08-August (3) CITY OF TIGARD MASTER PERMIT
3
: `= COMMUNITY DEVELOPMENT Permit#: MST2017-00254
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2017
t 4 9 Parcel: 2S104AD07600
Jurisdiction: Tigard
Site address: 12920 SW PARKDALE AVE
Subdivision: OLSON WOODS Lot: 12
Project: Olson Woods, Lot 12
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 933 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 2208 sf Garage: 653 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3141 sf Value: $386,793.76 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: 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: 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 3141
Owner: Contractor:
WINDWOOD CONSTRUCTION INC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
12655 SW NORTH DAKOTA ST 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 TIGARD,OR 97223 2 Geotechnical Inspection
Required before foundation
PHONE: 503-780-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $31,459.52
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 c... , e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
---7Issued By: Permittee Signature:
C 03.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Applicatio VES
Residential FOR OFFICE USE ONLY'
City of Tigard JUN 2 8 2017 Received (�
Date/By: �
1,1 . y: ti `6 1 Permit No.:M,57----
_,12(/.,a)Aci.
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review [
! Phone: 503.718.2439 Fax: 503.5 1 OF Ti/r,p R.) Date/By: •)2-)' Other Permit�fj,O� •i vv„0
c;,,,,s:D Inspection Line: 503.639.4175 JldIIl�R16 DateReady/By: , /,, f / loris: -21 See Page 2for
Internet: www.tigard-or.gov BUILDING DIVISION. Notified/Method: ` Supplemental Information
BUILDING DIVISION l4
m,„sa.. .,,,t w .� ,;t,i *,•z' a a:aa:,: '. 1, wsy $ ° ., „,,-,war+•
rNew construction 0 Demolition 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
,:.. "tTM” "s''''--7-3.--''''..7,7":C7'.-
'�'^f�^�, .:-'r te Ifa d*' 3a,
:.;,.� y ' ;` ,�� , � �S� � � work indicated on this application. �i
.., :,e.', p mak w s 4��,"�'r w :_'> iii'': $ rG/
1-and 2-familydwellingValuation: $ e�.�
0Commercial/industrial /I
❑Accessory building 0 Multi-family Number of bedrooms: L .
❑Master builder 0 Other: Number of bathrooms: 3
1j3) J 3 79't
t� �,� 1 .���s�` � f . "� °j �,,,,,,,,,,,,,,i,;1,0,-,'�� �, Total number of floors:
Job site address: /I. o I k0,0 fr 32115g)✓New dwelling area: -1r�/) squar feet
7 /
City/State/ZIP: ' 6 x/3 > `� 3 -/-��, 0 Garage/carport area: C 9 square feet
Suite/bldg./apt.no.: Project name: porch �6 a'3 ,1
Sat/ jVQL/� 4. overed area: square feet ell,0 C
Cross street/directions to job site: j ,/,,,-„,,,,A, ”
Meek arearca : square feet q3 3
Other structure ca: ISS- square feet
Subdivision: Aop 45).-0/1/ 4„,,,! Oa.. J Lot no.: Alp 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
talw " 7 " ' s °' work indicated on this a lication.
A,',••,,•':i' A,,,,..`»:t'' k 5,.`,: ` f,r,,3n " 4' sir �,,;l „ ... ` ,s�,ry,'�Y,z?... PP
1 ,"' ,,,/ 572'g. Valuation: $
Existing building area: square feet
New building area: square feet
. ;,:s.:- r,:: '-, a '. ,7" ' Pi _ S C-0AN4 .,;..' Number of stories:
Name: kt-li'it/j al Qa 4. e 14,.d xi C., Type of construction:
Address: /j *‘., - (.4-) 4_ `,,t/ "''iota '/4 3.. , Occupancy Panc
Y groups:
City/State/ZIP: i44 - , ' Existing:
Phone:t.." 7,l 6f f/3/ Fax:(`a J ) .(.:::;./.;:,)- ,rt 6 01(e
New:
Business name: �. ,`.��7 .¢_ :. ,
Contact name: ' ' / /< _ ' ""
Structural plan review fee(or deposit):
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application:
Amount received:
Phone:(5.--,25) 77 a_ G_ 3 -75- Fax: :6-03 ) -5.A.)-
., `•�. • ' n,t,.t'^: a',:. t " �'"` <E-mail: � J j/I �4,f Q�,r , „ 7 <'-„�E C. . *//7)L! ' fA Flf ,� v. a'<+, •r<:k", ^:;41`. na .; S sP.ae. .1„„n •x,."•',
,
) p.• ��� s � I ; "r' &� 'p r7 Commercial and residential prescriptive installation of
k � ,,�'' , , :.Nr . ,.. , ,, `.' ,:: , �, roof-top mounted Photovoltaic Solar Panel System.
Business name: 14.) J"/\J-/l b JQd. (0.4-'s 7 _0}(.,,, Submit two(2)sets of roof plan with connection details
Address: �} and fire department access,along with the 2010 Oregon
✓. Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: ! {, Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: *Fee methodology set by Tri-County Building Industry
AO/ , . /,t �.` ? Date: //09/.77„
^ Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46I3T(I 1/02/COM/WEB)
4
' Mechanical Permit A 5 • 1 FOR OFFICE USE ONLY
Y
City of Tigard 11 ReceivedDate/By: Permit No.: C"�'b 17-605--/
11 13125 SW Hall Blvd.,Tigard,OR 97223,NIl
Phone: 503.718.2439 Fax: 503.598.1960_ Plan Review
T 1 G A R D Inspection Line: 503.639.4175 JUN 2 fn1
Date/By: Other Permit:
Internet: www.tigard-or.gov ll Date Ready/ed/Me y: Juds: B See Page 2 for
Notified/Method: Supplemental Information
CITY OF T1GARD
,:,,,,,,,,i,:,:„. .. .-,,„. .,, VParisorl1 Y 1sLoN," COMMERCIAL FEE* SCHEDULE;- USE CHECKLIST
#21.slew construction 0 Addition/alteration/irJeplacement[� Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
4H
Value:$xt51oz ,* GY OICONST )GTON
RESIDENflAL EQUIPMENT/SYSTEMS FEES*
,1:21-rand 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
.,;fir ' A ,46,1&
#3!NFORI�'�A'II{)N, :I,OCriTTON Heating/cooling:
y�/ /0 LkLAz4" /' 14 Air conditioning 46.75
/fir
Job site address:! Furnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP: 7E�'4L/? 1 f14 Z-- -7-22- Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: 7 Project name:Ci'l,!2j j�? r.";,,,_,/ ,- Heat pump 61.06
'." `7 t./ `" Duct work 23.32
Cross street/directions to job site: 1,/.:,-7.,' A,>'., 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
Subdivision: �� ' �� /f2,::,..,4),f, Lot no.:/� Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater / 23.32
.r%r ,,F '73ESQienON OF WORK Gas fireplace/insert / 33.39
Flue vent for water heater or gas
„''',/,.:2_1 �:: ,/"-,,„<y fireplace / 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/ventj 23.32
' (PETt O 'NERi` Other: SCJ / 23.32
❑ T`ENAN3
Environmental exhaust and ventilation:
Name: �i-y f ^� fir: Range hood/other kitchen /
equipment / 33.39
Address: / ' Clothes dryer exhaust 33.39
City/State/ZIP: ? Single-duct exhaust(bathrooms, /
toilet compartments,utility rooms) / 23.32
Phone:(7,-;,,' ';) 7, ! Fax: Attic/crawlspace fans .3 23.32
.� Jam' ,� 71 (57:--2) ,S-29o-76,/
I,x". ,.. " AP1CA0T;;>..' 0 CONTACT'PERSON Other: 23.32
Business name: Fuel piping:
�_ 2 $14.15 for first four;$4.03 for each additional
Contact name:
,� �j� .,E��,!//��Z,,CFurnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
E-mail: i ' Range
� -"? �$J�I Barbecue
-,,,,.4.41-'',:,-.,-,.,:',''''' ') CONTRACTOR.. ."" Clothes dryer(gas)
/'7 i
Business name: 5 Other:
MECHANICAL:PERMIT'FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: ..---079/6 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized Sign * Fee methodology set by Tri-County Building Industry Service Board
Print name: `/7,- ,7(- Date:X/,
L\BuildingTermiits1MEC_PertnitApp_040113.doc 4400-4617T(11/02/COM/WEB)
Electrical Permit Applicatio FOR OFFICE ESE ONLY
III City of Tigard LCEI� � R
Date/By: Permit No.: kr- ,l 7....„(X).9....5—$1
13125 SW Hall Blvd..Tigard,OR 97223
= Plan Review
Phone: 503.718.2439 Fax: 503.598.196q nI of t1 Date/By: Other Permit:
T t G A R D Inspection Line: 503.639.4175 si I Y Le u Date Ready/By: saris: &1 See Page 2 for
Internet: www.tt rd-or, ov Notifed/Method:
8a 8 M * e , Supplemental Information
:n °p t) / 1 �y ,. ;-cs. c � t a ., �za s .,w,lf "y av s.a 0 3i'
I
"Iirsew construction ❑Addrtton/al 1�t 4'11 . {. F Please check all that apply(submit I sets of plans w/nems checked below 1
0 Service or feeder 400 amps or more 0 Building over three stories
❑Demolition 0 Other where the available fault current 0 Marinas and boatyards.
4 €4/ a:li 4 a �c' �K�.1 i j� �:.b;; ",* ;: exceeds 10,000 amps at 150 volts or 0 Floating buildings,
less to ground,or exceeds 14,000 0 Commercial-use agricultural
-and 2-family dwelling 0 Commercial/industrial ❑Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other 0 Fire pump. 0 Installation of 75 KVA or
.. ❑Emergency system. larger
derived
systemz« <a, * wt � ., #'s ' b ..1-,•-i " , f
.`1',.:,::<;4:10 x,. ,t. aY.1,!:'.!.. 34&k-eiat, lto ,4R % " 0 Addition of new motor load of 0"A","E","1-",-1-3",
Job no.: I Job site address�091:Z011A-Z4--
❑Sixor m .
more
oesidential units. 0occupancy.
Recreational vehicle parks.
City/State/ZIP: --, `�1- 3 a q), .1 ❑Health-care facilities. 0 Supply voltage for more than
13 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: , Project name: ni5a..9 {c,/C,?t jar ❑Service or feeder 600 amps or more.
4Ei-$:tilFDt0 .
Cross street/directions to job site: h/r T Description ) Qty, I Fee. l Total ) •
New residential single-or multi-family dwelling unit. —1
Includes attached garage.
Subdivision: C7!c5d>V Cc/et/4,S 1 Lotno,: i•000 sq.fi.orless
/Z / 168.54 a
Tax map/parcel no: a ada l Soo sq .residentialor portion i,,... 75.00 33.92 1
a .,�t't,., rr r t ■ 3 n ?. Lr(with abosq ft ?
energy,
ve
Limited energy,multi-family
01411.1 5'1 _./12-5'1 _./12- • residential(with above sq.ft.) 7500 -
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 `
'Iii t►t>t 'a.'i "'r `a 1 w3 ' .ia k;g u; t a a ,., ." 201 amps to 400 amps 133.56 i ,
401 amps to 600 amps '200.34
Name: /it/- ACA 'c'aO CO , L7
601 amps to 1,000 amps 301.04 2
Address: /t2‘!^s•- S Cr...) iva iiii 4,1946745, Over 1,000 amps or volts 552.26 2
City/State/ZIP: f , g' L 0t1 ... f, `^"t"! �^j_1 Temporary services or feeders installation,alteration,and/or
del��°'+ relocation
Phone:(573) '2642 a1,'3.7S' I Fax:(S 3),,,pa..." ea6r 200 amps or less 59.36 I
201 amps to 400 amps 125,08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
.f " . r 'vd'1.�{y t ep �- ��, above service or feeder fee, 7.42
''`z each branch circuit -
Business name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name: 7i i�4 4 // a branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling,service and/or feeder 67.84
Reconnect only 67.84 2
Phone:( ) Fax::( )
Pump or irrigation circle 67.84
E-mail: lett, ✓ J 4-14.14Y/0 ,,r ,',S", " era / 1 Sign or outline lighting 67.84 2
:;' ". ' .a e <-a y 010;'4,-1:.„1'",..,".;::, ,..>�_. "r"•, r "',. Signal circuit(s)or limited-energy
Business name: DreamHouse Electric,LLC panel,alteration,or extension. Page 2 _
Each additional inspection over allowable in any of the above
Address: 221 SW Moonridge Place Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: Portland,OR 97225
Investigation(1 hr min) 66.25/hr
Phone:(503) 519-6711 Fax:(503)648-9723 !
Industrial plant(1 hr min) 78.18/hr
CCB Lic.: 196726 Electrical Lic.: C-848 Suprv.Lic.: 4560S Inspections for which no fee is 90.00/hr
specifically listed(%r hr min)
Suprv.Electrician signature.required: '',, .,,';',.:',,,-;:.!,.'is
,4iVilRfiL:tE1CtMLI`IEICS
Subtotal:
Print name: Chris Maho Date:
w:o.
Plan review(25%of permit fee): I
Authorized signature: State surcharge(12%of permit fee): i
TOTAL PERMIT FEE:
Print name: y.s 740,4�/ry'f I Date: ke 1
I'tuildingWermits\ELC-PetmitAppdoe 07/01/10 V `440.46157(11/0S/COM/WEB
, Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
E Set DI E
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
E Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 2
with OAR 918-309-0040) 552.26
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
ELECTRICAL PERMIT. + !
eif
1+'EES
Subtotal(Enter on Page I):
$75.00 Number of inspections allowed per permit
Fee for each commercial system:
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
E Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
E Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
t:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application
' Building FixturesRECEIVED
FOR OFFICE USEONLY
City of TigardDateReceived Permit No.: .�!,
ill 13125 SW Hall Blvd.,Tigard,OR 972� e Plan Re: ( -t�7�5
Plan Review
11111 ! Phone: 503.718.2439 Fax: 503.541 40 L+ 0 E Date/By: Other Permit No.:
Inspection Line: 503.639.4175
T I G n K D $F Tiu� p Date Ready rho loris: See Pagefor
Internet: www.tigard-or.gov j Notified/Method: Supplemental Information
N'''..% C ? _ xis . .�s ''''''';:"L"'"
.ti. 'a " ,.�.. "' .,..;* is ? '3aa 'sx{. 4tA.4. .�' ,k..
For special information use checklist
�ew construction ■ Demolition P .(�
Description I Qty. 1 Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
�' 4'1'7 774 z aa� SFR(1)bath 312.70
/�' '-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen IN 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
. ., , . .,'. .a.;- ' "� ; r '��r 4» �.:' t _ ' Site utilities:
Job •site address: Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: f(?;:. h ,,,,':7....,,''', ::% , .„, f , ,., , Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: l Project name: ,, � / : Manufactured home utilities 50.03
Cross street/directions to job site: ' Vii,, + ;,
a8', _ Manholes 18.76
"
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: r J a d/,) t y; , Lot no.: jZ Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
t � `+ i . .- Backwater valve 12.51
kyyv k F "' "*.'X 3" "'fit �` 2 '' 4:.
5,,---,..2 Clothes washer 25.02
/2,,,,k7=6,.3Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r ;. , , t' Z'� >� Expansion tank 12.51
Fixture/sewer cap 25.02
Name: /f/-1 'v . aC1 K3f/n`I, //C Floor drain/floor sink/hub 25.02
Address: /,r_ ,.5-d..3 f.J7.�'-7/I 1.. 1' '' .
"c"` i Garbage disposal 25.02
City/State/ZIP:Y ; ,.�/1/2 il� j9,�.�.c=-.:, ,/,2,3_2 Hose bib 25.02
Phone:(5?2,) -26a 37 Fax ("° -''( )C't'"•- Ice maker 12.51
„ .`i.'''
, , ,. t: '..,�" ' R,,s..,.44:!„I''')",,' Interceptor/greasetrap 25.02
m Medical gas(value:$ ) Page 2
Business name: ‘,._...5-349/44.
Contact name: 1 r_.- ,l q Primer 12.51
"� ,,�`" °`" ` '• "" " 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
,x 'ae
25.02 25.02E-mail:P/ : z r * +x' Water closet
`rx '' , ',�r , 'r "" z ,. , am
Water heater 37.52
Business name: '"'/)/10e-A Water piping/DWV 56.29
Address: ' / , / '/ Other: 25.02
City/State/ZIP: ,j f�'r 7 ii/3 ,,� ;7,..,),;,,..,..,-.) '" Subtotal
Phone:( ,,." ) 2/, . e 73 Fax:( )
Minimum permit fee: $72.50
CCB Lic.: /3 706 Plumbing Lic.no.: f 4, Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: /`. TOTAL PERMIT FEE
Print name: + >' This permit application expires if a permit is not obtained within 180 days
f M '` Date: ,"%7 after it has been accepted as complete.
T"� *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
M COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: 113'5-2t)/7 C.9c2 2:5:474
Site Address: PC) -- , 0--,/-ch ' -e____
Project Name: CTAOn A:49cdg Lot #: AQ_
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: /1.)-40 `. ,
_...
Ltd Verify site address/suite# exists and actio permit rmlt system.
toner Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
i ran Elements:
e(3)copies of site plan 5sting structures on site
S' e plan must be on 8 1/2"x 11"or 11 x 17"paper
Y.Footprint of new structure(including decks)with finished
yawn to scale(standard architect or engineer scale)
or elevations
Oorth arrow :tility locations&easements(required for new and additions
address,project or subdivision name and lot number
e
10 )
�dewalk/driveway approach
plicant information(name and phone number) J ,: ation of wells/septic systems
of . ensions and building setback dimensions r Existing trees to be retained with drip line,and tree
.�� are footage of buildings to be demolishedta
otection measures
0,t area,building coverage area,percentage of coverage and eet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) Street names
if,Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? EYes ❑(o
4 foot differential) If yes,is a storm water quality facility shown? ❑Yes L1t7No
511P4 lean Water Services—Service Provider Lett-. (lot platted prior to 9/10/1995): Mc "c';, /12 Cfi " I7
•equired: ❑ Ye ,applicant was notified I No Received: ❑ Yes ❑ No " 11
rd Public Faciliti Improvement(PFI) Permit:
Required: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
and Use Case#: T,/, i4/ -(140De
/e _�_ZZOning:
equired Setbacks: Front / Rear /sj' Side S Street Side Garage c2C)
piandscape Requirement:
0 4 t Coverage Maximum:
❑ Building Height: Maximum Height / 7 t7
�. g �(_,� Actual Height �� �j
9 sual Clearance
e sitive Lands: fL�1 Yes ❑ No Type ,�Oji�-- (p )
E
rban Forestry Plan ��'- 'CJ �"
Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: L -
r
Date: 0---- -77: ---
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: e /,
Site Plans: #
Building Plans: # 3
Building Permit#: CiEnter building permit#above.
Workflow Routing: 0-Planning 2 err:ngineering Permit Coordinator .-Building
Workflow Sign-off: Er Sign-off for Planning(include notes from planning review)
Route Application Documents: Zr Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
/original plan review routing form.
0/Building:Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: �_ /
Engineering Review
Slope at building pad: ('
2-Conditions "Met"prior to issuance of building permit
2-Easements (encroachments)per engineering conditions of approval and plat
2-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [2.-No
Assess Water Quantity Fee in-lieu: ❑ Yes 1:2-"1Cio
LIDA Facility on lot: ❑ Yes 12-No
CiNOT Approved by Engineering: Date:
Notes: 40.0 i t 'Z A " `T's it.i t S
Approved by Engineering: (2.to (c 5 1-4-*/ Date: 7._tp--/7
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:
1r
DC Fees Entered: Wash Co Trans Dev Tax: ' Yes ❑ N/A
Tigard Trans SDC: IVYes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA Cl Yes ylo N/A
--21111°11K to Issue Permit
Approved by Permit Coordinator: Date: 03-fr-----
I:\Building\Forms\BldgPermitRvw_RES_061417.docx