Permit •
� MASTER PERMIT
CITY TIGARD PERMIT #: MST2004 -00354
�I� DEVELOPMENT SERVICES DATE ISSUED: 11/19/2004
P °-' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12701 SW 138TH AVE PARCEL: 2S104BD -06400
SUBDIVISION: ROSE MEADOWS ZONING: R -7
BLOCK: LOT: 023 JURISDICTION: TIG
REMARKS: To obtain FINAL INSPECTIONS on original permit #MST98- 00401.
Building and final only.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: MF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: DWELLING UNITS: THRD: sf RIGHT:
VALUE: 1,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR:
•
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: BOIUCMP < 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 SVOFDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: 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: LANDSCAPEJIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 125.00
This permit is subject to the regulations contained in the
KERKERI NG DICK SORRENTO CONSTRUCTION INC
Tigard Municipal Code, State of OR. Specialty Codes
12701 SW 138TH AVE. 1345 SW 158TH and all other applicable laws. All work will be done in
TIGARD, OR 97223 BEAVERTON, OR 97006 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.
Phone: Phone: 643 - 9602 ATTENTION: Oregon law requires you to follow ru les
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 6884 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Electrical Final
Final inspection
Building Final
Issued By : Permittee Signature : �
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the nett business day .
-Buil'ding Permit Appli ; -W : EVE FOR OFFICE USE ONLY
City of Tigard Received (/ Permit No.: B
I. Plan Re view
13125 SW Hall Blvd., Tigard, OR 97223 NOV 19 20 �/�
Phone: 503.639.4171 Fax: 503.598.1960 a . �"'l I { Date /B . Other Permit:
Inspection Line: 503.639.4 CITY OF TI 4,, " ._�` Date Ready/By: H See Attach Checklist for
Internet: www.ci.tigard.or.us
BUILDING DIVISION
Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Z 1- and 2 -family dwelling El Commercial /industrial Valuation: $
El Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND. LOCATION . Total number of floors:
Job site address: 1 ZO 1 s'tj 135 A U.1. New dwelling area: square feet
City /State /ZIP: 11 L 4 az _ Ill a 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: 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: 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.
Valuation: $
Existing building area: square feet
New building area: square feet
g PROPERTY OWNER ❑ TENANT Number of stories:
Name: p K14. h k K kP rI a Type of construction:
Address: I arc) I SW f -U5_, Occupancy groups:
City /State/ZIP: 71 6aV -ii , vL .... vt 722_3 Existing: '
Phone: (j 0 3) 5 a y - Og 7 4 Fax: ( ) New:
. ❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: S o r re / CONST -)✓C All contractors and subcontractors are required to be
Contact name: U licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13 ( . 560 I `) su- /1- jurisdiction in which work is being performed. If the
City /State /ZIP: $ uevr-h J t 0),2_ ' 2 as
applicant is exempt from licensing, the following reasons
r��� PI) /� / apply:
Phone: (503) b F ax::(PI) 6 u,3'' b/
E -mail:
CONTRACTOR
Business name: Cat r u %clou 5 7- >C-, • BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City /State /ZIP: y
Fees due upon application 6. 1 !) J
Phone:( ) Fax:( )
CCB lic.: G E3 8 q 9 -.. , --c)
received j
Date received: ~ ,rt
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:/V Date: //- / 4 • Fee methodology set by Tri- County Building Industry
D4 0 i4 - ll?Ot^Krn4� Service Board.
i :\ Building \Permits\BUB -Perm 1• pp.doc 12/03 440 -4613T(I I /02/COM/WEB) (-', �/
One- and Two - Family Dwelling r '
Building Permit Application Checklist • FOR OFFICE USE ONLY
City of Tigard Received ' PermitNo.:
13125 SW Hall Blvd., Tigard, OR 97223 social
ed permits:
Associated 503.639.4171 Fax: 503.598.1960 �� A I t ' J � ❑ Electrical ❑Plumbing ❑Mechanical
24- Hour Inspection Line: 503.639.4175 .` I
Internet: www.ci.tigard.or.us ❑ Other:
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. 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. El 0 ❑
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. 0 ❑ ❑
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 0 ❑ ❑
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 applicable to the .ro'ect under review.
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 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 tree protection measures as required by conditions 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 2
.Electrical Permi ;�. 11 1. ;l L D FOR OFFICE USE ONLY ,
' City Of Tigard _ — ReDatcee/iB M ved 1/ f 6 I �mi Permit Na: a , J , I f do ' /
13125 SW Hall Blvd Tigard, OR 93' 9 2004 Plan Review
Phone: 503.639.4171 Fax: 503.5'1. l ' •0 ii i'v'k;;g' I'`i ,\ . Date/B Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD � ' -, Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Rilil DING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 and 2 family dwellings 4 or more new residential
kt l - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
❑Health -care facility ❑Other:
Job no.: Job site address: a S 4..) „3,4 � Submit 2 sets of plans with any of the above.
City /State/ZIP: Ti 14 fG , d 9 7 2 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:
FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 •
401 amps to 600 amps 160.60 2
Name: 0 -k_ Ke V Y�l A.3 601 amps to 1,000 amps 240.60 2
Address: E 7 ' 1 5- W (9 Aix, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: T 6A f C / 0 L "l 7 2-2-3 Temporary services or feeders installation, alteration, and/or
( �3) 5,, f - Dc/ 7 ( ) relocation
Phone: L J ` Fax: 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
13 APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Belo +1 p� �s branch circuit
�/� U "` B. Fee for branch circuits
Contact name:
without service or feeder fee, 46.85 2
Address: / - each branch circuit
5 -. Each add'I branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (S "7 e '7 _ y 2 2 i Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: p),,, lott ..(..5._ C..
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: Investigation per hour (I hr min) 62.50
Phone: (61)3 ) "7 -n _ U 2 Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:4q ci qg Electrical Lic.: ..?..47(_ Suprv. Lic.: 13 Subtotal 6...g - )
Suprv. Electrician sigtlaiut r q red: -1 - f ` 0 l° Plan review (25% of permit fee) •
Print name: Date: State surcharge (8% of permit fee) 5 °
TOTAL PERMIT FEE 471,5 J
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 3'p.t.) vs e . + / el Date: // 2' • Fee methodology set by Tri- County Building Industry Service'Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 4404615T(10/02/COM/WEB
1 3 .
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
REsID.ENTIAL'WORK` ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONIY1
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
•
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PemiitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
MST a DO �— 063-517( INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested J )O� _ AM PM BUP
-7
Location / a 7 0 I /3� te� /4--f Suite MEC
Contact Person Ph ( ) PLM
Co tractor Ph ( SWR
UILDI Tenant/Owner S a — <=)? 7 ELC
ing
ELC
Foundation .
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm giOSe— )4117
Susp'd Ceiling
Roof
Other:
S PART FAIL
( LU ING /4V � C
� =
Post & Beam #PA.D144.
Under Slab
Rough -In �L / ' . — 9 r- 00 •5/ey
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
T FAIL
ECTRIC L
ice
Rough -In
UG /Slab
Low Voltage
�F' larm
i Reinspection fee of $ required befor- * inspection. P. -. City Hall, 13125 SW Hall Blvd:
__
o PART FAIL
Please call for rei :ectio "E: • U. • e to inspect – no ccess
Fire Supply Line
ADA
Approach /Sidewalk Date r ��
Other: /
Final DO OT REMOVE this I spection record from the Job site.
PASS PART FAIL
CITY OF TIGARD
BUILDING rinspection Line: (503) 639 -4175 �� y �� � 5 -�
INSPECTION DIVISION Busin ii e: ) 639 -4171
BUP
Received Date Requested /,- l AM PM BUP
Location / .; 7D l / A Suite MEC
Contact Person Ph ( ) PLM
Contractor / Ph ( ) SWR
ILDING) Tenant/Owner D_ i " ELC
Footing 5, y = o 9 7
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing /t/ ✓J fI� C771.1 (4 -L
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Oth
anal '
( R FAIL
PLUM
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
C TF e. 21CiL
•
Rough -In
UG/Slab
Low Voltage
Fire Alarm
anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS PART FAIL
SITE El Please call for reinspection RE: / ❑ Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date � � �' Inspector Ext
Other:
Final • DO NOT REMOVE this Inspection record from the job -site.
PASS PART FAIL
•