Permit (8) ,�IN
CITY OF TIGARD MASTER PERMIT
a . ., COMMUNITY DEVELOPMENT i Permit#: MST2016-00130
f ,�,RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ' Date Issued: 04/06/2016
�� Jurisdiction:
2S104AD04100
Tigard
Site address: 12983 SW PARKDALE AVE
Subdivision: BELLWOOD Lot: 50
Project: Olson Woods, Lot 7
Project Description: New SF. Model home. 5/3/16: Reprinted permit to show change of address from 12540 SW
Walnut St.to 12983 SW Parkdale Ave.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1513 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 1767 sf Garage: 657 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3280 sf Value: $404,222.44 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
0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 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: Y Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 6
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 addl 500 sf: 6 201-400 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 3280
Owner: Contractor:
WINDWOOD CONSTRUCTION INC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
12655 NORTH DAKOTA ST 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 TIGARD,OR 97223
PHONE: PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $31,085.23
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 e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: g,a i Permittee Signature: �c f'
`/3.639.4175 by 7:00 a.m.for the next available inspection date. �/L
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
n CITY OF TIGARD MASTER PERMIT
` *; COMMUNITY DEVELOPMENT Permit#: MST201600130
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/06/2016
Parcel: 2S104AD04100
Jurisdiction: Tigard
Site address: 12540 SW WALNUT ST
Subdivision: BELLWOOD Lot: 50
Project: Olson Woods, Lot 7
Project Description: New SF. Model home.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 at Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $404,222.44 Rear: 0
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: 4 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: Y Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 6
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'l 500 sf: 6 201-400 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 0
Owner: Contractor:
WINDWOOD CONSTRUCTION INC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
12655 NORTH DAKOTA ST 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97223 TIGARD,OR 97223
PHONE: PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $27,149.23
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 acc ance 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. AT TION: • -gon I-, requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 010 through OA' 9 -001-i••s. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 .1987 or 1.800.332.2344.
1 Issued y: I —/% Permittee Signature: 7( 1 I�� �I
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place.on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application LS 3 .ti /
Residential 1..,i-AVV1EV FOR OFFICE LSE 01L1"
F
City of Tigard i,�~" Received � 3c)
�,1 g
Date/By: �/ /j(p Permit No.: M •�0 1! �.,,�`
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review j �J� OC /lD—uJ
Date/By: Other Permit:
' I Phone: 503.718.2439 Fax: 503.598.1960 2% 7 $ 3 f J� 4�t (G`vo as
1 a C,ARD Inspection Line: 503.639.4175 MAR Date Ready/By: turfs: 0 See Page 2 for
Internet: www.tigard-or.gov liGiNV.,10 Notified/Method/11G _'MSupplemental Information
TYPE OF"WO. Lr ���%� �,' � t J€ /Y1r1 d G✓ <.JcRJeI
>J{13�1 VREQUIRED DATA:1-AND 2-FAMILY DWELLING
ew construction 0 DeMolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
' � CATEGORY OF.CONSTRUCTION work indicated on this application. �1
Valuation: $/641 ��� 14
f2r1-and 2-family dwelling ElCommercial/industrial I /
Number of bedrooms: 4/
0 Accessory building 0 Multi-family
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 9 31
Job site address: 42163 Plif-a-K4/4-#4 /.-4/j/4::- New dwelling area: ;ice,-:a) square feet
City/State/ZIP: T.T 6 44/.3 69/4 `! "2 . Garage/carport area: 657 square feet
Suite/bldg./apt.no.: Project name: ,(!)ZSoti iod,d_ j4-7 Covered porch area: square feet 1'� 1��]
Cross street/directions to job site: Ai/5/ /j/1 T w r Deck area: 9 square feet,S 13
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: /2/. O4/ el..) Qk)A)S Lot no.: 7 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
1,... SPA. Valuation: $
Existing building area: square feet
New building area: square feet
j2'PROPERTY OWNER . 0 TENANT Number of stories:
Name: w-Z'/(,/y0 a)avo eQNs 7 JAI , Type of construction:
Address: /#. ,,t T I?'"" 6c.._) Aid'—T// ST 4T Occupancy groups:
City/State/ZIP: 7.4r-a—„ 4:,,,i,,, c" 74 ,,:d;)ez# ' Existing:
Phone:LC 4 790-''37S Fax:(`2.1.L..?) - e O`"'. New:
APPLICANT B"CbNTACT PERSON BUILDING PERM T.FEES*
Business name: -•,--:":,_ 7.94':: (Please refer to fee schedule)
_ Structural plan review fee(or deposit):
Contact name: _ ',.>/:,L 7"'z' - r /�,-(� �-: 't-,2,
FLS plan review fee(if applicable):
Address: C Au -#66-kk uastA Total fees due upon application:
City/State/ZIP: (_5:_t;) 3M1�cieq,T-1 RtAc. c/ .CIL
Phone: ) 1 Fax Fax::(5:0 ` a -,1„._.) :
" Amount received:
E-mail / PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
,_,, %�U.✓Q U f/104-r ,71,/,:ki,..:..,-./. ;/)7 G< /, (j,1/
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: (A1 Sf`J W DD.D (Q it,s',7 ....0,_,Cr Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: ,. -- /)) L Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
y and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: :%/ L Total fee due upon application: $201.60
This permit application expires if a permit is not obtained
Authorized signature: within 180 days after it has been accepted as complete.
•Print name: fDate: *Fee methodology set by Tri-County Building Industry
• 1
1:� %`; � til ✓,` r. Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLI'
• City of TigardReceived
Date/By:
.f
( � Permit No.: ,_ 0 6_ , r
13125 SW Hall Blvd.,Tigard,OR 9 410
Plan Review
= Phone: 503.718.2439 Fax: 503.598. Date/By: Other Permit.
TI(i,�R D Inspection Line: 503.639.4175 Q �o1U Date Ready/By: loris: 0 See Page 2 for
Internet: www.tigard-or.gov V.\Pg `1,j D ��� Notified/Method: Supplemental Information
1 '
iNtAICS
{ {(q�
TYPE OF w( N
` V)V AN COMMERCIAL FEE* SCHEDULE USE CHECKLIST
`' �t y`'SMechanical permit fees*are based on the value of the work
ola"slew construction 0 Addition/alter�tjlt�t Int performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: 3y11 mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION •
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
)217--and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOS.SITE':!INFORMAtgN,:f.AND LOCATION
Heating/cooling:
Air conditioning / 46.75
9 _
Job site address:/ /34-1 4,O Lt ,/l,IV4�rFurnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP: /, L q 7,2,7_�� Furnace 100,000+BTU(ducts/vents) 54.91
��` D Heat pump 61.06
Suite/bldg./apt.no.: Project name: ., -Lji'1 .,,..,,„/r')0 -
Duct work 23.32
Cross street/directions to job site: j/f.. ,r , 7 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: / "l,- ) . Lot no.: Other: 23.32
�J/ . D/t .!_i ��. Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
' ;.-, ,r fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
OPERTY OWNER 0 TENANT
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
i
. ' r /', . ' .-.
equipment 33.39
Address: �,' F / / Clothes dryer exhaust / 33.39
City/State/ZIP: i_ Single-duct exhaust(bathrooms,
7 G,9. /1,—)• �-� toilet compartments,utility rooms) J 23.32
Phone:(;. 7,) , J� -- ,'? ,, I Fax:(5 ) r90 76 Attic/crawlspace fans 23.32
rAPP.LICAIVT. 0 CONTACT PERSON Other: 23.32
l Fuel piping:
Business name: ..---) /)'( $14.15 for first four;$4.03 for each additional
Contact name: ��/9.,2 f' ,/;_ `�.//)/. ,LJ 5 Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
li
Range
E-mail: 6(.4 Ailt.-vac/Cf10Al.---...S1',.1(-^-'s'Y i!/1 i ' /•,`CI 41 Barbecue
CONTRACTOR }``' Clothes dryer(gas)
Business name: �7 , •"-- _Other:
1/7i111;L MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: ,,,<--Z)/9/6 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized sign J . Fee methodology set by Tri-County Building Industry Service Board
Print name: `/J� ,jyj Date:3//y//4
I.\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
•
Electrical Permit Applicationciv:0416‘
T► FOR OFFICE USE ONLY
City• of Tigard WV DatGBy: PermitNo.: !g Re eive: M�37�o b"-III • 13125 SW Hall Blvd..Tigard.OR23r Plan Review
$ 1A
= Phone: 503.718.2439 Fax: 503.598.1960 g Date/By: Other Permit:
Inspection Line: 503.639.4175 t.A`p,R 41 Date Ready/By: Julie PI See Page 2 for
TIGARD lv
Internet: www.tigard-or.gov _„. _ � Notified/Method: Supplemental Information
;7 :.y ',vA„e 2.®t,. l N.:- .. , • •- ,4._ ..: F3 a'f`t,..; .'#'..'..!x_.444't8.
„21lew construction 0 Addition/alte (11jT - - t Please check all that apply(submit::sets of plans w/items checked below t
�1'y'�
0 Service or feeder 400 amps or more 0 Building over three stories
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards
73 '"`" 44, s�r` 7 4 ' exceeds 10,000 amps at 150 volts or 13 Floating buildings
� � ' �" `v' less to ground,or exceeds 14,000 0 Commercial-use agricultural
and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-f
amilY 0 Mast
er builder 0 Other: `*� 0 Fire pump. 0 Installation of 75 KVA or
z mac,,f-•y ❑Emergency system. larger separately derived s
ystem
u4, 14$ aQ vsKP.� 'S; ! '
0 Addition of new motor load of ❑_A _E....I Z,._1 i"
Job no.: Job site address: 6 n�f /'����� IOOHP or more. volts or 13 F0 vehicle parks
Cit /State/ZIP: 1� L,0 () .,‘„0-- q')012 ❑Health-care facilities. ❑GOOvlolt nominal e for more than
Y ❑Hazardous locations.
Suite/bldg./apt.no.: Project name: ---),/.50,4,1 £(„/c'o ❑Service or feeder 600 amps or more.
z I±'EE S_CH EDULE y
Cross street/directions to job site: /,4t4j17' Description ) Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Q,/tsd� aS Lot no.: 1.000 sq.ft.or less N'''
1..+ 168.54 4
Subdivision: ��� Ea add'1 500 sq.ft.or portion S 33.92 I
lI ax map/parcel no.: Limited energy,residential `i
< r v JQRA'TIUJx4Runr r_ , `> ' ' (with above sq. 1 75.00
,
Limited energy,multi-family 75.00
"'7./ J- L'ig residential(with above sq.Il.) _
� Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 _ I
1QFF L -. ,a.--..., 201 amps to 400 amps 133.56 -
401 amps to 600 amps '200.34 2
Name: ko7 j, )4/0,04 'o,T. tC 601 amps to 1,000 amps 301.04 2
Address: /c2‘s5 S (,'•) ,1j 7// / ,4v'r7/)674:7'47 Over 1,000 amps or volts 552.26 2
Y f•. 6,4 / M Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:(5i3) '?0a -Zf 37r Fax:(13)5"- a --'76 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54
for sale,lease,rent,or exchange,accordingto ORS 447,449,670,and 701. -
intended $ Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with i
�, c a. Ok4O Y®r w a . y above service or feeder fee,
7.42 ,
:.` �.) �+�. c .- M each branch circuit
B.Fee for branch circuits u•irhoua
Business name: ` ,,')� service or feeder fee,first
��/ �•— .#/$40-..c branch circuit 56.18 2
Contact name: /`• L;
Each add'I branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84
City/State/ZIP: dwelling,service and/or feeder
Phone:( ) Fax: ( ) -Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: �jl J f} ;J/,,--tUO� f1r.y t t ) it t-` / v / n.• t Sign or outline lighting 67.84
_,, its` •' 7.01.R+(t+ Qi 4P: �`:" e- -3•n' Signal circuit(s)or limited-energy
Business name: Dream House Electric,LLC panel,alteration,or extension. Page 2
Each additional inspection over allowable in any of the above
Address: 221 SW Moonridge Place Additional inspection(1 hr min) 66.25/hr
- -
City/State/ZIP: Portland,OR 97225 Investigation(I hr min) 66.25/hr
Phone:(503) 519-6711 Fax:(503)648-9723
Industrial plant(I hr min) 78.18/hr
CCB Lic.: 196726 Electrical Lic.: C-848 Suprv.Lic.: 4560S Inspections for which no fee is
90.1X1/hr
specifically listed('A hr min)
7Suprv.Electrician signature.required: EL RJCAL:-? .I;RMLI`EELS.
Subtotal:
Print name: Chris Mahon Date: Plan review(25°hof permit fee):
Authorized signature: State surcharge(12%of permit fee): I
Print name:( Ji-s /44,/706441I Date: e4vi� TOTAL PERMIT FEE:
1'Buildina)Putmits\EL.C-PmnitApp doe 07/01/10440-46IST(I I/0VCOM/WEB
Electrical Permit Application—City of Tigard
Page i—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
•
Fee for all residential systems combined: $75.00 Description I Qty. I Each I Total
)' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
ri B• urglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
Vacuum Systems*
>100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal Enteron Page 1):
Fee for each commercial system: $75.00
�' • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application
Building Fixtures 4* FOR OFFICE USE ONLY' �./�
City of Tigard Received
Date/By: Permit No.:petradi!'.W 130
- ■ 13125 SW Hall Blvd.,Tigard,OR 97 y' `'� "`� VJ
511 g Plan Review
Phone: 503.718.2439 Fax: 503.5 DateBy: Other Permit No.:
Inspection Line: 503.639.4175 1 0C3 Date Ready/By: Juris. 0 See Page 2 for
IIC A R D Internet: www.tigard-or.gov `� Y% Z� Notified/Method: Supplemental Information
} TYPE OF WORK 1`�*p� +��} [1� FEE* SCHEDULE
lew construction ❑Dem 1� `� �N For special information use checklist
��, t �j Description 1 Qty. I Ea. Total
❑Addition/alteration/replacement ❑Othe 1� New 1-2-family dwellings(includes 100 ft.for each utility connection)
1 CATEGORY OF CONSTRUMN SFR(I)bath 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath ,t" 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB:SITE INFORMATION AND LOCATIONSite utilities:
Job site address: m �''/ Catch basin or area drain 18.76
/� � /" Drywell,leach line,or trench drain 18.76
City/State/ZIP: . •' ,F . . j
- Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: l Project name: -) `j &/:06 '-; Manufactured home utilities 50.03
Cross street/directions to job site: `' / .5,' ,' , ;-7 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: `), J,j :',tf ` ' Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
J,I&O) 5/Ts Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
',ROPERTY OWNER ` ❑ TENANT Expansion tank 12.51
Name: ,t j i 1 r j J /;/C Fixture/sewer cap 25.02
' �`J/ Floor drain/floor sink/hub 25.02
Address: S <7)- Cv /,,,i)iLL 3 J/4 ,,:„;7,,"4 - - , , Garbage disposal 25.02
City/State/ZIP: . -;,/,'/2 , " :),i%,�- i77:3_2 Hose bib 25.02
Phone: c-') 75 -C"`0--L/37Fax: �.,__' ;,/,-± ,/ ,./:Z.••• Ice maker 12.51
XPPL.`ICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: �^ Medical gas(value:$ ) Page 2
' Primer 12.51
Contact name: „7"-----),;-) // "4 ‘iA
f 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
�`j - Urinal 25.02
E-mail '
Y Water closet 25.02
CONTRACTOR V
� Water heater 37.52
Business name: •'/5 0 A 6 i,rA Water piping/DWV 56.29
Address: 3) ,_ `Y,,1� -;j Other: 25.02
City/State/ZIP: f 4:' 7 .. j -,),/: / // _ Subtotal
Phone:( ) / /1?) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 3 6 7 / kOth 7 Plumbing Lic.no.:m , v. Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: , e. ,�.r 7/1 ll TOTAL PERMIT FEE
Print name: ."---/-' Date: __ '
This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
• *Fee methodology set by Tri-County Building Industry Service Board.
I\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
11111qS
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G n li D Building Permit Review — Residential
Building Permit #: _`/1757- j/6-(20 1 30
Site Address: /.7ggs $J' ) 4�, " Lc4.1,42_
Project Name: Ofnn ier.6. I'f) .4 / biT7A a Lot #:
(New dwelling=subdivision name;.kddition or Alteration= last name of owner)
Planning Review
Proposal: 4)&0 /C kodt,em0._
( Verify site address/suite# exists and active permit system.
/Aver Terrace Neighborhood: No ❑ Yes,See RiverTenace Review Addendum Attached
Site lan Elements:
Itr ree (3)copies of site plan 14-4:, sting structures on site
11 to plan must be on 8-1/2"x 11"or 11 x 17"paper II .00tprint of new structure(including decks)with finished
Drawn to scale (standard architect or engineer scale)
oor elevations
Worth arrow �/JUtility locations(required for new,may apply for additions)
e address,project or subdivision name and lot number ation of wells/septic systems
pplicant information(name and phone number)v?(
Erosion control(including drainage way protection, silt fence
iiot dimensions and building setback dimensions esign,location of catch basin,etc.)
F)I .area,building coverage area,percentage of coverage and 1/ treet names
pervious area (applicable if R-7,R-12,R-25&R-40) Street tree size,type and location
II roperty corner elevations(2 foot contour lines if more than OlAsting trees to be retained with drip line,and tree
4ot differential) protection measures
foot
0 1 can Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified E No Received: E Y s ❑ No
Public Facilitie Improvement(PFI) Permit:
V}6and
Required: Yes,applicant was notified ❑ No ^Applied/For: Yes E No,stop intake
Use Case #: sStA�0)f ' .r.J ".77,4� 2OX 0000/, /67. 0/*Q—UO! Ca
VS( oning: !�—�_
etbacks: Front QC) Rear /S--- Side4/ Street Side /cR Garage oC,-)
il�kandscape Requirement:
0/0
fd of Coverage Maximum:
wilding Height: Maximum Height 30 Actual Height o2�
Visual Clearance
p1I: asements
UUr�/ nsitive Lands: Vies ❑ No Type / ( —Z� /7ts2�/ 7�1 "
ban Forestry Plan
❑ Conditions "Met"prior tig iss ante of building permit
Notes: Mo, — 1, c,"27/
Approved By Planning: Date: / ,/ ,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: E Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPennitRvw RES 012116.docx
r•
Building Permit Submittal
Original Submittal Date: 1/4/4,
Site Plans:
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Lk-Planning _`ngineering - rmit Coordinator wilding
Workflow Sign-off: SW-n-off for Planning(include notes from planning review)
Route Application Documents: [krngineering: (1) copy of permit application, (1) site plan, (1) building plan and
originalgplan review routing form.
LYI3wlding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: G , „ :, Date: / ��6
/r
EnjJneering Review
Slope at building pad: /le)
ditions "Met”prior to issuance of building permit
Rcements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: E Yes ❑ No
LID1\Facility on lot: E Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: A.
P Date: _1.....7.0 .&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: 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:
DC Fees Entered: Wash Co Trans Dev Tax: !!
Tigard Trans SDC: Yes WO
!i NN
NI
Parks SDC: Yes r, ,,
/�OK to Issue Permit f
r Approved by Permit Coordinator: dfr-- Date: 0 14,
I: Building`Fonns`BldgPennitRvw_RES_11121 I 6.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
12983 SW PARKDALE AVE, TIGARD, OR, 97224
Residential - Master Permit
199 Electrical final
PASS
November 14, 2016 at
12:12:01 PM
MST2016-00130
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
12983 SW PARKDALE AVE, TIGARD, OR, 97224
Residential - Master Permit
699 Mechanical final
PASS
November 14, 2016 at
12:12:15 PM
MST2016-00130
Jeff Grove
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12983 SW PARKDALE AVE, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
399 Plumbing final
Result:
PASS
Comments:
Corrections completed
Violation Summary:
Tel: 503.718.2439
Inspection Date:
December 6, 2016 at 9:19:27
AM
Record ID:
MST2016-00130
Inspector:
Aaron Cillo-Gobel
Inspector Contractor