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Permit .. CITY OF TIGARD MASTER PERMIT 1 'F - :, COMMUNITY DEVELOPMENT Permit #: MST2009 0021 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/19/2010 _, Parcel: 1 S135DC01100 Jurisdiction: Tigard Site address: 11865 SW LINCOLN AVE Subdivision: Lot: 0 Project: Blunt Project Description: Create accessory residential unit. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: First: sf Basement: sf Left: Parking Spaces: Height: Bathrooms: Second: sf Garage: sf Front: Smoke Dwelling Units: 1 Third: sf Right: Detectors: Yes Total: sf Value: $500.00 Rear: PLUMBING Sinks: 1 Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: Dishwashers: 1 Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs /Showers: 1 Garbage Disp: Water Heaters: 1 Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: N Hoods: Other Units: Furn <100K: Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: _ W/ Svc or Fdr: Ea add'I 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: 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) BLUNT, ROBERT OWNER 11865 SW LINCOLN AVE TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $367.11 , This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and at 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. w Issued By: Permittee Signature: �- — 0(l .y-ICJ, \ Z1 \ '{ ( ( 1 - V _ MASTER PERMIT .4 CITY OF TIGARD a COMMUNITY DEVELOPMENT Permit #: MST2009 -00217 T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/19/2010 Parcel: 1 S135DC01100 Jurisdiction: Tigard Site address: 11865 SW LINCOLN AVE Subdivision: Lot: 0 Project: Blunt Project Description: Create accessory residential unit. ADDED 200 amp service and (2) branch circuits. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: First: sf Basement: sf Left: Parking Spaces: Height: Bathrooms: Second: sf Garage: sf Front: Smoke Dwelling Units: 1 Third: sf Right: Detectors: YeS Total: sf Value: $500.00 Rear: PLUMBING Sinks: 1 Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: Dishwashers: 1 Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs /Showers: 1 Garbage Disp: Water Heaters: 1 Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: N Hoods: Other Units: Furn <100K: Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea adds Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: 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) BLUNT, ROBERT OWNER 11865 SW LINCOLN AVE TIGARD, OR 97223 PHONE: 971 - 222 -5355 PHONE: FAX: Total Fees: $441.91 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. li Issued By: TA OA I . 1 9A--7 6 Permittee Signature: C�K t ) 01 C ( n.LJJ o CITY OF TIGARD MASTER PERMIT ® COMMUNITY DEVELOPMENT Permit#: MST2009-00217 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/19/2010 Parcel: 1 S 135DC01100 Jurisdiction: Tigard Site address: 11865 SW LINCOLN AVE Subdivision: Lot: 0 Project: Blunt Accessory Residential Unit Project Description: BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: First: sf Basement: sf Left: Parking Spaces: Height: Bathrooms: Second: sf Garage: sf Front: Smoke Dwelling Units: 1 Third: sf Right: Detectors: Yes Total: sf Value: $500.00 Rear: PLUMBING Sinks: 1 Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: Dishwashers: 1 Floor Drains: Sewer Lines: SF Rain Other Fixtures: Tubs/Showers: 1 Garbage Disp: Water Heaters: 1 Water Lines: Drains: Bckftw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: N Hoods: Other Units: Fum<100K: Vents: Woodstoves: Gas Outlets: Fum>=100K: ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0-200 amp: 0-200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 20 1-400 amp: 201-400 amp: 1st W/O Svc/Fdr: Limited Energy: 401-600 amp 401-600 amp: Ea add') Br Cir: 601-1000 amp: 601+amp-1000v: 1000+amp/volt: 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) BLUNT, ROBERT OWNER 11865 SW LINCOLN AVE TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $367.11 This permit 'ssued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be do in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or 6 work is suspended for more the 0 day ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifica' Center. Those rules are set f n 0 95 -001-0010 through OAR V52-001- 0. You ay obtain a copy of the rules or direct questions to OUNC by calling 503. 46.669 r 1.80 4. 