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Permit n CITY OF TIGARD MASTER PERMIT `'- 2 ' COMMUNITY DEVELOPMENT Permit #: MST2012 -00023 T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/02/2012 Parcel: 1 S136CA09400 Jurisdiction: TIGARD Site address: 11033 SW LEGACY OAK WAY Subdivision: WHITE OAK VILLAGE Lot: 15 Project: White Oak Village, Lot 15 Project Description: New SF. 3/2/12: DEMO CREDITS FROM BUP2007 -00107 APPLIED TO THIS PERMIT. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 3 First: 713 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 950 sf Garage: 198 sf Front: 10 Smoke Dwelling Units: 1 Third: 520 sf Right: 3 Detectors: Yes Total: 2183 sf Value: $230,591.71 Rear: 13 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder - Temp SrvclFeeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'l 500 sf: 3 201 -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 8 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: NEW SF VB R -3 2183 Owner: Contractor: WESTLAND INDUSTRIES WESTLAND INDUSTRIES Required Items and Reports (Conditions) 12670 SW 68TH AVE STE #400 12670 SW 68TH AVE 1 Ersn Cntrl 503 - 681 - 4444 TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503- 572 -0746 PHONE: 503- 245 -9715 FAX: 503 -598 -9081 Total Fees: $6,740.50 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 s •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifica'•• - - nter. Th• rule are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the ru r direct questions to OUNC by calling .03.232. 9: : .332. .44. l ift Issued By:(--. `/_ _ — Permittee Signature: `i,_la►/ Call 503 int ' y 7:00 a.m. for the next available inspectio This permit card shall be kept in a conspicuous place on the job site until co • lotion of the project. Approved plans are required on the job site at the time of each inspection. ' Building Permit Application /s Residential RECEIVED FOR OFFICE USE ONLY City of Tigard Re eived ®�� �.M Permit No.: / �a -y oz3 It -: w 13125 SW Hall Blvd., Tigard, OIFE8232 2 2012 Plan Review I Other Permit: 6 ' , af2 ': Phone: 503.718.2439 Fax: 503.598.1960 Date/B : i. TI G A � .0 Inspection Line: 503.639.417tTTY OF TIGARD Da Internet: : I : RI See Page 2 for Internet: www.tigard_or.gox. DILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA: 1 AND 2 FAMILY DWELLING j,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. 14 1- and 2 -famil dwellin Valuation: $ Z ( 4� y g ❑ Commercial /industrial 3 /- ) �— ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 2 , , 'S JOB SITE INFORMATION :AND LOCATION Total number of floors: *� Job site address: //0 33- Slit) L £G /tc v tz Wes/ New dwelling area: � � square feet City/ State/Z1P: "2 er f /), 7/J ' z2.3 Garage/carport area: iQ square feet Suite/bldg. /apt. no.: Project name: A)// '04,e AG4 -6-E. Covered porch area: l , square feet Cross street/directions to job site: Deck area: square feet Other structure area: �er square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST . Subdivision: t✓ /„ o �.,t< v,,146-6. I Lot no.: / ir ' Permit fees* are based on the value of the work performed. Tax map /parcel no.: /5/36 C�4 tO® ®D equipment, the value (rounded labor, to the nearest a, an d the profit of all eqpm materials, labor, overhead, and the profit for the • DESCRI ON OF WORK indicated on this application. Oit1;T2(1CT ti's 5"//16 5- Ai 74/� / ' (� Valuation: $ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/ State/ZIP: Existing: Phone: ( ) Fax: ( ) New: [APPLICANT ❑ CONTACT PERSON BUILDING PERMITFEES *. Business name: A4_57-44..g6 (Please refer to fee schedule) /J rI S T�/ES Structural plan review fee (or deposit): • Contact name: /60a f f / / D f l e t) f j _ ? 1 5��,u g,rte �/ FLS plan review fee (if applicable): Address: 42 6 70 5-1,./ 67B i 4/6 �T AOa _ q Total fees due upon application: City/State/ZIP: r /�, die ?22-3 y� pe / Amount received: t1SIJ Phone: (. ) c• 7 - , Fax: : (1� ) ?39- /f E -mail: Jlc / l q aO &7( i L. Gp/Jil /JS(AjE574 cJ �J�o ci,v PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof -top mounted Pho oltaic Solar Panel System Business name: UV /, 1 i, ST "�Q . ; 4 6 i5T� / £s Submit two (2) sets of roo plan with conn -; : details and fire department access, a ' i g wi . - 2010 Oregon Address: 4,26 70 .tu ih `L' E 6r Z7 Solar Installation Special Co - ecklist. q Permit Fee (includ T an rev, $180.00 City/State/ZIP: �� a , q 7 Z3 7j and . • nistrative fees): Phone: (95) 76 -6'6 Z, Fax: (503) cV - gad' / State surch. : (12% of permit fee): , $21.60 i CCB lic.: a 3 0 ) . . 3 3 - 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. Print name: �. (4 6 l 71 /✓ r i E...c^j I Date: 02 , y - - 1 ` Fee methodology set by Tri -County Building Industry t J Service Board. 1:\Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440- 4613T(1 I /02 /COM/WEB) • Electrical Permit ADDlicati CEIVED FOR OFFICE USE ONLY 'It City of Tigard "` : 1., / Permit No.: 51 �Yo2 .. 23 ' F.B2 22012 ^_ 13125 SW Hall Blvd., Tigard, OR 97 Plan Review Other PermitaW /n/� — C : Phone: 503.718.2439 Fax: 503. 0 Date/By: • Inspection Line: 503.639.4175 O TIGARD Date Ready/By: Saris: H See Page 2 for l_ I ° `\ Ii ° Internet: www.tigard -or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK - - PLAN REVIEW - ' • '. ,: ' : . ew construction Addition/alteration/re lacement Please check all that apply (submit 2, sets of plans wfitems checked below): ❑ P ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or . ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E", "1 ", "1 - ", J 100HP or more. occupancy. Job no.: Job site address:/ Si 2 f - i ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: 776-A ❑ Healthcare facilities. ❑ Supply voltage for more than q-77,, ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 4ai'r, vAL l ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qtr. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: /-f /T 0414 U�_« Lot no.: / 1,000 sq. ft or less -, 168.54 f (e, -4 Ea. add'l 500 sq. ft. or portion ", 33.92 � O(, -X, 1 Tax map /parcel no.: /5134, CA Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft) ` 75-44:6 Limited energy, multi - family 75.00 2 6/1 ); , `G1 /V C' W r , I 5 A u g residential (with above sq. f .) / /w Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State/ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with E APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: A/C Fee for branch circuits without s �Na �DI/57"�/� s service or feeder fee, first branch circuit 56.18 2 Contact name: go,5 11 N ®E/45 - 4 � /To". S7� C 4' �� Each adds branch circuit 7.42 2 Address: Id- 610 see) 69 `` c , 5u ire. 2 Miscellaneous (service or feeder not included) ty � �ie / © / e_ 1 7 2 - 3 Each manufactured service and/or d/ r modular 67.84 2 City/State/ZIP: ' ( 7 dwelling, service and/or feeder Phone: (D j )572 Fax: : (4 )5 ?o gi. / Reconnect only 67.84 2. Pump or irrigation circle 67.84 2 E - mail: Signor outline lighting 67.84 2 CONTRACTOR • Signal circuit(s) or limited -energy • L � anel, alteration, or extension. Page 2 2 Business name: C-G e ere / ' A / 0 • -rays Each additional inspection over allowable in any of the above Address: „Az f '3 $ 6, ;3 3� /, Additional inspection (1 hr min) 66.25/ hr ty ,.. " • , „ A 7 � # � Investigation p (1 hr min) 66.25/ hr City/State/ZIP: � /y Industrial plant (1 lir min) 78.18 / hr Phone: (9) ) 3 5 -- 6 / / ? Fax: (8 Ii )', �' Q . r3 Inspections for which no fee is 90.00 / hr specifically listed ('h hr min) CCB Lic.: 6 q (9._ Electrical Lic.: . - 49f Suprv. Lic.17 .0 ELECTRICAL PERMIT FEES Subtotal: Suprv. Electrician signature, required: ---- - Plan review (25% of permit fee): - - — Print name: ( 1 r Date: , State surcharge (12 % fee): 4r1 , 4..z ��'�'� molt TOTAL PERMIT FEE: 3 ffi, , 7 4 Authorized signatur'• This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: p • Number of inspections allowed per permit. I:\ Building\Permits\ELC- PemvtApp.d c 07 /01/10 440-4615T(1I/05/C01WW® Mechanical Permit Application iOlz OFFICE USE ONLY City of Tigard RECEIVED 2012 Da am Permit No.: S raof,- �a3 , ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ` /�� 4 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit �U�Pcj�i- 4a�0,Z . T I G A R IJ Ins Line: 503.639.4175 FEB 2 2 Date Ready/By: Ions: El See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information CITY OF TICARn TYPE: OF tiVilaDING DIVISION : ' . ,COMMERCIAL FEE * SCHEDULE - USE 'CI ECKLIST 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 EQUH'MENT / SYSTEMS F EES I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For spedal information usedrecklist ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total Heating/cooling: • JOBS INFORMATION AND LOCATION //( $ J L 1 Air conditioning Job site address: (requires site plan showing placement) 46.75 City/State/ZIP: V � 0/L. Furnace 100,000 BTU (ducts/vent 46.75 �,2i Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: IA' -6. / 'yf G ar � � Heat pump `'��� (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 � � — / Flue /vent for any of above 23.32 Subdivision: i7Jl l� 6 , ' Lot no.: Other: 23.32 Tax map /parcel no.: / 3 13 (4 i, `' Other fuel appliances: DESCRIPTION OF W I . Water heater A 23.32 Gas fireplace 33.39 �I 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 ❑ PROPERTY OWNER I ❑. TENANT Chimney/liner /flue/vent 23.32 Other: 23.32 Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen i equipment l 33.39 City/State /ZIP: Clothes dryer exhaust 1 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 1 5 23.32 1 irp•it - APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Other: 23.32 Business name: /y €— Fuel piping: Contact name: ( 'jam $14.15 for first four; $4.03 for each additional Address: ,q / / / ( Furnace, etc. I 14 .(5 ( �7 v Gas heat pump City/State /ZIP: 1 t�g Wall/suspended/unit heater Phone: a3) er - 6 3 Fax: : ( q).---- Water heater i Fireplace f E -mail: ._..--- Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: '_ MECHANICAL PERMIT FEES* City/State/ZIP: //1 i Pal L1 i`.' Subtotal 3n n ! /� Minimum permit fee ($90.00) ict Phone: (a p 3 �s-� r �� Fax: ( a -)- -__ _ Plan rexiew (25 %a.of permit fee) CCB lie.: /�. 1c r State surcharge (12% of permit fee) , I Z I TOTAL PERMIT FEE - 7, I Authorized signature: ge"4-4-. T his permit application expires if a permit is not obtained within 180 gn d ays after it bas been accepted as complete. Print name: r eeete., � Date: al.. f O' l a i * Fee methodology set by Tri-County Building Industry Service Board I:1 Building \Pemiits\MEC- PernutApp.doc 09/09/10 440.4617I'(I1/02/COM/WEB) ' Plumbing Per><nit A licati ft-- Building Fixtures CE�ED City of Tigard FEB 2 2 2012 R = $ /9- Permit No.: // .,-tf I q 13125 SW Hall Blvd., Tigard, OR 97223 plan Review Other permit No.: o� v�/� f �l g C Phone: 503.7182439 Fax: 503 1� )F TIGARD Date/By. fade: Ed See Page 2 for �_ I c `1 � Inspection Line: 503.639.4175 -orgov B UIL DING DIVISION od Internet: www.tigard or.gov Supplemental Information TYPE OF WORK • : - .. FEE *: SCHEDULE' : • - New construction ❑Demolition Forspedal information use checklist Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R for each utility connection) CATEGORY OF' CONSTRUCTION- . - SFR (1) bath f 312.70 SFR (2) bath 437.78 ud 2- family dwelling ❑ Commercial/mdustrial SFR (3) bath Q 50032 � .-?,� ❑ 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: // 5v1 r A Catch basin , or drain 18.76 Job site address: (- / / Drywell, leach h line line, or trench drain 18.76 City/ State/ZIP: / ! ; ,/ : r ®f q ��� Footing drain (no. linear ft: _) Page 2 Suite/bldg. /apt. no.: Project name: `_ �/1/ „1 ; j Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _) ( Page 2 Storm sewer (no. linear ft.: ___) / Page 2 Water service (no. linear ft: _) 1 Page 2 Subdivision: vfa Lot no.: f ' Fixture or item: Tax map /parcel no.: / / GI' i. / Backflow preventer 31.2 Backwater valve 12.51 Ill DESCRIPTION OF WO' 25.02 nn !! - Clothes washer � "�� ii),---xi At .-;,',,/6 "if Dishwasher � 25.02 Drinking fountain 25.02 . Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 - - - Fixture/sewer cap 25.02 Name: _ Floor drain/floor sink/hub 25.0 Address: Garbage disposal / 25.02 City/State/ZIP: Hose bib 7/ 25.02 Phone: ( ) Fax: ( ) Ice maker ( 12.51 � PLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Medical gas (value: $ ) Page 2 Business name: / ( ` r . 1 i iis A 7 / 12.51 � Primer Contact name: ■ j �� / V/� S Rk- Roof drain (commercial) 12.51 Address: / /� OK Sink/basin/lavatory C 25.02 City/ State/ZIP: (_ " '.' /") OaC 6j l2/ Solar units (potable water) 62.54 Phone: (t -7j Od Fax: ( p_94 / Tub /shower /shower pan 9.,- 12.51 �" Urinal 25.02 E-mail: ..°...1 %� /!� �) ■ 25.02 Water closet CONTRACTOR . Water heater 1 37.52 l , t r Business name: j e6 1 (( g , 6 (F5 Water piping/DWV 56.29 Address: 411 , ) Other: 25.02 Ci / State/ZIP: l / Subtotal ty l�� -/ Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB Lic.: i Plumbing Lic. no.: 3 - A S State surcharge -(1 -2% of permit fee) (PO . t. Authorized signature: TOTAL PERMIT FEE 5 • : a r Print nom, Ami Lama 0\ IS 1 1 D ate: 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:\ BuildingPermius \PLMU- PemutApp.doc 10/01 .' 440.4616T(10/02/COM/WEB) . • 09/7 - 1 OnA Ai, udag i llq C ° Building Division r 5 Development Code Provision Review T i c n Residential Projects • -Building Permit No: N L C 12- -00 ? 3 RECEiVED CWS Service Provider Letter Received: Yes ❑ No ❑ N/A `a FEB 2 2 2012 Routed Plans: Original Plan Submittal Date: 1 7' BU LD NG�[V� RD 1st Revision Submittal Date: A / 7' ❑ Site Plan Only DIVISION 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact � f at 503 - 7 -0 or .4A44.124.1 @ tigard- or.gov) Lan se Case No. PDQ. c o(l- 00001 Name 4i Hilt" on- Zoning' t X. Setbacks: — / Front (D Rear /a Side Street Side G�t'age 4 i Maximum Building Height 35 Actual Building Height '46 12' Visual Clearance F7'' sements Sensitive Lands Type: Notes: R evt z i L» ge otee .9415244 Pr' i _ cernfIi) P# P r't Li D 'L ?'U ' ¶ ? - i• ' - _, ti, a i 4 ' g. to Original Plan: Approved ` . Not Approved Er Date: 0 2.4 /A., Revision 1: Approved C" Not Approved ❑ Date: 3 /-2.-` R.- Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard- or.gov) .1 .Actual Slope: Notes: Original Plan: Approved Not Approved ❑ Date: `fi Z 1 Revision 1: Approved ❑ Not Approved ❑ Date: 11 Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 • City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @ tigard - or.gov) treet Trees L7 Protected Trees Notes: 5. k° SY"• SZe s�lurrn it t- i,rt;t7* �/ e A PI � ,,1 cry,.41.� P r Original Plan: Approved ❑ Not Approved Date: / - . Revision 1: Approved Not Approved ❑ Date: Revision 2: Approved ❑ 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 '4$ o . • Date Routed to Building: _ _ • Y Page 2 of 2 Building Permit Application . Residential •roR or FICFusL oNLY City of Tigard Received Date/B ® , I Permit No.: )9S /�!� - 3 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r . 2 . Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:_ s ��[ T I G r\ kW Inspection Line: 503.639.4175 Date Ready /By: Jam: El See Page 2 for .....::.ii• f Internet: www.tigard - or.gov Notified/Method: Supplemental Information • TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 154.1 -and 2- family dwelling ❑ Commercial /industrial _ . 3 ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder 0 Other: Number of bathrooms: 2- JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: I/O 3 . ss / � C t< 0,4,e t y New dwelling area: j 44 square feet City / State/ZIP: -- I/ 67 4—go , 0,/,� 172 2-3 Garage/carport area: iq q square feet Suite/bldg. /apt. no.: Project name: b /7 'd,¢,e_ A.4,46 .4,46 E. - Covered porch area: I square feet Cross street/directions to job site: Deck area: • square feet Other structure area: square feet . REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: / ,'-i fr6 Ate. ///b1.19.6-6.. Lot no.: /.6 Permit fees* are based on the value of the work performed. Tax map /parcel no.: 5 76 [ v� v Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRI O N OF WORK work indicated on this application. „ Valuation: $ /1157 — -OCT ti ter j /iJ6-G s cig:f / /=i:r?� Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/ State/ZIP: Existing: Phone: ( ) Fax: ( ) New: ' [APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* - . (Please refer to fee scliedule) Business name: , ��c S T[,�/D _�� /Jt/ST21GS Structural plan review fee (or deposit): Contact name: RCS f1 /. 0.;.J _ .7,4 , 1 $7,4,vp,2,C r� FLS plan review fee (if applicable): Address: `a 670 sW 68:`44. S A WO /7-2-7-3 Total fees due upon application: /E 4 City/State/ZIP: - . ,L) Q,Z L--/ / �, Amount received: 1 Phone: (S o - -'?4 Fax:: (07? ) a � //B ) p /j � �D �JYj,�JL, ((-OM -^ (, PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E -mail: j /�/5toi - 72A ,�o/: co/t4 Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted Pho • oltaic Solar Panel, System. Business name: /rVisr� - No /✓ai5T - j 5 Submit two (2) sets of roo •Ian with connec details and fire department access, a • i g.wit . - 2010 Oregon Address: 1�6 . 20 y/v lit, L ' Al .... 5 � Solar Installation Specialty Co = ecklist. �,/� ,vp $180.00 Permit Fee (includ • an rev'- City/State/ZIP.: 7- te-0 / v/L '1 12-3-5 ' and a• nistrative fees): Phone: (j ) Vi.) -- (96..2- , Fax: e 33) cci - 90g / State Burch. _ (12% of permit fee): $21.60 CCB lic.: 0 30d_ 33- -- = Total - fee-due -upon- application - - $201.60- - =— Authorized signature: �� This permit application expires if a permit is not obtained y �� - - - - • -- - within 180 days after it has-been-accepted as complete. � Ptint name: e . /� 1 ��1 ,,, P�iJ __3o._4. Date: / " Fee methodology set by Tn County Building Industry s� Service Board. I:\Building \Permits \BUP- ` RESPermiitApp.doc 02/24/2011 4404613T( I /02 /COM /WEB) . • • • RECEIVED II il r-i0 CITY OFTIGARD BUILDING DIVISION Cf) Lll 61TE PLAN NOTEe> IR E I ED %C I. AU. DEM GR1DII6 MATERIAL TO BE EXPORTED TO AN APPROVED DISPOSAL , , I LOCA7IOL ■Ii< I AU. F AREA. UNDER GARAGE FLOORS, 61DEWALK6, DRIVEWAYS, ETC- TO EE — LL IL COMPACTED GRAMLAR FILL 3. THERE WILL BE A SLIGHT OVER EXCAVATION TO PROVIDE CONCRETE PORING ALL HOMES AROUND NEW 6TRJC119RE. 4 PROVIDE A Ia FETlcun ARCM EXCAVATED AREA Skyline Homes PRIOR / 13' - 0" / 41'-6° \ 18'-6' 6021 SE PAilwaukie Ave. PRIOR TO 0 v TIa CN A C e rl UCTI LOKD GR°vELEO C°"°1R'Cn°" ENTRANCE 1 Portland, OR 97 ?(M 6. 6TOCKIRLE6 MUST GE COVERED UAW MLX34 OR PLASTIC SHEETING aE1UEEN Q 4 503.235.3810 OCTOBER I AND APRIL 30. 13.00' i E 0Af 1. COMPACTOR/ NT ACTOR/ OUB- CORACTOR TO VERIFY LOCATION OP AU. LRILRIES PRIOR TO CC1 \ O 0 � _ 1 uwhw.skyGneplans.eom a BOUmARY AND TOPOGRAPHY RFOR'IATIOI 14A6 BEEN PROVIDED TO SKYLINE INOMP -6 , 3 �' ' - t n Pva IN WATER MA • • AND DEGIE N INC. SKYLINE 14Or1E6 AND DP-61CA INC, WILL NOT BE HELD LIABLE FOR THE X 1: ; `: 163 _ ��'DRIVI ® O ACCURACY OP 11U6 IFGR'1ATICK IT 16 THE SOLE RESPONSIBILITY OP 114E CONTRACTOR 0 p I1�dIUNII SI i /OWNER TO VERIFY ALL SITE coma INCLUDING RU. PLACED ON SITE �.�. BD�Ie . �� L 6AK 60.10a LINE 1 I S. TOPOGRAP NY ELEVATION§ WERE COLLECTED FROM ACTUAL 6RE SURVEY. N F• PLAN 3044 B 2 i N 10. ELEVATION LEQN3� — _ ,' , � i 1 E. 0:1611146 GRADE ELEVATION - I TREE 2' CAL FE. FINAL GRADE ELEVATION \ 44' j J N FEE. FIUSFED FLOOR ELEVATION + - r R PROVIDE A 1111411121 GRAVEL BASE UNDER ALL DRlVEW4Y ANREAS EE 0A 13 �' J EE 0.0' 2 O. PROVIDE A 4' MINI ILI GRAVE. BASE UNDER ALL EIDBUALK AND PATIO AREA& Q o 13. PIPE ALL 6TOR1 DRAINAGE FROM THE eUILD1N6 TO A COMY/CRY DISPOSAL \ \ 48' - 0 ° ■ O A POI NT.006ECT10 IL 14. MAXII1 1 ELOPE OP OUTS AND FIL6 TO BE TWO C0140RZONTAL TO ONE CU DING 41 America. FOR BUILDINGS, 6TRJCIURE6, POL NDATIOw, AND RETAINING WA w 13 _ 1 11 / 1 ro " 11' -1(I� 11/32" II 1= 6. P160VIDE AND MAINTAIN PONI§H GRADE 11.1164 POSITIVE DRAI'IAGE AWAY FROM to 6TRJCIIJR= ON AU. 60E8 UJtTH A SLOPE OP 6' MIIIAJM IN 10' -O'. A N IMPERVIOUS AREA *: no 6Q. FT. DRIVEWAYS Q 65 6 FT. PORC14 • • 13 60. FT. WALK PLAN No.: 3044 100 PATIO 160 6Q. FT. OVERWANGS DRAIN: TF. 668 SQ. FT. BUILDING COVERAGE DATE: 02 -20 -12 1,386 TOTAL 50. FT. IMPERVIOUS AREA'S LOT LS SCALE: I'e20' -0' WHITE OAK VILLAGE • • LOT INFORMATION: TIGARD, OR. PLOT LOT AREA, 1911 6Q FT. PLAN IMPERVIOUS COVERAGE. 1,386 661 FT. ff r-a BUILDING COVERAGE' 10 % BUILDING HEIGHT. APPROX - - -- 31'•6' MIN. BUILDING SETBACKS' 113' FRONT, lb' REAR 3' 60E8. /� �� O • • • •111 ill CITY OF TIGARD BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: Phone: (503) 639-4171 yi Inspection Requests (24 Hrs.): (503) 639 -4175 1.L INSPECTION WORKSHEET FOR DATE• / (f (Z____) TIME: PAGE: SITE ADDRESS: I iO 3} � j G� L c t O k 1,0 4/ASS OF WORK: SUBDIVISION: ` LOT #: TYPE OF USE: PROJECT NAME: hem r/ ST //• DESCRIPTION: ma c e ( /{�� /� OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Fl o 4 t FA Corrections /Comments /Instructi ns: )11 ' ' S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL OR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: . . •■ Date: j' /Y (Z__-- Phone #: (503) 718- Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, /66 4, '&04.1 , am the general contractor or the owner - builder at the following address: Site Address: m33 Sa /)‘,/, City: Permit #: 50/e) Subdivision/Lot #: ' /Tz_ ate_ /S and/or Map and Tax Lot #: To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the general contractor that all moisture- sensitive wood framing members used in construction have a moisture content of not more than 19 percent by dry weight of dry framing members. Signature: `� ��'� � � Date: Ge Pr Contractor or Owner - Builder I:\ Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08 Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: A S T /? x00,07 Jurisdiction: " 77614/C-0 Site Address: fie 33 Stc) `c 6dC y ' a - / Subdivision/Lot #: 04, M '--e •4o hr- his and/or Map and Tax Lot #: By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2) 04 I Signature: Aar Date: lf� �d Op' /Gene al Contractor /Authorized Agent Print Name: �iQj Qi".6O/(/ ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. (:\Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08 . a STREET TREE TIGARD CERTIFICATION I, v 3 , owner/ agent for G z.ept7, (PLEASE PRINT) (PERMIT HOLDER) do hereby certift that the following location meets City of Tigard land use and development standards for street tree installation and is consistent with the approved site plan. PERMIT NO.: /195To - D00o SI"1 E ADDRESS: /(6 54) Ij6-46y 6 S UBDI VISION.• v4 - LOT #: SIGNATURE: (OWNER /AGENT) RE CEIVED d� _ VERIFIED BY DATE: Z6.- _ `CITY OF TIGARD) Tree location verified per approved site p la 17\ 04/01/2011 Program Use Only ' ( Form 640S FastTrack ID 1 Completion Certification —Site Inspection EnergyTrust New Homes Program— Single Family Data check by of Oregon (initials) To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. First Ins ctio Second Inspection Date: el 2d/� Verifier Name: P,��5'fo� Date: Verifier Name: Incentive Payee Company Name: Builder or Company: zs rf _�r,�D r of p . Contact Name: ; 4A 1 lv Performance Testing Company: Technician Name: Site Information Development Lot Number: REM /Rate SCO Project ID: y 7 Name: l5 File #: (required from verifier if 4-w / project Is ENERGY STAR) Site Address: 1 1 033 j t f 6 4.:/ t ttif City: L 45( 0 State OR Zip: S/ r) Unattached ❑ Attached Number of Stories: 3 f Total Building Square Footage: 20, 3 Number of Bedrooms 3 Basement ❑ None 0 Full Basement ❑ Half Basement Crawlspace Type El combo El Slab on grade ther Electric Provider § PGE ❑ PAC El Other. Gas Provider J'NWN ❑ CNG ❑ Other: Electric Meter Number: Gas Meter Number: (must apply to permanent meter) 3 C / /� n Q J q (.7077 r7 (must apply to permanent meter) t ( Additional Project Information (please marls all that apply) ❑ Code plus Best Practices (meets minimum Best Practice requirements with improvements above code) ❑ Path 1 EPS Best Practices 0.Path 2 ENERGY STAR ❑ Envelope Upgrade ❑ Ducts & HVAC Equipment Inside Equipment Upgrade ❑ Path 3 ENERGY STAR with ducts inside ❑ Path 4 Performance Plus with ducts inside ❑ Path 5 Advanced Performance ❑ Zonal Electric Efficient ❑ Advanced Electric Resistance ❑ Solar Electric (PV) El Solar Water Heating (SWH) ❑ Small Wind Renewable ❑ Solar Ready Electric (SRPV) ❑ Solar Ready Water Heating (SRWH) Energy ❑ Qualifies for Solar Ready Incentive (must attach checklist) Solar Installer: Name: Company: 7 Low Income ❑ Yes L ^ N Does this project qualify as Low income? (must provide documentation from builder) Accessory ❑ Yes c o Is this home an ADU? Dwelling Unit ❑ Yes atqo Is the ADU separately metered? If so, provide meter numbers above Other ❑ Earth Advantage — Certification Level: Certifications ❑ LEED -H - Certification Level: 0 Other (please specify): Form 640S v10 120101 Page 1 of 3 Return completed forth to: Energy Trust New Homes Program — Single Family 100 SW Main Street, #1600 • Portland, Oregon 97204 1.877.283.0698 • Fax 1.855.575.4315 newhomes@energytrust.org • - \1e.. i1\ C Completion Certification —Site Inspection EnergyTrust New Homes Program—Single Family of Oregon To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. Verification Type Actual Value Equipment Details& Notes Category Insulation Flat Ceiling R- (� Insulation Type: {� Framing Type: Vaulted Ceiling R- `i ` insulation Type: ❑ Standard Scissor Truss R- Insulation Type: ❑ Intermediate Above Grade Walls R- Insulation Type: ❑ Advanced 7 Framing Below Grade Walls R- v :, Insulation Type: Size: Floor Over Unheated Space R- Insulation Type: Floor Over Garage R- 111 Insulation Type: Slab Floor (unheated) R- ❑ Full Slab ❑ Perimeter Doors Door R- Windows Windows t/ U- _ Window Frame Material : v a � � SHGC: _ W Skylights U- SHGC: Window Area (Glazing) % Total window area: Lighting Indoor and Outdoor /-71-75 % # fixtures: # of ENERGY STAR fixtures or CFLs: I� )` Appliances ENERGY STAR Dishwasher Yes ❑ No EF N. Cooling Air Conditioning SEER: Btu /Hr. O Primary Heat ❑ Fireplace AFUE:154 Brand: f ,4,3 l(,i 3 Outdoor Unit (for heat Source IA Gas Furnace HSPF: Model # I ��js pumps) ❑ Electric ❑ Boiler ` d60 #.166ePaPr Model #: M Apes Heat Pumps: SEER: Serial #: �r l` Z�1 306 Serial #: ❑ Other: ❑ Air Source (ducted) COP: Btu /Hr. M i ❑ Mini Split (ductless) 4 14 r ❑ Ground Source (y1 �` Location: ECM: ❑ Yes o Heat u J\ ❑ Radiant Floor Heat pump commissioning 11111 �\` ❑ Cadets Electronic Air Cleaner ❑ No report attached or ❑ Z onal Backup fuel: ❑ Electric s Gas Other sou h for pumps that '04- u(- \ source heat pumps that ❑Other: v .i,v) manufacturer's start up L ( r t,• procedure was performed Additional notes on primary heating: Notes on secondary heating: Water Heater ❑ Storage Gallons: Brand: g, ,Any -A i Electric Tankless ��`f s Gas EF: Model #: -7 Location: Serial #: A o l� 3 Z ki Ai Btu/Hr: G ' Form 640S v10 120101 Page 2 of 3 Return completed form to: Energy Trust New Homes Program — Single Family 100 SW Main Street, #1600 • Portland. Oregon 97204 1.877.283.0698 • Fax 1.855.575.4315 newhome s @energytrust.org • A li Form 640S ?1■ Completion Certification —Site Inspection EnergyTrust New Homes Program—Single Family of Oregon To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. Verification Type Actual Value Equipment Details & Notes Category Ventilation Energy Trust Mechanical ❑ Exhaust Meets Energy Trust Mechanical Ventilation Requirements System Ventilation Requirement ❑ Supply1Yes ❑ No ❑ Exhaust & Supply ERV/HRV Model #: C L ❑ Heat Recovery Ducts i Ducts in Conditioned Space If claiming incentives ducts inside, check one of the following: ❑ Ducts Tested.F$fnspedion per RTF specs Duct Insulation R- / Duct Location 14, tt . ( it. p Duct Sealing w /Mastic Paste i ' Yes ❑ No Performance Testing & Duct System Information Ducts Duct leakage must not exceed 0.06 CFM @50 x floor area, or 75 CFM@50, whichever is greater. When tested without the air handler, leakage must not exceed 0.04 CFM@50 x floor area, or 50 CFM @50, whichever is greater. Multiple tests may be required. Duct Cubic Feet Per Minute Duct Leakage Air Handler In es Air Handler Present Yes Leakage: (CFM) a 50Pa: •gI / Pass ❑ Fail Conditioned Space ❑ o During Test N o Fan Pressure ❑ DG3 Fan / Ring Type ❑ O ER Leakage Test ArTotal Leakage Gauge DG700 Pressure: 3e .7 (check one) ❑ 1 Method Leakage to Outside Dud Blaster f r essure A) n" Location: ,.r' CN P Tap Location: 3 rcat,K. S• Area Tested: Whole House Air Changes per Hour E velope Tightness Cubic Feet Per Minute Leakage: (ACH) 50Pa:2 Pass ❑Fail (CFM) 50Pa: 77 House Volun � % 7 I Best Practices Requirements (.III requr.rOntents mint be met to receive an Energy Performance Score) • Thermal Enclosure Checklist Complete U Pass ❑ Fail Thermal Enclosure Checklist attached? El Yes • insulation Quality Inspection Performed 2es ❑ No 4 (complete insulation verification section below) • Approved Mechanical Ventilation Installed Er/es ❑ No 9 (complete mechanical ventilation section below) • Zonal Pressure Relief - All zones comply la/es ❑ No If no, state reason for failure: Combustion Appliance Zone Testing Net CAZ Pressure: Pa • If not applicable, please explain: i) (required) ��f 1 /� . Forced air system operation must not depressurize Combustion Appliance Zone (CAZ) by more than 3 Pascals (Pa.) 'All shaded sections are required for Best Practices. Applications will not be processed without these sections completed. Technical Compliance Options (please list all that apply) If any values on this form do not meet Builder Option Package (BOP) requirements, please indicate which Technical Compliance Option(s) allow the variance and explain which component was traded. TCO #: Explanation: Additional Notes: ,Signature By my signature below, I certify that I have performed the tests as described, that the form is complete, and that all information on the form is accu Verifier / 1 Verifier Date: Signature: r � Name: it l �' Red Tag Inspe tion (if noada Signature: Name: Date: Form 6405 v10 120101 Page 3 of 3 Return completed foml to: Energy Trust New Homes Program — Single Family 100 SW Main Street, #1600 • Portland, Oregon 97204 1.877.283.0698 • Fax 1.855.575.4315 newhomes @en ergyt rust. org