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Permit 9/2/09 �,,,vL->' ---- ---,&d t ' ._ ,_- MASTER PERMIT i.. CITY OF TIGARD ER PE ls' -' =; COMMUNITY DEVELOPMENT Permit #: MST2009 -00161 T I G ARD 13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 Date Issued: 09/09/2009 Parcel: 2S104DB03900 Jurisdiction: Tigard Site address: 13217 SW WELLINGTON PL Subdivision: Lot: 0 Project: Clark Project Description: Add 608 square feet habitable space 9/22/09, adding (15) additional branch circuits BUILDING Floor Areas Required Setbacks Required Stories' 1 Bedrooms 0 First 0 sf Basement. 0 sf Left. 0 Parking Spaces' 0 Height 23 Bathrooms 0 Second 608 sf Garage 0 sf Front 0 Smoke Dwelling Units 1 Third 0 sf Right 0 Detectors Yes Total sf Value $61,985 60 Rear 0 PLUMBING Sinks 0 Water Closets 0 Washing Mach 0 Laundry Trays 0 Rain Drain 0 Catch Basins 0 Lavatories 0 Dishwashers 0 Floor Drains 0 Sewer Lines: 0 SF Rain Other Fixtures 0 Tubs /Showers 0 Garbage Disp 0 Water Heaters 0 Water Lines 0 Drains 0 Bckflw Prevntr. 0 MECHANICAL Fuel Types Air Conditioning N Vent Fans 0 Clothes Dryers 0 Heat Pump N Hoods: 0 Other Units 1 Furn<100K 0 Vents 0 Woodstoves 0 Gas Outlets 0 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 20 1 -400 amp 0 201 -400 amp 0 1st W/O Svc/Fdr Limited Energy 401 -600 amp 0 401 -600 amp 0 Ea add.' Br Cir elf / - 7 601 -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: Owner: Contractor: Required Items and Reports (Conditions) CLARK, MICHAEL C & HEIDI E OWNER 13217 SW WELLINGTON PL TIGARD, OR 97224 PHONE PHONE FAX Total Fees: $1,960 79 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 accordan - . ith 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 • ENTION Oregon law . res you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 -• • 1 -0010 through OAR 952 -4 : -01. i • may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800.332 23 Iss ed By: _ / �/ L Permittee Signature: \( / • 1 CITY CITY OF TIGARD MASTER PERMIT la • COMMUNITY DEVELOPMENT Y Permit #: MST2009-00161 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2009 Parcel: 2S104DB03900 Jurisdiction: Tigard Site address: 13217 SW WELLINGTON PL Subdivision: Lot: 0 Project: Clark Project Description: Add 608 square feet habitable space. BUILDING Floor Areas Required Setbacks Required Stories. 1 Bedrooms' 0 First 0 sf Basement 0 sf Left: 0 Parking Spaces 0 Height. 23 Bathrooms 0 Second 608 sf Garage' 0 sf Front 0 Smoke Dwelling Units' 1 Third' 0 of Right: 0 Detectors. Yes Total sf Value $61,985 60 Rear 0 PLUMBING Sinks. 0 Water Closets 0 Washing Mach: 0 Laundry Trays 0 Rain Drain: 0 Catch Basins 0 Lavatories 0 Dishwashers 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers 0 Garbage Disp: 0 Water Heaters 0 Water Lines 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans 0 Clothes Dryers 0 Heat Pump N Hoods 0 Other Units: 1 Fum <100K: 0 Vents 0 Woodstoves 0 Gas Outlets. 0 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 add9 500 sf' 0 20 1 -400 amp: 0 201 -400 amp 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp' 0 401 -600 amp 0 Ea add9 Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt. 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio 8 Stereo N HVAC' N Security Alarm: N Vaccuum System' N Garage Opener: N All Other, N Other Descnption Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) CLARK, MICHAEL C 8 HEIDI E 13217 SW WELLINGTON PL TIGARD, OR 97224 PHONE PHONE' FAX Total Fees: $1,848.42 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 OAR 952-001-0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332 2344. Issued ByCO Permittee Signature: )( / ( �� -- I Building Permit Application 1 . CEIVED Residential FOR OFFICE USE ONLY JUL 2 3 2009. Received � City of Tigard Date /By: Permit No 1' \ a 7 009 05( rej q 13125 SW Hall Blvd., Tigard, OR 9722CITy OF TIGARD Plan Revie I �p v 7 1.J Phone: 503.639 4171 Fax: 503.598 DIVISION Date /By. L CJ ( 2I Other Permit T I G A RD ! Q Inspection Line: 503.639.4175 Date Ready : /, _Puns ® See Page 2 for Internet: www.tigard -or gov Notified /Method: OP id Supplemental Information LILT TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the dalue 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. 0 ,1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ r„ I I 8S, O ❑ 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: 13.11 W et1 -Pl New dwelling area: bQ square feet City/State /ZIP: 'r; �i 0 c ZZ -Pimp_ -Pimp_ l_i! 3 Garage /carport area: `� square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site I 9 " 12 4 )( 2; Deck area: square feet '' Other structure area.; ,5 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: AY 1 1..[ <JOIM 1 �"tS Lot no.: CI Permit fees* are based on the value of the work performed I 2 Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: �S 1 01.0B D31 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ Pb _ A _ V • V / /1! �� • e ..i1 - Existing building area: square feet New building area: square feet 5� PROPERTY OWNER ❑ TENANT Number of stones: Name: M` COY alp_ i 0`- ` 2 f ( t*i Type of construction: Address: 13211 sw Vv ( ► �0 P \ Occupancy groups: City/State /ZIP: T l D - c(722-3 Existing: Phone: ( 5q D LI %p .. Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) I Fax:: ( ) E -mail: CONTRACTOR Business na me: — +L C5& �) g`2. BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City/State /ZIP: Structural plan review fee (or deposit): `3� p . t a Phone: ( ) I Fax: ( ) FLS plan review fee Of applicable): CCB lie.: Total fees due upon application: Amount received: Authorized signature: f�i�� • 6.fes.,... This permit application expires if a permit is not obtained 1,6 within 180 days after it has been accepted as complete. Print name: /74 1 c Q e ( C Ca- d k__ Date: 7 2/-09 Fee methodology set by Tri-County Building Industry Service Board I• \Building\Permits \BUP -RES PermitApp.doc 11/6/07 440 -4613T(I1 /02 /COM /WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY IN City of Tigard Received Date /By Permit No 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits Phone. 503.639.4171 Fax: 503.598.1960 TIGARD 24- Hour Inspection Line 503 639.4175 El Electrical ❑ Plumbing ❑ Mechanical Internet www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW \'es 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. 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. 1 I 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 a to the I roject 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 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 accompanied by the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I \Buddmg\Permits \BUP- RES- PemmApp doe 03/21/06 440- 4613T(I 1 /02/COM/WEB) Electrical Pearmit Application 1'0k t)PIIf r. USE ONLY . City of Tigard RECEIVED Reeeivca Dnte/R Pemut No.. 1-1 —DO to / 13125 SW Hall Blvd., Tigard, OR 97223 f 1a„ Review i h Phone 503.639 4171 Fax: 503.598, I9G E P 10 2009 Date/tly: Utter Permit, 1 "d c: A It n Inspection Line 503.699.4175 Date Ready/By' Ions. ® see Page 2 for "' Internet: www.tigard- or'.gov Notified/Method: Supplemental Information 't . u a1 9t ^ { I as ya bb r t . Jt tF R, ' , s(t s ". @ I )l .3j °G Iit t r t I , m c f l f r ra } f . ,.