Permit III CITY OF TIGARD MASTER PERMIT
ii
ti COMMUNITY DEVELOPMENT Permit#: MST2022-00134
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503,718.2439 Date Issued: 07/25/2022
Parcel: 1 S136AC00200
Jurisdiction: Tigard
Site address: 10530 SW 72ND AVE
Subdivision: METZGER ACRE TRACTS Lot: 3
Project: BYRNES
Project Description: Interior renovation and roof alteration: Relocating kitchen and half bathroom, and adding a full
bathroom. Electrical permit will be created online separately.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Yes
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $82,918.30 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 2
Other Fixture Units: Kitchen prep sink&Water piping/DWV
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0
Heat Pump; N Hoods: 1 Other Units: 1
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add,500 sf: 0 201-400 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
N
Other: N Other Description: Ecompasing.
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
BYRNES,MIKE&KATE OWNER Required Items and Reports(Conditions)
5430 SW AMES WAY
PORTLAND,OR 97225
PHONE: PHONE:
FAX:
Total Fees: $2,213.47
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_owl n}hrn„nh nap QS9-nnl-nnon Vnn may nhtain a rnnv of tho rulac nr rlirort n„actinnc in Obi INn Kw Tallinn Q 979 10a7 nr 1 aro 119 9/44
Issued By: ../�c ermittee Signature:
Ca .639.4175 by 7:00 a.m,for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
din Permit Application
Residential FOR OFFICE L Sl ()NIA
Received
Cityof Tigard Permit No.:pi
lig " 131 SW Hall Blvd.,Tigard,OR 972 E I - I V F D Date/By:Plan Review /1~ Orr—
Plan O�j��
Phone: 503.718.2439 Fax: 503.598.1 6 V Date/By: 7��J 1/1/ A Other Permit:
I t .��`l t Inspection Line: 503.639.4175 P/,I It (� ly Date Ready/By. tars Iii See Page 2 for
Internet: www.tigard-or.gov I V "fie Metho z, Supplemental Information
TYPE OF WQR u i,6 ; 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
VI Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
a CATEGORY OF CONSTRUC""^"1 work indicated on this application.
Valuation:X 1-and 2-family dwelling 0 Commercial/industrial $ ^�b pi I Q 1 1 R . So
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms: ! I
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
I
Job site address: 10 530 S . 72" Ave... New dwelling area: square feet
City/State/ZIP: '175 ckr..d,I c _ Gil 22.3 Garage/carport area: square feet
/ Suite/bldg./apt.no.: Project name: /3y Afr, Covered porch area: square feet
` Cross street/ erections to job site: (1 ✓ Deck area: square feet
V ib lAla G/PI/jyr (,a,{(tits rev s tti-{a 3,r-'10 Other structure area: square feet
i� a.G74. .r ce-- #c j4D t rr'O.&f 4 1Y' REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: J 2,91.22 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
• yet I P/ E 9 S SLP1.21� work indicated on this application.
MOW, K 1 che>7 CLY1c,� 110,1� 17GC(11�J Ada FullValuation: $
Imo,- S lop. 1r b01 Existing building area: square feet
New building area: square feet
'PROPERTY OWNER 0 TENANT Number of stories:
Name: e�S tr . 't �.t 144+C. e `J Type of construction:
Address: I 05-30 S W 1 Z► /k A Occupancy groups:
City/State/ZIP: Tl ay.41 C t-7 223 Existing:
Phone:(Sb3)'1st - z�3D Fax:( )
New:
X APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Contact name: YIp� Qrn� Structural plan review fee(or deposit):
Address: FLS plan review fee(if applicable):
tbs 3'v —12�' I r t p,-
City/State/ZIP: r• r b� t l ZZ3 Total fees due upon application: 35 06
Phone:(S'0 )"1 a— t2 3o ( ) Amount received:
Fax:
E-mail: I-� rYl,esak q� 3 acl , (,pw� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: �"���`�� Submit two(2)sets of roof plan with connection details
nY10` "`^' h r� and fire department access,along with the 2010 Oregon
Address: l b c 30 5 W �rl/Y_- Solar Installation Specialty Code checklist.
City/State/ZIP:-1- )o 0 -1 22,J Permit Fee(includes plan review $180.00
I t t b t and administrative fees):
Phone:65.03) - 7,Z3AD 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:
Ai Date:Sy1G2I 24)z...7.. Service Board.
I:1Building\Permits\BUP-RESP pp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB)
Building Permit Application Checklist `
One- and Two-Family Dwelling FOR OFFICE I �t tr\I \ _ '
City of Tigard Received
Permit No.:
Date/0 B
1 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
/ I " Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical ❑ Plumbing 0 Mechanical
r I c,n R o Internet: www.tigard-or.gov p Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No y/t
I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 ❑ C
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 []'
3 Verification of approved plat/lot. 0 0 ["
4 Fire district approval required. Name of district: . 0 ❑ Ca-
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 2'
6 Sewer permit. - 0 ❑ a
7 Water district approval. 0 ❑ a
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 [�],'/
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 L7
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state m ❑ Cl
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 a 0 0
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 u ❑ 0
and location. -
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, a ❑ 0
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- E 0 ❑
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. [3 0 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- 0 0 [2'
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 Q' 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑. 0
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 12 0 ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 ❑,/
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required, 0 0 1Z
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 0' 0 0 :.
architect licensed in Ore on and shall be shown to be a licable to theproject under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 5 ❑ 0
25 Buildingplans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. , 0 , 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 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 ❑
Street Tree List. J
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, by 0 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 0 2'
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.
uilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46.13T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
�.4 y . City of Tigard Received
Date/By: Permit No.: ,/►) 0ri_�i At/
• 13125 SW Hall Blvd.,Tigard,OR 97223 I Ov
' Plan Rev= Phone: 503.718.2439 Date By iew Other Permit:
T I G AR D Inspection Line: 503.639.4175 Date Ready/By luris:
Internet: www.tigard-or.gov y y I See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
❑New construction ea-Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
0 Demolitionperformed.Indicate the value(rounded to the nearest dollar)of all
0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
1-and2-family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑Accessory building
❑ Multi-family ❑Master builder For special information use checklist
❑Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job sit1 address: 10S-SO k.C.: )` tclAve, Air conditioning 46.75
�r G� Furnace 100,000 BTU(ducts/vents) 46.75
City)State/ZIP: I I5� ( ci 9.7 zZ
Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: name: r Heat pump 61.06
' hw �fh�� O��Ov�
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fael-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
DE6( JRTI[]N.:OF.::wORK
Gas(CI Fluevent
fireplace/insertor 33.39
C\ �(���— Flue vent for water heater or gas
1 ' '-" '� � � t ^l r'�'�(�`r` fireplace 23.32
�t',,no -`ko`n O.- -ct CJUC-1-- � K Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ❑ TENANT Other: 23.32
Name: YTn no. 6; .cs k.� Environmental exhaust and ventilation:
JRange hood/other kitchen
Address: (pc30 SW �2:,L Jl_v� equipment i 33.39
City/State/ZIP: At LY �� Clothes dryer exhaust 33.39
C/# 9'� Single duct exhaust(bathrooms,
Phone:('" ) ��,� �� -� per.( ) toilet compartments,utility rooms) 423.32
Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON
Other: 23.32
Business name: Fuel piping:
Gontaei 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: �r Range
eiJ' CONTRACTOR Barbecue
r r Clothes dryer(gas)
Business name: �/
l�1...e.4..eT� 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)
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.
* Fee methodology set by Tri-County Building Industry Service Board
Print name:Vl nn 3 �"/I l_/V-
11BuildingPeumils\MEC_PermilApp_08252 c 440-4617T(111/02/COM/WEB)
Mechanical Permit Application - City of Tigard a .
Page 2 - Supplemental Information '
Commercial Submittal Requirements:
• (2) sets of plans, drawn to scale.
• (2) sets of equipment cut sheets.
• (2) copies of site plan for ground and roof top equipment
location and screening per Tigard development code.
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.
I:\Building\Permits\MEC_PernitApp_082520.doc 2
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit No.: "
• 13125 SW Hall Blvd.,Tigard,OR 97223 �' �,�
Plan Review
Phone: 503.718.2439 Fax: 503.598.1%0 gy. Other Permit No.:
T 1 G A R D Inspection Line: 503.639.4175 r.'f. '/r Ready/By: furls: ® See Page 2 for
Internet: www.tigard-or.gov Notilied,Method: Supplemental Information
TYPE OF WORK WlAS: I y FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description Qty. I Ea. I Total
pAddition/alleration/replacement E Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
B 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
0 Accessory building El Multi-family
SFR(3)bath 500.32
D Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ' Catch basin or area drain 18.76
1Je_ Drywell,leach line,or trench drain 18.76
C_ ZIP. (AZ
i Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: rners /2e kniC )r Manufactured home utilities 50.03
Cross street/directions to job site: 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
12.51
/' 'I / Clothes washer 25.02
""�I. j pi.Ut't'll�(, fcic hct(-t V\ '(�'l^1(i{`'�, Dishwasher ` 25.02
Q 1 Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: I'1 vtG, U Y lit Y -j Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 7 OS 3t, (.- --7 2 ( live,
Garbage disposal t 25.02
City/State/ZIP: T�acjt OZ 1-7 22- Hose bib 25.02
Phone:(SC S) 7 S 'e, '22 77j Fax:( ) Ice maker ‘ 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: 5"' Medical gas(value:$ ) Page 2
Jti/✓V e,) c;kj.°1rf' Primer 12.51
Contact name:
Roof drain(commercial) d 'y I 4) 12.51
Address: Sink/basin/lavatory 1 25.02
City/State/ZIP: Solar units(potable water) ` 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan ' 12.51
E-mail: Urinal 25.02
0 CONTRACTOR Water closet -2- 25.02
Business name: v /J� nn Water heater 37.52
C Ny !�/D Q7' nnitdblAdt6 piping/DWV 1 56.29
Address: Ca-J 92 S l u Florence.,e, 1 IU lL(-. Other: 25.02
City/State/ZIP: Po xl/ b1z '1 7 Z . Subtotal
Phone:(031 (p 83 bC[l0 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: ""3 jj7 / re/744
Plan review (25%of permit fee)
ZZ2 Jr 7 Plumbing Lic.no.: �!
State surcharge(12%of permit fee)
Authorized signature: y`_ _�� 7/Ji}� TOTAL PERMIT FEE
7nt name: '17 rhea / /.rj�7 This permit application expirbs if a permit is aotmplete. within 180 days
w" nc. 1.1 [/ [f L✓L after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pemrils'PLMU-PenmitApp.doc 10/01/09 440-4616T(10/02/COM/WFB)
Plumbing Permit Application - City of Tigard '
r
Page 2 - Supplemental Information '''
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. 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 Valuation: Permit Fee:
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 S72.50 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 S10,000.00.
