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Permit .. 6 9_4 /iv L,v._.� a :0 io„.,..jioyA, e...4„ . CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permtt #: MST2009 -00178 T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/06/2009 Parcel: 1S134DB12800 Jurisdiction: TIGARD Site address: 11303 SW ELLSON LN Subdivision: Lot: 0 Project: Berg Partition Project Description: New SF. 1/5/10, adding all encompassing low voltage. 2/2/10, adding backflow preventer for irrigation sysstem to this permit, installed by plumbing contractor. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First 1267 sf Basement: sf Left: 5 Parking Spaces: 2 Height: 24 Bathrooms: 3 Second: 1935 sf Garage: 667 sf Front 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes Total: sf Value: $358,549.00 Rear. 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Catch Basins: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0 Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 1 Bckliw Prevntr. 1 MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 5 Fumes =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 6 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr. Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'' Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet Owner: Contractor: Required Items and Reports (Conditions) BERG, DAVID KMC CONSTRUCTION 1 MST Ersn Cntrl 503 681 - 4444 11303 SW ELLSON 6706 SW 36TH AVE 2 Pln Gen FINAL ARBORISTS REPORT REQUIRE[ TIGARD, OR 97223 PORTLAND, OR 97219 PHONE: 503 - 804 -8310 PHONE: 503- 720 -1182 FAX: • Total Fees: $17,825.92 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 do r ' r >.r... 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 dr r. ATTENTION: Oreg•. law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 52- 001 -0010 through OAR 95 - : 4 1 'l 00. You may obtain a copy of the rules or direct questions to OUNC b 503.246.6699 or 1 800.332.2344. i Issued By: / / I I L4 �v . Permittee Sig 1 s/ G0 / t)di . V ' CITY I GAR® MASTER PERMIT q ' , ' ° _ COMMUNITY DEVELOPMENT Permit #: MST2009-00178 13125 S H all Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/06/2009 T [ G ARL?' Parcel: 1 S134DB12800 Jurisdiction: TIGARD Site address: 11303 SW ELLSON LN Subdivision: Lot: 0 Project: Berg Partition Project Description: New SF. 1/5/10, adding all encompassing low voltage. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1267 sf Basement: sf Left: 5 Parking Spaces: 2 Height: 24 Bathrooms: 3 Second: 1935 sf Garage: 667 sf Front: 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes Total: sf Value: $358,549.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Catch Basins: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0 Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 1 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 5 Fum > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp SrvcIFeeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add 500 sf: 6 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) BERG, DAVID KMC CONSTRUCTION 1 MST Ersn Cntrl 503 - 681 -4444 11303 SW ELLSON 6706 SW 36TH AVE 2 Pln Gen FINAL ARBORIST'S REPORT REQUIRE[ TIGARD, OR 97223 PORTLAND, OR 97219 PHONE: 503 - 804 -8310 PHONE: 503- 720 -1182 FAX: Total Fees: $17,825.92 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 do ' acco • - - - 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 da -. ATTENTION: Ore. • • law equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9 - 001 -0010 through OAR 95 •01 -0 00. .you may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. �/� � `` 1 ' r 166 • ed By: � f/ AO � �.1�[� _ Permittee Signature: /.40/ i 3127 . / v CITY OF ���±��® MASTER PERMIT V r a '• COMMUNITY DEVELOPMENT Permit #: MST2009 -00178 r? , ; Date Issued: 10/06/2009 T 1 GARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134DB12800 Jurisdiction: TIGARD Site address: 11303 SW ELLSON LN Subdivision: Lot: 0 Project: Berg Partition Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1267 sf Basement: sf Left: 5 Parking Spaces: 2 Height: 24 Bathrooms: 3 Second: 1935 sf Garage: 667 sf Front: 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes Total: sf Value: $358,549.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Catch Basins: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: '100 SF Rain Other Fixtures: 0 Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 1 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 5 Fum > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add! 500 sf: 6 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add! Br Cir: 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: Owner: Contractor: Required Items and Reports (Conditions) BERG, DAVID KMC CONSTRUCTION 1 MST Ersn Cntrl 503 - 681 -4444 11303 SW ELLSON 6706 SW 36TH AVE TIGARD, OR 97223 PORTLAND, OR 97219 PHONE: 503 - 804 -8310 PHONE: 503- 720 -1182 FAX: Total Fees: $18,669.94 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: �- �CJIVX, 4ALUkA PermitteeSignature: 0.3.p_ ( � v Z , : Building Permit pp it Alication Residential RECEIVED , tx , a ,, ; ,„ ,,�r i a , , 1+'" -tip, ':FOR OFFICE;USE ONLY = - ,,- 1-'';: 4 ';P . ; : .., c . :'Er- ''�;..1iL:' r a. 3 _ wa: :'... I'1r -1 't , .va a ... _ ' a City of Tigard YS 01 2009 Datem d / / 619 1 Permit No.: M � -. c /78 13125 SW Hall Blvd., Tigard, OR 972 Plan Review - Phone: 503.639.4171 Fax: Date/ By. p (, Other Permit: � p CITY. OF TIGARD y. Mn J /�� - S - � 9/ - I . n � , D Inspection Line: 503.639.4175 Date Ready /By: �Y" la See Page 2 for Internet: www.tigard- or.gov BU ILDING D1\ I)t�N Notified/Method: 1 II Supplemental Information TYPE OF WORK _._ .: REQUIRED DATA:. 1- AND 2- FAMILY DWELLING, 'i4 New construction ❑ 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. � Valuation: $ c /4-(/ c g.,.... and 2- family dwelling ❑ Commercial /industrial J O ❑ Accessory building ❑ Multi - family Number of bedrooms: 4 1:7 Master builder ❑ Other: Number of bathrooms: 2 Z JOB SITE INFORMATION AND LOCATION Total number of floors: Z • Job site address: J I 3 0 3 s w fl S on L New dwelling area: ,Si �' g square feet City /State /ZIP: / O C' 12-3 Garage /carport area: (0e07 square feet Suite/bldg. /apt. no.: Project name: _ ' � Covered porch area: ag 7 square feet Cross street/directions to job site: Deck area: square feet )00 r fk IT I4j - fo- Other structure area: square feet �1 REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: PAT, � � f �� Lot no. : Permit fees* are based on the value of the work performed. Tax map /parcel no.: 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. Valuation: $ Existing building area: square feet • New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: 1") 0 _ Type of construction: Address: P.' 0 , B ©•x 3 5 (5 Occupancy groups: City /State /ZIP: fit y C.a e - GO 4 7 2 ,/ / // Existing: e Phone: (5o3) g o Li - 3 1 0 Fax: (.G.3) 7 r ( 6 3 6 New: 'APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: {� C9` l J 6 e ;I'S licensed with the Oregon Construction Contractors Board n J under ORS 701 and may be required to be licensed in the Address: r 0 ll n . 2_3 S 1 3 jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State/ZIP: r y r t� j IZ �! 7 Z � a ppl y: Phone: (5 ) w O c j" /3 r 0 Fax:: ( _503) S 7? C, C, 3 l E -mail: B' - (L D 0. . i i l ' 1 S ij " C O Q -, CONTRACTOR . Business name: le VA C C L n S 1'r , a c-r i op), BUILDING PERMIT FEES* Address: Q 3 W 3 � Q U (Please refer to fee schedule) Structural plan review fee (or deposit): City /State /ZIP: PC r f ( ft. cQ FLS plan review fee (if applicable): Phone: (S 0 ) 720- i i ' 2 Fax: ( ) CCB lic.: , Q Total fees due upon application: /4zer Amount received: Authorized signature: x This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ¢ e �. v ^ 5 Date: g - 0?, * Fee methodology set by Tri- County Building Industry Service Board. 1: \Building \Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist f : t One- and Two- Family Dwelling k: Y r . � Y 'FOR AOFFICE USE :ONLYy x , r City of Tigard Received Permit No.: Date/By: a 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Ell.. Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical TIGARL) , "-, Internet: www.tigard- or.gov ❑ Other: '' r THE FOLLOWIN64TEMSa ` kkitt .U I RED c FOR''PLAN ;REVIE '' ,�' '� ��, t t 4 't �'es �No _N /Ark 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ® ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ® ❑ ❑ 3 Verification of approved plat/lot. I ❑ ❑ 4 Fire district approval required. Name of district: H ❑ 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. igr ❑ ❑ 7 Water district approval. Sr ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. 2' ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ 0 10 basin protection, etc. 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state a ❑ ❑ 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. (...) Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if l ❑ ❑ 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" ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, N., ❑ ❑ 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- ❑__ LI floo 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 . 1 and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. A ❑ ❑ 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 - fS1' ❑ ❑ 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 ,I ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ RI 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 IN ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform Toad. 20 Manufactured floor /roof truss design details. ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ for four or more appliances. (� 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or -mil ❑ ❑ architect licensed in Oregon and shall be shown to be as . licable to the •roject under review. � " S I0,5'. T A, �"*.` it erg yy Ty Y HgF ; y t 'y �) "' c 1, a F y l s � f 4 K. Y:'# ".7 •s I RISDICT f 1L -C,' PE Irr S ry '- 23 Five (5) 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. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type 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, ❑ ❑ ❑ and protection measures must be drawn to scale and accompanied by 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, ❑ ❑ ❑ including decks, patio covers (over non- impervious,surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 46I3T(11/02 /COM/WEB) 09/01/2009 05:53 5034749031 WEST HILLS PLBG INC PAGE 01/02 nu{,; 41 u:+ (1St :116p Rar6 503 3736636 p. 1 Plumbing Permit Almlicatio ECEI OR OFFI{ !• z.1. rl \ Ll City of Tigard P Pe rmltl 40.: C 0 ! 9 .� • 13124 SW Hall Blvd . Tigard. OR 97223 S L I 2 10' 1 �dl 7 g e ' Phonc: 503.639/1 1 7 Fax; 503.598.1960 D 'pu w r h Permit No.: �d �.� r n inspection Linc: 503 639.4175 CITY OF 'FIG RD Dec Reatly/By: hate El Seo Pa ee 2 a / Internet: www.tig • or.gov 1 6 ► a • ,, NoItl /Kethod: ,,.. m teemed'', }; t -`t� , ,,6 _ -_,...,.;.....i - lJ . y ., 1 J.u4.! c7- • - .- _ - �.. . R4R.. .'�� ..2:*; .:72. . : :- •7 �1 J`�! • Q : . �. Jr � .,_ 1`' •f'PJ•1111r.9fIJi)�iiLAM.��' / '_ . �1+i.�iiV . s l: , VV ++'. .. Ncve coruttuction 0 Demolition For 'a ntastioet use cheekisc Datcriptiar Qty. Ea. Tptaf 0 Addition/oltercton /replacement 0 Other. New 1- 2- family dwellings (includes 10011. fir each utility connection) p'`YE+G,' . .. SFR(1)bath � �a9.20 Ur - and 2- family dwelling . 0 Ctmtmercial/i • - in! SFR (2) bath 350.00 Q Accessory building ❑ Multi- family SFR (3) bath 1 399,00 0 Master blinder Q Ogg: End odditiortttl bath/kitchcn 45.00 .. _ . Fitt sprinkler (__ sq. tt) , Pogo 2 #110:* E'- _ .,. ' .c t . • : }• - Site atiliGes • Job site address: 113 0 ..3 1 S t.-0 S L. Catch basin or wets drain 16.60 City /State/ZIP: ' j ' 0 a., i (/ 7 Drywall, leach litre, or bench drain 16.60 -' t '- Footing drain (no. linear R: _J Page 2 Suite/bldg. /art. ig OiCetname: , MarufkctUred home utilities 110.00 Cross SUeet/dtrections t0 Jib site: Mlttthoks 16.60 1k.. n 14 . ■ C' k . +■ Rain drain conneclin 16.60 Sanitary sewer (no. linear ft: ) Page 2 . Storm sewer (nn. Hnetrr R: ) _ _ Paac 2 Water service (no. tint ar R: J Page 2 ' Subdivision: • `C• r1 _ _..9 n u : - Fixture or item Tax mnp/pareel no.. - Absorpuo vclvc 16.60 = u ; , .' 1Ptf i 'dF'G( 3J 1 ' "i...; - ' -,.. ; _ Becicflow pre venter Pogc 2 Backwater valve 16.60 • Clothes washer • 16.60 ' y, - Dishwashu 16.60 ' _ ?,Si ! '4 • a ' rG f ' i n .. t • -. ? f , .,� t..: Drinking fountain 16.60 •. =.1: - ;w:: , ri' :- :5.9i:~•,' 1...:. ..r,..y,: " 4: a Ejedors/sump 16.60 Name: � A_ 1.1 Q R r Expansion tank 16.60 Address: (3. , I 1 ! ; Pints/chewer cap - - 16.60 City /StmoMP 0 1.2_. Floor drain /floorsink/hub 1660 Phonc; (, ) f r 1 2 (, f_ f i ID Fax: (5P-.5 ) f S 6 6 3 6 t3nrbage dispos 16.60 r - �- t� r Hose bib 5_ 16.60 .... ;;i.. .. 3 '' , ` ci; : i. ` <: `.•'S. �: ., 4 " i r : ^ ke maker 16.60 -._. Business name: . interceptor /grease trap 16.60 Contact n.'smo: Z,.. 'b au , F = a " Medics! B ess (valse: x ) . Page 2 r Address: p • Ia . • 2 1.) Primer 16.60 Clly/Stntcl71P: 1- e -7 �- L . ` .. ow Roof drain (commercial) 16.60 -" Sink/basintlavatory 16.60 Phone: (5-03) F t„t - * 3 I • Fax: : ( So, 5 7 -- Co(os • Tub/shower/showerpan 16.60 E-mail: • Urinal • 16.60 . '. :... .' ''_,tl >/�il ' t, {� :: : e.•�-•a, .' Water , 16.60 Rusin sa name: 1 . ) p - ..), .5_p .7 b & C- t �'" ;� Wa Neer 16.60 16.60 Address .�waw._r^ q - "j' 2 . • ,Z Al ^ •,^tx ► ! f . Other: samosa Ciry/Slalerzrn: rY► c 'V\ . t a „ y � lJ le E 0 2 c 7 t 2 7 % Minimum permit tee: (72.50 Phone: (5.3 3 �[ . 0 Fax: (5 , .� 3 Residential bbckflow minimum permit fee: S36.25 Ca) Lic•: i rr .; n s T Plumbing tic. no. :.'' - . „ Plan review (25%oroennitlac) Authorized sign 2 �I � , 2 )P� State archaise (12'/0 of permit tee) TOTAL PERMIT FEE Print name: f ► ' i 'Tbb permit application expires it a per eta is not obtained within IAn days after it bas been accepted as complete. r) I-+ti I 1 • "FCC manoattligy set by 26-County Building Industry Service Board. I:vrmtdlrviwers It I.M- rcrmitAnp.doo 11 • • RI61110r01 /COMtw6e) 08/20/2009 23:31 5032350454 SKY HEATING AND AC PAGE 01/01 Rug 19 09 11:38a Berg 5035796530 2 Mechanical Permit A .1i tit ECEI ED ink t rl it', liSI; [�`t_t P IN City of Tigard Reee;v 13125 SW flail Blvd., Tigard, OR °727,3 Q09 DattafJ ed / Ug �! PamltlJo.; K h 9��� �Q Phone; 503.634.4171 Fax: 503.5:8,1460 Plan Review Other D Inspection Lint. 503.639.4175 tlnte/(?ly; Other Permit; ,,, / M�F( 'r rGAisa CITY OF T. ' RD Date `^°`�/ Internet: www.tiRatd or.gov See Pale f for BUILDlNG D. lSI�N Natified/Methnd: 3upplem nlbrmatlan t replaeement ❑ Addition /:Iteration. Mechanical permit fees* are based on the value of the work Now construction performed, Indicate the value (tounded.to the nearest dollar) of all C] Demolition E] Other: mechanical materials, •u•.mcnt, labor, overhead, and profit and 2-family CAT % of .C*stF(Ucp0;�t Value $ tfa 1- y dwelling ❑ Commerc' :1/indvstrial ❑ Ac..sory buildings / 5" = FOP special information use chec ❑ Multi family ❑ Master bu'der 0 0th Description I Qty, J Ea, I 'total - SityH: S1'P .0411. fA e[NYl ; ;opt p•a ' Heating/cooling Job site address, ( 3 0 7 LL Air conditioning or heat pump - A re. irce site • Inn showing toncem I nnt) 14.00 City /State /ZIP: ` t / ,i Z n .) C)(1---' Pomace 100 000 BTU (duels /vents _ 14.00 Suite /bldg. /apt. no.: / Project nom Furnace I00 000+ BTU ducts/vents) 17 90 _ ` Cas heat ,u • 14,00 Cross street/directions to job site Duct work . 1111 10.00 /1.1 1 + ?4 drank hot water a stem 14. 00 Residential boiler (radiator or h drams 14.00 • Unit heaters (fuel-type, not electric), - in-wall induct, suspended etc, 14.00 Subdivision: Lot n0 Flue/vent for an of above 5.60 NM Tax map /parcel no„ Other 1 10.00 Other fuel a , , Hallos „ rD CRIPT(O ''gr.`Vi fjiK' Water heater • . - 10,00 Gas fireplace 10.00 Flue vent fbr water heater or gas fire lace I 10,00 M Lo. W_hter • . 10.00 Wood /.ellststove 10,00 Wood firo,lacc/inscrt 10,00 G' P;<(Oi EflZ^7i: O IY r Chimney/liner /flue/vent 10.00 : CI�T Name Other: 10.00 t 5' (^ - Environmental exhaust and ventilation Address: 'C7' Q • x Range hood/other kitchen } equipment l e t d 1' 7 Z , Clothes d r exhaust 10.00 Phone: (7 �) Fax: t Singic - duet exhaust (bathrooms, 1 (5 3) S - (o ,6_� 6 toilet eom ■artments, atilt rooms S 6.80 :: - ,, i:toN'PA .- iidtkiN t Attidctawispace flats 10.00 Business name: . 1 a r F�h'r 10.00 Contact name; c piping 55.40 for Drat four; 51.00 for each additional Address: Furnace, etc. MEM City /State 1P: Oas heat pump Wall /su- .ended/unit heater Phone: ( ) Fax:: ( ) Water heater • I' E-mail: Business name: � . ► ' a • / Clothes d er gas) - 111MMIIIIMIll SIZEN ♦ �� Other 11.1.11111. City/State/ZIP: t I / � 7 1 SI E C`HA1 A; r ► ICI"]N�" w' • r _____ subtotal Phone:S-6N _ - • • 2 I Fax; - ) . Minimum penal, fee ($72,50) CC13 lie,: • P1ttn review (75% of permit fee) State surchar (12 e % ofpenni1 fee) Authorized signature f i TOTAL PERMIT FEE This permi A pp li cation expires it a permit is not o btaine d within IN = �'�,w� Date: / days after It has beer accented se comp/eft �! . -a 47 ' Fee methoderngy get by Tri- Ctninty Buntline Industry Service Blind 1 .WhOdinalpmmIta Vd'EGPcrmkApp dnc 01/10,0 40.461-.7 (1) /rrvcowwgm 08/18/2009 15:41 5036425815 ROSS ELECTRIC INC PAGE 01/01 ' Rug 18 09 03; 38p Berg 5035786636 fa- 1 Electrrcai Pertu t Aui �lga•itn . E EIV n i p ` �o i... , o , X tea v I ,v - City of Tigard' ,:; /,r M 10 ss tin.: ,i0,,„,,,, -ay g 13125 SW Hall Blvd,, Tigard,OR 97223 . �� i 903.639.4171 Fax 583398.16P 01 21109 r Otter hank ge019009 -000 y/ ,_- T :; n Inspection Line: 303.639,4175 Date ltesey/By: pa2 12 Vet .4,; ww °.''•' Iotemet artYw- tigaln4or.gov CITY nF •• RD N0ti16a mdbod Sttp�teattatalUi(ottatdba OE MIPPiNG n1 SION REVIEW ` ,New construction D Additto • • ..- , P/0350 1Aeac ai► Oat apply (abash 2 see cry= Wimps chada a blowy 1:l saeiac a 6cdcr 400 amps or maw ❑ Huila% ova tdioo aerie'. ❑ Demolition ❑ Other. duce aeaviltiele reek nano 0Marisas OW *math. 0.1441 (301tY OP CONE1r*UCITON a trazda 10.000 =Pa 130 .aea m O Flaitbug bull/Mg& loam um& a amcade 14,000 0 Comaaaa1400 egaicnloual .1- and 2-fitmily dwelling 0 Comore ziaVindta9trisl CI : coesaorp building mope f ail alts tostaitaloat. battings. D Multi - family in Mastct tildes 0 t -r ❑ Me pomp 0Ianallokop of 75 KVA or STl1 RIVFORM TlON AND L4CA ' O &°'° ' sys1°O- sep derived Ewan. g° - O MOWo4o/eat mew load a ID- A; "6; t- 2 2 "1 -3 ", Job no.: I Job site address 4 4 3 0 3 •w El i I Savi Lit/ O an rr a m room ere realo r. 1M t ery awe rortdartlsf man. CI ltcateeNoaal vchidc Aerie. City/Staten?: .� C3 y � 5 7 O 1ke18eemo realities. O supply vsdtaea Car mans 8uo i r r r 0 ttamadaa.loeatlsnt 600 toils nominal. Suit /bldg. /opt no.: Projec • name: ! r' ci D &relic or faota 600 pima a mane tsrls to job site; Cross st>ccdditecti ----- J A CPik ' (0 +a. 4�iaiss 1 or.. I roe, i 700 Y—" New resideatlal dtagle- or mo104batily dweling Dolt. Includes attacked Subdivision: .3 4 A , . . . r Lot no.: 3 1,000 eq. IL or lass 145.15 a El. odd'I 200 sq. ft. or portion 33.40 1 Tex map/parcel no.: Limited aurgy. residential 75.00 2 i , a: «: r 0 i OF WOUR • (we, above sq. ll) Limited energy, otutti4br,1y .75.00 2 • . residential (with above eq, a) n. and/or nelocs,tian 200 apes or has 80.30 2 44 PROPERTY Ovrf fl 1 ■ TENANT 201 amps to 400 am 106.85 2 Name: a () 42. ____2 7 (Q.- 40l amps to 600 an 160.60 2 601 tamps to 1,000 wisps 240.60 2 Address' p B Ox 23 ..5. Qva 1,1100 amps err volts • 434.63 , 2 City/State/ZIP: • r d 6 2 1 ? Z - / Temporary savv'Oerr errsiaslailaima, altaiatoa, mad /or • re100011474) Phone: (.5-70 ) fl 6. _ % 0 : (5 ,...5 7 `/ - 6 6 .s g ZOO mops err fete 66.85 1 1 Ovn,er bastailateoa: This installation is . _ wade on prop A , that I own which is not 201 amps t0 400 aas,ps 10030 2 intended for sale, lease, tent or exehan : according to 089 44 449, 670, and 7OJ. 401 mtges to 599 amps 1 33.75 2 Owner signature: Dam: A. F brands circuits Aeration. or aitcasion. ter panel _ with • Igi. APPLICANT - [ 0 r ACT PERSON . above service or trader fee. 6.65 2 each Meech circait Business name: BL Fee for brands circuits woken dames fteder or eder fee, ; 46.85 2 Contact name: b G.: 5 F, e,,-4 ! C, fast branch circuit Address: Each WWI brunch Omit . 6.65 2 1 f smitakeous (service or fetdev mot Iadoded) _ City/ State /ZIP: Each =undeclared ormodrler 90.90 2 derdling, service endlor feeder Pbtnat~ ( ) I Fax :: ( ) Raman= orlY 66.85 2 E -mail: • Ppm or Origami circl i 53.40 2 CON ilAClO>s< . - -• - - - ' S outline li ( 53.40 2 � Signal ctaart(s) or limited- • Business names R T.L.S s F. 1• c. I et I C., - energy panel, alteration or Address: 2_8 s'"6 7 5- 9'k �L rT (j e • * Za 3 j . tea Deserbe: Page 2 2 Ciry/State/ZIY: if s • i t S 0 p •^ L ) f ems, 7 '7 / 2 - 3 Inspect ion over allowable in man tittle ve e abo Phone: ( (,e7 T I zip Q Pax: (303) ke ct 2 ,. J 5 linesogatioo per hour (l w rein) ', 6230 CCB Lic.: 15'ig '1 I . 8lect ical L ic.: 3 C -oc sl tic. 3113 z 5 Iedatriel plant per (tour • 73.75 , E'Q.BCTRICAL FEES Suply. Electrician signature, required: (• 1t9d' 3 Subtotal; - • Print name: 64y4; SS ) Date: Pins review (25%ofpwoit Ike): State aadba rge (1296 of permit lock Authorized signature: • TOTAL PERMIT FEE: 1 r - - ,bhp permit apsuaitiw expires Ho permit if Dot obtained sna ne ISO Print name: • dmya ochry it beat bent accepmd ON annO to • limber 0Piest+ecbo a altooed per pewit iN134 eigwermidtat .GetrmirAppduc05ll7/06 440461ST914790014weu PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment/syste Description 1 Qty. 1 Fee(ea.) I Total Description Qty 1 Fee(ea.) I Total New 1- & 2- family dwellin Heating/Cooling (includes100 ft. for each utility connection) Air conditioning or heat pump* ( 14.00 /y SFR (1) bath 249.20 Furnace 100,000 BTU (ducts /vents) AI 14.00 SFR (2) bath 350.00 Furnace 100,000+ BTU (ducts /vents) / 17.90 /7-90 - SFR (3) bath , 399.00 3K Gas heat pump 14.00 Each additional bath/kitchen 45.00 Duct work 10.00 Rain Drain, single family dwelling 65.25 Hydronic hot water system . 14.00 Fire sprinkler - sq. ft. 0 to 2,000 115.00 Residential boiler Fire sprinkler - sq. ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14.00 Fire sprinkler - sq. ft. 3,601 to 7,200 220.00 Unit heaters (fuel, not electric) Fire sprinkler - sq. ft. 7,200 and greater 309.00 (in wall, in -duct, suspended, etc.) 14.00 Flu /vent (for any of above ,Site Utilities ,... ( Y ) 6.80 Catch basin/area drain 16.60 Repair units • 12.15 Drywell /leach line /trench drain 16.60 Other Fuel Appliances Footing drain - 1 100' 55.00 Water heater 10.00 /v - Footing drain - each additional 100' 46.40 Gas fireplace 10.00 /0 Flue vent (water heater /gas fireplace) 10.00 Manufactured home utilities 110.00 Log lighter (gas) 10.00 Manholes. 16.60 Wood/Pellet stove 10.00 Rain drain connector 16.60 Wood fireplace /insert 10.00 Sanitary sewer - 1 100' 55.00 Chimney /liner /flue /vent 10.00 Sanitary sewer - each additional 100' 46.40 Other: 10.00 Storm sewer - 1 100' / 55.00 Environmental Exhaust & Ventilation Storm sewer - each additional 100' 46.40 Range hood /other kitchen equipment i 10.00 /0 - Water service - I 100' 1 55.00 Water service - each additional 100' 46.40 . • .,Clothes dryer exhaust / 10.00 JD . F o r Item Single duct exhaust ' Absorption valve 16.60 (bathrooms, toilet compartments, - • utility rooms) Backflow preventer 27.55 Backwater valve 16.60 Attic /crawl space fans 10.00 Clothes washer / 16.60 Other: 10.00 Fuel Piping Dishwasher / 16.60 * *($5.40 for first 4; $1.00 each additional) Drinking fountain 16.60 Furnace, etc. / ** Ejectors /sump 16.60 Gas heat pump ** Expansion tank 16.60 • ' Wall /suspended /unit heater ** Fixture /sewer cap 16.60 - .Water heater 1 ** Floor drain /floor sink/hub 16.60 • Fireplace o1 ** Garbage disposal / 16.60 Range 1 ** Hose bib 2 16.60 . BBQ ** Ice maker / 16.60 Clothes dryer (gas) ** Interceptor /grease trap 16.60 Other: ** Primer 16.60 • Total: 1-, (' Roof drain (commercial) 16.60 Mechanical Permit Fees Sink/basin/lavatory j 1 1 /e 7 16.60 Subtotal: $ - }a- - )AA., 36 Tub /shower /shower pan !-/ 16.60 Minimum Permit Fee $72.50 $ Urinal 16.60 Plan Review Fee (25% of Permit Fee) $ Water closet 16.60 , . State Surcharge (12% of Permit Fee) $ f Y.611, Water heater / 16.60 TOTAL PERMIT FEE :$ Other: • Other: Plumbing Permit Fees ELECTRICAL FEES (residential single- or multi - family) Subtotal $ Si y, 00 Description Qty. Fee Total Insp Minimum Permit Fee $72.50 $ 1,000 sq. ft. or less 145.15 4 Plan Review (25% of Permit Fee) $ Ea. add'I 500 sq. ft. or portion / 33.40 1 State Surcharge (12% of Permit Fee) $ y7 $. Limited energy, residential 75.00 2 TOTAL PERMIT FEE $ Each manufactured or modular . 'dwelling, service and /or feeder 90.90 2 Electrical Permit Fees Subtotal: $ 3HS,s_5 Plan review (25% of permit fee) $ State surcharge (12% of permit fee) $ Li) y 7 TOTAL PERMIT FEE $ I:\ Building \Forms \ResPlanCheckFees.doc 01/19/07 Page 2 'k [ r15T uoi — 7% �'f R ELIC a `�' CONSU TING� ''' IC .1,;''4, 1 "11' 44 7 ' (i4 AP S c‘ i c r 0p PRO/ 4 ,4z MAIN OFFICE ❑ CENTRAL OREGON ❑ '<<( GINS F sd, 6969 SW Hampton Street 745 NW Mt. Washington Dr. Suite 204 \D O� F9 / Tigard, Oregon 97223 Bend, Oregon :97701 �(1 15 2 / f 503.624- 7005/503.624 -9770 FAX 541.383- 1828/541.383 -7696 FAX / y _ r MEMORANDUM ,itL� �C' 'i' EGON Date: March 10, 2009 .p g'` To: Kelly Cowan '9,L, • 25 '‘ P 1 ' From: Kyle Hays R2 DEP Subject: Dave Berg Residence / FCE # 08 -T280 1 EXPIRES: 4279/0 I Framing Issues: // 1) The post cap as detailed per SD /35 on the approved structural plans has not been installed. A column cap has been installed for the two 5 1/8" GluLam members running; . " side to side in the house, and top flange hangers have been used to frame in the .7,1-1. ° remaining two beams running front to back. All holes were not able to be filled in the •fader of the HGLT hanger due to the interference with the column cap. Based on pictures brought in by the framer, t column caysupporting the two 5 1/8" GluLams running side to side appear to be installed correctly and is. adequate. - The HGLT9 top flange hanger used for the 8.3/4" GluLam and the GLT5 top flange hanger used for the remaining 5 1/8" GluLa have been installed with '/z OSB shims to clear the post cap and SDS screw`heads below. Based on the ' calculations ,provided, the hangers are adequate to support the given loads but it is { our'belief that this shim will eventually crush when the beam is loaded and will . compromise the overall strength of the assembly. This needs to be corrected. .,. Steel wedge shims need to be jammed into locations indicated on the attached . drawings to prevent the rotation of the top flange hangers. r Y : PROVED / la C9 Cftl .. . 6969 SW Hampton Street CLIENT: DA vC & K-Pt -rt-1 PAGE / Portland, Oregon 97223 7r FAX 503.624.9770 PROJECT: 13��(s S 1 t7 E,�J _ F ' . 503624:7005 � �, � ;1 , �� �IIC 745 NW Mt. Washington Drive CsQNSULTING'' Suite 2 NUMBER: pQ, (3 p e Bend, Oregon • f E u FAX 541.383.7696 DATE: 3/ I 0 9 'ENGINEERS' . 541.383.1828 www.froelich- engineers.com O BY: X61,4 ANCz62 Llac'rlo:kJ rj 1 8 3 4xG Gf., 1 / G.c. LJ S 5 'is I ri ,,, I , I � G L 1 5 Y S/e HC7LT�i (,_,APACt Y > 12750 w /0IZ) F i4C� N r't-j 4- (6 • TOP FLANGE Iv/#r l.J/A USED X67 ToP L k -' C e J F (zea LC.T (CLA) ( � -r� -C e Ki �k 1 t i (co Li 5etZU VE t /Z 0 . - N 05Eb = ZO °o ?LD OC T f C) Os - r ve _ (0.55 12_7So _ 739S -2 i ALTUAL L..0AO = 39(:)&' So o UI-TS CA ?AC1 Y 81 bS (vLC.`/ ,JA- L c O /z os(3 SRIAA us€ A) Ci}PAcc I -- r = (®, P) (91 6 s . P�T�Jri Lc� m 2- IO 0 $o o g - i , -rti. Y'.. u^' y W rr �r� w ` ��`p !~ } ' h 1 �- • d " /� '� s yT l '. 1 s $ ' tit L ' { 1 r �. q t d f ° „ ,, ;Y *{ ;. ..; " , • k?..,„,..,:,,,,,.,...,,,,, Y ), t 4 r `�7 r Jf . t. -+ . ; 1r q,$ o f ;, . �r ( ) . 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CERTIFICATE OF OCCUPANCY : , CITY OF TIGARD `" COMMUNITY DEVELOPMENT Permit #: M /06/20 00178 .,,' P � a' Permit Issued: 10/06/2009 T IGARI3; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134DB12800 Jurisdiction: TIGARD Site address: 11303 SW ELLSON LN Subdivision: Lot: 0 Project Description: New SF. 1/5/10, adding all encompassing low voltage. 2/2/10, adding backflow preventer for irrigation sysstem to this permit, installed by plumbing contractor. Class of Work: NEW Type of Use: SF Type of Constr: VB Occupancy Group: R -3 Occupancy Load: Project Name: Berg Partition Owner: BERG, DAVID 11303 SW ELLSON TIGARD, OR 97223 Phone: 503 - 804 - 8310 Contractor: KMC CONSTRUCTION 6706 SW 36TH AVE PORTLAND, OR 97219 Phone: 503 - 720 -1182 Fax: This Certificate issued 2/26 /2010 grants occupancy of the above referenced building or portion thereof and confir s that the building has been inspected for compliance with the State of Oregon Specialty Codes for the grou 1 occupancy, and use under whi - -ferenced permit was issued. 61,$�•r g Inspect. Building Official POST IN CONSPICUOUS PLACE G Oregon Residential Specialty Code N1107.2 a)( HIGH- EFFICIENCY INTERIOR LIGHTING SYSTEMS 1 Permit No.: 5T 2005- G V 1 7 g Jurisdiction: q Site Address: 1 3 0 S c. L L__ S a nJ Z-4) , 1 1 2.q r- ; 44_?2223 SubdivisionlLot #: 3 2v Pco"- v vi and/or Map and Tax Lot #: r S 1 3 cf +D (3 (Z S-0 0 By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2) Signature: Date: 2 1 1 ! ' 2v ( Owner /General Contrac r /Authorized ent Print Name: 16 rT J -e i ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that . has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. I:\ Building\ Formsl RES- HighEfi<'iciencyLighting.doc 07/01/08 Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, /Ze LI-7 CO f^/ `'4r`' , am the general contractor or the owner - builder at the following address: Site Address: 1 3 O 3 , 56 _3 3 L� 7-•-L SC A' -,cl City: 1 , a d , b 12 97 ZZ 3 Permit #: Subdivision/Lot #: f - 6 R L f. 3 • and/or Map and Tax Lot #: I S( 3 j pep y_ - O 0 To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and • OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code' requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the general contractor that all moisture- sensitive wood framing members used in construction have a moisture content of not more than 19 percent by dry weight of dry , : ing members. Signature: Date: l / G eneral Cq tra or Owner- Builder / 1:1Buil ding) Form lRES- MoistureSensitiveWood.doc 09/25/08 STREET TREE CERTIFICATION .'u • t :tit` : S #' •.:„:.,, �, , , Tr .,.,i..i:: ,.'t,:. • ;.•.:'':... Y4'' f: „'•;::a: 1,,:y '!;ai. =: ';.i?' ' X" .ti 9 •. 4j ;?;ti1 ' �: f.:, t q t •• y ' ';�.s1u ;1r'}if Y ti' �. :. `L:it €d �::t:Ca• bt h , rr . � "+A `hr !1::4` , .ti a.l. iy, 1.' . • f: E i ; : p .. j i r' t i< ii h :f:L`, ,.t',_t.,� ,.;`: ., ^`.nr . a r„ , ,:G +l' ' ' .' ; • +�,i• „ F :::: " ;f t i . • ; .: a ,t,,, •' : : a:.rrr. 5� �::,1, + ,; >; „,: :; ,, �: " >: ' • , N.,:: ' = f / 1 / }%': : �'e w :,.c.V te l: ?:..::X n J t�`'{ L,.�'. ", r . , ly ,� , \ 1 1 vY I , 0 le_ex...7 I�Pd i ` f j' . „, ' i ltT i :CilCtIG C! Tfir ":y i 1 , - PR That ;.„..„,p.., " , .? " i ` F =' S :F.r �� a "., s .:, • ( R) (PLEASE P -; ;° ` 'i� (PERMIT HOLD � ' „I, �v <+ , , K:' rv ,: "�'::.ilst' ! :.Ixi.r ;:•' ;y�t.. :a' Di � � •,. C ... .:,- .:" fi , . } ... �.:., , ” y!. y : . sl. =' fi: ; : r .:wi YtfSr , Do hereby t t.`o "��;T7ytt °`.tca meets ^�,:tf yy,}Ly,,Rµ,%,:' ...,sw.a Eti r�...; "... C of Ti T� ;:°...,.-41.,... e r e : d - , ; t stan a : • � . ,; >< • , ; ; cp s: ,; l: y , ri ""l�5 �Yi;: : r, ^'•...1 �., ' °s;:,`::i` ?� : ; ;A,'a•ky,i, ii e , s fir e t ° :i s :114 :10..01 , 1t , .. N .u`�'..p", 1 ' 4::f''s: ';:,r:+t'���.: .r. : t: " 4 � . ( t, •� . i ' ..'v '?'� '`);`t': rdlt z'...'- �•"� "; 'it ih : ri, it :oY. 'i ii i r :9 ,r • .. Y ,,, , : :,.,, .':;:,:',f:i,,, , „,,,,,``hj2in ItRi :j :',: 4� :i•,,: y 9P:' : �,:, t i-„`S �fi ,.., .b.a ' ,...„!,F.::'. • i ..:.. V : .,.. 1 } ,;�, p� •- iP�r��:..., .rii'if''•�a,�.'i }�j�.! I•A 4 {� t ;tp � i •,` y : �.: !rha.,L,;,,Jr ,',,., t`'F f ” ' ,, 'T tr8 '�:�vv " }�!��t•,v j t " "'C J ' : .' , fi'fi,4 .,,, 5ii.: ,4.,r... � i � � � '�i ? +' :.o !t(. ^ , Z �,f b t, j ; � ::�•,�; zi. , ,,y `tit ".4: :v i:,,y' . • i, : :�;; n:n.,, \ . a:.d', . .N."-."'.4%.i • ' aye• N., a 4 J. �• r.: r : °:;v: .N 5 :4 "�"�,� ? . {x v� rt ,:.�,.� f ': e : f t . l .t p . , M i; ; •:ic i . ' 2 , :;4 � ':`,it`, :: V ';:?,;Jji,n ; : i1` rhiSr: ;.; •4' },;: u`.If�, „rafkv: ;`it %ii zp-v :. ;',: i .; ,�` NI : ,,, r , 4 1 : ii tl' ;s YM . t. '.I:�j. M, .:: 'Ji `�:rt \ ' i 1 : . i: ADDRESS: l/ 3 3 S w _ z..../__ S d tz i �. 612 ) SUBDIVISION: 2 Paa LOT: • SIGNATURE: , , 2 - /. 5 = a / U i.IEPNERJAG • RECENED B Y: DATE: (07Y 0? TIGARD) I : \Su1ding \Forms \SueetTreeCelrificate 01/19/07 ■ City of Tigard, Oregon ® 13125 SW Hall Blvd. o Tigard, OR 97223 � T , P;141,`j i �! f . , ® �4' Friday December 11 2009 jx T A. .1 t:1 0 Mr. David Berg ,. _ •4 °5 11303 SW Ellson Ln. Tigard, OR 97223 RE Transportation Development Tax ( 1DT) Refund. Our Permit No. MST2009 -00178 /130 ea-s i 4_. u Dear John: At the time the above building permit was issued you paid a Transportation Development Tax ( 1 DT) fee of $4,599.00. Effective December 1, 2009, Washington County approved a Temporary Discount on "1DT charges and has made that discount retroactive to July 1, 2009. The enclosed receipt for a credit to your credit card represents a refund to you of the difference between your original '1"DT payment for your project and the new Temporary Discount charge. The amount of the credit refund is $920.00. Please call m- at 503 -7 8 -2426 if you have any questions. Ai ), i ,ert Shie • Permijs- rojects Coordinator 50Y718-2426 Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772 n City of Tigard r «' TIGARD Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit fiction or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: David Berg DATE: 12/10/09 11303 SW Ellson Ln. Tigard, OR 97223 REQUESTED BY: Dianna Howse AMS TRANSACTION INFORMATION: Receipt #: 175510 Case #: MST2009 -00178 Date: 10/06/09 Address /Parcel: 11303 SW Ellson Ln. Pay Method: CreditCard Project Name: Berg Partition EXPLANATION: Refund amount discounted for 1'DT per Washington County. REFUND INFORMATION: • Fee Description From Receipt Revenue Account No. Refund 'Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount TDT - Transportation Development Tax 4050000 -43320 $920.00 TOTAL REFUND: $920.00 APPROVALS: If under $500) Professional Staff 0116 L _ c+_ If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Refund Request Reviewed: Date: j . ; u �' By: ,zv,". Case Refund Processed: Date: By: _ I: \Building \Refunds \RefundRequest.doc 04/13/09 • City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 I1 Friday, December 11, 2009 David Berg �` , 11303 SW Ellson Ln. Tigard, OR 97223 RE Transportation Development Tax (TDT) Refund. Our Permit No. MST2009 -00178 Dear John: At the time the above building permit was issued you paid a Transportation Development Tax (TDT) fee of $4,599.00. Effective December 1, 2009, Washington County approved a Temporary Discount on TDT charges and has made that discount retroactive to July 1, 2009. The enclosed receipt for a credit to your credit card represents a refund to you of the difference between your original TDT payment for your project and the new Temporary Discount charge. The amount of the credit refund is $920.00. Please call m at 503 -7 8 -2426 if you have any questions. 4 ert Shie Permi . rojects Coordinator 503'718 -2426 Phone: 503.639.4171 e Fax: 503.684.7297 . o www.tigard- or.gov • TTY Relay: 503.684.2772 1 111 a City of Tigard . T c A R D Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: David Berg DATE: 12/10/09 11303 SW Ellson Ln. Tigard, OR 97223 REQUESTED BY: Dianna Howse AMS TRANSACTION INFORMATION: Receipt #: 175510 Case #: MST2009 -00178 Date: 10/06/09 Address /Parcel: 11303 SW Ellson Ln. Pay Method: CreditCard Project Name: Berg Partition EXPLANATION: Refund amount discounted for TDT per Washington County. REFUND INFORMATION: : . - .:. :Fee, Description From Receipt Revenue Account No . : Refund , 'Example: [BUILD]. Permit Fee Example:' 245- 0000 - 432000: • .. $ Amount.- TDT - Transportation Development Tax 4050000 -43320 $920.00 TOTAL REFUND: $920.00 APPROVALS: If under $5000 Professional Staff alb ' k`._ ., _ _ALA_.• _ a_ r If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board •. • . FORACCELA SYSTEM ADMINISTRATION USE ONLyr , • - Refund Request Reviewed: Date: : i d t /./ By: I - Case Refund Processed: Date: i ,:7 : ' / r By: .) I: \Building \Refunds \RefundRequest.doc 04/13/09 - CITY OF TIGARD RECEIPT • . • 13125 SW Hall Blvd., Tigard OR 97223 I 503.639.4171 '/ ; f(;, , .IIGARD; Receipt Number: 175510 - 10/06/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2009 -00178 Building Permit 2300000 -43104 $1,898.87 MST2009 -00178 12% State Surcharge - Plumbing 1003100 -24001 $47.88 MST2009 -00178 12% State Surcharge - Building 1003100 -24001 $227.86 MST2009 -00178 CDC Plan Review, RES 1003100 -43112 $46.00 MST2009 -00178 CDC Plan Review, RES - LRP 1003100 -43117 $6.00 MST2009 -00178 Metro Const. Excise Tax - Residential 2300000 -24011 $430.26 Use MST2009 -00178 Tig -Tual School CET - Residential 2300000 -24102 $3,202.00 MST2009 -00178 Park - Single Family Unit 4250000 -43300 $5,370.00 —3► MST2009 -00178 TDT - Transportation Development Tax 4050000 -43320 $4,599.004;7-- MST2009 -00178 Erosion Control 1003100 -22002 $112.00 MST2009 -00178 Erosion Plan Review CWS . 1003100 -22003 $36.40 MST2009 -00178 Erosion Plan Review COT 2300000 -43102 $36.40 MST2009 -00178 Water Quality - Res 5200000 -43123 $225.00 MST2009 -00178 Water Quantity - Res 5200000 -43122 $275.00 MST2009 -00178 Permit Fee - Elect (per dwelling unit) 2200000 -43103 $345.55 MST2009 -00178 12% State Surcharge - Electrical 1003100 -24001 $41.47 MST2009 -00178 Air Conditioning or Heat Pump 2300000 -43102 $14.00 MST2009 -00178 Furnaces >= 100K BTU 2300000 -43102 $17.90 MST2009 -00178 Water Heater 2300000 -43102 $10.00 MST2009 -00178 Gas Fireplace 2300000 -43102 $20.00 MST2009 -00178 Range Hood /Other Kitchen 2300000 -43102 $10.00 MST2009 -00178 Clothes Dryer Exhaust 2300000 -43102 $10.00 MST2009 -00178 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 $34.00 Utility Rooms) MST2009 -00178 Fuel Piping 2300000 -43102 $6.40 MST2009 -00178 12% State Surcharge - Mechanical 1003100 -24001 $14.68 MST2009 -00178 SFR - Baths 2300000 -43101 $399.00 MST2009 -00178 Plan Review 2300000 -43106 $484.27 Total: $17,919.94 PAYMENT METHOD CHECK # CC AUTH. CODE . ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 02505d LSELLERS 10/06/2009 $17,919.94 Payor: David L Berg Total Payments: $17,919.94 Balance Due: $0.00 • Page 1 of 1 CITY OF TIGARD RECEIPT U a . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 176270 - 12/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID M ST2009 -00178 $- 920.00 Total: $- 920.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 02505d DHOWSE 12/11/2009 $- 920.00 Payor: David L Berg Total Payments: $- 920.00 Balance Due: $920.00 • Page 1 of 1 Community Development TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator • 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor - City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) / � � ° � ° 7 C ( ) Mailing Address: ov • City/State /Zip: /e Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). H REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). °� / Permit #: ��er4z ��E � ���J L/3 Site Address or Parcel #: Project Name: Subdivision Name: // Lot #: EXPLANATION: 7»X, Z®7.; 4 / 51P012 S7D / y 0-Z7) /QPirik-/ 6 % 9 N% • / . t ®� iea/ 7rve 7'2 /' d . Signature: / . , /i _ L . ate: ,�� 9 Print Name: • Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned CO the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. USE`ONL F :s Rte to S s Admire: Date B •Rte to Bld_ Admin: Date42 B afAmii Refund Processed: Date /a igrArg B 411A nvoice Processed: Date B Permit Canceled: Date /AMIE By Parcel Ta: Added: Date B Recei.t # Date -' Method Amount $ I: \Building \ Forms \RegPermitAction.doc Rev 07 /26/07 RECEIVES 100 Approximate 20 100 ' RE.f - - - - _ J - — - Do „ oI „ s.•Fir = - - -- r -e+ neighboring ' 19.0' property i CITY OF TIGAR I • v •'s TREE PRRTECTIIII -FENCE PLANNI�3/ENGINEE ING - &R ❑❑T• PROTECT IiN.- B❑ I 1 • '/ 1_ , .1 n 5 ,- ,: ,..... ■ > l 3 .1 q 1 1 - . - V*sa Fr ©I • • • ._ ..._ 3198 1 • AME?.I4,�1� Iasi :._.. ... 4 1 1ib75Q. Fl. - -------- - : ! 1 Medal rma¢rr . .: • 1, L' C . el • I .` 9 RI7Er1'YA J, .? L ,_ -4 $4Ki q -T -... -I ° a R.B c ;A,10Ar• 8R.03° 1(Yl 1 CO ; '�' - ::.ro. 1 Ar�:�� ',, tz71 � LANE 2 EASTERN .REDBUD • ";< MIN. CAL. 2' .. ,- . • 1 . 10 c 1 ' — � rcriwcla a 1eshensf91m La check —�. — � C Tl'1 AI C �"' L.J A 1�!- ' C_— `�1 ' silo piceu End nc-iif y rfrtrTr of ay L a �� 3S r N-EC ■ ■ A E °w, +� ■ � •� ■ •fie ■ et ews � ■ ■ s ■ � � PLYfe ar cr.nimiOns wiz Ile` earl of q ,�r�s� SW �® LANE `� n ronst�l`frcri 1 Oils find 303 S ELLISON LF N / rlki f►:;alicr�r. shill he optima' by l lorr1 kralcInq mathcrilin F•-;or cc TIGARD, OREGON start of r.?mintcln:r. 6673 SQ. FT. SCALE tc--4 I20o/- df,' 1 = 20' APP' 1 VE I. sETr atK �• 1 1 r 6: Ge • K Y 1 ii f..' FRONT' (I-C1J E) 2 (FROM P- FONT 'P4 )1 20' {l'F.+or1 PL.) CE” IEI) • RBEJRIST Ixa:Nr C54.12st,GEk: ZE7'(FRCM PJ I.S.A. #P1\1409A FIE, ' (Marti 1 FEE J i 14 F l !1 (FX-11 FL) I • . . . IC V tik) CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.:M<YrZCOCV PLANNING DIVISION: Required SeVeks 0 Approved/ 0 Not Approved Side ls / Froui. 0-Vc lIce. Rear: Visual (ear: 0 Arwrovt(i 0 No Approved - Maximum He _42_, fee CWS Serve Piovider Letter Required: 0 Yes 0 No B : 1/4.1A • -a—t Date: 43-57M t ENGINEERING EPARTMENT: Actual S pe:4.% 10 Approved 0 Not Approved Site PIa : (14 Approved 0 ( Bv: Date: Notes: 6 CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO: `1, 4 0* _ • 0 4# 8 N N p p p p r v v e e d d Street Trees: [Eipproved Protected T o0t1 rees: Approved 8 Date: d 0 Notes: ' � I �y4' 4y � 'a �.� Building Division a K One & Two-Family Dwelling r i can K 111 Fees Checklist k. `A S5 ry .a: !cF . PERMIT INFORMATION:' Permit #: M 7 ,2 009 _ c0178 Plan #: Date: Site Address: ) 1 3o 3 5 ' , J 6 Li......) „/ L N Parcel #: Subdivision: Lot #: Zoning: Jurisdiction: Setbacks: Front: 2,0 Rear: S ' / S ' L eft: S Right: S'' ' Class of Work: N JE.0 Stories: r ) First Floor:, ) p5 Type of Use: S f Height: .2 Second Floor: /y i /}1 Construction: 5- N Floor Load: Third Floor: Occupancy Group: / 2 3 Dwelling Units: Bonus Room: Valuation: 35- � i 5 el ti Bedrooms: y Total Floors: 3 i Bathrooms: 3 Basement: Decks: — Garage: 66 7 0 Porches: a5 41 Other: FEES:. Description: Fee oust: = Amount Paid: '`- Balance Due: Plan Check: Building: ' 1 - � 3 9 . 'Z 7 75 Extra Set: Permit: Building: ) 91St . 4s 7 Tax: a 7- 4(6 Metro CET: qv) [) , a 6, School CET: 3 a o 2. o0 Mechanical 2 ;. 30 Tax: i ti • 6g • Plumbing: 399.00 Tax: it 1- 4 it Electrical: 3 4S• S Tax: 1 1 y 7 Low Voltage: -- Tax: — CDC: CDC Ping. Rev.: lif ( CDC LRP Fee: 6 . Uo SDC: Parks: S 370•00 ti s.: 1- 15 - 9 y - 00 YIP MT: //2 bJ Erosion Permit: 36 ' u n Erosion CWS: 3 6- c i o Erosion COT: Water Quality: ;2, Water Quantity: �7 5' SUB - TOTAL: /i g 69. 9L( Sewer: Permit: Inspection: SUB - TOTAL: TOTAL MST & SWR: I:\ Building \Forms \ResPlanCheckFees.doc 01/19/07 Page 1