Permit ,, ... � CITY OF TIGARD MASTER PERMIT
,'a; COMMUNITY DEVELOPMENT Permit #: MST2011 -00081
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2011
TIGARD Parcel: 2S110CB08200 ■
Jurisdiction: Tigard
Site address: 12476 SW AUTUMNVIEW ST
Subdivision: MOUNTAIN VIEW ESTATES Lot: 7
Project: Mountain View Estates, Lot 7
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 5 First: 916 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 29 Bathrooms: 4 Second: 1456 sf Garage: 720 sf Front: 20 Smoke
Dwelling Units: 1 Third: 1569 sf Right: 5
Detectors: Yes
Total: 3941 sf Value: $440,198.71 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 500 sf: 8 201 -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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ,
NEW SF VB R -3 3941
Owner: Contractor:
J T ROTH CONSTRUCTION INC J T ROTH CONSTRUCTION Required Items and Reports (Conditions)
12600 SW 72ND AVE 12600 SW 72ND AVE #200 1 geo tech report prior to
TIGARD, OR 97223 TIGARD, OR 97223 footing inspection
2 Ersn Cntrl 503 - 681 - 4444
PHONE: 503 - 639 -2639 PHONE: 503 - 639 -2639
FAX: 503- 624 -0239
Total Fees: $20,817.31
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 fo • in OAR
952 - 001 -0010 through 0 • : :52- 001 -0090. You may obtaii - • • • • - ru es or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � !� •a. / / Permittee Signatur• - >> /�� " .---r-----
Call 503.6 • .y 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 th= • oject.
Approved plans are required on the job site at the time of each inspection.
Bililfdinu Permit Application ' ? Mir-. N ,
RE i F ' r { . - - - h Ol 0 1 , ICEPUSI ON9 1' -.--
Residential
City MAY V 1 2 Received
MA I �. / // �� �yq
` 1 Of Tigard g Date /By. � Permit No : 1 I Q o/ 1 ..._ 400 g1
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1.
p 3 .. Ot her Permit !�, / n� /�
Phone: 503.713.2439 Fax: 503.598.1960
C IT Y p}� � "t�i,' r DateB . �`1 1 v`KJKoI(!t' _0,0 / 7
Inspection Line: 503.639.4175 n t l(, ° ° ' Date Ready /: tuns: 10 See Page 2 for
TUGARD BUILD
_ Internet: www.tigard or.gov `' U d S/ Bo r Not ified/Method: ( / Supplemental Information
It flolf 14 tirpt/11
- ' TYPE OF WORK REQUIRED DATA:.1- A 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.
® I- and 2- family dwelling ❑ Commercial /industrial Valuation: :�� 1 !._
❑ Accessory building ❑ Multi - family Number of bedrooms: 5
❑ Master builder 0 Other: Number of bathrooms:
JOB SiTE INFORMATION AND LOCATION Total number of floors: 3
Job site address: 12476 SW Autumnview New dwelling area: 3941 square feet
City /State /ZIP: Tigard OR, 97224 Garage /carport. area: 720 square feet ( 61,,oi
Suite/bldg. /apt. no.: Project name: Covered porch area: 147 square feet (/
Cross street/directions to job site: Beef Bend to 122 ". Left on Autumnview Deck area: 390 square feet y
Other structure area: N square feet 25
REQUIRED DATA: COMMERCIAL -USE CHECKLIST -
Subdivision: Mountain View Estates Lot no.: 7 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.
Construction of new single family residence Valuation: $
Existing building area: square feet
New building area: square feet
' ■1 PROPERTY OWNER ❑ TENANT' Number of stories:
Name: .LT. Roth Construction Inc. Type of construction:
Address: 126(10 SW 72 " Occupancy groups:
City /State /ZIP:'l'igard OR, 97223 Existing:
Phone: (503)639 -2639 Fax: (503)624 -0239 New:
❑ APPLICANT ' , ' 1 CONTACT PERSON
'. � BUILDING PERMIT FEES *: • - .
(Please refer to fee schedule)
Business name: J.T. Roth Construction Inc. Structural plan review tee (or deposit): •
Contact name: David Jensen
FLS plan review fee (if applicable):
Address: 12600 SW 72
City /State/ZIP: Tigard OR, 97223 Tattal fees due upam application: � 0
Phone: (503) 806 -0602 Fax: : (503) 624 -0239 Amount rcecivicei: 7 '
E-mail: davidJ', tra3tl ➢inc.eoru PHOTOVOLTAiCSOLAR PANEL SYSTEM FEES*
1
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mo ted PhotoVollaic Solar Panel System. •
F➢t.linesa !II !!TIC: ,t 1'_ Roth Construction Inc. Submit two (2) ...ets of roof plan with connection details
and tire departmeta access, along with the 2010 Oregon
Address: 12600 SW 72 "" Solar Installation Sp . l Co • • ,'.chlist.
Permit Fee (inc - . n review
CiiyiSiate;7ir : Tigard OR, 97223 $ 1110.00
. administrative s):
Phone: (503) 639-2639 Fax: (503) 624 -0239
state surcharge t12% ,; s cif permit f ,.;. 5:
CCB lie.: 31700
/ Total fee dm: e'.pfin application: $;201.;0
Authorized signature: / .� - ! -/ J This permit application expires if a permit is not obtained
a,. !
' ,,..... within 180 days after it has been accepted as complete.
. .....:. name: David ..�..�,... t . _Cd1.' tee, 1 x lee methodotoitv set by i t i- County Buticisna Industry
! 1 1 Jc1 Vl,.li LVatii.
V:Buntl `;nTP Ef.;'enn:L`.: - 02: 1 22 i' 410-46;31(1 - i : I -.," ., r' )
Electrical Permit Application s'' FOVE FOR OFFICE USE ONLY
{ i
City of Tigard r �w/ 0 ,e,R'eceived I _ '
Date /B : �Artn Permit No.: ,9T� �, "map •
g 13125 SW Hall Blvd., Tigard, OR 97223 . 1y 2 1 2 Plan Review
s Phone: 503.718.2439 Fax: 503.598.1960 MAY 1 Date /B : Other Permit: /�
.11,1 Inspection Line: 503.639.4175 OF Date Ready /By: Juris: ® See Page 2 for
T LG A R D Internet: www.tigard- or.gov CITY OF .j 1 IGAi 1D Notified/Method: Supplemental information
UiLGii� D iv :IS IVI'v -
:. TYPE: OF `WOR ; :PL A N °:REVIEW
CI New construction ❑ 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 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
s I- and 2- family dwelling ❑ Commercial /industrial 0 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 loud of ❑ "A ", "C" "1 -T' "1 -3"
Job no.: Job 12476 SW Autumnview IOOWP or more. occupancy.
Jt.b site address:
❑ Six or more residential units. El Recreational vehicle parks.
City/State/ZIP: Tigard OR, 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
Y S ❑ Hazardous locations. 600 volts nominal.
. Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or snore.
FEE SCHEDULE,
Cross street /directions to job site: Beef Bend to 122" left on Autumnview Description I Qty. I Fee. I Total I
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: Mountain View Estates Lot no.: 7
1,000 sq. ft. or less 1 168.54 ('( .. 4
Ea. add'I 500 sq. It. or portion 8 33.92 vZ�f t. 2J , 1
Tax map /parcel no.: Limited energy, residential I 75.00
, DESCRIPTION OF WORK,.' - ' .. • (with above sq. it.) i co 2
Limited energy, multi - family 75.00 2
Wiring of new single family residence residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
. ►� • PROPERTY` OWNER = b . - - ' 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: J.T. Roth Construction Inc.
601 amps to 1.000 amps 301.04 2
Address: 12600 SW 72 °d . Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: Tigard OR, 97223 relocation
Phone: (503)639 -2639 Fax: (503)624- 0239 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT 1 . O` CONTACT `PERSON ' above service or feeder fee, 7 42 2
each branch circuit
Business name: J.T. Roth Coast. In c. B. Fee for branch circuits without
service or feeder fee, first 86.18 2
Contact name: David Jensen branch circuit
Each add'lbranch circuit 7.42 2
Address: 12600 SW 72 Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
CEt /City/State/ZIP: Tigard OK, : 8722 dwelling, service and/or feeder
Phone: (503) 806 -0602 Fax: : (503) 624 -0239 reconnect or+ly 67.84 2
Pump or irrigation circle 67.84 2
E - mail: davidj@jtrothine.com Sign or outline lighting 67.84 2
CONTRACTOR, - , Signal circuit(s) or limited - energy
Business name: Grizzly Electric
pane!, alteration, or e tension, Page 2 2
Each additional inspection over allowable in any of the above
Address: 8002 NE Ihvv. 99 suite #248 Addition::( inspection (1 hr min) 66.25/ hr
Investigation (1 hi mint 66.23/ hr
(:'ity!Stale//Zli': Vancouver WA, 9866
industrial plant (I hr tn. in) 78.14/ hr
Phone: (360) 909 - 4080 Fax: (360) 694 - 8939 inspections for which no fee is 90. 00i hr
spe listed (4 hr into)
CC13 Lie.: • 186218 Electrical Lie.: S' Suprv. Lie.: 2643 -S ELECTRICAL, PERMIT FEES '
3 I Snbtrital: .9(:).
Supra. Electrician signature, required: (25% n� mitfe^
Plan review (2_ /e of fee):
. t
Print name: Ron Nielson Date: May 12, 2011 State surcharge (12'Ya of permit fee): - 1 • o t -; /7 '
TOT A1. PPRMTT Ff E: 57 4p 4, Ct
Authorized i h[ r !! i C +
,,,,,,,•-• 1/4-......._ "Chic permit application expires if a permit is not obtained within 180
._-- ___ -,_... days after it has been accepted as complete.
riiit name: • Date:
" Number of inspections allowed per permit.
i`\Rzcii. ?inelparmit e- p,.,,,,<t s nn a■ 07..0 1 /in • -14f1.4(. I<Trt'.Yns /Crns1lL'ro
Mechanical Permit T
Applica f_: ilipr
, /... :1 ''' K,z LI . - FOR OFFICE USE ONLY
u fil,.. - -,-. - -- ' * •
-- - - - City of Tigard Received 5 ACKOM -
Date/By:
13125 SW Hall Blvd., Tigard, OR 97A Y 2A0 ,,
. 1 2 2011 Plan Review
' 2 .: Phone: 503.718.2439 Fax: 5O3.598.1' Date/By: Other Permit:*ot
Inspection Line: 503.639.4175 • is•
ri - 1 GA R D' Date Ready/By: iur EZI See Page 2 for
Internet: www.tigard-or.gov CITY 13F Ti IGARD Notified/Method: Supplemental Information
BUILDING DiVISIOr%'
. , TYPE OF WORK .: : '
, 7 COMMERCIAL ,TEE* SCHEDULE USE CHECKLIST
Mechanical permit fees* are based on the value of the work
El New construction 0 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
• CATEGORY OF CONSTRUCTION ‘ :
. , - -
• ' RESIDENTIAL EQUIPMENT SYSTEMS FEES*
CI 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
• - JOB SITE INFORMATION AND LOCATION . ' Heating/cooling:
• Air conditioning
lob site address: 12476 SW Autumnview (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 1 46.75 iteL.77..
City/State/ZIP: Tigard OR, 97224
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg./apt. no.: Project name: • Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Beef Bend to 122' Left on Autumnview Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronie) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Mountain View Estates Lot no.: 7
Other: 23.32
Tax map/parcel no.: . Other fuel appliances:
DESCRIPTION OF WORK • ' : ,, .: Water heater ( 23.32
. Gas fireplace ( 33.39
B% 7 AC installation at new single family residence
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
Chimney/liner/flue/vent 23.32
,, ■..11 PROPERTY OWNER ' . ,.- ID TENANT - . • ' ..
Other: 23.32
Name: J.T. Roth Construction Inc. Environmental exhaust and ventilation:
Address: 12600 SW 72"4. Range hood/other kitchen
equipment t 33.39 '3
City/StateIZIP: Tigard OR, 97223 Clothes dryer exhaust 1 33.39 , ..3•
Single-duct exhaust (bathrooms,
Phone: (503)639-2639 Fax: (503)624-0239 toilet compartments. utility rooms) (:, 23.32 1
, . 0 APPLICANT ' . . , ' ■.4i, CONTACT PERSON' . Attic/crawlspace fans 23.32
Other: • 23.32
BusinCss name: 3.'1. Roth Construction inc.
Fuel piping:
Coninei oiii: Phiviii ,loiieti $14.1.5 for first four; 54.03 for each additional
Address: 12600 SW 72. Furnace, etc. I Ilk'. e5
Gas heat pump
City/State/ZIP: Tigard OR, 97223 Wall/suspended/unit heater
Phone: (503 i 639-2639 Fax: : (503) 624-0239 Water heater I
Fireplace I
E-mail: davidi@jtrothine.com
Range
Barbecue CONTRACTOR , - ..
Business name: II&M Heating Clothes dryer (gas)
Other:
Address: PO Box 1111 MECHANICAL PERMIT iiEES*'
City/State/ZIP: Roving OR, 07009 Subtotal 324, .i
Minimum permit fee ($90.00)
Phone: (503) 637-3489 Fax: (503) 515-5763
Plan review (25% of permit fee)
CCB tic.: 124757 State surcharge (12% of permit fee) 2 / 2.-
uthorized signaLure: y'
..„, • , .."'74---' TOTAL PERMIT FEE 3 , z'3 d3
This permit application expires if a permit is not obtained within 180
A
days after it has been accepted as complete.
• —....■......—__ -I -
• -":-
i .. .
1 i i
i.ra.ild;may.,..a.,■mE.C-P....iiApp.,k. a;' -;-g. 7T i ii:.,2X-ONIAVETi)
Plumbing Permit Application m , E 0 1 p F.-- -,,,
Site Utilities E ' 1 i is r` USE - ONLY ~ _ - ` _
MAY 1 2 2011 Received ���yp
City Of Tigard Date/By: �� Permit No.: 14,40-090 / /
II
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review n^
__ C Phone: 503.718.2439 Fax: 503.598.196(CITY OF TIGAYi' 5 Date /By: Other Permit No. wQ 11.4 (JO
Inspection Line: 503.639.4175 i E ` • Date Ready/By: Juris: See Page 2 for
TI GARl7 Internet: www.tigard -or.gov BUILDING Dl�r "+ ' •. El
Supplemental Information
TYPE OF WORK , FEE* SCHEDULE • .. ,
® New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 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
SFR (3) bath I 500.32 6f/4 =
0 Accessory building ❑ Multi - family
Each additional bath/kitchen I 25.02 2.5, era
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB, SITE INFORMATION AND ,LOCATION Site utilities:
Job site address: 12476 SW Autumnview Catch basin or area drain 18.76
City/State /ZIP: Tigard OR, 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Beef Bend to 122 ". Left on Autumnview Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear I1.: _) Page 2
Storm sewer (no. linear ft.: ____) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Mountain View Estates I Lot no.: 7 Fixture or item:
Tax map /parcel no.: l3acktlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
. Clothes washer ' 25.02
Domestic plumbing of new single family residence Dishwasher 25.02
Drinking fountain 25.02
. Ejectors/sump . 25.02
' ❑ PROPERTY ;OWNER ' I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) lee maker 12.51
® 'APPLICANT '❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: .1.1'. Roth Construction Inc. Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: David Jensen Roof drain (commercial) 12.51
Address: 12600 SW 72"". Sink/basir✓favalury 25.02
City /State/ZIP: Tigard OR, 97223 Solar units (potable water) 62.54
Phone: (503) 806 -0602 Fax: : (503) 624 -0239 'rub /shower /shower pan 12.51
L-mail: davidj c�_jtrothinc.com Urinal 25.02
. Water closet 25.02
' - ', CONTRACTOR -
:.. > . .. „_ Water heater 37.52
Business name: Malmedal Enterprises Water piping/DW V 56.29 '
Address: PO Box 20 Other: 25,02
City /Stale /ZIP: Banks OR, 97106 Subtotal 525-4
Phone: (503) 324 -0828 Fax: (503) 324 -0580 Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lie.: 102535 Plumbing Lic. no.: 9 79 3 a- //j
State surcharge (12% of permit fee) 3 , CA
Authorized signature` �� y�' TOTAL PERMIT FEES'
Print name: Kris Malmedal �JDate: 5/12/11 �( This permit application expires if a permit is not obtained within 1St/ days
I I after it has been accepted as complete,
`Fee merbodc, ogv let by T ri- Coumty Building Industry Ser ice Board.
...ouuumgvc. w1..nu.uuunpp.uv.. .wuvvo +w -.v.vl ii uv<:Cvin::cvj
Building Division
Development Code Provision Review
T[cARq Residential Projects
",= k51 ...oti— Ovv
Building Permit No:
CWS Service Provider Letter Received: Yes ❑ No C N/A ❑
Routed Plans:
Original Plan Submittal Date: s1/ 21 1(
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.
Planning Review (contact S►I ,VGLI at 503-718-or L? 4 � @ tigard- or.gov)
Lan)-Use r 407)1i-000a-1 Use Case No. Name j n vi -fal.. / V t pelf LLL
Tr' Zoning I... .
L setbacks:
ont ,' b Rear Si e Street Side ( D Garage 7
yaximum Building Height ,__:3 Actual Building Height n
sual Clearance 1
,y i ce �s nuL�
� sements % ,, �
La" Sensitive Lands Type: tope-s T 4 %2/Y� (9-� GD
Notes:
Original Plan: Approved Not Approved ❑ Date: 6 t( d
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)
Z Actual Slope: 3 0
Notes:
Original Plan: Approved Not Approved ❑ Date: S r J
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
•
N.
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov) N
Street Trees
Protected Trees
Notes: '' raK p,,- I p
t7 i"AncJ Al\
Original Plan: Approved V Not Approved ❑ Date: /SroII
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 Eli No ❑
Date Routed to Building: ., / /
/
Page 2 of 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
;` RESIDENT.IAL. 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*
❑ 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 T .ighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
1,
City of Tigard
Building Division
TIGARD
TRANSMITTAL LETTER
fr� .
TO: ✓f /1 � �� DATE l JED: —
DEPT: BUILDING DIVISION EIVD
JUN 2 42011
FROM:
aVi � � CITY OF TIGARD
BUILDING DIVISION
• COMPANY: j 4�,»
PHONE:
RE: c
(Site Address) (Permit Number)
/1/); / i
' ro J ect name or su'. ivision name ans of num.er
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and /or lateral analysis.
Floor /roof framing. Basement and retaining walls.
eam calculations. Engineer's calculations.
Other (explain):
REMARKS:
FOR O FICF� USE ONLY
6 Routed to Permit Technicia . Date: /tea C ( Initials: .
Fees Due: ❑ Yes o Fee Description: Amount Due:
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\ Forms \TransmittalLetter- Revisions.doc 02/08/2011
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Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: Jurisdiction:
Site Address: SA-
Subdivision/Lot #: \.k 6L)...vA G. � � \1 3.4..W � UC
and/or
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: A ,,e,`��, Date: - 3 /' /
neral ontractor /Authorized Agent
Print Name: -\ &- ; nA. - '1n
1 ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
I:\Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, ,fl , am the general contractor or the owner- builder
at the following address:
Site Address: 4 o S w v, 1p.k
City: J
cX
Permit #:
Subdivision/Lot #: •• ` 1
and/or
Map and Tax Lot #:
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture- sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: Date: 3/ / f i
Gener Contractor or Owner- Builder
1:\ Building\ Form\RES - MoistureSensitiveWood.doc 09/25/08
STREET TREE
TIGARD TIFI A TI
CER C ON .
I� ftAktsiiv, f (4+ti. , owner /agent for iT ,
(PLEASE PRINT) (PERMIT HOLDER)
do hereby certify that the following location meets
City of Tigard land use and development standards
for street tree installation and is consistent
with the approved site plan.
PERMIT NO.: S \ C: \.\ - vo D \ V
S1 E ADDRESS: k -� ‘c, s� - u. ,nom v\ . '.,L,„.,
- SUBDIVISION: \1; , LOT #:
SIGNATURE: �_ ,�, k % DATE: 3 l
(I WNE :. GENT) l V
RE CEIVED &
VERIFIED BY: DATE: E: OF OF TIGARD)
❑ Tree location verified per approved site plan. _ .
I:\ Building \Forms \StreetTreeCertificate 04 /01/2011 .