Permit (55) CITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT74
Permit#: MST2016 00298
Date Issued: 05/16/2017
T l t ART)T) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 1
1!' Parcel: 2S 104AC 10900
1/ I� Jurisdiction: Tigard
Site address: 12817 SW 133RD AVE
Subdivision: Lot:
Project: Walnut Ridge, Lot 1
Project Description: New SF. 7/12/17: REPRINTED permit to show 80 sq.ft.deck addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 1352 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1533 sf Garage: 491 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2885 sf Value: $348,979.03 Rear: 20
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 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: 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: 5 201-400 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 2885
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PKWY 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
#370 BEAVERTON,OR 97006 2 Geotechnical Inspection
BEAVERTON,OR 97006 Required before foundation
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $30,921.53
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: « Permittee Signature: �'! �
«,- 503.639.4176 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.
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN
- Transmittal Letter
r ,,,,is r, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: TOM HOCHSTATTER DATI[�f $ 1Q3ET)
DEPT: BUILDING DIVISION [� j'�j
JUL 10 2017.
FROM: BRETT GROVES CITY OF ARD
COMPANY: RIVERSIDE HOMES BUILD ' DIVISION
PHONE: 503-581-3138
RE: 12817 SW 133RD AVE i T2016-00298
(Site Address) ^ Permit Number)
WALNUT RIDGE, LOT 01 I I
(Project name or subdivision name and lot number) /1 () i
A/A
ATTACHED ARE THE FOLLOWING ITEMS• 1 / I U
3 Additional set(s)of plans. c-u1' Revisions:
Cross section(s) and details. I. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
3 Other(explain): SITE PLA► TO SHOW DECK
REMARKS:
MAIN FLOOR BATH WAS NO: ACCOUNTED FOR IN ORIGINAL SUBMISSION
ADD�DECK TO THE RE'i' YARD Cib 1 X g I l g Q
� % z, v� ;.a,1 � =P" �.
Rout-. o Permit Tee', ician: Date: 7- —Y 1-7 Initials:
Fees Due: 11 Yes ■ No Fee Description: Amount Due:
1 Nr P1 w, re–v;t,,. $ q0 —
$
. a _ $
Speci a
Instructions:
Reprint Permit(per PE): 54 Yes ❑No ❑ Done
Applicant Notified: Date: 77/ll/i Initials: ` ---
31)01<r.... 7' untie..
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
CITY OF TIGARD MASTER PERMIT
illhlCOMMUNITY DEVELOPMENT
Permit#: MST2016-00298
Date Issued: 05/16/2017
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AC1 0900
Jurisdiction: Tigard
Site address: 12817 SW 133RD AVE
Subdivision: Lot:
Project: Walnut Ridge, Lot 1
Project Description: New SF
BUILDING
Floor Areas Reauired Setbacks Required
Stories: 2 Bedrooms: 4 First: 1352 sf Basement: 0 sf Left 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1533 sf Garage: 491 sf Front: 15 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 2885 sf Value: $347,245.43 Rear: 20
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF RainStorm Sewer: 100
0
Tubs/Showers: 3 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: 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!500 sf: 5 201-400 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 2885
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PKWY 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
#370 BEAVERTON,OR 97006 2 Geotechnical Inspection
BEAVERTON,OR 97006 Required before foundation
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $30,831.53
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cod... and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuan/e, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a coy, .-rules or direct questions to OUNC by calling 503.i2.1987 or .800.332.234.
( _ ..a
Issued By: �'�er-- Per -e Signature: /
.3.639.4175• by 7:00 a.m.for the next available inspection date. r -
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
t; I
Building Permit Application
Residential FOR OFFICE USE ONI-1
R FA
PIED
7 Received n �y;
City of Tigard
Date/By: 7 ;(6- �1 Permit No.: T����a 7X
13125 SW Hall Blvd.,Tigard,OR 9722 l l!
1S 1 Plan Review 49
1 Phone: 503.718.2439 Fax: 503.598.1 60 L 2 J Z 6 Date/By: ♦ ♦_.� Other Permit�� !d,_ ��,
7- c; ,R I-, Inspection Line: 503.639.4175 Date Ready/By: �j ��� ,,Q� Juris: (a See Page 2 for
Internet: www.tigard-or.gov � 6 (,),- a 0,-...7,1?-;,! Notified/Method: D��f�� Supplemental Information
3i? 1):N.',,- '''xtr ° I4
4 „N . 7 ." art>?°,^ x, .. i D A15I$+ ",.Z+R „Y t
u.. _z'g , „,moi r r „ 4J- ..
