Permit (64) CITY OF TIGARD MASTER PERMIT
1111.' . COMMUNITY DEVELOPMENT ,,,,,,,.,-,..-f s ' i��� Permit#: MST2017-00319
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ) f Date Issued: 11/02/2017
TIi;Akf) ^
�j Parcel: 2S 110AC00200
Jurisdiction: Tigard
Site address: 10993 SW ANNAND HILL CT
Subdivision: ANNAND HILL SUBDIVISION Lot:
Project: Annand Heights, Lot 12
Project Description: New SF. 3/20/18: REPRINT to change address from Annand Ct.to Annand Hill Ct.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1649 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 2 Second: 0 sf Garage: 400 sf Front: 15
Smoke
Dwelling Units: 1
Third: 0 sf Right: 3 Detectors: Yes
Total: 1649 sf Value: $209,179.70 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 LaundryTrays: 0
y Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100
SF Rain Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0
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: 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: 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: 3 201-400 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 G
NEW P yrou Group: Square Feet:
SF VB
R-3 1649
Owner: Contractor:
ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 GEO Tech Required before
12655 SW NORTH DAKOTA ST TIGARD,OR 97223 foundation inspection
TIGARD,OR 97223 2 Ersn Cntrl 503-639-4175
PHONE: 503-768-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $28,655.52
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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: //��� Permittee Signature: 57-it
Call 603.639.4175 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.
,t, iii-: C/TYOF
T►G
COMMUNITY qRp
ria 13125 SMUNITY DEVELOP
ll d., Tigard OR p7223 ° NT
Site 718.2439 MASTER
address: 10993 SW PERMIT
Subdivision; AN permit#: MST
pr Project: NAND HANNAND CT Date Issued: 2017-0031
Project Descriptio Annand Heights,SUBDIVISION
Par 11/02/2017 9
Description: New SF, ghts, Lot 12 cel: 25110 CO
Jurisdiction: Tigard A 0200
Lot:
Stories: 1
Height: 26 Bedrooms:ms: 3 BUILDING
g Units: 1
Bathrooms: 2 First: Floor Areas
1649
Second: sf
0 Basement: 0
Third: 0 sf Re uired
sf Setbacks
inks: 1 sf Garage 400 Left: 3
Total: 1649 sf �
Lavatories: 3 Water sf Parr
Re uired
Tub losets: 2 Front: 15 n
Tubs/Showers: 2 Dishwashers:
Washing P Value: $209,179.70
209,17 Right g Spaces: :eS
FootGarb 1 9Mach9 70 Drain: 0 agspDetecto
DryWell- ice Maker: 1 Water Heaters: 0
Laundry rays' 0
Trench grain: 0 Hose Bib: 2 Wa der Lines: 100 Rain grain: 1
Bac Lines: 100
Backwater Val SF Rain
Fuel T Value: 1 Bck Drams: 0 Urinals: 0
es tlw Prevntr: 0 Storrs Sewer:
Natural Gas Air Conditioning:
on Other F Catch 100
Furi�100 He ditioniig N MECHANICAL Other Fixture
0 Basins: 0
Furn'=1001( 1 at Pump. N Vent Fans xture Units:
0 Vents: 0 4
Hoods' 1
Residential WOodsto Clothes Dryers: 1
ential Unit ves: 0 Other Units:
0
Ea ad sf or less: 1 Service Feeder ELECTRICAL Gas Outlets: 4
Mfd Home/Feeder/Svc:
o d 1500 sf 3 0 200 amp 0
Te
me/Feeder/Svc 0 201 400 ends Tem SmZFeeders
p 0 0-200
601-1000 00 amp. 0 201-400 amp: 0 W�S Cch Circuits
1000+amp/vp p: 0 601401-600 amp 0
VV/0 Svc/F dr: 0
0 amp-1000v: dr' 0
Audio&Stereo: N ELEC 0
7RICAL.
Other: N RESTRICTE
HVAC DEN
Other Description: N Security Alarm: SF Residential ENERGY
Class of Work; Vaccuu
NEW m System: N
Owner: TYpe of Use: BUILDING Garage Opener: N
NAND HIL SF INFO
BY
Type ofC All
RICHgRpS LLC Contractor; °nstr Ecompasing: Y
WINDVV
TIGARp O12655 SVV R NOR
TH DAKOTA ST 1 655 OOD CONSTRUCT/ON V B Occupancy Group:
P TI GARD,OR 97 23 DAKOTA ON INC R-3 Square Feet:
HONE: 503-768- 1 Required 1649
Re d Items
4375 GEC Tech Re and Reports
Total Fees:
foundation Required before (Conditions)
PHONE: 503-625- 2 Ersn C n inspection ditions)
$28,655.52 FAX: 6528 ntr1503-639-417
This per
be
done mit is issued subject to 590 7606 5
the
nce
9:159:-s901 0010 thrONa O e9 on lawProved plalns'OT contained in
°ugh OqR 95 �Ol_requires You his permit will ehe Tigard Munici
pai Code,ow
Issued By: //090, you •-y obtto ain copy of hes'adopted not is startedwithinof OR. Specialtyby days Codes
This
I_� I''`/ / direct questions to OUNC by calling
Notification 2987 Center df work
ther a is 2.s S4. law. All
v °able
shl all kept y 7:0p nllttee Si 503.23 or 1.800 s added for more.the 180
will
s permit cards 9.4175 b Per 2.1987Those rule
Approved plans are required on he�oti site eeneeextheloh av bite inspection d �� G 332.2344. set forth in OAR
ate. ct,
at the time of each completionoff the proJect. 4
Appz... --tp 7— exf/a-1-1-73
•
Building Permit Application
ResidentialFOR OFFICE USE ONLY
of Tigard ' :. Received �/�
Cityg Date/By: i(at /2 / ,/jU Permit NA S �I? .�!
. Y 13125 SW Hall Blvd.,Tigard,OR 97223 f , Plan Review 0/7„.„. i / ,y�
Phone: 503.718.2439 Fax: 503.598.1960`''-1 '',a 'w°-D II Date/By: t/�7/ �7 Other Pennit�'G !7 LC/�7�
Inspection Line: 503.639.4175 Date Ready/By. loris: El See Page 2 for
TIGARD
Internet: www.tigard-or.gov Notified Method: Supplemental Information
`I
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
'New construction ❑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
work indicated on this application. -7e�
CATEGORY'OF CONSTRUCTION J'�� Valuationa(�(f "� p�� / /� /.
l�I-and 2-family dwelling ❑Commercial/industrial ./�' � l 0
Number of bedrooms: 3
❑Accessory building 0 Multi-family
❑Master builder ❑Other: Number of bathrooms:
JOB'SITE INFORMATION AND LOCATION
Total number of floors: i 0.04 c
Job site address: /'(J y_,3,51t) ig Aand r--- e ott r-"f New dwelling area: /6 41?? square feet Lie Lial
City/State/ZIP: T_'6/4-2,0 a/LG 9"7X7-' Garage/carport area: rot) square feet
Suite/bldg./apt.no.: Project name: Ann 4,, "leo h Covered porch area: SS square feet
Cross street/directions to job site: /a,Q 1-4 Deck area: l square feet
// Other structure area: square feet
/_ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ^/IQ xd I ( /t, 115 Lot no.12 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
�.`� ' �l DESCRIPTION OF WORK work indicated on this application.
G,c.) J PA Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER '''CU,I�-S/} ��,iT.—�1P0� 1
Name: �i( � �r,�O,A 0 TENANT Number of stories:
/ Type of construction:
°
Address: 494,s--5--- 5G54..) �j fd a„,ri( D(_, f p�s
ka iY-r-ce Occupancy groups:
City/State/ZIP: TA are,/ 492;2.3 Existing:
Phone:(5-G3 70 413 7 Fax:(513) 590-7L 6) New:
' 0 APPLICANT' 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: , ,/yl C' Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
14 o" es �� `/ �G� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: /4)/n QAJChi [t? G r
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: /1al-r U'r1 da 2A-5 74 L Submit two(2)sets of roof plan with connection details
�r and fire department access,along with the 2010 Oregon
Address: A—G 5—� sr 1° Ale. (f-�1 /24 k/�L Ve1- Solar Installation Specialty Code checklist.
City/State/ZIP: 7/ a/e nQ q'I-2-23 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(5'&3) bel _ 7s d Fax:( 6713 6-170—ZaL State surcharge(12%of permit fee): $21.60
CCB lic.: 6-0/4760. Total fee due upon application: $201.60
Authorized signature: ' ---may. This permit application expires if a permit is not obtained
�� —
� �` within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: ✓! a. S Date: e , Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
Received permit N9iJA C T�G� �
City of Tigard "' 7 Date/By. // J/
a 13125 SW Hall Blvd.,Tigard,OR 23 Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Otis: 8 See Page 2 for
Inspection Line: 503.639 4175 f w ij sl Date Ready/By:
T
:IG:R D Notified/Method: Supplemental Information
Internet: wvvw.tigazd-or.gov
., a t tt l`.Iy COMMERCIAL FEE* SCHEDULE USE CHECKLIST
# TYPE 06 � Mechanical permit fees*are based on the value of the work
ew construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
El Demolition ❑Other: Value:$
,-,:-'''' '',,- ;•:-..' CATTEGQItY`OE CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling rt❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other:
Description I Qty. I Ea. I Total
Heating/cooling:
1 4(pR'SITE INFORMATION AND LOCATION Air conditioning 46.75
Job site address: J/f.�/
,5� ARG - 1 /5 Ani Furnace 100,000 BTU(ducts/vents) ...i.''''. 46.75
` ! Fumace 100,000+BTU(ducts/vents) 54.91
City/State/ZIP: are,/ 1,1,e972..23 ` Heat pump 61.06
Suite/bldg./apt.no.:Y I Project name:/niQ� ,�y�`/5 Duct work 23.32
(� Hydronic hot water system 23.32
Cross street/directions to job site: f/e9i 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: �,
Other: 23.32
flfln4 Ail /,0 A/5 I Lot no./2 Other fuel appliances:
�"`
Water heater 23.32
Tax map/parcel no.: Gas fireplace/insert 33.39
:DESCRIP IQ1sI OE WORK Flue vent for water heater or gas
- .t. _ , :. / 23.32
�Nf gs�/j fireplace
✓� Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other 23.32
ROPERTY OWNLR '' 0 TEN'` Environmental exhaust and ventilation:
,,®�/- ' / Range hood/odter kitchen
Name: �/����U lVl�yo /t5T equipment 33.39
Address: I(/ a65 56,...3 /UIr/41 j)Ct / 5 t.ei Clothes dryer exhaust d 33.39
Single-duct exhaust(bathrooms,
City/State/ZIP: �j�, ®✓C � -?'3 toilet compartments,utility rooms) 23.32
� `� 23.32
Fax: 3) Q --7Gt9 Attic/crawlspace fans 23.32
Phone:( �'� '��� �'��� � � Other:
LICANI' .❑ CONTACT PERSON Fuelthei in
P P g:
Business name: 60 fit $14.15 for first four;$4.03 for each additional
Furnace,etc.
Contact name: Gas heat pump
Address: Wall/suspended/unit heater
City/State/ZIP: Water heater
Fireplace
Phone:( ) Fax: :( ) J Range
E-mail: w` (jam--ciddA c17 51t 0...) a.. A)69r,,, (0M Barbecue
CONTRACTOR- Y. _ Clothes dryer(gas)
Other:
Business name: -F l r51T Cw`® MECHANICAL PERMIT FEES*
3/5Z) �/ lGein Subtotal
Address: � k.5 ����/��' Minimum permit fee($90.00)
City/State/ZIP: ��� �J/1 yy� Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
TOTAL PERMIT FEE
CCB 11C.: -7,2.6;3This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
p.z,/,b_i-e______ * Fee methodology set by Tri-County Building Industry Service Board
Print name: it / I Date: 9/(/1-)L
/' 440-4617T(I1/02/COM/WEB)
\Building�PermitsVvlEC_PermitApp_040 13.doc
_Electrical Permit Application FOR OFFICE USE ONLY
'?* ' Received Permit# ���/7 j�
City of Tigard "'' Date/By:
a 13125 SW Hall Blvd.,Tigard,OR'97223 Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.5911,960, A . ill Date/By:Inspection Line: 503.639.4175 u x G;J i I Ready Date/By: Juris: I El See Page 2 for
T 1 G AR D Notified/Method: Supplemental Information
Internet: www.tigard-or.gov {..'
PLAN REVIEW
TYPE O'H to *-4,P,P31 v
Please check all that apply(submit New construction 0 Addition/alteration/replacement 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
['Emergency system. larger separately derived
JOB SITE INFORMATION AND LOCATIONsystem.
. • _ ,/ ❑Addition of new motor load of Y
Job#: I Job site addresslGP �/)n qn� �CIu/4-/ 100HP or more. ❑"A","E "1-2"•"1-s"•
!! occupancy.
_ t q 3,3 ❑ x more residential amts.
CitylState/ZIP: � ��ad Health-care❑ facilities. 0 Recreational vehicle parks.
L,J ❑Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: Project name: '` /AZ, /� 600 volts nominal.
AM Gf ❑Service u locations.
ns. amps or more.
Cross street/directions to job site: /colt FEE SCHEDULE
Description I Qty. 1 Each I Total I *
New residential single-or multi-family dwelling unit.
�6 Al7 Lot#:12 Includes attached garage.
Subdivision: _ 1,000 sq.ft.or less !" 168.54 4
Tax map/parcel#:°°°° ^nQ/1� Ea.add'I 500 sq.ftor portion 33.92 1
DESCRIPTIONOF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
�f 5�� Limited energy,multi-family 75.00 2
/- residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
_'PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Name: tl�t aradd 6,44 rite" iv- 201 amps to 400 amps 133.56 2
Address: g2. 5.-s^
'S 6%0 / r ,�/�r��i�� 6 � 401 amps to 600 amps 200.34 2
City/State/ZIP: 76 �/./U teq7��2_-3 601 amps to 1,000 amps 301.04 2
���/ Over 1,000 amps or volts 552.26 2
Phone:( 7b�--L/3 7s-- I Fax:(�j3 )tD ?(e[,
"� y,
Temporary services or feeders installation,alteration,and/or
Email:lNhelcl u✓d eld it Kt'S ,iflA 0 6 -c I ,(d�+ relocation
6 1
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.159.3306 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps
Owner signature: Date:
401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
ICANT I 0 CONTACT PERSON A.Fee for branch circuits with
V�
above service or feeder fee, 7.42 2
Business name: � � each branch circuit
Contact name: l/ B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Sign or outline lighting
Business name: ( ��/[ (Ju$C P�z(i�f/L
pitpanel,
circuit(s) 67.84 2
orlimited-energy
Address: �� / 54,P/140A r-(( panel,alteration,or extension. CI See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: 5D;),--/-lift./�, i), .f
C, , �1"�5 Additional inspection(1 hr mm) 66.25/hr
Phone:
.---c3) s/9 ....e,'2 LL I Fax:(rj3) ‘Yb--9V--3 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
CCB Lic.: /6,2,2_4 IElectrical Lic.� — f� I Suprv.Lic.: specifically listed('h hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: / Subtotal:
Print names A ry 5 hi Ct !!!I Date: f7///? 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
rJ TOTAL PERMIT FEE:
Authorized signature:,' This permit application expires if a permit is not obtained within 180
G (r t.,� Y��� � I Date: Glll� I dape tion has allowed pe accepted as complete.
Print name: /1 // . t-'''5
� Number of inspections per permit.
I:\Building\'ermits\ELC_PermitApp_ELR_ERE.doc Rev 06/1 . t-'5 440-46I5TO I/05/COM/WEB
?r" 7--,r r
Electrical Permit Application–City of Tigard TM
Page 2—Supplemental Information b
Uis E
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEE SCHEDULE
RESIDENTIAL WORK ONLY: Description I Qty. Each Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
In Burglar Alarm
25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Q Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El >100 kva—no additional charge 0.0 3
Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Yz hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
n Boiler Controls
— Clock Systems
[] Data Telecommunication Installation
T Fire Alarm Installation
HVAC
n Instrumentation
El Intercom and Paging Systems
Landscape Irrigation Control*
n Medical
Nurse Calls
Outdoor Landscape Lighting*
F-7 Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application
Building Fixtures
FOR OFFICE USE ONLY
Dd
ateBy: Permit Y�5'T�`7'Y�S
City of Tigard AUG 2017 Rei
ene
- e 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Permit No.:
Phone: 503.718.2439 Fax: 503.598 X960 Date/By. Otherris: El See Page 2 for
Inspection Line: 503.639.4175 3(rLD G 1, Y- Date Ready/By:
TIGARD ""'4 Notified/Method: Supplemental Information
Internet: www.tigard-or.gov
OF WORK. - FEE* SCHEDULE
For special information use checklist
joieew construction ❑Demolition 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
CATEGORY OF CONSTRUCTION l� 437.78
:":1-.."-�. SFR(2)bath
and 2-family dwelling ❑Commercial/industrial SFR(3)bath _ a 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
/ Catch basin or area drain 18.76
(�
Job site address: o-fg3 ,5 `(JA,,/1g/l' /fU4 Drywell,leach line,or trench drain 18.76
City/State/ZIP: T �' .11-- --- r7� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: nnand17Ie i A 715 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.:_) I Page 2
Subdivision: /4-„,illi it, ile
o
A/ ( Lot no.:l2 Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: Backwater valve 12.51
DESCRIPTION OF WORK Clothes washer 25.02
®) f.,-) $fvz Dishwasher 25.02 �
/ Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
❑'PROPERTY•OWNER I 0 TENANT Fixture/sewer cap 25.02
Name: ti find4d or ® zsa,ts. P IC , Floor drain/floor sink/hub I 25.02
Address: /(.345-57_5-10 ir�li -/9G�1�1/Z- 5- 1�.1 Garbage disposal 25.02
City/State/ZIP: T/ ard F1'C. en �7 Hose bib 25.02
Phone:( '''26--1-71'107
Fax:(S'3 5-, -< O Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON
Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: 50 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
Phone:( ) Fax: :( )
Tub/shower/shower pan 12.51 Urinal 25.02
� b�,
E-mail: i/t!B/i(i l✓0��/t C J"t S/V (iota 4 Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: /201-/-A,,..(// flh4-ALU(.. IS Water piping/DWV 56.29
Address: dio,f F
�c) 5 l i f /2 / Other: 25.02
� -
City/State/ZIP: OrceA ei cm �a �� SubtotalL�J
��/jFax:(P3) ,5 / Minimum permit fee: $72.50
Phone:(6V3) -7a73Plan review (25/o of permit fee)
CCB Lic.: //.2 /3.7 Plumbing Lic.no.:3S-Oeij State surcharge(12%of permit fee)
If/)-O TOTAL PERMIT FEE
Authorized signature:
�
� "/ 9 / //•7 This permit application expires if a permit is not obtained within 180 days
Print name: c:p *(//1 Date: [ ` after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
:1111 III COMMUNITY DEVELOPMENT DEPARTMENT
1
T I G A R D Building Permit Review — Residential
,u
Building Permit #: ///(57-i c(7—CO,311
Site Address: IOgq 3 sw Anand Couck
Project Name: Pnlaavtd 14c% his Lot #: II--
(New
2(New dwelling=subdivision nape;Addition or Alteration=last name of owner)
Planning Review
Proposal: NeAN C2 j _f' /fl Yf eXkior- 4-..e10,4ce
Verify site address/suite# exists and active in permit system.
.River Terrace Neighborhood: No . ❑ Yes,See River Terrace Review Addendum Attached
Site Plan IgThree(3)copies of site plan xisting structures on site
Site plan must be on 8-1/2"x 11"or 11 x 17"paper lat ootprint of new structure(including decks)with finished
D rawn to scale(standard architect or engineer scale)
floor elevations
;0 North arrow Jtility locations&easements(required for new and additions)
1 2 Site address,project or subdivision name and lot number idewalk/driveway approach
pplicant information(name and phone number) In .cation of wells/septic systems
Lot dimensions and building setback dimensions \3J xisting trees to be retained with drip line,and tree
r ?A' quare footage of buildings to be demolished rotection measures
►: of area,building coverage area,percentage of coverage and treet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) Street names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced?$Yes No
4 foot differential) If yes,is a storm water quality facility shown? ❑Yes NoN(.P-
1g Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified .K No Received: ❑ Yes ❑ No
gPublic Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#: <9'?'
Zoning: -I2 ( .P))
Required Setbacks: Front iS Rear t cj Side '.1 Street Side N f. . Garage 20
K. Landscape Requirement: jZ6___ /
XLot Coverage Maximum: ,0 %
Building Height: Maximum Height .S Actual Height -I-21Q
Visual ClearanceNJ/
Sensitive Lands: Yes ❑ No Type S f 0 2 S
XUrban Forestry Plan
Conditions "Met"prior to issuancee of building permit
Notes: :All cfrI t-h was DY 141 t( 19,- L '7,r�lUV 1J k,SSIAAAA-Q--
Approved By Planning: AtIja A 1 J / ii' '"\--- Date: '/k f t'1
Revisions (after‘Bptilding Submittal o Sy) Reviewer Date
Revision 1: Approved ❑ Not Approved _ _.- - - c-------_,44,-'
Revision 2: ❑ Approved E Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES 061417.docx
Building Permit Submittal
Original Submittal Date: Tfr6/77
Site Plans: #
Building Plans: ##
Building Permit#: Enter building permit#above.
Workflow Routing: Planning 'Engineering 'Permit Coordinator ''Building
Workflow Sign-off: 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
original plan review routing form.
17 Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician:
.......0_ ;��� _ L �4 /�_ Date: �/l yy
6��
Engineering Review
Slope at building pad: i?) 76
❑ Conditions "Met"prior to issuance of building permit
❑ F�asements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: El Yes ,Z/No
Assess Water Quantity Fee in-lieu: ❑ Yes ,ErNo
LIDA Facility on lot: ❑ Yes .,B'No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: A, /k l I Date: (6 /
Revisions (after Buil ing Submittal only) Reviewer ate
Revision 1: Approved El Not Approved (/j) ' Qj / 7
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:
C Fees Entered: Wash Co Trans Dev Tax: Yes 111 N/A
Tigard Trans SDC: Yes El N/A
Parks SDC: Yes ❑ N/A
LIDA ElYes L N/A
ii.4 --- .OK to Issue Permit Ad,
,per ��1Approved by Permit Coordinator: D ate: f /t
I:\Building\Forms\BldgPermitRvw_RES_061417.docx /
FOR OFFICE USE ONLY-SITE ADDRESS: 7(719 3 Si ,'ird e-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
114 Transmittal Letter
r;i:;n i D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: 5 DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
AUG 2 2 2017FROM , -1--cAd./
COMPANY: ttit n C t,..._eo 0'. BUILC, rj DI v',3 Ory
PHONE: V 3 - '7 -- Y3 ) c BY:
RE: /O 'f3s) A/La 14a,
ia/'" s( 1 ttfi?�I�(1(?)I 7 _UO. /
I1M �(Pame or subdivision a and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: _ Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: r ii-[ti 51A 1 74I
/I1-0v-‹ 46.
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: 9 , c-J'J Initials:
Fees Due: " Yes ❑ No Fee Description: Amount Du :
. PJ...r Yzvf. cam✓' $ !-kc —
$
$
$
Special
Instructions:
Reprint Permit(per P ): ' es E No E] Done
Applicant Notified: Date.— /`/2/) 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:
10993 SW ANNAND HILL CT, TIGARD, April 3, 2018 at 9:04:03 AM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00319
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Provide protection Ballard for appliances in garage. M1307.1
No ac installed at this time.
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:
10993 SW ANNAND HILL CT, TIGARD, April 6, 2018 at 9:26:03 AM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00319
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Final erosion control passed
Street tree certificate received
Moisture content form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10993 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00319
Inspection Type: Inspector:
699 Mechanical final Allyson Armstrong
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor