Permit li:::
-=;2_ CITY OF TIGARD MASTER PERMIT
IS 'a; COMMUNITY DEVELOPMENT Permit#: MST2009 -00097
[ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/01/2009
T
Parcel: 1 S135CD02702
Jurisdiction: Tigard
Site address: 11715 SW 95TH AVE
Subdivision: BOETCHERS ADDITION Lot: 6
Project: Jones
Project Description: Addito, • • • •downs alteration of openings in front of home. 1/5/10, adding (17) additional
branch circuits for a total of (27).
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 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: $2,000.00 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
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 Srvc /Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 27
Ea add' 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)
LEBEN, ANNES & KOLOLINSE OWNER
11715 SW 95TH AVE
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Total Fees: $416.32
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 do n a ccordance plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
da . ATTENTION: Oregon :w re. . - you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 2- 001 -0010 th ough OAR 952 -1.1 00. Yo
• •btain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
I ued By: __ / - . /..0 . .., �, . Permittee Signature: .
CITY OF TIGARD MASTER PERMIT
111 COMMUNITY DEVELOPMENT Permit #: MST2009-00097
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/01/2009
Parcel: 1 S135CD02702
Jurisdiction: Tigard
Site address: 11715 SW 95TH AVE
Subdivision: BOETCHERS ADDITION Lot: 6
Project: Jones
Project Description: Additon of holddowns, alteration of openings in front of home.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 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: $2,000.00 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 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: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr. 10
Ea add! 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: 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:
Owner: Contractor: Required Items and Reports (Conditions)
LEBEN, ANNES & KOLOLINSE OWNER
11715 SW 95TH AVE
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Total Fees: $275.05
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 throu OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503,246.66.9 or 1.8.0.332.2344.
Issued By: /l ��Jl �� S( L )0(,U / Permittee Signature: 7 / � 1' •
Building Permit Application .. ,,
Residential RECEIVED FOR OFFICE I'SE ONLY
City of Tigard MAY 01 2009 DateBReceivey: d
\°) ' I 09 Permit No.: 1'y1S\a _ (roc? 1
jig • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
= Phone: 503.639.4171 Fax: 503.598.1960 Date/By: ,S -6 9 Q / f g
Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: furls: 0 See Page 2 for
TIGARD
g g BU ILDING DIVISIO No tified/Method: Su pp Information
Internet: www.ti ard -or. o PP
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
EY1- and 2- family dwelling ❑ Commercial /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: \ \ - 1 \ s 0, S J e k L New dwelling area: square feet
City/State /ZIP: 1 k (, 2 , _ ! ()') 1 2 1 Garage /carport area: square feet
Suite/bldg. /apt. no.: _1 R Project name: Covered porch area: square feet
Cross street/directions to job site: R k" k i- („ l � \ r - Deck area: square feet
5� � O -< r\ c � h ` 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 OF WORK work indicated on this application.
PI C) .-k L,Dr\ kr,r, t3corvs (A(‘) sl( ee.s 0, -..nt4 Valuation: $
iru -c (or\-C ,D- J Mt` Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: n 02 >011 Ps Type of construction:
Address: CA, 5 —) --) i v ‘ , of NA.. r' L & t) L Occupancy groups:
City /State /ZIP: C.) ( f E -i -2 Z c-( Existing:
Phone: ( ,33) ..--1_, c‘.sV 5" Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors 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: A A jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City/State /ZIP: 01131\-Q_ Structural plan review fee (or deposit): 4( ( o3
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
Amount received: l I C1 , (c 3
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
X . Print name: AND2'c-•-i j ■-■ es- Date: � - k _ 0 C. * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Petmits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM/WEB)
To -\al 2 ,() 5
r
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received permit No.:
Associated 13125 SW Hall Blvd., Tigard, OR 97223 Associaja
III ted permits:
■ Phone: 503.639.4171 Fax: 503.598.1960
TIGARD
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard - or.gov ❑ lei.
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW "'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. ❑ 0 ❑
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 ❑ ❑ Cl
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 Oregon and shall be shown to be • • licable to the •ro under review.
JURISDICTIONAL SPECIFICS
23 Five (5) 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 accompanied by the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1:\ Building \Pennits\BUP- RES- PermitApp.doc 03/21/06 440.4613T(11/02/COM/WEB)
Electrical Permit Application RECEIVE 1 FOR OFFICE ISI 011.1
ve
City Tigard MAY DateB : ' ' O� _
Permit
111111 • 13125 SW W Hall Blvd., Tigard, OR 97223 1 2009 Received
Rev Review ii
a Phone: 503.639.4171 Fax: 503.598.1960 D eceiv e Other Permit: 4-- Z•`` • , 6 OOq
FIG A RD w Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: kri :: 0 See Page 2 for
Internet: ww.tigard or.gov BUILDING DIVISI I' otified/Method: t Ci Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction dition /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
O 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> , "1 -2 ", `9 -3 ",
! 1001-IP or more. occupancy.
Job no.: Job site address: O
't �A S S� �S �`` A ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: �' ❑ Health care facilities. ❑Supply voltage for more than
l 1 �.I A C7 (Z cY\ �� Z Z `f ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: t ^� 1( k G`et Description I Qty. I Fee. I Total I •
` J New residential single- or multi- family dwelling unit.
Z GI n al S F 4.% Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
C . -) -k-o ( e) e r -.2- c pct residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less I 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
b2t1.) tane5 601 amps to 1,000 amps 240.60 2
Address: (\ 4,1 1 , t %, <V , (-4.3 LA.) Over 1,000 amps or volts 454.65 2
City/ State/ZIP: p Temporary services or feeders installation, alteration, and/or
< (-1 N �Q 0 E- tl v^ q' 1 . 1 - relocation
Phone: 6.- Lk'S' 0.S („, 5 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, le rent, or cchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: 5. - / -(1
`f A. Fee for branch circuits with
❑ APPLIC ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
A first branch circuit
Address: (``.., \ Each add'I branch circuit `if) 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: energy panel, alteration, or
Address:
City/State/ZIP: (•') W n € \ ( extension. Describe: Page 2 2
' . Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: ) L.\ ( go
Print name: Date: Plan review (25% of permit fee):
/ �`/ State surcharge (12% of permit fee): I . 7 . l C Z
Authorized signature' //J _ w TOTAL PERMIT FEE: `� L-\ , � a
Print name: /� ' b D ate: This perm application expires if a permit is not obtained within 180
K ,r./,A , 1 y1 , p, s QC days after it has been accepted as complete.
r J • Number of inspections allowed per permit.
l:\ Building \Permits\EL.C- PetmitApp.doc 05/23/06 440- 4615T(ll/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:
n Audio and Stereo Systems*
n 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:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
H Intercom and Paging Systems
n Landscape Irrigation Control*
H Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
t \ Building \Permits\ELC- PermitApp.doe 03/23/06
i
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 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.
Of
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.
Pri ame of Permit Applicant
(L__,..—____,
° 5
Signature of it Applicant Date
Perm #: T n - ' fl
Address: kJ L si I. ASc V
Issued by: L Date: 0 ` C ,, F
U4S
This Copy for Permit Offices