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Permit (2) CITY OF TIGARD MASTER PERMIT a. . COMMUNITY DEVELOPMENT Permit#: MST2019-00383 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2019 T[ .,1 R D 9 Parcel: 1S134AD01900 Jurisdiction: Tigard Site address: 11369 SW LAKEWOOD CT Subdivision: ENGLEWOOD Lot: 59 Project: MCKENZIE Project Description: Small bonus room addition to be used as home office space. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First 104 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 12 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Total: 104 sf Value: $12,735.84 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 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 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: 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 asin N Other: N Other Description: Ecom p g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 104 Owner: Contractor: MCKENZIE,ELIZABETH&SHANE RICHARD PARKER CONTRACTOR LLC Required Items and Reports(Conditions) 11369 SW LAKEWOOD CT 6944 SE EILEEN LANE TIGARD,OR 97223 HILLSBORO,OR 97123 PHONE: 503-462-4550 PHONE: 503-347-7087 FAX: Total Fees: $840.48 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 lawrequires ou to folio the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through O x:,3:52-001 :090. may obtai, co. of the rules or direct questions to OUNC by calling 503.232. X87 or 1.800.332.2344. I Issued By: / � Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Builcipg Permit Application R'L i eritlalPI—I. . i OR 0141( I l SI o\l.l City of Tigard Received ecti B a 5' �Q l`7 iI P ''�Td�UI�—UGc3�� 13125 SW Hall Blvd.,Tigard,OR 97223 SE P 2019 Plan Review J a i :IN I Phone: 503.718.2439 Fax: 503.598.1960//, r q Date/By: 0 Other Permit: T 1 G A R D Inspection Line: 503.639.4175 V 1TY O p t AR Date Ready/By: / 1� ® See Page 2 for Internet: www.tigard-oi.gov1 1II)!, N "" �9�R s f» otified/Me .:d: ( ���� Supplemental Information ,,1 ,f. sil - / . TYPE OF WORK R QUIRED 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 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overh and the profit for the CATEGORY OF CONSTRUCTION work indicated on this applicationR 73s-„ pi 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ ❑Accessory building 0 Multi-family Number of bedrooms: 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: _ h Job site address: 113 b 9 S� LA _ �� `pia New dwelling area: (O square feet City/State/ZIP: 71 f O f °11-2.2 3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: on '} iSIIS 1e _Deck area: square feet\1e)Spnot , eT 6\R -Iva A j? ?, ..O Other structure area: square feet oop 1. i AAAXIN In17-3 ii. . • wocYTC:1-, REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivisto•p.'. `.. . I •� ►� .' y, +.a(�/ Permit fees*are based on the value of the work performed. I / Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: i i - -Ct+�` a �. �V �4e1� equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. C,, r A_� %on „ -,.. Valuation: $ MC;tIIc:✓1cS �r� m y t1�7 �° TI �U — _Existing building area: square feet Wised Gt_S VIotAxt -jr-P c-2 ) c.p ✓�)( 1 00 1, ;n New building area: square feet 1"`1❑ PROPERTY OWNER 0 TENANT Number of stories: Name: LLt7 jOn-) :b S 0 onto.64 Ci,c,7-1,32_1 -, Type of construction: Address: I i'5 b ci SIA I—.1-A VC–€-10 DOD L i Occupancy groups: City/State/ZIP: ---ti -12: t 011-2.23 Existing: Phone:(,c3) 477_ LS5U Fax:( ) New: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: ' s'' --; s Structural plan review fee(or deposit): Contact name: 'E 0 . , it Y-t- f 2_ 1E.- Address: l 13b°I S W ( E W�1j caFLS plan review fee(if applicable): City/State/ZIP: "–rtC1-12-1) l Q IQ 9'9-223. _ Total fees due upon application: Phone:(;.)5) �2_ ��Q Fax::( ) Amount received: t; �S,M PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: ,j. s Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: "-Q..1 GH pt... .D NI k1--,12.. L C, Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Lq IA. SE E I L EE 1J LA-h)£ Solar Installation Specialty Code checklist. City/State/ZIP: H 1 LLS Boa, , Q12 e1 T i 7,2> $180.00 Fee(includes plan review $180.00 and administrative fees): Phone:( l 3i sq- Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: a-O 11 I 3 Z CO/(C it/ Total fee due upon application: r- $201.60 Authorized signature: 1:17-\,_ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 'Jj7 fj-�� i"�� Z,L% Date: G )2c ) 19 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling Mk OFFICE ISE OMI.) ' Cityof Tigard Received llanDate/By: Permit No.: 1 II r 13125 SW Hall Blvd.,Tigard,OR 97223 Associated pennits: Phone: 503.718.2439 Fax: 503.598.1960 TIGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITE\IS ARE REQUIRED FOR PLAN REVIEW les No y/,' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. 0 0 ❑ 4 Fire district approval required. Name of district: . 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity . 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 ❑ 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 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 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 bearing 0 ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 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 ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 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 ❑ ❑ architect licensed in Oreton and shall be shown to be a..licable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ 0 ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ 0 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 trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ 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 ❑ 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) Mech`` lkal•Permit A t t lication M' ., / 1` FOR OFFICE USE ONLY ' . p Received City of Tigard Date/B : Permit No.: 314 . �' 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review S E P 0 ?_019Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Inspection Line: 503.639.4175 TIGARD ��-`'"' " > Fpma h a Date Ready/By: Jury Ila See Page 2 for 6s� i Internet: www.tigard-or.gov t Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 1211-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 11'J 10,—\ 3 VS LA1, L i_) CC;GLPS Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 3 Furnace 100,000+BTU(ducts/vents) 54.91 i t,rte�� Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work / 23.32 Cross street/directions to job site: ),, (') ,cY l 15 f s� Hydronic hot water system 23.32 Residential boiler(radiator or r.( CT6 � v` J ivN ov\ . hydronic) 23.32 f� c�i •* v -� Cf, ((�O LVC "nA Unit rs(fpe,not electric), in- all,in-duct,suspended, etc. 46.75 Flue/vent for any of above 23.32 ( O. Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: C-� 19-: 1 r - or 1I(-` Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 y�, p�, 'C Flue vent for water heater or gas 1L�%t(\ ..04 1 i 1 t`jul� i U.Jl�AUS `VI�I..J fireplaceT-01 23.32 V\lJ1 i 23.32 1` n Log lighter(gas) I�!! Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 0 PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: Elif'j Q j'J 5.0_,Al2._ mr j JA Range hood/other kitchen equipment 33.39 Address: 11 3 bd1 5 u3 LAKEwocz efti Clothes dryer exhaust 33.39 City/State/ZIP: 11 (2._"- Q l� eti2,73 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:('Sj i e 9._. (-'j`5Q Fax:( ) Attic/crawlspace fans 23.32 0 APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: 5...fiAberli Ikr, a,Z-1 E Furnace,etc. Address: ,l J b-1 S LA K_E V J DO]) CO lltfJi Gas heat pump Wall/suspended/unit heater City/State/ZIP: -TA ck- r(Z 3) t oa, ° j2 Water heater Phone:(x(7 ) 1.4.6 2 4-cOFax::( ) Fireplace Range E-mail: \'i2, e5MCa....ei .'\e___ n Barbecue CONTRACTOR Clothes dryer(gas) Business name: RI CVT °Y1t 1ti —C �"� Other: MECHANICAL PERMIT FEES* Address: bCf 4 , E 1,.....EE-1,3 L.ic}NE Subtotal City/State/ZIP: fi j LIS 1 OA 01-4-17�j Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:() 34,9- 90 4 Fax:( ) State surcharge(12%of permit fee) CCB lic.: a©,132. TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: .15) . c days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board Print name: .-1 -1l'1 kc Z1 e Date: 4)2�,i),01 of I:\Building\Permits\MEC_PermitApp_040113.