Permit (3) 71si CITY OF TIGARD MASTER PERMIT
_ COMMUNITY DEVELOPMENT Permit#: MST2022-00281
Date Issued: 09/29/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 CA04200
Jurisdiction: Tigard
Site address: 9740 SW LAKESIDE DR
Subdivision: SUMMERFIELD NO.12 Lot: 662
Project: Kadel
Project Description: Remodel kitchen and add windows. No water meter upsize per UB.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $30,000.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0
Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 0 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 0
Ea add.'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
KADEL,CAROL PREMIER CUSTOM HOMES Required Items and Reports(Conditions)
9740 SW LAKESIDE DR 18109 WALDOW RD
TIGARD,OR 97223 OREGON CITY,OR 97045
PHONE: PHONE: 503-309-9852
FAX:
Total Fees: $1,615.48
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 requir you to folio th rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
Q59_nn1_(V11n thrnt tnh r1 9_nn1_nnon nit m % htain a nn r of a rnlac nr riirrt ni iactinnc to n y l min b Tallinn Fn1 9 1QR7 nr 1 Ann'119 9144
/ ; rrd/S
Issued By: G.. Permittee Signature: C v` � G�� " v�
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.0001
��
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Building; Permit Application
Residential ECEIV f_: FOR OFFICE USE ONLY
City of Tigard Received "`
Date/By:
. ° 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 2 2022 �� Z � ` i ��
`�'� Plan Review /2flfZ't_
Phone: 503.718.2439 Fax: 503.598.19 Date/B Other Permitnspeco75 f IGAI-6 Datead/B / Juris:TIGARB Y Y ® See Page 2 for
Internet: www.tigard-or.gov No d/Metho
BUILDING DIVISII�t\ -ZO�LZ Supplemental Information
3
a c Aa
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑■ Addition/alteration/replacement ❑ Other: equipment,materials,labor,overhead,and theprofit
Ipfor the
vm t, ..N a.ii-i''' .:: l g = workindicated on this application.
ipmen,
'
1-and 2-family dwelling Valuation: $30,000
❑ Y g ❑Commercial/industrial
ElAccessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
a", SiiE R'' Total number of floors:
.. ..
Job site address:9740 SW Lakeside Drive New dwelling area: square feet
�� City/State/ZIP:Tigard, OR 97224 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
IA/&7 1. i i &i 'r Clod--tei'r/s/�.Sir Z' /S Other structure area: square feet
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
i•EScRIP O; O ' work indicated on this application.
Remodel of SFR to add windows and remodel kitchen Valuation: $
Existing building area: square feet
New building area: square feet
PROPLR O IE$ , ` 2,"XE � : Number of stories:
Name:Carol Kadel Type of construction:
Address:9740 SW Lakeside Dr Occupancy groups:
City/State/ZIP:Tigard, OR 97224 Existing:
Phone:( ) Fax:( ) New:
r x!' „:ti.ii kPi' CANT ; �� :, ,/y... r. 0 O;k6ritR; s1 BULDI '�
Business name:Faster Permits =' �
Structural plan review fee(or deposit):
Contact name:Kyron Christman
FLS plan review fee(if applicable):
Address:2000 SW First Ave, Suite 420
City/State/ZIP: Total fees due upon application:
Y Portland, OR 97201
Phone:( )503-780-5385 Fax: :( ) Amount received:
E-mail:kyron@fasterpermits.com pig A iiiii4 I f ?E t
Commercial and residential prescriptive installation of
V- «?•F' 'i --- .i,. , •7k ,,. Alitli : Itt roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Premier Custom Homes Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:18109 Waldow Road Solar Installation Specialty Code checklist.
City/State/ZIP:Oregon City, OR 97045 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) (503) 803-2029 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:155585 (/ 7/ 7 ��� Total fee due upon application: $201.60
Authorized signature: / >4 9)Z" This permit application expires if a permit is not obtained
(/// within 180 days after it has been accepted as complete.
Print name: *Fee methodology set by Tri-County Building Industry
Kyron Christman Date:8/23/2022
Service Board.
1:ABuilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
Date B Permit No.:
�� 13125 SW Hall Blvd.,Tigard,OR 97223 Y , 'O0 .:'
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD 24-Hour Inspection Line: 503.639.4175 El Electrical CI Plumbing El Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 LI 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: ElEl El
5 Septic system permit or authorization for remodel. Existing system capacity ❑ El El
6 Sewer permit. ❑ ❑ 0
7 Water district approval. ❑ ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ El 0
9 Erosion control ❑ plan ❑ permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state El El El
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 ❑
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- El ❑ 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- El ❑ ❑
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 ❑ ❑ El
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ El 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
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 ❑ El
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required El ❑ 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 engineer or 0 ❑ ❑
architect licensed in Oregon and shall be shown to be applicable to the 'ro'eet under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11-x 17". El El 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑ El
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ El
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. El 0 El
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 ❑ El El
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations.driplines, ❑ ❑ 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ 0
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:ABuilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard ; 4 -i 7`,ccrltcd
INt>a• 13125 SW Hall Blvd.,Tigard,OR 97223
te-33y Pc""No- l 0Z2, 002:1
' Phone_ 503 718 2439 Fax_ 503 598 1960 AUG 2 2 2022 C tars Review Other Permit
TIGARD Inspection Line: 503 639 4175 Ume=fly
CITY���I�A�,IJate Reatlyeily: ' bins0 See Page 2 for
Internet: www tigard-or_gov 1.111onped'Methvd Supplemental Information
BUILDING DIVIS ON''
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑New constructionAddititfnlalte ration/replacement Mechanical permit fees*are based on the value of the work
performed.indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
pI-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special Information use checklist
❑Multi-family 0 Master builderOther: Description 0 P OW. Ea, Total
JOB SITE INFORMATION AND LOCATION Ileatint;/coaling:
Job site address: `( J Air conditioning I 46.75 (f 11-
45i4 D+-, Furnace 100,000 BTU(ducts/vents) 1 46.75 %/It-
City/State/ZIP: 1-li ( OI Furnace 100,000+t3TU(duets/vents) 54.91
Suite/bldg./apt,no.: Project name: i feat pump 61.06
Duct work 23 32
Cross street./directions to job site: Nydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 2332
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 t 23.32 '23-32
DESCRIPTION OF WORK Gas fireplace/insert 1 33,39 V•41
2,�,. f `V�l t'� Y Flue vent for water heater or gas
}`- C { j S0!`tD yha tl fireplace 23.32
`^✓WCtr"' tit Log lighter(gas) 23 32
\ Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23 32
0 PROPERTY OWNER 0 TENANT Other 2332
Environmental exhaust and ventilation:
Name: Carol Kadel Range hood/other kitchen 7
equipment l 33.39 3?.?i
Address: 9740 SW Lakeside Dr Clothes dryer exhaust 33 39
City/State/ZIP:Tigard, OR 97224 Single duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other 23,32
Fuel piping:
Business name:Faster Permits S14.15 for first four;S4.0J for each additional
Contact name: Kyron Christman Furnace,etc l
Gas heat pump
Address: 2000 SW First Ave, Suite 420 Wall/suspended/unitheater '
City/State/?lP:portland, OR 97201 Water heater
Phone:(503) 780-5385 Fax: :( ) Fireplace
Range
E-mail: kyron@fasterpermits.com Barbecue
CONTRACTOR Clothes drser(gas)
Business name: trAt 1� LAI,ttv,..y Other
:MECHANICAL PERMIT FEES*
Address: '2,ES'0 l\) - Lariats lIl-e.. Subtotal t9 i*�i
City/Statefl..1P: '),,,,,144,,,t l �'Sl, et-1.�'0 Minimum permit fee($ra0.00)
Phone: Z _ d c-� Plan review(25%ol'permu fee)
Fax:( ) Slate surcharge(12%of permit lie) 11. i '
CCB lie.: e 9 `1 TO`LAI,PERM!"1'FEE 105., 43
I permit application expires if a permit is not nl»wined tuthin 1811
clay after it has been accepted as complete.
Authorized signature: ' fee n,cihodotigv set bs- Iti4't7unty tludding hxhiatrs Sets Ice firsahl
I Print name: Kyron Christman Date: 8/23/2022
i;lit JJ.n,¢pennni Mi C i'errn,Aps 040113 doe '110 i6171'111=U2 COM V,3113
# - , RECEIVED
..
1
,,,i,ni ty,,,,lit .cNi)uticatiuri ,. . .
AUG 2 2 2022 ,..,
----- ,,
lor t it, ,,,,"Iittlirti
I . • CITY OF TIGAHnD
. * bIG rit I UILDN
; t
t. t„:„...,.t„,t ,..... t.. .t.tit.,..-,,I i''..•
r• " <1,, '" : i•
tiOAftb . ,. , . , ,,,,,,_,,,
„ -,,,,, ,.
.. - t atats N,1,11st_rt sacra!az ttaT s„. ,-t„efta,
•
0,,,,,,,VT r",',....„19, i,4'v.,ft,,,,,..m,-,-,-, 0 A•.,,,,,,,,,,,,,,,,,.
4•p1/4,4., t ..,..„.„..„a,s ,.,'4..,-N.,,-/A,,,PIIImI 0", ''',.,,,,,- "-
,.-
- - - --'"-- CATTGORT OF aANSTRIXTION ,,,j : ,,,,,,„4„.=,a,tom o ,-.A--t. -•• 0 '., '
Lit 4.4,114x4-4044144„44i44.4,41 0 kccr-,,,,,r, h,4.,",-,-,2,
0\tract'Isu.'„hi ar ,I-a-7,,, ..: 0 r.sst httv
' fa",,,,r,-,tot,,,0,",,•,
t,10•,"? w,,,,,,r,-,4
, JtItt stle attirs. ',. (;'1 4 0 S144 ILtOsIf....4t44 0'6 Olt
".""""'"""'"'"• 0
si 0 Ms , (11 t't l'''‘ Ottraaa-aa,t,a.aams 0 nett.vats oat arta..,--, .tat I
I
0 ss, .,I.,I4,,t4,t.sr aats ass*
PIotes I name , "
. '".,,'" '., 0 f,a,",ve ea faa.,!ef N"...•ar-r*,V OW rlt-
,
°, ,€rett dirttliOnS.till ifit,.S.11 FEE SCEIEDELE
, -
.- _.- - , Nto residential single-Or maitl-fantily darning unit
`‘,ibdi%vqkin 1 Oi.6. I indsii"ilittith44 garatT,
I
I as mars'parcct —•
t 4 i,dd Ii..=.0 iil 0 Or pOillOrI -
1 DESCRIPTION OF WORK -. I"a,,,...d coop,cmcknIca)
S, ...(...1<)-T t.., ..-Ns.A.1 t v --e _
., 1 arartst trasgs mortt-farotts immimmiimen
„.„.,,,3„,,„,„,,at•osc tc ft aIIIIMFIIIIIIIg— 111111111111M1
Rene/amble r ne . OrilEMMEMIIIIIME
' ' 0 PROPERTY OWNER . 1 0 TENANT , sr,irr4 or trefirn in,folbiloo,oio,roto,„omvor„4„,,,,op,,,,
' i.....* . „_
N'Ime 111111111111- Carol Kadel , -'"'amr,cw'"1 maw , ...AJJ't'ss°, 9740 SW Lakeside Dr
4-01 amps to(4,aaamps Enjamon
, tt)',Statel.IP; 601 atom to 1,00o amps signamou
rb,,,,,,-( ) Fax,( )
r mail,. Temporary atm ices or feeder%insuallalion.alteration.andior
reloca lion
-
Ossner insta,llation:This installation is being made on property that I()1st)which is not 2tto,irrl1K or iti. 11111111111111111111111111
intended for sale,lease.rent,or eseltange,according to ORS 4,17.4.19.670.and 701. 201 amps q,-4(Xi amps IIIIMIIIIIIIIMEI
Olt 11CT sIgnature:_ _ i__ thtc, 401 amps to stxt amps
0• APPLICANT i 000NTACT PERSON — ' ,.°Nrattn:hi:tihrZi,1111,-uncr:,::1:741-Atian.ur'rxli"4.1"n'' r' mei
EiLr'rne.s.name'Faster Permits above senice or feeder fee,
ciikh hr,inkb k ot int
Contact name. Kyron Christman 9 Fee int branch citcuit.8*0 ithOlff 1
Cr'N tie Of feeder fee,lost kei tn
Address: 2000 SW First Ave, Suite 420 branch coctot
MEI
city staieziP:. Portland, OR, 97201 Each add`l branch etrintit
NI lwelkanectut(senke or[ceder not include&
Phone (503) 78O-53RF Fax::.( ) Each manotaciated Of tnixtular
dO•C',1t112...';Cf‘ICC antra(feeder =IMO
I mad kyron@fasterpermits.corn Re,,,.inc,t onlk 111121111111111111,1191
CONTRACTOR Pump or irrir,tion circle =MI 1E1
nusine.csnatney.et.;5 i 0 ,,j VI €
1J t c....c-rv-I c.„4,44,1„, s,rn or OtithriC lighting argnammu
NIgital koloolOI or limited-en:11;k rl =al
Address: v?0?4:,..) 5 p,„.....)Asj v:.. c.,-r. loci,alteration of c‘tcoww, .-.-----,----
City State/IIP.bit.,vs,„,tz,s (,sa S I It. ()I,-1V e CI Each nritlitittnal ink lion o lr ker ulonutme tle in arts or nhoke
AdJoional inTe%tion I I hr mint 66 2i'hr 111111111
Iur.hr 11111111111 Phone:(933 I LI I/ - ri 2)1 0 FaX ( ) inscsogtuoo rt to mint co' '''Inilintrol pl tnar nt II to t 1,g 1 hr III
I E.nlail:. *As V ':ter,i tast-scc 1 Si el*sa i•sr‘esi.bsa t.,:-41". , Inkrectionk lot kkhich no tar E. 111:111111111111
)(VII Ire, ‘‘03 I i B 1 Electrical Lie,: C.14.4. Sorry.Lic031 5 s 'itilts listed 0,hr tom
ELECTRICAL PER%ITT FEF.S
' - Sum Electrician signature,required:LIIVstk.aks.c.4.1eNA,
I )tA.."cA5..., /(' t, Stale SlirskilI,IC(12'.4,01 Subtotal
Print nametsri yDale: q' 0 Pln ReveRcAuret ) 11.1:1.t:'k_D-91,4/1 r.-Altai\jik
Authorized signature:s.,,,,,,„,trabs„A — - saa l li)lt\I It It\II r I"Lit ''',Ytit.: .7. ,'.•'
ittik permit opplirothinrkpirrti a a perillit is riot ahl'41fit(I Wiiiiit;ISO Prirtr name:ts,Als„‘„.E. clt to, Al 1(1 r),114,. 'I -- 22 tla)%talcr it ha,tutto wrrptol as camakia.
' Naalkl of ia.kre0aml,Allinseit pet permit 1
iii`Avr-JAer rip ratt 1st tto•-, ,';:,' 11 .I,,,IInII,A.t(r•I'Al/I ,
.,..
Plumbing Permit Application
Building Fixtures RECEIV.: '-FOR OFFICE USE ONLY .
Irk City of Tigard AUG 2 2 2022 rt"et,ed
Mit beano No Zb1Z��/t
13125 SW}{all Blvd 1 tgard.OR 97223 Uatc lay t�t
t- Phone 503 718 2439 Fax 503.598 1960 TIGARD
Res ION
Inspection I Inc 503 639.4175
CITY OF 1 IGARD Date liv Other Permit No
TIGARY? [me Reads ray tors Bf See Page 2 for
Internet ssssw tigard-or.gov BUILDING DIVISIOIt<,nt1ed Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
D'New construction ❑ Demolition For.special information use checklist.
Adduionialrcrationlre lacemcntDescription I Qty I Ea I total
P 0 Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath It 312.70
[} ,I-and 2-family dwellingSFR(2)bath ' j 437 78
0 Commercial/industrial 1
❑Accessory building 0 Multi-family SFR(3)bath 500 32
❑ Master builder - Each additional bath/kitchen „1 25 02
0 Other: Fire sprinkler(i sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: _
Job site address: q 7 go 5 (Cesit c sly Catch basin or area drain 18.76
Cit}/Statc'ZIP: c,� ( � 2`{ Drywcll,leach line,or trench drain 18 76
( Footing drain(no,linear ft.: ) Page 2
Suite/bldg.lapt.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 ft. __) Page 2
Stormsesser(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: 13ackflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
✓ ( t C Clothes washer / 25.02 -2C`--
K ( ,6.\ i 4+i )
Dishwasher / 25.0/ "I S a,
Drinking fountain 25_02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12 31
Name: Carol Kadel Fixture/sewer cap 25 02
Floor drain/floor sink/hub 25,02
Address: 9740 SW Lakeside Dr Garbage disposal ( 25 02 1.7"L
(ity1State/ZIP: Tigard, OR 97224 (lose bib 25.02
Phone:( ) Fax:( ) lee maker ` 12,51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Faster Permits
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Kyron Christman Roof drain(commercial) 12.51
Address:2000 SW First Ave, Suite 420 Sink/hasin/favatory 'Z'e..6 3_ 25 02
City/Stale/ZIP:Portland, OR 97201 Solar units(potable water) 62.54
Phone:( 503V80-5385 Fax::( ) Tub/shower/shower pan 1 12 51
E-mail: com Urinal 25 02
CONTRACTOR Water closet 25,02
Water heater 37 12
Business name: ?i b .`.,�( , W"\-1 Water p ping/DW V 56.29
Address: .(`,. &4C `��f'Lt '/— Other' 25 02
City/State/ZIP: (jt1`*iit�'� ,ytkid } (za L- 9[ ) 64A!bx0( } Subtotal 534 �--
Phone:( ) ZD — (( Fax:( ) 7/// Z Minimum permit fee $72 50
C'C13 Lie.: I L2;.(, cis( l L1l Plumbing Lie.nn. gr 3 Plan res tew t2590 of permit fee)
` State surcharge(12°0 olpermit fee) C,7ti-S`f
Authorized signature: ( �
� 1'O11�L PFiR}�1tt VLFt 1/446
Print name: Kyron C stman Date:8/23/2022 This permit application expires if a permit is not obtained sxithin ISO days
after it has been accepted as complete,
"F"nicihodologs sci by'frrC aunty ihuldurg Industry Scisice tloard
t Ito tldmN:PermasT1M1.1-Pet out Appdm. IOttt:09 J40-.i61611toti2,co>,t.wtnt
City of Tigard
d COMMUNITY DEVELOPMENT DEPARTMENT
: c
TIGARD Building Permit Review - Residential
Building Permit #:
Site Address: �..1�t ^ ++S AJ LckLS iC Pr
Project Name: It ®1 r e_WYIo Q_- Lot #: &(o7_
Land Use Case: 1`1 1 A Zone: reQ-S-C.
Required Submittal Elements A\-e,v,a;( n� u c kk)U `Jo ;nc1("(
L 3 copies of site plan CI Square footage of buildings to be demolished
❑ Drawn to standard scale ❑ Footprint of new structure and FEE-
D Retained trees, drip line / tree protection
El Site address, project name;`tot # ❑ Street trees shown / labelled
❑ Street names ❑ Sidewalk / driveway shown and dimensioned
❑ Applicant name and phone # ..-- ❑ Utility locations & easements (new / additions)
❑ Lot and setback dimensions ❑ Location of wells/ septic systems
❑ Existing structures on site ❑ Lot area and lot coverage per entage
❑ Erosion.control ❑ Corner elevations (2' contours if > 4' differential)
❑ sign clearance triangle shown ❑ Ground slope at building pad calculated / shown
Planning Review
Lg Verify address / suite # active in Accela.
lean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
Required: ❑ Yes [10
Received: ❑ Yes
Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes rwico
Applied For: ❑ Yes ❑ No, stop intake
Ohensitive Lands: ❑ Yes ❑ No
Type:
Housing Supplemental Sheets Completed
❑ Cottage Cluster C&O (1 site, 1 per unit) ❑ Quad
❑ Courtyard Units C&O (1 site, 1 per building) El owhouse
❑ Cottage Cluster Type II (1 per unit) Small Form Residential / ADU
❑ Courtyard Units Type II (1 per building) ❑ River Terrace Addendum
conditions met prior to issuance of building permit
Approved By Planning: 3 .M(Con v, Date: S3 1z.
Notes
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
I\Building\Forms\BldgPermitRvw_Res_070722.docx
Building Permit Submittal
Original Submittal Date: 4 -2,2-3 />>
Site Plans #:
Building Plans #:
Building Permit #: -in-Building permit # entered on page 1
Workflow Routing: .rPjanning El-Engine-eft-rig fErPermit Coordinator -E-Building
Workflow Sign-off: —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.
❑ Building: original permit application, site plans, building
plans, engineer and beam calculations and trust details, if
applicable, etc. �
Permit Technician: --_�- ---�- Date: _ Z2 ,�_
Notes
r"l/( C
Engineering Review
❑ Slope at building pad verified Slope:
❑ Conditions met prior to issuance of permit
❑ Easements (encroachments) per engineering conditions of approval arid-plat
❑ Water Quality/Quantity Facility: >4.
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No Add Fee: ❑ Yes ❑ No
❑ FaI Plat Recorded
❑ NOT Approved Date:
Notes
Approved By Engineering: Date:
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
❑ Conditions met prior to issuance of permit ,...- -
❑ Approved, NOT Released: Datee-notified applicant:
❑ ENG Revisions Required: __ -- "'bate notified applicant:
❑ SDC Exemption: ❑ Received ❑ Does not apply
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
LIDA �❑ Yes ❑ N/A
❑ OK to Issue/Approved by Permit Coordinatolr: Date:
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs
Please complete the following information:
Customer Name: (avd( *l)IC
Service Address: Street/Suite#: T ` 6 5(,) K..s)it. by, I
City: Ti 1 a State: (V1L Zip: ctT-ZZ
Phone Number: 3 - 3 Z 0 — .33v"4- Email: FAT IA IA-p tt3- Q- C7 1"'"I'I . 6►•"
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 AA Value Total
Bar sink x 1 = x 1 =
Bidet x 1 = x 1 =
Clothes washer I x 4 = 4 x 4 =
Dishwasher 1 x 1.5 = 1 ,,f x 1.5 =
lst Outside Water Spigot 1 x 2.5 = 2.r x 2.5 =
Water Spigot,each add'l I x 1 = I x 1 =
Kitchen sink 1 x 1.5 = I ,S" x 1.5 =
Laundry sink x 1.5 = x 1.5 =
Lavatory(bathroom sink) 2 x 1 = '2— I x 1 =
Water closet,1.6 GPF(toilet) -2— x 2.5 = V x 2.5 =
Bathtub/whirlpool x 4 = x 4 =
Shower stall I x 2 = "Z I x 2 = 7-
Bath/shower combo I x 4 = If — I x 4 = — ti
Current Points: 23.C Proposed Increase/L " I
irec . S/8
Current Points+Proposed Increase= ell.
3 =New Total Points =Required Meter Size
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: cle Cost: $ (see page 1)
Current Meter Sizeper UtilityBilling: .57 Cost: $ U
(see page 1)
New Meter Size Cost minus Current Meter Size Cost= $ cD
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
*************************************************************************************
FOR OFFICE USE ONLY Meter size will not need to be increased.
J
Current Meter Size Confirmed with UB Bentley 09/19/2022
Signature of UB Representative Date
1:/Building/Forms/WaterMeters_070121,Add.dOCX Page 2