Permit (29) CITY OF TIGARD MASTER PERMIT
'i 1.- COMMUNITY DEVELOPMENT Permit#: MST2016-00112
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/03/2016
Parcel: 23109DB08200
Jurisdiction: Tigard
Site address: 13161 SW BLACK WALNUT ST
Subdivision: SUMMIT RIDGE NO.5 Lot: 150
Project: Summit Ridge No. 5, Lot 150
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 136 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 1012 sf Garage: 746 sf Front: 20 Smoke
Dwelling Units: 1 Third: 957 sf Right: 5 Detectors: Yes
Total: 2105 sf Value: $270,167.54 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 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
Drywell-Trench Drain: 0 Other Fixtures: 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: 4 201-400 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 2105
Owner: Contractor:
DR HORTON INC DR HORTON INC PORTLAND Required Items and Reports(Conditions)
4380 SW MACADAM AVE 4380 SW MACADAM AVE SUITE 100 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97239 PORTLAND,OR 97239 2 A geotechnical report is
required before the footing
PHONE: PHONE: 503-222-4151
FAX: 503-222-1304
Total Fees: $28,182.64
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: l leer r ,a-.4.1 Permittee Signature: o. 41
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.
L 0 T /S2, Li -9-o 4 6-(Z.
Budin Permit Application LS��w� LS -
Residential D
FOR OFFICE USE ONLY
City of Tigard Received
g MAR 16 201 Date/By: �6 4921 'ennitNo.
r. /7S7r.?o/6—®D//d2
13125 SW Hall Blvd..Tigard,OR 97223 p Plan Review') ( f
a Phone: 503.718.2439 Fax: 503.598.1 TV OF TIGARD Date/By: J/,,9,1)).(, Other Penn ',i /b-pop 70
l , .`t,,, Inspection Line: 503.639.4175 -,• . .G DIVISION Date Ready/By: Juris: 65 See Page 2 fur
Internet: www.tigard-or.gov eyl� Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: I-AND 2-FAMILY DWELLING
If 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
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. I I
Q I-and 2-family dwelling 0 Commercial/industrial Valuationa10 1 C7 $ �G'I �1
J
❑Accessory building 0 Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
4.S3. J
Job site address: `n Vt 4W "Nact, \. 41.1 r\ut S\ , New dwelling a :`- ] square feet aj( c.
City/State/ZIP:Tigard, OR 97223 Garage/carport liga 1.4 C care feet
Suiteibldg./apt.no.: Project name:Summit Ridge Covered porch area: 3 square feet 9 7
job �pCross street/directions toDeck area: square feet i Q �
site:
Other structure area: square feet '3c
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 1 S7) 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.
New SFR Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: DR Horton Inc. Type of construction:
Address: 4380 SW Macadam Ave Suite 100 Occupancy groups:
City/State/ZIP: Portland, OR 97239 Existing:
Phone:( 503) 222-4151 Fax:( ) New:
0 APPLICANT • CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to lee schedule)
Business name: DR Horton Inc. Structural plan review fee(or deposit):
Contact name: Emerald Weeks
FLS plan review fee(if applicable):
Address: 4380 SW Macadam Ave Suite 100
Total fees due upon application:
City/State/ZIP: Portland, OR 97239
Phone:(503 )222-4151 X1107 Fax: :( ) Amount received:
E-mail: esweeks@drhorton.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photovoltaic Solar Panel System.
Business name: DR Horton Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:4380 SW Macadam Ave Suite 100 Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, OR 97239 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503 )222-4151 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 130859 tet, Total fee due upon application: $201.60
Authorized signature: */r� L,ira et This permit application expires if a permit is not obtained
`�C within 180 days after it has been accepted as complete.
Print name: -�f/fc 4 1 1"V'(€ *Fee methodology set by Tri-County Building Industry
[� r Date:2016 Service Board.
1:\Building..Permits\BUP-RESPcrmitApp.doc 02/24/2011 440.4613T(I 1/02/COM/WEB)
A .
r R
Electrical Permit Application EtVED FOR OFFICE LSE':O\l.l
•City o Tigard GG Receives ,(� -7�,
`J' b Date:Bv.: Permit?:&-Cre3C"r/F-..a9/42---
"
111 13125 SW Hail Blvd.,Tigard,OR 9T. ,• 16 2016 Plan Review
I Phone: 503.718.2439 Fax: 503.59 f •;t Date/Bv: Related Permit a:
Inspection Line: 503.639.4175 Ready Date By .lori, El See Page 2 for
TIGAKLI Internet: www.tigard-or.gov \otillcd'Method Supplemental Information
TYPE OF WORK PLAN REVIEW
al New construction ❑ Addition alteration replacement Please check all that apply(submit 2 sets of plans w,itcros checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
I-and 2-family dwelling Commercial/industrialIcss to ground.or exceeds 14.000 0 Commercial-use agricultural
i WI ❑ 0Accessary building
amps for all other installations. buildings.
❑ Multt-familv ❑ Master builder ❑Other: 0 Fire pump. 0 Installation of 150 EVA or
JOB SiTE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
El Addition of new motor load of system.
Job#: Job site address: 1'C n !i P, I 1001W or more. ❑'
City,State ZIP: Tigard, OR 97223 IC , ❑Six or more residential units.jMcutaMy.
5‘ ❑Health-care facilities. ❑Recreational vehicle parks.
Suite bldg.%apt.#: Project name: Summit Ridge 0 I lacardous location,. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qo I Each [ Total 1 •
fNew residential single-or multi-familydwelling unit.
Subdivision: Lot»: 1 �V includes attached garage.
1,000 sq.fl.or less t 168.54 4
Tax map/parcel»: Fa add'I 500 sq ft or potion _ 33.02 1
DESCRIPTION OF WORK Limited energy,residential I 1 75.00
j�
New SFR (with above sq.ft.) , -
Limited energy,multi-family 75.00
residential(with above sq.fi.1 -
Renewable Energy 0 See Page 2
a PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: DR Horton Inc. 200 amps or less 1 100.70 -
Address: 201 amps to 400 amps 133.56 2
4380 SW Macadam Ave Suite 100 401 amps to 600 amps 200.34
C1ly'State'ZIP: Portland. OR 97239 601 amps to 1,000 amps 301.04
Phone:(503 )222-4151 Fax:( I Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: esweeks@drhorton.com relocation
Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.30 I
intended for sale,lease.rent-or exchange.according to ORS 447.449,670.and 701. 201 amps to 4(5.)amps 125.0. -
Owner signature: Date: 401 amps 10 599 amps 168.54
❑ APPLICANT
CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: DR Horton Inc. above service or feeder fee,
7.42
each branch circuit - -
Contact name: Emerald Weeks B.Fee for branch circuits widrcnu
Address: 4380 SW Macadam Ave Suite 100 service or feeder fee,first branch hrtnch circuit
City/State/ZIP:Portland, OR 97239 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503 )222- 4151 X1107 Fax: :( ) Each nianuthcturcd or modular
67.84 2
dwelling,service and'or feeder
Email:esweeks@drhorton.com Reconnect only 67.84
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Wright 1 Electric Sign or outline lighting 67.84 _
Signal circuits)or limited-energy
Address. 11490 SE Jennifer St. panel,alteration.or extension. ❑ Sec Page 2
City.-State/ZIP: Each additional inspection over allowable in any of the above
lackamas, OR 97015 Additional inspection(I hr mitt) 66.25'hr
Phone:(503 ) 760-8522 Fax:( ) '114,2- 1 .. investigation(I hr mm) 90.00 hr
Email: Industrial plant(1 hr min) 78.181 hr }
rlane@wrtlelectri.com g inspecKions for which no fee is 90.00 hr
CCB Lic.:162368 Electrical Lic.:3-332c Suprv. Lie.:3i Es specifically listed C:hr mint
/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature.required: (C��� t/,.t��� .4_.•
,fp./� yt Subtotal:
Print name: Jt +�tS uor t N `„_ TDate: 2016 0 Plan Review Required(25%of permit fee):
�+' State surcharge(12%of perrnit fee):
Authorized seem arc: TOTAL PER/sill FEE:
_. This permit application expires if a permit is not obtained within 180
Print name: Date: 2016 days after it has been accepted as complete.
18 umber of inspections allowed per permit.
I )tudchn.Permnz Elf PernntApi' 111.8 ERF doe Rev 06 I"2015 .i(( 46151111 05 COM:WEB
f 4
•
Mechanical Permit Applica CE `"`t\'
ED FOR OFPI( I 1 `,l ON,I l
City of Tigard1 6 2 Received 6._00/42—
MAR 016 Dat/By: Permit No Sjre/
• 13125 SW Hall Blvd.,Tigard,OR 9722Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Other Permit:
�'ITY OF Date/By:
1 t l R Inspection Line: 503.639.4175 fit�9lQ Date ReadylBy taro ® See Page 2 for
Internet: www.tigard-or.gov BUILDING 1.+ Notitied/Methud: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
4110 New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
lig 1-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
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: ' } r^ 4 I cow. o /�j, Wa,`y S' Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223 """' Furnace 100,000+BTU(ducts/vents) 54.91
g ' Heat pump 61.06
Suite/bldg./apt.no.: Project name: Summit Ridge 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
Other: 23.32
Subdivision: Lot no.: ISD
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
New SFR 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
• PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name: DR Horton Inc. Range hood/other kitchen
equipment 33.39
Address:4380 SW Macadam Ave Suite 100 Clothes dryer exhaust 33.39
City/State/ZIP: OR 97239 Single-duct exhaust(bathrooms,
tY Portland, toilet compartments,utility rooms) 23.32
Phone:(503 ) 222-4151 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT • CONTACT PERSON Other: 23.32
Fuel piping:
Business name: DR Horton Inc.
$14.15 for first four;$4.03 for each additional
Contact name: Emerald Weeks Furnace,etc.
Address: 4380 SW Macadam Ave Suite 100 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Portland,OR 97239 Water heater
Phone:(503 ) 222- 4151 x1107 Fax::( ) Fireplace
Range
E-mail: esweeks@drhorton.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: Birchfield Heating&Air
MECHANICAL PERMIT FEES*
Address: 6 1 `P S ([)'Z,
Subtotal
City/State/ZIP: , )a A`'‘'L-4 el/' C(7 3 sa. ) Minimum permit fee($90.00)
) I Plan review(25%of permit fee)
Phone:(5 y 1 ) 4 Z(n )3 -7 pt Fax:(94) ) 5 2,6 7 1 7 State surcharge(12%of permit fee)
CCB lic.: C) STOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Authorized signature: 0e/
*to • Fee methodology set by Tri-County Building Industry Service Board
Print name: J o.cp'I )31`r t hSe l V J Date: J
1.1Building\Pcrmits\MEC Pcrma App_040113.dee 440-46171(11/02/COM/WEB)
Plumbing Permit ADDlicatioRECEWED `I/, Yb 741
Building Fixtures MAR 2 9 2016
Cityof Tigard RiYed
ITY OF TIGARD bat�By 3�3�/�� PcmitNtry�T ✓/6 Oce//oZ
13125 SW Hall Blvd.,Tigard O Ptah ttrnew
R Phone: 503.718.2439 Fax: 50' DI N G DIVISION.-DateIt Other Permit No.:
Inspection Line: 503.639.4175 batt ReadyBy: Jwis: &! Sec Page 2 for
Internet: www.tigard-or.gov Notified/Mahad: Supplemental Information
TITS OF WOK FE° W
❑New construction 0 Demolition Fur special information we rAlerkfirt
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-tufa
mlty dwellings(includes 100 R.for each utility connection)
• `. CATEGORY OF cONb7'R17cnow • _ SFR(1)bath 312.70
-
❑ 1-and 2-family dwelling I 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath ( 500.32
13 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler(?-I 05 sq.ft.) Page 2
.J013 WIT mFORMAT ON AND LOCATION : Site utilities:
Job site address: 1-31 G ( Ste{/ 0uta ij DoT' 5. ±. Catch basin or area drain 18.76
t c(-7,2y
A Drywell,leach line,or trench drain 18.76
City/State/ZIP: -Fl+ &2' "I-7 Z.2
/ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Summit Ridge 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
Water service(no.linear ft.:_) Page 2
Subdivision:
Lot no.: Ito Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
. DFBCRIPITON OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
NSFR Drinking fountain 25.02
Ejectors/suzup 25.02
t] PROPERTY OWNER I ' 11 TErmi'r Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib
25.02
Phone:( ) Fax:( ) Ice maker
12.51
• [.f AP!!,[CANT Q come"IP'$1t,UN Interceptor/grease trap 25.02
Business name: DR Horton Inc Medical gas(value:$_) Page 2
Contact name; Emerald Weeks Primer 12.51
Roof drain(commercial) 12.51
Address: 4380 SW Macadam Ave Ste. 100 Sink/basin/lavatory 25.02
City/State/ZIP: Portland,OR 97239 Solar units(potable water) 62.54
Phone:(503 ) 222-4151 ext 1107 Fax::( ) Tub/shower/showerrpan 12.51
E-mail: esweeks@drhorton.com tater 25.02
CONTRACTOR waerrloset s.oz
• . Water heater 37.52
Business name:Grav(A‘„( V 4t.tM (lAD Tv\C
Water piping/DWV 56.29
Address: Lyg3- S. (-re.Qv�-1)c---e,.e J 1,r Other: 25.02
City/State/ZIP: ()c,ue.%C.t-ki t Dt[2_ G7(AS Subtotal
Phone:(Sb,) 4c10-0-14; Fax:(9•ZI ) 2_s0-32,0 to Minimum permit fee: $7250
Plan review (25%of permit fee)
CCB Lie.: t 91,150c5 r. Plumbing Lic.no.: p6 i D io S
State surcharge(12% fee)
Authorized signature: SU TOTAL PERMIT FEE
Print name: Sp y1(�.cVt Cit tAk-te Date;
This permit application expires If a permit is sot obtained within ISO days
after it has been accepted as complete.
`Fee methodology set by Tri-County Building Industry Service Board.
I:\BuidiuglParmitAPLMU-PumitApp.duc 10/01104 440-4616T(IOM/COM/WEB)
City of Tigard
11114
I
COMMUNITY DEVELOPMENT DEPARTMENT
T T G A R D Building Permit Review — Residential
Building Permit #: /157020/C. 0/1.,/--
Site Address: /3/4o/ ,S' _ Zaakkt-/
Project Name: —S?I/iiyhi , c /Uc? S" Lot #: /W
(New dwelling= subdivision e;Addition or Alteration=last name of owner)
Planning Review
Proposal: -e , S
Verify site address/suite# exists and active ' permit system.
tiiIpver Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Site Ian Elements:
ee(3) copies of site plan °4 sting structures on site
plan must be on 8-1/2"x 11"or 11 x 17"paper 11 ootprint of new structure (including decks)with finished
.wn to scale(standard architect or engineer scale) •or elevations
r , th arrow It tility locations(required for new,may apply for additions)
ill ' - address,project or subdivision name and lot number in I ! ation of wells/septic systems
,1. .plicant information(name and phone number) 7.Erosion control(including drainage-way protection, silt fence
1/ . dimensions and building setback dimensions sign,location of catch basin,etc.)
IE ot area,building coverage area,percentage of coverage and 'freet names
ervious area (applicable if R-7,R-12,R-25&R-40) �S(reet tree size,type and location
roperty corner elevations (2 foot contour lines if more than 01A-i ting trees to be retained with drip line,and tree
4yyfoot differential) protection measures
16'AkanWater Services-Service Provider Lette (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified q,d No Received: ❑ Yes El No
Fig Facili . s Improvement (PFI) Permit:
./
equired: Yes,applicant was notified ❑ No Applied For:
'es ❑ No, stop intake
and Use Case#: �L��j" (J�S - �L�(JCI^
V7onin : T
g P-
�'/etbacks: Front /S Rear js Side Street Side /Off Garage c:.3(")
andscape Requirement: cn
ot Coverage Maximum: -
uilding Height:4,
Maximum Height 5.c- Actual Height
isual Clearance
IV/Easements
ensitive Lands: Ves ❑ No Type LOU)•_1/..2.4te A a i l
rban Forestry Plan
IjQ Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: _ Date:
r
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved D Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
1:\Building\Fonns\BldgPennitRvw_RES_0121 16.docx
Building Permit Submittal
Original Submittal Date: «//ef"
Site Plans: # _j
Building Plans: #
Building Permit#: [ Enter building permit#above.
Workflow Routing: a Planning engineering Vermit Coordinator -'Building
Workflow Sign-off: a-Sign-off for Planning(include notes from planning review)
Route Application Documents: Ei]'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original 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: Date: /��/,6
Engineering Review
g.Slope at building pad: r !
Conditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Q _...2) Date: 7�2—✓L,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved E 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:
rSDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
(it' OK to Issue Permit
Approved by Permit Coordinator: Date: 3A 3
1:\Building\Fonnns\B1dgPennitRvw_RES_O 121 1 6.docx
RECEIVED
Mechanical Permit Application 101,;,)Ffitliso (1\I \
City of 1 igard
24 SV. ILO IiINJ I Tart!oft '172::ISEP 21 2016
!(.ittlrY Ot.TIGARD
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irikilliv' •••,IA It 14,4(J.01 y,), I POkt,, .41 1,. ,
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BUILDING DIVISION _
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r TYPE OFI WORIC . , >CI NIMERCIAI. FEF*SCIIE011.1. - Mr Et
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________ _ -. ; '+-10.11mu.A perm.,It.-V' we it•Istti 1,71 It,.1 tittl 01 Ow•
sit.lt;
I iii Nett to.risrmttirtri D Atitiltron alicrselim rephts•eutoIr ' : r,r,,,rst-tor frt,r,„trs.the s AI,I tstotnsliti It•'N. 11..,,,••tt•1 4 " ,
0 1)4:11101/01114 0 4 4044.!: tli,,,baltt,,,1 mow.,5,I. ...11,23nrw IJI.o.:. s.c:i:...,..! .,,..1 r, • .;
CATEGORY ot (fAS 110 11 ION
, RESIDENTIAL EQUIPMENT i sys,Trvis rtrs-
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13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
13161 SW BLACK WALNUT ST, TIGARD, OR,
97224
Record Type:
Residential - Master Permit
Inspection Type:
699 Mechanical final
Result:
PASS
Comments:
Tel: 503.718.2439
Inspection Date:
January 4, 2017 at 9:09:19 AM
Record ID:
MST2016-00112
Inspector:
David Young
Fix fan vent cover in upper level main bath, will check at building final.
Note: no AC installed at time of final inspection, separate permit and inspections required
at time of installation.
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
13161 SW BLACK WALNUT ST, TIGARD, OR,
97224
Record Type:
Residential - Master Permit
Inspection Type:
199 Electrical final
Result:
PASS
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
January 4, 2017 at 11:19:16
AM
Record ID:
MST2016-00112
Inspector:
Jeff Grove
Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
13161 SW BLACK WALNUT ST, 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:
January 10, 2017 at 2:24:07
PM
Record ID:
MST2016-00112
Inspector:
Aaron Cillo-Gobel
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
13161 SW BLACK WALNUT ST, TIGARD, OR,
97224
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
PASS -CofO
Comments:
Hi efficiency lighting report received
Blower door test report received
Street tree certification report received
Moisture content report received
CWS approved final erosion
Violation Summary:
Tel: 503.718.2439
Inspection Date:
Record ID:
MST2016-00112
Inspector:
Chip Barnett
Inspector Contractor