Permit (18) CITY OF TIGARD
r
COMMUNITY DEVELOPMENT MASTER PERMIT
T I G A D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Permit#: MST2016-00314
Date Issued: 08/31/2016
Site address: Parcel: 2S112CB18400
15110 SW 81ST AVE
Subdivision: Jurisdiction: Tigard
CORBIN ESTATES
Project: Corbin Estates, Lot 1 Lot: 1
Project Description: New SF
BUILDING
Stories: 1 Bedrooms: 3 Fla r Areas
Height 24 First: 2112 sf Require d Se—k$
Dwelling Units: 1 Bathrooms: 2 Basement: 0 _Rea`_
Second: 0 sf Left: 5 Parking Spaces: 0
sf Garage: 929 sf
Third: 0 sf Front: 15 Smoke
Total: 2112 sf Right 5
Value: $286,632.07Detectors: Yes
Rear 20
Sinks: 1 Water Closets: 2 PLUMBING
Lavatories: 3 Washing Mach: 1 Laundry Trays: 1
Dishwashers: 1
Tubs/Showers: 2 Floor Drains: 0 Rain Drain: 1
Urinals: 0
SF Rain Storm Sewer: 100
Garbage Disp: 1 Sewer Lines: 100
Footing Drain: 0 Water Heaters: 1
Ice Maker: 1 Water Lines: 100 0
Hose Bib: 2 Drains:
Drywell-Trench Drain: 0 Backwater Value: 1 Bckflw Prevntr: 0 Catch Basins: 0
Other Fixtures: 0
Other Fixture Units:
Fuel Tvnes MECHANICAL
Air Conditioning: N
Natural Gas Vent Fans: q
Heat Pump: N Clothes Dryers: 1
Furn<100K: 1 Hoods: 1
Furn>- Vents: 0 Woodstoves: 0 Other Units: p
100K: 0Gas Outlets: 4
_________ResidentialUnitELECTRICAL
Service Feeder
1000 sf or less: 1 � Temo Srvc
Ea add?500 sf: 4 0-200 amp: p Branc— wits
201-400 amp: p 0-200 amp: 0 W/Svc or Fdr: p
Mfd Home/Feeder/Svc: 0 201-400 amp: 0
401-600 amp: 0 W/O SvGFdr: 0
601-1000 amp: 0 401-600 amp: p
p
1000+amp/volt: 601+amp-1000v: 0
ELECTRICAL-RESTRICTED ENERGY
Audio&Stereo: N SF Residential
HVAC: N Security Alarm: N
Other: N Other Description: Vaccuum System: N Garage Opener: N
All
Ecompasing: Y
Class of Work: BUILDING INFO
NEW Type of Use:
Group:
SF Type of Constr: Occupancy Gro
Owner: VB Square Feet:
JT ROTH CONSTRUCTION INC Contractor: R-3
J T ROTH CONSTRUCTION 2112
12600 SW 72ND AVE,STE 200
Required Items and Reports(Conditions)
TIGARD,OR 97223 12600 SW OR 72ND AVE#200
TIGARD, 97223 1 Ersn Cntrl 503-639-41775
PHONE: 503-639-2639
PHONE: 503-639-2639
Total Fees: FAX: 503-624-0239
$28,895.83
This permit is issued subject to
be done in accordance the regulations contained in the Tigard Municipal Code,
bedat's. ATTENTION: with approved plans. This permit will expire if work is not startedSw thin oftate 180 days of issuance, or if work is sus
952-001-0010 throughOregon law requires Specialty Codes and all other applicable law.
OAR 952lawl- you to follow the rules adopted by the OregonUtilityAll work will
obtain- _.. - e rules or direct questions to OUNC Notification Center. Those rules suspended
eedseor fmore orth in the 180
Issued By: by calling 503. •87 or 1.800.332.2344. OAR
.c Permittee Signature:
.639.4175 by 7:00 a.m.for the next available inspection date. ` `
This permit card shall be kept in a conspicuous place on the job site until completion of -...Q.1"---
� '
Approved plans are required on the job site at the time of each ins
•roject.
inspection.
1 Bgildin2 Permit Application L 0/4// ,,
Residential . V [OR 01 l l( 11 t SI,0',1,1
Received !
City of Tigard DDate/By: 41 46 I Permit No.: H (�a/%o—c 3iT/
lig . 11 1315 SW Hall Blvd.,Tigard,OR 9 l 4 a 15 Plan Review !�
Phone: 503.718.2439 Fax: 503.598. 930 Date/By: ptlie�Permit:1[ j/��2
r I k,n Ii t) Inspection Line: 503.639.4175 • I Date Ready/By: Joos: ® See Page 2 for
Internet: www.tigard-or.gov �TY d i=A S Notified/Method:f/ i/ l/ �,/ Supplemental Information
I t , a. .. AA� 0<, V
s'' m,r„ „Ne aw,.., .rr. fes. . E,. .dt .,x<., ,,,.' ' ..;, wm z .,e ..,, G�.r .o ,., .4 .w ,. ..., ' , ;�,-' .
®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
CA GO t �„� J t ? work indicated on this application.
® 1-and 2-family dwelling Valuation: 0 i
❑Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms: 3
❑Master builder 0 Other: Number of bathrooms: 2
Total number of floors: 1 )
Job site address:15110 SW 81A Ave New dwelling area: 2112 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 929 square feet
Suite/aldgiapt.no.: ( Project name: (;`,.-b_,,,,, F3 ► Leri_! Covered porch area: 14/Square feet
Cross street/directions to job site:Bonita Road to 81st Ave. �area: 4�1 square feet
I4. Wim- Q
Other structure area: square feet
1. ,
P i,i if „ . , .,
Subdivision:Corbin Estates I Lot no.:1 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
1,11,11,1111,11: =;RIOF W s , work indicated on this application.
Construction of new single family residence Valuation: $
Existing building area: square feet
New building area: square feet
i , m a... Vit: 2 > s 1 a 10**A11 .21Number of stories:
Name:J.T.Roth Construction Inc. Type of construction:
Address:12600 SW 72°d Ave. Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)639-2639 Fax:(503)6244)239 New:
z
` P A ma 2 i ..re +^b:; „. .*:qY . 4l $g9 l
f
gA4i 4
5
Business name:J.T.Roth Construction Inc. �
Structural plan review fee(or deposit):
Contact name:David Jensen
FLS plan review fee(if applicable):
Address:12600 SW 72nd Ave.
Total fees due upon application:
City/State/ZIP:Tigard,OR 97223 /�j�
Amount received .CT-7
Phone:(503)806-0602 Fax::(503)624-0239
E-mail:davidj@jtrothmc corn .,: ., , . r <, , a A; ., e ?4's
,, x Commercial and residential prescriptive installation of
a . s p
,y ,, - s . .ix : , ;i roof-top mounted PhotoVoltaic Solar Panel System.
Business name:J.T.Roth Construction Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:12600 SW 72°d Ave. Solar Installation Specialty Code checklist.
City/State/ZIP:Tigard,OR 97223 Permit Fee(includes plan review
and administrative fees):
'one:(503)639-2639 Fax:(503)624-0239 State surcharge(12%of permit
lie.:31700 Total fee due upon apt,
ed signa/%tt. ,......./ ei�.—� This permit application expire,
within 180 days after it has bt
David Jensen // Date:07/19/2016 'Fee methodology set by Tri-Coon
,r` Service Board.
'ermits\BUP-RE itApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit A t t li I:; ,1 .. .1F.
um(OF1.1( ii lSl: O\1.1
City of Tigard Dateive Permit No. hl !(Q-003/4Z
III 11 13125 SW Hall Blvd.,Tigard,OR 973.44f: 4 i r Plan Review Other Permit:
® Phone: 503.718.2439 Fax: 503.598. 11U Date/By:
i c,n it a Inspection Line: 503.639.4175y Date Ready/By: Juris: la See Page 2 for
w.t
Internet: wwigard-or.gov (AIV � 1 " Notified/Method: Supplemental Information
;` Z: _ -_ -. ~ " '" Mechanical permit fees"are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
aitiostoggfHeating/cooling:
T v � f 1..;. t �', e,'Y46.75
Job site address:15110 SW 81s`Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 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:Bonita Road to 81st Ave. 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
Other: 23.32
Subdivision:Corbin Estates Lot no.:1
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
I F ` 1 ` r# ' ;r Gas fireplace/insert 33.39
HVAC installation of 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:
r �1 *; $ gZq te g 23.32
a' 4 „r <. r , r , . .u. ' nr r 5 m4. '_
Environmental exhaust and ventilation:
Name:J.T.Roth Construction Inc. Range hood/other kitchen
equipment 33.39
Address:12600 SW 72"Ave. Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)639-2639 Fax:(503)624-0239 Attic/crawlspace fans 23.32
f :, '
. . ,.�.. *_ •,�. s..`t `-,t , k Other: 23.32
Fuel piping:
Business name:J.T.Roth Construction Inc. $14.15 for first four;$4.03 for each additional
Contact name:David Jensen Furnace,etc.
Gas heat pump
Address:12600 SW 72°d Ave. Wall/suspended/unit heater
City/State/ZIP:Tigard,OR 97223 Water heater
Phone:(503)806-0602 Fax::(503)624-0239 Fireplace
Range
E-mail:davidj@jtrothinc.com Barbecue
rv s1 f1 r ` Clothes dryer(gas)
,tml .:: 4.0V , „ . . . , VI N , s . . F
Other:
Business name:All Time Heating Inc. t to=`-',I•''' e 1, - 4
Address:PO Box 1341 Subtotal
Ci /State/ZIP:Lake Oswego,OR 97035 Minimum permit fee($90.00)
n Plan review(25%of permit fee)
Phone:(503)208-2276 Fax:(503)208-2276 State surcharge(12%of permit fee)
CCB lic.:184575 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:
* Fee methodology set by Tri-County Building Industry Service Board
'tint name:Aaron Svobova Date:07/19/2016
040113.doc 440-4617T(I1/02/COM/WEB)
'diog�Permits�MEC_PemdtApp_
liECElectrical Permit Applica • E ED 1-0R o u F R . I S l i ON 1.1
Received Permit#:
City of Tigard Dateiv : / /i 6 Mil
-
Illq - 0 13125 SW Hall Blvd.,Tigard,ORAi 4 Plan Review
Phone: 503.718.2439 Fax: 5 , 960 Date/B : Related Permit#:
Inspection Line: 503.639.4175$ ''�_;, {'i(';1 Jr Ready Date/By: Juris: ® See Page 2 for
T 1 G A R D Internet: www hgard or gov Notified/Method: Supplemental Informatton
twat;
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 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.
t b l r t at ,: exceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 1-and 2-family dwelling 01 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
00
'4, t 'S 311 * �% ❑Emergency system. Luger separately derive
d
'' '"' '` '" ❑Addition of new motor load of system.
Job#: Job site address:15110�SW 81e5 Ave 1ooHP or more. ❑"A "E","12","1-3
❑Six or more residential units. occupancy.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. 0 Recreational vehicle parks.
0 Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name:
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Bonita Road to 81'Ave.
x ' Iga .,
Description I Qty. [ Each I Total
New residential single-or multi-family dwelling unit.
Subdivision:Corbin Estates Lot#: 1 Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft.or portion (4. 33.92 1
1 i 3 zs . I' ,, , Limited energy,residential
t .� ,.,.. ;. �,. . ....�,. .. �. . 1 75.00 2
(with above sq.ft.)
Construction of new single family residence
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy
0 See Page 2
►4 * . y ., F ., . erri . ";.:. a:>Y - W . , Services or feeders installation,alteration,and/or relocation
Name:J.T.Roth Construction Inc. 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:12600 SW 72"Ave.
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:(503)639-2639 Fax:(503)624-0239 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
t ap t F a t,
Branch circuits—new,alteration,or extension, er panel
�.,�a �.. ��` .b„. ,�.� .� .. �w�,,.,e. ., �;.� ,t � .. �,„ ,.,. � A.Fee for branch circuits with
Business name:J.T.Roth Construction Inc. above service or feeder fee, 7 42 2
each branch circuit
Contact name:David Jensen B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:12600 SW 72nd Ave. branch circuit
City/State/ZIP:Tigard,OR 97223 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)806-0602 Fax::(503)624-0239 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:davidj@jtrothinc.com Reconnect only 67.84 2
a t, i . ,Z- M „ . . ..WRr .t'. t "" 4 , .� � Pump or irrigation circle 67.84
2
Business name:Dreamhouse Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See page 2 2
Address:13075 SW Canyon Road panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Beaverton,OR 97005 Additional inspection(1 hr min) 66.25/hr
Phone:(503)648-5144 Fax:(503)648-9723 Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
dreamhouseelectric@gmail.com
Inspections for which no fee is 90.00/hr
CCB Lic.: 196726 Electrical Lic.: C-848 Suprv.Lic.:L Q S s ificall listed V2 hr min
("Suprv.Electrician signature,required: Subtotal:
Print name: Chris Mahoney Date: 07/19/2016 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
1-?/ -- --..-. TOTAL PERMIT FEE:
Authorized signature: ...„.._______,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building�Permits�ELC_PemitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
.Plumbing Permit Application
Building Fixtures OR cirri( 1. l sr ONl.1
City of Tigard ECEIVIAll
ReceivedDateBy: Permit No.:H5raoi/:),_VC
3C
U 13125 SW Hall Blvd.,Tigard,OR 972 plan Review
I Phone: 501718.2439 Fax: 503.598.1960Other Permit No.:
I I G A�t t Inspection Line: 503.639.4175 AU Ei 4 2016 Date/By:
Date Ready/By: Juris: fli See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
1 J i
®New construction OwreitFor special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
�® I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 1 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
.,4 I ll A W6!- Site utilities:
Job site address:15110 SW 81's Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
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:Bonita Road to SW 81"Ave 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:Corbin Estates I Lot no.:1 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
h,geeiCP � L t Y K
Clothes washer 25.02
Plumbing of new single family residence Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
` �NRrVAA Expansion tank 12.51
Name:J.T.Roth Construction Inc. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:12600 SW 72nd Ave.
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)639-2639 Fax:(503)624-0239 Ice maker 12.51
Interceptor/grease trap 25.02
Business name:J.T.Roth Construction Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:David Jensen
Roof drain(commercial) 12.51
Address:12600 SW 72nd Ave Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)806-0602 Fax::(503)624-0239 Tub/shower/shower pan 12.51
E-mail:davidj@jtrothinc.com Urinal 25.02
e
Water closet 25.02
boa ttf37.52
� ��. . -... ......� �. w .� a,� �. ..n . ..�. Water heater
Business name:ALL Plumbing LLC Water piping/DWV 56.29
Address:9312 NW Skyline Blvd. Other: 25.02
City/State/ZIP:Portland,OR 97231 Subtotal
Phone:(503)520-0313 Fax:(503)469-1470 Minimum permit fee: $72.50
CCB Lic.:194089 Plumbing Lic.no.:PB-1022 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: 4,''� - TOTAL PERMIT FEE
Print name:Aaron Luchs Date:07/19/2016 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:\Building\Permits\PLMU-PermitApp-doc 10/01/09 440-4616T(10/02/COM/WEB) A
71 City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
■
T I G A R D Building Permit Review — Residential
Building Permit #: M h i /(, -co 3/9
Site Address: 1,5 RD SV\1 t&ts-A- i\ve
Project Name: Cor 9 j vi e-{ +Cs Lot #: 1
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: CVV Pe-
XVerify site address/suite# exists and active in permit system.
River Terrace Neighborhood: Igi, No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
XI hree(3) copies of site plan A Existing structures on site
-Site plan must be on 8-1/2"x 11"or 11 x 17"paper .00tprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
.North arrow ,Utility locations(required for new,may apply for additions)
351: ite address,project or subdivision name and lot number \Location of wells/septic systems
)Si'Applicant information(name and phone number) kEExisting trees to be retained with drip line,and tree
.jtot dimensions and building setback dimensions protection measures
tEtLot area,building coverage area,percentage of coverage and Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) ,Street names
N.Property corner elevations(2 foot contour lines if more than
4 foot differential)
A' Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified )6 No Applied For: ❑ Yes ❑ No,stop intake
S Land Use Case#: 5ik D7,01 y_0000 / /q..67--c=20/6,_ OCAR
...1?-"/Zoning: R Li •5
V Setbacks: 15 Front Rear I Side S Street Side pp, Garage 2,D
-NI Landscape Requirement: nct "/o
Lot Coverage Maximum: A 9L %
,Building Height: Maximum Height Actual Height $��
Visual Clearance
A Easements
Sensitive Lands: ❑ Yes -No Type
Urban Forestry Plan
yr Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: �'" _ ioi
Date: _Oil/42_
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\B1dgPermitRvw RES 06o116.docx
Building Permit Submittal /
Original Submittal Date: S 41(/
Site Plans: #
Building Plans: # 3
Building Permit#: [ 'Enter building permit#above. ��
Workflow Routing: Er Planning Engineering 1..3" Permit CoordinatorBuilding
Workflow Sign-off: Er Sign-off for Planning(include notes from planning review)
Route Application Documents: El Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
plan review routing form.
Er Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: tl, _/. _ Date: /(o
Engineering Review
Slope at building pad:
et000riginal
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: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: LI Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: ___Wi DDate: 9�
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
`f.DC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
OK to Issuev Tax:
pproved by Permit Coordinator: dlig-----Date:
I:\Building\Forms\BldgPermitRvw_RES_060116.docx
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
15110 SW 81 ST AVE, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
PASS -CofO
Comments:
Final erosion control passed
Street tree certificate received
Moisture content form received
High efficiency lighting form received
Insulation certification verified
Blower door or duct seal test certificate received
Violation Summary:
Tel: 503.718.2439
Inspection Date:
March 1, 2017 at 8:58:01 AM
Record ID:
MST2016-00314
Inspector:
Aaron Cillo-Gobel
Inspector Contractor