Permit _ CITY OF TIGARD MASTER PERMIT
• COMMUNITY DEVELOPMENT Permit St: MST2020-00167
T t LARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/01/2020
Parcel: 2S103BB07400
Jurisdiction: Tigard
Site address: 12522 SW 123RD AVE
Subdivision: LAKE TERRACE Lot: 2
Project: MCGOWAN,
Project Description: Partition wall removal,expansion of existing kitchen, remodel of master bathroom,construction of
new partition wall,and replacement of existing floor/wall finishes. No exterior changes. Electrical
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: First: sf Basement: sf Left: Parking Spaces:
Height: Bathrooms: Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right:
Detectors: Yes
Total: sf Value: $100,000.00 Rear:
PLUMBING
Sinks: 0 Water Closets: 3 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain 0 Storm Sewer: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 1
Drywell-Trench Drain: 0
Other Fixture Units: Water piping/DWV
MECHANICAL
Fuel Tvoes Air Conditioning: N Vent Fans: Clothes Dryers:
Heat Pump: N Hoods: Other Units:
Furn<100K: Vents: Woodstoves: Gas Outlets:
Fum>=100K:
ELECTRICAL
Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits
1000 sf or less: 0-200 amp: 0-200 amp: W/Svc or Fdr:
Ea add'I 500 sf: 201-400 amp: 201-400 amp: W/O Svc/Fdr:
Mfd Home/Feeder/Svc: 401-600 amp: 401-600 amp:
601-1000 amp: 601+amp-1000v:
1000+amp/volt:
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 COM VB R-3
Owner: Contractor:
RODGER,MATTHEW OWNER
Required Items and Reports(Conditions)
MCGOWAN,MOLLY BARBARA MOLLY MCGOWAN
12522 SW 123RD AVE 12522 SW 123
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: 503-805-4911 PHONE: 503-805-4911
FAX:
Total Fees: $3,552.38
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 y to follow the les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952 1-0090. ou obtain a co f the rul direct questions to OUNC by calling 503.232. 1.800.332..23444.. J
Issued By: Permittee Signature: ‘. Q/ •
Call 603.639.4176 by 7:00 a.m.for the next available Inspection date. �'�/
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
"building Permit Application
Residential I (l It O l 1 l( 1 1 .1, (Iv I l
Received n __ Permit No.: .T City of Tigard y / _ rn `
:III • 13125 SW Hall Blvd„Tigard,OR 97223 et 1 I Le.I . n Review J �� � G,
a Phone: 503.718.2439 Fax: 503.598.1960 DawBy: zee1o7 /4..A Other Permit: E f %] _609.01
1 I U n It II Inspection Line: 503.639.4175Date Ready/13 : Jura: ® See Page 2 for
Internet: www.tigard-or.gov MAY 2020 Noti ied/Me y,.: �i�� -� Supplemental Information
.I
t TYPE OF W 1 t\alµ=nli�9.,tt,�9�•v i S 9 r REQUIRED DATA:1-AND 2-FAMILY DWELLING
' , \ ❑New construction 0 Demolition Permit fees"'are based on the value of the work performed.
1/ Indicate the value(rounded to the nearest dollar)of all
N ZAddition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
' CATEGORY OF CONSTRUCTION work indicated on this application.
]j1-and 2-family dwelling 0 Commercial/industrial Valuation: $ J 0I Q 0 0
ElAccessory building 0 Multi-family
Number of bedrooms: (0) 2}
0 Master builder 0 Other: Number of bathrooms: Ce.) 3
JOB SITE INFORMATION AND LOCATION Total number of floors: (E' 2.
Job site address: 1252 . SvJ \"2, Y4 AV[„.. New dwelling area: 0 square feet
City/State/ZIP: li o‘AV a, O - C (74 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Mr,I.vowGv\- De•gyJl' jj Qi3e.A Covered porch area: square feet
Cross ` '
street/directions. to job site: 1 Deck area: square feet
�5VV Vti dt1 V1t -tto Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: LA� " N(a c._ I Lot no.: ,. Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 29\0 ER,D 74 0 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.
IvlVWlo( OhIli `(lN\OdlII . RP.hrnlOv svwtt, paYki�,ov�s,,-rpla Valuation: $
OUMaD I t�I0 .Fi I(i'I. 1t9 , booy4 , M -iIVIISl.c,- NO SA'IA(i UYAA Existing building area: square feet
,n ) No eAc--IAA T/ vi o - < ' • /-: _ . '7 New building area: square feet
PROPERTY OWNER 0 TENANT e Number of stories:
Name: o N 1,4 rJ ovkl ay' / Type of construction:
Address: 11:*2" WJ v2- Y6- PfV2-' -.ram/'f};rt.,4..." , `;/Occupancy groups:
City/State/ZIP: 11 QY� pp_ I7223 43,
Existing:
Phone:(5?)) tot7�.441 11 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Mease refer Iv fee schedule)
Structural plan review fee(or deposit):
Contact name: o'N tA{/t/
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fax::( ) Amount received:
E-mail:; Li e..�kfrt f,//y 9 r l®� .,/ l,o� ,t PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES'
Ob �1 Commercial and residential prescriptive installation of
NTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: b w Y W r Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180 00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: Total fee due upon application: $201.60
Authorized signature: e(,tJQ/i' � This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
o` M o ANC p5 ?AZU *Fee methodology set by Tri-County Building Industry
Print name: /1 1� (� Date: p Service Board.
1:\Building PermitslBl RESPermitApp,doc 02/24/201 I 440-4613T(I 1/02/COM/WEB)
. Building Permit Application Checklist
One— and Two-Family Dwelling ink O I III t_ I �1 ()NH ,
City of Tigard ReceivedDate/B : Permit No.:
114 • 13125 SW Hall Blvd.,Tigard,OR 97223 Associated Pests:
■ Phone: 503.718.2439 Fax: 503.598.1960 Electrical Plumbing Fr Mechanical
T'l it t, 24-Hour Inspection Line: 503.639.4175
Internet: www.tigard-or.gov 0 Other:
ruE: 1,01.LOvyIyG 1l iAlS ARE REQt'llt :i) FOR Pl.:vy lll,v IEWY 1 es
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ ■ r
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 "
3 Verification of approved plat/lot. J ❑
4 Fire district approval required. Name of district: . ] ❑ la'
5 Septic system permit or authorization for remodel. Existing system capacity 0 ❑ /�
6 Sewer permit. H 0 jcii
7 Water district approval. ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 gr
basin protection,etc.
10 ,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 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 ❑ ,El
and location. /
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, f Z 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 0 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.
I 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 R(
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendtuns 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 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 ❑ of
systems,see item 22,"Engineer's calculations." �,�f
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 ai
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑
for four or more appliances. ,(
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 yJ
architect licensed in Ore on and shall be shown to be licable to the 'ect under review.
23 Three(3)site plans are required for Item II above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ -
24 Two(2)sets each are required for Items 16,19,20 and 22 above. 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. g 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ Z
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 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 la'
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 2
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(1 I/02/COM/WEB)
' Plumbing Permit Application
Building Fixtures Ffll Ot1-1( T. 1 vi Oyl,v
City of Tigard 'REF 1. l'-. Received Permit No.:
II II I 13125 SW Hall Blvd.,Tigard,OR 97223 Date 9y.
Plan Review
Phone: Date/BY:503.718.2439 Fax: 503.598.1960 Other Permit No.:
Inspection Line:ine: 503.639.4175 MAY 6 2�1i; Y
I lc;A R I) Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
\d11 9 ;..•F I•' MS e•.
TYPE OF WORK .,z1 ii riiMC C)(il/E. k'ii'.: FEE* SCHEDULE
❑New construction ❑Demolition 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)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
..2 6-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ('1,5 2 Z c�yt/ 123 yd pcV(� Catch basin or area drain 18.76
City/State/ZIP: 1-1 cl a✓A. p R coss3 Doting drainleac( o. ,or trench drain 18.76
t�'��� Footing (no.linear ft.:_) Page 2
Suite/bldgJapt.no.: I Project name:(4&'owcol,1�pd9W ►.cnrudk Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
S W W al IhU_ 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: ' 4 l'exatt . I Lot no.: 2 Fixture or item:
Tax map/parcel no.: SS\O3?,'"D1 -i D O Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�yl ` Clothes washer 25.02
4 taw all 1 i'if11Vl� 1t m'ivldt .,Ftx-times QNAi� Dishwasher I 25.02
atue s\A P\ \�Vllb.yZeipl1A-LL wJo e, ILt1/t51 (A5 Drinking fountain 25.02
$A 6.. u. w fA l eX 4 t k t- w� texAAv l€ss. Ejectors/sump 25.02
Ug PROPERTY OWNER l TENANT Expansion tank 12.51
Name: to 0 tt Vl (, 0 W(AAA
cap 25.02
` Floor drain/floor sink/hub 25.02
Address: I25?/1, SW 123✓u /\Vt?i
�/ 2 Garbage disposal t 25.02
City/State/ZIP: 11"0i Cl y'a, 0 P ell //Z.' Hose bib 25.02
Phone:(St)j) 0O6"-yt'O\\ Fax:( ) Ice maker ( 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
0 M1 Yl, / Primer 12.51
Contact name: W
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory ,.0 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 4, 12.51
E-mail: Urinal 25.02
Water closet 3 25.02
CONTRACTOR
Water heater + 37.52
Business name: O W VV,41- Water pipinglDW V 1 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax ( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing Lic.no.: Plan review (25%of permit fee)
�/
State surcharge(12%of permit fee)
Authorized signature:-�44 el') TOTAL PERMIT FEE
Print name:M 0 1\11 M Date: p$,DS.2-Ott This permit applicationafteri[ba exres if a permit is not obtained within LSO days
s beea accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1Bulding\Permits\PLMU-PennitApp.doc 10/0009 440-4616T(l0/02/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' 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
Storm&Rain Drain-Ist 100' 62.54 Valuation: Permit Fee:
•
$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
Other Inspections or Fees Qty. Fee(ea) Total each and inc urdi ga$$100.00 0or fraction thereof,to
10,Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Bapfistry/Font ❑ Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
-Each Stall ❑ New exterior plumbing site utilities for any complex structure
Car Wash:
Ea Tam as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
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
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\Pemtits\PLMF_PermitApp.doc 08/04/2011 2