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Permit u CITY OF TIGARD ; MASTER PERMIT 111 / , COMMUNITY DEVELOPMENT Permit #: MST2012 -00125 T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 A4/�� Date Issued: 07/09/2012 �f►� Parcel: 2S111AB07100 Jurisdiction: Tigard Site address: 9280 SW INEZ ST Subdivision: PENROSE TERRACE Lot: 16 ' Project: SMITH Project Description: Deck with covered portion. 1/15/13, changed electrical contractor from owner to Three Dog Electric. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 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: No Total: 0 sf Value: $14,198.40 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 1 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 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders 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: 2 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: OTR SF VB R -3 0 Owner: Contractor: SMITH, TRAVIS J & SMITH, AMY J J & M BUILDERS INC Required Items and Reports (Conditions) 9280 SW INEZ ST PO BOX 393 TIGARD, OR 97224 BORING, OR 97009 PHONE: PHONE: 503- 663 -1424 FAX: Total Fees: $687.50 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 • • - - ith 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. • ENTION: Oreg• • law requires you to follow the rules adopted by the Oregon Util' etifi ation Center. Those rules are se forth in OAR 952- % r 1 -0010 through OAR 9 •• • r 1- Ili. • . You may obtain a copy of the rules or direct questions to C by cal '_•.4...-Am 2.1987 or 1.800.332.2344. ' Is- ed By: / i� i Permittee Si ature: .., c !t . Call 503.639.4175 by 7:00 a.m. for the next available n • ate. 10 This permit card shall be kept in a conspicuous place on the job site unti • pletlon of the project Approved plans are required on the job site at the time of each inspection. , Electrical Permit ApplicatioRECFIVED Received /J� � City of Tigard Date : f 13125 SW Hall Blvd., Tigard,OR 97223j AN 1 2013 Plan Review' PermitNo.: � °� m . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction .. Addition/alteration/replacement ❑ 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 ‘Sr 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. ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "I -3 ", Job no.: I Job site address: t 2„e 5. (L) 'e-L Syr 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ' (C A- ' ` C72 Healthcare facilities. ❑ Supply voltage for more than • �r Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project n. t e: /� �/� r ❑ Service or feeder 600 amps or more. ( l. ► J / r J � ] FEE SCHEDULE Cross Street it ions to job b site: ( , / / Description I Qtr. I Fee. I Total I �' �w . - New residential single- or multi - family dwelling unit. Includes attached garage. Subdivisi � i ' , w Lot no.: 1,000 sq. ft. or less 168.54 4 rn, Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: 4111b. (! / " Limited energy, residential I SCRIPTION OF WORK (with above sq. ft.) 75.00 2 RAN_ Limited energy, multi - family 75.00 2 �C (Ai t Lt C., (+T S i U Oti36A(k, 1 R CAL , residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 F Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 Branch circuits – new, alteration, or ex tension, ler panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: R p ZZ 'l �)�� ELK, B. Fee for branch circuits without R+F service or feeder fee, first branch circuit 56.18 2 Contact name: F r2..1 a R.4.3.0 Each add'I branch circuit 7.42 2 Address: S 2 S ,a te (ILO e...{Q Miscellaneous (service or feeder not included) — Each manufactured or modular City/State /ZIP: 7 • ' dwelling, service and/or feeder 67.84 2 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: -- r — g .tT p0 G l 1_4, L • E ( R . . G panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the abov Address: c Zs 0 S .. L‘.) ` C A-rn ft, R..0 to ‘1?-,1 Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City/State /ZIP: o (Z T LA - Nt t IZ 97 2Z ( Industrial plant (1 hr min) 78.18 / hr Phone: (s(j 3 ) 24 4, _ y -7 Z4G Fax: (S( 2 /4 42 - Z i i 3 Inspections for which no fee is 90.00 / hr specifically listed (%z hr min) CCB Lic.: 1 3 g s 0t1 I Electrical Lic.: C i 8 B I Suprv. Lic.: 44„, 13 S ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: v g o Subtotal: Plan review (25 /o of permit fee): Print name: F Y� ,f% I C I G- PJS Date: ' _ (S _ (. 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 um b er of inspections allowed per permit. I: \ Building \Permits\ELC- PermiiApp.doc 07/01 /10 440- 4615T(l 1/05 /COM/WEB • Electrical Permit Applic - 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 ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation El 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 I:\ BuildingWermits \ELC- PermitApp.doc 07/01/10 CITY OF TIGARD MASTER PERMIT a • COMMUNITY DEVELOPMENT Permit #: MST2012 -00125 T l G RR O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/09/2012 Parcel: 2S111AB07100 Jurisdiction: Tigard Site address: 9280 SW INEZ ST Subdivision: PENROSE TERRACE Lot: 16 Project: SMITH Project Description: Deck with covered portion. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 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: No Total: 0 sf Value: $14,198.40 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 add! 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O SvcJFdr: 2 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: OTR SF VB R -3 0 Owner: Contractor: SMITH, TRAVIS J & SMITH, AMY J J & M BUILDERS INC Required Items and Reports (Conditions) 9280 SW INEZ ST PO BOX 393 TIGARD, OR 97224 BORING, OR 97009 PHONE: PHONE: 503 -663 -1424 FAX: Total Fees: $687.50 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 ' • _ • • = - , 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. TENTION: Oreg• law equires you to follow the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR 952-111-0010 through OAR 9 2 :41-0 a 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 987 r •.800 332.2344. Issu= • By: 1 i % �, / Permittee Signature: de Call 503.639.4175 by 7:00 a.m. for the next available inspectirin 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. Bu* din Per i mit Ap plicat ion /), 5i l' NT/ ■ ��I "' OR OFFICE USE ONLY of Tigard Dal ` ►f • Permit No.:HS, , /ey,3- q 13125 SW Hall Blvd., Tigard,OR 97223 JUN 0 6 2012 Plan R ' a er Permit C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Ap �- - O?�� / / 0702_, T I G A R D Inspection Line: 503.639.4175 OF CITY TI^ p RD Date Read - c y: Q / , a . (D Jury Ill See Page 2 for Inter net: www.tigard- or.gov CITY I T har llflr Notified/Method: 7/ �+ ''/ / I� Supplemental Information BUILDING / . , TYPE OF WORK QUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed. Indicate the value (rotnded 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 applicatio 1:1 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ / 88'1/4 ID Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address:el z46 5t.✓ ,� Z S./..rLC'4_ New dwelling area: square feet City /State /ZIP: r'f G pl }zay Garage /carport area: square feet • Suite/bldg. /apt. no.: Project name: Covered porch area 4 3 square feet Cross street/directions to job site: 9 3 1.k Z ete Deck area: 2 ', square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees' are based on the value of the work performed. Indicate the value (rotnded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. 0 � . to V`V Valuation: $ 1j Existing building area square feet �/ New building area: square feet l PROPERTY OWNER ❑ TENANT Number of stories: Name:7;2 i S Si,.., t - 1 L Type of construction: Address: 1 Z/0 5 ta.' S z S+- r e'- - Occupancy groups: City/State /ZIP: Ti aar&' 0rz_ i..� -'Z2y Existing: Phone: (5v3 ) a ) c 1i_- 4, 3.+-1 Z Fax: (Sv3) (o7 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 lensed 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: ( ) I Fax:: ( ) E -mail: CONTRACTOR BUILDING PERMIT FEES* Business name: j j t4/( e i �� e-►. S i'vt, G t (Please refer to fee schedule) Permit fee: Address: () Li 13 0 X 3' 3 State surcharge (12% of permit fee): City/State /ZIP: Bo i"‘'in5 i Oa, a0 FLS plan review (40 %of permit fee): Phone: (1 ) ` ( 3 I t. ' L) I Fax: ( ) (Due upon application.) CCB lic.: I 1 1 2.1 $ I %'I 8l1 Total permit fees: Authorized signature: Amount received: 1 This permit application expires if a permit is not obtained Print nameTraviS S.- t2I-k I Date: 3/a6/ i Z within 180 days after it has been accepted as complete. ' Fee methodology set by Tri -County Building Industry Service Board I:\Building\Permits \FPS - PennitApp.doc 07/01 /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. ❑ Repair Number of sprinkler heads: Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler ❑ Wet ❑ 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 Mann 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 Electrical Permit Application r(>IZ tlrrlct: usl: t>�Nl., 71 C City of Tigard R Date/By: Permit No.:/y����� . 9/ 5 • 13125 SW Hall Blvd., Tigard,OR 97223 JUN 0 6 2012 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: l I L. A R D Inspection Line: 503.639.4175 Date Ready/By: )iris: El See Page 2 for Internet: www.tigard or.gov 6 1 OFMIC� D Notified/Method: / / (" Supplemental Information TYPE OF WO I LD�NG D Vib U�' 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 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 ❑ 1 - and 2- family dwelling ❑ Commercialindustrial ❑ 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. ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3 ", Job no.: Job site address: IOOHP or more. occupancy. ❑ 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: ['Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 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 168.54 4 Ea. add' 1 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi- family 75.00 2 residential (with above sq. ft.) _ Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ 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 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: "7 Date: C ^(( — 1 Z— 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 l 56.18 2 Contact name: branch circuit Each add'I branch circuit r 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: O k/A/�� 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 Investigation (1 hr min) 66.25/ hr City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is specifically listed (% hr min) 90.00/ hr CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Plan review (25% of permit fee): Print name: Date: C — C. -11-- State surcharge (12% of permit fee): Authorized signature: �` 'ti-.. TOTAL PERMIT FEE: g �Y svo t % J t^^t This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: r t` t k Date: ( ` Z • Number of inspections allowed per permit. I1Building \Permils\ELC- PermitApp.doc 07/01 /10 440- 4615T(11 /05 /COM/WEB Electrical Permit Application - City of Tigard L� - °• 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 $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems . ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 RECEIVED Property Owner Statement Regarding Construction Responsibilities C l B D NG j�J Oregon Law requires residential construction permit applicants who are not licensed with the �IV ISIQI�I Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement Is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement This statement will be flied with the permit Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: J.4- ° eut tot crs I 2 I g 1Z /1$/20' Name CCB# Expiration Date n I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or l I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office • issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the Information on this homeowner statement is true and accurate. Print Name of Permit Applicant • .:":47 ca040 . --1 I 6 1 I 2.— 0 I 2.— ! Signature of Permit Applicant Date Permit #: M 6T 2--oo t �S Address: UV) 1 x)Vr- "'- .b '' >..: r i 7 i /t ' r.i3 Issued b�: / Date: l This Copy for Permit Offices e ° Building Division Development Code Provision Review T I G A R D Residential Projects Building Permit No: / 57-01 40/o'Z — /9e / CWS Service Provider Letter Received: Yes ✓ lNo ❑ N/A ❑ R7"i°G /e1 "r n/D n /'mod 777497 /14E6 7O -Cu. /d/`s /f Routed Plans: P201/i A FL /..-&-71W-74 A ' o� Original Plan Submittal Date: 07/..2...) "�� " 6/7// Z 1st Revision Submittal Date: ❑ Site Plan Only 2 ^d 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 proved. Planning �/ Review (contact 1 � l at 503 -718 � ✓ Ti'vor A' 1 d d -or. ov g ( `� �@ l� g ) Lyfd Use Case pip. Name Z oning LLB" Sctbacks: . 'n ront ao Rear Side �]- Street Side / Garage � �/ ( Maximum Building Height -(T Actual Building Height - 2 r2 ❑ Visual Clearas— ❑ Easements ❑ Sensitive Lands Notes: Original Plan: Approved Not Approved ❑ Date: Wil// 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 )a" Not Approved ❑ Date: 6 l ( 2- Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 • City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) 'feet Trees • I Protected Trees • Notes: • Original Plan: Approved El Not Approved ❑ Date: 6/I j/ t 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 Applic t Okay to Issue Permit: Ye N ❑ Date Routed to Building: / / ✓/ 1 Page 2 of 2 RECEIVED RECEIVED JUN Y 4 11.11L Clean Water Services File Number By Laurie Harris at 8:33 am, Jun 08, 2012 \ I'('YOFTIG ARPl Clean Water\ '=,. ��viS)j �l i2- ooi3so l Sensitive Area Pre - Screening Site Assessment 1. Jurisdiction: Tigard 2. Property Information (example 1S234AB01400) 3.. Owner Information Tax lot ID(s): R0499829 Name: Travis &'Amy Smith Company: Address: 9280 SW Inez St Site Address: 9280 SW Inez St City, State, Zip: Tigard. OR 97224 City, State, Zip: Tigard, OR 97224 Phone /Fax: 503.313.4755 or 503.997.6342 Nearest Cross Street: 93rd & Inez E -Mail: asmith ©24hourfiLcom 4. Development Activity (check all that apply) 5. Applicant information i� Addi$on to.Single Family Residence (rooms, deck, garage) Name: same as above ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: ❑ Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial O Multi Lot Commercial City, State, Zip. Other Phone /Fax: E -Mail: 6. Will the project involve any off-site work' ❑ Yes Q9 No ❑ Unknown Location and description of off -site work n/a 7. Additional comments or information that may be needed to understand your project New deck on back of house to replace failing existing deck This application does NOT replace Grading and Control Permits, Connection Permits, Building Permits, Site Development Permits, DEO 1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands andlor 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 limes for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the informalion contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate, Print/Type Name ow ' S S ' I - t: ,, t.LL Print/Type Title Property Owners • Signature Ya;s - Date June 8, 2012 FOR DISTRICT USE ONLY ❑ . Sensitive areas potentially exist on site or within 200' of the site. 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 Resources Assessment Repon may also be required. (2E1 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 Pro - Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they aro 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 ava0abie information the above referenced project will not significan'Jy 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 additonal 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 rpeet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER_ IS REQUIRED: APPROVED Reviewed by l '- ti{ ) 1/4 - r. - Date By Laurie Harris at 1:03 Jun 13, 2012 2550`.SW Htllstipro Highway Hiikboro Ore 97:123 r Phone'(503) 681 5100 `Faxt\(503 • WiWiCIeanwa@services erg;: Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9280 SW INEZ ST, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical final 05/24/2013 00:00 MST2012-00125 PASS Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9280 SW INEZ ST, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical final 05/06/2013 MST2012-00125 FAIL Construction or work for a permit is required to be accessible R109.1 No access no one home 9:08 am Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9280 SW INEZ ST, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection 05/06/2013 00:00 MST2012-00125 FAIL Construction or work for a permit is required to be accessible R109.1 No access no one home 9:08 am Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9280 SW INEZ ST, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical final 05/06/2013 MST2012-00125 FAIL Construction or work for a permit is required to be accessible R109.1 No access no one home 9:08 am Violation Summary: Inspector Contractor