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Permit (105) CITY OF TIGARD MASTER PERMIT ;IN I . COMMUNITY DEVELOPMENT rs' �/� Permit#: MST2017-00360 T I c ; � ‘I<.n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 � i Date Issued: 11/02 /2017 Parcel: 2S110AD 11800 Site address: 10904 SW ANNAND HILL CT Jurisdiction: Tigard Subdivision: ANNAND HILL SUBDIVISION Lot: 30 Project: Annand Heights, Lot 30 Project Description: New SF. 3/20/18: REPRINT to change address from Annand Ct.to Annand Hill Ct. BUILDING Floor Areas Required Setbacks Stories: 2 Bedrooms: 4 First: 774 sf Rep Basement: 0 sf Left 3 Parking Spaces: ces: 0 Height: 24 Bathrooms: 3 Second: 1135 sf Garage: 380 sf Front 15 Smoke Dwelling Units: 1 Third: 0 sf Right 3 Detectors: Yes Total: 1909 sf Value: $236,052.35 Rear 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Urinals: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 0 Water Lines: 100 Drains: Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 BckFlw Prevntr: 0 Catch Basins: 0 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Tvpes 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 = 0 Gas Outlets: 4 Furn> ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders 1000 sf or less: 1 Branch Circuits 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 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 p W/O Svc/Fdr: 0 P 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: SF VB Square Feet: R-3 1909 Owner: Contractor: ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions) BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 Fire Rated Eave both sides 12655 SW NORTH DAKOTA ST TIGARD,OR 97223 TIGARD,OR 97223 2 Ersn Cntrl 503-639-4175 PHONE: PHONE: 503-625-6526 FAX: 590-7606 Total Fees: $29,408.14 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 95 01-0090. 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: ,(p, • �/ ��a Permittee Signature: r„'' l�/�!L rte./7 Call 503.639.4175 by 7:00 a.m.for the next available inspection date. �f 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. CITY OF TIGARD MASTER PERMIT II.' COMMUNITY DEVELOPMENTIN Permit#: MST2017 00360 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/02/2017 Tta;�R Parcel: 2S110AD11800 Jurisdiction: Tigard Site address: 10904 SW ANNAND CT Subdivision: ANNAND HILL SUBDIVISION Lot: 30 Project: Annand Heights, Lot 30 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 774 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1135 sf Garage: 380 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes Total: 1909 sf Value: $236,052.35 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 Rain0 r Storm Sewer: 100 Tubs/Showers: 2 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: 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 1909 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 2 Fire Rated Eave both sides TIGARD,OR 97223 PHONE: PHONE: 503-625-6526 FAX: 590-7606 Total Fees: $29,363.14 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 0 952-001-0 90. Y,qu may obtain_a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ,--e"(� t1s' Ce p Permittee Signature: ct'l'r /%� 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. • • t Building Permit Applicata • Residential FOR OFFICE USE ONLY City of Tigard e , , ,r. I/By: p�,tt . _a 13125 SW Hall Blvd. Tigard,OR 97223 t /�//7 ? ''p � Revi ... Permit N' �J/ � Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 0 -2- p'7 Ti Other tjio/� 0`2"-)76' 775 � T I GARD wInspection Line: 503.639.4175 SEP 2 0 2017 Date Ready/By. luras: p2GSee Page 2 for Internet: ww.tigard-or.gov Notified/Method:/0(1/(7 A. Supplemental Information e_r -g ` { =,\fIL'° TYPE OF.,WORKBU UILDI I. . 1 — REQUIRED DATA:1-AND 2-FAMILYDWELLING %New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ a.3 �I ©� a, --ii h1 ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: / 90 JOB SITE INFORMATION AND LOCATION ' Total number of floors: Q 9 Job site address: 4j ^/14�d (oh�7 New dwelling area:/fa 9 square feet OO City/State/ZIP: 2 Q IL ? Garage/carport area:/fa /� g rport area: ��K7'� square feet Suite/bldg./apt.no.: Project name: nn/14Ad Bet) ,6[� Covered porch area: 7 0 square feet I j 3 Cross street/directions to job site: Iii9 6 Deck area: / square feet 7a Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: AAaA,/ /.