Permit r
CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2004 -00230
� DEVELOPMENT SERVICES DATE ISSUED: 9/27/2004
" ��' I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09640 SW PIHAS ST PARCEL: 1S135CD-13900
SUBDIVISION: GREENBURG PINES ZONING: R - 4.5
BLOCK: LOT: 010 JURISDICTION: TIG
REMARKS: New SF.
BUILDING
REISSUE: MAS2230C STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,072 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,199 sf GARAGE: 676 sf FRONT: 17 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 Two- sf RIGHT: 5
VALUE: 228
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,271 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVOFDR: SIGN /OUT LIN LT: PER HOUR: .
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v. MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,724.25
VISTA NORTHWEST, INC VISTA NORTHWEST INC This permit is subject to the regulations contained in the
PO BOX 91459 PO BOX 91459 Tigard Municipal Code, State of OR. Specialty Codes
PORTLAND, OR 97291 PORTLAND„ OR 97291 and all other applicable laws. 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 the
work is suspended for more than 180 days.
Phone: 503 - 531 - 0505 Phone: 503 - 531 - 0505 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Rea 4: LIC 75507 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Rain drain Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp ' Roof Nailing Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Posh: _- -- - ctural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final
`
Is• ued By : ' ._ 0-:..,„_-4_..,?__.' ��• Permittee Signature
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
. ,,- e
Building Permit Applic Y FOR OFFICE USE ONLY
Cl of Tigard r Received N, _ / _ d/ 4. Permit No. r /
City g N � o DateB : a / � / 1,} 3 i,d 7 / •
13125 SW Hall Blvd., Tigard, OR 9 . `�, �. ��
Phone: 503.639.4171 Fax: 503. 0 �' ? / i,,5. m t t4 t \ Plan Review
Other Permit 0 y/ a 4 0
i►'' � .`\ �� 1�� I Date Ready
/13y: Date/B //A t.) � i�6 - 0 t t�
Inspection Line: 503.639.4175 4 �`3 ®� � Ready/13y: Jura: ® See Attached Checklist tor
Internet: www.ci.tigard.or.us ® / �, Notified/Method: Supplemental Information
4 A43
``�� v S)' {,2 7 / - 77 / ' TYPE 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.
nd 2- family dwelling ❑ Commercial/industrial Valuation: $
4/
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 2 ,....S
JOB SITE INFORMATION AND LOCATION -,F , ,, ., ", Total number of floors: 2
Job site address: L6 A/67, Szz / ,,27 A6, �/-- New dwelling area: zz 7/ square feet
City/State/ZIP: 7' - ,) Garage/carport area: A '�� square feet
Suite/bldg. /apt. no.: f Project name: Covered porch area: g �� square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision�7r, ! . /jv
//e s Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
' DESCRIPTION OF WORK work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
. ❑ 'PROPERTY OWNER - I ❑ TENANT Number of stories:
Name: /4 � �� - ���p Type of construction:
Address: / f��l // L 9/9's Occupancy groups:
/
City/State/ZIP: ----- " .... ,e x /i) g> f Existing:
y6
Phone: 3 ,... _-� S�� Fax: ( ) / / New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE' -
Business name: __2,. All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) • Fax:: ( )
E -mail:
CONTRACTOR '
Business name: .
4 c/� - 7(/,�,� BUILDING PERMIT FEES* ` -'
Address:
Please refer to fee schedule.
City/State/ZIP: Fees due upon application
Phone: ( ) Fax: ( )
�• (t!� �� Amount received
CCB lic.:
V Date received:
Authorized signature: '' This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 117, f L�4 gate: , _ * Fee methodology set by Tn -County Building Industry
Service Board.
i:\ Building \Permits\BUP- PcrmitApp.doc 12/03 440 I 1/02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
Ci}� an
of Tigard Received
`� g Date/13y: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 G�y
24- Hour Inspection Line: 503.639.4175 3 a�,h, ,�) I ❑ Electrical 0 Plumbing 0 Mechanical
Internet: www.ci.tigard.or.us ' " ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
1 1 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 applicable to the .ro under review.
JURISDICTIONAL SPECIFICS
23 Five (5) 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 tree protection measures as required by conditions 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 \One - Two - FamilyChecklist.doc 12/03
Mechanical Permit Application FOR OFFICE USE ONLY
Ti City of �® Received -� � n 5 � aZf , I
igard Da — //
( AD Permit No. V (� —�
13125 SW Hall Blvd., Tigard, OR 97223 ` Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 V //rid • i•, . •, 1 Date/By: Other Permit:
Inspection Line: 503.639.4175
Ins
P p� O� ■ r:!I I Date ed /Me Supplemental ��� See Page for
Internet: www.ci.tigard.or.us V \ A �`� Notified/Method: Supplemental l Information
. TYPK3F \ �Y \ , COMMERCIAL FEE* SCHEDULE' = USE CHECKLIST
+ - 0 New construction ❑ Additio a n Mechanical permit fees* are based on the value of the work
G ®` performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: # mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION TION . - , , : Value: $
;' ' , - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
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 or heat pump
Job site address:
9,(� 44,:, ,s�f�/j}� ��/ (requires site plan showing placement) 14.00
City/ State/ZIP: /��� !) Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivisio `�� / p Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF W ORK s - , - Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER: I ❑TENANT Other: 10.00
Other: 10.00
Name: 4 �� _ /1J J Environmental exhaust and ventilation
Address: �/ � Range hood/other kitchen
/5 . X > /,- - equipment 10.00
City/ State/ZIP: ���j Lev f' p ' Clothes dryer exhaust 10.00
� Single -duct exhaust (bathrooms,
Phone: ,JJ „5 QS ' -2. Fax: ( ) toilet compartments, utility rooms) 6.80
- ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
•
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
- • CONTRACTOR Barbecue
Business name: c Y��� Clothes dryer (gas)
L� / Other:
Address: MECHANICAL PERMIT FEES* '
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
-" r— TOTAL PERMIT FEE ,
Authorized signature: This permit application expires if a permit is not obtained within 180
�re: days after it has been accepted as complete.
��- Print name: o � �S ..... Date: I • Fee meth odology set by Tri- County Building Industry Service Board
is\ Bui [ding \PermittVlEC- PermitApp.doc 12/03 44046I7T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
. Total Valuation:' Permit Fee: .
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\ Building \Permits\MEC- PermitApp.doc 12/03 2
Electrical Permit Ap lication FOR OFFICE USE ONLY
Received //''c
4<)) DateBy: y: Perm Perm N it o� ��QV 'I Q[�,3
Cl of Ti and Planning Approval Sign
tY g Date/By: Permit No.:
13125 SW Hall Blvd. G 0 k Plan Review Other
Tigard, Oregon 97223 G r�0 Date/By: Permit No.:
Post - Review Land Use
Phone: 503 -639 -4171 . 503- St��'19¢��.Q i a,, :u:ti��, I r� Date/By: Case No.:
Internet: www.ci.tigar o
r.us -' \ , A . a r.41
Contact Juris.: El Page 2 for
24 -hour Inspection Request: 501 3 6 Name/Method: Supplemental Information.
G\ �
TYPE O PLAN REVIEW (Please check all that apply) .
,❑ N construction ❑Demolition
❑ Service over 225 amps- ❑ Health -care facility
commercial 0 Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
XI& 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: Ass #7:4 .S?' FEE* SCHEDULE
Suite #: IM Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total I
Cross street/Directions to job site: New residential-single gunit. nc d or multi-family per j
.l dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Lot #: Limited energy, residential 75.00 2
SUbd1V1S10
+ z,v s I /0 Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
ROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name 1/ A4 Reconnect only 66.85 2
Address: )30'� 7 / lJ-/, ? Temporary services or feeders - installation,
ty p: * i) . 9 alteration, 00 mps o l e relocation:
City/State/Zip: 200 amps or less 66.85 1
Phone: c.TY-0:6— Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT I 0 PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: ,. —Ul Signal circuit(s) or a limited energy panel,
Description:
ion extension Page 2 2
Business Name:
�� Description:
Address: ,237'c _SiJ 2 ?A 4 4
City /State /Zip: .. - " - . l Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone:, '7 ; 2 :? ) Fax: Investigation fee:
Other:
CCB Lic. #: ,Lic. #: �Q� rj Electrical Permit Fees*
Supervising electricia /�, Subtotal $
si 1 attire re • uired: J g f / � _ _ --� �.. Plan Review (25% of Permit Fee) $
Print Name: Lic. #: , State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: Notice: This permit application expires if a permit is not obtained within
Signature: Date days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Fotms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
▪ Audio and Stereo Systems
Burglar Alarm
Garage Door Opener
O Heating, Ventilation and Air Conditioning System
O Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
0 Clock Systems
El Data Telecommunication Installation
Ei Fire Alarm Installation
HVAC
❑ Instrumentation
D Intercom and Paging Systems
• Landscape Irrigation Control
0 Medical
0 Nurse Calls
El Outdoor Landscape Lighting
0 Protective Signaling
❑ Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
liuilamg r fixtures
P lumbing Permit A Received FOR OFFICE USE ONLY
fi eceived Plumbing
!' Date/By: Permit No. t202 -.94.4? 6
City of Tigard �`(/ Planning Approval Sewer
Date/By: Permit No.:
13125 SW Hall Blvd. G� � �w Plan Review Other
Tigard, Oregon 97223 v ® Datel9y: Permit No.:
Phone: 503 - 639 -417 50 � 1 eview
Date /B
�A� /�� y: Land Use
`` �. ' +�
ate/By: Case No.:
Internet: www.ci.tiga .onus v q � � - a s�i► , i I Contact Juris.: ® See Page 2 for
24 - hour Inspecti Request: 5 C 4 - Name/Method: Supplemental Information.
TYPE OI± FEE* SCHEDULE (for special information use checklist) , ; .. -
N ew construction ❑ Demolition Description . .1 Qty. 1 Fee(ea.) ' Total
❑ Addition/alteration/replacement , ❑ Other: New 1- & 2- family dwellings
CATEGORY OF C CONSTRUCTION (includes 100 ft. for each utility connection)
dwelling Commercial/Industrial SFR (I) bath 249.20
1 & 2-Family g ❑ SFR (2) bath 350.00
DAccessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: !_,,, , g - 4 ,;,,,. . --,,.e "F!' Site Utilities
Suite #: - 4 d Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: 4 5 7 � Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) • Page 2
SubdiviSion �lf i t-.#t4 Lot #: ,O Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
-
DESCRIPTION OF WORK Fixture or Item
Absorption valve 16.60
i, I� L % '���� Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I El TENANT Drinking fountain 16.60
El PROPERTY 16.60
Name: / /,S 7-7,0- ,/ /42 Expansion tank 16.60
Address: ___, geg=2;K 9/4/5-9 Fixture/sewer cap 16.60
City /State /Zip: ,k?e.T ~ 9'9_2.9/ Floor drain /floor sink/hub 16.60
Garbage disposal • 16.60
Phone: t j� /-- Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City/State/Zip: Primer 16.60
p Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower. pan 16.60
CONTRACTOR Urinal 16.60
Business Name ' __,/ey ' 4 d Water closet
ea e 16.60
Water heater 16.60
Address: ,Z3,-51J i J/, Aj" Other:
City /State /Zip: j aL -`¢.4- 7. Other:
Phone• 3 f Fax: Plumbing Permit Fees*
3 per!
CCB Lic. #/ , Plumb. Lic. #: y,�r' Subtotal $
Minimum Permit Fee $72.55 0 $
Authorized / -
'' __-_ /, Residential Backflow Minimum Fee $36.25
Signature: /� Date: J��� Permit Plan Review (25% of Peit Fee) $
!Q >��L , j'- of���� /� State Surcharge (8% of Permit Fee) $
v (Please print name) TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri - County Building Industry Service Board.
i:\Dsts\Permit Forms \PlmPermitApp.doc 01/03
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' 55.00 0 to • $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 - $220.00
Sewer - 1st 100' 55.0 7,201 and greater $309.00
Sewer - each additional 100' 46.40 '
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation: Permit Fee: •
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixture s could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash •
Floor Drain/sink - 2"
-3 "
-4"
Car Wash Drain *Note: If the fixture work under this ermit results in an
Garbage - Domestic p
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice MachiRefrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i : \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
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• • 120 DAYS = 11/25/2004
SECTION I. APPLICATION SUMMARY
FILE NAME: GREENBURG PINES FRONT YARD SETBACK ADJUSTMENT
CASE NO.: Adjustment (VAR) -' . ' ! . ' -' 7: VAR2004 -00064
PROPOSAL: The applicant has requested a 15% adjustment to the front yard setback to
reduce the setback from 20 feet to 17 on Lot 10 of the Greenburg Pines
Subdivision (SUB2001- 00003) feet to accommodate construction.
APPLICANT/ .
OWNER: Vista Northwest, Inc.
Attn: Chris Christensen
PO Box 91459 .
Portland, OR 97291
LOCATION: 9640 SW Pihas, Street; WGTM 1'S135CD, Tax- Lot 13900 (Lot 10 of the
Greenburg Pines Subdivision). - •
COMPREHENSIVE
PLAN .
DESIGNATION: R-4.5, Low Density Residential. . . ' •
ZONING "
DESIGNATION: R-4.5: Low - Density Residential District. The R-4.5 zoning district is
designed to accommodate detached single - family homes with or without
• • accessory residential units at a minimum lot size of 7,500 square feet.
Duplexes and attached single- family units 'are permitted conditionally:
' Some civic and institutional uses'are also permitted conditionally.
APPLICABLE
REVIEW , • .
CRITERIA: Community Development Code Chapters 18.370, 18.390'and
SECTION II. DECISION • AUG 11 10
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VAR2004 -00064 -SETBACK ADJUSTMENT ■ .. • . • PAGE 1 OF 3
NOTICE OF TYPE I DECISION
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1. All construction must be completed in compliance with the conditions of approval of the
Greenburg Pines Subdivision (SUB2001- 00003). :
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SECTION III. BACKGROUND INFORMATION
Site Information and Proposal Description: • i
The property is bordered on all sides by single - family residences. The proposal is to intrude
into the 20 -foot front yard setback by 3 feet to accommodate, a porch, The garage,setback
would remain at 20 feet.
SECTION IV. APPLICABLE REVIEW CRITERIA AND FINDINGS
COMPLIANCE WITH COMMUNITY DEVELOPMENT CODE SECTIONS:
Tigard Development Code Section 18.370 allows • the following development
Adjustments by means of a Type I procedure: t . , } �
Front yard setbacks. Up to a 25% reduction of the dirr>lensional standards for the front
yard setback required in the base zone. S of, garages may not be reduced by
this provision.
.
Interior setbacks. Up to a 20% reduction of the dimensional standards for the side,and
rear yard setbacks required in the base zone. : ,,; i. • i
Lot coverage. Up to 5% increase of the maximum lot coverage required in the base
zone.
The applicant has requested an Adjustment to, ; reduce the front yard, setback by 3 feet to
allow the placement of the house. The face of the garage setback will remain at 20 feet. The
required front yard setback ,is, 20 feet,, therefore, up to a•5- foot,reduction of this setback may
be allowed provided the following criteria are addressed.
A development Adjustment shall be granted if there is a demonstration of compliance
with all of the applicable standards:, . , - )
A demonstration that the Adjustment requested is the least required to achieve the
desired affect; _ ,
d
The adjustment is being requested to allow a portion of the structure, specifically a porch to
protrude into the front yard setback. According to the site plan the,3- foot.adjustment is the I
minimum relief required to allow placement of the porch,'while majntainrng, all other setbacks:
The Adjustment will result in the preservation of trees, if trees 'are :present' in the
development area;
VAR2004 -00064 -SETBACK ADJUSTMENT , , , , ., - PAGE 2 OF 3
NOTICE OF TYPE I DECISION
The applicant is preserving the trees in the rear of the lot. The adjustment would increase the -
distance between the building foundation and the tree's critical root zones:, By moving the
house footprint forward, the construction will have less adverse impact on the preserved
trees.
The Adjustment will not impede adequate emergency access to the site;. •,
Adjusting the front yard setback will not reduce clearance :around the house; therefore the
Adjustment will not impede emergency access. Emergency servic*an still access this
dwelling and adjacent dwellings. �� ' .' ' • -,�;..
•
There is not a reasonable alternative to the Adjustment which achieves the desired
affect.
Because of the size of the home, the shape of this lot, and the preservation of trees there are
no other reasonable alternatives to the placement of the home, that would achieve the desired
affect.
FINDING: Based on the analysis above, the adjustment criteria have been satisfied.
SECTION V. . PROCEDURE AND APPEAL INFORMATION
Notice: .0.
Notice was mailed to the applicant and owners.
Final Decision: • •
A setback Adjustment is a Type I procedure. As such, the Director's decision is final on the
date it is mailed or•otherwise provided to the applicant, whichever occurs first. The Director's
decision may not be appealed locally and is the final decision of the City'.
THIS DECISION IS FINAL ON AUGUST•6, 2004 • • -'
AND BECOMES EFFECTIVE ON AUGUST 7, 2004. ,
Questions: . •
If you have any questions, please call the City of Tigard Planning Division, Tigard City Hall,
13125 SW Half Boulevard, Tigard, Oregon at (503) 639 -4171.
• Fjz jaA
August DATA` 2004
PREPARED BY: 1Cristie Peerman
Planning Technician
•
•
•
•
VAR2004-00064 -SETBACK ADJUSTMENT PAGE 3 OF 3
NOTICE OF TYPE I DECISION
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BUILDING PERMIT NO.: /'95; a ,np if- -co 23e
PLANNING DIVISION: •
Required SetbAcks: Approved ❑ Not Approved
Side: .7 St eet Side: /
Front. ? Garage: 2Z Rear
Visual Clearance: V. Approved ❑ Not Approved
Maximum Building Height30 feet
CWS S 'c rovider Letter Required: ❑ Ye` , No
❑ {Z Ji c� •
B _ , Date: 3 l 7 (15
EN NEER G DEPARTMENT: I
Actual Slope:_% approved ❑ Not Approved
Site a Approved 7 Not Approved
By: cl� L7 . �` --- Date: - _
Notes:
I '
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00230
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2004
Phone: (503) 639 -4171 i�iu,��a,�41i$, 'llrI �
Inspection Requests (24 Hrs.): (503) 639 -4175 `
INSPECTION WORKSHEET FOR DATE: 4/1/2005 TIME: 7:10AM PAGE: 91
SITE ADDRESS: 09640 SW PIHAS ST CLASS OF WORK:
SUBDIVISION: GREENBURG PINES LOT #: 010 TYPE OF USE:
PROJECT NAME: GREENBURG PINES
DESCRIPTION: New SF.
OWNER: VISTA NORTHWEST, INC, PHONE #: 603 -531 -0506
CONTRACTOR: VISTA NORTHWEST INC PHONE #: 503-531 -0505
Inspection Request Scheduled For: Date: 4/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 003460-01 503720 -6239 Y
Corrections/Comments/Instructions:
j i��d (- ►A IZ'C-
cry
❑ PASS ) / PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL NI CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspecto : �. Date: Phone #: (503) 718-
/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00230
13125 SW Hall Blvd., Tigard, OR 97223 DAT ISSUED: 9/27/2004
Phone: (503) 639 -4171 a ,�,� „�� Al. Inspection Requests (24 Hrs.): (503) 639 -4175 _.
INSPECTION WORKSHEET FOR DATE: 3/31/2005 TIME: 7:05AM PAGE: 22
SITE ADDRESS: 09640 SW PIHAS ST CLASS OF WORK:
SUBDIVISION: GREENBURG PINES LOT #: 010 TYPE OF USE:
PROJECT NAME: GREENBURG PINES
DESCRIPTION: New SF.
OWNER: VISTA NORTHWEST, INC, PHONE #: 503 -531 -0505
CONTRACTOR: VISTA NORTHWEST INC PHONE #: 503 -531- 0505
Inspection Request Scheduled For: Date: 3/31/2005 Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 003374 -01 503 - 642 -2800 N
Corrections /Comments /Instructions:
K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 Date — �( Phone #: (503) 718-
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 Q 0 (- 'Oo z 3
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ` ° AM PM BUP
Location k.) Suite MEC
Contact Person Ph ( ) _ 7a
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation -44.i�✓ ,�
h-C' Ip v Te ✓,�-� s �-� ��) .fi. o✓ (.o�w�c -�
Drywall Nailing
Firewall
Fire Sprinkler souk l.s c ✓ T ° �-' e. ✓
Fire Alarm
Susp'd Ceiling
Roof So 4i l.. : Cam,.,, &j 0 ;rt. 'Q� �.�.� - 112 d �� rJb✓
Other:
Final p A-fi P Ize ✓T ,,i vv - r1_.
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab w ry � � f �../e tx 41r P 1 L 1 ,0 Ou't
Rough -In
Catch Basin / Manhole
S o Pan
Other: -
Fin. Ll•- d,Licw4./J9•aw,
PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date ) O 17 I ) D' Inspector rrb I \ l) Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
1
' CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00230
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2004
Phone: (503) 639 -4171
Alto '41 i i
Inspection Requests (24 Hrs.): (503) 639 -4175 ,�..J — "__..
INSPECTION WORKSHEET FOR DATE: 4/4/2005 TIME: 7:11AM PAGE: 16
SITE ADDRESS: 09640 SW PIHAS ST CLASS OF WORK:
SUBDIVISION: GREENBURG PINES LOT #: 010 TYPE OF USE:
PROJECT NAME: GREENBURG PINES
DESCRIPTION: New SF.
OWNER: VISTA NORTHWEST, INC, PHONE #: 503- 531 -0505
CONTRACTOR: VISTA NORTHWEST INC PHONE #: 503-531-0505
Inspection Request Scheduled For: Date: 4/4/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 003641 -01 503 - 720 -6239 Y
Corrections /Comments/ Instructions:
U S 1, °
'.--- ci
, Lep
K pASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
17- ng Inspector: Date: / 1/ 4 —(7
Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00230
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/27/2004
Phone: (503) 639 -4171 !al l Inspection Requests (24 Hrs.): (503) 639 -4175 _..
INSPECTION WORKSHEET FOR DATE: 4/5/2005 TIME: 7:09AM PAGE: 20
SITE ADDRESS: 09640 SW PIHAS ST CLASS OF WORK:
SUBDIVISION: GREENBURG PINES LOT #: 010 TYPE OF USE:
PROJECT NAME: GREENBURG PINES
DESCRIPTION: New SF.
OWNER: VISTA NORTHWEST, INC, • PHONE #: 503- 531 -0505
CONTRACTOR: VISTA NORTHWEST INC - PHONE #: 503 531 - 0505
Inspection Request Scheduled For: Date: 4/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 003746 -01 503 - 720 -6239 Y
Corrections/Comments/Instructions:
(JSA (7K0&i0.1 V
i KEG 1 ikEE CCU L`
) A I lam- r () A G 14 / S / l..//4- lC Al S 1 ° e - e G 7) 4.
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1AFAIL w CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
l i- —I 0
Ins ector: Date: hone
h. #: (503) 718
�
p � )
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00230
13125 1:3W Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/27/2004
Phone: (503) 639 -4171 u O4,��gp li
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_.. ■
INSPECTION WORKSHEET FOR DATE: 4/14/2005 TIME: 7:10AM PAGE: 75
SITE ADDRESS: 09640 SW PIHAS ST CLASS OF WORK:
SUBDIVISION: GREENBURG PINES LOT #: 010 TYPE OF USE:
PROJECT NAME: GREENBURG PINES
DESCRIPTION: New SF.
OWNER: VISTA NORTHWEST, INC, PHONE #: 503 - 531 -0505
CONTRACTOR: VISTA NORTHWEST INC PHONE #: 503 -531 -0505
Inspection Request Scheduled For: Date: 4/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 004440 -01 503 - 720-6239 Y
Corrections /Comments /Instructions:
1 ' -6 ._7 - c --/-/ - ej //. S 5 ---- - C_____ ) _.-,sei 6 - CS )
40
A A: bo
II IPIPIIr
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL %, , FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: __ Date: y /cne #: (503) 718-
.