Permit Building Permit Ap lic ation EXP �� �
p C x - C� U
Residential BV FOR OFFICE USE ONLY '
II City of Ti and Received Q� Permit No.: 4., ° 13125 SW Hall Blvd., Tigard, OR 97223 10,11• Plan Re
C : Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
II c. Ito Inspection Line: 503.639 c'T\ OF `flGAR I' Date Ready/By: Juris: ® See Page 2 for •
Internet: www.tigard -or.gov I � ® � t aints . ; otified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: I- 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
X Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
[XI 1- and 2- family dwelling ❑ Commercial/industrial
Valuation: $
El Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
.<
Job site address: 883 S SO SG4f—C.1.Lc oil- New dwelling area: square feet
City/State /ZIP: 11 (- t O (L 91224 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
146 7 LOO giatf.. S.A. 0 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.
Etjc.t l?Num "F. cfik.friL ViN ; A4 t04„, , Valuation: $
Existing building area: square feet
New building area: square feet
5 PROPERTY OWNER ❑ TENANT Number of stories:
Name: CA Qi i 5 i4Awia Doc. oh E. Type of construction:
Address: 8S3S S...) S ciAtiAA-0 04. Occupancy groups:
City /State /ZIP: Tt6 C OL 97;24 Existing:
Phone: (5 03 ) 515- (Nat, Fax: ( ) 4 S98 -1872 New:
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: 3 LlQlt/�J A�o2106rL licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 813,5 ,f14 St414 t.41,1.4 a► . jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
ty t'. S iltlo r 0 (L 1 731y apply:
Phone: (5133 ) St s- 941b Fax :: (So3) SSt 1 872,
E -mail: .
CONTRACTOR
Business name: BUILDING PERMIT FEES*
Address: -, (Please refer to fee schedule)
City /State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lit.:
Total fees due upon application:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
w ithin 180 days after it has been accepted as complete.
Print name: 54444 aw2.061. Date: ,316 / to * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Pennits\BUP -RES PermitApp.doc 10/01/09 440 -4613T(11 /02 /COM/WEB)
r
Building Permit Application Checklist
One- and Two - Family Dwelling roll OFFICE USE ONLY
City of Tigard Received
Permit No.:
Date/By:
V 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
I' 1 Ci R D Internet: www.tigard - or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ,« 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
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 'larked of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
.20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances. _ _
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or • - ❑ ❑ ❑
architect licensed in Ore•on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS -
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x II" 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:\BuildingWermits\BUP -RES- PermitApp.doc 03/21/06 440-4613T(11/02/COM/WEB)
✓14 y�oio --c> KS
Electrical Permit Application RE C jVE pecejvmi
- FOR OFFICE USE OiN�
City of Tigard Permit No.:
IN • Date/B :
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
o Phone: 503.639.4171 Fax: 503.598.1960 MAR. 2 6 Date/B : Other Permit:
I I 6 A It I) Inspection Line: 503.639.4175 Date Ready/By: turfs: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF wogitilLDING DIVISION PLAN REVIEW
❑ New construction J 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 agricultural
K ] I- 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 ", "I -2 ", "1 -3 ",
Job no.: Job site address: 88 3r svi SoNCr k.t•O Q. Six or or more residential R occupancy.
❑ Six or more residential units. ❑Recreational vehicle parks.
City/State /ZIP: T. Coto oc _ 97,N4 ❑ 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: 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 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
1-' Limited energy, multi - family 67.84 2
W i 4E 'tW o Lsq ii ' I A W‘.....) 1". I n. residential with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
12 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: (' 4 J d 401 amps to 600 amps 200.34 2
SI- {Ouln) AOILio6E 601 amps to 1,000 amps 301.04 2
Address: 8e3 ' S..,) S c4au t.LO U. Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
/i4 04 .0 O 2 X24 relocation
Phone: (5D3 ) S /S Q4 26 Fax: (S ) safe- 1 872 200 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. -
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: 5146iliwitgetaielgti. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: So4owo l..oa` branch circuit
Each add'I branch circuit 7.42 2
Address: 8 S■) S (.40, 4o-0 Oh . Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: mion, oa g7324 • dwelling, service and/or feeder 67.84 2
Phone: (S43) S! S • S `t t 6
I Fax: : (Sa3 ) Sf 8- 1 87'L 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:
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
d ope after it has been accepted as complete.
Print name: Sdarp) 131.42 Ails L Date:
3/2.0p � h • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440.4615T(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 $67.84
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 $67.84
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 -
I: \ Building \Permits\ELC- PermitApp.doc 10/01/09
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