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Permit
a CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permitd: MST22015 199 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2510 2015 Parcel: 2S 1060001500 Jurisdiction: TIGARD Site address: 17225 SW HOLLY RIDGE LN Subdivision: RIVER TERRACE NORTHWEST Lot: 18 Project: River Terrace Northwest, Lot 19 Project Description: New SF-Model Home. 12/21/15, Reprinted to change plumbing contractor to Kruckman Plumbing. 2/4/2016: REPRINT permit to change address from 17224 to 17225. BUILDING Floor Areas Required Setbacks Reauired Stories: 2 Bedrooms: 4 First: 948 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 28.5 Bathrooms: 3 Second: 1130 sf Garage: 380 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2078 sf Value: $252,112.34 Rear: 24 PLUMBING Sinks: 1 WaterClosets: 3 Washing Mach: 1 Laundry Trays: 0 Rain rain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF RainStorm Sewer: 100 0 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckfiw 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: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temo 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: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All 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 2078 Owner: Contractor: POLYGON WLH,LLC POLYGON WLH,LLC Required Items and Reports(Conditions) 109 E 13TH STREET 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $31,136.63 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 throug 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: 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. CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00199 IF ff 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �; , Date Issued: 12/03/2015 _ Parcel: 2S1060001500 021 S Jurisdiction: TIGARD Site address: 17224 SW HOLLY RIDGE LN Project: River Terrace Northwest,Lot 19 Subdivision: RIVER TERRACE NORTHWEST Lot: 18 Project Description: New SF-Model Home. 12/21/15,Reprinted to change plumbing contractor to Kruckman Plumbing. Contractor: POLYGON WLH, LLC Owner: POLYGON WLH, LLC 109 E 13TH STREET 109 E 13TH STREET VANCOUVER,WA 98660 VANCOUVER,WA 98660 PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: 360-693-4442 FEES Quantity Description Date Amount 1 ea Building Permit-New 12/03/2015 $1,543.80 Specifics: Construction 1 Plan Review 11/04/2015 $751.34 Type of Use: SF 1 ea 12%State Surcharge- 12/03/2015 $185.26 Building Class of Work: NEW 1 ea DC Provision Review,SF- 12/03/2015 $88.00 Type of Const: VI3 Ping Occupancy Grp: R-3 21 ea Info Process/Archiving-Lg 12/03/2015 $42.00 Stories: 2 $2.00(over 11x17) 48 ea Info Process/Archiving-Sm 12/03/2015 $24.00 $0.50(up to 11x17) 1 ea Metro Const. Excise Tax 12/03/2015 $302.53 1 ea Tig-Tual School CET- 12/03/2015 $2,493.60 Residential 0 Plan Review 12/03/2015 $252.13 2458 sf Permit Fee-Elect(per 12/03/2015 $270.30 dwelling unit) 1 ea Limited Energy 12/03/2015 $75.00 1 ea 12%State Surcharge- 12/03/2015 $41.44 Electrical Total $30,825.23 Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 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: Permittee Signature: ` 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. Dec/'7/2015 11'31:03 ANI A!\G) 1-5013-.323-256U 215 PIULTIL141P, Pe17rnit Application Site Utilities Cit RECEIVEn) y of TI &.4p 15-- i No.: (312:SW H-,Il BIvd.,T1gnfd,OR 972D Ploi Rpiew ID Pbollc: $03.713.2439 rax: 50 1113potion_11me. 503,0M 9" 5 2015 l ln!tmut; ww%v'Ll&nrd-orBuv I Nal:icd/M hod! Supplatnollial Inforly-mlon Q11 PQ I P [D Now LI D v.i I i olli i!,on POr spacial hLomiallon use cheekh'se, Des vlptioll 1.2-family dwollingli(InQlvdcs 100 IN for each utility connection' batt 31R(2)Wh 437.78 SM(3)badsS0032 ing \4u�ikfamily Lech 061timl taflAtchn j 25.02 _JNI"Wr builder Fir sprinkler •sq.A.) Page 2 J.OB Site utilitles: Catch bas In or area drain 1836 ob 92[6 riddrass:]7224 SW 11 olly Ridge Dlywcll'tollob line,ur trench(!calm 18.76 City/Stute,7117:Tigard OR Footiag drain(!)0.fimm it.:,,. no 2 Suiw-b!dg,/ap*.,no.; Illime; home 50,03 Cross stveeJdireo::om m job sitz: Mailholds l&76 4........_ Rain drnin connector j 18.76 Sanitary sower(r.o,llpnr ft,; I Page 2 Sturm mycr(no.linear R.: __ 'tinter cm stt(110,linear P'.:_j palp I 1 StiodivWon: Lui no.:19 1 Fixture or Item! TM Tax waip'ptmcl nu.; NckfID-N preveliter Backwlitcr YnIve ...... .. Clothes Nvaslwr 25.02 I'lullibing Dishwasher 25,02 Drin I cing fountain 25.02 F.J^.r!Gf5/sump 25.02 TP AN T Expanslorl 12.51 N..rime.:Polygon NW HomcN FixturUsewer clip 25.02 11 jor dralr/lloo,stn; hub 2,5,C12 lddrensc Garbage disposal 25,02 City/stat-'rZIP: Hoscbib Fm Ice mnker 72.31 r Mot Inwrccptor/greesc trap 25.02 merit ill gas(woue:S Kruckman Plumbirig LLC P.imer 12.51 Conlaot name:Nlark Kruckmam Rccfdrain(c*mmmial) 12.11 AddressPO Box 1375 25.02 C: ity/Stom.,11"IF:Gresham units(pcIBbIt,.woor) 62,54 Tlibhi�im�.r/iihowvr pim Phone:('ri)80c)-8183 _7 unnlil 25.02 Wwr closet arn CONT%Wrv1t 37.5;. nuiincss narm::1101 Water pir.j'1wfflvv 36.29 Aedrcsn:109 E IS 25.0i Subtotal vIk prmit ft: 572.50 Phone: J60 5 77011PlAnt.Yim (2s%afpernitroc) turnbingLi-.no,:CCD Lic� Cj SWe -C(12%Of r Rlrahil�C X71d.fee) Authorim's!gr.F&,1vC' TOTAL FERMIT FEE ------ ThIs pevailt Aliti4eg lion etpim!I(A licraill 6 not obfiflild wi ihi n:60 days III int rm-lid:Hark Kruckinrill Date:12/17i2Ul5 n1I*.F it has been AmIltza 23 COMPIVIC. industry SorviQi B;,anl. Dec/17/2015 11:31:08 AM AIG 1-503-323-2569 1/5 A-all Via. _ inC�UC�� - •17—! 5 CA>JW City Of Tigard 13125 SW Hall Blvd Tigard OR 97223 Re; Plumbing Permit To whom it may concern; We have been asked to provide you an updated application on plumbing projects at sites located at 17192 SW Holly Ridge and 17224-SW Holly Ridge in Tigard as we are the subcontractors on these jobs, Polygon NW Homes Is the contractor on this project and wanted us to provide our Information to update these applications.They will be taking care of the fees for these applications. If further information is needed, please contact me. Thank you Mark Kruckman Kruckman Plumbing LLC 971-806-8183 � f CITY OF TIGARD MASTER PERMIT •)•_-., '` 1; .,, COMMUNITY DEVELOPMENT Permit#: MST2015-00199 '> Date Issued: 12/03/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439. Parcel: 2S1060001500 Jurisdiction: TIGARD Site address: 17224 SW HOLLY RIDGE LN Subdivision: RIVER TERRACE NORTHWEST Lot: 18 Project: River Terrace Northwest, Lot 19 Project Description: New SF-Model Home BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 948 sf Basement. 0 sf Left: 5 Parking Spaces: 0 Height: 28.5 Bathrooms: 3 Second: 1130 sf Garage: 380 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total' 2078 sf Value. $252,112.34 Rear: 24 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: 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 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans' 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents. 0 Woodstoves 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less. 1 0-200 amp: 0 0-200 amp 0 W/Svc or Fdr: 0 Ea eddl 500 sf 3 201-400 amp' 0 201-400 amp 0 W/O Svc/Fdr 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All 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 2078 Owner: Contractor: POLYGON WLH,LLC POLYGON WLH,LLC Required Items and Reports(Conditions) 109 E 13TH STREET 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 i VANCOUVER,WA 98660 VANCOUVER,WA 98660 PHONE. 360-695-7700 PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $30,690.23 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 t e ru es. .irect questions to OUNC by calling 503.23 or 1.800.3 344. Issued By: ���-- s Perml •• •:•- .re: Call-411.:- 175 by 7:00 a.m.for the next available inspectio 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 i . ;, + ,:,v,q ',,;aResidentil RECEIVE* n.,e � I}f+:^F1OR OF FiC ti gS+E #\'a 2 ,, p,- ^ -; , ,GOLlvTf !1 t ` . ' • Received ' xCl nof Tigard NOV 2 2015 Date/BY: - PermitN IS7 O/_S'—o /99 'a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / t J], tl'-'• ~C Phone: 503.718.2439 Fax: 503.598.1ttry D DateBy: ®/ �J Other Permi. ���04s a,/9.3 G OF TIGARD Date Ready/By: loris: H See Page 2 for rTIG::' D Inspection Line: 503.639.4175 BUILDING DIVISION /�/ l r Internet: www.tigard-or.gov NotiSedRvlethod: / (� Supplemental Information 1�71rrp 1 M • , ,- .hqy*.. n«.e}'. y:X.if:, ,F "i,,, „...'-y - ' ' r.,„, "';;. -z ,3e ,. . :Com'. ........,..... 04 v., `° t a • ,--44-..,,RE-8 l a1 D,t -,.."01%. r"1 ' .I%1 TT;` 071:0„-..t,,,,..„..t; 'd. �. 1 ] � •.c ...y ? 7a f' ''.ir _m+UW.� A. '''ia 44 .�.' `...<t''. ;:,,.-s' '9'' L'}r44,,,',mow,. .+6-''`.X-'a .,_ _, _�, ,�.���A3�x'3u.-a,.�p4E .id.'�. aY,+:aT. s'"bi - -,:, :t4-.-..... ....4.741,n4..,. " ®New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the u a ,r; � �'0,-.,"&444",I, „,:3t� , , t �. � ,- �� "�'"=, work indicated on this app icanor� a. < -, �r '�+ ' off. �Q R - .._. , '3� , ( Valuation:- �) I IZ. $ a`'1�” ® 1-and 2-family dwelling 111 Commercial/industrial ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: -•ra‘.3 .Y,.,,::-..:::,;.ra= 5'+ :{-:-"�y;=�zr;=,'.�rsrc�„u`_-*: s;AI,K;;:c+. ,:°.�;: .:u ".;�,.^as.:@`i+'.s.�':z;�`3'. :," "`+ ' ,'}`px=_u-�, s "c v" ' QriliAt.Il�iE� ? " k.:I:.icaitt ,., , _M 1, w„ .= :4_1 Total number of floors: 2 . Job site address: 11 P f Ch Z1 l , 1 R AO) New dwelling area: a 7 g square feet D � 4 City/State/ZIF l l� 1 )0 d 0R Garage/carport area: 715 S O square feet Suite/bldg./apt.no.: Project name:River Terrace Area Covered porch area: "..+-2,. square feet I v 3 0 Cross street/directions to job site: 1 Deck area: square feet)4 g Other structure area: square feet ri ',!4ir JA. -14,11 x r fir'�".;.ili,,:y€»-" '" IIl( 1DDA 311 E1FH S ,i .t Subdivision: Lot no.: ICI 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,o�"erhead,and the profit for the s- , <" rear. ' ' W4'14'kC WW"Pa � ". 1 work indicatedonthis application. -, .+'-sc aml" .;' r..1.h V` .IP &9.X4 .d -._aknn._� a=,''",--n. ..1i .t.47,-,-,.:' I Valuation: $ Existing building area: square feet New building area: square feet g � i �� �g ,:i',��""'" p�a� "` � � �� � iNumber of stories: Name:Polygon WLH,LLC Type of construction: Address: 109 E 13`"Street Occupancy groups: City/State/ZIP:Vancouver,CA 98660 Existing: Phone:(360)695.7700 Fax:(360)693.4442 New: rP- a "- xrtr - . t � ..� as" . .4'''' ,tr" f"fi ' :?4` ,, s ,3" e../...t t " * ..=_ = ?.�a _. _ia: ' az—ate4. u?rma ; u: _ 5 , . �as NOS -• ' ' 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::( ) a - u E-mail:maggie.gordon@polygonhomes.com „" ySO ta'I 11 ` t+t+,,x0:St--.�� ;� 444. - . 4.,. r, ,.,,, Ira ;. °'r_ .,, -,114./00-018 Commercial and residential prescriptive installation of g � „�' t, , -•• w" : '_ roof-top mounted PhotoVoltaic Solar Panel System. finta-..- kr.9...= ,r�',3�::a '�z:;.,.rr,.�+:„.���=,a,: +zxS, 3�1v°s�.'*u�” N'*.����,.. s._w_,..ts: ,_ �,r..� ,. .:.�.,..... Business name: -S-12/1 E 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: $201.60 Authorized signature: ,ice I This permit application expires if a permit is not obtained • within 180 days after it has been accepted as complete. Print name: Date: 1 0— 5 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) .., Mechanical Permit.AP lteation. .Itifili) gat,:g6:-.:Mtga:i'fi.g.A37000.1,01:1:k:7',NAgIgkkm.Vit,Z04.392iNva0A , r..... 7' .."'4.' • '13'1,5 8,ktiail'Bhid'...tipaid•PI. IV .... • *. .....'...2.....,"Phobe 503'11.82439. Fax5.t 2 .:.19.69 'Other Perrmt.. .. . ... , fuspedion Lint:, 03639.4175 11 ZZ'\5 DaW.13.-iciyipkr. 1urits' I Fil.Sic kaie.74O.i- wwaratgand-or,gov ia...C, x '1,.•Oilit,Aet1i,z2c. ....... . . ,S.uinifita'..miell,t.iii"Ornditiiti: . . . ,tst. ,,,,......:„....... _.,....,,,..,... •.... . . . ..„....„... .,................. ..... .. . .. ............._................. ..... ... , .. . '',47.4".t4ri,i!Ig'VNVirn•FlrfaIRIZSlifiy,'.'4...:7,',W,,J....f. V.,,M,..0.544.47.4%,4 .,..-..,' lc,.;4"'"'l—" ' ' 1s.ftelianlenlperiiitt'feei*:tit'ellaie03.11:11ievaido.Oftilt*Pit- '''' 121 14:-,:ii'dOliteii dioil- .0 AridorN Liat:trii,.... q$:l var6..‘i 1 ./)eri*Cfriylert.thciicat'e the value..(rounded to the 1..1=mi...dollar)of till ,I. -. 1 ' • 0:*l7l).0.1.i.t,.°9.. 0.001criltit131 ........_ .. . . . ., nirslianiCatnateKats,ton-mit labor,overhead.acid profil, Valbc,..$ ralgtalVit.elaidMVOKTS4. --#24:04- fitrVill'IM P5'.'"rOiglat-61W-Alritiih-41 -1-$15- Al.46 ..i21 14,3024404y Ogqilirtg EI.Corrrtereia1iin4dstfial 0 Accessory btill din g F.ex!:+periirdinfiktibtf,leir ittt*.ilst.. ,. • . Ej.M14tti7faini ly tj Master builder 0 Other' De.cdijiticiiii at. I 54- Total ".'4 -•',-Wf4.14,1`.- t.•'1;'g''r'i,;V'o-lr'grtgb-i4itiOW.4Wdt.kiliOptf;4f,ig'ag•tts3~t^Ptlq-i ... :.— . . \ri-rb A 5,3 \-\--0\\ 4 cr 4 6.1 Tiirtuteel Of/SW 13tti..(dOeistiites) 1 ' -46. S Fut-mine 1043.0604-1311i ttiuctstyneNI Ot $*'14 : FD\n-C_CV)0 E)A • .. ) ..,.:. 7.-. ... • ..... .'- 'SUlbeibliliJa.0.:.ifi• I Plojea.U2d= R\QR1 -1- 1-c-aCe, ( ir\ .,..MP.. ut wur .'5461.':0691 23_32 'Ops,F2s,tr..etydi4-etions to.jub.site: , Ildrunie hot wakr syste.in - ' 2332 Res'IftrittIal,boiler'(radiator tyr byibiritic)• • 23.32 . . ........ _. 1-4?.ii)le,.fa4..$(f94A..xl,910txtriOr i , .t33 tic. . 46.75.. .FineArent fOr atikof above 7.332.- ---- Other _ • 2332 ',.§ub:di'rision: .1 Lot...no.: q. (../itierliiiriiitiiiisc'xiciss: . .,. ,„., ...... ....... .... ... .. .... . . .. '1'PL'ir0045)4'40 .9*::-.. Watii.he.41ei.':'::'.''.'' ' „ . • I 23.31 ... 1041,..eftWAYAM.S.A.!7:—.Cr6V-fg0tV5kaltagettiaattatt41: 5'1-tril3I'ltithii9c41'.- 1,33.59 -.. 7itte..vent fin.virtIrt- fteuDer,91 Ps .rtreiIiiiie' 1 .21.32 ig.1i4litti-(zitS) 23.32 - , WZilitittielletMOve 3339 .V.rotidTfU41arr.Jiisiirt. 2132 . . 'Llaiill8e4iiltvotir 23 .„., •-.,... •..23:.32 Fletal$.11:04,010:108.:Siging:MatiM.S.111.1W-0:tagaial -.1,- -- - own-entnT txtiust stud• ,ex)tit• '.-- - oil- av :Atom 'blitin nonNorthwest lttnge,hoeitifoliterkitelien ,.,. .. , ....„ ..„-. ,,... 1 3339. ..—.... .: . „ . ......„....,..,......., --. .,*iPS ,IP Or t ., .eltitiiitS:tityer.zebilust 1 3339 . ..... ........ . .... .. aiit.egti),Nitu-031/1;07,,S VA 90163 • Sii4eLdiuti itediecust(bitIti5ortik, ', • ., loildompartinents..uttiity.rocirrisl . . 4 2332., 'Fli,aiici:00)8'1648W Fax:' ) acefens 2332. •-•`-0,,,,,tr-cazz 23 (-Jibt Kire.50.131Wi .:WAVAIKIN$.Teat:Jrtg.0.14•AgetElTkz.§Pri ' ,., .,„..... . ' ... ' .......... - .ipiplw, .itiiiiii‘::.P:Oiiigti.ii.l!Iloe0i*E4i .EliS1,. ,114.15.Tor fast four:S4,03 for,eacli additional CotitiOetiiiiii . _Funitia.it . .._..._.._. .............._.. .. .Mrire ;....1:69 E1.it.b t . .. • .Cres.3:niatritittif.. . ... ... • 'WelliiusUendeeuniflittatei• -00k§1*r44'..lYP*01*er,M.it'.9661 . . 1 Plidite:(3-60)8164800 Fax :( ) F'tteplitee' . . . . I ri.-ildatl: , .1j:atixe'ne. *.OLONOMON13.410.0446~..44311SCEalialfatU adr6'(gai) • .., . . Oilier:: Business rame::Anikrseu'iiii tint,Inc NEkV,Stgaitte..46.—Milliligt":- ;-TailkiA Adaiess;...14.1.1i5-W0k-Ave.g!c.00 .Szbtiiiill . n..1... .,I 147 11'•.1,,,.,i. .. •. . ,•.:,......•••'......•' NiunizmImperniit r,,, 090 Ai' qtt>,Y.Sitte:rg.4lr:Ttg4rti,pn 9722.4 Plait N;,.(2 .90 ot*tnit ree)' Mahe',T503.)W1i6-664 1 Fax 'cf)3)S36-661 , . „ :,Sisic aitchpri46.0..2%of perirtiffee) . . .., .., . TOTAL PEIthilT.FEE. b03-.4e..:-ligia. . .... . .,. rbiss*.iii.:sopp!iiiiaryii. l.ri i,en,u,is riot outlined withas 180 dsys shot:ii.lo .Liam.'aoSaii tad Iss ciini;i1ciz: Authorized sip:wive: •: c.a methodology sat by Tri:Cosauy,Buil4ing indoAry Scrrvice Board Dat '1620/205 _ ivi.1.1.6 \pir.i4sukEty,,-.iat.'4,9,54oi 1.34o 4454617r(I titatomnvEn) . • • .ii?,1': 1 {}f.'•.'.' R"'1+ ..Lt. yi':;.•;' \1., yf . � '.l;.' ?.1:.,., tir: i!1,:�1.� ':i:• - :..i.! IA "t�}�'.... - Electr�cal Permit App!tcatlon �� �� x aY ,,.. .� r f,foKoiruF ,tsi 0t L� _:. . t r t: v '4.ccii cd Perini'No . 5 x„, Cit ' of Tigard 7i,57A 1 S=QtDig9 : ':.t:' X15 I�:Ita.nv: _ a 13125 SSV!lull Blvd..Tigard,OR 97223 Pl;w acv:a„• 0 -. Phone: 503.718.2439 Pax: 503.598.1900 C I>ntant r)thcr I'cnnrt: F 0?:; 3�:': Inspection Line: 503.639.4175 `' Date tic,J)/)ly: lino Dice Pars 2 fur>t+':IG1ij Kid' Not Supplemental demeniul lofurmaliun •..)......,t Internet: n'u'w.ttgard-or.gov dd��..,.vit �,4� )t .,,..ter 4i:o.ur lieu:.-;t:r_-;t '>i a���:i:�"..,=..,•: a�1�. .,_r,,,.7.�,.:,tp,, QQ�� tt� d�xft \m II Please aux!,all apply(subunit 2 sets orphans\.nuns'ch.ckeul hale c). ,®New construction ❑Addle i0tl/aliera( I ,1tC�Cn1 0 Service nr feeder 400 amps or more ❑101101p 0,01 Ihree steric: ❑Demolition ❑Other: „•here the avail Ile fault current ❑Marinas and hunt,:rrdo �}'^'Y;' _- J 1': . eNeCia Is I0 000 amps at 150,nits or ❑I:honing bll,hngs .:__' `ce::. -'","•,. . '..'_'CORYi•.;FcCONST••UCTI i. �'^i"'ail ` .,Q..r.. . ,... ..,r.....-. .... _,. -. r,'e,: e..--r..:•�'£!•i%'.i:.•::i7"+n)•..,,::;r'_.,,.;,...,;-, ... ,. .... Icas to ground.or exceeds 14.000 .'......;;i�: '�':}�.....- ❑C'OinlnvI l'::11-otic:op iemhurd ® I-and 2-1amily dwelling D Commercial/industrial L❑Accessory building amps for all other installations hni)dinps D Multi-family ❑Master builder ❑Other: ❑Fire pump 0 Installation of 75 t:VAor :';S%1>i:- ;'r\•';`f:3( .::!_:7,r"•Y:'•X+;•:...,;°'+•..-„-•:_:;+',:-5,:',': •::�'.'„ ❑1:nlerpolev..v%la.•nl. larger separalaly derr,ed:'sten :.Jt�B,s$tr OR tl'Or AND Lo^Ai ION:”., Addie:un ofnci,"moor 1 . i uI' rte- .. �....,a'.':.i:•.,;:'", ,'I,:::.n-�._.,�;,,-, ii'..'!":. .:rr. ...,,i my '�2-�t 1` IUO or m muura I' Job no.: lob site address: L�l \-A-0\\\ ` 1(J"� 0 xecreauonnl, nrele p;nk; 1 //�� �r1•-�, Y ,�-`-" ❑Si.,or more r,:>adcnlial wolf C ity/Stale/LIP: ` O08------(5-(2\ `il�\40 ❑Plealih-ca,c`facilities ❑Supply,oltagc for more thio / ❑I lary Jnus locations batt will,:nuuuul Suite/bldt'./api,no.: Project name: `,t.p r "-c'c c nO` ❑Service or feeder 600 amps or more. V t v :wit..:';:,,::.•:, - '< A CAO.t.0 E;F: :' Cross su'ect/dircctions to job si:e: W(5-1j 0c...ripron I c)tv. I F'r, I Tom, I New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: ` q 1.000 sy 0.or less 165.54 4 Iia,add'I 500 sq.II.or portion 33 92 I Tax map/parcel nu.: . Limited energy.residential 75.00 ) -"fir.. ri; ,1. .�.. eY8 r: _ '•:k:'>,;'-'C�=• with above sy.ft S� ..4 '4:G•�4r '1''r::re. .al aU,I:SSR'IPt.:.,,�',:OIC,:-:1'.F..Q�R,'KS. ..,..... _. .. ...,..,.. ( ) ' — :�� "l,rT.Vf_.._ ..,.)r,t�4•`''., inld:;l'.::_..:: ::,........•.!_.... . ...�..•. r:�," . . Limited , • . multi-family _ } .iml e energy. 7>ua i , New electrical service and wiring • residential(with above sq fl.) 1 Services or feeders installation,alteration•and/or relocation 200 amps or less 100.7(1 ' "` 'l ' . j : .,, 301 umps to 400 am's 133.36 ' >r.�'iz'br,.x� ,;o. ti ;a'>:� fD'>`ri�s�a�ir i?//� P�1�, 401 amps to 600 amps '00.34 _ Name: 1 Gut'amps to 11)u0 snips :0I 1)4 '- Address: 1 b q Vb\-4 ` 5-V _ Over 1.000 amps or volts 552_'6 City/State/ZIP: V Yvt\Y.l [nL (anoDu1 I q /fir b Temporary services or feeders installation,alteration,and/ur l` relocation In a5 � I 1 ) ,`'. r� r� 700amps orless 59 36 1 D) Phone: v ax: v l �� (Ji 201 amps to 400 amps 135 Os Owner installation: This installation is being made on property that I own which is not 401 amps to 599 romps 168 54 2 intended for sale,lease.rent.or exchange.according to ORS 447,449.670.and 701. Branch circuits-new,alteration,or extension, cr panel Owner signature: Date: A.Fee for branch circuits with ;-•wrr?"; :.;i;�{i'y 't< !r)i;;{sv. s :i' i!:"t; ahoi•c sen•ice or feeder lee. < Ne:Cp:, ,d':�•Ii4 i1`i�1 s, ,!..:;,r i.. ,.'' •A' 69-:CdtSj-•t•t P4.•ASO 7 a, );::1,w x� ;..r\.. _.,, •,a�,,, „ ........ .: ... N"<,:; ;,.• _ each branch circuit Business name: Po VY-"N: ,- II.Fee for brunch circuits trillion, �~ 1.Y_ service or feeder lee.first 5/r 1 Contact name: { e 0 r • Qr branch circuit - ll Each add')branch circuit 7 42 Address: \n I 1' 7-\_ ` I A — Miscellaneous(service or feeder not included) Cit '/State//IP: QJ A COU '• i y�„� i.:ach rng.service a or modular 67 44 I 2 CJY!V(• dtvclling.service an11/nr)ceder Reconnect only 67 54 I Phone:( ) Fax::( ) 1 { 2 = - . ., . .. Pump rirrigation circle67 84 I -mail:�9ke„Cbr �� � ( Sign r outline lihtin5 6784 c;? r,: r " r; Ai. CQhz. CT.0_ 4 .. . ... :.,:. .. SiLn aiirc its)or limited-energy Business name:Simply Electric panel.alteration.or extension Page 2 i . _ Each additional inspection over allowable in any of the above Address: PO Box 822408 Additional inspection(I hr min) 6625/hr , Investigation(I hr min) 60,25/hr City/Slate/QIP:Vancouver,WA. 98682 industrial plan)(1 hr min) 75 1211 hr Phone:(503)849-8202 Pax:(360)314-4945 Inspections fhr which no lee is mow hr specifically listed(V.hr min) CCB I.i[.: 204615 Iaectncai Lie.: . 067 Supn•. Lk.: 4'3945 ;, :..,.•,..,,:,;.:ECEC'TRXGx1S;;,E_Rn11T"FEES'r' 6Subtntal- Suprv. IIeclrician signature_ required: r6- S • flan review(25%or permit lie). Print name: Victor/.arzhilsky Dale: 1 1 17/2015 State surcharge(12/of permit lee). —^ 'IOTA).('(:RMI')'OI":L. Authorized signature: This permit application expires if a permit is null uhhaincd within 1311 days after it hug been accepted IS complete. Print nal ne: Date: • Number ul'inapecliuns allowed per permit I a::amnga'erw Saul C-I'crn,i,,\irp,lac 07,01;10 4n11..11,l S'i'I I 1,1 s c'OMAVIit) • Iluubin_ Permit Ns lication Building Fixtures I C ,, , � t,-.: i . ; i �ao�r�ccISE n\L1rt \ _ 1• , s • : :> ::1.. ; �,, / Date/Br Permit No.: ���Is 1 Q :•:i}#:i!!'•`t .• City of Tigard Q 1»emY ',1.!•:,;'t:1-' Other Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 5• P Review • tl.+ Phone: 503.7182439 Fax.: 503-598. �eyb�l m StxPoge2for ,. %;T'. Inspection Line: 503.639.4175 ,®`lY �`►✓' ge'"dy/BY Supplemental Information T:11!'' „L?; www.tigard-or.gov ,tai 1`NotifreNMethod Internet ` •- t*F�'� ? - u?`nLse:P ;,„.:s .. .::.���:�_.. ,,..;,_?z :x "�����•�� rs'`,�•”-S��.'••-y8.�""��� J:,�.�..ti- •L .^w.” S . ' -LLQ'^� Y �^ am,'%e LL—r - € ' T :�-� -' �:y ''t%"`''• For s.eciulin ormuffonuse diecklist t7`,ii' •coon D�ption Qty. En. Total Ncw construction ❑Addition/alteration/replacement ❑ OtherNew 1-2-Family dwellings(includes 100 ft for each utility connection)-41$5`..424:7„-....,.' . t �-'''• n.x i ''`4* SFR(1)bath 31270 :�; rg , .l ,;; .�,4 ate lanrSFR(2)brut 437,78 T .-and 2-family dwelling Commercial/industrial SFR(3)bath 1 5003 �3 2 5tDAAcce.sso building ❑Multi-fancily Each additional bath/kitchen 25.02 Other Firs sprinkler(_._sq.ft) . Page 2 0 Master builder .T _ _ •� :�- 0.48 1'^ :,',6.es: _i`i �n tr(:-a .' r t'` ; .-.1-...,-..%;vim •r Site utilities: tfi �-• 1 � ,.„s.- �...-. t 8.76 3YSt;.s � � �, ,) ` \ �r-. Catch basin or arca drain Job site address: , ZZ� �/"' ` �y � {Y�v' ` Drywell,leach line,or trench drain 18.76 Y hens `U tS (Al-A�/ Footing drain(no.linear ft.:__� Page 2 Cit/StatrlZll': ✓t 1 i♦ 1 50,03 Suite/bldg./apt no.: .Project name:RN-el T rcaC-e-C\O^(4 1 Manufactured home utilities • �J60 Manholes 18.76 Crass street/directions to job site: Rain drain connector 18.76 • Sanitary sewer(no.linear it:_-__) Page 2 Storm sewer(no,linear It:___) Page 2 Wates cervica(no.linear ft:_) Page 2 vLot no.: 1Fixture or item: ' 3127 `,Z 5 xmi api anrcel no.: a Backflow pnevcnter • Taa x urrapJpar _ ��. Backwater valve 1251 )2.5 4• -+'=" ' t., >=`-'' 25.02 r r- "•)ir4i ' 'y`d ti �r -r`:-.-6-';.,..', .,-,..12,__••=1,.. cloth=waslttx 0�5 YDish washra 25.02 ,9 ,0) 'Oki Drinking fountain 25.02 NEjectors/sump 25.02 ^� ion tank 12.51 rf S X 2« f}M 7 j•r•-• .--..E�., tee' c-� ''Ir .( .-- ^..e.4,LS 25.02 k Fixture/sewer cap Favre: �� Floor drain/floor sink/hub 25-02 �l`4 f,.� ejt 25-02 2_ „C/Z, Address: 1. z !'1-"t ' 5-AJ Grubage disposal I �� Hose bib I 25'02 City/State/G1P: an(1f)1,Q I 1251 12 1 /1 Fax( ) Ice maker �•t tor/ 25.02 Phone: f I � ,� ,��_ «o�• - Interceptor/grease tdease�P �--� sa-*��,,;."-�.�-•�..-r���;y �`'lea�.�y, r �:. ==�'� � Page 2 -'rte°°. .2'4Y1-=.. fr d,.`�dg _ .:,2.-.n,-.. Medical gas(value:$ ) x=sx - `� �� � Business name: �1)(_ I �WL�i 1/l1��- Puma 12.51 Contact name ya,V(L)n (antJd Roof drain(commercial) 12.51 Address:c.f.), 0 r ;ii," ` Sink/basin/lavatory . 25.02 ^ City/Stale/ZIP: 0"pits � ( ei-LV 19 Solar units(potable wafer) 6254 Phon : 5j)3539b3 Fax!-( ) Tub/shower/shower pan a 12.51 --2,5.o2 _, Urinal 25.02 E-mail: " . i r� .t.l - e0144.. 0 �r ~Mata closet 25.02 "v' „ ,�;„F' .44,4d-14mis ±7,Y; '�,1,6,.;-'41,:z4 ,MA„,,,,,--fit', W Water heater • i 37.52 "��. ' .eters_ Je �� 56.29 t mess. 13� t.(,l�Lbil2,S — 25.02 Business nmrte: Waite.piping/DWV Address: T, r� K other, Subtotal City/Stute/Z1P: tip 1 OF,.._ g1IE G p� Minimum permit fa: 47250 Phone. ?j) 1 3 /V� Fax ( ) Plan review (25%of permit fee) CCB Lie.: LBC ! (,�^' Plumbing Lic.t 12_ State surcharge(12%of permit fee) "f` TOTAL PERMIT FLt Authorized signature: �_ c,/., � after it bas been accepted as a'I'bis permit application expires if a permit k not obtained within 180 days JDate:// / /./ amplest.Print/rune: r-- r'�- (, `^ - r •Fee methodology.set by Tri•Coumy Building Indu+lty Service t3oarl. 446A616T(I ONUCOMM'm) I:U3.,n�,iulPrnnns\PL.�'N-PermitApp.Aoe 10/01/09 ' City of Tigard `'?E EVE 1.11 COMMUNITY DEVELOPMENT DEPARTMENT _: NOV 2 2015 1 BuildingPermit ReviewResidential — CITY OF TIGARD TIGARD1 aOUILDIIQ DIVI31e3h Building Permit #: /4fc imp/,5 —Do/1' Site Address: 11224 SW f'011 Ri'olvj,e Cil Project Name: Rire. TevelLA. (VOr4W,west Lot #: IG (New dwelling= subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: M ddeA HQrvlu. , iv Q.A,v G0vlf-vvawes 7 Verify site address/suite# exists and active in permit system. AdIreiste t l-Q k'-e-- fa!fA. River Terrace Neighborhood: / Yes ❑ No Site Plan Elements: tThree (3) copies of site plan 1 -isting structures on site itc plan must be on 8-1/2"x 11"or 11 x 17"paper --Bt'ootprint of new structure(including decks)with finished brawn to scale(standard architect or engineer scale) floor elevations ,zrNorth arrow /rUtility locations (required for new,may apply for additions) Site address,project or subdivision name and lot number errrocation of wells/septic systems ,�Applicant information (name and phone number) ZErosion control (including drainage-way protection, silt fence .L/Jl�ot dimensions and building setback dimensions design,location of catch basin,etc.) Xot area,building coverage area,pert rage of coverage and Street names impervious area (applicable if R-7,} 1 ,R-25&R-40) -'Street tree size,type and location %Property corner elevations (2 foot contour lines if more than13xisting trees to be retained with drip line,and tree 4 foot differential) protection measures �' Clean Water Services —Service Provider Letter (lot platted prior to 9/10/1995): �i DR 2,0i 0005 Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes E No Public Facilities Improvement (PFI) Permit: 1,\ 1Oiou,i S PFS Zoic -00( 1 2 Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes CINo,stop intake p X Land Use Case #: D122-o1 s -00005 / Zoning: R—I 2 Z Setbacks: Front I Rear 2q Side g Street Side 1N/A Garage SO Landscape Requirement: Lot Coverage Maximum: X Building Height: Maximum Heightti/A Actual Height 2-)140 7- 7 Visual Clearance Easements -tisnsitive Lands: ❑ Yes ❑ No Type 69 Urban Forestry Plan 0 Conditions "Met"prior to issuance of building permit Notes: Co 11 cii t'1`a 0 S h eiv-c no•-f beer rvliZ,}- Approved By Planning: 41.fl i' Ce. G,1 o 062_4r, Date: 11/ ' J I s' Revisions (after Building Submittal only) Reviewer Date • Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\B1dgPermitRvw_RES_070915.docx Building Permit Submittal Original Submittal Date: /12 �' Site Plans: # �/ Building Plans: # Building Permit#: IE']?nter building permit#above. Workflow Routing: ©-Planning U-J ginecring LI I ermit Coordinator -Ei'3uilding Workflow Sign-off: [L-Sign-off for Planning(include notes from planning review) Route Application Documents: c4---Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. rel wilding: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: 4 a§ , Date: //1/4//� Engineering Review ❑ Slope at building pad: ❑ Conditions "Met"prior to issuance of building permit4 /may/ ❑ Easements (encroachments) per engineering conditions of approval and plat C1 ❑ Water Quality/Quantity Facility: / Assess Water Quality Fee in-lieu: ❑ Yes ❑ No 4 - - / I Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No i LIDA Facility on lot: ❑ Yes ❑ No �_ ❑ NOT Approved by Engineering: Date: Notes: 5,.�.�� - . r;eP%a, 5 ..),,e ,/n0‘,..; rsa7 1,/.00.5r. , .i. • .is, A Approved by Engineering: AIL, .J) Date: _14_ 9- 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: A4 i 1 w;Gt�---- Aga Date: -iiw/S Notes: Ad /f47 -II° GrJi Gelfr , Hye /( 4? /j.s--- Revisions 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: N4 SDC Fees Entered: Wash Co Trans Dev Tax: �r Yes ❑ N/A Tigard Trans SDC: ❑ Yes 0 N/A Parks SDC: Yes ❑ N/A OK to Issue Permit -- //++ Approved by Permit Coordinator: "��� i�P►40. 1. . Date: 7Z�C /1 110 //l/91S— I: S— I:\Building\Forms\BldgPennitRvw_RES_0709I5.docx FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. MCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 0 Transmittal Letter 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-ongov- TO: ATE RECEIVED: DEPT: BUILDING DIVISION NJ nrrrjVEp � j� 1 FROM: L-2DEC 2 S 2015 COMPANY: Z CCTV 01 HGAKU PHONE: BUILDINGDIvISi. By: RE: rteress Number)ermit t.:e.,taa-cA C r ect name or subdivision name and lot4ium e i ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s)and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: ,�, oL> ° , L 01 FOR QFFIn E USE ONLY Routed to Permit Technician: Date: J D_ 3.o is Initials: Fees Due: D Yes No Fee Description: Amount Due: c \.,f $ 90 — $ $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes I ZLNO I ❑ Done —Applicant Notified: Date: I -- Initials: 1-9 ; I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 01/26/2016 11:32 2532882156 GARNER ELECTRIC PAGE 01/08 City of Tigatd • COMMUNITY DEVELOPMENT DEP..ARTMENT ,r .. Request for Permit Action RECEIVED m c.i r i, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 -wwv_aigu4ttey 9G16 - TO: CITY OF TIGARD CITY OF TIGARD BuildingBUILDING DIVISION Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermirs@dgard-or.gov FROM: ❑ Owner ❑ Applicant q Contractor ❑ City Staff Check(+')one REFUND OR Name: ._ � r INVOICE TO: (Business or indivldnu� GAM O �C Ski aay\5-1c� ' 'I e. Mailing Address: _ ---^ City/State/zip: ,,- Phone No.: V,J.3jry U ` r. PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (I): ❑ 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#: ID _�V2- Site.Address or Parcel#: 1 7, ,j �bN 94 Project Name: 1'7 �� Subdivision Name: c21 M-70(te Lot#: 'CI EXPLANATION: D fast 0 i ‘__IN.: I it 3__ fl) 4k1*( ,ech • 1.I • i Signature: ^►� I. ` 1 10 Date: \\:6\c)\\() Print Name: CM M ' 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or cnl.lected, • Nor mote than 801/4 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 ispuecl 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 Sys Admin: Date B Route to Records: Dat- `7/._ B i wj r Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By T:\T3u i l di ng\Forms\R cci Perm i lActinn_09231.•1,r,I c x: 01/27/2016 12:15 2532882156 GARNER ELECTRIC PAGE 02/04 LEIlectricai reA' 1ktA 14% � nxc1rFr._r i ' r llxir City ga..,r MM PhD=SW Hull TP !d. 8, 1 1 Men Raeder,.... Paitail a: M��� `ti(l s ���W p Raided Pertait A, „i WTI:etldnLine: 503.MA 175 Ronny 130.35r: rum RIStePolo2fot 1 MancetYww.riQAt[i•9t- F.' Nettle leoembo 7 mpiem Otto mron etNr .,_,�- ...�,.'L._._�. ',._....t.,✓✓"...ii-.keit dt+ �.h,a{, ly i t4n/�, ,t;:%, �°� :1 Ii:...J 14 ,, ,3�• .,,-eeE%a ��i_L,.'. i.91• 7,2T-7,k;v-S ,:, ., Ala�ry a0n3ItltOfldtl I a ► J - .R. lI'!ecce«1aeRdlin.r.ppty{rrbat�reuxplanewhtenwelwewa): Q 1 ^Other: a e vlee Of kaer40o=poor wee tl edldios M1hme elori s. where pre tooted*awn room 0M7,ieat and hono r& -ti. ._ iii-,1 '_� ,1<,_ , ,7i (,I j �„..t' :,:, "iE r* .::7 OXITC 7oornmor it ISO mho or ❑Floofingbnik6�L Q1-ipd2-�mtt d ling ❑Canmerc+abmdtrial [ ancory building las to pound,eremb14,000 DCmaarotalmeam auare =PI tor atlolharinetallalioac 6ulldiup. 0 Multi ily 0 Abater builder 0 Other 1D Fre pimp, ID tesnWdiaaer l s0 KVA or a -t:::'-'..,;:f:r;:§7:-',;;;',:5:':,,T,-;'-;',51'''�i1%;'4111 Li'l41,','.0.,T.;? L''' 4. � ' r, ✓ r,; LSF- 3-Y r'. larger eeponralyderived 4,i .• _ ' yea". D.ArrdiKao anew motor land or omen. rob P.: ilob site address:L rc-- SW FIollykgel 1oMfreormore 1:1-Ar,mw,^t.2*,'h.;°', CliltlStoie/ZLP:Sherwood OR P7140 t1" ---_--____ D:tizorexec=Methyl oink economy. [l HmYh raue Aadlkka. 0 AemmMbanl et isle polo 3uitE/bldg,/npt0: JProjectmane: Clarnonousdowtiaro. 0Supply*drape Romore thin Armeenrgrade•600ant• mrams MOIOW IMAM' Cross street/directionto job site: 'Ar...-1.-?:;.e,....,--;:‘,,:i..71:7•-:,--,v," 7 , t y, s: Nen.reel('cepaI*mie-nr OVUM-eerily d�unit, Subdly don:hirer Termite Lot 0:19 Ibch der attached prime, _. Tax map/parcel 8: 1.000 eq.n.a km 1685A 4 r.....i.,72,:37..°:yr t ).7'4.7. �i 1.'j1:%...CZ,r _)%€!„1:1�,0iy:n-ar - 1`-'11. , C4 00 y,,R,or pollen 33:17 1 Limited eennergy.tt aiderMi,l 75.00 2 New Singh FamliJ I jl/ - e__e1 fz_ (wihehoven0.). United mangy,multi-Molly 75.00 2 I residential(with ebovoey.R) rrr ,: '.,a..,,,sw �I ' w a Betnevrahle tly D See Pa_ 2 _,_r -,,E..,..q.',..0.-_,.,,r^'4�a,.,"!,:.1.,,. <:4'. LL les . l i'r ,,i ur;g(? s;," +�-� 1 '}'G4uu.C.61_��dL„t. .�: r`�18.z.,-- �� 8mina+artTeederaInaalMthminlrer'ativw Antt/dr relocation Name:Polygon Holm 200 amps ericay 100.70 2 Addrem:109 Z 13'"St 2013mpa to 400 Airco L 133,56 2 401 mnp3 to600 amps _ CitylStata/Z.IP:Vii Keavor WA 98660 601 amps to 1, :t�04 2 Phone:(350)695-77011 Fox:( ) _Over 1.000 amps nrvolt, - 532,26 _ 2 Email: '""'-•"-- 'Temporary peruke!or feeders lnstellntlon,akeretton,,ndfor rslo0aibn _ OWiler inat'allation:',llis inst:rlintion is being reads on propdtY Haat I own which is not700 er lc - 93 14 1 Intended fbr sale,lea c,rent,or exchange,neoording to URS 417,449,670,and 701. ; 2I!amps 4r 400 carps 123.Olt 2 Own signature Date: '101 atgpe eoS99nmra I68r54 2 +t c• _ • .v 11 fir- 1• , .• Try .,,;,.y• ! Erilteneinilb-nen allerAd Or triennium pod �<a n _�f Aa� ,lf M_u.wJ9er.. Wr�i.lr td , �e' ii-r * triennium,-'aA"• A,kree for 6tMah dmt�amt Butantr7 name:Garai r Eleetric Wl,hoboeltytton,LLC c service or feeder tea arch blanch drtuit 7-42 2 t Contact ndrne:B111 I)a iiele n,pee for branch olrettlts winnow ,.._. Address:610181,TalthsRoad _.-. Mandlmrcewendcr atm 56.1R 2 City/State/ZIP:Vancouver WA 98b6I End add't brunch circuit 7.42 .. Mitielli peon(serVice Or Plaone:(253)3211-365'1 Fax::( ) Beet,matmfoetuedormoaner feeder not letdtl0er[j Entail:Isdanielsregvre' eB terviaoMxdor!leder 678d 2 _ 5 In Reconnect ooly due 2 v. 'Z..,t 'c , 41 C3 2c :•i . ' 4.i e. . t.. .:,,,tz�j:'.+J «. :3..—-:,.: -,,,,-1,..,0,-.44 Pomp or angel on eihdc 6/.34 2 Bu5tnevl mums:GArn4r Electric Washington,LLC Sig oroodioo lighting 67.84 2 -- u c Address 610L St 3ohi5 Rd on,otln pr:ner{y ©See.Page 2 2 City/Stale/ZIPVenC I,VI WA 98661 Rich atldltloral immpectien neer Allowable in soy oftie above , .. _ Addhlanel impetl'bn(1 lir mlr) 6625!br Pim=(253)320465'7i I Frtu:( ) Investigation(1 hrmro) 90.0411w , Emdill:Ddattiela(dlltwerdttca.com � kldustriat plant(.t hr rein) 78,18!hr Tespoctleas Ibr wkinit no fro is 90 00.1 hr CCB Lk.; 01258 EketliCsl Lie.: 208174 upr Lie,: 14963 s •Gently 11034 h fit 3sa1r .-i ,, l S � l..7 `S F.ASupN.Electrician siv : , req&red `_.17c1 P " keAremSbmal. ,y Print name: Joao P Aiberl bate: >,6 D Prue Renew Required 025%ofPeretit 114'--� ` Stets:oWeheflo(7256 ofpare'be); Authnrimx1 sigttaIttre.I f TOTALPERMI PEE! _ Pitt atatba: Bit1 Dani ] Dittc '1:d`permit opprrtr °"u p rvY 4p nw moonedwhhtn 130 ^�� r Number of 1nrpcciione Awed per penult. 7,Qf.14e10PeanNIILCyaneiApp_P,LP Yar,tao Rev 1140/2015 4e045157114ra►r00MIlyga q$-, ab E•d b011bE809E oyi!7 pig(unlnp dti017091. gZ uaf 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 17225 SW HOLLY RIDGE LN, SHERWOOD, OR, 97140 Residential - Master Permit 699 Mechanical final PASS MST2015-00199 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: 17225 SW HOLLY RIDGE LN, SHERWOOD, March 22, 2018 at 1 :24:39 PM OR, 97140 Record Type: Record ID: Residential - Master Permit MST2015-00199 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Gfci at entry not working. No power and not re setting. Missing breaker lock for dishwasher. 422.31 (b) Remove old generator supply wire coming from neighboring property prior to final inspection. Note: Garage outlets loose in wall, kitchen outlet by fridge loose. Outlet covers taken off by painters in various locations. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 17225 SW HOLLY RIDGE LN, SHERWOOD, OR, 97140 Record Type: Record ID: Residential - Master Permit MST2015-00199 Inspection Type: Inspector: 399 Plumbing final Jeff Grove Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 17225 SW HOLLY RIDGE LN, SHERWOOD, OR, 97140 Record Type: Record ID: Residential - Master Permit MST2015-00199 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 17225 SW HOLLY RIDGE LN, SHERWOOD, April 5, 2018 at 6:20:48 AM OR, 97140 Record Type: Record ID: Residential - Master Permit MST2015-00199 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Contractor on site to install vent wells at left side and rear as needed to keep landscape material out of foundation vents and provide slope away from structure. R401 .3. Street tree hold removed by planning per Tom and Monica. Final erosion control approved. Moisture content form received. Vapor barrier form received. High efficiency lighting form received. Insulation certification checked. Blower door test report checked. C of 0 left on site with contractor. Violation Summary: Inspector Contractor