Permit INa
CITY OF TIGARD MASTER PERMIT
■ • COMMUNITY DEVELOPMENT Permit#: MST2014-00013
Date Issued: 03/12/2014
T I CiAR D 13125 SW Hall Blvd.Tigard OR 97223 503 718.2439
Parcel: 2S104CA06900
Jurisdiction: Tigard
Site address: 13430 SW HILLSHIRE DR
Subdivision: HILLSHIRE Lot: 69
Project: Young
Project Description: Create a 692 sq ft Accessory Residential Unit in existing basement and crawlspace
BUILDING
Floor Areas Required Setbacks Required
Stories 3 Bedrooms 1 First: 142 sf Basement' 550 sf Left 0 Parking Spaces 0
Height 0 Bathrooms. 1 Second: 0 sf Garage 0 sf Front 0 Smoke
Dwelling Units 2 Third: 0 sr Right 0
Detectors Yes
Total 692 s' Value $74.100 00 Rear 0
PLUMBING
Sinks 2 Water Closets 1 Washing Mach. 2 Laundry Trays 0 Rain Drain 0 Urinals 0
Lavatories 1 Dishwashers 1 Floor Drains 0 Sewer Lines 0 SF Rain Storm Sewer 0
Drains 0
Tubs/Showers 1 Garbage Disp 1 Water Heaters 0 Water Lines 0 Catch Basins 0
Bckflw Prevntr 0
Footing Drain: 0 Ice Maker 0 Hose Bib'. 0 Backwater Value. 0
Drywell-Trench Drain 0 Other Fixtures 1
Other Fixture Units sump
MECHANICAL
Fuel Tvoes Air Conditioning N Vent Fans 3 Clothes Dryers 2
Natural Gas Heat Pump N Hoods. 1 Other Units 0
Furn<100K 1 Vents 0 Woodstoves• 0 Gas Outlets 2
Furn>=100K 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less- 0 0-200 amp 0-200 amp 0 W/Svc or Fdr 3
Ea add'I 500 sf 0 201-400 amp 1 201-400 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 N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADU SF vB H-3 652
Owner: Contractor:
YOUNG.BRADLEY RONALD&REBECCFOWNER Required Items and Reports(Conditions)
13430 SW HILLSHIRE DR BRAD YOUNG
TIGARD.OR 97223 13430 SW HILLSHIRE DR
TIGARD.OR 97223
PHONE 503-807-6953 PHONE: 503-807-6953
FAX
Total Fees: $3,310.12
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 it work is not started within 180 days of issuance. or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are et forth in OAR
952-001-0010 through OAR 952-001-0090 You may obtain a c•• •. •- rules or direct questions to OUNC by calling 503 232.1987 or 1 80 2 2344
Issued By: -� Permittee Signature:
Ca •i .•39.4175 by 7:00 a.m.for the next available inspection date.
41°
This permit card shall be kept in a conspicuous place on the job site until completi• of the •roject.
Approved plans are required on the job site at the time of each inspec on.
