Permit n CITY OF TIGARD MASTER PERMIT
"! ' COMMUNITY DEVELOPMENT Permit MST2014-00196
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/10/2014
Parcel: 2S110CB09000
Jurisdiction: Tigard
Site address: 12412 SW AUTUMNVIEW ST
Subdivision: MOUNTAIN VIEW ESTATES Lot: 15
Project: Mountainview Estates, Lot 15
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 6 First: 1032 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height 35 Bathrooms: 4 Second: 1740 sf Garage: 671 sf Front: 15 Smoke
Dwelling Units: 1 Third: 1602 sf Right: 5
Detectors: Yes
Total: 4374 sf Value: $526,247.82 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 5 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 Tvpes Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 5
Fum>=100K: 1
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'I 500 sf: 9 201-400 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 4374
Owner: Contractor:
CHRIS&JENNIFER NGUYEN TIMBERRIDGE DEVELOPMENT INC Required Items and Reports(Conditions)
12412 SW AUTUMNVIEW ST 1001 NW LOVEJOY STREET#812 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97224 PORTLAND,OR 97209 2 geo tech report required prior
to footing inspection
PHONE: 503-351-9381 PHONE: 503-803-9184
FAX: 503-297-9029
Total Fees: $27,444.01
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the ' ct questions to OUNC by calling 503.232.1987 :00.332. 44.
Issued By: ,'�/�� r , Permittee Signature: 4'•
Call 503 y 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
sti
Transmittal Letter
TIGA,RD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: / E �d `n DATECE
DEPT: BUILDING DIVISION
-- Pr. 1VED
NOV 12 2015
FROM: JD I LI CITY OF TIGARD
BUILDING DIVISION
COMPANY: f l ✓t, ( - r Pitt, e 0--0/G(v p(H,ckt
PHONE: 3 - ry 3 ) By:B.?'
RE: Z -(Z S w l}�, 4-a vn v rGL:f—_ /
(site-Address) (Permit Number) -c240,,„/-/4 rN !4(-e-✓ Eo7-dr- • /5's-
(Project name or subdivision name and lot n • b-')
Ala°
ATTACHED ARE THE FO , : "
Copies: Description: M Copies: Description:
Additional , (s) of plans. 2 Revisions:
Cross sect'on(s) : d deta. . Wall bracing and/or lateral analysis.
Floor/ro r f framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other - plain):
•
REMARKS: ro 7 i . efc-1111°`' E I N1 5 if i414 kr'el I s a c;(
..»_ FOR OFFICE USE ONLY
Routed to Permit echnician: Date: I)//a f i 6-
• •
Fees Due: � es ❑ No Fee Description: Amount Due:
Ptah re.von-f_ I-4301 $ 90
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: ,o Date: j///y/j y Initials: /2.7-_
1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
Building Permit Application RECEIVED
Residential NOV 3 2014 FOR OFFICE l 1:O,NL1
City of Tigard Received
11 14 *1 13125rSW Hall Blvd.,Tigard,OR 976ITY OFTIGARD Datc/By 3 Permit No.: t�aQ� /q6
= Phone: 503.718.2439 Fax: 503.
Plan Re IP!" / I A Other Permit'5143 -o�0/��it(Q
TIGARD
Inspection Line: 503.639.4175 C DING DIVISION Dat Ready :y: Juris: ® See Page 2 for 400 Internet: www.tigard-or.gov /. thud: it /g / 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.
® I-and 2-family dwelling I.3 Commercial/industrial Valuation: $ 52-()24787::
Accesso building Number of bedrooms: 6
❑ ry g ❑Multi-family
❑Master builder ❑Other: Number of bathrooms: 4
JOB SITE INFORMATION AND LOCATION Total number of floors: 3
Job site address:12412 SW Autumnview Street New dwelling area: 4374 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 671 square feet/6e: 7
Suite/bldg./apt.no.: 1 Project name:Nguyen Residence Covered porch area: 362 square feet l74O
Cross street/directions to job site:Corner of SW St Andrews Lane Deck area: 360 square feet td �
Other structure area: 7-5.04,5— square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Mountain View Estates I Lot no.:15 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S110CB09000 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. _
New Single Family Residence Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Chris&Jennifer Nguyen Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:(503)351-9381 Fax:( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:RAE Design&Associates
(Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Rich Eisenhauer
FLS plan review fee(if applicable):
Address:6925 SW Netarts Court
City/State/ZIP:Beaverton,OR 97007
Total fees due upon application:
Phone:(503)310-5583 Fax::( )
Amount received: 475C".t�
E-mail:rich @ikeinc.net
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Co .cial and residential prescriptive installation of
CONTRACTOR roof-top . ted PhotoVoltaic Solar Panel Syst-
Business name:TimberRidge Development Inc Submit two(2 A of roof plan with connec'. details
and fire department . ess,along with 1• 010 Oregon
Address:1001 NW Lovejoy Street,#812 Solar Installation Specia ode c . list.
City/State/ZIP:Portland,OR 97209 Permit Fee(includes pl.1 •view
$180.00
and admini it . ive fee •
Phone:(503)803-9184 Fax:( ) )
State surcharge /o of permit fee): $21.60
CCB lic.:177551 *7 roZ4�S.-- T .1 fee due upon application: $201.60
Authorized signature: 1 /�1 This . rmit application expires if a permit is not obtained
�/ within 180 days after it has been accepted as complete.
Print name:Rich Eisenhauer Date:11/3/14 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
RC11\!IA'
Plumbing Permit App 'cation
Building Fixtures Nov 3 2014 FOR OFFICE USE ONLY
City of Tigard d�af�nG Datei"ea
TjGARDr/g �I Permit No.:� ddl�(
E.■ 13125 SW Ilan Blvd.,T�� NiS10N Plan Review /�_,/� ,�l ��/�
E.
Phone: 503.718.2439 iv Date/By: Other Permit No.:C 4,1 -01
Inspection Line: 503.63 Date Ready/By: Juns: 0 See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
,rv.-s r. ► n . Description Qty. I Ea. I Total
❑Addition/alteration/replacement [� )fit ter: New 1-2-family dwellings(includes 10(1 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen I 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:12412 SW Autumnview Street Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Nguyen Residence Manufactured home utilities 50.03
Cross street/directions to job site:Corner of SW St Andrews Lane 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:Mountain View Estates I Lot no.: 15 Fixture or item:
Tax map/parcel no.:2S110CB09000 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New Single Family Residence Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Chris&Jennifer Nguyen Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:(503)351-9381 Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:RAE Design&Associates Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Rich Eisenhauer
Roof drain(commercial) 12.51
Address:6925 SW Netarts Court Sink/basin/lavatory 25.02
City/State/ZIP:Beaverton,OR 97007 Solar units(potable water) 62.54
Phone:(503)310-5583 Fax::( ) Tub/shower/shower pan 12.51
E-mail:rich @ikeinc.net Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Garcia Plumbing LLC Water piping/DWV 56.29
Address:738 7th Street Other: 25.02
City/State/ZIP:Independence,OR 97351 Subtotal
Phone:(503)606-4178 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) -
CCB Lie.: /3835'/ i/!//J 44, Plumbing Lic.no 43835? vl 111 7 State surcharge(12%of permit fee)
Authorized signature: VU.1j- TOTAL PERMIT FEE
Print name: i`n_ Date: 1 I 3- f This permit application expires if a permit is not obtained within 180 days
Ci\{ ��5��l�pr"b after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1.\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02JCOM/WEB)
KIiLLIVI1J
Mechanical Permit Application FOR OFFICE USE ON L1
City of Tigard NOV 3 2014 Received 1 N�. /
• 13125 SW Hall Blvd.,Tigard,OR 972�
Date/By: /I 3//� � l /7ic..Ul`/._// 0l C/6
Phone: 503.718.2439 Fax: 503.598.14FiI1TY OF TIGARD
Plan
Date/By:Review Other Permit: u,�g()/y—!Jr//6
r I G A R h Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees'are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use check list
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 12412 SW Autumnview Street Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) k 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Nguyen Residence Duct work 23.32
Cross street/directions to job site:Corner of SW St Andrews Lane 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:Mountain View Estates Lot no.: 15 Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2S110CB09000 Water heater ( 23.32
DESCRIPTION OF WORK Gas fireplace/insert 2-- 33.39
Flue vent for water heater or gas
New Single Family Residence fireplace 23.32
Log 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 ❑ TENANT
Environmental exhaust and ventilation:
Name:Chris&Jennifer Nguyen Range hood/other kitchen
equipment 33.39
Address:
Clothes dryer exhaust 1 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) �-) 23.32
Phone:(503)351-9381 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ® CONTACT PERSON Other: 23.32 _
Business name:RAE Design&Associates
Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Rich Eisenhauer Furnace,etc.
Address:6925 SW Netarts Court Gas heat pump
WalUsuspended/unit heater
City/State/ZIP: Beaverton,OR 97007 Water heater 1
Phone:(503)310-5583 Fax::( ) Fireplace ,
Range
E-mail:rich @ikeinc.net Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Air Comfort Inc Other:
MECHANICAL PERMIT FEES*
Address:16055 SW 74th Avenue,Suite B Subtotal
City/State/ZIP:Portland,OR 97224 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)287-2888 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:58835 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
1 A /I days after it has been accepted as complete.
Authorized signature: Y 4 * Fee methodology set by Tri-County Building Industry Service Board
Print name: (2_1 L\54- e IS.CA erL Date: 1 i_ 3_ )4
I:\Building\Permits\MEC_PermitApp_040t 13.doc 440-4617r(I1/02/COM/WEB)
. •
Electrical Permit Application ti l�4 FOR OFFICE USE o�i1.Y
City of Tigard [\\ �,.� Received Permit No.: — • /
IN
a V �(�
Date/B ♦ infer I�
13125 SW Hall Blvd.,Tigard,OR e Plan Review
g '(, Plat Other Permit
Phone: 503.718.2439 Fax: 503.59 .1960,A Dateftiy.
Inspection Line: 503.639.4175 \N`-' V pate Ready/By: 1 Juris 1 El See Page 2 for
TIGARD Internet: Line. gard-Or.gov ( � .� (� � �otified/Method: � !r Supplemental Information Y.
TYPE OF WORT 71 PLAN REVIEW
®New construction ❑Addition/alteratio ement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
El 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
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E",'I-2"."I-3",
Job no.: Job site address: 12412 SW Autumnview Street 100HPormore. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations 600 volts nominal.
Suite/bldg./apt.no.: Project name:Nguyen Residence ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:Corner of SW St Andrews Lane Description 1 Qty. I Fee. 1 roaal 1 •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision:Mountain View Estates Lot no.: 15 1,000 sq.ft or less ( 1 168.54 4
Tax map/parcel no.:2S110CB09000 Fa.add'1500sq.ft.or portion ei 33.92 1
P/P Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00
New Single Family Residence residential(with above sq.ft) -
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
El PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 '-
Name:Chris&Jennifer Nguyen
401 amps to 600 amps 200.34 , 2
Address: 601 amps to 1,000 amps 301.04 , 2
Over 1,000 amps or volts 552.26 I
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:(503)351-9381 Fax:( ) relocation
200 amps or less 59.36 1 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447.449,670,and 701. 401 amps to 599 amps 168.54
Owner signature: Date: Branch circuits-new,alteration,or extension, Cr p panel
® APPLICANT I ® CONTACT PERSON A.Fee for branch circuits with 1
above service or feeder fee,
7.42
Business name: RAE Design&Associates each branch circuit
B.Fee for branch circuits without
Contact name: Rich Eisenhauer service or feeder fee,first
56.18 2
branch circuit
Address:6925 SW Netarts Court Each add'I branch circuit 7.42 2
City/State/ZIP: Beaverton,OR 97007 • Miscellaneous(service or feeder not included)
Each manufactured or modular ( 67.84 2
Phone:(503)310-5583 Fax: :( )
dwelling,service and/or feeder
Reconnect only 67.84 2
j E-mail:rich @ikeinc.net Pump or irrigation circle I 67.84 2
CONTRACTOR 1 Signor outline lighting 67.84 2
Business name: Elite Electric Group,LLC Signal circuit(s)or limited-energy j See
panel,alteration,or extension. Page 2 2
Address:6150 NE 92"d Drive,Suite 104 Each additional inspection over allowable in any of the above
Additional inspection(1 hr mm) 1 66.25/hr
City/State/ZIP: Portland,OR 97220 kIU Investigation(1 hr min) { 66.25/hr
Phone:(503)277-3788 Fax:(888)901-7914 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 191274 X11 Electrical Lie.: C639 AI Ik i1 Suprv.Lie.: 57625 specifically listed(%:hr min) I
Suprv.Electrician signature,required ELECTRICAL PERMIT FEES
GGG""" e,� � �-iJ� „ Subtotal.
Print name: Bob Armendariz i Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL.PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Max Panfilov Date: days after it has been accepted as complete.
I • Number of inspections allowed per permit
■ I BuildingV'ermimoELC_PennitApp_ELR_ERE.doc Rev 05121/20t3 440-4615T(II105iCOM/WEB
City of Tigard
. •
COMMUNITY DEVELOPMENT DEPARTMENT
TI C;A R D Building Permit Review — Residential
Building Permit #: 1'1 S i a 0 i LI - 00 i q(0
Site Address: 04 lc? 6t 4u-howl Ur e to
Project Name: M°LA cl4- e i-, 4-ct_ .r Lot #: 15
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: N e S F
XVerify site address/suite #exists and active in permit system.
Site Plan Elements:
Three(3) copies of site plan ( Existing structures on site N/A plan must h on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
North arrow Utility locations(required for new,may apply for additions)
Site address,project or subdivision name and lot number Location of wells/septic systems /V/i4
Applicant information(name and phone number) ,Erosion control(including drainage-way protection,silt fence
)EfLot dimensions and building setback dimensions design,location of catch basin,etc.)
PLot area,building coverage area,percentage of coverage and I'd Street names
impervious area(applicable if R-7,R-12,R-25&R-40) ��r� reet tree size,type and location_t' 'br'oo
Property comer elevations(2 foot contour lines if more than i xisting trees to be retained with drip line,and tree
4 foot differential) protection measures Ay h
Clean Water Services-Service Provider Letter: (lot platted prior to 9/10/1995):
Required: ❑ Yes-Applicant Notified No Received: ❑ Yes ❑ No
jt Land Use Case#: X1,1.13 a Da 4 -- 00°a 1
% Zoning: R - ,
P Setbacks: Front 15 Rear 4:0 15 Side 5 Street Side i o Garage ao
C ' Landscape Requirement: a p
I' Lot Coverage Maximum: DO
►3 Building Height: Maximum Height 3 5 Actual Height 3S
!:1 Visual Clearance 0111
ffSr Easements n
Sensitive Lands: N/1 ❑ Yes ( No Type
,r4 Urban Forestry Plan
CZ Conditions Met
Notes:
Approved By Planning: C" 4 aj . COA-AAA— Date: 1( - 3 - 1 LI
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_042914.docx
Building Permit Submits 1
Original Submittal Date: /i ' /I
Site Plans: # .3
Building Plans: #
Building Permit#: �VEE ter building permit#above.
Workflow Routing: Y�"-Ploning engineering 15rmit Coordinator la"-Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
uilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes: \
By Permit Technician:
(---_,� ._�24yt ( Date: 4/3/47
Engineering Review
Actual Slope: 3 3 10
❑ Conditions Met
Notes: ftp- ?1,0t1,1ri P 6- i it)(y c.TD+ft.. : ti ? eilLgOirK% 55 in le pm
*1 342 '
Approved by Engineering: k( a-16z,, Date: /(75//f---
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved El Not Approved
Permit Coordinator Review
,onditions Met-Prior to Issuance of Building Permit
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
XOK to Issue Permit
Approved by Permit Coordinator: / lai % Date: 1J/S A`
I:\B u i l d ing\Forms\B I dgPenni tRvw_RES_092914.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
12412 SW AUTUMNVIEW ST, TIGARD, OR,
97224
Residential - Master Permit
205 Footing
CNCL
MST2014-00196
David Young
Wrong inspection called in.
On site consultation for project.
Violation Summary:
Inspector Contractor
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
` ue
q Re st for Permit Action
1111
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.ti and-or. ov
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TO: CITY OF TIGARD AUG 17 2016
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223 CITY OF TIGARD
Phone: 503-718-2439 Fax: 503-598-1960 a •"tlitageigard-or.gov
FROM: E Owner ❑ Applicant g Contractor ❑ City Staff
Check(i)one /
REFUND OR Name:
INVOICE TO: (Business or Individual) 1,' L,,C,r2r (yc DtVC%yam{ji"'f'
Mailing Address: 6(I f N w Loki tic,y Si-, : {kr 2.
City/State/Zip:
P0 frt/44 �l 0R. 97"O7
Phone No.: (c03) e03-, 16.1(
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
RE!_MOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: , 2Q /Y _ 0 0 ' er (0
Site Address or Parcel#: 1'L Ll \2 S'-,J 4t) t v rh v+.i c(, ) s-j-k-c e-t-
Subdivision Name: Lot#:
EXPLANATION: N 0 h - PAY Grp sii✓l't-
- (JfLO „ 5 (CUr Ler(1.
- 1 r`i o-I jr6 c C7t' 0/Cc i 4L. . p-vvre K
Signature: a Date: ?" f-i-70((4,
Print Name: J(,) h U ,inc_C-h
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date I7 I/ By j Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc