Permit CITY O F TIGARD
MASTER PERMIT
PERMIT #: MST2003 -00294
'il DEVELOPMENT SERVICES DATE ISSUED: 8/25/03
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11100 SW 93RD AVE PARCEL: 1S135DB-09000
SUBDIVISION: ASHBROOK FARM ZONING: R -4.5
BLOCK: LOT: 023 JURISDICTION: TIG
REMARKS: 2 -story addition.
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 17 FIRST: 270 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 198 sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 43
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 468 sf REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /F DR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BRCIR: 1.00 SIGNAL /PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL .
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 912.71
SPRINGSTEAD, WADE AAND JSC INC This permit is subject to the regulations contained in the
Tigard Municipal Code, State of OR. Specialty Codes and
LINDA S 9000 SW OMARA ST all other applicable laws. All work will be done in
11100 SW 93RD COURT TIGARD, OR 97223 accordance with approved plans. This permit will expire if
TIGARD, OR 97223 work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: 503 684 - 0471 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 82224 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Crawl Drain /Backwater Insulation lnsp Final inspection
Foundation Insp Mechanical Insp Rain drain Insp
Post/Beam Structural Framing lnsp Roof Nailing
Post/Beam Mechanical Shear Wall lnsp Electrical Final
Underfloor insulation Exterior Sheathing Insj Mechanical Final
Issued By : Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ler business day
r �.> • FOR OFF USE ONLY
Building Permit 1 ' Re ceived f Building v_i
It..... Date /By: 7 1 D 3 Permit No.:U/ 5/ YJ .3'�,„ 9
City of Tigard 12003 Planning Approval Other
Date /By: Permit No.:
13125 SW Hall Blvd. 3u`- Plan Review Other
Tigard, Oregon 97223 o f TIG1\ Date /By: /✓)A 7- if - 0 3 Permit No.:
� �s,tmh ; � + f � Post - Review Land Use
Phone: 503-639-4171 Fax: 50� � L r 6O3l\J ' � Date/By: Case No.
Internet: www.ci.tigard.or.us BU a Contact ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: / /d' Supplemental Information \
7 45 44 e C . - e r� ,; L
.-Z ZEti , .. :: ",. _ P =E.'OF. WORK Z ' ` 5 t f :. "'W ,f ' RE a RED D AT A r l` 1
❑ New construction ❑Demolition
j 1 & 2 FA NIILI (# D i
❑ Addition/alteration/replacement ❑ Other:
`` CATEGORY°OFFCONSTRUCTION r
�� � ,.�, � � ;� _ _ ,_ f,�� Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application. t/3A
❑ Accessory Building El Multi-Family ✓✓ '
El Master Builder ❑ Other Valuation $ice! "
--i E N M No of bedrooms: -Cr- No. of baths: -�
�,,,3��, ; � and ° €,�' %;` =�
Job site address: III 0J BLS ".-'5`2-'"? Total number of floors 2.2-12._
New dwelling area (sq. ft.)
Suite #: I Bldg. /Ant #• Garage /carport area (sq. ft.)
Project Name: s?'<2 %.-.' &K. r"f4 r, Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.) Qt-c� 8-2 Other structure area (sq. ft.)
' 1 C - < 4 REQ .
_ On :h a . C U CHCK x_ -e r
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. In
a t r Indicate
d
.. ..> ,. ? :.. DESGRIP �' the value (rounded to the nearest dollar) of all equipment, materials, labor,
A ION,OF WORK >.. -
overhead and profit for the work indicated on this application.
2 . :s2 r P < ' . --"'
Valuation $
0
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
g ` PROPERTY.O,WNER lili M €;T.ENANT ,' ;, ;k i Type of construction
Name: (,i A LA v s v'4G,t2'r>=+'9ID Occupancy group(s): Existing:
New:
Address: 11 1po "i,,:, c'Vz '
City /State /Zip: 'NA 4-cc4a c7 cam- - I zz
NOTICE: All contractors and subcontractors are required to be
Phone: CeSc1 on I Fax --• q
_ � �, _��,_.. ._ licensed with the Oregon Construction Contractors Board under
APPI I,CANI �;;� 2i C QNsTACT „PERS®N . m . provisions of ORS 701 and maybe required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:.
Phone: Fax: „r 3 t. v a - a r
f , ” h, BUILDING, F EES "A";-,1,21,Z
E-mail p1e e chedule ` eg
� 4 " flse ICfCI t0 IC S �. s5
...:.x . W.. t C0.: +CONTRACTORS . 5 .. gin , ,..: ',N �- _ x7f i
Business Name: JSL : vs+C--. Fees due upon application $
Address: 9 000 5t 0p Q'' SC
City /State /Zip: r \ {►ate 6( 9-12-2-75 Amount received $
Phone:Paj; - - 1304 Fax: CC 8 4 O •"1 1 Date received:
CCB Lic. : ZZZ• -
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date:1-1- O�j 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 / 'Ji a 9 S
One- and Two- Family Dwelling
•
y Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard . Of Ti and
Y g ❑ Electrical Cl Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OP. 97223 0,'Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. •
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
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 Oregon and shall be shown to be applicable to the project under revi• . .
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. •
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6 /00 /COM)
Mechan• FOR OFFICE USE ONLY
ical Permit Application Received •
Mechanical
t, Date/By: 7 � �� 3 Permit No.: �` /5T;.p05 -c29.
Cit of Ti and Planning Approval Building
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 �j y,;di yi � i N I ,\ Post - Review Land Use Date/By: Case No.:
Internet: www.ci.tigard.or.us a • ' i l Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 - 639 -4175 - "' "'" 4 'I
P Q Name/Method: Supplemental Information.
I. tirj ...`,VEM,_:. `,n TYPE OF WO1t. M :;,. a. 1 5a2,1WCOMMEMPAgfMtS,CHEOULV;tVWC
❑ New construction ❑ Demolition Mechanical permit fees* are based on •the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
,-; t ' „CATWOR 0EiCONSTOWEI( E. „ "70 mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family k's' RESTEMS )>EE* SOHEDTJLE
Master Builder Other: Description j Qty i Fee(ea.) Total
f`,• . Heating/Cooling , j :fi , , <' 4:•:3..
//j. : a " JOB SITE"INFORM. TION and LOCATION dt :X , ,',; Furnace - add -on air conditioning* * 14.00
Job site address: i 1 U 0 'nlJ "1 Gas heat pump 14.00
Suite #: Bldg. /Apt. #: \Duct work 14.00
Project Name: try ronic hot water system 14.00 /-
Resin -ntial boiler j
Cross street/Directions to job site: (for me '..tor or hydronic system) 14.00
Unit heat: s (fuel, not electric)
(in wall, in- .suct, suspended, etc.) 14.01, \
Flue /vent (for :ny of above) 10.11 1
Subdivision: Lot #: Repair units 12 5
A ._..',� !,Z-: _ t`Other`Fue1Appliances :. ,... 'u F
, °'
Tax map /parcel #: • Water heater , 0.00
. -M l - , , DESGtRTP T ,IONTOF WORKz=, =.: 'Pty :;. M k:;
Gas fireplace 10.00
exexT "- Duo J) 2L Flue vent (water heater /ga fireplace) 10.00
-r-
lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
OPER1V OWNER #; k fiTEN I T ...ice. .11 er:
Other: 10.00
Name: (4' IB L�`.15 c _ IN l-� �� A�7 , Y.. , - *, § " i:,- Envi iiimental Ez:'adst, :; . ,eniilaiiiii m ;�r f , _ <. �, ." r
Range hood/other kitchen equipme 10.00
Address: l 1 100 St>. 9 3 2
,..}_� Clothes dryer exhaust 10.00
City /State /Zip • \ \ 6(k as 0 Z.._ c 1 - 1 '2-2_3 Single duct exhaust
Phonet6 0 1 l 0 Fax: (bathrooms, toilet compartments,
irg ;APPLICANT ..tt: ¥ .. , CONTfACT,PPERSOIN.' . utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 10.00
.,` i x = .:; . psi ; e19effiiiik s4,''' ,±
City /State /Zip: * *($5.40 for fie t 4, $1.00 each a i . itional)
Phone: Fax: Furnace, etc. *
Gas heat pump *
E -mail: Wall /suspended/unit hea •r
, ,. SS..° g ._. CON:TRACT®R ° t ° : ".; " Water heater **
Business Name: Qc,s .--Jlzz_._ Fireplace
** 1
Address: Range **
City/State/Zip: BBQ **
�' p' Clothes dryer (gas)
Phone: Fax: Other: **
CCB Lic. #: Total:
:Mechanical Permit Fees*
Authorized '
Signature: Date: Subtotal: $
Minimum Permit Fee $72.50 $
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
$1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52
for each additional $100.00 or fraction
thereof, to and including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and
$1.45 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
1:09' itafet'Alitirfi.Ae4
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater •
Vent not included in appliance permit 445
Repair units 805
<3 hp; absorb. unit, 955
to 100k BTU
3-15 hp; absorb. unit, 1,700
101k to 500k BTU
15-30 hp; absorb. unit, 501k to I mil. 2,310
BTU
30-50 hp; absorb. unit, 3,400
1-1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non-portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL
VALUATION:
i:\Dsts \Permit Forms NecPermitAppPg2.doc 01/03
Electrical Permit Application ' FOR OFFICE USE ONLY - .... •
Received Permit Date/By: I� s�
c atBy: � / �Q `j Permit N
City Tl and Planning Approval Sign
y g Date/By: Sign
No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
//�s» I ; �° A\ Date /By: Case No.:
�u4911I
Internet: www.ci.tigard.or.us 6. i Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 " Name /Method: Supplemental Information.
' ,;"' '":.; t ° ° "T PE OF WORK..;, ° 4. - 'f ' ".,., PI.OWO;V.tEW "(Please che that aPpl :P
❑ New construction . ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement El Other: ID Service over 320 amps - rating of ❑ Building over 10,000 square feet,
...
W,,,,�,,,,,�,� �? „_,�M ATECGORY OFrC®NSTRUCTIONVZaWiM 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: 0 gr ss g :
E e /li htin plan Other
gP
$JOB SIT-EnINF ndLO:OATION. ,,., Submit _ sets of plans with any of the above.
�� The above are not applicable to temporary construction service.
Job site address: . ' '” i . 's r " ek _ .. k i/s ' r s'? 's..� '
FEE SCNFDULE� ,,.
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
New residential - single or multi - family per 1
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
` it , 4DESCRIPTION.A. WORI{s ' ` ; & ' Z service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
- 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
V' liM PROPERTY OWNER„ . !;,., It - TEIANT.h , ° s <,E:.,r & .g 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: . Reconnect only 66.85 2
- - -, Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps
133.75 2
f#PI'I:rehlSI ' ::,':_, ,; ,..; . Y1 ES CO triCe `PERSON;,,,,, ,, :, alteration, Branch circu new, a or
n o
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 , 2
E-mail: Misc.(Service or feeder not included):
- �� Each pump or irrigation circle 53.40 2
fi- '�� °•`= - CONTIGTOR � Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: � V Description:
or extension Page 2 2
Descriptionn:
Address:
Each additional inspection over the allowable in any of the above:
City /State /Zip: • Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other: O Lii ff � -
,__. .. . ,� tL �ElectrtcahPermlt1Fees ,..,.... a .,__.a.. .. st -
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State' Surcharge (8% of Permit Fee) $
- TOTAL PERMIT FEE $ - -
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name) •
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
Garage Door Opener
I I Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system ... $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
0 Audio and Stereo Systems
n Boiler Controls
F Clock Systems
ri Data Telecommunication Installation
I T Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
l l Landscape Irrigation Control
n Medical
n Nurse Calls
ri Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
•
* No licenses are required. Licenses are required for all
other installations
•
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
:x.
CleanWater Services
Our commitment is clear.
August 14, 2003
John Schmidt
9000 SW O'Mara
Tigard, OR 97223
RE: Addition to single family residence located at 11100 SW 93 Ave. in
Tigard, OR
CWS file 3233 (Tax map 1S135DB, Tax lot 09000)
Clean Water Services has received your Sensitive Area Certification for the
above referenced site. District staff has reviewed the submitted materials
including site conditions and the description of your project (see enclosed site
plan). Staff concurs that the above referenced project will not significantly impact
the existing sensitive areas found near the site. In light of this result, this
document will serve as your Service Provider letter as required by Resolution
and Order 03 -11, Section 3.02.1, and your Stormwater Connection authorization
from Clean Water Services as required by Ordinance 27, Section 4.B. All
required permits and approvals must be obtained and completed under
applicable local, state, and federal law.
•
This letter does NOT eliminate the need to protect sensitive areas if they are
subsequently identified on your site.
If you have any questions, please feel free to call me at 503 - 846.3553.
Sincerely,
i
Chuck Buckallew
Environmental Plan Review
Site plan attached
E:\Development Svcs \SP 00 -7 \Concurrence Letters \1 S1 35D130900 - no impact to water quality.doc
155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124
Phone: (503) 846 -8621 • Fax: (503) 846 -3525 • www.cleanwaterservices.org
,/
A.
Permit #: N O3-GC A tL
Address: it; ; OCR e -�3 C i � 41-)e
e '
Issued by: Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Bill in the appropriate blanks and initial boxes 1 and 2, and either box .3A or 3B:
in, 1. I own, reside in, or will reside in the completed structure.
l
UM 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
•r 1 before or upon completion.
3A. My general contractor is -.3 gga,a
(Name) Contractor regis.
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
thereby certify that the above information is correct and that I have read and do understand the Information
• Notice to P r-I perty Ownir7 about Construction Responsibilities on the reverse side of this form.
if
. iAei if .**.- ILIA! AvaiLii V,5
( ` % nature of p f mit applicant) (Date)
• (White copy to issuing agency permit_ file,
pink copy to applicant) •
'—^
Information Notice to Prom)erty
About Construction R es ports . b . l e s
Note: This Notice to Property Owners about Construction D)h3iex
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
conx|mcdunorimyrovenoeotofnresidcndaiox,ucturc,ynuvvi1Linmostiootunces,hcru|edk/beuoemp|hyorundthcpcop|e
you hire will be employees. As the rnployer, you must comply with the following:
Oregon's withholding tax law: As an employer, you must withhld income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even i f you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-809].
Unemployment insurance tax: As an employer, you 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 378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation. Law, and must
obtain workers' compensation insurance for your employees. If you fail to obtain workers compensation insurance, you may
be subject to penalties and will be liable for all claim costs i f one ofyour employees is injured onthcjob. For more infonnuhon,
call the Workers' Compensation Division at the Department of ConSumer and Business Services at 945-7888.
U.S. internalRevenue Service: As an employer, you mustwithhold federal income tax from employees You will be
liable for the tax payment even i fyou didn't actually withhold the tax. For more in formation, eallthe•I ntcrna ReVenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: Au the permit holder for this project, youmrrcnp000Ob|efbrrcmn|vingunybai|upetomcercodcrequircmcnto
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to su employees: Make sure you have sufficienttime to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish
trades. and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309'5052,
• 503/}78-462]). The Board is located at 700 Summer St. NE Suite 300, in Salem.
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C inc.
9000 SW O'Mara St.
Tigard, OR 97223
(503) 730 -4450 FAX 503- 684 -0471
RECEIVED
ky SEP 0 5 2003
CITY OF TIGARD
BUILDING DIVISION
S � APPROVED ti\A'
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REVISION
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CITY OF TIGARD'. fillhela,641-oikii, 1) . ,,
BUILDING DIVISION
A . PERMIT #: MST2003-00294
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/2512003
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 502005 TIME: 7:10AM PAGE: 18
SITE ADDRESS: 11100 SW 93RD AVE CLASS OF WORK:
SUBDIVISION: ASHBROOK FARM LOT #: 023 TYPE OF USE:
PROJECT NAME: SPRINGSTEAD
DESCRIPTION: 2-story addition. 2/25/05:THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTIONS
FOR A PERIOD OFTHIRTY DAYS.
OWNER: SPRINGSTEAD, WADE A AND, PHONE #:
CONTRACTOR: JSC. INC PHONE #: 503-684-0471
Inspection Request Scheduled For: Date: 5/2/2005 Pour Time: '
Code # Inspection Description Confirm # Contact # . Message
199 Electrical final 005811-01 503-684-0710 N
Corrections /Comments / Instructions:
PASS 0 PARTIAL APPROVAL 0 CANCEL D NO ACCESS
fl FAIL 111 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
c/ - 1 - n (
Inspector: P1 Date: +' v7 Phone #: 503) 718
I , ,
CITY OF TIGARD'
BUILDING DIVISION PERMIT #: MST2003-00294
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: B/2612O03
Phone: (503) 639 -4171 � " n ' n rylu�u11'�� � "�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/3/2006 TIME: 7:14AM PAGE: 12
SITE ADDRESS: 11100 SW 93RD AVE CLASS OF WORK:
SUBDIVISION: ASHBROOK FARM LOT #: 023 TYPE OF USE:
PROJECT NAME: SPRINGSTEAD
DESCRIPTION: 2 - story addition. 2/25/06:THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTIONS
FOR A PERIOD OFTHIRTY DAYS.
OWNER: SPRINGSTEAD, WADE A AND, PHONE #:
CONTRACTOR: DISC INC PHONE #: 603-884-0471
Inspection Request Scheduled For: Date: 5/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 006971-01 603 -6B4 -0710 N
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r. Date:. e)� Phone #: (503) 718-