Permit IFICITY OF TIGARD MASTER PERMIT
1 . ' COMMUNITY DEVELOPMENT
Permit*: MST2022-00223
TFGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/25/2022
Parcel: 2S110131301900
Jurisdiction: Tigard
Site address: 12425 SW CORYLUS CT
Subdivision: AMES ORCHARD Lot: 6
Project: LaMarsh
Project Description: Primary bathroom remodel and addition above garage adding primary bedroom closet. No new
water fixtures.
BUILDING
Floor Areas Reauired Setbacks Required
Stones: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 244 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 244 sf Value: $36,812.28 Rear: 0
PLUMBING
Sinks; 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Bckflw Prevntr: 0
Drywall-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum>=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'I 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-3 244
Owner: Contractor:
LAMARSH,SHANA&STEVEN L BRIAN SCHMIDT BUILDER Required Items and Reports(Conditions)
12425 SW CORYLUS CT PO BOX 1603
TIGARD,OR 97224 LAKE OSWEGO,OR 97035
PHONE: PHONE: 503-636-3191
FAX:
Total Fees: $1,869.23
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
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Issued By: r `"1 "y 1 Permittee Signature: r
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the lob site at the time of each inspection.
1 '$uilding Permit Application
Residential RECEIVE r FOROFFICEUSEONLY
JUL1 3 2022 Received f� `�
_ City of TigardDateBy: /� ,7a, NT. Permit No.: ( St.dool _ Ala 3
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review(„mil 1_' "9'A •t
Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGARD DateBy: Other Permit:
TIGARD
Inspection Line: 503.639 4175 BUILDING DIVISION Date Ready/By: �; Jaris: ® See Page 2 for
Internet: www.tigard-or.gov /'/Method: ) fit /�' Supplemental Information
, 1, TYPE OF W -'•i ,.,,"rllrA € h '=i -,et. -FA1tll,1'I) "
❑New construction ❑Demolition Permit tees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
El Addition/alteration/replacement ❑ Other: equipment,materials,labor,overhead,and the profit for the
" = ;t.l.pl{j'" work indicated on this application.
�' GA1'1 GQR$ OF' CONSTRUCTION /"'l
Valuation: d
® 1-and 2-family dwelling El Commercial/industrial �7��0� �/�.�dd���"'
ElAccessory building ❑ Multi-family Number of bedrooms:
❑ Master builder El Other
Number of bathrooms:
JOB SITE INFOR11ATUON AND LOCATION Total number of floors:
Job site address: 12425 SW Corylus Ct. New dwelling area: 244 square feet
�/ City/State/ZIP: Tigard, OR Garage/carport area: square feet
�j, Suite/bldg./apt.no.: Project name: LaMarsh Residence Covered porch area: square feet
Cross street/directions to job site: ,y /� Deck area: square feet
J � �ll � l-.17?1 '- Other structure area. square feet
it,_� / I, �iV- - '.olia1R.ter A REQCIRED D 'f M,1:COMERCIAL-ESEI®, l P..'
Subdivision: Lot no.: Permit Ices*arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: Text equipment,materials,labor,overhead,and the profit for the
DESCRII I IOV OF WORK i * - work indicated on this application.
Addition of 244 sf of living space above garage. Remodel existing Valuation: S
bathroom Existing building area: square feet
New building area: square feet
Cl PROPERTY (2' I y,T Num
ber of stories:
r
Name: Steven LaMarsh Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( ) New:
® APPLICANT E CONI A( I PERSON BUILDING PERkY oi.l.g"ara §tP
(Neese refer Offifi., V.-
Business name: Faster Permits LLC.
Structural plan review fee(or deposit): -j=' 5)
Contact name: Richard Adams.
FLS plan review fee(if applicable):
Address:2000 SW 1st.Ave Suite 420
Total fees due upon application:
City/State/ZIP: Portland, OR 97201
Phone:( 503. 708-5244 Fax: :( )
Amount received:
E-mail: Richard@fasterpermits.com PHOTOVOLTAIC SOLAR PANEL.SYSTEM FEES*
!i r '41 Commercial and residential prescriptive installation of
:' t TRAM �nr`. "+ Itl?�I I(`i '' roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Brian Schmidt Builders Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: PO Box 1603 Solar Installation Specialty Code checklist.
City/State/ZIP: Lake Oswego, OR 97035 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( 503) 805-4178 ` Fax:( ) State surcharge(12%of permit fee): $21.60
ccs lic.:202703 . (I 72 1
Total fee due upon application: $201.60
Authorized signature: ,g/�1 This permit application expires if a permit is not obtained
7777���� within 180 days after it has been accepted as complete.
Print name: Richard Adams. Date: 5/31/2022 *Fee methodology set by Fri-County Building Industry
Service Board.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB)
Buildinv. Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of TigardE Received
'i 13125 SW Hall Blvd.,Tigard,OR 97223
Date/By.
No.:
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD 24-Hour Inspection Line: 503.639,4175 0 Electrical 0 Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ 0
3 Verification of approved plat/lot. ❑ 0 0
4 Fire district approval required. Name of district: 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan ❑ permit required. Include drainage-way protection,silt fence design and location of catch- D ❑ ❑
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 ❑ 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 ❑ 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 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- ❑ 0 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. 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
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 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 ❑ 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑
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
architect licensed in Ore.on and shall be shown to be a licable to the •roject under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item II above. Site plans must be 8-1/2"x 11"or 11"x I7'. ❑ ❑ ❑
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. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 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, ❑ ❑ ❑
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.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
r
Plumbing Permit Applicatjon
Site Utilities FOR OFFICE USE ONLY
City of Tigard Received
1 Date/ByPermit No.:rp �O _ �
4 13125 SW Hall Blvd.,Tigard,OR 97223 /'' 1
1 2; Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.
T14;ARD Inspection Line: 503.639.4175 Date Ready/By
Interne[ www.tieard-or-lieu S See en ta2t for
Notified/Mel h A Supplemental Information
TYPE OF WORK ( - FEE* SCHEDUL ,
Fur special information use checklist.
NI New construction ❑ Demolition
Description I Qty. Ea. I Total
Esi Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATECOR%OE CONSTRUCTION f SFR(I)bath 312.70
X❑ 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
ElAccesso buildin SFR(3)bath 500.32
rY g ❑Multi-family
❑Master builderEach additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE I\FORM.AIION . j. �-t Li e'T Site utilities: g
�110-
Job site address: 12425 SW Corylus Ct. Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: I a Marsh 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: Lot no.:
_ - Fixture or item:
Tax map/parcel no.: Backflow preventer 31 27
DF.SCRIP112dN OF Nil " Backwater valve 12.51
'� � �' 1. Clothes washer 25.02
Primary bathroom remodel and addition above Dishwasher 25.02
garage to arid primary bedroom closet Drinking fountain 25.02
Ejectors/sump 2;02
X PROPERTY OWNER f LI TENANT Expansion tank 12.51
Name: Steven LeMarsh - Fixmre/sewercap 25.02
Address: Floor drain/floor sink/hub 25.02
124?5 S W Corylus Ct Garbage disposal 25.02
City/State/ZIP: T'gard. OR, 98607 Hose bib
25.02
Phone:( ) Fox: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 2;.02
Business name: Faster Permits LLC. Medical gas(value:$ ) Page 2
Contact name: Richard Adams Primer 12.51
Roof drain(commercial) 12.51
Address: 2000 SW 1st. Ave Suite 420
Sink/basin/lavatory 2 25.02 50 04
City/State/ZIP: Portland, OR 97201 Solar units(potable water) 62.54
Phone:( 503-708-5244 Fax: :( ) Tub/shower/shower pan 2 12.51 25.02
E-mail: Richard@fasterpermits.com Urinal 25.02
1 CONTRACTOR Water closet 1 25.02 ,�C�07
Water heater 37.52
Businessname:Brian Schmidt Builder
Water piping/DWV 56.29
Address:PO Box 1603 Other:
25.02
City/State/ZIP:l ake Oswego, OR, 97035 Subtotal 100.08
Phone:(503)636-3191 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: PlumbingLie,no.:1 94 505 Plan review (25%ofpermit
202703 fee) 25.02
///v� J) State surcharge(12%of permit fee) 12.01
Authorized signature: T2 ��
9� TOTAL PERMff FEE 137.11
Print name: Richard Adams Date: 5/31/2022 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
'Fee methodology set by Tn-County Building Industry Service Board.
I.\Build]na\Permits1PLMU-PermitApp.doc 10/01/09 440-4616T(10./02,COM/WFn)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. l''Lt. (ra) total Square Footage: Permit Fee:
Pouting 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
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
WaterService-eachadditional 100' 37.52 Medical Gas Systems:-0-
Storm&Rain Drain-1st 100' 62.54 . d. � Pertnit Fee:
$1.00 to$5,000.00 Minimum lcc$72_i0
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. lee(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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type fur Replace/'
Work Performed: _ Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru D New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ 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"
Isometric or Riser Diagram
Car Wash Drain -
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
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
Washer-Clothes 'Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other I fixtures:
I:\Building\Permits\PLMu_PermitApp.doc 2
City of Tigard
Y COMMUNITY DEVELOPMENT DEPARTMENT
C
T I A D Building Permit Review — Residential
Building Permit #: %-'rgc4a— (=;c, 3
Site Address: 1214 Zs" S) C_,C,OYCL/ P—
Project Name: Le, 1-4 M2SK Lot #:
Planning Review
Proposal: A9c 1 Tl DY\--
Verify address/suite #active in Accela. ❑ In River Terrace i2t No 0 Yes, River Terrace Review Addendum
Site P an Elements: Erosion Control
pies of site plan on 8-1/2"x 11"or 11 x 17"paper ' R ed trees with drip line and tree protection measures
Dr vn to scale (standard architect or engineer scale) �1Fo Tint of new structure (including decks) and FFE
arrow eintlplat� y locations&easements (required for new and additions)
[ rpddress,project or subdivision name and lot number SIQ idewalk/driveway approach
D(A__pplicant information(name and phone number) Location of wells/septic systems
dimensions and building setback dimensions Syaet tree size,type and location
CAS re footage of buildings to be demolished tr names
LJExisting structures on site Omer elevations (2'contours if more than 4'differenti__a�l))
ELot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? EYes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑YesJNo
.lean Water Services—Service Provider Letter of platted prior to 9/10/1995):
scared: ❑ Yes,applicant was notified .I�f No Received: ❑ Yes ❑ No
21 Water Meter Fix re Unit Worksheet—Additions,Remodels and ADUs
wired: Elgertes,applicant was notified ❑ No Received: es ❑ No
!lJ SDC Exemption for ADU applied for: ❑ Yes 12"---No Received: ❑ Yes 0 No
iublic Facilities Improvement (PFI) Permit �
Required: ❑ Yes,applicant was notified ld'No Applied For: 0 Yes ❑ No,stop intake
❑ Land Use Case#: , ❑ Zoning. es ---,A-
O Required Setbacks: Front: 2-0 Rear: Side: C Street Side:�j �fiD Garage: 70
❑ Building Height: Max.Height: 'b Actual Height: jg
❑ Landscape Area: % ❑ Lot Coverage Max: g"V
trance ❑ Set back no more than 8'from street-facing wall LI Parallel to street or offset 45 degrees or less
Win'o"- ■ Minimum 12%of area of all street-facing facades
Garage ❑ ar._ •..r is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
❑ Door exten. : ".ore than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more . ' om wall and there is a 12 sq ft.window above garage on 2nd floor.
0 Garage door width is 0 12'or less ■ i' . • ess of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ W.I o ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding 0 Roof pitch 0 Gable, .,- •ambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window p .'; ion ❑ Balcony
Visual Clearance 0 Urban Forestry Plan
ensitive Lands: CIYes 2 Pl�o Type:
0 Conditions met prior to issuance of building permit
N. o�te ;
'y° r Approved By Planning: Date: -1/1 3/z
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
I:\Building\Fonns1BldgPennitRvw RES 122419.docx
Building Permit Submittal f
Original Submittal Date: VIVA
Site Plans: #
Building Plans: # 3
Building Permit#: er—Enter building permit#above.
Workflow Routing: -Planning J Engineering ®'hermit Coordinator E —Truilding
Workflow Sign-off: Tr-Sign-off for Planning(include notes from planning review)
Route Application Documents: gr.-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
gi Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: -7/ CC ✓) ) Date: 71212�
Engineering Review
L'Slope at building pad: 2%
g�' onditions "Met"prior to issuance of building permit 74
L'J Easements (encroachments)per engineering conditions of approval and plat by
[7-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: E Yes E 'No
Assess Water Quantity Fee in-lieu: ❑ Yes E3�
LIDA Facility on lot: ❑ Yes [Noo Add Fee: 0 Yes ❑ No
Mr Final Plat Recorded: ak
❑ NOT Approved by Engineering: Date:
Notes:
Q"Approved by Engineering: ?ryt t Date: 1/I t/z Z2.
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Permit Coordinator Review
fkonditions "Met,','prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
zrC Exemption: 0 Received Does not apply
L�J SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes , N/A
Tigard Trans SDC: ❑ Yes ,;2' N/A
Parks SDC: ❑ Yes p N/A
LIDA ❑ Yes N/A
/OK to Issue Permit
Approved by Permit Coordinator: ,L, Date: 112-0I Z
I:\Building\Forms\BldgPermitRvw_RES_1208021.docx
DocuSign Envelope ID:7FF9E1BB-D058-4B3C-B7D4-44154C26103D
Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs
Please complete the following information:
Customer Name: S t eY e d• ShQM La Mos S‘N
Service Address: Street/Suite#: I ViiS 6 W (or l ,S ly.
City: T:st,.� State: nit ! Zip: Ian 2.2,14
Phone Number: _Sol-tcg 1-J 47 LI Email: S t a n w. I d VP r Sh 9 Mii,1.L&
Please fill in the number of each fixture you currently have. Please fill in the number of futures you propose to add.
Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at
[Otal' the proposed total.
Fixture Unit Current Point Current Proposed Point Proposed
Quantity Value Total Addition Value Total
Bar sink 0 x 1 = o 0 x I = 0
Bidet 0 x I = 0 0 x I = o
Clothes washer / x 4 = Cf x 4 = _IL_
Dishwasher / x 1.5 = /,S / x 1.5 = ,),S
I"Outside Water Spigot x 2.5 = 2,f i — x 2.5 = •L�
Water Spigot,each addl 6 x 1 = x 1
Kitchen sink / x 1.5 = 1, ( i x 1.5 = i S
Laundry sink / x 1.5 = /,S f x 1.5 = /,s
Lavatory mom sink) 3 x I = 3 3 x l = 3
Water closet.1.6 GPFttoaen 3 x 2.5 = 7.5 3 x 2.5 = ,le r s
Bathtub/whirlpool l x 4 = ti ( x 4
Shower stall 2 x 2 = tf z x 2 = 1.4
Bath/shower combo f x 4 =_4__ I x 4 = 4
Current Points: 3 9.S Proposed Increase: 4 3•5
Current Points+Proposed Increase= i"r 3•S =New Total Points =Required Meter Size )"
Meter Sizes: I to 30 points=5/8" 30.5 to 37 points='4" 37.5 and over points= 1"
New Meter Size Needed for New Total Points: 1 Cost: $ ZO: (see page I)
Current Meter Size per Utility Billing: ir Cost: $ 20 y97
Ne7 (see page I)
New Meter Size Cost minus Current Meter Size Cost= $ ` J
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
FOR OFFICE USE ONLY 7/ --'19
� ^ed b .
Current Meter Size Confirmed with UBLv 10/17/2022 1:43 PM PDT
Signature or u0Kep rscntative Date
I. .. .. - _ _
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