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Permit CITY OF TIGARD MASTER PERMIT 11111 q C. COMMUNITY DEVELOPMENT Permit #: MST2012 -00017 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/07/2012 Parcel: 1 S136CA08000 Jurisdiction: TIGARD Site address: 11032 SW LEGACY OAK WAY Subdivision: WHITE OAK VILLAGE Lot: 1 Project: White Oak Village, Lot 1 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 3 First: 625 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 27.5 Bathrooms: 3 Second: 780 sf Garage: 198 sf Front: 10.5 Smoke Dwelling Units: 1 Third: 540 sf Right: 3 Detectors: Yes Total: 1945 sf Value: $212,669.57 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 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: N 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: 4 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits f 1000 sf or less: 1 0-200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 / Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401-600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ' ELECTRICAL - RESTRICTED ENERGY • • SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other. N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R -3 1945 Owner: Contractor: WESTLAND INDDUSTRIES WESTLAND INDUSTRIES Required Items and Reports (Conditions) 12670 SW 68TH AVE ST #400 12670 SW 68TH AVE 1 Ersn Cntrl 503 - 681 -4444 TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 -572 -0746 PHONE: 503- 245 -9715 FAX: 503 -598 -9081 Total Fees: $17,044.07 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 : •• •rdance • app • - • plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspen• • for more the 180 days. A ENTION: Oregon I • • req ires you to follow the rules adopted by the Oregon Utility Notification = - - . • se les - set forth in OAR 952 -001 • 010 through OAR 95 - 001 -00 may obtain a copy of the rules or direct questions to OUNC by calling 503. 2.1987 or : •0 • ..2 • �/ 1 AAZA ji , Issued : : Permittee Signature: All �'- ■= Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. This permit card shall be kept in a conspicuous place on the job site until completio .f the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential RECEIVED FOR OFFICE USE ONLY City of Ti and Received ��" City g FEB 1 4 2012 Date /B : • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review � 'i li Phone: 503.718.2439 Fax: 503.598. D � Date /B : � ` , A"�.N (Z Other Permit:�(o / A 3 I nspection Line: 503.639.4175 �� �I�� Date Ready .: Juris: la See Page 2 for I \ It n � d1ILD N(i DIII� Internet: www.tigard or.gov Notified /Method: Supplemental Information TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLING g i,New construction El 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. Valuation: $ '" /� 0 1- and 2- family dwelling ❑ Commercial /industrial Z�Z� �`� q ( + 67 El Accessory building ❑ Multi- family Number of bedrooms: 3 ❑ Master builder ❑ Other: Number of bathrooms: 2- JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /Jo 3 a. si4) L >r( G v 04-x u/ y New dwelling area: 1 4S square feet City/State /ZIP: 7 t , 4 -�, Q,Q 1 72 2,? Garage /carport area: lei q) square feet 6-Q Suite/bldg. /apt. no.: I Project name: !/l/ // '0,44 01 Covered porch area: 9., I square feet 71) Cross street/directions to job site: Deck area: _ _ z.�' square feet 1S/`�� Other structure area: 'A3 square feet 0.-.7t S REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: )H re anx 141.1 I Lot no.: / Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: L 5/36 eA p6,00 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. /i , f -- Valuation: $ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER I ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( Fax ( ) New: [APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: 0_57 - Ati./Q /J l/ST/0jES Structural plan review fee (or deposit): Contact name: �0t3 A,J 0A) — LT, STA Address: `a 6 7 0 CG/ 68= 4/E Sr erIvo FLS plan review fee (if applicable): Z Total fees due upon application City/State /ZIP: --77, , - D 9122_3 ��� , � /_ Amount received: Phone: (S i c7)- --071 II Fax: o a its, E -mail: Jloh4 aO�' f - /L, CQ/j4 A606,--1241.00, C.19/14 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof -top mounted PhotoVoltaic Solar Panel System. Business name: r�GST�-NQ � U C 7 - �£ 5 Submit two (2) sets of roof plan with connection details / and fire department access, along with the 2010 Oregon Address: /c.' ' -20 7 '8, .. 5" Solar Installation Specialty Code checklist. City/State/ZIP: T�/ g 2 9 Permi F (incl plan review ty / 23 3 $180.00 / and administrative fees): Phone: (S ) 7 t) -D621.- Fax: (523) 01- 908 State surcharge (12% of permit fee): $21.60 CCB tic.: 0 35- A r Total fee due upon application: $201.60 Authorized signature: 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 ,7 Print name: � 6_____6) p . N40a-kot) I Date: — 9 _Ia Service Board. I:\ Building\ Permits \BUP -R -R ESPermitApp.doc 02/24/2011 440 -4613T(I 1 /02 /COM /WEB) • Building Permit Application Checklist One- and Two - Family Dwelling Fort oiFlcl, USE ONLY ilh City of Tigard Received Date /By: Permit No.: 1 3125 SW Hall Blvd., Tigard, OR 97223 Associated permits: C Phone: 503.718.2439 Fax: 503.598.1960 T l - A I D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical CI Plumbing ❑ Mechanical Internet: www.tigard - or.gov ❑ Other: TI -IE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1" es No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. 74 ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. I' ❑ ❑ 3 Verification of approved plat/lot. t ❑ ❑ 4 Fire district approval required. Name of district: /'f % Q' ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ 1g/ 6 Sewer permit. g' ❑ _ ❑ 7 Water district approval. 1E' ❑ ❑ 8 Soils report. Must c original applicable stamp and signature on file or with applicatio 12 ❑ 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. I I Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if i ❑ ❑ 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 i ❑ ❑ 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- EK ❑ ❑ 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. 13" ❑ ❑ 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- ii ❑ ❑ 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 111/ ❑ ❑ locations. Show attic ventilation. �/ 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 12 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 lld' ❑ ❑ 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 Er ❑ ❑ architect licensed in Ore:on and shall be shown to be applicable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three (d site pl. s are required for Item 11 above. Site plans must . : -I/2" 11" or 11" x 17 ". ® ❑ ❑ 24 Two (2) sch are required for Items 16, 19, 20 and 22 above. fa ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. �]' ❑ 12 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ 14 27 "Drawn to scale" indicates standard architect or engineer scale. LY ❑ ❑ 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. l 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ lir 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, I� � ❑ ❑ 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 \Pennits \BUP- RESPennitApp.doc 02/24/2011 4404613T(I I /02 /COM /WEB) i 1LLCi VtJJ i Electrical Permit Applicat' FOR (WFICF HSI.: ONLY 0 l4 t '? City of Ti and Received � Permit No.: 111 •J g �.i T Date/By: ii ( I �' it ii5 t x.--o 00( • 13125 SW Hall Blvd., Tigard ifTIGARD Plan Review ^�_ C Phone: 503.718.2439 Fa1Q �l'�°DIVISION Date/By: • Other Permit: 5L0 413‘,20. 'TOO - I - i G AR a Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard or.gov Notified/Method: _ Supplemental Information TYPE OF WORK PLAN REVIEW ., construction ❑ Addition/alteration/replacement Please check all that apply (submit 3 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. El Demolition 0 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 L-. 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 AN LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: J/6)32_ , Z£6 Off�// I or r rs. occupancy. ❑ / X �� nay ❑ Six or or more residential units. Recreational vehicle parks. City/State /ZIP: �� (/ !/ ❑ Health -care facilities. ❑ Supply voltage for more than q-7 ❑Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: /4/ if- 0/ /t..1-416 ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qtv I Fee. I Total I " New residential single- or multi- family dwelling unit. Includes attached garage. /� /#�� DA-g 1GL4b / 1,000 sq. 168.54 «( - 4 Subdivision: (1v 1/ Lot no.: Ea. add'I 500 sq. ft. or portion 33.92 ((H. 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 --�e- 2 // _ , / / Limited energy, multi- family 75.00 2 C_ e/U (1G� /V e- 5c4 ie/t/ residential (with above sq. ft.) !! Services or feeders installation, alteration, and/or relocation _ 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP: relocation Phone: ( ) 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 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 branch circuit Business name: g572, 6 „� 5 B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: go A,0 a , /,T1 5Tjq- pQ,z.,,t,Yr branch circuit /� Each add'I branch circuit 7.42 2 Address: /d" 610 S1/ fig AVM SU /7'e- 4 Miscellaneous (service or feeder not included) Ci /State /ZIP: � 6- ,ED / ©,� [ z3 3 Each manufactured or modular 67.84 2 ty / dwelling, service and/or feeder Phone: (( Q 7 ) 5 " - b . — 0 7 / 6 Fax: : (41) 3 )s-to go g / Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy panel, alteration, or extension. _ Page 2 Business name: L£ �Q (61-� '7`�v 2 /4904 ��s Each additional inspection over allowable in any of the above Address: r Ays3 56, ;23? — A Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: /� / � 970,49F Investigation (1 hr min) 66.25/ hr ty �� -s ; , 6/�lGc Industrial plant (1 hr min) 78.18/ hr Phone: 6 ) -- �C/ 3 Q 6 Fax: ( e7) -lib-018 Inspections for which no fee is ��� specifically list (%: hr min) 90.00/ hr CCB Lic.: 6 , 9 (� Electrical Lic.: 2).. kgti Suprv. Lic.::- , 'J 3 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: /' Plan review (25 /o o Subtotal: S; _ of permit fee): Print name: I A. t r4/ ' Date: , . (6 . I State surcharge (12% of permit fee): 41 , TOTAL PERMIT FEE: �.3 6 6, -I A- Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: y r d • ( • Number of inspections allowed per permit. I:\Building\Permits\ELC- PermitApp.doc 07/01/10 440-4615T(11 /05 /COMM'FB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ 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 ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: ' 1 *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 / Mechanical Permit Applic on FOIL OFFICE USE t)iN'1.1 City of Tigard CEIVED Received Date/By: (1 41111Mil, Permit No.: 1111 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C . Phone: 503.718.2439 Fax: 503.598M Date/By: Other Permit: I _ i . . , . op T I G A It D Inspection Line: 503.639. ' 1 LL[[�3 1 4 2012 Date Ready/By: larig: 65 See Page 2 for Internet: www.tigard - or.gov CI Notified/Method: Supplemental Information p � � I F UtRi(� TY TIGARD TYPE ��SION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: // D27,� �� L g-A� � ` Air conditioning pi Job site address: . r ` (requires site plan showing placement) 46.75 City /State /ZIP: �� ot2— Furnace 100,000 BTU ( ducts/vents) r 46.75 (� 2-2i Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: 1, /` ✓�/ /,r� Heat pump „r `�� r `�/ �"� (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 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: 0 th Lot no.: / Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: / 5 /2, �1} (3 vU ° Other fuel appliances: DESCRIPTION OF WORK J Water heater 1 23.32 C� r —� Gas fireplace 1 33.39 5 /�Gv"' 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 I ❑ TENANT Chimney/liner /flue /vent 23.32 Other: _ 23.32 Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment I 33.39 City/State /ZIP: Clothes dryer exhaust ' 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) . — r toilet compartments, utility rooms) 23.32 11 6 •W APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 ^ � w _ / Other: 23.32 Business name: i J ' / � �/�' I J '7 �? '"" ' Fuel piping: Contact name: (�11//le $14.15 for first four; $4.03 for each additional Address: D, . III( Furnace, etc. 1 14, " Gas heat pump City /State /ZIP: ‘0ide.--' etl`� Q 4/Z9 Wall /suspended/unit heater , Phone: 3 S75 5 5-i 3 Fax: : ( Water heater Fireplace 1 E -mail: Range CONTRACTOR Barbecue Business name: i, • ��, / ,_— Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City/State /ZIP: Af � - // / r r . bg C , Subtotal ? , � ' F ( �_ Minimum permit fee ($90.00) ( Phone: 5 �� � f %3 Plan review (25% of permit fee) CCB lit.: /�.E�/S State surcharge (12% of permit fee) 7316.12- / e/C/k— TOTAL PERMIT FEE ✓ T, I ` Authorized signature: This p ermit a expires if a permit is not obtained within 180 d ays after it has been accepted as complete. Prin name: I t / Dat e: _. f o. ( ate * Fee 'Fri utility Building - Board I:\ Building \Permiis\MEC- PermitApp.doc 09/09/10 4404617T(II /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\Perrnits\MEC- PermitApp.doc 09/09/10 2 n' Plumbing Permit ApplicatRECEIVED / Building Fixtures FEB 14 2012 City of Tigard Receives Date/By: It{ i a' Permit No.: >i y (a pm, 000(7 V 13125 SW Hall Blvd., Tigard, OR OF TIGARD • Plan Review C Phone: 503.718.2439 Fax: 5 Date/By: Other Permit No. (� Inspection Line: 5013.639.4175 . E DIVISIO Date Date Ready/By: Juris: Ei See Page 2 for ! TIGARD Internet: www.tigard - or.gov Notified/Method: Supplemental Information • TYPE OF WORK TYPE SCHEDULE For special information use checklist New construction ❑ Demolition Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath r 312.70 nd 2- family dwelling ❑ Commercial/ industrial SFR (2) bath 437.78 SFR (3) bath l( 500.32 r ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler L sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: , i S•it I Catch basin or area drain 18.76 y, Drywell, leach line, or trench drain 18.76 City/State/ZIP: j, , / c2 q 2 -3 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: ile 411, j j i. Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _) I Page 2 Storm sewer (no. linear ft.: ) / Page 2 ; / Water service (no. linear ft.: ) 1 Page 2 of Subdivision: J Lot no _ Fixture or item: Tax map /parcel no.: / / ? C Op,--6 _ Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 �/ � Clothes washer J 25.02 a ksi /.ci �f ��t} ��aWi� /Gr i Dishwasher I ( 25.02 Drinking fountain 25.02 . Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal i 25.02 City/State /ZIP: Hose bib y 25.02 Phone: ( ) Fax: ( ) Ice maker ( 12.51 1! APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: LA �/ J ::,TAL . 1 ,C_7 o"1. Medical gas (value: $ ) Page 2 i . Primer 12.51 Contact name: � J „ , ? : . m � y ' �, Roof drain (commercial) 12.51 Address: i / ,/ , I�i Sink/basin/lavatory C 25.02 City/State /ZIP: A r ' Solar units (potable water) 62.54 Phone: (t • A - ]i�/ i r Tub /shower /shower pan 9s 12.51 I I I)/ � Urinal 25.02 % Water closet 25.02 CONTRACTOR A �_ n Water heater , 37.52 Business name: /� Water piping/DWV 56.29 Address: • A? . Other: 25.02 City/State/ZIP: / beb Of.-- 4 Subtotal gip, Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: • � III Plumbing Lic. no.: 3 - S Plan review (25% of permit fee) S tate surcharge (12% of permit fee) 6,9,C>. Authorized 5'430 signature: TOTAL PERMIT FEE Print nam = r' �� / This permit application expires if a permit is not obtained within 180 days t y t Date: a • 16 after it has been accepted as complete. " Fee methodology set by Tri-County Building Industry Service Board. I: �BuildingTennits \PLMr1- PermitApp.doc 10/01/09 44046I6T(10/04/COM/WEB) 1 4W 6044- ✓ 1 o ° Building Division Development Code Provision Review TIGARD Residential Projects Building Permit No: M o I o&o/ A - 0 0 0 / 7 CWS Service Provider Letter Received:. Yes ❑ No ❑ N/A / Routed Plans: Original Plan Submittal Date: /5� /ol. 1st Revision Submittal Date: ❑ Site Plan Only 2nd Revision Submittal Date: ❑ Site Plan Only / To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact (t( at 503 - 718 -)- S( or ■@tigard- or.gov) Land Use Case No. 5 6e'�0D(/" 00010 Name ( alt ❑ Zoning 1?-12/ ❑ Setbacks: Front 1 0 Rear J Side 3 Street Side S Garage X— ❑ Maximum Building Height 3 $' Actual Building Height X7-5 ❑ Visual Clearance ❑ Easements (t • S Pue ❑ Sensitive Lands Type: e: AI A "� Notes: rialf tet C- :5 ,Idk aee pile/ • t / Original Plan: Approved Er Not Approved E' Date: 2.115( , . 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) ,l f Actual Slope: 5 Notes: Original Plan: Approved Not Approved ❑ Date: 2 I z Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 / , . 4111 , City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) Er/Street Trees Protected Trees Notes: • Original Plan: Approved d Not Approved ❑ Date: 9 "/ /? 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 Applic t: Revision 1: Date Sent to App j ant Revision 2: Date Sent to A cant • Okay to Issue Permit: " Yes No ❑ Date Routed to Building: • • Page 2 of 2 • ■ ■ _________ . ' EIVED FEB 2, 2012 CITY OFTIGARD BUILDING DNISION C1) Lll arm PLAN NOTES: 1 Z 1. ALL DXCE66 GRADING MATERIAL TO BE EXPORTED TO AN APPROVED DEPOSAL LOCATION. IR< •■ 2. ALL PILL AREA. le UD•R GARAGE FLOORS. OIDENALK6, DRIVEWAYS ET.. TO EE COMPACTED G '4R RU- HOMES 3. THERE WILL EE A eLIGHT OVER EXCAVATION TO PROVIDE CONCRETE MMHG ALL AROUND NEW 6TRJCIVRE. Skyline 4. PROVIDE COWfl'/CITY APPROVED eEDPERT FENCING AROUND EXCAVATED AREA Homes PRIOR TO EXCAVATION AND CON611E 6021 UGTIO. 6021 SE Milwadie Ave. S. PROVIDE COWRY/CITY APPROVED 6TAeaIED GRAVELED CONSTRUCTION DERANGE Portland OR 90 RUC 72 PRIOR TO EXCAVATION AND CCNbTTIQL 502.235. 3810 6. O C T A P R I L M ED URN MILL AR OR PLAbnC a.EETn+G 121611113214 wVbw.skyGneplans.tom 1. COMRACTOR/ e11D- CCETTRAGTOR TO VERIFY LOCATION OP ALL UIILRE6 PRIOR TO EXCAVATION AND CONSTRJCTIQL • • a eOUDARY AND TOPOGRARIT 6ROR NATION HAG BEM PROVIDED TO OCR.I E HOMER o' -b IR• 3' -0' AIE GN DE61 INC. SKYLINE HOMER AND DE6IGN, INC. WILL NO eE HELD LD LIAOLE FOR THE ar -m �•_I• ACCLIRACY OP 11416 IFO 1A11 IT 16 THE ROLE IEePONeIed1T7 OP THE CONTRACTOR A71NER TO VERFY ALL 6ITE comma* ICLIDING FILL PLACED CR SITE 4 .A 8 TOPOGRAPHY ELEVATIO IE I6 WE COLI.eGTED FROM AGTlU1L SITE 6URV1:Y. EE. Od NS�781m4TU 6865' @ pd -11 CD 10. ELEVATION LEGED, EE- EXISTING GRADE ELEVATION CAMBRIDGE T 4p N N en FE. FINAL GRADE . FINIS ED R REELLE�VATIO+ O gal 3. B A71� z_ D --- • Q FLAN 0 IL PROVIDE A MINEy: M GRAVEL ease UNDER UNDER ALL DRIVEUWY a1EA& )— �� • I 1 13 .6464°714 I s 0 6- . s "r : Cl at G. PROVIDE A 4' MINI EI GRAVEL RASE U+DER AU. SIDEWALK AND PATIO AAEA& _ � 4 4 t O a '1 PIPE ALL 6TOR DRAINAGE FROM 1FE BUILDING TO A =LEVY/CRY DISPOML WATER MAIN . �lI�UE/I® POI14T OI. cue LE II " CORK. a 1® et GARAGE d Q 14. MA3G U1 ELOPE oP cute APO FILLS TO OE 1U nJ HOMXOITAL TO ME (I) tNE DR L _ im m I°. 8d ZE FT. m i1 Ns VERTICAL FID a: BUILDINae, STRJCnJRES, FOUNDATION%. AND 1ETAINEIG WALL& J I X E. PROVIDE A MAINTAIN PIU6N GRADE WRH POSITIVE DRAINAGE ALUIY FROM U 6T RUGT RE ON ALL MEE URN A SLOPE OP 6' MI NE ILA N 11E' -o'. E E. O N6"D781O41U 6863' EE O d 0 in N IMPERVIOUS AREA'S: 3T -0. IS' -0' 160 86L FT. DRIVEWAYS in ■ 19 8Q FT. PORCH PLAN No.: 3044 32 SQ. FT. WALK 100 PATIO DRAIN: Igo 80. FT. OVER+•IANGS+ MS 80. FT. BUILDING COVERAGE DATE: 02 -20 -12 1$ 0. IM 86 TOTAL 8 FT. PERVIOUS+ AREA'S SCALE: l' =20' -0' LOT INFOWATIONs i iii ■ PLOT LOT AREA, 1,880 60. FT. PLAN IMPERVIOUS COVERAGE. 1286 e0. FT. BUILDING COVERAGEz 61 T< BUILDING HEIGHT. APPROX---- 31' -0' LOT I // MN. BUILDING SETBACKS+ 119' F#20 .LT, IS' REAR, 3' SIDES. WHITE OAK VILLAGE TIGARD, OR �� e i l • • II II Oregon Residential Specialty Code R318. MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, /B An egs o/lJ , am the general contractor or the owner - builder at the following address: Site Address: p .574) /taw Y 64 k City: �6146/ Permit #: / L —‘120/ 7 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 R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the general contractor that all moisture - sensitive wood framing members used in construction have a moisture content of not more than 19 percent by dry weight of dry framing members. Signature: AP" W Date: 6 - 0 2 E l G :,rral Contractor or Owner - Builder l:\ Building \Form\RES - MoistureSensitiveWood.doc 09/25/08 Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: /1?5Ta0/ 1-8,00/ 7 Jurisdiction: hog/el) Site Address: /ft) 3)._. 5141 /iblGy (.444 dify Subdivision/Lbt #: fr/# / and /or Map an d 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) I / Signature: � �� Date: ^ Orr /General Contractor /Authorized Agent Print Name: � 4a04.. ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. 1: \ Building \ Forms \RES- HighEfficiencyLighting.doc 07/01/08 !Pi STREET TREE TIGARD CERTIFICATION I, 46' 4 emi , owner/ agent for s r 4..5 - CGS' 'fS (PLEASE PRINT) (PERMIT HOLDER) do hereby certl 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.: /1467O -00017 SI"1 E ADDRESS: /10 32 5 4) 1 6' 7 40/ Q, 4 SUBDIVISION: l/ (11 - 1 Q 14‘46-1_ LOT #: SIGNATURE: , / (.Z DAVE: -a -/ L (OWNER/AGENT) RE CEIVED d� VERIFIED BY DAVE: OF TIGARD) ❑ Tree location verified per approved site plan. I:\ Building \Forms \StreetTreeCertificate 04/01/2011 Program Use Only Form 640S FestTrack ID ij\ Completion Certification—Site Inspection EnergyTrust New Homes Program — Single Family Data check by of Oregon (initials) To be completed by verifier Portland Energy Conservation, Inc. (PECI) Is a Program Management Contractor for Energy Trust of Oregon. • First ins co l on Second / I9sp Date: yre!G I Verifier Name: �, a Date: b l l f /Cam} Verifier Name: Incentive Payee Company Name: Builder or Company: idg51-64 n Contact Name: Performance Testing Company: Technician Name: Site Information Development Lot Number. REM/Rate SCO Project ID: � Name: File #: (required from verifier if �� project Is ENERGY STAR') Site Address: 1la32 L ull y O City: r /4 State OR Zip: f 7ZZ3 C Onattached ❑ Attached Number of Stories Total Building Square Footage: L ?ees I Number of Bedrooms 3 Basement ❑ None ❑ Full Basement 0 Half Basement jgCrawlspace Type 0 Garage/basement combo ❑ Slab on grade Other Electric Provider �7 PGE ❑ PAC ❑ Other: Gas Provider JITICIWN ❑ CNG 0 Other: Electric Meter Number: Gas Meter Number: (must apply to permanent meter) 3' (k S q c t (must apply to permanent meter) 1 r% Additional: Project Information (please mark all that apply) ❑ Code plus Best Practices (meets minimum Best Practice requirements with improvements above code) ❑ Path 1 EPS Best Practices Path 2 ENERGY STAR ❑ Envelope Upgrade ❑ Ducts & HVAC Equipment Inside Equipment Upgrade Path 3 ENERGY STAR with ducts inside ❑ Path 4 Performance Plus with ducts inside ❑ Path 5 Advanced Performance ❑ Zonal Electric Efficient ❑ Advanced Electric Resistance ❑ Solar Electric (PV) ❑ Solar Water Heating (SWH) ❑ Small Wind Renewable ❑ Solar Ready Electric (SRPV) CI Solar Ready Water Heating (SRWH) Energy ❑ Qualifies for Solar Ready Incentive (must attach checklist) Solar Installer: Name: Company: Low Income _ ❑ Yes No Does this project qualify as Low Income? (must provide documentation from builder) Accessory ❑ Yes RNO Is this home an ADU? Dwelling Unit ❑ Yes l.,d^►vo Is the ADU separately metered? If so, provide meter numbers above Other ❑ Earth Advantage — Certification Level: Certifications ❑ LEED -H - Certification Level: 0 Other (please specify): — Form 640S v10 120101 Page 1 of 3 Return completed form to: Energy Trust New Homes Program— Single Family 100 SW Main Street, #1600 • Portland. Oregon 972D4 1.877.283.0698 • Fax 1.855.575.4315 newhomes ®en ergytrust. org • o N1t Form 640S "IC Completion Certification—Site Inspection EnergyTrust New Homes Program — Single Family of Oregon To be completed by verifier Portland Energy Conservation, Inc. (PECI) Is a Program Management Contractor for Energy Trust of Oregon. Verification 1 Category Type Actual Value Equipment Details• &Notes insulation Flat Ceiling R- (_t Insulation Type: 3� ) 1 Framing Type: Vaulted Ceiling R- 'i Insulation Type: ��ti ❑ Standard 3 Scissor Truss R- Insulation Type: ❑ Intermediate Above Grade Walls R- ❑ Advanced '2, Insulation Type: �i'' i, Framing Below Grade Walls R- MI5 Insulation Type: r Size: Floor Over Unheated Space R- X[,) insulation Type: f3 -t - Floor Over Garage R- 3 2> Insulation Type: if7/14 Slab Floor (unheated) R- ❑ Full Slab ❑ Perimeter Doors Door R- Windows Windows U- , 30 SHGC: 7t= Window Frame Material: 1 h tz Skylights U- SHGC: Window Area (Glazing) % Total window area: Lighting Indoor and Outdoor # fixtures: 2 1.• % # of ENERGY STAR fixtures or CFLs: LZ- Appliances ENERGY STAR Dishwasher ) Yes ❑ No EF Cooling Air Conditioning S ER: Btu/Hr: A/0 NC le Primary Heat ❑Fireplace / r l;'�' -- � ' Source AFUE: e , s r s- Brand: FR./1y evou, Outdoor Unit (for heat Gas Furnace pumps) ❑ Electric Boiler HSPF: Model #: as SEER: Serial #: Model #: 6 Heat Pumps: ❑ Other: ❑ Air Source (ducted) COP: gtu/ftr: Serial #: I ❑ Mini Split (ductless) 1 "� ❑ Ground Source Location: ❑ Radiant Floor Heat 11 ECM: ❑ Yes L I No Heat pump commissioning ❑ Cadets ` kS Electronic Air Cleaner ❑ Y es es [3'IVo report attached or ❑ Zonal C Backup fuel: ❑ Electric ►r Vas ❑ Other confirmation for ground source heat pumps that ❑ Other: C ( [y manufacturer's start up procedure was performed Additional notes on primary heating: Notes on secondary heating: Water Heater ❑ Storage Gallons: Brand: ' r ❑ Electric lTankiess EF: .6 Cr Model #: Gas �c,75' Location: Serial #: al _ea e'Z_ i M � �; Btu/Hr: V Form 640S v10 120101 Page 2 of 3 Return completed form to: Energy Trust New Homes Program — Single Family 100 SW Main Street, #1600 • Portland, Oregon 97204 1.877.283.0698 ♦ Fax 1.655.575.4315 n ewho m es Q ene rgytr u s 1. org 4 Form 640S \f, Completion Certification --Site Inspection EnergyTrust New Homes Program — Single Family of Oregon To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. Verification 1 Category T yp e Actual Value Equipment Details & Notes Ventilation Energy Trust Mechanical ❑ Exhaust Me nergy Trust Mechanical Ventilation Requirements System Ventilation Requirement ❑ Supply Yes ❑ No C �/ t` ,it, t✓ U Exhaust & Supply l Cl Heat Recovery ERVIHRV Model #: Ducts ❑ Ducts Inside % ducts inside: % Ducts in Conditioned Space If claiming incentives for ducts inside, check one of the following: ❑ Ducts Tested ❑ Visual Inspection per RTF specs Duct Insulation R- Duct Location Duct Sealing w/Mastic Paste ❑ Yes ❑ No Performance Testin . & Duct S stem Information Ducts Duct leakage must not exceed 0.06 CFM42;50 x floor area, or 75 CFM250, whichever is greater. When tested without the air handler, leakage must not exceed 0.04 CFM @50 x floor area, or 50 CFMf 50, whichever is greater. , ultiple tests may be required. Duct Cubic Feet Per Minute Duct Leakage Air Handler in y Air Handler Present (Yes Leakage: (CFM) 0 50Pa: ■, pass 0 Fail Conditioned Space During Test ❑ No Fan Pressure ❑ DG3 Ring Type ❑ 0 2 Leakage Test Total Leakage Gauge > D0700 (check one) ❑ 1 [13 Method [J Leakage to Outside Duct Blaster, to 4 Location: ,} Pressure Tap Location: k ` r � Area Tested: Whole House Air Changes per Hour Envelope Tightness Cubic Feet Per Minute Leakage: (ACH) 50Pa_ 'le Pass 0 Fail p [ , House Volume. (CFM) @ 50Pa: 60 Best Practices Requirements t ':ill requirements chest be met to receive an ErieTyy Performance Score) • Thermal Enclosure Checklist Complete [ass ❑ Fail Thermal Enclosure Checklist attached? ❑ Yes • Insulation Quality Inspection Performed [ 1'es ❑ No 4 (complete Insulation verification .section below) • Approved Mechanical Ventilation Installed [l-Yes ❑ No 4 (complete mechanical ventilation section below) • Zonal Pressure Relief — All zones comply 13'Yes ❑ No f If no, state reason for failure: • Combustion Appliance Zone Testing Net CAZ Pressure: Pa ( quired) If not applicable, please explain: 6-1 k DAi Forced air system operation must not depressurize Combustion Appliance Zone (CAZ) by more than 3 Pascals (Pa.) All shaded sections are required for Best Practices. Applications will not be processed without these sections completed. Technical Compliance Options (please list all that apply) - If any values on this form do not meet Builder Option Package (BOP) requirements, please indicate which Technical Compliance Option(s) allow the variance and explain which component was traded. TCO #: Explanation: Additional Notes: Signature • By my signature below, I certify that I have performed the tests as described, that the form is complete, and that all information on the form is acc _ate. Verifier G Verifier ; Signature: Name: r � y -tv,J 1'�lx� Zic Date: 4 7 / a__ Red Tag Inspection (rfneed - •): Signature: Name: Date: Form 640S v10 120101 Return completed form to: Page 3 of 3 Energy Trust New Homes Program — Single Family . 100 SW Main Street, #1600 • Portland, Oregon 97204 1.877.283.0698 • Fax 1.855.575.4315 newhom es ©e nerg ytrust. o rg