Permit I' CITY OF TIGARD MASTER PERMIT
�1 * • COMMUNITY DEVELOPMENT Permit MST2014-00034
Ti G A.R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/27/2014
Parcel: 2S 103BA00141
Jurisdiction: Tigard
Site address: 11965 SW LYNN ST
Subdivision: LERON HEIGHTS NO.2 Lot: 31
Project: DUTTON
Project Description: Closet addition in daylight basement and relocating(1)water closet and(1) lavatory.
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 Yes
Total: 0 sf Value: $2,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0
Tubs/Showers: 1 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:
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<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?500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 1
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:
ALT SF VB R-3 0
Owner: Contractor:
DUTTON.BRIAN&DEBRA OWNER Required Items and Reports(Conditions)
11965 SW LYNN ST
TIGARD,OR 97223
PHONE: PHONE.
FAX:
Total Fees: $329.37
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. ATT k • : Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 110 through OAR 952!. -r 1 0. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.23 87 or 1.800.332.2344.(--
Issu By: th„,... 14 AP Permittee Signature: /1l A AI /14 t U1
Call 503.639.4175 by 7:00 a.m.for the next available inspecti 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.
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.
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.
184 1,t-s.tj /41 t %) r,V
Print Name of Permit Applicant
il ,--
N k 1 4/ .- 7 -t 61 - 0-1
Signature of Permit Applicant Date
Permit#: ``— -Dralvi4 —600.3q •
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Address: I.<�t bS� �> ���r� A ' '�c
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Issued by: Date: X 71 I( El._
This Copy for Permit Offices
Building Permit Application
'Residential FOR OFFICE USE ONLY
it
IF pp.. City of Tigard Received . y Permit No �TaC) A 'r �)r,-
13125 SW Hall Blvd.,Tigard,OR "" Plan Revie��'
Other Permit:
Phone: 503.718.2439 Fax: 503 ,�� Date/B : �S ter. f�L tom.
Inspection Line: 503.639.4175 `L� Date Ready.y: _ ®K ® Page 2 for
TICARD Internet: www.tigard-or.gov P�1 `h�o • ed/Method: j, Supplemental Information
TYPE OF WORK ..`._\t '*''" REQUIRED DATA:1-AND 2-FAMILY DWELLING
emolition Permit fees*are based on the value of the work performed.
❑New construction ❑D
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.
Valuation: $ 0(..)0,`'v
J21-and 2-family dwelling ❑Commercial/industrial Q�
❑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: i i i1 CS '5G-1 L Y/\)■l3 S- New dwelling area: square feet
City/State/ZIP: -n 6.-K O<if 9 7�7-3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: at*I3 f Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 1 Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
/61.-0 C A'ftSv �.hv / TO t ufc / kb b Tod /5 r ow 02 Valuation: $
Existing building area: square feet
/IAA GLA5 Ter ex L5C/NJ !Or h
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: dad A,ti b u N Type of construction:
Address: 1/9_4 S 5 i") L VAIN 5 Occupancy groups:
ivr City/State/ZIP: --1---L6 rani-i 0/2 if Existing:
Phone:( p3) 5,7z, ?31 Z Fax:( ) New:
is ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
,, Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address: -
City/State/ZIP: Total fees due upon application:
Amount received: Ap 7 f
Phone:( ) I.ax: :( )
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
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
City/State/ZIP: and administrative fees): $180.00
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
h CCB lic.: Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained, /47 n within 180 days after it has been accepted as complete.
Print name: ,7ti C!� I u j' Date: �G *Fee methodology set by Tri-County Building Industry
����....//// �" VVV v Service Board.
I:1 Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440.4613T(I 1/02/COM/WEB)
F,. r •
or
1 Plumbing Permit Application
•Building Fixtures ��` FOR OFFICE USE ONLY
p Received
City of Tigard 1q
Date/By: Permit No.:
;74,- 13125 SW Hall Blvd.,Tigard,OR 2 3 PR 1% 1
. Plan Review
Phone: 503.718.2439 Fax: 503.598.190 R� Date/By: Other Permit No.:
Inspection Line: 503.639.4175 "j,G�'" Date Ready/By: kris: ® See Page 2 for
rig vkli C a,..Ir
Internet: www.tigard-or.gov C�1` Notified/Method: Supplemental Information
TYPE OF WORK 1 aa.,ra' FEE* SCHEDULE
❑New onstruction ❑ Demolition For special information use checklist.
Descri.lion Qt . Ea. Total
n Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( ,sq.ft.) Page 2
a JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 5 ,Y 5 Catch basin or area drain
� '7 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -rL��O�L� � � 9 i2 3
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: s T Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: 1 Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.5 I
DESCRIPTION OF WORK
�/
Clothes washer 25.02
' AA U Q ft 4Are i Ib al�J f. a
5Tu2.S K g fe Dishwasher 25.02
etOGk_r(S L>V t "l67t Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
/// Fixture/sewer cap 25.02
Name: e,,,..., 7)V r /1)
Fr
�U Floor drain/floor sink/hub 25.02 Address: i(9 LS S W f!YNN .,t._ Garbage disposal ■ 25.02
City/State/ZIP: -r,tmu r)2 f '77223 Hose bib 25.02
Phone: ea ) 4 7s- S 36 o Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory ! 25.02 5,Oz.
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 1 12.51 /02,4-1
E-mail: Urinal 25.02
CONTRACTOR Water closet t 25.02 AS.Q}-
Water heater 37.52
Business name: ornwirec Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal -
Phone:( ) Fax:( ) Minimum permit fee: $72.50 ' ?. -v
Plan review (25%of permit fee) -
CCB Lie.: Plumbing Lic.no.:
State surcharge(12%of permit fee) -"zv
Authorized signature: 4,/ TOTAL PERMIT FEE ?),?...0
I 7_`i-t 1 This permit application expires if a permit is not obtained within ISO days
Piinl name: �,/I'/ Date: J l after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pmnits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Electrical Permit Application FOR OFFICE l SEONLI
Received Permit No
. City of Tigard Date/B : —
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B
inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
TIGARD Internet: www.tigard-or.gov Not ilied/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ,0 Addition/alteration/replacement ❑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
J2 t-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Fire pump. ❑Installation of 150 KVA or
it ❑Multi-family ❑ Master builder ❑Other: ❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑°A","E","I-2","I-3",
-1. I00HP or more. occupancy.
Job no.: Job site address: 1(9 6S .5;,... L 0tJ 5 ❑Six or more residential units. ❑Recreational vehicle parks.
T a 2 Qn � ❑Health-care za do facilities.
❑Supply voltage for more than
City/State/ZIP: L ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: , 2( S r Description I Qtr• 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'l 500 sq.ft.or portion 33.92 1
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.)
jQELpCitTi dV(LCrrS $l-I iTG ti ES Renewable Energy ❑ See Page 2
i Services or feeders installation,alteration,and/or relocation
(0 PROPERTY OWNER I ❑ TENANT ' 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
► Name: R iA'hJ -2).17-Oki 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: ✓✓/Pi 6 S 5 tAJ .L yAJ/4 Z er
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Ti Fb OA- DA5 Temporary services or feeders installation,alteration,and/or
• relocation
Phone:(Sp 3) 5 7 Z 7 352- 1 Fax:( ) 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,lease nt,or exchange,accor • g to RS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: JOA/C4∎1,-, A// L.) .C. Date: 3-I -I N Branch circuits-new,alteration,or extension,per panel
APPLICANT I CONTACT PERSON A.Fee for branch circuits with
J 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 1 56.18 54,vis 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
,i., CONTRACTOR Sign or outline lighting 67.84 2
tr: Business name: //,�.'� e e- Signal circuit(s)or limited-energy See
C_J�J V"'r panel,alteration,or extension. Page 2 _ 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: Investigation(I hr min) 66.25/hr
Fax:( ) Industrial plant(1 hr min) 78.18/hr
Phone:( ) Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 57r-II
Date: Plan review(25%of permit fee):
Print name: State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: COa,Rol.
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I\Building\Permits\EL.C_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46151(11/05/COM/WEB
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