Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN
Request for Permit Action ECE1
VEr
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.ti nd"?` o
TO: CITY OF TIGARD BU���IV(a ���/41.
Building Division ®/V� �Q
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: [Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: J n >
INVOICE TO: (Business or Individual) ' l r 1 ^ 'I(441-
41 C l C 1_ 1`�4r� I V /
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Mailing Address: �jYi 0 SI ,4 (A + 7-�2 , /
City/State/Zip: I i QA
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Phone No.: •-(0 3 _ % Z S<" t5
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
• _ -._ANCEL/VOID PERMIT APPLICATION.
REFU1 PERMIT FEES (attach copy of original receipt and provide explanation below).
• E FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: '59"ZotF,— oo iqr
Site Address or Parcel #: G ri O Sw W4 Irk rred_
L, O✓Z 5 2 1_2.3
Subdivision Name: A ( 612-1' FIE-r 4
�? Lot#: 2_
E PLANATION: A �- 1 Z
' V r, °S' st- ,Dov �Ta i.n s t-e co".•-p Gam, e�
�' 21M
�IC�vut now Rr O 'SsV a ( RQ
Signature: L Date:
Print Name: ( 5 l i 7
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date 5 /7 :4 Route to Records: Date . /f— By t$41Y
Refund Processed: Date ` 7/7 By ,I' Invoice Processed: Date By
Permit Canceled: Date
Nj,��— By ��"� Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_042314.doc
. - a
TIGARD
City of Tigard
June 1, 2017
Urban Revival LLC
Attn: Michael Vaughn
6810 SW Walnut Ter
Tigard, OR 97223
Re:Permit No. MST2016-00148
Dear Applicant:
The City of Tigard has processed a refund for the deposit of fees on the above referenced
permit for the following:
Site Address: 6810 SW Walnut Ter
Project Name: Gilbert Partition
Job No.: N/A
Refund: ® Check#224916 in the amount of$2,000.00.
❑ Credit card"return"receipt in the amount of$ .
p Trust account"deposit"receipt in the amount of$ .
Notes: Refund deposit for completion of driveway.
If you have any questions please contact me at 503.718.2430.
Sincerely,
42) )/01-0-1-&_.
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
I City of Tigard
T T G fi R D Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable)must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Urban Revival LLC DATE: 5/26/2017
Attn: Michael Vaughn
6810 SW Walnut Ter REQUESTED BY: Dianna Howse
Tigard, OR 97223
TRANSACTION INFORMATION:
Receipt#: 408979 Case#: MST2016-00148
Date: 2/16/2017 Address/Parcel: 6810 SW Walnut.Sf ,r&.
Pay Method: Check Project Name: Gilbert Partition
EXPLANATION: Refund deposit for completion of driveway as approved by Chip Barnett.
b r 4 Y +X51 ''`- v� �� � ;:,h'. t ,:z".=s3'i "ef' '>n.
s1t = 3�a s � i
f' g 1� y xea:7,14.1* "r' � a r r� ' f
,...z.r... ..,1;aa • '' ` r- xr�i {1 7 ) �,r.,.�s..�+r
Customer De.osit 100-0000-22000 $2,000.00
TOTAL REFUND: $2,000.00
APPROVALS: SIGN: URES/D TE:
If under$5,000 Professional Staff /4•111!Jv r_
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
d
Case Refund '.m e#
Processed: Date:J .
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
H
II 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Gilbert Partition, Lot 2
Site Address: 6810 SW WALNUT TER
Receipt Number: 415897 - 03/02/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2016-00148 $-2,000.00
Total: $-2,000.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 408979 DHOWSE 03/02/2018 $-2,000.00
Payor: Urban Revival LLC
Total Payments: $-2,000.00
Balance Due: $2,000.00
Page 1 of 1
CITY OF TIGARD RECEIPT
t 1 13125 SW Hall Blvd.,Tigard OR 97223
r 11
503.639.4171
TIGARD
I Receipt Number: 408979 - 02/16/2017
I
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2016-00148 SW Menlor Lane-Customer Deposit 100-0000-22000
$2,000.00<—
MST2016-00148
Misc Administration Fee 230-0000-45319 $90.00
Total: $2,090.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1562 DADAMSKI 02/16/2017
Payor: Paramount Realtors LLC $2,090.00
Total Payments: $2,090.00
Balance Due: $0.00
Page 1 of 1
>A CITY OF TIGARD MASTER PERMIT
III11. COMMUNITY DEVELOPMENT Permit#: MST2016-00148
T t G;Ate D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/26/2016
Parcel: 1S125DA12500
Jurisdiction: Tigard
Site address: 6810 SW WALNUT TER
Subdivision: 2013-010 PARTITION PLAT Lot: 2
Project: Gilbert Partition, Lot 2
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 2239 sf Basement: 189 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 0 sf Garage: 682 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2428 sf Value: $303,672.02 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
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 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 Noes 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!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 2428
Owner: Contractor:
URBAN REVIVAL LLC URBAN REVIVAL LLC Required Items and Reports(Conditions)
1824 S EVANS ST 1824 SW EVANS ST 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97219 PORTLAND,OR 97219 2 A Geotechnical report is
required before the footing
PHONE: 503-425-9048 PHONE: 503-425-9048
FAX:
Total Fees: $28,971.62
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. ' ■ • : : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-•e 1-0010 throug' OAR 9�You may obtain`copy of the rules or direct questions to OUNC by calling 503.23 .1987 or 800.332.2344.
Is- ed By: - /- Permittee Signature:
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.
Building Permit Application 3 /
Residential �" FOR OFFICE ISE ONLI
City of Tigard Date/By.
Received
l7 /, ' / Permit No.: f j/p_i O i4
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1962016Date/By. Other Permit:o R.gp((o-QC
4APP, 13S'�3)!G 7
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
1 LCzAi l}
Internet: www.tigard-or.gov yv g i. • y I,j Notified/Method: Supplemental Information
TYPEOF y �l 1°` Il � ) REQUIRED''.DATA:i-AND 2-F AMILYDWELLIN
®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
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ 3 o3 6 7® 1-and 2-family dwelling 0 Commercial/industrial
�C.
0 Accessory building 0 Multi-family Number of bedrooms: 3
❑Master builder ❑Other: Number of bathrooms: 3
Total number of floors: 2
JOB SITE INFORMATION LOCATION ay �g O
Job site address:6810 SW Walnut Ter. New dwelling area: 3iRquare feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 49,6g)square feet
Suite/bldg./apt.no.: Project name: Covered porch area: 28 square feet
Cross street/directions to job site:SW Taylors Fy to 69th Ave.,S.to Walnut Deck area: 312 square feet,),,),.39
Other structure area: square feet j 2 9
REQUIRED RATA:COMMERCIAL-USE CHECKLIST
Subdivision:Partition Plat No.2013-010-Tigard Lot no.: Permit fees*are based on the value of the work pertormed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:Parcel 2 equipment,materials,labor,overhead,and the profit for the
.k D CItiPTrION,G WORK' work indicated on this application.
Construct new single family dwelling Valuation: $
Existing building area: square feet
New building area: square feet
1 PROPERTY OWNER 0 TENANT Number of stories:
Name:Urban Revival LLC Type of construction:
Address:1824 SW Evans St. Occupancy groups:
City/State/ZIP:Portland,OR 97219 Existing:
Phone:(503)425-9048 Fax:( ) New:
EI APPLICANT' 0 CONTACT PERSON BUILDING PERMIT IT FEES*
(Please refer to feeschedale) ,>
Business name:
Structural plan review fee(or deposit):
Contact name:Michael Vaughn
FLS plan review fee(if applicable):
Address:ALL CONTACT INFO.SAME AS ABOVE
Total fees due upon application:
City/State/ZIP:
Amount received: 1-76-?")•6°
Phone:( ) Fax::( )
E-mail:�'vlrIAv'Ake d nIfI'►�Ak►1 Olt1 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
d Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo• . •'c Solar Panel S .
Business name:Urban Revival LLC Submit two(2)sets of roof pl. ith co •• ion details
and fire department access,along • e 2010 Oregon
Address:ALL CONTACT INFO.SAME AS ABOVE Solar Installation S.ecial Co', ec'i'.
City/State/ZIP: Permit Fee(includes • .n review $180.00
an. .d • strative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:178452 9l/I?ll 7 t)
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Michael Vaughn Date: cf (3 (!j *Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46 3T(11/02/COM/WEB)
„: -; • : ,' , .
---E-tde-trical Permit Applicatieti,;„ ', :, .. ''' 4 FOR OFFICE USE ONLY
, City of Tigard Received
OnteMv. 17/4' . , ....sif 4'f-(' 690 e Ce; if
1111 . 13125 SW Hall Blvd91Permit '''
.,Tigard,OR V223 .1 '.' ' Plan Rev
1 1,1 Phone: 503.7182439 Fax: 503.598.1960iew' ' Datenly. _ Related Permit a.
n Inspection Line: 503.639.4175/ ,R,.: , . Ready Date/IVY,-— imic BI See Page 2 for
TIG AR''''‘ Internet: www.tigard-or.gov '''' Notified/Method: Supplemental Information
:',.'.1 ii'';it":::,';'f."'N .f."::.1';;;I.S .:•'-i7.-:','',"^?:::::::'5.-''''OP:i:3, --Pitit'iklitt,.t:1i.N.Vti.4)T'','',''.' .: ', i'''''',.' ; '.';', '''.".''',.,.-;i:i:' .,''' litt1.4*-11,CVMNV., ':'.'27::':::
0 New construction 0 Addition/alteration/replacement Please check all that apply(submit l sets of plans wiitems checked)
0 Service or(Cozier 400 amps or more 0 Building over three stories
0 1)emolition El Other: where the available fault current 0 Marinas and boatyards
....:eiV.Ir*P01tV'.o1,7,:eoNsTiktrizrioN.,.,,,,:: i, ,,'•,-.:.:,-:,-,-.,-,-:, exceeds 10,000 amps at 150 volts or 0 Flowing buildings.
(2) 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building lets to ground,or exceeds in.000 0 Coauncreiamse agricultural
mops for all other insiallations. buildings.
0 Muld-family 0 Master builder 0 Other: :. Ohre pump 0 Installation of 150 KVA or
' ''':'.::: '-'::'''''''.!•::;''','-'- 4°6:StrelNPORMATtON'ttl'in'.ixtesttctisr '.77.7:.,-: ' ''' :,,-. ' 0 EinergeneY systemlimier separately derived
El Addition of new motor load of system.
Job#: 1 Job site address:6810 SW Walnut Ter. 100or more.
City/State/ZIP:Tigard,OR 97223 0Six or more residential units occupancy.
_ DHealth-eare facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 011azardous locations. 0 Supply voltage for more than
OService or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW Taylors Fy./S.on 691h to Walnut '''':--7"'!!`a:''r;
Oti.sotim, 0. 111111013.1 Total ”
New residential single-or multi-family dwelling unit.
Subdivision:Partition Plat No.2013-010-Tigard Lot#: Includes attached garage.
_ _._.....____ .---"- 1,000 sq.ft.or less i 168.54 4
Tax map/parcel II:Parcel 2
fia.addl 500 sq.ft.or portion -, 33.92 1
DESPIPTiOti OF WORK ' - ',, '' , Limited energy,residential _
(with above sq.a.) _ i '500
Nev;single family dwelling
Limital energy,tnukt-family I
75.00 2
residential with above • It
"'.' ••':'-'` 1RO.PtOY:OWNER"'• •• '• " . .• i p'TENANT •....i ',.'.•..', Sileer:in veelsbeitr fEeled"eIrs'installation,alpteniSteicoriP2a:ned/2or relocation
Name:Urban Revival LLC 200 amps or less -1 100.70 2
Address: 1824 SW Evans St. 201 amps to 400 amps 1 133.56 2
401 amps to 600 amps ' 200.34 2
City/State/ZIP: Portland,OR 97219 601 amps to 1P00 amps 301.04 2
Phone:(503)425-9048 I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 0
,......„_
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps MI. 125.08 0
....._
Owner signature:_ _ Date: _ 401 amps to 599 amps alli 168.542
'tPPLICANT . ' : Ea CONTAtet.SON' - '
__.._
'77-7-777:-7— Branch circuits.-ncalteration,
v, or extension,per panel
4 ':'.' : ' It . 'L,
A Fee for branch circuits with
Business name: above service or feeder fee,
7 42 2
each branch circuit
Contact name:Michael Vaughn B.Pee for branch circuits mthaul
- service or feeder ,
Address:ALL CONTACT INFO.SAME AS ABOVE branch circuit feefirst 56.18 2
Cit3/Stute/Z1P: Each add'l brunch circuit 7.42 2
Miscellaneous(service or feeder not included) _
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
dweillimservice and/or feeder
Email: M rjA`likh eilei hef MAI( • COW% Reconnect only 67.84 2
,._...— ----i-•
•-•• ••• •-•',•ii•i"•.,•'',••;-,•"',-:,:•••:'','S.'••••••:'1"), - CONTRACTOR"•:•ii•:,"i-''•.: ._j '"77.•-•' • •• •': H Pump or irrigation circle 67.84
Business name:Three Phase ElectrielZt)t,4, r.z. Ez_te724e_ Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ,.-, r..„
Address: 11490 SE Jennifer St. j)ancl,alteration,or extension. Li See age 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Clackamas,OR 97015
Additional inspection(I tin min) 66.25/hr
Phone:(503)908-8058 Fax:5z.,..,s ) imi to,,, ... \s .:3 ,.Investigation(I hr nun) 90.00/hr
------
_ - __________— __ .._.:._
Industrial plant(I hr min) 78.IW hr
Email:rlan@threephaseelectric.com
Inspections for which no fix is
90.00/hr
CO)Lie.: 162368 Electrical Lic.: 3-332C Suprs.Lie.: 3398S _szcally listell(S5 hr min)
i,---;:\ / 4
7.f;.,,6 ,• .',. : • -ELECTRICALltitr4h4ES":'
X Suprv. Electrician signature,required: 6.,-.0.e..vr....,-,4;., -' ' • -- Subtotal:
---
Print name: Dennis Welchj ia.....S j Date: 0 Plan Review Required(25%of permit fee):
_
_.....,... State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
-1 'Flits permit application expires if a permit is nut obtained within ISO
Print name: Robert Lane I Date: 1 days after it has been accepted as complete.
--- J • Number of inspections allowed per pertnii.
I,iluiWmtlemileXt.C_PerrnaApp,LLA ERE doc fi,06170,715 455445 5Ttlizasictiwwtm
Mechanical Permit Applica ,Fir,„„-,--,,„ FOR OF(1('1: FSE OyLI
City of Tigard +,. j ,i v Date/By:Received
Permit No.:
III13125 SW Hall Blvd.,Tigard,OR 97223 N 5T. !6 SOD
C Phone: 503.718.2439 Fax: 503.598.19�(1 Plan Review Other Permit:
6iQ r) 1 1 g n i c, DateBy:
TI G A K D Inspection Line: 503.639.4175 11 i� 1 e Y Date Ready/By: Juris:
See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Inf
ormation
( CCgg 9')q-..�,.5 yy,,i g
T A (�.,F 4 9( A @i;
'tti l t t " t. G S iA CO141141ERRCiAL PEE* SCHEDULE.-USEi.:13.ECKLIST
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION .RESIDENTIAL EQUIPMENT/SYSTEMS ItEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
3011.SITE INFOI1, I'1ON Mat LOCATIONHeating/cooling:
Air conditioning 46.75
Job site address:6810 SW Walnut Ter. 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:
Duct work 23.32
Cross street/directions to job site:SW Taylors Fy./S.on 69th to Walnut Ter. 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:Partition Plat 2013-010-Tigard Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.:Parcel 2 Water heater 23.32
DESCRIPTION OF'WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
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
Other: 23.32
`® PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name:Urban Revival LLC Range hood/other kitchen
equipment 33.39
Address:1824 SW Evan St. Clothes dryer exhaust 33.39
City/State/ZIP:Portland,OR 97219 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)425-9048 Fax:( ) Attic/crawlspace fans 23.32
6 APP,TC T a CONTACT PERSON Other: 23.32
Fuel piping:
Business name: $14.15 for first four;$4.03 for each additional
Contact name:Michael Vaughn Furnace,etc.
Address:ALL CONTACT INFO.SAME AS ABOVE Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail:mrjavahead@hotmail.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:2 Brothers Heating Other:
MECHANICAL PEPIIT FEES*S*
Address:14501 Ames St. Subtotal
City/State/ZIP:Oregon City,OR 97045 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(971)533-2359 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:200292 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Charles Cruz Date: (1/i 7((,�
I\n..a,c..olo..,..�I.a,mr 13,....-n4snn 545111.1,-., 44A417T ill/7 roM54 PR1
uImbin2 Permit Applict,p, 4.4
Building Fixtures FOR OFFICE ISE O\L1
APR City of Tigard ?i'116Received t ,�jBcf&-W/��
Date/By: Permit No.:/7
r 13125 SW Hall Blvd.,Tigard,(;),A 97223 Plan Review
m" Phone: 503.718.2439 Fax:I.. 3c5 '8(1 10 !(`;21,k Date/By: Other Permit No.:
T 1 G A R D Inspection Line: 503.639.i-1751 a ,� ,_ ^ Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.g kiILIAI".i$ ,1)1`5'1+,90 Notified/Method: Supplemental Information
TYPE 10 WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
- - Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CON I{,I(,"TION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
building- SFR(3)bath 500.32
❑Accessory ❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION A141) LOCATION Site utilities:
Job site address:6810 SW Walnut St. Catch basin or area drain 18.76
City/State/ZIP:Portland,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site:SW Taylors Fy./S.on 69th to Walnut Ter 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:Partition Plat No.2013-010-Tigard I Lot no.: Fixture or item:
Tax map/parcel no.:Parcel 2 Backflow preventer 31.27
BESCRI4'TION OF WO1 ( Backwater valve 12.51
Clothes washer 25.02
New single family dwelling
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ya to ErRTY ovEr4 ( 0-TENANT Expansion tank 12.51
Name:Urban Revival LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1824 SW Evans St.
Garbage disposal 25.02
City/State/ZIP:Portland,OR 97219 Hose bib 25.02
Phone:(503)425-9048 Fax:( ) Ice maker 12.51
►ti APPLICANT 0 CONTACT+PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Michael Vaughn
Roof drain(commercial) 12.51
Address:ALL CONTACT INFO.SAME AS ABOVE Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail:mrjavahead@hotmail.com Urinal 25.02
Water closet 25.02
y,.
Water heater 37.52
Business name:Malmedal Plumbing Water piping/DWV 56.29
Address:P.O.Box 207 Other: 25.02
City/State/ZIP:Banks,OR 97106 Subtotal
Phone:(503)324-0759 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:102535 a Plumbing Lic.no.:34-276PB Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:x r"t TOTAL PERMIT FEE
Print name:Kris Malmedal Date: 1/ t/ 6
/(3 /(/ 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.
1\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
i II ■ City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: STS 1(n_ OD i g
Site Address: (8e/0 Sit.) /7t>✓ - 7?r/tiCe
Project Name: ark/7Roinvi1 LLC Lot #:
(New dwelling= subdivision name;.Addition or.AIteration=last name of owner)
Planning Review
Proposal: /PJ ` ;(
Verify site address/suite# exists and active in permit system.
�
p,�]diver Terrace Neighborhood: No ❑ Yes,See RiverTetrace ReviewAddendum Attached
1 � g
Siy Plan Elements:
VIZ hree (3)copies of site plan sting structures on site
e plan must be on 8-1/2"x11"or 11 x 17"paper Footprint of new structure (including decks)with finished
V•raven to scale (standard architect or engineer scale) •sr elevations
rth arrow '/. ltility-locations (required for new,may apply for additions)
`� i
e address,project or subdivision name and lot number .. anon of wells/septic s stems
P 1 U�-d
y
plicant information (name and phone number) Vi Erosion control(including drainage-way protection,silt fence
Lot dimensions and building setback dimensions
sign,location of catch basin,etc.)'t area,building coverage area,percentage of coverage and Street names
pervious area (applicable if R-7,R-12,R-25&R-40) eet tree size,type and location
roperty corner elevations (2 foot contour lines if more than Existing trees to be retained with drip line,and tree
4 foot differential) protection measures
Otelean Water Services —Service Provider Lett (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
Public Facilitie mprovement (PFI) Permit:
equired: Yes,applicant was notified ❑ No Applied For:
es ❑ No,stop intake
'jand Use Case#: 0' Crof' - Com5
,e_44Voning:
,eS'
tbacks: Front cQ0 Rear /s-- Side /0 Street Side Ay4 Garage o
lilandscape Requirement: °'o
101) of Coverage Maximum:
vip
Building Height: Maximum Height 301 Actual Height QS 1
fi 'Visual Clearance
0 asements
nsitive Lands: ❑ Yes �d No Type
Urban Forestry Plan
❑ Conditions "Met"pr or to issuance of building 'rmit
Notes: ndiehz5ni` -s //
i .sjf
j , jY -74 LZ
, ZPr1J2`
Approved By Planning: c. _ . ';; Date: .1127
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved E Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPer mitRvw_RES_O 12I 1 6.docx
Building Permit Submittal
Original Submittal Date: 7/;_//
Site Plans: #
Building Plans: # 3
Building Permit#: Enter building permit#above. ���
Workflow Routing: n-Planning -2-Engineering 1mit Coordinator i� Building
Workflow Sign-off: g-Sign-off for Planning(include notes from planning review)
Route Application Documents: r ngineering: (1) copy of permit application, (1) site plan, (1) building plan and
�
�o ginal plan review routing form.
I Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: ( IIiI . Date: j414,___
Engineering Review
❑ Slope at building pad: ie,5.1 4 112,,„, A I j
E 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: YesGI o
Assess Water Quantity Fee in-lieu: ... Yes No
LIDA Facility on lot: ❑ Yes .
it/ Ott
��,� NOT Approved by Engineering: Date:
itX tit
Notes: - / • rtz31-1,a'7s /YJ us G nap
tcb ; . r _moi, - . f. - /60
J6)fo . 51/14,9 by ht immli
Approved by Engi eering: 1/ „ll Plate: p
N* t.(s
0S•ktd Revisions (after Building Submittal only) Reviewer Date
ARevision 1: , rApproved ❑ Not Approved Ml itt mit, 5 - IA-lb
01-- Revision 2: ❑ Approved ❑ Not Approved
e‘• v Revision 3: ❑ Approved ❑ Not Approved
fPermit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
* Approved, NOT Released: CJ' 0-f1 4) Date: 4 -1 '6 - H P
Notes: co.')d 4i00S mu3 be w, e f- 1. ,--i l'' -TU pe f isJtt_r.-,ee -
(Enh.'N1Lt 1 ed 1a ; 4 u) , —11-6.. incic&ele... SL:,-. p -& S ' 4-4-1,----4-- - ( Lnel,./-j dii
Revisions (after Building Submittal only) a 9 .
Revision Notice 1: Date Sent to Applicant: i h - pets,: -• 4/01/ (o
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
elcl SDC Fees Entered: Wash Co Trans Dev Tax: R Yes E N/A
Tigard Trans SDC: 11 Yes ❑ N/A
Parks SDC: ay Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: a 0 CrAt,,,t,..2J Date: f--l(a - 1
I:'BuildingyForms\BldgPennitRvw_RES_0I21 16.docx
FOR OFFICE USE ONLY—SITE ADDRESS: '?/O . &) Go 9 4 A/66/ 162
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
:mr-
` Transmittal Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
�n I MAY 12 2016
FROM: ►" \lit-( UAw) CITY OF TIGARD
COMPANY: O/L5k,.. 49 � lifrt LLC BUILDING DIVISION
PHONE: , 13,Y27c` 70Yr
RE: 6 9( 0 h) I t.4(,.wT T7 . {A 1-2-o l-6— I
(Site Address) (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
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: 114,,y A/X.fir A-Li ..err 7 J /94t f
Routed to Permit Technician: Date: Initials:
Fees Due: • Yes ■ No Fee Descri tion: Amount Due:
$ .
Special
Instructions:
Re.rint Permit ser PE : 031 • No ❑ Done
A• •licant Notified: Date: Initials:
1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
13125 SW Hall Blvd.
Tigard, OR 97223
Location:
City of Tigard
6810 SW WALNUT TER, TIGARD, OR, 97223
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
FA I L
Comments:
Tel: 503.718.2439
Inspection Date:
January 27, 2017 at 9:43:33
AM
Record ID:
MST2016-00148
Inspector:
David Young
Provide approved final erosion control inspection.
Provide approved plumbing, mechanical and electrical final inspections.
Provide city required documents for final inspection. Approved plans, street tree
certification, moisture content form, high efficiency lighting form( installed lights do not
appear to meet requirements ) duct seal test report or blower door test report, insulation
certification report.
Provide approved hard surface driveway per planning requirements.
Finish siding on exterior for weatherproof barrier. R703.3
Step from entry egress to unfinished driveway not to code, riser exceeds 8" R311.7.4.1
Provide railing to code at entry and patio over 30" above grade at driveway. R321.1
No gutters and downspouts installed at this time.
House appears to be lived in, not approved for occupancy at this time.
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
6810 SW WALNUT TER, TIGARD, OR, 97223
Record Type:
Residential - Master Permit
Inspection Type:
199 Electrical final
Result:
PASS
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
MST2016-00148
Inspector:
Chip Barnett
Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
6810 SW WALNUT TER, TIGARD, OR, 97223
Record Type:
Residential - Master Permit
Inspection Type:
699 Mechanical final
Result:
PASS
Comments:
Previous corrections completed
Violation Summary:
Tel: 503.718.2439
Inspection Date:
Record ID:
MST2016-00148
Inspector:
Chip Barnett
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
6810 SW WALNUT TER, TIGARD, OR, 97223
Record Type:
Residential - Master Permit
Inspection Type:
399 Plumbing final
Result:
PASS
Comments:
Previous corrections completed
Violation Summary:
Tel: 503.718.2439
Inspection Date:
Record ID:
MST2016-00148
Inspector:
Chip Barnett
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
6810 SW WALNUT TER, TIGARD, OR, 97223
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
FA I L
Comments:
Tel: 503.718.2439
Inspection Date:
Record ID:
MST2016-00148
Inspector:
Chip Barnett
Previous corrections not completed;
Need final erosion approval
Provide approved hard surface driveway per planning requirements
Violation Summary:
Inspector Contractor