Loading...
Permit CITY OF TIGARD MASTER PERMIT i r 9 3 , COMMUNITY DEVELOPMENT Permit #: MST2009 -00160 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2009 Parcel: 1S125DA05100 Jurisdiction: Tigard Site address: 6545 SW ALFRED ST Subdivision: KINGS VIEW Lot: 36 Project: Schwab Project Description: Add 528 square foot detached garage. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: NO Total: sf Value: $20,914.08 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 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 Fum > =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: 2 Ea add'I 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir: 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: Owner: Contractor: Required Items and Reports (Conditions) SCHWAB, MICHAEL & MICHELLE OWNER fie 140 Coa> - L t(41_ yy419 6545 SW ALFRED ST TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $755.77 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. ATTENT • • : e - .on law requires you to follow the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR 952- 001 -0' . through OAR • 2 -0. 0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. . "/..„..te :is e A tz o j7 Issue By: Permittee Signature: Building Permit Application Residential RECENE) FoR oFFIcE 1 sr. OM.\ g 20 09 Received /l 111111 City of Tigard JUL 2 2 Date/B : . A Permit No : i. CO (vb • 13125 SW Hall Blvd., Tigard, OR 97223 1 Plan Reviewrilyal r = Phone: 503.639.4171 Fax: 503.598.1960 . DateB �( Other Permit: T' 1 6 A R D Inspection Line: 503.639 C OF TIG ate Ready : y: 1 ls: ® See Page 2 for Internet: www.tigard- or.gov gUILDINGDIVISII' otified/Method: ' 't ,,h, - Supplemental Information A 111 , 4) AL � '� TYPE OF W ORK v 5 s ; w`s a ', 4 -s�z a . ,Y» b ry ffi , P � r .. ? , C, , t 3 °.' 4 5 ., ❑ 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 01 CONS , ' m l ' k , "' ' work indicated on this application. f a l- - and 2- family dwelling ❑ Commercial /industrial Valuation: SO Q i q lit • (7 El Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 708 SIU 'TNFORMATToN A� LO i t gt^t r t ', Total number of floors: Job site address: K/ 5 i S fit) A C r r = / New dwelling area: square feet City /State /ZIP: T('9 tar d, pR 91 2-Z3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: D Covered p orch area: square S G� w� q Q /'it V q ` ware feet Cross street/directions to job site: V ✓ Deck area: square feet Other structure area: square feet 1. i of o s **I t#. Cow : CI�1L� -U j w 1sT Subdivision: 1 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 ,,,,z-': '� work indicated on this application. I e co d e �Q C� ed Q rQ Valuation: $ 9 jt. Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: M ( ter/Q Sc ivicb Type of construction: Address: 6 64 5 S W g. ( p e d Occupancy groups: City /State /ZIP: ''7` Q ,.d 2 �� pl223 Existing: Phone: (5 O - O'? 6 t Fax ( ) New: ' �,, ti O N i<'a6T 1PERR� z. � t f NOTICE Business name: �( 3 „A Ant 6 All contractors and subcontractors are required to be Contact name: ( S 4 S S uJ 14.1 fre c( licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: T ! a Q P d (' (7, 9 7 2 2 3 jurisdiction in which work is being performed. If the City /State /ZIP: ' (• applicant is exempt from licensing, the following reasons / apply: G Phone: (6031 $ 0 — O 6 -7 Fax:: ( ) E - mail: Business name: s t t Address: LO ; Structural ' plan review fee (or deposit): City /State /ZIP: Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: Total fees due upon application: Y c Amount received: X . Authorized signature: This permit application expires if a permit is not obtained Print name: i S c At b Dater 22 /OJ within 180 days after it has been accepted as complete. * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) , • Building Permit Application Checklist . - One- and Two - Family Dwelling FOR 0FF1(4: I SE ()NIA City of Tigard Received 7 Date/By: No.: 1 3125 SW Hall Blvd., Tigard, OR 97223 X Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: I ( itD 24- Hour Inspection Line: 503.639.4175 ❑Electrical ❑ Plumbing ❑Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ) c' `II `i.. I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ 1 ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state . ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size • sheet attached to the plans with cross references between plan location'and details. Plan review cannot be completed if copyright violations exist, , 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if 0 ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace; ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. - 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- - ❑ ❑ • ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacillg,,and bearing , ❑ ; ❑ ❑ locations. Show attic ventilation. . s 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ - ❑ ❑ systems, see item 22, "Engineer's calculations." _ 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. . ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required =❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ - architect licensed in Ore • on and shall be shown to be a, ' licable to the r ro'ect under review. • • JURISDICTIONAL, SPECIFICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. • I:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11 /02/COM/WEB) Plumbing Permit Application FOR t)Fhl( 1 St: O \1.1 City of Tigard Received Ty g an Date/By: Permit No.: • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: f 1 G A R D Inspection Line: 503.639 Date Ready/By. orris E1 See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information ,. TYP `'OF WORK r ' .1* .g ' `rs ., ❑ New construction El Demolition For special information use checklist. Description 1 Qty. 1 Ea. Total Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 [t1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 1=1 Accessory building CI Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 "" T F E E44FORMAt1cN AND'' LOCATION Site utilities Job site address: Catch basin or area drain 16.60 City /State /ZIP: Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 1 Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector ' 16.60 ( l r o .l Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 , r _ ./. , a ..,,,,t.„ " a ., , � ti 1 Backflow preventer Page 2 D ow n 5 a I r £ d 1f e 4 Backwater valve 16.60 d e i-a i� q a ,r a9 e Clothes washer 16.60 v V Dishwasher 16.60 ''` 0 IP OVERI't , 1 R 0 TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: nil ,i k2 3tyAW 44 Expansion tank 16.60 Address: G 545 S u) / ' ( Pre d Fixture /sewer cap 16.60 City /State /ZIP: 1 ard DR 9722-3 Floor drain/floor sink/hub 16.60 Phone: (5 o ' 6, � 0 en b? Fax: ( ) Garbage disposal 16.60 Hose bib I 16.60 I V . 0 u PuCAIV T 0 CONTAOT - I PERSONi C� / ce maker 16.60 Business name: ( C2 G'1 �� Interceptor /grease trap 16.60 Contact name: n ,� r / ,, • / V t I l.� Medical gas (value: $ ) Page 2 Address: 6 s 4 5 SGt) At)" re, Primer 16.60 City/State /ZIP: T( a, r ©R.. ✓ e7 2 3 Roof drain (commercial) 16.60 Phone: 603) G L/ ( / � p Sink/basin/lavatory 16.60 � 1(j � I Fax: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTR `CT'0RR' Water closet 16.60 Business name: Water heater 16.60 Address: Other: Subtotal City/State /ZIP: 0 + W f1 Minimum permit fee: $72.50 72 2 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) 0,70 X Authorized signature: /�� T TOTAL PERMIT FEE 31 !o Print name: Date: 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. 1:\ Building \ Permits \PLM- PermitApp. doc 12/27/06 440_4616T(10/02/COM/WEB) 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' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 S Vitt torm & Rain Drain - 1st 100' 55.00 " "" tr $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each � y { 'ow additional $100.00 or fraction thereof, to and - " including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", ,' 'r f > i tenit*I t allatreii please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees * . Please check all that apply. ' 'Quantittyby ( ififrei.WoirkPerfomi9ied, ❑ Any new commercial building with water service 2" and Fixture :: i e� _ greater, except systems designed and stamped by licensed ,Peivioua' Capped : Added kisting engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure Jacuzzi/Whirlpool as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive Stall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash'; €t" Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings 3 that meet the qualifications above. Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an - Bradley p - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: is\ Building \Permits\PLM- PermitApp.doc 12/27/06 • , F • Electrical Permit Application FOR OFFICE USE ONLY II:9 d ceiveive City of Tigard Received e Permit No.: Da 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: anil Inspection Line: 503.639.4175 Date Ready/By: teas ® See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit is sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural IA 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 ", "I -2 ", "1 -3 ", Job no.: Job site address: 100111' or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: ❑ Health - care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I " New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi family 75.00 2 residential (with above sq. ft.) /1/ OZ — r` . 3 6 F s �-> 6 / 1 Services or feeders installation, alteration, and/or re cation CJ " V 200 amps or less fl 80.30 2 ❑ PROPERTY OWNER ' TEEN �, ANNT 201 amps to 400 amps 106.85 2 Name: 111/ 1 e L G /`' 401 amps to 600 amps 160.60 2 J �j L," ,_ 0 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: 7 D Q e , Temporary services or feeders installation, alteration, and /or relocation Phone: (may d 6 - D Fax: (..S 'Z _2' 0'.._ 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, pr cha , ac g 401 amps to 599 amps 133.75 2 � /� .� /fi Branch circuits — new, alteration, or extension, r panel Owner signature: Dateto O r =aS 447, 449, 670, an 701. 4 te 0 A. Fee for branch circuits with ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, a 6.65 2 3' 7JG' z� 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRA TORR (� _ Sign or outline lighting 53.40 2 Business name: /� C _ (L, J -- `I Signal circuit(s) or limited - �L1 energy panel, alteration, or Address: extension. Describe: Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: ei , (�� Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): , I , L Authorized signature: TOTAL PERMIT FEE: 10 r p� j ' This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(ll /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 03/23/06 4 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. or 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. i/ L /7 i�c1 - 4<D Print Name of Permit Applicant Signature of Permit Applicant Date Permit #: ,ZOC�4 Co6LiS Address: < <.l� ���r� C Issue. .y: Date: 9%94/:"9 ••••[- This Copy for Permit Offices OM : NYS ASSOCIATES FAX NO. 503 2 6721 nrrril!FD Jul. 24 2009 12:11PM P1 AUG 1 1 2009 j .l ._ µY OF TIGARD 1 S\ 2 �� - c)d L (e0 J JUL 2 4 2009 C 01N6 Ulv►51dr � � Clean Water Services File Number By_ C 1eariW<�f Services r n1 -00 1 3 2® Sensitive Area Pre - Screening Site Assessment j i 1. Jurisdiction: t et, r ct 2. Property Information (example 15234A201400) x3. Owner Inform/til W �� 1K.. Tax lot ID(s): I S J 7 f �1 0 b Name: _ RA Company, Address: i lit ~ � B a y v ir. ' ` Site Address: �r Miliji_ja'Jl City, State, Zip: , moriama I t_ • City, State, Zip: 1 • t V GilellrinG Phone /Fax: Nearest Cross Street: E -Mail: 4. Development Activity (check all that apply) >15. ilfgrmation ,PAdditton to Single Family Residence (rooms, deck, garage) Name: �5__�r Q Lot Line Adjustment ❑ Minor Land Partition Company: 1T ` . gtoof e5 n ❑ Residential Condominium t0 Commercial Condominium .7►"T -1 r ir fry, U,e- Address: ❑ Residential Subdivision ID Commercial Subdivision i_: �;r.�;�,�� 0 � i City, State, Zip: r RI Ve a R. �2 a d Single Lot Commercial ❑ Multi Lot Commercial p tp Other Phone/Fax: 0 - lI 1'2 - E- Mail: S r aSS °_ oa a t�Y10r,rCCG 6. Will the project involve any off -site work? ❑ Yes 4No 0 Unknown —�J 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 1200.0 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 bo 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 end gathering Information related to the project site. I certify that I am familiar with the in contains tit dooumenj, and to the best of my knowledge and ballet this information is true, complete, and accurate, Y..' Print/Type Name 1 + f F e i )1 Hi a iji - Int/ ype This v W he r Signature - 4111"5"Wicr_,/ K Date 7 f 2 ti Dg FOR DISTRICT USE ONLY l 0 Sensitive areas potentially exist on site or within 200' of the Site. THEAPPLiCANT 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 pay also be required. (' Based on raview 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 SlteAssessment does NOT eiminate 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 end Order 07 -20, Seaton 3,02.1. All required permits and approvalslnust 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 ME not significantly impact the existing or potentially sensitive area(s) found near the site. This Sensitive Area Pre- Greening SifeASSessment 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 102.1, All required permits and approvals must be obtained and completed under applicable local, state and federal law. Q This Service Provider Latter Is not valid unless CWS approved site pistols) are attached. The proposed activity does not meet the dennition 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 Amplik. 1.---' q Date 38. O f 1 2550 SW Hillsboro Highway Hillsboro. Oregon 91123 - Pnci - (503) e at - 5100 . - fax: (503) 601 -a4�9 - : www:deanwaterserwces_org i 1 I - - • I r 1 7 ° V .. by > � t - t C' I .. .. . bH et`a . -�... ..tytty✓ :.OI T E ' ! � ' . GA - E:: '4F 111.- PI't`s • . • ' O 4- i nraFz. : , w : - -' . ` ' ''REOD • • , • • ; . 22 •: 1 © JUL 2 , L. 2009 ' Fa 1 • Ra r ; ` C TY 0 .�'I ono. ' • , � NG DiVIS S 1iLDI ON; 1 • .- I N �T i i � Lol: . ' — G F - i ✓ t : • P, R , t� .1 " `f' r ,,, , Lo d-: -, I. , . , i i , -7. 1___ r . • EAST' 't`' TRH r .` . tiff ■ I . i ; , I E'. IG.TIN' i ' i ..,, E Ic.�T 1 t S ! : ' • . I ' l i ' ' ' ' : . s I NI, 1-.. a , - . ` 0.e... . . . . I PIa v ; , I �. ' . . . . FA '-. 1.1. -r'; 1�. -- - • i 1 � ` ;L tr-t o Far R s P .I,� M , pI :PRoP. t� E.,.._ . • , • 48 • I . - R11TC�E :. `, "* : .•: i , r I DM NQ''OV —.,,tic ' f i _ . . . • I . . . - E M TRR'( : i f , ALL: ; : Tr P. :. ;' • • :\ : • E» / • 3 t -,a r aL I•: . , . 1 • ' ' • 1 : '� to R! B /E. w,A:` -r' ! i , L "/� Il i i ' t t ` _.f.;. • k L I� . �/ ` I� • N6// ! ' I i i I ; I .•, �. I1 Q /, C. 0 ' ! ., . I > 12 �w _ _ ! , ;) t- 41- .• A $ E ' \f N.; : t Pl��P- • .- • __ _ _ _._ -,_ _. • _ ..... . • i t . . : : . . . 1 ....... 1 E . . :, , ... ... ; ! Jli :!. i : e,;?4 ii ,, s , „ .; , : , i ;. ; , . , ; ; ; ; ; i . ,: ;:;; ( ' N Q.R 1 + : . ! P!_:.o1- l H • 1hA 1 1�R 1 : ■ i• ® '' � . / . C I t I � � „ , , • ' • . 9, ../ , - P' (': -ErJ . ST ET T :- . : I . , ; , : , ... . - , , . I - E,... . --........," . I P L ...: . : i 3/4....„,.. 4. H .:: i : ! w • Ny Associate . - _ ' , G - s- . i=& i -1 -ter • 4 . - 1 0250•: S. i . 8 Ave S C A LE: _ : �J APPROVE BY: DRAWN BY' � : . . e DATE f �� /Dp : REVISE* 1243/ ` �ii a nd O ''7 .. It _ 5� 3 - 24� - 1 . DRAWING NUMBER. ; : • • • CITY OF TIGARD - SITE PLAN REVIEW CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO: V'L 2C ? • (Dclf,C) BUILDING PERMIT NO.: m�1: 2 (Q Cc?( / PLANNING DIVISION: Street Trees: I ' proved ❑ Not Approved Required Setbacks: 12r Approved ❑ Not Approved Protected T LiT Approved ❑ Not Approved Side: Street Side: B Date: f l y /O9 Front. Garage: Rear: .. Notes: Visual Clearance: Approved J ❑ Not Approved Maximum Building Height CWS Service Provider Letter Required: EF Yes 0 No I .71-,3S ❑ Received tip: flee Date: 7/a31o9 ENGINEERII& DEPARTMENT: Actual Slope:.,,% Zr pproved ❑ Not Approved Site Plan Approved ❑ Not A proved By: Date: iZ3 Notes: a fe1 e'U- ZcQ- -- r