{J4h is I Lot no.: �i')� Permit fees*are based on the value of the work performed. Tax map/parcel no.: (! v / 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. Pelt) c,l` Valuation: $ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER Cl TENANT Number of stories: Name: ba_pop (-®Q 0 CO ��ti tSr ®� �'� Type of construction: Address: /01-.4 -s— 5'&.) l� Occupancy ko 14. 6' -rGT Occu y groups: City/State/ZIP: -7,4 a� r 4!'1 x23 Existing: Phone: 3 7 _ 7c Fax:(1?-3) $7V—77' 0APPLICANT New: ❑ CONTACT`PERSON BUILDING PERMIT FEES* Business name: cmi (Please refer to fee schedule) Contact name: Structural plan review fee(or deposit): Address: FLS plan review fee(if applicable): City/State/ZIP: Total fees due upon application: Phone:( ) Fax: :( ) Amount received: E-mail: C� a om�,4.?®,a AL Cq A s Cam PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* �lrt Qurler CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: Mari d�a,..5 L Submit two(2)sets of roof plan with connection details Address: v and fire department access,along with the 2010 Oregon �G' ,5-S 5CO /tier �� v € Solar Installation Specialty Code checklist. City/State/ZIP: 7/5 Q2 9-7 2..2-3 Permit Fee(includes plan review �' and administrative fees): $180.00 Phone:(1/45-&3) gel -L/6 75- Fax:( 6e'3 6`90—7ad4 State surcharge(12%of permit fee): $21.60 CCB lic.: 6---0/9� Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained _ ` within 180 days after it has been accepted as complete. Print name: 2-) _/2/ /t��S Date: *Fee methodology set by Tri-County Building Industry -"��+""�" Service Board. I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Applical R OFFICE USE ONLY City of Tigard Received . a '" i i Date/By:0 Permit No fti 13125 SW Hall Blvd.,Tigard,OR 97223 �1I, t ' Z J�/�/ {/7-Q�1 (�C7 Phone: 503.718.2439 Fax: 503.598.196 Plan11111 Review Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 [ nn 4/ Date Read Internet: www.tigard-or.gov )i �` U l! YBY kris: H See Page 2 for OF # t4 Notified/Method: Supplemental Information l-- Y { y i(,.� i . # fC .R, _ `<,TYPE 1F R'r, ".,g'WINGCOMMERCIAL FEE*.SCHEDULE- USE CHECKLIST dew constructionMechanical permit fees*are based on the value of the work 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. � � .r Value:$ - -," CATEGORY'OF CONSTRUCTION- r" RESIDENTIAL EQUIPMENT/SYSTEMS FEES* „ler: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 r 'Aj(.)g SftE'INFORIII<AlON.AND'"`LOCATION Heating/cooling: Air conditioning 46.75 Job site address/aflQ ,519-214a /Qli/`" Furnace 100,000 BTU(ducts/vents) .� 46.75 City/State/ZIP: 7----,,"„,,,,,,i ,�� /d, 9 , Furnace3 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Projekt name:'7 _i� ` Heat pump 61.06 n �'� ��G Duct work 23.32 Cross street/directions to job site: /69¢ f 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: �nn4 lidteo h 71j Lot no.•„ Other: 23.32 �� Other fuel appliances: Tax map/parcel no.: Water heater ✓ 23.32 rESCRIPIION. WORK , Gas fireplace/insert 33.39 4/C4--/- ccP1— Flue vent for water heater or gas fireplace —' 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ROPERTI' OWNER r"- Other: 23.32 . .. ©`TENANT. : Environmental exhaust and ventilation: Name: 6 ',ç /g , / )lig,57/ C.- Range hood/other kitchen equipment 33.39 45-5" 56,3 /vd��h Oa. .,o e brei Clothes dryer exhaust ."'" 33.39 City/State/ZIP: l e-rE� �. 23 Single-duct exhaust(bathrooms, / ' toilet compartments,utility rooms) 5 23.32 Phone:( 6-037d _ '1 G /' -c- Fax: ,3) gyo r:7` 2t Attic/crawlspace fans 23.32 PLICANT a"CONTACT PERSON. Other: 23.32 Business name: 50m� Fuel piping: $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 E-mail: Ran e �/,1 (Ila-cocf I,Oirte-5 Ua->d90/11-0-7 ' g ZlU Barbecued CONTRACTOR ryer(gas) r5/ Kit,// OClothesther: �3/� Ziac /e MECHANICAL PERMIT FEES* Business name: -F t Address: �Gin45 At1G/` pt.' Subtotal City/State/ZIP: ' f 3,, ,d& 4 D+ �Jdo 1- Y5--- '5J Minimum permit fee($90.00) Phone:( ) �f )"Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.: '7.2.6c23 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: call * Fee methodology set by Tri-County Building Industry Service Board Print name: - ceiteA Date: I:\Building\Permits%4ECC_PermitApp_040 11133.doc 440-4617T(11/02/COM/WEB) Electrical Permit Applicat )R OFFICE USE ONLY City of Tigard Received - ® 13125 SW Hall Blvd.,Tigard,OR 97223 r v,.)1,-• t Date/B : Permit#/7S 2;2e/7 aVo3 6 c Plan Review Phone: 503.718.2439 Fax: 503.598.1960 cRelated Permit#: �� �1 j Date/B Inspection Line: 503.639.4175 Ready Date/By: Juris: B See Page 2 for T I G AR D Internet: www.tigard-or.gov 3 a"' Notified/Method:'r - i,.., ti , a Supplemental Information TYPE OF WORT{ � • 1I I' ai "I 1!lti��li . I�_ PLAN REVIEW New construction 0 Addition/alteratl4 cement • Please check all that apply(submit 2 sets of plans w/items checked): my 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 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address �r�` ❑Addition of new motor load of system. _j /4/tt fl 4tt(, Atter/ 100HP or more. ❑"A" "E" "l-2" "1-3„ City/State/ZIP: a �9,,� (� �3 ❑Six or more residential units. occupancy. �� 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.4: Project name: fyy vta � !1- Ad t 0 Hazardous locations. 0 Supply voltage for more than t y n ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: �j1 t O th v FEE SCHEDULE 4 V7 Description I Qty. I Each I Total , New/ New residential single-or multi-family dwelling unit. Subdivision: Annan fT,C��S�L Lot#: Includes attached garage. Tax map/parcel 4: V 1,000 sq.ft or less 168.54 4 Ea.add'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential �/ ts''�2. (with above sq.ft.) / 75.00 2 j �f Limited energy,multi-family residential(with above sq.ft.) 75.00 2 'PIUOPERTY OWNERRenewable Energy 0 See Page 2 / 0 TENANT' Services or feeders installation,alteration,and/or relocation Name: ®� ,r.`jwad„` ats f-ra G 200 amps or less 100.70 2 Address: P�i�C,Ss ASCO Na,-V-h P ct,i(It 61 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 'L City/State/ZIP: 6,,c_ Q'72....23 601 amps to 1,000 amps 301.04 2 Phone:(lyi3 __ /• Tho/ 3 7S— Fax:(�,3 )57a —2444 Over 1,000 amps or volts 552.26 2 Email:lit.fr /�U✓-�.or i-QYlts fl�W / V"6 4 I ``h'il Temporary services or feeders installation,alteration,and/or ( 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 ICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A Fee for branch circuits with Business name: Le. above service or feeder fee, each branch circuit Contact name: 7.42 2 B.Fee for branch circuits without Address: service or feeder fee,first branch circuit 56.18 2 City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling, 67.84 2 Email: service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 j Business name: 424 i-A01 c frit /f Sign or outline lighting 67.84 2 Address: ii / / / Signal circuit(s)or limited-energy�'/ ODn j—( panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: �•4 g'l�1�� Each additional inspection over allowable in any of the above Phone: "3 (� +++ �� r�•fes ,e Additional inspection(1 hr min) 66.25/hr l/ -�7GC Fax:( G3) (i Yb—92)3 Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr /q6, 2,1,4 q / 7a^�/ ' Inspections for which no fee is CCB Lic.:/g6, Electrical Lic.:(— Suprv.Lic.:(5O.S specifically listed('/z hr min) 90.00/hr Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES Subtotal: Print name krt`5 ih ct ito Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature:^ — TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: C,f t r f p c, 11-0-As t Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/1*-d5 440-4615T(11/05/COM/WEB • p Electrical Permit Application—City Tigard 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 Descript1on I Qty. I Each I Total Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ 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 Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ 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 n Each additional inspection over allowable in any of the above: l l O• ther: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is specifically listed(/*hr min) 90.00/hr COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): (SEE OAR 918-309-0000) * Number of inspections allowed per permit. Check Type of Work Involved: ❑ A• udio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ D• ata Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC Li Instrumentation ri Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Plumbing Permit ApplicatIO Building Fixtures FOR OFFICE USE ONLY City of Tigard -t C v '""` Received _ n"°1 DateB Permit N9ti/f ''' a 13125 SW Hall Blvd.,Tigard,OR 972 . ,, c., � f- y" � �' - �' Plan Review Phone: 503.718.2439 Fax: 503.598.1960 D �y 02017ateBy: Other Permit No.: D Inspection Line: 503.639.4175 TIGARD L. Date Ready/By Juris H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information l' AHD TYPE OF WORIIY OF i I FEE* SCHEDULE` Prin For special information use checklist ew construction LOP-'I. o -' '' ' ` P r Description Qty. I Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) A CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 i-1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 El Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 -JOB SITE INFORMATION AND'LO CATION Site utilities: Job site address: /Iffy i f9-N A" /64 Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 1--A--/) O/•- -- v-2 -.2--3 Suite/bldg./apt.no.: Project name: dii`J A, Footing Manufactureddrahome(nolinear ieft ) 0 2 /1/16//► ! utilities 50.03 Cross street/directions to job site: Manholes 18.76 /®9 1 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: Al //ee 115 Lot no.:5c) Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 /UV-) 5,VL Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I , 0 TENANT; Expansion tank 12.51 Name: pjinaArC1 Qt� ZOrtS71-P Fixture/sewer cap 25.02 Address: /9 /5--5-54D �@rr j_/9 fL 5- �,,,�i Floor drain/floor sink/hub 25.02 v"'� Garbage disposal 25.02 City/State/ZIP: 77 a � 3 Hose bib 25.02 Phone:( O ,,' 7.5" Fax:(fe.3 3 -7ó2 Ice maker 12.51 0 APPLICANT El ,CONTACT PERSON Interceptor/grease trap 25.02 Business name: 5601 Medical gas(value:$ ) Page 2 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: kJ 1/t{j ill ere/ACV/1,e /V( ? /J//ta/'4 G[1' Urinal 25.02 vWater closet 25.02 CONTRACTOR f-,(dtf� lb Water heater 37.52 �- Business name: p0 - d 1°14.4,,6 Water piping/DWV 56.29 Address: /-- /00 5 hir 11 1TJ, / f" Other: 25.02 City/State/ZIP: OrcOA , G4 997.0 Subtotal Phone:(&3) 7,9.3 ^gS r Fax:(5Z3) -7- 3si,o/ Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: ,,/ .22 A39 Plumbing Lic.no.:-g s^-jdo 7� k✓ State surcharge(12%of permit fee) Authorized signature: 4AO TOTAL PERMIT FEE Print name: �J A /(J A.1Date: This permit application expires if a permit is not obtained within 180 days �/� '" after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 11111 City of Tigard M COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential e Building Permit #: /t/S-2-,20/7 _ 003 6 0 Site Address: 10°I 04 SW Ann Gin c& C,I- • Project Name: A nn P)n of 4eicd 3tj Lot #: 30 (New dwelling=subdivision name;Adaition or Alteration=last name of owner) Planning Review Proposal: NeAN S F 2 )1 Verify site address/suite#exists and active in permit system. River Terrace Neighborhood: / No ❑ Yes,See RiverTerrace Review Addendum Attached Site Plan Elements: [Three(3)copies of site plang 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 f ZrUtility locations&easements(required for new and additions) ❑Site addresssproject or subdivision name and lot number Sidewalk/driveway approach Applicant information(name and phone number) ❑L(. .ativII of wells/septic systems ZfLot dimensions and building setback dimensions Existing trees to be retained with drip line,and tree Square footage of buildings to be demolished protection measures iZitot area,building coverage area,percentage of coverage and Atreet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40 , ) Street names s,u^ ,2Property corner elevations (2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ZYes ❑`lNo 4 foot differential) If yes,is a storm water quality facility shown? ❑Yes ❑No/VA 7 Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ,.No Received: ❑ Yes ❑ No 7 Public Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: PP Yes ❑ No,stop intake Land Use Case#: pD(Z ?.oIS_ oOOOt / SU132o ( S .- QoO I 7 zoning: 2-I Z Required Setbacks: Front Rear `S Side 3 Street Side 16 Garage 7,1v /6 Landscape Requirement: 'Z,O /o g.Lot Coverage Maximum: % zr Building Height: Maximum Height S Actual Height I i /`J Visual Clearance fa—Stiisitive Lands: ❑ Yes ❑ No Type —Urin Forestry Plan 0 Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: Al, Q--‹ ' V1 Date: 9 / ZO l t Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPermitRv, RES 061417.docx Building Permit Submittal Original Submittal Date: //y /7 Site Plans: # Building Plans: # Building Permit#: Enter building permit#above. Workflow Routing: Planning ,-Engineering 0--"Permit Coordinator uilding Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: l 'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Er-Building: /Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: e `� %' t.,` e 74 Date: 02V/7 Engineering Review g Slope at building pad: O El Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ,B' Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: El Yes No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes „O.-No ❑ NOT Approved by Engineering: Date: Notes: q Approved by Engineering: -1 ��Ct., ( ' Date: / 17 Revisions (after Building Submittal only) Reviewer Date Revision 1: El Approved ❑ Not Approved Revision 2: ❑ Approved El Not Approved Revision 3: El Approved ❑ Not Approved Permit Coordinator Review El Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: DC Fees Entered: Wash Co Trans Dev Tax: "Yes ❑ N/A Tigard Trans SDC: r Yes ❑ N/A Parks SDC: 'es El N/A LIDA El Yes N/A K to Issue Permit � Ji�. Approved by Permit Coordinator: Date• I:\Building\Forms\BldgPemutRvw_RES_061417.docx FOR OFFICE USE ONLY—SITE ADDRESS: / 0 0 L( ��C/ /((1)'W -717 This form is recognized gn zed 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. Ph City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter i ,,A It n 1312512SW' Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 www.tigard-or.gov TO: l 7/7) ATE 7 RTR ED DEPT: BUILDING DIVISION K FEB 7 2018 FROM: p.4 R76-_-„4,,,,A .k d,:,' ,i\Gr COMPANY: //(j,n Ct u-d ,%,175./....,Z//c � 'i . Y� � � 5 v'1 PHONE: } — 7 g%9 — / 3 75.— By: RE: l d,O / ft '; i� M57---.2 /-2 —003r�(SiteAdess) (Permit Number) A I, 4- ( ect name or su ivisi n name arluilo numger) '4_ ' 0, � -�, �. "y via oilripyr ATTACHED ARE THE FOLLO11 t EMS: Copies: ) Description: I Copies: I Description: I Additional set(s) of plans. ; , Revisions: Cross section(s) and detail:. ' Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. _� --Beam calculations. Engineer's calculations. — Other(explain): REMARKS: 7:i/14' cf., /-__ :4 4 (, u t e'-' CO-e_ / //-( '''e-'Art FOR OFFICE USE ONLY Route to Permit Te, ician: Date: D__-- 7 , I ' 1' Initials: t Fees Due: Ye ❑No Fee Description: Amount Due. • SS HY Fit . re\t•c,... $ 1-K $ $ $ Special Instructions: Reprint Permit(per PE): I ❑ Yes I [ No 0 Done Applicant Notified: ( Date: I Initials: I:\BuildingWones\TransmittalLetter-Revisions.doc 05/25/2012 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10904 SW ANNAND HILL CT, TIGARD, May 21 , 2018 at 2:35:55 PM OR, 97224 Record Type: Record ID: Residential - Master Permit MST2017-00360 Inspection Type: Inspector: 699 Mechanical final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed. 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: 10904 SW ANNAND HILL CT, TIGARD, May 21 , 2018 at 2:38:07 PM OR, 97224 Record Type: Record ID: Residential - Master Permit MST2017-00360 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10904 SW ANNAND HILL CT, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2017-00360 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Correction from previous inspection complete. Street tree certification received. Moisture content form received. High efficiency lighting form received. Blower door test report checked. Insulation certification checked. C of 0 left on site at kitchen island. Note: front entry landing less than 30" above grade at time of final inspection. Violation Summary: Inspector Contractor