Permit (176) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2018 00099
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/11/2018
Parcel: 2S110AC04200
Jurisdiction: Tigard
Site address: 11074 SW ANNAND HILL CT
Subdivision: ANNAND HEIGHTS Lot: 19
Project: Annand Heights, Lot 19
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 883 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1131 sf Garage: 450 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2014 sf Value: $252,515.90 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
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'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: Square Feet:
NEW SF VB R-3 2014
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 Eaves
TIGARD,OR 97223
PHONE: PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,630.30
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 obtai a copyof e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 1i✓ `—^ < Permittee Signature: ACk -.
all 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 Application• •
Residential : . : '� '" f ' FOR OFFICE USE ONLY
Cityof Tigard Received
Permit No.: `�
a 131SW Hall Blvd.,Tigard,OR 97223 Date/By: ,57 i f�.s L "cyk, /
'' -' Plan Review l /�Q� Other Permit: L e,�' y�aeci3O
• Phone:p503.718.2439 Fax: 503.598.1960 '- Date/By: / ,� / „� v(�L7C�%Zj) Cr �
TIGARD Inspection Line: 503.639.4175 Date Ready/By: i Juris: Q See Page for
Internet: www.tigard-or.gov , Notifi-•/Method: , 761 a//� ��e Supplemental Information
TYPE OF WE/MC"' REQUIRED ATA:l-AND 2-FAMILY DWELLING
/New 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 ❑Other: equipment,materials,labor,overhead,and the profit fox.._
CATEGORY OF CONSTRUCTION work indicated on this application.
�' /44
Valuation: $ 26246/S--
l� '_and 2-family dwelling ElCommercial/industrial
Number of bedrooms: LI
ElAccessory building ElMulti-family❑Master builder 0 Other: Number of bathrooms: t
JOB SITE INFORMATION AND LOCATION Total number of floors: ,� 7 10
Job site address: //0 7 V Al Anand ,if•� (Oa r---i New dwelling area: /t square feet ) 13 L
City/State/ZIP: .7_4-6/-2,0 Of£ 972....-3 Garage/carport area #jp square feet 583
Suite/bldg./apt.no.: Project name: /91)n4Ad Ileo
eV A Covered porch area: 172C)
square feet
Cross street/directions to job site: /0'f'f-a Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST'
Subdivision: n Itaxd iit-e A 115 I Lot no.: / f Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
ilie 61P/2.
Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
t'�T
g� ,. p� Type of construction:
Name: r� "'� �l�f�Q� co�-S��T���
Address: /01"4S-5--- 5.4') NaielltiOako fG. 6(-T-C -ic Occupancy groups:
City/State/ZIP: ma id Q'?2-2.3 Existing:
Phone:(<03) 7 "Li3 7 Fax:(5213) 5-960--7 �� New:
• 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax: :( )
E-mail: . a""1 Ont��lc.? ®i�t Cc1'/1 coon
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
��n( dA�d4 Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: V/JJ�� OJ 2,t s� � Submit two(2)sets of roof plan with connection details
�r and fire department access,along with the 2010 Oregon
Address: �5"S Sto /Vol- �/1 /)4-kettZ t/��� Solar Installation Specialty Code checklist.
City/State/ZIP: 7/ �/r 9'77-2-3 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(, 3) ygo -Lt6 ?s Fax:( 6l 3 6-90-Zapd G State surcharge(12%of permit fee): $21.60
CCB lic.: 6-0/960, Total fee due upon application: $201.60
Authorized signature: ----- - - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: P a' $ Date: 3`1 f7, /e *Fee methodology set by Tri-County Building Industry
f Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicaticill Fs. OFFICE USE ONLY
City of Tigard : -.. , . - :. ' .Recaved
Permit No.:
" /yr ,
II in 13125 SW Hall Blvd.,Tigard,OR 97223 . Date/BY:
Plan Review
° Phone: 503.718.2439Fax: ;03.598.1960 , Date/By: Other Permit:
Inspection Line: 503.639.4175
TIGARD :V::':,i-,,, ?, .;._. / ._ Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
: = -;'''.,..::,-=',-.-='''''''-'.. '-P'=:.'' '''.`• - ,.'-':-, tiro F vvotiLz. . .-,-.--- ,,-,c,-,;„,,,,,,,,,--4,--_,-..1. COMMERCIAL FEE*.SCHEDULE - USE CHECKLIST
' -77111/".,'-r,F'N'J, ..',..-P it wN4i '''''t1 Mechanical permit fees*are based on the value of the work
„So<w construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
and 2-family dwelling 0 Commercial/industrial D Accessory building For special information use checklist.
0 Multi-family 0 Master builder D Other: Description Qty. Ea. Total
Heatin-.--- TOB-SILF.--IlsrfoRmATioN AND-LOCATION g g' . .
Air conditioning 46.75
Job site address://co iii ,ri4.1- j e f-A n a,, ?" /7/7 1//a-4/...../ Furnace 100,000 BTU(ducts/vents) ..:--,'''''. 46.75
City/State/ZIP: T--i.."a,7,/ Or. 972 23 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:h1.-AnazidiA.0. 45-
Duct work 23.32
Cross street/directions to job site: /of 9:---1 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: ifa--/ift4 xr4,/ /At('.ti/5 Lot no.://9 Other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater ....--*" 23.32
1";'-..,1* e1iiiS.-,=.6-F,--W0..iik ' ,;,",•.'.-_;.'-,_ -..„ Gas fireplace/insert ..,'".... 33.39
Flue vent for water heater or gas
NC"-1 <SPX- fireplace -'' 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
OPERTY,,OWNER-''.' - ' . 0 TENANT
,' ""' -, '''' '-- - ' - Environmental exhaust and ventilation:
Name: 6,t)iit-Gfiudad ‘-571 ,Pc- Range hood/other kitchen
.,."'".
equipment 33.39
Address: j45-5- 61,,,D Ndri..,), v0,46,4, s..,.ei
Clothes dryer exhaust ..,..' 33.39
City/State/ZIP: 7-,,,,,..rd . .2
7-2, . ,3 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 3 23.32
Phone:( 5-15 76(f -4/37 cFax:cC 3) gyo ----706 Attic/crawlspace fans 23.32
_.: '.,;%-f.71-------,_.A,P#LICANT : --:- '- ' :--1:1 CONTACT PERSON Other: 23.32
:
g
pipin
Fuel
Business name: 50 hi e
$14.15 for first four;$4.03 for each additional
11
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: t4...."1 (Jiu-ocidkoft,t-S/UUL )6 :)r g/Lai A (.. /ti Barbecue
; CONITIACTOW Clothes dryer(gas)
•Business name: -Fir-5/ (.4.1/ Other:
MECHANICAL PERMIT FEES*
Address: /3/5z) Zia(Atotts giue,,, A.. Subtotal
City/State/ZIP: 4.70e1,01, 4 elz--flyey, azy5-- Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: '7.2. 3TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
/2.. days after it has been accepted as complete.
Authorized signature: .-
* Fee methodology set by Tri-County Building Industry Service Board
Print name: it-reir eiiti7e/j....) Date:
I\Tol
ioildoTermitg\MEC.PermitAoo 040 13.doc 440-4617T(11/02/COMMEB)
Electrical Permit Applicatime F, OFFICE USE ONLY
. . .
City of Tigard - , _,.. - - .., ../Zeceived
' ' Date/B : IMIENIMINEEMI
. 11 13125 SW Hall Blvd.,Tigard,OR 97223 • Plan Review
l 2. Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 %,,'.1 c'' ;"IIP fi '`,.';I:1'.I Ready Date/By: Juris IZI See Page 2 for
TIGARD, Internet: www.tigard-or.gov ,, .` ' • Notified/Method: Supplemental Information
TYPE OF WORkE l'-? ,..-. ;.,!: '..r.,'"F: , ...,,,;-: .;; PLAN REVIEW
jal(rew construction p Addition/alteration/replacement . - ,' Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling p Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: El Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION DEmergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:/)09 V AA n 4,1c/M ii fiittPAI i 00HP or more.
0 Six or more residential units. occupancy.
City/State/ZIP: (./.)ad 9-)2,7:3
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: /9.-AmikiA# 0 Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
0 Service or feeder 600 amps or more.
Cross street/directions to job site: A,IA FEE SCHEDULE
e 1 Description I Qty. t Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: nhil4/1 /tee)t IS Lot#: i f Includes attached garage.
1,000 sq.ft.or less
/ 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion a., 33.92 1
DESCRIPTION OF WORK Limited energy,residential
fr5'F (with above sq.ft.)
Limited energy,multi-family f 75.00 2
a.i
75.00 2
residential(with above sq.ft.)
Renewable Energy 1:1 See Page 2
„...EPROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: &i fit cif tetedd 6A-574n161144 rikr- 200 amps or less 100.70 2
Address: 2Q5-s- 6-co itiv,-/----A pojcic, ejrc...c.-1 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 70 rtiej 6,c_ f72..2,3 601 amps to 1,000 amps 301.04 2
Phone:(IrL3 • 7ba--113 7S Fax:(cp3 )5-50 --24,,a. Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:tufric ,-"creihroves efix, (.." 6„41- I tev,,,,t
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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
Branch circuits-new,alteration,or extension,per panel
,,,.....aVTL-TEANT 0 CONTACT PERSON A.Fee for branch circuits with
Business name: (5Q1
mpLe. above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: 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
67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 4/...cair) 0,Loc kl..ecifi c.... Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: a/ e. C .fjn OC,A ri4„, i91 panel,alteration,or extension. ID See Page 2 2
f..
Each additional inspection over allowable in any of the above
City/State/ZIP: 4.,,,, ,,,,c .7'21-25 Additional inspection(1 hr min) 66.25/hr
Phone: ,..-z).3) 3---/f .....6,-71,t Fax:b—ti ) ‘9ifj•—9'7?-3 Investigation(1 hr min) 90.00/hr
Email: LI
Industrial plant(1 hr min) 78 18/hr
ii it •2_,, '
Inspections for which no fee is
90.00/hr
CCB Lic.:/q6,222.4. Electrical Lic... ..---gri.e Suprv.Lic.:115 ,OS specifically listed CA hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name kre5 4)4A0 Date:3/)...e./ 1/ 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized TOTAL II---"' ----
• ---1-77- - —ef TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: A,-,,, /11.6. AcrAs.e• Date: '3)Wititk days after it has been accepted as complete.
* Number of inspections allowed per permit.
I\Building\Permits\ELC_PermitApp_ELR_ERE doe Rev 06/t2 < 440-4615T(11/05/COM/WEB
Electri€al Permit Application—City o igard
•
Rage 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Descrf
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
El G• arage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
I I Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(%z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
$75.00 Subtotal(Enter on Page 1):
Fee for each commercial system: Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n B• oiler Controls
n C• lock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
[-] Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\BuildingTermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Applicatio.
. BUilding Fixtures FOR OFFICE USE ONLY
City of Tigard _.'Received
Date/By: Permit No.:p2St7.).,(2iss--clay-il
.., 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
III 11 Phone: 503.718.2439 Fax: 503.598.1960 . ,-,,Q
,-,!;,... Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov - , , ,,. , , .Notified/Method: Supplemental Information
TYPE OF WORK-f?4.4 f 4r-r. . ,,,,, , , FEE* SCHEDULE
,00„. ew construction El Demolition For special information use checklist.
Description Qty. Ea. Total
El Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
- - 312.70 CATEGORY OF CONSTRUCTION SFR(1)bath
and 2-family dwelling D Commercial/industrial SFR(2)bath 437.78
SFR(3)bath i. 500.32
Ei Accessory building 1:1 Multi-family
Each additional bath/kitchen 25.02
El Master builder El Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: //to'"? Cil ,5 4) /9..,ARAI /I
hit/(aLer-/ Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: T4-.61-A".0 if, Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: _,Airia4difie-0 kis' Manufactured home utilities 50.03
_
Cross street/directions to job site: Manholes 18.76
if 0 9 III 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: fir m iti kleol,„15 Lot no. Fixture Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Ajti--) 5:1--'-/2- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,EI PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: kfindiireed 6a,,s7z---pi .....,.
Floor drain/floor sink/hub 25.02
Address: /49.4 5-57.510 ,,,,ver,-/-h,/9 ejo/a._ 54)-&-,/ Garbage disposal 25.02
City/State/ZIP: 7(1i at?,/ oz, e 7-2 4 .3,_,.3 Hose bib 25.02
Phone:(6'73 716-i(2)7,5- Fax:(fe,3 5` 9t Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON
. Interceptor/grease trap 25.02
Business name: 5-0.,„, Medical gas(value:$ ) Page 2
t,
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
• / Urinal 25.02
E-mail: kiiitflad-ci 0-ditoirt.-es Al te..7 (49__„•1-1914 I i t(Col
v Water closet 25.02
CONTRACTOR
, di i- , , Water heater 37.52
Business name: po,-1--A,,.,// f'/(t.At-b i\,.., /0 Water piping/DWV 56.29
Address: dio,tic) 6 Al fi loll 121 Other: 25.02
City/State/ZIP: O.,..0,,,, q f- efr,1 pr2a5.-- Subtotal
Phone:(5Z3) 703 --ggI Fax:6-43) -7,26ie/ Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: /‘.2 A3 9' Plumbing Lic.no.j 6--36, loi
'`•J - State surcharge(12%of permit fee)
Authorized signature: 2,... 4/1„- 7 l 1/2. TOTAL PERMIT FEE
Print name: c p c i A tu k t 71.- Date: Didi 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.
1\Building\Permits\PLMU-PermitApp doe 10/01/09 440-4616T( 0/02/COM/WEB)
City of Tigard
.71 r COMMUNITY DEVELOPMENT DEPARTMENT
T l c A R D Building Permit Review — Residential
Building Permit #: / 3C/ 7
Site Address: II 074 S IA) Annan" all C!.
Project Name: �n p��, C�Q� �; Lot #: Iq
(New dwelling=subdivision nate; dition or Alteration=last name of owner)
Planning Review
Proposal: e,,t) rr 5 rg
Lam'V rify site address/suite# exists and active in permit system.
VRiver Terrace Neighborhood: o ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
,Three(3)copies of site plan ,,���'"'sttngstructures on site
Site plan must be on 8-1/2"x 11"or 11 x 17"paper �L'Pootprint of new structure(including decks)with finished
in-Drawn to scale(standard architect or engineer scale) floor elevations
2North arrow ✓,D_.,Utility locations&easements(required for new and additions)
,PSito address,project or subdivision name and lot number .rJ 5tdewalk/driveway approach
.pplicant information(name and phone number) -C nra cissa of wells/septic systems
.mot dimensions and building setback dimensions -g-ExisTiErrees to be retained with drip line,and tree
quare footage of buildings to be demolished protection measures
area,building coverage area,percentage of coverage and 2Srtreet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) ,13'treet names
PPfoperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? des No '91e
4 foot differential) If yes,is a storm water quality facility shown? ❑Yes eff(Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ..B'-No Received: ❑ Yes ❑ No
,,Er Public Facilities Improvement(PFI) Permit: ?F1 20/6-6C2°-5C/
Required: ❑ Yes,applicant was notified .21' No Applied For: ❑ Yes ❑ No,stop intake
.E Land Use Case#: FDRae i5 -0000 F
f 2rZoning: -Id('pp
.2' Required Setbacks: Front 5 Rear 15 Side '3 Street Side Garage
-ErLandscape Requirement: (J
0/0
.ZLot Coverage Maximum: Fo %
Building Height: Maximum Height 36 Actual Height P5
-Er—Visual Clearance
la-Sensitive Lands: ❑ Yes ❑ ..1>.r Type
Urban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
❑ Approved By Planning: Date: .3 e �
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\BldgPern itRvw_RES_061417.docx
1
Building Permit Submittal
Original Submittal Date: `, ,l l�i
Site Plans: # 3/
Building Plans: # 3
Building Permit#: Zf ter building permit#above.
Workflow Routing: Q.-Pianning gineering ri 'ermit Coordinator CT ]3uilding
Workflow Sign-off: Z.-Kin-off for Planning(include notes from planning review)
Route Application Documents: [g-engineering: (1) copy of permit application, (1) site plan, (1) building plan and
orial plan review routing form.
E wilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: 7.7.R.--
`�
By Permit Technician: �� � .-, - / Date: 3/30/4
Engineering Review i ?�
lope at building pad: l G
❑ 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 .2rNo
Assess Water Quantity Fee in-lieu: ❑ Yes .-•ErNo
LIDA Facility on lot: ❑ Yes -Er-No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
„2"AApproved by Engineering: W f k l t, I Date: + c( I
Revisions (after Building Submittal only) Reviewer Date
Revision 1: LI 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:
DC Fees Entered: Wash Co Trans Dev Tax: 0— es ❑ N/A
Tigard Trans SDC: ��°Yes ❑ N/A
Parks SDC: M Yes ❑ N/A
LIDA ❑ Yes N/A
OK to Issue Permit
Approved by Permit Coordinator: WalDate:4/4/1 Y
I:\Building\Forms\BldgPermitRvw_RES_010118.docx
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11074 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2018-00099
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Provide appliance impact protection in garage per M1307.1
Gas fireplace does not appear to be working at this time.
No ac installed at this time.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11074 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2018-00099
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Provide hard cap for un used rain drain stand pipe left side of house.
Secure T&P at water heater.
No water at rear hose bib.
Base of tub shower not sealed at floor main bath.
Cleanout cap in laundry missing.
Grouting not complete at master tub.
Cleanout caps not gas and water tight.
Not ready for inspection, work not complete. OPSC 103.5.4
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11074 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2018-00099
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
No ac installed at this time.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11074 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2018-00099
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Note: upper level handrail removed to be painted, contractor to re install after painting
prior to occupancy.
Provide missing drywall at exposed mud sill by furnace for required garage dwelling unit
separation prior to occupancy.
Final erosion control approved.
Moisture content form received.
Moisture barrier form received.
High efficiency lighting form received.
Duct seal test report checked.
Insulation certification checked.
C of 0 left on site at kitchen island.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11074 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2018-00099
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11074 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2018-00099
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor