Permit Ii -,, CITY OF TIGARD MASTER PERMIT
iii 2 , = COMMUNITY DEVELOPMENT Permit #: MST2010 -00219
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2011
Parcel: 2S103DA04600
Jurisdiction: Tigard
Site address: 10570 SW PARK ST
Subdivision: FANTASY HILL Lot: 1
Project: PUGSLEY
Project Description: 528 SF accessory dwelling unit.
BUILDING
Floor Areas Required Setbacks Required _
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 12 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $19,784.00 Rear: 5
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 • Sewer Lines: 0 SF Rain Storm Sewer: 0
0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 2
Ea adds 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB U 0
Owner: Contractor:
PUGSLEY, CLAYTON A & SAN CARLOS CONSTRUCTION LLC Required Items and Reports (Conditions)
FREEMAN - PUGSLEY, CAMIE 8966 N BERKELEY AVE. 1 Ersn Cntrl 503 - 681 - 4444
10570 SW PARK ST PORTLAND, OR 97203
TIGARD, OR 97223
PHONE: PHONE: 503- 705 -3584
FAX:
Total Fees: $917.19
This permit is issued subject to the regulations contained in the Tigard Muniapal 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 e set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 2.1987 or 1.800.332.23 4.
Issued By: Permiftee Signature: ,Gy h a ET /
Cali 503.639.4175 by 7:00 a.m. for the next available inspection date. / (/
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Building Permit Application
G►C:►_ *..- et.
Residential • , • FOR OFFICE USE ONLY
S ': Received • L
City of Tigard eD • ' �B Date/By: <l p 77 10 7.- Permit No.: ()1S _ �) or) I q
111
° 13125 SW Hall Blvd., Tigard, OR 9722 i Plan Review O� t
0 Phone: 503.639.4171 Fax: 503.598.19 9 TA Date /By: W) f Other Permit:
f I' Cl A IL D Inspection Line: 503.639.4175 C Date ReadyBy: + A Juris: See Page 2 for
Internet: www.tigard- or.gov V-4,-._. � C
Notified/Method: g/7 II87j' "l6 Supplemental Information
T V 0
TYPE OF WO 1310G REQUIR D DATA: 1- AND 2- FAMILY DWELLING
fees* based the the performed.
❑ New construction ❑ D emolition
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: 'RE_ � Permit are as e o t e value o e wor p equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION C0 work indicated on this application.
\ +� \ Valuation: $
1- and 2- family dwelling ❑ Commercial /industrial �RD ) �L
❑ Accessory building ❑ Multi- family��N1(0 411 SO Number of bedrooms:
❑ Master builder ❑ Other: •13v11, - - Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16 s S W pH? K New dwelling area: square feet
City /State /ZIP: / Glo iep 0 a q - 72_ 3 Garage /carport area: , 52£ square feet
Suite/bldg. /apt. no.: Project name: �D u c Z E..../ Covered porch area: square feet
Cross street/directions to job site: I 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.
04.c E SS Q r& F,() l LD N 4 Valuation: $
Existing building area: square feet
New building area: square feet
,PROPERTY OWNER ❑ TENANT Number of stories:
Name: C k . 't7/h P (ins Type of construction:
Address: 10 -3_0 9 w .vC Occupancy groups:
City /State /ZIP: rca-4-742, 0 C7 q 1 Zz 3 Existing:
Phone: (S G3) i3'- 71 b2., Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: S iilvt E. Ms p 0 V(2 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:( ) Fax::( )
E -mail:
61 13 0 CONTRACTOR
Business name:--7 J, 97C-i C , . i 0-5 (CIA /S772Q VC. /V CC -s BUILDING PERMIT FEES*
Address: Q9 fa e, A./ A /)j 'Et � ,±1/b—
(Please refer to fee schedule)
City/State /ZIP: `� /`/` Structural plan review fee (or deposit):
U2 \ Ole 9/ 0203
Phone: S 7Q,' - 3Sd 7' Fax: ( ) FLS plan review fee (if applicable):
l�� �� Total fees due upon application:
CCB lic.: 9
40y/ 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: G' 1 IA. X09 -P Date: (2.1.-2,g /ic * Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Permits \BUP -RES PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling FOR O FFICE USE ONLY
Cl of Tigard Received
114 • 7 g an Permit No.:
' 1 3125 SW Hall Blvd., Tigard, OR 97223 Date/By:
0 Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
I' l G A li D 24- Hour Inspection Line: 503.639.4175 ❑Electrical ❑Plumbing El Mechanical
Internet: www.tigard - or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 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 . ❑ ❑ 0
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 locdl;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
1 and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
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■ tlicable to the Iro'ect under review.
