Permit ", q CITY OF TIGARD MASTER PERMIT
I,,
r.c Permit #: MST2009 -00132
I COMMUNITY DEVELOPMENT Date Issued: 02/02/2010
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 112CC 19500
Jurisdiction: Tigard
Site address: 15848 SW 81ST AVE
Subdivision: GAGE FOREST Lot: 2
Project: Gage Forest
Project Description: New SFR
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 894 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1346 sf Garage: 419 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $245,608.42 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Catch Basins: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0
Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum <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] 500 sf: 4 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add] Br Cir:
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:
Owner: Contractor: Required Items and Reports (Conditions)
J R ROTH CONSTRUCTION INC J T ROTH CONSTRUCTION 1 MST Ersn Cntrl 503 - 681 - 4444
12600 SW 72ND AVE 12600 SW 72ND AVE #200
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503- 639 -2639 PHONE: 503- 639 -2639
FAX: 503- 624 -0239
Total Fees: $15,112.77
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100, You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
(�a lJ..—...6" Issued By: y' 0 1,y Permittee Signature: ..� .
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Mudding Permit Application
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C i ty of Tigard JUN 1 5 2 Date /:� V _
',. Permit No.
�t ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review,. r/
h' w C Phone: 503.639.4171 Fax: 503.598.1960 g ?� Date /B �A-.,P ► r(0o aher Permits j.° g • "A "fit Inspection Line: 503.639.4175 y I E +/gat ' Date Ready / � t ® See Page 2 for
J TIGA'RD �t :" , DIvIslUr�.� (/
+L -0��it "�iw:, Internet: www.tigard-or.gov Fit.; '� ,.: : .,e"t ; ,..,1,/� Notified /Method: � � _>� Supplemental Information
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411111P '
TYPE OF WORK REQUIRED 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.
Valuation: ¶300,00000
El 1- and 2- family dwelling ❑ Commercial /industrial `��'C7
❑ Accessory building ❑ Multi - family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2.5
6 ` 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site addressW 72 1 New dwelling area: 2240 square feet
City /State /ZIP: Tigard OR 97223 Garage /carport area: 419 square feet
Suite/bldg. /apt. no.: • Project name: Covered porch area: 32.5 square feet
Cross street/directions to job site: Hall Blvd. /Langtree Deck area: 0 square feet
Other structure area: 0 square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Gage Forest 1 I Lot no.: 02 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 5 j 1 a CC l �+ 500 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.
Construction of new single family residence Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: J.T. Roth Const. Inc. Type of construction:
Address: 12600 SW 72". Occupancy groups:
City /State/ZIP: Tigard OR, 97223 Existing:
_
Phone: (503)6396 -2639 Fax: (503)624 -0239 New:
❑ APPLICANT ® CONTACT PERSON NOTICE
Business name: J.T. Roth Const. Inc. All contractors and subcontractors are required to be
Contact name: David Jensen licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 12600 SW 72" jurisdiction in which work is being performed. If the
City /State /ZIP: Tigard OR, 97223 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 806 -0602 Fax: : (503) 624 -0239
E -mail: davidj @jtrothinc.com
CONTRACTOR
Business name: J.T. Roth Const. Inc. BUILDING PERMIT FEES*
Address: 12600 SW 72nd. (Please refer to fee schedule)
City /State /ZIP: Tigard OR, 97223 Structural plan review fee (or deposit):
Phone: (503) 639 -2639 Fax: (503) 624 -0239 FLS plan review fee (if applicable):
CCB lic.: 31700 Total fees due upon application:
Amount received:
Authorized signature: _ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: David Jense N Date: June 15, 200 * Fee methodology set by Tri -County Building Industry
Service Board.
1:\Building\Permits\BUP -RES PermitApp.doc 11/6/07 4404613T(11/02/COM/WEB)
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Building Permit Application Checklist
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City of Tigard Received Permit No.:
r ' ° + �' DatelB
ti }� a 1 3125 SW Hall Blvd., Tigard, OR 97223 y
e Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
'' 14,,, i 1 f1 11 }�:� 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
cTR ARD -
,p,
, lr4,lat; Internet: www.tigard -or.gov ID Other.
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1 Land use -,
e actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑
3 Verification of approved plat/lot. ❑ ® ❑
4 Fire district approval required. Name of district: . ❑ ® ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ Z ❑
6 Sewer permit. Z ❑ ❑
7 Water district approval. ❑ ® ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ® ❑
9 Erosion control ® plan ® permit required. Include drainage -way protection, silt fence design and location of catch- Z ❑ ❑
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 ® ❑ ❑
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 ® ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, Z ❑ ❑
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. ® ❑ ❑
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 ® ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered /.1 ❑ ❑
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 ® ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ® ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ® ❑ ❑
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 Z ❑ ❑
architect licensed in Ore. on and shall be shown to be ae s licable to the iroject under review.
II , I ) - II , I , V�r ll „ . F 1 O. I n {J I i1rl ' , ;i, y •� i 1I 1 ,', ) ELI i' I
JtJ R l SD I C I �I O I V AI S P �'L I I I C s � i
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 1 I" 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. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
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 accompanied by 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, ❑ ❑ ❑
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.
1:\ Building \Permits\BUP- RES- PennitApp.doc 0321/06 440- 4613T(I1 /02/COM/WEB)
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.Plumbing Permit Application ' .,,.._P'_ i; Y t__,L )
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u ' 3 R eceived
� 1 ,:,;da � y ogar Permit No.
F :
r z � , .'j Citf Ti d p. ._.. g P. R Date /B
' : 14" 13125 SW Hall Blvd., Tigard, OR 9722 � ) L b � 1 sr ' �`i plan Review
1: •!a i. Phone: 503.639.4171 Fax: 503.598.1960 JILDiNG D!VISIO Date /By: OtherPetmitNo.:
i Inspection Line: 503.639.4175 W Date Ready/By: luris: ® See Page 2 for
r i 1 U1=1i Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description I Qty. 1 Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 1 399.00 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
7 0 Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATIO Site utilities
Job site address 81 Catch basin or area drain 16.60
City/State /ZIP: Tigard OR, 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Hall Blvd./ Langtreee
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Gage Forest I Lot no.: 02 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Plumbing of new single family residence Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• ® PROPERTY OWNER I Drinking fountain 16.60
❑ TENANT
Ejectors /sump 16.60
Name: J.T. Roth Const. Inc. Expansion tank 16.60
Address: 12600 SW 72 " Fixture/sewer cap 16.60
City/State /ZIP: Tigard OR, 97223 Floor drain/floor sink/hub 16.60
Phone: (503)639 -2639 Fax: (503)624 -0239 Garbage disposal 16.60
❑ APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: J.T. Roth Const. Inc.
Interceptor /grease trap 16.60
Contact name: David Jensen Medical gas (value: $ ) Page 2
Address: 12600 SW 72 " Primer 16.60
City /State/ZIP: Tigard OR, 97223 Roof drain (commercial) 16.60
Phone: (503) 806 -0602 I Fax: : (503) 624-0239 Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: davidj @jtrothinc.com Urinal 16.60
•
CONTRACTOR Water closet 16.60
Business name: Malmedal Enterprises Inc. Water heater 16.60
Address: PO Box 207 Other:
City/State /ZIP: Banks OR, 97106 Subtotal 2,9`( r ri
Minimum permit fee: $72.50
Phone: (503) 324-0759 Fax: (503) 324 -0580 Residential backflow minimum permit fee: $36.25
CCB Lic.: 102535 Plumbing Lic. no.: 34 -276PB Plan review (25% of permit fee)
State surcharge ( 1 2 % permit fee) i - 7, e a
Authorized signature: 94 - �.2.-A4./.......71.,,,,-._ TOTAL PERMIT FEE..1{•4 t. ` 41t
Print name: Kris Malmedal Date: June 15, 2 009 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 \Pennits\PLMF- PennitApp.doc 12 /27/06 440- 4616T(I0 /02/COM/WEB)
6
'Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ' Qty. Fee Total Square Footage: ' Permit Fee
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 1 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 1 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: • Permit Fee: .
Storm &Rain Drain - 1st 100' 1 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing I
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: - Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
•
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
•
Drinking Fountain Isometric or Riser Diagram •
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
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� r y» � u� v - -, r p. R eceived
" ' '4Ja,�ry City of Tigard Date /By: Permit No.:
# 1� ° 13125 SW Hall Blvd Ti OR 9 7223 JUN 1 6 2009 Plan Review
f;''. '' C ;?;,, Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
I5 t 1 '"4 Inspection Line: 503.639.4175 6 �y��,� r g �
F 1 t . i Internet: WWW.ti ardor. ov CI OF • i� I A D Date Ready /By: Juris: ® See Page 2 for
www.tigard-or.gov { , g � Notified/Method: Supplemental Information
BUILDING DR /!SIGN!
TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
® New construction ❑ Addition/alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
/51'g JOB SITE INFORMATION AND LOCATION . Heating/cooling
Job site address:r W 8151. Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: Tigard OR, 97223 Fumace 100,000 BTU (ducts/vents) 1 14.00 14--
Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Hall Blvd./Langtree Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. _ 14.00
Subdivision: Gage Forest Lot no.: 02 Flue/vent for any of above 6.80
Other: 1 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 1 10.00 10-
Gas fireplace 1 10.00 1
HVAC and gas lines for new single family residence Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert . , 10.00
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
• Other: 10.00
Name: J.T. Roth Const. Inc. Environmental exhaust and ventilation
Address: 12600 SW 72nd Range hood/other kitchen
equipment 1 10.00 10
City/State /ZIP: Tigard OR, 97223 Clothes dryer exhaust 1 10.00 (0 —
Single -duct exhaust (bathrooms,
Phone: (503)639 -2639 Fax: (503)624-0239 toilet compartments, utility rooms) 5 6.80 `�'4
❑ APPLICANT ® CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: J.T. Roth Const. Inc.
Fuel piping
Contact name: David Jensen $5.40 for first four; 51.00 for each additional
Address: 12600 SW 72nd Furnace, etc. 'S,
Gas heat pump
City /State /ZIP: Tigard OR, 97223 WalUsuspended/unit heater
Phone: (503) 806-0602 Fax: : (503) 624 -0239 Water heater 1
Fireplace 1
E -mail: davidj @jtrothinc.com Range
CONTRACTOR Barbecue
Business name: B &M Heating Clothes dryer (gas)
Other:
Address: PO Box 1111 MECHANICAL PERMIT FEES*
City/State /ZIP: Boring OR, 97009 Subtotal 9 1,,,.C)
Minimum permit fee ($72.50)
Phone: (503) 515 -5763 A Fax: (503) 637 -5244
V: Plan review (25% of permit fee)
CCB Iic.: 124757 i;-t oft State surcharge (12% of permit fee) (, -2,1 " ' TOTAL PERMIT FEE (0 6
Authorized signatur-- , if This permit application expires if a permit is not obtained within 180
At 4% --....,:a.. -.. - Z �� days after it has been accepted as complete.
Print name: Bruce White Date: June 15, 2 * Fee methodology set by Tri-County Building Industry Service Board
: Building \Permits\MEC- PermitApp.doc 01/19/07 440 -461TT (11 /02/COM/WEB)
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Electrical Permit Application �, r� I r n �' m �6 4krd { t oll OR O1• I ILt 1„ ,,U 11, a r . tii' 6 'i ` i .,.
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R
t ' ale p City of Tigard Date/B : Permit No.:
I a 13125 SW Hall Blvd., Tigard, OR 97223 JUN 1. 6 / I i'
Review
p Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
, „t " 1p Inspection Line: 503.639.4175 Date Read /B Juris. RI See Page 2 for
� I G A rR 1 ��;� CITY c: TIG 1I'[ fied/Method: Supplemental Information
poa ...b Internet: www.tigard - or.gov �f pP
!?l i!i d l ue - - rara ft en.....
. — .....,....011,S,1 ill v I ''p ' PLAN REVIEW
TYPE OF WORK .
• ® New construction ❑ Addition/alteration /replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
1 ti G�g JOB SITE INFORMATION AND LOCATION ❑ o ❑ Emergency system. larger separately derived system.
" �! Addition of new motor load of ❑ "A ", "E ", "1 - ", "i - ",
Job no.: Job site address :j8 6 SW 72 "d. 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard OR, 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
• FEE SCHEDULE
Cross street/directions to job site: Hall Blvd. /Langtree Description I Qt . I Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
-
Subdivision: Gage Forest Lot no.: 02
1,000 sq. ft. or less 1 145.15 ( 45 4
Ea. add'I 500 sq. ft. or portion 4— 33.40 ,(_ 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 1 75.00 Z 03 2
of new single family residence Limited energy, multi-family
Wiring g y residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: J.T. Roth Const. Inc. 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 12600 SW 72 " Over 1,000 amps or volts 454.65 2
City/State /ZIP: Tigard OR, 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)639 -2639 Fax: (503)624 -0239 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
• ❑ APPLICANT ® CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: J.T. Roth Const. Inc. B. Fee for branch circuits
Contact name: David Jensen without service or feeder fee, 46.85 2
first branch circuit
Address: 12600 SW 72". Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Tigard OR, 97223 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 639 -2639 Fax: : (503) 624 -0239 Reconnect only 66.85 2
E -mail: davidj @jtrothinc.com Pump or irrigation circle . 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Grizzly Electric energy panel, e r t i o n ,
energy panel, alteration, or
Address: 8002 NE Hwy. 99 Suite 248 extension. Describe: Page 2 2
City/State /ZIP: Vancouver WA, 98665 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 909 -4080 Fax: (360) 694 -8939 Investigation per hour (1 hr min) 62.50
CCB Lic.: 186218 Electrical Lic.: 37446 -C Suprv. Lic.: 2643 -S Industrial plant per hour 73.75
. ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: '7f, ;-
Print name: Ron Nelson Date: June 15, 200 Plan review (25 % of permit fee):
State surcharge (12% of permit fee): '33,4.5
Authorized signature: ` % / / j 3 TOTAL PERMIT FEE: 4
�f This permit application expires if a permit is not obtained within 180
Print name: Date: June 15, 200 9 days after it has been accepted as complete.
* Number of inspections allowed per perm't. ` /'�
I:\ Building \Perm O
its\ELC- PermitApp.doc 05/ 23/06 440- 4615T(l1/05 /COM/WEB L, � �T -C)
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL.WORK ONLY: ,
Fee for all residential systems combined $75.00
Check Type of Work Involved:
® Audio and Stereo Systems*
❑ Burglar Alarm
® Garage Door Opener*
® Heating, Ventilation and Air Conditioning System*
® Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ C lock Systems
❑ D ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape 1 fighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
:\ Building \Permits\EL -PermitApp.doc 03/23/06
City of Tigard, Oregon o 13125 SW Hal 1 Blvd. o Tigard, OR 97223 ,"I �`y ', .
�"''
f ,. .14 f t x i •�, t ,
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July 9, 2009 `' `,. "
I Elm :
,,„, ., ,,.
, .
_ . .
RE: RESIDENTIAL NSFD ¶.CARD
•
Project Information
Building Permit: MST2009 -00132 Class of Work: NSFD
Address: «gjCg .157-66 81 Lot Number: 2
Area: 2240 Sq. Ft. Stories: 2
Builders Name: JT Roth Subdivision: Gage Forest
The plan review was performed under the State of Oregon Residential Specialty Code
(ORSC) 2008 edition. Please respond to conditions below.
1) Opening next to ABP requires 24 inch panels at each side and the cantilever
may not be greater than 4 times the depth of the joist at front of garage.
2) Please complete conditions required by arborist.
When responding, provide an itemized letter stating in what way each numbered
issue has been addressed in the revision.
When submitting revised drawings or additional information, please attach a copy of the
City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of Tigard
in tracking and processing the documents.
Respectfully,
' I \
Oi. / JO( if
Dan Nelson
Senior Plans Examiner
(503) 718 -2436
dann @tigard- or.gov
Post -it® Fax N 1 ot ` e �,� � 7 � 671 Date 7 ( (c pages ® I
To v t(b. ° " From a 4 vll p V_ , ,c i
Co. /Dept. —P ,
Co. A
Phone # Phone #,.. � 2 — �C
Fax # 2 1 _ s 4- 02- 7 Fax # J
Phone: 503.639.4171 0 Fax: 503.684.7297 o www.tigard- or.gov o TTY Relay: 503.684.2772
Todd Prager
From: Todd Prager
Sent: Tuesday, June 16, 2009 2:38 PM
To: 'davidj @jtrothinc.com'
Cc: Dan Nelson; Mark VanDomelen; Albert Shields; Cheryl Caines; walt.knapp @comcast.net
Subject: Lot 2 - Gage Forest Subdivision
Attachments: Gage Forest.pdf
Dear David,
I am reviewing the site plan for lot 2 of the Gage Forest subdivision. Condition 37 of land use approval requires:
Prior to issuance of building permits, the applicant shall submit site plan drawings indicating the location of the trees
that were preserved on the lot, location of tree protection fencing, and a signature of approval from the project arborist
regarding the placement and construction techniques to be employed in building the house. All proposed protection
fencing shall be installed and inspected prior to commencing construction, and shall remain in place through the duration
of home building. After approval from the City Forester, the tree protection measures may be removed.
The approved tree plan for the subdivision shows tree protection fencing on lot 2 in order to protect the neighbor's
trees (see sheet C300 attached). Please show the fencing dimensions to scale on a revised site plan and have your
project arborist install and verify (via email) that the fencing has been installed per plan. The arborist will also need to
sign off on the revised site plan and approve of any modifications or encroachments into the tree protection zone. The
project arborist is Walt Knapp, and I copied him on this email.
Please do not hesitate to contact me if you have any questions.
Sincerely,
Todd Prager
Associate Planner /Arborist
City of Tigard
503.718.2700
1
Walter H. Knapp & Associates
December 22, 2009
Gage Forest Trees: Lots 2,6,14,15,16,28
Lot # Species DBH Tag # Comments and Condition Recommended Action Builder
During site construction, a drainage swale filled
2 N/A N/A N/A with crushed rock was installed along the east J.T. Roth
property line. Based on the required depth of the
swale, it is unlikely that there are viable tree roots No action needed
beneath the swale. Thus it is unnecessary to install
6 N/A N/A N/A protection fencing to protect trees on the adjacent Timberland
property.
14 red alder 13 1870 Extensive dead bark on trunk. Tree in advanced Remove - J.T. Roth
decline; not sustainable condition/hazard
15 bigleaf 8 788 or Lean, old broken top, broken main branches - very Remove - Timberland
maple 789 poor condition. condition/hazard
16 Scouler's 785 or Remove -
Extensive dead bark - hollow trunk
8 J.T. Roth
willow 787 condition/hazard
Site plan shows a deciduous tree, #1761, on this
lot, but there are no trees currently on or adjacent
to the lot. The original arborist believes that this
was either a dead tree included in the inventory
28 deciduous 9 1761 but not in the arborist report, or a multi -stem large No action needed Timberland
shrub or tree that was estimated by the surveyor
below breast height. This would not have been
considered a tree, and therefore not included in
the arborist report.
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ROLLS IASIG ,
11181888. Crew 97082
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�: i A 1 io Sinew 1982
Important Manure
Mem Rog
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LOT *2 GAGE FOREST "r �
ea m mIZZAND SOWS
.81: ROTH CONEllEUCOON
SCALE: I' - 1S' -0r tot LOT ft 6180W ,01169!
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SITE
. ■ -,
N CITY OF °T iGA® CERTIFICATE OF OCCUPANCY
g , ',•: Permit #: MST2009 -00132
COMMUNITY DEVELOPMENT Permit Issued: 02/02/2010
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112CC19500
Jurisdiction: Tigard
Site address: 15848 SW 81ST AVE
Subdivision: GAGE FOREST Lot: 2
Project Description: New SFR
Class of Work: NEW
Type of Use: SF
Type of Constr: VB
Occupancy Group: R -3
Occupancy Load:
Project Name: Gage Forest
Owner: J R ROTH CONSTRUCTION INC
12600 SW 72ND AVE
TIGARD, OR 97223
Phone: 503 - 639 -2639
Contractor: J T ROTH CONSTRUCTION
12600 SW 72ND AVE #200
TIGARD, OR 97223
Phone: 503 - 639 -2639
Fax: 503 - 624 -0239
This Certificate issued 6/9/2010 grants occupancy of the above referenced building or portion thereof and
confirms that t .'building has been inspected for compliance with the State of Oregon Specialty Codes for the
group, occup -'y, and use under which the referenced permit was issued.
,- 11 s UG-) ? C
Buildin• spector Building Official
POST IN CONSPICUOUS PLACE
. P
Oregon Residential Specialty Code N1107.2
M. 1,00q-a3/ ? —_
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: s/ 2-009„ Jt Z Jurisdiction: cZ -I1I1,z2
Site Address: /5gJ/g S/✓ �1
Subdivision/Lot #: / OA y r
d /or 2-
an lJ /I �i
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: � � Date:
0
Owner /General , on for /Authorized Agent
Print Name: G� 9I O difr s
t ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
I:\ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08
I`
Oregon Residential Specialty Code 8318.2
•
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
ON IV ()4J3 E , am the general contractor or the owner- builder
at the following address:
Site Address: ) 5 10 ( ' 1 / 6-7
City:
T;i0
Permit #:
1 0 ' 1
Subdivision/Lot #: /i76-L7 F 7 �
and/or l/ / Q
Map and Tax Lot #:
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture - sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: or ��,� Date:
General Contractor • Owner - Builder
I: \Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08
STREET TREE CERTIFICATION
1, ONTO YEA/cen/ Owner/Agent for 7: ea,1 2i��
(PLEASE PRINT) (PERMIT HOLDER)
r a
Do hereby certify that the follow location meets
City of Ti 'land ti and , development standards
for street tree Installation.
ADDRESS: • Msr26J1 -Col 3 2-
SUBDIVISION: G rOC fr; LOT: U
SIGNATURE: / V DATE: 67S/r
(OFNER /AGENT)
RECEIVED BY: DATE:
(CITY OF TIGARD)
I: \ Building \ Forms \Strcctl'rceCcrtiticate 01/19/07
1, A
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO: al CITY OF TIGARD - SITE PLAN REVIEW
TP • got App�'o d o BUILDING PERMIT NO.:
r1
� proved � ' /�Sl 200:4 - O l3 Z
Street Trees: ,, N,. Approved PLANNING DIVISION:
Protected °� Approved (, / < J Required Setba ks: 0' Approved ❑ Not Approved
Date: Side: Street Side: _
Notes: From. I Garage: ? Rear: 'S
Oct e•-vi a'+` Visual Clearance: El Approved ❑ Not Approved
Maximum Building Height. .3 feet
e CWS Service Provider Letter Required: ❑ Yes No
wrei �li Try 1311(.4 l 4z a tr,� [I Received ,
, B): L Date: c�lJ
s Gr 0,40 d fFa/34 ENGINEERIN Ltd' DEPARTMENT:
Actual Slope:. a..% z " Approved 0 Not Approved
Site PI. n: ! Approved IN Not Approved
B . # Date:
•