Permit (95) 111 ,, CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2017-00276
Date Issued: 08/16/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S109AA00300
Jurisdiction: Tigard
Site address: 14165 SW 125TH AVE
Subdivision: None Lot: None
Project: Walker
Project Description: New SF. New septic tank approved by Washington County&City of Tigard Engineering
Department. 12/27/17: REPRINTED permit to include A/C unit.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 3003 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 4 Second: 1120 sf Garage: 945 sf Front: 20 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 4123 sf Value: $525,137.70 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 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: 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: 6 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: 9 201-400 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 4123
Owner: Contractor:
WALKER,THOMAS A&MELISSA A JOI PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
REVOCABLE LIVING TRUST 11815 NE 99TH ST#1200 1 Ersn Cntrl 503-639-4175
14215 SW 125TH AVE VANCOUVER,WA 98682
TIGARD,OR 97224
PHONE: PHONE: 360-213-0864
FAX: 360-574-6401
Total Fees: $35,335.12
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 thro AR 952-001-0090./ You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: �l �C/ CP-Zc� _ Permittee Signature: / t/ � ✓�G/ ,-9-77c)tel!
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
-
..,-
,N-N-
t,
Mechanical Permit Appllc t * Tj< FOR OFFICE USE ONLY
City of Tigard Received
Date/By:
a 13125 SW Hall Blvd.,Tigard,OR 97223 2Q� �a� 'crmitNo ` , <
: R Phone: 503.718.2439 Fax: 503.598.1960\-\V Plan Review
Inspection Line: 503.639.4175 Date/By:
Other Permit: MST2017-00276
t'tClt#l?t7 P +� sate Ready/By:
Internet: www.tigard-or.gov " ..T ' ''� y y' See Page 2 for
u 9' ;,1k ''led/Method: Supplemental information
-,I‘ V ..; Il'
TYPE OF ,i _ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ®Other:Add A/C mechanical materials,equipment,labor,overhead,and profit.
-
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder 0 Other: Description p Qty, Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
-
Air conditioningg l ""
Job site address: 14165 SW 1251h Ave 1 46,751
Furnace 100,000 BTU(ducts/vents) 46.75
-
City/State/ZIP:Tigard,OR 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 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:None Lot no.: Other: 23,32,
Other fuel appliances:
Tax map/parcel no.:2S109AA00300 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert, 33.39
Flue vent for water heater or gas
Add Air Conditioning to existing permit#MST2017-00276 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation: _
Name:Chris and Melissa Walker Range hood/other kitchen
equipment 33.39
Address:13421 SW DEERGROVE LANE Clothes dryer exhaust 33.39
City/State/ZIP:TIGARD,OR,97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 2332
Phone:(503)320-7497 Fax:( ) Attic/crawispace fans 23.32
El APPLICANT0 CONTACT PERSONOther: •
23.32
Business name:Pacific Lifestyle Homes Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Shanon Cherveny Furnace,etc.
Address:11815 NE 99th St,Suite 1200 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater
Phone:(360)213-0827 Fax::(360)574-6401 Fireplace
Range
E-mail:permits@buildplh.corn Barbecue
CONTRACTOR _Clothes dryer(gas)
Business name:Area Heating+Cooling Other:
t.
MECHANICAL PERMIT FEES*
Address:2721 NE 65th Ave Subtotal 14 75
City/State/ZIP:Vancouver,WA Minimum permit fee($90.00)
Plan review(25%of permit fee) ---
Phone:(360)737-0811 Fax:(360)737-6946 State surcharge(12%of permit fee) S•CO'
CCB lie.:64801 TOTAL PERMIT FEE a.3.
00
�1�,, ' — This permit application expires if a permit is not obtai ed within 180�� days after it has been accepted as complete.
Authorized signature. ( ��. . Fee methodology set by Tri-County Building Industry Service Board
Print name:Shanon Cherveny Date:12/26/2017
I:\Building\Pennies\MEC_PenniiApp_040113..doc 440-4617T(11/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
' . COMMUNITY DEVELOPMENT Permit#: MST2017-00276
Date Issued: 08/16/2017
TIG.ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S109AA00300
Jurisdiction: Tigard
Site address: 14165 SW 125TH AVE .
Subdivision: None Lot: None
Project: Walker
Project Description: New SF. New septic tank approved by Washington County&City of Tigard Engineering
Department.
BUILDING
Floor Areas . Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1047 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 4 Second: 3076 sf Garage: 945 sf Front: 20 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 4123 sf Value: $525,137.70 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain0 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: N Vent Fans: 6 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: 9 201-400 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 4123
Owner: Contractor:
WALKER,THOMAS A&MELISSA A JOI PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
REVOCABLE LIVING TRUST 11815 NE 99TH ST#1200 1 Ersn Cntrl 503-639-4175
14215 SW 125TH AVE VANCOUVER,WA 98682
TIGARD,OR 97224
PHONE: PHONE: 360-213-0864
FAX: 360-574-6401
Total Fees: $35,192.76
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 332.2344.
yi,
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspec' date.
This permit card shall be kept in a conspicuous place on the job site un' completion of the project.
Approved plans are required on the job site at the time of each inspection.
1
Mechanical Permit ApplicationFOR OFFICE 15 ()NIA- 1
City of Tigard Received
1IIII Date/By: Permit No.: 115r€90�7->�d a•��p
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Read/B inn
Internet: www.tigard-or.gov Ready/By: EI plePagezfor
Notified/Method: Supplemental Information
TYPE 01 ,WORIe r ^''; 4"ii11fi �COMMERCIAL•PEE" SCHEDULE—<LISE+CTIECKLIST
/� New construction Mechanical permit fees*are based on the value of the work
❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATECORV.OF E.OI TRLI£noI�+t,'. '.:",
Value:$
REM ENTTALEOIRP41ENTl;SYSTEM $IBES''':
P! I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building Far special information use checklist.
❑ Multi-family 0 Master builder ❑Other: Description
p Qty. Ea. Total
li
JOB SITE INFORMATION AND
Heating/cooting: 1
Air conditioning 46.75
Job site address: 14165 SW 125" Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump
Suite/bldg./apt.no.: _ Project name: Duct work 61.06
23.32
Cross street/directions to job site: 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:None Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2S109AA00300 Water heater 23.32
' DESCRIPTION'OF wOiK „„;.:i.;',',- :„.305;', $„, Gas fireplace/insert
33.39
NFA,SFR Flue vent for water heater or gas
fireplace 23.32
r
Log lighter(gas) ,„ 23.32 r
Wood/pellet stove 33.39 i
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
'PROPERTY-OWNER 23.32
,rt; Other:
” ? NAPA ��'� °`° Environmental exhaust and ventilation:
Name:Chris and Melissa Walker Range hood/other kitchen
Address: 13421 SW DEERGROVE LANE equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:TIGARD,OR,97224 Single-duct exhaust(bathrooms,
toilet comartments,utility rooms) 23.32
Phone:(503)320-7497 Fax:( ) Attic/crawlspace fans 23.32 €
APPLICANT tit°CONTACT PERSON" i Other: 23.32
Fuel
Business name:Pacific Lifestyle Homes piping:
$14.15 for first four;$4.03 for each additional
Contact name:Kayne Halliday Furnace,etc.
Address: 11815 NE 99th St Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater
Phone:(360)213-0813 Fax::(360)574-6401 Fireplace -
Range '
E-mail:kayneh@buildplh.com Barbecue
-,CON'" ACTOR ' '4,P,,,,.. 0 Clothes dryer(gas) i
Business name:Area Heating+Cooling Other:
MECHANICAL PERMIT ES* f
Address:2721 NE 65th Ave
Subtotal
City/State/ZIP:Vancouver,WA Minimum permit fee($90.00)
Phone:(360)737-0811 Fax:(360)737-6946 Plan review(25%of pemut fee)
State surcharge(12%of permit fee) ,
CCB lie.:64801 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: ,
r Fee methodology set by Tri-County Building Industry Service Board
Print name g.,,,, ""7
sxl Date: -- _ j
Iaauildin5\Perre Ski C„PermilApp,_0401I3.doe 440-46I (l I/OVC0M/WF.,6) r
Electrical Permit Application Olt Oa'FIC'1: = F�f)Vl
• I
api City of Tigard Received
•
Date/By: Permit N: �.J
t a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / 'S 1-iG7��� Ifo
Phone: 503.7182439 Fax: 503.598.1960DateESy:
Related Permit u:
TIGARD Inspection Line: 503.639.4175 Ready Date/By: tuns: See WI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: I Supplemental information
` TYPE OF',WORtC" '.a = `i J:. PLAS,REVI
New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked)"
❑ Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
' CATEGORY OF.CON8TRU(TTO!V = exceeds 10,000 amps at 150 volts or 0 Floating buildings, {
® I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or .
J6.W SITE INP'()R ATION`AND`LOCATIO ❑Emergency system. larger separately derived I
Job it: Job site address: 14165 SW 125th Ave ❑Addition of new motor load of system.
iOOl1P or more. ❑ A `'E"`t 2""1-3"
City/State/ZIP:Tigard,OR ❑Six or mare residential units. occupancy.
---- ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.4: Project name: ❑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: SEECHEI)IJLE
a '''',4-,;„,,,,-,,,
Description I Qty..I Each I Tocol I •
New residential single-or multi-family dwelling unit.
Subdivision:None Lot 4: includes attached garage.
Tax map/parcel 4:2S109AA00300 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
', ..'-DESCRIP`IIt ,OF'AVOthiZ'; n -
'''''''"''''!':' ,,r,4,,, Limited energy,residential
NEW SFR (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
► .PRtJPEI2T[�IOWI �� ❑ '3'Lr,,,,, 1'i`' Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name:Chris and Melissa Walker 200 amps or less 100.70 2
Address: 13421 SW DEERGROVE LANE 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:TIGARD,OR,97224 _601 amps to 1,000 amps 301.04 2
Phone:(503)320-7497 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation 1
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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
.� ,>t1PPLICAI�IT o Gt`olsti'AG"T PIt:ILS13N . .m Branch circuits—new,alteration,or extension,per panel
A.Fee Tor branch circuits wrrh
Business name:Pacific Lifestyle Homes
b above service or feeder fee,
7.42 2
each branch circuit
Contact name:Kayne Halliday B.Fee for branch circuits without
Address: 11815 NE 99th St service or feeder fee,first 56.18 2
branch circuit
City/Skate/ZIP:Vancouver,WA 98682 Each add'l branch circuit 7.42 2
Phone:(360)213-0813Miscellaneous(service or feeder not included)
Fax: :(360)574-6401 Each manufactured or modular
Email:kayneh@,buildplh.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
, �. -.4,41k--
w�� V" NTRACTOIe` 4iii" °i!' : Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting i 67,84 2
Address:2920 SE Brookwood Ave,Suite A Signal circuit(s)or limited-energy panel, Paget 2
panel,alteration,or extension.
City/State/ZIP:Beaverton,OR 97006 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)648-4552 I Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr
Email: mmorato rr,garnerelectric.com Industrial plant(1 hr min) 78.18!fir
Inspections for which no fee is
CCB Lie.: 121159 Electrical l,ic.: 34-305C Suprv.Lic.:5 70'7.eY,h
specifically listed( r min) 90.00/hr
t' ; -.ELEC($ICAL"PERMIT Fk -.
Suprv. Electrician signature,required:
Subtotal:
Print name: Chuck Garner Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signa . TOTAL PERMIT FEE:
rThis permit application expires if a permit is not obtained within 180
Print na r /-4,----2...,,„,, jute 'f ( y'. 7 days after it has been accepted as complete.
Number of inspections allowed per permit.
1\Bui)dingY OM-eiELC_Permit App ELR_ERE.doc R • /2015 440.46 15T(11IOS1COM(w'EB.
Electrical Permit Application–City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: ,FEE SCHEDULE -
I Qty. I Each I Total I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
501 to 15 kva 133.56 2
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
Li Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
L j Garage Door Opener*
>100 kva(fee in accordance
552 26 2
with OAR 918-309-0040)
[I] Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
] V• acuum 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 whtch no fee is 90 00/hr
specifically listed(Y2 hr min)
COMMtACIAL WORK ONLY: ' "ELECitue.4 PERMIT PEES
Subtotal(Enter on Page 1).
