Permit (78) CITY OF TIGARD f ` • pt; MASTER PERMIT
' COMMUNITY DEVELOPMENT IIIIIM�� Permit#: MST2016-00311
Date Issued: 08/18/2016
T[ RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2 S 104AD07000
Jurisdiction: Tigard
Site address: 12965 SW PARKDALE AVE
Subdivision: OLSON WOODS Lot: 6
Project: Olson Woods, Lot 6
Project Description: New SF. 4/24/17, REPRINTED to add gas line for barbecue.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 2400 sf Basement: 0 sf Left 5 Parking Spaces: 0
Height: 20 Bathrooms: 3 Second: 0 sf Garage: 660 sf Front: 15 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors.
Total: 2400 sf Value: $304,056.60 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 Rain0 Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: 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: 5
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 2400
Owner: Contractor:
WINDWOOD CONSTRUCTION INC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
12655 SW NORTH DAKOTA ST 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 TIGARD,OR 97223
PHONE: 503-780-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,560.72
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. 1 • : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. "Throe rules are set forth in OAR
952-401-0010 through•'R -001-0090. You may obtain a copy of the rules or direct questions to OUNC by callin• +3.232.1987 or 1.800.332.2344.
Permittee Signatu • .0: �6Y� �'
Iss,ed By: ��L��bC --kt g
Call 503.639.4176 by 7:00 a.m.for the next available inspection da
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
Date/By: Permit No•:Received r
City of Tigard . —4:9
_
()RECEIVE()
13125 SW Hall Blvd.,Tigard, Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit:
TI�'n R D Inspection Line: 503.639.4175 APR 2 4 2017 Date Ready By: Juris: 0 See Page 2 for
r Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
517,,,,?'._ „„0,,,,,,,,,,,-.: LTP 3 )N ' CO l l IAI flE*` : A a USECHECKIiST
2, `' 44426.444.4',' kR
Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition -{—]tether: mechanical materials,equipment,labor,overhead,and profit.
�T Value:$
,,..,. .. a=F 1 II) ME ifi{SYSTE kfS`FEES*
❑ 1-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
'„ ` ' +� '` ). Heating/cooling:
F ;' . ,.i w4 4,' �7 ,r,, ® ' '` '"'; ,i OCA .N, ,,,, .. . .r -- Air conditioning 46.75
Job site address: /2 �0 —��� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7:?j: 6. '79 23 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: 6,__c_./fit 7/ Hydronic hot water system 23.32
Residential boiler(radiator or
hydrA/11/1
/ Ir5� 2a/ _3// Unit h ic) 23.32
GJ� J[ 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.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
'''''''''''''''''''''Ts,':-
* DES ,-41i.:::...'!.1'11°
t t!.i -',, ,> � 33.39
:2 L ;44'4'M':'716';''' 1 'wo :
' ";„ .ri.u. FlueGas vent forfireplace/insertr heater or gas water
�� fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
j.'"::''
, '' 54. Other:
_. ` '” •- " ,' ,' Environmental exhaust and ventilation:
Name: r,(//"e45 1,-( et Range hood/other kitchen
nt
Address: (d //IAA /47
/I A�� /� Cleqothes dryer 33.39
y �� � /( 0.-44 Clothes exhaust 33.39
City/State/ZIP: ??..5-
� �- Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
ri..$ 'se:, APPLL ,, §x p> '44;.., Cl CO1 T'Alr'
CT a �i Other: 23.32
Fuel piping:
Business name: V,in't 5
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: if
Barbecue
.. 1,t =A' ,a bNTRACrOR ",` ;y . , Clothes dryer(gas)
Business name:
A,# ..,
Other:
r— I.'Mtdi.AiNICAL PY ,„,a 1 FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.: . /?9c. 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: �_ Date: V//7
I:\Building\Permits\MEC_PermitApp_040113.doe 44-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: ,Penit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
CITY OF TIGARD74 MASTER PERMIT
11 COMMUNITY DEVELOPMENT Permit#: MST2016-00311
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/18/2016
Parcel: 2S 104AD07000
Jurisdiction: Tigard
Site address: 12965 SW PARKDALE AVE
Subdivision: OLSON WOODS Lot: 6
Project: Olson Woods, Lot 6
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 2400 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 20 Bathrooms: 3 Second: 0 sf Garage: 660 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 --
Detectors: Yes
Total: 2400 sf Value: $304,056.60 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
0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: 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 2400
Owner: Contractor:
WINDWOOD CONSTRUCTION INC WNDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
12655 SW NORTH DAKOTA ST 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 TIGARD,OR 97223
PHONE: 503-780-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,556.21
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rule • •irect questions to OUNC by calling 503.232.1987 or 1.800,332.2344. -
Issued By:� Permittee Signature:
Call 503.1111 ,175 by 7:00 a.m.for the next available i•-•:"c ion da
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
' Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY"
City of Tigard p r g 2016 Received
13125 SW Hall Blvd.,Tigard,OR 97223AU G 3 Date/By: , 3 1�p Permit No.: Iy� l X 31 l
11 , Phone: 503.718.2439 Fax: 503.598,1a0_ DPlan Review 8_,1 — j ���Q�h
CITY OF TIGAR D Date/13y: U. Other Permit: See Page 2 for ���j�1
I i ,R[) Inspection Line: 503.639.4175 Date Ready/By: curls p See Page 2 for `/Y
Internet: www.tigard-or.gov BUILDING DIVISION
Noafied/Method
1 1��� Supplemental Information
` A 10 _.4,1
e''" :�"+4. i� 5' .g 4{ ,i' V^'n} SSA+ a:+:wca:7' n p r '4..:'''',':5*"::'
i v :',':'.T;;.
x
mak.. ,. ,€ i ,> 00' ,__' ' s 1 ktc 3t qs 4 ' 1 i s-'
0New construction 0 Demolition Permit fees*are based on the value of the work performed.
❑Addition/alteration/replacement 0 Other:
Indicate the value(rounded to the nearest dollar)of all
„� . equipment,materials,labor,overhead,and the profit for the
`f 1,'; '�, "a -e:,', Z r .k s c ear . a
�� . 4 �« t" 0 , ;�N , 'x work indicated on this application.
'-and 2-family dwelling Valuation: t..'., O�-
❑Commercial/industrial 0$ 1
❑Accessory building 0 Multi-family Number of bedrooms: 1'
❑Master builder 0 Other: Number of bathrooms:
a � '« ., , m e , '1 0 Total number of floors: �J
Job site address: /...2 9 Pili-tie4/4 /4.19,94;--- New dwelling area: square feet
City/State/ZIP: 7-,,T6 ,,,z n ,CF A� ,a.-Z Garage/carport area: 6,, 0 square feet
Suite/bldg./apt.no.: Project name: �j/�-04,,, jade_SCovered porch area: ) 7 0 square feet
Cross street/directions to job site: Ami Z/24..,( 7 Deck area:
Q square feeQr),c3
Other structure area:?'C) square feet
Subdivision: /41012/ Ct 4).....c. 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
.F., I, , )'S � . z *--r,5°zl . .. } . 1: ..,,� .NOI7h{} .M ..... . ., . work indicated on this application.
002/4-'1(.1 SP A Valuation: $
Existing building area: square feet
New building area: square feet
t �' r Number of stories:1. . W; .,a :,. ) .ttr MV an, A ; , 4 , ,
Name: >Q ad G -a4 e,o/ $ ,. it/ Type of construction:
Address: ,,i;;;.. ,as .,'^- 60Tht ,Q/11.x74 A7 Occupancy groups:
�
City/State/ZIP: °./.-
.` °,�'e� '" ,4 �')A', "3 Existing:
Phone:(57 7,o '/32 j Fax (',;;S„../3) ',..,--f,,::•:/,::_,) e'6 0
New:
pee, . ,1'; t `os,az{ . 0 x3,o " ;,v,:.a` adG,A. ,-4 ..s,...,,,1 'r:, ,, =., s 4" ,,, i .,',, ':'^,
7
Business name: 7,.<71/97 ��, .>.r..;>
Contact name: ':" - .• r::
Structural plan review fee(or deposit):
Address: FLS plan review fee(if applicable):
Total fees due upon pon application:
Phone:(5'. 3) 7.or. L/ 3 -7 Fax : ) 7✓�t,1 ,:,4,,,J2‘ Amount received: 75-e.GO
E-mail: !,t r/416-/,-, 9 {„ /} e ,,A,e4-1L.,-;.- 4.» E i L �i
b t Commercial,and residential prescriptive installation of
�'" ... ` ti. ,, .4 .44 ";`' t � ?„"< . roof-top mounted PhotoVoltaic Solar Panel System.
Business name: ✓4J_Tr"/) 4J d d /0 A1';7 .,,r2/C..• Submit t +(2)sets of roof plan with connection details
Address: and fire dep..ment access,along with the 010 Oregon
" Solar Installat.r:Specialty Code cher .
City/State/ZIP: Permit Fee C. ..- , r•view $180.00
— and as istrative fees):
Phone:( ) Fax:( )
State surcharge(12%o .•rmit fee): $21.60
CCB lic.: 6-a,,, 67
Total fee due upon applica +n: $201.60
Authorized signature: This permit application expires if a pe , it is not obtained
within 180 days after it has been accepted as complete.
Print name: w? *Fee methodology
/ ,! 7 //,,/:( / ',_. Date set by Tri-County Building Industry
�' f'� Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Applicafibk-CEIVED FOR OFFICE USE ON1.I.
City of Tigard pp ( •
R�ri°� pp / (.-Qi)
/�,
`, g ti l G 2016 Date/By: 6 3 /4 \.a.�J Permit No.: 1`-t �- G /—oO 51/
al 13125 SW Hall Blvd.,Tigard.OR 97
s Phone: 503.718.2439 Fax: 50L TVFTI GARD Plan Rview
Date/By:
Other Permit:
Inspection Line: 503.639.417 Date Ready/By: ions:
See Page 2for
TIGARDInternet: www.tigard-orgov jU(LD(NG DIVISION
Notified/Method: Supplemental information
`
lew construction 0 Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked below,
0 Service or feeder 400 amps or more 0 Building over three stones
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
'; s,I ;eA,,t n 'el' max, .0 o K a g7"„,4 FS,=:` a,4�f :14..i!•,;,:,,,,,,,:,,:.v. exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
and 2-family dwelling 0 Commercialtndustrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: O Fire pump. O Installation of 75 K VA or
O Emergency
p '. Addton of snyeswtemmo.tor load of larger separately
derived
d s,sten
, ., Q yf r IRi' iV ,`i ` 'e a 4. e I'it ViO iiO"A.,"E" '1-2,."1-i'•
Job no.: I Job site address:4,194,c �17 � 1 -z 100HP or more.
0Six or more residential units. 0occupancy.
Recreational vehicle parks.
City/State/ZIP: 717„:".‘,/ ®,e,,, ►7 .a 1 O Health-care facilities. O Supply voltage for more than
O Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: '; .°°, /C.70 Service or feeder 600 amps or more.
Cross street/directions to job site: , fA a.„7- Description I Qty. l Fee. I Total f •
New residential single-or multi-family dwelling unit.
Includes attached garage. ,
Subdivision: ®/ diet/'c'f�.., I Lot no.: 1,000 sq.ft.or less 1I 168 .54 4
Ea.add'1 500 sq.ft.or portion Li.>q 33.92 1
Tax map/parcel no.:
Limited energy,residential
{ ? ix W: L� �{fls� t t .. ..:31 e. �<�r;z: (withabovesq.ft.) , z/ 75.00 2
,,� L^y _ Limited energy,multi-family
l�1- Aa/ 5,P residential(with above sq.ft.) 75.00 ?
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70
Y Z $ ,t y+e M i201 amps to 400 amps 133.56 I 2
401 amps to 600 amps '200.34 2
Name. .GO,-74/4)1Ait2 ei 3 , Lr7)e 601 amps to 1,000 amps 301.04 2
Address: /o2‘ 6 ex) Not 7W ,O#41,14.674247Over 1,000 amps or volts 552.26 1 2
;yy Temporary services or feeders installation,alteration,and/or
t
City/State/ZIP: f ,Le ^ - 7)1relocation
Phone:(M, »41/3?S'°" I Fax: d3)e'y 2 --Ga6 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 -
intended for sale,lease,rent,or exchange,according to ORS 447.449,670,and 701.
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
1:,9-!:,:,..,.. .:,...4 ' " r tri. t^z t'ra above service or feeder tee,
42 3
ray ?. ?. w �; ;, �r., a^ezr m a 7.
��� ' -- -- •-* `�� each branch circuit l
Business name: ,-5--e-',c-- B.Fee for branch circuits without
service or feeder fee,first 56.18 ? I
Contact name: ..71,,,-,1,.„4.77 4,427:7/41043,-.Sbranch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling,service and/or feeder 67.84
Phone: Reconnect only 67.84 2
( ) Fax::( )
Pump or irrigation circle 67.84 2
E-mail ,I j„/ ¢ri , i :r''«,`°4" ...,4_,g9( 'fit s k / 1 Sign or outline lighting 67.84
- 4,,
"�� - ' A Signal circuit(s)or limited-energy
Business name: DreamHouse Electric,LLC panel,alteration,or extension. Page 2 -
Each additional inspection over allowable in any of the above
Address: 221 SW Moonridge Place
Additional inspection(t hr min) 66.25/hr
City/State/ZIP: Portland,OR 97225 Investigation(1 hr min) 66.25/hr
Phone:(503) 519-6711 Fax:(503)648-9723
Industrial plant(1 hr min) 78.18/hr
CCB Lic.: 196726 Electrical Lic.: C-848 Suprv.Lic.: 4560S Inspections for which no fee is 90.00/hr
specifically listed(Vs hr min)
Suprv.Electrician signature,required: ;,, ,'E>E RICALVERMMEEFS:
Print name: Chris Mahon Date: Subtotal:
Plan review(25%of permit fee):
Authorized signature: State surcharge(12%of permit fee):
Print name:�rl S ",/,,,,,, I Date: e//4,,,,,,,44, TOTAL PERMIT FEE:
1%Buitding\Petmits\ELC-PetmitApp doe 07/01/10 Y 440.4615711 I/05/COM/WEB
Mechanical Permit Applicattla-
FOR OFFICE t SE ONLY'
14 4 City of Tigard v C V C Lf Received V /
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: 0 3 40 I Permit No.: Lr:19.6 l0 cal
Phone: 503.718.2439 Fax: 503.598.1960 AU G 3 2016 Plan Review 7
Inspection Line: 503.639.4175 Date/By: Other Permit:
p
TIGARD
Internet: www.tigard-or.gov Date Ready/By: kris: ` H See Page 2 for
CITY OF TIGARD Notified/Method: I Supplemental Information
BUILDING DIVISION
,','TYPE.OF:WORK'. -
�'~� .. COMMERCIAT FEE* SCHEDULE - USE CHLG'I{LIST .,.
w construction 0 Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical 4 r materials,equipment,
labor,overhead,and profit.o$t.
Value:$Z , 3= , TEGOY OFGNS3RTCTION
Nand 2-family dwelling 0 Commercial/industrial ❑Accessory buildingRESIDENTLAL EQ>7If1 /SYSTEMS FEES*
For special informationon use checklist.
❑Multi-family 0 Master builder
0 Other: Description I Qty. I Ea. I Total
`'' ' JOB; 1TE JNFARNIATIOIt.AND LOCATION Heating/cooling:
Job site address: /a�j'G„5- �(�L-. ,,i` L AZ, ,Z4 ��r- Air conditioning 46.75
/ �T Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:
/ �n4,e) 01 Z ?-2,2 3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name: r"i% %j r? F-• Heat pump 61.06
. J G /0�{,�?..w Duct work
Cross street/directions to job site: ,it1 23.32
-- 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: I Lot no.: Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
,."'r.?...' 2 7 :.' fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
'' 01'ERTY;OlV1VER 1 0'TENANT Other: 23.32
Name: /4
Environmental exhaust and ventilation:
_ Range hood/other kitchen
equipment33.39
Address: J .p .-..+ .:,._ . ; / ., < / Clothes dryer exhaust 33.39
City/State/ZIP. -7:2•6/7,L_ f— .12-'72...„..);.)_, Single-duct exhaust(bathrooms,
Phone ( �';) '? til Fax: �� ) J c toilet compartments,utility rooms) 23.32
(J [�"���C Attic/crawlspace fans 23.32
APPLICANT
0 CONTACT 1?'EI+;SON, Other: 23.32
Business name: •1! Fuel piping:
/yI-'
$14.15 for first four;$4.03 for each additional
Contact name:
� . ,L47.- -fC-/`/27,'/ ,L) Furnace,etc.
Address: Gas heat pump
City/StatelZIP: Wall/suspended/unit heater
Water heater
Phone:( ) I Fax::( ) Fireplace
E-mail: Range
GV/A/ cci,(.40,4i;--� ,,,c y „�,_i ,
'� ' ,,,-0y.,,.1Barbecue
,CONTRACTOR; Clothes dryer(gas)
Business name: j 44.-)z....5"-- Other:
CH
Address: MEANICAL PERIVIIT FEES*
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) I Fax:( )
State surcharge(12%of permit fee)
CCB tic.: --7)f TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized sign .►
""` "�' ^-- days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
I Print name: `:2, ,fi _ %e. I Date: 3////4
I:\Building\PermiitsswEC_PermitApp 0401 I3.doc � � /
440-4617T(]1/02/COM/WEB)
Plu`ltnbing Permit Applic
Building Fixtures
CEIVE(
FOR OFFICE, USE ONLY
City W Tigard 7AUG 3 2016 Received G r
al 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: 0 Permit No.t/L.,7:461/0_ )2/)
IN = Phone: 503.718.2439 Fax: 5Q$ !F:TIGARD Date/By: Other Permit No.:
C.C.i 7
TIGARD Inspecttn www.• 503.639.41DUILDING DIVISION
Internet: www.ttgard or gov Date Re lues
} i $. x.
Notified/Method: H See Page 2 for
as ki , Supplemental InformationTew construction ❑Demolition For special information use checklist
0 Other: Description j Qty. e Ea. I Total
Addition/alteration/replacement
'�^ ��{a a �, �" � � New 1-2-family dwellings(includes 100 ft.for each utility connection)
i. :,4. � vv `1 : " :o- ' , �`�� P 'r.,` SFR(1)bath 312.70
1 and 2-family dwelling
0 Commercial/industrialSFR(2)bath
437.78
❑Accessory building ❑Multi-family SFR(3)bath ,/` 500.32
❑Master builder Each additional bath/kitchen 25.02
0 Other:
� ,,v,,,,,,.-,, > 1Fire sprinkler( sq.ft.) Page 2
hatitiii5 ad,` te,: A a Site utilities:
Job site address: "� 9'/ -. ,z,/),--,..,„;!,
, . !.. Catch basin or area drain 18.76
City/State/ZIP: �`
1' , ' Drywell,leach line,or trench drain
r r ._. , „,,. 18.76
Suite/bldg./apt.no.: Project name: ,, Footing drain(no.linear ft.: ) Page 2
� '" Manufactured home utilities 50.03
Cross street/directions to job site: l.i i x,;d< Ay,,,, '7
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: Water service(no.linear ft.:
:),h ,,,,,,L)f t _. t;;;.r7�.. --- I Lot no.: ) Page 2
Fixture or item:
■
Tax map/parcel no Backflow preventer 31.27
; , a a ; > f. ,, ;< fi4r t Backwater valve 12.51{ � : " , a iii;
% Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
lea 1...�' �.'R, ..*ii�-.. k4 ,� .. 7 - £- l t.'''',.. • "`x'f ` m"!. EX an
,,,: P Sion tank 12.51
Name: /7,1-y-f..,, .-X76),6 4i",2.14--/ 5 m ..///47. Fixture/sewer cap 25.02
Address: u.,.--.6,2) t t 2 7„/,, t14/ ,r 1 / ry .. Floor drain/floor sink/hub ■ 25.02
City/State/ZIP: ^tt g y Garbage disposal 25.02
Hose bib
Phone (j� ,) 4 '125.02
7,542- i Fax (y )/ , .,/ ,(:2_„'„,,' Ice maker
12.51
ki - r €!' X "k i Y"
' ' r
' ' , Interceptor/grease trap 25.02. . �, ..1, ? 494X1.-''''W 7 r '_'.'xtoi'':' ��..A,;..Vs4 Medical gas(value:$ ) Page 2Business name: ,,,„...,5;/9/4.
Contact name: ' ,, 1 ,; Primer
12.51
/
Address: Roof drain(commercial) 12.51
City/State/ZIP:
Sink/basin/lavatory 25.02
Solar units(potable water) 62.54
Phone:( ) Fax::
( ) Tub/shower/shower pan 12.51
E mail i „Jib 3� '�"`. ' d 4P` , Qa. " .), Urinal 25.02
r g "t° a q 'a' r' y,,h ; " - Water closet
n 4 ,rx .4 , 1" .o h ; :} 25.02
Business name: 1 Water heater 37.52
��/I � Water piping/DWV
Address: p'' 1.,w ;, .
Other: 25.02
56.29
r}
sem,i ,€,,e:. t 'o,l_" ,.1/7 7 r r Subtotal
City/State/ZIP:
Phone:( ) , .. : 5. -''....i...,5> "
1aFax:( ) Minimum permit fee: $72.50
CCB Lic.: /3 ‘i/i,6 Plumbing Lic.no.: f.".::: Plan review (25%of permit fee)
Authorized signature: ` „se/ State surcharge(12%of permit fee)
�....
Print name: �E,�
�V �n - -"- TOTAL PERMIT FEE
',� `" re Date: viz' F', 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
440-461 er(1o/oz/coMnvrrB)
City of Tigard
IN I
COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: ‘--)T- —00 S f
Site Address: rr
Project Name: Ok ,
(New dwelling=subdivision name;Addition or Alteration=last name of owner) Lot #:
Planning Review
Proposal: I V' ).a s
aVeri
fY site address/suite#exists and active
•
iver Terrace Neighborhood: permit system.
� No ❑ Yes,See Diver Terrace Review Addendum Attached
Sid Plan Elements:
h16171ree(3)copies of site plan
to plan must be on 8-1/2'x 11"or 11 x 17" it / sting structures on site
ye to scale e(standard architect or 11paper 1/Footprint ofo new structure(including decks)with finished
orth arrow engineer scale) 'oor elevations
e address,project or subdivision name and lot number14 Utility locations(required for new,mayapply for additions)
Lot dimensions and building setback dimensions) id " sting trees s be retained with drip line,and tree
rrA 4110k.t area,building coverage area,percentage of coverage andVI: otection measures
pervious area(applicable if R-7,R-12tin ,R-25&R-40) reet free size,type and location
Property corner elevations(2 foot contour �'Jtreet names
4 foot differential lines if more than
01 : can Water Services—Service Provider Lette (lot platted prior to 9 10
equired: El Yes,applicant was notified / /1995):
'IA Public Facilitis�ImprovementNO Received:
(PFI) Permit: ❑ Yes ❑ No
equired: Yes,applicant was notified
El No Applied For:
and Use Case#: i Yes ❑ No,stop intake
oning: r I�►la: 'iv 7 a -- 4400� � '
—
/ etbacks:kandscape Requirement: Front _ Rear Side Street Side
Garage
filkof Coverage Maximum:
❑ Buildin
g Height: Maximum Height
Visual Clearance Actual Height
refNJi
asements
itt ensitive Lands:
Yes 0 No Type J'in,
IrriXrban Forestry Planad
`--c.�
Cpnditions "Met"prior to issuance of building pent
Notes:
Approved By Planning: _"_'i�
Revisions (after Building Submittal only) Date: OW/ .�
Revision 1: 0 Approved ❑ Not Approved Reviewer
Date
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\BuildingWorms\BldgPermitRvw REg_060116.docx
Building Permit Submittal
Original Submittal Date: #
Site Plans: #
Building Plans:
Building Permit#: 0 Enter building permit#above. 0 Building Routing:
0 Planning 0 Engineering 0 Permit Coordinator
Workflow Sign-off: 0 Sign-off for Planning(include notes from planning review)
Route Application Documents: 0 Engineering: (1) copyof permit application, (1) site plan, ( )
building plan and
original plan review routing form. engineer and
0 Building: original permit application,site plans,building plans,
beam calculations and trust details,if applicable,etc.
Notes: Date:
By Permit Technician:
Engineering Review
/Slope at building pad: i.,:
/ Conditions"Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility: No
Assess Water Quality Fee in-lieu: 0 Yes No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot: 0 YesDate:
0 NOT Approved by Engineering:
Notes:
',WO Date: r ---��
Approved by Engineering: Date
Revisions (after Building Submittal only) Reviewer
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
0 Conditions"Met"prior to issuance of building permit Date:
0 Approved,NOT Released:
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:
C Fees Entered: Wash Co Trans Dev Tax: 'es 0 N/A
0 N/A
Tigard Trans SDC: Yes
Parks SDC: 12r Yes 0 N/A
0'41K to Issue Permit / Date:
( Approved by Permit Coordinator: ' 1
I:\Building\Forms\B1dgPermitRvw_RES_060116.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12965 SW PARKDALE AVE, TIGARD, OR, 97223 April 21 , 2017 at 12:23:32 PM
Record Type: Record ID:
Residential - Master Permit MST2016-00311
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Light bulb and trim above master shower not rated for wet location. 410
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12965 SW PARKDALE AVE, TIGARD, OR, 97223 April 25, 2017 at 9:36:43 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00311
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Correction complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12965 SW PARKDALE AVE, TIGARD, OR, 97223 April 25, 2017 at 9:39:44 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00311
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Corrections from previous inspections complete.
Violation Summary:
Inspector Contractor