Permit (102) CITY OF TIGARD MASTER PERMIT
I COMMUNITY DEVELOPMENT
}a �, I' Permit#: M ST2017-00292
T f C-A R.T7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 III7 I ! ', Date Issued: 08/24/2017
IIIPII Parcel: 2S110AC00200
Jurisdiction: Tigard
Site address: 10982 SW ANNAND HILL CT
Subdivision: ANNAND HILL SUBDIVISION Lot:
Project: Annand Heights, Lot 25
Project Description: New SF. 3/20/18: REPRINT to change address from Annand Ct.to Annand Hill Ct.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 897 sf Basement: 0 sf Left 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1275 sf Garage: 351 sf Front 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 2172 sf Value: $264,461.79 Rear: 15
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
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0
Bckflw Prevntr: 0 Catch Basins: 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: 6 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: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF
VB R_3
2172
Owner: Contractor:
ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
12655 SW NORTH DAKOTA ST TIGARD,OR 97223
TIGARD,OR 97223
PHONE: 503-780-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,945.54
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.
_X); :: Ze . _ ________ _
Issued By: Af• �,r Permittee Signature: r Q JGfrf: 4
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.
71 . CITY OF TIGARD MASTER PERMIT
44
11 ."'- COMMUNITY DEVELOPMENT Permit#: MST2017-00292
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/24/2017
t.O� '"L 9 Parcel: 2S 110AC00200
Jurisdiction: Tigard
Site address: 10982 SW ANNAND CT
Subdivision: ANNAND HILL SUBDIVISION Lot:
Project: Annand Heights, Lot 25
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 897 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1275 sf Garage: 351 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2172 sf Value: $264,461.79 Rear: 15
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
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 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: 6 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: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2172
Owner: Contractor:
ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
12655 SW NORTH DAKOTA ST TIGARD,OR 97223
TIGARD,OR 97223
PHONE: 503-780-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,945.54
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. btain a of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 ,
•
Issued By: �/ g 244 G. Permittee Signature:
al 03.639.4175 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.
B>!I<ildsng Permit Application � ,��� JJ` / 7S
EcE 1
Re idtntiial roit of i ici: a sI: 0y1,1
• City of Tigard J U L 2 7 2011 Received /
Date/By: r/„. 77 I Permit N _ST7, ,/�•�
13125 SW Hall Blvd.,Tigard,OR 97223 ( !r Y/
t , " an Review` ! / . ) y► Other Permit: {
' _ Phone: 503.718.2439 Fax: 503.598.1960„,� , Date/By: /f !
i-i ARD Inspection Line: 503.639.4175 U L— 4 " Date Ready/By: Juris: Seehe 2 for
Internet: www.tigard-or.gov Notified/Method: tif4p., Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
XNew 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.
Valuation:
14 1-and 2-family dwelling 0 Commercial/industrial $ !
4 g 4) i'6) 41
0 Accessory building 0 Multi-family Number of bedrooms:
o Master builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AM) LOCATION Total number of floors:pi. sa•Z D.3
Job site address: Ing t2 5�.� A..m,,,,c4 x- C�
New dwelling area:a' 1 a square feet
City/State/ZIP: ;,y- ,k , CC. l-L-1 3 Garage/carport area: 3,5 ) square feet
Suite/bldg./apt.no.: Project name: IL.l ,,-cc t 1'0-5Covered porch area: 6 b square feet ja7 s'
Cross street/directions to job site: ..c j, ‘0q-ll+l,� Deck area: square feet 89 7
Other structure area: square feet V
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ,k J„C,c' Lot no.: 2,s Permit fees*are based on the value of the work performed.
Tax map/parcel no.: J Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
CQL e
Existing building area: square feet
New building area: square feet
fit
PROPERTY OWNER ❑ TENANT Number of stories:
Name: kci, 1rdI ae(f Co 1D- Type of construction:
Address: \�r-Sc c t<:.'04.14_, c),, l,-c. cj Occupancy groups:
City/State/ZIP: -1, ,t,(1 1 (xi., Cl-1n Existing:
Phone:(�5 3,) 7 t l-.2,)-'1 c Fax:(';'.6 ) /;-1 b, - '76-7New:
a APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer tofee schedule)
Business name: 54.) e (A ttA 1
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
• Commercial and residential prescriptive installation of
CONTRACTO roof-top mounted PhotoVoltaic Solar Panel System.
Business name: F r ` p ,�,, -- Submit two(2)sets of roof plan with connection details
`• �tf I a- s ('I 63 (L t ' and fire department access,along with the 2010 Oregon
Address: 12(t - s ` t,j 4t /9,21,442.,. Solar Installation Specialty Code checklist.
City/State/ZIP: I` Permit Fee(includes plan review $180.00
5,-' - , C'� 1 Zr and administrative fees):
Phone:(eic7 ) 7f,0 :..y ?- Fax:(5eS ) S (12%
i L-_-J�.i Yf,, State surcharge of permit fee): $21.60
CCB lic.: Total fee due upon application: $201.60
Authorized signature:it This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: / *Fee methodology set by Tri-County Building Industry
I') ( `L � Date: pi/ Service Board.
I:\Building\Permits\BUUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling roR orrlcl. rSF Oyl.
City of Tigard Received Permit No.:
iil13125 SW Hall Blvd.,Tigard,OR 97223 DatedDate/Bat
IIPhone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
TIGARD
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les 10 i/1
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0
6. Sewer permit. •• 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must cairy original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0
architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17".
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
echanical Permit Application FOR OFFICE USE ONLY
of Tigard Received
Permit N
e g Date/By: `/ 611. —00i 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
i Phone: 503.718.2439 Fax: 503.598.1960 Other Permit
Date/By:
TI G A R U Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
Mechanical permit fees*are based on the value of the work
V 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:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
[z 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: j3t 1ci 14,\\I I, Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: )• , i,.�4 X11 Furnace 100,000+BTU(ducts/vents) 54.91
�' " ' Heat pump 61.06
Suite/bldg./apt.no.: Project name: ( { Duct work 23.32
Cross street/directions to job site: `;L" 1Lri.l.ti 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: /',,c >' 04`S Lot no.: j' Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
',' `' ' ' DESCRIPTION OF;WORK , r Gas fireplace/insert 33.39
_ Flue vent for water heater or gas
‘ ..')..-Cl.
tv \•L 5 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
E I: ROPERTY OWNER` ANT
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
�� v:,,,du.. tt. rc c., � -1nL
Address: , i � 1_ ,y
equipment33.39
(Lim tiv Clothes dryer exhaust 33.39
City/State/ZIP: ,� Single-duct exhaust(bathrooms,
1 '( -C.t ( ,�2� toilet compartments,utility rooms) 23.32
Phone:(.R,-,;) e l�t ,_�tWFax (12;3) c 7(- L Attic/crawlspace fans 23.32
-., ..APNT PLI 7 ❑ NT : t Other: 23.32
Fuel piping:
Business name: i3 •\ 4 4`.; LAQ
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail:
LQ4,.,( L,,,1 t l 9 kviry u ,"1,,p(.=;,..421,...v, CBarbecue
C 1,1
, , CONTRACTO1,R !',X4 s Clothes dryer(gas)
Business name: Fl 11 Other:
'°" a ,„11MEC$A.NICAT;pERMIl` ES*' ' �h
Address: 13 1 [�
c jCi' N1r4ra l�tuvlr, or Subtotal
City/State/ZIP: ^r -Th S Minimum permit fee($90.00)
Phone:( ) , Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.: 72_ (-4,23 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: / * Fee methodology set by Tri-County Building Industry Service Board
Print name: 6 i3O ‘2).....5e I- J Date: -i Iii 11-)
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard . .
Page 2 - Supplemental Information •
•
Commercial& Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit Application FOR orrice. F SL o N..l.l
k j` , ofTlg and Received ,
Date/B
U 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' a Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Jury: ® See Page 2 for '
T I G A K D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
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.
CATEGORY OF CONSTRUCTION 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
amps for all other installations. buildings.
0 Multi-family ElMaster builder 1:1um Other: ❑Fire
p p. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: IDA/t2. r p' (i -f- 10OHP or more. ❑"A","E","1-2","l-3",
.ltaU l;_„ / tY c.
City/State/ZIP: �j(�Y f l ❑Six or more residential units. occupancy.
,: e K-_ 1 l` / ?223 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than
rvs "V\'.-(.t e`� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 5L i C'i 1"h FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: ,f cyy kV:,SYALot#: 2,45- 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
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
LZ.L() I Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
M.PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: qj`l,6 r, .0 1 Ccl t,,{,,.tvJ` af\e 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: \1115 A:&. tCtax'tl. c")..,17•1„.. '''4.
401 amps to 600 amps 200.34 2
City/State/ZIP: -t-"S`'Z.J` Q (-a q-7 ") 601 amps to 1,000 amps 301.04 2
Phone:(*)2,) 7er*c 'Lf � �Fax:(a;-L- ) , ���'if y Over 1,000 amps or volts 552.26 2
- 3 -
Temporary services or feeders installation,alteration,and/or
Email: L0,a (t L.Ckv'i 4'1i-'^nt`i Al.(, € 4 ry1a. .1 : coy) 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
Eif
APPLICANT CI CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 3i1lv-4- 4.ts- 431-„z",.ke.- above service or feeder fee,
7.42 2
each branch circuit
Contact name: 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
' dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 91 P.1Mh.t.t A5'Z 1F[f'fY i Sign or outline lighting 67.84 2
Address: n Signal circuit(s)or limited-energy ❑ See Page 2 22
2''Z,1 .jt 2 7 ICA t.�C•rlt/'.L(cs -11 I panel,alteration,or extension.
City/State/ZIP: l [ _ Each additional inspection over allowable in any of the above
(41cQi N C).1-25j Additional inspection(I hr min) 66.25/hr
t
Phone:(5t') ,.� 1 pl-L,-i 1 1 Fax:('SCI)) LI-it 43-113 Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: ( el r(;7 Lt., Electrical Lic.: L_ flit. Suprv.Lic.: I �
.. --(#.C. c- specifically listed(%Z hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 7
C Li y`, Subtotal:
Print name: Lhlw� t A�,. D �'4 I 110Plan Review Required(25%of pennit fee):
v+`* State surcharge(12%of permit fee):
Authorized signature: (Ave-) . TOTAL PEIT FEE:
" This permit application expires if a permit is not obtained within 180
Print name: cvv f 5 {�P4at Date: 1 f i l l i1 days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 0671i/2015 440-46151(11/05/COM/WEB
Electrical Permit Application—City of Tigard kik
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description Qty. I Each Total •
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar 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:
❑ 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('/hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY:
Subtotal(Enter on 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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ 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:\Budding\Permits\ELCPermitAppELR_ERE.doc Rev 06/17/2015
,PlumbinPer
g mit Application s� ,
Building Fixtures -i1 rN', . k�°
Received
City of Tigard J J L / 0 / Date/By: Permit N>:12,� J /�(/A C 1 ,./ (r y l�5 Z
IN NI 13125 SW Hall Blvd.,Tigard,OR 97223 a' N
iC Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 -1 Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 E'Li: F, a ;'r Date Ready/By: Juris: la See Page 2 for www.tigard-or.gov Notified/Method:
Supplemental Information
.: ' TYPE OF WORK. ' FEE* SCHEDULE
[)ZNew construction 0 Demolition For special information use checklist.
Description Qty. I Ea. I Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Nr1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE.INFORMATION AND LOCATION Site utilities:
Job site address: lG(I Y..1. L if t' ` `L,tk L(.
Catch basin or area drain 18.76
T�` Drywell,leach line,or trench drain 18.76
City/State/ZIP: -7-1,,; l e1 n t�
�� 1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: fie'( \- ,� Manufactured home utilities 50.03
Cross street/directions to job site: <L 1 7)Cly 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: l t,,\ ',,v,,,kS I Lot no.: 25 Fixture or item:
Tax map/parcel no.: `.) Backflow preventer 31.27
7
Backwater valve 12.51
DESCRIPTION OF WORK •
Clothes washer 25.02
13k 3 F12- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
tif PROPERTY OWNER 1 ANTS-<' Expansion tank 12.51
Fixture/sewer cap 25.02
Name: LC%rdl.ctri.7C9 Cz.r^`C. :,c' ...„'1 1^(_.
Floor drain/floor sink/hub 25.02
Address: l�
l L(I �)1`) 1).T oda, L_{9�C `;+ Garbage disposal 25.02
City/State/ZIP: si-,. 0 t I,2_ 1..7223 Hose bib 25.02
Phone:(')-Z;-)) .1 t3-1S Fax:(ST,',,) 5-5.4:, ..7L„.i.-:{ . Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: r Medical gas(value:$ ) Page 2
Ye^t Li"5 /its'17 • Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
{ u q"r��.C�"Z)C V1CF'Q/CS(VC t',z l. C`1ei Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: ' ('}ie�^C.: pit,.l ht,1s -in( Water piping/DWV 56.29
Address: t kk u 1.1. ii ti,,-) lac/ Other: 25.02
City/State/ZIP: Clt5I rf1 ci-s CC_ CIDt(5- Subtotal
Minimum permit fee: $72.50
Phone:(Sts ) 7 21 60(..- l") Fax:('522;;) '71;_ i c5^ i
CCB Lic.: 16
L124 Plumbing Lic.no.iice tog Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:_Fax 7/1/240 TOTAL PERMIT FEE
ii^^ Date: 7 This permit application expires if a permit is not obtained within 180 days
Print name:
pe� 1, )h+1� /fit, 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(l0/02/COM/WEB)
Plumbing Permit Application - City of Tigard �. . .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities 2ty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1s`100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other er InS ections or Fees Qty. Fee(ea) Totaleach additional$100.00 or fraction thereof,to
Inspections and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations.:
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Stall 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each
Tani as defined in OAR918-780-0040.
Cuspidor/Water Aspirator-Drive
0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or.Riseriagram
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
'I COMMUNITY DEVELOPMENT DEPARTMENT
:1111 11
T I G A R D Building Permit Review — Residential
Building Permit #: ,4j r c /.„eV 2._
Site Address: -/ rm onoC. 1.-.ei9ht3
Project Name: t 0q 9 2 Ste/ Psn no n d 1-1-111 C.}- Lot #: ZS'
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
EpProposal: N eAA/ SE-
p/
Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: ie No El Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Three(3)copies of site plan B Bring 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&easements(required for new and additions)
/Site address,project or subdivision name and lot number /Sidewalk/driveway approach
`Applicant information(name and phone number) UL.,.atiu.i of wells/septic systems
/Lot dimensions and building setback dimensions -fig-trees to be retained with drip line,and tree
//Square footage of buildings to be demolished protection measures
/Lot area,building coverage area,perc age of coverage and /Street tree size,type and location
impervious area(applicable if R-7, -12 R-25&R-40) names
/Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced?-JYes Er-No SUQ
4 foot differential) If yes,is a storm water quality facility shown? Ci Yes LJ I-o
71 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: El Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI) Permit: PF- —Go 1 ld—0o o S O
Required: ❑ Yes,applicant was notified El No Applied For: I/Yes El No,stop intake
A Land Use Case#: ' D(Z2oiS -- 00003 SUB Z0 )S -- 0 0013
/
Zoning: (2- —(2-
XRequXRequired
ired Setbacks: Front 1 5 Rear , 5 Side 3 Street Side ca Garage 2,7
Vi Landscape Requirement: ¶i0 %
gr Lot Coverage Maximum: g D %
XBuilding Height: Maximum Height 35 Actual Height i g
Visual Clearance
'ye Lands: El Yes El No Type
Urban Forestry Plan
71 Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: M eM— 111/--------,=-- Date: 1 / 27 , 1 1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved El Not Approved
Revision 3: ❑ Approved El Not Approved
I:\Building\Fonns\BldgPermitRvw REs 061417.docx
Building Permit Submittal
Original Submittal Date: 742 7/7 7
Site Plans: # 3
Building Plans: # J
Building Permit#: Enter building permit#above.
Workflow Routing: Planning cr Engineering 'Permit Coordinator Building
Workflow Sign-off: 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: �. ,, -4t, .....i:—,Z,/,‘ Date:
Engineering Review Q
E Slope at building pad: j
)
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
j:KWater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes --Er.-No
Assess Water Quantity Fee in-lieu: ❑ Yes , ' No
LIDA Facility on lot: ❑ Yes IC No
ElNOT Approved by Engineering: Date:
Notes: it}>4 I r f - 0.„4---,
,,--6) ie--___K-- --e---
Approved by Engineering: 44/ iGti Date: , 3 l 2_//7
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:
‘79DC Fees Entered: Wash Co Trans Dev Tax: es ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: 'Yes ❑ N/A
LIDA ❑ Yesi\T/A
tg OK to Issue Permit
/ /fitIK:oateA/illlt
Approved by Permit Coordinator:
I:\Building\Fonns\BldgPennitRvw_RES 061417.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10982 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00292
Inspection Type: Inspector:
299 Final inspection Allyson Armstrong
Result:
PASS - CofO
Comments:
Previous correction complete.
Collected
Moisture content acknowledgement form
High efficiency lighting form
Air leakage test report
Street tree certification and verified tree location
Left C of 0 on the counter.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10982 SW ANNAND HILL CT, TIGARD, March 22, 2018 at 9:19:16 AM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00292
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS
Comments:
No A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10982 SW ANNAND HILL CT, TIGARD, March 22, 2018 at 9:18:21 AM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00292
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Water pressure = 70 psi
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10982 SW ANNAND HILL CT, TIGARD, May 1 , 2018 at 9:22:31 AM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00292
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS
Comments:
Previous corrections completed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10982 SW ANNAND HILL CT, TIGARD, May 8, 2018 at 9:24:59 AM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00292
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Condensate buried left side, does not terminate above grade or approved
location. M1411 .3
Seal foundation vent at same location. R408
House locked, no access for inspection, no further inspection done. R109.1
Violation Summary:
Inspector Contractor