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Permit v CITY OF TIGARD MASTER PERMIT 11111 Is COMMUNITY DEVELOPMENT I Permit#: MST2012 -00139 T I GARD 13125 SW Hall Blvd.. Tigard OR 97223 503.718.2439 Date Issued: 07/02/2012 . ®� Parcel: 1 S 136AD04500 Jurisdiction: Tigard Site address: 6715 SW PINE ST Subdivision: VILLA RIDGE Lot: 2 Project: Petersen Project Description: 513 square foot addition. 8/21/12, adding additional plumbing fixtures. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 513 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 513 sf Value: $30,780.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs /Showers: 2 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: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 ' Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 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: 2 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 Ecom asin N Other: N Other Description: P g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 513 Owner: Contractor: PETERSEN, OVE & LORA LEE SCANDINAVIAN GENERAL CONTRACTING Required Items and Reports (Conditions) 7608 SW PINE ST 7608 SW PINE ST 1 Ersn Cntrl 503 - 639 -4175 PORTLAND, OR 97223 TIGARD, OR 97223 PHONE: 503- 452 -9457 PHONE: 503 - 452 -9457 FAX: 503- 452 -9457 Total Fees: $2,032.83 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in a with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. NTION: Orego aw require ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0 -0010 t - ough OAR 952 - 081 -00• - . Yo may obtain a copy of the rules or direct questions to OUNC by call...? .. . .1987 or 1.800.332.Q44. . Issu By: A.- = _ /._ / _ , era I • Permittee Signatur ` .&_/ i ',..• _! _ Call 503.838.4176 by 7:00 a.m. for the next available Inspec / / This permit card shall be kept in a conspicuous place on the job site until compl = • of the project. Approved plans are required on the Job site at the time of each Inspection. CITY OF TIGARD MASTER PERMIT 11 1- a CO MMUNITY DEVELOPMENT Pe rmit #: MST2012 -00139 • T (<3 A.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2012 Parcel: 1 S136AD04500 Jurisdiction: Tigard Site address: 6715 SW PINE ST Subdivision: VILLA RIDGE Lot: 2 Project: Petersen Project Description: 513 square foot addition BUILDING Floor Areas Required Setbacks 1 Stories: 1 Bedrooms: 1 First: 513 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 513 sf Value: $30,780.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add] 500 sf: 0 201 -400 amp: 0 201 -400 amp. 0 W/O Svc/Fdr: 2 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 - 3 513 Owner: Contractor: PETERSEN, OVE & LORA LEE SCANDINAVIAN GENERAL CONTRACTING Required Items and Reports (Conditions) 7608 SW PINE ST 7608 SW PINE ST 1 Ersn Cntrl 503 - 639 -4175 PORTLAND, OR 97223 TIGARD, OR 97223 PHONE: 503 -452 -9457 PHONE: 503 -452 -9457 FAX: 503 -452 -9457 Total Fees: $1,850.69 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in a • with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. A ' NTION: Ore• • • law - quires you to follow the rules adopted by the Oregon Utility Notification Ce ter. T • = rules are set forth in OAR 952 -00 -0010 through OAR 95::11 -0r• ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232 :7 or . :00.3 2.2344. Issu -d By: — 4 / " " / Permittee Signature: _ , %�.41 td. 4 Call 503.639.4175 by 7:00 a.m. for the next available inspectio 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. .. _ . 1 Building Permit Application Residential rit r �i i - � FOR OFFICE USE ONLY x' . City of Tigard ' Date /B 0 NANI �g PermitNo.: /a ea/ 1 14 ° 13125 SW Hall Blvd., Tigard, OR 9722 II �p Plan Review ► ~� _ ` • Phone: 503.718.2439 Fax: 503.598.1960 N �+ 0 2��2 DateB : ���( ��� ' er Permit T1GA}:D Inspection Line: 503.639.4175 Date Rea. ;y: tuns: H See Paget for Internet: www.tigard - or.gov CITY OF TIGi F D Notified/Me,hod: Supplemental Information BUILDING O Vt3ION 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: $ 30 7 gp .00 I, 1- and 2- family dwelling ❑ Commercial /industrial J El Accessory building El Multi-family Number of bedrooms: i ID Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: (' 7/ S SI) PJ n.e, Si--... New dwelling area: 5' 3 square feet City /State /ZIP: T1 C €3.1rd 0 223 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: J Dcck arca: square feet 7 / S t 4o QA) Fl 1 Sf • 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. . � d t i 0 i o Kt 1 l Q Q Valuation: $ a� -n 7� Existing building area: square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: 0 V PQ.,jeq .-e-4,t Type of construction: Address: 76 0 % Sid.) P114J S4 - Occupancy groups: City /State /ZIP: _i 1 C C4Y 042 n 7 22-7 Existing: Phone: 6O;) li S Z q (s--7 Fax: COI ) tic 2 -9t' ) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) Structural plan review fee (or deposit): Contact name: FLS plan review fee (if applicable): Address: City/State /ZIP: Total fees due upon application: Phone: ( ) Fax:: ( ) Amount received: '33 • 'GS E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof -top mounted PhotoVoltaic Solar Panel System. Business name: geo..4 � t ✓-AA/ -ei" & ,vue.4' a."( t_ryCl — V0 , 4f I 61 Submit o (2) sets of roof plan with connection detail S PI �u S f - and fire dep..- I ent access, along with the 2010 S - :on �b 0 Address: 8 I Solar Installation _ . • laity Code checkl . City/State /ZIP: 7/ 9 01_ ypt o 0 77 22.3 Permit Fee (inclui • • an r• '-w $180.00 and adminis . • • fees): Phone: &p3) S Z ' of tf S Fax: (SO 3) y SZ ..1,15-7 State surcharge /o of permit e- • $21.60 CCB lic.: 3' O Li (o 0* IL' Authorized signature: T. . fee due upon application: $201.60 T his permit application expires if a permit is no obtained Q within 180 days after it has been accepted as complete. Print name: a / e PcTGxce_4 Date: 6 ft 5// Z • Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(I I /02 /COM/WEB) •Pldmling Permit Application r T n% i •S, Building Fixtures n ', ,„ ! 4 - - -.. FOR OFFICE USE ONLY City of Tigard JUN 2 0 2012 Received / 910 / • A Permit No.e eL Date/By: (Q Ar/ CD,* Permit v 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review 1 0 Phone: 503.718.2439 Fax: 503.598.1960 po r c 1 - i f t Date/By: Other Permit No.: Inspection Line: 503.639.4175 ° r � `" T I G A R D p! pI + ";;. Date ReadyBy: kris: la See Page 2 for Internet: www.tigard- or.gov Q�t� NC1 ? th °ia ;� Notifie Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 lig 1- and 2- family dwelling ❑ Comercial/mdustrial SFR (2) bath 437.78 m SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ( S (-1 PI Oh ST`. Catch basin or area drain 18.76 • City/State /ZIP: j ) 4 rd 0 Q 97 Z7.-3 Drywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: S IA) 7 /, 1 S 40 S 1.4) rl kL.0 S -. Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 r II t Clothes washer 25.02 p�old r ri n 40 (?..-)C 1S 4-'I 45 61 60,-._ Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: ©%) Q, RA -c...)/ l Fixture /sewer cap 25.02 Address: 7 ( d) S t.�) ?l S Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State /ZIP: T) )A al 0 12. 97223 Hose bib 25.02 Phone: 6a3) '- Z - 9' I c 7 Fax: ((o3) Lt c Z' 9 Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory Z, 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 1 12.51 E -mail: Urinal 25.02 CONTRACTOR Water closet I 25.02 Water heater 37.52 Business name: De,/ 4o Pi K 144 6l vt Water piping/DWV 56.29 Address: 1 IAA S SG ( 0W is Rift . Other: 25.02 City/State /ZIP: Ra3 O 7 V0.41 O j (et/ Subtotal Phone: (SC75) (9i - 7342 Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: 1 ic Z- $ #C 6/941/(1 Plumbing Lic. no.: PB -- Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: p,�7 TOTAL PERMIT FEE Print name: Zat 1R t✓t"td--• Date: ( Ltt °� 12/ This permit application tapires if a permit is not obtained within 180 days after it has been accepted as co mplete. *Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440.4616T(10 /02/COM/WEB) 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' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $ 1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to Inspection of existing plumbing or for and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath - Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918 -780 -0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. -3" Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram buildings is required for new buildin Garbage - Domestic -non -food q g Disposal - Domestic -food related that meet the qualifications above. - Commercial-food related - Industrial -food related Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink/Lav - Non -food related _ - Bradley - Commercial -food related - Service • Swimming Pool Filter *Note: If the fixture under this permit results in an Washer - Clothes - ure wor uner p Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: I:\Building\Permits\PLMF- PermitApp.doc 02/24/2011 2 Mechahical Permit Application r i i r � i roi Dirk: us, :. ONLY „ .q City of Tigard ` � Date/By: : ( a'b ./ Permit No." 7 r /2_ /39 :11 y 13125 SW Hall Blvd., Tigard, OR 97223 JUN 2 0 2012 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit: TI G n R D Inspection Line: 503.639 /� / w r� Date ReadyBy: Juris' RI See Page 2 for Internet: www.tigard - or.gov CITY O � I G I . 11 Notified/Method: Supplemental Information BUILDINC,� +Vi TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction 114 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* 0 21- 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: (` L Air conditioning Job site address: 6 f '3‘. pl „ J 1 , (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts/vents) i 46.75 City/State /ZIP: I el a t/d 0 R /n� ` C 7 2 23 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: S(i *-- ( S io s 0 rl S� Duct work t 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: 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 addadd( Gas fireplace 33.39 ( rt o Td We fSt t 4 0 vdl t_ 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 la PROPERTY OWNER ID TENANT Chimney/liner/flue/vent 23.32 Other: 23.32 Name: 0 y Q Pe, e,w Environmental exhaust and ventilation: Address: -7 60 g $ LAI 01 ✓u, S t • Range hood/other kitchen equipment 33.39 City/State /ZIP: l c, v02 012 3 7 7.-7i3 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (G'�.cf3) Z -9 457 Fax: (St 3) ( -K2- c1'4 ) toilet compartments, utility rooms) I 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Other: 23.32 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 P E -mail: Fireplace Range I CONTRACTOR Barbecue Business name: S if Ft tet i 1 -q 3,t. Clothes dryer (gas) Address: 21 SG $- / 7 7 A-v■e- Other: MECHANICAL PERMIT FEES* City /State /ZIP: Pay- f( a wog 0 2 ( 472 , 35 Subtotal Phone: (5 d Ci 1(41 - fa S C ' Fax: ( ) Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB lic.: I q q $ C t State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature: • � ' This permit application expires if a permit is not obtained within 180 . , t days after it has been accepted as complete. Print name: ID lyw robs (i2 Date: b / l/ /7014? * Fee methodology set by Tri -County Building Industry Service Board t:\ Building \P \ ermitsMEC- Permiu pp.doc 09/09/10 4404617 , 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 09/09/10 2 Electp. ical Permit Application FOR OFFICI-. USE ONLY City of Tigard I '� A edeived i. h: c ', 8 .r at8/Byt vv �� Permit No.: mT/J0;�^ c o/ 13125 SW Hall Blvd., Tigard,OR 97223 ` '" q Plah Review Ili C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: I I G A K D Inspection Line: 503.639.4175 JUN 2 0 201'i Date Ready/By: Saris: EI See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information TYPE OF WORK CITY OF rIG t '?r; PLAN REVIEW ❑ New construction 4ddition / alteratio �91 I r r , V ' ,, Please check all that apply (submit 2 sets of plans w /items checked below): Y; ❑ 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 agricultural it 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ 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 - ", "I - ", Job no.: Job site address: 6 S (A) Pi 141. St, 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: — 7 - 1 e &Aid 0 g 97 223 ['Health-care facilities. ❑ Supply voltage for more than ❑ 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: S wW \ 7 _..._S ' � 9.4) P L4,( S. Description I Qtr. 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 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Old el 4o Q.� S ` Kt? ti 0 Limited energy, multi-family a ov sl t O 1n ( T7 residential with above s ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 NN ED PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 O pC,{ _ r � 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: — 2 6o g SlI,J 6 0 , vu S 1- Over 1,000 amps or volts 552.26 2 City/State /ZIP: �� p ( 3 *7 ZZ� Temporary services or feeders installation, alteration, and/or ///� �,�r relocation Phone: (&03) ` T� t -C( iis� Fax: (SVS) y 9 its' 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits— new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first ` 56.18 2 Contact name: branch circuit Each add'I branch circuit I 7.42 2 Address: Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited-energy Business name: 'Fa I fl„ &k 4-V G panel, alteration, or extension. Page 2 2 �i- Each additional inspection over allowable in any of the above Address: Po Pjcy( Zd 7 r (O Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: We_ i 7Ay O 2 on 34) Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (Sod 39c) - Z c( Fax: (�d3 ) 3i 0 .. TS Inspections for which no fee is 90.00 / hr t specifically listed (%] hr min) CCB Lic.: iS 6 IQ I I Electrical Lic.: ' 1 Lic.: g576 5 I Ili ELECTRICAL PERMIT FEES i1 l 24 -Z / e. (0 Subtotal: Suprv. Electrician signature, required: Plan review (25 % of permit fee): Print name: Ve� H el 0 i Date: 6l I/ I 1-.0 •a State surcharge (12% of permit fee): Authorized signature: �51 TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within no Print name: Date: days after it has been accepted as complete. Number of inspections allowed per permit. l: \Building\Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11 /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 ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations C\Building\Permits\ELC- PermitApp.doc 07/01/10 6715 ,5t4D P4 1-)E. `fie 62 x3 )t 5T'aof -o0 /3? 111 e ° Building Division Development Code Provision Review T I G A R D Residential Projects Building Permit No: N 5 i 2O / a- dO i 3 CWS Service Provider Letter Received: Yes No ❑ N/A ❑ Routed Plans: / iI Original Plan Submittal Date: 6 20 2 1st Revision Submittal Date: ❑ Site Plan Only 2 ^d 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 Chem/ ( / Cu 1 n L J at 503 -718 - a y or a t-z, 1 6. @tigard- or.gov) Land Use Case No. N1 A Name N1 A Zoning R ` 4 .5 Setbacks: Front a D Rear Side 5 Street Side — Garage 62 ❑ Maximum Building Height . Actual Building Height 'A '424 ' Vi Visual Clearance Easements ` r 1 Sensitive Lands Type: 1`� r otes: Original Plan: Approved Or Not Approved ❑ Date: -r - 21 -I y Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard- or.gov) .l ' Actual Slope: S Notes: Original Plan: Approved Not Approved ❑ Date: 6 // Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 . .- . • .. i •. • City Arborist Review (contact Todd Prager at 503-718-2700 or todd@tigard-or.gov) 0 Street Trees 0 Protected Trees Notes: . .. Original Plan: Approved i )EC Not Approved 0 Date:' eo 2 Revision 1: Approved 0 Not Approved 0 Date: Revision 2: Approved 0 Not Approved 0 Date: .. . , . Permit Coordinator Review (contact Albert Shields at 503-718-2426 or albert@tigard-or.gov) ,---.. 0 Conditions of Approval Prior to Issuance of Building Permit Notes : • ' , _ 0 r . p , . Original Plan: Date Sent to Applicant: , . . Revision 1: Date Sent to Applicant . • ,-, Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes/Y6 No 0 .ir ? Date Routed to Building: i ,..: I. '.:. . . -- --'' ., • , ; , .. •.., . $ . . , . . - . . ' .. . ..,, • 'f', . .!.h . , . . . '-, • i., :(,■ 1 '0. . ,..; • Page 2 of 2 ,. • i . . . : k ' ' • . . - ' , - • Clean Water Services File Number C1eanWafier Services I 12-00 c •, romil , Sensitive Area Pre - Screening Site Assessment JUN 202012 1. Jurisdiction: Washington County ell OF 2. • Property Information (example 1S234AB01400) 3. Owner Information jg ' NC OlVI OD Tax lot ID (s): Name: Ove Petersen ��JII �� �` 'kJL,l r Company: Scandinavian General Contracting Address: 7608 SW Pine St. Site Address: 6715 SW Pine St. City, State, Zip: Tigard OR 97223 City, State, Zip: Tigard OR 97223 Phone /Fax: 503 452 9457 Nearest Cross Street SW 69th E -Mail: 1op8318 @aol.com 4. Development Activity (check all that apply) 5. Applicant Information 12 Addition to Single Family Residence (rooms, deck, garage) Name: Ove Petersen ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: ❑ Residential Subdivision ❑ Commercial Subdivision PI Single Lot Commercial ❑ Multi Lot Commercial City, State, Zp: r Phone /Fax: 503 452 9457 Othe E - Mail: lop8318@aol.com 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 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, 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. Print/Type Name Ove Petersen Print/Type Title ONLINE SUBMITTAL Date 4/4/2012 FOR DISTRICT USE ONLY 13 Sensitive areas potentially exist on site or within 200' of the site. THE APPUCANT 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. a Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 2W 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. AU required permits and • approvals must be obtained and completed under applicable local, State, and federal law. Drainage appears to be piped ❑ 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 Pm- 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 3.021. 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 plans) are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9195 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LE I I ER IS REQUIRED. Reviewed by Date 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • wwv.clean::atersenaices.org REC - JUN202012 IrD 95.89 CI j OB~ i�c `�`'�° �DUIo DB r'; �` � list; )IG��cBB�D N to M ` EXISTING Lo GRADES i • 21.00 I- 18.00 . 53.00 ' ' 5.00 +/- rn - NEW PATIO EXISTING r c°D 2 -0 x 10 -0 +: - PATIO t — 0 ;.-_ .. -__— . __________ _ - -- = _ _ -- - - - -- -- r - -- ; - r EXISTING EXISTI G ,r :4 ,�c MAIN, FLOOR 416 S a .FT! i /, 6 ' Ta'; a ELEV. 360.50' GARAc 975 SOST. 21.10 ,/ ` r 4,5:7. ,f �� EXIS , • NTRV . ,l . t t OR ,IH M EXISTING DRIVEWAY AC. PAVING N SITE P N • • • • • • 37.00 `�`' • 6715 SW PINE ST.- cis 1/16 = 1' - 0 LAN " 11 00447 FT. LLOOT VER - 1;I88 SQ. f: TOTAL L1VTNG AREAGE _'17:5% ��4 2,300 SQ.FT. ROOF AREA SCANDINAVIAN General Contracting 6715 SW PINE, TIGARD, WASHINGTON COUNTY, OREGON ZONING - R -4.5 • • 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 6715 SW PINE ST, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing final 04/15/2013 00:00 MST2012-00139 FAIL 1. Install water heater T&P to an approved location 608.5 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 6715 SW PINE ST, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing final 04/16/2013 00:00 MST2012-00139 PASS Violation Summary: Inspector Contractor