Permit CITY OF TIGARD MASTER PERMIT
-11 . COMMUNITY DEVELOPMENT Permit#: MST2017-00527
T"i i It I7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/22/2018
Parcel: 2S 111 AA01400
Site address: 8894 SW INEZ ST Jurisdiction: Tigard
Subdivision:
Lot:
Project: Butterfield Park, Lot 1
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks
Stories: 2 Bedrooms: 5 Required
First: 1436 sf Basement: 0 sf Left 5
Parking Spaces: 0
Height: 24 Bathrooms: 3
Second: 1867 sf Garage: 612 sf Front 20
Dwelling Units: 1Smoke
Third: 0 sf Right 5 Detectors: Yes
Total: 3303 sf Value: $413,409.08 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays:Y 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0
Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 0
Water Lines: 100 Drains: Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Bckflw Prevntr: 0
Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y 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
P W/Svc or Fdr: 0
Ea add'l 500 sf: 6 201-400 amp: 0 201-400 amp: 0
P 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: Y
Ecompasing:
BUILDING INFO
Class of Work: Type of Use:
Type of Constr: Occupancy Group:P Y P: Square Feet:
NEW SF VB
R-3 3303
Owner: Contractor:
DAVID DEHARPPORT FOUR D CONSTRUCTION Required Items and Reports(Conditions)
PO BOX 1577 PO BOX 1577 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97045 BEAVERTON,OR 97075
PHONE: 503-720-7445 PHONE: 503-720-7445
FAX: 503-590-1751
Total Fees: $33,109.66
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: s., �� � /�j /
� � - �" �� Permittee Signature: /� c_ i ��
Call 603.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential , w 11
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 r
Date/By: �, Permit No.
1111
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
i i ; ,h[ Inspection Line: 503.639.4175 Date/By: -2 j - i Other Perm't:
S �Ifor
Internet: www.tigard-or.gov � 4 DieRe/Metho (6 loris: S Seepage l far
Notified/MethodI:
� � ry� DIVISION Supplemental In formation
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
jNew construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other:
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
L'1-and 2-family dwelling 0 Commercial/industrial Valuation:4)3,y o9$
I A /
El Accessory building ❑Multi-family Number of bedrooms:
bk
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 2_ 3 9 j -.
Job site address: 8 t 9 7 s't,/ l,� Newd
` 3— welling area:
-.k:?•j square feet
City/State/ZIP: fI CO pts.o 0
7 22.V Garage/carport area: (J/� square feet
Suite/bldg./apt.no.: I Project name:
Covered porch Also square feet i 967
Cross street/directions to job site:
Eireletwoor square feet
ft A U.. g Lv.0 - 6'�.�/vSto Art-0 - �- C. 7-11 F'e 6tt v. ! �,1)G 1 y36
square feet
Subdivision: -Z`: •- - - /-ezF -
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
irviI Lot no.: , Permit fees*are based on the value of the work performed.
Tax map/parcel no.: "i - 1.) Indicate the value(rounded to the nearest dollar)of all
i L'.-::-.:
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
4/6'6,0S-//i/64.--G PA.Lyi 1 9., RE5/DeNGG Valuation: g
Existing building area square feet
New building area: square feet
pi(PROPERTY OWNER I 0 TENANT
Number of stones:
Name:
Type of construction:
Address: S7M6 i#,5 �t-s 'GOyc/
Occupancy groups:
City/State/ZIP:
Phone:( ) Existing:
Fax:( )
�$;APPLICANTNew:
0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: ��� +L d t (Please referto fee schedule)
J Co M5 TR U C i C ISI Structural plan review fee(or deposit):
Contact name: D F�\l1 p De. 14 pip,pbg-r-
Address: FLS plan review fee(if applicable):
F.0. Box i s 77
City/State/ZIP: $EP Yi✓g.ro �7 70_7 S Total fees due upon application:
Phone:(3 03) 7 023) - YS I Fax: 590 175 Amount received:
E-mail: Pa u t'Z'D co M57'P,,, 443 ' , Lo PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: . Submit two(2)sets of roof plan with connection details
Address: ` and fire department access,along with the 2010 Oregon
t✓ Solar Installation Specialty Code checklist.
City/State/ZIP: S Permit Fee(includes plan review
and administrative fees): $180.00
Phone:( ) I Fax:( )
CCB lic.: State surcharge(12%of permit fee): $21.60
7
Total fee due upon appication: $201.60
Authorized signature: _.../
__"...)
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
`dint name: �)� ....y._ t1�pki����J Date: I *Fee methodology set by Tri-County Building Industry
L/ Service Board
lildingiPermits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB)
Mechanical Perm A t Lica,'3i �� D
� _ .� �!�, ' tt)It()III( F. I tit. ()\I.l
City of T i.ar Received
13125 SW Hall i ivd., igazd,OR 97223[ :' r 8 h �
Date/By:Plan
No.:
_ Phone: 503.718.. 39 .ax: 503.598.1960 w/ Plan Review
Inspection Line: 5 .63 .4175 Date/By: Other Permit:
7(GARI) p r
Internet: tvw�t tig• .ow C t F 1 i t { Li Date Ready/By: Juris: ® See Page 2 for
Notified/Method:
a. x a
Supplemental Information
& D N,C D(4/ISiO
TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
New construction 0 Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
itg 1-and 2-familydwellingRESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 Commercial/industrial 0 Accessory building
For special information use checklist.
Multi-family 0 Master builder 0 Other: Description
Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 08 9 V S.Ws, .1 N E-7,- Air conditioning 46.75
VFurnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7--) pr RD 0V--- 9 7Zz9 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: ( Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
b Hydronic hot water system 23.32
!�R E/V5 t v A fLC� Residential boiler(radiator or
70 r-t; hydropic) 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: J— ap S ` I' I Lot no.: / Other: 23.32
� Other fuel appliances:
Tax map/parcel no.:
t tri .1--.j (.i..C) I ✓'A t&- Water heater . 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
N&LA-, S I N C9 L..C ��M 1 Ly 126-s a foe N LE.-,..-
.,1. Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER I 0 TENANT Other: 23.32
Name: Environmental exhaust and ventilation:
Range hood/other kitchen
Address: N1 5 equipment 33.39
B i - L OL J.r Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone:( ) toilet compartments,utility rooms) 23.32
Fax:( ) Attic/crawlspace fans 23.32
pi APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fours.. �,f Fuel piping:
gL�V �_ $14.15 for first four;$4.03 for each additional
Contact name: `L try I P 1)e i f A-�f'P� r,
17- Furnace,etc.
Address: p1 B b I s.7 Gas heat pump
x tate/ZIP: Wall/suspended/unit heater
L--1\\/e "�'1,....) j Cs` 1 C� 70'7 5 Water heater
Phone:(5 03) "?.../.„0 ._ '7`f`l.5 ] Fax::(503 , 70 .. i--7s i Fireplace
E-mail: 1 Cdt1 IZ0 C.-C1 iN3 ST-(z- .ISIS Ai,: C o ilii Range
Barbecue
CONTRACTOR Clothes dryer(gas)
t / L.� A Ie.. Other:
Business name: e
Address: P.®, Y 933 J? � MECHANICAL PERMIT FEES*
LJ 7 J Subtotal
City/State/ZIP: C'L cI C.. A rvt !'� I f 2 0 t SMinimum permit fee($90.00)
Phone:(j;r ) �e" r 536..8-- ( F :( ) '5_ — Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.: / TOTAL PERMIT FEE
� /f This permit application expires if a permit is not obtained within 180
ieAuthorized signature: days after it has been accepted as complete.
,� * Fee methodology set by Tri-County Building Industry Service Board
Print name: DtA Ill 0 Date: '
I:\Building\PermitsWEC_PermitAPP 040113.doe 440-46177(11/02/COM/WEB)
• Electrical Permit Apnlicatl ; 'Fir tP ic,►t011.ict 1si:tl,i ,
City of Tigard Received
IN13125 SW Hall Blvd.,Tigard,OR 97223 ,' Date/By: Permit#:
_ Phone: 503.718.2439 Fax: 501598.1960 Plan Review
DateJBy: Related Permit#:
Inspection Line: 503.639.4175 a..
f i c,.� :>> Internet: www_tigard-or.gov I�, �� (d a k r Ready Date/By: hais I S See Page 2 for
1. Notified/Method:
Supplemental Information
TYPE Or}PORI I a,�I;"1 :-.4 PLAN REVIEW
KNew construction 0 Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked):
0 Demolition Other: ❑Service or feeder 400 amps or more 0 Building over three stories,
CATEGORY OF CONSTRUCTION where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
123,I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Other: amps for all other installations. buildings.
1:3 Multi-family 0 Master builder
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger 0 Fire pump,
❑lacepa of 150 KVA or
separately derived
Job#: Job site address: j� �/ 5, 0 Addition of new motor load of system.
LIJI Z I00HP or more. ❑"A""E","1-2 "i-3",
City/State/ZIP: .-7--/&A j2-O 0 V cr 7 2-2 L/ ❑Six or more residential units. occupancy.
1° / 7 ❑Health-care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0 Hazardous locations. ❑Supply voltage for more A,
0
Cross street/directions to job site: Service or feeder 600 amps or more. 600 volts nominal.
14 1 ri 7 S1 v B S �f r� ) ,fy ) FEE SCHEDULE
►-'fa'r�1.. .�L rZ�..E=./rc5 + epi..+ lnA1 - �yLl 7`!4 Description I Qt9. I Each I Total I x
- ,,,� l New residential single-or multi-family dwelling unit.
Subdivision: Lot#: / Includes attached garage.
Tax map/parcel#: 1,000 s 168.54
, IT c: � ,��`�0 ,.i) 1 d ... 9.ft.or less 4
DESCRIPTION OF WORK Ea.add'!500 sq.ft.or portion 33.92 1
Limited energy,residential
(with above ft.) 75.00 2
Nei., S-.n/L$t F:Ar�/t Pea AW(. energy,
YLimited mufti-fatuity 75.04 2
residential(with above sq.ft.)
0 PROPERTY OWNER ! 0 TENANT Renewable Energy 0 See Page 2
Name:
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Address: A NIL:. is c a L. t 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) I 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 I i
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08
Owner signature: Date: 401 amps to 599 amps 168.54riK
122
APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,p r panel
A.Fee for branch circuits with
Business name: Foci,12 ) co,/S r Qu G,filo above service or feeder fee,
each branch circuit 7.42 2
Contact name: b xv,10 D t )4A 12-F?otazr B.Fee for branch circuits without
Address: , 1 7 service or feeder fee,first
branch circuit 56.I8
2
City/State/ZIP: � ay;lz_rom fe.„
9 70-7 5 Each add'l branch circuit 7.42 2
Phone: 0I Miscellaneous(service or feeder not included)
d'
V 5 Fes''(� )3 "� Each manufactured or modular
Email: �tJ lI ft ���1S'T' y dwelling,service and/or feeder 67.84 2
s ec. Col-4 Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84
Business name: 2
�Z. re SEC•7`/zi(._ 6ptt.C..p Sign or outline lighting b7.84 2
Address: r� j5 C3 4/k• Cy ND 12, 46lb j
Signal alteration,iaiorlextension. 0 �Page 2
�Y r � I panel, or extension. 2
City/StatelZIP: �KIG �O �, C��, Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(5 3) L 7 7 3 7 99 IFax:(S Jc
�' ) j�S! - � ,'Y Investigation(I hr min) 66.25!hr
Email: -L6.7. GSL 6.•c tied t._6,ect , ?6 A4,11 L. , GO Industrie!plant(1 min) 78.18/hr
Inspections for which no fee is
CCB Lic.:/ 97-2.7v 1 Electrical Lie.:C 6,3C Suprv.Lic.:5 7K,z S specifically listed(%hr min) 40.00/hr
Suprv.Electrician signature,required:f�' -s�/ ELECTRICAL PERMIT FEES
`� Subtotal:
K
Print name: a 13 e1ZTo 4 hr+e ivv AR,7_Date:/2-Z-7-/ 7 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature c TOTAL PERMIT FEE:
Print name: _ This permit application expires if a permit is not obtained within ISO
I ])P Li in r D„ _, -• Date: 12-2 '..._77 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:1Buiiding\PermitslELC PemitApp ELR ERE.doc Rev 04/21/20t4 440-4615T(1IPo5/COMIWEB
Plumbing Permit Anvil ° 7----1
.
BuildingFixtures -4 - �) ` -4
1,0N01u1( 1, lsl. om1
City of Tigard ` Received
III13125 SW Hall Blvd.,Tigard,OR1971L232' u '111 Plan Y: Permit No.:
Phone: 503.718.2439 Fax: 503 598.1 §0., , Plan Review
Inspection Line: 503.639.41�q 1p �'' Y k Date/By: Other Permit No.:
11(, ,0 � ' c& ''( 1i.d
11 Dat`ReadBy: Tins: 0 See Page 2 forInternet: www.tigard-or.gov , m 1 � Notified/Method: Supplemental Info
rmationatix + t3y , c
TYPEy
FEE* SCHEDULE
Or New construction 0 Demolition For special information use checklist
Description Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utilitylconnection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
pxf 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ElMulti-familySFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
�' Fire sprinkler( sq.R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 8g3 /y S . 1. Z Catch basin or area drain
18.76
City/State/ZIP: '--1---/t�A 0Dryweil,leach line,or trench drain 18.76
-72_2_4/
Footing drain(no,linear ft.:____) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
14 14 Li- BLVD &R t=ems Gv A Y1-D 1.11/'. - 90 , „i,,, 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: D Lot no.: / Fixture or item:
Tax map/parcel no.: e✓ci - __,� r, G. ) �1 Backflow preventer 31.27
DESCRIPTION`-- OF WORK Backwater valve 12.51
/ Clothes washer 25.02
�{
'` cam' " %N 6 4 6 ,rte M I Ly R G.�l ?6/✓ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: .S �� 13 -� Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: 1.7.01.4 , D Cj A,,s7.. .Lt L r I r /l:p Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: -0 jy V i D D C-)4 P P6g-
r Roof drain(commercial) 12.51
Address: T. O. 3 x j S "7 7 Sink/basin/lavatory 25.02
City/State/ZIP: BEA VEZRTo A% 0 R 9 7 C:,--)S Solar units(potable water) 62.54
Phone: )3 ) 70/0.-7 ly/'y S Fax::($ 3)s3-,90 ,/ 75/ Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: ,COUP- D G D A/sr e. i% SA 601.9
Water closet 25.02
CONTRACTOR
_ Water heater 37.52
Business name: -rife /l t 4 L L E i! e_o M P,4 AL/ Water piping/DWV 56.29
Address: /60/,4 5.c. ).I i/ r g gel
Other: 25.02
City/StateTLIP: Al1e, DR_ 97/2-3 Subtotal
Phone:(„5.43) 6.yo_ 0/13 1 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: /..,6 g Plumbing Lic.no.: -26 l f 1 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: t • TOTAL PERMIT FEE
Print name:DA V /h V I • s R x Date: 1 2._Z g:1 7 Thispermit 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:1BuildinglPermits\PLMU PermitApp.doc 10/01/09 440-4616T(10/02JCOM/WEB)
Albert Shields
From: Albert Shields
Sent: Tuesday,January 2, 2018 1:33 PM
To: fourdconst@msn.com
Cr Gary Pagenstecher;Al Dickman
Subject: MST2017-00527& -00528
David, we need to receive a copy of your recorded plat before these permits can be issued. Accordingly, I will classify
these as"Approved but Not Released" until we receive a copy of the recorded plat. Meanwhile, Plan Review will
continue. Please let me know if you have any questions.
Albert Shields
Permit Coordinator
City of Tigard
Albert(ci tigard-or.gov
503-718-2426
City of Tigard
v COMMUNITY DEVELOPMENT DEPARTMENT
i
T I G A R D Building Permit Review — Residential
Building Permit #: SSU/2_ CO S 0L>
Site Address: eP 92/l ) / 27/-
Project Name: ,8/0/44‘,Z- ,9,/L Lot #: /
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: tqc) g7 -k___
CJ Verifysite address/suite ess/suite#exists and actio permit system.
❑ River Terrace Neighborhood: No 0 Yes,See River Terrace Review Addendum Attached
Siy Plan Elements:
O ree(3)copies of site plan lih
sting structures on site
lOpite plan must be on 8-1/2"x 11"or 11 x 17"paper ►`l Footprint of new structure(including decks)with finished
awn to scale(standard architect or engineer scale)
r
1oor elevations
Orth arrow y tility locations&easements(required for new and additions)
F tliaddressi ,fproject or(subdivisid phb
on name and lot)number
Sidewalk/driveway approach
ppcant normation name anone numer
cation of wells/septic systems
NO
Lot dimensions and building setback dimensions S�;�
Wting trees to be are footage of buildings to be demolished protection mea urresretained with drip line,and tree
1l t o t area,building coverage area,percentage of coverage and
• pervious area(applicable if R-7,R-12,R-25&R-40) Street eet tree names
size,type and location
V Property corner elevations(2 foot contour lines if more than >1,000 aced? dyes 00 sf of impervious area created or reaced? ❑
4 foot differential) P ,,,�
If es,is a storm water quality facility shown? ❑Y•s L�'No
can Water Services—Service Provider Lett: (lot platted prior to 9/10/1995): i^Z)t/:i � U -
equired: ❑ y ,applicant was notified ® No Received:
Public Faciliti s Improvement(PFI) Permit: ❑ Yes 0 No
Required: Yes,applicant was notified ❑ No Applied For: Or7L 00
RC1 Yes [1❑ No,stop intake
Land Use Case#: ---)1,480_-e)/Ie d6 O1 U
`�
Zoning: 7- 471.s----
l
Required Setbacks: Front _Q Rear /L Side (S-- Street Side /S--- Gara e
I1 ,a.dscape Requirement: % g •„26)
0 tk of Coverage Maximum:
Building Height: Maximum Hei
g 6' Actual Height u2 � it
ht [-ii
igiA Visual Clearance
Ii •ensitive Lands: 0 Yes 0 No
Type
M rban Forestry Plan
Conditio "Met"prior to issuance of building permit /
Notes: O /7 /CLP Uoi � `77r,+z_-( ,a4.7/- r:ed,e)/7-ir 0-C
Approved By Planning: � ���g J�
/,I Date: /
Revisions (after Building Submittal only) Reviewer
Revision 1: 0 Approved 0 Not Approved Date
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\BuildingWorms\B1dgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: I-/
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning Engineering 7 Permit Coordinator Building
Workflow Sign-off: Fr Sign-off for lanning(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.
121 Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: I
� Date: /2 �
By Permit Technician: :�1� . � l��
/ "
Engineering Review
Slope at building pad: 771
El onditions "Met"prior �i
to issuance of building permit / 7
r Easements (encroachments)per engineering conditions of approval and plat
• Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: El Yes El No
Assess Water Quantity Fee in-lieu: Cl Yes Cl No
LIDA Facility on lot: ❑ Yes Cl No
Date:
CINOT Approve by ngineering:
Notes: , ' _ r I 1 ' .>! >.Is ,, AI/ ,.
Approved by Engineering:
4141r-
Date: `-����g
Revisions (after Building Submittal only)
Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: El Approved El Not Approved
Permit Coordinator Review
El Conditions "Met"prior to issuance of building permit
Approved,NOT Released: 14 / Y _ Date: V-2-7//
� APP � ��
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:
?i,DC Fees Entered: Wash Co Trans Dev Tax: es El N/A
Tigard Trans SDC: FA es El N/A
Parks SDC: es El N/A
LIDA El Yes pN/A
OK to Issue Permit -
4 10 -a-rte: yti J
Approved by Permit Coordinator:
I:\BuildingForms\BldgPermitRvw_RES_061417.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8894 SW INEZ ST, TIGARD, OR, 97224 October 4, 2018 at 8:45:47 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00527
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:
8894 SW INEZ ST, TIGARD, OR, 97224 October 9, 2018 at
10:44:17 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00527
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Final erosion control passed
Street tree certificate received
Moisture content form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor