Permit CITY OF TIGARDIN
MASTER PERMIT
I COMMUNITY DEVELOPMENT Permit#: MST2015 00117
Date Issued: 01/25/2016
T[G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 t
Parcel: 2S102CA00600
ggi7 '� Jurisdiction: Tigard
Site address: 13337 SW BARNUM DR
Subdivision: FREWING'S ORCHARD TRACTS Lot: 18
Project: Ashwood Estates, Lot 12
Project Description: New SF. 5/10/16: REPRINTED permit to include A/C unit. Placement of A/C unit must comply
with manufacturer's installation requirements.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1198 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 1347 sf Garage: 449 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2545 sf Value: $310,960.16 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 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
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'I 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 2545
Owner: Contractor:
LF 4 LLC JTSC LLC Required Items and Reports(Conditions)
9700 SW FREWING ST 5285 MEADOWS RD,SUITE 171 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97223 LAKE OSWEGO,OR 97035
PHONE: PHONE: 503-308-7324
FAX: 503-684-0102
Total Fees: $22,961.38
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to folio e rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
t_
Issued By: - _� '- ittee Signature:
. • .09.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completio i • • e project.
Approved plans are required on the job site at the time of each insp: ••n.
Mechanical Permit Application FOR OFFICE ISE ONEv
Received permit No.:
City of Tigard Date/By: Aggi �. ii • [ — ,
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
1 i(.,\1,1 Inspection Line: 503.639.4175 Date Ready/By: PM
H See Page 2 for
Internet: www.tigard-or.gov RECEIVED Notified/Method: Supplemental Information
TYPE OF wollitpy 1 0 ZulS COMMERCIAL FEE* SCHEDULE —USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction ®Addition/alterd�t[rety enttuQARp performed.Indicate the value(rounded to the nearest dollar)of all
El Demolition El Other. 1, tNG DIVISION mechanical materials,equipment,labor,overhead,and profit.
BV�� Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE,INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address:13337 SW Barnum Dr Furnace 100,000 BTU(ducts/vents) _ 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Ashwood Estates Duct work 23.32
Cross street/directions to job site:Frewing Street Hydronic hot water system . 23.32
Residential boiler(radiator or
hydronic) _ 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: 11 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
Air Conditioning fireplace 23.32
1 Log lighter(gas) 23.32 _
rf 4 ',, J l S�ek ,j fr.-yv-It* Tarms-" r7 Wood/pellet stove 33.39
J Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER 0 TENANT Other: 23.32 _
Environmental exhaust and ventilation:
Name:LF 4,LLC Range hood/other kitchen
equipment 33.39
Address:5285 Meadows Rd Ste 171 Clothes dryer exhaust 33.39
City/State/ZIP:Lake Oswego,OR 97035 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)657-3402 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:JTSC,LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:JERED OTEY Furnace,etc.
Address:5285 Meadows Rd Ste 171 Gas heat pump
Wall/suspended/unit heater _
City/State/ZIP:Lake Oswego,OR 97035 Water heater _
Phone:(503)890-0840 Fax::( ) Fireplace
Range
E-mail:JOTEY@JTSMITHCO.COM Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:INTEGRITY AIR LLC Other:
MECHANICAL PERMIT FEES*
Address:7301 SW KABLE LN STE 500 Subtotal
City/State/ZIP:PORTLAND,OR 97224 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)572-3594 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:203869TOTAL PERMIT FEE q7.36,-
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:Janelle G • o Date:05/10/2016
1:'.Building\Permits\MEC_PermitApp_0401 I3.doc 440-4617T(11/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2015-00117
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/25/2016
Parcel: 2S102CA00600
Jurisdiction: Tigard
Site address: 13337 SW BARNUM DR
Subdivision: FREWING'S ORCHARD TRACTS Lot: 18
Project: Ashwood Estates, Lot 12
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1198 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 1347 sf Garage: 449 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2545 sf Value: $310,960.16 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Healers: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel 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 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: 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 2545
Owner. Contractor:
LF 4 LLC JTSC LLC Required Items and Reports(Conditions)
9700 SW FREWING ST 5285 MEADOWS RD,SUITE 171 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97223 LAKE OSWEGO,OR 97035
PHONE PHONE: 503-308-7324
FAX 503-684-0102
Total Fees: $22,864.02
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 cop rules or direct questions to CLINIC by calling 503.2 .800.33 . 344.3
Issued By: '17 -rmittee Signature:
Call 503. 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
-04 project.
Approved plans are required on the job site at the time of each inspection.
1W VIN
Building Permit Applicgql�LIT
Residential p 2015FOR OlFICE USE ON L)
City of Tigard JUN 3 Received 15 Permit No.: JC�QQ,I
{� Date/Ei : 7
r 13125 SW Hall Blvd.,Tigard,ORS r6 ! 1! Plan Rev'
8 Phone: 503.718.2439 Fax: 501 !!1Bt � 1��� *1 Date/B : 4- Other Permit:
Inspection Line: 503.639.417 UIL�INO DIVISIO Date Ready,_ : loris: 0 See Page 2 for
Internet: www.tigard-or.gov �J L l Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. C)• 6 U• 1 6
$
® 1-and 2-family dwelling ❑ Valuation:Commercial/industrial 3 � � Ilk
❑Accessory building ❑Multi-family Number of bedrooms: L4
❑Master builder ❑Other: Number of bathrooms: :3
JOB SITE INFORMATION AND LOCATION Total number of floors: '� �3
Job site address: I%)' W p� New dwelling area: 2 5� 5 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: qW 111 square feet 6
Suite/bldg./apt.no.: Project name:Ashwood Covered porch area: a'a square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet 1
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.:1Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIP'T'ION OF WORK work indicated on this application.
New single family residence Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:LF 4,LLC Type of construction:
Address:5285 Meadows Rd Stel 171 Occupancy groups:
City/State/ZIP:Lake Oswego,OR 97035
Existing:
Phone:(503)657-3402 Fax:( ) New:
N APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:JTSC,LLC
Please r a to fee schedule
Contact name:JohnWyland Structural plan review fee(or deposit):
Address:5285 Meadows Rd Ste.171 FLS plan review fee(if applicable):
City/State/ZIP:Lake Oswego,OR 97035 Total fees due upon application:
Phone:(503)209-7555 Fax::( )
Amount received:
E-mail:jwyland@jtsmithco.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:JTSC,LLC Submit t (2)sets of roof plan with connectign details
and fire de ent access,along with th 0 Oregon
Address:5285 Meadows Rd.Ste 171 Solar Installa ' n Specialty Codec list.
City/State/ZIP:Lake Oswego,OR 97035 Permit Fee (nclude review $180.00
mistrative fees):
Phone:(503)657-3402 Fax:( ) surcharge(12%o ermit fee): $21.60
CCB lic.:200237 Total fee due upon applt ion: $201.60
Authorized signature: This permit application expires if a rmit is not obtained
within 180 days after it has been accepted as complete.
Print name:John Wyland TDate: l� *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 4404613T(11/02/COM/WEB)
Eleetrical Permit Alac i
/���� Received
lg�' O� Tigard Date/B �� ttLC�l ��
City P
ermit13125 SW tlail Blvd.,Tigard,OR 97223 Plmt ReviewPhone: 503.718.2439 fax: 503.59$.1960 Dale/By: a01 s��Inspection Line: 503.639.4175 JUN 3 0 Z015 Date Ready/By: Page 2 forIntemet: www.tigard-or.gov Notified/Method: mental Information
® ❑Addii � eH � N Please check all that apply(submit 2 sets of plans w/items checked below):
^
iVew construction va�l ill )
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
t, CAT.EGQ$X Olt C014S;TRUC'l IIQ,.I ! ? exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Conmercial-use agricuhur,d
M 1-anti 2 lamely dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
3013 SITEI1El Emergency system. larger separately derived system.OIt1V1AI�ON � LQAT1Q1�} ❑Addition of new mono load of El A","E" "I-2„ "I-3"
Job no.: Job site address: 3 3�7 W BAR NUM OR IOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suitelbldg./apt.no.: Project name' ASNWOOD IE STAT ES ❑Service or feeder 600 anips or more
� FEE 51�;CiLE '
Cross street/directions tojob site:
Description I Qty. I Fee. I Tote!
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lof no.: l 1,000 sq.ft.or less ( 168.54 4
Ea,add'I 500 sq.ft.or portion 3 33.92 1
Tax map/parcel c el no Limited energy,residential ( 75.00 2
DESCRIPTIC}Iti} Or WORit (with above sq.ft.)
Electrical for new single family residence Limited energy,(with
g Y residential(with above sr.ft.) 75.00 2
RenewatiteEner ❑:See Pa a 2`
Services or feeders installation,alteration,and/or relocation
® Px2QPERTY>OWNEI; ❑ TLN�N I 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: ' Ll— 4 I L.L C 401 amps to 600 amps 200.34 2
Address:5285 Meadows Road Suite 171 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Lake Oswego,OR 97035 Temporary services or feeders installation,alteration,and/or
Phone:(503)657-3402 Fax;( ) relocation
200 amps or less j 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, er panel
APPL1GAl!jT ❑ GONT C i PER3t?IY A.Fee for branch circuits Willi
above service or feeder fee, 7 4� 2
Business name:JTSC,LLC each branch circuit
B.Pee for branch circuits without
Contact natr, Td (D service or feeder fee,first 56.18 2
branch circuit
Address:5285 Meadows Road Suite 171 Each add'I branch circuit 7.42 2
City/State/ZIP: Lake Oswego,OR 97035 Miscellaneous(service or Feeder not included)
Each manufactured or modular
Phone:(503)ObCk -7 515 5 hax; ;( ) dwelling,service andior feeder 67.84 2
----- Reconnect only 67.84 2
E-mail: Iamck @ +sm l h m Pump or irrigation circle 67.84 2
GONTRr1CTOR
Sign or outline lighting 67.84 2
Business name: tit f,' Signal circuit(s)or limited-energy See
r t� / >r
panel,alteration,or extension. Pae 2 2
Address: ��u2, rbo) j�Po 1':"—Ven t 7 t/ Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: �SfInvestigation(I hr min) 66.25/hr
Phone:( 03) + � I'ax: �j��,`7 Industrial plant(I hr min) 78.181 hr
Inspections for which no fee is
CCI3 Lie,: ��� j�/
Electrical L10.: I upr
s c: ��r�� ecthcally listed(%x hr min) 90.00/hr
.: EILCGTRTCA[s P 1t14tiiJ? FE..5
Suprv. Electrician signature,required: ;
1001 Subtotal:
Print name: I Date: Plan review(25%of permit fee):
Statc surcharge(12%of permit fee):
Authorized signature:
� J, f tr !' ` TOTAL PERMIT FEE:
' --_-.-.-.—�� t��f This pe r mit application ays rexpires if a penult is not obtained within 180
I
Print name: Date: days after it has been accepted as complete.
— *---- Number of inspections allowed per permit.
rlRuil:ri,eutPerrtrtc,til-C'. Pe—:0,up_EL.R_ERE.doc Rec05;210013 . 140-?!IS'f11 1,05lC0t,•l-15'6ti
'Mechanical Permit Applica COW)
Received
City of Tigard DateBy: Permit
13125 SW Hall Blvd.,Tigard,OR 9722;WN 3 0 2 5
9�� Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit: rwl i5-,r
—1
Inspection Line: 503.639.4175
g g CITY OFTIGARD Date Rd/Meth : 7uris: S gee Pagel for
Internet: WWW.tI ard-or. ov Notified/Method: Supplemental Information
NG DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
Air conditioning 46.75
Job site address: 'WY7 SLA bo-mum I M Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: T1 GAP-r) / 0 P_ "121'3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite bldg./apt.no.: Project name:Ashwood Heat pump 61.06Duct work 23.32
Cross street/directions to job site: H dronic hot waters stem 23.32
Residential boiler(radiator or
h dronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/ventfor any of above 23.32
Subdivision: Lot no.: Other: 23.32�.Z
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
Mechanical for new single family residence fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:LF 4,LLC Range hood/other kitchen
equipment ( 33.39
Address:5285 Meadows Rd Ste 171 Clothes dryer exhaust 1 33.39
City/State/ZIP:Lake Oswego,OR 97035 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)657-3402 Fax:( ) Attic/crawls ace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:JTSC,LLC Fuel piping:
$14.15 for first four;54.03 for each additional
Contact name:JohnWyland Furnace,etc.
Address:5285 Meadows Rd Ste.171 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Lake Oswego,OR 97035 Water heater 1
Phone:(503)209-7555 Fax::( ) Fireplace
Range
E-mail:jwyland@jtsmithco.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Integrity Air,LLC Other:
MECHANICAL PERMIT FEES*
Address:7301 SW Kahle Ln Ste 500 Subtotal
City/State/ZIP:Portland,OR 97224 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)572-3594 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:203869 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:John Wyland Date: 'j0
IABui1ding\Permits\MEC_PermitApp_04 13.doc 4404617T(I 1/02/COM/wEB)
J
plumbing Permit ApplicationREI.EIVEI) 2�qy
Building Fixtures FOR OFFICE VSE ONLY
JUN 3 0 2015 Received I,n� S_«,
City of Tigard DateM,y Permit No.: �j o"�
� 13125 SW Hall Blvd.,Tigard,OR 9V/t���( A�� plan Review
■ )17
Phone: 503.718.2439 Fax: 503.59 00�� V V Other Permit No.� -L j --a
Date Re
Inspection Line: 503.639.4175 BUILDING T►T►lr(r�o*i Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Ui IS !d Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
El Accessory building E]Multi-family
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: kl-S31 W r} uM QR
Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:ASHWOOD Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.�Cb ) Page 2
Storm sewer(no.linear ft.: C1 ) Page 2
Water service(no.linear ft.:SQ) / Page 2
Subdivision: Lot no.: I Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORD Backwater valve 12.51
Clothes washer / 25.02
Plumbing for new single famiy residence Dishwasher / 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
®PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:LF 4,LLC Fixture/sewer cap 25.02
Address:5285 Meadows Rd Ste 171 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Lake Oswego,OR 97035
Hose bib Z 25.02
Phone:(503)657-3402 Fax:( ) Ice maker ' 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:JTSC,LLC Medical gas(value:$ ) Page 2
Contact name:John Wyland Primer 12.51
Roof drain(commercial) 12.51
Address:5285 Meadows Rd.Ste 171 Sink/basin/lavatory 25.02
City/State/ZIP:Lake Oswego,OR 97035 Solar units(potable water) 62.54
Phone:(503)209-7555 Fax::( ) Tub/shower/shower pan 3 12.51
E-mail:jwyland@jtsmithco.com Urinal 25.02
CONTRACTOR Water closet 3 25.02
Water heater / 37.52
Business name:The Mullen Co.dba Edward Mullen Plumbing Water piping/DWV 56.29
Address:1601 SE River Rd Other: 25.02
City/State/ZIP:Hillsboro,OR 97123 Subtotal
Phone:(503)640-0113 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:92689 Plumbing Lic.no.: 1),60 State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:John Wyland Date: 3 Q 1 t� This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildingTermits\PLW-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
■
Building Permit Review — Residential
Building Permit #: GSD 11 :2 N 65 - 2 a-n i 5— 6G 07 7
Site Address: /3,3U r
Project Name: s Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: AX�G) -P — r P�
4rify site address/suite# exists and active in permit syste
"�tver Terrace Plan District: ElYes O No
X
Plan Elements:
Sit
(3)copies of site plan po-tl
ing structures on site
IIa to plan must be on 8-1/2"x 11"or 11 x 17"paper rint of new structure(including decks)with finished
�rawn to scale (standard architect or engineer scale) fl�r elevations
1�rth arrow I�Erosion
IIGUtility locations(required for new,may apply for additions)
VxV S address,project or subdivision name and lot number cation ofwells/septic systems
plicant information(name and phone number) control(including drainage-way protection,silt fence
QV dimensions and building setback dimensions design,location of catch basin,etc.)
t area,building coverage area,percentage of coverage and S et names
Xervious area(applicable if R-7,R-12,R-25&R-40) ��et tree size,type and location
perty comer elevations (2 foot contour lines if more than iXisting trees to be retained with drip line,and tree
4 kot differentialprotection measures
Clean Water Services—Service Provider Letter lot platted prior to 9/10/1995):
&equired: El Yes,applicant was notified 7 No Received: ElYes ElNo
Public Facilitie,4'Improvement(PFI) Permit:
_ equired: Yes,applicant was notified ❑ No Applied For: Yes El No,stop intake
LTJ' "and Use Case #: 5W,6 Q/q — (AL0
AG oning:
IlG Setbacks: Front () Rear Side Street Side Garage
�_,andscape Requirement: %
of Coverage Maximum: %�ytte
�adding Height: Maximum Height f�C7 Actual Height c23 to
isual Clearance
L(�( Easements
XV4ensitive Lands: ❑ Yes VIN 0 Type
VUrban Forestry Plan
❑ Conditions "Met"prior to issuance orb ding permit
Notes: C
Approved By Plan Date:
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_RES_031015.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: #
Building Permit#: SCJ Enter building permit#above.
Workflow Routing: ,Planning E?Tngineering EJ—Permit Coordinator ❑wilding
Workflow Sign-off: (Sign-off for Planning(include notes from planning review)
Route Application Documents: ET Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
FT—Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date: 3C /
Engi eering Review
e at building pad:
Z
�Cnditions "Met"prior to issuance of building permit
E E ements (encroachments) per engineering conditions of approval and plat
ater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes
Assess Water Quantity Fee in-lieu: ❑ Yes :�NtKo LIDA Facility on lot: El Yes
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Dater
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
�► s
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
( Approved,NOT Released: ��yt <wJ�! 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:
OK to Issue Permit 00,
Approved by Permit Coordinator: l/ c Date: 3 ��
1:\Building\Forms\BldgPermitRvw_RES_031015.docx
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.ti arg d_or.g_ov_
TO: Ll �`f C3 T( q Q.-( DATE RECEIVED:
DEPT: BUILDING DIVISION Wt lVEP
FRO1Vii _ N Ll = _f lX 1 A JUL I'2 2"01�,
COMPANY: T S M I T H Co �A PA N ( C-S UICITY0'FFUNRU
PHONE: 201, Ge5 D �-
RE: 1333 SW bAkWUH DR T1GARD DR MS�o-p15'001I7
(Siteess) (Permit Number)
Pi5(Aw00D rS i A1"fS LOT ( 3-
roject name or subaivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
i� o
Additional set(s)of plans. Revisions:
Cross section(s)and details. Wall bracing and/or lateral analysis.
✓ Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
Routed to Permit Technician: IDate: Initials:
Fees Due: El YesNo Fee Description: Amount Due:
Special
Instructions:
Reprint Permit(per PE): I D Yes No Done
Applicant Notified: I Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
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
13337 SW BARNUM DR, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
PASS
MST2015-00117
Chip Barnett
Violation Summary:
Inspector Contractor