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Permit (3) CITY OF TIGARD MASTER PERMIT III I COMMUNITY DEVELOPMENT Permit#: MST2016-00052 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/10/2016 TIGARD 9 Parcel: 2S103AC09600 Jurisdiction: Tigard Site address: 11420 SW FONNER ST Subdivision: 2014-023 PARTITION PLAT Lot: 2 Project: Bean Partition, Lot 2 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 2 First: 1728 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 25 Bathrooms: 2 Second: 0 sf Garage: 604 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 1728 sf Value: $223,972.67 Rear 15 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 3 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: N Vent Fans: 3 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 st 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 1728 Owner: Contractor: LHL HOMES INC LHL HOMES INC Required Items and Reports(Conditions) 11580 SW 67TH AVE 11580 SW 67TH AVE 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-348-3003 FAX: 503-639-5523 Total Fees: $27,128.00 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 iss e, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati• enter. Those rules set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a -,, , ;- i les or direct questions to OUNC by calling 5., w.2.1987 or 1.8 . 2.2 Issued By: d--__—...01116.....— _ _ s— • • ee Signature: Xr Call • 0.4175 by 7:00 a.m.for the next available inspecti•n 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 Residential (`, `�e� iiiimmemaimay„ NCity of Tigard `°�' Received '1016 DateB ` Permit No F " 13125 SW Hall Blvd.,Tigard,OR 97223 __rot-S Phone: 503.718.2439 Fax: 503.598.1960F�� 2 Nan Revie rA Fa° Date/By: J J g Other PermitIddlo—cora037 -i i t, `R 0 Inspection Line: 503.639.4175 (311‘d'\100" 11 c`0 Date Ready/By: suds: Se Page 2 for Internet: www.tigard-or.gov G\l/ 050\�\ Notified/Method:3 3 /6. 7o Supplemental Information BW1- ®� i TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. catc1n t-and 2-family dwelling El Commercial/industrial Valuation: $ 3;CJ 7� �• � ❑Accessory building ❑Multi-family Number of bedrooms: __` ❑Master builder ❑Other: Number of bathrooms: 2. JOB Sn r. iNFORMATION AND LOCATION Total number of floors: / Job site address:p K Q'} S �� SD 76ea__/g722 3 New dwelling area: •1-7 iy square feet a,33 City/State/ZIP: �••� ! , "�f Garage/carport area: 11 _°Li square feet Suite/bldg./apt.no.: Project nam f t 7 Gds t/ / _tca Covered porch area: /tic square feet Cross street/directions to job site: ''V/ Deck area: _ square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: dce% / ... Lot no.: Permit fees*are based on the value of the work performed. �4 "4" Indicate the value(rounded to the Tax map/parcel no.: nearest dollar)of all �t!G� a1 WY•G2 j Atte s equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. �n �, -/1 C _ Valuation: $ �/�-� cJ Existing building area: square feet New building area: square feet g PROPERTY OWNER 0 TENANT Number of stories: Name: L,L / ..27,-It. Type of construction: i Address: Apse //Sgd s CU G 7 tZ ave. Occupancy groups: City/State/ZIP: T CrAR✓, ' QR 9 7 223 Existing: Phone:( ) lj'1 '..77f' Fax:(474) ,e3 pJZ 2.3 New: R APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: (Please reJamjusrhedak) S4 M Structural plan review fee(or deposit): Contact name: ,Ji.G 41 /14 !L . FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application: Phone:( ) Fax::( ) Amount received: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail:4 h 4 ' CONTRACTOR 11 OI S' C G - Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: 4ert Arne 3 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.: JS'y 7.2.7 Total fee due upon application: $201.60 - Authorized si • L This permit application expires if a permit is not obtained ,,I within 180 days after it has been accepted as complete. *Print name: �� !i ate: �/���/Z 6 Fee methodology set by Tri County Building Industry `r! Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB) Electrical Permit Application o iiiimmumensige ,.. ` Ci o Tigard q� Reccr,xcF . City �+1 `� c 4� p gY Permit it: A_��" S - a 13125 SW Flair.Blvd,Tigard,OR G tV'T_Y�Y� >o ' Phone: 503.718.2439 Fax:503.5 1960 p t) ` 0\- Deted3;"'" Related Permit f: T 1�,,+•I E> Inspection Line: 503.639.4175 V 0 l+ --- E � Ready I7ard$Y runs: 8 See 2 for Internet. www tigard-or•gov d ^���� �ry*� � �• { Supplemental Information .. .;- ,Y._ 3'X1.' �; 0 �. -- .. ..... - �New construction 0 Addition/altt; t�� �ment Please check all that apply(submita sets of plans wTtems checked): 0 Demolition 0 Other: 1 D Service or feeder 400 amps or mere 0 Building over three stories. where the available fault current D Marinas and boatyards .`;, 1e-._.:_0:-6;...,�.� ,. . ,!A exceeds 10,000 amps at!S0 volts or 0 Floating buildings 0 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 D tial-use agricultural ❑Multi-family 0 Master builder 0 Otheramps for allother installations. buildings. °Fire pomp. 0 Installation of 150 KVA or . .l. ? ^ v !JOB .� , . }o kit -6 AY. ,VMEn• larger separately parately derivedi oAddit; anew load of sem.Job S: Job site addressyq, 0 sw an AIOOftP omorc. City/State/Z�P: �"f;�_t ! ❑Six or inure residential units. occupancy.l r `1"/ OxeeNh care facilities. D Recreational vehicle parks. Suite/bldg./apt.#: Project name: O Haradous locations O Supply voltage for more than OServax or feeder 600 amps or more. 600 volts nominal Cross street/directions to Job site: - A, ^f*7_e4S . P*X, . - . Qtr F.a3s .i :. 1 New residential single-or multi-family dwelling unit Subdivision: i 1 . 4 w ek . // Lot#: 4 2 Includes attached garage. 1,000 ft.or Less Tax map/parcel# � t+. 7.0 y,© ▪ 9 to,1 3 2+ �I• j 168.54 4 :r),s s. ,n r i art....F- {! [Gj11:: 'r Ea.add'l500sq.ft.orportion .. 33.92 1 ▪ r °�z -._ } Limited energy,residential .. ^ ` (with above sq,ft.) / 75.00 2 ! -. Limited energy,mutts family 75.00 2 residentiacwith above sq.ft.) CI' R1"R - . newable Energy D See Page 2 e Narttr ' 5ervlcesReor feeders installation,alteration,andlor rtocation 200 amps or less 190.71 ! I Address: 201 amps to 400 amps 133.56 2 City/State/ZIP: 401 amps to deo amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) I Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders iastadafion,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps so 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 . 2 41.tiaigtktCO` ,ts + 3��+ � �k „� ���� M. ` BFnohbuaictiss-irncws wii h ation01'eXfenROfl,alt'panel Business name: { above service or feeder fee, each branch circuit 7,42 2 Contact name: _ B.Fee for branch circuits without service or feeder fee first 56-18 2 Address. branch circuit City/State/ZIP': T Each addl branch circuit 742 2 Phone:( ) Fax::( ) Miscellaneous(service or feeder not induded) Each manufactured or modules 67.84 2 Email: - dwelling,service and/or fonder Reconnect only 67.84 2 Sn ,C cy:. ON ,�t.f..' y .xti J $ ZiiiVitwN Pump or irrigation circle 6784 2Businessname: ,� condQ .. yL� Sign or outline lighting 67.84 2 Address: � ` Signal cur:uit(s)or limited-energy r/t,o, S W i l � FSe..1 i panel,alteration,or extension. D See Yage 2 2 City/State/VP: Noce /�� , [1 . ��� Each additional inspection over allowable in any of the above t f z tr Additional inspection(I hr min) 66.25/hr Phone:(51? ) ggd—6-3 2 y Fax:(93) 8Zy-$;11 7 m (I hr mixt) 90.00/hr I — Emarl �,! f® Indtnhiialplant(1 brmin) 78.18/hr udeebiral elcc 1 „'t Inspections CCB �sv Electrical 1.16.:3% C Supra. tarwhidtta )� 9a.001hr Sn .Lie.: 31SY S I tedP 1rr n,in f Stiprv.EIcctriciati signawtt rt:quurcd: L/ a$414 r fi=..:> `� _ Subtotal: _ Print name:Alit/241 a /,4 / 1 Date: /�� D Plan Review Requited(25%of permit tier !v� // State mucilage 12%of Ke( permit fee): Authorized si? 41 : TOTAL PERMIT FEE: Print name: N I 'this permit appfation expires if a permit is not obtained within 180 6� Date: days after it has been accepted as complete. ' Number of inspections allowed per pent*. I:Sl,u'Mireermitt a _PecmitApp. .R[:REdoe Rev06(t7iao15 440.4615T(I INStCOM/WPB Mechanical Permit Application F , OFFICE I SE o\LI' City of Tigard Received �5 g r, �� Date/By: Permit No.: ft L S-02- 11111 � ;� 13125 SW Hall Blvd.,Tigard,OR 972 /L�� C Phone: 503.7182439 Fax: 503.598.1 0 Pitt`Revte�v Q 1.3 206 BateBy: Other Permit: Inspection Line: 503.639.4175 cc_ , Date Ready/By: loris: ® See Page 2 for I IGi�hhJ p r Internet: www.tigard-or.gov ified/Method: `�, V �``AC�„rl Supplemental Information TYPE OF WO t%$\N Y •7 COMMERCIAL FEE* SCHEDULE— USE CHECKLIST Mechanical permit fees*are based on the value of the work New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* A'r and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: !!it1 0 8a) /7nriq sI Furnace 100,000 BTU(ducts/vents) , 46.75 City/State/ZIP: T �2 9���3 Furnace 100,000+BTU(ducts/vents) 54.91 _ J ' '�`� Heat pump 61.06 Suite/bldgiapt.no.: Project name: Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 • Flue/vent for any of above 23.32 Subdivision: 41 Pa 2 7z� Lot no.: Other: 23.32 gs Other fuel appliances: Tax map/parcel no.: p<<.+ pc e].0/41.... a 13 Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 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 23.32 Fr PROPERTY OWNER 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Litt. ,e ve 1 Range hood/other kitchen Address: equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 0 APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace E-mail: Range Barbecue CONTRACTOR Clothes dryer(gas) Business name:C Other. MECHANICAL PERMIT FEES Address: -7 C�'1 AJ7 /i-1f,vk,_ , ‘, ' WA Subtotal City/State/ZIP: VI 40:73.1v-g.: J A./iti- '7 Fe&Z Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(213...)* i 0 — Fax: ( ) State surcharge(12%of permit fee) CCB lie.: y>51 #. i a C TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: C ' • Fee methodology set by Tri-County Building Industry Service Board Print name: R. ... .-'4 A . f3/411,1 tus, Date: N13/� I:\Building\Permits\MEC_PermitApp 040113.doc 44 617T(I1/02/COM/WEB) Plumbing Permit Application Building Fixtures , I OFFICE (ISE ONE\ City of Tigard Received sceN Date/By: Permit No.:mSral i s.,rikX)s......1. ' ? 0 13125 SW Hall Blvd.,Tigard,Ol Plan Review 11 2 Phone: 503.718.2439 Fax: 503.598.196 ct , 'L�1� Date/By: Other Permit No.: Inspection Line: 503.639.4175 F�t� D c T 1 C,A RD ,i,4 t� Date Ready/By: Juris ® See Page 2 for Internet www.ttgard-or.gov 'c iOr`r. y c-t Notified/Method: Supplemental Information TYPE OF W0100 °- 101«4'` t i`� FEE* SCHEDULE ❑New construction olition For special information use checklist Description Qty. I Ea. I Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) _ CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 El1-and 2-familY dwellin SFR(2)bath , 437.78 g ❑Commercial/industrial 0 Accessory building ❑Multi-family SFR(3)bath 500.32 El Master builder ❑Other: Each additional bath/kitchen 25.02 Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: /`y a s nen St- Catch basin or area drain 18.76 / l v D Drywell,leach line,or trench drain 18.76 City/State/ZIP: U R 97 ZZ3 � Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.: ) Page 2 1 • Water service(no.linear ft.: ) Page 2 • Subdivision: Rlet.eh p4„, 4 4, Lot no.: a. Fixture or item: Tax map/parcel no.: Backflow reveate. f 31.27 el4 A. 1.0 f`� -Q 13 BackwaterP valve 3 12.51 DESCRIPTION OF WORK Clothes washer ) 25.02 Dishwasher i 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 g PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: [rg.L �[�-__ Fixture/sewer cap 25.02 7��S Floor drain/floor sink/hub 25.02 Address: Garbage disposal25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker I 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap J 25.02 Business name: < / / Medical gas(value:$ ) Page 2 Tt- 4 . I Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: -y� /' / Pic....1 UL /„ZeG�C / Water piping/DWV 56.29 Address: Pe- af)x -7 y Other: 25.02 City/State/ZIP: taS 71"" 4 NA! e. o R f o/1J Subtotal Phone:( ) Fax:( ) ! Minimum permit fee: $72.50 9 /li1 l ).Sit?� Plan review (25%of permit fee) CCB Lie.:'Q 3 2 o7 lumbing Lic.no.:'3r _ State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: 2. K / / Date: J� � h This permit application expires if a permit is not obtained within Igo days `�- [ 3 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard ~ COMMUNITY DEVELOPMENT DEPARTMENT S Building Permit Review — Residential TIGARD Building Permit #: /ris - j 6-- .)5d. Site Address: i l 41 TO SW F©r1 fl-ec .5-4-- Project 4'Project Name: ge-av1 PUr+itib v) Lot #: 2— (New dwelling= subdivision name;.Addition or.Alteration=last name of owner) Planning Review Proposal: New S F-0 W Verify site address/suite# exists and active in permit system. 7 River Terrace Neighborhood: X No ❑ Yes, See River Terrace Review_Addendum Attached Site Plan Elements: /Three (3)copies of site plan --8-E"xisting structures on site Xite plan must be on 8-1/2"x 11"or 11 x 17"paper /Footprint of new structure(including decks)with finished ,21trawn to scale (standard architect or engineer scale) floor elevations Siorth arrow /Utility locations (required for new,may apply for additions) Site address,project or subdivision name and lot number {kation of wells/septic systems pplicant 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.) CSL rt area,building coverage area,percentage of coverage and _eet names � impervious area (applicable if R-7,R-12,R-25&R-40) —�9TF et tree size,type and location .. roperty corner elevations(2 foot contour lines if more than /Existing trees to be retained with drip line,and tree 4 foot differential) protection measures ilZ/Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): quired: ❑ Yes,applicant was notified E No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified E No Applied For: E Yes E No,stop intake Land Use Case#: {• LP 200 8 0 00041 Zoning: 4 . S i- Setbacks: Front /O Rear Is Side 5 Street Side ' ' S Garage'%Q Landscape Requirement: - - °j0 ,.Lot Coverage Maximum: ,12--Building Height: Maximum Height Actual I'eight / 3 „ZrVisual Clearance Easements Sensitive Lands: ❑ Yes ❑ No Type cirban Forestry Plan onditions "Met"prior to issuance of building permit Notes: Approved By Planning: M0 v 1, (3 /j 0 L CA/tx— Date: '-2-/Sc / j (,, Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPermit Rvw_R ES_O 12116.docx Building Permit Submittal Original Submittal Date: AS//(� ar Site Plans: # 5 Building Plans: # 'j Building Permit#: nter building permit# above. Workflow Routing: nning Ly�Lngtnccringermit Coordinator ®—ihaifdtng Workflow Sign-off: E Siff for Planning(include notes from planning review) Route Application Documents: [engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. 1 ding: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable, etc. Notes: ImiftBy Permit Technician: Date: .02/)--30; ,-..amP Engineering Review /LJ Slope at building pad: Conditions "Met"prior to issuance of building permit Easements (encroachments) per engineering conditions of approval and plat C--447 Water Quality/Quantity Facility: ej Assess Water Quality Fee in-lieu: 'Yes IINo Assess Water Quantity Fee in-lieu: Yes ism! o LIDA Facility on lot: Yes W No ❑ NOT Appro •d Engineering: Date: Notes: —.IN.., _ ff: _ -1.11.4.111111r' �;•L� p.r /iAl! ��� � � w _ ' - -- Approve i by Engineering: i-42— ,D Date: .:�C� e,‘ 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 E 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 E N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: L Yes ❑ N/A OK to Issue Permit Approved by Permit Coordinator: Date: 3///6"' I:ABuilding',Fonns\BldgPennitRvw_RES_012116.docx 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 11420 SW FONNER ST, TIGARD, OR, 97223 Record Type: Residential - Master Permit Inspection Type: 399 Plumbing final Result: PASS Comments: Corrections completed Violation Summary: Tel: 503.718.2439 Inspection Date: Record ID: MST2016-00052 Inspector: Aaron Cillo-Gobel Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 11420 SW FONNER ST, TIGARD, OR, 97223 Record Type: Residential - Master Permit Inspection Type: 299 Final inspection Result: PASS -CofO Comments: Violation Summary: Inspector Tel: 503.718.2439 Inspection Date: December 12, 2016 at 1:39:52 PM Record ID: MST2016-00052 Inspector: Jeff Grove Contractor