Permit IN CITY OF TIGARD ' ' . ✓ .1 MASTER PERMIT
COMMUNITY DEVELOPMENT Permit a: MST2012 001a1
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2012
Parcel: 2S 101 DCO5000
Jurisdiction: Tigard
Site address: 13410 SW 76TH AVE
Subdivision: PACIFIC RIDGE Lot: 2
Project: Albertina Kerr Centers
Project Description: Addition. 7/18/12, adding ductwork to addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 470 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 470 sf Value: $48,842.40 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
Bckflw 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 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0
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 8 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:
ADD SF VB R -3 470
Owner: Contractor:
ALBERTINA KERR CENTERS RUSSELL RESTORATION LLC Required Items and Reports (Conditions)
ATTN: JERALD A HOFFERT 20915 SW 105TH AVE
424 NE 22ND TUALATIN, OR 97062
PORTLAND, OR 97232
PHONE: 503- 239 -8101 PHONE: 503 -692 -9002
FAX: 503- 692 -9008
Total Fees: $1,888.82
This permit is ' bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance wi ,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. TTENTION: Oregon 1 =w = . ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 01 -0010 th ough OAR 952 -• • -0090. •u may obtain a copy of the rules or direct questions to OUNC by calling 50 .232.1987 or 1.800.332.2344.
In ed By: ` _ �vi .....;..../-.... Permittee Signature: / 10,d-A. /
Call 503.639.4175 by 7:00 a.m. for the next available ins • : on dat I
This permit card shall be kept In a conspicuous place on the Job site until comp . Ion of the project.
Approved plans are required on the job site at the time of each Inspection.
Mechanical Permit Applicat FOR OFFICE USE ONLY
of Tigard IVED DateRecei/Bved y: iffiffyil i ♦ f
:� v 13125 SW Hall Blvd., Tigard, OR 972
C Plan Review
Phone: 503.718.2439 Fax: 503.598. (9¢ Date/By: Other Permit:
Inspection Line: 503.639.4175 JUL. 1 8 ; ;) Re
T I G n R D Internet: www.tigard - or.gov Notified/Method: e kris: S Efl pSee mental Information
CITYOFTIGARD
TYPE'kaWOR14llIVISION COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
6 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: I 3 / 1 'p 5 (, ) j (requires site plan showing placement) 46.75
T Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP:
"`"\-% PK� '3&- Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 1 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or •
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace/insert 33.39
N'eA.,J ? ert Y-k N Q1.,s' Flue vent for water heater or gas
1
�, `�, fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
• Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation: _
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
` t n 1 Clothes dryer (gas)
Business name:
L x K� Y lWV1 b lN$ Other Address: Q , O X (� r1 \ MECHANICAL PERMIT FEES" City/State /ZIP: P Q � p � Subtotal t��
0�R I L�/L ' `� !
Phone: (8) Li 1 3 Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCBlic.: ) O 1 t:Lq AI State surcharge (12% of permit fee) /Q . go
TOTAL PERMIT FEE 42
Authorized signature: This permit application expires if a permit is not obtamea within 1.80
_ �_ days after it has been accepted as complete.
Print name: 7 Date: 7 O ' Fee methodology set by Tri -County Building Industry Service Board
I:uilding�Pen \ m
nits MEC- PnitApp.doc 03/07/12 440- 4617T(1
\ B 1/0 COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 • Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
• $2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,0 and
• $2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
•
lNBuilding\Permits \NEC- PennitApp.doc 03/07/12 2
n CITY OF TIGARD MASTER PERMIT
: COMMUNITY DEVELOPMENT Permit #: MST2012 -00141
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2012
Parcel: 25101 DCO5000
Jurisdiction: Tigard
Site address: 13410 SW 76TH AVE
Subdivision: PACIFIC RIDGE Lot: 2 .
Project: Albertina Kerr Centers
Project Description: Addition
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 470 sf Basement: 0 sf Left 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 470 sf Value: $48,842.40 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
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 ,
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
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 addt 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +ampNolt: 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:
ADD SF VB R -3 470
Owner: Contractor:
ALBERTINA KERR CENTERS RUSSELL RESTORATION LLC Required Items and Reports (Conditions)
ATTN: JERALD A HOFFERT 20915 SW 105TH AVE
424 NE 22ND TUALATIN, OR 97082
PORTLAND, OR 97232
PHONE: 503- 239 -8101 PHONE: 503 -692 -9002
FAX: 503 -692 -9008
Total Fees: $1,788.02
This p d subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be one in accordance wi i 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
ys. ATTENTION: Oregon ,law e• uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
52- 001 -0010 through OAR 95 .91-00!-,. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 87 or 1.800.332.2344.
I ued By: k / � !� Permittee Signature: X /�
r \ /1 i �'�'/ 1
Call 503.639.4175 by 7:00 a.m. for the next available inspection da
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.
1
Building Permit Applicatio
Residential FOIL OFFICE USE ONLY
City of Tigard juN 2 0 2012 Received 0 Permit No.: �0� ��'��
- 7 1 .1,1=7 13125 SW Hall Blvd., Tigard, OR 97223 „ Plan Revie -
I! . Phone: 503.718.2439 Fax: 503.598 OF T� AUD DateB : 'i .4111117111Other Permit
T I c n R n Inspection Line: 503.639.4175 rs" �G DIVISION
g
Y7 lk J J t � � ��IO� Date Read l un ®
s: See Page 2 for
Internet: www.tigard or.gov ID Notified/Method: 7 / / / j�
� /�+�"/ Supplemental Information
TYPE OF WORK f REQUIRED DATA: 1- AND 2- FAMILY DWELLING X
❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed. V.
Indicate the value (rounded to the nearest dollar) of all '�1
Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION '0
1- and 2- family dwelling El Commercial /industrial
Valuation: $ 842 . . C t
El Accessory building El Multi-family Number of bedrooms: CN
❑ Master builder ❑ Other: Number of bathrooms: .ils•
Q
JOB SITE INFORMATION AND LOCATION Total number of floors: t x; 4.1-:).,=% s4c4-14-cra-"k
Job site address: / 39 / 0 S, us %Ws A New dwelling area: 47o square feet
City /State /ZIP: Ti‘ to rc l. a ? a
/ p 9 s 3 Garage /carport area: square feet (�
Suite/bldg. /apt. no.: Project name: AI De.1�, - ;N� ( J Covered porch area: square feet �,
Cross street/directions to job site: V A It- N S 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. I
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all 0
equipment, materials, labor, overhead, and the profit for the (
DESCRIPTION OF WORK work indicated on this application. V11
t Nq Valuation: $
86 .s 4-: add 4"fr�G�
+,� - '�
�� Existing building area: square feet
New building area: square feet b
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Y�
Name: A f 4 . (l o esr ee/J7TQ5 Type of construction:
Address: -7 a a N, C J e. a "'el A Occupancy groups:
.\. City /State /ZIP: i cy .„ 7'72 Sip Existing:
N Phone: ( ) .Z 3 t_ v 18 I Fax: ,6 ) 2(. 2 7t9 ( New: !b
.9 a APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
� R
` o Business name: Q 44 ( 1 5 4 ',� 4 � C C review fee
nta R t Structural plan review fee (or deposit): — k_
0 '� 1 ` _ k l� y f1f\ FLS plan review fee (if applicable):
Address: 2.4 (5 b L1 /6S Av�
City /State /ZIP: ' 1,444. f,' Q r . G� )bca Total fees due upon application:
/ T Amount received: f N6-.6Y
M Phone: 6-1>3) 4,9 a. 9 ®ba Fax: : (5-03 47 2_ 9 bag —
s PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E -mail: Ril�tya z . QUSSELL.Zf.1S
i s
. (b.e-,evl
Commercial and residential prescriptive installation of
CONTRACTOR roof -top ounted Photo Voltaic Solar Panel S = .
Business name: t . 2) sets of roof plan with c• -ction details
L L 1 and fire dep • • ent access, aloe : , 1 the 2010 Oregon
Address: Solar /nstallatio . 'eclat! "ode checklist.
City /State /ZIP: Permit Fee • • Ian review $180.00 g
d administra ' , ees):
Phone: ( ) Fax: Fax: ( ) Sta - surcharge (12% of permit fee): __ $21.60 •
CCBIic.: / S - 7 " '2 i 4 r / /°;
171 Total fee due upon application: 201.60 0
Authorized signature:
1# This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
�� M D * Fee methodology set by Tri -County Building Industry
Print name: R y 1b� ro�� p/l Service Board.
L: \Building \Permits \BUP- RESPermitApp.doc 02 /24/2011 440- 4613T(1 l /02 /COM/WEB)
'Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
Date1B : Permit No.:
q 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
lipq o Phone: 503.718.2439 Fax: 503.598.1960
fICARl
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard- or.gov 0 Other:
T I-I V FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ,« No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. El ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ El ❑
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 El ❑ ❑
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 ❑ El ❑
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. El El ❑
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 El ❑ ❑
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. El ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required El El ❑
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 a, I licable to the .ro'ect under review.
JURISDICTIONAL IONAL SPECIFICS •
23 Three (3) site plans are required for Item I I above. Site plans must be 8 -1/2" x 11" or II" x 17 ". El El ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. El ❑ El
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. ❑ El El
27 "Drawn to scale" indicates standard architect or engineer scale. El ❑ El
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ El
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, El ❑ El
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.
l: \Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440 4613T(11 /02 /COM/WEB)