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Permit CITY OF TIGARD MASTER PERMIT ■ • COMMUNITY DEVELOPMENT II Permit 0: MST2022-00265 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/12/2023 Parcel: 2S107AA20500 Jurisdiction: Tigard Site address: 16584 SW DARWIN LOOP Subdivision: ROSHAK RIDGE Lot: 205 Project: Rayamajhi Project Description: Enclosing patio to create kitchen BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 3 Detectors: Total: 0 sf Value: $6,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0 Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 0 Other Units: Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea addl 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 2 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VG R-3 0 Owner: Contractor: RAYAMAJHI, BISHES&ANJU BHARATI OWNER Required Items and Reports(Conditions) 16584 SW DARWIN LOOP TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $614.02 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR oa9-M1-nni n$hrn,,nh f l6R osO-nnl-neon Vni I mev nh of fha n line nr rlirnrf n„aernne fn flu'kin by rsllinn con 0R7 nr 1 Ann-41??IAA Issued By: // Permittee Signature: � / I� r 503.639.4175 by 7:00 a.m.for the next available inspection date. .>C 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 iob site at the time of each inspection. P ilding Permit Application Residential 1,oR MI ICE USE ONLY City of Tigard RECEIVE ') Received Reif Date/By: —..1,�, Permit No.: m,(-.cl ozd ' • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 7 roit Phone: 503.718.2439 Fax: 503.598.1960 AUG 11 2022 Date/Re 3 2 other Permit: T 1 t_A li P Inspection Line: 503.639.4175 Date Ready/By: I ` Juris: 6B See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Metho .> ( / ) I Supplemental Information BUIt DING DIVISION N'".'I("� $I S TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Ej 1-and 2-family dwelling ElCommercial/industrial Valuation: $ {D COO IDAccessory building El Multi-familyNumber of bedrooms: s'S El Master builder El Other: Number of bathrooms: AJOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 16S$4 S(.33Dar toir) Le Op New dwelling area: square feet City/State/ZIP: T�J q Q Ir-4 C)R. 99 2 Zy Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: 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 DESCRIPTION OF WORK work indicated on this application. Ell t=1®SL ex rf4 f7Gtio 1e:�(t4") SC tdi(N .f�dd Valuation: $ rtI-`z tW 1 rt d Ot g V(t o of r t-+..) 2 II'rj� 1,nk Existing building area: square feet Q n d ash ..3qq. hP/Z New building area: square feet I PROPERTY OWNER ❑ TENANT Number of stories: Name: 13I.S{105 4rrio.j11j Type of construction: Address: (65 fp r.O'lr) Co la Occupancy groups: City/State/ZIP: 1 jei, 0 932Zy �) Existing: Phone:(C�14 � I ��' Fax:( ) New: ❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) Contact name: Structural plan review fee(or deposit): ( oZ a Address: FLS plan review fee(if applicable): City/State/ZIP: Total fees due upon application: Phone:( ) Fax: :( ) Amount received: E-mail: Fk G,Li j x, to E y� i I C e✓� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRA OR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: � r Submit two(2)sets of roof plan with connection details Address: and fire department access,along with the 2010 Oregon Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review Phone:( ) Fax:( ) and administrative fees): $180.00 State surcharge(12%of permit fee): $21.60 CCB tic.: Total fee due upon application: $201.60 Authorized signature: `� This permit application expires if a permit is not obtained ice!—�► within 180 days after it has been accepted as complete. -ex rnaj/i Date: O gt I l'/ /Z'Z *Fee methodology set by Tri-County Building Industry Print name: B)sf 1Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 1/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No.: illh Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: C Phone: 503.718.2439 Fax: 503.598.1960 0 Electrical D Plumbing 0 Mechanical r I G A RD 24-Hour Inspection Line: 503.639.4175 p Other Internet: www.tigard-or.gov THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Ycs No N/AEl ❑ 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ 0 4 Fire district approval required. Name of district: capacity 0 0 0 5 Septic system permit or authorization for remodel. Existing system P ty 0 0 0 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ • 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 0 basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable 0 0 0 local and state 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 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. ❑ ❑ 0 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 0 0 0 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- 0 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. ❑ 0 0 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 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. 0 0 ❑ 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- prescriptive path analysis provide specifications and calculations to engineering standards. 0 0 0 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 ❑ 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 [3 over 10 feet long and/or any beam/joist carrying anon-uniform load. 0 0 0 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer0 0 0 or architect licensed in Ore.on and shall be shown to be applicable to the .ro'ect under review. JURISDICTIONAL SPECIFICS0 23 Three(3)site plans are required for Item II above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0 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. ❑ ❑ 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 . D 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 0 ❑ Street Tree List. 0 0 ❑ 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. 0 0 CI 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. I:\Buildnrg\Permits\BUP-RESPertnitApp.doc 02/24/2011 4404613T(11/02/COM/WEB) r Me^.hanlcal Permit Application FOR OFFICE USE ONLY City of Tigard ,xa P"°"`No.. 1'��1-ao�y i 111 • 13125 SW Hall Blvd Tigard OR 97223 RECEIVES w • Phone: 503.718.2439 Fax 503.598.1960 P`Tn"t I I,,;•„.h U Inspection line' 503.639.4175 mate Ready/gy: axis: ® See Page 2 for Internet: www.tigan1-ar.gov SEP 1�L ZOZZ Noeified/Methad: Supplemental information TYPE OF WO CITY OF TIGARD COMMERCIAL FEE* SCHEDULE— USE CHECKLIST UILDIN(DIVISIONMechanical permit fees*are based on the value of the work ❑New construction IN Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ 4,4. Sq CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT 1 SYSTEMS FEES* CA 1-and 2-family dwelling 0 Connnerciallindustrial 0 Accessory building For special information sue dieddive. ❑Multi-family 0 Master builder 0 Other: Description I QtY. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling. 7� Air conditioning 46.75 Job site address 14 S 2 1 .S w i"W f n L.1-p Furnace 100,000 BTU(duns/vans) , 46.75 City/State/ZIP: T;Q Qr74. oR 9 322.11 Furnace 100,000+BTU(du Wvents) 54.91 Heat getup 61.06 Suite/bldg./apt.no.: Project name: 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 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 �,� p Flue vent for water heater or gas /e l i ivi'(.-.a.? N�� , ,� � fireplace 23.32 fJ� Toe lighter(gas) 23.32 Wood!pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 aPROPERTY OWNER 0 TENANT Other: 23.32 � Etwhe mrental exhaust and ventilation: Name: Bfsf p �arnc jhi Range hood/other kitchen eqent . 3339 33. .5 U Address: 16 584 St....., r( r) � i tP Clothes dry exhaust 33.39 City/State/ZIP: To.a►-s_ b4 9122 y Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(*tocaLjggs Fax:( ) Attic/crawlspace fans 23.32 RI APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel poling: Business name: $14.15 for first four;S4.03 for each additional Contact name: ei. RA.j ar eha. i Furnace,etc. lJ Gas heat pump Address: (ts s84/ S��e'.lt-iJi/) [� WaWsuspended'unitheater City/State/ZIP: T` ak 9?224.I Water heater Phone:(4t13)G f355 Fax Fireplace:( ) Range 1 14 15 E-mail: l�dd-b G`460, r1A11. Oa-rj Barbecue �/ CONTRACTOR Clothes dryer(gas) Other Business name: etM�„/ MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(I2%of permit fee) CCB lie.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 18a days after it has been accepted as complete. Authorized signature: A�� * Fee methodology set by Ter-County Building Industry Service Board rill / Print name: I$IsheS I a. ►YD.f�r(j Date:0$3f 242.2 clBuog\P ldenninN,1EC_PennitAp,_040113 der; d3 440-4617r(11/02/COM/WEB) Mechanical Permit Application - City of Tigard • Pagc..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:\BuildinglPcmnits'MEC_PermitApp_040113.doc 2 r Electrical Permit Application FOR OFFICE USE ONLY' City of Tigard g DECEIVED PlanRew ed a 13125 SW Ball Blvd.,Tigard,OR 97 Phew: 503.7182439 Fax 503.598.1960 p 1-2 q q Date/B : Related Permit a: Inspection Line: 503.639.41dy Date/By: TIGARD Internet: www.tigsrd-or.gov75 SEr L02` Notified/Method: . _ . 2Tor Supplemental Information TYPE of woldTY OF TIGIAi1D PLAN REVIEW ❑New construction Addltlon/altera l l l IVISI ON Please check all that apply(submit arsets of plans w/items checked): DemolitionOtheI: ['Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. IR 1-and 2-family dwelling 0 Commelcialindustrial 0 ACCe_esory building less to ground,or rsrrrds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emeagenwy system. larger separately derived • ❑Addition of new motor bad of system. Job#: Job site address: 165M Spz, .2) 4rd....4 C) Leaf 100HP or more ❑"A E "1-2„,"1.3„, City/Sta1/ZlP: ,j qa� 04 97 ZL 0 Six or more residential waits. Recreation V ❑Healthcare facilities. 0 Recreational vehicle parks. Suite/bidg./apL#: Project name ❑Hazardous locations. 0 Supply voltage for more Cross street/directions to job site: ['Service or feeder 600 amps or more. 600 volts nominal FEE SCHEDULE necriptioa l OW. I Each I Tail I • New residential single-or multi-family dwelling unit. ' Subdivision: Lot#: Includes attached garage. 1,000 sq.R or less 168.54 4 Tax map/parcel#: Es.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 �tr _ p J `� (with above R} Fa'-C 7�/ �tl�nl Lat)`' � limited energy,multi-(amity 75.00 2 residential(with above sq.ft.) .® PROPERTY OWNER I El TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: 33ishcs 0rw 6; 200 amps or less 100.70 2 Address: [65 84 ..._Sc.."- 22,awi h Lo 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 7; , pC. 99.22 y 601 amps to 1,000 amps 301.04 2 Phone:(Li y3) 7 / 13 as Fax( ) Over 1,000 amps or volts 552.26 2 b(S L CS C� Temporary services or feeders installation,alteration,and/or Email: r.�. r 1 M �ai f. relocation Owner install n: This installation‘ii.being made on property that I own which is not 200 amps or less 5936 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: cs 31 2 '22 401 amps to 599 mnps 168.54 2 'Ezl APP 7 T I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for braneh circuits with Business name: above service or feeder fee, 7.42 2 L each branch circuit Contact name: 13 isI) a/►��i)1 • B.Fee for branch circuits without service or feeder fee,fast Address: J g 5 134 SL Arf.c)t,) Loop branch circuit5618 2 City/State/ZIP: 7730,yet OK. 3 722-4 • Each aldi branch circuit 7.42 2 . Miscellaneous(service or feeder not included) Phone:( ) I Fax::( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 (CONTRACTOR Pump or irrigation circle 67.84 2 Business name: .41_ rA r.J Sign or outline lighting 67.84 2 Address: '�V Signal circular()or limited-energy ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 6625/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr - Inspections for which no fee is 90.00!hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(34 hr man) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: ill,Qy Print name: 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 180 Print name: '$%,S 1/1, Date: D$ 3l 22 days after it has been accepted as complete. * Number of inspections allowed per permit. I:16aildungTermits\ELC PemitApp_ELa_ERE. 06/17 5 .140-16 I5T(11/65/COM/KEu r Ele'ctncal Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Fora I Tome I * Fee for all residential systems combined: $75.00 Renewable electncal energy systems: Check Type of Work Involved: s kva orless 100.70 z 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 El Burglar Alarm Wind generation systemsin excess of 25 kva: 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee m accordance with OAR 918-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: El Other Each additional inspection is 66.25/hr ] charged at an hourly(1 hr min) '.. Inspections for which no fee is 90.0o/hr specifically listed(/s hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal([inter on Page 1): W Number of inspections allowed per permit (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC El Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\BWebng\Permits\ELC_PermitApp_ELR_ERE doe Rev 06/17/2015 Plumbing Permit Application -. Building Fixtures FOR OFFICE USE ONLI City of Tigard RECEIVED ReceivedPermit No.:,r1S)ci 10 ■ 13125 SW Hall Blvd.,Tigard,OR 97223 ct�i q 0 Plan Review ' 2 Phone: 503.718.2439 Fax 503.5400t-A ZUZZ Date/By: Other Permit No.: T I GA RD Inspection Line: 503.639.4175 Date Ready/By: kris RI See Page 2 for Internet www.tigard-or.gov GO OF TICIARD Notified/Method: Supplemental Information TYPE OF gtAWING uiVISION FEE* SCHEDULE 0 New construction ❑Demolition For special information use checklist Description I Qty. 1 Ea I Total '®Addition/alteration/replacement • 0 Other: New 1-2-fanhly dwellings(includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR.(1)bath 312.70 m 1-and 2-family dwelling 0 Commercial/industrialSFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory,building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(_sq.ft.)• Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Jab site address: 1 6 S g4 ,S�,Da r(ajj n L.da-P Catch basin a area drain 18.76 J '�t Drywell,leach line,or trench drain 18.76 City/State/ZIP: I",,d. (51,2 97224 Footing drain(no.linear ft.:_) Page 2 ( Suite/bldg./apt.no.: " ( Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear It,: 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.: Bat$$ow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 P7i.." is-, -4,_ A' J u}...G..i Dishwasher 1 25.02 25.02.Drinking fountain 25.02 Ejectors/sump 25.02 jla PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: '31sI-AS �ti a r v a/h I Fixiurc sewer cap 25.02 Address: J C 5 g 4 Sc.-. � te:4 n � Garbage drain/floore sink/hub 25.02 p� Garbage disposal 1 25.02 �,oa City/State/ZIP: r te, one J -22Y Hose bib 25.02 Phone:((04 CAI i 2,55 Fax:( ) Ice maker _ 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$_) Page 2 Contact name: ' amg j-)� tr)�� Primer 12.51 I 1 " Roof drain(conmmercisl) 12.51 Address: J 4,5'gel ,$v.] .D4T1- LPap Sink/basin/lavatory 1 25.02 25 ea city/State/ZIP: -1 J b< 3 2.2`-/ Solar units(potable water) 62.54 Phone:(L443) 35 Fax: :( ) Tub/dower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: awArcurWater piping/DWY 5629 Address: Other: 25.02 City/State/ZIP: Subtotal 7.5.D6 Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lie.: Plumbing Lie.no.: Plan review (25%of permit fee) • State surcharge(12%of permit fee) Authorized signature: "'lit, At. TOTAL PERMIT FEE idriJ Print name: ',g),. he..c • rYtthl Date: Og. ig2, Thit permit app&ad.aezplres If a permit Is not obtained withIn 180 days after it has bees accepted as complete. 'Fee methodology set by Tri-County Building Industry Service Board. L\Betldng\Pennin\PLMU-PermtApp.doc 10/01/09 440-4616r00/02/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-Fa 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' 3,601 to 7,200 $233.20 b2.54 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 Storm&Rain Drain-1st 100' 62.54 $100 to V.00 to$ion: permit Fee: $5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or faction thereof to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal husiness 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 ihiwa Type Plan review is required for any of the following. Future Type for Replace! Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2"and Bath: Tub/Shower greater,except systems designed and stamped by licensed -Jacuzzi/Whirlpool engineer. Car Wash: Farb Stall 0 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 sprinkler sprirer system. -Domestic 0 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„ Isometric dr Riser Diagram 0 Isometric or riser diagram -Car Wash Drain is required for new buildings 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 Separaur(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 Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard p COMMUNITY DEVELOPMENT DEPARTMENT c TIGARD' Small Form Residential Supplemental (Non-RT) Building Permit #: 141�TMZ-bUZ(ocProject Name: 12Ai�arn 1 L Site Address: ` (o�� 1 SW G YU��- J1 Lot #: L t: Total Existing Units: ET One ❑ Two ❑ Three New Configuration: 0 Single Detached ❑ Duplex 0 Triplex 0 +ADU Small Form Residential #andards /✓ i v n Setbacks -�_ Rear: lc- Side: 7) Street Side.----Gaxager______ Height : Max. Height: ,T` Actual Height: I'L% Landscape ❑ Landscape Area: It % Lot Coverage Max: '' % 0/0 Entran ❑ Set back no more than 8' from street-facing wall Parallel to street or offset 45 degrees or less \indo s ❑ Minimum 12% of area of all street-facing facades Garage Garage doar is behind widest street-faemg wall ❑ Yes . ❑ No, and one of the following is met: ❑ Door extends no pli5re than 5' from wall and there is a covered porch extending beyonjarage. ❑ Door extends o more than 5' from wall and there is a 12 sq ft. window above'garage on 2nd floor. Garage door width is: ❑ 12' or less O 50% or less of facade ❑ 60% or less and includes 7 of following: ❑ Covered porch ❑ Recessed' ntrance 0 Wall offset ❑ 1' Roof eave 0 Roof offset 0 Fire shingles ❑ Lap Siding 0 Gable, hip, gambrel roof 0 Dormer ❑ Roof pitch ❑ Accent siding 0 Window trim ❑ Window recess 0 Window projection 0 Balcony Approved By Planning: gl,\aYd Date: '" I'1BoildinglFonmtBldgPenmtRt7t_SFR Supplemental 070722 i City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT TIGARD River Terrace Building Permit Review Addendum Building Permit #: /1fl ?ro Za-op)4,6 Site Address: I(ocg U Cc...) P4Q6tJf'1 Project Name: V46`/r4 M) 1+1 Lot #: Zps— (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review of River Terrace Plan District Design Standards (18.640.070.1.): Is the project subject to the plan district design standards? ❑ Yes 'No 1. -o• 'culation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional element re.. ed for lots with over 60 ft. of street frontage shall be provided every 30 ft. Porch nun. 5 ft. dee. Balcony w/ access 2 Window Projection Vertical Wall Offset a Gabled dormer ft. deep min. 2ft.,5 ft.wide min. 2 ft.,6ft.wide ❑ ❑ ❑ ❑ ❑ 2. Eyes on the street: a minimum of 1 ' . .f each street facing facade must include windows or entrance doors. Percentage Shown: . - •trances:At least one entrance must meet both of ' - following standards: Parallel to street,angle no more than 45° from street, ❑ Max. 8 . etback from longest street- facing wall or o.. onto porch Entrance opens to a ..rch: ❑ Yes ❑ No If yes,all the following ap. ': ❑ 25 sq.ft. t ❑ One street facing entry ❑ 12 ft.max.roo ..ove floor of porch ❑ 5 ft.depth min. ❑ 30%min. porch roo overage 4.Detailed Design:All buildings shall include . . . . of five of the following elements on a. street-facing facades: 51 Covered porch min. 5 ft.wide x 5 ft. deep ❑ Recessed entry area min. 5 ft. . de x 2 ft. deep ❑ V a• •ffset min. 16 inches ❑ Dormer min.4 ft.wide ❑ Roof eav- . . . 12 inch projection ■ ' .of offset min.of 2 ft. ❑ Roof shingles - --r tile or wood 0 Gab . hip or gambrel roof design ❑ Roof pitch oriented s._ min. 500 sq. ft. ❑ Horizont, ap siding min. 3-7 inches wide ❑ Accent siding min. 40%o - -et facade ❑ Window trim . 2 1/2"wide by 5/8"deep ❑ Window recess min.3 inches for ... treet facing 0 Bay window min. ^ .wide by 2 ft. deep ❑ Balcony min. 5 ft. wide x 3 ft. deep wit side access ❑ Attached garage is 35°o less of street facade 5. Garages and Carports:May face the front or side - line on a corner lot. Setbacks: No closer to front or side lot line,than longest street-facing wall. 5 I I Yes ❑ No. if No (Check one): ❑ May extend up to 5 ft. if there is a covered front porch and garage ..- not extend beyond the front porch. ❑ May extend up to 5 ft. where the garage is part of a two-story building an. •ere is a window at the second story above the garage that faces the street with a min. area of 12 sq.ft. Width: (Check one) ❑ 12-foot-wide garage door ❑ 40%max. of street facade ❑ 50%max. of street facade with 7 detailed design elements Notes: Approved By Planning: f/r Date: g/((/2 2 1 1Building\Fmms`BIdgPertniiR.w_RBS_RT_121417.docx City of Tigard 71 It COMMUNITY DEVELOPMENT DEPARTMENT TtGARD Building Permit Review - Residential Building Permit #: ,MS`t- a© -0c-a6=•5 Site Address: /Gsg y Sw 1- AQw111/4.1 l�cx=P Project Name: VAYaf'LA3t+i Lot #: 7os Proposal: EJ�s e Ex-• 'Pan o Land Use Case: RaeznIS" - ocxov Z Zone: -11 Required Submittal Elements Vc JJ opies of site plan Lsquare footage of buildings to be demolished prawn to standard scale 101 Footprint of new structure and FFE rth arrow (IJ Retained trees, drip line / tree protection ,Site address, project name, lot # 4treet trees shown / labelled 'adStreet names Sidewalk / driveway shown and dimensioned applicant name and phone # Utility locations & easements (new / additions) t and setback dimensions 1"` Location of wells / septic systems Cal Existing structures on site Lot area and lot coverage percentage t` 1 rosion control Corner elevations (2' contours if > 4'reVision clearance triangle shown Ground slope at building pad calculated / shown Pla , ning Review t1 rify address / suite # active in Accela. ❑ Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995) Required: ❑ Yes eNo Received: ❑ Yes ❑ No in Public Facilities Improvement (PFI) Pernj t: Required: ❑ Yes I-XNo Applied For: ❑ Yes ElNp, stop intake Sensitive Lands: ❑ YesPKNo Type: Housing Supplemental Sheets Completed X ❑ Cottage Cluster C&O (1 site, 1 per unit) 0 Quad ❑ Courtyard Units C&O (1 site, 1 per building) ❑ Rowhouse ❑ Cottage Cluster Type II (1 per unit) ❑mall Form Residential / ADU ❑ Courtyard Units Type II (1 per building) River Terrace Addendum 0 Conditions met prior to issuance of buil ing permit LOay�(� UgQ (''c *-- Approved By Planning: Date: g i//�2 Notes Revision 1: ❑ Approved ❑ Not Approved Date: Revision 2: 0 Approved 0 Not Approved Date: 1:Building\FannsVBldgPermilRvw_Res_070722.docx _ Building Permit Submittal Original Submittal Date: Y/A/-)1a Site Plans #: Building Plans #: Building Permit #: IR Building permit # entered on page 1 Workflow Routing: EP, Planning R-Engineering t -Permit Coordinator W- Building Workflow Sign-off: Gil-Sign-off for Planning (include notes from planning review) Route Documents: ❑ Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. El Building: original permit application, site plans, building plans, engineer and beam calculations and trust details, if applicable, etc. Permit Technician: y Date: qa Notes Engineering Review Slope at building pad verified Slope: / —� 0GConditions met prior to issuance of permit ///1 Easements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes I 1\lo Assess Water Quantity Fee in-lieu: ❑ Yes 2No LIDA Facility on lot: ❑ Yes l'No Add Fee: 0 Yes ❑ No final Plat Recorded 0 NOT Approved Date: Notes / Approved By Engineering: Date: 44! 2S1/4Z Revision 1: ❑ Approved Not Approved Date: Revision 2: ❑ Approved ❑ Not Approved Date: Peimit Coordinator Review Conditions met prior to issuance of permit Ap•roved, NOT Released: Date notified applicant: ❑ ENG Revisions Required: Date notified applicant: p_SDC Exemption: 0 Received ❑ Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes lI N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes N/A LIDA ❑ Yes N/A 1n } /OK to Issue/Approved by Permit Coordinator: t rFu1tyc Date: ' Revision 1: 0 Approved ❑ Not Approved Date: Revision 2: 0 Approved 0 Not Approved Date: 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 TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • TO: '1 v n 'f rr rb DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: '1 .shes ' -1b SEP 12 2022 COMPANY: J CITY OF TIGARD BUILDING DIVISIIUN„p_, PHONE: !4 691 - 356- _-_— EMAIL: rb S i (far" RE: (C5.: ,Dan_In T,aorzf csl; 39224 ' 1ST2a22--cO2C5 (Site Address) (Permit Number) (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. Wall bracing and/or lateral analysis. 3 Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): 'Pion 0-7 jrzioco S i2tS REMARKS: FOR )FyCE USE ONLY Routed to Permit Technics Date: c'( //?j Z='L Initials: 44- Fees Due: ❑ Yes No Fee Descriptio . Amount Due: $ Special Instructions: Reprint Permit(per PE): ❑ Yes 124 ❑Done Applicant Notified: Date: Initials: Water Meter Fixture Unit Worksheet for A, wt dels/AD Us Please complete the following information: . SEP 12 2022 Customer Name: '331'sfr1GS °'r''O) 111 CITY OE 71(inRD Service Address: Street/Suite#: 14 s'84 S' ,D, Lg►Pap D City: 7 arzt State: 4:3K Zip: 9/-22Y Phone Number: 4N3 / l3Ss Email: 1a bi..Si•teS rrha:;(• (+ Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you purpose 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 I x 4 = 41 x 4 = Dishwasher ,L x 1.5 = i .s s x 1.5 = 1 .5" 1"Outside Water Spigot A x 2.5 = .2•5• x 2.5 = Water Spigot,each add'l 1 x 1 = 1 x 1 = Kitchen sink A x 1.5 = t.5 __I x 1.5 = _,j.5 Laundry sink x 1.5 = x 1.5 Lavatory(bathroom sink) 3 x 1 = 3 x 1 = Water closet,1.6 GPF(toilet) 3 x 2.5 = q•5• x 2.5 = Bathtub/whirlpool x 4 = x 4 = Shower stall S x 2 = 6 x 2 = Bath/shower combo x 4 = x 4 = Current Points: 24 Proposed Increase: 3 Current Points+Proposed Increase= 3 0 = 5/ 4.New Total Paints =Required Meter Size 8 Meter Sizes: I to 30 points=5/8" 30.5 to 37 points=3/<" 37.5 and over points=1" I i New Meter Size Needed for New Total Points: $ Cost: $ / 125g. Oo (see page 1) Current Meter Size per Utility Billing: 5-/$ii Cost: $ // 2S oa (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ 0 • d° (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) FOR OFFICE USE ONLY Meter upsize is not required with additional fixtures. Current Meter Size Confirmed with UB J Bentley 09/12/22 Signature of U13 Representative Date I:/Building/Forms/WaterMeters 070127 Adddoex Page 2 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or ‘r (+ I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. , 1.0101-S;-)C. Cada ricjh; Print Name of Permit Applicant o$/ ► I /2_O'27 Signal -ermit Applicant Date Permit#: /17S7-0W— S Address: 43—iri7 w /rl'vi-i/rwlay T,fi t d '?im Issued by: % •/ _ Date: !� fr f . / _a This Copy for Permit Offices 'F Information Notice to Owners About F 64'7' `7 Construction Responsibilities tr-i (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, call 503-945-8091 or go to htto://www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms. • 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 503-947-7815. • 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, call the IRS at 1-800-829-4933 or visit their website at 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.oreoon.gov/ccb f/property_owner adopted 9-23-08 This Copy for Permit Applicant