Permit CITY OF TIGARD MASTER PERMIT
IIII
s COMMUNITY DEVELOPMENT Permit #: MST2012 -00100
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 2S110BB03200
Jurisdiction: Tigard
Site address: 12448 SW CHANDLER DR
Subdivision: ARLINGTON RIDGE Lot: 9
Project: Overby
Project Description: Remodel - house
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $25,000.00 Rear: 0
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
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckfiw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =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
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
OVERBY, JOHN & ROBERT J DOMZALSKI Required Items and Reports (Conditions)
OVERBY, INA RAE 8933 SW WOLDS DR
12448 SW CHANDLER DR BEAVERTON, OR 97007
TIGARD, OR 97224
PHONE: PHONE: 503- 349 -6332
FAX: 503- 746 -4459
Total Fees: $866.91
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 : - _ - • e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for ore the 180
days. • ENTION: 0 = ,on 1= requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set f h in OAR
952-.11-0010 through OAR a 2-01 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 2.19 or 1.800.' ' : 2344. I -
// ;%i2�C- .11
Iss =d By: r Pe rmittee Signature: /
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.
Building Permit Application `PL 0042
Residential ' RECEIVED FoR FFICI Hs,: oNI.,
City Cit of Tigard i 6 2011[ Ard ^ Dat Recei M 3/51, . / PermitNo.: /�
•J ved :.
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • er Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : l4 jkt1�
TIGARD Inspection Line: 503.639.4175 C ?'( OF TIGARD Date Ready /B . 'tag' RI See Page 2 for
Internet: www.tigard -or.gov 0; Id s ,i .�I C DIVISION Notified/Method: •• /° got � 4 A i - Supplemental Information
v AoG
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
ew construction ❑ Demolition Permit fees* are based on the value of the work performed.
hig
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.
L! J 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ 2_5 CDC Po'
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 1
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12444 S gam) , Cj1Q1Nbl,se.. ov4.1e New dwelling area: QS square feet
City/State /ZIP: I I 1 0 V-- 11223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: QV E V'( RED,1,6NGe. Covered porch area: square feet
Cross street/directions to job site: � t.%ej-( 1 apkAQ )E Fjp, A _EP$ Deck area: square feet
Other structure area: square feet
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 (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
TURt \N VINO C1J00P-- 16A111 FRort1 yz 6A�N Valuation: $
TO FU(,i BiNciA ct Xxo 1 u- O A eEpp.c tr Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: d L/tr/Z/. Type of construction:
Address: /A y 9.A.) c....#/ n/bLE1 _ Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name:
FLS plan review fee (if applicable):
Address:
City /State /ZIP: Total fees due upon application:
Phone: ( ) Fax:: ( ) Amount received: X 0 7
95 ,
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof • . mounted PhotoVoltaic Solar Panel System.
Business name: PDS 1 5 Port 1 NNPRoU g►1. 4 N CD • Submit . (2) sets of roof plan with connection det. "Is
and fire dep. _. ent access, alon: . ' • . I I Oregon
Address: 1,c1,3? S , hk - ( o(,.-t 5 Dv- , Solar Installation • ec'• "o • e checklist.
City/State /ZIP: BV\\I10 aR_ 9 7 00'7 Permit - Inc 1 : -s plan review $180.00
1 and adminis .: e fees :
Phone: ( O ) 34 63 v I Fax: ( 03) 146 - 4-45 1 State surcharge (12 %of permi s $21.60
CCB lic.: -- C b�1 (p ' Total fee due upon application: $201.60
Authorized signature: •' I This permit application expires if a permit is not obtained
■ `i1L. within 180 days after it has been accepted as complete.
Print name: US 00 (N\�( Date: 5 �- (b- Zp 12 * Fee methodology set by Tri County Building Industry
Service Board.
I :\ Building \Permits,BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(11 /02/COM/WEB)
Building Permit Application Checklist .
One- and Two - Family Dwelling roll ohhlcl IiSI: c N►,v
City of Tigard Received
Permit No.:
II Date/By:
q 1 3125 SW Hall Blvd., Tigard,OR 97223 Associated permits:
C Phone: 503.718.2439 Fax: 503.598.1960
I' I C. n R D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard- or.gov ❑ Other:
"fl -IE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ) es 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 . CI CI CI
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 Ore • on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three (3) 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 must include 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.
I:\ Building \Permits\BUP - RESPermitApp.doc 02/24/2011 440 -4613T(I I /02 /COM/WEB)
May 23 12 06:33a AC Electric, Inc 503- 232 -8656 p.1
Electrical Permit Appl' ..I . FOR OFFICE USE ONLY
Received 204 D
City of Tigard I V,. •
Receive �S� IJO /D
Permit No
13125 SW Hail Blvd., Tigard, OR 97223 ' ' Pian Review
Phone: 503.639.4171 Fax: 503,598.1960 2 . , y $ ; � ; ;J I ., Date./By: Other Permit:
Inspection Line: 503.639.4175 MAY 2 3 ay ', � Date Ready /By: r' El See Pave L for
Internet: www.ci.tigard.or.us NocifcL 4cCtod: / 1451 Supplemental Infirmation
i a'
` ::: :1.. �• a T . , ' a -
, ,V' -.�t ' . . 1' ,I 'r 'I P . s - , .ems - . _ • - . P J�I REV 1 13Vr'
El New construction Please check all that apply:
ED Demolition ❑Other. ❑Service over 225 amps, comm'l ❑Hazard_us location
:.,, ❑service over 320 amps - rating ❑Buildng over 10,000 sc. ft.,
' - Y ., t • CAGTEOQ .OE:'C NSTRUCTION of 1- and 2- family dwellings 4 o' more new residential
92 I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 vols nominal units in one structure
El Multi- family ❑ Master builder Oahe_: ['Building over three stories :Weeders, 400 antes or more e ry• y ,
DOccupant load over 99 persons QManufacturec stvctures or
- °r lit. : , 1 SfGE. R.IPA l'4iIOrV 6NUSLO 1;Uri :. " ['Egress/lighting htin plan RV park
Job no.: Job site address: /'7(( (18, 1 4 { T' eL1, P'br ❑Health -c facility El Other:
�I Submit 2 sets of plans with any of tie above.
City /State /ZIP: The above are not app:icable to temporary eonstructior. se :
Suite:bldg. /apt. no.: Project name: " -' °FEE'- SCHEDULE .
DncrIpnun I Qty. I Fca I Total E -•
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 503 sq. ft_ or portior. 33.40 I I
Tax map/parcel no.: Limited energy, residential 75.00 2
:rte t "a
Limited energy, non- residencal 75.00 2
i ,' t:. - ?.1 l': :? 5 '1 , ' DL�SCRJPTJOY OF' : 1f0C s :F ri . • - . ti ; ,.,, - Each manufactured or modular
dwelling, sery ce and /or feeder 90.90 2
• Services or feeders installation, alteration. and/or relocation I
200 amps or less 80.30 2
;rr,: ,,; 't: a ' :*. ' • ',rr -_;(: , 71 ,4 1 6 7 : , -- - 20: amps to 400 amps 106.85 2
401 amps to 600 amps 160.60
Name: 601 snips to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Recor.nec: only 66.85 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation 00 amps I 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not r20: amps to 400 amps 100.30 ' 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 40: amps to 600 amps 133.75 ,
Owner signature: Date: Branch circuits - new. alteration, or extension, per pane'
` k : : : .. _ . d ` f A P * - 1 .. 1. T ) ' : : f i :`iii, ' 11 ,: i " .."' t ( *? ZYLIiSONri :: tie' A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: withow service or feeder fee,
each branch circuit 76.85 2
Address:
Each add'l branch circuit � 6.65 2 I
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle I 53.40 2 1
Phone: ( ) Fax: : ( ) - --
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
*, - :r• : • , f.n i "';' ' ,%1 ; .. :.1' : energy p nel. alteration or •
� extension Describe I Page 2 2
Business name: A e r1 , u j ` , C� l 1
r p Each additional inspection over allowable in any of the above
Ate ,_
1 D O C 4141 .ti.l.►. BA e Per inspection 62.50
City/ State/ZIP: 6) � y A �,, ) R C S 0 4 < Investigation per hour Cl hr min) 62 50
( . • I / V Industrial plant per hour 73.75
Phone: ( j- ' ax: ( )
�.� J l��G(" : � eL�1nr---... 7 ,' • : : -t '" 1atCTRICxL:,+ . :FEES* , .
CCB Lic.:3:57 Electrical Lic.: 3 I � / r s ,Suprv. Lie.: iii5 ;? 7 ' Subtotal
Suprv. Electrician signature, required: � f ,,, . Plan review (25% of permit fed)
Print name: j �. f Date Star surcharge (&% of permit fee)
a��' �l r TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after It has been accepted as complete
Print name: Date: • Fee rnethndelogy set by Tri- County Bolding Industry Service Bond
•• Number of inspecncns per permit the wed.
i 43ut :d :ag1PermaalELC-Pe-mitApp,doc 1:/03 410 - sc 15T(IO102/COM VE5
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