Permit CITY OF TIGARD MASTER PERMIT
C • • COMMUNITY DEVELOPMENT Permit #: MST2010 -00191
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/15/2010
Parcel: 2S 111 AD05700
Jurisdiction: Tigard
Site address: 8710 SW PINEBROOK ST
Subdivision: PINEBROOK TERRACE Lot: 80
Project: Brault
Project Description: 352 SF addition with patio cover.
BUILDING
Floor Areas Reauired Setbacks Required
Stories: 0 Bedrooms: 0 First: 352 sf Basement: 0 sf Left: 0 Parking Spaces: p
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: $0.00 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
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 ' 0-200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 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'I 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: Y 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)
IRV TRUST, CARE OF PAULA OWNER
BRAULT
8710 SW PINEBROOK ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Total Fees: $201.60
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 o issuance, or if work uspended for more the 18
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility No' icati n Center. T se les are set forth in OA
952- 001 -0010 through OAR 9 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by call* g 5 .246.6699 or 1 00.332.2344.
Issued By: e/ J !� _ _ Permittee Signature:
•
Building Permit Application
Residential � '! soli o l� 1ccl�� l� cl: I�sI•: ()N1,) : C
City of Tigard ,r r, 0^, Dat i Received L/!SSlI� // 1 ' I el
g 1 Y Permit No.:
� Tigard, J 13125 SW Hall Blvd., Ti ard, OR 97223 � G�O Z I"
Plan Revie �; -M( ,�
Phone: 503.639.4171 Fax: 503.598.19 Date/B I I ! Other Permit:
i - I ∎ . A it l> Inspection Line: 503.639.4175 Q) I- Date Remy : y: ® See Page 2 for
Internet: www.tigard - or.gov y) Notified/Method: D j r, �) M Supplementallotormation
TYPE OF WORK l. G� REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Dem l 1 -• Permit fees* are based on the value of the work performed.
g Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration/replacement ther: L tu Iif 144 -- equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1 4 1- and 2- family dwelling ❑ Corrunercial/industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:v/ ID 6 t , td p/2,d e_ 1 New dwelling area: 3s1 square feet
City /State /ZIP: .-1 , 04- 1 v Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: r , ft _ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
T"*1--1- 'z Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION , n � - ,:/
� OF WORK work indicated on this application.
._ r C A/1IQ� I L 1 GIGt ^ v e t 1 . }�orr.` \nr, Pmt i y
ie- Valuation: $
_ p n 1,1\ l . FIRE 4. ('FFP 1 kSe- rr , �( Existing building area: square feet
��""�� New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: CA.4 L M Abby i%/ 7E067 Type of construction:
Address: ern ( 6,.J j j ap es 'S7 Occupancy groups:
City /State /ZIP: � , r o'2 £ 12Z� Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name:�(,� LT licensed with the Oregon Construction Contractors Board .
under ORS 701 and may be required to be licensed in the
Address: Z5.je45 14E. 0 i5 Fz • X) jurisdiction in which work is being performed. If the
City /State /ZIP : ` � P/ 7 4 7O0.z._ applicant is exempt from licensing, the following reasons
apply:
Phone: ( 5 $ ../6 i r 7 �. Fax:: ( )
E -mail: b rr 6 !�' (.(i f u -i I IJ�Z'
CONTRACTOR
Business name: (71 APMC.r / ece cµ BUILDING PERMIT FEES*
Address: (please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application: 44 1, 1 1 f , (12 0
Amount received:
Authorized signature)( pc c, This This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: PA u 1.A 1-.4. 1 Date: /0 7 - /0 * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\PermitABUP -RES PermitApp.doc 10/01/09 440- 4613T(11/02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling foil OFhlci.: Hsu: ONI.I
City of Tigard Received
I N
Associated Permit No.:
1 3125 SW Hall Blvd., Tigard, OR 97223 Associted permits:
C Phone: 503.639.4171 Fax: 503.598.1960
�_ i� I t I > 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑Mechanical
Internet: www.tigard - or.gov ❑ Other:
'I'll F. FOLLOWING I"hl :iNIS ;ARF, Ill -.:OUIREl) FOR PLAN REVIEW v es No 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.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
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 load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore. on and shall be shown to be a, #licable to the •ro'ect under review.
JURISDICT IONI \I SI'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/COM/WEB)
A
Electrical Permit Application ( � �� Ft►It tlFFici.: USE ONLY
City of Tigard C Received permit No.: i
1 Date/B : 7J V �ri� 6 1 d
q 131 SW Hall Blvd., Tigard, OR 9 ��rz11ILZ33s - Plan Review
Ill Phone: 503.639.4171 Fax: 503.598196 0 r 1 6 �.� D : Other Permit:
Inspection Line: 503.639.4175 _ •- ' D Date Ready/By: t �, t ) ® See Page 2 for
Internet: www.tigard or.gov �F� �PRin` Notified/Method: Supplemental Information
New construction Addition/alter TYPE OF W � j I OC) I)' ' PLAN REVIEW
❑ ❑ a �ff>re replacement Please check all that apply (submit / sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition p Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
p . 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 ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: S790 .Q voEiv.,040 T Six or more more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / / �� ' ❑ Health -care facilities. ❑ Supply voltage for more than
ty State /ZIP: �l ( D i "'"— �� . ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: f Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
S. PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name f 01, .A4 f Y 6r 401 amps to 600 amps 200.34 2
�"J 1 Y)CM&bP0C,r- ( 601 amps to amps amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: ( ( e A b bi__ tZ 2,3 relocation
Phone: ( ) / Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I 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
Branch circuits - new, alteration, or extension, per panel
Owner signature:X(j °tea 4, .t- ( 0 .• - •F Date: / a - 2 - / 0 A. Fee for branch circuits with
iij APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
fie. tai _t 4 V / aL -. — B. Fee for branch circuits without
�( �1 ts.i service or feeder fee, first 56.18 2
Contact name: branch circuit
NC ^ C �.. � Each add'I branch circuit 7.42 2
Address: 2!E t) N �5 I - i� PL t Miscellaneous (service or feeder not included)
—
Ci lState /ZIP: / �. 11P •� _ Each manufactured
service and/or or modular r wider 67.84 2
ty Each dwelling, service and/or feeder
Phone: ( 9 � -7 6 i Fax: : ( ) Reconnect only 67.84 2
,. / L Pump or irrigation circle 67.84 2
E -mail: ;�3Rts4.ZiL'f 6 CAN l m t f L i
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy '
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
spccifically listed (Y: hr min) _
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required:
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:\ Building \Pennits\ELC- PermitApp.doc 07/01 /10 440.4615T(I1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation •
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10
Information Notice to Owners About
Pl. C onstruction Responsibilities
I (ORS 701.055 (5))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503 - 378 -4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information,'call the Oregon Employment
Department at 503 - 947 -1488.
• Oregon's Business Identification Number (BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, call 503 - 945 -8091 or go to
http : //www.oregon.gov /DOR /BUS /dots /211- 055.pdf for the appropriate forms.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 503 - 947 -7815.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their website at www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough -in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052
Telephone: 503 - 378 -4621 — Fax: 503 - 373 -2007
Website Address: www.oregon.gov /ccb
f /property_owner adopted 12 -04 -07 This Copy for Permit Applicant
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:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCI3# 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
K1 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.
?c Pq -" • r.12 Au Z
Print Name of Pemnit Applicant
41.• a wl.` /o /7 O
S ignature of Permit Applicant Date
Permit #: H h l o -001 /
g iro ,Nt i� ��•*,
Address:
-r- D o2 Q7, 3 , f� i
Issued by: 6 Date: /0/(5
. .
This Copy for Permit Offices
, eel) vl 1--- i t , :, i 1 ii .. ___ a k:1 �cc�Y rv� ` i
, q F 7i 22' -----
RECEIVED 1 2 N• 1
a o,r,,,/
I
OCT 20 ....._.v_ F4zireeN? r EffaN
CITY OF TIGARD
BUILDING DIVISION
6,42A g
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OFFICE COPY
ei/ ,5,v a• MNE e cak. .1-7