Permit t CITY OF TIGARD MASTER PERMIT
:Pi ' • `- COMMUNITY DEVELOPMENT Permit #: MST2011 -00063
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/2712011
Parcel: 1 S134AC04200
Jurisdiction: Tigard
Site address: 11068 SW BLACK DIAMOND WAY
Subdivision: HARTS LANDING Lot: 13
Project: KERSHNER
Project Description: 65 sf. balcony.
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: 65 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 65 sf Value: $10,000.00 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: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
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
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea addl 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 1
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 65
Owner: Contractor:
KERSHNER, JEFFREY & BETHANY M M DESIGN BUILD LLC Required Items and Reports (Conditions)
11068 SW BLACK DIAMOND WAY 6431 NE 37TH AVE
TIGARD, OR 97223 PORTLAND, OR 97211
PHONE: PHONE: 503 -579 -7792
FAX:
Total Fees: $533.84
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 ri; y-• by the Oregon Utility Notification Center. j hose rules are set forth in OAR
952 -001 -0010 through • • - - 152- 001 -0090. You ma • • = a copy of - ^�►�T .lt t. •uestions to OUNC by calling 503,- •87 • 1.800.3 .2 , 4.
le Issued B /%� d _ . Permittee Signature: /l f � /I I L
Call 50 .• • ..r1- :00 a.m. for the next available inspection date. /
This permit card shall be kept in a conspicuous 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 ♦ ; , ,4 l el,�,� + N
Residential FOR OFFICE USE ONLY
City of Tigard e ' y DateB f / Permit No.: OCIA0—)
• 13125 SW Hall Blvd., Tigard, OR 972 1 Pl R 1 L
Phone: 503.718.2439 Fax: 503.598.19�0� 41 r°\ Date/By: 4. 24, l C Other Permit:
I I GARD Inspection Line: 503.639.4175 nQk R+ Date Ready/By: Juris. El See Page 2 for
Internet: www.tigard- or.gov Y �� ��jl� Notified/Method: L i /1 ii • A , Supplemental Information
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
'El4ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
- and 2- family dwelling ❑ Commercial /industrial Valuation: lei $ la COQ Ob
El 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 O ff, 6 5 gL 6/414.41-A-4 wY New dwelling area: square feet
' -
City /State /ZIP: 7 ,, o , oz. ' 2 2 3 I Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: /. -e„,/-s �. 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: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 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.
t,.a ! e t&s..t CeA.-c. es tk�.�' f� ' ] r 4 yL , 0...6 Valuation: $
U`� 'GC ` l ± G S - ! 0 a...--‘4, / l Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: 1 e - x/ (_, el Type of construction:
Address: / / 5 j' d/ ,,L ,b , 4 ?.J Y Occupancy groups:
City /State /ZIP: 77 ti +v , prt_ /7 2-z3 Existing:
Phone: ( ) Fax: ( ) New:
1SLAPPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: it" ry ff9 i ti/"I a J , t t c Structural plan review fee (or deposit):
Contact name: Alper ,ee.- -"ie—
FLS plan review fee (if applicable):
Address: 4 jl3 / A/e 37•• q.,,4
City /State /ZIP: Pc.�r _„j) G� -1 7 2 21
Total fees due upon application:
Amount received:
Phone: (473) 5-7y '- 7 7 72, Fax:: ( )
E -mail: .4.1. A751 '11,71 - S , f h l .. c/ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted PhotoVoltaic Solar Panel System.
Business name: ti! (9 �. y 1 n., rf ,- / j L L C Submit two (2) sets of roof plan with connection details
( and fire department access, along with the 2010 Oregon
Address: t. y3 1 iUO 37 A-"- Solar Installation Specialty Code checklist. .
City /StatelZIP: t� ✓7`Ls¢vL3 1 ` � Permit Fee (includes plan review
L r and administrative fees): $180.00
Phone: (565) s, y-777 Z Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lie.: ri-3 3 Total fee due upon application: $201.60
Authorized signature: L 1s -i / This permit application expires if a permit is not obtained
> _ within 180 days after it has been accepted as complete.
Date d * Fee methodology set by Tri -County Building Industry
Print name:
�de e- q 21, . 4 ,,, V zz / z4 /) Service Board
I: \ Building \Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(11 /02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
Received
City of Tigard Permit No.:
1 11 1 1 3125 SW Hall Blvd., Tigard, OR 97223 Associated
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
T I G A R l) 24- Hour Inspection Line: 503.639.4175 ❑Electrical ❑ Plumbing ❑Mechanical
Internet: www.tigard- or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes 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, roofmg, 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.
It RISDIC "FIONAL SPECIFIC'S
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.
I:1Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440 -4613T(11 /02 /COM/WEB)
Electrical Permit Application _.
.<:-. • •
City of Tigard
. ,,, Ari, 'to:\ V. ''.., :51- • •
. , . , ri,..m.u., i ... 14•••••• Permit No.: „i i r ., _
13125 SW Hail Blvd., Tigard, OR 9n2: -.7., 7 7 :: t:61r Plait
Si 111"111.1116111
Phone: 503.7181439 Fax: 503.598.1 • ....... IV Datel3y: Other-Permit
Inspection Lint: 503.639.4175 • 4N e ti L. , Dats Iteedy/By:
Internet vAvvr.tigard-or.gov R.‘ ..,-,411otifiedthAethod:
fart,-- [ El fles Page 2 for - -
59 10dementel Infonnatitte
TYPE OP WORK
1.. S\
, -11 , A PLAN REVIEW
1 .
. ' Please cheek all that apply (mann 2 sms eaters %Mem checked beiow):
0 New construction ' .II Addition/alteration/rep .'?'. - ‘
ViL .
El service or feeder 400 maps or more 0 Beading ova three morns.
. ,. '
0 Demolition 0 a „ _ . r„...„
ohne the available halt current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Fleming beildians.
CATEGORY OF CONSTRUCTION
km to mooed. or exceeds 14,000 0 Commacialime agricultaral
13,1- and 24amily dwelling 0 CommercialAndustrial 0 Accessory building maps for ell other inamtlations. buitedap.
0 Multi-family 0 Master builder 0 Other a Yoe pomp. 0 lestallatioa of 75 KVA OT
0Emagesey system. Wier soaretely derived system.
JOB SITE INFORMATION AND LOCATION 0 Addition of new motor 'oat of a 'A". "S "1-r,
• ocamency.
lob no.: I Job site address: // 0 .9. aefrekeie a A, si. or cr i nsidsatist wits. a necreatiosal vehicle pads.
d...7 0 Healthcare facilities. 0 Supply voltage fix more than
City/State/ZIP: 176 i f-,e0 / 04, .1 7 z - z-3 o Hazardous locations. 600 volts nominal.
, 0 Service
Suite/bldg./apt no.: Project name: .. e.,, , s5 & it-e--- or feeder 600 sumo ar mere.
FEE SCHEDULE
C r o s s s t r e e t / d i r e c t i o n s t o job site: l i t e r m i l e s QUI — 7 1 .PV I 4 1 Tetair
New residential single- or multi-family &relief! unit.
Ineades attached prep.
Subdivision: I Lot no.: 1,000 eq ft. or less , 168.54 4
Ea. addl 500 sq. ft. or portion 33.92 . 1
Tax map/pared no.: Limited menu, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, muki-famtly
, 75.00 2
residentialkvidi above sq. it.)
Bliffiell y 01/e-rf ' c44", Services or feeders instatiation alteration, andfor reierntioa -
200 amps or less 100.70 2
. _
SiiROPERTY OWNER 1 0 TENANT 201 amps to 400 naps 13356 . 2
401 amps to 600 anspe 20S.34 2
NaM j'ef e.AX L.. 601 amps to 1,000 amps 301.04 ' 2
A d d r e s s : / ft , b 8 Si- 6 " / - z - e 4 o,....- ...,,i i-Jr Over 1,000 amps a volts 552.26 2
CilY/StatialP lir / 2-2-3 Temporary services or feeders Installation, alteration, and/or
: iv.A-- t die._ 1 " relocation
llane: ( ) I Fax ( ) 200 amps or less , .. 59.36 1
201 m to 4110 amps 125.08 2 am
Owner installation: This installation is being made on property that I own which is not
401 amps
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 1�599 amps • 168.54 2
Brandt circuits- nes yilteration, or ratenskin, per mind
Owner Migratory _ Date: A. Fee for Match circuits with
"APPLICANT 1 0 CONTACT PERSON . above service or feeder fee,
aach branch circuit 742 2
, -
Business name: fry s areeir / el gulf id ti-,C., B. Fee for Wench circuits wirhow
1 service or feeder fee, fug
I 56. 18 Ain 18 2
breech circuit
Contact name: g .44trti L.1....e....... .
Each 'del branch circuit 7.42
Address: 6, y3 / Ai 4 3 - 71 4 %. 4. ..„,e .
Miscellaneous awoke or feeder sot Included) 2
Each manutheture.d or modular
City/State/ZIP: ,4 .. 77,,,,.... , 0. €,,,,c, 1 "1244 / . dwelling, service and/or feeder 67.84 2
rn 77/ z_ I Fax: :( ) Reconnect only - . 6724 2 1
Pomp Grit circle 67.84 2
E-mail: 41.9.-,....-1143 CO ,4 d is, "g. A *41 4 .. e...,..., Sign or outline fighting 67.84 2
CONIRACTOR Signal twangs) or linutedwleritY
Panel, alteration, er entension. c Page 2 2
Business name: e....jec..c5 efe-r......./0_,-.c Each additional Inspection over allowable In any oldie above
Address= e. 0- d 1.3 3 r Additional Macedon (I hr min) 662511w
Investigation (1 br min) „_ 6625/hr
City/State/ZIP: Se.„,o-pace-rtI ott 17 ryo Industrial plant 0 hr min) 7838/hr .
Phone: ( Sal3) ZS7 &Y-/ I FM ( :5) 3. --- c 7, a - Inspections for vArich no fee is 90.00f a
D speak:idly Mud CA hr min)
CCB Lic.:49,f8S7 Electrical Lic.: Cl-ili-li S_up 6.515 ' EIECIRICAL PERMIT HMS
p Suprv. Electrician signature, required: 1...---
Print name: /71011,44 5 (;--. , i ..- I ate: W7-
47.
Subtotal:
Plan review (2511of permit lis0 „.
Stem surcharge (1256 of permit KO &, 74
Authorized signature:/resr4-.. -a 1 *---
../.4 . TOTAL rumor rEar
nrs permit appliestien *spires ifn pent& beat ebtatmedmitlen 110
Prat 118Me: -166 t oi 6 /4) iiiit*t...5 Date:iV72 5-1(; days atter libel bees exigent as complete.
• Number dim/Mom Wowed pm permit.
mitteswenzimacArmit.tmume MUM 404615411/05/COMM/E13