Permit CITY OF TIGARD MASTER PERMIT
G fr a
l: COMMUNITY DEVELOPMENT Permit #: MST2010 -00042
tT 1 G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/13/2010
Parcel: 2S104CD05900
Jurisdiction: Tigard
Site address: 13685 SW WHITE CEDAR PL
Subdivision: HILLSHIRE ESTATES Lot: 59
Project: Wisener
Project Description: Construct patio cover over concrete slab (pre- existing impervious area).
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes
Total: sf Value: $20,000.00 Rear: 0
PLUMBING
Sinks: 0 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 Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 0 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea addl 500 sf: 0 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: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
NEPOKROEFF, NICHOLAS W & ROB'S HOME IMPROVEMENT CO
WISENER, PENNY L, 13685 SW 8933 SW WOLDS DR
WHITE CEDAR CT BEAVERTON, OR 97007
TIGARD, OR 97223
PHONE: 503 - 524 -4953 PHONE: 503 -590 -7754
FAX:
Total Fees: $892.92
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 ' da 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 TTENTION: on I• , requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 - 001 -0010 through OA 9 • -00 -010 You may obtain a copy of the rules or direct questions to OUNC by calling . 46.66 or 1.800. 2.2344.
/ `r .1r` r .
Is ued By: Permittee Signature: 1
'Building Permit Application 7 c '� .. ' E 2 I / - - - --
1
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Residential RECEIVED ir:. " + "y� 4� ���� OR4OI I ICL�UtiI OV' .+ �' µ. ";.:t'� u
City �� V 1LJ , dX zito v� iikg •l.!:Q�1 .` , 4! }t3 ?Lti4`+11�;�.C!%xEs�`.)„ , N t i d ogit �3 'r
1 114 S l lt3' Of Tigard Received n5 (0 Permit No.: �� /�ee V.9.- 13125 SW Hall Blvd., Tigard, OR U� 9, �l t II P Review . _ O `
C Phone: 503.639.4171 Fax: 503.59 960` (- (� D a teB 1�� Other Permit:
Inspection Line: 503.639.4175 I Date Ready /By: Ian ® See Page 2 for
f, l G n ' It I- Internet: www.tigard- o r.g o v CIT OF CI ARD '
Notified/Method: Supplemental Information
BUILDING DIVISION
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 IA Other: FAT V? CO U ER` equipment, materials, labor, overhead, and the profit for the
' CATEGORY OF CONSTRUCTION work indicated on this application.
�] 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 600
❑ Accessory building ❑ Multi- family Number of bedrooms: 75
❑ Master builder ❑ Other: Number of bathrooms: XJ
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 36 %S S,W . V►H oc. C.trAg_ PI.AC,E, New dwelling area: square feet
City /State /ZIP: 1\ G(4z-0 t OR. 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: W I - NEPOKt;OE ' Covered porch area: /Jv -00 square feet
Cross street/directions to job site: %JP SLJJ , V 1 Ew - L CF1 O1J Deck area: square feet
S W • W H11 CtiPAl- 1 4\c, . Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: VACy‘.) 1tr Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 5 1 0� CDC � - - 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.
NEw COtVG. PF \ 'w MI rs)Ew PAW GoklE . ol) ER. Valuation: $
5LAS3 PoR.EIN - ZEcr CI.E(,P -AP c E. f 1 R pAGE 01-3 Existing building area: square feet
EAS7 ° S IDE 0f r +E SY e.: JOE. New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) / Fax: ( ) New:
. • L+J APPLICANT ❑ CONTACT PERSON • NOTICE
Business name: I`Ot13 1 e\e 1t\ 7 OUEnEIV'' Co , All contractors and subcontractors are required to be
Contact name:` Q°�N` 1 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: % .),`.) • UJOLDS t{Z.,I jurisdiction in which work is being performed. If the
City /State /ZIP: Bc:AUtR.'sa� 012.. 9 100-7 picant is exempt from licensing, the following reasons
�� �{ 6337- � apply:
Phone: ( Q ) 3 t \ Fax:: �j) 4 .. t 4. r 9
E -mail: d■t ■helm *5 2-$0 @ conc.Pt,S1 , NET
CONTRACTOR
Business name: e( lA ( YQ . CO , BUILDING PERMIT FEES*
Address:
(Please refer to fee schedule)
City/State/ZIP: Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
CI �, Total fees due upon application: b 6 y
CCB lic.: l
I Amount received: °A(/S- . bq
Authorized signature: This permit application expires if a permit is not obtained
ti
f) w ��`� within 180 days after it has been accepted as complete.
Print name: ) 1 Date: �- Z.> 20) 0 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits \BUP -RES PermitApp.doc 10/01/09 440- 4613T(1 I /02 /COM/WEB)
3�.J .. ,_ ..
Building Permit Application Checklist
r � ql'$ �(rl`�'�, 5 n "')� I l i,r, '�I L,'"i J1, >° ,-,,,,.,.4.,'",71! = t a , ,IN:
One and Two - Family Dwelling ��r,�.�.�;ll �w 012 -. I Ic► , util O I \ - a 5
ir ,.;.,;, • Received
City of Tigard Date/By: No.:
lig 13125 SW Hall Blvd., Tigard, OR 97223
C Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
24- Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
•• = Internet: www.tigard- or.gov ❑ Other:
Y '�� { '1 M irr6 0 l I l MS kP Il
0ifli 0 ia RI if , .' u �ls • F 'N"'' N /A`;
1 Land use 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 . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
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- ❑ ❑ ❑
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.
1 I 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, ❑ ❑ ❑
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 ❑ ❑ ❑
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 Toad.
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 ❑ ❑ ❑
architect licensed in Ore : on and shall be shown to be a I d licable to the . ro'ect under review.
FlM r- I r. r(. •t 1, h.,C. .,r.. 1 I C A. r 1.14. ; f 1 ' ■ �IU I I � I ) I CII ICS � " � . � �
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
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 must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
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- PermitApp.doc 03/21/06 440 -4613T(11 /02/CO:WWEB)
Mechanical Permit Application ..:, y r M , 1 ,.Z, 9R c 11`` h r
i City of Tigard DateBy f Permit No.: ooh i P Received
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Re
IIII ''t Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
i i: i ( ii le Inspection Line: 503.639 Date Ready/By: Juds: ® See Page 2 for
; ': Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
dNew construction ❑ Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
• CATEGORY .OF CONSTRUCTION Value: $
[f dwelling RESIDENTIAL EQUIPMENT /SYSTEMS' FEES *
1- and 2 -famil
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address: t3(45 S ,W , W H OE CES)p ?tAc (requires site plan showing placement) 46.75
City /State /ZIP: Ti C.AR.p , OR. 9 1223 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: 4 ,v,) - BE NC Hk1 l£W `TU E, Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace ( 33.39
ZEQO C.LEA At c, C 1 RE P ACE, ', €;\:),,s1 Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I . .❑ TENANT . Chimney /liner /flue /vent 23.32
Other 23.32
Name: ?tkAw' W teNE P, Environmental exhaust and ventilation
Range hood/other kitchen
Address: ,36 5, - W IA In C p - V(, 0. equipment 33.39
City /State /ZIP: 4 N CAPS) 1 0�, - Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (303 ) 52-4 - 4 j 3 Fax: ( ) toilet compartments, utility rooms) 23.32
' ❑ APPLICANT , ❑ CONTACT PERSON Attic /crawlspace fans 23.32
?„()5 F ! MR CO C C 5 #k b,—� Other: 23.32
Business name:
KOI�� Fuel piping
Contact name: 2, B 100\245.-,K 1 $14.15 for first four; 54.03 for each additional
Furnace, etc.
Address: 133 5,W , WO LL5 DR . Gas heat pump
City/State /ZIP: 1 RD ) 0 F. . '\1p01 Wall /suspended/unit heater
Phone: (5()3) _. 6332— Fax: : ( )14k6 — .50\ Water heater Fireplace 1
E -mail: Range
CONTRACTOR • Barbecue
Clothes dryer (gas)
Business name: 13.0NE. k RF e j\DU�
Other:
Address: 1 s o t r5 I,fw\RKE 5 -- j , MECHANICAL PERMIT FEES*
City /State /ZIP: }\L.E' 0 - 9130 I Subtotal
1 2� Minimum permit fee ($90.00)
Phone: (F363 ) 364 — 6331 Fax: (503) 364 — 1V �c0
lY Plan review (25% of permit fee)
CCB lic.: 413630 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
J This permit application expires if a permit is not obtained within 180
Authorized signature: ;C . I days after it has been accepted as complete.
Print name: -.1) bQ,>�.) Date: 4. -\3-76 • Fee methodology set by Tri- County Building Industry Service Board
C\Building\Permits \NEC- PermitApp.doc 10/01/09 440 -4617T (1 I /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit :Fee: •
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
l:\ Building \Permits\MEC - PermitApp.doc 10/01/09 2
Electrical Permit Application ' t �'` ". ;' ,, It it l ( ' i ,',��qj¢j,��� ; ,� ' , �
.:, ' f' , Cl of Tigard Received permit No.:
lig
City g r�T WD -. 00,042... Y ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' ® Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
4 '"'1"/' 8 ^ 1 Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
f l 1
g
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):
PAT `v ❑ Service or feeder 400 amps or more ❑ Building over three stories.
p
❑ Demolition Other: f 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
F] 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 Toad of ❑ "A ", "E ", "1 -2 ", "I -3 ",
3 ' (C
Job no.: Job site address: ' �; 5 i./.3. v,11-1 1 NC., (.Rit,l rti `„ 100HP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: I 1C, p,RD 0 ... 11213 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: r ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: UV c..) .0 - gi.A\ C \) \ i.,4 - ' 1. -FT 0 0 Description FEE SCHEDULE
1 Qty. 1 Fee. 1 Total i •
New residential single- or multi- family dwelling unit.
• kiiN UM ?, V LAC fd Includes attached garage.
Subdivision: Q,Ch1C1 J 1 Ej.) Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: '13 1O4. Coo f-30(00 Ea. sq. portion 33.92 1
Limited ted e ener nergy, residential 67.84 2
DESCRIPTION OF .WORK (with above sq. ft.)
Limited energy, multi - family
residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or Tess 100.70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
r 1.P... — tsK.V0 Kgi, tcc: 401 amps to 600 amps 200.34 2
W
Name: V'N
601 amps to 1,000 amps 301.04 2
Address: 134'5 4 j .1.)-.1 . t.01-; 1Tf, CZt Aa., po\ce Over 1,000 amps or volts 552.26 2
City/State /ZIP: 1'1C - SAR.t) 0 - • 91
y Temporary services or feeders installation, alteration, and/or
2
Lt....)
relocation
C-
Phone: ( ( .J�? ' 7) �2,4 4\53 Fax: ( ) 200 amps or less 59.36 ' 1
201 amps to 400 amps . 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, le , rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signatur �.� Date 3 / A. Fee for branch circuits with
❑ APPL CANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without 1
service or feeder fee, first 1 56.18 2
Contact name: branch circuit
Each add'I branch circuit 1 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Q(/L/ / i '1 /0 E -/- panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (Y2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: .
Suprv. Electrician signature, required: o
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
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: Date: • Number of inspections allowed per permit. .
1:1Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB
,t® MAR 24,2010 11:45 Domzalski /Brooks 5037464459 Page 1
Clean Water Services FIIe Number
• II l
�I . C' 1010 l: (lea aWatc� Services
•
l :
Sensitive Area Pre - Screening Site Assessment
r
1. Jurisdiction: - -
2. Property Information (example 1 S934ARO/400) 3. Owner Information
Tax lot ID(s): _ _. t° l 1 C Name: wt Cwt t!_.. t ►CPc is Ry, L �F --
Company:
Address: . ! - 5 L.'•' • 4114 a C - C4hk, F(JcC
Site Address k f r j °' `a NISI: CO AV- 1'4t',CC City, State, Zip: 116 , r? R, . ( 11 7 -
City, State, Zip: VikkG CR••. 917;0 Phone /Fax: 505 r .)'/_q' • 4
Nearest Cross Street "'' EX:W:31Vt�,a .. E•Mail:
4. Development Activity (check all Ural apply) 5. Applicant Information
U Addition to Single Family Residence (rooms. deck. garage) Name: QOI 00 r`2A 4 K 1
IJ Lot Line Adjustment U Minor Land Partition Company: C"-4)t)".:3 Wirt Ir'( CL
IJ Residential Condominium ❑ Commercial Condominium Address: _ ( Ja J, ` ' ' *. • • '' �CCO Dr.
L_I Residential Subdivision Li Commercial Subdivision 1
❑ Single Lot Commercial U Multi Lot Commercial City. State. Zip: IGRg. D , . IL. 7 ��
Other !'1Ft'I•-•� "� . 111 -% ;fi.f� nF t-1Ew Phone /Fax. .
51.0.) .?k.:_ h 31.
51.0.i ikKA E(_"t3r•►r•. t'MVc (7-06 --' / C -Mail: _
6. Will tho project involve any off -site work? U Yes Ili No IJ Unknown
Location and description of off -site work
7. Additional comments or information that may bo needed to understand your project ‘ A F. bo I t-Dt t.IC;
ti
?-o CirJEF_ "J EP f - els LP ' f eA - Avow( 1z6 - -1.50 €1.0 ,
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 andlor Department of tho Army
COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law.
I3y signing this form. the Owner or Owner's authorized agent oi representative, acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable limes for the purpose of inspecting project site conditinns and gathering information related lo the project site. I certify
That I am familiar with the information contained in this document, and to the best of my knowledge and belief. this information is true, complete. and accurate.
PrindType Nam Qr'Q I-Viez If' '=` Enet.rt CL1, PrintiType Title `IL) ►.)E14_
Signature ... .'1 \ I L`1 ,
- -..... Dat L . -
FOR DISTRICT USE ONLY
D Sensitive areas potentially exist on silo or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER. II Sensilive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report
may also be required. •
l__J Based on review of the submitted materials and best available information Sensilive areas do not appear to exist on site or within 200' of the site. This
Sensitive Area Pre Screening Site Assessment does NOT eliminalo the need to evaluate and protect water quality sensitive areas if they are subsequently
discovered. This document will servo as your Service Provider teller as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local, State, and federal law. :.;
i J - Based on review of Ile submitted materials and best available information the above referenced project will rill sijnifrcanUy impai,l the existing or potentially
sensitive area(s) found near the site This Sensilive Araa Pra Sornoning SteAssessmenl does NOT eliminate'the need to evaluate and protect additional water
quality sensitive area if They are subsequently discovered. This document will serve as your Service Provider teller as required by Resolution and Order
0/ -20, Section 3.07.1. All required permits and approvals musl be obtained and completed under applicable local. state and federal law.
LJ Thls Service Provider Letter is not valid unless _ CWS approved site plan(s) aro attached.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT UR
SERVICE PROV16FR LETTER IS REQUIRED.
•
Reviewed by Yr • _
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City of Tigard, Oregon 0 13125 SW Hall Blvd. o Tigard, OR 97223
March 25, 2010 CIO
RE: NEW RESIDENTIAL PATIO ` rGARD
Project Information
Building Permit: MST2010 -00042 Class of Work: Addition
Address: 13685 SW White Cedar Pl. Lot Number: NA
Area: 600 Sq. Ft. Stories: 1
Builders Name: Rob's Home Improvement Subdivision: Benchview
The plan review was performed under the State of Oregon Residential Specialty Code
(ORSC) 2008 edition. Please respond to conditions below.
1) Please provide attachment details for roof assembly to existing house.
2) Prior to issuance of the master permit please submit a application for a
mechanical permit for the installation of the fireplace and vent.
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
enclosed City of Tigard, Letter of Transmittal. The letter of transmittal assists the City
of Tigard in tracking and processing the documents.
Respectfully,
Dan Nelson
Senior Plans Examiner
(503) 718 -2436
dann @tigard - or.gov
Post -it® Fax Note 7671 Date ; 105(10 IPagesDC�,I
To RO-0 From /
Co. /Dept. �,� /r I ' `1 I Co. �
Phone # --� �t Phone 3 '7t 2 k j
Fax # `�(� 4/� Fax # V�
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772