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Permit
Mechanical Permit Application FOR OFFICE USE ONLY Cl of Tigard Received `J g Date/By: 10 aI hal. Permit No.: t!y`s aGac,^ CJ� , 116 II 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review s Phone: 503.718.2439 Date/By: Other Permit: T I G A It I> Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for Internet: www.tigard-or.gov vik. Notified/Method: Supplemental Information TYPE OF WORK I 1tT I/ PS New construction ❑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 0 Other mechanical materials,equipment,labor;overhead,and profit. F S 8 wt 6 i 4f '' `i 74' t:. 4 Value.$ F] 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total 1 xY,4f i t.A: a: t° 1 Heating/cooling: Job site address: . 1- 144 1 c.) W l r 1 (5 fi ki Air conditioning 46.75 46.75 Furnace 100,000 BTU(ducts/vents) City/State/ZIP: 7 6,4P Q Q R .. 2 2, 3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: I Project name: 2j Heat pump 61.06 S / �� Duct work ` " 23.32 Cross street/directions to job site: a c - •Clair- __ Hydronic hot water system 23.32 t Residential boiler(radiator or —7-- - r — -- , . hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 ' ,,,- u *`s R ` ,• l'€ '" .3°;e + M c i Gas fireplace/insert 33.39 Flue vent for water heater or gas • fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ¢ - t ; WkTS; 4 `c—,d S.i iVek k Other: 23.32 (� 1._ Environmental exhaust and ventilation: Name: Ycs V G t Act.T1S Range hood/other kitchen / Address: i fj 3 sr)} C5(TOL 1kijy_- equipment 33.39 Po r tb, �� 7 2/? Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, `� i Phone:(5C�3) 200' e ' -7 u Fax:( ) toilet compartments,utility rooms) 23.32 , ' � ; Attic/crawlspace fans 23.32 : : t4 �� PPLICANTr E * t..p �_ � ���}�u�,4 Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. tr Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater Water heater Phone:( ) Fax: :( ) Fireplace Range 1 E-mail: l Barbecue CONTRACTOR Clothes dryer(gas) Business name: I iZ COM ' f HE M I t&G g,coot,M/pth j,G . / `�' MECIiANiCAL 1P� , ` Address: 2g©6' I S E 6G Pt Subtotal City/State/ZIP: D MA 148 C Ij 5 ©p., 7 7-el 9 Minimum permit fee($90.00) Phone: 'p&) S(.if 2 S� Fax:( ) Plan review(25%of permit fee) 2 ©� State surcharge(12%of permit fee) CCB lie;: TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 1.4.13 days after it has been accepted as complete. 'A ! r ;} * Fee methodology set by Tri-County Building Industry Service Board Print name: ( L.)(1A ri p y It U (V h A. Date: 0 6—�6— 2 uilding�Permits\MEC_PermitApp_082520.doc 440-06t 71(t t�02/COM/WFB) Electrical Permit Application . 1 FOR OFFICE: Lsl/ONLY Cityo f Tigard Received g Date'B : (� ...-w 13115 SW Hall Blvd..Tigard,OR 97223 Plan Review il Phone: 503.718.2439 Fax: 503.598.1960 Date,B : elinffini Related Permit#: Inspection Line: 503.639.4175 Ready Date:By: Juris: 0 See Page 2 for TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW 0 New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ['Service or feeder 4(x)amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.0(5)amps at 150 volts or 0 Floating buildings. 0 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground.or exceed.14.(x10 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 13 f Zi 7 5'w 1/ S' llt)HP or more. ❑"A'."E". 'l-2`."I-3', City/State/ZIP: r may./�{ �y✓� +� ❑Six or more residential units. occupancy. �l 9O2.4^1 [< 'I�, g /2 2 3 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 6(10 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each 1 Total I * 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#: La.add'l 500 sq.II_or portion 6 33.92 1 DESCRIPTION OF WORK Limited energy,residential (� / �L ,( /_ p �j (with above sq.ft.) 75.00 I taaijC7 &in/ �`/'t'5/7 P 4C1✓'i`(' WO -/( N,- / h e Limited energy,multi-family 2 �// / ' residential(with above sq.ft.) 75.00 e/'7/`1 i/v b o fat S e Renewable Energy 0 See Page 2 0 PROPERTY OWNER 0 TENANT . Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps ! 133.56 2 401 amps to 6(X)amps 2(X).34 2 City/State/ZIP: 601 amps to 1.0(X)amps 301.04 2 Phone:( ) Fax:( ) Over 1.000 amps or volts 552.26 2 ' Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 2(0)amps or less 59.36 , I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 4(0)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 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'!branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 5/92/7R ElEcrWc LLB' Sign or outline lighting 67.84 2 ^ Signal circuit(s)or limited-energy Address: 9 eys s - t. /o°pep /�,'«S !�'le, panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above pI9, G is ,lt .1 7 Oki Additional inspection(I hr min) 66 25/hr Phone:(503 337 — 3 730 Fax:(5 3) 6 '$ ._ 28/7 Investigation II hr min) 90.00/hr Email: r�, ,, Industrial plant(I hr min) 78.18/hr 0 SS/zt1Electal , C177 Inspections fr which no fee is• 90.00!hr CCB Lic.:/E 2 es Lic.: Suprv.Lic.:G' 1 S2 specifically listed(1/2 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,require el Subtotal: Print name: Drer2 p s, Sot. efu- Date: 6 6"— 2-7 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signaty: This permit application expires if a permit is not obtained within 180 Print name-/4/\,....--�Otrefei �,4.Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:'Building\t'ermits\Et.C_permitApp_ELR_ERE.doc Res 0617i2015 4-10-46t5T111:05-COM WER II CITY OF TIGARD MASTER PERMIT I COMMUNITY DEVELOPMENT Permit#: MST2020-00301 Date Issued: 03/21/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 103CA00111 Jurisdiction: Tigard Site address: 13147 SW 115TH AVE Subdivision: None Lot: None Project: Matis-Bldg 2 -Primary Dwelling Project Description: New primary dwelling with (2)ADUs on separate permits. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 573 sf Basement: 0 sf Left: 10 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 829 sf Garage: 278 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 10 Detectors: Total: 1402 sf Value: $185,235.86 Rear: 15 PLUMBING Sinks: 4 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 3 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'l 500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 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 Y Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 1402 Owner: Contractor: MATIS,PAVEL&LIVIA OWNER Required Items and Reports(Conditions) 11375 SW CAPITOL HWY 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97219 PHONE: PHONE: FAX: Total Fees: $33,206.09 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 oc ..nni nnin thrnunh r1Ao oc9.n 1 Vni i maw nhtnin a rnnw of thn rnloc nr rlirnrt nncctinnc to( I Mir by Tallinn cnZ 9Z9 1QR77/_nr I Ann Z199')Zild I Issued By: r / Permittee Signature: /jr"ruc�`t i vk 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. . b U4 (3- c- Building Permit Application /II & T i S \ ,-n . . . sidential RECEIVED 'FOR OFFICE USE o Lv Received ��L�L�/ City of Tigard2411 DateBy/O/V 4W Permit No ,� Q/ III 41 13125 SW Hall Blvd.,Tigard,OR 97223 Q C T Plan Review _I i W/CZUU2I.).�/76 Phone: 503.718.2439 Fax: 503.598.1960 DateBy: (Z1fik Other Perm I I t 1 tt I) liV Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By. /// _ii"-1 J 1 ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method:3/7��� 4 (/ ,,� Supplemental Information 474- �-,(/� Ali q-T '/y-z_ __ 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 ❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overheadi and the profit for the le CATEGORY OF CONSTRUCTION work indicated on this application. 1436- 2-3T I 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ rrr— 0 Accessory building 0 Multi-family Number of bedrooms: 3 ❑Master builder El Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 k,LISO Job site address: 13147 SW 115th Street //2.//n/15-727 .4(.4/ A - New dwelling area:1yoU96- square feet 9-2,9 City/State IP: Tigard,OR 97223 Garage/carport area-076;84' square feet 97/3 Sui ld apt.no.: Project name: /*WS — PA,/Mi¢7?/ . 1G1 C Q N&evered porch area: square feet t itss street/directions to job site: Gaarde/115th Street Deck area: square feet cy et7.1 f i.I/''.i t�-- /�% JLt7L. L E77 ---- Other structure area: square feet l� O REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: WDML Lot no.: 111 Permit fees*are based on the value of the work performed. Tax map/parcel no.: 2S103CA00111 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Proposed single family residence with two attached ADUs. Valuation: $ P #`7 , , 1J ` L` Existing building area: square feet •mow New building area: square feet 3 PROPERTY OWNER ❑ TENANT Number of stories: Name: Pavel and Livia Matis Type of construction: Address: 11375 SW Capitol Highway Occupancy groups: City/State/ZIP: Portland,OR 97219 Existing: Phone:( 503) 200-8564 Fax( ) New: 0 APPLICANT II CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: West Coast Design and Graphics,LLC Structural plan review fee(or deposit): 707. 6 If Contact name: Nathaniel Rotta FLS plan review fee(if applicable): Address: 11165 NW Copeland Street City/State/ZIP: Portland,OR 97229 Total fees due upon application: Amount received: Phone:(503 )805-4339 Fax::( ) E-mail: nrotta@wc-dg.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: ,�' / ' , rZ, Submit two(2)sets of roof plan with connection details L'/!v - � and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Nathaniel Rotta Date: 10/5/2020 *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) f Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard RECEIVED Received Date/By: �S�2O.. 3O/ Permii No.: 13125 SW Hall Blvd.,Tigard,OR 97223 = Phone: 503.718.2439 Fax: 5'03.598.1960 Plan Review CT ��� Date/By: Other Permit: II G A K D Inspection Line: 503.639.4175 Date Ready/By: Juris El See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* X❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 1 Job site address: 13147 SW 115th Ave (requires site plan showing placement) 46.75 City/State/ZIP: Tigard,OR 97223 Furnace 100,000 BTU(ducts/vents) 1 46.75 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Gaarde/115th Street Duct work 1 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 Subdivision: WDML Lot no.: 111 Flue/vent for any of above 23.32 Other: 23.32 Tax map/parcel no.: 2S103CA00111 Other fuel appliances: DESCRIPTION OF WORK Water heater 1 ` 23.32 Proposed single family residence Gas fireplace 33.39 Flue vent for water heater or gas 1 fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ® PROPERTY OWNER 0 TENANT Chimney/liner/flue/vent 23.32 Other: 23.32 Name: Pavel and Livia Matis Environmental exhaust and ventilation: Address: 11375 SW Capitol Highway Range hood/other kitchen 1 equipment 33.39 City/State/ZIP: Portland,OR 97219 Clothes dryer exhaust 1 33.39 Single-duct exhaust(bathrooms, Phone:(503 )200-8564 Fax: ( ) toilet compartments,utility rooms) 23.32 © APPLICANT ® CONTACT PERSON Attic/crawlspace fans 23.32 Business name: West Coast Design and Graphics,LLC Other: 23.32 Fuel piping: Contact name: Nathaniel Rotta $14.15 for first four;$4.03 for each additional Address: 11165 NW Copeland Street Furnace,etc. Gas heat pump City/State/ZIP: Portland,OR 97229 Wall/suspended/unit heater Phone:( 503) 805-4339 Fax::( ) Water heater 1 we-d com Fireplace nrotta E-mail: @ 9• Range 1 CONTRACTOR Barbecue Business name: TBD L /,I/6., Clothes dryer(gas) Other: Address: MECHANICAL PERMIT FEES* City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee($90.00) Plan review(25%of permit fee) CCB lic.: State surcharge(12%of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Nathaniel Rotta Date: 07/24/2020 * Fee methodology set by Tri-County Building Industry Service Board 1\Building\Permits\MEC-PermitApp.doc 09/09/10 440-4617T(11/02/COM/WEB) Electrical Permit ApplicationEMMEMZEMEMI i City of Tigard E V E Date/B,: Permit 4:�'1>;f, o'-cO30/ a 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review . Received ■ Phone: 503.718.2439 Fax: 503.598.1960 Date/B�: Related Permit#: • OCT 4 6 2018 e/ _._..._. .-_ Inspection Line: 503.639.4175 Ready Date/By: runs ElSee Page 2 for 11..;_A K l.) Internet: www.tigard-or.gov Notified+Method: j Supplemental Information CITY OF l IGARD TYPE OF WOl{ Ilj DING DIVISION PLAN REVIEW I)New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 DemolitionOther: 0 Service or feeder 400 amps or more 0 Building over three stories. 0where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial ❑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: 13147 SW 115th Ave 100HP or more. ❑"A "E","1-2","l-3", City/State/ZIP: Tigard,OR 97223 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. ❑Supply voltage far more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Gaarde/115th Street FEE SCHEDULE -..._ Description i Qtr. 1 Each i Total I • New residential single-or multi-family dwelling unit. Subdivision: WDML 1 Lot#: 111 Includes attached garage. Tax map/parcel#: 2S103CA00111 1,000 sq.ft.or less 168.54 4 Ea.add')500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential Proposed new single family residence (with above sq.ft.) 75.00 2 Limited energy,multi-family i 2 residential(with above sq.ft.) I I 75.00 Renewable Energy 1 ❑ See Page 2 ® PROPERTY OWNER R nIVE D _Services or feeders installation,alteration,and/or relocation Name: paves and Livia Matis 200 amps or less 100.70 2 Address: 11375 5W Capitol Highway 201 amps to 400 amps 133.56 2 SEP 1 4 2021 401 amps to 600 amps 1___ 200.34 2 City/State/ZIP: Portland,OR 97219 601 amps to 1,000 amps 301.04 , 2 G O rf AH D Over 1,000 amps or volts 552.26 2 Phone:(503 )200-8564 Fax:( H it DITYiNG DIVISION! G I Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 snips or less 59.36 1 ,� intended for sale,lease,re r change.according to ORS 447,449.670, d 011. 201 amps to 400 amps 125.08 2 'a' Owner signature: Date: ct .b\ZA 401 amps to 599 amps 168.54 2 IN APPLICANT ® CONTACT PE N Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: West Coast Design and Graphics,LLC above service or feeder fee, each branch circuit 7.42 2 Contact name: Nathaniel Rotta B.Fee for branch circuits without Address: 11165 NW Copeland Street brra hice circuit feeder fee,5ist it 56.18 2 City/State/ZIP: Portland,OR 97229 Each add')branch circuit 7.42 2 - — -- Miscellaneous(service or feeder not included) Phone:( 503) 805-4339 Fax::( ) Each manufactured or modular 1 dwelling. service and/or feeder 67.84 2 Email: nrotta©wc-dg.com . Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: TBD - /A( Sign or outline lighting 67.84 ` 2 {' �7•" Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel alteration or extension. Each additional inspection over allowable in any of the above City/State/ZIP: Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is slx cificalh listed(yx llr mini 40.00/tar CCB Lic.: Electrical Lic.: Suprv.Lic.: ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: _ Subtotal: Print name: Dale. 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): / y —wary/ �7 TOTAL PERMIT FEE: Authorized signature: 1,rr'nr _ This permit application expires if a permit is not obtained within 180 Print name: Nathaniel Rotta Date: 07/24/2020 days after it has been accepted as complete. • Number of inspections allowed per permit. 1:1Building\PermirslELC_PennitApp_ELR_ERE.doe Rev 06/17/2015 440.4615T(11/05/COMIWEB • Plumbing Permit Application Building Fixtures RECEIVED FOIz OFFI( E t SE ONIt City of Tigard n r 0T �O�q Received Permit No./�j r��� 11 13125 SW Hall Blvd.,Tigard,OR 9722 6 0 Date/By: //IS/w�0'Gl`>3O/ S Plan Review Phone: 503.718.2439 Fax: 503.598.tiffy OF TIGARD Date/By: Other Permit No.: 1 I G A R 1) Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris la See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE j New construction 0 Demolition For special information use checklist Description Qty. Ea. Total 0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 IDAccessory building ❑Multi-family SFR(3)bath 1 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 13147 SW 115th Ave Catch basin or area drain 18.76 City/State/ZIP: Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Gaarde/115th Street 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: WDML I Lot no.: 111 Fixture or item: Tax map/parcel no.: 2S103CA00111 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 Proposed single family residence Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 [n PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Pavel and Livia Matis Fixture/sewer cap 25.02 Address: 11375 SW Capitol Highway Floor drain/floor sink/hub 25.02 Garbage disposal 1 25.02 City/State/ZIP: Portland,OR 97219 Hose bib 2 25.02 Phone:(503 )200-8564 Fax:( ) Ice maker 1 12.51 ® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 Business name: West Coast Design and Graphics,LLC Medical gas(value:$ ) Page 2 Contact name: Nathaniel Rotta Primer 12.51 Roof drain(commercial) 12.51 Address: 11165 NW Copeland Street Sink/basin/lavatory 4 25.02 City/State/ZIP: Portland,OR 97229 Solar units(potable water) 62.54 Phone:( 503 ) 805-4339 Fax: :( ) Tub/shower/shower pan 2 12.51 E-mail: nrotta@wc-dg.com Urinal 25.02 CONTRACTOR Water closet 3 25.02 Water heater 1 37.52 Business name: TBD Lrl✓w Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Nathaniel Rotta Date: 10/05/2020 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:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) '3 �. -) G Dianna Ornelas From: #Building Permit Technicians Sent: Monday, August 2, 2021 12:21 PM To: 'Paul' Subject: RE: Matis ADU - Buildings 1 &2 - 115th Ave Attachments: SKM_C65921080212000.pdf Importance: High Hello Paul, I have updated all contractor information for these permits as 'owner'for all structural, mechanical,electrical and plumbing. 7 The electrical permit applications require that you sign and date each application for'owner installation' section next to the red * on the attached applications and return by email to TigardBuildingPermits@tigard-or.gov. We will need these applications signed before we can issue the permits. Thank you. Dianna L.Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits From:#Building Permit Technicians Sent:Thursday,July 29, 2021 10:47 AM To: Paul <matis87@yahoo.com> Subject: FW: Matis ADU- Buildings 1 &2 - 115th Ave Hi Paul, Thank you for contacting me. Per our conversation,we will list you as the owner' contractor for all trades, structural, mechanical,electrical and plumbing. When you hire a licensed contractor,you will immediately notify the city with the name of the contractor and license information. For electrical,we will require the electrical application be signed by the signing electrical supervisor. Please see the balance due for each building listed below. Call me to let me know if you are having a check mailed. When we receive the check,we will issue the permits and let you know they are ready for pick up. If they are not picked up right away,we will hold them for you on the shelf until you can send someone to pick up the site copies of the permit and plans. Thank you. Dianna L. Ornelas Building Division Services Supervisor 1 City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits From:#Building Permit Technicians Sent:Tuesday,July 27, 2021 8:36 AM To: Paul<matis87@yahoo.com> Subject: FW: Matis ADU - Buildings 1&2 - 115th Ave Good morning Paul, Thank you for your submittal of the CWS service provider letters and owner responsibility form. Based on this information,we will list you as the OWNER performing as contractor for the structural work. Here is a list of the of the remaining items due before we can issue permits (see original email below with required items highlighted): • Mechanical contractor name and license#. • Plumbing contractor name and license#. • Electrical permit application with contractor name and license#'s and signed by the electrical supervisor(see electrical permit application attached). Email the above information to TigardBuildingPermits@tgard-or.gov at your earliest convenience. The invoices are attached for the fees due and fees can be paid online at https://aca- prod.accela.com/TIGARD/Welcome.aspx by searching for each permit record number under the Building tab. Payment can be made by'card'for a 3%service fee or select the 'check' payment option and there is no service fee. Please email the permit technicians at TigardBuildingPermits@tgard-or.gov once the fees are paid so that we can issue the permit and make it available for pick up. Thank you and please let me know if you have any questions. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 503-718-2439 Permits From:#Building Permit Technicians<TigardBuildingPermits@tgard-or.gov> Sent:Tuesday, March 9, 2021 1:00 PM To: Nathaniel Rotta <nrotta@wc-dg.com> Cc:#Building Permit Technicians<TigardBuildingPermits@tgard-or.gov>; Allyson Armstrong<AllysonA@tgard-or.gov> Subject: Matis ADU - Buildings 1 &2 - 115th Ave Hello Nathaniel, Permits for Building 2 of the Matis project are ready to issue as follows(see invoices attached): Matis-Building 2 2 Unit Permit# Fees Due Primary MST2020-00301 $ 32,454.75 ADU 1 MST2020-00302 $ 21,045.49 ADU 2 MST2020-00303 $ 21,093.30 Sewer SWR2020-00170 $ 17,435.00 Total: $ 92,028.54 In addition to these permits,the permits for Building 1 re also ready to issue. Please note that we have revised the sewer permit by assessing all sewer connection fees for a primary dwelling and ADU's combined on one single sewer permit for the primary dwelling address. Here is a list of t e permit fees due for Building 1 and invoices are attached. Matis-Building 1 3 Unit Permit# Fees Due Primary MST2020-00257 $ 33,864.49 ADU 1 MST2020-00258 $ 21,297.30 ,4 Sewer SWR2020-00150 $ 8,735.00 Total: $ 63,896.79 The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for each permit record number under the Building tab. Please note that we must have the following items for both Buildings 1 and 2 prior to permit issuance: • Licensed contractor information for building, mechanical, and plumbing contractors. Include contractor business name and all license numbers. • Completed electrical permit application signed by the electrical supervisor. • Clean Water Services site assessment approval letter. Please email the above items to TigardBuildingPermits@tigard-or.gov as soon as possible. Please email the permit technicians at TigardBuildingPermits@tigard-or.gov once all of the fees are paid so that we can issue the permit and make permits available for pick up. I am out of the office until April 5th. If you have any questions regarding this project, please email the permit technicians at TigardBuildingPermits@tigard-or.gov. Thank you. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct ( 503-718-2439 Permits DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." 3 Dianna Ornelas From: #Building Permit Technicians Sent: Tuesday,July 27, 2021 8:36 AM To: Paul Subject: FW: Matis ADU - Buildings 1 &2 - 115th Ave Attachments: MST2020-00257_Matis_BIdg1_Primary.pdf; MST2020-00258_Matis_BIdg1_ADU.pdf; SWR2020-00150_Matis_BIdg1.pdf; MST2020-00301_Matis_BIdg2_Primary.pdf; MST2020-00302_Matis_BIdg2_ADU 1.pdf; MST2020-00303_Matis_BIdg2_ADU2.pdf; SWR2020-00170_Matis_BIdg2.pdf; ELC_PermitApp_ELR_ERE_061715.pdf Good morning Paul, Thank you for your submittal of the CWS service provider letters and owner responsibility form. Based on this information,we will list you as the OWNER performing as contractor for the structural work. Here is a list of the of the remaining items due before we can issue permits(see original email below with required items highlighted): • Mechanical contractor name and license#. • Plumbing contractor name and license#. • Electrical permit application with contractor name and license#'s and signed by the electrical supervisor(see electrical permit application attached). Email the above information to TigardBuildingPermits@tigard-or.gov at your earliest convenience. The invoices are attached for the fees due and fees can be paid online at https://aca- prod.accela.com/TIGARD/Welcome.aspx by searching for each permit record number under the Building tab. Payment can be made by 'card'for a 3%service fee or select the 'check' payment option and there is no service fee. Please email the permit technicians at TigardBuildingPermits@tigard-or.gov once the fees are paid so that we can issue the permit and make it available for pick up. Thank you and please let me know if you have any questions. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits From:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Sent:Tuesday, March 9, 2021 1:00 PM To: Nathaniel Rotta <nrotta@wc-dg.com> Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>;Allyson Armstrong<AllysonA@tigard-or.gov> Subject: Matis ADU - Buildings 1 &2 - 115th Ave Hello Nathaniel, Permits for Building 2 of the Matis project are ready to issue as follows(see invoices attached): 1 Matis-Building 2 Unit Permit# Fees Due Primary MST2020-00301 $ 32,454.75 ADU 1 MST2020-00302 $ 21,045.49 ADU 2 MST2020-00303 $ 21,093.30 Sewer SWR2020-00170 $ 17,435.00 Total: $ 92,028.54 In addition to these permits,the permits for Building 1 are also ready to issue. Please note that we have revised the sewer permit by assessing all sewer connection fees for the primary dwelling and ADU's combined on one single sewer permit for the primary dwelling address. Here is a list of the permit fees due for Building 1 and invoices are attached. Matis-Building 1 Unit Permit# Fees Due Primary MST2020-00257 $ 33,864.49 ADU 1 MST2020-00258 $ 21,297.30 Sewer SWR2020-00150 $ 8,735.00 Total: $ 63,896.79 The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for each permit record number under the Building tab. Please note that we must have the following items for both Buildings 1 and 2 prior to permit issuance: • Licensed contractor information for building, mechanical, and plumbing contractors. Include contractor business name and all license numbers. • Completed electrical permit application signed by the electrical supervisor. • Clean Water Services site assessment approval letter. Please email the above items to TigardBuildingPermits@tigard-or.gov as soon as possible. Please email the permit technicians at TigardBuildingPermits@tigard-or.gov once all of the fees are paid so that we can issue the permit and make permits available for pick up. I am out of the office until April 5th. If you have any questions regarding this project, please email the permit technicians at TigardBuildingPermits@tigard-or.gov. Thank you. Dianna L.Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 2 /17sic2,0 ;2-0 - oa 3 ( 9iRECEIVED iy7 -Cott/ JUL 26 2021 CITY Or-T1GANu BUILDING DIVISION CleanWate' Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number I 21-001857 1. Jurisdiction:Tigard 2. Property Information(example: 1 S234A801400) 3. Owner Information Tax lot ID(s): Name: Pavel Malls 2S103CA00111 Company: Address: 13147 SW 115th OR Site Address: 13147 SW 115th City,State,Zip: Tigard,Oregon,97223 City,State,Zip:Tigard,Oregon,97223 Phone/fax: 5032008564 Nearest cross street: Fonner St Email: matis87@yahoo.com • 4. Development Activity(check all that apply) 4. Applicant Information ❑ Addition to single family residence(rooms,deck,garage) Name: Pavel Matis ❑ Lot line adjustment ❑ Minor land partition Company: ❑ Residential condominium ❑ Commercial condominium Address: 13147 SW 115th ❑ Residential subdivision 0 Commercial subdivision City,State,Zip: Tigard,Oregon,97223 ElSingle lot commercial CIMulti lot commercial Phone/fax: 5032008564 Other New SFR w/ADUs Email: matis87@yahoo.com 6. Will the project involve any off-site work? ❑yes ❑No ❑Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate. Print/type name Pavel Matis Print/type title Signature ONLINE SUBMITTAL Date 6/9/2021 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also be required. Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,State and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02,1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,state and federal law. ❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2).NO SITE ASSESSMENT OR SERVI C:� Reviewed by a+.. Date 7122121 •nce comp e e,emai o: ' •eview@cleanwaterservices.org • Fax:(503)681-4439 OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway,Hillsboro,Oregon 97123 Reveed 212020 Mein Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p:503.681.3600 t.503.681,3603 • cleanwaterservices.org A'/ST2o42 0 dO3® / /' g-n7) RECEIVED /3/ y7 S // S JUL 26 2021 CITY OF TIGARD Property Owner Statement BUILDING DIVISION Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the 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: 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 X 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. ?Lk Ma iS Print Name of Permit Applicant Signature of Permit Applicant Date Permit#: �./-�t1 cJ 0 615 v/ Add ress:- a` 0 : r ��3 ' ZZvnrrrti -110,�1O� s3 3 Issued by: Date: t_r1i r /VS cgev Q 00.30 / ..g6,.2 361.3 /.3i1/'7, /3 19 73/ i S i y'� / This Copy for Permit Offices -, / S7?-' 'o�� -oa23 7 -�? /J/ . 3, /J/6S Sd.J <1-C ' 4= Namiimi City of Tigard q COMMUNITY DEVELOPMENT DEPARTMENT li T I G A ,1, Building Permit Review — Residential Building Permit #: / �5S 2d cV CJ/ ,4211y,•9-/L. Site Address: 13145, 13147 8 131;9-SW 115th Ave Project Name: Matis Lot #: Planning Review R2artSlun Il(z)20-Aetcteal (t 0A- Proposal: New single detached house with 2 attached ADUs QVerify address/suite #active in Accela. Q In River Terrace: ❑r No ❑ Yes, River Terrace Review Addendum Site Plan Elements: erosion Control 0: copies of site plan on 8-1/2"x 11"or 11 x 17"paper „ i etained trees with drip line and tree protection measures 0 Drawn to scale(standard architect or engineer scale) footprint of new structure(including decks)and FFE 0 orth arrow °JJtility locations&easements(required for new and additions) ISbite address,project or subdivision name and lot number Qidewalk/driveway approach 0 pplicant information(name and phone number) Are.,:.ocation of wells/septic systems •t dimensions and building setback dimensions street tree size,type and location I.quare footage of buildings to be demolished ,::,Street names \_ b II xisting structures on site v omer elevations (2'contours if more than 4'differential- II •t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es o impervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ° es o Cl.Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Required: El Yes,applicant was notified ❑No Received: ❑Yes El No ❑ Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: ❑Yes,applicant was notified ❑No Received: ❑ Yes �'' No OKEI SDC Exemption for ADU applied for: ❑Yes ❑r No Received: ❑Yes L"J No ❑ Public Facilities Improvement (PFI) Permit: Required: El Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake 0 Land Use Case #: ADU2020-00008 &ADU2020-00009 ❑ Zoning: R-4.5 0 Required Setbacks: Front: 20 Rear: 15 Side: 10 Street Side: N/A Garage: 20 0 Building Height: Max. Height: 30 Actual Height: 25 1 .••scape Area: % of Coverage Max: Entrance et back no more than 8'from street-facing wall ❑ Parallel to street • • set 45 degrees or less Windows Minim..-. 12%of area of all street-facing facades Garage Gara e door is •;..nd widest street-facing wall , ' P •es ❑ No,one of the following is met: Door extends no . - than 5' from wall and - is a covered porch extending beyond garage.. Door extends no more than ' ro .i and there is a 12 sq ft.window above garage on 2nd floor. Gara•e door width is ll12' • -ss '11. O%or less of facade 60%or less and includes 7 of following: Covered porch i •ecessed entrance S. all offset 1'Roof eave ._ Roof offset Fire s '•:es In Lap Siding ❑ Roof itch 1 Gable,hi ,or gambrel roof _ Dormer ccent siding II Window trim LI Window recess Window projection ❑ Balcony ❑ Visu. ' earance ❑ Urban ForestPlan e ,ensitive Lands: ❑ Yes if..1 No Type: 0 Conditions met prior to issuance of building permit Notes:Property is a flag lot so single detached house desi n standards do not apply ElApproved By Planning: W. Date: 10/8/20 Revisions (after Building Submittal only) Reviewer Date Revision 1: Approved ❑ Not Approved Al--- 1‘\II lz Revision 2: ❑ Approved ❑ Not Approved i:\BuildingTorms\BIdgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: /O/O6i/?CS2O Site Plans: # 5 Building Plans: # 3 Building Permit#: ❑-'Enter building ermit#above. Workflow Routing: El-Planning engineering 3-Permit Coordinator [Building Workflow Sign-off: 1;1-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. 0-Building: original permit application, site plans,building plans,engineer and beam calculations a : st details,if applicable,etc. Notes: By Permit Technician: i/ / Date: /0,2l4 Engineering Review Slope at building pad: 7'7, ErConditions "Met"prior to issuance of building permit ��Fasements (encroachments) per engineering conditions of approval and plat 'Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Er No Assess Water Quantity Fee in-lieu: ❑ Yes u No LIDA Facility on lot: Yes ❑ No Final Plat Recorded: la-NOT Approved by Engineering: ��-e4S gyl?:/✓ Date: 1p12a/24,z0 Notes: /1/te, re�viSivYl "'"? L/UA 5'i2e ❑ Approved by Engineering: Date: Revisions (after�Byuilding Submittal only) Reviewer Date Revision 1: Approved ❑ Not Approved Tj f e j6e.,7 it/9/2.420 Revision 2: ElApproved ElNot Approved Permit Coordinator Review /gl. Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: I "' Date: Notes: Qf}J 1 0 LA Q�t 2, '— en 2 G,9�UC ot,v [01241`ZO Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: r\L' U l 1Ck (2.•0 Revision Notice 2: Date Sent to Applicant: SDC Exemption:S. El Received Does not a ly SDC Fees Entered: Wash Co Trans Dev Tax: Yes N/A Tigard Trans SDC: i Yes ❑ N/A Parks SDC: Yes ❑ N/A LIDA ig,Yes ❑ N/A ErOK to Issue Permit Approved by Permit Coordinator: Date: G \q(-0 l:\Buildine\Fonns\BldePermitRvw RES 122419.docx ANEW 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 1114 t , i , 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED JAN 2 0 FROM: Nathaniel Rotta I021 vITY OF TIGARD COMPANY: WC Design and Graphics gt1ILDING DIVISION PHONE: 5038054339 By:,./,, RE: 13147/13145/13'49 SW 115th Street MST2020-00301, 302 & 303 (Site Address) (Permit Number) 13147 Residence (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Cooties. 1 Description: Copies: Description Additional set(s)of plans. 3 Revisions: Full Set Cross section(s)and details. 2 Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. 1 Other(explain): plan check response REMARKS: Revised Full Set and Wall Bracing Analysis. FOR OF ICE USE ONLY Routed to Permit Technician: Date: es '� Initials: Fees Due: ❑ Yes — No Fee Descri do : Amount Due: idrta•x'if"�L 4 4 pxd-di --,-ix virFA,14414'44:,otiNf;e: +n *.t \,..SO i'- : /0 r $ Special Instructions: Reprint Permit(per PE): ❑ Yes o ❑ Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012