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Permit
q CITY OF TIGARD MASTER PERMIT "• T'' COMMUNITY DEVELOPMENT Permit#: MST2014-00107 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 • Date Issued: 07/10/2014 Parcel: 1 S134DB01700 Jurisdiction: Tigard Site address: 11200 SW 115TH AVE Subdivision: WINTERS ADDITION Lot: 6 Project: Hufford Project Description: Construct a 532 sq ft attached garage. 9/29/14,added Fuzion Electric as electrical contractor. 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: 532 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Total: 0 sf Value: $22,599.00 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: D Tubs/Showers: 0 Garbage Disp: D 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 Tvpeg 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 Tomn 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: ADD SF 0 Owner: Contractor: HUFFORD,ARLY R&ANNETTE J OWNER Required Items and Reports(Conditions) 11200 SW 115TH AVE ANNETTE HUFFORD 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 11200 SW 115TH AVE TIGARD,OR 97223 PHONE: 971-227-2454 PHONE: 971-227-2454 FAX: Total Fees: $889.56 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 . =•on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0,110 through OAR •2-r 4090. You may obtain a copy of the rules or direct questions to OUNC by calling I-. 2.1987 or1.800.332.2344. -.441110 ejr.x. Issued :y: ' Permittee Signature: r Call 503.639.4175 by 7:00 a.m.for the next available inspection da -. 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. TO: CITY OF TIGARD Rilety-p:401 Building Division Services Supervisor 13135 SW H all Blvd.,Tigard,OR 47223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ® Owner ❑ Applicant ❑ Contractor B City Stko11 (check one) tp REFUND OR Name: Annette Hufford ♦G '(i Dl 4IQ0 INVOICE TO: (Business or Individual) VI ISON Mailing Address: 11200 SW 115th AVE City/State/Zip: Tigard/OR/97223 Phone No.: 9712272454 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). • REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: MST2014-00107 Site Address or Parcel#: 11200 SW 115th Ave Project Name: Subdivision Name: Lot#: .EXPLANATION: Adding Electircal Contractor ( e,r..8 E 1e.e1r �.•�S ,�,s,�,,,,� d-W.�t,¢.,� ' e )) Signature: Date: 9/23/14 Annette Huf or Refund Pub I. The Community Development Director or Building Official may authorize the refund of: a) any fee which was erroneously paid nr collected. b) not more than SO°a of the land use application fcc when an application is withdrawn or canceled before any review effort has been expended. c) not more than 8(1't.of the land use application fee for issued permits. d) not more than Sit" of the building plan review fcc when an application is canceled before any plan review effort has been expended. c) not more than 80"a of the building permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check Please allr w 1-a weeks for processing refund requests. FOR OFFICE USE ONLY Rte to S's Admin: Date ` MM. B Rte to Bid:Admin: Date #,ZM'E,Inkl% Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By Receipt# Date Method Amount$ 1:\Building\Forms\Rey PermitAction_062614.doe 1 RECEIVED City of Tigard p 2 9 2014 rDateBy Permit No.: I l of /t t Do/o 7 " 13125 SW Hall Blvd.,Tigard,OR Plan Review ' a Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other permit: T l(;A R l.) Inspection Line: 503.639.4175 CITY OF f I GARI) Date Ready/By: orris RI See Page 2 for Internet: www.tigard-or.gov Notified/Method: I Supplemental Information "—' TYPE%VI1G DIVISION 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 ❑Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","t-2","I-3", Job no.:2014-00107 Job site address: 11200 SW 115th Ave looHYormore. occupancy. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP:Tigard/OR/97223 ❑Health-care facilities. ❑Supply voltage for more than ❑Hazardous locations 600 volts nominal. Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more. -- —'T-- --' FEE SCHEDULE Cross street/directions to job site:115th Ave&North Dakota Description I QV. I FeC, 1 Total I . New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: 1—Lot no.: 1.000 sq.ft.or less 168.54 4 Ea.edd'l 500 sq.ft.or portion 33.92 1 Tax trap/parcel no.: Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) Limited energy,multi-family 75.00 2 Adding one breaker to new garage(1 Light,6 Plugs) 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 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,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits—new,alteration,or extension,eer panel ❑ APPLICANT ❑ CONTACT PERSON A Fee for branch circuits with above service or feeder fee, Business name: each branch circuit 7.42 2 — ---- B.Fee for branch circuits without Contact name: service or feeder fee,first 56.18 2 branch circuit Address: Each add')branch circuit 7.42 2 Miscellaneous(service or feeder not included) City/State/ZIP: Each manufactured or modular dwelling,service and/or feeder 67.84 2 Phone:( ) Fax: ( ) Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name:Fuzion Electric Signal circuit(s)or limited-energy See panel,alteration,or extension. Page 2 2 Address: 1335 SW 197th Ave Each additional inspection over allowable in any of the above CitylState/7..IP:Aloha/OR/97006 Additional inspection(1 hr min) 66.25/hr Investigation(1 hr min) 66.25/hr Phone:(503)5286033 1 Fax:(503)6492409 industrial plant(1 hr min) 78.18/hr p _f � / Inspections for which no fee}is CCB Lie.: 189798 Electrical Lic.: C59I ! /� Suprv.Lie.: r/7 "✓7 specifically listed 'h hr rain 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: lir di .I t 'Y".i Subtotal: Print name: Brett L..lohnson%y t1 1 litkcs. , Date: 9/23/2014 Plan review(25%of permit fee}: --e State surcharge(12%of permit fee): Authorized signature la I i , ,----- TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: +�' L� Date: ('J_�j)�� IY !! days after it has been accepted as complete. p CITY OF TIGARD MASTER PERMIT IllIl li '• COMMUNITY DEVELOPMENT Permit#: MST2014-00107 T t O A R a 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2014 Parcel: 1 S134DB01700 Jurisdiction: Tigard Site address: 11200 SW 115TH AVE Subdivision: WINTERS ADDITION Lot: 6 Project: Hufford Project Description: Construct a 532 sq ft attached garage. 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: 532 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Total: 0 sf Value: $22,599.00 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 Drywall-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<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: 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: ADD SF 0 Owner: Contractor: HUFFORD,ARLY R&ANNETTE J OWNER Required Items and Reports(Conditions) 11200 SW 115TH AVE ANNETTE HUFFORD 1 Ersn Cntrl 503-639-4175 TIGARD.OR 97223 11200 SW 115TH AVE TIGARD,OR 97223 PHONE: 971-227-2454 PHONE: 971-227-2454 FAX: Total Fees: $889.56 This permit ' ' -d subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be d• - in accordance 'th 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 d= . ATTENTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR •-2-001-0010 through OAR •• r r -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 •= •r 1.800. • X34* =sued By: /0 Permittee Signature: �` / '' ' Call 503.639.4175 by 7:00 a.m.for the next available inspection d - This permit card shall be kept in a conspicuous place on the job site until co • tion of the project. Approved plans are required on the job site at the time of each inspection. , Building Permit Application Residential RECEIVED t t 1 1 1 U 1 I 1 l 1 I ',I ()NI 1 City of Tigard Date/Be: 7 imam Permit No.:W T , —Cr.. r • 13125 SW Hall Blvd.,Tigard,OR 97223 II II II II Plan Review ' g Phone: 503.718.2439 Fax: 503.598.19140'L 2 014 Date/13 : UV/j� � Other Permit: Ti G R D Inspection Line: 503.639.4175 Date Ready 7: ,ff Juris 63 See Page 2 for Internet: www.tigard-or.gov CITY(*TIGARD Noti4 d/Method: ! Supplemental Information I I ■ a a . �_ �ar r.IM•_ TYPE OF WORK a 0 / 'EQ RED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit ees*are based on the value of the work performed. lig Indicate the value(rounded to the nearest dollar)of all lit 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: $ Z2 J S�1 01 IR 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 ZOO S L) I I *L 4 J e New dwelling area square feet City/State/ZIP: T i gc7,.ct1 ) 0 R q 1- ZZ� Garage/carport area: ,Z square feet ci Suite/bldg./apt.no.: JJ Project name: Covered porch area square feet Cross street/directions to job site: Deck area: square feet � c ,V {,l J � O rtk Da ) , .. Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I 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. (� ` {,. ` Valuation: $ 17r�, IL' {l� � 0. fChC �� e Existing building area square feet ,fir New building area: square feet (Jj`( PROPERTY OWNER I ❑ TENANT Number of stories: .1 Name: A n'i eh-7e F-1 tAV Po Ce4 Type of construction: Address: t`Z O p S t,_ I. VA- ' A v 2 Occupancy groups: City/State/ZIP: 1.-"' a w, l O R ` Z,2' Existing: Phone:(c{l`) LIT 2_. y 54 Fax:( ) New: ❑ APPLICANT 'CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee(or deposit):I Contact name: , � p t,r• 44,A.K ccril FLS plan review fee(if applicable): Address: I I 2_00 S t ) 11 St AJe City/State/ZIP:1--;, c o K °.TT ZZ Total fees due upon application: Phone:(owl) z_2_/ rl Q� I Fax::( ) Amount received: a 7rj .�� E-mail: '{ •� : — t ZO Z tK ; ( , co rd, PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* J Com -rcial and residential prescriptive installation of CONTRACTOR roof-to. • ounted Photo Voltaic Solar Panel System. Business name: ,/,12/0e Submit two sets of roof plan with connectio. .etails and fire depart ••t access,along with tit- i 0 Oregon Address: Solar Installation Ss' 'shy C o d e c o' ist. Permit Fee(include :... review City/State/ZIP: and •• nrsVativ s): $180.00 I Phone:( ) Fax:( ) St. - Ircharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon appication: $201.60 Authorized signature: /'K/%%��� /s This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: J � Date: Jl.� ) i l *Fee methodology set by Tri-County Building Industry O O� v. (/ / ( Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(111/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY City of Tigard Received ipi 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By • Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TIGARD 24-Hour Inspection Line: 503.639.4175 ID Electrical El Plumbmp ❑ Mecb:+nicat Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW v« No `/k I 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 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 ❑ ❑ ❑ 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,elicable to the •ro'ect under review. .JURISDICTIONAL SPECIFIC'S 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or l 1"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"buildingplans 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, ❑ ❑ ❑ 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:1 Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB) L • J CEIVED Electrical Permit Applicat' FOR OFFICE USE.ONLY Received /y City of Tigard L 3 2014 Date/By: �7 3 /1 (._.,1/4.__.,..49 PermitNo.: f (IirO/ �'/D 7 IN 111 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: i I. Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: luris, 0 See Page 2 for I I , Internet: www.tigard-or.gov BUILDING DIVISION 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","1-2","1-3", Job#: Job site address: Z0 j ( (Sties 100HP or more. occupancy. (� U ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: --T'• 9 O� 9r+ _z_-s ❑Health-care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.#: (project name: ❑Service or feeder 600 amps or more. f j� FEE SCHEDULE Cross street/directions to job site: I F }(` j. tic . /Ja.-L 14 Description I Qty. Each I Total I • ��ll�� New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot#: 1,000 sq.ft.or less 168.54 4 Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 — 1 Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) 1, — Limited energy,multi-family 12 I q�..r 1— Ft�^� 4. d N e 6j�t Q E' residential(with above ily ft.) 75.00 2 L�r`�"� ) /l J Renewable Energy ❑ See Page 2 _ --// Services or feeders installation,alteration,and/or relocation HOPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2 A 201 amps to 400 amps 133.56 2 Name: , O 401 amps to 600 amps 200.34 2 Address: (( 'z©a S� 1( 5-t-k.. 601 amps to 1,000 amps 301.04 , 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP: -'(�t q, 6 R Z Z¶ Temporary services or feeders installation,alteration,and/or Phone:q-71 ) 2,z z,(4 51 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,lease,rent,ore. •. e o •RS 447,449,670,and 701. . ' I qii-{ 401 amps to 599 amps 168.54 2 Owner signature• '✓��� Date: 7/ Branch circuits—new,alteration,or extension,per panel �J APPLI ' I ❑ CONTACT PE iiiRSON 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 / branch circuit 56.18 2 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 Le)CONTRACTOR Sign or outline lighting 67.84 2 Business name: 0 Le)(v U2.- 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 City/State/ZIP: Additional inspection(1 hr min) 66.25/hr Investigation(1 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 Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(V,hr min) Suprv. Electrician signature,required: ELECTRICAL FERMI FEES Subtotal: Print name: Date: Plan review(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: ' ! TOTAL PERMIT FEE: Print name: (� p, Date: 1 This permit application expires if a permit is not obtained within 180 d�' M 1 O 3 f, days after it has been accepted as complete. ` ' Number of inspections allowed per permit. I:1Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(11/05/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 Each I Total I • 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 to 25 kva 200.34 2 ❑ 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 552.26 2 1=I Heating, Ventilation and Air Conditioning OAR918-309-0040) System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 ❑ 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 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(4 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) * Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ 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:1Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ■ T 1 G A R D Building Permit Review — Residential Building Permit #: NI 1 / CO 1c7 Site Address: //2-0 O $ W / I c Ill 4-7,44— Project Name: t,Ocil A,/•p f,L 4 ddIP De4 �V dr r/t Lot #: dwelling=subdivision name;Addition or Alteration=last f owner) Planning Review Prop sal: Verify site address/suite #exists and active in permit system. Si lan Elements: V ree(3)copies of site plan CJF,xisting structures on site Site plan must dig on 8-1/2"x 11"or 11 x 17"paper 2.Footprint of new structure(including decks)with finished yawn to scale (standard arc ezr ngi sc lei floor elevations orth arrow E ' ty locations (required for new,may apply for additions) to address,project or subdivision name and lot number ocifion of wells/septic systems Lv./S A plicant information(name and phone number) ID rosion control(including drainage-way rdtection, silt fence 0 :trot dimensions and building setback dimensions - .-, •eiwu• •f catch basin,etc.) (j 4 > $O D s f') ^r fot area,building coverage area,percentage of coverage and t ❑S reet names v 1,..._ i ervious area(applicable if R-7,R-12,R-25&R-40) ►ti- ee size,type and location • Of C` 2froperty corner elevations (2 foot contour lines if mosgt r/ xisting trees to be retained with drip line,and tree n4I p 4 foot differential) 0 f I Lwi C 6) protection measures '°l Clean Water S ices—Service Provider Letter: (lot platted prior to 9/10/1995): ` Required: Yes ❑ No Received: ❑ Yes ❑ No ❑ Land Use Case #: Nii/r toning: ¶ (-II) Ai Setbacks: Front 10 Rear 1 5 Side IQ 5 Street Side 2 0 Garage Z 0 p,andscape Requirement: ` WO� t Coverage Maximum: L( Building Height: Maximum Height 3 v Actual Height Ind" Visual Clearance Easements 'Sensitive Lands: ❑ Yes No Type R' Urban Forestry Plan O Pe Conditions Met i4 pt Notes: Approved By Planning: ��il We I a i Date: 7 ©/ Lf Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Build ing\Forms\BI dgPermitRvw_RES_042914.docx Building Permit Submittal Original Submittal Date: Site Plans: # 3 Building Plans: # Building Permit#: Enter building permit#above. Workflow Routing: P'Planning [ E igineering ermit Coordinator 213uilding Workflow Sign-off: ign-off for Planning(include notes from planning review) Route Application Documents: Engineering. (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building. original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: �& lac& By Permit Technician: 1 Date: 7///f Engineering Review ❑ Actual Slope: ❑ Conditions Met Notes: Approved by Engineering: ��►4 Date: 7.7, ( - Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions Met-Prior to Issuance of Building Permit Notes: Revisions(after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: ??.. .OK to Issue Permit /Approved by Permit Coordinator: - Date: /9/1_47 I:1 Building\Forms\BldgPermitRvw_RES_042914.docx J 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 all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will 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. 4jk FrO LA_ Print Name ofrmit Applicant 7/I 01/ Signature of ermit Appli t Date Permit#: 1.15Td0//'d0 f' Address: NO0 /( /W 44 t 02 57P- -3 ;..��, Issued b : ate: 7/0/ t This Copy for Permit Offices Clean Water Services File Number C1eanWater Services 14-001935 Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: City of Tigard 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Jordon Hufford Company: Address: 11200 SW 115th Ave Site Address: 11200 SW 115th Ave City, State,Zip: Tigard,OR,97223 City,State, Zip: Tigard,OR 97223 Phone/Fax: 9712217107 Nearest Cross Street: North Dakota E-Mail: jhufford1202 @gmail.com 4. Development Activity (check all that apply) 5. Applicant Information • Addition to Single Family Residence(rooms,deck,garage) Name: Jordon Hufford ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: 11200 SW 115th Ave ❑ Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial ID Multi Lot Commercial City, State, Zip: Tigard,OR 97223 Other Phone/Fax: 9712217107 E Mail: jhufford1202 @gmail.com 6. Will the project involve any off-site work? ❑Yes C4 No ❑Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality,Department of State Lands andlor Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate. Print/Type Name Jordon Hufford Print/Type Title ONLINE SUBMITTAL Date 7/3/2014 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200'of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also be required. 110 Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 07-20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,State.and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 07-20,Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law. ❑ This Service Provider Letter is not valid unless CWS approved site plan(s)are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed by4z.zt. �� `�� Date 07/10/14 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone:(503)681-5100 • Fax:(503)681-4439 • www.cleanwaterservices.org 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 11200 SW 115TH AVE, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical final PASS MST2014-00107 Jeff Grove Violation Summary: Inspector Contractor 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 .111 --, r Transmittal Letter a e e r i ;n i, i, 13125 SW1 Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: DATE G DEPT: BUILDING DIVISION lJ[_1� '' 1 JUL'2 2 2014 (FROM: j ,z2A-0+� �l_V-,At CITY OF T D COMPANY: � ,�, C �T�K;�� o, t f cj-C-',r PHONE: 2Z( " BY. �RE: j Z 7-o c, S c_D 1,\,ct`' A-,) e_ I`-(,,ST Zoo-1 - 60 (U (Site Address) (PermitNumber) (Project name or subdivision name and lot number) ■ ATTACHED ARE THE FOLL G I Copies: I Description: i pies: Description: Additional set of plans. Revisions: Cross secti (s) an details. Wall bracing and/or lateral analysis. Floor/ro framing Basement and retaining walls. Be alculations. Engineer's calculations. Other(explain): } REMARKS: 1 -D /0--- � 'r FOR FFI E USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: III [Yes ji< Fee Description: Amount e: $ $ $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes I El No ❑ Done Applicant Notified: Date: 7/j.ijy e.j� Initials: e T 1`_\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 1ST Z© 1�t - C34 toy RECEIVED JUL 2 2 2014 CITY OP TIGARD CITY OF TIGMD Scale: 1/4"= 1' REVIEWED FOR CODE COMPUANCB BUILDING mem Approved: II.-�� OTCs ( Permit#: ‘4,6 7—W (C'(C7 Address: ( (2 l t) _ Sui #• By Dates -712-((`k- OFFICE COPY 2"x 10" Ridge 2"x 8" Rafters , 17 4-- 2"x 8" Strong back 2"x 6" Purlins 5.5"x12"x 19' Beam 28' 28' 4— 2 x 8 Strong Back 4-2x10Hips & Ridge 19' 5.5"x 12" /9/71 Beam m I 2'Overhang Scale: 1/4"_