Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2020-00272
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2020
TIC;A R t 9 Parcel: 2S104CD01700
Jurisdiction: Tigard
Site address: 13957 SW MISTLETOE DR
Subdivision: HILLSHIRE ESTATES Lot: 17
Project: Hayes
Project Description: Convert existing bedroom to walk in wardrobe,enlarge bedroom 3, remodel master bath
BUILDING
Floor Areas Reauired Setbacks Reauired
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 si Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $45,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
0
Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywall-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Alr Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 4
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: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
HAYES V ENTERPRISES LLC DOSIER CONSTRUCTION Required Items and Reports(Conditions)
13957 MISTLETOE DR 3519 NE 15TH AVE.STE 262
PORTLAND,OR 97223 PORTLAND,OR 97212
PHONE: PHONE: 503-985-9982
FAX:
Total Fees: $1,363.65
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
952-001-0010MVO--
Perrniftee 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: `-� Signature: rn o pp 1 f C��d�
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
'Residential P �, FOR OFFICE USE()NI.1
' City of Tigard r Date/BReceivea �0 02 2O Permit No.Ms d2L'm2
13125 SW Hall Blvd.,Tigard,OR 97223 Sr P 2 2 2021 y
g Plan Review I O/j n ��^ I / Other Permit:
Phone: 503.718.2439 Fax: 503.5981960 ! _ , namlBy: ce 2.07,0
T 1 GA R D Inspection Line: 503.639.4175 C l 3 Y O ' ) Date Ready/By: lwis El See Page 2 for
Internet: www.tigard-or.gov r". Notified/Method- f 0 r ql 1 470 Supplemental Information
TYPE OF WORK 6fLLING
ill New construction ill 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
work indicated on this application.
Valuation: $ 2 7yy�
�1-and 2-family dwelling ❑Commercial/industrial 51 ZXY�
ElAccessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
.1 4 f y s. i .,,r r Total number of floors:
Q
Job site address: 13951 St a t_.,‘\s-i-Lif Tbrs1' 1� , New dwelling area: square feet
City/State/ZIP: -'C s`C'�'�`jl P, j� (Ce_ Ci-�ZZ3 Garage/carport area: square feet
Suite/bldg./apt.no.: roject name: besrca4 p RE+„Lizt Covered porch area: square feet
Cross street/directions to job site: CiiiS t 1`iA 1 p Deck area: square feet
Other structure area: square feet
REQUIRED DAtA.COMMEIRCIAL-t15E CHICK/Aro
Subdivision: I Lot no.: Permit fees*are based on the value of the work :eriormed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
m ,, lil CP rlON cw work indicated on this application.
Valuation: $
6kiL= < l vNL.K-' its wr'\v-Aer-E ) ratacc,R.3 tA1jG
REMo.doe. 1'1�-T M 1 Existing building area: square feet
Cov\ -A- • „I ��,\ ...�-a rti 1:11)- .,:!,r- bop / r�building area: square feet
c J
&S ,1411i , -,r, k i. 1 6 remit'i Number of stories:
Name: /S•y Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:O 34 _ (0 4 Fax:( ) New:
i 7 a c ° °i
Business name.
Structural plan review fee(or deposit): ?..5 3
Contact name: cscus--r-( NI bc)S t��
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application:
Phone:(ojIJ.a 185.9 9 2_ Fax: :( ) Amount received
E-mail: PHOTOV'QL,TAt( ,Mil AR P<L\i.I SNSTi .111 ES* '
. .. < t,.�mtnetcial and raidcnueI l:aasc npu:c ui,tallation of
,, t '' '' i roof-top mounted Photo Voltaic Solar Panel System.
Business name: DOS`L--� C O'ti J��or-1
two(2)sets of roof plan with connection details
e and fire department access,along with the 2010 Oregon
Address: `a�l 9 )E t S NJ , StJ t'CE 2 a Solar Installation Specialty Code checklist.
City/State/ZIP: -r AC3 i I � Q^�21 Z Permit Fee(includes plan review $180.00
t and administrative fees):
Phone:(503) 9$ S-9 Q S Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: Z j Total fee due upon application: $201.60
Authorized signature: i , A This permit application expires if a permit is not obtained
. _ within 180 days after it has been accepted as complete.
Print name: j)t Itt j 4 D. (t'�. Date: g_4 -2d 20 *See methodology set by Tn-County Building Industry
L:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
Electrical Permit Application FOR OFFICE USE ONLY'
Received MS1�o2G-6J 272.
- City of Tigard DatelB : Permit#:
11 . 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
3 Phone: 503.718.2439 Fax: 503.598.1960 Date/B Related Permit#:
TIGARD Inspection Line: 503.639.4175 Ready Date/By: Luria: ® See Paget for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
..e 33 ,� vl . % e .z.t"l" .emu' `* "i"" x, ,,'
i, z,',� ter,«. e a-w,�. ,(� aL &. ..-�, s'�^ ' '",H.
' Please check all that a 1 submit 2 sets of,tans w/items checked:
❑ Now constructionAddition/alto • /replacement PPy< P )
❑Demolition ❑ Othei: ❑Service or feeder 400 amps or more ❑Building over three stories.
1 'Irv-
where the available fault current ❑Marinas and boatyards.
d,�•'y 4 ° r ' t .. I t.' `,.m;' exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building less to ground,or exceeds 14,000 ❑Commerc al-use agricultural
amps£or all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑Fire pump. 0 Installation of 150 KVA or
tIrriliaLii. LE. 4. 0 Teatdl' 1,f ❑Emergency system. larger separately derived
.lob 4: Job site address: 13Q5i -�� M1S•tt ,_TL r ❑100H oo of ore.motor load of system.
1 lS- l ]OOHP or more. ❑"A" "E" "I-2" "1-7"
City/State/ZIP: 9-1 ZZ 3 ❑R cu anc . P
❑Six or more residential units. p y
Y ��� t Recreational vehicle arks.
{ •� ❑Health-care facilitie.
Suite/bldg./apt.#: I Project name: U I JTit Rs RE &b€1, ❑Hazardous locations. ❑600volts no"'tag!
1aolr more than
❑Sernce or feeder 600 amps or more
Cross street/directions t0 job site: {% �^ �1 "+ '• ,�:eVa'"� .
�rti CT t,tALLsii t?� -z-r am a Fatavicna& vrw'`-_,. ,,, „> ..t7:v F, A-`'
Description Qty. Each Total *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
-I ' ea 3 ^' '- _ Limited energy,residential
(with above sq.ftJ
ENTENb IRel-oL°I 1 \sT 14 Cr c,‘Qh)icc ca., Limited energy,multi-family
� yy residential(with above sq.ft.) 75.00 2
T t' --' '✓, �.\ r't l" V't f-('.77:` C� _ Renewable Energy 0 See Page 2
-�" t f ' .. �. - Services or feeders installation,alteration,and/or relocation
Name: H j\V�-e 200 amps or less 100.70 2
Address: 13 ct51 SU TT�vST LE TO %. Ci 6 201 amps to 00 amps 133. 2
401 amps to 00 amps 200.34 2
City/State/ZIP: I . C11223 601 amps to 1,000 amps 301.04 2
Phone: (r)3)34\- Lodi 4 I 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
st- '711,11110,15PVIIMIFielielMill—T9MIIIll,ntrroltrrirligymil
Branch circuits-new,alteration,or extension, ler panel
�,,.�• - A.Fee for branch circuits udth
Business name: kil.JStr.-Cs. CO �,..,r� y, '�O� above service or feeder fee, 7 42 2
l �- `- each branch circuit
Contact name: NOSTi t,4 'bps,E B.Fee f'or branch circuits without
Address: 3S kq 1 -e . .so ITE 2402__ service or feeder fee,frst 56.18 2
branch circuit
City/State/ZIP: �^,\N 5Z 2-1 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ,'3)qg5 -99 8 2_ Fax: :( ) Each manufactured or modular
�X-�/,_r' dwelling,service and/or feeder 67.84 2
Email: l t'' 04 S r L _- 1 Ors i Al . . I Reconnect only 67.84 2
aE t r J »° +°. 3
+ c,a.�s,C_,,,�,,iTv„;-„,�a,+re" r/��'�,�`,'% ` � Pump or irrigation circle 67.84 2
Business name: -:_1-1` 3 E LeG-azi Imo.. C Co J6S-c-R1Xi.�O t-- Sign or outline lighting 67.84 2
r•- t` Signal circuit(s)or limited-energy 0 See Page 2 2
Address: Id5� sw c&_yNC5bA,- ' 2zj panel,alteration,or extension.
City/State/ZIP: 13v*1-pt .9-2ppg Each additional inspection over allowable in any of the above
W Additional inspection(I hr min) 66.25/hr
Phone:(503) 1(a I -35 37 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
` Inspections for which no fee is 90.00/hr
CCB Lic.:/e/r2 9.7 b Electrical Lic.: e 8 2 I Suprv.Lic.5-7 S, s r-cificall listed '/a hr min
err v„
„
Suprv.Electrician signature,required: Subtotal:
Print name: 5-0AA Kn2l4;) Date: q-15-2o Zv 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: `A TOTAL PERMIT FEE:
This permit applicefion expires if a permit is not obtained within 180
Print name: D AWSTI 4 i*St 67?--- Date: CI-IS -ZOZ J days after it has been accepted an
complete.
* Number of inspections allowed per penni[.
t\Building\Permils\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015 440.4615r(11105/COM/WEB
k
r Plumbing Permit Application
-Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received
Permit No.'
. 5720W er)27L
II a 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
S • Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date By: Other Permit No.:
'FIG AR D Inspection Line: 503.639.4175 Date Ready/By Ions RI See Page 2 far
Internet: www.tigard-or.gov NotitidiMethod I Supplemental Information
: .%4i t' bs. •'. ✓'b t ..' .1 ma. rvr
,,.,°, ,It?t; .:- 1,s 8 t a c." ' �:,- ° im+r Fr I- SC'1IF.I} }.t't�k
D New construction ❑Demolition For special information use checklist
Description I Qty. Ea. I Total
.12rAddition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
r "" `;i� SFR(t)bath 312.70
•1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
1° - t« i :skiiiIr - =I" : t' Site utilities:
Job site address: 1���1 Catch basin or area drain 18.76
W MLSi LCTdE 6.
DrCity/State/ZIP: Cri�4, ci-72Z Footing
dll,rain
line,or trench drain 1 ge 2
Suite Bldg./apt.no.: Project name:l /� A \ . Footing drain(no.linear ft.:_) Page 2
Ur JT!��(Z� Nla G Manufactured home utilities 50.03
Cross street/directions to job site: C�-nl �+ct� N NI Yi ILLSE- Manholes 18.76
�X 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: Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
. P f,. .a, t r a , ."•!` "t- Backwater valve 12.51
r� _ - Clothes washer 25.02
L Vv� � 1 - T t.)a b Jos.-,:s -I•- 5 v eeLt r- Dishwasher 25.02
( - To l LET- Drinking fountain 25.02
I 1 er_ ..t N` 1- '(.L4C Ejectors/sump 25.02
a
,,t' 't li , ., .iN . i,.. - ..t,_ .lt $� Expansion tank 12.51
•
Name: �/s y�-� Fixture/sewer cap 25.02
/`� Floor drain/floor sink/hub 25.02
Address: 1-3 c15.7 S‘N) M L STLC Td e
Garbage disposal 25.02
City/State/ZIP: 'CZCt--e&Rk) 9'7 Z .3 Hose bib 25.02
Phone:(. g) 34 i , c,C -7.. Fax:( ) Ice maker 12.51
^„". , , �w m Ale.'Arabs diff. Intereeptorlgrease trap 25.02
Business name: its �oc� Medical gas(value:$ ) Page 2
lam' l An O Primer 12.51
Contact name: i us-t--i N f 1C)S I E L
Roof drain(commercial) 12.51
SiIli ,
Address: 5 I S AVt__
V lrE 2.62_ Sink/basin/lavatory 25.02
City/State/ZIP: i-L�41 � 97 2(Z Solar units(potable water) 62.54
Fax: :( ) Tub/shower/shower pan 12.51
Phone:(�3) 9�J�$� '�,
E-mail: b,_ i� r ,j Sf -Lt.+ c J . t'L Urinal 25.02
f A aye P ,' Water closet 25.02
,` Water heater 37.52
Business name: Ruy-p .,1xti ?Lk)MSI N(7 Water piping/DWV 56.29
Address: 1 1O5 Iti1 C1 q"C} Ls ^r Other: 25.02
City/State/ZIP: V p ..cy>)�y-1 1hJ 4 9 O 4 Subtotal 5j t,oy
Phone:(5(3)8 (Z�q Fax:( 6 ) Minimum permit fee: $72.50.'+ ?j2•U l r Y
CCB Lic.: Plumbing Lic.no.: n172 ID
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: b , F�o Is) bay/Ft, Date: g_is 202o 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:IBuilding\ecmits'.PLMl1-PermitApp.doc 10/01/09 440-46I6T(I0/02/COM/WEB)