Permit CITY OF TIGARD MASTER PERMIT
`! '! 1.: COMMUNITY DEVELOP Permit #: MST2012-00208
T IGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/05/2012
Parcel: 1 S125DA10400
Jurisdiction: Tigard
Site address: 9425 SW 70TH AVE
Subdivision: 1994 -061 PARTITION PLAT Lot: 1
Project: Panutich
Project Description: New SF. SDC credits from demolition permit MST2012 -00207 applied to this permit. 9/5/12,
adding temp power.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 1365 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 736 sf Garage: 426 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 2101 sf Value: $239,140.52 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines 100 SF Rain Storm Sewer: 100
Drains: 1
Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 100 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn > =100K: 1
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 1 W/ Svc or Fdr: 0
Ea add! 500 sf: 4 201 -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
Ecompasing: Y
Other: N Other Description: P 9
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R -3 2101
Owner: Contractor:
PANUTICH, ALEXANDER V & ELENA FA PEVZNER CONSTRUCTION LLC Required Items and Reports (Conditions)
9520 NW CAXTON LN 12246 SW MEADER WAY 1 Ersn Cntrl 503- 639 -4175
PORTLAND, OR 97229 BEAVERTON, OR 97008 2 geo tech report required prior
to footing inspection
PHONE: PHONE: 503 - 313 -2466
FAX:
Total Fees: $6,984.47
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 - . • - ce with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is susp-nded for more the 1
days. . ENTION: • - .on requires you to follow the rules adopted by the Oregon Utility Notification Center. Those r are set forth in • • '-
952 -0'.1 -0010 through OA • - 2- 001•0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.804
/ / f
Issue. :y: it Permittee Signature: /lsi��
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 o,+ . • oject.
Approved plans are required on the job site at the time of each inspectio,
- —
Building Permit Application
Residential FOR OFFICE USE ONLY
Permit No.: ' 4'9 -�
City of Tigard yf 4 .� Date/B Received : .. a�e ✓/ �'( �g
• .` �;.
13125 SW Hall Blvd., Tigard,OR 9 Plan Review ice"
NI I Phone: 503.718.2439 Fax: 503.598.1960 Date/B : 6 � jir j� Other Permit: f IGO0/ cev 7
i 1 t \ i , 1 , Inspection Line: 503.639.4175 ! i j 0 6 201Z Date Ready : y: / / i Juris: 61 See Page 2 for
Internet: www.tigard - or.gov •.: re. l ( e�
ethod: f / Supplemental Information
TYPE OF WORK REQU DATA: 1- AND 2- FAMILY DWELLING
A 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.
al 1- and 2- family dwelling ❑ Commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms: 3
El Master builder 0 Other: Number of bathrooms: 2 1 /2-
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: . 9zi 25 - s z, ,- fk G?✓e New dwelling area: .cto - square feet
City /State /ZIP: `7 y l J O e .9 1- 2 Z 3 Garage/ t r �C 'Square feet
Suite/bldg. /apt. no.: Project name: Covered porch area r¢ k square feet 7 ,:,
Cross street/directions to job site: Deck area: /6 ! square feet'`
Other structure area: 260,7 square feet Z�
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.
C uA42-��-14 Valuation: $
Existing building area square feet
New building area: square feet
PROPERTY OWNER ❑TENANT Number of stories:
Name: ,`1x,na (oar) �.I, C �., �O�'1 Type of construction:
Address: q 5 7,t/ C aix / �� Occupancy groups:
City /State /ZIP: PO/LT n d , 0 R e77o9.2 -7 Existing:
Phone: ( 7..3)a CN _ / 5 bi Fax: ( )
_ New:
❑ APPLICANT CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: P�p C��cu e few / i Structural plan review fee (or deposit):
Contact name: P c IZ FLS plan review fee (if applicable):
Address: i 2 t ., v ,i(c u c � J f G 1 —
y � J Total fees due upon application:
City /State /ZIP: /J ea ve 12 (OR 9 II-62-0f '-<"2 Phone: ( fQ.5) 3 / '� 2 6 Fax:: ( ) Amount received: *756
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System.
Business name: Pt:,✓Y-ttie P. CQ,u,3, e >4 C1_Gt �J P Submit two (2) sets of roof plan with connection details
0 and fire • . • artment access, along with the 2010 Oregon
Address: /2 2x( S u.! e-Q �t ,k e y Solar Install, Specialty Code checklist.
p Permit Fee • ludes pl.
City /State /ZIP: ,� p ate y�O and ad ative fees): $180.00
Phone: ( jjS) 3 f 3 ZY cg Fax: ( ) States . ge (12% of pe • ee): $21.60
CCB lic.: / 7 f8 573 -
Total fee due upon application: $201.60
Authorized signature: -, ' This permit application expires if a permit is no • • tained
within 180 days after it has been accepted as complete.
Print name: 5e ye( p e4/ p , Date: 04 v.,- - 20 / 2 *Fee methodology set by Tri -County Building Industry
Service Board
I:\ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(1 I /02 /COM/WEB)
r .
Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
IIIII City of Tigard Received Date/By: Permit No.:
• 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
• Phone: 503.718.2439 Fax: 503.598.1960
t I G A R D 24- Hour Inspection Line: 503.639.4175 El Electrical 0 Plumbing ❑Mechanical
Internet: www.tigard- or.gov ❑ Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e 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. ❑ ❑ ❑
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 ❑ El 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 ❑ ❑ ❑
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 a . I licable 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 ❑ Cl ❑
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
oh a lot of record approved prior to September 9, 1995. _
I:\ Building \Permits\BUP- RESPennitApp.doc 02/ 24/2011 440- 4613T(11/02 /COM/WEB)
Pl Permit AppliC EW
l�� FOR OFFIC►: I.I.: 0yl.1
' i l l 0 6 20 Received �� , 1
City of Tigard Date/By:
l Permit No.: �tJ!v /O`"6C
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' • Phone: 503.718.2439 Fax: 503.598.t960TI{lARD Date/By: Other Permit No " : I *at., 44
Inspection Line: 503.639.4175 'IRON
II G A R l> Internet: www.ti azd -or. ov Date ReadyBy: Juris: RI See Page 2 for
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ 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 312.70
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑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: J Y zc s w . o IA Q v C Catch basin or area drain 18.76
City /State /ZIP: 7 r' K ae r1 !) 9 7 2 2 3 Drywell, leach line, or trench drain 18.76
y am` V1�� Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: U Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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.: 3 Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/� Clothes washer 25.02
p r,, k e_ �Q� k f 1(c 1c/K Dishwasher 25.02
(((!!! - Drinking fountain 25.02
Ejectors /sump 25.02
Or PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
, Fixture /sewer cap 25.02
Name: e f eAl a 1 _Q h ( f ,,n
R sa 0 _ / hit f /2 LM G drain/floor siric/hub 25.02
' V
Address: / .61_,k---/7)
arbb age e disposal 25.02
City /State /ZIP: fc/Ct / G Q /) 1 , f2 . -7o 9 Hose bib 25.02
Phone: (5 -O t - / 5 Fax: ( ) Ice maker 12.51
❑ APPLICANT CONTACT PERSON Interceptor /grease trap 25.02
p Medical gas (value: $ ) Page 2
Business name: A v '�-y C r[ � � 4( c �{� � C
Primer 12.51
Contact name: S e i c ey 1) e 2 i Roof drain (commercial) 12.51
Address: ) 2 Z y tg S t t / '‘t 1 (( Are k/'a"
Sink/basin/lavatory 25.02
City/State /ZIP: 6 t✓L/ OW g Wee r Solar units (potable water) 62.54
Phone: ($^d1) 3 f 3 4 t" I Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONT OR Water heater 37.52
Business name: P fiVaef-t4, piping/DWV 56.29
Address: A ,o ,J/ P Other: 25.02
City /State /ZIP: ._ c� 7 1�� 1.. Subtotal
Phone: ( 64'19 _ gl ; q Fax: ( _ Minimum permit fee: $72.50
CCB Lic.: ` t Plan review (25% of permit fee)
t _:•) Plumbing Lic. no.: , - .. o
State surcharge (12% of permit fee)
Authorized signature: i� ! �� %�' Z I
'��i �La TOTAL PERMIT FEE
Print name: r 7 p`' a �� Date: 4 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.
L\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)
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 - 1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Tub /Sr ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower Tub /S as defined in OAR918- 780 -0040.
-Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filer fees assessed for the sewer increase must be paid before the
Washer - Clothes lumbin permit can be issued.
Water Extractor P g P
Water Closet - Toilet
Urinal
Other Fixtures:
I:\ Building \Permits\PLM - PermitApp.doc 2
' Mechanical Permit Application -,, . . FoR O F F I C E 1 M'. t)NI.l L I Received ' A
r�
City of Tigard _ Date/By: Permit No.: i `� , , dl
111 I • 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2439 Fax: 503.598.19¢ 1 Q. 2012 Da e / By : w
Other Permit:
Inspection Line: 503.639.4175 y
T I G A R D p Date Ready/By: Jun s: ® See Page 2 for
Internet: www.tigard or.gov C" a; , Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
M, 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*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
�!1 Air conditioning
Job site address: �, 1 s ,,,/ /19 Q,/( (requires site plan showing placement) 46.75
City /State /ZIP: - 71 jog It/ 0 d2 g 2 Z 3 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU {ducts /vents) 54.91 1
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 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
/1.A.4 QQ y dit • o C k r 7 Flue vent for water heater or gas
9 fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Or PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32
�� Other: 23.32
Name: lL eM 0 Pa /2 o G Environmental exhaust and ventilation:
Address: 9C01 0 /V 710y A Range hood/other kitchen
equipment 33.39
City/State /ZIP: P 737 a /9 U 0 p___ q7 ? 0 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( 03 c qe..,1 — 15 6i Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT CONTACT PERSON Attic /crawlspace fans 23.32
Pe-vi Other: 23.32
Business name: / t e c_ 0///' Fuel piping:
Contact name: Se S // p p/ P.�f/ ) P $ 14.15 for first four; $4.03 for each additional
Address: 12 2 � it/ fit- p i w y Furnace, etc.
c24 9 Gas heat pump
8 City/State /ZIP: ea-Li � Wall /su/suspended/unitheatev
Phone: ( SC3) 3 / 3 2g 67".‘ Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: / Al pACT 11041 (t■ Lo o(_ I W (j- Clothes dryer (gas)
Other:
Address: 3 U q N F / lit U�
/� MECHANICAL PERMIT FEES*
�
City /State /ZIP: 1-r � G-jto , c m 60Lt Subtotal
Phone: eb q3 ) .. 3 g. B I ��
Fax: (3 6 b) 8'x _ /9 7 / Minimum fee )
Plan review (225% 5% of permrmit it f feeee)
CCB lic.: / 6 6 Z Z 5 7 1 7 k State surcharge (12% of permit fee)
f/ /i ` TOTAL PERMIT FEE
Authorized signature: 1✓ � This permit application expires if a permit is not obtained within 180
� �f jp / days after it has been accepted as complete.
1
!
Print name: i k Q l y PI ! Date: g - Q - /2.. * Fee methodology set by Tri- County Building Industry Service Board
I: \ Building \Permits\MEC- PermitApp.doc 03/07/12 �/ 440- 4617T(11 /02/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 $10,000.00 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.
I:\ Building \Permits\MEC - PermitApp.doc 03/07/12 2
,
Electrical Permit App1i
Fo
# - K,1 FOR OFFICE USE ONLY Received
City of Tigard �II II Date/By: Permit No.: f 6rVO / ,,.-OO ,24:::/ �
1, •
13125 SW Hall Blvd., Tigard, OR 3 4 201 Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T l G A R D Inspection Line: 503.639.4175 ' A 14 `I -1 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov . k,. Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
L.XI New construction ❑ Addition/alteration/replacement Please check all that apply (submit & 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 ❑ 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 ", `3 ", "1 -2 ", "I -3 ",
Job no.: Job site address: 9 i' of 3 u/ 770 aye' tootle or more. occupancy.
7 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: K 0 ie 9-il az 3 ❑ 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 I Qtr. 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'I 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
Vi PROPERTY OWNER ❑' TENANT 201 amps to 400 amps 133.56 2
P - , r j 401 amps to 600 amps 200.34 2
Name: ,�� r� � � rl 601 amps to 1,000 amps 301.04 2
q 5
Address: c 0 iv Gl/ �i[�i/� -to h 44, Over 1,000 amps or volts 552.26 2
City/State /ZIP: P02.7"-t:/ a n t / 12 t 9�?� Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503 c y q f3-- 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: Date: A. Fee for branch circuits with
❑ APPLICANT I CONTACT PE ON above service or feeder fee,
7.42 2
9 each branch circuit
Business name: Pest/ C 4 A / � ( B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name:
'S 0 P 1 P,e� ,L ft branch circuit
_ Each add'I branch circuit 7.42 2
Address: 12 2Y 6 S L e.-& Lao/ Miscellaneous (service or feeder not included) —
&,
City/State/ZIP: ea /e€t i-to4 r 9 ?-aer / Each manufactured or modular 67.84 2
dwelling, service and/or feeder
(� J 315 — g a � /`/
Phone: Q �./ IQ,Ej Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
�p CONTRACTOR Signal circuit(s)or limited-energy
Business name: 1 �!/ e � - t" i, panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 2 3 qz o A/F 21' J - ' y . C? ' s,—, • Additional inspection (1 hr min) 66.25/ hr
6 Investigation (1 hr min) 66.25/ hr
City/State /ZIP: J � 3 dustrial plant (1 hr min) 78.18 / hr
Phone: ( 360) 9'0 ? — 7 ?rt 2 Fax: ( ) / spections for which no fee is 90.00 / hr
- ciftcall listed %s hr min _
CCB Lic.: 19f Electrical Lic.: 'A 'Y Suprv. I.: i'j 9(� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ' � Subtotal:
Plan review (25% permit fee):
Print name: Date: // II L State surcharge (12% of permit fee):
Ar
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: /L,/ ( Date: 7/?/� i days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11 /05 /COM/WEB
• . . t
/Jew d A..)..s772ti.e__774 tu
I Building Division
a
Development Code Provision Review
T I G A R D Residential Projects
Building Permit No: 1 ` 5T a d 19-- 009,0g /�
CWS Service Provider Letter Received: Yes ❑ No N/A ❑ f / z0 [.w
Pa L4 io( Cc
Routed Plans: p
Original Plan Submittal Date: b to 19--
1st Revision Submittal Date: . EV ❑ Site Plan Only
2nd 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 approved.
Planning Review (contact (111 614 ( CQ a e J at 503 -718- o7 137 or C.-key /C- @tigard - or.gov)
Land Use Case No. MP 1' i - 000 8 Name
04 Zoning R - ei . 5
V Setbacks:
Front .20 Rear IS Side S Street Side 15 Garage as
af Maximum Building Height 30 Actual Building Height a
p i Visual Clearance
p Easements
9 a Sensitive Lands Type:
Notes: The new c i f ' . l vii ( I r 9,L4 i .- r`
e- 1-e n ova I 0-C a1 )eaJ4 on e .
v` -f'1,_ - y- f 5 4..'1 f 5-1-►-r-_ i - i"/`t,C.s . ! 1i .se -f-1 e es we re ✓e et , -c 8 aS Par -i-
e( rylinur )ard par f -,'-h' 01 1H9 LP q /- 0005. e at , p/; ca 0 * te edj
u JG re layarnen oil l Ort • VJarlL 1 . 0 ' r
Original Plan: Approved ❑ Not Approved yi Date: 8 - /3 -- /a 4 spz ei c J G n d
Revision 1: Approved Er Not Approved ❑ Date: V il//- rive to cAci 5'
Revision 2: Approved ❑ Not Approved ❑ Date: /+�0/
Engineering Review (contact Mike White at 503 -718 -2464 or MikeW @tigard - or.gov)
,0" Actual Slope: t 0 % �/ �'
Notes: EsCIb7"h. -- S S, Gv 0 - S (9-4.) V4 �`) I '7 “ ie G✓ 1 e-c- ax.
cx,1QNi b
Original Plan: Approved ❑ Not Approved Date: , 3)(
Revision 1: Approved Not Approved ❑ Date: O if 2-
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
A
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd@tigard- or.gov)
Street Trees
Protected Trees J I
Notes: &r•: rtl„c1� rt n.it"..)-1. ,- f ,e STrf 1 1pf) 1 L c r4�- c,,(u,,4 10.
Original Plan: Approved —❑ Not Approved ' Date: 5 - /y -1J
Revision 1: Approved E Ii Not Approved ❑ Date: ) - /6.1 yiltkif, pl. ziNy repirt
rib(
Revision 2: Approved ❑ Not Approved ❑ Date: I F Fsh. I 010.4-4
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: Yes No i% 0 6
Date Routed to Building: ; , r
Page 2 of 2
D � AUG l e L \N � � Clean Water Services File Number
1
LL ,
� 0 62012 CleanWater Services
I Iz -00V63
ensitive Area Pre - Screening Site Assessment RtCEIVED
By .— I I C -re-�
fi`.turleclfc�i .,�.....:::_. _,r,,, -.
` 1 4 Z012
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Elena Panutich ,.V OFTIGARD
1S125DA10400 Company: - niVISION
Address: 9520 NW Caxton Lane
Site Address: 9425 SW 70th ave City, State, Zip: Portland OR 97229
City, State, Zip: Tigard OR 97223 Phone /Fax: 503 - 292 -1568 j
Nearest Cross Street: Taylor ferry E -Mail: epanutich @yahoo.com 1
4. Development Activity (check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence (rooms, deck, garage) Name: Elena Panutich
❑ Lot Line Adjustment ❑ Minor Land Partition Company:
❑ Residential Condominium ❑ Commercial Condominium Address:
❑ Residential Subdivision ❑ Commercial Subdivision
❑ Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip:
Other Phone/Fax: 503 - 292 -1568/ 360- 695 -1503
Demolishing the old house and building the new one E -Mail: epanutich @yahoo.com
6. Will the project involve any off -site work? ❑ Yes No ❑ Unknown
Location and description of off -site work
7. Additional comments or information that may be needed to understand your project
This application does NOT replace 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 contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate.
Print/Type Name Elena Panutich Print/Type Title
ONLINE SUBMITTAL Date 8/6/2012
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 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 i
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 1
approvals must be obtained and completed under applicable local, State, and federal law.
al 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 OR
SERVICE PROVIDER LETTER IS REQUI"ED. /
Reviewed by �Ar _ 41,A A / Date !S / 1 3 / ' z
A.
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • www.cleanwaterservices.org
/
•••••• Ilmv•10 m•o■r....,owisagvatt■—. -■.., .....:11,
-tli CONCRE TE D RI VEW 0 iii 7 (anti o ,/, ill
_....i i
i I i - - - T
fut.-- --
a - -.4 --- 4 AI ___• "IL ____ ____ _... ..._ ..:, ._ _____..._ __. _ ,/,. ,.., _ _ _
/ 1 _
...] __. _._ _ ._ r ____ .__. —
Ow 7: ...;____._
_________..„_____
....,
l i l ir,
4. . [ 1 ,,,
o
■14-_ J)
t -_--
| | -- -- -- -- -- `---- -'
-. __ ��_ _ i - — - - — - -. — — — — _ ._ ._ _
--�� __ /
_ __ _ _ _ _ _�-
I - -_ _ __ __ -- --
" /� / - - - — — — - - - - - - - - - - - - — - | �
---------_ - | -- -----�
I I - - - - - - - - _ _
—_—_______ II ------- ----- -�__
----- ------- k
-- _ ---_L ��_
~�= ._ /��o
|�� .. ' - � - - - - -- ------ |
1 1 11111 ---- F �--
I I -- -- -- ---- -- -- --
. ------- ---------__ _ ' ___ -
� | ------- -----__ j| _ A
= | - --
A�� �
�� .
|
/
r_ |
1 n\
/ | t:
~ T| | i
" �� ` . ) �
v �� o
�-- --- --- -'-- � | �
� 'C.-6-. / . I
__ --_� ---. �
�
-- - j
-
�
� �
|
L \
) '��'z/' ^r».� i
, /�l-�j '
i --- ' - /
4) _ __ `_ ___~___ __ -- ___-__ -_ __ _ -____
_-_ _ _- _
�/�� �8 ��.� ^� . - /1/l� ��
~ '-^ . "-' -7� � «��x� /Y�' ��r^'c_-
�� v / /
i' = /
\ I j
^. '' \`'
� �~
0 N� » / /
" T. •
�~ ` /
- n.L ` , . .
�i�- ' - --- /I -~a
' �
"' -^ �� `-
���- `.
^�
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
9425 SW 70TH AVE, TIGARD, OR, 97223
Residential - Master Permit
699 Mechanical final
04/22/2013 00:00
MST2012-00208
PASS
Violation Summary:
Inspector Contractor
9q �5 5w
. a ,
STREET TREE
TIGARD CERTIFICATION
I,
5.ep /7-eV�f- , owner/ agent for
(PLEASE PRINT) (PERMIT HOLDER)
do hereby certifi that the following location meets
City of Tigard land use and development standards
for street tree installation and is consistent
with the approved site plan.
PERMIT NO.: D( S5 26 /? — 442 U2
HIE ADDRESS: 9 Y 2
SUBDIVISION: LOT #:
SIGNATURE: j ,� DA1 E: 01/ / 3
jer. , NT)
RE CEIVED
VERIFIED BY DALE: 0,0J-43
(f • • GARD)
❑ Tree location ven: ed per app oved site plan.
1: \ Building \ Forms \StreetTreeCertifcate 05/30/2012
Oregon Residential Specialty Code 8318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, gg � �''°` t , am the general contractor or the owner- builder
l
at the following address:
Site Address: 9 v ,'
City: �� jaa/
Permit #: S 20 /2 — <' -ej
Subdivision/Lot #:
and/or
Map and Tax Lot #:
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture- sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: el
= Date:
General ,.f l `tor or Own- - • der
IABuilding\Form\RES- MoistureSensitiveWood.doc 09/25/08
Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: kf 2/ 2 _ 1210 262-1 7 Jurisdiction: C; / p ,
Site Address: 9 S aVe
Subdivision/Lot #:
and/or
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: i ro" Date: ' i / 3
Own a trac : /Authorized Agent
Print Name:
ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
I:\ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08