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Permit
CITY OF TIGARD MASTER PERMIT 111; COMMUNITY DEVELOPMENT Permit#: MST2020-00197 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2020 Parcel: 2S1118B01501 Jurisdiction: Tigard Site address: 14135 SW 103RD AVE Subdivision: TIGARDVILLE HEIGHTS Lot: 1 Project: LEMLEY Project Description: Add 583 sf 2nd story addition with (2)bedrooms and (1) bathroom, and 68 sf deck. WATER METER UPSIZE REQUIRED PRIOR TO BUILDING FINAL AND C OF O. BUILDING Floor Areas Required Setbacks Reauired Stories: 2 Bedrooms: 2 First: sf Basement: sf Left: 5 Parking Spaces: Height: 35 Bathrooms: 1 Second: 583 sf Garage: sf Front: 15 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Total: 583 sf Value: $73,051.34 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker. 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 1 Other Fixture Units: Water piping/DWV MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 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 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 7 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-800 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 583 Owner: Contractor: LEMLEY,DANIEL M OWNER Required Items and Reports(Conditions) 14135 SW 103RD AVE 1 WATER METER UPSIZE PORTLAND,OR 97224 REQ'D PRIOR TO FINAL 2 Ersn Cntrl 503-639-4175 PHONE: PHONE: FAX: Total Fees: $3,846.34 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By:" .--Y \y(V d'4---- Permittee Signature: 0AI (�PG' /C O A/ l 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. Buildin¢ Permit Application i� ._ ,,, t €i Th Residential II 1-1 °' 1(T' J V N 0 2 2020 Receivid City of Tigard Y 2 . natdBy: a ��� Partner Nu.�s t _c1C14? 13125 SW Hall Blvd,Tigmd•OR 97223- t, Phone: 503.71 8.2439 Fax: 503.59g.19(r0 T �`' Plea Review Other hermit: UateMv: 11.,n1..t, Inspection Line: 503.639.4175 i` ) \ Ate ResdyiBy: L. �J lure. El See Pare 2 far Internet wwwtigarii or gov Notified/Method U//Ft/ J". Age Suppkaes.l Information t711f7L ,k94 r /✓4A L-- TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING Permit fees"are based cm the value of the work performed 0 New construction 0 Demolition ddrhonialteration/replacement El Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicatedon this application. 1-and 2-lamik d veIi:nt= ❑Commercial/industrialValuation: $ 7 3 , QS I , 3/ 4 ' ❑nc ccm building 0 Multi-family Number of bedrooms: 2 ❑Ma.,aer builder 0 Other: Number of bathrooms: 1 • JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address. t y i 3 s S4.,i lo3 Ito ME New dwelling area: 983 square feet City/State/ZIP ! C q-}0.P-4-A Garage/carport area: square feet Suitetbldg.lapt.no Project name: L(i-kCC-y AOotT,tt r' Covered porch area: square feet Cross street/directions to job site: ri►\c >n N.iAL ) 51 Deck area: 66square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision Lot no.: 1 Sp 1 Permit fees"are based on the value of the work performed. !i�� Indicate the value(rounded to the nearest dollar)of all Tax msp/parcel no. equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. yy�� Valuation: $ r{c)-) J , 3(J.,O 5 o LV : _ 1 Dt @ �D�) $ ,Y� ` Existing building area: square feet teP ,-k,1 i VTrt(4-,N"^ ( 553 J.A- New building area: square feet rit PROPERTY OWNER 0 TENANT Number of stories: Name. D -lift 14',1. y Type of construction: Address 1afi 3 s 54J ip_spz A.rg Occupancy groups: City/State/ZIP. i t 4p4-, n( cp. ay Existing: Phone:(5C-, ) sDy• P t'`e? Fax:( ) New: ❑ APPLICANT 0 CONTACT PERSON - —- BUILDING PERMIT FEES* Business name: (Plwrnhrml"sd" 19 Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP. Phone:( ) Fax: ( ) Amount received: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: Commercial and residential presroriptive installation of CONTRACTOR roof-top mounted PhotoVoltaie Solar Panel System. Business nameSubmit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Inslalfalion Special:),Code checklist, _ City/State/ZIP Permit Fee(includes Ohm review 5180.1111 and administrative lees): Phone( ) Fax:( ) State suteharge(12%of permit fee): S21.60 CCB lie: 'Fatal fee due upon application: $20I.60 Aulhumed signature: v ,�.; This Wln permit application after n expires if a lt has Men accepted permit h not obtained �� dayspall as cotupkte. Print name e: *Fee methodology sot by Tri-County Building Industry (�AN1LL Wit.. 0S• !i5 00 Service Board. l:1BuildinglPennits)3l1P-RIISPernitApp.doc 02/24/2011 440-46t]T(I I/02/COM/WI?f3) • • Mechanical Permit Application i=oR on It r: trsr ONLY City Receives 1111 of Ti gand 13125 SW Yell Blvd.,Tiganl,OR 9 E C E 11/E D P ate/By:lan Review Permit No:pls./..2.0 Id,.00 I ).7 I 0 ' Phone: 503.718 2439 Fax: 503.598.1960 DBy. Other Permit: t t G,R.t? hispcction Line: 503.639.4175 MAY 7 2020 Data Ready/By: a'i: 0Fee Psse 2 tor Internet www.t Bard-ot.gov NatifieNMethcxl: Supplemental Information Cl TYPE OF9itttt$K COMMERCIAL. FEE*SCHEDULE - USE CHECKLIST Mechanical permit fees'are based on the value of the wod 0 New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ®Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES5 - ❑ 1.-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-fancily 0 Master builder 0 Other: Description Qty. Ea. F Total JOB SITE INFORMATION AND LOCATION Heattnglcooltng: Air conditioning 46.75 Job site address: (Lt 13S S In.) 1 a3 aJI AAI e Furnace 100,000 BTU(ducts/vents) 46.75 1 City/State/ZIP: --f(,1 4 0.4:1 `,0 (k,,, '112 ZH Furnace 100,000+BTU(duets/vents) 54.91 C) Heat pump 61.06 V) Suite/bldg./apt.no.: Project name: Lei-^(L..E'1' ` Pot✓$4 Duct work 23.32 Cross streeUdirections to job site: Hydronic hot water system 23.32 �� / Residential boiler(radiator or / d W jt� s120 "b'-' SW M GA.iL�*y hydmnia) 23.32 1/(t�j go Unit Unit treaters(fuel-type,not electric), L in-wall,in-duct,suspended,etc. 46.75 J Flue/vent for any of above 1 23.32 Other: 23.32 Subdivision: Lot no.: 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 ,."r.JL_ fireplace 23.32 (gas (1) AID ter kt-- Ex Niw r EJ coIt`__C6Cet4.s0 Wgd/pellghter tsto 33.39 Wood/pellet stove 33.39 q't00 VLPYk 4 Wood fireplace/insett , 23.32 Chimney/liner/flue/vent 23.32 �( ,., Other: 23.32 LET-(PROPERTY OWNER 0 TENANT -Environnwiital exhaust and yendiafhon: _. Name: AA.)1 c t,.,-, t- N1 L(e y Range hood/other kitchen 33.39 7 equipment Address: Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments utility rooms) 1 23.32 Phone:( ) Fax:( ) Attic/erawispace fans 23.32 PPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: -. A.10 /4C $14.15 for first flint,$4.03 for each additional Contact name: '2,4.0jE,L_ ( 41•i(-,cy Furnace,etc. ^ Address: f y/ 3 S s ' Co 3 evo al/t Gas heat pump t� Wall/suspended/um[heater City/State/ZIP: Water healer 1 16Att-b tort, : Fireplace Phone:(�3) S Fax: ( )hc(- t oY 8 r ^�\ � ta Range J 4 V E-mail. ",i)Au 1 [,-6/ot t-f�Y �414. .G u M Barbecue CONTRACTOR Clothes dryer(gaps_)_ Business name: - Other: £Ja s� L , OWNE'K jN� 4L MECII.�AN!CAI.PERMIT FIRES* Address: Subtotal City/State/ZIP: N jj j�A 'Minimutn permit fee($90.00) Plan review(25%of permit fee) Phone: F ':( ) State surcharge(12%of posmit tee) - CCB he.: TOTAL PERMIT FEE This permit application expires If a permit is not obtained within 180 days after It has been accepted as complete. Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board Print name: YAti/l Ec,_ �.Efrl t.-4r Date:S! / Lir [Mudd inalPerrnasM C_PerautApp_O iIl3.doe 440.4e17T(I 1/02/COM/w[in) Electrical Permit Application Fok ovilil., t. 1.ONl.v' c�cyo�n$afa RECEIV zl x Permi,to:rAv- :.ie -00(c/- • 13125 SW Hall Blvd.,Tigard,OR 97223 ry Y1an Elea Phone: 503.718.2439 Fax: 503.598.1960 MAY / 202f Datenv'' Related Permit t. Inspection Line: 503.639.4175 Ready Data+By: hunt' R1 See Page 2 far TEC'\RLI Intomet: www.tiardor. ov CITY OF TIGAR olfted/Method: Supplemental Information g g TYPE OF WORK BUILDING DIYP, 1CN PLAN REVIEW ❑New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of Onus w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑1 and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agr culiuml amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of System. Job#: Dab site address: j L./I3$ Sbs..t to 311..,b AV looliM or more. ❑"A" °t^"1-2' t-3" City/State/ZIP:/State/ZIP: ,..��� •y 7- ❑Six or more rfacilities. wilts. 0�eatiooy. nal vehicle parks. Y !1�+stfL4_ 2 o t� °I / ❑Health-care facilities. Suite/bldg./apt.#: Project name: L Yt L 4 y R j i-la ro ❑Hazardous locations. 0 Supply voltage for more than CI Service or feeder 600 amps or more. 600"115 nominal. Cross street/directions to job site: !! {{ FEE SCHEDULE k,J I e)3,tun Y" S w cloio4 t>oxiirnsi I of I sate I 'ram I 1' r New residential single•or multi-family dwelling milt Subdivision: Lot#: Includes attached garage. 1,000sq.tt.orless 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 .r-/ W(,�F 'i)uG 6 D w1p2iJ(- (withabovesq. 1ti GOh�tpL i s G `Du S� 7 Lamitcdenergy,multi-family 75.00 2 p�, . ,..-pAm �.• [N abt 2_� 5tNi,u, residential(with above sq.ft.) Qt PROPERTY OWNER If T © TENANT Renewable Energy 0 See Page 2 ` —�_-`1 MA Services or feeders hrstallatlonoilteradon,and/or relocation Name: Viix.JI k .__.. Li Nl 1-•'.� iora""�"" et f W 200 amps or less 1 I00.70 2 Address: (r.(r 3 5 Shoal 101 te.0 AvE 401 amps to 600 amps 00.34 2 401 amps to IXr amps 200.34 2 City/State/ZIP: r G krat, /o yl_ o(?ZLS-/ 601 amps to 1,000 amps 301.04 2 Phone:(503 ) so`/ —(o Y 1t Fax:( ) Over 1,000 snips or volts _ 552.26 2 Temporary services or feeders Installation,alteration,and/or Email: `P,4r,,✓4 1.',L..4Yd. Cm Al 4.-•c oil relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange, rdit to ORS 447,449,670,7dl I. 201 amps to 400 amps 125.08 2 Owner signature:,..-"' ✓ Date: s" you Zp 401 amps to$99 amps 168.54 2 �-APPLICANT ' CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with �f Business name: /l /ptir - abort service or feeder foe, r 7.42 2 each branch circuit 1 Contact name:'pA>J)64.._.. (,..,�1n(.-44)' B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: /a.f/33 $kJ Io3440 41J4- branch circuit City/State/ZIP: /¢Its o cc"?z2...- Miscelaneou uit 7.42 2 T I R Miscellaneous(service or feeder not Included) Phone:(5o3 ) Soil-loll' Fax: :( ) Each manufactured or nodular 67.84 2 dwelling,service and/or feeder Email: ',,p 41./1-0--L y& G YL41 r.-.•e.t^1 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: L.e Tie,A — Sign or outline lighting 67.84 2 --. OW lU6 fti... (Nf'f'-d A Signal circuit(a)or limited-energy ag Address: panel,alteration,or extension. ❑ Sea P e 2 2 Ci /State/ IP; r Each additional Inspection over allowable in any of the above tY Additional inspection(1 hr min) 66.25/hr Phone:( ) ax:( ) Investigation(1 hr train) 90.00/in Email' Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Su .Lic. specifically listed(S5 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal. Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: Gam" .",/ TOTAL PERMIT FEE 'Phis permit application expires If a penult is not obtained within 180 Print ii,,,,-` , ,E,J.-- L.,0+1 t--,LY' '' Date:5/7/2-.4 Z.O y days after It has been accepted as complete. `� ... /-.y: Number of inspections allowed per permit. 440.4615T 11/05/COMAVEB 1:5auildiagSPamhalliL(:_PcrtnitApp_FS.R_Bltl:.doc F'^' • Plumbing Permit Application Building Fixtures E� E 1oa of i u-r: t si O I. ' Received City off Tigard SEC Permit No.:tot Sr all a 13125 SW Hall Blvd.,Tigard,OR 97223 natc/fty: "�(�(�'� Ptxn IFeviaw ^ X ; Phone 503718.2439 Fax: 503.598.1960 MAY 11202E Other PermitNe.: )nt f3Y TIGARD Inspection Line 50i 639.A 175 Bate Ready/13y: mru � flee Page 2 for Internet: www.tigard-or.gov GIT� �F 1 j��kv Netitied!Method: _ Supplemental Infm7nntion TYPE OF WORK BUILDING UlViS(s FEE* SCHEDULE CI New construction 0 Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.For each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 0 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 43278 SFR ❑Accessory building ❑Multi-Tamil}' 1 Eac (3)bath 500.32 ach additional bath/kitchen 25.02 ❑Muster builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Slte utilities: Job site address:/ ll 3 5 5 tf V (0 3 4J Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: ( ?as A(2'-> / f) 17, CP 7-'7...-f Footing drain(no linear I'L: ) Page 2 Suite/bldg./apt.no.: I Project name: L-.4t..1L(_Y pV (e �w� S Manufactured home utilities 50.03 Cross street/dimetions to job site: S J 1 V3 w7-0, ,. y,." Manholes I8.76 M r.. xiJici pM-Z Ruin drain connector 18.76 _. _..... Sanitary sewer(no linear ft.:-_) Page 2 Stone.sewer(no.linear ft.: ) Page 2 Water service(no linear ft.: 1 Page 2 Subdivision: Lot no.: Fixture or Item: Tax map/paced no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 y / } Clothes washer 25.02 (...-Qla� �,L1 ,! f�.. . ;h,J• .W ... UV(e R-_. ..L...t N e l.1iw�!)... Dishwasher 25.02 v._ E.Qrtl fl//r .P •QL.ut-Ig Ito& A4 lt..l Drinking famtain 25.02 Ejectors/sump 25.02 JROPERTY OWNER [ 0 TENANT Expansion tank 12.51 Nome: '74 !kr _ L.,6,,,A,L..ky _ Fixturalsoww�'cap 25.02 Floor drain/ticwr sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: hose bib 25.02 Phone: ( ) Fax:( ) Ice maker 12.51 E.APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$_) Page 2 _. !sir,o/,/ ____._ ._J Primer 12.51 Contact name: AnJ(6 t- M L(z. l Rocrfdm in(commercial) 12.5I Address /L/( '3 S S'14., 103 0,0 AV E' Sink/basin/lavatory ''j..- 25.02 City/State/ZIP: ."-T7GA0p...ty t o(L_„ `t"72.2t`71 Solar units(potable water) 62.54 Phone:(563 ).6( j -1 t7'i6 W Fax: :( ) Tub/shower/shower pan / 12.51 T::-rnail:" Q0 I.,.1(.Yl� Gh�41c-..CQt-y Urinal 25.02 Water closet i 25.02 CONTRACTOR i752 Water heater Business name' --- 1...+N 4l'l /pJ Vre,0-1.-4 Tto n) Water piping/DWV ' 56.29.. Address: Other 25.02 City/Slate/Z Subtotal Phone.( ) ax: ) Minimum permit fee: $72.50 Plan review (25%of permit Pee) CCf3 Lie.: Plumb'tg 1 c no.: State surcharge(12%of permit fee) Authorized signature: '� --^-,._ �X TOTAL PERMIT'FEE .�- Print name. Le...,„„, l�ot<,: //? 'f ids permit application expires if a permit la not obtained witNht la0 days �,.t/L/(A t.,,., . ( z0 Z.0 after it Iws been accepted as complete. *Fee methodology set by'Fri-County Building Industry Service Board. (❑SuitGangVPenmlaW't.MU-Pem5App.doc I01(V09 4-10.4e161(Itl/U2100utw1B) City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT i TIGARD Building Permit Review — Residential Building Permit #: f 1 S 1' )0 60 19 '7 Site Address: 1 LI 13 S t,J /03 AVE' Project Name: LEt—i L El Lot #: Planning Review Proposal: Air S S f,3 S P 2 `=- S7a 12-y L{-i is rn()Ai xe Verify address/suite# active in Accela. .1$In River Terrace: % No ❑ Yes,River Terrace Review Addendum Site Plan Elements: Retained Control (Le&l �b -- ( a • aW , 03 co ies of site plan on 8-1/2"x 11"or 11 x 17"paper Retained trees with drip line and tree protection measures ❑Dra n to scale(standard architect or engin r scale) ❑Fo of ew structure (including decks)and FFE ❑N n arr v r {` • •1 lions&easements (required for new and additions) Sit a dxe ect ors ' 'sipp�ime and lot number de a /dnveway approach li ant o a gran phone number) Loca on of wells/septic systems t ' ens ons, $ g setback dimensions ❑Street tree size,type and location ❑Square ootage of buil ' s to be demolished ❑Street names ❑Existing structures on site ❑Corner elevations(2'contours if more than 4'differential) Clot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes,XNo impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? OoeTNo KClean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): (PII(I 24 Required: X Yes,applicant was notified ❑ No Received: &Yes ❑ No ;gf Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: '1 Yes,applicant was notified ❑ No Received: Y e�2��, ❑ No TSDC Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No Os-Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified '$No Applied For: ❑ Yes ❑ No,stop intake Wt-tand Use Case#: -Zoning: Q.-17i Required Setbacks: Front: 14-- Rear: I t i Side: S Street Side: 10 Garage: 2 O Building Height: Max. Height: 3-S Actual Hei ht: f Z.Z- -'Landscape Area: IX % ' Lot Coverage Max: g0 Entrance Nikeget back no more than 8'from street-facing wall El Parallel to street or offset 45 degrees or less Windows Minimum 12%of area of all street-facing facades 1 3 V/o Garage ra e door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met: ❑ oor extends no more than 5' from wall and there is a covered porch extending beyond garage. ❑ oor ends no more than 5' from wall and there is a 12 sq ft.window above garage on 2nd floor. ara a doo 'd is ❑ 12'or less ❑ 50%or less of facade El 60%or less and includes 7 of following: ❑ Cove d rch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof cave ❑ Roof offset ❑ ire s ' gles El Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer ❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony l� isual Clearance tikurban Forestry Plan 74 Sensitive Lands: ❑ Yes , No Type: coteonditions met prior to issuance of building permit s: cA Approved By Planning: V 1 "19'� Date: Cp11/W Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved 1:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: S/1//26 Site Plans: # 3 Building Plans: # 3 Building Permit#: P.-Enter building permit#above. Workflow Routing: ❑ Planning ❑ Engineering Cl Permit Coordinator ❑ Building 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. ❑ Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: 1 � �� Date: ���/"Z_e_j Engineering Review ❑ Slope at building pad: ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: 0 Yes ❑ No n / ❑ Final Plat Recorded: ��/ ❑ NOT Approved by Engineering: Date: Notes: y\ ❑ Approved by Engineering: \\ Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of buildin• permit Cl Approved,NOT Released: Date: Notes: Revisions (after Building Submittal r nly) Revision Notice 1: Date S: t to Applicant: Revision Notice 2: Date :ent to Applicant: ❑ SDC Exemption: ■ Received ❑ Does not apply ❑ SDC Fees Entered: 'ash Co Trans Dev Tax: ❑ Yes ❑ N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes ❑ N/A LIDA ❑ Yes ❑ N/A ❑ OK to Issue Permit • Approved by Permit Coordinator: Date: I:\Building\Forms\B1dgPermitRvw_RES_1224I 9.docx , t MST�o 0 -06 /`�' 7 - JuN �38 �02Q e4nWateY Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number 20-001428 1. Jurisdiction: Tigard 2. Property Information(example: 15234AB01400) 3. Owner Information Tax lot ID(s): 2S111 BB01501 Name: Daniel Lemley Company: Address: 14135 SW 103rd Ave OR Site Address: 14135 SW 103rd Ave City, State,Zip: Tigard, Oregon, 97224 City, State,Zip:Tigard, Oregon, 97224 Phone/fax: 503.504.1088 Nearest cross street: McDonald St Email: danlemley@gmail.com 4. Applicant Information 4. Development Activity(check all that apply) ® Addition to single family residence(rooms, deck,garage) Name: Daniel Lemley ❑ Lot line adjustment ElMinor land partition Company: ❑ Residential condominium 0 Commercial condominium Address: 14135 SW 103rd Ave ❑ Residential subdivision ❑ Commercial subdivision City,State,Zip: Tigard, Oregon, 97224 ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 503.504.1088 Other Email: danlemley@gmail.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: Adding a second floor to the existing footprint. 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 Daniel Lemley Print/type title Signature ONLINE SUBMITTAL Date 5/21/2020 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 19-5,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. X 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 e �- Date 6/5/2020 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 Revised 2/20.20 Main Office * 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 - p: 503.681.3600 f:503.681.3603 • cleanwaterservices.org 0 9h by • • ..." • .� .:... ___ Ili K '. E ----.. 5 SW 103rd Ave, Tigard, OR 97224 SITE PLAN 1033:18PlN /t9S7-ao.2d — 00/9 7 Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs j\t71) JUN 02 2020 Please complete the following information: Customer Name: -DpeAcC. LcMtky r. 1 Service Address: Street/Suite #: / jJ35 SO )Cr. CU)kt6 City: I►ca&l.p State: Q . Zip: c2A1•( Phone Number: 3t3.Sb4 •i 0164ib Email: DpyJtraNcEy ( 6rImi .0 - 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 x 1 = x I = Bidet x 1 = x 1 --- Clothes washer I x 4 = Zi x 4 = Dishwasher I x 1.5 - / . S x 1.5 = Hose bib 1 x 2.5 = 1 . S x 2.5 = Hose bib, each 2 x I = 2 x 1 Kitchen sink i x 1.5 = 1 •5 x 1.5 = Laundry sink x 1.5 = x 1.5 = Lavatory 2 x 1 = a 2 x 1 = 2 Water closet, 1.6 GPF 2 x 2.5 = 5- 2 x 2.5 = 5- Bathtub/whirlpool x 4 = x 4 = Shower stall 1 x 2 = 2 I x 2 = - Bath/shower combo 1 x 4 = y x 4 = p Current Points: 341 S Proposed Increase: 9 hf Current Points+ Proposed Increase= 33•f._ =New Total Points =Required Meter Size Sly Meter Sizes: Ito 30 points=5/8" 30.5 to 37 points=3/4" 37.5 and over points= 1" New Meter Size Needed for New Total Points: '3/yrr Cost: $ /3li25 (see page 1) Current Meter Size per Utility Billing: 5/gi, Cost: $ 9yoo (see page I) New Meter Size Cost minus Current Meter Size Cost= $ 1101' (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) FOR OFFICE USE ONLY Current Meter Size Confirmed with UB S if-vr*C;W-€t EvN44h L— Fes-- 41 P 24.7-P4--z_._ Signature of UB Representative Date I:/Bultdtng/Porms/WaterMeters_070119_Add.docx Page 2 • Dianna Ornelas From: UB Online Sent: Tuesday, May 26, 2020 1:04 PM To: #Building Permit Technicians Subject: RE: Water Meter Fixture Unit Worksheet Yes,the information should show on their worksheet. Kind Regards, Jill Jill a City of Tigard-Utility Billing IN Senior Accounting Asst riGARO (888)826-7211 Payments (503)718-2460 UB Main ji ib©tigard-or.gov (503)718-2494 13125 SW Hail Blvd. Tigard, OR 97223 From:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Sent:Tuesday, May 26, 2020 8:52 AM To: UB Online<UBOnlinepay@tigard-or.gov> Subject: RE: Water Meter Fixture Unit Worksheet Good morning Jill, With the added bathroom, will they be required to upsize their water meter? Thanks. Dianna From: UB Online<UBOnlinepay@tigard-or.gov> Sent:Tuesday, May 26, 2020 8:35 AM To: Dan Lemley<danlemlev@gmail.com>; #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Cc: Rachel Rae <raeshine49@gmail.com> Subject: RE: Water Meter Fixture Unit Worksheet Dan, Utility Billing verifies that the address listed on the worksheet, 14135 SW 103rd Avenue, has a 5/8 inch meter. Please forward this email along with the worksheet to the Building division. Kind Regards, Jill 1 Jill • City of Tigard-Utility Billing 9 6 pq Senior Accounting Asst (888)826-7211 Payments (503)718-2460 UB Main jfltb©tigard-ar.gav (503)718-2494 13125 SW Hall Blvd. Tigard, OR 97223 From: Dan Lemley<danlemlev@gmail.com> Sent:Thursday, May 21, 2020 5:51 PM To: UB Online <UBOnlinepay@tigard-or.gov> Cc: Rachel Rae<raeshine49@gmail.com> Subject: Water Meter Fixture Unit Worksheet Caution!This message was sent from outside your organization. Hello, Will we receive an approval letter or will it be sent directly to Tigard Building Permits? Thank you, Daniel DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." 2 Dianna Ornelas From: Rachel Rae <raeshine49@gmail.com> Sent: Tuesday,June 2, 2020 4:21 PM To: #Building Permit Technicians Cc: Dan Lemley; Allyson Armstrong Subject: Fwd:Water Meter Fixture Unit Worksheet Attachments: Water Meter Fixture wksh.pdf Caution!This message was sent from outside your organization. Forwarded message From: UB Online<UBOnlinepay@tgard-or.gov> Date:Tue, May 26, 2020 at 8:35 AM Subject: RE: Water Meter Fixture Unit Worksheet To: Dan Lemley<danlemley@gmail.com>, #Building Permit Technicians<TigardBuildingPermits@tgard-or.gov> Cc: Rachel Rae <raeshine49@gmail.com> Dan, Utility Billing verifies that the address listed on the worksheet, 14135 SW 103rd Avenue, has a 5/8 inch meter. Please forward this email along with the worksheet to the Building division. Kind Regards, Jill Jill • City of Tigard-Utility Billing Senior Accounting Asst t `<!' (888)826-7211 Payments (503)718-2460 UB Main jilib©tigard-or.gov (503)718-2494 13125 SW Mall Blvd. Tigard, OR 97223 1 From: Dan Lemley<danlemley@gmail.com> Sent:Thursday, May 21, 2020 5:51 PM To: UB Online<UBOnlinepay@tigard-or.gov> Cc: Rachel Rae<raeshine49@gmail.com> Subject:Water Meter Fixture Unit Worksheet Hello, Will we receive an approval letter or will it be sent directly to Tigard Building Permits? Thank you, Daniel DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 2 Sc4/1 Dianna Ornelas riS 7 Za 7 —00/ 7 From: Rachel Rae <raeshine49©gmail.com> Sent: Monday, June 22, 2020 7:49 AM To: #Building Permit Technicians Cc: Dan Lemley;Allyson Armstrong Subject: Re: MST2018-00232 - Lemley - 14135 SW 103rd Ave Caution! This message was sent from outside your organization. Hello Dianna, Thank you for the detailed information. The fees for permitting have been paid. We look forward to picking up the permits and continuing on with our special project. We very much appreciate your communication and help through this process. Best regards, Rachel and Daniel On Fri,Jun 19, 2020, 12:14#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>wrote: Hello Dan & Rachel, This has proved to be a most challenging post-review, and after spending many hours sorting this out over many different days, I find it necessary that the '2"d story addition' work must be under a separate permit from the '1' level remodel' permit obtained in 2018 for a number of reasons. First, the remodel work was a 2018 permit under a different fee schedule effective 7/1/2018. A project valuation of $35,990 based on the amount provided by the applicant, also known as the 'contractor value' method, was used to calculate permit fees for the remodel. Second, the addition work submitted in 2020 is under a new fee schedule effective 1/1/2020. A project valuation of $73,051.34 based on the actual square footage amounts added to the structure, also known as 'valuation calculator' method, is used