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Permit { Mechanical Permit Application FOR OFFICE USE ONLY 74 City Of Tigard Date/By: �I �� s� °' Permit No.: ��= \`jr,'1_ { } 3 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review u" s Phone: 503.718.2439 Received Date/By: Other Permit: T I G A R l) Inspection Line: 503.639.4175 Date Ready/By: Juris: 93 See Page 2 for Internet: www.tigard-or.gov j- Notified/Method: Supplemental Information .... .,. S>� .-;f ���� ',w.m �riKfry� • �'ii..„,��,r.x :.. ����"s:3',1" ,°.�*. .�.b. v a!l�#rA � � x?'� ‘.s„ .a �u�.x,.,.w v, V 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 ❑Demolition ❑y Other: mechanical materials,equipment,labor;overhead,and profit. s h w - ,'il'i-6:, Li s'aC ,F. ' '� " idt'`. " 3„ . .. . . 6a Value:$ +�. fi. A < w r. -,,,A;oil, ."s ._ ss...A C'-_ . ' ' ` a- ,r 1 'Sr ,r�t *4 s'S^bxk `W-'.,.,u * t ..' 0 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total � , l�"t v , .-�1-++ Imo` ,Ifte4 ,, ' . rd.:. ,. '.,.. ', k'' Heating/cooling: Job site address: t 3 )' J i \r/55 / 15 � iiu I Air conditioning , 46.75 7 ww" Furnace 100,000 BTU(ducts/vents) ( 46.75 City/State/ZIP: 77&li o b R . 1-2 2. 3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: S /21-c�( Heat pump 61.06 ��`` Duct work I 23.32 Cross street/directions to job site: P S 5- ei ddyeC,ST.s Hydronic hot water system 23.32 U Residential boiler(radiator or --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 r II .� CRIPTION OF WORK L, Gas fireplace/insert 33.39 H V T t5 '1. 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 '` v I � ` ' Other: 23.32 , Q.,- .,K=L{ ,5 1.. ,.trimlte :tt '' /y� Environmental exhaust and ventilation: Name: T n VC I NA-Cs Range hood/other kitchen n Address: l I3K S� C. 1dwt- ITOC. equipment 1 33.39 Clothes dryer exhaust I 33.39 City/State/ZIP: Po r tkinJ ea � e ?72/? Single-duct exhaust(bathrooms, Phone:(5 ) 240' 8�6 7 Fax:( ) toilet compartments,utility rooms) (I 23.32 Attic/crawlspace fans 23.32 0 APPLICANT 'fit` ...zp XONTk `, ' itgON .J Lt` Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: 1 Furnace,etc. Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater Water heater Phone:( ) Fax::( ) Fireplace .y E-mail: Range < MC t a'�r (-1--- CONT��...� ,� ; Barbecue �. _(,. n ..... :` /: Clothes dryer(gas) ( Business name: IA (it COO f(..1' L t E 1'1-1 1�l G , CoOili4�the4i• C * , Address: 2 ©S l $ E G �� IM Subtotal City/State/ZIP:gy P ft IA 14 S C L 1 ©�, la 7-C 8 Minimum permit fee($90.00) Phone: ,: c7) S(s . 2 5-2 Fax:( ) Plan review(25%of permit fee) ©��,it State surcharge(12%of permit fee) CCB tic,: 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: * Fee methodology set by Tri-County Building Industry Service Board Print name: AL el(Ag p 1LU �Li h A. Date: 0 C / 22 . uilding\Permits\MEC_PermitApp_082520.doc 440-46I7T(11/02/COM/WEB) III CITY OF TIGARD MASTER PERMIT 11 COMMUNITY DEVELOPMENTPermit#: MST2020-00303 T I Cl A it(7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2022 Parcel: 2S 103CA00111 Jurisdiction: Tigard Site address: 13145 SW 115TH AVE Subdivision: None Lot: None Project: Matis-Bldg 2-ADU 2 Project Description: New attached ADU 2 of 2. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 480 sf Basement: 0 sf Left: 10 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 823 sf Garage: 376 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 10 Detectors: Yes Total: 1303 sf Value: $177,877.86 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 3 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 add'I 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 ADU VB R-3 1303 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: $21,844.64 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 oc9_nM11Mn thrnnnh OAP QR9_nfN-nn L%nn mar nhtain n rnm,of thn rnlcc nr rlirort'it ooctinnc to Ill INC'by rallinn Rf11 919 105177 nsrr 1 aria' '3 9 9 &4 Issued By: Permittee Signature: /i/ eC41,M / 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 Residential RECEIVED FOR OFFICE USE ONLY City Tigard Tl d 0 C T 0 6 Received Date/B : Permit No.:4W4T'L0Z0 ►W 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 401111.011 �w Phone: 503.718.2439 Fax: 503.598.1�6�-,I,OF TIGARD Date/B I I G A R D Inspection Line: 503.639.4175 Date Ready/By: luris ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method:3 2�- Supplemental Information 1 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,overhead,and the profit for the,-, CATEGORY OF CONSTRUCTION work indicated on this application. ('7'T s5-7 `O ® l-and 2-family dwelling ❑Commercial/industrial Valuation: $ $_ 0 Accessory building ❑Multi-family Number of bedrooms: 3 111Master builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 ( �"]� 7 ` Job site address: 13145 SW 115th Street J /�(r[ ;2— New dwelling area square feet $Z3 City/State/ZIP: Tigard,OR 97223 Garage/carport area:3 ..388' square feet '"f Suite/bldg./apt.no.: Project name: /-1 7s —• �j� L . ,2_, Covered porch area: square feet Cross street/directions to job site: Gaarde/115th Street 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. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: 2S103CA00111 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: $ Existing building area: square feet New building area: square feet B 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: ® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* Business name: West Coast Design and Graphics,LLC (Please refer to fee schedule) Contact name: Nathaniel Rotta Structural plan review fee(or deposit): 151 . 114 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 Photo Voltaic Solar Panel System. Business name: ?Ab e� - 5 froviyi 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 $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: • This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Nathaniel Rotta Date: 10/5/2020 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) Mechanical Permit Applica ECEIVED FOR OFFICE F SE ONLY City of Tigard Received O C T 0 6 2 018 Date/By: Permit No 114 • 13125 SW Hall Blvd.,Tigard,OR 97223 i Plan Review Phone: 503.718.2439 Fax: 503.598.19CITY OF TIGARD Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: ]nris ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all El Demolition El Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* X❑ 1-and 2-family dwelling ❑Commercial/industrial El Accessory building For special information use checklist. 0 Multi-family El Master builder El Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 1 Job site address: 13145 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 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 ® 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:( ) 4 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;S4.03 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 Clothes dryer(gas) [1 �" Other: Address: MECHANICAL PERMIT FEES* City/State/ZIP: Subtotal Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) CCB lie.: State surcharge(12%of permit fee) 4/ITOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Nathaniel Rotta Date: 07/24/2020 * Fee methodology set by Tri-County Building Industry Service Board I.\Building\Permits\MEC-PermitApp doc 09/09/10 440-4617T(I I/02/COM/WEB) Electrical Permit Ap llI iCatiO ECEIVED Received FOR OFFICE USE ONLY n City of Tigard Date/BI: Permit#f y$r _, a.0 p031t 3, • 13125 SW Hall Blvd.,Tigard,OR 97223 C T Q 6 �' pla,l Review 11 ' Phone: 503.718.2439 Fax: 503.598.1 960 Date/13 Related Permit#: Inspection Line: 503,639.4175 CITY OF T Ready Date/By: tuna 1 E See Page 2 for_---. 1;{:,�It Internet www.tigard-or.gov BUILDING DIVISIO Notified/Method: Supplemental Information TYPE OF WORK I PLAN REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked). -- 0 Demolition ID Other: 0 Service or feeder 400 amps or more 0 Building over three stories, where 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 El Multi-family ❑Master builder 0 Other: amps for all other installations. buildings. ❑ Installation pump. 0 of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived f 0 Addition of new motor load of system. Job#: ; Job site address: 13145 SW 115th Ave 100HP or more. ❑"A","E' "t-2",`t-3", City/State/ZIP: Tigard,OR 97223 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Reaeational 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 Qn. I Each I Total I New residential single-or multi-family dwelling unit. Subdivision: WDML Lot#: 111 Includes attached garage. Tax map/parcel#: 2Sf 03CA00111 1,000 sq.ft or less 168.54 4 Ea.add'l 500 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.) Renewable Energy i 0 See Page 2 ® PROPERTY OWNER ❑ TENANT • Services or feeders installation,alteration,and/or relocation Name: Pavel and Livia Matis 200 amps or less 100.70 2 RECEIVEDZ01 amps to 400 ampsT 133.56 2 Address: 11375 SW Capitol Highway f� 401 amps to 600 amps 200.34 2 City/State/ZIP: Portland,OR 97219 SEP 1 4 2 t-;r h 601 amps to 1,000 amps 301.04 2 Phone:(503 )200-8564 Fax:( )CITY OF T) A R D Over 1,000 amps or volts 552.26 , 2 Temporary services or feeders installation,alteration,and/or Email: BUILDING DIVISION relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 i1 intended for sale,leas xchange.according to ORS 447.449.670, d 70 201 amps to 400 amps 125.08 2 Owner signature ___-- Date q1 10 It 401 amps to 599 amps 168.54 2 d ____-- ._.. .... I) APPLICANT ® CONTACT PERSON Branch circuits-new,alteration,or extension,, r 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 service or feeder fee,first 56.18 2 Address: 11165 NW Copeland Street branch circuit _ Each add'l branch circuit - 7.42 2 City/State/ZIP: Portland,OR 97229I Miscellaneous(service or feeder not included) Phone:( 503) 805-4339 Fax::( ) Each manufactured or modular (d dwelling,service and/or feeder 67.84 2 Email: nrottawt>dg.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: TBD ja,r7t/f,/-t„, Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel alteration,or extension. 0 See Page 2 12 City/State/ZIP: Each additional inspection over allowable in any of the above _ 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 s cificallrlisted(%hrmin) 90.00/hr CCB Lic.: Electrical Lac.. Supry Lic.: � I ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: - ID Plan Review Required(25%of permit fee): L �/ " _ State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: — — This permit application expires it 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 I:1BuildingtPermitaaELC_PermitApp ELR ERE.doe Rev 06/17/2015 440-4615T(il/05/COM/WEB * Plumbing Permit Application , Building Fixtures RECEIVED FOR OFFICE LSE ONLY Cityof Tigard Received III g (� Permit No.: ill 13125 SW Hall Blvd.,Tigard,OR 9722Q CT 0 6 2018 Date/By: s Phone: 503.718.2439 Fax: 503.598 0 Plan Review Other Permit No.: G;ITY OF TIGARD Date/By: Inspection Line: 503.639.4175 y y IWARD e Page 2 for BUILDING DIVISIONNotified/Method:DateReady/By: Juris Supplemental Information Internet: www.tigard-or.gov TYPE OF WORK FEE* SCHEDULE ®New construction ❑Demolition For special information use checklist Description Qty. ] Ea. I 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 ❑Accessory buildingSFR(3)bath 1 500.32 ❑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: 13145 SW 115th Ave Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Tigard,OR 97223 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 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 Ei PROPERTY OWNER ( ❑ 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 Water closet 3 25.02 CONTRACTOR Water heater 1 37.52 Business name: TBD v 14/Al 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: 4.1.ifiede'% 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. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 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. �c�.v CI Mao Print Name of Permit Applicant -27 Z1 Signature of Permit Applicant Date Permit* `1ST' - DC) 3d3 Address: 1-1-414%? (... �Gf old y'�zz3 �I Issued by: Date: -r- . 4151 / Ms i�©.AD - 003o i 3o 2 3 03 /3/y', /3" y% /3/ys- /i S �� This Copy for Permit Offices -ter i`?S772-0 0 s 7 F /3/6 3, /3/(5 s4J //S cZ • City of Tigard III COMMUNITY DEVELOPMENT DEPARTMENT I T1cAUD Building Permit Review — Residential ,w, Building Permit #: M ST 202.0 - 00'503 Site Address: 13145 1-5-1-4-7-&-1-3-t41 SW 115th Ave Project Name: Matis Lot #: Planning Review (2mst,,, ' tt12120 /kd4,61 L-4t c Proposal: New single detached house with 2 attached ADUs ElVerify address/suite #active in Accela. El In River Terrace: ❑o No ❑ Yes, River Terrace Review Addendum Site Plan Elements: ° rosion Control 111 copies of site plan on 8-1/2"x 11"or 11 x 17"paper � etained trees with drip line and tree protection measures DIrawn to scale(standard architect or engineer scale) \ ,Footprint of new structure(including decks)and FFE IIorth arrow :,;,;Jtility locations&easements(required for new and additions) I.ite address,project or subdivision name and lot number °"idewalk/driveway approach Ill'kpplicant information(name and phone number) N cation of wells/septic systems 0 .t dimensions and building setback dimensions "treet tree size,type and location Il•quare footage of buildings to be demolished Street names Ifxisting structures on site °i 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? °�i 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 ❑ 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 Q No Received: Yes 0 No aAp'❑ SDC Exemption for ADU applied for: ❑Yes El No Received: Yes El No ElPublic Facilities Improvement (PFI) Permit: Required: ❑Yes,applicant was notified El No Applied For: ❑ Yes ❑ No,stop intake ❑• Land Use Case#: ADU2020-00008 &ADU2020-00009 El Zoning: R-4.5 ❑r Required Setbacks: Front: 20 Rear: 15 Side: 10 Street Side: N/A Garage: 20 0 Building Height: Max. Height: 30 Actual Height: 25 I •.scape Area: % \Mot Coverage Max: Entrance et back no more than 8'from street-facing wall ❑ Parallel to street • • set 45 degrees or less Windows N ' ' .-. 12%of area of all street-facing facades Garage Gara e door is .:•'nd widest street-facing wall , V / '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 tha ' ro .n and there is a 12 sq ft.window above garage on 2nd floor. ❑ Gara.e door width is I 12' . - s I 0%or less of facade 60%or less and includes 7 of following: Covered porch 'ecessed entrance al all offset 1'Roof eave Roof offset Fire s .•:es 111 Lap Siding ❑ Roof itch 1 Gable,hi7,or gambrel roof Dormer 1 ccent siding I Window trim LI Window recess Window projection ❑ Balcony ❑ Visu. ' earance ❑ Urban Forestry Plan El ensitive Lands: ❑ Yes Lil 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 El Approved By Planning: C '• - 4 Date: 10/8/20 Revisions (after Building Submittal only) Reviewer Date k -Revision 1: Approved ❑ Not Approved AI-- It 12)20 Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: \O ( la ZOZ 0 Site Plans: # 3 Building Plans: # 3 Building Permit#: ® Enter building ermit#above. Workflow Routing: ® Planning IN Engineering 2 Permit Coordinator 12 Building Workflow Sign-off: lit 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. ® Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: 1i� Date: \o`Z% ` aoZG Engineering Review "❑Slope at building pad: 7 0% QConditions "Met"prior to issuance of building permit Easements (encroachments) per engineering conditions of approval and plat RWater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑' Yes ❑ No ❑ Final Plat Recorded: 12 NOT Approved by Engineering: ?rem/ 6y-iejkC.A1 Date: /p f221ZpW Notes: /Veld r'e lS%UnS an UOfI 3'ize ❑ Approved by Engineering: Date: Revisions (after Building Submittal only) Reviewer Date t� Revision 1: Approved ❑ Not Approved /y ► ,f &yy Gte,ey 402.406 /ZoA$ Revision 2: El Approved ❑ Not Approved Permit Coordinator Review K.Conditions "Met"prior to issuance of building permit ❑ Approved, NOT Released: Date: Notes: <(SW) k 1---1D's S\ e. .ovalk a cuippLi C tn± ID`2v(24^k — Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Al-- I ki Y1-70 Revision Notice 2: Date Sent to Applicant: 6 SDC Exemption: El Received Does not apply 5 SDC Fees Entered: Wash Co Trans Dev Tax: Yes u N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: 2—Yes ❑ N/A intic "O pt0 e pD1A LIDA ❑ Yes aN/A '(,A " Mt(^r)2� OK to Issue Permit Approved by Permit Coordinator: Ariv.,./- de*, Date: l t i 1 120 1:\Building\Forms\BldgPermitRvw_RES_122419.docx