Permit CITY OF TIGARD MASTER PERMIT
III 2 '' COMMUNITY DEVELOPMENT Permit #: MST2012 -00035
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03(27!2012
T I 0 A It i? g Parcel: 2S112CB06100
Jurisdiction: Tigard
Site address: 15412 SW 82ND PL
Subdivision: ASHFORD OAKS NO.2 Lot: 75
Project: Stutevoss
Project Description: 470 sq ft addition to dining room and master bedroom and add cover over existing patio with
fireplace.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 63 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 161 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 224 sf Value: $59,500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add! 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 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: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R - 3 224
Owner: Contractor:
STUTEVOSS, CAROLINE ZONA SLS REMODEL & ADDITIONS Required Items and Reports (Conditions)
15412 SW 82ND PL PO BOX 1093
TIGARD, OR 97224 TUALATIN, OR 97062
PHONE: PHONE: 503 -691 -9878
FAX:
Total Fees: $2,021.38
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 ob -'.: - - ..- rules or direct questions to OUNC by callin a 1.03.232.198 or 1.800.332.2344.
I
Issued By: = _ - i� Permittee Signature: ANA. y
Ca .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 o the pro : t.
Approved plans are required on the Job site at the time of each inspection.
!
Building Permit Application RECEIVED
Residential FoR OFFICE USE ONLY
City of Ti and FEB 2 8 2012 Received I(♦ ,p ' 1
City g Date .. _ 1A Permit N.
_ 'U �0 �7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi i r .
C Phone: 503.718.2439 Fax: 503.598.198On OF TIGARD Date/By: �i Pr'' � Other Permit:
Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: ® See Page 2 for
TIGARD Internet: www.tigard- or.gov / 7 Supplemental Notified/Method. 7 1 + r Su lementalloformation
Anti n/Lr
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
Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
u l- and 2-family dwelling Valuation: $ 5 zoo y g ❑C ommercial /industrial
El Accessory building 1:1 Multi-family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: . 1 /1--- -
JOB SITE INFORMATION AND LOCATION Total number of floors: P--,
Job site address: 1 5(.( %,W g 1 t pt., New dwelling area: 'Z aare feet
City /State /ZIP: r(\,1 \ � 0, Garage /carport area: 4 square feet
Suite/bldg. /apt. no.: Project name: c.,,v s J Covered porch area: ) quare feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK �1 work indicated on this application.
�.>k2 004- F� S r— ,vrr-o & &apt'f , 9, loz. , IS Valuation: $
D f) S�� 6 ,4L Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: S4,.,r, -k 5 J Type of construction:
Address: _ Occupancy groups:
City /State /ZIP: vS Existing:
Phone: ( ) Fax: ( ) New:
[APPLICANT la PERSON BUILDING PERMIT FEES*
/� (Please refer to fee schedule)
Business name:
$ LS ,><a..dt-Saet- J AAo 0 rns -v Structural plan review fee (or deposit):
Contact name:
Address: /0 lo � FLS plan review fee (if applicable):
�
City /State /ZIP: aQ Gno Total fees due upon application:
Amount received: .5:...72. 0 9
Phone: ( 5,0) ) 6c ! - cal Y Fax:: (0.5 ) ke 7`11'
E -mail: S Q S L (, a'e� - C...--- PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
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: 1/°/ hR Permit Fee (includes plan review $180.00
and administrative fees):
P one: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60
i CCB lic.: G ! S 1 Total fee due upon application: $201.60
Authorized signature:
t f'15
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
-�
Print name: Cr z Y J I� * Fee methodology set by Tri -County Building Industry
Date:
Service Board.
l: \Building \Permits \BUP- RESPermitApp.doc 02/24/2011 4404613T(11/02 /COM/WEB)
•
- RECEIVED
Electrical Permit Applicatj 2 8 2012 Foot (WI:R : 'I: USE (-)N1.1
Received P No.:
T
City of Tigard d 42 Permit nor /c2 400.35
13125 SW Hall Blvd., Tigard,6j Date/By: °
12OF TIGARD Plan Review
Phone: 503.718.2439 Pax/1191MM DIVISION DatdBy: Other Permit:
TIGARD
Inspection Line: 503.639.411 Date Ready/By: relic I ® See Page 2 for
Internet: www.ligard or.gov Notifed/Method: Supplemental Information
• ., OF WORK • : : :- ;:.: i`' PL�IN, REVIEIIl, :` ' :`. . :., :. :' ?' : : : : :.: :
Please check all that apply (submit sets of plans w/items checked below): New construction Addition /alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Oilier: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF :CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
] I_ and 2-fa
niil dwelling less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
y g ❑ 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.
❑Additionofnewmotorloadof ❑- A ",'Ti", "1-2 ", "I -3 ",
Job no.: I lob site address: {{ 1 q i�� lam' ` 10011P or more. occupancy.
1 1 5 4 2.. �' ll� $� M L� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: -7 p El Heahh.care facilities. ❑ Supply voltage for more than
/ l Cl Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: Project name: S+ u f e V C� �S ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Denripaoa I 011. I Fee. I TWA I •
New residential single- or multifamily dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: l,000 sq. fl. or less 168.54 4
Ea. add'/ 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
ii tp.,no del_ residential (with above sq. ft.)
_ Services or feeders Installation, alteration, and/or relocation
200 amps or less \ 100.70 ' 10 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 ' t
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sate, 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, ear panel
Owner signature: Date: A. Fee for branch circuits with
Id APPLICANT I ❑ CONTACT PERSON above service or feeder fee, /' O 7.42 7'k ZO 2
each branch circuit
Business name: . 5_ 4 _ ,.. s 4. of/..„,r,...C—A-.0,-di B. Fee for branch circuits without
service or feeder fee, first 56.18 2
A.4- �
Contact name: i r `K branch circuit _
E ach WTI branch circuit 7.42 2
Address: / 1 0 r 3 Miscellaneous (service or feeder not included)
City /State /ZIP: �� /_ n3 O'& G T — dw sere ce feeder - 67,84 2
Phone: (" ) ( c((, ct e - d I Fax: : (. ) (, q a_ - ( 3 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: 3 -( ® S LS f-lo,ne.1 , ter Sign or outline lighting 67.84 2
CONTRACTOR _ _ „ Signal circuits) or flmited- energy
Business name: panel, alteration, or extension. , Page 2 _ 2
Red's Electric Company Inc. — Each additional Inspection over allowable In any of the above
Address: 3605 SE 21st Avenue Additional inspection (I lir min) 66.25/ hr
City /State/ZIP: 503- 233 -6467 fax:503 -233 -1281 — Investigation (1 hr min) 66.25/ hr
Industaial plant (1 hr min) 78.18/ hr
elaina@redselectric.com
Phone: ( ) Inspections for which no fee is 90.00 / br
CCB# 4443 Elec 26 -152C Metro# 1695 — specifically listed ('bhrmin)
CCB Lic.: , ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: --
• C-' Subtotal: / 7 �, 9 0
wed Plan review (25%of permit fee):
Print name: �� '� , \ ,,S Date: 2z z//a. State surcharge (12% of penuit fee): 2 .'
J l ! l TOTAL PERMIT FEE: , 95' . g)i
Authorized signature: This permit application expires If a permit is not obtained within 180
Print name: I Date: • days after It has been accepted as complete.
Number of inspections allowed per permit.
I :rButldingVpennhu ELC- PermitApp.doc 07/01 /10 410.4615T(11f05/COMIWEB
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C�lea ate � Clean Water Services File Number
E ; 21 2012. • nW rr Services ) 7. �t3N I
ffY OFTIGARD
6 - PI .- Raga Pre - Screening Site Assessment
1. Jurisdiction: _ _
2. Property Information (example 1 S234A801400) 3. Owner Information
Tax lot ID(s): Name: -rt j e ti J
• Company:
Address: f Slij 5L... g & & ?k..
Site Address: l SZJ/ a- .i4' « +)- A ' - ' 1 / - City, State, Zp: - Tx- ?°d - o'-- c`i z 7. "'i
City, State, Zip: --rz rye.- `i 1 -a 7.y. Phone/Fax:
Nearest Cross Street: E -Mall;
4. O veiopment Activity (check all that apply) 5. Applicant Information
Addition to Single Family Residence (rooms, deck, garage) Name: `-+`� -E C t -c S $ ..
❑ Lot Line Adjustment ❑ Minor Land Partition Company: S L. '7: ,t.,et L d ri0.0 ox-c,-X /...,..
❑ Residential Condominium ❑ Commercial Condominium Address: Pc kO' 3
❑ Residential Subdivision ❑ Commercial Subdivision City, State, Zip: "i uiv...+ -n. C: a r'% 0 4
❑ Single Lot Commercial Q Multi Lot Commercial
Other Phone /Fax: ' a i'i - ti P 1 S /$03 b'i J. 7' '3
E -Mail: S'i't ` Sc.; i-k er4. r.cY+ -.
S. Will the project Involve any of site work? ❑ Yes XNo I] Unknown
Location and description of off -site work
7. Additional comments or information that may be needed to understand your project p^l "cc". rs oc.
i xiS 77.- a c x 1e .- f.->c NC;..) r" / 4.-% • :7 / 1 .40 416.2. .
This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ
1200.0 Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands andlor Department of the Army
CO E. All required permits and approvals must be obtained and completed under applicable local, state, and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Senrioes have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify
that lam familiar with the information contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate.
Print/fype Name .- k - r. ∎' z ,S t•- • t }- Print/Type Tide � .^t 5 -
Signature ' ,� Date )- - X i - I y
C
FOR DISTRIC S E ONLY
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SiiE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site 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 Sensitive areas do not appear to exist on site or within 200' of the site. This
Sensitive Area Pro - Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently
discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07.20, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local, State, and federal law
❑ Based on review of the submitted materials and best available information the above referenced project will not significantly t the existing or potentially
sensitive area(s) found near the site This Sensitive Area Pre-Screening SiteAssessment does NOT eliminate the need to evaluate and protect additional water
quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order
07.20; Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law
evlr- r Letter IS not
V Se v CWS approved site plan(s) are attached.
The p activit does not meet the definition of development r tho lot was platted after 919/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDEKLETTE REQUIRED.
Reviewed by Date 2 Z_��
2550 SW 1 111(111;.e'; • H:1151)o q 1 .. - ( 1 h` - - .. .
Iii ! }fC 0�1 ! 71� FI }inu >. Q$? 1�,1 - +iDD � �. (; . 4j 1 -4 ;�J �•ti: ^.v.d�c�il�`;:11Ci: . Oiy
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•
• Building Division
I N
• Development Code Provision Review
FIGAR 1)
Residential Projects
Building Permit No: "1ST a 0/02 - o 00 3 5
CWS Service Provider Letter Received: Yes ❑ No N/A ❑ ,QE�j c/ &7 •
Routed Plans:
Original Plan Submittal Date: a /20.2-
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (1) 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 41.01 at 503- 718- a-`F5") or • @tigard- or.gov)
L d Use Case No. Name i l 4! O V0 SS, _
Zoning (21 f • ,
14 Setbacks:
Front t> Rear I J Side 5 Street Side (D arage 07-a mum lding Height
Maximum Building Actual Building Height L � t
[d Visual Clearance
12t' Easements 04- 0 Sensitive Lands Type:
Notes:
Original Plan: Approved J3 Not Approved ❑ Date: g ig// 2/
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)
Xi Actual Slope: 7'' %
Notes: •
Original Plan: Approved Not Approved ❑ Date: . 1 Z -
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
•
(Review Continues on Page 2) •
•
Page 1 of 2 •
•
City Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard- or.gov)
t reet Trees
Protected Trees
Notes:
Original Plan: Approved / Not Approved ❑ Date: 1 ,$ �a-
/
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 Applicant
Okay to Issue Permit: Yes N o 0 .
Date Routed to Building: 1
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Page 2 of 2
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