Permit _ t
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00053
�L��i� DEVELOPMENT SERVICES DATE ISSUED: 3/3/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09845 SW SERENA WAY PARCEL: 2S114BA -06100
SUBDIVISION: COPPER CREEK ZONING: R - 4.5
BLOCK: LOT: 003 JURISDICTION: TIG
REMARKS: Addition of 360 s.f. family room.
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST: 368 sf BASEMENT: sf LEFT: 7 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 34,003.20
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 368 of REAR: 35
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 2 TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 W00DSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: 00 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 1. SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps - 1000x. 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: $ 831.80
COLBY & JOANNA PANTER CRIMSON COMPANY INC This permit is subject to the regulations contained in the
9845 SW SERENA WAY 9970 SW SERENA WAY all other applicable cal Code, State able laws. All work w Specialty
be dne Codes and
TIGARD, OR 97224 TIGARD, OR 97224 all applic won
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. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 - 603 - 9407 Phone: 620 - 3678 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 00048974 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing lnsp Footing /Foundation Dr; Shear Wall Insp Mechanical Final
Foundation lnsp Mechanical Insp Exterior Sheathing Ins F Final inspection
Post/Beam Structural Electrical Service Insulation Insp
Post/Beam Mechanical Electrical Rough In Rain drain lnsp
Crawl Drain /Backwater Framing Insp Electrical Final
Issued By : A �I_ /ice ._-` Permittee Signature • ! /JI //� ��
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne business day
Buildin Per Rece
Permit , Application FOR OFFICE USE ONLY
ived D Building
Date/By: 07,—/c, —0 3 y � Permit No.: {NIST,,21V OM — � S 3
City of Tigard �� V Planning Approval Other
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other -1
Tigard, Oregon 97223 FEB (�j �� jin�1 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: - 598-- 1 9"6 CUU3 / ��,x�, gy t j � l in Post - Review Land Use
(r� OF . Date/By: Case No.
Internet: www.ci.tigard.or.i �/ TIGA °- Contact Juris.: El See Page 2 for
24 -ho Inspection Request -3V t n 11V+s(O Name /Method: Supplemental Information i
a
TYPE OF WORK REQUIRED DATA:
n New construction ❑ Demolition 1 & 2 FAMILY DWELLING
∎TA Addition/alteration /replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
El 1 & 2- Family dwelling ❑ Commercial/Industrial
the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family 39 001.'
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths: —______
Job site address: 9805 SW SE12ENA vatl , 114I D'/724 Total number of floors �\
1 New dwelling area (sq. ft.) 1
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
i l
Project Name: Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
DL11211{/tiM IWO> To PICK; 1-Arl I iki4 KICtat RlitoD Other structure area (sq. ft.)
L‘€r on► %ERENA WAY
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
3(00 5(6 f add o ktfet on rear of hA ace.
Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
g PROPERTY OWNER 1 ❑ TENANT Type of construction
Name: Goi_6y 3 PANre 2 Occupancy group(s): Existing:
New:
Address: ` edi5" bin/ 6eRENA iNA•I
City /State /Zip: yi ,4i2D , Ole_ 97224 -
Phone: SO3-- 603 - `a'Hb7 Fax: NOTICE: All contractors and subcontractors are required to be
® APPLICANT R CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: COL-BY 9 S0ANNIA PANTS-12- from licensing, the following reason applies:
Address:ggL5 61A/ SS - A 0
City /State /Zip:7 0 9722
Phone: 5 -(603-9 I Fax: . -
E-mail: j p a .( e p,-/ lie . i& BU PERMIT FEES*
J/ V1 �- CONTRACTOR Please refer to fee schedule.
Business Name: G $ON a Fees due upon application $
Address: 970 Sv4 se ie tr n1A- WAY
City /State /Zip: j U { �, 2 €172.2:14 > t o€172€172.2:14 ' Amount received $
Phone: 503 -(,20 -36 Fax: cog-903 Date received:
CCB Lie. #: t-I i'-i
Authorized
Si Signature: Notice: This permit application expires if a permit is not obtained within
gn % �qi Date: 0 2 /04 0 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
-
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
•
Aith One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City f Tigard ty b ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
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.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
''iit4r district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project 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 & 22 above.
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6/00 /COM)
Mechanical FOR OFFICE USE ONLY
nical Permit Application
Received Mechanical
Date/By: Permit No.:VV\S - r e , 1 4 B - OQ )
Planning Approval Building
City of Tigard Date/By: No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 /k�ao-tl Post- Review Land Use
�uI'
Internet: www.ci.tigard.or.us _AI, �.� Date/By: No.: ( Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
IA Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
gC ..1 & 2- Family dwelling n Commercial /Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: ej$NS stAf 5(tLem vJ,Q -'y Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work / 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Du2FFPrA 2OFlo TO Pic-g.5 LJ-N ►AJG NEic,l4 Unit heaters (fuel, not electric)
L -Y 0 / 4 5 ,VA v■AY (in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) f 10.00
Lot #: Repair units 12.15
Subdivision:. Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
'15a PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: C.-0/-15Y s 3 1 IT 1Z. Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: qRt 6 564-AVA why Clothes dryer exhaust 10.00
City /State /Zip: "n6A -12 D O _. °( 721 Sing d uct exhaust
Phone: 5b3 (003 - 9 (0 7 Fax: (bathrooms, toilet compartments,
APPLICANT n CONTACT PERSON utility rooms) 6.80
Y F T 6A -l�I1 fp1 PANT C-1 space fans 10.00
Name: GoG13 Other: 10.00
Address: •F31 S VJ 5E1e -&tj WO Fuel Piping
City /State /Zip: -r/6,n-g_ op_ T722.-1-1 * *($5.40 for first 4, $1.00 each additional)
**
Phone: 5o3 -( n 63 -9i10 Fax: Furnace, etc. **
L Gas heat pump
E -mail: J i p 4.frt1_e_e e e( r-/t h.,- 4. , vI L Wall /suspended/unit heater **
I CONTRACTOR Water heater **
Business Name: (a,Qy r,Q, C9j Fireplace **
**
Address: BBQ **
City /State /Zip: Clothes dryer (gas) **
Phone: Fax: Other: **
CCB Lic. #: Total:
� Mechanical Permit Fees*
Authorized / Subtotal: $
Signature: p Date: OZ /O% /a3 Minimum Permit Fee $72.50 $
To AATMA PA N-THQ, Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
$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 including $10,000.00. _
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$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 and including
$50,000.00. _
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU •
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm _ 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct _ 446
Vent system not included in appliance 656
permit _
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
Electrical Permit Application FOR OFFICE USE ONLY
Received y: Permit � - ��
Date/By: Permit No 3
City of Tigard Planning Approval Sign
`, g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
m� lf�+ if I Date/By: Case No.:
Internet: www.ci.tigard.or.us ■ � e I Contact Juris.: ® See Page 2 for
"
24 -hour Inspection Request: 503- 639 -4175 c " Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition /alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
Ig I & 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: c$ L/5 j - ytl $E12ENA i JA'/ FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential-single gincl d or multi-family per
� dwelling unit. Includes attached garage.
DIAl21419-r& ROAD Ws PICKS - 9NDIn/!a N tti3p12. 1OOD Service included:
LEfT oN 5 ..eNR WAY 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: I Lot #: 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
ig, PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: C-01-0 f JOANNA PAisi-reie. Reconnect only 66.85 2
Address: ejag5 5141 5 - 1-ENA- vi/A}\/ Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 7! G/{p p ,01 2, (-7722.1-1 200 amps or less 66.85 1
Phone: D 3 --(903 -9/107 Fax: 201 amps to 400 amps 100.30 2
APPLICANT Branch 0 CONTACT PERSON r n 600 c amps 133.75 2
Branch circuits - new, alteration, or
Name: Co 03Y 4 IMAM PANMK. extension per panel: of
Address: 98115 5V ' Sf ryA v 'At Y A. Fee for branch circuits each branch circuit service or feeder fee, each branch circuit 6.65 2
City /State /Zip:7 4/9 D � O . 17Z2 `f B . Fee for branch circuits without purchase of
service or feeder fee, first branch circuit / 46.85 2
Phone: o3 -( - 9 7 Fax: Each additional branch circuit % 6.65 2
.�
E -mail: pavl e ear,41,-,,k, vie'/` Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
CONTRACTOR f Each sign or outline lighting 53.40 2
�9
Job No: - — 14e I s o ��iC- Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name:
k E 150 El rCT+ - _ Description:
Address: S 7_ 3( j4 :113 Borac / 0R.
t /State /Zl 9 Each additional inspection over the allowable in any of the above:
Cl
,`j 1 S Be, 3 c?O j o(Z % 7 - ._3
Per inspection per hour (min. 1 hour) 62.50
Phon 3 'tiff -436o Fax: Investigation fee:
CCB Lic. #: dbaS y Lic. #: 3 `P' 1 -1 3 5C._ Other: Electrical Permit Fees*
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: JA e - I Date: QZh(o /03 180 days after it has been accepted as complete.
�/ *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \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
• Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
0 Audio and Stereo Systems
PI Boiler Controls
❑ Clock Systems
F - 7 Data Telecommunication Installation
El Fire Alarm Installation
0 HVAC
0 Instrumentation
Li Intercom and Paging Systems
n Landscape Irrigation Control
ri Medical
F - 7 Nurse Calls
O Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations -
i:\Dsts \Permit Forms\ElcPermitAppPg2.doc 01/03
CleanWater Services
Our commitment is clear.
RE
FEB 0 6 2 003
January 24, 2003 Rp
G► LD NG SIGN
Colby & Joanna Panter
9845 SW Serena Way
Tigard, OR 97224
RE: Addition to single family residence located at 9845 SW Serena Way
in Tigard, OR
CWS file 2618 (Tax map 2S114BA, Tax lot 06100)
Clean Water Services has received your Sensitive Area Certification for the
above referenced site. District staff has reviewed the submitted materials
including site conditions and the description of your project (see attached site
plan). Staff concurs that the above referenced project will not significantly impact
the existing sensitive areas found near the site. In light of this result, this
document will serve as your Service Provider letter as required by Resolution
and Order 00 -7, Section 3.02.1, and your Stormwater Connection authorization
from Clean Water Services as required by Ordinance 27, Section 4.B. All
required permits and approvals must be obtained and completed under
applicable local, state, and federal law.
This letter does NOT eliminate the need to protect sensitive areas if they are
subsequently identified on your site.
If you have any questions, please feel free to call me at 503 - 846 -3553.
Sincerely,
Chuck Buckallew
Environmental Plan Review
•
Site plan attached
E:\Development Svcs\SP 00 -7 \Concurrence Letters\2S 114BA06100 - no impact to water quality.doc
155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124
Phone: (503) 846 -8621 • Fax: (503) 846 -3525 • www.cleanwaterservices.org
CITY OF TI 24 -Hour G;/
BUILDING , i . . Inspection Line: (503) 639 -4175 MST p O 0,5
INSPECTION DIVISION Business Line: • (503) 639 -4171
BUP
Received Date Re ested A M PM BUP
Location 9 E 7 LkJ Suite MEC
Coritact Person Ph r ) O 4 -°2f 0'3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 1' 4 sliwk ft (7\d 40' ELC
Footing (D 0 3 - 9 6 7 ELC •
Foundation Access:
Ftg Drain C Q A 1 ,/L Q ELR
Crawl Drain �J
Slab Inspection Notes: - 77� SIT -
Post & Beam
Shear Anchors v �'�� �� -
Ext Sheath/Shear Z-'� � XJ- - . -rte CX i
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: .
V l* k PART FAIL
PLUMBING l ,V
Post & Beam
Under Slab
Rough -In;
Water Service 1l `
Sanitary Sewer \
Rain Drains
Catch Basin / Manhole ,1\
Storm Drain
Shower Pan _ 1) -\
Other:
Final
PASS PART FAIL
MECHANICAL ` '
Post& Beam � �
Rough -In
Gas Line - . I 1 `
Smoke Dampers
- T FAIL ,
Service , '' II
Rough -In Y+� I LJ /'
UG /Slab g U MBIN Low Voa e �C / Z • I/
Fire Alarm
4110 - 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE 11 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3 c a 3 Insp r c.,,, 1 . .,..s— . _ EXt
Other: -
Final DO NOT REMOVE this inspection recor from the job/site.
PASS PART FAIL •