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Permit p CITY OF TIGARD MASTER PERMIT ' N 2: • COMMUNITY DEVELOPMENT Permit #: MST2013 -00105 Date Issued: 05/09/2013 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 2S104DB03900 Jurisdiction: Tigard Site address: 13217 SW WELLINGTON PL Subdivision: AMESBURY HEIGHTS Lot: 39 Project: Clark Rear Yard Adjustment Project Description: Construct 400 sq ft patio cover. BUILDING Floor Areas Required Setbacks Required Stories 0 Bedrooms: 0 First 0 sf Basement 0 sf Left 0 Parking Spaces 0 Height 0 Bathrooms 0 Second 0 sf Garage 0 sf Front 0 Smoke Dwelling Units 0 Third' 0 sf Right 0 Detectors Total: 0 sf Value $8,124 00 Rear 0 PLUMBING Sinks 0 Water Closets. 0 Washing Mach 0 Laundry Trays 0 Rain Drain 0 Urinals 0 Lavatories 0 Dishwashers 0 Floor Drains. 0 Sewer Lines 0 SF Rain Storm Sewer 0 Tubs /Showers 0 Garbage Disp. 0 Water Heaters. 0 Water Lines 0 Drains 0 Catch Basins 0 Bckflw Prevntr 0 Footing Drain 0 Ice Maker 0 Hose Bib, 0 Backwater Value 0 Drywell- Trench Drain 0 Other Fixtures 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning N Vent Fans 0 Clothes Dryers 0 Heat Pump N Hoods 0 Other Units 0 Furn <10OK. 0 Vents 0 Woodstoves 0 Gas Outlets 0 Furn > =100K' 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less 0 0 -200 amp. 0 0 -200 amp 0 W/ Svc or Fdr 0 Ea add'I 500 sf 0 201 -400 amp. 0 201 -400 amp. 0 W/O Svc/Fdr 0 Mfd Home /Feeder /Svc 0 401 -600 amp 0 401 -600 amp 0 601 -1000 amp 0 601 +amp -1000v 0 1000 +amp /volt 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC N Secunty 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: ADD SF VB R -3 0 Owner: Contractor: CLARK, MICHAEL C & HEIDI E OWNER Required Items and Reports (Conditions) 13217 SW WELLINGTON PL TIGARD, OR 97224 PHONE PHONE FAX Total Fees: $384.24 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 OA 9 2 -001- 90 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 00 332 2344 Issued By: dJ/ L(d t Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 6 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. j ' Information Notice to Owners About c ` C ost c es onsi i ities (ORS 701.325 (3)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an em ployer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503 - 378 -4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Em ployment Department at 503 - 947 -1488. • Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503 - 945 -8091 or go to http: / /www.oregon.gov /DOR /BUS /docs /211- 055.pdf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503 - 947 -7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their website at www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction proj ect, the homeowner is responsible a, for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough -in and finish trades. CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052 Telephone. 503 - 378 -4621 — Fax: 503 - 373 -2007 Website Address: www.oregon.gov /ccb f /property_owner adopted 9 -23 -08 This Copy for Permit Applicant 1 Property Owner 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 701.325 (2)) = 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# Expiration Date • I will inform my general contractor that a II subcontractors who work on the structure must be ` licensed with the Construction Contractors Board. or j5ZL will be performing work on property I own, a residence that I reside in, or a residence that I w ill 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 horn eowner statement is true and accurate. ,,' /V/ .ems L./4i2 /C Print Name of Permit Applicant • Q a • Signature of Permit Applicant Date i Permit #: i# 10 1 3 ' DD / : Address: 3�-I1 le�Ell_I�6I0� Pt.— �! .,,,,vey ; 3 '.*.,,�.n,rd� ; Issued by: 5 Date: CM 1 i3 C This Copy for Permit Offices $uiading Permit Application Residential RE FOR OFFICE USE ONLY 11111 City of Tigard . Received _ " y u ��/ 3 I Permit No /Ye076/5- 6,0�� -- q 13125 SW Hall Blvd., Tigard, OR 97223 APR 2 5 2013 Date/By. L Phone 503.718 2439 Fax• 503 598 1960 Date By 1e W /�,J � l (•'[.. Other Permit 1 T I GARD Inspection Line: 503 639 CITY OF TIGARD Date Ready /By I ��� 3 _Tuns ® See Page 2 for Internet• www tigard -or gov BUILDING l� Noufied/ Supplemental Information C DI VISION LA 4{ MA, TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. I- and 2-family dwelling Valuation: $ �j g 9-`71 9-`71 [ y g ❑ Commercial/industrial / ❑ 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: /32/7 s - w `,, r ,�, „,-, ,� � New dwelling area: square feet City /State /ZIP: 77C.74 , U2 9 7223 Garage /carport area: // „ square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: r h a 4 3L M"" ,K Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: L TRL y �� /A 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. Valuation: $ Co ✓ e4. -t o ✓t=YL ,64 ;mss+ -rz-, / Existing building area: square feet New building area: square feet ,L PROPERTY OWNER ❑ TENANT Number of stories: Name: / 'i ,G` CAAK Type of construction. Address 132/7 Jr..-t_i G_/,- �/k z„\, An-,------ Occupancy groups: City /State /ZIP. 77670_4-6 C � 722-3 Existing: Phone: (Sa 5 c,. -.1,'6 ? (......// SD3) - 7,..w -0E-61 New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: �L` ,19-/i O ✓L (Please refer to fee schedule) Structural plan review fee (or deposit): Contact name: FLS plan review fee (if applicable)• Address: Total fees due upon application: City/State /ZIP: Amount received: K /3 . &k Phone: ( ) Fax:: ( ) E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: /' Lc 1J€(2_ Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address. Solar Installation Specialty Code checklist. City /State /ZIP: Permit Fee (includes plan review $1 80.00 and administrative fees): Phone ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60 CCB lie.: � Total fee due upon application $201.60 Authorized signature:./ "i�� �„ ' ` This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: /71, C_-1-41-4_14- Date: /-7/2_1 //3 * Fee methodology set by Tn- County Building Industry Service Board I \Building \Permits \BUP- RESPermitApp doc 02/24/2011 440- 4613T(I I /02 /COM/WEB) Building Division Development Code Provision Review T I G A R Residential Projects Building Permit No.: M`� aD l - 00105 Project /Subdivision Name: CI1.t2v , Lot #: Site Address: 1 t 6224 ,3 t2 Win) Pt_ CWS Service Provider Letter: Required: Yes ❑ No ❑ Received: Yes ❑ No ❑ Plans Routed: �� 3 Original Plan Submittal Date: 4 Routed B(- -- ��''✓ 1St Revision Submittal Date: ❑ Site Plan Only Routed By: r Revision Submittal Date: ❑ Site Plan Only Routed By: 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 (V) 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 o ly if approved. Planning Review (contact at (503) 718- 2y1/' or 44 @tigard- or.gov) Land Use Cas No. Il 1 ZO /' ' 4 3' Zoning i Setbacks: _ 2 V Front Z0 Rear / Side Street Side " S Garage ❑ Maximum Building Height: Actual Building Height ❑ Visual Clearance ❑ Easements ❑ Sensitive Lands Type: ❑ Street Trees ©Protected Trees Notes: Klee/ Gvys r ekee 4 72 -% 14-r) 44/1 Original Plan: Approved i'J Not Approved ❑ Date: 1 — / 3 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13 Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov) Actual Slope: 6 °/o Notes: Original Plan: Approve Not Approved ❑ Date: 't r 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 Applican Revision 2: Date Sent to App • - nt Okay to Issue Permit: Ye G No ❑ Date Routed to Building: Page 2 of 2 I: \CURPLN \Masters \Development Code Provision Review \DCPR_RDS.doc Rev 01/16/13 Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 13217 SW WELLINGTON PL, TIGARD, OR, 97223 Residential - Master Permit 205 Footing 06/03/2013 14:00 MST2013-00105 PASS NOTE home owner installed future gas and electrical sleeves from crawl. Setbacks 12' from rear prop line to posts. Violation Summary: Inspector Contractor