Permit CITY OF TIGARD MASTER PERMIT
„..1
COMMUNITY DEVELOPMENT Permit #: MST2011 -00191
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2011
Parcel: 2S103AC06100
Jurisdiction: Tigard
Site address: 11340 SW FONNER ST
Subdivision: 1996 -063 PARTITION PLAT Lot: 1
Project: Sexton
Project Description: Rebuild previous addition of 14' x 11' to add new foundation, interior remodel and change out flat
roof over garage to truss roof.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 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: 1 Third. 0 sf Right 0
Detectors: Yes
Total: 0 sf Value: $20,000 00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 1 Dishwashers: 1 Floor Drains. 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 1 Garbage Disp: 1 Water Heaters: 1 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: 1 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 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: 0 201 -400 amp: 0 W/O Svc /Fdr: 4
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:
ALT SF VB R -3 0
Owner: Contractor:
FEDERAL NATIONAL MORTGAGE ASSND & J CONSTRUCTION Required Items and Reports (Conditions)
BY QUALITY LOAN SERVICE CORP 20672 NW QUAIL HOLLOW DR
OF WA PORTLAND, OR 97229
ATTN: NICOLE M LAZARD
2141 5TH AVE
PHONE: PHONE: 503 - 519 -5258
FAX:
Total Fees: $1,078.54
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 - • •an - •'th approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A NTION Oregon law r- • ires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 thr ugh OAR 952 - +' -0090. ou ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1. .332.2344.
Issue: By: _ - & / 0 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspect 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.
Building Permit Application
Residential I, FCml is FOR OFFICE USE ONLY
f ' Received J /
1,,, .... C it y of Tigard Dat eB : ,f Perm No.: , / „, ...„0 ° 13125 SW Ha Blvd., Tigard, OR 4 2011 Plan Review ► 1>!NE Other Permit:
Phone: 503.718.2439 Fax: 503.59960 DateB
7' I G A R D Inspection Line: 503.639.4175 CITY TIGARD Date ReadyBy: 9 Juris: ® See Page 2 for
Internet: www.tigard- or.gov CI T OF i IGARD Notified/Method: �� 7 Supplemental Information
BUILDING DIVISIrN - /.ur
. TYPE OF WORK R DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
j Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ to O pp„ 6
❑ Accessory building ❑ Multi family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: (;4'
JOB. SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / J 3 _SW *N ,fC) New dwelling area: <25 square feet
City /State /ZIP: � 64 ( � 7 22-3 Garage /carport area: 0 square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: q square feet
Cross street/directions to job site: Deck area: 0 square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
/ _/o 14 /sr�- r0a/l 4 / ,. , 4), ,
Valuation: $
I �tr- A yes,/ ,fw n_ :F16/0., Existing building area square feet
F 4„Zc.,t (g) - r'4? l ", 2 w/� . New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: 9, 44..je S Type of construction:
Address: ii 3 qb 5f) FJrJ/1/c�' Occupancy groups:
1
City /State /ZIP: • �C-y�7ro i . ( G t 2z3 Existing:
Phone:( ) Fax:( )
New:
'APPLICANT A CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: 8-,, e.:D 8 fff��""«< �”" / �, )� �, )
Structural plan review fee (or deposit):
Contact name: t r ,. "ry k / �
t t FLS plan review fee (if applicable):
Address:
City /State /ZIP: --7-7.06 Total fees due upon application:
Phone: � Amount received: 7f251 ( e l 9
3) S)_ 70 G / Fax: ( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E -mail: pi/o DJt tf ieRVII d' ti CO
J Commercial and residential prescriptive installation of
CONTRACT R roof -top mounted PhotoVoltaic Solar Panel System.
Business name: � Submit two (2) sets of roof plan with connection details
V �N 5 ���C f !�� and fire department access, along with the 2010 Oregon
Address: z y .' 2. Ln7 4114 1 .....,S. i Solar Installation Specialty Code checklist.
City /State /ZIP: i f.c3„,,. be, 4772-2- Permit Fee (includes plan review $180.00
(( and administrative fees):
Phone: (5 r % Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lie.: 6,C c: ,s/ / y Total fee due upon application: $201.60
Authorized signature: - - This permit application expires if a permit is not obtained
-- ,C ' " ,:� 't1 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri - County Building Industry
Print name: ���y /�/ � vt Date: II� f' Service Board.
I:\ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(1 I /02 /COM /WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No.: •
v 13125 SW Hall Blvd., Tigard, OR 97223
Associated
' C Phone: 503.718.2439 Fax: 503.598.1960 Associated permits.
TLGARD 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.tigard - or.gov ❑ Other:
. THE F ITEMS ARE REQUIRED FOR PLAN REVIEW ; Yes ; 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 ❑ ❑ ❑
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 ❑ ❑ ❑
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, spacing, and bearing ❑ ❑ ❑
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."
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 as I licable to the ,ro under review.
JURISDICTIONAL SPECIFICS 1 ;
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.
1: \Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440 4613T(11 /02 /COM/WEB)
Mechanical Permit Application FoH_p IO2UUSE ONl Y
City of Tigard Received Permit No.: p
13125 SW Hall Blvd., Tigard, OR 97223 R E CE \1F a Y
`; ul '" ` � 1 ��� 7
Phone: 503.718.2439 Fax: 503.598.1960 i �, Plan Review Other Permit:
7rsn Date/13y:
TI G A R D Inspection Line: 503.639 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov NOV 0 4 2011 Notified/Method: Supplemental Information
TYPE OF WORK i ��'i
Y L)t 4 +1'Z[l COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Fit I` [_, Iii \Ill IjjVIJIV4'v' Mechanical permit fees* are based on the value of the work
❑ New construction (Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y ell-and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: / 1 3 if o 5 / J 1 ,.,.4 /I, (requires site plan showing placement) 46.75
YTS
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: 77 0 , ` G} Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 1 23.32 V ?2•
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -Type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
4 �_ JJ � ���- J Gas fireplace 33.39
-6 c C% / I/v � j /C 1 74 - . Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
16 PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: � �4p- , e.-- 350) Environmental exhaust and ventilation:
Range hood/other kitchen
Address: ' i .3 i y ® S, I , N� equipment 33.39
City /State /ZIP: j ie C7'71-23 Clothes dryer exhaust ! 33.39 ?IF/. -5c.
/ Single -duct exhaust (bathrooms, !!I
Phone:
( ) Fax: ( ) toilet compartments, utility rooms) I 23.32 Z `
it APPLICANT X CONTACT PERSON Attic /crawlspace fans 23.32
Business name: �-� �J i'
Other: 23.32
�ro.),(7 Iw /4 c 5�� A Fuel piping:
Contact name: '�- 1 J
� ery' l�j ` $14.15 for first four; $4.03 for each additional
Address: P° J3 GY 6 j 2 Furnace, etc.
Gas heat pump
City /State /ZIP: f r 0 '7' D 7 Wall /suspended/unit heater
Phone: c , 9:70, 6
( �( Fax: : ( ) Water heater
// . / /� / /� Fireplace
E -mail:
��Gd %(ulLr ( rc��r/✓ t Ca /Lt Range
CONTRACTOR -OD Barbecue
Business name: T i w r Q. A )2 ea-D j / 4 Clothes dryer (gas)
Q , 'w Other
Address: I • o ( Q,� o7 MECHANICAL PERMIT FEES*
City /State /ZIP: p-r L- to 97 Ago Subtotal bO, 00
(5 ll ) 33 - / 7 7 5 I Fax: ( ) 66 • 33 5' Minimum permit fee ($90.00) I A Phone:
a' Plan review (25% of permit fee)
CCB lie.: epy 59 State surcharge (12% of permit fee) mei
TOTAL PERMIT FEE r/ , 6 di
Authorized signature: re� - This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Tj Date: t/ /// * Fee methodology set by Tri- County Building Industry Service Board
1: \ Building \Permits\MEC- PermitApp.doc 09/09/10 440 -46I7T (11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I: \ Buildin g \Pemuts\MEC- PermitApp.doc 09/09/10 2
Electrical Permit Application EC i Cn FOR OFFICE USE ONLY
Received � �� /./ ��/ ��c /J
City of Tigard NOV Date /By: 7/ //
.1'�/ Permit I(hi /�f,,,97
13125 SW Hall Blvd., Tigard, OR 97223 11 0 Plan Review
.11 q a ° Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TlGARD Inspection Line: 503.639.4175 CITY OF DateReadyBy: Juris: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING p /�+ (vv➢ -I(tzt Notified/Method: Supplemental Information
TYPE OF WORK _ PLAN REVIEW
❑ New construction g.Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ 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
g_1 _ and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
�
- 100HP or more. occupancy.
Job no.: Job site address: (�
L�
�' -L � �,,/�� 0 Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: / ( � G/ ;22-3 ❑ Health-care za do facilities. vo ❑ 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
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
'Limited energy, multi - family 75.00 2
k2le)C - L / I Cif b>1. residential (with above sq. ft.)
6' � ! S or feeders installation, alteration, and/or relocation
7 /,Q/�'j 7 1 �1' (��/ ��,- A k tt� 200 amps or less 100.70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
a 401 amps to 600 amps 200.34 2
Name: / ,/� 601 amps to 1,000 amps 301.04 2
Address: 1 73/./ 0 f _. j , Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State/ZIP: G � oe ( 7 Z2-3 relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: It Date: A. Fee for branch circuits with
MAPPLICANT I/�.CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: l B. Fee for branch circuits without
�� t t� , ���''J service or feeder fee, first I 56 18 , ( 6 2
Contact name: branch circuit
�� Each add'I branch circuit 3 7.42 ZZ = 462
Address: a , e tfy 6 5 l Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP:
ofa 1 y l d.ti / Qe CI -- 2 dwelling, service and/or feeder 67.84 2
Phone: ($� 3) c9 , Fax: : ( ) Reconnect only 67.84 2
4i/ / � ; i r CUB Pump or irrigation circle 67.84 2
E [ /
�� (O Sign or outline lighting 67.84 2
CONTRACTOR 7/g t Signal circuit(s) or limited- energy
panel, alteration, or extension. Page 2 2
Business name: ^ n F.,/ e i - --t-y -- C �
'2 Each additional inspection over allowable in any of the above
p�
Address: r /7 , i ti fiR 1_67- 72.. Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: 9 .2 72 p 2 ! 7,;.-3 Industrial plant (1 hr min) 78.18/ hr
Phone: (50S) 3& • 136 Lr Fax: ( ' , ) Inspections for which no fee is 90.00/ hr
/ specifically listed (A hr min)
4dl Lie.: l ft 71i 2., Electrical Lie.:645 - 7 % Suprv. Lic.: 5-5135 101 ,3 ELECTRICAL PERMIT FEES
l
Suprv. Electrician signature, required:
..... ,/jr* ° " '---
Plan review (25% of permit fee): : J.
Print name: `� h I 0 , (I Date: / — ( ' State surcharge (12% of permit fee): 'I a 4'I
--•—", (7—
TOTAL PERMIT FEE: 7 , 85
c r
Authorized signature: �+ / rl�
This permit application expires if a permit is not ob rued within 180
' I j days after it has been accepted as complete.
Print name: / f W g l f C7/ , / * Number of inspections allowed per permit.
L \ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1 / /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*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
•
❑ Protective Signaling
•
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
P\ Building \Permits\ELC- PermitApp.doc 07/01/10
NOV-09-2011 13:31 From: 70:5035981960 Page:1/1
11/09/2011 14 :09 5035981950 CITY OF TIGARD PAGE 01/01
.Plu i Pe rm___. pit Application r �- ; - ---,-
Building Fixtures i ; - .:
r _ City of Tigard fled i, '' :. • R«o;,a �[ { n y
r_` /n ii : j tae[elB " : /� T // 44J y��``��
13125 SW Hall 1vd_, Tigard, OR, 97223 y �'"tir MQ' � /AL�P'l �t�l `�/
q
Phone: 503.718, 39 F 'mc; 2 3.598..1960, D a " Re .
inspection [ inc; W.639.4175 L+ . ° - _ DetcIB . ohm Permit Ho.:
Internet' wwW.ti D.t . � •r n , PateRcey/BY Mb:
or.gov _ '. , 1. ;L 'i ntotiAedtiVicthod,
TYPE OF WORK .. n0 860004
0 Nave construction 0 Demolition aka special information use ehwItlist
Wen In Adaitiar /after jnnfr ,�cem t ❑ostler, New 1 , on I cStY. 1 Es- I Total
New 1- d-Ihmay dwellin .. • includes 100 ft for each utility connection
CA'1'BORY OF CONSTRUCTION • f SFR (1) bath 312.70
1 1- and 2- family dwelling 1 0 Conunerciat/induettial SFR (2) bath
❑ Accessory building 7 0 Multi- flamily SFR (3) bath 50032
0 Master builder Each pri er bath/kitchen
It) 2$•02
Other: Fire sprinkler (_ sq, ft.) Page 2
JOB ant *FORMATION AND LOCATION Site at I es:
Job site address / (� Catch basin or arch drain 15.76
CitylState/�1P 'r`+ dz. �214 Orywell, leach line, or trench drain -
AL,: � Footing drain (no. linear ft.: Page 2
Suite/bldglapt. no,: Project name: B
Mmmfaaured honsc utilities 50.03
Cross seroctidireetions to job site Manholes 18.76
1 Rain drain connector 18.16 - ME
S s ewer sow (no(no. . linear linear 11 6,: _} P� 2
Storm sewer (fronetu R: � P 2
Water service (no. linear ft,; ) Page 2
Subdivision: I Lot . I. • or item:
Tax map/pereel no.:
Ritokftow; !rewriter 31,27
DESCRIPTION OF WORK ]3atkwaterValvc 12.51
Clothes washer I 25.02 2E, Cra.
�'" l 1 4. AtY ` Dishwasher 1 25.02 2 5 '
___ ra prinking founts ►n 25,02
p Ejectafaump IN 25.02 -
kt PROPERTY OWNER ❑ TENANT Expansion tank 12.51
I t A.l Fixture/sewer cap in 25.02
t l our drnin/floor siridhub 25.02 MIN
Address: 1 d j ,..,,,,,t,
Ci res sttslZlF: � Garbage dispo'snl am 35.02 NS
1Gn /pp Host bib 25.02
Phone_ ( Fax; ( ) ice maker
immazarazomin t:t CONTACT ' ON 1rilet'eeptoclgrtavc trap 25.02 NMI
Basirtcsa name: �� Medical gas (value: $) Fags 2 Mil
Contact flame: r� Rimer IIBII
!L �• ' . _ Roof drain (commercial) EBBIIIMIll
Address: _ Jo Ac( I Sink/bnsin/ItivgtQ Lim 25.02 . AMM
City/Stat&Pi?: ,, .. '7
'
li► . . , _id, 1 Solar units (potable water) 62 Mill
phone: 0,3 ) 7c7. ., , . Fax:: ( ) Tub/SRQWerJShowerpm IMIIISMI tz.'5(
E -mail: ' 1 kJ Cam' , /, (C' 25.02
CONTRACTOR ii� NM 25.02 Erb
name: - • a Water he m �' 37.52
)„, o ,. 1E ?�✓' _ . _ L N mkt- piping/WV 56.29
Address: " p ' ~ - k A co 5 i Other: MEI
City/State/ZlP: P 4. < 4 r '- � - C 2 97l Subtotal rr
ih.S� • - `V M : Pax: 103 )gAg.ei) /, Minimum permit the: $72.50
CCD Lic_: ftirtireiter Plumbing Lie, no.: loin 9 Plan review (23%q of permit fee)
� `��' '_ State surcharge of permit fee) i
fe" A uthorized thoty2ed sigriQhirc: Tt71 AL PERMIT PEE ,i mpa
,.,,I;; +► - Date TOTAL Thie permit appli ate IN a �spircr:r • penult IS not obtained within too
err it bat lees aeeapren to eoreatete.
"Aec methodology set by Tri<ownty Baildies tndttstry Service Boam
lAnnimiikoremitiwatthPumititpmed Immmo 44046 (700/02./t'OMMIM)
•
B uilding Division
Development Code Provision Review
TIGARD Residential Projects
Building Permit No: - 4 � / I -Do/ 9 /
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A
Routed Plans:
Original Plan Submittal Date: 11 9/II
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along 1 • ft only if approved. �j�j�
Planning Review (contact mti ._ 1 at 503 -718 or @ tigard- or.gov)
1,a -Use Case No. Name
Zoning
Er Setbacks: ' _ !` • , ,
Front 742 Rear r Side Street Side Garage G `! .
❑ Maximum Building Hei ht Actual Building Height A4 t 3
Visual ents n
Easem 0
ents �
Sensitive L ds Typc: ,
N • to •: I / ./ . 4 4 ia. 4:. � � P7 j‘_-,4 •
� ff, i_/ g.-• ,7 ✓l id r
_ �L.t
Original Plan: Approved `Y Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope:
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
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 to Applicant .. .
(v i ,t
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building: • ; •
•
fie; ' �.. • ' .
ii ,'•t. , !. .•t a.. i; r ^,L,. •ti �,�. y ', vN.. "!s*%.*:' � . ; `'
•
Page 2 of 2
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.
II City of Tigard
= Buildin g Division • TIGARD
TRANSMITTAL LETTER
TO: DATE J W" _ ••n : 7ED
DEPT: BUILDING DIVISION
DEC 21 2011
S! " I e-/ Ale—d /
BUILDING DIVISION.
FROM: ✓ �.
itE COMPANY: Pvjc-r Ll
PHONE: 3 , 2"? D • • CQ 1 _ (36_
( Sl3s td S� , 2 5 i tT'02o / r - 46 /7/
ite Address) (Permit Number)
l
S c, ID
(Project na me I or subdivisio ame and lot number)
ATTACHED ARE THE FOLL • ING ITEMS:
Copies: Description: Copi : Description: •
- Additional set(s) of slam. Revisions:
Cross section(s) an4 details. Wall bracing and/or lateral analysis.
Floor /roof framin;.. Basement and retaining walls.
Beam calculation... Engineer's calculations.
Other (explain):
REMARKS: Mr, v i i hm, to AT D ,O bc- Ctdc f o rJ '
FOR OFFI E USE ONLY
Routed to Permit hnician: Date: j24 ( ( Initials
Fees Due: es ❑ No Fee Description: Amount Due:
hnOt l l C �cc 1 klk iV1 t-Cij $ qv , On
$ .
$
. $
Special
•
Instructions:
Reprint Permit (per PE): ❑ Yes o El Done
Applicant Notified: Date: 7A/,/1// &4 Initials:
I:\Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011