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Permit i it n CITY OF TIGARD 1 MASTER PERMIT i COMMUNITY DEVELOPMENT Permit#: MST2015 00054 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 , Date Issued: 04/20/2015 Parcel: 2S109BA02100 Jurisdiction: Tigard Site address: 13882 SW ALPINE VIEW CT Subdivision: HILLSHIRE SUMMIT Lot: 6 Project: TIRUVALLUR Project Description: 566 square foot single story addition. 8/10/15, adding(1)gas fireplace plus gas line and(1) additional shower. ` BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 566 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height 14 Bathrooms: 0 Second: 0 sf Garage: 95 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 566 sf Value: $90,000.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 3 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 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: 2 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 566 Owner: Contractor: TIRUVALLUR,KESHAVAN K&NANDINI LHL HOMES INC Required Items and Reports(Conditions) FAMILY TRUST 11580 SW 67TH AVE 1 Ersn Cntrl 503-639-4175 13882 SW ALPINE VIEW CT TIGARD,OR 97223 PORTLAND,OR 97224 PHONE: PHONE: 503-348-3003 FAX: 503-639-5523 Total Fees: $3,176.52 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 acygance 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. NTION: Ore!, law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 1-0010 through OAR 9' -1.1-0)90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.400.332.2344. I sued By: / / ( Permittee Signature: (------ 2 (1'r C / ,,t_,,__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. INq CITY OF TIGARD MASTER PERMIT • COMMUNITY DEVELOPMENT Permit#: MST2015-00054 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/20/2015 Parcel: 2S 109BA02100 Jurisdiction: Tigard Site address: 13882 SW ALPINE VIEW CT Subdivision: HILLSHIRE SUMMIT Lot: 6 Project: TIRUVALLUR Project Description: 566 square foot single story addition. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 566 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 14 Bathrooms: 0 Second: 0 sf Garage: 95 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 566 sf Value: $90,000.00 Rear 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y 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'l 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 2 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 566 Owner: Contractor: TIRUVALLUR,KESHAVAN K&NANDINI LHL HOMES INC Required Items and Reports(Conditions) FAMILY TRUST 11580 SW 67TH AVE 1 Ersn Cntrl 503-639-4175 13882 SW ALPINE VIEW CT TIGARD,OR 97223 PORTLAND,OR 97224 PHONE: PHONE: 503-348-3003 FAX: 503-639-5523 Total Fees: $3,100.60 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes . d all other applicable law. All work will be done in anc- • approved plans. This permit will expire if work is not started within 180 days of issuan •r if work is suspended for ore the 180 days. ENTION: Oregon -w re•uires you to follow the rules adopted by the Oregon Utility Notification Those rule re - forth in OAR 952- -0010 hrough OAR 952-6• -6091 You may obtain a copy of the rules or direct questions to OUNC by calling 503,2! • • or 1.:00.3• I ued By: i f_ ��i1a—!.....�' Permittee Signature: , „ / / ■ 1 _ _ 1 vow— Call 503.639.4175 by 7:00 a.m.for the next available inspection• te. This permit card shall be kept in a conspicuous place on the job site until coin, etion of the project. Approved plans are required on the job site at the time of each inspection. / vs-cd4 / °� Building Permit Application Residential RECEIVED FOR OFFICE l '1:ONLY City of Tigard Received Date/By: 9 /S Permit No.: idev =d6 0 5 Y lig gi 13125 SW Hall Blvd.,Tigard,OR 9722 A .R 9 2015 Plan Re e s Phone: 503.718.2439 Fax: 5 0 3.5 9 8.1 't DateiB : L`k, •I s Other Permit: 1 1 c, \it U Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready :y: 7uria: ® See Page 2 for Internet: www.tigard or.gov BUILDING DIVIS:OI�%i/ 1 ethod: !�!/�' Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING • i?If[ mmier• ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all gAddition/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: (l Att- ❑Accessory building ❑Multi-family Number of bedrooms: / t ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: New dwelling area: b� s uare feet 13��sZ bw ��>�1>^.c vtoc.�, t�Qrr.C�z� 5� � City/State/ZIP: T t ,,A . op_ ?zz w Garage/carport area: square feet Suite/bldg./apt.no.: Project name: R 1 s---•L Covered porch area: square feet Cross street/directions to job site: L Deck area: square feet Sene i' vi tW co r/�I- L i I M 1-j 0o� Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 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. 't �^ •... - Valuation: $ Ll 70 • S1vt`r�( L.,I codch /24.4.‘. Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER 0-TENANT Number of stories: Name: kes- 6y V«,v Q, /VG nc�n,' 77/0(A VG/Let Type of construction: Address: i ti g"..r 2 S L. l /,n r (h e w U)rw'f` Occupancy groups: City/State/ZIP: Tr 94.4 e/ c R q71-2,q Existing: Phone:( ) Fax:( ) New: PPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Li/Ls f�ttmc_s L Structural plan review fee(or deposit): Contact name: /AJLGL(,. �� FLS plan review fee(if applicable): Address: //c- �J r ?�= Cl- -�j� Total fees due upon application: lY (0%2 City/State/ZIP: e,e 97 y2,� Phone:(s) ) ' 9-�s..'�P�J xQhJ 0) Amount received: ` {� E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FE 2 L' 4 J IAA. S . 'd AL Co n ercial and residential prescriptive instal . •on of CONTRACTOR roof-top - ted PhotoVoltaic Solar P. • ystem. Business name: C Submit two( • of roof plan wi snnection details Vi(lin L and fire departmen .• •- ,alo•: *th the 2010 Oregon Address: Solar Installation Specia •,' checklist. City/State/ZIP: Permit Fee(i • 14 es plan • *ew $180.00 .,. administrative fees. Phone:( ) I Fax:( ) States ,• arge(12%of permit fee): $21.60 CCB tic.: C5 q 121 #94((7 I Total fee due upon application: $ t .I Authorized signature: his permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. / Date: //, *Fee methodology set by Tri-County Building Industry Print name: R,,t,ii d A• vl VA //S Service Board. I:\Building1 Permits\BUP-RESPermitApp.doc 02/24/201 440-4613 (1 L Electrical Permit Applica CELVEP FOR OFFI( I I SF.ONLY' City Tigard Received ee Zit D� / ( 7-.. /5---4-15,5- / - Ci of Ti and p Permit No.: • 13125 SW Hall Blvd.,Tigard,OR 9 2015 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: Inspection Line: 503.639.4175 D Date Ready/By: funs. 65 See Page 2 for (ATV OF fIGARD www.tigard-or.gov Notified/Method: Supplemental Information TYPO W 1 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 gd_ and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. Multi-family ❑Master builder ❑Other: 0 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" "l-2" "l-3" Job no.: Job site address: / IOOHP or more. occupancy. c.h (� ■ e /MIA • if" ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: /� ❑Health-care facilities. ❑Supply voltage for more than �V ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: I Project name: ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Gov J J k od Description I Qty. I Fee. I Total I • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 Tax map/parcel no.: Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) ) Limited energy,multi-family 75.00 2 XS-46 14 5U, 4 6•Cu'C t .4L residential(with above sq.II) v Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation ❑ PROPERTY OWNER I ❑ TENANT 2„J,..nps 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:( ) I 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,per panel ❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name: each branch circuit B.Fee for branch circuits without Contact name: service or feeder fee,first 56.18 2 branch circuit Address: Each add'I branch circuit 7.42 2 City/State/ZIP: Miscellaneous(service or feeder it 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 n CONTRACTOR Sign or outline lighting 67.84 2 Business name: //(-, v / G Signal circuit(s)or limited-energy / See L- panel,alteration,or extension. Page 2 2 A Address: 316 p / S 01...9r24 r kffi Each additional inspection over allowable in any of the above t` Additional inspection(1 hr min) 66.25/hr \\. City/State/ZIP: /10/./c, /G Q Investigation(1 In min) 66.25/hr \N. Phone:()52.3 ) 9- -63 Z( Fax:( ) Industrial plant(1 hr min) 78.18/hr \%si Inspections for which no fee is 90.00/hr c\1 CCB Lic.:/ 7s-0 I Electrical Lie.:34,/_.) I Suprv.Lic.: 3QcyS specifically listed(/:hr min) - ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: a e4 .es. _� Subtotal: Print name: 4�� UL I Date: Plan review(25%of permit fee): ti State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within ISO Print name: Date: days after it has been accepted as complete. Number of inspections allowed per permit. I.\Building\Permi ts\EL.C_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(1t/05/COM/WEB RECEIVED Mechanical Permit Application FOR OFFICE 1 SF ONLY City Tigard �� 9 2015 �© phi ao/ —ocv5 _ Ci of Ti and A o Permit No.: • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.5 L r /, u Dat�gy Other Permit: TIGARD Inspection Line: 503.639.4175 -l�" F 1�VAi�lj Date R B t�s ® See Page 2for Internet: www.ti ardor. ov BUILDING DIVISION �r o g g Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration/replacement performed. Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* gI-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist ❑Multi-family ❑ Master builder ❑Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: A-14604, Air conditioning ! 46.75 Job site address: /3 ') s�f l . die t� (.id w-� Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 7_ ) O i>^ r7 ZZ u V Furnace 100,000+BTU(ducts/vents) 54.91 f C.'u`'�' �< Heat pump 61.06 Suite/bldg./apt.no.: Project name: R ts-Tn,t.. Duct work I 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 '_ Residential boiler(radiator or 1/ _(f kj t'L� a f-f' ii (,( (`-31.1 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 / Flue vent for water heater or gas 4 V /� 5,>`o,k it,, t o�,li h� fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ❑ PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) 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 a' r vt g-1 Clothes dryer(gas) _ Business name: © /1 L Other: k�/u1 "Ttl "( MECHANICAL PERMIT FEES* Address: vv /1-ii.) Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lie.: 1/2 5L 7 TOTAL PERMIT FEE __,(c.44,„ 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: y Date: (c, f r I:1Building\Permits\EC_PermitApp__04OOII3.ddocc \ 440 17T(I1102/COM/wEB) Plumbing Permit ApplicatiorECE1V J) Building Fixtures IOU O1 1-I( I I St_ ()NI.) APR 9 2015 City of Tigard Received O� � Permit No.: 5-34.441. .0=� i� • 13125 SW Hall Blvd.,Tigard,OR 9 ( i r Plan Review J Phone: 503.718.2439 Fax: 503.59 OF F A��J[��D p��gy. Other Permit No.: T I(., r,I Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: tuns 0 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ 0 For special information use checklist. New construction Description I Qty. I Ea. I Total (..Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) � CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 c,' and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 Accessory building SFR(3)bath 500.32 ❑ ry g ❑Multi-family 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: L'� �L� 41 Lam. V I' , G ,L Catch basin or area drain 18.76 City/State/ZIP: --J-7,7,4;„„,4 q,/� `+�[ Drywell,leach line,or trench drain 18.76 ( 7 LZ 9 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: 1[�cc--)� I Manufactured home utilities 50.03 Cross street/directions to job site: YV`` Manholes 18.76 Rain drain connector 18.76 -p_ t Sanitary sewer(no.linear ft.: ) Page 2 """'�`�Q�� '� `` ��� 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 25.02 cX�2q- A {- p . J,��'S Dishwasher 25.02 b tAat�--li--C--C IQ C-YLLd Drinking fountain 25.02 •Gk �C Ejectors sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory / 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 2_ 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 /� t h Water heater 37.52 Business name: G, ��j/ 4 ` C[/I S AnL L � Water piping/DWV 56.29 Address: PO x aL7 4 �Gb` ..NN �l Other: 25.02 City/State/ZIP: 97(1‘v- Subtotal Phone:(V ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: i C9.5, P bing Lic.no.:3- a s9 f Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: p0111/%_la TOTAL PERMIT FEE Print name: ' , Date: This permit application expires if a permit is not obtained within 180 days L�_ . after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard 'Pi COMMUNITY DEVELOPMENT DEPARTMENT N. T I G AR D Building Permit Review — Residential Building Permit #: F(411-c94315-00051/ Site Address: /39cc Sto /Y i/L( 1.v.v Qe Project Name: 7, 44/ i'Y ifiov . Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: ;1O 9ci kl- Siflyle levet i-Cv- IVerify site address/suite#exists and active in permit syste . tahiver Terrace Plan District: ❑ Yes V No Si Plan Elements: F. 1. e(3)copies of site plan IV. 'sting structures on site `. e plan must ke on 8-1/2"x 11"or 11 x 17"paper Ly:Footprint of new structure(including decks)with finished v. raven to scale(standard architect or engineer scale) oor elevations orth arrow II Utility locations(required for new,may apply for additions) )Site address,project or subdivision name and lot number AEI i. ation of wells/septic systems [ Applicant information(name and phone number) Y rosion control(including drainage-way protection,silt fence ZLot dimensions and building setback dimensions psign,location of catch basin,etc.) VLot area,building coverage area,percentage of coverage and ldStreet names impervious area(applicable if R-7,R-12,R-25&R-40) tjaireet tree size,type and location /Property corner elevations(2 foot contour lines if more than .Existing trees to be retained with drip line,and tree 4 foot differential) protection measures Wit Clean Water 5,enrices—Service Provider Letter(lot platted prior to 9/10/1995): Required: M Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No 0 Public Facilities Improvement(PFI)Permit: Required: ❑ Yes,applicant was notified tgr No Applied For: ❑ Yes ❑ No,stop intake 'Land Use Case#: 9 Zoning: 2.--9- n/, Setbacks: Front /5- Rear /S- Side S Street Side /D Garage �1 v 0 Landscape Requirement: cQ0 % 0 Lot Coverage Maximum: 80 % I 0 Building Height: Maximum Height Actual Height (4- ItifirVisual Clearance U : asements ift.k.7 Sensitive Lands: ❑ Yes iNo Type ttrUrban Forestry Plan tat Itonditions"Met"prior to issuance of building permit Notes: Approved By Planning: IN 0 n ;-cG_ ei!oci-2C. Date: `j/ I / 15 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved • I:\Buildingl Fonns\BldgPermitRvw_RES_031015.docx Building Permit Submittal Original Submittal Date: ///69/16 Site Plans: # Building Plans: # Building Permit#: Enter building permit#above. Workflow Routing: Planning a-Engineering e' 'ermit Coordinator '—Er/Building Workflow Sign-off: -Er Sign-off for Planning(include notes from planning review) Route Application Documents: a—Engineering: (1) copy of permit application,(1) site plan, (1) building plan and original plan review routing form. ld Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: Engineering Review ❑ Slope at building pad: 2 ❑ Conditions"Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes A No Assess Water Quantity Fee in-lieu: ❑ Yes ( No LIDA Facility on lot: ❑ Yes f No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: / ; j� /� _ - Date: 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 ❑ Approved, NOT Released: Date: 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: K to Issue Permit Approved by Permit Coordinator: Aellifidig Date: / (/r/ I:\Building\Forms\BldgPermitRvw_RES_031015.docx RECEIVED a 2015 OF 1 I(�A Clean Water Services File Number CleanWate j�rvic es �., 15-000978 Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: , ' ! 6C/PC-1/ 2. Property Information(example 1S234AB01400) 3. Owner Information Tax lot ID(s): 1 S L0 q d A r ) II 00 Name: adcl--.07 s iuerlinr /Kla(Xrdc.t Company: Address: 13?cr Z SCN Al,4474/ Cce% • Site Address: ['Nil 1 S W 4 t p>tnt Utt w C&t- City,State,Zip: %.ycjr,,ci 97 225/ City,State,Zip. .1-1'd-Meta , 0 k c( 1 1.1.`1 Phone/Fax: Nearest Cross Street. fie Of Ito iec,if&4( H(U Rel- E-Mail: 4. Development Activity(check all that apply) ' 5. Applicant Information t� 74 Addition to Single Family Residence(rooms,deck,garage) Name: 1Z-vcirc,ir�0 ir•t. 4120R11.1 0..5G- ❑ Lot Line Adjustment ❑ Minor Land Partition Company: L Ht. Otivnes rb,C ❑ Residential Condominium ❑ Commercial Condominium J Residential Subdivision Address' j !S �b S v.J 7 au ❑ Commercial Subdivision er 1:1 Single Lot Commercial ❑ Multi Lot Commercial City,State,Zip. Ti CrAyZV]. a 7 Z23 Other Phone/Fax: SCJ? —3 c( - 3 000 E-Mail: Li-}'C `!u-m/s.(7ryvt 6. Will the project involve any off-site work? ❑Yes S2tAlo ❑Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project Add/ S6() 0 5/17k 1csc/ £cr'/ & OrAn V' exrskril. lxvrne This application dogNOT 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 Ins dgalment,and to the best of my knowledge and belief,this information is true,complete,and accurate. Print/Type Name L ({�-_r — , rint/Type Title Cec • / Signature >o . • Date Y/.5-- 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 feel on adjacent properties,a Nahral Resources Assessment Report may also be required. LZ 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,Stale,and federal law. Lj Based on review of the submitted materials and best avaiable information the above referenced project will not sightly impact fie 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,slate and federal law. ❑This Service Provider Letter is not valid unless _CWS approved site plants)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 by l c-y ap I /7711 r2 i S Date 04/08/15 ii..rj•,.way • -,Ilstroro.Oregon 97123 • 1-hor,f ;,503)681-5100 • „ -4439 • vevM'.ciean walerservices.org s•pIiurC(-l.3 e 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 13882 SW ALPINE VIEW CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - No C of O MST2015-00054 Chip Barnett Violation Summary: Inspector Contractor