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12820 SW GLACIER LILY CIRCLE DENNIS , STEVE 4 NAJ4 2-2 12820 -Sw G /A1c It LI -9 4t j_rDc4i(t ATTAcm-tj %,%,31 Ab" LA;A lolls 0c.M 11 y [. � 1G �R�, D � y 722. 3 APd° Z G. i I � I rL-R-fAAr, T5 J-k osQD 12- ' f 1 l I i LU 7H C.2_ jAm-�,r-- 6SSwRf a"rep y� i I I f, .._ :1 ::a t.t._ �ti 1! r. ;•'tY ' g =r-S 17 — I L • i5t5 ooe Tic i I i i I �u wl � �aJ ALS TOS-rS qe µTGH 02 NsGN CR— N 1t�, T�s.�►t.. w £: L- F. TOL ArK � —I�-0 y NOTICE: IF THE PRINT OR TYPE ON ANY I I � I I I I � I � � � T �-� � i r 1- 1 T T 1` TTI t f i i i � r iii I � � � � ili ili � � I il � i �� 1 r-� � i � I � � � �� ��. . �r .i_� � I � i � lli ill . iili � ili I i I I i I I I 1 I I 1 I I 1 IMAGE IS NOT AS CLEAR AS THIS NOTICE 1 2 ( I �OQ c , 3 4 6 7 _ _ I I �ec� _._ _ -_ -- _ S J 10 11 12 IT IS DUE TO THE QUALITY OF THE _ _ _ —� No.136 lob ORIGINAL DOCUMENTIZ E Z 'L I Z 0 Z 6 i 8 I L T 9 I 4 I - fi i 'E Z T I T I 6 8 L 9 4 £ Z T a�+�i3w IIII Ilii�llil Illi llll�lill Illi lily fill �lll 1111 111111l11 u11ll I till lel ll 111 HII Ilulllll ���� ���� ���� Illl,llll�ilil Ilil�illl�ll�� IIII IIII IIII IIIIIIIII lllllllll Ilu 111 fill illi llll llll U ll If 1 1111 I 1111 I , D � NNIS STE- V )7- If Df WA J 12 521 .SC,✓ G 1�� ►�. t' �.. � ,i I,y ��' r. TIG RD, oQ. c7 2-2. T4X u)-r 5 y 00/ S[IMI'1 t R L #Nr 1.D9r* ;t6 Address shall be posted and visible from street. l ti � laps Approved CL shall be on lob sde. NN!� - Q < { s z • 13 cl D �1 ❑ ❑ � 1 •d i ( lon Of :111 ►..., '� � , G� . . C) n� p huri�e the v-olat Y ; - c? '; r• c, o ! "llis per�ntt Ones not tut - • The a �hts of holdcrs of private easements. P a y such parties and Q iicant is Urged to contact an d ccure thier app ruval before commencing work. `� - E ' __ ��: I .. ._� _ -- LIABILITY LU ..M - ,_ The Cit �l - E.. v i ;•� _ e (� Tigard and I#S `Ll c,,,, 'y • �' ..� �, ~ Q, employees shall not v - , _ cc ______ be a :A responsible fer ser ...1 y U; s.. ccs .... A. l �p c' n �e S Q - �- �' _ Which MY appear herein. w L Z V v O t C3. 6. I U Lb Ll.� G!� CL Z - rJTY OF'TIGARD Approved Conditionally Approved ...................... ( ); For only the Work as desCtibeci In: PERMIT Ni I . See Letter to: Foiiow...... ..........-------• ( )' Attach ' 5 _ — i ,lob Addres X41- cy ZI' .. .... -�Y )C - f - - z 01 --. c�1- .:� ll� rL • �Q�� f uC Rldgtcr�ST Y NOTICE: IF THE PR!NTORTYPEONANIf' T'�T � � I � � I � � � I � ili � i i � rlr � r iii lel ! ! I i �1- lI ! II I1I IJI ! � I .,t.� � .! JI I � I I � I � I � I ISI , � , � I � .... . I f T� I r.. I l I I ►-• I �1` II 1 f I a 1 IMAGE. IS NOT AS CLEAR AS THIS NOTICE 1 Z IJ�?.G� 6 02044/ -- --- - _ - - - ------ -- - ----- --- — 8 '9�_ 10 _ 1� -- 12, IT IS DUE TO THE QUALITY OF THE _ _ _ _ No.36 ORIGINAL DOCUMENT11 E 6Z 8Z LZ 9Z— � W � Z � ZZ TZ OZ 11,11 8I LT 9T 11 Ili, 9T I r J N 00 N O cn A m M r r q A_ 70 n r m 1 � i i i I l i 12820 SW GLACIER LILY CIRCLE - i CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 BUP Received —_ Date Requested (10 ­3- AM__-_. PM_ _ BLIP, Location Jc Suite. _ MEC__,' Contact Person Ph L PLM Contractor__ _.-_ - Ph ( _- ) __ —__—_ :?WR BUILDING �- -- Tenant/Owner -- _ -- _ __ ELC Footing ELC Ftg Drain Foundation Access: ELR Drawl Drain `t: <.1,�1' --- -- - Slab Inspection Not gS: Z / _ SIT Post&Beam a �-� � O��z y``D Shear Anchors Ext Sheath/Shear 2 �` Int Sheath/Shear Framing ------- Insulation Drywall Nailing - - -- --- --- --- -- - ----- Firewall Fire Sprinkler — -- Fire Alarm Susp'd Ceiling - - - - - - Hoof O►ner: - -- — f PART FAIL - GING -- _-- Post&Beam Under Slab ---- --- -- - - - Hough-In j Water Service -- Sanitary Sewer Rain Drains - ------ -- - --- -- --- i Catch Basin/Manhole Storm Drain - -Shower Pan Other: -- S PART FAIL ANICAL Post&Beam Rough-In Gas Line -----..-- - -- Smoke Dampers - ------ Final PASS PART FAIL - --- -—- --- ELECTRICAL Service — — Rouah-In UG/Slab -- - ------ -- - -- Low Voltage ------ Fire -__Fire Alarm FAD Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAiL_ Please call for reinspection RE: -- _- _-_ Unable to inspect-no access Supply Line Approach/Sidewalk Data_ � 3/e) 3 Inspector- -__ -_ - _Ext Other Find DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITYOF T I GA R D MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2001-00011 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/16/01 PARCEL: 1 S133DA-05400 SITE ADDRESS: 12820 SW GLACIER LILY CIR SUBDIVISION: AMART SUMMERLAKE ZONING: R-7 BLOCK: LOT: 076 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: _ BOILERS/COMPRESSORS _ HOODS: _ FUEL TYPES R 0 - 3 HP: DOMES. INCIN: SAS 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: Gf S PRESSURE: 50 + HP: CL.O DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Electric to gas furnace Owner: _ __FEES_ _ DENNIS, STEVEN J + DANA L Tipe� By Date Amour. Receipt 12820 SW GLACIER LILY CIR PRMT CTR 1/16/01 $72.50 :'72001000C TIGARD, OR 97223 5PCT CTR 1/16/01 $5.80 272001000C Phone: — Total $78.30 — -- Contractor: PREMIER HEATING + AIR COND PO BOX 86295 PORTLAND, OR 97286 REQUIRED INSPECTIONS Gas Line Insp Phone:233-6566 Mechanical Insp Reg #:LIC 96473 Final Inspection This permit is issued subject io the regulations contained in the 'Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law requires ,'ou to follow rules adopt6d iii the Oregon Utility Notification Center. Those rules are set forth in OAR 95'4 001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (50 )246-9189. Issue By: �,1 4 Permittee Signature: \ f 1 Call (43) 639-4175 by 7:00 P.M. for inspections needed the next business day 1Vlechanical Permit Application Date received: p Pormit .. City of Tigard Project/appl.no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: — Land use approval: — _— Building permit no.: Q I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New consttvction U Addition/alteration/replacement U Other. �'OMM Job address: I ;t U S �..-+ ( I c t<< II L4 C r Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City/county: 11P: 97J 13 Description and location of work on premises: KIMIN 3M —� 1 • (,_t�'� ` rRes. 7Res Total Est.dale of wmpletion/inspeclion: < Uex'ri ton 7Qt . .only Tenant improvement or change of use: 1 7handlingnit CFM Is existing space heated or conditioned'?61 Yes U No Air conditioning(site plan required) Is existing space insulated?®Yes U No -Aire Alteration of existing HVAT system m Boiler/compressors State boiler permit no.: Business name: _, 11 ('p,Y�,� �,ti,u _ HP Tons BTU/11 _ Address: _ _ tr smo c dampersiductsmokedetectors City: State: v,C. I ZIP: - eat pump(site plan required) _ Phone: Fax: t t t E-mail: Insta rep ace urnac urner.i o s 1 I Including ductwork/vent liner 11 Yes U No CCB no.: 7 _ — Instal/rep ac re locateficaters-suspended, r" r- City/metro lie.no.: ) 0 5 L, I wall,or flour mounted Name(please print): \. �� n '�t e Vent forappliance other than furnace e era u: Absorption units BTU/H Name: Chillers -- HP Address: Compressors HP my ronmenta exhaust find vent at on: City: Slate: ZIP: _ Appliance vent — Phone: Fax: E-mail: Uryercxl aust Hoods,I ype / i es. itchen/hazrnal hood fire suppression system _ Name NN t S Exhaust fan with single duct(hath fans) Mailing address: Exhaust system apart from hearing or AC City: p t State: G ZIP: r1 i a' Fuelpiping andistribution(up to outlets) Type: _t_PG __ NG Oil Phone: Fax: I E-mail: I`uel pi ping each additional over 4 outlets I I C, u 0 rocesspiping(schematic required) Nantc: Number of outlets ------_- — _ alt er st appl fif ace or eqn pment: Addie Decorative fireplace City:-- - - - Statc: ZIP: J nsert-type Phone: I:Ix: E-mail: oo stovelpc et stove of c"Applicant's signature: Date: _ Ot el Name (print): _ Na sll jurisdictiats eccep credit cods,please call juriwictiat for more Information. Perrnil fee.....................$ N Visa ❑ons ac r rA credit Noticc:This permit application Minimum fee................$ expires if a permit is not obtained d'rPlan review(al rfir) $ —-- -- rdii cud numc.tr --�-- _ — er<pims within 180 days after it has been State surcharge(8%) ....$ - None of cudhol r as shown on cmiaii cud $ accepted as complete. TOTAL $ Cudholder sitnuum - Amount x004617(600WOM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: _TOTAL VALUATION: _FEE: Description: Price Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code _ Oty (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 dnd 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or including ducts&vents 14 00 fraction thereof,to and including 2) Furnace 100,000 BTU+ -- $10,000.00. including ducts&vents _ 17 40 --------.--.._- - --_-- ...____-_-- -- -_-- 3) Floor Furnace � -'� $10,001.00 to$25,000.00 $148.50 for the first$10,000.003) $1.54 for each additional$100.00 or 'nicluding vent14 00 fraction thereof,to and including 4) Suspended heater,_wall heat- _ $25,000.00.___ _or floor mounted heater 1400 i-25,6151.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included I, appliance permit $1.45 for each additional$100.00 or 6.80 fraction thereof,to and Including 6) Pspair units _ __ $50,000.00. _ 12.;5 $50,001.00 and up $742 00 for the first$50,000.00 and Check all that appy: Boiler Heat Alr - $1.20 for each additional$100.00 or For Items 7-11,see I or Pump Cond fraction thereof. footnotes below. Com ' •• 7)<3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: to to look 14 00 - - 8)3-15 HP; absorb Value Total unit 100k to 500k BTU 25.6_0 Description: _ _ Qty_ _(EaL_ Amount 9)15-30 HP;absorb Furnace to 100,000 3TU,Including 955 unit.5-1 Hill BTU _ 35 00 ducts&vents _v 10)30-50 HP;absorb Furnace> 100,000 BTU including 1,170 unit 1-1.75 mil BTU 5220 ducts 8 vents --- 11)>50HP:absorb Floor furnace Including vent 955 unit>1.75 mil BTU 87.20 Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM -`- floor mounted heater ___ Vent not Included In applicance 445 10.0013)Air handling unit 10,000 CFM+ _ - __ 17.20 Repair units 805 <3 hp;absorb.unit, 955 14)Non-portable evaporate cooler to 100k BTU 10.00 3.15 hp;absorb.unit, -� 1,700 --- 15)Vent fan connected to a single duct W 101k to 500k BTU 680 15-30 hp;absorb.unit,501k to-1 ---2,310 i 16)Ventilation system not included in _-- mill._BTU apP­!iance permit 10.00 30-50 hp;absorb.unit, 3,400 17)Hood served by mechanical exhaust 1-1.75 mil.BTU10 00 - - -- _ - --- 18)Domestic incinerators >50 hp;absorb.unit, 5,725 >1.75 mil.BTU17 40 Air handling unit to 10,000 dm _ 656 19)commercial or Industrial type Incinerator Air handling unit>10,000 cfm 1,170 _ 69.95 Non-portable evaporate cooler 656 20)Other units,Including wood stoves ` Vent fan connected to a single duct _ 446 ____ _ 10.00 Vent system not Included in 656 21)Gas piping one to four outlets appllar,:e�ermit _`_ _ 5.40 Hood served by mechanical exhaust 656 22)More than 4-per outlet(each) __ _ Dome:•tic incinerator _ 1,170 1 00Minimum Permit Fee$72.50 SUBTOTAL: Comm 3rcial or Industrial R61neratcr 4,590 $ Other.mit,Including wood stoves, 656 inserts,etc. 8"i.State Surcharge $ _ _Gas piping 1-4 outlets _ _360 -�y5'/.Plan Review Fee(of subtotal) Each additional outlet 63 Required for ALL commercial permits orly a TOTAL COMMERCIAL a TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: Other Inspections and Fees: 1 Inspections outside of normal business hours(minimum c'arge-two hours) $72 50 per hour Inspections for which no lee is specifically indicated (m'nimum charge-half hour) $72 50 per hour 3 Additional plan review required by changes,addiD�,ns or revisions to plans(minimum charge-one-half hour)$7250 pei hour "State Contractor Boller Certification required for units>200k BTU. "Residential A/C requires site plan showinp placement of unit. iAdsts\formsUnech-fees.doc 10/11100 CITY OF TIGARD —L— MASTER PERMIT PERMIT#: MST2003-0012.0 DEVELOPMENT SERVICES DATE ISSUED: 3/28/03 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-0171 SITE ADDRESS: 12820 SW GLACIER LILY CIR PARCEL: 1S133DA-05400 SUBDIVISION: AMART SUMMERLAKE ZONING: 't-7 BLOCK: LOT: 070 JURISDICTION: TIG REMARKS: Interior remodel BUILDING REISSUE: L:USIOM STORIES: _ FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST. sf BASEMENT. of LEFT. SMOKE DETECTORS. TYPE OF USE: Sr FLOOR LOAD 40 SECOND: sf GARAGE sf FRONT. PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: 1 THRO sf RIGHT: VALUE: I ti(Inp nn OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: U sl REAR. PLUMBING SINKS. I WATER CLOSETS: WASHING MACH. LAUNDRY TRAYS: RAIN DRAIN. TRAPS. LAVATORIES-. DISHWASHERS: I FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS CATCH BASINS' TUBISHOWERS: GARBAGE UISP: I WATER HEATERS: WATER LINES: BCKFLW PREVNTR. GREASE TRAPS OTHER FIXTURF5: MECHANICAL FI IEL TYPES FURN<100K: BOILICMP<3HP` VENT FANS. CLOTHES DRYER: FURN—100K. UNIT HEATERS. HOODS. I OTHER UNITS: MAX IN btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTL.FTS' I ELECTRICA'._ _ RESIDENTIAL UNI I SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp 0 200 amp WISVC OR rD R PUMPIIRRIGATION. PER INSPECTION: EA ADD'L 500SF 201 - 400 imp. 201 400 amp 1st W/O SVC/FDR "^ SIGN/OUT LIN LT PER HOUR: LIMITED ENERGY. 401 600 amp: 401 600 amp EAADDL BR CIR: +"" SIGNALIPANEL. IN PLANT: MANU HMISVCIFDR- 601 1000 amp: 601♦amps•1000v MINOR LABEL.. 1000+amp/Voll PLAN REVIEW SECTION Reconnect Only: —4 RES UNITS- SVCIFDR-225 A. >600 V NOMIN%L Cl S AREA'SPC OCC: ELECTRICAL•RES1 RICTED ENERGY A.SF RESIDENTIAL. _ B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM. AUDIO 6 STEREO FIRE ALARM INTERCOMIPAGING. OUTnOOR LNDSC LT BURGLAR ALARM. OTH BOILER: HVAC LANDSCAPEIIRRIG: PROTECTIVE SIGNL GARAGE OPENER CLOCK: INSTRUMENTATION: MEDICAL: OTHR. HVAC: DATA/TELE COMM: NURSE CALLS TOTAL a SYSTEMS TOTAL FEES: $ 576.57 Owner: Contractor: This permit is subject to the regulations contained in the DENNIS,STEVEN J +DANA L RIDGECREST HOMES Tigard Municipal Code, State of OR. Specialty Codes and 12820 SW GLACIER LILY CIR 6600 SW 92ND AVE all other applicable laws. All work will be done in TIGARD.OR 97223 210 accordance with approved plans. This pemlit will expire if TIGARD,OR 97223 work is not started within 180 days of issuance,or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: Phone: 503-246-8808 Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952-001-0080 You Rep N: LICA 59228 may obtain copies of these rule,or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Plumb Top Out Mechanical Final Electrical Rough In Plumb Final Framing Insp Final inspection Gas Line Insp Elactrical Final 1 Issued By : L `:�L:�_1.�-L1,�i1 �. ,� Permittee Signature : �'f/l L v -- Call (503` 639-4175 by 7:00 p.m. for an inspection needed the neat businets day Building Permit Application ' ' ' 'NLY -- - Received liuildn'g Date/By: CV1400 City of Tigard Planning Approval Other Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-6394171 Fax: 503-598-1960 `'.', Post•Review Date/H : Case No. Land Use Internet: www.ci.tigard.or.us ContactJ �r� Sec Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: 1Supplemental tnformatiun kilo. TYPE OF WORK REQUIRED DATA: New construrl _ Demolition I &2 FAMILY DWELLING 0� Add itio alteration lacement Other: — _MEGORY OF CONSTRUCTION Note: Permit fees*are based on the total value of the work performed. Indicate 1 &2-Family dwelling ❑ Commercial/Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor, overhead and profit for the work indicated on this application. Accessory Building Multi-Family ❑ Master Builder Other: Valuation......................................................... a_Vs coo JOB SITE INFORMATION and LOCATION No.of bedrooms: No.of baths: Job site address: 128 ZC� 5w Lt Lj Total number of floors..................................... New dwelling area(sq.R.).............................. Suite#: Bldg,/Apt.#: Garage/carport area(sq. R.)............................ --- - - Project Name: ¢AMt(_W.-T -- CT1�tia�� �,.t,t,_-1.. Covered porch area(sq. ft.)............................. —� - Cross street/Directions to job site: Deck area(sq.ft.)............................................ CjW C-.I.PG� R- l.1 LL`� ���C(-�i Other structure arca(sq.R.)............................ REQUIRED DATA: #: COMMERCIAL-USE CHECKLIST Subdivision: Tax map/parcel #: note Permit fees'are based on the total value of the work performed. Indicate 5CRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor, L. IL'F Le-C V rt�G- VAoverhead and profit for the work indicated on this application. IM C 1�E l T C F1Ev tJ Valuation......................................................... S -- Existing building area(sq.ft. New building area(sq. ft.)............................... _ Number of stori:s..................................�Jk .......... OPERTY OWNBR I El TENANT Type of construction....... ............................... _ Name: I N kc/ AA A ATF V rc Occupancy group(s): Existing: Address:_ k7.E'Zt. C A u C1( 1 fc R t.�, New: Ay/State/ZiL Phone:'S'}`1 -cj Fax: NOTICE: All contractors and subcontractors are required to be APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name_ jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason applies: Address: City/State/Zip: - --- Phone: Fax: BUILDING PERMIT FEES* E-mail:— CONTRACTOR Please refer to fee schedule. Business Name: Qt,v(, �e r V*,5- Fees due upon application Address: A.�� 1 Z 1 Q.� A� 1 Z Amount received............ Cit /State/Zi Phone: &4il, - 8t• Fax: Z A - Date received: _ CCB Lic. — AUtl10ri7.Cd Notice: This permit application expire%it a permit i%not ohtainrd Signature: L _ Dde: 03 180 days after It has been accepted as complete. •Fee methodology set by Tri-Count Building Industry Service Board. lease print name) / r i\Dsts\I'emut Dorms\nidgPermitApp.doc 01103 One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: City f igar`/ City of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 U tither Phone: (503) 639-4171 Fax: (503) 598-1960 Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance Points,seismic soils designation,historic district,etc_ _ 3 Verification of approved plat/lot. — 4 Fire district____approval required. 5 Septic system permit or authorization for remodel.Existing system capacity 6 Sewer permit. _ 7 Water district approval. - 8 Soils report. Must carry of iginal applicable stamp and signature on file or with application. _ 9 Erosion control U plan U permit required. Include drainage-way protection,silt fence design and location of cutch-basin protection,etc. --- 10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state building codes.Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. ---- 11 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals):location of easements and driveway:footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. _ 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connectio,t details,vent size and location. -- -- 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beasts,headers,joists,sub-floor. wall construction,roof construction. ivlore than one cross section may be required to clearly portray constntction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. 15 Elevation views,Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing locations.Show attic ventilat in. - 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered systems,see item 22,"Engineer's calculations." 19 Beam calculations.Provide two sets of Lalculatiwis using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 !V%anufactured floor/root truss design details. 21 .aergy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided.(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect I.:ensed in Oregon and shall he 01own to he applicahlc to th, project under review. JURISDU1110NAL SPECIFICS 23 five(5)site plans are required for Item I 1 above. Site plans must he 8-1/2"x 1 I"or I1"x 17". 24 Two(2)sets each are required for Items 16, 19,20&22 above. I 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to Include tree size,type&location per approved project street tree plan(if applicable),and COT Street"free List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440-4614 trdavcon►r Building Fixtures Pl,,. umbinR Permit Application Received Plumbing Date/By: Permit No.: Planning Approval Sewer City of Tigard Date/By: Permit No.: 13125 SW Flail Blvd, Plan Review Other "Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review land Use Date/B Case No.: _ Internet: www.ci.tigard.or,us Contact luris. See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method:_ Supplemental Information. TYPE OF WORK FEE*SCHEDULE(for special Information use checklist _New construction_ _ Demolition Description Qty. I Fee(ca•) Total Addition/alteration/replacetnent [I ^:;ger; New t-&2-fandiy dwellings _ Includes 100 it.for each u Ility connection CATEGORY OF COi:STRUCTION 1 &2-Family dwelling Comk mercial/Industrial SPI0 (I)bath . SF2 350 bath iSU.0l) Accessory Building Multi-Fames_ SFR 3 bath - 99.00 ❑ Master Builder _ ,_ Other: Bach additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Firesprinkler-sq. fl.: Page 2 Job site address: tZeZ'' tri-, Site Utilities Suite#: $ld ./A to Catch basin/arca drain 16.60 Pro'ect Name: Dr ell/leach line/trench drain _ 16.60 Footing drain no.linear ft. _ Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer no. linear R.) Pare 2 Subdivision: _ _ Lot#: Storm sewer(no. linear(t. _ _ Page 2 Tax map/parcel #: Water service no. linear fl. _ Pa c2 Fixture or Item DESCRIPTION OF WORK — Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer _ 16.60 - ----- ——----- Dishwasher I 16.60 �7OPERTY TENANT Drinkingfountain 16.60 OWNER E cctors/sum 16.60 _Name: Vf%'AA + :;I w Expansion tank 16.60 Address: tZ&u) w a-,L K-trC,V— UWL, Fixture/sewer cap 16.60 Cit /State/Zi —f 1C-'MU'� Floor drain/floor sink/hub 16.60 Garbage disposal ( 16.60 _ Phone: '_,X11 - S 31,55 1 Fax: Hose bib 16 60 APPLICANT I Ll CONTACT PERSON Ice maker 1 16.60 Name: Interceptor/grease trap 16.60 Address: Medical gas-value: S Pae 2 Primer 16.60 City/State/Zip: Roof drain commercial IG.60 Phone: Fax: _ Sink/basin/lavatory 16.60 E-mail: Tub/shower/shower pan 16.60 CONTRACTOR Urinal 16.60 Business Name: c �111'F -I w Watercloset 16.60 Water heater 16.611 Address: ice- *l\ LiuS Other: City/State/Zip: puff-tQ 01 ��h Other: Phone: _ Fax: �44 - Sri n Plumbing Permit Fees* CCB Lic. M `� (� Plumb. Licsubtotal s .#: Minimum Permit Fe,:$72.50 $ 70� ,n Authorized / Residential Backflow Minimum Fee$36.25 Signature: '1 _—_ Date: ?�(Z 0 Plan Review 25%of Permit Fee S \�{ I c ( 1� State Surcharge 84%of Permit Fee S ' Please print name) _ 'TOTAL PERMIT FEE I S 7 -O N'otice: This permit application expires If a permit Is not ohlained ssithin All new commercial buildings require 2 sets of plans with Isometric or 180 da*i s after it has been accepted as comPlete, riser diagram for plan reslew. y/ *Fee methodology set by Trl-County Building;Industry Service Hoard. is\UstsV'ertnit Fomu\PImI'crnulApp doe 01/03 � �a0 PlumbinPermit_ADDlica tion - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppsession Systems: Site Utilities Q(y. Fee(ea) Total Square F oota e: Permit Fee: Footing drain- I" 100' 55.00 0 to 2,000 $115.00 Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 Sewer- I st 100' 550) 7,201 and greater $309.00 Sewer- .-ach additional 100' 46.40 Water S:rvicc-Ist I(1(P 55.0) Medical Gas S stems• Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain- I st 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction thereof,lc and Fixture or Item Qty. Fee(ea) Total incb,ding$10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the First$10,000.00 and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to (minimum permit fee$30.25) 27.55 and Including Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.:0 for the first$25,000.00 and$1.45 for --- each additional$100.00 or Tract on thereof,to Inspeclion of existing plumbing or and including$50,000.00. _ specially requested ins coons-per hour 72 50 $50,001.00 and up $742.00 for the first$50,000.00 And$1.20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing existing fixtures? If "Yes",please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. uanilt b Fixture Work Performed (bruments regarding fixture work. Fixture Type: Replace New Dloved Existing Capped --- -- -- -- Ba list il'ont - Bath -'Tub/Shower -Jacuzzi/Whirlpool _ — Car Wash -Each Stall -Drive"I'hru Cuspidor/Water Aspirator - Dishwasher -Commerc-al -Domestic Drmking Fountain ----- E e Wash _ -- -- - --- -- - — Flatt Drain/sink 2" _ 4„ — - Car Wash Drain *Note: If the fixture work under this permit results in all f7arbage -Domestic — Disposal -Commercial increase of sewer EI)lIs,a sewer permit will be issuedand -Industrial fees assessed for the sewer increase mus! be paid before the Ice Mach./Refri .Drains plumbing permit call be issued. Oil Separator Gas Station _ Rec.Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory .Bradley - -Commercial _ -Service _ Swimming Pool Filter Washer-Clothes Water Extractor Water Closet- I'oilct _ Urinal Other Fixtures. i Msts\Permit l:orms\PlmPermitAppPg2.doc 01103 FOR OFFICE I NLY Mechanical Permit Application Received Mechanical, Date/By: Pertnit No. Planning Apprnval Building City of Tigard Date/By: _ Permit No.: 13125 SW Hall Blvd. Plan Review other-- 'rigard,Orcgon 97223 Date/By: Permit NoPost- - -- Use Phone: 503-639-4171 Fax: 503-598-1960 Datc/ y: land ate/B Case No.: Internet: www.ci.tigard.or.us Contact Juris.: see Page z ror 24-hour Inspection Request: 503-639-4175 I Name/Method: Supplemental Information. TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST New constructionDemolition Mechanical permit fees*are based on the total value of the work Addition/alteration/re laCCmei t Other: performed, Indicate the value(rounded to the nearest dollar)of all mechanical materials,equipment,labor,overhead and profit. CATEGORY OF CONSTRUCTION kcce2-Fam±14dirlk welling ❑Commercial/Industrial value: S See Page 2 for Fee Schedule ssoBuil Multi-Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE*SCHEDULE ry -R- Desert tion �gtv Fee ca. Total Master Builder Other: Heat Cooun�— _ JOB SiTE INFORMATION and LOCATION Furnace-add-on air conditioning 14.00 Job site address: lZe7c; ,. C-t.(*C"E a u u. Gas heat pump 14.00 SBld ./A t.#: __ _ Duct work 14.00 Suite#: H dronic hot waters stem 14.00 Project Name: Residential boiler Cross street/Directions to job site: for radiator or hydronic system) 14.00 Unit heaters(fuel,not electric) in wall,in-duct,suspended,etc. 14.00 Flue/vent(for anof above 10.00 Repair units 12.15 Subdivision: Lot#: Other Fuel A liances Tax ma / arcel #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 Flue vent(water heater/gas lire lace 10.00 -- -- - ---" --- Log lighter as 10.00 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 _.._-- Chirnne /;finer/flue/vent 10.00 _ 41JOPERTY OWNEW TENANT I ether: 10.00 �— Environmental Exhaust&Ventilation Name: 'I)F l.s"i,, p F%"A 4 5� f J - Range hood/other kitchen equipment 10.00 Address: iZEZc, Sv:> C-SL Pia ULL-_� Clothes dryer exhaust 10.00 (��/$tate/Zi : T C-41'R�-0 tiTZ � Single duct exhaust Phone: !-; _j 31-51 j Fax: (bathrooms,toilet compartments, APPLICANT CONTACT PERSON utilityrooms) 6.80 Attic/crawls ace fans 10.00 Name: — -- other: to.00 -- Address: __ Fuel Piping City/State/Zip'. **($5.40 for first 4.$1.00 each additional -Fu—mace,etc. " Phone: Pax: _ Gas heat pump " E-mail: Wall/suspended/unit heater r� UNTRACTOR k Water heater " Fireplace Busintss Name: !'_'� Y' r. Address: -- T ���.` Cc u-�F FCC Range 1313 " -- Cit /State/Zi ( D v( LA- _ Clc:hty dimer(gas) •r Phone: Fax: C> Other: "— Total: CCB Lic. #: -_ Mechanical Permit Fees* Authorized < Subtotal: S Signature: date:— '� Minimum Permit Fee$72.50 $ J Plan Review Fee 25%of Permit Fee S Plc a rint name) _ State Surcharge 8%of Permit Fee $ ;(( p TOTAL PERMIT FEE $ Notice: This permit application expires If a permit is not obtained within *Fele—methodology set by for exteriortnty A/t'units. ding Industry Service Board. 180 days after It has been accepted as complete. Plan ODstsTermit Fom1s\MecPermitApp.doe 01103 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 $5,001.00 to$10,000.00 $72,50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction thereof to and including$10000.00. $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and $1.54 for each additional$100.00 or fraction thereof,to and including 525,000.00. _ $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and $1.45 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,001.00 and up $742-00 for the first$50,000.00 and $1.20 for each additional$100.00 or fraction thereof. Assumed Valuations Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU,including 955 ducts&vents Furnace>100,000 BTU including ducts 1,170 &vents Floor furnace including vent 955 Susry:nded heater,wall heater or floor 955 nar.tnted heater Vent not included in appliance permit 445 pepatr units 805 <3 hp;absorb.unit, 955 to 100k BTU I _ 3-15 hp;absorb.unit, 1,700 ' 101k to 500k BTU 15.30 hp;absorb.unit,501k to I mil. 2,310 BTU _ 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU >50 hp;absorb.unit, 5,725 >1.75 mil.BTU Air handling unit to 10,000 cfm 656 Air handling unit>10,000 cfm 1,170 Non-portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 unit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit,including wood stoves, 656 inserts,etc. Gas piping 14 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL $ VALUATION., i\Dsts\11ermit Fors\MecPermitAppPg2.doc 01103 r ril 1 N s -� f % ; (D a � (D I \ o.o CD Q � � �� 3m Q • Na� Q w ? N o n U c10 -3 ,ft(pp r CL Ian-' r� rwt itit-it ----�— _- - - ---- (1). i N P y CO V, If F; y( m ^ c. 14>n ; n ` PL ➢ d i calx. •.ori Cr .. DO�rjx� .� nt �.�:Fe,." .wo�n_i� -, (,� dLp- I jl �A ffT I ` r 3 ` 1 `• a •- � 1 I `�. � � j� I � _ •fi --!� ._.. _� 2�... GAG _ _.. _ It I » t z 5 'Q (pcl I r n £ I, E i� {} ,o 7Clit. ! 11 � � I 1 r r � y 1 OLSON GROUP ARCHITECTS,A.I.A. _ DURHAM,OREGON 503820-9870 RIDGECREST/76 SUMMERLAKE HEADER OVER STAIRS Prepared by: RO Date: 320/03 BeamChek 2.2 Choice 3_1/8x 13-112 GLB 24F-V4 DFIDF — BQSE Fb s 2400 ADJ Fb m 278 Conditions Min Bearing Area R1=6.1 in' R2=5_9 iin' DL Defl 0.11 in Suggested Camber 0.17 in Data Beam Span 12.5 ft Reaction 1 3982# Reaction 1 LL 2448# Beam Wt per ft 10.25# Reaction 2 3846# Reaction 2 LL 2364# Beam Weight 128# Maximum V 3982# Max Moment 12120'# Max V(R,�duced) 3239# TL Max Defl L/240 TI-Actual Defl L/510 LL Max Defl L/360 LL Actual Defl—L/830 Attnbutes Section in' Shear in' TL Defl(in) LL Defl Actudi 94.92 42.19 ---029' 0.18 ---- _ -- Critical 52.69 22.24 0.63 0.42 Status OK OK OK OK Ratio _ 56% _ 53% 47% 43% I Fb(psi) mil) _ Fc-L(psi) _ �J Values Base Values 2400 190 1.8 650 Base Adjusted 2760 219 1.8 650 Ao a:;!m4ots Cv Volume - 1 000 —---- ----- -- _-- --- i Cd Duration 1.15 1.15 Cr Repetitive Ch Shear Stress Cm Wet Use BeamChek has automatically added the beam self-weight into the calculations Loads ----------- Par U---L—Par I_L Par Unit TL Start End 406 H=650 0 4.0 375 1 =600 4.0 12.5 i r--TF- R1 R1 =3982 -- —_ R2=3846 SPAN= 12.5 FT Uniform and r-iitial uniform loads are lbs per lineal ft - — �,,%j`,D 1860 I RALPH G.OLSON RHAM,OREGON OF 0 04/07/2003 11:59 5036254455 66— HILL ELECTRIC INC PAGE 05 `61j �. — �I�^ Electrical Permit Application Date received: _ Permirno. $TZpQj—DOIZ Clay of Tigard ProjacUeppl,no.: Espiredate; �^ Ciry of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date luuod: Illy Receipt no.: Phone: (503) 639-4171 Case(503) 599.1960 se file no,: Payment type' Land use approval: ;Newconstniction y dwelling or accessory U f'orrtrnercial1industrial U Multi-family U Tenant improvement U Addition/allrrotiororrplucrment 0 Other: i:7 Partial JZ ZQ ) /Yl� Bldg,no.: Suite no.; ITax ma tax lot/account no Lot; Block. Subdivision: - _mel Jki-k Q Project name: Description and fixation of work on prrmises: jQ' Estimated duce of cornpl(!lir)nlinspection: Job not Fee M" Business name: Description ee Tv W tw.lrtl JVew rie"W t•*[a"or aped-raspy tar Address; c _ dweltfteet.tncwdeeeeorclydt imp. City W State: ZIP: Sardeahcls". Phone '• Fa L�t/i/ E-mail: 1000 sq.It.or less u 4 — — 50019.ft or portion thereof Each iii sy reli CCB ro,. Elec.bus.He.no: Limlte0�netty,ruidenJal _2 - etro lie, no,: Urrifiedenerl -maidential _ 2 -Z-- T Each manufsciured home or modulo dwelling t re a au rvisin elex n r uirexi Data Service and/or feeder Sop,slot name(prinq f4 �fy Ucerue no! OS Services or ferder-terlalWloo, alienation or relocation: 200 rnpr or 1041 1 Name(print): 20r atapa to 400 amps -- 2 Mailing address! — ---- - 601 VMS 10 10(x1 amps 2 City: S(#te: ZIP: Over 1000 unpr or volts ._- — 2 Phone Fal: E-mail: 11ev.onnectonly - I Owner installation:The installation is being made on property I own Taorperv-y arrrIves or feeder which is nut intended for sale,lease,rent,or exchange according to insratlrodoas,sillarsdoe,orrerootion: 200 Grips or Iw 2 ORS 447,455,479,670,701, - 2U I amps to/(X1 amps 2 Owner's A nature: Date: 401 to 600 ems - J -- 2 Ilraach clicalU-new,Ateration, or echaelon per parol: Name- A Fen for branch:irctnty with purchase of Address; fer�ioe or fender fee,each branch c(;can 2 Cj(y; ZIF' - -- EF—For for branch nmrirs without purchase of service or feeder foe,nor hranch'irc(It 2 MAW Phone: Fax. E ma - - - Fxh adruJdiJobranch circuit Msec.(Snrvicr or feeder not Included): U Service nver 223 arnpr-commercial U Halth-care fecrli Each ump or ice atinn circle U service over IN amprraUns of 1 k2 G Ha:ardour Incetion PAch 11an or outline lighting _2 fami)ydweliings U Building over 100x1 s iurtre tett four or Signal circuil(s)or a linuted energy panel. O system over 601)voila nomina) nom maidenual units.n one rwciure alierauon,nrratensione — 1 O Building over three stories U feeder,400 amps or more •ptycriP tion. 0 Occupanl I,sd over 99 persona U Manufactured struc,urea or R V peh Fath tdvlitlotaal haspedlrm over the c rlowebtn hit any of the abma: O Egresa'hghtingplan O other -- Pu inspection -- -- - 9Ybor '.�sets or plead whir may of the above. Inveau anon fee The above art not applicable to t-aporia y eowetrucitoa se"Ice. Other Permit fer f Nd ail i,ndlCtioNi occeipr crwDt card.,pl a tall Notior rhes permit application O Visa U MurerCud spires if a permit is not obtained Plan review(at _— credit card numhW, .— _.__ within Igo days after it has been State sllrrharge (R"i) S swiss ."pled a c-ornplee. TOTAL . . ......S Naive e as shown an credit C s C der,lanatum nroatnt 4­'1V ti+tote M CITY OF TIGARD BUILDING PERMIT PERMIT#: BUP2004-00221 DEVELOPMENT SERVICES DATE ISSUED: 5/26/2004 13125 SW Hall Blvd., Tiqard, OR 97223 (503)639-4171 PARCEL: 1S133DA-05400 SITE ADDRESS: 12820 SW GLACIER LILY CIR SUBDIVISION: AMART SUMMERLAKE ZONING: R-7 BLOCK: LOT: 076 JURISDICTIO'C TIG REISSUE: _ FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION CLASS OF WORK: OTR FIRST: sf N: S: E: W: TYPE OF USE: SF SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 5N sf N: S: E: W: OCCUPANCY GRP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: _ _READ SETBACKS _ REQUIRED FLO-R LOAD: 40 psf LEFT:v 5 ft RGHT: 5 ft FIR SPKL: SMOK DET: DWELLING UNITS: 1 FRNT: 15 ft REAR: 15 ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 3,818.00 Remarks: New jack and replacing of old deck, 230 sq.ft. Owner: Contractor: DENNIS, STEVEN J + DANA L RIDGECREST HOMES 12820 SW GLACIER LILY CIR 6600 SW 92ND AVE TIGARD, OR 97223 210 Phone: 503-793-4766 TIGARD, OR 97223 Phone: 503-246-8808 Reg #: LIC 59228 _ FEES _ REQUIRED INSPECTIONS Descr;ptlon Date Amount Footing Insp IRl!r'PLNJ I'In Rc 5/17/2004 $53.11 Final Framing Ins Insp Inspection Jt311ILUJ 1'ermit Fee 5126/2004 $81.70 p TAXI 8%State Surcharl 5/26/2004 $6.54 1('^';'PLNI CDC Pin Re, 5/26/2004 $40.00 Total $181.35 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 wo,k is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow die rules adopted by the Oregon Utility Notification Center. Tnose rules are set forth in OAR 952-001-0910 through AR952-001-0100. You m...iy obtain a copy of these rules or direct questions to OUNC by callir 9 (503)246 6699 or,1-800-3 -2344. P mittee Sig ro: 42 — - --- Call 639-4175 by 7 p.m. for an inspection the next business day "6y 06 04 lot 22a Karl Hoffses 503_-246-3682 P. 1 11 FF� File Number C,IeanWat;rNqN Services �_ I MAY p g 2004 �y298 out commitincnt is clear, --Sensitive Area Pr -Screening Site Assessment 13y- Jurisdiction tif< -cr Date Map & Tax Lot Ownerrnni -- 4��1in4 Site A(Jdr(,Ss /16'20 Stir 6�uerJl)� 6,1 7r�..pR `123 Contact /c >✓ No Proposed Activity ��Y"W p K A ZT I0 NAddress _6 60D SL✓ 92n s� r,� c„2io Phone -” — Officja,'use only below flus line y N NA Y N NA swat r Infrastructure mnps Man 15-10 -�c-pr - Map I-_� � � � cis# _ � 6 - r� r� ❑ c ❑ © Locally adopted studies or maps F r i t I Other /� opecify - I'�� L_1 lJ Specify It A�. _ Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04-9: 1 I Sensitive areas potentially exist on site or within 200' of the site. THE APPL_ICAN T MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SFRVICF PROVIDER LETTER OR STORMWATER CONNECTION PERMIT If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they ::re subsequently discovered on your property, NO FURTHER SITE. ASSESSMENT OR SERVICE PROVIDLR LL'I 1'LR IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUF A STORMWATER CONNECTION PERMIT. I The proposed activity doe:, not meot the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS RFOUIRED. Comments: (Seri vPoN 1602 40VAL /.q&lrb ROIECT Will MO _ jr,lvlCa".._E�tsR Reviewed Dy: --- . Date: Returned ro Applirnnr llluifL k'a r C'ounfrr Date _ L//4� 1i► tie ,I 2550 SW Hill9boro Highway"HIIIEbero.Oregon 07123 Phone: (503)651 3605•Fax: (503)081 4439•www 0;nn.vutrr Building Permit Application FOR OFFICE USE ONLV City of Tigard kr Received Perntit N t 13123 SW Hall[Sheth, fDateBlgard,OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.599.1960 Date/By. Other Perrmt Inspection Llne: 503.639.4175 Date Ready/By: Jul is ® See Attached Checkliat for Internet: www.ci.tigard.or.us Notiffed/Method: Supplemental Information YPE OF WOI � REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑ New construction ❑Demolition Permit fees'are based on the value of the work performed. — -- — - -- Indicate the value(rounded to the nearest dollar)of all ❑ Additic)n/alteration/replacement ❑Other: _ equipment,materials,labor,overhead,and the profit for the CATEGORY OF COtj$TRUCTION work indicated on this application. ❑ Valuation: $ 1-and 2-family dwelling ❑Commercial/industrial --04717 ElAccessory building ❑Multi-family Number of bedrooms: it ❑Master builder ❑Other Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: A�/ �I-- - New dwelling area: square feetJob site address: CA } ✓C✓ <L City/State/ZtP: 7/ 7 72-2 3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name Covered porch area: square feet Cross street/directions to job site: Deck area: _230 23v 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 -- --- - - - -— Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no. T equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. 141 t Valuation: S Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT _ Number of stories: Name: e iirI ' , S.r,�„* �2�� -- Type of construction: Address: 12 9t 17 V '(44 e t 4, h Occupancy groups: City/State/ZIP: 7-1 E - xisting: Phone:(�(�j) .� - eJ'l Fax:( ) New: ❑ APPLICANT ONTACT PERSONAKi NOTICE Business name: All contractors and subcontractors are required to be t� —�—+ on Construction Contractors Board licensed with the Ore Contact name: —- -----_--^_ g - -- -------- under QRS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State/ZIP: applicant is exempt from licensing,the following reasons apply Phone: -- F-mail: -- s, : CONTRACTOR — --— - -- - - -- Business name f C t C� � +�---- --- -- - BUILDING PERMIT FEES Address: ': � � ,y < /� Sic Tr 1<< Please refer to fee schedule.City/State/ZIP__P_�r '72 2i? Fees due upon application 3 CCB lic.: Phone:(��) '� Vice-- SI �r Fax:( 5") .�° ,ti •: .2 Amount received_ Date received: 5j-_11 -y Authorized signature �� This permit application ex ji-"If a permit Is not obtained within 190 days after it hvs been accepted as complete. Print name: Dat ? (l + Fee methodology set by Tri-County Building Industry + - Service Board. t 13u ldina\Pernun\BUP-PermitApp doe 12103 440.4613T(111021COINWEB) it ()lie- and 'Fwo-Fandly Dwelling Building Permit ;Application Checklist FOR OFFICE USE ONLV City of'1•igard Received Date/By I Permit No.: 13125 SW Hall Ilk,Tigard,OR 97223 Associated permits Phone: 503.639.417! Fax: 503.598,1960 24-Hour Inspection Line: 503.639.4175 O Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci,tigard.or.us ❑ other 'I'IIE FOLLOWING I'I'EMS ARE r FOR PLAN R9VIEW Yes No N/A I Land use actions completed. r teria for concurrent reviews. ❑ ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc ❑ 3 Verification of approved plat/lot. ❑ ❑ 4 Fire district approval required. Name of district: 5 Septic sstem permit or authorization for remodel Existing system capacity ❑ 6 Sewer permit. -- 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application, 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- •--- basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ building codes. Lateral design details and connection., must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references betwee;i plan location and details. Plan review cannot be completed if copyrl ht violations exist. I I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property comer elevations(if there is more than a 4-11.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 El ❑ and location. 13 Floor plans. Show all dimensi,;..,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross sectlon(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,rooting,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- prescriptive path anal sis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing Ll locations. Show attic ventilation, 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 13 systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for,.11 beams and multiple joists ❑ over 10 feet long and/or any heam/joist carrying a non-uniform load. El 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. _ 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or licensed in ore on and shall be shown to be a licable to the ro act under re%tew JURISDIC1110NAL SPECIFICS ' c3 Five 5 site ons are required for Item I 1 above. Site plans must be 8-112"x t l"or I I"x li" 24 Two(2)ggls each are required for Items 16, 19,20 and 22 above. `BUilding plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. El ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of a royal. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ �J including decks,patio covers(over non-impervious surface)41diaccess ry str tures to exist*9g residential dwellings on a lot of record approved prior to September 9 1995. i`dBuilding\Permits�One-Two-FamilyChecklist doc 12'03 SEE 35MM ROLL- # 23 FOR LARGE.-. DOCUMENT CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503) 639-4171 MST BLIP Received -/� Date Requested AM PM BUP Location �� G-r1r MEC Contact Person -__ Ph( � ) -7 PLM ____-__..._._.______-- _ Contractor Ph( ) SWR _ TenanUOwner — ---- ELC __--- -FtSoting on Access: ELC Ftg Drain ELR Crawl Drain -- Slab Inspection Notes: SIT Post&Beam Shear Anchors / . �(.«c -- - - Ext Sheath/Shearda Int Sheeth/Snear min - fa - I�n Drywall Nailing - - - - Firewall --_--- - -- Fire Sprinkler Fire Alarm usp'd Ceiling - ------ - Roof Other: trAs5 PART FAIL ----- - - -- - _ ING Post 8-Beam Under Slab Rough-In Water Service -- ---- Sanitary Sewer Rain Drains ----- -_- -- Catch Basin/Manho!e Storm Drain — ---- ---- -_ — - Shower Pan Other: -- --- ---- -- --- Final ---- PASS PART FAIL — MECHANICAL Post$ Bearn Rough-In — —_ Gas Line Smoke Dampe , - --- -- -- Final PASS PART FAIT_ - ELECTRICAL - - Service - -- Rough-In UG/Slab Low Voltage Fire Alarm — Final Reinspection fee of$_— required before next ins PASS PART FAIL pection. Pay at City Hall, 13125 SW Hall Blvd. SITE ❑ Please call for reinspection RE: _ , __ Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date Inspector -��� ¢'� Inspector Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL