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Permit CITY OF TIGARD MASTER PERMIT ti COMMUNITY DEVELOPMENT Permit#: MST2020-00043 AR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2020 T Parcel: 2S 103BA00124 Jurisdiction: Tigard Site address: 12080 SW 116TH AVE Subdivision: LERON HEIGHTS NO.2 Lot: 38 Project: WARD Project Description: A new 56 sq.ft.family room addition and demolition of walls, and beam installation. Upper level remodel includes combining two bedrooms into one large master. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 56 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 56 sf Value: $95,000.00 Rear: 15 PLUMBING Sinks: 3 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 400 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 3 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 4 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 2 0-200 amp: 0 W/Svc or Fdr: 20 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 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: ALT SF 56 Owner: Contractor: WARD,JEFFREY&CYNTHIA JW&ASSOCIATES LLC Required Items and Reports(Conditions) 12080 SW 116TH AVE 9080 SW GRAPHITE TERRACE TIGARD,OR 97223 BEAVERTON,OR 97007 PHONE: PHONE: 503-860-7031 FAX: Total Fees: $4,002.02 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 OAR 952-001-0090. You ma a e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 f Issued By: Permittee Signature: l G e 03.539.4175 by 7:00 a.m.for the next available insp This permit card shall be kept in a conspicuous place on the job site until comp etion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential RECEIVE roil Ol H( ►. l 'I: 0y1.1 City of Tigard Received / /� permit No.:/� i Date/By: /f L V Z '"3 i 7 i `s� - C 3 11,1 . 13125 SW Hall Blvd.,Tigard,OR 97223 iph 1 vt 6 ZULU Plan Review I p/� Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ,� AA- Other Permit: I, t 1l D Inspection Line: 503.639.4175 1(Y OF'TIGAR D Date Ready/By: / Juris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DI t1 !U tified/Method• ,jJ , ' '''.—C Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all SI Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead, nd the rofit for the '‘9\P CATEGORY OF CONSTRUCTION work indicated on this application. �j g1-and 2-family dwelling ElCommercial/industrial Valuation: ,G * CST ElAccessory building 0 Multi-family Number of bedrooms: ❑Master builder ElOther: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: Izago s; al, //i r.'i ,vim New dwelling area: j"� square feet City/State/ZIP: 7.<�,-ez,. QR C 7 J.,23 Garage/carport area: C square feet Suite/bldg./apt.no.: Project name: calm J7 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. 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. / Valuation: $ Remade l'05 474 Li.7/Pew 1 Moil--e✓be eI/ it-~de t ...4 di u o / �7 �y Existing building area: square feet ✓l S?afit i! )O c"ciJ,,s< r IgGrM10 4u r'teirvr( / /7o4,yrr! X I.+ . ,-irreg. , ....2f;,,.,,�,_,�PJ y4y / New building area: square feet 0 PRO�PE'RTY OWNER ❑ TENANT Number of stories: Name:j gcc f C,,,, � r Type of construction: Address:/,ZO tad S ✓l<t t / fljl/E Occupancy groups: City/State/ZIP: 7-" e.,.a e"g0 9 7 2 2.3 Existing: Phone:(3,3) gate,. 7a.3/ Fax:( ) New: ar APPLICANT 0 CONTACT`PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: ` Structural plan review fee(or deposit): J Contact name: e F1 66 ,-1 FLS plan review fee(if applicable): Address: of me__ Total fees due upon application: // City/State/ZIP: / f. , ( ..4.a. Phone:(S"a,) fel'® 2.0 3 I Fax::( ) Amount received: E-mail: delec• J3z &� e��--r�r� - PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* <" p Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. t,.�r-5 Submit two(2)sets of roof plan with connection details Business name: JW,h+'5l�G / and fire department access,along with the 2010 Oregon Address: fV A0 Sr/� G,.