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Permit MilCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ." Request Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov .V, TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant n Contractor g City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) , / ( :DG.,yyt l xT YUQJ , Mailing Address: /` P61--a-C... City/State/Zip: � ��--✓�. 742 97eO Phone No.: 603 - 96, - 3� PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ • _ /VOID PERMIT APPLICATION. REFUND ERMIT FEES (attach copy of original receipt and provide explanation below). a FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: r-161-,9-o! Site Address or Parcel #: I3t L C?7 5(.J-7,-;et_e_l. . Project Name: I 1 LOT-LA Subdivision Name: �Lot#: EXPLANATION: �.n�l L► � /� A i -Y k , ; cytit c6et l_e c Lt a9.4 I . Signature: (�k)- Date: /C/4 Sl !C Print Name: "- (-D'cp95 c:� /}-D• .-`-t 514,1 D r i O'kri C)`D rl Refund Policy Ljo C, 14114 14 1 1. The city's Community Development Director or Building Official may authorize the refund of: Yi Er a) any fee which was erroneously paid or collected. 17 b) not more than 80° of application fees when application is withdrawn/canceled before review effort has been rxpended Not is permi • prior to any inspection requests. 2. The city's Engineer may authorize the refund of: JJJfff�� a) any fee which was erroneously paid or collected. b) not more than 50%a of application fees when application is withdrawn/canceled before review effort has been expended or for issued rerikmits, Pip'1 prior to any inspection requests. 3. All refunds will be returned to the original payer in the form of a check. Please allow 3-4 weeks for processing refund requests. Rte to S s Admire: Date WS/ B.11111P ' Rte to Records: Date /d AMA B l_ij/' Refund Processed: Date A(19- ByA544 Invoice Processed: Date By Permit Canceled: Date //7— By ,!, Parcel Tag Added: Date By Receipt# Date Method Amount$ L \Building\Forms\Req Pemtitoction_082114.doc :. .� CITY OF TIGARD RECEIPT 1111 i 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 197279 - 08/19/2014 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2014-00123 12%State Surcharge-Building 100-0000-24001 $123.68 MST2014-00123 DC Provision Review, SF-Ping 100-0000-43112 $75.00 MST2014-00123 DC Provision Review, SF-LRP 100-0000-43117 $11.00 MST2014-00123 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $38.00 11x17) MST2014-00123 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $2.50 11x17) MST2014-00123 Tig-Tual School CET-Residential 230-0000-24102 $421.80 MST2014-00123 Branch Circuits wo/Purchase Service or 220-0000-43103 $85.86 Feeder MST2014-00123 12%State Surcharge-Electrical 100-0000-24001 $10.30 MST2014-00123 Gas Fireplace 230-0000-43102 $33.39' MST2014-00123 Range Hood/Other Kitchen 230-0000-43102 $33.39> b MST2014-00123 Fuel Piping 230-0000-43102 $14.15 MST2014-00123 12%State Surcharge-Mechanical 100-0000-24001 $9. 1 MST2014-00123 Building Permit-Additions,Alterations, 230-0000-43104 $ ,..... Demolition MST2014-00123 Erosion Control w/Permit-Eng 100-0000-43134 $150.00 MST2014-00123 12%State Surcharge-Plumbing 100-0000-24001 $8.70 MST2014-00123 Lavatories 230-0000-43101 $25.02 MST2014-00123 Sink 230-0000-43101 $25.02 MST2014-00123 Minimum Fee Adjustment-Plumbing 230-0000-43101 $22.46 Total: $2,120.63 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 07336G DADAMSKI 08/19/2014 $2,120.63 Payor: Jesse Tissot-Beaver Dam Construction Total Payments: $2,120.63 Balance Due: $0.00 fti°/'z-/e4s/7 /01.9-46: 61-o .93 — _6/L DoT Al ec--T /if/wit—fie H - . 9, 7/ d" , 9'0 , o---o , /1r0 ,v.z.) 6; 9a . 6y Page 1 of 1 J 7 /ale/-Oo1 3 RECEIVED t 0ullcck.,. _.._-__-.-.....- -. .. . . ..., -.,„,,,,,,,,,,..„:„....„,,,,-,7,,,,z,::.:. ''" , . : AUG 272014 y}'Address Book tyt Udr t.Bank CITY OF TIGARD goo tze renew ategorae 701135r up `i/Finer Email• up• t/Finer F man• '•' Ftnd BUILDING Dfv Fwd:Mistry footings a august 7014 ► Fwd:foundation 4 August 2014 Jesse Tissot<e55e®i]edverdam-conStruction.com> Su Mo Tu We Th Fr Sa Su Ma Tu We Th Ft SA 1 1 2 Beaver Dam Construction<Jesse @beaverdam-construction.com> ; 2 Mon 5r25R014 11:17 PM 3 4 5 6 7 8 9 Tue 8:2612014 5:13 PM 3 1 5 6 7 8 4 David rnarq 10 11 12 13 14 15 16 David young 10 11 12 13 14 15 16 17 18 19 20 21 22 23 __ 17 18 19 20 21 22 23 Hello David, 24 25 26 27 28 29 30 24 25 26 27 28 29 30 Hello,here is an updated description for the rebar Seems like a trivial ( � Si change but it makes installing the hold dawns 100x easier Permit mst?014- F.I. Please see below the response from my architect regarding the construction Wednesday Se�tembe 10 701.1 00123.Thanks Jesse. Wednesday.September 10,7014 of the pier pads for the deck.The permit for this job is�IST2014- Building Division staff meeting Building gNSion staff meeting _ 7.30 MO.82q MA 7:30 AM.800 AM 00123. R e will also have a printed Version On site CR__l_Permrt Center;Mark Yard/ern CR: Permn_Center,Mark VanDom Thanks Jesse Begin forwarded message. Beaver Darn Constriction From:ERIC G HESS Owner<erchitectacenturylink.ner> 503-961-2636 Date:August 26,2014,12:42:34 PM PDT To:Beaver Dam Construction<jesseBabeaverdam- construction.com> Forwarded message Subject:foundation ' From.ERIC G HESS Owner<erchitect accrual-link new 7 0 Arrange Ey Flag Our 17a,e Arrange E Flag Our Vale Due:Mon,Aug 25,2014 at_. 2 PM Jesse, r' Subject-Mstry footings ' To Beaver Dam Construction<jesse abeaverdamconstrucrion coin> There are no Hems to show in this There ate no Semi o show in this 'AM. wew. fain 1Sx1S footings.use(2)-4's each way, Jesse lot 24"x24"use(3)-4's each way, You have my appro.al to modify deck footings so that they are min 21" deep(18"embedment in ground,and min 3"above grade with(4).=ti's EW frost depth is 18"to bottom of footing Top and Bottom Refer to plans for exact plan dimensions. Cone shape is acceptable maintain,10"high from bottom,and then • start coning up to 10'x10 min. Thanks Eric Hess Architect 503-816-4558 hi vl}Gadwin PrintScreen * ' To capture image press'PrinsScrcen' e_ source:&Full Screen An l0Men or or In date i1j connected to Miaosott rzcMnge-fin' 5h0w'hidden cam; .;`_'•tj[ ".:. - r AlttPrdtrt Me up to date. 1,}Q Destination:Clipboard;Printer -.ti') it 1 ' n CITY OF TIGARD /I MASTER PERMIT 1111 s COMMUNITY DEVELOPMENT �� A► Permit#: MST2014-00123 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �� Date Issued: 08/19/2014 Parcel: 2S104CD10600 Jurisdiction: Tigard Site address: 13697 SW TRACY PL Subdivision: HILLSHIRE ESTATES NO.2 Lot: 105 Project: Mistry Project Description: Two story addition. 9/30/14, reprinted to add retaining wall to permit. 10/1/14, removing(1)range hood and adding(1)lay to permit. 12/17/14, reprinted to add(1)garbage disposal&(1)ice BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 370 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 28 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 370 sf Value: $90,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add,500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 6 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 Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 370 Owner: Contractor: MISTRY,ASHISH&RITABEN REV LIV BEAVER DAM CONSTRUCTION Required Items and Reports(Conditions) 13697 SW TRACY PL 565 SW 130TH AVE 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 BEAVERTON,OR 97005 PHONE: 503-970-9489 PHONE: 503-961-2636 FAX: Total Fees: $2,897.43 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. ATTE - Oregon law requires you to follow the rules adopted by the Oregon Utility No ion Center. Those rules are set forth in OAR 952-00 .110 through e R 95 •41-0090. You may obtain a copy of the rules or direct questions to OUN •<uu..-_03.232.19,8r71orr1.800.332.2344. ■ / '� Permittee Si nature. 110 r cd,e,rt ckl:) By: Call 503.639.4175 by 7:00 a.m.for the next available inspection•,te. 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. Debbie Adamski From: Debbie Adamski Sent: Wednesday, December 17, 2014 10:26 AM To: George Heimos;jesse @beaverdam-construction.com; Dianne Byrne Cc: #Building Permit Technicians Subject: RE: 20141217094348947.pdf, MST2014-00123, 12697 SW Tracy P1, Tigard, OR Jesse, The garbage disposal and the ice maker have been added to this permit. There is a balance due of$16.88. You can pay this online through our city's web site or come into the office to pay. We do not take credit card information over the phone or by fax. Let me know if you have any questions regarding this. Debbie Adamski Senior Permit Technician City of Tigard I Community Development 13125 SW Hall Blvd.,Tigard, OR 97223 503-718-2450 Original Message From: George Heimos Sent: Wednesday, December 17, 2014 9:44 AM To: jesse @beaverdam-construction.com; Debbie Adamski; Dianne Byrne Subject: 20141217094348947.pdf DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 1 p CITY OF TIGARD I MASTER PERMIT - II COMMUNITY DEVELOPMENT l /o / �� Permit#: MST2014-00123 • TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2014 Parcel: 2S104CD10600 Jurisdiction: Tigard Site address: 13697 SW TRACY PL Subdivision: HILLSHIRE ESTATES NO.2 Lot: 105 Project: Mistry Project Description: Two story addition. 9/30/14, reprinted to add retaining wall to permit. 10/1/14, removing(1)range hood and adding_(1)lav to permit. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 370 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 28 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 370 sf Value: $90,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Tvices Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add/500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 6 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 Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 370 Owner: Contractor: MISTRY,ASHISH&RITABEN REV LIV BEAVER DAM CONSTRUCTION Required Items and Reports(Conditions) 13697 SW TRACY PL 565 SW 130TH AVE 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 BEAVERTON,OR 97005 PHONE: 503-970-9489 PHONE: 503-961-2636 FAX: Total Fees: $2,880.55 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. AT . Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0 -0010 through OAR•,2-08 .it•D. You may obtain a copy of the rules or direct questions to OUN y calling •• .1987 or 1.800.332.2344. Is ed By: A. _ I AftLAA.d....r. Permittee Signatu "-lir e&-& 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 comp/-,•n of the project Approved plans are required on the job site at the time of each inspection. FOR OFFICE USE ONLY-SITE ADDRESS: 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. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 1111 _ Transmittal Letter TIGARD 1 Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • w� arg d-or.gov TO: DA RE '+• & Iy DEPT: BUILDING DIVISION SEP 2 9 2014 ROM: CITY OFTIGARi COMPANY: Cp,.4(,,, -+. BUILDING DIVI PONE: �� 9G/ - Z& 3 ea _ Y: RE: 1 7 5.Ji r.,/ i1 97223 1-"1‘ T6/4/'o(/�3 (Site Address) (Permit Number) (Project name or subdivision n. e and ; ber) ATTACHED ARE THE FOLL►, NG IT ' S: Copies:Copies: Description: \ I Copies. Description: -0455 Additional set(s)o'pl. i . 3 Revisions: j61--*■-4 Cross section(s) d detai . Wall bracing and/or lateral analysis. Floor/roof frami/g. Basement and retaining walls. Beam calculations. c Engineer's calculations. Other(ex.lain): REMARKS: -- ZUec—ee FOR FFIC USE ONLY Routed to Permit Technician: Date: j�- Initial Fees Due: es ❑ No Fee Description: Amount Due: P vt $ Cc,cc $ Special Instructions: Reprint Permit(per PE): ❑ Yes I ❑No ❑ Done Applicant Notified: Date: //g0l0y Initials: 41.3-, I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 q CITY OF TIGARD MASTER PERMIT s COMMUNITY DEVELOPMENT Permit#: MST2014-00123 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2014 Parcel: 2S 104C D 10600 Jurisdiction: Tigard Site address: 13697 SW TRACY PL Subdivision: HILLSHIRE ESTATES NO.2 Lot: 105 Project: Mistry Project Description: Two story addition BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 370 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 28 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 370 sf Value: 590,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Times Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add.'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 6 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 Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 370 Owner: Contractor: MISTRY,ASHISH&RITABEN REV LIV BEAVER DAM CONSTRUCTION Required Items and Reports(Conditions) 13697 SW TRACY PL 565 SW 130TH AVE 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 BEAVERTON,OR 97005 PHONE: 503-970-9489 PHONE: 503-961-2636 FAX: Total Fees: $2,790.55 i 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 952-001-0010 • ••_ -•- 9 601 :090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. OA - _ Issue• By: _ a� �`' Permittee Signature: •ii Call 503.639.4175 by 7:00 a.m.for the next available inspecti• . This permit card shall be kept in a conspicuous place on the job site u„;.'pletion of the project. Approved plans are required on the job site at the tim, each inspection. Building Permit Application Residential RECEIVE!) FOR OFFICE LSE°NL1 Received City of Tigard Permit No.: `J g Date/B �� / � - , r-pio "veby 13125 SW Hall Blvd.,Tigard,OR 972 Plan Revie • ►� �' • Other Permit: ' I Phone: 503.718.2439 Fax: 503.598. 2 9 214 DateB : i�M�®� TI G A K D Inspection Line: 503.639.4175 Date Ready/By: .• Jude. ® See Page 2 for Internet www.tigard-or.gov CITY OFTIGARD Notified/Method:d-4,3 4��' Supplemental Information A v�rr — TYPE ONADIGVVISION 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 la Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the work indicated on this application. CATEGORY OF CONSTRUCTION Valuation: $ CIO 000 W 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Z Job site address: 136 / 7 5 l,..i 7 foc y IV). New dwelling area: 3 2 p square feet City/State/ZIP: "T'`, "fel R ti' 7 Z Z 5 Garage/carport area: square feet Suite/bldg./apt.no.: � Project name: " I -sJ4yy Covered porch area square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: 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 DESCRIPTION OF WORK work indicated on this application. fT/►0 1e); J T Valuation: $ Existing building area square feet New building area: square feet VP PROPERTY OWNER ❑ TENANT Number of stories: Name: 161.1 -•5 14 141 ;j,y/ Type of construction: Address: 123&q 7 50 -Tracy 11 ' Occupancy groups: City/State/ZIP: --1-- 1l O ' - 9722 3 Existing: Phone:(503 ) 776-- Ty 61 Fax:( ) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: l (Please refer to fee schedule) P6w`/ DA r� C0.5-'hf 1 •d ti Structural plan review fee(or deposit): Contact name: J ,e T; %.67 Address: 5c "7y.0 D FLS plan review fee(if applicable): �Jl..i t �.-1 r„,,,,a1 411%, t 7 D6 Total fees due upon application: City/State/ZIP: 0e Phone:(5O3) /4/-2634 Fax: :( ) Amount received: l' 9.�� E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* JQ5$ ��Qr�"'�°I\S+VUZ. -i*e�^ - tad Commercial and residential prescriptive installation of CONTRACTOR roof-to. ounted PhotoVoltaic Solar Panel System. Business name: Y` 5 v.i� °A Cc4, -/K•d--e-� Submit two sets of roof plan with connection tails and fire depatmen . -ss,along with the i I Oregon Address: 5(S 51,, 1 50s 4,,,e, Solar Installation Specia ty .•.re the st. City/State/ZIP:�P�Ji.3 Ct� � Permit Fee(includes plan ew $180.00 and adminis . e fees Phone:(5 3 IV) Q/ o /r I _u Fax:( ) State surcharge(1 'o of permit fee): $21.60 CCB lic.: 1 4 5-5-g c"". /,' l To ee due upon appication: $201.60 Authorized signature: * / This Permit application expires if a permit is not o• ained �k°-. '.,5$0 within 180 days after it has been accepted as complete. Print name: i *Fee methodology set by Tri-County Building Industry i Date: 7�Zaf �ilI Service Board (:\Build. •- -rmits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) J Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY Received 1111 City of Tigard Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: T I G n K n 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW "es `° N./ I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • • 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. _ ❑ ❑ . ❑ 4 Fire district approval required. Name of district: ❑ CI . 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑ basin protection,etc. 10 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑ 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, ❑ ❑ ❑ 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- ❑ ❑ ❑ 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- ❑ ❑ ❑ 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 ❑ ❑ ❑ 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. ❑ ❑ ❑ 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 ❑ ❑ ❑ architect licensed in Ore:on and shall be shown to be applicable to the •ro'ect under review. It RISI)I( I ION.V. 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". ❑ ❑ ❑ 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. ❑ ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑ _ 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. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) Electrical Permit Application FoR olFICI: USE ONLY '. City of Tigard k E 71 41 P 9- l t eie/.3 13125 SW Hall Blvd.,Tigerd,OR 97223 n Review • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit u Inspection Line: 503.639.4175 ',II r Ready Date/By: Juris: Ed See Page 2 for 1.IGARI) Internet: www.tigard-or.gov 9 2014 Notified/vfothod: I Supplemental Information TYPE OE'wQ.*Ci r•;,‘' NB: 1. (r�ly - PIAAN ItEViRAV "nRD Please check all that apply(submit I ed) ❑New construction [�Addition/alterati �l�@rit�t t l?p y( Imltt sets a� w/items check 1r l Y IROl r ❑Service or feeder 400 amps or more l✓ ding over three stories. ❑Demolition El Other: 1\ where the available fault current ❑h'i inas and boatyards. CATEGORY.OF CONSFRUCI'ION exceeds 10,000 amps at 150 volts or ❑:. icing buildings. 01-and 2-family dwelling El Commercial/industrial El Accessory building leas to ground,or exceeds 14,000 ❑Commercial-t,ae agricultural amps for all other installations. b,,i I Flings. ❑Multi-family ❑Master builder ❑Other: ['Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMA'T'ION.AND LOCATION ❑Em ergency system, t a,.er separately derived Job 4: Job site address: 13G 9 7 51,0 T y ei ❑Additioo omoew motor load of s iem. foC,c, IOOHP or more. City/StatelZIP: ❑Six or more residential units. panty. �,�'�o ) !7 Z 3 ❑Health-care facilities. L. ■eational vehicle parks. Suite/bldg./apt.4:v I Project name: ih;j .. ❑Hazardous locations. 0 I. dolt voltage for more than / ❑Service or feeder 600 amps or more. Cross street/directions to job site: FEE,$CHF; Description I Qw.QUI Eadt Total New residential single-or multi-fain il∎ .veiling unit. ' Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 ,,, BU'SCRII?I`IAN OF WOE1K Limited energy,residential (with above sq.ft.) 75.00 2 l �� Limited energy,multi-family 75.00 2 residential(with above sq.ft.) l<'ERIY OWNER Renewable Energy Cl 'age 2 RO 1ENANT Services or feeders inatallationta!ler, ,and/or relocation Name: 5k. L �1 -' �y 200 amps or less 100.70 2 r /' ,./-I 7 1 I 201 amps to 400 amps 1 33.56 2 Address: fG � •'1—,�.L 401 amps to 600 amps 200.34 2 City/State/ZIP: fl 94,r I 1 7 72-5 601 amps to 1,000 amps 301.04 2 Phone:(503) q la— q e 34 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders instal it,alteration,and/or Email: relocation I Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 EitsAPPLACANT 1 ( CONTACT Pirok.SoN . Branch circuits-new,altcratiu I,or r asion ter 'and A.Fee for branch circuits with Business name: , s,.` 4,1 L 64.. above service or feeder fee, 7.42 ', ! � each branch circuit Contact name: .)55e r 55e "Ti'T� bt-- B.Fee for branch circuits without Address: C 4 service or feeder fee,first branch circuit / 56,18 . 2 ✓ 0 City/State/ZIP: I t� 9 7o0c Each add'I branch circuit 4-,, 7.42 2 Q.Ji Miscellaneous(service or feed rr mint dud) Phone:(5O3) 90/-_656 Fax::( ) Each manufactured or niod,dat 67.84 Email: dwelling,service and/or feeder Reconnect only 67.84 i .. _ . , COI 'CRAC'rOR' , Pump or irrigation circle 67.84 2 Business name: C �.. . I I, r,..c_. - Signor outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: j,2/ 7's r� hf 2 III Paget 4 2 C r 4i7---e 2. panel,alteration,or extension. _ Each additional inspection nv.-r'all i e in awy of the abo, City/State/ZIP: .._7--i-G 42 Q 2 5;7,2-2- 3 Additional inspection(I hr r. 66.25/hr Phone:( - , _. �U3) �'8e�-- 7/3/O[< Fax:( ) Investigation(1 hr min, 66.25/hr / // Industrial plant(1 hr mill) 78.18/hr 1 Email: ''j / ./ ,!D / /(z Inspections for which no fee is ' CCB Lie.:/q/7/ E ctrical Lic.: G► (S'7 Suprv.Lie.:55935 specifically listed(!4 In min) )0.001 hr 9 ELECTRICAL I'1-.1: P)GpS Suprv.Electrician signa e,r u ed: �tal: ,ale Print name: c, 1? _/4r Date: ❑Plan Review Required('t° ,f, Fee): ,S Ciro/ ' "° ' " ' State surcf i.rge i' f i'. fee): Authorized signature: TO I AL 1 ' is 'EE: ' ��//// This permit application expires if p„ riot obtained withia 1 Print name: be jr ft r jr .6f Date: 7-z y— d,rys stir'it has bet• <c.; z complete. 1 * Number of inspectior.s allowed per 1:1Buitding\PennitstiiLC PermitApp_ELR ERE.docx Rev 04/21/2014 440-4615T(11/OS/COM/WEE • Mechanical Permit Applica1ECEIVED FOR OFFICE USE ONLY City of Tigard Received 7 9A� Permit No.: /' 4r.�! / 114 s • Phone: 503.718.2439 Fax:13125 SW Hall Blvd.,Tigard,OR 503.598.19 9722)503.598.2124V_ 2 9 2014 Plan Review Date/By: Other Permit: r 1 t: \r u Inspection Line: 503.639.4175 Date Ready/By: luris. 65 See Page 2 for Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF F WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST WORK Mechanical permit fees*are based on the value of the work ❑New construction -Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and pro Value:$ 3/QQ d CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* &I`I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating cooling: Air conditioning 46.75 Job site address: 134,Q7 S(� T fc c y (7I. Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 1y -J / e q 7 Z Z 5 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: M 5 Duct work / 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 Flue vent for water heater or gas kdd :4-■d*1 fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 :..PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation: Name: 44-,9 M -, S4_f/ Range hood/other kitchen r equipment 1 . 33.39 Address: I 3o9 7 5 W mi., Pi Clothes dryer exhaust 33.39 City/State/ZIP: -1.,dM 4) � q ZZ 3 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(5 O ✓�70 ly 6 q Fax:( ) Attic/crawlspace fans . 23.32 0-APPLICANT ❑ CONTACT PERSON Other: 23.32 W f , Fuel piping: � Business name: 5ur� D 1/ a "‘ 514.15 for first four;$4.03 for each additional Contact name: Furnace,etc. S{' Ti,�S of _ , Address: $7 5 5i,..5 130 - A v..,_ Gas heat pump 4,v R7 MS' Wall/suspended/unit heater — City/State/ZIP: W Water heater Phone:(4.0�j) Ta/-Z4 3 Fax: :( ) Fireplace I // Range E-mail: Barbecue I , CONTRACTOR Clothes dryer(gas) / j Other: Business name: q,.Nr Pa try 6Di,4 lti l 01. MECHANICAL PERMIT FEES* Address: 5G 5 5 V 1 30 TN / t>e Subtotal City/State/ZIP: -' -)157%,‘ 67zs 4 70o 5- Minimum permit fee($90.00) / Plan review(25%of permit fee) Phone:(5703) 9�/-Z(r 36 Fax:( ) State surcharge(12%of permit fee) CCB lic.: /11554 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: .�c� 3e-1,>6 'r,5so1 Date:7-Zy /11 I:\Build ermits\MEC_PermitApp_040113.doc 440-4617T(I1/02/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. l:\Building\Permits\MEC_PennitApp_040113.doc 2 ' 'Plumbing Permit Application ��f 1�� Building Fixtures Received City of Tigard Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 JUL 2 9 2014 Date/By: 7 8y /f! ST�I -tom/ : • Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.: I c, \I;I Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WO:'1 I I , I I I , FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. I Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 e1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath - 437.78 SFR(3)bath . ❑Accessory building ❑Multi-family - 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 36 q 7 5 , -r,�c er Catch basin or area drain 18.76 City/State/ZIP: / y Drywell,leach line,or trench drain 18.76 T t 7 2 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.. Project name: /1/1 1 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 a Clothes washer 25.02 t I e) a *z a''L Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: h;t>/x, I' ► 51-t y Fixture/sewer cap 25.02 Floor drain/Floor sink/hub 25.02 Address: 136 q 7 , i,,0 1- i a G P� ,,��77 p Garbage disposal 25.02 City/State/ZIP: 'r• arJ U _ 9' 2,2 3 Hose bib 25.02 Phone:(503) cf` o- gi7i gq Fax:( ) Ice maker 12.51 a-APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: . Medical gas(value:$ ) Page 2 ter/ a ar• 6.o #6.,_.1',d� Primer 12.51 Contact name: ^ L-e `X 'SSv Roof drain(commercial) 12.51 Address: Lj,s ) 3 t.)1S A a Sink/basin/lavatory ( 25.02 City/State/ZIP: V Gr p6S- Solar units(potable water) 62.54 Phone:( 03) w/ 26;6 Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: PC 4y„( VI'tw„� ,ti5 5jeZv;�S Waterpiping/DWV 56.29 Address: f Jd I / Other 25.02 City/State/ZIP: cC 10 h f2 111 VVYC P_ ^' 13 2„ Subtotal Phone:( i(1 ) 390- 4/17 9 Fax:( ) Minimum permit fee: $72.50 CCB Lic.: l7.). )1.4 1 Plumbing Lic.no.: pp q q� Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: C� ia,55C. i 1 TOTAL PERMIT FEE Print name: •• Date: ^f% 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\PLMU-PermitApp.doc 10/01/09 440-4616T(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-151 100' 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 (minimum charge 1/2 hour) each additional$100.00 or fraction thereof. 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 Baptistry/Font El Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram ❑ 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: -LavBar non-food related -Bradley -Com/Scrv/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 • : . • III City of Tigard• ■ COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED T I G A K D Building Permit Review — Residential II II 2 P 2011 Building Permit #: H 5 i c C [ c-L- CO /a 3 CITY OFTIGARD BUILDING DIVISION Site Address: 1 369 5 Tv-w7i PI . Project Name: Misr Lot #: (New dwelli g=subdivision name;Addition or Alteration=last name of owner) Planning Review r Proposal: re,moval c4 d e c),C and Y-we st'ruictu,(ee'; 310 scar. foci- add i-ion, f conversion of 9graa3� space, "1-0 ltvinq N Verify site address/suite #exists and active in permit system. J Site Plan Elements: E ,f 'l'h (3)copies of site plan IJExisting structures on site ire plan must l g on 8-1/2"x 11"or 11 x 17"paper El ootprint of new structure(including decks)with finished ]drawn to scale(standard architect or engineer scale) or elevations worth arrow Utility locations(required for new,may apply for additions) ite address,project or subdivision name and lot number -iftLosation of wells/septic systems E'Applicant information(name and phone number) Ll ,rosion control(including drainage-way protection,silt fence of dimensions and building setback dimensions �design,location of catch basin,etc.) Lot area,building coverage area,percentage of coverage and [Street names impervious area(applicable if R-7,R-12,R-25&R-40) a'rreet tree size,type and location [perry corner elevations(2 foot contour lines if more than i Existing trees to be retained with drip line,and tree 4 foot differential) protection measures Clean Water Services-Service Provider Letter: (lot platted prior to 9/10/ 995): Required: IV Yes ❑ No Received: ®/Yes ❑ No -g-Land Use Case#: rd/Zoning: R.,-, LJ Setbacks: Front 15 t Rear (5 1 Side 5 ' Street Side — Garage 20 [[Landscape Requirement: 10 0/Lot Coverage Maximum: g0 % �uilding Height: Maximum Height 35 Actual Height N 2$ isual Clearance Lid' Easements show $1 real" of -Fror l" PUE Sensitive Lands: rr Yes ❑ No Type 25 to q rode-- --S--Urban Forestry Plan �l -R-Conditions Met Notes: Approved By Planning: Date: -I 151 , N Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Bu ilding\Forms\BldgPermitRvw_RES_042914.docx Building Permit Submittal Original Submittal Date: 7/0 9/Mt Site Plans: # Building Plans: # Building Permit#: ,I'Enter building permit#above. Workflow Routing: Planning [ -Engineering Permit Coordinator -a—Building Workflow Sign-off: 2Sign-off for Planning(include notes from planning review) Route Application Documents: engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. L1 B�uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: L> Date: ,7/x.9 Engineering Review ❑ Actual Slope: ❑ Conditions Met Notes: V U‹ r c.,.e_. js,S•'us S Approved by Engineering: / Date: 7 n 14 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved .711■/1/1■ 411•10111111M Permit Coordinator Review ❑ Conditions Met-Prior to Issuance of Building Permit Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Scnt to Applicant: Revision Notice 3: Date Sent to Applicant: K to Issue Permit Approved by Permit Coordinator: r • Date: �/3v//ii I:\B uilding\Forms\BldgPermitRvw_RES_042914.docx Clean Water Services File Number CleanWateer Services 14-001946 Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: Tigard ._ N r 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Ashish Mistry JUL. 9 -.14 25104CD10600 Company: Address: 13697 SW Tracy PI ��(- 1 r'I(`A Site Address: 13697 SW Tracy PI Tigard,OR 97223 �UILIJI r City, State,Zip: IVGDIVISIVN City, State,Zip: Tigard,OR 97223 Phone/Fax: 5030970-9489 Nearest Cross Street: E-Mail: mistry_family @hotmail.com 4. Development Activity (check all that apply) 5. Applicant Information IN Addition to Single Family Residence(rooms,deck,garage) Name: Eric Hess ❑ Lot Line Adjustment ❑ Minor Land Partition Company: Eric Hess,Architect ❑ Residential Condominium ❑ Commercial Condominium Address: 3501 26th PI W,#120 ❑ Residential Subdivision ❑ Commercial Subdivision Li Single Lot Commercial Li Multi Lot Commercial City,State,Zip: Seattle,WA 98199 Other Phone/Fax: 503-816-4858 E Mail: erchitect @centurylink.net 6. Will the project involve any off-site work? ❑Yes 0 No ❑ Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project The existing deck goes 14 1/2'beyond House on NW side,new addition will be 11'with a 5'deck 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 Eric Hess Print/Type Title Architect ONLINE SUBMITTAL Date 7/4/2014 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. Ij 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 07-20, Section 3.02.1. 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 SensitiveArea 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 07-20,Section 3.02.1. 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 PROVIDER LETTER IS REQUIRED. Reviewed by "'mac /-141,11-1- Date 07/14/14 2550 SW Hillsboro Highway • -idlsboro. Oregon 97123 • Phone (5031 681-5100 • Fax. (503)681-4439 • www.cleanwaterservices.org :.•#64 141:ioji '-' ' ' V.. - 4 • 41,14\ . • 0' •v Pjl: - .1 . 1: '33 '' ju II: ‘ ,.. :' • , c. ;te,6.,, , __T .. ilie.+01 i 11.T./ " . '. , , OF fi.•`-.'-'•• ' . 171) I • et '-' • . r #11 i -.4 , 0., ,S. .....,t !2.1t.74-.::I ,O• V4is, ,,. ' •* • iiirlit • t ./- . AI,C1'.% -40 1 I al: . .",, . .. 's. ..-.41: 1 11.tpr) ,..• 00 4(1?$4zr...1. .111110511•6'1,.: . * --. ...14;:, (,/. .',211. , lik6• ,.;,,c17/H. CA , ' _ - ' • ' rill:lilt' ef .,- 4. ..4".- "014:: .., I %,‘ y,it# , * .1378 1 1.4 1 ,' 11101,21k .. 0.11r 1 libitHVAr iler it ' 11 3742.: “ 41;1" . 5.7,, GRADE RECEIVED M,�se JUL 2 9 2014 �- / - I SITE INFORMATION OWNER ' _n, pttyv� ADDRESS: 13697 SW TRACY PL ASHISH AND RITA MISTRY CITY OF TIGARD P .oaccm.* — TIGARD,OR 97223 13697 SW TRACY PL. BUILDING DIVISION 9� X45 � GmDE — / . LEGAL DESCRIPTION: - TIGARD,OREGON 972223 OF 0a 597 01'0-'111'4— L°,675 PHONE:503- / I PROPERTY ID: R2041045 —912— TAX ID NUMBER: 2S104CD10600 _ LOT AREA 12,197 SQ FT,.28 ACRES - 0 I ZONING NORTH R-7(PD) 0, BUILDING AREAS IMPERVIOUS AREAS „TE CURRENT ADDITION EXISTING IMPERVIOUS ROOF AREA: 2,752 SF I 0 SIDE YARD TOP OF _ ' GARAGE 790 SF 592 SF NEW ROOF AREA ADDED: 355 SF co O �� FIRST FLOOR(HABITABLE 1733 SF 1733 SF TOTAL IMPERVIOUS ROOF AREA 3,107 SF v � GARAGE CONVERSION TO LIVING 198 SF F d a �CONTROLVALVE ADDITION - 354 SF -,1., I SECOND FLOOR 1658 SF 1656 SF F 2 ADDITION - 16 SF vi cYc s I ❑ �� 1G — TOTAL ADDITION 370 SF r as (N)ROOF.A TOTAL F ��`% �F* I REQUIRED SETBACKS � DJ � I �� EK►Ettl'80F F Co- C,DE F. 4 are a ROAMED DECK FRONT SETBACK HOUSE: 15 FEET Q rn r D pgn�D� ( REAR SETBACK: 15 FEET 2- O o ` � ° �� era • .LIM SIDE SETBACK: 5 FEET V). V - %�/ ' ` •GRADE _ — -- MAX AVERAGE w w Z '��11`,� 'EL�1S � —� HEIGHT ALLOWED 35 FEET ¢ Z w a.z O DEMOLISH —_II r TREE (E)DECK h% - - A �_■ 0 F a I � (N)DECK / a �1 I a �\ �h C� d '^ U F (E)DOWNSPOUT L vJ 4. TO REMAIN - DS r -` - � s co -- J - ❑ RELOCA DOWNS•••' o U) o ABOUT 10• , .RE-TIE INT. uo o I ORAOE), UNDERGROUND- ORM °'522- °v_ qJ I INSTALL(1)NEW DOWNSPOUT EL DRAIN LINE AND TIE INTO(E)UNDERGROUND I STORM DRAIN LINE z —(E)GAS METER I 2-STORY WOOD FRAMED AND BRICK HOUSE, \ (E)AC COMPRESSOR FIRST FLOOR ELEV=6220' A-4 4 _L —JI I+ (E)ELEC METER J rEl F I \I F- S U I I I a I-" Ui \ CO W I GRAM J a•ar U I l��1;. — J — J 111 I w r��l� /DRNEWAY / I I 1 (E)UNDERGROUND ��I – – – – ELEC LINE NO. REVISIONS '�d``• I 1 (E)CONTROL VALVE 5 TREE •�.II.. s BOX 1�(E)COWER �`UJ 4 (E)DECIDUOUS 'wax '�yAL ��(E)CONTROL VALVE 3 GRADE 1, �(E)VALVE BOX EL 0324' 0 l__ 1 -! 2 - _. ______ —~ — — U DrIT R ( ')ry� ! ham[ �GL(� CITY OF TIGARD SUB. Issue For Pernik PROPERTY LME L=77. \\\ ate' P`'t Approved by Planning DATE 15 JULY 2014 (E)STREET LIGHT I I �(E)FACE CURB (BIDL�K METER I FILE Motry-MO �i Date: 01- X1. 1 W BA)S ATCH ; S W TRACY P L I _(E)UNDER- -GROUND GAS Al .0 // LINE Initials: _ 8'DIA SANITARY MAIN n� is1 z /� /. �00e S 12'DIA.STORM MAIN O O SI PLA N I 0 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13697 SW TRACY PL, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal PASS December 19, 2014 at 9:47:04 AM MST2014-00123 David Young Corrections from previous inspection done, Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13697 SW TRACY PL, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL December 19, 2014 at 10:52:21 AM MST2014-00123 David Young Provide smoke detectors in all sleeping rooms. R313 Recall after correction complete. Engineers letter received for retaining wall as built. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13697 SW TRACY PL, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal FAIL MST2014-00123 George Heimos 1. Add to existing permit: 1-ea garbage disposal and 1-ea ice maker, all else ok. 2. Recall inspection when correction has been completed. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13697 SW TRACY PL, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS MST2014-00123 Jeff Grove Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13697 SW TRACY PL, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2014-00123 George Heimos Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13697 SW TRACY PL, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection PASS - No C of O December 30, 2014 at 9:15:47 AM MST2014-00123 David Young Correction done. Smoke and carbon monoxide detectors installed. Violation Summary: Inspector Contractor