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Permit IN CITY OF TIGARD MASTER PERMIT • COMMUNITY DEVELOPMENT' ,. Permit #: MST2012 00018 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 /, Date Issued: 03/01/2012 Parcel: 2S102DC00200 Jurisdiction: Tigard Site address: 9325 SW EDGEWOOD ST Subdivision: EDGEWOOD Lot: 16 Project: Bean Project Description: Addition 3/15/12: REPRINT PERMIT for additional project valuation and square footage added: 74 sq ft to BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 22.5 Bathrooms: 1 Second: 851 sf Garage: 851 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 851 sf Value: $139,330.72 Rear: 15 PLUMBING Sinks: 2 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 100 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 20 Ea add'l 500 sf: 0 201 -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 I 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: ADD SF VB R -3 851 Owner: Contractor: BEAN, JAMES D & YELENA EMPERIAL CONSTRUCTION Required Items and Reports (Conditions) 9325 SW EDGEWOOD ST PO BOX 86353 1 Ersn Cntrl 503 - 681 - 4444 PORTLAND, OR 97223 PORTLAND, OR 97286 PHONE: 503- 685 -0586 PHONE: 503- 969 -6160 FAX: Total Fees: $4,518.43 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. A TION: 0 - , • law - • uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rue - e set forth in OAR 952 -00 -0010 hrough OAR 9 • •01 -0090. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 -- or 1.800.33 344. Issu d By: 1_ _&/ / Permittee Signatur =. - 1 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 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. .II q City of Tigard I Buildin g Division ' TIGARD TRANSMITTAL LETTER TO: DO/I/. DATE IRE II D DEPT: BUILDING DIVISION 2012 • • CITY OF TIGARD FROM: 5. >e - • �,,,, . BUILDING DIVISION COMPANY: � 12--k ii . ,L u n ' ,,¢, PHONE: S D 'S 96 9 — 616 U By.ft,C2__ RE: 930 stu EDGEw 5 , 144 I cola_ o•• l/ (Site Address) (Permit Number) 1oi S T —A. a u ( II Project name or s edivision name and lot nu ii - r) ATTACHED ARE TH ■ FOLLOWING ITEMS: Copies: Descriptio 1 . Co ■ es: I Description: Addition. set(s) of plans. Revisions: Cross se tion(s) all. details. Wall bracing and/or lateral analysis. Floor /ri of framing. / Basement and retaining walls. Beam 4 al lations. Engineer's calculations. 3 Other , : plain): A - REMARKS: FOR ¶FIC USE ONLY Ro ' • d to Pe •t Tec ician: Date: (� ((G-- Initials: Fe s Du e: i► '• s ❑ No F ee Description: Amount Due: • $ _ _ • $ 02(729.5/ Special " ;)' . l — (., A f Re.rint Permit .er PE : v ``• '�' �i �.: ���am • No ■Done A..licant Notified: el r' Initials: / I , e (:\Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011 a CITY OF TIGARD MASTER PERMIT III 2 ' • COMMUNITY DEVELOPMENT Perm #: MST2012 -00018 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/01/2012 Parcel: 2S102DC00200 Jurisdiction: Tigard Site address: 9325 SW EDGEWOOD ST Subdivision: EDGEWOOD Lot: 16 Project: Bean Project Description: Addition BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 22.5 Bathrooms: 1 Second: 777 sf Garage: 777 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 777 sf Value: $128,899.68 Rear: 15 PLUMBING Sinks: 2 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 100 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr. 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 0 Drywell -Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 20 Ea add! 500 sf: 0 201-400 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: ADD SF VB R -3 777 Owner: Contractor: BEAN, JAMES D & YELENA EMPERIAL CONSTRUCTION Required Items and Reports (Conditions) 9325 SW EDGEWOOD ST PO BOX 86353 1 Ersn Cntrl 503- 681 -4444 PORTLAND, OR 97223 PORTLAND, OR 97286 PHONE: 503 -685 -0586 PHONE: 503- 969 -6160 FAX: Total Fees: $4,289.12 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 through OAR 952- 001 -0090. You may obtain a co. of t e i - • direct questions to OUNC by calling 503.232.1987 or 1.8k339 7344 Issued By: _ ' --- : mittee Signatur . Call 503.639.4 • •y a.m. for the next available Inspection date. This permit card shall be ke • • place on the job site until completion of the project. Approved plans are required on the job site at the time of each Inspection. Building Permit Application ►_ Residential l CEI FOR OFFICE USE ONLY City of Tigard 1 � � Received /���� , i Permit No.: 67P00,1::::41/e) • 1 3125 SW Hall Blvd., Tigard, OR 9 DD Plan Revie _ .. • lJ/ : C Phone: 503.718.2439 Fax: 503.598 a 1 5 2012 Date /B : Z41�Ilin Other Permit: -V l G A lit) Inspection Line: 503.639.4175 p�+�� Date Ready /:y: tug: Fa See Page 2 for Internet: www.tigard - or.gov C1 A g ° i n Notified /Method: Supplemental Information B UILDING d p,I% %' Al TYPE OF WORK I REQUIRED DATA: I- 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 rzr Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 12(1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ ( ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: q3.75 Sw Cd3e wflo.4 s4 . New dwelling area: "j` square fe t City/State /ZIP: T 5 . r 8 o'. 2 oil 2 3 Garage /carport area: square feet Suite/bldg. /apt. no.: I Project name: C3e Covered porch area: G�.*'7 square fee Cross street/directions to job site: Deck area: L � - � 1` � square feet Other structure area: 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. In ew Act i 4 ■ 0.4 Valuation: $ Existing building area: square feet ih New building area: square feet 1Q PROPERTY OWNER I ❑ TENANT Number of stories: i, Name: ) a W1 e 5 Ye l ei q rect h Type of construction: Address: 9 3 2 5 'S i„v e.-.A e w u O A S 4- Occupancy groups: City/State /ZIP: ` i & CI • A p lg Gil 9, ON 5 Existing: Phone: ( 5,,3) 6 $ 5 0 5 n. Fax: ( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedul) Business name: S e K G ��.e.a c,. .i 4 M t,CR oq 5 r S u 3 C Structural plan review fee (or deposit): Contact name: SC K g er 0 /L. v r3 — - Address: FLS plan review fee (if applicable): I'.o • fS�� Bt; 353 Total fees due upon application: City/State /ZIP: Po 14 }., (a oK 1-72 16( CD D Phone: ( C(( _ 6(6 p I Fax: : (S D5 ) 2 5 1 0 � Amount received: E -mail: sex 5ey '��w4505 Q COU4c0.3 F . VIQX PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof -top .unted PhotoVoltaic Solar Panel System. Business name: 5' 5 est D. q v e , 14c 4" 4 vC4 i 0^ a ( mit two sets of roof plan with connection details J / .J ar ire depart - t access, along with the 2010 • • Address: p. 0 . 1 3 G. s 53 Solar Installation : •cialty Code - • . Permit Fee •. pan review $180.00 City/State /ZIP: p 4-(0 .48. p 9 �(Q G nd admini five fees): Phone: (9 'D 3) C r Gq— 6160 I Fax: (59 RS '1 1 1 - surcharge (12% of pe ee): $21.60 CCB lic.: ('y y ei R q. �� 3 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is .t obtained within 180 days after it has been accepted as complete. Print name: 0 " _- A li Date: ? (q r , * Fee methodology set by Tri- County Building Industry Service Board. I: \Building \Permits \BUP- RESPennitApp.doc 02/24/2011 440- 4613T(1 I /02 /COM /WEB) From: Elite Electric Group Fax: (888) 901 -7914 To: R F CE 1 +1 (503) 598 -1960 Page 2 of 2 4/26/2012 10:38 tsra_C- C 0_ i \ . a v I LL Electrical Permit Applica ion APR 2 6 2 FOIt OF1•'icF: I:sF: O::LV g Rccc ivcd �m� . - - , lo ti' l g City of Ti ardi , Permit No.: W v b CITY O FTIG '�a ' n 13125 SW Hail Blvd., Tigard. OR 97223 ! ' ? - ' Phone: 503.718.2439 Fax: 503.598.1960 BUILDING DIV `- I _ ti Other Permit: TIC, A 1: [) Inspection Line: 503.639 4175 hais H See Page 2 for It www.ligwd - w.gov Supplemental Information TXPIS OF WORK - : PLAI\,' W ;: ❑ New construction ❑ Addition /alteration. /replacement Please. cheek all that apply (submit 2 sere of plans wlitemschecked below): ❑ Service or feeder 400 amps or more ❑ Building over three stones. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and hoary'ards. ' ,C ......QR) QF CONSTRUCTION � � - � -, . - exceeds 10 .000 apps at ISO volts or ❑Floating buildings. - less to ground, or exceeds 14,000 ❑ Commercial.uscagricultural ❑ 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ (Aber: ❑ Fire pump. ❑ Installation of 75 KVA or r +cosy s stem larger s rattly derive em JOB SITE JNNF0RMATIIO1Y ANA LOCAT1W Addition anew motor load of ❑' "F 1 -a' "I - d system. Job no.: Job site address: 9325 SW Edgewood St IOOHP m room. ccupanc,y. ❑ Six ur more residential units. ❑ Recreational vehicle parks. C'ic }'iStatr` %li r : Tigard OR 97223 ❑ Health - care facilities. ❑ Supply voltage fin more than ❑ Hazardous locations. 60n volts nominal. l Suite hldgiapt. no.: Project name: ❑ Service or feeder 600 amps or more. FEIE SGIHFDt'LF, . ` Cross strectld irect ions to job site: Description I Otl • 1 Fre I Total I • New residential single or multi - family dwelling unit. Include} attached garage. Subdivision: Lot no.: 1,000 sq. t). or lets 168.54 4 t_____. En. add'I 500 sq. It. or portion 33.42 I Tax tn'tprpare(.I no. _ Limited energy, residential 75.00 — — _..'_ j i with above ft.) :' _- : nEsriipmolr.��' v►ciRh - .' w_ C—i ` ' " - Limited energy, multi - !amply 75.66 ? � t —_ ^may _f _ residential (with above s q. tt. ��++���fff Services or feeders installation, alteration• and/or relocation Qt ��t i ZUO amps or less 100.71) 2 •:,' C Pttontta o%visti , 0 1 'EL Yi ' _01 snips Id 400 amps 133.56 401 amps to 600 amps 200.34 2 1 Name: • —. (101 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 352.26 Citv;Stafe Tip'. Temporary services or feeders installation, alteration, and /or relocation Phone: (. ) Fax: ( ) 200 amps or less l 59.36 I 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on properly that I own which is not 401 amps to 599 amps i 168.54 intended for sale. lease, rent, or exchange. according to ORS 447, 449. 670, and 701. Branch circuits— new, alteration, or extension, per panel Owner signature: -- Date: � A. Fee for branch circuits with I above service or feeder tee :: Q APPLTCAIVT ('A� 1 Ak 7' PFRSUIk 7.42 2 ' ..... each branch ctircuit Business name: Imperial Construction R. Fee for branch circuits •iliiuur Service or feeder fee. first 56 18 Contact name: branch circuit I Each add'I branch circuit j 7 42 2 Address: Miscellaneous (service or feeder not included) City/State/71P: Each manufactured or modular 67.84 dwelling, service and/or feeder ` Phone: ( ) Fax: : ( ) Reconueci only 67.84 Pump or irrigation circle 1 67.84 2 E-mail: Sign or outline lighting 67.84 2 .: ('C6J4 k B 4Cl'.QR, Signal circuit(s) or linuled entrgy Business name: Elite Electric Group panel, aherauon, or extension. j Page 2 2 Each additional inspection over allowable in any of the above Address: PO BOX 823026 Additional inspection ( I hr min) 66 251 hr Investigation (1 hr min) 66. hr City ?State!"" / Vancouver WA 98682 Industrial plant (1 hr min) I 78.18 hr Phone: (503) 277-3788 Fax: (888) 901 -7914 Inspections for which no fee is I 40.00/ hr spccificall listed I' hr mini l CCD Lc.: 191274 Electrical Lic.: 0639 1 Suprc. tic.: $762. k,Ta; I`RK AL:'PU4MV1`IT; ,FEES - Suprv. Electrician signature. required: Subtotal. Plan review (25% of permit fee). Print name: Bob Armenderiz Date: Stale surcharge (12 %of permit feel: Q �J /� TOTAL PERMIT FEE. V / 0' G � Authorized signature: l This p ermit application expires it a permit is not obtained within ISO I days after it has been accepted as complete. Print name: f Date: I • N oiler of inspections allowed pei permit. r'AuildingtPermits'ELC - Pelmil app dee 05W!14 440- 461 st(, Ihis:comAvEs ' \ w/ Pf 414 ' 4 ter From: Elite Electric Group Fax: (888) 901 -7914 To: Fax: +1 (503) 598 -1960 Page 1 of 2 4/26/2012 10:38 FAX Date: 4/26/2012 Pages including cover sheet: 12 To: From: Elite Electric Group PO BOX 823026 Vancouver WA 98682 Phone Phone +1 (503) 277 -3788 Fax Number +1 (503) 598 -1960 Fax Number (888) 901 -7914 NOTE: Contractor Change • Send and receive faxes with RingCentral, www.ringcentral.com RbfiCer ( Building Permit Application Checklist One- and Two - Family Dwelling V A ssociate d FOR OFFICE USE ONLY VI City of Tigard /J10 Received Permit No.: � '` Date /By: l • 13125 SW Hall Blvd., Tigard, OR 97223 p ermits: Phone: 503.718.2439 Fax: 503.598.1960 `l� T I G r\ I: D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW es No N/A I 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. P /an review cannot be completed if copyright violations exist. I I 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 land foundation, stairs, fireplace construction, thermal insulation, etc. 15 ,Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ ,xterior 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 ' ❑ O. ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams joists ❑ ❑ ❑ over 10 feet long and /or any beam/joist carrying a non - uniform load. • 20 Manufactured floor /roof truss 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 slicable to the .ro'ect 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 1 I" 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- RESPennitApp.doc 02/24/2011 440 -4613T(I I /02 /COM /WEB) Electrical Permit Application r1 I l o F F icy H H S I•. OIN L City of Tigard RECEIVE DateB p(1 S Permit No.: )..,�( .2 fir 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review ' 17 Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit: 1 - i < <� li D Inspection Line: 503.639.4175 B 1 5 2012 Date Ready/By: Juris: 63 See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information CITY OF TIGAKD TYPE O I r: D PLAN REVIEW ❑ New construction d Addition / alt ra a ti n/r Please check all that apply (submit 7 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural di 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "I -3 ", Job no.: Job site address: 9 525 Ga / ix or or more. Recreational Gt S e re. � Al Si ❑ Six or more residential units. ❑R vehicle parks. City/State /ZIP: 11 p 7 995 ❑ Health -care facilities. ❑ Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: (5 e p N ❑ Service or feeder 600 amps or more. FEE SCHEDULE 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 168.54 4 Ea. add'I 500 sq. ft. or portion ' 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi- family 75.00 2 /4041i Aci c + •1-t 0 k residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less i 100.70 i 00,70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: ,,.1 W4 e S 'fele 4 4 5e a N 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: q; a S .5u) L/ s et ' c' 5 Over 1,000 amps or volts 552.26 2 City/State /ZIP: Tel Temporary services or feeders installation, alteration, and/or 4� a o R q ' t 2 2 3 relocation Phone: (S o9 6 g S o S8 6 Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with [ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 70 7.42 2 each branch circuit Business name: B. Fee for branch circuits without e K g (�E s v g Co�Sd ►. uGk -ritc. service or feeder fee, first Contact name: S e k 4. J (2j branch circuit 56.18 2 S� Each add'I branch circuit 7.42 2 Address: I), 0 . ri>g) g6 3 5 3 Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 Q City/State /ZIP: 1 o IA k',.QQ .4,4 02 'II 2 L dwelling, service and/or feeder Phone: ( C. ai q6,?...- 6/ 6 o Fax: : ( 5 a 3) a S 7 if 7/ Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: S e lec t e ... e u fS � co.tca 4-I • rut - }� 5 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: Pc 4i� d_ e--1 e e4 p IC panel, alteration, or extension. 1 Page 2 75,e0 2 Each additional inspection over allowable in any of the above Address: q/5 6 s q .f — Sv D Additional inspection (I hr min) 66.25/hr Investigation (I hr min) 66.25/ hr City/State /ZIP: Va.c c•-• w 9,tec Industrial plant (1 hr min) 78.18/ hr Phone: (5 o$) Pt 9 v p,q f l Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (% hr min) CCB Lic.: tC,l e6 Electrical Lic.: G 7z Suprv. Lic ELECTRICAL PERMIT FEES Suprv. Electricidfllsign tufe, required: s Subtotal: r Plan review (25% of permit fee): Print name: .dg_)t S q I y9 Date: a ) l I State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: 4' (e3„, S(, () ( Date: lief ( days after it has been accepted as complete. (•f ((�'j i Number of inspections allowed per permit. \ 1:Building \Permits'ELC- PermitApp.doc 07/01/10 ( 440-4615T(11/05 /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: El Audio and Stereo Systems* ❑ Burglar Alarm • ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR -918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems , • • ❑ - Boiler Controls . • ❑ Clock Systems • ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ' • El Intercom and Paging Systems ' s • • • Landscape Irrigation Control* , - ' ID a. • ❑ Medical r I • El Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling • • ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required • for all other installations I:\ Building \PermitssELC- PmnitApp.doc 07/01/10 Mechanical. Permit Application Fog orFicI: Hsi.: ()NIA City of Tigard Recei Date/B : J Permit No.: �D ova/5r ° 13125 SW Hall Blvd., Tigard, OR 9722 CE Plan Review : ti Phone: 503.718.2439 Fax: 503.598.1960 �� DateBy: Other Permit: T i G A It D Inspection Line: 503.639.4175 FEB 1 5 Date Ready/By: kris: El See Page 2 for Internet: www.tigard -or.gov 2012 Notified/Method: Supplemental Information -010 () F TIGARD COMMERCIAL FEE" SCHEDULE - USE CHECKLIST TYPE 0 f NG n IV!SION Mechanical permit fees' are based on the value of the work ID New construction Ei 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' gi 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: __ ( Air conditioning Job site address: ti 52 5 A W acts e w 54. (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts/vents) 46.75 City/State /ZIP: -1-; gA N d. 0 K q19,2 S Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: 1 q Li Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work k 23.32 7:3,3 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 3.32 Gas fireplace K "�. view ciele; t ; ert 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 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32 Other: 23.32 Name: ...5(4 e5 ` f e lea44 e e a h Environmental exhaust and ventilation: Address: C ' a 5 5 ,,r/ a 4 e w 004 so, Range hood/other kitchen S equipment 33.39 City/State /ZIP: T; 5 a ,. 0 K 9129 3 Clothes dryer exhaust 33.39 ) 6 /{ Fax: toilet compartments, (u tility oms, Phone: ( o ) 1 23.32 3 S � � 6 ( ) toilet corn ents, utili rooms) , Er APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Other: 23.32 Business name: 5 GK Sey p.e.K 5 ✓ f3 Ge.stt4I- te..4-10, Fuel piping: Contact name: S e 5 „ 1' (),p 5 ,.) 15 $14.15 for first four; $4.03 for each additional Address: p. 0 . 5 jj' 6 3 � Furnace, etc. Gas heat pump City /State /ZIP: po 4 a c5) I? 1I2 itG Wall/suspended/unit heater Phone: ( o45) ?6 ? _6/6 Fax:: (Sv3) 2 51 14 71 Water heater w Fireplace 1� IAA-S E -mail: $ e Seepek5ut3 0 co.44eus'.r . iev4- Range CONTRACTOR Barbecue ✓.--- Clothes dryer (gas) Business name: S t . h 5 h; 9 „ t Ne 5 Other: Address: I it a ,fq '3l. w left 5k- MECHANICAL PERMIT FEES* City/State /ZIP: I- 1Qpp 1, e de r O fre q 7 °pi Subtotal , tf Phone: (S Fax: ( ) Minimum permit fee ($90.00) 7/� q / Plan review (25% of permit fee) CCB lic.: /a 7 /q$ )10,1 ? C) State surcharge (12% of permit fee) L (r ' TOTAL PERMIT FEE ( 4-SI Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: I Date: 07//1//7 • Fee methodology set by Tri - County Building Industry Service Board I:\ Building \Permits PemmitApp.doc 09/09/10 4404617T (I1/02/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 • • I:\BuildingTermits\MEC- PermitApp.doc 09/09/10 2 • PluthbinePermit Application Building Fixtures RECEIVED ,,,,, Ofl ICI USE ONLY Ci of Ti and Received s Mn � � g Dat B i l r �.` r Permit No.: . • 0 -iii tr a 13125 SW Hall Blvd., Tigard,OR 9722 Plan Review . C . Phone: 503.718.2439 Fax: 503.598.1 B 1 5 2012 DateBy: Other Permit No.: Inspection Line: 503.639.4175 Date Ready/By: runs: ®See Page 2 for Internet: www.ti '' I G ^'j D ardor. ov CITY OF TIGARD y y Supplemental g g g Notified/Method: lmtormatiom TYPE OF wIoI3.DING DIVISION FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total 0 Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 1- and 2- family dwelling ❑ Commercialindustrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: q 3;5 5 ) c w o o Lt 5 Catch basin or area drain 18.76 City /State/ZIP: p µ ,f / 1 o J 9-1 2 3 Drywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: _) Page 2 Suite/bldg./apt. no.: I Project name: 1� eQ H Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.:k W ( Page 2 (OZ-` Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Q dd i It eq., Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 D' PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture /sewer cap 25.02 Name: jo t4.4 es ye fe,,,, q /3 eg g., Address: q 3�? S 5 w f el 5 e w v o 1 5 Floor drain floor sink/hub 25.02 Garbage disposal 25.02 City /State /ZIP: T f S a„ J p n 9 -122 5 Hose bib I 25.02 26", O2 Phone: (S 9j) 6 45 OSFC Fax: ( ) Ice maker 12.51 ( APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: S e c c e c1 !/C 5 , .. G.-is-1 'Vat oz. Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: S e k 5C. /7 e a v f3 S Roof drain (commercial) 12.51 Address: p ,'J • i3 „c >F 2 ) 6 3 5 3 Sink/basin/lavatory 25.02 15,0c, City /State /ZIP: po .t + I Q.r c oil 9 7' g' ( Solar units (potable water) 62.54 Phone: ( 5' Y61-6(6 O Fax: : ( S' , 3) 4 757 /f ,/ Tub /shower /shower pan 12.51 Urinal 25.02 E -mail: A 5 a be„ f i, s a co ...w co, p .s . 1.w CONTRACTOR Water closet 1 25.02 2. , d Water heater 37.52 Business name: 5 C e.. 4' P ` w { k, .... L cc Water piping/DW V 56.29 Address: /6/ / 3 3 .5 W a q A� Other: 25.02 City /State /ZIP: O k e5 o t. G'�y IP R ei7 045 Subtotal Phone: (5o3) 5 7a 5 7 / Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: /K2,2 -7 5 ( n " 0, Plumbing Lic. no.: pe, 551 Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: l 77/i / � TOTAL PERMIT FEE V a C Print name: 1, ' . e& -r 1,.., � £cO 2 0-( I D a t e: a ' ( 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. 1:\ Building \Permits\PLM11- PermitApp.doc 10 /01/09 440- 4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: 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 - Ist 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 P 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 Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: - Tub /Shower -Jacuzzi/Whirlpool engineer. Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Stall 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 ❑ 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 ❑ 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 fees assessed for the sewer increase must be.paid before the Water Extractor Water Closet - Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\ Building \Permits\PLMF- PermitApp.doc 08/04/2011 2 RECEIVED o lA _ coo/e. — FEB 17 2012 1,1 fa .q 0 — BUILDING DIVIS • FL�31 2012 Clean Water Services Pile Number . W ter \�` Services I 9- -( Clean a - I ` �, gy . _ --._ ___tans Area Sitive A Pre - Screening Site Assessment . , _ 1. Jurisdiction: Rd l4 t n`^ I N di • • • 2.. Property information (example 1S234AR014I ►) 3. Owner Information • Tax lot ID(e):.. R • 16 8 4.3f Name: .)j M VeLei d r5 G k k) Company: Address: 9 3 RS $w e•l:j ra w pod ,,•a•. Site Address: g3s75 SW E W G OO 0 s+ City, State, Zip: 3`f�4 a oR R 2 City, State, Zip: T I Coq Ili 0 03_91 R.R"S _____ tr 50 Q5 O$ , — .._..._._,._,_ N earest Cross Street E-Mall: ' 4. Development Activity (check all that apply) 8. Applicant Information --- ---- ---- 1 ®' Addition to Single Family Residence (rooms, deck, garage) Name: S e S e D e... El Lot Line Adjustment 0 Minor Land PartitIon Company: 312 gay Cc. n se, & Go » s 41 ►'al. j Residential Condominium Commercial Condominium Address: P O • � $s ,..58....5 • El Residential Subdivision D Commercial Subdivision Single Lot Commercial CRY State, ZIP: PP k 1 ' 1 °'d. 0/C 9 7...? F4 © g © M uhl Lot Commercial Other r Phone/Fax: 5 'O'? '9'6 —d /6 v. 8- -Mail: se•re $ 0..4- s 4s44 4e I 0. WIII the project Involve any off-e Ito work? []Yes ' No J Unknown . Location and description of off-site work N o , ■ 7. Additional comments or Information that may be needed to understand your project • This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Slje Development Permits, DEQ 1200•C Permit or other permits as Issued by the Department of Environmental Quality, Department of State Lands andlor Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. By signing this form, the Owner or Owners authorized agent or representative, acknowledges and agrees that employees of Clean Water Scythes have authority to enter the project site at all reasonable times for the purpose of Inspecting project site condldons and gathering information related to the project site. I cud& that I am familiar with the Inibrmatlon contained In this document, and to the best of my knowledge and belief, Ws information Is true, complete, and accurate. Prind•ry Name 3 eAllvf o..._5 v U , Print/type Title C.0M•r- k,e4•c• K. • Signature $ Date o2 ft / FOR DISTRICT USE ONLY • ❑ Sensitive areas potentially exist on site or withn 200' of the eke. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A • SERVICE PROVIDER LETTER. It SensitiveAveas exist on the al(e or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required, ❑ Based on review of the submitted materials and'best available information Sensit areas, do not appear to exist on site or within 200' of the site, This Sensitive'Area Pre—Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas t they are aubsequenty .. vaned. This documentw'M serve as your Service Provider letter as required by Resolution and Order 07.20, Section 3.02.1. All required permite and • approvals must be obtained and completed under applicable local, Slate, and federal law. 1 VS lased on review of the submitted materials and best available information the above referenced projectwW not significantly impeot the existing or potentially ' sensitive areas) found near the site. This Sensit o Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect eddiuoral water quality sensitive areas t they are subsequently discovered. This dooumentwill serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits end approvals must be obtained and completed under applicable local, state and federal law. . ❑ This Service provider Letter Is not valid unless CW8 approved site are attached. O The proposed activity does not meet the definition of development or the lot was platted after 919195 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDE ETTER Ia REQUI'ED. ' . 211 Reviewed by � = a-io • . Data 55U t$■ Hillsboro Hiyliv;ny • 1111151)N o, Olopon 071 23 -• Mom:: (5D) 6 01-51l10 Fax; (50:3) 661 -4439 • w.n•+,elcrmvaler58ruiLes.org j • . 1 'PI o ° Building Division Development Code Provision Review T I G A R D Residential Projects Building Permit No: a0 la -000 1 8 CWS Service Provider Letter Received: Yes. No ❑ N/A ❑ ��p t t2 Gft V �� Routed Plans: Original Plan Submittal Date: A- / /'Y 1st Revision Submittal Date: ❑ Site Plan Only 2 °d 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 at 503 -718e2 1 or ___$64 @tigard- or.gov) Land Use Case o. Name (30+0 ❑ Zoning Ku : s ❑ Setbacks: Front at) Rear I S Side Street Side I Garage ❑ Maximum Building Height ) Actual Building Height v■c2 IY Visual Clearance LKEasements C Sensitive Lands Type: Notes: Original Plan: Approved IV Not Approved ❑ Date: 4itati Y Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard- or.gov) Actual Slope: 7 Notes: Original Plan: Approved Er Not Approved ❑ Date: 2 i /IL' Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arbotist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) El Trees IV Protected Trees Notes: Original Plan: Approved / Not Approved ❑ Date: 9/P7 a °/� 1 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Appli nt Okay to Issue Permit: Yes o • Date Routed to Building , ._ , , I Page 2 of 2 RECEIVED FEB 162012 CITY OF TIGARD BUILDING DIVISION • • /\/ SLOPE �lll_1 it m o Ff•'OSIOII co. ItOI_ I III r � .� ) of 1 -1 1/2" II 7 1 c µGnO" =L _ 4 N rye,ik,1,a2 m - -- -- - f DRIVEWAY PLOT PLAN ' ASPHALT Scale 1" - 20' JIM if YELENA SEAT 9325 SW EDGEINOOD ST. U TIGARD, OREGON 91223 31 � WASHINGTON COUNTY, OREGC PROPERTY ID 1$ W251141 STATE ID* 251O2DGOO2OO 1 00.00' 54.33' 1 00.00' c,w Pnr-,Pwnnn G,T