Permit CITY OF TIGARD MASTER PERMIT
II . . a
°
.. COMMUNITY DEVELOPMENT Permit #: MST2010 -00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2010
Parcel: 1 S 133AD06400
Jurisdiction: Tigard
Site address: 10915 SW SUMMER LAKE DR
Subdivision: Lot: 0
Project: Van Stone
Project Description: Remove fireplace and chimney and replace with window opening.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes
Total: sf Value: $9,200.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0
Ea add! 500 sf: 0 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)
VAN STONE, TERRY STRAIGHT EDGE PAINTING &
10915 SW SUMMER LAKE DR CONSTRUCTION LLC
TIGARD, OR 97223 10330 SW KENNEDY ST
Beaverton, OR 97005
PHONE: 503 - 579 -1964 PHONE: 503- 998 -9294
FAX:
Total Fees: $462.59
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 Notificatio =r. Those rules are set forth in OAR
952 - 001 -0010 thr• ; *AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5. • • 9 or 1.800.33 344
Issue. ° - � ` Permittee Signature: e I ' -
la
Building Permit Application
Residential RECEIVED iuIt 0FFIC1: ust: ONI_,
City of Tigard AUG 1 ? C I n DateB : / Permit No.: ,
2 Received O ti ♦ , (O,
l ig ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie ► 1 j v�
p Other Permit% ,
Phone: 503.639.4171 Fax: 503. Date/B : A l
TIG \ILD
Inspection Line: 503.639.4175 ��F TIGARD Date Ready/By: See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: ` . Supplemental Inform
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING I�
❑ New construction uemolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
'Addition alteratio lacement EJ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
and 2- family dwelling El Commercial/industrial
Valuation: $ goiCe od
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: !,Off /.5 SW S({ Ail vYt Pr /Ake 4i '"! / I/'e.., New dwelling area: square feet
City /State /ZIP: / / G le /Yl di 9 712 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: ��JJ Q Project name: 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
Subdivision: I 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.
r te,. AZ,z-f-ez.-e—e Valuation: $
/ Existing building area: square feet
..L.,... t. i . _. _ -- i. . i .44. #f .
112177A ' , l,t ) Ile& y~( _/ 14.4.14■" - New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: / c U J�J _ /_ _ Type of construction:
Address: /09 , J
ij /.t i mo
vr ..t_ LJ 1� fiLL Occupancy groups:
City /State /ZIP: 7-4 9 ri / n7l 9 72 Z 3 Existing:
Phone: (503) Lt - /1 6 V Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 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:: ( )
E -mail:
CONTRACTOR
Business name: cii-v !/ f � P , L 71..1 BUILDING PERMIT FEES*
?7/1 `. „) "� " eN (Please referrojee
City /State /ZIP: lJ
Address: /0 J.JV ✓ / Structural plan review fee (or deposit):
�ei D`L J 700 5
Phone: (503) r} ?If 92, y Fax: ( ) FLS plan review fee (if applicable):
CCB tic.: / /�� 3� Total fees due upon application:
/ Amount received: if144 • /,
Authorized signature: (
2'
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: A zi / C/s n r t e I Date: 6� //i /2/ 7//1 • Fee methodology set by ri -County Building Industry
` Service Board. y
I:\Building\Permits\BUP -RES PermitApp.doc 11/6/07 440 -4613 /02/COM/WEB) I 4
Building Permit Application Checklist
One- and Two - Family Dwelling FOI2 OFFICI•; IJSI•1 ONI.\
111 City of Tigard Received
Date/By: Permit No.:
Y 1 3125 SW Hall Blvd., Tigard, OR 97223
C ' Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
IIGAIRD
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑ Mechanical
Internet: www.tigard- or.gov ❑ Other:
THE FOLLOWING: ITENIS 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: ❑ ❑ ❑
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 ❑ ❑ ❑
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 a, I licable to the ' ro'ect under review.
JURISDICTIONAL, SITCII ICS
23 Three (3) 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 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\BUP- RES- PermitApp.doc 03 /21/06 440.4613T(1I/02/COM/WEB)
Electrical Permit Application - .. . (W it 11 1'51; ONI.1
City of Tigard Received
g Date/B Permit No.:
liii . • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/13 : Other Permit:
I _ Inspection Line: 503.639.4175 Date Ready/By: saris: ® See Page 2 for
Internet: www.tigard or.gov ll .. i' Notified/Method: Supplemental Information
TYPE OF - iilt ,.::> t)" '', i'_%t.
PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit J sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION RE C EW e xceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1- and 2- family dwelling ID Commercial/industrial ❑ Access AA'�iQliS 'LA less to ground, or exceeds o 00 ❑ Commercial -use agricultural
Y� g amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: A ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION CITY OF 1 T IGADD CI system. larger separately d system.
II .OING DI I 04 ❑ Addition of new motor load of ❑ larger separately
derived ry
`� 100HP or more. occupancy.
Job no.: Job site address: /0 / s � � � j n
Six or more residential units. ❑Recreational vehicle parks.
City/State /ZIP: 77 r . d o 2 q 7 �J 2 Z ❑ Health -care facilities. ❑ Supply voltage for more than
t� / ❑ Hazardous locations. 600 volts nominal.
Suite/bidg. /apt. no. V I Project name: ie ,,, , i l / n f + - '_ Y I ❑ Service or feeder 600 amps or more.
c (/ /U� FEE SCHEDULE
Cross street/directions to job site: ' Description 14ty. I Fee. I Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
- Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/ /// Limited energy, multi - family 75.00 2
04).1 e �/ {�' �� O a h y residential (with above sq. ft.)
I ��' ��� ` ,(� �Gt Services or feeders installation, alteration, and/or relocation
7 7 �/it c //"� loc. // �I 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
k !/ /� y aa � ."_ 601 amps to 1,000 amps 301.04 2
Address: to ? .// g j SI, rhilitz ,,,- L4 ,e� l�r _/ v - Over 1,000 amps or volts 552.26 2
City/State /ZIP: 6�c _/ O � 7 3 Temporary services or feeders installation, alteration, and/or
! relocation
Phone: (5(8 c.7 5 7 _ /?6,y Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease nt, or exchange cordin o ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
�- Branch circuits — new, alteration, or extension, er panel
Owner signature: t/(2.11_ ,k74 c- Date: A' _ /v7 / 6 A. Fee for branch circuits with
❑ APPLICAN I ❑ CONTACT PERSON above service or feeder fee •
7.42 2
V ���/// each branch circuit
Business name: B. Fee for branch circuits without A
service or feeder fee, first ( y � 56 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
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: cL,,1 / `� ��//. /. i (� � J . panel, alteration, or extension. Page 2 2
'J�� // �J / � (s' �F/ Each additional inspection over allowable in any of the above
Address: / j/�
25)O (p � , P k /1K S17 Additional inspection (1 hr min) 66.25/ hr •
City/State /ZIP:
i � i V 6 DI /f 4 70D /S Investigation (1 hr min) 66.25 / hr
v
Industrial plant (1 hr min) 78.18 / hr
Phone: SSa3 ) 9 i z9 / I Fax: ( ) Inspections for which no fee is
/
specifically listed (Y3 hr min) 90.00 / hr
CCB Lic.: /f U 3/ / Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Pa 4 l ( ' 4 n i Y Date: n `� 1 Z�,io. Number of inspections allowed per permit.
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