-G774.7-G ?,eo/,-<- Solar Installation Specialty Code checklist. City/State/ZIP: Beli r Z Permit Fee(includes plan review ��< aH ( Gr/ 7�/d T and administrative fees): $180.00 Phone:(S 3) gee-70 7/ Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: /9 7d.5—e Total fee due upon application: $201.60 Authorized signature:. ii. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: j @ f C/./6/1 Date: /_/ ..,02,e5 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist r One- and Two-Family Dwelling I O R O 11 l c l. I '1. O y l.v Received City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical TIGARD Internet: www.tigard-or.gov 0 Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No 'i' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. ❑ 0 0 4 Fire district approval required. Name of district: • ❑ 0 0 5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0 6 Sewer permit. ❑ 0 0 7 Water district approval. 0 ❑ 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 ❑ ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0 building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 ❑ 0 there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. . 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0 furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ 0 ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ 0 ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0 prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0 systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 0 for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ 0 architect licensed in Ore•on and shall be shown to be a.•licable to the .ro'ect under review. JURISDICTIONAL. SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 ❑ ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ 0 ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0 including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE IJSE 0' I.1 Received City of Tigard Permit No.: - _ 'r, 1 u Date/By: A+5 L_ / t., 13125 SW Hall Blvd.,Tigard,OR 97223 , a:- r,, Plan Review a Phone: 503.718.2439 Fax: 503.598.1 i,.• Date/By: Other Permit: l I c;A R D Inspection Line: 503.639.4175 4" y rr �2� Date Ready/By: Jur s: ® See Page 2 for Internet: www.tigard-or.gov a N I, . V Notified/Method: Supplemental Information TYPE,`0- woR i�� e> - COMMERCIAL.FEE* SCHEDULE.'usE C .iS3 t O Mechanical permit fees*are based on the value of the work ❑New construction X Addition/alteratififfreplacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY Old' � IRIIcnoN- r Value: u. , , n «_,, RESiD ENTIAL EQUIPMENT/SWI' hi$FEW 12.1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB 1►R.MATION 1t .� oN !7 Heating/cooling: , " , K: �' ''',--"';'*1 '"" ' Air conditioning 46.75 Job site address: Izo sO _...5,-4/ //I ?' ,7t/t Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: -ri G,,,. / , 9 7Z2,3 Furnace u 100,000+BTU(ducts/vents) - 54.91 HeatSuite/bldg./apt.no.: Project name: L,�. t� pump us Duct work , 23.32 Cross street/directions to job site: Hydronic pot 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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 ; i.,� ' " ' i t ,k Gas fireplace/insert 33.39 r.. `` r --_ r - '. , . i �, Flue vent for water heater or gas J fireplace 23.32 • �e'r--C> �f fi G/t.�G7 i v.C'q �® f,./tlt�/f'1 JO ,� CC/G// � e"44,4,� l' �J Log lighter(gas) 23.32 /� ! Wood/pellet stove 33.39 Velir /L/�6.6,/6i76i4/GI'e+G ci!/� /4r;/ �ti./ � �fLf Wood fireplace/insert 23.32 /� s / Chimney/liner/flue/vent 23.32 d G�at �r Ai �s ..,c -,' Other: 23.32 • : .7','1.--' v •°� ,.''. Environmental exhaust and ventilation: Name: jeII f C,bicjv 6e��/ Range hood other kitchen ✓/ I equipment • 33.39 Address: /Zed O s' ta //I9fr tie.- Clothes dryer exhaust _ 33.39 City/State/ZIP: ;�`'� 9 7 Z zi Single-duct exhaust(bathrooms, f ..�"` , +'' 23.32 Phone:(S'-43) f�'d.°--7011 Fax:( ) Attic/crawlspace fans 23.32 m ,AP 'e ti: tt"� •, DWI I4 Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: J a_ft 4_4/// Furnace,etc. Address: /`C 1 f /76'>N /A Gas heat pump Wall/suspended/unit heater City/State/ZIP: 1 ,✓ f A 9 7�.2.3 Water heater Phone:(f03) ?l, Q_76,3 / Fax::( ) FireplaceRange / E-mail:j,..( , (.I/ a/Q e-Gi �ls-7v/'stGT Barbecue Y 3 i .-1 + t 4ti .. ..«... i :� Clothes dryer(gas) Business name: 70- ,/4� ,7- ut o Other: Address: S�'y‘ ��/L/ey�s�►: Subtotal �� City/State/ZIP: /n•r/G✓ L J(r,' e�/Z '7z zz Minimum permit fee($90.00)e J Plan review(25%of permit fee) Phone:( ) 7 ez....i y,7 Fax:( ) State surcharge(12%of permit fee) CCB lic.: /9��.e.,5� 7 17 ) / TOTAL PERMIT FEE �" 1 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: e �� Date: f—/S.Zerja I:\Building\Permits\MEC_Pe mitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi Family Fee Schedule: Total Valuat qn .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. I:\Building\Permits\MEC_PermitApp_040113.doc 2 Electrical Permit Application ro►z oil i i• 1 S►. otl.l City of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223RECEIVE " Date/B : ��, Plan Review ' g ll Phone: 503.718.2439 Date/B : Related Permit#: i !(, It I) Email: TigardBuildingPermits@Tigard-or.gov p y w, Ready Date/By: Juris: H See Page 2 for Inspection Line: 503.639.4175 Internet: wt (tiaii;► . Notified/Method: Supplemental Information TYPE OF WORKCtfy OF TIGARD I PLAN REVIEW 0 New construction Addition/alteratiotTY1 1'Q IDlVISION Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. j1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural Multi-familyampMaster builder Other: Fire for all other installations. buitngs. 0 ❑ ❑ 0Fire pump. Installation❑ of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑/�r/F �L� Addition of new motor load of system. Job#: Job site address: � s g® .. N > 100HP or more. ❑ A„ E„ l_z„ l_3„ City/State/ZIP: - 'cr 7z,Z-3 ❑Six or more residential units. occupancy. ` jai 0 Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: ' Project name: f��f� 0 Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.)�J 75.00 2 /1eP/tiles 40/OM, �✓cr/lC/ t/0.0�r ,QC-41 r..a7j YsiiC/ Limited energy,multi-family 1a 607- t" /Ze-Gr/4✓ 7 /G residential(with above sq.ft.) 75.00 2 Er PROPERTY OWNER El TENANT , Renewable Energy 0 See Page 2 0, / Services or feeders installation,alteration,and/or relocation Name:.Je/'l c,Nam /�`�s,./ / 200 amps or less 1 100.70 2 / C ff6s66� 201 amps to 400 amps 133.56 2 Address: /2 ake,, Seu. ,,,l?Lt./4;71„./L 401 amps to 600 amps 200.34 2 City/State/ZIP: -7 , 1,/,�/ ®R 5'7 3 601 amps to 1,000 amps _ 301.04 2 Phone:(3j73) a _7'3/ Over 1,000 amps or volts 552.26 2 �z Temporary services or feeders installation,alteration,and/or Email:,-fe 0 //''e,f7' f 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 exchhanggee accordin to ORS 447,449,670,and 701. i01'amps to 400 amps 125.08 2 Owner signature: �'F1 Date: J,—/5--- -)' 401 amps to 599 amps 168.54 2 !' APPLICANT El CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, .26 each branch circuit 7.42 2 Contact name:`i y4Ate' B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. g City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 J /Print name: _le ?' �� Date: /—/s=z o e, days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(I1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: i SIR WORK ONLY: FES SCHEDULE Description I Qty. I Each I Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: ._a Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 El Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specificaliz listed 0,171 m) Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC El Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical El Nurse Calls El Outdoor Landscape Lighting* El Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 Plumbing Permit Application • Building Fixtures Foiz (Auk is tsi. oyl.l Cl of Tigard Received Permit No.: .;.��_„ 114 u 13125 SW Hallll Blvd.,Tigard,O t '+ EVE Date/By: mJ I J(;r (,)i1�)i?) a Phone: 503.718.2439 Fax: 50 . A Plan Review D Date/By: Other Permit No.: Inspection Line: 503.639.4175 Lo I I G A R D JAN !,,44 '1 6L Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov c N!!Y .! Notified/Method: Supplemental Information 7 �' ',E Of TIGARD ; SCHS,,,, „ O New construction BEnlig>^�+bQi�it�lISI(.)1\1 For special information use checklist Description Qty. I Ea. I Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) a,« - 1�' a s,, , SFR(1)bath 312.70 P4 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory buildingSFR(3)bath 500.32 ❑Multi-family - -- Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 It. az , I CAi N Site utilities: Job site address: 7-� Catch basin or area drain 18.76 Jz � � �/� ��� Drywell,leach line,or trench drain 18.76 _City/State/ZIP: �`,��� r z 3 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: t:t/cere/ 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 nree is . "" ,t :,.r „ Backwater valve 12.51 Z: l'. Sesa ,nRc nw. :* l s F 5s !!' ' k a�i ii Clothes washer „/ I 25.02 e-?.j7- l'/c Lr1°o, 'f4ty/l Dishwasher 6/ I 25.02 -- /V4(/e- lG i ir•7 1/ -ei, Drinking fountain 25.02 Aw "" GCVerS°7G 1 i v7�- Ejectors/sump 25.02 AV'-., �. 1 Expansion tank 12.51 ", ' 'Y i a' ,.c � � a ,; P x a�, 3'brvx:Gi-..+�$'"sYst zxis.crz., s z s a � be . Name:.fe ,c. t,t4. /, Fixture/sewer cap 25.02 �// Floor drain/floor sink/hub 25.02 Address: jg'e,i.� 4' //I t/� Garbage disposal V 1 25.02 City/State/ZIP: ��e..„<��� 9 7 -.2-3 Hose bib V 3 25.02 Phone:(5-43) e6rG7.-7 ,,y/ Fax:( ) Ice maker ` 12.51 r'° '^ t . . . s� ,-, k `p • - ate `^z 4 V _ , g $ t' € , Interceptor/grease trap 25.02 Business name: ,- Medical gas(value:$ ) Page 2 Contact name:•_.J e l/. Primer 12.51 7 Roof drain(commercial) 12.51 Address: / it +p6/ J 4/ //1 tie Sink/basin/lavatory f 3 25.02 City/State/ZIP: 7 6, �/Z, 9 727' Solar units(potable water) 62.54 Phone:(..53) 72"3/ Fax::( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail:J ,�e ,a S z e c� t ' t" L.t t�'u, N,, r ti .���' ,r4. .rpit r+, ; g, Water closet i 25.02 ,.f Water heater r 37.52 Business name: //Q� W r ,�7b [�yy,'/� �yaterpiping/DWV l,,Op j 56.29 Address:jKj6 3 0 _�lit1 r a. ,./t jri ���rrr "`^^^"'"""_ LOther: ♦ 25.02 City/State/ZIP:j�Q�f,�p�� ��✓©��I � 7 70 Subtotal Phone:50,6 2.-9"9/ Fax:(�>� ,'� -� V Minimum permit fee: $72.50 ( / Plan review (25%of permit fee) CCB Lic.:/ 3 7 �1/( )(w Plumbing Lic 7 7/i/)..0 State surcharge(12%of permit fee) Authorized signature: ✓ TOTAL PERMIT FEE Date:/^� €7 _ / J ZO This permit applicatiafteronit expireshas if a permit is not obtained within 180 days Print name: s [�(���(� been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Tigard Permit Application - City of g and Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site vta + Q Qty. Fee(ea) low Square Foota ge: Perldt Fee: Footing drain-1 g'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 VVeil* +tie' ;x 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 Fee( TOtai each additional$100.00 or fraction thereof,to Otherill ' i , 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 accuratelyreport fixtures could result in increased sewer fees*. °'r 'd x r`" '4 : '" s= 411,2g"'e. ` 1 , �lr�r #'pe Plan review is required for any of the following. Fixture Type for 14.0*0. Please check all that apply. Work P ►>s s ' Added.~; cite: ❑ 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 Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR9 1 8-780-0040. -Drive Thru 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" 4" ❑ 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: -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 Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard p COMMUNITY DEVELOPMENT DEPARTMENT ■ T 1 c a R o Building Permit Review — Residential Building Permit #: "/ 4 'cz'r—t Site Address: i2 O O ,1„1 110- AV(. Project Name: V/14 t, ,' Lot #: Planning Review sy ii f l Pro osal: 2 r,� 21 ,'. ��c.� k wv �v t l P .t L.a tt$ ,i v- I I t S l;J�� �� A 17 >�x `1 i I � �, or Verify address/suite#active in Accela. Lfd In River Terra -: No ❑ Yes,River Terrace Review Addendum&,t,J Site an Elements: 0 rosion Control ed_,. copies of site plan on 8-1/2"x 11"or 11 x 17"paper P'i ained trees with drip line and tree protection measures drawn to scale(standard architect or engineer scale) tit' ,•tprint of new structure(including decks) and FFE arrow -`7 . 'ty locations&easements(required for new and additions) LilS address,project or subdivision name and lot number a Sidewalk/driveway approach licant information(name and phone number) Fi1', •cation of wells/septic systems of dimensions and building setback dimensions treet tree size,type and location quare footage of buildings to be demolished 116.eet names i xisting structures on site 2tomer elevations(2'contours if more than 4'differential)� Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes Ltd'No impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes ❑No Clean Water S rvices Service Provider,Letter(lot platted prior to 9/10/1995): equired: Yes,applicant was notified ❑ No Received: l,d'Yes ❑ No IV Water Meter Fy' tore Unit Worksheet—Additions,Remodels and ADUs .214 0 > Required: i2' Yes,applicant was notified ❑ No Received: ❑ Yes Lid'No -SDC Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No E/Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified IVNo Ixplied For: 0 Yes ❑ No,stop intake J and Use Case#: [p Zoning: ��,5 �: )'equired Setbacks: Front: Rear: Side: Street Side: !"it Garage: 7-0 t: Building Height: Max. Height: 5 C Actual Height: 2.1 - ri Landscape Area: % ❑ Lot Coverage Max: 0/0 Entrance kt Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows Minimum 12%of area of all street-facing facades Garage tom' Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met: ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage. ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor. -Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer ❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony r��q 'Vsual Clearance It. Urban ForestryJP n Sensitive Lands: ❑ Yes L� No Type: ! C;onditions met prior to issuance of building permit No s: cif Approved By Planning: � — Date: H G Revisions (after Building Submittal only) Reviewer Date Revision 1: E Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw RES_122419.docx Building Permit Submittal Original Submittal Date: 061X Site Plans: # Building Plans: # 3 Building Permit#: ter ' ding permit above. Workflow Routing: arming ngineering 0.-P�rmit Coordinator ceding Workflow Sign-off: -off for Planning(include notes from planning review) Route Application Documents: gineering: (1) copy of permit application, (1) site plan, (1) building plan and orr plan review routing form. wilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: it: v�, � Date:Air ///;r''. Engineering Review a Slope at building pad: 5,,/b 'I 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 lot: ❑ Yes No 'n Final Plat Recorded: U/A ❑ NOT Approved by Engineering: Date: Notes: [le-Approved by Engineering: ,>—.Q7 Date: 2_b - ao1 Revisions (after Building Submittal only) / Reviewer Date Revision 1: ❑ Approved Z- Not Approved t0.4 cal % p Revision 2: ❑ 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: ❑ SDC Exemption: ❑ Received ❑ Does not apply C'Fees Entered: Wash Co Trans Dev Tax: ❑ Yes L`f N/A Tigard Trans SDC: ❑ Yes r Parks SDC: ❑ Yes LIDA ❑ Yes LYN/A I J OK to Issue Permit PPby Approved Permit Coordinator: Date: l I:\Building\Forms\BldgPernutRvw_RES_122419.docx