Permit '� ,, CITY OF TIGAR MASTER PERMIT
' ' / :.'- COMMUNITY DEVELOPMENT Permit #: MST2011 -00073
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2011
T 1Ci AR D Parcel: 2S 104AA01400
Jurisdiction: Tigard
Site address: 12270 SW BELL CT
Subdivision: BELLWOOD Lot: 63
Project: ALLENDER
Project Description: 525 sf. addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 525 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 525 sf Value: $53,497.50 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach. 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 2 Garbage Disp Drains: 0 0 Water Heaters 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain. 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 1
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 1
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
F u rn> =100 K: 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: 4
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:
ADD SF VB R -3 525
Owner: Contractor:
ALLENDER, TARA & THOMAS OWNER Required Items and Reports (Conditions)
12270 SW BELL CT 1 Ersn Cntrl 503 - 681 -4444
TIGARD, OR 97223
PHONE: PHONE:
FAX'
Total Fees: $2,045.69
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cot s 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 iss - • ..- • ' - is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon ' • i'cation I e rules are set forth in OAR
952 - 001 -0010 throu•h OAR 952 - 001 -0090. You mav_obta'n a copy of the rules or direct questions to OUNC by cal '. 503.232 :' or 1.801.332.2344.
Issued By: `w , i�� /- ... /` Permittee Signature: •`
503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit ca . hall be kept in a conspicuous place on the job site until completion • -the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
�
t^,
Residential \ FOR OFFICE USE ONLY
City of Tigard Date /B : /;' Permit No.: a �� , f_
Date /B :
M
13125 SW Hall Blvd., Tigard, O ' n %'\\ Plan Review 7/ �
Phone: 503.718.2439 Fax: 503 Y>0 (• Received
L�.`• Other Permit.
�i
TIGARD Inspection Line: 503.639 �n y��Q Date Ready /By: ® See Page 2for
Internet: www.tigard- or.gov \�` f q \� Notified/Method: aU // )4 Supplemental Information
TYPE OF W ` Q �' REQUIRED DATA: 1 - AND 2 FAMILY DWELLING
El New construction ❑� molition 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: $3 0 �`3 4/7 5
❑ Accessory building ❑ Multi - family Number of bedroom : 1
❑ Master builder ❑ Other: Number of bathrooms: 1
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address: 12270 SW Bell Ct. New dwelling area: 525 square feet •
City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Allender Covered porch area: square feet
Cross street/directions to job site: 127 / Bell Ct. 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.
New master bath/ bedroom Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Thomas Allender Type of construction:
Address: 12270 SW Bell Ct. Occupancy groups:
City /State /ZIP: Tigard, OR 97223 Existing:
Phone: (971)219 -9313 Fax: (503)213 -5993 New:
❑ APPLICANT . ® CONTACT PERSON • BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee (or deposit):
Contact name: Thomas Allender
FLS plan review fee (if applicable):
Address: 12270 SW Bell Ct.
City /State /ZIP: Tigard, OR 97223 Total fees due upon application: /10 .7)..
•
Phone: (971) 219 - 9313 Fax: : (503) 213 -5993 • Amount received:
E -mail: thomas.allender @gmail.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System.
Business name: Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City /State /ZIP: Permit Fee (includes plan review $180.00
and administrative fees):
Phone: ( ) n Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lie.: -.�-----7
Total fee due upon application: $201.60
,. I
Authorized si nature: \ 1 ' This permit application expires if a permit is not obtained
g L t \ / .. within 180 days after it has been accepted as complete.
Print name: Thomas C. Allender Date: 5/3/2011 *Fee methodology set by Tri -County Building Industry
Service Board.
.r -
Electrical Permit Application `\ FOR OFFICE USE ONLY
City of Tigard
n Received Permit No.: v wit
`, g Tigard, S ' l!r122 � Q�\ Date/By: r// ti t.XX)7
13125 S W Hall Blvd., . , . I Plan Review
Phone: 503.718.2439 Fax: 503.5'8`.1960 \ •••• B Date : Other Permit:
TIGARD Inspection Line: 503.639.4175 a p r �' O Is Date Ready/By: tuns: ® See Page 2 for
Internet: www.tigard- or.gov \\�t`` t � "�V Notified/Method: Supplemental Information
TY PE OF WO PLAN REVIEW .
❑ New construction ® Addition /alterati0 , A Pracement Please check all that apply (submit 2 sets of plans w /items checked below):
V ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY GORY 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: 12270 SW Bell Ct. 10ORP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ 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: 127 / Bell Ct. Description I Qty. I Fee. I Total l
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'I 500 sq. ft. or portion 33.92 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
New panel, new bedrrom / bathroom circuits residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 0,70 2
® PROPERTY OWNER ' 0- TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Thomas Allender 601 amps to 1,000 amps 301.04 2
Address: 12270 SW Bell Ct. Over 1,000 amps or volts ' 552.26 2
City/State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (971)219 - 9313 N Fax: (503)213 - 5993 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: Thislinstallation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale lease, re t, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: J /"."\. Date: c ° ° 7I 1 ( A. Fee for branch circuits with
' El APPLI'CANr ' ' ' — above service or feeder fee, 4
❑RCONTACT PERSON each branch circuit 7.42 O� ��. 2
Business name: B. Fee for branch circuits without 1 ��
service or feeder fee, first 56.18 2
Contact name: Thomas Allender branch circuit
Each add'' branch circuit 7.42 2
Address: 12270 SW Bell Ct. Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: Tigard, OR 97223 dwelling, service and /or feeder
Phone: (971) 219 -9313 Fax: : (503) 213 -5993 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: thomas.allender @gmail.com Sign or outline lighting 67.84 ' 2
. CONTRACTOR . Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 2
lflAi Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Phone: ( ) Fax: ( )
Industrial plant (1 hr min) 78.18 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: Inspections for which no fee is 90.00 / hr
specifically listed (''A hr min)
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES..,
Print name: R Date: Subtotal: r h t
�-lI Plan review (25% of permit fee): t
Authorized signature:\+(k A State surcharge (12% of permit fee): 5, G�
TOTAL PERMIT FEET K3 0
Print name:''° e A �tA L Date:5.5, e 2.61 e
J - '
Mechanical Permit Application FOR OFFICE USE ONLY
V, tf$
City of Tigard Received
`J � r - Date/By: Permit No.: `/ 1/ - 13125 SW Hall Blvd., Tigard, OR 97223 ' Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 p \ Date/By: Other Permit:
TI G A R D Inspection Line: 503.639 � , p P { - 6 Date Ready/By: Juris: ® See Page 2 for
5 T
Internet: www.tigard - or.gov \`�` )1\1c fied/Method: Supplemental Information
a t
c'� OF ,.,\l,t�
TYPE OF WORK \ 11 D1w� U t v COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
}}}}����,,,,{{{{ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
ulti- family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: l 2:22 SLR (2_ (.. (requires site plan showing placement) 46.75
Furnace 100,000 BTU
City /State /ZIP: rJt�fk e_D / °L322 (ducts/vents) t ) 46.75
Furnace 100,000+ BTU (du/ven 54.91
Suite/bldg. /apt. no.: Project name: -AL LT-.., Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: (,2 - 4 -11-k / ..e et Duct work l 23.32 2-
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
ADO Gas fireplace 33.39
ll �� , Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
PROPERTY OWNER l ❑TENANT Chimney /liner /flue /vent
23.32
X Other: 23.32
Name: (4 C t A 1,`W Environmental exhaust and ventilation:
Address: 12 Q�� ( A E �7 L t!`"_ Range hood /other kitchen
C (� equipment 33.39
City /State /ZIP: I r t f ' ` c 6722..-3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms, / d
Phone: (C ) 2 lei -el 51 3 Fax: (j3) 'L (5 - 5T [3 toilet compartments, utility rooms) Z 23.32 i1a
j':1 APPLICANT )(CONTACT PERSON Attic /crawlspace fans 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: 5 C ? ALL : 6 $14.15 for first four; $4.03 for each additional
Address: 1 222 3 C �� CT Fumace, etc.
�� n p, Gas heat pump
,� v - 6
City /State /ZIP: 4L9 3 0 ( 'l7'Z`3 Wall/suspended/unit heater
Phone: (cm )- 2Do(. �`3 (3 Fax: : (5503) 2A3 . 5003 Water heater
t (,,, 6:14A Fireplace
E -mail: ---- �o�c-S . t�l (,LV( ( f f / 4 C (� , � Range
CONTRACTOR �I Barbecue
Business name: C� Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal et
9
Minimum permit fee ($90.00) S('),
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB tic.: State surcharge (12% of permit fee) to, E, 0 / �
TOTAL PERMIT FEE (no r e
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
/
Print name: (�'b 5 L. - - Date: 514/ l i • Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits\MEC- PermitApp.doc 09/09/10 440 -4617T (1 I /02/COM/WEB)
` 4
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
I:\ Building \Permits\MEC - PermitApp.doc 09/09/10 2
Y t •'
Plumbing Permit Application
Building Fixtures OFFICE USE ONLY
City of Tigard �� Date /Bed T PermitNo.. $ `- 7 a 13125 SW Hall Blvd., Tigard, OR u " \\I y ��
C ... Plan Review
II
Phone: 503.718.2439 Fax: 503.59 * 8�I�b0 A
'k 0 11 Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD \\10.'\( DateReady/By: tuns. ® See Page 2 for
'
Internet: www.tigard- or.gov Y
1 .N Notified/Method: Supplemental Information
TYPE OF WORK r 1"( dfr (p100 FEE'*' SCHEDULE
❑ New construction ❑ Demb v ` �liU�In � For special information use checklist
"" Description I Qty. I Ea. I Total
® Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE -INFORMATION AND LOCATION Site utilities:
Job site address: 12270 SW Bell Ct. Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: Tigard, OR 97223
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Allender Manufactured home utilities 50.03
Cross street/directions to job site: 127 / Bell Ct. Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New master bath
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER . I ❑ TENANT, , Expansion tank 12.51
Name: Thomas Allender Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 12270 SW Bell Ct.
Garbage disposal 25.02
City/State /ZIP: Tigard, OR 97223 Hose bib 1 25.02 '2602-
Phone: (971)219 -9313 Fax: (503)213 -5993 Ice maker 12.51
. ® APPLICANT - ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: .
Primer 12.51
Contact name: Thomas Allender
Roof drain (commercial) 12.51
Address: 12270 SW Bell Ct. Sink/basin/lavatory 2 25.02 ;:).(:)
City/State/ZIP: Tigard, OR 97223 Solar units (potable water) 62.54
Phone: (971) 219 -9313 Fax: : (503) 213 -5993 Tub /shower /shower pan 2 12.51 25, 02...
E -mail: Urinal 25.02
CONTRAC TOR Water closet 1 25.02 Z_5,
Water heater 37.52
Business name: (nt lJg'PAr Water pipinglDWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal 105-. ( t)
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: i Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) (5 I
Authorized signal re: Icy TOTAL PERMIT FEE) 4 (7 ( I
Print name: 11,1 OftA v Z.. ,\.//A LLE M 1e..„ Date: .5 .3 • Z8 ( ` This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
ft
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.
Li 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.
Print Name of Pe 1 it Applicant
GA I /Z. 01
Signature of Pe i Ap• 'cant Date
Permit #: MST .) j// -- 00n7 j
Address: / SZAI. dz// ~ s
S y .
• r` ,� •
T,a, 973 •
5. Issued by: Date: 5 74
This Copy for Permit Offices
II
Building Division
Development Code Provision Review
rIGARD Residential Projects
Building Permit No: MS 7 — CX.Y) ..
CWS Service Provider Letter Received: Yes ❑ No -/A ❑
Routed Plans:
Original Plan Submittal Date: 5/0/
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
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. C D
Planning Review (contact at 503 - 718 - oti't i or cAP` ,/ , @tigard- or.gov)
Land Use Case No. Name -6 l ( 6-)'LCJeir
Lei Zoning 24. c;
Er Setbacks: .-/ / ', ,
Front 22 Rear I Side J Street Side /S Garage /
❑ Maximum Building Height 3V Actual Building Height (Ft
Er Visual Clearance
f Easements
I ensitive Lands Type: A) /FY
Notes:
Original Plan: Approved d Not Approved ❑ Date: SI
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (co tact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope:
Notes:
Original Plan: Approved f Cl Not Approved ❑ Date: #1_____
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City t rborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
trees Trees
Protected Trees
Notes:
Original Plan: Approved V Not Approved ❑ Date: 5j
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @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: I/
Page 2 of 2
Clean Water Services File Number
C1eanWater Services 11- 002045
Sensitive Area Pre - Screening Site Assessment
1. Jurisdiction: Tigard
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Thomas Allender
Company:
Address: 12270 SW Bell Ct.
Site Address: 12270 SW Bell Court City, State, Zip: 97223
City, State, Zip: Tigard, OR, 97223 Phone /Fax: 971 219 -9313
Nearest Cross Street: 127th / Bell Ct. E -Mail: thomas.allender @gmail.com
4. Development Activity (check all that apply) 5. Applicant Information
• Addition to Single Family Residence (rooms, deck, garage) Name: Thomas Allender
❑ Lot Line Adjustment ❑ Minor Land Partition Company:
❑ Residential Condominium ❑ Commercial Condominium
Address: 12270 SW Bell Ct.
❑ Residential Subdivision ❑ Commercial Subdivision
❑ Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip: 97223
Other Phone /Fax: 971219 -9313
E -Mail: thomas.allender @gmail.com
6. Will the project involve any off -site work? U Yes No ❑ Unknown
Location and description of off -site work
7. Additional comments or information that may be needed to understand your project
This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ
1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and /or Department of the Army
COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify
that I am familiar with the information contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate.
Print/Type Name Thomas Allender Print/Type Title
ONLINE SUBMITTAL Date 5/9/2011
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially 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 the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report
may also be required.
ZI Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site. This
Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently
discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local, State, and federal law.
❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially
sensitive area(s) found near the site. This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water
quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order
07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law.
❑ This Service Provider Letter is not valid unless CWS approved site plan(s) are attached.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by Date 05/ 10 / 2 011
www: cleanwaterservices. or
2550 SW Hill ... - . .�.. - .. o; Oregon:97123 Phone: (503) 681 -5100 • Fax (503) 681 -4439 g
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TAX I D #: 104AA01400 MAY — 4 2011 +
(E) / TAX ACCT #: R47'1413 -,- fl p, re ,�
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SUBDIVISION: BELLWO =1,� 11 1 °'
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STRUCTURAL FOUNDATION DETAILS W
C ' S4.1 STRUCTURAL WALL AND ROOF DTLS.
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VICINITY NAP
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• SW BELL COURT AI.O NTS
' MASTER PERMIT
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CITY OF TIGARD �` i . . °1
`' ' COMMUNITY DEVELOPMEN Permit #: MST2011 -00073
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2011
Parcel: 2S 104AA01400
Jurisdiction: Tigard
Site address: 12270 SW BELL CT
Subdivision: BELLWOOD Lot: 63
Project: ALLENDER
Project Description: 525 sf. addition. 6/1/11, reprinted to show u•dated Total Fees.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 525 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 525 sf Value: $53,497.50 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker. 0 Hose Bib: 1 Backwater Value: 1
Drywell- Trench Drain' 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 1
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. 4
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:
ADD SF VB R -3 525
Owner: Contractor:
ALLENDER, TARA & THOMAS OWNER Required Items and Reports (Conditions)
12270 SW BELL CT 1 Ersn Cntrl 503 - 681 -4444
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Total Fees: $2,467.65
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. A - s • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 % -0010 through 16 • R • - - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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I sued By:_. / ! A� - =L Permittee Signatur • 02
Call 503.639.4175 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.