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Permit (113) INCITY OF TIGARD MASTER PERMIT ''' COMMUNITY DEVELOPMENT Permit#: MST2017-00427 T GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/21/2017 Parcel: 2S102BA02200 Jurisdiction: Tigard Site address: 9975 SW JOHNSON ST Subdivision: None Lot: None Project: Stroum Project Description: 59 sq. ft. Kitchen addition and remodel. Electrical permit submitted separately. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: First: 59 sf Basement: sf Left 5 Parking Spaces: Height: Bathrooms: Second: sf Garage: sf Front 20 Dwelling Units: Smoke Third: sf Right: 5 Detectors: No Total: 59 sf Value: $6,717.15 Rear: 15 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 LaundryTrays: 0 Y Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0-200 amp: 0-200 amp: W/Svc or Fdr: Ea add'500 sf: 201-400 amp: 201-400 amp: W/O Svc/Fdr: Mfd Home/Feeder/Svc: 401-600 amp: 401-600 amp: 601-1000 amp: 601+amp-1000v: 1000+amp/volt: ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy G ADD p yrou Group: Square Feet: SF VB R-3 59 Owner: Contractor: STROUM,DONALD M& JOSH JONES CONSTRUCTION LLC Required Items and Reports(Conditions) ANDREA J PO BOX 5777 9975 SW JOHNSON ST ALOHA,OR 97007 TIGARD,OR 97223 PHONE: PHONE: 503-568-3937 FAX: Total Fees: $677.61 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes aII • 'er--ppF-.bl: 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, r i ,.r s -pen•-d for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce er. T • e riles -re set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 87 1.:'0. ,.234 • Issued By: j7��Permittee Signature: /. 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. Building Permit Application r Residential FOR OFFI( FSE ONI.I City of Tigard REEiew" a II D : BEMNIZI PermitNo.• n• 13125 SW Hall Blvd.,Tigard,OR 97 (� %?' J'-/ 7 CPhone: 503.718.2439 Fax: 503.5981.e)(14 _ � � Date/By: $ Other Permit: cy 7.��� T I G A R D Inspection Line: 503.639.4175' Date Ready/By: Juris: Internet: www.ti and-or. ov S See Pagel for g g trtii .`y k Noti ed Need:/( 1� (?/1 Supplemental Information f�tt1 /" TYPE OF WO l I;G DIV ISION REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction ■9i- olition Permit fees*are based on the value of the work performed. Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: dwelling 0Commercial/industrial $ b ) l I -7_ 15 IA 1-and 2-family ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: I 5 SIA__) 1—b n 5 c n C f New dwelling area: square feet City/State/ZIP: 1 1 I Qin,-[ F� , h a, CYJT Garage/carport�—+ —I � � g arport area: square feet Suite/bldg./apt.no.: Project name: Coveredorch area: p square feet Cross street/directions to job site: st,3 ( C1 ,n -Ave_�x 1 t-a- Deck area: square feet Other structure area: 5 7 square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application.Ki t, chto cpm Do-c__' rrk O } vm{• iL . Valuation: $ Existing building area: square feet New building area: square feet ill PROPERTY OWNER 0 TENANT Number of stories: Name:Do ('i na- l( r\y�� S-}-rbu Type of construction: Address:gg1 5 SW Soh fS �� Occupancy 1 p --�> s: groups: City/State/ZIP: 1 1 o tr, ; 0 K i I9, ] Phone:� P 7/i,9, q i 6060)?I ' / Existing:g6131) New: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) Contact name: Structural plan review fee(or deposit): Address: FLS plan review fee(if applicable): City/State/ZIP: Total fees due upon application: `/2 // Phone:( ) I Fax::( ) Amount received: E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: J DSh 3©*p Q C cn C tr/ 1 c-h or) Submit two(2)sets of roof plan with connection details Address:—7[) c)� 0-Dir) 7 T) 7 J I (•C f J d fire department access,along with the 2010 Oregon Solar Installation Specialty Code checklist. City/State/ZIP: A-t Dha D q.'-7 De,-.7 Permit Fee(includes plan review �` a and administrative fees): $180.00 Phone:€3-,v 510g l 31 Fax:( ) CCB lic.: p g ` State surcharge(12%of permit fee): $21.60 /�.....v‘ 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. Print name: /ALD sigo Um Date: 11-2—/7 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPer nitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FORR OlFiCl1 1 S OyLl % City of Tigard Received Permit No.: Dale/By: U 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: C Phone: 503.718.2439 Fax: 503.598.1960 0 Electrical 0 Plumbing 0 Mechanical 24-Hour Inspection Line: 503.639.4175 T I G A R D Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1`s NO 1/'1 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. 4 Fire district approval required. Name of district: • 00 00 5 Septic system permit or authorization for remodel. Existing system capacity • 00 00 0 6 Sewer permit. 0 0 0 7 Water district approval. 0 ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0 basin protection,etc. 0 0 0 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0 there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0 and location. 0 0 0 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0 floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 0 0 0 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 0 0 ❑ 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- prescriptive path analysis provide specifications and calculations to engineering standards. 0 0 0 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0 systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 0 0 0 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0 for four or more appliances. 0 0 0 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review. 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 00 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 00 0 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0 Street Tree List. 0 0 0 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0 0 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP-RESPetmitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE LSE ONLY eceived City of Tigard E(EcEivE-., ,. D ate/By: Permit No.: , 13125 SW Hall Blvd., Tigard,OR 97223 - ' - Plan Review " 111 Phone: 503.718.2439Fax: Date/By 503.598.1960 Other Permit: : GA RD Inspection Line: 503.639.4175 NOV 2 2017 Date Ready/By: kris VI See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information -, •• • aly Of:TIGARD. FEE* 14 vi, - - .--- du, TYPE OF vvoil4C , COMMERCIAL SC ED E -- USE LIM 1ST r•-i ....14 A MILVING DIVISION Mechanical permit fees*are based on the value of the work L j New construction ,ddition/alter i rep cement ' ' performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition El Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ ,CAir EGID IIY OF CONSTiliCTION ' , '''' , 4, '''- RESIDENTIAL EQUIPMENT/SYS'FEMS t EE 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION AH.eating/cooling: r conditioning 46.75 Job site address:ci q 15 5L.,....)1.--ohnsor) Se, Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:"1---;1 ar "; Og., 979- 9. ._) Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: j Project name: A Duct work 23.32 Cross street/directions to job site: Sup Cq reu-A,1- frVC_.) Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 iiEstatiqicm pF'Woiiic -' .., -,:41- Gas fireplace/insert 33.39 Flue vent for water heater or gas i. 4 23.32 (JJ e- (p.-z_e. tAA c"....1 i...NI ta A :L-re 4Z LA)A L.L. OJT froi.):Z-4--€.+CT fireplace Log lighter(gas) 23.32 (.0-11-L- (0E6,2) 1-0 (2-"1--Lb, 4i- . A '6.- 4"04.-• FALte:7 A1411 Wood/pellet stove 33.39 1)1,4c A cAcAa-2.- , , No -L--c-a< 0 0( ri,ti5L,L.-sr (Aki_i_ 1,4, IM;TcrE.), Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 ,.... .1,1,,.. .3, ,..„,,,,.." ` ,,,,,, A, «, ,4...,, 24 4n ,..„.,i ,v.,Wr ,,,,' (1;„, .. P,40PEKTY 0 v*Pm•K 4, 4 ,Ir-- 4 --1- Environmental exhaust and ventilation: Name:Dma\6 czn6 AA.ncifej.:1_ 5\-1-E-xtyy-) )( Range hood/other kitchen Address:Uri 75 sLA.....) 3-d-,„-NQ ,-----1,-, equipment 33.39 ', ti .t__...,, I k..--- 1 Clothes dryer exhaust 33.39 City/State/ZIP:-11 pia or\a DR, 97 2...2- Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 .,---, Phone:61). 14.-8 bya (q-it) 5co(t, )3)6, J Attic/crawlspace fans 23.32 0 mitdemser -'71 , 0 CONTACT *pi , '''' Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Gas heat pump Address: Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue CONTRACTOR -4' 41 44 : ''' Clothes doter(gas) Other: ,c. Business name: Dk._on e__Ar.. z., .. MEEHAINTICA,PERAfti FEES* - -, Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: 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:7-Aliki A I. ..'...rpsakd,r.1 Date: ii /2/I 7 I:\Building\Permits\MEC_PermrtApp_040113.doc 440-46I7T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information J Commercial& Multi-Family Fee Schedule: 'Total Valuation:x tt.Permit Fe_�e. $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_Pe nitAPP_040113.doc 2 Plumbing Permit Application Building FixturesFOR OFFICE USE ONE) City of Tigard REl VEr C Received .F- Date/By: Permit No.: 41 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960Other Permit No.: Date/By: Inspection Line: 503.639.4175 (l 2ii / T I C.Alt D ll 1Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov FTI p�y Notified/Method: Supplemental Information RC GAR TYP. F WO * SCHEDtI El New construction Y] J. ' DING DIV/BION For special information use checklist DIJJ Description Qty. J Ea. Total l Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) JCATEGORY O1 QNSTRUCTION�. - SFR(1)bath 312.70 I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 0 Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB ITE'*4FORMATIQN AND LOCATION site utilities: )-` Job site address:aq J 5 sit) l'oh fl��Y- S`}" Catch basin or area drain 18.76 �I „r ci i Drywell,leach line,or trench drain 18.76 City/State/ZIP: ' 2, Footing drain(no.linear ft.:_) Page 2 3 Suite/bldg./apt.no.: S Project name: Manufactured home utilities 50.03 Cross street/directions to job site: 45.L) " l r(ie_, Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 .x r DESCi*jioj1T QF 3b' R1C r Backwater valve 12.51 Clothes washer 25.02 ,'" ttiz. pas" MOijL.NGn i kX TC/rEri tWJ jll,.+-- 1%'( (ot,h2 rE.ET' AO 11 Dishwasher i 25.02 iiil Li- NEED 'ja VF.I.e.ANATE- A-SL►AK/ rAUC,51;AND rZ544)45N ei . Drinking fountain 25.02 Ejectors/sump 25.02 u.; ' ;(' OPERTY ow t 0 TENANT Expansion tank 12.51 Name:DvnctlA cc v.\ c e(L a vV� Fixture/sewer cap 25.02 Address:coq i 5 a,.) 3 f DT S* Floor drain/floor sink/hub 25.02 d -1�� Garbage disposal 25.02 City/State/ZIP: (� 6 I Hose bib 25.02 Phone:6-C. LB ��l i) 500 3 1 J ) Ice maker 12.51 APPLICAt ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Contact name: Primer 12.51 Roof drain(commercial) 12.51 Address: Sink/basin/lavatory ( 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 ,,;; co- � C'T'OR r.: Water closet 25.02 RA $' Water heater 37.52 Business name: ©t.)f e-C Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE .fr Print name: Date: -� This permit application expires if a permit is not obtained within 180 days Dom FIt "ti2uJf)'1 i after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information 4 Fee Schedule: Residential Fire Suppression Systems: S' Midis Qty. Fee(ea) Total Square ' Q ge: Permit Fee: Footing drain-1s'100' H 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 Valu aon: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Fee 4 each additional$100.00 or fraction thereof,to Other Inspeons or fees em ,, and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. 4147,..„7„, nAeAeview or Plumbing install:44s t Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 414sometricor Miser Diagram 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 City of Tigard 'I COMMUNITY DEVELOPMENT DEPARTMENT 1111I TIGARD Building Permit Review — Residential Building Permit #: /)-7S7--2/7 1.fz7 Site Address: °Pi 79 S �ohns�� �1r�'' Project Name: St2CLI M MA 1+1Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: Atm S9 Qt F+, JVerify site address/suite# exists and active in permit system. . River Terrace Neighborhood: A No ❑ Yes,See River Terrace Review Addendum Attached - Plan Elements: rI1r ree(3)copies of site plan 'xisting structures on site dir'/- ite plan must be on 8-1/2"x 11"or 11 x 17"paper �,I :ootprint of new structure(including decks)with finished a ►rawn to scale(standard architect or engineer scale) floor elevations El orth arrow / I. '. 'ty locations&easements(required for new and additions) > tSite address,project or subdivision name and lot number 'P.'dewalk/driveway approach -,Applicant information(name and phone number) Ai •cation of wells/septic systems ` �. Lot dimensions and building setback dimensions ; xisting trees to be retained with drip line,and tree Nr ..quare footage of buildings to be demolished .rotection measures N T_.t area,building coverage area,percentage of coverage and IL►• reet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) /i.treet names NiplProperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ❑Yes K,No 4 foot differential) If yes,is a storm water quality facility shown? 'epNo A Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): CAA)& Required: XYes,applicant was notified Cl No Received: J Yes CICeq No v 1.p Pto'l�r Public Facilities Improvement(PFI) Permit: J 11'/d 7 is Required: ❑ Yes,applicant was notified No A lied For: r ' Pp ❑ Yes El No,stop intake .154 Land Use Case#: 0IA Zoning: R -c Required Setbacks: Front 2-0 Rear 15 Side S Street SideGarage j�,) ALandscape Requirement: % / 1} .g, Lot Coverage Maximum: J I Building Height: Maximum Height Actual Height ,3-(c Visual Clearance I,J f, Sensitive Lands: Yes El No Type (y p�I V1 J 'nal 0 t-h -Vttl� 1`f11Jrban Forestry Plan ' IJA.Conditions "Met"prior to issuance of building permit sites: Approved By Planning: /1"1 co. -: Date: 1 0/24 / 11 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: El Approved El Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\Building\Forms\B1dgPennitRvw RES 061417.docx Building Permit Submittal Original Submittal Date: /V -7 Site Plans: # Building Plans: # 3 Building Permit#: nter building permit#above. Workflow Routing: Canning 4�r,ngineeringermit Coordinator ding Workflow Sign-off: gn-off for Planning(include notes from planning review) Route Application Documents: LJgineering: (1) copy of permit application, (1) site plan, (1) building plan and ori anal plan review routing form. Ly''Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: ' 0....„.. ., - Date: /0/7 Engineering Review Ei Slope at building pad: 7. t4 conditions "Met"prior to issuance of building permit , asements (encroachments)per engineering conditions of approval and plat .,Id'Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 12'‹o Assess Water Quantity Fee in-lieu: 0 Yes Er—No LIDA Facility on lot: 0 Yes [ o 0 NOT Approved by Engineering: Date: Notes: Approved by Engineering: g.t-I% /1 S>a Date: j 1 - s -17 Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: 0 Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: CI Yes N/A Parks SDC: ❑ Yes N/A LIDA ❑ Yes N/A OK to Issue Permit Approved by Permit Coordinator: gr/Date: i 1�./ I:\Building\Forms\BldgPermitRvw_RES 061417.docx RECEIVED NOV 2 2017 , Clean Water Services File Number CIT'OF ° G O nWater\`Services 17-003453 ILDN G DEMO 9 ensitive Area re-Screenin Site Assessment 1. Jurisdiction: TIGARD 2. Property Information (example 1 S234AB01400) 3. Owner Information Tax lot ID(s): 2S102BA02200 Name: Donald Stroum Company: Address: 9975,SW Johnson St Site Address: 9975,SW Johnson St City, State,Zip: Tigard,Oregon,97223 City, State,Zip: Tigard,Oregon,97223 Phone/Fax: Nearest Cross Street: Johnson St E-Mail: 4. Development Activity(check all that apply) 5. Applicant Information Gd Addition to Single Family Residence(rooms,deck,garage) Name: Donald Stroum ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium ❑ Residential Subdivision Address: 9975,SW Johnson St ❑ Commercial Subdivision 121Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Tigard,Oregon,97223 Other 62 SF ADDITION Phone/Fax: 5034817682 E-Mail: pdx3dms@gmail.com;andreastroum@gmail.com 6. Will the project involve any off-site work? ❑Yes W No ❑Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project 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 andtor 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 Donald Stroum Print/Type Title ONLINE SUBMITTAL Date 10/23/2017 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 17-05, Section 3.02.1. 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 07-20,Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law. ❑ This Service Provider Letter is not valid unless CWS approved site plan(s)are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed by 44.--4,4/44.---- Date 10/27/17 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone: (503)681-5100 • Fax:(503)681-4439 • www.cleanwaterservices.org City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9975 SW JOHNSON ST, TIGARD, OR, 97223 April 4, 2018 at 2:30:03 PM Record Type: Record ID: Residential - Master Permit MST2017-00427 Inspection Type: Inspector: 699 Mechanical final David Young Result: CNCL Comments: Wrong inspection scheduled, will schedule mechanical rough in inspection for hood vent. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9975 SW JOHNSON ST, TIGARD, OR, 97223 September 11 , 2018 at 11 :57:43 AM Record Type: Record ID: Residential - Master Permit MST2017-00427 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9975 SW JOHNSON ST, TIGARD, OR, 97223 September 11 , 2018 at 11 :55:33 AM Record Type: Record ID: Residential - Master Permit MST2017-00427 Inspection Type: Inspector: 399 Plumbing final David Young Result: PASS Comments: Owner to finish caulking backsplash at kitchen counter. Owner to secure dishwasher hose to bottom side of counter top or top of cabinet side. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9975 SW JOHNSON ST, TIGARD, OR, 97223 September 11 , 2018 at 11 :58:40 AM Record Type: Record ID: Residential - Master Permit MST2017-00427 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Violation Summary: Inspector Contractor