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Permit g CITY OF TIGARD j MASTER PERMIT I 2 ' COMMUNITY DEVELOPMENT 4 Permit #: MST2011 -00045 T (GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 �' Date Issued: 04/06/2011 Parcel: 2S111DB12000 Jurisdiction: Tigard Site address: 15225 SW 94TH AVE Subdivision: SUMMERFIELD NO.12 Lot: 647 Project: Greenwood Project Description: Fire repair. 5/511, reprinted to note that plumbing work to be done under PLM2011- 00133. 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: 0 sf Value: $45,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 2 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 10 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 13 Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -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: ALT SF VB R -3 0 Owner: Contractor: GREENWOOD, JO ANNE KENNEDY RESTORATION Required Items and Reports (Conditions) 15225 SW 94TH 315 SE 7TH AVE TIGARD, OR 97224 PORTLAND, OR 97214 PHONE: PHONE: 503 - 234 -0509 FAX: 503 - 234 -4479 Total Fees: $1,780.69 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 do in accordan ith 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 day . ATTENTION: Orego law equi e ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 001 -001 through OAR 95 01 -0090. may obtain a copy of the rules or direct questions to OUNC by c -,' g 503.23 .1987 or 1.800.332.2344. a A �/ / g ' / r ` Iss d By: Permittee Sign —.(11 % �i_i.A Call 503.639.4175 by 7:00 a.m. for the next available inspection .. e. O This permit card shall be kept in a conspicuous place on the job site until completion of the projec . Approved plans are required on the job site at the time of each inspection. r q CITY OF TIGARD MASTER PERMIT 11111 s COMMUNITY DEVELOPMENT Permit #: MST2011 -00045 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011 Parcel: 25111 DB12000 Jurisdiction: Tigard Site address: 15225 SW 94TH AVE Subdivision: SUMMERFIELD NO.12 Lot: 647 Project: Greenwood Project Description: Fire repair. 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: 0 sf Value: $45,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 2 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 10 Vents: 0 Woodstoves: 0 Gas Outlets: 2 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: 13 Ea add 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -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: ALT SF VB R - 3 0 Owner: Contractor: GREENWOOD, JO ANNE KENNEDY RESTORATION Required Items and Reports (Conditions) 15225 SW 94TH 315 SE 7TH AVE TIGARD, OR 97224 PORTLAND, OR 97214 PHONE: PHONE: 503 - 234 -0509 FAX: 503 - 234 -4479 Total Fees: $1,780.69 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 t doc_a ted by the Oregon Utility Notification Center. Tho - rules are set forth in OAR 952- 001 -0010 through OAR 9 -' • 1 -0090. You m- .• _ _ - • - ru astia to OUNC by calling 503.232. •87 or .816.332.2344. Issued By: '---<■�_ % �_ =� ittee Signature:i��� %�� /4 � Call 503.6x. .,u a.m. for the next available inspection at - This permit card shall be ep r . • spicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application ,,t, .. Residential FOIL OFFICE. USE ONI.1 City b of Tigard t V Received Permit No. � `� Date B : f e ��, " 13125 SW Hall Blvd., Tigard, OR 97223 ma^ , Plan Review Phone: 503.7182439 Fax 503.598.1 {y � �1 DateBy: „nth, 1/ Li_G - l/ Other Permit: i�. �VW 4.l C 1 GARD Inspection Line: 503.639 lV 41 0, Date Ready/By: 1 H See Page 2 for Internet www.tigard - or.gov \, \ �t� U � Notified/Method: 7 Cj f/ dr� �(,r Supplemental Information c�, 7j ( (_,/fir, (j. TYPE OF WORK] O 4 1� � a REQUIRED DATA: 1- AND 2 -FAMILY DWELLING ❑ New construction ❑ Demoli UU )►� \�8 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. ® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ 1-14., wo ❑ Accessory building ❑ Multi - family Number of bedrooms: 2 ❑ Master builder ❑ Other: Number of bathrooms: 2 JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address: 15225 SW 94th New dwelling area: 0 square feet City/State/ZIP: Tigard, Oregon Garage/carport area: square feet Suite/bldg. /apt. no.: I Project name: Greenwood - Fire Repair Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: Summerfield I Lot no.: 12000 Permit fees* are based on the value of the work performed. Tax map/parcel no.: R1006306 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. Restore the existing structure back to its original condition, prior to the fire Valuation: $ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER I ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone: ( ) Fax: ( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: Barry R Smith PC, Architect (Please refer to fee schedule Structural plan review fee (or deposit): Contact name: Chris Nestlerode FLS plan review fee (if applicable): Address: 715 SW Morrison Street, Suite 909 Total fees due upon application: City/State/ZIP: Portland, Oregon 97225 Phone: (503) 341 - 6801 I Fax: : ( ) Amount received: E -mail: Chris @barryrsmith.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System. Business name: Kennedy Restoration Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: 315 SE 7 AVE. Solar Installation Specialty Code checklist. City/State/ZIP: Portland, Oregon 97214 Permit Fee (includes plan review $180.00 and administrative fees): Phone: (503) 234 - 0509 I Fax: ( ) State surcharge (12% of permit fee): $21.60 CCB lic.: 3402 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days atter it has been accepted as complete. I Print name: Chris Nestlerode I Date: 3/29/2011 * Fee methodology set by Tn- County Building Industry Service Board. I:\ Building \Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(11 /02/COM/WEB) Mechanical Permit Application �� f , , i, , ,) ; I, ! I ,, i Cty gard . Perna' u 1 0 I ' t - 131 SW of Hall Ti Blvd (� RI , Tigard, OR 97223 Cr\ plan Review Phone: 503.639.4171 Fax 503.598 -19G , �- Dateny: O1 Inspection Line: 503.639.4175 q ' b • B See tame 2 for V Irfor ation nit Internet www.rigard- or \\\s gov ' S�P� TYPE OF WORK 0 ` C}, COMMERCIAL FEE* SCHEDULE - USE CHECKLIST - t Mechanical permit fees* are based on the value of the work ❑New construction ig Addition/alterati f rep ..ik,3:Zjk Pte. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition fkCSJ L- T1n3c„‘. cp[3 IAN '.,, t2 o DA1NV materials, equipment, labor, overhead, and profit CATEGORY OF CONSTRUCTION Value S RESIDENTIAL EQUIPMENT / SYSTEMS FEES* Of 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea Total JOB SITE INFORMATION AND LOCATION Heatium/eooliug Air conditioning Job site address CH ( site showing T ,�'�� S>,J� � s 46.75 City/State/71P: \ �4 j n R.�0,) 61-1- - Furnace 100,000 BTU 1 46.75 L.1 c ,i Furnace MOW » BTU (ducts/vents) 54.91 Suite/bldg./apt. no.: Project name: l . © . - 822,. Heat pump 61.06 Crass stmet/direetions to job site: (s `l m A p k-t 1 Duct work 23.32 _ ' 1 /� n Hydrceic hot water system 23.32 - n 1.V V c t 1 ,(���5t S, ''1,1 -�, Residential bonier (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in-duct, suspended, etc. s 46.75 Flue/vent for any of above, 1 2332 '23 32 Subdivision: I Lot no.: e nutter 2332 Tax map /parcel no.: Other lid \ 23.32 23 23 DESCRIPTION OF WORK Water heater LN J Gas fireplace 33.39 Flue vent for water heater or gas _ fireplace 23.32 Lc (�•� e-t� 117,E ) j 5'C�WI Log lighter WO 23.32 Re...? Ac . A k- EN-0 AL-) V t%-i- Wood/pellet stove 3339 W NJ - . Wood fireplace/insert 23.32 .-C `�t—1 �t'� �� veNti` :?2 tj t ey/linex /fiue/vent 23.32 Et PROPERTY OWNER J ❑ ITdNANT Other 2332 N a m e : SO4\ A 1 J 1J C r cii:43 oo Environmental exhaust and ventilation u Range hood/other kitchen t Q Address: S Li S viz Sr3R t�� equipment t 3339 3A City/State/ZIP: Clothes dryer exhaust t 3339 3S 34 Single-duct exhaust (bathrooms, Phone: ( LTA ��-x. ,�) J Fax: ( ) toilet compartments, lity rooms) 2,_ 2332 23 . Z A PPLICANT IA CONTACT PERSON Attic%rawispace fans 23.32 Other: 2332 Business name: Fad Itipt®g Contact name: S & J HEATING AND _ i _ . $14.15 for first four . • , each ' - • l g • l 1 1 Furnace, eta I Address. Gas heat -ia me mRir City /State/ZIP: • w: . .1 ' _:' illiffirlle"' ' 1 water heater y Li oWM'MIN Phone: ( j) 2 (A-11-1174.11E111112 `: (�o`S) 2 (a�2 �LS7 F `WMILIM� E -mail: � n., t 4GS - 1AP [I � . A 1r 1� G� C rrr.. \Dint - • R a I.� CONTRACTOR 1 Barbecue •, Business name: Clothes : -- ��= "� S & J HEATING AND other �!_�I/ Address: AIR CONDITIQNING INC. «; City/State/ZIP: 1004 NE 4Th AVENUE subtotal _ Minimum permit fee ($90.00) Phone: ( ) r ' ) - Plan review (25% of permit fee) CCB lie.: cl 6 • Z / -C(21 , . «3 Q L L - Std surcharge (12% of permit fee) "' TOTAL PERMIT FEE Authorized si :.• ' . ' 4,4_.L. ti ) This permit spondee empires if a permit is not obtained within 180 y A- days after it has beep accepted as complete. Print name: .e 0 Nki ,‘:, I Date: di I.,bt Za'020, 1 * Fee methodology set by Tri - County Building Industry Service Board rAewaaiag‘r«,mr *mac . „- . ,.arw 10101ro9 4404617T (1 trotico'ct/wEa) t rc %_S B 1 ( ee.'0L =A\A Vt✓StC c l i Plumbing Permit Applicatiar- `�� • • Building Fixtures 1 ( 1, tii l tc I t 4i () ) • City of Tigard � � Permit No.: r/r?� 1 OSA1�PN RI �S l3125SW Hail Blvd., Tigard. OR 97223 r' . }1aI Phone: 503.718 -2439 Fax: 503-598 C Del kr Other Permit No.: Inspection Line: 503. 639.4175 ( ate , - 1 t : I t ' e� `r, Ask Ready/Ny: A 21 gee Pare 2 for Internet www.rigard- or.gov - /+9 xeMAed/tvernred D Rots sap,gleateatei trs rryueri TYPE OF WORK ` . 1 ` ` *:. Fab' S <.... - . .. ❑ New construction ❑ Danoli O For ' ! • o meno,c M K the *I1e i ' Description city. Ea- Total N I. 2-family ddition/atteraionlrepl cemeett ❑Other `143 New - -am dwellings (includes 100 It. for each utility t ' �L� - y l � ity comedian) CATEfsOKY OF (JO1Vig170.1&111N SPR (1) bath 312.70 %I- and 2- family dwelling ❑ Commeroialh,cdusirial SFR (2) bath 437.78 0 Accessory building 0 Multi - family SPR (3) bath 500,32 -- Each additional baW{citchen 25.02 © Master builder ❑ Other. Fire sprinkler ( .. , sq• ft.) Page 2 JOH SITE 1 FO1MATtoN AND LOCATION Site Utilities: Job site address +622 t ' 111 a coat basin a area drain 18.76 Qrywell. leach line, or trench drain 18,76 City /State/ZIP: l 4 • at it" Footing Jelin (no. linear R.: _J Page 2 Suite/bldgJappt. no.: Project name: .fig I 111111 ' f a e 1: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes _ 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear R-' ) Page 2 - - Stone sever (no. linear R.: _ a T- Page Z Water service (no. linear t.: _J j Page 2 Subdivision: _ Lot no.: Future or Item: Tax map/parcel no.: 13ackflow plevnnter 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clefts washer 25.02 C \11. iWe Ck ( + \ra* - _ - Dishwasher 25.02 Drinking 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER 0 TiNA•T Expansion teak 12.51 Name: 25.02 Floor drain/floor ailiciluili 25.02 Address: __ Garbage disposal 25.02 City /Statc/ZIP: Hose btb I 25.02 D Phone: ( ) Fax. ( ) ice maker 12.51 ❑ APPLICANT [ ❑ CONTACT PERSON Interceptor /grass trap 25.02 Business Medical gas (value: S _) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City /State/ZIP: Solar units (potable; water) 62.54 Phone: ( ) I Fars:: ( ) Tub/ahowcr/a pan ?. 12.51 E-mail: /� e r,,,( ► y l c.Qlrn Urinal 25.02 ^ vt , vv +r r, lC-OTN Water closet 25.02 Water lama L 31-52 ..-Iiir5Z. Bueiltees ix r :: t 1 a � i 1c. CO Water piping/DW V 56.24 Address: \ - Other. L 25.02 City/State/1P: , . AA 0, ► 6 11D IS Subtotal 'i Minimum gamic fee: 572.50 Phone: ("iii ' rte- � a Fax: (m! ) i c• J'�C�jQ • y Plan review (25%ofpermit fee) CCB Lit,: .91) Plumbing Lie. no.: .- + 5 Site surcharge (t2Sf� of permit fro) , Authorized signature: . .._41.. _di All TOTAL PERMIT FEE g,07 im i Pas permit spplle.Uaa eaprrss its picot h rat ■Ata.ed winds lap doss Pratt name: w 1 l , t a D a t e . alter N tea baw aaocgrM d t»s Wsee "Fee methodology set by Tri- Cosuty BuSding industry Scioto: Bard. ilkiWiry lPamiuPLIAIJdermilApp.dn¢ 1amIIn9 I404616T( Ieovcouncen) Electrical Permit Application � �� 1 4 'II I it t 1 .1 i)\ I 1 I II City of Tigard �,� V � ^ Des Permit No.: 5iso I ,- 't 13125 SW Hall Blvd., Tigard OR 972%, Q' ` Plan Review I Phone: 503.718.2439 Fax: 503.598.19966b0 tl �' Datc/By: Other Permit: G 1 T I R D Inspection Line: 503.639.4175 0 LI �: Ri D, c Ready/By: t :: 6d See Page 2 far Internet: www.tigard- or.gov .CIGT (11Polified/Method: SupplemeatalInformation TYPE OF WORK `� ... 1C1 ... .:PL.A V REVIEW ... .:: .. ❑ New construction 'I rlddition/alteration/rep]* ant Please check all that apply (submit; sets of plans w/iteros checked below): i ,iv - 0 Service or feeder 400 amps or more 0 Building over three stories. C) Demolition 0 Other: where the available fault current ❑ Mannas 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 Eir and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - famil ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or 0 Emergency system. larger separately derived system. JOB. SITE INFORMATION AND LOCATION 0 Addition of new motor load of © "A" "E", "1 - 2" "1 Job no.: Job site address: IS ZZS tS to , 7 100HP or more. occupancy. 0 ❑ Six or more residential units. Recreational vehicle parks. City/State/ZIP: 0 Healthcare facilities. 0 Supply voltage for more than "`+ �` ..._.... -: 0 Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 0 Service or feeder 600 amps or more. ^_ FEE SCHEDULE. Cross street/directions to job site: Description I Qtr. r Pa. I Totes I - New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft or less 168.54 14 Ea. add'I 500 sq. ft. or portion 33.92 I Tax map/parcel no.: - Limited energy, residential 75.00 2 • DESCRIPTION OF WORT( (with - (with above sq. n.) ' Limited energy, multi- family 75.00 2 g t9 - .0 \, r G (Le" 4 y a-( residential (with above sq. ft.) W t Services or feeders installation, alteration, and/or relocation 200 amps or less f 100.70 /6C, ` er 2 ❑ PROPERTY OWNER 0: TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City /Stu rIZIP: Phone: ( ) Fax: ( ) 200 amps or less 59.36 I 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 ex tension, per panel Owner signature: _ Date: A. Fee for branch circuits with above service or feeder foe Q APPLICANT' ❑CONTACT PERSON /3 7.42 a f y 2 each branch circuit Business name: B. Fee for branch circuits without . service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'/ branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular G7 84 2 tY dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: Signor outline lighting 67.84 2 CONTRACTOR_ Signal circuit(s) or limited- energy Business name: a ( panel, alteration, or extension. Page 2 2 W 1 c&.t3 A "!� t, mss v„1� .../\)c - Each additional inspection over allowable in any of the above Address: 100 L l Ac, 5� / Additional inspection (1 hr min) 66.25/ be Investigation (1 hr min) 66.25/ hr City/State/ZIP' -am, ` ;� [1 i t� C Q i �-�1f � / p / -7 0 Industrial plant (I hr min) 78.18/ hr Phone: (5b'3) (t, 3 z _ Lc/ 2J, Fax: (SIzo. ‘32_ - 292 i Inspections for which no fee is 90.001 hr specifically listed (V, hr min) CCB Lie.: it q 2 Electrical Lic.: , ` Suprv. Lie.: 5 ELECTRICAL PERMIT FEES Subtotal: 1 17 • 16 Suprv. Electrician signature, required: - `--- Plan review (25% of permit fee): Print name: Sc 1 Date; State surcharge (12% of permit fee): 2�� 6 7 TOTAL. PERMIT FEE 2 � 2_ Authorized signature Print name: F This permit application expires if a permit is not obtained within 180 � 3 liZi // j days after it has been accepted as complete. L. li "' ) �t P Jtx Date: J/2,0 1 * N umber of inspections allowed per permit. Il Building %P°nnit\ELC- PemitApp.doc 07/01/10 440- 4615T(I1 /051COM!WEa --l 417 be- t?■' • bli4;.■3S—Psf . - ( s - N 9 ..1 ---/) '...1- Of • \ v - air-raps 0 0 5/')/L(Al LiLf17 . V C) — an. VorY3-t c l i -ated 2 00-).a oivh cs.) L. ( % L . e .7 ) ri ¢' 4 ci ll \iv 1000v4 stew s • w s I 1M 4") e I > .7 > 13 N —rrraTi‘r9zql 1 .,Ar 1-.1 7.9.• L i tt r Qi _ —yaw'. 51 Mrer.211I 0 7 ,... .1oLvp cal %yr i) (I I hi (} ._ m 2t. ;M. toillii.s IA 4 L , 9 I' NY ,0.11 Trrar • S.1. 03 4. i . 4 1 ; -a E X ' fp j j • , (C•41,-% . oZ vi . 4- S Sriolo 0 le el I 1 taS w 7 Z s,) c or \__ it- `4"11P * i.ci A 4 4 c . i t 4, t ■It : r • , :ri,' t6 ,.i , ://)4.. . \ • e. : '1-3‘1) t...fti'osjr ) ,...s x .,....: ,„, . • ‘ 'at 41 F Pr 1 4 .7NPRIO 4, . 1 . ezincns as ... = 3 c ) .;) ` ) Cr / i i / Z P -? , 01( . 11 a .. -- 11 it , \ \ d ^ , 0 a - cpzi . , e t .. ------- - ,.I III _ • Building Division Development Code Provision Review T i c. n Ei Residential Projects Building Permit No: Mb/ 4?-0l1 --'C0 I.S CWS Service Provider Letter Received: Yes ❑ No ❑ N /A. Routed Plans: / Original Plan Submittal Date: / / /, 1St Revision Submittal Date: ❑ Site Plan Only (LNiJt fe ^' R4-e- Oc*Ac "t ft 1 6 " N r 2nd Revision Submittal Date: ❑ Site Plan Only Y To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact . r6 c. at 503 - 718 -` - J or _A-A- f @tigard- or.gov) Land Use Case No. Name Stx VA. NL.0 r 1-10- /- 1 C3 12. 1 �-D� `( 17I Setbacks: Front (� Rear 1 5 Side S Street Side / v Garage ) ❑ Maximum Building Height .35" Actual Building Height Er Visual Clearance Easements E -Sensitive Lands Type: Ili I FA Notes: Original Plan: Approved 13 Not Approved ❑ Date: 3 /a (lit Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) .Pr Actual Slope: J Notes: Original Plan: Approved� Not Approved ❑ Date: 3 3 I 1 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) ❑ Street Trees ❑ Protected Trees Notes: Original Plan: Approved ❑ Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or abert@tigard-or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes ❑ No ❑ Date Routed to Building: Page 2 of 2 i y3y c t Y F irtfaiala City of Tigard June 16, 2011 Kennedy Restoration 315 SE 7 Ave. Portland, OR 97214 Re: Permit No. MST2011 -00045 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 15225 SW 94 Ave. Project Name: Greenwood Job No.: N/A Refund: ® Check #202508 in the amount of $78.45. ❑ Credit card "return " receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as plumbing work was completed under PLM2011- 00133. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, • Dianna Howse Building Division Services Supervisor • Enc. • i:\ Buildin \Refunds i EstimEgifuN iceiPe siriokar'eton 97223 0 503.639.4171 TTY Relay: 503.684.2772 0 www.tigard- or.gov CC LL, rr L a City of Tigard T l G A RD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Kennedy Restoration DATE: 6/10/2011 315 SE 7 Ave. Portland, OR 97214 REQUESTED BY: Dianna Howse Debbie Adamski TRANSACTION INFORMATION: Receipt #: 182058 Case #: MST2011 -00045 Date: 4/6/2011 Address /Parcel: 15225 SW 94th Ave. Pay Method: Check • Project Name: Greenwood EXPLANATION: Per applicant's request as plumbing work was completed under PLM2011- 00133. Refund 80% of permit fees. ;REF. U P N >\ii - ,. • �,..:. _ . }:,, �;':.. ���:.. OR11IA`i'I :t•: +. :a %';: " «�= :;.•:. �; - _ - .:-; ,. 't -r ' }.`.i�" �J�'?��. i'1:`,. = �`is. - .r.r.. � ' '„�nir.`:r =�. 'G" .;a'.: • h` - in.� i.Y .;1 n.,, gip,.. '.A . - - k . : s -. .. '.r: �•� 4f:.:_p• - °r: !:::' "i:l.: 'i-^" -`.�' tkt-' :ti aii' Fee:D'e"scip'ton'Fo Rc . j , °_ `-;.�...•. � •.l?. - m e.:Pt':; 4�- ,�..,.. ?;;�t;.,. Reven.ue�Ac�CO.untNo.,.. ,:�:- ..�'r. ,•Refir`i�d. .a, •-.:�< 4' :aa � • i• a 'i'; %' . iY a - :. .. Plumbing permit fees 2300000 -43101 $70.05 12% State Surcharge 1003100 -24001 8.40 TOTAL REFUND: $78.45 APPROVALS: If under $5,000 Professional Staff Ciz,610-4;t. 11 Z-GC A If under $12,500 Division Manager If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Rcview Board FOR: TIDEMARK SYSTEM. ADM INI STRATION. UsE;ONLY' .. Case Refund Processed: I Date: I 4 I By / - I: \Building \Refunds\ RcfundRcqucst.doc x 09/01 /2010 71 CITY OF TIGARD RECEIPT g . __ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 182936 - 06/21/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2011 -00045 /:-6u'9/. ,Af& /'1�1/ - —" 02. Soma) - 9 ' /O/ Pe ' 0 5 . /.2. 9t j i Sct4 t4 46 /ao 3/co - d e7.0/ > 5re' $ -78.45 Total: $ -78.45 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 202508 DHOWSE 06/21/2011 $ -78.45 • Payor: Kennedy Restoration Total Payments: $ - 78.45 Balance Due: $78.45 • • • Page 1 of 1 CITY OF TIGARD RECEIPT q • . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 , TIGARt) il k Receipt Number: Number: 182058 - 04/06/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2011 -00045 Building Permit - Additions, Alterations, 2300000 -43104 $674.35 Demolition MST2011 -00045 12% State Surcharge - Building 1003100 -24001 $80.92 MST2011 -00045 Hose Bib 2300000 -43101 $25.02 MST2011 -00045 Tub /Shower /Shower Pan 2300000 -43101 $25.02 MST2011 -00045 Water Heater 2300000 -43101 $37.52 MST2011 -00045 12% State Surcharge - Plumbing 1003100 -24001 $10.51 MST2011 -00045 Furnaces < 100K BTU 2300000 -43102 $46.75 MST2011 -00045 Duct Work 2300000 -43102 $23.32 MST2011 -00045 Flue/Vent For Any of Above 2300000 -43102 $23.32 MST2011 -00045 Water Heater 2300000 -43102 $23.32 MST2011 -00045 Clothes Dryer Exhaust 2300000 -43102 $33.39 MST2011 -00045 Single Duct Exhaust (Bathrooms, Toilet, 2300000-431.02 $46.64 Utility Rooms) MST2011 -00045 Fuel Piping 2300000 -43102 $14.15 MST2011 -00045 • 12% State Surcharge - Mechanical 1003100 -24001 $25.31 MST2011 -00045 Services or Feeders - 200 amps or less 2200000 -43103 $100.70 MST2011 -00045 Branch Circuits w /Purchase Service or 2200000 -43103 $96.46 Feeder MST2011 -00045 12% State Surcharge - Electrical 1003100 -24001 $23.66 MST2011 -00045 Info Process /Archiving - Lg Sheet (over 2300000 -43135 $18.00 11x17) MST2011 -00045 Info Process /Archiving - Sm Sheet (up to 2300000 -43135 $14.00 11x17) Total: $1,342.36 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 8303 DADAMSKI . 04/06/2011 $1,342.36 Payor: Kennedy Restoration Total Payments: $1,342.36 Balance Due: $0.00 • • Page 1 of 1 n cL. of ill . Community Development TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov . • FROM: ❑ Owner p Applicant ❑ Contractor 'City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) f,A3t,)eG--D V sr-ail-770,i Mailing Address: 615 7 140E, City/State /Zip: p Q-T LA ,St, Ora 7 A ( 7 Phone No.: '-) - A3 656 9 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): 4 CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). • Permit #: N57 O► of /-O O Site Address or Parcel #: 15 o2 5 t..0 et 4 } `fi-o c. Project Name: net-El) c00`0 Subdivision Name: Lot #: 44' EXPLANATION: _ 1. �. en 11 012._ [ e. of r" . II _ . ; w ■ � O ►A ITJ( ■o * /O5 A-at1 D63€ - € -. 11 0 1 o11 mo0 i33• Signature: / Date: 5---16-1,, Print•Name: -- D ill I _ IQ. AD PriLt gk.. Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to S s Admin: Date / Rte to Bld • Admin: Date B 1j . _i'1 /P .�i �i iii Refund Processed: Date Invoice Processed: Date By Permit Canceled: Date B �; Parcel Ta: Added: Date B Receipt # / ,� s ' f Date %, f/ Me od /O't . _ Amount $ /> Ya., 3 I: \Building \Forms \RegPermitAction.doc ' ev 07/26/07 ,_,- 0.B/01/2011 07:03 5039390162 KNEZ INSUL PAGE 01 1/7V ' /ra b/ bio /iJ,55 /9 INSULATION DIVISION • CERTIFICATE OF COMPLIANCE Date 08/01/11 Builders Name: KENNEDY RESTORATIONS Job Address: 15225 SW 90 AVE City: TIGARD, OR Job Number 22792 Type of Application Material Type R- Factor Dept. ATTIC BLOW Fiberglass R -381N 14.5 CAPS Fiberglass R -38UF 12 EXT. WALL Fiberglass R -15K 3.5 GARAGE WALLS Fiberglass R -11 OF 3.5 GARAGE WALLS Fiberglass R -13K 3 . 5 GARAGE CEILING Flberglass R -30 OF 9.5 PARTYWALLS Fiberglass R -11 OF 3.5 WALL BLOW Fiberglass R -30IN 11.75 1 r e s tn ∎ rized Sign e