Permit CITY OF TIGARD MASTER PERMIT
1, .
a COMMUNITY DEVELOPMENT Permit #: MST2012 -00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/10/2012
Parcel: 2S114BA17700
Jurisdiction: TIGARD
Site address: 9654 SW FERN HOLLOW CT
Subdivision: FERN HOLLOW Lot: 3
Project: Fern Hollow, Lot 3
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 932 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1080 sf Garage: 378 sf Front: 11 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2012 sf Value: $224,744.72 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 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
Drywell -Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add! 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 & 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 2012
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports (Conditions)
17933 NW EVERGREEN PKWY 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503 - 639 -4175
SUITE 370 BEAVERTON, OR 97006
BEAVERTON, OR 97006
PHONE: 503 - 645 -0986 PHONE: 503 -645 -0986
FAX: 503 -690 -2942
Total Fees: $17,209.48
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 don: ' : • • : nce 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: . egon I: . requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 '01-0010 rough OA 9 -001-001. You may obtain a copy of the rules or direct questions to OUNC by calling 5 3.232.1987 or 1.800.332.2344.
Iss =d By: • P Permittee Signature: n''
Call 503.639.4175 by 7:00 a.m. for the next available Inspection dat .
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.
, _ , .
RECEEVED
JUN 18 2012
Building Permit Application
CITY pF o TD
Residential BUILDING , O1v. +jl,; 1 R OFFlCr; USE ONLY
City of Tigard Recehed Data"6y:rVW D ' — IS ) Pemut `o6S - 1 - a � o I•, - O�j(3
• 13125 SW Hall Blvd.. Tigard. OR 97223 Plan Rct' ► r 7 e t other Penner C
' C Phone: 503.718 2439 Fax: 503.598.1960 DateRv: r dea I . - • .
r l c ,t K u Inspection Line: 503.639.4175 Date Read' :.: tuns ® See Page ? for
Internet: www.ttgard- nr.goy Notified / // I 61.;• Supplemental Information
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XI 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
, -rr: � „.,,;: ;; ;,dare ,:a-.�.;, , {'
-t�:::;• .�, ?t:;::' : a -- . ,.;,: >,. •' "td. tf on this application.
=� > :s; ,.,, , ;�.� ,,,,.,�:1,,, ork indicated t t s a lucaut n.
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;x;:, :,;: :G"�TEGU <OF CUTIST �11C > lOhl . , :,�, , , , ,,, , �. :..,. , , :
23 I- 2-family 'dwelling Valuation. $ 2Z4
I- a
❑ Commercial /industrial
El Accessory building ❑ Multi- family Number of bedrooms: 5
❑ Master builder ❑ Other: Number of bathrooms:
:�„ „ ch'4 ,.�: „i:•, _ _. ,'.:,:;: �,• .a,, a yr. «A >' ;:� s��J T otal number of floors: 2
.? r "r ..;` OMA E..' S4RI�IA04:6 A]?DtiJSOG'f'j}Till ra .,r N '' � ?s u rer rs: o
,^. Y�.-.:':': iJ• ��lii '.C�`>''i: \t.:.;%:�.)i:�.: "al.:.T:'. <fs,;��cx.� v.::.,::. Y' I:.:. AVY:..:?' n i'iY:.'�.'(,:,.f.T,:Ctn:l:',., :`L`3ri:.(�`��kl���Y%v._��i
Job site address: 9654 SW Fern Hollow Ct Nov dwelling area: 2012 square feet
City/State/ZIP: Tigard, OR 97224 Garage/carpon area: 378 square feet
Suite/bldg. /apt. no.: I Project name: Fern Hollow Covered porch area: 38 square feet 10$n
Cross street/directions to job site: Deck area: NA square feet 1' 32_,
Other structure area 2390 square feet 26
tFi4 ^? i'h.A --" L +3y W•rtir" ,wry -�..Y 1. :"rte ^: 4ilr3 '-fs
Subdivision: Fern Hollow no.: 3 Permit fees” are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.:
y�x,;'r. •.w'e �,v'r'�
� + ?a,�� n1�, �. ;� �,�.- ,,, y ,,;;,� ; ,.,,�,,..� „ �_� { �r,,�� ,:,-,�:,, ^�,• �� equipment, materials, labor, overhead and the profit for the
::V i "i l �.' ?.:, <,... We ry`% „" - :..�'441a
; ' ? °st , 2 : :A' ; . r .t ., g UE'SCRIpO i inFs W,.ORfA,:A't r rf'°_,. r .� ,. r r °_ � y work indicated on this application.
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Valuation: $
Existing building area: square feet
New building area: square feet
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✓PhT�T_' =' _ �i'.i;�• •.. .i3m.ev.- � +i?i `�Y��.'1'�rn'r`: �` ie' fA: x°.', �J. iiil' i. 4e� A�. �.., �� ~i'�;GS'• + ?��.`.•E�''�S''aT�* -, Number of stories:
Name: Riverside Homes, LLC Type of construction:
Address: 17933 NW Evergreen Pkwy, Suite 370 Occupancy groups:
City/State/ZIP: Beaverton, OR 97006 Existing:
Phone: ( 503)645-0986 Fax: (503)690-2942 New-.
: "n U�tir�r"F..£_ a,;yC trw:M °tcr�.?•]!� f�:1 t ?t {:�.� , , , ,y:� - � w.rr � - =• .,�. e ' ;
�;a��.. .. �, SW t s1A. grate i �i ,T" c f aY ' •n ,^'. n " ++ ¢ r•.: 4 = t .. ,
rr ° � z� . �; [] „' �;;- ,��' =�:�p �.� � t ^�rs�,;
� .1:r S:�?T„r xll T.v r~• gigtr.,_ �'.. f•y � _ o � .
�� �: F2>;.; :f- 9srr. .rc,� � �-a {�'f Tg - R :� - 4•' . J ' � y ,.' ° . -.
�* �” ��t���% eSC��ftb�hf�b�l����� $i r4 �
Business name: Riverside Homes, LLC
Structural plan review fee (or deposit):
Contact name: Lindsay Adams
Address: 17933 NW Evergreen Pkwy, Suite 370 FLS plan review fee (if applicable):
City /State/ZIP: Beaverton, OR 97006 Total Pecs due upon application:
Amount received:
Phone: ( 503)645 -0986 I Fax: : (503)690-2942
cry' : ''' z- fi»..y 4 K s . s_ .,, s <
&email: LAdams @Riversidehome.com 7 , t g r1p e "s x
c yL ;r � -�..... x Q Commcial pres iptive insn
ma' tifr- � wog 0. :+ ,u N ., roof -top er mounted and Photovoltaic residential So
lar Panel Systemtallatio of .
Business name: Riverside Homes, LLC Submit two (2) sets ol' roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 17933 NW Evergreen Pkwy, Suite 370 So/ar Installation &,ecia)tv Code checklist.
City/State/ZIP: Beaverton, OR 97006 P ermit Fee (includes plan review $180.00
and administrative fees):
Phone: ( 503)645 -0986 Fax: ( 503)690 -2942 State surcharge (12% of permit fee): $21.60
CeB tic.: 189148 Total fee due upon application: $201.60
Authorized signature. Ci� This permit application expires if a permit is not obtained
VVV�� within 180 days after it has been accepted as complete.
Print name: Lindsay Adams I Date: • Fee methodology set by'fri- County Building Industry
Service Board.
I:1 BuildinglPermits \BUP- RESPcrmitApp.doc 02/24/201 I 440- 4613T(I 1 /02 /COM/WEB)
Plumbing Permit AppliRFC Eli/ E D
{ Building Fixtures JUN 18 2012 I (U 01 I.: USE ONLY
Received /
City s v 01 vd.,Tigard, may: 6 /eh,. if Permits o.: • 5r�/. -Gty�i • i � ' ■ iS9 TIGAID Phn Review
Phone: 503 Fax 59.1 t Date/By: Other Permit Noileo
1 WARD InspectionLine: 503.639.41 DIviSiuN DateReady/By: ,uric ® See Page 3for
/� -� /��
Internet: www.t or.gov NotlfkdlMethod: Su. •lemenralInformation
{t) i rill: _ - =--.-=-=--„F--: - 3 JA 1 t I ' 9 1 11
Qa New construction ❑ Demolition Forspedal Information use e eeeklist
Description I Qty. I Ea. j Total
❑ Addition/alteration/replacement ❑ Other: New 1.2- family dwellings (includes 100 ft for each utility connection)
-- - =t •i {aiej 7 Tai ; i.+ %1E ;(a)._ _ SFR(1)bath 312.70
® 1 -end 2•Camdy dwelling ❑ Commercial/industrial
SFR (2) bath 437.78
❑ Accessory building ❑ Multi-family SPR(3)beth 500.32 _•��
❑ Master builder Each additional bathlkilehen 25.02
❑ Other: Fire sprinkler( eq. It) Paget
.l )L} 1' i :i:(•) a ,rvu(t) r'l ,i;,c a c J i13 - Slte unilties:
Job site address: 9654 SW Fern Hollow Ct Catch basin or area drain 18.76
GtyiSialeraP: Tigard, OR 97224 Dm"ell, leach line or trench drain 18.76
Suite/bldgJapt. no.: 1 Project name: Fern Hollow Manufactured drain home utilities tic _) Page 3
Mamlfacttuedhomeutilitiw _ 50.03
Cross street/directions to job site: Manholes 18.76
Rein drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear IL: _) Page 2
Wateraervke (no. linear fl.: _) Page2
Subdivision: Fern Hollow ` Lot no.: 3 Mabee orHem:
Tax map /parcel no.: Backflow preventer 31.27
- -_,%t +y t(; y( :)iii+) ,, r - Backwelttvelva 12.51
_., golha washy 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectoralsump 25.02
__ _ .... :., l : % � �:<;., L>•:',-,-1 _�, - - - --- ;; • �r� -y - -- - F.xpansiontenk
_. .- • - ,C 7` ..,•. �.,:.:r'• ,�; 12.51
Name: Rivers . e " Omes, Fixture/se«er cap 25.02
Address: 17933 NW Evergreen Pkwy, Suite 370 FloordraiNllooratrdRtub 25.02
City/State2IP: Beaverton, OR 97006 H 25.02
Bose bffi 25.02
Phone: (503)645 -0 Fax: (503)690 -2942 Ice maker 12.51
4 , ) . l 'el- _ --'r- - i.,;t e inr : ?t t - - lnterceptor/greesetrap 25.02
Business name: Riverside Homes, LLC Medical gas (valueS Paget
Contact name: Lindsay Adams Primer 12.51
Roof Address: 17933 NW Evergreen Pkwy, Suite 370 SlrWbs1nk/bsain(miaq
slMavatoryvatory 25.01
25.02
ity /slate/ZIP: Beaverton, OR 97006 Solar units (potable water) 62.54 +
c
Phony (503)645 -0986 I Fax: : (503)690 -2942 Tub/shone/shower pan 12.51
s -mall: LAdams @Riversidehome.com Urinal 25.02
25.02
:..
Weux heater 37.52
Business name: H &H Mechanical Waterpiping/DWV 56.29
Address: 5757 SW Willow Lane other: 25.02 '
City/StaterLIP: Miliwaukie, OR 97267 Subtotal
Phone: (503) 975 -9787 Fax: (503)659 -2979 Minimum permh fee S72.50
CCB Lie.: 178122 Plumbing Lie, no.: PB414 Plan review (25% of pennit fee)
State surcharge (12% of permit Ibis)
Authorized signature: � y.am 4 TOTAL PERMIT FEE I
/` , Date' Thu permit application wins if ■ permit le not obtained within 160 drys
r L ` /777771 after it has been accepted u complete.
'Fee methodology cat by Trl.County Building IndasnySenice Board.
L iButdurgkPenaitARMU.Pemitepptloo 1091!09 440-4616T(I002/CO5VW88)
R ECE IV ED
JUN 18 2012
Plumbing Permit Application - City of Tigard CITY OF TIGARD
Page 2 - Supplemental Information BUILDING DIVISION
Fee Schedule: Residential Fire Sur ' ression S stems:
i (7 !'iiltL( ': _ ._ ? `'1 i L ' - w Jz ?ill ) 11' r. ,.._j '!)yii; + -;
Footing drain -1 100' 50.03 0 to 2 000 $121.90
Fooling drain - each addiu • 100' 37.52 20011°3 • r S169.69
Sewer - 1st 100' 62.54 3 601 to 7 00 S23320
7 1 and 2 eater $327.54
Sewer - each additional 100' 37.52
Water service - lst loo' 62.54 Medical Gas S stems:
Water Service • each additional 100' 37.52
SWIM & Rain Drain- 1s1100' 62.54
= 51.00 to $5 000.00 Minimum fee $72.50
Storm & Rein 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
• i r ' ..� r xr ,. r raj /t -� f (,.� J�1r1; each additional $100.00 or fraction thereof, to
ti Il ..a 11!X sr! (_1 i L� }.,I and inch:din_$10,000.00.
• inspection of existing plumbing or for SI0,001.00 to $25,000.00 $148.50 for the first S10,000.00 end 1.54 for
which no fee is specifically indicated ■ 90.00/hr ■ each additional $100.00 or fraction thereof, to
mWmumeh..e- l/dhour andincludin: $25000.00.
inspections outside ofnormalbusiness 90.00/hr - $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours minimum ch::e -2 hours each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and includin : $50 000.00.
Additional plan review for revisions . 90.03/hr - S50,001.00 and up " $742.00 for the first $50,000.00 and $ 120 for
minimum eh . -1/2 hour each additional 5100.00 or fraction thereof.
Subtotal:
•
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes",
please indicate work performed by fixture. Failure to
accurate) re r ort fixtures could result in increased sewer fees * .
3� lelliiiL +1����(I(L:t�I} 1 (.1 �= .UJIT X �Q0lr y.' ��'}
'ii3i 1, it r.b; S s 7F �r." f c ,,Isla iir v
� u'l.s3'akiir t ,r .;<_b is c' ' ,� l am : `, . t LE t , . ; Plan review is required for any of iho following.
Be Minn a Please check all that apply.
Bath - Tub/Shower ❑ Any new commercial building with water service 2 " and
- iacumlAVhid..ol greater, except systems designed and stamped by licensed
Car Wash -Each Stall - -_ engineer. ,
-Drive Thm ❑ New exterior plumbing site utilities for any complex structure
Cus . idor/Water As • rator as defined in 0AR918- 780 -0040.
Dishwasher - Commerc a ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose Eire sprinkler system.
Drinkm: Fountain = ❑ Any complex structure as defined in OAR918- 780-0040:
• e Wash
FloorDrain/aink • 2" -_ Submit 2 sets of plans with any of the above.
-4 ,.
Car Wash Drain
Garbage - Domeulc- non-food M • Isometric or riser diagram is required for new buildings
Disposal - Domestlo -food related MIIM � that meet the • ualifications above.
- Commercialo related --
-Industrial-food related
Ice MacbJRelt :: Drains
I S r r Station MEM NM= Comments regarding fixture work:
Rec. Vehicle Dam • Station -
Shower -Gang -
-Stall -
Sink/Lev - Non-f• . • related _
- Bradley MINMEN
- Commercial -food related -
- Service _ ��_
S vitamin Fool Filter
1Veaher - Clothes *Note: If the fixture work under this permit results In an
Water Ext actor � �= Increase of sewer EDUs, a sewer permit will be issued and
Water Coset- Toilet INMIN -_ fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Elxdaea:
httpJ/www.tigatd or.gov /city hallideparunents /cd/doeslPLMF•PermitApedoe
•
ii RECEIVED
Mechanical Permit Application ' ' • ' — - 1R 0 ii1( 1. I sr
JUN 1 8 2012 Received Aerlerrpr' Permit Ne.: A r/ 4,9a/A-er)/33
City of Tigard
omen ,
N 13125 SW Hall Blvd., Tigard. OR 97223 „ .,„ -
' 1 Phone: 503.718.2439 Fax: 503.598.100TV OF Tri. A - 71D P Eri 'cir.: -3v Other Penult: ..... ,
TIGARD Inspection Linz: 503.639.4175 'Pk el r MIR 3/..., ,, . -,,, ,,,, D ote a
Juns El See Page 2 for
Internet www.tigard D i d ILumu bavi6101\i , . "'
houfied/Method: Supplemental Information
:-;.''..',i.'3'.:Sr:i.a:1.2:::1*.:4*.0.#;:'*Og.}0.:;A%la.:;:.:':i:::.:i..::::::.;:::;-i::::::-..il':::;',:;;.-::N:::::,:',.:: '1..'''-:0StSfr-030800-**11EPO-04,410-031E-04441:P.:
Mechanical permit fees we based on the value of the work
egi New construction 0 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials. equipment, labor, overhead. and profit
440000V ------- - ------- ----- Y ••-, -------, - - - •
• - r•i.:::?;.::,:_,wipmEnpiA.t.,,tEllwrywignkmems.„*UstA:‘gg:;
r I- and 2-family dwelling 0 CommereiaVindustrial 0 Accessory building For special Information use ckeettlie.
0 Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
ll
:':•:.:a::::::'-..e:::::::-.:,...0..g:.:41,NYAITEIT0004...Pcg,1:4$0:440.0-Off.:.:'.4:;;N:::,-;:',W., Aieracottictcliopnlii:
conditioning
J°b site addn 9654 SW Fern Hollow Ct (requires site plan showing Dimmest , 46.75
Furnace 100,000 BTU (thEtshents) I 46,75
City/State/ZIP: Tigard, OR 97224
Furnace 100400+ BTU (duets/vents) 54.91
Suitribldg/apt. no.: I Project name: Fern Hollow Heal pump
(require; site plan showing pbeentenn 61.06
Cross street/directions to job site: Duct work 2132
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-d uct suspended, etc. 46,75
Subdivision: Fern Hollow I Lot no.: 3 Flue/vent for any of above 2132
Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
il:$ Water beater I 2132
Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Lon liable: (Zas) 23.32
Wood/Pellet stove .33.39
. • Wood *enlace/insert 23.32 .
g1.5.i..fiNS#401.i.0096-: 45 **Crealg.ag..1 - t-Mtlittg.4.1.KOM alimneY/161er"aeivent 23.32
23.32 _
Name: Riverside.Homes, LLC
Environmental exhaust and ventilation: _
Address: 17933 NW Evergreen Pkwy, Suite 370 R hood/other kitchen
equipment I 33.39
City;State/ZU': Beaverton, OR 97006 abthes diyer exhaust I 33.39
Phone: ( 503)645-0986 Fax: ( 503) 690-2942 Single-duet arhaust (bathrooms. zr-
taikteompanments, utility rooms) v 23.32 fit, -60
NISMSIgn*B4COttigig00:ai, 6213aufkootio2;: Attic/crauispace fans 2132
Bisirlis *the: s .Rivertidellorries; LLC Other: 23.32
Fuel WOW.:
Contact name:
• - St4.15 for first four; $4.03 for each additional
Address: 17983:NW:Evergreen Pkwy, Suite 370 . Furnace, etc. I /4.1 -t
Gas heat pumP
City/Stale/ZIP; Beaverton, OR 97006 Wall/suspended/unit heater
Phone: (503)54540986 I Fax: : (503)690-2942 Water heater I
Fireplace (
E-mail: LAdairS@RiVerSidehOMe.COM
Range% t ,
it•SRXT-Wgt;-V-*g-Wia;:.;:ge.t#.4..t*:Kn.t§..gittaflf.iYgMggNt Barbecue
Business name: Ari.deiteitHeating, Inc • Clothes dryer (p,as)
Other: •
Address: 6463 Dawn Ave
1-
City/State/ZIP: Lake Oswego, OR 97035 Sabiotal
Permit•fee (890.00)
Phone: ( 503)841-Q74') I Fan: (503)536-6615 Minim:
Plan review (25% of permit fee)
cal lie.: 168214 State surcharge (12% °twit it fee)
"")( . , TOTAL PERMIT FEE
Thls permit application expIrestro•perneth ata obtained id dila ISO
Authorized SiglIalUTC:
days after it has been aentlitml*eatattlete.
I Print name: Art Andersen . I Date: 5- /7 t-L I • Fee methodology set by Tri•Counly &aiding Industry Service Board
138nadinePerzninAMEC-ParratAwdoe 03/07/12 17T (11/02/COMMETI)
Electrical Permit A licati EC E EJ l:OR Olsrl(c 1 SF' ONLY
City of Tigard J UN 18 2012 °aie . �� / '' J
1 SW Hall Blvd., Tigard, OR 97223
' 0 ' Phone: 503.718.2439 Fax: 503.598.1960 t.: , : Other Parmir e �Ve.) l2.-.erw
: I .I ( i A R Inspection Line: 503.67 V75 CITY OF 1`IGAs�D haw ® see tee: For
BUILDING DIVISION Supplemental Information
TYPE OF WORK PLAN REVIEW
f New construction ❑ Addition/alteration/replacement Please cheek all that apply (submit z sets of plans wilicom checked below):
❑ Service or fader 400 amps or more 0 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
ill I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all otter installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pan4. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ �*smry � y derived system.
❑ Addition of new motor load of ❑ °A" "C "1 -2 `1 -3'
Job no.: I Job site address: 9654 SW Fern Hollow Ct IxxHPormom. occupancy'
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97224 ❑ Health-care facilities. ❑ Supply voltage for MOW than
❑ Hazardous locations. 600 volts nominal.
Suitc/bldgJapt_no.: I Project name: Fern Hollow ❑ scn'ice areedet600 amps or more.
FEE SCHEDULE '
Cross street/directions to job site: - Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Fern Hollow I Lot no.: 3 1,000 sq. 11. or less 1 168.54 4
Tax map/parcel no.: Fa add'I 500 sq. R or ponicn 33.92 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft)
Limited energy, multi- family 75.00 2
residential (with above sq. R.)
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
l PROPERTY OWNER I ❑ TENANT • 201 amps 10 400 amps 133.56 2
Name: Riverside Homes, LLC 40! amps to 600 amps 200 .34 2
601 amps to 1,000 amps 301.04 2
Address: NW Evergreen Pkwy, Suite 370 Over 1,000 amps or volts 552.26 _ 2
City/State/ZIP: Beaverton, OR 97006 Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( 503)645 -0986 I Fax: (503)690 -2942 200 amps or less 59.36 1
201 amps 10400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits wrth
) APPLICANT . I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch ciacuil
Business name: Riverside Homes, LLC B. Fee fur branch circuits without
service or feeder fee, fttsl 56.18 2
Contact name: Lindsay Adams branch circuit
Each add') branch circuit 7.42 2
Address: 17933 NW Evergreen Pkwy, Suite 370 Miscellaneous (servtee or feeder not included)
City/State/ZIP: dwelling, IP: Beaverton, OR 97006 darning, service s arred or and/or vr er 6784 2
feeder
Phone: ( 503)645 -0986 I Fax:: ( 503)690 -2942 Reconnector,ty 67.84 2
E -mail: LAdams(RIversidehome.com Pump orirngationcircle 67.84 2
Sign or incline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited
Business name: Western Cascade Electric panel, alteration, or extension. Pagc2 _ 2
Each additional inspection over allowable in any of the above
Address: 8900 SW Bumham St. G18 Additional inspection() hr min) 66.25/hr
City /State/ZIP: ligard, OR 97223 Investigation (Ihrmin) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( 503) 521 -0000 I Fax: (503 )521 - 8876 Inspections for which no fee is
90.00/ hr
specifically listed (fa hr min)
CCB Lie.: 153415 I Electrical Lic.: 34 -6160 I Suprv. Lie.:*` ZSs' : .. •• :.ELECTRICAL' PERMIT 'FEES : • • •
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Jeff Evens I Date: • .�91 , State surcharge (12% of pennit fee):
Authorized signature: 4 TOTAL PERMIT FEE:
�'
, The permit appliendon expires Ma permit as not obtained within 180
Print name: Jeff Evens I Date: 7 hull days tioo it has been accepted as complete.
• Number of inspections allowed per permit
clataldo PearmltELC PermnApp doe 07/01/10 440-46t5Tp 1 /05/COMIWEB
•
ii
• • •• R
Electrical Permit Application - City of Tigard JUN 1 8 2012
Page 2 - Supplemental Information
CITY OF Ta !_ ?s.
LIMITED ENERGY PERMIT FEES: BUILDING i►!i !:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ l Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
E l Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1.1130dd 1Pc eir- vcrtwApp.da 07/01/10
III
e ° Building Division
Development Code Provision Review
T i c n K Residential Projects
Building Permit No: "1 a C, I — 0 0 1 3 ? J
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A
Routed Plans: n
Original Plan Submittal Date: l� — (iS ^ 2.01 �
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approv d.
Planning Review (contact I' ILL. t " • e I 'A at 503 -718- ZV3f or o @tigard- or.gov)
Land Use Case No. 0 L +1e ' it- la ■ Name FJ9€i) Hb"t/ -bI.) ! ,/
.12- ' - • •
,D- Setbacks: l ` _ / /
Front J'/ Rear ( J Side S Street Side 10 Garage 2 d
J Maximum Building Height 3 Actual Building Height 2S`
B' Visual Clearance _
Easements /
❑ Sensitive Lands Type: t'Y/
Notes:
Original Plan: Approved.2 Not Approved ❑ Date: & —2 t Z
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
0 Actual Slope: et
Notes:
Original Plan: Approved ,e Not Approved ❑ Date: (o z5 /2
Revision 1: Approved ❑ Not Approved ❑ Date:
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)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved »a Not Approved ❑ Date: Cv Z
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
• Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or abert@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 ∎ IIII No ❑
Date Routed to Building:
•
•
•
Page 2 of 2
\ \ / \ 10.00' c
9654 SW Fern Hollow Ct \\ 25. \\ •$ 0' �ti'�
2012 B LEFT \ 1 <'
5/17/20 / '� %
RECEIVED ;v/ • / --
JUN 18 2012 I ¢ ' ,� (D � '
CITY OF TIGARD 61 � V � � ` ;o
BUILDING DlifiSION ;F
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20' 10' 0 20' 199 \
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SCALE: 1" = 20' \ 1
MINIMUM FRONT YARD:10 FEET (N) \a' \ \ 1 ^ '
MINIMUM FRONT YARD:5 FEET (E) \ /
MINIMUM SIDE YARD: 5 FEET (S) 1 '
MINIMUM REAR YARD: 7.90 FEET (W)
MINIMUM GARAGE: 20 FEET (W) \ I
P.U.E.: 10 FEET \ I
S �PAO� FERN HOLL W
TIGARD, OREGON
DESIGN GROUP INC. 0 LOT 3
14025 SW FARMlNGTON RD 0 � � le
sous 770 i. ow Project No. RVR001 Dote: 05/11/12
BEAVERTON, OR 97005 of 2
(503) 644 -4628 EXAMS 124143 J Scale: 1" = 20' Drawn By. KRF
Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: M Sr 201 L 00 a 3 Jurisdiction: `-, G,.A tizN
Site Address: CI GS s J - ttbi Ita.0 cr.
Subdivision/Lot #: 66 ie Ler 3
and/or
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: 2 a Date:
Owner /General Contractor /Authorized Agent
•
Print Name: b�� N 1 `_ S
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.
1:\Building\Forms\RES- HighEfficiencyLighting.doc 07/01/08
Oregon Residential Specialty Code 8318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, VI VEraiNs 14 0 44.1eS • , am the general contractor or the owner- builder
at the following address:
Site Address:
654 Sw FERni -� c 1„,„"
City: t CrAg-{7
Permit #: M ST Zo I L 001 33
Subdivision/Lot #: TE 1 1401 f o
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: 12- -3— / 2
Gene ontractor or Owner - Builder
1:\Building\Form\RES- MoistureSensitiveWood.doc 09/25/08
co xi.vr Vt 11 — g— I ins s V I— �� °��
Air & Duct Leakage Affidavit
Permit#: r
House address or lot number 4t 'ix� 1 e, nn- Noilod•P ('f
City: - `� A, r t/� Zip:
Cond. Floor Area (ft2): 7,1,117.- Average Ceiling Height: t 5—
Air Leakage test;
Maximum Alr Leakage: (EACH x V / 60) = I 7t0 CFM @50 Pa
Measured Air Leakage: 1, ) 5ii- CFM @50 Pa
Baseline: ! I Pa
Ring (circle one if applicable): Opee2 3
Windy? Yes No
Air Handler in condltio pace? yes 0 Air Handler present during test no
Circle Test Meth B. Leakage to Outside To . I Leakage
aximum duct le ka
Post Construction, total duct leakage: (floor area x .08) = CFM @50 Pa
Post Construction, leakage to outdoors: (floor area x .06) = I 7...0 CFM @50 Pa
Rough -In, total duct leakage with air handler installed: (floor area x .06) = CFM @50 Pa
Rough -In, total duct leakage with air handler not installed: (floor area x .04) = CFM @50 Pa
Test Result: 1 17 CFM @50Pa
Ring (circle one if applicable): Open 1 20
Duct Tester Location: 2fv Ul
Pressure Tap Location: -1--0 *4+ "0 P IA- ( 2 0 / ? I ( I f ,
I certify that these air leakage rates are accurate and determined using standard ODOE protocol.
Company Name: Westside Dr a 1t8rins • lation
Technician: K le Chase _■
Technician Signature: „'`r, °'-- . •
Date: ' oht' u 503 -806 -1339
71 1 q STREET TREE
TIGARD CERTIFICATION
, owner/ r agent o .► vas o- (4,0*14-ed, ,
g f
(PLEASE PRINT) (PERMIT HOLDER)
do hereby certj 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.: M 5 t' 20 c Z 00
ST1 E ADDRESS: Cf GS 4
SUBDIVISION: FE .1 C (d w LOT #: ? J
SIGNATURE: DAVE: IL
R /AGENT)
RECEIVED &
VERIFIED BY kf DA'1 E: 1Z - - /
(CITY OF TIGARD)
❑ Tree location verified per approved site plan.
I:\ Building \Forms \StreetTreeCertificate 05/30/2012