Permit / MASTER PERMIT
CITY OF TIGARD
a ° PERMIT #: MST2008 -00146
COMMUNITY DEVELOPMENT DATE ISSUED: 9/24/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 134AC -01700
SITE ADDRESS: 11397 SW IRONWOOD LP ZONING: R -4.5
SUBDIVISION: ENGLEWOOD LOT: 045 JURISDICTION: TIG
PROJECT: GEORGE
Project Description: 429 sf. garage addition. Gas meter being relocated.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: 429 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 20,000 00 REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
BRUCE & JONI GEORGE RESTORATIONS BY K & C INC laws. All work will be done in accordance with approved plans. This
11397 SW IRONWOOD LOOP 3523 NE 119TH AVE permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 PORTLAND, OR 97220 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through 952- 001 -0080. You may obtain copies of these rules or direct
Phone: Contact #: PRI 503 936 - 5361 questions to OUNC by calling 503.246.6699 or 1.800.332 2344.
FAX 503 - 256 -6212
Reg #: LIC 170416
TOTAL FEES: $ 648.79
REQUIRED ITEMS AND REPORTS
Issued By `/ / / '� i lir Permittee Signatu :
Call 50' `5 by 7:00 a.m. for an inspection that business day.
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.
Building Permit Application
Residential � ,4 FOR OFFICE USE ONLY
City of Tigard ck A ,- Received /�� permit No r , -
1111 si - s'' Tv- Date /B _/ /
13125 SW Hall Blvd., Tigard, OR !72 3 N. 'J Plan Review t
Phone: 503.639.4171 Fax: 503.598.19600 � �� #, Date /By . Li • Og Other Permit:
TI GA R D Inspection Line: 503.639 � S ` t Date Rea dyBy: lures: Fa See Page 2 for
Internet: www.tigard- or.gov ` 1 \ 1 * 0 0° NotifiedlMethod. 776. Supplemental Information
- TYPE OF W } , REQUIRED' DATA:;f AND.2- FAMILY DWELLING'; ' =°
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
L ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY; OF work indicated on this application.
—nd 2- family dwelling ❑ Commercial /industrial Valuation: $ ��� �dG
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
J.OB``SITE. MATION „ LOCATION , 'a;' ° " = , a" Total number of floors:
Job site address: t t ; CO �C, - '
_t Oe [AO.0 0 :Q 1,0 o 1 New dwelling area: square feet
City /State /ZIP: ��_ C/\ ti 0 >I Garage /carport area: y '# square feet
Suite/bldg. /apt. no.: Project name: Celli— Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
•REQUIRED"DATA:'COMMERCIAL-USE CHECKLIST ",F
Subdivision: 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
- " '' 0' 'b "• ..,
DESCRIPTION OF WORK !c,.. _ " :,` work indicated on this application.
CA 11 ik A 6 � O A ..-.3.0e—) Valuation: $
�l 0/ Existing building area: square feet
New building area: square feet
.4 'a
7°,ti4` ' ®, PROPERTY- OWNER`. �' • r , ❑.- 1'ENAN`I'� Number of stories:
Name: /1 (f Cfter/ITC Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax ( )
New:
; , a APPLICANT' • . • ;. ., ❑'� CO NTACT, PERSON, . , icf-cs - ,, NOTICE " -; ' ..;
Business name: Q S fi A t �Ur5 C All contractors and subcontractors are required to be i
Contact name: IC.WL -r4 4.--) (",/O Acir4 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 5'1_3 f"� `, jurisdiction in which work is being performed. If the
City /State /ZIP: U /` -iko■,, 0e� . applicant is exempt from licensing, the following reasons
� 2 r c, "6 Z f 'L apply:
Phone: r
(co �G`�) C (3 C�j••�y G � Fax: (�� 257 44
E -mail:
30-ER
µ , , r'r CONTRACTOR.. » ; :
Business name: �a jt,I Q , '', - , ' ' • ” ' _ BUILDING, PERMTT FEES* .
Address: . -: (Please refer to fee.schedule)' a , _, , . • -
City /State /ZIP: Structural plan review fee (or deposit): `6 `, • .
FLS plan review fee (if applicable): -- -/
Phone: ( ) Fax: ( )
�/ Total fees due upon application: I7
CCB lic.: l ] `.� (C
Amount received:
Authorized signature: r Thi permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: r C 46) ����_ Date: 1 I /Slay * Fee methodology set by Tri- County Building Industry
I Service Board.
I: \Building \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(I l /02 /COM /WEB)
•
Building Permit Application Checklist ,
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigar Received
Permit No..
i - v 13125 SW Hall Blvd., Tigard, OR 97223. Date /By.
Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
- TIGARD
24- Hour Inspection Line: 503.639.4175 ❑ Electrical CI Plumbing ❑ Mechanical
Internet: www.tigard- or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N /A:
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. ❑ ❑ ❑
4 Fire district approval required. Name of district: CI CI ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state • ❑ ❑ ❑
building codes. • Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
•
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of 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. ❑ ❑ ❑
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 ❑ ❑ ❑
architect licensed in Oregon and shall be shown to be applicable to the project under review.
•
JURISDICTIONAL SPECIFICS ..
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- 4613T(11 /02 /COM/WEB)
Mechanical Permit Application F O F F ICE us : O N LY
City of Tigard ReceiDateBy: ved � Pit N
q 13125 SW Hall Blvd., Tigard, OR 97223 q liil/ ��� erm o.: �1 l 2 � / �
Vi i t
Phone: 503.639.4171 Fax: 503.598.1 � o Plan Review MAME
Date /By:
( 1 Other Permit:
,, ,.+
Inspection Line: 503.639.4175 c�
T I G AR D `* Date Ready /By: 1Z1 See Page 2 for
Internet: www tigard- or.gov 4`��t Notified/Method. BM Supplemental Information
Si .w.. %AO
TYPE OF WORK;' 'r, - COMMERCIAL FEE* SCHEDUL .= USE'CI3ECKLIST'
❑New construction ❑ Addition /alteratiohbt8 l �r tt�A��� Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition ❑Other: � y C�`� mechanical materials, equipment, labor, overhead, and profit.
- CATEGORY O F CO NSTR U CTION ' . t' Value. $
❑ 1- 2-family dwelling , RESIDENTTAL ,EQUIPMENT1 *,�
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
i ° "� '� J OB � 'SITE', INFORMATI AND 'LOCATION, ,, _ . , , t Heating/cooling
A Air conditioning or heat pump
Job site address: 1/ 3'7 -7 . _LvoC Z, (requires site plan showing placement) 14.00
City /State /ZIP: 7-700/ / C/ � Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: Project name: 0 Gas heat pump 14.00
Cross street/directions to job site: IIJJ`` Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
, '_. , DESCRIPTION' OF D WORK., , ,, a Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
❑ ;PROPERTY - OWNER, , , ❑..TEN AN T . : Chimney/liner/flue/vent mer /flue /vent
B Other: 10.00
Name: x /;ce Environmental exhaust and ventilation
vv�� CY �j�'� Range hood /other kitchen
Address:
(/ equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
, � -` 0' A D;. CONTACT° PERSON. - -' Attic /crawlspace fans 10.00
Other: 10.00
'
Business name: D Shiva, -, � 6 y /! ()LC >i Fuel p iping
v
Contact name: j /�, r ^ „ /„ ^ / C M v� " v $5.40 for first four; $1.00 for each additional
J
Address: �-� d` . v � // 9 Furnace, etc.
Gas heat pump
City /State /ZIP: Pa Mi/liof 1 O- . Wall /suspended/unit heater
Phone: (5C) �/ 6 --5 6, / l Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR "- Barbecue
J �i �-� Clothes dryer (gas)
Business name:
� .J I t Other: To - A ko tiJ. , I
Address: f� ,
(� p
� f}21� � � Ytwr, MECHANICAL PERMIT FEES* : "_ : .
��. Subtotal ��
City /State /ZIP:e/}� P-_-, y e) /2. 9. ? � � ,
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lie.: a 7 7 2 , pl . State surcharge (12% of permit fee) 8 '
1 n l TOTAL PERMIT FEE 10
Authorized signatur. Lk)
. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
V ,
Print name: K Er -fiviri v / 4 ` /, Date: 9'�c�((� 8 * Fee methodology set by Tri- County Building Industry Service Board
\ \ M
I \ Building Permits EC- PermitApp.doe 01/19/07 1 440 -4617T (11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
`TofalValuation. Permit; F`ee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
+� e eived / Permit No.:
c ° ] 3125 SW Hall Blvd., Tigard, OR ' V t Z71 TMZOn s ,, 40,4b
��
Plan g � an R ev i ew
t Phone: 503.639.4171 Fax: 503, u 1 7223 1960 � � l Date/By: Other Permit:
T I G A Rv vv
Inspection Line: 503 639.4175 U n Date Ready /By: ions ® See Page 2 for
Internet: www.tigard-or.gov
C.GP 4ZOU Notified/Method: rO Supplemental Information
''TYPE_ ° OF WOR I s ;PLAN REVIEW' - . , • -
❑ ❑ Addition /alter s r l n r_ ace ce mp
s • %,, I `pt� Please check all that apply (submit 2 sets of plans w /items checked below):
❑
New construction t \l a l
�,` C Service or feeder 400 amps or more ❑ Building over three stories
El Demolition ❑ Other: �Q 94\ Doe where the available fault current ❑ Marinas and boatyards.
CATEGORY OF: CONSTRUCTION ,, ` - ,*, '.' - i r. � exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
= , less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
i ' %'* - %," ` ❑ Emergency system. larger separately derived system. • JOB' SITE,, INFORMATION -AND 'LOCATION' ''` „ #
`$_ = El Addition of new motor load of
❑ "A" " E" "1 -2" "1 -3°
P Job site address: 3 � '' ',,` 100HP or more. occupancy.
Job no.:
/� J / / �/ GF ✓�� 0 or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: T ❑ Health -care facilities.
El locations. ❑ Supply voltage for more than
/ 600 volts nominal.
Suite /bldg. /apt. no.: f Project name: a I ❑ Service or feeder 600 amps or more.
- - . , ", a..: '''-FEE' SCHEDULE , •-. , , - •
Cross street/directions to job site: Description I Qty. I Fee. I Total I b ,
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
-- . , ?' -� 44,DESCRWTION,'OF WORK '' (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
- -- 4 5 - Er PROPERTY •OWNER" j .. -la .❑. TENANT p ° .,r. 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
r G2 6r-el-e-- 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. ": , . �' ill' ,;APPLICANT . , may .'�;� CONT PERSON above service or feeder fee,
Z--,-4-. each branch circuit 6.65 2
Business name: �/ 1" �l /� CI-- - G B. Fee for branch circuits
/, / / 9_ !� t without i rthout service or feeder fee, 46.85 L 2
Contact name:
//� (/j'� OVV C/UA Arn/ first branch circuit �0
Address: l /� Each add'l branch circuit I 6.65 2
3��3 / Q � - Miscellaneous (service or feeder not included)
City/State /ZIP: /9 �� /C Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (5o'S ) c r 3 , v - J ' ,/ Fax: : ( ) Reconnect only 66.85 2
E -mail: "" Pump or irrigation circle 53.40 2
, , °' , ' ,' ,: ''..7':, CONTRACT >4 " + ' ' - Sign or outline lighting 53.40 2
/� G
EL circuit(s) or limited -
Business name:
L`r� L G C�� / t � energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 62.50
CCB Lic.: I Electrical Lic.: I Suprv. Lic.: Industrial plant per hour 73.75
,`A ELECTRICAL PERMIT FEES ,'• .. _, `? .
Suprv. Electrician signature, required: Subtotal: 5 `{ 7 v
Print name: I Date: Plan review (25% of permit fee): / f
State surcharge (12% of permit fee): (p •
Authorized signature: �} TOTAL PERMIT FEE: 5 ot
1cr...------- This permit application expires if a permit is not obtained within 180
Print name: , I I ��^ ``` 2� D (/ p pp p p
�" '��1.p -�q � �/V ray !J � (� ! days after it has been accepted as complete.
' Number of inspections allowed per permit.
C \Buitding\Permits \£LC- PermitApp doe 05/23/06 440- 4615T(t 1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information ..
LIMITED ENERGY PERMIT FEES:
i R ESIDENTIAL W ORK:ONLY: r
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
f COMIVIERCIAL4WORK'ONI:Y:. ,, :-,
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
I - 1 Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
O Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06
Sep. 23. 2008 2:15PM No 1086 P. 1
uer air uu i P• 1
. • Sty. 16. 2008 11, 58AM —" No. ]03? P. 2
p C CI[IdLE 7
.
•
I s n . ii;
'
Clean Water Services File Number
` tW
ay ab4ervices llfit ' " . A!
Sensitive Area Pre - Screening Site Assessment
•
1. Jueetscltun: Na. cki _ ,
2. Property Information (example 1S234Aep1400) 5. Owner intonation
Tex lot 1D(a): Name: (j (Lh CE Geer e
Company:
Address: sAme
siteAeereas tl� 3,IN- SAD "'Won Lf City, State, Zip:
City, Slate. 2Is; 'T$(a t o, it-0 J 0 ". E_ — PhoAa /Fern:
Nopteal Goss SI(eei: C 4oe-$ f` E•Mall:
4. Uevei pmentActivity (cheek 0. Applicant Information
• l a l' o Non -to Single Famill+ Residence (moms, dcok : Name: Ke.(1'tJA e.) L.0 A � N E rt-
I ] lot Line Adjustment r i War lend Pettttion Company: _ RaSTO( - CZ D's r IC d C _J 1 C.
. Q Rusldenne) CondomintuM 0 Commercial Condominium Address: _,3 -3 N ..k \�
in Residential Subdivision D cbmmercis subdmsfon CIIy, State: 4.. P c■tiT-A,"1 001.5 91221I0
SNIP Lot Commereial r] Multi Lot commercial PhonelFaw: SO3 ^ 3C2 —53 .S - 2_5 :. -4 L 1 L
Other
E•Mag:
G. WtII the project involve any off -elte Work? f Yes pit 0 Unknown •
Location end description of off-elle work
7. Additional commonte ortntormettoir that may be needed to undorelond your prop ot 1 _Kt 3 q AnA GE .
Ato tD TIar' — ?._,iPxt prtaTN>' TJ S CsN c.t. ..__..
11 ,11 application does NOT replace Wading end Emden Control Pem,ite, Connection Permit;, Brdl4Ing Pamdlo, We Development Pernilt9, DEQ
1200.0 Permit or other permits 96 groped by (he !Nemirow( of Envirenmon(al QUalety, Cep/Amen' of Stale Lends andfer Depadmenl et the Army
GOE. All moulted permits and approvals must be obtained end completed under appficebro meal, elate, and federal Into,
By signing min term, ma truly( or Owners authorized agent of teprelertlalve, ackeowledge( and vats Net ant yees tithes Water SBMOeS hale Wholly
lo enter the protect elle at all reaeoneble lanes ter the purpose of Impeding project site eonddons and gathering formalim teleted to NB proled elle. I certify
Mall am temiliar with the intern non oonfeined in Oils document end to the best of at/knowledge and belief, thhj Is but, cemptete, and accurate.
Print/Tlrpe Name ...e 01') A r) W A E". Pr1nV pe Title ` I LES , Qp, -
Signature �( 0 Date CI % I 1 (91
FOR DISTRICT USE ONLY
L1 Sensible arrow potential/ eiel oh site et Within 200' of the silt. IRE APPt1CART MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
• SERVICE PROVIDER LETTER. II Waite Areas stet on the silo or wenn ZOO feel on atlaccnr propalipa, o Neluret Racovrcea Mammon! Report
tray also be required.
• ) (Bated on (View of lire submitted matadals and best available INrxmatlon Sensttlya meet dent appear to erasion alto or vr4hin900' 01 Ito silo, Thu
Sensitive Mee Pre•Sctaaninp 500 AttA5SMOTA does NOT a11minte the need to evaluate end ptcted water Audit/ sensitive meal d they are subsequently
discovered, TN; document will solve as your Service Presider letter es respired by Reoclulien and Ordm 07-20, Section 302.1. All tagUlled permits and •
approvals meat be obtained sad orrrptated under applicable local, Slate, and federsf law.
0 Dosed on review of Ike submitted welarials end best swastika kitennation lire atm rem raced protected not 81001011W impact preaaisltnp or potemiatly
sentlfke Wee(a) rewriters the lib. fhb Sensant Area Pre•Screeting SkeAssesernent dose NOT eitnbata the need to avaruate end pretest ed?rtianal water
yuelily smash* areas I they are subsequehtty discovered. This doaarcnt t tl servo en your Service Provider loiter as molted by Resol(11ton and Order
07 -20, BeNion 3.02.1. All required permits and eppmvetc must be oblarsed and completed under ;polls able lout elate and Moral law.
Q Thte Servlea Provider Lefler Is not valid unitise CWS eismoved she plans) are snaked.
0 The proposed activity does hot meet the dsrininon of development or the tot des platted elm 919193 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDE LETTER IS REOUI Cr.
.•.— Date 7 Z3 DS
Reviewed by —
-, i� F c l: Q ?;:c•.f,, • FPI (L b Fi t,r'i! o:cl r7, t �:K ( 1
,5 pj p ■l tl. ah'no , 7 ■uF,f1 F.'Is'go,o drt,9 i.17 ., ..
g,
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: MST200t3.00 i�i6 9/24/2008
Phone: (503) 639 -4171
A Il i
Inspection Requests (24 Hrs.): (503) 639 -4175 s
INSPECTION WORKSHEET FOR DATE: 10/1/2008 TIME: 7 :t1 ?AM PAGE 14
■
SITE ADDRESS: 11397 SW IRONWOOD LP
CLASS OF WORK:
SUBDIVISION: LOT #: ,- TYPE OF USE:
E
PROJECT NAME: NGLEWOOD 04.E
GEORGE
DESCRIPTION:
429 sf. garage addition. Gas meter being relocated.
OWNER: GEORGE, BRUCE & JONI PHONE #:
CONTRACTOR: RESTOR BY K & c INC PHONE # 503-936-5361
Inspection Request Scheduled For: Date: 10/112000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
235 Shear walls/anchor 076160.01 503.938 -5361 Y
Corrections/Comments/Instructions:
ei) o _
- \
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Via-- >_c $ Phone #: (503) 718- -,¢45/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST 2008-00146
00146
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/24/2008
Phone: (503) 639 -4171 • ��I+�
Inspection Requests (24 Hrs.): (503) 639 -4175 ,.:' ":_..
INSPECTION WORKSHEET FOR DATE: 10/1/2008 TIME T:02APV1 PAGE 13
SITE ADDRESS: 11397 SW IRONWOOD LP CLASS OF WORK:
SUBDIVISION: f NGLE1di/OOD LOT # 045 LOT OF USE:
PROJECT NAME: GEORGE
DESCRIPTION: 42 sf garage addition. Gras meter being relocated.
OWNER: GEORGE, BRUCE & JONI PHONE #:
CONTRACTOR: RESTORATIONS BY K & C INC PHONE #: 503- 936.536I
Inspection Request Scheduled For: Date: 1011/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 076160 -02 503.935 -5361 Y
Corrections /Comments/ Instructions:
PASS D PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /- Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2008-00146
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/24 /2006
Phone: (503) 639 -4171 + �
Inspection Requests (24 Hrs.): (503) 639 -4175 s' R'f_L.
INSPECTION WORKSHEET FOR DATE: 10/1/2008 TIME: 7:0 PAGE: 12
•
SITE ADDRESS: 11397 SV'! IRONWOOD LP
CLASS OF WORK:
SUBDIVISION: NCItDD LOT #: 046 TYPE OF USE:
PROJECT NAME: GEORGE
DESCRIPTION: 4.9 st_ garage addition. Gas meter being relocated.
OWNER: GEORGE BRUCE & JONI PHONE #:
CONTRACTOR: FlFSTO�tf�
RESTORATIONS BY C INC
#: 503 - 336.536 1
Inspection Request Scheduled For: Date: 10/1/2008
Pour Time:
Code # Inspection Description Confirm # Contact # Message
250 Roof nailing 076160 -03 503 -5361 Y
Corrections /Comments /Instructions:
PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: J6 / l Phone #: (503) 718 -
P ��
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
MST200 3 -00146
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9./
Phone: (503) 639 -4171 ri .
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/1/2000 TIME: 7 :02AM PAGE: 10
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 11397 SW IRONWOOD LP
LOT #: TYPE OF USE:
PROJECT NAME: E NGLE OOD 045
GEORGE
DESCRIPTION:
429 sI. gal age addition. Gas meter being relocated.
OWNER: GEORGE, BRUCE & JONI PHONE #:
C ONTRACTOR: RESTORATIONS BY K & C INC PHONE #: 503-936-5361
Inspection Request Scheduled For: Date: 10/1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 076160-05 503936.5361 Y
Corrections/Comments/Instructions:
•
❑ PASS ❑ PARTIAL APPROVAL — CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: iii, Date: /fj — /ill o U / • Phone #: (503) 718- -_
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2008-00146
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/24/20011
Phone: (503) 639 -4171 las - "' A,
Inspection Requests (24 Hrs.): (503) 639 -4175 ` .L
INSPECTION WORKSHEET FOR DATE: 10/1 /7008 TIME 7:02AM PAGE 11
SITE ADDRESS: 11397 SW IRONWOOD LP CLASS OF WORK:
SUBDIVISION: ENGLEWOOD LOT # 045 TYPE OF USE:
PROJECT NAME: GEORGE
DESCRIPTION: 429 sf garage addition. Gadss meter being relocated.
OWNER: GEORGE, BRUCE & JONI PHONE #:
CONTRACTOR: PHONE #: 503 936-536'1
RESTORATIONS BY l: & C INC,
Inspection Request Scheduled For: Date: 10/1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 07616004 603- - 6361 Y
Corrections /Comments /Instructions:
///e 6t � L�Gf72-r e.13G Ql i L'P'
❑ PA ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED • Inspector: I Date: /---/ --- _( Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST'2008 0U146
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/24/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 - 4175 Vtitil
INSPECTION WORKSHEET FOR DATE: g�2d 2008 TIME: 7:0()APJi PAGE 15
SITE ADDRESS: 11397 SW IRONWOOD I P CLASS OF WORK:
SUBDIVISION: ENGLEWOOD EYVt)OD LOT #: 045 TYPE OF USE:
PROJECT NAME: GEORGE
DESCRIPTION: 429 sf. garage addition. Gus meter being relocated.
OWNER: GEORGE, BRUCE & JONI PHONE #:
CONTRACTOR: RESTORATIONS BY K & C INC PHONE #: c03 936 5361
Inspection Request Scheduled For: Date: 9/25/ X008 Pour Time: 1 :00
Code # Inspection Description Confirm # Contact # Message p
205 Footing 075936 -01 503-936-5361 Y
Corrections /Comments/ Instructions:
/1 1 Po /) e.)(A. ►-, S 4 be s," F € J / .s f - G 5, (r ...":„
r
2 i q ✓r
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0- Date: 0 5 S f0 B Phone #: (503) 718- 2 % -73
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2008-00146
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/24/2006
Phone: (503) 639-4171 , 1 ICI
•
Inspection Requests (24 Hrs.): (503) 639 -4175 �_' `+� °:_..
INSPECTION WORKSHEET FOR DATE: 9/ 25/7008 TIME: 7 :00AM PAGE: 14
SITE ADDRESS: 11397 SW IRONWOOD LP CLASS OF WORK:
SUBDIVISION: ENrt EWc:ytaD LOT # 045 TYPE OF USE:
PROJECT NAME: GEOE OF
DESCRIPTION: 4 si garage addition. Gas meter being relocated.
OWNER: GEORGE, BRUCE & JONI PHONE #:
CONTRACTOR: RESTORATIONS BY K & C INC PHONE #: 503,936.636I
Inspection Request Scheduled For: Date. ' 9125/2008 Pour Time: n
Q
Code # Inspection Description Confirm # Contact # Message ` PJ
610 Gas line 075936.02 503936.5361 Y
Corrections /Comments /Instructions:
_A+ L2S esr rcdr I 5 vA
PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,S Date: 4253.ep Phone #: (503) 718- ' '2 3
CITY OF TIGARI) - SITE PLAN REVIEW A pr_
BUILDING PERMIT NO: ,er157' 2 5-- - £0 1 ` I 6
Street Trees: (' Approved ❑ Not Approved
Protected Trecs: trE Approved ❑ Not Approved
By . p 1 ( Date: //G/ f — L
Notes: .�--' —_ ---- 1
"7 . c '':_ . --
t
O EJ.-
1
0 0 •
lir CITY OF TIGARD - SITE PLAN REVIEW _
BUILDING PERMIT NO.: Tr) ` AIVA %�����..� f7�1
PLANNING DIVISION:
Required Setba-• Street Side: cks: ❑ Approved ❑ Not Approved
Side:
��
Front. Garage:: Rear:
�`� - Visual Clearance: ❑ Apurbved ❑ Not Approved
Maximum Building Heigh:• . le:
CWS Service Provider Lctrer K enutreu. Yes 0 No
j Received
•
lea: �1te� Date: ctilo0v
- ENGIN�G DEPARTMENT:
/ Actual Slop ' 3 % Approved ❑ Not Approved
( Site P n: (' 'Approved ❑ N t Approved
By: Date:
Notes: a- ° `itLeM s _.—
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ilt 8
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