Permit N
CITY OF TIGARD BUILDING PERMIT
1
1 1 COMMUNITY DEVELOPMENT Permit#: BUP2021-00283
Date Issued: 2/10/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD12300
Jurisdiction: Tigard
Site address: 10871 SW ANNAND HILL CT
Project: Annand Hill Partition, Lot 2,Primary Subdivision: ANNAND HILL CT PARTITION Lot: 2
Project Description: New multi-family dwelling on the main level with(2)attached ADUs.Trade permits pulled 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 $1,026.56
Occupancy Grp: R-2 Occupancy Load: 3 Plan Review 11/18/2021 $751.34
12%State Surcharge-Building 02/09/2022 $123.19
Dwelling Units: 1
Stories: 3 Height: 30 ft Wash Co Trans Dev Tax- 02/09/2022 $5,756.00
Condominium/Townhouse
Bedrooms: 2 Bathrooms: 2 Tigard Trans SDC Improvement-Other 02/09/2022 $3,903.00
Value: $136,748 Residential
Tigard Trans SDC Reimbursement- 02/09/2022 $225.00
Other Residential
Floor Areas: Parks SDC Improvement-Other 02/09/2022 $4,727.00
Total Area: 1100 Residential
Accessory Struct: 0 Parks SDC Reimbursement-Other 02/09/2022 $1,112.00
Basement: 0 Residential
Carport: 0 Parks SDC Neighborhood-Other 02/09/2022 $1,752.00
Residential
Covered Porch: 40 Plan Review-Fire Life Safety 02/09/2022 $410.62
Deck: 125 Info Process/Archiving-Lg$2.00(over 02/09/2022 $50.00
Garage: 0 11x17)
Mezzanine: 0
Total $23,236.61
Required: Required Items and Reports(Conditions)
1 Special Inspection(see plans)
Fire Sprinkler: Yes Parapet: No 2 Ersn Cntrl 503-639-4175
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: Eolga.roto-Ma-l.ofov1.44,9- Permittee Signature: SU-
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 j- tOlZI I
RECEIVED ,Iill
Residential r(l z OFFICE[ t : : t. 11,1 i ,, , ,' ,.
City of Tigard i I
a Received /2 /� 2 �! 400702,1
^
Ipilrl g OCT 21 202 Datc.By: IO 7 0 / Pe:rmitNO.:, f8(,,�0070 1 , 3
13125 SW Hall Blvd.,Tigard.OR 97223 Plan Review u —.J
Phone: 503.718.2439 Fax: 503.598.1960 Datc/By: �� 7�C OtherPermiQAJ Zp2,._���
Inspection Line: 503.639.4175 CITY OF P IGAR�
`T I C3:1 I:]7 P , Date Ready/By: — T� Set Page 2 6or
yy Internet: www.tigard-or.gov BUILDING DIVISION •itied/Method: a 1 Supplemental Information
x 4 3'4C'- 'Hl `+..t 4tWri t �` E "'�. ""s."�j S,S; E n t mk's{'/ � "-7-' 1 .t
3�,:r ,kr �x R x ti n '-. -``..rt7-' "4, 7ie�' -,P .'5.t l � �j ° tl���_td
5 New construction 0 Demolition j Permit fees*are based on the value of the work perform-ed.
Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement 0 Other: ; eq teria]s labor,overhead,andc f
r * r , Y , s v tit;irt�ica 51 oneil„ lication. .
�.. _ rt on: JJ
the pr at fc�t e
aPP
( 1-and 2-family dwelling 0 Commercial/industrial alua'�ion: $ /Z_�. I J
❑Accessory building Multi-family Number of bedrooms: -
[]Master builder ❑Other: Number of bathrooms: "aC
Total number of floors: 5 lt
Job site address: fogfferAAWAVD ff/LL- G7" /c'7/ GOT Z New dwelling area: rt_ square feet f ,�
City/State/ZIP: T''(6. p Q� Garage/carport area: — (7 square feet i
Suite/bldg./apt.no.: Project nam,4H,$D , /Si/ gcht•04 Covered porch area: 1-0 square feet
Goss street/directions to job site: G -Ali ,i j4f/ 4 /470,/ ,K/ f14/41- Deck area: /Z51- square feet �N
Other structure area: 0 square feet
.,fir t;: 't_:;'' ; rt ,: } $ e -,si.
il
Subdivision: — Lot no.: Permit fees*are based on the value of the work performed.
L s�l C. D a I. Z gQd L or:-Z Indicate the value(rounded to the nearer dollar)of all
Tax map/parcel noequipment,materials,labor,overhead,ar�d the profit for the
.,..aa < s .r :ear. sx a x t e s
all r An.. � �1 p work indicated on this application.
—A/E-Vi Se/2- u' 7— IrOU$ Valuation: $
/ .. Ya4-ii &la .iGrr, St G✓lily Existing building area: _— square feet
New building area: square feet
4
rrirtl.a ataiktEl} g � a � `ivg, Number of stones: ---" - --
Name: 13G(I R`?z- e6- , 44 776 / j- Type of construction:
Address: 33 3 .5.S/iT- sr 5c-//L - V`T l�7 Z- Occupancy groups:
Cr_ty/State/ZIP: 6.446 C CUe "4 .770.0 Existing:
Phone:03) 9'36 32 /Z Fax:( ) — New: ----
,. f�x..' if,:: , ..,. :7 H°r.ae :-' - K1 "—1 asap : .. 1 >7,4 s ' '.t, r1 _RR`a,,,,. i, "A @t d.'
)N.--LE / Oi(..V(/ /�LX I..u�-1! ''j a:=r- plan
review fee(or deposit): i 61`(
Contact name: Aes -mat _— — .-________-_-
Address: 3 3 5, 57 76- -- , V�2 FI.S plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP: �A 4-iC C�� oiL — -- --
Phone
03) 93g ?2/Z Fax: :( ) Amount received
E marl ' / l0/Q(. P 6i o-4 irol ..* •
� i r>11 � ,'
E j u ""' R i'ua ` ,, o r . .; rxw: a Commercial and residential prescriptive installation of
? 0�� - e -s . „ t roof-top mounted Photovoltaic solar Panel System.
Business name: � � 5 -7i 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 $!YO 00
and administrative fees):
Phone:( ) Fax: ( ) State surcharge(12%of permit fee): $21.6'
CC'B lie.: / /t- --- ---_______
Total fee due upon application: $2f
Authorized signature: This permit application expires if a permit is not oh
within 180 days after it has beer accepted as cor
Print name: Ael Date: Q /8' Z *Fee methodology set by Tri-Cou:aty Building Ind
/ �f' Service Board. 1y,
Ia3uilding\Petmits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COMIWEB)
Building Permit Application Checklist
i; , it I , i
One- and Two-Family y Dwelling FOR Oi FICA ., I1 E ), 1�1
i City of Tigard Received
DatcB Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 y■ g Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing ❑ Mechanical
T I�,,1 K f) ❑ Ocher:
Internet: www.tigard-or.gov _
THE FOLL.)WING ITEMS ARE REQUIRED FOR PLAN REV1I W ‘ ` . 's
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. E _❑ ❑_
3 Verification of approved plat/lot. E 0 0
4 Fire district approval required. Name of district: • Elt ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0
6 Sewer permit.
7 Water district approval. ❑ E El
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ . F_____
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence desig:l and location.of catch- Ed ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state Ef El 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 2- ❑ ❑
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 N ' 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, kr ❑ 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- R 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. (r ❑ ❑
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- [e- El ❑
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 (r ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered K El ❑
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 R ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. _ El ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required [i ❑ El
for four or more appliances.
E 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 2- ❑ ❑
j architect licensed in Ore.on and shall be shown to be applicable to the .ro'ect under review.
t JURISDI("1.10NAL 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". ■ ■
iv
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ 0 ❑
Ij-,,: 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. El El 0
1 11
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
t 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ 0
ill'' 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.
l;l•,, 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 ❑
3!,j 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
j,NIII4,. including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
(!„jl';{, on a lot of record approved prior to September 9, 1995.
,pit{,;, ':
1 , ;.'uilding\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
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IllIt' d^
lechan.ical Permit Application tUiz 011 It I I SI l)1! ' +,
City 25 Tigard RECEIVED Date/By:y Permit No._ /�>.�'1 w s 1.,, '
13125 SW Hall Blvd.,Tigard,OR 97223 ---- �1(�21(� 1
Review
Phone: 503.718.2439 Fax: 503.598.1960 Plan_PlanDate R : Other Pcrr}ir.
U A iz ti In,pection Line: 503.639A[75 0 C T 21 2021Date Ready By: tuns: la See Pale 2 for
l' Internet: www.tigard-or.gov Notified/Metbod: Supplemental informaliooi
CITY OF TIGARD _
1 a ai m r, -• - o A a 'r A t 'N '�.
" R Mechanical permit fees*are oa:ed on t he value of the wort
C] ?dew construction ❑Addition/alteration/replacement pelfo:med.Ladicate the value(r tuned to the nearest dollar;of all.
C] Demolition ❑Other: -mechanical materials,equip;ner.t'labor,overhead,and profit
-- .¢ '✓Flat s
€N ,,,,m t # t . $g grc r xe 112 1 ^s�*qn } r^ R- i '°
r.�� ,�_ �� ��< 5. `•'R�e� 4Yd.'6�s €i {-{M`F'!� "'S°'1 'F �G 'i ���� TtlIF
rL(3 I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building rFor special information ase checklist
(1v1u.lti-family ❑Master builder El Other: Description --- I Qty.T Ea. Total
ts_i r n -f! -- 4, _..'-, ti �z 1 Head i/cooling: ---
64.n.. '' '1.4 L 3 • is ,'..'i: . . .t. ...;',,,,n 1. 9E.; ' •,' '$ Aircouditioriing 46.75
Jc b site address: /'/e - / Furnace:100,000 BTU ducts.'vemes) --- 46.75
City/State/ZIP: _Furnace:100,000+BTU(dtu,.s/vr�its)_ _ 54.99
------ Beat;sump - 61.Or
Suite/bldg./apt.no.: Project name: Duct work - - 23.32
f
C: Hyelrunic hot water stem 2332
-uss street/directions to job site: ,. y �/;��,�� tot. Sy` __--.
, Residential boiler(radiator or
hydrcnic) _ 23.32
Unit heaters(fuel-type,not electric),
- - in-wall,in-duct,suspended,etc. 46.75 _--
Flaeh:ent for any of above 23.32
Subdivision: Lot no.: /L Other: ---- 23.32
--------.-._-__ _Q her.fuel appliances_---_ _T--_ _----
Tax map/parcei no.: Z.Cam' /'el 7O l Z 00 _Water_b.eater -- .� _ - 23.32 _--
£ " it : s , 1 I i u r, Gas f'e�F/insert 33.39
1:r . nai_- ;il..° .i'. :e. ..:3.i ... ,._.,:.,..w- ...._.._ee;A q : _ Flue tent for water heater or
.__._.r
/,�!��,,,�'�' :gas
/V td _SIjl P14'G2 ft..i /Ce/f'rcLT ___td/Z- 14i0ak _frr p tcc _---.3 23.32 -
Log I;ghtcr(gas) 23.32
-- -•- - Woocipellet stove ---_ 33.39
-_ _--_-- Woo(.fireplace/insert 23.32
-r t a Chimney/liner/flue/vent 23.32
1 -> n r , Other;
23.32
_ x r � --� - -=
Environmental exhaust and ventilation:
Name: BCVE PA-6-QU5.6 04-Pew-n s _Rrng.:hood/othcrkitchen _--~
- -alu�rncnt �+^-_- 33.39
Address: 3 '5 3 5. 57 - ST .5C1/� ►/4�- Clothes dryer exhaust 3_ 33.39 ___-
City/State/ZIP: r �Z Single-duct exhaust(bathrooms, �^
_.-- � V "� - toilet compartments,utility rooms) - ✓ 23.32 -
Phone:( ) Y 7 Z(Z Fax:( ) Attic/erawlspace fans --_ 23.32 -_
1 ` 7 T w-T., � �•.,- 7-7; f tY �� :r+M- Other: - -- 23.32
Fuel piping:
Business name: �'J1 �oT _ $14.15 for first four;14.03 for each additional
Contact name: _Furnace,etc. ----
Address. Cras heat pump - __ _ _
- Wall/suspended/unit heater
City/State/ZIP: _Water heater p-_.___ ___,___--_
Phone:( ) Fax: :( ) Fize lace
- R'na'.- - ------......__
Email Barbecue
x' 9 f € Y g.' , -Clothes rdryer(gas) - ----
a
Easiness name Sher n _
_ _ /(/( err'-l _ --- =�'t ..:` L... .�h°- . ,lE ! '. �'
Address: 2; 14"/ip CO�(PFOse-r Suit tatat
City/State/ZIP: 7i C(p70 NI')1kt✓ U Minimrarn permit fee($90.00) --�
- - --�ie tT 0u r! 1 Plan review(25%of permit fee)
Phone:(553) Fax:( ) e
407-- Z'�'4'"g F -- State surcharge(":_2/o of permit fee)
CCB lie.: (0640 3 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: j4 - Fee methodology'et by Tn Courry Building industry Service Berard
Print name: intp.F /(, rsp,u Date: r% %Z(
1:'nunldiuyTermits\MJ.<:_PmoiiApp 040t13.doc a40-4617r(11/02/CUM/WEB)
Electrical Permit Application , FOR OF1; I.l USN: crN i.�
City Ti of ������� � Received
Date/By: Permit it:111 M. Tigard
13125 SW Hall Blvd.,Tigard,OR 97223 0 C T `i 1 2021 Plan Review
0 " Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 Ready DateBy: runs: RI Set Page 2 for
I ';A k n CITY OF TIGARD
Internet www.tigard-or.gov Notified/Method. Supplemental Information
�.gi. .31 m ,x . -- _..___...— 3' 1,a , 1.l...xo... ...�i€ -lF#rf ni .,. ,,e m.,,, 1.,
New construction ❑Addition/alteration/replaccmer t Please cheek all tlutt apply(submit 2 sets of plans w,item:checked):
0 Server or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
c ,,, 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.
arvlulti-family 0 Master builder 0 Other: ❑Fires�a mp. `-]. Installation of 150 KVA or
F . *164 �, 1. „ [t c °" []Emergency system. larger separately derived
—�� a .._..
Job#: Job site address: O'7( ,44/il,wo i/// . ❑Addition of new motor load of system.
�D D 1 /i LiY lool[P of more. ❑ A, F,„I_2 I_. ,
City/State/Z1P: '�] p� 0 Six or more residential units. occupancy.
! + �[J 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: A.,(a/f i'1 I, ,/ / /rj-.{ 0 Hazardous locations. 0 Supply voltage for more than
/��N�1/V(„/ f r�LL-- `t/I 7ii 600 volts nominal.
-I ❑Serv,ce or feeder 600 amps or more.
Cross street/directions to job site: G CE.-BUQV 4 A"17NO �� l Q$ ii,rra .,.,o, i. ji-E. "''' x " ;,, ,F t
Description 1___gtv r Each I 'Total I "
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Z. Includes attached garage.
�^ 1,000 sq.ft.or less 168.54 4
Tax map/parcel# ZSj I O T lY J Z Ea.add'1500 sq.ft.or portion 33.92 1
i .,i ' 1 ,p 17t t`r Limited energy,residential
Yee() �/� n,/ (with above sq.ft.)
1�ew sr 1�--- �7 2 f-.D V.S Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
psi c � Renewable Energy 0 See Page 2_
�9.
s _ =zx >> "°"" Services or feeders installation alteration tmd/or relocation
� � .' ;air 1C'
Name: 1J C-U eA t oos5- re d p ez 200 amps or less 100.70 —_ 2
Address: 3 3 7 ' S, 5 si- , di V�s� 401 amps to 400 amps 133.5601
33. -- 2
/}�- 401 amps to 600 amps 200.34 34 2
City/State/ZIP: ,trk�' Occ Je--c eiti 601 amps to 1,000 amps 301.04 2
0 q 7/ 3 Z 1 Z amps or volts 552.26 2( ) Over 1,000
Phone:( 1 7C� Fax:
Temporary services or feeders installation,alteration,and/or
Email: 120 B WI,4- i74e14/5 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 I 2
Owner signature: Date: 401 amps to 599 amps — 1,.58.54 2
tct� A PPl IC ANT 1 i �1 C i I- z Branch circuits-new,alteration,or extension, er panel
r,tazsN l : 14�.�. .�, e �,7 1 ..<s<x�,x ..I.,�d»,..-,,,'W�. -
-.- A.Flee or branch circuits with
Business name: 3�A - above service or feeder fee, 7,, 7.42 `
each branch circuit _
Contact name: B.Fee for branch circuits without —
service or feeder fee,first 56.18 2
Address:
branch circuit _
City/State/Z1P: Each add'l branch circuit 7.42 2
— — Miscellaneousjservice or feeder not included)
Phone:( ) Fax: : ( ) Each manufactured or modular
- — dwelling,service and/or feeder 67.84 2
Email — -- ---Reconnect only 67.84 __-+—
2
¢ ,
�tsri , a o.,:4 rONTR CTO L r _ Pump or inigation circle 67.34 2
Business name: 4� /t P y- 1 L,Cr-cG _ — Sign or outline lighting — 67.84 - 2
Address: � ��� P��/E Signal circuits)or limited-energy 0 See Page 2 2
O panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/Z1 P: N 06 Additional inspection(1 fir min) 66.251 fir
Phone:(err ( - 9 4-6 6 Fax:( ) Investigation(1 hr min) _ 90.00/hr
R Email: 13GA-Ki✓:! ifivW^/1,EIndustrial plant(1 fir min) 78.18/fir --_
t Inspections for which no fee is 90 00/air
CCB Lic.: 22 j i 7( Electrical Lie.: G( / Suprv.Lie.: specifically listed(1/2 In min),,
Nil I, ., . (1g .,4.r ri
E r .t..4lil,„.
Suprv. Electrician signature,required: _ Subtotal:
Print name: &...4c f[&--- 97 V Date: f_ �/z/ 0 Plan Review Required(25%of permit fee): -
State surcharge(12%of permit fee):
TOTAL I'ERM'T FEE:
Authorized signature:
1 This permit application expires if a pe:-mit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit
I:'Building rmits\aLCjermitApp_ELR...aRE.doc Rev 06/17/2015 446-4615T(l1/05/COM/WEB
Plumbing Permit Application
Building Fixtures (RECEIVED 1 t/K :tlrrlc'l; 1 sr '(),l.ti
Received Cityof Tigard OCTT 21 2021 aBy"
Permit No.: A�Q'"13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
e i I Phone: 503.718.2439 Fax: 503.598.19CITY OF I IGARD Date/By: Other PermitNc.:
l e,A It Tr Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: to See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
; '� FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.Description 1 Qty. La. 1 'Total--
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CAltrarORE EiFl%>C0E4S'1"litFtTIO+T SFR(1)bath 312.70 - -
ili 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath .. 500.32
❑Accessory building ®'Multi-family Each additional bath kitchen 25,02
❑Master builder 0 Other: -
Fire sprinkler(1/(0sq.ft.) Page 2
JOB SITE INFORMA�fi'A ! LOCATION' Site utilities: -- ----
Job site address: /O O 7( hilAitw V/� Al�� Catch basin or area drain -�J 8.76 - -
City/State/ZIP: 7-7 p eNz q_2c1 Drywell,leach line,or trench drain _- 18.76 -- ---_
�T� Footing drain(no.linear ft.:A) ,60Lr Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: G //eQW-r/ i /07w y Manholes 18.76
F- Rain drain connector ( 18.76
Sanitary sewer(no.linear fl.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: 1..r Fixture or item: _
Tax map/parcel no.: .5 Ito f'I-,0 Il4c /Z 300 Backflow preventer r 31.27 -
'-.'° ' "` Backwater valve 12.51
Clothes washer 3 25.02
A e 2 5/ir4rt e 40 (.// 2 r°re(!S Dishwasher ---
3 2<5 02
Drinking fountain 25.02
ter Ejectors/sump ( 25.02
I 1> *4 O 7 0''IE`'1 ANI' Expansion tank 12.51
---
Fixture/sewer cap 25.02
-
Name: t_V ." P ovs-6 A-OPa i T7t . - -
Floor drain/floor sink/hub 25.02
Address: 333 s. 57.--Art- #U�'SL-
--- Garbage disposal 3 25.02
City/State/ZIP: i- ' tsti,r -1) c _ Hose bib 25.02
Phone:(cD)) 9.76 3 Z t Z Fax:( ) Ice maker -- ---
12.51
Are A ONTAL1* prasoN Interceptor/grease trap 25.02
Business name: /3Lev it9 Q0sw- `/#4,0, 7-(45 Medical gas(value:$ ) Page 2
�n Primer 12.51
Contact name: /2414 �i4 e,g - .--
- Roof drain(commercial) 12.51
Address: 33 3 C, 571- Ste - - v��
Sink/basin/tavatoryFj 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(02) f36 3Z[Z Fax: :( ) Tub/shower/shower pan S 12.51
E-mail: lam-✓
/7 r J� B P4 fe Urinal _ 25.02
Water closet 25.02
-CONTRAOR. Water heater 3 37.52 -
Business name: j/ 5R1te p +tfpx p 1 -
`T �ilit!i Water irin DWV 56.29
Address: 7 g �-E /T6 _- --
Other: 25.02
Ciiy/State/ZIP: vpak7-(-�ri(/t i'f -- Subtotal -_ --
Bhone:(�j3) R Cf'7_S- Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
:,(76 7 Sao Plumbing Lie.no.: P637a
-, r. State surcharge(12%of permit fee)
',t4tre. °r •,~"" TOTAL PERMIT FEE
`4( ctig_ Date: Z,7t S7Z,r 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.
"1/09 440-4616T(10/02/COM/WEB)
}/
.
s>t
Plumbing Permit Application - City of Tigard • . •
ar Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sup•ression Systems:
:Site ,lies Q re!;(13 1, Square 'oo . e,. P _ m4 Eft:.
Footing drain-1'' 100' f„..- 50.03 0 to 2,000 $121.90 _ -
4 Footing drain-each additional 100' f 37.52 2,001 to 3,600 $169.69 .r
3,601 to 7,200 $233.20
Sewer-1st 100' t 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
`s Water Service- 1st 100' 62.54
i Medical Gas Systems:
{', Water Service-each additional 100' 37.52
_ ktfli Y'@Tl � ;"
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
l - ' ems �. each additional$100.00 or fraction thereof,to
` 6011400. 0,000 5 01. - .v . 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
tt which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
1ninimum 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 ton
11 hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and includil50,000.00.
' 90.00/hr $ O and up $742.00 for the first$50,000.00and$1.20 for
q Additional plan review for revisions
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
11
ii
Commercial Fixture Work:
f Are you capping,adding or replacing fixtures? if"yes",
please indicate work performed by fixture. Failure to
ii
accurately report fixtures could result in increased sewer fees*. Plan R:im rplunimb J1 aoRtLo1 ,.
Quaftit,bye!iztune`rpie Plan review is required for any of the following.
Fixture Type for ;Ft Flom Please check all that apply.
Performed:'oxk ' appedC Added a ❑ Any new commercial building with water service 2"and
1 Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
1 -Jacuzzi/Whirlpool
' Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
_ -Drivet o as defined in OAR918-780-0040.
ii
`I 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.
Pi
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
1, Floor Drain/sink: -2" ,
3„ 1 0f trio or Rise, D Iigraiifi
a 4" ❑ Isometric or riser diagram is required for new buildings
ii _ -Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
_ -Industrial food related
I. Ice Mach./Refrig.Drains Comments regarding fixture work:
1 Oil Separator(Gas Station)
} Rec.Vehicle Dump Station
II Shower: -Gang
4 -Stall
Sink: -Lay/Bar non-food related
, -Bradley
-Com/Serv/Util food related
' -Service *Note: If the fixture work under this permit results in an
`! Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes Water Extractor fees assessed for the sewer increase must be paid before the
', _Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
n
i 1:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
.1111/
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Residential
Building Permit #: ?/ _ 2 3
Site Address: 10 6 41 & A nywa f-{tl( 4
Project Name: A��U,,/1,k, kill C-4 atri-i4-roviLot #: Z
Planning Re "ew "Wt.,/ )4'7 A - -"evi eAtn. itivv) my /'14,1N /ova
Proposal:
ciii Verify address/suite# active in Accela. ❑ In River Terrace: p No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: g/Erosion Control
I 03 copies of site plan on 8-1/2"x 11"or 11 x 17"paper IiItetained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) QPFootprint of new structure(including decks)and FFE
®North arrow iS3Utility locations&easements(required for new and additions)
j QgSite address,project or subdivision name and lot number R2Sidewalk/driveway approach
14Applicant information(name and phone number) wells!sep c
'j Mot dimensions and building setback dimensions g/Street tree size,type and location
t 17c trP f�.,+ .o ct••.ta. g r.,h ao.. t�t,oa Street names
nE
Jting a r rco on bit,. more
LLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? 0Yes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes ONo
pClean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified e5:1) No Received: ❑ Yes ❑ No
jg Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: i3'Yes,applicant was notified ❑ No Received: iV Yes ❑ No
f 9 SDC Exemption for ADU applied for: ❑ Yes L,6No Received: ❑ Yes ❑ No
iPublic Facilities Improvement (PFI) Permit: t`� Zy
Required: ❑ Yes,applicantpAA was notified I "No r Applied For: /�❑ Yes ❑ No,stop intake
® Land Use Case#: I4�'P 2 /�O24 ' 0000 Z I GP Zoning: (2
C' Required Setbacks: Front: I 9t Rear: 155 r Side: 5 Street S' I 0` Garage: 20
GO Building Height: Max. Height: 3 5( Actual Hei h 5.7
0 Landscape Area: .0 % ❑ Lot Coverage Max: C)
Entrance p Set back no more than 8'from street-facing wall P Parallel to street or offset 45 degrees or less
Windows p Minimum 12%of area of all street-facing facades
Garage �' ... _ • wall ❑ Yes ❑ No,one o • ..wing is met:
❑ It.. -xtetits no more than 5'from wall and there is a covered .. •xten.rr • beyond garage.
❑ Door exten.- .o more than 5'from wall and there is a 1 t.window a ove g rage on 2nd floor.
❑ Garage door width is • - . - • !' . . ess of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ' -cessed entrance ^!..•I.a ! ' ' .. -. e ❑ Roof offset
❑ Fires ' ❑ Lap Siding ❑ Roof pitch ❑ Gable, i., • :. brel roof ❑ Dormer
ccent siding ❑ Window trim ❑ Window recess ❑ Window projec a'. U Balcony
De Visual Clearance kl Urban Forestry Plan
® Sensitive Lands: ❑ Yes )k3 No Type:
Conditions met prior to issuance of building permit
Notes:
p Approved By Planning: XMAA Date: 0 4
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
1:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: L0l2(72021
Site Plans: # ,3
Building Plans: # 3
Building Permit#: [I '"Enter building permit#above. �/
Workflow Routing: Er Planning ILL-Engineering Permit Coordinator `LJ' Building
Workflow Sign-off: EVSign-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.
e Building: original permit application, site plans,building plans, engineer and
yy��, �f,�T�/,Ulry�� ' beam calculations and trust details,if applicable, etc.
Notesit� G(Y `2 C �1✓'t ZCAn / Ite/. /'''),STY r 54A.1 Cc42"7�)
By Permit Technician: Date: /0/.2/2CJ2( �/ j
Engineering Review
r(Slope at building pad: Zd 707
Conditions "Met"prior to issuance of building permit
ieVEasements (encroachments) per engineering conditions of approval and plat
af Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes L No
Assess Water Quantity Fee in-lieu: ❑ Yes L' ,.
LIDA Facility on lot: ErYes No
ir Final Plat Recorded:[
NOT Approved by Engineering: Date: �/3/Z'
Notes: /l 1)d /S 14444/47
•
Lt Approved by Engineering: f ' Date: ___4_AV'
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
aft
Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: ' ( j\,DA' Date: I1 l I?.a21
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
C� SDC Exemption: ❑ Received xi Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: /Yes ❑ N/A
Parks SDC: fr Yes ❑ N/A
LIDA \Yes . N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: 1 119I I 1-'01"1-
I:\Building\Fonns\BldgPennitRvw_RES_122419.docx
Water Meter Fitture unit Worksheet RECEIVED
OCT 21 2O21
Please complete the following informat low CITY Or g loi-Ini,i
BUILDING DIVISION
t'antnit'hit N.iiinic /4k.' U PA L 00 I.e. pp?0",rte..
ililittl$ Addles,. Siteet Suite P -777:5 -r .. 4:4-Artp 5r- .si," it _At • I-
t "v L'..Atti -rattiEriel SAt' '4., - ,Zgl'i /7C41-_
Phone Number -Z3 tiN? 41Z 12
NoN Meet Aiiiirem ,/,,,pf37 1 :ski AA)Amive AN i
t
Sub.hvision Name Lc *
Budding Permit Si fol.
P itCASt fill In the number of - li fixture WI donned on the mots Multtply the mammy hy the
to amse at the point total Add 811 point totals tether lot total fixture unit
Fiume Unit quantity Point V , Poor Total
Bar tusk
0
Wet C.' s
Clothes washer 3 DIshwashet s 1 4 ., 4..5
Host bib I x
Rost bib, each ad,iltionei .„ _ ,i lt, 1 . ,I.
...
Klub= sink * 15
Lauadry sink 4:3 s. / 3
,..Lavatory .5 x
okia.ki,..5
Water closet I 6 GPF
.1 _ 't
*. ...
iripooi
-
, 4 •,,
I %paw stag
,t ,4
Itaththowtv citwoho 4 .
4 * . ,......._.
bTitatrioti(01 of heads in isaltst torso C ti I
* ,,,,,.
1 04alitxture t 041 raasec 42.,.'War* that PtAtits:
Up so 30 ... 54" Over 37 r
Iv to 37 - 3/4"
Skiff Meet"COW: $ .444,* '
*******,0,4********eseee*****,80,00,4******4,0411.***•••••.**********************************40,0
[ FOR OFFICE USE ONLY
Fixture Units Points verified with
liolidins(Mawr)Pemsit or Plumb Ung LA '
Nos 0 No C)Other
meter a
F
e,
SOX'Moe eceipt
Mr.....”44100..................----
Matt COO:
woserag......wwomemgmoreas..,............100•1101.14..ra....
' I tb011411,41,P4011{44 i Vi*OH ktofiro OD t I*fieo
1 „ ,,
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
11/
= Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: M H • DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: DEC 2 2 2021
COMPANY: CITY OF TIGARD
BUILDING DIVISION By:
PHONE:
EMAIL:
RE: IDS7 / NA/ Nt -4\30 I 130P2621- 00233
(Site Address) (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit echnician:/Date: f— .a„,),_ Initials:
Fees Due: ❑ Yes 11k6 Fee Description: Amount Due:
$ �
$
Special
Instructions: I L� No
Reprint Permit(per PE): ❑ Yes ❑ Done
Applicant Notified: ` Date: p. (3 /22 . Initials: LA
I:\Building\Forms\TransmittalLetter-Revisions_073120.doc
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
= Transmittal Letter
T i G A Iz r� 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: 7-0 A4 1L . DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: DEC 7 2U21
COMPANY: 134-V E- P L oUS- CITY OF TIGHRD
�
BUILDING DIVISION
PHONE: 4
EMAIL:
RE: /0e7 / c.SW RNA/ A2J HILL �C--. WP202 /—OOZc33
(Site Address) (Permit Number)
ANN +41 LL 1 L0T2
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. a Revisions: P1AO S
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Permi echnician: Date: f —CI— ZZ Initials: ---j#
Fees Due: ❑ Yes No Fee Description: Amount Due:
$ �
Special
Instructions:
Reprint Permit (per PE): ❑Yes No n Done /70_
Applicant Notified: i--- Date: ,2 I /.. Initials:
L:\Building\Forms\TransmittalLetter-Revisions 073120.doc
Agnes Lindor
From: Agnes Lindor
Sent: Thursday, November 4, 2021 9:09 AM
To: robm bluepalouse.com
Cc: Boris Piatski; Sean Vermilya;#Building Permit Technicians
Subject: Annand Hill Ct MST2021-00463 -469
Attachments: TransmittalLetter.pdf
Hi Rob-
Engineering has requested revision to your site plan. Please show and provide dimensions of the LIDA and resubmit
along with the attached transmittal sheet. If you have any questions related to the LIDA and how big in needs to be,
please contact Boris Piatski (copied on this email.Thanks,
Agnes Lindor I Associate Planner
City of Tigard I Community Development
13125 SW Hall Boulevard
Tigard, Oregon 97223
Phone: 503.718.2429
Email: AgnesL@tigard-or.gov
1