Permit 14 T . CITY OF TIGARD MASTER PERMIT
2 COMMUNITY DEVELOPMENT Permit#: MST2016-00290
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2016
Parcel: 2S 111 AA07500
Jurisdiction: Tigard
Site address: 8970 SW INEZ ST
Subdivision: GREENSWARD PARK NO.4 Lot:
Project: Greensward South, Lot 3
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1206 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1415 sf Garage: 628 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: 2621 sf Value: $330,094.73 Rear: 20
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
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0
Catch Basins: 0
Footing Drain: Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0
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: 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 2621
Owner: Contractor:
GP4 LLC FOUR D CONSTRUCTION Required Items and Reports(Conditions)
PO BOX 1577 PO BOX 1577 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97075 BEAVERTON,OR 97075
PHONE: PHONE: 503-720-7445
FAX: 503-590-1751
Total Fees: $29,537.53
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. ATTE • �n —Q Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 0 through AR950. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 32.1987 or 1.800.332.2344.
.. ....Qr_-009
Issued B • �J�4 ' ' 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
Residential . i1;°-, 1,012.OF FIC'l: ISE ON EN
City of Tigard ;. " Received _ � 2 � A
DateB : y , AdsPermit No.:A
13125 SW Hall Blvd.,Tigard,OR72�23, Plan Review
D Phone: 503.718.2439 Fax: 503.$8i960 Date/By: Other Permit:sc„ ,
Inspection Line: 503.639.4175 t x Date ReadylBy: / gar s: ®See Page 2 far
Illigal Internet: www.tigard-or.gov \\,..`�� T Notified/Method. /O It(,;, y " ' Supplemental Information
icel affiii
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
sjEr
New construction 0 j1itton
Iin1 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
01-and 2-family dwelling 0 Commercial/industrial Valuation: $ .33(0✓ q if
❑Accessory building ❑Multi-family Number of bedrooms: It
❑Master builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors 3)J-i-q
Job site address: Sq.7 0 5 W, X'NC New dwelling area: d16 I square feet
City/State/ZIP: T-i Ch o ca c--/ 22 Li Garage/carport area: 6 a square feet
Suite/bldg./apt.no.: Project name: Ersef SCS icT 3 Covered porch area 7 c square feet i 4 Iv
Cross street/directions to job site: . 1,°G 2.. z ,_.5.‘,......, c O `tL Deck area: a g 0 square feet jso 4
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ejv sv AN) pile , t,„,„11,4.. Lot no.: 3 Permit 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
DESCRIPTION OF WORK work indicated on this application.
a t L._i _ Valuation: $
Via` ' ��Jl'v2 t l...� � t. � i D cc.:
Existing building area square feet
New building area: square feet
64 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address:
SpAyliti i.N Occupancy groups:
City/State/ZIP: Existing:
g
Phone:( ) Fax:( ) New:
IX APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: I) (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: „ 3t l D 0 e Al °'t"cvZ.r FLS plan review fee(if applicable):
Address: F i. Cr. L X i.S 7 ?
Total fees due upon application:
City/State/ZIP: a •iitxvL.1tIIt$j 0 , `r.76-7 S
Phone: Amount received:
3 ) .J 90 .<t' ass Fax::(5:>3) f/o — t 7 5
�^ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: Coad, D cc..).S icy., m.5 Ai ,cc iLex
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
..-- and fire department access,along with the 2010 Oregon
Address: e• t`;; Solar Installation Specialty Code checklist.
City/State/ZIP: eA`7 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: `"7 j 0 3 7 Total fee due upon applcation: $201.60
Authorized signature:,r`� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: !1) /` " _ - t i Date: 3 v ��
*Fee
ce Bo logy set by Tri-County Building IndustryVi Service Board
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1l/02/COM/WEB)
Mechanical Permit Application _,.----,,
- ,, '40= I OR()Fp I( CSE 0yl.1
City of Tigard 4 Received -.�,r� �, ��
* s Permit No.: ,M\ O t�'r(sem (,.(v"L
13125 SW Hall Blvd.,Tigard,OR 97223 . t. Date/By: f, "�
_ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ( Other Permit:
;,'�ti. Date/By:
1.I G A R t> Inspection Line: 503.639.4175 k>,`'1 pate Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov ) tified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
lidNew construction ❑Addition/alteration/repl,(lcelept performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Ell=and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
®
Job site address: U q 7C 5 tAJ.. no E_7----- Furnace 100,000 BTU(ducts/vents) ) 46.75
City/State/ZIP: la i ,y°!. , c L 9 -1'2.2-4 Furnace 100,000+BTU(ducts/vents) 54.91
C �a^ Heat pump 61.06
Suite/bldg/apt.no.: I Project name: Duct work 23.32
Cross street/directions to job site: r , s, CI Ca t ii- 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:C . t Lot no.: ,.,3` Other: 23.32
/�> (y�2 r) F FgKt"c-t t`" 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
6 t...--, S i t L,E "=il t-t'i i,i, ) c3,D1,,c 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
V PROPERTY OWNER 0 TENANT
Environmental exhaust and ventilation:
Name: , Range hood/other kitchen
1- et....,-:,
equipment 33.39
Address: .. -'7 Clothes dryer exhaust 33.39
City(State/ZIP: ..- Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ), Fax:( ) Attic/crawlspace fans 23.32
�y.APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: Fi-'.u- m,1.-? ! iaticric,/..i
0 $14.15 for first four;54.03 for each additional
Contact name: y,�1,0 0 E.144\ pi')t2_r Furnace,etc. ,
Address: y� 7 Gas heat pump
P,0 TJ' t 7 Wall/suspended/unit heater
City/State/ZIP: 13 61‘\e' llt)`mss' AZ.. ct"70'"7 C Water heater
Fireplace
Phone:(L5,„.j) ``7�-.0 .6 '"7�t``i s Fax::(5,...-.3)� ,C "' 175 l
Range
E-mail: ,L ..l ., b CC-('sSV '�` MS .('.L;p„f°1 Barbecue
CONTRACTOR Clothes dryer(gas)
t Other
Business name: :
. !t o.( 'W.,, U MECHANICAL PERMIT FEES*
Address: c), Ct, x Li 3 i Subtotal
City/State/ZIP: c L FSC IC- Wil,(• ()1_ ( -1 6 t Minimum permit fee($90.00)
I Plan review(25%of permit fee)
Phone:(5$) t.„5-‘.„ - t q u bb Fax:(�..3 ) (J - ,f f E,, State surcharge(12%of permit fee)
CCB lic.: 1'7 6 t„ Z ilTOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: 4.,.. OU'741 * Fee methodology set by Tri-County Building Industry Service Board
Print name:/y,44-btti: ,. /i i 0 7"" Date: —3`.) .-e
I:\Building\Permits1MEC_PermitApp_040113.doc 440-46I7T(11/02/COM/WEB)
Electrical Permit Application .:,:‘-: FOR of.u icy t s F. o\I.1
' ..
City of Tigard . 4, - - Received
Date/B : 11=111=MMEMI
111 q 13125 SW Hall Blvd.,Tigard,OR 9724.: -', -. . ,t., Plan Review
: 2 Phone: 503.718.2439 Fax: 503.598.19 ,. 'S\-',‘'' Date/BRelated Permit#:
-:- :
Inspection Line: 503.6394175 ,..- :,. eady Date/By: Juris: 66 See Page 2 for
T I G"‘.RD Internet: www.tigard-or.gov ,",:,k Notified/Method: Supplemental Information
TYPE OF WORK ' PLAN REVIEW
New construction O Additionsalterationfreoafeeinear , Please check all that apply(submit a sets of plans w/items checked):
-' ,-- 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: ',' where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
ail-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system, larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:
45 q 70 S ,W., 1 N Et-- 100HP or more. 0"A","E","1-2","1-3",
City/State/ZIP: 'TIC!,A ..V0 4.7. V... cri /2 4-ti E.Siexalotrhmore-care fraecsiildietinetsial units.
0 R°ceccreu aticoyn.al vehicle parks.
0 Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name:
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: .1'44ve 7_ & S_t,_;-- ci(-7 .t W FEE SCHEDULE
Description I Qty. I Each I Total I .
New residential single-or multi-family dwelling unit.
Subdivision: 6 r_e a Ai,s ?Al .c ..Sc.,1,ti+ Lot#: •S Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 1-1-• 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
,,, ,---, (with above sq.ft.)
A/eV/ Si-PA"4.,C5 FIM it./ Re 5 i Pf.i".=:A,(-4:: Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
V(PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: , 200 amps or less 100.70 2
,,
Address:
201 amps to 400 amps 133.56 2
ix; 1:3 L'''''
401 amps to 600 amps 200.34 2
,p1,4
City/State/ZIP: c-
601 amps to 1,000 amps 301.04 2
Phone:( ) 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 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT 0 CONTACT PERSON per Branch circuits-new,alteration,or extension, panel
A.Fee for branch circuits with
Business name: rojp...„ I) ,it cig lief it'AJ above service or feeder fee,
7.42 2
each branch circuit
Contact name: „ON;riti) tc.44itAiLept ja 1,-- B.Fee for branch circuits without
service or feeder fee,first
Address: r(„7.), A1, c.,,sX i S 1 7 branch circuit 56.18 2
City/State/ZIP: ci , i gr- .2, cv- 47 70'7 <-, Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(5i3 ) '472 C;,--- 247i k.i 5 Fax: :(54: )-5 90. 175 i Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: 4:,:i;:tt 41-D to 1-,5T (3I.. it.,t6k.to Wk. Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: E 4,IF-2,TC: 4.31..c. r-P6-i=7.1.-Lie Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: el- S-L AI 6-, 9,2 A„,) /),A1., PI A.)/ panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:
Each additional inspection over allowable in any of the above
pc,f....,t i., ft, ci °2-2(:j Additional inspection(1 hr mm ) 66.25/hr
Phone:(5)c-4) . 77 -.3 7 Fax:(5, 3 ) 96/ , 7,7 7 y Investigation(1 hr min) 66.25/hr
Industrial plant(I hr min) 78.18/hr
Email: a/...e- e'.E.iz_ae, (L,/A NIL, i C,4/1
Inspections for which no fee is
CCB Lic.: 1 ci i 2.1 7+4 Electrical Lic.: (7 e,,39 Suprv.Lic.: ,5---7621 S specifically listedPERMIT FEES(V.hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL A.AL/e,.....„1,...._
Subtotal:
I ..
Print name:If?. / -12.4r, wu.„:ivbvttt.1 -L_ I Date: 6-30-ic., 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: . .:00W27_________
• 119 TOTAL PERMIT FEE:
, -
This permit application expires if a permit is not obtained within 180
Print name: 1) 2t 0 - , ix":1.44,*pe,r,r.-- Date: 6-3„ -/6 _ days after it has been accepted as complete.
* Number of inspections allowed per permit.
IMuildingTermits\ELC_PermitApp_ELR_EREdoc Rev 04/21/2014 440-4615TO 1/05/C01WWEB
Plumbing Permit Application
Building Fixtures FOR OFFICE: FOSE ()NEN
6 Received
City of Tigard Permit No.: --0(;;Zein
M
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �- } �►'-
1� Plan Review
Phone: 503.718.2439 Fax: 503;5'z•.1964 Date/By:Received
Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Pane 2 for
IIIMININ Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK',',,j'i, '' FEE* SCHEDULE
New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
❑Addition/alteration/replacement [f Other: ,' New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
paand 2-familydwellingSFR(2)bath 437.78
.1- 0 Commercial/industrial
❑Accessory building 0 Multi-family SFR(3)bath 50032
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( ,sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: sq-70 5.t,, , r/u -� Catch basin or area drain 18.76
Ci /StatelZIP: a C"=
Drywell,leach line,or trench drain 18.76
City/State/ZIP: '1tr",t � g, t 7 �'
t Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: nd j „,,,%., cio -r_it 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:C;-i. :Nait=tide (2111 .tt, Lot no.:
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
‘5,14,1(1., i.C. rAdviet / c I= Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
V PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
3 LFloor drain/floor sink/hub 25.02
Address: ,R;� y ,; Garbage disposal 25.02
City/State/ZIP: `�I Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
(t APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: R 1 I Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: )X41 1 01)t 14 f$s y-r--
Roof drain(commercial) 12.51
Address: I3 6, 'z_ --,,c i S 7....® Sink/basin/lavatory 25.02
City/State/ZIP: j' '.1�t-11.IoE z (.-� 9-707
C "1 /
S Solar units(potable water) 62.54
Phone:(Si)14) 7 2 c.., 7 ti,7 5 Fax::( lam) .5c - L75 / Tub/shower/shower pan 12.51
E-mail: }:_s; td.., (:..z:?8n;:,''...-)71- NO i , C__t,N 6-, Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: "'r"` LA IL t. ,44,1yA ,,,, Water piping/DWV 56.29
Address: i (3 t i - r �2,,,� e ci Other: 25.02
City/State/ZIP: ti,t`_ - 'Z, ci %l 1-3 Subtotal
Phone:( 4 ) :,Li-s '>/l Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: (-1 2k. c C/ Plumbing Lic.no.: 3-iici g 1 0
State surcharge(12%of permit fee)
Authorized signature�®� TOTAL PERMIT FEE
Print name: .+--SCC ® / ./(0 This permit application expires if a permit is not obtained within 180 days
4t t.L r�a Date: (>-3,3` after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits,,PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
III COMMUNITY DEVELOPMENT DEPARTMENT
T l c A u D Building Permit Review — Residential
Building Permit #: 5 ,2j ' -. c1&
Site Address: 8 J 70 5 W ! 6-4 S7 k E-7
Project Name: 010 ,y rciO i?"174k fch.i`f 06.26/y-/e) Lot #: 3
(New dwelling=subdivision name;Addition or Alte tion=last name of owner)
Planning Review
Proposal: N E ' S F(.
'Verify site address/suite# exists and active in permit system.
❑ River Terrace Neighborhood: „O.—No E Yes, See River Terrace Review Addendum Attached
Site Plan Elements:
Three(3)copies of site plan 'K.:sting sting structures on site N4
,Site plan must be on 8-1/2"x 11"or 11 x 17"paperootprint of new structure(including decks)with finished
brawn to scale(standard architect or engineer scale) floor elevations
North arrow ✓ 0.V-tility locations (required for new,may apply for additions)
,.Site address,project or subdivision name and lot number ,ErLocation of wells/septic systems Ar17
- pplicant information(name and phone number) ,Erosion control(including drainage-way protection,silt fence
,Sot dimensions and building setback dimensions design,location of catch basin,etc.)
.ot area,building coverage area,percentage of coverage andtreet names
impervious area (applicable if R-7,R-12,R-25&R-40) ,IJrs-S/treet tree size,type and location
)2-Property corner elevations (2 foot contour lines if more than Existing trees to be retained with drip line,and tree
4 foot differential) protection measures Nit
1
.ErC1ean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: ,2' Yes,applicant was notified ❑ No . Received:
Yes ❑ No
8'Public Facilities Improvement (PFI) Permit:
Required: E Yes,applicant was notified ❑ No Applied For: .'Yes E No,stop intake
Land Use Case#: SU13 .20/Y O vd/0
El' Zoning: R-11 s—
,0" Setbacks: Front 2.O Rear / 5— Side 5- Street Side iv/9 Garage 20
s Landscape Requirement: Atli.
0/0
'Lot Coverage Maximum: N4
,2 Building Height: Maximum Height t
Agr g 30 Actual Height z y
Z'Visual Clearance /"v'
Easements eun
Zr Sensitive Lands: NA ❑ Yes ,,I2 No Type
rban Forestry Plan
, Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: (.... /3_____,� Date: 6—34,—/�
Revisions (after Building Submata of nly) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
l:\Building\Forms\BIdgPennitRvw REs 012116.docx
Building Permit Submittal
Original Submittal Date: 0ft("1
Site Plans: # 3
Building Plans: 1.„+_____Building Permit#: er building permit#above.
Workflow Routing: anning engineering ermit Coordinator wilding
Workflow Sign-off: C.Y<gn-off for Planning(include notes from planning review)
Route Application Documents: i i'igineering: (1) copy of permit application, (1) site plan, (1) building plan and
on nal plan review routing form.
l�Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: , Date:
Engineering Review
/Slope at building pad: Of
'Conditions "Met"prior to issuance of building permit
4 Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No _
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes: 'r
Approved by Engineering: e/Z-1) Date: 7���F j
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved El 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:
74)1DC Fees Entered: Wash Co Trans Dev Tax: 'es ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: 7-//4/(4'
l:\Building\Fonns\B1dgPennitRvw_RES_012116.docx
Building Permit Application
Res' ential - '
MIMIIIIIIIIIIIIMII
City of Tigard Received
" DateBy: 6/30
j -Permit No.:��Y),��l:l�/••C� '�
13125 SW Hall Blvd.,Tigard O . ' Pian Review
K!r p-•�r�Y�
Phone: 503.71$.2439 Fax. 503. 11'.0 ���% Date/By: Other Permit ScoR49ll�D
1,, Inspection Line: 503.639.4175 cl Date Ready/By: Juri: B see papa 2 for
Internet: www.tigard-or.gov `\\� y" -,,j Notified/Method: CP Supplemental Information
AP'
1 C1 X Ict
TYPE OF WORLD ,co REQUIRED DATA:1-AND 2-FAMILY DWELLING
*IiirNew construction 0 Istik106r 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 e I er: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
01-and 2-famil y dwellin Valuation: $
g ❑Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: S q 7 p 5. w, NE 7-, New dwelling area: square feet
City/State/ZIP: Tic,pt� r.v-, c17 "1 7 Garage/carport area: square feet
Suite/bldg.apt.no.: Project name: y kllf &I` toy- Covered porch area: square feet
Cross street/directions to job site: T tom=c z. a, ,5,,L;;, tro -t-%4 Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 6 actem sires tp►{4-3 Pry RR_ Lot no.: Permit 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
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
acs= 5 tNI L,Lei PAM t1-.) i+S iJn% LE
Existing building area square feet
New building area: square feet
lEt PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: ' yL'v ,
N 06 L Occupancy groups:
City/State/ZIP: Existing:
g
Phone:( ) Fax:( ) New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
- �� CCAS r� Structural plan review fee(or deposit):
Contact name: Dr,„i:D 0 E 4A12-r1Pc2at f FLS plan review fee(if applicable):
Address: - C' 6 C-.-% i S I.?
Total fees due upon application:
City/State/ZIP: v 03 `I-76'75
Phone:5.,,3 ) 5qo _>e,$OS Fax::(6%;3) 59'0,- t 5 [ Amount received:
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: , ;t. S; .5s.? ktz hok Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: .. t °� Solar Installation Specialty Code checklist.
City/State/ZIP: ik.' Permit Fee(includes planreview $180.00
NI L-' and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: "--7✓ et 1 Total fee due upon appication: $201.60
Authorized signature:12j,,`��i�3� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1) V l0 c- - , WO.t!Date: (3v .-A:, *
ServiceoarFee d set by Tri-County Building Industry
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8970 SW INEZ ST, TIGARD, OR, 97224 April 21 , 2017 at 9:03:50 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00290
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Duel outlet for possible second fridge in mud room to be gfci protected, arc fault
protected or changed to single marked non gfci protected. OESC 210.8
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8970 SW INEZ ST, TIGARD, OR, 97224 May 3, 2017 at 10:39:46 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00290
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Corrections from previous inspection complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8970 SW INEZ ST, TIGARD, OR, 97224 May 3, 2017 at 10:56:44 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00290
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Contractor on site finishing sealing penetrations.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8970 SW INEZ ST, TIGARD, OR, 97224 May 3, 2017 at 10:36:32 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00290
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Correction from previous inspection complete.
Violation Summary:
Inspector Contractor