HomeMy WebLinkAboutPermit (5) I� CITY OF TIGARD MASTER PERMIT
F COMMUNITY DEVELOPMENT Permit MST2023-00120
Date Issued: 05/08/2023
T[G,ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111BB01600
Jurisdiction: Tigard
Site address: 14165 SW 103RD AVE
Subdivision: TIGARDVILLE HEIGHTS Lot: 1
Project: Cox
Project Description: 206 sq.ft. kitchen relocation/addition. Electrical under ELC2023-00011.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: First: 206 sf Basement: sf Left: 5 Parking Spaces:
Height: 11 Bathrooms: Second: sf Garage: sf Front: 15 Smoke
No
Dwelling Units: 0 Third: sf Right: 5 Detectors:
Total: 206 sf Value: $31,079.22 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
Heat Pump: N Hoods: 1 Other Units: 1
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0-200 amp: 0-200 amp: W/Svc or Fdr:
Ea add'I 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:
ADD SF VB R-3 206
Owner: Contractor:
COX,CALEB E&CATHERINE OWNER Required Items and Reports(Conditions)
14165 SW 103RD AVE
TIGARD,OR 97224
PHONE: PHONE:
FAX:
Total Fees: $1,552.60
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
::::;:"
thrniinhflR -nnl-Mon n rn Mainn fthndnr t nnactinnc fn fll me.hu Tallinn Permittee Signature: C I/���
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. L
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.
* Buildin Permit A licatio
Residential mum FICI. I F 0\1.1'
Received � �
City of Tigard 2023 , -1. , , J
u 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1Q6¢r OF TIGARD DateB : ��-A� _ '''
c, u n Inspection Line: 503.639.4175 BUILDING D.r R R . •B Jaris_ 0 See Page 4 for
I
Internet: www.tigard-or.goviB�iOI� Notified/Method: 5I1 i a l . Supplemental Information
tMRtLED CNL;R
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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:0 equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. 3 t 011 22
❑� 1-and 2-family dwelling 0 Commercial/industrial
�.Qg pig Valuation: '
❑Accessory building ❑Multi-family Number of bedrooms: 0
❑Master builder 0 Other: Number of bathrooms: 0
JOB SITE INFORMATION AND LOCATION Total number of floors: 0
Job site address:14165 SW 103rd Ave New dwelling area: 206 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 0 square feet
Suite/bldg./apt.no.: Project name:14165 Addition Covered porch area: 0 square feet
Cross street/directions to job site: Deck area: 0 square feet
Located on a flag lot down at the end of a gravel driveway on the right Other structure area: 0 square feet
hand side REQUIRED DATA:COMMERCIAL-USE t;I.il!,CKLIST
Subdivision:Tigardville Heights Lot no.:1600 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S111 B601600 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.
Constructing a 206 sq. ft. kitchen addition on the front of my Valuation: $
house. Exterior const. in 2023, interior const. in 2024. Owner to Existing building area: square feet
perform all work New building area: square feet
l� PROPERTY OWNER 0 TENANT v Number of stories:
Name:Caleb Cox Zlz e fri Iva ( WUea_ Lt p1,Ar Type of construction:
Address:14165 SW 103rd Ave 6,p4 _ fir/l4y/f-- Occupancy groups:
City/State/ZIP:Tigard,OR 97224 e CCU aC)o(1 Existing:
Phone:( 503 ) 953-5526 Fax:( ) New:
a APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:N/A (Please refer to fee schedul
Structural plan review fee(or deposit):
Contact name:Caleb Cox
FLS plan review fee(if applicable):
Address:14165 SW 103rd Ave
Total fees due upon application:
City/State/ZIP:Tigard,OR 97224
Amount received:
Phone:( 503 )953-5526 Fax::( )
E-mail:calebcox51@gmail.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:pHf{' �A, / Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: � Total fee due upon application: $201.60
Authorized signature: Zii jC " � This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Caleb Cox Date:
f 41/202,3 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USU. ON 11
City of Tigard Received
Permit No.:M ft.
^ •
, i II 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: ( L ` I
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
1 1 c 1 K D 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing El Mechanical
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW v es No v/-'
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. I t
3 Verification of approved plat/lot. n
4 Fire district approval required. Name of district: n
5 Septic system permit or authorization for remodel. Existing system capacity . I- n
6 Sewer permit.
7 Water district approval. n n n
8 Soils report. Must carry original applicable stamp and signature on file or with application. n n n
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ El �✓
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state p✓ 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 U U U
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, 12 ❑ •
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✓
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. Q✓
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- p✓ 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 ❑✓ 0 121
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered El 0 CI
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. • ✓
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 i
Q✓
architect licensed in Ore Ion and shall be shown to be applicable to the .ro'ect under review.
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✓lin
•
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. I
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted.
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. n n n
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 B El El
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, p✓ ❑ ❑
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:\Building\Permits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOx OFF1cL t°sE()NI.)()NI.)CIIIl Tigard 11 and Received
g Date/By: Permit No.: t - I I
g 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1
Phone: 503.718.2439
Date/By: Other Permit
T'I 0 Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE*SCHEDULE—USE CHECKLIST
0 New construction ®Addition/alteration/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.
CATEGORY OF CONSTRUCTION Value:$
ISI-and 2-family dwelling ElCommercial/industrial ElAccessory building BESB'ENTI
`O EQITIPiMIE1VT 1 SYSTEMS FEES*
For special information use checklist
❑Multi-family 0 Master builder 0 Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 19165 t,/ Jo 3:-n( L Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: I I\q�,raii 0 R, 7?211 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.:U Project name: I Li/6 ihifo,1 Heat pump 4 61.06
! Duct work 23.32
Cross street/directions to job site: 1! 1c 4,-` eva Hydronic hot water system 23.32
� left r1 Cy'v y D v1 n j 1— Residential boiler(radiator or
hydronic) 23.32
t Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
1TS �G � t// l'4e L Lot no.: /600 Other: 23.32
r
Tax map/parcel no.: 2,5 I 116 6 d ‘ Other fuel appliances:
Water heater 23.32
D ON.QF WORK Gas fireplace/insert 33.39
Z/6 --(- 1<: 11 11 Gam0 vt)Iit vYj ' Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
fig PROPERTY OWNER t3 TENANT Other: 23.32
Name: 6.-- 1+f/'t, W K Environmental exhaust and ventilation:
I / g - Range hood/other kitchen I
Address: )vl J 16 5 V,✓ )03 , , -v equipment 33.39
(� , LZ� Single-duct exhaust Clothes dryer exhaust 33.39
�iB
City/State/ZIP: 7 (bathrooms,
Phone:(t )3) 5 3 :J 5�L Fax:( ) toilet compartments,utility rooms) 23.32
Attic/crawlspace fans 23.32
03 APPLICANT x ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: 31'✓vt� ,a-5 Gt Lcy vL Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) Fax::( )
Fireplace
E-mail: Range
CONTRACTOR Barbecue
e/LA Clothes dryer(gas)
Business name: /YT�'T a(vi, rr Other:
Address: MECHANICAL PERMIT FEES*
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.:
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name: Cu 1L4 i,x Date: 9/5 l 03
I:\Building\Permits\MEC_PetmitApp_082520.doc 440-4617T(11/02/COM/W EB)
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information
Commercial Submittal Requirements:
• (2) sets of plans, drawn to scale.
• (2) sets of equipment cut sheets.
• (2) copies of site plan for ground and roof top equipment
location and screening per Tigard development code.
Commercial& Multi-Family Fee Schedule:
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 $100.00 or
fraction thereof.
I:\Building\Permits\MEC_PermitAPP_082520.doc 2
Plumbing Permit Application
Building Fixtures i oiz Orric'I: I si: ONI.l
Cityof Tigard Received MI 1. 13 V1.0
li ll Date/By:n Permit No.: rr`` n
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review V �"
I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A K 1) Inspection Line: 503.639.4175 Date Read/B Juris: ® See Page 2 for
Internet: www.tigard-or.gov y o'
Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
t]Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
13 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: j { 11,5 . 1,✓ t73 r.` ,J Catch basin or area drain 18.76
v�
City/State/ZIP: t Li
Drywell,leach line,or trench drain 18.76
/ �� 7�Z J Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 1 1 1 b w Manufactured home utilities 50.03
Cross street/directions to job site: 1'`Ce 1ci- A.I. I Manholes 18.76
oil ,,, yy( 4 1 v t (1 U Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
j , Water service(no.linear ft.: ) Page 2
Subdivision: T l`(.„t, V, le. lei ,� Lot no.:i(>Ol. Fixture or item:
Tax map/parcel no::L I I IS B 911,00 Backflow preventer 31.27
•
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
/70(2 -(- 1<,-{zNL.,s. J 'Vg / I Dishwasher 1 25.02
/t'V(-L"i--. .?('U le.$ C.4.1/y. 'Vat �( � Drinking fountain 25.02
35� ('CS i v J� Ejectors/sump 25.02
bzi PROPERTY OWNER ❑ TENANT" Expansion tank 12.51
Name: 6v IA (2 jib Fixture/sewer cap 25.02
Address: <LI l G 5 •4/ 103 r� Ave_ Floor drain/floor sink/hub 25.02
Garbage disposal j 25.02
City/State/ZIP: Ti4Arrii 0)2, ei'71 jam' Hose bib 25.02
Phone: t
(�ji��) ��� - 5�1., Fax:( ) Ice maker 12.51
rig APPLICANT Q CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: u,.r,t"_ c-4,.} c-
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR./ Water heater 37.52
/v�Business name: %�^
Qcii`l re Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.:
Plan review (25%of permit fee)
�,�/ State surcharge(12%of permit fee)
Authorized signature: ` ! TOTAL PERMIT FEE
Print name: z.I.e b Zo< Date: /,5/ -�j This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
I
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-l s`100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 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
C ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial El Any complex structure as defined in OAR918-780-0040.
-Domesticmer
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3° Isometric or Riser Diagram
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Property Owner Statement F1ECEIVED
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensepd?with5the023
Construction Contractors Board to sign the following statement before a buildingow {D
issued. (ORS 701.325 (2)) BUILDING G DIVISION
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
_ J I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board. •
or
l
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.
Print Name of Permit Applicant
(:ezedig 4/- 1j/5 / .z 7Z3
Signature of Permit Applicant Date
Permit#:
Address: "
• 1tuyM1+�., .Z
'IR •
Issued by: Date:
This Copy for Permit Offices
.F
•
Information Notice to Owners About
°`° '= Construction Responsibilities
(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, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• 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 800-452-0288.
• 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, go online to 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.oregon.gov/ccb
f/property_owner adopted 9-2016 This Copy for Permit
City of Tigard
ilillll Ire
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #: /" 5r;2--(22-3 "" 0 L 2 £Site Address: I C��.--- ctikj IV? fw° otl•V e✓rifi�v ed in Accela
Project Name: CC $ Lot/Unit #:
Proposal: APT)010 Nt Zone: PO ` Q
Housing Type: SFR( Ingle Detached ❑ Duplex❑Triplex 0 ADU)0 Rowhouse❑Cottage Cluster 0 CYU ❑Quad 0 Other
Requir Site Plan Elements:
co�of site plan on max 11x17"
r9i c n to standard scale Retained trees, drip line/ tree protection
3'9rth arrow Street and site trees shown/ labeled
S' ddress, project name, lot # Table calculating tree canopy at maturity
0 eet names (N/A for SFR)
Cal pill name and phone # Courtyard rectangle dimensioned (if applicable)
)
and setback dimensions Vision clearance triangle
Ex ing structures &square footage Utility locations &easements
pr'.t of new structure and FFE Property corner elevations
,el S walk/driveway dimensioned LIDA (>1,000 sf disturbance)
o t area and lot coverage percentage Erosion control
Require Elevation Plan Elements:
(For alcs needed only on street-facing) Su ry table with calculations for:
awn to standard scale otal facade area
C i ing height dimensioned 0Total window and door area
,� Sade dimensioned
Q flows and doors i o dimensioned
arage doors dimensioned
Floor Plan Elements:
(Not require ummary table that includes
❑ Each story dimensioned 0 Total floor area
❑ Each story floor ar ated er story
inning Review '`
The following standar .have been met:Setbacks 0 Front: /0 Rear: I /Side: Min/Max Street Side: s/ Garage:
t y"'�� ` d
Hei 0 Max. Height: 'Proposed Height: i 1
Yes Landscape
❑ s N/A Screening (Quad only)
jz
Y 0 N/A % Window Coverage
B"Y ❑ N/ Garage (SFR Only) Parking (Other Res)
!a"Yes ❑ A -Entrance (SFR, Rowhouse, Quad only)
❑ Yes -"Other buildingdesign standards (Rowhouse
g ( ouse only)
❑ Yes 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
Additi nal standards for Courtyard Units and Cottage Clusters only:
❑ Yes 0 N/A Unit Area:
❑ Yes IR N/A Floor Area (per story)
❑ Yes 4p N/A Courtyard
0 Yes L N/A Fence
es ❑ No N/A Clean Water Services - Service Provider Letter(lot platted prior to 9/10/1995)
❑ Yes owTo ❑N/A Public Facilities Improvement (PFI) Permit:
Required: 0 Yes 0 No
Applied For: ❑ Yes 0 No,stop intake
❑ Sensitive Lands: ❑ Yesn 12-IVo
❑ Main Land Use Case #s: /VA 0 Conditions met
❑Applicant notified of land use ex it on date: // -
� . Date: /�--�Z-3 q
Approved By Planning: - --�
Notes
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Building Permit Submittal
Original Submittal Date: q/c- /2-3
Site Plans #:
Building Plans #:
Building Permit #: r1Building permit # entered on page 1
Workflow Routing: fTlanning a-Engineering Permit Coordinator _Building
Workflow Sign-off: B'Sign-off for Planning (include notes from planning review)
Route Documents: 6-Engineering: (1) copy of permit application, (1) site plan, (1) building plan
a�r d original plan review routing form.
0 Building: original permit application, site plans, building plans, engineer and
beam calculati ns and trust details, if applicable, etc.Permit Technician: Date: Lli�/2-3
Notes:
Engineering Review
E1 FI Permit: /!(p4 ct�
( lope at building pad: oZ`v
(Conditions met prior to issuance of permit
I2rtasements (encroachments) per engineering conditions of approval and plat
'ter Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes -E1-N
Assess Water Quantity Fee in-lieu: 0 Yes D-f o
LIDA Facility on lot: 0 Yes R1Jo Add Fee: 0 Yes 0 No
final Plat Recorded
0 NOT Approved: Date:
Notes:
Approved By Engineering: t4. t,544CYZ_. Date: '-{-C,-p.0013
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Permit Coordinator Review
Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
1SDC Exemption: 0 Applied for ❑ Received /Does not apply
/SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes N/A
Tigard Trans SDC: 0 Yes /A 0 Deferred
Parks SDC: 0 Yes N/A ❑ Deferred
LIDA ❑ Yes /N/A � nn
/0K to Issue/Approved by Permit Coordinator: II Date: �I(W`9t)
Approved 1: 0 Approved 0 Not Date:
Revision 2: 0 Approved ❑ Not Approved Date:
FOR OFFICE USE ONLY—SITE ADDRESS: \AkIo5 '1,11/41 MO rkuu.•MST1o'. -(and
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.
liti City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
r I C;A I:I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov_
TO: Allyson Armstrong DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Caleb Cox APR 1 2 2023
COMPANY: NM CITY OF TIGARD
BUILDING DIVISION By:
PHONE: 503-953-5526 .i
EMAIL: calebcox51@gmail.com
RE: 14165 SW 103rd Ave,Tigard,OR 97224 MST-2023-00120
• (Site Address) (Permit Number)
Kitchen Addition
(Project name or subdivision name and lot number)
AATTACHED ARE THE FOLLOWING ITEMS _ ,p q�� ,
4,° A 1es B y�iri 4 1 yf' &�`SC" 3,.& a f' w 4* r,.: c ., ' r�l,'�- ci 1 e2-irte .4.k; '..-; a:is i.' t ..
3 Additional set(s)of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. 2 Engineer's calculations.
1 Other(explain):Comment response document
REMARKS: I am submitting a revised set of plans and calculations in response to Allyson's 4/5/2023 review.
. A` r.M:. y{"¢,:A 4,+4 .���...e.�`s a,� sw �'""' ., .. .F��t.. ,,,:r� '"'.��y �s,�.w�MA,_ , L,�
Routed to Permit Technic : Date: (.1 2'5 Initials: MT
Fees Due: [l Yes No Fee Descn do : Amount Due:
, i } .ti ' $
x R ���
`- $- w
t 13
$
Special
Instructions:
Reprint Permit(per PE : ❑ Yes No ❑ Done
Applicant Notified:J Date:5I\ 11„All. 4,\J \KtO cRA' Initials:
RECEIVED
�e
CleanWate\ Services
O 5
SENSITIVE AREA PRE-SCREENING SITE ASS�ESSM N I
OET I OF TIGARD
Clean Wateri i l.1ik3' 1r 23-000975
1. Jurisdiction: Washington County
2. Property Information (example: 15234AB01400) 3. Owner Information
Tax lot ID(s): Name: Caleb Cox
2S111 BB01600 Company: N/A
Address: 14165 SW 103rd Ave
OR Site Address: 14165 SW 103rd Ave City, State,Zip: Tigard,OR,97224
City, State,Zip: Tigard,OR,97224 Phone/fax: 503-953-5526
Nearest cross street: Email: calebcox51@gmail.com
4. Development Activity(check all that apply) 4. Applicant Information
J Addition to single family residence(rooms, deck, garage) Name: Caleb Cox
❑ Lot line adjustment 0 Minor land partition Company: N/A
❑ Residential condominium ❑ Commercial condominium Address: 14165 SW 103rd Ave
❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Tigard,OR,97224
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 503-953-5526
Other Email: calebcox51@gmail.com
6. Will the project involve any off-site work? Dyes 0 No 0 Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project:
Constructing a 200 SF addition onto the front of my house.City of Tigard permit requires this pre-screening form.
This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits,Site
Development Permits, DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality,
Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and
completed under applicable local,state,and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water
Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering
information related to the project site. I certify that I am familiar with the information contained in this document, and to the best of my
knowledge and belief,this information is true, complete, and accurate.
Print/type name Caleb Cox Print/type title
Signature ONLINE SUBMITTAL Date 3/26/2023
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO
ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural
Resources Assessment Report may also be required.
El Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the
site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if
they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5, Section
3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable
local,State and federal law.
❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the
existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to
evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service
Provider Letter as required by Resolution and Order 19-5,Section 3.02.1, as amended by Resolution and Order 19-22.All required permits and
approvals must be obtained and completed under applicable local,state and federal law.
❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT
OR SERVICE PROVIDERO LETTER IS REQUIRED.
7
Reviewed by lie •lo ,L. n - Date 03/27/2023
ce c plet mail to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services,2550 SW Hillsboro Highway, Hillsboro,Oregon 97123
Main Office • 2550 SW Hillsboro Highway • Hillsboro. Oregon 97123 - p: 503.681.3600 f0 503.681.3603 cieanwaterservices.ora