Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2016-00275
T"I C;A It.r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/03/2016
Parcel: 2S102DC01900
Site address: 9290 SW EDGEWOOD ST Jurisdiction: Tigard
Subdivision: EDGEWOOD Lot: 15
Project: Crisp-Davila Partition, Lot 2
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1053 sf Basement: 0 sf Left: 5
Parking Spaces: 0
Height: 25 Bathrooms: 3
Second: 1470 sf Garage: 651 sf Front 15 Smoke
Dwelling Units: 1
Third: 0 sf Right: 5 Detectors: Yes
Total: 2523 sf Value: $315,479.25 Rear: 20
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays: 0
Y Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0
Sewer Lines: 100 SF Rain Storm Sewer 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains' 0
BckFlw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Catch Basins: 0
Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders
Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add9 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
Other: N Other Description: All
Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use:
NEW TYPe of Constr: Occupancy Group: Square Feet:
SF VB
R-3 2523
Owner: Contractor:
NJSJDS II LLC JTSC LLC Required Items and Reports(Conditions)
5285 MEADOWS RD STE 171 5285 MEADOWS RD,SUITE 171 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035
PHONE: 503-657-3402 PHONE: 503-308-7324
FAX: 503-684-0102
Total Fees: $750.00
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 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. Yoymav_obtain a,•py of the or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
='s Permittee Signature:
a'e . 39.4175 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.
k
Building Permit Applicatjon
Residential41
mrti�s- ---
City of TigardFOR OFFICE USE ONLY
r 13125 SW Hall Blvd.,Tigard,OR 97223 Received
Date/Bn Review Ce D Co ! Permit No.: i3
Phone: 503.718.2439 Fax: 503.598.1960hTdQ/La CX>d�-?
Plan . .
i t ,\V.!)
Inspection Line: 503.639.4175 Date/B : _ ' ,� 3 e/2_,.0/
`4,J�
/ Other Permit: a Z
Internet: www.tigard-or.gov Date Ready/By J
Notified/Methodj/ 2 ,Ie� ® See Page 2 nr
Supplemental Information
TYPE OF WORK "9/G•- ,
®New construction REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 Demolition Permit fees*are based on the value of the work performed.
❑Addition/alteration/replacement 0 Indicate the value(rounded to the nearest dollar)of all
Other:
CATEGORY OF CONSTRUCTION equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
® 1-and 2-family dwelling
0 Commercial/industrial Valuation: i
❑Accessory building �_= ti
0 Multi-family Number of bedrooms: S
0 Master builder
0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION
Job site address: Total number of floors: 2 7 j`
ga_C0 EDG T "7
w(op S
City/State/ZIP: New dwelling area: 2 523 square feet
Suite/bldg./apt.no.: Garage/carport area: (ps-( square feet
Project name: t C�1 g P DAV 1 l.A _
Cross street/directions to job site: Covered porch area: ���(
1'v, square feet ' ' 0
Deck area: '°"� ''
g s — square feet J
Other structure area: ) 0 7 square feet
Subdivision: REQUIRED DATA:COMMERCIAL-USE CH
� ECKLIST
`Zod4 OOOp Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: �,
�" Z Indicate the value(rounded to the nearest dollar)of all
DESCRIPTION OF WORK equipment,materials,labor,overhead,and the profit for the
work indicated on this a..lication.
NEW SINGLE FAMILY RESIDENCE
Valuation: $
Existing building area:
square feet
10
PROPERTY OWNER New building area:
square feet
Name:NJSJDS II,LLC ❑ TENANT Number of stories:
Address:5285 MEADOWS RD STE 171 Type of construction:
City/State/ZIP:LAKE OSWEGO,OR 97035 Occupancy groups:
Phone:(503)657-3402
APPLICANT -
Business name: :1 AP LLC ® CONTACT PERSON
BUILDING PERMIT FEES*
Contact name:NATHAN SMITH !'tease re er to ee schedule
Structural plan review fee(or deposit): 1111111111111
Address:5285 MEADOWS RD STE 171
City/State/ZIP:LAKE OSWEGO,OR 97035 FLS plan review fee(if applicable): 1111111111111
Total fees due upon application: IIIIIIII
Phone:(503)358-5001
Amount received: :75 .).GZ"j
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:NSMITH@JTSMITHCO.COM
CONTRACTOR Commercial and residential prescriptive'• tallation of
Business name:JTSC,LLC plan . 1 connection details
roof-top mounted Photovoltaic Sol. " el System.
Submit tw. (2)sets of roof •
and fire dep. . ent access,a : g with the 2010 Oregon
Address:5285 MEADOWS RD STE 171
City/State/ZIP:LAKE OSWEGO,OR 97035 Solar Installation ecia Code checklist.
Phone:(503)657-3402 Permit Fee(in i's plan review
an. .dministr. e fees): $180.00
(12%111
CCB lic.:200237 ge of permit. $21.60
s
Authorized signature: �, rtal fee due upon application:
'`,--f g201.60
ained
This i ermit application expires if a permit is not obtained
Print name:JOHN WYLAND within 180 days after it has been accepted as complete.
Date: 1.• 3O les *Fee methodology set by Tri-County Building Industry
Service Board.
�Building�Permits�BUP-RESPermitApp.doc 02/24/2011
L
440-4613T(11/02/COM/WEB)
Electrical Permit AppIicatitArt 1 x(Mt Or i�is L Lrr� oNL
lLecee � lo �7Permit No..
`P 040. ZC1tYof Tigard 5 Date .
.:.-.,N,-,::-....,0„::m 13125 SW Hall Blvd.,"Tigard,OR 97223 t; •/,;I tiIi Plan Review
'-' Phone: 503.718.2439 Fax: 503.598.1960 ... ' Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: iuris. 13 See Page 2 for
T3G�l` o , Notified/Method: Supplemental Information
Internet: www.tigard-or.I,ot��}} - r � �.Y
i .� T gIa IWO* $4 �e a LA1r#s� Y .. 3 iii_.......t .,?.
Please check all that apply(submit 2 sets of plans w/items checked below):
®New construction ❑Addition/alteration/replacement
❑Service or feeder 400 amps or store ❑Building over three stories.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY„O1' CQNSFRIJC'I,II$N exceeds 10,000 amps at 150 volts or ❑Floating buildings,
'' less to ground,or exceeds 14,000 0 Commercial-use agricultural
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multifamily 0 Master builder ❑Other: 0 l'ir'e pump. 0 Installation of 150 KVA or
0 Emergency system, larger separately derived system.
JOB Si' E INFORMAT.ON.ANI) LOtrA'TION . 0 Addition ot'new motor load of ❑"A""E" "1-2" "1-3"•
~ I OOHP or more. occupancy.
Job no.: Job site address: . 0 t(�4' w�D S1' 0 Recreational vehicle parks.
❑Six or more residential units.
Cit,/State/ZIP: �t n ❑Health care facilities 0 Supply voltage for more than
�iY.,Gt' U K ['Hazardous locations 600 volts nominal.
Suite/bldg./apt.no.: Project name:, ,CR\S-p 'QAV 1 L A D Service or feeder 600 amps or more.
c , - - TEE [?fLE 2
Cross street/directions to job site: Description I Qty. I Fee. I Total I "
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: r a Zai _0000 S Lot no.: 1,000 sq.ft.or less 168.54 4
Ea,add'I 500 sq.ft.or portion I f 33.92 I
6
Tax map/parcel no.: G�1 Limited energy,residential y
DESCRIPTION OF„WORK ; (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 -
Electrical for new single family residence residential(with above sq.ft)
,Renewable.Energy.` ❑`.See Paite'2.
Services or feeders installation,alteration,and/or relocation
i4 PROPERTY OWNCR ❑ TLNI N`I . 200 amps or less , 100.70 2
N1'S,'OS It , {k 201 amps to 400 amps 133.56 2
Name' 401 amps to 600 ams 200.34 2
Address:5285 Meadows Road Suite 171 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Lake Oswego,OR 97035 Temporary services or feeders installation,alteration,and/or
Phone: (503)657-3402 Fax:( ) relocation
200 amps or less 59.36 i
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
. 9d A0,,O Aii ,, .. �.EQT`IT']t✓'I PERSON above service or feeder fee,
. 7.42 2
Business name:JTSC,LLC each branch circuit
B.Fee for branch circuits without
Contact name: 1.0 ATIAA N S 14IT 14 service or feeder fee,first 56.18 2
branch circuit
Address:5285 Meadows Road Suite 171 Each add'l branch circuit 7.42 2
_Miscellaneous(service or feeder not included)
City/State/ZIP: Lake Oswego,OR 97035
Each manufactured or modular 67.84 2
Phone:(' ' SCIS 14 ft 500 I Fax: :( ) dwelling,service and/or feeder
E-mail NSMITN a ' TSMITHc0 CO Pump
uori igt 67.84 1
67.84 2
y, . CONT t4 TOR, .. Sign or outlineilightinge 67.84 2
Business name: fj ji�01.4--P7 Signal lterat(s)orlimited-energy See
t�° _ t IQ panel,alteration,or extension. Page 2 2
Address: )02:06i7.1.7004/066041/16 ' 7"-1t//1 Each additional inspection over allowable in any of the above
ti yyAdditional inspection(I hr min) 66.25/hr
City/State/ZIP: l '1�/SY'(JY0 Or\—/ I , ,3 Investigation(I hr min) 66.25/hr
( 3)L ,,v, .2.•. 6 �-`7�, 5'"
Phone: Fax: Industrial plant I hr min) 78.18/hr
e Inspections for which no fee is 9p q0/hr
CC'1:3 1ic.: i ` Electrical Lia: if.C.,
acne : , specifically listed(V2 hr min)
ELEcTRTCAI.1:RMIT xE`LES ,..
Suprv. Electrician signature,required: =
,. . ,-____-. Subtotal:
d j� �,gdi r Plan review(25% permit fee):
Print name: ( 4'i, •k 44 Date: o a
.1r State surcharge(12/o of permit fee):
Authorized signature: ir' �_ TOTAL PERMPF FEE:
s - ms This permit application expires if a permit is not obtained within 180
Print name: (Pu,�,� t`yt„•r r •_ Date: q /bc, days after it has been accepted as complete.
����✓✓✓✓1V✓✓ '-.'-LLL ' Number of inspections allowed per permit.
I\nuilding1.Perntits:ELC_PermitApp_ELR ERE.doe Rev 05/21/200 If 440-45151111/05/CO15/RVGi3
Mechanical Permit Application FOR OFFICE USE ONLY
11 City of Tigard Received
f Date/By: Permit No.:
f M 13125 SW Hall Blvd.,Tigard,OR 97223 % Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
l i I.A , t Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
` 3= COMMERCIAL FEE* SCHEDULE —. USE CHECKLIST
TYPE OF �YbRK
° Mechanical permit fees*are based on the value of the work
®New construction ❑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:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 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 1 46.75
Job site address: Ck QO p( E WOOD ST' Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
Tr sc t'� /Q R Heat pump 61.06
Suite/bldg./apt.no.: Project name:C 2_1 S Q D_ Av lr L . _ 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: mi-F0 10i'!-00 00 s Lot no.: Other fuel appliances:
Tax map/parcel no.: 7G rte) 2 Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
MECHANICAL FOR NEW SINGLE FAMILY RESIDENCE 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:NJSJDS II,LLC Range hood/other kitchen
equipment 33.39
Address:5285 MEADOWS RD STE 171 Clothes dryer exhaust 1 33.39
City/State/ZIP:LAKE OSWEGO,OR 97035 Single-duct exhaust(bathrooms, '1
toilet compartments,utility rooms) 4 23.32
Phone:(503)657-3402 Fax:( ) Attic/crawlspace fans 23.32
D APPLICANT 1D CONTACT PERSON Other: 23.32
Fuel piping:
Business name:JTSC,LLC $14.15 for first four;$4.03 for each additional
Contact name:5285 MEADOWS RD STE 171 Furnace,etc.
Gas heat pump
Address:5285 MEADOWS RD STE 171
Wall/suspended/unit heater
City/State/ZIP:LAKE OSWEGO,OR 97035 Water heater
Phone:(503)348 5001 Fax::( ) Fireplace
Range
E-mail:NSMITH@JTSMITHCO.VOM Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: %N TF 6►9 Y Al R. LI CM MECHANICAL PERMIT FEES*
Address: , Q S w Kip►�7 L�► L N b 1 C oo Subtotal
City/State/ZIP: P O PT lls PJ 0 OR 4:51 2.2 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503 5 �. 35 q y Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 2.1)SltipTOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:John Wyland Date:g /�6
I:\Buildin\Permits\MEC_PermitAPP_040113.doc 440-411/02/COM/WEB)
Plumbing Permit Applieatibn ' ' '
Building Fixtures FOR OFFICE USE ONLY
Received
City of Tigard Received
Permit No.: 1.4.5?-;poi62,�Q09�5
a 13125 SW Hall Blvd.,Tigard;OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 •' Other Permit No.:
aey:
Inspection Line: 503.639.4175 Date Ready/By: Juris. El See Page 2 for
I I`'A I`I) Internet: Www.tl ardor. v'' '
g So Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description Qty. 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
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath I 437.78
SFR(3)bath 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 LOCATION Site utilities:
Job site address: Cita q b C-1'D e;. - W QO 0 S- r Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: T' acct /0
's Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:,eg.1s P V i L+ Manufactured home utilities 50.03
v
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: Z2) 1 Page 2
Storm sewer(no.linear ft.: ZO ) 1 Page 2
Water service(no.linear ft.: I0 ) ( Page 2
Subdivision: dv(4 p ..2d/y.•a Co pyo 5 1 Lot no.: Fixture or item:
Tax map/parcel no.: r cel Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer i 25.02
PLUMBING FOR NEW SINGLE FAMILY RESIDENCE Dishwasher 125.02
Drinking fountain 25.02
Ejectors/sump 25.02
e< PROPERTY OWNER 0 TENANT ' Expansion tank 12.51
Name:NJSJDS II,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:5285 MEADOWS RD STE 171
Garbage disposal I 25.02
City/State/ZIP:LAKE OSWEGO,OR 97035 Hose bib 2- 25.02
Phone:(503)657-3402 Fax:( ) Ice maker i 12.51
FII APPLICANT' ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:JTSC,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:NATHAN SMITH
Roof drain(commercial) 12.51
Address:5285 MEADOWS RD STE 171 Sink/basin/lavatory 1 25.02
City/State/ZIP:LAKE OSWEGO,OR 97035 Solar units(potable water) 62.54
Phone:(503)348-5001 Fax::( ) Tub/shower/shower pan 3 12.51
E-mail:NSMITH@JTSMITHCO.COM Urinal 25.02
Cy�'1/2Y CONTRACTOR Water closet 3 25.02
Water heater i 37.52
Business name: 'TAM 14,ALLE N (0 P4?A1J y
Water piping/DWV 56.29
Address: ilea I A SE ROUE R ROA O Other: 25.02
City/State/ZIP: W 1 S 13O RO 1 0 it 41 ' 2 3 Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: gZoQ'al Plumbing Lic.no.:3a a,2.40 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:JOHN WYLAND Date: C 3d'I,C, 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(I0/02/COM/WEB)
City of Tigard
q COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 c A Ro Building Permit Review — Residential
Building Permit #: HSTa..vI(.e_ao x27`5
Site Address: ��----��
9e) C_C /10(11< .74""
Project Name: 074.0, __ )�.?.4 % U/4?: -.-2c> Lot
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: //J) ` j
LvJ Verify site address/suite#exists and active ' permit system.
ever Terrace Neighborhood: I It N o ❑ Yes,See River Terrace Review Addendum Attached
Sit- Plan Elements:
rip, ee(3)copies of site plan
01'6 sting structures on site
0 • plan must be on 8-1/2"x 11"or 11 x 17"paper I1 ootprint of new structure(includingdecks)with finished
f 'oawn to scale(standard architect or engineer scale) fl r elevations
rth arrowty locations(required for new,mayapply for additions)
address,project or subdivision name and lot number \ pp y
ve
-!ation of wells/septic systems
plicant information(name and phone number) III': i sting trees to be retained with drip line,and tree
r
.t dimensions and building setback dimensions tection measures
O`Xarea,building coverage area,percentage of coverage and S ee tree size,type and location
ervious area(applicable if R-7,R-12,R-25&R-40
treet names
roperty corner elevations(2 foot contour lines if more than
4 foot differential)
tol klean Water Services—Service Provider Lette of platted prior to 9/10/1995):
:(9)..,aPnnind.
equred: ❑ Yes,applicant was notified l� No Received:
Yes ❑ Noublic Facilitig�Improvement(PFI) Permit:
equired: V Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
Use Case#: LLC)ii1 �� X�`�--g. _ /,c-- 7
IV Setbacks: Front �� Rear Side Street Side
�� f •Garage
�l�andscape Requirement:
fp of Coverage Maximum:
I"A Building Height: Maximum Height Actual Height c.��
isual Clearance
U Easements
tIR!ensitive Lands: ❑ Yes ❑ No Type
IF Urban Forestry Plan
❑ Conditions "Met"prior to issuance of buildin• permit
/"
Notes: __.%/41,
Approved By Planning:
` �. .A' Date: 6/24
Revisions (after Building Submittal only) Reviewer
Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Bui lding\Forms\BldgpermitRvw_RES_060116.docx
Building Permit Submittal// � ��""�I1 1 ca
Original Subml Date: (p
Site Plans: #
Building Plans: #
Building Permit#: ❑'Enter building permit#above.
Workflow Routing: ®" Planning Engineering D---Krmit Coordinator Building
Workflow Sign-off: [l" Sign-off 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.
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: _ Ad, __...&_.
Date: 6/G4
Engineering Review
Slope at building pad:
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: El Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approveby ngineerin
Date:
Notes: Gi/r)54 0° pates`' '4—kid r-Pfil .
1
Approved by Engineering: lz 1 Date: 7--/L —AF
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
El Conditions "Met"prior to issuance of building permit
7fkpproved
,NOT Released: Date:_'/141/1
„D
Notes: e rrl cA—Cr- '
"i7
C
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: M Yes ❑ N/A
Tigard Trans SDC: /:•Yes ❑ N/A
Parks SDC: r, es ❑ N/A
OK to Issue Permit �` f/ l
roved b Permit Coordinator: Date:
eP Y
I:\BuildingTorms\BldgPermitRvw_RES_060116.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9290 SW EDGEWOOD ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2016-00275
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9290 SW EDGEWOOD ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2016-00275
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9290 SW EDGEWOOD ST, TIGARD, OR, 97223 April 3, 2017 at 10:15:45 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00275
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Expose storm cleanout for final inspection.
Provide permit and final inspection for lawn irrigation Backflow devise.
Note: for building final inspection, mechanical final for AC on separate permit needed.
Provide permit and inspection for lawn irrigation Backflow devise.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9290 SW EDGEWOOD ST, TIGARD, OR, 97223 April 6, 2017 at 8:09:09 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00275
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Final erosion control approved.
Street tree certification received.
Moisture content form received.
High efficiency lighting form received.
Duct seal test report checked.
Insulation certification checked.
C of 0 left with contractor.
Violation Summary:
Inspector Contractor