Fee for each commercial system: $75.00 Number of inspections allowed per pemut.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
0 Audio and Stereo Systems
Fl B• oiler Controls
• Clock Systems
O Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
0 Instrumentation
—1 Intercom and Paging Systems
E Landscape Irrigation Control*
[1 M• edical
E Nurse Calls
Outdoor Landscape Lighting*
E Protective Signaling
O Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
i
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
d
iv
Recee �is�
City of Tlgal t)1 Permit No-:N.1 Tao 1,7-c4 ..* i
, 4113125 SW Hall Blvd.,Tigard,OR 97223 Date/By: )
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.:
Date/By:
Inspection Line: 503 639.4175 Date Read/B cur,,:
TIGARD Ready/By: el See Page 2 for
Internet: www tigard or gov Notitied/Method: Supplemental Information
"014 OF WORK r -NK: FEE* SCUEDILE ,,
)i New construction 0 Demolition For special information use checklist.
Description ( Qty. j Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1.2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY",OFaoisfl1 TCTi0N , ' SFR(I)bath 312.70
►1 I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
1 i JOB I SITE INFORMATION;AND':LOCATION '" Site utilities:
Job site address: 14165 SW 125th Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/LIP:Tigard,OR
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities - 50.03
Cross street/directions to job site: 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:None Lot no.: Fixture or item:
Tax map/parcel no.:2S109AA00300 Backflow preventer 31.27
.-; m.,; Backwater valve 12.51
Z Clothes washer 25.02
NEW SFR _.
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r4''PROVE-RYE OWNER
Expansion tank 12.51
Name:Chris and Melissa Walker Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13421 SW DEERGROVE LANE
Garbage disposal 25.02
City/State/ZIP:TIGARD,OR,97224 Hose bib 25.02 I
Phone:(503)320-7497 Fax:( ) lee maker 12.51
0 APPLICANT C C 1 17'AC1 I" 1I.St 1>, ' , Interceptor/grease trap 25.02 i
Business name:Pacific Lifestlye Homes Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Kayne Halliday
Roof drain(commercial) 12.51
Address: 11815 NE 99th St Sink/basin/lavatory 25.02 ,
'1
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54
'
Phone:(360)213-0813 Fax::(360)574-6401 Tub/shower/shower pan 12.51
E-mail:kayneh@buildplh.com Urinal 25.02
�, - Water closet 25.02 �E
-, ._ ° C`ON'ftRA4TOIT;!I,. . A�..: - .r.‘!;'L''-'"
Water heater 37.52
Business name:Malmedal Enterprises Inc Water piping/DWV 56.29
Address:P.O.Box 207 Other: 25.02 i
I City/State/ZIP:Banks,OR _ Subtotal
IPhone:(503)324-0759 . Fax:(503)324-0580 Minimum permit fee: $72.50
Plan review (25%of permit fee)
I CCB Lie.:102535 Plumbing Lie.no.:34-276PB 1
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Date: r"? ' ff "^� This permit application expires if a permit is not obtained within ISO days
f > f J after it has been accepted as complete.
� �
*Fee methodology set by Tri-County Building Industry Service Board.
1alluilding\Permis1PLMU-PermitApp.doe 10/01/09 440.4616T(10/021CO:vf/WEn)
I
City of Tigard
14 'I COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c a R D Building Permit Review — Residential
IP)
Building Permit #: l r / 7-CO a 70'
Site Address: /ZJ/(pc— .spa ) J7 S"-1A "lye_
Project Name: / 4f- Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Aieto 2-Fe_
PI.f Verify site address/suite# exists and actin in permit system.
1 Il tkiver Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Si lan Elements:
ree(3)copies of site plan0 sting structures on site
tte plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
yawn to scale(standard architect or engineer scale) or elevations
orth arrow • •ty locations&easements(required for new and additions)
i e address,project or subdivision name and lot number walk/driveway approach
Vpplicant information(name and phone number) VIS cation of wells/septic systems
VA . dimensions and building setback dimensions lel fisting trees to be retained with drip line,and tree
�1:�.uare footage of buildings to be demolished .rotection measures
•
101 f area,building coverage area,percentage of coverage and S', -et tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) T7.Street names ,�
Property corner elevations (2 foot contour lines if more than >1,000 sf of impervious area created or replaced? NJY CI No
4 'oot differential) If yes,is a storm water quali facility shown? Yes ❑No
n Clean Water rvices—Service Provider Letter(lot platted prior to 9/10/1995):
0,8equired: IG Yes,applicant was notified ❑ No Received: Yes ❑ No
kiPublic Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified V No Applied For: ❑ Yes ❑ No,stop intake
liand Use Case#:
/Zoning: /2 —1-/,Vif equired Setbacks: Front ,Q O Rear /5" Side 7 Street Side /V/�'.Garage Q 0
PI. andscape Requirement:
t $ of Coverage Maximum:
ra Building Height: Maximum Height ' ) / Actual Height /`" //
0 kl isual Clearance
7 Sensitive Lands: /Yes ❑ No Type Veer1).--.-67,7L e1 de,- t3._
tdi'Nrban Forestry Plan �✓ �' €p bAP-
sIXonditions "Met"prior to issu ce of building permit p
Notes: �P�� K rJ ii ()T.!7 c'Q ?1S'/7'7V( A 1S'
Approved By Planning: - _ ,,i Date: -9 /3
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\BldgPermitRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: 3//
7 7
Site Plans: # 3
Building Plans: # 3
Building Permit#: O'Enter building permit#above. �
Workflow Routing: 5—Planning engineering rEmit Coordinator Building
Workflow Sign-off: 2—Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑'"Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
yriginal plan review routing form.
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: CZ,
By Permit Technician: aLeo_...0.4-4-1L1' Date: 7/4/,7
Engineering Review
❑ Slope at building pad: G t
Conditions "Met"prior to issuance of building permit
4/0 Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
sess Water Quantity Fee in-lieu: ❑ /=es ❑ No
+�.�A Facility on lot: Yes No
11^�►�"r- Approved byEngineering: Date:
��e� PP �� �� 7/7 7/7
Zot:s: Iv L1/ /S wt Sod a Pwbl,c Sgni�q-*f S�d{urt. /1��'ca/N oak U, /� ✓ +�/l�w� Sz
Li
Approved by Engineering: Al Date: 72' i
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
'SDC Fees Entered: Wash Co Trans Dev Tax: rig Yes ❑ N/A
Tigard Trans SDC: E/Yes ❑ N/A
Parks SDC: 'Yes ❑ N/A
LIDA aYes ❑ N/A
OK to Issue Permit pa
Approved by Permit Coordinator: i; .C%GvtG tigicalf(-/-11)
te: li
1:\Building\Forms\BldgPermitRvw RES_061417.docx
RECEIVED
JUL 13 2017
CleanWater Services CITY OF TIGARD
Our commitment is clear.
BUILDING DIVISION CWS File Number
Service Provider`Letter' 17-001626
This form and the attached conditions will serve as your Service Provider Letter in accordance
with Clean Water Services Design and Construction Standards (R&O 17-5).
Jurisdiction: Tigard Review Type: No Impact
Site Address 14165 SW 125th AVE SPL Issue Date: July 07,2017
/Location: Tigard,OR 97224 SPL Expiration Date: July 07,2019
Applicant Information: Owner Information:
Name THOMAS AND MELISSA WALKER Name WALKER,THOMAS A&MELISSA A
Company Company JOINT REVOCABLE LIVING TRUST
Address 13421 SW DEERGROVE LN Address 14215 SW 125TH AVE
TIGARD OR 97224 TIGARD OR 97224
Phone/Fax (503)320-7497 Phone/Fax
E-mail: Tomwalker144@gmaii,com E-mail:
Tax lot ID Development Activity
2S109AA00300 New single family home
Drainfield
Pre-Development Site Conditions: Post Development 6-A4-Conditions:
Sensitive Area Present X On-Site IX I Off-Site Sensitive Area Present X On-Site X Off-Site
Vegetated Corridor Width: 200 Vegetated Corridor Width: 200
0-50 ft:Good
Vegetated Corridor Condition: 50-200 ft Marginal
incl
Enhancement of Remaining
Vegetated Corridor Required: Square Footage to be enhanced: 0
Encroachments into Pre-Development Vegetated Corridor:
Type and location of Encroachment: Square Footage:
none
0
Mitigation Requirements:
Type/Location Sq.Ft./Ratio/Cost
N/A
X
Conditions Attached X Development Figures Attached(2) Planting Plan Attached I Geotech Report Required
This Service Provider Letter does NOT eliminate the need to evaluate and protect water quality
sensitive areas if they are subsequently discovered on your property.
Page 1 of 3
CWS File Number 17.001626
in order to comply with Clean Water Services water quality protection
requirements the project must comply with the following conditions:
1. No structures, development,construction activities, gardens, lawns, application of chemicals,
uncontained areas of hazardous materials as defined by Oregon Department of Environmental
Quality, pet wastes, dumping of materials of any kind, or other activities shall be permitted
within the sensitive area or Vegetated Corridor which may negatively impact water quality,
except those allowed in R&O 17-5,Chapter 3.
2. Prior to any site clearing,grading or construction the Vegetated Corridor and water quality
sensitive areas shall be surveyed,staked,and temporarily fenced per approved plan. During
construction the Vegetated Corridor shall remain fenced and undisturbed except as allowed by
R&O 17-5,Section 3.06.1 and per approved plans.
3. If there is any activity within the sensitive area,the applicant shall gain authorization for the
project from the Oregon Department of State Lands(DSL)and US Army Corps of Engineers
(USACE). The applicant shall provide Clean Water Services or its designee(appropriate city)
with copies of all DSL and USACE project authorization permits.
4. An approved Oregon Department of Forestry Notification is required for one or more trees
harvested for sale, trade, or barter, on any non-federal lands within the State of Oregon.
5. Prior to ground disturbance,an erosion control inspection permit is required from City
of Tigard.Appropriate Best Management Practices(BMP's)for Erosion Control, in accordance
with Clean Water Services'Erosion Prevention and Sediment Control Planning and Design
Manual, shall be used prior to, during, and following earth disturbing activities.
6. Prior to construction,a Stormwater Connection Permit from Clean Water Services or its
designee is required pursuant to Ordinance 27,Section 4.B.
7. Activities located within the 100-year floodplain shall comply with R&O 17-5, Section 5.10.
8. Removal of native,woody vegetation shall be limited to the greatest extent practicable.
9. Water quality approaches shall be planted with Clean Water Services approved native species,
and designed to blend into the natural surroundings.
10. Should final development plans differ significantly from those submitted for review by
Clean Water Services,the applicant shall provide updated drawings,and if necessary,
obtain a revised Service Provider Letter.
SPECIAL CONDITIONS
11. The Vegetated Corridor width for sensitive areas within the project site shall be a minimum of
50 feet wide, and up to 200 feet where slopes are 25%or greater,as measured horizontally
from the delineated boundary of the sensitive area.
12. Within the first 50 feet,removal of invasive non-native species by hand is required in all
Vegetated Corridors rated"good." Replanting is required in any cleared areas larger
than 25 square feet using low impact methods. The applicant shall calculate all cleared
areas larger than 25 square feet prior to the preparation of the required Vegetated Corridor
enhancement/restoration plan.
13. Prior to any site clearing, grading or construction, the applicant shall provide Clean Water
Services with a Vegetated Corridor enhancement/restoration plan. Enhancement/restoration of
the Vegetated Corridor shall be provided in accordance with R&O 17-5,Appendix A,and shall
include planting specifications for all Vegetated Corridor,including any cleared areas larger
than 25 square feet in Vegetated Corridor rated"good."
14. Prior to installation of plant materials, all invasive vegetation within the Vegetated Corridor shall
be removed per methods described in Clean Water Services'Integrated Pest Management
Guide,2012. During removal of invasive vegetation care shall be taken to minimize impacts to
existing native tree and shrub species.
Page 2 of 3
• GWS File Number J 17 001828
15. Clean Water Services shall be notified 72 hours prior to the start and completion of
enhancement/restoration activities. Enhancement/restoration activities shall comply with the
guidelines provided in Planting Requirements(R&017-5,Appendix A).
16. Maintenance and monitoring requirements shall comply with R&O 17-5, Section 2.12.2. If at
any time during the warranty period the landscaping falls below the 80%survival level,the
owner shall reinstall all deficient planting at the next appropriate planting opportunity and the
two year maintenance period shall begin again from the date of replanting.
17. Clean Water Services shall require an easement over the Vegetated Corridor conveying storm
and surface water management to Clean Water Services or the City that would prevent the
owner of the.Vegetated Corridor from activities and uses inconsistent with the purpose of the
corridor and any easements therein.
18. Vegetated Corridor boundaries shall be marked in the field prior to construction.
19. If necessary, protection of the Vegetated Corridors and associated sensitive areas shall be
provided by the installation of permanent fencing and signage between the development and
the outer limits of the Vegetated Corridors.
This Service Provider Letter is not valid unless CWS-approved site plan is attached.
Please call(503)681-3639 with any questions.
urie Bunce
Environmental Plan Review
Attachments( 2 )
Page 3 of 3
FOR OFFICE USE ONLY-SITE ADDRESS: / 11/6"/6 ,CSC/ /2 S-7
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
(,A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: �S .G ,Fa 4),t31_, DATE RED:
DEPT: BUILDING DIVISION titGE1VED
OCT 172017
FROM: \-c - CITY OF T!GAl
3COMPANY: ti v Ut�.l l ,1 DIVISION
PHONE: — Z - -ea-C> I By:
RE: �4. �w 1ZS � ' 2�ti 0°27-4-,
(Site Address) (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: I Description: I Copies: I Description: 1
Additional set(s) of plans. Revisions:
Cross section(s) and details. c Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. y<, Engineer's calculations.
Other(explain):
REMARKS: tt) . o w Li,
FOR OFFICE USE ONLY
Routed to Permit Tec Lcian: Date: J n i-y-. r7 Initials:
Fees Due: Yes ❑No Fee Description:
Amount Due:
pi 4.v rev.:,cv $ 9 0 -
$
$
Special
$
Instructions:
Reprint Permit(per PE): ❑ Yes rki No ❑ Done
tz._
Applicant Notified: t
D
ae: (v(�
��-- �/� Initials:
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14165 SW 125TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
240 Exterior shearwall Allyson Armstrong
Result:
FAIL
Comments:
Provide revised lateral and gravity engineering for additional story by definition 2014
ORSC chapter 2 with correct building height and revised site plan showing correct
elevations to the city of Tigard prior to shearwall inspections. See inspection dated
9/27/17
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14165 SW 125TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
240 Exterior shearwall Allyson Armstrong
Result:
FAIL
Comments:
Provide revised lateral and gravity engineering for additional story by definition 2014
ORSC chapter 2 with correct building height and revised site plan showing correct
elevations to the city of Tigard prior to shearwall inspections. See inspection dated
9/27/17
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14165 SW 125TH AVE, TIGARD, OR, 97224 January 5, 2018 at
10:18:03 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
199 Electrical 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:
14165 SW 125TH AVE, TIGARD, OR, 97224 January 5, 2018 at
10:17:36 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Corrections from previous inspection for dryer vent not done.
Debris in dryer vent.
Finish filling protection Ballard with concrete as noted on previous inspection.
Other corrections from previous inspection complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14165 SW 125TH AVE, TIGARD, OR, 97224 January 8, 2018 at
12:40:41 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
699 Mechanical 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:
14165 SW 125TH AVE, TIGARD, OR, 97224 January 8, 2018 at
12:41 :51 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
399 Plumbing 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:
14165 SW 125TH AVE, TIGARD, OR, 97224 January 8, 2018 at
12:52:03 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide city required documents for final inspection.
Street tree certification.
Moisture content form.
High efficiency lighting form.
All else appears ok.
Note: duct seal test report and insulation certification checked, posted on
electrical panel.
Septic final approval received.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14165 SW 125TH AVE, TIGARD, OR, 97224 December 26, 2017 at
2:06:45 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Provide mechanical permit for ac, not on permit.
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:
14165 SW 125TH AVE, TIGARD, OR, 97224 December 26, 2017 at
2:05:42 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Provide permit for ac, not on original permit.
Protection Ballard in garage to be filled with concrete not rock. ORSC Figure M1307.1
Label net aggregate length of dryer vent. ORSC M1502.4.5
Gas cooktop not installed.
Not ready for inspection, work not complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14165 SW 125TH AVE, TIGARD, OR, 97224 January 9, 2018 at
1 :24:53 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Final erosion control approved.
Street tree certification received, no street trees required.
Moisture content form received.
High efficiency lighting form received.
Duct seal test report checked, posted on site.
Insulation certification checked.
Septic approval document received.
Contractor received C of O.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14165 SW 125TH AVE, TIGARD, OR, 97224 December 28, 2017 at
7:04:07 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00276
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Not ready for final inspection.
Provide approved plumbing, electrical and mechanical final inspections prior to building
final inspection. R109.1 .6
Violation Summary:
Inspector Contractor