Permit CITY OF TIGARD +, MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2017-00163
T[G AR13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 1 Date Issued: 05/31/2017
Parcel: 1 S 135 DC09000
Jurisdiction: Tigard
Site address: 11625 SW 91ST AVE
Subdivision: CHARBEN Lot: 8
Project: Pacific Evergreen Homes
Project Description: New SF with 462 sf attached garage, and(2)detached garages of 480 sf each for a total of(3)
garages. 8/7/17, REPRINTED to add(4)mini splits(2 of detached garages&2 for house).
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 883 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1247 sf Garage: 1422 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right 5 Detectors: Yes
Total: 2130 sf Value: $304,747.56 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Drains: 0
Water Lines: 100 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: 4 Clothes Dryers: 1
Natural Gas Heat Pump: Y Hoods: 1 Other Units: 4 Hi 01 SPL.'r
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K:
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 2130
Owner: Contractor:
PACIFIC EVERGREEN HOMES PACIFIC EVERGREEN HOMES LLC Required Items and Reports(Conditions)
7410 SW OLESON RD STE 133 7410 SW OLESON ROAD#133 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 PORTLAND,OR 97034
PHONE: 503-664-6423 PHONE: 503-664-6423
FAX: 503-671-0204
Total Fees: $29,921.03
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT e Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 .010 through O.' 95 :q1-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2/1987 or 1.8.2.332. 44.
Issue. By: / 0
Permittee Signature: i </
_.j
Call 503.639.4175 by 7:00 a.m.for the next available inspecti.n.ate.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applifft FOR OFFICE USE ONLY
City of Tigard El VEDReceived
Date/By: Permit No.:
II . 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
' I Phone: 503.718.2439 Fax: 503.598.lUIE 7 2017 Date/By: Other Permit:
TIGARD
Inspection Line: 503.639.4175
Date Ready/By: Alas' FZI See Page 2 for
OF TIG
Internet: www.tigard-or.gov CITY 'ARO Notified/Method: Supplemental Information
BUILDING ENVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
[6‹w construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
o Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Eland 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: p 6 g.,5 6"/4_.) ?741,(..t, Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: /2 ioAcif Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: 6//1-6/4e7/ Duct work 23.32
Cross street/directions to job site: frnhe 7_ , 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DistitipTio14,OF WORK 5,,,,i, ., . ,..0. $ ‘3, , Gas fireplace/insert 33.39
_.... ,....,,,, J.' 5 0- Flue vent for water heater or gas
y44+4). aliki.4t (q ) Nut‘i tto fireplace 23.32
Log lighter(gas) 23.32
li J1--C/Y1A0-0-€ - AZ,-0...19 • Wood/pellet stove 33.39
Cfr•LA
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
23.32
Z4liQPiRTY OWNER 4 :' 14 ‘' • - 3 ,"Aki• Other:
la,s 4 • 4 4 ,, • ' '''' d, ", 4' ' Environmental exhaust and ventilation:
Name: ?a .A
Lt. (-- 261 14 es
&a/yr(7,te tf ' 7
, l Range hood/other kitchen
equipment 33.39
Address: i--//u _s til (.21esoo ,?d /33 Clothes dryer exhaust 33.39
i
Single-duct exhaust(bathrooms,
City/State/ZIP: -?6,y- O t- Fax:( )1'1,7I 3
7 - R 6,„z 7
aceenfants
• 'S' 0 40 00--4.4)iPc°, i:' 70700210,00 Li/ A0r47*.t*** : t" i Other:
Atottiliect/ccraomwpisarptm
compartments, rooms) 2233..3322
Phone:(503) i
23.32
Fuel piping:
Business name: c f, p
-...)vi(14-,-- $14.15 for first four;$4.03 for each additional
Contact name: A/0 t 1 ‘.._oft4i ej 6)46 Furnace,etc.
Gas heat pump
Address: 7 3 90 5 k),2a},/00 st
Wall/suspended/unit heater
City/State/ZIP: ‘Aeali_6404 o . Water heater
Phone:(co 3) 4,6, 3 .._6c2. Fax::( ) Fireplace
Range
0
E-mail: Thews c,:2‘- 0-nad,co al ,
Barbecue
,,../1,4 v4 ' 'fr"' 4 CONTRACTOR 1.:.,, 4$,., ::: r' 144,44 ''';''4 -4 ' Clothes dryer(gas)
O
Business name: ",
v ,, _,/,,
„ ,saht,i„ _ ther:
,,, 44 t Mt-CANICAt 4i
Address: /g 7-00 L5 40 itza.//,j/ve/ Subtotal
Minimum permit fee($90.00)
City/State/ZIP: 77,•(,frr a O.g q .2.2„3
Plan review(25%of permit fee)
Phone:(S-03) svi_ y 0 O/ Fax:( )
State surcharge(12%of permit fee)
CCB lie.: / e/q i'/1/ r
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: ii" * Fee methodology set by Tti-County Building Industry Service Board
Print name: - 64)4.56a., — Date:
MBuilchngTermits\MEC_permitApp(0401gdoc 440-4617T(11/02/COM/WEB)
MPageechanical2 Permit ApplicationInformation - City of Tigard
- Supplemental
Commercial& Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
101 11 1 'CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT 'b �` r Permit#: MST2017-00163
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 0Irian Date Issued: 05/31/2017
Parcel: 1 S 135DC09000
Site address: 11625 SW 91ST AVE Jurisdiction: Tigard
Subdivision: CHARBEN Lot: 8
Project: Pacific Evergreen Homes
Project Description: New SF with 462 sf attached garage, and(2)detached garages of 480 sf each for a total of(3)
garages. 8/7/17, REPRINTED to add (4)mini splits(2 of detached garages&2 for house).
BUILDING c/7/» fIlAnJr h -re .4 ob (6 Lti:SAZrCAL. Ckenses
Floor Areas Required Setbacks �fiBlr cR ��
Stories: 2 Bedrooms: 4 Required
First: 883 sf Basement: 0 sf Left: 5
Height: 24 Parking Spaces: 0
9 Bathrooms: 3 Second: 1247 sf Garage: 1422 sf Front: 20
Dwelling Units: 1 Smoke
Third: 0 sf Right: 5 Detectors: Yes
Total: 2130 sf Value: $304,747.56 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays: 1
Y Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0
Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: i 0
Water Lines: 100 Drains: Catch Basins: 0
Footing Drain. 0 Ice Maker: 1 Hose Bib: 2 Bckflw Prevntr: 0
Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 4
Clothes Dryers: 1
Natural Gas Heat Pump: Y Hoods: 1
Other Units: 4
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K:
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders
Branch Circuits
1000 sf or less: 1 0-200 • 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: Y
Ecompasing:
BUILDING INFO
Class of Work: Type of Use:
NEW Type of Constr: Occupancy Group: Square Feet:
SF VB R-3
2130
Owner: Contractor:
PACIFIC EVERGREEN HOMES PACIFIC EVERGREEN HOMES LLC Required Items and Reports(Conditions)
7410 SW OLESON RD STE 133 7410 SW OLESON ROAD#133 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 PORTLAND,OR 97034
PHONE: 503-664-6423 PHONE: 503-664-6423
FAX: 503-671-0204
Total Fees: $30,033.81
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
952-001-00/ ough 952-0 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 2.198 or 1.8 .332.2344.
Issued B10}/HPermittee Signature: . Lel G4" L
Call 503.639.4175 by 7:00 a.m.for the next available inspe ion 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.
Electrical Permit APDlicatiE1V
vir City of Tigard Received �
13125 SW Hall Blvd.,Tigard,OR 9722A U G 7 1 Date/B : •,� ...<4
Permit#: 1�p'�D/ -../
Phone: 503.7182439 Fax: 503.5 O t 1111/1
Plan Review
Inspection Line: 503.639.4175 98.1960 �y r TIGARD./��y f� Date/B : Related Permit#:
T 1(;at tt[) Internet: www,tiga 3 or.gov CITY `�'r + 7P 1 fl L3 Ready Date/By: Jura: �l See Page 2 for
_ k Notified/Method: Supplerseatal ipfortnation
TYPE OF WORK i kI.
❑New construction `� PLAN REVIEW
0 Addition/alteration/replacement
Please cheek all that apply(submit 2 sets of plans wfitems checked): t
❑Demolition
❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
CATEGORY OF CONSTRUCTION where the available fault current' . ❑Marinas and boatyards. 1
❑ 1-and 2-family dwellingexceeds 10,000 amps at 150 volts or [❑Floating buildings
0Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
0 Multi-family 0 Master builder 0 amps for all other installations. buildings.
Other: 0 Fire pump,
JOB SITE INFORMATION AND LOCATION ❑Installation of 150 KVA or
Job#: ❑Emergency system. larger separately derived
Job site address: a� mom
(�Addition of new motor of system.
City/State/ZIP: •LJ I 10011P or more.
occupancy.
cc
❑Six or more residential units,
occupation.
Suite/bldg.(apt.#: 0 Health-care facilities: Recreational vehicle parks.
Project name:
Cross street/directions to job site: ❑ServiHazace
8ou>;locations. t CI Supply voltage ibr more than
❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Demi.ion ilIMINIMMIIII Total
Subdivision: New residential single-or multi-family dwelling unit, •
—_______`— Lot#: Includes attached garage.
Tax map/parcel 4:
1,000 sq.ft.or less 168:54 MI 4
DESCRIPTION OF WORK Ea.add'I 500 sq:ft or
portion 33.92
Ira i. el:>"TiSa!��1� ��� � Limited 1
�gy,.,fdential
A, with above 8 75.00 2
f ___.__. [,invited energ•
y,multi-family
• MIMI
J�:S,OPERTY OWNER residential with above ft. 75,00
' ❑ TENANT Renewable Ener 11.111 2
Name: ' Services or feeders installation alter -e 2
lC C rr1 .?E
Address: ��' - 200 amps or less 100.70 111.1111 and/or relocation
City/State/ZIP: �t7✓71IG 1 f -(5(f+ 201 amps to 400 amps
133.56 2
�✓ 401 amps to 600 amps 2
Phone:(503) (3~ 601 amps to 1,000 amps
200.34
2
Email: Over Low 302:04MIN 2
amps or nolle 552:26
INN Owner installation: is being made on propertyTemporary services or feeders installs 2
Owintener i for sale,lease,This installation,or exchange,i that I own which is not relocation200amps installation,alteration,and/or
according to ORS 447,449,670,and 701. or less
Owner signature: 201 amps59.36
Date: to 400 amps ]
t APPLICANT2
0 401 amps to 599 amps 125.08 MN
CONTACT PERSON Branch circuits- 168.54 r 2
Business name: new alt
SuLY?� A.Fee for branch don,or extenslo
Contact name: /1/01.1
circuits wit er •enol
✓7�Gr yt `U/ yPy b 171', above service or feeder fee,
Address: Feeh
circuit
3/�sU S W �� t B. for branch cult is wiz/rout
7.42 IN
Addre ateJZ1P: �I service - 2
,„4i l branch circuiter fen first
'� ��, q70-0v
56.18
City/S
Phone:($tj 2j) `c _ Z3 Each add`l branch:circuit Ill
Each a d 2
ueous service or feeder not included MIS
Each manufactured or modular 2
CONTRACTOR dwellin, service
Recon and/or feeder 67.84
Business name: S +only MN
2
/ 2
Address: ' a Pump or irrigation circle, 67.84 illmis
i U G� ,� >'ll Signor outline lighting 67.84 allim 2
City/State/ZIP:ZIP: Signal circttit(s)or lirrtitW enm 67,84 2
Ya G2f.0 t Al. g� .enol alteration or extension. g Cl See hge'2 2
Phone:(3�a) 5 Each additional ins.
+ ' �`s� Additional inspec j0 ( lir n over allowable in a 2
ove
Email: S6(N/l kt. rite d investigation (1 mjn) n oli
Emaimminini
CoYr'tLte yf K. (1 hr min) 66.25/lir `__
CCB Lie.: C.L3(� Electrical Lic.: ( ,LS m •
$ t'iaiplant(i hr min) 90.00/ln "'�1�
7 19 Suprv.Lie:: /7 e Peettons for which78.1'
Suprv.Electrician signature,required: s.`ection listed no fee is 8/hr M
._ f 1 hr min 90.0OJ hr .
Print name: 4111 � ELECTRICAL
S E� r 2 / Date;.- [ PE
R]r;MIT FEES
LCS/ 7 0 Plan Review Subtotal:
Authorized signature: Stasurcharge
Required(25%ofpermit fere), ��a/,
Print name: Date:
This %ofp it fee);
Permit application ex TOTAL PERMIT PEE: .a'
I:18ai1dirzg�Yer*nits�ELC_Pern�itAPP_ _ERE.dnc Rev 06/1'7/2015
- * Number insdays pections
it has t penult la not Obtained
440.16151111>p61COMNVEB Pectlo
ns allowed per ace
as cothplete. within l”
permit.
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT
III
Permit#: MST2017-00163
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/31/2017
T t"� a Parcel: 1 S 135DC09000
Jurisdiction: Tigard
Site address: 11625 SW 91ST AVE
Subdivision: CHARBEN Lot: 8
Project: Pacific Evergreen Homes
Project Description: New SF with 462 sf attached garage, and(2)detached garages of 480 sf each for a total of(3)
garages.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 883 sf Basement: 0 sf Left 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1247 sf Garage: 1422 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2130 sf Value: $304,747.56 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 2 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: N 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:
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: 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 2130
Owner: Contractor:
PACIFIC EVERGREEN HOMES PACIFIC EVERGREEN HOMES LLC Required Items and Reports(Conditions)
7410 SW OLESON RD STE 133 7410 SW OLESON ROAD#133 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 PORTLAND,OR 97034
PHONE: 503-664-6423 PHONE: 503-664-6423
FAX: 503-671-0204
Total Fees: $29,593.43
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes = 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, if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen •r. 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 503.232.1s J or 1.80'. •.2344.
F
Issued By: _ �� Rermittee Signature: \��1�
..i 3.639.4175 by 7:00 a.m.for the next available inspection•. e. ��
This permit card shall be kept in a conspicuous place on the job site until c• pletion of the project.
Approved plans are required on the job site at the time of each inspection.
i5>_i..,
13eildine Permit Application
Residential E(Et 1/ .c, -I ft i: i ',:t>Nt.
City of Tigrd 8 2011 Dates $ it �,¢) n: It-I5f�c7-Do[623
1312e Phone: 501ia11 Blvd.,2439Tigard,
♦ w Plan Review _ i t 0 1? Permit: e. -LYS l7
St Line: 503. FaTIGAVID , Dnterit .
l on Line: 5$83.639.45 Dare Resrra y: r 6f sac Page 2 tar
1 U1LDING DIVISIONl :g re ,7 'a Supplementallntorma3ian
OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
13 New construction 0 Demolition Permit fees*are based on the value of the work ormed.
Indicate the value(rounded to the nearest dollar)of all
Q Additional Addition/alterationheplacement 0 Other equipment,materials,labor,overhead,and profit for the
CATEGORY OF CONSTRUCTION work indi d on this licatinn.
[2 i-and 2-family dwelling 0 CommercialFndustrial Valuation: $ 3 43't1 7 L,. 7
11
Q Accessory building 0 Multi-family Number of bedrooms: 4
Q Master builder Other
0 Number of bathrooms: .3 "1�5, 1
^hoB.SITE INFORMATION AND LOCATION 'Tote number of fl
Job site address: 11625 SW 91st Ave 3 New dwelling : 2130 square feet
City/State/ZIP: Tigard, OR. 97223 G : `iso. feet
SuiteibltiglapL no= Project name: Covered porch arm: 60 square fes)a,
Ceess stroctidlrectiollsCross street/directions toidb tile: Greenburg Deckarea: square feet;
Other structure 976-6"14 square feet
1 REQUIRED DATA:COMMERCIALTISE CITECITLIST
Subdivision: Lot no,: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax l no.: equipment,materials,labor,overhead,and the profit for the
osscatimoNt OF WORK work indicated on this application.
New home Valuaton.
building
` -wo d G G.c.k,e. d 8 C.eG G S square feet
IV
ii` pa
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of
Name* sameType of construction:
Address: Occupancy ca:+ups.
City/Stave/ZIP: Existing:
Ph ( ) Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILD/NG PETOUT FE
— Moon near safe.. ;
Business name: S ame Structural plate review fee(or deposit):
Contact e: FLS plan review fee(if aPPlioahleli IIIIIIIIIIIIIIIIIII
A Total fees due upon application:
City/State/ZIP: --. —
. b 7�J
. wAmount received:
..,
Winne:( ) Fax::( TOVOLTAIC SOLAR PANEL SYSTEM FEES*
-z ll: clan offmoore@ mail.com
� � Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Pahl System.
Submit two(2)sets of roof plan with connection details
Busimmwahle: Pacific Evergreen Homes fire dep t aneess,along with the 2 10CJre a:
Address: 7410 Sw Oleson Rd Ste 133 SlarInstaltaton '` lal Code cklist.
Permit Fee(incl plan review
City/State/ZIP:Portland, OR. 97223 and administrativefees); 518£1.tH1
503-664-6423 Fax:( ) S (12%of permit fee): S21°60
CCB lie.: 19 2 8 5 2Total fee due upon application: $201.60
Authorized signature: if
TStis permit q catitrn expires eta permit Is ant obtained
within 150 days after it has beers as complete.
*Fee methodology set by Tui-County Building Industry
a'
Prtrit name. at x- # d a Date:
Service Board.
l:tEuilding itstBUP-RFSPemii .doe 02/24/2011 440 6 131151/02,COMIWFB)
,
Electrical Permit A li • EI � FOR OFFICE USE ONLY
Received
City of Tigard
DateB Permit#: J 4(y..,.z.50/(p?j
13125 SW Hall Blvd.,Tigard,OR ' U3 8 Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503 1!:1960 2017 DateBv:
Inspection Line: 503.639.417 Ready Date/By: Tuns H See Page 2 for
Internet: www.tigard-or.gov u'TY OF TIGARD ed/Method: Supplemental Information
AW$1Q , g ,, 4tCm . , 1' 40 'litir,,
®New construction 0 Addition/alteration/replacement
Please check all that apply(submit 2 sets of plans w/items checked)
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
6 Emergency system. larger separately derived,ar,. . •, �� � � ... .�w ...., . system.
❑Addition of new motor load of
Job#: 1 Job site address: 11625 SW 91St Ave 100HP or more. ❑"A","E","t-z",`°t-3
❑Six or more residential units. occupancy.
City/State/ZIP:Tigard,OR.972230 Health-care facilities. 0 Recreational vehicle parks.
0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more.
Suite/bldg./apt.#: Project name: 600 volts nominal.
Cross street/directions to job site:greenburg ', : E0 �, `
Description I Qty. t Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: 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
r,, k,, % -? 0 ,, •r, , Limited energy,residential 75.00 2
(with above sq.ft.)
New home Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
• . , Renewable Energy
See Page 2
<; �E T D'. y „v,,,''''''''17:' .. Tt A , \ services
or feeders installation,alteration,and/or relocation
Name:Pacific Evergreen Homes 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:7410 SW Oleson Rd,Suite 133 401 amps to 600 amps 200.34 2
City/State/ZIP:Portland,OR.97223 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
Phone:(503)664-6423 Fax:( Temporary services or feeders installation,alteration,and/or
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 125.08 2
Owner signature: Date: p s to 599 amp
401 s 168.54 2
Branch r h circuits—new,alteration,or extension,per panel
k1IaT1t •, �` ' E A,'.s • ane A.Fee for branch circuits with
Business name:Same above service or feeder fee, 7.42 2
each branch circuit
Contact name:Alan GoffMoore B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
Each add'l branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:alangoffmoore@gmail.com Reconnect only
.* ...... , '1,,,,,z-,--,---,,.j:01,-401\00#7.. ..i �,....... -,:.:..:.•:,...;,:•:,i. amu= 1L '¼.' Pump or irrigation circle 67 84
67.842
67 84 2
Sign or outline lighting 2
Business name:Sunlight Electric
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2804 Ne 65th Ave st D panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Vancouver,WA.98661 Additional inspection(1 hr mm) 66.25/hr
Phone:(360-5) Fax:( ) Investigation(1 hr mm) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: Inspections for which no fee is 90.00/hr
7f
CCB Lie.: 172549 Electrical Lic.: C230 Suprv.Lic. ec
: "" 11q;- specifically listed(.1/hr min)
„ ET C V ES., ik„ ,' <
Suprv.Electrician signature,required: Subtotal:
Print name: Chester Garrett I Date: 5/8/17 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
�i / TOTAL PERMIT FEE:
Authorized signature: / �/ This permit application expires if a permit is not obtained within 180
Date: 5/8/17 days after it has been accepted as complete.
Print name: * Number of inspections allowed per permit.
I:\Building\Permits\ELCPermitAppELR_ERE.doc Rev 06/17/2015 440-4615T(l1/05/COM/WEB
I ,
• FOR OFFICE CSE ONLY
Mechanical Permit Appl' E`�/p++
City of TigardritQ+ Received Permit No.: / P
- I{�imm Date/By: �i l 7' C e
11111 v 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
4 8 2017 Other Permit:
Phone: 503.718.2439 Fax: 503.5 40060 Date/By:
T 1 G AR D Inspection Line: 503.639.4175 Date Ready By: tuns: H See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGAI�D Notified/Method: Supplemental Information
BUILDING DIVISI ��FF
> 1 ` , b°`' £PIN „ � , `�O tile,**,;' at -�1 t0G.,^441,,
J » ` "
� � � �'� A� �`" ��"�" ��' """ nom " ��` Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
8
Value:
GAT T SN'�18II 'AN � + I7 8 � ,
"4"'''°1'4 •. ,„ '' � ' ... ,. .. �.. �r� IE1, � lI � 5 �r� �”
® 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
` lii0 l # I .. " Si' Heating/cooling:
46.75
�., Aconditioning
Job site address: 11625 SW 91`t Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR,.97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt,no.: Project name: Duct work 23.32
Cross street/directions to job site:greenburg 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
g 7 Gas fireplace/insert 33.39
D �" Flue vent for water heater or gas
New home fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32u x= Other: 23.32
'. Oh1G+R' 4- '„ , R �,. �' N52. Environmental exhaust and ventilation:
Name:Pacific Evergreen Homes Range hood/other kitchen
equipment 33.39
Address:7410 Sw Oleson Rd Suite 133 Clothes dryer exhaust 33.39
City/State/ZIP:Portland,OR.97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)664-6423 Fax:( ) Attic/crawlspace fans 23.32
23.32
Fuel piping:
Business name:Same $14.15 for first four;$4.03 for each additional
Contact name:Alan GoffMoore Furnace,etc.
Gas heat pump
Address: Wall/suspended/unit heater
City/State/ZIP: Water heater
Fireplace
Phone:( ) Fax: :( ) Range
E-mail:alangoffmoore@gmail.com Barbecue
` 1! t ....1£ ,:, ..,, Clothes dryer(gas)
Other:
Business name:Performance Insulation and Energy ts4 4 ( *S ate.
Address:12700 SW Hall BLVD Subtotal
City/State/ZIP:Tigard,OR.97223 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)598-8001 Fax:( ) State surcharge(12%of permit fee)
TOTAL
lic.: 199448 PERMIT FEE
/ This permit application expires if a permit is not obtained within 180
�y, W./i
i 2 days after it has been accepted as complete.
Authortzed Signaturr� s/L�'J t�J * Fee methodology set by Tri-County Building Industry Service Board
Print name: gonJ dAm,5 Date:5/8/17
I:\Building\Permits\MEC_PermitApp_040113.doe 440-4617T(11/02/COM/WEB)
e
' Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLI"
Received
City of Tigard Permit No.:/1/41,5r.(90/7--� j�
w�
IIII4 . ® 13125 SW Hall Blvd.,Tigard,OR 972Q IV 217 DateBy:
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Tuns H See Page 2 for
TIGARD ental Information
Internet: www tigard or gov l t1 11�N�` D�� °� Noafied Method Supplemental
$per Ul 1,/ Q
❑Demolition For special information use checklist
®New construction Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
437.78
® 1-and 2-family dwelling 0 Commercial/industrial
SFR(2)bath
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
Site utilities:
4 . B' PIS' ' lfClt All �,..' ' .9 -
4. ;, �. ..v a, �., 18.76
Catch basin or area drain
Job site address: 11625 SW 91st,AVE
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site:Greenburg Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: Page 2
Subdivision: I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:. ter valve 12 51
� ,y � Backwater
�. 4, ��1 . . ..,. Clothes washer
• ',
B Cl th 25.02
Dishwasher 25.02
New home Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
,� ..�. .....,r Pit kO , A . ' � ,, \, Fixture/sewer cap 25.02
Name:Pacific Evergreen[tomes 25.02
Floor drain/floor sink/hub
Address:7410 Sw Oleson Rd,Suite 133Garbage disposal 25.02
City/State/ZIP:Portland,OR.97223 Hose bib 25.02
Phone:(503)664-6423 Fax ( ) Ice maker 12.51
Interceptor/grease trap 25.02
'�,.. �� � Di l l ' = �• 97,89 *WV. , '4 gas as(value:$ ) Page 2
Business name:Same
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Tub/shower/shower pan 12.51
Phone:( ) Fax: :( )
Urinal 25.02
E-mail:alangoffmoore@t,gmail.com
,, RACt 1 ° Water closet 37.520
�, {ft� Water heater
Business name:Edward Mullen Plumbing Water piping/DWV 56.29
Address:1601 SE River Road Other: 25.02
Subtotal
City/State/ZIP:Hillsboro,OR.97123
Minimum permit fee: $72.50
Phone:(503)640-0113 Fax:( )
Plan review (25%of permit fee)
CCB Lic.:92689 Plumbing Lic.no.:34-260PB o
State surcharge(12%of permit fee)
Authorized signatu -: ;t7 ci/1/'. .-.---____ TOTAL PERMIT FEE
1
Date:5/8/17 This permit application expires if a permit is not obtained within 180 days
Print name:Ray Mullen after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitAPP doc 10/01/09 440-4616T(t0/02/COM/WEB)
Clean Water Services File Number
C1eanWatee� Services 17-001796
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: Tigard
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): 1S135DC09000 Name:
Company: Pacific Evergreen Homes,LLC
Address: 7410 SW Oleson Rd,#133
Site Address: City, State,Zip: Portland,OR,97223
City, State,Zip: Tigard,OR,97223 P e/Fax: 503-713-8627
Nearest Cross Street: Green burg E-Mail: Harlant.PacificEvergreenHomes.com
4. Development Activity (check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence(rooms,deck,garage) Name: Harlan Borow
❑ Lot Line Adjustment ❑ Minor Land PartitionCompany: Pacific Evergreen Homes,LLC
❑ Residential Condominium ❑ Commercial Condominium Address: 7410 SW Oleson Rd,#133
❑ Residential Subdivision ❑ Commercial Subdivision Portland,OR,97223
❑ Single Lot Commercial 3 Multi Lot Commercial City, State,Zip:
Other NEW SFR Phone/Fax: 503-713-8627
Single lot residential on recently partitioned lot E-Mail: HarlanAPacificEvergreenHomes.corn
6. Will the project involve any off-site work? f$j Yes ❑No ❑Unknown
Location and description of off-site work Connection of onsite LIDA to storm line in Greenburg as no storm line in SW 91st per attached
7. Additional comments or information that may be needed to understand your project
This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ
1200-C Permit or other permits as issued by the Department of Environmental Quality,Department of State Lands and/or Department of the Army
COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law.
By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify
that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate.
Print/Type Name Harlan Borow Print/Type Title Chief Operating Officer
ONLINE SUBMITTAL Date 5/24/2017
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200'of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report
may also be required.
❑ Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200'of the site.This
Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently
discovered.This document will serve as your Service Provider letter as required by Resolution and Order 07-20, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local,State,and federal law.
❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially
sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water
quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order
07-20,Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law.
❑ This Service Provider Letter is not valid unless CWS approved site plan(s)are attached.
❑ The propose .✓ of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by Date 5/30/17
2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone:(503)681-5100 • Fax: (503)681-4439 • www.cleanwaterservices.org
,/,/e/
City of Tigard
INCOMMUNITY DEVELOPMENT DEPARTMENT
I
T l c a R o Building Permit Review — Residential
Building Permit #: x'1, 3011 -0011.,e3
Site Address: 11(A2*--- &'h) '9A5 /ii/e_
Project Name: Aac1 1 r-�� � Lot #:
(New dwelling=subdivisio n e;Addition or Alteration name of owner)
Planning Review
Proposal: 434,,c) SQ
'Verify site address/suite#exists and active in permit system.
tai A aver Terrace Neighborhood: ❑ No ❑ Yes,See River Terrace Review Addendum Attached
SiyE Plan Elements:
ViTree(3)copies of site plan E I: sting structures on site
bto plan must be on 8-1/2"x 11"or 11 x 17"paper YI Footprint of new structure(including decks)with finished
rawn to scale(standard'architect or engineer scale) oor elevations
orth arrow Utility locations (required for new,may apply for additions)ii4
to address,project or subdivision name and lot number ation of wells/septic systems
.plicant information(name and phone number) 1":' sting trees to be retained with drip line,and tree
L Lot dimensions and building setback dimensions protection measures
a".ot area,building coverage area,percentage of coverage and ie4` ,-et tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) Y, eet names
Property corner elevations (2 foot contour lines if more than Storm water quality facility,if>1,000 sf of impervious ri
4 foot differential) area is created or re'laced. On site .la.: ❑ Yes ❑ No
❑ Clean Water S rvices—.Service Provider Letter(lot platted prior to 9/10/1995):
7equired: Yes,applicant was notified ❑ No Received: 4 Yes oblic Facilitie mprovement (PFI) Permit f3:/>) 71
equired: Yes,applicant was notified No Applied For: Yes ❑ No,stop intake
rdzi(Land Use Case#: LLg Qoitp— poli
oning: �,lJ
VJ
Required Setbacks: Front Rear Side Street Side ikY74. Garage on
landscape Requirement:
IA k.i of Coverage Maximum:
rA Building Height: Maximum Height v 0 Actual Height t 2' -
kisual Clearance
asements
0 ensitive Lands: ❑ Yes riNo Type
Yl�
TO rban Forestry Plan
icA onditions "Met"prior to issuance of building permit
Notes:
/P/t
Approved By Planning: � �� � ..------ �
i i � Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
1 I:\Building\Forms\B1dgPermitRvw RES_042017.docx
Building Permit Submittal
Original Submittal Date: 9 1 7
Site Plans: #
Building Plans: # 5
Building Permit#: Z—Enter building_er
permit#above. �
Workflow Routing: Planning lJ Engineering L'Per �
mit Coordinator ,I� Building
Workflow Sign-off: ��S gn off for Planning(include notes from planning review)
Route Application Documents: CJ Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
43,0ginal plan review routing form.
MPV-Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: ',
By Permit Technician: ( ii ') CLQ/o_44./. -,K,c. Date: 5 e /
Engineering Review
Slope at building pad: 24
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat Mr*d/dr
❑ 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 ❑
.i) NOT Approved by Engineering: L Date: 5:7...../7
R...---f tit—i.- ...:1Ar, *, A ' 4, '
.P
ii
Approve by Engineeri : Date: 0-47-1
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
pproved,NOT Released: //,,,A p��— ‘ iI�CG Date: 0/0-----
Notes: 012•'///7 "u a-Sk Its,°° ki n� O_!i-44.— -)p k'
U
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: ` ,Yes ❑ N/A
Tigard Trans SDC: D es ❑ N/A
Parks SDC: 0— es ❑ N/A
LIDA U Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator:
//f/t/
Date: /1(56 -----
I:\Building\Forms\BIdgPennitRvw
"—I:\Building\Forms\BldgPerntitRvw RES_091216.docx
Albert Shields
From: Albert Shields
Sent: Tuesday, May 09, 2017 7:03 PM
To: AlanGoffMoore@gmail.com
Cc: Al Dickman
Subject: MST2017-00163, 11625 SW 91st Ave
Alan, Engineering tells me that there are no existing utilities serving this property. Accordingly, a PFI permit is required
and I will put this application aside as"Approved but Not Released" pending issuance of a PFI. Plan Review will proceed.
Albert Shields
1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11625 SW 91ST AVE, TIGARD, OR, 97223 October 5, 2017 at 10:53:04
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00163
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Provide address on site for inspection. R319.1
Provide approved storm inspection.
Appears storm was not inspected from catch basin to street lateral connection.
Provide PRV and expansion tank for water pressure exceeding 80 psi. 608.2
Install cleanout risers to grade and glue main body cap at cleanout. 719
Provide approved thread sealant. 316.1
Remove debris from kitchen sink for inspection.
Remove cover from master shower strainer for inspection.
Work not complete, not ready for inspection.
No further inspection done.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11625 SW 91ST AVE, TIGARD, OR, 97223 October 5, 2017 at 10:52:01
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00163
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Max breaker for ac units 15 amp per manufacturer rating, 20 amp breakers installed in
panels for all ac's
Non fused disconnects.
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:
11625 SW 91ST AVE, TIGARD, OR, 97223 October 11 , 2017 at 3:18:39
PM
Record Type: Record ID:
Residential - Master Permit MST2017-00163
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Correction for ac breakers in back garage not done.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11625 SW 91ST AVE, TIGARD, OR, 97223 October 13, 2017 at 10:44:44
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00163
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11625 SW 91ST AVE, TIGARD, OR, 97223 October 13, 2017 at 10:52:15
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00163
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Provide approved final inspections for open electrical permits
ELR 2017-00169
ELC 2017-00422
Inspections scheduled for Monday (next day available)
Final erosion control approved.
No street tree required per approved site plan.
No sidewalks required per engineering.
Moisture content form received.
High efficiency lighting form received.
Insulation checked.
Exterior grade ok at this time with drainage swale, city not responsible for landscape
changes after final inspection.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11625 SW 91ST AVE, TIGARD, OR, 97223 October 13, 2017 at 10:45:58
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00163
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Correction complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11625 SW 91ST AVE, TIGARD, OR, 97223 October 13, 2017 at 10:46:43
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00163
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor