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Permit CITY OF TIGARD MASTER PERMIT 1 b 3 ;; . COMMUNITY DEVELOPMENT Permit #: MST2009-00088 t " 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009 TiGAAD Parcel: 2S104BB12400 Jurisdiction: Tigard Site address: 13967 SW WALNUT CREEK WAY Subdivision: Lot: 0 Project: Walnut Creek Project Description: New SFR BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 925 sf Basement: 0 sf Left 5 Parking Spaces: 0 Height: 27 Bathrooms: 3 Second: 1349 sf Garage: 421 sf Front 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $249,242.90 Rear: 15 PLUMBING • Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 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 1 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 Furn <100K: Vents: 0 Woodstoves: 0 Gas Outlets 4 Furn > =100K: 1 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: 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) MATRIX DEVELOPMENT CORP MATRIX DEVELOPMENT 12755 SW 69TH AVE #100 CORPORATION TIGARD, OR 97223 12755 SW 69TH AVE #100 TIGARD, OR 97224 PHONE: PHONE: 503- 620 -8080 FAX: 503 - 598 -8900 Total Fees: $11,024.42 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. Issued By: uC 0_ Oa, VA,( ( _All IA AAL Permittee Signature: 1 Baiging Permit Application Residential RECEIVED FOR OFFICE USE ONLY City of Tigard APR " 7 2009 Received Q DateB : • 0 Perm No.: •V s •e7 . C)oO ` S III ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598Et i OF � �i�i! Gpp� Date/B : A ir ♦ Other Permit: 7 IGARD Ins Line: 503 Date Read /B ® See Page 2 for Internet: www.tigard or BUILDINGD Notified/Method: Supplemental Information 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 ❑ Addition/alteration/replacement ❑ Other: dollar) of all equipment, materials, labor, overhead, and CATEGORY OF CONSTRUCTION the profit for the work indicated on this application. ® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 231,546.37 ❑ Accessory building ❑ Multi - family Number of bedrooms: 3 ® Master builder ❑ Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: 13967 Sw Walnut Creek Way New dwelling area: 2,274 square feet City /State /ZIP: Tigard, OR 97223 Garage /carport area: 421 square feet Suite/bldg. /apt. no.: Project name: Walnut Creek Covered porch area: square feet Cross street/directions to job site: Barrows & Walnut Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Walnut Creek Lot no.: 041 Permit fees* are based on the value of the work Tax map /parcel no.: 2S104BB12400 performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and DESCRIPTION OF WORK the profit for the work indicated on this application. ' , , S Q. A G 1 t -( e. - c r f - IO,tC 1, Valuation: $ r T 40 SSl Existing building area: square feet 1 C ] / S - 2 oo ( oc\ L -D.,41) New building area: square feet "'1 1 l 1 PROPERTY OWNER ❑TENANT Number of stories: Name: Matrix Development dba Legend Homes Type of construction: Address: 12755 SW 69 Avenue, Suite #100 Occupancy groups: City /State /ZIP: Portland, OR 97223 Existing: Phone: (503) 620 -8080 Fax: (503) 598 -8900 New: ® APPLICANT ❑ CONTACT PERSON NOTICE Business name: Matrix Development dba Legend Homes All contractors and subcontractors are required to be Contact name: Steve Lucas licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 12755 SW 69' Avenue, Suite #100 jurisdiction in which work is being performed. If the City /State /ZIP: Portland, OR 97223 applicant is exempt from licensing, the following reasons apply: Phone: (503) 620 -8080 Fax: : (503) 598-8900 E -mail: slucas @legendhomes.com CONTRACTOR Business name: Matrix Development dba Legend Homes BUILDING PERMIT FEES* Address: 12755 SW 69 Avenue, Suite #100 (Please refer to fee schedule) Structural plan review fee (or deposit): City /State /ZIP: Portland, OR 97223 Phone: (503) 620 -8080 1, Fax: (503) 598 -8900 FLS plan review fee (if applicable): CCB lic.: 55151 Total fees due upon application: i � 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: Steve Lucas Date: 4/6/2009 * Fee methodology set by Tri- County Building Industry Service Board. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received Date/By: Permit No.: U PI ° 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 DateBy: TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tlgard- or.gov Notified/Method: Supplemental Information 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: $ ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYSTEMS FEES* For special information use checklist. ❑ Multi- family ® Master builder ❑ Other: Description 1 Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: 13967 Sw Walnut Creek Way Air conditioning or heat pump (requires site plan showing placement) 14.00 City /State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts /vents) I 14.00 14.00 Suite/bldg. /apt. no.: Project name: Walnut Creek Furnace 100,000+ BTU (ducts /vents) 17.90 Gas heat pump 14.00 Cross street/directions to job site: Barrows & Walnut 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: Walnut Creek Lot no.: 041 Flue /vent for any of above 1 6.80 6.80 Other: 10.00 Tax map /parcel no.: 2S104BB12400 Other fuel appliances DESCRIPTION OF WORK Water heater 1 10.00 10.00 Gas fireplace 1 10.00 10.00 Flue vent for water heater or gas fireplace 2 10.00 20.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 Z PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00 Other: 10.00 Name: Matrix Development dba Legend Homes Environmental exhaust and ventilation Address: 12755 SW 69 Avenue, Suite #100 Range hood /other kitchen equipment 1 10.00 10.00 City /State /ZIP: Portland, OR 97223 Clothes dryer exhaust 1 10.00 10.00 Single -duct exhaust (bathrooms, Phone: (503)620 -8080 Fax: (503)589 -8900 toilet compartments, utility rooms) 5 6.80 34.00 ® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Business name: Matrix Development dba Legend Homes Other: 10.00 Fuel piping Contact name: Steve Lucas $5.40 for first four; $1.00 for each additional Address: 12755 SW 69 Avenue, Suite #100 Furnace, etc I Gas heat pump City /State /ZIP: Portland, OR 97223 Wall /suspended/unit heater Phone: (503) 620 -8080 Fax: : (503) 598 -8900 Water heater 1 Fireplace 1 E -mail: slucasglegendhomes.com Range 1 5.40 CONTRACTOR Barbecue Business name: Tri County Temp Control Clothes dryer (gas) Other: Address: 13150 Clackamas River Drive MECHANICAL PERMIT FEES* City /State /ZIP: Oregon City, OR 97045 Subtotal $120.20 Minimum permit fee ($72.50) Phone: (503) 557 -2200 Fax: (503) 557 -0919 Plan review (25% of permit fee) 30.05 CCB lic.: 72623 State surcharge (12% of permit fee) 3.61 TOTAL PERMIT FEE $ 153.86 Authorized signature: 7,4 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Steve Lucas Date: 4/6/2009 * Fee methodology set by Tri- County Building Industry Service Board Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard Received Permit No: li Date /By: V 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.: if I G AR D 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 FEE* SCHEDULE ® New construction ❑ Demolition For special information use checklist Description Qty. I Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 ® 1- 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: Fire sprinkler ( sq. ft) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 13967 Sw Walnut Creek Way 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.: Project name: Walnut Creek Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Barrows & Walnut Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Walnut Creek Lot no.: 041 Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: 2S104BB12400 Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ® PROPERTY OWNER El TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: Matrix Development dba Legend Homes Expansion tank 16.60 Address: 12755 SW 69 Avenue, Suite #100 Fixture /sewer cap 16.60 City /State /ZIP: Portland, OR 97223 Floor drain /floor sink/hub 16.60 Phone: (503)620 -8080 Fax: (503)598 -8900 Garbage disposal 16.60 ® APPLICANT El CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Matrix Development dba Legend Homes Interceptor /grease trap 16.60 Contact name: Steve Lucas Medical gas (value: $ ) Page 2 Address: 12755 SW 69' Avenue, Suite #100 Primer 16.60 City /State /ZIP: Portland, OR 97223 Roof drain (commercial) 16.60 Phone: (503) 620 -8080 Fax: : (503) 598 -8900 Sink /basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: slucas @legendhomes.com Urinal 16.60 CONTRACTOR Water closet 16.60 Business name:- Weleett- Plumbing CaVQ.1 Cyr A.)0(41. logZ51 Water heater 16.60 Address: 1075 W. Historic Columbia River Hwy Other: l �ne.- City /State /ZIP: Troutdale, OR 97060 Subtotal 399.00 Minimum permit fee: $72.50 Phone: (503) 667 -1781 Fax: (503) 667 -9891 Residential backflow minimum permit fee: $36.25 CCB Lic.: 112220 LA. t 8 ` k Plumbing Lic. no.: 26 -824PB Plan review (25% of permit fee) 99.75 -- ,, • ti State surcharge (12% of permit fee) 47.88 Authorized signature: Y /_ TOTAL PERMIT FEE $546.63 Print name: Gloria Hawes Date: 4/6/2009 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. Ele Perm Applicat FOR OFFICE USE ONLY City of Tigard Received Date/By: Permit No.: III - ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TI GARD Inspection Line: 503.639.4175 Date Ready /By: lads: El See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ® 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 JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", ' 1 -3 ", Job no.: Job site address: 13967 Sw Walnut Creek Way 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: Walnut Creek ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Barrows & Walnut Description 1 Qty. 1 Fee. 1 Total 1 New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Walnut Creek Lot no.:041 1,000 sq. ft. or less 1 145.15 145.15 4 Ea. add] 500 sq. ft. or portion 3 33.40 100.20 1 Tax map /parcel no.: 2S104BB12400 Limited energy, residential 1 75.00 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) _ Limited energy, multi - family 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: Matrix Development dba Legend Homes 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 12755 SW 69 Avenue, Suite #100 Over 1,000 amps or volts 454.65 2 City /State /ZIP: Portland, OR 97223 Temporary services or feeders installation, alteration, and /or relocation Phone: (503)620 -8080 Fax: (503)598 -8900 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is 201 amps to 400 amps 100.30 2 not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 401 amps to 599 amps 133.75 2 701. Branch circuits - new, alteration, or extension, Qer panel A. Fee for branch circuits with Owner signature: Date: above service or feeder fee, ® APPLICANT ❑ CONTACT PERSON each branch circuit 6.65 2 B. Fee for branch circuits Business name: Matrix Development dba Legend Homes without service or feeder fee, 46.85 2 first branch circuit Contact name: Steve Lucas Each add'l branch circuit 6.65 2 Address: 12755 SW 69' Avenue, Suite #100 Miscellaneous (service or feeder not included) Each manufactured or modular 90.90 2 City /State /ZIP: Portland, OR 97223 dwelling, service and /or feeder Phone: (503) 620 -8080 Fax: : (503) 598 -8900 Reconnect only 66.85 2 Pump or irrigation circle 53.40 2 E -mail: slucas @legendhomes.com Sign or outline lighting 53.40 2 CONTRACTOR Signal circuit(s) or limited - energy panel, alteration, or Business name: Garner Electric Page 2 2 extension. Describe: Address: 2920 SE Brookwood Avenue #A Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Hillsboro, OR 97123 Investigation per hour (1 hr min) 62.50 Phone: (503) 648 -4552 Fax: (503) 642 -7925 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES CCB Lic.: 121159 Electrical • i -305C Suprv. Lic.: 3707 -S Subtotal: $320.35 Suprv. Electrician signature, requir 4: Plan review (25% of permit fee): $80.09 %• State surcharge (12% of permit fee): $38.44 Print name: Chuck Garner / / / /' 7 a • •/2009 TOTAL PERMIT FEE: $438.88 This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. " Number of inspections allowed per permit. Print name: Date: FIXTURE UNIT WORKSHEET - WATER METER Contractor Name Matrix Development dba Legend Homes Billing Address 12755 SW 69 Avenue #100, Portland, OR 97223 Address of New Meter 13967 Sw walnut Creek Way Lot # 041 Subdivision Walnut Creek Please fill in the number of each fixture as detailed on the plans, then multiply quantity by the point value given to arrive at the point total. Add all point totals together for total fixture unit points. Fixture Unit Quantity Point Value Point Total Bar Sink 0 X 1 = 0 Bidet 0 X 1 = 0 Closewasher 1 X 4 = 4 Dishwasher 1 X 1.5 = 1.5 Hose Bibb 1 X 2.5 = 2.5 Hose Bibb, ea. Adt'l 1 X 1 = 1 Kitchen Sink 1 X 1.5 = 1.5 Laundry Sink 0 X 1.5 = 0.0 Lavatories 5 X 1 = 5 Water Closet, 1.6 gpf 3 X 2.5 = 7.5 Bathtub /Whirlpool 1 X 4 = 4 Shower Stalls 1 X 2 = 2 Bath/Shower Combo 1 X 4 = 4 Under 34= 3 /4" Over 34 = 1" Total Fixture Points 33 Meter Size 3/4" Meter Cost ****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** FOR OFFICE USE ONLY Fixture Count Verified with Plumbing Permit Meter # Receipt # Emp. Name PL -Or PLAN FILE COPY, LOT *041 WALNUT CREEK � 13961 SW WALNUT CREEK WAY NE :SECTION 4, T. 2S, R.1W, W.M. ApR _ 1 "• 20'_0" CITY OF TIGARD 9 2009 WASHINGTON COUNTY, OREGON CI TYC F T ,cAh ' "�.,.1" LE GE ND �U!LD D /v1s 8 t�F411601 HOMES pi , ` Ei 111) � 12766 6f 69th AVE. 0FR (603) 620 -0080 n�llll 8UR8 100 FAX (603) 608 -6 000 ( PORTLAND, OR. 97223 COB/ 66161 co LOT r a) `,, 45 01 0, m N N N N \ 88' 19 E N. — ' 41.50' \�° 1 1 LOT 1 � 44 N di N I 1 1 235 238)5' 231.3' 4.00'1 -1 ) \ 50' / / d 2391 g r- // ' gI : , 1 l'si /_, OT 41 // 41 I 39173�C�FT / G I OT L LOT , D WOOD B% 1 43 m I :4 // FIN. FLLR •239.0' /� :l 40 1 0/,,GAR. � • 238.5 % j 91 1 I , / 71 6.510' 239 I z / I f / / ,��'C I 238.5' /\ // � � 235 4. 7j / / r W — - - — WATER LINE ` : f:t-. • :238.3':. ��\ \, ' �t `2 35 SS -- — — -- SANITARY SEWER l 231.3 \ SD — - - — STORM DRAIN J ' / LOT EROSION FENCE L=43 „'15' / 4 2 0 o = 133.00'. r q - CE OF STREET 238 : R = O WATER METER a . . i� � g; O MANHOLE 231.3' . / O ` /\ ® CATCH BASIN _, \ .a �• `%. 81 AZJE :,V' PROPOSED '' % I ` (. • l ' �..°. : • ". ,j `/ STREET TREES I ` /�E� • 8 STREET LIGHT �`` ; \ 7 -.,- • FIRE HYDRANT � \ _ v , / � \/ ` �� 235 STREET TREE: yY0 K7 ' \ ` _ Cu CHANTICLEER PEAR PROVIDE EROSION ,� W � 1 ` � 2 " Caliper CONTROL FENCE NLJ�' _ i EROSION LAN 'L�� C � �� - SETBACKS : ti FRONT YAW • 5 FEET GARAGE • 20 FEET REAR YARD • 15 FEET SIDE YARD • 4 FEET , STREET SIDE YARD • 10 FEET CITY OF TIG • • D - SITE PLAN REVIEW Y BUILDING PERMIT No • *ow • PLANNING DIVISIO .. u�� <<� Required Setba ss: Approved o p• Side: St eet Side: �— /� Garage: . — Rear l5_.__ Front. ...C... Visual Clearance: ❑ Approved ❑ Not App�i•:;i Maximum Building Height feet CWS Service Provider Letter Required: 0 Yes 0 No 0 Received B : K .Q..Q, Date: ENGINEERING DEPART NT: Approved Actual Siope:2, % `! A *proved ❑ No App S ite P /:% Not ' pproved ❑ t A p roved // / Date: , • Notes: ! CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO. 2_00 006 R Street Trees: Approved ❑ Not Approved Protected Ives: Approved Approved By: ,'(c (r,_ { Date: 0/ Notes: FROM : CANBY ELECTRIC INC PHONE NO. : 5032665543 May. 29 2009 11:17AM P1 RECEIVED .••.........•,•..: ...:„...„.„.„.,:„....••:....::..,,,, ••-• • Electrical Per i2 z :,,A)filicatii) c' , OR (1EPICE10$1:•rON1:;N: • • .,:.:' • , . . ,. ... ..., .... ,. , .... . , . II ‘ ( .. ity Of • 1‘ -14„,';.1rti - r Fl / 0 Received DateiTiy__ _ _ .... t.c/L± OF TIGARD 1' ii lik i Pill••1 : . 2 " Phone: 5(1 0 s') , : ' i I 2 \ 503.5Vg IWO" 11 - Datc/L3Y , ..... . . - — Date Read . • i-- 4)"6"''' I '"'' ''' 1 (i( '" 1 BUILDING DIVISION 1 h. 1- 10 so: l'iole 2 fur - tit_A1.11 , Notified/Method. i , .,,, i i:iiiiiikiiiiiiistAt laardiati01 'memo. ,,,,,. U: pc, I... _____ ---- --- ....._...... - --, . - , ,., - — TYPE OF WORK -- , ple check iin nix ,miitv iii 2 \ffif.77TI: ,,,,, c.hecked bele\v)1 El N' COCIStrill:11011 Li Addition/alloration/replaCcment 0 Sc,ryl,.., ip 1 1,11 ,k t1117. 01 I/10N El 1111114111)r , iVtir throe StOriCS . D Demolition 11'1 ( )it,,,:. _ v 11,, arailahlii lists] i es II E Mar illia.. and tivitlyardS. .- ,-....,i- ht r' 111.1.1t/1/ iiiiiii:i al I ' soli. iii El .1 kllp (..ATEGORV OF CONSTRUCTION , ;,, 1 00; t ,,,,,,,I ,, ,. , ,.,,,,,j, 1.1,u1A: ri (..,,iT,11,,,al-fiv: agrieulnia ..___. ,__..,.. . ...___. . ,. - . 0 I- and 2-family av,.faiff! D Commercial/industrial 0 Accessory building ; ,, , ,,pi for ;Ili oll“.1 11).:cillal■oll,.. Itulh11 El Multi-family LI Muster builder 0 Other: 0 hoz iiiiiilp. Li L of 75 KVA or . , , Er]F.incr iiyiaciii laq4cr ,kpifralely derived sy in. -:. JOB srrE INFORMATION AND LOCATION: .:. .... . . El Addit ioil of ilov iihfloi load el ...„..- _ I 100HP or 11,011,' occupaney. Job no.: . J ob sire address: /0S 514,/ , /.. . t-- • 0 Recrcactoaai vchiCI parks. 1 .) 0 sii.. cir iiiiiic ii:isidtinital atS. I -_-_---------- -- - — v - --- - - • 0 Health-care iniiiiii:',. 0 Supply volliwe for mem thin City/State/7,1 PI / 0,,,a/ff, • ,. 0 Hazardniiii. locaiion: 600 ,olis nominal. . • . _., . , , Suite/bldg./apt no : It I Project name' 0 Scrvicai of teeoer ni./0 amps Or MOle. . . I' FEE 5CH . ' Cross 5/reel/directions to jiib !,ite: Dn.-4)110n TOIL En ' - - - - New residential single- or multi-family dwelling unit. . . . . , Includes attached garage. • • ...._ „...... 1,000 sq. ft, or less 145.15 Subdivision; Lot no.: -- • --• • ' - - Ea, add il 500 5q it or portion 3.3.40 WM Tax map/parcul no.: -- , Limited energy, residential , 75.00 Mil . , ,_ _._ . . • DESCRIPTION OF•, '.!.:::::::.:.;:::::.'• I. (with above su. ft ) . . • ,... Limited energy. multi-family )ttiC11141_4Dtin. 4 . i Jail g Fe r i I I residermat (wichabove so n .1 .. _71°0 .2 . . SeTriCini or feeders installation, alteration, and/or relocation • • 200 amps or less 80.30 111.1.11Ell, ,._ . ..... • .. " —4•• • - •". • • •• ' 0 PROPERTY OWNER , ' : , ;•... El:TENANT' ; - 201 amps tu 400 amps 106.85 . -) ....._ - _ „.. - ..... Name: 401 amps to 600 snips i 60 60 MI • 2 • - •• 601 amps to 1,000 amps 240.60 • ' all . r . Address: 45 4.6 5 2 r I ■ .. ■ 4‘..... ,, ..■• Over 1,000 amps or volts Temporary services or feeders installation. alteration, and/or City/State/ZIP: relocation__ .. .,.. ____ - Phone: ( ) Fax ( ) 200 amps or less 66.85 1111 Owner installation: This insLullation is being made on property that I own which is not 201 amps no 400 amps 100.30 ot .,.„.,._ - _...,.. 599 air 133.75 ' . intended for sic. lease. rent, or exchange. iiccor 40 amps to :l ding to ORS 447, 449, 670, and 701. I ..... 2 . , Owner ignature: Date: Branch circuits - new, alteration, or extension, per panel s _. • . . . . • . , 2. . A, Fee for branch cireuits with . . . . . . ' • 0 APPLICANT I : :.. •.', ii:. , above service or feeder fee. ' . . . 6.65 ' .. 2 each branch circuit Business name: B. Fee tbr branch circuits ,... • __ without service or feeder tee, . Contact name: J6,85 fi ,.. --. rst branch circuit __.,.._ , • , . Address: Each add' branch circuit 6,65 .... 2 '- -. -- ' ni keeflaneOlts (service or feeder not includedi . . CityState/ZIP: Each manufactured or modular •" 90.90 " thy,ellirla, service and/or feF_der • Phone: t ) Fax: : ( ) :.., Reconnect only ' 66.85 -_-_ ----- ' ----- - --___ .. .. ..... • 1 , . E-mail: Purim or irrigation circle 53.40 ' • 2 . ' . . ____________ - Sign or outline lighting 3.40 . 2. B ... ..-- • ... . .. ' v--,, am usiness ne: L.. .cf- 1 _ t C...\-- ,_ --A-f■ c_. Signal circuit(s) or limited- energy panel. alteration, or • • . , • . Address: 't 9 c- ---- ,), Si extens,on, Doscribu• Page 2 2 " —__......,„ ., .., City/Staix/7.,it' .. • k,a .. r?„._ q. -1 . 0 l ''2 Each additional inspection over allowable in any of the above . . . . ---- Per inspection 62.50 111111111 . Phone: tc0 - ‘' _1_,_ ' C - v -- Fax: ( So - ... c 6 L.( -14 Investigation per hour r t hi mil» 0..50 . • . . • . . (---'ac_;-_ t-• v ..._ ...... ... . . CCB Lie.: , 2 , 1 0 t\ •-•‘ Electrical Lic,: 3,4 k 2 c Suprv. Lie.: 2_1,2_7 C Industrial plait _ t per hour 73.75 • --w- " - -....-- ..: . ELECTRICAL. PERMIT FEES,''.':, • . SuprY. Eleeirieian signature. required: - ' k: s ) C Subtotal. ' , ' • •• ' ......,.............. .- Print na plan review ( of permit tee) magi , . rtie - ,) ' Date: . ------ . ----- - • 1 -‘L ". • ...) . n - a I o d-t ' - Stale sun:hinge (12% of permit let): iripr. Authorized signaturt. _ '' ( --,---^:-- 4, --k k.--) -0------: ........ • 4 • __. . .. TOTAL. PERMIT FEE: . ' . . - • Print narrn , .e i- --- • __0... to,. i Date: has. permit application esprires 7; 1 it is not obtained within 180 • , days after it has been accepted 4A oniplete. . . -- • Number of InF;pcelion allowed per !wind ' • i1fiMills\P4rriiiiii,d11.C•PerntitApp du. 6 'i".' I/ 4 I 1/05/COMAVEll • • , . '• . i q CITY OF TIGARD MASTER PERMIT °. '° COMMUNITY DEVELOPMENT • Permit #: MST2009-00086 Date Issued: 04/22/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S110DA02000 Jurisdiction: Tigard Site address: 10572 SW NAEVE ST Subdivision: Lot: 0 • Project: Imai Project Description: Kitchen /family room addition, 204 square foot habitable, 322 square foot deck. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 204 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: Yes Total: sf Value: $27,176.32 Rear. 0 PLUMBING • Sinks: 2 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: Vent Fans: 0 Clothes Dryers: 0 Heat Pump: Hoods: 1 Other Units: 1 Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =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 addi 500 sf: 0 20 1.400, amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: • Limited Energy: 0 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 , ELECTRICAL - RESTRICTED ENERGY SF Residential Audio 8, Stereo: HVAC: Security Alarm: Vaccuum System: Garage Opener. All Other: Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD Single Family VB R -3 506 Owner: Contractor: Required Items and Reports (Conditions) IMAI, RUSSEL & JUDY Y BRITTANY HOMES INC. 10572 SW NAEVE ST 22275 SW SCHOLLS - SHERWOOD RD. TIGARD, OR 97224 Sherwood, OR 97140 PHONE: PHONE: 503 -628 -3518 FAX: 503- 628 -5421 • Total Fees: $906.88 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will b= • - - - . . rdance with approved plans. This permit will expire if work is not started within 180 days • issue • •_, o i work is s • • - ded for more the 180 days. ATTENT c : Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi , Ce' er. T •se ules =, - in OAR 9' 2- 001 -0010 through OAR • -0. • 100. You may obtain a copy of the rules or direct questions to OUNC by calling • • • •.669: or 1.8 • •.332.23 • • / 1 Iss ed By: • t_ . 