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Permit (103) CITY OF TIGARD MASTER PERMIT a f COMMUNITY DEVELOPMENT Permit#: MST2017-00085 Date Issued: 04/17/2017 T fcal, FC D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AC15000 Jurisdiction: Tigard Site address: 12839 SW 133RD AVE Subdivision: WALNUT RIDGE Lot: 4 Project: Walnut Ridge, Lot 4 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1670 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 1723 sf Garage: 532 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 3393 sf Value: $410,607.17 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: 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 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: 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 3393 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: 503-645-0986 PHONE: 503-645-0986 FAX: 503-690-2942 Total Fees: $32,006.18 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 1.800,3 A t (.6Z Issued By: L% 4611.706. 4tiFs __ Permittee Signature: ; fri 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 th' project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Y Residential A FOR OFF1cF I s1.Oy1.1 F d Cl of Tigard �d h�+ Received "I }�� �'. Permit No.: `'J g lt-E '` .�sy e.�` Date/By: /� 02-) 17 � .�J� � ii 13125 SW Hall Blvd.,Tigard,O / l S Plan Review Phone: 503.718.2439 Fax: 503.598.1960 p�—.. 7 17 Other Permit:S r,.4/ 0 j 7iZ v7 Date/By: tJ� 1- i ^It 1 J Inspection Line: 503.639.4175 F ((�� ?;i ;' Date Ready/By: 7 Jura: ® See Page 2 for Internet: www.tigard-or.gov o t_ Notified/Metho �A/ ���� 7-. ..--6° I Supplemental Information TYPE OI0.%.,.,.. REQUIRED DATA:1-AND 2-FAMILY DWELLING I'�i mi' r1 SIO ' ®New construction tib>i° 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 CATEGORY OF CONSTRUCTION work indicated on this application. k ® 1-and 2-family dwelling ElCommercial/industrial Valuation: $ O, ! .�J ❑Accessory building ElMulti-familyNumber of bedrooms: 5 tt�� ❑Master builder 0 Other: Number of bathrooms:+3�6, _ `' JOB SITE INFORMATION AND LOCATION Total number of floors: 2 L.` _. Job site address:12839 SW 133'Ave New dwelling area: X338Z 3 98guare -et 3 s-' City/State/ZIP:Tigard,OR 97223 Garage/carport area: ,.r e feet Suite/bldg./apt.no.: Project name:Walnut Ridge Covered porch area: -2,02,6-6 square feet'7 a3 Cross street/directions to job site:SW Walnut&SW 133"Ave. ~lS a 0 square feet "Tv 6_ i Other structure area: 0 square feet ) C 7 o REQUIRED DATA:COMMERCIAL-USE CHE'.CKLIST Subdivision:Walnut Ridge Lot no.:04 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 DESCRIPTION OF WORK work indicated on this application. Construction of SFR Home Valuation: $ Existing building area: square feet New building area: square feet i_ PROPERTY OWNER 0 TENANT 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: 0 APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name:Same as Above (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name:Brett Groves FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application: Phone: Amount received: ( ) Fax::( ) E-mail:bgroves@riversidehome.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial 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: l� ' This permit application expires if a permit is not obtained ✓✓✓/ within 180 days after it has been accepted as complete. Print name:Brett Groves Date:2/20/17 *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 Tigard x ( 'ived ,, ll - ale/B Permit No.: may, r �,, u 13125 SW Hall Blvd.,Tigard,OR 97223 ,,1 1 y' S/�'7 :1�> t, ! Plan Review I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: Date By: I i C. K t> Inspection Line: 503.639.4175 \y Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard-or.gov L EB Notified/Method: Supplemental Information ir�. .+:,1 r o- ,.�r ,err* ?,� -,_. '!' 4 _ -- ..- ?e. „¢;m�-+a3 _ �, ' s * '4 Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/r n'. performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. -... rw, ' ' - # `� -t. ;" 42 ks:'. .. ',;�. 'c,- ' a' Value : ..# i ® 1-and 2-family dwelling 0 Commercial/industrial (s, nra ❑Accessory building For pecial information use checklist. ❑Multi-family ❑Master builder 0 Other: DescriptionIQty. I Ea. 1 Total ,w *: p�� �W," Heating/cooting: � � �"` Air conditioning 1 46.75 46.75 Job site address: 12839 SW 133rd Ave. Furnace 100,000 BTU(ducts vests) 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.: I Project name: Walnut Ridge Duct work 1 23.32 93 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 I Lot no.: 004 Other: 23.32 Other fuel appliances: Tax map/parcel no.: " Water heater 1 23.32 23 32I r ( t r I '8 t _ Gas fireplace/insert '1 33.39 13:1(4" , ; _ -', ta : "�t Flue vent for water heater or gas Construction of SFR fireplace 1 23.32 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 _- Other: .,,; t .• ' , F-. a 23.32 4 .4' °''�„s.. ' Environmental exhaust and ventilation: Name: Riverside Homes, LLC Range hood/other kitchen equipment Address: 1 33.39 33.39 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) 5 23.32 116.60 Phone:( 503) 645-0986 Fax:( ) Attic/crawlspace fans 23.32 'f .x� a.,a. . it t It . 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 1 14.15 Phone:( ) I Fax::( ) Fireplace 1 14.15 Range 1 14.15 E-mail: bgroves@riversidehome.com Barbecue -,.;.. ' tit-' . '4' . . 4. !4 Clothes dryer(gas) Business name: Pyramid Heating&Cooling Other: I Jam` M Address: 9409 NE Colfax St. subtotal 46(1 15 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 pennit fee) CCB lic.: 59382 , /,.//2c/rl 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: * Fee methodology set by Tri-County Building Industry Service Board Print name: Brett Groves Date: 02/20/2017 I:\Building\Permits\MEC_PerntitApp 040113.doc 440-4617T(11/02/COM/WEB) Electrical Permit Application b 1-� 0 ' FOR OFFICE L Si 011.1 City of Tigard ,it"s..' d Received :, u 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 .y !lj f Date/B :III Related Permit#: Inspection Line: 503.639.4175 \:"I:Ci j' Ready Date/By: Juris: ® See Page 2 for l I(,A h 1) Internet: www.tigard-or.gov fied/Method: ,1 lit' Supplemental Information TYPE OF WORK A 31 1 '-4,' 1 �� PLAN REVIEW aMo-1 ` Please check all that apply(submit sets of plans w/items checked): 23 New construction 0 Addition/alteratiolpt1a IL.o, ❑Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 12839 SW 133rd Ave 100HP or more. ❑"A","E","1-2","1-3", ❑Six or more residential units. occupancy. City/State/ZIP: Tigard, OR 97223 0Recreational vehicle ❑Health-care facilities. parks. Suite/bldg./apt.#: Project name: Walnut Ridge 0 Hazardous locations. ❑Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: SW Walnut&SW 133rd Ave. FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Walnut Ridge Lot#: 004 Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential Construction of SFR (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 (B,PROPERTY OWNER 0 TENANT 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 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 Branch circuits—new,alteration,or extension,per panel CI APPLICANT CI CONTACT PERSON 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 service or feeder fee,first Address: branch circuit 56.18 2 City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: bgroves@riversidehome.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Garner Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: 2920 SE Brookwood Ave#1 panel,alteration,or extension. 0 See Page 2 2 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 Email: ge@garnerelectric.com 34f.r 3o Ste, Industrial plant(1 hr min) 78.18/hr / Inspections for which no fee is CCB Lic.: 121159 Electrical Lic.:4747-5-- Suprv.Lic.: 37075 specifically listed(%hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: AdZA Subtotal: Print name: Chuck Garner Date: 02/20/2017 0 Plan Review Required(25%of permit fee): State surcharge T L 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: 02/20/2017 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitAppELR_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: i i..T47a ri "�,�t.,S7 �x'�`�;° � ..�'�` .��sc.4 ,� ,C'.5 � �`*�`•,�„ .i;- �t. T Demi�[ion lie t.for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 _© 5.01 to 15 kva 111. 133.56 _© ❑ Audio and Stereo Systems* 15.01 to 25 kva I. 200.34 _© Wind •eneration s stems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 _© 50.01 to 100 kva 11.1 552.26 _© ❑X Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040 ■ 552.26 —© ❑X Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 _© ❑ Vacuum Systems* >100 kva—no additional charge 0.0 _© Each additional ins ection over allowable in an of the above: ❑ Other: Each additional inspection is ■ 66.25/hr —� charred at an hourl 1 lir min Inspections for which no fee is ■ 90.00/hr _. s•:ificall listed %hr min Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 , Number of inspections allowed per perm,[. (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 ❑ Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling El Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:'Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/172015 Plumbing Permit Application ' Building Fixtures y1.,,immillEsommimmi Cityof Tl and .41 Received g 1 °- Permit No.: Plan :S% '/7_a-,!:,,,,,,73-5.- 11 v u 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 ,i-1 a' Review Inspection Line: 503.639.4175 V. -.B � s �. �_��`' Date/By: Other Permit No.: L [C A I.L) t D e Ready/By: Jurist H See Page 2 for Internet: www.tigard-or.gov �- ';(Le - ,� ,� - ethod: SupplementalIuformahon ®New construction 0 De, ,,'VITA', For special information use checklist Description I Qty. I Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) ah ct y.• ' r SFR(1)bath _AIM 312.70'4 .v- .te , ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 K �- Cr �- tis : i • t' :rw 4: Site utilities: Job site address: 12839 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.linear ft.:_ ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: Walnut Ridge I Lot no.: 04 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 , , Backwater valve 12.51 Clothes washer 25.02 Construction of SFR Home Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 a a ' t t 'x a; ( a s • h ,- $ -•c 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 Garbage disposal 25.02 City/State/ZIP: Beaverton, OR 97006 Hose bib 25.02 Phone:(503) 645-0986 Fax:( ) Ice maker 12.51 k. • t ; Interceptor/grease trap 25.02 „z, !...•. t ' r at, , . 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: brroves@riversidehome.com Urinal 25.02 , Water closet • ° 25.02 : y ,4t ` 1{,.'�x t e Water heater 37.52 Business name: H &H Mechanical Water piping/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 Plan review (25%of permit fee) CCB Lic.: 178122 ! „ Plumbi t c no.: PB414 State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Brett roves Date: 02/20/2017 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-PemitApp.doc 10/01/09 440-4016T(l0/02/COM/WEB) City of Tigard q COMMUNITY DEVELOPMENT DEPARTMENT ■ T l c A R D Building Permit Review — Residential Building Permit #: cj S j a0/7_666 tt Site Address: P s 9 S ) J -srzt, , ve Project Name: , h - / , Lot #: 2-72 (New dwelling=subdivision name dation or Alteration=last name of owner) Planning Review Proposal: /A)40 -C%-'1 ----g, Verify site address/suite# exists and acti in permit system. 'Elver Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached Si Plan Elements: ree(3)copies of site plan '.. ..sting structures on site Ate plan must be on 8 1/2"x 11"or 11 x 17"paper A Footprint of new structure(including decks)with finished VFyawn to scale(standard architect or engineer scale) foot elevations orth arrow U.• locations(required for new,may apply for additions) o address,project or subdivision name and lot number : anon of wells/septic systems plicant information(name and phone number)1 � xisting trees to be retained with drip line,and tree t .. ensions and building setback dimensions otection measures 1.3 f 1.16 area,building coverage area,percentage of coverage and reet tree size,type and location pervious area(applicable if R-7,R-12,R-25&R-40) Street names iA Property corner elevations (2 foot contour lines if more than 4 foot differential i 11 , lean Water Services—Service Provider Lett: (lot platted prior to 9/10/1995): Required: ❑ es,applicant was notified T4 No Received: ❑ Yes ❑ No Il Public Facili . s Improvement(PFI)Permit: /Required: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake Land Use Case#: tia6 /'/ 060// I I oning. R— Required Setbacks: ront ,_ . ( Rear Side ,S Street Sidew ,44as no �V andscape Requirement: 0,Kot Coverage Maximum: % " CI Building Height: Maximum Height t: / Actual Height ! f' isual Clearance /A Easements VJ' ensitive Lands: CI Yes ❑ No Type I rban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: Date: f Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved El Not Approved I:\Building\Forms\BldgPermitRvw_RES_091216.docx Building Permit Submittal Original Submittal Date: 2/J.)/l 7 Site Plans: # '3 Building Plans: / __ Building Permit#: nter building permiitt#above. Workflow Routing: lanning L7 Rngineering C ermit Coordinator L+— ding Workflow Sign-off: 0.J3ign-off for Planning(include notes from planning review) Route Application Documents: 0,.E'ngineering: (1) copy of permit application, (1) site plan, (1) building plan and ,� ori inal plan review routing form. L13uilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: , Date: A )y /7 ,r Engineering Review Slope at building pad: Vi; 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: ❑ YesNo LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: I1L2," Date: �8,1 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: 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: ill/ es ❑ N/A Tigard Trans SDC: 1*Yes ❑ N/A Parks SDC: 211 Yes ❑ N/A OK to Issue Permit Approved by Permit Coordinator: Date: 3//// I:\Building\Forms\BldgPermitRvw_RES_091216.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12839 SW 133RD AVE, TIGARD, OR, 97223 August 29, 2017 at 11 :42:07 AM Record Type: Record ID: Residential - Master Permit MST2017-00085 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12839 SW 133RD AVE, TIGARD, OR, 97223 August 29, 2017 at 11 :43:07 AM Record Type: Record ID: Residential - Master Permit MST2017-00085 Inspection Type: Inspector: 699 Mechanical final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12839 SW 133RD AVE, TIGARD, OR, 97223 August 29, 2017 at 11 :41 :22 AM Record Type: Record ID: Residential - Master Permit MST2017-00085 Inspection Type: Inspector: 199 Electrical final Aaron Cillo-Gobel Result: PASS Comments: Violation Summary: Inspector Contractor