Permit (57) CITY OF TIGARD ,� = ` MASTER PERMIT
``` lit' ' COMMUNITY DEVELOPMENT I Permit#: MST2017-00245
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2017
' ' ' Parcel: 2S1036608200
Jurisdiction: Tigard
Site address: 12280 SW 124TH AVE
Subdivision: LAKE TERRACE Lot: PTS 9-1Q PLUS P
Project: Parker
Project Description: Construction of 484 SF carport: 11/30/17: REPRINTED to add(2)branch circuits and(2)rain
drains.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 20 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front 20
Smoke
Dwelling Units: 0 Third: 0 sf Right 5 Detectors: No
Total: 0 sf Value: $10,802.88 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0
Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains:
2 Storm Sewer: 0
Bckflw Prevntr: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group:Y Square Feet:
ADD SF VB
U 0
Owner: Contractor:
PARKER,CHERYL S J C PARKER CONSTRUCTION INC Required Items and Reports(Conditions)
12280 SW 124TH AVE 12245 SW WALNUT ST
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: 503-969-5676 PHONE: 503-547-9590
FAX:
Total Fees: $778.81
This permit is issued subject to the regulations contained in the Tigard Municipal Code, -te of OR. Special '.. odes a .— .th'ev apple able law. All work will
be done in accordance with approved plans. This permit will expire if work is not star, d within 180 days of issu-ace 'r,if wor sus ended for more the 180
days. ATTENTION Or-:.n law requires ou to follow the rules adopted by the:Oregon Utility Notification nt- . T .s- rule:' are set forth in OAR
952-001-0010 through 0 952-00 0090. Y may obtain a c py of the rules or direct ques ions to OUNC by calling 503.232.1 \. 00/3•.23,4.
.; �
Issued By: / Permitte Signature: , iral
eritif 41110
Call 503.639.4175 by 7:00 a.m.for the next a Table inspecti.,.- . e �
This permit card shall be kept in a conspicuous place on the job si a until completion of the p .je/t
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application ' „ •
ia� ��� IUR OITI( 1: ( til:U\L1
. City of Tigard �'!" Received
13125 SW Hall Blvd.,Tigard,OR 97223r.5\41
Date/BY. f /AO Penni": r
5�4 Plan Review
Related
ti��'T5
Phone: 503.7182439 Fax: 503.598.19 !!loos►► Related Permit#;
1 1 t ,,1,11 Inspection Line 503 639 4175 ReadyRDate/By:
ateB
Internet www tigard or gov y 2 '.41� y kris:
S Notified/Method:
�- J ® Sc�rage 2 for
r � 3�
_ ,/�[r Supplemental Information
`;1 �`I'-* ':°r ..,,....x Fie",'i,Z n: fe:;:,; t J @t W7'S; W.k >, ^'4 a: .s y; I:‘,' -'1,411.4*..--,
1,411.4
❑New construction �'� v � era � ,s�a �.� 11.�_ � °:`� -gym�,.�,���� y .,.�sf`
(�Addition/alteration! el • �*.�� 11:q
1 -1 V. •1'J apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other of "' ce or feeder 400 am or more
r;LQ Ps0 Building over throe stories.
where the available fault current 0 Marinas and boatyards.
r L '.4 4# ti *111 0 , :, ' t i°. '1 y1'e t•` . 11 amps at 150 volts or
❑ 1-and 2-familydwelling �,..u.� ❑Floatingbuitdings.
0 Commercial/mdustrlal , Accessory building �M \'I C� or exceeds 14,000 ❑Commercial-ase agricultural
0 Multi family 0 Master builder
0 Other: amps for auppo(tgi�stallations. buildings
y I 1`i 0 Installation of 150 KVA or
x M 9 N r;'_ .r,. ,4..p '.•l.r.,'�,��M I�Gi ,i �4 J t ,r ��fT ., C V
�* ,` k e�genc larger separately derived
Job 4: I Job site address: '2.4.J t'1 .1.¢A it oad of system.
�f ..,..„1,1,.
.��� D �or more.
City/State/ZIP: ► (�Q,/��/ t7 r- (�t?y�2 3 ❑Six or more residential units. occupancy.
Suite/bldg./apt.#' 1 !il { J ❑Health-care facilities. ❑Recreational vehicle parks.
: (Project name: Cris I po rl- ❑Hazardous locations.
0 Supply voltage for more than
Cross street/directions to job site: ❑Service or feeder 600 amps or more 600 volts nominal
.c,ro
Description ia .., $tr .r;'s�
°. �Y" I
Qty. Each l � t �'h' ''Total
Subdivision: i pU /�.ll New residential single-or multi-family dwelling unit.
1 7 •*�i zt iL-� ei ire-t elt+ Lot#: Includes attached garage.
Tax map/parcel# f� 4 / 1,000 sq.ft.or less 168.54 4
. a s 4r s 1 f` l Ea.add'1500
,i. k ids r°.� s ,,t a s ,, " ' > sf�h f rf, tai sq.ft.orportion 33.92
1
`e" * /, Limited energy,residential
- Add u�hi.- Q ( .. 0. -Pao
Cv 1 UL°�c7 (with above sq.ft.) 75.00 2
�� car pe„rt Limited energy,muaiove sq.
.*�/ _ �y V residential(with above sq.ft.) 75.00 2
-- .,°s .. ;5 . t '. ' �� x , .s. ,; r .. : i 4° 40;; Renewable Energy Cl See Page 2
Name: (. 1 rut I P�y-,v.
"�`� "` " Services or feeders installation,alteration,and/or relocation
l✓ ire.- 200 amps or less 100.70 2
Address: ZZ�� /1�{�.. 201 amps to 400 amps 133.56
�'i 2
City/State/ZIP: / Y- /fit-2,-73
-3 401 amps to 600 amps 200.34 2
Phone:
(So3) � �l�! 601 amps to 1,000 amp9 301.04 2
Q l0� - 4,160 [ Fax:( ) Over 1,000 amps or volts 552.26 2
Email: C Q� Y- oat) S/1Temporary services or feeders installation,alteration,and/or
•wner installation:This installation is being made on property that I own which is not 200 amps or less
tended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 59.36 i
/ `r 201 amps to 400 amps 125.08 2
I Owner signature: r yLU Date: 401
168.54 2
y�� 0 ��� i .,,- amps to 599 amps
,4x. e :.777.70,77,,,,,x4-474.40* y 4 i,•� 7sw r, Branch circuits-new,alteration,or extension,per panel
Business name:
A.Fee for branch circuits with
J above service or feeder fee,
Contact name: G hL�/r ( Para( each branch circuit 7.42 2
t 1 T Y B.Fee for branch circuits without ,...Q...-•
Address: service or feeder fee,first -�c.�
�• / • ,, branch circuit 56.18 J t•l y 2
City/State/ZIP: —r'�I f t 9 9 Each add'I branchcircuit
�i p'� 7.42 2
Phone:(5-03) a(p Q. s-4,7 cO 1 Fax::( ) Miscellaneous(service or feeder not included)
Email Each manufactured or modular
L c 6 vliS n• COM service and/or feeder 67.84 2
aF.. ,> 4, r F #; & d a < , rr Reconnect only 67.84 2
w '"F ".,.r. a S,"nPump or irrigation circle
/�- / 67.84 2
Business name:
L'CZ/ / Sign or outline lighting 67.84 2
Address: Signal circuit(s)orlimited-energy
panel,alteration,or extension. ❑ Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Phone:( ) Additional inspection(1 hr min) 66.25/hr
Fax:( ) Investigation(1 hr min) 90.00/hr i
Email: Industrial plant(I hr min) 78.18/hr
CCB Lic.: ElectricalInspections for which no fee is 9000/hr
Lie.: Suprv.Lie.: ,,specifically listed i4 hr mm
)'r " 3t < s,Ll v ��'
Suprv.Electrician signature,required:
Print name: Subtotal: ..Gy
Date: 0 Plan Review Required(25%of permit fee): .--
State
-•
State surcharge(12%of permit fee): -51-7-s j
uthorized signature: TOTAL PERMIT FEE: ,,671----/*--
'[.-.
r
I Print name: Gh`e' "I1 , Paileijk4r t(' Thr permit applications arbssrbe ifa permit is noto obtained within 180
I Date: rJ 1 �Z 1 t r/ � days after it has been accepted as complete.
1:\Building\Pernats\ELC_PenahApp_ELR ERE.doc Rey 06/17/2015 l t ( 1 # Number of inspections allowed per permit. I G/ �
440-4615T(11/05/COM/WEB
^7
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Plumbing Permit Applicatio 1'
BuildingFixtures
FOR FOR OFFICE USE ONEY
114 City of Tigard N(l V +� Received
13125 SW Hall Blvd.,Tigard,OR 97223 =3 �' Date/By: �f 30//7 Permit No.:�Ve/?_L
Phone: 503.718.2439 Fax: 503.5 Plan Review
tin OF /tiA R D Date/By: Other Permit No.:
T I G A R p Inspection Line: 503.639.4175 €.t�t�
g g r T , 1 Date Ready/By: Juris: El See Page 2 for
Internet: www.ti and-or. ov EJ �N� m/sotified/Method:
�rty�l rl®p�f Supplemental Information
TYPE OF WORK V1 11�� -. FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Addition/alteration/replacement 0 Other: Description Qty. Ea. I Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
]-1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITESite utilities:
INFORMATION:AND LOCATION
M.
Job site address: 1 •27-'46 C.) (lC./`kt '�U'-C� Catch basin or area drain 18.76
City/State/ZIP: t Drywell,leach line,or trench drain 18.76
�� ��� ,2;2__;::;31 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: (4 vi�( Pa y.., CGct Y�I t Manufactured home utilities
f� 50.03
Cross street/directions to job site: Manholes
18.76
Ay) G._ / 1 ,'I' Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.:
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
i.' 1.1,'''''' DESRITjONF„WORK 4 Backwater valve 12.51
/�,,� Clothes washer 25.02
-PcD,D J) C\(CL\fl 1 9 j e e r s Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' PROPIRRTY OW1 E)El _," I] TENANT= Expansion tank 12.51
Name: C, L Pa r��`r Fixture/sewer cap 25.02
Address: .2'2- 5(3
7 ('614)
P �i Floor drain/floor sink/hub 25.02
vZ5 ') I � y{-fl--Q- Garbage disposal 25.02
City/State/ZIP: "-Tito o Col L/ln 07 9
� Hose bib 25.02
Phone:(
S ) Fax ( ) Ice maker 12.51
'" AP 9LtiC T ICO} Interceptor/grease trap 25.02
.'� � � � � ;, �� 1!iCT PERSON
Business name: �--i"vla or c i-�� �, Medical gas(value:$ ) Page 2
Contact name: ►5� ' t`' Primer 12.51
U .Q4�I� %L 7: 5
Roof drain(commercial) 12.51
Address: ' Lwci
U\I L(_ -�t1A Al '5+ Sink/basin/lavatory 25.02
City/State/ZIP: • . r c/ CA !7 2,-- 5 Solar units(potable water) 62.54
Phone:( i ) 5-9 ?- w s- 6 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
-� 'i -' Water heater
Business name: �twojt� �y37.522
�s�- �a{� r Water piping/DWV 56.29
Address: I 725250 (-C'514) 1204\- �041 Other:
25.02
City/State/ZIP: Tjc 021 , (512---- C,) 9�y .3 Subtotal
Phone:(,=j o'j) (7 kf c>t 7(. Fax:( ) Minimum permit fee: $72.50 , 9O
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
Authorized signature:
State surcharge(12%of permit fee) 2 O
•
TOTAL PERMIT FEE R d'/6
\print name: ,411.1r^ Date: / /t'J This permit application expires if a permit is not obtained within 180 days
/ / T after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-Permit�pp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. fee lead Total Square Footage:,- Permit Fee: ,
Footing drain-15`100'
50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 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' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $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
Fee"fed) Total each additional$100.00 or fraction thereof,to
Qty
Other Inspections of Fees 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 charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*. .P.,„,, lan Rev ie for P'ul nbulg Innt lations -
Quantity by Fixture Type = Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate El Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" �� *,
3„ x . A Isl le`tIr'IC or ser 4i a to
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
Com/Serv/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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
CITY OF TIGARD MASTER PERMIT
Ili.....- ill
F ' .. COMMUNITY DEVELOPMENT Permit#: MST2017-00245
T[GARD[GAR13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2017
Parcel: 2S 1038608200
Jurisdiction: Tigard
Site address: 12280 SW 124TH AVE
Subdivision: LAKE TERRACE Lot: PTS 9-10, PLUS P
Project: Parker
Project Description: Construction of 484 SF carport
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 20 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors: No
Total: 0 sf Value: $10,802.88 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 1
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description:
Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB U 0
Owner: Contractor:
PARKER,CHERYL S J C PARKER CONSTRUCTION INC Required Items and Reports(Conditions)
12280 SW 124TH AVE 12245 SW WALNUT ST
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: 503-969-5676 PHONE: 503-547-9590
FAX:
Total Fees: $680.99
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of S . -.- '.ty Codes and all oth- applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started with' 180 days of is ance, or ' t ork is suspende• for more the 180
days. TION: : -gon law requires you to follow the rules adopted by the Ore••n Utility Notification . er. � -s are et forth in OAR
952- 1-0010 through OA" 952-r. .090. You may obtain a copy of the rules or direct questions •OUNC by calling 503.23-.987 or: :00.332.• .
I / . i l � �
Is ued By: `.� /�j _ Permittee Si.nature: /� ! �,�®
,..,
Call 503.639.4175 by 7:00 a.m.for the next avails• inspection date. - r�� ��
This permit card shall be kept in a conspicuous place on the job site un . • he pr,ect.
Approved plans are required on the job site at the time of each inspection.
i
Building Permit Application
Residential
City TigardCE1V Received oP
'Date/By: Permit No.: y��Q!7-00 1 S
13125 SW Hall Blvd.,Tigard,OR'9
Plan Review el
I Phone: 503.718.2439 Fax: 503.598.1 60 q 7 Date/By: �' Other Permit:
Inspection Line: 503.639.4175 �U
DI !r LU l I Date Ready/By: Juris. ® See Page 2 for
T I G A K D Notified/Method:�3 /7 / f Supplemental Information
Internet: www.tigard-or.gov CITY OF TIGARD
G DIVISIONill WA// =
TYPE REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this appy on.
Valuation: •----}'� $ -.6 -------
❑ 1-and 2-family dwelling 0 Commercial/industrial , /
Number of bedrooms: ) o 8
❑Accessory building 0 Multi-family J
❑Master builder
0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: f.3i 0! 1241/U1 i New dweller area: square feet
Ci /State/ZIP: �i' L'I'- �� 7 /carport are square feet
Suite/bldg./apt.no.: `J Project name: Fa(f I' (I t n7/-J Covered porch area: square feeCross street/directions to job site: I Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
/ Valuation: $
l (tri l° ---
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
--` Type of construction:
Name: � (�et-L) � }'�i( ��Y
Address: `/0 "51 " w" ;- Occupancy groups:
City/State/ZIP: 1-~ G CI j° f�7 > Existing:
Phone:(rjt,s5 ) (ii(E c.) . c j C-i Fax:( ) New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable): \
Address:
Total fees due upon application:
City/State/ZIP: ,c7,246-•�tL
Amount received: (
Phone:( ) Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
/ Submit two(2)sets of roof plan with connection details
Business name: C 67C T Ci}/! `j�'rv� ` )L and fire department access,along with the 2010 Oregon
Address: I(f J. 9-c9 ,, i1. ,-j J Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
City/State/ZIP: ( (-x ((-- I - T _ and administrative fees): $180.00
Phone: �A '4 r-j 5-1(„3 ... _ ) State surcharge(12%of permit fee): $21.60
CCB lic.: i 0"----; !' i: �i'' C, Total fee due upon application: $201.60
lie This permit application expires if a permit is not obtained
Authorized signature: within 180 days after it has been accepted as complete.
/ *Fee methodology set by Tri-County Building Industry
�� /
Print name: 1 l a S. Date: 2,,(t) 1 q Service Board.
I:\Building\Permits\BUP-RESPermitApp.4oc 02/24/2011 440-4613T(11/02/COM/WEB)
iN
Building Permit Application Checklist
One— and Two—Family Dwelling i.o1z oiri:i( I. I Si. ()NEN
City of Tigard Received
lig13125 SW Hall Blvd.,Tigard,OR 97223
Date/By: Permit No.:
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
T 1 G n R D 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov ❑ Other:
TILE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les yo yi:1
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ■ N
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ 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
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 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ 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 licable to the ro'ect under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17".
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.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
_1
Electrical Permit Application FOR 0141(1: 1 SE 0\l.1
Received _
City of Tigard • Date/BY: 7 (A/17 JT PPenn": �``Vj,01 7 o �1,c
- u 13125 SW Hall Blvd.,Tigard,OR 97223 E N Plan Review �"t
Phone: 503.718.2439 Fax: 503.598.19 Date/By: Related Permit#:
Inspection Line: 503.639.4175 n Ready Date/By: .roris: I H St.rage 2 for 1
I I( .1 R D Internet: www.tigard-or.gov ` t 2 1 Notified/Method. (r Supplemental Information
,OF W Ut .. ,e -y Y1l W
❑New construction C1 Addition/alteratron/I® 00191%.)‘`' Please check all that apply(submit 2 sets of plans w/items checked):
��� 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other �� where the available fault current ❑Marinas and boatyards.
. t exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial .El Accessory building less to ground or exceeds 14,000 ❑Commercial-ase agricultural
F
❑Multi-family 0 Master builder 0 Other: all other installations. buildings.
0 Fire re for pump. 0 Installation of 150 KVA or
L,. 71101: 0 ; 0 Emergency system. larger separately derived
Job#: Job site address: 1 2..../..co DA) 1' ❑Addition of new motor load of system.
I OOHP or more. ❑"A","E","1-2","I-3",
City/State/ZIP: fit ya 1 ' d o r a 7 Project name: 0 ri- 0 Hazardous Car r 2-3 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Hazardlocations. 0 Supply voltage for more than ElService or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 1/�, 11- Alk n 6.I.-,
V i
Description I Qty. 1 Each I Total I ".'•
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
N
4 WO ';,�, / . Limited energy,residential 75.00 2
-t-.
t- Md.,, U9 hf� 4 61 -Pat) v v j (t+t7 4 (with above sq.ft.)
T Limited energy,multi-family 75.00 2
New car p0 c`-.f-- residential(with above sq.ft.)
Renewable Energy
0 See Page 2
*-- RTy o h ' MW Services or feeders installation,alteration,and/or relocation
Name: f ini I P�t,r 200 amps or less 100.70 2
Address: �✓i 27,500 c l 044c.".. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: /2 el ' 6 r` '?i'-3 601 amps to 1,000 amps 301.04 2
Phone:( 5.05) a(I - S'd, 'y Co Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: G ptzc 2 4 4 J Q mch , WWI relocation
wner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
tended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: (oi e_-*--41,L) 1 Date: 401 amps to 599 amps 168.54 2
JJ Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: C.f} rt I ?a rG( B.Fee for branch circuits without
C G,} ^[� service or feeder fee,first >/
Address: \vl��0 �W f 9, " branch circuit ' 56.18 V.1 ,1 2
City/State/ZIP: ^ei I � �i '7'9,'3 Each add'I branch circuit 7.42 9 2
1 't�)l Miscellaneous(service or feeder not included)
Phone:(S03) Cj L, t $�rf(o Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email G p41 sew 6 WI 3 n• Conionn
Rec ect only 67.84 2
x .r ,;f rC . _ , . . . a Pump or irrigation circle 67.84 2
Business name: ,ih, . Sign or outline lighting 67.84 2
L����1•/ Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
ificall
90.00/hr
CCB s Lic.: Electrical Lic.: Suprv.Lic.: P� Ylisted(%x hrmm�.
Suprv.Electrician signature,required: Subtotal: )&.6 I(
Print name: Date: 0 Plan Review Required(25%of permit fee): •-
State surcharge(12%of permit fee): f
TOTAL PERMIT FEE:
uthorized signature: ?�/N` (Jr ,�in
66 This permit application expires if a permit is not obtained within 180
Print name: G�l'e rll\ SQ ( Date: 1 I 12.1 (r7 days after it has been accepted as complete.
1 * Number of inspections allowed per permit.
I:�Building�Permits�ELC PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
IN
T 1 c A R D Building Permit Review — Residential
Building Permit #: \--pyr i l'b0 at
Site Address: r2-7Z0 SW ‘2.4-TAA ME.
Project Name: Vasrk-ex iZeslckvlw Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review (1
Proposal: 642,\A) carpo rk \h ttoy1.-N' oQ• l'y x$}k'l'L Clid2I���0�
dVerify site address/suite# exists and active in permit system.
g River Terrace Neighborhood: 154 No ❑ Yes,See River Terrace Review Addendum Attached
SithPlan Elements:
ree(3)copies of site plan sting structures on site
[ 'Site plan must be on 8-1/2"x 11"or 11 x 17"paper LJ Footprint of new structure(including decks)with finished
E113rawn to scale(standard architect or engineer scale) floor elevations
florth
arrow OJtility locations&easements(required for new and additions)
address,project or subdivision name and lot number E idewalk/driveway approach
1,pplicant information(name and phone number) tJ(bLocation of wells/septic systems
I of dimensions and building setback dimensions EfExisting trees to be retained with drip line,and tree
istiliquare footage of buildings to be demolished .rotection measures
roLot area,building coverage area,percentage of coverage and Jktreet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) E Jtreet names
OProperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ❑Yes 5No
^4 foot differential) If yes,is a storm water quality facility shown? o
ID Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: I"Yes,applicant was notified ❑ No Received: E Yes ❑ No
OW Public Facilities Improvement(PFI) Permit:
Required: E Yes,applicant was notified X No Applied For: ❑ Yes ❑ No,stop intake
® Land Use Case#: N lik
ErZoning: 12--y �j
Lod ,Required Setbacks: Front Rear )t) Side 5 Street Side 15 Garage 20
III, Landscape Requirement: 0/0
On Lot Coverage Maximum: % Cof a gory 14144
CI Building Height: Maximum Height is Actual Height 12 A I C"
OhVisual Clearance
Er Sensitive Lands: ErYes ❑ No Type C ne\dei`-- Y`Qar oP
a(8 Urban Forestry Plan S Ca,-42 cvy 41'0+1 Q,f ros °.ci o0e1¢)
130 Conditions "Met"priorto issuancce�oflbuilding pe t nhV.t
Notes: U-Wiltaco,:kolls 1-v p£'.. C cah11YYl/Ipci
Approved By Planning: � p/ Date: (P P24// (7
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\BldgPemritRvw RES_061417.docx
Building Permit Submittal
Original Submittal Date: 67.0// 7
Site Plans: # 3
Building Plans: # 3
Building Permit#: .2—Enter building permit#above.
Workflow Routing: []'Planning f a'ngineering Permit Coordinator L2 Building
Workflow Sign-off: Cil"Sign-off for Planning(include notes from planning review)
Route Application Documents: 0'En ' eering: (1) copy of permit application, (1) site plan, (1) building plan and
vuiriginal plan review routing form.
Blding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: , ;� Date:
Engineering Review
lope at building pad: 3 Le
C /Conditions "Met"prior to issuance of building permit
R Easements (encroachments)per engineering conditions of approval and plat
+2—Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [2'No
Assess Water Quantity Fee in-lieu: ❑ Yes [No
LIDA Facility on lot: ❑ Yes ❑''No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: , 1.n _ Date: & - Z B —1 —7
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
pproved,NOT Released: II at:•i
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:
r SDC Fees Entered: Wash Co Trans Dev Tax: 7 es ❑ N/A
Tigard Trans SDC: . Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes XN/A
OK to Issue Permit
/�/
/Approved by Permit Coordinator: Date: C9/"
I:\Building\Forms\B1dgPermitRvw_RES_061417.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12280 SW 124TH AVE, TIGARD, OR, 97223 January 8, 2018 at
1 :39:39 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00245
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Picture provided for rough in Inspection.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12280 SW 124TH AVE, TIGARD, OR, 97223 January 8, 2018 at
1 :38:18 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00245
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12280 SW 124TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2017-00245
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Picture provided for rough in Inspection.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12280 SW 124TH AVE, TIGARD, OR, 97223 January 8, 2018 at
1 :40:59 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00245
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Protect non pt or decay resistant wood exposed to the weather. R317.1 (5),
R317.1 .3, R317.1 .5
Violation Summary:
Inspector Contractor