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Permit i9 CITY OF TIGARD MASTER PERMIT i COMMUNITY DEVELOPMENT Permitd: MST2020-00033 Date Issued: 02/25/2020 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S135AA00805 Jurisdiction: Tigard Site address: 10183 SW JEFFERSON ST Subdivision: METZGER,TOWN OF Lot: 8 Project: VO Project Description: A new 977 sq.ft. attached ADU. BUILDING Floor Areas Required Setbacks Required - Stories: 1 Bedrooms: 3 First: 976 sf Basement 0 sf Left 5 Parking Spaces: 0 Height: 12 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors. Total: 976 sf Value: $119,520.96 Rear: 15 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 1 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 135 SF Rain 0 Storm Sewer: 135 Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 135 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 1 Drywell-Trench Drain: 0 Other Fixture Units: Ejector/Sump MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Electricity Heat Pump: Y Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 of or less: 1 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: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/vob: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Y Other: N Other Description: Ecompasing. BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW ADU VB R-3 976 Owner: Contractor: VO,TRUNGTUYEN OWNER Required Items and Reports(Conditions) 10181 SW JEFFERSON ST TRUNG VO 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 10181 SW JEFFERSON STREET TIGARD,OR 97223 PHONE: PHONE: 503-913-0205 FAX: Total Fees: $10,119.67 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 issuan. - .rk is suspended for more the 180 days. ATTENTION: Oregon equires ,u to •II•w the rules adopted by the Oregon Utility Notifi - - •• , • — , - set forth in OAR 952-001-0010 through OAR: 2/-0• -00�• may ob- - •.•• of v�r'lea or direct questions to OUNC by = • r . 98 • .:••.-32. . Issued By: ,ml ._ 111, i_ ittee Slgna,- e: Call 503.639.4175 by 7:00 a.m.for the next avail,•le inspection date. This permit card shall be kept in a conspicuous place on the Jo.site until completio of the project. Approved plans are required on the job site at the ' e of each i ction. Building Permit Application Residential ��� t1� p FOR OFFICE USE ONLY q\1 Received f '•j Permit No.:/I-s �/,.y'►�{�j,r_„ 3 City of Tigard n® ����11XXXY Received Z (, QGVECJ k� fJ III " 13125 S W Hall Blvd.,Tigard,OR 9722, Plan Review .1Phone: 503.718.2439 Fax: 503.598.1960 JAN 13 2d20 DateBy: 13 14 o A* Other Permit TtGAR17 Inspection Line: 503.639.4175 Date Ready/By- mr�s ElSee Paget for Internet www.tigard-or.gov r� o:::f'.Rf N. ied/Meth.•i k �/ LT—P Supplemental information CITY or-', w TYPE OF WO --REQU D DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑ Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. vtde Valuation: ' Sfi08fl11 El1-and 2-family dwelling ❑ Commercial/industrial I� (/ ''i" �Y ❑Accessory building El Multi-familyNumber of bedrooms: 3 ❑Master builder El Other: Number of bathrooms: 1 JOB SITE INFORMATION AM) LOCATION Total number of floors: 1 97(49 Job site address:10183 Sw Jefferson St New dwelling area: 976 square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name:Vo AD( Covered porch area: square feet Cross street/directions to job site:SW Locust St Deck area: square feet Other structure area: square feet REQUIRED DATE 11 141FCIAL-F3SE CIIECKLIS'I' Subdivision: Lot no.: Permit fees*are based on the value of the work performed. lax map/parcel no.: 1 S135A,100805 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. Adding an attached ado(977 sqft)to 10181 Sw Jefferson St. Tigard,OR 97223 Valuation: $ Existing building area: square feet New building area: square feet El PROPERTY OWNER Cl "I'ENANT Number of stories: Name:Trung Vo Type of construction: Address:10181 Sw Jefferson ST Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:(503)913-0205 Fax:( ) New: El APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* (Meuse refer to jee schedule) Business name: Structural plan review fee(or deposit): Contact name:Trung Vo FLS plan review fee(if applicable): Address: 10181 Sw Jefferson St City/State/ZIP:Tigard,OR 97223 Total fees due upon application: Amount received: Phone:(503) 913-0205 Fax::( ) E-mail:tpvo503@gmail eom PlIOTOVOLTAICSOLAR PANEL SYSTEM FEES*_ Commercial and residential prescriptive installation of 7 CONTRACTOR rooftop mounted PhotoVoltaic Solar Panel System. p /` ^ Submit two(2)sets of roof plan with connection details Business name: IL/Alirjl� jlF� 1G71C C�.f, 1 lrrrLlLr J / and fire department access,along with the 2010 Oregon Address: $G1'0 . .j,� LO(.t t.S't s-'1" Solar Installation Specialty Code checklist. City/State/ZIP: t� ez !7+ 2 2 Permit Fee(includes plan review $180.00 T%Sir and administrative fees): Phone:(CO ) T 09s r- Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: (g,, 3 5r Total fee due upon application: $201.60 Authorized signature: , d" " Vim,. This permit application expires if a permit is not obtained — Date: �? 9�f/ *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) r , Mechanical Permit Application FOR OFFIcf. I SI.ONI.1 City of Tigard _ Received y_ Permit No.: Ny J 1n " + Phone:13125 SW Hall Blvd.,Tigard,OR 9722 I� E , Plan Rev iy�! vY/ (/�(/ 503.718.2439 Fax: 503.598.19 33 Other Permit: Date By: r I Cr A It I} Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov .JAN 1 3 2020 Notified/Method: Supplemental Information ri �n i'.. ' y ]r'`1 yw.t < .< COMMERCIAL FEE* SCHTIITWT' USE CHECKLIST iis�,,�rI . [j�!k r3 jr1 Mechanical permit tees*are based on the value of the work O New construction ❑x Addition/alteratitfdlacelite performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition El Other: mechanical materials,equipment,labor,overhead,and profit. Value $ CATEGORY OF CONSTRUCTION 4. E : REMDFN7IA L QE IPM ENT/SYSTEMS FEES* x❑ 1-and 2-family dwelling ❑CommerciaUindustrial ['Accessory building For special information use checklist El Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND TkQ- F )r Heating/cooling: "' Air conditioning 46.75 Job site address: 10183 Sw Jefferson St. Furnace 100,000 B111(ducts/vents) 46.75 City/State/ZIP: Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 1 61 06 61.06 Suite/bldg./apt.no.: Project name: Vo ADU Duct work 23.32 Cross street/directions to job site: Sw Locust St 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.: 1 S 135AA00805 Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 -'-- --- Flue vent for water heater or gas Building an attached ADU with 977 sgft,to 10181 Sw Jefferson St. fireplace 23.32 New address of attached ADU is 10183 Sw Jefferson St. Tigard,OR 97223 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 © PROPERTY OWNER 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Trung Vo Range hood/other kitchen 1 3339 33.39 equipment Address: 10181 Sw Jefferson St. Clothes dryer exhaust 1 33.39 33.39 City/State/ZIP: Tigard,OR 97223 Single-duct exhaust(bathrooms,toilet compartments,utility rooms) 1 23.32 23.32 Phone: ( 503 1 913-0205 Fax:( ) Attic/crawlspace fans 23.32 ® APPLICANT IT] CONTACT PERSI:N r`; Other 23.32 ....... Fuel piping: Business name. 514.15 for first four;$4.03 for each additional Contact name: Trung Vo Furnace,etc. Address: 10181 Sw Jefferson St. Gas heat pump Wall/suspended/unit heater City/State/ZIP: Tigard,OR 97223 Water heater Phone:(503 ) 913-0205 Fax.:( ) Fireplace Range E-mail: tpvo503@gmail.com Barbecue CON'TRACI'OR Clothes dryer(gas) Business name: Owner Other. MFCHANICA6 PER MII FEES* Address: 10181 Sw Jefferson St. Subtotal 152.00 City/State/ZIP: Tigard,OR 97223 Minimum permit fee($90.00) Plan review(25%of permit fee) 38.00 Phone:(503 ) 913-0205 Fax:( ) State surcharge(12%of permit fee) 18.25 CCH lie.: TOTAL PERMIT FEE 208.25 This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: Trung Vo Date: J/�7/%get9 I\Building\Permits\MEC_PermitApp_040113.doe aa004611 (II/OUCOM/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 $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1:1Building\Permits\MEC_PermitApp_040113.doc 2 , 'Electrical Permit Application FOR OFFICE l SE ON11 City of Tigard i EI Received '+ 13125 SW Ilan Blvd.,Tigard,OR Plan Review Phone: 503.718.2439 Fax: 503.5 .1111 Date/By. Related Permit k: Inspection Line: 503.639 4175 J AN 13 2021 Ready Date/By: Juris. 65 See Page 2 for I N.iAR6 Internet: www.tigard-or.gov Notified/Method: Supplemental Information . ,q j'��y6 "' " t r PLAN REVIEW ❑x New construction a 0 Addltion/alt�f�q• 1.1�1S1 Please check all that apply(submit 2 sets of plans w/items checked). 9•,7 Ld t ++ ['Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY £ 0014I„i i ' exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds 14,000 ❑Commercial-use agricultural ❑x 1-and 2-family dwelling El Commercial/industrial ❑Accessory building amps for all other installations. buildings ❑x Multi-family ❑ Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or r4603 SITE INFORMATI$ . tD LOCATION ❑Emergency system. larger separately derived _.. 0 Addition of new motor load of system. Job#: Job site address: 10183 Sw Jefferson St IooHP or more. ❑ A',..�. "I-z ,°1-3n City/State/ZIP: Tigard,OR 97223 ❑Six or more residential units. occupancy. O Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: Vo ADU 0 Hazardous locations. 0 Supply voltage for more than O Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Sw Locust St FEE SCHEDULE Description I Qtr. I Each I Total I " New residential single-or multi-family dwelling unit. Subdivision: Lot.#: Includes attached garage. Tax map/parcel#: 1 S135AA00805 1,000 sq.ft or less 1 168.54 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential 75.00 `(with above sq.ft.) New attached ADU on existing lot Limited energy,multi-family 75.00 2 residential(with above sq-R) Renewable Energy ❑ See Page 2 ® PROPERTY OWNER D TENANT " Services or feeders installation,alteration,and/or relocation Name: Trung Vo 200 amps or less ..'' 100.70 2 Address: 10181 Sw Jefferson St 201 amps to 400 amps 1 133.56 1?'' 2 401 amps to 600 amps 20034 2 City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps 301.04 2 Phone: ( 503 )913-0205 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: tpvo503@gmail.com relocation 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 2 } , Branch circuits-new,alteration,or extension,per panel °: .., .r i,.) ' .--. . -° `4--'''`a*O -4.r A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: Trull 6,...1.)o B.Fee for branch circuits without Address: ,{,. service or feeder fee,first 56.18 2 )Qic. SiA/'3.Qp��e lio A St branch circuit City/State/ZIP: Ti'C "1 1 o '` 9-�z 2 3 Each add'I branch circuit 7.42 2 Q / Miscellaneous(service or feeder not included) Phone:( SS-1 1 i 3 0 L0 J Fax: :( ) Each manufactured or modular 67 84 2 l dwelling,service and/or feeder Email: T F r, b7( , I '�'I' Reconnect only 67.84 2 .:' r ` ` i° v. CONTRACTOR ,e ,, i, ,,,,,. . .�-� .... �.� Pump or irrigation circle 67 84 2 Business name: n�' C L �,, 6— Sign or outline lighting 67.84 2 v"/i � l Signal circuil(s)or limited-energy Address: /3 /� _ S — l L!rit'/ panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Cyr?CC/�C,` GS , /V 777,91 c— Each Additional inspection inspection over allowable in any of the above Additional ins ection(I hr min 66.25. hr Phone:( t )/y 1,7 Fax:( ) Investigation(1 hr min) 90.00/hr ��� �� Industrial plant(1 hr min) 78.18/hr . .,.may+ '/ r Email: /.,��Lt 4 es6/10{�1 �Llli,evil i('it 1-2— Inspections for which no lee(f' jyi1 90 00,hr CCB Lic.: JJJ`T 5/ Electrical Lie.: ....Rev Suprv.Lic.: g 0$ specifically listed t,:termini h9 L� ELECTRICAL PERMITbt FEES Suprv. n lgnature,required: / ` Subtotal Print name: 1�,v/, ,(1�eb s f p 1, Date: 19//�t1/ ) 0 Plan Review Required(25%of permit fee): i'J / ///) '' ',f State surcharge(12%of permit fee): Authorized signature L TOTAL PERMIT PEG: ` ®�� _/� This permit application expires if a permit is not obtained within 180 Print name:Trung GTr1 y1 , / Date: 9�P /S days after it has been accepted as complete. ��f vvv /// /`� * Number of inspections allowed per permu. C1Building\Permits\ELC_PermitApp_ELR_CRC.doe Rev 06/17/2015 440-4615T I/OSICOM/WEB . . . • Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCIIEDULE Description Fee for all residential systems $75.00 Renewable on. Each Total yems combined: Renwable electrical energy systems: Check Type of Work Involved: s kva or 00.70 2 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 1501 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 n 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: n Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(%hr min) COMMERCIAL WORK ONLY: i L CT CAL pEt2tl tT VEE5 Fee for each commercial system: S75.00 Subtotal(Enter on Page I ' Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical n Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I.\nuilding\Permits\ELC_PermitApp_ELR_ERE.doc RevON17/2015 , ' Plumbing Permit Application Building Fixtures 'r*_ �, FOR OFFICE I SE ONLY a ¢r� F‘VCity of Tigard �� I.�.�aFA �� Recei"ea Date/By: Peunit No.:.(-y iie)" f„ - • 13125 SW Hall Blvd.,Tigard,OR 97223 ) J� ' i, 3 2U i_ Plan Review Other Permit No.: Phone: 503.718 2439 Fax: 503.598.1I1 Date/By: TIGARD Inspection Line: 503.639.4175 Rh} Date Ready/By: Ions: RI See Page 2 for Internet: wWW ti and-or. ov -:'i ce La`ir ,,-'s� , g € i.J� Notified/Method: Supplemental Information 'l Y'I'F OF WORK .- - FF.E* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total x❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION , SFR(1)bath 312.70 x❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 43778 SFR(3)bath 500.32 0 Accessory building 0 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: 10183 Sw Jefferson St Catch basin or area drain 18.76 City/State/ZIP: Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: 135) Page 2 87.55 Suite/bldg./apt.no.: I Project name: Vo ADU Manufactured home utilities 50.03 Cross street/directions to job site: Sw Locust St Manholes 18.76 Rain drain connector I 18.76 112.56 Sanitary sewer(no.linear ft.:135) 1.5 Page 2 100.06 Storm sewer(no linear ft:135) 1.5 Page 2 _ 100.06 Water service(no.linear ft.: 135) 1.5 Page 2 100.06 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: 1 S135AA00805 Backflow preventer 3 L27 31.27 Backwater valve 1 12.51 12.51 DESCRIPTION OF WORK - - . ° - 'i Clothes washer 1 25.02 25.02 Building an attached ADU with 976 sqft Dishwasher 1 25.02 25.02 Drinking fountain 25.02 Ejectors/sump 1 25.02 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 1 25.02 25.02 Name' Trung Vo - Address: 10181 Sw Jefferson St Floor drainlFloorsink/hub 25.02 Garbage disposal 1 25.02 25.02 City/State/ZIP: Tigard,OR 97223 Hose bib 1 25.02 25.02 Phone:( 503) 913-0205 Fax:( ) Ice maker 12.51 ® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 Business name Medical gas(value:$_) Page 2 Primer 12.51 Contact name: Trung Vo Roof drain(commercial) 12.51 Address: 10181 Sw Jefferson St Sink/basin/lavatory 2 25.02 50.04 City/State/ZIP: Tigard,OR 97223 Solar units(potable water) 62.54 Phone:(503 )913-0205 Fax::( ) Tub/shower/shower pan 1 12.51 12.51 E-mail: tpvo503@gmail.com Urinal - 25.02 CONTRACTOR Water closet 1 25.02 25.02 - Water heater 1 37.52 37.52 Business name. Itc. 1 1 e I 1,1 I �/1 tyy1b i(t Water piping/DW V 56 29 Address: 4�f(`too , /J �y c Other: 1 25.02 90.00 City/State/ZIP: J r 1 1 b G[�7 Subtotal 796.26 (C &/e*l � -A1(e6/ra' ( )4 Minimum permit fee: $72.50 Phone: JJJYe1 Fax: CCB Lic.:2(I 51 Plumbing Lie.no.:3 LC2 10 Plan review (25%of permit tee) 199.06 State surcharge(12%of permit fee) 95.55 Authorized signature: TOTAL PERMIT FEE 1304.17 Print name: Tri/.(/1/'. L/ Date: �,? ze)2_. This permit application expires if a permit is not obtained within ISO days 1! V / after it has been accepted as complete. 'Fee methodology set by Tri-County Building Industry Service Board. I:1Buildineermas\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- I'' 100' 1 50.03 50,03 0 to 2,000 $121.90 Footing drain-each additional 100' 1 37,52 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 1 62.54 62.54 7,201 and greater $327.54 Sewer-each additional 100' 1 37.52 37.52 Water Service-1st 100' 1 62.54 62.54 Medical Gas Systems: Water Service-each additional 100' 1 37.52 37,52 Valuation' Permit Fee: Storm&Rain Drain-1st 100' 1 62.54 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 1 3752 37.52 $5,001.00 to$10,000.00 $7250 for the first$5,000 00 and$1.52 for Other Inspect, ons or Fees Qly. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumhing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no tee is specifically indicated 1 90.00/hr 90.00 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 $37950 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 pp y' Baptistry/Font ❑ 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 -Driv Thm as defined in OAR918-780-0040. Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities. Dishwasher: Commercial CI 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 pia.ram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. 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/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 Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: L\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard .111 COMMUNITY DEVELOPMENT DEPARTMENT ■ TIGARD Building Permit Review — Residential Ca) MiliSaYstlal Building Permit #: /7-S 0b2U-Gi Site Address: Lo l$3 S1At tjeVpu,-t Project Name: V O A-Cu. kffrAC41,2d Lot #: (New dwelling=subdivision name;Addition or Alteration=last name g'�ggwncr PlanningReview 1 'I �, d C s,�.p4w -(w La,. I-2�-Lto Proposal: A�1� 1l !�i — C 7 7 5 F- i e,viiii,^1 1, � S�� i Verify address/suite#active in Accela. ❑ In River Terrace:- D No ❑ Yes,River Terrace Review Addendum Site Plan Elements: 1 J�rosion Control icopies of site plan on 8-1/2"x 11"or 11 x 17"paper etained trees with drip line and tree protection measures Drawn to scale(standard architect or engineer scale) LFootprint of new structure(including decks)and FFE orth arrow � tTtility locations&easements(required for new and additions) te address,project or subdivision name and lot number glSidewalk/driveway approach Jpplicant information(name and phone number) '.oration of wells/septic systems Lot dimensions and building setback dimensions 4 treet tree size,type and location Square footage of buildings to be demolished /iiiiiki'-':.treet names fe xisting structures on site Corner elevations(2'contours if more than 4'differential) .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? [Yes No impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? I�/Yes ❑No ig Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995): Required: Yes,applicant was notified ❑ No Received: Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: 0 Yes,applicant was notified V pNo Applied For: 0 Yes 0 No,stop intake Land Use Case#: �CQ}21�.�"Q0[k) p -Zoning R-9.0 Vi Required Setbacks: Front: 2 Rear: 15- Side: 5 Street Side: Ni/A- Garage: 2b Nr-Building Height: Max.Height: SO Actual Height to..' Landscape Area: 2 % Lot Coverage Max: g0 % Entrance 0 Set back more than 8'from street-facing wall 0 Parallel to street or offset 45 degrees or less Windows ❑ ' um 12%of area of all street-facing facades Garage El (A. :e d or d widest street-facing wall 0 Yes ❑ No,one of the following is met: O Do r e ds no more than 5'fr. 4all and there is a covered porch extending beyond garage. 1")/ 0 Do r extends n•` or: 1 '£rf and there is a 12 sq ft.window above garage on 2"a floor. ❑ Garage door is 1►' 1. r��50%or less of facade 0 60%or less and includes 7 of following: O Covered orch ■ Re -ssed entrance 0 Wall offset 0 1'Roof eave ❑ Roof offset ❑ Fire shingles 0 Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof 0 Dormer ❑ Accent siding 0 Window trim 0 Window recess 0 Window projection ❑ Balcony /q' Visual Clearance -Urban Forestry Plan Sensitive Lands: ❑ Yes %` No Type: Conditions met prior to issuance of building permit Notes: ❑ Approved By Planning: A 'I I.e t- Date: 12-1-2-3 I Revisions (after B ding Submittal on ) �] Q eviewer Date Revision 1: Approved 0 Not Approved �J(�`" , '�� 1-2 i-1.-41,4 Revision 2: 0 Approved ❑ Not Approved Revision 3: 0 Approved ❑ Not Approved I:\Building\Fors\BldgPermitRvw_RES_0228I 9.docx Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: er building permit#above. Workflow Routing: [T planning U�ngineering P-11.grrmit Coordinator Ei." ilding Workflow Sign-off: Sign-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. 10- Building original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: '//(,/h, Engineering Review [''Slope at building pad: r ❑ 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: 0 Yes ErNo Assess Water Quantity Fee in-lieu: 0 Yes ErNo LIDA Facility on lot: E Yes ❑ No ❑ Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: [ Approved by Engineering: T Date: 'fib fe 07 a Revisions (after Building Submittal only) Reviewer Date Revision 1: "Approved ❑ Not Approved % /Z27/07440 Revision 2: 0 Approved ❑ Not Approved Revision 3: 0 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: R ision Notice 3: Date Sent to Applicant. SDC Fees Entered: Wash Co Trans Dev Tax: 2" Yes ❑ N/AN/ Tigard Trans SDC: 0 Yes O�N/A ,N Parks SDC: ❑��Y s L. N/A " / �"'"� LIDA D Yes ❑ N/A OK to Issue Permit ��v. �/ D , � Approved by Permit Coordinator: Date: I:\Building\Fonns\BldgPermitRvw_RES_022819.docx /0 4 P3 s'� s���.' -S Clean Water Services File Number 1"2S c — CleanWaterr Services 19-003318 Sensitive Area Pre-Screening Site Assessment - 1. Jurisdiction: Tigard i1 2. Property Information (example 1S234AB01400) 3. Owner Information AN Tax lot ID(s): Name: Trung 1S135AA00805 Company: N/A isui ; ). Address: 10181 Sw Jefferson St OR Site Address: 10181 Sw Jefferson St City, State,Zip: Tigard, OR, 97223 City, State,Zip: Tigard, OR, 97223 Phone/Fax: 503-913-0205 Nearest Cross Street: Locust E-Mail: 4. Development Activity (check all that apply) 5. Applicant Information la Addition to Single Family Residence(rooms,deck,garage) Name: Trung Vo ❑ Lot Line Adjustment ❑ Minor Land Partition Company: N/A ❑ Residential Condominium ❑ Commercial Condominium DI Residential Subdivision Address: 10181 Sw Jefferson St ❑ Commercial Subdivision ❑ Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Tigard, OR, 97223 Other Phone/Fax: 503-913-0205 We are building 2 adus and need site assessment. E-Mail: tpvo503@gmail.com 6. Will the project involve any off-site work? ❑Yes ❑ No ❑Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project We are building 2 adus and need site assessment. 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 Trung Vo Print/Type Title Signature ONLINE SUBMITTAL Date 8/25/2019 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. ❑ Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 19-05, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,State,and federal law. IX Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 19-05,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 2 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 / _ Date 10/29/19 Once complete, email to: SPLReview@cleanwaterservices.org • Fax: (503) 681-4439 OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123 Revised 612017 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 7111 "9 41 Transmittal Letter T:G,A R lI 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 4//,304 DATE RECEIVED: DEPT: BUItThNG DIVISION RECEIVED FROM: lamer VO FEB 6 2020 CITY OF TIGARD COMPANY: BUILDING DIVISION PHONE: S03 9/3- 02.©,S By e RE: (0/7g S i,! 3e-{-{etc St (Site Address) (Number) 14) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): // /� REMARKS: 1,00.1*tjr tkei/ 1.[9 / /7di/ 4DUs S Ham/ M.e ) SI1ea r h'cy) f/VU f/id FO7 O CE USE ONLY Routed to Penn T'p cian: Date: _2 6, 7ib?_ Initials: , Fees Due: Yes ❑No Fee Desc ipti Amount Due: $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes No (� ❑ Done Applicant Notified: te: Initials: `r I:\Building\Forms\TransmittalLetter-Revisions 061316.doc 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 .114 . Transmittal Letter 1 ]c_;n R I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: / erjp y iL -e DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED JAN 21 2020 FROM: 7T{l t h V0 CITY OF TIGARD BUILDING DIVISION COMPANY: PHONE: Czw?) 9f? 02_0 6 - BY' RE: /6l'3 EcJ .Tj 4) AO -6,V633 (Site Address) (Permit Number) / Vo (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. Revisions: Cross section(s) and details. _ Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. V( Other(explain):REMARKS: Adiev43 2lo<sy ircir;aAr/ a /irm le 3 to14 c'o/ k 1p /-ne. -t.ea A)GICCfi'tinll(J k Crr/Asy :41-icr7, duel-tp .S ra/pump a Ad vide 5'.41 ° FO OFFICE USE ONLY Routed to Permi ec ician: ate: l �'? _cZC2 Initials: /9-�"- Fees Due: es 0 Now Fee Des ription: Amount Due: Y 7 Ca vi cam ' t-`'` $ Lis �/ $ Special Instructions: - v Reprint Permit(per PE ❑Yes No ❑Initials: Applicant Notified: ate: Initials: I:1 Building\Fonns1TransmittalLetter-Revisions_061316.doc 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 III Transmittal Letter T 1 G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: ( 4Crchl DATE RECEIVED: DEPT: BUILDING DIVISION n ,' l L pre x. ,.� , FROM: 1 (ZI,41 C P /~ COMPANY: - i: PHONE: CF))9(3- 07 By:fr- RE: itl-Mj /9«`" Xl SO 3efreil St-- Zvi'—4i20 Md 3' (Site ddress) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. V` Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): g.sq.21 p-yl Q_e of Cls=h �skti REMARKS: FOR OF 'ICE USE ONLY Routed to Permit Technician: D te: 1/ZQ Zc yts Initials: " (,)Fees Due: ❑ Yes o Fee De�cripti n: Amount Due: . C.,_____:_, $/\_) 0 i\,../ $ //(7 Special Instructions: Reprint Permit(per PE): ❑ Yes No E Done Applicant Notified: Date: Initials: l:\Building\Forms\TransmittalLetter-Revisions_061316.doc