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Permit III CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2014-00099 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/17/2014 T[t'"`1 p D g Parcel: 1 S134DC04800 Jurisdiction: Tigard Site address: 11370 SW TIGARD ST Subdivision: MUTTLEY'S ADDITION Lot: 1 Project: MICHIELS Project Description: 1,020 sq.ft.addition and kitchen remodel.Addition to include master bedroom, master bath, laundry room, utility/mechanical room and family/aviary room. BUILDING Floor Areas Reauired Setbacks Required Stories: 1 Bedrooms: 1 First: 1020 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: 1020 sf Value: $115,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 2 Laundry Trays: 2 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker 1 Hose Bib: 1 Backwater Value: 0 Drywall-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 2 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 15 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. Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-2 1020 Owner: Contractor: MICHIELS,TRACY L CARBON DOVETAIL LLC Required Items and Reports(Conditions) 11370 SW TIGARD ST 8300 SW FAIRWAY 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 PORTLAND,OR 97225 PHONE: PHONE: 503-887-9711 FAX: Total Fees: $4,811.78 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 ru-s are set forth in OAR 952-001-0010 throu•h OAR 952-001-0090. You I- •_ _It___•• of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 AO '. Issued By " - __� Permittee Signature: . ,ei Agrillffir /, 1P- 0111.411ri, .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 of the project. / Approved plans are required on the job site at the time of each inspection. .1 1 ', Building Permit Application Residential I (112 ()III( I I ,I O\11 City of Tigard J 1� Received Permit No.:111111 `J 1�t Date/B : , :.. .4.%, t —,l I,.,s 13125 SW Hall Blvd.,Tigard,OR 97 3 cdcfr,,,\ ,�\v �-� Plan Rev�e��.,'. � a Phone: 503.718.2439 Fax: 503.598. 60 \t v DatelB . '=, Ti G.1 h D Inspection Line: 503.639.4175 C��► Date Rea. .. ® See Page 2 for Internet: www.tigard-or.gov ,{� It \ d\O Notified/method: ./ Supplemental Information CM``` r� TYPE OF WOJ S 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-fanlily dwelling ❑Commercial/industrial Valuation: $ It15 6, ❑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: 11370 SW Tigard Street New dwelling area: I Oa 0 square feet City/State/ZIP:Tigard,OR 97223 � Garage/carport area: \ square feet 1� Suite/bldg./apt.no.: Project name: j l 1 C (4 i i-1-5 Covered porch area: N. square feet Cross street/directions to job site:Cross street: SW 113th Place Deck area: 1 C square feet On corner of SW 113th Place and SW Tigard Street.Park and enter property Other structure area: square feet on SW 113th Place. REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Muttley's Addition Lot no.: 1 Permit fees*are based on the value of the work performed. Tax map/parcel no.: 1 S134DC04800 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. Small kitchen remodel including removal of exterior door. Valuation: $ Approximately 24'by 43'addition that includes new master bedroom,master bath, Existing building area: square feet laundry room,utility/mechanical room,and family/aviary room. New building area: square feet ® PROPERTY OWNER I ❑ TENANT Number of stories: Name:Tracy Michiels Type of construction: Address: 11370 SW Tigard Street Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:(920)370-0191 Fax:( ) New: ❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* — Business name:Carbon Dovetail LLC (�fears►r�►mheaeN Structural plan review fee(or deposit): Contact name:Todd Stewart - - FLS plan review fee(if applicable): Address:8300 SW Fairway 763 Total fees due upon application: 477 7 City/State/ZIP: Portland,Oregon 97225 Phone:(503)887-9711 Fax::( ) Amount received: E-mail:admin*CarbonDovetaiLcom PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name:Carbon Dovetail LLC Submit two(2)sets of roof plan with connection details 1 and fire department access,along with the 2010 Oregon Address:8300 SW Fairway Solar Installation Specialty Code checklist. Permit Fee(includes plan review City/State/ZIP:Portland,Oregon 97225 $180.00 and administrative fees): Phone:(503)887-9711 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.:203029 .;//q f/4' 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. Date: /� �J "ill *Fee methodology set by Tri-County Building Industry Print name p g 5 6( Aac 2.0 Service Board. •Sb3-`f`1-4-gao i , f 1' • t Building Permit Application Checklist One- and Two-Family Dwelling i oil oil-1(T I SE ON1.1 City of Tigard Received Date/By: Permit"O • 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: I Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical TIGARD Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR 1'1. \\ REVIEW \es No •,,A I 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 ❑ ❑ ❑ 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 ..r licable to the uro'ect under review. .11 RISDICTIONAL 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"buildingplans 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 ❑ ❑ ❑ 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 on a lot of record approved prior to September 9, 1995. I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) r .• l'lumbing Permit Application Building Fixtures 1 (lli Ui I Il I I ',I 1)\,1 City of Tigard Received permitNo.: cr ea . R DateBy: list Ot i i c'od e 1 13125 SW Hall Blvd.,Tigard, ''. ` Plan Review 114 �r (k • Phone: 503.718.2439 Fax: 5,� Y� 1 • ` 1) Date/By: Other Permit No.: Inspection Line: 503.639.4175 J Date Rea /B lam ® See Pa e 2 for I Ili ARI1 �� M y S Internet: www.tigard-or.gov ( Notified/Method: Supplemental Information TYPE OF WORK a• ,, FEE* SCHEDULE ❑New construction ❑ WiA�rft ' For special information use checklist ��` Description Qty. I Ea. I Total ®Addition/alteration/replacement ❑ 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 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: 11370 SW Tigard Street Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: l Project name: Manufactured home utilities 50.03 Cross street/directions to job site:Cross street: SW 113th Place 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:Muttley's Addition I Lot no.: 1 Fixture or item: Tax map/parcel no.: 1 S134DC04800 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer _ 2....., 25.02 Small kitchen remodel including removal of exterior door. Dishwasher 25.02 Approximately 24'by 43'addition that includes new master bedroom,master bath, Drinking fountain 25.02 laundry room,utility/mechanical room,and family/aviary room. Ejectors/sump 25.02 0 PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51 Name:Tracy Michiels Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 11370 SW Tigard Street P Garbage disposal 1 25.02 City/State/ZIP:Tigard,OR 97223 Hose bib 25.02 Phone:(320)370-0191 Fax:( ) Ice maker _ 12.51 ❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Carbon Dovetail LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Todd Stewart Roof drain(commercial) , 12.51 Address:8300 SW Fairway Sink/basin/lavatory (,/ /2. •" 25.02 City/State/ZIP: Portland,Oregon 97225 Solar units(potable water)"""fff 62.54 Phone:(503)887-9711 Fax: :( ) Tub/shower/shower pan .14...- 12.51 E-mail:admin @CarbonDovetail.com Urinal 25.02 Water closet ' 25.02 CONTRACTOR Water heater 37.52 Business name: (3 1„ r i .-(. A��b �` p, j�F`°`+�" 1 J Water piping/DWV 56.29 Address: r(23C 5 , 7 ,(�,,..e Other: 25.02 City/State/ZIP: vv,J aR qH,��4 Subtotal °I ? Minimum permit fee: $72.50 Phone:c*2 ) 'l , d':Ql ax:( ) CCB Lice.:: ( � �I31 1 Plumbing Lic.no.: pQ `(Q 7/1/)-7 Plan review (25%of permit fee) I'/ State surcharge(12%of permit fee) Authorized signature. / TOTAL PERMIT FEE Print name:, ,, t,�,.. - E G/ Datt� .Dt+ This permit application expires if a permit is not obtained within 180 days f �.' ^I7 CJt+r after it has been accepted as complete. SOA _ "Fee methodology set by Tri-County Building Industry Service Board. 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: Other Fixtures: 1 1 Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantity by Fixture Type Fixture Type for Replace/ Plan Review for Plumbing Installations Work Performed: Capped Added Relocate Baptistry/Font Plan review is required for any of the following. Bath -Tub/Shower Please check all that apply. -Jacuzzi/Whirlpool El Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain ❑ Any multipurpose fire sprinkler system. Eye Wash ❑ Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3" Submit 2 sets of plans with any of the above. -4" Car Wash Drain Isometric or Riser Diagram Garbage -Domestic-non-food Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-Clothes Water Extractor *Note: If the fixture work under this permit results in an Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the C:\Users\Ross\Documents\Chief Architect X6 olans\Tracv Mitchels(Bird1adv Tieardl\USING\Permits and maooina\PLMF-PermitAon filled • '• • • a Mechanical Permit Application c. FOR OFFICE USE ONLY City of Tigard Datee/Bey Permit No.: (VAS i 13125 SW Hall Blvd.,Tigard,OR Review Plan rilli n 718 24 Fax: 503.5 Other Permit: Phone: 503 39 F illirckr\*II p��By. T I G AR 1 Inspection Line: 503.639.4175 `` % �,Q14 Date Ready/By: ions. SS See Page 2 for Internet: www.tigard-or.gov \ N vi, Notified/Method: Supplemental Information �v�l 1 TYPE OF WOI Ct 3�t1• COMMERCIAL FEE SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work El New construction ®Addition/altera ment 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 specialin ormationusechecklist. ❑ M ulti-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 11370 SW Tigard Street Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work I 23.32 Cross street/directions to job site:Cross street: SW 113th Place 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:Muttley's Addition Lot no.: 1 Other: 23.32 Other fuel appliances: Tax map/parcel no.: 1 S134DC04800 Water heater 1 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent , 23.32 ❑ PROPERTY OWNER I ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name:Tracy Michiels Range hood/other kitchen equipment ' 33.39 Address: 11370 SW Tigard Street Clothes dryer exhaust _ry 33.39 City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) , 23.32 Phone:(920)370-0191 Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ® CONTACT PERSON Other: 23.32 Fuel piping: Business name:Carbon Dovetail LLC $14.15 for first four;$4.03 for each additional Contact name:Todd Stewart Furnace,etc. Address:8300 SW Fairway Gas heat pump WalUsuspended/unitheater City/State/ZIP:Portland,Oregon 97225 Water heater Phone:(503)887-9711 Fax::( ) Fireplace Range E-mail:admin@CarbonDovetail.com Barbecue CONTRACTOR Clothes dryer(gas) _ Business name: ` ( Other. t° MECHANICAL PERMIT FEES* Address: P,J, n 15 Subtotal City/State/ZIP: CA.aef)ni, /10‘11`" `i Minimum permit fee($90.00) �- l R Plan review(25%of permit fee) Phone:(503) - ^ IJ v,( Fax:( ) State surcharge(12%of permit fee) CCB lie.: 0c) Ar if i At. TOTAL PERMIT FEE .% This permit application expires if a permit is not obtained within ISO I. ' days after it has been accepted as complete. Authorized signat :. 0 • Fee methodology set by Tri-County Building Industry Service Board 1 .,_:_ -/?4:10.5-/?4:10.5 c / I I x'03-4419 b(z� l25)/ti 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. 1:\Building\Perm its\MEC_PermitApp_040I 13.doc 2 r OW'S) Electrical Permit Applicati 1 111. 111 I II I I •1 11.1 1 p14Received City of Tigard ,`` 16 DateB : _ v • 13125 SW!fall Blvd.,Tigard,OR 97223�v\- Plan Review n Other Permit: g Phone: 503.718.2439 Fax: 503.598.1960 0 `�11 a Date/B : I I:1 Inspection Line: 503.639.4175 (�`�� ppCAO Date Ready/By: hats: B See Page 2 for Internet: www.tigard-or.gov „y�V,1� (`�!'��°°` Notified/Method: Supplemental Information tla t . TYPE OF PLAN REVIEW ❑New construction ®Addition/alteration/replacement Please check all that apply(submit;i 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(50 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 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ❑Addition of new motor load of ❑"A","E","1-2",°l-3", Job no.: Job site address: 11370 SW Tigard Street 100 or or more. occupancy. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP:Tigard,OR 97223 ❑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:Cross street: SW 113th Place Description 1 Qty. I Fee. I Total I • New residential single-or multi-family dwelling unit. On corner of SW 113th Place and SW Tigard Street.Enter property on SW 113th Includes attached garage. Subdivision:Muttley's Addition Lot no.: 1 1,000 sq.ft.or less 168.54 4 Tax map/parcel no.: 1S134DC04800 Ea.add'I 500 sq.ft.or portion 33.92 1 Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 Small kitchen remodel including removal of exterior door. residential(with above sq.ft.) . Renewable Energy _ ❑ See Page 2 Approximately 24' by 43'addition. Services or feeders installation,alteration,and/or relocation ® PROPERTY OWNER I © TENNANT 200 amps or less f 100.70 2 201 amps to 400 amps 133.56 2 Name:Tracy Michiels 401 amps to 600 amps 200.34 2 Address: 11370 SW Tigard Street 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or Phone:(920)370-0191 Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits–new,alteration,or extension,per panel ❑ APPLICANT I ® CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7A2 2 Business name:Carbon Dovetail LLC each branch circuit B.Fee for branch circuits without Contact name:Todd Stewart service or feeder fee,first 56.18 2 branch circuit Address:8300 SW Fairway Each add'l branch circuit 7.42 2 City/State/ZIP:Portland,Oregon 97225 Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:(503)887-9711 Fax: :( ) dwelling,service and/or feeder Reconnect only 67.84 2 E-mail:admin @CarbonDovetail.com Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: B&0 Electric Signal circuit(s)or limited-energy See ^ A panel,alteration,or extension. Page 2 2 Address: ZI Z 40 g�/� red j//nJ(fy A ) Each additional inspection over allowable in any of the above A (�/L Additional inspection(1 hr min) 66.25/hr City/State/ZIP: l Qs AA-- CA f/-A • -1 Investigation(I hr min) 66.25/hr Phone:( 5a3) 341- 9.0 3 Fax:( ) Industrial plant(1 hr min) 78.18/hr u Inspections for which no fee is 90.00/hr CCB Lic.: 114032 1.1(.1k I Electrical Lic.:Z 1.-12 L,Suprv.Lic.: yl!is specifically listed(4 hr min) 7 't/7 /`f///# ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: 17.1 A./) ^t— 0� /�//�..Date: 7,_A- 1 y Plan review(25%of permit fee): .1 '7w' State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. Electrical Permit Application —City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined .. $75.00 Description 1 Qty. I Fee I Total I • Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 ❑ Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 n Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with 552.26 2 ❑ Heating, Ventilation and Air Conditioning OAR918-309-0040) System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: l I Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(%2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review,if required(25%of permit fec): State surcharge(12%of permit fee): Check Type of Work Involved: TOTAI.PERMIT FEE: This permit application expires if•permit is not obtained within 180 nAudio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical n Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations Clean Water Services File Number C1eanWater Services 14-t't"79' Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: City of Tigard 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Tracy Michiels 1S134DC04800 Company: Address: 11370 SW Tigard Street Site Address: 11370 SW Tigard Street City, State,Zip: Tigard,Oregon 97223 City, State,Zip: Tigard,Oregon 97223 Phone/Fax: Nearest Cross Street: E-Mail: 4. Development Activity (check all that apply) 5. Applicant Information • Addition to Single Family Residence(rooms,deck,garage) Name: Ross Folberg ❑ Lot Line Adjustment ❑ Minor Land Partition Company: Carbon Dovetail LC ❑ Residential Condominium ❑ Commercial Condominium Address: 8300 SW Fairway ❑ Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Portland,Oregon 97225 Other Phone/Fax: 53-449-7820 E Mail: admin @CarbonDovetail.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 Please note: Elevation differential where scope of work is being done is less than 1 foot.Thank you 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 Ross Folberg Print/Type Title ONLINE SUBMITTAL Date 6/25/2014 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. Yi 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 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 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 REQUIRED. Reviewed by 4i"-'vt 7/f44,tits • Date 07/02/14 2550 SW Hillsboro Highway • Hillsboro.Oregon 97123 • Phone:(503)681-5100 • Fax: )503)681-4439 • www.cleanwaterservices.org . . City of Tigard • III COMMUNITY DEVELOPMENT DEPARTMENT ■ T I G A R D Building Permit Review — Residential Building Permit #: (5TAO I H- t ''l Site Address: It 3-70 S l,J j 1 et,c1 J S4-. Project Name: M Clike,L5 Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: I poo St. -cvJk exctcV-{iUv 4i .e.-;S-fi�F S,n (e -G w., (1 t v-eS ; d¢ .. eJt-, 1v-A 44 e (C-1 he--.. gVerify site address/suite #exists and active in permit system. Site Plan Elements: Three(3)copies of site plan l Existing structures on site Site plan must Le on 8-1/2"x 11"or 11 x 17"paper YFootprint of new structure (including decks)with finished prawn to scale(standard architect or engineer scale) floor elevations ((North arrow tg Utility locations (required for new,may apply for additions) Site address,project or subdivision name and lot number Location of wells/septic systems la Applicant information(name and phone number) Erosion control(including drainage-way protection,silt fence NLot dimensions and building setback dimensions design,location of catch basin,etc.) NLot area,building coverage area,percentage of coverage and Street names impervious area (applicable if R-7,R-12,R-25&R-40) 2/treet tree size,type and location [Property corner elevations(2 foot contour lines if more than , Existing trees to be retained with drip line,and tree 4 foot differential) protection measures Clean Water Services-Service Provider Letter: (lot platted prior to 9/10/1995): Required: jg Yes ❑ No Received: ❑ Yes Af No - W i(( P r oV i de, Land Use Case#: N/A Zoning: R - 4 • 5 cg Setbacks: Front a0 Rear 1 5 Side S Street Side 15 Garage aO 7 Landscape Requirement: — cyo Lot Coverage Maximum: fil Building Height: Maximum Height 30 Actual Height 15-1-,,ry cg Visual Clearance rif Easements Sensitive Lands: ❑ Yes ❑ No Type ,� Urban Forestry Plan !)2/Conditions Met Notes: Approved By Planning: a , CGtL,1.2` Date: (o -c2 S-/l' Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:1 Building\Forms\BldgPerm itRv w_RES_042914.docx 4 4 .. . . Building Permit Submittal Original Submittal Date: (p/p25//� Site Plans: Building Plans: # Building Permit#: B En building permit above. Workflow Routing: W/15-13„naing ngineering ermit Coordinator 9-131-0 ding Workflow Sign-off: i off for Planning(include notes from planning review) Route Application Documents: LAX Engineering: (1) copy of permit application, (1) site plan, (1) building plan and on nal plan review routing form. Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: alpheciAii L-' (1 /r &i. rk �r k1�4_r;i11 [�h? .P7�t 0� S��v� �.tilJ,oCe r /G7`'�`'.'✓ 2AJaIaa �ec'f"/l'cctl i �✓I/Svf S S 5,ua1?wrC dnl By Permit Technician: 8 tJ Date: .‘,,i//y Engineering Review Actual Slope: / ❑ Conditions Met Notes: Approved by Engineering: -4-41)-84 Date: 4/50/10/// Revisions (after Building Submittal only) Reviewer Date 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions Met- Prior to Issuance of Building Permit Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: 1111 K to Issue Permit Approved by Permit Coordinator: / Date: olWA I:\Building\Forms\B IdgPerm i tRvw_RE S_0429 14.do cx Site Plan (Addition Location N Property Info: U CO t P y Existing fence. (to remain) J L Property address: 11370 SE Tigard Street, Tigard, OR 97223 SILT FENCE per code (during construction) —� Property ID: W268940 Existing carport. (to remain) -— .o County: WASHINGTON Existing concrete driveway. (to remain) }/ State Tax ID: 1S134DC04800 I 1 , 4) Tax Account #: R270290 k ! 1 s Plat/ Subdivision: Muttley's Addition, lot 1 P / L _ P L _- _�.. / L_ ' P / L -, , -1 ° Zoning: R-4.5 (per Washington County records) J � �� V N 8 Total structure area after remodel: -2,030 sq. ft. ( less than 20% of lot) M N �' - 045 o Total impervious area after remodel: 2,971 sq. ft. ( less than 30% of lot) a — -_ ' .� mo 'moms (including all parking, driveways, &walkways) Ir i_.� Ar M '� A i CITY OF TIGARD m L Lot size (per city records): 10,454.4 sq. ft. 9 , 'NI M / ) Qz " p U\ MASTER BAT V Y— �,- I,AONOR„N �� Approved y Pla nning 0 Location of existing electrical meter /�� f %/ Af ■ 3a'-10 13/16” Date: Co 10:.� - `�Existing door (to be removed). — ..off 't J �I Existin MABTERBDRY I J Initials: C CG v a� Existing deck (to be removed). _,c.' n � � Structure 4u�T L a co Location of existing gas meter .--- . el - j � NI VA/// a�� YECRANIAL� . se CO N-..- i — JUN 2 5 2014 rn III III DECK .Z5 CITYUr II�RD O -. �WW1 �L AV L,R: -- gUlL.atNr nt'�fl410�' 5 (n N .� le QP J 0- - - ' I J o� O -� co - • ® '— _ -� —- r2 mi 24'-1 5/8" H 7 LIVING ARE / 1967sgft New deck is less than }, �� or'�P a 24" above grade T . i- in n o O Existing overhead cable and data lines. II CV Existing overhead power line �' o co a 3 N CL m S pP , N- 4 6 w I ,, % !��\\.4 P / L / ial i�� L\ N IIJ_./_i rliA\sx .gliAl it%! . 0 cm Existing utility pole a N Existing overhead utility lines 0, , Copyright 2014, Carbon Dovetail LLC. These plans are property of Location of survey pin Dovetail LLC. The plans, designsCarbon, Existing water meter location SW Tigard Street concepts, and images shown may not be used in whole or in part with out the express written permission of an 1 authorized representative of Carbon Dovetail LLC. Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2014-00099 David Young Provide approved plumbing, electrical, and mechanical ﬁnals prior to building ﬁnal inspection. Previous plumbing ﬁnal failed inspection on 11/4/15, correction # 5 was to recall when corrections completed. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal FAIL January 28, 2016 at 12:00:30 PM MST2014-00099 David Young Grading to slope away from building 6" in 10'. Downspout extensions to sheet water away from structure. Secure sink in Avery room to ﬂoor or wall. Bathroom back splash to be sealed at wall. 310.4,407.2 No inspection done for crawl drain. Note: no kitchen remodel at this time, not part of this permit. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal FAIL MST2014-00099 David Young Provide listing of fan in shower approved for wet location. Outlet within 6' of laundry sink and washer not gfci protected. 210.8 Min circuit amps on AC tag is 21.8, 20 amp fuse in panel not sufﬁcient. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal FAIL MST2014-00099 David Young Bath fans to be on timer or de humidistat. Provide listing for fan in shower compartment. Provide locking tamper resistant access port caps on AC. M1411.6 Seal line set penetration at foundation vent. Note: kitchen remodel not done at this time, not part of this permit. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2014-00099 Jeff Grove Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS MST2014-00099 Jeff Grove Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2014-00099 Jeff Grove Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2014-00099 David Young Provide grade away from new addition to code, 6" in 10' or approved drainage swale. R401.3 Provide steps and railing to code at back doors. Provide hand rail that meets grip requirements at man door on side. R311 Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11370 SW TIGARD ST, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection PASS - No C of O MST2014-00099 Jeff Grove Violation Summary: Inspector Contractor