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Permit I t��' III _ CITY OF TIGARD � J MASTER PERMIT g r, COMMUNITY DEVELOPMENT Permit#: MST2015-00124 Date Issued: 08/18/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S134BD07011 Jurisdiction: Tigard Site address: 11490 SW SPRINGWOOD DR Subdivision: ENGLEWOOD NO.3 Lot: 200 Project: Smith Project Description: 770 sf addition to rear of residence. 9/15/2015: REPRINT permit to remove mechanical work being performed under MEC2015-00630. ---- BUILDING Floor Areas Reauired Setbacks Reaulred Stories: 1 Bedrooms: 3 First: 712 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 12 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 712 sf Value: $101,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers: 0 Heat Pump: N Hoods: Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 10 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: ADD SF VB R-3 712 Owner: Contractor: SMITH,DAVID A HENSLEY CONSTRUCTION CO Required Items and Reports(Conditions) 11490 SW SPRINGWOOD DR PO BOX 2844 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 HILLSBORO,OR 97123 PHONE: 503-734-0899 PHONE: 503-312-1601 FAX: Total Fees: $3,310.86 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 R0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. "/ Issued By: ■I / -- Pernittee Signature: l✓N ,/ /t�l��0 Call 503.639.4175 by 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. CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit MASTER MST2015-00124 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/18/2015 Parcel: 1 S 134 B D07011 Jurisdiction: Tigard Site address: 11490 SW SPRINGWOOD DR Subdivision: ENGLEWOOD NO.3 Lot: 200 Project: Smith Project Description: 770 sf addition to rear of residence. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 3 First: 712 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 12 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 712 sf Value: $101,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 1 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 TYPOS Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc!Feedors Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea addl 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 10 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 712 Owner: Contractor: SMITH,DAVID A HENSLEY CONSTRUCTION CO Required Items and Reports(Conditions) 11490 SW SPRINGWOOD DR PO BOX 2844 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 HILLSBORO,OR 97123 PHONE: 503-734-0899 PHONE: 503-312-1601 FAX: Total Fees: $3,310.86 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. ATTENTIO • •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-001/ rough O•- 95_ :•1-0090. You may obtain a copy of the rules or direct questions to OUNC by cliiiag 503.232.1987 or 1.800.332.2344. Issued B : A. Permittee Signature-e--a/-147-41---4 0---------_ Call 503.639.4175 by 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. l Building Permit Application Residential FOR OF 11( I I tit. (►\I l City of Tigard RECEIVED Received n Date/By: f / Permit No.: !1�'s I� .. III • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Re • Phone: 503.718.2439 Fax: 503.598��0 12015 Date/By: 7 1...11 _, Other Permit. Y I IC,n R l) Inspection Line: 503.639.4175 Date Read / furls. 65 See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: ��i (S I Supplemental Information L[3UILDING DIVISION L.U.!n /heir /tr,.�i th' TYP OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 12 New construction 0 Demolition Permit fees'are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all rtddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 'e1-and 2-family dwelling ❑Commercial/industrial Valuation: $ r0 /,coo e.),- ❑Accessory building ❑Multi-family Number of bedrooms: ['Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 Ily3 0 6,..J S'tort,, "3 G.,,4 DA New dwelling area: -71 rL square feet City/State/ZIP:—'fl Q `A=. ' V n q 7,23 Garage/carport area: ..— square feet Suite/bldg./apt.no.: Project name: Jiy)1 Jl 1 Covered porch area: i Ei v square feet Cross street/directions to job site: Deck area: (J square feet 3 p ILA /1G iit/v.�.J 'r4 L11,,2 0 (mows.-- Cr Other structure area: square feet I 1 7 REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: 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.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: 1�✓1.to S v►�- f n,, Type of construction: Address: 04 610 $'t) .6-01-1_,fr_...5. ,,,, - Occupancy groups: City/State/ZII76,(4Y✓j t 6�_ '-7 i Z3 Existing: Phone: ) 7.3q_ 0 691 Fax:( ) New: 94 APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedul Business name: .!, !f - Structural plan review fee(or deposit): Contact name: (,�e.1 Addressl��f O C9 i FLS plan review fee(if applicable): 1.4:1-A Total fees due upon application: City/State/ZIP: 1,g())(5 i,,,� �yL e3-7 ( Z 3 77 Amount received: If7 • l Phone:51)1) 31...i_ I L O I Fax:: ) tv4v 3q/e I ` �� /� ``__ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail:L'}'6-1VI `� '1 �>1l517'1liz • F-►�Lt>1r✓t c_INY+ Commercial .id residential prescriptive installation of ' CONTRACTOR roo f-top mounte. 'hotoVoltaic Solar Panel ystem. Business name: (..4.1 S IA_ Submit two(2)sets a oof plan with : ection details and fire department acce .lo.: "th the 2010 Oregon Address: ' (6 K (9 /Lf Solar Installation Specia •• ..• checklist. City/State/ZIP: l Li 0i Rn,� C� I Permit Fee(is' des administrative fee w $180'00 Phone:) ' i — ,(o(.)•I.- r... x:(!9) ( v -F9 / State .. charge(12%of permit fee): $21.60 CCB lic.: 4g Y / L/5— / AJ 6C+1.4 Total fee due upon application: $201.60 Authorized sign. e: / 111��1�vv 7/�N/ ' 9 •1 • This permit application expires if a permit is not .btained within 180 days after it has been accepted as complete. lete.// Y P P Print name: �� 'En *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermi . ••.doc 02/24/2011 440-4613T(11/02/COM/WEB) • Electrical Permit ApplicaECEIVED City of Tigard 1 2015 R"°'"°" 7 I S ,� __-.. ) c )I oil 5-�1 g: 13125 SW Hall Blvd.,Tigard,OR 4 zi Phone: 503.639.4171 Fax: 50 "R�1e" Inspection Line: 503.639.417 ' F TIGARD nee-s, Other Per>nit Internet: www.tigardor.gov 13UILDING DIVISION NAM ior15 a Seepage Supplemental I taf rafermanw TYPE OF WORK PLAN REVIEW ❑New construction "grAddition/alteration/replacement Please check.0 that,pph(sebum 1 sets of plans w Items checked below r ❑Demolition ❑Other: ❑Service or a feeder 400 amps or more 0 over three stones. where the available fault current ❑Marinas and boatyards _ CATEGORY OF CONSTRUCT/ON exoaeds 10.000 arils at 150 volts or ❑Floating buildings. I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,a exceeds 14,000 ❑Commercial-use agrtculttaal amps❑Multi-family ❑Master builder rest/ever Instalati ❑Other: �Fire pump. ❑Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION O Emery system. larger separately derived system. ❑Addition of new motor load of ❑-A" "E•,"1-2" "1-3•' Job no.: Job site address: L)r 1� 100HP or more occupancy (� 1 �^ J�y �~I�L�t ht' (]Su or more recrdential units. ❑Recreational vehicle Arks. City/State/ZIP: Ti ykr-d t c,f 1-•1 ❑Hen -c facilities ❑Supply voltage for more than C t 1 11� ❑Hazardous locations 600 volts nominal. Suite/bldg./apt.no.: Project name: 'Sir tt 0 Service Of feeder 600 amps or more Cross street/directions to job site: FEE SCHEDUL E owerw se I Qt. 1 ter. 1 rear I • I VI ��p\, ., New residential single-or multi-family dwelling vest. �O' "- ' 0.1 1,,w06.0 lecheries attached garage. Subdivision: _ ' Lot no.: 1.000 sq ft.or less 168.54 4 Tax map/parcel no.: Fa.add'1500 sq.ft.or portion 33.92 I Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 67.84 2 ' Limited energy.multi-tamely. residential(with above sq.ft.) 67.84 2 Services or feeders iastafation,alteration,and/or relocation 200 amps or less 100.70 2 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: !1 )l /A t5�1 I,�.tI, 401 amps to 600 amps 200.34 2 Address: !� J • 601 amps to 1,000 amps 301.04 2 l 1490 5,J 5p� I/1/4,19„e .�j _r Over 1,000 amps or volts 552.26 2 City/State/ZIP'�?C-i,p �J 'fin 7 ZZ, YY r„� a services or feeders iesWlation,alteration and/or Phone:(�) 11.7' �_. 6 r�Gt 7`/r -Fax:( ) 200 amps or less 59.36 Owner installation:This installation is being made on property that I own which is not 201 amps to 400""ps 12S08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 to 599 amps 168.54 2 Owner signature:_ Branch circuits-sew,alteration,or extension,per panel Date: A.Fee for branch circuits with It APPLICANT 1 ❑ CONTACT PERSON above service or(Ceder fee, each brace circuit 7.42 2 Business name: I`1 t4 ^ .S�'L. ( _^ B.Fee for branch circuses without 1 —C� service or feeder fee,fast 56 1 s 2 Contact name: 2>✓. branch circuit Address:C (� ()30 ,e Y Each acid'(breach circuit g 7 42 2 �-`)• t t��, t�J Lf Gt Misce l nneous(service or feeder sot included) Each City/State/ZIP: l.4i,1 S 6+ * �V� �� ` ! ) ( Z-�! Irrwrufaetured or modular 67.84 2 urg,service and/or feeder Reconnect only 67.84 2 Phone j Z )(o 0 I Fax: : y Ivy J ,3 4/ ei Pimp or irrigation circle 67.84 2 s L4 t . ) , S �, • Q CONTRACTOR r •1:_ilAes1 Sign Of outline lighting 67.84 2 Signal circutls1 or limited-energy Business name:(.,,r E. \( II t( , J \�� 'alteration, I o allowable Page I. 2 2 �L9 Each additional i nay of the above Address:4(L tz Additional i `7 I(S �l� �:1.y g t� #D�+'S inspection(I hr mm) 66.25/hr City/State/ZIP: y C C t Lard (ir ci 1 Investigation(I hr min) 66.25/hr /'�, 4 Industrial plant(I hr min) 78.18/hr Phone:(C (9 X ( - 4 3L I Fax:(a5)L �_,t-1 3 Inspectrons for winch no fee is -^1 speafially listed(44 hr min) 90 hr CCB Lie.: 4 Electrical Lic.: 3 5 7 id Suprv.Lice:¶173 ELECTRICAL PERMIT FEES Suprv.Electrician signature,refit- l a 1 a t(e Subtotal: Plan review(25%of permit fee): Prim mane as 1 IC. •• Date: I~� State surcharge(12%of permit fee): Authorized si 4 I „ /� TOTAL PERMIT FEE: ,r 1J� Tab permit appinlism eapins if a perit b ask abtaieed wii /alt Print nettlen k r Date: a.ra after a tray trees accepted u c.mpkle. l /.')?)1I') • Number of inspections allowed pa pemrt. Mechanical Permit Application I OR 0141( I 1 'NI ()\1.1 Received City of Tigard c I`IC n Date/By: Permit No.: O6/01- A■1111 . • 13125 SW Hall Blvd.,Tigard,C�R��7Z G V ED Dan Review Phone: 503.718.2439 Fax 5 Date/By: Other Permit: I I t�A I:1� Inspection Line: 503.639.4175 Date Ready/By: Jens ® See Page 2 for Internet: www.tigard-or.gov jl V IL 1 2015 Notified/Method: Supplemental Information R TIGARD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ddit{TYPE ou Cie do D%VtStnN Mechanical permit fees*are based on the value of the work ❑New construction dditloo�alt`eratlon/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 checklist and ❑Master builder ❑Other: Description Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 1 14 a O V u-) SiZ'h ,. , , ,t n L)/3 OA- • Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:"�; e IA/0,3i `� . q`�-7ZW13 Furnace 100,000+BTU(ducts/vents) 54.91 i 1 V Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 �7 Residential boiler(radiator or ?a()�VLo,LLtp- tAJOZ><)L itt/►^, �'a' hydronic) 23.32 `� 1 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 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 /9100/ n 0 1.,) 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: A V 1 v) '5 rv� I I Y Range hood other kitchen /equipment I 33.39 Address: I WO e -510rut r e�JV)vO t)ff-. Clothes dryer exhaust 33.39 City/State/ZIP�t et l � )q Z2-) Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(�j 7 3 q,68,41 Fax:( ) Attic/crawlspace fans 23.32 APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: 4.1-6 k1 f� G/P�-- $14.15 for first four;$4.03 for each additional Contact name: 1/1.4 ,t1.�rrr S"Q,,., Furnace,etc. Address: ..1,( a 5—q /'/ Gas heat pump T Wall/suspended/unit heater City/State/ZIP: 1 5,6 u O 9 7 / �3 Water heater Phone: 7l) `Z / Co O I Fax: :(�� V 3 4�/v Fireplace 1 Range 1 E-mail: NS [ e 1,_ ,.-,/f L'd Qi F✓j,26 l L:VI , (.0 4n, Barbecue Fig CONTRACTOR r •y` ' Clothes dryer(gas) Business name: Other /� 5 J`� MECHANICAL PERMIT FEES* Address: g 2 3 jJ i,u V t pi),"..1- P� Subtotal City/State/ZIP: /AM'5 6 on-Q. I0 � 7/ 2 3 Minimum permit fee($90.00) Phone:1) JrZZ -7C{_1 i Fax:( ) Plan surcharge(12%of permit fee) State surcharge(12/o of permit fee) CCB lic.: 1 3-3•2,„‘Z TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized s ,--: 1 e: * Fee methodology set by Tri-County Building Industry Service Board Print name: i1A Date: r I:1 Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1 I/02/COM/WEB) Plumbing Permit Application Site Utilities FOR OFFICE USE ONLY City of Tigard RECEIVED Received , // //S PermitNo.:�-/ /� )!�� - • 1 3125 SW HaII Blvd.,Tigard,OR 97223 Plan Review(/ r Phone: 503.718.2439 Fax: 503.53.1.960 1 2015 Date/By: Other Permit No: Inspection Line: 503.639.4175 Date Read B kris: El Page 2 for TIGARD Ready/By: B Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPEia DIVISION FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. Total "it)k ddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 KI-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building Multi-family SFR(3)bath 500.32 ❑Multi-famil Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ' 14 of V .6(..,0 V P 9�� QA. , Catch basin or area drain 18.76 1 ell,leach line,or trench drain 18.76 City/State/ZIP: /� �� O "'/ 2_23 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Projeciname: 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 Clothes washer / 25.02 14 0 6 I -1)0.3 Dishwasher 25.02 Drinking fountain 25.02 �f Ejectors/sump 25.02 kQ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 D4 1;^ wl t �� Fixture/sewer cap 25.02 ) Name: Y J Address: 11 4 9,0 S�J g P 1 w�..0 Pn • Garbage ge disposal sink/hub 25.02 F� Garbage disposal 25.02 City/State/ZIP: TI 6.ve4..1,.0( GA. Hose bib 25.02 Phone:( y D (y Fax:( ) Ice maker / 12.51 [ ^AP LICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 y d; 6::17%/5-77r.... /�+ Medical gas(value:$ ) Page 2 Business name: [`-� �� Y'1. �� Primer 12.51 Contact name: (4.-1-7- R drain(commercial) 12.51 Address: 0 . Lc c2 Y'/ V ��aasin/I ry 25.02 City/State/ZIP: 1-.A.1 )5 , 1-7/ Z 3 Solar units(po le water) 62.54 / Tub/shower/shower pan I 12.51 Phone:(�-� 3 tt Z I Go I Fax: �"3) �t-/U '�S/ � E-mail: 1 �iS _- - , �1,y,ritL �.9 'L)/J7 L rc,,,� Urinal 25.02 7 Water closet / 25.02 CONTRACTOR Water heater 37.52 Business name: s.�..� �� /'�f��C'I L,4/t'►"1/J/ / Water piping/DWV 56.29 Address: 3 O 3O 5 t (a- 4, L r� ). Other: 25.02 City/State/ZIP: '( (.c) �)it .9 7i 2- 3(4,03 �7 Subtotal Q C.Phone:( � � � Z Fax:( ) Minimum permit fee: $72.50 CCB Lic.: 14 g 43-7 Plumbing Lie.no.:34_3 -5?i3 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signal • /� TOTAL PERMIT FEE Print name: 2 tA- Dater/V 15'1 This permit application expires if a permit is not obtained within 180 days IAA L after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Perrnits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard , . COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R l) Building Permit Review — Residential Building Permit #: MST 0015--CC:. ) apt/ Site Address: 7)14- 6 S.AJ l41O(11 2r- Project Name: 11,4 Aidifihlk Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: 'Si ' -.- A. _ t. A■ i//. p ©Yl /----.,_ 7 h. I • 4 • [I Verify site address/suite#exists and active in permit sy te .. ever Terrace Neighborhood: ❑ Yes LU' No Sit Plan Elements: 1! Is, ee(3)copies of site plan L • sting structures on site I jte plan must 1 on 8-1/2"x 11"or 11 x 17"paper 74.Footprint of new structure(including decks)with finished wn to scale(standard architect or engineer scale) Poor elevations rth arrow i .i"ty locations(required for new,may apply for additions) � e address,project or subdivision name and lot number M ation of wells/septic systems Ild� licant information(name and phone number) l(including drainage way protection,silt fence dimensions and building setback dimensions ostgn,location of catch basin,etc.) t area,building coverage area,percentage of coverage and Street ion names .pervious area(applicable if R-7,R-12,R-25&R-40) afiteet tree size,type and location i1 •roperty corner elevations(2 foot contour lines if more than Prnxisting trees to be retained with drip line,and tree 4 • .t differential) protection measures N Clean Water S ces—Service Provider Letter(lot platted prior to 9/10/1995): / Required: Yes,applicant was notified ❑ No Received: El Yes No /iblic Facilities Improvement(PF1)Permit: Required: ❑ Yes,applicant was notified 1No Applied For: ❑ Yes ❑ No,stop intake � d Use Case#: LIY oning. -4. V,Setbacks: Front 070 Rear /5 Side Street Side 1 Garage aO dscape Requirement: a °�0 . � )of Coverage Maximum: £ / Il,� uilding Height: Maximum Height -d Actual Height f e) AV Visual Clearance fid asements itlItensitive Lands: ❑ Yes V o Type il ►JA ".rban Forestry Plan /iAonditions"Met"prior to issuance of building permit Notes: 7*icr 7t) ,, 1 .Viadicee Thee' (?4)- - PL. Approved By Planning: _ ` Date: / c Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved . Revision 2: ❑ Approved ❑ Not Approved PP Revision 3: ❑ Approved ❑ Not Approved 1 I:\Buil ding\Forms\BldgPernvtRvw_RES_070115.docx • . . w Building Permit Submittal Original Submittal Date: y 7/, ii -- Site Plans: # Building Plans: # Building Permit#: Enter building permit#above. Workflow Routing. 3-Planning ..12--Engineering C-Permit Coordinator a uilding Workflow Sign-off: R 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 c2,4inal plan review routing form. Building. original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician �,S `f�iy Date: / / Engineering Review 2Slope at building pad: 7 ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ET No Assess Water Quantity Fee in-lieu: ❑ Yes 8 No LIDA Facility on lot ❑ Yes Td' No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: /141 VAQ.. Date: Z 1,r Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved, NOT Released: Date: 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 y.....01(t: =rdinator:Issue G(�� C_V1-c"/c4-1-------)ate: Z i J I:\Building\Forms\BldgPermitRvw_RES_0701 1 5.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 11490 SW SPRINGWOOD DR, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal FAIL MST2015-00124 David Young Hot and cold reversed at front bedroom bath tub. Seal backsplash to wall in main 1/2 bath. Other baths not done. 310.4, 407.2 And behind kitchen sink at window. 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 11490 SW SPRINGWOOD DR, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2015-00124 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 11490 SW SPRINGWOOD DR, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal FAIL MST2015-00124 David Young Outlet in laundry to be gfci protected or single outlet marked not gfci protected. 210.8 Provide listing for outdoor lighting ﬁxtures suitable for wet locations. Fix loose outlet in area outside 2 bedrooms by hall to laundry. 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 11490 SW SPRINGWOOD DR, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2015-00124 David Young Not ready for ﬁnal inspection. Provide approved electrical and plumbing ﬁnal inspections prior to building ﬁnal inspection. 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 11490 SW SPRINGWOOD DR, TIGARD, OR, 97223 Residential - Master Permit 399 Plumbing ﬁnal PASS MST2015-00124 David Young Corrections complete. 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 11490 SW SPRINGWOOD DR, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS MST2015-00124 David Young Corrections done. 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 11490 SW SPRINGWOOD DR, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2015-00124 David Young Schedule ﬁnal inspections for open electrical permit ELC 2015-00941, and mechanical permit MEC 2015-00630. Re call with ﬁnal building inspection MST 2015-00124, to close all open permits. Add new water heater to MST permit, not on existing permit. 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 11490 SW SPRINGWOOD DR, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection PASS - No C of O MST2015-00124 David Young Violation Summary: Inspector Contractor