Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT ",- .; 4- 1Permit#: MST2016 00568
-T t � RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439�� Date Issued: 02/01/2017
Parcel: 2S 104AC 15200
Jurisdiction: Tigard
Site address: 12881 SW 133RD AVE
Subdivision: WALNUT RIDGE Lot: 6
Project: Walnut Ridge, Lot 6
Project Description: New SF. 6/8/17, REPRINTED to add a/c
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1189 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1447 sf Garage: 379 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2636 sf Value: $314,596.73 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
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'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 2636
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PKVVY, 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
#370 BEAVERTON,OR 97006 2 Geotechnical Inspection
BEAVERTON,OR 97006 Required before foundation
PHONE: PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $30,066.83
This permit is iss.-• ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all .ther applicable law. All work will
be done in -ccordance wit •proved plans. This permit will expire if work is not started within 180 days of issuance, or if irk is suspended fo more the 180
days. A. ENTION: Oregon la re• ' -s you to follow the rules adopted by the Oregon Utility Notification Center. 'hose rules are s,, o in OAR
952-00 0010 through OAR 952-00 .090. You ma obtain a copy of the rules or direct questions to OUNC by calling 50.. 32.1987 0 .8.•. .2344.
Issue. By: e. tea. #_.2 Permittee Signature: . ..I
Call 503.639.4175 by 7:00 a.m.for the next available inspection da"
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
C F_I IV,EP
Mechanical Permit Applic •
FOR OFFICE FSI.O\L\
City of Tigard Received
Date/By: Permit No.:
13125 S W Hall Blvd.,Tigard,OR 97223,"
I Phone: 503.718.2439 Fax: 503.598.! NI ? / Plan Review
f I c :�R t) Inspection Line: 503.639.4175 Date/By: Other Permit:
Internet: Line:www.ngard_er.gov 'g g` Date Ready/By: kris: ® See Page 2 for
g g CITY Ora '16/ 9 Notified/Method: Supplemental Information
.k..�., ,.- ,r d t x "..&r d t p, 88 t;aM.: . t,• a h
., ,i?;,.N k A , earns c »-.. ^ '
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement
performed.Indicate the value(rounded to the nearest dollar)of all
Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
t.: ' tt 6 s t a az Value:$
-+. ,. a .. ' I ''. *4 ..,wa'eac s .: bra d a w„.
® 1-and 2-familyg • It �� .' .
dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family ❑Master builder
0 Other: Description Qty. I Ea. I Total
a ; a�f,, ice
. t Heating/cooling:
,: :. .. . Ni-e mar .
Job site address: 12881 SW 133rd Ave Air conditioning 1 46.75 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name: Walnut Ridge Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: SW Walnut&SW 133rd Ave. Hydropic 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: Walnut Ridge I Lot no.: 006 Other: 23.32
Other fuel appliances:
.74
Tax map/parcel no Water heater 23.32
� '$ it 't�• Gas fireplace/insert 33.39
C� Flue vent for water heater or gas
C fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
.. x ' Other: 23.32
� I• �� "" '` ' " Environmental exhaust and ventilation:
Name: Riverside Homes, LLC
Rangehood/otherkitchen
Address: 17933 NW Evergreen Parkway, Suite 370 equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Beaverton, OR 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( 503) 645-0986 Fax:( ) Attic/crawlspace fans 23.32
--'''.,-14 # gI c3c„ ' •
._ ,�.��' . , ��t+� .xy Other: 23 32
Business name: game as above Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Brett Groves Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) I Fax::( ) Fireplace
E-mail: bgroves@riversidehome.com Range
K
Barbecue
1: nix, .. x , ., 41 tee”®..v . .: ,,.. Clothes dryer(gas)
Business name: Pyramid Heating&Cooling Other':
Address: 9409 NE Colfax St.
Subtotal a.7
City/State/ZIP: Portland, OR 97220 Minimum permit fee($90.00) . -
Plan review(25%of permit fee) .----
Phone:( 503) 786-9522 Fax:(
503)786-3432 State surcharge(12%of permit fee) 6.62
CCB lie.: 59382 TOTAL PERMIT FEE p�•..
This permit application expires if a permit is not obtain within 180
days after it has been accepted as complete.
Authorized signature:
* Fee methodology set by Tri-County Building Industry Service Board
Print name: Brett roves Date: 12/19/2016
440-4617T(11/02/COM/WEB)
I:\BuildingPermits\MEC_PermitApp040113.doc
\
CITY OF TIGARD MASTER PERMIT
111....„ -
2.. COMMUNITY DEVELOPMENT Permit#: MST2016-00568
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/01/2017
T[ a �° 9 Parcel: 2S 104AC 15200
Jurisdiction: Tigard
Site address: 12881 SW 133RD AVE
Subdivision: WALNUT RIDGE Lot: 6
Project: Walnut Ridge, Lot 6
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1189 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1447 sf Garage: 379 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2636 sf Value: $314,596.73 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 4 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 add'500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2636
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PKWY, 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
#370 BEAVERTON,OR 97006 2 Geotechnical Inspection
BEAVERTON,OR 97006 Required before foundation
PHONE: PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $30,014.47
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and -II 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, • ''work is susp-. ded /more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C- to. Those rul-- are - forth in OAR
952-00 010 throb,,h OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2. .1 t:7 or 1.:$0 t 4
Issu By: ,. I I Permittee Signature: � /
i
Call 503.639.4175 by 7:00 a.m.for the next available inspecti• 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.
, i3uildini Permit Application
Residential .
City of Tigard Received
'� ''J g }}�� /_ Permit No.: w-1 i
�1G' �� 9+ �^5����(F1'/.GJtfJI`-
� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie
Phone: 503.718.2439 Fax: 503.598.1960 { Date/By: 2,-2,7- �o Other Permit: $c4 ,16`07`17 7
, . R Inspection Line: 503.639.4175 DE
( Q %"1
� I Date Ready y: Jur s: ® See Page 2 for W F
Internet: www.tigard-or.gov D Notified/Method: /2/ ll&# 7� Supplemental Information
�;°',�"first .yy+ ., ; ,: {�`. `; � .. t� `.* a $ y ^"''��"-S �`�, ✓"� �5�` a%'j'�,.'. �.�«
s,'�X,av"f 7.• t .ar Y,. . .moi'.. .... a .:.C9."am..3. ":. 'i 2 3.u, 4,<1,
®New construction ❑ t,, 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
r �� � work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 3 1J
ElAccessory building 0 Multi-family Number of bedrooms: 4
El builder 0 Other: Number of bathrooms: 3
{MTg J s- ,� • a<<i Total number of floors: 2 a C. 3t
Job site address:12881 SW 133rd Ave New dwelling area: 2 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 3 square feet
Suite/bldg./apt.no.: I Project name:Walnut Ridge Covered porch area: 33 square feetCILD
�7
Cross street/directions to job site:SW Walnut and SW 133rd Ave Deck area: square feet
Other structure area: square feet r / S 1
Subdivision:Walnut Ridge I Lot no.:006 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
' work indicated on this application.
Construction of SFR Home Valuation: $
Existing building area: square feet
New building area: square feet
w „ P> * <„ Number of stories:
Name:Riverside Homes,LLC Type of construction:
Address:17933 NW Evergreen Parkway,Suite 370 Occupancy groups:
City/State/ZIP:Beaverton,OR 97006 Existing:
Phone:(503)645-0986 Fax:( ) New:
Business name:Same as Above
Structural plan review fee(or deposit):
Contact name:Brett Groves
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fes;;( ) Amount received:
E-mail:bgroves@riversidehome.com ,� FL ) ;� l irri
•
x fCommercial and residential prescriptive installation of
` .. � roof-top mounted Photo Voltaic Solar Panel System.
Business name:Riverside Homes,LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:17933 NW Evergreen Parkway,Suite 370 Solar Installation Specialty Code checklist.
City/State/ZIP:Beaverton,OR 97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)645-0986 Fax ( ) State surcharge(12%of permit fee): $21.60
CCB lic.:189148 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
�.. 7j within 180 days after it has been accepted as complete.
Print name:Brett Groves Date:12/16/2016 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application
City of Tigaard EcEivE ceived
b ate/B : Permit No.:
;, Date/By:
4 13125 SW Hall Blvd.,Tigard,OR 97223 y �/ -cJ jC��
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit:
Da
i IC \12 13 Inspection Line: 503.639.4175 ��C C 2 0 01 Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov C Notified Method: Supplemental Information
11� ' urrT"�x„ Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alterat 1 . . emen performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
b
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description
Qty. I Ea. I Total
" $1 '-'1=iii-;'::"?17:. "1 �'µ t 1 - Heating/cooling:
Air conditioning 46.75
Job site address: 12881 SW 133rd Ave Furnace 100,000 BTU(ducts/vents) 1 46.75 46 75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Walnut Ridge Duct work 1 23.32
23 32
Cross street/directions to job site: SW Walnut&SW 133rd Ave. Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 1 23.32 23.32
Subdivision: Walnut Ridge Lot no.: 006 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23 32
ls'tt'" .. �..�.� ,x E . ,,,® , +•< * �.,. '• .' t�y?� Gas fireplace/insert 1 33.39 33 39
Flue vent for water heater or gas 23.32
Construction of SFR fireplace 1 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
;�� i i',.1°$'4`,.'
", , 23.32
W,`„:„
" � n,"` '� " ' ` ' f� ...-, Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Range hood/other kitchen
equipment 1 33.39 33.39
Address: 17933 NW Evergreen Parkway, Suite 370 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Beaverton, OR 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32 93.28
Phone:( 503) 645-0986 Fax:( ) Attic/crawlspace fans 23.32
,' r i ..
,a '.; 't.. 1. a . ,. -: l »1 .4 ' .• Other: 23.32
Fuel piping:
Business name: Same as above
$14.15 for first four;$4.03 for each additional
Contact name: Brett Groves Furnace,etc. 1 14 15
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) J Fax::( ) Fireplace 1 14 15
E-mail: bgroves@riversidehome.com Range 1 1415
,� < v r." Barbecue
<;:,1 , l.., i`iv. t ,,,,,Hill � . Clothes dryer(gas)
Business name: Pyramid Heating&Cooling Other:.
Address: 9409 NE Colfax St. Subtotal 375 93
City/State/ZIP: Portland, OR 97220 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 503) 786-9522 Fax:(503)786-3432 State surcharge(12%of permit fee)
CCB lic.: 59382 / 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: / "f * Fee methodology set by Tri-County Building Industry Service Board
Print name: Br: avec Date: 12/19/2016
I:\Building\Permits\MEC_Pem itApp_040113.doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application �y
City of Tigard Received Permit#:
I Date/BY.
( <1 gr
u 13125 SW Hall Blvd.,Tigard,OR 9722 '( Plan Review �� �6 a
I Phone: 503.718.2439 Fax: 503.598.19 DateBy: Related Permit#:
Inspection Line: 503.639.4175
13 Q'��) Ready Date/By: lurks: ® See Page 2 for
1 r"R D Internet: www.tigard-or.gov 'r-fs Notified/Method: Supplemental Information
®New construction 0 Addition/alteration - I t v'511 Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition 0 Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
m Mv u�t- .+ where the available fault current 0 Marinas and boatyards.
' t I t 1as'rt, k t ,'? exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building fess to gmnad,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-family 0 Master builderamps for all other installations. buildings.
❑Other: 0 Fire pump. 0 Installation of 150 KVA or
q v a $ t lF '1 " '.
l > B " " ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 12881 SW 133rd Ave 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: Tigard, OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: Walnut Ridge ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Walnut&SW 133rd Ave. 7. .k:::,1,•,:,-_,'..- -,:.'- ii,-,:,::,_ ' T-iiili,.c-,14- .-„-.,x
Description Qty. M Each Total
New residential single-or multi-family dwelling unit.
Subdivision: Walnut Ridge I Lot#: 006 Includes attached garage.
1,000 sq.ft.or less i 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion LI 33.92 1
'_ a i i' t t ; #' -'ia * , : :: Limited energy,residential
75.00 2
Construction of SFR (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
1 .i'-'V E' :� ' t q r x* a 'q. r:::.
:., f..-3
t *7 ,, Renewable Energy ❑ See Page 2
.. a- Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen Parkway, Suite 370 201 amps to 400 amps 133.56 2
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) 645-0986 I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: bgroves@riversidehome.com 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
.;, : n= , rte,. Branch circuits-new,alteration,or extension, er panel
i ''' A.Fee for branch circuits with
Business name: Same as above above service or Feeder fee, 7.42 2
each branch circuit
Contact name: Brett Groves B.Fee for branch circuits without
Address:
service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: b.roves • riversidehome.com Reconnect only 67.84 2
�_�; Pump or irrigation circle 67.84 2
Business name: Garner Electric Sign or outline lighting 67.84 2
Address: 2920 SE Brookwood Ave#1 Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 503) 648-4552 Fax:( 503)642-7925 Investigation(1 hr min) 90.00/hr
ti-�3�s
Industrial plant(1 hr min) 78.18/hr
Email: ge@garnerelectric.com 3
Inspections for which no fee is ,,90.00/hr
CCB Lic.: 121159 Electrical Lic.: 3675•- Suprv.Lic.:3 70 7C ,sPecificall listed CA hr min)
•Suprv.Electrician signature,required: aii‘e
Subtotal:
Print name: Chuck Garner I Date: 12/19/20160 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Brett Groves Date: 12/19/2016 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:�Building�Permits�EI.0_PermitApp_EI,R_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
' Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
::: 1 .I,. *
Fee for allresidentialsystems combined: $75.00 °° I Qty. I Each I Total 1
RRenewenewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑X Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
X❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min) 66.25/
Inspections for which no fee is 90.00/hr
s.=ificall listed Y.hr min
Subtotal(Enteron Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
LI Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits'ELC_PemtitApp_ELR_ERE.doe Rev 06/17/2015
• Plumbing Permit Application
Building Fixtures Fox OFFICE Lsl;1:N:.):\1.1
City of Tigard ittCY, DateBy:iAl ReceivedPermit No.: �.Tre/(y. X15
1,1 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 �q Other Permit No.:
��pp 1 DateBy:
I I t A It ) Inspection Line: 503.639.4175 �j V �- Date Ready/By: Juris: ® See Page 2 for
Internet: Hall Blvd.,
r.gov Notified/Method: Supplemental Information
sr
�' <,� Vis' .. , e t - .. . ,� , . 9�s,i' y4r
®New construction ❑D • o l� '` ` For special information use checklist
� Description Qty. Ea. I Total
❑Addition/alteration/replacement ■ I er: New 1-2-family dwellings(includes 100 ft.for each utility connection)
n/
"
SFR 1 bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
l a 4` ,t •P i 'tl t e t -• Site utilities:
lob site address 12881 SW 133rd Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Walnut Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Walnut&SW 133rd Ave. Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linearft.:_) Page 2
Stone sewer(no.linearft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Walnut Ridge I Lot no.: 06 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
I t• t # tt.
• v Backwater valve 12.51
Clothes washer 25.02
Construction of SFR Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
yp� 4 t i ..t Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Parkway, Suite 370
Garbagedisposal 2s.o2
City/State/ZIP: Beaverton, OR 97006 Hose bib 25.02
Phone:(503) 645-0986 Fax:( ) Ice maker 12.51
sa
# Interceptor/grease trap 25.02
a� �'" , �. ,.• -:ter,'- ��. ;., ., , '
Business name: Same aS above Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Brett Groves
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: bgroveS@riverSldehome.COmiir, urinal 25.02
;,.,,),.,e,,,,,' Water closet25.02
. . . ., Water heater 37.52
Business name: H &H Mechanical Waterpiping/DWV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Phone:(503) 975-9787 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 178122 Plumbing Lic.no.: PB414 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
40/
Authorized signature: TOTAL PERMIT FEE
Print name: me
Brett Date: 12/19/2016 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 Seryice Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
1111q COMMUNITY DEVELOPMENT DEPARTMENT
I
T I G A R D Building Permit Review — Residential
Building Permit #: _ m z i �621,
Site Address: ; 2 8 V, I SW 133 r A ci
Project Name: WO I n V t- Q icl j e Lot #: G
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: (VeNV E p 1t
Verify site address/suite#exists and active in permit system.
7 River Terrace Neighborhood: ❑ No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
/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
t'lDyawn to scale(standard architect or engineer scale) floor elevations
North arrow
JZ(Utility locations(required for new,mayapply for additions)
Site address,project or subdivision name and lot number pP y
of wells/septic systems
Applicant information(name and phone number) DExisfing trees to be retained with drip line,and tree
7Lot dimensions and building setback dimensions rotection measures
;-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
❑Property corner elevations(2 foot contour lines if more than
4 foot differential)
)71 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 ❑ No Applied For:
Pp Yes ❑ No,stop intake
Land Use Case#: Co Q Will coo)
T Zoning: s
c
cz Required Setbacks: Front 2,0 Rear 15 Side S" Street Side j C Garage 2 0
)Z1 Landscape Requirement: 1\/ /-
V] Lot Coverage Maximum: N/
3� BuildingHeight: Maximum Height F3 Actual Heightb
RI Visual Clearance
Easements
Sensitive Lands: ❑ Yes ❑ No Type
/ Urban Forestry Plan
4 Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: MD vi j2-4,..,.. 66,10 c(.52-eAA-A, Date: 17-i 2—/ 1
Revisions (after Building Submittal only) Reviewer
Revision 1: 0 Approved ❑ Not Approved Date
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
Building Permit Submittal
Original Submittal Date: j;Jae
J1c
Site Plans: # 3
Building Plans: # 3
Building Permit#: g- er building ppermitt##above.
Workflow Routing: rmi
ang ItYEngineering ermit Coordinator g
Workflow Sign-off: Coin-off for Planning(include notes from planning review)
Route Application Documents: -eering: (1) copy of permit application, (1) site plan, (1) building plan and
orial 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: 1`Ant_ Date: /01 //w
Engineering Review
Slope at building pad: 77,g.
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: ❑ Yes No
❑ NOT Approved by Engineering:
Date:
Notes:
Approved by Engineering: 4(7, ,L/ Date: ./...: AK
Revisions (after Building Submittal only)
Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El 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:
SDC Fees Entered: Wash Co Trans Dev Tax: V Yes ❑ N/A
Tigard Trans SDC: CrYes ❑ N/A
Parks SDC: CR'Yes ❑ N/A
I1OK to Issue Permit
Approved by Permit Coordinator: (J,,z ,f' ec a, Date: I - D-7 - 16
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III _ Transmittal Letter
1 c A lz 1) 13125 SW Hall Blvd.• Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: d ylA DATE
DEPT: BUILDING DIVISIONvE
Nic 2
FROM: U �`l r0 Ve- '11:'p ()1 n n( w r
COMPANY: ' _-\ ,trv5LAU ai-0--6S BUILDING DIV
PHONE: tr5 4 1 - -5 1-. C By:
RE: \ Z co$ 1 S t,J rlil,4 P- 1,-/-. Z o — 1�o su
(Site Address) ff i
J nn (Permit Number
, c,l vvvA \(,v\ij L0 (c '
(Project name or subdivision name and lot numb-
ATTACHED ARE THE FOLLOWING I ''' '
Copies: _ Description: V Copies: I Description:
Additional set(s)of: ans. 3 Revisions: S I l ? 1
Cross section(s) . a a etails. Wall bracing and/or lateral analysis.
Floor/roof fram. g. Basement and retaining walls.
Beam calculat ons. Engineer's calculations.
Other(explain):
REMRKS: `�'\--•vv-v\--' owl �' rlIAHX- ralfz--/A- TtLi-e-ii 6
t 1 .4L4 --v t-ri klm-f f1C-60-,x- 6-u_. `n-�c.-) a+-n
(67110, — a i)c)-u .PAR 6a .41— fo /7
1 /0)
FOR OFFICE U ON S
NLYC.,)
Routed to Permit Technician: Date - j 4. - 1-3 Initials: H
Fees Due: 0 Yes ►�I No Fee Description: Amount Due:
$ cY
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑Yes . No [ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
I City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Residential
IIGARD
Building Permit #: 07S7-136)&,--c/c.20/
Site Address: 12 91 i SW )33 M m v.e..
Project Name: VNO)r s Qid9 e_ Lot #: C
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: N€AN 2 PZ.
)Verify site address/suite#exists and active in permit system.
J21 River Terrace Neighborhood: 0 No 0 Yes,See River Terrace ReviewAddendrrm Attached
Site Plan Elements:
(3)copies of site plan J'Existing structures on site
i'Site plan mut bg on 8-1/2"x 11"or 11 x 17"paper A6Footprint of new structure(including decks)with finished
yawn to scale(standard architect or engineer scale) /floor elevations
fa
orth arrow Utility locations(required for new,may apply for additions)
!!
ite address,project or subdivision name and lot number ❑L.,..dlh..t of wells/septic systems
.Applicant information(name and phone number) ung tees to be retained with drip line,and tree
t dimensions and building setback dimensionsrotection measures
3 ^dies,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) RTStreet names
0 Property corner elevations(2 foot contour lines if more than
4 foot differential)
J~1 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified 0 No Received: 0 Yes 0 No
Public Facilities Improvement(PFI)Permit•.
Required: 0 Yes,applicant was notified 0 No Applied For. A/Yes 0 No,stop intake
pLand Use Case#: CU Q )4 -- 0001 1
in Zoning. R 4 . S
cd Required Setbacks: Front j.O Rear ,,S' Side E Street Side I c Garage 2.0
) i Landscape Requirementilk %
aLot Coverage Maximum: iv/
le Building Height: Maximum Height '3D Actual Height 23 '12
f i Visual Clearance
JI Easements
Sensitive Lands: 0 Yes 0 No Type -
f2:` Urban Forestry Plan
4 Conditions"Met"prior to issuance of building permit
Notes:
Approved By Planning, no o 0 0.4",. 6 i I O Date: j..Z/J / i 6
Revisions(after Building Submittal only) evi wer to
Revision 1: . Approved 0 Not Approved --A /mak) ,(,f-i 2- 17
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw_RFS 091216.docx
Building Permit Submittal
Original Submittal Date: 42/90//4'
Site Plans: ## 1
Building Plans:
Building Permit#: [r7•Emer building permitt##above.
Workflow Routing: [-Ptaniung ICYEngtneering [ Pt Coordinator Q-'BtuTding
Workflow Sign-off CiSign-off for Planning(include notes from planning review)
Route Application Documents: eering. (1)copy of permit application,(1)site plan,(1)building plan and
or ginai plan review routing form.
:3'Building. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Allteinge,, erPDate: 4�/,OJA,
Engineering Review
Slope at building pad: 1744
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: 0 Yes No
Assess Water Quantity Fee in-lieu: 0 Yes No
LIDA Facility on lot: 0 Yes o
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: itil...22._ Date:
Revisions(aftAy'Ming Submittal only) Revievq�tL. P ate
l'/D-/7
Revision 1: Approved 0 Not Approved TT���{JJ
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 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:
XSDC Fees Entered: Wash Co Trans Dev Tax: Gir Yes 0 N/A
Tigard Trans SDC: a Yes 0 N/A
__/ Parks SDC: I Yes 0 N/A
tOK to Issa Permit
App ed by Permit Coordinator. ', � C - 4 Date: - j J .- 37 - I!,
5/.3//
1:\Building\Forms\BldgPermitRvw_RES_091216.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12881 SW 133RD AVE, TIGARD, OR, 97223 June 12, 2017 at 12:18:08 PM
Record Type: Record ID:
Residential - Master Permit MST2016-00568
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide slope away from structure 6" in 10' or approved drainage swale left side
between house and boulder retaining wall. R401 .3
Insulate to code for conditioned space and provide lid with clearance to grade per code
under FP and book case bump out. R317, chapter 11
Provide clearance to grade per manufacturer for materials used.
Insulation inspection required.
Note: front porch 29-29 3/4" above adjacent driveway grade. Guard rail not required by
code. R321 .1
Violation Summary:
Inspector Contractor