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Permit JO //q /lo okAc (,) -L r n CITY OF TIGARD MASTER PERMIT a - COMMUNITY DEVELOPMENT Permit #: MST2010 -00085 TIGARD A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2010 . I Parcel: 2S103CD04500 Jurisdiction: Site address: 13543 SW PIPER TER Subdivision: TINDALL PARTITION Lot: 1 Project: TINDALL Project Description: New SF. 10/19/10 added (1) feeder B.T. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1559 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1473 sf Garage: 600 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $325,987.92 Rear: 15 PLUMBING Sinks: 3 Water Closets: 3 Washing Mach: 1 Laundry Trays: Rain Drain: 1 Catch Basins: Lavatories: 5 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: MECHANICAL Fuel Tvpes Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: Fum <100K: 1 Vents: Woodstoves: Gas Outlets: 5 Fum > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add! 500 sf: 6 20 1-400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea addl Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: 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) LAWSON, BRENT E OWNER 1 MST Ersn Cntrl 503 - 681 -4444 7524 SW RED CEDAR WAY TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $17,469.10 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 OA 952 - 001 -0100. - • • - • - copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /-� Issued By: Permittee Signature: <'/ Q Y i10 9 / ��- Gf�fir �*a . CITY OF TIGARD MASTER PERMIT 111 COMMUNITY DEVELOPMENT Permit #: MST2010 -00085 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2010 T(CARi� 9 Parcel: 2S103CD04500 Jurisdiction: Site address: 13543 SW PIPER TER Subdivision: TINDALL PARTITION Lot: 1 Project: TINDALL Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1559 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1473 sf Garage: 600 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $325,987.92 Rear: 15 PLUMBING Sinks: 3 Water Closets: 3 Washing Mach: 1 Laundry Trays: Rain Drain: 1 Catch Basins: Lavatories: 5 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: MECHANICAL Fuel Tvpes Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: Fum <100K: 1 Vents: Woodstoves: Gas Outlets: 5 Fum > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea addl 500 sf: 6 20 1-400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea addl Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: 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) LAWSON, BRENT E OWNER 1 MST Ersn Cntrl 503 - 681 -4444 7524 SW RED CEDAR WAY TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $17,356.32 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. • - ` • •. • - gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 $01 -0010 through OA` • - - •01 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Iss • • By: /_' ` .� Permittee Signature: PLA/ /E1J0.-. Oft_ "cif ffjJ?I/,o Building Permit Application % q ( ` • _QooC 5 Residential FOR OFFICE USE ONLY City of Tigard Date/B ved A Permit No.: u - 13125 SW Hall Blvd., Tigard, OR 97223 :� Plan Review Other Permit: • 0 Ph one: 50 3.639.4171 Fax: 503.598.196tt��j Date/B : t . M I O r I C. n It 1) Inspection Line: 503.639.4175 R C i Date Ready/By: Juris: ee Page 2 for Internet: www.tigard- or.gov 1_ Notifies ethod: A hi • ri.G Supplemental Information 7 � � - • , TYPE OF WO ' ,o' GpR� REQUIRED DATA: 1- AND 2- FAMILY DWELLING [ New construction ❑ i � DVISk u Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition /alteration/replacement [r. equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: S -226- 4 67 9Z- 1- and 2- family dwelling ❑ Commercial/industrial —) c ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: Z Job site address: t 3 5 4 3 S W t' ", -r New dwelling area: 3 j b - • square feet City /State /ZIP: 1: 9 0,rc1/ 0 2 q 7 2 3 Garage /carport area: 6 D a square feet Suite/bldg. /apt. no.: I Project name: 1 _ 0 , , . . , 4 0 , (2, le,,, cc Covered porch area:2 square feet il.' Cross street/directions to job site: t, Z i'± 4•0 h4-1-4,-- Loup -{, SW Pee. Ter Deck area: 6 0 square feet k5.5 Other structure area:3 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: 2_ Permit fees* are based on the value of the work performed. Tax map /parcel no.: 2 9 3 C — ! �) g 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. Alt-La Cotj e2 � Valuation: $ Existing building area: square feet New building area: square feet [PROPERTY OWNER ❑ TENANT Number of stories: Name: 'Q re,,, A.. L p, S o ,, t Type of construction: Address: ) 3 500 St„ 1 2 1 `. f4v L Occupancy groups: City /State /ZIP: 'r i5 qr�i �� q 72 Z Existing: Phone: ( So'i) go S — 7$ So Fax: (CO3 ) 796 — 4 3ci 1 New: ErrAPPLICANT ❑ CONTACT PERSON NOTICE Business name: • * !,-S p rve.e , 4- a w „ All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) • I Fax: : ( ) 0- • Qui+ei r-� /� t 4 - at t E -mail: F -egS 2tau I /2- -b /•` E,e, CONTRACTOR MI I4>< W• Business name: C ,, c.,s pro per d-y o w y&" BUILDING PERMIT FEES* Address: (Please refer to fee schedule) Structural plan review fee (or deposit): City/State /ZIP: FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) - CCB lic.: Total fees due upon application: -4 7540-0° Amount received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: S — S— 20 t 0 * Fee methodology set by Tri -County Building Industry Service Board. I: \Building\Permits\BU - ES PermitApp.doc 10/01/09 440- 4613T(I I /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling I OIr ) I IC1 IIS1 ON1 ,,• City of Tigard Received `, g Date By: Permit No.: :. 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: III ®' Phone: 503.639.4171 Fax: 503.598.1960 - I 10 A10) 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other: 1 nc 14) LEO W1Nc. 1 EMS ii F. 12 U iRFI) rOii PLAN IZkV «' ' ,es `'''s' iV„ 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: ❑ ❑ ❑ 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. f 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state Q ❑ ❑ 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. 1 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 ❑ ❑ ❑ 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 Ore. on and shall be shown to be ap plicable to the .ro'ect under review. -'JURISDIC Il()NA \I'. SI'I.CII ICS : T. ! ; r Three (3) site plans are required for Item-11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 2 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 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, ❑ ❑ ❑ 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 RES- PermitApp.doe 03/21/06 440- 4613T(I I /02/COM/WEB) Lm,.. _rJvt CP Electrical Permit Application •J g Date/B J I o ...40 ill III Ci of Ti and y 5 f / 3 / 677- Permit No.: sT )0kr _ (jai ys �� /� ' Phone: 503.639.4171 Fax: 503.598.19 Date/By: , r• Date/By: Other Permit: I I c I n li D Inspection Line: 503.639 c� ` Date Ready/By: Juris. Ei See Page 2 for 1 J I Notified/Method: Supplemental Information Internet: www.tigard-or.gov _ / . TYPE. OF WORK - \` '` r . . G �1GV l cI O ` ` . PLAN • REVIEW El New construction ❑ Addition/alterat �` Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑Other: �� where the available fault current ❑ Marinas and boatyards. CATEGORY OF 'CONSTRIISION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 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 JOB SITE aINFORMATION AND LOCATION' ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 - ", Job no.: Job site address: 3 54 3 9,,, 9:624, Ter 1 Six or or more residential Recreational ❑ Six or more residential units. ❑R vehicle parks. City/State/ZIP: p (412.7 ❑ Health -care facilities. ❑ Supply voltage for more than T' 9 A.✓ 0 Z. "5 ❑ Hazardous locations. 600 volts'nominal. Suite/bldg. /apt. no.: Project name: (, as,. eili.,44e ❑ Service or feeder 600 amps or more. - .FEE SCHEDULE Cross street/directions to job site: 1 Z.1 ` 4_e LnJI.R ,(,er_(_aor A-a P-64 Te r Description 1 Qty. 1 Fee. 1 Total 1 " New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 2 1,000 sq. ft. or Tess i 168.54 (� - 4 Tax map /parcel no.: 2 , 3 C p - 'f' ��,,(( 9 g Ea. add' 1 500 sq. ft. or portion b 33.92 - 2.03,:c 3 7.1 J Y7' Limited energy, residential DESCRIPTION OF WORK: .. ' . (with above sq. ft.) 1 75s . 