'r. I ued By: t Permittee Signature: Pjm- ' b! Permit A liCation Building Fixtures City of Tigard Reczi<ra 13125 SW Hall B 00-2~ 1vd., Tigard, OR 97223 Review Phone: 503.639.4171 Fax 503598.1960 P4aa tA>:z p~ Inspection Lane: 503.639.4175 Imernet: www.tigard•or goy Oas ' t~ ® Sae Prue 2 for .,,,-h .~~s.+~ ~"r f'y~ ! i✓.W' S '1'~ 'h~ S~i 'i+3~~.^..:.+hny~~•~S=YS~"~'"-i'-liY-~~ _ r TR7tiOmsc~ -l+l'" New construction ~ DmdiL:on For SV=d ornation we dreek&L F.a Total ] Addition/alteration/replacement ❑ Other. Now y_ (includes 100 8 for zx yw w K a . ~ dnVUh;p ( each utility connection) t''i...'J - -IN. ` SFR (1) barb 249.20 1- and 2-family dwelling ❑ Commertaalrmdustrial SFR (2) barb 350.00 Accessory building ❑ Multi-family SFR (3) batty 399.00 Master Wider ❑ Other. Each additional baflOcitdmn 45.00 ; Q.~~_r~ej~- sr+ r r zF. te r- _ _ Fie spy L__ S4 fL) Page 2 )s.4.. Sees b site address: 11868 SW Lkwoln Ave Catch baste or arm drain 16.60 ty/State/ZIP: Tigard, OR 97223 IAywdL leach line, or trench dram 16.60 ite/bldgJapt. no.: Project name: Bunt - Accessory U,& Footing dram linear lt: Page 2 A2amtfactmed home utilities 110.00 oss slteeVdirections to job site: 64anhaics 16.60 Rain drain ownector 16.60 Sznitary sewer (UM linear 11: Page 2 Stone sewer (no Gncar 1L: Page 2 bdivision: Let no.: water service (ao. foxes tL: Page 2 Fie or ft= x map/parcel no.: v~:.: ; r - - ~yf"' ~s.N' - •c- a~:r-~u~~s;~;,r ~ Abr~ vslvt 16.60 9=kflVa p7etaQ2u Page 2 Id a new bathroom Badkvmervahv 16.60 C 149hss vvasb= 16.60 Disbar Drinismg &Unt in 16.60 r MITT, me: Robert Bhmt Ejecto /snap 16.60 Expansion tw& 16.60 dress: 11865 SW Lincoln Ave Fishadseticer cap 16.60 y/State/ZIP: Tigard, OR 97223 Floor drain/8oor sialc/trub 16.60 one: (971)222-5355 Fax ( ) C>atbage disporal 16.60 Hose bb 16.60 ke maker 16.60 siness name: II EL-/grease trap 16.60 ntact name: Medical.gas (value. S ) Page 2 dress: Prim 16.60 y/State/ZIP: Roofdrain(c a!) 16.60 ( ) Fax : ( ) SIId/b-in~ l Z~, O one: Tab/sbawer/sbowrrpan l 12- 1 nail. Urinal 16.60 ';_y~ cam. n ~auT= x _s rc Nv ' " R y A _ , Water doset 16.60 siness name: Owner WaIerhezter ~j dress: 11865 SW Lincoln Ave Other. y/State/Z P: Tigard, OR 97223 $°~O~ ~•t~ Mir>in8m permit fee: $72.50 jne- (971) 222-5355 Fate ( ) Residential baddlow, miairaan permit fee. $36.25 Plan Inc.: NIA Plumbing Lie. no.: NIA review (25% of permit fee) signature: Statc smdmrge (12%ofpermit fee) thor Z, Q TOTAL PERMIT FEE nt name: Robert Bhmt Late, 08/07/2089 This try appDrollon ezp5res V a permit is not obtaizred within 190 days after it has been accepted as complete. `Fee rr>ethoddogy set by Tri-Goao;y Building Industry Service Board adQ,xvcrudh\PLMF-PamAApp.doc W27106 40-4616t(1010vcoavwER) 03/10/2010 10:14 FRAHLER ELECTRIC - INSPECT TIGARD NO.436 DO1 t t h , J< tii C 1 1 ' Electrical Permit Application tilt o7i i Ic I t»1 r ` 1 l P C ity of Tigard Received permit No.: MST 2009-00217 I ' r Date/By: 1 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r ' III .; ., Phone; 503,639.4171 Pax: 503.598.1960 Date/By: Ocher Permit: ' . ` "" '' Ins action Line: 503.639.417 Date Ready /By- mric see Page for 11•1,, ' Internet www.tigotd•ot,gov p Notified/Method: Supplemental Information yy r± ,r 1 i t''' p tit• ( r '�•� c gr i rlrF� r : iiti�lsli'dt l..6 NSfl�I;fi. «���+1' J'iri I t r : i ] p fi/ t 'dl . -1 ( 1 •i� +f i n • �i4Irifil5 :7iir., ' , l i• ' r1 lF u. ifs i r I . �' ^ids X1 !1 1 fi 'L :. t l} i r � tl ' er4i . P4t — ' iiiia', ' 111 i ' ' .1 ` .. - .. • a L �.MrDi _,'rk 111 ��iI .td .1,• 0 New construction ® Addition /alteration /replacement Please chock all tbai apply (submit 2 sere of plans Atoms checked below): ❑ Service or feeder 400 amps ar more ❑ Building ova three stories. ❑ Demolition El Other: wbere the available fault currant ❑ Marinas and boatyards, ' !n G ti ilriYe t U fi� k ' ^4''r r;'''i I lit i nI �a(, J ! �� d e , fl t� T I �1T� exceeds 10,000 amps al 150 vo �, tes or ❑ Flaa1ing buildings. T I. r els i ', 'JJ.a r .,. l ' y L 4 F w l"r.. E � i D.r,t,�r, 1_ i':i::, :.,!'i+14∎f.:.'t. ,iia :1'.2f r.E {.�s ik; , ., , „ teas to ground, or exceeds 14,000 1:1 Commercial-use apricuhtmtl Q 1- and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. E] Multi family y t / ❑ Master builder ❑ Other . ❑ Fire polo. CI Installation of 75 KvA or Pk iY y .r T r t t + ,e.t r r rk v i its+ ," P rr�n I Vp"1 ❑ Emtsrgenry cyatem, • larger separately derived sysiern . , i 6 ' , rv` k MI Z l i r i l I �� �l`' 1 �I 1 a �t1 11: d , wp ��f ' 11 r ��':r e . t , II l • : rJ n n Oil i 1-- , x•1.1 , .r! �j � r , ;:x r ,1„ , e,, , 1 :�.;a4rr �,ti�:t �ra w:ln..T+ot�r..u .�a .. u ....l . t .0.1� .....ii � '1 i.: �)i ❑ Addition of new motor toad of ❑ ..A •, " E ", " 1001-11 or more. occupancy. Job no.: 6 : 5 Job site address: 865 SW LINCOLN AVENU>r ❑ aecrearienel vehioie parka. CI Six or more residential units. ❑ He fsciions 0 Supply voltage for mare titan City/State/ZIP! TIGARD OR 97223 (] Hazardous locati 600 volts nominal. Suite/bldg./apt. BL UNT RESIDENCE 0 Service or feeder 600 amps or more n o.: Project name: IfA,P,1,X,i'/nl.',"i7.10,),.! , ./. II:.i ,�771ir I^I li}�I � 1 - : .: un Cross street/directions to,job site: an CL'l>1111CTIMAIMIBITIM ' New residential single- or multi- family dwelling unit. includes attached garage. Subdivision: • tut no.; 1,000 sq. ft. or leas 168.54_ 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tat map/parcel no Limited energy, residential t , t 1 , f LJ . n f LY�fA1%. ". 1 ,,c. . �• J r ( ..a. 67.84 2 11:12 1, , ,%.. , ,,,-„,.. , , , ; , 1 4 '. , r , � ' 1 . IIl .F _.,�r,i�e : , (with above .ft. .. ........;F Limited energy, multi - family 67.84 2 REEPLACEME . . RIN — MANGE 0 ; . i 04\ . ,I,LM.. residential (with above so, fl.) _ Services or feeders installation alteration, and/or relocation u M al _ ,I BI' 21 MM' • ► 01 . Mtft: TO i • 1 200 amps or less 100.70 2 r I ti . ,, s l { l 1 1 ,( 1 , i' 2 133.56 2 • 1 /IL �Jt li 1 .: L .tier/ Ol m nps to 400 tt rrtps , 1 �i Y� � ') ' i t� .t... ^1 .:.. !• i , 1,i ...,.. _1. P:.:�� 1 _..� � _.Clit . ... L3.. .4 i. 401 amps to 600 arms 200.34 2 • _1.4. Mb. , 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 55226 2 Temporary City /StateJZ.1P: relocation services or feeders inatallstiop, alteration, and/or Phone: Ct 200 amps or less 59.36 1 l \) 22 • Fax: ( ) —. .08 2 amps 400 to a mp 125 Owner installation: This installation is being made on property that 1 own which is not 201 amps 125 intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. - 401 amps to 599 amps l 68.54 2 Date: � Branch circuits— new, alteration, or extension, per panel Owner signature; 1 �,f�. A. Fce for circuits with 6r l•JI"�i : 'Ii 4k NY, `lot l ` l /1 2 f 9i ✓I l n 74t . , I 1 1 1 1 L 1 1 _ { 1� 1 �! iiii 7 i a x - ∎' ' +11 "1I lime service or feeder kr" 7.42 2 Fc � . ,. 1..! },..:IG / Y � .. a . . • each branch circuit Business name: B. Pee for branch circuits withatir service or feeds fee, 56,18 2 Address; Contact name: _ first branch circuit Each add'I branch circuit _1 7A2 2 1, Miscellaneous (service or feeder not included) , ( City /State/ZIP: Each manufactured or modular 67.84 2 dwelling, service and /or feeder Phone: ( ) Fax :: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67,84 2 E-mail: — - ,M r a; rb rL�1 + , 1 `J :1 � 1 , „ i��' 1<< s3f Vic t >r �` Pau F � vir `n1",7, c� ' I , .^ J� Sigr1 or outline lig 67.84 ^ 2 I A 1 I 4 Laiit;i1rt16' fd Signal circuit(s) or limited - Business name: 'MAH .ER ECTRIC Co. r ' 1 energy panel, alteration, or extension. Describe Page 2 2 Address: 11860 SW GREENBURG ROAD ._- c ity/State /ZIP: TIGARD OR 9 223 Each additional inspection over allowable fin anyof the above Per inspection 66.25 Phone: ( 503) 639 -4627 ' ( 503) 639-4673 Investigation per hour 0 Itrm;n) 6b.25 11 CCB Lie,: 3 7 10 Electrical Lic.: 34 -13C Suprv. Lie.: 5110S / industrial .lant per ^ hour 78.18 N , a ira i i, 10 I. o .tl o,n ' : 'v •l J a , � t ,, + i S Electrician s required: . /, . Subtotal, _ uprv. �� Plan review (25% of permit fee): Print name; A A M .1ot;;.tN ; ■ Date: s 10 10 State au,rcharce (12% Of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit appliwtlan aspires if o permit is not obtained within 120 Date: days after it has been accepted as complete. � Print name: • Number diminutions allowed per permit. 440-4615T(11105/COMNES IlaaildinylPcrmiletELC •PermitApp. 10/01(09 Electrical Permit Application) 7C 4WE (D -• . FOR OFFICE USE ONLY 711 1 City of Tigard 1 Received MST 2009 =0��17 g +{� Plan Re : Pdrmit No.: 13125 SW Hail Blvd., Tigard, OR 97223 LIAR 1 " 0 I i= L u I U Plan Review Phone: 503.639.4171 Fax: 503.598.1960 DatefBy: Other Permit: T 1 G A it D Inspection Line: 503.639.4175 Date Ready /By: luris: El See Page 2 for . Internet: www.tigard - or.gov CITY O,; 9 fiGARD Notified/Method: Supplemental Information i` r l - `x c 3 3 `u . E G .'r f)r d 4• ∎- 3b t ,: *:. 17 ar t a MY* i`s ❑ New construction © Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories. where the available fault current ❑ Marinas and boatyards. .P b r " s dA " O6 o cpgAW.04 ly ` "x : a exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ID Commercial-use agricultural 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building • amps for all other installations.. buildings. 0 Multi - family ❑ Master builder ❑ Other: . ❑ Fire pump. ❑ Installation of 75 KVA or r + m a ❑ Emergency system: larger separately derived system r �`? ...: z,U1g "'`IIYFp1E 3 TrloI� , 4�N e r ❑Additionofnewmotorloadof "A" "E" "1 - "1 -i" Job no.: 67385 Job site address: 11865 SW LINCOLN AVENUE 1 or r es. c r eation. ❑ Six o o r r more a residential units. ❑ R ecreational 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: BLUNT RESIDENCE ❑ Service or feeder 600 amps or more. , r %F s -- VIM' "tl 13, to ' s "sx r Cross street/directions to job site: nesen non Elm ®® , New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no 5 '::11'':'.i Limited energy, residential LI Id ' :„ .. _ _ . B, 5..: D "" ds Q '44I)R s „°, .i (with above sq. ft -) 67.84 2 , Limited energy, multi - family 67.84 2 WIRING FOR ADDED LIVING UNIT residential (with above sq. 8.) Services or feeders installation, alteration, and /or relocation ADDED TO REFERENCED PERMIT FOR FT 200 amps or less 1 1 00.70 100,70 2 (=' ...1419JiT 116 1 :, �. ;. „:, x u :J t�I „ '�° 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or Tess 59.36 1 Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with 0 ° . ,t .'. � `' [ ' ,. -1, - , - , ., _ C-p *Rs'di! 11 , °' above service feeder f ce or eeer ee, 7.42 2 Business name: each branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, 56.18 2 first branch circuit Address: Each add') branch circuit 2 7.42 ' 14.84 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular • dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 _ 2 W.,Yrx^ ry �';� -r T � , _ „ � v..,4 5 .�� ry,41jO i c*, � ?, xf ?, , r 'f � fi ; t; :-� � ' Sign or outline Lighting 67.84 2 Signal circuit(s) or limited - Business name: FRAHLER FT,FL1'RIC COMPANY energy panel, alteration, or Address: 11860 SW GREENBURG ROAD extension. Describe: Page 2 2 ity /State /ZIP: TIGARD, OR 97223 Each additional inspection over allowable in any of the above Per inspection 66.25 Phone: ( 503) 639 -4627 Fax: ( 503) 639 -4673 Investigation per hour (1 hr min) 66.25 CCB Lic.: 37410 Electrical Lic.: 34 -13C Suprv. Lic.: 5110S Industrial plant per hour 78.18 '. x ' 8 t` : )<t1i F ,RIOA`>F;'- FEES `G...' Suprv. Electrician signature, required: //t Subtotal: • 11 5.54 Plan review (25% of permit fee): Print name: ADAM FT4FRTN(;TON Date: 03/12/10 State surcharge (12% of permit fee): 43,36 Authorized signature: TOTAL PERMIT FEE: /.„2.9, iii t) Print name: Date: This.permit application. expires if a permit is not.obtaiaed within 180 days after it has been accepted as complet ,, 4 , Number of inspections allowed , p � er permit. rY ".� Y 1:\Building\PermitsEELC- PermitApp.doc 10/01/09 440 - 46157(11 /05 /COM/WEB I'T n (i) T 'NT? **THIS WILL BE ADDED TO THE (3) CIRCUITS ALREADY PURCHASED. TOTAL CIRCUITS (5) Z= L Electrical Permit ARy ication 0 City of Tigard Rcceived perm No.: pad - it{~ -co 21 0 13125 HaU BhdTigard OR 97223 Q Phone: 503.639.4171 Fax 503-M 1960 Pim V, t Permit: hupeW on Une: 503.639.4175 Drns Rez3y r rmrs: 0 See Page 2 for h*nwL- www_tigard-or.gov ha AVtetho3 >~~q ~ y~•r~t/~~ Sapptaneat:;! lntbrmatton •`~r~`'IV- [`v3~a.~Y 4 -.i1~,. -`1~__`b,=+1' -AA ...r.a-.v.~~u 4' f ] New construction ❑ Addition/Acrationtreplai=bcot Pteae chart all U= gVly (u&mit Z seta afpbm wtito alerted below): OService or 400 amps or timc DBuilding over three stores :1 Demolition pOther wbae uric avathh3c fault c~aari D Maria= aid t WE > 10.00o amps at 150 Vohs a ❑Fl buildinEp. lY 12 I= to paced, ®eeds t4.~ D coal- epriculdaal ] I - and 2-family dwelling p p Accessary building =:ps fw ag v*cr batitilemam baildaW. Multi-family ❑ Master builder ❑ Other. O b'ac t=p' D boon of 75 KVA or x r c a vw , ¢uv k° 'w tr-: `s _ ❑Emern y systc- larger scparatcly derived systrm '.:fns; s . s a ~~~ftA D` $F11~(t _ y ~s ck Wis. " O A f. mnmr lad of O -A-, `E . -i -r. -l-3,% ob no.: Job site address: 11865 SW Lincoln Ave ~ ar mm` °C~`Y- iOQ Six or a= reddential ta,im E3 Reacaticital vehicle patio ;ity/State/LIP: Tigard. OR 97223 D lfc fautiti®- ❑ Supply voltage for more than OHamrhata tazanmts. 600 Vohs nominal. :uitetbldoapt no.: Project name: Blunt - Accessory Unit O Service at facia 600 antes m mare. 'ross streeddirections to job site: Greenburg and Lincoln Ave vQ a:,t Near res5lea" V sttqft-or y dsreiimg mdt. Iartmffl a3tatbed garage. :ubdivision: Lot n0_: 1,000 sq. IL or less 145.15 4 map/parcel no.: Ea. aM 500 a~ tt. or portion 33.40 1 Limited 75.00 2 : Limited tualti-fimily Wiring for Accessory Residential Unit idea' 75-00 2 (with sbovc sq. >i Service or feeders histoMitkin, and/or relocation _ 200 strips or b= 8030 2 :r~if1RIZ'.~"'► 201 am;is to 400 106.85 2 amps lame: Robert Blunt 401.iraraps to 600 an ps 160.60 2 601 amps to 1,000 ataps 240.60 2 Adress: 11865 SW Lincoln Ave Over 1,000 amps or valLs 454.65 2 :ity/State/ZIP: Tigard, OR 97223 Temporary services or feeders iastaSatiaa, alteraflm and/or relocation hone: (971)222-5355 Fax:( ) 200 amps or bets 66.85 1 honer installation: This installation is being made an property that I own wbich is not. 201 amps to 400 amps 100.30 2 !tended for sale, lease, rent, or exchange, accw*ng to ORS 447, 449, 670, and 701. 401 maps to 599 amps 133.75 2 honer signature: Date: Urn ab eitculis - ales , alterotloo6 or e=temdoa, per P-d A. Fee fm brimrb r " ~ with t- -s . • feeds' above service W fk~ club branch c-tratit 6.65 2 ftminess name: S Fee far brartclt circaits withma service or feeder fee :ontact name first branch circuit 2 Adress: Each add'1 trrs>t~ ennui -7.+L j 2 hluseeMneous service or Carder not :ity/State/zlp: Each v=vfiwbmvd mmodular dw eftm_p mviceand/orfeedw 90.90 2 hone: ( ) Fax : ( ) Rem aniy 66.85 2 -mail: Pump or iai&itton circle 53.40 2 r 'A r. Sigp or aatl$e fighfing 53.40 2 ttsiness name: Owner - Sig d mss) or liar eod- cn-u P-+ aftcration, Adress: 11865 SW Lincoln Ave tL Desaibr- Page 2 2 ity/State/W: Tigard, OR 97223 Farb an over aRawabte in smy of the above hone: (971) 2225355 Fax: ( ) Pa w4ma® 62.50 rnvesaigaiirm per bola (t hr can) 62.50 'CB Lic.: Electrical Lic.: Suprv. Lk: hVhMftW pb= per hrna 73.75 uprv. Electrician signature, tegt3iznd: subtotal: , O'L lint !!stile: IJnh-- Pion review (250/6 of permit fee): Slate stucNaW (12% of permit fee): 8-1 X51 uthorized Signature: TOTAL PERMIT FEE: 7 '1 zj tint name: Date_ Ttds pin epplieeliaa expires if a permit Is not obtained within 180 days after tt tins been accepted as complete, ° Nmnber of mgmctitm allowed pa petariL nl&*ftrtaitslELC-PemclApp.dno OY23M6 440 460701JUSCOnW B Building Permit Application REcEr 040,.00 FOR OFFIC E t SE OM_N V • evened Peennlio.: •• City of Tigard NOV 13125 SW Hall Blvd., Tignst, OR 97723 11m,- -- .: .-iitliWgiMil Ma PenniL i MOM 11 1 E . ' Phone: 503.639.4171 Fax 503.598.1960 tion Line 639.4175 CITY OF TIGA ' t . :..,-7,-. kUS Ed See Page 2 tor , v 1 G ‘\ r , Inspec 503. . " Internet www.tigard-or.gov BUILDING DIVI ia.'." - Al 11.....wi2411111frov Supplemental loThrmation _ ' i; .' - . •T: -1--- _ 11-4 ' .., ' ' '. 4 Permit fees* are based on i 0 Demolition the value of the wcak perfcrrmed. 0 New construction indicate the value (rounded to the nearest dollar) of all 0 Addition/aheratico/replacement 0 Other: equipment, matoials, labor, overhead, and the profit for the ..P.:-.-.:,.-. i27:taiiiii:OiiiniA6.-.00iigie-,:4-iifii:-R-&-7;W:...:.;-?, ;-t work indicated on this a Valuation: $ z D . Co 0 • 0 1- and 2-family dwelling 0 C.ormnaeillfindastrial 0 Accessory building 0 Multi-limay Number of bedroom= 1 Number of baibrooms 1 0 Master builder 0 Other: . ..4.46- 1 4 :. ..ti . V... - 4 - ..," Total number of boor= 1 -. :::.:- -.: Job site address: 11865 SW Lincoln Ave New dwelling area square feet City/State/ZIP: Tigard, OR 97223 Game/carport area: square feet Suite no.: I Project name: Bhmt - Accessory Unit Coveted porch arc square feet Cross street/directions to job sit= Greenburg and linear Ave. Deck aim square feet Other structure area: square feet Subdivision: (Lot no.: Permit fees* are based on the value of the work Forearmed. Indicate the value (rounded to the nearest dollar) of all Tax map/parcel no.: wmipinent, materials, labor, overhead, and the profit for the : .',_ iiiiiiiii*i‘iiiii, .1.. ," :: work helmeted on this application. -1:ii-:,- - ;,-.:>. . . _ — .. ,-. . ...: : : -,.„,..;-:-% :; - : - ;:- , :5::.:::: - . - 7_ -. ; ,,,,:.:: -2--.;:,., : .-:_-,. : .--, Valuaikez $ Create Accessory Residential Unit, Type 1 Existing building area: square feet New building ansa: square feet T,._:.,„....,-,..„--.2 ftv ?.-:-.2 1 : 1. -: . Number of stories Ti •- • •'',- - -- • ••• • : - • •- ,-. •• . -, . - -;,'":.. - -.' . --- ' : - - --_•,- --e --:,-. Z7 '•: -. - -;' , 5,.;:.- Name: Robert Blunt Type of canatruction: Address: 11865 SW Lincoln Ave Oasupaney group= City/StateIZIP: Tigard, OR 97223 Existing Phone: (971)222-5355 Four ( ) New: :•!t'."4" >'.:, :00 ji. -?;,=.: -='; :- ,=::;-;:::::: Z. 43 Oi_iiiiir-OliOilit ...' ' 1- . : „- ., :,.--: - -: -; -- - ,. — . ,- -,.-• ,:, ,. 4, --=.- ' ="if ' !g i rk - a• : : : : !e 4 C F> li.: Business name: All contnators and subcordraetors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being perforated. If the City/StaterZ1P: applicant is exempt from licensing, the following reasons aPP Phone: ( ) 1 Fax : ( ) E-mail: -.., -,.- - .J_ .•- - : ti4l.4!-NE:::: Business name: Owner Address: 11865 SW Lincoln Ave Sanctum! plan review fee (or deposit): 3q.( CityatatrJZIP: Tigard, OR 97223 Phone: (971) 222-5355 I Far ( ) RS plan review fee (if applicable): CCB tic.: NIA Total fees due upon application: Amount received: Authorized simmanno: 11 permit appitention expires Ifs permit is not obtained snide 180 days after it has been accepted es complete. I Print name: Robert Blunt I Date 08/07/2809 I • Fee methodology set by Tri-Ommty Building Industry Service Board I:\BuildinPermits\BUP-RES PermitApp.doc 11/6/07 440-4613T(1UO2(COM/WEB) Mechanical Permit Aimluatlon FOR O F F i C E LSE (.3ti L ). Received City of Tigard Dettifty: Permit No.: MST da •► - - 0021 ; _ 13125 SW Hal Blvd., Turd, OR 97221 » Rem - PemR phon= 503.639.4171 Pas 503598.1960 Dstd Other t3Y See Page 2 for T 1 O , p. D Inspection Line: 503.639.4175 D 1 la Se e>aeata! tntarmaflon .. . _ . - Internet: www.ti�d'o gov ;T „ ._ - w..I,y`- -sew ---=`' ';.r ,9*** ±�+ '"?-' g °T� :"= l ^'�.i:s�. .. �.*} ::'ab3._ s aJ= ,c -?`:^ :- r. =r.._,_:r. i. :..� s dithe :. ° - :c K i-'-;:i.L-sl=t w? :.'•. -.�- -. - •- :. �,,....aef fees* MC based on tlle value weak ❑ New ermstruction (3 Additionfaltemtiot performed !ohmic the value (rounded to the nearest dollar) of all ❑ mte ed n>a:e is1s equipment, labor, overhead, and profit. Demolition ❑ � _ vin $ :a:•.;: qa ;; ; 4: 5 0"'vc `;� -- y p�� 4^i..;.-'' :..- 'C', . -� a:• zw��s ?: -� ..��.,o-..' > '..•:�_.'R`. ,...s = 37.::'�: �� �. ❑ 1- and 2- family dwelling ❑ -. .,. � ��' •; •• •.' ❑ Accessory � For special information use checklist ❑ Multi - fly ❑ Master builder ❑ Other Dew I Qty. I Fa I Total Air conridioning or heat pmnp Job site address: 11865 SW Lincoln Ave Omni= site plei showiest plaeonmt) 14.00 Pone 100,000 BfU O 14.00 City/State/UP: Tigard, OR 97223 Furnace 100,000+ BTU (duashrems) 17.90 SuitrJbldgJapt no.: , Project oama 1E01mt - Accessory Unit Gas heat pump 10.00 Cross street/directions to job site: Gru+enlurg and Maths Ave. Duct us mot Rychwaieh water system 14.00 Resided boiler (radiator at 69dloms) 14.00 Unit heaters (fisdtype, not electric), ink, ink. suspended, etc. 14.00 Flue/vent far any of above 6.80 Subdivision: I Lot no.: Omer . 10.00 Tax map/parcel no.: Other that appliances _ - -- _ - Water heater 10.00 ;�rsp:r.. ., , � � •�� : =: �"=' mss'` =� �• �,,{.,,. TG.��OC 1 '' - . ird's `: ':: f��ik''.r, r •x ,. 's _ Gash fireplace 10.00 The vent far Recta heater or gas fireplace 10.00 1.08 m' (05) 10.00 Wood/pellet stove 10.00 WoodOseplaoeJsert 10.00 y 10.00 ,... - -.✓ :•' � _- _ 2,5-,,,„_4=,4,,,:::: .� . l ray ._ ,,,,:.. .� -��.'- '1'.a1,r., "'�'�'�`z?G�:. �.-: - s � - ,x.. } .'•:..1. • .4 " -� " � ac ~-•, -:_ ._': - - oth 10.00 Name: Robert Blunt gives eft and ventilation Range hood/other kh�a Address: 11865 SW Lincoln Ave 10.00 C i t y / t a t e r Z I P : Tigard, O R 9 7 2 2 3 ere c a b a n a '33, t Single-duet eithront ( 1 -2.. 32- 23;32 Phone: (971 )222 -535 Fax ( ) tact o utility rte) plz.;lr > t ._�:�}:81.1E�111F'1..,...,r,5,,,::::...;;:,;:4-:.W :- _;-;`: % �:� ... � , . �� Akio_ t. _ _r _.. �... ...c - „. c.,r� . ..z , ,� �!... �> �_- �- :'�.;.. ... � ._ ._.-._ .. 10.00 Business name: 1?atei plena Contact name: $5.40 for that fern, $1.00 for each additional F¢msae, der Address: Gas heap City/StaterziP: Wag/suspended/Emit b - - - Phone: ( ) ,Fax: : ( ) Water hearts _ E-mail: — s-455;-, :,:,.2 . ::o' it � ti; =:v : kr-X -.:+_ _: `'.t =z ' ✓'-'..- : -tv.;c Barbecue 'y' :::F:T.,. ::''",:e',-;',:: '.`.�,�..,�t_ _; F'> �.i r�' � .; .: �:tia•c:- � �- r�+.:.::: -:: -' T t - Clothes dryer (ens) Business name: Owner Other, _ � -�' ,•� ,an.�. c a '-'143::- ~1:�. - "�•' �: : � 11865 SW Lincoln Ave _ = ti� ' � *0140-....... t •. ; .. M e - I�:,a fit,. City/StateJLIP: Tigard, OR 97223 Subtotal ... • 6 -1 ( .: TVfmuwm permit fee ($72.50) (' , Phone (971)222 353 Fns ( ) Plan review (25%of permit fee) CCB lit.: State smduarge (12% of permit fee) I ,�d TOTAL PERMIT FEE t3 y o D Authorized signaturec tit appfttotlan tt bas wit � b within 180 dap after I Print name: Robert Blunt I Doats 08107/2009 I • Fee methodoloua sit byTri Ceusay Building 1ndiany Service Board 1, .dot 0U1907 4444617T0UO2/CW?