Z New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
o Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
s r e (" work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ . { �+7, G},
❑Accessory building 0 Multi-family Number of bedrooms: \ L-.
❑Master builder 0 Other: Number of bathrooms:
Le4*''*
a1 $, * „t a Total number of floors: 2 '33 /. aJJob siteaddress:12817 SW 133rd New dwelling area: 2885 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 491 square feet
Suite/bldg./apt.no.: Project name:Walnut Ridge Covered porch area: 45 square feet s' 23
Cross street/directions to job site:SW Walnut and SW 133rd Ave Deck area: square feet 13sa
Other structure area: square feet
Subdivision:Walnut Ridge Lot no.:001 Permit fees'are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
Construction of SFR Home Valuation: $
Existing building area: square feet
New building area: square feet
'3 OWN i �„ - Number of stories:
Name:Riverside Homes,LLC Type of construction:
Address:17933 NW Evergreen Parkway,Suite 370 Occupancy groups:
City/State/ZIP:Beaverton,OR 97006 Existing:
Phone:(503)645-0986 Fax:( ) New:
„� � # At,,':4"'"-'
a ia ,F',,:. '.1 f" :.!*'1416
a � 4. • 4' #•, '*),:11;::',* mow- . :.
Business name:Same as Above =' " ti
Structural plan review fee(or deposit):
Contact name:Wes Boisvert
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fax:
( ) Amount received: 7�'49'
•‘;•,'"'"..r; tk �
0.
E-mail:wboisvert@riversidehome.com y , „: r., "
z Commercial and residentialprescriptive installation of.r r0. roof-top mounted Photo +ltaic Solar Panel System
Business name:Riverside Homes,LLC Submit two(2)sets of roo an with connecti s• •etails
and fire department access,a 4 g with - 110 Oregon
Address:17933 NW Evergreen Parkway,Suite 370 Solar Installation Specialty Co list.
Permit Fee includes re,.
ew $180.00
City/State/ZIP:Beaverton,OR 97006 and a tstrarive fees`
•
Phone:(503)645-0986 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lic.:189148
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Wes Boisvert Date:07/12/2016 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440 4613T(11/02/COM/WEB)
•
Electrical Permit Application H 1 \,1 FOR OFFICE LSE OyLv
City of Tigard Received
/ 2 O q C Date/B : 7 /ej J Perm"' 1-157-,PakcC a.5 q
13125 SW Hall Blvd.,Tigard,OR 97223JUL 2 I U Plan Review
i Phone: 503.718.2439 Fax: 503.598.1960Date/B Related Permit#: a-cj//e-61096_
Inspection Line: 503.639.4175 CITY Q „ 1 t t,F, ,eady Date/By: Juris: Bl See Page 2 for
I 1 G A R 1 Internet: www tig -or. ov
and g g I pLsI 'z e�,. D (l't..«t i t ed Method: Supplemental Information
�5 g 4- s
: t .1' 'x .1 .;, - - r t tlly"vnb' T a ` ;
®New construction 0 Addition/alteration/replacement ■ Please check all that apply(submit 2 sets of plans w/items checked):
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.
''"t°8 RY;'-OPS ,/ )ctIl ; "" , r _,1:,::,,:44,.: exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-familyMaster builderamps for all other installations. buildings.
0 0 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
,-' '' ''
� � . JOB 4���INFO*t- t'' i< •a i''>�OeA�`Itltl3 : 0 Emergency system. larger separately derived
Job#: I Job site address: 12817 SW 133rd Ave ❑Addition of new motor load of system.
100HP or more. ❑"A","E","I-2","1-3",
City/State/ZIP: Tigard, OR 97223 ❑Six or more residential units.
doccupancy.
g 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: Walnut Ridge 0 Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Walnut&SW 133rd Ave. £_ ,x :.:h tr'i •
Description I Qty. I Each '1 Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Walnut Ridge I Lot#: 001 Includes attached garage.
1,000 sq.ft.or less ) 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion " 33.92 1
' .. 't .T,4. Limited energy,residential ) 75.00 2
(with above sq.ft.)
Construction of SFR Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
ei `°,' , oPEI C wNIR -- ` t ` '_gi d •_ RSnveiweasboler edrfs installation,alteration,aaged2/o
r relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen Parkway, Suite 370 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( 503) 645-0986 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: wboisvert@riversidehome.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
al I Branch circuits—new,alteration,or extension,per panel
� #l�fl.► 77,,,,,i.:,;..... ...„4
� -__ A.Fee for branch circuits with
Business name: Same as above above service or feeder fee,
7.42 2
each branch circuit
Contact name: Wesley Boisvert B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: wboisvert@riversidehome.com Reconnect only 67.84 2
, ' ► e!z... vi ro r , ,P„:4 Pump or irrigation circle 67.84 2
Business name: Gamer Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 2920 SE Brookwood Ave#1 panel,alteration,or extension.
City/State/ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 503) 648-4552 Fax:( 503)642-7925 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: ge@garnerelectric.com Inspections for which no fee is
CCB Lie.: 121159 Electrical aze
Lie.: 37075 Suprv.Lie.: specifically listed(%A hr min) 90.00/hr
Suprv.Electrician signature,required: rt*WM#., Ver
Subtotal:
Print name: Chuck Garner I Date: 7/12/2016 0 Plan Review Required(25%of permit fee):
1 State surcharge(12%of permit fee):
Authorized signature: q� 3 TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Wesley Boisvert Date: 7/12/2016 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:Building\Pmnits\PLCPermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Mechanical Permit Application Foa OFFICE USE ONEv
City of Tigard 11;,;( ED
Received lb ^Jo
�,^,� DateBy: 7' PerndtNo.:Hy/-2.1,,/o...60 p g I
1111q II 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ,
q 2016
d 16 DateBy: Other Permit:
fiaj� 2....Inspection Line: 503.639.4175 J U L G �
TtGnRD Date Ready/By: Juris: 63 See Page 2 for
Internet: www.tigard-or.govr, 5,., Notified/Method: Supplemental Information
en Y Or Pi
x '*$x ' TY '-`. 1Sl� cco . E'. ,.int, , ,: : .' 9 .,
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
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition ❑Other:
' Value:- , r
', ;. eATEGORY OF1 0U i! .u. 1 1ES�iF1���. �e
/�...� f Y�1EVl3 > .k
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. _ Total
Fd$ 'tiK:. J 1 �,..I I +: a Heating/cooling:
A" ,� '' a ,,. H, Ak,*� . ''' "''.I Air conditioning 46.75
Job site address: 12817 SW 133rd Ave Furnace 100,000 BTU(ducts/vents) 1 46.75 4R 75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name: Walnut Ridge Heat pump 61.06 Duct work 1 23.32 23 32
Cross street/directions to job site: SW Walnut&SW 133rd Ave. 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 1 23.32 23.32
Subdivision: Walnut Ridge I Lot no.: 001
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23 32
t d x, Ii~ ,.::1";:f.--''''.0 t N t a` f • . Gas fireplace/insert 1 33.39 33 3g
'"'4" ` f':- ¢`` Flue vent for water heater or gas 23.32
Construction of SFR fireplace 1 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
lia'PROPERTY « R :A I. t," 'i Arilt1
Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Range hood/other kitchen
equipment 1 33.39 33.39
Address: 17933 NW Evergreen Parkway, Suite 370 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Beaverton, OR 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32 116.60
Phone:( 503) 645-0986 Fax:( ) Attic/crawlspace fans 23.32
qqT • u" IC ` a
Other: 23.32ii
Fuel piping:
Business name: Same as above $14.15 for first four;$4.03 for each additional
Contact name: Wesley Boisvert Furnace,etc. 1 14 15
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) I Fax::( ) Fireplace 1 14 15
Range 1 14 15
E-mail: wboisvert@riversidehome.com Barbecue
°_. , t C t,. Clothes dryer(gas)
Other:
Business name: Pyramid Heating&Cooling i, n t AI.PE t l�
Address: 9409 NE Colfax St. Subtotal 39g 25
City/State/ZIP: Portland, OR 97220 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 503) 786-9522 Fax:(503)786-3432 State surcharge(12%of permit fee)
CCB lie.: 59382 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
�tlPbr days after it has been accepted as complete.
Authorized signature: rt * Fee methodology set by Tri-County Building Industry Service Board
Print name: Wesley Boisvert Date: 7/12/2016
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Plumbing Permit Application
Building Fixtures ( 1/ : FOR OFFICE I.SF ONE\
Ci of Tigard Received ��ny-, A ' !� ��d
g Date/By: 7 'S ' l Permit No.: /75 T� a 9 g
II 13125 SW Hall Blvd.,Tigard,OR 972�3i 2c? 2016
= Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.:
Date/By: /1,--ex �^
Inspection Line: 503.639.4175 ; a w`t
l,1 1 t;q R I 1 CITY �. w Date Ready/By: Juris: rii See Page 2 for
Internet: www.tigard-or.gov 5 v l 4r,/I C.:',!C:,-t Notified/Method: Supplemental Information
`k ,c s .s ,6 $ t
®New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
'GY`bF C NST/ruc .'ION,', SFR(1)bath 312.70
CJIR
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(_sq.ft.) Page 2
s SITE,1 ORMi OYtf ` t t e Site utilities:
Job site address: 12817 SW 133rd Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Walnut Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Walnut&SW 133rd Ave. 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: Walnut Ridge I Lot no.: 001 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
,,,;.* ?•:. ;. Backwater valve 12.51
Clothes washer 25.02
Construction of SFR Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
'74,,,,,Z,Ake-::,' RI I' ,.:It 'Ixty z
Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Parkway, Suite 370 Garbage disposal 25.02
City/State/ZIP: Beaverton, OR 97006 Hose bib 25.02
Phone:(503) 645-0986 Fax:( ) Ice maker 12.51
',O "Pile" } ; X3077 Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: Same as above
Primer 12.51
Contact name: Wesley Boisvert
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: wboisvert@riversidehome.com urinal 25.02
Y2,,n , .. Water closet 25.02
.. Ik, � ._ Water heater 37.52
Business name: H &H Mechanical Water piping/DWv 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Phone:(503) 975-9787 I Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 178122 , J Plumbing Lic.no.: PB414 Plan review (25%of permit fee)
14-14-124-4,;) State surcharge(12%of permit fee)
Authorized signature: 3 v."4 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: Wesley Boisvert Date: 7/12/2016
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
a IIICOMMUNITY DEVELOPMENT DEPARTMENT
■
T I G A R D Building Permit Review — Residential
Building Permit #: H 5 i a-o i (i - CO a9 q,
Site Address: l Z{1j l S Vl'(ii
Project Name: WGllnu,-k- 120Lot #: i--)X.
(New dwelling=subdivisime;Addition or Alteration=last name of owner)
Planning Review
Proposal: New SQL
ik Verify site address/suite#exists and active in permit system.
0 River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Three(3)copies of site plan nLExisting structures on site
..,Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
,Drawn to scale(standard architect or engineer scale) floor elevations
North arrow Utility locations(required for new,may apply for additions)
,,Site address,project or subdivision name and lot number Y' ocation of wells/septic systems
1RlApplicant information(name and phone number) hViExisting trees to be retained with drip line,and tree
,I$Lot dimensions and building setback dimensions protection measures
i,ot area,building coverage area,percentage of coverage and Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) IRStreet names
Property corner elevations (2 foot contour lines if more than
4 foot differential)
Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
12(Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified r7l No Applied For: ❑ Yes ❑ No,stop intake
.IS' Land Use Case#: Wi 7OtL --0X0 11
Zoning: Q L.
W Setbacks: Front 70 Rear �G) Side 5 Street Side tS Garage 2.0
Nt Landscape Requirement: Nnfig
13-Lot Coverage Maximum: vvic %
Building Height: Maximum Height Actual Height±24
,I Visual Clearance
Easements
Sensitive Lands: ❑ Yes 4. No Type
ISI Urban Forestry Plan
,Nit-'Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: PrAM 461,171-- Date: 1 15`lto
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES 060116.docx
Building Permit Submittal
Original Submittal Date: -7/44
Site Plans: #
Building Plans: #
Building Permit#: ErEnter 0' �rm
building permit#above. ,�
�
Workflow Routing: Planning L� engineering P''' ermit Coordinator I� tsutlding
Workflow Sign-off: EY Sign-off for Planning(include notes from planning review)
Route Application Documents: a-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: --N\
ByPermit Technician: �__).(7a0/0,0 -KA Date: 745.-//4'
WA
Engineering Review
Slope at building pad: 6j
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 C, No
LIDA Facility on lot: ❑ Yes yo
ElNOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 42 .27Date: 7.4„z 7—/J
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:
SDC Fees Entered: Wash Co Trans Dev Tax: 'P Yes CI N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
OK to Issue Permit
,--
Approved
Approved by Permit Coordinator: 700/Date: -/c -4" i fr
I:\Building\Forms\BldgPerniltRvw_RES_060116.docx
City of Tigard
■
~ COMMUNITY DEVELOPMENT DEPARTMENT
�;,�,,1, Building Permit Review — Residential
Building Permit #: 1•.LTcp.o i (,-cc(9-9S
Site Address: t'2 fl LSw tk--Pi ,
Project Name: Watnu.+ 12 t' Lot#: i--)e,
(New dwelling=subdivis'. name;Addition or Alteration=last name of owner)
Planning Review
Proposal: New SQL
Verify site address/suite#exists and active in permit system.
1' River Terrace Neighborhood: kNo 0 Yes,See River Terence Review Addendum Attached
Site Plan Elements:
Ja.inree(3)copies of site plan nriExisting structures on site
Xsite plan must bj on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
' , Drawn to scale(standard architect or engineer scale) floor elevations
North arrow JEtUtility locations(required for new,may apply for additions)
Site address,project or subdivision name and lot number Vocation of wells/septic systems
U.Applicant information(name and phone number) ONExisting trees to be retained with drip line,and tree
.tLot dimensions and building setback dimensions protection measures
aikLot area,building coverage area,percentage of coverage and Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) Street names
Property corner elevations(2 foot contour lines if more than
4 foot differential)
)S1 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified 4ST No Received: ❑ Yes 0 No
' lk Public Facilities Improvement(PFI)Permit
Required: ❑ Yes,applicant was notified rI No Applied For: 0 Yes 0 No,stop intake
,S' Land Use Case#: Sk J$.901( —00011
1 zoning. Q 14. .
Setbacks: Front 2D Rear 1GJ Side 5 Street Side (J Garage 2D
A" Landscape Requirement y)(.
IT Lot Coverage Maximum: IAA,
Building Height: Maximum Height 3 Actual Height±24
,IR, Visual Clearance
Easements
Sensitive Lands: 0 Yes 14 No Type
Urban Forestry Plan
Air Conditions"Met"prior to issuance of building permit
Notes:
Approved By Planning: Date: 1 25 Ito
Revisions(after Building Submittal only) eviewer
Revision 1: Approved 0 Not Approved 7 In ate
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
1:1BuildingTorms181dgpeatnitRvw RES 060116.docx
Building Permit Submittal l
Original Submittal Date: 7// 7 0
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above. �,_
Workflow Routing: a'Planning L�'f. r ngineenng Permit Coordinator E tswlding
Workflow Sign-off: a Sign-off for Planning(include notes from planning review)
Route Application Documents: Er 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 Pe
rmit Technician: J Date: �/a r/k
Engineering Review
1
Slope at building pad: 6,
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: 0 Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot 0 Yes No
❑ NOT Approved Engineering: Date:
PP by �' ��
Notes: ' �I
Approved by Engineering: Date: 7;T i�t�
Revisions(after Building Submittal only) Reviewer Date
/19"V e ste,tdtevision 1: VI Approved 0 Not Approved 14 , %S}4tdl '7 ' 1.1-1-7
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
0 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: PYes 0 N/A
Tigard Trans SDC: Yes 0 N/A
Parks SDC: Yes 0 N/A 7` /of)/ —
OK to Issue Permit
" 4.-/j fr
APP y roved b Permit Coordinator: Date: ��
IABuilding\Forms\BldgPennitRvw_RFS 060116.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12817 SW 133RD AVE, TIGARD, OR, 97223 September 22, 2017 at
10:21 :11 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00298
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12817 SW 133RD AVE, TIGARD, OR, 97223 September 22, 2017 at
10:23:15 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00298
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
No ac installed at this time, permits and inspection required at time of installation.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12817 SW 133RD AVE, TIGARD, OR, 97223 September 22, 2017 at
10:24:08 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00298
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Outdoor outlet at rear deck not gfci protected.
No ac installed at this time.
All else appears ok.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12817 SW 133RD AVE, TIGARD, OR, 97223 September 25, 2017 at
2:43:01 PM
Record Type: Record ID:
Residential - Master Permit MST2016-00298
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Correction from previous inspection complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12817 SW 133RD AVE, TIGARD, OR, 97223 September 25, 2017 at
3:16:55 PM
Record Type: Record ID:
Residential - Master Permit MST2016-00298
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Final erosion control approved.
Street tree certificate received.
Moisture content form received.
High efficiency lighting form received.
Blower door test report checked.
Insulation certification checked.
C of 0 left on site with contractor.
Violation Summary:
Inspector Contractor