Permit 11 11 ,, CITY OF TIGARD MASTER PERMIT
.• '- COMMUNITY DEVELOPMENT Permit #: MST2011 -00196
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/10/2012
Parcel: 2S103CB02100
Jurisdiction: Tigard
Site address: 12194 SW JAMES ST
Subdivision: WILLAMETTE Lot: 8
Project: Wilson Partition, Lot 2
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1769 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 893 sf Garage: 493 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 2662 sf Value: $292,076.78 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib 2 Backwater Value: 1
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning Y Vent Fans: 5 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: 5 201 -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: Y 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 2662
Owner: Contractor:
BIG MOOSE DEVELOPMENT INC BIG MOOSE DEVELOPMENT INC Required Items and Reports (Conditions)
9450 SW JAMIESON RD PO BOX 2208 1 Ersn Cntrl 503 - 681 - 4444
BEAVERTON, OR 97005 BEAVERTON, OR 97075
PHONE: 503- 522 -0426 PHONE: 503 - 522 -0426
FAX:
Total Fees: $19,155.39
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spe ialty Codes and all other applicable law. All work will
be do : accor.a with approved plans. This permit will expire if work is not started within 180 days •, issuance, or if work is suspended for more the 180 .
day:. ATTENTION: Oreg• law requires you to follow the rules adopted by the Oregon Utility Noti' ion Center. Those rules are set forth in OAR
9 '- 001 -0010 through OAR 9 . ' • 0. You may obtain a copy of the rules or direct questions to OUNC by callin• ■.232.1987 or 1.800.332.2344.
Iss. - d By: • ■ et. / Per mittee Signature: 1V
Call 503.639.4175 by 7 :00 a.m. for the next available inspection . a `
This permit card shall be kept in a conspicuous place on the job site until complet on of the project.
Approved plans are required on the job site at the time of each inspection.
��`
Electrical Permit Applica ' �`� t: ` ii o l 1_
11- 1 SE 0\1.1
\ti
City of Tigard ! 1 r. ,4- i W Permit No.: La 1) —
• 13125 SW Hall Blvd., Ti . ` .'
r 0 _ Plan Review
11 Phone: 503.718.2439 Fax: 13.59 ) 4.41. S Date/By: Other Permit:
is, A RD
Inspection Line: 503.639.4175 o� > Date Ready/By: luris: la See Page 2 for
Internet: www.tigard or.gov f� � od - �,t Supplemental Information
W
TYPE OF G 0' ` J pD PLAN REVIEW
® New construction El Addition/alteralshn/replacement Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other, where the mailable fault curreor ❑ 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
® I- and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVAor
JOB SITE INFORMATION AND LOCATION ❑ ❑ Addition o f new system.
m otor load of ❑ "A", "E", " E", "1-2", "1- system.
o cre motor "A ^E", "1 ^, "I 3 ^,
Job no.: Job site address: wept SW JAMES ST 1 m more. c ❑ Six x o or r RIME RIME e residential units. ❑ R Recreationon
al vehicle parks.
City/State/ZIP: TIGARD, OREGON ❑ Health - cue facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: radaa FEE SCHEDULE y. I
J ! gu Fee. ► Total I •
New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add'l 500 sq. R or portion 33.92 I
Tax map /parcel no.: Limited en orgy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
e- p _ - C Limited energy, multi -family 75.00 2
( 111 ) Ci‘atitA cf cap` 4Ariv7„r,rc./r residential (with above sq. ft.)
NEW WIRING-200 AMPS SERVICE UNDERGROUND FEED 20 am Services or feeders installation, alterstioB relocation
amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts I I 552.26 I 12
City/State/ZIP:
Tempora services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 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 I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each bunch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit I I 7.42 I 12
Address: Miscellaneous (service or feeder not included)
City/State/LIP:
Each manufacturod or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: CRAINIC ELECTRIC CO. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 15812 SE BROOKLYN ST. Additional inspection (I hr mm) I 6625/ hr
City/State/ZIP: PORTLAND , OREGON,
Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (593) 913 - 8005 I Fax: (503) 760 - 1787 Inspections for which no fee is 9000 / hr
specifically listed ('A hr min)
CCB Lic.: 159562 Electrical Lic.: C619 Suprv. Lic.: 3729S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required : Q..,� o Subtotal:
Plan review (25% of permit fee):
Print name: JAMES DAVID EBERST Date: 03/01 /12 State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires ifs permit is not obtained within 180
I • days after it has been accepted as complete
Print name: Date: • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11/05/COM/WEB
Building Permit Application �
Residential RECEIVED ED - FOR OFFICE USE ONLY Received z City of Tigard NOV 1 6 2011 Date/By /7 /6 /7 Permit No:: yS7-02011.— Bo! 9(�
q
II 13125 SW Hall Blvd., Tigard,OR 97223 Plan Reyie0 0 4, ., J C . • Phone: 503.718.2439 Fax: 503.598.1960 D ate/By: 1 /16/12___Other Permit:SW/420y— ON „ TS'
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready It y: Juris: � I El See Page 2 for
TIGARD g g BU ILDING DIVISION 7 / �f
Internet: www.ti azd -or. ov Notified/Metho Supplemental Information
TYPE OF WORK 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
rf 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 Valuation: $ 'Z 076
y g ❑ Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
Number of bathrooms:
❑ Master builder ❑ Other: �`,
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /2/9Lf SL../ ,/A Sr New dwelling area: t�` ( square feet
!
City /State /ZIP: - p ly) ( ( r ot_ a Garage /carport area: 493 square feet
Suite/bldg. /apt. no.: C � Project name: ` -' Covered porch area 60 square feet
r
Cross street/directions to job site: Deck area: square feet 1 7 (0/
/ s fr j ∎ :,-7" S, ' Other structure area: 31'5 square feet 2_6
- - 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.
r Valuation: $
Existing building area square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT . Number of stories:
Name?' / ` A Q,7rv' ` Type of construction:
Address: v • ,a, �. Occupancy groups:
City/State ZIP: _� . i OP- Existing:
Phone: (S...,9 a.. — wa Fax: ( ) New: f
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer. to fee schedule)
(/.\. Structural plan review fee (or deposit): '9U _ .5"- Contact name: . eVe \ (LS..a.J FLS plan review fee (if applicable):
Address:
City /State /ZIP: Total fees due upon application:
Phone: ( ) I Fax: : ( ) Amount received:
E -mail: PHOTO VOLTAIC. SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
" .--- S ubmit two (2) sets of roof
Business name: i �O , /�� ! , P, O plan with connection details P
and fire department access, along with the 2010 Oregon
Address: r / a g Solar Installation Specialty Code checklist.
City/State/ZI4U7-1\) Qi2.- , 7 7 07 S Permit Fee (includes plan review $180.00
and administrative fees):
Phone: (7) 5-4,9-2. - 674/'1 '�/ ' Fax: ( ) o
O State surcharge (12% of permit fee): $21.60
CCB lie.: /9 ` t Total fee due upon application: $201.60
Authorized signature: It� This permit application expires if a permit is not obtained
i within 180 days after it has been accepted as complete.
Print name: ! i in Date: r ( * Fee methodology set by Tri- County Building Industry
I r� 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.:
71 q 13125 SW Hall Blvd., Tigard,OR 97223 Date/By: ' e , .... 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 1 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 Oregon and shall be shown to be as 1licable to the •ro'ect under review.
JURISDICTIONAL SPECIFICS
' 23 Three (3) site plans are required for Item 11 above. Site plalrs must be 8 -1/2" x 11" or 11" x 17 ". " " �., CI ' El CI
24 Two (2) sets each are required for Items 16, 19, 20 and Bove'.. ' CI _ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "n itor ilding -trot be- will ❑ ❑ ❑
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(I 1 /02 /COM/WEB)
Mechanical Permit Application 1 FOR OFFICE USE ONLY
r�% Q Received
III City of Tigard ,� Permit No.:
° 13125 SW Hall Blvd. Ti OR 972 ) \ DateBy: /�� . Q , 1 Plan Review Oth Permit ` �7
Phone: 503.718.2439 Fax: 503.598.19 0 Date /By: �Cd/4 / — D(' /$
T I GA R D Inspection Line: 503.639 �:�� F Date Ready/By: Juris See Page 2 for
Internet: www.tigard- or.gov �� (, G Notified/Method: Supplemental Information
TYPE OF WORK 1`� COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
ew 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*
2"( 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: l C AL/T1� (requires site plan showing placement) I 46.75
(� `�� ,,c7--- Furnace 100,000 BTU (ducts /vents) f 46.75 q t1C
(
Cit /State /ZIF , - - - ` �� " �0,,,,,_, � Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: t i / / Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
&I 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 1 23.32 Z3. Yi-
hi 1 _ Gas fireplace 33.39 33 ••f S
�!" 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
OPERTY OWNER, ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: Zi6 /' /1,7 d `»j/ ss / 7 fnl�.. Environmental exhaust and ventilation: �+
Address: — `Z b K 'a Range
q eno d /other kitchen / 33.39 7
/ P
City /State /ZIP: � ��� I Q7 f pi Clothes dryer exhaust / 33.39 33 t '
Single -duct exhaust (bathrooms,
Phone: ) 5t�a. - .) G Fax: ( ) toilet compartments, utility rooms) 5 23.32 11 6
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Other: 23.32
Fuel pi
m
Contact naes ( L j -J 1,- t � $14.15 for first four; $4.03 for each additional
Address:
Furnace, etc. /
Gas heat pump _
City /State /ZIP: Wall /suspended/unit heater
Phone: js) _ V y a Fax:: ( ) Water heater /
Fireplace i it'd(
E -mail: i
Range I Y
750 CON - RACTOR Barbecue I 4 ►
Business name:
ELI. A fJ� ;-)LIA 6/ Ale g Hee,4 fit^, Clothes dryer (gas)
.-Y/ Other:
Address: _ ! � 57 ..� ,4 /4�7 MECHANICAL PERMIT FEES*
City /State /ZIP: o4- €7e...---- Subtotal 77
f " Minimum permit fee ($90.00)
Phone: () 24, or /,20/ Fax: ( )
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) 2 t 21
TOTAL PERMIT FEE 3 ,
-
Authorized signature: This permit application expires if a permit is not obtained within 180
g days after it has been accepted as complete.
Print nam- ic , t Date: 1 I - * Fee methodology set by Tri- County Building Industry Service Board
I:\Building\Permits MEC- PermitApp.doc 09/09/10 440 -4617T (1 I /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 $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\ Building \Permits \MEC- PennitApp.doc 09/09/10 2
1
Plumbing Permit Application
Building Fixtures ') . FOR OFFICE USE ONLY \
-.
III City of Tigard Receivd /.Sim /de 0�9� /
.
Date/By: Permit No.lt
'r 13125 SW Hall Blvd., Tigard, OR 9 �Z7 2� I qq
11 Plan Review 1
Phone: 503.718.2439 Fax: 503.598.1960 ° ! Other Permit No.. � ,
Date/By: o di .2 /��D /�C
TIGARD Inspection Line: 503.639.4175 ■ See Page 2 for \ \
Internet: www.tigard or.gov ; D Notified Mehod: JUf 1$ Supplement I Information
�•_ .., .. .,,r. �, -: �
z._i ._:'., ,. -, ':��1 '., t .. - rf1� e - R,•n - t - - i,�i?,..._. ..`tr.. -..
_" ;,,�, i i ,..t ,0, TYPE_ ' °OF', WORK> � � : = ,FEE* ;SCREDUI..Et i. -, . `s i ::
u�r .. -'49z ..� • "„ _�f'y.�yaS _. 'a. \f�,.- ���. .� - .. '; �� .� o .fw- . ��. :w, _ F... .. Vh _.. �_,.k -. = ,+ . r �,.a•: -; •!
❑ New construction ❑ DernAt %n For special information use checklist.
Description Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
Fej;_ -x`- r l,)'••..CATEGORY, °.CONSTRUCTION ',A' > ` - SFR (1) bath 312.70 •
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building SFR (3) bath ( 500.32 =3y
❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
• :' "` ' ...J O B S I - AN „ - Site utilities:
/ � // / ...- Catch basin or area drain 18.76
Job site address: ` 7 )+•f J
Drywell, leach line, or trench drain 18.76
City/State /ZI Q Cyr
d�' I 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: Manholes 18.76
PA I "7 f '5r 3 c1Q� Rain drain connector 18.76
l Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF :WORK ..
t- y Clothes washer 25.02 • J µ Dishwasher 25.02
Drinking fountain 25.02
�� Ejectors /sump 25.02
PROPERTY OWNER • ' I „ . ❑. TENANT Expansion tank 12.51
Name: C, bi � 11,ry°l+"LG'li'i- Li'- -/ Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: Qj5 j,/ �2� ": Garbage disposal 25.02
City/State /ZIP: (" Ji%_t,rsi ( , o 9 I r
Hose bib 25.02
t r
Phone: (� .-t ) � - 1� Fax: ( ) Ice maker 12.51
n'' APPLICANT ., ' - )<CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name: �� LK '5p fj 7Ltr'(c+ Li It-e) Primer 12.51
r 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
CONTRA Water closet 25.02
n Water heater 37.52
Business name: K-T t' L � is / 0 c,
Water piping/DWV 56.29
Address: /,5" j 5 t /4 H woO �'T Other: 25.02
City /State /ZIP: 1 t ■ t e2 17 go % Subtotal 5
) Fax: ( ) Minimum permit fee: $72.50
Phone: (
�� 7LP
CCB Lic.: l s i . \ / : / Plumbing Lic. no.: ' 3 4-34/1)/5
Plan review (25% of permit fee)
l State surcharge (12% of permit fee) 0 t Cy4-
Authorized signature: - - TOTAL PERMIT FEE / 7�
Print name:, /e� isle) -- Date: l -� C. 1 Tis permit application expires if a permit is not obtained within 180 days
LJ r I after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I \Building\Permits\PLMU- PermitApp doe 10/01/09 440- 4616T(10 /02/COM/WEB)
Electrical Permit Application FOR OFFICE USE ONLY
.. •,.-A-c,
City of Tigard
q 13125 SW Hall Blvd., Tigard OR 97223
Ill ., , r I 49 • I Received
1 , ,-.
. '-' Plan Review Permit No./ — 63
Other PermiSiz),,,c1,17 "0045:5-
2 ' • Phone: 503.718.2439 Fax: 503.598.1960 - liTate/By:
TIGARD Inspection Line: 503.639.4175 - Ions: 10 See Page 2 for
l'N j.)t '
Internet: www.tigard-or.gov
e 1.. " . 1 . %; ,.. J• :-,, - ipi 1:::.Votified/Method: Supplemental Information
TVPE OF WORK - .kia-,IP ,::: Ci5a, P,L*N*YIE*'*VIAttigittir7;,
Please check all that apply (submit 2 sets of plans w/items checked below):
0 New construction 0 Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY ORY OF CONSTRUCTON exceeds 10,000 amps at 150 volts or 0 Floating buildings.
z _ I_ ,;-.,,•:. ,,,,-,- t, ,,,:„.iQf.,,,
less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
larger separately derived system.
....:' 4 -; , ','' JOB „SITE .INFORMATION'ANFt LOCATION; ,,,r,,:',,- 0 Addition of new motor load of
100HP or more. occupancy.
Job no.: I Job site address: /Ai q ti /5 ) ---- )/ ,,, es _ i ., 7 1. ,
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: 0 Health-care facilities. 0 Suppl voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt, no.: 1 Project name: 0 Service or feeder 600 amps or more.
FEE SCHEDULE - 7i:'.4 . - r i , ' ' ''':'1:='!3:5A -
Cross street/directions to job site:
Description I Qty. I_ Fee. I Total I .
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less i 168.54
Tax map/parcel no.: Ea. add'I 500 sq ft. or portion 6 33.92 lO CO 1
Limited energy, residential
DESCRIPTION OF WORK • .: :.. : ' • • (with above sq. it) 1 75 00 1.520 2
Limited energy, multi-family
/t/&L) " ...
S residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' • ' ..
PROPERTY OWNER .- 11 : -, -1 '; 1; • Z: ,.:: .:1 --''' '':'''':' a TENANT, '',;, -,:':,".:,...: 1' 201 amps to 400 amps 133,56 2
401 amp t
s m 600 amps 200.34 2
Name: 3.(_ /14 c -, , ,AL Df. ...)Y1.44,14.71 t rvc,
• 601 amps o 1,000 amps 301.04 2
c
Address: C pC1 - ) - i5y 6 ,2 ! ) - 0 . ( ' Over 1,000 amps or volts 552.26 2
City/State/ZIP 6r1/4--- Temporary services or feeders installation, alteration, and/or
: ,•T' 9q —
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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 168.5 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
,1. OHAPPLICANT:., , ' ?. ."'.' - .'''-:„ [ , ',Hr 7' . f ' CONTACT PERSON •::::,,, .' 7.42 2
' _.---- each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
il / 7 56.18 2
Contact name: _5717.i/c j/ Lii--- - 4 ,4//,,ti branch circuit
, Each add'I branch circuit 7.42 2
Address:
Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
dwelling, service and/or feeder 67.84 2
Phone: () 5:99_ - 0 d‘„, I Fax: : ( / Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
_ . . Sign or outline lighting 67.84 2
: • . '„, . "-'_;-:'. , '. ,-. '' CONTRACTOR .:'- • '...:•- • ' ' - .. - - 7 '.;:- 'i' Signal circuit(s) or limited-ener
Business name: ' E'Tejo ei te-7 I C.-- panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: I to Additional inspection (1 hr min) , 66.25/ hr
City/State/ZIP: g 0 €_ Al> f.., Oa Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (8:3) 73 5. 7 34./. I Fax: ( ) Inspections for which no fee is
90.00/ hr
specifically listed CA hr mm)
CCB Lic.: lip? 4,,s. i 1 Electrical Lic.: 0 5, [ Suprv. Lie.: , ..,' •,-,. ■,';, .,-;::1."‘:.,; 'ELECFRICAL'PERMILfEES`;;;2flinj,,,
r Subtotal: 4 ‘Z , IA—
Suprv. Electrician signature, required: -
Coloct.4, Plan review (25% of permit fee):
Print name: ED 0 , 3 A go c 0 c 4 2? /A...— Date: 6 i f 0/26,- /a State surcharge (12% of permit fee): Aq ,
Authorized signature: TOTAL PERMIT FEE: 44, z 7 '7 2
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date:
Number of inspections allowed per permit.
•<—
I: \Building \Permits \ELC-permitApp.doe 07/01/10 440-4615T(11/05/COM/WEB
ri N
I
e Building Division
Development Code Provision Review
TIGARD Residential Projects
Building Permit No: / 1 l.5TvgO // — 60/9
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A --
Routed Plans:
Original Plan Submittal Date: /04:///'
1st Revision Submittal Date: i /.2 / 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 only if approved.
Planning Review (contact \J,7 /4 at 503 -718- a e l or j' VI @tigard- or.gov)
Land Use Case No. 4/11-/a -)01/ -go Name hi; 436^ /IOWA" ' •
❑ Zoning /Q-Lfh
❑ Setbacks:
Front au Rear i / Side /0 Street Side Garage
❑ aximum Building Height as' ( '/2 .5 d4.,) Actual Building Height `9/
La / Visual Clearance
U Easements
❑ Sensitive Lands Type:
Notes:
Original Plan: Approved 12( Not Approved ❑ Date: //
Revision 1: Approved L Not Approved ❑ Date: / / J "2.2,-- I
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
.I- Actual Slope: 8
Notes:
Original Plan: Approved Not Approved ❑ Date: ii I 1
Revision 1: Approved ,( Not Approved ❑ Date: /1 1 7 —u (
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
0 Protected Trees
Notes: Se
Original Plan: Approved ❑ Not Approved Date: i/M/Ooll ;Jul'
Revision 1: Approved ❑ Not Approved 1 Date: 11/it1/)0/J E . Sa2 <),hh Poiscifs
Revision 2: Approved Not Approved ❑ Date: F/6po/d-
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 :
• ii /A t e-- 01F 74'�44
e. _ _ - ,I /
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ►: o / j I ' i _�( 31:54
Date Routed to Building:
Page 2 of 2
Building3ermit Application
Residential FOR OFFICE USE ONLY
City of Tigard eceived
p b Permit No.: /� .y , / /0 /
11114 O NOV L 1 2 €011 Date/By///76 /-S� �`G' /` L �
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 D ate /B Other Permit:�(Z`�0/` •r ON 41
I j f f A Y
Inspection Line 503.639.4175 <I g' –I Date Read /B :link:
'I�IGAR Ins p Y Y' ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DR` / SIO}' >a Notified/Method: ''77 6'" Supplemental Information
< TYPE -OF WOR . REQUIRED DATA:'1= AND.2= FAMI 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
t it Addition/alteration /replacement ' ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY -OF CONSTRUCTION work indicated on this application.
