Permit CITY OF TIGARD MASTER PERMIT
a COMMUNITY DEVELOPMENT prISED Permit #: MST2010 -00154
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/07/2010
T [ GARD 9 �� / j T, Parcel: 1S133DA05200
Jurisdiction: Tigard
Site address: 12760 SW GLACIER LILY CIR
Subdivision: amart Lot: 74
Project: Liebreich
Project Description: New SF. 3/17/2011: Reprinted permit for additional bonus /storage 252 sq ft on 2nd floor. DLH.
6/12/2013: Reprinted permit to include (1) additional water heater. BT.
BUILDING -
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 2078 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 4 Second: 2382 sf Garage: 540 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 4460 sf Value: $484,045.75 Rear: 15
PLUMBING
Sinks: 3 Water Closets: 5 Washing Mach: 2 Laundry Trays: 3 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 ,
a Disp: 2 Water Heaters: Drains:
Tubs /Showers: 3 Garba 0
g p: a Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
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: 9 Clothes Dryers: 2
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 2 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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 adds 500 sf: 8 201 -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 +ampNolt: 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 4460
Owner: Contractor:
LIEBREICH BC CUSTOM HOMES CORP Required Items and Reports (Conditions)
12760 SW GLACIER LILY CIR 410 HIGH ST 1 Ersn Cntrl 503- 681 -4444
TIGARD, OR 97223 OREGON CITY, OR 97045 •
PHONE: PHONE: 503- 722 -8700
FAX: 503- 722 -1013
Total Fees: $21,953.41
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: Pe Signature:
Ca 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.
e , CITY OF TIGARD MASTER PERMIT
1 1 1 11 : CO MMUNITY DEVELOPMENT Permit #: MST2010 00154
Date Issued: 10/07/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S133DA05200
Jurisdiction: Tigard
Site address: 12760 SW GLACIER LILY CIR
Subdivision: smart Lot: 74
Project: Liebreich
Project Description: New SF
3/17/2011: Reprinted permit for additional bonus /storage 252 sq ft on 2nd floor. DLH
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 2078 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 4 Second: 2382 sf Garage: 540 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 4460 sf Value: $484,045.75 Rear: 15
PLUMBING
Sinks: 3 Water Closets: 5 Washing Mach: 2 Laundry Trays: 3 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 2 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 Tvoes Air Conditioning: Y Vent Fans: 9 Clothes Dryers: 2
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 2 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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: 8 201 -400 amp: 0 201 -400 amp: 0 WO 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 4460
Owner: Contractor:
LIEBREICH BC CUSTOM HOMES CORP Required Items and Reports (Conditions)
12760 SW GLACIER LILY CIR 410 HIGH ST 1 Ersn Cntrl 503 - 681 -4444
TIGARD, OR 97223 OREGON CITY, OR 97045
PHONE: PHONE: 503 - 722 -8700
FAX: 503 - 722 -1013
Total Fees: $21,337.68
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. ose rules are set forth in OAR
952- 001 -0010 through OAR 9 - 01 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 or . 00.33 344.
, 4 2 Issued By: / dam-- Permittee Signature: �i ____,
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.
n CITY OF TIGARD MASTER PERMIT
a COMMUNITY DEVELOPMENT Permit #: MST2010 -00154
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 1S133DA05200
Jurisdiction: Tigard
Site address: 12760 SW GLACIER LILY CIR
Subdivision: amart Lot: 74
Project: Liebreich
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 2078 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 4 Second: 2127 sf Garage: 540 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right 5 Detectors: Yes
Total: sf Value: $459,362.35 Rear: 15
PLUMBING
Sinks: 3 Water Closets: 5 Washing Mach: 2 Laundry Trays: 3 Rain Drain: 1 Catch Basins: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0
Tubs/Showers: 3 Garbage Disp: 2 Water Heaters: 1 Water Lines: 100
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 9 Clothes Dryers: 2
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum <100K: 2 Vents: 0 Woodstoves: 0 Gas Outlets: 5
Fum > =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 WI Svc or Fdr: 0
Ea addl 500 sf: 8 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea addl Br Cir:
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:
Owner: Contractor: Required Items and Reports (Conditions)
LIEBREICH BC CUSTOM HOMES CORP 1 MST Ersn Cntrl 503 - 681 - 4444
12760 SW GLACIER LILY CIR 410 HIGH ST
TIGARD, OR 97223 OREGON CITY, OR 97045
PHONE: PHONE: 503- 722 -8700
FAX: 503 -722 -1013
Total Fees: $19,789.68
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 . •a . 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. : ENTION: Ore:o• , quires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-• ' 1 -0010 through 0' ' . -0 .00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6 or 1.800.332.2344.
I ued By: Permittee Signature: E
Building Permit Application RECEIVED
Resid
ential C f'i Poll OFFICI.: USE ONLY
S C f r� ®2 2010 1 0 Received
III City of Tigard Date/B : a ff e. Permit No.: , , , A „ s
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ► l>
� Phone: 503.639.4171 Fax: 503.598.1960CITY OF TIGARD DateB : �C D Other Permit: 46,...4010/49....e0 ARO
l 1 G AR Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/13y: A / 1 J !' RI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 1 V it` — ft Supplemental Information
. e uN '., _ --?
TYPE OF WORK REQUIRED DATA: 1- AND FAMILY DWELLING
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 the
CATEGORY OF CONSTRIICTION work indicated on this application. 4. . h z ,35
Valuation: $ hh
X - and 2- family dwelling ❑ Commercial/industrial ��� U �V� �0
❑ Accessory building ❑ Multi- family Number of bedrooms: V # —
❑ Master builder ❑ Other: Number of bathrooms: 3 /-z,
JOB SITE INFORMATION AND LOCATION Total number of floors: 7
Job site address: / New dwelling area: square feet
City / State/ZIP: --7-7,7, d R — r Garage/carport area: 5 y 6 square feet
Suite/bldg. /apt. no.: I Ptdject name: �4�.. Covered porch area: 49 120 square feet 21 :7
Cross street/directions to job site: Deck area: square feet 2_78
Other structure area: 4 square feet - OA-
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision:,/ .41 ffr >L>✓ Lute, I Lot no.: 7c Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
13 ..-iii AA, Q ~(2- Existing building area: square feet
New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: `-1 1= ge g_L Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT CONTACT PERSON NOTICE V
Business name: 13c_ ( /i., All contractors and subcontractors are required to be '
[r�{J��^ � licensed with the Oregon Construction Contractors Board
Contact name:
DQ✓q �\ f under ORS 701 and may be required to be licensed in the
Address: JJ 5/ ��^ 5/ jurisdiction in which work is being performed. If the
^ applicant is exempt from licensing, the following reasons
City/State/ZIP: d G�'h OR 170 95 apply:
Phone: () ) 7 Z I- L ? O " I Fax: : (s 771,2_ "` /6/ 3
E -mail: b 0, to BC.G✓STd,. /4 -,,,,,r . AV 1/
CONTRACTOR
Business name: 6 C C 4.1 l „` /4,,,
Address: y a [ /�� L l �� G7 BUILDING PERMIT FEES*
(Please refer toJee schedule)
/�t / Structural plan review fee (or deposit):
City/ State/ZIP: �'
Phone: ( ) ZZ I g � ) 2,-L- �� FLS plan review fee (if applicable):
� 3
CCB lic.: X5/9 0 Z // , ( Total fees due upon application:
Amount received: Y�� .�L • Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: , 4/ 8130 - Date: 0 * Fee methodology set by Tri-County Building Industry
Service Board.
I: \Building\Petmits\BUP -RES PermitApp.doc 10 /01/09 440- 4613T(11/02/COM/WEB) I
From: 06/12/2013 10:00 #062 P.0011002
Plumbing Permit A licat. D . .
. .. , • , • .
Building Fixtures .-, -, " ' . FOR OFFICE USE ONLY : ..- • - . .
• City of Tigard JUN 1 2 2013 Received . , w --,,
Date/By: (.0 /2. rS On Permit No.: 7010/40 -- '60/6 -1 -. 4
• 13125 SW Hall Blvd., Tigard, 0 i
Plan Review
: 11111 1 11 Phone: 503.718.2439 Fax: soMOFTIGARD Date/By: Other Permit No.:
TI GA R. D Inspection Line: 503.639417B UILDINGDIVISION Date Ready/By: Allis: 0 See Page 2 for
Internet: www.tigard Notified/Method: Tto Supplemental Information
'
: .",:, - Z:' - ','•%• - i.. 4- : - . --- . - - 7 .-Z :- :ir- - -.: r."'.: 'i .`1.`," •''' ;kite isi. w6itic-,--,4 A,
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....-.--.;... ;`:-: - -"1":: . :.t-'.:.:: - .. - :-.: -. . : ''/ , :"' i:, • .. ;'. : ,E,•". - - • : ',.. '..■" .':■;,.:-',, . _ .,.' ':, •.: ''',..:,, :;': , , 7 !''.?..? ' ''...' .1' '.,: - -: ..V .'... ,,
aNew construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1- 2-famlly dwellings (includes 100 ft. for each utility connection)
:ei OF aiisiiitititdr+CLi :-;,:- 4::-'4:Isr?::::;-.i.;,, SFR (1) bath 312.70
-- - :"--,--,
fiLl - and 2-family dwelling u Comm-ircial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder • 0 Other:
Fire sprinkler ( sq. ft.) Page 2
.''., s' , - -' ' : ' ".: .JOB SITE AND -LOCATION , , --, - , - . Site utilities:
Catch basin or area drain 18.76
Job site address: . -
i - 7 /4( e?0leiZ. 1 .it ,q
Drywell, leach line, or trench drain 18.76
City/State/ZIP: i 6A-gZ, . O z., 9- oa 3
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg./apt. no.: 1 Project name:
Manufactured home utilities 50.03
Cross street/directions to job site: 3 ‘ ..,)Lif / ri c--3..... Lky_i- -VD Manholes 18.76
,
( k7 . LI (...4 Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Stonn sewer (no. linear ft.: ) Page 2
Water service (no. linear R.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51
. A... -.:-- ' .:". ..:::- .:. ,':": '''' DESCRIPTION OF 'WORK: --- - ' --- . " r '. ' ''' ': '
Clothes washer 25.02
iCII5n b.) b( ki M2- lb Dishwasher 25.02
M (,:-)1 2.-n) r- o() / 5 q Drinking fountain 25.02
Ejectors/sump 25.02
. _, ._ _ ,_, .
-.----::: a PROPERTY OWNER ., v i , : -,,,, ;:z -."......-- Q TENANT !..:,,,,,-. Expansion tank 12.51
Fixture/sewer cap 25.02
Name: )4()AD M 2 - 41) 4-- b3E L., /0,7k)C41
Floor drain/floor sink/hub 25.02
Address: 77 50 Garbage disposal 25.02
City/State/ZIP: . Th . A.. \)(...Tzirtki nil_ 13 -)Np(c) Hose bib 25.02
Phone: (5 6 , -/V- 2,2,2,4• Fax: ( ) Ice maker 12.51
j .._:::-...,•,-:: :',.. . : ::, Al :CONtAtl frilLSOS ' i, ': .:, Interceptor/grease trap 25.02
Business name:
Medical gas (value: S _ ) Page 2
75 1. „,„ /../ F. S
Plimer 12.51
Contact name: 5 ic
z) ?Lk__S
Roof drain (commercial) 12.51
Address: (4)0 4 )(1/ 4 6.514,1:-...1' Sink/basin/lavatory 25.02
City/State/ZIP: ng4..6 j Q?- n
ri -rq 9 --ipci...5 Solar units (potable water) 62.54
' . '""
Phone: (S ) 7 . e,-, 0D 1 Fax: : (1)1 ) -- 7 „l 101 3 Tub/shower/shower pan 12.51
Urinal closet 25.02
E-mail: 5'.(fr(65Ce.iA11"))1 fribi K.16!f
Water 25.02
1 37.52
Business name: 1\4.--1c, Tz - - P LAAfr , ;1 2, ) N 6
Water piping/DWV 56.29
Address: RD F ( 2, Other 25.02
City/State/ZIP: 1 c q -7 oti Subtotal 3 .5)-
Phone: (5 c./t./ , 02,jt Fax: ( ) Minimum permit fee: $72.50 ----
Plan review (25% of permit fee)
CCB Lic.: / t5c./ i] Plumbing Lic. no.:
State surcharge (12% of permit fee) 1 4 -S
Authorized signature: JO a L -"' TOTAL PERMIT FEE 1 0)-
1 Print name: DO/.1 6 Z bf / 4. Date: /71/ 3 1.1115 permit application expires if a permit is not obtained wit in 180 days
after it bas been accepted as complete.
*Fee methodology set by Tri-Counly Building Industry Service Board.
1:11:Wilding \ PermicsTLMU-PamitApp doc 10,0 I9 440-4616T( 111,02iCOMVEB)
09/02/2010 12:24 5039253512 SHERWOODATAX PAGE 01/01
From: BC Custom Homes RE CE 722 . 1013. 09/02/2010 10:29 3970 P.001/001
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_______
■
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Rec Permit No.: y --
' 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
U PI
7 Phone: 503.718.2439 Fax: 503.598.19 � Dme/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 ,
K ►' 1% �, Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov f) Notified/Method: off Supplemental Information
TYPE OF WORK '', �V PLAN REVIEW
ill New construction ❑ Addition/alteration/rep � � Please check all that apply (submit sets of plans w /items checked below):
\ - ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: ,�,` where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTR exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
J 1 - and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 "1 -3 ",
7 / `� / IOOHP or more. occupancy.
Job no.: Job site address:
Z 7(, ' U ��� (, kC-I �L` ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: `7 �d. / . b q7 u J1 � 1 -. i y ❑ Health-care facilities. ❑ Supply voltage for more than
^� - �" ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
J Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less f 168.54 (69. S 4
Ea. add'l 500 sq. ft. or portion 2, 33.92 0 ,-7., /* I
Tax map /parcel no.:
Limited energy, residential 7500 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 7500 2
/ - _ (/`-) (4 _ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
k C n a ' (J I � (tv t 200 amps or less 100.70 2
W
❑ PROPERTY O ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 7 panel, alteration, or extension. Page 2 2
1 (' L ! %�L [ C C Each additional inspection over allowable in any of the above
Address: l? 6 _ �� �7 Additional inspection (1 hr min) 66.25/ hr
G r�� r Investigation (1 hr min) 66.25/ hr
City/ State/ZIP: � T � fJV .► 7 l (t0 Industrial plant (1 hr min) 78.18/ hr
Phone: (95) 29g( tic / Fax: (5b3) 3- sys Inspections for which no fee is 90.00 / hr
specifically listed ('h hr min)
CCB Lic.: /459g-to Electrical Lic.: CZ%) S . Lic.: Zv S ELECTRICAL PERMIT FEES
Subtotal: 4 7 . i) . cl J
Suprv. Electrician signature, required: L Plan review (25% of permit fee):
(
Print name: � � Date: q Z l l
Y State surcharge (12% of permit fee): —
c. a TOTAL PERMIT FEE: 0
Authorized signs a re: / U 1) n S ,�y /Z This permit application expires if a permit is not obtained within 180 80
Print name: � h de / . 5( e_ � Date: ', {,s� x' f ( y days after it has been accepted as complete.
r / " ` / / Numberofinspectionsallowedperpermit.
I:\Building\ Permits \ELC-P -, , itApp.doc 07/01 /10 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ 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:\ Building \Permits\ELC- PermitApp.doc 07/01/10
Mechanical Permit Applic 1; ~1; - FOli, OFFICE USE ONLY
City of Tigard E Date/By: ' 4 a 0 y/ Permit No.: t r , o'49 /5li
N . q 13125 SW Hall Blvd., Tigard, OR 972p, Plan Review
Phone: 503.639.4171 Fax: 503.598.1$8pP O 2010 Date/By: Other Permit. A j , , , - DO /AC) Inspection Line: 503.639.4175 V
TIGARD g Date Ready/By: r u n s: Supplemental See Page 2 for
Internet: www.tigard C ITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
N ew construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
be - and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / /,,...)-e,,.. / fr., Air conditioning
f Z 7 4 ` y� ♦ SL, t7 /� / `� /" y 4 i 1 r' (requires site plan showing placement) 46.75 440, �
City /State /ZIP: , J /�
Fumace 100,000 BTU (ducts /vents) l 46.75 3. r
V Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: at name: L f 6.,e_; Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
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
Subdivision: � S Lot no.: ^� c/ Flue/vent for any of above 23.32
4A,,,,t r ) V �I�1 -r 4 / / Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 1 23.32 7.0,02,,,,
Gas Gas fireplace I 33.39
Flue vent for water heater or gas
/ L/) / J - L l igh 23.32
! / �' j Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue/vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen s3:3
equipment 1 33.39 .
City/State/ZIP: Clothes dryer exhaust '- 33.39 (PC, I
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 9 23.32 '
X APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
� /� 1 ! l Other: 23.32
Business name: /3 C . �S7 iJ� Jh.. RCS Co #7) . Fuel piping
Contact name: b �, Is -11 . / $14.15 for first four; 54.03 for each additional
Address: Fumace, etc. Z 14.1'5
Gas heat pump 4. 03
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace t
E -mail: Range 1
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name:
,4-2.- c i;, Other:
J/
Address: / 4 n .5 - j - J - L , 7v , Ave_ MECHANICAL PERMIT FEES*
City/State/Z1P: TT` A� Subtotal 92�=j , 0 ° � J
�� ' Minimum permit fee ($90.00)
Phone: (3 3) l 0 - 7 r C Fax: ( ) Plan review (25% of permit fee)
CCB lic.: S 7 7 36 - State surcharge (12% of permit fee) G56,
TOTAL PERMIT FEE 8,
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Print name: b D,,, / t P i f I Date: 9 z �Q • Fee methodology set by Tri-County Building Industry Service Board
\ B \
I:uilding Permiu V NEC- PcmAtApp.docc /0 /01/09 440 -4617T (11 /02/COM/WEB)
Plumbing Permit ApDlica r i ' S CE/
Building Fixtures
City of Tigard EP 2 201
g Received 9 R �G ( Permit No.: fr
IN Date/By: ib /O' Ay/
V 13125 SW Hall Blvd., Tigard, 009P-7 Plan Review
e Phone: 503.639.4171 Fax: 7i Other Permit No.: le
�Ap Date/By: � o?o /,p G1GII�D
Inspection Line: 503.639.417 ®
T 1 G A R 1) �`�� �Uj piVlSl N Date Ready/By: Juris: VI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
V ew construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
›r1- and 2- family dwelling El Commercial/industrial SFR (2) bath 437.78
SFR (3) bath ( 500.32 ,'32-
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen ‘ 25.02 Z' 'Z-
❑ Master builder ❑ Other: Fire tinkler
sp ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
/ 7 7 0 S� /���, i~r Lr C'r Catch basin or area drain 18.76
Job site address: �r
Y Drywell, leach line, or trench drain 18.76
City/ State/ZIP:
'777 ,f Ore Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 4 ,' Manufactured home utilities 50.03
Cross street/directions to job site: 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.: ) 1 I Page 2
Subdivision: f 7 �} S � � C_ Lot no.: 7 5/ Fixture or item:
Tax map /parcel no.: ! ! Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
A le./..../ /---1 j , Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( Fax: ( ) Ice maker 12.51
i
ift ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: (� Medical gas (value: $ ) Page 2
G 7U� �o 00 Primer 12.51
Contact name: Do / � ` `'v /tee f r -
`. Roof drain (commercial) 12.51
Address: 910 - 9 /I', Q1 Si ' Sink/basin/lavatory 25.02
City/ State/ZIP: e)6#211' Ci .1l OR 1 ?D A5" Solar units (potable water) 62.54
Phone: (S-03) 7 L1_ F 7 74) Fax: : ( ) 7 Z -2..- /p /3 Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet I 25.02 r tom
.
Water heater 37.52
Business name: 4, tie' Pkth.Lg ('e i rtG� Water piping/DWV 56.29
Address: / S4/ K00/ T i r l / Other: 25.02
yy �� Subtotal ►750,
City/State /ZIP:
be C t /s J K -
/ Minimum permit fee: $72.50
Phone: (5-03) 5,4, y - 4 VC Fax: ( )
P iew % permit fee)
CCB Lic. lisp �3 PI l bing Lic. no Pg State surcharge rev (12% (25 of of permit fee) [ P 6
v ✓ .
Authoriz signature �y, „ 7 iI l TOTAL PERM FEE I (ait Q
Print name: - � n '`I , D ate : 1/7_,/i0 Tbis permit appllcadon expir lan if a permit is not obtained wit in 180 days
D by /.9 ale a ,,„/ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\ Building \Permits\PLMtl- PertnitApp.doc 10 /01/09 440- 4616T(l0/02 /COM/WEB)
il From:BC Custom Homes 603 722 1013 09/09/2010 08:47 N976 P.001/002
nF rE tit 0
11 0 9 20 10 U Clean Water Services File Number
C1eanWatie Services
1 I0 006/ 0 giro I
BY , z, ve Are Pre - Screening Site Assessment
.. 1. Jurisdiction: . • a - ad"-
2. Property Information. (example 1 S234A801400) 3. Owner Inf rmation
TaxlotlD(s): 0 S433Da OS2-00 Name: ftn t-l r
Company:
Address: 47'5°5 S1N Witsoin Ve,•
Site Address: /2-7 6 b 31..1 4 Iasi¢./ //Y C.4",.. CIty, State, Zip: 8444Ale, f trYt , t ej - 71,0
City, State, Zip: "Ti gtisrri ! OR Phone/Fax
Nearest Cross Street: V E -Mail:
•
4. Development Activity (check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence (rooms, deck, garage) Name: b 0 „A t irmis
❑ Lot Line Adjustment ❑ Minor Land Partition Compargr: rr n "vd Coto.
❑ Residential Condominium ❑ Commerdal Condominium Address: yid . ,/i t . c./
❑ Re CI Commercial Subdivision 9 .�
❑ Single Lot Commercial 13 M IU Lot f ommercial City, State, Zip: It 970V
Other Ne.,ci Sr•� �� a,A+4 225'/ . Phone /Fax: 5 0 3 7') ,t' 700 7 ' /) 1 3
E -Mall: D e ...G LEZ d.. nrm,t t'..9
8. WUI the project involve any offsite wort? ❑ Yes N1 ❑ Unknown
Location and description of off -site work
7. Additional comments or Information that may be needed to understand your project
This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Buliding Pemdts, Site Development Permits, DEQ
1200.0 Permit or other permits as Issued by the Department of Environmental Quality, Department of State Lands andlor Department of the Army
COE All required limits and approvals must lie obtained and completed under applicable local, state, and federal law.
By signing this form, the Owner or Owner's authorized agent or representative. acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions end gathering information related to the project site. I owitty
that l am familiar with the infonnalion contained to this document, and to the best of my knowledge and belief, this information Is true, complete, and accurate.
Printllype Name b _ , Print/Type Title Pero J a rm
Signature % ./..t'. Date 9/2
FOR DISTRICT USE ONLY
ID Sensitive areas potentially mist on site or within 200'd the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER If Sensltive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report
may also be required.
❑ Based on review of the submitted materiels and best available information Sensitive mess do not appear to exist on site or witltfi 200' of the site. This
Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas If they are subsequently
red. This document will serve as your Service Provider letter es required by Resolution and Order 47 -20, Section 3.021. All required pennite and
a pprovals must be obtained and completed under applicable local, State, and federal law
Based on review of the submitted materials and best available Information the above referenced project will not significantly impact the existing or potentially
sensitive area(s) found near the site. This Sensitive Area Pre- Screening Site Assessment does NOT elminate the need to evaluate and protect additional water
quality sensitive areas If they are subsequently discovered. This document will serve your Service Provider letter as required by Resolution and Order
0720, Section 3. 02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law.
❑ This Service Provider Letter Is not vend unless. CWS approved site plan(s) are attached.
[i The proposed activity does not meat the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVID z - LETTER IS ' QU I - �!' .
Reviewed by 411211/4 t� Si Z 1 r_ -_ Date / t .' if
. ) Ym ` ! 1 lill:;how I hail a • .'1 611 ooro i( ma a n,9 • 1 i- (' t ) 6E 1 I • . I !7 >; ( , ,,I 1 , • v c.lu n:\:', E i :r:c r ,I
•
12765
I
12735 12705
• CWS FEMA 100 Yr Flood
0
Gtgc CWS Vegetated Corridor
tity ciR ■
CWS Potential Impact
MI
t 7 Goal 5 Safe Harbor
i
12820 4
Goal 5 Significant Habitat
12790 / / , Areas
/ IM Strictly Limit
} 1 0 -- Moderately Limit
� i Lightly Limit
�- -� r 12730 12700
_,�1- , RLIS Slopes Greater than
,
25%
VA
Tigard Local Wetland
Inventory
® SIGNIFICANT
(1 1, ,
®NON- SIGNIFICANT
=UNDER CWS REGS
ONF.F.TlS F.RF.F.
Ma p et PM on Sep-1
DATA IS DE RNED pri nt FROM MULTIPLE SOURCES. THE 03- C OF TIGARD
MANES NO W MRANTY, REPR O GUAR AS TO THE
CONTEN AC CURACY. TDI ELINESS 03:19 OR COMP OF M Y OF THE
DATA PROVIDED NEREIN. THE C RY OF TIGARD SHALL ASSUME NO
UASILRY FOR MY ERRORS. OMISSIONS, OR INACCURACIES IN THE
INFORMATION PROVIDED REOMDLESS OF HOW CAUSED.
gg
City of Tigard
0 Feet 63 ?icARmaps tT O 417123d • •
Www.tigard•or.gov i—
From:BC Custom Homes 503 722 1013 10/01/2010 08:56 8008 P.001/002
c
,
ves:ittte ot-900
B.C. Custom Homes Corp.
FAX TRANSMITTAL
DATE: October 1. 2010
TO: Citv of Tigard FROM: Doug Weeks
FAX: 503- 624-3681 FAX: 503 -722 -1013
TEL: TEL: 503 -722 -8700
ATTN: Dan Nelson PAGES: 2
COMMENTS:
Dan,
Here is a copy of the engineers stamp for the trusses on the project located at 12760 SW
Glacier Lilly Cir.
The elevator for this project is valued at $25,000.00. It is an electric driven residential lift
manufactured by Nationwide Lifts. The inside car dimensions are 3'x5'.
Please call with any questions you may have at 503 -914 -7919.
Thanks,
Doug Weeks
Project Manager
BC Custom Homes Corp.
410 HIGH STREET • OREGON CITY, OREGON • 97045
OFFICE (503) 722-8700 ♦ FAX (503) 722.1013
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: MST2010-00154 Jurisdiction: City of Tigard
Site Address: 12760 SW Glacier Lily Circle
Subdivision/Lot#: Amart Summer Lake/ Lot 74
and/or
Map and Tax Lot#: 1 S 133DA05200
By my signature below, I certify that a minimum of fifty (50)percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)1
Signature: SC ,/)/ Date: June 20, 2013
Owner/Gene al Con actor/Authorized Agent
Print Name: Scott Bowles
ORSC Section N1107.2.High-efficiency interior lighting systems. A minimum of fifty(50)percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent,or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw-in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the fmal inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent,or a minimum efficacy of 40 lumens per
input watt.
1:\Building\Forms\RES-High Efficiency Lighting.doc 07/01/08
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, Scott Bowles/BC Custom Homes , am the general contractor or the owner-builder
at the following address:
Site Address: 12760 SW Glacier Lily Circle
City: Tigard
Permit#: MST2010-00154
Subdivision/Lot#: Amart Summer Lake/ Lot 74
and/or
Map and Tax Lot#: 1S133DA05200
To conform with the 2008 Oregon Residential Specialty Code(ORSC), Section R318.2 and
OAR 918-480-0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture-sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: _al 0 a / • Date: June 20, 2013
General Con u actor or Owner-:ui der
1:\Building\Fonn\RES-MoistureSensitiveWood.doc 09/25/08
.A457—,Z610 — aro I 51-f
STREET TREE CERTIFICATION
I, ErD1"� �' c�L c-S vvner/Agent for
(PLEASE PRINT) (PERMIT HOLDER)
as
Do hereby cer that the s llowii location meets
City f T�gaxd d Washingfo unty
land use and devielopment`s' ds4° stree l tree installation.
DD � G ° D
ADDRESS: 1,Z--) 14D 3(A) ( j cI 2 (-/LY CALCLe O�-
SUBDIVISION: ,k ' LA.c LOT: 7 y
SIGNATURE: _,1 �
, JiLD.- DATE: (� 7 f,-2)
(OWNER/AGENT)
RECEIVED BY: DATE: Z 6
GARD) I
1:\Building\Dorms\StrecifreeCcrtificate 01/19/07
From: 06/21 /2013 OB:46 #067 P.002/004
RECBYp0
Oregon Residential Specialty Code N1107.2 JUN 2 0 2013
CITY OF TiG
n DipIIS�®fir
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: MST201 0-00154 Jurisdiction: City of Tigard
Site Address: 12760 SW Glacier Lily Circle
Subdivision/Lot#: Amart Summer Lake/Lot 74
and/or
Map and Tax Lot#: 1 S 133DA05200
By my signature below, I certify that a minimum of fifty(50)percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent,or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)1
Signature: Date: June 20,2013
Owner/Gene al Con actor/Authorized Agent
Print Name: Scott Bowles
ORSC Section N1107.2.High-efficiency interior lighting systems. A minimum of fifty(50)percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent,or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw-in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent,or a minimum efficacy of 40 lumens per
input watt.
I:\Building\Forms\RES-HighE(ticiencyLighting.doc 07/01/08
From: 06/21/2013 08:46 #067 P_003/004
RECE!
VED
Oregon Residential Specialty Code R318.2 JUN 2 0 2013
CITY OF TIGARD
AIe1LDING DIVISION
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
1, Scott Bowles/BC Custom Homes , am the general contractor or the owner-builder
at the following address:
Site Address: 12760 SW Glacier Lily Circle
City: Tigard
Permit#: MST2010-00154
Subdivision/Lot#: Amart Summer Lake/Lot 74
and/or
Map and Tax Lot#: 1S133DA05200
To conform with the 2008 Oregon Residential Specialty Code(ORSC),Section R318.2 and
OAR 918-480-0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes,the building
official shall be notified in writing by the general contractor that all moisture-sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: ter- Date: June 20, 2013
General Con actor or Owner-�ui der
I:\Building\Fora\RES-MoistureSensitiveWood.doc 09/25/08
Nis -zoi0 - c-° I SI.
•
q
0
0
0
0
a
STREET TREE CERTIFICATION0
.9. ��ut q,;.,a. "��_cFa n4;_4 l4r� •,tr�r`',.r � ,
G
1�O• ;.„r,. 7o?nf ` U «T
�r TMa v , � _ ;Eo \ , 0m L S6 a w." m5Sy k',•a ,▪h 4 tirt,4, ii,-. ,�� it.r y‘„0;h ?iv: ®O��{1_ fr--o
�fA 7s U-', ,f ,w tar�vC SI v � ti Fmg ,:,,,, , r'u 4p t , ,, ,yv yS �\i 10 lSV` Cl 'ro � S p+- 0O0,4 u ,� 4 ;,2,,o� S! � r: 51 c�tN �m ,i � F ° � fi ,. .N ��)�, i ; <0 f, „:1 0��pV �" :304 : u s w;O1 ;s 1`� ,l yl:ch a v,.:..,----'''''. ;;,,,; �A rt for> fto �, . d` (PERMIT HOLDER)' //'� t � :.' , Owi vvV f yr _-_e rf`I, . l (PL FASE PRINT)
Cc
w,t 'rs ,nl"'.,t
Do hereby&,-, , '�,: . that they o]l iwu g cation meets
Ci j o ..f 'd�; nd1�" ;>as in oia� _t4-ounty
! 2',r, ,,,°�Lin r i •4,,s: c v` , ..�.; .., J
.gip .•'•1.0∎`�:1�r", s',;�kt,., .411',,.0! `,,N"t .t"foil t" `"'":r
:ix` , vi 'A,4,, tree installation.
land use and dev;e o ent s� .da ds ;oY== ;
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ADDRESS: ia - op 31_Ac "
-1 LiL Cac.,(. , o -
SUBDIVISION: ,b��i• %- ' )"A-;p; K , I .,A LOT: v
SIGNATURE: 5I1 TD1(J\A DATE: 69/2-0//3
(OWNER/AGENT
RECEIVED BY: DATE: () Zo f i3
(CITY OF '+:
e
0
LL 1:\Boil ding\Forms\StreetTreeCcrtificate 01/19/07
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12760 SW GLACIER LILY CIR, TIGARD, OR,
97223
Residential - Master Permit
299 Final inspection
06/21/2013 00:00
MST2010-00154
PASS - C of O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12760 SW GLACIER LILY CIR, TIGARD, OR,
97223
Residential - Master Permit
399 Plumbing final
06/06/2013 00:00
MST2010-00154
FAIL
1. Cannot repair leak on kitchen sink with sealants. 310.0
2. Provide expansion tank for tank water heater (PRV addition). 608.2
3. Provide drain for tank water heater, from pan to an approved location. 508.4
4. Add additional water heater to existing permit. 103.1
Recall
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12760 SW GLACIER LILY CIR, TIGARD, OR,
97223
Residential - Master Permit
399 Plumbing final
05/14/2013 00:00
MST2010-00154
FAIL
1. water pressure exceeds maximum of 80 PSI, PRV required 608.2
2. Correct leak at kitchen sink. 310.0
3. earthquake straps for water heaters (Plbg Code Interp 08/12/05) 1 ½”penetration, #12
wood screws with washers 508.212
4. water heater T&P tube minimum (6” to 12” garage) (6” to 24“) outside (16’ ) 608.5
5. Complete upstairs hall bath tub waste and overflow. 310.4
6. Remove 2" test cap from master bath floor drain. 310.4
7. complete roman soaking tub to operate. 310.4
8. Provide permit for lawn irrigation backflow device. 103.4.4
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12760 SW GLACIER LILY CIR, TIGARD, OR,
97223
Residential - Master Permit
399 Plumbing final
06/06/2013 00:00
MST2010-00154
FAIL
1. Cannot repair leak on kitchen sink with sealants. 310.0
2. Provide expansion tank for tank water heater (PRV addition). 608.2
3. Provide drain for tank water heater, from pan to an approved location. 508.4
4. Add additional water heater to existing permit. 103.1
Recall
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12760 SW GLACIER LILY CIR, TIGARD, OR,
97223
Residential - Master Permit
399 Plumbing final
05/14/2013 00:00
MST2010-00154
FAIL
1. water pressure exceeds maximum of 80 PSI, PRV required 608.2
2. Correct leak at kitchen sink. 310.0
3. earthquake straps for water heaters (Plbg Code Interp 08/12/05) 1 ½”penetration, #12
wood screws with washers 508.212
4. water heater T&P tube minimum (6” to 12” garage) (6” to 24“) outside (16’ ) 608.5
5. Complete upstairs hall bath tub waste and overflow. 310.4
6. Remove 2" test cap from master bath floor drain. 310.4
7. complete roman soaking tub to operate. 310.4
8. Provide permit for lawn irrigation backflow device. 103.4.4
Violation Summary:
Inspector Contractor