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Permit Mechanical Permit Application FOR OFFICE USE ONEN' m 'PiReceived City of Tigard Date/By: _a l� Permit No.:�M�>� � ^ • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1 "" = Phone: 503.718.2439 Date/By: Other Permit: T I G A R 1) Inspection Line: 503.639.4175 Date Ready/By: runs: ® See Page 2 for Internet: www.tigard-or.gov S. Notified/Method: Supplemental Information TYPE OF %VORK C I, ;� I ILF>-USE CHECKLIST K�New construction 0 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 0 Demolition 0 Other mechanical materials,equipment,labor:overhead,and profit. % _r �,, "� Value $ .R`i, t}.sw i i;_._ 0 .,R 'vie, &... 0, as�n.S4,a -"Piag .•': '":4 3A ., ,k���� a m t t -` t i` � t j 3� s '�' `� a . lij I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building �' �'` � r s For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total f `e� i yti" " :r ` t �' i V . s. ait a'1;,Q4' t-: ' ' Heatin coolin Job site address: (y L tiq S r� � �5 0/ kr Air conditioning f 46.75 w Furnace 100,000 BTU(ducts/vents) f 46.75 City/State/ZIP: 77 #1/2-. tt /l . .2 2 3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: I Project name: S /2t_)( Heat pump 61.06 `` Duct work 1 23.32 Cross street/directions to job site: przferiNG S 5- Qi dditCS�S Hydronic hot water system 23.32 Residential boiler(radiator or f -_--r ._l , . 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: I Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: :"*# a ° Water heater 23.32 s f o rt� � ' Gas fireplace/insert 33.39 ak.S�c..:�``� .w.� ,r.,�u.. ;s:,, ,,,:Ne-� m v t.� a s <asn`au��.�. t,� ,�' a.�3��,...s. H Vhd 7454.0611 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 l PROPERTY OWNER ❑ TENANT Other: 23.32 (� 1'_ Environmental exhaust and ventilation: Name: 1�a9C t f..'}iS Range hood/other kitchen Address: 113 TJ ,5A) cir ITOL 1 y_ equipment 1 33.39 n q Clothes dryer exhaust / 33.39 City/State/ZIP: PO t•fir.,(Id Lae 72/? Single-duct exhaust(bathrooms, Phone:(SRC) 240' �S6 y Fax ( ) toilet compartments,utility rooms) 23.32 ���g° Attic/crawlspace fans 23.32 j,APPIICANT � Al � � �, � �; ._ ...,����v��a,.�n��,±` Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. f Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater Water heater Phone:( ) Fax: :( ) Fireplace e E-mail: Range Barbecue i.----' CONTRACTOR Clothes dryer(gas) Business name: Gt�� 4- N ��� G itcooLima•th.t f*c, Address: 2 C O e I S E G G P4 Q ,. Subtotal City/State/ZIP: I) IA P s c L 5 ©p., /7_0 8 Minimum permit fee($90.00) Phone:(5'p&) 5-�S 4 2 �2 Fax:( ) Plan review(25%of permit fee) ©8 State surcharge(12%of permit fee) CCB lie,: TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. ' !r AA N L /' / t� • Fee methodology set by Tri-County Building Industry Service Board Print name: AL EIC 1A M V 01,1.,3 f(J`{A, Date: Q D-f -' 2/Cr uildiag�Permits�MEC_PermitApp_082520.doe 440-0619T(I 1/02/COM/W1:B) CITY OF TIGARD MASTER PERMIT - 11 COMMUNITY DEVELOPMENT Permit#: MST2020-00302 Date Issued: 03/21/2022 -FICA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S 103CA00111 Jurisdiction: Tigard Site address: 13149 SW 115TH AVE Subdivision: None Lot: None Project: Matis-Bldg 2-ADU 1 Project Description: New attached ADU 1 of 2. BUILDING Floor Areas Required Setbacks Required Stones: 2 Bedrooms: 3 First: 485 sf Basement: 0 sf Left: 10 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 797 sf Garage: 380 g sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 10 Detectors: Yes Total: 1282 sf Value: $175,511.12 Rear: 15 PLUMBING Sinks: 1 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 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 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 add9 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 Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW ADU VB R-3 1282 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: $21,796.83 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 require- ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR Q59-nnLM1n thrni,nh CIA Q M F9- 1-n0Qn nhtnin n rnrnr of tho nano nr rtirort nnoctinnc fn fl11NC by rallinn SO-1 9Z9 10R7 nr 1 win 119 9Z4.11 �r Issued By: Ai" Permittee Signature: -iGv /'n" ' f v 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 . Residential Foil ou Ficl- t SI,011.1 City of Tigard RECEIVE , Receiv Date/Bed:A 21/202O :� Permit No.pe57,20219-00302_ 13125 SW Hall Blvd.,Tigard,OR 97223 OCTc Plan Review ' Phone: 503.718.2439 Fax: 503.598.1960 I o v Date/B : 2� Other Per I I ,.�I;i 7 Inspection Line: 503.639.4175 Date Ready/By © Supplemental Juris See Page 2 for V Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method S Information BUILDING DIVISION L—'7-74-It. N(1--7-4r-e--" TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING E 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 El Other: equipment,materials,labor,overhead,and p ir th rofit f thS2 CATEGORY OF CONSTRUCTION work indicated on this application. I E I-and 2-family dwelling ❑Commercial/industrial Valuation: $ ,,z77-2(r ❑Accessory building ❑Multi-family Number of bedrooms: 3 El Master builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 , ea. 1 ii�� Job site address: 13149 SW 115th Street ,9-,6 l� 1 New dwelling area: square feet qi City/State/ZIP: Tigard,OR 97223 Garage/carport area: �SZI2..... square feet 4 Ss- _ Suite/bldg./apt.no.: Project name: /-7,4 Tr7S - 19--461,(_ 1 Covered porch area: square feet Cross street/directions to job site: Gaarde/115th Street /Z Deck area: square feet Other structure area: square feet 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 ADU attached to single family residence. Valuation: $ 44-4k114- Existing building area: square feet New building area: square feet 3 PROPERTY OWNER 0 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: ® APPLICANT E CONTACT PERSON BUILDING PERMIT FEES* Business name: West Coast Design and Graphics,LLC (Please refer m fee schedule) Contact name: Nathaniel Rotta Structural plan review fee(or deposit): 7j/,3 FLS plan review fee(if applicable): Address: 11165 NW Copeland Street Total fees due upon application: City/State/ZIP: Portland,OR 97229 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 Photo Voltaic Solar Panel System. Business name: ^� — _ el Submit two(2)sets of roof plan with connection details " " �� and fire department access,along with the 2010 Oregon Address: Solar Installation Specially 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: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Nathaniel Rotta Date: 10/5/2020 *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) • Mechanical Permit Application FOR OFFICE (SE ONLY ' City of Tigard n En C I"E® Date ReceivedB Permit No.: v C V 13125 SW Hall Blvd.,Tigard,OR 97229PS. Plan Review S Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: OCT 6 Date/By: I I GARD Inspection Line: 503.639.4175 I ® 2018 Date Ready/By: Juris El See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information (( CITY OF TIGARD TYPE OF W(jRKLDlPIG DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* X❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: 13149 SW 115th Ave (requires site plan showing placement) 1 46.75 Furnace 100,000 BTU(ducts/vents) 1 46.75 City/State/ZIP: Tigard,OR 97223 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 ADU attached to 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 El PROPERTY OWNER El 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, Z At 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. 1 Gas heat pump City/State/ZIP: Portland,OR 97229 Wall/suspended/unit heater Phone:( 503) 805-4339 Fax: :( ) Water heater 1 Fireplace E-mail: nrotta@wc-dg.com Range 1 CONTRACTOR Barbecue Business name: TBD 7 l i,,j L.,_ Clothes dryer(gas) !/ Other: Address: MECHANICAL PERMIT FEES* City/State/ZIP: Subtotal Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) CCB lic.: State surcharge(12%of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: 81lE 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 L\Building\Permits\MEC-PermitAppdoc 09/09/10 440-4617T(11/02/COM/WEB) Electrical Permit Applicatiol, ECE,VED Received FOR(1111(1, t'Sl.ON'I.l- City of Tigard Date/B,: Permit ft/`lST.2d,Z t} -D4�i9„Z III e 13125 SW Hall Blvd.,Tigard,OR 97223 () T 6 2 Q Plan Review Related Permit 0 Phone: 503.718.2439 Fax: 503.598.196 Date1B Inspection Line: 503.639.4175 Ready Date/By• luris ® See Pagel for 1 16'AitPi: Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information B1I11 DING DIVISION TYPE OF WORK PLAN REVIEW ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or II Floating buildings. ®1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family El Master builder El Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived 0 Addition of new motor load of system. Job# Job site address: 13149 SW 115th Ave 700HP or more. ❑"A"`T""1-2""1.3„ City/State/ZIP: Tigard,OR 97223 ❑Six or more residential units occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for 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 qt.. 1 Each i Total I New residential single-or multi-family dwelling unit. Subdivision: WDML Lot#: 111 Includes attached garage. Tax map/parcel#: 2S103CA0011 t 1,000 sq.ft or less 168.54 4 Ea.add'1500 sq.ft or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 Proposed ADU attached to single family residence. +with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) I Renewable Energs 0 See Page 2 ® PROPERTY OWNER - 0 TENANT Services or feeders installation,alteration,and/or relocation Name: Pavel and Livia Matis 200 amps or less 100.70 2 I 201 amps to 400 amps 133.56 2 Address: 11375 SW Capitol Highway 401 amps to 600 amps 200.34 2 City/State/ZIP: Portland,OR 97219 S C rj 1 601 amps to 1,000 amps 1 301.04 2 f 0 Over 1,000 Phone:(503 )200-8564 amps or volts 552.26 2 Fax:( ) CITY O i-1 I GAR D Temporary services or feeders installation,alteration,and/or Email: [����(� n��t1�I �1 relocation Owner installation:This installation is being made on prope �lNat i own lirdler 'nt)t - 200 amps or less � 59.36 1 intended for sale,lea•- , exchange,according to ORS 447,449,670rl d 7V1. 201 amps to 400 amps 125.08 2 r Owner signature: _, Date. J F_� 401 amps to 599 amps 168.54 2 ® APPLICANT ® CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with I 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 service or feeder fee,first Address: 11165 NW Copeland Street _ branch circuit 56.18 2 City/State/ZIP: Portland,OR 97229 Each add'(branch circuit 7.42 2 — -----w- Miscellaneous(service or feeder not included) Phone:( 503 ) 805-4339 Fax::( ) Each manufactured or modular dwellinp,service and/or feeder ` 67.84 2 Email: nrotta@wc-dg.comI s Reconnect only 67.84 r 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: TBD fAre- Signor outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel alteration,or extension. ❑ See Page 2 2 Each additional inspection over allowable in and of the above City/State/ZIP: Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 9U.00/hr CCB Lie.: Electrical Lic.: Supry Lic.: shecificalh listed,'V2 hr min; _ ELECTRICAL PERMIT FEES Suprti.Electrician signature.required Subtotal: _ Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Nathaniel Rotta Date: 07/24/2020 days after it has been accepted as complete. " Number of inspections allowed per permit, t\Beilding\Permits\ELC PennitApp ELR_ERE.doc Rev 06/I7/2015 440-4615T(11/05/COM/WEB • 'Plumbing Permit Application ' ' Building Fixtures FOR OFFICE USE ONLY Cityof Tigard RECEIVED Received g Permit No.: :1111 II 13125 SW Hall Blvd.,Tigard,OR 9722 Date/By: Phone: 503.718.2439 Fax: 503.598.1 T 0 6 2 Plan Review Other Permit No. Date/By: Inspection Line: 503.639.4175 CITY OF TIGARD I I :1 RI) Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.goV BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction ❑Demolition For special information use checklist. Description Qty. Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 1 500.32 ❑Accessory ❑Multi-family 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: 13149 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.: I 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 ADU attached to single family residence. Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 in PROPERTY OWNER 1 ❑ 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 IJ 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 Water closet 3 25.02 CONTRACTOR Water heater 1 37.52 Business name: TBD O la A/fs 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. t.\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) /`/.57 .2-o - 0U.30,2 1 -. . �. / d� -�� RECEIVED /3/y9- .cam //sw vt 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 701.326(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. ?avc. ai° Print Name of Permit Applicant Signature of Permit Applicant Date Permit#: /hST d. o 00. d.2 Amo] r Address: , 4, J0 f?zzj F 'f� vtdri+� Vo1 •& . Issued by: Date: [ S iA©01Q - 003o/ , .30 2, .3 c1.3 /3/y 7 /3/ y 9 fiftvE- i 3 '.5 ��, / `� This Copy for Permit Offices -�� flS712-F1 1O —0a-7-S7 4.2-c /3/4 3, /3/65 Ss ) l/..s City of Tigard I. COMMUNITY DEVELOPMENT DEPARTMENT :III I RD Building Permit Review — Residential TIGA 0',' ww-riti-t'.3&fi3�iff.3 !,3 4, m•I.,1 s+3•l t etw.rite .33iti lig i�+7' €, ali as n ,�tat. , i•-if v r7,- ,;'n.r_1/4-7,143{:r3t§';i 3RFg.103 i.;s+,,- Building Permit #: M ST-2Q O?>OL ,/. - ,- Site Address: 1&145, 13147' 13149 W 115th Ave Project Name: Matis Lot #: Planning Review (2eAvtiStw,••it 12'Z' —Md4d £4 DPI Proposal: New single detached house with 2 attached ADUs 0 Verify address/suite #active in Accela. Q In River Terrace: Q No ❑ Yes, River Terrace Review Addendum Site Plan Elements: erosion Control 13: copies of site plan on 8-1/2"x 11"or 11 x 17"paper ...Retained trees with drip line and tree protection measures 12 Drawn to scale(standard architect or engineer scale) Footprint of new structure (including decks) and FFE 0 orth arrow .Jtility locations&easements(required for new and additions) 11 bite address,project or subdivision name and lot number •idewalk/driveway approach 113 pplicant information(name and phone number) 1 r._-,ocation of wells/septic systems 0 •t dimensions and building setback dimensions Street tree size,type and location ]square footage of buildings to be demolished ,Street names IIxisting structures on site v 7-orner 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? L"fYes o ❑ Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑Yes,applicant was notified ❑ No Received: ❑Yes 0 No Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs Required: ❑Yes,applicant was notified 0 No Received: ❑Yes CI No OKSDC Exemption for ADU applied for: ❑Yes Q No Received: ❑ Yes 0 No Public Facilities Improvement (PH) Permit: Required: ❑Yes,applicant was notified ❑r No Applied For: ❑ Yes ❑ No,stop intake 0 Land Use Case#: ADU2020-00008 &ADU2020-00009 Q Zoning: R-4.5 ❑r Required Setbacks: Front: 20 Rear: 15 Side: 10 Street Side: N/A Garage: 20 El Building Height: Max. Height: 30 Actual Height: 25 1 . -•scape Area: % \' ,ot Coverage Max: Entrance et back no more than 8'from street-facing wall ❑ Parallel to street • • set 45 degrees or less Windows . . . ..•. 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 111 12' • -ss "► 0%or less of facade — 60%or less and includes 7 of following: Covered porch an 'ecessed entrance ill all offset ` 1'Roof eave — Roof offset Fire s .•:es ILap Siding ❑ Roof itch 1 Gable,hi7,or gambrel roof — Dormer ccent siding 1 Window trim Window recess Window projection ❑ Balcony ❑ Visu. - earance ❑ Urban Forestry Plan ensitive Lands: ❑ Yes ° No Type: ElConditions met prior to issuance of building permit Notes:Property is a flag lot so single detached house design standards do not apply ❑ Approved By Planning: C-� Date: 10/8/20 Revisions (after B ilding Submittal only) Reviewer ate Revision 1: b4 Approved ❑ Not Approved Al- It 2 20 Revision 2: ❑ Approved ❑ Not Approved 1:\Building\Forms\BIdgPennitRvw_RES_122419.docx ar► ,w' _ u Building Permit Submittal Original Submittal Date: la ®ao ,ZO2c Site Plans: # ,3 Building Plans: # 3 Building Permit#I nter building t errmmit#above. Workflow Routing: LT Planning Engineering IA—Permit Coordinator gtsuilding Workflow Sign-off: Q'Sign-off for Planning(include notes from planning review) . Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and n original plan review routing form. ID-Building: original permit application, site plans,building plans,engineer and beam calculations and t details,if applicable,etc. Notes: By Permit Technician: Date: /O2P/D2a Engineering Review E S lope at building pad: 7% Conditions "Met"prior to issuance of building permit Easements (encroachments) per engineering conditions of approval and plat Pater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes BNo Assess Water Quantity Fee in-lieu: ❑ Yes ErNo LIDA Facility on lot: ✓❑ Yes ❑ No Final Plat Recorded: Er NOT Approved by Engineering: 7 / ari ey Date: /v/Zi/ye w Notes: //e&/ ,y.ij'Y.SiG71s 077 U./ Si2C ❑ Approved by Engineering: Date: Revisions (after B ui ding Submittal only) Reviewer Date Revision 1: CI Approved ❑ Not Approved TyY. ve Qi.. (//`f I ZVZO Revision 2: ❑ Approved El Not Approved Permit Coordinator Review Conditions "Met"prior to issuance of building permit ❑ Approved, NOT Released:� Date: Notes: teUt&C (AD 1_�l2ed' eMt10 1DI2LeIV — Al,- Revisions (after Building Submittal only) + Revision Notice 1: Date Sent to Applicant: it lqI-2,0 Revision Notice 2: Date Sent to Applicant: SDC Exemption: ❑ Received Does not aly SDC Fees Entered: Wash Co Trans Dev Tax: I Yes Li N/A Tigard Trans SDC: A Yes ❑ N/A �, n� Parks SDC: 2 Yes ❑ N/A �n 1ptr /V C�"�' LIDA ❑ Yes /A l/,►'A"�,- ZOK to Issue Permit �` Approved by Permit Coordinator: A(0Y-1 Date: \,1, f� t(ZD 1:\Building\Forms\BldgPermitRvw_RES_122419.docx