Permit i," \ii
t
CITY O F TIG MASTER PERMIT
PERMIT #: MST2004 -00374
, ill DEVELOPMENT SERVICES DATE ISSUED: 12/8/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13817 SW BENCHVIEW TERR PARCEL: 2S104CD -04500
SUBDIVISION: HILLSHIRE ESTATES ZONING: R -7
BLOCK: LOT: 045 JURISDICTION: TIG
REMARKS: Convert existing crawl space to 15' x 13' play /craft room.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: 326 sf BASEMENT: 326 sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THR0. sf RIGHT:
VALUE: 5,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 326 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: 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 SVCIFDR: oo SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 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: $ 208.55
WHITE, RICHARD & CANDACE OWNER This permit is subject to the regulations contained in the
W
W H IT SW BEN & CA DAC Tigard Municipal Code, State of OR. Specialty Codes
TIGARD, OR CHV and all other applicable laws. 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 the
work is suspended for more than 180 days.
Phone: 503 - 590 - 0209 Phone: ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: 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
Post/Beam Structural Electrical Final
Underfloor insulation Final inspection
Electrical Rough In
Framing lnsp
Insulation lnsp /
/ � I I /
Issu By : L _ _A ! " l /,L.L L, Permittee Signature : _
Call (503) •39 -4175 by 7:00 p.m. for an inspection needed the nex I'• usiness day
J-• ,..I1
Building Permit Application ' ' - FOR OFFICE USE ONLY
City of Tigard Dateis / $' o� Permit No.: /15jr �_a) j 7,1e 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
i...
I Date/B : Other Permit: Inspection Line: 503.639.4175 " �` Date Ready /By: Ju ' � 9 See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: /' /G• Supplemental Information
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❑ 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 • 1=1 Other: equipment, materials, labor, overhead, and the profit for the
;«X . ' ��•; weir^ 4,. M Mu: - = ',,,n h ; t ae,s *?s „, e" ;., PI i 57; i ,:N work indicated on this application.
� . i r �. 'CATEG ORY OF�CONSTIV43.4 IY Tn:: :k r.., . u p
/-- and 2- family dwelling ❑ Commercial/industrial Valuation: 9o0
°�
[=1 Accessory building ❑ Multi- family • Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
-, %"` „ :. .;. , . i „ ”' 's-` ° �<; s �t , ���": rr. l .n : r i "i "'=t "1 .. of floors:
-41 , - : r �JQB,SITE INFORMATION AND �L®CATION: Total number o
r' �, -.. „.3d.'s�<'� �� � -�:Sw� ��,v.,�, -.�7_ �iR €,.. Y ,� x- x ., .:`a.ri?"1e,'Y�Sa. . _,. , , h _, a x , .: . :,,'Cs.
lob site address: I 9 J Jd,% Z' / New dwelling area: square feet
City /State /ZIP: l l � 972-73 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: 53 p `„'T v! ¢ �. jf� ( Deck area: square feet
/ Other structure area: '3 2c square feet
a E4 T
i i AAC
r O VIIVIERC ; CH ECKLIS
Subdivision: tb (...(�f ii/�_A -/�k Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: G�/t6 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
7= 1 :� ,� , i ..,:v PTLON OE WORK - work indicated on this application.
"��,.�,t ` .. _��a -�. ay .„ � �_ .4 4,a � - . -. , . � .�,
1 )Ci3 1 a .1L. ° • Li/ ;em Valuation: $
Existing building area: square feet
New building area: square feet
% " m t O , v+v W E R 't QtTENANT ` ` , -3,, Number of stories:
' §atzgc „r, __ xm =Rai a' ". w„,, irliez t,
-�i, +� fl... .. ,q4, ,A
,,,.., ,.A. :061 ,2
Name: 26G (J .Cy— Type of construction:
Address: Sl e. Ael eig°L)" Occupancy groups:
City/State/ZIP: Existing:
Phone: 9;) D�t a Fax: ( 50) 64 t ) / /2; New:
ea J �.u�??'�� .�' '::`:-�:i '�r. , .. ,:°5 ':>h;5�a.� ,y.,� �:� �, .�v�� �:���.�;mA;a:°.,:i"', "s g�. :�i �7, � ��;
,. max? 4; I " :" : R , :i a Tv 'w4 C ; ,� j 4 ._' ` Y'3al,,'i d°Zv` ,,,,.: s
,", ''! as�-, . RPL ICANT <. � : .; .. CONT4C PERSO ; i ,Q 9 HIr3 �`" 4 ,' ; .3
k. .,r.,, ... t': ��t' :. °- : w M °' � 3,a , a j 1 ,. :at u :. , .. . N:OTpIGE '' e ., ..
Business name: ������ pp to h, All contractors and subcontractors are required to be
����
Contact name: 4'[t N o! N licensed with the Oregon Construction Contractors Board
A /J !.� (' / � � under ORS 701 and may be required to be licensed in the
Address: L',///J4 P , jurisdiction in which work is being performed. If the
City /State /ZIP: "il �Cr 7 applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
'�E .. ',p vA $" _'v�,* V g -t .V a A , - "'^'t .�. 'QV: '
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- Z " - �' C Az) , n '4%,".&, li
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Business name: "" _.. - >g::.F ... , ,.,..,. ,, .,.
e ' t k BUILDING PER1yIIT F ES *P '
Address:
Please refer to fee schedule.
City/State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lie.:
/ Date received:
Authorized sigier This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: fIcatity_4") W j 4 Q Date: / * Fee methodology st by Tri Building Industry
•
Service oard.
i Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(1 l /02 /COM/WEB)
One- and Two - Family Dwelling • . _ "
Building Permit Application Checklist .. FOR OFFICE USE ONLY
'City 'of Tigard • Received
Permit No.:
Date/By:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 //u ,IIt �i' a
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑Mechanical
Internet: www.ci.tigard.or.us '" --'� ❑ Other:
• THE FOLLOWING ITEMS ARE REQUIRED FOR.PLAN REVIEW • 'Yes No N/A .
I 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. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage- wayprotection, 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 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 \One - Two - FamilyChecklist.doc 12/03
Electrical Peri i A' plication FOR OFFICE u si ONLY • '
GO 'of T i and ' Received �� PermitNo.: ? ! �.• 751
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' Phone: 503.639.4171 Fax: 503.598.1960 /4 ) 7 4 1, p„ r i'� D • Other Permit:
Inspection Line: 503.639.4175 '' I Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: MI Supplemental Information
. _ TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration /replacement Please check all that apply:
CI Demolition Other: ❑Service over 225 amps, comm'l El Hazardous location
. ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION • of I- and 2- family dwellings 4 or more new residential
and 2- family dwelling ❑'Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
Multi family ❑ Master builder ❑Other: ❑Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manu factured structures or
• JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
l ❑Health -care facility ❑Other:
- 7,1,0 Job no.: Job site address: / � a/ Submit 2 sets of plans with any of the above.
City/State/ZIP: d gal�l 62, 47373 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Project name: FEE* SCHEDULE
(� J Description I Qty. I Fee. I Total I **
Cross street/directions to job site: &NI I v) %rl ` Oa(N °al New residential single or multi family dwelling unit.
OM �C Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: [4,11L711,10 ( 4 Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: �[ rV' Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/11� / ![�J /yl# ) 161)( 1 3 ( [ )I ( i � n „_� dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 V 2
PROPERTY OWNER I 0 201 amps to 400 amps 106.85 2
/ \ �i 401 amps to 600 amps 160.60 2
A
Name: 2� V. ed FYI i �f p iL� d i " k. 601 amps to 1,000 amps 240.60 2
Address: 1 tr"' A Lf I f' ' e11° Lbb f' Over 1,000 amps or volts 454.65 2
7 I�C� Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( 602) 04D Q Fax: ) 5,16A lc relocation
200 amps or less 66.85 I
Owner installation: This • • stallation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended, for sale, leas • , or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: A/ . i Date: Branch circuits — new, alteration, or extension, per panel
❑ • : ICANT _ ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
h �� B. Fee for branch circuits
Contact name: [�
�d / ''L�C... - without service or feeder fee, I 46.85 T� •° ryS r
2
alike_ n , each branch circuit
Address:
��1.C1 vi e_ O S - t_ Each add'I branch circuit IF 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
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: .
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pernits\EL.C- PennitApp.doc 12/03 440-4615T(l0/02JCOM/WEB
Electrical Permit Application - City. of Tigard W
Page 2 - Supplemental Information " .
LIMITED ENERGY PERMIT FEES:
SII)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:
COMIC RCIAL. WORK
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
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
iABuilding\Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD- 24 -Hour
BUILDING ti►`, Inspectiontine: • (503) 639 -4175 ms-w7&) &23 � 7(-7 INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested G. — AM PM BUP
Location / 3 F) 7 ,fl/-/' 7 Suite MEC
Contact Person Ph ( 1 570 (C) g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: e� , (,,) � SIT
Post & Beam
Shear Anchors n_
Ext Sheath /Shear lam. 1 41--
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm Al
Susp'd Ceiling
Roof
Other:
. PAS8' 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
Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date -2 -'�� Inspector ' Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL