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Permit `" 1 1 y :: . i i i ®� u ® r ®. _ MASTER PERMIT • S ` ,. COMMUNITY DEVLLOPM PERMIT #: M 5/2008 - 00022 ENT DATE ISSUED: 5/5/2008 r1GAiD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S104AA - 03200 SITE ADDRESS: 12160 SW 126TH AVE ZONING: R -4.5 SUBDIVISION: BELLWOOD LOT: 034 JURISDICTION: TIG PROJECT: FANNING /GRANT Project Description: 480 sq ft outbuilding BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ACS HEIGHT: 11 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: N TYPE OF USE: SF FLOOR LOAD: - SECOND: sf GARAGE: 480 sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 5 VALUE: OCCUPANCY GRP: U1 BDRM: BATH: TOTAL: 0 sf 17.923.20 REAR. 5 PLUMBING • SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: • TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: • WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: • OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: . ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS, 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN/OUT LIN LT: PER HOUR: ti) LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601-tamps-1000v: MINOR LABEL: 1000. amplvolt : o PLAN REVIEW SECTION Q Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/5PC OCC: 1 ELECTRICAL - RESTRICTED ENERGY 1 A. SF RESIDENTIAL B. COMMERCIAL Q AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: 0 BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: • 0 GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: o HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL Y SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable JON FANNING & KENDRA GRANT OWNER laws. All work will be done in accordance with approved plans. This 12160 SW 126TH AVE permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 . through 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503 - 579 - 0709 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 550.53 REQUIRED ITEMS AND REPORTS Issued B -L_ ` Permittee Signature : /• Call 50 . • 9.4175 by 7:00 a.m. for an inspection that business day. 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. 1 a 4 CITY OF TIGARD MASTER PERMIT 4. f PERMIT #: MST2008 -00022 COMMUNITY DEVELOPMENT DATE ISSUED: 5/5/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S104AA -03200 SITE ADDRESS: 12160 SW 126TH AVE ZONING: R -4.5 SUBDIVISION: BELLWOOD LOT: 034 JURISDICTION: TIG PROJECT: FANNING /GRANT Project Description: 480 sq ft outbuilding BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ACS HEIGHT: 11 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: N TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: 480 sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 5 VALUE: OCCUPANCY GRP: U1 BDRM: BATH: TOTAL: 0 et 17.923.20 REAR: 5 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: let W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC/FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM, AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable JON FANNING & KENDRA GRANT OWNER laws. All work will be done in accordance with approved plans. This 12160 SW 126TH AVE permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct Phone: 503- 579 -0709 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 550.53 REQUIRED ITEMS AND REPORTS Issued B mss, _ iii ■ Permittee Signature : vi a ,A Call 50 . • 9.4175 by 7:00 a.m. for an inspection that business day. 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. RESIDENTIAL PERMIT APPLICATION REVIEW Permit No.: MST2008- 00021 Site Address: 12160 SW 126th Ave. Subdivision: Bellwood Lot No.: Contact Name: Kendra Grant Business: Street: 12160 SW 126th Ave. • City: Tigard State: OR Zip: 97223 As required by the 1999 Legislative action (Senate Bill 587), your residential permit application and plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or "complex" as defined in ORS 455.467 and 455.469. The application is complete. The application is incomplete for the following reason: As per our discussion at the counter, I need 2 copies of the truss details. 6e Crc , et f ":1- 7 1 S cc -4;031 caul 62_ copy, fie 1 . ❑ The submitted plans will be reviewed; however, a permit cannot be issued until the above information is reviewed and /or approved. ❑ The submitted plans cannot be reviewed until the above information has been submitted and /or approved. © The plans are deemed "simple ". n The plans are deemed "complex ". Signature: 77 A4 r O &' Name: Brandon Shaw Date: March 24, 08 Title: Plans Examiner Phone: 503 - 718 -2425 E -Mail: BrandonS @tigard - or.gov I: \ Buil ding\ Forms \RES- PcrmitAppRcvw- Blank.doc 1/18/07 1115 i 2006 -& oLZ Kendra Grant & Jon Fanning l i E 1 12160 SW 126 AVE Tigard, OR i 1 4 97223 CITY OF TIGARD !J f'Rr, DIVISION Re: permit #- mst:2008=00022 Address above City of Tigard: We were unable to make the 6 month deadline of our first check off on our outbuilding. The economy has delayed the progress because we are unable to pay for the concrete at this time. In addition to that, we feel that the spring would be a better time for the project. Please extend our permit deadline. Thank you )(9) 1 .,,%7 l \ /th am, . Building Permit Application ' Residential RECEIVED FOR OFFICE USE ONLY City of Tigard Received � ! l U O O 6, , p No.: • , 5j;���"y"�g -( X 92 Deceive (/w 13125 SW Hall Blvd., Tigard, OR 972 Plan Review Phone: 503.639.4171 Fax: 503.598.1 ` R 1 92008 Date/B / . ., ./e4 ,,�B Other Permit: TI G A R D Inspection Line: 503.639.4175 Date Ready /By: 0 See Page 2 for Internet: www.tigard or.gov CITY OF TIGARD Notified/Method 7 (f (� Suppleaeuhl Information B 1 111 1^t 1 A ! f, 1- c../i Wieb 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: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ `7 1 V iAccessory building ❑ Multi- family Number of bedrooms: ID Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 ' ` ' New dwelling area: square feet City /State /ZIP: 1 n r 1 1 7, Z.3 }} Garage /carport area: 41 square feet Suite/bldg. /apt.no.: Project name: 6W ilA Covered porch area: square feet Cross street/directions to job site: , 2, s l ' -h K al e I +0 1 _t h: ` Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivisiotil,' w a 4. 1 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. N PA 011Ct"b1AA lli f A V l A /ktAt Valuation: $ ! J Vol( U Existing building area: square feet New building area: square feet 4.$-C) \p. PROPERTY OWNER ❑ TENANT Number of stories: Name: 14 a yA !tyt r I A- 4 J con c n t n � Type of construction: Address: rap) i 11 Occupancy groups: City /State /ZIE. «y'-4 ,,,,a 6,--, LZ 2) _ Existing: Phone: (9.71, ) II cli 0161 Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: Kuy� �nr<� licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: i Z( tp0 4y,1 1 Z It 41— jurisdiction in which work is being performed. If the ty ti . OW—. L Z3 applicant is exempt from licensing, the following reasons City/State/ZIP: apply: Phone: ( ) ') S '1q G7p e Fax:: ( ) E -mail: kirwirc,i ill 37( / 06. `l t - of . t.0 e"'" COfiTRACTOR Business name: OH 1 1 ) i BUILDING PERMIT FEES* Address: t� (Please refer to fee schedule) City/State /ZIP: Structural plan review fee (or deposit): FLS plan review fee (if applicable): ' Phone: ( ) Fax: ( ) Total fees due upon application: F/ CCB lic.: J .° Amount received: 0 ll 3 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: , & v .. vU( Date: i 0 6 * Fee methodology set by Tri - County Building Industry Service Board. I:\Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(I1 /02 /COM/WEB) w Building Permit Application Checklist . One- and Two- Family Dwelling FOR OFFICE USE ONLY M il City of Tigard Received Permit No • 13125 SW Hall Blvd., Tigard, OR 97223 Dated t Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical TIGARD Internet: www.tigard- or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ _ ❑ O 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ El 4 Fire district approval required. Name of district: . ❑ ❑ El 5 Septic system permit or authorization for remodel. Existing system capacity El ❑ ❑ 6 Sewer permit. El El ❑ 7 Water district approval. El ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ El ❑ 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 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 ❑ El ❑ 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, ❑ El El 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 ❑ El 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- El ❑ 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 ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ El ❑ 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. ❑ El El 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ 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 ❑ El El architect licensed in Ore • on and shall be shown to be . , s licable to the . ro'ect under review. .11 IRISI)1(' SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ El El 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. El El ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ El ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. El El El 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ 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 accompanied by 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, ❑ ❑ El 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- RES- PermitApp.doc 03 /21/06 440- 4613T( /02/COM/WEB) n • .P�l umbing Permit Application ' `/ FOR OFFICE USE ONLY City of Tigard RECjEI Y 'a y 1 9 Di ( Permit No.: ..._kT 8- uM � j2 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review N " Phone: 503.639.4171 Fax: 503.598.1960 1 D Other Permit No.: Inspection Line: 503.639.4175 MAR 1 Z C' y T I G A R D Date Ready/13y: 1 0 See Page 2 for Internet: www.tigard - or.gov Notified/Method: / (' Supplemental Information TYPE OF WORK t FEE* SCHEDULE p. ' blew construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2-family dwellings ngs (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ccessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 1 121 U 0 S1/j 12,u-tib Catch basin or area drain 16.60 City/State/ZIP: 1100,4 ay. X72 Z3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: ..)-0-/(2.-4 Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site����//�� Manufactured home utilities 110.00 7` 1""`ti`R't't '1,e...) Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _____) Page 2 Storm sewer (no. linear ft.: it (3 Page 2 Subdivision: \ v",,k Lot no.: Water service (no. linear ft.: ) I Page 2 Tax map /parcel no.: 2. s 1 , 4 AA - O 5 CO Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 rci- -` F . I l2 VuU tit ) le k S � �� O' � 111. e∎ Backwater valve 16.60 t71,1 r , J Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER El TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: Ki4- +7L6114 -1 dirn 'rAr►nt.tu Expansion tank 16.60 Address: r2_11,0 D Si, 11... U Fixture/sewer cap , City/State/ZIP:'1( Z (XL- 01l -L3 _ Floor drain/floor sink/hub 16.60 ( , 97 D c 71 „Ion Phone: Fax: ( ) Garbage disposal 16.60 - El APPLICANT p. CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap I 16.60 Contact name: /ij 1) Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) F es; ; ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 \\ Business name: 1( ) /� t I) - Water heater 16.60 Address: Other: City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: State surcharge (12% of permit fee) J} J TOTAL PERMIT FEE I Print name: KL v� �;� �,�, Date: r5 ( 1 i �( 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. 1.\ Building \Permits\PLM- PermitApp.doe 12/27/06 440-4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - I 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, adding or replacing fixtures? If "yes", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive Thru ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometric or Riser Diagram Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings 3 " that meet the qualifications above. Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an - Bradley - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\Building\Permits\PLM- PermitApp.doc 12/27/06 1 22 05 07:53p ACC _ (503) 972 -2299 p.1 r AUG 2 3 RECEIVED MAR 1 92008 � CITY OF TIGARD Clea \ � File Numbe RUIi n��C N ISI ®N nWater Services - 0036 t41 Our commitment is clear. Sensitive Area Pre- Screening Site Assessment Jurisdiction �) y i Date Ar j 110 \� Map & Tax Lot Owner 2aly -,7 iL►D Applicant_. .U VIMi1/1 t l 1 trt4t j�t►�� Site Address i. i.2_11 Company ,5 J - TI . 0-44. Cie 4 172-2 Address 12160 Svv i,2tr - /-1 - rL' Proposed Activity eibtywribt td;ns it2 City State Zip --- Ti l Oe tj7Z23 Phone '15� 71 e7tv1 Fax By submitting 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. Official use only below this line Official use only below this line Official use only below this line Y N NA Y N NA L r ®l I Sensitive Area Composite Map , Stormwater Infrastructure maps Map # �5/W(3 QS # q 3/6 ( N Locally adopted studies or maps Other • I I LA. Specify [ ] - V' Specify Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04 -9: I I Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. Sensitive areas do not appear to exist on site or within 200' of the site. This 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 04 -9, Section 3.02.1. An required permits and approvals mint be obtained and completed under appiicabie local, state, and federal law. The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewer Comments: Reviewed By: Date: Fl3V .5 Official use only Returned to Applicant Mail V Fa Counter a - .. .'. hway • Hillsboro, Oregon 97123 Date �/ 3 a/o By � ;- Phone: (503) 681 -5100 • ax' (503) 681 -4439 • www.cleaswaterserviccsn� - / �� s in MAR 1 9 200 ,: CITY OF TIGAFb ^�=�d B UILDING DIVISION • S. din 5 3 0 �' CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO: i % - 0 0 C ) . - 411192ra Approved 0 Not Approved Street Trees: Protected3ee}:� Approved ❑ Not Approved. h B : ° ( N• Date` op o Notes: p .ttc,; ,)� . - . Fns At 4 IIIIIV CITY OF TIGARD - SITE PLAN REVIEW * j J' ILDING PERMIT NO.: 7i , /0: -AA/ A PLANNING DIVISION: Not Approved Required Setb ks: Street Side: ❑ Side: St F// Front. 41—* _ Garage: 2.7.AL Rear: - Not Approved Visual Clearance: ❑ Approved ❑ Maximum Building Height -- feet CWS . ervice Provider Letter Required: v. Yes ❑ Na, 0.."0 -. . - d-C9 „u /ai4P- Vleg '0 Receiv / Date: 3 z% D� fit; - B _........ ENGINEERING G DEPAR]-MENT: Not Approved � ( Actual S o % 0 Approved 0 of • 'proved B Site PIa : Li__ IA-Approved ❑ 0 e) Date: Z