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Permit CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT14 Permit#: MST2014-00198 T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 i ` ``• Date Issued: 11/25/2014 Parcel: 2S103AC01800 ® iiM Jurisdiction: Tigard Site address: 11200 SW FONNER ST Subdivision: WALNUT GLEN Lot: D Project: LIN Project Description: Lift house to add foundation and unfinished basement with laundry room and bathroom. Connect existing house to sewer service. Public sewer connection done under PF12014-00098. No BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 520 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 520 sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 50 SF Rain Storm Sewer: 0 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 92 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: 1 Clothes Dryers: 1 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: 31 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 N Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 520 Owner: Contractor: LIN,JESSICA CHIACHI STEVEN MELVIN HOLLIS&SPENCER DERE Required Items and Reports(Conditions) 498 JEROME ST PO BOX 40475 1 Ersn Cntrl 503-639-4175 SAN JOSE,CA 95125 EUGENE,OR 97404 PHONE: 408-368-0739 PHONE: 541-521-1553 FAX: Total Fees: $2,881.69 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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a co;.• ;s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344., r Issued By: k r>!�r_ -- -- Signature: -t- 4. I .•39.4175 by 7:00 a.m.for the next availa.e inspection date. +V 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. ilL,,,.,,,, CITY OF TIGARD MASTER PERMIT ril COMMUNITY DEVELOPMENT Permit#: MST2014-00198 TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 4. ` Date Issued: 11/25/2014 � kif Parcel: 2S103AC01800 EININCIM Jurisdiction: Tigard Site address: 11200 SW FONNER ST Subdivision: WALNUT GLEN Lot: D Project: Booth Project Description: Lift house to add foundation and unfinished basement with laundry room and bathroom. Connect existing house to sewer service. Public sewer connection done under PF12014-00098. No BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 520 sf Basement: 0 sf Left 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 520 sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 50 SF Rain Storm Sewer 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 100 Drains:00 Bckflw Prevntr: 0 Catch Basins: 0 Footing Drain: 92 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: 1 Clothes Dryers: 1 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: 31 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: Ecpmpasin N g: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: ALT p y Square Feet: SF VB R-3 520 Owner: Contractor: BOOTH,DAVID K STEVEN MELVIN HOLLIS&SPENCER DERE Required Items and Reports(Conditions) 3005 N PACIFIC HWY W PO BOX 40475 1 Ersn Cntrl 503-639-4175 RICKREALL,OR 97371 EUGENE,OR 97404 PHONE: PHONE: 541-521-1553 FAX: Total Fees: $2,881.69 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 rules adopted by the Oregon Utility Notification Center. T ose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You .' .. .' - opy of the rules or direct questions to OUNC by calling 503.23 : or .800.332.. 44. Issued By: �� ittee Signature: �I -- ..• ��all 503.639. /�' 4175 by 7:00 a.m.for the next available inspection data 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. Electrical Permit Application IOIl t)I Fllt I ,L O\1.1 City of Tigard C�� NVO Received / 13125 SW Hall Blvd.,Tigard, 23 DatcBy: �� S 7`f j Permit No.: �/ l Phone: 503.718.2439 Fax: 503.598.1960 9\4 Plan Review �f ©r �� i, , , Inspection Line: 503.639.4175 la `I ©� Date Re Other Permit: Line:gard-or.gov \'tc v 1 Ak]v Date Ready/By: Juni- Internet: I 0 See P■ge z for ,` INWV Supplementallnform■tion 2. TYPE OF L+z`'v��N1S�O� 1, PLAN REVIEW ❑New construction ErAddition/. -1,,r 1 l`; • Please ar amen[ check all that apply(submit sets of plans wltems checked below): ❑DemolitionOther: } 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. ? ,, ,; CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 51 -and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural 1❑Multi-family 0 Master builderampsrefor all other insWlations. buildings. . 0 Other: 0Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system. 0 Addition of new motor load of ❑'•A^ '•E^,••I-2" "I-3•' Job no.: Job site address: 11 zoo 5w F�IA,Me' 100I-IP or more, occupancy. � -� 0 Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: ( e ❑ ealth-care facilities.H t 9 412,3 ❑Supply voltage for more than Suite/bldg./apt.n0.: ❑Hazardous locations. 600 volts nominal. I Project name: 0 Service or feeder 600 amps or more. Cross street/directions to job site: I I-3 �1 FEE SCHEDULE n { t Descriuiwe I Qty- I Fen 1 Total I • _ s_ifrAi 7/7 .-_p 1-2 !_- o New residential single-or multi family dwelling unit. Zl ,2—2 L;Y-(4.4.73 Includes attached garage. Subdivision: e I Lot no.: 1,000 sq.ft.or less 168.54 4 Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 1 Limited energy,residential ' DESCRIPTION OF WORK (with above sq ft.) 75.00 2 VA, {i��%>) �,� S Q tn� U Limited energy,multi-family r"v/1 a'1 7 t•1 residential(with above sq.ft.) 75.00 2 RB IOGIv1 14.44 v(Jct w ke a Renewable Energy 0 See Paget G►' Services or feeders installation,alteration,and/or relocation tg PROPERTY OWNER 0 TENANT - 200 amps or leas 100.70 Name: D 4,,,J1'a y: -cry 1�/ 201 amps to 400 amps 133.56 2 � ©--h.L• 401 amps to 600 amps 200.34 2 Address: 3 0 o - N r Afr'(L Wy /, 601 amps to 1,000 amps 301.04 r rp 2 City/State/ZIP: �, , ]`� 1�33'I Over 1,000 amps or volts 552.26 2 (503) 3 V l Temporary services or feeders installation,alteration,and/or Phone: 3 0�� 2 Fax:( ) relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 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: 401 amps to 599 amps 168.54 2 Date: Branch circuits-new,alteration,or extension,per panel 0 APPLICANT l 0 CONTACT PERSON A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without service or feeder fest,fustI Address: branch circuit 56 18 2 Each add'I branch circuit 3 7 42 2 City/State/ZIP: Miscellaneous(service or feeder not included) Each manufactured or modular Phone:( ) I Fax: :( ) dwelling,service and/or feeder 67 84 2 E-mail' Reconnect only 67.84 2 oCONTRACTOR 7�� Pump Sign or r outlineirrigation circle 67.84 2 / lighting 67.84 2 Business name: (�l ----74-C 7-sity.....__ Signal circuit(s)or limited-energy See Address: panel,alteration,or extension. Z ( 1-5 vJ eine2 2 �7 ���"•"n-r Ca`s—�j-�' � Each additional inspection over allowable in any of the above �/! 4 re_ q �u-� Additional inspection(I hr min) 66.251 hr City/State/ZIP: 1-Ikl ,r. Phone; (�03).�b�•4 I Investigation(1 hr min) 6615/hr 3/, Fax:( ) Industrial plant(1 hr min) 78.18/hr ' Electrical Lic.: G Inspections for which no fee is CCB Lie./ 6 sem- I Suprv. Lic.:5— 35 specifically listed('/,hr min) 90.00/hr ELECTRICAL PERMIT Suprv.Electrician signature,required: .�,c.�.- FEES Print name: 5�� I.•— g h A Subtotal: (� 1 Date: f/i hr '4 Plan review(25%of permit fee): Authorized signature: State surcharge(12%of permit fee): TOTAL PERMIT FEE: Print name: 6Z.A.„ a,._.4 I Date: 11 —6- (4- This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. t.�BuildingSPermit�IFLC_PcrmitApp ELR ERE.dnc Rn 05/21/3017 • Number of inspections allowed per permit. 440-1615T(I I/05/COM/WEB 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. 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. 7 it /n (Y(/1• Print - orPemtff-pal t V)_.--e/2 Signature of Permit Ap. ' •nt Date Permit#: /VT,2e) — cie Address: //-92(10 54.1 i—erynied" 411, .• • • Issued by: e / . Date: ,A-77/7 y f= .• This Copy for Permit Offices A CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT r r Permit#: MST2014-00198 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243•�� Date Issued: 11/25/2014 Parcel: 2S103AC01800 Jurisdiction: Tigard Site address: 11200 SW FONNER ST Subdivision: WALNUT GLEN Lot: D Project: Booth Project Description: Lift house to add foundation and unfinished basement with laundry room and bathroom. Connect existing house to sewer service. Public sewer connection done under PF12014-00098. No (I) P,e,ti L, BUILDING di�✓ 'j I//V/ A>DLb (/)rue, wr-k r- est'.ea c4 Floor Areas Required Setbacks I Required Stories: 2 Bedrooms: 0 First: 520 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 520 sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 50 SF Rain Storm Sewer 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 92 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: 1 Clothes Dryers: 1 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: 4 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-3 520 Owner: Contractor: BOOTH,DAVID K STEVEN MELVIN HOLLIS&SPENCER DERE Required Items and Reports(Conditions) 3005 N PACIFIC HWY W PO BOX 40475 1 Ersn Cntrl 503-639-4175 RICKREALL,OR 97371 EUGENE,OR 97404 PHONE: PHONE: 541-521-1553 FAX: Total Fees: $2,611.05 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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0 roug 2-001-0 ou mmaa obtain as copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issue By: k / (/S� �CJ�L�?'Z"" D"�li Permittee Signature: (2---'1/ — Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Site Utilities i oix of.FIt i, I'si. ()NIA City of Tigard Received Datell t v 13125 SW'Hal!Blvd.,Tigard,OR 9 s Plan Review L ��Ott i ■ Phone: 503.718-2 339 Fax: N. t>atuDy: Other Permit No: Inspection Line: 503.639,41 - ['ltiAltD Internet www.tigard-or.gov ry���s 1 ciReadyeth 'Will S plemenc2tor S Nuti1'xd2Nelhod. 3upplewental[otorraaaaa - TYPE OF WO: ..•� . FEE* SCHEDULE mi.❑New construction ❑ a - e special I C� �' For r ecial in ormarion use checklist ° `tt� .r' - ! Description 1 Qty. 1 Ea. [ Total ®Addition/alteration/replacement II1 , �l � New I-2-family dwellings(includes 100 ft.for each utility comection) CATEGORY OF CON'i t it' IN SFR(l)bath 312.70 ($1-and 2-family dwelling ❑Cormnercialiindustrial SFR(2)bath 437 78 SFR(.3)bath 500 32 ❑Accessory building ❑Multi-family -- • Each additional bathAkitchen 23.02 ❑Master builder ❑Other . __, Fire sprinkler( sq.ft.) I Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: Catch basin or area drain 18 76 j zoo . S1n1 �J N K i V c, , Drywell,leach line,or trench drain 18.76 -1 City/State/71P: ^. J 0 9,_ q 4 _2- ....3_ sir Footing drain(no linear ft.:g2, ) Page 2 Suttelbldg.rapt no: I Project name: Manufactured home utilities i 50.03 Cross street/directions to job site: 1 I ! • Manholes 18..76 1.041-6 12- 5k e.0 1 C.>` }/OC' '9 (i) P/J1 h1Z Rain drain connec r -, ,; ,./sot'' 1 8.76 ^ . , Sanitary sewer(no linear ltd ) ! j Page 2 ,..Gtd� Lr 4 r.ir Lletv,of eaclTI, , -7- ��' Storm sewer(no.linear IL ) 1 Page 2 1/1/1.5..._.._..6.7--- ,x Water service(no.linear @.:4/9) f Page 2 1 LPa.si Subdivision: 1 Lot no.. Fixture oritem: Tax map/parcel no: _. backtlow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51. A ) 1 J - ' L Clothes washer g,{+bC Oitty 1 25.02 t �•111 set_ . -. • ►4 4- :. T Dishwasher 25-0. .S1.Nele 11rt V.4..___/2° i CIA . t•Ly C Drinking fountain 25 02 r 5. e t -. ._._..__... C� t Y d G R.�"'�� E.Jectors�'sumP _ 25.02 1 ® PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name, ` ` _� Fixture/sewer cap T. 25.02 i .tr.. Floor drain/floor sidcfiub 25.02 .� Address: -3 U S N ?,t c.;4,1'l,_ }'{w llv . ) t Garbage disposal City/State/ZIP- t j(t 0 TR-34f 25.02 I Hose bib 25.02 Phone:( S b3) '3?j 7_ '3 0-4'4- Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:S_) Page e 2 g �j57 Contact ontact name: )C.Primer . 12.51 /2- Address: Roof drain(commercial) 12.51 _...•.,.•. Sink/basin/lavatory' 25 02 C ity:/State/2i P: Solar units(potable water) 62.53 Phone:( ) I Fax::( ) X Tub/shower/shower pan i 12.51 7,2‘.5/,a. E-mail: I Urinal 25.02 ( Water closet r 1, , 25.02 I CONTRACTOR ,(� I ]�.....tr � J. ,G J. _ ---- Water heater R4tecakt041. ( 37.52 a;,7 1' Business name: Crr1 PY ?1 I5 r\c`q Water tin WV 56.29 Address: 2„,,/ r.-_.__ - i [ J f. . Other: 25.02 R. 71-02/ _ City/State/71P: _�.s r ..._0 It .1-��e Tt en=tq L 1-4->e 2� Subtotal ! g'� ti(p� Phone:(503) .0 Z Z 2315 Fax:( ) • Minimum permit fee. $72.50 _ 1 CC/3 l.ic.: Plumbing Lic.na. Plan review (2530 of permit fee) • �o$ s�� y ��ir , g �a State surcharge(12%ofpermit tee) • M. Authorized signature: TOTAL PERMIT FE& 9 T.,c17 Print name: �a V• i Date: +o-Z1 ,-l y This permit application expire ila pertain is not obaioed within ISO days lb_ after it has been accepted as complete. •Fee methodology set by Tn-County Bul'.ding Industry Service Board I ANuddinelvernuteP1M.on.Peg m rApp Aoc 15/01M 440.46 i61i 10;C2'COM/WE61 71 p CITY OF TIGARD MASTER PERMIT 'r1 • COMMUNITY DEVELOPMENT Permit#: MST2014-00198 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/25/2014 Parcel: 2S 103AC01800 Jurisdiction: Tigard Site address: 11200 SW FONNER ST Subdivision: WALNUT GLEN Lot: D Project: Booth Project Description: Lift house to add foundation and unfinished basement with laundry room and bathroom. Connect existing house to sewer service. Public sewer connection done under PF12014-00098. No BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 520 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 520 sf Value: $50,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 50 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: D Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 92 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: 1 Clothes Dryers: 1 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: 4 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-3 520 Owner: Contractor: BOOTH,DAVID K STEVEN MELVIN HOLLIS&SPENCER DERE Required Items and Reports(Conditions) 3005 N PACIFIC HWY W PO BOX 40475 1 Ersn Cntrl 503-639-4175 RICKREALL,OR 97371 EUGENE,OR 97404 PHONE: PHONE: 541-521-1553 FAX: Total Fees: $2,512.98 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 rule- adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of th- ules o •irect questions to OUNC by calling 503.232..19877 or 1.800.332.2344. Issued By: / , Perm "!nature: / V"�Fj� 0- �y Z - Cal�iR�• 5 by 7:00 a.m.for the next availab e -section date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. , Building Permit Application Residential F RECEJ Received IN - City_of Tigard 2014 Date/By: // ��/ Permit No 115r �p lc 1 13125 SW Hall Blvd.,Tigard,OR 97 $7 V Plan Revi / 1 Q+� Phone: 503.718.2439 Fax: 503.598.1960 �_„ter,(\ DateBy: t l 17 herPermit:Si_/It. OI�rCX)IOt5 1. �_ `1,1� Inspection Line: 503.639.4175 CITY 16�u Date R / Juns ®W See Page 2 for Internet: www.tigard-or.gov I�t)lr°' 1�`ligIO�1 Notified/Method: //p��,c�, /47 !7�"/-, 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 1 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this applll:ation. 1 tg 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ Tj6 l �Q El Accessory building ❑Multi-family Number of bedrooms: D ❑Master builder Number of bathrooms: ¢ 1 0 y(� JOB SITE INFORMATION AND LOCATION Total number of floors: j (b� Job site address: ew dwelling area: O square feet l I ZOO 5W FvvlNer Si 5�-. City/State/ZIP: T g a irsok I D R 11-2.2"3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: 60G Covered porch area square feet Cross street/directions to job site: 1131- P if„ Deck area: square feet Other structure area: 5 2.0 square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work pe • ed. Tax map/parcel no.: A /d 3 � C' Indicate e value(rounded to the nearest dollar r all equipment, s aterials,labor,overhead,and •- profit for the DESCRIPTION OF WORK work indicates in this application. M (� 1 I / L Valuation: $ EY-6 kr)kSe. kg r.o T►ukIAA ,,l„ • W e ..wC Uk ll t-1 1 Existing building are. square feet ko IA.S¢ 404A adds LOA P;rt;s1 td VNISt iii g..144 w I awKly1, V 0 0 Pvk d- be,-14 c--” `.` de khJ E C7 'jam d ew f it: New building area: square feet 'a�¢R(OPERTY OWNER ❑ TENANT Number of st r es: U Name: lbav,tk . O 0-14,, Type o onstruction: Address: 3 0 0 5 N . 1?atc. ►i W , 0• upancy groups: §' City/State/ZIP: R i Lkreq�) o 1` I 9--1 Existing: Phone:(SQ3) 3-6 Z 3 O - - Fax:( ) New: -5 ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* ` Business name: (Please refer roJee schedule) Structural plan review fee(or deposit): Contact name: - FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application: j Phone:( ) Fes::( ) Amount received: 1 /7 l T E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installa on of CONTRACTOR roof-top i ounted PhotoVoltaic Solar Pan- "ystem. Business name: V.e>i Tl0 15 Submit two sets of roof plan wi s rnnection details ^� V` and fire departm- ..ccess,alo. with the 2010 Oregon T Address: D 16 t X, 4 D y 4 S Solar Installation Spec:, . ode checklist. City/State/ZIP: v,q J Zt„,e q l+4 O 4 Permit Fee(i ides p eview $180.00 .• administrative - Phone:(5 ) I ' (s� Fax:( ) State . harge(12%of permit fee): $21.60 CCB lic.: 11-/ 033 51w1 to Total fee due upon appication: $201.60 Authorized signature: _ This permit application expires if a permit is not obtained • within 180 days after it has been accepted as complete. Print name: ^ JJ Q Date: *Fee methodology set by Tri-County Building Industry D0.V l t7� 1J0o �r Z�' I Service Board :\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB) r • Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY MI City of Tigard Received ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Date By: Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TIGARp 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑ 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 ❑ ❑ ❑ 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 ,y.licable to the .ro"ect under review. .fit RISUICTIONAL SPECIFIC'S 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-12"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, ❑ ❑ ❑ 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:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(l 1/02/COM/WEB) * Plumbing Permit Application Site Utilities Permit No.: i/<�r l L -to ; 'Ci City Tigard � Received e 13125 SW Hall Blvd.,Tigard,OR9 , 'A \ Date/By: / /y 114 Plan Review Phone: 503.718.2439 Fax: E`It N Date/By: Other Permit No.: Inspection Line: 503.639.41 1. y. I 1 t„\J'O Internet: www.ti ard or. ov 1� Date Rea /B Juris: ® See Page 2 for g g 6ti� Notified/Method: Supplemental Information TYPE OF WOltk. , v C V FEE* SCHEDULE ❑New construction ❑�```D'eit� S�O� For special information use checklist �� Description i Qty. I Ea. I Total ®Addition/alteration/replacement ' New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CON ON SFR(1)bath 312.70 cg 1-and 2-family dwelling SFR(2)bath 437.78 y g ❑Commercial/industrial ❑Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: Li 700 511,1 ry vi K Cy Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 6,c� , 1 A � Il � 74-1a-3 *Footing drain(no.linear ft.:R2 ) Page 2 Suite/bldg./apt.no.: f Project name: Manufactured home utilities 50.03 Cross street/directions to job site: it-5 'I? 'Pi Manholes 18.76 Rain drain conned?r1�,(iU 18.76 17ej Sanitary sewer(no.linear ftr?SO) Page 2 - Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer Rfl oC*kt, ' 25.02 .25.UL f V NJ (11,4- i h I °iL Gel CQ ruA.- oflSr hwi'i-+ � Dishwasher 25.02 n v.a �1t L v4 b O Ck t A..t id vLi Drinking fountain 25.02 4 C` tt '' r e I 0 G RA-e). . 1 Ejectors/sump 25.02 ® PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: l�C.f1V a J Fixturelsewer cap 25.02 Address: �a L .� `` ''w kA) Floor drain/floor sink/hub ) 25.02 r to 3 (7 S Nl �'l • Garbage disposal 25.02 City/State/ZIP: � v J O_ 11-34 I Hose bib 25.02 Phone:( 5-o3) 3 3 Z -3 0-4-1- Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Contact name: • Primer 12.51 Roof drain(commercial) 12.51 • Address: Sink/basin/lavatory 1_ 25.02 c. Oil City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR / ,(6 Water closet I 25.02 ),5�, Water heater RQl0C4A1.O> . _ ( 37.52 3 7 . Business name: Car�/� eY rp( 6 r� Water piping/DWV 56.29 Address: C Z 1 1 9 S f? S-W,e Other: 25.02 City/State/ZIP: 10 10/4444(45(..,4 S � 7 7 $9 Subtotal Minimum permit fee: $72.50 Phone:(503) 713 2._ Z 2..4% Fax:( ) Plan review (25%of permit fee)CCB Lic.: r D$ 5-6 y q I i t I tc Plumbing Lic.no.Z - 513 4 PB *Ill - - State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: �a V'. 'O3'l,1 1../1 11 /�/L Date: 10-z1' (y This permit application expires if a permit is not obtained within 180 days -' l y.!<1 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\PermitsiPLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) I Mechanical Permit A • 1 ii;. ,Li . t(I It ()1 I l l I I ∎I t 1\11 City of Tigard Q,,. Received Date/By: Permit No.: �O j a 13125 SW Hall Blvd.,Tigard,OR 97, /I © r / Phone: 503.718.2439 Fax: 503.598 2014 Plan Review Date/By: Other Permit: Inspection Line: 503.639.4175 F I u A R u Date Ready/By: Sufis: ® See Page 2 for Internet: www.tigard-or.gov CITYOtr�61 ) Notified/Method: Supplemental Information It m c 49,MI In?► TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST �( Mechanical permit fees*are based on the value of the work ❑New construction J°1 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* ig 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: T S 1 Air conditioning 46.75 Job site address: (( Z 0 0 5V4 F Ohm• D I . Furnace 100,000 BTU(ducts/vents) , 46.75 City/State/ZIP: 1.1k,4 l 0 q 122.3 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: I(3 ' --pt 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 DESCRIPTION OF WORK Gas fireplace/insert 33.39 I� 61'4 Flue vent for water heater or gas 1 _ e W vt,l,/l,�NI n),I r ck b®1S Y 1M L�-t aM-) �e • fireplace 23.32 Log lighter(gas) 23.32__ Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 g PROPERTY OWNER I ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: .a.)-d �O ' q equipment hood/other kitchen 33.39 Address: 300 iv . ?aC j f,L 0,vv 14 • Clothes dryer exhaust 1. 33.39 City/State/ZIP: R Gky,eA I 0 L 39.1 Single-duct exhaust(bathrooms, L 23.32 I toilet compartments,utility rooms) Phone:(So3) 33 2 3 0'1-)— Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater _ Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) _ Business name: '5: -tomtr� 4,4 Other: T l MECHANICAL PERMIT FEES* Address: Oy, Le 0 TIC. Subtotal City/State/ZIP: Q M SO 1 1_ 9 °L( Minimum permit fee($90.00) / Plan review(25%of permit fee) Phone:(511 I) �2 I S S 3 Fax:( ) State surcharge(12%of permit fee) CCB lic.: I+C 0 3 3 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:cAA,is i3 Date: LI:'Building\Permits\MEC_PermitApp_040113.dce 4404617r(t1/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 Electrical Permit Application ���j1 )` Ft>R OFFICE. I SE ONLY II City of Tigard • �� Date/Bya 1) 5 /`i �� Permit No.: i t O A� �j/'? / 1 —O 13125 SW Hall Blvd.,Tigard,•' " 223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 1 0 201 Date/By: Other Permit: Inspection Line: 503.639.4175 0 1 Date Ready/By: Juris: ® See Page 2 for I IGARD p V \r�� Internet: www.tigard-or.gov ��,`��V Notified/Method: Supplemental Information TYPE OF W� i'�VI VVIN1 �oS PLAIN REVIEW ❑New construction Et Addition/a +.1 1�' . ement Please check all that apply(submit 2 sets of plans w/items checked below): 1 ❑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 [:21 I-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- 1 3 , {� CIA 100HP or more. occupancy. Job no.: Job site address: 112,00 5A/ t'cm K e' ' ZYl. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: (^?� awe 4-�23 ❑Health-care aza douse facilities. ❑Supply voltage for more than t_ '^ ❑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: 'l-3"'" ?1 Description I Qty. I Fee. I Total 1 • _ 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'1 500 sq.ft.or portion 33.92 I Tax map/parcel no.: Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 75.00 2 Limited energy,multi-family 4 v QW 14"�k-vK eg2 bias e t�rt o e '�" i residential(with aove sq.ft.) 75.00 2 r Renewable Energy ❑ See Page 2 Re(OG 11nq 1,4.4.K.) V(/ D(,,At.t t�1� It Loa/ i1 ' . Services or feeders installation,alteration,and/or relocation EX PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2 �{ 201 amps to 400 amps 133.56 2 Name: 1)0,,V I a o 1 7 6_ 401 amps to 600 amps 200.34 2 Address: � -3- 601 amps to 1,000 amps 301.04 2 3 o r ��l�� Over 1,000 amps or volts 552.26 2 City/State/ZIP: _"y i V �_ 7'3 J Temporary services or feeders installation,alteration,and/or Phone:( S) 3 3 2 3 0}I- Fax:( ) relocation 200 amps or less 59.36 I■I 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 Owner signature: Date: Branch circuits–new,alteration,or extension,per 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 1 56 18 2 branch circuit Address: Each add'I branch circuit 3 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 ---7157:::) Sign or outline lighting 67.84 2 Business name: (6.e. �� (� /'�k`- Signal circuit(s)or limited-energy See — d _ panel,alteration,or extension. Page 2 2 Address: I Z ( f-'5 1(,J $ a...Kr 6.4_54- Ai/. Each additional inspection over allowable in any of the above City/State/ZIP: �t"( f—p// d 2 I �'u_ Additional inspection(1 hr min) 66.25/hr /l Investigation(I hr min) 66.25/hr Phone:(. 3)` 15o.4)1 I- Fax:( ) Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lie...,Cl('f1?j Electrical Lic.: C 6 s----f-- Suprv.Lie.:'---S-93,5 specifically listed('l/hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: PAL Subtotal: Print name: 1..— A.r_ .I it Date: //...„6--14 Plan review(25%of permit fee): v State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: ti (( Date: 6 I This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. " Number of inspections allowed per permit. 1:1Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/2 I/2013 440-4615T(II/OS/COM/WEB FOR OFFICE USE ONLY-SITE ADDRESS: //0200 £'Gt, /---0A/n/ 2 • 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 UPI ■ Transmittal Letter 1 I .,,\It I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: ■9A/ DATF, �L�EJ l DEPT: BUILDING DIVISION NO V 12 2014 FROM: -//LC, �,9-Z &ivrGinl� 'r v/C3- t,ITYOFTIGA BUILDING DNISION COMPANY: ' PHONE: 57Y—F6, 'd 6 6 7 By: / RE: //2d 0 J ) /i✓�c%-� AlS57 /�f—Q0l,`" (Site Address) (Permit Num er) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: I Description: I 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: /4-0`7t ic/�1TIOn/ /4& q-,A1/47A-- kJ, -L - FOR OFFI E SE ONLY Routed to Permit Technici Date: (I C7(11_ Initials Fees Due: ❑ Yes a o Fee Description: Amount Due: $ $ $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes ❑ No ❑ Done • Applicant Notified: Date: Initials: 1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 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 FONNER ST, TIGARD, OR, 97223 Residential - Master Permit 120 Electrical rough-in FAIL MST2014-00198 Herb Stabenow All devices are to be removed from all boxes-all wires in the boxes must be no less than six inches long before any splices are made-permit needs to be amended to show all circuits in the new addition Violation Summary: Inspector Contractor City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ` = Request q est for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard- r.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. 0 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#: 7v)S7-v2O14/-©c) i`ir Site Address or Parcel#: F-01/rvV-Y 5i d , Subdivision Name: Lot#: EXPLANATION: . /�'I r1( 2) a.`�/ A,1 ct.t. >� h, ccY•,�lp .•*1 ,/ e„CG r7� �� c✓ /( i444--/-e., s'31 S l v2U f y-00/1 k pis /e et i �I.�G✓ A(tMrLc trr S r it/j el.c/Arte^ lerd M/S, 6. 1, 74C1✓r."... CA/tfd <t 3 S-c-✓v‘a i red liu.z d. r 7 �,Qre44cl.t.s. Signature: ,22/eiv, Date: c %� ta/v✓�! Print Name: 7 Refund Policy S i NiGo( '� 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or 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 via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date 07 J By 67. Route to Records: Date 3 9 /7 Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\Forms\RegP ermi tAc tion_092314.doe Electrical Permit ApplicationFolz 014 l c E LSI.0'v l.l City of Tigard RECEIV , t'ive 7 l 6/ (d7.7 Permit co'Y Permit#: 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Date/By: Related Permit#: Email: TigardBuildingPermits@Tigard-or.gov 1'6 2 018 Ready Date/By: to ®JUL See Page 2 for T 1 G ARD Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK �F A`41 PLAN REVIEW 0 New construction 0 Addition/alteratioI3 19t1(q DIVISION N Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: il-2—D() 51 ) Fop,er c 100HP or more. ❑"A">"E">"1-2">"1-3"> ..� / 0 Six or more residential units. occupancy. City/State/ZIP: / i` 4 rd r QA 7 7_).,.>_, ❑Health-care facilities. ED Recreational vehicle parks. Suite/bldg./apt.#: Project name: re -/JP,/G701 A p145,6' 0 Hazardous locations. ❑Supply voltage for more than n❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential oS' (with above sq.ft.) 75.00 2 //2 /—1 s/ i2M' hl It 7i 7 -V 1 J gA/'evi � Limited energy,multi-family (/ residential(with above sq.ft.) 75.00 2 �� Y e4"45-r ,t i ` I '7x/1b.-,5, (4k Renewable Energy 0 See Page 2 PROPERTY OWNER 0 T1 ANT Services or feeders installation,alteration,and/or relocation Name: X0 1/"y Su00 amps or less / 100.70 2 , 1 /I 7,5q7/ 201 amps to 400 amps 133.56 2 Address: ,4...)444. J Sif NJyl S Opt 9 I/ f7 J 401 amps to 600 amps 200.34 2 City/State/ZIP: 14}4 S`(eee 9 // 11/4 7(Y6 7/ 601 amps to 1,000 amps 301.04 2 Phone:(Off 3 b 8— o 7)7 Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: o%//V J P 'U l 6 ® £/'14/L , C--o/1 relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,I-.40.e S or e < ge,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: r `'"` ' Date: d7A/--x-13'/a$ 401 amps to 599 amps 168.54 2 0 APPLICANT ❑ CONTACT 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 service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 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 any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Email: 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(`/z hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: 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\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 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 Description I Qty. I Each I Total I * 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 ❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 n G• arage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n Other: Each additional inspection is 66.25/hr 1 charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(A hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES $75.00 Fee for each commercial system: Subtotal(Enter on Page 1):* Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n H• VAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical n N• urse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 A5% j1y- E EIVED Property Owner Statement Regarding Construction Responsibilities 1 2018 TKOregon Law requires residential construction permit applicants who are not license._ ; is e°FT1GARD Construction Contractors Board to sign the following statement before a building p-' • <f ':T DIVISION 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. 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. ike7Zin St°(7 Print Na - of P:'mit Applicant Signature of Permit Appli t Date ( 69 3G(Y' 0737 Permit#: /►1ST�ot1— I4V Address: 4��y�� ,SL✓ f--zvvvc!" 3 Issued by: 'Tr Date: 7/1 /i f I This Copy for Permit Offices 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 = 41 Transmittal Letter T 1 G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 7)-264( DATE RECEIVED: DEPT: BUILDING DIVISION JUL 26 2018 CITY OF TIGARD FROM: 419,w BUILDING DIVISION COMPANY: PHONE: C C 4 y 0-7 ,3 7 Bye r ' Ic c..x Fs-1t RE: ll� 5L3 F N/j/er .IT //-a /T r (Site Address) (Permit Number) (Project name or subdivision name and lot number 4 ATTACHED ARE THE FOLLOWING ITE ,, Copies: Description: f Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and deta' s: Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. 02• Other(explain): i"/ Sr 1/1-06'Ile REMARKS: i14 5 )'rAit.i II ,tC 6ILA;I7`' CPV/18 6 %A/Vt)(11 t1/ 'i I G (",,W i,Ut.✓ e4 7 ) 5 Yelp yv, e_J fz. e;116){S-c.- /11 7-p4 I S--c.)00 ill FOR OFFICE USE ONLY Routed to Perm' Technician: Date: --7/2,--7/2,6,/ Initials: /49 4(� ,� ,4-(S Fees Due: • es JNo Fee Description: 6///9- Amount Due: $ /) - Special Instructions: Reprint Permit(per PE): ❑ Yes E{'NOo El Done Applicant Notified: ye„,___ Date: 7k-z,A s' Initials: a7)-• I:\Building\Forms\TransmittalLetter-Revisions_061316.doc