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Permit (11) IN CITY OF TIGARD * , ' <. _ MASTER PERMIT COMMUNITY DEVELOPMENT I� Y Permit#: MST2017-00019 T(GA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/09/2017 Parcel: 2S104AD07500 Jurisdiction: Tigard Site address: 12936 SW PARKDALE AVE Subdivision: OLSON WOODS Lot: 11 Project: Olson Woods, Lot 11 Project Description: New SF. 9/12/2017: REPRINT permit to change covered patio to covered deck of 184 sf. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1632 sf Basement: 0 sf Left 5 Parking Spaces: 0 Height: 26 Bathrooms: 4 Second: 2008 sf Garage: 600 sf Front 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3640 sf Value: $448,162.56 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: 0 Catch Basins: 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: 6 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: 7 201-400 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:Y Square Feet: NEW SF VB R-3 3640 Owner: Contractor: WINDWOOD CONSTRUCTION INC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions) 12655 SW NORTH DAKOTA ST 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97223 TIGARD,OR 97223 2 Geotechnical Inspection Required before foundation PHONE: 503-780-4375 PHONE: 503-625-6526 FAX: 590-7606 Total Fees: $32,852.07 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: S -gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throug•R 9 41-.090. 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: # �. Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspe �!i� 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. CITY OF TIGARD MASTER PERMIT II 1 COMMUNITY DEVELOPMENT Permit#: MST2017-00019 13125 SW Hall Blvd.,Ti Date Issued: 02/09/2017 TffaFd.0 and OR 97223 503.718.2439 9 Parcel: 2S104AD07500 Jurisdiction: Tigard Site address: 12936 SW PARKDALE AVE Subdivision: OLSON WOODS Lot: 11 Project: Olson Woods, Lot 11 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1632 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 26 Bathrooms: 4 Second: 2008 sf Garage: 600 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3640 sf Value: $444,055.68 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 6 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 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 6 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: 7 201-400 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 3640 Owner: Contractor: WINDWOOD CONSTRUCTION INC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions) 12655 SW NORTH DAKOTA ST 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97223 TIGARD,OR 97223 2 Geotechnical Inspection Required before foundation PHONE: 503-780-4375 PHONE: 503-625-6526 FAX: 590-7606 Total Fees: $32,685.78 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 dance 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. ENTION. OF�gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 01-0010 through OA 95 01- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Iss ed By: ILf — -- Permittee Signature: Call 603.639.4175 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. Building Permit Application Residential RECEIVEr) FOR OFFICE USE ONLY Received , City of Tigard / Date/By. /1//7 A Permit No.:1,-/ -/-a/6/7—600/9 1 . 13125 SW Hall Blvd.,Tigard,410K9742.37 9017 Plan Review i : 3 Phone: 503.718.2439 Fax: Se3"!51487119t0 ' Date/By: j••• - j-7 --1/ Other Permitje‘Rol-7---Oceig Inspection Line: 503.639.4175 Date Ready/By: i a , . Juris El See Page 2 for TIGARD gGITY OF-FIGAFiD Internet: www.tigard-or. Notified/Method: 1 ;?47 /7 Supplemental Information , F3U 1 LD N 0- DIVIS.A01\1 TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING KNew construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the j2work indicated on this applsicattt CATEGORY OF.CONSTRUCTION JC.)r-z-, -and 2-family dwelling 0 Commercial/industrial - ..? Valuation:11 '..... 9 1s 0 Accessory building 0 Multi-family Number of bedrooms: 77 0 Master builder El Other: Number of bathroomr1-1-. 14,4:111.,to JOB SITE INFORMATION AND LOCATION Total number of floors;, ..5‘Job site address: i' ,...43 40, /47.131--/Lie4/4„,/,,, _/9,,f`,/4.---- New dwelling area: --,...--- square feet City/State/ZIP: 7:-/. 6"/4/ r:-2,.:::,,f.:-. ,../ -,/;:z 7::'; a Garage/carport area: „:" co square feet Suite/bldg./apt.no.: 1 Project name: /5,04; ‘Afe,ide__, Covered porch area: / Ye) square feet lAtfib • Cross street/directions to job site: Ititir,,,,1/-4,/z T Deck area: square feet 16/y// C Other structure area: 1 t 9". square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 04/ 4./,....1 CIO"42...:: Lot no.: ti Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet 1PROPERTY OWNER 1 . 0 TENANT Number of stories: Name: kt.)riti70 ai _us)(...... Type of construction: Address: /,` 53-- e 44._,) 4/0,,,,,,T/h/ (71,e a 7-4 ,574,,,1-----1,,:1,7 Occupancy groups: City/State/ZIP: --1.,,,,T",,,,, ,,,,,,,J ''' :::,; )„/":74,-.7. ,,i'„,,,r2,,,;"-4 Existing: Phone:(f;', 4 79,/,/-//3)c).-- Fax:(:::,3) ::.-:‘, .7- New: --El'APPLICANT -43-CUNTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee(or deposit): Contact name: "'` ;' riz z: . ,,_ /Ii....; FLS plan review fee(if applicable): (ddress: Total fees due upon application: City/State/ZIP: Amount received: Phone: -').--,:':7:-)) ';',7: „):.._. ..:-/ 3 -7c- I Fax::(5-,1:7 ) -:..”-;,,i,- :„,,,I.,.../.;:, PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: /'„,r/1,:-/-0-i, ,:,(Li. (//71',...),/:'e--I A./Y1---"H;c„..5 .-:/7) 7 Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: /4,i_Firj (A_/c/6;,() 70 i'-/: 7 _/-"-V C.,.- Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: ,,. --4/13 4,....._ Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) I Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: /co/ zi .... Total fee due upon application: $201.60 A wilui izet;sigilai. e — This perit ation 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 ,„, Print name: 4.7b4 ,);, ,„:" /..'..,j, ,, -.,. .-;L is„-.1 .. Date - Service Board. fr t 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard RECEIVE) RDate eceived 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Re: I`/�2�C7�GY�C� Plan Review Phone: 503.718.2439 Fax: 503.598.196Q AN 1 7 2017III DateBPermitNo.:y: Other Permit: TIGARD Inspection Line: 503.639.4175 J Date ReadB Juris: Internet: www.tigard-or.gov ! `� t {�� r Notified/Method: Supplemental See Page for C{iS C,,,,i�.Tl��s�t Information TYPE'OF WORK' COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work w 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. Value: CATEGORY OE,CONSTRUCTION' - RESIDENTIAL EQUIPMENT/SYSTEMS FEES* j2-1"--and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB S1TE INFORMATION.AND LOCATION. Heating/cooling: ' Air conditioning I•*'°'-'r46.75 Job site address:/ C. -,e-4/3,.Li' , j 4'1h'-' Furnace 100,000 BTU(ducts/vents) /0.`.' 46.75 City/State/ZIP: /..7E- n/2.^r) 0/L- g,„2. 7 a Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: /.-"),/,'_:..-.;:::j ,r ;i 0 '---;' Duct work 23.32 Cross street/directions to job site: (w/r;',._ __i Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: / I, :.,-::.'2,:-.3: j`; Y, Lot no.: Other: 23.32 ��` �' a/ v Other fuel appliances: Tax map/parcel no.: Water heater r' 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 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 OPERTY OWNER {] TENANT Environmental exhaust and ventilation: Name: L ! //' l a 1 _ ?-r Range hood/other kitchen .er Address: I __ equipment 33.39 Clothes dryer exhaust //' 33.39 City/State/ZIP: ,-7-6--_,,,,7.._:„,:,) -: Single-duct exhaust bathrooms, 71 ~� r- � '' ( toilet compartments,utility rooms) 23.32 Phone:(i-T:.-.. :1'.)) r ,, _ _ 7-.:- Fax:(37.--,--8) j —76(").- -- Attic/crawls ace fans 23.32 rAEPLICANT ❑ CONTACT:PERSON Other: 23.32 �. Fuel piping: Business name: , 1 4.,c-.- $14.15 for first four;$4.03 for each additional Contact name: //✓!" .2%",y/.. ', `/j 5 Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace 4041 ; Range/E-mail: 4f4 Ai�Cu(Uc , j/,_�` -i �.1J'::a' , /* Ca "i Barbecue CONTRACTOR- . Clothes dryer(gas) Business name: r-�// .,,,,,it)_. Other:-;:::: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) 1 CCB lit.: ��J/2a6" TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized Sign * Fee methodology set by Tri-County Building Industry Service Board Print name: `%J� /afe•-- Date:3//`/`/4. I'\Building\Permits'J C_PennitApp_040113.doc 440-4637T(11/02/C01\6/WEB) . r Electrical Permit Appl' V'rT.. FOR OFFICE USE()NuCity of Tigard ReceivedDate/By: Permit No.: //k/ 7:Ap/7 /9 I = • 13125 SW Hall Blvd.,Tigard.0RIR7421 7 Plan Review Phone: 503.718.2439 Fax: 50 5 g.1 04 201 Date/By: Other Permit: TI G A R D Inspection Line: 503.639. S-r + Date Ready/By: tuns: H See Page 2 for Internet: yg wwwtigard-ot 4 � g�(7 *D Notified/Method: Supplemental information New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below I 0 Service or feeder 400 amps or more 0 Building over three stories 0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards �P 1`,0Q ',kk,[t r n k,S R p` : � `N 'h^.�/,i exceeds 10,000 amps at 150 volts or ❑Floating buildings ' ""' less to round,or exceeds 14,000 8 ❑Commercial-use agricultural and 7-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. 0 Multi family 0 Master builder ❑Other ❑Fire pump. ❑Installation of 75 K VA or ° a � s � } Emergency system. larger separately derived system f >T � R=w ..7�0 .. ..,� �- ..�s ��,��.".' �a":�r,-#4a°,_" 0 Addition of new motor load of 0.•A....E....l_Z.. ..l_;,. Job no.: Job site address:/29X,„. )(2/9-4,4,01,4&/71/7.4-'--- ix or or moreoccupancy. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: ,/___F-. //41-i..440 C7 9'70,1-. - 0 Health-care facilities. 0 Supply voltage for more than ✓ ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: -,"'").<,5..7041 &r 7(2 0 Service or feeder 600 amps or more. VEE'SCHEDULE Cross street/directions to job site: Zr(�, � /,��f- Description I Qty. I Fee. I Total I • New residential single-or multi-famil g y,• g unit. Includes attached garage. .t' Subdivision: r // 1,000 sq.ft.or less 168.54 4 /�S�l✓' cJ`// � Lot n0.: Ea.add'I 500 sq.ft.or portion 33.92 I Tax map/parcel no 't d 'd I =5 * ' CD S:R )IQP1`O' OR1H w t r tie" �`z Lt o a(with absqen[iaI fl.) 75.00 ,� L� � � • • Limited energy,multi-family 75.00 r residential(with above sq.ft.) - • Services or feeders installation,altera on,and/or relocation 200 amps or less 100.70 2 ) 'PI*QPER C O'fii'1Y11;,; .ro. ., r a,s } r S:^ • (*I .,,,.., ,., 201 amps to 400 amps 133.56 2 Name: vV- ,C..r kfc::;( c0 f ` �Pt C 601 amps to 600 amps •330101 34 2 -�`' F 601 amps to 1,000 amps .04 Address: /72‘s----s---- 4.5 pal thi f"'I ^ ,a 6 7/ Over 1,000 amps or volts 552.26 2 f f Temporary services or feeders installation,alteration,and/or City/State/ZIP: 7-.4:ef/4.-/('L. 4)41, -))., relocation Phone:( 3) ?la ....4/ Fax:(9./3) ;,q-7 .a6,6✓ 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation:This installation is being made on property that I own which is not 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: A.Fee for branch circuits with '' • iti „ , ' a Y4,-,..-.0* { � X „ 4.1 abohvebranch service or feedercircuit fee, 7.42 eac2 Business name: ,-5.-/y-7c.- B. Fee for branch circuits without service or feeder fee,first 56.18 Contact name: / �� j1 $ branch circuit � Each add'I branch circuit 7.42 2 Address: Miscellaneous(service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 dwelling,service and/or feeder - Phone:( ) Fes::( ) Reconnect only 67.84 2 E-mail: i {11;,!,,,ia / .ti d t Pump or irrigation circle 67.84 2 Sign or outline lighting 67,84 2 " r w "0OJVT1G -012... ' 7M.IMM:g.: R1t4 , .•' Signal circuit(s)or limited-energy Business name: DreamHouse Electric,LLC panel,alteration,or extension. Page 2 Each additional inspection over allowable in any of the above Address: 221 SW Moonridge Place Additional inspection(I hr min) 66.25/hr City/State/ZIP: Portland,OR 97225 { Investigation(1 hr min) 66.25/hr Phone:(503) 519-6711 Fax:(503)648-9723 Industrial plant(1 hr min) 78.18/hr CCB Lie.: 196726 Electrical Lic.: C-848 Suprv.Lie.: 4560S Inspections for which no fee is 90.00/hr specifically listed(%:hr min) Suprv.Electrician signature,required: lw „ , 'ELEellOCAL; :ERMIr PEES I Print name: Chris Mahon Date: Subtotal: Plan review(25%of permit fee): Authorized signature: State surcharge(12%of permit fee): Print name:1. /04j /,lahU I Date: e/ /i/o TOTAL PERMI f FEE: i I\BuildingiPermits\ELC.PermitApp doe 07/01/10 I 44f0-46151(11/OS/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined: $75.00 DeI Qty. Each TotalI Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 E Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 FlBurglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 i acuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(%,hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC LI Instrumentation ❑ Intercom and Paging Systems n 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 IABuilding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Plumbing Permit Application Building FixturesROFFICE USE ONLY City of Tigard ' ' "" """" Received _ Date/By: � /7 /7 9i Permit No.: N✓!./ Imo,-7 yy lig - 13125 SW Hall Blvd.,Tigard,OR,9,73-1 ,0,-, Plan Review / O" Phone: 503.718.2439 Fax: 503. 199404 _ P Date/By: Other Permit No.: Inspection Line: 503.639.417 TIGARD ! `{ y.2 Date Ready/By: Juris: Q See Page 2 for Internet: www.tigard-or.gov IT i O1- 0 I(:%ARO Notified/Method: Supplemental Information TYPI �U!VIS! N FEE* SCHEDULE Z\1ew construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 -and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78 i. EI Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen I , 25.02 0 Master builder ❑Other: / Fire sprinkler( sq.ft.) Page 2 JOB"SITE INFORMATION AND: LOCATION Site utilities: Job site address: Catch basin or area drain 18.76 �,4 36, r,1 /3/1,/ _,./ , __ City/State/ZIP: ,' *., ' " Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt,no.: Project name: > ',.;./2.,, "-, Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 ' Water service(no.linear ft.: ) Page 2 Subdivision: /., - Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK: Backwater valve 12.51 Clothes washer 25.02 /?. (`) `5- `P Dishwasher 25.02 1 Drinking fountain 25.02 Ejectors/sump 25.02 ROPERTY OWNER I, 0 TENANT Expansion tank 12.51 Name: ki ,1, / if } �� A Fixture/sewer cap 25.02 Address: s -� �) Floor drain/floor sink/hub 25.02 , ' �' C `� /4/7; � ` Garbage disposal 25.02 City/State/ZIP: /2 ` ,._ 1- :_..._.,t".,,,. Hose bib 25.02 Phone: c. ' (� ..:) )✓rU7-%f32� Fax (":"..-..,:„>) ) -I //� Ice maker 12.51 PPLICANT0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: rw,c i Medical gas(value:$ ) Page 2 Contact name: '�y r) Primer 12.51 Roof drain(commercial) 12.51 Address: 1 Sink/basin/lavatory 25.02 City/State/ZIP: ( Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 E-mail ' - ;f r :_? Urinal 25.02 CONTRACTOR ,,. Water closet 25.02 Water heater 37.52 Business name: �Y/'fury 6�(/ / A�./ /.:�L.t Water piping/DWV 56.29 " Address: L.-,j7.) j `, Other: 25.02 City/State/ZIP: / .i _'r - Subtotal Phone:( 1.) '.-:,7_,,,,,,,,-> i- , Fax:( ) Minimum permit fee: $72.50 CCB Lic.: ! 6", ,,;, Plumbing Lic.no.: :: ,.b Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: , " Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I.\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) IIICity of Tigard imi COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Y BuildingPermit #: H 3t c>q_d !7—(min 19 Site Address: ( 2 9 3 Ci Por r Kct ot Lc. LSI rut, Project Name: bison W ooat s Lot #: ( 1 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N-%/W =S (-c gi Verify site address/suite# exists and active in permit system. River Terrace Neighborhood: ' No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: /Three(3)copies of site plan misting 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 Utility locations(required for new,may apply for additions) /`J Site address,project or subdivision name and lot number ❑-Location of wells/septic systems Applicant information(name and phone number) /Existing trees to be retained with drip line,and tree 4Lot dimensions and building setback dimensions protection measures ZLot area,building coverage area,percentage of coverage and ,Street tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) %Street names ,Property corner elevations(2 foot contour lines if more than 4 foot differential) Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: E Yes ❑ No f Z'Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake X Land Use Case#: S U 13 Zn 1 y - o 0d Q S V Zoning: j2- , S gr Required Setbacks: Front Zits Rear ! s Side 5 Street Side I S Garage 20 Landscape Requirement: 4 Lot Coverage Maximum: Z Building Height: Maximum Height 3 0 Actual Height Z S Visual Clearance 71 Easements Sensitive Lands: ❑ Yes ❑ No Type ,!i Urban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: ,1/1 ()/1"., IV\ — Date: 1/ 1 7 / 1 1 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\BldgPermitRvw RES_091216.docx Building Permit Submittal Original Submittal Date: //7/7 Site Plans: # 3 Building Plans: # 3 Building Permit#: B'Enter building permit#above. Workflow Routing: Er Planning ❑-Engineering rmit Coordinator IJ Building Workflow Sign-off: L7 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 � iginal plan review routing form. n Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician . � , ,.�. Date: //7/7 IMP Engineering Review ❑ Slope at building pad: Or ❑ 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: Date: 1 %1 L`7' Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: Cl 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: DC Fees Entered: Wash Co Trans Dev Tax: es ❑ N/A Tigard Trans SDC: L/J Yes ❑ N/A Parks SDC: JQ Yes ❑ N/A 4)OK to Issue Permit (( A-5/1 Approved by Permit Coordinator: Ai—Date: I:\Building\Forms\BldgPermitRvw_RES 091216.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12936 SW PARKDALE AVE, TIGARD, OR, 97223 September 21 , 2017 at 3:13:12 PM Record Type: Record ID: Residential - Master Permit MST2017-00019 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Provide permit for ac installed not on 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: 12936 SW PARKDALE AVE, TIGARD, OR, 97223 September 21 , 2017 at 3:12:03 PM Record Type: Record ID: Residential - Master Permit MST2017-00019 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Provide permit for ac installed not on 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: 12936 SW PARKDALE AVE, TIGARD, OR, 97223 September 27, 2017 at 12:21 :29 PM Record Type: Record ID: Residential - Master Permit MST2017-00019 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Water closet in main level master bath not flushing. Sink stopper not working upper level master bath, left side. 310.0 Seal water heater condensate drain at exterior. 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: 12936 SW PARKDALE AVE, TIGARD, OR, 97223 October 13, 2017 at 12:13:10 PM Record Type: Record ID: Residential - Master Permit MST2017-00019 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