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Permit CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit X: MST2015-00214 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/03/2015 Parcel: 2S1060001500 Jurisdiction: TIGARD Site address: 13515 SW CALABASH TER Subdivision: RIVER TERRACE NORTHWEST Lot: 19 Project: River Terrace Northwest, Lot 1 Project Description: New SF. 2/4/2016: REPRINT permit to correct address from 13510 to 13515. BUILDING Floor Areas ReauiredSetbacks Reouired Stories: 2 Bedrooms: 4 First: 625 sf Basement: 0 sf Left: 11 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1017 sf Garage: 418 sf Front: 18.5 Smoke Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes Total: 1642 sf Value: $203,538.31 Rear: 5 PLUMBING Sinks: 1 ter losets: 3 singMach: 1 sundry rays: 0 ain rain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL FuelTypes Air Conditioning: Y Vent Fans: 4 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 Terri)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: 1 201-400 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 1642 Owner: Contractor: ADLV LAND HOLDINGS LLC POLYGON WLH,LLC Required Items and Reports(Conditions) BY FORSUM,MICHAEL 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660 STE 1 SCOTTSDALE,AZ 85258 PHONE: PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $29,973.31 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 11..800.332.2344. Issued By: Permittee Signature: Call 503.639.4176 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• 4.t:1,iCITY OF TIGARD MASTER PERMIT -2,1,E COMMUNITY DEVELOPMENT Permit#: MST2015-00214 • " Date Issued: 12/03/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 .. :,_; ,i Parcel: 2S1060001500 Jurisdiction: TIGARD Site address: 13510 SW CALABASH TER Subdivision: RIVER TERRACE NORTHWEST Lot: 19 Project: River Terrace Northwest, Lot 1 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 625 sf Basement: 0 sf Left 11 Parking Spaces. 0 Height: 24 Bathrooms: 3 Second: 1017 sf Garage: 418 sf Front 18 5 Smoke Dwelling Units: 1 Third: 0 sf Right' 3 Detectors' Yes Total: 1642 sf Value: $203,538.31 Rear 5 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays. 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers' 1 Floor Drains 0 Sewer Lines. 100 SF Rain Storm Sewer: 100 Drains 0 Tubs/Showers: 2 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 4 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 1 201-400 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 1642 Owner: Contractor: ADLV LAND HOLDINGS LLC POLYGON WLH,LLC Required Items and Reports(Conditions) , BY FORSUM,MICHAEL 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660 STE 1 SCOTTSDALE,AZ 85258 PHONE. PHONE 360-695-7700 FAX 360-693-4442 Total Fees: $29,661.91 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 direct questions to OUNC by calling 503 232.1987 or 1 :00.332.234• Issued By –� PermI Signature: ,k r—.— �� Call 5a3e9 75 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 n t 6 N fr-. . �.7 ,. Residen;tia ,-.t,.,.,.FOROFFICE:l SE O 1.2 •,:,,,,:.,,:.?;' �. .^'" rt2^ 'b mKw..mYvw ra'»i 1...„. ~l •• , . • .s. . . f, .,;•,:y':•:... `Ab Received Permit No.: /„� City of Tigard �� Date/By: //�"/O V> f)')5 (i/c // 13125 SW Hall Blvd.,Tigard,0;it 0" Plan Review• Other Permit. .a Phone: 503.718.2439 Fax 50'.•,:•l, cybov 1 q 2Q1� Date/By: i J)23l iS �t"J�i s-,...-act /Ll 7 -T I G::R 0 Inspection Line: 503.639.4175 \' . !d Date ReadyBy. Jw;s. H See Page 2 for • - Internet www.tigard-or.gov NO tr.4,.A Notified/Method: �� `i� 47).— Supplemental Information y r L 7 _tea 0 Y{ } � 1 5Y° gn cr*+E A { l a t{, tr`z 1 ;; lirg e�^_:vaat1 .- >e.1 .„"• , a' -,'l,,n ,..ar. "'= «..°A oz4.- ',.. - . .1 >__...�;, 4.....4.4.,,,,,,.......06.-:, n - 2,`;.41 v9.1 ®New construction ,,.-%ea 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 4, m.'''''44- kg craa - A4xr; work indicated on this application. F 9��.s{'R 6 €6 ,t. 10'3 i s�'LI4hiti L; a fce_ Valuation:•1 0l r�? $ l)I I frJ ® 1-and 2-family dwelling ❑Commercial/industrial cel /tom 000 tit JJJ���� Number of bedrooms: 4 ❑Accessory building ❑Multi-family 9 Master builder 9 Other: Number of bathrooms3 , :1-:.:.'7.-4, .� , ,- '- - : .1;-�� - ' Total number of floors: 2 EJt IGTE a '�. .0 �� e` " ;�_ _ Job site address: 1'7 c \C 5� CS 0,00 K New dwelling area: ,u�Z square feet.ao 6 c City/State/ZIP: Sh9,'1), )78 bP\ Garage/carport area: L'„S square feet Suite/bldgJapt-no.: I Project name:River Terrace Area I Covered porch area: a i square feet)0 1 7 Cross street/directions to job site: Deck area: "�j square feet 6c).A--- Other structure area: square feet "stmt i,t- w st to L1V Subdivision: Lot no.: 1 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 NlijNiP4i { P- a FTFT ,: e. $4 r .- work indicated on this application. N -,i' ST7' Valuation: $ Existing building area: square feet New building area: square feet fi - , .� ,A4 t '„ a �'T.---=''' , ` :i ��,k. siik* Number of stories: Name:Polygon WLH,LLC Type of construction: Address: 109 E 136 Street Occupancy groups: City/State/ZIP:Vancouver,CA 98660 Existing: Phone:(360)695.7700 Fax:(360)693.4442 New: 1 >it -7'' :,"'"”" ` 44- :;4!...t.4.7..kata9das - Nw;0774,', r y- .5,-:.,'.3.--,ii,..--------' : ar _ � "-74 n Business name:Same Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Amount received: Phone:( ) Fax::( ) E-mail:magg{e.gordon@polygonhomes.com t-,` .t-,. " 4T-0 - S �, ", r . :-.,-....,v,-.5-.4 & 4;, Commercial and residential prescriptive installation of ,, _ '� � roof-to mounted PhotoVoltaic Solar Panel System. ' ,,,-;,. ..-„,i,..x .9 Qt :ems t«.d _' moi-` P Business name: Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.:204238 Total fee due upon application: $201.60 ,ice I• This permit application expires if a permit is not obtained Authorized signature: within 180 days after it has been accepted as complete. Print name: Date: I -2,..45 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) RECENED L R':OFFICC.IIS Q.. ;;his,.._ .:*1• V 2015 =;FO . . .... . . . lication ��,�'� , ..... .. .. . . Electrical Permit App ��� .. : �, `:: „ .::�`/.,. ,. , ., CITY 01 II'l ARD itcurvetl Permit fl: ST `�D9� ;; ;;, City of Tigard Date/11 . • f ... • 13125 SWHall Blvd.,Tigarti OK�72,.. NG DIVISION Plan Review RelntedPermii8: lir Phone: 503.7182439 Fax: 503.598.1960 Date/B • 1e; H See Page 2 for • i: .� Ready Date/By: Inspection Line: 503.639.4175 Notified/Method: Supplemental Information TIG 1.1 Internet: www.tigard-or.gov � � Y'r r • „r 7 sS;a:Yi,',MESE =t 'ialij s \:��°� k G' K 'ter e . ".: :,,at:n Vin:t, ts, 7�- E �x:.0.i!}g' ,:0 5� b. 6 't� ,7syl,` i, 1 � 3;aa'"; construction rr.n � Please cheek all that apply(submit 2 sets of plans wfitems checked): ®New Construction ❑Addition/alteratiotl/replacernent p Service or feeder 400 amps or more 0 Building over three stories. �]Other: where The available fault current 0 Marinas and boatyards. ❑Demolition .I. , a� F exceeds 10,000 amps at 150 volts or ❑Floating buildings. e�+"��; ,x�,.n•.' '; .�"!k .14.14k4WI:Mk less to ground, excr r1z 0 volts ❑Commercial-use agricultural 0 1-and2-familydwelling ❑Commercial/industrial 0 Accessory building amps for all other installations. ❑buildings. of 150 KVA or ❑Master builder ❑Other. ❑Fire pump' yderivedA 0 Multi-family _ �, ,A ❑Emergency system. lager separately d. :.. ,y. �c- 1 system. X� �� I' :-..Ii�i���l(�1�rt'.=-Tk-� -� ti��, ����� L-. ❑Addition of new motor load of Job#: Job site address:13510 SW Calabash Terrace 10011P or more. occupancy. ❑Six or more residential units. 0 occupancy. vehicle City/State/21P:Sherwood,OR 97140 ❑health-care facilities. 0 Recreational voltage isle parks.ar than 0 Hazardous locations. Sup volts voltage ownif L Suite/bldg./apt.#: l Project name: 0 Service or feeder 600 amps or more. - Cross street/directions to job site: Description Ohl. Eacb Total New residential single-or multi-family dwelling unit. I Lot ii: 1 Includes attached garage- Subdivision: 1,000 sq.ft.or less 1 168.54 4 Tax map/parcel#: M ^' 16,4 " Ea add'1500 sq.ft.or portion 1 3192 1 r �= ,",)`,Xi C"'Tl-( .,sh•� ` *.;*;•;?..' ,o' Limited energy,residential 75.00 2 xE6 �, t o " i� (with above sq.it) • Limited energy,multi-family 75.00 2 residential(with above sq.ft) !� Renewable Energy ❑ See Page 2 '';. 0T . t.:3s.,.�al'ir;3<'g'- ?`� ' )lg' x ',4,lid ; l_ ' E '• ' *'r Services or feeders installation,alteration,and/or relocation 200 amps or less 1 100.70 2 Name:Polygon WELL,LLC 133.56 2 201 amps to 400 amps Address:109 E 13th St 401 amps to 600 amps 200.34 2 1,000 amps 301.04 2 to City/State/71P:Vancouver,WA 98660 601 amps Phone:(360)695.7700 , I 55226 � 2 Fax:(360)693.4442 Over 1,000 amps or volts Temporary services or feeders installation,alteration,and/or Email: relocation 5936 1 Owner installation:'This installation is being made on property that I own which is not 200 amps or less 15936 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 401 amps to 400 168.54 2 Owner signature: Date: m ^t Branch circuits—new,alteration,or extension,per panel �az 'ir -`i24-'. '. / �sw h o vM ;.r ;.4-'----,'ipG� a ppi A.Fee for branch circuits w. a •,F .'l�',t: - ,, 1.,. ;,r"'",''',r.4z'4R= -, ".4",� ,*.. ; .a feederfee, k - above service or 7.42 2 Business name:Polygon WL13 each branch circuit E.Fee for branch circuits without Contact name:Maggie Gordon service or feeder fee,first 56.18 2 Address:109 E 13t1 St branch circuit Each add'I branch circuit 7.42 2 City/State/ZIP:Vancouver,WA 98660 Miscellaneous(service or feeder not included) Phone:(360)695.7700 l Fax::(360)693.4442 Each manufactured or modular 67.84 2 dwelling,service and/or feeder Reconnect only 67.84 2 Email: ;� 2 °v a:cr�t •'u .ets•.,"� ., 1.0tr3.Q ,8.;_Z1�;�,r�.OI ::.,.t p.,. - y4.4=r,`" 1">I. .„at Pump or irrigation circle 67.84 2 �:�sh`,1+t:��`,,,:it5�.t1� , .. t;°z� -t>;i lb.• �.� - � 67.84 Sign or outline lighting Business name:Simply Electric Signal circuit(s)or limited-energy ❑ see rage 2 2 panel,alteration,or extension. ` Address:PO Box 822408 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 6625/ler City/State/ZIP:Vancouver,WA 98661 90.00/hr 360 314.4945 Investigation(1 hr min) Phone:(360)258.0070 Fax:( ) Industrial plant(1 ler min) 78.18/hr Email:pawl a@portlandelectric_biz G Inspections for which no fee is 90 0D/ hr — •Suprv.Lic.:G13�f l� 'feu listed /rhrmn y.:: -A,-,,,, � CCB Lic.. 204615 Electrical Li Lr .r.�_iCA ..... 4 ` n em ,., .7 ` 17 � Subtotal: Supervising electrician signature,required: J ' �r /`(�� • 0 Plan Review Required(25%of permit fee): ` Cl_t _ State surcharge(12%of permit ftp): print trams Victor/Zarzhilsky6;1)/( TOTAL PERMIT FEE: Authorized siandlure` V`, This permit application expires if a permit is not obtained within 180 - 1 days after it has been accepted as complete. Print name: Dimitry Mishchuk Date: I ons allowed per permit. • Number of inspect ELR_ERE.dJW oe Rev 06/17/2015 440.461 ST(]1/OS/COMEB 1:\aoildingtPamas\FlL PrnnrtfWP_ • mit A plication ....,.,. ..,.,,. . PYulnb><n Per p fOR Ol•F1t L l SF O\Ll { Building Fixtures t..(573D/S�,2'/y Received Permit No.: "'i a' City of TigardP4Date/By: 13125 SW Hall Blvd.,Tigard,OR 9722,, 2O\ Plan Review ether Permit No.: !:. i..�'.�. Phone: 503.7182439 Fax: 5td3�5\98.IP Date By: Ot Inspection Line: ine: 503.639A175 3ll;\ iD � ' GP ) �e�dy/BY ` it S«Page Z for '...'..,,••::,-..- .;: Internet www.tgard or.gov .�� ( ND ifedlMetwbSupplementalInformation ormastioa ""-' or..A y1, ^�� ', .._. • �'- ) x3 y : ",- -- r+ :::.s .� I -�xs. "':3`71.tr1 . .t . ,xins �/s�.,sitA1�"rx. For special information use checklist New'construction ❑Demolition pescriptioll 1 Qty. { Ea { Total Other: New 1-2-fatuity dwellings(includes 100 ft for each utility connection) �❑Addition/alteration/replacement I '�.�s s� --x . -.,4,-,4:,,:,..- sl�kt(1)ball, l 12 70 j `�FY ` cam tr,:�n~_1�dr: . -.his l , •t+- SFR(2)bath 437.78 i-cft-and 2-family dwelling _ 0 Commercial industrial SFR(3)bath 1 50032 5 1��� \ building0 Multi-family Each additional bath/kitchen 25.02 o0 Ass sso(y Other Fire sprinkler(,__sq.fl-) . Page 2 1:1 Masao'builder 7 , _;,c�rnT.-.�-, -.,.-�hili wren, '-:.-1.4,-1:-.';'-3•74 , c-'�..'-.'.•a+ V•. i�.k.' ^s`` -•% Mite utilities: .�"f r _ r F��, ''c,"•;S.,r t.., . _ '• - -_- 18.76 rsJobsit;a,; ,,sS \�. a , t^^N. f S Catch basin or area drain lob site address: 135)lJ _�^�, t CQ4/ /f��]�1 `� Drywell,leach line,or trench drain 18.76 City/Stat/LIP: - ( YI \jj19C _} ut 3_--") 71`�C Footing drain(no.linear ft.:, _) Page 2 f�1 Manufactured home utilities 50.03 Suitc/bidgJapt no.: Project name:1 \�to�1.--n-1-cu.- . _ • Manholes 18.76 Crus street/directions to job site: Rain drain connector 18.76 Sanitary sewer(no.linear ft: ) Page 2 �- `Storm sewer(no.linear ft: ) Page 2 Water service(no.linear IL:. ) Page 2 Subdivision: . ! Lot no.: l Fixture or item: Backflow preventer 31.27 �` • Tax map/parcel no.: 1• Backwater valve ( 12.51 1`Z ,'w_ - ` t e''n7D=,:.,'-..2,-c,---,,,-..21.,-,-.' Jj �::.. - ' -" K._, clothes washer { 25.02 05,0 Dishwasher { _ 25.02 05,o2 VC/ k/tJ 0. 0V �n,►,V/ tr�// Vh f Drinking fountain • 25.02 Ejectors/sump 25.02 ,r �^ ' %.• = Expansion tank 12.51 . 616Y1- e= : f 'r -,J . 4x __ •� p 25.02 Nam° :s; '• r - � Fixture/sewer ea Name: Q©� l Floor drain/floor sink/hub �` .02 5-A- Garbage disposal t 25.02 Z�V Address: �y _ J1 A cl , lib Hose bib 1 25.02 Z` , City/State/ZIP: (A,�'�CQ�,Q�;t' __I 12.51 r 0 Fax:( ) Ice maker -I2-•' ,\ Phone /q ss } q? � Interceptor/grease trap 25.02 ��•f����: �".,- ,}'. . {,i,.," )) �� pp ;'r: .�.,a:e�r Medical gas(value:S ) Page 2 Business name: �j1�Ltl.ltit,btvt�Cs. J�. Primer 12_51 Contact mune: I: Roof drain(commercial) 12.51 Address: . p r Alb w Sink/basin/lavatory 25.02 I 9 1/S 19 Solar units(potable water) 62.54 City/State/ZIP: Co.'9 T,� /v 11z 51 � 2 Tub/shower/shower pan c�- '2,5.(-)Z,_Phone: )351 �3�b3 Fax::( ) 25.02 Urinal E-mail: :t i r) Vka-:i eo . Water closet 25.02 r sr'..-('.i.....:-...4'4,1'47:2 w.. lir fry t'.',4:4 ev'x arm • 4. . ,.,•: Water heater t . 37.52 )1...512,..- Water pipinglDWV 56.29 Business name: � .-- . y.i Other. 25.02 Address: �t r � oz. q 1Ot •A 5- Subtotal City!State/ZIP: � , I I // ei Minimum permitfce: $72.50P}wne; 3) (/3 Fa"-( Plan review (25%of permit fen) CCB Lic.: L ,� Plumbing Lic. �2. State surcharge(32%of permit fee) • TOTAL PERMIT FEE Authorized signature: nil permit application expires N a permit is not obtained within 180 days Date: iff after it his been accepted as complete • [Print namC: .' !' 'Fee methodology set by Tri-County Building Industry Service Board. I:\ 440-4616T(I WRLCOM/wEa) . Au�Idir�V'cnnilslPLMt1-FkrmilApp-doe Iwow; City of Tigard r . , ...14 1 COMMUNITY DEVELOPMENT DEPARTMENTC T G A z o Building Permit Review — Residential Building Permit #: s7- /c-=0U,),1 i1 Site Address: 13570 Sc,J c' (a c t„ Project Name: n ser •TerrctL2. N o c--IM wes t- Lot #: 1 (New dwelling=subdivision name;Addition or Alteration= last name of owner) Planning Review Proposal: Model home COI L c* NPrN C,o r)s ley c ' ,{ X.1 Verify site address/suite# exists and active in permit system. River Terrace Neighborhood: / Yes ❑ No Site Plan Elements: %Three (3) copies of site plan ^--Busting structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished 1/raven to scale(standard architect or engineer scale) floor elevations North arrow /Utility locations (required for new,may apply for additions) Site address,project or subdivision name and lot number -E1757ation of wells/septic systems \pplicant information (name and phone number) rosion control (including drainage-way protection, silt fence /]Lot dimensions and building setback dimensions design,location of catch basin,etc.) km. Me . $f,ot arca,building coverage area,percentage of coverage and /Street names (V CrT Ct 5$-. Sect,0 v-I- 00 t _ U wri impervious area (applicable if R-7,R-12,R-25&R-40) Street tree size,type and location c ho W S 6 , 1 ns 1{ud /Property corner elevations (2 foot contour lines if more than •'n17 sting trees to be retained with drip line,and tree 01- eZ 4 foot differential) protection measures Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995): rD ZOOS —oo os Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No 0 Public Facilities Improvement(PFI) Permit: in Proatis eft Zo is.,pp Ii L Required: ❑ Yes,applicant was notified ❑ No Appli d For: 0 Yes - 0 No,stop intake X' Land Use Case#: P Pe /40 iS - d'CQ O S l , zoning: R q. s /Setbacks: Front lg.S Rear s' Side 3 Street Side ( / Garage S .D andscape Requirement: ,--14-tot Coverage Maximum: — % r�x V Building Height: Maximum Height 6/7A Actual Height �i /Er Visual Clearance basements -LJ Sensitive Lands: 0 Yes 0 No Type 0 Urban Forestry Plan CConditions "Met" prior to issuance of building permit . Notes: Con ciAb 0 Fl I hove., inO A-- to earl ✓Yve.,♦- Approved By Planning: /1.4 (D /c-11c g i (z Abw- Date: 11 / 12./ IS Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved I:\Building\Forms\BldgPermitRvw_RES_070915.docx Building Permit Submittal Original Submittal Date: ii/ /IT Site Plans: # Building Plans: # 3 Building Permit#: 7"nter building permit#above. Workflow Routing: -44M iingngmeering KI-14-Crrnit Coordinatorwilding Workflow Sign-off: KI—Si'gi off for Planning(include notes from planning review) Route Application Documents: - ngineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. mg: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable, etc. Notes: , By Permit Technician: _� Date: // /7/f Engineering Review ❑ Slope at building pad: ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments) per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 14Date: ///—f -'; —T Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit �Approved, NOT Released: diDate. hil` 6 otes: /), --)---7-7' CAA / Ge* -T evt.../ fie.,! .era is-C Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: ❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes ❑ N/A �OK to Issue Permit /Approved by Permit Coordinator: 11 40 Date: itA /3— I:\Building\Forms\BldgPermitRvw_RES_0709I 5.docx 01/26/2016 11:32 2532882156 GARNER ELECTRIC PAGE 05/08 City of Tigard, • COMMUNITY DEVELOPMENT DEPARTMENT 0 711 Request for Permit Action T 1 C;A11 n 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •'RECEIVED TO: CITY OF TIGARD JAN 2 6 2016 Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 CITY OF TIGARD Phone: 503-718-2439 Fax: 503-598-1960 Tigard13u.ildingPcr> QAPAS`ON FROM: ❑ Owner E Applicant Contractor ❑ City Staff Check(✓)one REFUND OR Name: '/ INVOICE TO: (Naslne:: orindividuati Vc\ • (1C ,, \ I M^ Mailing Address: 61�� a . City/State/Zip: "L Wt- Q 3 Phone No.: k.O \ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ 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). REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: 1'b1l" J - l"l Site Address or Parcel #: viL.a\aWitl Project Name: /S5/ ----YSubdivision Name: Lot#: EXPLANATION: ` '. 1P Yl-a) Nu* 4,_A1`�Le, � aL & . ' . '.>,'. i_ ►1 U.K./ Signature: 1► $ li.`,l Date: �� ,� 4 Print Tint Name: G �, t . Edon.d Pplicg 1. The city's Community Development Director,Building Official or City Enircer may authorize the refund of: • Any fee which was erroneously paid of collected. • No(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 fcc for issued permits prior to any inspection requests. 2. All refunds will he 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 Syv admin: Date 13 Route to Records: Date, ! WD_ Refund Processed: Date fay Invoice Processed: Date By Permit Canceled: Datem. By Parcel Tag Added: Date I3y T.:\Build ing\forms\RcciPcrrnitActi0n_192314.doc 01/27/2016 12:15 2532882156 GARNER ELECTRIC PAGE 04/04 IN El) Electrical P ,1 it AP P1 A f1. J ' city I ..- 13125•' 14ar le 01rigout o 2 7 2016 •PI Renew r 1'hOtto: : Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13515 SW CALABASH TER, SHERWOOD, OR, 97140 Residential - Master Permit 699 Mechanical final PASS MST2015-00214 Chip Barnett Provide correct address posting on structure as per ORSC R319 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13515 SW CALABASH TER, SHERWOOD, December 1 , 2017 at OR, 97140 11 :09:23 AM Record Type: Record ID: Residential - Master Permit MST2015-00214 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Corrections from previous inspection complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13515 SW CALABASH TER, SHERWOOD, December 8, 2017 at OR, 97140 11 :59:39 AM Record Type: Record ID: Residential - Master Permit MST2015-00214 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed. Water pressure = 65 psi Violation Summary: Inspector Contractor