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Permit • Mechanical Permit Application FOR OFFICE USE ONLY t' City of Tigard Received Date Permit No.: t ,1C 1,' c ) 't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review s Phone: 503.718.2439 Date/By: Other Permit: T I G n R 1) Inspection Line: 503.639.4175 Date Ready/By: Juris 65 See Page 2 for Internet: www.tigard-or.gov '4, Notified/Method: Supplemental Information fTYPE OF WORT{ 4,fik 4, g rs a^xnvvr :, ' , >, r 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 ❑Other: mechanical materials,equipment,labor,overhead,and profit. -. . _�, 7 rL'. R Value:$ .1'.t: `, `: 1.i S�-"#N a - .F k... ;�v�.444c 6.j.t -<. .; =c ,. .�' „ ,t c, , . .*1 k a (l 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building �' :.;2.., For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total b�f s�,r 'ro r '' r t tr;, xt ��-�"� �y;' 4 9 7$ ,mac 1 " t` 0 f ' 6 r t't �� r,; 11 Heating/cooling: Job site address: r/ 1.17 -�- S 1r/ / 15 fit ,4UE Air conditioning '� 46.75 cl tvv++nr+rr Fumace 100,000 BTU(ducts/vents) % 46.75 City/State/ZIP: 77 K 12-_P b R J 2 2 5 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: I Project name: S /9L )( Heat pump 61.06 ` Duct work f 23.32 Cross street/directions to job site: PtrzfeL- �"� 0,S 5- 4,ddirCS9. Hydronic hot water system 23.32 �UJ�'_ Residential boiler(radiator or t -- ' r - • 1 , 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 6. . 't . , /. _- r .i t k. + ' ,4%:; . a 4::, Gas fireplace/insert 33.39 H VIR� 7 46 ,I. 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 a tot> `W *i. 4 ,: x`,�t,i^'„`, m" ti Other: 23.32 Q.�., .usa,. ,§r"s w.t > 1. Environmental exhaust and ventilation: Name: P4,VC t 4.TIS Range hood/other kitchen ,7 Address: l A 3 sit-' C, Got_ 1 `_ equipment , 33.39 PO r tkit J iy, 7 2/Y Clothes dryer exhaust 1 33.39 City/State/ZIP: f Single-duct exhaust(bathrooms, % Phone:(5-03) 240' r5' y Fax:( ) toilet compartments,utility rooms) 23.32 Attic/crawlspace fans 23.32 r" at � �l �14ZI t AiiiiCA ; 'a ` ` � , , .,. : :s Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. / Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: r ._ Barbecue CONTRACTOR NEAT( `t / Clothes dryer(gas) Business name: D` G17� �'f" ` L t 1"�� 1`l(a �jtf©O(-f�i� th �, C MECHANICAL It Address: 2 �' I S r, ' G �� Subtotal City/State/ZIP: D kt P S C D 5 ©fie la 7-0$9 Minimum permit fee($90.00) Phone: 60&) S(S if 2 5-� Fax:( ) Plan review(25%of permit fee) 2 4©�3 L State surcharge(12%of permit fee) CCB lie,: TOTAL PERMIT FEE Authorized signature: Print name: AL This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. t� * Fee methodology set by Tri-County Building Industry Service Board X AF(0dLU Fu h A, Date: 6-�6-~ 2 ier uildiuglPermits�MEC_PermitApp_082520.doc 440-0617T(l l/02/COM/WEB) CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2020-00258 Date Issued: 03/21/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103CA00101 Jurisdiction: Tigard Site address: 13165 SW 115TH AVE Subdivision: None Lot: None Project: Matis-Bldg 1 -ADU Project Description: New attached accessory dwelling unit. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 630 sf Basement: 0 sf Left: 10 Parking Spaces: 0 Height: 23.5 Bathrooms: 3 Second: 847 sf Garage: 261 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 10 Detectors: Total: 1477 sf Value: $166,000.00 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: 4 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]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 1477 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: $22,048.64 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 Qc9-nM_nnin rhrniinh flAP OF9_nn1-nnon Vnn mat,nhr,in a rnnv of The ndAc nr rlirArt nuAcsnne Tn r1l inir by rniIinn cn-A 739 1QR7 nr 1 'Inn lq,r344 Issued By: Ho-U.A.j Va-vv De W ege- Permittee Signature: ()r^'App- t,ca4-t,o-w 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. Building Permit Application -� - Residential REC Y VE ®� 2020 FOR OFFICE SI:ONI1 Cityof Tigard SEP Received I/, Permit Noys i 2 p 20 eo Z ree 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2439 Fax: 503.598.196(OiY OF TIGARD DateBPlanReview: 471// At OtherPern4)4,02EI„20 �eV/si TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: kris: Eli See Page 2for Internet: www.tigard-or.gov Notified/Method: I 12, 2, 4 Information > 1 Pt Itr iii l-r1+4&i,c—Z_.. TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® I-and 2-family dwelling ElCommercial/industrial Valuation: $ ` 1 13S°1 I El Accessory building 0 Multi-family Number of bedrooms: 3 0 Master builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 (-1 3 Job site address: 13165 SW 115th Street /4,6 U- New dwelling area: 1477 square feet 9)(11 City/State/ZIP: Tigard,OR 97223 Garage/carport area: 261 square feet u. ` Suite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: Gaarde/115th Street Deck area: square feet NES etas -S€n.0/L'G P th" .. L'�� , Other structure area: square feet • REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: WDML Lot no.: 101 Permit fees*are based on the value of the work performed. Tax map/parcel no.: 2S103CA00101 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the ,9.�- 6 DESCRIPTION OF WORK work indicated on this application. Proposed ADU to single family residence at 13163. Valuation: $ 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 ® CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule Business name: West Coast Design and Graphics, LLC Contact name: Nathaniel Rotta Structural plan review fee(or deposit): FLS plan review fee(if applicable): Address: 10108 SW Morrison Street City/State/ZIP: Portland,OR 97225 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: `J—lam/,�j L S �� Submit two(2)sets of roof plan with connection details 7 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 lie.: 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: 07/13/2020 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE Fsl: ONLY City of Tigard RecDateived Permit No.: 13125 SW Hall Blvd.,Ti ard,OR 97223 Y 8 Associated permits: • Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical TIGARn Internet: www.tigard-or.gov ❑ Other. THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑X ❑ ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. © ❑ ❑ 3 Verification of approved plat/lot. ® ❑ ❑ 4 Fire district approval required. Name of district: TVFR • ® ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity 11El El 6 Sewer permit. ❑ ❑ El 7 Water district approval. 0 ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ El 9 Erosion control ®plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ® ❑ ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® 0 ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ® ❑ ❑ there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size X❑ 0 ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® ❑ ❑ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ® ❑ ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ® ❑ 0 Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- x❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ® 0 ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ® ❑ ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ® ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ® ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required X❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ El architect licensed in Ore:on and shall be shown to be as•licable to the sro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or II"x 17'". ® ❑ ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ® 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ® ❑ 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 El 27 "Drawn to scale"indicates standard architect or engineer scale. ® ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 ❑ EI Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, © 0 ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ 0 ❑X including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application / U �� ' ` ' `, ' b f • Residential FOR OFFICE USE ONLY City of Tlgal(� �� � Received ADate/By: Permit No.: 13125 SW Hall Blvd.,Tigard, Plan Review 11 i Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: q Date/By: T I c i A R I) Inspection Line: 503.639.4175 JULJ 1 �t 2U20 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information c :- ET ( AL TYrti. , voiti( 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 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. El1-and 2-family dwelling 0 Commercial/industrial Valuation: $ ✓ 58 ❑Accessory building 0 Multi-family Number of bedrooms: /6 ❑Master builder 0 Other: Number of bathroo s: 6 JOB SITE INFORMATION AND LOCATION Total number floors: 2 Job site address: 13163 SW 115th Street New dwijeng area: 3175 square feet City/State/ZIP: Tigard,OR 97223 Garage/carport area: 678 square feet Suite/bldg./apt.no.: Project name: govered porch area: square feet Cross street/directions to job site: Gaarde/115th Street Y ,/' Delf area: square feet ,, �/ QfiLfstructure area: square feet ` EQUI��D DATA:COMMERCIAL-USE CHECKLIST Subdivision: WDML t o.: 101` erm}t IXe�*are based on the value of the work performed. Tax map/parcel no.: 2S103CA00101 `J In i tile tote value(rounded to the nearest dollar)of all • e Ment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK X �w r indicated on this application. Proposed single family residence with an attached ADU. / t(/ laluation: $ v f''� ting building area: square feet ' >ew building area: square feet El PROPERTY PROPERTY OWNER ❑ T ` e/ / Number of stories: Name: Pavel and Livia Matis �. / / Type of construction: Address: 11375 SW Capitol Highway . / _c__;V Occupancy groups: City/State/ZIP: Portland,OR 97219 V 7S Existing: Phone:( 503) 200-8564 ,"/Fax:( ) New: ® APPLICANT ® CO TACT PERS®N BUILDING PERMIT FEES* Business name: West Coast Design and Graphics,LLC (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name: Nathaniel Rotta/ Address: 10108 SW Mta nson Street FLS plan review fee(if applicable): City/State/ZIP: Portland, R 97225 Total fees due upon application: {7�� Phone:(503 )805-4339 Fax::( ) Amount received: E-mail: nrotta@wc-dg.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: Zf-201✓ E 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 lie.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name: Nathaniel Rotta Date: 07/13/2020 Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) IA 4 Mechanical Permit Application ` ��,_ FOR OFFICE USE ONLY Cityof Tigard `p b eceived �J g �'`�,� " V/VffW// Gate/By: PermitNo.MST20Z v� E ! " 13125 SW Hall Blvd.,Tigard,OR 97223� Plan Review Phone: 503.718.2439 Fax: 503.598.1960 q Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 JUL 0 (02o Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov ,,,Notified/Method: Supplemental information k P U TYPE OF" I.?t� �i *Jt` '' �,M COMMERCIAL EEE* SCHEDULE-'USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION : , ,, ' RESIDENTIAL F- UH'MEN�!t/ S' EI,, l ES* u ` '' © 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use check/isl. ❑ Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total ;Tow SIT ,INFORMATION.AND'LOCATION Heating/cooling: Air conditioning Job site address: 13165 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 Gaarde/115th Street (requires site plan showing placement) 61.06 Cross street/directions to job site: 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.: 101 Flue/vent for any of above 23.32 Other: 23.32 Tax map/parcel no.: 2S103CA00101 Other fuel appliances: DESCIRIPTION`OF'WORD Water heater 1 23.32 Proposed ADU to single family residence at 13163 SW 115th Ave Gas fireplace 33.39 Flue vent for water heater or gas fireplace 1 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 PRO> TY O CR ❑ ' t 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) 4 23.32 ® APPLICANT CONTACT PERSON i ' 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 nrotta Fireplace we-d E-mail: @ 9com Range 1 o- NT CORACTO t 1 1 Barbecue Business name: TBD �{ A/ -��— Clothes dryer(gas) V 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) 4.1.10d?(;i5v TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: 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(II/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. { I:\Building\Permits'MEC-PermitApp.doc 09/09/10 2 , ,Electrical Permit Applicatio FOR OFFICE I SE ONLY City of Tigard �� m` Received Permit# ,�.7 w 13125 SW Hall Blvd.,Tigard,OR 97223 Pdn Review5 t f+C�2 Q ZS iP a. Phone: 503.718.2439 Fax: 503.598.1960 J U L. 3 {0 202� > y; iterated Permit#: Inspection Line: 503.639.4175 • Ready Date/8y; firm: 65 See Page 2 for itU 4'1.L3 w Internet: ww .tigard-or.gov CFTY OF TIGPF';{ `Notilied/Method: SapplementalInformation TYPE OF WORK PLAN REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans whtems checked): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas end boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ®1-and 2-family dwellingCommercial/industrial less to ground,or exceeds 14,000 ❑Commercial-use agricultural y ❑ El building amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: 1 Job site address: 13165 SW 115th Ave El Addition of IODHP or mnew motor load of system. awns ❑"A «E","1-2","1-3», City/State/ZIP: Tigard,OR 97223 ❑Six or more residential units. occupy. ❑Health-care facrlities. 0 Riemational vehicle parks. Suite/bldg./apt.#: Project name: O 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 3 Qtp. 1 Each I Total 1 • New residential single-or multi-family dwelling unit. Subdivision: WDML Lot#: 101 Includes attached garage. Tax map/parcel#: 2S103CA00101 1,000 sq.ft or less 168.54 4 Ea.add'l 500 sq.ft.or portion ! 33.92 I DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Proposed ADU to single family residence at 13163 SW 115th Ave Limited ener gy,multi-family 75.00 2 residential(with above sq.f.;i 04 PROPERTY OWNER Renewable Energy 0 See Page 2 / Services or feeders installation,alteration,and/or relocation Name: Pavel and Livia Mats y E D 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Address: 11375 SW Capitol Highway SEP 1 4 2021 401 amps to 600 amps 200.34 2 City/State/ZIP: Portland,OR 97218 601 amps to 1,000 amps 301.04 1 2. CITY O f TIGARD Over 1,000 amps or volts ss2.26 rr- 2 Phone:(503 )20043584 Fax:( BbiLnING DIVISION 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 amps or less 59.36 1 intended for sale,lease,r-=� -,i ange,according to ORS 447,449,670,and 01. 201 amps to 400 amps 125.08 1 2 Owner signature:^ ,i L_.1 Date: % 401 amps to 599 amps 168.54 i 2 ® APPLICANT ® CONTACT PERSON Branch circuits-new,alteration,or extension,per panel West Coast Design Graphics,LLC A.Fee for branch circuits with l Business name: 9 p 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 service rawn h or feeder fee,first circuit 56.18 2 City/StateJZIP: Portland,OR 97229 Each add'I branch circuit 7.42 1 2 Miscellaneous(service or feeder not included) Phone:( 503 ) 805-4339 Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: nrottat§wc-dg.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: TBD D j1i�.- r t Sign or outline lighting 67.84 2 - — — ! Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable hiany 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 90.00/hr . CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min) j ELECTRICAL PERMIT FEES Suprv.Electrician signature.required: i Subtotal: IPant name: Date: I 0 Plan Review Required(25%ofpermit 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 bus been accepted as complete. • Number of inspections allowed per permit. l:\BuildingPermits\ELC PermitApp_ELR ERE.doe Rev 06/17/2015 4404615r(11M3/COM/WEB 1 I ,41111111111111111.11111111111111104144614 "Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Deieriprion I Qty. I 1....II I total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: Li Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is charged at an hourly(1 hr min) 66.25/hr 1 Inspections for which no fee is 90.00/hr specifically listed('/z hr min) cgMMERC)<AI. WQRK QNLY; ELECTRICAL PERMIT,FEES Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: Li Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation Fire Alarm Installation HVAC [t Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* Li Protective Signaling ri Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Pemvts\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 �i' Plumbing Permit Application Building Fixtures r1 �1�;-� FOR OFFICE USE ONLY Cityof Tigard and ((t�� � Received y+' : ll Permit No.:ML4 C ZC��C�Z�P a 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: •� _J 4UL 3 0 2020 Plan Review Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit No.: Inspection Line: 503.639.4175 TIGARD Date Ready/By: kris ® See Page 2 for Internet' www.tigard-or.gov TI('-y,- RT) Notified/Method: Supplemental Information sft'' TYPE,OF t ' ,.rDING I I 1<"+JL+E*''SC ,DULL ar °ib l; ® New construction E Demolition For special information use checklist. Description . Qty. I 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 El 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: 13165 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 Lot no.: 101 Fixture or item: Tax map/parcel no.: 2S 103CA00101 Backflow preventer 31.27 " '''' ' �,fi�i� i Backwater valve 12.51 DESCRIPTION"oFi,WORT- , , Clothes washer 1 25.02 Proposed attached ADU to single family residence at 13163 SW 115th Ave Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ( PROPERTY"OWNER ❑ TENANT i., 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 In 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 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 Lie.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Nathaniel Rotta Date: 07/24/2020 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) • Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Q Fee(ea) Total Square Footage: Permit Fee: Footing drain-ls' 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service- I st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 , �l �� awn �iy'•, UaluatlQn�4I'FMll itee.oll ;m" Storm&Rain Drain- 1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees QtY Fee{ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan'if.''view for Plumbing`Installatioti °IP Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure -Drive Thru as defined in OAR918-780 0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" Isometric or Riser Diagram 4 ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lay/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 JUL— Q..2 -5-(f- (716-e-t_. RECPIVED 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. Print Name of Permit Applicant -ZZ z I Signature of Permit Applicant Date Permit It: f-S 06) SeP Address: -tom 19,+ rf 9Zz J oil � vnrri� tot n.b Issued by: Date: NJs i eA0,AQ ._ 003o i , 34,.2` 3 0.3 /3/q 7, /3/ 1/9 /3/YS /i .S �E This Copy for Permit Offices - fi` r 0 -oo2s 2 02-cl /3/6 3` /3/65 3. City of Tigard 71 Ir COMMUNITY DEVELOPMENT DEPARTMENT nD Building Permit Review — Residential TIG Building Permit #: ST20 i,+O—oo 2.58 4' Sc4) 12. 2e) 2-0 — OO i 5 j Site Address: -13165 SW 115th Ave . ,9-6+ A- &-rS Project Name: Matis Lot #: Planning Reviez .,., l 3 i(, %e/i3%?o; �cv{a�-/I: �„ S1-,en,��W Lt Ult. Proposal: attached ADU fi 0 Verify address/suite#active in Accela. 0 In River Terrace: 0 No ❑ Yes, River Terrace Review Addendum Site Plan Elements: , erosion Control It copies of siteplan on 8-1/2"x 11"or 11 x 17"paper etained trees with dripline and tree protection measures P PP a1� ODPrawn to scale(standard architect or engineer scale) 9'' Footprint of new structure(including decks)and FFE 0 orth arrow „;',Jtility locations&easements(required for new and additions) Dbite address,project or subdivision name and lot number sidewalk/driveway approach 0 Applicant information(name and phone number) cation of wells/septic systems II .t dimensions and building setback dimensions ktp eet tree size,type and location II.quare footage of buildings to be demolished Street names g \j�41 1 xisting structures on site L Corner elevations(2'contours if more than 4'differential a 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 0 Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Regvit6�le 0 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: El Yes 0 No SDC Exemption for ADU applied for: ❑Yes 0 No Received: 0 Yes El No Public Facilities Improvement(PFI) Permit: Required: ElYes,applicant was notified 0 No Applied For: ❑ Yes ❑ No,stop intake El Land Use Case#: ADU2020-00006 0 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: 23.5 1 : '.scape Area: % El Lot Coverage Max: 0/0 Entrance et back no more than 8'from street-facing wall ❑ Parallel to sir-. .r offset 45 degrees or less Windows .•. 12%of area of all street-facing facades Garage Gara e door is .•."nd widest street-facing wall 01 a Yes ❑ No,one of the following is met: Door extends no . - than 5' from wa -• ere is a covered porch extending beyond garage. . Door extends no more tha -'. .m wall and there is a 12 sq ft.window above garage on 2na floor. ❑ Garage door width is P or less 3 0%or less of facade 60%or less and includes 7 of following: Covere. .: c Recessed entrance 1 all offset ❑ 1'Roof eave Roof offset 're shingles Lap Siding ❑ Roof itch 1 Gable,hip,or gambrel roof ❑ Dormer Accent siding Window trim Window reces Window projection ❑Balcony 1 visual Clearance v/1 rban Forest Plan 0 Sensitive Lands: _ Yes LI No Type: 0 Conditions met prior to issuance of building permit Notes:Property is a flag lot, so design stan a ii CDC 18.290.040 do not apply 0 Approved By Planning: Z Date: 8/6/20 Revisions (after Building Submittal only) Reviewer Date Revision 1: 2 Approved ❑ Not Approved AIL- ln'(y f?o Revision 2: El Approved El NotApproved tv..1 I:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: 7/'30/2) Site Plans: # 3 Building Plans: # _3 Building Permit#: ©"Enter building ermit# above. Workflow Routing: Planning engineering 0-Permit Coordinator Building Workflow Sign-off: 0-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. gtuilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: dYl e/20 Engineering Review Slope at building pad: 7 l ©'Conditions "Met"prior to issuance of building permit fR Easements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: 12 Yes ❑ No —1 e-adettet vpdAr Final Plat Recorded: h MST2-020 ^0O2 57 ❑ NOT Approved by Engineering: %ref 121- -ke_y Date: ,1-03/LQ0 Notes: Akeel 45h0w L/Did to 7`rra f S7 41/el' (i)7), i `e S ,Le `7 or- 2 'i0 t/s� fEZ) ❑ Approved by Engineering: Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: Approved ❑ Not Approved igi 7 icy ip//s12420 Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review Conditions "Met"prior to issuance of building permit I ill Approved, NOT Released: ve,vvc ( b A sue _ /cy (DI(3170 Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: iirSDC Exemption: ❑ Received El Does not a ly 2 SDC Fees Entered: Wash Co Trans Dev Tax: to Yes � N/A Tigard Trans SDC: feYes El N/A Parks SDC: El Yes ❑ N/A LIDA ❑ Yes N/A r1 OK to Issue Permit Approved by Permit Coordinator: Date: 10 15 Zc7 I:\Building\Forms\BldgPemiitRvw_RES_122419.docx