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 each additional$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. I:\Building\Permits\MEC_PennitApp_040113.doc 2 Electrical Permit Application FOR OFFICE: USE()NIA' City of Tigard Received Perntit it: , 13125 SW Hall Blvd.,Tigard,OR 97223 1111 DatclBy: Plan Review Related Permit V: 1 1 ^0Phone: 503.718.2439 Fax: 503.598.1960 Date/BE ' Inspection Line: 503.639.4175 Ready Date'By: Juris. Ea See Page 2 for T I G ARD Internet: www.tigard-or.gov Notitied/Method: Supplemental Information TYPE OF WORK I PLAN REVIEW 0 New construction ,ErAddition/alteration/replacement Please check all that apply(submit a sets of plans w/itetns checked): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 sobs or 0 Floating buildings, less to ground,or exceeds 14,000 0 Commercial-use agricultural ...Pail and 2-family dwelling 0 Commercial/industrial El Accessory building amps for all other installations. buildings. 0 Multi-family 0 Master builder El Other: 0 Fire pump. 0 Installation of ISO KVA or I JOB SITE INFORMATION,AND LOCATION 0 Emergency system. larger separately derived 0 Addition of new motor load of system. Job#: Job site address: /I 36,i 5 4--) LIfice---wcaa -1 1001-1.P or more. 0 Six or more residential units. occupancy. City/State/ZIP: 77c-0-126 04— q-71230 Health-care facilities. 0 Recreational vehicle parks. - i Suite/bldg./apt.it: Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal Cross street/directions to job site: FEE SCHEDULE Descrlpiion i'. MEM Total New residential single-or multi-family dwelling unit. Subdivision: Lot 0: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.It.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 (with above sq.tt), CNC Rbc'‘ front 71 oiN-) _____ Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 -i ;a-PROPERTY OWNER, 0 TENANT Services or feeders installation,alteration,and/or relocation Name: LE 2-Al`ext5,-14" < ,<g>4-7N-C--, ill C.-IZt.7^J 2-1-t: 200 amps or less 100.70 2 Address: // 201 amps to 400 amps 133.56 -t (1,e) ,S4„,_.$ 4,A--16 .4.4.24elo El-- — . 401 amps to 600 amps 200.34 2 _ City/State/ZIP: -ri 6.,Aitz, e 1-7 2_2,3 601 amps to 1,000 amps 301.04 2 Phone:(5141 ) q( ._ 4 5-5-7) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: 44 y,AD sne jz..4_,.-_,A,z4 &,-- relocation Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: _ 401 amps to 599 amps 168.54 2 . _ 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel ja-APPLICANT I A.Fee for branch circuits with Business name: /..;;;.":h_iz, - i c ,, 2.4.6,, above service or feeder lee, 7.42 2 each branch circuit - Contact name: ....--1.7 B.Fee for branch circuits without service or feeder fee,first i 56.18 5 Ca•is 2 Address: I 3(e. 7 c_ciA.) 674-4 e:‘4„,a20 e:7--- branch circuit City/State/ZIP: TIAA- OP . 1'7 Z-2-3 Each add'I branch circuit i 7.42 7 ' 2.._2 r Miscellaneous fservice or feeder not included) Phone:(50) 17102_ Li 5-5-0 Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: / a 091,/cay_ei1/4,ai 6 , 620m Reconnect only 67.84 _ 2 CONTRACTOR Pump or irrigation circle 67,84 2 Business name: /4- pit..e) le_ / Sign or outline lighting 67.84 2 I Signal circuit(s)or limited-energy Address: (4,30,...._ S,/„..c....) (2,orp i Tz/L,... _/-/_- .. / SM. 24)2.--- panel,alteration,or extension. 0 See Page 2 2 ----------- Each additional inspection over allowable in an,y of the above City/State/ZIP: ,#• --",i17‘4 e),--: /723/ Additional inspection(1 hr mm ) 66.25/hr Phone:(673) 2,tap . (513 e,/ Fax:( 2_4,4,_ 6 4i 4,„ investigation(1 hr min) 90.00/hr Industrial plant(1 hr mm ) 78.18/hr Email: mi Fo . Lc.- pito- ,51,..6:6_72e..16... e011-1 IQ((/ -7 Inspections for which no fee is 90.00 hr CCB Lie.: NO/12e, 1 Electrical Lie.:24,-f,- Suprv. Lie.: za 30s specifically listed t V)hr min) ,- ...• ELECTRICAL PERMIT FEES Subtotal: 90 Suprv.Electrician signature,required: ,-----,--/,,_----/ AV 6‘,...a.0 - Print name: at..-;-\ji , 6 , 00(....6 Date: /4, .2.4(, to? 0 Plan Review Required(25%olpermit fee): State surcharge(12%of permit fee): <7-7"/ Authorized signature' . TOTAL PERMIT FEE: Thi,.._---.. ,...) 2,i/ • This permit application expires if a permit Is not obtained within 180 Print name: te4,,.., . Aot,c, Date:/0. 2,i./. /9 days after it has been accepted as complete. * Number of inspections allowed per permit. 1:s.Build ings.Pen-ails1:1,C_Pertu0App_EI,R_ERE.doe Rev 06/17/2015 440-46 I 5 T(11/05/COM/WEB Electrical Permit Application "- ,-0,,..c,( FOR OFFICE USE ONLY CI ofTiTigard '?delved g Date/B Permit#: _ 13125 SW Hall Blvd.,Tigard,OR 97223 SEP of 0 7 01 Plan Review Phone: 503.718.2439 Date/B : Related Permit#: T_ E n Email: TigardBuildingPernvts@Tigard-or.gov e -: • Electrical Permit Application—City of Tigard Page 2—Supplemental Information �� • Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Each I Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 n Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n 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('/hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES SubtotalEnteron 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 n Boiler Controls n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n 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:ABuilding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 Electrical Permit Application—City of Tigard Pagd 2—Supplemental Information Umited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEF SCHEDULE Descriplion t I Total Feeforfor all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 Check Type of Work Involved: 5.01 to 15 kva 133.56 2 I 1 Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generationlystems in excess of 25 kva: [ Burglar Alarm i 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 - Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) 1 H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 I I * >100 kva-no additional charge 0.0 3 Vacuum Systems Each additional inspection over allowable in any of the above: I Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed Gil hr min) COMMERCIAL WORK ONLY: , ELECTRICAL PERMIT FEES 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: 7 Audio and Stereo Systems — Boiler Controls I I Clock Systems - Data Telecommunication Installation I I Fire Alarm Installation - HVAC Instrumentation I Intercom and Paging Systems I Landscape Irrigation Control* Medical [1 N• urse Calls Outdoor Landscape Lighting* 1 1 Protective Signaling - O• ther: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations BuildnigTermiisTLC_PanutApp_ELR_EN E doe Rev DO/17/20 I 5 Clean Water Services File Number C1eanWateer Services 19-00f-lbj' EIVED Sensitive Area Pre-Screening Site Assessment OCT 16 2019 1. Jurisdiction: Tigard C(TY OF TIGARD 2. Property Information (example 1S234AB01400) 3. Owner Information BUILDING DIVISION Tax lot ID(s): Name: ELIZABETH AND SHANE MCKENZIE 1 S134AD-01900 Company: Address: 11369 SW LAKEWOOD COURT OR Site Address: 11369 SW LAKEWOOD COURT City, State, Zip: TIGARD, OREGON, 97223 City, State, Zip: TIGARD, OREGON, 97223 Phone/Fax: 5034624550 Nearest Cross Street: IRONWOOD LOOP E-Mail: LIZ@SMCKENZIE.COM 4. Development Activity (check all that apply) 5. Applicant Information ❑ Addition to Single Family Residence(rooms,deck,garage) Name: ELIZABETH MCKENZIE U Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium U Commercial Condominium Address: 11369 SW LAKEWOOD COURT ❑ Residential Subdivision ❑ Commercial Subdivision TIGARD, OREGON, 97223 ❑ Single Lot Commercial Li Multi Lot Commercial City, State, Zip: Other Phone/Fax: 5034624550 E-Mail: LIZ@SMCKENZIE.COM 6. Will the project involve any off-site work? ❑Yes © No ❑ Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project It is a small addition 100 sq ft, where there is already a concrete slab. This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate. Print/Type Name ELIZABETH MCKENZIE Print/Type Title Signature ONLINE SUBMITTAL Date 9/25/2019 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200'of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also be required. X Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 19-05, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,State,and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 19-05,Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law. This Service Provider Letter is not valid unless 1 CWS approved site plan(s)are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed by e — -- Date 10/16/19 Once complete, email to: SPLReview@cleanwaterservices.org • Fax: (503) 681-4439 OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123 Revised 6/2017 City of Tigard u C COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R D Building Permit Review — Residential Building Permit #: /77447?(/7 7 SOW Site Address: //3&9 --c Leak-Pa)/9.0; -C r — Project Name: n AUiL___ Lot #: ~ (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review G Pro• i sal: / c'I7ftYt On r-tear' cifAOnuZA ff. Verify address/suite#active in Accela. '_n River Terra e: 4Q No CI Yes,River Terrace Review Addendum ESite Ian Elements: 7 rosion Control L✓J3,copies of site plan on 8-1/2"x 11"or 11 x 17"paper1V% m ri tamed trees with drip line and tree protection measures VD awn to scale (standard architect or engineer scale) n F..tprint of new structure(including decks)and FFE 6 rth arrow •A i; ity locations&easements(required for new and additions) e address,project or subdivision name and lot number ; walk/driveway approach l .plicant information(name and phone number) ', ,tion of wells/septic systems li FA Lot dimensions and building setback dimensions •'�. eet tree size,type and location 4. ale. are footage of buildings to be demolished L'Street names 7 'listing structures on site Domer elevations(2'contours if more than 4'differential) nt of area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes 7 im7pervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes ►• o [ Clean Water rvices-Service Provider Letter(lot phatted prior to 9/10/1995): Required: V Yes,applicant was notified ❑ No ewe-11"V Received: ❑ Yes di No \`1V 1 ublic Facilities Improvement(PFI) Permit/ /0 1 ild f/ Required: ❑ Yes,applicant was notified f No Api:9ed For: ❑ Yes ❑ No,stop intake 1,.' and Use Case#: Zoning: ie-1:4,C- VA 'equired Setbacks: Front: 4N A-- Rear: /5" Side: S.— Street Side: A-- Garage: 1i'''"`•u.ilding Height: Max. Height: ( Actual Height: 1?.. 0 andscape Area: % —r of Coverage Max: Entrance i _- back no more than 8'from street-facing wall ❑ Parallel to street or offs• ' a egrees or less Windows ❑ Minimum -°, of area of all street-facing facades Garage ❑ Garage door is behin a •:a est street-facing wall Y- ■ No,one of the following is met: ❑ Door extends no more tha ' om wall and ther- covered porch extending beyond garage. ❑ Door extends no more than 5'from w.u •r: there is a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is ❑ 12'or -: • 50%or less a .cade ❑ 60%or less and includes 7 of following: ❑ Covered porch P 'ecessed entrance ❑ Wall offset 'Roof eave ❑ Roof offset ❑ Fire s '• -s ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or a rel roof ❑ Dormer ccent siding ❑ Window trim ❑ Window recess CI Window projec 1. ❑ Balcony eIA isual Clearance Jrban Forestry P n \�►lq�.ensitive Lands: ❑ Yes No Type: PIO'onditions met prior to issuance of building permit o Approved By Planning: CDate: 1-1-(' Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_022819.docx Building Permit Submittal Original Submittal Date: ,s(307// Site Plans: # J' Building Plans: # �? Building Permit#: nter building permit#above. Workflow Routing: PlanningEngineering -Permit Coordinator ,,,,›—Building Workflow Sign-off: Sign-off for(Planning(include notes from planning review) Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application, site plans,building plans, engineer and beam c. culations and trust details,if applicable,etc. Notes: ,/ By Permit Technician: AL iii _ A 4� Date: 7/1'&0/1/ - Engineering Review Slope at building pad: 0Z-S, ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Et o Assess Water Quantity Fee in-lieu: ❑ Yes IBI-No LIDA Facility on lot: CI Yes [3/No Et/Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: ZApproved by Engineering: /.••60.-7"-Afe.4 Date: /o/2//q 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 El Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 8/N/A Tigard Trans SDC: ❑ Yes g]'N/A Parks SDC: ❑ Yes CSN/A ,�� LIDA CI Yes N/A CJ OK to Issue Permit Approved by Permit Coordinator: ��`I%U"K;ate: 1 C 2_11 q l I:\Building\Forms\BldgPermitRvw RES 022819.docx