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Permit ?/7/ 1 / f r i- -t,* "/v / h/G l c 7` --e 4V 6.,,' , CITY OF TIGARD ELECTRICAL PERMIT 1ph . _ COMMUNITY DEVELOPMENT Permit #: MST2011-00105 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/30/2011 T Parcel: 1 S135DB03000 Jurisdiction: Tigard Site address: 11555 SW 91ST AVE Project: SCHUETTKE Subdivision: CHARBEN Lot: 11 Project Description: 480 sf. detached garage. 9/8/2011, reprinted permit to include (1) feeder. Contractor: PRECISION NORTHWEST INC. Owner: SCHUETTKE, CARL 12403 NE 60TH WAY, D -1 11555 SW 91ST AVE VANCOUVER, WA 98682 TIGARD, OR 97223 PHONE: 360- 566 -8455 PHONE: FAX: 360- 566 -8453 FEES Quantity Description Date Amount 1 ea Building Permit - Additions, 07/15/2011 $362.69 Specifics: Alterations, Demolition 1 Plan Review 06/30/2011 $255.52 Type of Use: SF 1 ea 12% State Surcharge - 07/15/2011 $43.52 Class of Work: ALT Building Type of Const: VB 0 Plan Review 07/15/2011 $ -19.77 Occupancy Grp: U 1 ea DC Provision Review, SF - 07/15/2011 $65.00 Ping 1 ea DC Provision Review, SF - 07/15/2011 $10.00 LRP 5 ea Info Process /Archiving - Lg 07/15/2011 $10.00 Sheet (over 11x17) 4 ea Info Process /Archiving - Sm 07/15/2011 $2.00 Sheet (up to 11x17) 1 ea Erosion Control 07/15/2011 $26.00 Total $892.95 Required Items and Reports (Conditions) 1 Ersn Cntrl 503 - 681 -4444 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is sus ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rule are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. You may obtain a co• of th les or dir t questions to OUNC by calling 503. 2.1987 or .800.332.234 . Issued By - < — _ _ Perm ittee Signature: ,/Kr OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application , t) t U5 �� FOR OFFICE USE ONLY C O T and ;��� r /1 /� -� Permit No.: �' g Date /By: t !/ air- / I T �1 / �J ° 13125 SW Hall I Blvd., Ti g ard , OR 972 +t� Received plan Review Other Permit: i ' • 0 • Phone: 503.718.2439 Fax: 503.598.1 . i 1\1" DateBy. CS T l G A R D Inspection Line: 503.639 c` 0 ^� Date ReadyBy: 1 p 3 0 See Page 2 for Internet: www.tigard or.gov } Y otified/Method: L Supplemental Information TYPE O WORK OS�II lSi PLAN REVIEW ❑ New construction dition/alteration/�rp v 'IC$hlent Please check all that apply (submit 2 sets of plans w /items checked below): ❑ 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 - 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. n ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: 215 S'� q j £ /}� y. Six or or more. occupancy. L ��, ��/ vvv «` ❑ 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.: Project name: s' J t^ ❑ Service or feeder 600 amps or more. l FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total 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'1500 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 / I / ?- residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 1 100.70 r(, 7 0 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 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: ( ) Fax: ( ) 200 amps or less 59.36 l 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 2 each branch circuit 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) City/State /ZIP: Each manufactured or modular 67.84 2 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 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 (Vs hr min) CCB Lie.: , Electrical Lie.: Suprv. Lie.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: o Subtotal: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. N umber o 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: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* H 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 n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n 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 1: \Building\Permits\ELC- PermitApp.doc 07/01/10 Iii CITY OF TIGARD MASTER PERMIT v Permit #: MST2011 -00105 S COMMUNITY DEVELOPMENT TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/30/2011 T Parcel: 1S135DB03000 Jurisdiction: Tigard Site address: 11555 SW 91ST AVE Subdivision: CHARBEN Lot: 11 Project: SCHUETTKE Project Description: 480 sf. detached garage. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 15 Bathrooms: 0 Second: 0 sf Garage: 480 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No Total: 0 sf Value: $18,748.80 Rear: 15 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 Drains. 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 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: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 1 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 Ecompasing: N Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB U 0 Owner: Contractor: SCHUETTKE, CARL PRECISION NORTHWEST INC. Required Items and Reports (Conditions) 11555 SW 91ST AVE 12403 NE 60TH WAY, D -1 1 Ersn Cntrl 503 - 681 - 4444 TIGARD, OR 97223 VANCOUVER, WA 98682 PHONE: PHONE: 360- 566 -8455 FAX: 360 -566 -8453 Total Fees: $854.55 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through O_ a •52- 001 -0090. You ma • • - : = • of the - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.234 . Issued By: - l - - ' �� mot - - Permittee Signature: `''_ /y \ / Cal 03 .' ' 5 by 7:00 a.m. for the next available inspection ate. 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. Build Permit Application 1 i FOR OFFICE USE ONLY City and Permit No.: ` 1 g ^ � \ R e ceived Date/B : .ii v' { / 14 Lair il - 1 l 13125 SW Hall Blvd., Tigard, OR 972 � O` Plan Review ,,, III { I • Phone: 503.718.2439 Fax: 503.59'1,,, 44 Date/B : A � 1 Other Permit: CI? T I GARD Inspection Line: 503.639.4175 \ O Date Ready/133: Juris: Ia See Page 2 for Internet: www.tigard - or.gov �\�' � �G_�cj� Notified/Method: f� Vf/ Supplemental Information TYPE OF WORKG • REQUIRED DATA: 1 -•AND 2- FAMILY DWELLING . New construction ❑ Den Permit fees* are based on the value of the work performed. Indicate the value (romded 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. ❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ ( f ) 7 t Q0 42-Accessory building ❑ Multi - family Number of bedrooms: G 1 ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: , (S 5 5 Si,) C (Sr /l Je , New dwelling area: square feet City /State /ZIP: Cq-42d 0 rz_ , C% 22-1 Garage /carport area: 4Q V square feet Suite/bldg. /apt. no.: Project name: 51h,. , Covered porch area square feet Cross street/directions to job site: CrlZeQ kt(A,21 'c, Deck area: square feet Other structure area: square feet I. 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 (romded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. - 7.-2 - - 1 �k c -- - -� Valuation: $ Existing building area square feet ,,/ New building area: square feet l� rROPERTY OWNER ❑ TENANT Number of stories: Name: Cg Sv4 u L f f,_ Type of construction: Address: }i,.t.e S Zp 3 5 , `'( , Occupancy groups: City /State /ZIP: Existin g: Phone: (5x73) 5c 'g 7c? S -7 Fax: ( ) New: a APPLICANT - CONTACT PERSON NOTICE c . Business name: pQ�I ,oi✓ �, (� . /" - Old{ All contract U rs and subcontractors are required to be Contact name: �}� 1, licensed with the Oregon Construction Contractors Board �" u 1 " A �� under ORS 701 and may be required to be licensed in the Address: / 2 C fo 3 N C. (R O -7},, w,9 V 7 .- ( f jurisdiction in which work is being performed. If the City /State /ZIP: / ff . applicant is exempt from licensing, the following reasons V R,�+C 0,0„, �/ ��✓ yF . Z (1�� apply: Phone:(31v0) *(e(Q -$"/.� T Fax:: (34,0) 5(e 8°/ - ,3 I t - E- mail: N'l h ost@ pItec /S/onl, . C.© -'-t 64 J CONTRACTOR BUILDING PERMIT FEES* Business name: (Please refer to jee schedule) Permit fee: Address: State surcharge (12% of permit fee): City /State /ZIP: FLS plan review (40 %ofpermit fee): Phone: ( ) Fax: ( ) (Due upon application.) CCB lie.: /s9 to ,3/ // % PIoN (� ,,�ti , 1 5.5A Authorized signature �/] . Amount received: �' ✓ l / This permit application expires if a permit is not obtained Print name: rki,, /' ', .5 S Date: within 180 days after it has been accepted as complete. �!� * Fee methodology set by Tri -County Building Industry er`Ade . r C I tL C.) 940 .. — 7 f.4. Service Board. I:\Building\Permits \FPS- PermitApp.doc 02/01/2011 / 440- 4613T(11 /02/COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: . 1.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition ❑ 1 -10 heads: No plan review required. ❑ Alteration ❑ 11+ heads: Plan review required. El Repair Number of sprinkler heads: Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler ❑ Wet El Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I - Hood Fire Suppression System Hood Project Valuation: $ • C.) Fire Alarm Submittal shall Battery Calculations ❑ Yes include: Individual Component ❑ Yes Cut Sheets Fire Alarm Project Valuation: $ D.) Residential Sprinkler (Stand Alone System) Square Footage: Permit Fee: 0 to 2,000 $198.75 2,001 to 3,600 $246.45 3,601 to 7,200 $310.05 7,201 and greater $404.39 Sprinkler Project Square Footage: sq. ft. Fire Protection Permit Fees Project valuation subtotal (see A, B & C above): $ Permit fee based on project valuation (see fee schedule): $ Permit fee based on square footage (see D above): $ State Surcharge (12% of permit fee): $ FLS Plan Review (40% of permit fee): $ TOTAL: $ Plan review requires a completed application and three (3) sets of plans at submittal. Plan review fees are required at submittal. i: Building \Permits \FPS- PermitApp.doc 02/01/2011 2 El6ktileal Permit Application ..- ii City of Tigard . d R Da ece leffi lve : w il Liiir 13125 SW Hail Blvd., Tigard, OR 97223 Permit No.: Plan Review ;.• ... l":i '''ki Phone: 503.718.2439 Fax 503.598.1960 . ,A:\ Date/ iff/ ,2 y: / ) 1 . 1:Mher Pennii: 1a inspection Line; 503.639A175 . - It3s) ...„te Ready/Br - , Anis: Sil See Page 2 for VANYetti:40 Internet: www.tigard-orgov ,,,'1.' % . •',"'' A. . 1. 11) 'alined/Method: 7714 Supplemental Information ),„:. V s \ ityOg..:(**0;? ' ' ',"•::::-' -... ,!:-':::,'.,',,,':::',',-.:,:':: rH: ZOTew Construction 0 Addition/alteration/repla Please check all that apply (submit l sets of plans wlitems checked below): C3 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: „,„ i ,, . , where the available fault current 0 Marinas and boatyards. : 5 -''' : ' ' ' cikir.00liOr OV.: COI ::.• :. : , ':: : : , ,,,, ' exceeds 10,000 amps at 150 volts or 0 Floating buildings —=------- ' . less to ground, or exceeds 14,000 0 Cominereiel-use agricultural 0 1- and 2-family dwelling 0 Commercial/industrial ‘ErAccessory building amps for all other installations. buildings, 0 Multi-family 0 Master builder 0 Other: El Fire pump. 0 Installation of 75 KVA or ' : ': ' ' I dlo13 S1176 ii4iNitiiiiikiiiiii4 : AM) 1:0 ,= .:':' . £3 Fanergcncy system. larger separately derived system. :. -,: :-.: • - .: , ' : : : . - . , -, . El Addition of new motor load of 0"A", "B" "1-2", "1..3", 10011P or oleic. occupancy. Job no.: Job site address:_ Syr . 51„.0 eft tr A1., a Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: •ri G J c) IL 9 '72.11 0 Health-care facilitie,s, 0 Supply voltage for more than ['Hazardous locations 600 volts nominal. Suite/bldg./apt. no.: Project name: ,... 1.4.41, ..,74,_ 0 Service or feeder 600 amps or more. Cross street/directions to job site: C iN s..3.4.4 41 /24 tame tan 1 Qiy. I Ike. I Total I * 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 I Tax map/parcel no.: _ Limited energy, residential 75.00 2 1001111PTION. WOR11•C ::, ,.:: -;:• .:, ..., : , ',...';;;‘::',:.,..;..:•::-. ;'': (with ahovqA.P ) ._„ - Limited energy, multi-family 67,.4--n-kee, residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 :•=-,,. ,::•':.'..: , .crof i evitektrify, - *,1,4717.1.nt i 44 1yr ..,: .::.;: 201 amps to 400 amps 133.56 2 : .. :-. . :... ,a.,..., • . ,. . " • _ 401 amps to 600 amps 200.34 2 Name. ' C.A.4)-1- gal lA ,R,f1---e , 601 amps to 1,000 amps 301.04 2 Address: ( ( S so di r sr A _. err" ... Over 1,000 amps or volts 552.26 2 ... City/State/ZIP. '' 4 ofk 9 71,17 Temporary services or feeders installation, alteration, and/or relocation Phone: (SD?) 5 ./ 9 5 Fax: ( - )-- 200 amps or less 59.36 1 201 amps to 400 amps 125.08 Owner installation: This installation is being made on property that 1 own which i 2 s 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 alteratio 1, or extension, er panel Owner signature: Date: _ . A. Fee for branch circuits with - ' - ' ' ' " ' . • - ervice or feeder fee 44'7A11141 '' •••••':: L.:' :: T "- 1, .' . . : :3 -CONTACT :1!ER'5.1* above s ' ..''. '''':' each branch circuit ' 742 2 , Business name: Pit ,..e.‘ (5, ( Op j% 00 ' B. Fee for branch circuits without service or feeder fee, first 56,63 Contact name: Ai ,es,.., i t" branch circuit 56.18 ,( 2 Bach add"( branch circuit 7.42 2 Address: i -1,..( a A i a 6. 0 ( -A- "L, - ) Miscellaneous (service or feeder not included) Bach manufactured or mectular It City/State/ZIP: \f erAk..... 78 ( 2, dwelling, service andior feeder 67.84 2 Reconnect only 67.84 2 Phone: Cf ) 6 - keirl.S"' Fax: : (34,0) . 5 - 6,0, sn rig l ir - ;-- . Pump or irrigation circle ' 67.84 2 A '' : S SS t7 P/L-rac. a '0;4 0 1.P4.1..r. c- 0 0,-... Sign or outline lighting 67.84 ' Business name: _ zfeo 4 .6 - e. 7 ,,, , e....... panel,Atenition, or extension. Page 2 , 2 I ''''' _ Each additional inspection over allowable in any of the above Address: y3a3 /YE 3, p a ,s Additional inspection (I hr min) 66.25/ hr _ ---- Investigation (1 hr min) 66.25/ hr f'r City/State/ZIP: 05 ti ec...e. .4"7- ?rep 6 ft / Industrial plant (1 hr min) 78.18/ hr •... a phone: a‘e) ?s , 3 vAp Fax ( ) , i / .." Inspections for which no fee is 90.00/ hr a a oiV,‘ e - - -- - - - - ' 5 ' • specifically listed ( fr min) CCI3 Lic.: / 1 V 5 3 Electrical Lie : ,rt;,,,i...,•,..4 , 1, p .Lie.: 5 11 - '': - :V;": : 'V:' , 0$(.IltitgAVAttsliWtOsi . Suprv. Electrician signature, required: V'''' ..- - ti-.- .._ . Plan review (25% of permit fee): Print name: ,"....." A 4:7 it , _ ---- "." Date: 62 --- (I State surcharge (12% of permit fee): . . 74.- .._ , TOTAL PERMIT FEB:1 e e r - 2.-• Authorized signature"1/11 *- 1. 1 4 .4, c This permit application expires if a permit Is not obliiined withia 180 -- v .-- . _ days after it has been accepted as complete. Print name:-1/x.rt ,,,t Date: le - -2 -91 ,- / i • Number of inspections allowed per permit. 1 :\Buirding\Permils'ELC•PermItApp.doc, 07/01/10 ry n ,,,, tea dr -- dAta:fi615T(11/05/C01141WEB W 1 RECEIVED JUN 2.920!11 CITY OF TIGARD BUILDING DIVISION • I I I I H r I I -J G .I I — I � I W • r Z cJ I I L TII J!a `��Tf�LIGTUL I r ` uJ L • • i1 �`II`,T AVE COPYRIGHT © 2011 DESIGN NW SCALE: f FEGI3TION NW ( `GHUETTE KESIPENGE) r - 20' 11555 SW gIST AVE TIGARD OR 87227 DeS1g RNW gliZEIEV 1 111 F : Building Division Development Code Provision Review TIGARD Residential Projects Building Permit No: (\S <) I 1 00 ( O'5 CWS Service Provider Letter Received: Yes ❑ No gr ❑ Routed Plans: Original Plan Submittal Date: 6730//1 1St Revision Submittal Date: ❑ Site Plan Only 2 Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. I Planning Review (contact __y_e at 503-718-0 or JW4i.,/ @tigard - or.gov) Land Use Case No. �� II Name _ `>ckut / - Zoning i' 1-1 a Setbacks: ,/ Front : Rear / c7 Side .5 Street Side / Garage -- ❑ Maximum Building Height _ '. Actual Building Height 76 Er Visual Clearance 0/Easements IJ Sensitive Lands Type: �� Notes: / 49 (' 11i Original Plan: Approved Q Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov) Actual Slope: Notes: Original Plan: Approved Er Not Approved ❑ Date: a 1 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) • Page 1 of 2 Ciir borist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard - or.gov) tree t Trees Protected Trees Notes: Original Plan: Approved Il Not Approved ❑ Date: (,' -^30 "a b 11 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes ❑ No ❑ Date Routed to Building: Page 2 of 2 / 2_0// - o0/0.3 Clean Water Services rile Number �_� [r:., f ry :, i� ` 1 Cle anW er Services I 11-0o-040 1 T. DECEIVE S si tive Area Pre-Screening Site Assess men# 1. ditst 1I I1 0 2. e ^ yt 1rlforma (,e,.v�txr,,ale 1S2 4.4901400) 3. Owner Information az l"ot�l> • Name: Carl Schuette CITY OF TIGARD Company: ii NG Address: 11555 SW 91st av:9 Site Address: 11555 sw Si et Ave City, State, Zip: Ti or. 89227 City, State, Zip: tigard oregon 87227_ Phone /Pax: 503- 588 -7857 Nearest Crow Street: reenburg rd >= - Mail: 4. t}evelopinant Activity (check all that apply) B. Applicant Information d Addition to Single Family Residence (rooms, deck, garage) N ame: mark huss C] Lot Line Adjustment ❑ Minor Land Partkion company: precision n inc ❑ Residential Condominium a Commercial Condominium Address : 12443 ne 60th way d - ❑ Residential Subdivision b Commercial Subdivision vancouver Wa. 98682 a Single Lot Commercial C4 Stare, zip: g ❑ Mufti Lot Commerarol Other detatched gar o n ba of property Phone /Fax: 360- 566 -8455 fax 36D 566 8 }53 - Mail; rnhuss C preCtSionnorthwast.com 6, Will the project Involve any off -site work? ❑ Yes Q No d Unknown Location and description of off-site work none T. Additional oammente or Information that may be needed to under tend your project This application doom NOT replace Grading and Erosion Centre( Permits, Connection Permits, nellaing Permits, Site Development Permits, DEO 1200.0 Permit or other permits es iaaued by the Department of Environmental Quality, Department of State Lands endfer Department of the Army COE, All required permits and approvals must be obtained and completed under applicable local, Mate, and federal taW, By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project cite at all reasonable time for the purpose of impacting project alto conditions and gathering infra related to the prof eot site, I certify that I am familiar with the information contained in this document, and to the best of my knowledge and belief, this informefio le true, complete, and accurate, Printrrype Name mark Huss Print/Type Title Manager Signature Date , (4 ^3Ci -' 11 ...`. .rte .. ,.�.� FOR DISTRICT USE ONLY C] Sensitive Breast potentially exist on nitb or within 200' of the sits. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER, If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resource Assessment Report may also be required, Based on review of the aubmltted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site. This Sensitive Area Pro- Screening ens Assessment does NOT eliminate the need to evaluate and protest water quality sensitive areas If they ere subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, State, and federal law, D Based on review of the submitted materials and best available Information the above referenced project will not significantly impact the existing or potentially sensitive area(sl found near the site. Thin Sensitive Ares Pre- 8craenb,g Site Amassment dons NOT eliminate the need to evaluate and protest additional water quality sensitive areas If they are subsequently discovered. This document will servo ss your Service Provider letter as required by Resolution and Order 07 -20, Section J.b2.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law. 0 This service Provider Letter tenet not valid unless CWS approved site plan(s) are attached, . I❑ Tee proposed activity does not meet the definition of development or the lot was platted after a/0/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROM! r i• LETTER IS R.QUIRED, Reviewed by A+ 1 P `' , j 444 Date 9- Ali f Mir 2550 •' tr1! liittsboro t- I w:iy ' Hill51)' ", OrNgon 97I2'.5 • Pknrie: (6n) 4i21 siof . Fax. 0:1) SS1.4419 • www w tertie,,i,,,, ,rg This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. 14 _ I City of Tigard • = Buildin g Division T IGARD TRANSMITTAL LETTER TO: 1 !0E1-. DATE RECEIVED: DEPT: BUILDING DIVISION RECEVED . JUL 2 2 2011 FROM: Atj Y tO(-( - CITY OF TIGARD COMPANY: _cc� 0 LO BUILDING DIVISION PHONE: 6 C-,C) 2—LO (1 By:C�' RE: 1 I '' I 16 (' (Site Address) (Permit Number) -N —( ET — ,. !ter- OK ) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEM . Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. v Engineer's calculations. Other (explain): REMARKS: \' , YJ t 1,)-1(, )1' / FOR OFVICE IJSE ONLY Routed to Permit Tec e.o,. Date: Z ( ( Initials: Fees Due: ❑ Ye: r0 Fee Description: Amount ue: 1____429_ . Special Instructions: Reprint Permit (per PE): ❑Yes ` • o ❑ Don - Applicant Notified: Date: , . 0, �A to _ • Initials I 1: \Buildin Forms \TransmittalLetter - Revisions.doc 02/08/2011