- :lye/ t 1 .'. it ' i; nit!trltvda 1 ;t � ; 1 a �jC ,. n tp[ f:1, ++ s Yip it ' $$ Il'1�1 it �r'' ,? ; � j,4 ;�'I p f i �,µ9� q'Y{ rui', l {t lf tl �I. � 9 t � !hi d.) ti>t, At,'11'•.. ;lr, her. i' l�1,• !a(l4 +; lil 4�x:DA,. ,t Lt ∎1icu ,ntl1.,rr,,ill , • 16 ; .,.pd, It 114 a ,.t" � 1, ❑ New construction 'Addition/alt- i . 11 I v ' : acement please cbcok an that apply (suhrnit 2 bets of plans w /uonu checked below); ❑ Other Service or 1>•eder 400 amps or more 1 J 130(114 over three stories. ❑ Demolition where the available (huh currant ❑ Marinas and boat arda, i � � � ") '"+ r ,: ppfl s !r r �nt't d 1 l,, , aU r , n d t> Z n 1 t e �' tt �t y (" r (k l iv r u l I Y ' aa{j a !' m r ,,n ,r iy t\ fzw �. I s i ',I , r its , r exeoeda 1 0,000 U Sat 150 Volts or g S , a 0.. � iL i M1 � , t, t � sit r,'11i, + � m; ucic elig•,rr , T04 ;'il\I 'W.1 ,i�s' fJ,tf ! tl;t1,11!n le . mP ❑ Cora n but in s ss to ground, or exceeds 14,000 ❑ Conuuercral "use agricultural 1- and 2- family dwcllmg ❑ Commercial /industrial ❑ Accessory building amps for all other inatallettons. buildings, ❑ Multi family ❑ Master builder ❑ Other ❑ Fire purrs. ❑ Installation of 75 KV A or V s f It , aq ^ 1ry� c t rp n t t �e 1 R, v , n vs (se �t�� p1 t r q a c � I R tt at' I l ❑ 't )• Enu:reency system larger ardtel d erived ste system 11' y, � 1 7 ! ' + ti l . 4 . , �� A � L , I � f �t,) ' ,SW • Ids, .'� , d' 1 F it l,,11 I t ' i S tl� Y Y kA II 85�i}ia! I. i 1:1 r �dlta ' ' l.:V,.Ii9CY M �� 1 e1,�i 7r tll' 1 �f �, »° ■ ttu��l il, , ,; u�.,;wFiQ7 i� �t91, +a' ❑ Addition of new motor load of Job no.: Rib site address: 132.17 , IN i C tan p� I001iP or more occupancy. ❑ Six or nw,e re,identiai units ❑ Recreational vehicle parks City /State /ZIP: " " ' d , O GI7 ❑ Healdncure incrbhea. 0 voltage for amps than 1 ❑ Hazardous locations. G00 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 ampa or more pp T...., _. - i` "1R �I�n. E 1 h1 } •, i i �. a�/rnu a= a !zfl. l�fwl i'1,11 r il; l lliu.' + ! `'��{ �; 1 4Jtel�u,a lls to job site: t�'1 'l�f �1 l l 1 ` "` s ++ Cross street/directio r �• Description �e� F eb. New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision; Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map/parcel no.: F.a. a dd'l 500 sy, ft. or portion 33 40 i am ` kI,;J4(" k "I ' ) r „ Limited en residential !" 11h1 r , ih ko t , I M'' n n ' t T.j1 7 c 9 i tw rig, d t , d I' , Ate. I .P ' °n 14, , l � . In 1 ' I'9 N . �k 1'�f � �� 1� i r wrthabove s 1L 75.00 III �2 /^' b / �� ' Limited energy, multi - family 75.00 III ) / 7 ie No07 Ckdc(; /U'r) " W _ residential (wltyabove aq. ft) Services or feeders inatallatio,n, alteration, and/or relocation i � ' I„ „1 f +A'' y f �• .x., r g 1 lllr V,.jS , t , Y' tlrt71 !T{te �R it�pw +1 201) amps or less 80.30 IN ,,A.3., t 4 ., 51 ' , � ' 7� �, ' Y, '?�:.L t M∎ ■∎'!:1 el�llii" eftCr4�i � .1,, t l;v�,� Zv is .n� r a>i il" �d 201 amps to 400 amps 106.85 Name: e � 401 lumps to 600 amps 160.60 - ".,./.. - — 601 amps to 1,000 amps 240,60 _ Address: _ Over 1,000 amps or volts '451.65 4 El CN' i • PI I - Temporary services or feeders installation, alteration, and/or �/ �➢ relocation Phone: ( ) Fax: ( ) 200 amps or less .....- " ".` Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps - 1(10.30 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 4 01 amps to 599 amps 133.75 EN Owner signature: Date: Branch circuits - new alteration or extension er pig A, tee for branch circuits with (i s ,Sri+�P 1+�9 t � r lw w� '" 1�, �J a} rl!'� {�� 11 i)"" lrr bfli' r i ,^r,q,npast " 0"M it ' I i . . ,, , �a tt , ' ., mist ,ti!l, , '. f E1 � l �i t�" If �a f t l t� u �' ? l ryl' Itli, , ,,� .,; ! YH ,,, above service or feeder fee, each branch circuit 6,65 Business name. _ B. Fee for branch circuits �. Contact name: -- without service or feeder fee, 46,85 4 bt8 first branch circuit Address: Each add') brunch circuit psi _ 6,65 y �- •• -- Miscellaneous service or feeder nut included City /Stale /ZIP: P.ach manufactured or modular dwelling, service and/or feeder ■ 90,90 2 Phone: ( ) Fax:: ( ) --- _ Reconnect only 66.85 2 E - mail: P '''�'{��{+n� �k�d,�f� ,r� 1y ,�±yr��tr' " } , r nfn ^1 X4a 1 � trty tt1 r� {{ Pump OT irrigation circle 53.40 2 i 414'SWf�t,.l'1YWtiELL'• Y'r:.. i1G" - R a .i' • .' 4s� r.iir '� ,� � ail l�' I i (a 40s l! a",I'c � �u i '1"l , it, i or 5340 as Rail l,. „r..,nx, ul,y'��, �,,thll,:, u,�f,�� ,w Si g° outLna lighting , 2 Business name: GAR N ER g ) Signal circuit(s) or limited- energy panel, alteration, or Address: 2 920 Ste GDd C g extension, Describe: Page 2 2 __ City /State /ZIP: ' a 1 "'? ,•.. ,�,� ,n 1 1 2 3 Each additional inspection over allowable In iw above a of the abo r u �, L�1 �7 � + Q �� Per inspection 62.50 - Phone ( 503 ) t , Fax x (srl) t(JLi ?J cia, — _ lnvesti per hour (1 hr nun) 62.50 II q Electrical Lie r �. �.11 - � S � 7 p7 � v- Lie.: w . B t 2 ..1 i Lie.: �.� Industrial plant per hour 73 75 " 1 ... � e� , lERC 1 ,n ". �)1l��l .,,.,; of �w fir Ptiai ; i �k 'Hie, r,, 11r SO Supry Electrician signature, required: 4 v'•„,�, "�try ") S /.;i� yr' _ Subtotal: 11,7;jrziis Print name: 4 i_.., , e Plan review (25% of p 01'rrnl fCC) Slate surcharge (12% of permit fee): ke - gO Z Authorized signature: w ^T TOTAL PERMIT FEE: fq 4 9 2 Print name: not applleat:en expires if a permi _ ame: y' is not obtained within 180 �� Date: 4,01 dap' after it has been accepted as complete. el • Number of inspections allowed per pernnt. LJJ�s V19 Td NdTP:2 6002 0T 'dS SE 6LZt'920S: OI�119d19 �1dN�Iti9: WO e 44 ,5' 5 7 - aao 7 -ate l to / Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received Date /By. Permit No. lig • ° 13125 SW W Hall Blvd., Tigard, OR 97223 Plan Review ' M Phone 503 639.4171 Fax: 503 598.1960 D ate /By. Other Permit. TI G A R D Inspection Line. 503.639 Date Ready /By. Jura ® See Page 2 for Internet www.tigard -or gov Noufied/Method• Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction Vt Addition /alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical matenals, equipment, labor, overhead, and profit CATEGORY OF CONSTRUCTION Value $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 0 .1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling i �QI ` r Air conditioning or heat pump Job site address: 1��11 � W UT�l ( t uY l ` (requires site plan showing placement) 14.00 City/State /ZIP: \ ( D . 22 3 Furnace 100,000 BTU (ducts /vents) 14 00 / ' Furnace 100,000+ BTU (ducts /vents) 17 90 Suite/bldg. /apt. no.: J Project name: J ,,/ Gas heat pump 14.00 Cross street/directions to job site: ( 62 4- n_ t ^ t Y lv/) Duct work / 10.00 JO 1� �" "J� Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14 00 Unit heaters (fuel -type, not electric), 1' ii' in -wall, in -duct, suspended, etc. 14.00 Subdivision: av r {. „ k QD ts Lot no.: 3 Flue/vent for any of above 6.80 � `J Other: 10.00 Tax map /parcel no.: Si o �'1" � CS i {`T Other fuel a pp liances DESCRIPTION OF WORK Water heater 10 00 n ,,Q _Q Gas fireplace 10 00 ?IA/ u� l V��11 (/ dot,ti No5y1ct-ocz Flue vent for water heater or gas n fireplace 10 00 ` 1 ✓1 /- 45 L.JX.// 67- EIvd /L`i Log lighter (gas) 10 00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 f, PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00 Q ) 0 Other: 10.00 Name: � i C / � ` � c� Environmental exhaust and ventilation Address: 3 JV�/ � e - y , ,1) (act equipment 10.00 1 1 1 equipment 10.00 City/State /ZIP: '"� 0 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( 51 1 .4 so 3 Fax: ( ) toilet compartments, utility rooms) 6 80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10 00 Other: 10.00 Business name: Fuel piping Contact name. $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall/suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: 1e^ A n 1 c , i �- Clothes d er (gas) ^ OtOther a t t 3 L1 � � Address: Q f r2, MECHANICAL PERMIT FEES* City/State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) -r Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) j. 7,0 TOTAL PERMIT FEE I v OLP Authorized signature: This permit application expires if a permit is not obtaine within 180 days after it has been accepted as complete. Print name: Date: • Fee methodology set by Tn- County Building Industry Service Board 1 \Buddmg\Permits \MEC- PermiApp doc 01/19/07 440 -4617T (11 /02 /C0M/WEB) • Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1: \Building\Permits\MEC -PermitApp.doc 01/19/07 2 .Jul. 30' 2009' 4:47PM No. 8908 P. 1 • V -- 033 9 19(x0 . , 1 y L L I V 1 Clean Water Services File Number % I la , � � 0 • 00 a- �� , 4 20 09 C1ean�lVater Services CV <1 B Sens live Area Pre - Screening Site Assessment 1. Jurisdiction: G . . 2. Property Information (example 1S234A801400) 3. Owner Information . , Tax lot ID(s); r9 :1 a1 3e,� Name: 11/1 i Him e k C Vt Company; Address: I X21 'j t ‘ Site Address; 119, (+ 5H 4 v ic..k,u1 rJ i1 TpA City. State. Zip n4. rd C1'P 9 8 ,.7,--_, .. City, State. Zip: 'IL . _ _ . Phone /Fax. .�13 _ ,S C) '-SLR Nearest Cross Strelet: E -Mail: 4. Development Activity (check all that apply) 5. Applicant Information X Addition to Single Family Residence (rooms, deck, garage) Name; ❑ Lot Line AdJUstment ❑ Minor Land Partition Company: A ❑ Residential Condominium ❑ Commercial Condominium Address; ❑ Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial [2 Multi Lot Commercial City, State, Zip: Other _ Phone /Fax: E -Mall; . e. WIII the project involve any off -alto work? fa Yes) No Q Unknown Location and description of off-site work 7. Additional comments or Information that may be needed to understand your project This applloatlon does NOT replace Grading and Erosion Control Permits, Connection Permits, adding Permits, Site Development Permits, DEQ 1200 -C Permit or other permits as Issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. Ely signing this form, the Owner at 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 end gathering information related to the project site. I certify that I am familiar vath the information contained in this document, and to the besi f my knowledge and belief, this Information Is true, complete, and accurate. PrintVType Name _Zit _ .*yZ� Printrrype Title OC-v vE'7Z. Signature 7 � bate "Z / /O `._ FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200' of the eke. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required, O Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site. This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas If they ere subsequently Iscovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 102.1. All required permits and pprovels must be obtained end completed under applicable local, Stale, and federal law Boned on review of the submitted materials and best available i nformation the above referenced project will not signilicantly Impact the existing o p otentially sensitive area(s) found near the silo. This Sensitive Area Pre Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas If they aro subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07-20. Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law. ❑ This Service Provider Letter Is not valid unless CWS approved she plan(s) are attached. I] The proposed activity does not meet the definition of development or the lot was platted after 919195 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS RECUT E0, Reviewed by ( --- Date ( 2(r50 SIN Hill boro'H iv = Hill )-6ro O, r_ yon 07 123 , I'iimr_: ('‘03) 601 ` r.1 i CiF,1 - WM. rin..nwalerNery r s.nrg i l' T coc Property O wner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# 1 Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or • I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Print Name of Permit Applicant ./ii_yi " /4 Signature of Permit Applicant Date Permit #: I 906 9 -0 to I ,-, 13 -1 �w „► Address: S �-• �;r711 �' .� I�ctre9 oQ. Or7 017.2; r7"' ,&;r711'4, ,i,, N � - i ; Issued Date: 9 (tcl l This Copy for Permit Offices ` IMAVIN DATE - RECEIVE D : .. '. _ ..:.. _' 8 . Wy U JUL 2 3 2009 .. r , , ' ... . LL,6 W ,. ; 1g g g! - wSt CITE' GFTIG gg latilDING DIVISION � _ _ _ �5 < � s C _ — _ NN 89 ° 53'55" E 0 1 �_ CBI o 69.01' . Z . r . ' . . L :_ v 17'-0" w > :. I I - -- I zz7n � I . 0C9 o Y � Oo m o 15'-5," * 99 1 aw ...... r A • ' i MAIN FLOOR i 3 g ;a EL._100.0' / 10' -0" N o �o ao / I� w c1-1 m W / / I�� I o l 1 --1--••=r 23... cs. ..,. ... J . .. . ., PROP SECOND 1'• ♦�\ ♦.\� ' 41/4. */ / l Cr.'' i � �i' � ♦ ice i ♦i � • / FLOOR ADDITION �• ♦ �� •��• � ♦i v3 / ♦ • ♦ ♦ ♦ • ♦♦♦ I EXISTING ,t... :A r ig rAar.!.. '.A` ■■ DRIVEWAY _ ■ / ■ 13500 PS I GARAGE 10'-O w / if. ■ ∎ . ,_ EL.:99.5' I uu 9e5 L af . . ,,. _, .- •. ii, , , ;'� . 0 5 • 4, � � �5 -0 -,1.19' �9' S� � A lto , , - , - h MET 9' WZ s.w. °C g WELLINGTON LOT COVERAGE Y • F HOUSE 2,275 SO. FT. ♦l L PLACE DRIVE 1,359 S0. FT. Vi0 TOTAL IMPERVIOUS 3,634 SO. FT. LOT AREA 8,507 SO. FT. V PERCENTAGE 42.7 X m 1- x C7 W C D 0 : z 7'' SITE PLAN o m O SCALE I ' : 20 ' -0' r x ° C O acn J < I— N �� 9 RE LT39AH SlCeT 7x 7T (e) ® WATTON DGN WORKS SITE CITY OF TIGAI}D • SITE PLAN REVIEW BUILDING PERMIT NO.: M,�I�2 • GO (l nl PLANNING DIVISION: Required Setbacks: 0- Approved ❑ Not Approved Side: 5 5 Street Side: �� From. Garage: Rear: Visual Clearance: el Approved ❑ Not Approved Maximum Building Height . feet �r s CWS Service Provider Letter Required: la Yes ❑ No ❑ Received B Date: "70-9/0 ENGI DEPARTMENT: Actual Slope Approved 0 Not Approved Site Plan: � � A{�proved 13 Not App ved By Wait/ l Date: 7 . Notes: c &12 4 11 - e-� / 24.4_ CITY OF TIGARD . SITE PLAN REVIEW BUILDING PERMIT NO: 11 ` • y , i I - I Street Trees. r.1 r! pproved Protec Trees, ❑Not Approved Approved ❑ Not A , proved Notes: �u '� Date: 7-, , Q