Permit Support Document CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2017-00489
7 !c. ;\It.r, 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 `r Date Issued: 02/28/2018
e Parcel: 2S 111 AA01400
AJurisdiction: Tigard
Site address: 8879 SW INEZ ST
Subdivision:
Lot:
Project: Butterfield Park, Lot 11
Project Description: New SF. 3/19/18: REPRINT to correct general contractor information.
BUILDING
•
Floor Areas Required Setbacks
Stories: 2 Bedrooms: 5 Required
First: 2070 sf Basement: 0 sf Left: 5
Parking Spaces: 0
Height: 28 Bathrooms: 3
Second: 994 sf Garage: 686 sf Front: 20
Dwelling Units: 1 Smoke
Third: 0 sf
Right 5 Detectors: Yes
Total: 3064 sf Value: $384,954.64 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 Water Li0
Lines: 100 Drains: Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckfiw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y 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
P W/Svc or Fdr: 0
Ea add!500 sf: 6 201-400 amp: 0 201-400 amp: 0
P W/O SvGFdr: 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: hl Security Alarm: N Vaccuum System: N
y 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 3064
Owner: Contractor:
FOUR D CONSTRUCTION FOUR D CONSTRUCTION Required Items and Reports(Conditions)
P.O.BOX 1577 PO BOX 1577 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97075 BEAVERTON,OR 97075
PHONE: 503-720-7445 PHONE: 503-720-7445
FAX: 503-590-1751
Total Fees: $32,381.15
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 52-001-0090. /ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
c
Issued By: ����. /A_Alle �i SrPere next vaiabture:Call 503.639.4175 by 7:00 a.m.for the next available inspection date. i7w,,,..-75 ._„_
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
f
Residential raiz OF FI( F: ISF: ONI.\
City of Tigard E CEIVE I) Receives _
1111 . Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �� �� / �7�L 5`j
Phone: 503/18.2439 Fax: 503.598.1960 DEC
tt Plan Review ,� ,, t
I i i, \h i. Inspection Line: 503.639.4175 U C 5 (� Date/By: ja-)1)-t-7 Other Permit � �
Date Ready/By. / Juris: H See Page 2 for
InternetXis
www.tigard-or.gov tifiedlMet od: / Supplemental Information
TYPE OF rG DIVISION REQUIRED DATA:1-12-FAMILY DWELLING
'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
❑Addition/altereion/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. /(j_
fif 1-and 2-familydwellingValuation: $3 $'4, /S-1 RJ
0 CommerciaUindustrial
❑Accessory building 0 Multi-family Number of bedrooms: `5"'
❑Master builder 0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 'Z 3 76 0
Job site address: 88`7CC f ..5t kv' ive .J New dwelling area: 3 )& square feet
-T-1 City/State/ZIP: j & V-D o R 9 7 22-‘7/ Garage/carport area: 4.7g‘„ square feet
Suite/bldg./apt.no.: Project name:di, '�1,CjGI Avi,, ,,L,T/r Covere c t artrea 2&C) square feet('9L1...
Cross street/directions to job site: roviv- 1 3 o square feetao 70
i4 lA U.- LVD - 6 g e- -e/yst,i iNn-p Li,/ -- 9,c) 1 )-/- Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: -Cai, .1..1 I Lot no.: / Permit fees*are based on the value of the work performed.
Indicate the value rotnded to the nearest dollar)of all
Tax map/parcel no.: 11 i.-'~ io..j tf/Z
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
A/c...-760 ,$f i 6 t-C i-A it`l ;9/ RES/DeNC Valuation: S
Existing building area square feet
New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: 6. /3 S R -L d % Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
XAPPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: � p..., (P�refertofeeschedrtt))
Foil C N.5 T R U C T! /`1 Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
':0 C. BOX j S 7 7
City/State/ZIP: Total fees due upon application:
�EAyeR-row C 7 70~7
Phone:(5-..3) 7 A0 _- I y S Fax::(3590.- /7.5/ Amount received:
E-mail: F'a r'rl D C.o W5 r ms i- C O ra PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: t . Submit two(2)sets of roof plan with connection details
Address: I 0 t.:)I L" and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP: NyePermit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 7/(.3' 1/7[2-0
Total fee due upon appication: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: .A v),.)..?,/
De J4c RPP„ .Date: /2.—5 >/ *Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
echanical Perm A s I lication FOR OFFICI: FSI: O"I.v
eceived
City of Ti;ar ®! Permit No.:
III13125 SW Hall r'Ivd.,I igard,OR 97223 � � �! '�' 'ate/By.
_ Plan Review
Phone: 503.718.239 .ax: 503.598.1960 Date/By: Other Permit:
I i c, \R I) Inspection Line: 3 t .63'.4175 ry Date Ready/By: Juris: Ba See Page 2 for
Internet: www.tiPar- rev DEC q� t Notified/Method: Supplemental Information
TYPE OF WOROTA(ggOA Tiv c_y�IGAr�� D COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
New construction 0 Addition/alterat � d141b}I�IlIVISIO1, Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
o Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
Ix 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning / 46.75
Job site address: 8 2-?C1 ,5 �N�z._ sr" Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1"'Lift- C.3 7 Z Z t/ Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
I4 L L a LV b &(Z E E NS to \1Z 4L/t/ -- ?a j-/4 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: - .. .-:� p ;:.t.i.- Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: t trE iZ 1 i(::L!D PA IOC__ Water heater . 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
_ _ Log lighter(gas) 23.32
/f,/&14S / C'L..G fi}a M I Ly P.ES I D'e/l3 t;-.l1 Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
a PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: $Pr KC ps B j 0..6W i Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
fir APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: FC)t-L R. C) Cb tui ST14.1.C.TI p k) $14.13 for first four;$4.03 for each additional
Contact name: 1:).t.1/ i P D E 41412-1'PC42-r- Furnace,etc.
Address: j� Gas heat pump
P, 0 ` <�-)C x I5 7 7 Wall/suspended/unit heater
City/State/ZIP: f3Ekkv ek-Tz i J G 9'7 0`7 5 Water heater
Phone:(6 u3) 7),0 7 y`(S Fax::(503 5 70 .. 17S I Fireplace .
Range
E-mail: f o Lt.ALO co jam} ST.- c:: `, io co Aft Barbecue ,
CONTRACTOR Clothes dryer(gas)
Other:
Business name:
&/r" iv_
00 tr MECHANICAL PERMIT FEES*
Address: ) o t fio>c 933 Subtotal
City/State/ZIP: ��a`L J-,4 M /�`�s 1(2. i7 Q 1 C, Minimum permit fee($90.00)
J Plan review(25%of permit fee)
Phone:(5c3) & 6..,. , ?0,8-- Fax:(... .t3) &5 o-3 g 9S State surcharge(12%of permit fee)
CCB lic.: /'76 6.,J V TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:Z./1..2/ , / * Fee methodology set by Tri-County Building Industry Service Board
Print name: tjv!b 41-7 ate: 2-s
I:\Building\Permits\MEC PermitApp 040113.doc 440-4617T(I1/02/COM/WE.B)
Electrical Permit Application 1 ()R ()I r I( 1. 1 l ()NI
` CityofTigard 1VE Ree�yed
IN g `;DRe e/By: Permit#:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
IPhone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit 4:
Inspection Line: 5113.639.4175 � c r Ready Date/By: hail. 0 See Page 1 for
I i �' Internet: www.ti and-or. ov f ��
g g �J�L Notified/Method: Supplemental Information
TYPE OF WoRic1 OF TICARD PLAN REVIEW
KNew construction 0 Addition/alteratio3d�11a q Please check all that apply(submit I sets of plans w/items checked):
❑Demolition ❑Other: UD1V1 IO
0 Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
pi,1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Sob#: Job site address: (2i-•:):
�j r�- 0 Addition of new motor load of system.
CJ CJ 77 4$/ 'Z 5 r 100HP or more. ❑"A","E","i-2"«t-3",
City/State/ZIP: .-1--/ 91 7 zzV ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
13 Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name: 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each 1 Taus l
14 A Lt.. P i_V D " RC::L-1II iw k 1' 1-1(I — 6, 7-/4 New residential single-or multi-family dwelling unit,
A7
Subdivision: ' t -f� Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 0,1-T fes z c" i LI) i•S IL Ea.mld'l 504 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
n n (with above sq.ft.) 75.00 2
,,,,Vel ' /�b L F 3 t Ly I esDe/tic Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 13 See Page 2
'PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
1'�t 1.'C L U l 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
Temporary services or feeders installation,alteration,and/or
Email:
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
APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Foci,y� U Co F JS �U co o Aj above service or fender fee,
7.42 2
each branch circuit
Contact name:
I)xv/Q .t I4R-F'1'ci2_"r B.Fee for branch circuits without
service or feeder fee,first
Address:
Pr Box is-7.7 branch circuit 56.18 2
City/State/ZIP: , A Vc._-- t tM) - 9 70'7 S Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:603)77 o .7 y V 5 Fax::(S-03 )j c: -t 7 S / Each manufactured or modular 67.84 2
Email: `P'"O LA 1`` D (.....61,45'rte dwelling,service and/or feeder
�'hs't Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: -L 7-g L.&c'.r7z-4 c:- ( getup Sign or outline lighting 67.84 2
Address: 0 L L . C 0 OR lb 4/ Signalnl, s)or extension. 0 See Page 2 2
�Lj %� � ��� panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
�} L �� �'� Additional inspection(1 hr min) 66.25/hr
Phone: 03) L,7 7 3 7,99 Fax:( 4.3 ) ?tj/ '"` 79i v Investigation(1 hr min) 66.25/hr
IV/
Industrial plant(1 fir min) 78.18/hr
Email: /-67-6 L.&-�=T'/�j(,,,.6 ge t P mil't11 t.- , t0 !t/1 Inspections for which no fee is 90.001 hr
CCB Lie.: c Electrical Lie.:C c Suprv.Lie.: specifically listed(h hr min)
/ �/L7 �3� p 5 7�L S
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: P ., .r..•--� Subtotal:
Print name: }P U 8 EYLTD ieg.g./i elovi24,e,Z Date: 2 _5._/2 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-- � L,✓�� Date:/7.-5- / 2 days after it has been accepted as complete.
"22 * Number of inspections allowed per permit.
I:1 Building\Permits\ELC P tApp ELR ERE.doe Rev 0421/2014 440.4615T(11/05/COM/WEB
Plumbing Permit Application
Building Fixtures
',E �.Cityof Tigard *1-F . _ Received
IIIIIDate/By:
No.:
■ 13125 SW Hall Blvd.,Tigard,OR 97223C
Plan Review
Phone: 503.718.2439 Fax: 503.598.19 0r Date/By: Other Permit No.:
Inspection Line: 503.639.4175 (JJ 5 2 0 1
7 H(.i(; A L i l Date Ready/By: Juris: ®See Page 2 for
Internet: www.tigard-or.govNotified/Method: Supplemental Information
TYPE OF WO....,I I Il OII TiGAR�g FEE* SCHEDULE
121 New construction litilniNUDIVISION For special information use checklist
Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
141-and 2-family dwelling 0 Commercial/industrial SFR(2)bath I 437.78
❑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 LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: %b.-7 7 .St 4z"Jjv67-- Sr
DrCity/State/ZIP: '1-1 &A 0 R. cl 7 Z°L 7 Footing
drain
line,linearor trench drain Page 18.76
/ Footing drain(no. ft.: ) 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
14 14 LL BLVD &R tr GNs,.-A. to /,Ali. _ 90 rip.
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 j
Subdivision: 6-4aEltit4tkistag. I Lot no.: Fixture or item:
Tax map/parcel no.: "/u r`, LA, J) pl�,q(-.- Backflow preventer 31.27
"✓ DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
A/� 3/N641E "14M I Ly RE5AD&'/Vt!
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER l 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: 514,11E As 23 ALO
Garbage disposal 25.42
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
Ca'APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: 'o u y-4 D co AisrRU Lt/C)AI Medical gas(value:$ } Page 2
Contact name: j Primer 12.51
j4%i.0 D j� p bJ&r Roof drain(commercial) 12.51
Address: $?, O. 43 x / 5 -7 7 Sink/basin/lavatory 25.02
City/State/ZIP: ,,Z3 -/4 ve gro AU 0 R / 7 e.!-2)-7 S Solar units(potable water) 62.54
Phone: )3 ) 7 O•-7 v y 5 Fax::(j- 3)5-90..175/ Tub/shower/shower pan 12.51
al
W
E-mail: ,cOUI'.. DGbA/5T 44.5,4/ C-0/x7 ter 25.02
CONTRACTOR Water closet 25.02
Water heater 33.52
Business name: --/-1-t(r 144 64 c(- P l/ Water piping/DWV 56.29
Address: /60/14 S,C. Rive-12 R dY. Other: 25.02
City/State/ZIP: A//t.. 1 7/2.3 Subtotal
6, 7 3 Minimum permit fee: $72.50
Phone:(,,s ) tj /.` Fax:( )
Plumbing Lic.no.:
g
CCB Lic.: !. �j C- .-3Y-264////j Plan review (25%of permit fee}
State surcharge(12%of permit fee)
Authorized signature: 40001;,...,----- TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: j v/� ib-A3/49,04 Date:/2_3-- 17 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:tBuilding\PcrmitslPLMU-PormitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
■
T I G A R D Building Permit Review — Residential
Building Permit #: ,rY);31-3.j t 7-c i Lill
fProjSite Address: a'$7'7 S w /h e z s+-
Project
ect Name: Ne;11),-/ Pa,---4 Lot #: 1
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: /11e,,(2 s- _R
.E Verify site address/suite# exists and activetiin permit system.
.E7 River Terrace Neighborhood: .IBJ No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Three(3)copies of site plan --E tExisting_structures on site
tte plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
��rawn to scale(standard architect or engineer scale) elevations
- 1 t ]orth arrow 1)tility locations&easements (required for new and additions)
/ElSite address,project or subdivision name and lot number idewalk/driveway approach
2 plicant information(name and phone number) cation of wells septic systems
OLot dimensions and building setback dimensions -EExisringrrees tip be retained with drip line,and tree
Square of buildings to be demolished protection measures
❑Lut-areaiflding coverage area,percentage of coverage and t tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) '.2. treet names
DP erty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? E E No
� (:l
4 foot differential) If yes,is a storm water quality facility shown? ❑Yes E'Ko
.Ir e/an Water Services—Service Provider Letter platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
al1blic Facilities Improvement(PFI)Permit: /.7F/ ' O/ -000(37
Required: es,applicant was notified ❑ No Applied For: des ❑ No,stop intake
0. Land Use Case#: -5. B aOJ — po b I 0
J2—Zoning: 'R --2-1._s
,Required Setbacks: Front '.t) Rear ! Side E Street Side r5 Garage �(�
D Laird tape Requirement: % b
"0 Lot Coverage Maximum:
wilding Height: Maximum Height 30 Actual Height a,`(
...0--Visual Clearance
,a—Sensitive Lands: ❑ Yes LTo Type
[2' Urban Forestry Plan
,- J Condi ions " et"Fiorito issuance o building permit ff
Notes: ri✓1q( Q -4, vv e 2''"4 pr lay- 740 15.5--6 ,--,Ge.
Approved By Planning: .,-`�-__— Date: 1, //6/1---7
oZ
Revisions (after Building Submittal only) Reviewer Date
Revision 1: D Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES 061417.docx
Building Permit Submittal
Original Submittal Date: /02/y j 7
Site Plans: ##
Building Plans: #
Building Permit#: Inter building permit above.
Workflow Routing: Manning ngineering CoordinatorD- I iding
Workflow Sign-off: [LS_�TEgn--off for Planning(include notes from planning review)
Route Application Documents: ls�F:ngsneering: (1) copy of permit application, (1) site plan, (1) building plan and
original� plan review routing form.
Eg-15original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: /tv Date: /2 kip
Engineering Review
Slope at building pad:
Conditions "Met"prior to issuance of building permit �C
/ Easements (encroachments)per engineering conditions or 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 No
❑ Final Plat Recorded:
❑ NOT Appr.. ed b Engineering: Date:
Notes: 4 ';'�, a - `�J �/c�.�l/_�'� %� - .i.v rte
Approved •y Engineering: 4/Z Y Date: 12
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: iy " 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:
"SDC Fees Entered: Wash Co Trans Dev Tax: ,Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes p/A
" OK to Issue Permit
Approved by Permit Coordinator: Date: - 67
I:\Building\Forms\BldgPermitRvw REs 111617.docx
Albert Shields
From: Albert Shields
Sent: Thursday, December 07, 2017 10:39 AM
To: 'fourdconst@msn.com'
Subject: MST2017-00489 & -00490
David, on reviewing your applications for the above permits Engineering finds that we do not yet have a copy of a
recorded plat for the subdivision, SUB2016-00010. Accordingly, I have noted these applications as "Approved (for Plan
Review) but Not Released." Plan review will continue but the permits cannot be issued until we receive a copy of the
recorded plat. Please let me know if you have any questions.
Albert Shields
Permit Coordinator
City of Tigard
Albert atigard-or.gov
503-718-2426
1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8879 SW INEZ ST, TIGARD, OR, 97224 October 11 , 2018 at
10:18:25 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00489
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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8879 SW INEZ ST, TIGARD, OR, 97224 October 2, 2018 at 9:03:29 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00489
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS
Comments:
No A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8879 SW INEZ ST, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2017-00489
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
No A/C installed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8879 SW INEZ ST, TIGARD, OR, 97224 October 4, 2018 at 8:43:30 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00489
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed
Violation Summary:
Inspector Contractor