Suilding_Permit Application
Residential RECEIVE. FOFtt)FFICE: I SE t)\t.l
City of Tigard
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
r,
■ FEB 5 2014 t� : P I = [+:� Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960
r�,�
l 1 G A K 17 Inspection Line: slate Ready : : See Page 2 for
Internet; www.tigard-or.gov CITY OF TIGARD N .' ethod: /° �� Supplemental Information
TYPE OF W 1 r ` /�Iiir REQUIRED DATA:1-AND 2-FAMILY DWELLING
,
❑New construction ❑Demolition Wi•'41,1111 Q Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement El Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application
® I-and 2-family dwelling ❑Commercial/industrial Valuation: $74,100
❑Accessory building El Multi-family Number of bedrooms: I
El Master builder ❑Other: Number of bathrooms: I
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address:13430 SW Hillshire Drive New dwelling area: 550 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldgJapt.no.: Project name:Young ARU Covered porch area: square feet
Cross street/directions to job site:Between Mistletoe and 135th Deck area: square feet
Other structure area: 142 square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Hillshire J Lot no.:06900 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:WCTM 2S104CA Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Create an approximaetly 692 square foot accessory residential unit spanning two Valuation' S
stories within an existing basement and crawlspace below an existing 3730 square Existing building area: square feet
foot single family residence. New building area: square feet
0 PROPERTY OWNER l ❑ TENANT Number of stories:
Name:Brad Young Type of construction:
Address: 13430 SW HilLshire Drive Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)8074953 Fax:(503)5797845 New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Meese refer refer schedalee)
Business name: '
Structural plan review fee(or deposit): 596
Contact name:Brad Young
-
FLS plan review fee(if applicable):
Address: 13430 SW Hillshire Drive •
Total fees due upon application:
City/State/ZIP:Tigard,OR 97223
Phone:(503)807-6953 Fax::(503)579-7845 Amount received:
E-mail:brad.young(ugraceclinic.org PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: C50 E(i---- Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review 5180.00
and administrative fees):
Phone:( ) I Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lie.: 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:Brad Youn Da e:2/5/2014 *Fee methodology set by Tri-County Building Industry
Service Board.
1:1Building\Permits1BUP- itApp.doc 0 011 440-4613T(11/02/COM/WEB)
Plumbing Permit Application RECEIV Fixtures RECEI V I'OR OFFICE USE (INI l
Received
City of Tigard Permit No.:
a 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: 02 /yam fiJ 5T4�i/ -GDo�3
_ Phone: 503.718.2439 Fax: 503.598.1960 FEB 5 LO Plan Review
Date/By Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: orris I El See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGi l__iiftc&Method. Supplemental Information
TYPE OF WORK BUILDING DIVISIO, FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility correction)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Comerciallindustrial SFR(2)bath 437.78
m
SFR(3)bath 500.32
❑Accessory building ❑Multi-family •
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site addrest /?;./ . .5w /7/&z, Catch basin or area drain 18.76
City/State/ZIP:
/ Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: l Project name: >%�✓/�r
L7 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.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer _ 31.27
DESCRIPTION OF WORK Backwater valve 12.51
J Clothes washer 2. 25.02
` � /T .1,40 Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump / 25.02
54 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Yn44,7„,(-7 Floor drain/floor sink/hub 25.02
Address:
Garbage disposal i 25.02
City/State/ZIP: Hose bib 25.02
Phone9 O) v7 49c9 Fax:( ) Ice maker 12.51
`� ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 3 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan / 12.51
E-mail: , Urinal 25.02
Water closet J 25.02
CONTRACTOR
Water heater / 37.52
Business name: ! ire_ 4444,v Water piping/DWV 56.29
Address: //5--7,), C!-.,/ Trea_ to 1.4 Fe 44, Other: 25.02
City/State/ZIP: del ur..9t Lie 47vo? Subtotal
Phone:(et71 ) '5-1,/4,_ ` 39i Fax:( ) _
Minimum permit fee: $72.50
CCB Lic.: pe 70Z'i/ Plum•'ng Lic.no.: /)�{`a d Plan review (25%of permit fee)
/" State surcharge(12%of permit fee)
Authorized signature: ,/ TOTAL.PERMIT FEE
Print name: f r i ,0, `_ Dated 4- This permit application expires it'll permit is not obtained within 180 days
after it has been accepted as complete.
IPV *Fee methodology set by Tri-County Building Industry Service Board.
I\Building\Permits\PLMU-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEli)
A
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 010 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer- l st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty- Fee(ea) Total each
including 0 0or fraction thereof,to
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 fur the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) _ each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Each stall ❑ New exterior plumbing site utilities for any complex structure
Drive'tall as defined in OAR918-780-0040.
ID Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash p Y
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
-4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related _
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filer increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be aid before the
Water Extractor p
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
l:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Mechanical Permit Applica iCE f`J r'D FOR OFFICE USE ONI.1
City of Tigard Received , igrall MI 1'elmit No.:fl Ti .' //3
11 13125 SW Hall Blvd.,Tigard,OR 97223._ Plan Review
Phone: 503.718.2439 Fax: 503.598.1h608 5 2014 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: leis El See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
f IUIILDaG DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
TYPE OF
Mechanical permit fees*are based on the value of die work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑ Master builder ❑Other: Description I Qty. Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning :.46.75
Job site address: d./.? /....g.,0 !2 ,w/ �LGS /je/ /lc, Furnace 100,000 BTU(ducts/vents) ,_ r 46.75
City/State/ZIP: vV Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Y�lJ�6 Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: 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
Other: 23.32
Subdivision: Lot no.: Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert / 33.39
Flue vent for water heater or gas
('4 477 f/ U fireplace 23.32
l.og lighter(gas) 23.32
Wood/pellet stove 33.39 _
_ Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
'PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name: yn:i / Range hood/other kitchen
equipment / _ 33.39
Address: Clothes dryer exhaust 2., 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 3 23.32
Phone:c goy Z, r/ g Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
514.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. /
Gas heat pump
Address: ,
•
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: q II �Y,.i.t lv Lu. .
j' MECHANICAL PERMIT FEES*
Address: /PU "q /5 e I
,9 Subtotal
City/State/71P: 14 tL! Of ex q A-,— Minimum permit fee permit fee)
t- Plan review(25%of permit fee)
Phone:(5 3 ) r)e— Fax:( )
p�}'-Z.{� State surcharge(12%of permit fee)
CCB lic.: Jr, S:".. _i/ or TOTAL PERMIT FEE
f This permit application expires if a permit is not obtained within IRO
days after it has been accepted as complete.
Authorized signaturgf • Fee methodology set by TO-County Building Industry Service Board
Print name: e,,�U DDate: __— /e/
I:\BuildinglpermitslMEC_Pmnitgpp_04011},dot 440-461 (I1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:113uilding.Pcnnits\MEC_PennitApp_040113.doc 2
Mar 12 14 07:26a Pacwest Electric Inc 3605736755 p.1
Mar 11 1405:05p Young Family 503-928-4779 p.1
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Owner signature: Date: . Branch circuits-new,alteration.ati letuneio n.per panel
A.Fee for bunch curtails wit' L
❑ iarri tcwrri ❑ GOTrfACT T61t$OtY RgVe Service or metier fee. ��
Business name: emirbratchcircuit r-
--- - -- - -- - - a.Fee far brooch omits•rrowrr
Contact name. service or-realer ke.list 3416 L-
--- - branch circuit
Address: Each 2611 branch circuit 7.42 2
City'StaoeiZIP. R e.c.Ilrnenex Oa-vvieo•err•female a ewe iadr.JeJ) - -
Each manufactured or modular 6724 I 2
Phone:( ) I Fier--( 1 t'aeliri,service aed'orfcedes
Recomect only 67.14 —2
E-mail: ANmp orirsigerooncirclo 67.14 2
. CONTRACTOR. Sign Q outline ligtea 6714 '
8usits C-tw � � � 2 C
Signal drcuit(s)1WUnused-deem/ See
panel,ataxation,or extension. ! l Page? 12
Address: P.Q. Zip)( $a(p Each additional inspection over allowable is so}of the above
. Addc.onal inspection tic trio) 64.23.1 hr
City/Stale/ZIP: ��i�c �,�2RTa.�:r.� . v.;� Gj�ty�.f. 1
Imes Moi(1 hr twin) 56?57►r '
IPhorte:(360,)) fir:�To-v1 Fax:( 3c ) 5't 3- (41.G S + Industrial p&ue(1 hr cea) ii,18/hr
i� -9 �� , Su i�' lnsaaLtons fcrwhichop fete
GCIA Lit! MIS/hr
' par.[,;c-: , spwittsc (:5 br min)
1 Super.Electrician . � 0,- equired. r -7 + 1 Id ELECTRICAL PERMIT FEES • -
Subtodk
i nn1 naree - —� ►. . ��� f off. fl yL ter rrrinv OSlL ofp;rmit flea)
/ '1 r— Slat{surrev igr'(12%of permit fay)
/LUthoiizzd signs 411-1 �r 3''G1 TOTAL PERIIIIT iE&
Print name. )/fi�J / r y d[C'��5 I4 T h i s p e r m i t applies a i if ei inot otite
d with k 190
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- Nan bn or ince:1i wt an.-,sod per perrne.
119oildirKJrrsrn`ELc ibrgApp-eu t3laac F CSP.J/Xtf 14)44IST11br)bCCM/WEB
!'n',- Z
Building Permit Number: H'-f �ic /4-000 /3
Building Permit Review
Residential Projects
IIGARU
Site Address: I�j�}7jp SyJ i}iltshlre) Drive}
Fi(rify site address is valid.
Project Name & Lot #: }-4 11` 111-1 S A 061 IV lS I O i I Li*
Clean Water Services—Service Provider Letter: (lot platted prior to 9/10/1995)
Required: Yes ❑ No yl, Received: Yes ❑ No
Site lan Elements:
ite plan must he on 8-1/2"x 11"or 11"x 17"paper ,_, ree(3)copies of site plan
C'r'rgwn to scale(standard architect or engineer scale) LYNoith arrow
Map and tax lot number,site address,project or subdivision ootprint of new structure(including decks)with finished
game,lot number,and zoning floor elevations
L7,lpplicant information(name and phone number) Ctyand building setback dimensions
roperty corner elevations(2 foot contour lines if more than t area,building coverage area,percentage of coverage and
�/4 foot differential) impervious area.
[}utility locations 2,� cation of wells/septic systems.
C� sting structures on site EiSur�face drainage
G181.5cet names GY�tteet tree size,type and location
agiosion control(including drainage-way protection,silt fence existing trees to be retained with drip line,and tree
design,location of catch basin,etc.) protection measures
Planning Review
L14-and Use Case Number: -A 201,-cpp I
1 'Zning: f2 f2-1 1 tr'Setbacks:
,�_/Front IS Rear l r� Side 5 Street Side E O Garage 7C)L� dscape Requirement: SO
LW t Coverage Maximum: 90
'
�B ulding Height: Maximum Height ' Actual Height t1 JPc
tsual Clearance
yEasements
EY<nsitive
Lands: I/Yes Type S '"`" Slopes
an Forestry Plan
IL Conditions Satisfied
Approved by: -' • M Date: 2.19//y
Notes:
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
I:\Building\Forms\ul dgPermitRvw_RES_123013.docx
Building Permit Submittal
Original Plan Submittal: Date: ,,2J' 4 Y B . , ,,
Site Plans: # 3
Building Plans: # .9.)
Create Case Record#: ❑'Enter case# bove for Building Pe t Number. ,(
Workflow Routing: Planning Engineering EPermit Coordinator LI Building
Workflow Sign-off: Sign-off for Planning staff,including notes from planning review(page 1)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan,(1) building plan and
original plan review routing form.
2 Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Reviewed By: Date:
Notes:
Engineering Review—reviewed by: hi.f lz,1. Gv
Actual Slope: ¢-f ZO 70
e.Conditions Satisfied
Notes:
Approved by LI Date: t- 5
f
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
ermit Coordinator Review
(Seeonditions Met-Prior to Issuance of Building Permit
Notes:
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant
Revision Notice 3: Date Sent to Ap. ' ant
11 �� , 11
Okay to Issue Permit - / � i �_/ Date:
i:\BuildingWorms1131dgPermitRvw_RES_123013.docx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13430 SW HILLSHIRE DR, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
PASS
July 16, 2014 at 10:23:47 AM
MST2014-00013
Jeff Grove
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13430 SW HILLSHIRE DR, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - No C of O
January 12, 2015 at 10:53:52
AM
MST2014-00013
David Young
Violation Summary:
Inspector Contractor