"0� - wand 2-family dwelling ❑ Commercial /industrial Valuation: $ / , 1 /t,
0 Accessory building ❑ fatnil Number of bedrooms: t
g Y _
❑ Master builder ❑ Other: Number of bathrooms: „? � j
JOB- SITE INFORMATION -AND LOCATION Total number of floors: r�
Job site address: /_ / ..,:..52---/j4/./.-4 ` — New dwelling area: f �� ; ( square feet
- CC
City /State /ZIP: f r l� , r C!5Y— Garage /carport area: 41 square feet
Suite/bldg./apt. no.: Project name: Covered porch area U ,i square feet
Cross street/directions to job site: Deck area: �� j� square feet
/77/ ji,S2.} ,l l/ 1 i Other structure area: C4 square feet
REQUIRED :DATA: COMMERCIAL= USE'CHECKLIST - '
Subdivision: I 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.
[' Valuation: $
Existing building area square feet
New building area: square feet
PROPERTY- OWNER. ' ,_' ,- ., • .. ❑TENANT Number of stories:
Name:`' f ' 44 Ac V w I .,� l �„/r-, ,;� � Type of construction:
Address: v '' 1 4 `ate (49..,>&,, °J Occupancy groups:
City /State ZIP: ` / A.11 v 1 / <)I' eigl) Existing:
Phone: ( 9 tea. , t 2 G Fax: ( ) New: //
. - ' 0' ,APPLICANT , _ • • ❑_ CONTACT' PERSON .- BUILDING'PERMIT FELS . •
Business name: 4'
' -.:.. (Please refer,to fee schedule) _ z -
( plan review fee (or deposit): '7 , � Contact name: ��,� ; �� Address: v FLS plan review fee (if applicable):
Total fees due upon application:
City/State /ZIP:
Phone: ( ) : ( ) Amount received:
Fax:
Z.R.
E -mail: f o) 1 � ;PHOTO,YOLTAIC SOLAR
- 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 Installation Specialty Code checklist.
City /State /ZIP: Permit Fee (includes planreview $180.00
and administrative fees):
Phone: ( ) Fax: ( )
State surcharge (12% of permit fee): $21.60
CCB lic.: flip' r 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.
• (dam to" �,• 01 ‘ Date: s ( { ' * Fee methodology set by Tri -County Building Industry
Print name:
e t I t �t�'� Service Board
I:\Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11/02/COM /WEB)
Aug 2912 01:44p BIG MOOSE DEVELOPMENT INC 5039542632 p.1
5c3_ (02 'f - (06 l
Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: a0 / G 0 1 116 Jurisdiction: j g
Site Address: at 4 $'ij - 2(5 c f
Subdivision/Lot #: j A Riz( Pfra7 , 'Ha 4i
and /or
Map and Tax Lot #:
'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)
r\1
I
Signature: A Date: d (' L V l L
t�.wneriGeneral Contractor /Authorized Agent r
Print Name: c � / Li i e�°i��•..�
ORSC Section N l 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.
I:■BuildingT orris \RES- HighEfftciencyLiehting.doe 07/01/08
Aug 20 12 01:44p BIG MOOSE DEVELOPMENT INC 5039542632 p.2
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, eJ&,. -J C - -- , am the general contractor or the owner- builder
at the following address:
Site Address: /?/qL
City: 7G 6fL
Permit MS► 2elq — 0 al4�
Subdivision/'Lot #:
and /or
Map and Tax Lot #:
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 8318.2 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: ,4 D �/Z / . Z
General Contractor or Owner- Builder
l:' BuildingWorm \RES- MoistureScnsitiveWood.dec 09/25/08
11 4-
q STREET TREE
TIGARD CERTIFICATION
U i Ls.u. owner/ agent a or 1\ t 1110■ss� v������� ,
f
(PLEASE PRINT) (PERMIT HOLDER)
do hereby certifi 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.
PERMIT NO.: rYl � 20l (- C7b 1 q�
STI E ADDRESS. . 0
SUBDIVISION: . E , RiVain uN LOT #:
SIGNATURE: 1 N *\ \ DA11J: 3v(aa l 12_
(OWNER/AGENT)
RE CEIVED &
VERIFIED BY: DA DATE: g
I OF TIGARD)
I lJ
Tree location verified per approved site plan.
I: \Building\ Forms \StreetTreeCertificate 04 /01/2011