7 ) 2 Limited energy, multi - family residential (with above sq. ft.) 67.84 5 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 • ROPERTY OWNER . . . . ❑ TENANT . .. . 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: $ 4_ Lt1 On 601 amps to 1,000 amps 301.04 2 Address: \'3-o V 5 - w t ... t — / 4 LAC J Over 1,000 amps or volts 552.26 2 City/State /ZIP: -r Temporary services or feeders installation, alteration, and /or 1 50, - d Z . 7 2 Z relocation Phone: (Sa; ) Sod _75.5. Fax: (So 7 ) 1L64 34/ 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exc ge, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 � J Branch circuits — new, alteration, or extension, per panel Owner signature: - —..-- Date: S —L — 24) la A. Fee for branch circuits with above service or feeder fee, ❑' T , • . 1 ❑ CONTACT 'PERSON 7.42 2 each branch circuit Business name: S 0.tn.R_ a 0 t,,,,w� B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 tY dwelling, service and/or feeder Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: - OW , i/l_J 'N panel, alteration, or extension. Page 2 2 �`+� Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr specifically listed (%x hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL .PERMIT 'FEES . Suprv. Electrician signature, required: o Subtotal: Plan review (25% of permit fee): . Print name: o „ Date: State surcharge (12% of permit fee): F3 , lD TOTAL PERMIT FEE: SO 0 1 ( Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. N um b er of inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(I1/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: j ;RESIDE-NTIAL -WORK ONLY: Fee for all residential systems combined ... $67.84 Check Type of Work Involved: Er Audio and Stereo Systems* ❑ Burglar Alarm Et Garage Door Opener* Q Heating, Ventilation and Air Conditioning System* 0 ' Vacuum Systems* ❑ Other: COMMERCIAL.WORK ONLY: Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: _ *No licenses are required. 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' NI #1 r • gi, 'G.' Ato Wel IMMIIPAINOS gria tO Oa : erga" moll Pme0 - 70kolritri otrovol gems gog.44 — - ow pgri11.110111 _..............___-. 1 --- g am In) we 111110011 r2,1. A. k• iti 0 8 .- ' 414 : 4. :41r1.4motscat.) ...... .. ..... go . - • — - — as 1 .4 f j,- , 4. 1 =gm Ng ger t• c.o.. :•::, ,%„4 .4. '...',!::,, t • .17.4,1'4. geidiVr.;:ti,:::.?: ryas': ' ( I k ' .--- 1 Mikado kJ ;ARV ri Aolval awn 0 ......„. ...... ._.. .. .piq� is heamlippi a SUIRsexe Aforecesay n ■ "iiii(tYitio ryampailmtezNaviago, 0 tompae issig-t Pa .1 i. Eilll • . ..71 . .....• , ,. 3 r,•• v• r , % .7..1 ". , `.•71), 4.,‘,. .' t-41...A. • . *IR SO no • , ...+ -° '' !A'',. kiilvirki., • ...-.4, -.:•.-^4.46 i -- .4',...A....::..4-:-.6.1....r..- • aufPlawa to*. go 1 oot ax•42.13 dkullikor igorItT N 1 . ...‘ . a Mt 1 oggiugg ,-- . ..., ongemaglare amegja T.-7-170 11 ..._;ei 0 _ ... , .-.4- , -- - . .. .. ,... • - . . . ).$.. . i.. -..-.., . -.-..:....,,..,.:;., ...... — - . Mal/04.4. s***I . 12,,, ,...-. t mo I diNi «a go mg - ..-.1--.....4 - 46,910•11 OW 1 ‘ ' - ,, 4 1/4 )'.: swarms 'Nil 4 ':-__, , - .L.. : ..1 MUM &MO : . Xiiial $ 11 fix 3014 maracas ~14 X0 - pa PIN AO a ICI ,...! : Awe - 0041-ts....i ',.;.-,,,,,,-: ,-.---•:- ,.,,,••••--, '..-.:-: • '• , -,-. • 7' ' :. r 'f. ',-: 7- '..' .'"•-,-- • '' ": . :-- :', (0 gagnallit 141 Willra , 0000— ?. ''''' • " ! 90 ••• ''''' . " • aeginfiddV Wand ltalqUAILL 4 i Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or <<,„ I will be performing work on property I own, a residence that I reside in, or a residence that I will . reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. E ft s — 1-Jad-A-Ovt Print Name of Permit A! _ '.: nt gnature, - ermit Applicant Date Permit #: NiT" 9 is 6.®O ' /3 3 I PA 'TA* Address: - p'?uj /6, v 2 70.3 ,....... .;, Issued bye Date: t /5 I D Eli This Copy for Permit Offices 09/29/2010 19:22 FAX 5035942873 PRECISION NW la002/002 Electrical Permit A licatio etDiti FOR OFFICE I1SE ONI X City of 'figard * , i*, N'k)h lteeeived Datc/B : .‘ , ii,..1 nit Nu.: pv-n act) • II 13125 SW Hall Blvd., Tigard, OR 97223 . ? .., k) \ ` ' Plan Review I • Phone: 503.639.4171 Fax: 503.598.19ik ". nste/B . Other Permit: TIGARD Inspection Line: 503.639.4175 ? WI P ° --......._ ... Date Ready/By: kris: FE SeerffilI111111/ Internet; www.tigard-or.gov ci .....- '"C Nx s ‘ ,,, ci IN Notified/Method: Supplemental Information ' •:: • . •.• ..• ttirpOOtit, .,' 1;, ;.,.;. 0,1:1„,;,,if,:;:14,;:1;;;;:i12.111611::!;:1;,kiii.i44 AL,Z1';:1i,i: . - .' .. :, .., :,.. A New construction .ddition/alteration/replaccmcnt Please check all that apply (submit 1 sets of plans w/items checked below): 0 Service or feeder 400 amps or more 0 Building over three stories. ED Demolition 0 Other: where the available fault current 0 Marinas and boatyards. '::•::. .. ' • . 7. •• • • . 77 . 7 .777 .7 77r7Ti'llkmmirp7n.'rmmmg rwiroti,P:; : ,.. exceeds 10,000 amps at 150 volts or 0 Floating buildings. ... ..- .• ........ .; • '.'4 ' ;.; ,•'‘• '• . fee&44.(114A:i1.4/9•101141iii;iii: l''';''''' J .', .,, .41.! less to ground, or mccoeds 14.000 0 Coinmercial-use agricultural I - and 2 dwelling 0 Commercial/industrial 0 Accessory building auips for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: ID Fire pump. 0 instailinign 075 KVA or . voig,rii_ wio . 0rweiv wig ,,,,,..„, ,,, .,. , „ , ,. ,, 0 Emergency system. larger zeparately derived vleiti. .. , • • ••• • 41 *OP.g . !! 4 .. , ... ' -, I r.:.!. 4 "..1 C ' ii '''•° - h%■'''''' 6 0 Addition of rim motor load of CI - A - 1 - I - '3", " • ' lob no.: Job site address.ISS/L 54 ._„. .cLP•V7. .1 m 4 c\ t991•LP or mom. occupancy. ..... ...... _ .......'...,,' ' ! ,, or mo residential units. 1:1 Recrealicmal vehicle parkit. City/Statc/ZIP:+r ( ott_ cri 1:1- 0 linallh•care fociliiieN. 0 Supply voltage fir more than 131.1rizardous locations. 600 volts nominal. Suite/bldg./apt. no.; Project name: ja.400viAANA5 1 1,4 0 . ..o Service or fccdcr 600 amps or more. ....._ 1 Yo't■ 14 •, : :igt o' , D L".t:•••:': :',. ' . . : •,....',. :,:, Cross Street/directions to job site: Desert. don 1 N, • NM= TOW 111 New residential single- or multi-family dwelling unit. includes attached garage. .., ......... Subdivision: Lot no.: 1,000 sq. ft. ur less 168.54 Ell . .. - - - • '' • -- • -- - - Ea. addl 500 sq. R. Or portion 33.92 III 7 (with above tl I Tax map/parcel no.; Limited energy, residential ' • ::. :• :,• '• ''', '• - ,• •'•'"'•' ' it t i ''.0"1„' ;„.,;;" 'Ip:,1161: . II 75.00 • . .) . ........'... • .. ...7 .. .i. 1 1‘sei , :. '3 ...:T , 7inaiiiii'.....:L' i..'•;:41■15tiaL:itii A101 00 ‘ Limited energy, multi-family I 0 e,w4 (o..- ...2 CJ"...) A-NO1/4.2 c -% residential (with above : .. ft. 75. ..._ Services or feeders installation alteration, and/or relocation 200 amps or less Mil 100.70 El ...... •.„........•.• ..-.._ ....•...,..-...,....-•••„,,.„.,,,-„:„••:,.,.. f.FrAR,. rf i t 400 am 1 s El 33.56 .'• ' I4ItTIIi!ti!,1,‘:11 i ' fig Ellaill.,nii. i ,,, , 4 .41 0 '1^ ,;',! 2. 1 an P ° r 131 c; - - e -, V 401 amps to fi00 amps 200.34 El Narne: -)'' 11111 301.04 (J/3 Address: ‘ \ 1E1 ,1‘ _ (AkVD 601 amps to 1,000 amps Over 1.000 amps or volts MI 352.26 a Temporary services or feeders Ingtallation, alteration, and/or City/State/LIP: relocation ( ) .\ • 200 amps ur less 59.36 I Phone: 1, ) 201 amps to 400 amps 125.08 13 Owner installation: is installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 El intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new. alteration, or extension, per panel Owner signature: Date: A. Fcc for branch circuits with „ above service nr fixdcr fee, ' ' ... . ,•,' tli. itiltik4 ;‘;,,,: (,'..' ;::2•.;,:;:;,;.:,. El ii.' ;C . each branch CITC.Un 7.42 2 B. Fee for branch circuits withom Business name: serviv.e.ur feeder roc, first 56.18 1 2 branch circuit - Contact namc: - . ' Each add' I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) ... .. 1 - -- . '' Each rnanufacture4 ur modular 67.84 2 C ity/Statc/ZIP; dwellinkservice iincVor feeder . Reconnect only 67.84 2 Phone; ( ) F' ... r: : ( ) pump or irrigation circle 67.84 El E . Sign or outline lighting 67.84 13 • :•,....• • .. ....- . , .... ,- ..,-,:.J ,,, ; ,, ,:::i. , .,•:;-:::4. , ,:..:Itruz i rib i zr .;;4‘ ' i3O , t1; Sigull or limited-energy . eltendion, or extension. Page 2 2 BuSiness namc: p „ . . . , , , , , s , 0 „, j 1 ...„),,..) ,e,A eCTVICAort, Each additional inspection over allowable In an uf the above ... Address: $ „ -0 Additional inspection (1 hr min) 66.25/ hr k 2_ -z_ e h 1 , , c_i- . Investigation (1 hr mm) City/Slate/1P: 11111 66.25/ hr 4 biNA64$8 .) 6,S C,3 S i ckt, et -Iola et hr . . . I ndustrial plant (1 hr min) 78.18/ Phone: (551 £4. -q 56-1 0 Fax: ('Z) S44- 5 inspections for which no fix is si - ificall listed V., Itr min. 90.00/ hr . . .. . ,. . , . . . .. , . . ..i ..,,.-..,..,...,:,,,,,.. • ..,- , i . C4 pr , T t , . . ... . CCB Lie.: 1 u ,31.b i 8 Electrical Lie.: C Suprv. Lie.: G 4, , ..7•••:(.:•,.. , ;..',. , : ::.■•!•.2-'.;:" ,..• ....... . . .... . • '. S uhtotul: . Suprv. Flectrician signature, rcquired; Plan review (25% of permit Ite): _ - - Print name: e ,{) NNAAAIDN3-14.% .0 Date: ci ..ase 2.040 State surcharge (12% of permit fee): TOTAL PF.R1v111 FEE: ", ' ' ' Authorized signature: ws.:AtAe.D....ez...a ,. This peralft application expires if a permit W not obtained with ii; ted days after It has been accepted as complete. Print name: • &towed per pernat. P tAtiabeiDatc: ...Of -- 07_01 Number or inspections • 1:1Bid1rling,\Perrnits\ELC-PtanhApp.doc 07101110 44114613111 4f05/COMAVE8 Oct 15 10 02:34p brelawso 5037464391 p.1 Electrical Permit Application ‘,0 FOR OFFICE USE ONLY i III City of Tigard 13125 SW Hall 131vd., Tigard, OR 97223 Review Permit No.: "• • •1 ¶ 503.639.4171 l'ax: 503.598.1960 6 Received , Daie,q3 : ' Date/By• !NW 1 Oilier Permit: ST,A. . " Inspection Lirtc: 503.639.4175 , , c .- .\ ri-% . .k K. - • dy.'lly: tuns El See Pagel for TtGARD Internet: www.tigard-er.gov , x1..1 IIV.k '1' ethc'di "1-0) Supplemental Information i .r i '= : : . . , ' ;:i !"'1•:.',. -. 41 . - '," : : : " : "---.:7 #i 7**A...'' .!.'; ;: :-' :,c,, let,Y 7v I t .. * .. . -*,:_' - -. 1 -1: , _'''..•:::•••:::i • eu.' construction 1 Pl=sc elteck all that apply (submit 2 SVIS of plans ...Akins checked below): 0 Additiontalterationlreplt J • El Service 'Jr feeder 400 airs or more 0 Building eVer three stories 0 Demolition 0 Other: where the available fault current CI Marinas and boar.ards. er, 1...%.",-,,,4:•;:r.r. - .... . l.11 7 ' f. ':: . l . C ' '11F Akflial l g i' ' ' ' '•i exceeds 10,000 amps at 15U volts er (:1 Floating bui dings. less to ground, or exceeds 14,000 0 Commercial-use agricaltoral 11"i- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. 0 Multi- lam ily 0 Nelastcr builder D Other: 13 Fire punip. ID [wit:illation 9175 KVA or 0 Adoa of Ttew motff laF.ger separately derived system. '•'.' •-• • •' - '''''-J ' tit - , - , • • . - - ' --, ..-A. It load of 100111' or more oectipancy. Job no.: Job site address: A - 3 cy 3 c 1 9, , x , T 10,1 C. 0 Six or more residential nails EI Recreational vehicle parks. 1 ( : T isd,c5L, (1 rz_ 97 '2 2 3 D Health-care facilities CI Hazardous locatiens. 0 Suppt. volinge rel mote (hail 60C: volts nominal. Sttileibitiglapt. no.: Project name: Lex ge.stk•--c-C D scwice or feed Cr 60C nal ps Or 1110re. , . '77 ., ' ! ' : - . -: 41 - •,_ .-:: .t,.: .ge ^ . ti.. ' %.. ' 7. , ;_ . 7 .. 7 '.. . Cross street4lirections to job site: I 2 t %- 4- G.-J.14144 L..., 4_, eipee DCSErL111 iOT 1 Qrs. ' ri•e. 1 Twat New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: .2.._ 1,000 sq. 11. or less 16854 ' Ea add'I 500 sq. 11. or portion 73.92 Tax 1 'nap/parcel no.: ZW P l9-- 0 e iOd 1 7-.7Sir.'-•:;-= 2-‘7 1.mited energy, residential ?,.. 75.00 ' 2 '. ....' ": firitkikittiWifkit . 4 r " -.'''="-"..:" Tr'i 1.44 (with ebovc im. It ) - / - - . Limited cnerey. multi-family 75.00 ., Z a C)`4931-0-- residential (with above sq ft.) Servicoi or feeders installation. alteration, a ndrbr relocation 200 amps or less I 10(1.70 i(.Ji), 7C) 2 t] 412eil ' ••..1=`&5,441s-.,l.lil':1 201 amps to 400 amps 133 50 2 .,.. . ,, . - , , C; . :•'•;: , l'iill ' ,• l' r '.' '. ' tl t ' P ' .... . , t ' ' ' ' A n'' ' 14t .' . i . ■ 401 am 200 34 2 ps to 600 amps Nome: g,,,,i_ LA.,......, . 