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Permit // 1 4-Pvir----//)&77y0c) ./U A/G iat /-i i)v der /Iv,f . 6 )-- CITY OF TIGARD MASTER PERMIT 3 1111 11- :;_ COMMUNITY DEVELOPMENT Permit #: MST2011 00144 Date Issued: 08/18/2011 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 1S135DB04000 Jurisdiction: Tigard Site address: 11360 SW 92ND AVE Subdivision: DOGWOOD RIDGE Lot: 13 Project: ERVIN Project Description: 380 Sq ft. garage addition 9/29/11, reprinted permit to include rain drains BUILDING Floor Areas Required Setbacks Required Stories* 1 Bedrooms 0 First 0 sf Basement 0 sf Left 5 Parking Spaces 0 Height 18 Bathrooms 0 Second 0 sf Garage 380 sf Front 20 Smoke Dwelling Units: 0 Third' 0 sf Right 5 Detectors No Total 0 sf Value $20,000 00 Rear 15 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 Drywell- Trench Drain 0 Other Fixtures 0 Other Fixture Units* MECHANICAL Fuel Types Air Conditioning N Vent Fans 0 Clothes Dryers 0 Heat Pump N Hoods 0 Other Units 0 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 0 0 -200 amp 0 W/ Svc or Fdr 0 Ea add! 500 sf 0 201 -400 amp 1 201 -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 U 0 Owner: Contractor: ERVIN, ROBERT & KIMBERLY OWNER Required Items and Reports (Conditions) 11360 SW 92ND AVE TIGARD, OR 97223 PHONE PHONE' FAX Total Fees: $1,004.18 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 through O:: 952 -001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 2 2 1987 or 1 800 3 2344 Issued By: —�� � Ilk - e - ttee-Signature: �'V V~ Call 5 .y 7 :00 a.m. for the next available inspection date. This permit card shal •e , in a conspicuous place on the job site until completion of the roject. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures ures C VIED FOR OFFICE USE ONLY City of Tigard 1 Date : "r // /7 a:77 Permit No' f /)- -00-)/ ky 'I 13125 SW Hall Blvd , Tigard, OR 97 22 3 '9 7,�1 Plan Review I r Phone: 503.718 2439 Fax 503 598.196Q C? Other Permit No • J Date/By: Inspection Line. 503.639 4175 r Date Ready/By. runs See Page 2 for TIGAIi'D Internet: www ard -or. ov �1V� y y g g g � pF - 1•11510 N o t i fi e d/ Method '��'p Supplemental Information TYPE OF WORK 10 - 9 I �G FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty I Ea I Total dition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312 70 nd 2 - family dwelling ❑ Commercial /industrial SFR (2) bath 437 78 SFR (3) bath 500 32 ❑ Accessory building ❑ 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: 1) (Pj } ))/ ( 1`I� Oil/(,r: ) Catch basin or area drain 18 76 City/State/ZIP: ff if r Drywell, leach line, or trench drain 18 76 i ( L A1 , 1 ") 7�? - 2 f Footing drain (no. linear ft.• ) Page 2 Suite/bldg./apt. no.: Project name: rt'I%) �i1 J ` ' f M1 I ; j Manufactured home utilities 50 03 Cross street/directions to job site: � Manholes 18 76 Rain drain connector / 18 76 ( 8 ; 76, Sanitary sewer (no linear ft ) Page 2 Storm sewer (no. linear ft ) Page 2 Water service (no linear ft.. ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.5 J ) f , Clothes washer 25.02 iV r / >'' f A� ( _Y-4 � fl?–' 12>/ i/7 9 1�X Dishwasher 25 02 (f / Drinking fountain 25 02 Ejectors /sump 25 02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51 Fixture /sewer cap 25.02 Name. k 191 '4-. \ o iv,t- - tr,, ,,�� Floor drain /floor stnk/ltub 25 02 Address: ! ? L d Garbage disposal 25 02 City /State /ZIP: �� 7 Hose bib 25 02 Phone: (F--50. . - -0 i. Fax ( ) Ice maker 12 51 ❑ APPLICANT / ❑ CONTACT PERSON Interceptor /grease trap 25.02 Medical gas (value: $ ) Page 2 Business name: yam r7.P , f' oti _ Primer 12 51 Contact name: Roof drain (commercial) 12 51 Address: Sink/basin/lavatory 25 02 City /State /ZIP: Solar units (potable water) 62 54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12 51 E -mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37 52 Business name: /'mac Water piping/DWV 56 29 Address: Other: 25 02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72 50 7 (c)) CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) -- State surcharge (12% of permit fee) sir, 7O Authorized signature: TOTAL PERMIT FEE ''),,,X. Print name: y' 1 Date. / This permit application expires if a permit is not obtained within 180 days K ( (�� T (( �% � `mil H �-1 / after it has been accepted as complete. *Fee methodology set by Tn- County Building Industry Service Board 1 \Building\Permits\PLMU- PermitApp doe 10/01/09 440- 4616T(l0 /02 /COM/WEB) CITY OF TIGARD MASTER PERMIT 2 . : COMMUNITY DEVELOPMENT Permit #: MST2011 -00144 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08118/2011 . Parcel: 1 S135DB04000 Jurisdiction: Tigard Site address: 11360 SW 92ND AVE Subdivision: DOGWOOD RIDGE Lot: 13 Project: ERVIN Project Description: 380 Sq. ft. garage addition. 9/29/11, reprinted permit to include rain drains. 9/30/2011: REPRINTED to add electrical work (transferred from ELC2011- 00518). - BUILDING Floor Areas Required Setbacks Required Stories 1 Bedrooms 0 First 0 sf Basement 0 sf Left 5 Parking Spaces' 0 Height 18 Bathrooms 0 Second 0 sf Garage 380 sf Front 20 Smoke Dwelling Units 0 Third. 0 sf Right 5 Detectors No Total 0 sf Value. $20,000 00 Rear 15 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 Drywell- Trench Drain 0 Other Fixtures 0 Other Fixture Units. MECHANICAL Fuel Types Air Conditioning N Vent Fans 0 Clothes Dryers 0 Heat Pump' N Hoods 0 Other Units 0 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 2 0 -200 amp 0 W/ Svc or Fdr 6 Ea add! 500 sf 0 201 -400 amp 1 201 -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 com Other N Other Description* E p asin g N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB U 0 Owner: Contractor: ERVIN, ROBERT & KIMBERLY OWNER Required Items and Reports (Conditions) 11360 SW 92ND AVE TIGARD, OR 97223 PHONE PHONE FAX Total Fees: $1,130.02 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 through OA' = •' 1 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344. Issued By: - t r / Permittee Signature: DA/ 19 / 6/ 2 - 77 - 0/\/ 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. 6 / s -&- D.r 6 z& e4 FROM :GARNER ELECTRIC FAX NO. '5036427925 Sep. 20 2011 11:37AM P1 Electrical Permit A lication °� �°`�� tok(ll Ile, I, USE ONLY • ' • D ateg F ermrt N u. ���„ifi %7f, I>•7 City of Tigard 3 ' , 1\ D d �1 .,i► ,_�� '' 13'125 SW Hall Blvd., Tigard, OR 9•'72 a ® L� me netnew tltlror Pc r �� t II M I ..' Phone. 503.71x.2439 Fax; 503.598.1960 `Y 1 (.; A l 1 Inspection t Inc 503,634 -4175 0 - ji Q * (3 t� �,, t Dote ReatYBY S - e — l ✓', r' NotificdMtth eed; 7�Q upt em ' 'Internet: www.tigard 01 1 ` 'fi x ". "' ... : ,t + J\ H 't _ , 1 :: , i . ei , k' ' Fi ■ t ` . " ' r l , : T ' i1,. , **4�1 ' !ill, 1`1cw, , .,1 ' i:. ! , N r , -;:∎p "mp. 1 , G:+ upp Ip,• ' I' ! ii 41 , ; .j, , 1 ; i•; ' " , ' uj y u n,. • ;(Ire';, *f„ 'I•, , , - • t, %t';'-.., ;I. li7i'% t , ,l�lu' , 1� , {� iN;{ 1 a �, �;, n h and • , ,,,: %I,+ .'H „� cl victig +'i c h ec J , " ��rr 3�+lim;, „I N ew construct = % f tr ll tI'" t han kl Addition /alterabO , e'- _v l'Icaoe check all that apply (submit idle of pinoe whtcros checked below), ❑ New ti/feplaccment A Service or feeder 400 amps or moo ❑ Building over three stories ❑ Demolition ❑ Other: where Ole available fault current ❑ Marinas and boatyards. „„ art V 1' a In ^ 1 ii , " , t,�'4 ;' % hlx. , v,u'oedt 10.000 amts .1t150 volts or El Floating buildings, r ii :I % f✓G j. ' i • `,i) , .'ii, J., , a ",t ' a 0f h , a�.,. t k;; ' ' ,;:;' ' •„ +' ' 1 "l l , ,,., • m rk „ ,';1 =' „ j ,d , ! ;. ' f-g iGS+aaN r , ,1 , • • •h . ' 1 la t o gtvun or nxccc 1 4, 000 ❑ Cu mtcroto -ttso agricultural 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building stripe for all other installation buildings Other: ❑ Faro pUmp. 0 Installation of 75 KVA nr ❑ Multi ❑Master builder ❑ prnorgency system larger separately derived syt•te % l;,;r „ rr +h, .e•N!•,' „.Ijiiriir Mi' yy + 1' la 1. ,a� , 1,,,`, , +{ ,r t , , . " yll; h ❑ "1, t ;�)t .,; ` � � 1 (�1” 1 r�� �;Ai^NR� r •1 ' 1 4H� 1 �,; ' 'n %;• • ; • t "; "iq' ❑ Addition of new motor len of , . A ,... B „ �, I . 7 , . 3 „ I,l!Y "I „ �'lj;! ',H,yria •' {fU'' d, {u',� I t nxl, • i >+ n �i '. - IlQ 100tiP on occupancy. uP Y• Job no.: Job site address: f I ?l LD() � � t) CI Six or mare resldonttai units, ❑ Rwrntlonal vehicle ports —' Supply ._ e � - El I le,dth -taro fncilitie,e ❑ tpp y for Mora than City /State /7.IP' r \ ii I� a ❑ Huvsrdnuslocetiona, 6U0 volts nominal. Suite/bldg. /apt. no.: 1 Project name: D Service or feeder 600 amps or more j 1,'`' 1 .d .1i1 % " 1`'�,'1' ���rra M � ^" I 7 li'.t.1 ; : •Ill{ I 1 Cross street /directions to job site: noredptton tan /M Total j " - - New residential aliigl • or multi - family dwelling unit. includes attached garage. Subdivision; Lot no.: 1.000 sq d or lees 105.54 - - 111 - _, • _. • Ea. add'l 500 sq. ft, ur portion 33.92 Tax map /parcel no.: Limited energy, residential 75 00 2 y ii, 1 1 % , q , ; , ' 7',r - ,, .al` (with abuve sq. ft ) :, ,Li 1 "I ,11 ,i • ':' { ,, 1 ,1 i, y. itiQ " D Kt ",,+•'.:i4 r ";;6r,, '"Mq l „1 t'f 'i' Ls,r' %'ib ✓” : + + �_ y ; 1 + , (MI �A ": ';;. r, ", r,11 �� j'� {, ., r., ," tl e`t:,. +:,:''' atw e 1 "4! ++ ;. „ • 1 ��, , `� ;n, ., • 1 Mori energy, mulli•fnlnlly 75110 2 -\'ef A 1' l ( I ' ` J A - • L I M rcaidential (with above sq. It.) 1 Services or feeders Installation alter, rn, and /nr rclocallon 200 amps or leas r r. 100.70 A►.,(/ 0 1 1 t IN ft j r i •1 f�l ' r i; i , l'�'., t; +tl�l��� ji� ��7��IJ;'�^'� .. '• �, ���1����111r'; 4k.;��,(L % t i ll ' I f �'Af,�'�tM�'�.���:' +!i' % %Idltl 1�, 201 amps to 400 amps II 133.56 401 amps to 600 amps 200.34 Tl8n3C: - 601 amps to 1,000 amps 11 301.04 Address: - ' Over 1,000 amps or vole 552.26 _ 2 Temporary services or feed Instalfatlon, alteration, and /or City /State/ZIP: relocation Phone: I I Fax: ( ) 200 amps or lest 0 59,36 , ` , . I , - 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, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 Limps 168.54 2 Branch circuits ,- newt Iteration, or extension, per panel �1 Owner signature: Date; _ A. Fee for blanch circuits tvuh - 5 .•, l r , �T:n� „i �'p "ul, r�Y,yJy i�� + "'I , �.Is'' •,•' alrnvaecrviu:arftrader t wi'li,F1`9, r„n,11f°I;"�fkN " M qi�t"M`111,,n.:k4.li r „ '1'1i1:t%I.i;4"Itt{ !A 41r t•.#0: ,:,,•,..•'1,,: ;"', eirCutl 7.42 2 loll i<i °' i Rosiness name: t 13, Fee for branch circuits without service or feeder Ore, fiat 56 18 2 ('ontact name: Toil $1 t7j' -a�-v branch circuit _ _ r .. Ouch arld'I branch circuit 7.42 Q 2 AddrCSS: P t g Re-,( 1 - „ Miscellaneous (service or feeder not Included - • _ n Each manufactured or nodular City /State /ZIP: Pe a r'v 's R' J dwcllin , sarnca and /nr tc«lcr 67-84 2 Phone: ( .•- • • (, Fax: • ( f it. - 0 : I_ Reconnect only ME 67.84 2 Pump or irrigation circle 111111 6714 E -mail' t14,1` h '!Q1 5'2'1 � �... a Sign or outline /letting 67.84 2 f +7+' A�� r IMTI / � '''I � f � C � v i +,,,, F ...h �,m• r J ,..,,,, , h , . ,, . v I ' " ,ti• ii , ' ` If . i'. t!a,7i,11 ) I lit1,t, 4 „ i Sig ct of lim oncrgy pnnet at ciao Page 2 2 Business name: - . - a l Each additional inairectlun over allowable In an of the above Address: L�S_Li:di 4. • r ^ �� ' Additional inspectiun (I hr min) 6625/ hr City/State/ZIP: • r i (1 item) bfi.2.5lhr ` �.` .•q�71� . ]ndtistrlsi plant (1 hr mm) 7518/ hr Phonc: r l l r� { r Pax: ( "vigi .. . w inspections for which no tbo is • 4 w 1 (� { �r R Y•ec l isted 'fihrmin 90.00/ hr CCB Lie.: 1 a 1i 5J ` Electrical Lie.: - 4• •) 4 1/1 Suprv. L' .: ' ' i . ";'it , N•; 1, " % s ,. l . : .,a ''G'.... E. ;',7'5i41'(glsjlh ' • � 7 " Suhtntal, a d S Suprv. Electrician signature, reyuircei: - �i '„ n "1 , ;f' Pla review (25% of penult fee O l !la / % r �r Stale surcharge (12 %ofpermlt fee): r - .) t 7 Print name. < itr ,.. rr'" : 1 .el i .. TOTAL PERMIT F8E. � 0/ Aulhnri2edsignature; This permit application expires if a permit is eat o,taioedwithin[xo ` „f 3 Date: Print name: days after It has been accepted as complete. I L �J • Number of inxpee.tiunx al lowed per permit, d /// 7 I • \aeitdlneWern101Pi.C.PcrmitApp clot 07/01/10 -' 44e- 4615T(I 1165 /COMIw68 Vl Y° • (J' ,V_ Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - l 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37 52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62 54 7,201 and greater $327 54 Sewer - each additional 100' 37 52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm &Ram Drain - 1st 100' 62 54 Valuation: Permit Fee: $1 00 to $5,000 00 Minimum fee $72 50 Storm & Rain Drain - each additional 100' 37 52 $5,001 00 to $10,000 00 $72 50 for the first $5,000 00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to and Including $10,000.00 Inspection of existing plumbing or for $10,001.00 to $25,000 00 $148.50 for the first $10,000.00 and $1 54 for which no fee is specifically indicated 90 00/hr each additional $100 00 or fraction thereof, to (minimum charge — 1/2 hour) and including $25,000 00 Inspections outside of normal business 90 00/hr $25,001 00 to $50,000.00 $379.50 for the first $25,000.00 and $1 45 for hours (minimum charge — 2 hours) each additional $100 00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90 00/hr $50,001.00 and up $742 00 for the first $50,000.00 and $1 20 for (minimum charge — 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace! Plan review is required for any of the following. Performed: Capped Added Relocate q y ow g Baptistry/Font Please check all that apply. Bath Tub /Shower ❑ Any new commercial building with water service 2" and - Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. - Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor /Water Aspirator as defined in OAR918 780 - 0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918 780 - 0040. Eye Wash Floor Drain /sink - 2" Submit 2 sets of plans with any of the above. -3" 4 ' Isometric or Riser Diagram Car Wash Dram ❑ Isometric or riser diagram is required for new buildings - Domestic—non -food s g q g Disposal - Domestic—food related that meet the qualifications above. - Commercial —food related - Industrial -food related Ice Mach /Refng. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes increase of sewer EDUs, permit will be issued and Water Extractor + a sewer p Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures I: \Building \Permits \PLMF - PermitApp.doc 02/24/2011 2 RECEIVED .j, 9 2011 • CITY OFTIGARID ry g IILDINO DIVISION 3/8" = 1'- ®" f 5' -O' i I LHI HI I I 111, !II III 111 I I III HI T i I - 11 1 11 1 _ 1 � _ I 11- 1 ! II II �a Native Soli \ '�� �'�— 'l II ! 1 ! I i ill I � I �, 1 / ! 1 - . • N H 1 I -_I 1 ( / I 1 _I! ! I ! / 4_ i 1 ---1 ! , I I i_I 1 I ! 8' -0" [ • I H I - III_ . - . _ , _ 11 =1 I Ii lli - 1 1 1 1 -- 11/2" Drain Rock ! !! ! I- !!! ! I I �, I ! -- I --I II I1 i — Mil _ _— ! ! _- _= ! ! i __ _ _ Filter Fabric wrap around i �; ! ! ! brain Rock Al l 1 1 yl 1 1 __ ! 1 — Imo - -I „ CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT COMMUNITY MST2011 -00144 13 125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/18/2011 T . , . , . ? Parcel: 1S135DB04000 Jurisdiction: Tigard Site address: 11360 SW 92ND AVE Subdivision: DOGWOOD RIDGE Lot: 13 Project: ERVIN Project Description: 380 Sq. ft. garage addition. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 18 Bathrooms: 0 Second: 0 sf Garage: 380 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No Total: 0 sf Value: $20,000.00 Rear: 15 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 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: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add 500 sf: 0 201 -400 amp: 1 201 -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 U 0 Owner: Contractor: ERVIN, ROBERT & KIMBERLY OWNER Required Items and Reports (Conditions) 11360 SW 92ND AVE TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $922.98 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will - - 0. started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow th- .les adopted by the •regon Utility Notification Center. Those rules are se) forth in OAR 952 - 001 -0010 throug• . -•' •52- 001 -0090. You may ohfai• - .. - • . - ru es • • = - - rs o OUNC by calling 503.232.1987 or 1.800.332.2 Ailtft, lLl Issued B �% _ _` � � Pe ee Signature: Call 503�. 9.417 ..m. for the next available inspection date. This permit card shal •be ke.t'. - .nspicuous place on the job site until completion of the project. Approve. plans are required on the job site at the time of each inspection. Biniiding Permit Application r Residential 40 FOR O USE o��'LV City of Tigard v� ,��� Dated ; /n. PermitNo.: �` , � 1 I d '� 13125 SW Hall Blvd., Tigard, O 223 '1 Plan Reviev77.. 4 d e : • • Phone: 503.718.2439 Fax: 503.598.1 pY' c G0O'` Date ReadyDate/By: AO' - ,' Other Permit: Inspection Line: 503.639.4175 Tl G A R D T� �l$Ready/By: • Jas: ® See Page 2 for I nternet: www.tigard- or.gov �,sy Or .\ Notified/Method: J /t . � 1 !�/ j y i � j -a. Supplemental Information q F� ti ; �1 l+i '.4 ,'l` y ✓k� :^es- S.kY.:....r..3 n:• y .a K 3 r. f u 'a&- : f • } TV YP E M S, ` r; xx a ll i REQ «1 A ND 2 FAVAtl VAI rg„ , -'< ..,.J* .. �; iw.,._ �», �s �) m< xn;- �, �X ve. af.:.Jf�.�r�f�c ,t � ,� ' �g . � ' I..aNk - .�` ,,, � vam�, rF, aE«.. r:: Y��, �Aa. ��; t: �_ �.,. asr <��.,�...a ^�x�...�a, �_�•: ❑ New construction ❑ Demolition Pernritfees* 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 , s ,gym 1 1 �. � , , a* r ead efre "i " z4 , t V4 � , work indicated on this application. 4 •Z }� ° � n ` ,,, t`*P 't- , C A f T E G ORY OF aC ONSTRU '' ' sv , Ix 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ 20 I Quo ❑ Accessory building 111 Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: a ,,*' A " v ?4 ` e JOB STTEEINFO MATIONt APW 'LOCATION��� ,',',,,e„,- ', Total number of floors: ,,, ,iozixti m,,?s.,. .. %; �NNi ,ar... ' ita n steam, ., ar�:w ,, :,,, vd^: + ew <e ,,,.,,a N.,, ,,, t „ ..g Job site address: I 1 ? � (l) 5 w ( 32.0— Ave” , New dwelling area: square feet City/State /ZIP: 'it q � 0 iq a 9 )( Garage /carport area: square feet 3 g0 Suite/bldg. /apt. no.: � Project name: 7 p l / Covered porch area: square feet Cross street/directions to job site: - S r f j b u (3 £ 1 a2.l� oe) Deck area: square feet v Other structure area: square feet REQUI CO MMERCIA L US CH 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 , 4 . ,, DESCRIPTION OF W & ORIK ,I ; up t ;z� G & work indicated on this application. • Valuation: $ Existing building area: square feet New building area: square feet , t o a x roses -� ,.: era r '714;11:1'; ,� - " `^4 ` � ' :t ss , { r PROPERTYt O a � qk r L>" * � ® � !a Number of stories: « ,,tea; „ „xa � xi€� �. , . �� . - m � , m >;,� ' � o�_acmr��m.,zax^ s=.o s „�;� &� ,�k.,t `a`� Name: J� ( 11(1 P' ,, 111(\) Type of construction: Address: i f 3t.00 () Z" Cille■- Occupancy groups: City/State /ZIP: !, t Q � Existing: Phone: (( S� b C U q Fax ( a 13 -6 l O I New: :-0 a� �.. - •t asp s �...'mr>, r�� � ,� ; ,. kt,�.rt(�e :aA4��' " .. °* ansr ^_ �na ����,��. r s,� "���,� ?t s , t , J _ .. }�� ,AP PLICA rfei + _ F a '� ti , 1 F ® #CO T � Piirgbe 0 s r ` BUI PE RNIIT'FEE S * n'� '. �s. b., x a` r\ h ,..;4 -" frmx. ,.:�t '3' Y.rfy, .," --- :+ .':v. ° J J3 3 ,�. , , }: �.C�1 let_ ® tt3 Structural plan review fee (or deposit): � �'' V lease,iefer io fee sekedule)me : ra, _ .. , „ t , Business name: f AL/57C II Contact name: .16 m Ertif L) FLS plan review fee (if applicable): -� Address: t i 3 1 n 5 Lti 61 2)4 (..e� Total fees due upon application: , , 5 , 4, ii City/State /ZIP: r i,4 ) , ,9 i d, Ole °7 Amount received . l ll Phone: (503) •' 1 JU !..--.0.5 I Fax: : ( ) , � 6, { r a r �a x � � ; E-mail: r o b rr v i n _ (1 J.-) e�3r net PHOT S OLAR PANE ,w 4 ,. T g; ,:1 ,f,„' a g :� k �,R N , ,� „ v�yJ iv� Commercial and residential prescriptive installation of P s a `'' ' � .. . > C ONTRACT O RS nti. ,', I m ;N �ra�,r:r'�. �. /�.. '���,'�_ .� �.Y.,. M, + yx vuJC, �u ev.�S ��s.�x� ���_f:.:., n. w.���. fit 1. " ^.i .`..�°� :� - � � ,� �s, roof -top mounted Photovoltaic Solar Panel System. Business name: , (`"i C4 F ) 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: 4J {/ Permit Fee (includes plan review $180.00 and administrative fees): Phone: ( ) A 7 �i , e � . ( ) State surcharge (12% of permit fee): $21.60 CCB lie.: 8 ,, Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained V WA) within 180 days after it has been accepted as complete. . D ate: * Fee methodology set by Tri County Building Industry Print name: i 1 YY� E r y 1.,1 2 i i J Service Board. I:\ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11 /02 /COM/WEB) s FROM' :GARNER ELECTRIC r r .FAX;OD: 5036427925 Aug. 15 2011 11:28AM P1 1 .1,-.- 4Tom, 2 01\ .r, iectrlcar rernz.iit Appricatio AUG 16 ), [f/ City ,....00,14.;41,.., JRncCiv¢d �0.. SJ''� �� D T Tigard if �o O I of 1 1 � �f cr'i, w . 3`I' rermit • 1.3125 SW boll Blvd 11 iutl 9 7 a � 1 "" ° t r1w > u� 'Ian itcolaw - ._.._. — ._.._ ,,.,. ._ , . ... t II PhotnC. 1 03 7I8, . .,-w 5 . (1.i 59 ; 9 »2 ex � ,t t` ' 91 Y 1.)att/Ffy_:_ f'o,tnit. a } ;. C, �' s �t) Ctaac1vr11 S .__ 1 I C. A it -.l) fo f oit In4 )()3.6-'19.(117 nu ,i ,. �" ' � ?'" ,, 'd 11, _ .�.. , 11,Gd __ ._,, „,,,,,,,...,.........._... _..._..., Juua....,, tics I'x k 1 to � • In�Yrmtatiao traftatta wtAw.tigard- nr. & ov M1 _ ....___ - - - ._....— ...,�... — ._. qq,, °1.� .. 11 �uplt emental hl- ...__— TYPE O WORT( - PLAN REVIEW -- l...l ASId 111Q11 /Illt<r{Stllltl /r ]Q. eflt Noce etmck all Oust apply (subrlli( ;r N of plenN w/ kit's dutr below). 0 5nrwno or feeder' 400 only; or mono 0 tluildi aver lhWC 0,,,i,rs D •Deltlol 0 Other; wh,:re the nv;ulahits fault current El :u Mulas bonlyarrls. l ";A7'I;CORY Of CONSTRUCTION exceeds It1,000 amps at 150 volts in 0 f lotaing hii I iri ;. . .. _......._ ......:. .......... ...._...._._.._._.- _.._.._...,: les% In k erOtlnll, or CXcuede 1J,000 t.-I Commarcinl•u.a0 agricultural 0 t • MCI 2- family tlwellill.g. ii Colnrttct'aiul /induslriat Q Accessory boil /ling ally; fol all cdiax installotious, hai1 r..j 1vitilti-taltiity 0 Master bulkier 0 Other; OPoe pump. Q lnsnnllL,ti,m 01 75 KVA or -- ................................._,................__.-- ....,,.,................ „.,. —._ _....•.:,.,.,---.....- --- .........,..,..........._...... ......,,_,............,........ twl fulcrt ;cncy syseurn. Impel ;Op401017' denve'r SY4oro. Jon strE INFOR.MATI(N AND LOCATION °Addition of ucw motor load of d / 0 71)11 no.; , '1 site ICtrIyC'� „ . f .. ' , LLw( ,_ �i . � _ a [r I (, - � t .. Q }{ % I l tr n i : a re rend offal nnit9. Ci ROCAtYtio vnl vehicle p;a<k5 f 1 R Supply elt o for mom v two City/State/ZIP; I t el ((:C -( r ! ... c' .,_ 0 ti,tzardann i■anlicnns, neu wart troiriiaal. S iitClhl(i 1,.11( no.: 'Project Flame; r \ , y^^ ' , I. P `1 ._ ;_.'. nrlur 601) amps or more. ... u,., ........ ..... ..._..............._............_............ ,...................._......... -........ ....,.,.. ......_... : ......_... _ - PEE SCHEDULE r enal (':;rosy straaf /cfiru',uont, tC), ob s1tw, ticNrr, uvn _ .......__.... ,. .................__._......_...,.,,.,,.........................__....,,,.._.._,............._...._........_..........,..,........,,..,,. ,............_..._............. New re..rtdential singic- or Mill li- family dwelling nttll. includes nttochect. gartl .... ............. .... ...._.. - -- .. ........_...........,.......... ,_._......................,,. 1,L)tk so. ft- or lesv ,,,.... ..... 108.14 i ttbdiV,,i:clun: I I .,ol no,: . C',a. add 'l 500 r 1css or punt 4ri ,....._. .......... ;i.y .. ' ... I ti Vomited encigy re idooial y DESCRIPTION .,, „, „ fix. rt1__....nl'c..„, etc .,,...,- ...._.._.......... -'' ' —.... __....._...._......,... — .... with shootsc 75.00 S ()F WORK y il.) r ... . .................. ...... - -. °_._.. .,., ...... - - -' Limited clogs, rnniti^ anll y 75.110 2 rhsrwdh ahnv4.sH_f?. ), J, .. ...... ........__._ t� . cL 1 r .. -- _............._ _.....:.,,_......_.. :. G: 'C.._:._...........__: _ ! ��.4 / ti :..... .............._......._...._.. - dcnn st I _ r nnlUur rr lucNtlOn 100.70 2 _ ._,. .......... .. ..................... 2fI0 1011:15 or Inns a ...... ..,. ....... .,,.... ........ Ratters trtytAllltlau 11tcr'litor (1 amps , 400 . ',. -,_ �rvlrtB 0r. ee PROPERTY OWNER 1 0 TENANT � :.._ ' .._..... ant :k' ....... ......._..'- ....... 1335(1 ...... _j. L 2 �1 1 ,,....,...... 4111 gulps to Ot) amps ....................... 1 tul Im pwNl ✓ : r l �” P C>vnr i fr0(I nnr }w or vnlls S' 2 r1 I Addre r ,e C °. °. -' - "" ”" m "'-"" ""-'" ”' -'� "' °" - 'Y ell ylorm revilers ln9a1 kt 1711 11 a nlion, and/or ,. -Licit.::( _.__......._.._.._. 1. tfY /�r1:1t1. %la.i�: ° I -I � "' - °, " rrlocation ervices or (It Icse i 5)..]!3 1. __......__,.. ,.... .- . - 70t +u1l t¢ M , l00 ,ml s i 1 25.08 Owner inotnllalion: Ibis instaHetion is lteing made on properly that 1 owrr which is 1101 - , t0(Jtm l 7s m 599 amps - -- 168.54 ..! k @ ..BrYpch cirr•.nits ; ,liew . , ultcrnnon extcnAt�n,.,Ilr!1 intended for Sitio, ketlse, neat, or exehan'e, itl'cordirl , to ORS 447. 449. 67U land 701. 1 ,... - I . ......._ Intel (Owner Sign;ilure Dale: 1 A. roe for br;ulclt wrc.lali n f ;11reV0 aravlce Of ( oc•Ch r t i +r: 0 APPLICAN I 0 (:ON I •A(.,1 PERSON c:;lwlt brooch. uncoil 7 4" ' nl 5F name: O. fee for brunch .I[ 1I%ls n'ahour __..__.._..... .................._...._......._. „...,,.,,..._....._ ._.....,.: ,_,,......._...... — - .......... .,,,......,.............,_..... )e.rvico or tixder ice, Tirol 5ti .t name! m.,„..=.__._.....-._..,.._...,,,,,,„,.,,. ..._............_._�_. 1 ..,.,, .. _......_.._.......... _. l7r'u1C11 circuit t_'.n'r)tter:..... ....:........ ...........__,........_._._._...._...._,..,,.,.,...... ....................,,......._. Loch add'I b1'anC11 60.M 1 1,4'2 2 _. ............ .. .......,...............:.., -.._... .......•....•...,.,.,..._..._.....-.__......: .......,....................._. ” "t aeh mana(il or n�c)dttitlr - Vilsccllaneoua s e or feeder not S nelaClyd) - - -..._. -- ......... ............ ... ............. ............... ... ............... - ....... i 67 H (.:it.)'(5t »tCl7,fi Iw ctNng scrvntnniVnr.lbaxicc' , ...__._._ Phone: I. 1 I Itox:: ( ) Reconnect only f F7Iii .. .......................__ .. ................... ,:,......._..--._,....... ...._,......_..,_._.__,.,,..,., .........._„_.-_.... . .........,.......,.,.....,__... — ....._,_... ...,.......,.,...........,...__ Pump ar Irri al,orl circle, i 'i /.84 t:; 11011E ; Si n or uutl ! .... - .... - ., _...__......__. TOR .........:............... _— ...,,.,,...- ..__.... _ ,,, K nn Itlu ul x7.84 --- -- ._. ..r . N' l l ciruu( +) nr l energy - a , anti alteration ur pitc,. _ Ion_ 1' I u "' 'Business nine,: ,,, t 1 .. . _ 1. ._._......- ....... . — ,JW _ ,.,:.i,.1..'. .. . E .. .'_e. � r t 1 .... ..�.J _ (,.' . .'.. � � J:._ ( : ...:. .......�^ ,,,r ,,,,„,,,.„,,,,,,w)... hik ecllon aver allowabir I an of the 11)0Vf ..-- P Y lltfdrr• s. 0 ("',f;' A.ddltronal lnspec_tion O hr min) .. fit, .5r ttr ___ ..._. (v/Si ttt %/ I I yy '� J Irweslipion f l ill" RO) be 2 ) i in �..__._.__._.._. ) C.7r.�1'- © ?. ..„ —i .,,. ,, -. ,,,„„slr111pilotf - 1818 /hl Phone: ( pp � { :1: 't �) nrlxcunns lar which no font is . ---' - , S 4 � . _. '�'r' -�' _ .. I 9000/ In .... A- • ° '4r Iurtec 4, hr n un / / Z FEES X ic,: ) �[ I i>c11t\at i 1e, ti lv - 1 c ELEC "T7IC:Al PFRhlil V , { i fi -1 a+.70 . -- ......... Suba Sttpty l.doctiman sign tore, requllt d / .i" t � • plant review c1.`n4 of ih nnit Ice i „ �� tatesurch c 1 12 %O crnul lac r , Nrultnitsrte: I)tfa R l n ) TnrAt.Pltxy t,. li ik Au.thori'redsignaturc; __ - _ .._._. r ,._.._..,.....- ......_..._.,... _ ..1 ._-.._.. Tk,. permit npplfrnlin11 en.ylire5 i permit it not nhtalned wll Ito 0111 day.; aft(r' It NR; been St (limed as rnmplrrr. Print I )toe, ' Number of iMpercliu■; alhn,T..,i z.wr paimil I +n,i Jthnp \l,rtni,alil:c reimii,llrr JO, 'ruin') i l) 449.46: 'I (I 1 "a't> AVI,fTi e 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 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing per mits. 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 a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I w ill 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 hom eowner statement is true and accurate. Kry, (A/U Print Name of Permit Applicant Signatu e of Permit Applicant Date Permit #: t --06) 7 47' 1 / 1 ad 4 1 0 1 . 111111r ,-.. Address: 03 two Sct/- ok T-- ;'•; u�ul s -� Issued by: �/ Date: I / This Copy for Permit Offices 17 ce n qj �� Clean Water Services File Number II CleanWater Services I II /90 I Au ' z e tive Area Pre - Screening Site Assessment 1. Ju ict Tigard _— ED 2. Property Information (example 1 S234AB01400) 3. Owner Information IWG I' 1 12 2.011 Tax lot ID(s): 151350B04000 Name: Robert and Kim Ervin 11A G Company: 0� I�ISION Address: 11360 SW 92nd RI111_,p1Nti v Site Address: 11360 SW 92nd Ave City, State, Zip: Tigard OR City, State, Zip: Tigard OR Phone /Fax: 503.750.0909 Nearest Cross Street: E - Mail: kebefiaopus @comcast.net 4. Development Activity (check all that apply) 5. Applicant Information Iii Addition to Single Family Residence (rooms, deck, garage) Name: John Stark ❑ Lot Line Adjustment ❑ Minor Land Partition Company: Bella Opus Inc. ❑ Residential Condominium ❑ Commercial Condominium Address: PO Box 23215 ❑ Residential Subdivision ❑ Commercial Subdivision Portland OR 97281 ❑ Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip: Other Phone /Fax: 503.544.6840 E -Mail: )sbellaopus @msn.com 6. Will the project involve any off -site work? ❑ Yes in No ❑ Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project 380 sq. ft. expansion of existing garage 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 John Stark. A ------ Print/Type Title Owner Bella. Opus Inc. Signature Date 8.12.2011 . w FOR DISTRICT USE '4 NLY ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPUCANT 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. 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 after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROViD/ LETTER IS REQ I - ' D. Reviewed by ,ri....— AN! /.. Date ' . 2550 SWHiilsboio Highway • Hilkbolo Drcycni 97 Phone t5D3) 681-5100 • ;Fay (503) 681,-4439 • wwwdeanwatet ervicc org • II IR Building Division Development Code Provision Review TIGARD Residential Projects Building Permit No: h _ 1''/ CWS Service Provider Letter Received: Yes No ❑ N/A ❑ Routed Plans: Or r /� O Plan Submittal Date: r / 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 (V) 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 alon left only if approved. l Planning Review (contact ( c./ Re vrva.h at 503 -718- z y S or K 6.5 v @tigard - or.gov) Land Use Case No. Name U u�!)od Z�(J L Zoning �. '?'. S /A C "S etbacks: ront e Rear Side s Street Side 1 5 Gari ? / Maximum Building Height 30 Actual Building Height k V isual isual Clearance asements LY Sensitive Lands Type: &Os / s S '9#' 1 T` Notes: �.�.■.��a�,��_ - � __ -_ - - Original Plan: Approved ❑ Not Approved 12 Date: & is /// Revision 1: Approved Not Approved ❑ Date: / / 4, //,/ Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) ❑ Actual Slope: cyo Notes: Original Plan: Approved Not Approved ❑ Date: 6/ 1 iv/ 4 1 — Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 Citty / Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard- or.gov) treet Trees Protectenndi�Trees / Notes: �' Wo .-4o 4 a-e, for ii L. /o pe fw,7 , Original Plan: Approved d Not Approved ❑ Date: gfibeoli 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: Page 2 of 2 RECEIVED AUG 1 2 2011 �� ���° . co | ----- ' F ���^ � || _-_' ! . , } | !. ( | ( ] \ | /| Roof Line | / ' | / | | | ! / | / � / | � ^ k Existing | | . U 1 �\ Garage !/ | � v I | |� | ' _ ' | | 6 | | co . / Existing Residence '| 11360 SW 92nd Avo | ' , � | | ' I. | | ' | � | | Driveway | \� | ' | � _J—L_____\ � � | / � + ! ' .o r^ | | | . `` 95l]' `\ | ! 6iVKg2ndAvm | �� Plan ! | � ��U U ~� U-U~�.. ' | | SCALE: 1 ��/�o� � '- 0" ' - _ �} | ! � | ---- ------------- ' / | ' | \ | \ c�:~^�—G�--=—_:^. '/^ i | ' Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 11360 SW 92ND AVE, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical final 04/01/2013 00:00 MST2011-00144 PASS Violation Summary: Inspector Contractor