Permit (232) CITY OF TIGARD1111 MASTER PERMIT
■ COMMUNITY DEVELOPMENT s Permit#:
//�� MST2017-00457
T I i;,h R.f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439' Date Issued: 12/18/2017
i� '" Parcel: 2S110AD11700
‘ � Jurisdiction: Tigard
Site address: 10926 SW ANNAND HILL CT
Subdivision: ANNAND HEIGHTS Lot: 29
Project: Annand Heights, Lot 29
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: 796 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 35 Bathrooms: 3 Second: 1158 sf Garage: 380 sf Front 15
Dwelling Units: 1 Smoke
Third: 0 sf Right 3 Detectors: Yes
Total: 1954 sf Value: $241,085.40 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
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0
Catch Basins: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N
P Hoods: 1 Other Units: 0
Furna100K: 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:
NEW P y Square Feet:
SF VB
R-3 1954
Owner: Contractor:
ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 1 Hour Fire Rated Eaves
12655 SW NORTH DAKOTA ST TIGARD,OR 97223 2 Ersn Cntrl 503-639-4175
TIGARD,OR 97223
PHONE: PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,425.73
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 -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.
•
P ct
am'
Issued By: ef� Permittee Signature: '��G7/�� ��t/��^
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. T —
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.
oh . CITY OF TIGARD MASTER PERMIT
44
I.' '''
COMMUNITY DEVELOPMENT Permit#: MST2017-00457
T[GAR r) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/18/2017
Parcel: 2S110AD11700
Jurisdiction: Tigard
Site address: 10926 SW ANNAND CT
Subdivision: ANNAND HEIGHTS Lot: 29
Project: Annand Heights, Lot 29
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 796 sf Basement: 0 sf
Left 3 Parking Spaces: 0
Height: 35 Bathrooms: 3 Second: 1158 sf Garage: 380 sf Front: 15
Dwelling Units: 1 Smoke
Third: 0 sf Right: 3 Detectors: Yes
Total: 1954 sf Value: $241,085.40 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays: 0
Y Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100
SF Rain Storm Sewer 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Catch Basins: 0
Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 4 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
Other: N Other Description: All
Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr:
NEW Occupancy Group: Square Feet:
SF VB
R-3 1954
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 1 Hour Fire Rated Eaves
TIGARD,OR 97223
PHONE: PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,425.73
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 .R 952-0.1-009j) You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
11,/
_._. _..
Issued By: / r�j�.1 id." — Permittee Signature:
?'.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.
Building Permit AonlicatiS •
kesidential cEiv '
FOR OFFICE USE ONLY
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 DateB
2IN
y ry dry,, r — Permit No.;M 17-
Phone: 503.718.2439 Fax: 503.598.1960 NOV A 6 111/ Plan Review G' "`�
TIGARD Inspection Line: 503.639.4175 DateB : co , Other Permit: / (r. 10 ,`V
Internet: www.tigard-or.gov ®F •TZGA 1• i ed/Me o l
CITY !l f.ified Method Si' See Page 2 for
a I. I ;
�_ Supplemental Information
TYPE OF WOR ® � a : .li
Ir. New construction REQ RED DATA:1-AND 2-FAMILY DWELLING
0 Demolition Permit fees*are based on the value of the work performed.
❑Addition/alteration/replacement 0 Other:
Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the pro tt for the
CATEGORY OF CONSTRUCTION ' ��� d
work indicated on this application.
Fri.1-and 2-family dwelling
0 Commercial/industrial Valuation:
�
❑Accessory building $ !�
0 Multi-family Number of bedrooms:
❑Master builder
0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION
Total number of floors:
Job site address:/0902 d
a.d -:-_ / New dwelling area:
X1
�` r 4 r/ o �- •.uare feet ,IS �
City/State/ZIP:
-.6 4-2 r CLL; 9 "7 .2.3
Suite/bldg./apt.no.: Garage/carport area: 3/ square feet "'��`4
Project name:
4•"413I grCross street/directions to job site: /4. - Covered porch area:
t t square feet
Deck area: square feet
Other structure area: square feet
Subdivision: ` REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Lot no.:
Tax map/parcel no.: Permit fees*are based on the value of the work performed.
it
Indicate the value(rounded to the nearest dollar)of all
DESCRIPTION OF WORK equipment,materials,labor,overhead,and the profit for the
work indicated on this a.plication.
Valuation: $
Existing building area: square feet
New building area: square feet
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Name:
0.PROPERTY OWNER 0 TENANT
Number of stories:
1 kf®0 .4 coaS f-/2i, - at)
. 4 3--s— (5-4...) - Type of construction:
Address: ZIP: / aka er -rel Occupancy groups:
Phone: 3 lop a / 76-
0 APPLICANT ❑ CONTACT PERSON -
Business name: , /fr1 eBUILDING PERMIT FEES*
Please re er to ee schedule
Contact name: Structural plan review fee(or deposit):
11111111111111
Address:
FLS plan review fee(if applicable): IIIIIIIIII
City/State/ZIP:
Total fees due upon application:
Phone:( )
CirIIIIIIIIIIIIIIIIIIII Amount received:
E-mail: B,(,tM ,,ta„ -d d0A,es,/„/ ,..7
�� i PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR d9 At1rCommercialand residential prescriptive installation of
fEallillill
Business name: ,/ roof-top mounted Photovoltaic Solar Panel System.
L (fid ' ,t L Submit two(2)sets of roof plan with connection details
Address: �� ��` 94-h ' and fire department access,along with the 2010 Oregon
City/State/ZIP: Solar Installation S.ecialry Code checklist.
' z 972
Phone:( 3)
and Permit Fee(includes plan review
ger — 7s Fax:(�j3 6"90_-�6o‘ and administrative fees): $180.00
CCB lic.: 6---0 i State surcharge(12%of permit fee): $21.60
Authorized signature: Total fee due upon application: $201.60
� This permit application expires if a permit is not obtained
Print name: within 180 days after it has been accepted as complete.
Imo: Q S Date: *Fee methodology set by Tri-County Building Industry
Service Board.
44
I:\BuildinglPermits\BUP-RESPennitApp.doc 02/24/2011 0-4613T(11/02/COM/WEB)
r
Mechanical Permit Applica>i R OFFICE USE ONLY
City of Tigard , Received
RECEIVE1,Iate/BanReview y Permit No.: . 01
-47 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 �:'
Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Read B luris
Internet: www.tigard-or.gov Ready/By: 8 See Page 2 for
NOV21 2017 Notified/Method: Supplemental Information
G L I!
:::';:::"'W.,0- ;-'41"':'-':'''-'.:-1,:- TYPE.'OF WOi i" T:WARD ' COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
ew construction 0 Addition/alterasrit;ED �rviSI®1►T performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: �D�J agar >t r 1 1't mechanical materials,equipment,labor,overhead,and profit.
�. ,�
CTION .
Value:$
CATEGcOR OF CONSTRU
j21-:
�� � ° RESIDENTIAL EQDIP1fIENT/SYSTEMS FEES*
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description P Qty. Ea. Total
ey« t , JOB SITE''I(NFOR111ATION AND LOCATION, ` _ , ` Heating/cooling:
Job site address: /)9ç. �� ,Afa / /
Air conditioning 46.75
" [QLt pi Furnace 100,000 BTU(ducts/vents) ,� 46.75
City/State/ZIP: 7T are,/ ®Z 9n�3 Furnace 100,000+BTU(ducts/vents) 54.91
'7Heat pump 61.06
Suite/bldg./apt.no.: Project name:/n,4, AV
y 47;-.
Duct work 23.32
Cross street/directions to job site: /o¢ �� 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: 19-.Itn4/d /„L Oh b . Lot no.:29 Other: 23.32
�/ Other fuel appliances:
Tax map/parcel no.: Water heater a.O 23.32
DESCRIPTION.OF WORK Gas fireplace/insert ,�
33.39
gas
4/ f <S P' Flue vent for water heater or fireplace / 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
R_.,DPER'i'Y OWNER ❑ TFNANT Other: 23.32
Environmental exhaust and ventilation:
Name: old,litritudad f _5� T)� Range hood/other kitchen
Address: Qf°' 6 5-5-' 5 �-C�d '-$,1i" O L 5 equipment 33.39
t� t fi Clothes dryer exhaust 33.39
City/State/ZIP: �j� cy� ,722,3 Single-duct exhaust(bathrooms,
® G Y -7toilet compartments,utility rooms) 0 23.32
3
Phone:( 61 ,U d -4/37 Fax: ''-'0 ) -7`06,
3 Q �- Attic/crawlspace fans 23.32
PLICANT , ❑,CONTACT PERSON Other: 23.32
Business name: (� 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
/ l Range
E-mail:
ti...)/1 (,PIU®d(� 1J`ts/(JGv®/�j/n�! ® < <t%/ Barbecue
CONTRACTOR` Clothes dryer(gas)
Business name: -Ft r5 /� 9 Other:
Address: /3 �F/i L/
MECHANICAL.PERMIT FEES*
G�,,t4 l2k4c. /9,. Subtotal
City/State/ZIP: t'.podk .07.070.,,Qy z` J Minimum permit fee($90.00)
Phone:( ) Fv �I/ Plan review(25%of permit fee)
Fax:( ) State surcharge(12%of permit fee)
CCB lie.: '72 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: J/ Date:
I:\Building\Permits\MEC_PermitApp_040 13.doc 440-4617T(1 1/02/COM/WEB)
r ,
Electrical Permit Applicata )R OFFICE USE ONLY
City of Tigard RECEIV,, j.: edMI ANNIMINIffinfila
. a 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
1111111 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
T I C A R D Inspection Line: 503.639.4175 N O V 21 201 Ready Date/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov CITY
'�yNotified/Method: Supplemental Information
Cl TYPE OF WORK OF
IGARD PLAN REVIEW
w construction 0 Addition/alterati0 Please check all that apply(submit 2 sets of plans w/items checked):
� `'r DIVISION
0 Servicefeeder or 400 amps or more
❑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.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ['Emergency system. larger separately derived
s 4 k An n qn / ❑Addition of new motor load of system.
Job#: Job site addre
(� � n 1001-1P or more. ❑"A" "E" "1-2" "l-3"
City/State/ZIP: 0,Cc9c9,-)2.7,_-3 ❑Six or more residential units. occupancy.
`f 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: nAN'/ hie: !
�y A 0 Hazardous locations. 0 Supply voltage for more than
v ❑Service or feeder 600 amps or more pPy g
600 volts nominal.
Cross street/directions to job site: /09 f� FEE SCHEDULE
V Description
Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: nAnil/t f itc9I Ic Lot#:_'1(% Includes attached garage.
��CC ``((���� ``���� 1,000 sq.ft.or less / 168.54 4
Tax map/parcel#:
Ea.add]500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
$f� 5 FZ (with above sq.ft.) ® 75.00 2
1 �� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
• 'PIFOPERTY OWNER El TENANT Services or feeders installation,alteration,and/or relocation
Name: ®o� �Osdc �vs�dim' 200 amps or less 100.70 2
Address: w�"}��,"`000���ttt 5-5- 6-� �{ CAF p���� 61 201 amps to 400 amps 133.56 2
l� ��+J.. 401 amps to 600 amps 200.34 2
City/State/ZIP: y,L �c_ Q.72...23
601 amps to 1,000 amps 301.04 2
Phone:( • 7b0--� '3 7 Fax:(5 3 )570 7 Over 1,000 amps or volts 552.26 2
Email: h �-dd� 6 .e5 �iy / /k�A � j cc/A 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-c ne ,alteration,or extension,per panel
A.Fee for branch circuitswwith
Business name: c5apoe. above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email:
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 2Q'`�j ,sC frir r!L Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: � .4/ �'cj /n°MI ri„/ panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: ip„),—. •,41 g��5 Each additional inspection over allowable in any of the above
I v r Additional inspection(1 hr min) 66.25/hr
Phone:
` ) l�7 �j 7 tt Fax:457/3) ‘5/1)--97.23 Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: qElectrical Lic. — b Suprv.Lic.:
65OS specifically listed(%hr min) 90.00/hr
G
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name Am:5 hi 4iw Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:^ -- TOTAL PERMIT FEE:
/ i-AThis permit application expires if a permit is not obtained within 180
Print name: C_A j^i`D a k . Date: days after it has been accepted as complete.
��!"`444��� * Number of inspections allowed per permit.
I.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/1 S 440-4615T(11/05/COM/WEB
• ,
Plumbing Permit Applica.
. Building Fixtures RECEIVE'' FOR OFFICE USE ONLY
0113 Of TIgaI fl •;
Received
III - Plan Permit No.: M 5 y
13125 SW Hall Bivd.,Tigard,OR 97223 Date/By: / "� 1 7'c y /
Phone: 503.718.2439 Fax: s03.s98.196p' �y Plan Review
IV O v Lj 2017 Date/By: Other Permit No.:
T 1 GARD Inspection Line: 503.639.4175 Date Read/B
Internet: www.tigard-or.gov Ready/By: Juris: H See Page 2 for
i"9 iJ F TI GAIID Notified/Method: Supplemental Information
;.{'' TYPE OF WO dd AA l�IA�4�t1l�ll*/�xl FEE* SCHEDULE
ew construction mapfioti DIVISION For special information use checklist
Description Qty. 1 Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTIONS - SFR(1)bath 312.70
and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address/Oq p � 4J A9Anq�AF� f64 Catch basin or area drain
!� 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
frit-I) O/Li ?'7Z2- Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: -nnGltd//rJ k a
! Manufactured home utilities 50.03
Cross street/directions to job site: �j Manholes 18.76
10 9 fes" Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: M/lat/L 1�,e A/ Water service(no.linear ft.:_) Page 2
d� !s I Lot no.�� Fixtureeor item: a
Tax map/parcel no.: 9� Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
���jj' n Clothes washer 25.02
/UV-) `��� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 1 ❑ TENANT' Expansion tank
' 12.51
Name: 0/I ' C' a-d Mrd 140/1-5 74 p Fixture/sewer cap 25.02
Address: D� /s--5 5& A/err j-� f� 5i4)-e..--./ Floor drain/floor sink/hub 25.02
Y v"� Garbage disposal 25.02
City/State/ZIP: m-!?/ gz, Q7 3 Hose bib
25.02
Phone:(
6,--lib'7S' Fax:(Sti3 S'?"U-76,04" Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: ;�j� Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
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: erdlitzota Urinal25.02
CONTRACTOR .
V Water closet 25.02
-A P V /U Water heater 56.29
Business name: paf- �Il.dt- f
�d Pr/ Water piping/DWV 56.29
Address: Qo,i,®C2 5 , 1( �� Other: 25.02
City/State/ZIP: Ore," a O4 �O Subtotal
Phone:(5' 3) 72_3 ..g� Fax:(5-L3)7
Minimum permit fee: $72.50
CCB Lic.: /a/.2 /3 9 Plumbing Lic.no.:7�SO1/1� Plan review (25%of permit fee)
�y /A J 7 i/(2.o
2 State surcharge T L% Ef permitMIfee)E
Authorized signature:�C�- %�' _� TOTAL PERMIT FEE
Print name: �e.4 t k1 A' Date: This permit application expires if a permit is not obtained within 180 days
c1/'� 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
• " COMMUNITY DEVELOPMENT DEPARTMENT
III
T I G A R D Building Permit Review — Residential
Building Permit #: /4?-57-016 17—0415—7
Site Address: 10(12 SQ A n RA4 Girl"
Project Name: A'- 1-kijhli Lot #: Z 1
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review l
Proposal: L^bjf✓G4diN. (t/\R,,./ S F le
Ierify site address/suite# exists and active iin permit system.
l River Terrace Neighborhood: D" No ❑ Yes,See River Terrace Review Addendum Attached
Sits Plan Elements:
t�t( ree(3) copies of site plan x�i ring structures on site
E ' j e plan must be on 8-1/2"x 11"or 11 x 17"paper L 'ootprint of new structure(including decks)with finished
I✓JDwn to scale(standard architect or engineer scale)
orth arrow
oor elevations
�9tility locations&easements (required for new and additions)
Sjt address,project or subdivision name and lot number IC idewalk/driveway approach
g pphcant information(name and phone number) ,�//ocation of wells/septic systems
trees to be retained with drip line,and tree
t dimensions and building setback dimensions
S uare footage of buildings to be demolished
pytection measures
l of area,building coverage area,percentage of coverage and L��'St eet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) Lld'Street names
e4I roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? dYes ❑No
foot differential) If yes,is a storm water quality facility shown? ❑Yes1No
lZ(Clean Water Services—Service Provider Lett r(lot platted prior to 9/10/1995): n n
Required: Yes,applicant was notified No Received: ❑ Yes !No �PP
Lid' Public Facilities Improvement (PFI) Permit: lG„k. ,/J,e
iR
equired: M yes,applicant was notified�`� ❑ No Applied For: ❑ Yes ❑ No,stop intake
GEr nd Use Case#: �D� (,v IS-Q�po8 'S_Q�b
,PO l
PF� ?� o�
oning: R-12- I d 1
2'/Required Setbacks: Front IS Rear I S Side 3 Street Side 9 Garage Zo
L' Landscape Requirement: 2,0
of Coverage Maximum: p % 33 Building Height: Maximum Height Actual Height
ZS-
!Z./Visual Clearance
/Sensitive Lands: ❑ Yes VNo Type
LJCrban Forestry Plan
onditions "Met"prior to issLance o building permit
Notes: CiNt;)-1a.N1 n w.t,1- pny,r I kM1Ai'q �tnti� / ,e
Approved By Planning: 1 l C Date: I t' L I-IA.
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\B1dgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: f//r ih 7
Site Plans: # J'
Building Plans: # 7
Building Permit#: C ,rater building permit#above.
Workflow Routing: arming [veeringC P[t Coordinator [T Building
Workflow Sign-off: EL-Sigh-off for Planning(include notes from planning review)
Route Application Documents: gineering: (1) copy of permit application, (1) site plan, (1) building plan and
originali� plan review routing form.
[ _- i lding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: //_u f
En ineering Review
Slope at building pad: 0
E Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes ' No
LIDA Facility on lot: ❑ Yes ,Er.No
❑ NOT Approved by Engineering: Date:
Notes: r�
Approved by Engineering: �,i k� W L Date: II) 2- 7 /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:
JXSDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: ryes ❑ N/A
LIDA ❑ Yes EN/A
XOK to Issue Permit
Approved by Permit Coordinator: /I` / Date: ll
I:\Building\Forms\B1dgPermitRvw_RES_061417.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10926 SW ANNAND HILL CT, TIGARD, June 20, 2018 at 1 :05:47 PM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00457
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
No ac installed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10926 SW ANNAND HILL CT, TIGARD, June 20, 2018 at 1 :05:01 PM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00457
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Gas fireplace does not appear to be working, doesn't light. G2401 .1
All else appears ok.
No ac installed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10926 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00457
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Correction complete.
No ac installed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10926 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00457
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:
10926 SW ANNAND HILL CT, TIGARD, June 22, 2018 at 7:02:42 AM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00457
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide approved final erosion control inspection prior to building final inspection as
noted on approved plans.
No record of interior brace panel inspection.
No final inspection done at this time.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10926 SW ANNAND HILL CT, TIGARD, June 25, 2018 at 10:53:09 AM
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00457
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Note: contractor adjusting grade left side of front porch to less than 30" measured 3'
horizontal.dig out starting for adjacent lot with 3' setback.
Final erosion control approved.
No street tree required per approved site plan.
Street tree certification received.
Moisture content form received.
High efficiency lighting form received.
Insulation certification checked.
Blower door test report checked.
C of 0 left on site with contractor.
Violation Summary:
Inspector Contractor