Permit (31) CITY OF TIGARD MASTER PERMIT
111.' ..-. COMMUNITY DEVELOPMENT Permit#: MST2017-00009
TEG RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/14/2017
Parcel: 2 S 106 D B 12900
Jurisdiction: Tigard
Site address: 17375 SW SHADOW TRAIL ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 129
Project: River Terrace Northwest, Lot 129
Project Description: New SF. 4/12/17: REPRINT to add patio cover.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 978 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1251 sf Garage: 380 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2229 sf Value: $273,680.89 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'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
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 2229
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
BY FORSUM,MICHAEL 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660 2 Fire Rated Eaves-Both
STE 1 Sides
SCOTTSDALE,AZ 85258
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $32,284.18
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 503.232.1987 or 1.800.332.2344.
•
Issued By: Permittee Signature: c>0'r ale/'G ‘
��9I�2%2
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.
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
11111
Transmittal s ittal Letter
T f G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Tom H. DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
APR 3 2017
FROM: Angela Grajewski CITY Of TIGARD
COMPANY: Polygon Northwest BUILDING DIVISION
PHONE: 971-212-2144 By:
RE: 17375 SW Shadow Trails ST MST2017-00009
(Site Address) (Permit Number)
River Terrace Northwest Lot 129
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies:. d.0 rai..: : s
�3e�'er><pt><oA�: � .' Capi<''es.-. Oeicr>lpi�iTn• �y ..F..
0 Additional set(s) of plans. 3 Revisions: deck A o e .,
0 Cross section(s) and details. 0 Wall bracing and/ lateral analysis.
0 Floor/roof framing. 0 Basement and retaining walls.
0 Beam calculations. 0 Engineer's calculations.
0 Other(explain):
REMARKS: Please pay fees owed with Trust Account.
add deck due to terrain j )-to ►�
p466 Co..rev
': - FUR OFFICE USE ON .�. ,.,.
Routed to Permit Technician: Date: t f l d )7 Initials:
Fees Due: Yes ❑No Fee Description: ount Du :
A
$�nC
�,• )ter r�v: r� $ oz4 4cr
kv
Special
Instructions:
Reprint Permit(per PE): Yes ❑No ❑ Done
Applicant Notified: %-z ate: 3 j Initials: xo
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
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City of Tigard
"II ■ COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
T1G,ARD
Building Permit #: CI S i /7 — d e Q O 2
Site Address: t13f15 <S\Nl S 004 Twit t Wee'
Project Name: 12.Wer .1-efftk f N Ntsitg-Y Lot #: 1/61
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: LLL!J - "9- /2144/ r.6,14------4t4O G°e r✓'
Verify site address/suite#exists and active in permit system.
,K River Terrace Neighborhood: ❑ No ,Yes,See RiverTomoReview Addendum Attached
Site Plan Elements:
.three(3)copies of site plan sting structures on site
„Site plan mist lj 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 %Jtility locations(required for new,may apply for additions)
,Site address,project or subdivision name and lot numberhilt tion of wells/septic systems
. plicant information(name and phone number) Existing trees to be retained with drip line,and tree
t dimensions and building setback dimensions protection measures
Blot 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
roperty corner elevations(2 foot contour lines if more than
foot differential)
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified X No Received: El Yes 0 No
V.Public Facilities Improvement(PFI)Permit:
Required: 0 Yes,applicant was notified No Applied For. 0 Yes 0 No,stop intake
Land Use Case#: R. • — S
Zoning 9.---1(._P
Required Setbacks: Front 23 Rear IC) Side Street Side Iv Garage
Landscape Requirement 7,4e2 "A)
•Lot Coverage Maximum: %
'< Building Height MaximumHeight NA- Actual Height' .2q
• ,
Visual Clearance
Easements
Sensitive Lands: 0 Yes 1511 No Type
Urban Forestry Plan
Conditi ns"Met"prior to issuanceofbuilding permit
Notes: �(*IS 61 ki prr lb tsvanc.p
Approved By Planning: 4f/ 4 4 Date: ‘2_12.2.1 1 T
Revisions(after Building Submitta ,nly) Review Date
Revision 1: Ie Approved ❑ Not Approved *NA '7t t 1„� 14 I t
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Buildingg\Forms\BldgPennitRvw_RES 091216.docx
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Building Permit Submittal
Original Submittal Date: / /)-efr7
Site Plans: # '3
Building Plans: # 3
Building Permit#: [r Enter building permit#above.
Workflow Routing. 9''`Planning engineering W—Permit Coordinator nilding
Workflow Sign-off: QrSign-off for Planning(include notes from planning review) '
Route Application Documents: .E) 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: /Y)//2
Engineering Review
■ Slope at building pad: ` _4,.
0 onditions"Met"prior to isnance of building permit O/ fee
0 Easements (encroachments)per engineering conditions of approval and plat
0 Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes 0 No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot 0 Yes 0 No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: ____,Z) Date: /...-4‘747._
Revisions(after uilding Submittal only) R��r Date
Revision 1: Approved 0 Not Approved
Revision 2: Approved 0 Not Approved
Revision 3: ❑ Approved 0 Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
pproved,NOT Released:(Vga
��� G' 2'1"- -
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
Fees Entered: Wash Co Trans Dev Tax: 'es 0 N/A
7IEFF'SDC
Tigard Trans SDC: 7bYes 0 N/A
Parks SDC: Yes ❑ N/A
'Z./ OK to Issue Permit Afr
Approved by Permit Coordinator. /���/012---De: ///t li .---
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17375 SW SHADOW TRAIL ST, BEAVERTON, September 1 , 2017 at
OR, 97007 11 :58:02 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00009
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:
17375 SW SHADOW TRAIL ST, BEAVERTON, September 13, 2017 at
OR, 97007 10:10:04 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00009
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
Moisture barrier acknowledgement 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.
Note: Carlson reports received for hold downs
Violation Summary:
Inspector Contractor