Permit (102) CITY OF TIGARD MASTER PERMIT
141B. COMMUNITY DEVELOPMENT Permit#: MST2018-00250
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/04/2018
Parcel: 2S111AA13100
Jurisdiction: Tigard
Site address: 8849 SW INEZ ST
Subdivision: IRMA DELL BUTTERFIELD PARK Lot: 9
Project: Butterfield Park, Lot 9
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1799 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1490 sf Garage: 637 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3289 sf Value: $425,312.55 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 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: 0
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: 6 201-400 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 3289
Owner: Contractor:
LWD LLC FOUR D CONSTRUCTION Required Items and Reports(Conditions)
FOUR D CONSTRUCTION CO PO BOX 1577 1 Ersn Cntrl 503-639-4175
5740 SW ARROWWOOD LN BEAVERTON,OR 97075
PORTLAND,OR 97225
PHONE: PHONE: 503-720-7445
FAX: 503-590-1751
Total Fees: $34,136.65
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 C ter. hose rules are se forth in OAR
952-001-0010 through R 952-001-0090. You may obtain a epp e rules or direct questions to OUNC by calling 503.23.19 7 .800.33 ''•4
Issued By: t Permittee Signature: _
I 3.639.4176 by 7:00 a.m.for the next available inspection d e.
This permit card shall be kept in a conspicuous place on the job site until completion of th project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
ke Residential RECEIVE 9 1,111z of i R L l sr-.ON1.v
16D7EView
, ' PermitNoo:ig h ne25 S50 Hall Blvd.,Tigard,OR 97223 SE 2 D 1 I,7 b A
A Othg�etelie2Q'T`O60Z ,
Phone: 503.718.2439 Fax: 503.598.1960 /^�pp Date/By: /
i_i, `hD Inspection Line: 503.639.4175 CITY OF TIGARD DateReadyBy: �� Juris: WI See Page 2 for
Internet: www.tigard-or.gov oti. " ethod: , (I /. --- --c, Supplemental Information
BUILDING ®I�/I�IQ Li�_ P'7-/.4
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
KNew 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/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
01-and 2-family dwelling 0 Commercial/industrial Valuation: $ L z .s ?,(2-
❑Accessory building ❑Multi-family Number of bedrooms: Li
❑Master builder 0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: ., 31 Ol.P
Job site address: se L 1 s',Y/ r,/e Z, S T New dwelling area:32:6 6 C square feet i Cj q 4
City/State/ZIP: Ti &A-v-D o (2, 9 7 ZZ' Garage/carport area: ( i3-7 square feet/79a,
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: ZZ I square feet
/4 jA U.- j Lv L) -• (;m g ivSt o Art-t3 L./.J -- 90 7"J-- Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ' ( Lot no.: q Permit fees*are based on the value of the work performed.
, Indicate the value(rouided to the nearest dollar)of all
Tax map/parcel no.:
4`t i€ :/C L.0 PFI equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
A/L1 5/IV6L.. yI e P-Ait v Re-5/ Valuation: $
Existing building area square feet
New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: 674040 g A'S REL O y1 f Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
X APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(PleasBusiness name: Fou i1. D 6,14,5 rgL G'C ,Iv reviewe fee(orer fee schedule)
Structural plan (or deposit):
Contact name: D pv 1 p 1I 14)4.124)P b g-r
FLS plan review fee(if applicable):
Address: '',0. Bo x I S 7 7
PIS upon
Total fees due application:
,,
City/State/ZIP: BEA vE R-ro i c7 707 S
Phone:(5o3) "7, Q --'7 y y S Fax::(; 59'o-- /75 Amount received:
E-mail: F au IQ D coW5 r P 64 s !.% i LC} PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
r= ti� and fire department access,along with the 2010 Oregon
Address: g P5
I Solar Installation Specialty Code checklist.
City/State/ZIP: .5 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
k
CCB lic.: `1. '7 Total fee due upon application:
This permit $201.60
Authorized signature:
..."/
application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ' Date: c�- *Fee methodology set by Tri-County Building Industry
v)D ....�- L/k=/IA Repeat-- / Service Board.
I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
A
Mechanical Perm A t •licatio i FOR OFFICI. 1 SF OyLv
11 q City of Z'T;ar Q. ECE: CVE Received Permit No.:
(n j
13125 SW Hall f lvd.,1 igard,OR 97223 C pi Review ��� ��
11 Phone: 503.718.E 39 .ax: 503.598.1960 5 ®P 20Date/By: Other Permit:
1(;A R f) Inspection Line: 51 .63 .4175
T Date Ready/By: Juris: H See Page 2 for
Internet: www.tig. '.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISIO
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
ONew construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
Pr 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
> �, Air conditioning / 46.75
Job site address: 59 9 S YY i�t /e.z- 5 r. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: T-1("er g..0 C) el 7 2.7-Y 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
14F1 LL 0 Lv b - &R e E iVS c�AflIZ L.t/ - ?'o rN 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
Other: 23.32
Subdivision: pa,.f..0- Lot no.: q Other fuel appliances:
Tax map/parcel no.: ai IT: ,--jz.ll"J L ID PA t& , Water heater , 23.32
DESCRIP'T'ION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
_ _ Log lighter(gas) 23.32
Al&i-4-1S /i',-)C',' -C P>A Ma Lyg G3 t i D Le- 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: _ ,.r46- INS' B i e L(jL, j 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
lid APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: Fo uL R. c 1-{cZ 1j $14.15 for first four;$4.03 for each additional
Contact name: T '/ P D is c-lz-P Pc42-t--- Furnace,etc.
Gas heat pump
Address: i 6 . B by i 5 7...7 Wall/suspended/unit heater .
City/State/ZIP: 13E-, .v E24 e 9.7 0 7 S Water heater
Phone:(5b3) -2si..0 .- ') r`i 5 Fax::(503 5 70 . 175 1 Fireplace
Range
E-mail: FOU 3x!-'17 CO I SI-( 1/ /I3; CO Mi Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: t' r /,m,L. i�-- 1.-0.J Other:
MECHANICAL PERMIT FEES*
Address: P.0 4 i3o>c 443 3 Subtotal
City/State/ZIP:
e:La k AS ( � t Minimum permit fee($90.00)
? Plan review(25%of permit fee)
Phone:(5c3) (QS.6._ / 9,0 ' Fax: ) 650 0 a 3 S 94' State surcharge(12%of permit fee)
CCB lie.: /76 6.„..-4 9/ 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: /a2"" Fee methodology set by Tri-County Building Industry Service Board
Print name: aini l✓i!� nc_ .12,114.41/4_1--Date: 7, 6--/g
I:\Building\PermitAME.C_PermitApp_040113.doc 440-4617T(31/OJKOMIWEB)
Electrical Permit Application 1.01t (11 l u i, l '.1: Oy 1 v
City of TigardEE I ""Y' Permit#: -r
• ' C 13125 SW Hall Blvd.,Tigard,OR 97223 V an Review ��/ /�' ,L�1�
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 SPP 6 9 0 t' Ready Ins Supplemental Information
See Page 2 for
Internet: www.tigard-or.gov
TYPE OF WO CITY Of- DIVISION
FLAN REVIEW
.New construction 0 Addition/alteratio Please check alt that apply(submit I sets of plans wlitems 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.
ifil,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
_
0 Addition of new motor load of system.
Job#: Job site address: 00 y 7 _5;y/ l le y Sr. 100HP or more. ❑"A","E»."i-2""i-3'>
❑Six or more residential units. occupancy.
City/State/ZIP: "I �-� 7 2-2-V ❑Health-care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.11: 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
_ �y Description I Qt9. I Each I Total i *
N IA LL 2)4.v D `- Co R t:..LNS t s.a it t2-0L-A/ - !6 r/4 1 New residential single-or multi-family dwelling unit.
Subdivision: &iledfsaSi,,,,- Co .5-Eit Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: `5'V `r 11/4.,... LI) l) Ea.add')500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
NG ,5-,"/L'L t=A U t Ly P Es, /VCtE Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
0 PROPERTY OWNER ❑ TENANT
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: ,5 A M6 Pls B E LOLL)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
t�APPLICANT 0CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
w A.Fee for branch circuits with
Business name: Foci,1ZD coK/$T72U 6.1lcJ JL above service or feeder fee,
7.42 2
each branch circuit
Contact name: b Nv i O D f HA gP t ct2( B.Fee for branch circuits without
�7 service or feeder fee,that
I)Address: ;t3, 13 OX /5'7.7 branch circuit 56.18 2
City/State/ZIP: B jwc LXCttU e::::3 12- 9 70.7 5
Each add'I branch circuit 7.42 2
/ Miscellaneous(service or feeder not included)
Phone:663)-7 0 .7 y L,/5 Fax::(613 )3170 .j 7 5' Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: FC.)t �-, D c.6,,,./51-G.2 tit /y't Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: . -l- ...7-6" �L,b-i!"r"/2 I C. 6P-ctU) Sign or outline lighting 67.84 2
, � Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: /,'e? /5 0 ,%, k. �a2 A/D ase '6 10 / panel,alteration,or extension.
City/State/ZIP: C/ I L �� Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:003) 7_7 7 3 739 Fax:($,3 ) 10 j -- 7 el/V Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Email: rare 4 e e::r'/2I c-6gact e(o c2.6 A41.11,... , 64 /(A Inspections for which no fee is
CCB Lie.:1 eh/ ?27V Electrical Lie.:G 63suprv.Lic.:576 Z S
specifically listed('h hr min) 90.001 hr
��,,,,„,„..„../p„,,
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: pC7 8 ep. /4 AZ ILA 6-,va9R,Z.Date: nj-5---/j1 0 Plan Review Required(25%of permit fee):
// State surcharge(12%of permit fee):
Authorized signature: .di TOTAL PERMIT FEE:
This permit application expires ifs permit is not obtained within 180
Date: days after it has been accepted as complete.
Print name: `��v /� ��� �� • Number of inspections allowed it.
1 per 1
1::Building\Permits\ELC PermitApp ELR ERE.doc Rev 04/21/2014 440-4615T(11/05/COM/WES
Plumbing Permit Application
Building Fixtures RECEIVE �„Received 1,0R `)1.1�Ri. 1 �1 Oil 1
City of Tigard Date/By: Permit No.:: f x-- 50
iliii • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
1 Phone: 503.718.2439 Fax: 503.598.1960 SEP 6 2018 Date/By: Other Permit No.:
H c..:1 .t) Inspection Line: 503.639.4175 CITY �r r� e] Date Ready/By; rugs: H See Page 2 for
Internet: www.tigard-or.gov v�' i (��' i�t7l�il Natified/Method: Supplemental
TYPE OF WORU I LD!N G D V S I O FEE* SCHEDULE information
&
For al i
ig New construction 0 Demolition special use checklist.1.
Description Qty. , Ea. I Total
0 Addition/attention/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
AI 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 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:
Job site address: go V? __co/ 3T- Catch basin or area drain 18.76
Drywe6
City/State/ZIP: -1 &i4RjJ C R. el 7 Z 2-5/ Frohn 1,leach line,or trench drain 18. 2
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
14 t u- Q I-VP CvR E ems 4o okrup -41t/� - 9c rill_ 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 I
Subdivision: , lax j) I Lot no.: ! Fixture or item:
Tax map/parcel no.: A 1 ci-t-rc--• f j ca. ) P1�1(, c, - Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
,/3// e4-) $,A/6 46 'Pt 1»1 t- R E.SID ENI Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER 1 0 TENANT
Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: .514IY1 AS 13 ELOW
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone;( )
Fax:( ) Ice maker 12.51
(j' APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
-QLirz, D com,srRttt:t/ti/l/
Primer 12.51
Contact name: 0 f>V i fl D El/4 P.P PbI&T Roof drain(commercial) _ 12.51
Address: T, 0 O. abX / 5 "7 7 Sink/basin/lavatory 25.02
City/State/ZIP: ,:/3&-#14v .Th 0 R 9 7 b 75 Solar units(potable water) 62.54
Phone:5 j t)3 ) 7 O 7 vy s Fax::( '1+ ,3-90 i 75/ Tub/shower/shower pan 12.51
0 U/2_ t`-=G.�? Urinal 25.02
E-mail: L`t 3/� ["' ri✓15i✓ Water closet 25.02
CONTRACTOR
Water heater 3'3.52
Business name: -r-if G m i,(( Lc- p 1. ))/ Water piping/DW V 56.29
Address: /1 66/1.4 ,5,t • j2 i 1/612 fl eJ Other: 25.02
City/State/ZIP: /6 „„„.5',/:30,f2.0 &j 9 7/2, Subtotal
IMinimum permit fee: $72.50
Phone:(Se) f.yo_ U j 1 3 Fax:( ) Plan review (25%of permit fee)
CCB Lic.: �.,2 6 g Plumbing Lie.no.:.3V-26e P/
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: 2 i&',t) _37 D 1 /b�,f Date: 5���� This permit application has
s if a permit is not obtained within 180 days
��J[[J/// after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Budding\Pennits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
1
INCity of°Tigard
' COMMUNITY DEVELOPMENT DEPARTMENT
TIGARI) Building Permit Review — Residential
YET✓ .._ �, _ ---
Building Permit #: _ � _. yv� _.
Site Address: S8i y Stii Intl {l
Project Name: Ir-,•v, WI Li. 1 19 -L Lot #: 9
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: +Utv J HZ
CO Verify site address/suite#exists and activen permit system.
M./River Terrace Neighborhood: l./ 'No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
hree(3)copies of site plan [(kissing structures on site
to plan must be on 8-1/2"x 11"or 11 x 17"paper Lid Footprint of new structure(including decks)with finished
Top awn to scale(standard architect or engineer scale) 9 or elevations
it orth arrow � ..'ty locations&easements(required for new and additions)
i1: a address,project or subdivision name and lot number L�d'Sidewalk/driveway approach
plicant information(name and phone number) ►.1`,..cation of wells/septic systems
[ Lot dimensions and building setback dimensions 1P xisting trees to be etained with dripline,
quare footage of buildings to be demolished and tree
g tection measures �V
Lot area,building coverage area,percentage of coverage and tree size,type and location f --4, " ,per.k� u+ +q
rfipervious area(applicable if R-7,R-12,R-25&R-40) Street names
property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? Efies 0No
4 foot differential) If yes,is a storm water quality facility shown? ❑ ❑No
tia Clean Water Services—Service Provider Letttte of platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified gd' No Received: `4 4r1 4�'k
❑ Yes ❑ No r t �
Public Facilities Improvement(PFI)Permit:
equired: Yes,applicant was notified ❑ No Applied For: l
LL pp r/Yes 0 No,stop intake
Fri/Land Use Case#: lJL 0) C—VVQ (�
oning: K_1 S
iia Required Setbacks: Front Z ) Rear 1,5 Side E Street Side IS Garage LD
IM Landscape Requirement:
C V,Lot Coverage Maximum: 0/0
[5 :uilding Height Maximum Height 30 Actual Height 26
J •sual ClearanceIn �/
/Sensitive Lands: 0 Yes IJa No Type
DV .rban Forestry Plan
i Conditions "Met"prior to issuance of building permit
'Approved By Planning: .2-2/ w
Date: I-6- 1e
Revisions (after Building Submittal only)) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BIdgPermitRvw RES 061417.docx
1
Building Permit Submittal
Original Submittal Date: `�j Ci 7/Gr--
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planning p>Engineering 7 Permit Coordinator ) Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: 17 Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
0 Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: //►�� �1 �� �f Date: /4
Engineering Review
ErSlopeat building pad: 3/
2I1 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: 0 Yes [Zr No
Assess Water Quantity Fee in-lieu: 0 Yes Er No
LIDA Facility on lot: 0 Yes 13'No
❑ Final Plat Recorded:
O NOT Approved by Engineering: Date:
Notes:
[Approved by Engineering: - j,,,,.,,r(.1A.A. ..• ,v.- Date: 7 • 17 • /8
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 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:
pvision Notice 3: Date Sent to Applicant:
• SDC Fees Entered: Wash Co Trans Dev Tax: P' Yes 0 N/A
Tigard Trans SDC: V s 0 N/A
Parks SDC: ( Yes 0 A
LIDA 0 Yes g l"'A
OK to Issue Permitl
Approved by Permit Coordinator:
Date: gA�/
I:\Building\Forms\BldgPermitRvw_RES_010118.docx .
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
1111 _ " Transmittal Letter
r (_,n R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: PLLYS'oN) An-,M3 NC., DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM:
D6\) \b De Cz-P P02� OCT 1 7 2018
C Tis
COMPANY: rott DOJ Sr'R U CT-!o ,tV BUiW;t<
PHONE: 5,_)-3 -7,), - 7(Y 5 By.
RE: 5397 StC.J 1fE7 sr An5T, U/ai-mZ-sO
(Site Address) (P- Number)
---F-IMA bet.. -- BUr e q?L-t-D FA .t' 9
(Project name or subdivision name and lot number) s �
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copie A Description:
Additional set(s) of plans. 1 t) Revisions:
Cross section(s) and details. 1 Wall bracing and/or lateral analysis.
Floor/roof framing. S `3 Basement and retaining walls.
Beam calculations. 1 Engineer's calculations.
Other(explain):
REMARKS: ,e-'ia)N/N b to LL.. )e--1y► 1 L-. -1=�V— S) .1 T�
w i(-LS 0 ue� y - )49P-x iAtpt . 6 .- /71E/7�
FOR OFFICE USE ONLY
Routed to Permit Technici : Date: Initials:
Fees Due: ❑Yes . -'• Fee Description: Amount Due:
/..-(;)---n $
fir k[/rKeil, No tzxs Aye $
Special
Instruc '•ns:
Rep r nt Permit(per PE): _ ❑ Yes -1:2'115 ❑ Done
A,,plicant Notified: Date: /U //7/`/r Initials:
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
8849 SW INEZ ST, TIGARD, OR, 97224 April 12, 2019 at 10:00:04 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00250
Inspection Type: Inspector:
399 Plumbing final Jeremy Burrows
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
8849 SW INEZ ST, TIGARD, OR, 97224 April 12, 2019 at 10:00:25 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00250
Inspection Type: Inspector:
199 Electrical final Jeremy Burrows
Result:
PASS
Comments:
Label breakers 28 and 30. Will verify at building final inspection.
Note: A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
8849 SW INEZ ST, TIGARD, OR, 97224 April 12, 2019 at 10:00:46 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00250
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS
Comments:
Note: A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
8849 SW INEZ ST, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Master Permit MST2018-00250
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Correction from previous inspection complete.
Final erosion control approved.
Moisture content form received.
Moisture barrier form received.
Insulation certification checked.
Duct seal test report checked.
C of 0 left on site with contractor.
Violation Summary:
Inspector Contractor