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Permit (53)
lAil TIGARD July 26, 2017 City of Tigard Gary Sinise Foundation Attn: Kim Payne PO Box 50008 Studio City, CA 91614-5001 Re:Permit No. MST2016-00504 Dear Applicant: The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 8961 SW Inez St. Project Name: Greensward South,Lot 13 Job No.: N/A Refund: ® Check#225398 in the amount of$23,674.53. ❑ Credit card"return"receipt in the amount of$ . Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. 0 Trust account"deposit"receipt in the amount of$ . Comments: Refund permit and system development fees associated with the construction of a single-family residence that were waived by City Council Resolution No. 17-16 (see attached). If you have any questions please contact me at 503.718.2430. Sincerely, / 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 CITY OF TIGARD RECEIPT III it II. 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIC ARD Project Name: Greensward South, Lot 13 ,\ Site Address: 8961 SW INEZ ST A6w Receipt Number: 415900 - 03/02/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00504 $-11,115.53 Total: $-11,115.53 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 225398 DHOWSE 03/02/2018 $-11,115.53 Payor: Gary Sinise Foundation Total Payments: $-11,115.53 Balance Due: $11,865.53 Page 1 of 1 CITY OF TIGARD 11111 RECEIPT . • 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD ©#/(rig✓/L__ I Receipt Number: 408407 - 01/23/2017 I CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00504 Building Permit-New Construction 230-0000-43104 ✓ MST2016-00504 Plan Review 230-0000-43106 v"" $2,0$1 78 E-- MST2016-00504 12%State Surcharge-Building $1.37 M5T2016-00504 g 100-0000-24001 $248.37 Wash Co Trans Dev Tax-SF Detached 405-0000-43320 $8,278.00 MST2016-00504 Tigard Trans SDC Improvement-SF 415-0000-43300 ri Detached $5,488.00 -- MST2016-00504 Tigard Trans SDC Reimbursement-SF 415-0000-43301 Detached $317.00 MST2016-00504 Parks SDC Improvement-SF Dwelling 425-0000-43300 (detached/attached) $4,356.00 MST2016-00504 Parks SDC Reimbursement-SF 425-0000-43301 Dwelling(detached/attached) $1,207.00 MST2016-00504 Parks SDC Neighborhood-SF Dwelling 425-0000-43300 ✓ (detached/attached) $1,615.00 MST2016-00504 DC Provision Review,SF-Ping 100-0000-43112 ✓ $ .00MST2016-00504 Info Process/Archiving'Lg$2.00(over 230-0000-43135 $34.00 11x17) MST2016-00504 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 11x17) $50.00 MST2016-00504 Metro Const. Excise Tax 230-0000-24010 MST2016-00504 Tig-Tual School CET-Residential $54 MST2016-00504 Permit Fee-Elect(per dwellingunit) 2 MST2016-00504 0-0000-43103 $3,552.00. 220-0000-43103 ,✓ $372.06 •�"" Limited Energy 220-0000-43103 ✓ $75.00 <---- MST2016-00504 12%State Surcharge-Electrical 100-0000-24001 $53.65 MST2016-00504 Furnaces< 100K BTU 230-0000-43102 v $46.75 .<--- MST2016-00504 Water Heater 230-0000-43102 ,� MST2016-00504 Gas Fireplace $23.32 <—.. 230-0000-43102 MST2016-00504 t/ $33.39 �-- Range Hood/Other Kitchen 230-0000-43102 .-- $33.39 4-- MST2016-00504 Clothes Dryer Exhaust 230-0000-43102 MST2016-00504 Single Duct Exhaust(Bathrooms,Toilet, ,i $116✓ 116.60.60 H— <— 230-0000-43102 Utility Rooms) MST2016-00504 Fuel Piping 230-0000-43102 MST2016-00504 12%State Surcharge-Mechanical ✓ $36.12 �- 100 MST2016-00504 -0000-24001 $36.12 SFR-Baths 230-0000-43101 ✓ $500.32 E MST2016-00504 Laundry Tray MST2016-00504 0 230-0000-43101 r.'" $25.02 �--- 12/o State Surcharge-Plumbing 100-0000-24001 $63.04 MST2016-00504 Erosion Control w/Development 100-0000-43134 MST2016-00504 Plan Review 230-0000-43106 ✓ $39 ��r 4�2 $594.02.00 (-- Total: $30,159.09 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 06279D DADAMSKI 01/23/2017 Payor: David DeHarpport-Four D Construction $30,159.09 Total Payments: $30,159.09 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD RECEIPT n 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Greensward South, Lot 13 Site Address: 8961 SW INEZ ST Receipt Number: 415898 - 03/02/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00504 $-750.00 Total: $-750.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 225398 DHOWSE 03/02/2018 $-750.00 Payor: Gary Sinise Foundation Total Payments: $-750.00 Balance Due: $750.00 Page 1 of 1 CITY OF TIGARD14 RECEIPT S • 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD ff//171—t— Receipt Number: 407664 - 11/28/2016 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00504 Plan Review 230-0000-43106 $750.00 Total: $750.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 049930 DADAMSKI 11/28/2016 $750.00 Payor: David DeHarpport-Four D Construction Total Payments: $750.00 Balance Due: $0.00 Page 1 of 1 I 1 lig N 'I City Tigard of Ti and TI GARD 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 forPow?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: Gaty Sinise Foundation DATE: 7/6/2017 Attn: Kim Payne PO Box 50008 REQUESTED BY: Dianna Howse Studio City, CA 91614-5001 MAV TRANSACTION INFORMATION: cei & 08C #: MST20 DReate:pt#: 11/28/24076640164 &407 1/23/2017 Addaseress/Parcel: 8961 SW 016In0ez504 St Pay Method: CreditCard Project Name: Greensward South,Lot 13 EXPLANATION: Refund of permit and system development fees waived by City of Tigard for house built by Gary Sinise Foundation 144 0:IPJ© s'A �0 41Ti' i i ii'• 'r�, as c ;`- , .7.; a� �'Y�. �v 2. � ��. _ _��a�°-� a: ,.s�'=mss -r_ s a� *�r'�T��y�"�� �c,""'r' � z_2_,..;,,„4-,,,,,,4%,,-;)-} , ,-prf 5.. �s 7„ ��s� FFA 1 , � r'� '.7-',-;;;;;.;.1'.',1:;t7.01.��G+ '"c5t'y �F e i i s e E� ' � � +'k '" Building Permit Fee 230-0000-43104 $2,069.78 Plan Review 230-0000-43106 1,329.36 Mechanical Permit Fee 230-0000-43102 300.99 Electrical Permit Fee 220-0000-43103 447.06 Plumbing Permit Fee 230-0000-43101 525.34 DC Provision Review 100-0000-43112 90.00 Tigard Transportation SDC Improvement 415-0000-43300 5,488.00 Parks SDC Neighborhood 425-0000-43300 1,615.00 Water Meter SDC(charge) 531-0000-43301 do, 5,171.00 Water Meter SDF(fund) 531-0000-43300 74,Pars 1 6,231.00 4rz t7 5-30-good- V5,0y s". to TOTAL REFUND: $23,674.53 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager 47:°""*...--2 If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board ,:;:3.;,_::',•4-.!-1- 0L/:4:030M,TOYGM ��+ ���1�V����`.®��� k $ ri�+xS�� ,�*F� Case Refund Processed: I Date:l 2//Y I rx By:. �._> ° I I:\Building\Refunds\RefundRequest.doc x 09/0]/20]0 CITY OF TIGARD, OREGON TIGARD CITY COUNCIL RESOLUTION NO. 17- 16 ;\. RESOLUTION WAIVING CITY OF TIGARD FEES S AND CI IARGES, INCLUDING SYSTEM DEVELOPMENT i C;I-I \RGES . ','O( IA'CI D \k I'I'11 BUILDING \ NL\\ SINGI,1:?-F:\MII:Y I IOME BY THE GARY SINIS1i ON_PROFI'1 FOI'NDATION FOR A LOCAL DISABLED VETI RAN.cc-4 6-'41,U_Ok cif e \V"I ILREAS,Tigard Municipal Code 3.32.1)70 authorized City Council to waive tees for nonprofits when the request is made in writing and council determines that the community benefit outweighs the financial burden to the city:and 'WHEREAS, The Gary Sinise Foundation has requested in writing the waiver of fees associated with building a new single-family home;and WHEREAS,the Master Hees and Charges Schedule states that the City of'Tigard tees associated with building the proposed new single family home are as follows: Permit/Plan Review fees S 4,672.53 Tigard transportation SDC; S 5,488.00 Tigard parks SDC S 1,615.00 Planning DC. review S 90.00 Water SDC and meter fee $11,809.00 Total $23,674.53;and WHEREAS, council determines that the community benefit outweighs the $23,674.53 financial burden to the city. NOW,Tilt RETC)RI;,BE IT RIiSOINFl) by the Tigard City Council that: SECTION 1: The Gary Sinise Foundation receives a waiver of$23,674.53 in permit and system development charges. SECTION 2: This resolution is effective immediately upon passage. L. i!,\PASSED: This_ / day of / '�t I 2017. ,. ,J . /14 ;May( -City of Tigard ATI'EST: * . . /iL Kelly Burgoyne, Deputy City Recorder I iSOL[ 'IiON NO. 17- IL, Page 1 CITY OF TIGARD FEE AND PAYMENT HISTORY i 1 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TiT,�11.i� � � i . MST2016-00504 - 8961 SW INEZ ST, TIGARD, OR 97224 I Revenue Fee Description Payment Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Building Permit-New Construction 230-0000-43104 ''"-- $2,069.78 ✓ $2,069.78 $2,069.78 1/23/17 Credit Card 408407 $0.00 Plan Review 230-0000-43106 V $751.34 D2! V $751.34 $750.00 11/28/16 Credit Card 407664 I $0.00 $1.34 1/23/17 Credit Card 408407 Plan Review 230-0000-43106 $751.34 $751.34 $750.00 11/28/16 Credit Card 407664 $0.00 $1.34 1/23/17 Credit Card 408407 12%State Surcharge-Building 100-0000-24001 $248.37 $248.37 $248.37 1/23/17 Credit Card 408407 $0.00 Wash Co Trans Dev Tax-SF Detached 405-0000-43320 $8,278.00 $8,278.00 $8,278.00 1/23/17 Credit Card 408407 $0.00 Tigard Trans SDC Improvement-SF 415-0000-43300 /' $5,488.00 ✓ $5,488.00 Detached $5,488.00 1/23/17 Credit Card 408407 $0.00 Tigard Trans SDC Reimbursement-SF 415-0000-43301 $317.00 $317.00 Detached $317.00 1/23/17 Credit Card 408407 $0.00 Parks SDC Improvement-SF Dwelling 425-0000-43300 $4,356.00 $4,356.00 (detached/attached) $4,356.00 1/23/17 Credit Card 408407 $0.00 Parks SDC Reimbursement-SF 425-0000-43301 $1,207.00 $1,207.00 $1,207.00 1/23/17 Credit Card 408407 Dwelling(detached/attached) $0.00 Parks SDC Neighborhood-SF Dwelling 425-0000-43300 ✓ $1,615.00 t, '- $1,615.00 (detached/attached) $1,615.00 1/23/17 Credit Card 408407 $0.00 DC Provision Review, SF-Ping 100-0000-43112 ✓ $90.00 ✓ $90.00 $90.00 1/23/17 Credit Card 408407 $0.00 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $34.00 $34.00 11x17) $34.00 1/23/17 Credit Card 408407 $0.00 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $50.00 $50.00 11x17) $50.00 1/23/17 Credit Card 408407 $0.00 Metro Const. Excise Tax 230-0000-24010 $445.98 $445.98 $445.98 1/23/17 Credit Card 408407 $0.00 Tig-Tual School CET-Residential 230-0000-24102 $3,552.00 $3,552.00 $3,552.00 1/23/17 Credit Card 408407 $0.00 Permit Fee-Elect(per dwelling unit) 220-0000-43103 V $372.06 � Limited Energy � u $372.06 $372.06 1/23/17 Credit Card 408407 $0.00 220-0000-43103 ✓ $75.00 E " $75.00 $75.00 1/23/17 Credit Card 408407 $0.00 12%State Surcharge-Electrical 100-0000-24001 $53.65 $53.65 $53.65 1/23/17 Credit Card 408407 $0.00 Furnaces< 100K BTU 230-0000-43102 i%. $46.75 /V / $46.75 $46.75 1/23/17 Credit Card 408407 $0.00 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Water Heater 230-0000-.43102 $23.32 PI ✓ $23.32 $23.32 1/23/17 Credit Card 408407 $0.00 Gas Fireplace 230-0000-43102 $33.39 I $33.39 $33.39 1/23/17 Credit Card 408407 $0.00 Range Hood/Other Kitchen 230-0000-43102 $33.39 PI • $33.39 $33.39 1/23/17 Credit Card 408407 $0.00 Clothes Dryer Exhaust 230-0000-43102 $33.39 /1 / $33.39 $33.39 1/23/17 Credit Card 408407 $0.00 Single Duct Exhaust(Bathrooms, Toilet, 230-0000-43102 $116.60 /"1 ;/ $116.60 $116.60 1/23/17 Credit Card 408407 Utility Rooms) $0.00 Fuel Piping 230-0000-43102 $14.15 11 ./ $14.15 $14.15 1/23/17 Credit Card 408407 $0.00 12%State Surcharge-Mechanical 100-0000-24001 $36.12 $36.12 $36.12 1/23/17 Credit Card 408407 $0.00 SFR-Baths 230-0000-43101 $500.32 P/ $500.32 $500.32 1/23/17 Credit Card 408407 Laund Tra $0.00 ry y 230-0000-43101 $25.02 P / $25.02 $25.02 1/23/17 Credit Card 408407 $0.00 12%State Surcharge-Plumbing 100-0000-24001 $63.04 $63.04 $63.04 1/23/17 Credit Card 408407 $0.00 Erosion Control w/Development 100-0000-43134 z$386.40 $386.40 $386.40 1/23/17 Credit Card 408407 $0.00 Plan Review 230-0000-43106 •gi:.(L' $594.02 $594.02 $594.02 1/23/17 Credit Card 408407 $0.00 Totals for Fees $31,660.43 $31,660.43 $30,909.09 $751.34 ')-7%i , Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 407664 Credit Card David DeHarpport- 11/28/2016 $750.00 Four D Construction 408407 Credit Card David DeHarpport- 01/23/2017 $30,159.09 Four D Construction Total Payments: $30,909.09 Balance Due: $0.00 rice f9-7✓/ eel& c .30 e , e F ✓ gzce;�z-/r.9-e- = Vr?, Clv ,--- "444.016,,,v6.-- _ �`,2 34/ t- - /494-9L-A1 //494.9AJ , Z//6&) - /3;29 , 3 CITY OF TIGARD MASTER PERMIT !F' COMMUNITY DEVELOPMENT Permit#: MST2016 00504 spm ► Date Issued: 01/23/2017 T(G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ;.� s.� ,, Parcel: 2S111AA11900 1111 Site address: 8961 SW INEZ ST ff 7 \ Jurisdiction: Tigard Subdivision: GREENSWARD SOUTH Lot: 13 Project: Greensward South, Lot 13 Project Description: New SF. 8/1/17: REPRINTED permit to include NC unit. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 1902 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 1058 sf Garage: 789 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2960 sf Value: $371,647.95 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 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: 6 201-400 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 2960 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: 503-720-7445 PHONE: 503-720-7445 FAX: 503-590-1751 Total Fees: $30,961.45 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. hose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a cop of th ules or direct questions to OUNC by calling 503.232 7 r 00.332.2344. Issued By: ��Lf� C Permittee Signature: / \ ._....... . ) . 39.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Applicatit - k ,. rt)K OI Flcl. l SI:t)\l l 11 q City of Tigard Received u Date/By: /( a-g//62 04 Permit No.:l lt,,,e,(L''(56.5—b� / 13125 SW Hall Blvd.,Tigard,OR 97223 NI .1 V 2 8 2 G if; Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: 11.,A 1,t Inspection Line: 503.639.4175 t R J t ,' 1., l e Ready/By: Juria: 0 See Page 2 for Internet: www.tigard-or.gov t Notified/Method: Supplemental information )*11l) ,I'g'VI et TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST New constructionMechanical permit fees*are based onthe value of the work 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all • 0 Demolition 0 Other: .!a j, A mechanical materials,equipment,labor,overhead,and profit Value:$ CATEGORY OF CONSTRUCTION �r iii 17 SJ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* X1-and 2-family dwelling 0 Commercial/industrial 0 .ut .mg For special information use checklist. ❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning / 46.75 i ,7 Sr Job site address: s 1 St w ,Z- &Z-.- �' Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: r-)OP.ILO 0'g- u '7 2-2-L/ Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or /4-A L-I-. Q LV b (Aze.Ems c,.,A ZrD Ljt,/ — q'a r-i4 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: 63R t E/V5/4.5tri_q -r-1-4- Lot no.: /3 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 2332 N& A. Si62L-E: Prt Mi L FES D ii x)(,,,1;,;� Log (gas)o23.32 j � Woodd/p/pellell et stove 33.39 11/17 ; (.40 e✓ tt,sA7 Wood fireplace/insert 2332 Chimney/liner/flue/vent 23.32 PROPERTY OWNER 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: 5 'KC pS 8 i OW Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 2332 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name: FOL .. .C) C(i 03 ST U.-N C Ai $14.15 for first four;$4.03 for each additional Contact name: I)Av-/ P 1)E W p}.i2-p PGra.r Furnace,etc. Gas heat pump Address: P. � ` ca��}� � � 7 � WalUsuspended/unit heater City/State/ZIP: 13E-, V e-g_tt,io ) 9.7 0 7 s Water heater Filace Phone:(j 03) -7�a "7�y Y 5 Fax::(503 $ ?C .. i"TS I Range Fait 12-0CoN ST- abe E-mail: c'' .C�,/1,S/�, COLQ N1 Barbecue CONTRACTOR Clothes dryer(gas) Business name: Other: e-/ L 1-19_ 1ik7 (-- MECHANICAL PERMIT FEES* Address: P.o, Box 933 Subtotal City/State/ZIP: . C7 C 1-AM J CsCZ. 7 0 1 S Minimum permit fee($90.00) 1Plan review(25%of permit fee) Phone:(503) 6,5 4,- / 20.8/ I Fax:()3) 46-0-3 89i/ State surcharge(12%of permit fee) CCB lie.: / 76 2- 7 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: //`� * Fe, -- ee methodology set by Tri-County Building Industry Service Board Print name: U7 ' -, Date: /7- • I:1Building\Penniu1MEC PermitApp 040113.doe 440-4617T(I1/02/COM/WEB) i CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2016-00504 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2017 TIC"�[GAR I) 9 Parcel: 2S111AA11900 Jurisdiction: Tigard Site address: 8961 SW INEZ ST Subdivision: GREENSWARD SOUTH Lot: 13 Project: Greensward South, Lot 13 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 1902 sf Basement: 0 sf Left 5 Parking Spaces: 0 Height 26 Bathrooms: 3 Second: 1058 sf Garage: 789 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2960 sf Value: $371,647.95 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: 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 add9 500 sf: 6 201-400 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: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2960 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: 503-720-7445 PHONE: 503-720-7445 FAX: 503-590-1751 Total Fees: $30,909.09 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 d•• ' •_• - 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 •- s. ATTENTION: Ore.•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR •52-001-0010 thf6ugh OAR• •01 01°•. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 . 987 1.800. 2.2 4. sued By: - _/ ' ' 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. '• Buird. int Permit Applicat �' `I" ' . ' Residential FOR 011 1( F l Sl; ONl-1 City of Tigard ND V 2 8 2016 Received � �/,� permit No.: 13125 SW Hall Blvd.,Tigard,OR-,;97743 Date/By: It 9 16 'lJ�"J 1'{St�pt0(�p-G `j?J IN g ;.` 3 r r PlanReview Phone: 503.7182439 Fax: 50i59&1966.;t w t ) Date/By: lv� J L/ Other Permit: ie�(6,,.toCf�1 1 I \k t, Inspection Line: 503.639.417;f i i r^ ., Date Ready y: .runs: H See Page 2 for Internet: www.tigard-or.gov ..f - .,- + -= i 1 . Notified/Method:/02/,94, Supplemental Information 41/4-/-7/7- - . ,9 ',6 TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 'New construction 0 Demolition Permit fees*are based on the value of the work performed. ❑Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. u Valuation: $3 1 (A T 1 Esti I-and 2-family dwelling 0 Commercial/industrial Y' 8 y l ❑AccessoryNumber of bedrooms: building 0 Multi-family ❑Master builder 0 Other: Number of bathrooms: ..-24-1.50.2 JOB SITE INFORMATION AND LOCATION Total number of floors: -2,....- 3 7 4 9 Job site address: 8 9 ) .5, vv 'N iaz-_ New dwelling area: 2.96° square feet City/State/ZIP: -7-1(,ry Av-j) ® (z, 9 7 Z2-7 Garage/carport area: '73 7 square feet Suite/bldg./apt.no.: Project name: 7 govered porch area square feet j C r Cross street/directions to job site: Deck area: square feet )9© 2 1'F i U.- 13 LVD - £n L G-enatL 4YU-) N1 - 9 f0 D / - P Other r structure area: Co..—. square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 6 g E1v 5 c Irl.RD :y..{-7-1 _ Lot no.: 13 Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(romded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: S /4//6 6-,A/6 4-6- 1=p M it./ I 65,'DeNCc Existing building area square feet New building area: square feet ,PROPERTY OWNER 0 TENANT Number of stories: Name: Type of construction: Address: ‘5140141 6 AS R67Lr)ec/ Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (PleasBusiness name: Fou IA, D Cd M.5 rizu CrIa t� review fee ( rder to eeosit): Structural plan fee(or deposit): Contact name: D py 1 S'} D G 14 lz-P P }Zi- FLS plan review fee(if applicable): Address: °F.C• Box i S 7 7 City/State/ZIP: BEA ye-..�f1/43 '� 7 b 7 Total fees due upon application: Phone:('o: ) 7,-,/,a ...'7 9,y s Fax:: 5'90 -_ 175 Amount received: 75-0•ad E-mail: OTOVOLTAIC SOLAR PANEL SYSTEM FEES* r'� G b d�S T' Eyi �% ` COLl� Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: Submit tw. 2)sets of roof plan with connection details Address: f3 z lt3 LT and fire dep. is • t access,along with the 2010 Ore Solar Installation 'ally Code checklist. ,,,��,i�/i� ti City/State/ZIP: tx'" Permit Fee(inclu. ew $180.00 . a.ministra, ,- fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee: $21.60 CCB lic.: 7 Total fee due upon application: $201.60 Authorized signature: e/....2../ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: .3 A y),D -_/'0 e 1)141-2, Po --Date: //—Z�f -/6. Fee methodology set by Tri County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) , Electrical Permit Annlicatiam, 1,--T-7,4'4 T'17 IR I 1 '',1 I)\1 1 , t=...,..itf,,,1.-,rt . -0 -r Received City of Tigard Date/By: it/ag/it G Permit#: He-,r-g-o/to-005-651 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 11111-II Phone: 503.718.2439 Fax: 503.59811M/ 2 8 ;2016 Date/By: Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Juno WI See Page 2 for \Pi) Internet: www.tigard-or.gov - ' t .1 e f; R l'i Notified/Method: Supplemental Information ili' / t. 'i;. I 1,,..-:s.i....i TYPE gl'-.1Y9RK,,,, g^L,-,'r;f 1 rkj PLAN REVIEW KNew construction 0 Addition/altetrado'it*Ike(itiefit'‘`-'I' 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 cwrent 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. pit 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 13 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: 8 9 6 i 5, W _Z-"/E Z._ 100HP or more. 0"A","E","1-2","1-3", City/State/ZIP: 1-7 6,AP-0 012. 9"'? 12V 0 Six or more residential units. 0 Health-care facilities. 0 occupancy. Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than 13 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I s E-1141.1- 17)e..V D - Cc>RE EWS'Li A V2-0 i...A1 - 7'/4 New residential single-or multi-family dwelling unit. Subdivision: C. g. /$w Pr Ito Sou hi- Lot#: /3 Includes attached garage. 1,000 sq.ft.or less 1 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion G 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 NeiA5 Si iV b i-& 1---=-J A t 0 i Ly P E.5 i DeiNCe- Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy , 0 See Page 2 lif PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less' 100.70 2 201 amps to 400 amps 133.56 2 Address: LS MA6 A-S BEL-01,J 401 amps to 600 amps 200.34 2 City/State/ZIP: 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 Branch circuits-new,alteration,or extension,per panel af,APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with Business name: Foci V... 1) co x./.57-/zu cr-to kJ above service or feeder fee, 7.42 2 each branch circuit Contact name: )pv I 0 D c.-74-HA larrot2a- B.Fee for branch circuits without service or feeder fee,first Address: f2,0. Box is-77 branch circuit 56.18 2 Each addl branch circuit 7.42 2 City/State/ZIP: „Be Ave,?....-rok) c)F.- 9 70-7 s Miscellaneous(service or feeder not included) Phone:6-63) -2,2 0-?(iv s Fax: :(610 ),590 .4 7s / Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: 'FOLI 12, D c_oiLIST-G.,-..1) MS itL). Cot-A Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: -2_ te- c-ri24c.. 6 pea p Sign or outline lighting 67.84 2 I 0,.. Signal circuit(s)or limited-energy See Page 2 2 Address: /50 At k , -,;.4,VL) O,& ''6 lb Y panel,alteration,or extension. Each additional inspection over allowable in any of the above City/State/Z1P: pov:z I 140,/c) ,e)iZ. 9.'72.Z.0 Additional inspection(1 hr min) 66.25!hr , ,„ Phone:(503) 1,77 - i -Lbw, Fax:(53 ) Ct i - 7y ,/' Investigation 0 hi'min) 66.25/lir Industrial plant(1 hr min) 78.18/hr Email: •.e.-6.-.7-&-"4:--,-46.-c-ritic.-6goap c 6 mF11,- I ez AA Inspections for which no fee is 90.00/hr CCE Lic.:i ep Z7V Electrical Lie.:C ,3C/ Suprv.Lic.:576?"7 S specifically listed(Vs hr min) ti ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: 0, , /CP Wi Subtotal: Print name: k a g e124-o /4_A 0 67-ivatv 1 z_Date:iy-Zi-/C ID Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signatureAae, ---- TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name:DAL;ID ..3: Do 14741241,- ›Oic4-- Date: ///-zgi-j& days after it baa been accepted as complete. ' Number of inspections allowed per permit. IMuildingTerniits\ELC PermitApp_ELR ERE.doe Rev 04/21/2014 440-46151(11/051CONEWEB 1 Mechanical Permit Applicati 1 ',..� 1,0R OFFlCL USE 0y1.1 City of Tigard Date/By: /( a-g//(o 04 Permit No.:)-(y rge,/6-66564/ 13125 SW Hall Blvd.,Tigard,OR 97223 I(1 1 v • Phone: 503.718.2439 Fax: 503.598.1960 '`' Received ,/ Plan Review Date/By: Other Permit: E 1 c 4 1.R D Inspection Line: 503.639.4175 .. .t a,-, , I.y Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov t . t ,.... t i=. Notified/Method: Supplemental Information aIi '., tt Y TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based onthe value of the work tirNew construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* pI-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 46.75 Job site address: tg, k,t �i w ,r/\&Z---_ Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 1-1("Pc12-0 0 9 72-z-t2/ Furnace 100,000+BTU(ducts/vents) 54.91 0 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or /4-A L-L B L-V ) - &Re.ENSty\f2.lD L/, - 9'n r14 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: (_3R (E Nisi,`.)A]Z r) .1-1 - Lot no.: /3 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 fireplace 23.32 Log lighter(gas) 23.32 N&L 0 $ /1.-)6 l.-( PPM 1 Ly F es) D ii JI.J LA=7 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 a PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: 5 Pr KC ) X311~L OCJ 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 tit APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name: fu. '. i) Ce.)13srjeticerick i $14.15 for first four;$4.03 for each additional Contact name: T)AV/ cP t)e J4442-PPbt2-r Furnace,etc. Gas heat pump Address: 19, 6 , t by IS-7-7 Wall/suspended/unit heater City/State/ZIP: 13E AV e(21--01 ,::), , 9 07 0 7 S Water heater Phone:(5 3) 7). 0 .- "7 y Li s Fax::(503 5 70 .. 17S i Fireplace Range E-mail: Pau.$2-0 CO JO SIT u 14/1,. /01 CO Ail Barbecue CONTRACTOR Clothes dryer(gas) �.+ Other: Business name: G-.e L. A j r-0.), ._ MECHANICAL PERMIT FEES* Address: o, X (/33 Subtotal ___ Minimum permit fee($90.00) City/State/ZIP: L Q C.1.A M /c`y l Plan review(25%of permit fee) Phone:(5,3) 6,- 5 ra y' 1 Cd E" Fax:(.. ,)°3 650.-3 S 9c3 State surcharge(12%of permit fee) CCB lie.: /76 ..,--2, (J/ 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: er4-- * Fee methodology set by Tri-County Building Industry Service Board Print name: e,,, Date: 11- l:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1 I/02/COM/WEB) Plumbing Permit Application - v L Building Fixtures City of Tigard`J ll - Q, Permit No.: p � 13125 SW Hall Blvd.,Tigard,OR 97223 NOV��U 2 ?(��� Dewy' It(/'� � _�� ` "� D Z ��G(��`�� • Phone: 503.718.2439 Fax: 503.598.1960; ,, Plan Review 4 a � '� " `� `� Other Permit No.: Inspection Line: 503.639.4175 i- ) a eRy, ate Ready/BY: f I c r\!Z p Internetge 2 for www.tigard-or.gov 1aa��� (1 r �`f 5 PITI `r�.Y�z�.y11ed/Method: �a�c Supplemental mental Information xf'. � Jr IN tia�r� I Y'A�?'i.�Yf TYPE OF WORK FEE* SCHEDULE IN New construction 0 Demolition For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler C___sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: "� Catch basin or area drain 18.76 Job site address: 59ev/ 5, v j).. &z Drywell,leach line,or trench drain 18.76 City/State/ZIP: i &p 12,D c R. 9 7 2..z.4/ Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 14 i LZ B`vim - CviZ GNS ev A rub Z,114 - 90 ri- Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear 1L: ) Page 2 Subdivision: dig E4'�/V'a4, /}L D SOL/ ' Lot no.: /3 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 iti/ �i 3,iv 6 4 6 .'F}M I Ly R E5 ii)Eb'c L Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: SA WE S 13 E L.OW Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: roam D co A457--g L1 cr/CI n'$ Primer 12,51 Contact name: 0 AV//0 D -&-4 .RP Pox-T- Roof drain(commercial) 12.51 Address: P. 0. 3x / 5 '-7 7 Sinklbasin/lavatory 25.02 City/State/ZIP: B v 1Z7'O IU e) R 9-7 p ).S Solar units(potable water) 62.54 Phone:j5ul3 ) 7 0 '7 9 y5 Fax::(5-03),596.•i 7„s / Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: f=d U l=- D Cts Al5 l e., Ms Aii. 6 Clel Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: 't"ii G M t4 C C t 1 J ( OM f 1A�. , Water piping/DWV 56.29 Address: /66/14 5,C. ;121V67.12 g4V Other: 25.02 City/State/ZIP: f c.e,,,..5-.&40 Z:)��.-. J'7/23 Subtotal Phone:(s°J) 6 ya_ 6i/3 I Fax:( ) Minimum permit fee: $72.50 CCB Lic.: /.2 6Plumbing Lic.no.: V-26 O f�jj Plan review (25%1of permit fee) State surcharge(I 2%%of permit fee) Authorized signature: ,4... TOTAL PERMIT FEE Print name ^'7�) / Date f l - /i,, This permit application expires if a permit is not obtained within 110 days PA I//0 47 �� �o IZtr 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) City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT 114 TIGARD Building Permit Review — Residential Building Permit #: H 5y 90 I Co- CO 5O q Site Address: p)q(0f c(,,s ,tee Project Name: (-)re eels (7,ed S 0� - Lot #: 13 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N to i.v c -c4-cA . SF✓t-- Verify site address/suite# exists and active in permit system. k--River Terrace Neighborhood: k'No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: ,l Three(3)copies of site plan ..Existing structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper [Footprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations ®North arrow 1X1ttility locations(required for new,may apply for additions) Site address,project or subdivision name and lot numberocation of wells/septic systems Ir-Applicant information(name and phone number) Existing trees to be retained with drip line,and tree tot dimensions and building setback dimensions protection measures of area,building coverage area,percentage of coverage and g'Street tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) 11-Street names Property corner elevations (2 foot contour lines if more than 4 foot differential) V"--Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ,IAINo Received: ❑ Yes ❑ No `Public Facilities Improvement(PFI) Permit: Required: Yes,applicant was notified ❑ No Applied For: JR—Yes ❑ No,stop intake k Land Use Case#: S U 6d01,4 — U t 10 Zoning: AZ-Li . 5 Required Setbacks: Front v Rear ( 5 Side 5 Street Side Garage ,?(D .Landscape Requirement: % Lot Coverage Maximum: 0/0 ..P-Building Height: Maximum Height a) Actual Height �" „Ci—Visual Clearance I"Easements iRt" Sensitive Lands: ❑ Yes ,a1 No Type ,Urban Forestry Plan C1 Conditions "Met”prior to issuance of building permit Notes: Approved By Planning: 040 Date: I -,)_2.) (4, Revisions (after Building Submittal only Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPermitRvw REs 091216.docx Building Permit Submittal / Original Submittal Date: /1/ .81 Site Plans: # Building Plans: # Building Permit#: Eli Enter building permit#above. Workflow Routing: E"'-Planning a-Engineering [Permit Coordinator Luilding Workflow Sign-off: Er Sign-off for Planning(include notes from planning review) Route Application Documents: Er Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. ❑ Building: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: J. _ ' Date: Engineering Review : ope at building pad: p?/ �'I onditions "Met"prior to issuance of building permit It7 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 LIDA Facility on lot: ❑ Yes ZNo ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: idiA4 Date: ///MAL 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: Mk DC Fees Entered: Wash Co Trans Dev Tax: 'es ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: rYes ❑ N/A rOK to Issue Permit Approved by Permit Coordinator: Date: O//4 I:\Building\Forms\BldgPermitRvw_RES 091216.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 8961 SW INEZ ST, TIGARD, OR, 97224 July 28, 2017 at 10:20:32 AM Record Type: Record ID: Residential - Master Permit MST2016-00504 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Provide permit for AC not on permit. Remove non gfci protected sticker from dual outlet in garage on garage gfci. All else appears ok. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 8961 SW INEZ ST, TIGARD, OR, 97224 July 28, 2017 at 9:56:47 AM Record Type: Record ID: Residential - Master Permit MST2016-00504 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Seal penetration in garage ceiling back side of plenum. Provide permit for AC installed without permit. All else appears ok. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 8961 SW INEZ ST, TIGARD, OR, 97224 August 2, 2017 at 8:50:24 AM Record Type: Record ID: Residential - Master Permit MST2016-00504 Inspection Type: Inspector: 399 Plumbing final David Young Result: PASS Comments: Corrections complete. Note: provide approved plumbing final for lawn irrigation Backflow devise. PLM 2017-00304 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 8961 SW INEZ ST, TIGARD, OR, 97224 August 2, 2017 at 8:51 :04 AM Record Type: Record ID: Residential - Master Permit MST2016-00504 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: 8961 SW INEZ ST, TIGARD, OR, 97224 August 2, 2017 at 8:51 :59 AM Record Type: Record ID: Residential - Master Permit MST2016-00504 Inspection Type: Inspector: 699 Mechanical 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: 8961 SW INEZ ST, TIGARD, OR, 97224 August 10, 2017 at 9:29:00 AM Record Type: Record ID: Residential - Master Permit MST2016-00504 Inspection Type: Inspector: 299 Final inspection Aaron Cillo-Gobel 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 and/or duct seal test certificate received C of 0 left on counter. Violation Summary: Inspector Contractor