Permit ` r CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00518
rti''I DEVEL P I M EN d SE RV ICES 639 -4171 DATE ISSUED: 11/20/03
13125 SW
SITE ADDRESS: 14925 SW 100TH AVE PARCEL: 25111 CB -02601
SUBDIVISION: MURDOCK HILL ZONING: R -3.5
BLOCK: LOT: 007 JURISDICTION: TIG
REMARKS: 656sf new deck and door.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: OTR HEIGHT: FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 6,930.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 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: 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:--eet I SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: t✓ , O 0 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: $ 281.77
WINSTON, MARK OWNER This permit is subject to the regulations contained in the
Tigard Municipal Code, State of OR. Specialty Codes and
14925 SW 100TH AVE. all other applicable laws. All work will be done in
TIGARD, OR 97224 accordance with approved plans. This permit will expire if
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: 503 624 - 1633 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 -001 -0080. You
Reg #: may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp
Electrical Rough In
Framing Insp
Electrical Final
Fina • spection ---
i /—
Is ued By : ■ I _:i.__ QS. � '4 1 - Permittee Signature La
w
Call (50 ) 639 -4175 by 7:00 p.m. for an inspection needed e ft bus - ss day
• 1 P T b 7 -o PAA-✓
BuiJ ng Permi Applicatio FOR OFFICE USE O \L1'
Building
Received . I
Date/By: / �'- a Permit No. f 1 1 8O3j -C '5
Other
City of Tigard RECEI C Planning . .pr.val
y g �` Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 NOV 3 200 K Date/By: ciA U - // 7- 63 Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 111N4', II' Post Review Land Use
J,� _ _� Date/By: Case No.
Internet: www.ci.tigard.or.us CITY OF G . , Contact ®See Page z for
24 -hour Inspection Request: �I VISION Narne/Method: S up lemental Infor mation
C-1PS -- PAa■AAJA7 1 JAJItUt-- IV- r ---..7-____-
TYPE OF WORK 1 ,f .
❑ New construction ❑ Demolition i & It
Addition /alteration/replacement ❑ Other:
C GORY Note: Permit fees* are based on the total value of the work performed. Indicate
K. & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, ^.
ofit for the work indicated on this application.
❑ Accessory Building Di Multi- Family
0 Master Builder Other: � on. $
ac
JOBSin INFORNUTIor *1 'LOCATION o. o edrooms: No of baths:
Job site address: / qq 25 Sim /00111 Atte Total number of floors
New dwelling area (sq. ft -)
Suite #: Bldg. /Apt. #: /(3, 5 — Garage /carport area (sq. ft.)
Project Name: 17 1- Q Oot— Covered porch area (sq. )..
Cross street/Directions to 'ob site: Deck area (sq. ft.) j.
5e-' i-c. / p (° 1 (19. 2 0Pi Other structure area (sq. ft.)
3
CO + °l € '
Subdivision: /// ,,Z -014 Q i Lot #:07 <<
Tax map/ parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate \.
r OFlLl"TOI `3 �InC the value (rounded to the nearest dollar) of all equipment materials, labor,
overhead and profit for the work indicated on this application. "`�
Dale- 6"4‹. cfi�n t r � 0'
Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
° PER OWNER.'" 0 TENANT .` ta Type of construction
ante: M ae — M�o vS to h Occupancy group(s): Existing:
New:
Address: i t-f q Zs St., /000 Alg-
City /State /Zip:' ,' 6/2..— 517L.
i NOTICE: All contractors and subcontractors are required to be
Phone: 5127--6,Z.4--/(
c�( Svc, r •rr i _ 18�
` licensed with th e Oregon Construction Contractors Board under
'13
' ..< provisions of ORS 701 and may be 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: I Fax:
Email. .
Business Name: Ct Fees due upon application $
Address:
City /State /Zip: Amount received $
Phone: Fax: Date received:
CCB Lic. #:
I Authorized / z 03 Notice: This permit application expires if a permit is not obtained within
Signature: r / / Date: 1 I ✓ 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
7 /.g3
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 -�
A
Plan Submittal Requirement Matrix
1�. f � Commercial & Multi- Family
City of Tigard New, Additions or Alterations
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing - Building Fixtures 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
*For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
is \Building \Forms \PlanSubMatrix.doc 04/03
Electrical Permit A , f, }D FOR OFFICE USE ONLY
Received Electrical �
Date/By: Permit No. ro J3 - Did sit'
Cif of Ti and Planning Approval Sign
y g NOV 3 21 I Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 58ILD�F T) RD Post- Review Land Use
Internet: www.ci.tigard.or.us
M G r �A :, 1% „ `
' � Date/By: Case No.:
Juris.: � r
. � ! ! �i ` ` •j i i ��� ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply) .
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Z Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
l & 2- Family dwelling n Commercial/Industrial 0 System over 600 volts nominal one structure
❑❑ Accessory Building ❑ Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
n The above are not applicable to temporary construction service.
/
Job site address: L so 161.91 N FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to ob site:
� ,( dwelling unit. Includes attached garage.
Sz+f e4 I �[
/ 4
A. \ , �
2 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
DESCRIPTION Oj WORK service and/or feeder 90.90 2
1 Services or feeders - installation,
Choi a f ? li' ( ( p f 1`�O{� (� I U'1 alteration or relocation:
„/ - � k- 200 amps or less 80.30 2
(� 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
tf
PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
'r r11 Over 1000 amps or volts 454.65 2
ame • Q-'' , w I 1 *'t Reconnect only 66.85 2
Address: /(1(1 Sw �0 � 41/4-, Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: , -2,,,A 7i 200 amps or less 66.85 1
Phone: ST 3 -(c Zy -/ � 3 : , 5-03-- rrr_./ tti% 201 amps to 400 amps 100.30 2
0 401 to 600 amps 133.75 2
APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
Phone: Fax: service or feeder fee, first branch circuit / 46.85 2
Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
/r'�, / , ) o f alteration, or extension Page 2 2
(J
Business Name: C it., Description:
Address:
Clt /State /Zl Each additional inspection over the allowable in any of the above:
y p Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
Supervising electrician Electrical Permit Fees* . .
p g Subtotal $ y6.
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ 7-5
_ TOTAL PERMIT FEE S �(; R (�
Authorized v / Notice: This permit application expires if a permit is not obtained within
Signature:'` L�� Date./I3 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:
Audio and Stereo Systems
F - 7 Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
E Audio and Stereo Systems
❑ Boiler Controls
0 Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
0 Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting
❑ 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
Permit #: ._(--)061g
o F •
N - \ . 5 S . O C 4 .4
' A ddr —
� #4114 L Date: // ' G�
Issu: • by:;
.59
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.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
. _,„E 1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
n 3A. My general contractor is
I I (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.
I hereby certify that t ' . 'Cove information is correct and that I have read and do understand the Information
Notice to Prope ► - • ers about I . ' on Responsibilities on the reverse side of t is f m.
w o3
!Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
CleanWater Services
November 20, 2003
Mark Winston
14925 SW 100 Ave.
Tigard, OR 97225
RE: Deck addition located at 14925 SW 100 Ave., Tigard, OR
CWS file 3557 (Tax map 2S111 CB, Tax lot 02601)
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 attached 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,
Chuck Buckallew
Environmental Plan Review
Site plan attached
E:\Development Svcs\SP 00 -7 \Concurrence Letters\2S 1 1 1 CB02601 - 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
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 02 3- 045/
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested d - AM PM BUP
Location / /Ot , ( Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner /tA k SR g'— / F3 ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain SIT ‘;—
Slab Inspection Notes:
Post & Beam
Shear Anchors
Ext Sheath/Shear iM;'
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
origitaiip 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
(MN PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA tz4
Approach/Sidewalk Date � Inspector " ^ , " (36`"-e Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL