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Permit
111 CITY OF TIGARD MASTER PERMIT ,. :_ e COMMUNITY DEVELOPMENT "� 1 Permit #: MST2011 -00183 i ::.„. :,:: i Ti G ARIA 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 ,� Date Issued: 12/20/2011 Parcel: 2S110BA10400 Jurisdiction: Tigard Site address: 14204 SW 119TH PL Subdivision: 2010 -004 PARTITION PLAT Lot: 1 Project: Treehill Partition, Lot 1 Project Description: New SF. y _ff, � ".4'J BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1050 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 4 Second: 1586 sf Garage: 864 sf Front: 20 Smoke Dwelling Units: 1 Third: 1123 sf Right: 5 Detectors: Yes Total: 3761 sf Value: $431,485.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs /Showers: 5 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 3 Backwater Value: 1 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea addl 500 sf: 8 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R -3 3761 Owner: Contractor: FOUR D CONSTRUCTION FOUR D CONSTRUCTION Required Items and Reports (Conditions) P.O. BOX 1577 PO BOX 1577 1 Ersn Cntrl 503 - 681 -4444 BEAVERTON, OR 97075 BEAVERTON, OR 97075 PHONE: 503 - 720 -7445 PHONE: 503 -590 -0805 FAX: 503 - 590 -1751 Total Fees: $22,112.06 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 rough 0. - •52-001 u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.600.332.2344. iii:12.4=41(iii Issued By: C Permittee Signature: Call 603.639.4175 by 7:00 a.m. for the next available Inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project Approved plans are required on the job site at the time of each Inspection. 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. IIIII City of Tigard Buildin g Division TIGARD TRANSMITTAL LETTER TO: (v E01? -- GE ! / 141 OS DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED MAR 13 2012 CITY OF TIGARD FROM: "CAW 1c) D e‘1p,NR -Mrtzr BUILDING DIVISION COMPANY: Fou YZ ID (oci S 1 a u c t - L v 0...J PHONE: Sea —72,_0 ---? 4 y � RE: ljQo- S(c'. It ct tN rt., Ms -c go11 -oof8 2 (Site Address) (Permi Number) t o l-1 1 ( roject name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: I Description: Copies: I Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. — Other (explain): C - t� SF g 1 NI_ L e� . REMARKS: FOR OFFICE USE ONLY i outed to P chnician: Date: y � /e1 /f Initials: / Fees Due: Yes ❑ No Fee Description: Amount Due: $ .?33• ao (Ma i_ Special Instructions: Reprint Permit (per PE): ❑ Yes 10 ❑ Done Applicant Notified: Date: /if j)— / � 1 _wi dt Initials: /...),..09 . 1:\Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011 • 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. a - City of Tigard Building Division g TIGARD - TRANSMITTAL LETTER TO: DATE P E jkat i D DEPT: BUILDING DIVISION ; FEB 172012 FROM: " V 1t) BUI DING D VIS ON COMPANY: .r— C-.Pw1351 -U c - t - i o tJ • PHONE: •S — By: 0 .,2o l .— oa ! $3 (Site Address) (Permit umber Ee6t1LL - P CEL 1 (roject name or subdivision name and lot number) • ATTACHED. ARE THE FOLLOWING ITEMS: Copies: Description: Copies: I Description: Additional set(s) of plans. • • Revisions: Cross section(s) and d etails. Wall bracing and/or lateral analysis. • Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): FAKE sr g, /cl V.117__. .REMARKS: . FOR OFFICE USE ONLY Routed to Permit Technician: Date: • Initials: _ Fees Due: • Yes ❑ No Fee Description: 'Amount Due: • $ • Special Instructions: ° Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I:\Building\ Forms \TransmittalLetter - Revisions.doc 02/08!2011 14 - . CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2011 -00183 13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 12/20/2011 .TIGARD ; Parcel: 2S110BA10400 Jurisdiction: Tigard Site address: 14204 SW 119TH PL Subdivision: 2010 -004 PARTITION PLAT Lot: 1 Project: Treehill Partition Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1050 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 4 Second: 1588 sf Garage: 864 sf Front: 20 Smoke Dwelling Units: 1 Third: 1123 sf Right: 5 Detectors: Yes Total: 3761 sf Value: $431,485.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs /Showers: 5 Garbage Disp: 1 Water Heaters: 1 Water Lines. 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib. 3 Backwater Value. 1 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 8 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp. 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC' N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R -3 3761 Owner: Contractor: FOUR D CONSTRUCTION FOUR D CONSTRUCTION Required Items and Reports (Conditions) P.O. BOX 1577 PO BOX 1577 1 Ersn Cntrl 503 - 681 -4444 BEAVERTON, OR 97075 BEAVERTON, OR 97075 PHONE: 503- 720 -7445 PHONE: 503 -590 -0805 FAX: 503- 590 -1751 Total Fees: $21,850.88 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 - - - • - 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. AT • NTION: Ore" law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -J010 through OAR 9 ! -00 'r ?0. may obtain a copy of the rules or direct questions to OUNC = • - ........ 3 1987 or 1.800.332.2344. Issued B • ' 1 . P // i ILt��l Perm Signatur -. ` / • A . / /6�� Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completio of the project. Approved plans are required on the job site at the time of each inspection. ifuilding Permit Application NJ LP 27 -t3Oc Residential V FOR OFFICE USE ONLY O \� Received ``�� A City of Tigard Date/B : V i� I')� Permit No.: VS 1 � 7/_ 0o f0 p� U PI ° 13125 SW Hall Blvd., Tigard, OR 97223 (� - J Phone: 503.718.2439 Fax: 503.598.1960 .AC r . „,n DateB : Plan Revie , jj � : � Other Permit. Q a O d /57 � I' I C. A IL D Inspection Line: 503.639.4175 0V 1 ' � �" Date Ready : y: ® See Page 2 for Internet: www.tigard - or.gov C ,�`(�jv Notified/Method: � Supplemental Information TYPE OF WOR REQUIRED DATA: 1- AND 2- FAMILY DWELLING A New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. itv 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ El Accessory building ❑ Multi - family Number of bedrooms: q ❑ Master builder ❑ Other: Number of bathrooms: Li O S INFORMATION AND LOCATIO Total number of floors: 3 Job site address: / S // 9t> PL New dwelling area: 'S 6 quare feet City /State /ZIP: ` l (Al2_J i U Ot ! 7 'Z Zt� Garage /carport area: �(,� square feet (1' -2, -2, Suite/bldg. /apt. no.: Project name: Covered porch area 1 6k square feet (56 Cross street/directions to job site: j 1 9 14 p.. C c, A �� bE Deck area: s _5(:. square feet 1 Other structure area: 4. square feet 2. REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: llzCE, 14 lLL- PART It to t,. ( Lot no.:far .cl ( Permit fees* are based on the value of the work performed. Tax map /parcel no.: .PL t �/ o1 0 _ tC) C ip � Ce 1 1 Indicate the value (ls, labor, to the nearest dollar) of all equipment, materials, laborr , overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. iGC,) S' /A)C6 38 Ly )FSjj �tLt V $ l Existing building area square feet New building area: square feet a PROPERTY OWNER ❑ TENANT Number of stories: Name: ,.,E _ ' 5 ci-i ate] Type of construction: Address: P, o. -_,)( I S Occupancy groups: City /State /ZIP: 12. a w E t _ q 07 5 Existing: Phone: ( ) ' 7 , 2 _ 0 — 7 C{ Li S Fax: (G -3 ) 59 D — PS I New: APPLICANT igi CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Foul D J 6 S .. Ru GY D 1 ``I Structural plan review fee (or deposit): Contact name: D /, V I 0 D� i-FA? pece. 1 FLS plan review fee (if applicable): Address: City /State /ZIP: 0 b(- Total fees due upon application: Phone: ( ) Fax: : ( ) Amount received: F ou t — DC-c' o MS N Co L 'l PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E -mail: Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: � Solar I nstallation Specialty Code checklist. City /State /ZIP: 0 Permit Fee (includes plan review $180.00 and administrative fees): Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60 — CCB lic.: ( 3 Total fee due upon application: $201.60 Authorized signature: 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 Print name: 1--- �O It) ' ` s p , j Date: t l ci - ( Service Board I:\Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No.: a 13125 SW Hall Blvd., Tigard,OR 97223 Associat . 1111 1 Phone: 503.718.2439 Fax: 503.598.1960 Associated 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 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 a. plicable to the .ro 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- RESPermitApp.doc 02/24/2011 440- 4613T(11/02 /COM/WEB) A Electrical Permit Application v � FOR OFFICE USE ONLY City of Tigard r,� v Date/By: Permit No.:./I'l e ! )k — ' F} ° 13125 SW Hall Blvd., Tigard, OR v ii Plan Review ( t Ll ' 1 : ' Phone: 503.718.2439 Fax: 503.5' . .0 �Q1� Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 N.% Date Ready/By: Juris: 63 See Page 2 for Internet: www.tigard- or.gov G 1 G hR O Notified/Method: Supplemental Information TYPE OF WO� w \`, PLAN REVIEW wN f�G Please check all that apply (submit 2 sets of plans w /items checked below): ew construction ❑ Addition/alterati ment ❑ Demolition 0 Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories. 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 12t I- 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 ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND ❑ LOCATION Addition of new motor load of t' ❑ "A ", "E ", "1 -2 ", "1 -3 ", L� G � I OOHP or more. occupancy. Job no.: Job site address` y p, 5101- , 1 Q I l 1� 0 Six or more residential units. 0 Recreational vehicle parks. City/State /ZIP: l( il?-i-- r) t 0 7 �J' q Yip . 2 4 ❑ Health -care facilities. ❑ Supply voltage for more than ` �- L ❑ 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: I q to. p ci,„,,,Tia(z.fl C Description I Qty. I Fee. I Total I " New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: -- (L s.. V C--I .0 id Lot no.: ( 1,000 sq. ft. or less j 168.54 U e •54 4 Ea. add'I 500 sq. ft. or portion e 33.92 27i 1 Tax map /parcel no.: F(■-y-- .. .261b -- 06 4 / Pip _EL 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) ) •� Limited energy, multi - family 75.00 2 6e N 0 -1 117 ,. . t 17 —S(D to C residential (with above sq. ft.) t�tv Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 • PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 ✓ 401 amps to 600 amps 200.34 2 Name: UU. _ C6N 1 - (.LC-4 -t (NJ 601 amps to 1,000 amps 301.04 2 Address: P. O t g 4 5 Over 1,000 amps or volts 552.26 2 l Temporary services or feeders installation, alteration, and /or City/State /ZIP: vet •TepfJ cc c ) 6 ?. relocation ( 3) 7 - 7 t4'- S F ax : 563 SQ Phone: � � ( ) (3 _ 17 5 I 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: Date: A. Fee for branch circuits with APPLICANT a CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: A - \ - ) 6, - S B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: (v) D�-0 (-y` 1 n (��v_r branch circuit Each add'l branch circuit 7.42 2 Address: - Miscellaneous (service or feeder not included) �w L - Each manufactured or modular 67.84 2 City/State /ZIP: dwelling, service and/or feeder Phone: 603 ) - 72._ 0 7 9 4 5 Fax:: ( 5 p G_ 1- t Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: L b C.0t.3ST t451N.) . C.01 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name: panel, alteration, or extension. Page 2 2 r s L -Z L Each additional inspection over allowable in any of the above Address: 5 °7O W CL8 P;)#AW t--III g-V' Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City/State /ZIP: (�(L �w�vE 71 I Industrial plant (1 hr min) 78.18/ hr Phone: (ss , ) 35- V -- z3,5(2) Fax: (10'3 ) 2 j/ 6 16'1 /1 Inspections for which no fee is 90.00 / hr specifically listed (1/4 hr min) CCB Lie.: ,1 2 1 9 (Q Electrical Lie.: 0A4 1$ G "3 Z Suprv. Lie.: 1 ELECTRICAL PERMIT FEES 1 ( Subtotal: slag() Suprv. Electrician re, required: 1( to (� o � L .� , Plan review (25% of permit fee): Print name: /T�,r V , � R i Date: / ', _it State surcharge (12% of permit fee): � , � TOTAL PERMIT FEE: 576, e (99 Authorized signature: g /, This permit application expires if a permit is not obtained within 80 1 '_^ days after it has been accepted as complete. Print nameL 0 4 0 �c D r .F-- Date: lb— `9- ` 1 l * Number of inspections allowed per permit. B P \ E 1:\ uilding \ermitsLC- PermitApp.doc 07/01/10 _ � ' 440- 4615T(1 I /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* n 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 n 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 C\Building\Permits\ELC- PermuApp doc 07/01/10 Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard 3 6 �. Date/By: Permit No.: is a . —!1 $3 © IIIIII I " 13125 SW Hall Blvd., Tigard, OR 97223 ^ x Review I ' vT f ( — lJ Phone: 503.718.2439 Fax: 503.598.1960 1 OJ l Date/By: Other Permit: T 1 G A R R Inspection Line: 503.639 �� 1 eady /By: Juris H See Page 2 for Internet: www.tigard - or.gov O O � � etho Supplemental Information TYPE OF WORK v \ C3 1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work R 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* 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB $i' J INFORMATION AND LOCATION Heating/coolin: pl �j/� Air conditioning Job site address: _j t."J1. f ' f q ` " ` p (_ (requires site plan showing placement) , 46,75 / ! p� l , Furnace 100,000 BTU (ducts /vents) ' 46.75 City /State /ZIP: 1 I (., j.3� 0 / 72 2- ! 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 23.32 p / Hydronic hot water system 23.32 119 '-4- b v/ F}RD Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: -- � ` � ` 17 � b jJ Lot no.: Flue /vent for any of above • 23.32 1`-� 9_11 Other: 23.32 Tax map /parcel no.: / /ieji y- 6/0 — 60 y4/ 7Ay c, I Other fuel appliances: DESCRIPTION OF WO Water heater I 23.32 Gas fireplace 33.39 5/ /U6 L e t=iam 6 cy / CSI D E]L1C 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 - ROPERTY OWNER El TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: FoU 12.- {) it..)S-1 Cttr� Environmental exhaust and ventilation: Address: t e a x )s-77 Range e hood /other kitchen ` equipment 1 33.39 City /State /ZIP: p i-.,v (e_ro Q C-- ? 2 6 7S Clothes dryer exhaust i 33.39 Single -duct exhaust (bathrooms, Phone: ( 5133) lap —7 y i/ 5 Fax: (53 ) . S90 _ ('7 ( toilet compartments, utility rooms) (Cj 23.32 1,1,12— t fil APPLICANT ti CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Fuel piping: Contact name: DA U 1, S P E ) 4- 4 ? p l--- $14.15 for first four; $4.03 for each additional Fumace, etc. I I A l 5 Address: b�`� V ( Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater i Fireplace i E-mail: jU y-_ D 0,05-1-- ( J SAJ . P" Range CONTRACTOR Barbecue I 4.0 3 Business name: C'�N p PifZ -- O ther: Ot dryer (gas) Address: M q 56 -p j Ns (; i MECHANICAL PERMIT FEES* City /State /ZIP: 6 Llf (AL PO p', Qt 970 1 S Subtotal • 75: Q' .33) 6 5 _ 1 q ( 9 O 5. U Minimum permit fee ($90.00) ( Phone: 3 V d Fax: s i� o Plan review (25% of permit fee) CCB lic.: f 1 V (92 State surcharge (12% of permit fee) ' 6 . h TOTAL PERMIT FEE 4- 0., 1 C This permit application expires if a permit is not obtained within 180 Authorized signature: 4,7------- days after it has been accepted as complete. • Print name: to L`•-) ODL_a ""�t y Q5-- Date: ) O — i i _ t ( * Fee methodology set by Tri- County Building Industry Service Board [: \Building \Permits \ MEC- PermitApp doe 099 /09/10 `�!/' 440 -4617T (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:\ Building \Permits \MEC- PermitApp.doc 09/09/10 2 • Plum being Permit Application Y Building Fixtures � 4C) FOR OFFICE USE ONLY ++ Received 1,11 City of Tigard � �O�` Date/By: q 13125 SW Hall Blvd., Tigard, OR 9722 _ - 1 Plan Review Pennit No.: --o a a __,cr i a -3 Phone: 503.718.2439 Fax: 503.598.1960 t, y ate/B Other Permit No.: T I GA R D Inspection Line: 503.639 \ y G '�G 1 Date Ready/By: Juris. El See Page 2 for Internet: www.tigard - or.gov ��,rN di Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE Fr New construction ❑ Demo ition For special information use checklist Description Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 `►t 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath ( 500.32 t ' _ ❑ Accessory building ❑ Multi- family Each additional bath kitchen ( l 25.02 25 ©`Z ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE I,1VFORMATION AND LOCATION Site utilities: r oe n A r171 C' T Job site address: Catch basin or area drain 18.76 ' S� � - �' fi Drywell, leach line, or trench drain 18.76 City /State /ZIP: ' tb A\i'- -D cn 2-2 LI Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: ` 1 CI i- g G' bRZQ 1. Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: _) Page 2 Subdivision: �E e 1.4 l LL Pp, ey - rt O Ni I Lot no.: ' Fixture or item: Tax map /parcel no.: IDL -i- 1- z o to - o O /p t2 Le L � Backflow preventer 31.27 DESCRIPTION OF WORK 1 Backwater valve 12.51 O Clothes washer 25.02 -_ 1 N CO L E '11 t Ly (1D1� •is . Dishwasher 25.02 /J Drinking fountain 25.02 Ejectors /sump 25.02 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: _ �a Fixture /sewer cap 25.02 O�� 'D ` o ps au c � Floor drain/floor sink/hub 25.02 Address: 69, (, Bo I S`7 7 Garbage disposal 25.02 City /State /ZIP: E ✓ Tc , t ,_ 3 ©R- 99 bps Hose bib 25.02 Phone: (53 ) - ap --?y H S Fax: (5_‘;) SqO -1-75 I Ice maker 12.51 c iq APPLICANT (,+CONTACT PERSON Interceptor /grease trap 25.02 Business name: �l-1 (2 D (0 N S Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: - D A u 0 D pP' _-T ( ) Roof drain commercial 12.51 Address: . 25.02 , City /State /ZIP: , v 6 Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: .. . -r r '� "" ,s r7a f1 [t� a Th u rzp tbi yism. Urina 25.02 �'°'`""1-L` n Water closet 25.02 CONTRACTOR L Water heater . 37.52 Business name: e i oce t_L-/ pima/, Water piping/DWV 56.29 Address: I b a I St' fr- uc;12 Ad Other: 25.02 City /State /ZIP: e. /...:-- -/ 1l15 w 4 q712"/ Subtotal 625, Phone: ( 3 ) 57 `7 2. 5 7 JJJ Fax: ( ) Minimum permit fee: $72.50 Plan review (25% of permit fee) CCB Lic.: •--71= g2F Pl robin Lic. no.: 3(. State surcharge (12% of permit fee) 6 oi Authorized signature: fj � Print name: TOTAL PERMIT FEE 6 r � 8 �p vl0 `' C 9 � � � Date: I /6 _ i 9 , ` / / 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. 11 Building \ Permits \PLMU- PermitApp doe 10/01/09 440- 4616T(10 /02/COMJWEB) 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 - 1" 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge -2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate CI Any new commercial building with water service 2" and Bapti stry/Font Bath Tub /Shower greater, except systems designed and stamped by licensed - Jacuzzi /Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918- 780 -0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic CI Any complex structure as defined in OAR918- 780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain /sink: - 2" 3 " Isometric or Riser Diagram 4 ❑ Isometric or riser diagram is required for new buildings - Car Wash Drain Garbage Domestic non -food that meet the qualifications above. Disposal: - Domestic food related - Commercial food related - Industrial food related Ice Mach. /Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav /Bar non -food related - Bradley - Com/Serv/Util food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes Water Extractor fees assessed for the sewer increase must be paid before the Water Closet- Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\ Building \Permits\PLMF - PermitApp.doc 08/04/2011 2 I, Building Division Development Code Provision Review TIGARD Residential Projects Building Permit No: Y 'S JTo <) I I 1 Y3 CWS Service Provider Letter Received: Yes ❑ No ❑ N/A Routed Plans: Original Plan Submittal Date: 101 rill 1st Revision Submittal Date: ❑ Site Plan Only 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left onl f approved. Planning Review (contact s s f G 4.4r-fw r.40 at 503 - 718 - 2 -YSL pr Are.. @tigard - or.gov) Land Use Case �z -0030. Name . ' " 7 "- r 4 - 4 -41 It `4 W 67'l oning�z1. L9' Setbacks: Front to Rear 15 Side 6 Street Side /S Gar e m IV Maximum Building Height 3 a Actual Building Height Z 5 dual Clearance t H. V . Ea.-Easements /O J 1 ❑/Sensitive Lands Type: Work. Notes: Original Plan: Approved Not Approved ❑ Date: /Of?. d jf/ 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) ,ErActual Slope: 7 Notes: Original Plan: Approved Not Approved ❑ Date: / If Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 • I • City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard- or.gov) Eli Street Trees IN Protected Trees Notes: Original Plan: Approved ©/ Not Approved ❑ Date: /1/)/,/) 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 Applica. Revision 2: Date Sent to App :cant Okay to Issue Permit: Yes ■Y No ❑ • Date Routed to Building: • • • Page 2 of 2 . . RECEIVED OCT 19 2011 7)2 )V1 CITY OF TIGARD BUILDING DIVISION TAR7 1 7 % 0 A / 22 )07 .? 0 io - oo q 3 6 / ..... ?_pRe e„Z / 4,q . - LA) fiqik AAA--Titc Sc, 2e_ j' I z a °' 0' 1 1 v _ 44, 1 e I 37 or / 4 ..... . ... -4: ai , _....... 13 -\:-' 0,...tvA7C04:74., _ -- --• -' \ — 1 46"g Plitt-L- \ _ 1* 6 - ,AN. (1, Otrin• ;$*46 . +.5 1.15 X/-e— ,\ . \ \ \ \ P a R c// 1 \ \ \ - \ t v) 1 • ik,N 'I /Ai ' AZ :._ . - --- sZI. -, De ci< -4 • . ,, 1., • , 14 E A g 7)1 i FeNc` e f _ . _ • . i ! l e 3 Sk —C / • -'. Siilr gAi e n . _ Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, Tjr� D e, idAV_P POT-I , am the general contractor or the owner - builder at the following address: Site Address: Li 2, d L i s, W `17 ri& PL City: G AR-P Permit #: MST 2.011 -00/S3 Subdivision/Lot #: Tie€ ie-L- Pirai.T inoN 1 and /or Map and Tax Lot #: 4,2s � t O B f4 , oo To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the general contractor that all moisture - sensitive wood framing members used in construction have a moisture content of not more than 19 percent by dry weight of dry framing members. Signature: /i Date: X20 / 1 General • ractor or ,%*" er- Builder I:\ Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08 Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: MST Z o)) — O O 1 83 Jurisdiction .T-' 6 ING-.D Site Address: 142-04 S, W. 11 9 7 Pi- Subdivision/Lot #: T R.EE 44'r IT I h tJ and/or Map and Tax Lot #: as//OLaf /0900 By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2) Signature: Date: [ , --ZD L Owner/ neral Contr /Authorized Agent Print Name: 1).44)(11) . D € r AAZ.F901Z1 ORSC Section N1 107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. 1:1Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08 STREET TREE TIGARD ER TIFICA TIO C N I, ZAynD .DE1-)A JaPi R- , owner/ agent for Fo u g-- iD Cons u cri o iu , (PLEASE PRINT) (PERMIT HOLDER) do hereby certify that the following location meets City of Tigard land use and development standards for street tree installation and is consistent with the approved site plan. PERMITNO.: MST zoiJ 00183 511E ADDRESS: / y/ o 9 3,w // 9 rh► PG SUBDIVISION: T! r/ O, / LOT #: SIGNATURE: DA"1 E: ( -Z ( - /2, -414-2---- F/NER/AGENT) RE CEIVED d� VERIFIED BY ( DA1 E: (CITY OF TIGARD) Tree location verified per approved site plan. I: \Building \Forms \StreetTreeCertificate 04/01/2011