601 a7rps to 1.000 amps 301 04 2 Address: 1 .. 3S 00 51....; V2 1: #1"-e- Over 1.000 amps or volts 552.26 2 - Temporary services or feeders installation, an , alteration, d/or City/Stalc/ZIP: 1- ,;.,„,,,.„ on _ ei - 7 2 :2. 3 relocation Phone: ( 5og ) g'," 5 - a Fax: ( ) 200 amps or less . I - 201 amps to CO amps 25.08 2 Owner installation: This installation is being made on property that I own which is not I 1 . intended ror sal c. lease, re or exch. oweaccording to ORS 401 amps to 5'99 a mps 6K.54 - 447. 449. 670, and 70 I. Branch circuits- new. alteration, or extension, per panel Olkner signature: Dam: IC' 1 A. Fee for branch mints letar ...... ... .._... above serv;a: or feeder lec. ..!' '. ....' 1:)....4.00_31-Mititill.;:,,O....111z;,-i : .:,'.1rilt;"; • each branch circuit 7.42 . -, ... Rusine3s name: ,,,..c ,e, 6 4._ b G.e._ o S ' 13. Fec for branch circtirx without service or feeder fee., first Contact name: 0 0 branch circuit 56 18 -) Each add'I branch circuit 7.42 2 ' AddreSS: i \ 1)'' V4L' Miscellaneous (service or feeder mat incindedl _ I. - \ rAt:' . trAs1 ,, Fitch martufactur or modular 67.s4 CitylStaleZ1P: c dwelling, service andfor lia‘ler _ 7 .------ ' Rtvonnect only 67./14 „ Vi1011C: ( ) ( 1 Pump or irrigation circle 67.8 2 F,-mail: , , , , __. Sign or malice lig,hting o7.xe. - • • 7 - '' '' ' 7. g f' ; 17 •-741 ':t1t06100400)Vrii::'it- 'AL 7." : - Signal circuit(s) or limited-energy tlanel. alteration, or extension Pagc 2 , , Business natne: pe , st,,_ Each additional inspection over allowable in any of the above Address: . Additional inspection (1 hr min) 1 06.25/ tr Investigation (1 hr min) 66.25/ lir CilyiState/ZIP: . Industrial plant (1 hr mill) 78 1S/ hr Phone: ( ) Fax: ( ) inspections for which no fez is vr. On/ hr s min) , ., _ . . • - --, -., ..-. - ,.A, A C.C11 Lie.: Electrical Lic.: Suprv. Lic.: : ._::::,4 -:,:-.:, C ' • , ; . ..: . J Subtotal: i do, l Suprv. Electrician signature, required: Plan review (25% of permit fee): j Print name: Date: State surcharge (12% °I fccl: i / )... 0 TOTAL. PERMIT FLE: j /2.. 71r Authorized signature: This permit application expires if s permit is not obtained within 180 days after it has been accepted as enrnnlete. Print manic: I Date: • Number of inspectiOns alion.ecl pel permit 1 \ littifili-IgTermitNTLC-P.rmit Apr inc 71101110 440 1/0STOM/1WE - -- ...,,,-..,,,,,,,,,..............i . Cfl Y OF TIGARD - SITE PLAN REVIEW 11 I :,4!=;RMIT NO ell , t —a.r ,i • ,• , )---U-08 - 5 -7 7 PLANNING DIVISION: / Required SetbOcs: la Approved ,, 0 Not Approved Side: jit Street ; .1.....,. ; / 1 Front. y1 a . _ ___, ear: Visual Clearance: 0 A rInrd 0 Not Approved Maximum Buildlit :-ieighk CWS Servi4:.e Pro tte,r P:;Th,;reci 7 f'f,.s r No t.,.. t 1..,-.,-- ,i- • 501-4"4._27-k--. 41 \-4/LeAL____ ii.tc:: _IL ' - ENGINEERINf'E PARTMENT; Actual Slope: % ira Approved 0 Not Approved Site P an: it____Approved 0 ,isi ot Approved liv B : . . i a , ro Date: i slotcs:' ,, gil- 0-A-oe-- ..Ae--ti-e-1.- zpit-tiai, b6( .. ... .... 111111111111ff, t go _'AP.D. SITE PLAN 4 VIM _ ______ . _ _ - ,_ __ -Tr-..i":11,.1,:i.:_;41,:p: iv>i--?-012..7.7c506,-t_OVIR--crucrs—.377-- Street ileac tli Approved 0 Not ApProved . PfOtCCICeS: n Approved 0 . ot Approved Date: c .r.; 0 Notes: —I Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: Jurisdiction: 1.v15 2c� tU - - 0002 5 Site Address: l 3 C N 3 - fro Subdivision/Lot #: per - r I ► / t - and /or ch v� Map and Tax Lot #: 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: O r /Genera ontractor /Authorized Agent ` Print Name: f`Q.,V`� o r` ' 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. C\ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08 Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, rj,,,,„ lees^- , am the general contractor or the owner - builder at the following address: Site Address: \ 3 S S w .(i,' p..ei 1., c e City: " r ( 9a. " a g 7 23 Permit #: X 5 4 2o lo— OO O'35 Subdivision/Lot #: T °, _Q„ ( n� 1 7 2 and/or ^�`� i Map and Tax Lot #: 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 framing members. / 7 6- 1_rt Signature: / Date: e neral Covtor or Owner - Builder IABuilding\Form\RES- MoistureSensitiveWood.doc 09/25/08 STREET TREE CERTIFICATION I, we Laws , owner /a agent or 1 K se Lo � g f _ (PLEASE PRINT) (PERMIT HOLDER) do hereby certij that the folio )ing , :location meets City of Tigarct l4nd use and development standards for street .tree - instezllation andt',<is consistent with the a pproved site plan. 'ND 5 - 1---te_d - 4-ms 'g o 1. etr Pi" kw5� SITE ADDRESS: \ 3S 3 5 SUBDIVISION: L-■A.e, fc if LOT #: SIGNATURE: DATE: (OWNER /AGENT) RECEIVED & VERIFIED BY DATE: (CITY OF TIGARD) Tree location verified per approved site plan. I:\ Building \Forms \StrecffreeCertificate 07/01/2010 City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 . 4 September 1, 2010 Brent Lawson 13500 SW 121 Ave. Tigard, OR 97223 Re: Permit No. MST2010 -00085 Dear Mr. Lawson: The City of Tigard has processed a refund for fees on the above referenced permit(s) for the following: Site Address: 13543 SW Piper Ter Project Name: Tindall Partition Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $3,679.00. ❑ Trust account "deposit" receipt in the amount of $ Notes: Refund TDT fee to be paid by TDT credit voucher. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. I: \ Building\ Refunds \Administ ration \LtrRefund- RefundOnly.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Brent Lawson DATE: 9/1/2010 1 3500 SW 121" Ave. Tigard, OR 97223 REQUESTED BY: Dianna Howse AMS TRANSACTION INFORMATION: Receipt #: 178959 Case #: MST2010 -00085 Date: 8/5/2010 Address /Parcel: 13543 SW Piper Ter Pay Method: CreditCard Project Name: Tindall Partition EXPLANATION: Refund TDT fee to be paid by TDT credit voucher. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. • Refund Example: Building Permit Fee • • Example: 2300000 -43104 $ Amount TDT - Transportation Development Tax 4050000 -43320 $3,679.00 • TOTAL REFUND: $3,679.00 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager - r'M'Vn l! ZAAAIL_ If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY . - . Case Refund Processed: I Date: I (7/// By: 1:\ Building \ Refunds \RefundRcyucst.doc x 09/01/2010 11 11111 c ° Community Development r 1 c. n 11 Request for Permit Action RECEIVED AUG p 51Q10 TO: CITY OF TIGARD CIT Y OF TIGARD Building Division Services Coordinator BUILDING DJ�ISION 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov FROM: [Owner 0 Applicant ❑ Contractor ❑ City Staff (check one) REFUND R Name: co „,..,.... IN CE TO: (Business or Individual) L Mailing Address: 1 3 5 0 6 . 51.,.., 12I 5± A.tA.2 City/State /Zip: i 9 a .-S. t 02 c 172:2 3' . Phone No.: 4n 3 - 7 L( G- ce 391 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 1J CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: i `-` i d-r - AO/0 660 85 Is 513 Site Address or Parcel #: •1 - `aw p, -7--cg.... Project Name: w /3 E- I t. ti Subdivision Name: — 1; r. T)A L QA' 2T1"ri a Lot #: EXPLANATION: .--" P\Ek,-u - 0 N- t - 0 1 )1 rf_4 - t -- Dk'e- To A u3 t427 tr of —7-- CQfii,r \Ioue.N-iQ. Signature: , AO / Date: q- $ - 2°10 Print Name: 4- Ll✓Sah 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 to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to Sys Admin: Date By Rte to Bldg Admin: Date By Refund Processed: Date rx// O By,(— Invoice Processed: Date By Permit Canceled: Date ,// By Parcel Tag Added: Date By Receipt # Date i 2 S9 Method t_C__ Amount $ I:\ Building \Forms \RegPemutAction.doc Rev 07/26/07 CITY OF TIGARD RECEIPT I -n 2 . _. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD "VC — 14, ) Receipt Number: 179335 - 09/01/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010 -00085 TDT - Transportation Development Tax 4050000 -43320 $3,679.00 Total: $3,679.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Trust Account 10 -0001 DHOWSE 09/01/2010 $3,679.00 Payor. TDT Credit Voucher 10 -0001, Tindall Partition Total Payments: $3,679.00 Balance Due: $0.00 ' Tidemark S ystem Administration ' "' " Finance Department Request Date: 9/// 0 To: Liz Lutz Angela McCoy From: Dianna Howse/ Re: , Receipt #: / 7 f''5 ,9, /793 3,2 Please process this request as follows: Journal Entry (route copy of JE to Dianna Howse). Reversal (fees have been reversed on Revenue Account Report). Credit Card Return (fees have been reversed on Revenue Account Report). Other /Explanation: 77 /2 7c..s,/� 7 7 J ? L Thank you! 1: \Bolding \Forms \RteSlip- FinanceReq.doc Page 1 of 1 - ■.4 • :• CITY OF TIGARD RECEIPT Q E D .. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD R A- - - -- -/ ---- (4 ,V Receipt Number: 179332 - 09/01/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010- 00085 $- 3,679.00 Total: $- 3,679.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 67254B DHOWSE 09/01/2010 $- 3,679.00 Payor: Brent Lawson Total Payments: $- 3,679.00 Balance Due: $3,679.00 • Page 1 of 1 -.. 1 141 CITY OF TIGARD RECEIPT S • : 13125 SW Hall Blvd., Tigard OR 97223 . 503.639.4171 TIG ;\RI) 0 Ai C- Receipt Number: 178959 - 08/05/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010 -00085 Building Permit - New Construction 2300000 -43104 $1,866.46 MST2010 -00085 Plan Review 2300000 -43106 $1.34 MST2010 -00085 Plan Review 2300000- 43106 $461.86 MST2010 -00085 CDC Plan Review, RES 1003100 - 43112 $46.00 MST2010 -00085 CDC Plan Review, RES - LRP 1003100 -43117 $6.00 MST2010 -00085 12% State Surcharge - Building 1003100 -24001 $223.98 MST2010 -00085 Metro Const. Excise Tax - Residential 2300000 -24010 $391.19 Use MST2010 -00085 Tig -Tual School CET - Residential 2300000 -24102 $3,032.00 MST2010 -00085 Park - Single Family Unit 4250000 - 43300 $4,811.00 MST2010 -00085 TDT - Transportation Development Tax 4050000 -43320 $3,679.00 MST2010 -00085 Erosion Control 1003100 -22002 $112.00 MST2010 -00085 Erosion Plan Review CWS 1003100 -22003 $36.40 MST2010 -00085 Erosion Plan Review COT 2300000 -43107 $36.40 MST2010 -00085 Water Quality - Res 5200000 -43123 $225.00 MST2010 -00085 Water Quantity - Res 5200000 -43122 $275.00 MST2010 -00085 Permit Fee - Elect (per dwelling unit) 2200000 -43103 $372.06 MST2010.00085 Limited Energy 2200000 -43103 $75.00 MST2010 -00085 12% State Surcharge - Electrical 1003100 -24001 $53.65 MST2010 -00085 Furnaces < 100K BTU 2300000- 43102 $46.75 MST2010 -00085 Water Heater 2300000 -43102 $23.32 MST2010 -00085 Gas Fireplace 2300000 -43102 $33.39 MST2010 -00085 Range Hood /Other Kitchen 2300000 -43102 $33.39 MST2010-00085 Clothes Dryer Exhaust 2300000 -43102 $33.39 MST2010 -00085 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 $116.60 Utility Rooms) MST2010 -00085 Fuel Piping 2300000 -43102 $18.18 MST2010 -00085 12% State Surcharge - Mechanical 1003100 -24001 $36.60 MST2010 -00085 SFR - Baths 2300000 -43101 $500.32 MST2010 -00085 12% State Surcharge - Plumbing 1003100 - 24001 $60.04 Total: $16,606.32 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 67254B DADAMSKI 08/05/2010 $16,606.32 Payor: Brent Lawson Total Payments: $16,606.32 Balance Due: $0.00 Page 1 of 1 Jul 06 10 08:27a brelawso `` _ " 5037464391 p2 JUL -5-?010 07:23 FROM 70:5037464391 P.1 FJl I (.4 IV VY.WI) VI by :JVJfYVYJ� I N _ Robert Matany r _ ,,p .rk( / AMERICAN SOCIETY of _ f " _ _ _ , _ CONSULTING - . - Registered Consulting Arbcrist #133 I -- ', r E VI p c, 0 p h� r • U� 1 r . r t- � . � � r � t o 30 t t " i Y t r ti L - . 3 ■ r G �sao I , :. w t . . . fi l . • _ . . ,i . -298- e v , I l • .. . . I;' / t _I c 27-s4 ....‘ - m __......--- , , • - i >. - . .. . - I II 1 2_ - .......-\ ` ...".::.4..,..:,:.*: _ J I B w -4C � ._ -4 -.- - - ... �trte Tv '- r,. � e - _ - . 1 ....49 }'` ' _ ?tea � . ��.+ e r a � a +`i ; ' I L - i • . t�. t - 1� _- r L , . nwr. - - - . , �tic ? r.�ir a� • �, rr�sc =r � � ~'� � -- -- x - - - - - - - - _ - - , _ - -- 'x..4 9.: ' Pxojcct Nam= Lawson Resiticucc Site Address: 13543 SW Piper Tcxacc ., 1 r , Parcel #: 231303489M . , ,,w . - a 7 • - Submitted By: Brant Lawson 13500 SW 121 Ave. Tigard, OR 97223- 1 Prepared By: Brut Lawson t � • ' � Sca le; 1'1=20T =.;y .. ' - ! ` :, ST=S a` a 3Y 1 '. .!-', -k,.. Drkr,.,, .. ..1