Permit 11111 . 9 CITY OF TIGARD MASTER PERMIT
I . COMMUNITY DEVELOPMENT ��� Date Permit#: MST2019-00463
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243• +: • Issued: 01/21/2020
j i Parcel: 2S103CA00311
Jurisdiction: Tigard
Site address: 13194 SW 121ST AVE
Subdivision: BIRCH MILL SUBDIVISION Lot:
Project: Birch Mill Estates, Lot 6
Project Description: New SF. 4/10/2020: REPRINT permit to add NC.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1249 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1187 sf Garage: 664 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
•
Total: 2436 sf Value: $330,669.28 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2436
Owner: Contractor:
LF121 LLC JTSC LLC Required Items and Reports(Conditions)
5285 MEADOWS RD,STE 171 5265 MEADOWS RD,SUITE 171 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035
PHONE: 503-657-3402 PHONE: 503-308-7324
FAX: 503-684-0102
Total Fees: $34,150.95
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires y u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9 -001- 90. You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.��
Issued By: Permittee Signature: S r �y/�/lfi�G' ,
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.
RECEIVED
Mechanical Permit� Applicati�itft R 0 8 2020 101,1 4)i'I 11 1 1 tit I b\I l
_ Cie'0«igard /U ! Para,No C 1
I3125SW Hall Blvd,T rut OR 9nalY OF TIGARD at:4 " / Y� �TO1L)/f—ale)ii63
F Pttac 503.4182439 Fax 503 4J? DING DIVISION r Omer Permit
i t •,t t htapeetim Line: 503.tt39.4f 75 DNe Resdy/Sy: raic I El Sae hp 1 for '
Wand: www.tigard-orgor. /4nafittIOdathott 9ePP(ttatee1 ie otwpa
TYi'E OF WORK .`... . . .. Fi`Lkt A£- , ;Y4uPb[1#Y,: (t e,i4l
Nov wa&tuclionhkclainal penni1 thus*are based on the rate of the wort
® 0 Addition/a1tet*tionireplacemeat perfumed Mimeo gn vaM¢(rounded to the snot dollar)of ell
❑Demolidan 0 Odur: mechanics/materials,equipment,labor,ovedtead,and profit
Val ore S
®t-and 2-family dwelling 0 ConunetuisPiodwaial 0 Accessory building Far apedd teem aadae urn ductal&
❑Mniti-tamlly 0 Master builder 0 Other. Description I Qty. I Ea. I Tow
•. ' • 3".0g11 R4F{SIt Ill t4 • - Ratlagteoatlpl:
•Job site addmcae Furnace
e100,000 BTIJ(doedaat) 11 46.75 �6 75
City/SmtedZlP: Furnace 100,000+B11.1(d..o .) 54.91
Host
Sukdbidgiapt.no.: Project umglitrGh M;(f/`t. 1- (r Duct pump 6I.06
i 23.32
Cross sheet/directions tojob site: ] lolls} Apt .t- SW :Tames S-tr Hydzook batav wamann 23.32
RinidMial boiler(radiator ar
hydros le) 23.32
Unit heaves(fuel-type,notch:chic).
io-wall,induct,1,suapendad,etc. 46.75
Flue/rent for any of above 23.32
Sobdivisim ITA. WA. Es 9 Lot no.: (D Oder: 23.32
Omer tact appasaas:
Tax¢up/pe[Oai no.: Water hater 1 23.32
.. . Q#;WfOR.C:::. . Gas 67eplaaJhmt I 33.39
Flue:vent for water hewer or gas
Flew bone eomtructlen }// /�,q �v/�n/yam _,(/,, firoplaot 23.32
t.efg GI / �e�L[-�(vJ //-•Yk�L GU Wood/pellet lVhter( O 2332
7�'sT i 9 610 63 - gb�7` (p Wand fnepiaodinsest 23.32
C2dnuscy/Rner)nuelvan 23.32
.-. '...3 etennoTY O'WI B.; Othrr. 2332
.: . : ;:-.r �. =.', '. '.. ,, Endraawtanl exhaust sad validation:
None: ! «!1 4 tt. Range baodlaher kitchen
Address:5285 Meadows Rd Ste 171 cq 1 33.39
Clodses dryer exhaust 1 33.39
City/Stale/ZIP:Lake Oswego,OR 97035 5ingtedex exhaust(bathrooms,
toilet compartments,ability rooms) 5 73.32
Phone:(503)657-3402 Pax:( ) Atdckaawlspece faits 2332
.. El Ammer!. ' '4 3 (7f2kJ'+►CF r$ -• Other. 2332
Business name:3 TSC,LLC Fad p[ping:
S1435 for neat lour,54.43 for oar+eddn W a l
Concert name•.John Wyland Pomace,etc. 1
Address:5285 Meadows Rd Ste 171Gas heat Pump
WaYsuspmdeNmit heater
City/State/ZIP:Lslte Oswego,OR 97035 Water boater I
Pbone:(503)209-7555 Fax::( ) Fiep/aoe 1
E-mail:JwytaadQJtsrahbeo.ca, ! I
Barbecue
CONTRACTOR - Clothes dryer(gas)
Business name:lategrity Air.LLC Other
MRG9AN1C aL MAUI lRIV. .
Address:16756 8W 72i0 Ave Babt.W ye.r-2_5-
City/State/ZIP:Portland,OR 97224 Mhrbmmt permit lee(590.00)
Plan review(25%of permit lee)
Phone:(503)5723594 Fax:(503)598-8498 State sn:Jwge(12%of permit fee) ` 4./
CCB lie.:203869 TOTAL PERMIT FEE
,.5 2. 3 y
• 11'a gonoit appMwaa anion Re pecsit is set obtained said ISO
Authorized ,V days after a lw m beet cepad as toww ple
signature: • Fee aiMo3bMgr sat by TraCounty Badding foamy Smite Board
Priotname:Kyle Birnan Deter
eNAdWmePesied.M5C Pe nitADP_em1 tl. 411046i7rir 1622C*4w )
I
Building Permit Application
Residential RECEIVE I FOR OFFICE USE ONLY
Cityof TigardEril
Received
g Date/B �� l /47.
�- �, /1
13125 SW Hall Blvd.,Tigard,OR 97223 G';, 6/59�9 PlanReview 2,� ( �y0'' �Ul 9�1 CGfI
Phone: 503.718.2439 Fax: 503.598.1960 Date/By ` w (1 404 G9h�gi T (/�536
T IG A RD Inspection Line: 503.639.4175 Ul i'-( Of- IIGARDt��Date Ready/By: Juris: El ee Page 2 for
Internet: www.tigard-or.gov RI !II DING DIVISIOI`r'o. ethod: 7(..(:-
..(: „ .1 Supplemental Information
//I'r
TYPE OF WORK RE FIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit� for the
CATEGORY OF CONSTRUCTION work indicated on this application. -3`2.)(� (
f �.Pt4,9
CO 1-and 2-family dwelling 0 Commercial/industrial Valuation: $fib;
0 Accessory building 0 Multi-family Number of bedrooms: 5
❑Master builder 0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: ., 3t°0
01,
Job site address: i J Ci—1 SLO I I "?-r A\i L. New dwellinraze .5-44--square feet \.`gj-7
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 6‘ci square feet ��4
Suite/bldg./apt.no.: Project name:Birch Mill-Lai- (Q Covered porch area: square feet
Cross street/directions to job site:SW 121"Ave&SW James St. Deck area: -- square feet
Other structure area: — square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Birch Mill Estates 1 Lot no.: 62 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:TBD equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New home construction Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:LF 121,LLC Type of construction:
Address:5285 Meadows Rd Ste.171 Occupancy groups:
City/State/ZIP:Lake Oswego,OR 97035 Existing:
Phone:(503)657-3402 Fax:( ) New:
® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:JTSC,LLC
Structural plan review fee(or deposit):
Contact name:John Wyland
FLS plan review fee(if applicable):
Address:5285 Meadows Rd Ste.171
Total fees due upon application:
City/State/ZIP:Lake Oswego,OR 97035
Amount received:
Phone:(503)209-7555 Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:jwyland@jtsmithco.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:JTSC,LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:5285 Meadows Rd Ste.171 Solar Installation Specialty Code checklist.
City/State/ZIP:Lake Oswego,OR 97035 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)209-7555 ,4 /M.. ' ) State surcharge(12%of permit fee): $21.60
CCB lic.:200237 Total fee due upon application: $201.60
Authorized signature: �1 Ta f 1 1 �,Y This permit application expires if a permit is not obtained
„ "JJ CC�� within 180 days after it has been accepted as complete.
Print name Wei J Date:' *Fee methodology set by Tri-County Building Industry
I_ `i(i� Vt� ��r Service Board.
I:\Building\Permits\BUP-RESPermitApp.uvc 02/24/2011 441110-4613T(11/02/COM/WEB)
1
Building Permit Application Checklist ,
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard d Received
g Date/By: Permit No.:
110 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
TIGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
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
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: 0 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacityCI ❑ 0
6 Sewer permit. 0 ❑ 0
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 ❑
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
basin protection,etc.
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 El El ❑
there is more than a 4-fft 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 El ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑
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.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ 0 0
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.
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.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ 0 0
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
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0
architect licensed in Oreton and shall be shown to be a..licable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. 0 ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, El El ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 ❑ ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
.
Mechanical Permit Application ICOR OI' It ► t til:ONLY
City of Tigard Received No.:
II13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
a ' Phone: 503.718.2439 Fax: 503.598.1960" / Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Janis: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE C1UsCKLIST
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 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 Heating/cooling:
Air conditioning 46.75
Job site address:I 6/Li 5� )(9 I'21 j�e- Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP: / Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:(be) M j i I•'"&o+ Ce Heat pump 2
Duct work 1 233.32
.32
Cross street/directions to job site:C, 611 s+- ..Ai .r stk. -Tames 5-}, 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
Subdivision:16;0\\ ky1 -64,7,4e-.9 Lot no.: W Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
New home construction fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other. 23.32
Environmental exhaust and ventilation:
Name: LF f JI L Range hood/other kitchen
equipment 1 33.39
Address:5285 Meadows Rd Ste 171 Clothes dryer exhaust 1 33.39
City/State/ZIP:Lake Oswego,OR 97035 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32
Phone:(503)657-3402 Fax:( ) Attic/crawlspace fans 23.32
APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:JTSC,LLC Fuel piping:
$14.15 for first four,$4.03 for each additional
Contact name:John Wyland Furnace,etc. 1
Address:5285 Meadows Rd Ste 171 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Lake Oswego,OR 97035 Water heater 1
Phone:(503)209-7555 Fax::( ) Fireplace 1
Range 1
E-mail:jwyland@jtsmithco.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Integrity Air,LLC Other:
MECHANICAL PERMIT FEES*
Address:16756 SW 72nd Ave Subtotal
City/State/ZIP:Portland,OR 97224 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)572-3594 Fax:(503)598-8498 State surcharge(12%of permit fee)
CCB lie.:203869 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
"1 C days after it has been accepted as complete.
Authorized signature: f� / * Fee methodology set by Tri-County Building Industry Service Board
Print name:Kyle Birman Date:
1:\Building\Permits\MEC_PermitApp_040113.do• 440-46170(11/02/CL.M/WEB)
Mechanical Permit Application - City of Tigard
Page 2 -Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit Application , , FOR OFFICE USE ONLY
City of Tigard Received
/� Date/B : Permit#:
Ill 13125 SW Hall Blvd.,Tigard,OR 97223 0 `�' Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 II
00.4. Date B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: 61 See Page 2 for
TIGARD Internet: www.ligard-or.gov Notified/Method: Supplemental Information
TYPE OF.WORK i'LA,T!1 REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
„ , ,,,`,, Ct#9Ea± ORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
® I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family 0 Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE 111 ..ORtMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 1 '616•1 c t ' J(f,,,) ia)=)-''' A 100HP or more. ❑"A" E^"1-2""1-3^
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bld /a t.#: Project name:
Z1(ch ,V;
' -
Lot-/e 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: S W It,Z IS--' AVe, "ie 6I 3-41Vi•e$ S. -TEE:SCHEDULE
Description I Qtv. I Each j Total I *
New residential single-or multi-family dwelling unit.
Subdivision:. ii t th MI EE5fevie5 Lot#: [p Includes attached garage.
1,000 sq.ft.or less I 168.54 4
Tax map/parcel#:
Ea.add'!500 sq.ft.or portion II 33.92 1
DESCRIPTION OF WORK ,,,-,`. Limited energy,residential 75.00 2
(with above sq.ft.)
New home construction
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
.aw Okt11.Y1i'NI ER >- z- i4ANT_
-�' Services orRenewable Enerfeedersgy installation,alteratio❑ SeenPage,andl2or relocation
Name' CF /02/1 Lt, C 200 amps or less 100.70 2
Address:5285 Meadows Rd Ste 171 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Lake Oswego,OR 97035 601 amps to 1,000 amps 301.04 2
Phone:(503)657-3402 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits—new alteration,or extension,per panel
PW, , ElCONTACT PERSON A.Fee for branch circuitswwith
Business name:JTSC,LLC above service or feeder fee,
7.42 2
each branch circuit
Contact name:John Wyland B.Fee for branch circuits without
Address:5285 Meadows Rd Ste 171 amps 156.18 circuit
City/State/ZIP:Lake Oswego,OR 97035 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)209-7555 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:jwyland@Jtsmithco.com Reconnect only 67.84
. ' - 2
CONTRACTOR . '
Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Address:2920 SW Brookwood Ave.Ste A Signal lesrcut(s)or limited-energy
panel,alIteration,or extension. 0 See Page 2 2
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr
Email:andreap@garnerelectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 121159 Electrical Lie.: 34-30 S pry ic.: 3707S specifically y listed(1 hr min)
.EECTRICAL
"PERMIT FEES
Suprv. Electrician signature,required: . 1.1.; Subtotal:
Print name: Charles Garn Date: 10/8/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature'
TOTAL PERMIT FEE:
Th. thp
is permit application expires if a permit is not obtained within 180
Print name: Andrea Phillips Date: 10/8/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:Building.PermitsELC_PermitApp_ELR_ERE.doc Rev 06%17,2015 440-361iT(II 05 COM WEB
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard 3 / Received
Permit No.:
IN • 13125 SW Hall Blvd.,Tigard,OR 97223 y '
g Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G ARD Inspection Line: 503.639.4175 Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF- WORK ' IIZE*S EDULE
®New construction ❑Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
"`� X,as' k ,F , y , ^ E .1. SFR(1)bath 312.70
® 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
SFR(3)bath i 500.32
0 Accessory building ❑Multi-family Each additional bath kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
`I 4 RIVt 0O11%+AND44 ):54 Site utilities:
Job site address: t' '1&I l-i r,L I UC j:='. A Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name:Vl rC,h Mi il 'ti"--40 Manufactured home utilities 50.03
Cross street/directions to job site:9W la I5.. ,' .5 iite54: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: +W) / Page 2
Storm sewer(no.linear ft.: 100 ) / Page 2
Water service(no.linear ft.:JOc) ) Page 2
Subdivision: ?j rc.,h j 1 I I -Es-I-a1e5 Lot no.: (9 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
Backwater valve 12.51
* W J', "l .' _ ',`.. Clothes washer , 25.02
New home construction
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t` OPER rb ";' ,: a4^, I�:t:; "' Expansion tank 12.51
Name: LF 1A/ f LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:5285 Meadows Rd Ste 171
Garbage disposal i 25.02
City/State/ZIP:Lake Oswego,OR 97035 Hose bib ,2 25.02
Phone:(503)657-3402 Fax:( ) Ice maker I 12.51
,:'- 4116 } '"J r'" . 0 CONlydl `J'*RsoN Interceptor/grease trap 25.02
Business name:JTSC,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:John Wyland
Roof drain(commercial) 12.51
Address:5285 Meadows Rd Ste 171 Sink/basin/lavatory 5 25.02
City/State/ZIP:Lake Oswego,OR 9703.5 Solar units(potable water) 62.54
Phone:(503)209-7555 Fax::( ) Tub/shower/shower pan 3 12.51
E-mail:jwyland@jtsmithco.com Urinal 25.02
q ry ; o r Water closet 3 25.02
• �� Water heater i 37.52
Business name:Mullen Company Water piping/DWV 56.29
Address:1601 A SE River Road Other: 25.02
City/State/ZIP:Hillsboro,OR 97123 Subtotal
Phone:(503)640-0113 Fax:( ) Minimum permit fee: $72.50
%
CCB Lic.:92689 Plumbing Lic.no.:34-260PB
Plan reviewState surcharge(12TOTA(25L%of permit fee)
.c)
Authorized sign re:
Print name:Jeremy ce PERMITofpermitFEEfee)
Date: 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 Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46t6T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
q�
. . Qty. Fee(ea) Total ,°� " "" g Pel�ttil#� '
etil>< es
., e)�dtita"e• � .
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Vatl�t�t�iaib:�" � Perin-it 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
aFec,fea� Nihil" 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-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*.
Quantity by Fixture Type Plalr IICmtoktianib t Hitto�ltSm
Iii nre Type for Replace/
Work Performed: Capped Added Relocate Plan review iss 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 Thru ❑ 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 ❑ 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"
� �r�a� �� tnr-, c�reT� gt�m
Car Wash Drain 0 Isometric or riser diagramis required for new buildings
Garbage -Domestic-non-food G g
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:
C:\Users\jeremy\AppData\Local\Microsoft\Windows\INetCache\Content.Qutlook\BTBRFOU6\04 Plumbing Permit-Blank.doc
City of Tigard
111 1111 COMMUNITY DEVELOPMENT DEPARTMENT
C
rlcARn Building Permit Review — Residential
e
Building Permit #: V&572\0(7— Q('-f'
Site Address: / I9 J Sit)Pi S .�
Project Name: , jjrGfi_ 47,I/ Lot #: Z6,
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Pro a1: 4,1('to ,-2 _
Ye Verify address/suite# active in Accela. tailf)-T--
n River Terr. e: I!d' No ElYes, River Terrace Review Addendum
SityPlan Elements: %Er.sion Control
Flaig copies of site plan on 8-1/2"x 11"or 11 x 17"paper illy:twined trees with drip line and tree protection measures
vilawn to scale(standard architect or engineer scale) otprint of new structure(including decks)and FFE
II orth arrowIOU i.ty locations&easements(required for new and additions)
e address,project or subdivision name and lot numbergm approach
plicant information(name and phone number) r►11):,• anon of wells/septic systems
Lot dimensions and building setback dimensions C1 j-eet tree size,type and location
t Ill:• are footage of buildings to be demolished 1 St6et names
Il' 'sting structures on site aComer elevations(2'contours if more than 4'differ nal)
Ill i►\•t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es ❑No
lean Water Services—Service Provider Lette (lot platted prior to 9/10/1995):
'equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
Public Faciliti Improvement (PFI) Permit:
R .red: 17 Yes,applicant was
notified ❑ No AppliededFor: Yes ❑ No,stop intake
d Use Case #: U1eS-o/� '— OUOO Ei oning: oe-' C-
2equired Setbacks: Front: 2O Rear: /C--- Side: Street Side: t- Garage: -O
1Building Height: Max. Height: �_ ' Actual Height: o!
Q` andscape krea: % of Coverage May
Entrance V Set back no more than 8'from street-facing wall 10 Parallel to street or offset 45 degrees or less
Windows V" Minimum 12%of area of all street-facing facades
Garage V-Garage door is behind widest street-facing wall Yes ❑ 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 2nd floor.
tiarraa e door width is ❑ 12'or less ❑ 50%or 1 s of facade 0%or less and includes 7 f following:
J)l overed porch 0 ecessed entrance Z Wall offset/ EV 1'Roof eave YJ Roof offset
Id Fire shingles 1✓J Lap Siding ❑ Roof pitch Vgr Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding Window trim Cl Window recess ❑ Window projection ❑ Balcony
t d1*l 'sual Clearance rban Forestry Plan �—�-
V Sensitive Lands: Zes El No Type: �/Uii3a/C y2.vl
❑ Co di s m t prior to issua ce f building p rmit Vey Air C 6�'
No s: (/1C�/ oii�d Mia-4-
E. ,
J1ia � YIb>' � Zia17C
Approved By Planning: -.._, ,f,C-- Date: -
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_0228I 9.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: # —
Building Plans: #
Building Permit#: ►i— nter building permit#above.
Workflow Routing: oli' lanning 9oEngineering ermit Coordinator `II.Building
/
Workflow Sign-off: -Sign-off for Planning(include not 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: /�.�` ,a/L`(�,_, / Date:
i
Engineering Review
0
V Slope at building pad: 2.-Y,
® Conditions "Met"prior to issuance of building permit
`L4 Easements (encroachments) per engineering conditions of approval and plat
t Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes V No
Assess Water Quantity Fee in-lieu: E Yes El No
LIDA Facility on lot: V Yes E No
❑ Final Plat Recorded: N U Orr T
❑ NOT Approved by Engineering: Date:
Notes:
X�, Approved by Engineering: 17....41 15,,(( _.. Date: ( . t 3 • 20
Revisions (after Building Submittal only) � Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
.(
Approved,NOT Released: G ?•-•?-e-Ac deDate: k/< /'
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Rev' 'on Notice 3: Date Sent to Applicant: �/
DC Fees Entered: Wash Co Trans Dev Tax: L�� es ❑ N/A
Tigard Trans SDC: l� Y s ❑ N/A
Parks SDC: Ls ❑ N
LIDA Yes /A
VY OK to Issue Permit J
Approved by Permit Coordinator: ( / Date: 6Ol /Z v
I:\Building\Forms\BldgPermitRvw_RES_022819.docx
Albert Shields
From: Albert Shields
Sent: Monday,January 13, 2020 6:42 PM
To: jwyland@jtsmithco.com
Subject: Birch Mill Subdivision - MST2019-00455, -00462, & -00463
Attachments: Birch Mill - 01-13-2020.pdf
John, in reviewing the above permit applications I have found that a number of the Conditions of Approval highlighted
on the attached list pertaining to final plat approval and receipt have not yet been met. We need to have those met
before we can issue these permits. Accordingly, I will code these permits as"Approved (for Plan Review) but Not
Released." Plan Review will proceed but the permits will otherwise be on Hold until the subject conditions have been
met.
Please let me know if you have any questions.
Albert Shields.
CITY OF TIGARD MASTER PERMIT
' . - COMMUNITY DEVELOPMENT Permit#: MST2019-00463
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/21/2020
TIGARD Parcel: 2S 103CA00311
Jurisdiction: Tigard
Site address: 13194 SW 121ST AVE
Subdivision: BIRCH MILL SUBDIVISION Lot:
Project: Birch Mill Estates, Lot 6
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1249 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1187 sf Garage: 664 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 2436 sf Value: $330,669.28 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains. 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2436
Owner: Contractor:
LF121 LLC JTSC LLC Required Items and Reports(Conditions)
5285 MEADOWS RD,STE 171 5285 MEADOWS RD,SUITE 171 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035
PHONE: 503-657-3402 PHONE: 503-308-7324
FAX: 503-684-0102
Total Fees: $34,004.24
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 No,fication Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may ob -' •• •f the rules or direct questions to OUNC by call' 5i .232.1•87 or 1.800. 2. c44.
1 /
Issued By: r! xw ' �f Permittee Signature: •
..--
all 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 oft - project.
Approved plans are required on the job site at the time of each inspection.