Permit (89) CITY OF TIGARD COMMERCIAL MANUFACTURED
t STRUCTURE PERMIT
: - COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Permit#: CMS2017 00002
Date Issued: 11/22/2017
Parcel: 2S106DA13800
Site address: 13009 SW REDFOX TER Jurisdiction: Tigard
Project: River Terrace East,Sales Trailer,Lots 137&138 Subdivision: RIVER TERRACE EAST Lot: 138
Project Description: Manufactured structure placement permit across(2)lots at site address 13009 and 13019
Contractor: MODSPACE CORP Owner: ADLV LAND HOLDINGS LLC
13132 N WOODRUSH WAY BY FORSUM, MICHAEL
PORTLAND, OR 97203 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 866-322-0120 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: CMS MH State Admin 11/22/2017 $30.00
Class of Work: NEW Type of Const: VB MH BLD Permit 11/22/2017 $275.50
Occupancy Group: B 12%State Surcharge-Building 11/22/2017 $33.06
Stories: 1 Height: 0 ft Investigation Fee 11/22/2017 $90.00
Project Valuation: $0.00 Investigation Building 12%State 11/22/2017 $10.80
Surcharge
Erosion Control w/Development 11/22/2017 $80.70
Floor Areas:
First Floor Area: 1420
Second Floor Area: 0
Third Floor Area: 0
Total Area: 0
Required Setbacks:
Left: 0 Right: 0
Front: 0 Rear: 0
Required:
Parking Spaces: 0 Fire Sprinklers: No Total $520.06
Smoke Detectors: Party Wall: No
Required Items and Reports(Conditions)
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.
.,(2sIssued By: / A _ Permittee Signature: a/ae
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.
Manufactured Dwelling
Placement Permit Applica 14 '"A
± "� . - FOIL 0}1. N
l( L l SL UL1
City of Tigard } .IP ' 4 ' Received i �(l PennitN
11111 r 13125 SW Hall Blvd.,Tigard,OR 97223 DateB : /s S:�I 7-619x,
Plan Review
Phone: 503.718.2439 FaX 503.598.1SGQ j) Date/B : m� Other Permit:
11VV UU '����
Inspection Line: 503.639.4175 Date Ready/By: ® See Plan Submittal
TIGARD Y Y i! • 7ur s:
Internet: www.tigard-or.gov } r + a Notified/Method��% � Nei, Requirements
JOB SITE INFORMATION , _ OWNER INFORMATION
Site Address: 1" 0 vci t 130 g..%Ai 1; , • • , �exxName: A Ni... Lo
Park Name: � `�1��5 us___
Subdivision&Lot#: R=ve,r fi�. rue_�a �s 137-3�Address:
1 V)l» 6 0U,,hl-ertY'ee VLO4\Oh 12-4
Directions to inspection site: City:S C — ` _ 1p, State: -Z I ZIP�ZS6
+�Z
Phonev ,Leci`i „kaki 1 ' Fax
Is property inside city limits? aYes 0 No E-mail: l�
LOCAL GOVERNMENT APPROVALS
Zoning Sanitation
Signature: Signature:
Jurisdiction: Jurisdiction:
Date: Date:
MANUFACTURED DWELLING PLACEMENT PERMIT FEES
(1) Installation/re-inspection Cost(each) No.of Sum
Items
(a) Placement(includes placement,electrical feeder,30'of water/sewer connection). $ 275.50 t $ 2.IS b
(b) State surcharge at 12%(of placement fee only)- $ 33.06 1 $ 1,9, LI 0
(b) Re-inspection(includes inspection and 12%state surcharge). $ 100.80 $
Placement permit to be obtained only by homeowner,or Oregon-licensed manufactured dwelling installer.
(2) Electrical
(a) Service and/or feeder(new service installation or alteration/relocation of existing service). $ See Electrical Permit Application
Electrical service permit to be obtained only by homeowner performing work or signing supervisor of Oregon-licensed electrical contractor
performing work.
(3) Plumbing
(a) New water service(for services over 30 lineal feet). $ See Plumbing Permit Application
(b) New sanitation/storm sewer or rain drain(for services over 30 lineal feet). $ See Plumbing Permit Application
Plumbing permit to be obtained only by homeowner performing work or Oregon-licensed plumbing contractor performing work.
(4) Miscellaneous fees
(a) Administrative fee(State of Oregon). $ 30.00 / $ 30 ,Gre
(b) System development fees(sewer connection,storm water,parks development&traffic impact). $ See Permit&System Development Fees
SUB-TOTAL r$ 3 d 54.;
SET-UP OR INSTALLATION CONTRACTOR APPLICANT
Name: Name:
JD�VIGi _Space_ Ci orcchan Ni inCt-e-M �(PD14C n i�xAA,�S .
Address: tuo
sweA seor d
17 \ Address: ��1..� `‘--
Sulk
�O
City: �. Stated K��ZIP City; State ' ZIP:
-rJed
Phone:eel O_ 232:quo Fax: Phone: ( „� m� Fax:
CCB No.: 17 Liq MDI No.: E-Mail: \, (r)4i
Ala- . a ai,-
SKIRTING CONTRACTOR ,— 1
Name: iOCIa lair Sp I hereby certify that the information above is true and correct.
Spate `so r All work to be performed shall be in accordance with all
Address: :i 'lo ��{ p JS governing laws and rules.
City: . CMJ C1 State: r�ZIP: /
P�e,nrw4 n P`A lg3\L .!/ u
Phone: - Fax: ( / l` 7
t 0 2../u -\ Authorized Signature Date
CCB No.: '1 D, 414 s— I MDI/LSI No.:
1 V _ Print Name: /�J 1 co61e, type_
I:\Building\Permits\SFM-PermitApp.doc 10/16/2014 4 I �' _ 4
72_. Al;e-at t-c1" g l-cP7 4
City of Tigard
111111
�I COMMUNITY DEVELOPMENT DEPARTMENT
T1cARD Building Permit Review — Commercial - With Land Use
6,5
Building Permit #: C/`I5 c/ 7 - ➢' Q
Site Address: 130N t- 1100` ��( �, ���raCe Suite/Bldg#:
Project Name: klxr [ enact bt-J4-
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review ('
Proposal: CpAj1`a461 OP limn *i SNIP, 1112-ile
LII Verify site address/suite#exists and active in permit system.
Aver Terrace Neighborhood: �J Yes ❑ No
L/ Land Use Case#: 7 UPZ016 -000h
PlatyMatch Approved Land Use:
gla Site Plan ❑ c Arcape Plan ❑ Other:
Urban Forestry Plan i,!elevation Plan
2/Building Height: Maximum Height 3s Actual Height I
i Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
LJ Business License:
/Exists: CIYe�1❑ No,applicant notified to obtain business license
Le Public Facilities �
Improvement(PFI) Permit:
Required: CI Yes,applicant was notified �No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: Ce Date: II' 11-1 /
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: /1I3h7
Site Plans: # :.
Building Plans: #
Building Permit#: X Enter building permit#above.
Workflow Routing: p Planning Engineering /.''Permit Coordinator Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: /5 Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: t/ zr_._. Date: ////3//7
I:\Building\Forms\BldgPermitRvwCOM WithLandUse 060116.docx
Engineering Review
j2KSlope at building pad: 4
7e5
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP)
%Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 21-"No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: kiikli, ZA) ' Date: 16 /Lf
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: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
OK to Issue Permit
Approved by Permit Coordinator: .k61A,O, t n dA Date: J1[20 117
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13009 SW REDFOX TER, BEAVERTON,
OR, 97007
Record Type: Record ID:
Commercial - Manufactured Structure CMS2017-00002
Inspection Type: Inspector:
899 MFG-Structure final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor