Permit CITY OF TIGARD MASTER PERMIT
IN ---
■ COMMUNITY DEVELOPMENT Permit#: MST2018-00293
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/27/2018
T t r.. 4 It r_yg Parcel: 1S125DB03700
Jurisdiction: Tigard
Site address: 9494 SW 74TH AVE
Subdivision: GERRITZ PARTITION Lot:
Project: Gerritz partition, Lot 1
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1232 sf Basement 0 sf Left: 5 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1372 sf Garage: 590 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2604 sf Value: $336,645.80 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: 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: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 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 2604
Owner: Contractor:
JOHN GERRITZ ENTERPRISES INC GERRITZ CUSTOM HOMES Required Items and Reports(Conditions)
BY GERRITZ,JOHN M 515 NW SALTZMAN RD PMB 800 1 Ersn Cntrl 503-639-4175
9500 SW 74TH AVE PORLTAND,OR 97229
PORTLAND,OR 97223
PHONE: 503-320-7280 PHONE: 503-320-7280
FAX:
Total Fees: $32,603.95
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•.d 07190. You ray obtain a copy of the rul-s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/'
Issued By: /,L,L A49A'._ / Ir Permittee Signature: r-r /k-e ,9Q9..,-,-t
Call 503.639.4175 by 7:00 a.m.for the next available inspection e.
.> ..j
This permit card shall be kept in a conspicuous place on the job site until co etion of the project
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential ` - y Fri
FOR OF l ICI: t Sl'.O\Ll
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 T '01 Date/By: � 717 T /4 Pe . .7-A a1 r-604.,73Plan Review p�
��11 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: t,0ti1
2 ( AAA- 95Eo h ,t. t r---.9 1(2,cs:\pt D Inspection Line: 503.639.4175 ( J Date Ready/By: loris: ® See Page 2 for
Internet: www.tigard-or.gov U i LL } ;LL;i i i 2 i O N Notified/Method / Supplemental Information
®New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
A- � � � work indicated on this application.
Valuation: $ 00 s7 �
® 1-and 2-family dwelling ❑Commercial/industrial �J/LY�(0(1
❑Accessory building 0 Multi-family Number of bedrooms: 5
❑Master builder 0 Other: Number of bathrooms:�:S`3 G}
,,5?1,14,,, ,
LI
q4„��,.. ,. . . , `, ,, , Total number of floors: 2 `
Job site address:44,1 q W 74th Ave. New dwelling area: � square feet •W 9._
City/State/ZIP:Tigard Or.97225 Garage/carport area: > square feet( 2' '-
Suite/bldg./apt.no.: Project name:Gerritz P.PFI2017-00261 Covered porch area: square feet
Cross street/directions to job site:Taylors Ferry To 74th down to 9500 Deck area: square feet
Other structure area: square feet
''_
Subdivision: Lot no.: 1 Permit fees*are based on the value of the work performed. z
Tax map/parcel no.:1S125DB Lot 3100 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
. ,., O(., ,,,� . , . , _ work indicated on this application.
New Single Family Home Valuation: $
Existing building area: square feet
New building ea. square feet
i" �. �
Numberof stories:
ek2 , .. . ,. .� . . i � . , n. .. * wy
Name:John Gerritz Ent.,Inc. Type of construction:
Address:333 S.State St. Ste.V-146 Occupancy groups: I
City/State/ZIP:Lake Oswego,Or.97034 Existing:
Phone:(503)320-7280 Fax:( ) New:
Business name:John Gerritz Ent.,Inc Structural plan review fee(or deposit):
Contact name:John Gerritz FLS plan review fee(if applicable): I
Address:333 S.State St. Ste.V-146 Total fees due upon application:
City/State/ZIP:Lake Oswego,Or.97034 Amount received:
Phone:(503)320-7280 I Fax::( ) � *, ';V
E-mail:johng@roundstoneproperties.com Commercial and residential prescriptive installation of
.; o t roof-top mounted Photo Voltaic Solar Panel System.
" ,,,; ,‘<',-,-.1." ` '` Submit two(2)sets of roof plan with connection details
Business name:John Gerritz Ent.,Inc. and fire department access,along with the 2010 Oregon
Address:333 S.State St.Ste.V-146 Solar Installation Specialty Code checklist.
Permit Fee(includes plan review $180.00
City/State/ZIP:Lake Oswego,Or.97034 and administrative fees):
Phone:(503)320-7280 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:43494 Total fee due upon application: $201.60
This permit application expires if a permit is not obtained
Authorized signature: �tA . within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name:John M.Gerritz Date:10-11-18 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One-,and Two-Family Dwelling FOR <ll1 It'I1 sl: oyI.A
City of Tigard ReceivedDate/13y: Permit No.:
11 w 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
t' F`I)
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITF\IS ARE REQL IREI FOR PLAN REVIEW 'e, No y,k
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. • 0 •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 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 El
6 Sewer permit. ® 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 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 0 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 0 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. 0 0 0
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 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 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 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 0
architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 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 0 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.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application
City of Tigard Received permit No.:
. �t�Reey:
N 13125 S W Hall Blvd.,TigardOR 97223
, , Pian view
C Phone: 503.718.2439 Fax: 503.598.1960 D81C/By: Other Permit:
(1,,
Id t i) Inspection Line: 503.639.4175
Date Ready/By: Jura: el See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CMitCKLiST
Mechanical permit fees*are based on the value of the work
tNew construction 0 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/SYSTEMS FEES*
ggl I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other. Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning I 46.75
Job site address: eiti St...., r7 y A-t.g. Furnace 100,000 BTU(duces vents) 46.75
City/State/ZIP: ` Furnace 100,000+BTU(dueWvenu) 54.91
�` errd �2 �t7 �;� � .
Suite/bldg./apt.no.: Project name: , Heat pump 61.06
Geri i L beet i, Duct work
23.32
Cross street/directions to job site: "'r'a y4.4 t z �Ttyr✓ V !1 y its �'p Hydropic hot water system 23.32
Residential boiler(radiator or
9 y/9 S iAi --/K f/- IL-. hydronic) 23.32
Unit heaters(fuel-type,not electric).
in-wall,in-duct,suspended,etc. 46.75
/� 1.L �}a rl •
Flue/vent for any of above 23.32
Subdivision C.7 e qtr i "1 )-t l i Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: E 5 i AS Q(6 t_4;,...7 3,i a0 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
et, S W c L.aa M T1^� 1,-1,.1-r,-(i.
fireplace 23.32
/ Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flueivent 23.32 ,
(sr PROPERTY OWNER TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: So kr.. Gv..f .i-2 6:A. De A.. Range hood/other kitchen
equipment I 33.39 I
Address:
.333 5. S t A k 57. 57ti r. ii-/W V Clothes dryer exhaust % 33.39
City/State/ZIP: e 06 w C (N-4, g 7 Q 3`� single duct exhaust(bathrooms,
). , toilet compartments,utility rooms) es? 23.32
Phone:( j 37_0 12 2 st Fax:( ) Attic/erawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other 23.32
Fuel piping:
Business name: e--5tik Mg. S h 6L v:. $14.15 for first four;$4.03 for each additional
Contact name: .-5C)/111/ G e I C i 4 7' Furnace.etc. i
Address: Gas heat pump
Wall/suspended/unit heater 1
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace I
Range 4
E-mail:
Barbecue i
CONTRACTOR Clothes dryer(gas) ,
Business name: py Q,A� 4-1- - f / �C_`^yV�� Other
,�} ( MECHANiCAL PERMIT FEES*
Address: "l L(QC{ Ne c-a.-Fk ,( STS / Subtotal
City/State/ZIP: z�- I 0(2... n( a Z Z V Minimum permit fee($90.00)
-7 Plan review(25%of permit fee)
s0
Phone:( )7 SZ
•-tt 'Z Fax:(9Y)7 - 3L1 32.. State surcharge(12%of permit fee)
CCB lie.: 5-01 3 gZ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 130
days after it has bees accepted as complete.
Authorized signature: /�� • Fee methodology set by Tri-County Building Industry Service Board
Print name: -3'6 ., Gc,r -. l'1,...„..- Date: /4•(b l t3
I:?Ruddier Permes,:MtEC P tApp_040113.dec 4404617-1I 1,022COMVEB)
Electrical Permit Application 1 l 0: ,n ? 1 t I 1 •, t).1.1
IIIII 13125 CityEZIIIIIIIII
sox nidi,Tigard,OR 9rr�3 ' ���
Phone: 503.7181439 Fax: 503598.1960 r..,
•
Inspection Line:503.639,4175 Ready Datefey:
� � Internet: wwW.ti�td-orgov Notified/Method:d/�ethd: _ SI
TYPE OF WORK PLAN REVIEW
New construction 0 Addition/alteration/replacement Please check all that apply(subtni*3 sets of plans wlitenschecked):
Dcmolitton ❑Other Q Service or feeder 400 amps or more p Building over*me stories,
where due available fault current Q Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Cloning bundinga.
E 1-and 2-family dwelling 0 Commerciallindustrial 0 Accessory building less to ground,or exceeds 14.000 O Commacisfuse agricultural
amps for all other installations. twildinp.
Multi-family D Master builder ❑Other. CIFite pump. p tnaallnion of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 EIRRIFIRY system larger separately derived
Job 4 Jots site address P ❑Addition' motorload of system
{ crti 5 0) 79 ' 4.1� #oOHAornwat (�`A"."E".-1.r."1-3".
City/State/ZIP: 1 l`Oy /� d O Six or more residential grits. Y•
L1( O Health-care facilities. Q Recreational vehicle parka.
Suite/bldg./apt.#: Project name: �i�.t�+tf l it j On 0 Hazardous locations. 0 voliagc for mom than
1 feeder 600 ampsormore. lolls non ncl.
Cross street/directions to job site: 10 ys ell. IV 14 tr+ FEE SCHEDULE
Daeriodoa I Oar. [ tacit 1 Total 1
New residential single-or multi-family dwelling unit.
Subdivision: ioie rt cfl-l3iesf) Lot#: i includes attached garage.
t1,000 sq ft.or less 168;54 4
Tax map/parcel#: 1 S } P ("3 ipf 3 t 118 Ea.add•i 500 sq.ft,or ponian 33.92 1
DESCRIPTION OF WORK Limited energy,residential
6.r k. el l W 6i7M (with above aq.ft) 75;00 2
s Limited energy,multi-family 75.00 2
tesideuttial(with above s9.it)
EifPROPERTY OWNER ( (� TENANT Renewable Energy 0 Sec Page 2
Services or feeders installation,alteration,andtor relocation
Name: I A A 6e(r;fa S'"'4, .►T e-„, 200 amps or less 100.70 2
'
AddreM '33 , 5 f hie V r J y L 201 mops to 400 a401 amps
133.56 2
f s 200.34 2
City/State/ZIP: LC4 wG 051,1,,,,,0051,1,,,,, 7 6 34 601 amps to 1000 amps 301.04 2'
Phone:( ) 37.45 _ '?2 f'Q Fax:( ) Over 1,000 amps or volts 552. 1 2
{�
Temporary services or feeders installation,alteration,and/or
Email:
c rt ,. n j5•18f e 9cae ),jd. Co i relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or 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 3
Owner signature: Date: 401 amps to 599 amps 166.54 2
Q APPLICANT f ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per pane,
A.Fee far b ach circuits with
Business nem 4c (te y above t/e Teethe fee.each branch circuit 742 2
Contact name: '3 k it i' 2 R Fee for branch circuits w,how
service or feeder fee,act 56.18 2
Addr st brand►circuit
City/State/ZIP: Each add'I blanch circuit 7,42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 3
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Elite Electric Group,LLC Sign or outline lighting 67.114 2
Signal circue ts)or limited , See Page 2 2
Address8150 NE 92nd Dr.#104 Panel,alteration.or menial.
City/State/ZIP: Porlfand,OR 97220 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66._51 hr
Pte;4 503 432.8845 Fax:(1388)901-7914 Investigation i l hr min) 90.00/hr
Email: Industrial plain(1 hr min) 78.181 hr
office(i ellteefecti1c polt.com Inspections for which no fee is
CCB Lic.: 191274 Electrical Lic.:C$39 Suprv.Lic.: 57625 specifically listed('/,hr min)
90.001 hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: •,,x e-Z-1G^re-•--saw - Date: 1O. 1') 1 to Plata Review Required(2555 of permit fee):
State surcharge(12%of permit fee);
Authorized signature: ,. yTOTAL PERMIT FEE:
�iThis permit application expires if a permit is not obtained within NO
Print name: 't1, t y eN 1-4--*" Date: I ti--11—`1 g •
days ter is arms Meal aeeapted
Number of inspectionsmaallowed par permit. ss cmnptBre.
1:58 iId W naintEt.C;,PamitApp_ELn ERE.doe Rev 041712015 440.4615T(11/0ICOM'WE0
Pludi.bing Permit Application
Building Fixtures roe 011 tc l I tit ct+i 1
City of Tigard Received
No.:13125 SW Hall Blvd..Tigard,OR 97223 DHy:
Phone. 503,718.2439 Fax 503.598.1960 Plan Review
U®trBy Other Permit Pio.:
Inspection lane 503.639.4]75 Date Ready/8y ] 9J Ser Page 1 for
Internet www tigatd or gov Notified'Methnd;
K: ,,.. ' , , SCHEDULE
Supplemental talemadon
�'�' �'� FEE*_ °
'!New construction 0 Demolition
For dot in oorenaB�on use checklist
Addition/alteration/replacement ❑Utlter Description } Qty [ Ea- ( Total
Ness 1-2-family dwellings(includes 100 ft.for each utility connection)
...4 k RY OFT ,' t st SFR(I)bath 312.70
ig 1-and 2-family dwelling Q Commercial,"industrial SFR(2)bath 431.18
a[j Accessory building ( Multi-family - SFR(3)bath 500.32
Master builder ®Orv". Each additional bath dtchen 25.02
Other:
Fire sprinkler( so It,) Page e 2
Job site address. `�+ 1 tai
,[� Catch basin or area drain
..��-^i , i,+«J '14 roc
: City/State/ZIP: ! () 01.41 oA M1 Thywell,(each line,or trench drain 18.?6 .
r _. Footing drain(no.linear ft.:„_-•_)
Suite/bldg./apt,no.: Project name: ' -' _..
I
JL'rt' I fit Y ;'`./---.-- Manufactured home utilities 50.03
I Cross street/directions to job site: - -. 18.7
...._. .-� _ 't .,. e r7 ._.__.. Manholes 1s.76
,�,,t tr i Gl Rain drain connector 18.76
Sanitary sewer(no.loan,R.:__,)
Storm sewer(no,linear ft ) EMI
Water service(no.linear ft.:
-� _a_
,{"} ) ; Page 2
Subdivision:
a 'l..•^ "`"(4„,,,,,,i,-,II,,y nod no.: 4111111
Fixture or item:
Tax map-parcel 1 S i ')51.3Les-3,, 31'o Backflow preventer 3127
tf 1, . �.: . ` �` 1`+51
,�. 1 clothes wistr
t'".1 t'w S t },1 t,4 FA i _o . 0.1." 25.02
-,� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
i ROPERTY O7 ,` Expansion tent12.51
t,�
Sc,Nme ' ,,. .Y.{` t L t. _ ¢!C. Fixnttesewer cap y I 2S_2
Floor drainifloor sink'hub 25.02
I Address: 333 "✓, S'+ + 1. S1'e lf, 14- .4_
City/State/ZIP: g� `-- Cxarlruge disposal 25.02
K 5 k,1 r;i C/'^ I'7 0 +cit Hose pm 25.02
Plante:( ) 3 \
"1 " 0 �/ ! Fait:( } Ice maker _�_...
12.51
APPL:IcAit1 a" ON TAC3 N interceptor;grease trap 25.02
I
Business name: A et c' pi, a boner Medical gas(value:$-) Page 2
7 -
�.-.- Primer 1 12.51
e,onmct name: rye.-- C's•*.`f,r s 41_
i.
' Address:
Roof drain(commercial) 12.S1
-- Sink.-hasin'lavatory 25.02
eityr`StatelZIP; _ _ _�.
-_----. - - Solar Solar units'pc able vett.,} 62.51
-]
Ahotue,( )
1 Fax: ( ) I Tub/shower/showerpan 12.51.mail: } -_ _ ,_
yi
I:- Gi.i c ] tIt „r{dy Y>�3y tia<.0}'t [:1' '-'1"3,'"" Lrina! 2502
t
' Watrcoset -
25.02CO �_, _ - Water 3?.52 �
--
I Business name: NO r ( ttom„ .tki(3
_ _ I Watc•rptptngT?WV r 5629
t Address: 2q30 5E -ice' AVr, ;t
CttvfStite%ZIP:
t I..r t_ i30 .#2. T 4(23 Subtotal
Plume;( t67- Minimum
03) 4q2-20(0' - t Fax:(. :f ] - u_ _ _-_ ti ter: S72 Sia #
-..�_,..._ _
CCB Lit.: t PI=review (�SSk of permit fere t
-.-
Plumbing Lir.no.: ?j 1 t ) !
Authorized Ut tatu C. T State surcharge f 12°x:of permit fee)
Print naxnt: -'°�-�f ✓ - r # TOTAL AEItMTT FEE
I Tt .`.___.. tS-i, ., , 4-,,,,t.....167:-.j s -1 Thi,pvrmir application expires if a permit h not obtained within 150 dans
........... _..Y_..._.,_ i i r i 'J after it has beta aeerptett as complete.
ttce raetb000kly set by T`ri-County f3;rlttl0, Industry Serirue boani.
ttutkitaz Pcrmits3'L,'tt-,Pe aeAop do,. 1;).,04 446.44141/ID n:,VOM't`[n:
IIIICity of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
GA Building Permit Review — Residential
Building Permit4_,. ...o_i_ri.,(2.#: (2,2_5.1
Site Address:
Project Name: Cie n-i.t P ,
#- f i 2c i -7 —c c‘,2cr I Lot #: (
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 6 Ni e vJ 5 F(R -
Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: ,el No ❑ Yes,See River Tetrace Review Addendum Attached
Site Plan Elements:
fliThree(3)copies of site plan
`ng shintures on site
Site plan must be on 8-1/2"x 11"or 11 x 17"paper
rawn to scale(standard architect or engineer scale) �floorpelevationsrint of w structure(including decks)with finished
C, forth arrow
1(� ;U�ty locations&easements(required for new and additions)
Site address,project or subdivision name and lot number
xi Applicant information(name and phone number) a is :'- --- - ---- -.--c
,VLot dimensions and building setback dimensions grExisting trees to be retained with drip line,and tree
dings to be demolished protection measures
coverage area,percentage of coverage and Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40
treet names
jZiProperty corner elevations(2 foot contour lines if more than >1 000 sf of impervious area created or re laced? Yes ❑No
4 foot differential) p
If yes,is a storm water quality facility shown? Yes ❑No
Ile Clean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
/ Required: ❑ Yes,applicant was notified
o Received: ❑ Yes ❑ No
y Public Facilities Improvement(PFI)Permit:
/ Required: ❑ Yes,applicant was notified ❑ No Applied For:
9/Yes ❑ No,stop intake
Q( Land Use Case#: M L(9 2-C17 - o c U t) S
pi. Zoning: g- 1 . 5
,�J Required Setbacks: Front � Rear `
2("; 1 S Side Street Side (fir/A. Garage
Ap Landscape Requirement: (./j A %
jiLot Coverage Maximum: N j f)
Building Height Maximum Height2i
e Visual Clearance Actual Height
Sensitive Lands: 0 Yes 0 No
Type
in Urban Forestry Plan
FfConditions "Met"prior to issuance of building permit
Notes:
I3' Approved By Planning: ivl ,004,1,„........;:, �
Date: ( 0 L, 1 i '-',-
Revisions (after Building Submittal only)
Revision 1: 0 Approved ❑ Not Approved Reviewer Date
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved 0 Not Approved
EBuildingWormslBldgPernutRvw RES_061417.docx
I
Building Permit Submittal 7/
Original Submittal Date: /0 / (� r
Site Plans: #
Building Plans: #
Building Permit#: t' `nter building permit#above.
Workflow Routing: E` Tanning rnguieering
Permit Coordinator Building
Workflow Sign-off: I4 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.
[ uilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: / (? i
� Date:
��� D t
By Permit Technician � �., ..... w ..
En 'neering Review c
Di/grope at building pad: 1.6 /a
lei p nditions "Met"prior to issuance of building permit
ements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes 0 No
Assess Water Quantity Fee in-lieu: 0 Y 0 No
LIDA Facility on lot: Yes 0 No
Final Plat Recorded:
Date:
0 NOT Approved by Engineering:
Notes:
0
I7A—p ' �j' Date: /a/��
proved by Engineering:
Revisions (after Building Submittal .nly)
Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved.
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
XConditions'Mee'prior to issuance of building_p_ermit
0 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:
A SDC Fees Entered: Wash Co Trans Dev Tax: .15, Yes 0 N/A
Tigard Trans SDC: 12CYes 0 N/A
Parks SDC: 15E<Yes 0 N/A
LIDA X Yes , rN/A
,KOK to Issue Permit C��` ' Date: ��'�$I ��'
Approved by Permit Coordinator: +°
I:\Building\F'orms\BldgPermitRvw_RES 010118.docx
a
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9494 SW 74TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00293
Inspection Type: Inspector:
135 Low voltage rough-in David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9494 SW 74TH AVE, TIGARD, OR, 97223 June 4, 2019 at 9:17:22 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00293
Inspection Type: Inspector:
299 Final inspection Chip Barnett
Result:
PASS - CofO
Comments:
Previous corrections have been completed
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9494 SW 74TH AVE, TIGARD, OR, 97223 June 4, 2019 at 9:15:52 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00293
Inspection Type: Inspector:
399 Plumbing final Chip Barnett
Result:
PASS
Comments:
Previous corrections have been completed
Violation Summary:
Inspector Contractor