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Permit CITY OF TIGARD MASTER PERMIT a • COMMUNITY DEVELOPMENT Permit #: MST2012 -00060 T f GARC) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/17/2012 Parcel: 1 S136AD01901 Jurisdiction: Tigard Site address: 6910 SW OAK ST Subdivision: VILLA RIDGE Lot: 1 Project: Botteron Project Description: Add 276 square feet to kitchen BUILDING Floor Areas , Required Setbacks Required Stones: 1 Bedrooms: 0 First: 276 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 11 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 2 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 276 sf Value: $30,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs /Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 2 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 1 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =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'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 8 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: Eeompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr. Occupancy Group: Square Feet: ADD SF VB R -3 276 Owner: Contractor: BOTTERON, DAVID & CONSTANCE E KENNETH J LEMMONS MASONRY Required Items and Reports (Conditions) 6910 SW OAK ST 5702 SW SEYMOUR ST • TIGARD, OR 97223 PORTLAND, OR 97221 PHONE: PHONE: 503- 784 -3127 FAX: Total Fees: $1,636.33 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and :II other icable law. All work will be done cordan - 'th approved plans. This permit will expire if work is not started within 180 days of issuance, or if ork i sus•ended for more the 180 days. ENTION: Oregon aw re.uires you to follow the rules adopted by the Oregon Utility Notification Center. T • = rul s are set forth in OAR 952- 1 -0010 through OAR 952 -'! -$090. •u may obtain a copy of the rules or direct questions to OUNC . y callinr 03.232.1987 0 :'0. 32.2344. Issu By: a `/ -- " ' l Permittee Signature: � Call 503.639.4175 by 7:00 a.m. for the next available lnspec on date. This permit card shall be kept in a conspicuous place on the job site until completion of the _ -Jett Approved plans are required on the job site at the time of each Inspection. Building'Permit Application Residential RECEIVED FOR OFFICE tisi; ONLY City of Tigard q 7 R /�1 ed , i Permit No.: W VQ /v1 - 10400& 2 13125 SW Hall Blvd., Tigard,OR 97NAR 1 20 2 Plan Re ' w W ► Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : /�/ 2 r Other Permit: T I G A It I Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: /��� /'Q t� it RI See Page 2 for w Internet: ww.tigard or.gov BUILDING DIVISION Notified/Method ,7 supplemental Information fCk 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. Valuation: $ 2� ° ° El 1- and 2- family dwelling El Commercial/industrial .�.7C ��� El Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: b (O `5c..1 tL1 S 1 New dwelling area: c 2 76, square feet City/State/ZIP: ^i 1 � (s. -A.-✓LD C3`i\._ Garage /carport area: square feet Suite/bldg. /apt. no.: I Project name: Covered porch area square 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 work indicated on this application. J1- - t Valuation: $ Existing building area square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: C-©1` kk �Z R. �A-.NA _ _ ` Type of construction: Address: ( (.0 `5l., Oa i 2 g � ` l '�� Occupancy groups: City/State /ZIP: — t (,-g-,/L 9 0" 17) )- - 2 j Existing: Phone: ( ) Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee (or deposit): Contact name: FLS plan review fee (if applicable): Address: Total fees due upon application: City /State /ZIP: „`' Amount received: �6 Phone: ( ) Fax:: ( ) E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES' Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: �4_ L� NA".„`, o„--j Submit two (2) sets of roof plan with connection details S �. J and fire department access, along with the 2010 Oregon Address: 5Z L S �vw.L 5 ' Solar Installation Specialty Code checklist. Permit Fee (includes plan review City/ State/ZIP: "Pc.,-A_........‘, �) C2" 72 2_ ( and administrative fees): $180.00 Phone: (<u '�8‘...i 2) I l Fes ( ) State surcharge (12% of permit fee): $21.60 CCB lic.: 10 i A l 1 4.c 5il jrL 66_ 41 ) L P PP Total fee due upon a fication: $201.60 Authorized signature: 1 _This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Date: * Fee methodology set by Tri -County Building Industry Print name: L N �� �- �- Service Board I: Building \Permits\BUP- RESPermitApp.doc 02/24/2011 44 - 4613T(11/02/COM/WEB) Building Permit Application Checklist r . One- and Two - Family Dwelling FoR OFFICE USE ONLY City of Tigard Received Permit No.: 74 q 1 3125 SW Hall Blvd., Tigard,OR 97223 Date/By. C Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: "I IGARD 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard -or.gov ❑ Other: THE FOLLOWING ITI?1VIS ARE REQUIRED FOR PLAN REVIEW' 1 e 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. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors; water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details: Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." . 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore:on and shall be shown to be a' s licable to the sro'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 11" 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- RESPermitApp.doc 02/24/2011 440 - 4613T(1 1/02 /COM/WEB) • Mechanical Permit ApplicationRECEIVED FOR OFFICE USE ONLY d ce Reive /� 5r�ia -� City of Tigard Received / /r= Permit Not a 13125 SW Hall Blvd., Tigard,OR 97223 MAR 2 7 2012 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit: TIGARD Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Juris: fa See Page 2 for Internet: www.tigard -or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK 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: Air conditioning Job site address: CO (b , 5(-AD 0. \l4Z_ -5� (requires site plan showing placement) 46.75 S ww ,,�� '' J Furnace 100,000 BTU (ducts/vents) 46.75 City/State /ZIP: \ � C� - `0�, 9 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work ‘ 23.32 '23 - 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 23.32 I ��`` Gas fireplace/insert 33.39 ?-.G � G (C.tfy+Z Z- fl.�ZaR w -- L Ci-a 5 �.-i44tc Flue vent for water heater or gas `��C \ N 4. { fireplace 23.32 �/ xA 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: Cc:i A_ V , (� ∎ A JC ,- ,T'fr�p Environmental exhaust and ventilation: Address: ( el 10 �� � Range hood/other kitchen C--) a It' ST , equipment 1 33.39 .�1 City/State /ZIP: � ( p t7_ 9 Z A -- Clothes dryer exhaust 33.39 � Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) partments, utili rooms 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawispace fans 23.32 Other: 23.32 Business name: - Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater E -mail: Fireplace Range CONTRACTOR Barbecue Business name: A ' Zg/ /4-40/4S Clothes dryer (gas) Other: Address: .510a $ 1 0 S cie/Ye 61 - MECHANICAL PERMIT FEES* City/State /ZIP: ag -/( (/ L 9 7 5:-,11- % Z I Subtotal 5( ' G Minimum permit fee ($90.00) 7 3.2°/ Phone: (S � 7 y 3 /,.Z Fax: ( ) _ Plan review (25% of permit fee) CCB lie.: G c A State surcharge (12% of permit fee) , go TOTAL PERMIT FEE 1 .. , 6§ Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: C L L�1. * •--,-- Date: .i , / L • Fee methodology set by Tri -County Building Industry Service Board I:\Building\Permits\MEC- PermitApp.doc 03/07/12 / 440.461 ( 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 $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • 1:\Building\Permits\MEC- PermitApp.doc 03/07/12 2 • MAY -18 -2012 02:59 FROM: TO: 5035981960 P.1'1 Plumbing Permit 1 :1 I,. ,; } Building Fixtures MAY 18 201 �y�s City of Tigar y�/ n 1+ A 2 7 2012 Receives Permit Nn.: gr� /'^^e,{�v y 1312 SW Ball