/WFB) . R®1 - u/14' , 12, /legs. sw Avg.. T9 /Rd c.2R. 772. -3 • $Doom C) _ REC EIVED NO V 18 2009 CITY OF DIVASIO BUILDING N 5' Do 0R- — i vl /Zat c.oM,woN MO( ....y k _ AT ' .............. t I 5 r {, .�_ L See Loom b: Follow► t q t �g u c ■ 841, s j Al T S.. - 1 v, ( OFFICE COPY o r►livu ( p w UFQil ► ;nTEJ o6oQ o 4 ' 1 4 k-& S�k _ 9 R 3 S lNSUf - o�' 'I) cc i cet t-t: , f 4 1 I AA 1 _ 6A RP &r 1/4r) • 2 V' • • • 3AY N103N11 \N„ t ern OF 1 . , Approved...... t I only the wojk as described in: 'MIT NO - bee Letter to: - - - .4 .•••• • .... 1 Job Aela e ,4 Date: 1' f re . 0 NOTICE OF TYPE I DECISION ACCESSORY RESIDENTIAL UNIT (ARU) 2009 -00001 : N BLUNT ACCESSORY RESIDENTIAL UNIT • 120 DAYS = 01/08/10 SECTION I. APPLICATION SUMMARY FILE NAME: BLUNT ACCESSORY RESIDENTIAL UNIT CASE NO.: Accessory Residential Unit (ARU) ARU2009 -00001 PROPOSAL: The applicant is proposing to convert existing living space into a 364 square foot accessory residential unit (ARU). APPLICANT: Robert J. Blunt RECEIVED 11865 SW Lincoln Ave. Nov 18 2009 Tigard, OR 97223 OWNER: Same as applicant. CITY TIGARD BUILDINNG G DIVISION LOCATION: 11865 SW Lincoln Ave.; WCTM 1S135DC, Tax Lot 01100. COMPREHENSIVE PLAN DESIGNATION: R - 4.5 (PD); Medium - Density Residential. ZONING DESIGNATION: R -4.5: Low- Density Residential District. The R -4.5 zoning district is designed to accommodate detached single- family homes with or without accessory residential units at a minimum lot size of 7,500 square feet. Duplexes and attached single - family units are permitted conditionally. Some civic and institutional uses are also permitted conditionally. APPLICABLE REVIEW CRITERIA: Community Development Code Chapters 18.390, 18.510 and 18.710. SECTION II. DECISION Notice is hereby given that the City of Tigard Community Development Director's designee has APPROVED the above request. The findings and conclusions on which the decision is based are noted in Section IV. THIS APPROVAL SHALL BE VALID FOR 18 MONTHS FROM THE EFFECTIVE DATE OF THIS DECISION. ARU2009 -00001 Blunt Accessory Dwelling Unit Decision 091109 Page 1 SECTION III. BACKGROUND INFORMATION Site Information: The subject parcel is located on a residential street south of Greenburg Road and west of Pacific Highway in the Tigardville Park Subdivision. The site is surrounded by detached single - family development. The home has been partially remodeled to convert garage space to living space. Proposal Description: The applicant is proposing to convert existing living space into a 364 square foot accessory residential unit (ARU). A portion of the garage was converted into living space without building and land use approvals. Per the submitted plans, the area contains a bedroom, kitchen, bath, and living room, which meets the definition of dwelling as defined by the Tigard Development Code. Because of the site size, a duplex would not be permitted. The proposed unit is 364 square feet. SECTION IV. APPLICABLE REVIEW CRITERIA AND FINDINGS COMPLIANCE WITH COMMUNITY DEVELOPMENT CODE SECTIONS: ACCESSORY RESIDENTIAL UNITS - APPROVAL STANDARDS: Section 18.710.020 contains the following standards for approval of an Accessory Residential Unit request: Section 18.710.020 - Approval Criteria states that an accessory residential unit is permitted providing there is compliance with all of the following standards: An accessory residential unit may be created within or as an addition to a detached single - family dwelling. For the purposes of this chapter, "addition" means the sharing of a common wall with the primary residence. A garage may not be converted to an accessory residential unit unless it is rebuilt as part of the primary structure; According to the submitted plans, the accessory dwelling unit is incorporated into the footprint of the single- family residence. Therefore, this standard has been met. An accessory residential unit may not exceed 50% of the size of the primary unit, up to a maximum of 800 square feet; The proposed accessory residential unit is 364 square feet. The single - family residence is approximately 2,500 square feet. The conversion does not exceed 50% of the size of the primary residence nor does it exceed 800 square feet. Therefore, this standard has been met. The number of residents permitted to inhabit the accessory residential unit is regulated by the Uniform Building Code; In the event that the number of residents exceeds that which is allowed by the Building Code, the Housing Inspector will be notified, and the condition will be corrected. Therefore, this standard has been met. Either the primary or accessory residential unit must be owner- occupied; The applicant has stated that he will occupy the primary or accessory unit. Therefore, this standard is met. A primary residence in which an accessory residential unit has been created may have only one home occupation. A review of City records shows no application for a home occupation permit is on file at this time. Therefore, this standard has been met. In addition to the number of parking spaces required for the primary residence, as established in Chapter 18.765, one parking space shall be provided for the accessory residential unit. This parking space shall be paved and /or covered; ARU2009 -00001 Blunt Accessory Dwelling Unit Decision 091109 Page 2 The primary residence is required to have one parking space. The accessory residential unit is also required to have one parking space. The applicant's plan shows a secondary driveway that may or may y elltollism provide adequate parking space and a primary driveway capable of providing two parking spaces. Therefore, this standard is satisfied. The front door of the accessory residential unit shall not be located on the front facade of the +1 -*.; ,.. ,primary unit unless the door already exists. i tt ot Tae front facade and door of the primary dwelling faces east and the plans show the accessory unit iii entrance facing west. Therefore, this standard has been met. h ere shall be compliance with all development standards established in the base zone. :1"' cording to the site plan, the residence meets all of the applicable setbacks of the R -4.5 zoning f district. No changes are proposed to the site or exterior of the existing structure. i lig FINDING: Based on the analysis above, Staff finds that the Accessory Residential Unit standards have been satisfied. A ' ` ECTION V. PROCEDURE AND APPEAL INFORMATION „ otice: `+ otice was posted at City Hall and mailed to: X The applicant and owners C 1 X Affected government agencies ' . ,n nal Decision: An Accessory Residential Unit is a Type I procedure. As such, the Director's decision is final on the date it is mailed or otherwise provided to the applicant, whichever occurs first. The Director's decision may not be appealed locally and is the final decision of the City. • o' THIS DECISION IS FINAL ON SEPTEMBER 11, 2009 AND BECOMES EFFECTIVE ON SEPTEMBER 12, 2009. , 4 uestions: f you have any questions, please call the City of Tigard Planning Division, Tigard City Hall, 13125 SW .. ,: Hall Boulevard, Tigard, Oregon at (503) 639 -4171. k it 4 r ' Septe4mber 11, 2008 PREPARED BY: Darrel #: Watkins DATE °, '1, Associate Planner 1 a • ARU2009 -00001 Blunt Accessory Dwelling Unit Decision 091109 Page 3 . • r . . I' I ill II 4 0 ( I 1 ::: 3 I VICINITY MAP r � 11780 c dp it , ARU2009 -00001 ti� W. BLUNT ACCESSORY 11 765 � � RESIDENTIAL UNIT • 11795 11800 1 11805 11775 11845 1184511845 1184511845 11845 11830 Subject Site 11845 11845 1 1845 11840 11795 _ 11835 uu i o °i 11860 z . Q Ti td (.... J 118.65 Q 11870 • 11890 11895 11905 11900 Information on this map is for general location only and should be verified with the Development Services Division. 11905 11905 11985 11925 11905 11905 Scale 1 979 -1 in = 82 n 11905 11905 11905 Map printed at 11- Sep-09 10:01 AM 11905 L DATA IS DERIVED FROM MULTIPLE SOURCES THE CITY OF TIGARO /f 11930 MAKES NO WARRANTY, REPRESENTATION OR GUARANTEE PS TO THE CONTENT, ACCURACY, TIMELINESS OR COMPLETENESS OF ANY OF THE 11905 11905 °ABILITY FOR ANY ERRORS. OMISSIONS, OR INACCCUURAC ES N THE INFORMATION PROVIDED REGARDLESS OF HOW CAUSED. \\ City of Tigard 3 S Hall Blv \ `,,,-7"/ — ` ` �- � - - TIGARDMAPS 1 Tigar125 d W OR 97223 d 503 639 -4171 11950 8711 www.tigard- or.gov 12045 \ Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: • PI own, reside in, or will reside in the completed structure and my general contractor is: p Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will //' reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. 4,4e4 B6 nn ' • me of Permit Applicant ,— ure of Permit Applicant �� Date Permit #: ` ir9∎00 ' — DO a 17 Address: 11 86 5 � dU) 00-0(.40 ft �•: T �, • \AUZis • o, 2- cQ 97Aa3 Issued by: Date: t ->L This Copy for Permit Offices