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 I
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
ElAny new commercial building with water service 2"and
Bath -Tub/Shower
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4" Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU_PermitApp.doc 2
Tu2tlatin Valley Water District
Delivering the Best Water Service Value
Sizing of Residential Water Meter Worksheet
Date: 5/24/22
Site Address: 10530 SW 72nd Ave
City: Tigard Zip Code: 97223
Subdivision/Lot#:
Builder/Contact Person: Anna Byrnes Phone: (503)758-2230
Number of X Fixture unit = Fixture
1. Kitchen fixtures fixture(s) equivalent count
A. Dishwasher 1 X 1.50 = 1.5
B. Sink 1 X 1.50 = 1.5
2. Utility room fixtures
A. Washer 1 X 4.00 = 4
B. Laundry tub 1 X 2.00 = 2
3. Bath fixtures
A. Toilet 3 X 2.50 = 7.5
B. Lavatory sink 3 X 1.00 = 3
C.Whirlpool bath or shower/bath 1 X 4.00 = 4
D. Shower only 1 X 2.00 = 2
4. Miscellaneous fixtures
A. Outside hose bibb (enter only one here) 1 X 2.50 = 2.5
B. Additional hose bibb 3 X 1.00 = 3
C. Bar sink X 1.00 =
D. Bidet X 1.00
E. Irrigation (Largest zone only) Number of heads: X 1.00
5. Total fixture count(fixture units) Total of 1 through 4 31
Additional questions:
I) Will the property have any of the following features? (check all that apply) Yes V No
❑ Auxiliary water source, i.e. well, pond, spring or creek
❑ Decorative water features, i.e. pond, hot tub or swimming pool
❑ Solar heating unit, boiler, or hydronic radiant floor heating
❑ Taller than three stories with a basement OR four stories and taller
❑ Underground irrigation system
II) Is this property going to have a fire sprinkler system? Yes V No
If yes, check the meter size: 3/4" 1"
A COPY OF THE BUILDING PERMIT AND PAYMENT IS REQUIRED AT THE TIME OF PURCHASE
1850 SW 170th Avenue,Beaverton,Oregon 97003 // a+or 503-848-3000 // ;: 503-591-0986// www.tvwd.org
Property Owner Statement RECEIVED
Regarding Construction Responsibilities JuN 2 ' 2022
flF TIGARD
Oregon Law requires residential construction permit applicants who are not licensed witththe,_DIVISION
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 p 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
XI 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.
no._ DIDj1v ,S
Print Name of PermitA ant /
--------..—....,, (32/2:7
Signature of Permit Appli a t Date 666
Permit#: /11$7-wtt--o0)3y
Address: 10
rss 3 �.
Issued by: Date: 7/?5—/y1, t
This Copy for Permit Offices
; Information Notice to Owners About
"' ,i:- Construction Responsibilities
_. (ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance:As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 97309-5052
Telephone: 503-378-4621 —Fax: 503-373-2007
Website Address: www oregon.gov/ccb
f/property_owner adopted 9-2016 This Copy for Permit
RECEIVED
To:tustomer Service <customerservice@ tvwd org>
Subject:Water Meter Worksheet for Case no. MST2022-00134 JJN 2 7 2022
CITY OF TIGARD
'Id ll DING Dl\/ISI"'
)ION: This email originated from outside of the organization. Do not click links or open
ttachments unless you recognize the sender and know the content is safe.
1,a
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Anna Bymes<bymesak@ gmaii.com> Tue,May 24,2022 at 2:36 PM
To: Michelle Rosa <Michelle.Rosa@tvwd.org>
Thank you for your email. I have attached the filled out form.
-Anna
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Michelle Rosa<Michelle.Rosa@ tvwd.org> Tue,May 24,2022 at 3:56 PM
To: Anna Byrnes <bymesak@gmail.com>
Cc: Sarah Alton <sarah.alton@tvwd.org>
Hi Anna,
Thank you for completing the form. Based on the total of 31 fixture units, the existing 5/8' meter will be su cient for the
existing and additional fixture units and you're your meter does not need to be upgraded. Should you have any questions,
please feel free to contact me directly.
Thanks,
Michelle
put,trd text hiddenI
Anna Byrnes<bymesak@gmail.com> Tue,May 24,2022 at 4:00 PM
To: Michelle Rosa <Michelle.Rosa@tvwd.org>
Thanks for getting back to me and for the good news!
Hope you have a lovely rest of the day!
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Michelle Rosa<Michelle.Rosa@ tvwd.org> Tue,May 24,2022 at 4:02 PM
To:Anna Bymes <byrnesak@gmail.com>
You're welcome and same to you!
iouoted irxI hidden!