Permit �t CITY OF TIGARD MASTER PERMIT
'`1 1 ' COMMUNITY DEVELOPMENT Permit#: MST2014-00217
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/17/2014
Parcel: 2S109AD11900
Jurisdiction: Tigard
Site address: 14988 SW LOOKOUT DR
Subdivision: ARBOR SUMMIT Lot: 17
Project: GOLDBERG
Project Description: Crawl space addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 1244 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 1244 sf Value: $119,113.20 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 1 Garbage Disp: 0 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: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 6
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:
ALT SF VB R-3 1244
Owner: Contractor:
GOLDBERG,MAILE WILSHIRE CONSTRUCTION LLC Required Items and Reports(Conditions)
14988 SW LOOKOUT DR 14845 SW MURRAY SCHOLLS DR STE
TIGARD.OR 97224 110-324
BEAVERTON,OR 97007
PHONE: PHONE: 503-320-2100
FAX:
Total Fees: $4,054.60
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and -II other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, ork is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules •ted by the Oregon Utility Notification r /7 ,, a rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the ru— -n•• •uestions to OUNC by calling 50 -,/..800.332.2344.
Issued By: . Permittee Signature: Z.,
Call 5. .• by 7:00 a.m.for the next available inspection
This permit card shall be kept in a conspicuous place on the job site until comp a project.
Approved plans are required on the job site at the time of each inspection.
9
N Building Permit Application
.>7 Residential FOR OFFICE USE O\l l
P Received
City of Tigard DateB : I IN Permit No.:fa1S't .i - •_ !
• 13125 SW Hall Blvd.,Tigard,OR 97223 P hone: 503.718.2439 Fax: 503.598.1960 : ��r Permit
i _;��t Inspection Line: 503639.4175 i: Ready/13);:• � S: RI See Page 2 for
Internet: www.tigard-or.gov Notified/Methoda/�/ / a� (^ Supplemental Information
DEC 8 TYPE OF WORK 20 i4 REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Dettiliai of'f um) Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
,,��,,!!
L�Addition/alteration/replacement ❑&GILDING DIVISION equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
and 2-family dwelling ❑Commercial/industrial Valuation: J7E$,,T'�j o"' I,!'
❑Accessory building ❑Multi-family Number of bedrooms: I'l i/ .' _ /✓f,¢1/
(
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
� ` r
Job site address: P i f ft s L J Look-p c. p, ellng
area: (err square feet
7
City/State/ZIP: f b D Garage/carport area: —'•" square feet IQ 4' '
s&
Suite/bldg./apt.no.: Project name: (430 lbe(5 Covered porch area: square feet rr7�
Cross street/directions to job site: 8'cejj Deck area: square feet s'IP7 '•
f�.� Other structure area: r square feet
5 f{ r Pe- REQUIRED DATA:COMMERCIAL-USE CHECKLIST
✓
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
0�' Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
4 di 4 I44 /lea,- e.,,,'r, sittev- 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:
0.4PuCANT CONTACT PERSON BUILDING PERMIT FEES*
(Meese refer to fee schedule)
Business name: t ff it.0 1-1\,e, , .j -CI, Structural plan review fee(or deposit):
Contact name: rr,�, ll �-�- y FLS plan review fee(if applicable):
Address: /q i�it S- S 4,tt <,....4.6.1.6.-- f/�
City/State/ZIP: t).a.z y sj Q/1— (70?1 Total fees due upon application: x`5 f j 3�
Phone:, _�l `_ Amount received: j�
�}-(� a V Fax: :( )
E-mail: �F�'4."'. � CO 1.C-6k(rJ2 Cat 'u �Z 15� , COQ` PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES•
�( � Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: 61.AAti�-e..___ 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.
Permit Fee(includes plan review
City/State/ZIP: ermand administrative fees): 5180.00
P '( ) Fax'( ) State surcharge(12%of permit fee): $21.60
CCB lic.: ! 331./.2_,_____--'- /y Total fee due upon application: $201.60
Authorized signatu ./� /: , This permit application expires if a permit is not obtained
�p within 180 days after it has been accepted as complete.
Print name:l'7 V e /4 V I/J Date:I� •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)
Electrical Permit A licatio ECE1V'E'
1 O12 (Ill It I_ I til- (1vI t Received
City of Tigard Date/B : Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' g Phone: 503.718.2439 Fax: 503.598.1960 014 Date/B : Other Permit
1 1I, ,\1:1 Inspection Line: 503.639.4175 DEC D 2 Date Ready/By. hais: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information ita
OF tibia Oti �16�8/ ' PLAN PLAN REVIEW
❑New construction ddition/a �1icEfrfelli f'! Please check all that apply(submit 2 sets of plans wfitems checked below):
❑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 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A" "E" "1-2" 'l-3"
Job no.: Job site address:/[/�/� /, - / / p 100HP or more. occupancy.
T!66 7eL/ L�%t-• ❑Six or more residential units. ❑Recreational vehicle parks.
A ❑Health-care facilities. ❑Supply voltage for more than
City/State/ZIP: �erit f v ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: i. (e (,t- „e rripuor, Qt,. 1 Fee. 1 Total I •
l New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less I 168.54 —4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
e � 4 4- �"w` b 4 Limited energy,multi-family ae q.
n. residential(with above sq.ft.) 75.00 2
(,� • Renewable Energy ❑ See Page 2
4 b � `iv ' cp_ 1 - Services or feeders installation,alteration,and/or relocation
❑ PROPEAY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 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 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
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 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
er-;PPLICANT f ❑ CONTACT PERSON A.Fee for branch circuits with
_ �,, �, above service or feeder fee, 7.42 2
Business name: �d �,5ti(e-4X y'`�l t ��'` &L each branch circuit a `(
B.Fee for branch circuits without
Contact name: L',�c�a,p /4-�J15 service or feeder fee,first I
°t ��,t��//���^�_ / ` . � branch circuit 56.18 2
Address:/ L{,4 S` 5w d i�4 (•\Ty SGJ �.il'""" act-3+-5< Each add'!branch circuit 7.42 2
/ Miscellaneous(service or feeder not included)
City/State/ZIP: ie,te tt( li i2 /71r-77 Each manufactured or modular
Phone:0. ) )40-6,to O Fax: :( ) dwelling,service and/or feeder 67.84 2
L /� Reconnect only 67.84 2
E-mail: G t. L.e e- Led t G6 "-P
C�l�'t 4 Lam` Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: l�(/tin.e Fe._ 4.r \l/ Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: 116 —"' pp AA-,r Pee NE Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: A, r7'' Investigation(1 hr min) 66.25/hr
Phone:(05 1_9p-797y Fax:( ) Industrial plant(1 hr min) 78.18/hr
��T' Inspections for which no fee is 90.00/hr
CCB Electrical Lic.: v Suprv.Lic.: 34.,1 iS specifically listed(V:hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required— it • / w------ Subtotal:
I'
Print name: lino 11( tom, , z, Date:�� —S�i y- Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: 00/ ,.)---
/ TOTAL PERMIT FEE:
Print name (� / This permit application expires if a permit is not obtained within 180
(Jp Date://(( days after it has been accepted as complete.
f I ' Number of inspections allowed per permit.
t:\Building\Pem,its\Er C_ParoitAppEI.R_ERE.doc Rev 03/21/2013 440-4615T(11/03/COM/WEB
Mechanical Permit Application l Oli OM( I: I SE (1\1.)
City of Tigard ,� ; Permit No.:
:� 13125 SW Hall Blvd.,Tigard,OR 97223 Tj'+�CEIVE ,an Review
E Phone: 503.718.2439 Fax: 503.598.1960 �#(aL1 Other Permit:
DateBy.
i 11, \It I> Inspection Line: 503.639.4175 Date Ready/By: Jwis: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
DEC S 2014
TYPE OF WORK T COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
YoF 1 U3M40 Mechanical permit fees*are based on the value of the work
❑New construction ddition/alterationfi .i++1+ DIVIS10N 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*
P-^l�and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
/ Air conditioning 46.75
Job site address: / .j6 /f4 (,.) • �0t-'t el-4- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 71 e■-ir_ ai t2-- Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: /� Duct work 23.32
/Ji c
Cross street/directions to job site: _'e-_ ' 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 33 I
— Flue vent for water heater or gas
La-N (- J v 1 k— +I, R 4( e_ fireplace 23.32
/ Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address' Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) j 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
APPLICANT ❑ CONTACT PERSON Other: 23.32
/ , ��, �` Fuel piping:
Business name: t.{)r 6 lu,C l`( 60.1, + f' �t't1 a—C..- $14.15 for first four;$4.03 for each additional
Contact name: ��(j kus v 1 Furnace,etc.
Address: 1 ki kt f r .(.(> mu rcpj, t TA • .s"''� /f 3 ljf Gas heat pump
I Wall/suspended/unit heater
City/State/ZIP: 7 ��k e2� Water heater
Phone:ttl; ) 3' .94(p/v� / Fax: :( ) Fireplace M `{
E-mail: 1,-�-1,v-(A tA,(,t.S to f� £ ., - 4.1. •4i1)✓ Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: W t i-s l,t,i 1\„p Co.,,j Os.L [_-L.-C Other:
MECHANICAL PERMIT FEES"
Address: l l D`t� }�, 1w4--QN1 A / 74v S /p-a rf Subtotal l
City/State/ZIP: b.P►,tl\441,� ®1 - Minimum permit fee($90.00)
�/) 5L ,,—L v v Fax:( ) Plan review(25%of permit fee)
Phone:(
State surcharge(12%of permit fee)
CCB lie.: , ? ;(.,(1...--,-. TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized Signature' • Fee methodology set by Tri-County Building Industry Service Board
Print name: 4 t/)P Date: /0)-�S
I:\Btilmvg\PermitsUMEC_PennitApp_OWJ 13.doc 440-1617T(11/02/COM/WEB)
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
• Received
: City of Tigard �� Date/By: Permit Na.
IN EP
• 13125 SW Hall Blvd.,Tigard,OR`,2• i 1 .
r Plan Review Other Permit No.:
Phone: 503.718.2439 Fax: 503 , a Date/By:
T 1 G A RD Inspection Line: 503.639.4175 Date Ready/By: axis: 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WO17Jld.L 8 2014 FEE" SCHEDULE
❑New.construction =:, i For special information use checklist
MIIIIME Description I Qty. I Ea. I Total
G Addition/alteration/replacement �. �;. ( t
it t New 1-2-family dwellings(includes 100 ft.for each utility connection)
� CATEGORY OF CONSTRUCTION SFR(1)bath f I 312.70 30,142,
Ei 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
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:
4 9 G or Catch basin or area drain 18.76
Job site address: Q J Cw C
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 6'.41.--1 t9 Footing drain(no.linear ft: ) Page 2
Suite/bldg./apt no.: I Project name: 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
,t ,",f'id d- b7z � Clothes washer 25.02
_/1� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sinlc/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
i APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: (,t f (�(-5 4 t-A -P C�t<-1 i�may; j,,� .l Medical gas(value:S ) Page 2
' Iv r "'l `
Primer 12.51
Contact name: � -(�- ,/) ��))�� Roof drain(commercial) 12.51
Address: / rig-4c S(,t/ /4,1,4a� /,>� ..t,L ?L I, � -3 1`t' Sink/basin/lavatory 1 25.02 2."•2.
City/State/ZIP: r, _,i e rI a i- 9x,0'7 Solar units(potable water) 62.54
Phone:(.2.1." ) 3,)-0 -milts c., Fax: :( ) Tub/shower/shower pan / 12.51 ()31
E-mail: �,���- �? ('9 ��<11 i(N. Gp.r<_'t't �"�-. c-[)� Urinal 25.02
Water closet II( 25.02 ) 1`t-6.-
CONTRACTOR
r, Water heater 37.52
Business name:4)l 112 (-• RIAA ‘1-r.` Water piping/DWV ( 56.29 -it,a..
Address: a,44- N ∎a.._cr-bls l ®-e 51-- a , Other: 25.02
City/State/ZIP: bil e w-- 9/ R 7V,.3 7 Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: /7 Is--1 Plumbing Lic.no.: P8 d 7
State surcharge(12%of permit fee)
Authorized signaturille �- TOTAL PERMIT FEE
-ANS 1111-M.` I`r ' Date://®t J.3---/ This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
i *Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Pemits\PLMIJ-PenritApp.doc 10/01/09 440-4616r(10/02/COM/WEB)
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
14988 SW LOOKOUT DR, TIGARD, OR, 97224
Residential - Master Permit
399 Plumbing final
PASS
MST2014-00217
David Young
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
14988 SW LOOKOUT DR, TIGARD, OR, 97224
Residential - Master Permit
299 Final inspection
PASS - No C of O
MST2014-00217
David Young
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
14988 SW LOOKOUT DR, TIGARD, OR, 97224
Residential - Master Permit
199 Electrical final
PASS
June 1, 2015 at 12:31:50 PM
MST2014-00217
David Young
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
14988 SW LOOKOUT DR, TIGARD, OR, 97224
Residential - Master Permit
699 Mechanical final
PASS
MST2014-00217
David Young
Violation Summary:
Inspector Contractor