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Permit
�+.IB.'. ( 1 144 "{A'?B *As, a =.J re s.::� .4 1 P111m1)im2 Permit AppijiLiggii r I1+3uildiag Fltiurry .eS1.., I*7..*k PA-s)-1t C�,.c(,), ,1 'i City or Tigard �I " 11123 S W lis1I p1.0.1.1 fart.OR o i . fN.n 0.e•arm t II No 1,eyt Me �„_ a pLewe y,1.ria 34/4 to X111'H I400 ` 1Wu H. ' J .. i , r I+ A. lnr+tctlrt Lh. 1E1*VI 41r1 toe i.ar t . itt,AMs) N ile.eMNttM MuNMwvl.1 Iotu . il'nntt.l ww.ty.4 OS p,v ilia luCllEnllli Tl'tiS Or N7tKli �'` " },tr gverrrl wwu�n rM1+r e-AnAlrre- - i I Atu..!rain t)t+ir�rl4 L�—" 1Slrstaa Nc....,*uwlt.rl p. NOW I.1—lrwtil AArlltsri♦lAU11n 100 A fro each uhl e.r+'tn*tAI 4'f ©Atic`Aton a)terat lltn tapir cruet* 0 titbit «- 1 )12.7'tr SMR III IN* . CAY1t^uN1Kl' t)M t11!t1)11NtC'[N/N 'SFRI21blob 417?ri Q (-atu!?•(roily d»clhlnp 0{ttllntrlercl#1-Infunn la %I R 1)l hs& SCD 12 Q ACcrrtory btu'ding 0 Matti-flair, tack rRSrwxtel%sailachew 25092 i 0 Maxim'builder ❑Ck`ter. , Flu arnW11e4 t w ft) L _.l ref',2 t ]ON slit DNrflRMATIDt( AND laCAtlo14 ski,►rltaint_ , ' 3� Caul!harm ono arra drain IN 76 Job ate at1,]res* J 3141 S LU 7.4%ft Drywall.k h line.a teach drain 1l Sy Ciry(StaId21P i t J { rt,,T � Fn«Inp drain inn tint a+'........0 _PEW 1 i Sit re''bidp'ar d AA J Prrj mint S'`ex 'Miii r citi' d(ante witla.n Y v)4S -/, tNattb.4a 1ltf 7rr Croru lineilditt htata infer(cit:: �ro Gt° � �esS�S I L7a 5163 ISI‘r IS 47� I.5(ilf �1Y9 Ran drain ton i+nlrrr , _ 1 l 1 Sanitary fe+.a Ind, Iteier A.,•..--) Part 2 j Pare 2 - Strain setter inn has it: 1 1 .Wale Wort Itneat ft ) 1 Parr 2 St.A+iii•uc+n lw m. Marital r Iles: ,,.__....ram.-. ^--' Mal(ltto prrvtettre 3117 7#a n.;prne9 inn . i Raebn al rptw r .+t 11 SI p 'GCAIlrlSON or ►if)RK 1 t iw#ahet 25.02 1]intrtp ft7reila 23.17C { ! 2S. �f t72 , Elm wrier-taw 1'f.Raorr r'rt three Isnl (Z} tttt)PE>iTl'OK NER F 2S ell _ /� ntau'te.e cat Name 1 PVC'1 1 1c`rts rimednr►llnat cal.Stub 23 02 Address: 1139-5" - s(,i)� COP(Zoe-- ( ), Ctrrltayrttt.pes& 2i02 City.'Rcnrell1P. (Paine+^'. OA ' ? ict shoe bob 2107 rIrne•1 So3) ko-zCS6y Fri ( ) t.:crtulrtr 1111 []Altt.11;AIYT CI 1rtptrrAC1 PERSON Iratwttf.ttle+petarrtap F 23.Ct2 Mala:ai pm(value I ) Page 2 Ratio rose name- . Pruner ( 12 Sl Cwtlx t bawdRonf Gam ltx.trtmercial I 12 31 Addicts Sirt Patin a+'nary 25 to CtryeState'/1P-_ -Soar units tarsier osier) 62 S4 F'at`:( 1 Tuft's/tower ow - .r.tivc pan y 12 31 . , Phoce i1 t tend 2107 E-rrsal: - i YeAtreiolA 7702 21 41 7!trIRAC1't)R V.tart belowi 37 32 Iiusmess rant f)C 42(.i1/44. 4A(6' (.A!G. wafer p,r•�.ni DWI.' i an A:srr�• f 22 Q 5 - /O ir' crtl,rr ' 2502 Cu)'Stair:VP. r' C Ka6,.ta) —! Pat nuft pant'.!ter S12 3U Plttx+t: r ¢ Fix:{ ) ntt t p _...�.__ ii PLn revlt. 125%of pemmlt fat ['CB Llc. �,. VG,.. tluntMnp LW,to /i Slaty wsrurrpe(12%Cf perrnil feel Authorized alpnaruar. f ,/, TOTAL PER.MTT FEE `�� ( L iya ibis pn►rli rptdku rer reYUi$aa eapt Ifs permit la sui ard winds Milda Print rime i r V /f 1)O[! ,� eilve I bap bran ter opted r c.wplat/. •Foe nethziolujy art b It,rivet,Ilallthni Industry Stnnise Wand 1&dos"Mrtn I/X,1-t'=+rnal,dui :A,A',CIO 034bli►It)nJ(i ('wilt+ n4lewem..1 • Mechanical Permit Application FOR OFFICE USE ONLY City Of Tigard Received y permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: wA/�(/ a 1—" ms E)(�(� tea 57 s 11111 Phone: 503.718.2439 Plan Review I" Other Permit: Date/By: 1 I c;A R i) Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST Kam,New construction ❑Addition/alteration/replacement Mechanical permit fees*are based on the value of the work 0 Demolition El Other: performed.Indicate the value(rounded to the nearest dollar)of all mechanical materials,equipment,labor;overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ [i I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building "s,''.•x �x, For special information use checklist. ❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: 1 i '6 i' S Vi / 15 6/ iefUE Air conditioning 4, 46.75 A Furnace 100,000 BTU(ducts/vents) '1 46.75 "i City/State/ZIP: / > K F-A Q n .9 T L-2 3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: 5 124 jx Heat pump 61.06 Cross street/directions to job site: I�_ / Duct work 23.32 P l4Q s S 4 dclIre.s .c Hydronic hot water system 23.32 Residential boiler(radiator or - 't - - r - t J - 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 Tax map/parcel no.: Other fuel appliances: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 H V1 ''. 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 (I.PROPERTY OWNER r ❑ TENANT Other: 23.32 ((�� Environmental exhaust and ventilation: Name: 1 'nyG t .A.s Range hood/other kitchen Address: 1A3K So, c (Toc l `_ equipment 33.39 ClothCity/State/ZIP: P tbnl �e 97,2`? es dryer exhaust , 33.39 `� p t- Single-duct exhaust(bathrooms, Phone:(5-03) 200' Ks7 # Fax:( ) toilet compartments,utility rooms) 6 23.32 Attic/crawlspace fans 23.32 0 APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: Contact name: $14.15 for first four;$4.03 for each additional Furnace,etc. Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater Water heater Phone:( ) Fax::( ) Fireplace E-mail: Range -I Barbecue ,+ . . .rt 4.1 m}'k`.?. : , .t z, ,' .`; am ,, 1. Clothes dryer(gas) Business name: ii 1 st COi g f- N E i'r( R 6 t CooUmath J,C Address: 2 c©D I S' £ G 6 Fie� MECHANICAL PERMIT FEES* r' Subtotal City/State/ZIP: D pt ul AS C L 5 OR, g' -6$ Minimum permit fee($90.00) Phone:0&) 5(S 4 2 5-2, Fax:( ) Plan review(25%of permit fee) CCB lice: /-© State surcharge(12%of permit fee) "[ la /dy TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 1.413 days after it has been accepted as complete. 11 ' * Fee methodology set by Tri-County Building Industry Service Board Print name: AL ••X 1A ist Q S1.0 al h A. Date: Q C-/6--2 wilding\Permits\MEC_PermitApp_082520.doc 440-4617T(11/02/COM/WEB) Electrical Permit Application it:, V x „,,,,,,r. FOR OFFICE USE ONLY CityofTigard w� 'Ce"ed �� c, a 5� Ilk - . te,B-: Permit#: 'T--� �G`dC -• 13125 SW Hall Blvd.,Tigard,OR 97223 9 an Review Phone: 503.718.2439 Fax: 503.598.1960 DJ1c,gy Related Permit#: Inspection Line: 503.639.4175 Ready Date,By: lurk ® See Page 2 for T I G A R D, Internet: www.tigard-or.gov Notified-Method: Supplemental Information TYPE OF WORK PLAN REVIEW ;id New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 4(X)amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings. N I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14.(XX) 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived / p ❑Addition of new motor load of system. Job#: Job site address: i3/ 5 SW 1/5 5T 100HPormore. ❑'A . E - 1.2 . I-3 . ❑Six or more residential units. occupancy. City/State/ZIP: •T/yard ok Gf 22,3 ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 6(8)amps or more. 60()volts nominal Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I a New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1.000 sq.ft.or less / 168.54 4 Tax map/parcel#: Ea.ad(II 500 sq.R.or portion $ 33.92 1 DESCRIPTION OF WORK Limited energy,residential /� ` �(� , Q (with above sq.ft.) 75-(x) Roefg�, eat-4 Itr/S6 e4`ei ,c 'o,± i Limited energy.multi-family 75 00 f-A.e en /,�, A S / _ residential(with above sq.ft.) 1`Y Renewable Energy 0 See Page 2 ❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 201 amps to 40)amps I 133.56 2 Address: 401 amps to 6(8)amps 200.34 2 City/State/ZIP: 601 amps to 1.(XX)amps 301.04 2 Phone'( ) Fax:( ) Over I.000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I ' intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 0 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee. 7.42 2 at each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 branch circuit 2 City/State/ZIP: Each add'I branch circuit 7.42 2t Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67 dwelling,service and/or feeder iti Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 5° 2,icig FKC7`i 1e 4LC Sign or outline lighting 67.84 2 fft y Signal circuits)or limited-energy Address: l>c J 6 4./$— s'E- uvo p N<« t�S /e panel.alteration.or extension. ❑ See Page 2 ' City/State/ZIP: Each additional inspection over allowable in any of the above 1>r?�'/?SCCi, C`J Cr 1 89 Additional inspection(I hr min) 66.25/hr Phone:t3' s--/ j Fax:($'O ) _28.,17 Investigation(I hr min) 90.(1)/hr 3 1a ®® /� ,6 Industrial plant(I hr train) 78.18/hr Email: dr pis s' ��//t!t's co-/P� r!Y �_>7C�f G . C Q/�� Inspections for which no tee is �zjj V specifically listed(%x hr min) 90.00/hr 1114" CCB Lie.:/602gs Electrical Lic.: Suprv.Lic.:C / }' ELECTRICAL PERMIT FEES Suprv.Electrician signature,require • r1 f/,Z Subtotal: Print name: pi—cz Q���S S ie,'� ^ Date: .1_,.6 _ ' 0 Plan Review Required(25%of permit fee): - 0 State surcharge(12%of permit fee): Authorized signature: 5,440ciic7,v TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:Building\Permits\ELC_PermitApp_ELR ERE.dec Rev 06 7,2(115 4 0-4615T111,1S'COM WER uMM+Muu u++i+ttltM+N)tiMWl3k{1+iA+N.+{WiiiAii{}!Ai{iFr F 1artMusu a+ts+.Ai+ .+. an .arux+.a sAei+i+rriiH tH1a+NFikA+kAt 1LAiik4r.+.k .+++ <-.,: , ,..,,, +ni -.ereiarr l,e e.ii + R+3f++Fd 4FbiAHM.r+tdA4 F.ia a+D4kMt aiiMketurM lsr.aiaf, CITY OF TIGARD MASTER PERMIT III ` COMMUNITY DEVELOPMENT Permit#: MST2020-00257 Date Issued: 03/21/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103CA00101 Jurisdiction: Tigard Site address: 13163 SW 115TH AVE Subdivision: None Lot: None Project: Matis-Bldg 1 -Primary Dwelling Project Description: New primary dwelling with(1)attached ADU on separate permit. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 1134 sf Basement: 0 sf Left: 10 Parking Spaces: 0 Height: 23.5 Bathrooms: 3 Second: 564 sf Garage: 417 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 10 Detectors: Total: 1698 sf Value: $228,257.49 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 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 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 SrvclFeeders 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 3 201-400 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 SF VB R-3 1698 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: $34,615.83 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 requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR oc9_nn1-nn'Ir)thrni inh(1GR Qc9..nn1-nnon mnai nhtnfn nnns,of tho ndoc nr riirAnt nnoctinnc to OI INr hM r,ufnn Sn7 949 1,117 nr 1 Ann 119 9Qdd Issued By: Ha L i yam.De,We-ye, Permittee Signature: Ow A 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 ?12rn4-fl—y /14" ri.s ,3 c--6 G / Residential RECEIVED FOR OFFICE USE ONLY Cit of Tigard Received 7 y 0 2020 Date/By: a// /'Z 0Permit No .S%ye LO 00 2 C 74 " 13125 SW Hall Blvd.,Ti ard,OR 97223 S g Plan Review r Phone: 503.718.2439 Fax: 503.598.191TY OF TI GAR D Date/By: I Vait Other Pern,v l//e 2cZ0"j2O/SO TIGARD Inspection Line: 503.639.4175 Date Ready/By: f tuns: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: I i2, 71 40D Supplemental Information e-Al'1-1 1--- IVY ft"'T 1 i 4 nl, 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 ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. E 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 8611 ZZg'7,57 0 Accessory building 0 Multi-family Number of bedrooms: 3 ❑Master builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 it 1 c- Job site address: 13163 SW 115th Street PRjH 4727 New dwelling area: 1698 square feet 514 City/State/ZIP: Tigard,OR 97223 Garage/carport area: 417 square feet 11- -.1 Suite/bldg./apt.no.: Project name: Covered porch area: square feet iLijross street/directions to job site: Gaarde/115th Street Deck area: square feet t6---6-6 AJS C671-Vi Cr "tze—Vi6eT72-- Lk, Z/-/� Other structure area: square feet rlI ' , 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 DESCRIPTION OF WORK work indicated on this application. Proposed single family residence with an attached ADU. 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 E 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): 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: '762) /I I A" /FA- - e /,G,/L,7 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 and administrative fees): $180.00 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: 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 USE ONLY City of Ti and Received Permit No.: . elIN13125 SW Hall of Blvd.,Tigard,OR 97223 Associated permits: Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical IIC;;1RI) Internet: www.tigard-or.gov 0 Other: TILE FOLLOWING ITENIS ARE REQUIRED FOR PLAN REVIEW %'t's No y/.` 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. X❑ 0 ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. X❑ ❑ ❑ 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 ❑ 0 IE 6 Sewer permit. 0 0 7 Water district approval. ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ Cl 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 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 ® 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. ® El CIExterior 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- il ❑ ❑ 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 ® ❑ ❑ 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 ❑ ❑ architect licensed in Ore:on and shall be shown to be applicable to the .ro'ect under review. JURISDICTIONAL SI'F.CII'1('S 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ® ❑ ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ® ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ® ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ 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 ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ® ❑ ❑ 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 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) /4-ff Building Permit Application I " ���1 , p . Residential FOR OFFICE USE ONLY 32EVEDReceivedCity of Tigard Permit No.: Date/By: 3125 SW Hall Blvd.,TigardPlan Review ■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: t t G A it t) Inspection Line: 503.639.4175 JUL 14 2020 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov �+ Notified/Method: Supplemental Information TIGARD Ty fTY w VISION OF 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 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 4 ,558 ❑Accessory building 0 Multi-family Number of bedrooms: 6 ❑Master builder El Other: Number of bathroo 6 JOB SITE INFORMATION AND LOCATION Total number, floors: 2 Job site address: 13163 SW 115th Street New dwe mg area: 3175 square feet City/State/ZIP: Tigard,OR 97223 Garage/carport area: 678 square feet --t Suite/bidg./apt.no.: Project name: Q'overed porch area: square feet \�Cross street/directions to job site: Gaarde/115th Street /Deyt area: square feet I U Qfi�f structure area: square feet � ''� EQUI D DATA:COMMERCIAL-USE CHECKLIST Subdivision: WDML Lvtt1o.: 1 ,1, end f *are based on the value of the work performed. Tax map/parcel no.: 2S 103CA00101 V /f In.i• t e value(rounded to the nearest dollar)of all e.ih. . ent,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK t /�v.r indicated on this application. Proposed single family residence with an attached ADU. ++ ,; C aluation: $ V �7 4C,,ning building area: square feet ✓✓✓ lew building area: square feet ® PROPERTY OWNER ❑ T Number of stories: Name: Pavel and Livia Matis Type of construction: Address: 11375 SW Capitol Highway Occupancy groups: City/State/ZIP: Portland,OR 97219 1j Existing: Phone:( 503) 200-8564 Fax:( ) New: ® APPLICANT ® CO TACT 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): ✓ FLS plan review fee(if applicable): Address: 10108 SW Mofrison Street ii City/State/ZIP: Portland, R 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 -rot) CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: (Id r/.:.--72. 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: $201.60 Authorized signature: 7441Z4025— This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Nathaniel Rotta Date: 07/13/2020 *Fee methodology set by Tri-County Building Industry Service Board. I:\Buildmg\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) V E. Mechanical Permit Applicatio FOR OFFICE USE ONLY City of Tigard EIVI7 -ceived Permit No. a 13125 SW Hall Blvd.,Tigard,OR 97223111111 Date/By: S T <e7"'('�2$ e ' Phone: 503.718.2439 Fax: 503.598.1960 JUL 3 0 2020 PlanDate/ByReview: Other Permit: TIGARD Inspection Line: 503.639.4175 /�o w Dive Ready/By: tutus: ® See Page 2 for Internet: www.tigard-or.gov CITY(FT!(t-r Ndtified/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 ❑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 7 Heating/cooling: Air conditioning Job site address: 13163 SW 115th Ave (requires site plan showing placement) 1 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/b►dg./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.: 101 Flue/vent for any of above 23.32 Other: 23.32 Tax map/parcel no.: 2S103CA00101 Other fuel appliances: DESCRIPTION OF WORK Water heater 1 23.32 Proposed single family residence Gas fireplace 33.39 Flue vent for water heater or gas 1 fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ® PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32 -- Other: 23.32 Name: Pavel and Livia Matis Environmental exhaust and ventilation: Address: 11375 SW Capitol Highway Range hood/other kitchen 1 equipment 33.39 City/State/ZIP: Portland,OR 97219 Clothes dryer exhaust 1 33.39 Single-duct exhaust(bathrooms, Phone:( 503 )200-8564 Fax:( ) toilet compartments,utility rooms) 4 23.32 ® APPLICANT 1 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 nrotta we-d Fireplace E-mail: 9com Range 1 CONTRACTOR Barbecue Business name: TBD iriti i j L+- Clothes dryer(gas) Other: Address: MECHANICAL PERMIT FEES* City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee($90.00) Plan review(25%of permit fee) CCB tic.: State surcharge(12%of permit fee) 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 1:\Building\Permits\MEC-PermilApp.doe 09/09/10 440-4617T(I I/02/COM/WSB) 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 INV • EIectrical Permit Application 1 OR on ici',i SE ONLY City of Tigard ECEIVtReceives Date/Br: Permit#: . 13125 SW Hall Blvd.,Tigard,OR 9 22 i (3'a �s 7 r 1: ' Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Related Permit 6: �p {y Date/By: 7 i G A T.U Inspection Line: 503.639.4175 J U L 30 2020 Ready Date/By: hair: l 0 See Page 2 for .. Internet: www.tigard-or.gov „,... Notified/Method: i Supplemental Information TYPE OF WORK _ PLAN REVIEW i ®New construction ❑Addition/attAfidahe 11arbitlen1 f Please check all that apply(submit t2 sets of plans wlitems checked): ❑Demolition ❑Other. 0 Service or feeder 400 amps or more 0 Building over three storks. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. In 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14.000 ❑Commercial-use agricultural ❑Multi-family ❑Master builder amps for all other installations. buildings. ❑Other: 0 Fire pump. 0 Installation of 150 KV A or JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separately derived Job#: l Job site address: 13163 SW 115th Ave O Addition of new motor load of system. 104HP or more ❑"A","B,"1-2""1-3", City/State/ZIP: Tigard,OR 97223 ❑Six or more residential units. occupancy. 1---- ❑Ha CI**rational facilities. reational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal Cross street/directions to job site: Gaarde/115th Street FEE SCHEDULE Description I Qty. ] Each I Total I t New residential single-or multi-family dwelling unit. Subdivision: WDML Lot#: 101 l Includes attached garage. Tax neap/parcel#: 2S103CA00101 1,000 eq.ft.or less I 168.54 4 Ea add'l 500 sq.ft.or portion f 33.92 1 DESCRIPTION OF WORK Limited energy,residential . Proposed new single family residence at 13163 SW 115th Ave (with above al.ft./ 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) illPROPERTY OWNER 1 Renewable Energy 0 See Page 2 RECEIVED Services or feeders installation,alteration,and/or relocation Name: Pavel and Livia Matis 200 amps or less 100.70 2 Address: 11375 SW Capitol Highway S E P 1 4 2021 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 f 2 City/State/ZIP: Portland,OR 97219 CITY OF i IGARD 601 amps to 1,000 amps 301.04 2 Phone:(503 )200-8564 Fax:( ) BUILDING DIVISION 1 O`'Er1'000ampsorvolts 552.26 i 2 Email: i Temporary services or feeders installation,alteration,and/or relocation Owner Installation:This in.' tion is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease, - -xchange,according to ORS 447,449,670,aid 7 1. 201 amps to 400 snips 125.08 2 Owner signature: `�,. Data I ,n q 401 amps to 599 amps 168.54 2 r APPI N 1 Branch circuits—new,alteration,or extension ® I ® CONTACT PERSON A.Fee for branch circuits with perpanel Business name: West Coast Design and Graphics,LLC above service or feeder fee, each branch circuit 7,42 2 Contact name: Nathaniel Rotta B.Fee for branch circuits without Address: service or feeder fee,first 11165 NW Copeland Street branch circuit 56.18 2 City/State/ZIP: Portland,OR 97229 Each add'I branch circuit 7.42 2 — Miscellaneous(service or feeder not included Phone:( 503) 805-4339 Fax::( ) Each manufactured or modular ■ dwellin service and/or feeder 67.84 2 Email: nrotta@wc-dg.com Reconnect only .; 1111111110131 CONTRACTOR Pump or irrigation circle ;. Business name: TBD 117t/A/E/` Sign or outline lighting MI2 Signal circuit(s)or limited-energy Address: anal aherati, or extension. 0 See Page 2 i 2 City/State/ZIP' Each additional Ins,action over allowable in any of the above Additional inspection(I br min) ` 66.25/hr Phone:( ) j Fax:( ) Investigation(1 hr min) - 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr i11111 Inspections for which no fee is III CCB Lic.: Electrical Lic.: Suprv.Lic.: ifia0 listed t1/4 hr min 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: I Date: ❑Plan Review Required(25%of permit fee): — State surcharge(12%of permit fee): ' Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 150 Print name: Nathaniel Rotta I Date: 07/24/2020 { days after it has been accepted as complete. * Number of inspections allowed per permit. 1:lBuildagWernrits\LC_PermhApp_PLR_ERE.doe Rev 06/17/2015 440.4615T(1185/COM/wEa 1 • Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: h FEE SCHEDULE RESIDENTIAL WORK ONLY: Fee for all residential systemscombined: $75.00 ne Qty F.aen natal Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 Ti 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 n V• acuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: I I Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(Ys hr min) {iCOMMERC: L WPNIA;miihrdldittsd,,aAP okii,i 0o ! ,)ELECTRICAL PERMIT FEES ti Fee for each commercial system: $75.00 Subtotal(Enter Page 1): * (SEE OAR 918-309-0000) Number of inspections allowed per permitt. Check Type of Work Involved: I Audio and Stereo Systems Ti B• oiler Controls U Clock Systems ❑ Data Telecommunication Installation Fire Alarm Installation ❑ H• VAC Instrumentation Ti Intercom and Paging Systems Ti L• andscape Irrigation Control* Ti Medical Nurse Calls 7 O• utdoor Landscape Lighting* Protective Signaling Ti Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PennitApp_ELR_ERE.doe Rev 06/17/2015 • Plumbing Permit Application Building Fixtures a 13125 SW Hall Blvd.,Tigard,OR 97223 FOR OFFICE USE ONLY Clt Of TiaY(jIVE Received - y g Date/By: Permit No.:I M lS r_Z'' .00 25 7 • 3 S Phone: 503.718.2439 Fax: 503.598.1960,E Plan Review ` V 2020 Date/By Other Permit No.: TIGARD Inspection Line: 503.639.4175 « Date Ready/By: hums 0 See Page 2 for Internet: www.tigard-or.gov OF-a i1,;�f"st",a,�NDoufied/Method Supplemental Information {{� }( ` t pp TYPE OF 6� G � I I FEE* SCDEDULE,. .;till " ei(a kk 2 New construction ❑Demolition For special information use checklist. Description I Qty. i Ea. I Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONS'I'ItUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 1 500.32 0 Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 4O11 SITE INFORIVIA.TION.AND LOCATION; *' Site utilities: Job site address: 13163 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.: 2S103CA00101 Backflowpreventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 Proposed single family residence Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 j PROF,ERTTY,OWNER ' ❑ TENANT Expansion tank 12.51 Name: Pavel and Livia Matis Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 11375 SW Capitol Highway . 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 It ',CONTACT 1'EIZSON 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 1 E-mail: nrotta@wc-dg.com Urinal 25.02 Water closet 3 25.02 ', CONTRACTOR 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 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) 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. I1BuildingWermits\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- 1"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- 1st 100' 62.54 Medical Gas Systems Water Service-each additional 100' 37.52 V ��; a r r d1U� F4? iw £' " Pe>t'Jnlly� 'C. 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 Qry. fpo WO 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 Review for Plumbing Installations 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 tall 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" 3" Isometri `or RiserDiagirlain't!' 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: -Lav/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 fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:ABuilding\Permits\PLMF PermitApp.doc 08/04/2011 2 cis r ,a0 -Oo 2 7 JRECE VE /i/ 3 s j //S J CITY OF TIGARD BUILDING DIVISIO'r CleanWate Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number 21-001856 1. Jurisdiction:Tigard 2. Property Information(example: 15234A801400) 3. Owner Information Tax lot ID(s): Name: Pavel Matis 2S 103CA00101 Company: Address: 13163 SW 115th 13163 SW 115th City,State,Zip: Tigard,Oregon,97223 2008564 OR Site Address: 503 City,State,Zip:Tigard,Oregon,97223 Phone/fax: Nearest cross street: Former St Email: matis87@yahoo.com 4. Development Activity(check all that apply) 4. Applicant Information ❑ Addition to single family residence(rooms,deck,garage) Name: Pavel Matis ❑ Lot line adjustment 0 Minor land partition Company. ❑ Residential condominium 0 Commercial condominium Address: 13163 SW 115th ❑ Residential subdivision 0 Commercial subdivision City,State,Zip: Tigard,Oregon,97223 ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 5032008564 Other New SFR w/ADUs Email: matis87@yahoo.corn 6. Will the project involve any off-site work? ❑Yes 0 No 0 Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate. Print/type name Pavel Matis Print/type title Signature ONLINE SUBMITTAL Date 6/9/2021 FOR DISTRICT USE ONLY O Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also be required. Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,State and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,state and federal law. ❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2).NO SITE ASSESSMENT OR SERVICE " ">c-^'c Reviewed by Date 7/22/21 Once complete,email to:SPLReview@cleanwaterservices.org • Fax:(503)681-4439 OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway,Hillsboro,Oregon 97123 nFv;eaz/zozo c_�.==-�.=� _�� —-- Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p.503.681.3600 1:503.681.3603 • cleanwaterservices.org / s 7.,2d Cal S7 jRECEIVED /.3/61 ,s"zJ //( Aim JUL 2 6 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. 1 have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. ?Lk Mo'Ir Print Name of Permit Applicant -ZZ--Z I Signature of Permit Applicant Date Permit#: -57 01'D e7(J 2Z 2 1111 �? 4110" Address: � . Fa S :✓_�a. a norJ of 9zzS .".:. Issued by: Date: A/s i��.�Q -- 003o / 30.2 3 03 /-3/ '7, /3/ 4/9 /3/ 3— /' S 'fit his Copy for Permit Offices /3/6 3, /J/ ,5 S‘,.J //S` — i ' City of Tigard 74 N COMMUNITY DEVELOPMENT DEPARTMENT T l c A R D Building Permit Review — Residential 0 ,W,,,,,,,,,m .,—, Ra,..mr,,,.,4 4k.ts1='' t7teK 5s2 = s?.o t .tit" '._a ham-Att .&,.-. -.. _, 004tt#44xim Building Permit #: /11S7 j . .p - CO3 .5'7 ' SuJ/L 4 ..0 ..t?'-'O7/SO Site Address: 13163 82EifiNaW 115th Ave /2,/2/ti, �/'2. e'1'64 . JS Project Name: Matis / Lot #: Planning Review13 i(03 1— /fit /0/ v` � 5;*.,D1 Proposal: New house wilt4Eftschstga=tt siloui,t^y (0. 0 Verify address/suite #active in Accela. 0 In River Terrace: ❑° No ❑ Yes, River Terrace Review Addendum Site Plan Elements: ,Erosion Control 12; copies of site plan on 8-1/2"x 11"or 11 x 17"paper \,� , etained trees with drip line and tree protection measures Dltrawn to scale(standard architect or engineer scale) k1 ...Fbotprint of new structure(including decks)and FFE IIworth arrow 'LlJtility locations&easements(required for new and additions) Ill.ite address,project or subdivision name and lot number sidewalk/driveway approach 1111.pplicant information(name and phone number) cation of wells/septic systems 1111 .t dimensions and building setback dimensions kl-) eet tree size,type and location Ooquare footage of buildings to be demolished street names 41 xisting structures on site °�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? ° es o 0 Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Req.in Q Yes,applicant was notified 0 No ��e ved: ❑Yes ❑'No t3. Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs A� Required: ❑Yes,applicant was notified ❑o No Received: ❑ Yes ❑ No `�" SDC Exemption for ADU applied for: El Yes ❑° No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: CI Yes,applicant was notified ❑ No Applied For: CI Yes ❑ No,stop intake 0 Land Use Case#: ADU2020-00006 ❑r Zoning: R-4.5 QRequired Setbacks: Front: 20 Rear: 15 Side: 1 0 Street Side: N/A Garage: 20 ❑° Building Height: Max. Height: 30 Actual Height: 23.5 1 : •escape Area: % ❑ Lot Coverage Max: 0/0 Entrance et back no more than 8' from street-facing wall ❑ Parallel to str-_ .r offset 45 degrees or less Windows , . ... 12%of area of all street-facing facades Garage Gara e door is .•a'lid widest street-facing wall I 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 . em wall and there is a 12 sq ft.window above garage on 2nd floor. ❑ Gara•.e door width is or less 0%or less of facade 60%or less and includes 7 of following: Covere. .: c Recessed entrance E. all offset 1'Roof eave — Roof offset .re shingles Lap Siding ❑ Roof itch II Gable,his,or gambrel roof _ Dormer Accent siding Window trim Window reces Window projection CI Balcony I visual Clearance 1'`1 rban Fores Plan ❑ Sensitive Lands: Yes ' No Type: ❑r Conditions met prior to issuance of building permit Notes:Pro ert is a fla lot so desi n stan ar ' , CDC 18.290.040 do not apply Q Approved By Planning: Date: 8/6/20 Revisions (after Building Submittal only) Reviewer Date Revision 1: El Approved El Not Approved (t)I i t /Za Revision 2: ❑ Approved CI Not Approved v I:\Building\Forms\B1dgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: 7 / 2 0 Site Plans: # 3 Building Plans: # `3 Building Permit#: Inter buildin Ier permit# above. I Workflow Routing: Planning 6 Engineering LJ Permit Coordinator Elluilding Workflow Sign-off: ❑'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 ort "nal plan review routing form. uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: /� By Permit Technician: �C o l Gam—. Date: >7a 1„0 Engineering Review la-Slope at building pad: 7 % QConditions "Met"prior to issuance of building permit 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: E Yes ❑ No Final Plat Recorded: el/A. [ NOT Approved by Engineering: lr'eii / di'' c-R-7i Date: /t //3/ZG? Notes: Amid ID 6hrrk) ugh iv 4- S7'rir/V1 IJ, -,,, Lit)/4 Aeas td he 6`t d, • 2uW ( /c'Bc ) ❑ Approved by Engineering: Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: Er Approved ❑ Not Approved %rieoitf di-.7?If-P, /UIl C-/20 Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review iaConditions"Met"prior to issuance of building permit id Approved, NOT Released: 1I\JlS . L M SI2e — Al- IOl 13(2O Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: SDC Exemption: El Received Does not a ly S SDC Fees Entered: Wash Co Trans Dev Tax: 14 Yes � N/A Tigard Trans SDC: Yes ❑ N/A rks SDC: t Yes ❑ N/A LIDA Yes ❑ N/A ,®,OK to Issue Permit Approved by Permit Coordinator: At\( Date: (0 [t''J 17A0 I:\Building\Forms\BldgPermitRvw_RES_122419.docx FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: Nathaniel Rotta DEC 3 0 2020 COMPANY: WC Design and Graphics CITY OF TIG RD PHONE: 5038054339 BUILDING DIVI : .N RE: 13163/13165 SW 115th Street MST2020-00257 & 258 • (Site Address) (Permit Number) 13163 Residence (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. 3 Revisions: A0.1,A1.0,A1.1,A1.2,A1.4,A1.5,A2.1 Cross section(s)and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. 1 Other(explain): plan check response REMARKS: Revised Sheets (To be slip-sheeted) FOROFiFICE USE ONLY Routed to Pe ' Technician: Date: 1 t/ 4 Initials: Fees Due: Yes ❑No Fee Desc .ption: Amount Due: kr 1,/nf1 y L J Special Instructions: Reprint Permit(per PE): ❑ Yes ❑No El Done Applicant Notified: Date: Initials: I:\Building\Fonns\TransmittalLetter-Revisions.doc 05/25/2012 FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 4 Ns Transmittal Letter i ;c;A 1;1) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: Nathaniel Rotta NOV 10 2020 CITY OF TIGARD COMPANY: WC Design and Graphics BUILDING DIVISION PHONE: 5038054339 BY: RE: 1 31 63/1 31 65 SW 115th,Street MST2020-00257 & 258 (Site Address) (Permit Number) 13163 Residence (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. 3 Revisions: A1.0 Cross section(s)and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: Revised Sheet A1.0 (To be slip-sheeted) 77FICE USE ONLY Routed to Permit Techni . . Date: /) Initials: Fees Due: ❑ Yes No Fee D : Amount ue: : 70-- Special Instructions: Reprint Permit(per PE): El Yes ❑No ❑Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 \t FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information itprovides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT i . " '011Transmittal Letter T t i,,,I< 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: Nathaniel Rotta NOV 2 2020 CITY OF TIGARD COMPANY: WC Design and Graphics BUILDING DIVISION PHONE: 5038054339 By.` _ RE: 13163/13165 SW 115th Street MST2020-00257 & 258 (Site Address) (Permit Number) 13163 Residence (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. 3 Revisions: A1 .4 and A1.5 Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: Revised Sheet A1.4 and A1.5 (To be slip-sheeted) FOR F CE USE ONLY Routed to Permit Technician: Date: ( -? ZI Initials: Aii— Fees Due: ❑ Yes No7 Fee Descri io : Amount Due: Special Z $ Instructions: Reprint Permit(per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions.doe 05/25/2012