Permit (96) CITY OF TIGARD MASTER PERMIT
'IN COMMUNITY DEVELOPMENT .0��1"' Permit#: MST2017-00289
T f c_;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ,kr; t
Date Issued: 03/07/2018
i Parcel: 2S110AC00200
Jurisdiction: Tigard
Site address: 11014 SW ANNAND HILL CT
Subdivision: ANNAND HILL SUBDIVISION Lot:
Project: Annand Heights, Lot 22
Project Description: New SF. 3/26/18: REPRINT to change address.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 883 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1131 sf Garage: 462 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2014 sf Value: $253,056.98 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 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!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 Group: Square Feet:
NEW SF VB R-3 2014
Owner: Contractor:
ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
12655 SW NORTH DAKOTA ST TIGARD,OR 97223 2 Fire Rated Eaves-Both
TIGARD,OR 97223 Sides
PHONE: 603-768-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,619.47
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`1.800.332.2344.1
Issued By: /.% Permittee Signature:
/11�Gft7
iffLe".
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.
g
. Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD MASTER PERMIT
a . COMMUNITY DEVELOPMENT Permit#: MST2017-00289
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2018
€ fC�� jt'j 9 Parcel: 2S110AC00200
Jurisdiction: Tigard
Site address: 11014 SW ANNAND CT
Subdivision: ANNAND HILL SUBDIVISION Lot:
Project: Annand Heights, Lot 22
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stones: 2 Bedrooms: 4 First: 883 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1131 sf Garage: 462 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2014 sf Value: $253,056.98 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywall-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: 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 Group: Square Feet:
NEW SF VB R-3 2014
Owner: Contractor:
ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
12655 SW NORTH DAKOTA ST TIGARD,OR 97223 2 Fire Rated Eaves-Both
TIGARD,OR 97223 Sides
PHONE: 603-768-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,619.47
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 obt•'• - ••, • . ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. --
Issued By: ---- .s"-- PRTmittee Signature: f
. 503.639.4176 by 7:00 a.m.for the next available inspect. •ate.
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 Application /\.10 L: ; _2
Residential
FOR OFFICE USE ONLY
INI10
City of Tigard Received r l
" 13125 SW Hall Blvd.,Ti,ard,OR 97223 Date/I3 : /' 1�� Permit No.: �. �...
Phone: 503.718.2439 Fax: 503.598.196t ..\\.** Plan Reviewd % �►
Inspection Line: 503.639.4175Date/By: y �� f'7 Other Permit:
TIGARD p .� y Date Read /B � r ,,,e.„4
` L'� � y3
Internet: www.tigard-or.gov { Ready/By. / mrs: I p See Page 2 for
�� Notified Method: /�) !� PP
A. �- / Su lemental Information
TYPE OF WO X41, 1 - -•..% _
\I\ClA REQUIRED DATA:7 AND 2-FAMILY DWELLING
New construction
❑ .IgkV� Permit fees*are based on the value of the work performed.
1-]�tlo ,� Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement
`11‘.7— equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
-1-and 2-family dwelling 0 Commercial/industrial Valuation: /r y, g as 3 OS G -II
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder
0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION'` Total number of floors: V ay„ 7 /
Job site address: /Mil
�( New dwellingarea: O
!0/�/ �k) A/lan ((14/`0 ..ZG/Ci square feet
City/State/ZIP: 7.4-6 /L 2�
9 aa-3 Garage/carport area: �yj,6I64square feet
/a/1 R t1 6 a
Suite/bldg./apt.no.: Project name: / U //Co A ' /
Covered porch arE . square feet' ),3)
Cross street/directions to job site: S17 f t-b
Deck area: r 30 square feet 8$3
Other structure area: square feet
/-/ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: fill -e/ L
Ris I Lot no.: ren Permit fees*are based on the value of the work performed.
Tax map/parcel no.: .q2........ Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
/1)t.k 67P/2 Valuation: $
Existing building area: square feet
New building area: square feet
®❑ PROPERTY OWNER I 0 TENANT Number of stories:
Name: , J 4 00
UA"$
ri..146,T�®'A.1 px-- Type of construction:
Address: / 4 - 5'& �j� n �} /
0" /"d/��2 „✓Q.��d �G 67i'teT Occupancy groups:
City/State/ZIP: 7/ a� r ' "7 2-23
. 7d Existing:
Phone:
703 �9 - /3 7 c Fax:(23) S y0"-7j '
New:
0 APPLICANT 0 CONTACT PERSON
BUILDING PERMIT FEES*
Business name: .0orie., (Please refer to fee schedule)
Contact name: Structural plan review fee(or deposit):
Address: FLS plan review fee(if applicable):
City/State/ZIP: Total fees due upon application:
Phone:( ) I Fax:
( ) Amount received:
E-mail: tAi/n ciwo-eretfi()Ales t/4.7 .e r‘'0PHOTOVOLTAIC PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
C �j./XCcs "
CONTRACTOR v Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: kiindrr--ded 1•f-5 76 L Submit two(2)sets of roof plan with connection details
Address: /024 S--\� � �� �!6 L/ � �� and fire department access,along with the 2010 Oregon
4C� Solar Installation Specialty Code checklist.
City/State/ZIP: � �� 9'72.- Permit Fee(includes plan review
Phone:(�'Z3) 7/5�1' and administrative fees):
$180.00
f1d -% 75" I Fax:( 2'3 6-97-7d )
CCB lia: State surcharge(12%of permit fee): $21.60
U/9� _
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ¢ Date: *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp,doc 02/24/2011 440-4613T(11/02/COM/WEB)
U
Mechanical Permit Application
FOR OFFICE USE ONLY
City of Tigard Received
14
° ]3125 SW Hall Blvd., rd, 2Date/13y:
Permit No.:
Phone: 503.718.2439 TigaFax: 503.598.1960OR9723 Plan Review
T I G A R D Inspection Line: 503.639.4175 telly: Other Permit:
Internet: www.tigard-or.gov441 „''e Ready/By mrs: p See Page 2 for
Notified/14ethod:
Supplemental Information
Ilitike.C) it
Mfr.1 TYPE OF WORK :, 1 1Q\ ."�. COMMERCIAL FEE*"SCHEDULE— USE CHECKLIST
���w construction h.,' \I d." wt Mechanical permit fees*are based one the value of the work
❑Addition/alteration/replacerrht ���`�, y fl`� performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: v� � n, mechanical materials,equipment,labor,overhead,and profit.
CATEGURY OF:coNSTRUCTIiAlYlst1„Q� Value:$
and 2-family dwelling 0 Commercial/industrial '�`� RESIDENTIA EQUIPMENT/SYSTEMS FEES*
0 Accessory building For s ecial in
0 Multi-family P formation use checklist
❑Master builder ❑Other: Description
3O$ SITE INFORMATION AND LOCATION Qty. I Ea. Total
� � �' � Heating/cooling:
Job site address: //G/t/ /l��4a 1 Air conditioning 46.75
f 7 � t A/aref Furnace 100,000 BTU(ducts/vents) vo''''` 46.75
City/State/ZIP: '-�are/ or 9��3
� 6 iliz Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name:g/ _ �/ >/_ ft- Heat pump 61.06
Cross street/directions to job site: 4-4 /I d�Cl✓`i Duct work 23.32
oQ¢ 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: Min4 „ `/ [_/�o h ifs, I Lot no.Z Other:
iw7 �iT"� d 23.32
Tax map/parcel no.: Other fuel appliances:
Water heater 23.32
'':DESCRIPTION OF,WORK Gas fireplace/insert ,/"
33.39
/J i�� /=� Flue vent for water heater or gas
P� fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent
23.32
ROPERTY.OWNER ! 0 TENANT Other: 23.32
Name: pI,���� _/f �5 / Environmental exhaust and ventilation:
6` T J . Range hood/other kitchen
Address: ,,a6,--- 5� /Nd1 $4/1 / 5 Clothes dryer ', 33.39
G,�Q r� Clothes exhaust ,�'
City/State/ZIP: �� 33.39
(i 9'72,23 Single-duct exhaust(bathrooms,
Phone:( �d toilet compartments,utility rooms)
�� Fax:.(-,'3) r'9"r,o . :7`(�(� Attic/crawlspace fans 23.32
;rD APPLICANT �Y 23.32
0 CONTACT PERSON Other: 23.32
Business name: 6'rm� Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( )
I Fax: :( ) Fireplace
E-mail: (.4-'0 d I c _.mt5N�® Range
-f1 r�j/1'IG'���� �(/I� Barbecue
' CONTRACTOR Clothes dryer(gas)
Business name: -F I r5/ 6,k-// Other:
Address: /3/5-0 // MECHANICAL PERMIT FEES*
t1t �1c e„. 4,,. Subtotal
City/State/ZIP: d/l
iax:
d� ‘,-yVSMinimum permit fee($90.00)
Phone:( ) ( ) Plan review(25%of permit fee)
CCB tic.: �� ) ' State surcharge(12%of permit fee)
v�cJ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
r
* Fee methodology set by Tri-County Building Industry Service Board
Print name: , d I�,to/�� Date:
I1BuildingPermits\MEC_PermitApp_040 ]3.doc
440-4617T(11/02/COM/WEB)
Electrical Permit Application
FOR OFFICE USE ONLY
City of Tigard Received
II 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Re Permit#:
` Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Inspection Line: 503.639.4175 II
Date By: Related Permit 4:
TI G A R D Internet: www.tigard-or.gov �'''� (�g� Ready Date/By:
4�+ Juris Supplemental See Pagefor
{� Notified/Method:
TYPE;OF g !. t `,„% Information
New construction 0 Addition/alterationAilace n v PLAN REVIEW
t`�I`` i" ��� Please check all that apply(submit 2 sets of plans w/items checked)
:I Demolition 0 Other: r/ ❑Service or feeder 400 amps or moreBuilding
where the available fault current ❑ over three stones.
CATEGORY OF CONSTR ►�`` 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-family dwelling 0 Commercial/industless to
0Accessory buildingground,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-family 0 Master builder amps for all other installations. buildings.
❑Other' ❑Fire pump.
JOB SITE INFORMATION AND LOCATION ❑Installation of 150 KVA or
❑Emergency system. larger separately derived
Job#: Job site address/M/5/ 4 /14rt / ❑Addition of new motor load of system.
City/State/ZIP: ® "` '' • ` Z'r 100HPormore. ❑ °A„ E„ "l-2„ "l-3„
/, �� ��2�3 ❑Six or more residential units. occupancy.
Suite/bldg./apt.#: �./ Project name: f / ❑Health-care facilities. 0 Recreational vehicle parks.
/I ,,td ,fig ❑Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: j5 9`J1 rr�• "'V ❑Service or feeder 600 amps or more. 600 volts nominal.
r FEE SCHEDULE
Description IQty. I E»chI .
Total
Subdivision: // New residential single-or multi-family dwelling unit.
�In4iIi Alec t b I Lot#: 2Z Includes attached garage.
Tax map/parcel#: v 1,000 sq.ft.or less
168.54 4
DESCRIPTION OF WORK Ea.add'I 500 sq.ft.or portion 33.92
1
�
+ Wit, Limited energy,residential
/2/ S/2/e...) r/
P (with above sq.ft.) / 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
�B 151rOPERTY OWNER I 0 TENANT SReneweable Energy ❑ See Page 2
Name: /(1��_/mad_ ! /^mss / 200vmps or feeders installation,alteration,and/or relocation
�`� G� (—O �j amps or less 100.70
Address: p 7 � y�a--�d/t S, � 2
/�G SS' cc CO N��-� 201 amps to 400 amps 133.56
2
City/State/ZIP: l j /72 .' r� 401 amps to 600 amps 200.34
' S '[iGi► L 1� 2
Phone: v601 amps to 1,000 amps 301.04
—7�ir 2 7s-- r,�' 2
( !rf®�v I Fax: `W� )�Q ,� Over 1,000 amps or volts 552.26 2
Email:�h .����^,�is �� �
Temporary services or feeders installation,alteration,and/or
Owner installation:This installation is being made on property that I own which is not 2 0 amps or less
intended for sale,leas201 amps to 400 amps 125e,rent,or exchange,according to ORS 447,449,670,and 701. 25 08.0 2
1
Owner signature:
Date: 401 amps to 599 amps 168.54
LIANT 2
C
I 0 CONTACT`PERSON Branch circuits—new,alteration,or extension,per panel
Business name: 1 ‹ A.Fee for branch circuits with
above service or feeder fee,
Contact name: each branch circuit 7.42 2
Address:
B.Fee for branch circuits without
service or feeder fee,first
City/State/ZIP:
branch circuit 56.18 2
Each add'l branch circuit 7 42
Phone:( ) 2
Fax::( ) Each manufausctured
ed(service r r feeder not included)
Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
CONTRACTOR Reconnect only 67.84
2
Pump or irrigation circle 67.84
Business name: „fest ��-eciri2
Sign or outline lighting 67 84
Address: .r� / C. in f7 / 2
4 9 Signal circuit(s)or limited-energy
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: ���. ,t/�� �� Gf' Z� Each additional inspection over allowable in any of the above
Phone:t-03) 5- Q Additional inspection(I hr min) 66.25/hr
/ '�s 7 a I Fax:(5-4,- ) ‘yr _92;33
Investigation(]hr min) 90.00/hr
Email:
Industrial plant(1 hr min) 78.18/hr
CCB L1C.:D 9�7 Inspections for which no fee is
Electrical Lic.
' � Suprv.Lic.:��'ps specifically listed('/hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Print name
� r5 ki 1 Subtotal.
ito I Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
yr
Authorized signature:,% �
Print name: cl_ TOTAL PERMIT FEE:
rip {pr I This permit application expires if a permit is not obtained within 180
/l CCt /�AO-As�/;/ I Date' days after it has been accepted as complete.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/1*:i 5 ' Number of inspections allowed per permit.
440-4615T(11/05/COM/WEB
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received
II . ® 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Permit No.:
Phone: 503.718.2439 Fax: 503.598.1960 '�� Plan
Inspection Line: 503.639.4175 ��� l,� � y Other Permit No.:
TIGARD P Ready/By
Internet: www.tigard-or.gov Juris: H See Page 2 for
` �®� otified/Method.
Supplemental Information
TYPE OF WO o _ FEE* SCHEDULE
rim,�` ew constructionFor special information use checklist
P" 0 Demolition td
0 Addition/alteration/re lacementc �� Description
P 0 Other: ®� Qty. Ea. Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTIO ® SFR(1)bath
312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
o Accessory building 0 Multi-family SFR(3)bath 500.32
o Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:// 9N ,5 � R ng ® (a' Catch basin or area drain 18.76
/�Fi� .� Y,- ,-4 Drywell,leach line,or trench drain
City/State/ZIP: T77►ffi) O'- 7,?2L2 age 2Suite/bld ./a t.no.: ?? �� Footing drain(no.linear ft.: ) page 2g P ect name: 4A.a4 �d�`� A,
Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18.76
il®f- Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: / Water service(no.linear ft.: ) Page 2
i,n /I // EL I Lot no.:Z2 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
5,1--V2-
_ Clothes washer 25.02
f� `VJ 5f i Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑'TENANT Expansion tank 12.51
Name: 1fl,l°�(/l�7�ad ,,a�5 /_ p Fixture/sewer cap 25.02
Address: //9 / Cto �oc/-J, / /z_ l,L�� Floor drain/floor sink/hub
l Cie V 1 �� Cam(// J f6! 25.02
City/State/ZIP: /. Q-,fil
Garbage disposal 25.02
l� 7,3 Hose bib 25.02
Phone:(3 '7 U /' 7� Fax:(S '3x7-76 Ice maker
12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: 5-a e Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address: Roof drain(commercial) 12.51
City/State/ZIP:
Sink/basin/lavatory 25.02
Solar units(potable water) 62.54
Phone:( )
Fax: :( ) Tub/shower/shower pan 12.51
E-mail: kil �'-0erdf �LCIA'I-•e5 A/Li, Urinal
���f/J1CIl /l�G 25.02
CONTRACTOR �/ Water closet 25.02
Business name: 00r/A P4. 4 ;, Water heater 37.52
� �� Water piping/DWV 56.29
Address: /,., J/ 2 6 A[ //
f / Other: 25.02
City/State/ZIP: cyy�d/L „0 O40-2091-
-
Phone:(5--- 3) ��// � Subtotal
7g.3 ---gg Fax:0523) 7 ,5 `,/ Minimum permit fee: $72.50
CCB Lic.: ��.2 /3 9 Plumbing Lic.no.:3 S 3Q jp� Plan review (25%of permit fee)
Authorized signature: 7///-244 TOTAL
surcharge(12%of permit fee)
TOTAL PERMIT FEE
Print name: Cu it, Date: 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 Service Board.
I:\Building\Permits\PLMU-permitApp.doe 10/01/09
440-4616T(10/02/COM/WEB)
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
illh
III
T I G A R D Building Permit Review — Residential
6,
Building Permit #: 7- it
Site Address: //9/271 scit) / (. i.,er'-/—
Project Name: /9 ,1 ; J /42;f0hA Lot #: � , ,
(New dwelling=subdivision n •Addition or Alteration=last name of owner)
Planning Review
Proposal: /(1 ,SF
'Z'Verify site address/suite# exists and actio in permit system.
.fiver Terrace Neighborhood: LNo ❑ Yes,See River Terrace Review Addendum Attached
Sit Plan Elements:
VEI ree(3)copies of site plan sting structures on site
DAthe plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
rawn to scale(standard architect or engineer scale) or elevations
arrow Ltility locations&easements(required for new and additions)
K,te address,project or subdivision name and lot number ,Sidewalk/driveway approach
Mpplicant information(name and phone number) : ation of wells/septic systems
ot dimensions and building setback dimensions (ICJ 1:','sting trees to be retained with drip line,and tree
‘.�,!uare footage of buildings to be demolished pro ection measures
T,Lot area,building coverage area,percentage of coverage and 111'' eet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) .1/4 Street names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? s 0N
fin
4 foot differential) If yes,is a storm water •uality facili shown? i es ■No,
ii lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995): � f
� 0 t'
]Pequired: ❑ Yes,applicant was notified No Received: El Yes El No
ublic Faciliti Improvement(PFI) Permit: PFl -oi� J— O
equired: rYes,applicant was notified CI No Applied For: V YY )1,
Yes El No,stop intake
•Voning:
L�and Use Case#: L�.6 ,^ '�c —quired Setbacks: Front Rear /S' Side Street Side Gara e
Landscape Requirement: c() %
ot Coverage Maximum:
Building Height: Maximum Height - Actual Height o2
9eD f°isual ClearanceTA ,
nsitive Lands: Yes CI No Type �J 7�C�. ,S'1C a_('
qd Urban Forestry Plan
e
❑ Conditions "Met"prio to issuance c4 b 1din permit
Notes: all 7511Y1 S (C / ' ,
O-C- 74 p 1-4,711- l,-c-z-c/kx7r_e_
Approved ByPlannin07
PP g: Date: i /3—
Revisions (after Building Submittal only) 11111111111WReviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: /
Site Plans:
Building Plans: #
Building Permit#: L nt building permit#above.
Workflow Routing: lanning nguieering er--- Coordinator [—Briding
Workflow Sign-off: [ ,igti-off for Planning(include notes from planning review)
Route Application Documents: ngineering: (1) copy of permit application, (1) site plan, (1)building plan and
originalig�--- plan review routing form.
LiTiuidtng: original permit application,site plans,building plans,engineer and
beam calculations and trust_ details,if applicable,etc.
efo,jr{,44 Notes: L yli- z/ /Z' 1/44 j-kid/7/ :5Lt i 14,14) ryieixt,et '
By Permit Technician: d9t ,_ ,'�� Date: 41/,_ i. ,f
Engineering Review
lope at building pad: /0 7O
❑ Conditions"Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes iErNo
Assess Water Quantity Fee in-lieu: ❑ Yes ,2KNo
LIDA Facility on lot: ❑ Yes ��No
❑ NOT Approved by Engineering: Date:
Notes: /'
Approved by Engineering: /k tL i4, Date: /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:
rDC Fees Entered: Wash Co Trans Dev Tax: es ❑ N/A
Tigard Trans SDC: fi Yes ❑ N/A
Parks SDC: "Yes ❑ N/A
LIDA ❑ Yes 510 N/A
7 ?OK to Issue Permit81/ -47
Approved by
Permit Coordinator: d7/43ate:
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11014 SW ANNAND HILL CT, TIGARD, September 28, 2018 at
OR, 97224 10:03:07 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00289
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
No A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11014 SW ANNAND HILL CT, TIGARD, November 27, 2018 at
OR, 97224 11 :04:04 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00289
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Previous corrections completed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11014 SW ANNAND HILL CT, TIGARD, January 18, 2019 at
OR, 97224 11 :15:02 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00289
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Final erosion control passed
Moisture content form received
Moisture barrier acknowledgement 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