DI 1 t tgatd�T6 7¢�dl� D0 Re Plan Review • ■ Phone: 503.718,�i BQII j,151 �$I i if OF T1G I dg Other Permit No Inspection Line: 1 75 ' I 1 <i Alt L) BUILDING DIVISION Daft RerKIYBY: brim Ia See Page 2 for Internet: www.tigard-or.gov Notified/Method: Su • !mental Information TYPE OF WORK FEE" SCHEDULE • ❑ New constriction ❑ Demolition For special itifuntutflan use checklist Description i . ' I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other New I- 2- family dwellings (includes 100 It, for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 C] 1. and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath -- 500.32 ❑ Accessury building ❑ Multi- family - • Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler t___ sq ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: T _ Job site address (01//-'t 5 0 to 4C S r Catch basin nr area drain 18.76 City/State/ZIP: i `/ t�� q • � Drywall. leach lino, or trench drain • 18.76 / Footi drain (no. lnear It.: _) Page 2 Suite/bldg./apt. no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear R: _) Page 2 Storm sewer (no. linear It: 1 Page 2 .. _ ._ .. ... Water service (no. linear L: _) _ Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Ractflm+r preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 • r -- z., t. -. -i • wa . Clothes washer 25,02 c f Dishwasher 25.02 � �S`�T F W`� CEP-- '" q e t 4(. - t � ( i? Drinking fountain 25.02 '70- . Ejectors/sump 25.02 , Q PROPERTY OWNER I ❑ TENANT . Expansion tank 12.51 Name: (("� / tom f ' Fixture/sewer cap 25.02 -i",,,,�� �w 6t - T •` " " � "`° ; Floor drain/floor sink /huh 25.02 ( Address: xPC\(0 .5 t.'.) c:041.Z.Syr. , Garbage disposal • ' 25.02 j 1 t]r�, C. iry /State/71P: '� 1 ‘. ..D p f` '1 1 .7.a• 3 Hose bib 2- 25.02 �,0,6 1'honc: (1j"b ra 4�/ C\- , 33 ? C) • Fax: ( ) Ice maker 1 I 12.51 G. ❑ APPLI CANT CI CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: S) Page 2 Primer 12.51 Contact name: ' .. Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 1 25.02 2...0 - City /State/ZIP: Solar units (potable water) 62.54 Phone: ( ) I Fax; ; ( ) Tub /shower /shower pan 12.51 E -mail: Urinal • 25.02 Water closet 25.02 CONTRACTOR ----r - - �/ 1 Water heater 37.52 Business name:) J� a N j_ ;o) p /4 . Water piping/DWV 56.29 Address: F5, 7 5 (. 5 •. Other. 25 02 Cit /State/Z1P: . f//C/ O it I 9 /? Subtotal r I /Phone: (r i)3 �.- 6- - 3D 0 Fax: (5 z ih _ 7334 D math.... permit fee. 572.50 �,, ` CC'R Lie.: 4.50 7 E Z6 �l/ B Plan review (25% of permit fee) ��`' Plumbing Lie no. State surcharge (12% of permit fee) . Authorized signaturrlt� � / /� TOTAL PERMIT FEE Print nturte: ��/ �j � v D ule� I This permit appli expires if a permit is not obtained within I90 days u G .r 40/Q 3F. l ofer tt has been accepted as complete. •Fen methodology sot by Tn•Couny Building Industry Service Rnnrd t: uildingWermitOPLMU.PermitApp doe 10!01!09 440- 4e16T(10/O icokuwEa) 05/18/2012 14:56 0• 7 :: POSTAL ANNEX 99 PAGE 01/01 Electrical Pemmttl : , • a . ! f COVED t, 1t cu. , It I; 1:!•4: O:. City ofTigald Y 18 2012 1RRIIIIIIIMIIIIII n nmttrl0. .4.----• / . ��i 13125 SW Hall Blvd-, Tigard.OR 97223 - AR 7 2012 '. ` Phone: 503.71 r r : . 7 '1' OP " -IGARD - . Other permit. I h C; ;\ li l i AMR ® See Page 2 Pot Mi ' ` �� P. = " . U VI I Dli`(GUIV SI4N rto6r Supplemental mforauta � .. TYPS•OF•.WORK .. • . ' . ' 0 New construction 0 Addition/alterationheplacement Please cheek an that apply (submit a ssm of plums w6tems checked below) p Service or fader 400 amps or more p i3mlding aver three stories. ❑ Demolition [J Other. wane the mailable fault current O Marinus and boatyards. ' CATEGORY OP CONSTRUCTION ' . aceeM 10,000 amps at 140 vcheer D Floating buildings. less to ghoond, or exceeds 14,000 D Onnoterelakere ag ❑ I - and 2- family dwelling ❑ Commercial/industrial El Accessory building amps air all other installations. buildings. ❑ Multi - family 0 Master builder © Other DNB pump. D Installation of 75 KYA or JOB 3rr INFORMKTION •AND LOCATION . . [IEmnBen system. larger separately :-3 system. [,7 Atkiih'an o of new motor load of © "A", "s", "I-2", "tea' ", . Job no.: !ob site eddies: ( p ( 6 t..... L sr oa 100HP or more. t !cadential mi 8„ p Recreational vemde parka `� © Iie zonloo a ca tluhm. D Supply voltage thr more than clty/State2iP: �( I �j,� .. /L �(� D Iitaasdoos lo« as 600 volts seminal. Suite/ bldg. /apt. no.: Project name: °Serviceorfeeder600 amps ea more. Cross street/directions to job site: onnfpn°a I ore. -1 fro} I Tor 1 • New residential single- or multi family dwelling nub. Includes sttseied garage. Subdivision: j Lot no.: 1,000 sq. tt or less 168.54 4 Ea, add'I 500 sq. ft. or portion 33.92 I Tax map/parcel no.: Limited enemy. residenal DESCRIPTION. OF WORK • . (with above 76.00 z Limited energy, multifamily 75.00 2 residential (with above sq. R) Servltes or feeders Insmilatlon alteration, and/or relocation 200 maps or len 100.70 2 • .. o PROPERTY OWNER • 1 Q TENANT 201 amts to 400 amps 133.56 2 Name: s w ' 401 rasps to 600 asps 200.34 2 8. 4. h v • ; e 601 amps to 1.000 amps 301.04 2 Address: c 1:5C.., t i_ j°,� i Over I,aa0 amps or volts 552.26 2 Temporary services or feeders i ts lti lndon, alteration, and/or City /State/ZIP: 0, Phone: ( ) Fax: ( ) 200 romps or less 59.36 I Owner installation: This installation is being made on property that l own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or =change, according to ORS 447; 449, 670, and 701. 401 amps to 599 amps 16834 2 Broads circuits Owner signature: _ , _ Date: A. Fee for branch circui m�� or extension, Qe yanel with A above service or (Ceder fee, E7 `PPI C I ' F ACT PERSON brands eitt uit 7.42 2 CON Business name: B. Fee for branch circuits wit/roar service or feeder fee, first I 56.18 q 1e 2 Contact name: Mend' circuit Each add') branch circuit 1 7.42 r...14- 2 Address: _ Miscellaneous (service or feeder not Included) - City/State/ZiP: Each a ma n r odul r r 67.64 2 Phone: ( ) Fax:: Reconnect poly 67.84 2 E -mail: Pwnp or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 CONTRAt,'I'OR . . Signal circuit or If energy Business name: e G . — ,- ovnel mtemr as orcdcmf — Page . 2 Each additional inversion over allowable In any of the above Address: 3 ► �t- _i Beaten. estaa inspection on (I is min 66.25/ hr I - City /State/ZIP: Investigation (L hr min) 66251 in lnde:Wel plant (1 hr min) 78.18/ hr VPhorm: (gem) Fax: ( ) r , l spntesy lis ted aspegions for which no fee b 90.00/ hr • r (K hr min) GCB Lie.: ( - 11 G ill Electrical Lie.: CI : r f n • , , _ Lic.: 4 l3I.EClll1CAL P£RA117[. F61�5. . i Subtotal: lob, I Suprv. Electrician signature, required: - _ _� ( b) l Plan rev (25 %ofpetmitf Print name: Q _ I . S , . _ _ . . o - Date: S 1 _, 2. State surcharge (Ins of permit Om): . Authorized signatuure: f 1/ �� TOTAL PERMLC FEE t �j9 . � This permit t ies taping If a permit is not obtained winds 160 A pr It has been accepted let crosplete. Print name: Date: • NumbE1 ;Mowed par permit o / �o /U III Building Division 6!/ 04- �� 0 Development Code Provision Review TIGARD Residential Projects Building Permit No: H iDT '. / ' i', ,r � � Q �� ;A CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ❑ o� lei P��j G �' Routed Plans: `' GW/ Original Plan Submittal Date: I I 1st Revision Submittal Date: ❑ Site Plan Only 2 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 onl if approved. • Planning Review (contact Y, STi $ e' _Y r a.i y at 503 -718- a V S Z or t r.>+i .Q, @tigard-or.gov Land Use Case Name fi I I t ' t tQ- 4 P. ❑ Zoning A I le S / 92) Q etbacks: Front o2-- Rear /5 Side S Street Side i$ Garage lik"Maximum Building Height 313 Actual Building Height U ID/Visual Clearance GI/Easements n, C"Sensitive Lands Type: I v_ Notes: Original Plan: Approved Not Approved ❑ Date: 3/261/1, Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (co tact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) Actual Slope: cyo Notes: Original Plan: Approved Not Approved ❑ Date: 1L Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 Citty fi r rist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) I . treet Trees 0 Protected Trees Notes: Original PP Pp al Plan: A roved Not Approved ❑ Date: 3 - 'd5- - 14 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 Applic t Revision 2: Date Sent to Ap cant Okay to Issue Permit Yes No ❑ , Date Routed to Building d • Page 2 of 2 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. City of Tigard Buildin g Division TIGARD TRANSMITTAL LETTER TO: .= "9 / ATELS 0/1 DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: c:7ket•-•(., MAY -8 2012 CITY OF TIGARD COMPANY: QQ c� BUILDING DIVISION PHONE: 5o) 9U l �c�. By:4W RE: (9/ 0 SA) D 6 s i A/Si aoia -000 6 0 (Site Address) (Permit Number) tSa7 c20 (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: I Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. 1/ Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. ✓ Engineer's calculations. Other (explain): REMARKS: /'E& /, r L / /a 7 OM FOR OFFICE USE ONLY Routed to Permit Techn s ician: Date: II (Z- Initials: Fees Due: ❑ Yes R Fee Description: Amount Due: $ Special Instructions: Reprint Permit (per PE): ❑ Yes I ❑ No ❑ Done Applicant Notified: Date: Initials: I:\Building\ Forms \TransmittalLetter- Revisions.doc 02/08/2011 REck.\\153 � ���� ppa 20 2012 �-� G D ,, Q �Clean Water Services File Number APR 1 6 2O12 ( � � CleanWater « ;� -� • ces ! - G � 6 B Ser'sitive Area Pre - Screening 7ri'L Site Assessment 1. Jurisdiction: v ( L ( i 2. Property Information (example 1 S234AB01400) 3. Owrr Info atlon Tex lot ID(s): Name: 't pJ Lev`v- S Company: Address: ��n? Site Address: (1 !O 6( QA k S City, State, Zip: City, State, Zip: 7i (j-,l tP Phone/Fax Nearest Cross Street PFl— E -Mall: 4. Development Activity (check all that apply) 6. Applicant Info i nflation 't Addition to Single Family Residence (rooms, deck, garage) Name: Info C G \n— la Lot Line AdJustment ❑ Minor Land Partition Company. ❑ Residential Condominium ❑ Commercial Condominium Address: S w ❑ Residential Subdivision ❑ Commercial Subdivision /-1 2 (3 Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip: �rvtiZi� Other Phone /Fax: Cc() ell t t E -Mail: . rA r2 ( v r47 #LU1ti- 6. Will the project Involve any off -site work? ❑ Yes No ❑ Unknown Location and description of off site work 7. Additional comments or Information that may be needed to understand your project This application does NOT replace Grading and Erosion Control Pemdts, Connection Permits, Building Permits, Site 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 Owner's authorized agent or representative, admowledges and agrees that employees of Clean Water Services 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 I am familiar with the In . I ation contained in this document, and to the best of my knowledge and belief, this information is true, complete, :1 accurate. Printllype am = C_ C w- w 0P....1 Print/Type Title Slgnatu :� z_- _ Date /ff 42 - FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A . SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or vnlhin 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 Pre-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, end federal law. Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive areas) found near the site. This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quallty 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 ❑ This Service •Provider Letter le not valid unless CWS approved site plan(s) are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 919/95 ORS 92.040(2). NO-SITE ASSESSMENT•OR SERVICE PROVIDE - , ETTER IS RE UI ED. !` Reviewed by / / V Date "i A 3 ,4 Z INV 25■0 SW 1 lillsboro Highway • Hillshnrn. Oregon 57123 • Phone: (503) 681 -5100 • Far.: (503) 681 -4439 • MN/ cleanwaterservices.org