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Permit A e A r - c ; .4 _ ..) - e-, e ,.. n el) •�' '-', ` ..i MASTER PERMIT p CITY OF TIGARD � ° � PERMIT #: MST2006 -00255 COMMUNITY DEVELOPMENT DATE ISSUED: 1/26/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134CC-02600 SITE ADDRESS: 12005 SW 122ND CT ZONING: R -4.5 SUBDIVISION: YE OLDE WINDMILL LOT: 012 JURISDICTION: TIG Project Description: 384 sq ft accessory structure. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ACS HEIGHT: 12 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 384 of FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: 1.11 BDRM: BATH: TOTAL: 0 sf 9.331.20 REAR: 10 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 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: MAX INP: btu FLOOR FURNANCES: VENTS: W00DSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 • 200 amp: 1 0 • 200 amp: W /SVC OR FOR: 3 PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 • 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601*amps•1000v: MINOR LABEL: 1000* ampNolt : PLAN REVIEW SECTION Reconnect only: »4 RES UNITS: SVC/FDR> =225 A.: > 600 V NOMINAL: CLS ARENSPC OCC: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 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 0 SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code. State of OR. Specialty Codes and all other applicable CRAIG FOX OWNER laws. All work will be done in accordance with approved plans. This 12005 SW 122ND CT permit will expire if work is not started within 180 days of issuance, or PORTLAND, OR 97223 if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 -001 -0080. You may obtain copies of these rules or direct Phone: 971 -570 -9680 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 478.56 REQUIRED ITEMS AND REPORTS Issued By : ___,./.44,2" Permittee Signature : 6;6e Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building p Permit Application FO OFFICE use ONLY City of Tigard C E oVE® Received / ®� A , Permit No.: r f. /w �j hr g �4� Plan Review . /0 II - ° 13125 SW Hall Blvd., Tigard, R Plan Review • Phone: 503.639.4171 Fax: 503.5; j1� 7 ' D , • 7- Q ,,� Other Permit: . T I G A R �� Inspection Line: 503.639.4175 U 1 Date Ready/By. ® See Attached Checldist for Internet: www.tigard- or.gov Notified/Method. Supplemental Information CITY 111tN BUILD% i TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING New construction ❑ Demolition Permit fees* are p based on the value of the work erformed. O J 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. ❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 9li0 lit Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: D JOB SITE INFORMATION AND LOCATION Total number of floors: ( Job site address: / Z 00 5- S • 1-' (, 2-2, H d c f. New dwelling area: 0 square feet -A City /State/ZIP: t /5 a r a OR 97 Z Z 3 Garage /carport area: 3 R / , square feet Suite/bldg. /apt. no.: -- Project name: S h Covered porch area: O square feet Cross street/directions to job site: /<'a -•1-11 7 h Deck area: 0 square feet Other structure area: D square feet ' REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivis ion: Ye a /d' G✓( III I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Gl CC e .Sp ly g f /( /C' l el /e Valuation: $ Existing building area: 6 square feet New building area: 3 R-ef square feet PROPERTY OWNER I ❑ TENANT Number of stories: Name: C vial) fo N4 Type of construction: I S f I ✓ aK d Address: l 2 Oo s' S- /2 7 111 C - . Occupancy groups: City / State/ZIP: 1s a rci 0 4 77 2 7_3 Existing: Phone: ( () ,s- 70 `- ce 6'8'o Fax: ( ) New: ' APPLICANT par CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board pi . --...- under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons Cit / State/ZIP: pp P g y apply: Phone: ( ) C n I Fax:: ( ) E -mail: c71 ` r ( 11 t`%1 'C 0 1 �\11��n . `` v l (1 \I o CONTRACTOR Business name: lt■J/ BUILDING PERMIT FEES* • Address: , ^ o /'/� (Please refer to fee schedule) • City / State/ZIP: ( I I/ t V �/ Structural plan review fee (or deposit): Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: C---- Total fees due upon application: r / Amount rece C / �► 5 Authorized signature: /- This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Cie" S t I Date: • Fee methodology set by Tri- County Building Industry Service Board. 1 : \ Building \ pen, ia \Bt1P- RES- PamitApp.dac 0321/06 440.4613T(II /02/COM/WEB) • One- and Two - Family Dwelling Building Permit Application Checklist rc,ii orrICE tiSI•: ()Nix City of Tigard R1V0d Permit No.: 1 1114 n 1 3125 SW Hall Blvd., Tigard, OR 97223 A Associated � sodated permits: • C Phone: 503.639.4171 Fax: 503.598.1960 . • vi I GAI:I : ) 24- Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical • Internet: www.tigard- or.gov ❑ Other. 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- ❑ ❑ ❑ n protection, etc. 1 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ ding 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. K 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, ❑ 0 ❑ 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. - ?. X 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. (.. Manufactured floor /roof truss design details. ❑ ❑ ❑ 4 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore Ion and shall be shown to be ...livable to the .ro'ect under review. , .IURISDICTION' \I.. SPECIFIC' Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". • • • Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 5 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 ❑ 0 ❑ Street Tree List. • 29 Site plan to include tree protection measures as required by conditions of approval. 0 0 ❑ 30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ Inc n u pa tio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\ Building \Pcmits \BUP- RFSPmmitApp.doc 03/21/06 Plumbine Permit ADDlication r Building Fixtures ��CEIVE' FOli t)FFICI:. I;sI: ONLY City of Tigard OCT 2 e Zoos �,o iy/a/ 1, /� Permit No.:; / �?0 X �� 111 V 13125 SW Hall Blvd Tigard, OR 97223 Plan Retie f / l!� -�'�i Phone: 503.639.4171 Fax: 503.598.1 OF TIGARD D�eB Other Permit No.: • TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By. 1 ' . Ea See Page 2 for Internet: www.tigard -or.gov Notified/Method: ' ( 1( Supplemental Information TYPE OF WORK FEE* SCHEDULE ' ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 ❑ 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: (ZOp 5 G/ /. , z ,1rt t' 7 Catch basin or area drain 16.60 City /State/ZIP: 1 ` 'S a id 6 Drywell, leach line, or trench drain 16.60 • Suite/bldg. /apt. no.: I Project name: Sy Footing drain (no. linear ft.: Page 2 Cross street/directions to job site: f Manufactured home utilities 110.00 (� 01.-1-4 �f � / t C h Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: Page 2 Storm sewer (no. linear ft.: . 1 , Page 2 55,0c Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map/parcel no.: - . Absorption valve 16.60 DESCRIPTION OF WORK Back flow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 . Dishwasher 16.60 XPROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: CcO e g B Expansion tank 16.60 Address: (2 Q W t 2 2 dl `' e Fixture/sewer cap 16.60 City /State/ZIP: r a. Floor drain/floor sink/hub 16.60 Phone: (q 7f) , s^70 s q () Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60 Tub /shower/shower pan 16.60 E-mail: Urinal 16.60 • CONTRACTOR Water closet 16.60 Business name: 0 c f /Re Water heater 16.60 I Address: Other: 1 City /State/ZIP: Subtotal Minimum permit fee: $72.50 G • Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 �lJ CCB Lic.: Plumbing Lic. no.: Plan review (25 %ofpermit fee) Authorized signature: , State surcharge (8% of permit fee) 5 O C) • TOTAL PERMIT FEE Print name: I Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. . *Fee methodology set by Tri- County Building Industry Service Board. I :\ Building \Pamits\Pr.MF- PmnilApp.doc 04/06106 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard , • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 a 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 • 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 - Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty Fee (ea) Total additional $100.00 or fraction thereof to and including $10,000.00. • Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Back flow Prevention Device each additional $100.00 or fraction thereof to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof; to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and • Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed • Fixture Type: Replace engineer. Previous Capped Added Existing ❑ Any, new exterior plumbing site utilities. • Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities. Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system. -Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918 780 Car Wash -Each Stall -Drive Thru Submit 2 sets of plans with any of the above. Cuspidor/Water Aspirator Dishwasher -Commercial - Domestic Isometric or Riser Diagram Drinking Fountain ❑ Isometric or riser diagram is required for new buildings Eye Wash that meet the qualifications above. Floor Drain /sink - 2" -3" -4 „ Car Wash Drain Comments regarding fixture work: • Garbage - Domestic Disposal -Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang • -Stall Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an - Bradley increase of sewer EDUs, a sewer permit will be issued and - Commercial fees assessed for the sewer increase must be paid before the - Service plumbing permit can be issued. Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i: Building \Pamib\PL1N- PeflnMpp.doc 0921/06 Electrical Permit Application IUR (►rrl(t: usi.: ()NI-N. I. RECEIVE 6 City of Tigard 'p � /0 /7 La7 0 Permit No.: • la, / -I.' / 5 q 13125 SW Hall Blvd., Tigard, OR 97223 ft Phone: 503.639.4171 Fax: 503.598.1960 OCT 2 7 2006 Review Plan Nan Rev Rev Other Pemtit: • f I L. It t) Inspection Line: 503.639.4175 Date Ready/By: Iu 6565 See Page 2 for Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: I' Supplemental Information BUILDING DIVISION TYPE OF WORK PLAN REVIEW ❑ New construction ❑ 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 ❑ 1- and 2- family dwelling ❑ Commercial/industrial NAccessory 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 ", T ", "I -2 ", "I -3 Job no.: Job site address: IOOHP or more. occupancy. ZQO S S w' Z, 2 w t� ❑ Six or more residential units. ❑ Recreational vehicle parks. , /� /� \ q 7 7 ❑ Health-care facilities. ❑ Supply voltage for more than City/State/ZIP: ir' a . �/ / / 2 2__3 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: J Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: ` ,�/' f Q/' Description I Qty. I R«. I Total I • ' 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.: Ea. add'! 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 (e e 5:5"0/ 7 , c vci r •L residential (with above sq. ft.) Services or feeders installation, alt f ration, and/or relocation 200 amps or less 80.30 2 pPROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: e✓ayx re, K 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: & `41 A • Over 1,000 amps or volts - 454.65 2 City/State/ZIP: S C Temporary services or feeders installation, alteration, and/or relocation Phone: (q 7/) $ 7 Q -qa�(j Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is bein • made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, - • t, oy.exch • .•!r. _:.• rrding to ORS 447, 449, 67 701. 401 amps to 599 amps 133.75 - - 2 Owner signature: • _ a� -. Date: `( " - Branch circuits - new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLIC • .T I ❑ CONTACT PERSON above service or feeder fee, 3 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee 46.85 2 first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder n of included) City/Statc/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E - mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: () Y v e Signal circuit(s) or limited - energy panel, alteration, or Address: extension. Describe: Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 • Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: I Electrical Lic.: Suprv. Lic.: Industrial plant per hour - 73.75 Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES Su P ! q Subtotal: Print name: Date: Plan review (25% of permit fee): State surcharge (8% of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. • Number of inspections allowed per permit. I:\ Building \Pehmits \ELC- PetmitApp.doc 05/23/06 440-4615T(II/05 /COM/WIB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 - 260 -260) 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\Pamit \ELC- PamitApp.doc 03/23/06 Permit #: Hgraoo ep- G�aS� Address: /;e6 5 Issued by. Date: /6( % 7 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: I. I own, reside in, or will reside in the completed structure. F `1 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale l before or upon completion. ri 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR / 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about C .sttiction Responsibilities on the reverse side of this form. ( ig : u re of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) J m�lQuoml o Ppope y Owuoems A o Comisfa�ct000v Note: This Information Notice to Property (hrners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). ifyou are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure you can prevent many problems by being aware of the following responsibilities and areas of concern. EIZfdPILOYER RESPOBC9SlILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you mustcornplywith the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages atthetime employees are paid. You will be liable for the tax payments even ifyou don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945 -8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 378 -3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. Ifyou fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs ifoneofyourentployees is injured onthe job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888. J.S. ➢eternal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even ifyou didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1- 800 -829 -1040. OTHER RESPO�SIE OCITIES ADD AREAS OF COf�CER�l: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property damage innsurance: Contact your insurance agent to see ifyou have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. (Expertise: Make sure you have the expertise to act asyourow° n general contractor, to coordinate (lie work ofrough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. if you have additional questions write or call the Construction Contractors Board (PO Box 14140. Salem, OR 97309 -5052 503/378 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop- own.pm4 t/94 ..... LA 91 Np �k. t 2.. r .� © .e►\ _ c3 • k s r te �' / �� . ---‹ \ L cr- . :-._ eaC o v iorp v t h s I 4 Z + o lZ N---'2 . 3 --, .z - e \ - 1.. [ 6,,,. 1 , i--4*__ Nv§4,--.(‘ • _____:..,,. '.: (1 .... .. t Z. � , s CA ... ...(\ >j pil;71 7„ h .1 ., '•; :. i 7 , a ...c, --. ■i w. ; / -1/4(1 ! VJ 1 CITY OF TIGARD-- SITE PLAN REVIEW 1 1 . .7" fiQ.7 1 BUILDING PERMIT NO.: H' 7 0C ,ZP- CO; . ;. PLANNING DIVISION: - t Required Setbacks: Approv- • ❑ pp I ) L / b� -1' S Not Approved. � . _ _,_ ._ r _,.. - � Side: A. Side: � /0 / 2, � Front. Garage: J o ' e� S O 101.06 �� • Visual Clearance: •� Approved ❑ No . pproved 'p i . v1aximum Building He ght• gS feet O -' Serviy�e Prov a tter , equired: Yes ❑ No c m Q i& Received S∎: Date: Date: o- -, NGINEERING DEPARTMENT: �� Actual Slope: _g:.% a Approved ❑ Not Approved 2,r(r)ro o'{ m S Site P : / la Approved ❑ Not 'pproved :a o C B Date: I 7 D 6 1 71 o M N otes: ? 2 F.2._--Y�E 10 ( Z� 9- • 11: it:i_ I i ��� h lb �? � t'�Cth .i�,l_ F•:d:+t 0J1 r ill • .'... 4'.I,. i ce• .. I _.... 1 Iii • 1 ii I S E P J `• 2035 Ili); N i �Y - - .. -- Number r t0 g-57 EN L . _ _.7777:- _.. _ - -11JS Fite 0 J 7 20�� ;� Services gen sinw Area P gcrwrnlr+0 Site A l O TI GARD C eara thWING D%VISION ow c omm,tm.nt it sit., ' Dab Jurisdiction I i OtMMr ~. _. Tax mop S Tax Lot 1$ r 3 •i � Applicant - A I i .. _JJ-� �, /7� Car►Pany _ r�) -r� I� -/-� -} - She Address ' -v - 1.1 ♦ ddress 1 u� C7 ) J W _ 1 �.• GJ![1 --� _. 1 — Qby State Z4p JTi ! cr I • --q-1 } , f ( Proposed Activity , t c ; i .,- _ rt r_ — 7 `_ — Pew _ _ t , . •.: ' <.nt? ` 't - SUS - A. 89: .3 Jo_llic—La-c-L On/ acknowledges fey submitting this forth the Owner, or Owners authw aid apsnt Or repressn4Upr' site at all and sortable that employees of urp of Water gerV ail project to condi and gatheri Information times for the p related to the project site. �w �.. • s.ra. Ike - - - -- .... mow uoa Sisiv r►MOw tap Us - pRoit ts� ongr barns th we Y N NA Y N NA 2 ❑ El Sensitive Are! Co posite Map ❑ ❑ ® 08 r,nwgt fracture maps Ma p M J I/ lJ Locally adopted studies or maps Other El N : 1 Specify ❑ ❑ Spec � cht. __.._ Based on a review of the above Information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04 -9: ❑ Sensitive areas potentially exist on alts or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER. If Sensitive Areas eclat on the site or within 200 Net on adjacent properties, a Natural Resources Assessment Report may also be required. I.1 Sensitive areas do not appear to exist on site or within 200' of the alto. This pre- screening site assessment doss NOT eliminate the need to evaluate and protect water quality sensitive areas If they are subsequently discovered. The document will serve as your Service Provider letter as required by Resolution and Order 044, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. Ej The proposed activity does not meet the definition of development. NO SUE ASSESSMENT • OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewer Comments: - a.., l e,.: ew✓ 0 1 /Ie___gs e /' /A Ey .0 u.r •: /ra••r•r6e iany er rare japrr.•il1/ r; t elxkri, /o r _. - _. kaw. Mr/hU. Reviewed By: e�C,,,,C Date: _0102 ,f .. __.. I. fir..;_..:,.: : • -r: :.::.... .: �. - -- -- °' -' ' 1 Post-it' Fax Note 7671 uat Offi use only +, b u � w s y 1 .I , —.,-- t'► J (16 wu s I Reiwner! to Appl rrur:� - C g_82 �'r A�iii! Fax _ C:ounter Co.!D - ep!. Co Co.,D a S � Date V yo6' By • - I OW. p p�,� /y , �IC!,e N Ta3 611 . nerd FpXp �,7." 'MR Fri #$ - - . . . ..• . •. gkcil..i-e—Q CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.: . PLANNING DIVISION: Required Setbacks: ' Approved 0 Not Approved Side: 1___ S\det Cide• ......._ • 0 / ./ -et 0/ Front. - Garage: .....___ Rear: --X— . CcN04.64,c4 Vst, Clearance. ig A pproved 0 Not Approved m 2,.:! Oetql'o r. fei:i I AA......_, c' Provider Letter Req!I■i'<i:: 0 \. n No (7 0 "tt.e-ivd 8 ENGINEERING DEPARTMENT: Actual Slope:---% 0 Approved 0 Not Approved Site Plan: 0 Approved 0 Not Approved By: Date: Notes: , . .R.c.v.6 fi se4. s ; i c P!Olfrl ,.,. ve. �_� • qr. ec• .. . 42 . ..r " 1 <:'%:„... i , p1/ 1^ '. 6 .9 M o ' N I L , • + 1(-4-/ 5 /. • I r. ...1,,, r F . 'S . lima 0 0 l < VG . e \ `v y "r' S � ` ql� 12 (Po.s 5, v✓. i 2,1.1d C t. C ra) F (11) vo -- q` 9'0 Pax - 1 S13 GG -- 02600 C, s .r M sr1°06- - ©© Zs :5--- • TO 3Jtid 30f 83S3M 99TE999E0S TT :LT 5002 /6Z /ZT 7 CITY OF TIGARD BUILDING DIVISION • PERMIT #: MST200S-00255 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/26(2007 - Phone: (503) 639 -4171 l AA Inspection Requests (24 Hrs.): (503) 639 -4175 -' '' L INSPECTION WORKSHEET FOR DATE: 2/2712007 TIME: 7 :01AM PAGE: G4 SITE ADDRESS: 12005 SW 122ND CT CLASS OF WORK: SUBDIVISION: YE OLDE WINDMILL LOT #: 012 TYPE OF USE: PROJECT NAME: FOX DESCRIPTION: 384 sq ft accessory structure. OWNER: FOX, CRAIG PHONE #: 971 -570 -9680 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 2/27/2007 Pour Time: 11:00 Code # Inspection Description Confirm # Contact # Message 205 Footing 043944 -01 971 - 570.9680 • N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Z – 2 7 — O 7 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006- 00 255 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2612007 Phone: (503) 639 -4171 ,. tti�i Inspection Requests (24 Hrs.): (503) 639 -4175 �'i °:_.. . INSPECTION WORKSHEET FOR DATE: 2/13/2007 TIME: 7:02AM PAGE: 14 SITE ADDRESS: 12005 SW 122ND CT CLASS OF WORK: SUBDIVISION: YE OLDE WINDMILL LOT #: 012 TYPE OF USE: PROJECT NAME: FOX DESCRIPTION: 384 sq ft accessory structure. OWNER: FOX, CRAIG PHONE #: 971 570 - 9680 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 2/13/2007 Pour Time: 11:00 . Code # Inspection Description Confirm # Contact # Message 205 Footing 043345 -01 971-570-9680 N Corrections /Comments /Instructions: r - c e,-----?„. Nf , Gt% \ C.4 4... i" '--- " .:.. -- 9! L 7 , _5_, • ❑ PAS.S' ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ` ' Date: '�— e--3--- ° ? Phone #: (503) 718- ��1 -4C— "I e ✓• News 100 • 1''- - FT,C f LL 2 001 �`� APPROVED Aook) " 01 1171 - n REVISION btu a 1(4-07 �P �p OFFICE COPY +..reIMIZIMMII..•Wilan•L■■••••■=07..swescwoverraw..••■•••••■■■•■lt. 11, F ,o d PEVID ef s 17154 g---(425r C 2) 2° 5(..tr3 - . Moos' i ngic i et 6 S - g P I - C-