addsit'1
ft or less or n 133.St 4
fax map/parcel# —-- —
ii�,aft } !tutu # t t 1 t a ►t, Ea t JJ'1 500 sq ft. portion ^, 33 92 ,
as> z xr.> uJ x ,.: ,P ' 'I ti r'c. �,I� ly , ,»sail Limited cncrgy,restdcntial
Aj2 c ( / i4t" Lt1"&L\ (with,ahovc se.ft.) 75.0)residemial 2sl_— C J Limited energy,multi-family
� r RenovaaleEnetrgyabove Ca SaePam'_—_-
�+ yy�+�
t 4 I: .t .. r t s:."DFf' ES t%'. j E,� 7�74 1
Il�i # lie u,:,>a •.: tCa t. , ,r :, ». I _
Services or feeders installation,allEeralIGll�aR1�ar l'l'l0'admit _
Name: 19�tr f c 203 amp:or less --100.7,0- 2
- 201 amp:to 400 loops 133.56 - 2
Address: 3 3 3 S. $T/ria" Sr. SwF V4 ` 401 amp:to 600 amps ----^ 200_34---
City/State/ZIP: 6,4tr aaSrt/_ Id ,. - 9?a.* 601 amp:to 1,00)amps 301.04 3.I
Phone:(03) 'F'36 3L/Z• Fax:( ) Cher 1,000 amps or volts 512.26 2
Email: /.-p8kr,e�d,$LL °,,q 6-« Temporary services or feeders installation,alteration,and/or
� relocation
Owner installation:This installation is being made on property that I own which is not 200 ampr or less _ 59.3.5 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amie to 400 amps ---- 125.03 2
Owner signature: Date: 401 amp:to 599 amps 168.5•t--__�
. t t , t air 'ta 4r tt_, i it 1 grelifi i�, Branch:Inuits-new,alterationioe a(tension c:r coat--
f .s's 1. : .lv-,,,- ',. •._.t :..-.. l ecJ. 3 A.Fe ;'o-hraacb circuits with - -- -
Business name: 314-I_,s above service or feeder the, 7.42 .,
-
ea,:h branch circuit __
Contact name: B.Fco''c�branch circuits witkoei ...- -- - �^
Address: — �— seavic:or tccdcr tee.first ?b.l S ^
brand circuit _ _ _
City/State/ZIP: Eadi ad bran
ch nch circuit — . 7.42 2
— Miscellaneous(service or feeder not included
Phone:( ) Fax: :( ) Each manufactured or modular
•
( -'----- dwo Ilha& 67.81 -
service and/or feeder
1 Email:3 pt�ey� _ w Recc met tonly ---.— 67.8t-�-- ''
. tl yx ,� , e p k£ lP * lvl.& 1} . Y r ` (11 Pumf or rigation circle -6 . 2 Business name: ,AJ y7 Lev Gvecritits,i2 4 c� Sign or'pinion lighting 67.8}�'�__ 2
SS 1?77 r LeN� palml cal eration or limited-energy _- — --
Address:- 7 pot*—� panel,alteration,or extension. �d Sa Pnge?-_— _'
Cit /State/: IP: q F.acb addthonal inspection over at owabie in wZof the above
y 1QVOA)« f !D64 Additional inspection(1 to min) i •56.25/hr _ _
Phone:( 1 Fax:( ) lnvestiga:ien(t hr min) i ')0.(10/hr -_--
tnplant min) I 18.18/tidustria. (I hr —r�8/_t•
Email: _ --
Inspe:uo is for which no fcc is )0.00''tr
.Z6
CCB Lie.: P Y s Electrical Lic.: G1�J� � Suprv.Lie.: s(+crlca;l hared 4/r)u mmt
Tt4 ii' smu g;'.`[. �kAtt,i .. . ' fi:_a...,i iji
Suprv.Electrician signature,required: _ _ Se.btnt tl _ _
Print name: Date: ❑Plan Review Required(25°ic of pern it fee): _
/, State surcharge(12%of pens it fee):
5 ///�� <-0_ _ „s it• — �_— TOTAL PERMIT FEE: ______.1;
Authorized signature: ____ �C`� l�y�—l_ — _ _
Tbls per mit expires II a ptMI.is notob:shred witliln 1g0
Print name: k. t Date: days after it has been accepte l as complete.
* Numb,r of inspections allowed par peimii.
1:'Butldina'Pcrntit-ELC_PuntirApp_E ERE.doe Rcv(i/I7rzm 44(F•7A 'C 1ST(11,0SON/WEII �.
°
pefr
Electrical Permit Application-City of Tigard 6C( ov� Ve
Page 2-Supplemental Information g I
\O / V
Limited Energy Permit Fees: rO Renewable Energy Permit Fees:
.• c:01q rre 7': Y a t y� 11
.:@ � :M N ••i
I ___sj__on Qt" Sacs Total Fee fora residential systems combined: $75•U0 Renews ale electrical energy systems:
5 kva or less J 100.70 2 li
Check Type of Work Involved: 5.01 to 15 kva 173 5f, 2
It
0 15.01 w 25 kva 200.34 2
Audio and Stereo Systems*
Windieoeration systems in excess of 25 kva: 1
❑ Burglar Alarm 25.01 to Solna 301.04 2.1
---_
- - 552.2c 2
n n 1 to,CO kva ..i
❑ Garage Door Opener* 5 r-d 00 kva(fee in accordance I s.i2?h
with OAR 91R-309-i1040) 1—. _-- 1
❑ Heating,Ventilation and Air Conditioning i solar generation systems in excess of:.5 hva:
1 System* L Each additional kva over 25 i 7.42 }
ri
>100 kva—no additional charge I 0.0 3
Vacuum Systems*
I Each additional inspection over allowable in an of the above:
n Each additional inspection is 66.251 hi — i
Other: charged a an hourly 0hr min)1 _ lnspectiois for which no fee is 9e1,00;hr
specifically listed(V:hr'Mal T, 1
k ,: `it t x e;,t . t l 3lf...3,a ri t ll? `4$ Y 6 iiT i�'rA.:,..lF,4 3 �i3
1...... t 3 a 1 ll �t E, `r,. i l Subtotal alter o.t Ease l):
Fee for each commercial system: $75.00 • Ni.rnbrr of inspections ullnacd per permit
(SEE OAR 918-309-00001
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n F• ire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ L• andscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ P• rotective Signaling
n Other: _
Total number of commercial systems:
*No licenses are required: Licenses are required for all
other installations
L BuildingtPrmuwTLc Permilnpp_ELR_ERE.dcc R ro lW✓17/20 5
Plumbin2 Permit Applicatio ecn
E >�E
Building Fixtures Hsi; i l l i I('I I ;I:•i it l
1
City of Tigard OCT 21 2021 Received Poneit No.: �' �Q :�M�'�' �
IINK 13125 SW Hall Blvd..Tigard,OR 97223 Date/By:
Wit''``'' �� `
Phone: 503.718.2439 Fax: 503.598.1 T r�� Plan Review
' i.H 1 y 0 I�(a�(l(.) Date/By: Other Parini:No..
(';c,.,;.I-1! InspectionIine: 503.639.4175 BUILDING D!VISIC)I",' DateReady/By: 7uris: h1 Sea Page 2for
I i Internet: www.tigard-or.gov Notified/Method: Suppiementat Information
t o is laRsF t'r ° , r` 8( j a ' a :xi tb orps� f i r r i
x« gi;,s dill r t`:r i�.+`1 1 itiNgi a ilMi�.i ' ,ih:M ! i(19 i_i`,.tl€, t n Veir:S:m..., r:liti . t 111114,li ;a. 1
It
.0 New construction 0 Demolition For special information use checklist.—
Description_—_ 1 Irv. ] _Ea 1 Tend _
❑Addition./alteration/replacement ❑Other: Nevi 1-2-family dwellings(incicdes 190 ft.ter each utility connection)
) i i` ,z i # lit c ° I }' SFR(1)bath 1 312 70 _
tz °.I 11:11 ° la. 1 vu u ,x 1- «.y.w.u.. a,li ,>,.N#1.11 , „. I W
,. —
de1-and 2-family dwelling 0 Commercial/industrial SFR(2)both 437.7E
SFR(3)bath 50032
❑Accessory building ❑Multi-family — —,
Each additional bath/kitchen I 25,02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) &1c>! NV_^.
rriq a,igs ° 7 ; tI' c Site utilities:a t . l t .. --— — -- —
Job site address: /0 f pp ( Sw if JAJM UO R/if, -- Catch basin or area drain 18.76 --_
}�6��n -- Drywell,leach line,or trench drain 7 18 7t,
City/State./ZIP: / F ,/Ii ---
f//�" Y7Q — _ Footing drain(no.linear ft.:_) I is air :.
Suite/bldg./apt.no.: Project name: Manufactured home utilities 1 50 O.,
Cross street/directions to job site: C "�(//e/ 1 ah f(/a#/`G Manholes --- 1£ 76
Rain drain connector —1 ?8.7ii
Sanitary sewer(no.linear ft.:_) Page -i
Storm sewer(no.linear ft.:_) Page 2
_— Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Z Fixture or item: __
Tax map/parcel no.: ZtS !!D Z 3OD Backflow presenter 7_ 31.27
i act e i tn= n g• °� :t .i , gIEn 0ret il Backwater valve — 1 12.51�—__
r � .q .I. '17A144 L 51 :';- ,.ta`it,PIP'l
—s=-'—ram �s.,rf., i Clothes washer -1 25.0:
419J .L (L O 2_ L -_ Dishwasher __ ( 25.02
— — Drinking fountain 25.02 -
g Ejectors;swop ( 25.02
' tf fir# t s s1. 0 k°i-.r1 �:. ...a 1 x''c �4 t Expansion tank 12.5 I
1111a;rll tl�.t, =. :r 17.1 ,::r ...acts,,.s` �n4 .1'r i. . .,tad*. ---
�L 4 P ov loge5 nes Fixture/sewer cap 25.02
Name: —�`_0'
Floor drain/floor sink,'hub I 25 02
Address: ?3? S S. s - '-'sf a£�/I _ V4 Garbage disposal I 25.0:: -_—
CityiState'zIP: O .Ktr- G5(.c/E40 , ®i2 Y7'3¢ Hose bib —Q-- 25.0'____— ._
Phone:(03) q.36 3 .fZ,_ Fax ( ) ice maker I 12.51 __ --
_
_
I i x rjztt a 't, t , ' TTT
Iiar 1 e ,c ��-4'£ Interceptor/grease trap25.02
4, .id. x ., 7- Medical gas(vaiue:$ ) Pale<
Buiness name: —
Primer 1 2.51
Contact name: ---' ._'—_— -
Roofdrain(commercial) 12.51
Address: Sink/basin'lavatory ( 255.02
City/State'ZIP: Solar units(potable water) 62.5,:
Phone:( ) Fax: :( ) Tub/showeishowerpan i — 12-51
Urinal 25
E-mail:
a " 'i i3 31 rt a mzr� ��I�. f f t tr I' Watercoset —L2'0-2
4' ' ,isi iligif lu.ti r Ili„rel l ,, . Ili, 1111;1.» 37.52
Water heater (
Business name: FlL S,"� /p&tin/A//VG" Water piping/DWV — 56.29 �—
Address: (; 7 Se I3(O'et- Other: —_---25.02
City-/State/ZiP: /3.6/7271,, t4 aij, Subtotal
Phone:( � ge r 7- c Fax:( ) !_ Minimum permit fee: $72.50 -_
CCB Lie.: ' l76 7Sb Plumbing Lic.no.: Pg 37f� Plan review (25%ofp nnit.'eel -_
State surcharge(I2a%of permit reel
Authorized signature: ��_ TOTAL P11RVi1T FEE
Print name: /�q� '" Date: This permit application expires if a permit is not obtained within 180 days
�a, L after it has been accepted as camplete.
*Fee methodology set by Tri-County Building industry t r'icc Board.
I'..Building1 Perm il\PLMU-PcrmitApp.dnc 10u01,09 44154616Ti I tbO?'COM'WEa)
t:kt)Plumbing Permit Application - City of Tigard O$ It
Page 2 - Supplemental Information
Fee Schedule:
,4 , Residential FtreSu� ress i
n Srtens
.�.. M r ar.5a po , :, a i';
7 ; ' t� Ai ra ,l : c: t a u s
l.u_
Footing drain-I"100' 50.03 0 to 2,000 $12190
Footing drain-each additional 100' 37.52 2 OGl to 3,600 $169.69 `_�----_-_
3,601 to 7,200 S233.20
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 S stems:
Water Service-each additional 100' 37.52 ar f' t x s '' ^r�yy�,d ikf i c ET fii
_ t hill 1' ,l i "'." iB„ALIBI a �,;_°
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 $5,001.00 to$I0,000U(. - $72.50 for the•firs $:000 00 and S.L5.2 for
,
a each additional$100 00 o friction th",reof,to
,€,.,, s � `' ..' . -, . lfjw ' ..
�?;�.� , , ..,.: .,#. and including$(0,000.00.
Inspection of existing plumbing or for •
$10,001.00 to$25,000.0 S 148.50 for the first$10,0)0.00 and$1.54 for
N.,hich no fee is specifically indicated 90.00/hr each additional$100.00 oa traction 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 S379.50 for the firs:S 35,0)0.00 end$1.45 for
hours(minimum charge-2 hours) each additional S 100.00 01 fraction thereof,to
Reinspcction Fees 90.00/hr and including S50.000.00.•
Additional plan review for revisions 90.00/hr $50,001.00 and up $142.00 for the ins.:S50,0)0.00 end$1.20 for
each additional$100.('0 of fraction thereof.
1ntinimum charge- 1/2 hour) -- --
Subtotal
Commercial Fixture Work:
Are you capping,adding or replacing futures? If"yes",
please indicate work performed by fixture. Failure to
accurately rejort fixtures could result in increased sewer fees'. •wok ' ,•`li" y.{MI4'1i p• z'i? ,;;, ,a tip= t F
} F tE i Plan review is required for any of the following.
'` „; � t��y Nt41040, Please check all:hat apply.
ra 'n r� iii 1 S e 1!11 ;is ,t .�-1`-f . �.
' tt� f'1'.,3,.�._.�+ � 0 Any new con-,rtercial building with water sen'ice 2"and
Baptistry/Font . grater,exc:pt systems designed and stumped by licensed
Bath: -Tub/Shower engineer.
= Jacuzzi/Whirlpool
❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR915-780-0040.
-Drive Thru
0Medical gas and vacuum systems for health:care facilities.
Cuspidor/Water Medical
❑ Any multipurpose fire sprinkler system.
} Dishwasher: -Commercial ❑ Any complex structure as defined in OAR918-780-0040.
-Domestic _
(, Drinking Fountain Submit2 sets of plans with any of tt,e above.
Eve Wash �q _
Floor Drain'sink: 3"2"
Ejiia<.l.. f...i1!Fa: d tli 1 l f stlM� � #3i:F
���1 ems+ �. � "tl t�
■ 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 MachJRefrig.Drains Comments regarding fixture%vork:
Oil Separator(Gas Station)
Rea Vehicle Dump Station -- -._ -
Shower: -Gang -
-Stall - _
Sink: -Lav/Bar non-food related
-Bradley
Cotn/Serv/Uti1 food related
-Service *Note: If the fixture work under this permit results in an
Swimming pool Filter increase of sewer I:DUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase mutt be paid before the
Water Extractor
Water Closet-Toilet ' plumbing permit can be issued.
Urinal
Other Fixtures:
ii
1:\Building\Permits\PLMF_PetmitApp.doc 08/04/2011 2
f
City of Tigard
I/ COMMUNITY DEVELOPMENT DEPARTMENT
I
I
T I C;A RD Building Permit Review — Residential
1Building Permit #: ,/i3O /- grg
, Site Address: 1 6 86' (4/r1 Vluiavd, I'-Fill C-T-,
Project Name: /1 4, J-1 j([ C4 , rott4-HLr�fri Lot #: Z
Planning Review/'(/Gt..! / —Alen, ly t t tle-1 '� em / hot.
Proposal: #—
AVerify address/suite# active in Accela. 0 In River Terrace: 2') No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: 4Erosion Control
,F A3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper f Retained trees with drip line and tree protection measures
1
[Drawn to scale(standard architect or engineer scale) WFootprint of new structure(including decks)and FFE
North arrow rtaJtility locations&easements(required for new and additions)
FSite address,project or subdivision name and lot number Sidewalk/driveway approach
Applicant information(name and phone number) _ ms
OlLot dimensions and building setback dimensions I0treet tree size,type and location
Pitreet names
g•E �ernPr t .: i� c�ttotitrs if d'a+ • )
pLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ofiYes ENO
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? EYes PZk:o
cgi Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified i No Received: ❑ Yes ❑ No
Ai Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: pYes,applicant was notified ❑ No Received: .0+Yes ❑ No
iilSDC Exemption for ADU applied for: ❑ Yes ,�No Received: ❑ Yes ❑ No
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ZPNo Applied For: ❑ Yes El No,stop intake
Land Use Case#: 14 D `C/U 2.0 am 2_Z- 7�oning: "-" 17i
Required Setbacks: Front: I $ Rear: L D Side: 5 Street Side: / 3 t Garage: 20r 1
1:0 Building Height: Max.Height: . 5 i Actual Height: 2- 5'
P Landscape Area: 2-4 % p Lot Coverage Max: 4 0
Entrance ria Set back no more than 8'from street-facing wall Parallel to street or offset 45 degrees or less
Windows l Minimum 12%of area of all street-facing facades
Garage ---1E3—c„arage door is behind widest street-facing wall ❑ Yes ❑ No,one of the fo et:
❑ Door ex more than 5'from wall and there is a covered porc tng beyond garage.
❑ Door extends no more ' om wall and there is t.window above garage on 2nd floor.
❑ Garage door width is ❑ 12'or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ssed entrance ❑ Wall offset ' of eave ❑ Roof offset
❑ Fire • s ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gam of ❑ Dormer
ccent siding ❑ Window trim ❑ Window recess ❑ Window projection alcony
O Visual Clearance -2 Urban Forestry Plan
g Sensitive Lands: ❑ Yes No Type:
C Conditions met prior to issuance of building permit
Notes:
Approved By Planning: 4-eav( Date: IC/2J/ZO 21
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
is
Building Permit Submittal
Original Submittal Date: /0/21/202/
Site Plans: # 3
Building Plans: # �j
Building Permit#: LJ Enter building permit# above.
Workflow Routing: LPlanning Engineering [I Permit Coordinator Er Building
Workflow Sign-off: Its'Sign-off for Planning(include notes from planning review)
Route Application Documents: (ik-Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
[V Building: original permit application, site plans,building plans, engineer and
,/ beam calculations and trust details,if applicable, etc. .
Notes i44 S eire— /04'44A) 14 . `, �5i 1/u r o! 4 l�I )F 8/4/
By Permit Technician: // Date: 6 2 202/ �.
Engineering Review
•
L'Slope at building pad: 2 2
0/Conditions "Met"prior to issuance of building permit
IrEasements (encroachments)per engineering conditions of approval and plat
[Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 45/No
Assess Water Quantity Fee in-lieu: ❑ Yes L' b
LIDA Facility on lot: [Yes No
Final Plat Recorded: `101/
C'NOT Approved by Engineering: Date: I/A3/e
Notes: 4. /aid /IS PhD' /4
Approved by Engineering: A Date: eey,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
XConditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Shay,' L ) Date: II I y 1202.4
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption: 0 Received Does not apply _— Qr P.(
SDC Fees Entered: Wash Co Trans Dev Tax: 7 Yes ❑ N/A
Tigard Trans SDC: VYes ❑ N/A O
Parks SDC: Yes ❑ N/A a�� �� k,
LIDA ❑ Yes J N/A44,
eOK to Issue Permit
Approved by Permit Coordinator: ., ./ Date: 1 INV)/I
\Building\Fonn s\B ldgPennitRvw_RES_122419.docx
RECEIVED
City ofTigard JAN 1 0 2022
III
�� FINANCE DEPARTMENT
: : . JAN
OF MARL
TiGARD Systems Development Charge (SDC) Exempi!i8 fi ication
o
REQUEST FOR ACCESSORY DWELLING UNIT (ADU) SDC EXEMPTION
(Allowed under TMC 3.24.100.F)
Note:Refer to TMC 3.24.180 and the Systems Development Charge(SDC)Exemptions for AccessoryDwelling Units
Guideline for eligibility requirements before completing application.City Transportation and Park SDCs exemption
only.
