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Permit (61) , CITY OF TIGARD 1 MASTER PERMIT COMMUNITY DEVELOPMENT iAA� Permit#: MST2016-00262 T[ Af,D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 i%f Date Issued: 07/13/2016 Parcel: 2S 112CD02001 Jurisdiction: Tigard Site address: 15660 SW 79TH AVE Subdivision: DURHAM ACRES Lot: 14 Project: Brand Project Description: New SF. 9/12/16: REPRINTED permit to show change from gas fireplace to wood fireplace. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 3 First: 2340 sf Basement 0 sf Left: 5 Parking Spaces: 0 Height: 20 Bathrooms: 3 Second: 0 sf Garage: 1000 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2340 sf Value: $313,713.71 Rear: 15 PLUMBING Sinks: 2 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Drains: 0 gWater Lines: 100 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 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 Furn<100K: 1 Vents: 0 Woodstoves: 1 Gas Outlets: 4 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 VB R-3 2340 Owner: Contractor: JEREMY BRAND ML FRAMING LLC Required Items and Reports(Conditions) 7966 SW KELSO CT 2019 NE 107TH STREET 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 VANCOUVER,WA 98686 PHONE: 503-887-2094 PHONE: 360-600-0253 FAX: Total Fees: $29,129.20 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 CAR 952-001-0010 through OAR 952-001-0090. You may obtain a c•-. • -rules or direct questions to OUNC by callin• • 232.1987 Jr 1.800,33 . Issued By: i Perini •- Signature: / A /� .41 IM-4 AA r -. .•39.4175 by 7:00 am,for the next available inspectu. .at'. This permit card shall be kept in a conspicuous place on the job site until compl:Ion of the project. Approved plans are required on the job site at the time of each insp;�ction. CITY OF TIGARD MASTER PERMIT 1111. 2 ''. COMMUNITY DEVELOPMENT Permit#: MST2016-00262 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016 Parcel: 2S112CD02001 Jurisdiction: Tigard Site address: 15660 SW 79TH AVE Subdivision: DURHAM ACRES Lot: 14 Project: Brand Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 3 First: 2340 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 20 Bathrooms: 3 Second: 0 sf Garage: 1000 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2340 sf Value: $313,713.71 Rear: 15 PLUMBING Sinks: 2 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: Drywell-Trench Drain: 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 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 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!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 VB R-3 2340 Owner: Contractor: JEREMY BRAND ML FRAMING LLC Required Items and Reports(Conditions) 7966 SW KELSO CT 2019 NE 107TH STREET 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 VANCOUVER,WA 98686 PHONE: 503-887-2094 PHONE: 360-600-0253 FAX: Total Fees: $29,129.20 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 952-0011-6)9 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. i . \ /� Issue By: V\ � C.ekVLA_rLit Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection dat This permit card shall be kept in a conspicuous place on the job site until comple on of the ject. Approved plans are required on the job site at the time of each insp ction. w Building Permit Applic i ` \ 1,. Residential MAY �� FOR OFFICE LSE OyI.1 City of Tigard 4 Received �/6", PermitNo.: Horde,/6 —600/ . r13125 SW Hall Blvd.,Tigard, 47Y2 I It `/NK) Phone: 503.7182439 Fax t10ryxs ;S ° Date/By' Plan Review Date/By: 0.7JJ i / Other Permit:vf'QO10/6 -COAIII T I C A R D Inspection Line: 503.639.417S Date Ready/By: orris: ® See Page 2 for (0/3O J Internet: www.tigard-or.gov Notified/Method: }D P•} •� Supplemental Information tpSp t o ( fn. c� r'v i��,rky,,, (Dcv) —4-,-F txt:k era�t TYPE OF WORK"' REQUIRED DATA:1-AND 2-FAMILY DWELLING 2(New construction 0 Demolition Permit fees*are based on the value of the work performed. 1. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the w CATEGORY OF CONSTRUCTION work indicated on this application. ,` Valuation3 7/ $ cye o 1-and 2-familydwelling 0 Commercial/industrial 1 - , ❑Accessory building 0 Multi-family Number of bedrooms: 3 Q ❑Master builder 0 Other: Number of bathrooms: 3 R JOB SITE INFORMATION AND LOCATION Total number of floors: 1 33 4 0 ' Job site address: I5b N 0 cW 1 a))e• New dwelling area: 0_3(4Q square feet City/State/ZIP:`1 1 6 Q e D (3e q 2_2_T Garage/carport area: ( X0 square feet Suite/bldg./apt.no.: Project name: B ran�,T ee S I pence Covered porch area:``Cat, t ' square feet Cross street/directions to job site: BO fl \' 3t 1 -1-y, , �.lp.4 it ^,� � . Slit,---; �✓ �� -�� l>J(�J'j� Deck area: `� i 3 � square feet V�f , 1(�'ab 1 V Other structure area: square feet K'2 L� x REQUIREDDATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. I Tax map/parcel no.: 3_,j i b 3 7 i 0 Indicate the value(rounded to the nearest dollar)of all Q G L/V equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. W N 'ev.3 cln9(.6 -�a.+�n I Jet( IIl,_9 Valuation: $ Existing building area: square feet New building area: square feet El/PROPERTY OWNER 0 TENANT Number of stories: Name: Type of construction: Address: "19 1r7gO 1. Occupancy groups: City/State/ZIP: LAt� (9 0A 1'22-'4-- Existing: g Phone:(5153 1 .1._ 61(4.. Fax:( ) New: r i APPLICANT IWCONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name: .SOC 6l2r D �cj�b 'w K'f J so �� FLS plan review fee(if applicable): Address: City/State/ZIP: I l a le,(,) 011 q-7-22_,LI--- Total fees due upon application: n 7��C/q� Phone:(5141) q�.l-1 —sqsg Fax::( ) Amount received: rX E-mail: pC' `J t (J Jb syr. )a ( , . y),,.) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-.•• mounted PhotoVoltaic Solar Panel System. Business name: i LSubmit two ets of roof plan with connection• .1 s Address: Q...0 101 0 c L a �` and fire department a along with 0 Oregon 0� Solar Installation Specialty s ecklist. City/State/ZIP: A/C CC-Wtise l Uk.3ACPermit Fee(in .. s plan revs- �� administrative fees): $180.00 Phone:(3(1b) (eC -' 62,EFax:( ) CCB lic.: q � v7//4, State surcharge(12%of permit fee): $21.60 Total fee due upon application: `,$201.60 Authorized sign ture: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:I Date: 76/1 *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Pern \BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 l/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE CSE ONLY 4- City City of Tigard ReceivDeceived Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 g Associated permits: ■ Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical T 1 G AIR D Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l es No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. 0 0 0 4 Fire district approval required. Name of district: • 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0 6 Sewer permit. 0 0 0 7 Water district approval. 0 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0 basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0 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 0 0 0 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 0 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0 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- 0 0 0 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. 0 0 0 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- 0 0 0 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 0 0 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0 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 ❑ 0 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 0 0 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0 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 0 0 0 architect licensed in Ore_on and shall be shown to be a•slicable to the •ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0 27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0 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, 0 0 0 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. 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Applica X17.1- %r- l OR().:...,,E l S1 ()NIA .' I Received City of Tigard 2 Date/By: Permit No.:K w r- -1 x-06 , III .4 13125 SW Hall Blvd.,Tigard,OR 97223 J AY 0 2.016 Plan Review I Phone: 503.718.2439 Fax: 503.598.196Date/By: Date/By: Other Permit: T 1 G A R D Inspection Line: 503.639.4175 I F 1 x t t`+ req Date Ready/By: Juris: ® See Page 2 for Internet: www.ti and-or. ov 1 1 "' '°" t' y y g g j z t ,-• 3 a_ Notified/Method: Supplemental Information -31,i n_:..n,,1\i.s i.ki;,�;,-,�„N TYPE OF WORK COMMERCIAL FEE* SCHEDULE I/SE CHECKLIST Mechanical permit fees*are based on the value of the work 0 New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ci 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOE SITE INFORMATION AND LOCATIONHeating/cooling: r Air conditioning 1 46.75 4(a I7 Job site address: (_ -- +h Furnace 100,000 BTU(ducts/vents) i 46.75 •"75- City/State/ZIP: ""- 16 6:1(24) Q 2 (1-1'-).--2-- Furnace 100,000+BTU(ducts vents) 54.91 Suite/bldg./apt.no.: Project name: `J Octn D I D Ch CeHeat pump 61.06 Duct work t 23.32 <).3. 32 Cross street/directions to job site: (3U )t 70. "7C' L e D Hydronic hot water system 23.32 Dr k �D . '5(Tt. 6 COS F ie C n^ Residential boiler(radiator or l/� K I T ' hydropic) 23.32 1`�iLi (_�C c� /a.-r^ Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 1 23.32 2.._;,32,. Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: 1 {l +2(1) 1 %Y -7C'7,0 1 Water heater ( 23.32 7_3.32 DESCRIPTION OF 1frQRK Gas fireplace/insert 33.39 / � Flue vent for water heater or gas ,'/ ,I 3 u I c--DJ tn b k.)' -u)-u) Ze5 D e n C€ fireplace `t 23.32 'b �t} Log lighter(gas) \ 23.32 23. 3z Wood/pellet stove 33.39 Wood fireplace/insert 1 23.32 "n.� Chimney/liner/flue/vent \ 23.32 2.3. 32- {� PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: `e ms i rK lnfl I) Range hood/other kitchen -7�q Address: 7 q(,(j sw ( .,etc) C-k-- equipment 33.39 �3.J 1 Clothes dryer exhaust 33.39 �3.39 City/State/ZIP: "1-1 C(9 -D a 1C-- °i-1 22 Single-duct exhaust(bathrooms, � . 33---/ , ( toilet compartments,utility rooms) I-4- 'I 23.32 9 . Zq (1 Phone:( ) U 3"7 �`--f Fax:( ) Attic/crawlspace fans 23.32 [( APPLICANT at CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: 7-cte..16 3 vat)0 Furnace,etc. Address: -tot (oj s UK-e1auo C T Gas heat pump Wall/suspended/unit heater City/State/ZIP: ‘7"--)G'2 i2' ©0r2._ "n[^-�(22-t Water heater Phone:(54()4L4.1 5-0)6--sFax: :( ) Fireplace J Range E-mail: Pp S\b,..A.. ,,,,,,1 • Q0'r{) Barbecue i NTRACTOR Clothes dryer(gas) 9 Other: 1-J.ii5 n'�� (-a m L.l Business name: ' F 1 n& �� MECHANICAL PERMIT FEES* Address: \ 6 pr_;---, 10-71-(-) J I CoSubtotal .40-7 City/State/ZIP: i'Cl r 0k),-k)e fe WQ lt38( Minimum permit fee($90.00) �` Plan review(25%of permit fee) /i 3..7 Phone:('3( O WO 62c3 Fax:( ) State surcharge(12%of permit fee) , CCB lie.: 1 CI''7 ((j 5 3 TOTAL PERMIT FEE 6 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized si Lii re: * Fee methodology set by Tri-County Building Industry Service Board ,n Print name: ► l ,- Date: Co I /5 I j („, I:iBuildingWermits\ME iØermitApp 0401 13.doc 440-4617T(11/02/COM/WEB) ell! ctrical Permit Applicatio �`�E FOR OFFI('E ISE O\1.1 City of Tigard Date/Bed Permit#: N eir�/(,o-O 9-(G 9-- 13125 SW Hall Blvd.,Tigard,OR 97223MAY 2 0 2.016 Plan Review Related Permit#: Phone: 503.718.2439 Fax: 503.598.1960 DateB Inspection Line: 503.639.4175 '...€ a. ° "{°•-( s. f`) Ready DateBy: Juris l See Page 2 for Notified/Method: PP Internet: www.ti ard-Or. ov ��U Su lemental Information TYPE OF WORK PLAN REVIEW ew construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ri -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 ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 1ooHP or more. ❑"A","E","1-2",°°1-3", ❑Six or more residential units. occupancy. City/State/ZIP: ❑Health-care facilities. 0 Recreational vehicle parks. #: Project name: ❑Hazardous locations. 0 Supply voltage for snore than Suite/bldg./apt. jl 600 volts nominal. ❑Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE Description 1 Qty. I Each I Total New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. t ��y�p 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: ). �� G I Ea.add'1500 sq.ft.or portion 33.92 x'' 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 1 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 PROPERTY OWNER . i © TENANT Services or feeders installation,alteration,and/or relocation Name: (2)k-eh('\q Ber,Ln,D 200 amps or less 100.70 2 Address: "CatO S W e.1 so CA- 201 amps to 400 amps 133.56 2 \ �l CQ122-9- 601p ampsto0amps200.34 2 City/State/ZIP: g(2__ 601 amps to 1,000 amps 301.04 2 Phone:(55 .(g--7 wq Fax:( ) Over 1,000 amps or volts 552.26 2 �^ Temporary services or feeders installation,alteration,and/or Email: .T h`e_ M S--c r met I I' s C Q ) relocation Owner installation:This installation is beg made on property that I own which is not 200 amps or less 59.36 l intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Date: 401 amps to 599 amps 168.54 2 111111111111111.1% APPLICAI4Tlg CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: 3-aC,� 8121(2(r) above service or feeder fee, 7.42 2 each branch circuit Contact name: '3666, 1j ea n t;;��J B.Fee for branch circuits without ` `� service or feeder fee,first 56.18 2 Address: 1 q�& Suo �,e t d G, branch circuit City/State/ZIP: —VI G a .,P 0e_ C "]'2_ Each add'1 branch circuit 7.42 2 q44-1\ 3- � _ Miscellaneous(service or feeder not included) Phone:(54() ze Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: •J\ r 0.1 R C C1 Reconnect only 67.84 2 CO CTOR Pump or irrigation circle 67.84 2 Business name: f k 1v(—i N G [ Sign or outline lighting 67.84 2 _ .t..�c.� fir, Signal circuit(s)or limited-energy 0 See Page 2 2 Address: 5 t9-1- ‘1A-, t 1- G .1:).R. panel,alteration,or extension. City/State/ZIP: 61,10,&,,,...1-15,..A.) Each additional inspection over allowable in any of the above Y Fj f 7V C� ��5 Additional inspection(1 hr min) 66.25/hr Phone:(503) "?q,q,—Lt so'- Fax:( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: CAI-`LJ ' if--`t t•41AJ C ' ' Inspections for which no fee is 90.00/hr CCB Lic.: 3a a 6 Electrical Lic.: G i 1(".4Suprv.Lic.: Ea•6a specifically listed(''/z hr min) ELECTRICAL PERMIT FEES Sup - Subtotal: / Print name: D 1... Date: 4(/f 6, 0 Plan Review Required(25%of permit fee): ((( State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: 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_doe Rev 06/17/2015 440-46I5T(I 1/05/COM/WEB Plumbing Permit Application Building Fixtures1,EWED 1FOR OFFICE LSE ONE 1 City Received IA' r 00� of Tigard Permit No.: IN . 13125 SW Hall Blvd.,Tigard,OR 9722MAY 2 0 2016 PlaDan RevBy: rd.() to_000.6 Phone: 503.718.2439 Fax: 503.598.1960 Date/By:an Review Other Permit No.: f I G A :ll Inspection Line: 503.639.4175 C 1Y OF T€ D Date Read /BY Juris: ® See Page 2 for Internet: www.tigard-or.gov : bt�. et � Notified/Method: Supplemental Information ': . " V . . YM m. rr% S 4 . a e :A J pyt " t ,tro,':;:'... k!1 New construction 0 Demolition For special information use checklist. Description I Qty. I Ea. Total 0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) ' W'114 � , �' ;iav: " SFR(1)bath 312.70 " ,. $i,.,,K is.. t . ,a.:c41, .�o r a �40: .o , 437.78 ... "A 1-and 2-family dwelling El Commercial/industrial SFR(2)bath SFR(3)bath 11 n,5� ❑Accessory building ❑Multi-family Each additional bath/kitchen / 25.02 7.15,02,. ❑Master builder ❑ Other: Fire sprinkler( sq.ft.) Page '::- ....w5M r,": ' ..l .f, .. U A Fl., u„w R Site utilities: Job site address: 151,1:3 O 5U3 1 q-44.I t� Catch basin or area drain 18.76 DrCity/State/ZIP: -i,( ��(� © q�2�� Footing n(line,or trench drain . �$,5 Footing drain(no.linear ft..,. IIMSuite/bldg./apt.no.: Project name: O r) jk(e�c5� Manufactured home utilities Lj1 1 Cross street/directions to job site: 3dn (�c\ O --�t�- ') Manholes 18 76 1-0 (2 1) filo o rn e� 5\-\-e 14 e aces Rain drain connector18.76 )CO I J•e co c C (il Sanitary sewer(no.linear ft.: ) '._ 7j Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.:-74) t Page 2 (O 2, Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: -S ` ' -c-1), r *ei Backflow preventer ( 31.27 3) 21 Wee, J 1 IO D t r Backwater valve I 12.51 `� ') .ew r\&1_{. / 1 L-V `.DWe '11� '"" `"` Clothes washer 25.02 .2. Dishwasher I 25.02 2.S ,©Z Drinking fountain 25.02 ' Ejectors/sump 25.02 ' i l :H ° t : it i 3a 'C iraffa Expansion tank 12.51 Name: -If i2,e rYl q B r\0 Fixture/sewer cap 25.02 Address: 1 q co co Cj w 1.�.�C SG Floor drain/floor sink/hub 25.02 Z5 6 IGarbage disposal t 25.02 2 S,62 City/State/ZIP: "\--l A) a 2 c1-12-'2(-1-- Hose bib 25.02 -7c,6 6 Phone:( 5(Y3 . ,(6'1 2,0q Fax ( ) Ice maker t 12.51 (2, 1.-1 ` ' ^X,, ^ )1 ate Interceptor/grease trap 25.02 e��i �e4 Medical gas(value:$ ) Page 2 Business name: Contact name: 73 a 3 12 61 h D Primer 12.51 Roof drain(commercial) 12.51 Address:-71 G6 S v,e. SO Of Sink/basin lavatory .6-- 25.02 1 a5, ID City/State/ZIP: --rt,£E( �y'ce q--72_. ---c).- Solar units(potable water) 62.54 Phone:64 I) qu ..\ SCiis g iI Fax: :( ) ' Tub/shower/shower pan 12.51 S.(jL ' Urinal 25.02E-mail: �� 1` ` /' ��k , ��'` 1 Water closet j 25.02 7(_ i7r , z . t f T!'b � ,, lv,,,, !1 ,, z ° . . ' e .i_ .. a , '' Water heater 37.52 Business name: E k. P l�t.L-t-'t-6 t kt,-.?Q, Eater piping/DWV I 56.29 q Address: ,. po "DC7 (-c g 3- t ' Other: 25.02 City/State/ZIP e,€( lieu fJ 4 9.env, Subtotal 1 t7"w 3 Phone: rs, tto /cis-2-4 6 q q Fax:( ) Minimum pennit fee: $72.50 CCB Lic.: 7 ci-54'3 Plumbing Lic.no.: *3•7-t-f 3a Plan review (25%of permit fee) 3 _ ' l State surcharge(12%of permit fee) j 53 ,7)(0 Authorized signature: TOTAL PERMIT FEE I 'S o 53 ey\c4(y\c( Print name 't I ( 9� Date: 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.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information gFee Schedule: Residential gym ire Su n :,.I ressio n Systems: x ;;, E , Footing drain-1"100' 50.03 ME 0 to 2,000 $121.90 Footing drain-each additional 100' EMI 37.52 MIN 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' ' 62.541, Medical Gas Systems: Water Service-each additional 100' 37.52 . w Storm&Rain Drain-1st 100' 62.54 t"° '-'2"V";"fl $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for nff each additional$100.00 or fraction thereof,to i 4 €=a - and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr ■ each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business - 90.00/hr - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum char_e-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees _ 90.00/hr and including$50,000.00. Additional plan review for revisions - 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge 1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. � " 'a p i iwAiu,z4 t i s ; Quantity by Fixture Type Plan review is required for any of the following. lrixture Type for Replace/ Please check all that apply. Work Performed: Capped Added'. Relocate Baptistry Font ❑ Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure tallThras defined in OAR918-780-0040. -DrivCuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" -3" - 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Sery/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:ABuilding\Permits\PLMF PermitApp.doc 08/04/2011 2 City of Tigard aIN COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Building Permit #: ‘-a-T 1 Ls—CSU a-(s 2-- Site Address: \ (ApQ SSU 7 9141 Qve Project Name: 1rnilS1Irt(:& Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: Oe1,r\j LSA Verify site address/suite# exists and active in permit system. RRiver Terrace Neighborhood: 14,No E Yes,See River Terrace Review Addendum Attached Site Plan Elements: Three(3)copies of site plan \ikxisting structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations North arrow Utility locations(required for new,may apply for additions) ,Fite address,project or subdivision name and lot number 01i. ocation of wells/septic systems ❑Applicant information(name and phone number) 11:41 xisting trees to be retained with drip line,and tree Lot dimensions and building setback dimensions protection measures BLot area,building coverage area,percentage of coverage and \( treet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) 4treet names Property corner elevations(2 foot contour lines if more than 4 foot differential) Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: < Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No Public Facilities Improvement (PFI) Permit: Required: k.-Yes,applicant was notified ❑ No Applied For: XL,Yes ❑ No,stop intake ,Land Use Case#: LLI3c201 " 000Q `Zoning: (2-'1.2- , El Setbacks: Front \S Rear 5 Side 5 Street Side Nibior Garage tZ, Landscape Requirement: .2_ 0 0/0 Lot Coverage Maximum: V 1 Building Height: Maximum Height Actual Height ' ri -Visual Clearance Easements Sensitive Lands: ❑ Yes .. No Type (Urban Forestry Plan( f� / Conditions "Met"prior to issuance of building permit Notes: Ch-c&14- W f Ll r-e Y, �( L_L_ c Approved By Planning: iI V`Ls (k01114- Date: i 0 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_060116.docx Building Permit Submittal Original Submittal Date: (,p(94)I Site Plans: # �j Building Plans: # �j Building Permit#: [2--Enter building permit#above. Workflow Routing: a-Planning Engineering iermit Coordinator 1Q tsuilding Workflow Sign-off: 2r Sign-off for Planning(include notes from planning review) Route Application Documents: 17 Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. "Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: (Q. Date: 6/P-th6, Engineering Review Slope at building pad: �l b Conditions "Met"p rior to issuance of building permit fie Easements (encroachments)per engineering conditions of approval and plat 1/Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Assess Water Quantity Fee in-lieu: ❑ Yes LIDA Facility on lot: ❑ Yes No ❑ NOT Appr,v d by ngineering: Date: Notes: _ iI� )t. .i. _ .4,01119151r," i/ Approved by Engineering: // 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: 1 /4 SDC Fees Entered: Wash Co Trans Dev Tax: )Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: 716 Yes ❑ N/A PPOK to Issue Permit Approved by Permit Coordinator: 7457-Date: 2/3A I:\Building\Forms\BldgPermitRvw_RES_060116.docx Building Permit Applic '? `; , . I ., Residential MAY 2 0 2016 FOR OFFI( I, t S►:ONI.I City of Tl and Date/B Received g t Permit No.: u 13125 SW Hall Blvd.,Tigard,( { 7 2 P I 'TGARD �3 '`yf��Qa i Plan Review I Phone: 503.718.2439 Fax:R134)114G DIVISION Date/B : Other Permit: 'p16�a[ 1 1 G A R 1) Inspection Line: 503.639.41'a Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information r < 'i:'1,-;-::::/"`,,., . = T.-1*k Of WOE IR OAT-A.01 1-AND 2-FAMII LY DELLI 1 -. El 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 0 Other: equipment,materials,labor,overhead,and the profit for the - Y . work indicated on this application. 1-and 2-familydwellingValuation: $ 1 El Commercial/industrial ElAccessory building ElMulti-familyNumber of bedrooms: 3 ❑Master builder 0 Other: Number of bathrooms: JOB SITEINFORMATION AND LOCATION Total number of floors: 1 Job site address: I 5ee(00 560 1 ci4h au ei New dwelling area: 340 square feet City/State/ZIP: (,a 0IJ O q^1 iici- Garage/carport area: f CrO square feet Suite/bldg./apt.no.: Project name: B i2an,. EesIDerce SCovered porch area: �o,t_l— square feet Cross street/directions to job site: . n ;Tal To 1 Q-t1'l .-to f P Deck area: square feet 1. 0 t taFtacr/1� El) e S lit:- �G5S 1 : j� Other structure area: square feet %K e 149UooDDATA:COMMERCIAL-USE C iECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: 5 ��_ / ivalue(roundedls, dollar)of r�'� tel. Indicate the to the nearest all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK'. work indicated on this application. u 'e W 5)11C)(s -ear n i �, d w e� .I rt j Valuation: $ J Existing building area: square feet New building area: square feet PROPERTY OWNER - 1 . , ❑"TENANT ' Number of stories: Name: Type of construction: Address: "1CI tof _ S� 1�d Occupancy groups: City/State/ZIP: `P S (3A —1204" Existing: Phone:C'53 44:�7.-. 240L+ Fax:( ) New: i,, APPLICANT RP CONTACT PERSON BUILDING PERMIT FEES* * 'Business name: (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name7� � 7a� 6 in 0 Address: -/ci(ob S(A.) K.e 1 SQ ....,,4- FLS plan review fee(if applicable): -T-1 G Q��\ 0 q�r4- City/State/ZIP: J Total fees due upon application: ji p 7�"" Phone:( �) q�� { — �O Fax::( ) Amount received: E-mail: ,pox i b 4- Od 3 rt-)a l l . CO1•» PROTOVOI TAIC SOLAR PANEL SYSTEM FEES* 1 r �J CONTRACTOR Commercial and residential prescriptive installation of roof .•. mounted Photo Voltaic Solar Panel System. Business name: ► ► 1 L--t �l 114 1 Ll � Submit two ets of roof plan with connectio .- .i s and fire department a - along with .: i 0 Oregon Address: I E 1 ,01 Solar Installation Specialty s.-. ecklist. City/State/ZIP: V t' (\C.0-t.k.t.)--el (A '(OO(tC2 Permit Fee(in s plan revs $180.00 administrative fees): Phone:(3(00) t/( 02_53/ Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: 1 cr) ,53 8/77/‘ (o Total fee due upon application: $201.60 Authorized sig ture: This permit application expires if a permit is not obtained within 180 days after it been accepted as complete. Print name: ackkyi Date: 7/5"/1 *Fee methodology set after ihas been Building las complete. Service Board. I:\Building\Pe \BUP-RESPermitApp.doe 02/24/2011 440 4613T(I1/02/COM/WEB) RECEIVED , MAY 2 0 2016 -b....,.. Clean Water Services Fire Number -,,. :1 CriY OF IIGAR1) 16-002242 —1 d-tilLDING rAPS;Olvi acarAVaterT'Services „ Sensitive Area Pre-Screening Site Assessment 1, Jurisdiction: Tig.2rd 2. Property Information tegaug*.f S23411,9014002 3. Ownor informatiori , Tax Iol ID;fil g...5 I 1:412-O XNoc. 4.2x2L. Name:_ V 4D ,., Compny,: , —E,0--cr— _ jj vek ..,.., . . Address'_ OB Site Addrnsa: f 5-6 erii (Ad it. ./6.-`, City,Stale Zip: City Suite, Zip: 777)(1',I AP Pho :T-ax — IV ne 1N i jrI ...., ,. 11107541f 'limb Nearest Cross Sreet i :me...gm, _,Maro" _ , F-Mail: • if i ' '''' 117,C___flai 4, Development Activily(mliook all thw Amy) 5. Applicant Information LI Adpitor to Scii33 FeinlyRein;d..71ce ati.-iCyrn deck.ga'age: Name: ---- --ker- B ' 'Oa J LWLine Adjustment 7.11- Minor Land Part-lion Compar,y.__, ,,,,) Res:tier-alai rxmdoir niurn .....J Comme:cial Cianclomnium ' Address- -19(C-/ee CLO ''Q112C ' j Rusaiontal SoWsvision D Cwrimermai Siision . —k- nl gle c:Co,-rm-,en.-A .j Mei Lot Curreriercii el City Ste,e,Lip _..A J SifoaeD C . La_ c c.,:her_SnE., tictrAiLV_Du..,,,e, 1.3406._ PneneiTPX:. 5(-1-1 '-- ql- ' -CA _ - -- „..... 1.-:-Ma I-.., dvin a •7 0' rig' a,. _ . Caw, . .,..,. 6. Will the project involve any off.sito work.? :,-,J Yes f No ',..F Link-tvitm Lxaton.;:try.:.rictecrvion of ref-sits vocal 7. Additional comments.or In non that may Im needed to understand your project .. This appilcaliee flees NOT leplase Grading an Erszion Coultel Permits.Connection Permits,I:Wilding Permits,Site Devetopment Permits, DEO 320 -C Permit or other permits as issued tiiil the Department of Errrironinentel Duality,-Department of State Link andl'or Department a the Army CUE. All required permits and approvals most he obtained and ralTiPleleli ender applicable losal,slate,and federal int_ 'I!'is.4:r1 rre Li a..;'i3'*--4v-arS alecliatiaprt ri'iticii,:iiliaNE. ,,,rir -,,,,I-jar.;at 7-13feaz(fat:71.-k:rf.w 11 C:uip'tifz:B7 Finty.:s!tisk:Tun:fly tl,ixt:r il:2-All 11”.. 1::117P3!utt`e;f-ri2Li3E eirne.r.-c V.:' 7:''Si:ICIIIA4:1S.Liv,:l-3.Ii .;,.:-ftr7-aIinn reni'x'lc OW r.filX F:11!:. !:3rIFY nit Nil Lint..1 v,i,m-i-. srtm-mul 7.7,,,,,a-gi7lat.n vs ry;:::;,1,111,! ,,-1;:np 17.7: ,cl Irrp lir:IWO:11Di;1P.j Xlte,:IS frInfri,gi a i'J'tap,17.411pWt irc P ° NaTOCK nit b.‘varIO nittiType a ...... PrintiType Title t ,.-,. _,..., pt. .,..-t _..., 1 fifitie_. , — Signature .,:j f 1 L34 V,...fAilelf,--_,T—. :1— aata I CU FOR DISTRICT USE ONLY J 'at'f.;i: ren.7f-,, :q", v oj'.1 cn rAF°c,eilb.;2C3 e 7e sre THE APPLICANT MUST PERFORM A SITE ASSESSMENT PROti TO ISSUANCE OF A SERVICE PROVIDER LEITER. 'Srr.siluasscxti cn!re fAu.:7,,within 2,:-1.;;leti ul; KE-t,T,„,:zi,:eric,,LI Nalini iiesc.j3i;:s1,1-1.-immKt p,...4:fft Trz.„.s.,sn Xamin On le.,inv,:itte airin,t);:d HT:trill yr,re.31 m0tre tetn,Tra Qv Scaslays yeas ut;Flu!7zpf2r h elif,s,;:,--;s!,-„E cr yarhil nut ul li-,s sli, ;le,,,11-%;;;ive Ala 1.1'F- Deeltini S77::1...s.ifsTre,r,-;_i;a2s fOr e r:rol:VIE r,i'll Is t&Jitar,c Ira'arcart Arx;ctLalty serni,,e zrari if th:yx4.tr,k11441,:mily cisnelvj --eis umirszy vil.!.titi 41-t; :','EUT Folfwif31 Pf",Nitir Ira'Y.frl:IJ•i",d:71'4,K2LI".:11 Zmi ZYLIT:::-X...: *:.itZ7iY:::.1_2.i, i leluileJlel isp.;:r. ' ttsly.,j 2 rr.1 umiple.tri i.tztt•ax..,,,-.1.tie ,.;k7,,;,3a,,,,., aril'iclit.4,iif,v, D R.aEfi‘-'4',7;....:41, ..--.0.F:rr,Int:5.7'-uY.:1 ia:•.1,7!twt.", ic.,r-sr-Ati-l'1%.:•;-..?...-e%te.-,71;yatoy,tylux;,v;,;1-,c1:,,iyou'r.;,,-7-47y..I.-eitt2it....:irg:c.:7:.. -na. :r:),:i 71,7g(*",!Lull-ar,t-a.r.417; -his ay:jive,r,'1,11'T fi:tori7g:DIP AThz.....,,,,q 7t:f r:d a::kf:). 1,!:;n;:i-P.',n':rad 1:1:,,:,7;1,411.ire war.=at:11hp r..,,i;,,x1,:t q. r1 ix_rtvre.i:!;;;;;',,,:z::,y.,_:Se,vil:ztcr du t,:f.f,f af;:wtir:-.:,ty Ri5;.:.,:r:w.x,rd Cantu.:147:,, :::.!:(4.1, :%! .:,::•;i7u7i....d7,71-s,7r,g ki::.r,;,id Mat'te Cdtfti•td:Yr.!r-cr-rtfral idrjr U;j7,11='F.!=t1t1 Z.;!:-U2,art Inirst fit •jj This Service Provider Lefler is not valid Haien CM Sport:wed site plan(s)are attached. ,:j T!,r;yr-;:i.;,7-e, iLaket..:717.,7s t;: !.,,,,:,:t nt:ii,,----,:n 1,te,,,,,:çf-Arg Wil:-!.:&las 7,,,,,M1,1p,i::Ir,,,g5 5.4F,i47:,....„:r2L N3 Si f,i,-.‘:;-•,...I.:.Esst,,;E,-,i; ',Ty!sitte,;;:-E r;;;;11,1i; RE:111A7-;-.- i RevewaC ize ei..4.4e 0.54:.-4441----- Date 6/16/16 ,„. Once complete, oma]to: SPIReviiewfactfrarivvaterservioesorg . Fox: (603)6611-4436 OR mrid to: SPL Review, Clean Water Serwicea. 2;550 SW FliKSboro Highway, Hilsboro,Ofegen 97123 , 1.1111•MIIIMIIMM•••••••••••••011•11111111111.111•M•••• =.• , '. ----- '' ..rox•ormfa•••••••• _ Apx•••••• • City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT IN III . Request for q Permit Action . , 4, . .� ... i w i TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718M-M•74V ,a;r -, ,r.gov SEP 1 2 2016 TO: CITY OF TIGARD Building Division CITY Oi" ' ' k` L= 13125 SW Hall Blvd.,Tigard,OR 97223 i ��' � ��kiV Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner cant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) B r C, fl Mailing Address: 7 \ CA-- City/State/Zip: -I [1 ( -C) 0 V C77Z� Phone No.: 54-t r 4-l - c-c.' PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): III _....►.[N VOID PERMIT APPLICATION. � 0 REFU ERMIT FEES (attach copy of original receipt and provide explanation below). k. 1::= ' OICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: 2$7 )Z—Ci4Z,ok Site Address or Parcel#: /5.C Sk.) 79 /Are Project Name: r ,� Subdivision Name: r lir ac/leJ Lot#: /147" EXPLANATION: b VYl 1 j''(\Guo 'O as i s, t O( buu- tThkir5 v x.�S ona , t cad((J r) , Signature: a\G\AAG99 Date: 1 6i Print Name: J CNC nc\ P a n I I Refund Policy 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. /e�'4N A 3. Please allow 3-4 weeks for processing refund requests. 3/. 17 — A3, 3 / . 0.7 P/1/6 G.S c)nc)A .—, -r ' %7, 4-i FOR OFFICE USE ONLY Route to Sys Admin: Date q�4jt, By 9 , Route to Records: Date b/ 40 a, 7 By '2 Refund Processed: Date /Q /f, B ,'�,' Invoice Processed: Date By Permit Canceled: Date N 4.. By /* arcel Tag Added: Date By I:\Building\Forms\RegPermitAction_t 2314.doc -I' q TIGARD City of Tigard September 23, 2016 Jack Brand 7966 SW Kelso Ct Tigard, OR 97224 Re: Permit No. MST2016-00262 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 15660 SW 79th Ave Project Name: Brand Job No.: N/A Refund: ❑ Check#222401 in the amount of$11.28. ❑ Credit card "return"receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Permit application indicated wood fireplace,but gas fireplace was entered on permit in error. Refund difference of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I:\Building\Refunds Ald2,5-LagolliateglaympTigatc14ioregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 1111 City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the RequestforPermitAction form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Jack Brand DATE: 9/16/2016 7966 SW Kelso Ct Tigard, OR 97224 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 404923 Case#: MST2016-00262 Date: 7/13/2016 Address/Parcel: 15660 SW 79th Ave Pay Method: CreditCard Project Name: Brand EXPLANATION: Permit application indicated wood fireplace,but gas fireplace was entered by plans examiner;{� refund difference in permit fees. 54`! 's rq A`"•,P'"�"`",,` i d # �� '�a✓'�e�: Ra" ,� �i 4.� `±5 ;+ :,, $z�P�' r�i M� �.n 2# ip e °FromR o "# a .4;7. � , ° �A' �t�aythe a� �� e ' �„. ze � = Mechancial permit 230-0000-43102 $10.07 12%State Surcharge 100-0000-24001 1.21 TOTAL REFUND: APPROVALS: SIGNATUR,'DATE: 2f If under$5,000 Professional Staff ,` 0-I / •f If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board Case Refund Processed: Date: /617//1:, By: 4 I:\Building\Refunds\RefundRequest.doc x 09/01/2010 Electrical Permit Application Folz Oj i i i. l si:oyl.l City of Tigard -$ Received - IIMIMIIII u 13125 SW Hall Blvd.,Tigard,OR 9722 DateB : MEM 1 f '� Plan Review Phone: 503.718.2439 Fax: 503. ) Date/B : Related Permit#: Inspection Line: 503.639.4175 �`l\�` Ready Date/By: loris: See Page 2 for 1 I V A R D Internet: www.tigard-or.gov f\ q Notified/Method: OSupplemental Information TYPE OF WOI aC�� A[� PLAN REVIEW ❑New construction 0 Addition/alteration/repla l lit ,1A� 1_ Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition ❑Other' � �� 0 Service or feeder 400 amps or more 0 Building over three stories. i where the available fault current 0 Marinas and boatyards. CATEGORY OF CONS L T exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling 0 Commercial/ind* al ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATIONAND LOCATION 0 Emergency system. larger separately derived �� Q �-7,-; ❑Addition of new motor load of system. Job#: Job site address: ICJlp n LU �q Q`)t, 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP: 16�2 �j G -7 2 ❑Six or more residential units. occupancy. "' ` ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 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. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 i � Limited energy,residential DESCRIPTION OF WORK �7L) Vo ,- ec i(,-1c1 (\.*.Io1. Limitedh negesm multi-family 75.00 2 J energy,multi-family 75.00 2 ,� residential(with above sq.ft.) pd PROPER Y OWNER ❑ Nr Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: `et tvr '{ B iv a £ 200 amps or less 100.70 2 Address: V (CCj Cji 1 l JV t a 0201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: l' W G "72.2t� 601 amps to 1,000 amps 301.04 2 Phone:(51.}l )0)LA(_ �c-)C Fax:,c ) Over 1,000 amps or volts 552.26 2 Email: .G i ( /� . Temporary services or feeders installation,alteration,and/or } �mo 7)Voc, .[�(()4 T�1, c Cc,YY) relocation Owner i6stallation: is irigrallation 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 signaturre: Date: 401 amps to 599 amps 168.54 2 Q' APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7'42 2 Contact name: _ V_.V 'c2 ah b B.Fee for branch circuits without Address: qJ r i3o C.+ service or feeder fee,first A:) ) < J3 branch circuit 56.18 2 City/State/ZIP: '(60 e/O n e 7224 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(94( )C.t U i — s G O Fax::( ) Each manufactured or modular Email: dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 6c,::, ---reEtroyylyykL,w k CC:k4 cc f Sign or outline lighting 67.84 2 i Signal circuit(s)or limited-energy Address: l '_‘ SC4j -\C'V\ <t panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: fes,('f InCR_ Ci-72-04 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( e,) Cmc Fax:( ) Investigation(1 hr min) 90.00/hr � Industrial plant(1 hr min) 78.18/hrEmail: (1' G e - r CO• Q.Ove CCB Lic (. (� Inspections for which no fee is `7 n(2 Electrical Lic.: 1 p specifically listed 'h hr min) 90.00/hr ] 3'l�t,tti te Suprv.Lic.: I .(j 4-1-4 Pe Y ( Suprv.Electrician sign �e, I� uired: --lib J tij ELECTRICAL PERMIT FEES e9 7 Q1 t 11' 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 06/17/2015 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: 5 kva or less 100.70 2 Check Type of Work Involved: 5.O1to15kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 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 0 Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('A hr min) ELECTRICAL PERMIT FEES COMMERCIAL It+CI��L WORKONLY: Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 # Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Cloc ystems Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ 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 06/17/2015 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15660 SW 79TH AVE, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 399 Plumbing final Result: PASS Comments: Corrections completed Violation Summary: Tel: 503.718.2439 Inspection Date: January 19, 2017 at 12:26:04 PM Record ID: MST2016-00262 Inspector: Aaron Cillo-Gobel Inspector Contractor