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Permit CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2022-00114 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/08/2022 Parcel: 2S103DA02700 Jurisdiction: Tigard Site address: 10730 SW DERRY DELL CT Subdivision: DERRY-DELL NO.2 Lot 29 Project: DOUN Project Description: 1,250 sq.ft.addition and remodel to existing dwelling. WATER METER UPSIZE to 3/4" REQUIRED per UB. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1. First: 1250 at Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 14 Bathrooms: 1 - Second: 0 at Garage: 0 - sf Front: 20 Smoke Yes Dwelling Units: 0 'Third: 0 sf Right 5 Detectors: Total: 1250 sf Value: $370,000.00 Rear 15 PLUMBING Sinks: 0 Water Closets: 3 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0 Tubs/Showers: 4 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 1 Footing Drain: 0 Ice Maker: 0 Hose Bib: 2 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types - Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: Y Hoods: 0 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvctFeeders Branch Circuits 1000 sf or less: 0 - 0-200 amp:. 1 0-20D amp: 0 W/Svc or Fdr: 15 Ea add?500 sf: 0 - 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 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: ADD SF VB R-3 1250 Owner: Contractor: DOUN,TOK&NARETH HIS BUILDERS LLC Required Items and Reports(Conditions) 10730 SW DERRY DELL CT PO BOX 967 TIGARD,OR 97223 BORING,OR 97009 PHONE: PHONE: 503-260-5008 Total Fees: $12,038.15 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-nni_nn1n thrn,inh nap OF9-nr 1.nnon Nino! nhtAln of}hu n nr diro t ni mennne fn fit INCFnl 919 9 QA7 nr 1 Ann 339 93dd Issued By: • Lure: _ -... _ _. _.. . ... 9.4175 by 7:00 a.m.for the next available Inspection te. . This permit card shall be kept In a conspicuous place on the Job site until com letion of the project. __. .. .... . _t Approved plans are required onn the lob site at the time of each inspection. V Bi'A link Permit Application Residential FOR OFFICE USE ONLY City of Tigard Received `, g // Permit No.: y 13125 SW Hall Blvd.,Tigard,OR 972 Date By. 1 as fl dJ���u f g Plan Review �, / Phone: 503.718.2439 Fax: 503.598. E C E V Date/By: /ZL/22 tithe Permit. CIGARD Inspection Line: 503.639.4175 (� Date Ready/By: /// Juris: Bi See Page 2 for Internet: www.tigard-or.gov ,APR 25 202? N. 'lied/Method: )/q1.2 i Supplemental Information r 1v x dx x 7 fi F �, +V;t1 RJds� ,. ?, 0,9, s, 9 Z., p 0 New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all )grAddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the 0224,0,LignatingMeffnIrTnr:MrratiMMingtorsforn work indicated on this application. ''// Valuation: $ X1-and 2-family dwelling 0 Commercial/industrial 70/00G ID Accessory building 0 Multi-family Number of bedrooms: r ❑Master builder ❑Other: Number of bathrooms: J` 1 '" =`®� _ l�•, ''®P ':, ® Total number of floors: 1 Job site address: l0 73d 5J DecryDe II C�' New dwelling area: 1 a S" square feet 1 City/State/ZIP: Ti CCj c,f j R CI 7 a' 3 Garage/carport area:.4 square feet Suite/bldg./apt.no.: 0 " ]Project name: Mo de I Covered porch area: L f, square feet Cross street/directions to job site: 5 CA) UJGi. k;n5 /1 ue. r Deck area: square feet /t ,C nc 1h r ri ies)%i "i4xt-hc. Other structure area: square feet /�rr�vbt�eGl !/Y i �IY�I??,�lfSlf�Gei'r. i s 2k6;k f s % a , , A 451, /Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the , . a, ��� r work indicated on this application. [1064e 2eniodei cod ciddi4rm Valuation: $ Existing building area: square feet New building area: square feet gggqcrd:Ve t t / .v.`ri r Number of stories: Name: e, ,� 11 O tx n Type of construction: Address: 10`?'2 o/ s W Derr`? Dell C.l Occupancy groups: City/State/ZIP: Ti AG",cif O( Q 7, a 3 Existing: Phone:( '") so?... a 0 ua Fax:( ) New: 2' rtt�r ffiffi //g�a ,xr ram` xx°e. /n m xxx x ds i8 .'Y�,ra�;t 6x ";: e ila 6'e.'ST"xx mo ?� <a' z,d � Business name: l"r 14 f] I Hers I L C Contact name: ' j e r fU01_C S !I Structural plan review fee(or deposit): Y7 FLS plan review fee(if applicable): Address: l a 6 t cc- 3Q7 I pm, ` Total fees due upon application: City/State/ZIP: $3 C I z Q 2 c 7 Q a c Phone:(5c13)e6 3 _ 00 I Fate::( ) Amount received: E-mail: 4/14 ,. ' '''' ,'%/ i4 ,M .. 'r§�5 a ar l t f, r 1 © �/ ® rrr Commercial and residential prescr ptive installation ieiof Mri e - �� 661 r / iWi ®" `r xxxx, , 9965Mxixxxxx r / roof-top mounted Photovoltaic Solar Panel System. Business name: 5iA i �r(i (5 / / ,- Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: ('0 , I 5. z a?fit /1 tie Solar Installation Specially Code checklist. City/State/ZIP: f�9 Permit Fee(includes plan review $180.00 NoenI [q 7 d( and administrative fees): Phone:(S©S) ‘c 3 _ 5O0 0 0 I Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: t v 318.1i 7/((,L,(. Total fee due upon application: $201.60 Authorized signature:�l F This permit application expires if a permit is not obtained { within 180 days after it has been accepted as complete. Print name.ji A ) be.), Date: _ as *Fee methodology set by Tri-County Building Industry 6 r 1/er /V d 6 i LI Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY .0 City of Tigard Date/By: III II • 13125 SW Hall Blvd.,Tigard,OR 97223 _ �� "- Phone: 503.718.2439 I Other Permit T I G A R D Inspection Line: 503.639.4175 E C I V■ l*. •. ; orris: See Page 2 for Internet: www.tigard-or.gov ; Supplemental Information 4PP 2 5 ?( TYPE OF WORK (4,iTY l.)1' i iGAIU COMMERCIAL FEE*SCHEDULE-USE CHECKLIST ❑New construction ❑ Addition/alteration/replacement l lVi SIO N Mechanical permit fees*are based on the value of the work El Demolition El Other: performed.Indicate the value(rounded to the nearest dollar)of all mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 0 Multi-family E For special information use checklist. ❑ Master builderOther: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: Sc ✓IhJ -Devi D .� 7li �r.,� - Air conditioning 46.75 �� 7 7 CFurnace 100,000 BTU(ductsNents) I 46.75 City/State/ZIP: 'i r /, fn d/ 0 �`` I ?.?3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Li Project name: To k R e fviode I Heal pump l 61.06 Duct work 23.32 Cross street/directions to job site: 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 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater ir 23.32 .- , y ,GSC s1!ON OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas RceMock f cut)o( illaSfer4-u`‘,,-,-/,/'i/.-D.: `f_y, r-1 fireplace 23.32 4ddl4i0 n , Weci-iinq r}' (-oe!i*dy^i sod' etcAri('r1 SpnCe.f Loglighter(gas) 23.32 /VI J Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROPERTY OWNER ❑ TENANT Other: 23.32 Name: Environmental exhaust and ventilation: Cy(S iw i; Range hood/other kitchen Address: 10.7 30 5 7e(`ix/ De!! cit.. equipment 33.39 — , Clothes dryer exhaust 33.39 City/State/ZIP: 1 1 6 Grt� a R et 7,2 a.3 Single-duct exhaust(bathrooms, Phone:( ) i. Fax:( ) toilet compartments,utility rooms) I 23.32 Attic/crawlspace fans 23.32 APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: k . 5 L'.>.I ide ,, L. LC Fuel piping: Contact name: -y ? r �,, t.. = 5 $14.15 for first four;$4.03 for each additional Furnace,etc. Address: co 6 1 5 6-: .3 a 7 ;L five Gas heat pump City/State/ZIP: B O f i"/l U e C(200 O Wall/suspended/unithcater 0 ( Water heater Phone:(5 3) ,63 -_ 5000 Fax::( ) Fireplace E-mail: 1 y ,i e.i G ) F : 'I.., . . (- - Range Barbecue CONTRACTOR %}�� Clothes dryer(gas) Business name: f 1[.'. k, ;r-r„,_1,7 Other; I Address: �o !)/,U MECHANICAL PERMIT FEES" / (P Subtotal City/State/ZIP: q 3 o I Minimum permit fee($90.00) Phone:(5-8 ) 6 -hja yy ( Fax:( ) Plan review(25%of permit fee) CCB lie.: U�' State surcharge(12%of permit fee) t�31,1 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: I '/e r l o re,J ' /Q�_,„ Date: (I-22.s-a z B \P I\ uildingermits\MEC PermilApp_082520.doe //,�` 440-4617T(I l/02!COM/WEB) Mechanical Permit Application - City of Tigard 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: Tptai.,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\Pernits\MEC_PemtitApp_082520.doc 2 DocuSign Envelope ID: B889A114-2895-464D-A4F7-5BB6EBF040F1 ` Electrical Permit Application FOR OFFICE 1 sh O\L1 City of Tigard Reeeiwd �'/ Dates3c Pamir a. 5,-..�, 1 131us SW Hall Blvd.,Tigard,OR 97223 z r�\ /MI rOp Revew fie' ^��, Phone 503.718.2439 Fax: 503.598.1960 4" !t Diem, Related Pe nit a I i. i;1 i Inspection Line, 503.639.4175 heady DaterBy lam a See Page 2 far Internet: www.ligardor.gov lntified,'Method g Supplemental information •:.. _ '`rVP* OF WORK t,,,,.. 1 r- PLAN REVIEW - ❑NewConstruction -\ddwon alteration rerilacetnt.rll ,- • Please check all that apply(submit2 sets of plans w items checked) ❑Demo!ition f)thor �tll�nl ❑Service or feeder 400 amps or more 0 Building over three stories, where the available fault current ❑Marinas and boatyards. l TEGORY OF CONSTRUCTION exceeds It o00 amps at 150 volts or ❑Floating buildings -I-and 2-family dwelling ❑Cunlntereml industrial ❑Auce,,,or> building less to ground.orexceeds 14,000 ❑Commercial-use agricultural ❑Multi-famil amps for all other install/Mons. buildings. ❑ ,1laster builder �OlhCf ❑Fire pump ❑Installation of 150 KVAor fJfTE INFORMATION AND LOCATION ❑Emergency system larger separately derived Job p: Job silo addr ss: f 1 o ❑Addition of new motor load of system. 3 s-w0evvy Pei/ 6.1- 100HP or more. ❑"A "E'."I.2","13", City/State/ZIP: —17((4 V d Oa o.7 2Z 3 ❑Six or more residential units. occupancy. Suite/bld 1.f): ❑Health-care facilities El Recreational vehicle parks ./ . gap I Project name: !f yetnz 4 ❑Hazardous location 0 Supply voltage for more than Cross street/directionstojobSite: ❑Se need feeder600ampsormore 600 volts nominal S1n3 Pet,,14 C t" IMrriprion Q . Each Total • J 7 _ New residential single-or multi-family dwelling unit. Subdivision: Lot g: Includes attached garage. TaN map/parcel 4: 1.060 sq.R.or less 168.54 4 ---- ----DESCRKPT[UN-pF WORK •add'1500 sq.R.or portion _ 33.92 I ,r� ��/ Limited energy,raidential 75 00 2 — ___ KGf!u�Gt a t//4-1/GrCt I)/7 (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.n.) PROPHRTF ORNER Renewable Energy 0 See Page 2 ❑ TENANT Services or feeders installation,alteration,and/or relocation INamc: 14- t)44.1•v_ 200 amps or less ( 100.70 2 Address: 201 amps to 400 amps 133.56 i 2 City/State/ZIP: 401 amps to 600 amps 20D 34 2 601 amps to 1,000 amps 301.04 2 Phone:( ) Cr 7/ - S'Z) ..Q,3 0.4 Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,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 - .TC�L>\rI• ❑ CONTA y^ Branchcircuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 --— each branch circuit Contact name: B.Fee for branch circuits without Address: service or(eerier fee,first l 56.18 2 branch circuit City/State/ZIP: Each add.]branch circuit 7.42 1 2 Miscellaneous(service or feeder not Included) Phone:( ) Fax::( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: _,. —, Reconnect only 67.84 2 :CONTRACTOR ,-,7,; ,, Pump or irrigation circle 67.84 2 Business name: s a yi d y £(e G-�(L_ Sign or outline lighting 67.84 2 Address: K!i G' S!C Signal circuit(s)or limited-energy0 g 1 Z1} S't-- panel,alteration,or extension. Page 2 2 ,�7p �y �, Each additional inspection over allowable in any of the above City/State/ZIP: rt f 1't't (ge- `t 7 O ____________ Additional inspection(Ihrmin) 66.25/hr Phone:(5-p 3) el(e/_31 N Q Fax:( ) Investigation(1 hr min) 90.00/hr Email: +_ _ Industrial plant(I hr min) 78.18/hr C p Inspections for which no fee is CCB Lic.:i 7/R(o r�/ Electrical Lic �f Suprv.Lic.: s. ificalt listed %hrmin �'�br Suprv.Electrician signaH/rl ui �/s y� �/° � Subtotal: Print name: PAN! c Jcw.e 3 .I Date: t'-7--Ix)Z2 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): r--000vstoa.a err: Authorized signature: TOTAL PERMIT FEE: ' 11/7 j1 t)11 This permit application expires if a permit is not obtained within 180 Print name: Davi C`7tirtritaaaaor w Date. days after it has been accepted as complete. ' Number of inspection allowed per permit. IsBuitdininnenner'ELC_PenehApp ELR ERE der Rev a6l172015 440-4615T11ta5/COMAVEe , Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard .C E IV E D Received .t Date/By: Permit No.: .ql no 13125 SW Hall Blvd.,Tigard,OR 97223 " �(�T�77!! �d�` Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Plan Review 5 i Other Permit No.: Inspection Line: 503.639.4175 -' Date Re I-lit A R D Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WQ ILDING ON SjION FEE* SCHEDULE ❑New construction El Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ] 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ElAccessory building El Multi-familySFR(3)bath 500.32 El 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: i o 7 3 tD 5 LA) `fie C(/ Pe II C 7 1 Catch basin or area drain 18.76 City/State/ZIP: Drywell,leach line,or trench drain 18.76 T 1 ft P di (�Q -I o�d J Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: 0 Project name: ((, k Rein()Je / 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 i 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 (RPnvi)ve1 4- Ma5t � H P e( bet)ro /SrUr7f`t Cii�(11/ ; Dishwasher 25.02 IS tl i'd i7t q ni(,1 M a 540( DG-4. I,. Drinking fountain 25.02 (/�� Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: Hose bib 2. 25.02 Phone:( ) Fax:( ) Ice maker 12.51 APPLICANT El CONTACT PERSON Interceptor/grease trap 25.02 Business name: 14 1 C (� , /O��, G L Medical gas(value:$_) Page 2 I� Primer 12.51 Contact name: cl-y(PC v0l„cC, Address: r` 7 n Roof drain(commercial) 12.51 I V 61 5 r 3°' . )tk (T ve Sink/basin/lavatory Xt1 25.02 City/State/ZIP: Bo C i n 172 r t(?0 D Solar units(potable water) 62.54 Phone:(5 3)66 3 ./ 50 eta Fax::( ) Tub/shower/shower pan Li 12.51 E-mail: 13/ ( r e 1415 B- ((t C S cc,/ Urinal 25.02 Water closet 25.02 CONTRACTOR 7-�QD JJ� Water heater i 37.52 Business name: �# , i p€ y Water i m DWV�^'� '/ ! ' P P � 56.29 Address: P� d� e �0.1 i3 Other: 25.02 City/State/ZIP: 17X/Y ofD 41-.edl Subtotal Phone:(C'03) C tot ? Fax:( ) Minimum permit fee: $72.50 CCB Lic.: ( 775� -' /14? PlumbingLic.no.: ti)-,¢) Plan review (25%of permit fee) { „v State surcharge(12%of pennit fee) Authorized signature�� 1 7 % �/ TOTAL PERMIT FEE Print name:�-tP( ��)(7 Date: 7-.e 5-2 2 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:'Building\Permis\PLM1J-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 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 I00' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Fees 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 90.00/1u 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 each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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 Quantit by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Waded Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru ❑ Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system. Dishwasher: -Commercial ❑ Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" 3„ Isometric or Riser Diagram 4" ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food 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: -LavBar 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 plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT III T 1 G A RD Building Permit Review - Residential Building Permit #: —a)/1 lj Site Address: /0-7 3b SGU Dale '1fl,W e7- Project Name: Do U f�f Lot #: Planning Review Proposal: Apo ui p fJ l�Verify address/suite #active in Accela. ❑ In River Terrace: E No ❑ Yes,River Terrace Review Addendum Site an Elements: rosion Control 3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper E1JR aired trees with drip line and tree protection measures 315,ravvn to scale(standard architect or engineer scale) Er-Footprint of new structure (including decks) and FFE G North arrow 4 [ U i' ''locations&easements(required for new and additions) Zite address,project or subdivision name and lot number idewalk/driveway approach ❑lipplicant information (name and phone number) k.114, Location of wells/septic systems Clot dimensions and building setback dimensions S t tree size,type and location 13, (DS5ua.re footage of buildings to be demolished treet names IdExisting structures on site pk liComer elevations (2'contours if more than 4'differ al) h(k IJLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es ❑]N f ►T ern envious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes IQNo Clean Water S.exvices—Service Provider Letter(lot platted prior to 9/10/1995): quired: ( Yes,applicant was notified ❑ No Received: 0 Yes ❑ No E Water Meter F. re Unit Worksheet—Additions,Remodels and ADUs R ed: Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No rlr-SDC Exemption for ADU applied for. ❑ Yes ❑ No Received: ❑ Yes ❑ No ❑ Public Facilities Improvement (PFI) Permit Required: 0 Yes,applicant was notified . No Applied For: ❑ Yes ❑ No,stop intake 0 Land Use Case #: AiPs ❑ Zoning: (2 -3 - 5- Required Setbacks: Front: 2•0 Rear: / Side: 5— Street Side: 20 Garage: 2 b jBuilding Height: Max. Height: OFr Actual Height: iy FT- L ,� Landscape,,A.rea: Ph- % ❑ Lot Coverage Max: j&Ji i-- % Entrance Fl Set back no more than 8'from street-facing wall parallel to street or offset 45 degrees or less Windows • ' um 12%of area of all street-facing facades Garage ❑ Garage ehind widest street-facing wall ❑ Yes ❑ No,one of the following is met: ❑ Door extends no an 5'from wall and there is a covered porch extending beyond garage. ❑ Door extends no more than 5 l and there is a 12 sq ft.window above garage on 2°d floor. ❑ Garage door width is ❑ 12'or less ❑ 50%or acade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ' oof eave ❑ Roof offset ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or g roof ❑ Dormer / ID Accent siding ❑ Window trim 0 Window recess ❑ Window projectio 0 Balcony l' \istial Clearance 0 Urban Forestry Plan la/Sensitive Lands: ID Yes ,lam No Type: 0 Conditions met prior to issuance of building permit Not Approved By Planning: Date: Y 2 2 Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved I:\Bu ildingTonus\BldgPemritRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: t//A"/a Site Plans: #�� —�-- Building Plans: E Building PermitEJ-#: �,�nter building permit#above. Workflow Routing: 1r Ylanning Engineering ermit Coordinator Building Workflow Sign-off: Z1.-439'gn-off for Planning(include notes from planning review) Route Application Documents: GLEngineering: (1) copy of permit application, (1) site plan, (1)building plan and original plan review routing form. L .-131 lding: original permit application,site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: ` 7 By Permit Technician: ,�� � �`- Date: Allis721,, Engineering Review 0 2 Slope at building pad: 2 o [ Conditions "Met"prior to issuance of building permit Ef Easements (encroachments)per engineering conditions of approval and plat Z"Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes CNo Assess Water Quantity Fee in-lieu: ❑ Yes Ei>lo LIDA Facility on lot: ❑ Yes P1f No Add Fee: ❑ Yes ❑ No D Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: Date: ,5-- a -cza Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review Conditions "Met"prior to issuance of building permit 0 Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: ,"0"SDC Exemption: ❑ Received .0 Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: ❑ Yes /16. N/A Parks SDC: ❑ Yes /N/A LIDA ❑ Yes / N/A f7 OK to Issue Permit I Approved by Permit Coordinator: Date: 21/0 Z?/ I:\Building1Fomis\BldgPermitRvw_RES_1208021.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 I _ Transmittal Letter T I G A it D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE RECEIVED: DEPT: BUILDING DIVISION EL E I V E D FROM: Tyler Nobes JUN29 z'i" COMPANY: His Builders LLC CITY OF TIC BUILDING DP.: By. , 1, PHONE: 503-663-5000 EMAIL: Tyler@hisbuilders.com RE: 10730 SW Derry Dell Ct. MST2022-00114 (Site Address) (Permit Number) Tok Remodel (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: 3 Additional set(s) of plans. Revisions: 3 Cross section(s) and details. 3 Wall bracing and/or lateral analysis. 3 Floor/roof framing. Basement and retaining walls. 3 Beam calculations. 3 Engineer's calculations. Other(explain): REMARKS: FO OF ICE USE ONLY Fl ��, Routed to Permit Technic n: Date:A/2?� 2'L Initials: ,(4 Fees Due: Yes [ Ni/ e Descripti : Amount Due: !1 $ 1, i), 0.E G/ $ , ,._. Special Instructions: Reprint Permit(per PE : ❑ Yes No ❑ Done//. Applicant Notified: ate: �.ZVL2— Initials:�'�f \ Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs J22 Please complete the following information: Li i t OF t ItaARD -;� BUILDING DIVISION Customer Name: o t< I tC,u 0 Service Address: Street/Suite#: 10 7 30 5IV i)ACf 5' De 1/ C . city: 1 1,,r State: 0 R Zip: c 7,2,2 3 Phone Number: U Email: Please fill in the number of each fixture you currently have. Please fill in the number of fixtures 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 total• the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = x 1 = ....._.._.. Bidet x 1 = x 1 = Clothes washer ! x 4 = y x 4 = Dishwasher I x 1.5 = I, 5 x 1.5 = In Outside Water Spigot I x 2.5 = a_5 x 2.5 = Water Spigot,each add'l I x 1 = i l x 1 = Kitchen sink i x 1.5 = t,5 x 1.5 = Laundry sink 1 x 1.5 = L.5 x 1.5 = Lavatory(bathroom sink) a X I = 0a a x 1 = a Water closet,1 6 GPF(toilet) '� X 2.5 = a. $ '' x 2,5 = .5 _............ Bathtub/whirlpool x 4 = x 4 = Shower stall x 2 = I x 2 = a Bath/shower combo a. x 4 = V x 4 = Current Points: Ilk .7 Proposed Increase: 7. 5 Current Points+Proposed Increase= '. =New Total Points =Required Meter Size 3/f" .2 Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=%" 37.5 and over points= 1" New Meter Size Needed for New Total Points: Cost: $ (see page 1) Current Meter Size per Utility Billing: Cost: $ (seepage ]) New Meter Size Cost minus Current Meter Size Cost= $ (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY Meter is required to increase to 3/4 inch size. J Bentley 07/05/22 Current Meter Size Confirmed with UB Signature of UB Representative Date l:/Building/Forms/WaterMetcrs_070121_Add.doCx Page 2 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT . it Water Meter Fixture Unit Worksheet IGAKiz For Additions /Remodels /ADUs 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov LOCATION: City of Tigard—City Hall WATER METER SALES: Utility Billing By Email Only. Please contact 13125 SW Hall Blvd. ubonlinepay@tigard-or.gov Tigard,OR 97223 to discuss sending documents and payment METER: SIZE: FEE: _ Pricing effective 07/01/2021 5/8" $9,495.00 Fee includes: 3/4" $13,554.00 water system development charge, 1" $24,886.00 - water meter, and 1-1/2" $73,689.00 meter installation fee. 2" $119,333.00 _ DETERMINING METER SIZE FOR RESIDENTIAL CUSTOMERS City of Tigard Water Service Area uses the American Water Works Association Manual and the Oregon Plumbing Specialty Code to determine the size of meter needed to adequately serve buildings. Due to the variety of home sizes built in the Tigard area, we count the fixture units of all homes to determine the appropriate meter size. Use the worksheet on Page 2 to calculate the current number of fixture units compared to the proposed increased number of fixture units,which will determine whether an increased meter size will be required. Submit this signed worksheet with your building or plumbing permit application submittal. DOCUMENTATION Once you are ready to purchase the new meter,please provide the following items to the Utility Billing counter: • Completed water meter fixture unit worksheet for additions, remodels, ADUs, etc. (on back page). • Copy of building or plumbing permit application date-stamped by building division. • Copy of issued building or plumbing permit. Your fixture count will be verified and your request will be processed upon receipt of these documents. No exceptions INSTALLATION TIME Once the upgraded meter size has been purchased,most meters are installed within 10-14 business days. I:/auil ding/Form s/WaterMeters O7o121_1dd.docx Page 1