REQUIRED DOCUMENTS
PROPERTY INFORMATION
❑ Recorded Deed with the legal
Name of property owner(s): Blue Palouse Properties description of the Property
❑ Proof of Ownership/
Authorized Representative
Address of ADU : 10869 SW Annand Hill Ct
Tax map and tax lot numbers: 2s 110 ad 12300
Land Use Approval Case Number: MLP2020-00002 ADU 2020-0021,0022,0023
Type of Unit Total Units Square footage of each unit
Attached ADU 1 676
Detached ADU
APPLICANT INFORMATION
Name(s), as appears on title of property: Blue Palouse Properties
Mailing address: 333 S State St Suite V452 City/State: or Zip: 97034
Phone: 503-936-3212 Email: robm@bluepalouse.com
Applicant's representative (if not property owner):
Phone: Email: robm@bluepalouse.com
THE PROPERTY OWNER ACKNOWLEDGES AND AGREES TO THE
FOLLOWING:
1. I understand that acceptance of this application and required documents by the City does not constitute an
approval of an exemption. Exemptions are not granted until after all required documentation is received, the
property owner(s) sign, notarize and record with Washington County the restrictive covenants agreement.
2. I understand that if at any time during a period of 10 years from the time my final inspection is approved the
Page I 1 Rev. 10/21
accessory dwelling unit for which an exemption is granted is rented or listed as a short-term rental (AirBnti,
VRBO,etc.),the owner of the property at that time will be required to pay to the City the amount of the
exempted system development charges,plus interest. I also understand that an advertisement of the accessory
dwelling unit as a short-term rental is sufficient evidence for the city to assess the amount of the exempted SDCs.
I understand that this restriction will bind the property even through transfers of ownership.
3. I understand that the City may verify any of the information contained in this application at any time.
4. 1 understand that the City, its agents,successors and assigns will rely on the information contained in this
application and the information represented herein;if any information should change prior to obtaining a
certificate of occupancy,1 will notify the City.
I certify that to the best of my knowledge,all the information provided in this application is true and accurate as of
the date rovided opposite my signatures below.
Rob Matthews 11/23/21
1'r crty owner signature Print Name Date
Property owner signature Print Name Date
APPLICANTS
It is the responsibility of the applicant to ensure that the application for the SDC exemption is submitted and approved
before the payment of all SDCs are due to the City.SDCs are calculated and due and payable pursuant to Tigard
Municipal Code 3.24.080. In accordance with TMC 3.24.080.B, the City may not issue a building permit or allow
connection to the City's systems until either all SDCs have been paid in full or an exemption has been granted. It is the
applicant's sole responsibility to ensure an exemption application is submitted to the City in a timely manner in order to
meet the timelines in TMC 3.24.080.
Electronic submittal of this application and required documentation is preferred and can he sent to SD(:(ce.tigard-
ot.gov
Hardcopy applications and required documentation can be mailed to:
City of Tigard—SDC Administrator, 13125 SW Hall Blvd.,Tigard,OR 97223.
Questions can be directed to Christine Moody, at Christine(rig trd-or.gov or 503-718-2415.
STAFF I SE ONLY
Date Received: 11/23/21 Approved by: Christine Baker 1/6/22 Date:11/23/21
Amount of SDCs Exempt $11,719.00 Park $7,591.00 Transpoti:uion $4,128.00
Pugv 12 Rev.10/21