Permit ,. Building Permit Application FOR OFFICE USE ONLI'
�� R eived
City of Tigard - Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 '�� Plan Review
Phone: 503.639.4171 Fax: 503.598.19 , " DateB : AP• 11.46,61. Other Permit �d 6 .�tickyli
Inspection Line: 503.639.4175 J L '' Date ReadyBy: I �� 1uris: El See Attached Checklist fot
Internet: www.ci.tigard.or.us Notified Method: al 16� Supplemental Information
!�E �:, ; ?' * REQUIRED DATA:1-AND 2-FAMILY DWELLING-1
®New construction • Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rou nded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
I work indicated on this application.
CATEGORY OF CONSTRUCTION
IN I-and 2-family dwellma Valuation: $ ���
y _ ❑Commercial/industrial
❑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: J_55 1 ei 5w / ihit-r L'-'-scL_ New dwelling area: 32 3 2 square feet
City/State/ZIP: ,I dr �_ • oe • a,a Garage/carport area: e/S a square feet
Suite/bldg./apt.no.: Project name: 11a 1 0. Covered porch area: q0 square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: t.Q,k a. \‘ G Lot no.: z1 Permit fees*are based on the value of the work pelorted.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and t he profit for the
DESCRIPTION 0 WORK work indicated on this application.
Valuation: $
• / -
y�^ Existing building area: square feet
/►'I S 2 O —00�tl New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name' i 1 v 4.A `>I ,,i : {Vl.i .7 -J 0( • Type of construction:
Address: '`i 7 5 NIN ,Q'IVl i-p�51,e44. , 1SYVt,V Lt. # 2! (. Occupancy groups:
City/State/ZIP: 6'6tye/r yL d r '7 O O (.s Existing:
Phone:( :.. ) leLI - C ci f.//; Fax:(4)7 7.->) 1CCre -'`�14 7 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: i:= .v-c.Y' i c 1_- `it,r-1 , -1-)-1(..-- All contractors and subcontractors are required to be
Contact name: ( �;5011 C� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: lit 7 6 At w 1x rei Le-vt icoAi i) SUt f� Z0 C) jurisdiction in which work is being performed.If the
City/State/ZIP: 6:eky�, ,yam 0 r2. q 7 Ci 0(O applicant is exempt from licensing,the following reasons
apply:
Phone:(`ar"?>) tec4 S ' cj 8 te Fax::(SCn )to-q D" �9I-E•Z
E-mail: Cl fYt[,i, rl v- •1_: A •,,r. _,
t
i
Business name: ftt V r.7,'&(,,e 1-{cy J Z".inC, , BUILDING PERMIT FEES*
Address: .1 2 5 N yV Ai b-ey- t/ > 60i it 2C C.) Please refer to fee schedule.
City/State/ZIP: 19.e&V, r-1.,-,),....L., d 11° -'te
Fees due upon application
Phone:(cc-1) ) (P 1 -c., -( Q if Fax:(9;5) 47/ij- 2-/ Z.
Amount received
CCB lie.:
/� �j'� ( Date received:
Authorized signature: (�r.�✓vvJ / 1 /�,&Lf (PC ) This permit application expires if a permit is not obtained
within ISO days after it has been accepted as complete.
Print name:A1,6 t iL.rYL. /((,.-<-1 Date: 11- 7_0- U9 * Fee methodology set by Tri-County Building Industry
r— t Service Board. / deil
i:\Building 1BUP-PesmitApp.doc 12103 440.4613T(11/02/COM�WEB) / A)V/"79)6
9,3 , )
/7 E7/6-7e 7,/ l°Aty 2 7oJ
p Plumbing Permit Application FOR OFFICE USE ONEN'
City of Tigard Received A.: ," Permit No.: ur ":
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 II ' Date/By: Other Permit No.:
-,,
24-Hour Inspection Line: 503.639.4175 1 1 Ready/By: Avis: H See Page 2 for
Internet: www.ci.ti ard.or.us Date Read B
i' Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
X New construction ❑Demolition
For special information use checklist.
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
a 1-and 2-family dwelling ❑ Commercial/industrial SFR(2)bath 350.00 1
❑Accessory building El Multi-family SFR(3)bath I 399.00 3‘,II
Each additional bath/kitchen 45.00 L{Cj
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION `
Site utilities
Job site address: 16- 6 ,---t S l 1[ ei pD174 ( £14' . Catch basin or area drain 16.60
"�`
City/State/ZIP: 1 q a�} D e O f a)L4 Drywell,leach line,or trench drain 16.60
Suite/bldg./apt.no.: J Project name: 1\a \t,SkN, Footing drain(no.linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: e."a V Lot no.: 2'? Water service(no.linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK t>�
Backflow preventer If Page 2 3(,.
Backwater valve 16.60
Clothes washer S 16.60 ,t.,,(pG
Dishwasher 16.60 /to,&()
❑ PROPERTY OWNER Drinking fountain 16.60
❑ TENANT
Ejectors/sump 16.60
Name: LI V. Y'-i1['Le._ t(iYl' '`) . kY)C_ • Expansion tank 16.60
Address: III 2 5 NW .kryl h-e eAi ,.- . 1r ,1 }1- ?£ [ Fixture/sewer cap 16.60
City/State/ZIP: b0�4,,"r.�4,1,1 p a .4-700 Floor drain/floor sink/hub 16.60
_ Garbage disposal I 16.60 L)
Phone:(L7- 1 . L: - (- 7 Y (.: Fax:(=, '-) 4...."?c. .'_c1 L1- (o•(v
❑ APPLICANT ❑ CONTACT PERSON Hose bib 3 16.60 ?i,Qj(7Ice maker ' 16.60 (,Iv°
Business name: Li v -i51(,/..e H ..,
1',(: Interceptor/grease trap 16.60
Contact name: At,(,i °7/t- ✓t/t(., A Medical gas(value:$ ) Page 2
Address: 1 q 2 F, Al .401 r.JZ--„ _, pYL );1 ,tj 2_0(.2 Primer 16.60
City/State/ZIP: Roof drain(commercial) 16.60
Phone:( ) Fax: :( ) Sink/basin/lavatory 16.60
Tub/shower/shower pan - 16.60 tt. q,1[)
E-mail: Urinal 16.60
CONTRACTOR Water closet i 16.60 1u, .6,,X,
Business name: j•y-1,-RN,WI 1 1 Y1 C )l V■[+ryb■ri Water heater I 16.60 `t,,
Address: Z S DS- •S•t c/• A tie 0-4- b( • Other:
City/State/ZIP: 4��k 02. 97006 subtotal
Minimum permit fee: $72.50
Phone:C5-43 ) 09)8- b 6s 7 Fax:(503 ) �7 2.- 954/3 Residential backflow minimum permit fee: $36.25
CCB Lic.: ('(2 (I i Plumbing Lic.no.: 3 q- 3-70 6 Plan review (25%of permit fee) cis-
State surcharge(8%of permit fee)
Authorized signatureC__ G 41
TOTAL PERMIT FEE
Print name: .30n,0'hC l t,r $j d( Date: -e_. 05- This permit application expires if a permit is not obtained within
- 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\Building\Permits\PLM-PermitApp.doc 12/03 440-4616T(10/02/COM/WEB) 5`"f f 35
1 / 2.<66'
Mechanical Permit Application FOR OFFICE USE ONLY
City Tigard Received
345/08 f 17 Permit No.. / ,s/ -( Vp�- yM0U Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan
Phone: 503.639.4171 Fax: 503.598.1960 / Fys Date/By:view
Other Permit:
Inspection Line: 503.639.4175 . '
_�_� Date Ready/By: luris. la See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
N.New construction ID Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
gi 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
For special information use checklist.
❑ Multi-family ❑Master builder ❑ Other: Description
Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: /6 Fj. sty C ph u e ( All conditioning or heat pump
(requires site plan showing placement) I 14.00
City/State/ZIP: "'r'*,9°" 3 t p c 61-7 4p Furnace 100,000 BTU(ducts/vents) 14.00
Suite/bldg./apt.no.: Project name: ,e`t a sk� Furnace 100,000+BTU(ducts/vents) 17.90
Y Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler(radiator or
hydronic) 14.00
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 10.00
Subdivision: ',Il A vt c.4 cL Lot no.: 2 G� Flue/vent for any of above 10.00
v`•' ( Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 1 10.00 10
Gas fireplace I 10.00 1D)
Flue vent for water heater or gas
fireplace 10.00
Log lighter(gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
❑ PROPERTY OWNER El TENANT
Other: 10.00
Name: Li yet-5i`-d�, �,-y- J , �- Environmental exhaust and ventilation
Address: (e N ! �. 'l U Range hood/other kitchen
t 7 S Ai vu 4YY7 ..e,y1 • NVI,t t 2- equipment i 10.00 )J✓
City/State/ZIP: J-ct v e y'lt Y'-) CV.. ci 7 C' )�% Clothes dryer exhaust 10.00 1 0
Single-duct exhaust(bathrooms,
Phone:( C ) (4 L(.S-C(ri 64, Fax:(yZ ... ) (. ;_7-/Z' toilet compartments,utility rooms) � 6.80 7°'YO
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: �Li y. y,c Lk i F-br-ii.z..3
_77--__,-
__,-lC. _ Fuel pip r in
g
Contact name: $5.40 for first four;$1.00 for each additional
ALL,'��rh'L ..
_ Furnace,etc.
Address: iCJ2S No/ iii-yylf,G- -C ,,P/L. ,01 2CS6
J Gas heat pump
City/State/ZIP: c t,t,ye-,- 4-e.1.%,/ q 7(,i 0( e Wall/suspended/unit heater
d% Fax: (L,7�j) t 0-2114 2- Water heater
Phone:(rj�1) (�/ S- j(� Fireplace
E-mail: a, • - 1 r 1 ✓eir ;6 ...criOYvie•c c1'K____ Range
g
;. * n t rir.1 .1 't'i8 .2, Barbecue
Business name: kit - !-A..„....\-r., i..�,,i,a.-•,:n t P. C. Clothes dryer(gas)
Other:
Address: M� 17 2 8=r'' U i r b. 6_,.. R cl ,;„�,t t + 6 MECHANICAL PERMIT FEES*
City/State/ZIP: (. -.A_t L r. 5(L r:; 6 3 r. Subtotal 'l Lj Liu:
Phone: <-. 1 Minimum permit fee($72.50)
(r 3 ) .3K1 _ b;5 Z. Fax:(x,"r. ; ) °-, qa 3z-:: ;
Plan review(25%of permit fee)
CCB lie.: j•j 2 1 3 4 State surcharge(8%of permit fee)
/' TOTAL PERMIT FEE ,Li�r
Authorized signature: ,r_ This permit application expires if a permit is not obtained within 80
�� days after it has been accepted as complete.
Print name: 2 f_ - e_,.o.._.�J r Date: o~. I c et 1e. ',7- * Fee methodology set by Tri-County Building Industry Service Board
is Ruilding\Pe mits\MEC-PermitApp.doc 12/03 440-4617T(11/02/COM/WEB)
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: , O t 637 Permit No.: � i-...fy ytt
e 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review "w—�+
Phone: 503.639.4171 Fax: 503.598.1960 "Ill Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
g New construction ❑Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: 0 Service over 225 amps,comm'l ❑Hazardous location
0 Service over 320 amps-rating ❑Buildng over 10,000 sq.ft.,
CATEGORY OF CONSTRUCTION of 1-and 2-family dwellings 4 or more new residential
P I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi-family ❑Master builder ❑Building over three stories ❑Feeders,400 amps or more
❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
� y � / ❑Health-care facility ['Other-.
Job no.: Job site address: /6 C L n ( /�-e'p/7c?-'l L�Sabmit 2 sets of plans with any of the above.
City/State/ZIP:f+ J a ) D 1 3,24 The above are not applicable to temporary construction service.
Suite/bldg./apt.no.: Project name: 1{ c.4.0 FEE* SCHEDULE
`�a Description Qty. Fee Total I `
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
Includes attached garage.
1,000 sq.ft.or less i 145.15 JA/5115 4
Subdivision: 'e`k. V,,, Lot no.:z C� Ea.add'l 500 sq.ft or portion X15. 33.40 )(q7 1
map/parcel Limited energy,residential 75.00 r 2
Tax ma no.:
P p Limited energy,non-residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling,service and/or feeder 90.90 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: r.. Over 1,000 amps or volts 454.65 2
I 12 ' n/Le/ ui i'? 'y J ( Yt t-i J # .:C G Reconnect only 66.85 2
City/State/ZIP: r c ct a-c Y--�-, C' 7(j()(� Temporary services or feeders installation,alteration,and/or
_ relocation
Phone:(S1.)) ti,-4-15- - G.el F l:!-' Fax:(&-)) /o v- 2_,,--;L.1 a 200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
-re__ service or feeder fee,each 6.65 2
Business name: i V4'll's i rj,,_ f Lvt'L2 , _1?•'1C r branch circuit
�A/i, B.Fee for branch circuits
.14
Contact name: L L...:1 'v /Sc t without service or feeder fee, 46.85
Address: "+ T each branch circuit
7" / l�/ 77� �,e�,� Pr o.4)`� G(j Each add'l branch circuit 6.65
City/State/ZIP: 4t.V,e,r_4.c,,y-i b -7L)�j Miscellaneous(service or feeder not included)
Phone:(<;Z: ) C@'Lf S—09, c.� Fax::(Ct 3) G -, Pump or irrigation circle 53.40 2
C� �'FV' �(L4.7... Sign or outline lighting 53.40 2
E-mail: lt_fl l e.c. { )r i vs y i-c'C 1 ,.--A 1.c., C cyifrl Signal circuit(s)or limited-
ci CONTRACTOR energy panel,alteration,or
extension.Describe: Page 2 2
Business name: r f e,c -t—
• Each additional inspection over allowable in any of the above
Address- P 0 ki/1 Qi 3 g I Per inspection 62.50
{
CityfState/ZIP: p O ,��( 0 ,.. q,.' Investigation per hour(1 hr min) 62.50
Industrial plant per hour 73.75
Phone:(r°3) G 7 $ . /3 Ss:- j Fax:Coe'3) 6 7 g —/j O S ELECTRICAL PERMIT FEES*
COB Lie.: 20 C/9' Electrical Lie,:2 /U7¢ Suprv.Lic.:31 4 s Subtotal 31 Z. /S
Supry Electrician sig;tarure,ra uired:& B g A Plan review(25%of permit fee)
Pant tmame: 17 /���Q��'� j U� State surcharge(8%of permit fee) 26 6--
I2 au,7.4, !� Dare: 2 7 R
TOTAL PERMIT FEE !.3--7. 15
Authorized signature: This permit application expires if a permit is not obtained within 130
- days after it has been accepted as complete
Print name: I Date: ■ Fee methodology set by Tri-County Building Industry Service Board
•*Number of inspections per pennit allowed.
i'Building'.Pennits,ELC-PermitApp.doe 12/03 440-4615T(10/02/COMMIEB
`Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received ,�fOi e� Permit No.:�5►-� 8-�.�✓Y-.,,
DateBy: / —�M�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /�""" yp )'1 i Date/13y:
Other Permit:
Inspection Line: 503.639.4175 •I Date Ready/By: runs: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
w construction ❑Addition/alteration/replacement Please check all that apply:
El
❑Other: ❑Service over 225 amps,control ['Hazardous location
❑Service over 320 amps-rating ❑Buildng over 10,000 sq.ft.,
.� CATEGORY OF CONSTRUCTION of 1-and 2-family dwellings 4 or more new residential
Y 1 and 2-family dwelling El Commercial/industrial ❑Accessory building ❑System over 600 volts nominal traits in one structure
❑Multi family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders,400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: /550 7 s'`2 /Ci i� llL( Health-care facility ❑0��
l t/8tlbmit 2 sets of plans with any of the above.
City/State/ZIP:'--j/',4j%t l f G� 6/-, 7_714_, The above are not applicable to temporary construction service.
'' ''`"��111111 ( 1 FEE* SCHEDULE
Suite/bldg./apt.no.: Project name: opt, 1 v �-�, ��
✓ Description Qty. Fee Total
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
Includes attached garage.
1,000 sq.ft.or less —a.". �=— .
Subdivision: �J . Lot no.: add'l 500 sq.ft.or portion !!,--,'
V 1 7- . fa
Tax map/parcel no.: Limited energy,residential 75.00 2
Limited energy,non-residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
ye) y 0 C J /CC dwelling,service and/or feeder 90.90 2
�{,�/`j V r j� Services or feeders installation,alteration,and/or relocation
�/ 200 amps or less 80.30 2
1d"PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: u f / � / f/IC 0 0 601 amps to 1,000 amps 240.60 2
Address: Zc �V Vl/ //J,�/ ' Lli f NLl/1%l4-t/ Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: py� ve-'/ 12 -7 C 0 Temporary services or feeders installation,alteration,and/or
Phone:(5P) ( �-j Fax:(9)j) V y 0—25-i q 2_ relocation 0
.c4 5—p
200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
service or feeder fee,each
Business name: 12) y z y--,:: t-(- 1 1 ' .1 , yic branch circuit 6.65 2
Contact name: / yuL4 ?JY/1 .1 - C , / l i B.without for service circuits
j t i / � without service or feeder fee,
Address: �/ phi/tit/ t- each branch circuit 46.85 2
{ �� �� Each add'l branch circuit 6.65 2
City/State/ZIP: 6/1( 4" , /1/ r 1 7 0 0(� Miscellaneous(service or feeder not included)
Phone:(.9.- ) O//(1J'�.�1i� Fax: :( ) TG)—�7 �[ Pump or irrigation circle 53.40 2
/ ) / Sign or outline lighting 53.40 2
E-mail: Signal circuit(s)or limited-
CONTRACTOR energy panel,alteration,or
J� j //�O extension.Describe: + Page 2 2
Business name: I2A j/ /' � / AMA& 4 r
A , 20 c' Each additional inspection over allowable in any of the above
Address: /Cj 2_-) i Dl�/�� l b G 1v vt pr o4 ty
City/State/ZIP: �`1 V�� /1 U ) 1 r Per inspection 62.50
7 L Y Investigation per hour 0 hr min) 62.50
Phone: ) -- ve, I Fax:(97 ) IC--Z? L 2......
Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:16C&S Electrical Lic.: Suprv.Lic.: Subtotal "'
X17 ./5
Suprv.Electrician signature,required: Plan review(25%of permit fee)
State surcharge(8%of permit fee) Z C -
Print name: Date:
TOTAL PERMIT FEE 3)7 )c,
Authorized signature: t/Z ) This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: A t, 3`cK �`,L Dater)i/).;t ` • Fee methodology set by Tri-County Building Industry Service Board
-' ` `1 *•Number of inspections per permit allowed.
i:\Building\Permits\ELC-PermitApp.doc 12/03 440-4615rp0i02/CO1Ww>:B
Electrical Permit Application - City of Tigard
Page 2 -Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
▪ Burglar Alarm
["Garage Door Opener*
YHeating,Ventilation and Air Conditioning
System*
Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
ii\Building\Permits\ELC-PermitApp.doc 04'03
"One- and Two-Family Dwelling
• Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received l'cnnti tio.:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated
Phone: 503.639.4171 Fax: 503.598.1960 r Associated permits:
w.J�ll ❑ Electrical ❑ Plumbinc ❑ Mechanical
24-Hour Inspection Line: 503.639.4175 j _
Internet: www.ci.tigard.or.us ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l es 'so 's%: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.
4-t--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. ,
"1.2-- Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑
and location.
.l3 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.
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.
).6 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ ❑
prescriptivepath analysis provide specifications and calculations to engineering standards.
,J,Y Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑
locations. Show attic ventilation.
l Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems,see item 22,"Engineer's calculations."
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. ❑ ❑ ❑
;,Y Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑
for four or more appliances.
?;Y Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Oregon and shall be shown to be applicable to the ro'ect under review.
JURISDICTIONAL SPECIFICS
3,?' Five(5)site plans are required for Item 1 1 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑
2,4' Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
7,8' Building plans shall not contain red lines or tape-ons. "Mirrored"buildingplans will not be accepted. ❑ ❑ ❑
3,e "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
3yT "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
Ar Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑
Street Tree List.
70 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
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.
1:\Building\Permits\One-Two-FamilyChecklist.doc 12/03
CONSULTING, �NGIN��/z5
ENGINEERING EXCELLENCE
March 17, 2008 RECEIVED '' ?r�
[008 cup/
Riverside Homes CI f'Ui- :crop
1925 NW Amber Glen Pkwy #200 BLILDiNQ I;i*; N
Beaverton, OR 97006
Re: Authorization for use of engineering, RECEIVED
Plan 3386-00-C-L-03-03-OR
Bella Vista, Lot 29 MAR 2 . �. )
CSA Job #004-4R CITY OF TlrARD
etiloweintsicN
CSA Consulting Engineers authorizes Riverside Homes to use all applicable engineering
designs and calculations we have performed for the subject plan in order to obtain permits
for the referenced lots. This use is authorized with the following conditions.
1. The plans being submitted have not been modified from the plans for which the
engineering was done.
2. The structural codes and design criteria under which the engineering was done is
consistent with the codes and criteria currently used by the permitting agency.
CSA Consulting Engineers can take no responsibility to insure that these conditions
are met unless we review the specific plan submitted for permits and all applicable
engineering.
If we can be of further help please do not hesitate to call.
Cordially,
CSA Consulting Engineers, LLC agilankr
`evo-
'�AA'' E
•
411..irliM WINO
C� °k 12 2 0+
Dwight D. Mason, P.E. "-,Qher 05
Structural Manager
�>ExP1RBs: �s-3i-OZ 1
2895 Beavercreek Rd. Oregon City, OR 97045
(503) 228-3848 FAX(503)228-0475
RECtFVED.
I ; A I JUL 0 8 2C ? ..
•?e BUILDING DIVISION
414
CIT t,;, 011 a . : ► 'jlill311JIF :f,i�P�l�i� I I 1 \ 4 Ul 58.64'
PLANNING !IVISION:
Required Set�:cis: 'Appr ved ❑ Not f pproved CITY OF TIGA1&D- PLAN REVIF V I
Side: °. Street Side: (0 S BUII. ING PERMIT NQ. s7- - t
Front. /V G age: 1_a— Rear: J5,-- ` ` limo .
Visual Clear nc : [ Ap ro ed ❑ Not A,proved Street T j pprov ❑ Not Approved
Maximum B ilc nb Height. t Protected ft proved\ A raved \
CWS Servic• Provider Letter Req 'red: ❑ Yes ❑ No By: Yo(�d,'`y`�jp Q Date\ D
❑ Rec v�l Notes: \
BS:
Dse: 1 tiof -
ENGINEERI G PA TMENT: \ - \ 0 1
Actual Slope Approve �NOt N
Site Plan. Approved of pprov
By: Date: I \ I I
Notcs: eG.n•-e�ar Date:
- i 79 \ _
,� - \ \ \
• 4. \ \ II w
40,_0.
MIN. PROPERTY
\ SIDE TWO STORYtJ�IT1-1 1 f LINE
YARD D YL IGNT C�AACxE 1
_\ 3386- O-G-R-03- -OR m
61. FF�. ELEV. = 3085 N 'f f _■
\ MAIN FLOOR i-
IP (VE IFY IN FIELD) \ I
\ \ OT 29 \
Ili
\ 5,1012 SQ. FT. 13'-8' I ,N
\ STA LL T5 ui
't 3�•�•5
a \ ,�0 4 /\ e
4 a n) / N
II
Z \N 2-CAR / N II 4
\CIIRA7
/ \ II
\ I / \ \ \
\ \ \ II \
PROPERTY I \
LINE \ \ / \ :yof)
\ \
• \ * \ \ i EXIST'Cs. ROCK
RET. WALL
\ <P4, \ \ \ \ II
-).-N.,..,..-_� \ \ 11'-6. \
0 CONS... 4' CQt1C DRIVE \
?a n \
I
IL WALK (3,800 P .I) \� -----\`. \ \ OVER S. A---vEL 71-14-
4 N al P
1 Ullr' IY SILT F CE \-Vv.‘(\°1
}w it� -j 8
��;. d �� to AS READ fr
•to m _1 �-- ) 4AV
444 N. 46'-35'- . 5426'
WATER 1
METER I 1 I I
I I
IR4Fk4E L L4NE I
( fi iz1 V4TE iR
O A D ) /5519 `:�
—tissoeL6LE-L , ' 09
ADDRE°
ii// PLAN NU
SITE FLAN DATE:
SCALE: W =I -0 i
%���o/i,/, IMPERV I
2,248 Sc
RESIDENTIAL PERMIT APPLICATION REVIEW
Permit No.: MST2008 -000 , S
Site Address: /558,7 Sec) Qhcce
Subdivision: Bella Vista
Lot No.: ,29
Contact Name: Allison May
Business: Riverside Homes Inc.
Street: 1925 NW Amberglen Pkwy Suite 200
City: Beaverton State: OR Zip: 97006
As required by the 1999 Legislative action (Senate Bill 587), your residential permit application and
plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or
"complex" as defined in ORS 455.467 and 455.469.
❑ The application is complete.
n The application is incomplete for the following reason:
A S r L.-hew! IS, AAp ;CA n• Cheek - HO - - ete J - o,^S "'era) )/.. /' fec1
Si 4e Oct.& — S 0x /A ( '145 - ' ?Vi ;3hc) 00csr c2 36)� 6o/( � Zew 3 ^ Fir
Cwt VU`N 5(?- c + (/+ s � i (51 ) 7(q ��o 3d�
4 7;11, 11 J S 5 de_ i \ l \ 5 r r ke " �f lCtiSe re.,.);. se) Laic) i ,S > e et, - )c' 4w .' cc,Qi
The submitted plans will be reviewed; however, a permit cannot be issued until the above
information is reviewed and /or approved.
❑ The submitted plans cannot be reviewed until the above information has been submitted
and /or approved.
❑ The plans are deemed "simple ".
The plans are deemed "complex ".
Signature: ? yc 2
Name: Brandon Shaw Date
. Tide: Plans Examiner
Phone: 503- 718 -2425
E -Mail: BrandonS @tigard - or.gov
I: \Building \Forms \RES- PermitAppRcvw- Blank.doc 1/18/07