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Permit
+ IIt CITY OF TIGARD MASTER PERMIT c r . COMMUNITY DEVELOPMENT Permit#: MST2015 00160 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/23/2015 Parcel: 251118801800 Jurisdiction: Tigard Site address: 10350 SW AMANDA CT Subdivision: TIGARDVILLE HEIGHTS Lot: 1 Project: Harbick Project Description: New SF. Demo credits from BUP2015-00087 applied to this permit. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 3 First: 2659 sf Basement: 0 sf Lett: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 0 sf Garage: 639 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2659 sf Value: $337,972.54 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 120 SF Rain Storm Sewer: 100 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 200 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 1 Vents: 0 Woodstoves: 1 Gas Outlets: 5 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr 0 Ea add'I 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF 2659 Owner: Contractor: HARBICK,CHARLES C RICHARD A GRIM Required Items and Reports(Conditions) 16057 SW 2ND ST 688 OAK STREET 1 Ersn Cntrl 503-639-4175 SHERWOOD,OR 97140 LAKE OSWEGO,OR 97034 PHONE: 503-522-4768 PHONE: 503-635-8500 FAX: Total Fees: $8,640.19 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 N: • --• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set •rth in OAR 952-001 10 through OAR 9' -Or -�•. 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503. .198 •r 1.800.• 2344. II ,� , . u4 Issue By: Permittee Signature: A. '0&& _ ..•�i I 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. Building Permit Application Residential REC dEP Re�ivea ttllt (ii Iilt I I .I tI.I \ City of Tigard �' Date/By: 7 / i3 Permit No.: Het /s— f •Ill 13125 SW Hall Blvd.,Tigard,OR 97223 s Plan Revi Phone: 503.718.2439 Fax: 503.598.1960 Date/By: — 2 - Other Peimit: 1 I G A R D Inspection Line: 503.639.4175 A Date ReadyBy: / q Juris: &1 See Page 2 for Internet: www.tigard-or.gov Notified/Method I Supplemental Information CITY Ole 1'R A IM ��+ TYPE OF w ,DING DIVISION REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this a lication. —4..- CATEGORY Valuation: J k S , 3..3 (1 7 ®1-and 2-family dwelling ❑Commercial/industrial t °�• ❑Accessory building ❑Multi-family Number of bedrooms: 3 ❑Master builder ❑Other: Number of bathrooms: 2�5 3 Total number of floors 'snet�..iee ~='(O 273 5Z) T JOB SITE INFORMATION AND LOCATION ELLS m,.. lob site address-,.J.0e9trgW Amanda Court New dwelling area: a6 f l,y' uare feet3aC)8 City/State/ZIP:Tigard,OR 97224 Garage/carport area: 639' square feet Suite/bldg./apt.no.: Project name:Charles Harbick Covered porch area: 496 square feet Cross street/directions to job site: 103rd and Amanda Court Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.:#2SI11BB-01800 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Construct new single story home, Plan 1248. Valuation: $ - Two-car garage with covered outside living area Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name:Charles and Peggy Harbick Type of construction: Address: 16057 SW 2"d Street Occupancy groups: City/State/ZIP:Sherwood,OR 97140 Existing: Phone:(503-)522-4768 Fax:( ) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name:Same as Above (Pkaserejermjeesrhedrrle) Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: eiC) Amount received: 757,• Phone:( ) Fax: :( ) E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: Rickard A.Grim Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:688 Oak Street Solar Installation Specialty Code checklist. City/State/ZIP: Lake Oswego,OR 97034 Permit Fee(includes plan review $180.00 and administrative fees): _ Phone:(503)635-8500 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.:33980 q . Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained g sigipmwpwp within 180 days after it has been accepted as complete. Print name:Charles Harbick Date:08/31/2015 *Fee methodology set by Tri-County Building Industry Service Board. l:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Sep/23/2015 7:29:50 AM Engelman Electric Inc 503-981-4026 1/1 Electrical Permit ApplicaTIECEIVED 1"ciu Oi l It I. i 'NI.()NI 1 City of Tigard Received .�: - 13125 SW Hall Blvd.,Tigard,OR 97 2 3 2015 Plan s Review ` �i Phone: 501718.2439 Fax 503.597•y ,- /g : Related Permit k: Inspection Line: 503.639.4175 Ready bete/By: hub: la see Page 2 for I I`.'\It Internet: www tigard-or.gt v CITY OF TIGARD Notified/Method: Supplemental Information G DIVISION Fr AN REVIEW ®New construction El Addition/alteration/replacement Please cheek of that apply(submit I sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition 0 Other: where the available ihult current 0 Mamas end boetyerda. CATEGORIC OF CONSTRUCTION exceeds 10,000 amps et 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling El Commercial/industrial 0 Accessory building leas to pound,or exceeds 14,000 0 commercial-use egrieutturei ❑Multi-Family ❑Master builder amps for all other installations. buildings. ❑Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SIT$INFORMATION AND LOCATION 0 Emergency quern, larger separately derived Job#:29985 Job site address:10350 SW AMANDA COURT ❑I ORP0o' moew motor load of "A."E.ry l W S'Y'or more. ❑"A".�L."1-2","1-3"1 City/State/ZIP:TIGARD OR 97223 ❑Six or more rasldentld units. occupancy. 0 Health-Dare facilities 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:RICK GRIM ❑Heardoue locations. ❑Supply voltage for more than O Service or fader 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Ptriot1O. I Qtr. I Each I Total I - New residential since or muitl-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 1, or sq.It / 168.54 ' Tax map/parcel#: Ea.add'I 500 sq.ft.or portion h 33.92 1 DESCRIPTION OF WORK . Limited energy,residential WIRE FOR NEW HOUSE (with above sq.ft.) 75,00 2 Limited energy,multi-fhmlly 75 2 residential(with above sq.ft.) PROPERTY OWNER 0 TENANT Renewable Energy ❑ See Pale 2 Services or feeders insteliattonLalreration,and/or relocation_ Name: 200 amps or less 100100 70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders Installation,alteration,and/or 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,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ■ APPLICANT la CONfAC i PERSON Branch circuits—new,alteration,or extension,per panel A.Foe for branch circuits with Business name: above service or feeder fee, 7.42 1 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56,1 B 2 branch circuit City/State/ZIP; Each add'l branch circuit 7,42 1 2 Miscellaneous(service or feeder not Included) Phone:( ) Fax;:( ) Each manufinetured or modular dwelling, nd/orfeeder 67.84 2 Email: only Xf. ''"'' y( 1(1u,. / 67.84 2 CONTRACTOR Pump or irrigation circle y 67.84 2 Business name:ENGELMAN ELECTRIC INC _Sign or outline lighting 67.84 :2 Address:P 0 BOX 451 Signal circuits)or limited-energy ❑ see 2 2 panel,alteration,or extension, , City/State/ZIP;HUBBARD OR 97032 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)981-8041 Fax:(503)981.4026 Investigation(1 hr min) 90.00/hr Email:KRIS©ENGELMANELECI<RIC.COM Industrial plant(1 hr min) 78,181 hr Inspections for which no fee is 90,00!hr CCB Lic.: 94581 Electrical Lic.: 24-46C Suprv.Lic.: 4739S specifically listed(s hr min) 4 Suprv.Electrician signature,required !��'' to / /0 ELECTRICAL.PERMIT PEES Subtotal: Print name; RON THUNDERBIRD Date: 09/21/15 r 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: I Date: days after It has been accepted ex complete. t:Vluudtn vsn,ntaum c_a ' Number of inspections allowed per permit. g amitApp,�LP.,5RLdac Rev 06/17/201! 440-4615T(1I%os/COM'weJ fCL' VtL) Mechanical Permit Application S E P 1 2015 I O li ()I IA( 1 l ,,I ()NI., Received City of Tigard ITY ��- ;-! A!�D Date/BY: 9� is ��j Pem,itNo.:�./��0�5-- �� • 13125 S50 Hall Blvd.,Tigard,OR 9 r /-, iv!s Plan Review _ Phone: 503.7182439 Fax: 503.598.` �!i�' } II/!�I��'� DateBy: Other Permit: TI G A R D Inspection Line: 503.639.4175 Date Ready/fly: Juris. H See Page 2 for Internet: www.tigard-or.gov 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:$$11,762.00 CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. I Fa. .1 Total � / < JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 1 46.75 Job site address: 'SW Amanda Ct. Furnace 100,000 BTU(ducts/vents) l 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name:Charles Harbick Duct work 23.32 Cross street/directions to job site: 103`i Street 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.:#25111BB-01800 Water heater I 23.32 DESCRIPTION OF WORK Gas fireplace/insert I 33.39 Flue vent for water heater or gas fireplace I 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert`l,,,,f/10÷ ! 23.32 Chimney/liner/flue/vent 23.32 ® PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name:Charles and Peggy Harbick Range hood/other kitchen equipment I 33.39 Address: 16057 SW Y°Street Clothes dryer exhaust 1 33.39 City/State/ZIP:Sherwood,OR 97140 Single-duct exhaust(bathrooms, —- toilet compartments,utility moms) 5 23.32 Phone:(503)522-4768 Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name:Same as above Furnace,etc. 1 Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater 1 Phone:( ) Fax: :( ) Fireplace I Range 1 E-mail: Barbecue 1 CONTRACTOR Clothes dryer(gas) Business name:Jacobs Heating and Air Conditioning Other: - MECHANICAL PERMIT FEES* Address:4474 SE Milwaukie Ave. Subtotal City/State/ZIP:Portland,OR 97101 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(503)234-7331 Fax:(503)813-9257 State surcharge(12%of permit fee) CCB lic.: jqt.(i TOTAL PERMIT FEE . This permit application expires it's 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:Charles Harbick Date:09/1/2015 I\Building\Pennits\ EC PermitApp 040113.dor 440-4617T(11/02/COM/WEB) Plumbing Permit Application ' Building Fixtures RECEIVED , Il,z Ml tI( I I `,I 10,1 City of Tigard R0CCived /.,s.- •, /`- �/S-ex,/� P 1 2015 Date/By: 9 Permit No.: 1104 • 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review ■ ' Phone: 503.718.2439 Fax: 503. 9 960 y Other Permit No.: Inspection Line: 503.639.4175 krill'' OF TIGARD e ReadyBy: )aria ® See Page 2 for I I( :fit:l) Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction For special information use checklist. ❑Demolition 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 l 312.70 0 1-and 2-family dwelling ❑Comercial/industrial SFR(2)bath 437.78 m SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 t� 73 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:jj1390'SW Amanda Court Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name:Charles Harbick Manufactured home utilities 50.03 Cross street/directions to job site: 103"Street Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:120) Page 2 Storm sewer(no.linear ft.:j).7,0 Page 2 Water service(no.linear ft.:200) I _Y Page 2 Subdivision: I Lot no.: Fixture or item: . Tax map/parcel no.:#2S111BB-01800 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve i 12.51 Clothes washer -1 25.02 Construct new single story home,Plan 1248 Dishwasher I !- 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name:Charles and Peggy Harbick Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 16057 SW 2nd Street Garbage disposal 1 25.02 City/State/ZIP:Sherwood,OR 97140 Hose bib s, , 25.02 Phone:(503)522-4768 Fax:( ) Ice maker 1 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Same as above 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 ,3 12.51 E-mail: Urinal 1-- 25.02 CONTRACTOR Water closet 1 25.02 Water heater i 37.52 Business name:Woodburn Plumbing Inc Water piping/DWV 56.29 Address:PO Box 252/950 Deer Run Lane Other: l 25.02 City/State/ZIP:Woodburn,OR 97071 Subtotal Minimum permit fee: $72.50 Phone:(503)981-4063 Fax:( ) .2(-14JP) CCB Lic.:931144..5/ IL/0 Plumbing Lic no.:Bi'ZOQDC Plan review (25%of permit fee)■ State surcharge(12%of permit fee) Authorized signature: _r �A � ' r. TOTAL PERMIT FEE Print name:Charles Harbick Date:09/01/2015 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard 11/1 COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R 1) Building Permit Review — Residential Building Permit #D ,N6 jiS -00 1CoO Site Address: /O'3 5Vi1 Amand0, CA-. Project Name: Hart ick Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: Rtv,/ SF homes erify site address/suite#exists and active in permit syst7r. M River Terrace Neighborhood: ❑ Yes WI No Si Plan Elements:l ree(3)copies of site plan leyfil sting structures on site ite plan must be,on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished to scale(standard architect or engineer scale) 1 •r elevations orth arrow ►!Utility locations(required for new,may apply for additions)address,project or subdivision name and lot number cation of wells/septic systems •plicant information(name and phone number) Erosion control(including drainage-way protection,silt fence k' Lot dimensions and building setback dimensions sign,location of catch basin,etc.) `- tot area,building coverage area,percentage of coverage and L10Street names pervious area(applicable if R-7,R-12,R-25&R-40) -Street 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 oot differential) protection measures nif Clean Water§ervices—Service Provider Letter(lot platted prior to 9/10/1995): equired: ig Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified V' No Applied For: ❑ Yes ❑ No,stop intake —B/Land Use Case#: er/zoning: R-3•S Mi Setbacks: Front ' Rear I S' Side 5' Street Side 2a' Garage 2 • 2.01 Ei .ndscape Requirement: 9 Lot Coverage Maximum: k!1 Building Height: Maximum Height 30' Actual Height 2H 1 Visual Clearance asements �/ Sensitive Lands: ❑ Yes Lid No Type — hUrban Forestry Plan ---Conditions"Met"prior to issuance of building permit Notes: SPL reopi pr,' or -b i sstnance, Approved By Planning: / d - A a I._ J Date: u •31 t 1 S Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:1Building\Forms\BldgPermitRvw_RES_070915.docx Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: 2nter building permit#above. Workflow Routing: p-Planning Jgineeringrmit Coordinator .BBuilding Workflow Sign-off: 2—Sign-off for Planning(include notes from planning review) Route Application Documents: Er Engineering: (1) copy of permit application, (1) site plan, (1)building plan and original plan review routing form. 0-Building: original permit application,site plans,building plans,engineer and beam , culations nd trust details,if applicable,etc. j- /' Notes: r JQ�rv,i� , •� D- tr ___g7 921# Dt-ehe-C-ems z� By Permit Technician: A �J/ _ Date: 9�tX� Engineering Review 70 Slope at building pad: ❑ 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 No Assess Water Quantity Fee in-lieu: ❑ Yes Vf No LIDA Facility on lot: ❑ Yes 7 No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: /'it l kit-- Date: � ) /'c 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: DC Fees Entered: Wash Co Trans Dev Tax: "C Yes /A r( Tigard Trans SDC: CI Yes N/A Parks SDC: Yes ❑ N/A FAA K to Issue Permit Approved by Permit Coordinator: / I Date: 9/V/5"j 1:\Building Worms\BldgPennitRvw_RES_070915.docx RECEIVED SEP 312 Clean Water Services Fife Number I;ITY OF RD ( 15 Oaf BUILDING DIVISION CIean\Vate ` Services Sensitive Area Pre-Screening Site Assessment Tigard 1. Jurisdiction_ ¢� 2. Property Info2611 nd-01 ample 15234A801400) 3. Owner to ornleS Harbick Tax lot 10(5): 1 t3ti U tf Name: Chart Company: Address- R f Q$ Site Address: • City,State,z Sherwood,OR 97140 24 PhonelFax: 003-522-4768 City.State,Zip: 1 03rd Nearest Cross Street E-Marl: 4. Development Activity(chedc all that apply) 5. Applicant information ❑ Addition to Single Family Residence(rooms,deck garage) Name. Same as above ❑ Lot Line Adjustment LI Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium ,address: ❑ Residential Subdivision ❑ Commercial Subdivision Simile City,State.Zip: ❑ Sr Newt Come amity home Lot.Commercial Other Phone/Fax. E-Mail: 6. Wilt the project involve any off-site work? ❑Yes a 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, DEO 1200-C Permit or other permits as issued by the Department of Environmental Duality,Department al Slate Lands and/or Department of the Army COE. MI required permits and approvals mustbe obtained and completed under applicable local,state,and federal law. By signing this Ion.the(k,ner cr Oxner's auth3taed a n!at m_tresenta' ackroerfedri and agrees Put employees of Clean Mater Services hang autivirty t enter &ie project site at all reasonable b tees Ix the purpose of inspecting pro}a:t site conditions and gathering information related to lie protect site l certddy Leaf I au familiar aith the intomration contained in tan docivent and to tte List of my linp.ledge and belief.this i' arnr>tion's true,complete.and accurate Charles Harbick Owner PrintiType Name Print/Type Title �1r / l 09/01/2015 Signature � � � Date FOR DISTRICT USE ONLY Sc-rt;;5,e arm p Cial;it east on site&within 200 of lire s__ THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERV CE PROVIDER LETTER. It Sensibme Areas exist on trie site or within 200 fete ea a fiaen'pen rttes,a tIlara1 Resources Assess r..ent Report tray also trod Based an ralea ut be submtled nueriats and test available infarmaliai Semith a areas do not appear to e:u4 on site or within 200'at the site.This Sensitive Area Pre-Screening Site Assessn ent does flOTehmina;e t'ie media eiatuate and proem water quality sensitive areas it try are subsequently discovered.This dtcu.-P will sere as gas Service Piavider letter as regirel by Rr saltticn and Order 07-20. Section 1U2.1 All required permits and approvals mast be obtained and com:pided undx applicable lacai.52'e.and Ideal Ian_ ❑ Based on review at the submited materials and tie.aaailBe iatomialiari the above teluenced prated will not significantly impact be uist ng u pot ertialt} sensitive arras)band near the site This Semetk'Area Pre-Sneering See Assessment does NOT efirni;>ate the reed to evaluate and prole t additional wafer quahty senssiti a areas if they are subsequently discovered This dxrr eri'rill set e as your Service Proriv leter as regtared by Resca.rtion and Order 07-20.Section 3 021. All Muffed N nits an 1 appro.ats mist be attained and c:-.ptFee i under applicable local.sate and federal la h ❑ This Service Provider Letter is not valid unless CWS approved site plan(s)are attached. ❑ the proposed actni'y des not met:tie definition el der&OpTerr or Ire'-I it was platted atdrr 9/9295 ORS 92.040(2) NO SiTE ASSESSIhEUT OR SERVICE PROVIDER LETTER IS 61U',731- r� r.�^ Reviewed by -- a�• Date b +�'�!J Once complete,email to:SPLReview @cleanwaterservices.org • Fax: (503)6814439 OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123 FOR OFFICE USE ONLY-SITE ADDRESS: /(. 50 S647 471,41✓6 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. ill City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT = Transmittal Letter T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: DATE RECEIVED: DEPT: BUILD G DIVISION RECEIVED FROM: C\-\A CH 21 w-- OCT 5 2015 COMPANY: / CI I Y OF I1(iAI�U PHONE: 5r O 3- 635 ' s O� BUILDING D 17519A7 RE: / O 35o su3 AlAkEn!J DA CA &A �' ZQ - Doibo f _._.._ ite • ..ress - (Permit lumber) —rl G-,A R-.A < L-LE t-k E ICS NTS (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. `? — Other(explain): �iQ U 55 . f'C.Cs REMARKS: FOR OFFICE USE ONLY Routed to Permit Technician: Date: - - i5 Initials: f� Fees Due: ❑ Yes No Fee Description: Amount Due: Special Instructions: Reprint Permit (per PE): ❑ Yes o ❑ Done Applicant Notified: Date: /n/6`j 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 10350 SW AMANDA CT, TIGARD, OR, 97224 Residential - Master Permit 610 Gas Line PASS MST2015-00160 Jeff Grove 20 lbs 15 min verified standard pressure Violation Summary: Inspector Contractor 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 10350 SW AMANDA CT, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical final PASS MST2015-00160 Herb Stabenow Violation Summary: Inspector Contractor 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 10350 SW AMANDA CT, TIGARD, OR, 97224 Residential - Master Permit 399 Plumbing final PASS MST2015-00160 Jeff Grove Violation Summary: Inspector Contractor 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 10350 SW AMANDA CT, TIGARD, OR, 97224 Residential - Master Permit 699 Mechanical final PASS MST2015-00160 Jeff Grove Violation Summary: Inspector Contractor