Permit (51) CITY OF TIGARD MASTER PERMIT
2 COMMUNITY DEVELOPMENT fig. Permit#: MST2017-00510
4 .. g >, Date Issued: 06/18/2018
TtGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104A600100
W �NO
Jurisdiction: Tigard
Site address: 11990 SW REDBERRY CT
Subdivision: PROGRESS LANDING Lot:
Project: Progress Landing, Lot 9
Project Description: New SF. 8/15/18: REPRINT to add A/C unit. 9/24/18: REPRINTED permit to include(1)laundry
tray.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1179 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 3 Second: 1447 of Garage: 593 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2626 sf Value: $325,708.47 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 2 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 1
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: 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'I 500 sf: 5 201-400 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 2626
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PKWY STE 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
370 BEAVERTON,OR 97006
BEAVERTON,OR 97006
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $31,394.27
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 f• = Ie ruies—adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 thhrou•h OAR 952-001-00•e • •a obt- a copy of the rules p/direct questions to OUNC by calling 503.232.198/ or 1.800.332.2344.
Issued By:✓ f ...edam( "-- _,......21, Permittee Signa i -: 42 4,
s al •1 .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.
Plumbing Permit Application llkk ,
Building Fixtures j_}-l; 13 2U
11
�r �^y y� 1-012 01.11('I: 1 SI. 0\1.1
/ z`1`i . -,eceived 7
City of Tigard C ' "• Permit N›,;‘,fs/d.(IR>_6.
j.c'/1
u 13125 SW Hall Blvd.,Tigard,OR 97223 cote �1 l� ew f �+
■ Phone: 503.718.2439 Fax: 503.598.19 '0 1,a E l 'o Date/By: Other Permit No.:
1 1 t 1c 1 Inspection Line: 503.639.4175 Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplementalluformadon
,.° ,+r ..'sEOt` r ' .Y,••Yd tr
M;, '',L'.‘,.''.,,:::%'-- , . 1,z , ,q, f , ,,i.....1''' �,_ ••• .,,.,T. , .^` ,.^••• , 4. ,:I ,,,kg
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
t Tv .t 4,'''''''s d 1V 414WW:§1041;:i' SFR(1)bath 312.70
®1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath , 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
,,, :: .JOB• . - .l. e -�`., r tJ..,AND s aXn QN ,- Site utilities:
Job site address: 11990 SW REDBERRY CT lfc. Catch basin or area drain 18.76
City/State/ZIP: TIGARD, OR 97223 till�ll Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: PROGR :" t'NDING Manufactured home utilities 50.03
Cross street/directions to job site: SW WALNUT ST. &SW 135TH AVE. 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.:_) Page 2
Subdivision: PROGRESS LANDING I Lot no.: 09 Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
t'-'"(:-;`-'4- < 4 sPT:IS Backwater valve 12.51
`s° r, ' ' ' ' Clothes washer 25.02
Construction of SFR // / Dishwasher 25.02
ef4t/ ll 4 , i"j 1'�'C k) L:&I(ff /,) /G;',-t,,.*'(i. Drinking fountain 25.02
R Ejectors/sump 25.02
f}TIER .\11 ,. Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Parkway,Suite 370 Garbage disposal 25.02
City/State/ZIP: Beaverton,OR 97006 Hose bib 25.02
Phone:(503) 645-0986 Fax:( ) Ice maker 12.51 i
t,,;-,,,,, ,4,4;,,-YAP ( Al'' " "t°` "� T ;tgl�i a e,a)A t` � Interceptor/grease trap 25.02
Y Medical gas(value:$_) Page 2
Business name: Same as above Primer 12.51
Contact name: BRETT GROVES
Roof drain(commercial) 12.51
-Address: Sink/basin/lavatory 1 25.02 2-5- ()
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: bgroves@riversidehome com i
t, o- Water closet
25.02
fir „
4"1",,,W_
g A mak. sect,,: .s ',max Water heater 37.52
Business name: H & H Mechanical Water piping/DWV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal y) .v,Z
Phone:(503) 975-9787 Fax:( ) Minimum permit fee: $72.50
fl Plan review (25%of permit fee)
CCB Lic.: 178122 1 Plumbing Lic.no.: PB414 State surcharge(12%of permit fee) J_�
Authorized signature: p1,4� TOTAL PERMIT FEE iii- C
Date: 11/30/2017 This permit application expires if a permit is not obtained WI hin 180 days
Print name: Brett Groves after it has been accepted as complete.
`Fee methodology set by Tri-County Building Industry Service Board,
1:\Budding\Permits\PLMIJ-PermitApp.doc 10/01/09 440-4616T110/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
: I � COMMUNITY DEVELOPMENT Permit#: MST2017-00510
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 :` Date Issued: 06/18/2018
T f i a l D9 Parcel: 2S104AB00100
Site address: 11990 SW REDBERRY CT
111111901.
A Jurisdiction: Tigard
Subdivision: PROGRESS LANDING Lot:
Project: Progress Landing, Lot 9
Project Description: New SF. 8/15/18: REPRINT to add A/C unit.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1179 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 3 Second: 1447 sf Garage: 593 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2626 sf Value: $325,708.47 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
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 1
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'I 500 sf: 5 201-400 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 2626
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PKWY STE 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
370 BEAVERTON,OR 97006
BEAVERTON,OR 97006
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $31,366.24
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i.. . . At i, s.Jr_- - — Permittee Signature: • h`Gi 75(/(,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application ,: - 1 o R()I i 1( 1 1 s 1 0\1 1
City of Tigard Received „
`J g Date/By: IV , /u LL IM. / I
13125 SW Hall Blvd.,Tigard,OR 97223 I^ ,°a
g Phone: 503.718.2439 Fax: 503.598.1960 t ii- 2131,i'° Plan Review
Date/By: Other Permit:
1 I t,A RI, Inspection Line: 503.639.4175 (' . Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE —USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address: 11990 SW Redberry Court Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: PROGRESS LANDING Duct work 23.32
Cross street/directions to job site: SW WALNUT ST. &SW 135 AVE 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: PROGRESS LANDING Lot no.: 09 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Add NC to permit MST2017-00510 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
RI PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Range hood/other kitchen
equipment 33.39
Address: 17933 NW Evergreen Parkway, Suite 370 Clothes dryer exhaust 33.39
City/State/ZIP: Beaverton, OR 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32 ,
Phone:( 503) 645-0986 Fax:( ) Attic/crawlspace fans 23.32
al APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
Same as above $14.15 for first four;$4.03 for each additional
Contact name: Wes Boisvert Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: wboisvert@riversidehome.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: Pro Heating &Cooling MECHANICAL PERMIT FEES*
Address: 2095 NW Alocleck Rd.#1103 Subtotal
City/State/ZIP: Hillsboro OR 97124 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(971 )205-4989 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 209001 TOTAL PERMIT FEE 52,4
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: Wes BOlsvertq'!2 Date: 8/13/18
I:\Buildi g\PennitskMEC PermitApp 040113.doc 440-4617r(11/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
a 3. . COMMUNITY DEVELOPMENT Permit#: MST2017-00510
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2018
Tt Gi 'O 9 Parcel: 2S104AB00100
Jurisdiction: Tigard
Site address: 11990 SW REDBERRY CT
Subdivision: PROGRESS LANDING Lot:
Project: Progress Landing, Lot 9
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1179 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 3 Second: 1447 sf Garage: 593 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2626 sf Value: $325,708.47 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: 0 Catch Basins: 0
Bckflw Prevntr: 1
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: 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 add9 500 sf: 5 201-400 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 2626
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PKWY STE 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
370 BEAVERTON,OR 97006
BEAVERTON,OR 97006
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $31,313.88
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to folio. e ru e adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obta' a copy of the es or direct questions to OUNC by calling
503.232.1987(11.10.‹...._
or 1.800.332.2344.
Issued By: . —���. .,' ignature:
all 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application .,E L or
Residential FOR OFFICE I;SE ONl-1
DEC i 3 201
City of Tigard Received ` f> / ,ermit No-�/A �y
all 1413125 SW Hall Blvd.,Tigard,OR 97223 rOF 9RIBY' /�'l � G���r�y!/S
_ ,asx Review' fief. 4 [/
Phone: 503.718.2439 Fax: 503.598.1960
qJ �_ Other Permit: - J _ -,= ,
TIGARD Inspection Line: 503.639.4175 � g q� r '$i,d/B : Juris: '"
Internet: www.tigard-or.gov it U iL 11l(I t"a Y . y Y 7 S See Page Information„1,1
.fid-� i:' 01 4 44'`, .` _l:':':",,,,,,
`4 " 'r. a te` X -?,61:-. 1 D i _.,, 1 .,1'
®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 ❑Other: equipment,materials,labor,overhead,and the profit for
y < „„ ,:::# ® .y � s.41 " v 0 !V "A` work indicated on this application.
dwelling 0 Commercial/industrial Valuation: 326— 7 0 g�
® 1-and 2-family $
ElAccessory building ElMulti-familyNumber of bedrooms: 4
El Master builder El Other:
Number of bathrooms: 3
.. , :`t , ` iB. O' if,
-. ' ` A ° i Total number of floors: 2
Job site address:11990 SW REDBERRY CT. New dwelling area: 2626 square feet 1171
City/State/ZIP:TIGARD.OR Garage/carport area: ,565 5[3square feet 144
Suite/bldg./apt.no.:97223 Project name:PROGRESS LANDING Covered porch area: ,) 'square feet
Cross street/directions to job site:SWWALNUT ST.&SW 135Th AVE Deck area: 0 square feet
A}!✓rod),. 14ap,( L.*anoffk 7,. Other structure area: 0 square feet
Subdivision:PROGRESS LANDING Lot no.:09 based• the value of the work �_ _d..
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
labor,
• • • • • ••:6 ? C1 E
Construction of SFR HomeValuation: $
Existing building area: square feet
New building area: square feet
f .�x1E oirR*077 4 ,o,
Name:Riverside Homes,LLC Typ-
of construction:
Address:17933 NW Evergreen Parkway,Suite 370 Occupancy
City/State/ZIP:Beaverton,OR 97006
Phone:(503)645-0986 Fax:( )
Business name:Same as Above ±
Structural plan review fee(or deposit):
Contact name:Brett Groves
Address: FLS plan review fee(if applicable):
City/State/ZIP: Total fees due upon application:
Phone:( ) I Fax::( ) Amount received:
HQ0V0L'1[AIS'; - i'' '
;P.
E-mail:bgroves@riversidehome.com
, �C,i3OR t , * Commercial and residential prescriptive installation of
' ,a ,,*•' 1 s ,,, r„ -tet ., , �, . roof-top mounted Photo Voltaic Solar Panel System.
Business name:Riverside Homes,LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:17933 NW Evergreen Parkway,Suite 370 Solar Installation Specialty Code checklist.
City/State/ZIP:Beaverton,OR 97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)645-0986 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:189148r7
Total fee due upon application: $201.60
Authorized signature: /. rx��✓' This permit application expires if a permit is not obtained
u' within 180 days after it has been accepted as complete.
`name:Brett Groves Date:11/30/2017 *Fee methodology set by Tri-County Building Industry
Service Board.
'Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ovl.v
City of Tigard of 0
el Received
Associat Permit No.:
� 13125 SW Hall Blvd.,Tigard,OR 97223
1111 2 Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
T I G A R D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 ❑
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0
6 Sewer permit. 0 ❑ 0
7 Water district approval. ❑ ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑ 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 ❑
architect licensed in Ore:on and shall be shown to be a..licable to the •ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 ❑ ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
ldingTetmits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicatio N FOR Orrin, i SF 0yl.1
IL ) }� ied 7"—A
_ /I
City of Tigard ^,. it Date/ReceBvy: Permit No Lr
13125 SW Hall Blvd.,Tigard,OR 97223
n Review
_ Phone: 503.718.2439 Fax: 503.598.1960 f ',e Other Permit:
Inspection Line: 503.639.4175 '� ` J 3' telly:
I I G;1 R D P ;. a ' 1 ''eadyBY: Juris: ® See Page 2 for
Internet: www.tigard-or.gov ai de 9 psi ed/Method: Supplemental Information
r ; TYPE 1DP O cOMMERCIAL FEE*:: ° Il S` "
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
•A l• e s a F.CONsTR 4-11" I I L
`NTiAI'EQI1P.MY1111SYSTT*FEES"
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
; 1 Heating/cooling:
"` Air conditioning 46.75
Job site address: 11990 SW REDBERRY CT. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: PROGRESS LANDING Duct work 23.32
Cross street/directions to job site: SW WALNUT ST. &SW 135 AVE Hydronic hot water system s s 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: PROGRESS LANDING Lot no.: 09 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
Da a t oN v Gas fireplace/insert 33.39
Flue vent for water heater or gas
Construction of SFR fireplace _ _ 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
'71.474414 pm Other: 23.32
PROPERTY OWNEI " i i
- �� - •eta_ - � "� '� Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Range hood/other kitchen
equipment 33.39
Address: 17933 NW Evergreen Parkway, Suite 370 Clothes dryer exhaust 33.39
City/State/ZIP: Beaverton, OR 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( 503) 645-0986 Fax:( ) Attic/crawlspace fans _ 23.32
77770' " 'i � $ , Other: 23.32
Fuel piping:
Business name:
Same as above $14.15 for first four;$4.03 for each additional
Contact name: BRETT GROVES Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: bgroves@riversidehome.com Barbecue
CUNtOR Clothes dryer(gas)
Other:
Business name: Pro Heating&Cooling
14IECHANICAL P
Address: 2095 NW Alocleck Rd.#1103 Subtotal
City/State/ZIP: Hillsboro, OR 97124 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(971 )205-4989 Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 209001 try' TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: b�� * Fee methodology set by Tri-County Building Industry Service Board
Print name: Brett Groves v" t Date: 11/30/2017
!,Building1Permits\MEC_PermitApp_040113.doc 440-4617T(I 1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 -Supplemental Information
Commercial &Multi-Family Fee Schedule:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC PermitApp_040113.doc 2
RECEIVED
• Electrical Permit Application rOR Orrlc 1. t 'i.Oy1.1
City of Tigard DEC 1 3 2017 1 1 Received
DateB EIZ.M
MillErin
11 41 13125 SW Hall Blvd.,Tigard,OR 97223
II Phone: 503.718.2439 Fax: 503.598.1960'1rfl/OF I A Milli Related Permit#:
Inspection Line: 503.639.4175 ';�dy Date/By: Jaris: ® See Page 2 for
TIG'\RD t
Internet: www.tigard-or.govl j 'y, tfied/Method
Illy�w.,� � Supplemental Information
a'' '',.--413'—,----, ''
.rn`...•. � ,i Bid 1'i '��'i ¢ 4''' 777
--'.„„iii, .-',14:4171' "' ,,-,'
El New construction 0 Addition/alteration/replacement Please check all that apply(submit 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.
',., ,, LA" •r' ', ' �, ` ' Y' s' fi r exceeds 10,000 ampsat 150 volts or f: �r r, v0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 t ommercial-use agricultural
❑Multi family 0 Master builder 0 Other: ❑FirepuomP I other installations. 0 b Installationiof 150 KVA or
I
P'
',Allot i i '-'i ` t?; • W 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 11990 SW REDBERRY CT. 100HP or more. ❑ `A","E", `I-z `l-3",
❑Six or more residential units. occupancy.
City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: PROGRESS LANDING 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: SW WALNUT ST. &SW 135 AVE 4;e:',.?s. N. a:FEE tk:l ,mei :L
Description I QtyI Each l Total (*.�
New residential single-or multi-Ifamily dwelling unit.
Subdivision: PROGRESS LANDING Lot#: 09 Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
x Ea.add'I 500 sq.ft.or portion 33.92 1
w, �` «' Limited energy,residential 75.00 2
Construction of SFR (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
ib
, ti- `„ Renewable Energy 0 See Page 2
1` '1'i1 RO 6„ Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes,LLC 200 amps or less 100.70 2
•
Address: 17933 NW Evergreen Parkway, Suite 370 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( 503) 645-0986 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: bgroves@riversidehome.com 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 2y Branch circuits—new,alteration,or extension, •er panel
''',''\ 1 , L1'APPi30' .`. 511:: " 'i' ; 1 . ` -. +.t d:N4, .. A.Fee for branch circuits with
Business name: Same as above above service or feeder fee,
7.42 2
each branch circuit
Contact name: Brett Groves 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 67.84 2
Email: bgroves@riversidehome.com
.:,,,,,,„ <,�r � Reconnect only 67.84 2
Com)' . ,' 3,t R 4 .. t Pump or irrigation circle 67.84 2
Business name: Garner Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 2920 SE Brookwood Ave#1 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503) 648-4552 Fax:( 503)642-7925 Investigation(1 hr min) 90.00/hr
Email: ge@garnerelectric.com ...517,30_3— _ 7/// Industrial plant{l hr min) 78.181 hr
` Inspections for which no fee is
CCB Lic.: 121159 Electrical Lic.: Suprv.Lic.: ?70?S , specifically listed(%hr min) 90.00/hr
EIECTR �.L PI3.MIT:FEES tet'
(Aithitt
Suprv.Electrician signature,required: Subtotal:
Print name: Chuck Garner, Date: 11/30/2017 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Brett Groves Date: 11/30/2017 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:1BuiidinglPermits\ELC__PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I 1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
5"R *QRK,1K ''... " w z A+ Y.. a'..:. '<ti'£ +6 7 a �.z4'JL A ...;..s,. x.`,:•
Description 147. 1 Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
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:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑X Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
0 Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
y Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr mm)
Inspections for which no fee is 90.00/hr
001"
` ¢,� s ectfically listed %:hr mm) moi.
#'3,, Cd it �! X1 ,1 .n' jr s �'` A 1 .,n a � � (
Fee for each commercial system: $75.00 Subtotal(Enter Page 1):
3r * Number of inspections allowed per
peer pemtit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
C Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
C Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:1Buitding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
CI
,..., N
tCli,
Plumbing Permit Application
- Al` 11
zo
Building Fixtures _ €� Folz omit i_ I si_ oyl.l
City of Tigard f O mewed
In 13125 SW Hall Blvd.,Tigard,OR 97223 ,IS(" y, el: Permit /�((�ld� / U
111111 g SA 1' •-
I Phone: 503.718.2439 Fax: 503.598.19 'i t 1.l Date/By: Other Permit No.:
y:
1 I c i.�I`l) Inspection Line: 503.639.4175 Date Ready/By: Juris: 63 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
s..r , sem;:' � "�� ',4
44,
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
`�k c '� i,-.4 Yr `te ": SFR(1)bath 312.70
`.; CATS I I o t I► 4
®1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
r 'ri, ,JOB Well' AND O r ,;r
=` ) e �$ t t� ®" Site utilities:
Job site address: 11990 SW REDBERRY CT Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: TIGARD, OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: PROGRESS LANDING Manufactured home utilities 50.03
Cross street/directions to job site: SW WALNUT ST. &SW 135TH AVE. 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.:_) Page 2
Subdivision: PROGRESS LANDING I Lot no.: 09 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
r - Backwater valve 12.51
^t s" Clothes washer 25.02
Construction of SFR Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Cyt OPE&_ E. .. }} . Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Parkway, Suite 370 Garbage disposal 25.02
City/State/ZIP: Beaverton, OR 97006 Hose bib 25.02
Phone:(503) 645-0986 Fax:( ) Ice maker 12.51
7.='; �1 Interceptor/grease trap 25.02
A1�CLIC ,. . Medical gas(value:$ ) Page 2
Business name: Same as above
Primer 12.51
Contact name: BRETT GROVES
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: bgroves@riversidehome.com Urinal 25.02
, s,9 1 .. .if : ,,` Water closet 25.02
._ , Ji.,q'r,,: t Water heater 37.52
Business name: H & H Mechanical Water piping/DWV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Phone:(503) 975-9787 Fax:( ) Minimum permit fee: $72.50
,n Plan review (25%of permit fee)
CCB Lic.: 178122 il Plumbing Lic.no.: PB414 State surcharge(12%of permit fee)
Authorized signature: ✓"T TOTAL PERMIT FEE
Print name: Brett Groves Date: 11/30/2017 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.
Ir\nailding\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(t0102/COM/WEB)
• Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
r i Fee(ea Tota -.
Sfte. ! . .. fn °, SgUare..'i .s,�. lie
Footing drain 1"`100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 ValUatiOn `" ' • "" `""
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
.w r each additional$100.00 or fraction thereof,to
' 'R S111t$ a (a) ".
�� .".: :: °,� ,a,�.;,� and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type lfl. , * olr
rType for Replace/
Plan review is required for any of the following.
WorkFixture
Performed: cam Added Relocate
Please check all that apply.
Baptistry/Font
Bath Tub/Shower
0 Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Car Wash Drain >i etrlc O ®� er 1Diagr to
Garbage Domeskic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\npruett\Downloads\PLMF_PermitApp(I).doc 2
Plumbing Permit Application
Building Fixtures FOR OFFICE LSF O'Lv
ft.r "13
4 Received ti 11 Permit N 7-- �1)
City of Tigard /"i,_;t 2 Lu i DateBy: ' �r ! G2�5 '
4 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
IIIII C Phone: 503.718.2439 Fax: 503.598 t96ay ''1 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 , r e
I I G A R D putj _ Date Ready/By: Iw s: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
, ';.-'\4:"..'" � 1 " ' ms .,-. ' ' .r,- 7t' .. . m. «.x �..„
®New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
is �,7 .. a�n ,n,'. a,. ea t .�, tx € ,r � SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
0 Accessory 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler(_sq.ft.) Page 2
} :w .'.• t t ,:''4) Q I w4 . .. , Site utilities
k. , 'Lis
Job site address: 11990 SW REDBERRY CT Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: TIGARD, OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: PROGRESS LANDING Manufactured home utilities 50.03
Cross street/directions to job site: SW WALNUT ST. &SW 135TH AVE. 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.:_) Page 2
Subdivision: PROGRESS LANDING I Lot no.: 09 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
-12746
Backwater valve 12.51
Clothes washer 25.02
Adding backflow preventer to lot for irrigation Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t<t ,, t' • 4 4 iA',. Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Parkway, Suite 370 Garbage disposal 25.02
City/State/ZIP: Beaverton, OR 97006 Hose bib 25.02
Phone:(503) 645-0986 Fax:( ) Ice maker 12.51
i l t t s= * Interctor/ ease trap 25.02
epgr
� �_., _�. _ ���tea.:
Business name: Same as above
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: WES BOISVERT
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: wboisvert@riversidehome.com Urinal 25.02
4,. 4 Water closet 25.02
r
, `' -
" " Water heater 37.52
Business name: TruScapes Water piping/DWV 56.29
Address: 21600 SW Amberwood Dr. Other: 25.02
City/State/ZIP: Hillsboro, OR 97124 Subtotal 31.27
Phone:(503) 531-8216 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: LCB#7962 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) 3.75
Authorized signature: TOTAL PERMIT FEE 35.02
Print name: Wes Boisvert &�,4y / �`---' Date: 5/17/18 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.
C\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
NMIb.
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• .•: ILY.•. a ,, v•
Footing drain-la 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 :- -- ,1.":4,'--.4t.;,& 'AV-
Storm
° -Storm&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
i °• ' + ` and including$10,000.00.
Inspection of existing plumbing or for ■ ■ $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum char•e-1/2 hour) and including$25,000.00.
Inspections outside of normal business - 90.00/hr - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum char•e-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions - 90.00/hr - $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
minimum char•e 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
na City by Fixfore Type
Work Perfu. Capped.j tot Adate Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font
Bath Tub/Shower
0 Any new commercial building with water service 2"and
Jacuzzi/whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
.Cry I
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\npruett\Downloads\PLMF_PermitApp(1).doc 2
■ City of Tigard
74 COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c a R o Building Permit Review — Residential
Building Permit #: //4,47-)..(90—60 Q
Site Address: /1 90 4C1u &0/Lrn, 6 it-
Project Name: 760,•; ,,5�S' .._( 6 . / Lot #: _--
(New dwell. g subdivision name;Addi'.n or Alteration=last name of owner)
Planning Review
Proposal: / 1) �'F, e_
P Verify site address/suite# exists and activ permit system.
tItver Terrace Neighborhood: IV No ❑ Yes,See River Terrace Review Addendum Attached
Sipe Plan Elements:
'IC) 1 ree(3)copies of site plan U " sting structures on site
ite plan must be on 8-1/2"x 11"or 11 x 17"paper Ai F otprint of new structure(including decks)with finished
j$rawn to scale(standard architect or engineer scale) oor elevations
orth arrow , Itility location ; _ eats(required for new and additions)
to address,project or subdivision name and lot number VJ Sidewalk/driveway approach
pplicant information(name and phone number) Il; ,cation of wells/septic systems
41JLot dimensions and building setback dimensions
FA Existing trees to be retained with drip line,and tree
'u uare footage of buildings to be demolished otection measures
II :
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning p-Engineering Permit Coordinator ,-Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: Do,Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
p.Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ,i .... — Date: �� %` i /,)
En�i�teering Review
plcipe_ G
at building pad: 62 /a
�onditions "Met"prior to issuance of building permit
asements (encroachments)per engineering conditions of approval and plat
L7 Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
V/LIDA Facility on lot: CI Yes ❑ No
Fal Plat Recorded:
'NOT Approved by Engineering: Date: /.2./*/-7
-7
Notes: 61,0,,, CoJim/ L11442 ' 14/49/ CdA- NKoft e t<� P! ..1— hdS- prepay-0i.
Approved by Engineering: Date:
Revisions (after Bu' inp Submittal only) ewer Date
Revision 1: Approved ❑ Not Approved 3 13//$'
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: ��a .f rn, Col tc�o e C/� t�/ ateeV L c l r aLv7 e
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant: 4.2 /74—
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: es CIN/A
(i)
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: 'Yes ❑ N/A
LIDA ❑ Yes 20 N/A
OK to Issue Permit
3//4.1 /(r-
Approved by Permit Coordinator: 1 17 Date:
I:\Building\Forms\BldgPermitRvw_RES_111617.docx
(.,o 't 1)
FOR OFFICE USE ONLY-SITE ADDRESS:
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
41
111 I Transmittal Letter
etter
T i t;A R[) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: 1 I I kI 0 DATE ;`, i_� IJVEI)
DEPT: BUILDING DIVISION
MAR 7 2018
CITY FTIGA .
FROM: L O C, Y.-'c 1,4' BUILDING DIVISION
COMPANY: k v (A--5t�L 4-. o i---)(-(;
PHONE: e3 v-5 - Lk C t 5 1-5 60 BY:els
RE: 1\ e‘90 *51,,i �2 tG\ij-Ly1,1,1 L .. 1 l`il 'i G 1--1' - Open l 0
(Site Address) (Permit Number)
7 Y12 v'PS 5 ( GtivVt. Li. 7 I)
(Project name or subdivision name and 1dt 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.
x Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Pe it Tec 'clan: Date: Initials:
Fees Due: Yes ❑No Fee Description: Amount Due:
th— 9 tAi• /4.A):,
r� -b A .� $
Special
Instructions:
Reprint Permit(per PE): ❑Yes 1 No ❑ Done
Applicant Notified: 7�� Date: 3 /g.egi , Initials:
fr.---
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11990 SW REDBERRY CT, TIGARD, OR, 97223 September 21 , 2018 at
11 :21 :11 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00510
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS
Comments:
Note: 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:
11990 SW REDBERRY CT, TIGARD, OR, 97223 September 25, 2018 at
1 :16:30 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00510
Inspection Type: Inspector:
199 Electrical final Jeremy Burrows
Result:
PASS
Comments:
Corrections completed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11990 SW REDBERRY CT, TIGARD, OR, 97223 October 3, 2018 at
11 :19:26 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00510
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Previous corrections completed.
Irrigation backflow device approved with test report
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11990 SW REDBERRY CT, TIGARD, OR, 97223 October 3, 2018 at
11 :22:54 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00510
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.
Note: A/C at installed
Violation Summary:
Inspector Contractor
r.
Electrical Permit Application FOR orrlcl.: t SE:ONl.v
City Of Tigard Received
DateBy:
`i /3 /t-' P tST-z0/7— ds7&
II • 13125 SW Hall Blvd.,Tigard,OR 97 F Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 (. Ready Date/By: Sufis: 1 H See Page 2 for
I l(;A It 1) Internet: www.tigard-or.gov Ell l D,•. ,l i-.,:1J ,w,, Notified/Method a Supplemental Information
�
': , ,:,,_ .. # 4F\.WiORK , l'''' ' ,,'0Mr!: `;' [TAN RE Ei nn ,...
®New construction ❑Addition/alteration/replacement '`: II that apply(submit 2 sets of plans w/items checked):
: ice or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATE, O Y"OJ? - 'ST7tt1CI'ION :=:' : exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION -,1''-, 0 Emergency system. larger separately derived
Job#: Job site address: 11990 SW REDBERRY CT. ❑AddHP o of new motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: PROGRESS LANDING 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW WALNUT ST. &SW 135 AVEFEE SCHEDULE ':
Description I Qtr. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: PROGRESS LANDING I Lot#: 09 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIP ON O"'WT . Limited energy,residential
Construction of SFR (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
wEey ❑ 2
51 PttoPE �# NEI s -'._ NANt ,,,I. �= ServicesReneable or feedersnrginstallation,alteration,SeePage and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen Parkway, Suite 370 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( 503) 645-0986 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: wboisvert@riversidehome.com 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
AP1' IE:tN( 17, 0,,'compAci PERSON T Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Same as above above service or feeder fee,
each branch circuit 7.42 2
Contact name: Wes Boisvert B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: wboisvert@riversidehome.com Reconnect only 67.84 2
_ , , CONTRACTOR,,. . Pump or irrigation circle 67.84 2
Business name: Sunlight Electric, Inc Sign or outline lighting 67.84 2
Address: 2804 NE 65th Ave. St. D Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Vancouver,WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 360)518-7589 I Fax:( ) Investigation(1 hr min) 90.00/lir
c y Industrial plant(1 hr min) 78.18/hr
Email:
Pi Fee `a(, O G��� 2 / ) to if h7 Inspections for which no fee is
CCB Lie.: I Electrical Lic.:'e23e` Suprv.Lic.: s ificall listed(�/z hr min) 90.00/hr
Ss/z S y
Suprv.Electrician signature,required: (2 CFRTC>4I. 15
Subtotal:
Print name: Chester Garrett Date: 9/11/2018 0 Plan Review Required(25%of pennit fee):
State surcharge(12%of permit fee):
Authorized signature: 4,uoti
G TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Wes Boisvert Date: 9/11/2018 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB
1/4
p.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
Tit;A R f7 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD .;.0
Building Division Cr-)
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ® Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Riverside Homes, LLC-Wes Boisvert
Mailing Address: 17933 NW Evergreen Place, Suite 370
City/State/Zip: Beaverton, OR 97006
Phone No.: 503-645-0986
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑X REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: MST2017-00510
Site Address or Parcel#: 11990 SW REDBERRY COURT
Project Name: PROGRESS LANDING
Subdivision Name: PROGRESS LANDING Lot#: 09
EXPLANATION: CHANGED ELECTRICAL SUBCONTRACTOR-SEE ELECTRICAL PERMIT
Signature: Date: 9/11/18
Print Name: Wes B isvert
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc