Permit (125) CITY OF TIGARD MASTER PERMIT
f . ';; COMMUNITY DEVELOPMENT Permit#: MST2016-00542
T t A D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2017
n
Parcel: 2S 111 DA20300
Jurisdiction: Tigard
Site address: 8550 SW SCHMIDT LP
Subdivision: HERITAGE CROSSING Lot: 22
Project: Heritage Crossing, Lot 22
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 711 sf Basement: 0 sf Left: 4 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1109 sf Garage: 342 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 4
Detectors: Yes
Total: 1820 sf Value: $222,496.14 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 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 add'I 500 sf: 3 201-400 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 I
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
i
asn Y
Other: N Other Description: Ecom p 9
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1820
Owner: Contractor:
DR HORTON INC. DR HORTON INC PORTLAND Required Items and Reports(Conditions)
4380 SW MACADAM AVE STE 100 4380 SW MACADAM AVE SUITE 100 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97239 PORTLAND,OR 97239
PHONE: 503-222-4151 PHONE: 503-222-4151
FAX: 503-222-1304
Total Fees: $27,961.02
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 gh OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 00,1'.�i/i'�-A- Permittee Signature: C:C-fC.=
Call 503.639.4176 by 7:00 a.m.for the next available inspection date. (/
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit ApplicationR 1c} iv 7' 311 b A'L
Residential I ou OIl ICI I 'I Oyl
City of Tigard OLT T 2 2116 Pan /Lt 57--)c)/6,-UO IZ
� 13125 SW Hall Blvd.,Tigard,OR 97223, :::.',3`,'-: (z��� /G I Permit Nn
�/ Plan RcNicu
Phone: 503.718 2439 Fax. 503.598.I (4� g l 114
l" Dale Dr. 1-"-.1 -)7 Other Permit. 'D' �0
t ;,. . l t Inspection Line, 503.639 4178 i l�ec��i GLV�✓��
c tate Read H.) Jura 0 Sce Page 2 for
Internet: www.tigardo.gov BUILDING DJ i io ' NotitiedMedod/,/��,e(t -- Sapplemeotal Information
1
M2ii /L 1 L:�
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
tli New construction 0 Demolition Permit fees*arc based on the%aiue of the work perfonned.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,material&labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. _
e I-and 2-family dwellingValuation: Srlaa. 4y
0 Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder /
0 Other
Number of bathrooms _
JOB SITE INFORMATION AND LOCATION fotal number of floors: al C Z
Job site address: 1 � 1 A n i )0.g New dwelling area: \C!i}C) square feet
City/State/ZIP:Tigard,OR 07223 1f v i Garage carport area: ,V" square feet
Suitebldg./apt.no.: Project.tame ` vi-tq� /� Coveredporch area: ` 1
l./Y U��h L� �/�1► square feet J ) Q t
Cross street/directions to job site: ,., J Deck area: '" square feet '7 1 J i
Other structure area: square feet j
REQUIRED DATA:COMMERC IAL-USE CHECKLIST"
Subdivision: Lot no.: Permit fees*arc based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor.overhead.and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New SFR Valuation: S
Existing building area: square feet
New building area: square feet
iri PROPERTY OWNER 0 TENANT Number of stories:
Name: DR Horton Inc. Type of construction:
Address: 4380 SW Macadam_Ave Suite L00 Occupancy groups:
City/State/ZIP:Portland, OR 97239 Existing:
Phone:( 503) 222-4151 Fax:( )
_
0 APPLICANT
Neu:
CONTACT PERSON BUILDING PERMIT FEES-
Business name: DR Horton Inc. (Please refer w/ee seAedwfJ
Structural plan review fee(or deposit):
Contact name:Emerald Weeks
Address: FLS plan review fee(if applicable);
4380 SW Macadam Ave Suite I00
City/State/ZIP:Portland, OR 97239 Total fees due upon application:
Phone:(503 )222-4151 x1107 Fax: :( ) Amount received:
E-mail: esweeks@drhorton.com PHOTOVOL TAI( SOLAR PANEL S't STEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: DR Horton Inc Submit two(2)sets of roof plan with connection details
Address:4380 SW Macadam Ave Suite 100 and fire department access,along with the 201 t)Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, OR 97239 Permit Fee(includes plan review .18(100
Phone:(503 )222-4151 Fax ( ) and administrative fees):
State surcharge(12%of permit fee): 521.60
CCB lic.: 130859
Total fee due upon application: S201.60
Authorized signatureThis permit application expires If a permit is not obtained
within 180 days after it hat been accepted as complete.
Print name: , t ,., . f i k_, (t Date:2016 '"Fee methodology set by Tri-County Building Industry
Service Board.
L Building.Pennits BUP-RESPcnnitApp.doc 62 24-2011 440.46137(1 102 COM'WEB t
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tECFAVEP
Electrical Permit Applies on • , (;,;f,, t 1( 1 I t,„
INCity of Tigard '11(' `2`i 1 t Paull*No.
,.�T 13125 SW Hall Blvd.,Tigard,OR 97223 �i1s7�0/G-Y f /L
V Phone: 503318.2439 Fax: 503.104,1R§0, c, Plan Review Other Permit
Inspection Line: 503.639.4I75 ' , a l+i.5,- :.1 D
Rea•dy/By 7arir. See Page 2 for
Internet: www.tigard-or.gov Y p r w- Not fedlMethod:
q )I1 lF I "SI 1k. Supplemental Information
TYPE O wORIC ' PLAN.REVIEW -
O New construction 0 Addition/alteration/replacement Please check all that apply(submitI sets of plans wMems checked below):
CI where
or feeder 400 angor:or more 13 Building over three stories
❑Demolition ❑Other:
where the available fault current 13 Marinas and boatyards.
CATEGORY•OF CONSTRUCTION exceeds 10,000 snaps at ISO volts or O Floating buildings.
El 2-family dwelling 0 Commerrcial/iadtrstriai ❑Accessory building less to ground,or exceeds 14,000- 0 Coum erciat.use agricultural
ElMulti-family 0 Master builder "°P for an o"111OSt'll buildings.aden
0 Other: Fire»• ❑hulapation of 75 KVA or
JOB SITE INFORMATION AND LOCATION D Emageucy system.mlarger separately derived system.
^ 0 Addition of new motor load of a"A","�^,"1-2;"1.3-
Job no.: Job site address: j } C1,) CAA M I k looBp or more. occupancy.
i�� UU��//�� ❑Six or more residential units. ❑Reenzatiooal vehicle parks.
City/State/ZIP: ,/1 El Health-care facilities. 0 Supply voltage for more than
�/�/ Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: LIP N- � s ( > \A a 0 Service o facer 600 maps or more.
Cross street/directions to job site: Off`' SCHEDULE
nava i Qty. I Fee. I Tett 1
- New residential single or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: •d.` 1,000 sq.ft.or less i, 168.54 4
Tax map/parcel no.: Ea add't 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft)
- Limited energy,multi-thmily
Is c 1 residential(with above sq.ft.) 75.E 2
Services or feeders hrstallatio. alteration,and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER 1
i 10 TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/Stete/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax ( ) 200 amps or less 59.361
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps H125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
• Branch circuits-new,alteration,or extension,per panel
Owner signature: Date:
so A.Fee for branch circuits with
0 APPLICANT 1 0 CONTACT PERSON above service or feeder fee, 7.42 2
DR Horton Inc each brands circuit
Business name: B.Fee for blanch circuits without
Contact name: Emerald Weeks branch ciserviB nrcuit fee,eedern 56.18 2
branc
Address; 4380 SW macadam Ave
Each 'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Portland OR 97239 Each manufactured or modular 6784 i 2
(503) 222-4151 Fax: dwersand/orfeeder
Phone: .( ) y 67.84 2
E-mail: Pump of irrigation circle 67.84•
• CONTRACTOR i Sign or outline lighting 67.84122
Signal cireuit(s)or limited-energy
Business name: So.14';�_44.. g l � v G. panel,alteration,orgRension. Paget ( 2
't�/f �C' ,/ Each additional inspection over allowable in any of the above _
Address: 2 go �E CS-'z: 4_ . I l . f Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: V�h C e7 Gt V$ vfi. (444• .g116'Cl Investigat ce(1 br min) 66.25/hr
/„ �719_ .�s69,s Inspection plant(i s min) 78.18/hr
Phone:
f7(/1 Fax:�b ?) ,gs ' J'6f� Inspections for which no fee is
CCB Lic.: / Electrical Lic.:•
specificallylisted(h4 hrmin) 90.00/hr
17-2c// CZ3 2 Suprv.Lic.: /79) $ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:/l4 _D Subtotal:
/ ... Plan review(25%ofpermit fee)
Print name:Ch(:S7'�4 ,l grit I Date: - State smrharge(12%of
permit fee):
v
Authorized signature: TOTAL FERMI FE
This permit application expires if a permit is not obtained within 180
Print name: -- V I Date days after it baa been accepted as complete.
* Number of inspections allowed per permit.
LlauadtsgVrerk.sxal9 c PermitApp 44046157(1 1105/cOMlwes
Ft FE ° .E
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information i}^, S j(_(V �Z
Limited Energy Permit Fees: C PI; : I. A kii.fr Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75,00 Descript1on I Qt.. 1 Each I Two I
Rene»able electrical energy systems:
Check Type of Work Involved: 5 13k.a or less itr;a.73..s6
5.01 toiSkva - I
❑ Audio and Stereo Systems*
15.01 to'>kva 2ut).3a
I
%ind generation systems in excess of 25 kva:
—] Burglar Alarm
25.01 to 50 kva 301.04 1 I
M Garage Door Opener* 50.01 to l Uu kra 552.2
>101)ksa(fee in accordance —
with()AR 41S-309-01)40) I 5A2'26 I
[d Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva mut S ^ ,n 3
n Vacuum Systems* -loi)to-ro additional charge ❑ 0 ti 3
Each additional inspection over allowable in any of the above:
Other: Each additional inspection is 6).25 hr !�
charged at an hourly(1 hr min)
Inspections for which no lee is
00.00 hr
specifically listed(.Y hr min) I
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Pagel):
(SEE OAR 918-309-0000) Number of inspections allowed per permit
Check Type of Work Involved:
C Audio and Stereo Systems
n B• oiler Controls
❑ C• lock Systems
C Data Telecommunication Installation
❑ F• ire Alarm Installation
I HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
C Outdoor Landscape Lighting*
Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I..Bui dtnp Penne,U.0 Pa-rmitApp FLR ERE.ck; 14,0 1'.71!15
Ti 1-1 a
Plumbing Permit Application "
Building Fixtures ?016 iOR of l ft I. I.S1: 0yL1
City of Tigard Received
g �' Y Pamir N
1114 II 13125 SW Hall Blvd,Tigar40 9 i i-, ri k yi- Fr) [Seedily. 57'016`7� G/2
I Plan Review
Phone: 503.7182439 Fagg On aha Permit No.:
Inspection Line: 503.639. 73 t ); a )(}J `I ray pele Ri
TIG 1 K U Internet: www gov °I Date RadyBy: mit B See Palet for
NWified/Meden' Sappkmearl lefarnsadoe
. TYPE TYPE OF WORK. FEE• SCBRDi1I G,`i '
❑New construction 0 Demolition For spedal/gfonnerlon use checklist
- Description j Qtz. ) Ea. ( Total
❑Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 R for each utility connection)
CATEGORY OF CONSIRUUI1ON SFR(I)bath 312.70
❑I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 50032
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
yOB'BtEE;WON* AND THIN Site utilities:
lob site address. Catch basin a area drain 18.76
} � 1 'v t �i 1 �� ' Drywall,leach line.or trench drain 18.76
City/State/LIP: v ,
T v c Footing drain(no.linear ft.: Page 2
--f
Suite/bldgJapt.no.: ` Project name: , ( /{4) )t( Manufactured home utilities 50.03 1
Cross slreWdirections to job site: 1 v I, Manholes 18.76
c/ Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_,-_) Page 2
Storm sewer(no.linear ft.:___) Page 2
/L Water service(no.linear ft.:,� Page 2
Subdivision: f Lot no.:�`(J- Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
. DESCRIPTION.OF WORK Badwater valve 12.51 1
•
.. Clothes washer 25.02
Dishwasher 25.02
V): \G._- Drinking fountain 25.02
Ejectors/sump 25.02
0 P OOnrL ..OWNER . 1 0 TENANT 1 Expansion tank 12.51
Name:
`
Y(iV\ 1 ti _Fixture/sewer cap 25.02
Fl
oor drain/floor sink/hub 25.02
Address: J(J j cam} \A&OD1G G �" -)\., Garbage disposal 25.02
City/State/ZIP: VO a.K.
() ocia Jt I Hose bib 25.02
Pie; ) /) _\-- \i \ Fax:( ) Ice maker 12.51
C i AtPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: >2._ \- '/ IA
i Medical gas(value:S ) Page 2
���1 01 '�.,€a Primer 12.51
Contact nom' �` 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: e 66 cAv Vi. O/ 1 .C0144 Urinal 25.02
Water closet 25.02
. -CONTRACTOR ^Water heater 37.52
Business name:EDWARD MULLEN PLUMBING Water piping/DWV 56.29
Address:1601 SE RIVER ROAD Other: 25.02
City/State/ZIP:HILLSBORO,OREGON 97123 _ Subtotal
Phone:(S03)640-0113 Fax:(503)640-4483 Minimum permit fee $72.50
Plan review (25%of permit fee)
CCB Lic.:94689 Plumbing Lic.no.:34-260PS State surcharge(12%of permit fee)
Authorized signature: J/� / TOTAL PERMIT FEE ^
Print name:RAY MULLEN / Date: This perieit appUcatioa expires if a permit is net obtalaed withlo ll4 days
after it has baa accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:MtrcUpt easiWRMU-enntAyp.doc 10/01/09 410.1616TtIOW21COM/WES)
City of Tigard
p COMMUNITY DEVELOPMENT DEPARTMENT
I
T 1 c A R D Building Permit Review — Residential
Building Permit #: /A s7-4,;-)..6/6.- 00 $-92
Site Address: eSW S/() C7e4S1 Loo
Project Name: 171, Cage j , Lot #:
(New dwellin name;Ad. .r Alteration=last name of owner)
Planning Review
Proposal: [J IJ &fI
/Verify site address/suite#exists and actio m permit system.
t J . 1ver Terrace Neighborhood: 'V No ❑ Yes,See River Terrace Review Addendum Attached
Sit Plan Elements:
ree(3)copies of site plan ! %' .ting structures on site
to plan must be on 8-1/2"x 11"or 11 x 17"paperlh
VI,Footprint of new structure(including decks)with finished
rawn to scale(standard architect or engineer scale) •or elevations
orth arrow i7,i t 'ty locations(required for new,may apply for additions)
V)Site address,project or subdivision name and lot number f r; ation of wells/septic systems
ElYtii,pplicant information(name and phone number) 3 L t sting trees to be retained with drip line,and tree
Ur
of dimensions and building setback dimensions otection measures
VgLot area,building coverage area,percentage of coverage and eet tree size,type and location
pervious 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)
1 lean Water Services—Service Provider Lette (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified TNo Received: ❑ Yes ❑ No
NJ Public Faci,li�s Improvement(PFI)Permit:
/Required: IQ Yes,applicant was notified ❑ No Applied For: WYes ❑ No,stopintake41;4/L
and Use Case#: 0k_ it .5 01 - .. o ' z S_
oning: _ 00,_C
.s
�/Required Setbacks: Front /5"-. Rear /6---- Side 4/ Street Side /1,7,44 arage r
11A "andscape Requirement: c>26)
CSL of Coverage Maximum:
V ,_...1
Building Height: Maximum Height .3Actual Height c (Q 'e, "
isual Clearance
Easements
SI O;ensitive Lands: ❑ Yes 12(No Type
/4 Urban Forestry Plan
❑ Conditions/�"M� et"prior to issuance/o9f b • ding permit_ /
Notes: C?Olidthe gV S% 1/ l ,- i- y _/7n1 „SSik2,7ce _
Approved By Planning: ----- Iii,--If�,, " Date: 0,
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\BldgPennitRvw RES 091216.docx
Building Permit Submittal
Original Submittal Date: Ic)Il61/0O
Site Plans: # 3
Building Plans: # 3
Building Permit#: .Enter building permit#above.
Workflow Routing: Rr Planning Engineering 7IPermit Coordinator Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: r•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: - Date: /a2,'/�j/�(�
Engineering Review
Slope at building pad:
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: E Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: biv Date: (2,40--A.,,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ 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:
ySDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes 0 N/A
Parks SDC: Yes ❑ N/A
144) OK to Issue Permit
Approvedby Permit Coordinator: Date: /421"///6?
I:\Building\Fonns\BldgPermitRvw_RES_091216.docx
Plumbing Permit Appli :, . .• .FIVED
Building Fixtures (Hz ()! I 1( I I
.. ..
City of 8 2017 IITigtird AUG i P
thite/13 iN- i (0/(7 ft enni'4°' P46r-c90//io-06 6L/.2.
-; 1.3125 SW Hall Blvd.,Tigard..t/R 9722.3 Pha Review- Phone: 503.71112439 Fax8111.9r3et0TIGARD moray. Odic Pent*too.:
n Line. 503 639.64,
linnretencteti°: www,tiprd-or.pd ILDING DIVISION Dam Ready/By: imit. RI See Pagel(or
. Notifted/Mettiod: Supplemental!atomisation
- ' TYPE OP WORK FiE* SMOULE
,
0 New construction 0 Demolition For soda!Wornothon use thrall%
Description I Qty. 1 Ea. I Total
0 A.ddition/alterationhoplaeement 0 Other: New 1-2-family dweSings(includes 100 0.fOr each illilit)etinnee(ion)
' . cAl;CORY"OT CONSTIR/CT1019 SFR 0/*I 312.70
. .,
0 1-and 24amily dwelling 0 Commercial/industrial SFR(2)bath 43178
SFR(3)bath 500.32
0 AcoMisory building 0 Millti-flonllY ' Each additional bathiltiteheri 25.02
0 Master builder f3 Other:
Fire Sprinkler(____sq.It) Page 2
xis,stip iNitottfttArtoN AND.LOCA , Site utilltleS:
,--_ /_ -2 A ' •--? Catch basin or area drain
7
Job site Iddnede-6517 c''',-.1,V ) L..)(:ti 11/1 e - 1..-ocf v 38.76
Drywell.leach line,or trend'drain Ill.76
City/State/Z.1P:'
, + Footing drain(no.linear'ft.:_) Page 2
Suite/bldg./opt no.:
Project name': VcC,VIAlle, 6Aftt‘b*3t Q4ucttiedhome.utilues 0.03
Caw streattdifentions to job Site: .hetes 11.16
'n drain connector 18.76
Saltine,sewer(no.linear ft.:____) Page 2
Storm sewer(no,linear ft:,__) Pap 2
Witter service(ob.linear ft.:____) Page 2
Subdivision: I 14 00,12 1:1„2, Fixture or Item
Tax map/parcel no.: Backflow premier 31.27
'
. , Backwater valve 12,51
. 4- .....'_-_- 1"qtri°14...- °F...T4)111(
VAACACV CiA6lifiSq) VII3n145 Wa5
Dishwasher 25.02
25,02
Li Drinking fountain 25.02
EjeologhluniP 25.02
. 0 4514120T.Millen , -- - -,E)TENANT ExPontion tea 12.51
Name.
. . • c.-) \ UV-A-CrYI !latter/Rover cap 25.02
Aciditss: 1/4,..\„b b._ ,..1 ,...)ca...., 0Flatoorba:EdirlOposair sinkibutt 253)2
City/State/ZIP: p)(, 1, Hose bib
(A2
Phone4=0 . ..3.„.:Li t 51 Fax ) Ice metier 215.°0
22
12.51
''.77, :1 Atikillejk40,,T. :, .,' ',.:...cycoNtAtt Agsg00( , ' Interceptor/grease trap 25,02
Busittess,name Medical gas(value:$ ) Page2
Contact name: ..-d\\A-LIIPIA. te)\ VUV--t-r--E) Primer
Ruof drain(commercial) 12.51
1231
Address; .---,--
.510k/basin/lavatory. 25.02
City/Stele/ZIP Solar units(potable water) 6234
Phone:( ) tax::( ) Towsliow,e,r/shower pan 12.51
E-mail: Urinal 25.02 ,
.. . , 25.02
C°14TRA. C11)14.- ' WaterWaterclosetliaer 37:52
Business name;Wolcott Pia'tibia* ' Water pipinge)WV '5'6.29
Address:107SW.Mita*Colunibla River Hwy Other: 25.02
City/State/Z1P:tnialthile Or.90611 Subtotal
Phone:(503)667-1181 Fax:(503)667-9091 Minimum permit fee: $72.56
Plan review (25%of pcmiit fee)
CCB Lie.:112220 Plumbing Lie.no.:26-874PB
State surcharge(12%of.pemtit fee)
Authorized signatu -. TOTAL PERMIT FEL
Print name:Mark Hokin* Date:2/17/17 This permit application expires Oa permit is not obtained within 180 days
atter b too been accepted as complete.
*Tee methodology set t)In-Connor sodding Industry Sussine Booth
I lituildinOtrini!OPLMV-PensitApp.doc I*4)1169 4404610 110.1MINtl,WEB) .
1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8550 SW SCHMIDT LOOP, TIGARD, OR, 97224 August 30, 2017 at 1 :11 :51
PM
Record Type: Record ID:
Residential - Master Permit MST2016-00542
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