Permit CITY OF I IGARD
1 1 MASTER PERMIT
I
s • COMMUNITY DEVELOPMENT Permit #: MST2013 -00117
•
TI GARO 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 05/30/2013
Parcel: 2S 110BC00300
Jurisdiction: Tigard
Site address: 14440 SW HAZELHILL DR
Subdivision: AMES ORCHARD Lot: 19
Project: Nordt
Project Description: Additions and remodel to master bedroom and deck. 6/26/2013 REPRINT permit to add
mechanical permit for duct work
BUILDING
Floor Areas Required Setbacks Required
Stories 2 Bedrooms 0 First 0 sf Basement. 0 sf Left 0 Parking Spaces 0
Height 23 Bathrooms 0 Second 384 sf Garage 0 sf Front 0 , Smoke
Dwelling Units 1 Third 0 sf Right 0
Detectors Yes
Total. 384 sf Value $50,000.00 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
Other Fixtures. 0
Drywell- Trench Drain: 0
Other Fixture Units
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 add! 500 sf 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 2
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 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:
ADD SF VB R -3 384
Owner: Contractor:
NORDT, FRANK J KK CONSTRUCTION LLC Required Items and Reports (Conditions)
14440 SW HAZELHILL DR 16250 S NEIBUR RD
PORTLAND, OR 97210 OREGON CITY, OR 97045
PHONE 503 -381 -0606 PHONE 503 - 750 -7756
FAX 503 - 631 -8529
Total Fees: $1,974.89
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Special. Code and .11 other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of r-suanc= or if work is suspended for more the 180
days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility Notific- i• Ce er. Those rules are set forth in OAR
952 - 001 -0010 through R 952 -0 090. You may obtain a copy of the rules or direct questions to OUNC by calling . 232 1 7 0 � 800 332.2344
11110111 By: Permittee Signature:
t
Call 503.639.4175 by 7 :00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Mechanical Permit Application Fo12 OFFICE USE ONLY
City of Tigard Pennrt No
`J g EIVED
Date/By. Received 26, !.� 5 -
13125 SW Hall Blvd , Tigard,OR 97. R s ��$qqq ��
' C ' Phone. 503.718 2439 Fax 503 598 . t D yew Other Permit
lFt A R D Inspection Line: 503.639 417 6 n Date Ready/By ®See Page 2 for
Internet. www tigard -or gov JUN 2 7 U 13 Notified/Method Supplemental Information
OFTIGARD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
TYPE O
� Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value. $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 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:
Air conditioning 46 75
Job site address:
/4654.c. 4 x.,571 cA5,.. , Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: '. n bp., Furnace 100,000+ BTU (ducts/vents) 54.91
Jf d � � Heat pump 61.06
t r
Suite/bldg. /apt. no.: Project name: i Cams) Duct work / 23 32
Cross street/directions to job site: 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
Flue /vent for any of above 23 32
Subdivision: I Lot no.: Other 23 32
Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas 6replace/msert 33 39
�� Flue vent for water heater or gas
��i2 "` s� fi P, fireplace 23.32
Log lighter (gas) 23 32
Wood/pellet stove 33 39
!i'L, 6 is 4, 6i<L 70 �f C /ST //\/ ( Wood fireplace /insert 23 32
6:7 (� Chimney /liner /flue /vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other. 23.32
Environmental exhaust and ventilation:
Name: ; 'vi'' L, , 4/1:,,, ' i — Range hood/other kitchen
equipment 33.39
Address: (.{4 ( b ,/ - / _ z) Clothes dryer exhaust 33 39
City /State /ZIP: �� fiL,7 � f -f : .D Single -duct exhaust (bathrooms,
7 toilet compartments, utility rooms) 23 32
Phone: (2 YZ , 05, Fax: ( ) Attic /crawlspace fans 23 32
'❑ APPLICANT ❑ CONTACT PERSON Other. 23 32
Fuel piping:
Business name:
$14.15 for first four; $4.03 for each additional
Contact name: Furnace, etc
Address: Gas heat pump
Wall /suspended/unit heater
City /Slate /ZIP: Water heater
Phone: ( ) I Fax: : ( ) Fireplace
Range
E -mail:
Barbecue
CONTRACTOR Clothes dryer (gas)
Other.
Business name: e_40.7s , ' 4 c 5 b) MECHANICAL PERMIT FEES*
Address: /4,---S-0 s A24 Subtotal
City /State /ZIP: 75 4 _ Minimum permit fee ($90 00) 94 , OT)
Phone: Pl an review (25%ofpermit fee) p
'�5' F ( ) State surcharge (12% of permit fee) /Q r p )
CCB lic.: /9 6 ty TOTAL PERMIT FEE hbi , i)
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tn- County Building Industry Service Board
Print name: art /a y Date: 6
I \ Building \Permits\MEC_PermitApp_040113 doc 440 -46177 (I I /02/COM/WEB)
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee:
$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.
1•\ Building\ Permits \MEC_PermitApp_040113.doc 2
CITY OF TIGARD MASTER PERMIT
` - 2 . COMMUNITY DEVELOPMENT Permit #: MST2013 -00117
T t GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2013
Parcel: 2S110BC00300
Jurisdiction: Tigard
Site address: 14440 SW HAZELHILL DR
Subdivision: AMES ORCHARD Lot: 19
Project: Nordt
Project Description: Additions and remodel to master bedroom and deck.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 23 Bathrooms: 0 Second: 384 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes.
Total: 384 sf Value: $50,000.00 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
Drains: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum <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'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 2
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 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:
ADD SF VB R -3 384
Owner: Contractor:
NORDT, FRANK J KK CONSTRUCTION LLC Required Items and Reports (Conditions)
14440 SW HAZELHILL DR 16250 S NEIBUR RD
PORTLAND, OR 97210 OREGON CITY, OR 97045
PHONE: 503 - 381 -0606 PHONE: 503 - 750 -7756
FAX: 503 - 631 -8529
Total Fees: $1,874.09
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. AT • • •. •regon law requires you to follow the rules adopted by the Oregon Utility Notification - ter. Those rules are set forth in OAR
952 -00 -0010 through O • • • - -001-0.90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 or 1.800.332.2344.
/ / �v1
Issu • d By: ! — - /. / � it Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 Permit Application RECEIVED
Residential MAY 1 5 2013 t( )R (II I It I I 'I ()NI 1
IN ■ City of Tigard � ima Permit No.: /Tat,/ x � - !
131 R eceived SW Hall Tigard, OR 97223 CITY OF TIGARD Plan Revie r
I Phone: 503 Fax: 503.598. I9fm I J Date/B : or ' - Other Permit
I IGARD
Inspection Line: 503.639.4175 3 '.'I� ��G � tVISIDr`t Date Ready/By: Jura : ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
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
f Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicatedapplication.
fICIG
❑ 1- and 2- family dwelling ❑ Comerciallindustrial Valuation: $ ' )�f� "
m
❑ Accessory building ❑ Multi- family Number of bedrooms: -mob
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: is/4/W) 7 fv yh l it not New dwelling are, . square feet
City /State /ZIP: 7 a e 9'7 ;Z1.f Garage /carport area: ` square feet
Suite/bldg. /apt. no.: I Project name: 4,t;,K.0 r Covered porch area: square feet
Cross street/directions to job site: Deck area: 15" square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
1 •t3Tr.c.. Cit) Sc., r
Valuation: S
i)G`-aC Existing building area square feet
,e_.4.i/ w4.1C4/ 6 q. r,,vo C K T New building area: square feet
❑ PROPERTY OWNER 1 ❑ TENANT Number of stories:
Name: j ka„ti,,vbC njUK. 0 r Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: (Sst) 3$'/ `UG UG Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: (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: y O o /5.a /
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: `/ Submit two (2) sets of roof plan with connection details
Co ry S 7. L ( c I2C t.2 ..v i e Le .. , and fire department access, along with the 2010 Oregon
Address: i 6 2,5-0 1 - ∎(/E 1d u a 14 Solar Installation Specialty Code checklist.
City /State /ZIP: i< C.4.4-.7 U Q 1V c {� $180.00 Permit Fee (includes plan review
r r'� �� and administrative fees):
Phone: ( pal 3) 7 s _ 7 7 5 Fax: (S" 3) 63( -ir J e) 1 State surcharge (12% of permit fee): $21.60
CCB lic.: / 76 y/ ti 3 I y Total fee due upon appication: $201.60
Authorized signature: / This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
L / . Date: ` j * Fee methodology set by Tri -County Building Industry
Print name:
l t t-v lLriJ [-e •'�-- �S /�_ Service Board
I:\Building\Permits\BUP - RESPermitApp.doc 02/ 24/2011 440- 4613T(11/02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
lig City of Tigard Received
Date/By: Permit No.:
q 1 3125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
C Phone: 503.718.2439 Fax: 503.598.1960
T I G n R p 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.tigard - or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes 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. ❑ ❑ El
3 Verification of approved plat/lot. El ❑ ❑
4 Fire district approval required. Name of district: . El ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . El El 0
6 Sewer permit. El El ❑
7 Water district approval. El El ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. El ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- El ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state El ❑ El
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ El El
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 ❑ ❑ El
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, El El El
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- El El El
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. El ❑ El
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 ❑ El ❑
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 El El ❑
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 ❑ ❑ El
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ El El
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ El ❑
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 El ❑ ❑
architect licensed in Ore • on and shall be shown to be applicable to the . ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. El El ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. El El El
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ El El
27 "Drawn to scale" indicates standard architect or engineer scale. El ❑ El
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard El El El
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ El
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:\Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440 -4613T(11 /02 /COM/WEB)
Electrical Permit Application H i i FOR OFFICE USE ONLY
City of Tigard Received
Date/By: 5 3 Permit No IFS / O � �'� ! ( 7
13125 SW Hall Blvd., Tigard, OR 97223 MAY 1 013 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I t i n R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard - or.gov fl Notified/Method: Supplemental Information
Ai .- "n1, Di r
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 ❑ CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "t -3 ",
y` (v /'I IOOHP or more. occupancy.
Job no.: Job site address:
/It12 (I i 1'1 ! /94. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /Z[P: t G �r �) rig_ C7 �L� ❑ Health -care facilities. ❑ Supply voltage for more than
L l l ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: xi°v.-4 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
J Description I Qty. I Fee. I Total I•
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi-family 75.00 2
residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
200 amps or less 59.36 1
Owner installatio h inst , latio s being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, • •, en I exc ge, according to ORS 447, 449, 670, d 741. 401 amps to 599 amps 168.54 2
• ,Owner signature: Date: 6 G Branch circuits - new, alteration, or extension, per panel
1 A Fee for branch circuits with
❑ APPLICANT ❑CONTACT PERSON above service or feeder fee,
Business name: each branch circuit 7.42 2
B. Fee for branch circuits without I
Contact name: service or feeder fee, first
branch circuit 56.18 2
Address: Each add'I branch circuit j 7.42 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Far:: ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Q (.0 Er- Signal circuit(s) or limited- energy
Al Er- alteration, or extension. Page 2 2
Address: 1� sz Each additional inspection over allowable in any of the above
�` �'� Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP:
I op..... Investigation (1 hr min) 66.25/ hr
Phone: (SPA tff, V Fax: ( ) Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed (Y3 hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name:
-q" • , 1x. ,A Date:
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signatur ^ �� - TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: V Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building\ Permi ts\ELC_PermitApp_040913.doe 440 -461 ST(11 /OS /COM/WEB
r
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 per mits.
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:
1N I own, reside in, or will reside in the completed structure and my general contractor is:
3cg1(1
, . - 196Ily -4ia-
Name CCB# Expiration Date
K I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
l or
will be performing work on property I own, a residence that I reside in, or a residence that I w ill
eside 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.
I F _ 0 YZY1
Prin Nrm • I Permit Applicant
t 503
Sig - e • pplicant Date
Permit #: �e2T' ' �- ddb /�
Address: 1 4 /0 �'�F ► �-(, t ,,,,.,..„......;, 0 ,
,.... ,;I, :
1
3� � 1,
Issued by: A Date: —�-3 ir.i r
This Copy for Permit Offices
1111 Building Division
Development Code Provision Review
T l G A R D Residential Projects
Building Permit No.: r 1 ` Tao l - DO l 17
Project /Subdivision Name: j�o ✓L`D 1 , Lot #:
Site Address: I L/ L/ Li 0 LL—
CWS Service Provider Letter:
Required: Yes ❑ No gr
Received: Yes ❑ No C
Plans Routed:
Original Plan Submittal Date: . l / 4/ 3 Routed By:(
1St Revision Submittal Date: ❑ Site Plan Only Routed By:
2n 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 (✓) 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 el OV (2 at (503) 718- 2 2.1 or ty1.0. @ t- @tigard-
or.gov)
Land Use Case No.
Zoning 12 -1
EV
Front Rear Side 5 Street Side 2.0 Garage '7sC
❑ Maximum Building Height: Actual Building Height — 2 3
®' isual Clearance N I P
❑ Easements
[sensitive Lands Type: ! v one,
I3Street Trees p
❑ Protected Trees
Notes:
Original Plan: Approved.( Not Approved ❑ Date: I KO I 13
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:
Notes: li
Original Plan: Approved ❑ Not Approved ❑ Date:
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
I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13
ti
FOR OFFICE USE ONLY - SITE ADDRESS:
This form is recognized by most building departments in the Tri -County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN ■ •
r T ransmittal Letter
I , ■ I I Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: _____L__)_-L.A---- DEPT: B ING DIVISION DATE RECEIV � D�� � D
MAY 2 2 2013
FROM: et iJ )a a. 12-f CITY OF TIGARD
COMPANY: BUILDING DIVISION
PHONE: 5O _ '2 j ?l -04_04° (Y.-:_k-:,
RE: l_ / (> z�� 1 s -00 r / 7
ite re (Permit Number)
e0---1
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS. 5) ‘ j e j 1 6
6 6 —Q A All,--A LI , /54c.- "1 -2-eiriA, vt._.> 6 FOR OF C E SE ONLY
Routed to Permit Technician: - Date: .S12...$9 / Initials: "
Fees Due: ❑ Yes 111'l56 Fee Description: Amount l ue:
$
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes I ❑ No ❑ Done
Applicant Notified: Date: Initials:
1:\Building\ Forms \TransmittalLetter - Revisions.doc 05/25t2012
R EC VE D 115
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MAY 152013
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THOMAS Z ELLICOTT
. • ARCHITECT & PLANNER
City of Tigard Building Division
Chip Barnett, Sr. Building Inspector
13125 SW Hall Blvd
Tigard, Oregon 97223
Phone: 503-718-2439
May 30, 2013
Dear Mr. Barnett:
RE: Changes to the Construction documents under permit No. MST 201300117
This letter is to note the following approved changes in the Construction documents for
the Nordt residence located at 14440 SW Hazel Hill Drive.
1. Sht A -1 detail 3 Foundation plan: Change the north strip footing from a combined to a
single strip footing with a 10 "sauna tub footing for the 4x4 column in support of the deck
beam. The embed Simpson CB44 remains the same. The 1'-6" dimension changes to
61/2 ", the 2' -3 "dimension change to 1' -61/2 "dimension and the 93/4 "dimension change
to accommodate the 10" sauna tub at 12 ", and the north corner of house dimension
changes to 7' -2" respectfully.
2. The north deck beam column note as a 6X6 PT column changes to a 4X4 PT column.
The Simpson framing bracket change to reflect the column size, embed CB44, column to
beam CC44, Contractor to verify connection bracket.
3. Sht A -1 plan details 2 and 4 change section bubble 3 /A -2 to 4/A -2
End of Changes
Sin ly,
, Thomas Ellicott
Cc: KK Construction
0513- 530131tr .
4314 NE 30 Portland, Or. 97211 503 -548 -8674
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
14440 SW HAZELHILL DR, TIGARD, OR, 97224
Residential - Master Permit
205 Footing
05/31/2013 10:00
MST2013-00117
PASS
Violation Summary:
Inspector Contractor