Permit . A k,,,iy6/t,at (* ezeci--ri
y ,, CITY OF TIGARD
MASTER PERMIT
$ , C OMMUNITY DEVELOPMENT P ermit #: MST2009 -00083
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/20/2009
Parcel: 1 S 133DC 10200
Jurisdiction: TIG
Site address: 13210 SW BRITTANY DR
Subdivision: Lot:
Project: PAVLUKOVICH
Project Description: Add 240 sf attached shop. 5/6/11, reprinted permit to include (2) additional circuits.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: First: sf Basement: sf Left: 15 Parking Spaces:
Height: 13 Bathrooms: Second: sf Garage: 240 sf Front: 15 Smoke
Dwelling Units: 1 Third: sf Right: 5
Detectors: No
Total: sf Value: $9,052.80 Rear: 15
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Urinals:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Storm Sewer:
Tubs /Showers: Garbage Disp: Water Heaters: Water Lines: Drains: Catch Basins:
Bckflw Prevntr:
Footing Drain: Ice Maker: Hose Bib: Backwater Value:
Other Fixtures:
Drywell- Trench Drain:
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers:
Heat Pump: N Hoods: Other Units:
Fum <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: 201 -400 amp: 201 -400 amp: W/O Svc/Fdr: 2
Mfd Home /Feeder /Svc: 401 -600 amp: 401 -600 amp:
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:
ADD SF VB R -3
Owner: Contractor:
PAVLUKOVICH, ROBERT REMODELING & MAINTENANCE SERVICES Required Items and Reports (Conditions)
13210 SW BRITTANY DR PO BOX 231061 1 Ersn Cntrl 503 - 681 -4444
TIGARD, OR 97223 TIGARD, OR 97281
PHONE: PHONE:
FAX:
Total Fees: $435.42
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• • = ' R 952 - 001 You ma • • - • • - • • of the t questions to OUNC by calling 503.23 .1987 or 1.800.332.2344.
4
Issued By /� ermRtee Signature:
Ca I .0k= - 5 by 7:00 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.
CITY OF TIGARD MASTER PERMIT
1114 COMMUNITY DEVELOPMENT Permit #: MST2009-00083
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/20/2009
Parcel: 1S133DC10200
Jurisdiction: TIG
Site address: 13210 SW BRITTANY DR
Subdivision: Lot:
Project: PAVLUKOVICH
Project Description: Add 240 sf attached shop.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: First: sf Basement: sf Left: 15 Parking Spaces:
Height: 13 Bathrooms: Second: sf Garage: 240 sf Front: 15 Smoke
1 15 Detectors: No
Dwelling Units: Third: sf Right:
Total: sf Value: $0.00 Rear: 15
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain Catch Basins:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Drains: Other Fixtures:
Tubs /Showers: Garbage Disp: Water Heaters: Water Lines:
Bckflw Prevntr:
MECHANICAL
Fuel Types Air Conditioning: Vent Fans: Clothes Dryers:
Heat Pump: Hoods: Other Units
Fum <100K: Vents: Woodstoves: Gas Outlets:
Fum > =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'I Br Cir:
601 -1000 amp 601 +amp- 1000v:
1000 +amp /volt:
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:
ADD Single Family VB R -3 240
Owner: Contractor: Required Items and Reports (Conditions)
PAVLUKOVICH, ROBERT REMODELING & MAINTENANCE 1 MST Ersn Crltrl 503 - 681 - 4444
13210 SW BRITTANY DR SERVICES
TIGARD, OR 97223 PO BOX 231061
PHONE: PHONE:
FAX:
Total Fees: $418.80
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 h 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.
Issued B y: LUL ` L�, Permittee Signature:
�.._
. Building Permit Application
Residential CEi \TED „ - .FOR OFFICE USE ONLY
L _
City of Tigard Recei Date/B ve a ,a14. • - Permit No 11 ., O. Q ' �I�Y
13125 SW Hall Blvd., Tigard, OR 97223 FEB 2 4 2009
Plan Review
Phone: 503.639.4171 Fax: 503 598.1960 Da /By: / k,_, � j I i Oe3 Other Permit:
TIGARD Inspection Line: 503.639 CITY OF TIGARD Date Ready /By. q Juris: ® See Page 2 for
Internet: www. tigard- or.gov BUILDING DIVISION Notified/Method:0 • � , 7 c l 7 ■ /, Supplemental Information
TYPE OF WORK • • REQUIRED DATA: 1 AND 24AMILY 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.
�� Valuation: $ g v
05z� 8
v"' 1- and 2- family dwelling El Commercial /industrial 1
111 Accessory building 1:1 Multi-family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
. .. JOB SITE INFORMATION AND LOCATION . Total number of floors:
Job site address: / 3 Z I 0 3 ■,./ 5/Ztir; 0 , 1 Q a. New dwelling area: _9i square feet
City /State /ZIP: p( • aL 5' 1 Z ZU Garage /carport area: D14 0 square feet
Suite/bldg. /apt. no.: Project name: (,t,,0,.1-g.) r.Ne Covered porch area: square feet
Cross street/directions to job site: Co. t,.�tt,. "SA ; 7Yfr.Jy 'l- —.1 iqey -C— Deck area: square feet
Other structure area: square feet
REQUIRED DATA :.:COMMERCIAL -USE CHECKLIST
- Subdivision: Lot rto.: 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.
WO a.- t 1 f •- .41 . 7 -- v .,jor. -S 0 i /fJIr�G Valuation: $
5 ca' � � � Existing building area: square feet
New building area: square feet
%PROPERTY OWNER ` - ❑ TENANT Number of stories:
Name: ri..0.(1 0,1v Lukco Type of construction:
Address: 1 3 Z fa "4 rI 1 ()F1_ Occupancy groups:
City /State /ZIP: 77(0.1.„4,0. 0,4, 4 ? LLB
Existing:
Phone: (Of ) 33,0 7 L f, ) Fax: (4'03 )1'7 5' — 5/up I New:
❑ APPLICANT . r ' ❑ CONTACT PERSON
NOTICE .
Business name: All contractors and subcontractors are required to be
Contact name: 4 (2 �,,,i licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: (j LI j 5 ,,,,/ eit,,( i DA_ jurisdiction in which work is being performed. If the
City /State /ZIP: 77671.,,,„,2 ZL3 applicant is exempt from licensing, the following reasons
(, 5 apply:
Phone: (CO i ) 3 3' -? Li, - 7 Fax: : (5 93 )s-?5 3 yo f
E -mail: Y �q ft., ✓ e 1 ; ,ie
CONTRACTOR .
Business name: j2�n S Ct C.C;� . -e- BUILDING PERMIT FEES*
•
Address: /°j 63 e v 2.3 I 4 I' (Please refer to fee schedule)
City /State /ZIP: Structural plan review fee (or deposit):
�� f Qi � FLS plan review fee (if applicable):
Phone: (fPJ ) I70 7 ? ' Fax: (Jb 3 ).C? 5 i Sid %
CCB lie.: C'.4 IV Total fees due upon application:
Amount received: Tu,
Authorized signature:
This permit application expires if a permit is not obtaine .
within 180 days after it has been accepted as complete.
Print name: / ■ - Date: L `t
T y' * Fee methodology set by Tri County Building Industry
Service Board.
L \Building \Permits \BUP -RES PertnitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB)
Building Permit Application Checklist .
One- and Two-Family Dwelling FOR ,OFFICE USE :ONLY.
Received . . ,, ..
City of Tigard d Permit No..
III . - u 13125 SW Hall Blvd., Tigard, OR 97223 Date/
By
503.639.4171 Fax: 503.598.1960 Associated penults.
TIGAR D
24- Hour Inspection Line' 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard- or.gov ❑ Other:
' I E' R L
_ ;
I. THE'FOLLOWING .. • • , ., . S , REQUIRED' PAN 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. ❑ ❑ ❑ I
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 Oregon and shall be shown to be applicable to the project under review.
IURISDICTIONAL SPECIFICS
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.\ Building \Permits\BUP- RES- PermitApp doe 03/21/06 440- 4613T( I I /02 /COM/WEB)
Electrical Permit ApplicatioiRECEI�TED FOR OFFICE USE ONLY
City of Tigard Received iii J
• �. _ i- Permit No.: ] 4 . • 4.00 404
° 13125 SW Hall Blvd., Tigard, OR 97223 FEB 2 4 2009 Plan Review
, '. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit.
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: lu ® See Page 2 for
Internet: www.tigard or.gov Notified/Method Supplemental Information
BUII DING DIVISION
- TYPE, OF" WORK . . PLAN REVIEW ," •
❑ New construction XS Addition /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
T 61- 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 0 Emergency system. larger separately derived system.
,. 12 Addition of new motor load of ❑ "A ", "E ", "I - 2 ", "l - ",
q 100HP or more. occupancy.
Job no.: Job site address:
32 /0 S w .4AA i 7?1 A..1 0 R ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: i7 44¢4„1) oit. q >, . L j ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: (40/Lic.S ff,9 e ❑ Service or feeder 600 amps or more.
_FEE SCHEDULE `
Cross street/directions to job site: cV` „��J 4 t _ /1 Description I Qty. I Fee. j Total
_' T New residential single- or multi- family dwelling unit.
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,' -OFtiR O RK . (with above sq. ft.)
Limited energy, multi- family 75.00 2
G.42iL,ie_ l - 4,7-t zl j7 xlc✓° ) € c j , ,4 / -6 i L - 5W4(t4 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
• ct/f" 200 amps or less 80.30 2
' c PROPERTY „OWNER " , ' ' ❑ TENANT, , . 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
3 �� `�� ��
-- - 601 amps to 1,000 amps 240.60 2
` ' ` Address: ( it ( 2 St es 4,A...,_ T-Tyfrk 0' Over 1,000 amps or volts 454.65 2
___ City/State /ZIP: , * � � 2 3 Temporary services or feeders installation, alteration, and/or
relocation
- --- Phone: ($) ) 30 11_6,7 Fax: (,O)) ..5 3' y,.)/ 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, lease, rent, or exchange, 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: i°( Date: �/ / lY / t1
A. Fee for branch circuits with
APPLICANT ' - ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: fl-u -6 71,E _ .tl CAL' without service or feeder fee, 4 46.85 �' -3 2
K first branch circuit ���
Address: f 3 'Li v 5 „,J el , ; ,r r D 2 Each add'I branch circuit I 6.65 ( 45
Miscellaneous (service or feeder not included)
City/State /ZIP: (7144 .0 G .A., 9 )L L 7 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (Pi ) 330 '7 Zto 7 Fax: : (W ' ) _ 7 ) " , �r Reconnect only 66.85 2
E -mail: rrj.►1 a q '� - e, n Pump or irrigation circle 53.40 2
- . - CONTRACTOR ,' - . , Sign or outline lighting 53.40 2
Business name:
it 0 0 Signal circuit(s) or limited-
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: 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 Lic.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
_ ELECTRICAL' PERMIT :FEE_S 1 .. • -
Suprv. Electrician signature, required: Subtotal: - j 0
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): (0,41Z-
Authorized signature: TOTAL PERMIT FEE: 69
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
L\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(t 1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
iRESIDENTIAI ":W,ORK ONLY:` , ": -',
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n 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
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other .
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I. \Building\Permits\ELC- PermitApp doc 03/23/06
Nov 20.08 08:09a RAM Services 503 - 579 -3401 p.2
Nov. 19. 2008 11:11AM No. 1509 P. 2
` 1°A1 1 2008
Clean Water Services File Number
Clea r e -G� S
nWai�a� Sea-vices % -7
bit
Sensitive Area A Pre- Screening Site Assessment
•
1. Jurisdiction: �l 4 /1
2. Property Information (example 1S234A801400) 3. Owner Information
Tax lot i D(s); _ 95/ 33 Pd. O2,OO Name: 11.0 tl'/I V t u ( <o v
Company:
1513.3 Dc - to Z v o Address: (3 Z 604.'7774- A2
Site Address: ( 32. t S •a✓r—r T7 - V.--'y D E- City, Slate, Zip: 9 72_Z -
City, State, Zip: it lor4 --t9 e . oit- Q 7Z. z 3 PhonelFax: SD 3 S`2 9 3 Vo
Nearest Cross Street. 5C F`L y / 3c., 54A d'a .•-• s e r Ci..), g t & 4
4. Development Activity (check all (het apply) 3. Applicant information
I a Addition to Single Fancily Residence) (rooms, deck, garage) Name: 54 45
0 Lot Line Adjustment M:nor Land Partition : Com an
A Y
0" Residential Condominium Q Commercial Condominium
Address:
Residenlial Subdivision 1l Commercial Subdivision
Single) Lot Commercial 171 Multi Lot Commercial City, Stets Zip:
Other Phone/Fax: _
E -Meil:
6, Will the project Involve any off -site work? oyes g.tdo ❑ Unknown
Location and description of off -site work
7. Additional comments or fnf� rmatiora that may be needed to urrderstaad your project WDre(cs ov-1 •
SL�t m: Los 4e,s•t-O !c. i Z ? Ld
This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ
1200 Permit or other permits as Issued by the Department of Environmental Quality. Department of State Lands andlor'Department of the Army
COE. All required perm`t.s and approvals must be obtained and completed under applicable local, stale, and federal law.
Hy signing trnls 'orm, Me Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Olean Water Smites have minority
to enter the pro site at all reasonable times far the purpose of inspecting project eltecondMons end gathering Information related to the pooled site. i 6eilify
that I am familiar with the Information contained In this document, and to the bast of my tmowlodge and belief. this infermaion is true, comprete, and accurate.
Print/Typo Name s 4 -..vcr P ✓L- (t f<cr� Lvc Prinf/Type Title ,
��
signature � - - -- - - - - - - -- - - - -nete zo - s -
FOR DISTRICT USE ONLY
Q Sen ateaspotentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A •
SERVICE PROVIDER LETTER, If Sensitive Areas exist on (he site or within 200 feet on adjacent properties, a Natural Resources Assessment Repoli
may also be required.
❑ Eased on review of the submitted materials and best available information Sensitive areas do riot appear to exist on site or within 200' of the -oRe. This
Sensitive Area Prescreening SlleAssessrreni does NOT eliminate the need to evaluate and protect water quality sensitive areas if They are subsequently
discovered. This documenlwill serve as your Service Provider letter as required by Res oluion and Order 07. -20, Section 3,02,1. All required permits and
approvals must be obtained and completed under epp:leable local, Stale, and federal law.
Based on revew of the submitted mate ems and beat available ihformaticn the above referenced protect will not significantly impact fne existing or potentially
scnsieve area(s) found near the Fite. This SensiliveArea Prescreening Sits r asessmenteoes NOT eliminate the need to evaluate and protect addiionaiwe
qua5(y serisliiva If (hey are subsequently disoovared This document will serve as your Service Provider letter as required by Resolution and Order
07 -20, Section 3.02.1, All required permits end approvals must be obtained and completed'Under applicable local, state and federal law.
This Service Provi letter l not 'ialld unless J CWS approved site pianis ) are attached:
❑ The proposed aoliviiy does no! meet the de.nilion of development or the col was plaited after 9)9)95 on 92.040(21. NO SiTE ASSESSMENT OR
SERVICE PROVIDER TER IS REQUIRED.
Reviewed by • Date Q g
a m.
2550 SV6' I. 1 Q11, „J •, r{ esbci o !Oregcn t'tionc: (503) -S100 1 (503) -4335 - wn I cl ticterscrvices.prg
Nov 20 08 08:10a RAM Services 503 - 579 -3401 p.3
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•
Approved
Clean Water Services
By 0 ,-- Date 1,
13210 ' SLL 5fRITTANY DR
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CITY OF TIGARD
0 Approved C V ]
:7,!onditionally Approved
Fr only the work as de cribejil in: , •
PEFIMIT NO. v al - t9'
See Letter to: Follow i I
Attach [ 3
Job Add s: 19-/0 50)AKITT lvf—biz
: _ _ Date: "5/15' .0_79_.......
CITY.OF TIGARD - SITE 1
CITY OF TIGARD -SITE PLAN REVIEW PLAN
' _ � �� v� IN VIEW
BUILDING PERMIT N
BUILDING PERMIT NO.: ►► ■ 0,00 • _
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PLANNING DIVISION: roved O. PLAN
O ` I E
71 N Approved 3 ' ( o s:
Required Setbacks: , O Approved
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Side: j
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Front. _ :. - T—y - � ': �"
pProved Date: 3 /- G
rt -:_ . / _ Notes:
VisuarCieacance CWS
Maximum C .. O No
CW'S Service ? ::. . k e vived = -- _
B . _: " ` ~
ENGINEERING DE i° < Not Approved
Actual Slope: °i0 Al � A1'pr0ved N ot Approved
- .roved --/•'1"
Site Plan: Date _
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- Notes: Gz
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1 , CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: 111AZ51.2sMC:3 . CoC2)0 8
CITY OF TIGARD - SITE PLAN REVIEW PLANNING DIVISION:
BUILDING PERMIT NO: f\A_T2_0:::)9 _got. • mitt Required Setbvks: 0 Approved Approved
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Side: ......._ Street Side: i c )
Street Trees: GiAPProved 0 Not Approved Fron c'
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Protected Trees Approved 0 Norproved Visual Clearance: 0 App 0 Not Approved
By: --1-1dPliti Date: 'ya o 7 \ I maximum Building Heie.ht 2..L. feet
Notes: Y)` C\VS Service Provider Letter Required: 0 Yes 0 No
lib Too "rs- Received
z 13Lsje dibtaf Date: -1-4.2ado 9
ENGINEERING DEPARTMENT:
Actual S opet % El Approved 0 Not Approved
Site PI : IZI-Approve d 0 lot7proved.
By: '.1-"'-- Date:
1t.Lotes:
REVISION
APPROVED
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512-1 ()AR -2 0 Oq — 0.00.
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Electrical Permit Application FOR OFFI(E. I. SL OM.)
City of Tigard � t itl' ived / i" Permit No Tha rk , � ..— 000a3
1�1 teB : �/.� Thar v �N
13125 SW Hall Blvd., Tigard, OR 97223 w
(~ P lan Review
Phone: 503.718.2439 Fax: 503.598.1960\/ /B Other Permit:
TI G A R D Inspection Line: 503.639.4175 I �e ReadyBy: Juris: ® See Page 2 for
Internet: www.tigard or.gov Noti ad(Method: 7'1 Z Supplemental Information
TYPE OF WORK O0) )5° PLAN REVIEW
tct, ACS Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition /alteration/replaceme
�,`` ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Other: `)P \\ 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
❑ 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 ", "1 -3 ",
Job no.: Job site address: 1 D 1 OOHP or more. occupancy.
3 � U n Y Or. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /LIP: I ❑ Health -care facilities. ❑ Supply voltage for more than
❑ 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: Description I Qty. I Fee. I Total I *
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' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
G a1d CJ
I f, n /'c ( b r7yk %„ c% r- ' residential (with above sq. ft.)
� " 1 / -J � Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 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
n relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease ent�ge, ' g to ORS 447, 449, 670, d 7 1. 401 amps to 599 amps 168.54 2
/ Branch circuits— new, alteration, or extension, per panel
Owner signature: Date ,5 P l / A. Fee for branch circuits with /�
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, a 7.42 l (- (� 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'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
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 (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (%: hr min) 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: Ai
Suprv. Electrician signature, required: Plan review (25% of permit fee): ref
Print name: Date: State surcharge (12% of permit fee): i - 7 r
TOTAL PERMIT FEE: C ( .
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doe 07/01/10 440- 4615T(11/05 /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*
n 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
I: \Building\Permits\ELC- PermitApp.doc 07/01/10