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Permit 16 CITY OF TIGARD MASTER PERMIT ` s ' COMMUNITY DEVELOPMENT Permit#: MST2015-00225 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 -, k Date Issued: 12/09/2015 T>ra.lR" g Parcel: 2S102BC01102 MIES .Jurisdiction: Tigard Site address: 12816 SW KING PL Subdivision: GRACELAND Lot: 4 Project: Graceland, Lot 2 Project Description: New SF. 5/10/16: REPRINTED permit to include(1)laundry tray. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 1245 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 3 Second: 1120 sf Garage: 360 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2365 sf Value: $284,508.10 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 l5rywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 at 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 2365 Owner: Contractor: PACIFIC EVERGREEN HOMES LLC ALAN NATHANIEL GOFFMOORE Required Items and Reports(Conditions) 7410 SW OLESON RD#133 13950 SW BARLOW RD 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97223 BEAVERTON,OR 97008 2 Geotech needed for each lot in Graceland PHONE: PHONE: 503-664-6423 FAX: Total Fees: $22,996.27 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to 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 NI, the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. p. Issued By: i "/�Z�'l'�p-- Permittee Signature: i ‘2- °-...-1 ...� `uL C .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. '. CEIVErt Plumbing Permit Applica P',s , i\A SI-20 i - 0022S Building Fixtures MAY 0 9 2016 City of Tigard Recen.vd .7, " 13125 SW Hall Blyd.,Tigard.OR,9,712-1Datemy ,.5-- Permit No : 1 Phone: 503.718.2439 Fax: 503/01 19100F fIGARD Plan Bevies.. DateTty• Other Penni;No Inspection Line: 503.639 4175 T IGA RD N DAIC Ready/Tly Anis 0 See Page?for Internet: www.tigard-orgov BUILDING DIVISIO Notified/Method TZ•Ci Supplemental Information .0'1..iiilt`616Virb*: '.'„,.., , ,..,`,,,,it..', , '1', ' ''' ' ' ' ,itta:,SC :01 .:1''''"' 0 New construction 0 Demolition For special information use checklist. Desert tion I OW. Ea I Total 0 Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 fl fur each utility connection) • ' .'-',, .'''::-4'.r*q121rOr 01!*ft:00:tON' • • SFR(I)bath 312.70 1-and 2-family dwelling, 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 D Accessory building 0 Multi-family Each additional bath/kitchen 25.07 _ 0 Master builder 0 Other: Fire sprinkler( sq.ft.) I Page 2 • '• JOBTSITE*FORMATION AND LOCATION Site utilities: Job site address: 12,110 Si.,,,.) k-rN.4.7) Pt- Catch basin or urea drain 18.76 -- Drywell:leach line,or trench drain 13.76 (ity/State/7.1P: --r-,Te-., •g_D _ Footing drain(no linear It _) I, Page 2 _ Suite/bldg./apt.no.: Project name: 6-7 a.-4(_E-L-4/..i.D Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 64)4z_NUT Rain drain connector 18.76 I Sanitary sewer(tto linear fl.'_) Page H - - Storm sewer(no.linear ft.: ) Page 2 . Water service(no linear ft.._1 Page 2 Subdivision: (....-7 a.4 cc.L-PA-rUC) Lot no.: Z. - Fixture or item: Baekflow preventer 31.27 Tax map/parcel no.: . • _,.., .. ..„. . „ ... , .. _ , , Backwater valve 12.51 - .. '•' -. . DESCRTPTIQW0F4WORK- Clothes vv a.sher 25.02 AV L-Av of)1Z-.( 51-13 V-- Dishwasher _ 25.02 — ---i To ? RW'.-t--c• Drinking lountatn 25.02 - _______... Ejectors/sump 25 02 EizzPROPERTY.QWNt4. ' • , - ,, 0 TENANT '*, F1)a ;( "52?"tank I 12.51 Fixture/sewer cap Name:Pacific Evergreen Homes --- Floor drain/floor sink/hub 25.02 Address:7410 Sw Oleson Rd,Suite 13315 01 _. . Garbage disposal City/State/7.1P:Portland,OR.97223 I lose bib 25.02 Phone:(503)664-6423 Fax:( ) Ice maker l25 _ .. . `•.•.•:-A.,§1:AppLicor.-.' . .,,,,,,,. 0 corium- pEksoN, . iiitc.recptorigrease trap _ 25.02 - ...- , .. . . Medical gas(value:S ) Page 2 Business name:Same Primer Contact name: --- Root drain(commercial) 12 51 I Address: Sink/basin/lavatory 25,02 Fe ,,C _.. City/StateIZIP: Solar units(potable water) 62 S t rub's-bower/shower pan 11 51 ' Phone:( ) Fax::( ) Urinal 25.02 E-mail:alangoffmooreecgmail.com -- Water closet 25 02 . . -. ,. Water heater 37.52 Business name:EDWARD MULLEN PLUMBING Water piping/l)W V 56.20 Address: 1601 SE RIVER ROAD Other _ Subtotal 1-City/State/ZIP:IIILLSBORO,OR 97123 ._------------ Minimum permit fee S72.50 Phone:(503)640-0113 Fax:(503)640-4483 ,--- — Plan review (25°,‘of permit fee) CCB Lie.:92689 Plumbing Lie.no.:34-2601'B —-- - -a State surcharge(12`1'.of permit lee) 1 •0,0 ' • 1 Authorized signature: TOTAL PERMIT FEE ' •- icrout application expires if n permit is not obtained within 180 days Print name:RAN'M ILLEN Date:it...,=,--1;;:,.,--I....7, after it has been accepted Its Complete. 4E"niall0610g)5CI fr, 1'64:twiny Building Industry Ser.=Board I*ButldinglPcrmItaLMU•PcnnitApp dot 100109 445.5061,1.1o:A(MUNI) y „ CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00225 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/09/2015 Parcel: 2S102BC01102 Jurisdiction: Tigard Site address: 12816 SW KING PL Subdivision: GRACELAND Lot: 4 Project: Graceland, Lot 2 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 1245 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 3 Second: 1120 sf Garage: 360 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2365 sf Value: $284,508.10 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea 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 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2365 Owner: Contractor: PACIFIC EVERGREEN HOMES LLC ALAN NATHANIEL GOFFMOORE Required Items and Reports(Conditions) 7410 SW OLESON RD#133 13950 SW BARLOW RD 1 Geotech needed for each lot PORTLAND,OR 97223 BEAVERTON,OR 97008 in Graceland 2 Ersn Cntrl 503-639-4175 PHONE: PHONE: 503-664-6423 FAX: Total Fees: $22,608.85 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 issu nee, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio Center. Those ru-- are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a co. - -s or direct questions to OUNC by calling 5i 3 2.1987 0 .80e Issued By: • ittee Signature: ,r . X4.4.i . '3.639.4175 by 7:00 a.m.for the next available inspection Pit. 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. I--�� - r ^ 4.3§1iiii^0� P��it ��licatiun )L �� ~ `, ��:~ , ` ' • `~��- ` , ` -.�ientiai Q��@ �� ~�_ r� . - O��ccsUsm�mNc�� ^~~- • u=.c..! 2:115 I Pim Re\let CIVN 0 imstin,.._!,,,..,,id. /3-_-_6127_ ,w..G .. supplemental In to eniatior. . T1 PE OF ,A•ORK azwiNG bra , . .„.,„IRED DATA: I-AND 2-FAMILY DWELLING ; • ther: I :,.i..•:-!-:,_'; ::materials.labor.overhead,and the prolit lOr the ' '�_-__��~ ^ ''- replacement--' ------ -- ----- ---1 ,1,:!,-„ L-�-t'_ ". :.`'/.!^»this up p|icmkw . CA7pxos: OF CONSTRUCTION . _ - .^. J_0 _ 14 [�-;'and 2'mmo� .u.um,� iLu,s``'z �/ .n�```'iu/ ��w� �� = -- -- | / =^uu"��*m- 3 7 u '.r, ./ .'. �� _______ --�'------' ----�---- -� ----- --'-- - a.Fn1)�,^r^mxn^m`,: [] ymu,ho|oc, / []''o.�,; «~-�� | ----' ------'_). / ---- �!eta!number of floors: 2 ' JOB SITE xm --'—1 . '.u�o ON° king w` �ux�� 7,346 �umc�� 7),.%.( . ! - -- ! '»/mm�//pT�a"�*n��2zw _____ | / .xo�*•"�p^numo: ^z` -' ---- C,��uoo ' | Coveredp^nx�= / �u i � �L�� *o� mu:'.pcoo� � Project name. ___ � . _`, �`� , , ___� - _'-_ --_ -__-__ --___- '_-__ '� �xs,`'ou��u°^ *v*r�� M:mm _ _ .�c area: p square__- --_' ---_--_-__ --_ . ___a__ '*,'structure xnu: ,* x, leo '_ --_- _ _ -- _ _- _--_ -------- --- -_ • ._ _ _ ;:t,,o1mLoDATA:momMuu(./AL.1.SE CHECKLIST ^ - ----------� - ---' �� ' ��umnVuvu/oco[oe^wx,^nom,cu S�d"/^.^x•C,*zuou • _|��.•:,.,• �~ _ ._` - - ------�---' 1/''`:.': . u/;i�m�m��cd.cm��o:m vcxom6ukx`^r�| r^mo»nooc n°�: L� _ --� -- -----'------ v .r:',:.^- -,-..,urios.lau^r.'xerne^u and the profit u ^mc DESCRIPTION o+ MouK _____ --- ---- ---- __ �....,,.'' S • v"° u°m, - -' -------' --- --- - --' ' ----''-- i..:\.`l'ngbuilding area: square feet -_- -_ --- ----' - - ------�� --'-----'- '---�� `o'. *^.u/n:meu: square feu NN�- - '----- ------�-----'---------- - -- i - PROPERTY 0 TENANT `x``/�.^/s^v�s. n� -- - , __ -_ _ --_�__ ___ � �� oelpmir� Er,,gucvHomes __ _ _ _ ___�_____ _ __ _ _ .��"/*,v�wu`^o. _______� Add/es, 7-1)oSM.Meson Rd Suite |a» ..'�:n,o groups: '-_--__- __-' -_ _ _-- _ .. --'__� _ _ -__ ____-_' ,�,m*/n. yv��w�0&YT223 __ __� ____ ____ | 'wme �-___--_' -- -_- _ ___- --_-__�-- • `; ,,.' .*s�a�6�2o � z . .s".• , ---.---- ----r• ------- ----'—'-- - -- - �--� 0 XprucAvr [] CONTACT rpnN`N • BUILDING PERMIT FEES* -- -- -- '---- - --~ - ----------------------'-- --- _ -___-��sy-12zeter tofee Nc»°»le/ ____--__ - ;^.,�,'^.u�, m, \`Anm' _ ---_--_ -_' -___--_ __ '- »- _-^---_--_---_---''------_-_-_--'-__--'--__-_---_-_--_-----_------_----_--------__'---_-__�----_�_--_----_---_----------_-_--_--_---_-_-.--� -_--_-'�-_-.:_--:-_-:----.--- `^--' .`� |`:,.-e.:cx 1.e..::or deposit). . | ! • L''"`/n /x. n' u^"u.mni."n --- - ^uox�: �' . .�uo,,^n ;Ce Ili. n ^m: _ -_--_ _----- I - ` Vv/.sm^/o^ 'hone.. ` � c+noo: Alan°pooific""', '^'»h"m's.* ^ --- i-:.):•;. t CONTRACTOR ilwx^^. =me• Alan( vnMv^r^Construction ; _- _--- _ Auuu,r |3v50+" o^l"v Rd 97008 ' 50664^4z3_ _ ' �.' /*r ^x -�_ '- _z ` - - , ^- momonc ^cU: | - . _--puw1o`mcTAucSOLAR PANEL SYSTEM raaS^- II i,`ci^xand n»uc uu|p�so.phmino�|*iw`o/ . ..�,,a..`uupxmxV^|o"cs^lmPanel py^mm. • �v�.,.�^-, 2�^u^vr�^/�uo"imcowwcumouv*i.s �u : ./-er�v�emu�wsumn�nvh�ezom'/^�`. `^A,'-�`vm^a,,^x,c^x�Code�ca`xm. �� -_ _Ill . t!admirrsfees _,''��,� � "�ryun^mmue� � u�m�euponxvp�umo -- �� ~�I ^,' alai z »y ~- This ;it x,nomnexpires n^nw,nxum not mp, ~^ ,.s. .`^days"n`,/.has m`n^n"nuo"°«°n�* ---_- --' - °~- -~-- ~ ^'� ^ • ''`'.O^do,x» set o/Tri-County Building/odu° y '`'`,�^`� x,,'�rnu^,�_ � ,_____ ___ ' At- ^ , • Electrical Permit Application . , City Tigard v, neVjeW1,, Pernm if: Date/B.- flel cal-ea • of Hall Blvd..Tigard.OR 97: 1... ,.1 - PlaR 1 13125 SW C, Phone: 503.718.2439 Fax: 503.598.19k Date/By: Related Permit H. Inspection Line: 503.639.4175Ready Date/By: tori®. r FII Sec Page 2 for 'If lCiAR-9,, Internet: www.tigard-orgov \I 1. C3 4 - .._NO1iliediMetilO1 ___L Supplemental Information -• TYPE OF WORIC,-,:,, - *-.‘i'toes,:- %, -• • . PLAN:,-. ••- ,-„,-;-i.,;,•c,,.. .;• - - - FE] \1:•‘s construction 0 Add it iontallcrattrffiElaihei*ANbPJ14111 Please check all that apply(submit 2 sets of plans writems checked): 0 Semi:::or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: ,s,.. .i, ,ditalli)t, ' -- where the available fault current 0 Mannas and boatyards. CATEGORY OF CONION,;,4-:- .•,,,Tr-,,,,, ,,,--. . '„ exceeds 10,000 amps at 150 volts or 0 Floating buildings. Eg I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps tot all other installations. buildings. 0 Multi-family El Master builder 0 Other: 01-ire pump 0 Installation of 150 KVA or ,;.•;-.110H3Off).-)11NFOf4MTION AND,LOCATION . -,--.. _ -,,,, 0 Emergency system. larger separately derived — ' Addition of new motor load of system. Job#: Job site address: / 0 Z.Mg 4,„ A ,0011P or more. 0 Six or more residential units. occupancy. City/State/ZIP: 0 Health-cam facilities. 0 Reel eational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than -- 0 Service or feeder 600 amps or more. 600 volts minium. Cross street/directions to job site: - . / A' , Description .1 Qty. Each I Total 1 VIA New residential single-or multi-family dwelling unit. AL Subdivision: 1,a oqi,e,„AANI9 1 lot ft: Z. Includes attached garage. , 1.000 sq.ft.or leis i 1 168.54' 4 Tax map/parcel 4: __ _ Fa adef1500 sq.R.or portion s3 33.92 1 • . , 'DESCRIPTION OU WORK . _I_ Limited energy,residential _ — I 7 (with above sq.ti1 5.00 2 Limited clergy,multi-family . residential(v,itli above sq.ft.) 75 00 --.- ---1 Renewable Energy 0 See Page 2 'PROPERTY OWNER .._ ft.N A Nil Servicex ur feeders installation,alteration,and/or relocation - Name: Pacific Evergreen Homes I 200 amps or less- 100.70 2 - - - - • - --1 201 amps to 400 amps 133.56 2 Address:7410 SW Oleson Rd,Suite 133 --,- 401 imps to 600 amps 200.34 2 City/State/ZIP:Portland,OR.97223 601 amps to 1.000 amps 301 04 2 Phone:(503)664-6423 I Fax:( ) Over 1.000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 _ intended for sale,lease.rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168,54 2 Branch circuits-new.alteration,or extension,per panel - ------------------- -------- ---------------------.PA _L • `1-1 1* PERSON A Fee for branch circuits with Business name:Same above service or feeder fee, - L___each branch circuit 7.42 2 - ' Contact name:Alan GoffMoore B Fee for branch circuits without service or feeder fee,first 56.18 2 Address: hriineh circuit ('ity/State/ZIP: Each add'l branch circuit 7.42 2 - - -Miscellaneous(service or feeder not included) Phone:( ) I Fax.:t 1 Each manufactured or modular I dwelling,service and/or feeder 67.84 Email.alangoffmooreintall.com Reconnect only 67.84 2 CONTRACTOR _ _ 1 ' Pi.rii.-.‘t a r,:Latmu circle 67.84 2 Business name:Sunlight Electric Inc Sign or outline lighting 67.84 1 - Signal circuiasi or limited-energy • Address:2804 NE 65th Ave,Sute D _panel.aiteration,or extension. 0 See Page 2 2 . Each additional inspection over allowable in any of the above_ City/State/ZIP:Vancouver WA 98661 • Additional inspection(1 hr min) 66.25/hr . Phone:(971)222-5758 Fax:(360)326-9660 Investigation(1 hr min) 90.00/hr _ Industrial plant(1 hr min) 78.18/hr Email:sunlight.incl@comcast.net C?-30 Inspections for which no fee is ' CCB Lie,: 172549 Electrical tic.:4elife2r Suprv.Lie,: 793 ; specifically listed(Vi hr mini 90.00/hr l'.-':'"'..___.' : • .4.1,00$11tittatifitalVeLiWA'f.,:; Suprv.Electrician signature.required / AI! Subtotal: 1 Print name: Chester Garrett ! Date: 10/20/15 0 Plan Review Required(25%of permit fee): - State surcharge(12%of permit tee): 1 Tt _ Authorized signature: i IOTAL PERMIT FEE: 1 ---1 This permit application expires if a permit is not obtained within 180 Print name: Peter Kozarez • Date: 10i20.11'.; iduys after it has been accepted as complete. ' :',snivel of inspe.aletis allowed per permit. I:\Buitdingmernuts\EI.C_PtruutApp..E.1.14.ERE dos:Res(IL.,,"i 7;201 5 44C-466 l'i I • . Mechanical Permit Applicatio> 1 (NVAN ReceivedCit}J Of Tigard Date,By: ' Perrot No. A`'ZSTaIf)✓, �.1-s5"" • 13125 SW Hall Blvd.,'Tigard,OR 97223 1 :s "Vera;,Re>:�eW Phone: 503.718.2439 Fax: 503.598.1960 Nps 19 2U Date/By: 1 Other Permit. T f G A it D Inspection Line: 503.639.4175 p�+ !pate Ready/By: I-Juris: 110 See Page 2 for Internet: www.ttgard-or.gov ��Q.CiICI 1"TlottfiedMlethod - SupplementalI + Information TYPE OF WOW,„,_:_{..�--- r."VISION r---- COMMERCIAL FEE" SCHEDULE - USE CHECKLIST - --' ' Mechanical permit fees"are based on the value of the work ®New construction ❑Addition/alteratiortireplacernent ! performed.Indicate the value(rounded to the nearest dollar)of all ( 0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value S CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® I-arid 2-family dwelling ❑CommerciaL'industrial ❑Accessory build n,-; For special information use checklist ❑ Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total- JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 1 r ,J Furnace 1^0.000 BTU(duets/vents) ! J 46.75 City/State/ZIP: Furnace 100,000+BTU(duets/vents) f 54.91 Heat pump 1 61.06 Suite/bldg./apt.no.: Project name: ' Duct work,nrk 23.32 _ i 1 Cross street/directions to job site: --_- Ilydronic hot water system 23.32 - W14;114 ` - --_._ 1 en- 01 Residential boiler(radiator ww�h hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. _ 46.75 Flue/vent for any of above 23 32 Subdivision: �,7A4.,, LM , — —_ i I_ot no.:Z Other: 23.32 __. L: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert I 33.39 i I -- Flue vent for water heater or gas fireplace 23.32 I Log lighter(gas) 23.32 --------- (` Wood/pellet stove 33.39 - _- - !� Wood fireplace/insert 23.32 Chimney/liner/flue/vent I 23.32 Other: ® PROPERTY OWNER I 0 TENANT ( 23.32 Environmental exhaust and ventilation: Name:Pacific Evergreen Homes Range hood/other kitchen f -- - - equipment 1 33.39 Address:7410 Sw Oleson Rd Suite 133 ! Clothes dryer exhaust j 33.39 City/State/ZIP:Portland,OR.97223 Single-duct exhaust(bathrooms, _ _ —� toilet compartments,utility rooms) ' 23.32 Phone:(503)664-6423 -- 1 Fax;( ) Attic/crawispace fans 23.32 1 ® APPLICANT 0 CONTACT PERSON Other: 23.32 Business name:Same Fuel piping __--. 514.15 for first four;$4.03 for each additional Contact name:Alan Goflvloore -- Furnace,etc. Gas heat pump {+ Address: Wall/suspended/unit heater City/State/ZIP: — --- j Water heater { Phone:( ) --- fax::It. f f- ----- I � Fireplace 1 '' Range I 1 E-mail.ala ngoffmnoraring maileum j Barbecue CONTRACTOR j Clothes dryer(gas) I I• Business name:I ,-N t�ea,4iin • 4 05,0 1.'ll Other MECHANICAL PERMIT FEES" ; Address: P-® -Lz Subtotal I City/State/ZIP: (71 irt,k) 014- 1 Minimum permit fee(590.00) 1 - Plan review(25%of permit fee) • Phone: �U.3 ) to' - \,2,4-Le; -I Fax:("9:". )2C ti, -j [ State surcharge(12%ofpermit fee) _____ CCB lie.: /et 0©E? -_ __ —.--__-.____-_.a --- TOTAL PERMIT FEE /f This permit application expires if a permit is not obtained within 180 //" / days after it has been accepted as complete. Authorized signaturee�k ✓'� _ • lea methodology set by t-County Building industry Service Board i Pnnt name:Li l( -- Date:/0 i;/:z, ( 4H t: uildinglPermi:siMEC_Ps+,ne Ap 040113.doc 440-461nfir:/ry':011.f1WEB1 ^ . - Plumbing Permit Application ' Building Fixtures FOR OFFICE USE ONLY City of ` `�~^° ,==.~° | 1111 . 13125 SW'Hall Blvd.,Tigard.WV - "��,� �7�� c�)��` . Phone: 503.718.2439 Fax: . ,598 1960 1 Date:By Other Permit No Inspection Line: 503.639.4175 ' A,)'''' . • : New I-2-family dwellings(mcltuks/00 n.tor each utility connection) 1 / p« /'�mz'mm/ko"r"`"p-- --' u` `"'`m=`.m"'=`'=" ' I *�x ^bath | � nmzo-L ^ building i7o,uuuv. - _ ritch additional hama.me` 25.02 | Eli Master buiikler 1-7«:� i �` � * �z — ___ � xO�srrvpOnwX,/n" `‘o m` ` n'^ / ! I_2,_ 1111/" Aoel,_ g , 1 Catch ba•in or arca drain �-_ --- | m r« / trench--- -76 1 | c'� y�uxp | n :__- 50 03 ------- __ - . pw�� \ | s"uauu»��m�w`� � Project»*o�� ___ _ Manufactured ---- - street/directionsl Cross m��oia� | �o�x�� 1»a r- _ __ ; | f�»�� . n"mum`"",""=m, 1 ---/*-ra - � `�=*n�°w/""�x""",u. ) Page 2 ' -- ---- --- ------ -- ------ | smnv sewer(no.linear n Page Page 2 --?-/,/,`` � - Waterservice - linear' ) . I . ---' ------ \ i __�� __��1 Backwater 1,:tive12.51 DESCRIPTION or ~~ ! nmxm -------------------- � �� ^ _____-_. ` -- ------ ------- -r -- � --- e pRmrEmr� m*�sR ] /��`x/ ! -_- l '�5^ ..---------- ------------ -- FI,,"m^`. ..71,..^r / 25 02 Nam*: mcotc Evergreen Home- i Address:7410 Sw Meson Rd.Suite 133 :i -' Garbaec disposal f 25.02 1 (iniStateittr Portland,OR.97223 I II APPLICANT Medical Page 2 | ��mc�name:Same . --- ---- -------- --- Primer 12.51 Contact name: 12 51 ______ - ___-__-_� -- cial) Address: _ _ _ ___________ L��w°n'"`y"p 25.02 ciw3mte/ZiP: __� / m | pxv�'( ` ' )' "" '^'"� `'"'—''°' ` 12 51 _- _-_� �__-____-_____-_�-________-_ ' c~^x/ ^u"�.o""~"",m"o"~/ ---------- -- -, [varom ~° CON ruAc/oe — -__- ________- — '-___-_ ' »�=�":� 37.52; | | | Business name:EDWARD Mt LLrvp|I'S:1mNc - - _--- �"~ r _ ��n'�� Address: 1*o/ wEerunROAD ',/.' 25.02 ' • minimum permit fee: $72 50 Authorized signature TOTAL PERMIT FEE -- — __ _ � �� ' ��.�,,,��,�� u� { Printname: RAI nrLL^, °n~^*=�" "="*" as complete. _ ^�"�hodology set by Tri-County Building Industry Service Board /^"./��m,m""mwv^~.~^�.m" `^m'q9 City of Tigard IN 4■ COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential A Building Permit #: Myrolo(5-0,:_-.?4}r Site Address: 1243 IL, kit r7 c) Y i ci LC Project Name: G an c t ci 11 A Lot #: Z (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: f\/.Q-AA/ S F-Q xf Verify site address/suite#exists and active in permit system. XRiver Terrace Neighborhood: ❑ Yes -❑ N5 Site Plan Elements: Three(3)copies of site planxisting structures on site tte plan must be on 8-1/2"x 11"or 11 x 17"paper ,footprint of new structure(including decks)with finished prawn to scale(standard architect or engineer scale) floor elevations orth arrowCJtility locations(required for new,may apply for additions) Site address,project or subdivision name and lot number /-21 canon of wells/septic systems lApplicant information(name and phone number) /Erosion control(including drainage-way protection,silt fence Lot dimensions and building setback dimensions design,location of catch basin,etc.) met area,building coverage area,percentage of coverage and Street names impervious area(applicable if R-7,R-12,R-25&R-40) (Street tree size,type and location /Property corner elevations(2 foot contour lines if more than /)Xxisting trees to be retained with drip line,and tree 4 foot differential) protection measures /Clean Water Services—Service Provider Lett5r(lot platted prior to 9/10/1995): equired: ❑ Yes,applicant was notified X No CReceived: ❑ Yes ❑ No ❑ ''ublic Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes E No,stop intake Land Use Case#: u 8 /0+1 -- 0000 2 Zoning. R .4 . S Setbacks: Front 10 Rear f S J Side 5 Street Side 5j Garage 2.-V 'Landscape Requirement: — 7-Lot Coverage Maximum: --' , ^ Building Height: Maximum Height 30 Actual Height 'L-3 `E"--Visual Clearance --Er—Easements - ' Sensitive Lands: ❑ Yes ❑ No Type - au rban Forestry Plan alonditions"Met"prior to issuance of building permit otes: el- Approved By Planning: 4/177 Vi 2( _ 6 7 p Date: 1 1/1 9/if 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 l:\Building\Forms\BldgPermitRvw_RES_070915.docx Building Permit Submittal Original Submittal Date: ///�Zy�/5— Site Plans: �t Building Plans: # 3 Building Permit#: iter building permit#above. Workflow Routing. fanning neering ermit Coordinator C,1B`rin g Workflow Sign-off: -off for Planning(include notes from planning review) Route Application Documents: G] gineering: (1) copy of permit application,(1) site plan, (1)building plan and E�on nal plan review routing form. Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: ,7-.. .---1.J' ,„,--Ci-- -i': 2---- Date: "MA-- Engineering Review Slope at building pad: /7 Conditions "Met"prior to issuance of building permit 7 Easements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 0 No Assess Water Quantity Fee in-lieu: Yes 0 No LIDA Facility on lot: Yes 0 No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: A 7 Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: 0 Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved, NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: ❑ Yes X N/A Parks SDC: i?i Yes ❑ N/A OK to Issue Permit Approved by Permit Coordinator: ��v//47— Date: //l7-)/I/S- I: I: Building Furans BldgPennitRvw_RES 070915.docx 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 12816 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal FAIL MST2015-00225 David Young Seal duct penetration in garage ceiling. R302.5 Seal around vibration isolater in ductwork in garage, no return air from garage allowed. R302.5 Violation Summary: Inspector Contractor 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 12816 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2015-00225 David Young Provide approved plumbing ﬁnal inspection for landscape Backﬂow devise as noted on previous inspection for PLM2016-00213. Provide approved Lida box ﬁnal inspection. Provide approved electrical ﬁnal inspection. Provide approved plumbing ﬁnal inspection. Add laundry tray to permit prior to plumbing ﬁnal inspection. Provide approved mechanical ﬁnal inspection. Not ready for building ﬁnal inspection, no inspection done. Violation Summary: Inspector Contractor 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 12816 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2015-00225 Jeff Grove Violation Summary: Inspector Contractor 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 12816 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection FAIL MST2015-00225 David Young Elbows from Lida box not removed as noted on ﬁnal Lida inspection. Provide approved plans and approved plot plan on site for ﬁnal inspection and street tree location veriﬁcation. Provide slope away from house in back 6" in 10' or approved drainage swale. R401.3. Remove covers from supply register upper level. Insulate non insulated ductwork in garage unconditioned space. N1105.2, M1601. Violation Summary: Inspector Contractor 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 12816 SW KING PL, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection PASS - C of O MST2015-00225 Jeff Grove Street tree Moisture content Lighting efﬁciency Blower door test All forms received Violation Summary: Inspector Contractor