Permit CITY OF TIGARD MASTER PERMITf
r ,. COMMUNITY DEVELOPMENT Permit#: MST2023-00141
Date Issued: 08/16/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 28104AA00900
Jurisdiction: Tigard
Site address: 12500 SW BELL CT
Subdivision: BELLWOOD Lot: 58
Project: Samson Remodel
Project Description: Enclosing laundry room,adding(1)bathroom,moving bedroom entry,removing non-bearing wall in
dining room, and returning garage door to original size.Trade permits to be pulled separately.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: First 87 sf Basement: sf Left: Parking Spaces:
Height: Bathrooms: 1 Second: sf Garage: sf Front: Smoke Yes
Dwelling Units: Third: sf Right: Detectors:
Total: 87 sf Value: 590,000.00 Rear:
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Urinals:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Drains: Storm Sewer:
Tubs/Showers: Garbage Disp: Water Heaters: Water Lines: Catch Basins:
Footing Drain: Ice Maker: Hose Bib: Backwater Value:
Bckflw Prevntr:
Other Fixtures:
Drywall-Trench Drain:
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers:
Heat Pump: N Hoods: Other Units:
Furn<100K: Vents: Woodstoves: Gas Outlets:
Furn>=100K:
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0-200 amp: 0-200 amp: W/Svc or Fdr:
Ea add!500 sf: 201-400 amp: 201-400 amp: W/O Svc/Fdr:
Mfd Home/Feeder/Svc: 401-600 amp: 401-600 amp:
601-1000 amp: 601+amp-1000v:
1000+amp/volt:
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 VS R-3 87
Owner: Contractor:
SAMSON CONSULTING LLC SAMSON CONSTRUCTION Required Items and Reports(Conditions)
PO BOX 23966 PO BOX 23966
PORTLAND,OR 97281 PORTLAND,OR 97281
PHONE: PHONE: 503-840-7088
FAX:
Total Fees: $2,886.97
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cod:O- alll er a.: ..ble law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of is or I wo suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification - - Tho r are set forth in OAR
o59-nn1-nnln Mrnunh Q59-nn1-nnon V Main a',row nf+ho n,lpc nr'limn n„ncrnne+n nl 1MC hu raninn Sill 9n9 I 117 . •.b 0 `.A
Issued By: t r l( Permittee Signature:"------------._
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONL �/City of Tigard p tee/Oed h./ ,? .j 1 M _ ?"U�/
;�i 4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review i J` n 2 ��eri`
Phone: 503.718.2439 Fax: 503.598.1944AR 1 3 2023 Date/By: �Or l �/7 Other Permit:
tic \ ,i, Inspection Line: 503.63.4175 Date Ready/By: 1 I kris: 1 H See Page 2 for
Internet: wwwtig and-or. ov Notified/Method: !1 O Supplemental Information
CITY OF TIGARD
DING DIVISION `Q J
TYPE OF REQUIltED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
g[Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
xl-and 2-famil y dwellin Valuation: S CAO �(
g ❑CommerciaUindustrial /`
❑Accessory building El Multi-familyNumber of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: t 25 '(.4...) Set.1 A New dwelling area: s 7 square feet
City/State/ZIP: Ticlara )10Q 9`t ZZ 3 Garage/carport area: square feet
Suite/bldg./apt.no.: / Project name: ',l` oic Covered porch area: square feet
�
Cross street/directions
ns to job it SC
site: A.)
' ' k area: square feet
s . t) �Q `` te/ IZ1��AVE' / Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: \` AJ 071=6 Lot no.:SS Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
1 DESCRIPTION OF WORK 1 work indicated on this application.
CtnC�GSE''dff I�Llt^ ,(y CC9fJf]M FC�^t^� +cla CI4'� VIA. Valuation: $
2 lid �A1.tAc:'.0(9� �0 (�klShrH? S9 i • r/ In`ved frT�p Existing building area: square feet
(�.t1�� I3;z 7.1�3 (�t'atio fr 11 pec fl,1,[fit`I i tt rt,hall,(�Si2Ci• v, New building area: square feet
t"' PROPERTY OWNER ❑ TENANTS \o ovv1441 Number of stories:
Name:' fie' n COO--. / r 1,1.9 512,e' Type of construction:
Address: L- ' r'L Occupancy groups:
City/State/ZIP: -1c b _ iI e�fy.—"'.4y Existing:
Phone:( ) Fax:( ) New:
11:1 APPLICANT /0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: S� 0ol»ga!i/h 9 reviewPlease:e(or rofeposite ): [J
Structural plan fee deposit):
Contact name: ...Sesejoid„..)4 ®r'uet 45
FLS plan review fee(if applicable):
Address: PQ oy Gloc
ty ,,,..4`1 i Q� 17 z 8, / Total fees due upon application:
City/State/ZIP:/State/ZIP: O ! l
Phone:(CO? glob_70 S g Fax::( ) Amount received:
E-mail ,� %r �N «S 14/4K f , C 6/a7 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photovoltaic Solar Panel System.
Business name: Sarsis516., n 5Li vC.l•#'064 Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: ePO to< 2396 Solar Installation Speciahry Code checklist.
City/State/ZIP: t�c�c*�, 7Z8 to A e 9 t Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(505��..��:r y,' Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 2 Total fee due upon application: $201.60
Authorized signatu "7".......„= This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: , dr"e IG s' Date: 9•�Z]2 *Fee methodology set by Tri-County Building Industry
31� Service Board.
l:\Building\Permits\BUP-RE PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONI.I
City of Tigard ReceivedPermit No:
1111 ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
11 Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
7 1 G.4 F.D Internet: www.tigard-or.gov 0 Other.
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW V es No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 ❑
4 Fire district approval required. Name of district: 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 ❑ 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ 0 ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 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 0 0
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 engineer or ❑ 0 0
architect licensed in Ore_on and shall be shown to be applicable to the ,ro'ect 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". 0 0 0
24 Two(2)sets each are required for Items 16,19,20 and 22 above. 0 ❑ 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 ❑ 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 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.
l:\Building1Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
11 . " COMMUNITY DEVELOPMENT DEPARTMENT
• Building Permit Review - Residential
TIGARD''
Building Permit #: y' rST 2o2 - oc) I 9
Site Address: (b COD �� / e�,,U"' erified in Accela
Project Name: ' AMSvl•-1 Lot/Unit #: f
Proposal: (j4 - AL1- l 1k)s 'fD 1 XMia SINble tx1) e0 zone•• F1nu-S- 0l'J W ioQ- At•+ win1)2%fi AO1,rp non-srgatr-Fauu LH •,sii'C
Housing Type: ,F SFR( Single Detached ❑ Duplex❑ Triplex❑ ADU) ❑ Rowhouse❑Cottage Cluster❑ CYU OQuad❑Other
Required Site Plan Elements:
❑ opies of site plan on max 11x17"
❑ n rawn to standard scale ❑ Retained trees, drip line/ tree protectio. �
❑ No • arrow CIn�
Street and site trees shown / label-: Oa I
❑ Site a.• ess, project name, lot # ❑ Table calculating tree canopy - aturityYL(uYZ-
❑ Street na - (N/A for SFR)
O Applicant na - and phone # CI Courtyard rectangle d ensioned (if applicable) "1/llti0
❑ Lot and setback .'. ensions ElVision clearance ••ngle Nol oo
❑ Existing structures : quare footage ❑ Utility locati.- & easements
❑ Footprint of new structu - and FFE ❑ Propert orner elevations
❑ Sidewalk/driveway dimensi. ed ❑ LIP : (>1,000 sf disturbance)
❑ Lot area and lot coverage per -ntage % rosion control /}i�1 (,Jr- rti O�
r Required Elevation Plan Elements: L--" SY) S It
tN• e 9(p
(For SFR: calcs needed only on street-fa ' • Summary table with calculations for: S,,,,,Lc 9
❑ Drawn to standard scale CI Total facade area
CI �Gl�
Building height dimensione. • Total window and door area 'bra -
❑ Facade dimensioned
❑ Windows and doors .' ensioned
❑ Garage doors di - sioned
Required Floor • an Elements: _ ff
(Not require. ".r SFR) CI Summary Summary table •at includes ' s'r- IGNb
O Eac• story dimensioned 0 Total floor area w/1 p DYE oe Picf2S'
❑ •-ch story floor area calculated ❑ Floor area per story /4P` b
Pla ping Review
The following standardsl have been met: JI..— / /
Setbacks ❑ Front: I r(Rear: (5 'Side: S ,(M�iin/Max Street Side: / / Garage: !w
Height 0 Max. Height: 50 Proposed Height: NA-
❑ Yes N/A Landscape I
0 Yes N/A Screening (Quad only)
0 Yes N/A To 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
O Yes No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
0 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 1611 N/A Unit Area:
❑ Yes Gil N/A Floor Area (per story)
❑ Yes ip N/A Courtyard
O Yes N/A Fence
❑ Yes ❑ No pi Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ No /A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes ❑ ,, stop intake
Sensitive Lands: ❑ Yes 'No
❑ Main Land Use Case #s: ❑ Conditions met
❑Applicant notified of land use expiration d
Approved By PIa•+•+�ng: Date: (D/jy/13
Notes vrik: An° iounix2 6 AODtzo EAOVubY1 Sta-QLT FAe1Yub StOe 6F 1tbv%Yi
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date:
Site Plans #:
Building Plans #:
Building Permit #: ❑ Building permit # entered on page 1
Workflow Routing: ❑ Planning ❑ Engineering ❑ Permit Coordinator ❑ 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:
Notes:
Engineering Review
❑ Pr it:
❑ Slope at b =".• pad:
❑ Conditions met pn. • issuance of permit
❑ Easements (encroachment- •-r engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu. ■ Yes ❑ •
Assess Water Quantity Fee in-lieu: ❑ Yes IN No
LIDA Facility on lot: P -s • •• Add Fee: ❑ Yes ❑ No
❑ Final Plat Recorded
❑ NOT Approved: • : -
Notes:
Approv- - :y Engineering: Date:
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
Permit Coordinator Review
❑ Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
❑ SDC Exemption: ❑ Applied for ❑ Received ❑ Does not apply
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A ❑ Deferred
Parks SDC: ❑ Yes ❑ N/A ❑ Deferred
LIDA ❑ Yes ❑ N/A
❑ OK to Issue/Approved by Permit Coordinator: Date:
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Water Meter Fixture Unit Worksheet for Additions/Remodels/AD Us
Please complete the following information: IvIAe 13 tuz3
Customer Name: ,e_s-2uV1.\-f o nA does CITY OF TIGARD
Service Address: Street/Suite#: l 2 D 'SW -ale,ll CA BUILDING DIVISION
City: `ft 94 r a State: Qee•% Zip:q - 2Z 3
Phone Number: 503-Q¢10768Qj Email:jeso. y €_.3�Glw) O/,,,..$ )H 9.. CO',
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 l =
Bidet x 1 = x 1
Clothes washer I x 4 =__4_ x 4 =
Dishwasher ( x 1.5 = (,5 x 1.5 =
Pt Outside Water Spigot I x 2.5 = 1 ,S x 2.5 =
Water Spigot,each add'I ( x 1 = ( x 1 =
Kitchen sink 1 x 1.5 = ',S x 1.5 =
Laundry sink x 1.5 = x 1.5 =
Lavatory(bathroom sink) 1 x 1 = f I x 1 = j
Water closet,1.6 GPF(toilet) 1 x 2.5 = -L.S i x 2.5 = z .S
Bathtub/whirlpool x 4 = x 4 =
Shower stall I x 2 = - , x 2 =
Bath/shower combo I x 4 = L( l x 4 = 11
Current Points: 1.0 Proposed Increase: -3.
Current Points+Proposed Increase= " 3- New Total Points =Required Meter Size s7$
Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points ='/d' 37.5 and over points= 1"
New Meter Size Needed for New Total Points: Cost: $ (see page 1)
Current Meter Size per Utility Billing: Cost: $ (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
FOR OFFICE USE ONLY �,/
Current Meter Size Confirmed with UB O' v'f t o lqi3
Signature of ; •epresentative Date `
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Water Meter Fixture Unit Worksheet
1111
P 11 For Additions /Remodels /ADUs
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
LOCATION: City of Tigard—City Hall WATER METER SALES:
Utility Billing By Email Only. Please contact
13125 SW Hall Blvd. ubonlinepay(a,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.
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