Permit •
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III
. " R e q uest Permit Action
- r IC A It 1 13125 SW Hall Blvd. • Tigard, Oregon 97223. 503.718.2439 • www.tigard- or.gov
TO: CITY OF TIGARD n
Building Division Services Supervisor v ( ti' _ .,
13125 SW Hall Blvd., Tigard, OR 97223 �. `,�`�
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov / % //Z '
FROM: p Owner ❑ Applicant ❑ Contractor ,g1 City Staff
(check one)
REFUND OR Name: I
INVOICE TO: (Business or Individual) CEpy F , Nes
Mailing Address: / CO oleo i�
9 o1 i+o E
City/State /Zip: R LAT 4 CD q 706:0 D-
Phone No.: 3- Let 2.- 3340
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
CANCEL /VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
R INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: H 4 D - 7 — .910 ( a. -001 1 % s t.J Q, A0 12- - 000 57
Site Address or Parcel #: 137 (p 1 ), S' 0 Pt--0€_.
Project Name: Co t2rx 14,0 j•-j E.,6 Ayr f.-Te xc:5 /�p. a.
Subdivision Name: CO f2T 7■ (4.o H e 3 f1'r ea( 4 .. 2 -Lot #: 12
EXPLANATION: ,u, H I -r1 t.. '(o — DI FF &.)--/ ge) Li_s E. Pc.A-t. .
SC- t1STzo /a — 40 v2S0, 1/ oi..2 - 000203
Signature: -... _ - ��., _ . ,! ' Date: 9 1,9. ( 17--
• Print Name: ¢ gPf iZ - PM) A- t
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. '
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2 -4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date '� friM B 6,_1,, Rte to Bid Admin: Date iBB1® B .;.•
Refund Processed: Date ii/ 1—. By.. Invoice Processed: Date /d ® B ;%•—
Permit Canceled: Date /p /Z /j By ,: Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 05/25/2012
Building Permit Application ki 0 • I 0 ,-,/,AL 4o/iv--
Residential - -. • __.. FOR OFFICE USE ONLY
City of Tigard -- ..._.,_,, Received
Permit No/y_s-r _a9/42 _
. • 13125 SW Hall
11 Blvd., Tigard, OR 97
Phone: 503.718.2439 Fax: 503.598.1960 MAY '2, ,.: ?OiZ Plan Rev f ,
( lal Other PenntSidieRIV -0O9
TIC
Inspection Line: 503.639.4175 Date ReadyTy: , i Jur ei See Page 2 for
AR D
Internet: www.tigard alrl p.:::-:-;•,. Notified/Met d: /tU f ?fs //CY" Supplemental Information
f'''' 7 -' • n: :.::-.' .4-4tItt., .
• , . , ‘..... ....... I !L.....1‘..:1\:
' . .. -• • . • • . • TYPE OF WORK REQUIRED DATA: 1.7AND1-FAMILY. DVVELLINd : .. lc
J O New construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
0 Addition/alteration/replacement 0 Other: equipment, materials, labor, overhead, and the profit for the
'; ....:-.. !,..:' .. '.7 . :. • ;.' " . -:;.' ■ • .■
C . •15E. .CCiNSMCION , " '. .:- : : '.: . ''' :' ; . work indicated on this application.
0 1- and 2-family dwelling 0 Commercial/industrial Valuation: $
0 Number of Z;\
Accessory building 0 Multi-family Nb f bedrooms: 4- --
Number of bathrooms:
0 Master builder 0 Other: 5-
.Top AND •LOCATION . - , . i Total number of floors: 7...---
Job site address: /57 ‘V'• g ( ?° 1:t New dwelling area: -24 !are feet
—
City/State/ZIP: Tigard OR 97224 Garage/carport area: 4 1 2.( square feet
,
Suite/bldg./apt. no.: Project name: Covered porch area: zoo square feet 15--- 6 - ,)
Cross street/directions to job site: Deck area: square feet / ( z t kg
Other structure area: ?() 78 square feet 2
REQUIRED D4TA: comivigRaa,uEenvapsisti:
Subdi ,eco,) 2— 1 Lot no.: 18 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map/parcel no.:
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application. h
Valuation: s
Existing building area: square feet
New building area: square feet
:••*;''::)..: „: 5pRoggo:pcyrrot .. , ;;., :,...,. Et TENANT '' '' ..,:' • ' . . Number of stories:
. Name: ( . ,,,,,(-,.... ce,,,,,,f- 4) 4- c..- . Type of construction:
Address: /12,4:77) . c .(-- Occupancy groups:
City/State/ZIP: --/ cr , .., ,. T2 °(Z__ Existing:
il Phone: ( 5/>3 4c? 2.--S 3 I 0 Fax: (,,Z 3 ) C yz-s 33 New:
. •
FEES
/I .1:'....: ''' itt'Al - • -
c i ,..... ; ..,...s . , .. . ,. . .. . . J : . a CONTACT PERSON BUILDINGPERMIT'!'.
. . -:c
(Please rarer to ferscliethdep - ...
\- name:
5a , - _ 0-le Structural plan review fee (or deposit): 9 5- , (T v
..._ Contact name: e • .
., .e..4. -e - _
FLS plan review fee (if applicable):
Address: /1 2...cm -fc.4.) za l
..n Total fees due upon application:
t City/State/ZIP: ""T e.., .1 Oa— '7 2— .
‘),.. Phone: (611?) 6. - 31 f a Fax: : (5423)4 f 2_-.3- y3 1 Amount received:
P SOLAR PANEL SYSTESEFEEST:
t t... , ° E-mail: /..e.dir CP aro.d*zo,,e_cros,
.
' -. ?.
: Commercial and residential prescriptive installation of
.'.'.:7,! • .f. , . : .00 .. • , : . • • ' . -..; • roof-top mounted Photo Voltaic Solar Panel System.
,,J\ Business name:
Submit two (2) sets of roof plan with connection details
6 e67 /c 0 l 40".
and fire department access, along with the 2010 Oregon
((\ Address: / 7 2-cro 5 - c ,... ) yc -e--e, Solar Installation Specialty Code checklist.
City/State/ZIP: 17. (,....t 0( 1 •) 0 C- 2-- Permit Fee (includes plan review
$180.00
and administrative fees):
Phone: ( ) 4.1'2 - ,? 'tS Fax: ( 5 t ? 2 - 5 c e 3 3 State surcharge (12% of permit fee): — $21.60
CCB lie.: - i' , ii: 3 s
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.
Print name Date Fee methodology set by Tri-County Building Industry
: ii9c : 5-fir/K2__ * Service Board.
1: \BuildingiPermits \BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
. . .
,
Plumbing Permit Application „.,,, ,, ,
.,,..... .-4..! ,/ i • it T, --
Buildin Fixtures FoR OFFICE USE ()NEN
City of Tigard MAY .U/4 m Received
Permit h2 IV //
- 2_,
Date/By: Necr 0
q 13125 SW Hall Blvd., Tigard, OR 97223 ,--,,,,,-, .,,, 2 4 4 Plan Review
IIII a Phone: 503.718.2439 Fax: 503.598.1960,1H '' ,.:•';;'''',, ,7• ; ii Other Permit No.:
Inspection Line: 503.639.4175 Date/By:
:1 ill...... -- ,:-.. Date Ready/By. Juris: El See Page 2 for
T 1 G AR I) -
Internet: www.tigard-or. gov vs- ;....4:i t'4:.:),70Kitslotified/Method: Supplemental Information
TYPE 1 0F We* •••... ,:.:- .!...,:.: :,..., .., :. , • • -. ....-.: . , • . • ..-: ,TEE
PNew construction Demoli .. ti
on
. . .. For special information use checklist
it I__,
Description I Qty. I Ea. I Total
O Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
: ''',.. ''''.. .: ' • Y .. .,-•:- . OF . diNSiIitICiON : - :: !. • . , • SFR (1) bath I 312.70
SFR (2) bath 437.78
O 1- and 2-family dwelling 0 Commercial/industrial
SFR (3) bath t 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder CI Other: Fire sprinkler ( sq. ft.) I Page 2
. . . . . .
i'3'..'r• ' ': 7:'460,-fit:tOcitOrioN7.:Agii.4cicAITION.: . . .• . : :...,....: Site utilities:
Catch basin or area drain 18.76
Job site address: Drywell, leach line, or trench drain 18.76
City/State/ZIP: Footing drain (no. linear ft.: ___.) Page 2
Suite/bldg./apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ___) Page 2
Water service (no. linear ft.: _,....) Page 2
Subdivision: I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
' "';'. ':''''' .I. ' '' ''' '. I IiiiCittPtItii; OF . ":: -./ • ,. . ..... . . ..
. . - Backwater valve 12.51
• •••.....".•--,::•4 :. -..: . . , ,. ,.. . . . . Clothes washer 25.02
ae 44.1 /4/bat. _
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.:',...lkt*V-itoih446t ::f.....'':•,;4; ir.:;::•:.,i.;:"•;i:, ,..: ..11:litNANr •: •.:' !...• Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 6 e Cl d /4.4, Floor drain/floor sink/hub 25.02
Address: / 9 Zt:s 6 1%.4-) ifia -0 1 Garbage disposal 25.02
City/State/ZIP: 1 41 2,,i C)/Z. 9 $ 2e) 4 2_ Hose bib 25.02
Phone: (S63 )612- f ) Fax: (133)472- 5" 4 3 Ice maker 12.51
;;'•!.,, .•;:' Ai4tiiiii,-,....;,:;,:•,.....!..:•'.i..,•,■.-2,;,!;:',:i.:fitiOityii.4.0......,pkitgpS 02
7' i . ; .1: : : ,. Interceptor/grease trap 25.
Medical gas (value: $ _ ) Page 2
Business name: Ge c i- di A-e._ -
Primer 12.51
Contact name: /4,,,J 6 , e4.1"-E Roof drain (commercial) 12.51
Address: ley 2. Cr 4.37 _
Sink/basin/lavatory 1 25.02
City/State/ZIP: <Ct. q, (4..6:4) oe'L q?eL 2-- Solar units (potable water) 62.54
Phone: ('63) 4 cr2. - 3 3 qo Fax: : (503) 4 ?)..- 45-y33 Tub/shower/shower pan 12.51
Urinal _ 25.02
E-mail: /(0K &q 0 , COO, . .
- • : I
.. 4
!.; 0'.'d.4 :i...- Water closet 25.02 ....... - , - 7•'' . . .7
,ii.::i ,.!. ,, .: tf .' -i ., :L.; : : ...; . . .. .: 7:„':`. '... e .• 3 . ' " , • •- • "%• Water heater 37.52
_
Business name: _-- c f - P 6 Aft i I t, Water piping/DWV 56.29
Address: P 0 3 0 s . 2 7(-( Other: _ 25.02
City/State/ZIP: w es -t 4 ; N 6/4 17 OC8 Subtotal
Minimum permit fee: $72.50
Phone: ($63 )s5 '2
7. ,- g 5 Fax: (SG3)65111 2-
Plan review (25% of permit fee)
CCB Lic.: 1 b3 7 / 2.... Plumbing Lic. no.: 3-251 Pe • State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
,. . ,..„„
: This permit application expires if a permit is not obtained within 180 days
Print name: Date
after it luu been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Buildineamits\PLMU-PennitApP.doe 10/01/09 440.4616T(10102/COMAVEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information -
Fee Schedule: Residential Fire Suppression Systems:
Site..Utilities . Qry..
t
Foo100' .. ' Square'.�Fo'tit,� � �::. ; :: ,, �:..; . ; r ..•:,,.,
t drain - 1° 50.03 0to2 $121.90 2,000 �,e.. $e1F 11�. ' @e.. '• .' .... : • .r .
Footing drain - each additional 100' 37.52 • 2,001 to 3,600 $169.69
Sewer - 1st 100' 62.54 3,601 to 7,200 $233.20
Sewer - each additional 100' 7,201 and greater $327.54
37.52
Water Service - 1st 100' t 62.54
Water Service - each additional 100' 37.52 Medical Gas Systems:
•
Vataation:� ,
Storm & Rain Drain - 1st 100' 62.54 Pe"
Storm
& Rain Drain - each additional 100' $1.00 to $5,000.00 Minimum fee $72.50
37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
:Other Or Fees Qty... Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or for and including $10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof, to
Inspections outside of normal business 90.00/hr and including $25,000.00.
hours (minimum charge - 2 hours) $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Reinspection Fees 90.00/hr each additional $100.00 or fraction thereof, to
and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
•
•
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
•
accurately report fixtures could result in increased sewer fees * .
Quantity by Fixture Type Plan R e v iew f Pliim 1<tl>g; 1
Fixture Type for Replace/ �! _A1U>119
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath - Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain '. • 1:9�Oti1,C Or'R19er . jgi '. • . ,
Garbage Domestic -non -food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic -food related that meet the qualifications above.
•
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http : / /www. ti gard -o r. gov /city_hal I /departments/ed/docs/P L M F -Perm i tApp2do c
Mechanical Permit Application \,,, 0 I lh log 01:Fi(i.: usu:
City of Tigard T.: .. Received
' • ‘:"--./':'':- ..• V . ...'1.. Date/By: Permit No.11 91 g,, i I?-
• 13125 SW Hall Blvd., Tigard, OR 97223
.
1111 Plan Review
: I I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 i ,. ); A Date y 2 4:: 2 0 , ,
T I G A R D I I- Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard Notified/Method: Supplemental Information
OF
. . .
.
COMMERCIAL FEE'' SCHEDII.S.
WORK.: - -.... . ,
Mechanical permit fees are based on the value of the work
New construction
g
0 Other: .•
Demolition 0 Addition/alteration/replacement
• rm *
perfoed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit
Value: $
:. - ....,CA:FIRGORY , O . F . CONSTRUCTION „. -,, -, • - . : . . , , - . . REstDE g 1§W.fiiilsitisli,;'7:'
11 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
':.:iO13 SITE INFORMATION AND LOCATION. - :: ' ' • ' .. -'. . • Heating/cooling:
' Air conditioning
Job site address: 5 To 14-1 (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 1 46.75
City/State/ZIP: -7 a. „...„,p DA__ f ? 21c-(
„t7 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 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75 .
Subdivision: - .c .4)7 Z. Lot no.: / r Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK • . ....,.. : s -. . .. . . .... .: .. Water heater I 23.32
Gas fireplace/insert 1 33.39
At -e €4..) il(a •ft-e, • Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
?.':-.,t...,f,'2-4t1.:1;'.e,i',AglijitOlificfaix,iiiiiiisr.:: ..:' - '.iki, . ..' '-..-. :....;i;;;' ,.. ,.,,.. . Chimney/liner/flue/vent 23.32
' Other: 23.32
Name: 6 tu a M s-t d 664..., Environmental exhaust and ventilation:
Range hood/other kitchen
Address: / 7.0-b 5' 4-1 4 eC, 144 equipment I 33.39
City/State/ZIP: -"I:. ( IC, .) 04_ ' )C ‘ L. Clothes dryer exhaust 1 33.39
Single-duct exhaust (bathrooms,
.6
Phone: (6/ ) 41,2.-33 f6 Fax: (5 6 3 )17 2 r'' 3 3 toilet compartments, utility rooms) 23.32 I (67.1ze
Mrfirl,VA4*4.i:! , '- ; -POISON .. ... Attic/crawlspace fans 23.32
. Other: 23.32
Business name: A i ta , 1/4 4 2.... 6 A. p.1- d 4-.,,, Fuel piping:
Contact name: i.s.,j c••-lesz,_ $14.15 for first four; $4.03 for each additional
Address: 67 ,2.4 ‘1-.C.1 t et ..1d(") Furnace, etc. I 1445
Gas heat pump
City/State/ZIP: 7i„,,...62,4,-,..) OA f 70C 2___ Wall/suspended/unit heater
Phone: (soy ) 4 2_. - 4 31 el Fax: : 03 )4?2, s C113 Water heater I
Fireplace 1
E-mail: /.(, ,„ 0 qe,...-teg_c . , 00,0-7 Range 1
" '' .''':...:".": 7 s -'.':.'.';'::%.' ..l'etiikilirillit ...•••:...,.•-• T ' •. .!-.. .' • '.• ..:.' Barbecue
Business name: 6466 Cm C,e pp, -rrh. i it/ . : Clothes dryer (gas)
Other
Address: / 0 . 4 tr. g Z ilaq . • . MECHAMM-00 'I" '' ' 1 ' , tEES'?";:." -, ;: ',. -1',
City/State/ZIP: V eig e ocau44. eJ4. I 'hi 4.8 2- Subtotal
Minimum permit fee ($90.00)
Phone: (S03 ) 4 5- . 5 . 6 22A Fax: (W ) 4 so - 21f3 Plan review (25% of permit fee)
CCB lic.: 4 /2 571 State surcharge (12% of permit fee)
4,...,....../'ei
/ days after it TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature:
has been accepted as complete.
Print name: 644,11,...-- Date: 5/;02__ • Fee methodology set by Tri-County Building industry Service Board
I:\Building\Permits\MEC.PermitApp.dOC 03/07/12 440 (1 I/02/COMNJEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information •
Commercial & Multi - Family Fee Schedule:
' ?otal' Va of o'n '': c Perm
$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.
I:\ Building \Permits \MEC- PennitApp.doc 03/07/12 2
E:__;..N L.;,. \ / " 'ON i•
EYectrical Permit ApplicationV A, FOR (OFFICE l S1: ()MN
III City of Tigard ' :'.. red Permit No. s �d2; / ./ill O1 a--
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 MAY 4 r Date/B : Other Permit:
f I c; n {t D Inspection Line: 503.639.4175 2 J I A Date Ready /By: lurir la See Page 2 for
Internet: www.tigard - or.gov ;., Notified/Method: Supplemental Information
. TYPE OF'WORtn LI:1 1;∎ ,! 4 _ . P1AN'REVIF' 0! •,r;•.i;, 0: • N ew construction ❑ Addition/alteration/replacement Please check all that apply (submit a 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.
‘•l '. ' ' 1 '. : ' • '' • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
•, ; .. CATEGORY laF� �:O1V�'ItUG'i'IO1V.. ' ;: �.: ; :: `', ,, : �` ..: .. :..,.� .
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 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
0 Emergency system. larger separately derived system.
. B SITE I NF O RMAT I O N AND :.LOCATION:' . . •
0 Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: 5 c.,,) f Q 100 or more. occupancy.
or
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: + �,,�Q �/L g 2 Z ❑ Health-care facilities. ❑ Supply voltage for more than
f ❑ 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: Deacription I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: c c - Z Lot no.: /er 1,000 sq. ft. or less ( I 168.54 4
5 , .J ib - ur Ea. add'I 500 sq. ft. or portion 5 33.92 I b1, (oQ 1
Tax map /parcel no.. I
Limited energy, residential 75.00 2
. : ".: ; 4 " '' DES •. ... 1)'O]!1: Ob'' WORK ; . • � . ,: ; , . -- :.: (with above sq. ft.)
Limited energy, multi - family 75.00 2
e residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
• :;;.,..,• . .:pgi.PROPERTY OWNER.` ::!: '..1 .. p TENANT'.. 201 amps to 400 amps 133.56 2
Name: G L , .te C=am,J4 ' ±. ( 401 amps to 600 amps amps 30.04 2
/L `'P 601 amps to 1,000 amps 3011.04 2
Address: / ct 2 401 S ez cg, 4 C Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: T , , ,d 02 q 7 Q 6 Z relocation
( `06 ) / 72 _ 3 � \ (5 2) 4 . e f 7 2 200 amps or less 59.36 1
Phone: `J (O L V Fax: J�'a -� 6 1, — 7 c7.,,�
2W amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not - aol 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
,
APP)r 1• • .. ' ' =. • s , .CONTACT: PERSOI!F above service or feeder fee 7.a2 2
• each branch circuit
Business name: G t �z..--- Cam.. s--- ce, (,_ B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: '/ branch circuit
� � ar�� L
�,(/ � Each add'I branch circuit 7.42 2
Address: (T 2.4-0 1 k•) G y 1 Miscellaneous (service or feeder not included)
City/ State/ZIP: ,i 6.4 A ag_ l q OG Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: (SO3 ) 4/2_ /3 .7 a Fax:: (5d3) C.1 3 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: 4pA,1 w4;(2..c0 , 4 -C,..l
.r %i µ:°fa , t '. ^3 (y �� ��p ..• , . 'i : . . - t :7 Sign or outline lighting 67.84 2
'.: :ltY. ^,.. • 1:. , 1.1 �1 T1n4:1:/If'/ � ;'' :' . .. .'' ' , , Si 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 (%r hr min)
CCB Lie.: Electrical Lic.: Suprv. Lie.: ELECTRI hL..PFs .''L)E5., . '
Suprv. Electrician signature, required: o 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
Print name: Date: days after it has been accepted as complete.
N umber o inspections allowed per permit.
I: tBuildingPermita\ELC- PermaApp.doe 07/01/10 440461ST(11 /0S /COM/WEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESII}ENTIAL: WORKONLY: •
Fee for all residential systems combined $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
Heating, Ventilation and Air Conditioning System*
12 Systems*
❑ Other:
' COM],1NIaCIAL:. W ORK .ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
1:\ Building\PmnitAELC•PmnitApp.doc 07/01/10
Vol _. ,
I o ° Building Division
Development Code Provision Review
T I G A R D Residential Projects
Building Permit No: fST0 4 /a — 00//
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A r
Routed Plans:
Original Plan Submittal Date: s/as / /Z' 4`+' r
1st Revision Submittal Date: ❑ Site Plan Only
2 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 (1) 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 C144 R(1 at 503 -718- or @tigard- or.gov)
Land Use Case No. JosOnn7-406/ Name * Cd 2_
Er Zoning X g
Cr Setbacks: /
Front Rear /. Side kiAr Street Side /.S Garage
I aximum Building Height JU Actual Building Height •• e?3 {+ -f-D n,; d p a;., 4
0 Visual Clearance o F ezi 04-
12' Easements
ErSensitive Lands Type:
Notes: s i fe pia./ not fi scale y d ;n- f" r onr sh4,4 n r".1.1 Je
v e , R.r..• „1-+ . M i.l;1 4, wA.. P l a n ■ s K tc.i d Pri a r -it et ten. i f
S A t a K �.e.. T , - c . . r 4u be . S c w c di n s I t A or o-' , el." o vc d n1 u4 4-- b.c. sh e a n
o r, -tvta i-- P (ar, pet -k c to d- d+. H n c Ge PIS 4 c -k a .i..
Original Plan: Approved yi Not Approved ❑ Date: 5 -•? 9 - IA !�
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)
H Actual Slope: 5
Notes:
Original Plan: Approved Not Approved ❑ Date: 5 3/12-
Revision 1: Approved ❑ Not Approved ❑ Date: +
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
r
City &rborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
/s treet Trees
Protected Trees
Notes:
Original Plan: Approved Imo' Not Approved ❑ Date: 5 -3 t --ia
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 Applicant
Okay to Issue Permit: Yes No ❑
Date Routed to Building:
•
•
•
•
Page 2 of 2
TIGARD,
Wednesday, June 20, 2012 City of Tigard
Ken Gertz
19200 SW 46th Ave.
Tualatin, OR 97239
RE MST2012 -00112 & SUB2007 -00013 Edgewood No. 2, Sewer Reimbursement Fee
Deferral and Fee -In -Lieu of Undergrounding.
Dear Ken:
As part of our review of your building permit application, MST2012- 00112, for 13762 SW
90th Ave., we have reviewed the status of the underlying subdivision land use approval,
SUB2007- 00013.
Our records show two fee items for SUB2007 -00013 that remain unpaid. Both of these fees
must be paid before the MST can be issued. You are probably well aware of them and the
purpose of this note is simply to remind you of them so that there need not be any delay in
issuing the MST when it is otherwise ready for issue.
The two fees are:
1. Per Condition of Approval #51, a Fee -In -Lieu of Undergrounding for Edgewood St.
in the amount of $8,655.50 per; and
2. Per Condition #40, the balance of a Sewer District Reimbursement Fee in the
amount of $21,832.00, payment of which was deferred in accordance with a deferral
agreement signed by you and dated June 29, 2009. A copy is attached.
There were originally three parts to the Sewer District Reimbursement Fee:
1. A $6,000.00 initial payment which you paid on June 29, 2009, receipt copy attached;
2. A $9,000.00 amount that was forgiven upon your payment of the $6,000.00;
3. The balance of $21,832.00
Please let me know if your records do not agree with ours in any respect or if you have any
questions.
•
Thanks for your cooperation.
Sincerely,
//7 P
Albert Shields
Permits /Projects Coordinator
cc: SUB2007- 00013, Kim McMillan, Debbie damski, Greg Berry.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
RETURN RECORDED DOCUMENT TO:
CITY HALL RECORDS DEPARTMENT,
CITY OF TIGARD
13125 SW Hall Blvd.
Tigard, OR 97223
INDIVIDUAL
File No. 0504
City of Tigard
O'Mara/Edgewwod..Sewer Reimbursement District No. 3 1Deferral Agreement
City of Tigard Resolution No. 03 -55 provide that payment of certain portions of reimbursement fees
imposed on lot owners who have connected to sewers construction through City Reimbursement Districts
(Tigard Municipal Code Chapter 13.09) may be deferred until the lot is developed.
The undersigned owner(s) of the real property described below do hereby acknowledge deferral in the
amount of $21,832.00 and record their agreement to pay this amount to the City of Tigard upon partitioning
or otherwise developing the property in accordance with Resolution No. 03 -55. The obligation to pay this
deferred amount transfers to purchasers upon sale of the real property.
The real property that is the subject of this agreement is within the Edgewood Plat Washington County (Tax
Lot 2S102DC lot 01400, addressed as 8990 SW Edgewood St, Tigard, OR 97223) and subject to land use
decision Sub 2007 -13. -
IN WITNESS WHEREOF, I hereunto set my hand on this Z9 day of JAA n e , 2009
/K e» -{tt.�j C����tt �rx �� .
Print Name Prin I e
•
Signature : ignature
Address Address
Ti lard OR 97223 Tigard, OR 97223
STATE OF OREGON )
)ss.
County of Washington )
This instrument was acknowledged before me on (4 7 2 — 9 / 0 7 (date) by: /\ 2 h q e r I 1 L '
(name of person(s)).
#"..) OFFICIAL SEAL • ' Notary's Signature � _ - • "
(Y ) K RISTIE J PEERMAN � J
( NOTARY PUBLIC- OREGON f)
� _° ' COMMISSION NO. 419242 ( My Commission Expires: u l' z 8, ao /
MY COMMISSION CY.PIRES JULY 28, 2011 v
��• �-c or �ca `:a s." 1-;L'S
Accepted on behalf of the City of Tigard this , q day of J , 2009
J I _ l /
City Engine
6 , AAANAA*1NO CHANGE IN TAX STATEMENT
rA vNg-v
R E CEIV E D
MAV 2 2012
gUI L DIn � F TIGA R D
Walter H. Knapp & Associates, LLC � IV ISION
Consultants in Arboriculture, Silviculture, and Forest Ecology
1223
MEMORANDUM
Date: May 24, 2012
To: Ken Gertz, Gertz Fine Homes
Cc: Christy Wiegel
Re: Tree Protection, Lot 18 - Edgewood East
Reference: Site plan, lot 18 — Edgewood East 5/17/12
As shown on the referenced site plan, trees Z04 and Z10 will need protection during house
construction. The following protection standards are provided for this lot.
Protection Standards:
1. Prior to start of work, orange construction fence shall be installed at the tree dripline,
which is a measured distance of 18 feet from each of the trees as shown on the site
plan. The area within the fence is designated as the Tree Protection Zone (TPZ).
2. No construction activity shall occur within the TPZ, including but not limited to
dumping or storage of materials such as building supplies, soil, waste items, or
parked vehicles or equipment.
3. The TPZ shall remain free of chemically injurious materials and liquids such as
paints, thinners, cleaning solutions, petroleum products, and concrete or dry wall
excess, construction debris, or run -off.
4. No excavation, trenching, grading, root pruning or other activity shall occur within
the TPZ unless directed by the project arborist present on site.
%"4' '
Walter H. Knapp
Certified Forester, SAF 406
Certified Arborist, ISA PN -0497A
Certified Tree Risk Assessor, ISA PN -450
7615 SW Dunsmuir Lane, Beaverton, OR 97007
Phone: (503) 646 -4349 Fax: (503) 747 -4863
•
►' Ketch..! 6 -3 /- la S 70,'A Pt . - ✓r. e,^.,
•
•
Tree Protection Verification - Edgewood East Lot 18
Tree protection has been installed as shown on this
plan and verified by me In the field. Protection of
tree KZ 1 Is provided by fencing of tree #Z10.
4 :► Street trees Zelkova Elev. 200
:' Serra to 2- 53 ' Walter 5.31.12,
� Walter H. Knao
0 Street trees 11110 STORM E SMT
Ameranano 2 i. � \��l
li�� 6,2; Sir
I � °, V 0 1
Co 0
! I 1 I
I I I
I
rn1 I
el 0 • � o0
rn ,
'
Elev. 205 S,1A
O y I - -c," L LL L 1l
I ❑
O 5 ; —„ -I o
IIIIIIIFk
C CO Elev. 205 , ' — "
J V) I -
SEE LOT 1 8� e �• "'- —
.,. I `�� >< - ". I
VCE DETAIL �! zin %,
Elev. 204 , ' ` , ' "•. r c
' .,., ` c.2\
������ r 4 1 — W` 0
r 16 if
nw ■
Elev. 205 ' 3 9.70'
Elev. 206
SW 90TH
GER Z C INC.
HOME SQUARE FOOTAGE
MAIN FLOOR • 1121 SQ.FT. BUILDING
UPPER FLOOR • 1538 SQ. FT. CUSTOM HOMES SINCE 1977 / ZI
(503) 692-3390 Wir
TOTAL - 2857 SQ. FT. SW 90th
GARAGE • 421 SCUT. Lot 18 EDGEWOOD EAST
SCALE 7' n 20'
GERTZ CONSTRUCTION COMPANY INC.
PLOT PLAN 5/17/12
RE CEIVED 11-7
.1Y 2 4 20
C
Street trees Zelkova • Elev. 200 801,0 N, ARD
"0 Serrata 2" 200 53.70' v i sioN
Elev. 200
O Street trees Tilia l - STORM ESMT 0
�N A 6,282 SOFT - - -- -- - - - - --
u
y
; , ► N � v►
1 1
r � 7ti°GUPJ:
�Q 0
0 Ptic.
0 aill°‘i N � e ' CO /7 / '
vi I II e/678 7ic� 4Ev -a-' aft
.... , ,,---, II .1'. - Pv otiv- A
� Elev. 205 o
CO - 1 Elev. 205 0
i u, r - N
SEE LOT S e�,e� R - - , 00
LO 18 �� 1:� ,
VCE DETAIL ' `° P� 1:, co
Vi — -�
`�, `' — �o - -- o
Elev. 204 a0 , � ;, k /f , '. > ? E
�\\ o
j liio -- ---- --
A pm ._.,
• 0 IF,
Elev. 205' 39 .70 '
Elev. 206
SW 90TH 1"
G ER Tz 00
NC
HOME SQUARE FOOTAGE ' BUILDING
MAIN FLOOR = 1121 SQ.FT.
UPPER FLOOR =1536 SQ. FT. CUSTOM HOMES SINCE 1977 Z)
(503) 692 -3390 �I
TOTAL = 2657 SQ. FT. SW 90th
GARAGE = 421 SQ.FT. Lot 18 EDGEWOOD EAST
SCALE = 20'
GERTZ CONSTRUCTION COMPANY INC.
PLOT PLAN 5/17/12