Permit (138) CITY OF TIGARDIII
MASTER PERMIT
l'' ' COMMUNITY DEVELOPMENT Permit#: MST2017-00490
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/22/2018
T t� ;'E I<.D9 Parcel: 2S111AA01400
Jurisdiction: Tigard
Site address: 8852 SW INEZ ST
Subdivision: Lot:
Project: Butterfield Park, Lot 2
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1666 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1893 sf Garage: 747 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3559 sf Value: $453,171.08 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 7 201-400 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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3559
Owner: Contractor:
FOUR D CONSTRUCTIOIN FOUR D CONSTRUCTION Required Items and Reports(Conditions)
P.O.BOX 1577 PO BOX 1577 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97075 BEAVERTON,OR 97075
PHONE: 503-720-7445 PHONE: 503-720-7445
FAX: 503-590-1751
Total Fees: $33,795.63
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: /d/'�Zl:�(� D1���� 1��Z� � Permittee Signature: '
.. .-
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.
Bu>I_g Permit Application
•, Residential
� • City of TigardRE( 1 UR Ul rl( E i St: 0v1,1
_ ` :� ; • 13125 SW Hal!Blvd.,Tigard,OR 97223 �4 ,1 EECW
Phone: 503.7182439 Fax: 503.5981960 (� 5-41111 Permit No.:
tic; ;:t Inspection Line: 503.639.4175 C �1 DateB : _di J 00,E permit.
Internet: Line:www.tigard-or.gov
W 1 Date Ready/By:
?��
if
M ry�g Nom ed/Method: 3 �,L /� 0 See Page for
- 1 1 4'MAD G A � �� Supplements!Information
TxPE OF w i
'� New construction tilt CT ` `
❑ • ' °'ION REQUIRED DATA:1-AND 2-FAMILY DWELLING
•emolttton Permit fees*are based on the value of the work performed.
t M. 0 Addition/alteration/replacement Indicate the value(rounded to the nearest dollar)of all
❑Other:
CATEGORY OF CONSTRUCTION equipment,materials,labor,overhead,and the profit for the
% ':Ej
1-and 2-family dwelling work indicated on this application.
0 Commercial/industrialValuation: $
0 Accessory building ��`
0 Multi-family Number of bedrooms: -
0 Master builder
0 Other:
Number of bathrooms: 3
3OB SITE INFORMATION
p AND LOCATION Total number of floors:
Job site address: O Z �. L! ?Q
:' f site
t address:
,� New dwelling area: - .: squarerefee(
-T"i&Agt) a R 9 7ZZ
Suite/bldg./apt.no.: Garage/Carport area: • c�`7 square feet
Project name:
•
Cross slreet/directions to job site: Covered porch area ' " i glare fee.1 •
•
(� iminim.......m..moipum.t.-4-- L V D r` $C.) f_3 7- DDeck area: '' it(� square feet'•t er s dure area: Q square feetSubdivision: REQUIRED DATA:COMMERCIAL-USE CHECKLIST
'� ,r D Lot no.:
`z Tax map/parcel no.: �► ill Permit fees*are based on the value of the work performed.
C %rj Indicate the value(rotnded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for tt
DESCRIPTION OF WORK
work indicated on this .o plication.
E.5/De �� Valuation: $
Existing building area square feet
tlliIllIllIllMIIIIIIIIIIIIIIIIMIIIIIIIMIIIIII.im
New building
e\i PROPERTY OWNER area: square feet
P.ICMIIIMIIIIIIIIIIIIIIIINIMIIIIIMIMIIIIIIIIII❑ TENANT Number of stories:
Address: Type of construction:
' il City/State/ZIP: ". -Lf:1 Occupancy groups:
MOIMIIIIIIIIIINIMI 1111:1
Phone:( )
I
C.<APPLICANT ❑ CONTACT PERSON
Business name: F0 I� . BUILDING PERMIT FEES*
•
Contact name: U lease re er to ee sche4ale
-r�Y 1 j� a „ �, Structural plan review fee(or deposit):
Address:
1111111111
FLS plan review fee(if applicable): IIIIIIMIIIIII
,' City/State/ZIP:
'` r Ep Ya✓g. C) 07 S Total fees due upon Phone:(5`y3) -7 D .7 y 5t Fax:: Po application: 11111111111
a 590-- ,75 Amount received: EMU
E-mail: 1}U Y-D C+D,9�/i 7'
si
1 , (4/.11-
iv,. PIIOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
,y
Business name; roof-top mounted Photo Voltaic Solar Panel System.
Address: Submit two(2)sets of roof plan with connection details
• and fire department access,along with the 2010 Oregon
City/State/ZIP:
lZlP: Solar Installation S.ecial Code checklist.
Phone:( ) Permit Fee(includes plan review
and administrative fees: $180.1 t
State surcharge(12%of permit fee): $21.61
CCB lic.: '7/4)3'
Authorized signature: Total fee due upon application: $201.61
This permit application expires if a permit is not obtained
Print name: ,, Y) �) within 180 days after it has been accepted as complete.
--� I"t IP-0,, Date:��S_ *Fee methodology set by Tri-County Balding Industry
Service Board
I:1Building\Permits\BUP RESPermitApp.doc 02/24/2011
440-4613T(11/02/COM/WEB)
Mechanical Perm, A t t licallon
City of Ti,ar, roe orrlcl- 1s1� tl\►.1
13125 S W Hall‘i'lvd.,t igard,OR 9722 DEew
Phone: 503.71839 tte.'
tiEax: 503.59814 Permit No.:/415
rf(,,vRn Inspection Line: 51 .63t.4175 ( `
Internet: Line:g. _t. .41 t Re Other Permit:
20V OE�, fi Date Ready/By:
U Notified/method. H See Pegent 2l for
1_ Supplemental Information
TYPE OF W rt i ' x r
firNew construction
COMMERCIAL FEE* SCHEDULE
0 Addition/alt';"'t t�` " HECKLIST
�,".F , ; 'I' Mechanical permit fees*are based on the vallue oSE f work
❑Demolition performed.Indicate the value(rounded to the nearest dollar)of all
0 Other:
CATEGORY OF CON mechanical materials,e, i iment,labor,overhead,and .rofit.
pi 1-and 2-family dwellinSUCTION Value:$
g 0 Commercial/industrial 0 Accessory buildingRESIDForTIALspecial
EQUIPMENT/SYSTEMS FEES*
❑Master builderFor information use ykeckl
❑Multi-family
0 Other: Descriptionist
JOB SITE INFORMATION AND LOCATION �,�
Job site address: e Z S, Heatin_ coolin l: Tota!
J Air conditionin
75
City/State/ZIP: ` '�♦ -, 46.75
Furnace 100 000 BTU ducts/vents
Suite/bldg./apt.to/ZIp,no.: 9 7 Z a 9 Furnace 100,000+BTU ducts/vents _ 44.91
Project name: 54.92
Cross street/directions to job site: effeliiminnu61.06
Duct work _®
/4�.-t- �„�d _ r H dromic hot water s stem _®
E EN,sL,A rLt3 Z — +b Residential boiler(radiator or NMI h dromic
Unit heaters(fuel-type not electric),
in-wall,in-duct,sus.ended,etc.
11111 Subdivision: Flue/vent for an of above
Other:
46.75
6' y►�ra.i-- Lot no.: mom
Othe
Tax map/1ce1 no.: _®
- e----i- Other fuel a,•fiances:
1Z'
DESCRIPTION OF WORKEMI
_®
Flue vent for water heater or gas 33.39
.®
A 66,1 .Sg /A.}V I-e: rk.
fire'lace
l ----C ► Lo. !Otter :as —®
Wood/.ellet stove
Wood fire,lace/insert
......
nal
3
a PROPERTY OWNER
❑ TENANT
Environmental exhaust and ventilation:
Address: .r
1UL Range hood/other kitchen 1111
elui,ment
Address:
ate/ZIP: ®tai Clothes 33.39
er exhaust 33.39
Phone:( ) Single-duct exhaust(bathrooms, •®
toilet com ents,utili rooms
Business ❑ CONTACT PERSONIIIIIII Other: MINI
name: Ou b _®
Contact name: 1) E C1 fit Fuel ,i ilk:
� ♦ . r�� r. $24.15 for first four $4.03 for each additional
Address: • __
imm
City/State/ZIP: f� •
`'"- V eta_ . ♦t� Wall/sus:ended/unit heater =_
Phone:(563) 7) a ._ 7`7`lS 707 __
E-mail: }=O4ILOS-7- - __
(a1 5 COQ __
CONTRACTOR Barbecue __
Business name: Clothes d er :as __
Address: �` L Other: 1111111111
` ii.� MECHANICAL PERMIT RMIT FEES
.� C. j M CV_ ci70 15 Subtotal
Phone:(.5-:J3) 6 6r Minimum permit fee($90.00)
CCB lic.: /7
6--z
�U Fax: ) �j L#ar Plan review(25%of permit fee)
4/' State surcharge(12%ofpermit fee)
/ TOTAL PERMIT FEE
Authorized signature; + This permit application expires
ined
180
days after it has been y Bupted as comprmit is not lete.
ry ee Bon d
name: �� � ;, * Fee methodology set by Tri-County Building Indus
I:PrintBuilding �1=r%%L._fr 4Y Service Board
\Permits\MEC_PermitApp 040113.doc
440-4617T(I I/02JCOM 'an>
Electrical Permit A lication
CitlyofTigard ► c�ltf)lIll ► I 5> ��N►
! 13125 SW Hall Blvd.,Tigard,OR 97223I. '4
Phone: 503.718.2439 Fax: 503.598.1960 rermit#'
Inspection Line: 503.639.4175 DEC_--
Plan Review L =�7�1 'c
c U 5Date/B : Related Pe
Internet: Wsvw.tigard-or. G 01 Ready Date/By: Permit#:
Notified/Method:
barn VI See Page 2 for
TYPE OF WO a: Supplemental information
EW
New construction < '
0 Additian/alterati
PLAN
❑Demolition DIVISION' Please check all that
❑Other: . „, apply{submit sets of plans w/items checked):
CATEGORY OF CO
0 Service or feeder 400 amps or more ❑Building over three stories.
1-and 2-family dwelling CONSTRUCTION
where the available fault current
0Commercial/industrialAccessory exceeds 10,000 amps at 150 volts or ❑Marinas and boatyards.
❑Multi-family 0 Accesso building less to groan or 0 Floating buildings.
0ta Master builder d 14,000 0 Commercial-use s
JOB SITE INFORMATION Other: amps for all other installations. agricultural
AND LOCATION ❑Fire pump. buildings.
Job# Job site address: _ ❑Erne nc
0 Installation of 150 KVA or
do Z Y system.
larger
City/State/ZIP: i//__ cJ;W; j �� ❑Addition of new motor load of gseparately moved
/C� I00HP or more. system.
Suite/bldg./apt.4: / 2-2-V ❑A^«E„ «1 2.°vehicle
p,
El or more residential units. oeaapanoy.
Project name: ❑Health-care facilities_
Cross street/directions ❑Recreational vehicle parks.
to job site: ❑Hazardous locations. 0 Supply voltagefor
0 service or feeder 600 ampsmore thanri L or more. 600 volts nominal.
'o L V► -- V E.CiA/Sc,, 12-0 L..A/ .. FEE SCHEDULE
Subdivision: (`} y'I4 pear ion
New residential single- �' li
Tax map/parcel#: Li)
Lot#: Includes attached a ge multi-family dwelling unit.
6,..\1 c-.4w ,ri iti,;. i r'"1� #L.. ' 1,000 sq.ft or less
DESCRIPTION OF WOE Ea.add't 500 sq.fl.or portion 4
't Limited energy, 33 92 2
• � residential
with above <.ft. III75.00 2
1111111— Limited ever
= PROPERTY OWNER residential with above multi-family
ft. 3III
5.00 MN 2
❑ TENANT Renewable Eue
Services or feeders installation,altteeration,and/or rel
ocation
IIIIIIII
Address: 200 amps or less' 1111City/State/ZIP: M6 • 1,0 201 amps to 400 amps 1 7Q 2
401 amps to600 amps 2
Phone:( ) 602 amps to 000 amps EMI 200.34 2
■■, Over 1,000 amps1111 301.04 1111111112
or volts -®mum
Owner installation:This installation is beingTemporary services or feeders installation,alteration,and/or
2
intended for sale,lease, made on property that I own which is not relocation
rent,or exchange,according to ORS 447,449, 200 amps or less
Owner signature:
g 670,and 701. -
$nature: 201 amps to 400 stn 1
Date:�, 401 amps to 699 ampsi 126.08 2
0 CONTACT _
Business name: 1ZERSON Branch circuits—new,alteration.or extension,
2
CoAJS%RU 01-10 k A.aboveee fori branch circuits with n+ "r anei
Contact name: service or feeder fee, 1111.11111111
' ,'�1 rT i��(��-- each branch circuit
Address: Pi 0' Bux B.Fee for branch circuits without 2
Cityrens:/ZIP: Y- 1 7 11171611111111
service or feeder fee,first
Y 1ZTGtl3 branch circuit .
Phone: - 5 Each add'I branch circuit 2
Miscellaneous service or feeder not included unzaame 2
Email: �'b LI Each manufactured or modular
`��� v` . co/�►'1 dwellin• service and/or feeder ■
CONTRACTOR 67.84 - 2
Business name: Reconnect only -
Z t� GC 7-/z f (� tirit p Pump or irrigation circle 2
Address: Sign or outline lighting 11111111 67.84 2
City/State/ZIP:ZIP: .. „. /V� �/1 JO Signal circuit(s)or limited-energy 2
Po ice.i G., ivo �.� el aiteratio or extension. 0see Page 2 -
C
Each additional ins ection over allowable in an of the above
2
Phone: L�7 ,_37
�t'.✓} O�7' Additions(ins -
inspection(1 hr min) `P _
Investigation hr min)
Email: G&7--&.Le r_r -
K 1 t> 'a ' tll/4 Industria!plant(1 hr min) 66.25/hr Inn
CCB Lic.: e�`
7 V Electrical Lic.:C 3 c. Suprv.Lie.: InspectionsclIfor which r fee is
Suprv.Electrician signature, ,�z j s• ificalt listed is hr min ■Subtotal: hr -
gn are,required: '
Print name: o g�1 ELECTRICAL PERMIT FEES
f7 />f1 =+,(/l ��p1 Date: 2Subtotal:
I 0 Plan Review Required(25%of permit fee):
Authorized signature:/.. State surcharge(12%
,__ s of
permit fee):
Print name: ApArp.
TOTAL PERMIT FEE:
t:l6.� ,� J Date: J Z.-- This permit application expires if a permit is not obtained within ISO
oglPermitslELC_PermitApp_ELR ERE.doc Rev / 4 days after it has been ecce
04/21/2014 Number,of ins Pled as complete,
440-4615TO 1/05/COANWEB inspections allowed per permit.
Plumbing Permit Annl_ic_at_ion
Building Fixtures +v"
City of Tigard 1OR Olf 1( 1: 1 SI 0y t.1
III ,iCFI"
•` eceived
i it 13125 SW Hall Blvd.,Tigard,OR 97223 - Dan R
Phone: 503.718.2439 Fax: 503.598.1960 Permit No.: 7'tf
Inspection Line: 503.639.4175 Plan Review u ;,
rr�,.,t<t/ 5 2017 Date/By:
Internet: www.tigard-or.govDEC Permit No.:
Date Ready/By:
TYPE OF WORK gam) • d - , fied/Method: fill See page t for
I!t n Supplemental Information
�Newconstntction FEE* SCHEDULE
0 r, ,, .•`Z IN 9 ' `:i s
❑Addition/alteration/replacementFors,'dal in ormaGionuse checklist
0 Other: Desai.tion
1[3211CATEGORY OF CONSTRUCTION New 1-2-family dwellings(includes 100 ®cotmeetton)
RI 1-and 2-family dwelling SFR(I)bath
0nil Commercial/industrial SFR(2)bath 312.70
❑Accessory building ��
0 Multi-family SFR(3)bath _
❑Master builder Each additional 500.32
❑Other: bath/kitchen 11 25.02
JOB SITE INFORMATION AND LOCATION Fire sprinkler(•____sq.ft.) 1111111223
Job site address: Zr Site utilities:
City/State/ZIP: 1 E Catch basin or area drain 11111&nom c(Z, 0 7 ZZ. 18.76
Drywall,leach line,or trench drain _
Suite/bldg./apt.no.: Footing drain(no.linear ft.: ___) 18.76
Project name: _
Cross street/directions to job site: Page 2
Manufactured home utilities 11111 50.03
i4 LZ Q ,,/p R Manholes 111111 18.76
A.,4 L.. - A ( - Rain drain connector _
18.76
Sanitary sewer(no.linear ft.:_) NIS
Storm sewer(no.linear 8.:•_� Page 2
S�.tbdivision: ,y Zir .... _ Water service(no.linear$.:�)
.._..... j� , : Lot no.: _
Tax map/parcel no.: j >r -w Fixture or item: Page 2
Backflow preventer �®
DESCRIPTION OF WORK !� li�.-_®
4,0 E _ •.1 4.6 1 L f' l� Clothes washer
Dishwasher NEM 25.02
Drinking fountain INN
25.02
MI Ejectors/sump
25.02
Ej
�� PROPERTY OWNER NEM 25.02
0 TENANT Expansion tank _113111
Fixture/sewer cap
Address: S � Floor drain/floor sink/hub
r 25.02 alIll 25.02
Garbage disposal
111111 Phone:( ) Hose bib 25.02
1.11125.02
1111111111119111
0 CONTACT PERSON Interceptor/grease trap _
Business name: F=o tt jZ D T 25.02
Contact name:
N'_' p Medical gas(value:$ }
11111111...11931
Address: ?, b, Roof drain(commercial) _
f S —2
City/State/ZIP: Sink/basin/lavatory _
7 qv ' _ m . 0 970 S 6252.502
4
Phone: 't ) ` 0._ Solar units(potable water) _
�y Tub/shower/shower pan 62.54
E-mail: P 6 U l D 4.CI/VS" v rt4 '4 CO _®
CONTRA ` 25.02
OR Water closet _
Business name: -�-- '�° t 25A2
Address: ����C� r ��
ti c ,4 5 c Water piping/DW V
City/State/ZIP: -)ii C� - �' 56.29
Other:
Phone: ._ d / .rINN 25.02
(`�'' c)�(s 0" /. Subtotal
CCB Lic.: /..2 6 *,C Minimum permit fee: $72.50
Plumbing Lic.no.: -26e��
Plan review (25%of permit fee)
Authorized signature: ///
State surcharge(12%of
permit fee)
Print name: .._,,,,,,,,L '_! � TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
I:\Building}pipLMU-PennitApp.doe 10/01/09 *Fee methodology set by Tri-County Building Industry Service Board.
440-4616T(10/02/COM/wEB)
Albert Shields
From: Albert Shields
Sent: Thursday, December 07, 2017 10:39 AM
To: 'fourdconst@msn.corn'
Subject: MST2017-00489 & -00490
David, on reviewing your applications for the above permits Engineering finds that we do not yet have a copy of a
recorded plat for the subdivision, SUB2016-00010. Accordingly, I have noted these applications as "Approved (for Plan
Review) but Not Released." Plan review will continue but the permits cannot be issued until we receive a copy of the
recorded plat. Please let me know if you have any questions.
Albert Shields
Permit Coordinator
City of Tigard
A I bert( tigard-or.gov
503-718-2426
1
City of Tigard
Ilk . COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: ., O 7
Site Address: 355a -1,t) Inez, .S+
Project Name: %+?el� -Pa,-.IG
(New dwelling=subdivision name;Addition or Alteration=last name of owner) Lot # :
Planning Review
Proposal: e,A. -.F.W.
erify site address/suite#exists and active ipermit system.
Oz.River Terrace Neighborhood: ' 1"o ❑ Yes,See River Terrace ReviewAddendum Attached
Site Plan Elements:
❑Three(3)copies of site plan
�te plan must be on 8-1/2"x 11"or 11 x 17"paper `��g-structures on site
Footprint of new structure(including decks)with finished
- 1 raven to scale(standard architect or engineer scale)
floor elevations
Wirth arrow
2Viiity locations&easements (required for new and additions)
2te address,project or subdivision name and lot number
, cant information(name and phone number) 'sidewalk/driveway approach
���
Lot dimensions and building setback dimensions n oIfItuntrj — wells/septic systems
to
Sre-feetage of buildings to be demolished � s be retained with drip line,and tree
protection measures
ding coverage area,percentage of coverage and Street tree size,type and location
i3pervious area(applicable if R-7,R-12,R-25&R-40) greet names
roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? No
4 foot differential)
If es,is a storm water •uali facili shown? EYes o
lean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified
2—"No Received: 0 Yes 0 No
Public Facilities provement(PFI) Permit: Pte/a C)17-6.%74,77
Required: AKCYes,applicant was notified 0 No
Applied For: eS 0 No,stop intake
Land Use Case#: U • a0l , -. 006iD
--ET-Zoning: ^ y`5
Er—Required Setbacks: FrontRear
a O /s Side s Street Side a Garage -26)
as-ere Requirement: %
gam-Maximum:
2-13-uilding Height: Maximum Height 3//\\
B/s Clearance V Actual Height 7
Sensitive Lands: 0 Yes .2 No
.Urban Forestry Plan Type
J1 Conditions "Met"prior to issuan e of buil.' g permit
Notes: ; (I a( • / _/
.e re prtieC, ir, or 40
G-2
Approved By Planning: ____.__ :=Z __________
Revisions (after Building Submittal only) Date: 1� D
Revision 1: 0 ApprovedReviewer Date
pp 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgpermitRvw RES_061417.docx
Building Permit Submittal
Original Submittal Date: ✓
Site Plans: #
Building Plans: # —
Building Permit#: nter building permit#above.
Engineering7ermit Coordinator Building
Workflow Routing: Planning
Workflow Sign-off: Sign-off for lanning(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.
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: , �ff�� � Date: J�
By Permit Technician: �A.�•• �-L��- �
Engineering Review
Slope at building pad:
)Zr Conditions "Met"prior to issuance of building permit
per engineering conditions of approval and plat
A Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes n.No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot: 0 Yes
rail 0 Final Plat Recorded: Date:
0 NOT Ay rov;� by Engineering:
Pr
Notes: � 'e ,..r.,,,go Or ,1 -
�����T"'s . !, :ow v
/' � Date: �"—�
Approved by Engineering: "' Date
Revisions (after Building Submittal only)
Reviewer
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
0 Conditions"Met"prior to issuance of building permit
------------- i I� l
Date:
��Approved,NOT Released: / 01
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: 1\d es 0 N/A
Tigard Trans SDC: 0. Yes 0 N/A
Parks SDC: i Yes 0 N/A
LIDA 0 Yes 1(N/A
OK to Issue Permit / / `
�// Date: '1"
Approved by Permit Coordinator:
I:\BuildingForms\BldgPermitRvw_RES_111617.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8852 SW INEZ ST, TIGARD, OR, 97224 October 24, 2018 at
1 :16:58 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00490
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8852 SW INEZ ST, TIGARD, OR, 97224 November 1 , 2018 at
10:04:46 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00490
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:
8852 SW INEZ ST, TIGARD, OR, 97224 November 1 , 2018 at
10:06:19 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00490
Inspection Type: Inspector:
699 Mechanical 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:
8852 SW INEZ ST, TIGARD, OR, 97224 November 2, 2018 at
10:53:58 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00490
Inspection Type: Inspector:
299 Final inspection Jeremy Burrows
Result:
PASS - CofO
Comments:
Final erosion control passed
Street tree certificate received
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