Permit r n CITY OF TIGARD MASTER PERMIT
"-!
° ...‘ COMMUNITY DEVELOPMENT Permit#: MST2013-00253
T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/07/2014
Parcel: 25111 BCO2700
Jurisdiction: Tigard
Site address: 10380 SW CANTERBURY LN
Subdivision: TIGARDVILLE HEIGHTS Lot: 5
Project: Miller
Project Description: 650 sq ft addition, (2)bedrooms and(1)bath. Sewer connection and french drain to be done
under separate permit.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 2 First: 650 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 650 sf Value: $69,602.00 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 1 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: 1 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 1 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 addl 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 5
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:
ADD SF VB R-3 650
Owner: Contractor:
MILLER,PAUL&JUDITH LIVING TRU NEIL KELLY CO INC Required Items and Reports(Conditions)
10380 SW CANTERBURY LN 804 N ALBERTA ST 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97224 PORTLAND,OR 97217
PHONE: 503-684-8513 PHONE: 503-335-9240
FAX:
Total Fees: $2,827.65
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. ENTIO . •regon law requires you to follow the rules adopted by the Oregon Utility Notificatio� Center. Those rules are set forth in OAR
952- 1-0010 through 0'' 9 :11-01'0. You may obtain a copy of the rules or direct questions to OUNC-by--- ng•5 I 232.1987 or 1.800.3. .2344.
Iss ed By: i• ! _.140C//L �1�/ ~/ Permittee Signature: / Pr,`l.��( ,�9---'
Call 503.639.4175 by 7:00 a.m.for the next a4ijable inspectio .
This permit card shall be kept in a conspicuous place on the job site until com. , ion of the project.
Approved plans are required on the job site at the time of eac- inspection.
Building Permit Applic
Residential FOR OFFICE 1.SE ONLY
City of Tigard Recc,,vd DateB•: /A I Penmt No.•il-/ 7,90.3'68 425-3 \
13125 SW Hall Blvd.,Tigard,OR Pig 17 2013 Plan Retiiebv" t
: Z • Phone: 503.718.2439 Fax: 503.598.1960 Date/By. I, ' 1 .� Ir.her Penna.
T I G A R D Inspection Line: 503.639.4175 CITY ,OF TIG/ARDA Date Ready/By: / hui+. 0 See Page 2 for
Internet: �tww.tigard-or.gov BUILDING DIVISION ISIOt`O Method: � / Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*arc 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-family dwelling ❑Commercial/industrial Valuation: ,j 62, $
❑Accessory building El Multi-family
Number of.edrooms: 2
❑Master builder ❑Other: Number of bathrooms: 1
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address:10380 SW Canterbury Ln New dwelling area: 650 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Miller Residence Covered porch area: square feet
Cross street/directions to job site:103rd St and Canterbury Ln Deck area square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all .
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
650 sq It addition for 2 bedrooms and 1 bath Valuation: S
Existing building area: square feet
New building area: square feel
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name:Paul and Judy Miller Type of construction:
Address:10380 SW Canterbury Ln Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:(503)684-8513 Fax:("-'----'----, New:
❑ APPLICANT CONTACT PERSON BUILDING PERMIT FEES*
Business name:Neil Kelly Company /1 A 1• (A� H6-1,1•71-6119-01-4-11-4 review fee r deposit):
Contact name:Dan Moore /"� _ /_ Structural plan ret7ew tee(or deposit):
v 3 - 5/5 eoLf i S FLS plan review fee(if applicable):
Address:804 N Alberta St
Total fees due upon application:
City//State/ZIP:Portland,OR 97217
Amount received: -#3 50 •9 p p Phone:(503)335-92405 Fax::(503)288-7461
o
E-mail:danm/arteill:elly.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Neil Kelly Cornptnn (1J f.. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:804 N Alberta St Solar Installation Specialty Code checklist.
CitylState'Z_IP:Portland,OR 97217 Permit Fee(includes plan review $180 00
and administrative fees):
Phone:(503)335-9240 Fax:(503)288-7461
/� State surcharge(12%of permit fee). $21.60
CCB lie.:1663 IA Z Total fee due upon application: $201.60
Authorized signature: ' This permit application expires if a permit is not obtained
within 180 days after It has been accepted as complete.
IPrint name I Date: 1 -/!a,// 1 `Fee methodology set by fri-County Building industry
Plumbing Permit Application RECEIVED .
g DE D ,7 ky 'Building Fixtures t l zI ul r i ri5r u�l�fi x y r a
1 7 2013 a mil" .. � ..� - , ,:a .,.....:,�_ .�.,.,. a,..< „r_t. � .._S.._
isr,N3T14,!, City of Tigard Received Permit No.; d0�
g I�OF TIGARD plan i"'l 7 /3 l,-/r��3- s3
13125 S W Hall Blvd.,Tigard,OR 97
"5 111.44 Phone; 503.718.2439 Fax: 503.59 DING DIVISION her Permit No.:
� Aaz�Y-
TI BC n h�i Inspection Line: 503.639.4175 O 1�R08dy/By 1 runs: HI See Page 2 for
:'=_,a:=[_,_ Internet: www.tigard-or.gov Notified/Method: Supplementallniorwutou
�PUd m r r".. ,.:. i.+:h4ii, gii;V,W l... , tactic'ity:.,;g4n: "a:.t ,:ra.ii,.::m:is "v+'
slt_pb fr o tl}1�+?F'�P•n... AJ ig-igi, °L9(.,°:-'.heir°.si :1.0.,,r:*,:s 2.'`2:%. I',. 14-Re., pyI ,�yl'Qr al ;n yr,:r1:4 r".:∎:
•L ,. ��Ry rr b ..;;K - •i:ik. .♦fill 'C4b.h:.1,.i...invs.d/ 3',Z;., ...e...,4, ._:'!S.:.1.,rt r 1, •• -... -. ..:K..R.J.:y:i{.SA'i'�.:5,+,
F1r�.Fi:7�,.'4'H`!:7V7[.t: �i:rt!��-.�•.:-. ��..:I,�lf�}•I r::°tii�"•di'•ddrag Lt:+•nweo:°a�•+ISrr:dl. ::A'L::iS;::•.�1 n`u,.1.1P:�Srd:«_:o,e:mm...ta•n.,t.r�.•,.., .:.u,..r. ..S:.¢p:inj•.an.a.+o,»;,n�.A.:.,..
❑New conSttuction ❑Demolition For spedal Information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
a. -x w: `-�! �. .- .,i.,--TM::... .-, . SFR 1 bath I 312.70•'IF• a%r: 4°1 t# n,4V '�+ N"ft"���,: i
ti -x... ,sC $9'4 FF, m-..., Ity: f.:81 Y n%;g...`j G N{ O 'i' +i' ,r,,A . 1:ilf ( )
7 S't..,. °t•RI�^tCH•-.: ;_.':.ti,.^ . ..a4 Ri0r vt��-�,..Y' •'.: ._.. - .��i�v�°�'qt%a� +. ^` °•:?r.
®1-and 2-family dwelling ❑Cor»mercialfindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building ❑Multi-family •
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) 1 Page 2
°ui�:k:S dNa!•L•�. e :°, i• �1 Ilq'^' :' L"l:o��m}�i��;.'•ir a�<ai;i.Ji';y:"'r -
_ of �� a ..-.."lei__ K '• ...-vi :__._ .,____ Site ublitiear
.-,-♦�2.u��:ewo:�•�l '�'f�i�?__,Y!'♦.p��t_N „�s vet � L':♦:_ �-'c4,! :.��;i�ttf: -
Job site address:10380 SW Canterbury Ln
Catch basin or area drain 18.76
-- • Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no,linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Miller Residence Manufacnaed home utilities 50.03
Cross street/directions to job site: 103Rd St and Canterbury Ln Manholes r . 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.: ) 1 Page 2
Subdivision: 1 LOt no.: Fixture or item:
Tax map/parcel no.: • _Backflow preventer 31.27
rY.r•ffi gt g il 1 P r'u - r-•r u, >: `r bk g KK ,,, tCy,t1rYe4:rit,%:, ,N,:,p
Backwater valve 12.51
l $ i i? , rnv 1 nTat w-v,,o,/j,;sa . .
Clothes washer 25,02
650 sq ft addition for 2 bedrooms and 1 bath Dishwasher 25.02
Drinkingfbuntain 25.02
Ejectors/sump 25.02
`''11; '�'''''.1.
-� i g i=3T•:.:r:,�aljfg'";r 4.I• 't °6`I$n Q,- VE mati; ii Pfpa05iontank 12.51
Name:Paul and Judy Miller Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:10380 SW Canterbury Ln
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:(503)684-8513 Fax:( ) Ice maker 12.51
•n.. '�'�i.-p {� ^., �.' iu,.r."u,..a 1. knl 8'.!:816"•_K.. ". •n yr. •.+i".,,• a� InterC tor/ cease trap
1 02
i^°' �iY?sP qto ts��,• :tE;'a!:k H ir�, ,c i "N:.�E3YI6 ,t. a'i c.,• ,,e.,�,inc`0•;A eP g _aP 25-
GN1FL.P..gf Aft;; • --`t'Jl.L. l.:a:3'i-•ire--• _'?. di, v .• X.+•.,r+,,. ', a,C..-
Business name:Neil Kelly Company Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Dan Moore -
Roof drain(commercial) 12.51,
Address:804 N Alberta St Sink/basin/lavatory T I 25.02
City/State/ZIP:Portland,OR 97217 Solar units(potable water) ( 6254
Phone:(503)335-9240 L Fax::(503)2884461 Tub/shower/shower pan / 12.51
E-mail:danta@nellkely.com Urinal 25.02
-,y .y,yoo, Az • q- e, kix;?l T' as:X r=f,..:e,,/•,n, Pe,4. ;.y Water closet 25,02
io�nr, -Xy�'�. cF'2 •1k,tl•:�-Cx mp ,- �;nw.raa:.ThirV'.r�•/iTil l I.+
Gt „261aR�..Mir 51'''.t1 J tr+9 •,,.:r inn t assn.;a/v'� !Ly'�i U-i,=tE`i,.; 'e� .........; Water heater 37.52
Business name:Bruner Plumbing water piping/DWV a 56.29
Address: FO .f?0 K 7,3 i g . Other 25.02
City/State/ZIP: t , o . 0 c 7251 Subtotal
Phone:(Sb3)I,z 4_4 g'0 Fax:(9 S)�j 214 -217 3 Minimum permit fee: 572.50
r-
CCB Lie.: �� A ,,7 Plumbing Lic.no.:2.(q- 1'}4se� Plan review (25%ofpermit fee)
VAC )/\ ( t^^!Y` L. State surcharge TOTAL of fee)
Authorized signature; J`4 ti1 TOTAL PBRM17 FEE
Print name: YA/ki rt,(vl I Date:/2-4. -j,3 This permit application expires it a permit is trot obtained`vithin 180 days
after it has been accepted as complete
*Fee methodology set by Tri-County Building Industry Service Hoard.
11Baildieg1Peenite\PLMU-PermitApp.doc 10/01/09 440.4516T(10102/COM/wPB)
Mechanical Permit Application. FOR OFFICE USE ONLY
City of Tigard ' covEt Received
��: D Permit No.:13125 SW Hall Blvd.,Tigard,OR ,i'. Date/By:
f'. ���/ ��, —�..g 5-3
.1,1 .0 *:.I'3. Plan Review
Phone: 503.718.2439 Fax: 503.5 r Date/By: Other Permit:
Ti GA R D Inspection Line: 503.639.4175 DEC 17 2013 Date Ready/By: Jura: 0 See Page 2 for •
Internet: www.tlgard-or.gov Notified/Method: Supplemental Information
CITY OF TIIGrARDp COMMERCIAL FEE* SCHEDULE USE CHECKLIST
TYPE OSI�1 t 4G DIVISION
vtt.,u 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*
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 10380 SW Canterbury Ln _Furnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Miller Residence Duct work y 23.32
Cross street/directions to job site: 103`d St and Canterbury Ln 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32 •
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
650 sq ft addition with 2 bedrooms and 1 bath.New furnace system and trunklines fireplace 23.32
to addition. Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Paul and Judy Miller Range hood/other kitchen
equipment 33.39
Address: 10380 SW Canterbury Ln Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) I 23.32
Phone:(503)684-8513 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 •
Fuel piping:
Business name:Neil Kelly Company
$14.15 for first four;$4.03 for each additional
Contact name: Dan Moore Furnace,etc.
Address:804 N.Alberta St
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Portland,OR 97217 Water heater
Phone:(503)335-9240 Fax: :(503)288-7461 ' Fireplace
Range
E-mail:danm @neilkelly.com Barbecue
CONTRACTOR Clothes dryer(gas)
•
Business name:Sunset Heating and Cooling Other:
,1 a MECHANICAL PERMIT FEES*
Address: ()i,j(1 J-( J ' txGL6' :5'1
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
i Plan review(25%of permit fee)
Phone:663) 2_3 it_OW Fax:(56-..i 234—,OLt: State surcharge(12%of permit fee)
CCB lic.: I Its d b TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: - f * Fee methodology set by Tri-County Building Industry Service Board
Print name: CA vul,LA Date:/nib 11
L\Building\Permits\MEC_Permit App_040!13.doc 440-4617T(I I/02/COM/W EB)
Electrical Permit A I licati I If
ECEflIE FoR OFFICE. USE ONLY
Rcceh.cd
Ipli City of Tigard [ Date By: /�? /7 /3 Permit Nn. Ste,/3-c� a—S�
i•• 13125 SW I tall Blvd..Tigard.OR 9722 C C 1 2013 Plan Review
Phone: 503.718.2439 Fax: 503.508.1960 Date n Oilier Permit
v.
'tGARD Inspection I,.ine: 503.6324175 GI�®FTIGARD Date Ready Ii). Jun. El See Page 2 for
Internet: www.tigard-or.gov B la���� �aer�sio Noulied,Method: Supplemental Information
TYPE OF WORK Il 1 PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans%%litmus 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 of ❑Floating buildings.
less to ground.or exceeds 14.000 ❑Commercial-use agricultural
® I-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Ldti o on system. larger sepamtely 3'. system
❑Addition of new motor load of ❑"A"•"G","I-_ , I ?
Job no.: l Job site address: 10380 SW Canterbury Ln 10011P or more. occupancy
❑Six or more residential units. ❑Recreational%chicle parks.
City/Stale/71P:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage tin mute titan
❑Hazardous locations. 600 volts nominal.
Suite/hldg./apt. no.: Project name: Miller Residence ❑Service or feeder 600 amps or more.
' FEE SCHEDULE
Cross street/directions to joh site: 103rd St and Canterbury Ln Description I Qt . I Fee. I Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq.(1 or less 168 54 4
Ea.add'I 500 sq.II.or portion 33.92 1
Tax map/parcel no.: '
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq It.)
Limited energy.multi-family
75.00 '
650 sf addition for 2 bedrooms and bath residential(with above sq.It.) -
Renewable Energy _ ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
* PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Paul and Judy Miller 401 amps to 600 amps 200.34 2
Address: 10380 SW Canterbury Ln 601 amps to 1.000 amps 301.04 2
Over 1,01)0 amps or volts 552.26 2
City/State/ZIP:Tigard,OR 97224 Temporary services or feeders installation,alteration,and/or
Phone:(503)684-8513 Fax:( ) relocation
200 amps or less 59.36
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
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: Neil Kelly Company each branch circuit 7'42 2
B.Fee for branch circuits wnhonr
Contact name: Dan Moore service or feeder fee,first I 56 I8 56 18
branch circuit
Address:804 N Alberta St Each add'l branch circuit 4 7.42 29.68 2
City/State//.II': Portland,OR 97217
Miscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
Phone:(503)335-9240 Fax: :(503)288-7461 dwelling•service and/or feeder
Reconnect only 67.84 2
E-mail:danm@neilkelly.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
I3usincss name: Reds Electric Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:6336 SE 107th Each additional inspection over allowable in any of the above
• Additional inspection(I hr min) 66.25/hr
City/State/71P: Portland OR 97266 Investigation(I hr min) 66.25/hr
Phone:(503)233-6467 Fax:(503-)233-1281 Industrial plant(I hr min) 78.18 hr
Inspections for which no fee is 90 q0/hr
CCB Lie.: 4443 Electrical Lie.: 26-I52c Suprv. Lie.: 50105 specificallylisted('i=hrmin)
. ELECTRICAL PERMIT FEES
Suprv. Electrician signature.required: Subtotal: 85.86
Print name: Jim Ferris Date: 12-9-13 Plan review(25%of permit fee): 21.47
State surcharge(12%of permit fee): 10.3
Authorized signature: TOTAL PERMIT FEE: 117.64
Print name: Dale: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I Building Permit.fl f Permit App Fl R FRt doe Res 05.21,2611 34o-46151111.05('MLwt:B
Building Division
Development Code Provision Review
T I G A D Residential Projects
Building Permit No.: �2Tp�UI - 0S 3
Project/Subdivision Name: X i L L-f 2 , Lot #:
Site Address: 103$0 6tw
CWS Service Provider Letter:
Required:Yes la No ❑
Received:Yes Fr-- No ❑
Plans Routed:
Original Plan Submittal Date: /0,/7 7/5 Routed B.: ; _
1St Revision Submittal Date: i A/i 9//3 ❑ Site Plan Only Routed By: _ -
2nd Revision Submittal Date: ❑ Site Plan Only Routed By:
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 ° el at(503) 718- or @tigard-
or.gov) /11/A
Land Use Case No.
Zoning
❑ Setbacks:
Front o ) Rear f Side Street Side Garage "v
❑ Maximum Building Height: c 0 Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitive Lands Type:
❑ Street Trees
❑ Protected Trees - cir7) -
Notes: ./�/' V' _ -/- •! >..;� =� �:LC�!�./%' ,► �'" i' .d
_
Original Plan: Approved Not Approved ❑ Date:
Revision 1: Approved1 Not Approved ❑ Date: 12--19`/3 CO4
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13
Engineering Review(contact Mike White at 503-718-2464 or MikeW @tigard-or.gov)
❑ Actual Slope: .5 % •
Notes: S>r _1 eCrr O
116 Sc ' p S is N g >r�
Original Plan: Approved ❑ Not Approved ® Date: 12- -11-13
Revision 1: Approved ply Not Approved ❑ Date: /2/1 /3
Revision 2: Approved 0 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 Applicant
Okay to Issue Permit: Yes � o •
Date Routed to Building:
110"/
Page 2 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13
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.it.ECEIVEP
Miller Residence DEC 1 2013
10380 SW Canterbury Ln CITY OF TIGARD
BUILDING DIVISION
Tigard, OR 97224
Residential Addition
• Decommission septic tank and connect to city sewer line (under separate plumbing permit)
• Remove and replace existing concrete patio in backyard
• Add approx. 650 sf addition to rear of home for 2 bedrooms, 1 bathroom.
• Slab on grade foundation,other materials to blend with existing; hardi siding with cedar in
gable, comp roof.
• Replace gas furnace, relocate and reuse existing heat pump.
• Add attic insulation to existing home .
RECEIVED
DEC 1 7-20-13
CITY OF TIGARD
BUILDING DIVISION
7/ Clean Water Services File Number
CleanWater Services
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction:Washington County o
2. Property Information(example 1S234A1301400) 3. Owner Information (h t 1��tr
Tax lot ID(s): Name: 4)&14 f:4 4.4,4 11
Company:
Address: 10380 M) C4 e\fCr(O4c nM Lrt
site Address: 0 SOO S u) Car e r 10 u v y L n City.State,Zip: -Ti�t t�r'v4, Dia 17 a:f-
City.State,Zip: "I'I�J a.rot_ ow. (17 2T�•- Phone/Fax: 503• bF34• $S i 3
Nearest Cross Street l o' ref gal— e-Mau: deiAt. m 11(e,-17()Connc a of•net
4. Development Activity(check all that apply) 5. Applicant Information
Addition to Single Family Residence(rooms,deck.garage) Name: rkti1 j OOf1.
❑ Lot Line Adjustment Q Minor Land Partition Company: 1.-1.B.:1 s Cosv:pam vy
Q Residential Condominium Q Commercial Condominium Address: 4?Y)4 r& > 117e%Tilt. S
C Residential Subdivision Q Commercial Subdivision
Q Single Lot Commercial 0 Mufti Lot Commercial city,state,Zip: Qof 1 tA,v�d. BIZ ]7 Zj�7
Other
Phone/Fax: 503 • 335 • q7.41-p
E-Man: da n tY ( ilea i 14 a lls4 • La nn
6. Will the project Involve any offsite work? Q Yes pi No Q Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
(4S0 gQ Fr t'ci 1, 2 1A-.O -WP& , 1 g 44
This application does NOT replace Grading and Erosion Control Permits.Connection Permits,Building Permits,Site Development Permits.DEG
1200-C Permit or other permits as issued by the Deparmnent of Environmental Quality,Department of State Lands snd/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 at Owners authorized agent or representative.admowledges and agues that employees of Clean vttater Services have authority
to enter the project site at all reasonable tunes for the purpose of inspecting project site conditions and gathering information related to the project site. I certify
that tam familiar with the infonnaoon contained in this document.and to the best of my tinowledge and Wel.this information is true.complete.and accurate.
Printflype Name A/ Ao0- Print/TypeTitle P1 CJC -T/Ll4-4)4-6
Signature ! Date /1--//6//3
FOR DISTRICT USE ONLY
❑ Sensitive areas potentialy 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 Whin 200 feel on adjacent properties,a Natural Resources Assernment Report
may also be required.
Q 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-Saeening Site Assessment does NOT eliminate the need to evaluate and protect 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.AB required permits and
approvals must be obtained and competed under applicable local.Stab,and federal law.
❑ Based on review of the submitted materials and best available information the above referenced project MD not significantly impact the existing or potentially
sensitive areas)found near the site.This SensitiveArea Pre.Saeencing SiteAssessment does NOT eferinate the need to evaluate and protect additional water
quality sensitive areas if they are subsequedly discovered.This doarmen!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 taw.
❑ThIs Service Provider tatter Is not valid unless CWS approved site plan(s)ate attached. •
❑The proposed activity does not meet the definition of development or the lot was platted after 919195 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by Date
•
e7123'.
2550;SW'HiJlsbao:Mlgfrwmrrki. Fftisboro;',Oregon '^Phoner-A503)'681-5100S� Fax::(503)681=4439s* www. i4
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10380 SW CANTERBURY LN, TIGARD, OR,
97224
Residential - Master Permit
199 Electrical final
PASS
May 29, 2014 at 9:03:26 AM
MST2013-00253
Jeff Grove
Violation Summary:
Inspector Contractor