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Permit _ CITY OF TIGARD A MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2013-00183 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/27/2013Parcel: 1S125DA09000 Jurisdiction: Tigard Site address: 9070 SW 69TH AVE Subdivision: 1991-066 PARTITION PLAT Lot: 1 Project: Crosby/Carey Project Description: Demo existing porch and add(1)bedroom. 12/31/15, REPRINTED to add furnace and(1) additional branch circuit for furnace reconnec BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First 210 sf Basement. 0 at Left 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second. 0 sf Garage: 0 at Front. 0 Smoke Dwelling Units: 0 Third 0 sf Right 0 Detectgrs. Total 210 sf Value: $10,000.00 Rear. 0 PLUMBING Sinks: 0 Water Closets- 0 Washing Mach 0 Laundry Trays: 0 Rain Drain 0 Urinals:--6- Lavatories Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer. 0 0. Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 DrainsCatch 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'. 1 Furn<100K: 1 Vents: 0 Woodstoves'. 0 Gas Outlets 0 Furor=100K0 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 at 0 201400 amp'. 0 201-000 amp 0 W/O SvcJFdr. 3 Mfd Home/Feeder/Svc'. 0 401-600 amp: 0 401-600 amp'. 0 601-1000 amp: 0 601+amp-1000x. 0 1000+amp/volt. 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio 8 Stereo: N HVAC'. N Security Alarm: N Vaccuum System: N Garage Opener N All Other'. N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Consh: Occupancy Group: Square Feet: ADD SF VB R-3 210 Owner: Contractor: CROSBY,RONALD S& OWNER Required Items and Reports(Conditions) CAREY,NOEL CROSBY/CAREY 9070 SW 59TH AVE 9070 SW 69TH AVE TIGARD,OR 97223 TIGARD,OR 97223 PHONE: 971-313-1916 PHONE'. 971-313-1916 FAX Total Fees: $878.61 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. ATTEN on law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-00 through OA 952 009 Vou may obtain a copy of the rules or direct questions to OUNC by calhi 98'432.1987 or 1.600.332.2344. Issued By: `�✓rte Y7 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 thejob site at the time of each inspection. Electrical Permit APPIUU,IV EP City of Tigard Received �� permit 4: f'�y a0 ?�- p0143 a 13125 SW Hall Blvd.,Tigard,pR'9731 ?n15 Plan Revie ■ Phone: 503.718.2439 Fax: 3.598.1960 Date/8 Related Permits: Inspection Line: 503.639.4175 p, y Ready Date/By: tum. ® See Pug 2 for Internet: www.tigard-or.go+,11Y U1 II�O:�I`� Notified/Method: Supplemenpl lnfornafion PLAN REVIEW ❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marims and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address:9070 SW 69th Ave IOOHP or more. ❑"A",-E","1.2",-1.3", City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy. C1 Healthcare [I Facilities. Recreational vehicle parks. Suite/bidg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site:Taylor's Ferry FEE SCHEDULE Dcxd fwe Each I Total New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.It or less 168.54 4 Tax map/parcel#: IS125DA09000 Fa.add'I 500 sqft.or portion 3392 1 DESCRIPTION OF WORK Limited energy,residential 7500 2 (1)electrical circuit to reconnect new furnace with above sq.ft. Limited energy,multi-family 7500 2 residential with above sq ft.) Renewable Energy ❑ See Pa e 2 ® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name:Ron Crosby and Noel Carey 200 amps or less AE 2 Address:9070 SW 69th Ave 201 amps to 400 amps 2 401 amps to 600 amps 2 City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 2 Phone:(971)313-1916 Fax:( ) Over 1,000 amps or volts 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation- is ins [i99 is b ing made on property that 1 own which is not 200 amps or less 1 1 59.36 1 1 intended for sale, as re or h g ,accordin o ORS 447,449,670, d 01,� 201 amps to 400 amps 1 125.08 1 2 Owner signature: Date:(2- �Jl 401 amps to 599 amps 168.54 2 ® APPLICANT ® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 742 2 each branch circuit Contact name:Ron Crosby and Noel Carey B Fee for branch circuits without Address:9070 SW 69th Ave service or feeder fee,first 56.18 2 branch circuit City/State/ZIP:Tigard,OR 97223 Each add'I branch circuit 7 42 2 Miscellaneous service or feeder not included Phone:(971)Tigard,OR 9722 Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67'84 2 Email: ron@siteworksportland.enm Reconnect only 1 67.84 67.84 2 CONTRACTOR Pump or irrigation circle 6784 2 Business name: Wit Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in an of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(I hr min) 00/hr Email: Industrial pint(I hr min) 77818/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lic.: Sultry.Lic.: specifically listed 'G hr min ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: 67.84 Print name: Date: ❑Plan Review Required(25%of permit fee): 16.96 State surcharge(12%of permit fee): 8.14 Authorized signature: TOTAL PERMIT FEE: 92.94 This permit application expires if a permit is not obtained within 180 Print name: Ron Crosby Date: 12/31/2015 days after it has been accepted as complete. • Number of inspections allowed per permit. 14ui1dingWermhsTLC PcmirApp_ELR ERE.doc Rev ObIM015 440-1615T(I I/05/(70? W B CITY OF TIGARD MASTER PERMIT 11111 s; Permit#: MST2013-00183 COMMUNITY DEVELOPMENT T i OAR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/27/2013 Parcel: 1 S125DA09000 Jurisdiction: Tigard Site address: 9070 SW 69TH AVE Subdivision: 1991-066 PARTITION PLAT Lot: 1 Project: Crosby/Carey Project Description: Demo existing porch and add(1)bedroom BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 210 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: 210 sf Value: $10,000.00 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 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 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'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-3 210 Owner: Contractor: CROSBY,RONALD S& OWNER Required Items and Reports(Conditions) CAREY,NOEL CROSBY/CAREY 9070 SW 69TH AVE 9070 SW 69TH AVE TIGARD,OR 97223 TIGARD,OR 97223 PHONE: 971-313-1916 PHONE: 971-313-1916 FAX: Total Fees: $825.30 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all othe applicable law. All ,ork will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if wor.- is suspended for mo - the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N• 'cation Center T •se rules are set •rth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a co,, - - - or direct questions to OUNC by c- in • l r.232. 8 r 1.:i0. 2. 344. Issued By: —t.ei ,r Permittee Signature: --<.-- J_ A 1411 .4175 by 7:00 a.m.for the next available Inspectio !dat:. Ili° This permit card shall be kept In a conspicuous place on the job site until completio • the project. Approved plans are required on the job site at the time of each Inspection. . Building Permit Application Residential FOR 01.1 I(-l.: I'SI.:ONL1' City of Tigard RECEIVED `e'"ed Permit No.: Date B : 4��3 J H5ro?ot3-DO i r 3 lig • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /� a Phone: 503.718.2439 Fax: 503.598.1960 A U G 1 2 013 Date�B : 9'S /-3 lr� Other Permit: T i c 1 It i) Inspection Line: 503.639.4175 Date Ready/By: n ,i. Alill ® See Page 2 for Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method:7 7 ,( IF Supplemental Information TYPE OF ®OIiIt"ING DIVISION M �jREQUIRED 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. ® 1-and 2-family dwelling ❑Commercial/industrial Valuation: $10,000 ❑Accessory building ❑Multi-family Number of bedrooms: 1 ❑Master builder ❑Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address:9070 SW 69th Ave New dwelling area: 210 square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name:Crosby Residence Addition Covered porch area: square feet Cross street/directions to job site:69th and Taylors Ferry Deck area: square feet I blk south of Taylors Ferry on 69`h Ave 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.: 1S125DA09000 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. Demolition of existing porch and addition of(1)bedroom on NW corner. Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name:Ronald Crosby and Noel Carey Type of construction: Address:9070 SW 69th Ave Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:(971)313-1916 Fax:( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee(or deposit): Contact name:Same as above FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Phone:( ) Fax::( ) Amount received: P I L/� • 7 7 E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name:none D[.c9 A 1 Eft— Submit two(2)sets of roof plan with connection details I and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): _ Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: 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: N V�/ I t Date: I (� *Fee methodology set by Tri-County Building Industry Service Board. I:\Buildin \Permits\BUP-RESPermitA .dI 02/24/2011 4404 13T(1102/COM/WEB) Building PP Building Permit Application Checklist One- and Two-Family Dwelling roll OFFICE litiF. ONLY City of Tigard Received Date/By: Permit No.: 11,1 a 13125 SW Hall Blvd.,Tigard,OR 97223 associated permits: e Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical •r IC;A IC; R D Internet: www.tigard-or.gov ❑ Other: TI-IE FOI.LO\VIN( ITEMS .AIZF IZI (,tilRZf:l) FOR PLAN REVIEW v't•s N(i N/% 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • • 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ . ❑ ❑ 3 Verification of approved plat/lot. . ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ' ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 ❑ ❑ there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑. ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore:on and shall be shown to be a.,.licable to the 1ro'ect under review. JL'RI'I)ICTIONAI-. 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. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. . ❑ ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 ❑ ❑ 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, ❑ ❑ ❑ 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:\Building1Pennits\BUP-RESPermitApp.doc 02/24/2011 440-613T(I 1/02/COM/WEB) Mechanical Permit Ap t l cill °,: FOR OFFICE USE ONLY • Received City of Tigard �V / Permit No.: — 13125,SW Hall lvd.,Tigard,OR Date/By: / //7j _ �/ �j/�O/ -�� a ' Phone: 503.718.2439 Fax: 503.5 0 1 2013 Plan Review Other Permit: Date/By: TI GA R D Inspection Line: 503.639.4175 Date Ready/By: Sufis ® See Page 2 for Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST . 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 Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: 'A 1 Air conditioning 46.75 U Job site address: V" LA Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: G g3 Furnace 100,000+BTU(ducts/vents) 54.91 T J 6 Heat pump 61.06 Suite/bIdg./apt.no.: Project name: d op-mi. Hjd r ftac., 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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 I h DESCRIPTION OF WORK Gas fireplace/insert 33.39 2 I O �Qf, C 4 0-ed krp j�l/�/L 11CId 1� v f rep vent for water heater or gas U fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ❑ PROPERTY OWNER ❑ TENANT Other: 23.32 N p ^ Environmental exhaust and ventilation: Name: /i V Range hood/other kitchen /� -�\ C � equipment 33.39 Address: i v 7 q ' "] Clothes dryer exhaust 33.39 City/State/ZIP: 9-7py- G Z 7 21.3 Single-duct exhaust(bathrooms, toilet compartments,utility rooms)s) 23.32 Phone:(S3) ')LTA . 9,7-Cf 3 Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT . ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax: :( ) Fireplace Range E-mail: Barbecue • CONTRACTOR Clothes dryer(gas) 1 Other: Business name: G I 1 E MECHANICAL PERMIT FEES* Address: �` Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lie.: TOTAL PERMIT FEE ~ 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 Tri-County Building Industry Service Board Print name: NO.f Date: AIl 33 I:\Building�Perrnits\MEC_PermitApp_040II3.d c 44 Tr 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. I:\Building\Permits\MEC_PermitApp_040113.doc 2 • CEIVED Electrical Permit Applica I 0I roli of Flcl: use;O�l.i . 14 City of Tigard (, 1 013 DateBea S �� Permit No.: tt r,, O g_00/i 3 v 13125 SW Hall Blvd.,Tigard,OR 97 u Plan Review ' C : .- Phone: 503.718.2439 Fax: 503.59�,�qyo Date/By: Other Permit: Inspection Line: 503.639.4175 l�I I Y OF TIGARD Date Ready/By: Juris: HI See Page 2 for ` BUILDING DIVISION Internet: www.tigard-or.gov Notified/Method: Supplemental Information ' 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 ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND'LOCATION ❑Emergency system. larger separately derived system. ❑Addition of new motor load of ❑"A","E","I-2","1-3", Job no.: Job site address: ID S', 1 G i4 O IOOHP or more. occupancy. n�0 r t/ J W IaQ 1 `^ V ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: 1 (� �} 1?-�j ❑Health-care facilities. ❑Supply voltage for more than \`Jt {{{{ 9 1 v/ ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: d,font, v17.101, J ❑Service or feeder 600 amps or more. FEE SCHEDULE ' Cross street/directions to job site: 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 . 1 Tax map/parcel no.: Limited energy,residential . DESCRIPTION.OF WORK . (with above sq.ft.) 75.00 2 LAID `� � j (; Limited energy,multi family 75.00 2 1L residential(with above sq.ft.) Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation 'S r PROPERTY'OWNER' • . ❑ TENANT 200 amps or less 100.70 2 /� 201 amps to 400 amps 133.56 2 Name: �p v L l.- I V ND,�V eiwei- 401 amps to 600 amps 200.34 2 Address: -L O IV 1 V.) nit- '`""'"{{{{ 601 amps to 1,000 amps 301.04 2 I 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP: T'�e �� 7 Temporary services or feeders installation,alteration,and/or Phone:(57) b 'h-L.( Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,I>.Ne ent�oli-change,according to ORS 447,449,6700 as/nd 7011. 401 amps to 599 amps 168.54 2 Owner signature: / Ll �.. Date: 0/ i/13 Branch circuits—new,alteration,or extension,per panel •❑-AIM s T • "❑ CONTACT PERSOPI A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name: each branch circuit B.Fee for branch circuits without Contact name: service or feeder fee,first 56.18 2 branch circuit Address: Each add'I branch circuit 7.42 2 City/State/ZIP: Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:( ) Fax: :( ) dwelling,service and/or feeder Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 . 'CONTRACTOR ' : • ' ' • . Signor outline lighting 67.84 2 Business name: D COO E Signal circuit(s)or limited-energy See panel,alteration,or extension. Page 2 2 Address: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr City/State/ZIP: Investigation(I hr min) 66.25/hr Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(%:hr min) . ELECTRICAL'PERMIT'FEE_S' . , Suprv.Electrician signature,required: Subtotal: Print name: Date: Plan review(25%of permit fee): 77 State surcharge(12%of permit fee): Authorized signature: (' / TOTAL PERMIT FEE: i This permit application expires if a permit is not obtained within 180 Print name: l�/� -,1 Date: I!/ ' �j days after it has been accepted as complete./v 1 J • Number of inspections allowed per permit. I:t Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2 3 440-4615T( 1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 1=1 Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 • >100 kva(fee in accordance with El Heating,Ventilation and Air Conditioning OAR 918-309-0040) 552.26 2 System* Solar generation systems in excess of 25 kva: Each additional kva over25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 ❑ Each additional inspection over allowable in any of the above: Other: Each additional inspection is charged at an hourly(I hr min) 66.25/hr Inspections for which no fee is 90.00/hr specifically listed('A hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review,if required(25%of permit fee): State surcharge(12%of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. ❑ 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\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 1,1 q Building Division Development Code Provision Review T I G A ft Residential Projects Building Permit No.: M'`T►cS O 193-601 g { Project/Subdivision Name: 0 Lv5P Y 6 6 2 c Y , Lot #: ) Site Address: q-ID--x) cue (o9& / D E, CWS Service Provider Letter: Required:Yes ❑ No ❑ Received:Yes ❑ No ❑ Plans Routed: � / Original Plan Submittal Date: g / i 3 Routed . 1st Revision Submittal Date: ❑ Site Plan Only Routed By: 2nd 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 (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 'f approved. Planning Review(contact at(503) 718-02"I r or @tigard- or.gov) Land Use c.)gse Np.� Zoning Er Setbacks: Front DO, Rear I lc Side _ Street Side Garage �- ErMaximum Building Height: ?i 0 Actual Building Height ❑ Visual Clearance ❑ Easements ❑ Sensitive Lands Type: ❑ Street Trees ❑ Protected Trees Notes: (1JJ4IL2y1 ' — Original Plan: Approved l Not Approved ❑ Date: g'1 r/ 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: g Notes: Original Plan: Approved Not Approved ❑ Date: 8 IA 3 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: / 3 Page 2 of 2 1:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13 , 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: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCI3# 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 W/ I 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 homeowner statement is true and accurate. X \°f CO/ Prin Name of Permit Applicant /3 zc r Signatu of ermitApplicant Date J 1 Permit#: 1-1 trite l 3" D a 14 3 Address: 9670 d t_o ALA- �•0^ \ ::';Iuun%f. d - lpg2� 02 c(79-2-5 z; :: Issued by: I T Date: /4-7/. ti_.: This Copy for Permit Offices :� . EXISTING BUILDING COVERAGE: 1420 SQ. FT. 1 - PROPOSED BUILDING COVERAGE: 16,58 SQ. FT. F L A G LOT D R I V E W A Y PROPOSED COVERAGE PERCENTAGE 22% n 1 107'-6 3/4" RECEIVED � i s ' ' AUG 12013 •- '4 , 20'-0" , PROPERTY LINE CITY OFTIGA 5'-0" — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ---gdIt DIVI 11 - - — M /i / witz.4. ,--1 ...--- / .7; y/ MINIMUM SETBACKS in cets/02v W• 9070 70 Q." �Y l /T42 ,i' I EXISTING TREE f I i , .I AREA OF NEW ADDITION • I 1 /' N. , • 1 // (' 4 'A-----I .,! , I 1 'C.": Q 1 �� ' 09.04 sq ft T ..1levi( Q� ,, A = I I ,e ;, F- I 29.03 dft ;; OI 01 I 1 1 •,-; / 1 1 I o 1 / 1 '1`]; I I I I ` I I I I 1 1 _ 1 1 . I 1 1 ! 1 a,' 1 I I 1 I 1 . I I I I r 1 1 EXISTING RESIDENCE 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 I 1 1 1 1 I I 1 I 1 1 i I L DRIVEWAY �. 1 ;I 11 0 I • Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 9070 SW 69TH AVE, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS MST2013-00183 David Young Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 9070 SW 69TH AVE, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection PASS - No C of O March 7, 2016 at 10:07:20 AM MST2013-00183 David Young Violation Summary: Inspector Contractor