Permit III �, CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2015-00224
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/07/2015
bir
Parcel: 2S102BC01102
Jurisdiction: Tigard
Site address: 12802 SW KING PL
Subdivision: GRACELAND Lot: 4
Project: Graceland, Lot 3
Project Description: New SF. 5/10/16: REPRINTED permit to include(1)laundry tray.
BUILDING
Floor Areas Reauired Setbacks Reauired
Stories: 2 Bedrooms: 3 First: 1245 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1120 sf Garage: 360 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2365 sf Value: $283,229.57 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temo Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2365
Owner: Contractor:
PACIFIC EVERGREEN HOMES LLC ALAN NATHANIEL GOFFMOORE Required Items and Reports(Conditions)
7410 SW OLESON RD#133 13950 SW BARLOW RD 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 BEAVERTON,OR 97008 2 Other Report(see note)
PHONE: PHONE: 503-664-6423
FAX:
Total Fees: $22,886.31
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or
1.800.332.2344..80
.. `
Issued By: Z �_ P�Tmittexe Signature: � U .✓�� .
Call 50 . . 175 by 7:00 a.m.for the next available inspectionatd e.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED .
Plumbing Permit Application NIZUI , 002-14-1
Building Fixtures MAY 0 9 2016
Received
City of Tigard Perin No. Y
74 + 13125 SW Hall Blvd.,Tigard,OR 972k,3 Date nV
ITY OF T1GAR ` n Review i0 1� /�'�STtots=per
Phone: 503.718.2439 Fax: 503,598(11,-
ll
03,598 C(ou Other Permit No
inspection Line: 503,639,41 BUILDING DIV �71t �j tcd)•�
T I G A R D ate Ready/By- loris IA See Page 2 for
Internet www.tigard-or.gov r��ir . Notified/Method r Supplemental Information
to•.c c.5 .•'�,+h "#`sir 3�$ 7 Tr*0a1t W,�Oii . ,h. °,, ,1 tis '
®New construction 0 Demolition For special information use checklist.
---- Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New I.2-family dwellings(includes 100 ft for each utility connection)
cATEGOR p O S V.IgTION- SFR(I)hath I 312.70
l I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
-
- Each additional bath/kitchen I 25.02
0 Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 7 ,
JOIZarTE INFORMATION.AND LOCATION Site utilities:
Job site address: /Z'Q'2_ • . N� Pe, -Catch basin or area drain 18.76
Sf`2 k -- Drrwell,leach lint,or trench drain 13.76
City/State/ZIP: 1 -7
Footing drain(no.linear ti:_1 I Page 2
Suite/hldg.lapt.no.: Project name: 6'7/z. L,4,J Manufactured home utilities 50.03
Cross street/directions to job spire: Manholes 18.76
!,1)aL/J u T Rain drain connector ( 18.76
Sanitary sewer(no.linear ft.._) ! Page 2
- Storm sewer(no.linear It.: ) Page 2 i .
Water service(no.linear It:_) Page 2
Subdivision: Lot no.: ' -____-____
�.� }�.(��L/�(JD 3 Fixture ur item:
Tax map/parcel no.: l3ackllow•preventer ' 31.27 1
_: DESGi2-IP-TTQIrtl WOR&' - Backwater valve � 12.51
tf) - _
t� Clothes washer 25.02 1
AD 1.--110 NOR..] 511:'4:-.v_.__.______ Dishwasher 25 02 1-- '
O PERvADrinking I tuntain 25.02
Ejectors/sump 25.02 1___
®.1!13OPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Pacific Evergreen Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7410 Sw Oleson Rd,Suite 133 ,;0� •
Garbage disposal
City/State/ZIP:Portland.OR.97223 Ilose bib 25.02
Phone:(503)6644423 Fax:( ) lee maker ---__�._ 12.51
®'•;APrU N7` 0 GON'rAcT PERSON: hncrecptor/grease trap 25.02
Business name:Same
Medical gas(value.S ) Page 2
Primer 12.51
Contact name:
-_-- Root drain(commercial) ( 12.51
Address: Sink/basin/lavatory 25.02 ,_42,2'.,_(/,?.7.4
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) i'ub/shower/shower pan 12.51
E-mail:alangoffmoore(a?gmail.com Urinal 25.02
Water closet 25.02
cover tAcIQR•
Water heater 37.52
-
Business name:EDWARD MULLEN PLIIMBINC -
Water piping/DI'V 56.29
Address: 1601 SE RIVER ROAD Other: 25.02
City/State/ZIP:HIILLSBORO,OR 97123 Subtotal
Phone:(503)640-0113 I Fax:(503)640-4483 _ Minimum permit fee 5;2.50 I
Plan review (25%of permit feet
CCB Lie.:92689 Plumbing Lic.no.:34-260PB - - -.
State surcharge(12%of permit fee) } ,
Authorized signature: .44..._4..airaJam` 1
TOTAL PERMIT FEE 73.(1)
_
Print name:IgA1'NI tLLEN -_ Date:lc>.../ iermii application expires if n permit is nut obtained within ISO days
after i,him Igen accepted au complete.
•Fee methodology act by Tri-County Building Industry Service Board
I'tlu.Idal1S11.V1 inasTLNI13-14,mnApp.:ku 10.01.05 44,,.4,1,10.1,,.'-(051wflit)
ftn.,
t, CITY OF TIGARD MASTER PERMIT
, z:.,
1 lav
2 •• COMMUNITY DEVELOPMENT Permit#: MST2015 00224
•
, 4:-.-11* 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/07/2015
TIGARD 2S102BC01102
Jurisdiction: Tigard
Site address: 12802 SW KING PL
Subdivision: GRACELAND Lot: 4
Project: Graceland, Lot 3
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms' 3 First: 1245 sf Basement: 0 sf Left: 5 Parking Spaces. 0
Height 24 Bathrooms: 3 Second 1120 sf Garage: 360 sf Front' 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2365 sf Value: $283,229.57 Rear: 15
PLUMBING
Sinks 1 Water Closets 3 Washing Mach. 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains 0 Sewer Lines 100 SF Rain Storm Sewer 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines 100 Drains: 0 Catch Basins 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib 2 Backwater Value 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less. 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add]500 sf: 3 201-400 amp. 0 201-400 amp 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp 0 401-600 amp 0
601-1000 amp- 0 601+amp-1000v 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo- N HVAC. N Security Alarm: N Vaccuum System. N Garage Opener: N All
Other: N Other Description: Ecompasing Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2365
Owner: Contractor:
PACIFIC EVERGREEN HOMES LLC ALAN NATHANIEL GOFFMOORE Required Items and Reports(Conditions)
7410 SW OLESON RD#133 13950 SW BARLOW RD 1 Other Report(see note)
PORTLAND,OR 97223 BEAVERTON,OR 97008 2 Ersn Cntrl 503-639-4175
PHONE. PHONE: 503-664-6423
FAX:
Total Fees: $22,498.89
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a : .10Per 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, is .spended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen A •.40,Iles
: les are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of . -. • direct questions to OUNC by calling 503.23 rias 2344.
Issued By: / ,_r s,_-- — 'ttee Signature: A'
Call 503.0:( 5 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.
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i tnmw r' O a.; " ` mss:t{ w6ir*3chanical Permit Application I N It (�1 ;
• WYM•10 City of Tigard ' Received
(Y/. S7dca -�
Permit No.: e
aatt
t a 13125 SW Nall Blvd.,Tigard,OR 972;ss3J Plan Review (� C
r 9 Phone: 503.718.2439 Fax: 503.598.1960 �Q15 Date/By: 1 Other Permit: •
'"' Inspection Line: 503.639A175 Ov I Date Ready/Ry: I tans: I 0 See Page 2 for
T I,a,,,I;KV
i- t Internet: www.tigard-or.gov N 4 NNotified/Method: I I Supplemental information
a .3 n ---
TYPE OF Wr���-t
� ,t��.`��a��VICL COMMERCIAL FEE' SCHEDULE - USE CHECKLIST
�
i t a, -----'-! Mechanical permit fees'are based on the value of the work
(E New construction 0 Addition/altcraGLo� Ott tiac�ement performed.Indicate the value(rounded to the nearest dollar)of all
[❑Demolition ❑Other: 1111�� mechanical materials,equipment,labor,overhead,and profit.
1----1----
CATEGORY OF CONSTRUCTION t"- -
_ ___.- RESIDENTIAL EQUIPMENT/SYSIEMSFEtS*
X4 1-and 2-family dwelling 0 Commercial,tndustriai 0 Accessory building ; For.special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION ��_-____._.-.E #iearingeaolin _ - i
PI
f ! Air conditioning , 46.75
Job site address: /Z 301 �,_.1 Pi__-- -�-_--_ .____ -_i =trrna::e 100,000 BTU(duets/vents) ! ` 46.75
City/State/ZIP: L Furnace 100,000+BTU(ducts/vents) I 54.91
----' -------I Heat p mrd- I _ 61.06
Suite/bldg./apt.no.: Project name: ___ L Duct work + 23.32
Cross street/directions to job site: - - - _- ; f hiydronic hot water system 233.32 --1
-4 I Residential holler(radiator or
3vdron 41 23.32
- __ _________._-_- __- Unit heaters(fuel-type,not electric),
t--_ - - _ - _____ In-wall,in-duct,suspended,etc. 46.75
I Flue/vent for any of above I 23.32
-
I Subdivision: Cg4le 23.32
o I
Lot no.3 tither:
Other fuel alianees: - 1
Tax map/parcel no.: L Water heater -i 23.32 t
-DESCRIPTION OF WORK ]
_Ga fi lace/insert - l ) 33.39
Flue vent fbr water heater or gas
I
..replace 23.32
I i Loa lighter(gas) 23.32 - - 1
_.------_-_._-_-___..._.._..._._.. ....._-.._.... . ......___..............._. .._... ;vr,:lit- ii.:s 33
L .39
'.bold filace./inset 11 23.32
�----- - - ------- -_I [ hi„tree;//linrr!fuervent 23.32 - 1
1 -_.._.r_. -- .
_ -_ __ 1 __. __._._�_T_-____N. _ _ _ _ -, { r)ther: ( 2"3.32-
{( ► PROPERTY OWNER - 0 IEpy;fly'? _�___.__-.___-_-.___ _ -:
Environmental exhaust and ventilation:
Name:Pacific Evergreen Homes Range hood/other kitchen
- -- ---- - - 1 e3 tiprnent 1 33.39
Address:7410 Sw Oleson Rd Suite 133 _______ j t Clothes dryer exhaust 1 33.39 ••
City/State/ZIP:Portland,OR.97223 -! Single-duct exhaust(bathrooms, '
- t toilet compartments,utility rooms) 1 23.32 t 1
Phone:(503)664-6423 ! Fax:( ) I Attic/crawispace fans I 23.32
^1 APPLICANT - 0 CONTACT PERSON _ I I OtherA--_ ; 23.32
I- j 1 Fuel p ing:
Business name:Same
______ __________ i _ 514.15 514.15 for first four;54.03 for each additional
Contact name:Alan GoffMoore ` Furnace,etc. I_I
i Gae heat pump
Address: i
-._____.__-___ _____ - .--________.___--_-____.___.____. -, Wall/suspended/unit heater
City/State/ZIP: .Yater heater I
Phone:( ) _ Fax::( ) --- ------- _ �1 .,;replace _ ! i
----}
- Lane- -_ I 1
E-mail:alangoffmoore®gmaiLI 1
com i Rarhecre
CONTRACTOR Clothes dryer/vas) i j
( ' ( Other
Business name: i ttitl VCU l _ O ;-VL II Mt t IIANICAL PERMIT FEES*
-- - -c
' ! Address: i.6) _ l_-{GI Subtotal
/., I Minimum permit fee($90.00)
City,StateibZi r -- -----.-------. - --- Plan review(25%of permit fee)
t'-- --- / r - - -
I Phone:(�U".j ) ((v - IZC.. [ax:(`I l' )2ce(y- ?xi= -- State surcitarge(t25 of permit fee)
I CCM /4-1„,)0Q, 1 TOTAL PERMIT F'EE
I-_-- -__.-. L'_______.______._.._._..-.._._.__. .-_._..---_.-._.,_.__...._-_-_.__._--__ __, 1 his permit application expires if a permit is not obtained within 180
een
as
Authorized signature ! -.`.`• ' Fee':r,ethn olopy se!
by
Tal CountytBuPding Industry Service Board
i -dr U -
Prntm :n -� iiL.
I`,BaSdmg\PermnslaEC_Pem/IAp, 04011 i,d e 440-4617r{1!"41.2(CON;w3:B)
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' ...... b`r`a. T>':+x r,i ; •F r r l....
E.ectrical Permit Application � .`''. -,„i-_,,,,,,',-47 r{t.,au j .�isP,xo�.1 Y. . • • _
ce\.1I.ccet•:cclPermit 4'
., 4-�:��g City of'Tigard � Dnte;nv -- T• • � - ..,� -
st141; i'r 13125 SW Hall Blvd..Tigard.OR 7 �}1 Pian Revie.r Related Permit N:
i Phone: 503.718.2439 fax. 503 5,$.1960 015 Datell3y
f >a, l. Inspection Line: 503.639.4175 '1-1 :
Ready Date/fiy: Iuris: f$ See Page 2 for
.T P4M'llJ: Internet: www.ti'ard-or.gov Notified/Method: Supplemental ental Information
�(,y�� t u tp a �'���,,��VV'
- S.. Ty.,s Y^ „ ArTAC:f '.5I .:�..: :,5ygr. 'qtr Esti:` -�F�4 �+¢.p Mr�'kj�"�:; .
^.
❑New construction0Additionlaltcrati'o�r1
ecplacelirnnt VI\011- Please check all that apply(submit 2 sets of plans whims checked):
11] Demolition El Other:
•+a+A�1� 0 Service or feeder 400 amps or more 0 Building over three stories.
G t_
; ,'.�.
where navailablest
Marinas
and
.:,C. O2X'::OF.`CoN tU'cTl9,1N, : .`;< '< " , eeceeis10,0(p,npai150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps rot all oilier installations. buildings.
E Multi-Family ❑Master builder ❑Other: ( 0 Fits pump• 0 Installation of 150 KVA or
--- „ •e,'..',.,. :t1. srrfvc`oR t Ti ti'i i :�c� r) .
. , - O tne -'1.1'.•-•sys;cm.
larger separately derived
0 i(' tun-new motor loadof system.
I .lob;,l; ! Job site address: 1Z gee_ }
! i; ,..,.._
-- f; calf-care residential units.
Clt SLzt1c/7,IP: e facilities. 0 Recreational vehicle parks.
Salle/bld / Project name: locations 0 Supply voltage for more than
�- -- g..apt.#: J - 600 volts nominal.
� -_- .-----------'- --- ------ 1 1J Service or feeder ti0ii amps or more . . -, -
Cross street/directions to job site: • i " ._ giFE,E. 5.-•RED /`, `,` :`0
I oes niun Qty'. Eneh TWat
-_ Ti _M_ - - - --J_ __ I [New residential single-or multi-family dwelling unit.
Subdivision: 4 �I/�N V _ (sot I: ; Includes aft ached garage.
7 -
C - __ - - 1 1.000 ssq.f1,or Sass 168.54 4
Tax map/parcel#: - Ea add'i 500 sq.n.or portion 33.92 I
-. ;" - 0O .S(CR1['-JONOl''•r,W:URK : r -1 . Limitedener ,residential
.::,,ate:::„�«�F ,'.:.:' energy,
(with above sq.ft.) f75.00 2
• limited energy,multi-family 75.00 2
residential(with above sq.11.)
�,s_r,r, _ Renewable Energy See Page
-,�{tP-1t(JI.,EttT't=;OWNER:i'.;>.'f.''..!.i.i i:. '_':::l' ;;'W',.ir-1";f1'Ve111.104;'%`'i:iNT Sor feeders installation,alteration and/or relocation
,... ..... .. .,. ., -<... . s. _.r Services e
Name: Pacific Evergreen Homes 200 amps or less 100.70 2
Address:7410 SW Oleson Rd,Suite 133 - j 201 amps to 400 amps , 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Portland,OR.97223t ,1,1601 amo' o 1;000 amps 301.04 2
Uut
Over i, t am sot volts 552.26 2
Phone:(503)664-6423 Fax:( ) 1 -.-- ( 1 f
--.. - - - 1 rtcntporary services or feeders installation,alteration,and/or
Email: ' : r:aorlition
Owner installation:"Phis installation is being made on property that I own which is not ' 200 amps or less 1 59.36 I 1
intended for sale. lease.rent.or exchange,according to ORS 44 7.4 9.6 70.a11d 701. 2ril a-^ :0 amps 1 I 125.08 2
Owner signature: - -- ----_- 1 `7D I 16854
L _.
Date: }; ' amps to yc''mrls _
;,,.,. •-.-- ------x • . i 11-13.r'a_nch circuits-new,alteration,or extension,per panel I
-_ ..' ;;,,I'I�IC 1T-'.-iii'Ai,::.-..i - :`. ' %•"t; --i ti1'r1(�__ k ER _.._____.--_-_._ I A.Fee for branch circuits with
Business name:Same - -- -_--- - - - ` above service or leader fee, 7.42 2
1 `_
-- each Manch circuit
Contact name: Alan GoffMoore i B Foe for Manch circitits without
---- --- --- service or feeder fee,first 56.18 2
Address: branch circuit -_
Each add'I branch circuit 7.42 2
City/State/ZiP:
-1 Miscellaneous(service or feeder not included)
iPhone:( ) 1'ax: :( ) I Each manufactured or modular 6284
- dwelling,service and/or feeder
Email:alangoffmoore@gmail.com Reconnect only 67.84 2
"£t -,< ;i"l&,-, iFazM u>sl?,..<xCt1 "�'l;ilR
� hT �i:`,," r: ` i um p or irrigation circle 67.84 2
Business name:Sunlight'Electric Inc -- Sign or outline lighting 67.84 2
ISignal circuit(s)or limited-energy
Address:2804 NE 65th Ave,Sute DI panel,alteration.or extension. 0 Sec Page 2 2
-- - - -- --'- Each additional inspection over allowable in any of the above
City/State/IIP:Vancouver WA 98661 _ 1 I Adduion;!inspection(I hr min) i 66.25/hr
Phone:(97:)222-5758 1 1;1)'‹:(3teI) -s i=,'-9660 -- I i in' uiiiit n 11 lir ii itt =;0.00/hr
Ind esti Nil plant lihrmin) 78.18/hr
Finail:sun li ht_incI@comcast,net fr,vn -i
g � �' -- - -- -I ` Inspections1 ich no fee is
90.00/hr
CCB Lie.: 172549 Electrical i.ic.r I Sttprv. I.i:'.: t f•j-z e j spe::tica!i}listed('A lir!Mill t
- ---- --� -- - _ - -a t "r'.3..EC1'Iii0';u;:PEali;k1iTg.FCEs:`.>; ;' ; ,_
Suprv. Electrician signature. required `r- I I Subtotal:
Dial:
'tint name: Chester Garrett I Date: to/20/15 - L_Ei Plan Review Required(25/of permit tee):
------- --- --- --- - State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
'\uthotixed signature: L____ -- ---
T l this permit application expires if a permit isnot obtained within 180
I I days after it has beenaccepted complete.
Print name: Peter Kozarez I Cate: l iJl ,,2n/15 -I as
�.------_ ------ ' Numi,ei of in=spections allowed per permit.
I'i5iIdi:n:ii'coons\pd.c_:'erm:IAop_.6LR ERE.eioc Rev 06/17120!5 �a9.44i4:iI o..COM'W'tin
. .
Plumbing Permit Application
NC,\\
,.. 6 ,,, ,..4 „I ?)..4.4.v.,.:-slw...:.8.,L,.p..,,,o,.._,o_,k ;,4...,..,.4..--4,,..,list2,v,.t,Rg,,wirc,„..g.v,:;,,.,.?,.,.;... .....7.-,.....,,,l. ..:,,,:„.„
Building Fixtures ',TT, ?,...., - '11:1'"'d'frck'N..V.71'n-:-1•FURTOFFICEAISE•-,ONLV't.,..• •. :. .,.. .., . ' i.
it
rclq...5.g7'.e14.14r-',..r.atiLt'itii::,if,0':-",•4: ' ``..,:a3;3.._..i*,;':,;:
City of Tigarti
et, VA0 L');11c,11:
' - 1 Perinii N.,
I ') in_Sras_O I STVCadki„-
tt.',.4 .1.0',4;q1 13 I I'S SVc Hai;likd.,Til)arri,OP. 9'227, VI I.
)11i:: ,. 1i1,:,ki.1.... Phone: 303.718.2430 Fax, 503,568.1960 \,,,0\-, Otim Pm
,6ai No'
.......:._,:.2.,..P'.'1'A 16eciion!ant- -50 z 6 m 4!175 it:„. --I-. .
'1 ."k ,it
O'k
Internetwww.11 W ' a: i '.1..7 Sve PAgt.i ita
ormatin
: 62ard-or.tioa. "N1 ' 7' ‘11Q: method- I Sonntementai info
TN'PE OF WORN
1,13F.*SCAIEDULE', • !! '?' .' : :
I-L--- 1°1•11%'5i l'' !
El Nek: consmIction n 1-)::itil .
For ypeiIV/infitfttitairitt use checklist.
—-j
, ,-,
Oty, I Es. i lotal
I :I ler:
' F.Adddif.:01',Oteriition26.1,1,,amea
ce _ ()fimilt i N'eNa 1-2-faly&Aching!,fine/title:,1-00 rt.Mr eanyn
ch ninconection)-11
' 112 70 CATEGORY:OF:ci)NsTflucTioN ! , sIM,R t 1)ha , , 2 . 1 ,
i '-, ' ShR r2t1-:101 I I 437.78
1-unti 2-11tmily tio.e11110. ! LI CouttruzNittUirriutstrit.'.1
i 3
5FR13Rffli 1 50032
1
i D Acctssnry building i 0 Multi-family
Each ibblitiim,11 hatlblitelbni I 1 23.02
. i
i 1 tr_D . :i-J Nlaster bujidcr . C)111''r' Fife irii
JcilattTE:,p(FORN1AT1 cr. AND L9cATION 1 : Sib:wiliiii-:,.:
Joh site addrta_ 0.Z
ss: _JA PI
)irr _ , „2„,,„
, h.,,„ara edr,.
...._
D,,:cli,leach line.or trench drain i 18.76
18.76 i I
1
, city;StaterZIP: ,
l'ootina drain in0 linear il. i ['age 2. I
1 SuitelbIdgiapt.no.: ' Project ne:
__
,..• ______ . ,: ! Alimiirsmr,-,1 home iniiities I 50 03-I- I
Cross streeildirections to job site: ' , Niani164:s I 18,76
:
i I —
I (A441 el,
, :.Im d
ar.iin,,20iiihicior
--
S'an-iim, V;',:r(flu )irwar R.1-001 1,
; Paze 2
-
1-- . ., ; slimy,sev,m init.!meat ft,
I1' .
11. 11:l ef 10::,f10 linear ii. i I Page 2 1 ,
L.SubiJivision: (146P-A?JD t t'@1 nun: 3 , li‘iiire ni!nein:
.._
Tr;mapparel tin
- -4
:',..,..i.liov.pin,..iite: 1 31.27 ' 1:
`,41,..`r,;xt-...! ) 1 12 51 3 I
ors('It t il'ION-OF WI IR I*1: _-
• - , : . !- --i-
! i i 25 02 i
1 -.
1 ,5,0,
i ; Do,,,,,h,
,.-•
; I:;rii ;;;,:fnt.nnInl , 25.02
,,i".i3i.,sdna} ; 2 17 i
: g,pRo-p-c-R- --- 1 -------bfi,...! -A!. i• ! 1,•:.!::!!!stiln:,aili; I 1 i2 51
; iv\nit .swei cap I--- 25 02 I , •
I Name: Pacific Evergreen I-II wiles {
, [
1 t
I lour sir2.i-,fi,,,,r,inkillub 1 1 25.02 I
Address:7,,i ID S":,,, Olesott Rd,Suitt:133 I— --.1
!!( p.-im,p&ai I 21...5„!)..2,_..t.H.._._________„
CiiviSiniciiih:P61-flR.aw:L.O 97223 ! 11,),::bi ;1i
j, ......— 1
Phone:(503)664-6423 la\:( ) 1 I Ici2 maker I !
i 1
- :, :•:-/ID APPLICANT - - , fl coNTA.c:T pi,,Rsi-iN 1 , P.:Q/01,1,Y;,:k.'1,..2.Irn, -25.02
; '. ;,...n!,..:': (,..;. :. :;,. ..______; i i'in' '
rinSilleSS nall);:' Sa all,' .1 ' 7-I.-
1 9'1(1,.-: i 1 i?.•ii ;
I
COIStaCi name: , 1 d
_, ; ' !: ,•;m;m- 0namirch! 12 51 1
, --i
Address: \mi,1,,r in',,,,,115 I
1 Cit', Stah://...11'. , k, 6im- p.o.Thle w,..itcr
.... _.... .._._ •i
_ .
1 1'bonc•{ i ' 130,• I , : ,7,••,...t.,el ,..imver pan 13 ! 12 51 1
z' 1I 1 r 25.02
F-01ttil:alitrtgoffmtntre t1/111),iii.t.tom :
f:ONTRAC1 OR 1.1. tc!c Io3.1 i 1 25 02 I
------., : W;!;..; n;;;I:;; )V72
Business name: EDWA RD:\IELL EN PLC NIBIN4-; '
" \ .1 p)1-;:lg D'W\' 56.29
-3-2
! Address: 141(41 SE RIVER 1-t0A1) i;Jr.:. 1 I 25.02 I
.. ,. i
I Cit\/SMicrlih.1111:L
S130RO:OR 97123( 1 ! Subtot-il
' I
Minimum permit fee: 5;72 50 L
Phone:1503)6411-41113 ; Fn.,:(:;031 G40-4483 ____
L-7.7--- _ Plan review (25%of permit fee) _i
1 CCB Lie.:02689 : Plunibino lit- no.:34-26611,) -1- 1
________ _ -- . Smie sorchnrae(12'1:ii of pcnnit f6e) i
2
Ant honi_ed siemaiure: ... 4 /41 , ,Ar .," .4 -77
TOTAL.PLICA,IITI:EE I
„.,..." • '''' 4,fr'ff__ -. "..:.T.
/ . _ 3...:3-i-milnit,iiimiranim tis laces it 3 permit is not obtained bititin 1804.1;ws:
Prim name: RA\ NIfl..112N : Dote.
I.,___.._ _______3_ _____/<›.._1-7,),,. ._____/, it has iltfell aCCepfeii fi5 compime.
•'i•-„,r-•:•!!!,..--2•_!•,•-...., •••!!.I.!::I ri•I7!!!!!!ty B.,31,Thig Industry Service Beard
1 lit.;;Id,,T,Nt;;;;;;;;P!,\1;-;;`,..;,;-,,,;;,;., • ;;„1,
City of Tigard
.71u COMMUNITY DEVELOPMENT DEPARTMENT
°,. . BuildingPermit Review — Residential
G1ARD; m,..w,. .
Building Permit #: rd-015-- 00'.
Site Address: A,/frYD.- /.,'.1j A c e,
Project Name: ____62r-ce.lk,,--e ( Lot #: 2
(New dwelling=subdivision name;Addition or Alteration= last name of owner)
Planning Review
Proposal: /Jci - Si/CO
7.
Verify site address/suite# exists and active in permits ,stem. /(24-yd,`n)
River Terrace Neighborhood: ❑ Yes No
Site 'Lan Elements:
hree (3)copies of site plan —@-Existing structures on site
lite p1 an must be on 8-1/r x11"or 11 x 17"paper1 ootpruit of new stnicture (including decks)with finished
•,�,,�Drawn-to-seale—standard-aicliitector_enguieaaae) ) floor-elevations._./ ��
North arrow ,Utility locations(requy�l for new,may apply for additions) 1vA ec •
Lite address,project or subdivision name and lot number - 6cation of wells/septic systems
k\pplicant information(name and phone number) )4rosion control (including drainage-way protection, silt fence
( ot dimensions and building setback dimensions design,location of catch basin,etc.)
Lor area,building coverage area,percentage of coverage and treet names
impervious area (applicable if R-7,R-12,R-25&R-40) Street tree size,type and location
'roperty corner elevations (2 foot contour lines if more than -misting trees to be retained with drip line,and tree
4 foot differential) protection measures
KClean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
02equired: ❑ Yes,applicant was notified `�' No Received: ❑ Yes E No
❑ ublic Facilities Improvement(PFI) Permit:
2equired: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
i -Land Use Case #: 3 6 c:2(J/1/4 0000 Z
Zoning: R- ��
S
❑ Setbacks: Front a0 Rear /S Side 5 Street Side Garage
E Landscape Requirement:
❑ Lot Coverage Maximum: --
NK Building Height: Maximum Height 36 Actual 1-Leight
Visual Clearance
KEasements
❑ Sensitive Lands: ❑ Yes No Type
❑ Urban Forestry Plan
Conditions "Met" prior to issuance of building permit
Notes: (v0 pct. Su bvni+c- C( ? P-: ? ) 11-i —Oc))C9t7
Approved By Planning: An 0(t)0-a, 13i)0 otLeAR-J- Date: I I-)1 GI 1 1 S
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\BldgPermitRvw_R ES_0709 I 5.docx
Building Permit Submittal
Original Submittal Date: // 9 %-
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: arming leeringermit Coordinatorui ding
Workflow Sign-off: ign off for Planning(include notes from planning review)
Route Application Documents: ngineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
P-131-----iikling: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: _40Date: /7 2
Engineering Review
Slope at building pad: 5gp1
yrConditions "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 ❑ No
Assess Water Quantity Fee in-lieu: ❑ YesElNo
LIDA Facility on lot: AYes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: A Date: /1��'�. ,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved D 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 Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: ❑ Yes K N/A
Parks SDC: 'P Yes ❑ N/A
OK to Issue Permit •
Approved by Permit Coordinator:
Date: J� `VI j___
I:\Building\Forms\BldgPermitRvw_RES_0709I 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
12802 SW KING PL, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
PASS
MST2015-00224
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
12802 SW KING PL, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - C of O
MST2015-00224
Jeff Grove
Street tree
Moisture content
Lighting efficiency
Blower door test
All forms received
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
12802 SW KING PL, TIGARD, OR, 97223
Residential - Master Permit
699 Mechanical final
PASS
MST2015-00224
Jeff Grove
Street tree
Moisture content
Lighting efficiency
Blower door test
All forms received
Violation Summary:
Inspector Contractor