Permit II CITY OF TIGARD MASTER PERMIT
ti
1 : COMMUNITY DEVELOPMENT Permit #: MST2012 -00181
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01/2012
Parcel: 1S134ACO2652
Jurisdiction: Tigard
Site address: 11150 SW COTTONWOOD LN
Subdivision: ENGLEWOOD NO.3 Lot: 218
Project: Hunter
Project Description: 2 -story addition of bedroom and office /playroom
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 1 First: 320 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 21.5 Bathrooms: 0 Second: 320 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 640 sf Value: $66,508.80 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckfiw 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: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 2
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders 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: 4
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 - 3 640
Owner: Contractor:
HUNTER, JOHN R & BETTY Q ANDERSON & ASSOCIATES GENERAL CON' Required Items and Reports (Conditions)
11150 SW COTTON WOOD LN 11655 SW SPRINGWOOD DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: PHONE: 503- 329 -2903
FAX:
Total Fees: $1,729.38
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 accordance 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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 FIECE VE I FOR OFFICE USE ONL1
ew
City of Tigard Received 7 / ' - /Z Permit No�1"j�,a Do ///
:� . 13125 SW Hall Blvd., Tigard,OR 97223 JUL 19 2012
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Re ate/By: 1` vi ► f ' r 7(27 , ther Permit:
1 C; A i n Inspection Line: 503.639.4175 CI'Fy OF TIGt �1 ARD� �� / ff,9'�/E
Date fi ReadyBy: rte ; Juries ' / RI See Page 2 for
Internet: www.tigard - or.gov
BUILDING I DIVISION Notie / 42 I (T Supplemental Information
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. _ —L
Valuation: $ ) 4 15�
and 2- family dwelling ❑ Commercial/industrial ,
❑ Accessory building ❑ Multi - family Number of bedrooms: /
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: / /�5 7 sty �O ... Lq,., New dwelling area: b4 are feet
City/State/ZIP: ,e, AO 77ZZ 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: , , I 'Project name: Hu/VT—a. Covered porch area square feet 3 20
Cross street/directions to job site: Deck area: square feet `3`2C,
Other structure area: square feet 24 .'j
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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.
2 _547 601107.01:4......, Valuation: $
� Existing building area square feet
New building area: square feet
fic PROPERTY OWNER I ❑ TENANT Number of stories:
Name: 5 (,.,, � C. - -11� r..4-fr. Type of construction:
Address: //Ac sc. ( o0y�,,. *..ao G,,.,e_ Occupancy groups:
City /State /ZIP: T ',fro/ ,772.." Existing:
Phone: ( ) „ Fax: ( ) New:
„a:APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer name: 40 ..el . ��,
• , •• —` ' �- /, � Structural plan revview iew fee ( (or or schedule)
deposit): ee epoosit)sit): : s3 7, 7f
Contact name: ....574. . 40490es --■
FLS plan review fee (if applicable):
Address:
City /State /ZIP: Total fees due upon application:
Amount received: .53 7, 7 7
Phone: (9>3) 329— • /c.)3 I Fax:: ( )
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
•'t ,Commercial and residential prescriptive installation of
/ �
CONTRACTOR -0b I ,9 50cm- t'-foof- -top mounted PhotoVoltaic Solar Panel System.
Business name: /445,,,, # "#S ,,,,„•‘_S• 15. /arl. i s ubmit two (2) sets of roof plan with connection details
�i ,, d fire department access, along with the 2010 Oregon
Address: /AU 7r 4/ -- •• s...e.Ap<: ' ` e Solar Installation Specialty Code checklist.
/ • Permit Fee (includes plan review $180.00
City /State /ZIP:
�/ / P 9722 3 and administrative fees):
�'/ Phone: (7 ) g� 290 -s Fax: ( ) State surcharge (12% of permit fee): $21.60
(� CCB lie.: /790919 � /ij1
00 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Date: * Fee methodology set by Tri -County Building Industry
Print name:
19�z Service Board.
I:\ Building \Pennits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T( l I /02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling voii Ol FICI, (i51 ONLY
City of Tigard Received
Permit No.:
7 Date/By:
q 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
TIG RD
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing 0 Mechanical
Internet: www.tigard- or.gov 0 Other:
TI-IE FOLLOWING' ITEMS ARE REQUIRED FOR PLAN REVIEW 1' No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • i
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray ,
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non .0 • ❑ ❑
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 Ion and shall be shown to be a. plicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. . ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ' ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1: \ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440.4613T(11/02/COM/WEB) •
Mechanical Permit Applicatiol f E •iV ; rOIZ OI,FIC : uSl: c)Ni.l
City of Tigard Received
Date/By: Permit No.. frea�(/ 2��
02 _ 00/6
to 13125 SW Hall Blvd., Tigard,OR 97223 JUL 19 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DatrJBy: Other Permit:
- r I G A it. I) Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: fads: Pi See Page 2 for
Internet: www.tigard- or.gov B' JILDh �;� Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees" are based on the value of the work
❑ New construction . ddition/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*
441- 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: 1/52 Pa/ `. .. _A.r (requires site plan showing placement) 46.75
City/State /ZIP: ��' v q Furnace 100,000 BTU (ducts/vents) 46.75
- 0 ! 72Z3 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 2, 23.32 2.6. Lk
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
2 s Q' d� Gas fireplace/insert g 33.39
Flue vent for water heater or as
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 23.32
J \A., Ether: 23.32
Name: Environmental exhaust and ventilation:
Address: i I S—O S' 'a . Z,.., equipment hood/other kitchen
equipment 33.39
City/State /ZIP: Tay/ eye 9 7 2 2 -3 Clothes dryer exhaust 33.39
Phone: Single -duct exhaust (bathrooms,
( ) Fax: ! ( ) toilet compartments, utility rooms) 23.32
121 ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
,464,..6._,.. . -J Se /•"--, 4:17 Fuel piping:
Contact name: 5 $14.15 for first four; $4.03 for each additional
Address: /`C7.-- �_ Furnace, etc.
��'� �/ o �'" 0O '" � �� ' Gas heat pump
City /State /ZIP: �� / �/& 7�Z Wall /suspended/unit heater
Phone: 3) 2 9 -- zve Fax::( 3) 2r4-- 1 Water heater
Fireplace
E -mail: v /W V40€.- - sp( 44601 Range
CONTRACTOR Barbecue
Business name: ,�j Clothes dryer (gas)
S yf r� Other:
Address: /7 I9Lf -5 / S2 MECHANICAL PERMIT FEES*
City /State /ZIP: 7 7 � Subtotal WI, " 4,40/.
Minimum permit fee ($90.00) 43.'3C,
'one: fr 3) _52 Fax Plan review (25% of permit fee)
? 8 ' d,VCCB lic.: , ' Z . • State surcharge (12% of permit fee)
'64*Y./.---------' TOTAL PERMIT FEE
Authorized signature:
This permit ap expires if a permit is not obtained within 180
days after it has been accepted as complete. •
Print name: y ..4„. ��A <`�Z I Date: 77/7//e_ " Fee methodology set by Tri -County Building Industry Service Board
1:\ BuiIding \Permits\MEC- PermilApp.doc 09/09/10 4404617T(II /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and -,
•
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including •
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
•
1
1:\Building\Permits \NEC - PermitApp.doc 09/09/10 2 --
a
Electrical Permit Application Ak vis I FOR OFFICE. USE ONLY
City of Tigard . eceived Permit No./ y0 04,2 - 00/11
Date/By:
• 13125 SW Hall Blvd., Tigard,OR 97223 JUL 19 201 Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
F I c. A It a Inspection Line: 503.639.4175 CITY OFT�aR 9 Date Ready/Bty: Ins: ® See Page 2 for
Internet: www.tigard- or.gov BUIA L 1� �G Dial ` , � oti fied/Method: Supplemental Information
srf TYPE OF WORK PLAN REVIEW
❑ New construction ,, Addition/alteration/replacement Please check all that apply (submit / 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.
p � less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
�l 1- 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 ", "l -3 ",
/ I00HP or more. occupancy.
�� Job no.: Job site address: #4,S• Se.,/ 6 ., ❑ Six or more residential units. ❑ Recreational vehicle parks.
Cl /State /ZIP: T A 9 ❑ Hcalth -care facilities. ❑ Supply voltage for more than
ty / / 41 '/ 1/, / 77Z 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: I Project name: 14 1, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtv. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 l
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
IP
Limited energy, multi- family 75.00 2
/4 residential (with above sq. ft.)
2 S " ���� 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: -- 331 14h j 601 amps to 1,000 amps 301.04 2
Address: 05 54 eerj,, Over 1,000 amps or volts 552.26 2
City/State /ZIP: �� 6� ? Temporary services or feeders installation, alteration, and/or
�// ' 2 / relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits— new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
El APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: /411,5 ie tiffs /s„ Vr B. Fee for branch circuits without
service or feeder fee, first / 56.18 2
Contact name: _z �� branch circuit
Each add'l branch circuit 3 7.42 2
Address: / 4�r s',/ 4-4, / 4„,..i. ig`"4 Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
�k/� / Qj' 9 7Z Z 5 dwelling, service and/or feeder
Phone: (e3 3 4) — 2c/03 Fax: : ( ) Reconnect only 67.84 2
� ' /�� �trrr Pump or irrigation circle 67.84 2
E - mail: Y p v ea spe H
Sign or outline lighting 67.84 2
ONTRACTOR Signal circuit(s) or limited- energy
Business name: /lg��r /205# r /� panel, alterato or extension. Page 2 2
/'� G /� Each additi nal inspection over allowable in any of the above
Address: / U. Additional inspection (1 hr min) 66.25/ hr
�/, // L(J/ Investigation (I hr min) 66.25/ hr
City/State /ZIP: '✓ vii i i •...t , o ' 7. 3 Industrial plant (1 hr min) 78.18/ hr
Phone: $ Fa x: (,�3) 6t�g sy Inspections for which no fee is 90.00/ hr
specifically listed (G hr min)
1� B Lic.: �5jG Electrical Lic.: 3y OG 7 FEES
Suprv. Lic.: 767 ELECTRICAL PERMIT FE
0 Suprv. Electricirt sigha�ure, required: `, /0�/ Subtotal:
/4A. I/ /� � Plan review (25% of permit fee):
Print name: Arii ,PeNe_ Date: 7�j� /y State surcharge (12% of permit fee):
Authorized signature: -s�g�f 1 TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
c/ Date: / •
days has been accepted as complete.
Print name:
I � �,�'�� 7 / �Z • Number of inspections allowed per permit.
I:t Building \ Permits \ELC- PermitApp.doc 07/01 /10 440- 4615T(t I /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*
El Burglar Alarm
❑ Garage Door Opener*
El 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:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building 'Permits\ELC- PermitApp.dac 07/01/10
IN o ° Building Division
Development Code Provision Review
T I G A R D Residential Projects
Building Permit No: /`7S % 020 /02 r (20/f/
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A J
Routed Plans:
Original Plan Submittal Date: j
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 J. 1'6 Pr 7f at 503 - 718 -) j 00 or I° t (j @tigard - or.gov)
Lapd Use Case No. Name
C7 Zoning R Li, 5 Ei Setbacks:
Front S V Rear 5 Side 5 Street Side / 5 Gauge " O
Maximum Building Height 3 0 Actual Building Height )), /U n-
O /Visual Clearance
O Easements /,r /�
❑ Sensitive Lands Type: /v /(T
Notes:
Original Plan: Approved / Not Approved ❑ Date: 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)
0 Actual Slope: w
Notes:
Original Plan: Approved Not Approved ❑ Date: f 9.1 , 0 12-
Revision 1: Approved ❑ Not Approved ❑ Date:
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)
/Street Trees
El Protected Trees
Notes:
Original Plan: Approved L`� Not Appro ❑ Date: 7-/1 -9
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard-or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to A plicant
Okay to Issue Permit: Yes o ❑
Date Routed to Building:
•
Page 2 of 2
U
RECEIVED a
V ^ O � ,. A Y
JUL 1 2012 '— a0C . .
CIS OF ;;A% ,
B'itONS O V,S,_ON V
�.
P.L.= 100.00'
!
❑ ❑ ❑ ❑ N o
EXISTING II in
WOOD FENCE J Q?
0 6 FT, (1)
I
N
N
"d
0
8'- 0, -�� — — — c ' S� `9, QA q N
° O / { _ ❑ NEW ADDITION , a
II / LOCATION ,�
II ( •
O 0
J ❑ — _ 7:1-i dQ
a I j , 1.01' 218 Z F,
— "� I _ L I • ' 1 i fY In: 1;264181
7 � W269668
+=� i 71865Q. fir,
c'a \o Q om.
(E) CONC. , " ./a = 600 50, rt,
DRIVEWAY EX151TNG - 2,112 50. FT,
ITOP0512 = 640 50. MI,
f01'AL . 5,552 50. Fr.
0
P.L.= 25.20'
r--I
hi
0
a.) SITE PLAN \ N 'v1
SCALE: 1" = 16' -0" ,1
CS
07 -19 -12