to calculate permit fees for the addition. Also, because of the age and status of the 2018 permit, and the two different project valuation methods, it was necessary to create a new and separate 2020 permit for the 2nd story addition using the current fee schedule. Our 1 permit system does not allow us to have two separate project valuation methods on the same permit, especially one that has already been paid for and issued. Please note that the fees calculated for the 2020 permit are the identical amounts that we would have been added to the existing 2018 permit if the system would have allowed us to do so. Moving forward, here is what to expect: • The mechanical work for the boiler and gas piping have been added to the existing 2018 permit MST2018-00232 and there is a balance due of$45.64 (see attached invoice). • The new master permit MST2020-00197 for the 2"d story addition has been created and is ready to issue with a balance due of$3,846.34 (see attached invoice). • The fees can be paid online at https://aca.accela.com/TIGARD/Welcome.aspx by searching for the permit record number MST2018-00232 and MST2020-00197 under the Building tab. • Email the permit technicians at TigardBuildingPermits@tgard-or.gov once the fees are paid. We will reprint the revised 2018 permit and issue the 2020 permit and will let you know when the site copy of the permit and plans will be available to pick up In the outer lobby of the Permit Center, Monday-Thursday, 8 am to 5 pm. We are closed on Fridays. Masks are required to be worn when in the building. • Per Clean Water Services (CWS), erosion control measures are required due to the scope of work for the 2"d story addition. You will need to put erosion control measures in place and schedule a code 750 Initial Erosion Control inspection before any work can commence for the addition. An erosion control site plan example is attached. If you have any questions about methods of erosion control, please contact CWS at http://cleanwaterservices.org/contact-us/. At permit issuance the city will provide a list of required inspections for this project. • Addition of the 4t' bathroom requires a 4" sanitary sewer line as noted on the construction plans. • The upsized water meter will need to be installed prior to scheduling final building inspection and obtaining certificate of occupancy. Please contact our Utility Billing division at UBOnlinepay@tgard-or.gov when you are ready to upsize the water meter. • All inspections (including erosion control inspections)for work specific to each permit will need to be scheduled separately by permit number at http://inspections.tigard-or.gov/WebOnlinelnspections by searching for the permit record number MST2018-00232 and MST2020-00197. We appreciate your patience during these remote working conditions. Thank you and please let me if you have any questions. Dianna L. Ornelas(Howse) Building Division Services Supervisor City of Tigard I Community Development 2 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits From: Rachel Rae <raeshine49@gmail.com> Sent:Thursday,June 4, 2020 8:07 AM To: Dianna Ornelas <Dianna@tigard-or.gov> Cc: Dan Lemley<danlemley@gmail.com>; #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>; Allyson Armstrong<AllysonA@tigard-or.gov> Subject: Re: MST2018-00232 - Lemley- 14135 SW 103rd Ave Good morning Dianna, Glad you received the emails and a day out of the office. Thank you for the advice and help through this process. Best, Rachel On Thu, Jun 4, 2020,07:35 Dianna Ornelas<Dianna@tigard-or.gov>wrote: Good morning Rachel, My apologies, I was out Tuesday and did not see the emails. I have printed the water meter worksheet and the building permit application. We will wait for the Clean Water Services letter to complete post-review and make the permit ready to issue. Thank you. Dianna L. Ornelas(Howse) 3 • Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits From:Allyson Armstrong<AllysonA@tigard-or.gov> Sent:Thursday, June 4, 2020 6:21 AM To: Rachel Rae<raeshine49@gmail.com>; Dianna Ornelas<Dianna@tigard-or.gov> Cc: Dan Lemley<danlemley@gmail.com>; #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Subject: RE: MST2018-00232 - Lemley- 14135 SW 103rd Ave Rachel, No further revisions required Allyson From: Rachel Rae<raeshine49@gmail.com> Sent:Thursday,June 4, 2020 5:55 AM To: Dianna Ornelas<Dianna@tigard-or.gov> Cc: Dan Lemley<danlemley@gmail.com>;#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>; Allyson Armstrong<AllysonA@tigard-or.gov> Subject: Re: MST2018-00232 - Lemley- 14135 SW 103rd Ave Hello Dianna, Daniel forwarded me the two recap emails. I appreciate you taking the time to note our discussion. I sent two emails on Tuesday to the email address:TigardBuildingPermits@tigard-or.gov The first had the building permit for the second story attached and an update for clean water services, likely our pre- screen is being processed today or Monday. The second email was a forward from Utility Billing with the water meter worksheet attached. 4 I confirmed with Daniel that we did drop off 3 copies of the building plans and structural calculations to the City of Tigard. Should we expect the building plans to be handed back with markups or do they pass for permitting?Curious if our permit is already processed waiting on the fee schedule to be completed (and CWS approval letter) or if we should be prepared to adjust our building plans further? Thank you for your time, Rachel and Daniel On Wed, Jun 3, 2020 at 6:53 PM Dan Lemley<danlemley@gmail.com>wrote: Forwarded message From: Dianna Ornelas<Dianna@tigard-or.gov> Date: Wed,Jun 3, 2020 at 3:30 PM Subject: MST2018-00232 - Lemley- 14135 SW 103rd Ave To: danlemley@gmail.com <danlemlev@gmail.com> Cc: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Hello Rachel, Per our conversation on 5/21/2020, we are waiting for the following items so that we can complete post-review to make this permit ready to issue: • Completed building permit application with new scope of work for 2"d story addition (see attached application). • Copy of water meter fixture unit worksheet containing additional plumbing fixtures approved by Utility Billing. • CWS pre-screen assessment for approval of addition. To clarify further about our conversation, plumbing fixtures will cause the water meter to be upsized, and you asked if we allowed installation of an Asian water closet/lavatory fixture combo retention system. I spoke with Chip Barnett, our inspection supervisor, and he said 'no' our residential plumbing and structural code do not allow use of 'retention' systems. You also asked about when the water meter upsize fees would need to be paid. I mentioned that a note will be placed in the description of the permit indicating that water meter upsize is required prior to building final and certificate of occupancy. 5 Please email all items above to TigardBuildingPermits@tgard-or.gov. Thank you. Dianna L. Ornelas (Howse) Building Division Services Supervisor : ?i City of Tigard I Community Development i 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits tE Ifi DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e- mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 6 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 i'Al _ " Transmittal Letter tic A it,) 13125 SW Hall Blvd.-• Tigard, Oregon 97223 • 503.71.8.2439 • www.tigard-or.gov TO: AU-00/3 Aa, -u ,J(,- DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: Ditoa - L��E� MAY 2020 C CITY OF TIGARD COMPANY: BUILDING DIVISION PHONE: 503 y .JQ By:. .I °0 RE: /q/35 Su/ /U s RO Aafc, ririAep 012 ciVaq (Site Address) Peruut Number) �FMt�� �l��iTlotil ki—C ( 2© 70 .- 06 l97 ( rorect nam or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: scription: J 3 Additional set(s)of plans. Revisions: 3 Cross section(s)and details. Wall bracing and/or lateral analysis. 3 Floor/roof framing. Basement and retaining walls. 3 Beam calculations. 3 Engineer's calculations. Other(explain): REMARKS: �_ d�sc-� ,c,A-1., c i. Cr JoeL _ GL d rG s-- j g 3 0 / (o B 0 b k-- U FOR OFFICE USE ONLY Routed to Penn Technician: Date: /�7�y� Initials: AA Fees Due: gi Yes ❑ No Fee Desc rpti n: Amount Due: $ OD $ ,y3)4-Riwiti 'e t SO $ /,S0 Special 74-- /t"61-4'4- Pr E. /tm,/ 46-vie.) Instructions: ON ,A tea.✓ Poi " Ve-iu ii c�� `� 23,0 3/- 3 / 1.� • Reprint Permit(per PE): Yes ❑ No ❑Done Applicant Notified: • Date: Initials: I P4eJ V4-4-4 9-770Aif ST3 C /'-2 W., ' 7/i 3 SY, /, , ,4WS.>. /W I:1t3uildingu'ormslTransmittalI.etter-Revisions.doc 05/25/2�� � 3 , _ - �/d /71 sf �,QL7OAI nSL. ,11 L- 1 P 1,464,4_ p)L c,1/‘,a 4 f13( 401a rtfrAtre._- s. 6n Py c3-7 -4- I LAV + & ( ( ill tta/4-it-ci4