JURISDICTIONAL SPECIFICS i
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.
1 \ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11/02 /COM/WEB)
Electrical Permit Application FOR OFFICE USE ONLY,
Received �V U
City of Tigard Date/B : it �{/ i a Permit No.: " d.(
V 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
Phone: 503.718.2439 Fax: 50 9 6 Fj Date/B : Other Permit:
- f 16 A li D Inspection Line: 503.639.4175 i Date Ready/By: See Page 2 for
Internet: www.tigard- or.gov 9 2410 Notified/Method: IM Supplemental Information
TYPE OF W " PLAN REVIEW
1=1 New construction ❑ Addition/alte t S'l P, �Q
`���, D� Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more El over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", 'l -2 ", "I -3 ",
( (-e ,j � Job site address: 0 S (N Six or or more. occupancy.
Job no.: 14
U S t` ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: (( & AirR 0 0 g. q 12 Z ? ❑ Health - care facilities. ❑ Supply voltage for more than
l / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: p( 65 COY ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
P r (2 } &C t � ], ,,U , k �/ e P B (.) 6 ' '' residential (with above sq. ft.)
)� l r ` ^ t ink Services or feeders installation, alteration, and/or relocation
c , r wa A-Gce ),57 l t4 t (61 I \N� f y 200 amps or less / 100.70 100 ,? 0 2
❑ PROPERTY OWNER D./TENANT 201 amps to 400 amps 133.56 2
C� ( 401 amps to 600 amps 200.34 2
Name: ' , G 601 amps to 1,000 amps 301.04 2
'
Address: `0 ? - o S' W p 7 14- Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: ( e 4.) DI q 7'l 2 3 relocation
Phone: (563 ) 4;1_ I-'2. 8 2. Fax: ( ) 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 exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, , 7.42 ' it. 2
each branch circuit O� o ! /
Business name: Skte.A a j l'.\130 B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Ci (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: panel, alteration, or extension. Page 2 2
(nA 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 (% hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: ( 5 ,5-4,
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): ( 'jr G ;
�6 TOTAL PERMIT FEE: 1 Z
Authorized signature: 66 Thi permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
Print name: CI a.7 f ��o s l Date: (•2. 2 q 1 d * Number of inspections allowed per permit.
1: \Building\Permits \ELC- PermitApp.do c 07/01/10 J 440- 4615T(I1 /05 /COM/WEB
Electrical Permit Applicatic F r F ! 1 jr ' O OFFICE USE ONLY
City of Tigard f° ; ^ #" DDat Received � 1� Permit No.: .tea / --(A9 - Ali 13125 SW Hall Blvd., Tigard, OR 9722 y Plan Review
Phone: 503.639.4171 Fax: 503.598.1 B 1 Z O 11 Dates : Other Permit:
i 1\I1 Inspection Line: 503.639.4175 r � ^ Date Ready/By: _Furls: Si See Page 2 for
I Internet: www.tigard- or.gov CITY OF j Il�tP Notified/Method: Supplemental Information
TYPE OF life.. Di 4. • I D PLAN REVIEW
•
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition/alteration/replaceme t
..2, l/ fff
1 ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF. CONSTRUCTION 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: /0 5tt1 ,174/4-, IooHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Pit.e S LEy ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 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 WO (with above sq. ft.)
/ /� , Li mited energy, multi - family 75.00 2
t� k,,QLI�� !1 W� fYI� residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 2
;'• ROPERTY WNER I ❑ TENANT 201 amps to 400 amps 133.56 2
S 401 amps to 600 amps 200.34 2
Name: (�(o -Le. V 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 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 401 amps to 599 amps 168.54 2
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. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT P ERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name:
branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
7 ✓I f
CONTRA OR ) Signal circuit(s) or limited- energy
Business name: . ,'-/ /-{ g l / ( �^/ p � f /, r �'�t r 6 panel, alteration, or extension. Page 2 2
rrf 44ff` /'J C f�`(� V Each additional i nspection over allowable in any of the above
Address: r, /b s �j e / Additional inspection (1 hr min) * 66.25/ hr
1 > Investigation (1 hr min) 66.25/ hr
City /State /ZIP: t � (/ {/ .
Qiti 0� / q'707 Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
hr
specifically listed (%s hr min) 90.00/
CCB Lic.: /95 6,171 Electrical Lic.: 9 V---91, Suprv. Lic.: .9, FEES
PERMIT ES
Suprv. Electrician signature, required: C Subtotal:
Plan review (25% of permit fee):
Print name: 6 ,' Date: o ` / State surcharge (12% of permit fee):
Authorized signature: / TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Num of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 07/01 /10 440.4615T(11/05/COM/WEB
• �
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 07/01/10
• • ... - 3l�� . � r
JAN 112011
• 15;) [ • it \ 1 1 - CITY OF TIGARD
�►�::.
BUILDING. DIVISION :: :
•
• Clean Water Servlcee F ile Number
may CleanWat ,Servi
&l- �.
Sens itive Area'P Screening 'Site Assessment
•
1 J City of Tigard , Wa County, ;.Oregon
- .- - . .:.. ''-'
2 Property Inforrtmatle (e xample 1 S 234AB014CU) 3._ Owner:f nfonmatlon
Z
- •.Ta lot ID(s 5 � 03a7/� O 4 (eOO N Cla Pudslev .
Company i
Address 10570 SW;Park St .
Sit eAd dresa 10570 SW Park St city, Slate, zip :Tigard, OR :97223.
C iry State,; Zip Tigard ';. 97223 Phone /Fax 503 -639 -7282 cell' 503.705.8619 • �'
• Nearest C St Wa t k ins Ma clayto gma co ,
E
4. Development •Activity (check alt that apply) • 6. Applicant information
Q Addition to Single Fa mily Residence (rooms, d ®dc, •garage) Name ' Clayton Pupsle •.
[a Lot Line Adjustment Q Minor Land Partition Company
Resldentlal Condominium •®Cammercial candornlnlu.nr A 10570 SW- Par'k'St
:0 Residontlal Subdivision. Q Commercl0:8uhdivielo i. •
[] • S in g i e Lo Co Q M Lot Co City 3 #ate, zip Ti , O R 9 7 223 , •
: Other Accessory Buiidinc • : . . 503 - 639 7 ceI 50 :
89 ..
PhonelFax • - claytonpUgsle "mail.cam_
Y�g
.• • • B. ',Will the protect Iuwolve any of¢site work? Q Ye e I ii No Q Unknown •
:Location and deaoription of off alto work .... •
7. Addltion comme or Information tha maybe n eeded to underetand.your project Please see enclosed site,
. This application does NOT;replace Grading •and'Eroalon Control Permits, Connection Permits, 9utlding Psrmltq Development Permute, DEQ, -•
1200 -C Permit or ether permits as Issued by theiDapartment of Environmental Quallty, Department of. state Lands andlor Departmen of the Army
COE. All required permits:and approvals must be obtained and c ompleted under applicable lacer, stale, and federal law
By signing •Ihis form, •the Owner or O wner's authorized agent or representative, acknowledges avid agrees that employees of Chan Wafer 3eMoee have euthorfty •
to enter the project site at alt reasonable tlmes for the purpose of Inspecting protect ells •condltlons and gathering • Informeilon retated.to the projeoi site 1 certify
that t am famlllerwith the Ii!O'nnation contalned in this document; and to the best of
my knoMedge and belief this Inbrmajbn fa true, complete, eti4 accurate;
Pr Na a Clayton I=.!!) ley . : Prin •
.._ •TYPB Title • sig Date 1 /7/2011 '
FOR DISTRICT USE O NLY
(] Sensiti areas potential y exat on site or wi him „200' •of the nits THE APPLICANT MUST PERFORM A SITE ASSE88MENT PRIOR TO ISSUANCE Op A
. SERVICE PROVIDER LETTER. If.Sensltive Areas exist on the •site or wlthin 200 featon adjacent propenlae, •a Natural Resources Assessment Report
may also be °required
Based on review of the t3ubmltted mated end best available information Sensiti areas do not appear to exist on,site or within 200' o th efts This
Senshive Area Pre - Screening Site Assesamentdoas NOT eliminate the rued to evaluate and protect water quality ee nsltive_erepa N they ere bseguenti -
discovered This docu ment toll serve as ur Service Provider tatter es required by Resolution and Order 07 20 Sec tion 3 02.1 Ali required permts and ”
yo su
,
'epprovals must be obtained lilt: c ompleted under applicable local, State, and federal •law r-�,,` :-( t - 4 ec Q -
0 eased on review of the submitked materials and best available lntormaffon. the above referenced protect wti) no t nl5canty bnpact the existing • orpotentiaay , -
sensitive area(s) found near the site the Seraitnie a Are Prescreening Site Assessment does NOT elim inate the need to.evaluate and protect eddilionalwatet
quali sar v • aftl erase I t ere subsequently discovered T document wl l serve as your Service Provider letter as� b Resolution and Order :
`' 0720, Secti 3 021 A l: requlre p er mi ts and a rovals must be obtained and completed under e
p pp PPI ` able b oll, state and t'e Ia♦v :
❑ Thls Servtce:Provtder Letter is not valid unless • CWS approved site plan(-) are •attached
The proposed activity does not meet the detaltion of d evelopment or the lot was platted after et,95, ORS 92040(2) NO SITEASSESSMENT OR.
SERVICE PROVIDE / LETTER IS REQUi
Re
•I CIf
2 ,t u.d i-iilisbuo Highway • 110k:born, Dragon f.) 1 ?;t • 11)on . (,>r s) 61.' *5 JOU • I fi x: (5r13 iii; l 44:.•1, • Lrer;,,r, .nisrak.r.:nnc! ;,.9
Roof Beam( 2006 International Residential Code (05 NDS)1 Ver: 7.01.14
By: city of tigard , city of tigard on: 01 -07 -2011 : 11:30:30 AM
Project: - Location:
Summary:
5.125 IN x 15.0 IN x 21.0 FT / 24F -1.8E - Stress Class Rated Western Species - Dry Use
Section Adequate By: 68.4% Controlling Factor: Section Modulus /'Depth Required 12.37 In
Deflections:
Dead Load: DLD= 0.32 IN
Live Load: LLD= 0.46 IN = L/543
Total Load: TLD= 0.79 IN = L/321
Reactions (Each End):
Live Load: LL -Rxn= 2887 LB
Dead Load: DL -Rxn= 2001 LB
Total Load: TL -Rxn= 4889 LB
Bearing Length Required (Beam only, support capacity not checked): BL= 1.47 IN
Camber Regd.: C= 0.48 IN
Beam Data:
Span: L= 21.0 FT
Maximum Unbraced Span: Lu= 0.0 FT
Pitch Of Roof: RP= 4. : 12
Live Load Deflect. Criteria: L/ 240
Total Load Deflect. Criteria: L/ 180
Camber Adjustment Factor: CAF= 1.5 X DLD
Roof Loading:
Roof Live Load -Side One: LL1= 25.0 PSF
Roof Dead Load -Side One: DL1= 15.0 PSF
Tributary Width -Side One: TW1= 5.5 FT
Roof Live Load -Side Two: LL2= 25.0 PSF
Roof Dead Load -Side Two: DL2= 15.0 PSF
Tributary Width -Side Two: TW2= 5.5 FT
Roof Duration Factor: Cd= 1.15
Beam Self Weight: BSW= 17 PLF
Slope /Pitch Adjusted Lengths and Loads:
Adjusted Beam Length: Ladj= 21.0 FT
Beam Uniform Live Load: wL= 275 PLF
Beam Uniform Dead Load: wD_adi= 191 PLF
Total Uniform Load: wT= 466 PLF
Properties For: 24F -1.8E- Stress Class Rated Westem Species
Bending Stress: Fb= 2400 PS
Shear Stress: Fv= 265 PS
Modulus of Elasticity: E= 1800000 PS
Adjusted Modulus of Elasticity: E -Min= 930000 PS
Stress Perpendicular to Grain: Fc perp= 650 PS
Bending Stress of Comp. Face in Tension: Fb_cpr= 1450 PS
Adjusted Properties
Fb' (Tension): Fb'= 2699 PS
Adjustment Factors: Cd =1.15 Cv =0.98
Fv': Fv'= 305 PS
Adjustment Factors: Cd =1.15
Design Requirements:
Controlling Moment: M= 25666 FT -LB
10.5 ft from left support
Critical moment created by combining all dead and live loads.
Controlling Shear: V= 4400 LB
At a distance d from support.
Critical shear created by combining all dead and live loads.
Comparisons With Required Sections:
Section Modulus (Moment): Sreq= 114.11 N3
S= 192.19 N3
Area (Shear): Areq= 21.66 N2
A= 76.88 N2
Moment of Inertia (Deflection): Ireq= 808.34 N4
1= 1441.41 N4
Information Notice to Owners About
; *!'! ' Construction Responsibilities
r - (ORS 701.055 (5))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503 - 378 -4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503 - 947 -1488.
• Oregon's Business Identification Number (BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, call 503 - 945 -8091 or go to
http: / /www.oregon.gov /DOR /BUS /docs /211- 055.pdf for the appropriate forms.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 503 - 947 -7815.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their website at www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough -in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052
Telephone: 503 - 378 -4621 — Fax: 503 - 373 -2007
Website Address: www.oregon.gov /ccb
f /property_owner adopted 12 -04 -07 This Copy for Permit Applicant
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:
, I 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.
fM
( ((Al ( 0 0 el
Print Nan a of PermitAppli n
(2 21 (O
61144-47-- Signatur of Permit Applicant Date
Permit #: msTa-o Ic) r 41 1
Address: 1CA - 1.0 81-J• GNI k ��7 ∎74,
r�wg . �
Tt0cv I oR' 7+3 � ; : 1 r�:
Issued by: R T. 0.17'00 Date: F
This Copy for Permit Offices
RECEIVED
DEC 2 8 2010. _ — __9i. oo • -
CITY OF TIGARD . .._.. _ . .. ' . 3 a -c. i► 413 :.. ...LO .. 1
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"fl&Al O SON 9722 9GAL- - i "= 20 ' - e'• 126A
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: S - 1 , /
PLANNING DIVISION:
Required Setbacks: ErApproved 0 Not Approved
Side: 6 Street Side:
Front. .2:212 Garaite: (:)/7 Rear:
Visual Clearance: ErApproved 0 Not Approved ;
P Maximum
eceived
/
ENGIN EERINci_DEPARTMENT :
Actual SlIpe: GA) 8 Approved 0 Not Approved
Site PI : % 0 ,ot pproved
13: Date: / /
Notes: ar ett444,--x/a_ '
CITY OF TIGARD - SITE PLAN ittvaw
BUILDING PERMIT NO:
Street Trees:
Approved
l Approved 0 Not A 'roved
0 • proved
Protect_gLi-ree.1: t
/ 6,
Date:
Notf.s:
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10