Permit .,,,, ,.
A CITY OF TIGARD
DEVELOPMENT SERVICES MASTER PERMIT
PERMIT #: MST2004 -00234
�I DATE ISSUED: 8/31/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10465 SW HIGHLAND DR PARCEL: 2S111CC -11600
SUBDIVISION: SUMMERFIELD NO.4 ZONING: R -
BLOCK: LOT: 167 JURISDICTION: TIG
REMARKS: Remove existing sunroom and replace with same (to code).
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST: 0 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 0 sf GARAGE: sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: 5
VALUE: 15
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: 12
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: 1.00 SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner Contractor TOTAL FEES: $ 423.81
VESTA LIBBY ALDERCREST DEVELOPEMENT INCThis permit is subject to the regulations contained in the
10465 SW HIGHLAND DRIVE 5911 SW SOUTHVIEW PL. Tigard Municipal Code, State of OR. Specialty Codes
TIGARD, OR 97224 PORTLAND, OR 97219 and all other applicable laws. 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 the
work is suspended for more than 180 days.
Phone: Phone: 503 799 - 9755 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 66956 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Electrical Final
Electrical Rough In Final inspection
Framing Insp Final inspection
Shear Wall Insp
Exterior Sheathing Insj 1
Issued By : . 2,P9`C Permittee Signature : �
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
.' �n I 0 • r
'Building Permit li �ti4,�, FOR OFFICE USE ONLY
City of Tigard Date/By: P en
13125
mit No.�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review .
Phone: 503.639.4171 Fax: 503. l 6013 2004 ttlli`I DateBy: Other Permit.
Inspection Line: 503.639.4175 , '_ Date Ready/B,: Juris. ®See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: r iG Supplemental Information
CITY OF TIGARD
BUILDItSJJ REQUIRED 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 ^�
Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
11'
❑ Master builder ❑ Other: Number of bathrooms: C VV )
JOB SITE INFORMATION AND LOCATION Total number of floors: i
Job site address: t J -L LAC New dwelling area: \ 0 `� square feet
City/State/ZIP: ' L i) Garage /carport area: T3 square feet
Suite/bldg. /apt. no.: Project name: L. ` �� � Covered porch area: square feet
Cross street/directions to job site: 3 ) ; 1 Deck area: () square feet
� W Other structure area: '� square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: £ Iy1 L?`�p I Lot no.: Lj� 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.
C Valuation: $
L Existing building area: square feet
W New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: / `�� L_ Type of construction:
Address: -j4 ) 'P J Occupancy groups:
City/State /ZIP: L �'1��' -k Existing:
Phone: () Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: �� _(.t_E-sv F y 'C All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:
�tJZV under ORS 701 and may be required to be licensed in the
Address: JtI) , Jl � ) pL� jurisdiction in which work is being performed. If the
"' ' r)-9 applicant is exempt from licensing, the following reasons
City /State /ZIP:
DIL1 D� � _ q apply: 1 aD%'1
Phone: (`1(73) `SJ99JoI�5 I Fax:: (( ) f-k��'
E -mail:
CONTRACTOR o3
Business name: �( J 1 1f`
i^.' BUILDING PERMIT FEES*
Address: �11� 1' s , S`7 J CL) k G _
i � BIZ ' � � � F P /ease refer to fee schedule.
City /State /ZIP: �of1. 11 .
1 _ Fees due upon application
Phone: (�S�i ) t" r ' Fax: (j ) Lt).... ` � �
� ' J Amount received
CCB lic.: . L, .9
Date received:
Authorized sigma _ �,` This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
Print name: ��-� Date: * Fee methodology set by Tr-County Building Industry
U Service Board.
E1ectrical.Permit Ap a lrh. <7, 0 FOR OFFICE USE ONLY ..--.
■
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: 0157;1004„ oa013
g bUG 1 3 2004 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 0 hat1, t f j'i Date/By: Other Permit
Inspection Line: 503.639.4175 =' ' I Date Ready/By: 1 ®Sce Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: /G Supplemental I nformation
TYPE OF WORK PLAN REVIEW
❑ New construction filAddition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
®J. and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑ Building over three stories 17] Feeders, 400 amps or more
❑ Other:
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park
❑
y Health -care facility ['Other:
7
Job no.: Job site address: IOL �� �b Opt. Submit 2 sets of plans with any of the above.
City/State /ZIP: -IA k �V ■ e_ - CI-I)-14t The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: QQ n M FEE* SCHEDULE
L` D el C :A t Description I Qty. I Fee. I Total **
Cross street/directions to job site: C..‘ t Gil--e-V.._t l )4\t New residential single or multi family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less- 145.15 4
Subdivision: � ��Q." lam" o l Lot no.: I 1074 Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Pt 00 t't' mr._ b f SA \> f- vii Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
'PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 11 k ( 4, r� F, � \I 601 amps to 1,000 amps 240.60 2
1^�[ `_ �� j Over 1,000 amps or volts 454.65 2
Address:
`V \ `c � + �� r Reconnect only 66.85 2
City/State /ZIP: -TA L.,A 9_ 41 V L . O() ) r 4 .9 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (" j , 13,x-, Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
`APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: f � I3 t � T 0' ` branch circuit
t 1 � - k . B. Fee for branch circuits
Contact name: ` iv �� without service or feeder fee,
��[[��..11 each branch circuit / 46.85 2
Address l ..,(,.) ..,(,.) C am, ",l 1 xx�; _ 3 }tCE Each add'I branch circuit / 6.65 2
City/State /ZIP: /�7 LA) O� q "\ 1,6) Miscellaneous (service or feeder not included)
Phone: (fib) --) — , 9 S ' Fax : : ( z t 1 )z O rj Pump or irrigation circle 53.40 2
I Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
:4_4i C extension. Describe: Page 2 2
Business name: LA
Address: Each additional inspection over allowable in any of the above
Y \ Per inspection 62.50
City/State/ZIP: , O� O / Investigation per hour (I hr min) 62.50
Fax Phone: ( ) r , \ # i Industrial plant per hour 73.75
0 ( I0 \O ELECTRICAL PERMIT FEES*
CCB Lic.:( 1 to i Electrical Lie.: S'-- qQ. Suprv. Lic.:3586S Subtotal
-.-
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4 l ..
Print name: Date:
TOTAL PERMIT FEE C7 ,
Authorized signature: This permit application expires ifa permit is not obtained within 180 days
' after it has been accepted as complete
Print name: Date: * Fee methodologyset by Tri -County Building Industry Service Board
** Number of inspections per permit allowed.
Rug 23 04 11:51a Root 503 - 452 -9893 p.6
Aug 12 04 07:44a Root 503- 452 -9893 p.1
■
AUG I 2004
File Number
61
•
CleanWater Services
Our commitment s dear. Sensitive Area Pre - Screening Site Assessment
Jurisdiction 7;9,,,.d Date a -' ( —cv
Map & Tax Lot 2.5 /// d //600 Owner � STS t L r 1
Site Address 1°41A _t•J. {1tr,1riLicr)
--Lt V — 0 01,-.4.1 1 Contact
Proposed Activity S1 At i > (tetra wt Address 1J is
• Phone
sod
Official use only below this fine
Y N NA Y N NA
F n n Sensitive Area Composite Map El n SStor�mwate Infrastructure maps
Map # zf!!4 9
L—I L Locally adopted studies or maps r Other
Specify l 1 Specify zoos. a
Based on a review of the above information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. 04 -9:
Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas
exist on the site or within 200 feet on adjacent properties, a Natural Resources
Assessment Report may also be required.
ral Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently discovered on your
property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
STORMWATER CONNECTION PERMIT.
n The proposed activity does not meet the definition of development- NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
f Tear:4 les, fe'fi gptG4 d1�e.4e9 to he i O`vow'
Reviewed By: Z-C•ei/‘A 14" Date: rep, /ot
/�/ # of Returned to Counter Applicant
Post -it' Fax Note 7671 Date
,y �`/ /p glpages / / et Mail Fax A/ Cunte_
To ASO, I9 r From 644,5 s _ t lc � /ld Dale Sy/9/0 y _ By
Co. /Dept / Co. /G
Phone # Phone 45.' % 61 1.305.
Fax 45i13. 9 Fax# 77
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639-4175 ''� ' --oc� 3 ti
INSPECTION DIVISIt N Business Line: (503) q39 -4171 MST n� � l
BUP -
Received Date Requested AM PM BUP
Location ( j( L o S N G ._?a, t'z4€) Suite MEC
Contact Person Ph ( ) 7 9 5 - 123TSPLM
Contractor Ph ( ) SWR
UI LD� _ Tenant/Owner ELC
looting
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
:1
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
E RT FAIL
LECTRICA
Service
Rough -In
UG /Slab
Low Voltage
F' a Alarm
Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
(AS) PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /
ADA
Approach /Sidewalk Date Inspector .� � Ot( Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL