Permit IIy y CITY OF TIGARD j MASTER PERMIT
s COMMUNITY DEVELOPMENT Permit#: MST2014-00087
41440/ Date Issued: 06/16/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S109AB06100
Jurisdiction: Tigard
Site address: 13083 SW STARVIEW DR
Subdivision: FORAN Lot: 3
Project: Olson 7)
Project Description: Finish unfinished basement to create a game room. No additional charge for school tax as '� g A-J
square footage was covered under original building permit. 6/19/14, REPRINTED TO ADD .��Ly,7---
TO 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: $8,250.00 Rear: 0
PLUMBING
Sinks: 1 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
Furn<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 0
Owner: Contractor:
OLSON,TIMOTHY&HEIDI DUSENBERY CONSTRUCTION&REMODEL! Required Items and Reports(Conditions)
13083 SW STARVIEW DR 1914 BROOKSIDE AVE NW
TIGARD,OR 97224 SALEM.OR 97304
PHONE: 503-349-8139 PHONE: 503-851-3559
FAX:
Total Fees: $526.17
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 - Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0' -0010 through••R 95 s+1-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 .1987 or 1.800.332.2344.
•/
lssu d By: ' — Permittee Signature 7/
Call 503.639.4175 by 7:00 a.m.for the next available Inspec onti date.
This permit card shall be kept in a conspicuous place on the job site until com etion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit A licati FOR OFFICE USE ONLY
iii, City of Tigard Received JO J Permit#: 11 sra;U j --01^6�d
• 13125 SW Hall Blvd.,Tigard,OR 9
VF ) Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Date/B :
Related Permit#:
Inspection Line: 503.639.4175 1 9 ?OM Ready Date/By: kris. B See Page 2 for
[I G A R D Internet: www.tigard-or.gov r Notified/Method: Supplemental Information
TYPE a r.e. ';`. PLAN REVIEW -
New construction ddition' tiratioig CI"atTment Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 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.
l-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 4: I Job site address: 12 O 8r 3 5W 51,1 r i ew 0 r• 100HP or more. ❑"A","E","l-2","l-3",
City/State/ZIP: ro r �� G ❑Six or more residential units. occupancy.
/ ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I lsroject name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: t30 t /1/1 c,-,,-.14c•.w. FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel 4: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Ba
C Vv...z....... �?t V"`° a t ( Limited
energy,multi-family
75.00 2
Cl eJ Q . / / J7 n/ ��o d
7 residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
El
I- El
PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
56.18 I 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 1 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR (1 Pump or irrigation circle 67.84 2
Business name: 'ZAP Pie/Of-E./Z.E t 7 I(,14'4' Signor outline lighting 67.84 2
Address: )ft)q (,,, P "-it,' pineal alteration,or limited-energy ❑ See Page 2 2
ee art t r) panel,alteratio or extension.
City/State/ZIP: 'e G Z- 7 3 U'-/ Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) I I 66.25/hr
Phone:(5-02)) 11 9---0`/v '9- Fax:( ) Investigation(1 hr min) 66.25/hr
Email: v h v y 6 Y 0 C p�co�i- . 11'1 e-f Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: beryoi 6 Electrical Lic.: C-20 6 Suprv.Lic.:tric95 specifically listed(V:hr min)
/� 1'I'- I (14 ELECTRICAL PERMIT FEES
Suprv.Electrician s a e, equired: �y—I� 10 t Subtotal: 6 3.io
Print name: D o„e C tY f Date: 6/') 41 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 3
Authorized signature: TOTAL PERMIT FEE: 7/, D3
� J This permit application expires if a permit is not obtained within 180
Print name: �l C.c> w% Fo,�I q .tr Date: 6 I)I/ y days after it has been accepted as complete.
/ • Number of inspections allowed per permit.
1:1Building\Permit s\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440.4615T(l1/05/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
Description 1 Qty. I Each I Total 1 "
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
El Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%I hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I uilding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
Plumbing Permit An ; `trIFIW �
Building Fixtures :` �� ,.
City of Tigard J U N 1 9 2014 nacre 4//9//q (D a, Permit No.:•1 f ' 7
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 F RD Date/By: Other Permit No.:
Inspection Line: 503.63 � oK1�nR ���0� Date Ready/By: Juris: See Page 2 for
I I n K I Internet: www.tigard-or L LOW,I/PINUP? Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
id 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
•
❑Accessory building ❑Multi-family SFR(3)bath I 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
L Catch basin or area drain 18.76
Job site address: /30,3 ct,v S 1'4 r v/7.w Dr,
p Drywell,leach line,or trench drain 18.76
City/State/ZIP: r,,a.. 0/e 97i2 t' Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: ' -te .r+ Manufactured home utilities 50.03
Cross street/directions to job site: 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.: ) Page 2 i
Subdivision: FO ^ I Lot no.: 3' Fixture or item:
Tax map/parcel no.: 2S l o Y A eo /00 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
add we bo,' Dishwasher 25.02
CL-G(2-GO L Drinking fountain 25.02
? / 7 I/4/e96 k? Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: D��^ Medical gas(value:$ ) Page 2
5e, , (,N s 1.-"�s- ,,,cl tom"",°Is/,1 Primer 12.51
Contact name: fe O/�U LOU),
y Roof drain(commercial) 12.51
Address: /flq &gook SSet ILI, 'OW Sink/basin/lavatory + 25.02
City/State/ZIP: se.,(�„, a Q 1)3o ti Solar units(potable water) 62.54
Phone:( ç ) g's- _7s-s--7 Fax::( ) Tub/shower/shower pan 12.51
�/
I Urinal 25.02
E-mail:
Olvse.•be.y re 6r-ocl. '1-j Ar`ou. c o..--a Water closet 25.02
CONTRACTOR
pp / Water heater 37.52
Business name: p.e+'I�o" f **"s 1 Water piping/DWV 56.29
Address: pd 13ste I'Eac Other: 25.02
City/State/ZIP: t dbL 9 i3 a ---- Subtotal
Phone:(5-7s6) Or%- ({9-7 Fax:( ) Minimum permit fee: $72.50 7,R,150
CCB Lic.: 149 • I/4 Plumbing Lic.no.: p 8 9 Oct Plan review (25%of permit fee) �`
Authorized gnature 7�l/i7 State surcharge(12%of permit fee) g• 70
TOTAL PERMIT FEE gf,2-0
Or
Print name: ' This permit application
l -mate; pe expires if a permit is not obtained within 180 days
�S L -1 ��y after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
eu tuildiiwermits'PLMU-Penroitnpp.doe 10/01,09 440.4616r(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-Is'100' 50.03 0 to 2,000 $121.90
•
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater _ $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate 9 Y g
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4" Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food gram q g
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes P
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Heidi Olson\Downloads\PLMF-PermitApp.doc 2
CITY OF TIGARD MASTER PERMIT
s COMMUNITY DEVELOPMENT Permit#: MST2014-00087
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/16/2014
Parcel: 2S109AB06100
Jurisdiction: Tigard
Site address: 13083 SW STARVIEW DR
Subdivision: FORAN Lot: 3
Project: Olson
Project Description: Finish unfinished basement to create a game room. No additional charge for school tax as
square footage was covered under original building permit.
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: $8,250.00 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 WI Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O SvclFdr: 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 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 0
Owner: Contractor:
OLSON,TIMOTHY&HEIDI DUSENBERY CONSTRUCTION&REMODEL! Required Items and Reports(Conditions)
13083 SW STARVIEW DR 1914 BROOKSIDE AVE NW
TIGARD,OR 97224 SALEM,OR 97304
PHONE: 503-349-8139 PHONE: 503-851-3559
FAX:
Total Fees: $373.74
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 es adopt by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma •• -'i ,.copy o e rules or di ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: v — _ �.. Permittee Signature: — �`��
Call ' / 7:00 a.m.for the next available inspe�
This permit card shall •= 'ept in a conspicuous place on the job site ••. pletjon"of the project.
Approved plans are required on the job site at the ti .gfeich Ipapection.
Building Permit ApplicatircECEI[IEP
Residential [[��1� vv FOR OFFICE USE ONLY
Received
City of Tigard �U N : Se 2 / e1.P Permit s �� _DoO�
• 13125 SW Hall Blvd.,Tigard,OR 97223 - 2014 Phan Review �- r
Z �'� �®� Other Permit:
Phone: 503.718.2439 Fax: 503. Date/B
TIGARD Inspection Line: 503.639.4175 �, tOF TIGARD Date Ready 111112
y12 l ai./r FE See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Cif/S y � 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
Addition/altcration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
pir 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ Se; ZS'n
❑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: f 3 U 8 3 S W c i- _- td It: w ay-- New dwelling area: square feet
City/State/ZIP: ril OIC �r 72 z Y c._� Garage/carport area: square feet
Suite/bldg./apt.no.: oject name: ' '`� Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: (./9 0 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(minded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
nn DESCRIPTION OF WORK /J work indicated on this application.
ai T3 k L.w} .k la Y-o,Jh i'n h.-ge e � ":^of Valuation: $
'1-.4e4—,-,),,,L. ail,-.3s •-..l' w,((4 , b r.,{ e/e.,, 1 Existing building area square feet
c. J New building area: square feet
`)Z PROPERTY OWNER I 0 TENANT Number of stories:
Name: Q LS 0A1 1 Ti•(io 7 V y E �c/b/ Type of construction:
Address: /,�6CP3 .S� 5779-2 /V/ E GO Occupancy groups:
City/State/ZIP: 17 ( D2 97a,l-Y Existing:
Phone:6/03) 3 (/9 ,-7y 3 Fax:( ) New:
g APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: . _/___ J p___ l /� review fee(or deposit):
osit):le)
�ScH 7TVr.urr d F-p^t�dEl
�n6 ^''" Structural plan review fee(or deposit):
Contact name: Z (. 0 e--1 Jug
Y FLS plan review fee(if applicable):
Address: pm, e4 &„.. N v.)
City/State/ZIP: S ( Total fees due upon application:
e� q�jv Amount received: A36 ,f2
Phone:(9,3) gr/-35-5-7 Fax: :( )
E-mail: / ' /� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
gUe-n4.e y rer..o fie// (PV Yo.A00•C6
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: p,,s„be, Co.+S,, ./.. , .,,d 4_,...delj Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: ivy p„,„,4,,,,de. A.._ N w Solar Installation Specialty Code checklist.
City/State/ZIP: ?3p Y Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(5ii3) ci _ 35-5-1 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: /b(/1/3 Q 1/121111C Total fee due upon appication: $201.60
Authorized signature: r � This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date: *Fee methodology set by Tri-County Building Industry
— ��- 6- Z' Y Service Board
I:\Buildin!i•ermf s :IP-RESPermitApp.doc : 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received P
13125 SW Hall Blvd.,Tigard,OR 97223 Date
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD 24-Hour Inspection Line: 503.639.4175
0 Electrical ❑ Phunvni ❑ Mechanic d
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. ❑ ❑ ❑
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.
I l Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑
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 :,s licable to the iro'ect under review.
.It RISI)ICTIONAL 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, ❑ El ❑
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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46I3T(I I/02/COM/WEB)
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RECEIVED
JUN -2 2014
CITY OF TIGARD
BUILDING DIVISION
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REVISION City of Tigard
App d Plans �B y Date ( lIy
®FFICE COPY C
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JUN 1 g 2014
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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
114 = r Transmittal Letter
F I c�,\IL i) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
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TO: ,�� DATE RECEIVED;
DEPT: BUILDING IVISION BEGEW "'D
JUN 19 2014
FROM: /V// )9v�0r? e.Y ct v 1i(7MD
COMPANY: D evi e y co e,s A,44c e� k BUILL .l51°
PHONE: c ? -r..r/"Y.53'r- B
RE: H 7z(V— eC%-7
(Site Address) (Permit Number)
(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:
FOR OFFICE USE ONLY
Routed to Permit Technicia Date: Initials:
Fees Due: ❑ Yes o Fee Description: Amount Due:
$
$
. $
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes [ ir— ❑ Done
Applicant Notified: Date: 6/141i1 3 .1, (,w p-r v4.) Initials: /j .;.
1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012