Permit 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
No Transmittal Letter
,;;-,i: r) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Ailir,o'V� DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM: La-As 1 v tsi--ov _____ RECEIVED
COMPANY: v�O t.t� MAY 12 Z02Z
PHONE: CITY OF TIGAR JBy:
°��?I-~1 ZH 7�� BUILDING DIVISION
EMAIL: �-- t vV.ch. CO 14 g vt4A,( I• co vt-' _
1-14 G 04 e'c,44174 Cash 410 soi4 ff. ct.a"`7
RE: (7-tl 3G $t t I IL' /c._, W..s7: 02/---ootiCi'
(Site Address) (Permit u ber)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. )( Revisions: Cofrkiivwtou5 l oetd pot'.
Cross section(s) and details. Wall bracing and/or lateral analysis.
X. Floor/roof framing. Basement and retaining walls.
4 Beam calculations. Engineer's calculations.
Other(explain)::�n
REMARKS: 0 Q �.zanx above- (ee_ c,ck i(k-S. b c)`t yak A rGc.w�✓kS
( ,L& vVo\- 4e ki_ ► }O c�lksId�«i10,� --t/,0- lo.e�w►s c )0 Lk(A s�++ 1U0s,►tom..
\)P W i'1-V\ Pack O C
FOR FF CE USE ONLY
Routed to P ' Tec ic. . Date: ' 1`1 21--- Initials:
Fees Due: Yes No Fee Descri tion. Amount Due:
lb- f
I $
$
Special
Instructions:
Reprint Permit(per PE : ❑ Yes ' N ❑Done
Applicant Notified: Date: stJ 7 424— Initials:
1:\Building\Forms\TransmittalLetter-Revisions_073120.doc
q CITY OF TIGARD MASTER PERMIT
i '``1 . COMMUNITY DEVELOPMENT Permit#: MST2021-00461
{ Date Issued: 12/22/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103AB01400
l Jurisdiction: Tigard
{ Site address: 12435 SW 112TH AVE
1 Subdivision: MCMICHAEL HEIGHTS Lot: 8
Project: Hamilton
1 Project Description: Remove existing fireplace in bsmt rec room and install wood stove with alcove . Main floor,partially
remove wall separating the kit from living. Relocate laundry to garage.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $3,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
1Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 1 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders 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: 2
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 N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
HAMILTON,LUCAS&MARIA OWNER Required Items and Reports(Conditions)
12435 SW 112TH AVE
TIGARD,OR 97223
PHONE: PHONE:
FAX:
Total Fees: $502.55
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
QS9-nnl-no1n fhrniinh nGR oc,ool-noon vn,1 mow nhtmin n rnnv of fho rnlcc nr dinar}Hilo ctinnc 1n ni ini by nnllinn cO 919 1QR7 nr 1 son zR9 91en
Issued By: Ed9o4 dO M Permittee Signature: �� OyTy `-
i 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 lob site at the time of each inspection.
Building Permit Application ?)- 10126(2
Residential
City of Tigard OCT 2 0 2021
M Rerrnxd'o 2z1q r/��/1-� /"oc4(.
13125 SW Hall Blvd..Tigard.OR 972 (Y OF TIGARD l)ntr t3� ` Permit Noi ) �L —C�t/
Phone: 503.718.2439 Tar: 503.598.1 ( Plan Rcvtew
TIGARD Inspection Line 503639.4175 I.DING DIVISION D:1%11 0.. 3.a j Ail,
�iOther Permit
Inlcrnec www.tigurd or-goy Date Rcn 'Pv Inn I El Page 2 for
Notified/Method. 1 ( I-f "4i�r'11 Supplemental lnformrtioa
FVPE OF V'ORK REQ1'IRE:If DATA:1-AND 2-FA1111.V DAi"E(,LANG
_❑ ` w construction ❑Demolition Permit fees'are based on the t alue of"the work perl'unne.
Addition/alteration/replacementIndicate the value(rounded to the nearest dollar)of all
0 Other: equipment,materials,labor,overhead.and the profit for the
i'.UF( OR1' OF (C1N51 RI C I lON work indicated on this application.
X'''
and 2-family d��elling ❑Commercial!industnal Valuation:
Number of bedrooms:S 3,0(10
p ❑Accessorybuilding ❑Multi-family ,
`�41 Number of bathrooms:
` 1 ❑Master:.,;;!der ❑Outer:
.101B Stir 1NFORnitTiON AND LOCATION Total number of floors:
~
,,b>ite address: 12435 SW 112th Ave New dwelling area: square feet
city State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Covered porch area: square feet
Suite'bldglupt.no.: I Project name:
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees`are based on the value ofthe work perlimned.
Tax map%parse!na.' 2S 103A130I4()0 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor.os erhead,and the profit for the
11F%I.-1211'"I'Itty 01 SS ORK work indicated on this application.
Valuation: S
I]Ru16..ii we znis1ittg fr tp:,ci: in recreation room in basement and in living room oil main
door.
21 Proposed new wood stove installed in recreation room in basement with alcove around wood stove Existing building area: square feet
310n mils floor the titan separating the kitchen from living room is partially removed New building area: square feet
d'Iii-TP T( A t}AA N F,R I 0 ITN IA 1
�._ Number of stories:
\;;tut.: t ukt:l ldntuurtt Type of construction:
C t
Address: 13435 SW 112`s Ave 4�"V{ `' EA 0ML` Occupancy groups:
t:it /State/ZIP' Tigard,OR 97223 Vv>Gi�i •C-Lnex I:.xisting:
�q q I I:o. I ) New:
e! 7'a i � (ON6:#t I Pt "," ii7si
BUILDING PERMIT FEES*
tl'frasr refim so fee srhrdrfe)
IIELSiiteSS name:
Str t:turd plan rx•s kw Ice(Or deposit):
Contact mime. 'Michael Ciurlutkici 77- .
TLS plan review fcc(ifupplicablc):
Address: 34578 S.Barlow Rd
Total Ices due upon application:
City/State/ZIP: 15 oodbum,OR 9?1i'' _
—
I
Amount received:
}py
Phone:(503)310-4105 F ax::( ) PIIO'hOVOL h.UC SOL, R PANEL SYSTEM FEES'
l atoll:
t he n eve hG- he erne D 1,U►Conunercial and residential prescriptitc installation of
roof-top mounted PhotoVoltaic Solar Panel System.
CONTRA(TOR Submit two(2)sets ol'roof plan is ith connection details
Business name: Home Owner is the Contractor and will do all the work and lire department access,along with the 2010 Oregon
Solar Installation Specialty Corte checklist.
Address:
City/Suitei/IP: Permit Fee(includes plan rev iev $18u.(Ht
and administrant lees):
I'htatc:t ) Fax:( ) State surcharge(12`%of penttit Ice); S31.6U
CCit lie.:.
Total lire doe upon application: 5201.60
9 `
Authorized signature: This permit application expires ifa permit is not obtained
within 180 days after it has been accepted as complete.*Fee methodology set by Tri-County Building industry Service Board.
i Print name: Luke Hamilton Date: 10/13/2021 l lBuilding\Permits\BUP-RESPemtiIApp,doc 02/24/2011
440-4613T(I 1/02ICOM/WEB)
Building Permit Application Checklist One- and Two-Family Dwelling
City of Tigard
13125 SW Hall Blvd.,Tigard.OR 97223 FOR O1'hi('E USE ONLY
Phone 503 718.2439 Fax: 503.598.1960 Received
t t II 24-Hour Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Date/By Perm a No
Associated permits'
TIGARD p
Electrical 0 Plumbing 0 Mechanical
Other,
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews.
t, 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/Int.
.4 Fire district approval required. Name of district:
Septic system permit or authorization for remodel. Existing system capacity
ti Sewer permit.
i Water district approval.
)t Soils report. Must carry original applicable stamp and signature on Tile or with application.
i..,
9 I.rasiutt cunt plan permit required. Include drainage-way protection,silt fence design and location of catch-
basin protection.d-- — — —
It) 3 ( ompiete sets of legible plans. Must be drawn to scale,showing conlOrmance to applicable local and stale
huildilt t oafs, Lateral design details and connections must be incorporated into the plans or on a separate full-size _ — —
j sheet auac hed to the plans with cross references between plan location and details. Plant review cannot be completed if
I I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions:property corner elevations Of
a there is more than a 4-ti.elevation differential.plan must show contour lines at 2-13.intervals);location of easements — —.
and dritetc,n:footprint of structure(including decks):location ofwells/septic systems:utility locations:direction
indicator:lot area:building coverage area.percentage ofcoverage:impervious area:existing structures on site:and
,aolare drainage.
12 (Foundation plan. Shoo dimensions.anchor bolts.any hold-downs mtd reinforcing pads.connection details.tent site
alai Ia'teal Ion_ —' --
t Floor plans. Shots ,ill dimensions,room identification.window size.location of smoke detectors,water heater.
taria,ac.,t colt Imii to ram'.plumbing fixtures.balconies and decks 30 inches above evade,etc. — -- —
Mechanical Permit Applicaii4lECEIVED
City of Tigard Received Permit No.:
NonIly:
I d' 13125 SW I lull Blvd.,Tigard,OR 97223 OCT
2 0 2021
-
Phone: 503 71k.2439 Fax: 503.598.196(1 Plan Review Other Penile
TIGARD
Inspection line: 503.639,4F75 CITY OF TIGARU t:)ateflmy:
Date Ready/1y: lurks' 0 See Page 2 Mr
, Internet: www.tigatd•or.gov 3UILDING DIVISION Notificd/Mcttwd: Supplemental Information
TYPE OF WORK `COMMERCIAL FEE" SCHEDULE -- USE CHECKLIST
—
_._.______ _.______._ '--' Mechanical permit fees*arc h.ucd on the value of the work
0 New construction EfAdditioanIteratioutreplacement performed.Indicate the value(rounded to the near t dollar)of all
❑Demolition 0 Other: mechanical materials,cgwpnsrnt,labor,overhead,and profit.
.__.________.-.___—__.-_. Value:$CONSTRUCTION
t.:
�-�; _ . _ _ t''__ RESIDE NTIAL EQUIPMENT/SYSTEMS FEES
t-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special infurmaslon use cherklLnt
, 0 Multi-family 0 Master builder ❑Other'. Description Qty. Ea. Total
JOB SITE INFORM:1E1ON AND LOCATION Heating/cooling: _
Job site address: F 2!f 3 s i ) 1 f 2 Tf•t i Air conditioning 46.75
Furnace 100,000 Bill(ducts/vents) _ 46.75
City'StaietZ1P: T/bit R- , 0 R q 7 223 _Furnace 100000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite.lildglapt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
__ hyeirunic) 23.32
Unit heaters(fuel-type,not electric),..._..._. in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other 23.32
Other fuel appliances:
} Tax map,Iparcel no: 2_S L 0 3 14.8 C)1 1 f D 0 Water heater 23.32
----- --- --- ------- Gas fir lacc/inscrt 33.39
DESCRIPTION OF WORK eP __
— Flue vent for water heater or gas
t'¢,e,,,-, 0 fJ b L*To VC.--", 1('l. F*,E-C RE,'t o 1 12.o07x-I (!c _fireplace 23.32
,- Log lighter(gas) 23.32
t
NI Wood/pellet stove 3339
hi r r L.LAFri c�.L S E+iv v,y j 1-Z' e'c? W fircptacdinse n 23.32 i
e Chimney/liner/flue/vent 1 23.32
Other. 23.32
_.-___ - OPERTY OWNER — 0 TENANT
C Environmental exhaust and ventilation:
Name: (- t( f~ El A P 1,01 t L-TC,C,( Range hood/other kitchen
equipment
Address: ) '7 i 3,5 6- f i 2 Tit 19-1/�_ Clothes
33.39
ts al dtr ars exhaust f 33.39
City/State/ZIP: "1`1 C A t2 b ! 0 '� Q •7-L2 o^y 3 Single-duct exhaust(bathrooms,
L toilet compartments,utility rooms) 23.32
Phone:t '!F11 f,'f - 9 7 2 Fax-( ) Attic/crawlspace fans 23.32
j ❑ APPLICANT-
NI'A(T PERSON Other. __._. 2332
Fuel piping:
Business name:
S14.1S for first four;S4.03 for each additional
Contact name: iv).I f. k ft F L, ��u R.
E/ 1��_ Furnace,etc.
Gas heat pump
Address: 3 Li- 5-7 8 s, H R L o cAD fk D W
alVsutpcnded/utut heater
City fStatcJZI P: up 0 c' p 8 k ft>\t ,, G K. (3 .7 n 71 Watts heater_—
Phone:(6-C'3) '3 1 0- ii ff_7_.C.- Fax -, 4 Fireplace
Range_
Barbecue
('O.'vl'RA('I tit2 Clothes dryer(gas)
Other.
Busine s name: t,i LC)Cir E tom. t> r 0 N [A t3 TO(4.. A N.I, MECHANICAL PERMIT FEES"
Address: (,U i t,-..L, lit O ( -L, confik.K. Subtotal
Cif}.'Statc'ZIP' Minimum permit fee($90.00)
Phone:( ) Fax:( } Plan review %(25of permit fee)
__ State surcharge(12%of permit fee)
1 CCL3 tic: TOTAL PERMIT FEE
-•-•' - l'trls permit application expires if a permit is not obinloed eritbia tau
c days after it has been accepted as complete.
Authorized sigtature:Iattl ' 7 • Fee mcthodoloay set by TO-County Bu:'ding industry Service Board
t L Litt:Print aurae: E i-'f.;^ ty'°"I L,1"-r NI Date: ( f 316.0 r l
�Tr 3 t.'I'..JCONINier.i4)
.`:fir.Bielie��Yrzrila.'.'\aEt'_rt�nnsnp�P9s;!t stoc f
Electrical Permit A(]pj.IC Ip» E EIVEI 1•01201 I l(.1: 1 6,l t)\1 1
City of Tigard Received
17ateniv�: Permit a:
13125 SW Hall 11W.,1gaAt,OR 97223/Pi OCT 2 0 2��1 Phut n ew
i Phone: 5t)3,71&?43V Fax. 5Q3,S9ii.19fi0 Related Permits:
Inspc�lion Link 503.639,4175 Date/By:
D:
`f•IGARD CITY OF TIGARU Rcmiy mit/By rnr>a Pay Z�a:
Internet: wt a*ur.tih�rrd-tar,goy Motiftedlhlettaod• Supplemental information
,. ...._•—_ — 1LDiNGDIVISIOIv
4_ N dtlitiott'aiteretmn,tv l�tcon� tt �i f O Please cheek
m feeder apply f: i 121 _YD3W
G\i W construction cheek all that (submit sets ofpiias«/tarts checked): _W,
0 Detttolition [3 Other: amps 0 Building over three stories
where the nvailabk fault current 0 Mannar and boatyards.
CATEGORI; OF CONS"' itiiC`:[lt),�' .w —_.____ cctetx1s 10,000 anq,s at ISO volts)v 0 Floating buildings.
I-and 2-ftinilyr dwelling 0 Contnuatial industrial 0 Ae sory building
ce+gtprapd,or exceeds 14.0 0 0 C on s enial use agncuutcat
amps for all other installations. buildings.
El Multt-ftunily ❑Master builder [l Other: _ p Fire pump. 0ltnctllation of 150 KVA Of
JOB SITE INFORMATION AND LOCATION 0 Emergency ssstcm. Larger separately derived
❑Addition of new motor toad of s}atutt.
Job r.: lob site address:t 2 3 S" S t i t t "Z,TH 4 VE 1001 m or more. 0"A"."17,"1-2","1-37,
City/State/ZIP: "ri G Pr R O
Sic ar atom residential units. occupancy.
❑Hratth•care facilities 0 Recreational«chick parks.
Sttitcrhldglapt name:#: Project nae; 0 Italmrdous locations, El Supply voltage for more than
❑Sen'ACC Of tiedcr 600 amps or snare. t100"Ls uomimal.
Cross set✓ditextions to job site: FEE. SCHEDULE
____
Description Loch Tent t `�
----•------ New residential single-or multi-family dwelling unit_
Subdivision: Lot#: Includes attached garage.
tptt 1,000 sq.R or less 168.54 4
Tax l# 251 0 A'B d► q 0 a Ea.addi 500 ft.or portion 33.92 1
I' - `O C.RCI''['ION OE WORK _ s4,
------- Limited energy,residential 75.00 2
n`tv<0 li 1 N 6 0(L-r'•L tv-( g Plat F 0 K. w'RS tit'/.. 78- b t`%� rev,.. I(� (with above sq.It.)
Limited enertoc muhi-family 75.W 2
I= 1 T-e(i____ t HP'("!I f~ 6Lt t.: e+l C�co c�fl TG,F �:1!-4 iffy( 6rrsideatial(with above sq.illPROPERk OT � NEkt ANT Renewable Energy 0 See Page 2
�J Services or feeders installation,alteration,sad/or relocation_
Name: L Ld K 5 �Awl t 1---1-0 N 200 amps to less 100.702
tlilre3S: I 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
l, C"ilyiStateiZ1P:L) r'f^7'�`t�c,i, 'p I 0 61722 '3 601 amps to i.000 amps 301.04 2
x7nc.{ 2 cl 72 I?l Fax ( ) Over!.000 amps or volts 552.26 2
)) Temporary services or feeders installation,alteration,and/or
, m t l../t-i t 'f+t;... M 1=0 6 Gtrt ri I L_ . Co ivt" relocation
1 J :til: it Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1
Iintended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
i Owner s,tgnarurti Qpc _....__ T_ Date: 1 flit 33]d 02► 401 amps to 599 amps 168.54
0 APPI..I tr. 1" I CON CAC:I'.PERSON Branch circuits-stew,alteration,or extension,per panel
A.Fee for branch circuits with
name: above seniec or feeder fee,
....._- each branch cittatit 7 42 ?
Cixttat 1 taarrIc:_Ni t C E{--- U 14 K e i ii ')s~- I—
.........._
B.Fee for brand,circuits with xtr
i Address: ti- service or feeder fir fiat .2
Y 3 4/5-7,a S, P !. p cog b branch circuit
, 56.18
( ityr StatclZ.1P: ( �j R. Each add''branch tunics �W_� 7.42 2
`� "� �` > +i- Miscellaneous(service or feeder not included)
Phone ( c 0 t) 1 i f? - 4"t c 5— Fax::( ) Each manufactured or'nodular
_....... •-—
- •" - "'"".—
67.84 2
. dwelling,service and/or fender `
Emaai , r ,Gr
r 3.-'Tt�r ��Krr4't•' n E 6}fref'+
—t Recotutect only b7,S4 2
f3=}
—
� r R, _ Pump or tmprion circle 67.t�t 2
Iktsiness natrn Gv t,ij Pi f: IN$• Co*47 S(j C TC c Ft rt S; t or outline lighting 67.84 _.__..._ 2
I Address: cA-°I L.i_-, P t7 4 L.t_.. [.tl L"' , pineal tioaurwi or limited-energy 0 See Page 2 2
panel alteration,or extension. _
m " Each additional inspection over allowable in any of the above
t it`viStatrlP_ll':~ Additional inupoaton(1 hr min') 66.25'to
s
l Phone:{ ) i Fax:( ) tnresugattoa{i hr min) 90.00/hi
Entail Industrial plant(1 hr nun) 78 18,'hr
.. tnaprotttms for which no fee n _
63 specifically listed t:S hi min)
C.. ?.I:e I l.ledrical Lie.: Supry Lie.:
spe'c....._. 1i
_ .„ I __ -- ELECTRICAL PERMIT FEES
Suprv,Electrician€signature.rewired: _ Subtatad:
Print nnr n _ J Date: 0 Plan Review Requited(2516 of-permit fee):
" State surcharge(12%of permit fee): i
Adtiluna i.igytatuxt , , {$ ,„"^,. �t,:_.t.•,Zr et7. * ., ., I TOTAL.PERMIT FEE: :ITan permit lytpiisatiett aspires it a permit it not obtained wrtttia 1 Sft j
£ i rtrtl nartlt My(1-: r #( 1 t p yei t j-,f 0 p, rDate: €'e / l:Ya L days after It has been aceepted rs complete.
yt • Number of inspections allowed per patnit
F„d.ar.'ernrsa,riff';t's+rsvodo,,,tt_R t.tt,dt a'arst'r'W.I;S 440'481$Ti119t,tti,"NKA5tL1t
Alt r .01S'e
vall111111101-•IMINIMIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIW
, .
_ ,...,........_,.............,....... . .
g_leetrical Permit ApoWEIVED it:-.,,,-,.-- .-.:., 1 Olt tilt ULF*1 '4 OM 4
•;.
City of Tigard Renew
oist.0). , 11 Penlo o•
.. . : s i z 1,173 SW Nall Dhst.liesnl,OR?WV 2 0 2021 flulterie. t
i . ',.. Phone 303 718.:430 FoN' $03-tlit.*19or 1 Itclred Perna.
yr,. ,,,,,,.• (1100000 UDC' Mil 010 4171 rn,e,.T. Roth Den13y -.0.;ars1101'..*,•%. ur 1 IGARLJ Nutlfi4dlilethnt.1! Srppleoraul Laliprou0Ka. I_ •- ..
--1:TtELMkljIVISICyk -1 r— pids„.s; R.11/1E3,4 1
.---------... — —
0 Nos concenction ca AtIslitisitt'altcralion/teplacenteni reaps owl,an 030 apply Onsbash j Kis of sacs.fiturs ebeckett.
ElSevors.or rrrt.ln 400 sur..../ea= CI Iltokttel cm?cvcr-zfif, !0 Danolition 0 011icr.
-......_ _
.
- her the s,rattable latat cirtrat 0 Marv%MS bj.altia.
..-...--...
CATECOVI.V. CIF,co -no N __I coaccd.10.000 arms at 150 volt,Jr 0 TI:JJKI tthll.:14,...
..._..
14,...1 Ira ert•ari,of examb t4.000 a(.011:613elrily,t,4,11....r...1"?i.and 2-frinul)Ustelliug 0 Corrunercial'indostnnl 0 Accessory---b-nilding -
431911 re,600ter,IlfaLit3ileft, Imul,1824,
i 0 Nluiti-farnil) 0 Ntristsv builder 0 Other OFirs p,00p a lersdione..01 ISO KVA.4
L----- 3013 SITE 1NFORRIATION AND LOCATION 1 0 EtrerlFscr 4Yocv^
eq.=separmeh 4:;vrec :
cr ;Joh r • I job soc osj„.„1„1 2 4 3$- s(Ai II elm A je a Addiriois it aco ava I tar/cud o
100111'or mom 0am-r.-1-2..-to,-. 1
caystmezip: -n e it R.I.'.•1 i 0 R
0 Siroxa:spinout
Suitt/bldg.:apt c: 1 Project name;- s or e unit-
0 licabb•care facilities
0 Ilmardota Iceanons. ocamancy.
0 beteanoon1 vehicle puts i
0 Supply whsp.for mon
'.".
. ' 4
—. . 0 Scrvice or ktda KO amps or MOM ,.. g*'mks mrinak i
I Oros aireCt'dircet00$10 jot' ur:
rF.1....361EDmi
-----ti-rasaily d '
. News resideatial slick-or mW wenn oait.
SeiNiss-ssisin
Lot it: includes attached prage. --......
s,tinpa.n-.c r , 3 1000qrle 16334 4il1 - _..
0
— - I To.add,300 tn.It or Pedion ____ r. 3192 1..... - ----I .
'DLNCRIr TiON OF:WORK tlialicdenerzy,residential I 75.00 ' 1 2
-
- ...7 .
twith above:..:.11.)
ird 6 0 tfrr I cl'i• lex P-0 R. iss)sli'11 f A 14- /At
Limited mazy,andli.famity
-
'withI" -.--
1 Fteoevrable Escro:.. . E rs:ttrurriT 3t I 0 Tr.s .NT J Services or feeders Install'doe,alteratioa,tad/or relocation ..
-_
i-
Naas:-
1 200 mops or loss _ 103 70 i
13 44'..f-- J-4-4'sel-t 1,..,..r.0 N
2-I 20 mos 400 2I-' '3 5- s .) i 1 2. Tit 4 V e
1 to-63•-4-01 ur,p,10 —,..p. 1 _ _7-00.34 I ____
i Csty,State/Z.W -7--1,-., pp -0 , 0 l'•-• E.(' 2 2 '3 i
If1 601 amps to 1,000 amps ' I 30114 T.._ ..__.:
_-__9 7 2 3 Fax _.•__._
- '.1 Temporary unites or feeder a laitailanon.'Iterate&a adtar
, ------
/".4 e- 14/i-i A r-t- c._o Nt E e.) &twilit-. (...o t,ir
On err instellAtiont This installation is being made on property the town which is not 200 amps or len . ' 59:4 . 1
Inettosisi tr,s-.IL.. .s:as.c trot.or chatief,according to ORS 447,449,670,and 701. 201 amps to 400 amps i , 125 as -
1 Osirr.r:ti--.:.:tire .4,11,0_,Alr Dam 1°62/.1202 1 401 amps to 599 amps I r 16L.44 •.
-
Breech iireWt3-new.atmratiota.sr Lete-asion.isr aoel ,
srt't 0 sN't I :3(COMACE rnisus•
! A.Pm for breach cirosio witk i
I
i
above semen or feeder tee
Eltr.r...-.".:-..:rt.,..--'-=
I- ___--- each branch circuit ,
IC3-'311-443 III= iyfic_Iii-i--(-- I Cio-JR.Fli4I'::le: L- D.Fee for bruch circuit wintosu
icriice or Ryder fee.first
& nt Sti 4 Li r,,-7 a .-+
S. IS ti-R L-0 C) I
brndas wean :
rbt 7. ... Each a6i'l bruieb ornsit ' 1.4: I 2
' 4,171P. 6,4_c•<: D R If R 1,1 CIA's'....--1 :-..4.0.--i----- hltscettaatom tIeMiCT Or feed;sotTsdedl - I
' •
• q 1 ci f., I Fast::( 4 Fitt manufactured or modu ,.
lar l' ' - -
.•s...1 'I
-- slissellinz.ser,Sec nate froda ..... 1 _ .
_.
F.rcstl . • -
Reconnect ad) 1---1,—67.64- :!
i'l 1N1111.0.1.7I Ott Pinup or itriptioo curie I- I -6;114 .
___ ___________
-....._ _... ..
1.3tr-tr-,s,tune. s:-.,..•,_.)ts,,--t;,1.. 4 - 7-'"E C C r#:., (....7:::-/-:, a t: b _sig... ,,,Winton I v'.44 2
--—-- - - -• --------•-- - Sipml eircuirts'i or limilcd-amir 1 -
kshirm: ,......'I 1.-L. C.)a r.,-,t_s- Ct.,'0 A:. 1-1:. pan:1.alienumo.°I cum. : 0 see Pore 2 i I 2 I
Kerb additional lasitectioa over allowable la any of the above I
Crty5cOnzir
Adcoal invasion(1 br mad 6o.7,3 ha
,
l'or4a. t 3
j itisessiption il lir rain)
todushial-plard(I tat non) ----___ . - . . .
E.na)1..
burn nom for which on ke is
..._ ...- --- .- --
1 C(.31 1 - 1 Elecuseal Lic.: SE,TA is: ,i-.- e.,11t listed I':lu mint
.isi- --- — hi
i -
_JL-:___-______.-_ - ELECTRICAI PERMIT S FEES
_ . . .up.ry LIKI7iiitt tt4.,.':tt r.-c.trtti
—
1 Pfr..0 r.l.ress,-
I
I li h . SuN,isI
. [ te ____ , 0 Plan Revic Requittd(25 (pant feel
.
_ -
14
State ucargc(12%ofperma feel
, TOTAL PERMIT FEE
,taloammi r;2::-.,r t ..:.•C(4../ ..--• 4/144_,..i ....."77-.7-77
i..- nib permit ap"--E-NicailiTit-ca-pirm---Ir.
__. .
i
I Prt-. sr - r.- ••:1,11.1, -.7-1--..4 1 lief.. ;f113/102 tla i I days after li Ms teen meconid as ec-oplete.
— . • Nu elbll ng 125PerrJ DO alinred per rem. •
•,.....,.i.t.......,1•4••••:-.. -i - • - -r...1•::..-..!
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Plumbing Permit Applicati� CEIVED
Building Fixtures OCT ) eg FOR ()HA(F. 1 E. CIyI.v
City of Tigard I G �Y� Ro ciut
illPernik Na:
• 131z5 SW Ball Blvd.,r nt>i,OR 9r.2i, f Y OF TIGARLi tan Review
i Phone: 503.718.2439 Fax: 503_598.10 nary, Other Permit No.:
3UILDING DIVISION --'---- --- -----I
Inspection t one. 503.639.4175 .---------�_---
P;CpkltD 1/tc7rrct- ww7�h tint<,r nv 1)dm Ready/By: Jars: fa See Page 2 for
Nutifirat/Mc(bcxt: i Supplemental Information
i\IT, C)F WORK FEE' SCIIFI)LULE:
El New construction 0 Demolition -____,.. --- -. -.For strccial infonxt;tion usrhcrkGss e - .----
,_____. Description I qty. 1 Ea71 Total
�A ldition'niteratiom'rcP taeernesit _.___
[�father New 1-2-family AweUims(includes 100 ft.for each utility connection)
A,TEC f)RV OF C ONS`I ltt=(:'PION SFR(I)bath 312.70
0.1 and 2-Earthly dwelling SFR(2)bath 437.78
_ ❑Commercial:industrial
❑Accessory building __ SFR(3)bath 500.32
❑Multi-family
Q Master builder ---- Each additional b;ith/kitchcrt 25.02
n Gather: Fire sprinkler( sq.IL) Page 2
JOB SITE INEORMATION AN!) LOCATION Site utilities:
Job site ad.h:ss- I L if ;5 L2.: i I L I rY T,i_116 Caich basin or a a drain 18.76
Ihywell,leach line,or trench drain 18.76
City;Stater7_IP. f i (.:s 14 C?R 1 -7 2 2
Footing drain(no.linear(t.: ) Pagc 2
SuitGJb;dg.lupt no.: Project natne Manufactured home utilities 50.03
---------
Cross streetidirecticnn to job site: Manholes 18.76
Rain drain connector 18.76
_ Sanitary sewer(no.linear ft.: ) Page 2
- Storm sewer(no.linear ft.:_J Page 2
Water service(no.linear fL: ) Page 2
Subdivision: Lot no.: Fixture or item:
I Tax roan/parcel no 2 , f 1,7,7 ' r. f" ,-, 1 t_! .--'0 Backflow preventer 31.27
- - - -__. Backwater valve 12.51 1
or -at et•I.m)', r-1 ,, e i ;
_
Clothes washer ( 25.02
`- P t 5 r%N t [T. PL -F-rn C-b('rti F s• C t'it=,Ii7=.`Z- Dishwasher 25.02
I Ii R 11-e-if E t•; � - Drinking fountain 25.02
Ejectors/sump- ', ;l CL) F
L '1,Q /!,. F'c+m'e 1) +R,. C LOT!t C' LLB ff;hE IR G A h t'G-�a' ectors/sump 25.02
.l 110Pt.1.1T 4 o\t',tiI:it 0 TENANT Expansion tank 12,51
________, ____________ ____--_..._.______._ FLtttrrosewe.r cap 25.02
Name'. L..
Address: 2) 1� I - Floor drain/floor sink/hub i 25.02
`I a t l 2 T A tj Garbage disposal 25.02
CitytStatetZ1P: - -t 6e6,R n t (2 - Z Z- '3 .-_..__ (lose bib 25.02
Phone:( Q 7( 7...2 ti -- Cf. 23 Fax:( ) Ice maker 12.51
❑ APPLICANT KC ONTAC 1 PERSON interceptor/grease crap 25.02
j _____._ Medical gas(prairie S ) Page 2
Busrnms name.:. i
- Printer a 12.51
Contact name: M I G rt fi r L &U IR.F/lJ K I e 1..-. Roof drain(commercial) r 12.51
1 r\ddresv 3 y 5",.3 S. B,TR 1_,O Cc) 4. Ca25.02
__„__ . Sirik/baain/lavatory
City/State/ZIP: 0.30 0 t,0,(,(R 7 (37 e2 7 l Solar units(potable water) '�'_ .„_ 62.54 ; ._._.
Phone:(cc'';3) '31 0- if 147 S Farr::( ) 7'ub/shawcrtshower pan _ 12.51
E-/nail: (v7 t C N r} i, a (.7 L4 ( 1N� r 1 L.O COTO. �� Urinal 25.02
i 25.02
_ Water hams- 37.52
Busness na �_15... -rite__ c i'l�[ .. <'12 rms,t, _firi,j) Water pipingfDW\r 56,29
dxtAdss• t..?I i-1.--.
t r a.Lt.. T`ft« („AlC 2 K Other: 25,02
_ _. -
City StnterLIP: Subtotal
Phone:( ) Fax:( ) ��-, Minittrum permit fee: S72.50 I.
__..,..__...._ �__�._ -- Plan review (25%of permit fee)
t CCIf t_ic,,: Plumbing tic.no.: ---
i, State atiu dtatgc(12%of pantie fee)
signature: ,Ltd:, ..-
Authorized `_ TQTAL PBli4ilT)1 E
_ K It 0.4.,<-Ce.y'-, ' 1 -
Print raitte , This permit application expires it*permit is not obtained,iihtu IN days
1 iZ ( !) f�Ti r r 1.4 Date. (C ', SYrrl after It has bean accepted as COmpktc.
(( 'Pet m.ttsa tutegy set by Tri•Couoty Building tndutitry Service Oka uJ.
t,rue -Mtn ratpi.htt..1'uwe.App.duc 1pHitdY. 41.046t57ttu'ttllCt:)l5.WI'i;il)
1,'''''::
i! ,�1 e , S N t1.4 I r � 1011,044f
yg e ' t o �};'
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.
111 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
T I G A►t D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Allyson Armstrong DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Michael Gurfinkiel, [Contact Person] NOV 2 4 2021
COMPANY: t;ITY OF TIGARD
PHONE: (503) 310-4105 3UILDING DIVISIOI' By: + ,
EMAIL: michael.gurfinkiel@gmail.com
RE: 12435 SW 112th Ave MST2021-00461
(Site Address) (Permit Number)
Luke Hamilton
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. Revisions:
Cross section(s)and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Yes Beam calculations. Engineer's calculations.
Yes Other(explain):Cross section showing load path shows the existing 12"X 16"footing and conc pad
REMARKS: 1] New location for Laundry is in Garage. Applications for four permits have been submited.
2]Beam calcs are in attachment.3]Continuous load path drawing is shown in attachment.4]Yes.An existing 5'X 7'-4"X 16"
conc pad supported a brick fireplace. (ORSC)2021, R1001.2, p.439,states that conc pad under fireplace needs to be 12"deep.
JOR FFI E USE ONLY
Routed to Permit Technici • I Z J Initials: AA'
Fees Due: ❑ Yes 'No.Fee Descri tion: Amount Due:
$
Nj
1\SO
Special
Instructions:
Reprint Permit(per PE): ❑ Yes No ❑ Donep)A____
Applicant Notified: .//�Date: L1�� Initials:
V
FOR OFFICE USE ONLY—SITE ADDRESS: /491i/AJ -n
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
"II ■ Transmittal Letter
l 16 AM)I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Allyson Armstrong DATE RECEIVED:
DEPT: BUILDING DIVISION E C E I v E
FROM: Michael Gurfinkiel (Contact Person ) DEC I " 2021
CI"I-Y OF TIGARL
COMPANY: '3UILDING DIVIS OIL
PHONE: (503)3104105 By: 07.
EMAIL: michael.gurfinkiel@gmail.com
RE: 12435 SW 112th Ave, Tigard, OR, 97223 MST2021-00461
(Site Address) (Permit Number)
Luke Hamilton
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
3 Additional set(s)of plans. 3 Revisions: Showing new beam Ienghts
Cross section(s)and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
3 Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: 1]The three large sheets have been revised and now the beams on these sheets match the
the continuous load path documentation.
2)Beam calcs for beam 9 are shown. Half the load of beam 7 lands in the middle of beam 9.The calcs are now shown.
FOR F CE USE ONLY
Routed to Permit Tech�nic . Date` 7j Zb Z/ Initials:
Fees Due: ❑ Yes LJ Nc- Fee Desc ption. Amount Due:
i
\.50 U 7
v $
i $
Special ,------
Instructions:
Reprint Permit(per PE): ❑ Yes / No ❑ Done
Applicant Notified: te: !) / 7j( Initials:
RECEIVED
Property Owner Statement OCT o ���
Construction Responsibilities it
Regarding p 1
u uF rIUaHD
Oregon Law requires residential construction permit applicants who are not licensed with the UiLDIN F TiViSiODN
''I Construction Contractors Board to sign the following statement before a building permit can b
issued (ORS 701.325 (2))
r.
This statement is required for residential building,electrical,mechanical,and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7),need not
!• submit this statement.This statement will be filed with the permit.
i
Please check the appropriate box:
ii _
' 7
f I own, reside in, or will reside in the completed structure and my general contractor is:
ii
Name CCB# Expiration Date
I
j I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
171 I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractorswith th o y licensed e Construction
C
I Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
r and I hereby certify that the information on this homeowner statement is true and accurate.
LtA,ttQ,. H,Na th-..-
t Print Name of Permit Applicant
i
cam- 10 — Iq—zoz1
Signature of Permit Applicant Date
Permit#:
C.
t Address: 'pill"kt4; 41
Issued by: Date:
This Copy for Permit Offices
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Information Notice to Owners About
Construction Responsibilities
(ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure,can prevent many problems
by being aware of the following responsibilities:
• • Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
• withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance:As the permit holder for a construction project,the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140,Salem,OR 97309-5052
Telephone 503-378-4621 —Fax 503-373-2007
Website Address www oregon uov/ccb
f/property_owner adopted 9-2016 This Copy for Permit
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