Permit MASTER PERMIT
CITY OF TIGARD
I COMMUNITY DEVELOPMENT Permit#: MST2023-00307
TIGA.R[) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2023
Parcel: 2S109DD08900
Jurisdiction: Tigard
Site address: 12703 SW DA VINCI LN
Subdivision: BELLA VISTA Lot: 19
Project: GULATI
Project Description: Interior remodel and part garage conversion.Adding 1 Bdrm, 1 bath,and a kitchen. WATER METER
UPSIZE REQUIRED.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 1 First: 0 sf Basement: 419 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Yes
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 419 sf Value: $70,128.03 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 15 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Bckfw Prevntr: 0
Drywall-Trench Drain: 0 Other Fixtures: 1
Other Fixture Units: Water Piping/DWV
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 1 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 1
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 5
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr Occupancy Group: Square Feet:
ALT SF V I3 R-3 419
Owner: Contractor:
GULATI,AKANKSHA MORALES CONSTRUCTION LLC Required Items and Reports(Conditions)
RAI,AMRITESH 5500 SW 180TH AVE APT 29
12703 SW DA VINCI LN BEAVERTIB,OR 97078
TIGARD,OR 97224
PHONE: PHONE: 971-297-4381
FAX:
Total Fees: $3,705.80
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
OS9_nnt-M1n/hrnunh nap oc9-nni..nnon Vnii m fain a rnrnr offha ndne nr dinar/mmefinne fn flu IAIC by rollinn Sill 9191 7 nr 1 Ann'11.9 flAA
Issued By: -/ ��--- Permittee Signature:
a 3.639.4175 by 7:00 a.m.for the next available inspection d .
Thls permit card shall be kept in a conspicuous place on the job site until comp etion of the project.
Approved plans are required on the lob site at the time of each inspection.
s
Building Permit Application
' Residential RECEIVED
d ve iRece FOR orFlcrusEONLY
City of Tigard • DateB Peanut No.
74 i • 13125 SW Hall Blvd.,Tigard,OR 97223 q q PlanRevie-7�j��j9-� �s� „xi._
-�' ��
Phone: 503.718.2439 Fax: 503.598.1960.1�U I- 2�23 Date/By: `d `7 Other Permit:
5
_� I(;A,,t t,D Inspection Line: 503.639.4175 Date Ready/By: raris. PI See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method:if ie _ 3?j,,', ) '.G. Supplemental Information
BULDING DIVISION_ 'F-M.4i e &44r?c
TYPE OF W REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
/ Indicate the value(rounded to the nearest dollar)of all
E Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. "70 (ZS, O
1,11 0 1-and 2-family dwelling IDCommercial/industrial Valuation: $
' - 0 Accessory building ulti-family Number of bedrooms: -�- ,
❑Master builder 0 Other: Number of bathrooms: -4-
JOB SITE INFORMATION AND LOCATION Total number of floors:
CI-
Job site address: I pl..•403 Sub Da, \in 6 ( n New dwelling area: 9 'of square feet
Q., City/State/ZIP:Tj9ar J I 012„ 4.71 2 2,ti Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: GU L41 x-.. .S j j . Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
o6.y,41e L J4rc/' erk,r,. yl irs aut r,y( 7/>T/y,3�; Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I 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.
¢.1 eg:AO I.f1(71 1 ✓' tLCGPit� 2jl7r.-1 -vooM 1 i_ �xTry� Valuation: $
1. 44-t9 t� _\�� 1 06Q ` " _ O. a p tl l ��n Existing building area: square feet
J�LP t 'Tt�G q CL. P� hk�'t_.
bn 1 k� B0r� COr .? - , ,9 �i hik f v 5i�c hew building area: square feet
t PROPERTY OWNER �/�„7�3❑ TENANT N(Q�1fC umber ofstories:
OName: A t�n k 5�(,fa r..S 0 fI k I �� Type of construction:
Address: '17b3 C� R7:12211
`a Vinci �(\ Occupancy groups:
tCity/State/ZIP: 7"rl^,-.,fp� i 0� Existing:
Phone:(737 an 2- 0O„Z� Fax:( ) New:
El APPLICANT C.•°`- 0 CONTACT PERSON BUILDING PERMIT FEES*
(PleasBusiness name: /1. q/ (4w 46.rna;1,,,- s j{Az u� viewere((orr depe osit):schedule)
•IrSJ�'tsF'J :j��w-i• Structural plan review fee(or deposit):
t. Contact name: // // �r "uati
GS+�7 FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fax::( )
E-mail: reto catt?S co( A CTTt Q qrc' t 1.�QV Amount received:
A PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
J Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: riAPS �CA(IJG-k-tc r �� Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
v Address: St) tg� Ave, G Solar Installation Specialty Code checklist.
p _ �]l�n t D rr) �?/ i y C� Permit Fee(includes plan review
City/State/ZIP: 1�f'(�]l P� -!lJ l CJ $180.00
,J and administrative fees):
Phone:Icl) �'13�y Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:2 3/v?C) Total fee due upon application: $201.60
Authorized signature: ,� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1'n L p,," ^1 V I�SH a L j LP-ril Date: 6 /3 p/'� *Fee methodology set by Tri-County Building Industry
t ( r Service Board.
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
11111 + 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
' Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
- 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing ❑ Mechanical
I.U
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 'cs No NI'
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 0
3 Verification of approved plat/lot. 0 ❑ 0
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. ❑ 0 ❑
7 Water district approval. ❑ 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 0
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑
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 ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ 0 ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
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 ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑ 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ 0 0
architect licensed in Ore•on and shall be shown to be al,licable to the ,ro'ect under review.
.HJRISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x ll"or 11"x 17". ❑ 0 0
24 Two(2)sets each are required for Items 16,19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ 0
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ []
Street Tree List.
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.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9,1995.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 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:\Building\Permits\MEC_Pem'ritApp_040113.doc 2
Electrical Permit Application RECEIVE' FOR OFFICE USE ONLY ct�
City
Of Tigardhl ‘calved
DateB : Permit#: a -rVV
11 • 13125 SW Hall Blvd.,Tigard,OR 97223 JUL 5 2023 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
1`i 1 Inspection Line: 503.639.4175 Ready Date/By: kris_ GI See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notifed/Method: Supplemental Information
TYPE OF WORIB IM VI O, ; PLAN REVIEW
❑New construction I Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
ElService or feeder 400 amps or more CI Building over three stories
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
Multi-family 0 Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
-JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
.� C)n El Addition of new motor load of system.
Job#: Job site address: t Z- CJ 6uJ C jtvc\ � 100HP or more. ❑"A","E','l-2^,'l-s , •
City/State/ZIP: Tk ctsa, C) 0, ` t I z2� 0 Six or more residential units. occupancy. i
o Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 'a ❑Hazardous locations. 0 Supply voltage for more than
Cz v�« �� P m ❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: TEE SCHEDULE
Description I Qty. I Each 1. Total r
New residential single-or multi-family dwelling unit. 1
Subdivision: Lot#: Includes attached garage.
1,000 sq.R.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92 1
y, � DESCRIPTION OFWORK Limited energy,residential 75.00 2
�G 1 ko e.leGkrtro, 10 `I' \DC%d,t,30 ON / 1 RCI:EL1 (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: QKa,r,% ��a C0\a11 200 amps or less .2 100.70 2
Address: 2`1(7 7 G Da_ \J L�c.i I 201 amps to 400 amps • 133.56 2
"Y Y 0 CO �j.�v- 401 amps to 1,600 amps 200.341 2
City/State/ZIP: T Q C 601 amps to 1,000 amps - 301.04 2
Phone: 5 (2) -ZA CS Fax:( ) Over 1,000 amps or vohs 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
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,le e, r exc ange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: _ Date: b j w)! L 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—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
service or feeder fee,first
Address: branch circuit l 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder no included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy 0 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) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed(7:hr min)
. ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
n f 7 This permit application expires If a permit is not obtained within 180
Print name: /"rl•C��N Ks-HA— et VLF / f Date: 6j/`�0/2-3 days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:lnuildingtPermits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015 440.4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
combined: $75.00 Description Qty. I Each Tidal I
•
Fee for all residential systems Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66 25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed CO hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: S75.00 • 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 Alann Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Pttmits\ELC_PemMApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information " - ,
Residential Fire Sup i ression S stems:
Fee Schedule: »
Footing drain-l"100' 50.03 O to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 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 S stems:
37.52 l" y ..1 a 1
Water Service-each additional 100' ����I�r,g t�'") k e';IY,.5,5.J'L� �� > < _ � *
Storm&Ram Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001 00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
i.` 3y ''w° a* c tips 3'C3t`� `at i;: each additional$100.00 or fraction thereof,to
, z,� i r t t ,t r,s°, ' a a e',.1 ' , and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
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*
. r ,*"Waijij 4.itT71; 1r t js., e 1` :fir'- ll, ;✓ c Tg:a.
.r, ;`* ,,,; 1C'sgt7'entttyp,Fatledy,pej 1 Plan review is required for any of the following.
f 9_ 0 -' a `''" �# sf e012 Please check all that apply.
iViiil ea'frfor net- r P it4� .s
��'orMPerfor�ied,V .t , ,; ;:.' r;.ca jied,- cn,,s .;� xe,lpcahn ❑ 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 0 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 0 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" ; r=r;
' ` � %N`r 'Y0,F t1S S. 'r a ' 'rP' i_s `:.
a" ❑ 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(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 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:1Building\PermitsWPLMF_PermitApp.doc 08/04/2011 2
City of Tigard
III COMMUNITY DEVELOPMENT DEPARTMENT
Ix
Building Permit Review - Residential
TIGARD
e we .. Atimmoi
Building Permit #: /S7--t ?-3 — 00307
Site Address: 12403 SW DA VIf1Ct LkJ er field in Accela
Project Name: C9UL-AT Lot/Unit #:
Proposal: 7 (1JeQ4- QJO:nIf OAF (p�l e-ID o oine: S "C
'/ 1 Pr A IDCIA M Ur)i r• inrb)t rcia LrrArl�'►S cu. n
Housing Type: (0
Single Single Detached ❑ Duplex❑Triplex ADU) 0 Rowhouse ❑Cottage Cluster 0 CYU ❑Quad❑ ther Q/3Tt1
Required Site Plan Elements:
0 3 copies of site plan on max 11x17"
c'U n to standard scale R ction
h arrow site rees s own a eled
�S' address, project name, lot # rity
p'S et names (N/A for SFR) ���
t name and phone # coned (if applicable)
and setback dimensions 1efarteetrixrrrgie-- lA
Existing structures &square footage tility locations &easements
ire,. siru-cfu`re and t`FE 22 P i ALL irT 0A
idewalk/driveway dimensioned u -ro -7'.
r 'at '"" ' '^* yea * e Ja-Er•csion controf-----
S' •R.
ired Elevation Plan Elements:
(For SF . r s,u ed only on street-facing) Summary table with calculations for:
rawn to standar s ❑ Total facade area
❑ Building height dimensioned ❑ Total window and door area
❑ F de dimensioned
Ire
and doors dimensioned
❑ Garage doors dimensioned
Floor Plan Elements:
(Not require o ❑ Summary table that includes
❑ Each story dimensioned Total floor area
❑ Each story floor area calculated 0 Floor a ry
Planning Review
The following standards have heen non).
Setbacks El Front: Rear: in ax Street Side: / Garge:
Height . eight: Proposed Height:
❑ Yes N/A Landscape
❑ Yes N/A Screening (Quad only)
❑ Yes N/A % Window Coverage
❑ Yes N/A Garage (SFR Only) Parking (Other Res)
❑ Yes N/A Entrance (SFR, Rowhouse, Quad only)
❑ Yes N/A Other building design standards (Rowhouse only)
❑ Yes N/A Accessory Structure Standards
❑ Yes No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
❑ Yes N/A Unit Count:
❑ Yes N/A Lot Width and Size
❑ Yes N/A Pathway
Additional standards for Courtyard Units and Cottage Clusters only:
❑ Yes 0 N/A Unit Area:
❑ Yes 0 N/A Floor Area (per story)
❑ Yes 0 N/A Courtyard
0 Yes li N/A Fence
❑ Yes I ]N/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes No ❑N/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes ❑ NNoo-stop intake
ensitive Lands: ❑ Yes 'No
0` Main Land Use Case #s: ❑ Conditions met
t" Ai Applicant notified of land use expiration da
Approved By Planning: Date: 715-4-
Notes 'Rope° NQRr IS Al` IY)T -I ; incEiic fAl:nncN wFlU,S, V I .Go,1Vieer FAO- of Ga11QA-c 'a p�u `/
Revision 1: ❑ Approved ❑ Not Approved Date: alias �Pn
Revision 2: ❑ Approved ❑ Not Approved Date: 4
Building Permit Submittal i? c
Original Submittal Date: 1 (An nOOW
� �ep puitt
Site Plans #:
Building Plans #: ncc Pc or)
Building Permit #: V/13uilding permit # entered on page 1 �Cg�e_
Workflow Routing: VPlanning ❑ Engineering lermit Coordinator QYuilding ,��ceq
Workflow Sign-off: @/Sign-off for Planning (include notes from planning review) Yr"
Route Documents: ❑ Engineering: (1) copy of permit application, (1) site plan, (1) building plan 0pF"'" '
and origihal plan review routing form. Aof A
uilding: original permit application, site plans, building plans, engineer and __n, n�
beam calculations and trust details, if applicable, etc. vnl(
Permit Technician: IP� A-J Date: 1I1011,191/3
Notes:
Engineering Review
❑ PFI Permit:
❑ Slope at building pad: 0/0
❑ Conditions met prior to issuance of permit
❑ Easements (encroachments) per engineering con.' .ns of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in- '-.: ❑ Yes ❑ No
Assess Water Quantity F, in-lieu: ❑ Yes ❑ No
LIDA Facility on lot' ❑ Yes ❑ No Add Fee: ❑ Yes ❑ No
❑ Final Plat Recorded
❑ NOT Approved' Date:
Notes:
Approv- • By Engineering: Date:
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved _ Date:
',r it Coordinator Review
�'!�.nditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
-DC Exemption: ❑ Applied for ❑ Received kl,Does not apply \ Zik
a ! &A) i- -•
1 DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A 0 Deferred n) 5
Parks SDC: ❑ Yes N/A 0 Deferred
LIDA ❑ Yes ii `N!/� —�1 n,�,2
K to Issue/Approved by Permit Coordinator: � ',\�Yl� Date: 1' `\- 2 7Z J
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Water Meter Fixture Unit Worksheet for Additions/RemodgS9A `ABED
AUG 8 2023
Please complete the following information:—,Customer Name: KO f'X51'YJt 6kk-\ UD l B nIN( 17
1VISION
Service Address: Street/Suite#: ( 9 1O 3 S i Qa\t Act L h
City:-InNr�) State: 0 Zip: Qr/2-2-11
Phone Number: tS 16 313- 28°5 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 — I ' x 1
Clothes washer "'- x 4 = "7 mil. x 1.5 =
Dishwasher 4/ x 1.5 = 1.5-
1.5
13`Outside Water Spigot 1 x 2.5 = a._5'
x 2.5 =
Water Spigot,each add'l x 1 — x l
Kitchen sink . x 1.5 = I.5 1, x 1.5 = 1 ,5
Laundry sink .1-- x 1.5 = ,5 x 1.5 =
Lavatory(bathroom sink) let b X I = 6 I x 1 =
Water closet,1.6 GPF(toilet) 7-UT x 2.5 = (,I/ '� x 2.5 = 2,5
Bathtub/whirlpool 1 x 4 = x 4
Shower stall .1.--2 x 2 = 2 ,y x 2 =
Bath/shower combo x 4 = 2 2 x 4 =
Current Points: Z� Proposed Increase: )'� *5
_tit
Current Points+Proposed Increase= 455 =New Total Points =Required Meter Size
Meter Sizes: l to 30 points=5/8" 30.5 to 37 points=V." 37.5 and over points= 1"
New Meter Size Needed for New Total Points: 1 Cost: $ ►,3 (see page 1) C‘i p*6
Current Meter Size per Utility Billing: 3 Cost: $ 11
, (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $ ) S t9 k'
crD
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
*************************************************************************************
FOR OFFICE USE ONLY
- 141
Current Meter Size Confirmed with U if/! Z)
Sig ature of UB Representative Date
_ -- ---- Page 2
I:/Building/Forms/WaterMeters_070121 Add.docx
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
"` Water Meter Fixture Unit Worksheet
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. ubonlinepayna,tigard-or.gov
Tigard, OR 97223 to discuss sending documents and payment
METER: SIZE: FEE: Pricing effective 07/01/2022
5/8" $11,258.00 Fee includes:
3/4" $16.094.00 water system development charge,
1" $29,588.00 water meter, and
1-1/2" $87,787.00 meter installation fee.
2" $142,227.00
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:/Building/Forms/WaterMeters_070121 Add.dOCX Page 1
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)LngeMot,��
submit this statement. This statement will be filed with the permit. RCGG V
Please check the appropriate box: AUG 3 1 2023
/ CITY OF TIGARD
I own, reside in, or will reside in the completed structure and my general contractjlING DIVISION
1 p�rr�.�e5 Cans-kod-jam LC.0 23G,s.7O Zc)Z/i
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
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.
A a v\Yx,5 )-\a GAO lc -1-I
Print Name of Permit Applicant
gPZ//2 ;
Signature of Per ' scant Date
Permit#: 11,17- v/��` C3.77 F .
Address: 0-7)3 fl....i g t, / v _ :f 1 0
y �5
Issued by: 6 / - Date: `3i Ji3 .
This Copy for Permit Offices