The URL can be used to link to this page

Permit El liq CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00223 Tigard OR 97223 503.718.2439 Date Issued: 12/07/2015 T j G RD 13125 SW Hall Blvd.,Ti 9 1 Parcel: 2S102BC01102 pyilifmaz Jurisdiction: Tigard Site address: 12793 SW KING PL Subdivision: GRACELAND Lot: 4 Project: Graceland, Lot 1 Project Description: New SF. 5/10/16: REPRINTED permit to include(1)laundry tray. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1365 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1178 sf Garage: 360 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2543 sf Value: $312,033.57 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: 1 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y 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 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: 4 201-400 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 2543 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 PHONE: PHONE: 503-664-6423 FAX: Total Fees: $23,503.33 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. Issued By: A-11.--7".491.4.---- , Permittee Signature: .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. Plumbing Permit ApplicatRECEIV AA 5I-201 S- 002-13 Building Fixtures l� FOR OFFICE l SF. ONLI' Received t City of Tigard MAY 0 9 2016 • l(a # l7— Permit N°.: n�e�5..,00 3 � 13125 SW Hall Blvd Tigard.OR 972 Dalen• Pian Revue N • Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No nate;By T I G A R D inspection Lint: 303.639.4175 Date Ready/tty W kris I ti9 See Page 2 for Internet www band-or. ov �,�rlY OF 11GAlt 8 B t�[('(� ,,,,, Notified/m.1.d '� � Supplemental Information hxg .I' ` I y 55` r ;OP 1.a ' l 14:-D l":11 .I 0';' O -,t, t,' ®New construction 0 Demolition For special information use checklist. -----._.--- Ilcscripuun J Qty. Ea. I Total ❑Addition/alteration/replacement 0 Other: ._ New I-2-family dwellings(includes 100 ftfor each utility connection; CATEGORYYOF'CON RU-CI',1O`A`: .. - SFR(I)hath 312.70 N I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(_sq.0.) 1'age 2 • . 7O1 gITE 7NFORI CT1ON-'AND LOCATION Site utilities: Job site address: �7(i3 Stn..) k..:7-..NCI Pe-- Catch basin or area drain (8.76 --—` —i Dr)well,leach line,or trench drain 18.76 City/Stalc2lP: %-�o I _-..- —_: —_--__ __- ____ Footing drain(no.linear ft: ) Page 2 Suite/bldg./apt.no.: Project name: �7 2A �AN� Manufactured home utilities 54.03 — Cross street/directions to job site: Manholes 18.76 (il I aL is/U-r Rain drain connector I R.76 Sanitary sewer(no.linear ft.: ) Page 2 --' Storm sewer(no.linear ft.: ) I Page 2 , Water service(no.linear Ii.: ) j Page 2 Subdivision: e-i 2 cc t.A NJ Lot no.: i Fixture or item: _____ _ _ preventer7 Tax map/parcel no.: -- Itackwater valve 12.51 '1%.-:•:,,.-`, DESCIIILTI(]+IV 11rORK; /t f1 Clothes washer 25.02 AV\ �1U N DILL `JZ-,-� Dishwasher 25.02 I O PERYtX Drinking fountain 23.02 Electors/sump 225 02 181 PROPERTY OWNER 0 TENANT Iixp:utsiun tank 12.31 Fixture/sewer cap 25 02 ' Name:Pacific Evergreen Homes -- F Floor drain/floor sink/hub 25.02 Address:7410 Sw Oleson Rd,Suite 133 25 02 • Garbage disposal City/State/ZIP:Portland,OR.97223 I lose bib ` 25.02 Phone:(503)664-6423 Fax:( ) lee maker � 12.51 la:I APPLICANT 0 COIN'TAC.I' PERSON I Interceptor/grease trap 2S 02 Medical gas(value S 1 Page 2 Business name:Same i Primer12.51 I Contact name: in( _i_ 2- + ------ _- —__ — — Roof drain(commercial) l_51 Address: Sink/basin/lavatory 1 i 25.112 City/State/ZIP: Solar units(potable water) --y lit 51 Y�} Phone:( 1 Fax::( ) I t'ubishowerisllower parr 1251 Urinal 25.02 I E-mail:alangoffmoore®gmaii.com Water chisel _ _'02 i CONTRACI'QRn { Water heater 37.52 Business name:EDWARD MULLEN PLUMBING Water piping/DWV' 56.29 Address: 1601 SE RI%'ER ROAD Other. ( ii 25 ' City/State/ZIP:IIILLSBORO,OR 97123tiubtnt d Minimum permit fc S72 50 t Phone:(503)640-0113 Fax:(503)640-4483 --t Plan review (25%of permit fee) CCB Lie.:92689 Plumbing Lie.no.:34-2601'11 r State surcharge(12%of permit fee) .GeV . . Authorized signature: /`y fr/ — TOTAL PERMIT FEE Thie.permit application expires it a permit is nut obtained will n 180 tiny. Print name:RAN'Ni LLE\ Date: c., 1;:z„--/), .n.r i.ho,been accepted..complete.I 'Fre methodology sct h1 Tri-County Building Industry Service Board I'JluddmelpmmniTiAlIAPearmApp dux 10.01.5-) 4s0.4ul1•l0nt or!co'. F.r11 r ` 'I'' CITY OF TIGARD MASTER PERMIT F t ,rr is COMMUNITY DEVELOPMENT Permit#: MST2015-00223 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/07/2015 I. , ,4,. Parcel: 2S102BC01102 Jurisdiction: Tigard Site address: 12793 SW KING PL Subdivision: GRACELAND Lot: 4 Project: Graceland, Lot 1 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First 1365 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1178 sf Garage: 360 sf Front: 20 Smoke Dwelling Units' 1 Third: 0 sf Right: 5 Detectors' Yes Total: 2543 sf Value' $312,033 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: 1 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: Y 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 F u rn>=100 K: 0 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: 4 201-400 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+a m p/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm' N Vaccuum System: N Garage Opener: N All Ecom assn Y Other: N Other Description. Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2543 Owner: Contractor: PACIFIC EVERGREEN HOMES LLC ALAN NATHANIEL GOFFMOORE Required Items and Reports(Conditions) 7410 SW OLESON RD 4133 13950 SW BARLOW RD 1 Ersn Cntrl 503-639-4175 PORTLAND.OR 97223 BEAVERTON,OR 97008 PHONE. PHONE' 503-664-6423 FAX: _ Total Fees: $23,040.91 1 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and r other : .able 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, •rk is .,-nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent,' \T se AIV are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy o-. - . - . -ct questions to OUNC by calling 503.232. •87 or .,....1,,!..2,00-44. Issued By: d �L�-.-.-7 Permittee Signature: Call : • by 7:00 a.m.for the next available inspectio sate. This permit card shall be kept in a conspicuous place on the job site until co pletion of the project. Approved plans are required on the job site at the time of each inspection. ^ ` ~��l ��g'{�� .�T}�x ��:0� �� ,* tkECV.,4 V . ' attaks,.,,,,,``._;:...,:7,7,1 -,...-1VM1.141..iii24:ti..N....';V.6?;,::IIWV.'1.‘3.1,2.:...,,:i47,N•ieCc.'4.,. ,7: 4",'' irgla..):Ntii.44r.v.4' ihtliii.1/41t IK}INKsiDoODES'eso . ,,„.e . 6-,. I - ______H! Covered porch arca. 51Sp.9_Csquart: feel iv-7 2 . • r. ross sireei'direciitsits to;oh site: I\alnut ' • i:',e;:k ar.-::i 0 square reel/ ___6,5 , i LIN map.parcel no. -•.:!••Il.•If.-tII-•'I•I'••IcI:I,Ii•'• III•hor-n`In:lie-ad.and ille Prot II II:-"II Ihe -'--- '------ ----'- -----------' ---''---- ----� — `•..'.."u�': S ‘V.:‘, 1/'""" -_ --_--__-- --- ------ -----'---�- --�-----'-------'-'----�� 1 `• .:v: x^':'a,d duu square---- --- ---- --- --------- �� ---.---- '.c`. building square /e'/ ___ __ -_________, _ _ _ E� PROPER-I') OWNER / [] Jczxx�� / � �u�^c^um,iu. �� '�� • . N",.,- r^'a, c.,=',"oo^=u ! ��r^/mueoux^n� � --__-_-_' _ --_-____--__' -- '__ _-_- `,xu.o,- 74m*x'ol,momdSuite o3 __� -/ 'x��,vx,/� umup: '__'-____-_-_- � -- . -_ -_ ____- - ____ �i�s^u'//p� m��ox,oun223 ____ � u/,u,p: !----------------' _. - ------------ -- r--------' __________ ,:,":. (503±66-:0423 | m`� ` I x,". -_-_-_' ` E `rn.mrr ! [] coxz`'� rE:so� nm/.umcrcxm�reucs~ ��-- - — ��-- -------�` (Please refer to‘fee 'clrethile) _ ._--xv-x;IxaSo,, e__: Same `// »_-'"`e_-----''-'---'-----'_'-'----------_-----------'----'--_-------------'----------��-----------' -- - '----'--------- -' � | _ `.:�•`;.'_I`:..�``/`. u:w/u,�uio. --------------'- ' '\ `uuxxmc ^/,on^n.1|"vn i : ` pun'�`/eo l'ec , .x.i:|u* - 1.1.,11 ;,�,u:�"p.^^,ri''�i"n: . k.. s;ulk: a`' . m`'~ , ^u. 0�] n.`�. • ' ' ' ------ '-----'-------' �---'--� '----' ----' --�� ' --'- '-- '- -- - i'..=,^ai/Vu�SOLAR rANa�srsr/: 1 ��, i °`"x .uu"/",io',=,'x,"i "z..,"" ---___'__------- �-----------'---�'---�------ --' --' '. •° .`...::-,..0 :u/res.xmxa nuuriwx,mxo:*.^x'/ CONT«`:T-1`01C __________________� ,~��':^^v^um~mxvu/,�^/mpu�/ ��^'^o� -- -------------- �� `,.,.s1�"..:l,.u."1x`vrnlu.`,oxmnnovm.`u:../~ ^,^^�`o.m`/- uxnu,n��.".0 , , v ^ m* ` "`r--' __' --_----_ --�______' dud /'r,:department access.along"imthe zom'*g"' � "..u.':o /s5.0." iia,/"" xx ` /..' ^s^»lam,,."):^«ixv (»achecklist. _� "' . plan review ` ,x' w= """""" 97 08 s/nuoo . and^omxm ^ � _ _ ._, i'Ih • . s/.:.•..^+;,;e'o%^/Inonni, �e: --- S'c/ 60 �'� - "''' / ~ '' / � i^w' Fee uponapplication: | `.•-",)I m' _ -�� __-- v�� Nmr /�='r^/`,p�/m�°,.�""/r^p,"/'�"*.m"a,o v.v^.,=oo:""u"�'~ '`' ��mw~�=�� "�'��" m.days,r,,xhas been",,"r�u,^=~o/""- --' -~--�--------'---------' ` /•.'"m/."o,i"g ,e.`b /,/'o"."/yBuilding/"uo.o:. | Print.""^k.... `/mc"n)/vvn - __ __l`/^�__________�______' S"".=�*u. __ 1uviijm�.pon i.„m/P-xar/nn:AppLI,,, o--,,,.2, --,(�.: , < '�s1r P-Aje > ia- ; e tii. 4 gS ,..',. ,,s£ k", E➢cctical Permit N � , v foo o.FIC1usaoivr :fi " ,, ' \/ •• r '.? k1 City of Tigard Received Permit it: Date/By: �n�tens --_4,7"6?„)._ 3 r-� ''"';"' u 1312$SW Nail Blvd..Tigard-OR 9?h'~ Pian Re r-iew Related Permit 0: Phone: 503 7718.2439 lax 503 598.1960 ZO�� Date/By: i +_•wig Inspection Line: 503.639.4173 v I �, oY Ready Date/By: Jar's. BI See Page 2 for TIG RDE Internet: www"tigard-or.gov Notified/Method: Supplemental Information ,. ,.,.....'rl`.PL.UI!:-14"(.7(215, ,`;=rz:: , -n.::�"..._�,,, .--s� .��}r,.r....,rs�;:. : ' s . \d of 1t I IPlease check all that apply(submit it 2 sets of plans ye/items ns checked): New construction ❑Aduttion/aitcratiotpld trpg1 yy q\ �1��j1t 11 ( 1 0 Service or feeder 400 amps or more ❑Building over three strn ie,. I 11.1 Demolition ❑Other: �'y�� ( Where ilio available fruit current 0 Marinas and boatyards. hs� � --- r ='-t;A'1=t@i(�t)Rk=.:L71?'C0ISTRIJ�1;"InN,•_<, exceeds I Q000 amps at I i0 jolts or ❑Floating buildings. --- ` = i less to ground,or exceeds 14,0011 0 Commercial-use agricultural I El 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building amps MI all od, rinstauanons. buildings. I J I ' :Aiulti-l; nily ❑ ivtac,tcr builder {�other: ❑Fite primp ❑Installation of 1SO Kv:�or — .— — ---- — e ."1 ' ❑I rcIr,;cnc:•s,stais• target separately derived SOP $t;r; OFORT:IATtON.AtV1.i.lo..vrio, -' ;- I -:._:- —.-- — '1 I ❑Audition of new motor load of system" I ob?: H Jobsiteaddress: {2�]qq.— 100Hper,„0„, ❑"�A P "12 I3'- -------— -- —.__— _/ (_ L �/('�.- — -, i occupancy. J0 Six or more residential units. (aiv:'Siate'l.lP: I ❑tiealdrealc facilities. ❑Recreational vehicle parks. ----- —---------------- -- -------------- ------1 I-- 0 Supply voltage'for more than �Suite/bldg./apt.4: Project name: 0 Hazardous locations. 0p o b ___—_ _ — __.___ _ ___— 0 Service or feeder 600 amps or more. 600 volts naninal, Cross street/directions to.job site: /��y �— - /;;'w`e i�Descrrption: Qq•. Each Tutal New residential single-or multi-family dwelling unit. Subdivision: L�{ukit` 1'- J Lot 9: ' Includes attached garage. 1,000 sq.ft.or less f 168.54 4 Tax map/parcel 4: Ea add'I 500 sq.ti.or portion 4 33.92 I u::, - I ... :\�':,R1C�?`;u"::5ts:: <,x: : - energy,residential :�.5,= ;F%s .�:i"DES"CR'1PT Utti,b.. O_.......-;z`.......,,:,.... .:. ....... .<M. ..,, Limited enc,g,. e 75"00 I 2 .I.,. „ ,._..�.... ..... ...... ". (with above sq.ti.) -- —_— ' Limited energy,multi-family I 75 0(1 I-- residential(with above sq.II.) - -a -- - - -- 1 12cac:;r'able Energy ❑ Se.e Page 2 I PROPERT.1'rOWNER-"";:_.".,,::"II I} N.i, c 1 ®'_r.,,y..., 1O, .: ~_�'� --_._-- ; Services or.ceders installation,alteration,and/or t elocation l Name: Pacific Evergreen Homes i j 2/.0 amps_t less 100.70 I I Address:7410 SW Oleson Rd,Suite 133 i 20I amps to 4n0 amps 1 133.56 2 --- -- --.__-- ---------- I 141/1 acipii to 600 amps _ 200.34 2 Iity/StaleiZ1P: Portland,OR.97223 dt -_ �Ui -gulp;;o I stir) ups 301 04 — — -- — —.__... --- — — I , :lbc1 i.U4U;Ir:'>sot volts 552.26 `2 - Phone:(503)664-6423 ! lta:,:i •1 '— - t .. -'-- I I cmporary services or feeders installation,alteration,and/or • 1:)11311. 1 relocation_ Owner installation:This installation is being etude on property that 1 own which is not L200 amps or less I 59.36 I intended for sale, lease.rent.or exchange,according to ORS 447,449.670,and 701. -201 amps to 400 amps I 125.08 2 Owner sinaturc: Date: 01 amts to 599 snips 168.54 2 {--------_ ''';'.;<_ .,.• .,s ;� " . . .I I Branch circuits-new,alteration,or extension,per panel 1 '•P, 1 Ga�T" ------ACT;:;i-,L12ua,ti _.-`:�tr t�Y:�:�'®: ,Y').� ...,..Mr- a :; :�<e ::t:��. �;z."„.'�" ..-, _ ,.- I A.i'ee for branch circuits with Business name:Same above service or feeder fee, 7.42 2 each branch circuit Contact name:Alan GoffMoore 1 B.Fee.for branch circuits without - 1 service or feeder fee,first 56.18 2 Address: branch circuit -- - Each add'I branch circuit 7.42 -2 City/State/ZIP: - Miscellaneous service or feeder not included) Phone:( ) Fax::( ) 1 Each manutachtred or modular 67.84 2 - i•.ve iIing_service and/or feeder -j Email:alangoffmoore@gmail.com- , p con Act only I 67.84 12 I .. s a .i . . , --I 1--- - 1 , s .es'=' t' )Ai1'I21C i t1R„ Pr, p cr rrigt!nn clrcic 617.33 .- ..•e+:,�, . ms's.: �:!t'`-,'i;Y �I I 2 I �- '.✓• w - --i LSt"n or outline lighting , 67.84 h Business name:Sunlight Electric Inc I g g g Signal cireuuist or limited-energy , 2 I Address:2804 NE 651 Ave,Sute D - --� I_nel.alteration.et extension. El See Page 2 1 -- - -----"- - - 1 Each additional inspection over allowable in any of the above] t.ah/State/LIP: Vancouver WA 118661 I t" "- -� ---- _--___----•-_ . -_____-____- - -_ ' :'\cd:t::u•a nsnection(1 hr •min) 1 j 66.25!hr Thune:1971)222-5753 i Fax:(360)32610660 Itt•.esti:at:cn t: lir min': 90"00/ht' I 1- - - - ---- - -= - -- - -- -- I tnJustria;plant(1 hr min) 78.18/hr - — 1 Email sunlight.incl(ir comcast.net '-� - ��30 _ _ __ __ Inspections for which no tee is - 90.00,hr CCB Lie. 172549 1 Electrical i ic.• 11608 Seprv. Lic. /793 S _ speeificaily listed('rihrmin) _ ,,' "1x11*?I*'1C ii*, } #40til E :t;x,;..811.1:.., ❑}Ian Review Required 25/o ofpermit fee): :X;y,...=.,�;`�, ; " i Supra,. Electrician signature,required yf"-- Subtotal: IIi 1 Plan ( o f IPrint name: Chester Garrett I Date: 10/20h.5 I- - -- 1 -- - - 11 State surcharge(12%of permit fee): Authorized signature: I TOTAL PERMIT FEE: J -- This permit application expires if a permit is not obtained within 180 I I Print name: Peter Kozarez _ -1 Date: 1`3/210115 — —I days after it has been accepted as complete. -- 1 - -anther of eto"pections allowed per permit" 1lauitdtng\Permits\El.C_I'ermitApp_6LR_F"RE doe Rev 06/17/20;5 410-4617ni'/0'/COM/WEB 1's t., `',$'oi' 'f€ slit �`'. .s�'. ,moi"'re°" tee&ntr Meaanical Per m Applicatia�>ti 'e . "' CIIZIOftt l�i l _ 1A _ ii4» g. og -. ''y� � §� r -+r, t.�+ _`-`"t€.. ��iscarst }«�,- .4n. a�' <r.� m..dx `' S`+cu. raze+.'; City of Tigard R:Ite(}.,ed `s 13125 SW Hall blvd.,Tigard,ff 9 ,� Han Rei.iew 1 t "�.-r'° - Phone: 503.71 8.2439 Fax: 503�'.�..' � re3 Datc'fiy� Other Permit: �T inspection Line: 563.639.417.5 `` Date ReadylBy; Pals: is Ser Page 2 for Internet: www'.tigard-or.gov A\OV �� Iontied/Method— --'-- •�� 1 Supplemental Information �� TYPE OF YORI`Vi0�6-VP'U 1 I COMMERCIAL FEE* SCHEDULE - USE CHECKLIST1 i ---- -� ---r� y -- ""--j ! Mechanical permit fees"are based on the value of the work El New construction ❑Addition/altcratto -meat i performed Indicate the value(rounded to the nearest dollar)of all i ❑rN mechanical materials,equipment,labor,overhead,and profit I Demolition ❑Other: _ � -------------- Value.$ 1 - -- CATEGORY OF CONSTRUCTION— - - {tESIDENTIALEQUIPMENT ISYSTEMS FEES*ll--® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building j t For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description j Qty. Ea. Total Heatingjcooling: JOB SITE INFORMATION AND LOCATION t--_- - - - - - ! Air conditioning ; 1 46.75 - j .lug site address. )'_�q 3 k _ - ^Furnace 100,000 BTU(ducts/vents) 1 1 46.75 - City/State/ZIP: - Furnace 100,000+BTU(duets/vents) 1 54.91 Heat pum�B � 61.06 Suite/bldg./apt.t.no.: Project name: i - g.`rap J -_-- Duct work ; 23.32 --I Cross street/directions to job site: _--- -- -- ! 1{ydronic hot water system 23.32 -- weal. -- �- mResidential boiler(radiator or hydroc) 23.32 I -WI Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. • 46.75 r---- --J --- --- � � Flue/vent for any of above 23.32 --' 1 Other j 23.32i- 1 Subdivision: Cl , L�t no.: - 4 -A(�d-AnNj_. ---------__-------- ____I_--_ __ Other`__.I nuance Tax map/parcel no.: j Water heater_ 2332 - - - DESCRIPTION OF WORK -- -- - - Gas fireplace/insert II 33.39 - - Flue vent for water heater or gas fire lace 23.32 Log lighter(gas; 23.32 — -- — — — - ---- — -- _ Wood/pellet stove ! 33.39 Wood fireplace/insert - 23.32 Chimnev.'liner/flue/vent 1 23.32 ___ -- _-- Other: j 23.32 1:- C PROPERTY OWNER 10 TENANT - Environmental exhaust and ventilation: Name:Pacific Evergreen Homes Range hood/other kitchen equipment s 33.39 Address:7410 Sw Oleson Rd Suite 133 Clothes dryer exhaust i ) 33.39 Sin le-duct exhaust bathrooms, City/State/ZIP:Portland,012.97223 Single-duct __-- , I toilet compartments,utility rooms) 4 23.32 1- Phone:(503)664-6423 Fax:( ) i Atticicrawlspace fans 23.32 la APPLICANT t 0 CONTACT PERSON 1 Other -23.32 Fuel piping-_-- _ Business,name:Same _ 514.15 for first four;54.03 for each additional 1 Contact name:Alan GoflMoore - Furnace,etc 1 Address: -- --- - ------------------H I Wa;i/suscended/unit heater City/State/ZI P: - -- "xr'ater heater-_ J - _ Phone:( ) Fax::{ Fireplace i -- l E-mail:alangofftnoore@gmail.cnm Barbecue_ CONTRACTOR OR Clothes diver(�aa; I t k Other: Business name: ..��+.j; le,U v-` • ,i (4? � ti`v1 MECHANICAL PERMIT FEES* - Address: r } -------------------1- -- -� Subtotal � �- �� C (Z ff — Cityr'SEate/ZIP; Minimum permit fee($90.00) Lv>b 1 -' - -- Plan review(25%of permit fee) Phone:(5ti j ) {� \z.�,ci ______1 Fax (` '')2(6.60 3 �� _ E ( permitfee) (o .7Lt ] State surcharge 12/n of I`t 0 p TOTAL PERMIT FEE i CCB lie.: LU C1 --� C-- �,�J ----.-.--- `` --- - -"1'his permit application expires if a permit is not obtained within 180 /es// days after it has been accepted as complete. Authorized signature L; mac.- Fee methodology set by Tri-County Building Industry Service Board • Print name_�1s' -! ---___ ± R: f D y .( - _...i 1:VBuild,ng\Permits\MEC_PermitAp,_ua0113.d i 440-4617T(I 1/02/COSL BJ • • . Plumbing Permit19plica lion lluiltling Fixtures .4.17:tw ,..w4y.-4g 10,154f4MV,..c.f.*F.*', -6, ft,EausEilf9xisy.,,,,,.,,,L. vpria$,g; ;i..,-, ^714;..ia, ,1"1!,;',.;,.:2•,,TR•idige,,i-.-',4iAii:51.4.ikw't4.=4:1047gAftgli'480,ttreDi: rictoOsVoiAtii C t ty (If TiTitril i ..,.,,,,,,,,,,, i . ,.. ! „ i tEL ,,,, art.4':,- illott.::. :,03.7 I 2-43') Fax: 503.5-},1960 (3\1, '1-°1 Other Perlin:No. , ..,0, EL, ..4444,,LaT:•lf1 'WIC-1,,in 1 me co.',is',1417.1 .10%.")) l71:ltlitZt.hri):..; . „ I I 1 .4.i, a See Page 2 for V.MAiita ' -- ' . '''.- '. ' ‘ .- _,,iii inter:lc::: ,..,....,,,.\ilgard_or.gov J', - ; ' -• '.'"Il'ed'MT,,7d Supplemental Information . , . , -.1-1 • .z..1117, ., IF 01- NV 1,}R Iii: '''-i . i' ,V..4 1' ,.. i.FEE*.,SCIIEDLIEFI('' . , „ ZI.(‘'.,-,-..,c((n,( ueion 0DenIZILIIP , , For special itiliwinalion use checklist. . ............ „. "I I tr?="?'tr.......4tt,!ttttt_______ ! Qty. 1 Ea. 7 10.1 1 •, E,Vidliit-mizlite:•abonireplactinient 0 Other: -. .. i New I-2-family dwellings(includes 100 It for each utility col:men) 1 ,..., ., _..,i t--. i t. l' Ctit'VE01-{V;-()Ft,COnt'fRUCTION, ' ' '""'T= 'I i SFR(1:1 bath i i 312.7C, . l _).... T i (2)bulb i 1 437.78 und 2-f mil i I,,dwell ital. I 0 Crmintircialiintiustriitl -------- .-1 i ,, SEE Co iimli i ll I 500 32 n Astvy ccentbuilding D Multi-family i i* • l i'litell aticioional(athrkilihen 1 l 25.02 I i I ! 0 ',,laster bkiikler ED Other: it i i 1 Page 2 I .1013,SITE INFORMATION AND'LOCATION 1 Site utilities: ! Ji.)11 siti2.atitirta,...,: / vet 3 /4015 11 L i-- Di:‘Yz.11,tench line.ni irench drain i 1 l i I I Cit‘'Stinci/.1P- I Page 2 I 1 Suitt.ihicig,,apt.nu,: i Projeti mom:: ,i , ' ,,aininacta:,.:ii]-.::::‘,tiiinin.., 1 (I c .^..,< ::.;i r tlf..ii l',.C I i On,i.f,i t q :,h i t4)• , ,\i,..,i,i,,P.:'..; ' ' 14 1 IV- : ' ' ......, &sun i5,np.,:'...r 1 i 18 70 ; 1 _-_________-_—.--- } -------- 1 i :n188.>,..v.L.:1[Ito hric;ii Ii;,)eQ ) I Page 2 ' ! : Storm.sewer t nu,linear 11' ) 1 1 Page 2 i ll 1 •I , 1 ,--. V.'atel•ser.tce t no.!meat.ft.: ) i Page 2 I i i ! Stahclitision: 6 . J , .., ,„„ ,,, lin,. ..), :,..,11,?•,,, rrevente I I I IIIN map parcel no.: l ) 37 12:251 ---i.1 - ,''• ''<:',;'1,`•;.,,....k17)ESCRI.P:rIgNi,-,,OF,:yv ,":' :.,:'''- J. : , i_ -4 I (:1 01 ite u asher1 1 1 25.02 I 1 • I I ,,.., ,- I NPL'ISI}W. r 1 1 I 25.02 I i „ __.__„..____ __ ______ _____„ . „ Drii,k.ni. futin.iin ' '''. ' ' ' _ ! 25,02 1 ; ;:ctor.s;);i18);-; >'S ? .:t - .- -Ii.R0I'ERPC)OWNER . (Li 'FIZ,NANT i F.<, 4,10n pcii, 1 12 51 i ._.1 1 i 4 : ' :',,,,nitt'i,.:Ai.er,;:ip 1 i ''5 02 1 Nainti: Pacific Evergreen I Iomcs : - L I I — II:or(.111.,(1,II,.,,r-,Ink,,hph I 1 25.02 I i I Address:741(1 Syr Oleson Rd.Suite 133 -•-- I-- i- _______ ____ ._ . (.111(3ne or,no-..a( , j I 23 02 . City/Stale/7i I': l'ortfand,OR.97223 (1Int) 1 ,02 ! Pli,inc: 0,11)6-1-0-123 i II.«,..•1. , .. 1..,.:ii,iik,,n- : ) 12.51 i g APPLICANT I 'LI- t-orYrtv.,t" PERSON , ,..,,...n.,.:p(„4.:,(:.,-,..:( .(1( 25,02 __ i 1 Pve 2 1 i .,.. , , 1•1.1,.•1:1, 5 naii)::.Sa lilt: -i- I it,. - 7- , 1-,.-.t1 1 1 1 I I Contain IlaIllt• r i ktt:q ti,;11): ,,,,,,,,,,, t ! 1 121 1 , --I ‘,11:1,.ii Fan,:,1,:iii,r, I 25.02 : 1 3 3 1 (.it:..!Siate,"711': 1 ' •,....iiii win,,potable watt:1'). i ' 62,54 — w --...------ -- .) — ), , 13 ' 12 51 t, ' iiiniii,,eilidio,ier part _ ... __________________________ ... Urinal 25.02 mail:alangoffmooreatIgnlad•c"m --li i Water clime( I 25 02 . ,, .. 'CONTR..XCE,OR ': --i ' \N ata il,".;11.21 1---- 1--- -I i i3tiSine5f). name: EDWARD N1I'LLEN PLEMIIINIC I,‘,ne:inpon.t =' '' 1T 5019 :-- • - : i -..: - ' Aildre . 10(11 SE RIVER 120A11 ' ()11(e, . 25,02 ; I, Cive/StateiZIP: IIILLSBORIE OR 97123 Subtotal i 1"------ Minimum permit fec S72.50 1 fi Phnlle:(5113)6411-11113 I 1',.r.k: 51.13)641-4483 ._ ' Plan r,:vlev., 12:5'..;of perinit(CC) 1 I Crli LIC-.92089 I Plumbinr...-Lie 1:n.-3.I.,2601,13 .. __. t-- . i.;:,,,i,,slin,-.11:nin.i(12'.•-t,of liamit ice) ' Authini.ted signiiim. „..., , 4 1,,,' •, . . _ N1 '...,<„,•:,,v,„ TOT AI PER11.FEE .„...„„_____ / ,..' .....„,„,:ui.i.-in..nni api iii,,:ion ii1nii•-ii:if a perMi-I is-itht tit:Tallied nithin I80 days Print mane: RAN \If 1.1.1.\ , I,-te '- le-.I>-- 1---;?,*7-1'', At,-it ilos be..ni accepte.t I 3•complete., 4 _ -___ _ II."' — ' ,i_. ;..sel Iii,..1[;-Colvity Bloldint:inthistry Service II,..a,,,,I City of Tigard .1114 ,a COMMUNITY DEVELOPMENT DEPARTMENT `4oz BuildingPermit Review — Residential TIG . ::' Building Permit #: !nSroA.plS—cxD a a.-1 Site Address: 1 2, q 3 k-i n ci Pl lir L.„ Project Name: rtrIC.tZ(CUlr1c.3,- Lot #: (New dwelling= subdivision name;Addition or Alteration = last name of owner) Planning Review Proposal: NI.e'AJ S (-0 Verify site address/suite # exists and active in permit system. A River Terrace Neighborhood: ❑ Yes —B--No Site Plan Elements: /Three(3) copies of site plan /Existing structures on site C]'S�ite plan must be on 8-1/2" x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished yNawn to scale (standard architect or engineer scale) floor elevations Torth arrow /tility locations (required for new,may apply for additions) /Site address,project or subdivision name and lot number ocation of wells/septic systems ,pplicant information (name and phone number) erosion control (including drainage-way protection, silt fence C ,ot dimensions and building setback dimensions design,location of catch basin,etc.) Lol 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 �r:usung trees to be retained with drip line,and tree 4 foot differential) protection measures XClean Water Services -Service Provider Letter (lot platted prior to 9/10/1995): equired: ❑ Yes,applicant was notified 0 No Received: 0 Yes 0 No 0 1 ublic Facilities Improvement (PH) Permit: equired: 0 Yes,applicant was notified 0 No Applied For: 0 Yes 0 No,stop intake Ly 1-and Use Case#: 'Vs(3 -w i 4 -Q 0 QO' Zontng: al _ S Setbacks: Front 2� Rear I.S Side 5 Street Side 14 Garage *-2A,--)Landscape Requirement: % /171 Lot Coverage Maximum: Building 1-Ieight: Maximum Height 30 Actual Height 2 ---8--Visual Clearance --4;}-':asements ` ❑ Sensitive Lands: 0 Yes 0 No Type ' O- 4r}San Forestry Plan - -Eonditions "Met"prior to issuance of building permit Notes: F L Approved By Planning: .M 0 0 I?-6t 6( 00112...Z44.4_, Date: I Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: ❑ Approved 0 Not Approved I:\Building\Forms\BldgPennitRvw-_RES_070915.docx Building Permit Submittal Original Submittal Date: 11ai/t 5 /-3-7 Site Plans: # / 3 Building Plans: # _ _ Building Permit#: n�ter building permit#above. 'Workflow Routing: anning ngineeringrmit Coordinator EI-13tillaing Workflow Sign-off: --off for Planning(include notes from planning review) Route Application Documents: l eering: (1) cope 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: Date: /// 4',%c-- Engineering Review Slope at building pad: 2 TB Conditions "Met"prior to issuance of building permit Easements (encroachments)( perengineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: ,4' 7 Date: / --,,,Z j 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 Applicant: AqDC Fees Entered: Wash Co Trans Dev Tax: , Yes ❑ N/A Tigard Trans SDC: ❑ Yes /A . Parks SDC: /'�7 Yes ❑ N/A OK to Issue Permit i • Approved Y roved b Permit Coordinator: , I Date: / ,-.5"/A- I:\Building\Forms\BldgPermitRvw_RES_07091 5.docx ,-.5" jI:ABuilding\Forms\BldgPennitRvw_RES_070915.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 12793 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS MST2015-00223 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 12793 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal PASS MST2015-00223 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 12793 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2015-00223 David Young Replace missing clean out cap and glue ﬁtting on clean out pipe as per plumbing ﬁnal approved with correction. Correction not complete. Provide approved mechanical ﬁnal inspection. Provide approved plans with approved site plan on site for ﬁnal inspection for street tree location veriﬁcation. 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 12793 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal FAIL MST2015-00223 David Young Seal furnace electrical supply in garage ceiling. R302.5.3 Insulate duct work in garage not insulated on the interior in unconditioned space to R8. N1105.2, M1601 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 12793 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection PASS - C of O MST2015-00223 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 12793 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2015-00223 Jeff Grove Violation Summary: Inspector Contractor 44 5 t - u s-, d 2-2-3 z CITY OF TIGARD �3 sc../ / -/ RCIPT 0 . 13125 SW Hail Blvd.,Tigard OR 97223 L G--i- I — 503.639.4171 Receipt Number: 403830 - 05/11/2016 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER pAR MST2015-00223 Laundry Tray 230-0000-43101 $25.02 MST2015-00223 Misc Administration Fee 230-0000-45319 $45.00 MST2015-00223 12%State Surcharge-Plumbing 100-0000-24001 $3.00 MST2015-00223 12%State Surcharge-Plumbing 100-0000-24001 $3.00 Total: $76.02 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 06008G PUBUCUSERO 05/11/2016 $76.02 Payor: Harlan Borow Total Payments: $76.02 Balance Due: $0.00 6, v , 1 R___ ii -1•5 s kt-t)-1..� .)1141 , :/t.'‘• 0 3 V Page 1 of 1