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Permit • City of Tigard, Oregon 0 13125 SW Hall Blvd. ° Tigard, OR 97223 . 11 • • • m. September 11, 2009 Jay K. Poizer 7123 SW Locust St. Tigard, OR 97223 Re: Permit No. MST 2008 -00078 Dear Mr. Poizer: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 7123 SW Locust St. • Project Name: Poizer Job No.: N/A Refund: ® Check #100582 in the amount of $611.04. ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as garage project was put on hold due to economic issues. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. 1: \ Building\ Refunds \ Administration \LtrRefund- CancelPermit.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 CITY OF TIGARD RECEIPT Vp! . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 175181 - 09/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2008 5 611.04 Total: $411.04 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check • 100582 DHOWSE 09/11/2009 $- 611.04 Payor: Jay K. Poizer Total Payments: $ - 611.04 Balance Due: $611.04 Page 1 of 1 ,...; .' CITY OF TIGARD 3190009 13125 SW Ilan Blvd. 3:39:081 Tigard. OR 97223 503.639.4171 TIGARD' Receipt #: 27200800000000003590 Date: 10/16/2008 Line Items: Case No TPan Code Description Revenue Account No Amount Paid ENG2008 -O()I56 [PUBIMP] CAP Fee 100 - 0000 - 43600(1 300.00 ENG2008 -00 I56 [EBOND] Cash Assurance 100 - 0000 - 229009 1.500.00 MST2008 -00078 [CDCPLN] CDC Pln Rev 100- 0000 - 433060 46.00 MST2008 -00078 [LRPF] LR Planning Surcharge I00- 0000- 438050 6.00 MST2008 -00078 [BUILD] Bldg Permit 245- 0000 - 432000 385.75 MST2008 -00078 [TAX] Build 12% State Surchr�1c 100 -0000- 207020 46.29 MST2008 -00078 [PLUMB] PLM Permit 245- 0000 - 431000 72.5( MST2008 -00078 [TAX] PLM 12% State Surcharge 100- 0000 - 207020 8.70 MST2008- 00078 [ELPRMT] ELC Permit 220- 0000 - 431510 200.50 MST2008 -00078 [TAX] ELC 12% State Surcharge 100- 0000 - 207020 24.06 MST2008 -00078 [ERPRMT] Erosion Control 100- 0000 - 207307 26.00 MST2008 -00078 [ERPLN] Erosn Pln Rv CWS 100 -0000- 207308 8.45 MST2008 -00078 [EROSN] Erosn Pln Rv COT 245- 0000 - 433010 8.45 Line Item Total: $2,632.70 Payments: iNiethod Payer User ID Acct. /Check No. Approval No. How Received Amount Paid Check JAY K POIZER ST 1222 In Person 2,632.70 Payment Total: $2,632.70 ark % • .I:,eeipi.rya Pa,c I ul' I e ° City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday' at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Jay K. Poizer DATE: 7/16/09 7123 SW Locust St. Tigard, OR 97223. REQUESTED BY: Dianna Howse • TRANSACTION INFORMATION: Receipt #: 2008 -3590 Case #: MST2008 -00078 Date: 10/16/2008 Address /Parcel: 7123 SW Locust St. Pay Method: Check Project Name: Poizer EXPLANATION: Per applicant's request, as garage project put on hold due to economic issues. Request refund for 80% of permit fees. 1F.. . .�lF`.. . �... _. 1` • .. _ f y. +� A� :I� n s• v T.i•.. •. ., - r. Y'1 -t! ii T[- Lr. :� �:'� i7,• ,� t _ .F. �.•`'::� .i •'�'`�', "'��'���" :F;' .•: > - pl` K,: ':4:�. 'a;,f +. l+' 1w ,- �',•:..K' .': +.�� :9�: • k•�.:,... [BUILD] Bldg Permit 245- 0000 - 432000 ✓ $308.60 [TAX] Build 12% State Surcharge 100- 0000 - 207020 37.03 [ELPRMT] ELC Permit 220- 0000 - 431510 ✓ 160.40 [TAX] ELC 12% State Surcharge 100 - 0000 - 207020 ✓ 19.25 [PLUMB] PLM Permit 245- 0000 - 431000 ✓ 58.00 [TAX] PLM 12% State Surcharge 100- 0000 - 207020 ✓ 6.96 [ERPRMT] Erosion Control 100- 0000 - 207307 ,✓ 20.80 • • TOTAL REFUND: $611.04 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager 7644 v;,..-3O If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board ''` ;s, ` `r"= :FOR`A_ CCEtA<SYST-EM ABMII�IISTRA :IQ$ USE ONI Y: `" ' Refund Request Reviewed: Date: "2 /fi � - By: ,�— Case Refund Processed: Date: � '� �`e By: , -yip • I: \ Building \Refunds \RefundRequest.doc 04/13/09 CITY OF TIGARD RECEIPT S . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TFC. \RF) Receipt Number: 27200800000000003590 - 10/16/2008 a y CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER 4., 3 Z5 _ P AID ENG2008 -00156 [EBOND] Cash Assurance 100 - 0000 - 229009 $1 1,500.0 ENG2008 -00156 [PUBIMP] CAP Fee 100 - 0000 -436000 00.00 MST2008 -00078 [BUILD] Bldg Permit 245 - 0000 - 432000 3 0cf'• Co 0 $385.75 MST2008 -00078 [TAX] Build 12% State Surchrge . 100 - 0000 - 207020 .27. 03 $46.29 MST2008 -00078 [EROSN] Erosn Pln Rv COT 245 - 0000 - 433010 $8.45 MST2008 -00078 [TAX] PLM 12% State Surcharge 100- 0000 - 207020 G .96 $8.70 MST2008 -00078 [ELPRMT] ELC Permit 220 - 0000 - 431510 /( 0 , VO $200.50 MST2008 -00078 [TAX] ELC 12% State Surcharge 100 - 0000 - 207020 / 9 • a5 $24.06 MST2008 -00078 [ERPRMT] Erosion Control 100- 0000 - 207307 02 0 . £0 $26.00 MST2008 -00078 [ERPLN] Erosn Pln Rv CWS 100 - 0000 - 207308 $8.45 MST2008 -00078 [LRPF] LR Planning Surcharge 100 - 0000 - 438050 $6.00 MST2008 -00078 [CDCPLN] CDC Pln Rev 100 - 0000 -433060 $46.00 MST2008 -00078 [PLUMB] PLM Permit 245- 0000 - 431000 SP•, $72.50 Total: $2,632.70 6//‘ e PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1222' TAAA CONV 10/16/2008 $832.70 Payor: Total Payments: $832.70 Balance Due: $0.00 • X f0�d • RECE i V/ pp 1 141 M A R 0 9 Z009 e Community Development CITY ®I: GAR Request for Permit Action B CIILI)ING DIVISION TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov • FROM: r Owner ❑ Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: C ° `� Ft Z1` 2 INVOICE TO (Business or Individual) Mailing Address: - 7 / Z 3 .Sc.--) L e L.0 S S4 City/State /Zip: T i firvel Di'Z. 17 2 Z 5 Phone No.: 77/ - 6 YS— Z / 3 / PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓): a CANCEL PERMIT APPLICATION. S REFUND PERMIT FEES (attach receipt, if available). •❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: A// / Site Address or Parcel #: � � ZZ 3 ,$1.4.) 1oGc. S ■ 72 /2Y / 7Z z 3 Project Name: r ✓C Subdivision Name: Lot #: EXPLANATION: � ' c ()Pt oE, . ' L ' SS tt� W ` 1 ( I /i ! h7c� �A-• /� �Q �ro i e G1 / or-- /� �G` !/n y - �. 6e o>✓ck / ,4 �•'t SM.. -rlu ✓ 4 -bow - C . Signature: Date: ✓ - Y G f Print Name: (� Poo. _ 7 Refund Poli y 1. The Director or Building Official may authorize the refund of. a) any fcc which was erroneously paid or collected. b) not more than 80% of the land use application fcc when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. 11'0'10 s 1 ICI Ll',I ONI\ Rte to S s rldrnin: Date Q Q4w1 Rte to Bid Admin: �M/� Refund Processed: Date 9 • C B ,2� Invoice Processed: Date B Permit Canceled: Date 4 1eM B Parcel Ta Added: Date • B Recei • t # Date Method Amount $ 1: \Building \Forms\ Reg PcrmitAction.doc Rev 07/26/07 I'd 096i86S2OS :Ol 2P29P2220S 1331S rlllD 3SOIid8 :Waid b1SE :60 6002- 6 -2itit Dianna Howse From: Al Dickman Sent: Tuesday, March 10, 2009 1:56 PM To: 'Jay Poizer; Dianna Howse Cc: Albert Shields Subject: RE: 7123 SW Locust Jay, I have spoken with my supervisor regarding your refund request. The $1,500.00 cash assurance is to be refunded. The $300.00 permit fee is non - refundable and will remain so. Dianna, I will prepare a refund of the cash assurance in the amount of $1,500.00. Al Original Message From: Jay Poizer [ mailto :jayp @bridgecitysteel.com] • Sent: Tuesday, March 10, 2009 9:11 AM To: Al Dickman Subject: RE: 7123 SW Locust Al, I had the Garage foundation re engineered. I was going to resubmit the plans, but I have to hold off for a While until I save up some more money. I now have over 3k into plans, engineering, surveys etc. I will proceed, but probably not this year. Between work slowing down, our furnace and oven going out in the last couple of weeks, I have to put this project on hold. I faxed Dianna a form to get some of my deposit money / other fees back for now. I know you have put quite a bit of time into this also. This is not a waste, because I will proceed on this eventually. Please work with Dianna to come up with a dollar amount that I can get back. Thanks, Jay Poizer 971 - 645 -2131 Original Message From: Al Dickman [mailto:AL @tigard - or.gov] Sent: Monday, January 12, 2009 11:59 AM To: 'Jay Poizer' Subject: RE: 7123 SW Locust I was under the impression that Mr. Roper was going to call you but I must have been wrong.. Original Message From: Jay Poizer [ mailto:jayp @bridgecitysteel.com] Sent: Monday, January 12, 2009 11:45 AM To: Al Dickman Subject: RE: 7123 SW Locust 1 • Thanks for your help. Original Message From: Al Dickman [mailto:AL @tigard - or.gov] Sent: Monday, January 12, 2009 11:28 AM To: 'Jay Poizer' Subject: RE: 7123 SW Locust Steve Roper 503 -469 -1213, Steve is not a structural engineer but should be able to direct you to a reliable. Original Message From: Jay Poizer [ mailto:jayp @bridgecitysteel.com] Sent: Monday, January 12, 2009 11:12 AM To: Al Dickman Subject: RE: 7123 SW Locust Al, Any word on this ? Thanks, Jay Original Message From: Al Dickman [mailto:AL @tigard - or.gov] Sent: Tuesday, January 06, 2009 11:34 AM To: 'Jay Poizer' Subject: RE: 7123 SW Locust Jay, Let me talk to a few who have knowledge of the type of engineer you're in need of and I'll get back to you asap. Al Original Message From: Jay Poizer [ mailto:jayp @bridgecitysteel.com] Sent: Monday, January 05, 2009 11:06 AM To: Al Dickman Subject: 7123 SW Locust Al, I have submitted all of my plans to the City and have my permit to start my garage. My concrete guy Is telling me my engineer has over built all of the walls and it is going to cost me more than double What I originally had planned on. I have been really un happy with the engineer I used. I sent him the City's original list of items that required and engineer to work on. I paid him to do this along with the Extra time he had spent at the jobsite. When I turned in his revised plans, Tigard declined them a second Time because the engineer had not addressed any of the items on the list. He resubmitted a few days later With a plan that calls out over 4300 feet of rebar for my small garage and huge footings. Do you have another Engineer that you could recommend so I can get a second opinion on the foundation ? Thanks, Jay Poizer 971 - 645 -2131 2 / I t-G \ t Buildin �P er 3 mit A t licatio ` V . ' t., , ki i ; Residential ` ' ' \IP FOR OFFICE USE ONLY City of Tigard J Q R eceived p `J g ®� D O Date /By. 9 v y Permit No }- 7 13125 SW Hall Blvd , Tigard, OR 97 ' Phone 503 639 4171 Fax 5 fj ��� /Q Plan RDate /B y i t A J 1 U i 5 /., Other Permit T I G A It u In Line 503 639.41 1 a a TIGAI�D Date Ready /By. / g 1e�i RI See Page 2 for Internet• www tigard - govBUILDING DIVISION Notified/Method �` J (5/0% ( (Co 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 t e rofrsr the CATEGORY OF CONSTRUCTION work indicated on this application. ,' 5j p ❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 7 Job site address: 1 Z 3 S oC-OLV - s T 54.. New dwelling area: square feet City /State /ZIP: 7 i ✓ v -,, c On_ 17 Z Z.:3 � Garage /carport area: $ 2c, square feet Suite/bldg. /apt. no.: Project name: PO'Z r 2 64„ Covered porch area: square feet Cross street directions to job site: Deck area: square feet Other structure area: square feet RE QUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: �� 1 t Lot no.: Permit fees* are based on the value of the work performed. Tax inap /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. 2- /tie..., 6/1-..-4 f ,¢..i �\/1� . Valuation: $ 0 tFrJrc� rb� Existing building area: square feet New building area: square feet ROPERTY OWNER I • ❑ TENANT Number of stories: -- Name: �1 'p t 2 e_ l Type of construction: Address: "I ( "Z S w - /J c(.v-ST ST P y groups: Occu erne rou s City /State /ZIP: T ■Svv OA_ 7 •ZZ Existing: Phone: (Q)I) 6, l(S .- Z1 1 Fax -(ro3) 224 - 6342 New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: CONTRACTOR • Business name: OCAj N E ve BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City /State /ZIP: Structural plan review fee (or deposit): Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lie.: Total fees due upon application: Amount received: Authorized signature: This permit application expires if a permit is not obtained Print name: — Date: within 180 days after it has been accepted as complete. i �� - * Fee methodology set by Tn- County Building Industry Service Board I• \Building \Permits \BUP -RES PermitApp doe 11/6/07 440- 4613T(I 1/02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City of Tigard Received lipg y Permit No.. a 1 3125 SW Hall Blvd , Tigard, OR 97223 As sociated permits C Phone. 503.639 4171 Fax 503 598.1960 24- Hour Inspection Line 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical T I G A It D Internet www tigard -or.gov O 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 -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 .roject 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 trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and accompanied by the project arborist's signature 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. 1 \ Building \Permits\BUP- RES- PennitApp doe 03/21/06 440.4613T(11/02/COM/WEB) Electrical Permit Application FOR OFFICE USE ONLY I�+ CE 1 , , ED Received � City of Tigard Date /By Gb Permit No > �i -ao7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review U i C . Phone 503 639.4171 Fax 503 598tN 9 2008 Date/By Other Permit T I G A K D Inspection Line 503 639 4175 Date Ready /By Suns ® See Page 2 for Internet www tigard gov CITY OFTIGARD Notified/Method ` r ( Supplemental Information TYPE MEWING DIVISION PLAN REVIEW ❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below) ❑ Service or feeder 400 amps or more ❑ Building over three stones ❑ 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 ❑ 1- 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 A ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ", 2 C ( IOOHP or more occupancy Job no.: Job site address: Z " 7 5 (-4., S T) ❑ Six or more residential units ❑ Recreational vehicle parks City /State /ZIP: I r. ON` 177 ., ❑ Health -care facilities ❑ Supply voltage for more than ❑Hazardous locations 600 volts nominal Suite/bldg. /apt. no.: Project name: tp Cvx 6„,,...„,e_ ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145 15 4 Ea. add'I 500 sq ft or portion 33 40 I Tax map /parcel no.: Limited energy, residential 75 00 2 DESCRIPTION OF WORK (with above sq. fl ) Limited energy, multi-family 75 00 2 2_ Nei, -, 6-e-. - residential (with above sq fl ) Services or feeders installation, alteration, and/or relocation 200 amps or less a 80 30 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2 401 amps to 600 amps 160.60 2 Name: C JA- --) �o i Z 71 601 amps to 1,000 amps 240 60 2 Address: -1 II- 3 5 t-..) -2o Lv S -,r S-f Over 1,000 amps or volts 454 65 2 City/State/ZIP: 0 2 g Z Temporary services or feeders installation, alteration, and/or relocation Phone: ( 97 I ) 4,4 S _ 'L 1 3 (' Fax: ( So) ) Z 2 y - 6 3 y z 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 .. ording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2 r /o- 9- tag Branch circuits- new, alteration, or extension, per panel Owner signature: /11 Date: A Fee for branch circuits with ❑ APP - I ❑ CONTACT PERSON above service or feeder fee, L 6.65 2 each branch circuit Business name: B Fee for branch circuits Contact name: without service or feeder fee, 46 85 2 first branch circuit Address: Each add] branch circuit 6 65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 90 90 2 dwelling, service and /or feeder Phone: ( ) Fax: : ( ) Reconnect only 66 85 2 E -mail: Pump or irrigation circle 53 40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited - encrgy panel, alteration, or Address: extension Describe Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62 50 CCB Lic.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal Print name: Date: Plan review (25% of permit fee). State surcharge (12% of permit fee). Authorized signature: TOTAL PERMIT FEE Print name: Date: days permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. • Number of inspections allowed per permit. 1 \Budding\Permns\ELC- PermitApp doe 05/23/06 440-46 t 5T(1 I /05 /COMM'EB 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* , ❑ 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 ❑ Boiler Controls n 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 1 \Budding\Pertnns\ELC- PermuApp doc 03/23/06 Plumbin Permit A lica Building Fixtures �'EIVED FOR OFFICE USE ONLY City of Ti and Received 9 gy •J g JUN 0 9 2008 Date /By ( � Q ,, I Permit No f7/��Qe 7 114 V 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review 0 Phone 503 639 4171 Fax 503.5 eltprOF TIGARID BUILDING Date/By Other Permit No T I G A R D Inspection Line 503 639.4175 B Date Ready /By 2..77-- See Page 2 for Internet www t 1 gard -or. gov G DIVISI Notified/Method. ( Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction 0 Demolition For special information use checklist. Description I Qty I Ea I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249 20 ❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45 00 ❑ Master builder ❑ Other: Fire sprinkler ( sq ft ) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 1 ( 2 ^j Si..-) 10c,vS S.+ Catch basin or area drain 16 60 City /State /ZIP: — T"i j 9 7 Z Z -3 Drywell, leach line, or trench drain 16 60 ,; t t =✓L Footing drain (no linear ft. • ) Page 2 Suite/bldg. /apt. no.: I Project name: rpt Manufactured home utilities 110 00 Cross street/directions to job site: Manholes 16 60 Rain drain connector 16 60 Sanitary sewer (no. linear ft.. _) Page 2 Storm sewer (no. linear ft.: _) X00 Page 2 Subdivision: I Lot no.: Water service (no linear ft _ ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16 60 DESCRIPTION OF WORK Backflow prevcntcr Page 2 c:, /l(i—i 64-'v r , �\ c� Backwater valve 16 60 �`� ► Clothes washer 16 60 Dishwasher 16 60 'g,PROPERTY OWNER I 0 TENANT Drinking fountain 16.60 Ejectors/sump 16 60 Name: 1- �tii 2 F_YZ Expansion tank 16 60 Address: — 7 I - '2 Sv. -20 r u - S - 1 — S 4- Fixture /sewer cap 16 60 City /State /ZIP: '€ m � (3 L 17 Z - .3 Floor drain/floor sink/hub 16.60 3 (50 ) Garbage disposal 16 60 Phone: (Sl'j 1) 6 4. t s _ z (3 ( Fax: 3 2 2 ti —4 3%.1 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16 60 Ice maker 16 60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value $ ) Page 2 Address: Primer 16 60 City /State /ZIP: Roof drain (commercial) 16 60 Phone: ( ) Fax::( ) Sink/basin/lavatory 16 60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: ©w N E V? Water heater 16.60 Address: Other. Subtotal City /State /ZIP: Minimum permit fee $72 50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee. $36 25 CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: / TOTAL PERMIT FEE Print name: f o ■ 4 111b Date: 6- ...p This permit application expires if a permit is not obtained within N. 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board i \ Buiidtng \Permns\PLMF- PermitAppdoc 12/ 27/06 440.46t 6T(10/02/CO.M/VEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - l 100' 55 00 0 to 2.000 $115 00 Footing drain - each additional 100' 46 40 2,001 to 3.600 $160 00 3,601 to 7,200 $220 00 Sewer - 1st 100' 55 00 7,201 and greater $309 00 Sewer - each additional 100' 46 40 Water Service - 1st 100' 55 00 Medical Gas Systems: Water Service - each additional 100' 46 40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55 00 $1 00 to $5,000 00 Minimum fee $72 50 Storm & Rain Drain - each additional 100' 46 40 $5,001 00 to $10,000 00 $72 50 for the first $5,000 00 and $1 52 for each Q ty. Fee (ea) Total additional $100 00 or fraction thereof, to and Fixture or Item including $10.000 00 Commercial Back Flow Prevention Device 46.40 $10,001 00 to $25,000 00 $148 50 for the first $10,000 00 and $1 54 for Residential Backflow Prevention Device each additional $100 00 or fraction thereof, to (minimum permit fee $36 25) 27 55 and including $25,000 00 Rain Drain, single family dwelling 65.25 $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 Inspection of existing plumbing or and specially requested inspections - per hour 72.50 $74 including 0 t e first 0 00 , $50 00 and up $742 00 for the first $50,000 00 and $1 20 for Subtotal: each additional $100 00 or fraction thereof Commercial Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. - 3" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig Drains Oil Separator (Gas Station) Rec Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: I \Budding \ Permits \PL11- PcrmlApp doc 12/27/06 t • D -m RO JUN 1 2 2008 CIS o�,,1 (1141 Cle�uz «�ater Services . _:� Our (Q111111111111:111 i, Vicar, . - ���tir'N BSAnsitive Area Pro- Screening1U1, — 00 166? Site Assessment Jurisdiction: r /G.4 - R y Property Information: (example 1S234AB01400) Owner Information: Taxlot ID(s): Name: e,•4l� ?o 1 SI 36 A8o030 I Company: Address: `7 ( Z3 Ss- .oc -ciS T S' Site Address: - 71Z-3 St--v o loccrs City State Zip •Ti ■-ck O✓t Y7Z City State Zip: Ti ✓1Ye 9722- ovi-- 97Z-S Phone /Fax: 71— 6'15 2 /3 // Nearest Cross Stree'T` 79 ' 4 00c.c.; s E-mail' Je1 p e hr.-p&p c.v.., Eke". Cv�� Development Activity: Check all that apply Applicant Information: Addition to Single Family Residence (rooms, deck, garage) Name: ° Lot Line Adjustment ❑ Minor Land Partition ❑ Company: Residential Condominium ❑ Commercial Condominium ❑ Address: Residential Subdivision ❑ Commercial Subdivision ❑ City State Zip: Single Lot Commercial ❑ Multi Lot Commercial ❑ Phone /Fax: / Other E -mail: Will the project involve any off -site work: YES ❑ NOlg. Unknown ❑ Location and description of off -site work: Additional comments or information that may be needed to understand your project: This application does NOT replace the need for Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ 1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and /or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. 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 site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site I certify that I am familiar with the information q ' d in thi current, and to the best of my knowledge and belief, this information ', is "- true, complete, and accurate. Printrrype Name: o te r/ Print/Type Title: lJt�tJ(�.2/L Signature: Date: /O -Op FOR DISTRICT USE ONLY ❑ Sensitive areas potentiall exist • site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE 0 • - - VICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site. This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are 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 ❑ 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(s) found near the site. This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are 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. ❑ This Service Provider Letter is not valid unless CWS approved site plan(s) are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT S RVICE PROVIDER LETTER IS REQUIRED. Reviewed By: Date: - 6// 7 jf 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • www.cleanwaterservices.orq Revised May a, 2007 . - -- - 106' -0" I I . -. V CITY OF TIGARD - SITE PLAN REVIEW Y. N Z ' BUILDING - PEfi!�91TNU�r/ISraoo� – rtr»7. Z Street Trees: " Protected Tre • 121 Approved [ ] Not Approved W 4 �' Approved ❑ Not Approved - N EXISTING DRIVEWAY Fly: -� 1 (.. r;.ace: Notes: "' —° 64 , 6 v N ill 1 i gE it P q PROPOSED GARAGE C - . �M Z S 4 N 4 `° � �� N ig 1 EXISTING HOUSE ° ° .i-a � v 3 i � oQ 4 PROPOSED . co GARAGE , _.. _ q' • • N ' — —� .-` CITY OF TIGARD - SITE PLAN REVIEW V C Ia t,tk9Taj91�� 4 1 4 0 1/ • -'' : •'1� • U ILDING PERMIT NO.: rl Y7 �,�ob >7q PLANNING DIVISION: - 0 �, - Required Setbacks: ❑- Approved ❑ Not Approved z - - Side: 1 v1_ Street Side: . - " Front. NI A' s Garage: T Rear: F 4 Visual Clearance: (rAppr ved ❑ Not Approved w o b l Maximum Building Height t3 feet 1- Q zz EXI �, - �c., CWS Service Provider Letter Required: ❑ Yes ❑ No 1 d D' - A q ❑ Received W i ' _ r I3)-: �°"' L ol/l /.J. c D ate: (D � lO �U7 = a f/`•��, _� ENGINEERING DEP RTMENT: co WI v� a 1 — onn KR 1 KR Actual Slope: S % A Approved ❑ Not Approve • - = -: -� ... Site Pla / • pproved N Ap =ALL ,, ?G g; � t '' . • By: l/l� � Date: � 0 4' / / / /1AS m"° ,r-�-- NolCs. i / .. % SITE 15 "28'-0 - 15'4" /) 1 e Q U /P , 1 TE PLAN 106' -0" C_O.,_ ► ,— AL - b/ C.K At/4/d SCALE: NTS ' - ' SHEET NO. . SW LOCUST ST D1 -1 •