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Permit (61) CITY OF TIGARD MASTER PERMIT II 11Permit#: MST2017-00339 F; COMMUNITY DEVELOPMENT Date Issued: 12/04/2017 Parcel: 1 S136CA07900 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Jurisdiction: Tigard Site address: 11265 SW 79TH AVE Lot: 2 Subdivision: 2009-023 PARTITION PLAT Project: Cimpan Partition, Lot 2 Project Description: New SF. BUILDING Required Reauir�etbacks Floor Areas Left: 5 Parking Spaces: 0 Basement: 0 sf Smoke Bedrooms: 4 First: 1411 sf Front 20 Yes Stories: 2 Garage: 688 sf Detectors: Bathrooms: 3 Second: 1700 sf Right: 5 Height 24 Third: 0 sf Dwelling Units: 1 Total: 3111 sf Value: $390,395.77 Rear: 15 PLUMBING Urinals: 0 Laundry Trays: 1 Rain Drain: 1 Washing Mach: 1 SF Rain Storm Sewer: 100 Sinks: 1 Water Closets: 3 Sewer Lines: 100 0 Catch Basins: 0 Floor Drains: 0 Drains: Lavatories: 5 Dishwashers: 1 Water Lines: 100 Water Heaters: 1 Bckflw Preen : 0 Tubs/Showers: 3 Garbage Disp: 1 Bckwater Value: 1 Ice Maker: 1 a Hose Bib: 2 Other Fixtures: 0 Footing Drain: 0 Other Fixture Units: Drywell-Trench Drain: 0 MECHANICAL Vent Fans: 5 Clothes Dryers: 1 Fuel Tvpes _ Air Conditioning: Y Hoods: 1 Other Units: 0 Natural Gas Heat Pump: N Gas Outlets: 5 Furn<100K: 1 Vents: 0 Woodstoves: 0 Furn>=100K: 0 ELECTRICAL Branch Circuits Servic der Tem o ers WI Svc or Fdr: 0 Re 000 sfia 0-200 amp: 0 0-200 amp: 0GFdr: 0 1000 sf or loss: 1 201-400 amp: 0 W/O Sv Ea add!500 sf: 6 201-400 amp: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amplvolt 0 ELECTRICAL-RESTRICTED ENERGY SF Residential All Garage Opener: N Y Vaccuum System: N Ecompasing: Audio&Stereo: N HVAC: N Security Alarm: N Other: N Other Description: BUILDING INFO Square Feet: Type of Constr: Occupancy Group: 3111 Type of Use: VB R-3 Class of Work: SF NEW Owner: Contractor:WESTWOOD HOMES LLC Required Items and Reports(Conditions) CIMPAN,STELIAN A 1 Ersn Cntrl 503-639-4175 11225555CIMPAN,SW 779TH 12700 NW CORNELL RD A&IONEL PORTLAND,OR 97229 19TH AVE TIGARD,OR 97223 PHONE: 503-330-2215 PHONE: FAX: 503-342-2403 766.24 livable law. All work will Total Fees: $32, CoState of OR. Specialty Codes and all other app tans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for moreAllthe 180 This permit is issued subject to the regulations contained in the Tigard Municipal thee Oregon Utility Notification Center. Those rules are set forth in OAR be done in ATTENTION: with lawaroreqved p _001-00.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. , days. ATTENTION: Oregon requires you to follow the rules adopted by 952-001-0010 thro '� �� �"�/ �f� .���� Permittee Signature: Issued By. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. project. This permit card shall be kept in a conspicuous place on the job site until completion of the p ro1 Approved plans are required on the job site at the time of each inspection. Buiidng Perm._ Application Residential City of Tigard a i oR 01 11("e t�S►:011.1 II �� y Received 42 i _ 's 13125 SW Hall Blvd.,Tigard,OR 97 DaR :t! / Phone: 503.7 ll Blvd., Fax: 50R 98.1, Permit No.:�t ,_ Plan Revi:" , T t G n R n Inspection Line: 503.63 `�Q1-1 DateB ; w - ,ftp ■• - ' Internet: g �' (` Date Ready , Other Pefit � /fo www.tigard-or.gov (q tY / /�, L) �" Noufied/Method: ( See Page 2l for _ Y I /,i�i1�, n,wi /,� � Supplemental Information . TYPE OF WO' �`� L/ ®New construction %' REQUIRED DATA:I-AND 2-FAMILYDOLLING ❑Addition/alteration/replacement 0 0 ,her: $ Permit fees*are based on the value of the work performed. Other: Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CON equipment,materials,labor,overhead,and the profit for the rRUCTION work indicated on this application. ® 1-and 2-family dwelling 0 Commercial/industrial Valuation: • ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 34 ❑Other: Number of bathrooms: JOB SITEI INFORMATION AND LOCATION Job site address: ( (�f� �� "?� i Total number of floors: City/ / ®� . New dwelling area: 67 1.Z, square feet City/ tae/apt.no.: Garage/carport area: / Project name: • ,, ��� square feet Cross street/directions to job site: )4. r+, ► `� Covered porch area: jolt square feet 0 + Deck area: — _ � _ • square feet Other stiuctu e.area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:map/parcel no.: Lot no.: , ,e....., Permit fees*are based on the value of the work ed Ta performed. Indicate the value(rounded to the nearest dollar)of all ON.OF 'l>ORR work equipment,materials,labor,overhead,and the profit for the DESCRIPTIwork indicated on this a..lication. Valuation: $ Existing building area: square feet 1'RtP;R'�+j' " New building area: ' xC] ANT square feet :120Name:Same as applicant Number of stories: Address: Type of construction: City/State/ZIP: Occupancy groups: Phone:( ) - Business name:Westwood Homes LLC a CONTACT PERSOIIT BUILDING"pE?�MIT SEES* Contact name:Matt Fricke -- Address:12700 NW Cornell Rd Structural plan review fee(or deposit): IIIIIIIIIII FLS plan review fee(if applicable): 11111111111 City/State/Zip:Portland,OR,97229 Phone:(503)406-2442 Total fees due upon application: E-mail:Matt@westwoodhomesllc.com Amount received: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of Business name:Same as applicant roof-top mounted Photo Voltaic Solar Panel System. Address: Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon City/State/ZIP: Solar Installation Siecial Code checklist. Phone:( ) Permit Fee(includes plan review and adnririistrative fees : $180.00 CCB 195597 State surcharge(12%ofpermit fee); $21.60 liAuthorized signature: � Total fee due upon application: $201.60 AL....., This permit application expires if a permit is not obtained 0� within 180 days after it has been accepted as complete. Date: , *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Petmits\BUP-RESPermitA pp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit A lication City of Tigard + FOR orr►cc I s►:oy►.1 , *I 13125 SW Hall Blvd.,Tigard,OR 97223 Received 3 Date/By: Permit No.: Phone: 503.718.2439 Fax: 503.598.1960 q�111 Plan Review T It f) Inspection Line: 503.639.4175 ty e7 Date/By: Other Permit: Internet: www.tigard-or.gov � eady/By: � ` ethod: ® Id See Page 2 for Supplemental Information TYPE OF WORK ``kj , CO MERCIAL .1 New construction ❑Addition/alteration/r FEESSCHEDULE— 1SE CHEMIST ��'ent Mechanical permit fees*are based on the value of the work El Demolition Other: performed.Indicate the value(rounded to the nearest dollar)of all mechanical materials -•ui.ment labor,overhead and .rofit. CATEGORY OF CONSTRUCTION ® 1-and 2-family dwelling 0 Commercial/industrial RES iDENTIALEQIIIPAIE11iT/SyS ME Fps* ❑Multi-family ❑Accessory building 0 Master builder For special information use checklistOthaz' Description JOB SITE INFORMATION AND LOCATION Heatin_coolin : Qty. Ea. Total Job site address: (�6.5 5L /toe- Air conditionin_ o+`k. `qFurnace 100 000 BTU ducts/vents v 46.75 ri GZ�3 Furnace 100 000+Bducts/vents ® 46.75 City/state/ZIP: �" 1111111111111111111111111 Suite/bldg./apt.no.: Project name: 54.91 Cross street/directions to job site: Duct work 61.06 H dronic hot water stem =®_ Residential boiler(radiator or h dronic .®_ M Unit heaters(fuel-type,not electric), in-wall in-duct sus.ended etc. Flue/vent for an of above 46.75 Subdivision: �®_ Lot no.: mer: _®_ Tax map/parcel no.: Other fuel a !lances: Water heater 111111111DESCRIPTION OF WORK 23.32 Gas fir-.lace/insert _ Flue vent for water heater or gas © 33.39 firo,lace ©®- Lo li_.ter :as _®_ Wood/.ellet stove _ Wood fir .lace/insert MEI 33.39 Chimn /liner/flue/vent =®� ® Pitot t y ownit _®_ Other: ®_ Environmental exhaust and ventilation: Name:Same as applicant1/1 Address: Range hood/other kitchen ='ui.ment Cityress:/ZIP: 1111 Clothes. exhaust 33.39 ® 33.39 MN Single-duct exhaust(bathrooms, ®®- Phone:( ) toilet co...artments utili rooms APPLICANTla w Attic/crawls fans _®MN Business name:Westwood Homes LLC CI CONS ACT PERSON, Other: 1111111M1111111111Fuel 'I'111 : Contact name:Matt Fricke $14.15 for first four•$4.03 for each additional Address:12700 NW Cornell Rd Furnace etc. �__ Gas heat. 1111111.111111111 City/State/ZII':Portland,OR 97229 Wall/sus.ended/unit heater __ Phone:(503)406-2442EIMIIIIIIIIiiiiii Water heater ©_= E-mail:Matt@westwoodhomeslIc.com Ran�e v__ CONTRACTOR Barbecue v__ 111111111 Business name:Central Air Inc. Clothes' ern :as _=_ Other: Address:PO Box 433 MECHANICAL PER * -_ MITFEES City/State/ZIP:Clackamas,OR 97015 Subtotal 1111111111111 Phone:(503)656-1908 Minimum permit fee($90.00) — Plan review(25%of permit fee) 1111111111111CCB lie.:178624 State surcharge(1212%of — permit fee) TOTAL PERMIT FEE — This permit application expires if a permit is not obtained within 180 as complete. Authorized signature: l days after it has been aces * Fee methodology set by Tri-County Buildingil Industry Service Board EMN MA g'e la 0 A Date: j I:\Buildinaermits\MEC_Permitgpp_040113.doc 440.461 (11/02/COM/WEB) Electrical Permit Application FOR OI°F1('I l sE 0.y1 1 Cl ofTigardeceived `'f g g Iii t�� te/B : Permit#: 13125 SW Hall Blvd.,Ti ard,OR 97223' kta 'Ian Review I Phone: 503.718.2439 Fax: 503.598.196 1' Date/B : Related Permit 4: Inspection Line: 503.639.4175 ReadyDate/By: See Page 2 for II(JARU Juris: ® Internet: www.tigard-or.gov cw otlif Notified/Method: Supplemental Information U TYPE OF WORK '' ir,I n Aii PLAN REVIEW ®New construction 0 Addition/alteration/rp 1 '1 Zvi I Please check all that apply(submit 2 sets of plans w/items checked): Demolition l ( J "'6 0 Service or feeder 400 amps or more 0 Building over three stories. 0 ❑O� 4 1 1pwhere the available fault current 0 Marinas and boatyards. CATEGORY OF CON exceeds 10,000 amps at 150 volts or ❑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 ❑Addition of new motor load of system. Job#: ,/^ Job site address: I 17.6-5 �jl/,/ : 1V-e., or more. ❑ `A","E",°`1-2",°`I-s", City/State/ZIP: '' 7 4/ y, o 3 0 Six or more residential units. occupancy. 0 ❑Health-care facilities. Recreational vehicle parks. Suite/bldg./apt.#: 1 Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: jot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less if 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 New SFR (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) �< PROPERTY OWNER ©`1'ENANI' Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation Name:Same as applicant 200 amps or less 1 100.70 2 Address: 201 amps to 400 amps 1 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: 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 APPUCAPIT 1:3 CO p N. Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Westwood Homes LLC above service or feeder fee, 7.42 2 each branch circuit Contact name:Matt Fricke B.Fee for branch circuits without Address: 12700 NW Cornell Rd service or feeder fee,first 56.18 2 branch circuit City/State/ZIP:Portland,OR,97229 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)406-2442 Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email:Matt@westwoodhomeslle.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Ross Electric Inc. Sign or outline lighting 67.84 2 m Signal circuit(s)or limited-energy Address:2870 SE 75 Ave#203 panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)642-2800 Fax:( ) Investigation(1 hr min) 90.00/hr Email:Rosselectric@comcast.net Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 157891 Electrical Lic.: 34-436C Suprv.Lic.: specifically listed CAhr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: �t5 Subtotal: Print name: (N f(5 1"t t/(f✓ Date: 0 Plan Review Required(25%of permit fee): ' /�!!l �� State surcharge(12%of permit fee): uthonzeature: 6 •�"�l -.774746TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: _5 , 4i / ate: 17Z days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Plumbing Permit Application Building Fixtures FOR Oil 1( lse 0\1.1 City of Tigardi Received ..,,,, w 13125 SW Hall Blvd.,Tigard,OR 97223 , cv-tiv.- 1, ....y: Permit No.: Phone: 503.718.2439 Fax: 503.598.RV Plan Review = Inspection Line: 503.639.41757 N Date/By: Other Permit No.: i I G A R Ui Date Read/B Internet: www.tigard-or.gov y y: Jude: I Ei See Page 2 for a L,? 1 cy i Notified/Method: Supplemental Information TYPE OF WORK k,�7 ?I FEE* SCHEDULE ®New construction ❑Demol' ' 1 i Fors ecial in ormation use checklist b ""` Description ❑Addition/alteration/replacement 0 oth t '( .11 1 p Qty. I Ea. I Total a .ti, ` ' " New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTR. : tit ' SFR(1)bath 312.70 ®1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building SFRbath 1 500.32 ❑Multi-family (3) ❑Master builder Each additional bath/ken itch ❑Other: 25.02 Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ( 1z6 5 d,eki 3.4( e Catch basin or area drain 18.76 , 0f- clI ' �`1*d l'-Lz Drywell,leach line,or trench drain 18.76 City/State/ZIP: Suite/bldg./apt.no.: I Project name: 3 Footing drain(no.linear ft.: ) Page 2 Cross street/directions to job site: Manufactured home utilities 50.03 Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: Water service(no.linear ft.: ) Page 2 I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF wARK Backwater valve 12.51 New SFR Clothes washer I 25.02 Dishwasher I 25.02 Drinking fountain 25.02 Si' Ejectors/sump 25.02 Wu !;4, q 0 R: 1 ' *` i Expansion tank 12.51 Name:Same as applicant Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 City/State/ZIP: Garbage disposal / 25.02 Phone:( ) Hose bib a. 25.02 Fax ( ) Ice maker 12.51 ®a APl'LTCAI,TI ' j'7IV1'Ai'1t+E '(N Interceptor/grease trap . 25.02 Business name:Westwood Homes LLC Medical gas(value:$ ) Page 2 Contact name:Matt Fricke Primer 12.51 Address:12700 NW Cornell Rd Roof drain(commercial) 12.51 City/State/ZIP:Portland,OR 97229 Sink/basin/lavatory 5 25.02 Solar units(potable water) 62.54 Phone:(503)406-2442 Fax::( ) Tub/shower/shower pan 5 12.51 E-mail:Matt@westwoodhomesllc.com Urinal 25.02 i' ,. -CONTRACTOR Watei.closet 25.02 Business name:H&H Mechanical Water heater 37.52 Address:5757 SE Willow Lane Water piping/DWV 56.29 Other: 25.02 City/State/ZIP:Milwaukie,OR 97267 Subtotal ( ) l ITO Phone:(503)975-9787 Fax: .7 I1 Minimum permit fee: $72.50 CCB Lic.:178122 Plumbing Lic.no.: /IS//PIPlan review(25%of permit fee) Authorized signature: P." -- State surcharge(12%of permit fee) � TOTAL PERMIT FEE Print name:Dustin Ha l ue Date: r ? .0 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 10/01/09 440-0616T(10/02/COM/W EB) City of Tigard " COMMUNITY DEVELOPMENT DEPARTMENT 11111 i T I c A R o Building Permit Review — Residential (N, Building Permit #: /-Lcr 21 f'7 n 3 1 q Site Address: \ Z1o53 SA] 1 q111 Au— Project Name: 0 m7PI-N PAT-11-no NI Lot #: 2. _ (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: NevvI sTig gi Verify site address/suite# exists and active in permit system. Z River Terrace Neighborhood: X No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: I`hree(3)copies of site plan II:"`xisting structures on site bite plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint 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 XSidewalk/driveway approach Applicant information(name and phone number) ocation of wells/septic systems } .ot dimensions and building setback dimensions Xxisting trees to be retained with drip line,and tree 0Square footage of buildings to be demolished kprotection measures v i `� ' Lot area,building coverage area,percentage of coverage andStreet treenames size,type and location mpervious area(applicable if R-7,R-12,R-25&R-40) trees 1:4 roperty corner elevations(2 foot contour lines`if more than >1 u10 sf of impervious area created or replaced?XYes`❑No 4 foot differential) If ye . a storm water quality facility shown? XYes ❑No .,KClean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified . No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake Land Use Case#: ikA(PW1--®0)1(f, .t Zoning: t' 5- Required Setbacks: Front (il/ Rear Side 5 Street Side/ Garage 2i .a.Landscape Requirement: 'v! Lot Coverage Maximum: f iS Building Height: '-MMaximum Height Actual Height ±-2140 ZI Visual Clearance /, Sensitive Lands: ❑ Yes ,No Type U ban Forestry Plan '" �nditions "Met"prior to *ssup.nce of building permit ; Notes: rYi ..,a, ,` /�t�il�� � �- :w �.�r��rr..: ri'� gra . Approved By Planning: 4.-:—_—_ ,dIMMIlr Date: 7,/7 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: Cl Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\BuildingTonns\BldgPermitRvw RES 061417.docx Building Permit Submittal Original Submittal Date: el29// 7 Site Plans: # Building Plans: # ,`.3 Building Permit#: [ 7Enter building permit#above. Workflow Routing: i .131anning Engineering Permit Coordinator Building Workflow Sign-off: C 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: "" Date: 1/ //7 Engineering Review /6 Slope at building pad: Q 01 Conditions"Met"prior to issuance of building permit IIEasements (encroachments)per engineering conditions of approval and plat ":-K..."1"1.44/ j�� ❑ Water Quality/Quantity Facility: ,, ,/ �,t) ice"' Fee in-lieu: ❑ Yes El No �`�J�C Assess Water Quality ��Assess Water Quantity Fee in-lieu: 111Yes CiNo C • Al.i O :ZV/ LIDA Facility on lot: ,Yes ❑ No ❑ NOT Approved by , ngineering: Date: _ • � y -2 .� ifs .ter ✓r✓ Notes: -"' ,i 1 71'.� f1:: 1Orrs . � illei'S_'�PA IIIW ��� Approved by Engineering: / Date: 9-1-i'7 Revisions (after Building Submittal only) Reviewer .7 Date Revision 1: El Approved Cl Not Approved Revision 2: El 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: f�) !XL 0/ovNh.n-1 d: ate: 9l5// Notes: /16,0 P"41-af7( Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: Yes CI N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: l% Yes ❑ N/A LIDA $ Yes ❑ N/A OK to Issue Permit ,��1 �n� ��� 4dpnApproved by Permit Coordinator: - i e�%1 ,vhh V . / " Date: 11 1 I:\Building\F onns\BldgPermitRvw_RES_061417.docx 114 City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT ti ■ Building Permit Review -- Residential TIGARD Building Permit #: 1 -c..7-,:?Co/'? an 3'39 Site Address: , \\205 gni igm Alt-e Project Name: C{InPkN PAPITIO NI Lot #: 2- (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review • Proposal: J\ J 9 - gr Verify site address/suite# exists and active in permit system. ..2 River Terrace Neighborhood: 0"No 0 Yes,See River Terrace Review Addendum Attached Site Plan Elements: xistin structures on site �hree(3)copies of site plan g 1Wite plan must he on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished ,Drawn to scale(standard architect or engineer scale) floor elevations orth arrow •1. Jtility locations&easements(required for new and additions) Site address,project or subdivision name and lot number ,, idewalk/driveway approach Applicant information(name and phone number) .ocation of wells/septic systems Xof dimensions and building setback dimensions '.xisting trees to be retained with drip line,and tree 0quare footage of buildings to be demolished tprotection measures Lot area,building coverage area,percentage of coverage and XStreet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) 3534treet names *toperty corner elevations(2 foot contour linesif more than > sf of impervious area created or replaced?0/es`❑No 4 foot differential) Ifye ' a storm water quality facility shown? Yes ❑No Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: 0 Yes,applicant was notified .. No Received: 0 Yes 0 No Public Facilities Improvement(PFI) Permit: Required: 0 Yes,applicant was notified ,(No Applied For: 0 Yes ❑ No,stop intake XLand Use Case#: VAVV-l`Olnl(ft X zoning: (-'5.- f` 1 , ( Required Setbacks: Front SO Rear 1S Side 5 Street Side/A_ Garage ZS,Landscape Requirement: WA ' )5 Lot Coverage Maximum: _ Building Height: Maximum Height Actual Height 24 Visual Clearance ►' Sensitive Lands: 0 Yes 'No Type • ban Forestry Plan , - nditions"Met"prior to ssu.nce of building permit / Notes: Approved By Planning: ` — _ Date: $/7 //7 Revisions (after Building Submittal only) n Reviep . t Date 0 Revision 1: Approved 0 Not Approved `r r �� 6 2i ( I I `� Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved I:\Building\Fonns\1dgPetRvw RES 061417.docx Building Permit Submittal Original Submittal Date: d7"29 /7 Site Plans: # t Building Plans: # . .3 Building Permit#: [ Enter building permit#above. Workflow Routing. Planning ?Engineering Permit Coordinator , � Building -Z Workflow Sign-off: Sign-off for Planning(include notes from planning review) '' Route Application Documents: �,Engineering: (1) copyofpermit application,(1) site plan, (1)building plan and — gpp original plan review routing form. "?' Building. original permit application,site plans,building plans, engineer and LI beam calculations and trust details,if applicable, etc. INotes: h By Permit Technician: ' )tC *4.-tic—' Date: /.3 /7 Engineering Review /If Slope at building pad: Q 1.... Conditions "Met" rior to issuance of buildinp g pernutr/J/�Easements (encroachments)per engineering conditions of approval and plat � ` I''' ❑ Water Quality/Quantity Facility: �J�G .� tc3P� Assess Water Quality Fee in-lieu: 0 Yes 0 No C I Assess Water Quantity Fee in-lieu: 0 Yes 0 No r. G�.ye '���C,� ���i1 6 LIDA Facility on lot ,Yes 0 No � �/ '�/ 0 NOT Approved by , ngineering: Date: Notes: - _ `i► .. Approved by Engineering: 1) Date: 91 (7 IRevisions (after Building Submittal only) Reviewer `.,7 ate Revision 1: pproved 0 Not Approved hike- w . Z_ 18 ZRevision 2: 0 Approved ❑ Not Approved ' Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review ❑ Conditions"Met"prior to issuance of building permit AZ Approved,NOT Released: i 1;411-1'v7 yj 'yu a 5 !� Notes: 410? 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: ye SDC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A Tigard Trans SDC: Yes 0 N/A Parks SDC: V Yes 0 N/A LIDA $ Yes 0 N/A /rOK to Issue Permit Approved by Permit Coordinator: 4L2,j,(s AA 2 1 6i � �� � ' §ate: II (2,1 r) 1:\Building\Forms\BldgPermitRuw RES_061417.docx eg3/57,/, FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT N . Transmittal Letter <(,n R E) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 7M DATE DEPT: BUILDING DIVISION FROM: t ��! Gt t x ' ",} ,t ' -1/11?"--V" .nom y1 / -i COMPANY: �� _ . ',,= � � 3,t PHONE: • RE: l/ /OS✓ / ('i; - f ✓i (Site Address) (P- it Number) . IA A "'VAlra 1 t 'rolect ame or su..ivisi.n name ant t num ter ATTACHED ARE THE FOLLOWING ITEMS: 7r1 Copies: Description: o' •s Description: Additional set(s)of plans. Revisions: p Cross section(s)and detail . A` � Wall bracing and/orllatera analysis. i '�r'p'?. Floor/roof framing. r V 1 . Basement and retaining walls. Beam calculations. ` (7 Engineer's calculations. Other(explain): REMARKS: ✓,/!` *'rte L.11,1 %;'"147 ( /.1 � '' ;i! r• fC • t_.i° In FOR OFFICE USE ONLY Routed to Permit Tec cian: Date: Initials: Fees Due: ❑ Yes No Fee Description: Amount Due: Special Inst tions: Reprint Permit(per PE): ❑ Yes 21,,No ❑ Done Applicant Notified: Date: /i Initials: 6, I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11265 SW 79TH AVE, TIGARD, OR, 97223 Record Type: Record ID: Residential - Master Permit MST2017-00339 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11265 SW 79TH AVE, TIGARD, OR, 97223 August 1 , 2018 at 11 :11 :25 AM Record Type: Record ID: Residential - Master Permit MST2017-00339 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: 11265 SW 79TH AVE, TIGARD, OR, 97223 August 1 , 2018 at 11 :12:06 AM Record Type: Record ID: Residential - Master Permit MST2017-00339 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Inspection cancelled by contractor, contractor to add ac. All other mechanical appears ok. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11265 SW 79TH AVE, TIGARD, OR, 97223 August 1 , 2018 at 11 :13:09 AM Record Type: Record ID: Residential - Master Permit MST2017-00339 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Inspection cancelled by contractor. Ac to be added to per contractor, not installed at this time. Provide approved Lida box final inspection. Provide approved plumbing final for backflow irrigation devise. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11265 SW 79TH AVE, TIGARD, OR, 97223 August 8, 2018 at 8:59:56 AM Record Type: Record ID: Residential - Master Permit MST2017-00339 Inspection Type: Inspector: 699 Mechanical final Aaron Cillo-Gobel Result: PASS Comments: Installed using minor label ELS662231 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11265 SW 79TH AVE, TIGARD, OR, 97223 August 13, 2018 at 10:22:49 AM Record Type: Record ID: Residential - Master Permit MST2017-00339 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Final erosion control approved. Street tree certification received. Moisture content form received. High efficiency lighting form received. Blower door test report checked. Insulation certification checked. C of 0 left on site at kitchen counter with approved site plan. Ac installed. Violation Summary: Inspector Contractor