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Permit (23) CITY OF TIGARD MASTER PERMIT III 'l , 'r' COMMUNITY DEVELOPMENT Permit#: MST2017-00211 Date Issued: 06/29/2017 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 i Parcel: 2S111AA10700 � � Jurisdiction: Tigard Site address: 8928 SW INEZ ST /e Subdivision: GREENSWARD SOUTH Lot: 1 Project: Greensward South, Lot 1 Project Description: New SF. 8/21/17: REPRINTED permit to include(1)kitchen sink. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1654 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 25 Bathrooms: 4 Second: 1345 sf Garage: 550 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 2999 sf Value: $372,584.09 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 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: 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: 7 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: 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 Y Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2999 Owner: Contractor: FOUR D CONSTRUCTION FOUR D CONSTRUCTION Required Items and Reports(Conditions) PO BOX 1577 PO BOX 1577 1 Ersn Cntrl 503-639-4175 BEAVERTON,OR 97075 BEAVERTON,OR 97075 PHONE: 503-720-7445 PHONE: 503-720-7445 FAX: 503-590-1751 Total Fees: $31,225.03 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 issuanc 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 Cen er. Those rules ar set forth in OAR ::u: thh OAR 952-001-0090. You..- •• - =copy of1 rules or direct questions to OUNC by calling 5031800 • d By: �;.( aar..- Permittee Signature: c i"C. 503.639.4176 by 7:00 a.m.for the next available inspect' date. This permit card shall be kept in a conspicuous place on the job site until completio of the project. Approved plans are required on the job site at the time of each inspection. 1114C{ ITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2017 00211 T( ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2017 Parcel: 2S 111 AA 10700 Jurisdiction: Tigard Site address: 8928 SW INEZ ST Subdivision: GREENSWARD SOUTH Lot: 1 Project: Greensward South, Lot 1 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1654 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 25 Bathrooms: 4 Second: 1345 sf Garage: 550 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2999 sf Value: $372,584.09 Rear: 15 PLUMBING Sinks: 0 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer: 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 7 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: 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: NEWP y Square Feet: SF VB R-3 2999 Owner: Contractor: FOUR D CONSTRUCTION FOUR D CONSTRUCTION Required Items and Reports(Conditions) PO BOX 1577 PO BOX 1577 1 Ersn Cntrl 503-639-4175 BEAVERTON,OR 97075 BEAVERTON,OR 97075 PHONE: 503-720-7445 PHONE: 503-720-7445 FAX: 503-590-1751 Total Fees: $31,225.03 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 r more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi - '-- --,ter. ose rule are et forth in OAR 952-001-0010 through OAR 952-001-0090. You ma obt-'i . ..y of the rules or direct questions to OUNC by calling 503. .19;7. .:00 Issued By: l ��/� Permittee Signature: !L ,tib 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 o ' e project. Approved plans are required on the job site at the time of each inspection. $uildin2 Permit Application * Residential oR oli i.ICE I SI. ON 1.1 City of Tigard Received /_� /� 13125 SW Hall Blvd.,Tigard,OR 97223 RECEIVE Date/By: lCl ( 7 3"1 7`S Permit No.:�y° _�.} 7._, /� Phone: 5033.718.2439 Fax: 503.598.1960 ..- Plan Review thy— No./VD-7—Ru I I I, \11, Inspection Line: 503.639.4175 t y • �j Other permit S��PAcv 7r JUN 6 £.01 t Date Ready/tho J 2 it .. See Page 2 for Internet: www.tigard-or.gov L Notified/Method: l//7� �• Supplemental Information CITY OF TIGARD Cul/tI( 44144( .eti R'774° 7 jt*("1— TYPE OF `FILL I IU(DIVISION gISION REQUIRED DATA:1-AND 2-FAMILY DWELLING 'New construction 0 Demolition a Permit fees*are based on the value of the work performed. ❑Addition/alteration/replacement 0 Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 511-and 2-family dwellingValuation: $ •8(1 ,.cif 0 Commercial/industrial 3 7p1 Q / JJ ❑Accessory building 0 Multi-family Number of bedrooms: G. , ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 'fj 3S. 4.9 Job site address: S 9,2 8 -S: y/ .rivet sr New dwelling area: square feet City/State/ZIP: '-r`I ('AV-0 O t 9 722 T z / Garage/carport area: S S O square feet Suite/bldg./apt.no.: Project name: Covered porch i arealisquare feet ).3 4 S" Cross street/directions to job site: J' Deck area: ZOOsquare feet 16ur Lt ft A u- 8 LV D -- C.g G-epato Alto LAV - 9'0 D Jf- 1stnt�au area: 1 ) 1..i_ square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: (g E/1%s, 4RD l j- Lot no.: / Permit fees*pre based on the value of the work performed. Tax map/parcel no.: Indicate the value(romded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. ,V/664, ,it 6 t.,L- P-A.t>01 I Ly E.5 i De/VCG Valuation: $ Existing building area square feet New building area: square feet PROPERTY OWNER 0 TENANT Number of stories: Name: Type of construction: Address: S7 M6' AS 2C-Le et/' Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: FOCI 1"L D C p N,5 T1z U C 7'/0� (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name: D F YI P DE. H.}t-�P puur FLS plan review fee(if applicable): Address: '.3. Bo iS 77 City/State/ZIP: � vC g ro r., c `7 7 d 7 S Total fees due upon application: Phone:(5o3) '7 2,Q V y S Fax: :( 590 _ 173'i Amount received: E-mail: F o ct rz-b C o wS r e 64,S 1- ` C:.O PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: Submit two(2)sets of roof plan with connection details Address: and fire department access,along with the 2010 Oregon ,�,�/� L.1. Solar Installation Specialty Code checklist. City/State/ZIP: 6 1'-'ir1 Permit Fee(includes planreview $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB Iia: ?/03' Total fee due upon application: $201.60 Authorized signature: "IF — This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: DA yrl D bE Pry ppp@a--Date: 0" "17 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application • City of Tigard Received • � Permit No.:/1157.3-0/ J,,7�/'111 u 13125 SW all v .,Tigard,OR 97223 E EIVEaReview= Phone: 503.718.2439 Fax: 503.598.1960 Inection Line: 503.639.4175 Date/By: Other Permit: l I c;ARD p Internet: www.tigard-or.gov JUN 62 Q Date Read y/B y Juris• H See Page 2 for Notified/Method: Supplemental Information CITY OF TIGAPE) TYPE OF WORM IILr1ING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST New construction ❑Addition/alteration/rLe�plaoeJmen�t� Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ I-and 2-family dwelling ❑Commercial/industrialRESIDENTIAL EQUIPMENT/SYSTEMS FEES* 0 Accessory building For special Information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: 9•� S Air conditioning 46.75 r r' „rdve - 's r- Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: r l-fA- ) O` el 7 z. y Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: Hydronic 23.32 14-h i-L- a LV b &R E Ems itis c arResidentialhot boilerwater(radiatorsystem or /U - 70 t'/->t hydropic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: 1 &e ids`, A.12,173 ....a:„..,114_ Lot no.: I Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 /y CO /N<V L C Log lighter(gas) 23.32 1=�M t Ly j /[1( (� Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 a PROPERTY OWNER 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen Address: �,14.j`� equipment 33.39 I,`s 81 1 ow Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 pif APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: C-C�A) 112- (� 0ki $14.15 for first four;$4.03 for each additional Contact name: T i v' a De j_IA, .p pc r- Furnace,etc. Address: Pi X I ,7•� Gas heat pump Wall/suspended/unit heater City/State/ZIP: BEAN/E(L'- ,i c' i "7 0-7 S Water heater Phone:(503) 7A 0 ._ 7.1v S Fax::( (3 5 70 -- 1-75 I Fireplace �ou ILO /0 S•.� c--' t Range E-mail: �� Lb IVA Barbecue CONTRACTOR Clothes dryer(gas) Business name: e A I 1.-x., t _ Other: MECHANICAL PERMIT FEES* Address: P.C), Box 933 Subtotal City/State/ZIP: LC �� l /d 1 Minimum permit fee($90.00) } Plan review(25%of permit fee) Phone:(5,1,3) &-S. :-- / 47o fs' Fax:( 3) 650-3 S Cfa, State surcharge(12%of permit fee) CCB lic.: /76 (c)--Z LJ TOTAL PERMIT FEE This permit application expires if a permit is not obtained within ISO —�.. .", days after it has been accepted as complete. Authorized signature: Ar * Fee methodology set by Tri-County Building Industry Service Board Print name: . , / _ E ,4/2 //J Date: 6 -G -/7 I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02KOM/WEB) Electrical Permit Application Hat t ()r 1.►( i• l `si; 0\1 City of Tigard Received Permit#: rh.57j?....0001,i r 13125 SW Hall Blvd.,Tigard,OR 972 �`�; J L/ Plan Review I , Phone: 503.718.2439 Fax: 503.598.1 Date/By: Related Permit#: _ Inspection Line: 503.639.4175 Ready Date/By: hais: M See Page 2 for 1 i`' '' 1' Internet: www.tigard-or.gov JUN 6 zai7 Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW KNew construction 0 Addition/alterati��p�,��a0 e �`�/ARpD�p Please check all that apply(submit J sets of plans w/items checked): BUIL Li J 6� l id IS t O N 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition ❑Other: IL7��JJJ where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 15§.1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to groundor exceeds 14,000 (]Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: 5, .L 0 Addition 0Hof new motor load of syASE", 9�$ e L Si_ )OOHP or more. 0 City/State/ZIP: ' (A RD 0 12, 9 7 22V ©Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt/1: Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I = }-I a}Z.C. 2'L V D C3 Rt::t' NS 44 1t L-Jt/ " b r/4 New residential single-or multi-family dwelling unit. Subdivision: C., Sig-1 6-1,454,1}ito lt./.1. Lot#: / Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less I 168.54 I 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential �-y (with above sq.It:)-_ -___ - 75.00 2 NGLv 5 i IV v t.. P A a t Ly //Es 1 ;i e.t� Limited energy,multi-family 75.m) I , residential(with above sq.ft). ` Renewable Energy ` 0 See Page 2 0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less' 100.70 2 Address: _ 201 amps to 400 amps 133.56 2 1�/1C: � 13 C 4 3 401 amps to 600 amps 200.34 2 City/State/Z1P: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 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: 401 amps to 599 amps 168.54 2 fir APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: Fou 1z co K/57-"12,u cm 1,3 above service or feeder fee, 7.42 2 each branch circuit Contact name: v I 0 I) }4 14 larpotzr B.Fee for branch circuits without service or feeder fee,first Address: f),0. BOX 15-77 branch circuit 56.18 2 City/State/ZIP: BE.Ay�1...1-0 LD Cs g., 9 70`7 5 Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(533)7,2 o 2 y t-S Fax::(5,1 )s59� -17 5 / Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: 'FO.Li ra, I c...2? .5.7"'6' MS A.D. coF.►'t Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: pea p Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: , 15 Cy M k, � ,Vp OR /Ct V panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above fit s oda Additional inspection(1 hr min) 66.25/hr i Phone:(503) 2_77 37,89 Fax:(5'1/43 ) ?fj/ ei/y Investigation(1 hr min) 66.25/hr Industrial plant(1 hr min) 78.18/hr Email: SLC=TG=z.e cr,2l c_6 aPou e e6 mt1 t 4.- j Inspections for which no fee is 90.00/hr CCB Lic.:/'7/z7 V Electrical Lic.:C 63 J Suprv.Lic.:5 76,L S specifically listed(%r hr min) ( ELECTRICAL PERMIT FEES Suprv.Electrician signature,required%? 41:"....4.c...„, Subtotal: Print name: R613 ei 14 rz..i' -(/D4z1 Z.Date: G —6 f 7 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: ',../ 'oil"� .0 TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: (, � „ i. 2J , A.., ' A/`Date: -6 =-6'- /7 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Buiiding.Permits4ELC PermitApp_ELR ERE.doc Rev 04/21/2014 440-4615T(i I/05/COM/WEB • Plumbi� m rit Applicatio n - 'Building Fixtures r-OK (Hilt I 1 y1 Oyl 1 RECEIVE I ; eceived City Permit No.: 01� i1 of TigaDatelBy: /r151' t'7- 13125 SW Hall Blvd.,rd Tigard,OR 97223 Plan Review ether Permit No.: Phone: 503.718.2439 Fax: 503.598.1960 el u N 6 2. / DateBy: rods: it NO. Page 2 for __ inspection Line: 503.639.4175 Date Ready/By. Supplemental Informationr I I ,21 I: '' otified&Method: Internet: www.tigard-or.gov � a • � FEE* SCHEDULETYPE OF WO' IVISIQ For s,ecial in ornurdat use checklist 121 New construction ❑Demolition Descri.tion 'MI Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-famil dwellin,y(includes 100 ft.for each utility connection) SFR(1)bath 312.70 CATEGORY OF CONSTRUCTION SFR(2)bath 111111115201N1-and 2-family dwelling CICommerciai/industrial SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 0 Other: Fire sprinkler C____sq.ft.) Page 2 ❑Master builder Site utilities: JOB SITE INFORMATION AND LOCATION Catch basin or area drain r 18.76 Job site 3ddreaddress: O 7 © pp� 8 -5; /1/,eZ s T Drywell,leach line,or trench drain 111111 18.76 City/State/ZIP: f L*(412...D ProjectR -7 2.Z.- Footing drain(no.linear ft.:__,_) = Page 2 name: Manufactured home utilities 50.03 Suitelbtdg./apt.no.: Manholes 18.76 Cross street/directions to job site: 18.76 o Rain drain connector LZ Zv •- L. - Sanitary sewer(no.linear ft.:____) Storm sewer(no.linear ft.:_,__) i 10211 Water service(no.linear ft.:_) Page 2 cx., Lot no.: / Fixture or item: Subdivision: ✓ Backflow preventer 12.51 Tax map/parcel no.: Backwater valve - DESCRIPTION OF WORK Clothes washer 25.02 L R 65/1 - -- Dishwasher MI 25.02 25.02 it , G ,* Drinking fountain Ejectors/sump 11111 25.02INN12.51 0 TENANT Expansion tank ail►: PROPERTY OWNER 25.02 Fixture/sewer cap Floor drain/floor sink/hub 11111 25.02 25.02 Address: 'we As 23 •�ktl Garbage disposal 1111111 25.02 Hose bib CitylState/ZIP: -■__ 12.51 Phone:( ■ Interceptor/grease trap 11111 25.02 , ' aOMIIII❑ CONTACT PERSON IIIII Page 2 Medical gas(value:$ ) 12.51 Business name: ro a}2D Lt 112:21112.51 r_ s . Ky Roof drain(commercial) Contact name: 0 -v 1� _ �' -� �- Address: T• 0 O. 25.02 Sink/basin/lavatory lo, � I S -7 Sink/basin/lavatory water) 62.54 C) 9 7 b-�5 Solar units(po City/State/ZIP: / - - v_ gTQ• / Phone: t`5 ) A 0-7 yy. Tub/shower/shower pan 12.51 25.02 " N7 "A ' CO Water closet - 25.02 IMIIIIIIIIIIIIINIMIEn CONTRACTOR , - 11111111 56.29 A Water piping/DW V Business name: 1'1.4 tw j t L L 1(I 25.02 6,,,-- - Other: Subtotal Address: ,�� ' -c- . 1 City/State/ZIP: Minimum permit fee: $72.50 Plan review (25%of permit fee) Phone:(:j) �� I State surcharge(12%of permit fee) 6 C Plumbing Lie.no.:3 -260 P� TOTAL PERMIT FEE CCB Lie.: �� permit is not obtained within 180 days Authorized signature: This permit application expires if a i Date. i after it bas been accepted as complete-Service Board. Print name: P/0(//0 J.4,12 :�`� *Fee methodology set by Tri-County Building dusuy 44014616T(10102/COMIwEB) I:\Building\Pumits\PLMU-PeamitApp.doc 10/01/09 City of Tigard rIIII COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Building Permit #: S7 ,/7- ..a.),,?/I Site Address: 2g eStA) EZ.- ST Project Name: Ltv v f;i yi,- , 5 Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: I \,<). g 2/Verify site address/suite#exists and active in permit system. EI River Terrace Neighborhood: ® No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: ree(3)copies of site plan $YrExisting structures on site `Ll'Site plan must be on 8-1/2"x 11"or 11 x 17"paper {ootprint of new structure(includin decks with finished �rawn to scale(standard architect or engineer scale) floor elevations g ) l E�North arrow tility locations&easements (required for new and additions) IIiSite address,project or subdivision name and lot number gidewalk/driveway approach El/Applicant information(name and phone number) ) Location of wells/septic systems .hilEliot dimensions and building setback dimensions ErExisting trees to be retained with drip line,and tree lSquare footage of buildings to be demolished protection measures " tot area,building coverage area,percentage of coverage and ,,E�Street tree size,type and location .._j/ pervious area(applicable if R-7,R-12,R-25&R-40) IJStreet names Property corner elevations (2 foot contour lines if more than *Storm water quality facility required if>1,000 sf of 4 foot differential) impervious area is created or replaced. !Qh- Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No i_/Public Facilities Improvement(PFI) Permit: —` Required: E Yes,applicant was notified ❑ No Applied For: L9' Yes ❑ No,stop intake Riand Use Case#: (A 2 )`(.. -70C(i \ iJ a Zoning: 'Z (.(,5 Required Setbacks: Front 2c) Rear ( 5 Side 5 Street Side i 5 Garage 1C) Landscape Requirement: Aµ� S Lot Coverage Maximum: 0/0 Z2" Building Height: Maximum Height 7U Actual Height 9B Visual Clearance 2'Sensitive Lands: EY Yes ❑ No Type '.v:� � �=(� �l� HN 61 c- ec 1 ElUrban Forestry Plan aConditions "Met"prior to issuance of building permit ti Notes: 5 tvt { ,tisc\ co,Ct4 vv> c 5t-q32-0 °C, 1u (t'-,1u-t;Y0� `� rt 1 0-4,4 �Y t i' _ , ) :J i S I ;UYNYI . Approved By Planning: i ' /' - Date:�I! ate: , f�,/, //7 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPernutRvw RES 051617.docx Building Permit Submittal Original Submittal Date: W(�// 7 Site Plans: # Building Plans: # ? Building Permit#: rater building permit#above. Workflow Routing: arming ngineering B P init Coordinator H' ding Workflow Sign-off: C ig -6ff for Planning(include notes from planning review) Route Application Documents: neering: (1) copy of permit application, (1) site plan, (1) building plan and origina plan review routing form. wilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: r�►►�. 4.. Date: C w Engineering Review /e Slope at building pad: a Conditions "Met"prior to issuance of building permit fr Easements (encroachments)per engineering conditions of approval and plat /�rT Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: D Yes No ❑ NOT Approved by Engineering: Date: Notes: 4 Approved byEn ineering: z7Date: ,40....a...... 7 pp g Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved El 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: 6,liSDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: Yes El N/A Parks SDC: Yes ❑ N/A LIDA ❑ Yes N/A OK to Issue Permit ,K-2/7 ,--- Approved by Permit Coordinator: 47-Date: I:\Building\Forms\BldgPermitRvw_RES_051617.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 8928 SW INEZ ST, TIGARD, OR, 97224 January 4, 2018 at 2:09:43 PM Record Type: Record ID: Residential - Master Permit MST2017-00211 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Corrections from previous inspection complete. Final erosion control approved. Street tree certification received. Moisture content form received. High efficiency lighting form received. Duct seal test report received. Insulation certification checked. C of 0 left on site. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 8928 SW INEZ ST, TIGARD, OR, 97224 December 26, 2017 at 8:25:41 AM Record Type: Record ID: Residential - Master Permit MST2017-00211 Inspection Type: Inspector: 199 Electrical final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed A/C installed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 8928 SW INEZ ST, TIGARD, OR, 97224 December 26, 2017 at 8:26:55 AM Record Type: Record ID: Residential - Master Permit MST2017-00211 Inspection Type: Inspector: 699 Mechanical final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed. A/C installed Violation Summary: Inspector Contractor