Permit CITY OF TIGARD MASTER PERMIT
.
S • COMMUNITY DEVELOPMENT Permit #: MST2012 -00078
Date Issued: 06/05/2012
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S134BD07700
Jurisdiction: Tigard
Site address: 11675 SW PENN CT
Subdivision: PENN LAWN ESTATES Lot: 5
Project: Alder
Project Description: Addition of 355 square feet
BUILDING
Floor Areas Required Setbacks Required
Stones: 2 Bedrooms: 0 First: 128 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 310 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 438 sf Value: $45,516.96 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 0 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 100
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1
Heat Pump: N Hoods: 1 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvciFeeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add! 500 sf: 0 201-400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 3
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet
ADD SF VB R - 3 438
Owner: Contractor:
ALDER, MARK D AND CATHY L FULLY RESTORED INC Required Items and Reports (Conditions)
11675 SW PENN CT 11825 NW TUALATIN AVE
TIGARD, OR 97223 PORTLAND, OR 97229
PHONE: PHONE: 503 -816 -8881
FAX:
Total Fees: $1,670.56
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an. all other applicable la . All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, o if work is suspended f. more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent= . Those rules are -t forth in OAR
952 - 001 -0010 throug AR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5 r .232.198' or 1.800.332.2344.
Issued By: �/�� P ermittee Signature: /ir . .
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Application
Residential roR orrlcy list.: ()NI.,
,T7 I' ; ,, �' , , ��
City of Tigard Received ��a O 7�
,( _ - , Date/B • y Permit
.
III
• 13125 SW Hall Blvd., Tigard,OR 97221 - : Plan Review I � -- /3 ta
Phone: 503.718.2439 Fax: 503.598.1968 P a ]1 2 01 Date/B : 1 t/ • er Permit:
Inspection Line: 503.639.4175 „ Date Ready/By: Juris: ® See Page 2 for
TI (1 ARD p / y�.
Internet: www.tigard - or.gov Notifie. ethod: a Supplemental Information
TYPE OF • WORK _ — 4 .7 I tIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction 0 Demolition Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
I ii Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
It 1 -and 2-family dwelling Valuation: $ �( (.
y g ❑ Commercial/industrial
CI Accessory building ❑ Multi- family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2 .
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
lob site address: ((tv76 sit...) p _,, 60(.4z7 New dwelling area: ! � square feet
City/State /ZIP: 7�c_Azo Az. 9 7 Z Z 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: , 2_,.,,..,..,.,- ¢ �0.z. Covered porch area square feet 4 3 ( Q
Cross street/directions to job site: S� P,e � Ccx.41.7 4 //5 77-4 j gt,F Deck area: square feet f 2.6
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: / Qj equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
/ )� A 71ZbWrri --- G°( '.55 5 O
(.../Si Sr'A�� Existing building area square feet
New building area: square feet
V PROPERTY OWNER ❑ TENANT Number of stories:
Name: (-,-774 t / .t; /..1,4eziL At-,6E2 Type of construction:
Address: /(L1 ,e.4..) p C z4" Occupancy groups:
City /State /ZIP: -7,,.„,.,. i n62 w 7Z 7-3 Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: / 5 ^- 4 Lc_ review fe e (or r i t):
Structural plan review fee (or deposit):
Contact name: 1 35.61.- FLS plan review fee (if applicable):
Address: /*175 NC....? 7 0 1 „-- .,ol!{ ,/aC.,E ri-3 Total fees due upon application:
City /State /ZIP: A)o2_;7. /4 5 6SZ Q 7 ♦ '3 3 q
Amount received: f/6111 Phone: (3PJ�) 70Z - 9 /( e i lax:: (a3) L10/ /0 ell el
1 e Cv�o ,-1 c.-4- PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES"
E -mail:
rjagee,i o, eej , ,
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mo ed PhotoVoltaic Solar Panel System.
Business name: r� ; 84- 5 .7 ;?.. ��C Submit two (2) is of roof plan with connecti. • : ails
and fire departmen • ccess, along wi . 010 Oregon
Address: // j Z S 4-) -9-&"u Ave Solar Installation S,ec . C. • ecklist.
Permit Fee • - s • review
City/State /ZIP: Rfj,, j q Z-Zq (administrative s : $180.00
Phone: ( ,.,3) w ( ._ 5z$ / 1 Fax: ( ) . to surcharge (12% of permit fee): 6, $21.60
CCB lie.: /5(.06 L IS , ' \
Total fee due upon application: $201.60
Authorized signature: I This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: , IC—/ JAC7,' /4/l. /3 Date: d s� _ - /Z. " Fee methodology set by Tri County Building Industry
n
Service Board
I:\Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(I I /02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling FoR OI FIci; us': OiNI.l'
City of Tigard Received
11114 g Date/By:
No.:
n 1 3125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
G Phone: 503.718.2439 Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 ❑Electrical ❑Plumbing 0 Mechanical
r 1 c. n it D Internet: www.tigard - or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW W Yes 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 l
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 ' ❑ ❑ ❑
. _ ■ architecelicensed in Ore • on and shall be shown to be a..licable.to the . ro'ect under review:' ' • .
JURISDICTIONAL SPECIFICS
23 Three (3) "site plans are required for Item 1.1 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- RESPerrnitApp.doc 02/24/2011 440 -4613T(11 /02 /COM/WEB)
Mechanical Permit Application suit of i i cI': 11si. O,NI.1
City of Tigard Received RECEIVED LD eceived
Permit No.: r /�s a . -0,
q 13125 SW Hall Blvd., Tigard, OR 97223 Pat e R e: ,
0 . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639 i I D a t e R ea d y B y: kris: HI See Page 2 for .
Internet: www.tigard - or.gov J N 0 6 2 012 Notified/Method: Supplemental Information
CITY OF TIGARD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
TYPE OF willicniNin DIVISION Mechanical permit fees* are based on the value of the work
❑ New construction pi 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: V,, 01 six.) 1gv (, f- (requires site plan showing placement) 4.6.75
■ City/State/ZIP: Furnace 100,000 BTU (ducts/vents) 46.75
C\ prtr o 9 TZ.Z3 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: )1 I Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work Z 23.32 4.44-
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: I 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
Gas fireplace/insert 33.39
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: myth_ A Cis _ Environmental exhaust and ventilation:
Address: 1% (17 Sc. i P A C+ Range hood/other kitchen
equipment 33.39
City /State/ZIP: - lyit-020 O 4?..... 97223 Clothes dryer exhaust J 33.39 ,5 31
Single -duct exhaust (bathrooms,
Phone: (553),510 - 287 at Fax: ( ) toilet compartments, utility rooms) 23.32
lig APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
`' Other: 23.32
Business name:`•[ (2 1 klt._. Fuel r io
PP 1:•
Contact name: .?:::, tlL P -- $14.15 for first four, $4.03 for each additional
Address: , \ KILO 1VA -A kJ G as s h h ea t p
Gas pump •
City/ State/ZIP: Pcrr . 0i2 , co . 221 Wall /suspended/unit heater
Phone: (7 131 4., -. t Fax: : ( 5113 1 %as Water heater
Fireplace
E-mail: „co ` (1°r- ,,e A'j 3 @ G V (Aj , r CBGL(, Range
CONTRACTOR Barbecue
Business name: /�,� 11 Clothes dryer (gas)
/ r"(a , - ' et eon. ' Other:
Address: 1 .3'p iJ , A v l MECHANICAL PERMIT FEES*
City/ State/ZIP: 1 , 01 41 44.1 .0 6e. cm 2 41 Subtotal 80,
of permit fee)
Phone: (5 ) z [ - 0 I Fax: ( )
Minimum ew (25 permit fee ($90.00)
] Plan review /o
t?u' CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
I Print name: le 4 e . v I Date c. 4 (� I • Fee methodology set by Tri- County Building Industry Service Board
1ABuildinaWermitAMEC-PermitApp .doc 03/07/12 440-461Tr(I1/02/COM/WEB)
• Electrical Permit AnPIicatio C EJJED rOR OFFICE tJSl ONLY
Received 2] — 7}} Oco7 '
City of Tigard Date/By: Permit No.:�sTROIrX
114 . 13125 SW Hall Blvd., Tigard,OR 972231HN 0 4 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
TI GAItD
Internet: www.tigard or.gov CITYOFTIG Notified/Method: Supplemental Information
TYPE O DIU NG DIVISION
PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use - and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: /1C ( <J/' GT Six or or more residential R occupancy.
�p 7 7 �) � / . ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: / AJZ 0 (� 2 ❑ Health -care facilities. ❑ Supply voltage for more than
774 / 7 Z Z3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
h relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for 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: 1 Z . L \ _ e ) (∎ B. Fee for branch circuits without
service or feeder fee, first / 56.18 / 2
Contact name: .T3 kLk_ p0.6/...c.--r-r- branch circuit
Each add'I branch circuit ' 7.42 7 2
Address: \ VESZS ,--, 1 4 , A 1J Miscellaneous (service or feeder not included)
(� �'� Each manufactured or modular
City/State/ZIP: ty t" en/4 , dwelling, service and/or feeder 67.84 2
Phone: (5 l e ep,,p Fax : : (8%) - S 1 -.. ^ Reconnect only 67.84 2
_ �` '� ess Pump or irrigation circle 67.84 2
E -mail: ',,t..p 0 e, -? � 10,, -
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: d j7 eC// 2 GTn /C panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the abov
Address: /&o 76 W AJ/04 /7 S- Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (I hr min) 66.25/ hr
.a/r/4 O A 9 7007 Industrial plant (I hr min) 78.18 / hr
Phone: (Sal ) -79 7- O S o Fax: (spa) Inspections for which no fee is 90.00 / hr
specifically listed (%: hr min)
CCB Lic.:/76 (,/ Electrical Lic.: G 75 - Suprv. Lic.: / Z 7oS ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: // Subtotal:
/� �! i� Plan review (25% of permit fee):
Print name: �Obi.(i Kn. Date: .9. , z G / Z State surcharge (12% of permit fee):
VV TOTAL PERMIT FEE:
Authorized signature: j/ 1C 0�� ,E....4...-----.. This permit application expires if a permit is not obtained within 180
't/ D a t e: days after it has been accepted as complete.
Print name:
(, ) f i • pL f(� 6 . 4 . / N um be r o inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(II /05 /COM/WEB
Electrical Permit Application City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined • $75.00 •
Check Type of Work Involved:
❑ 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 - t
i•
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control* -
❑ Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling r
❑ Other
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doe 07/01/10
Plumbing Permit Application RECE _ _
Site Utilities FOR o F C E USE r o Ly
City of Tigard JUN 06 .' li vy: Permit No Sr ...000 Z1,
11 • 13125 SW Hall Blvd., Ti 97223 Plan Review ,i
C Phone: 503.718.2439 ax: 503.598.1 r.�; , _ :; Y Other Permit No.:
Inspection Line: 503.639. CITY OF T t ' !, '.. /By: taro see Page a for
r i c it D Internet www.tigard- or.gov BUILDING D I ,tyrr1,� . ethod: Supplanental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For spedal Information use checklist
_ Description I Qty. I En. 1 Total
4/ Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (t) bath 312.70
yli 1-
and 2- family dwelling ❑ Commercialindustrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building . ❑ Multi - family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other. Fite sprinkler ( sq. ft.) Page 2 •
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11 tP i7 $ J 'P�i) c+.
Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/ State/ZIP: - I" - , �( e "� . 1 223 Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt. no.: ` �f 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 ft: _J Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear S: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer .31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer t 25.02 2. b
Dishwasher j 25.02 .. r J 4,41,..- G
Drinking fountain 25.02 .
-
Ejectors/sump 25.02
rs PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Ad t- , 4 covri,44 A Floor drain/floor sink/hub - 25.02
Address: L 1 17 5 pfrCAn el _ Garbage disposal L 25.02 /h.a?i
City /State/ZIP: •�ci a 112 a j, ( 72Z 3 Hose bib - 25.02
Phone: (3 0/0 -- 2-811) Fax: ( ) Ice maker 12.51
Ei APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name:. ,�11 Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: E, i tt. . i ic - Roof drain (commercial) 12.51
Address: I w...5 Al 4-1-1 . 1J Sink/basin/lavatory 25.02 fp -Olt
City/ State/ZIP: P i t, Omit. • Solar units (potable water) 62.54
Phone: (e t>3) $1(r 8151:,.. I Fax:: (e66) 5I3 te,g5 Tub/shower /shower pan 12.51
p Urinal 25.02
E -mail: -FVLX-Nire q; 4P_. Ct14 A X. ` Water closet 25.02
CONTRACTOR Water heater 37.52
Business name:. ) P I�AMr ktt Diit/W • Waterpiping/DWV 56.29
Address: ' L L tL` ' i• J tt( - dck ee 44: j Other: 25.02
City/ State/ZIP: + )4614- tie -- 9t ]2G-C Subtotal I7. 1
Minimum permit fee: $7 $72.50
16/Phone: (�ti j ) - Fax: ) - ' S V 3 Plan review (25% of pe fee)
CCB Lic.: 94 65'5, ' lambing Lic. no.: a - Y-(/ 3 .. Pei o )
r
State surcharge (12% of permit fee) 5 ,�.
Authorized s' u : , ( / . � ! ( l l y TOTAL PERMIT FEE ( lam, 4
(� This it appikn e :pi if a permit is not obtained within 180 days
Print name: er4i -te ' �T � I ' / : Date: a . I perm a }�r tt has been accepted as complete.
4 A i *Fee methodology set by Td-County Building industry Service Board.
miMiiPaminAPIMU.Pami*■pp.doc 10/01/09 44o.4616T(I0r07./QOMIW®)
I • ° Building Division
Development Code Provision Review
r i c n R Residential Projects
Building Permit No: ' 5 T A 0/A — oce,7 O
CWS Service Provider Letter Received: Yes ❑ No F N/A ❑ ari401 ;—(:4; ^'"( Pas
��
Routed Plans: 1/73A2--
Original Plan Submittal Date:
Pt 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
It � 5�t -� �� trP w�Gh at 50 - 718 - LY L or i r i s f r -f. @tigard - or.gov)
Land Use Case No. — Name PGtin� �cS�a ( c�8�
17 Zoning 4 -y.S
l etbacks:
ront 2 Rear /s Side S Street Side / c° Gara e
aximum Building Height 3 a Actual Building Height 7-.
isual Clearance
Lid" Easements n
C� Sensitive Lands Type: /�
Notes:
Original Plan: Approved M' Not Approved ❑ Date: gin/ 1 7 —
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope: 4
Notes:
Original Plan: Approved Ji Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date: -4-2:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City // Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard - or.gov)
Q treet Trees
" Protected Trees
Notes:
Original Plan: Approved ' ' Not Approved ❑ Date: fl i 7 207).
Revision 1: Approved '❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applic
Okay to Issue Permit: Yes No ,❑ ,.: ',
Date Routed to Building: l/ /g/ii#
•
•
•
1
Page2of2
RECEIVED
Clean Water Services File Number
MAY 2 9 2012 12- 001013
C1eanWater\ Services
CITY OF TIGARD
FUILDINO DIVISION Sensitive Area Pre - Screening Site Assessment
1. Jurisdiction: Washington County
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: MARK AND CATHY ALDER
1S134BD07700 Company:
Address: 11675 SW PENN COURT
Site Address: 11675 SW PENN COURT City, State, Zip: TIGARD, OR 97223
City, State, Zip: TIGARD, OR 97223 Phone /Fax: (503) 590 -2874
Nearest Cross Street: SW 115TH AVE E -Mail:
4. Development Activity (check all that apply) 5. Applicant Information
51 Addition to Single Family Residence (rooms, deck, garage) Name: RICH BOYER
❑ Lot Line Adjustment ❑ Minor Land Partition Company: RIDGE ENGINEERING LLC
❑ Residential Condominium ❑ Commercial Condominium Address: 15475 NW PUMPKIN RIDGE RD
❑ Residential Subdivision ❑ Commercial Subdivision
❑ Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip: NORTH PLAINS, OR 97133
Other Phone/Fax: (503) 702 - 9169
E - Mall: ridgeengineering @coho.net
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 Permits, 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 and/or 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, acknowledges 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 information contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate.
Printl'lype Name RICH BOYER Print/Type Title PRESIDENT
ONLINE SUBMITTAL Date 5/3/2012
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 within 200 feet on adjacent properties, a Natural Resources Assessment Report
may also be required.
[2 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, and 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 area(s) found near the site. This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water
quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order
07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law_
❑ This Service Provider Letter is 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 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED. APPROVED
Reviewed by _ 4 7 Date ay Laurra Harris at 1:55 vm. /Amy 09, 2012 -
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • www.cleanwaterservices_org
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Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11675 SW PENN CT, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
04/23/2013 00:00
MST2012-00078
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11675 SW PENN CT, TIGARD, OR, 97223
Residential - Master Permit
399 Plumbing final
04/23/2013 00:00
MST2012-00078
PASS
George's corrections completed
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11675 SW PENN CT, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
04/24/2013 00:00
MST2012-00078
PASS - C of O
Violation Summary:
Inspector Contractor