Permit (58) CITY OF TIGARD MASTER PERMIT
'; COMMUNITY DEVELOPMENT Permit#: MST2017-00045
13125 SW Hall Blvd.,Ti Date Issued: 02/14/2017
T E C A R-L and OR 97223 503.718.2439 9
Parcel: 2S 106D B 13400
Jurisdiction: Tigard
Site address: 17412 SW FOREST HOLLOW ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 134
Project: River Terrace Northwest, Lot 134
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 978 sf Basement: 814 sf Left: 3 Parking Spaces: 0
Height: 38 Bathrooms: 3 Second: 1251 sf Garage: 368 sf Front: 8 Smoke
DwellingUnits: 1 Detectors: Yes
Third: 0 sf Right: 3
Total: 3043 sf Value: $365,690.59 Rear: 10
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
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 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: 4 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: 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 3043
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
BY FORSUM,MICHAEL 109 E 13TH STREET 1 Fire Rated Eaves-Both
7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660 Sides
STE 1 2 Ersn Cntrl 503-639-4175
SCOTTSDALE,AZ 85258
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $34,100.62
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 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2321987 or 1.800.332.2344.
Issued By: /(�( �ite'4,G%G Permittee Signature: Srr � a7 ,
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.
„Building Permit Application? / 3 I
w FOR OFFICE LSE O\L1
City of Tigard i'Z 2 i [1 IF Received ,, Permit No.
111 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie �% �Gf�����
Phone: 503.718.2439 Fax: 503.54460:t ' x h p Date/By: 1 J er P coGf t.v4e/ �QCQ7C/
T RI) Inspection Line: 503.639.4175Date Ready/fly: �g /+�{/ Juris: H See Page 2 for
Internet: www.tigard-or.gov li h T s ° * )4,, Notified/Method///�E Supplemental Information
, r:.,tt .n,F " spy* rs •s€ €€ ��"
®New construction 0 Demolition Permit fees*are based on the value of the work performed
0 Addition/alteration/replacement Other: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
s s ,, -s -w'x �'"ary.sy�a � a = work indicated on this application.
�
<,� „r��.� �. ,,,,� .:'�' �,� ,tea �:��; ;'�r �
1-and 2-family dwelling 0 Commercial mdustrial Valuation: /01-44...74 6 + o
0Accessory building ❑Multi-family Number of bedrooms:
�,
0 Master builder. 0 Other: Number of bathrooms:
sF ' ', 'g(,�ttT 3 = 'a ,I Total number of floors:
�_d._ www. . sF a � `` 4 -
Job site address \ i Li, New dwelling area:3 D 4 square feet 4
City/State/ZIP:Tigard,OR 97224 Garage/carportarea: square feettS
Suite/bldg./apt.no.: Project name:I1 ey-2, . NW Covered porch are fdarefeet Az—)
Cross street/directions to job site: Deck area: ii(00s. - feet 9 7
Other structure area: f' *' square feet 8 J
Subdivision: U Lot no.: j' 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
p t imp work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
- Number of stories:
- ,
Name:ADVL Land Holdings,LLC Type of construction:
Address:7600 E Doubletree Ranch Road Occupancy groups:
City/StateTLLF:Scottsdale,AZ 85258 Existing:
Phone:(602)694-4031 Fax:( ) New:
:LL i
Business name:Polygon WLH,LLC
Structural plan review fee(or deposit):
Contact name:Angela Grajewski
FLS plan review fee(if applicable):
Address:109 East 13th Street
Total fees due upon application:
City/State/ZIP:Vancouver WA 98660
Phone:(360)695-7700 Fax::( ) Amount received:
E-mail:Angela.Grajewski@polygonhomes.com li € k— ,
Commercial and residential prescriptive installation of
` �` p roof-top mounted PhotoVoltaic Solar Panel System.
Business name:William Lyon Homes,Inc Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 109 East 13th Street Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee):
CCB lie.:207247 Total fee due upon application:
Authorized signature: f J,,n C This permit application expires if a permit is not obtained
11 t J �{"��( within,180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: - _ Date: Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11IO2/COM/WEB)
' R.ECEIVED ..................... ,., . .
Mechanical Permit Applicationi
City of Tigard aomitcd-
A N 1 :� _017 try: Permit N6/41-C70/7—e00>3-
1312i SW Nn1113111;Tigard,OR 97223°' Plan Review
Phone: 503.7182439 Fan: 503.598.1960 p yy Other l'cmie
Jnsptacticn Linc: 503.639.4175 ` t T I GA RD t Y
Internet aLinr.:503439.4v f l�ue Rnadv�Hp: I..." 4F Ste Page 2 roe
31111,701'V IVISIO�1 NairialrNtcdroct srrppkn,enut lnfarmatiofi
2". - , .q,.,Vz^r '^S ..7, J2i4S."j„ 0 4'SmJ. . k.^�'';`y:"C4"a A, .nAy, �.�w' E.+:.,iit ,t..n ✓, '4'.!.
Mechanical permit fnse am based on the value of the work
El New construction 0 Addition/alterationtt,eplacement performed.indicate the value(rounded to the nearcxt dollar)of all
❑Demolition 0 taller: mechanical materials.cquiptnenL labor.overhead.and milt.
r+. . ynt "f 'o o dace. a u' Value S
�. :::• i ;', r.'a^- re A arse t, fir. ra :z a
a.n-.v �ti, � ..t..w.mr.'..�; 'fit,,,.�.."`a'a� t;'7e.q,. 5.ti:'.i ��.: ;r- 'may. ;.1-s;,
.wr, f.
El !-and 2-family dwelling 0 Commercial/industrial „ .ear ��ttime t ;; , >. ''
0 Accessory building Farrpedafinformation sae chastest
IN Multi-family 0 Mager builder 0 Other. Description I Qty. } Ea. _1 Total
'A-c'r ',:' y z`t 4"`r•,::',Z �Y 4. i-1., Fl:4 4- p T;5a a`` ..��tP, q.- 14a.s -apt ';;e1." ltco diti otipt;:
�w ' y II, �[ ADrcanditiopiuR I 46,75
Sob site address: r,9 12, 5 V f 1 yes 1 dill. 5r Furnace 100.000 BTU Oedemas) 1 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100.000 BlU(ducts/vents) 54.91
SrriCtfhl / �j /' -^ . Heat pump 61,06
dgapt.no.: Prnjeci name/1*r•ter itt glee olIUGR''{' Duct wort 2332
Cross groin/directions to job site: Hydronic hot water system 2332
- Residential boiler(radiator or
hydronicl 23.32
Unit heaters(fuel-type.,not electric),
in-wall.in-duct,suspended.etc. 46.75
T Flue/vent for any of above 1 23.32
Subdivision: rt t 4, ! Ge, . 1 I,.L,'-- Lot no. I'm r 23,32
Other fact appliances:
fax map/parcel no.: Winer heater t , 2.1.32
r,' :, 7-r'Y - `e'lt:. Gia.Z "x : '+ark '!a t+ @ F +i & T'C - 2a}-i r . 'VV tA. I .33.39
.” a,z.r..��....-�. =.��.:tL.�3:.x,z.....�r u...n.��i�.�w���a.�r_ , �r,..ra� �+ki.,.S tea.;..+..�i Q43 f�laC:C/inStxt
Fine vett for vMaicr heater or gss
fireplace 2332
Log fielder fasts) 23.32
Woad/petictszove3339
Wood fireplace/insert v 1 2332
Chhnncy iner:tluervrnt , 23.32
8., Lq ,'-'f-1.!;'''',':''''',:-''''
2332"t--4.--,F ' K ➢ 6 CIYJ.=airK3i . . Other;t :4* ,I1_ ,� w sfke. , ,,T �_ i .1_ .', _ e x_.13,: }, .!r
Enriroamxatat=hunt Rad vcntoatlon:
Name:Polygon WIN,LLC Range hoodfother kitchen
Adclress;109 East Le'Street
equipment 33.39
Clothes dryer exhaust. _ t 3339 1
City/SlateiZIP:Vancouver,WA 98660 Single-duct exhaust(bathroom:;,V'
toilet compartments,utility rooms) Li- 23.32 ,
(360)69S-7700 Atticferawispacc fans 23.32
LEIA::.: f`:" 'roe ,f. `0-F x _:;Mi: nt i rn 6`.f' t t 4 r O' "'i .;Z Other. 2332
Business name:Polygon WL11,LLC
Fad plying:
31445 Gtr fust four,54.03 for r additional
name;Contact Angela GrajewskiFernee.tto.
Address:109 East 13th Street Gets heat rump
Wall/suspended/unit heater
CityiStaterLIF:Vancouver,WA t Water heater
Phone:(36 :(360)6934442 0)695-7700 Fireplace
E-mail:Aageht.Grajewski&xtlygonhatues.cotn
Ranke f
-T c _ Batbecuc
E-,`,,,,,-/.,,,,,',.;;',.,-.,, ...�.._,:n '',:?i=';'_. .-.;:','•:!"&.221-1':40-:,L-,,r 'fi c''F4.. ;1.V:..... .r. ...,z ....;
Clothes ddry
rytx(teas)
Business name:Apex Air LLC Other:
n
1 -'-',;;;;;T;..';',1,--- i' ..L.:- : 1,.--- Aub f ,— t -� .=
Address:18004 NE 72"Ave L a _.., :.� E
_�-;z ^lr rvs
Subtotal
City/State/ZfP:Vancouver,WA 98686 Minimum permit fee(90;00)
Phone:(36013424109 Fax:(360)3264769 Plan review(2S°rt of permit fee)
State surcharge(12%eofpermit fire)
CCB Ga:203034 TOTAL PERMIT FEE
This permit application expires ifs permit is sot obtained within luta
dt t after it has Meet accepted as mmpierr.
Authorized signature: ' Fee methodology set try Tri-County 11w0ding induatzt Servito Dowd
Prim name ("IL of I D� 4./.7.14, I
ligtuadtestl' tiMBC PermitXtp mart3Gx 444.14 07 11 102K.'4!.0 ES)
. 'IECEIVED , ....,.,:,..,,,,,..,:::
Electrical Permit Application FOR.OFFICE LSE 0\LY
City of Tigard - 2017 nD ra Permit ivi5i j/7-OOo
23125 SW Hall Blvd.,Tigard,OR 97223
ew
' Phone; 503.718.2439 Fax: 503.59 GARD Platt BY: Related Pcnmit d:
Inspatxion Line: 503.639.4175 �dy batelBy: bene See Page 2 far
1 16 A R D Interact www.tigard-o£ VT4 T,-,
► 9 : Supplemental Information
_ 3 r"..i ,a C P I : Y L?t '--+`_ �f � 7�• -4.-,-,14t,',;-4: ';� ` b f
...,,."•-,----..: � .-'-'.--;:-:-•i':a:2 dx�'T.3• � __t�i.L. ��n,/4. ?'v__K .� 1'k. �.�" - i��•�' '� Cj:�_.�.t��• n�'.11 r s.'>?ik x•ti,••„figi;�,
®New construction 0 Addition/alteration/replacement Please cheek all that apply(submit;sets ofplana wfttfema cid:
❑Demolition 0 Other0 Service or feeder 400 amps or mote Q Building over three stories.
em k,,-x A r�r1 wham the available holt Cornett [Marinas and boatyards.
Zr , a .ru ra ti;:"Pr c C0;?.f. �C0 x, _ - _ WPC 000 amps at 150 volts or El Plowing buildings.
®I-and 2-family dwelling 0 Cornmercial/iridtistrial 0 Accessory building> less to ground.or exceeds 14,000 Cl Commeectel-me agr1cultrai
Q Multi-family Q Master builderamps for a0 other inataeatioos. boIl@ings.•
0 Other: _ 0 Fac pump. El Installation of 150 KVA or
trr,,,A 'r-,..s s.6;; >:,�''4'nafi Nt.tF t p N,17,4,.-t 6,4c4 e•yFF?rn --' ` ''4j Pim
E;Addn mel'system• larger separately derived
Job#: 3ob site addressfl f't a �,{. ❑Mdition of new motor load of system_
r,. I ' +JVD! 1 tio\m J! Icofee:moo. ❑"A".'S","r-2",'I-3",
City/Sta e/ JP:Tigard,OR 97224 Q Six or more residential mots. occupancy.
p _ 0Ilealpt nate.facilities. Q Recreational vehicle parks.
Sulte/bldgJapt,tl: Project name:(Li 4 y T't7'P t't✓tt,'" t Jt •Hazardous locations. El Supply votive for s war more than
`►" 0 Service or feeder 600 sops or more.
Cross street/directions to job site: liV--t>_, i z ,J 0 mat r
Aeaedptlen Or,. l Bach Total
\k1 Tit y- a. Ai fi w i- I Ntw residential single-or multi-family dwelling unit
Subdivision: YLY vI/ Let#:1131 Includes attached garage,
,ax parcel 1.000 sq.R or less 168.54 4
Ea.edd'l 500 sq,ft or portion 433.92 1
°> >} .._,,,_rs-£-m".;s..s.:,.' _',-.. i R,:z e..1',IleO .1'E,'171;,�-�'-:t;TA da`4,!g'i:A', r✓,a,,,Z z.ef, .. Limited energy.residential
(with above Sq,ft) 75.00 2
Limited energy,multi-family 75.00 2
residential(with abovesq.ft)
Renewable Energy ❑ See Page 2
"-t'Ir s ' LI' r;�.�^. w" :`-Ke:, .4. ` , .`-ri''. '• -r' .A`Z„LM4-' -4 Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
Address:7600 E Doubletree Ranch Road 201 to 400 stripe 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 1 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or i
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 I I 125.052 •
Owner signature: Date: 401 amps to 599 amps 168.54 j 2
1. '>'zY, , r.r'w-+-u ,<" t',,i-, '. , „` -'Vol,'ii..3s .� Branch circuits-new,alteration,or extension,per panel p
' 6.Y-,,v-,,•,=--,4a ,,y. )_ t r' ,, .„,x rn,,4 '4k yY 1��"'J?Ib �-�• - .•,'^a V%7;: C
A,Fee for branch circuits with
Business name:William Lyon Homes,Inc. _ above service or feeder fee. 7.42 2
each branch circuit
Contact name:Angela Gr�ewsri B.Fee for branch
circuits without
service or*der fee,first
.Address:109 Bast 13th Street branch chtsrit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Eachadd'l branch circuit 7.42 2
Mis ellaneoos(service or feeder not included)
Phone:(360)695-7700 • • I Fax::(360)693-4442 Each manufbctured or modular 67.84 2
dwelling,serviceaad/orfeeder
Email.Angelakrajewsid@polygonhoutes.com
Reeratnect only 67.84 2
... -F;,q`"p;`-sem - _ . . . " z Pump orIrrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2
<".,. Signal eircit(s)or limited-energy
Address:6101 NE St Johns Rd panel,alteration,or erdeasion. 0 See Page 2 2
-
City/State/ZIP:Vancouver WA 98661 Each additional inspection over allowable In any of the above ,
Additional inspecdoa(I hr min) 66.25/hr
Phone:(253)320-1657 Fax:( ) 7nwestigation(1 iambi) 50.00/hr
Email:bdaniels@gweusa.com
Industrial plant(i hr min) • 78.78/hr 2
Inspections fbrwhich no fee is 90.00/hr
CCB Lie.: 01158 Electrical Lk.:
208174 Suprv.Lac:: 44965 .`: ' � Yhaled(- mi°•
3•
" aE �,-_ra�,; rte ::•17j::1-_,,,;4-:.4::, 1
Stp .FICCfIiCial signature,required: / � . y,'=
•
Subtotal
i1
7 Print name: Joan P Albert • Date: 4/26/2016 0 Plan Reviewui ed(25%of
Reqpermit fee):
5`. `• r' State surcharge(12%Of permit fee):
`'f`�; _ _ 7. TOTAL Maar FEE:
,;I'.;•;; Authorized signature: -
This permit application expires its permitis sot obtained within 180
:•01't Print name: Bill Daniels Date: 4/26/2016 days alter It Isms been accepted as complete.
a=iF; ::i * Number of inspections allowed per permit.
...t,t4 etBuilebs PemeBallii.0 PenaltApp t.R MEd=Rev minus inoiS 44046157t11/0SZO VV. a
i„.-111:,,i1x.:: i _
Plumbing Permit Application
Building Fixtures J A N 1.7 ?Jill :
City of Tigard 'g' ltxelved s l�Y.7// cat^`��
13126 SW Hall Blvd.,Tigard,OR �3 �'A ter. Permit No
IPhare: S03.7)82439 Fax 191dAf�; I i' 1 )N atc/By: Other Permit No.:
11., .,t' LtspectionLi e: 503.639.41 T5 II599�1 1 liDate Ready/Br.. y4 t„ir RI Sec Page 2for
Internet www.tigani-or.gov Notifiad/Aleibod: Supplemental Information
®New construction ' 0 Demoliton For speciallffarnmhen use checkl t
❑Addidon/alterationheplacement 0 Other
Description 1 Qty. 1 Ea 1 Total
New 1-2-family dwellings(includes 300 S.for each utility connection)
:t. '' ,. .CA GORY OF CONSTROC[iCf ' : . . •SFR(I)bath 312.70
®I-and 2-family dwelling 0 Commercial!mdustrial SFR(2)bath 437.78
SFR(3)bath I 50032
0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02
Master builder ❑ erFire sprinkler(_,,,__sq.IL) Page 2
.. : dOB arra INFORMATION'AND-LOCAIION . She utilities:
Job site address:ntIi2.- sw 0 rfr3:S...01LL1V StCatch basin or area drain 18.76
Aryweti,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft..:, ) Page 2
Sultelbldgfapt.no.: 1 Project name: giV r *Te-n/aLt, JU -- Menufaahued 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 f: ) I Page 2
Subdivision:giNmaartct lv a/Wer t_wit Lot no.:13y Fixture or item:
Tax map/parel no.: Y1 Backflow prevent= I 31.27
• DF.SCREPTION OF.WORK. • Backwater valve j 12.51
•
Clothes washer 25.02
Dishwasher 25.02 _
Drinking fountain 25.02
Ejectors/num r 25.02
tt:TROPERTY OWNER - , I. 0 TENANT Expansion tank . 12.51
Name:ADVL Land Holdings,LLC Fixhve/sewar cap 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Road
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phoaa(602)694-4031 I Fax:( ) Ice maker 12.51
. 1t APFIACANT. . 1i CONTACT PERSON• Interceptor/grease trap 25.02
Business name:William Lyon Homes,Inc Medical gas(vale $"_) Page 2
Contact name:Angela Grajwski Primer 12.51
e
Roof drain(commercial) 12.51
Address:109 East 13th Street Sink/basin/lavatory 25.02
City/State/Z/P:Vancouver,WA 98660 Solar units(potable water) 62.54
.
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:Angela.Grajewski®polygoahomeacom Urinal 25.02
Water closet 25.02
CON) tACTOR . Water beater 37.52
Business name:Maimedal Enterprises Inc.
Water pipiag/DW V 56.29
Address;PO Box 207 Other: 25.02
City/State/ZIP:Ranks,OR 97106 Subtotal ,
Phone:(503)324.0759 Fax:(503-)324-0580 Minimum permit fee: 872.50
Plan review (25%of permit fee)
' CCB Lie.:102535 'Plumbing lie.no.:34-276PB
State surcharge(12%of permit fee)
Authorized signature: C.---------k TOTAL PERMIT FEE
penult lt application expires if a permit is not obtained within 180 days
Print name:Carolina Malmedel Date:04/25/2016atter it has been accepted as complete.
*Fee methodology set by Tri-County Buffing Industry Service Board.
Lehi ru9MendtdPU J.PetaelAppdoe 10/01/09 440-4616T(10/02ICOM/WEa)
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
IIC
TIGARD Building Permit Review — Residential
Building Permit #: /Jf j /7 --- y1/5--
Site
Site Address: ,---1141-2-' .Sv\i It eS4- tkoilt-N SA-.
Project Name: -\\i-er Tet race Nei vie k- Lot #: 1971'
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: T\i-CLAi j' Z-
Ati Verify site address/suite#exists and active in permit system.
X.,giver Terrace Neighborhood: ❑ No Nr Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
ree(3)copies of site plan xisting structures on site
I►site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
Nprawn to scale(standard architect or engineer scale) floor elevations
`
litNorth arrow Utility locations(required for new,may apply for additions)
IN: *l
Site address,project or subdivision name and lot number 1[ocation of wells/septic systems
Applicant information(name and phone number) *Existing trees to be retained with drip line,and tree
,Lot dimensions and building setback dimensions protection measures
A,ot area,building coverage area,percentage of coverage and treet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) treet names
.'roperty 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 tg.No Received: ❑ Yes ❑ No
.E.SC Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified IX No Applied For: ❑ Yes ❑ No,stop intake
fa Land Use Case#: ?pacts-ccoos
Zoning: R=1 ((=1S )
Required Setbacks: Front $ Rear
IQ Side 3 Street Side rl A Garage 7„0
N. Landscape Requirement: 20 %
Lot Coverage Maximum: %
Building Height: Maximum Height N'A Actual Height }211
Visual Clearance
..X.Easements
.a Sensitive Lands: ❑ Yes 141. No Type
a Urban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes: tertirtions 511A lit, nv.i. cnoY 10 k cutxxxcp.
Approved By Planning: 1 ' (VQ-U4- Date: 12_125-1,(i to
Revisions (after Building Submi .1 only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\BuildingTorms\BldgPermitRvw RES 091216.docx
F' ,,
Building Permit Submittal
Original Submittal Date: /2/2e//„
Site Plans: # 3
Building Plans: # _3
Building Permit#: KT-Enter building permit#above.
Workflow Routing: R.—Planning a-Engineering [-Permit Coordinator Q. ding
Workflow Sign-off: Er Sign-off for Planning(include notes from planning review)
Route Application Documents: CE'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Er Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Atit
-Il Date: /AV,7
Engineering Review
f�Slope at building pad: /S:Z.
/ 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: I4 ]7 Date: l-��--17
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: /����►' liate: i 3' / q
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: IPf es ❑ N/A
Tigard Trans SDC: !'' es ❑ N/A
Parks SDC: ii-Yes ❑ N/A
to Issue Permit
Date: �2. //
Approved by Permit Coordinator:
/1
I:\BuildingForms\BldgPermitRvw_RES_091216.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17412 SW FOREST HOLLOW ST, BEAVERTON, November 27, 2017 at
OR, 97007 1 :37:00 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00045
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17412 SW FOREST HOLLOW ST, BEAVERTON, November 29, 2017 at
OR, 97007 12:47:30 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00045
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed.
Water pressure = 45 psi
Violation Summary:
Inspector Contractor