Permit (117) CITY OF TIGARD MASTER PERMIT
1,1111
`' E' COMMUNITY DEVELOPMENT Permit#: MST2017-00296
T G,ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/19/2018
Parcel: 2S 110AC00200
Jurisdiction: Tigard
Site address: 11034 SW ANNAND HILL CT
Subdivision: ANNAND HILL SUBDIVISION Lot:
Project: Annand Heights, Lot 21
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 883 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 4 Second: 1131 sf Garage: 457 sf Front: 15 Smoke
Dwelling Units: 0 Third: 0 sf Right: 3
Detectors: Yes
Total: 2014 sf Value: $252,335.43 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 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 Tema 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
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 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 Eave both sides
TIGARD,OR 97223
PHONE: 503-768-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,633.80
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 R 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.
y�� / -yam '
Issued By: !/ Permittee Signature: e��✓ <✓� ./�- e
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.
BuildingPermit Application 7. ' ''
Residential
FOR OFFICE USE ONLY
City of Tigard Received ��/
.1111111 M 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: . Permit No. 7] /7 /
Phone: 503.718.2439 Fax: 503.598.196 � � Plan Review /� s l/1C/
Inspection Line: 503.639.4175
Date/By. $ �� Other Permi.
TIGARI? p 1 �(I�� Date Read /B `^��C'/� '�/� v
Internet: www.tigard-or.gov AUG U y o. �/� surfs: I 0 See Page 2 for
Notified Method. Supplemental Information
TYPE OF WORK}TY OF 11 BeIrGARDthl
New construction �i����a 111 V IA. 1 `" REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑Demo ikon Permit fees*are based on the value of the work performed.
❑Addition/alteration/replacementIndicate the value(rounded to the nearest dollar)of all
0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION- work indicated on this application.
2 i-and 2-family dwelling ❑Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms: �'�--a.,
❑Master builder � �'a,33
❑Other: Number of bathrooms: 4
` JOB SITE INFORMATION AND'LOCATION Total number of floors: Il 7 I
Job site address: 03 y �� �Jnnand C�_ ( New dwellingarea: vI
`!�7/ / /T �' �j4�—'� ao ' � square feet
City/State/ZIP: .7...Ta/_2 ) 021=-7 7 r
23 Garage/carport area: �,�,J 7 square feet
Suite/bldg./apt.no.: Project name: a/ V t
./L
/�/)�tN C Covered porch area: 'O g square feet 11 3 ,
Cross street/directions to job site: /ff/ f�
Deck area: square feet g 83
Other structure area: square feet
�� REQUIRED DATA:COMMERCIAL-USE CHECKLIST
t�
Subdivision: Ad �o L
!1is I Lot no.: ,,/ Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 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� e- j p1 Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER I 0 TENANT Number of stories:
/
Name: up ki,90j3 CUts f-"�'�'"`�/
n /7
�0� ,�� Type of construction:
Address: 422,6J'w pid/L�-tl 4)GL-,�`41 f 6ral-r-rel
Occupancy groups:
City/State/ZIP: ma izi 3-2
3 Phone:(<•"03) 70Fax: Existing:
�� 76' (S2t3) SyU—7�CIG
0 APPLICANT New:
CONTACT PERSON BUILDING PERMIT FEES*
Business name:. (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::
dwell". ( ) Amount received:
E-mail: li
t,Inafiff o j es,1�it-7 rPHOTOVOLTAIC-SOLAR PANEL SYSTEM FEES*
P�/ltCcl�r�(/�1
CONTRACTOR Commercial Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: k fN c1 c at_71�LC Submit two(2)sets of roof plan with connection details
Address: �} /-'�-� !lam �� �� ��� y �� and fire department access,along with the 2010 Oregon
`p`-�['`7 �(�"C� �� �/Z Solar Installation Specialty Code checklist.
City/State/ZIP: 9'7223 Permit Fee(includes plan review
Phone:( and administrative fees): $180.00
1ge/ -1-13 7s J Fax:( 6?/3 (5-17 l'-ZaOC )
State surcharge(12%of permit fee): $21.60
CCB sic.:
� 0/96,-
Total fee due upon application: $201.60
Authorized signature — - This permit application expires if apermit is not obtained
within 180 days after it has been accepted as complete.
Print name: 44'44 Date: //!//7 *Fee methodology set by Tri-County Building Industry
4 / Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicatiol Ft JFFICE USE
ONLY
City of Tigard Received
. Date/By: Permit No ekt /7.-041,3g...
13125 SW Hall Blvd.,Tigard,OR 97223 ''--LL
Phone: 503.718.2439 Fax: 503.598.1960 RECEN
–11j111.11111111
Other Permit:
TIGARD Inspection Line: 503.639.4175
Date Ready/By: Juris a See Page 2 for
Internet: www.tigard-or.gov , tified/Method: Supplemental Information
AUG
')61kPE"OF:WORK', '!'tf op T I GAViV COMI1D';RCIAL FEE* SCHEDULE– USE CHECKLIST
ew construction kit i 1 �+�n LISIOT'- Mechanical permit fees*are based on the value of the work
0 Addition/alteration/rep i VING performed.Indicate the valuerounded to the nearest dollar))of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGtORY OF CONSTRUCTION ,,
� RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
S 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family 0 Master builder ❑Other: Description P Qty. Ea. Total
'' 7O$`S1TE*FORMATIONAND,LOCATION' Heating/cooling:
Air conditioning 46.75
Job site address: //Q 7 / � �i��� �" 46.75
! �� /® �G Furnace 100,000 BTU(ducts/vents)
City/State/ZIP: Q rJ,,,a� �� 972,23 Furnace 100,000+BTU(ducts/vents) 54.91
/ Heat pump 61.06
Suite/bldg./apt.no.: Project name:6n4a %
. 9 Duct work 23.32
Cross street/directions to job site: /of 1✓ Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: / Other: 23.32
�j(�j� `/y h Lot no.: 2.4
Other fuel appliances:
Tax map/parcel no.: (/ Water heater ./ 23.32
,' DESCRIPTION O.F.WORK • Gas fireplace/insert .e.""--- 33.39
Flue vent for water heater or gas
1 cjP-1— fireplace / 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
. . ROPER'TX,,,OR'NER .' ,:` :. ,,
❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: lildiu6vd &t.51 IAC Range hood/other kitchen nt .�
Address: J r--` 5� /Vdr$') �'• �' 5 -1 Cleqothes dryer
33.39
�? '� v '-t'u/ r� Clothes dexhaust ..,"' 33.39
City/State/ZIP: 7:,‘‘,64,...al (:)� Q.-2. 23 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 0 23.32
Phone:( 6-03 �t5 d -7c Fax: "j) �Q --76.u6
Attic/crawlspace fans 23.32
, APPLICANT; ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
–" � e $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
t S/
4Jl (Ju-cai9�At1110-)� M Range
E-mail: i
®��J/nGt-l'�t �(/ Barbecue
CONTRACTOR- V Clothes dryer(gas)
Business name: -i i r5/ f . /1 Other:
MECHANICAL PERMIT FEES*
Address: J3/50 /lam Ltote g,�tz, /Dt Subtotal
City/State/ZIP: ,,,,_,,d,_ 4 �n aI✓' us Minimum permit fee($90.00)
Phone: '[!< Plan review(25%of permit fee)
( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: -7TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: � Date: e////?1\Reildine\Permits\MEC PermitAno 040 13.doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application
Fl JFFICE USE ONLY
City of Tigard >RECCi ed Permit#: 57-x0/7 w9_,4/
a '. .
. e 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960illh 1 atetBy: Related Permit#:
T I G A R D Inspection Line: 503.639.4175 ( 1 O Steady Date/By: Juris GI See Page 2 for
Internet: www.tigard-or.gov ��°3 Notifsed/Method: Supplemental Information
TYPE OF; WORK I O 1 PLAN REVIEW
ilOrNew COriStruCtiOn ❑Additiori/alteration/rep e �i�t� --. Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or El Floating buildings.
1-and 2-familydwelling ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ ❑Commercial/industrial amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ` El Emergency system. larger separately derived
/lc 3v ` / El Addition of new motor load of system
Job 4: Job site address:/l
6 /T/1 n4�tK �tit(/� I OOHP or more. ❑•.A„ `•E" .`l-2" •.l-3"
City/State/ZIP: 0/)aid 4(.9,c 9n�3 ❑Six or more residential units. occupancy.
f tom'` 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. CI Supply voltage for more than
^ �� /J' '! ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: /j'lQ t FEE SCHEDULE
e V Description I Qty. I Each 1 Total I *
New residential single-or multi-family dwelling unit.
Subdivision: A-Afoiti #{(94( x—15 Lot#:.� 17/ Includes attached garage.
1,000 sq.ft.or less / 168.54 4
Tax map/parcel 4: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential S 75.00 2
f/�f 5F/1. (with above sq.ft.) t
d �G Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
„.Et—FIFOPERTY;OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: tout ®uteGc,/ at„s/As 200 amps or less 100.70 2
Address: p&5.--s- 6-4,) Nam 0ct_ic�� 6' a 201 amps to 400 amps 133.56 2
City/State/ZIP: 7-04„..,/ f-0.23 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:(3 • 76ra"L/3 ,S-- Fax:(7i3 )57/D —24,44 Over 1,000 amps or volts 552.26 2
I / / I Temporary services or feeders installation,alteration,and/or
Email: �(�p,i-te(/I ZS ,v 61 6,t ic(h4A relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
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
LICANTBranch circuits—new,alteration,or extension,per panel
0 CONTACT PERSON A.Fee for branch circuits with
Business name: (5a, .„ above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 4r-ca ,�
41tL-g( iY�TI/L Sign or outline lighting 67.84 2
II'— panel,alteration,or extension. CISignal circuit(s)or limited-energy
�� pil
Address: / Ct1 ridy See Page 2 2
City/State/ZIP: 5w [ j Each additional inspection over allowable in any of the above
r c. odo� �. .1.'1,1-.2-5�� Additional inspection(1 hr min) 66.25/hr
Phone:(�-j3) 5/9 ,6'2 a Fax:(j- 7) ‘yb 97.23 Investigation(1 hr min) 90.00/hr
/ Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.://6,77x,4. Electrical Lic.:e.-- e Suprv.Lic.:ii5- 0S specifically listed(i hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name /1,y73 -)4,� Date: 0!17//7 ❑Plan Review Required(25%of permit fee):
" State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE:
�^g�y �, This permit application expires if a permit is not obtained within 180
Print name: C Ari, // e_� ! ^i A • Date: ,1///2 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I.'Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/I 5 5 440-4615T(11/05/COM/WEB
Plumbing Permit ApplicatioSII
$wilding Fixtures FOR OFFICE USE ONLY
Received 1 �` /� )�j
City of Tigard '@ Date/BPermit No.;,/A ST/'O/7 70)
- 13125 SW Hall Blvd.,Tigard,OR 972 1' �! y /`��
Plan Review
Phone: 503.718.2439 Fax: 503.598.'' 1 n i DateBy: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 �yyCm u\! Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.govlJ P Nonfied/Method: Supplemental Information
FID
TYPE OF WORKcir -n;pf�± I ls� FEE*'SCHEDULE
Jry` ew construction ❑1-80111014 -1 0 For special information use checklist
° Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION; SFR(1)bath 312.70
and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath ,f,==-'' ' 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: //9 3r L 4) /9AIIQ/tFr �a4 Catch basin or area drain 18.76
/State/ZIP: ! !! Drywell,leach line,or trench drain 18.76
City/State/ZIP:
T h z,/1' -- v.-7 -.2--3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: n z.idili1b A/5 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
/®9 f-J Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: itlii pt l/e/s A, Lot no.: 2/ Fixture or item:
Tax map/parcel no.: �1 / Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
t/-J 5,R Dishwasher 1
/ Drinking fountain 25 1
Ejectors/sump 25 1
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: I/tJP/�el )ff� za�s7 p cFixture/sewer cap 1
p"A• Floor drain/floor sink/hub 1
Address: s-5-54D ./1,4971--h 5-(4)-e.„-://
Garbage disposal 25.02
City/State/ZIP: 77 arm 4 47 3 Hose bib 25.02
Phone:(3 -27b--L/1 7$"- Fax:(se 3,5, -7 ,al Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page
Business name: 5044 to
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
E-mail: A./tet_c iiiverdA,�f�f'LZS4/w �,_eitat.4`G� Urinal 1
CONTRACTOR Water closet 1
/ Water heater 37 52
Business name: par–F f P'(i.A-4!\� Water piping/DWV 56 29
yy
/ QJ�
'S
Address: /4o Ho 6- 6f `1 lel" Other: 25.02
City/State/ZIP: Orcezi d� �l/W Subtotal
`�// Fax: Minimum permit fee: $72.50
Phone:(�'!/3) '702'3 "rd�j (t5 3) 7,..atie/
review (25%of permit fee)
CCB Lic.: , .„2 9 Plumbing Lic.no.3...c.-34,i41
/ State surcharge(12%of permit fee)
Authorized signature: /` TOTAL PERMIT FEE
Print name: WIt}Al Date:g////'7 This permit application expires if a permit is not obtained within 180 days
J�` after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(]0/02/COM/WEB)
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
I
T 1 c A R D Building Permit Review — Residential
Building Permit #: jj /2„, Ap-- _ ,
Site Address: d 9521 scit) /9/ >/ 0-02/1---/—
Project
7 + -
Project Name: 1 �fl,4 Lot #: /
(New dwelling=subdivision n J Addition or Alteration=last name of owner)
Planning Review
Proposal: 4.140 ,CFlh
IX Verify site address/suite# exists and actio m permit system.
ever Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Sit Plan Elements:
ee(3)copies of site plan i fisting structures on site
,_,(
Ate plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
NJrawn to scale(standard architect or engineer scale) 7.or Igyorth arrow t1 tility locations&easements(required for new and additions)
lkto address,project or subdivision name and lot number ,Sidewalk/driveway approach
Lpplicant information(name and phone number) t : ation of wells/septic systems
o dimensions and building setback dimensions 01:4'sting trees to be retained with drip line,and tree
',uare footage of buildings to be demolished pro ection measures
7 Lot area,building coverage area,percentage of coverage and !1'',eet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) ,p Street names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? s ❑No in
4 foot differential) If yes,is a storm water quality facility shown? e ❑N
0 Clean Water Services-Service Provider Lett (lot platted prior to 9/10/1995): 4 e��e"n` o// 414
equired: El Yes,applicant was notified Le;
No Received: El Yes CI No
lR
1 Public Faciliti Improvement(PFI) Permit: PF0 0/e— G 'D
equired: DYes,applicant was notified ❑ No Applied For: V Yes ❑ No,stop intake
and Use Case#: pl.vm/L ---/L-- or- A a/ Q 7 S J
/
ZiOning: ?--�quired Setbacks: Front A� Rear AS' Side '' Street Side �4_Garage 6
l
Requirement: c„.2e)
0131/Lot Coverage Maximum: -
qQ Building Height: Maximum Height S----- Actual Height Q
V'a '"isual Clearance
TA
ensitive Lands: ll Yes 0 No Type lie �S',1� __c[jZ Urban Forestry Plan
❑ Conditions "Met"prio to issuance q bqding permit '
Notes: a/)d17511�'tS cch ) 7c7r 4Y//2/— j--C-Cli r'-C_
Approved By Planning: — ' Date: SO / 19 -
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES_061417.docx
Building Permit Submittal
Original Submittal Date: 7/�/0
Site Plans: #
Building Plans: #
Building Permit#: ►: " nter building permit#above.
Workflow Routing: E' Planning , Engineering D7Krmit Coordinator / -Building
Workflow Sign-off: I 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.
191 Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
B Permit Technician: - i
Date: * /7
Y /ter _��, �t� „.i„ 7
Engineering Review D ga
,E1 Slope at building pad:
❑ 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 Afr1No
Assess Water Quantity Fee in-lieu: ❑ Yes 'U No
LIDA Facility on lot: 0 Yes )2'No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Al /41 - LA-) , Date: /I7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 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:
DC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: WYes ❑ N/A
Parks SDC: 301 Yes ❑ N/A
LIDA ❑ Yes RN/A
-K to Issue Permit '�f�
/APPby roved Permit Coordinator: /�� i' Date: All
I:\Building\Forms\BldgPemiitRvw_RES 061417.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11034 SW ANNAND HILL CT, TIGARD, December 3, 2018 at
OR, 97224 1 :34:52 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00296
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Water pressure = 75 psi
All previous corrections completed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11034 SW ANNAND HILL CT, TIGARD, March 11 , 2019 at
OR, 97224 10:27:39 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00296
Inspection Type: Inspector:
299 Final inspection Jeremy Burrows
Result:
PASS - CofO
Comments:
Corrections completed
Note: No A/C installed
Final erosion control passed
Moisture content form received
Moisture barrier acknowledgement form received
High efficiency lighting form received
Blower door and/or duct seal test certificate received
Insulation certificate verified
C of 0 left on counter.
Violation Summary:
Inspector Contractor