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Permit Building Permit Application 2!,D To P '� �S-r 2'2z- 00 C 2,3 Residential FOR OFFICE USE ONLY City5 SW Tigard , Received ,. DaleB : Phone: Hall Blvd.,Tigard,OR 98.19 Plan Review f ,� / / 7223 Vir Phone: 503.718.2439 Fax: 503.598.1960 Date/B . `� t . ei D�'Permtt T 1 GARD Inspection Line: 503.639.4175 Date Ready/By: rum: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the [ CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 1/O, 0 oO ID 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building El Multi-familyNumber of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: l 45 '? J� 9 Z�9 New dwelling area: 2`-1 square feet City/State/ZIP: �)( Garage/carport area: square feet Suite/bldg./apt.no.: l Project name: 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 411311 7 {p�nn A (� DESCRIPTIONOF WORK work indicated on this application. V S'T1,"J^ (�i(2�`,��`-�71��"�4..�j p_(l) � 4titAczi eArG(c Valuation: $ (1J 1 / ' "" L/ht L( k-k Tt. "�. Existing building area: square feet l A G k. 1/G Z 1,1 5 F '�'17 t)V rkv\ k ;t/' `-(CV . New building area: square feet El PROPERTY OWNER 0 TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: 0 APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: -- Amount received: Phone:( ) Fax: :( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: Commercial and residential prescriptive installation of CONTRACTORt roof-top mounted PhotoVoltaic Solar Panel System. Business name: b1cii V-- Ott `ti ski ^t/ iris W1-:) t V\(" 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/G1Y: Permit Fee(includes plan review $180.00 and administrative fees): Phone:(l..6 2,q( (D3 c,LA Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: Total fee due upon application: $201.60 Authorized signature: 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 Print name: J LI 1' 'T�[ �FLL I ate: �9C3 7�Zo Service Board. I:1 Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46613T(11/02/COM/WEB) Building Permit Application i. Residential 0.‘--\.5t1 FOR OFFICE ISE ONI.A City of Tigard Received Permit No.: 13125 SW Hall Blvd,Tigard OR 97223 Plan Review e Phone: 503.7182439 Fax: 503.548.1960 DateBy: OtherPermit: R p Inspection Line: 503.639.4175 Date Ready/By: Jaris: I El See Page 2 for Internet www.tigard-or.gov Nobrard/Method: Supplemental tnforeoaeoo TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING I 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 9 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. s�•- 01-and 2-family dwelling 0 Commercial industrial Valuation: $ J/oeO ❑Accessory building 0 Multi-family Number of bedrooms: — ❑Master builder 0 Other: Number of bathrooms: --, JOB SITE INFORMATION AND LOCATION Total number of floors: — Job site address: t -l5' )S S(,J e-Z'^d New dwelling area: 3 Li 1 square feet City/State/ZIP: "T-l ) V �,.1 22 k+ Garage/carport area: ,—• square feet SuitelbldgJapt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: 5 3 tt',,at- {ke AANIA---trk. ti ` Deck area: — square feet el Z1~9 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 apphcation Single Family Residence — ADD -7•-21-14,ao rt - . 9.JXAvI5tPv1 Valuation: $ iM�fT� �`N-[1r�.�i��Q p,�. tkNn�.t`t' V nn fit. lb1\}3Tu� Existing building area: square feet ` / New building area: square feet ® PROPERTY OWNER 0 TENANT Number of stories: Name: j f 4'w A 0 C,tA+^bitectS &leAt A. Type of construction: Address: 1 14 -7 S s l,.j 9 z,Y) Occupancy groups: City/State/ZIP: T( G, ) ( i' /2Z� Existing: Phone:(L )3) Co 3 9 -0 Cr151 Fax-( ) New: ® APPLICANT IX CONTACT PERSON BUILDING PERMIT FEES* Business name:Black Diamond Homes,Inc (Fleece refer ro fee scfada/e) Structural plan review fee(or deposit): Contact name:Jeff Bettinelli FLS plan review fee(if applicable): Address:15685 SW I161"Ave.Ste 290 Total fees due upon application: City/State/ZIP:Tigard/OR/97224 Phone:(503)201-6304 Fax::( ) Amount received: E-mail:Jeff@blackdiamondhomesinc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name:Black Diamond Homes,Inc Submit two(2)sets of roof plan with connection details Address:15685 SW 116th Ave Ste 290 and fire department access,along with the 2010 Oregon Solar Installation Specially Code chr*•klist City/State/ZIP:Tigard/OR/97224 Permit Fee(includes plan review $180 00 and administrative fees): Phone:(503)2016304 Fax:( ) State surcharge(12a/o of permit fee): $21.60 CCB tic.:109542 ,' Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained q ! within 180 days after it has been accepted as complete. Print name:JeffBettinelli / v L Dade:3 J' -2.0 *Fee methodology set by Tti-County Building Indust* t(/ _`T Service Hoard. I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 /02ICOM/WEB) City of Tigard 7111 ■ II COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Building Permit #: l S7-02"p-O - l2d/2-3 Site Address: 1 4 515 SW &2leld Project Name: Bb\Q_,.1 Yl PctU l-I r•-' Lot #: Planning Review (/2/1 //s 7 71 4-sL r7 S. t,/T7e, / % - Proposal: rhliv) -ko -1 (2-S"iCkt- RAP(ttv,-t.) 9iLT /2t ,i Verify address/suite#active in Accela. )In River Terrace: No 0 Yes,River Terrace Review Addendum Site Plan Elements: 1rosion Control copies of site plan on 8-1/2"x 11"or 11 x 17"paper Retained trees with drip line and tree protection measures prawn to scale(standard architect or engineer scale) Nrootprint of new structure(including decks)and FFE oath arrowigUtility locations&easements(required for new and additions) Oite address,project or subdivision name and lot number Ia'Sidewalk/driveway approach ]tr pplicant information(name and phone number) N 1s •cation of wells/septic systems . Tot dimensions and building setback dimensions NOIStreet tree size,type and location 1':-•naxe footage of buildings to be demolished gStreet names CAI xisting structures on siteorner elevations(2'contours if more than 4'differential) ��I,at area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes.1Vo "�'jimpervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ), Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified X No Received: ❑ Yes 0 No ater Meter Fixture Unit Worksheet-Additions,Remodels and AD �' equired: 0 Yes,applicant was notified 0 No Received: Yes 0 o` X.--SDC Exemption for ADU applied for. 0 Yes X.-No eived: ❑ No 5i Public Facilities Improvement(PF1)Permit: Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake 414cLand Use Case#: ta Zoning: R-4t•� Required Setbacks: Front: 2-0 Rear: IS Side: S Street Side: N/11C Garage: 2.0 .Building Height: Max.Height: 30 Actual Height: t I a- 1 Landscape Area: % NA-Lot Coverage Max: Entrance NA-Set back no more than 8'from street-facing wall Nt-Parallel to street or offset 45 degrees or less Windows )Minimum 12%of area of all street-facing facades -rSv j-Gt,4t-IZn 01,1.1.41 . Garage 18t, Garage door is behind widest street-facing wall g Yes D 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 2"1 floor. .Garage door width is ❑ 12'or less ;S:t 50%or less of facade 0 60%or less and includes 7 of following. ❑ Covered porch ❑ Recessed entrance ❑ Wall offset 0 1'Roof eave 0 Roof offset ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof 0 Dormer ❑ Accent siding ❑ Window trim 0 Window recess ❑ Window projection ❑ Balcony ]1' Visual Clearance 1 Urban Forestry Plan Sensitive Lands: 0 Yes RNo Type: `T(Conditions met prior to issuance of building permit Notes: ri<tipproved By Planning: Date: 41(e 120 Revisions (after Building Submittal only) Rey ewer Date Revision 1: Approved 0 Not Approved A "• /C,ll_ (p/�t24 Revision 2: 0 Approved 0 Not Approved I:\Building\Fonus1BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: 'a-Enter building permit#above. Workflow Routing: Planning 'Engineering gl--r mit Coordinator ding Workflow Sign-off: N Sign-off for Planning(include notes from planning review) Route Application Documents: ID--Engineering: (1) copy of permit application,(1) site plan,(1) building plan and o al plan review routing form. uilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: �j/2-dr?� Engineering Review ia Slope at building pad: I� nditions"Met"prior to issuance of building permit NM Er Easements (encroachments)per engineering conditions of approval and plat At//01- [ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Er No Assess Water Quantity Fee in-lieu: ❑ Yes a No LIDA Facility on lot: 0 Yes ❑'No ["Final Plat Recorded: N/pr ❑ NOT Approved by Engineering: Date: Notes: N Approved by Engineering: % Date: 41l/3/11/ZO Revisions(after Building Submittal only) er Date Revision 1: L�Approved ❑ Not Approved /y4,.,7' vi {lJ0/ZG+Z(J Revision 2: 0 Approved ❑ Not Approved Permit Coordinator pi:A-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: V ((J(?1O Revision Notice 2: Date Sent to Applicant SDC Exemption: ❑ Received gkDoes not ap ly SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes , N/A Tigard Trans SDC: 0 Yes N/A Parks SDC: ❑ Yes 4 N/A LIDA 0 Yes %N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: 4115 I'?/0 I:\Building\Forms\BIdgPemritRvw_RES_122419.docx 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 Transmittal Letter ,„1; r. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: DATE RECEIVED: DEPT: BUILDI1NG DIVISION RECEIVED FROM: et(? ) /AJr✓Z, JUN 3 2020 CITY OF TIGARD COMPANY: Wa Di NN3`40 JgyAAg( /4 BUILDING DIVISION PHONE: (33 — Zc 1 301-f By= RE: �p--7S SW 9?} m5T202© oc12 (Site Ad�ess) (Permit Number) (Project de or unsision name and lot number) ATTACHE!)ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. 3 Revisions: fc�. Cross section(s)and details. Wall bracing aMor lateral analysis. Floor/roof framing. Basement and retaining walls. '2-. Beam calculations. Engineer's calculations. Other(explain): RE®KP/D L`�i bfb2 CteeA ,trn f, Its w�)1E eV (— Z /KQ 13 cim,t / PeA.,,. vicar p_trawie,. ® ✓l c+.��, v$ h 0 c 114 Ift.w 0 Z 1'7 s F)/9Iarrn0J FOR OFFICE USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes ❑No Fee Description: Amount Due: Special Instructions: Reprint Permit(per PE): ❑Yes ❑No ❑Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 CITY OF TIGARD MASTER PERMIT ■ ' COMMUNITY DEVELOPMENT Permit#: MST2020 00123 Date Issued: 06/03/2020 T i 1,-.;;\Ix D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111AC01700 Jurisdiction: Tigard Site address: 14575 SW 92ND AVE Subdivision: PINEBROOK TERRACE Lot: 58 Project: Boleyn Project Description: 347 sf addition/remodel of master bedroom and bathroom; conversion of bathroom to utility room. Water meter upsize not required. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 347 sf Basement: 0 sf Left: 5 Parking Spaces, 0 Height: 12 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 347 sf Value: $75,000.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain 0 Storm Sewer: 100 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: D Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1 000 st ar less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr. 0 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr. 8 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 Ecompasing: N Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 347 Owner: Contractor: BOLEYN,NORMAN&CANDACE REV LI.BLACK DIAMOND HOMES INC Required Items and Reports(Conditions) 14575 SW 92ND AVE 15685 SW 116TH AVE SUITE 290 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 TIGARD,OR 97224 PHONE: PHONE: 503-201-6304 FAX: 503-579-3990 Total Fees: $3,673.57 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 throug AR 952-001-00,9,0._You mayma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 orr1.800.332.2344. // Issued By: Y DAY L A� Permittee Signature: �� "7� /�L/ C *�T 7U/�' Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the Job site until completion of the project. Approved plans are required on the job site at the time of each inspection. ovFyto,Ued !/ Ij'% Building Permit Application • Residential RECEIVED FOR OFFICE IiSE ONLY City of Tigard Receives 'g APR 0 2 2020 Date/By: % 9 kj ,2k) Permit No.ilJr2. 20 DO/�3 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax 503.598.1960 Date/By: A14, Other Permit. Inspection Line: 503.639.4175 BUILDING DIVISION SION DateReadyBy: //� 470 hail I et See Page 2 for T fit'',f.I� Notified2viethod. Supplemental Information Internet: www.tigard-or.gov PN L�.7`1 4'/L _J?1r--f= TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 1 New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ly Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ ") S-000 l/o ® 1-and 2-family dwelling 0 Commercial/industrial / - ElAccessory building El Multi-familyNumber of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: r Job site address: t L 5 )S St.,) cl Zia New dwelling area- square feet 343 City/State/ZIP: -t-t ) of- 11 2,7,y. Garage/carport area. square feet Suite/bldgfapt.no.: Project name: Covered porch area: - square feet Cross sheet/directions to job site: 5A it I,ei- Trj n f x am. Deck area: - square feet Cl i1'9 Other structure area: — square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. d to the of all Tax map/parcel no.: Indicate equipment, aaterials labor,overhead,eland thest ar) for the profit DESCRIPTION OF WORK work indicated on this application. Single Family Residence - i4�T `'- (( (CtZ 7E+Af CIA_ Valuation: $ �`�( f Existing building area: square feet v-e.w�c tip vvAg5Thr l0 , CQ),'+v0A`c 6(tZ 11 .rn t„cry r 6-14W. Ale l dl j�',J21 /`7 j 2 4tT,S l 2,- --k.b 77rr New building area: square feet El PROPERTY OWNER 0 TENANT .(�v Number of stories: Name: iv e jLWA._ 0 C 010hk) ,-u 131 , leAl t{k. Type of construction: %ddress: l 45 'Z c 5� ?$ Occupancy.i 9? Occupancy groups: ( :ity/State/ZIP: - -f ) GA.- 12-2 Existing: 'hone:(503) t.J 3 Cj 0t5--LtFax:( ) New: ® APPLICANT 1 ,CONTACT PERSON BUILDING PERMIT FEES* Business name: Black Diamond Homes,Inc (Please refer to fee schedule) Structural plan review fee(or deposit): S" f 5 Contact name:Jeff Bettinelli 'Address:15685 SW 116's Ave.Ste 290 FLS plan review fee(if applicable): f :City/State/ZIP:Tigard/OR/97224 Total fees due upon application: IN Phone:(503)201-6304 Fax::( ) Amount received: E-mail:Jeff@blackdiamondhomesinc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name:Black Diamond Homes,Inc Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:15685 SW 116th Ave.Ste 290 Solar Installation Specialty Code checklist. City/State/ZIP:Tigard/OR/97224 Permit Fee(includes plan review $180.00 and administrative fees): Phone:(503)2016304 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.:109542 ` Total fee due upon application: $201.60 Authorized signature: ! ( ;lj,Nk, This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Jeff Bettinelli Date:3(11) 20'LO *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Pennits\BUP-RESPemtitApp.doc 02/24/2011 440-4613T(1 /02/COMNJEB) Mechanical Permit Application FOR OFFICE 1 SE ONLI City of Tigard REC E IVE L Received J - Date/By: Permit No. C/21� � 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review W Phone: 503.718.2439 Fax: 503.598.1960111 APR 02 2020 Date/By: Other Penult T I GA R D Inspection Line: 503.639.4175 Date Ready/By: Juts: I l See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information n r•Isir nI'/ICI(ll TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work 1 New construction [J Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all CIDemolition Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES* ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist El Multi-family 0 Master builder ❑Other: Description Qty. Ea Total JOB SITEINFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: l 5 Z A„» Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: n,jl ) 9 i Z'LI1. Furnace 100,000+BTU(ducts/vents) 54.91 "I�� Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work ` 23.32 Cross street/directions to job site: 5-Ao -(�L�' 7 01 N Hydronic hot water system 23.32 Zit, hydronic) �1 � �+ r Residential boiler(radiator or 9 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 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas Single family residence --tit p ' 0..,t(,‘. TO (3�e�S Fttot* 6 Liep — fireplace 23.32 t 4M�P ) 1 k. re_ , `ye �V (r V Log d lighter t(gas 23.32 Wf Wood/ Ilet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32_ ® PROPERTY OWNER 0 TENANTS 23.32 Environmental exhaust and ventilation: Name: Al64{1,40,... /1M0 C tic)v-LE 60L67Ai Range hood/other kitchen equipment 33.39 Address: 1 t} L^� Clothes dryer exhaust I 33.39 City/State/ZIP:Tigard/OR/97224 ` Single-duct exhaust(bathrooms, toilet compartments,utility rooms) I 23.32 Phone:(503): ,.,3et — C t5-q, Fax:( ) Attic/crawlspace fans 23.32 ® APPLICANT roit CONTACT PERSON Other: 23.32 Business name:Black Diamond Homes,Inc Fuel piping: S14.15 for first four$4.03 for each additional Contact name:Jeff Bettinelli Furnace,etc. Address:15685 SW 116th Ave.Ste 290 Gas heat pump Wall/suspended/unit heater City/State/ZIP:Tigard/OR/97224 Water heater Phone:(503)201-6304 Fax::( ) Fireplace . Range E-mail:.1effnblackdiamondhomesine.com Barbecue CONTRACTOR Clothes dryer(gas) Business name:Integrity Air LLC Other: MECHANICAL PERMIT FEES* Address:7301 SW Kahle Ln,STE 500 Subtotal City/State/ZIP:Portland/Oft/97224 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(503)572-3594 Fax:( ) State surcharge(12%of permit fee) CCB lie.:203869 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 ,•; days after it has been accepted as complete. Authorized signature: e r IV. * Fee methodology set by Tri-County Building Industry Service Board Print name:Jeff Bettinelli Date:3/yri (2,G-� lAtkilding\Pemdts1MEC PemitApp 44 040113.doc `0-461Tr(I I/oYCOM/WF.9) Electrical Permit Application FOR OFFICE USE O\1 1 R��-+ Received , ', City of Tigard i --CEIVE Receive Permit#:/t-j ape �t7/.�3 • 13125 SW Hall Blvd.,Tigard,OR 9 2 Plan Review e Phone: 503.718.2439 Fax: 503.598.196tj p R a 2 2020 Date/By: Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: luris. ® See Page 2 for T F G A I(I I Internet: www.tigard-or.gov Notified/Method: Supplemental Information OF TIGARD TYPE OF '•.I ING'DIVISION PLAN REVIEW New construction gl Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked). 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building less to ground,or exceeds14,000 ID Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA Of JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived 0 Addition of new motor load of system. Job#: Job site address: (Lt -7 S 100HP or more. ❑`A","E","t-2 ,"l-3 City/State/ZIP: ❑Six or more residential units. occupancy. ty I VI /Z ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than p,� ..�\ �/� ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: 5'/l" I O J - ovk 9'tj... ...- FEE SCHEDULE I�" `rl Description I Qty. I Each I 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 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 SIngle family residence - 14�p ZZ �(((a OZH,` Sty It (;M Limited energy, 75.00 2 q.ft. family GI P- residential(with above sq.ft.) ( '✓ + "j�� V1iZL�� `�sv� (3�i SF Renewable Energy ❑ See Page 2 ® PROPERTYt OWNERR I TENANT Services or feeders installation,alteration,and/or relocation /• P..-AA. rp Name: v) C-O 3)A-CC 13 L LPL A) 200 amps or less 100.70 2 - 7 201 amps to 400 amps 133.56 2 Address: I LO 7 S s w Tel 401 amps to 600 amps 200.34 2 City/State/ZIP:Tigard/OR/97224 601 amps to 1,000 amps 301.04 2 Phone:(503) G3 CC , 0 1S4 Fax:( ) Over 1,000 amps or volts 552.26 2 _ '�t / Temporary services or feeders installation,alteration,and/or Email: Al O L(- y4 `,�( (45'r,^l relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 t 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 .. - F Branch circuits—new,alteration,or extension,per panel , - - � `� - A.Fee for branch circuits with Business name:Black Diamond Homes,Inc above service or feeder fee, 7.42 2 each branch circuit Contact name:Jeff Bettinelli B.Fee for branch circuits without Address: 15685 SW 116th Ave.Ste 290 service or feeder fee,first 56.18 2 brazlch circuit City/State/ZIP:Tigard/OR/97224 Each add'I branch circuit -7 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)201-6304 I Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 c Email:Jeff@blackd ia m ondhomesine.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Hotwire Electric,Inc. Sign or outline lighting 67.84 2 Si circuit(s)or limited-energy Address:7435 SW 240th Place panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP:Beaverton/OR/97007 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)572-1317 I Fax:( ) Investigation(1 hr min) 90.00/hr Email:IIotwire.electric@frontier.com Industrial plant(I hr min) 78.t 8!hr Inspections for which no fee is 90.00/hr �1t6��` I 3Lj `tjp_ I p 44t1� C specifically listed(4 hr min) CCB Lic.: 'L {� Electrical Lic.: t J l t [-j Suprv.Lic.: V .J ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: ��in� '� Subtotal: Print name: Derek Nab ` `� Date:" 3 L 3,1-,,,,,vo ❑Plan Review Required(25%of permit fee): Authorized signature: 1 State surcharge(12%of permit fee): 4111111. / 1 , TOTAL PERMIT FEE: /,. 1 ti, 1,' This permit application expires if a permit is not obtained within 180 �'U (-7.4-4.4, Print name: Jeff Bettinelli Date: 3 days after it has been accepted as complete. • Number of inspections allowed per permit. I:\BuildingtPermitsWFTf_PamitApp ELR_ERE.doc Rev 06/17/2015 410-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard . Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined: $75.00 Dea Q 1 Each Total Y Renewable electrical energy systems: 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 to25 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 ❑ 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(I lu min) Inspections for which no fee is 90.00/hr specifically listed(%z hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I'.1RuildisglPennits\EL.C_PertmtApp_ELR_ERE don Rev 06/17/2015 Plumbing Permit Application Site Utilities RECEIVED FOR OFFICE USE ONLY City of Tigard Received -1111 13125 SW Hall Blvd.,Tigard,OR 97223AP R 0 2 2020 Date By: Permit No Alf jig lb/R3 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Inspection Line 503.639.4175 C TY OF TIGARD DateBy: i)ther Permit No.: T I G A R D _., ._,,., •.,.. , , Date Ready/9y: Ions RI Sec Paget for Internet: www.tigard-or.gov - Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE 1 New construction 0 Demolition For special information use checklist Description I Qty. I Ea. I Total RAddition/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath , 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: l�5--1 S 510 9.Z"� Catch basin or area drain 18.76 City/State/ZIP: �` Drywell,leach line,or trench drain 18.76 `1 LZ Footing drain(no.linear ft.:_) Page 2 Suite/bldgJapt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: ' e,i 'O A '0� �J' Manholes 18.76 ` `W� Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) l Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ( Clothes washer ( 25.02 Single family residence - k (IUC Lpit zw.iP- 0..czi/.I•1 v.tt Dishwasher 25.02 II\Asdcte l$L. ' N O Neu.) el r(r 1 t t tAtN. Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:Black Diamond Homes,Inc Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 15685 SW 116th Ave.Ste 290 Garbage disposal 25.02 City/State/ZIP:Tigard/OR/97224 Hose bib 25.02 Phone:(503)201-6304 Fax:( ) Ice maker 12.51 17 APPLICANT ¢?I CONTACT PERSON Interceptor/grease trap 25.02 Business name:Black Diamond Homes,Inc Medical gas(value:$_) Page 2 Primer Contact name:Jeff Bettinelli 12.51 Roof drain(commercial) P, 12.51 Address:15685 SW 116th Ave.Ste 290 Sink/basin/lavatory .( jt 25.02 City/State/ZIP:Tigard/OR/97224 Solar units(potable water) '. 62.54 Phone:(503)201-6304 Fax::( ) Tub/shower/shower pan ( 12.51 E-mail:Jeff@blackdiamondhomesinc.com Urinal 25.02 Water closet l 25.02 CONTRACTOR Water heater 37.52 Business name:G&B Plumbing&Sons Inc. Water PIPing/DWV 56.29 Address:P.O.Box 92 Other: 25.02 City/State/ZIP:St Paul/OR/97137 Subtotal Phone:(503)868-1417 Fax:( ) Minimum permit fee: $72.50 CCB Lie.:184372 Plumbing Lic.no.:PB634 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: tAijiz_ TOTAL PERMIT FEE Print name: ``i s /� '�e� Date:31,//3 `� This permit application expires if a permit is not obtained within 180 days l/ ' �/.. r 11.. after it has been accepted as complete. 'Fee methodology set by Tri-County Building Industry Service Board. I\Building\Permits\PLMU-PamitApp.d°c 10/01/09 440-4616r(10/02/tAM/WEa) 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-Is'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-Ist 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 Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to 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-12 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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type fur Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath Tub/Shower ❑ Any new commercial building with water service 2"and -Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thin ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" 4' Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food � Q Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lay -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: G:\My Drive\Black Diamond Homes\Admin.Documents\City of Tigard\PPrrnits apps\PLMU_PemutApp.doc City of Tigard 'PIa COMMUNITY DEVELOPMENT DEPARTMENT a TIGARD Building Permit Review — Residential Building Permit #: f5Tc20 - Oa/-3 Site Address: 141-5 S SW 01,2not p Project Name: B6\e, in P 1-�-k� Lot #: Planning Review i }�{ Proposal: /4 t icsvl -1-D *S-e- (2-S'10Y-A 1\dc1 t-t --. ) Verify address/suite#active in Accela. 3R"In River Terrace: No ❑ Yes,River Terrace Review Addendum Site Plan Elements: rosion Control copies of site plan on 8-1/2"x 11"or 11 x 17"paper2:, Retained trees with drip line and tree protection measures yawn to scale (standard architect or engineer scale) Etrootprint of new structure(including decks)and FFE .� orth arrow 19 tihty locations&easements(required for new and additions) y<Site address,project or subdivision name and lot number MSidewalk/driveway approach l Applicant information(name and phone number) AN-Location of wells/septic systems aT of dimensions and building setback dimensions ( Street tree size,type and location l\UPMuare footage of buildings to be demolished XStreet names 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? 0Yes..12:1Vo unpervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? /T I° xi Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified X No Received: ❑ Yes ❑ No ft ater Meter Fixture Unit Worksheet-Additions,Remodels and AD 0 Required: ❑ Yes,applicant was notified ❑ No Received: Xes ❑ o N SDC Exemption for ADU applied for: ❑ Yes ,-No eived: ❑ No Public Facilities Improvement(PFI)Permit: Required: ❑ Yes,applicant was notified ' No Applied For: ❑ Yes 0 No,stop intake 'Land Use Case#: Ia.Zoning: R-4 •C- Required Setbacks: Front: 2C) Rear: 15 Side: 5 Street Side: N/fA Garage: Z: .`Building Height: Max. Height: -2)0 Actual Height: \a- PQA'Landscape Area: % NA-Lot Coverage Max: Entrance AtOr 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 -5v$4-k-eac{dt-b ...., ov.l.vl Garage )t Garage door is behind widest street-facing wall g Yes ❑ No,one of the following is met: 0 Door extends no more than 5'from wall and there is a covered porch extending beyond garage. O Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2°d floor. .Garage door width is ❑ 12'or less ,lK 50%or less of facade ❑ 60%or less and includes 7 of following: O Covered porch ❑ Recessed entrance 0 Wall offset ❑ 1'Roof eave 0 Roof offset O Fire shingles ❑ Lap Siding ❑ Roof pitch 0 Gable,hip,or gambrel roof 0 Dormer O Accent siding 0 Window trim 0 Window recess 0 Window projection ❑ Balcony Ih Visual Clearance ! Urban Forestry Plan Sensitive Lands: ❑ Yes No Type: MA-Conditions met prior to issuance of building permit Notes: Approved By Planning: Date: ii(Q 120 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: 0 Approved ❑ Not Approved 1:1Building\Fonns\BIdgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: V.PJ" Site Plans: # Building Plans: # Building Permit#: 'Enter building permit#above. Workflow Routing: Planning -Engineering -1 ermit Coordinator C-TIding Workflow Sign-off: Er-Sign-off for Planning(include notes from planning review) Route Application Documents: ID--Engineering: (1) copy of permit application, (1) site plan, (1) building plan and ori3inal plan review routing form. ding. original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: . By Permit Technician: +) %7 . &-z/ Date: fy /2c//zj Engineering Review g Slope at building pad: EY: nditions"Met"prior to issuance of building permit /V/H Easements (encroachments)per engineering conditions of approval and plat N/fl ['Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes C'' No Assess Water Quantity Fee in-lieu: ❑ Yes a No LIDA Facility on lot: ❑ Yes ❑'No 0/Final Plat Recorded: ni/p ❑ NOT Approved by Engineering: Date: Notes:�te [ Approved by Engineering: % � Date: 403/Zaa) Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved 0 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 (SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: 0 Yes C N/A Parks SDC: ❑ Yes , N/A LIDA 0 Yes %N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Ri-r)U Date: 4115 \2.o I:\Building\Forms\BldgPermitRvw_RES_122419.docx RECEIVED S-r-AO - 00A2, 3 APR 0 2 2020 OF TiGARD Water Meter Fixture Unit Worksheet for Additions/Remodels/ ITYING DIVISION Please complete the following information: Customer Name: GM A.Q..E Ave) Ar v‘ et)L,eYiJ Service Address: Street/Suite#: "(�If575- 5uJ (1 Z�1' Alit.- City: 'T 6 kti2-V/ � State: OIL Zip: ( ?'7'Z't} 1 Phone Number: 55�'3 ( 7 i1— 0 Email: ft3 6 OL 9, � C 2/AG:I -To riQ.,+ Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink 0 x 1 = p x 1 = O Bidet 0 x 1 = c0 x 1 = 0 Clothes washer I x 4 = t{ ' x 4 = Dishwasher i x 1.5 = i ,S x 1.5 = Hose bib i x 2.5 = 2,S x 2.5 = Hose bib,each I x 1 = to a x 1 = Kitchen sink I x 1.5 = t.5 x 1.5 = Laundry sink 0 x 1.5 = o f x 1.5 = f 5- Lavatory Z.. x 1 = Z. _ x I = _ l_ Water closet, 1.6 GPF 2 x 2.5 = fj x 2.5 = Bathtub/whirlpool 6 x 4 = 1J x 4 = Shower stall ( x 2 = 2 x 2 = Bath/shower combo ( x 4 = W- x 4 = Current Points: 2-35— Proposed Increase: /,-- Current Points+Proposed Increase= 2-(4) t O =New Total Points =Required Meter Size 57 Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=%" 37.5 and over points= 1" New Meter Size Needed for New Total Points: 1t Cost: $ Cl. ` 4`�O (see page 1) Current Meter Size per Utility Billing: x�- Cost: $ Qt`-k 0co— (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ .-&` (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) *►*********************************************************************************** FOR OFFICE USE ONLY Current Meter Size Confirmed with UB Signature of UB Representative Date —_ —I:/Building/Rorms/WaterMeters_070119_ldd.docx ` A i ` 1 `,n Pa How g e 2r'"°`;/ III l OAril a'1 bd "� C tY li vL, 93=Li 1-63o•/ RECEIVED /( S %.20 APR 142020 /z/.5-7S S40 9,7 BUI CITY OF TIGARD C1eanWate�\Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMDEK 'N Clean Water Services File Number 20-001044 1. Jurisdiction: Tigard 2. Property Information(example: 1S234AB01400) 3. Owner Information Tax lot ID(s): 7S111AC01700 Name: NORM AND CANDACE BOLEYN Company: Address: 14575 SW 92ND OR Site Address: 14575 SW 92ND City, State,Zip: TIGARD, OREGON, 97224 City, State,Zip:TIGARD, OREGON, 97224 Phone/fax: S036390854 Nearest cross street: SATTLER Email: NBOLEYN@COMCAST.NET 4. Development Activity(check all that apply) 4. Applicant Information © Addition to single family residence(rooms, deck,garage) Name: JEFF BETTINELLI ❑ Lot line adjustment 0 Minor land partition Company: BLACK DIAMOND HOMES INC ❑ Residential condominium ❑ Commercial condominium Address: 15685 SW 116th Avenue suite 290 ❑ Residential subdivision 0 Commercial subdivision City, State,Zip: TIGARD, Oregon, 97224 ❑ Single lot commercial 0 Multi lot commercial Phone/fax: 5035791336 Other Email: JEFF@BLACKDIAMONDHOMESINC.COM 6. Will the project involve any off-site work? ❑Yes 0 No 0 Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: ROOM IS 22'W X16'DEEP(CLOSER TO THE STREET- RIGHT FRONT ROOM ADDITION) 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 JEFF BETTINELLI Print/type title PRESIDENT Signature ONLINE SUBMITTAL Date 3/31/2020 FOR DISTRICT USE ONLY 0 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. g 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 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local, State and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This 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 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.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 PROVIDERp LETTER IS REQUIRED. c� ' Reviewed by . �� ,«.— Date 4/14/2020 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 Re'sed 7,2020 Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p:503.681.3600 t: 503.681.3603 • cleanwaterservices.org 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 _ Transmittal Letter r ,,A I; n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 77/ DATE RECEIVED: DEPT: BUILIING DIVISION p REC ED FROM: `�( IJ61 ? /N -( 3 20 20 ITY OF TIGARD COMPANY: (, /ci,C,k.- DeAy►\TAO Wc,,vt 3( IKCt 2 UILDING DIVISION PHONE: 503 — z-ot — 6309- By 17.i RE: J � 75 s(N G7i fl 2©� ^ ©c 2.T3 (Site Ads) i (Permit Number) 1 VA (Project nbameor/ubdi-ision name and lot number) `I 1A t 0 ATTACHED ARE THE FOLLOWING ITEMS• ,► pi Copies: Descriptions e, `, s ies: Description: Additional set(s) of plans. 3 Revisions: Cross section(s)and details ei Wall bracing�al analysis. Floor/roof framing. �' t" Basement and retaining walls. '2— Beam calculations. Engineer's calculations. Other(explain): RE VIAARKS ADD 1911.(1.- M,t�clet 6 7 W`a)7 ('�0 v /1 w'PO I32ar t er/►e.&,,..ctvQ_ WA(( k-iT ® Lvt-c(,vOE, ' -. 0-6 ftQtj (II tewt,3a0_4 Z l'7 SP)_i • --r-,Eoatr, FO OFFICE USE ONLY /� Routed to Perm' echnician: Date: L / (€(2-1)ZQ Initials: /� Fees Due: me es ❑No Fee Description: Amount Due: $ D0 $ S 6 //v'V 1/ (es $ .P'/$ 9. ' -40P pecial Instructions: Reprint Permit(per PE): Yes ElNo ❑ Done �n Applicant Notified: _J"t'f� ate:& &vi/2o Initials: ,1/ I:\Building\Forms\TransnnttalLetter-Revisions.doc 05/25/2012