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Permit ,, r th''.: t'' MASTER PERMIT Illii ,,, CITY OF TIGARD � '- '_. COMMUNITY DEVELOPMENT Permit #: MST2009 -00172 FI WRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2009 Parcel: 2S 102 DC00900 Jurisdiction: Tigard Site address: 8855 SW EDGEWOOD ST Subdivision: Lot: 0 Project: Maclean Project Description: Construct (2) separate 528 square foot accessary structures No electrical work at this time 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 Total sf Value $46,582 56 Rear 0 PLUMBING Sinks 0 Water Closets 0 Washing Mach 0 Laundry Trays 0 Rain Drain 0 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 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'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) MACLEAN, DANIEL M OWNER 1 MST Ersn Cntrl 503- 681 -4444 8855 SW EDGEWOOD ST TIGARD, OR 97223 PHONE PHONE FAX Total Fees: $1,048.71 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 � Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952- 1 -0010 thr O ' '52 -Or 100 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 66 332 2344 � r Iss ed B ' �' �� t Permittee Signature: . A.:7-2-1 Building Permit Application , Residential Ir., fl/ :FOR OFF IC.E 11SL O\Lti City of Tigard - R i , Permit No 7j�.�Q �'t/� 111 • ° 13125 SW Hall Blvd , Tigard, OR 97223 AUG 1 20 Plan Re' � Date/B _ Phone' 503 639 4171 Fax. 503.598 1960 Date/B will', [6 .� Other Permit 'T I G A R D Inspection Line 503 639 4175 C (} (gip Date Ready/By. > ® See Page 2 for Internet www.tigard -or gov �� " � Notif 10/14 1 Supplemental Information BR"LOM M DI VISION w/ ..`_ : �: -..r °` "t u „t A;r4 .5��t = < x - *, :, f k- t3 aa l� ".aa: ^ . < rVI T TE _ i t . s20/ =:x b, , t om: , = ° 4.,V , : : TYPE - O`F WOBK;a, ; Y= ,. t ' ... , �,. ; q t } R E UIRE ;DA` ./ - _�_�:�. - �,��.,,�,. ". .. ,�„s..,u� "�';; :�,_ , � °�� .•- ��.:.. - -.:� h�t:.,�� <, ;: <• � � .�� -.< Q TA .I� ANDR 2 " ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all g, ❑ Other: equipment, materials, labor, overhead, and the profit for the "'' " * �~� ° °� °' f`= =�°`l — ` c " ", . rF� M - 'zzr .V v...; =a_ 'CAa'IjEGORY ®F CONS "TRUCsTIONk, = a�: z: `z.; 4 "� ".. ',' -3.> ° work indicated on this application. �{ �0 2 • ,�,;�€',� � ; "x� ; ` k- �... -n , U'r.n:� -: ��;� �- �- °�zs��c%� �.-,� > _ ^rocs» �� :o< �+�&�;'r�saz�°"� ;. R . �;�; ��aw� P >�, _ ; s X1- and 2-family dwelling ❑ Commercial /industrial Valuation: $ l ❑ Accessory building 111 Multi-family Number of bedrooms" / ❑ Master builder ❑ Other: Number of bathrooms , "P-Ok f N:{ . , ":; �,;:" tT�" i ; .°'^ �` �.. a,fm:«et' . ? d . a` l n-` :r- ;t�s V K , s x."o- s ".0 i' ' ;; 115 -1 ; r OBi SITE < SAN L OGA T IO iv 4 �, � , :t: -r Total number of floors ,, .. P >4, „�” r° , ,"�"�."s _ :,� `�.'�'- :ro',r �`,.� :.�*�"�Eaha, a�rr W s - .��?�'��.� �sN^ •�s�" ,?^ ' v�� - -d -.. � *s ;; <„ <e "a ;:g Job site address: C New dwelling area: square feet City /State /ZIP TiC q Garage /carport area: �0 square feet Suite/bldg. /apt. no : Project name: 93p-7) kezt AA 3 Covered porch area: square feet Cross street/directions to job site: Deck area. square feet Other structure area: square feet ,.�= ssa=z, -`�s.'x.� - ,ta z - rsr.:Ym' :Rila D i'AiA CO IV.& ' eA>ri eidisIZIST .$ - .. " sue,=_ -,, rv. ,,TO :,6 .... . .,.,..g " ,-a s. ra ,,,r,,,. Subdivision: Lot no : Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the ; ` = : �DESCRIPTIC 40,olzA . � a ` =. work indicated on this a - ;,. ,;>."`�ia ^',x ;r' § -x- ,,, , ,s' ° C�''�.j+ tk�.'��2,v"; � - �:; c: �, a$ 2�r":�e'�it�s.,.�xu#rs�� °�:` Sri . ° 1 =:;,:;a.s;:` "= f;; =,;�: ,.a� , W � application. A -C� ai_ -��C /1 � Valuation" $ L Existing building area: square feet New building area square feet ; ""f; a :,�`r 2 :, ° " �"ffi a e..ESZ-�'t. "��`. -�'xd 4ta..., l gx• ° - r .,._.. .. On ;:ROPER ®WIER•- _.:wf e g , - = TENANT" z "� Number of stones: ..: ��x �ar� r �.t•�a "� ..,,� `� �»4,�'r'_.51 H a _, ." , -� z : �... ._< >irs' �' ;�r_r_, * - `� `' "; - - Name: `Daniel o �t:�.-r� Type of construction. Address C)5 5L I G 1.�L < Occupancy groups Y� s P City/State/ZIP' q y TI � �.� l ti '1 7t3 7 � Existing: Phone: (5.3) 1D�5 ^Li J I C"� Fax. ( 5�i3) 359 - � c 1y 1 New: t g :;' }; -" 0 ° ^.. C - •' °. ,. .. �,. s. k . i , t ,�"•'"1�`-.tr -AC 1.- ------ -,-, -:-... - - --, --- ,"a "-- „,,,x;Y . ?are;.: 3"-"., -- �,, - > ,„,r ., s.�) ,-. ,�A ICANI r ,f. il ®k;CON TERSC ; , 4 ,+ ,, _ . ;�„yr; + :r . ,- .,..�. .... .?�'a��:n,��':.�. . Zt.: �. �: 8,' �. s' �' a'itaa.f�. t ' „ �� ,'a,��ra"i-,: �: ,w .,, �`3„ . �a> :��. = x q,gk :.. =`°�”' -3.�, 9 �� .�" ? °- -. �,�x t > . yam w , s r _ a..; , _ " s. ., . li NOTI �., r. ° = ° - . � 2 :.x� ":- :a ��sw ° ^�'��c�� bz ','t. �.:. e-: �... _ . ,,._ ».::iac��x,:: V.I.WFw Business name All contractors and subcontractors are required to Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax::( ) E -mail • '- ,elm;,m;x ,, : : z= 4 ," s - ; " F. ..rf / ^nr : ., ;°ra .ad;- G=, , s y t 1 e^ ' my: , ,a, . ,), ,- = e ` � ., -;,•- s. t : t , s ,," A CON' TRA CT,/ R s o = 'v w _. N -7 " I .�, a. �x4�_`� . ��' s" �_+ �'. �= a. ��e.' �.- ri' �.,> a�w�kaw. ��r�r ®.��satg��e.: ='�" •,.ate,- ,�;,y.� _ "`= .�,.��.- " Business name: f z`a, ° r(�� b _ � ° ?� T.III;DTNO ll'ERiVIIT�FEE'- �� • Nu ,4 1; " : ;r �aeI �° . ". S k ; _ Address: (-c.( 11�- b=: :��. >,�,�;,�;:s."._f�[ ease. referlojee• sehed�i "!e)'r;- z� City /State /ZIP: /`J Structural plan review fee (or deposit): @ 7 7. 55 Phone: ( ) Fax. ( ) FLS plan review fee (if applicable). CCB lic.: Total fees due upon application: Amount received. Authorized signature:/ This permit application expires if a permit is not obtained Print name: �._ . Date: , .. � e - J 2 within 180 days after it has been accepted as complete. y c �'' * Fee methodology set by Tri -County Building Industry Service Board. 1 \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 OFFICE 'USE ONLY 11111 City of Tigard Received Permit No.. ® 13125 SW Hall Blvd , Tigard, OR 97223 Date/By C Phone. 503 639 4171 Fax' 503 598 1960 Date / a[ed permits TIGARD 24 - Hour Inspection Line, 503 639 4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet. www tigard -or gov ❑ Other THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW %es No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews, ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 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 X ❑ ❑ 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 .1Et ❑ ❑ 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), le - _ •.. . . - - . • . • - -- •• . • ' -. : - ; ' c - • direction indicator; lam; bt l.. ,--,– ..... ea; , impervious area; existing structures on site; and surface drainage. -' 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing Dads, connection mat ils, vent size .R ❑ ❑ and location. —i 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, 4,4 ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. —7 14 Cross section(s) and details. Show all framing member sizes and such as floor beams, hea, joists, sub- 11 ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof shehing, roofing, roof slope, ceilin�i, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. F1 rE u D 1 t assernh1 . — 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remoans. irr ❑ ❑ 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 ( Brescriptive path) and /j lateral analvcis plans. Must indicate details and locations; for non- 3 ❑ ❑ prescriptive path analysis provide specifirations nor) oalrnlations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing Sir ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." —719 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 01 ❑ ❑ over 10 feet long and /or any beam/joist carrying a non - uniform load 7 20 Manufactured floor /roof truss cti,gn details. 151 ❑ ❑ 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., shea ll, roof truss) shall be stamped by an engineer or .® ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS . —723 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 'a ❑ ❑ 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. g ❑ -" 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 \Bu ldmg\Permrcs\BUP- RES- PermttApp doc 03/21/06 440- 4613T( 1 1 /02 /COM/WEB) Plumbing Permit Application Building Fixtures .. FOR 'OFFICE USE ONLY'' City of Tigard a Permit No S rQ 4y � 9 / 72_ 13125 SW Hall Bvd Tigard, OR 97223 w �"' Phone 503 639 4171 Fax 503 598 1960 Date /By Other Permit No T'I � Inspection Line 503 639.4175 Date Ready /By 1 ® See Page 2 for Internet' www tigard -or gov . Supplemental Information on m•.- - `a�= ar` =s,u ^:ate - v.�::= �"'��,ws.�;.� . ;..fit �� ,��.• ;, >>°.�, - ,`�" °;v °� ; #3 ;s- - °. n.^_ xr�- xa �.; a�..a:zar.. ^n;g'c c t^ - ; _�� sib - ` � ;d+,.;�m,.a '` - ¢ ';';` x_ ;t,Y_ ter` =,:-�. sue ; W ;':: iu` FV': °"^ ', " 'fin'"'. e .. s . t " I I.4 ate •.. XI ft0,4 .,u , 1 - s`,�.w t ,: „ >. . '.A 4- ': . FEE {,SCH EDIJLE4: - ,e F �ti ��' �' {s - ;. ±T'YPE OE;WORK� ;�``�+' �, ,�3 ,; ' �IT,.�_� , ; =�.` .: its �,:. �x, �, �z: �� :��,•�..n,.,.•��n..- _s�,a"�h a � '`F'�,:� 2;�� r:�` - -.r a�,�` ax .,:t:w...:r,.x >;a.r a+?�� :�-�;a s'a"r,< "F,��.•.k�`;:*' r - �,.,,...,.�, ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea I Total - ❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) t4E t ``5 r,'° # r "1=.'Vr : SFR (1) bath 312.70 x :.; ..;,.- C?AT'EG,OR ( .OFD. CONSTRUCTION: " " ° ,-; :l ,: ,, `''' k � " r;�,a : M�`SL � � �' r: T§ `�'.. x J'2 R .'. .- #�;�Y �"i, „i �n'+ . sx .� &.` c �.�..:�: , d�a3".n �. o-e ..sz.+"+."IJS hw"Y �s • "'.5'it+.`"1'Si" ".f.n_3�, ��',�•' ,X. ❑ 1- and 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 s '�;,L..,.�sfit' s . <,.^�r,� }+�s,�rr - - - xt ' s y c.� s > °,ms .. _ c ,, ;; w = tom- '' ' r ''P' 4; 4` ^ Site utilities: z -�� ,},;� � 3.,�J,OBSTTEI1V�'ORMTION;�. AND; i> IiOGATIOIV ;;;- �,�4�:��y;�:�,. _ Job site address' $ 555 �1 A) Glj�� (..,,,,,on Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP 4:1 d2 q7 a-g "5 Footing drain (no linear ft.. _) Page 2 Suite/bldg. /apt. no.: Project name: H c tjit x) Manufactured home utilities 50 03 Cross street/directions to job site: Manholes 18 76 Rain drain connector 18 76 Sanitary sewer (no linear ft . ) Page 2 Storm sewer (no linear ft. _) /Q, r Page 2 55 Water service (no linear ft.. ) Page 2 Subdivision: I Lot no . Fixture or item: Tax map /parcel no • Backflow preventer 31.27 " ° � : ,, s jr w€mwm r_ . i, t: - z . - ;� . mr,, q � °, : wr z. 4 ., r. • Backwater valve 12 51 - °`��'x:r, �?:r`' , '� >� - � � .,.. � ; z. ;v €�` -' ��` ?�`, i " .pia `' � ', , pTIO OF WOKNtr..M �,_� tK ,°° . i,%�t<.. <f�.�::�`'7?.a;µ'�ti:ak C.s"�PRu,T,l.�i'rF�`'zx� at ts4.:aq asw7d ✓.xt$1a..� +� ^o:.,s:)'��°�v`ts; ", _. a - � t `"Q'' '��" '`�"�''� " Clothes washer 25 02 Dishwasher 25.02 Drinking fountain 25.02 Electors /sump 25 02 w? «:S;s: '.tf ry m me- vt:a�. uz:- .-'• xs -- `.�.. q.�;:s� ^g.,,<�.,r: >r „r Expansion tank 12 51 '- 4 . ' t r; ; A* ,., ' x.-...r<.,r.-.:,G» iA 1'''A ? x ha yt ® PRORERTI� '`-OWN.ER. �. ”' - -21,4 �F, :t® °ThE1V,'N` f "";- 4, P %, � .. ..� �.� ��.n « � :�i� . °, b ,„ . ,� ?:,.. �,,t� r ��r b . � ,6 ,., ,? �, •�> ° ". � s see.. , r�u. �� Name. —i Dpi, \ t L ___ Hit c_i_ A Fixture /sewer cap 25.02 Floor drain /floor sink/hub 25 02 Address: 8C. C law ,).>()a*_._...k. i Garbage disposal 25.02 City /State /ZIP. i A (Lit 02 .q7.7.....2 Hose bib 25 02 Phone. ( jl (Q ,c4 -- q,5 q Fax: (5b3) 35A» 4 ( Ice maker 12 51 '- : 'r: `ri z 9: <s et ' �' `�'' , i, �-� >.�..: b a �.;.,. r;;:. V I°: ,aia =<afi� ap °' ` Interceptor/grease tra 25 02 Aer.5 , '° � ®tGONTACT PERSON' x:�x " �r � =rt; „� �tAPPLIGANT�° �,^� .: `k �,.��. � � '� , �°;^` a >,�;: }?` trap _�to-«`�k``v.h�3d`�,.a, rzssc�!,^ f' ��.. a�su• �. �F.%` �.; �: u. �-.' ��r-. �. f* �»°` ex ,.,.��rs.. ? ^��',...�- bt.�3cx`. ,= z•! ..�'.�� Business name: Medical gas (value $ ) Page 2 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 > ..�,, - * -: T •, ; .=„ tx,> I '. =' 1wf :h° ,i Water closet 25 02 "I''" ' ^+ »5 's.`•`',: r-: ire: ?S .- .7 ;Ra v?u5< "ral,:`.".'`.x �%'-v , �. -, "' ,='S4. ,tJ t <isy% Q- .: . mCON:TRACTOR ,: . . 7 - .; 4 Vin' .s�,.r_ a °s�x;,; „_. �ff.. s:�,� <Ax� ��= 'rxr =� �: Water heater 37.52 Business name. 6t).? 12— Water piping/DWV 56.29 Address: Other 25.02 City /State /ZIP: Subtotal Phone ( ) Fax ( ) Minimum permit fee $72 50 «7a.`J' C CCB Lie.: Plumbing Lie, no . Plan review (25% of permit fee) ..— State surcharge (12% of permit fee) g. 7t) Authorized signature: TOTAL PERMIT FEE g. 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 Tn- County Building Industry Service Board 1 \Bwldmg\Permns \PLMU PeimitApp dm 10/01/09 440- 4616T(10 /02 /COM/wEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ;�. tg °�r., .,.„4 . _ ��,�e,�,r,�i.� a`- w•r4?;,�. .; �v`�: ; $ty' ,,, eet(ea)`'•'s _ To tal ; =' y. , * � .. Site Utiht est j _ : uare f.Foota e:. s Pem>t qJg e. k� { -T.�� .f tie _. ,._.. � _, M "�;�' +. ^' t:,. w >..�.. ,a_�w �. ,,- e:rn�l�s�a�J�Mk "�s�r ��as.�S;�"`;,� s sr�- c�,a -- -x. 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 - I st 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 u x E Storm & Rain Drain - 1st 100' 62 54 4, „t- ...... _ - ...r...uR rt;- _ -.,. 'PCrITIIt k�•n : , rN �xa °:r= ` ;< :T $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 r ® •;uS ;, each additional $100 00 or fraction thereof, � r € s,Fee' ea Toial` � 0 0 o t ereof, to then lmspections or F eesA ;_ E t?L '`, ( ); . . �'�°� ��= ��w�� `�` ~� 1'� 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 ou capping, adding or replacing fixtures? If es Y PP g, g P g "yes”, Y K h f 1� Mi please indicate work performed by fixture. Failure to s��`�� °�" -5-an'r evieW�,�_ ors PMU�It1b1I1� . Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. = " `: `� .: Quan'ti ` by =(F, Xfyre).Wo "rk`Perforuied',;'° ❑ Any new commercial building with water service 2" and �Fixture Type: �,; >4 ,� ; Capp •� «,, F. .: P g except � � �;=, �,° ,,„ ;a -,, � ; r R e lacea < greater, exc systems :�' ��`. e designed and stamped by licensed engineer. B Bath Baptistry/Font Shower ❑ New exterior plumbing site utilities for any complex structure Jacuzzi /Whirlpool as defined in OAR918- 780 -0040. El Car Wash Each Stall Medical gas and vacuum systems for health care facilities. Drive Thru ❑ 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 Fountains et :.�..: e�� r• Eye Wash #iF011ll'IC orRiserDagra'm { -- IS s . - - _ c � per u._ i Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. -4" Car Wash Drain Garbage - Domestic Disposal - Commercial Industrial Comments regarding fixture work: Ice Mach /Refrig Drams Oil Separator (Gas Station) Rec Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial *Note: if the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal _ Other Fixtures I:\ Building\Permits \PLMF - PermitApp doc 2 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 I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of "the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. � 7 1 e_IE4k) Print Name of Permit Applicant /04/0? Signature of Permit Applicant Date Permit #: M51 acxa9- 00 1 79, 0 Address: St66 ebe.eux)01, C12- C r V 5 i�l � itnTl�F: , � i • ., Issue by: Date: 10l g /09 1 This Copy for Permit Offices Sep Sep. 28. 20.0933:01PM Dan N Son's Tree Service 503-352-4541 No. 9138 P 3, R E C EIVED -- W . _ . - - ._........... SEP 29 2009 ° - " -�_ : - • , cc: :r ... . . ARD JG l.009 f i a,i 2 's 1 ! D(7 IS(O i ly:l ~Y ` %]' ,! .'Rw111F1:,i I .� < — _ ..-,, • �.+– r� `n . �. LA .. '� : w `."' w J• X • l i ?U !3 a'�' it:1�I14A1 f 1 I • I x.1 1' • ( . B EVISED I , t 4.1 'I Its ,..� - is j i . • I • .. . _ ;y_.,I .,. - LI 1 I 1 i i I 6.1 1 5 Y, N y I 1 I •A•q.. ••�... I f ' I 1 �/ I ' , °J ' i ,1 I i i�'� • 7 '' . - 41 0./. q. a is r, l ' • - , . y • * . . 4 . i 1 : i trIK7) • : • $.w t')c, P pi.ol PI_ A N • A . R E S I D E I N C.E. I F a p_. 1 `µ`11.1''F''°" 1 M•I MILS, MakRV VI T6X LOT a c R r._ Bic 5 s L o ' k w 1] O o i '-- r; ^',...., � 11.• M H RJI p l [E II 03”t! i ; E3 Fp a ` I uo= s. •r• euuu aK . n om 6xpi ( ° , 5...1..". !' . i .. ^.:.711efF7 ee.x •• cKa lit. w• ILIA f0. ; 4511 • ,, „ - • ,•, CITY OF TIGARD - $ITE'PLAN REVIEW BUILDING PERMIT NO.: MA • . • .4 PLANNING DIVISION: Required Setbacks- Approve. 0 Not Approved Side 5-- St eet Side• Front ...La._ Garage. Rear: . - 5 L--- I `... isu.., i:.•01.-,Ic -.- Not Approved *vIront-0,-, :1•.:L',, 1 '....)-,' : :.___ ,,,,,,,, ,. I !IANS. Servi -- 0 _ \ -:.-- 'e., 0 No : ±.-=:,.: .ved Qjt iel • 77 ji .. -..... . ..........- _ .......------ ,... . . . ...1%1C1 i N F. ER IN G UEFA KT iv:::,NT: Actuai 'lop . A. Prrt)v e 0 Not Approved Site P an: / Approved • • ot A 'proved eMvM4tr,t9 By: , . 4- Date: 47) 4 ? , . Notes: 1. , .,,..,,,, .......,..,. ,_,,....•,,... .,.., aprii ire 4 6 . 1 1 6 , 4 2_ A_o_rtie.-- 521 s ,C, GA-loi) c c 050( 5 CITY OF TIGARD -SITE PLAN REVIEW / BUILDING PERMIT NO: pn nT2 06q.. r 00 Street Trees: c 1:3 3 Approved 0 Not Approved Protected_Dr es: / 0 n , BY: 4 Pi 1.-,1 ./ 41 Approved 7 7t Approved Date: q ,50 07 Notes: , ;r; Sec: 28. 2009iLr3 :01PMnen N Son's Tree Service 503-352 -4541 No. 9138 P 2 �� 5 °I es' ; <9LQO trim 5■-1/4c 'tt \a D D tl �' Glean Water Services File SEP 2 4 2009 tj Clean vVate %Services Qer Q0170 ENED Sensitive Area Pre. Screening Site Assessment SEP 2 9 2009 5.1t on: T Q� Ora CITY OF IGARD 2. Property Information (example 1S234A801400) 3. Owner Information BUILDING )IVISION Tax tot ID(s): sl( 2_ _C5( Name: (1 t e,_ l fl •e\.o, \ Company: Address: tZ\ El, � Cac `\ csP ee If :CIA Site Address: +�'�+ s ! ._ _ �.. s City. State Zip: `T i Lend Me_ q - 77:2.3 City, State. Zip: , l 1 v c4 if ci e e x ''17 22 Phone/Pax: Sc3 fg L} - 419gi /5e 362- 45 41 Nearest Cross Street: • E- Mail: a7L _ 4. Development Activity (check all that apply) 5. Applicant Information g Addition to Single Family Residence (rooms, deck, garage) Name: • Q Lot Line Adjustment 0 Minor Land Partition Company: ❑ Residential Condominium Q Commercial Condominium Address: • Q Residential Subdivision 0 Commercial Subdivision City, State, Zip: a Single Lot Commercial Q Multi Lot Commercial - Other \x�•cG.C.'"-•. cirx.rA5,, Phone /Fax: E -Mail: 6. WIll the project involve any off -site work? 0 Yes .SgNo ❑ Unknown . Location and description of off -site work 7. Additional comments or information that may be needed to- understand your project This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEO 12004 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 sire ai all reasonable times for the purpose of Inspecting project site condillons and gathering information related to the projed site. I certify that I am familiar with the information contained in this document and to the best of my knowledge and belief, Ibis information is true, complete, and accurate. Print/Type Name ; "Ge.Y'1 \ e._ \ j'' 0, C (- a Print/Type Title ?.--.:_€.V1_17. y _ Signature , /e.--'44--------- Date FOR DISTRICT USE ONLY Q Sensitive areas potentially exist on site or within 200' of Mesita THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feel on adjacent properties. a Natural Resources Assessment Repot( may also be required. LI %aced 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. T his 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 s required by Resolution and Order 07.20, Section 3,02.1. At required permits and approvals must be obtained and completed under applicable local, St le, and federal law ❑ Based on review of the submitted materials and best available inform ton the above referenced project will not significantly impact the existing or potentially sensitive areas) found near the site. This Sensitive Area Prescreening its Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive er- . ' they are subsequently discovered. This datum al will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3. r . 1. All required permits any - 'pr'vail must be o. ined and completed under applicable local, state and federal law. 07 This Service Pr. r ide Letter is not valid ti les - CWS . , p ed site plan(s) are attached. • CI The proposed a ' does not meet the d ni) on .1 develop nip the to . platted after 9/9195 ORS 92040(2). NO SI E ASST= '.MENTOR SERV. •R • r R LET ER IS REQUI'' b I • Reviewed by - AI ilamill i/ Date : mmmw 2550 :; SW Hill;troro Hinhway lliilsborr oracron.97123 Phone: (5031681 -5100 t F (`0_) E6 1-4439 • rw ri.clea ti1v0LfSCNiCC5.Org Sple -f eki 1 I zzlog. . . . - . LlIU/ Ban N Sen's Tree Service 503-352-4541 NO• 1.30 r )3 , - — - — - • — ■ • . f'•' i,.F•''' ‘ 7; fi pwa rz:, . . 1” Yr:1 .15 rl r' i, V III • . , . ,.....• .. . . . - • , .. • • . • . . . — ,. . . .. • • „ . .. 1 ! • . , . • . • . . • • - . i vi_...,P.- .? T.:: p r4F - - - - ,.....,. ,_....... - • ir •„-,• , • 7 4.1.16 . 8 "i009 • .. .,....ii• , ..1'. , .,.:1 - } 04 , C.',ITYOF'TIOARD 1 . • I . . , .• .. LA ,--.If-.......S... -....-" • `...".."--- ,._. :.--, ".. ' t * .e , ° — .. .. ...--....----N . . „.„...,,, . I i 41 laDINt D, VISION f . f ' - • . , . . . .. , • . • . 4 , . . 1 • . . IL•le‘ ' ; I . . 1 I - -..."‘ -:. : :.C .\\SN•f , ' , • 4 '.. :' . ....:''' . ' ).' '•N'' ' '' t ••• ' :" . • I ; I •:,,,, . ... . 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W 0 p D I _ ,.. -- . . . . _ . . - -cr.- • ---•0•1•4 PLO - r P L N . AGItisiDEINLE ° F 0 11- I Li-Ltilitvf•-c;^ I TO( LOT 1 00 M R. MU, Hr 4 ATF!ELD _____ ) !I 1 / , ,-...,,,,,,,. I ... se s5 5.ba. • T I te & MI 0 it.. 1 . , _ (.., C. 14 -1'014011U A 11 0.3S(! ft,i 1 , 10.: I .,,.. tam, MK • 11 0/ , • e ./ ■•••1 I 1.E els .,._,• ( :i .3 .g4e t iil 'Up NO 1 et Arty li,- . , 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. BUILDING DIVISION TLWARD TRANSMITTAL LETTER a TO: __A DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED 01 2009 FROM: Ock_v CITY OF TIGARD COMPANY: BUILDING DIVISION PHONE: By VD RE: 111 '' a (Site Address) rmi r ase lum.er (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Co ies:. Descri' `tion: ; g,, Co" ies: '- Descr - -r tioi$" Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and /or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: � (Z9 1 � Q C r \,SSe r p v18 Ac) CSi_rl 4 \,Q,\ 5 ∎ 1 0 0 v dd ,Ro FOROFF ICE_- USE,ON;' : . Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes ❑ No Fee Description: Amount Due: $ $ Special Instructions: Reprint Permit (per PE): n Yes n No ❑ Done Applicant Notified: Date: Initials: I \Building\ Forms \TransmittalLetter - Revisions doc 4/4/07