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Permit CITY OF TIGARD `P MASTER PERMIT ni I COMMUNITY DEVELOPMENT Permit #: MST2012 -00213 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 I Rb4r,.0 Date Issued: 08/16/2012 T GAIip 9 I �I FS Parcel: 2S104CD04800 GJ'kuS Jurisdiction: Tigard Site address: 13923 SW MISTLETOE DR Subdivision: HILLSHIRE ESTATES Lot: 48 Project: Rothstein Project Description: Add wetbar and remodel bedroom. Added 4 branch circuits 8- 16 -12. BUILDING Floor Areas Required Setbacks Required Stories: 0 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: Yes Total: 0 sf Value: $31,000.00 Rear: 0 PLUMBING Sinks: 1 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 Drywall- 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 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvelFeeders 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: 4 Mid 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: ROTHSTEIN, MICHAEL HARTWELL HOMES Required Items and Reports (Conditions) ROTHSTEIN, ROMAINE 5100 NW 137TH AVE ROTHSTEIN, LORRAINE M PORTTLAND, OR 97229 13923 SW MISTLETOE DR TIGARD, OR 97223 PHONE: 503 -617 -9766 PHONE: 503 -617 -9766 FAX: Total Fees: $1,093.58 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 accordance 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Cali 603.639.4176 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. RECEIVED 13125 SW Hall Blvd-'I'i 3rd, OR 97223' , ^ Plum R q ' - " ' Phone: 503,639,4171 Fax: 503.598.1960 1 1 6 2012 �� Ryv , 1C'" Othm Permit: T : 6 A h `) Inspection Line: 503.639,4175 Date ed/Meth l la Sae Pane 2 for Inicuiet: www,tigard -oegov CITYOFTIG NedsedANet4od Supplemental Information _ ,. �' � '7�tY; '!,7i'�j� . ::X:'�r� „1•` ��,'�. ,itt4 `J ,;,. : � ,,: ;.,;,�:: w''di cl r ta�a. l n,al S. 7 P� 44WR :' `�`r`•'' "' ,). �•,:,,..,.... � 1'4.1; n.T ;i . ❑ Now construction gAddition/alt - +��a<t9 �, •�sdW .+n i .�f•.. .. ..�.!,•�.I.•... . `�:, s1 °'�'�i 'R� .. ;: /:. �.E;� r. � r + �Fl ��'l.�'rM.:.: J Please aback • - a ( sir mN' �;,::;: ; = checked era tion/rr: lacement apply ( � sots of plans w/i "r. �c.:,,. . that a (submit ❑ Demolition p ea. 0 other: a� dbel w'•�i0 � +.r;:rc +ao•r. ,;x,• �... +... P tams below): ❑ Service or feeder 400 amps or more 0 Building over �; where the available faun current ❑ Marinas and boatyards, - ^':trjgai vigkr�7it%'iY{:.h:S ;'; ;� 4Q ',p {;Q Q( 0 4 x 77 ` :' '" exceeds 10.000 amps at 150 volts or Q Floating building, , 1- and 2- family dwelling ❑ Commereia)/tadustrial ❑ Accessory building - less to 3eoruad, or a xceeds 13,000 p CvCommercial-use reiol.use agricultural amps fey all other installations, buildings. M ulti - family ❑Master builder ❑ Other: ❑ Fire PAP Q Iasmllation of 75 KVA or a..r.:.:,,iE e a.y <. '. Y ... - system '” �'- %`^+' % ; •�:^ � �: :%:. *.�' ii.' D Addition of new motor load of (] A ". •'E' "1.2 ", `I -3 " Jab no.: 0 21 "I I Job site address: l 99- 4 3 l.0 del ' be tooHPormor rampancy ❑ Six or mot resid ential units, Q Recreational vehicle parks, City /State/ZIP: ' , (S, ‘c'e ft o + go'5 O Ho/0h•care fneilees. ❑ Supply voltage for more than O Hazardous locations, 600 volts nominal, Suite/bldgJapt. no.: Project [lame: f 0•-‘i,A. , fit fl C) Service or feeder 600 amps or more. Cross street/directions to job site: :ZWja >' , k gal. ,` ,,. !: + >= "'PIE``S4'It1LE;y:. .lea t:: ;r;;'; Deeceiaelon . I OM I Fee. I Toed I • New residential single- or multi-family dwelling unit. Incindes attached garage. Subdivision: Lot no.: 1000 sal, It. or less 168,54 4 Tax map /parcel no.: Ea. add'I 500 SQ. R or portion 33,92 t Mid �,�,y,./} n ' fi �.�p�l�x,�{, Y �7f-B ,y�. .� -r'i;,: �,�'•..,� C'a r.:x...: i5 �+� Limited energy. residential ,.. �.�•7.itiatttit `If :,1"3i�lt`.1 t / ..,. ' !. VA,. ZR! '�-��.-.r.�i�'S:+l!'!E:�! h";+`i,,5� (with ab ove ) 75 2 �. ama t: s4, R \, w \� � \'- \Ll e& -v\-Q , ° — ' Limited residential ( ith a bove s . � � .� �2� MOM tesidentinl(with above sq. >x) 75,00 2 1 Services or feeders instal1ation, alteration, and/or relocation a n r ' L1.4' 200 amps or less 100.70 2 „ce.:l e . E 's,:a r n 4f��tR a! r•!x: i3G.r:;z„r�" �•:r•, ,. ••. ' ;r.�• 201 am 4 'i , ....... ..., ..,.._.,1;:�,� 4: �yy; �; �:+ �.iY�i'���;J4d:�,tl'4t�L49i:;J' t;:� °�n`'a: -ia' amps 00 stn s+.: �..:�,...:.,;� =. _ Ps 133.56 2 Nom 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: ( ) I Fax: ( ) 200 amps or less 59.36 I Owner installation: This installation is being made on property that 1 own which is not 201 am to 400 amps I I, 125 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 2 Branch circuits - new alteration or extension, eer panel _ Owner signature: . Date: ' — A. Fax for branch circuits with ISM? $ 3 �..y. i Ah �, .ir. M ti' n. _ above SWie o o 3u iE�A�r`::, �' "J:'':OG7fp �f +4 ?rrh::dGr fee- 742 . '" �'''" "�_ auh branch GirCat it 2 Business name: B. Fee for branch circuits withom Contact name: branch i t feeder fee. first ! 56.18 ,(.p.1 Q� 2 branch circuit Address: Each add'! branch circuit A 7.42 ici12. . P'-(O 2 Miscellaneous (service or feeder not included) City/State/ZIP: • Each manufactured or modular 67,34 2 dwelling, service and/or f�dnr Phone: ( ) I Fax: : ( ) Reconnect only _ 67.34 2 E - mail: - Pump or irrigation circle, 67.84 2 �„ Si r S sane=, r 1 r i , a , e r . Y i"?�!.y�!�, �r!! �� � , , tires , Sign o carbine lighting mi 67,84 2 ' i i +';�vi.1:�'1,A .:a�lL;�,J;i.;:H:r;a:v,. �'.•YL: �'}:;,4"�,..n. Signal OICQIIt(8) Or Iltntted�erf� — Business name: West Side Electric Co. , Inc. Pon0 alteration.or Page 2 Each additional Inspection over allowable in any of the Abov Address: 1834 SE 8th Ave . Additional inspection (1 hr aria) L 66,25/ ler City /State/ZIP: POrtland /OR /97214 investigation (1 strain) 6625 / hr Industrial plant (1 hr min) 78,18/ hr Phone: (503) 231 -1548 I Fax' (503) 736-0677 Inspections for which no fee is Cat Lie.: 26-135C aDeo iEtallY liste r min) 90,OW hr 13 3 0 6 I Electrical Lie.: Suprv. Lie.: 4654 - S_e'!-'"m;ri:'' 1GP:C.�RYGA, r xtr ELS':e 4 ;a Suprv. Electrician signature, required: ` .11 r — Subtotal: — I V . LI LI - Plan review (25% of permit fee): Print name: Randall P Roberts I Date: gln4 1 State surcharge (12% of permit fee): 4 , (( Authorized signature: TOTAL PERMIT FEE: "7, rj Ibis permit application expires if a permit is not obtained within ISO Print name: days after it has been accepted as complete. Date: • Number of anspeedeea allowed per permit. nlauildineen itaLC•PauiitApp,doc 07/91 /Ice 440.4615Ti11roYCOMIWFe Z /L # L866L£ZEO9! 0961.869E0S:o1 3 !aloal2 ap!S }s;m:woJj! 00 :L0'ZL -9L -80 CITY OF TIGARD MASTER PERMIT s COMMUNITY DEVELOPMENT Permit #: MST2012 -00213 T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2012 Parcel: 2S104CD04800 Jurisdiction: Tigard Site address: 13923 SW MISTLETOE DR Subdivision: HILLSHIRE ESTATES Lot: 48 Project: Rothstein Project Description: Add wetbar and remodel bedroom BUILDING Floor Areas Required Setbacks Required Stones: 0 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: Yes Total: 0 sf Value: $31,000.00 Rear: 0 PLUMBING Sinks: 1 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 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'I 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 & 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: ROTHSTEIN, MICHAEL HARTWELL HOMES Required Items and Reports (Conditions) ROTHSTEIN, ROMAINE 5100 NW 137TH AVE ROTHSTEIN, LORRAINE M PORTTLAND, OR 97229 13923 SW MISTLETOE DR TIGARD, OR 97223 PHONE: 503 -617 -9766 PHONE: 503 -617 -9766 FAX: Total Fees: $1,005.73 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 accordance 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through •AR 952 -00 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 2.1 • : or 1.800.3 .23 4. IL�I� Issued By: _ , i ..1 �.. - � _ � Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available inspectio ate. This permit card shall be kept In a conspicuous place on the job site until, • pletion of the project Approved plans are required on the job site at the time of each inspection. IM-din Permit Application RECEIVED Residential FOR OFFICE USE ONLY City of Tigard AU ' 1 3 2 012 o, DateBy: / 1 yr Permit Nc 14S 7 1 p l �_ o a a . / 3 13125 SW Hall Blvd., Tigard, OR 9722 R'fnitrOrTIGA DateBy: ■ / Plan Review , a . Q? � _ Phone: 503.718.2439 Fax: 503.598 v '. I RD e 9 (( Other Permit: T t G A R p Inspection Line: 503.639.4175 �' LD g /(3'D VISIO Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov SJ Noti ed/Meth : g /51/ / f( ( 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 the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1- and 2 -famil dwellin Valuation: $ y g ❑C ommercial /industrial ❑ Accessory building El Multi- family Number of bedrooms: El Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 13923 SW Mistletoe Dr. New dwelling area: square feet City /State/ZIP: Tigard, OR Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Rothstein Covered porch area: square feet Cross street/directions to job site: Benchview Terr. & Mistletoe Deck area: 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. Tax map /parcel no.: 2S104CD04800 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. Add Wetbar &Remodel Bedroom Valuation: $ I oOD Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Michael Rothstein Type of construction: Address: 13923 SW Mistletoe Dr. Occupancy groups: City/State/ZIP: Tigard, Or Existing: Phone: (503)690 -8985 Fax:( ) New: ® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* Business name: Hartwell Homes (Please refer m tee schedule) Structural plan review fee (or deposit): Contact name: John Hartwell FLS plan review fee (if applicable): Address: 5100 NW 137 Ave City / State/ZIP: Portland, Or 97229 Total fees due upon application: Phone: (503) 617 -9766 Fax:: (503) 617 -2929 Amount received:32, g.05 E -mail: John @hartwellhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top ted PhotoVoltaic Solar Panel System. Business name: Hartwell Homee Submit two (2 • : of roof plan with connectio , atls and fire department a : - s, along with th : 0 Oregon Address: 5100 NW 137 Ave Solar Installation Special . • •e ch- 41st. City / State/ZIP: Portland, Or 97229 Permit Fee (includes pl • ew $180.00 and admini . ive fees . Phone: (503) 617 -9766 Fax: (503) 617 -2929 State surcharge /o of permit fee): $21.60 Z CCB lic.: 147531 14( t to _ Total fee due upon application: 201.60 /• Authorized signature: f / • . This permit application expires if a permit is not obtained .,i , within 180 days after it has been accepted as complete. Print name: John Hartwe `Date: 8/13/12 ' Fee methodology set by Tri -County Building Industry Service Board. l:\Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11 /02 /COM/WEB) Plumbing Permit Application E D Building Fixtures FOR OFFICE USE ONLY . City of Tigard AUG 1 2012 Received ( � �/ Date/By: rr PermitNt. /1.451 /01- -o0 -18. a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 0050 � C Phone: 503.718.2439 Fax: 503.598.16 / ®F�GARD Date/By: Other Permit EC�' Inspection Line: 503.639.4175 B[JJLD[hlGDIVI D ate Rea B Juris: G! ® See Page 2 for T I G A Ii D Internet: www.ti ardor. ov y ri Y B g g . Notified/Me 11 Supplemental Information TYPE OF WORK . FEE* SCHEDULE ❑ New construction ❑Demolition For special information use check list. 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 (I) bath 312.70 ® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION . Site utilities: Job site address: 13923 SW Mistletoe Dr. Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State/ZIP: Tigard, OR Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Rothstein Manufactured home utilities 50.03 Cross street/directions to job site: Benchview Terr & Mistletoe Dr. Manholes ' 18.76 Rain drain connector 18.76 Sanitary sewer (no: linear ft.: ) Page 2 • Storm sewer (no. linear ft.: ) Page 2 • Water service (no. linear ft.: _) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: 25104CD04800 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Add wetbar and remodel bedroom Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ® PROPERTY OWNER" I ❑ TENANT Expansion tank 12.51 Name: Michael Rothstein Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 13923 SW Mistletoe Dr. Garbage disposal 25.02 City /State /ZIP: Tigard, Or Hose bib 25.02 Phone: (503)690 -8985 Fax: ( ) Ice maker 12.51 0 APPLICANT CONTACT PERSON Interceptor /grease trap 25.02 Business name: Hartwell Homes Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: John Hartwell Roof drain (commercial) 12.51 Address: 5100 NW 137 Ave Sink/basin/lavatory r 25.02 City /State /ZIP: Portland, OR 97229 . Solar units (potable water) . 62.54 Phone: (503) 617 -9766 Fax: : (503) 617 -2929 Tub /shower /shower pan 12.51 E -mail: John @hartwellhomes.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: Five Star Plumbing Water piping/DWV 56.29 Address: 6138 SE 136 Ave • Other: 25.02 City/State /ZIP: Portland, OR 97236 Subtotal Phone: (503) 970 -5000 Fax: (503) 762 -5795 Minimum permit fee: $72.50 Plan review (25% of permit fee) CCB Lic.: 176756 (91 Plumbing Lic. no.: PB370 11111 4 - State surcharge (12% of permit fee) Authorized signature: F ' \, /(J /i TOTAL PERMIT FEE $�ce Print name: John Hartwell, I Date: 8/13/12 This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. - 'Fee methodology set by Tri -County Building Industry Service Board. 1:\ Building \Permits\PLMU - PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)