Permit (19) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2016-00291
TJIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/23/2016
Parcel: 2S115AA04200
Site address: 10531 SW KENT ST Jurisdiction: Tigard
Subdivision: DOVER LANDING NO.2 Lot: 81
Project: Leggett
Project Description: Covered patio addition with 2nd story living space over and interior remodel.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5
Height: 24 Parking Spaces: 0
9 Bathrooms: 0 Second: 296 sf Garage: 0 sf Front: 20
Dwelling Units: 1 Smoke
Third: 0 sf Right: 5 Detectors:
Total: 296 sf Value: $80,000.00 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 2 Washing Mach: 0 LaundryTrays: 0
Y Rain Drain: 0 Urinals: 0
Lavatories: 3 Dishwashers: 0 Floor Drains: 0
Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Drains: 0
Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: p 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: 0 Other Units: 0
Furn<100K: Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders
Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add9 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 5
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
Y Garage Opener: N All
Other: N Other Description: N
Ecompasing:
BUILDING INFO
Class of Work: Type of Use:
ADD Type of Constr: Occupancy Group: Square Feet:
SF VB
R-3 296
Owner: Contractor:
LEGGETT,ADAM R GIBB CONSTRUCTION&REMODELING INC Required Items and Reports(Conditions)
10531 SW KENT ST 15755 SW SERENA WAY
TIGARD,OR 97224 TIGARD,OR 97224
PHONE: PHONE: 503-407-9686
FAX: 503-549-8986
Total Fees: $2,515.73
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 through 0•R 952-001-0090. You ma obtai -copy of the rue . direct questions to OUNC by callin.503.232.1987 or 1.800.332.2344.
Issued By: L _ G
-' •- i.nature: Allfr-''
'. ---'6tlft 39.4175 by 7:00 a.m.for the next available inspection dat.,
This permit card shall be kept in a conspicuous place on the job site until completi•n of the project.
Approved plans are required on the job site at the time of each inspection.
Bui_ Permit Application
• Residential
City of Tigard FOR oHr1cl. Lyse otiL1
:" " 13125 SW full Blvd.,Tigard,OR 97223
Received
I Phone: 503.7182439 Fax: 503.598.190 Date/B : %y �� ,� permit No.: ��(6�.�xQ
Plan Review y 6'
T t G g R p Inspection Line: Date/B : g
Internet: Line:g 503.639.4175.gov Date Ready/By: Other Permit:
Notified/Method f✓ lin H See Page 2 for
Supplemental Information
TYPE I • .. 4 , ..,,r i V i-. .1�'
tT REQUIRED DATA:1-
AND 2-FAMILY DWELLING
0 New construction
0 Demolition 1
K,/Addition/alteration/replacement Permit fees*are based on the value of the work performed.
0 Other: Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION equipment,materials,labor,overhead,and the profit for the
■' ! 1-and 2-family dwelling work indicated on this application.
0 Commercial/industrial
NumberValuation:
❑Accessory building $ d�y
er Deo
0 Multi-family of bedrooms:
0 Master builderQ
0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION
Job site address: 0 -
-- Total number of floors:
City/State/ZIP: �r' New dwelling area:
1 7 Z 2 i square feet
e/
Suite/bldg./apt.no.:
Garage/carport area: square feet
Project name:
Cross street/directions to job site: Covered porch area:
15/, 7 square feet
ti I---> /b2-4"' Deck area:
square feet
Iiiiiiiiiiip
Other structure area:
ax
square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:
Tmap/parno.: Lot no.: Permit fees*are based on the value of the work performed.
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 a..lication.
Valuation: $
Existing building area:
square feet
IM
�' PROPERTY OWNER New building area:
0 TENANT square feet
Aill 4441Number of stories:
Address: d -3( j lam- T Type of construction:
City/State/ZIP: ST
77641frp 4 L r 742- Occupancy groups:
Phone:( )
111111111111N APPLICANT
le CONTACT PERSON
11211111111111111111111111
Business name: BUILDING PERMIT FEES*
, vim
Contact name: -1,44 %�,, Please re er to ee schedule
Address: f��� 1111111111
�✓t Structural plan review fee(or deposit):
City/State/ZIP: 111111111
�Z Q C,r, FLS plan review fee(if applicable):
` ' " et X1722
Phone:( ) Total fees due upon application:
MEM
Amount received: ��
/M r i
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
Business name: �� roof-top mounted PhotoVoltaic Solar Panel System.
3 C ''5 c , -nv
ails
Address:
Submit two(2)sets of roof plan with connecft
i_
and depa ent access,along �uieegon
City/State/ZIP:
Solar firesta//a ion .ecus e c -the 2010 Oregon
e checklist.
Phone:( ) es plan review
admin' ative fees): $180.00
CCB]ic.: Ir _ 11111
.icharge(12%ofpertn t
$21.60
Authorized signature: #�� �L- Total fee due upon application:
This permit application $201.60
Print name: expires if a permit is not obtained
-7 Manwithin 180 days after it has been accepted as complete.
Date: *Fee methodology set by Tri-County Building Industry
1:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 Service Board.
440 4613T(11/12/COM/WEB)
y r
Buildin Permit A lication Checklist Fox OFFICE USE omv •
One- and Two-Family Dwelling
Received Permit No.:
Date/By:
City of Tigard Associated permits: ❑ Mechanical
IN ■ 13125 SW Hall Blvd.,Tigard,OR 97223 0 Electricald pe ❑ Plumbing
■' Phone: 503.718.2439 Fax: 503.598.1960 0Other:
24-Hour Inspection Line: 503.639.4175N.T 1 V A R 1) Internet: www.tigard-or.gov 1'es o
FOR PLAN REVIEW 0 `/A
THE FOLLOWING ITEMS ARE REQUIRED0 0 0
1 Land use
Floodslain,s solar balance •of ts,se seismic soils desi:nat on on criteria for concurrent
historic reviews.
district,etc. 0 0 0
2 Zonin_ 0 0 0
34 Fire
Verification of a r o rovedl u red. . 0 0 0
4 Fire district a royal re•aired. Name of district: 0 0
5 Se i tic s stem ,ermit or authorization for remodel. Existin• system ca•acity 0 0 0
67 Sewer district 0 0 0
Water district a royal. 0
permit required. Include drainage-way protection,silt fence design and location of catch- 0
8 Soils report. Must cao❑ al a��hcable stamp and si_nature on file or with a��hcatton. 0
9 Erosion control 0 plan local and state 0 0
basin rotection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable
es between plan location and details. Plan review cannot be completed if
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 refer 0
co. right violations exist.
ck
opertY corner
ons
]1 Site/plot plan drawn to scale. The plan must show lot and building e back at 2-ft.dimensions;iopr)location of easements
and
location of wells/septic utility locations;direction
there isi more than a footprint
of elevation differential,ting planmust show contour impervious s systems;
area; uting structurestio ;on site;and
and driveway; structurecveraarea decks);
indicator;lot area;building coverage area;percentage of coverage; p0 0 0
surface draina:e. connection0
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connects water details,
vent size 0 0
and r plans. on, 0
on.
13 Floor venShow fall ans,dimensions,
fixtures,balconies anddecks30 size,nches above :rade,etc.detectors, 0
furnace, at> -
ders,
re than one cross section may be required to clearly portray
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,neamaterialSfootings
floor,wall con. Show; et ilsroofcall want, 0
construction. Show defare•of lacelconstructdion�t thermal ogulation,e t sof slope,ceiling height, g 0 0
and foundation,stairs,
c.
if the change in grade is greater than four foot at building envelope.
15 Elevation views. Provide elevations for
new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the grade0 0 0
Full-sizea sheetngaddenrum vepath)
o t n• foundation and/or lateral analysis plans.ons with Musteind indicate details and locations;for non- 0
16 Wall bracing th anal
kis p ) 0 0
•rescri rive •ate anal kis •rovide s•ecifications and calculations to en�ineerin• standards.
Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing0 0
17 Floor/roof framing.
locations. Show attic ventilation. of debar. For engineered
18 Basement and retaining walls. Provide cross sections and details showing placement0 0 0
s stems,see item 22,"En tineer's calculations." 0
19 Beam calculations. Provide two sets of calculationsausing current
code
de design values for all beams and multiple joists 0 0
l
over 10 feet Ion:and/or an beam/'fist carr top pathprovideschematic is required 0 0 0
20 Energy Codeoed floor/roof truss pass n details. 0
21 Energy compliance. Identify the prescriptive or calculations. A gas-piping 0 0
for four or more a••liances.
22 Engineer's calculations. When required o provided,e (i.e.,
l.,shear
e to the rooftr ss)shaller be stamped by an engineer or
architect licensed in Oreton and shall be0
.JURISDICTIONAL SPECIFICS 0 0 0
23 Three 3)site •lans are re•uired for Item 11 above. Site •lans must be 8-1/2"x 11"or 11"x 17". 0 0 0
24 Two(2)sets each are re•uired for Items 16,19,20 and 22 above. 0 0 0
25 Buildin• glans"bshah not ns remelines or et criteria outlined in the Permit irrored" &Snstem Develo•ment Fees ldocument. 0 0 0
26 -Reversed" a "ingin dans must applicable),and City of Tigard 0 0 0
27 "Drawn scale"indicates standard,type arcoor er appro scale. 0
28 Site plan to include tree size,type and location per approved project street tree plan(if app )�
1 Street Tree List. 0
0
le and must include the •ro'ect arborist's si:nature of a, roval. ons 0 0 0
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,drip roes
sca
and •date Watere measuresicmustenbe drawn to e-
ver non-impervious surface)and accessory structures to existing residential dwellings
30 A Clean Services' Sensitive Area Pre-Screening Site Assessment form is required for all building
including decks,patio covers(o
on a lot of record a••roved •rior to Se•tember 9, 1995.
I:\Building\Pennits\BUP-RESPennitApp.doe 02/24/2011
44011613T(11/02/COM/WEB)
Mechanical Permit Applictjon ' '
FOR OFFICE usr 011.1
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Permit No.:
11111 il Phone: 503.718.2439 Fax: 503.598.1 6O Plan Review I .,5q
T I G A R U Inspection Line: 503.639.4175 Date/By: Other Permit:
Internet: Line:g Date Ready/By: Juris:
Notified/Method: See Page 2 nr
Supplemental Information
TYPE OF WORK COMMERCIAL. FEE* SCHEDULE - USE CHECKLIST
Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
❑New construction
Performed.Indicate the value(rounded to the nearest dollar)of all
L=1 Demolition
Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION• Value:$
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory RESIDENTIAL EQUIPMENT/SYSTEMS FEES*`
building
For special information use checklist
❑Multi-family
0 Master builder 0 Other: Description
JOB SITE INFORMATION AND LOCATION Qty. Ea. I Total
' Heating/cooling:
Job site address: /115-3 / 47 i. ' Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: `^�')
/ o ` �l Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name: Heat pump
61.06
Cross street/directions to job site: Duct work /I 23.32
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
Subdivision: Other:
I Lot no.: 23.32
Tax map/parcel no.: Other fuel appliances:
Water heater 23.32
DESC i ON QF 'fin ,. g- . Gas fireplace/insert 33.39
yy� f1 Flue vent for water heater or gas
�/ rtt�'V > % �� D�Z.' fireplace
23.32
Log lighter(gas)
23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
23.32
, PROPERTY OWNER - , IENII ,.m . : Environmental exhaust and ventilation:Name: 1
40
>C�?
Range hood/other kitchen
Address: equipment
33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) ; 23.32
Phone:( ) Fax:( )
Attic/crawlspace fans 23.32
APPLICANT . CONTACT P>RsON, Other:
Business name:
G ( Si-. _. 23.32
6�� Ga i iq Z."r 1 v)-t-4 = Fuel piping:
Contact name:
` �� $14.15 for first four;$4.03 for each additional
`111-4,4_ C. tialis
Furnace,etc.
Address: /E77��r7‘,7-3-5i. f - Gas heat pump
City/State/ZIP: - Wall/suspended/unit heater
�3 ,, �-j+72z-z.y Water heater
Phone:( �gt...)-1
f I Fax::( ) Fireplace
E-mail: �j+piz�r$T/f,4-.CTr ..,...1.-, Range
r."lBarbecue
CONTRACTOR Clothes dryer
Business name: Ti f drY (gas)
�� 'j a/� 3 6fty"L-c=-,u Other:
Address: �ItJ 1 �-� MECHANICAL PERMIT FEES*
City/State/ZIP: l - Subtotal
Phone: )-1 v0)-1 C) . 7 / Minimum permit fee($90.00)
C Fax:( ) Plan review(25%of permit fee)
CCB lic.: / (.�0 State surcharge(12%of permit fee)
trt�� TOTAL PERMIT FEE
.tom' — 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: Tal-yy J' 14 ( t
( !r i��- CMZ ea-j3 Date: t-�r Y
I.\Building\Permits\MEC_Permi1App 040113.doc
440 4617T(11 2/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information a.
Commercial& Multi-Family Fee Schedule:
Total Valuation: ; Permit Fe :
$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.
000.00 and
$2.49 for each to$100,000.00 oh additonal$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2. .71 92 for eaoch additional$100.00 or the first$100,000.00 r
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PemutApp_040113.doc 2
Electrical Permit Ap .t!atIi .i- a 1 4FOR 0I 11( 1'. ( '1, o y l.l'
'1! i ' a t .
City of Tigard "' p s eceived !�
11111 4 , +s s.,, bete/B : 747 _ �,t Permit#: M e90/ -64?)`
� 13125 SW Hall Blvd.,Tigard,OR 9727 Plan Review
Phone: 503.718.2439 Fax: 59 ,1 0 Date/B Related Permit#:
7 WARD IInprnnwLwinwetg5a0r3d.6o3r9g4ov1 -
` ,r'''140?‘ ? NRabdDMo:d A-is:
SpSpleemneaflnrfo
rmaUonr t-,,,,..,-, 1ap,,
,, s�- �^ � - �, z- r 'tea r s m
;`.',. �`z a .,.14,4 ,' :. e .,t! 11_,,, ,i , r $: "'Z'ao t- z ,,ri: x ?< ,6 4'r# `zA ::. K«`:
❑New construction It, L fit ;h/ittt` .tion/rep acini; i ;i V,' Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition Ej Other t H" r e l� r,i ❑Service or feeder 400 amps or more ❑Building over three stories.
v where the available fault current 0 Marinas and boatyards.
aV 4�.;''r r a 1 :,A> .D,:: Co` `' r a z exceeds 10,000 amps at 150 volts or
* W•�. «�,.?-�.��..� , ,-� -.� 0 Floating buildings.
g/ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
• Multi-familyOther: amps for all other installations. buildings.
0 Master builder0
,-. , .. Fire pump.
❑Installation of 150 KVA
or
' r . I� .1 �, ttl ,1_ .3. T4sit> 0 Emergencysystem. larger separately derived
Job#: Job site address: t / 0 Addition of new motor load of system.
r®s-3/ 7 V `jT 100HP or more. 0"A","E","1-2","1-3",
City/State/ZIP: dr4i / . 972'y� ❑Six or more residential units. occupancy.
❑Health-care facilities ❑Recreational vehicle parks.
Aiguitebldg./apt.#: I Project name: ❑Hazardous locations 0 Supply voltage for more than
❑Service or feeder 600 amps or more600 volts nominal
toss street/directions to job site: �-- rix-a ,m.� ,j¢F g.� ,
7,1
Description Qty. 1 Each Total *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
�
� �� ,, Ea.add'l 500 sq.ft.or portion 33.92 1
_ : 4-'1":: �_`., . '/ as�a�l�rU�v�,. -. a A. P4ti , " Limited energy,residential
ye (with above sq.ft.) 75.00 2
a
�v�ri N Limited energy,multi-family
-, L residential(with above sq.ft.) 75.00 2
r A4� r>xY ❑ See Page 2
� - ��- -� :-w�. ���,�,�t � �. � � .a a j� � � Renewable Ene
_T = Services or feeders installation,alteration,and/or relocation
Name: ��'✓�' /3...bt200 ampsor less
100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Illity/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,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 2
°`: `t , '' `' �t: -`� o• --;:t„.1? Branch circuits-new,alteration,or extension,per panel
� � 4` � "` A.Fee for branch circuits with
Business name: i'3. c ,r styut`?(�J -� 'Cr I 2 above service or feeder fee,
�•C� v Z•���'� each branch circuit 7.42 2
Contact name: 7y1,L B.Fee for branch circuits without
['�- service or feeder fee,first
S 7 J //J ���� G"r branch circuit 56.18 2
Address:
City/State/ZIP: 'ri`�yf-, bvt _ 477 if_'yQ Each add'l branch circuit 7.42 j'L1 2
��J[[V 1 V�•- ( vvT I
one:(P)1) LID 7_g/_ 7 Fax: :( ) Each manufactured or moduus(service lr feeder not included)
mail: 01 5 G�S lrlv�f it (moo I�J C- 4,,,
dwelling,service and/or feeder 67.84 2
T•v E-
.,� Reconnect ect on1Y 67.84 2
,` ,- C'O 09.R , Pump or irrigation circle 67.84 2
Business name: 124 L Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. 0 See Page 2 2
-
•ty/State/ZIP: Each additional inspection over allowable in any of the above
Phone:(9)31 ! 5 3" 3 z....1
Fax: Additional inspection(1 hr min) 66.25/hr
( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.:( 3 2.9) A Electrical Lic.: !j.:7 Suprv.Lic.: /c^ specifically listed(%z hr min) 90.00/hr
*pry.Electrician signature,required: [��J ELECTRICAL PERMIT FEES
Subtotal:
Milirtint name: 'n.a..e pt t ya-t,2- .r tj Date: 95 I t I 0 Plan Review Required(25%of permit fee):
Authorized signature: `jam`-
��_/:% L`" State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
ry�.� _ _ / This permit application expires if a permit is not obtained within 180
Print name: /pili n Date: 7 /a.. f y days after it has been accepted as complete.
I * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 0-4615T(11/05/COM/WEB
' ' Plumbing Permit Application
.Building Fixtures 4 FOR OFFICE GSE ONE
City of Tigard Received
411 1 g 13125 S W Hall Blvd.,Tigard,OR 97224 Date/By: Permit No.: �� �i �o41/Phone: 503.718.2439 Fax: 503.598.1960 Plan Review f
Ins ection Line: 503.639.4175 Date/By: Other Permit No.:
I l G A R D p Date Ready/By: Juris: I ® See Page 2 for
Internet: www.tigard-or.gov
Notifted/Method: Supplemental Information
TYPE:OF YitbiaDING DIVISION _., 'FEE* SCUT DULE £ '
0 New construction ❑Demolition For special information use checklist
Addition/alteration/replacement Description Qty. Ea. Total
❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION, SFR(1)bath 312.70
El1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath
437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities:
Job site address: ( /19-3 f 4 J , /4E-Air .Sr Catch basin or area drain 18.76
City/State/ZIP: 'Tf� ! L✓/�yj a Drywell,leach line,or trench drain 18.76
/ �'/ '97?214Footing drain(no.linear ft.:-) Page 2
Suite/bldg./apt.no.: I Project name:
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 serviceno.linear ft.:
Subdivision: I Lot no.: ( -) Page 2
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
" °` A' Backwater valve 12.51
DESCRIPTIQN OF wo*iC
/!t9_ '` Diothes shwasher 25.02
€31-n--/ �� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
'PROPERTY 6WNE1k
TE 1ANT` Expansion tank 12.51
Name: -047-n t .-r-r Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
Phone:( ) i Fax:( ) Ice maker
12.51
AI"PLICANT +CO," ACT PERSON Interceptor/grease
.
vT.r: . trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: ♦ `amt /'�.i ? �/ Primer 12.51
Address: /5-? C _ Roof drain(commercial) 12.51
` 4 -/e - G1-* Sink/basin/lavatory `> 25.02
City/State/Z1P: 776' 1'��j i3-71 .. 9 7 2 Solar units(potable water) 62.54
Phone:(c-b-3) ct0-7-qt/ /a I Fax:::( ) Tub/shower{shower pan/
/ 12.51
E-mail:et PJ�J ( 1L1 LSA Urinal e ✓
C-r�+JS't/L+-LGT1 ct . (.704..e...41-r. NJ t1=� 25.02
CONTRACTOR Water closet 2- 25.02
Business name: lWater heater 37.52
fri 1 ' `r ����6/ \I 6 Water piping/DWV 56.29
Address:
rS4-./ Ci r rt,{j Or /d ? Other: 25.02
City/State/ZIP: i 1 .g gw67( Subtotal
Phone:(533) , 1 r/ Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 7 1 6(4) j �+0 �S Plumbing Lic.no.: ...1/71��y Plan review (25%of permit fee)
Authorized signature: State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Print name: 7piekI Date: °/1/4,(//0 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\PLMU-permitApp.doc 10/01/09 440-4616T(l0/02/COM/WEB)
PPagelumbing2 Permit ApInformationplication - City of Tigard
- Supplemental
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. Fee tea) Total Square Footage: Permit Fee:
50.03 0 to 2,000 $121.90
Footing drain 1s`100' 2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Fee{ a) Total 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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
9-0.00/hr
Additional plan review for revisions 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 Repine/ Please check all that apply.
Work Performed: Capped Added Relocate 0 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 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
_3" IsometricDia
``or Riser gram ,,4
4>°
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
. '
Clean Water Services File Number
AUG 2 3 21eanWate\ Services I 16-002928
tt re-Screening Site Assessment
A
1. Jurisdiction Tigard u.� 14 <j� `�; (p
• 2. Property Information(example 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Adam Leggett
Company:
Address: 105315W Kent St
Site Address: 10531 sw Kent St City,State,Zip: Tigard,Or,97224
City,State,Zip: Tigard,Or,97224 Phone/Fax:
• Nearest Cross Street: Durham E-Mail:
4. Development Activity(check all that apply) 5. Applicant Information
fia Addition to Single Family Residence(rooms,deck,garage) Name: Tom Gibb
❑ Lot Line Adjustment ❑ Minor Land Partition
Company: Gibb Construction&Remodeling
❑ Residential Condominium ❑ Commercial Condominium
EaResidential Subdivision Address: 15755 SW Serena Ct
❑ Commercial Subdivision
DISingle Lot Commercial LaMulti Lot Commercial City,State,Zip: Tigard,Or,97224
Other Phone/Fax: (503)407-9686
151 square foot addition to back of home
E-mail: gibbconstruction@comcast.net
6. Will the project involve any off-site work? ❑Yes id No ❑Unknown
Location and description of off-site work
• 7. Additional comments or information that may be needed to understand your project
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, agrees acknowledges andthat
u g 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 Tom Gibb
Print/Type Title General Contractor
ONLINE SUBMITTAL Date 8/3/2016
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
ay also be required.
' 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
410 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
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.
41) Reviewed by +/a a'tie "7'" 1".
Date 08/04/16
2453 S rd f flJk$. `,'ai,Jf-r:�� 'y !sill f coo i ,i 23
d _ • 01 ( ;,I �Fit-51011 • F5
F�'.1-4439 • �^reanev,3lrr,ervicr�.o!q
City of Tigard
1,1 . a COMMUNITY DEVELOPMENT DEPARTMENT
T l c A R o Building Permit Review — Residential
Building Permit #: ���-p l(P _0 D - /
Site Address: /OS / `a J 14
Project Name: Le'g /7
e7- ,C,,�Sr1 _ Lot #:
(Ne 4w011ing=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: /(, Cz 1.,,e,-f'� ,
n �` Vic, -- / 7yL dlal /9-7 1,,.."_
Verify site address/suite# exists and activein
permit
Y ermit system.
M�iver Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Sit lan Elements:
ee(3)copies of site plan 'sting structures on site
ll
b"� - plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including
7'II awn to scale(standard architect or engineer scale) oor elevations decks)with finished
�'rth arrow 1
ii ty locations (required for new,may apply for additions)
'5te address,project or subdivision name and lot number fIll'11 6cation of wells/septic systems
re plicant information(name and phone number) N .',sting trees to be retained with dripline,and tree
ro
ot dimensions and building setback dimensions . tection measures
III I t area,building coverage area,percentage of coverage and ret tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40)
��Street names
(perry corner elevations (2 foot contour lines if more than
4 foot differential)
❑ Clean Water S ices—Service Provider Letter(lot platted prior to 9/10/1995):
Oy� Yes ',: `,'.
Required: Yes,applicant was notified ❑ No Received:
T>A'ublic Facilities Improvement(PFI) Permit: / /f )5s J t
Required: V �
Re
q ❑ Yes,applicant was notifiedNo Applied For: ❑ Yes ❑ No,stop intake
;p and Use Case#:
° oning: p, 2 71.g. 0)2))/5""
PA Setbacks: Front 7O Rear / c Side ,S Street Side 4..)49 Garage
J Alandscape Requirement:
V 1 ot Coverage Maximum:
II4 Building Height: Height Maximum, 30 Actual Height �f 16v h1'�'isual Clearance
` asements
W'r.ensitive Lands: ❑ Yes ❑ No Type
X, rban Forestry Plan
kConditions "Met"prior to issuance of building permit
otes:i,ft‘
Approved By Planning: - -~ Date:
Revisions (after Building Submittal only) Reviewer
Revision 1: ❑ Approved ❑ Not Approved Date
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\BuildingTorms\BldgPermitRvw RES 060116.docx
Building Permit Submittal
Original Submittal Date: �/iti/i
Site Plans: # 3
Building Plans: #
Building Permit#: Enter building permit#above. �'�uildmg
Workflow Routing: 121"Planning . -Engineering u-Permit Coordinator
Workflow Sign-off: Er Sign-off for Planning(include notes from planning review)
Route Application Documents: Er Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: . _ Date: 7y /lo
En veering Review
Slope at building pad:
Conditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on 1st: ❑ Yes No
❑ NOT Approve• y Engineering:
Date:
Notes: . /Fle/���
Approvedby �Engineering: 1JDate: 7-/ 6
Revisions (after Building Submittal only)
Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
EigDC Fees Entered: Wash Co Trans Dev Tax: C] Yes !a /A
Tigard Trans SDC:
e-CI Yes FAQ /A
Parks SDC: ❑ Yes ���N/A
AI K to Issue Permit //6V4p
Approved by Permit Coordinator: Date:
I:\BuildingTorms\BldgPermitRvw_RES_060116.docx
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
10531 SW KENT ST, TIGARD, OR, 97224
Residential - Master Permit
699 Mechanical final
PASS
November 4, 2016 at 9:36:59
AM
MST2016-00291
Jeff Grove
Violation Summary:
Inspector Contractor