1 _ .: Pe rmlttee Signature: L I� MM." • ,7 Branding Permit Application ` Commercial . S FOR OFFICE USE ONLY II q City of Tigard Received Q7 Permit No.: m ST ZOO4 • QOC$ (o 13125 SW Hall lvd., Tigard, OR 97223 MAR 2 5 2009 P1an `/// ■ Phone: 503.639.4171 Fax: 503.598.1960 Date/B ` (z 1 Other Permit: .Inspection Line: 503.639.4175 CITY OF TIGARD ins Date Ready� rie: 0 See Page Z for T I G A R D p p� u Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: —1 • O ! /� Supplemental lnformatioo • TYPE OF WORK DIVISION REQUIRED DATA: 1 - 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 Al Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION _ • work indicated on this application. " • A 1- and 2-family . dwelling . ❑ Commercial/industrial Valuation: $ ❑ Accessory building . •:'r ❑ Multi- family Number of bedrooms: ❑ Master builder ' " ' ' ' O' �t}ieri .- ° Number of bathrooms: 'r. JOB SITE INFORMATION AND LOCATION Total number of floors: Job site addr63s: /6 . g-L.1 'yV il 8 v/ gr ' ' New dwelling area: �,u square feet City/State/ZIP: -: 'P d es - 9-7 L ale Garage /carport area square feet Suite/bldgJapt. no.: Project name: (( Zovered porch area: ` ( 3Z 1 7 s uare feet - Cross street/directions to job site: ' Deek area: t 42 14 square feet • . . - 1 - Other structure area: square feet r.' -, .. :tiREQ DbATA: COMMERCIAL -USE CHECKLIST Subdivision: . Lot no.: Permit fees* are based on the value of the work performed. - , •) j ic$p th lue (rounded to the nearest dollar) of all Tax map /parcel no.: _ -2,. 5 1 i Q 0 4 m 2_000 equipnent, materials, labor, overhead, and the profit for the W DESCRIPTION OF WORK - . -... _.._ -..__ _ ____Itioitindicated onthis application. At ' - k ..st f F dZ Q /J b TcA n) Valuation: $ • • . , , r 'ExisSing,building area: square feet - "` ` /NtW building area: ' square feet • 8. PROPERTY OWNER I ❑ TENANT Number of stories: Name: Kti-S S J T ■ Type of construction: Address: - I a Si 2 % LNAE (/ IT Occupancy groups: I ' • City /State /ZIP: I %.1 A ��,_ -• 91 22-t f Existing: Phone: ( ) Fax: ( • ) New: • pit APPLICANT ❑ CONTACT PERSON NOTICE • Business name: ��N y j - °1ioi� All contractors and subcontractors are required to be Contact name: — 3'E-71e. 1:-.146 O� licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: _..2.:2..l 5 5. .a its - 5 itc.rt.3,:a 6CJ.. jurisdiction in which work is being performed. If the Q applicant is exempt from licensing, the following reasons City/State /ZIP: 5� -.r ae g 6Z • 1 )'{ apply: Phone: (4 3) 1.2_11- . 3 S (8 I Fax: : ci>3) 6,2.3- 54/Z/ E -mail: CONTRACTOR • Business name: . l ,,, -e /4C 4 , Ay ,+/ ". -.1""---- BUILDING PERMIT FEES* Address: (Please refer to fee schedule Structural plan review fee (or deposit): ' City/State /ZIP: FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) CCB tic.: 3 82Y 8' a. p( • 11 Total fees due upon application: a 1 f. ( Q Z Amount received: a (; . , Z Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: s' 1.44,`c iJ Les fxF Date: $ Q - • Fee methodology set by Tri -County Building Industry Service Board. 1: \Building\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(11/02 /COM/WEB) • Mechanical Permit Application FOR OFFICE USE ONLY RECEIVED Received City of Tigard Date/By: Permit No. :114 ••• , . . , 11 2. • 13125 SW Hall Blvd., Tigard, OR 97223 - ` Phone: 503.639.4171 Fax: 503.598.1960 Plan Review APR 1 b 2009 Date/By: Other Permit: T I G A It D Ins Line: 503.639 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigazd or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE BIJILDING DIVISION YPE OF WO COMMERCIAL FEE* SCHEDULE - USE CHECKLIST taNew 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* J1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling /J Air conditioning or heat pump Job site address: /of 7 Z 5 - „ / ,, (requires site plan showing placement) 14.00 City/State /ZIP: "77/ f o- ✓d On. Furnace 100,000 BTU (ducts/vents) 14.00 �� Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: ��MA ( Gas heat pump 14.00 Cross street/directions to job site: Duct work ' 10.00 �60 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: Lot no.: Flue /vent for any of above 6.80 Other: 10.00 _ Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 / Gas fireplace 10.00 "4:4 L- f -,, o 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 A PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 10.00 _ Other 10.00 Name: ..00.,0-5 S J- S L_.S_`I ^ �M� c Environmental exhaust and ventilation Address: 1 0 5'7 2 5 t l /VA-a-0 a Range hood /other kitchen equipment ` 10.00 (D City /State /ZIP: "-----^ ' a� Z r~ Clothes dryer exhaust 10.00 1 `1 Single -duct exhaust (bathrooms, Phone: (56 ?) sal_ _ i o S O Fax: ( ) toilet compartments, utility rooms) 6.80 ,APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Business name: 102_4. ?7 j• „/ " ,--2.A-Z.5 S Other: 10.00 Fuel piping Contact name: " L.__ ,9 4,...,"-e-ja $5.40 for first four; $1.00 for each additional Furnace, etc. Address: 2-- c S'.---- S _4- CLf ' S _4 ) 000 Gas heat pump City/State /ZIP: S' ,,,•-' � ,3t,._ grATra. 9 ? / YO WalUsuspended/unit heater Phone: ( 3 ) 62,5- 2$7& Fax: : (3 ) 6 2.B S L( Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: /--.77 -, '7Z )4/4, Clothes dryer (gas) ` 'G" Other: Address: 2„ J 7 / S 2/4 "L MECHANICAL PERMIT FEES* City /State /ZIP: 5'`�v, ��) e4.__ Subtotal 9 Minimum permit fee ($72.50) Phone: (5 a 3 4 L _ - �/ yi - j Fax ( ) Plan review (25% of permit fee) CCB lie.: 7 7 3 j' 5 State surcharge (12% of permit fee) t� TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: (1459 t...b f# I Date: 1,G(CS /a 9 • Fee methodology set by Tri- County Building Industry Service Board I :\Building\Permits\MEC- PermitApp.doc 01 /19/07 4400- 4617T(II /02/COM/WEB) Mechanical_Permit Application - City of Tigard '- Page SUpple Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • • • I:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2 • ' Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard D a at eB y `„ � ��p ll DteB Permit No.. V \ \ 6� .C� fE3 • 13125 SW 11x11 Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.: "1 I G A R U Inspection Line: 503.639 Date Ready/By: luris: B See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ID New construction ❑ Demolition For special information on use checklist Description I Qty. I Ea. I Total Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 A l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: igt3 70 7 5 z_._ S /,4- / s- 7 Catch basin or area drain 16.60 City /State /ZIP: - / J ` Drywell, leach line, or trench drain 16.60 / Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _) Page 2 Cross street/directions to job site: 9', (..J Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: 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 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ,PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 /, Ejectors/sump I 16.60 Name: Ail-- J4( / � -2 Expansion tank 16.60 Address: �, /D S 7 Z 5,......) � /` , 16i/s S T Fixture /sewer cap 16.60 City /State /Z[P: v a-..- L Floor drain/floor sink/hub 16.60 Phone: S c „ . 7) ,t, Z /Oj O Fax: ( ) Garbage disposal 16.60 APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: 77_47"7' ► Interceptor /grease trap 16.60 Contact name: (�� Z-1-4.-.2 e _ / Medical gas (value: $ ) Page 2 Address: Z22 `• 7 + S s--,, s--,, s /6 SK/ t.✓„, vu0 Primer 16.60 • City/State /ZIP: S dna`, Roof drain (commercial) 16.60 Phone: 3 ) ‘2J 3st/ r Fax: : S j 4:2_1.- Sys / Sink /basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: /42..7-�� A.& ry e ✓ !, / (I E; Water heater 16.60 Address: /7 z D P. 7 e `• G "" fr Other: Ci ty /State /ZIP: /-1 tw 5 l4. t- 9 7 03 Z Subtotal Minimum permit fee: $72.50 Phone: (,, 9- 73-/Z�/ Fax: ( ) Residential backflow minimum permit fee: $36.25 Q /5.2...v g 3 - - / 9 -/� Plan review (25% of permit fee) CCB Lic.: / Plumbing Lic. no.: R fr :3 State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: j f f 4o/52 I Date: l//r / 9 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. I: Building 'Permits\PLMF- PermitApp.doc 12/27/06 4404616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) 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' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: . Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 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 00 ot e first $ .00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. • Commercial Fixture Work: Plan Review for Plumbing Installations 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" 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: i:\ Building \Permits\PLM- PermitApp.doc 12/27/06 • FROM : CANBY ELECTRIC INC PHONE NO. : 5032665543 Apr. 07 2009 02:58PM P1 EleCtrillil 1 ii .A oplication octiNBI' . FOR OFFICE USE ONLY 71 cit of Tigard •" 13125 SW ll 1:is d.. I tpitl. OR 97723 5 , itcyciv,d pato/11v' 3 Phone: 5fli t, ii .; i 7 i Pax • i()).5911.1960 PIP 1 i , , l t - ittl :Hi: Nth e (it 7 .0( i : 0,1..... ,,...,„!„. _., TIGARD Inspection 1.1ne . 5(1 h9 i9 41 15 vrio .-, , Kcaymy: ; It - 1 - fei Six I'ms. 2 for tri 0 I supplonvntal Information Interact: www t yord-or.eo% Cu - Ni1:1 si ad/method : .._ • • TYPE OF WORKS13 .• ' r i AN ItEVIP:w . , - Pleoeo check all Mat Apply (submit 2 cell ail' vlam w,tvi,.s clact:11.cd kWh* Ei New eon...Ann:Tina k it iltt daltcrat ion/replacement 0 SerViGe iir fuedUr 4U0 :Illy, U. ■IMAI 0 uniki;n ,„ 7 those stories. 0 Demolition u Other when: the e avail:a laull 1:1.11 U Matioa4 :Ind boalyardS. - - • _......c• • __.., _.: ,.;.: cloc4Cdt 10.000 amp at I ill c.,11:: m 0 Ftssotuy btladings. ' • CATE(;0141 OF..CONtxt.404v•;4.',.7„.:::41f..:git.F,.:,;:e •• • 1 mily dwellinlz 0 Commorcial/industrial 0 Accessory building 4 ulti-family 0 Master builder 0 Other: 0 Firc punt ;,. lc to ground, in cacccds 1.1,000 0 Corninal-use agricultural - and 2 amps fin all ollici insiallahont. isuildiugs. 0 imuallatian of 75 KVA Of .4 . • '.•......■?•,: " .,. ' • 0 EOM pale) SySIClo lufgOf stmarately derived system t:, - : . ; . 4 ••••••"....-. • . JOB SITE INgo ...... -(- ; , e OCA Ita .-01, -,:„._ 0 Addition of new motor mail if LI - A", " F . " . .* I -7 - I-3", I 100HP or mow. ocuuriaftY. Job no.! I Job site address: /0 5 72. yid A.Ati",/-e_. _ • I' 0 &Mar moo: residermal .11111h. 0 Rocroational vehicle parks. • City/Siate/7.I I" : 7;cie4,,,, • zz 0 Healtb facilities. CI Supply voltage for more than -• 0 Ilamtious 10C.011Oos (11/11 volts OOMillili. ...Suite/bldg./opt. no.: 0 Project name: 4 • Lti _ 13 Service or reedul rt130 amps or more. __ ..„ .. . . - • StiffoW4NIYCIFSET:SgHt4,7:1MAS1/..gttlf ..: • • • Cross street/directions ti job site: 4 Deaniptioo : : ; . .• . New residential sismlo or multi-family a r".. welling unit • 111117M11311..1 Includes attached garage. . . - .. . . . 145.15 • 4 •' Subdivision: F17....... 1,000 sq. ft. or less . • • - Ea. addi 500 sq. fi. of ponion 33.40 ' • . • Tax map/parcel no.: • Limited energy. residential , 73 00 :1 •. . '...-4.1.i..FT.,•,:i..:: • D : I t NJ i,si, 42:4 ,• ilaficaisi ;. (with above aL. jt.)__ . l'i5••,* r • te / . IV fi o---% ' a ' Limited energy, multi-family 2 _ residential frith atawe sq. H.) L 7500 • . I • • Services or feeders installation. alteration, and/or relocation . . • 200 amps or less xu.30 .. r.a••• • - '• , ',..a. , . *bit .? , , • .. :Fi...•:?..:71 PR011:RTY OWNEIC • ;,:itr 201 amps to 400 amp 1 s . 06.10 401 amps to 600 amps 160.60 • • • 2 ... ' Name: • 601 amps to 1.000 amps 240.60 " -2 ' • .. AddresS: Over 1,00 amps or volts 454.65 • , • • . 2. ' . - • • • • • - Temporary services or feeders installation. alteration. and/or. - . - • City/State/ZIP: relocation _ _ _ ' ' I 66.85 .1 • .• Phone:( ) Fax: ( ) 200 amps or less . .. • •."..2 .• . Owner installation: This installation is being made on property that 1 own which iS not 201 Omps to 400 amps 100.30 . '• • : 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. nerpane1' Owner signature: __ A. Fee for branch circuits With . 4,tittla • 0 APpLICANT . '. . -, Jr r , j - • • . ••• .!#,. p ' above service or Redo' fee, b 6.65 37 7.. each branch circuit . . • • _ . • Business name: • B. Fee for branch circuits ou Contact name . • .• • • .,...., • witht service or feeder fee. / 485 16 • 6. . '.5.,.. -... : first branch circuit • - • Address: Each addi brunch circuit 6.65 ' • 2 • • •• • Miscellaneous service or feeder nut included) : • • ' . City/State/ZIP: Feels manufactured or modular 90.90 . • ... ' • . • ' dwelling, service and/or feeder . • ... Phone: ( ) Fax: : ( ) Reconnect only 66.85 • • • • 2: --• .. , E-mail: Pump or irrigation circle 53.40 . : 2 •i4r.":4'..x.,:e..i.it,:. --1.-:. - - - -,., . . 1 -K::•••.0 • • ..-i- -CONTRAL470 ;15.11WZMW.M. '..,.. Sign or outline lighting 53.40 • • . . 2 Business name: •• • _ ___ oe ... A. ‘„. r 1 L A. 1 .--..- -.r.... I 412 r 4 X , C-. Signal circuit(s) or limited- energy panel. alteration, or . • • .• . . ____ • Address: ' q 0 c . extension. Describe: Page 2 ' ' 2 - . • - • City/State/ZIP: C.4 _De- e --4 4- c i "to t '24 - Each additional Inspection over allowable in an of the above-. Pcr inspection 62.50 . .' • ' .... :. .. PhOne:.(5 .- 6 _ - i _ s .„ I Fwc ( SO) 2 -‘ Ca: - S 5 m "'s Invcstigation per hour (I /IT min) 62.50' .. • • • • • • ... .. -• cCB:Lic.: 2 on i 1 Electrical Lie.; "1 -tt c • Sup rv: Lic.":' 2 1 c• , Industrial plant per hour . 73.75: • • • . • . . • - I M ItEMIOAL .:• PERMI r•;.: ■•i'a, ;,:q.:ILISi/ . • 1 ' Suprir. Electrician signature, required: ' • al•-•:--- Subtot s scg,„,-iii • . _., • : :* •PrinttiameThs ' C: Date: Plan review (25% urpentlit fec): . . _ . • . • • - ' ---- . 0 1%4 r .3.0-4 • 1 ; -1.. - State surcharge (12% of permit fee): . • 1.%.1 f) . .. . Authorized signature: - s -C.?.....•••••••-• • . . , TOTAL. PERM IT FEE: 0 7, • I. kr . • - -- , This permit application expires if o permit hi nal obtained winder IOU • :. • Print nam■i7 ' Date: • a-r-t k_v 0 . e) ^4 t o,,, days after it has baen acceplad as tomPlete:: .... • • . • Number of inupectirms :WAWA 130f OCrIllii. . . ODuildingTorcm0- I .l: •Pernin top doc 05:2'406 4410.461srotaistcowviED • - . Apr 17 09 09:38a Brittany Homes, Inc 5036285421 p.2 RECEIVED APR 17 2009 � � � � 11 13 �I � l 2 (5 nG • (`� C'� C� � ( Clean Water Services File Number CITY OF TIGARD II MAR 2 ater� "Services '06V C� E UILDING DIVISION Sw3sitive Area Pre - Screening Site Assessment 1. Jurisdiction: `c-, � % // 0-se c--e f� 2. Property Information (example 1S234A1301400) 3. Owner Information Tax lot ID(s): 25 I l d D14 v 0 Name: le-4.srj• -317-4-7 Company: Address: i eo 5 - I z S•• 1 A-G. E. sill Site Address: / 6.r 7Z- Sy 44*6 st- City, State, Zip: I 0.z.. p 72,2-y Cry, State, Zip: -- Tip) art—. 9 722-'/ Phone/Fax: Nearest Cross Street: E -Mail: 4. Development Activity (check all that apply) 5. Applicant Information Addition to Single Family Residence (rooms, deck, garage) Name: -- S - E L[ -r-ep Lee Pe • Cf Lot Line Adjustment ❑ Minor Land Partition Company: / -r 7. ,may ¢•�Er,v e �`a. O Residential Condominium ❑ Commercial Condominium [� rJ Residential Subdivision Address: 2-2_'? S S•j �CJ•e us- Ck4.,f•• +..oq 1-�• ❑ Commercial Subdivision ❑ Single Lot Commercial C Multi Lot Commercial City, State, Zip. Sham'" ' °`�'a ea.. 9 1 I `t u Other Phone/Fax: ' -. ? L5 -7S(9 fG.e. er -5q/z1 E -Mail: 6. Win the project involve any off-site work? ❑ Yes Xi No ❑ Unknown Locatioe and description of off -site work //�� 7. Additional comments or information that may be needed to understand your project r+eee , *.ee' S �ro 6 .5, 7 a✓ /lam o i" G• I ',i5 Q reee g_ This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ 1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands endlor Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. By signing this foam, the Owner or Owner's authorized agent or representative acknowledges and agrees that anployees of peen Water Services have authorty to enter the peeve site at at reasonable times for the purpose of Inspecting project site conditions and gathering information related to the protect site. I certify that lam familiar with the information contained in this document and to the best of my knowledge and belief the information is tree, complete, and aerate. Printffype Name .S Fc=4= LSE t7 to. Fp Print/Type Title u w r•e.,r Signature '�`�" Date / Zy ca FOR DISTRICT USE ONLY ❑ Sensiflve areas potentially existonsitea within 200 'of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist m the she or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be rec.ueed. ❑ Based on review of the submitted materials and best avatablo information Sensitive areas do not appear to exist on site or within 200' of the site. This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect water qualite semen areas if they are subsequently discovered. This document will serve as your Service Provider Wier as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and ovals must be obtained and completed under appkcable local, Slate, and federal law elf Based on review of the submitted materials and best available mfcrmation the above referenced project will not significantly impact the existing or potentially sensitive area(s) found near the site. This SensiUveArea Pre-Screening S"rteAssesrrient does NOT eliminate the need to evaluate and protect additional water qua ity sensitive areas if they are subsequently discovered. This documental serve as your Service Prcvtiter letter as required ty Resolution and Oder Q 07 -20, Section 3.02.1. All required permits and approvals must he obtained and completed under applicable local, slate and federal lam Cif' IPP3 Oi ❑ This Service Provider Letter is not valid unless CWS approved site plans) are attached. � Q The proposed activity does not meet the . of nitlon of development or the lot was platted after 919f95 ORS 92.040 NO SITE ASSESSMENT OR SERVICE PROV1D a a• I -, Q RED. Reviewed by ,t, Date NS 121 IQ l 2550 SW Hillsboro Highway - Hillsboro, Oregon 97723 • Phone: (iO3) 651 • Fax: , :503) 681 - 4429 - vJww .deanxaterservlrces.org Z•d 1 Z1798Z9£09 out 'sewoH AueitiJ8 e09:06 60 5Z leyy /75 7 2 00.. . 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. III BUILDING DIVISION T I G A R D TRANSMITTAL LETTER a TO: � �� DATE C((�� DEPT: ING DIVISION `�''- JUN 10 2009 �� (�,c,L.-1)--C-0 c.. CITY OF TIGARD FROM: DIVISION DIVISION COMPANY: c392--( `t'Ii} -o-i ' ( -{2).,--.2y \ ,, PHONE: a - 3 t-C 9 - 3 2._.. �y: S�: • oS 5w No-eu e C k 31 --�g( • (Site Address) 'emu • ig um 1 er t1 (n,.c. . A IS ( o,.., ' (Project name or subdivision name and lot number) 0 I _V 7-)1 -- ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: . , Copies: Descript on: a Additional set(s) of plans. 2 Revisions: °" Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. • Beam calculations. Engineer's calculations. r Other (explain): L REMARKS: 4-61-- a " ( RcotscS v (2 a- J I o a r1 (- F ..,..r- w{ .- Le-.s.-S r A --t-- e i to - —1 c ....- , FOR OF IC USE ONLY . Routed to Permit .'e ici: • Date: (-.� I(( ( Initials: 1 ' .' Fees Due: ❑ Yes E o Fee Description: Amount 0 ue: $ $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑Yes J TIo Done Applicant Notified: Date: iC /D - ` Initials��J� -„ 5/06-itui_. gt,(6 • I:\ BuildingWorrns \TransmittalLetter- Revisions.doc 4/4/07 • 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. q BUILDING DIVISION T I G A R D TRANSMITTAL LETTER a TO: J \ 3 ,Q \ DATE RECEIVED DEPT: BUILDING DIVISION RECEI ---- GF TIGAR1) 'FROM: c.Dr� CI'I� NGDIVISION COMPANY: ;PHONE: 3 — 6 357f X- - 3 y9 ,Y BY: RE: 1*? P .,I Q ��- LJCaseNurnber � - 2 9 (aim O� A ress (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: I 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. Beam calculations. Engineer's calculations. ■C Other (explain): QQ n � � v1 e Qv1 .el L.Q P r REMARKS: p1z -0,■ V\ FOR OFFICE USE ONLY Routed to Permit Technici : Date: 4 �2( ( ' Initials Fees Due: ❑ Yes L 'N° Fee Description: Amount Due: Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: 1: \Building\ Forms \TransmittalLetter - Revisions.doc 4/4/07 V 11: M _ _ _ 6 1. 0 0' PROPERTY LINE .. 7 E o 4 9 RECE Li I I MAR 2 5 2009 - f B 22 HATCHING INDICATES PROPOSED ADDITION I - W CITY OF TIGARD \ ? BUILDING DIVISION '® I IJ W O �v A � r / 3A >-. E I a Z� I � o o 0/ p N J 4 p J N ,,,�ggf • 4 W " I \ L Ma) ��M{7M9Q EXISTING I J W� W 1p ; "' A N ii'-',. SINGLE FAMILY RESIDENCE I p zo 4 ;JD �� !` : ATTACHED 3-CAR GARAGE a� H 1 1 _ p air..? J \e W n0 O O ■ J \ CC f ; 1 \� \ \--\ n N \ 63 ---------\ k � &. \ \� Im I ,,,, N SITE PLAN - ..... ---N...„:„N\ ,..---- ....- \-- Site ,......._ 1 0 5 1 2 cU SI ROE and MODEL / S. W. N A E �/ E s T. J 503-692-0777 Raising the Standard for Healthy Independent living CITY OF TIGARD - SITE PLAN REVIEW CITY OF TIGARD - SITE PLAN REVIEW PLANNING DIVISION: BUILDING PERMIT NO.: U 2• -i • • ��O' M BU PERMIT NO: YY1U2_0 00 0K, Not Approved Required Setbacks: Approve d ❑ Trees: Approved ❑ Not Approved Street Side: Street T Approved N t Approved Side: aJ tole Rear: �..– g G � / Date: i�26 0 Front. � Garage: _— or'. visual Clearance: [Approved ❑Not Approved Notes: laxitnunt Building Height Z feet No ► �t��lk 1941 . •'S service Provider Letter Required: 0 Yes ❑ Received /, d/Lea,-/ Date: 3/.l0 /�9 ENGINEERING DEPARTMENT: Not Approved Site PI • n: Actual Slope:j1L% � 0 Not Approved � � _• 1 ,�, , Date: Notes: are/Lou-Id "AA_ eid..4444A • •