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Permit • City of Tigard • CC)i\t\ILNI'I'Y DEVELOPMENT DEPARTMENT RECEIVED Request for Permit Action FEB 14 2018 TIGARD 13125 SW: I fall Blvd. • Tigard, Oregon 97223 • 503.718 2439 • wwti ;1t cl.( :(j - TIGARD 3UILD w OlSON TO: CITY OF TIGARD ;Biding Division 13125 SW I tall Blvd.,Tigard,OR 97223 Motu:": 503--718-24.39 I x 03-598-I 960 'I'igard$uildingPermits rt tigarcl-or.gov FROM: ❑ Owner Applicant ❑ Contractor ❑ City Staff (Away)"lie REFUND OR Name: INVOICE TO: o's"w"or lndicidu:dj /reitt 7 Mailing Address: /605---$4 /r efoe,, / etve. City/State/Zip: T?)af_Dr 97?2'/ Phone No.: a � � l 3037 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): (� CANCi?I./VOID IThRMIT APPLICATION. ❑ Rl:l I N1) PI,R\111' 1:1'.1;,S (attach copy of original receipt and provide explanation below). ❑ 1NVOIC1, FOR I I.1',S [)V i, (attach case fee schedule and provide explanation below). ❑ RI.,MOVI:./R1.,Pi,,\Ci�.Ct.)N•1•RA(:'I'OR ON PERMIT(do not cancel permit). Permit 445T2v0/7— — �— -- —�� Site Address or Parcel #: l 5-57 J 161Gtc/L°4,/ Ct ke--- Project Name: Subdivision Name: CA Q K Ct Lot #: EXPLANATION: add NC(t C 1 QM r'.7 11€i C 1.(cv/>S OVA -) Zj Signature: 4,0 Date: —!t1 / Print Name: 'p tr/L l2L f iuxl.i i 1 cy I. 'I'hc cin-'s(:omnwnio-Dcrelopment Director,Building()frtcial or(:in I:v6:leer may authorize that refund of: • Any to:which was erroneously paid or collected. • Nor marc than HO of his aq,plicarioo or jinn 111-47W air when:in Application is withdrawn or c';(nccied before rcl7ew c(torr has been exlu•nded. • Nrnr I1101T than -1 tiff ht.apphcatinn or Pe-rmit for f,r issued hermits print tit;air inyu•cricm requests. 2. .19.1 refunds will be returned to the original haver in the form of a check viii t'S postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Srs;\drain: Date li\ Route to Records: Date lir Refund Processed: Date liv- Invoice Processed: Date Dv Permit Canceled: Date I Hv [ Parcel'Jag Added: Date ): Ruikling':Pnruts\Rcyl'cnuitAeti.n (>92>1-1 di CITY OF TIGARD MASTER PERMIT Permit#: MST2017-00328 a .' COMMUNITY DEVELOPMENT ,, , IP' ..q', Date Issued: 08/31/2017 -t-tGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 114BA09200 /d("1'7— Jurisdiction: Tigard Site address: 16585 SW WOODCREST AVE Subdivision: COPPER CREEK STAGE 2 Lot: 45 Project: McKnight Project Description: Kitchen remodel. 2/14/18: REPRINTED permit to add(5)branch circuits. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Total: 0 sf Value: $67,500.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 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: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 3 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 addl 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 9 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: ALT SF VB R-3 0 Owner: Contractor: MCKNIGHT,ROBIN L OWNER Required Items and Reports(Conditions) 16585 SW WOODCREST AVE TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $1,966.27 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 -s are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain ales or direct questions to OUNC by calling 503.232.1987 or 1.88% 44. Issued By: r.f.. •- mittee Signature: _.;;:--> aar, * r. 5 639.4175 by 7:00 a.m.for the next avai •le insp cin*date. ////... This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application - FOR OFFICE USE ONLY City of Tigard ccts,t Rcccivell Dal oily: Pernut q: .11111 -" 13125 SW!hill Blvd..Tigard.OR ' 1 ,V21,k: Man Review 1 r I . Phone: :50.1.7IS.2439 Fox: 503.5 ,. I/mealy Related Permit Inspection Linc: 503,639.4175 ' ie 1., 10(6 Ready Daioliy: , hills: 1 EI See Page 2 fur I TIGARD nternet: www.tigard-or.gov Notified Method: L Supplemental Information TYPE OF \VOL. . , • Vai r,c ri"kit j A. PLAN REVIEW , ...LEINew construction 0 AdditioniatteratipktiftWerrt 1,.M. 015' - Please check all Mao apply(submit 2 sets of plans witcsus checked): • 0.Si cc or feeder 4(0:imps or more 0 Building over three storics. 0 Demolition E Oher: ":i4t rkCi where the available faith current 0 Marinas:Ind twiny:ink CATEGORY OF CO110_ N exceeds 10.1100 amps at 150 volts or 0 Floating buildings. less to ground.or CNCO:dS I,1000 0 COMM iii•use agricolln ra I D i-:Ind 2-family dwelling 0 Conmiercialiini ustrial E Acceziserv-bt ;ili amps Mr all other installations. hoildings Li Multi-family 0 Master builder 0 Fire pump. 0 Installation a 150 KVA ot JOB SITE INFORMATION AND LOC '.:Le:,s_ 4 .14 it 0 limergency system. larger separately derived system. Job(4: Job site address: tp5-9c 5a7760- ' --ores ve 0 AddIition of 110.‘al,Aor loid of I MI)1'or more. 0 ii-.-I-2 .-I-3-. C it y'StateIZIP: r 1-60. ,, , or 9?2i1 - a Six or more resident ialtOlitS. occupancy. 0 Recreational vehicle parks. 0 I lcalth-care facilities, Suite:bldg./apt.ii: 1 Project name: 0 Iliwardaus lOcaliOOS. 0 Simply voltage for more than 0 Service or feeder 600 amps or 7110re. (")vPlis""min"li - Cross strectidirect ions to job site: oz,,-1/e(14700C FEE SCHEDULE F-- inscription . ;17-F- FT)i -1 1'nt al I ^ New residential single-or multi-family dwelling unit. Subdivision: (Ave,- ci-N.k. 1 Lot m Lis- 1 Includes attached garage._ 105)sq.ft.or less ] 165.54 I 1 4- 'Tax map/parcel#: EEla.adt500 sq.11.or portion 33.92 I I I DESCRIPTION OF WORK Limited energy.residential 75.00 I A edn0.40 : 4714)I ,/N 1 -,i"'CAA i limited energy.multi-family residential(with above sq.Ft) 75.00 i , , Renewahle Energy 0 See Page 2 r ..% PROPERTY OWNER ED TENANT Services or feeders installation.alteration,and/or relocation Name: /Wit 1.) /176k1:047---- L200 amps or kiss r 100.70 2 - .------ Address: 4--gc 5‘174,4-Vef5/aig--• 201 ampsamps , 133.56 2 -- 40 I amps to 600 amps 200.34 1 City/State/ZIP: 7-_0.arrt, C1 0 imps to I mix)amps 301.04 2 Phone:(1)(:)1) 310-334-0 { as ( ) Over 1.000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: rviCKNIgriii. CatoitiCtt4/, /Kri---- relocation _ Owner installation:This installation is being made on properly that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449.670,and 701. rio I amps to 400 amps 125.08 2 Owner signalure: Date:..__ .... 401 amps Co 599 amps 168.54 2 Branch circuits-new,alteration,or c tension, ter panel !HYPPLICANT 1 0 CONTACT PERSON A.Fee lig-branch circuits with Business name: abuse Service Or litter 1'40, each branch circuit 7. 2 2 t-,- Contact'mine: j v57--(0) 131(1,* 13.Fee for branch circuits without service or leeder tee,first Address: ii,3---6 -- 5//WaytCreetc I branch ciam2 il 56.15 _ - Cit;aStatel.ZIP: nybret 0r q714 _ 01,AEach arld'I branch circuit ,..,. 7.42 1:57.ii; 2 - Miscellaneous(service or feeder not included)_ - ,,, 3 j. ..rA, Phone:(1065) .r- 7 ::(z039 Fax _iI Each mamiliictured or modular 67.54 f 2 --_-..---i•- divelline,service and•or feeder Email:fiKenil/ r Cainkij t trie/' Reconnect only 67.84 I • --- CONTRACTOR _ jump or irrigation ci.rele_______ _____.,_67,54, _ _ .2 ----------- Business name: Vi-'jI „{:: i 1.,•:- !,•,, ,-- Sign or outline lighting 67.54 I _ tt ..,.i'N i E t .,4 i ..._. ...- ' - Signal cirettiqs)dr Mulled-energy Address: f f:::7-7 )„,.. ,,,,„ ,, ,,._ ..Q,/,.. ,,,, ,.., ,...;.: ,„,, :; , ,, panel.alteration,or eXtellS11111. - CI See Paw 2 L ..)...LL.11! .,.. .L .i.24, 211_ ,;,..„, L,-.E.L.',._-_ ;'__Lfir L_4. L--. __ ,; Each additional inspection over allowable in any of the aim,e,_ City/State/ZIP: / ,, .,-„-) ,, ,,,,, ., ,,,-,,,,-..- ,',,T..2 ___ . ......_........__ LI.A..,-.4:2_.- __1,-,,/,:ft1.11 ....,,,.......!i2,1.-:,,,__........_.___,........______________________ [Additional insocciion(1 lir min) 66.25/hr Phone:( yl) !.,-,',24-1. , ,:,,,j. i 2 ,,• -- Fax:(:-.:(i•,-, ) ',',•: ,•-•, . /; , Investigation LI hr loin) 90.00;hr s.., t•,,:) .,,,,„, 4..L', i " ' - Industrial plant II hr nun) 78.1g;hr Email: 1)1 0,1 .'"-J..-q ,,e'.,-; r,f i .f-(..., ,,..'.-- ,. .,1 O's '• /,..,,, 3 It . - ,-t,' , Inspectitms for which no Ice is . / ' 911(51.'hr CCB Lie.: 1(..1"):1:2, i Electrical Lie.: /1 /";/i' , A, ,.tic.: '.-.7,,i,j'---::. specifically listed l',• hr ilk) i :,-• 1 .,... iELECTRICAL PERMIT FEES gr, __ „________ Suprv.Electrician signature,required: Aprf, Sublotal: 1-)i G Print name: ?,,..,'7 7',, --:.,. l ),:`• f,•? ,, I Date: ',/,..,,,/r:',.1 f A D Plan Review Required(25%of permit fee): V 61 Y i v' ,,-f' ;$1-' 0 , a,-- . -' State surcharge(trii of permit feel: L, _-____ Atli horized signature: ll d / TOTAL PERMIT FEE: 14 a 4.."rd 1 i..) --,--- ---r_ -7 This permit application es:FM.4.1;if a permit is not obtained within 150 . 1 Pratt nime- ,,,t , . .1 ,; i , f Ir. , ,„ Date: ;70 r.,,i, ? t,c?' tins s after it has been accepted as c.implete. . ' i lt4. ..iz--i-,f.. r vi /44,44,2,./Q' . ,, , . ! ,r, I i ._,...i i ..., .7 - . Number of inspections allowed per permit. I holding l'crm its LLC_PininitApp_1.1.1412r.doc Ito.(16 17 2115 441545151111 0.5 ON1rWLII CITY OF TIGARD MASTER PERMIT 111 all ' COMMUNITY DEVELOPMENT Permit#: MST2017-00328 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2017 Parcel: 2S 114BA09200 Jurisdiction: Tigard Site address: 16585 SW WOODCREST AVE Subdivision: COPPER CREEK STAGE 2 Lot: 45 Project: McKnight Project Description: Kitchen remodel. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Total: 0 sf Value: $67,500.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Drains: 0 Water Lines: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 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: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 3 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: 4 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: ALT SF VB R-3 0 Owner: Contractor: MCKNIGHT,ROBIN L OWNER Required Items and Reports(Conditions) 16585 SW WOODCREST AVE TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $1,924.72 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 thro . OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1:• /2344. Issued By �ZC.J�f' Permittee Signature: ,000. —� "�/100 .--- Call Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the Pr- ect. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential ,� City of Tigard CLI Received �/ ^^ ^� b i(®1 �7 Permit No.:M0j/I6/7--.640.6.2-S, 41 13125 SW Hall Blvd.,Tigard,OR 9722 Date/By. np� Phone: 503.718.2439 Fax: 503.598.1 G 2 2 2017 Plan Review ��.. T i G A K D Inspection Line: 503.639.4175 III Date/By: '�g- �� Other Permit: �qry� Date Ready/By: kris' ® See Page 2 for Internet www.tigard-or.gov CI t I ® pry Notified Me hod:lr/f��,/j7 / `' I Supplemental Information tJILDING nivisioN I / -6T"'` TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING 0 New construction 0 Demolition Permit fees*are based on the value of the work performed. Addition/alteration/replacement 0 Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. -and 2-family dwelling 0 Commercial/industrial Valuation: $ /Z c&c. ❑Accessory building 0 Multi-family Number of bedrooms: 3 12 Master builder 0 Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 3 Job site address:/65- ' SG,/ G'!!(JC ..-eq .u i New dwelling area: square feet City/State/ZIP: �,,-,,,,d, -e). f/ 77?), `1 Garage/carport area: square feet Suite/bldg./apt.no.: I Project name: mn� /`l�� 7 pCovered porch area: square feet Cross street/directions to job site: d Deck area: c4t19square feet Aii/ W0,61/ Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Co,�p j/C� I Lot no.: fees* /""" � Permit are based on the value of the work performed. Tax map/parcel no.: 0/6-1/ Li a,4 a?a 00 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. k �t T 1 e i12 n- rg, / Valuation: $ ( Existing building area: square feet , / New building area: square feet ,{a 1 OPERT��Y OWNER I ' 0 TENANT Number of stories: Name: R d t7t I1 y�t Gk>,%p`j� '_ Type of construction: Address: C- " oo Gv 1 S �7 S� w � HQ�l/Gli 'ems Occupancy groups: City/State/ZIP: 7 y wrd... C K q?,-pl-y Existing: Phone:(S--03) Sies_. 3 3 5O Fax:( ) New: 0 APPLICANT NI'ACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name: �5/r 1 pratlx Address: 165"6-6` sieGw FLS plan review fee(if applicable): vn Gi^�v�. City/State/ZIP: Tiro 4..r. N f — K 9'2 AA Total fees due upon application: Phone:(5 j) 3*LL'-'3l D t i I Fax: ( () Amount received: �lQ� ,.2 V E-mail:Acio/'dt/ix �,, Com .� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of � 1 roof-top ounted Photo Voltaic Solar Panel Syste Business name: 6,60/�.J E' gr>aJrIJ He_KA*, � Submit tw; sets of roof plan with connect'* details � Address: and fire depa :it access,along with , 010 Oregon Solar Installation Sp-.'#lty Code c r- ist. City/State/ZIP: Permit Fee(includes review I $180.00 admi i' ative' $180.00 Phone:( ) Fax:( ) State surcha , 12%of permit fee): $21.60 CCB lic.: Total fee due upon application: _11.60 Authorized signature: This permit application expires if a permit is not obtaine. T within 180 days after it has been accepted as complete. I Print name:(/Vt5r ® V d I Date: g"�1? I * methodology set byTri-Conn BuildingIndustry /� Fee Tri-County Service Board. I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) r Building Permit Application Checklist One- and Two-Family Dwelling roR orrice: t si: 011.1 . City of Tigard Received Permit No.: Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: ■ Phone: 503.718.2439 Fax: 503.598.1960 ❑ Electrical 0 Plumbing 0 Mechanical T I c A R D 24-Hour Inspection Line: 503.639.4175 Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0M IN MI 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. 4 Fire district approval required. Name of district: • 0 00 00 5 Septic system permit or authorization for remodel. Existing system capacity0❑ 0 0 6 Sewer permit. 0 0 0 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0 basin pr. -ction,etc. 10 3 Com'lete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state e/ ❑ 0 buil.'•• codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size s eet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 .ite/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 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 •dicator;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 size0 0 0 and location. 0 0 0 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 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. 0 0 0 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. f/Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. t Full-size sheet addendums showing foundation elevations with cross references are acceptable. 0 0 0 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. 0 0 0 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 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. 0 ❑ 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 for four or more appliances. 0 0 0 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Ore•on and shall be shown to be a,•licable to the ,ro'ect under review. JURISDICTIONAL SPECIFICS Ns ee 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 T. • ets each are required for Items 16, 19,20 and 22 above. 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. 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 CI 0 and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0 0 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 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) Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received Date/By: Permit No.:11 r ).,,,:g 13125 SW Hall Blvd.,Tigard,OR 97 i _ Phone: 503.718.2439 Fax: 503.598. Plan Review Date/By: Other Permit: TI G A K D Inspection Line: 503.639.4175 Date Read/B aur s: Internet: www.tigard-or.gov n t 2 ?_017 Ready/By: Supplemental See Page 2 for i���Tri Ur� 2 [01 7 Notified/Method: Information TYPE OF V�ORKY OF" /IL't41 COMMERCIAL FEE* SCHEDULE USE CHECKLIST 1�...{{'t !� LNC finis 0l�� 0 New construction ddition/altefdt on replacement Mechanical permitdicthe*are based on to theue of the work performed.Indicate value(rounded to nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ,g]-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder ❑Other: Description P Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating cooling: �4��/ N/ �� / Air conditioning 46.75 Job site address: (jare ehf Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 27.90,-0(7 Oc g2?-ox/r Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name:414241:0Heat pump 61.06 ,4, Duct work 23.32 Cross street/directions to job site: A iv`�NG Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: C00/60KCreekLot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: aci l itB 0/01 D0 Water heater 23.32 DESCRIP f ON a F WORK Gas l /nsertJ 33.39 3 33? Flue ventfirepace i for water heater or gas pp p ki?Ghl�n /' 142104 f fireplace t 23.32 a3.31 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 `` ;J'RPERtTYt R ; Other: 1�n ©;,T IAN'Y Wit. '. ;,.6,,,, 23.32 Environmental exhaust and ventilation: Name: io b I 4,2,,,,k74/` Range hood/other kitchen / r.5 ------ Address: equipment 1 33.39 33.' �"S dCr'le4sl �q..... Clothes dryer exhaust 33.39 City/State/ZIP: 1' ,W Or' q7 t j Single-duct exhaust(bathrooms, , toilet compartments,utility rooms) 23.32 Phone:(5-) ) 3 ( y 3'�v Fax:( ) Attic/crawlspace fans 23.32 46,,,,1„,I APP' IC 1: C ONTACT PERSON %,:' Other: 23.32 Fuel piping: Business name: /�- $14.15 for first four;$4.03 for each additional Contact name: J Atll f pt7 �„(jlFurnace,etc. Address: /6c6 r V�/e„,,,,,,..„47---i,,. Gas heat pump City/State/ZIP: 2--,:,,,,,e,-ac vd, y Water heater d/unitheater tTo+ Water heater Phone:(5-03) 319.-3t Fax::( ) Fireplace I I h/./5— Range zl,(S Email: �arov q__. Com J lei- age I y./S I '� th Barbecue ' Oi A,.... r,. Clothes dryer(gas) C Business name: D v 1 E /� Other: / vt, ` " MECH)I aL 1*Vn TS4'FE Address: Subtotal 13a* 4 City/State/ZIP: Minimum permit fee($90.00) Phone: Plan review(25%of permit fee) 33 4 ( ) Fax:( ) State surcharge(12%of permit fee) (, .4 CCB lie.: TOTAL PERMIT FEE 1 i 4* This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: J prey/A, Date: 11 I:\Building\Penniis\MEc_PernitApp_0401I3.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for eachacditional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1:\Building\Permits\MECPermitApp_040113.doc 2 Electrical Permit Application I � 1.0R01hlc I. I. oil City of Tigard Received r , a ^ 063�� . 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 2 2017 Date/B : Permit#: V I Pk Phone: 503.718.2439 Fax: 503.598.19 Plan Review Date/B : Related Permit#: Inspection Line: 503.639.4175 o TY OF T1 ,ARL ReadyDate/By: I3 See Page 2 for I I G n R D Juris: Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction Iddition/alteration/r lacement Please check all that apply ep pp y(submit 2 sets of plans w/items checked): 0 Demolition Qth� ❑Service or feeder 400 amps or more ❑Building over three stories. CATEGORY OF CONSTRUCTION, where the available fault current 0 Marinas and boatyards. exceeds 10,000 amps at 150 volts or 0 Floating buildings. and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural 0 Multi-familyamps for all other installations. buildings. ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: /4 ��l� ��/ �'' 0 Addition of new motor load of system. r/ y wood100HP or more. 0"A","E","1-2","1-3", City/State/ZIP: e--, 4 ,�� ��/ q72-9.41 ❑Six or more residential units. occupancy. �, 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: hi,h> ❑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: Ai k j FEE SCHEDULE Description IQty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: o �r�'`8 ei/1 Lot#: Includes attached garage. Tax map/parcel#: AS-1115 Aoci�D 1,000 sq.ft.or less 168.54 4 DESCRIPTION`' OF WORK Ea.add'l 500 sq.ft.or portion 33.92 1 ki��,,,,// Limited energy,residential 75.00 2 LA C/, / /A (with above sq.ft.) "y Limited energy,multi-family residential(with above sq.ft.) 75.00 2 PROPERTY OWNER I 0 TENANT Renewable Energy ❑ See Page 2 �� /-.� Services or feeders installation,alteration,and/or relocation Name: /�ob�Ah 4t/dc /3/ ' 200 amps or less 100.70 2 Address: /6 5—A 5(,e/ O e �G, 201 amps to 400 amps 133.56 2 T j G�11,�` b? 2 T!� � 401 amps to 600 amps 200.34 2 City/State/ZIP: (/t/ 7 601 amps to 1,000 amps 301.04 2 Phone:(5 3 V/�— 3 3 co Fax:( ) Over 1,000 amps or volts 552.26 2 Email:ARA lce 1-�j�'60 G 4,61-:,„,67-- relocation J ,) Temporary services or feeders installation,alteration,and/or /1f r 9•'sjt/ relocation Owner installatl n:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 APPLICANT CONTACT PERSON Branch circuits new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, f 7.42 2 Contact name:vjia,�,,1y, B.Feeeach forbranbchranchcircuit circuits without Address:G4 7'5 W l(/q r, service or feeder fee,first 5-6,/�� branch circuit 56.18 fr(j 2 City/State/ZIP: ir �v�©r 97 1AEach add'1 branch circuit 3 7.42 2 Phone:(9,3) J?3) q?-. CJ O��� Fes: :( ) Miscellaneous(service or feeder not included) ` Each manufactured or modular �LLp7 j &i�� cr, n� Recdweonnect serviceonland/or feeder 67.84 2 Email: /_ t�fUj� Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Q,A ,�v C\GT Sign or outline lighting 67.84 2 Address: (t ' Signal circuit(s)or limited-energy panel,alteration,or extension. 0 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 CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(/hr min) 90.00/hr Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES Subtotal: t:" !! '(��� Print name: Date: 0 Plan Review Required(25%of permit fee): ✓✓j(*[,/gill State surcharge(12%of permit fee): �' Authorized signature: TOTAL PERMIT FEE: 6 /6 /��,�J This permit application expires if a permit is not obtained within 180 Print name: J V-//Q/Yi Prd v f� `✓k. Date:67-9.X-17 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\BuildingTermits\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 1. 1. Description I Qty Each Total 1 * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 5.01 to 15 kva 133.56 2 J 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 I-1 G• arage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) n H• eating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 >100 kva—no additional charge 0.0 3 ❑ Vacuum Systems* 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('h hr min) ,Q ELECTRICAL PERMIT FE COMMERCIAL WORK 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 ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 Plumbing Permit Application Building FixturesRE ,EI ED FOR OFFICE USE oI,v City of Tigard Received , ■ ' Date/By: Permit No.: ��'�17 OO 3 S 13125 SW Hall Blvd.,Tigard,OR 97223 C Phone: 503.718.2439 Fax: 503.598.19 U G 2 2 2017 Plan Review Date/By: Other Permit No.: T 1 G A R D Inspection Line: 503.639.4175 Internet: www.tigard-or.gov CITY OF TIGARD Date Ready/By: Juris: See Page 2 for n Notified/Method: Supplemental Information TYPE OF WE1��LDINb� DIVISION FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description Qty. I Ea. I Total ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 X.1-and 2-family dwelling 0 Comercial/industrial SFR(2)bath 437.78 m IDAccessory building 0 Multi-family SFR(3)bath 500.32 0 Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:/44'56- 5/17 /o(y / a4.e_ Catch basin or area drain 18.76 City/State/ZIP: 777' � 0/ ( ?�A i,�t Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Ac>+/ "'!1,94/. Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 A;vet-- Ikettetz Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Subdivision: ',OK-Creek- Waterservice(no.linear ft.: ) Page 2 Lot no.: Fixture or item: Tax map/parcel no.:p�5-1/to v.0 q &o(f Backflow preventer 31.27 x' ,DESCRIPTION OF WOI Backwater valve 12.51 ,, Clothes washer *- A J // 25.02 Dishwasher 1 25.02 a s©), Drinking fountain 25.02 Ejectors/sump 25.02 ;ate QPR' OW `NER . . PNT x Expansion tank 12.51 Name: 6`n file,k '� Fixture/sewer cap 25.02 Address:lb cis 5V u/�� -eaG7 Floor ewdre- Garbage disposalosink/hub 25.02 City/State/ZIP: �� Q (,�/ Garbage I 25.02 A ,Da ' y 7 Hose bib 25.02 Phone: 5' 3 30"- ( ) Lj0 Fax:( ) Ice maker i 12.51 1 a 4 4 tp A PP1t C `' '' s" N G O� Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Contact name: .71V5-1-407 PcOv/x Primer 12.51 Address:/k 8"5 W' ��,/ re� � Roof drain(commercial) 12.51 6 �'i/ asin/lavatory ( 25.02 g,6;64. City/State/ZIP:reet,fo( .' ©c 9??...111 olar units(potable water) 62.54 Phone:(97 ) I qto?? Z Fax::( ) Tub/shower/shower pan 12.51 / ✓ Urinal QtCome�/ .rpt 25.02 E-mail: OV((l Water closet ;r b .: i CONTRACTOR, "4. „ 4 ` ... 25.02 , \c S s Water heater 37.52 Business name: 0 10Imo-'C Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 4-7 Minimum permit fee: $72.50 Phone:( ) Fax:( ) Plan CCB Lic.: review (25%of permit fee) Plumbing Lie,no.: a 1.6 State surcharge(12%of permit fee) !O'er Authorized signature: TOTAL PERMIT FEE ii Qo Q� Print name: J / Prvvdc 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.doe 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(ea) Total Square Footage: Permit Fee: Footing drain-1'100' 50.03 0 to 2,000 $121.90 2,001 to 3,600 $169.69 Footing drain-each additional 100' 37.52 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 Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Feesand 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$50,060.00 $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. 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 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*. Plan ReView foi-Plumbing fnstallatiops r.=. Quantity by Fixture Type Plan review is required for any of the following. *Fixture Type for Replace/ Please check all that apply. Capped Added Relocate Work Performed: ❑ 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" '" Isometric pr'., ,Ser > gll a 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 4 -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 • RECEIVED AUG 3 1 2017 information Notice to Owners About crryOF �I t ti BUILDING DIVISION Construction Responsibilities c's (ORS 701.325 (3)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure,can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer. and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more nformation, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of ail employees. For more information. call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN. call 503-945-8091 or go to t..; for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for ail claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503-947-7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Faderal EIN number, call the IRS at 1-800-829-4933 or visit their website at ,f ,__,, ,c..� Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions. such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD 0C,S r mer S;NE S,;,;e 3U) PC Bea '4140 Sale-, OR 97309-5052 e rr. r'e 5 -5.462' _Fax 503-373.230' Acr res><. ,','property ri v, r accrue o s,R Tion Copy or Pei rna Ap licdr;t Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate ncx- I own, reside in, or{sril` reside in the completed structure and my general contractor is Na;ne � --- -------- CCB> Expirat:an Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in. or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. if I change my mind and hire a general contractor, I will select a contractor who is licensed with the COB and will immediately Give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. i Print Name of Permit App;cant stn f Signa ureal PermilApilyca •' Date Permit*: /`1S-7-. 7/7 —CO3t7 Address /k ..re41L)e )C'4 Issued ay: ,<*74"--_ Dote: Cl/ i// Tttis Copy for i-ermlt Offices City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 16585 SW WOODCREST AVE, TIGARD, January 8, 2019 at 9:47:23 AM OR, 97224 Record Type: Record ID: Residential - Master Permit MST2017-00328 Inspection Type: Inspector: 399 Plumbing final David Young Result: PASS Comments: Note: backsplash at kitchen sink not complete at this time. To be installed and checked at building final inspection. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 16585 SW WOODCREST AVE, TIGARD, January 8, 2019 at 9:40:38 AM OR, 97224 Record Type: Record ID: Residential - Master Permit MST2017-00328 Inspection Type: Inspector: 699 Mechanical 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: 16585 SW WOODCREST AVE, TIGARD, January 8, 2019 at 9:41 :53 AM OR, 97224 Record Type: Record ID: Residential - Master Permit MST2017-00328 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Electrical final for ELR 2018-00023 to be approved prior to building final. Violation Summary: Inspector Contractor City of Tigard Tel: 503.718.2439 Location: Inspection Date: 16585 SW WOODCREST AVE, TIGARD, July 24, 2019 at 9:04:18 AM OR, 97224 Record Type: Record ID: Residential - Master Permit MST2017-00328 Inspection Type: Inspector: 299 Final inspection Jeremy Burrows Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor