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Permit (77) CITY OF TIGARD MASTER PERMIT • _ 114 . . . COMMUNITY DEVELOPMENT ' Permit#: MST2018-00298 Date Issued: 11/15/2018 T I G A R ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ': ,,-:- /Ai Parcel: 2S112BC05200 Jurisdiction: Tigard Site address: 14920 SW 83RD AVE A.� Subdivision: LA MANCHA ESTATES Lot: 5 Project: FRIEDMAN Project Description: Garage conversion to habitable space with(2)bedrooms and(1)bathroom. 4/22/19: REPRINT to change contractor. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 2 First: 420 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 420 sf Value: $49,749.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 6 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 420 Owner: Contractor: FRIEDMAN,MITCH DAVID OWNER Required Items and Reports(Conditions) 14920 SW 83RD AVE MITCH FRIEDMAN TIGARD,OR 97224 14920 SW 83RD AVENUE TIGARD,OR 97224 PHONE: PHONE: 503-869-7310 FAX: Total Fees: $2,322.49 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090You may obtain acopy of the rules or direct questions to OUNC by calling 50 2.1987 or .800.332.2344. ".../.4.Sel/te6S,1Issued By: Permittee Signature: ? --) Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential - ,..� ., ` ...x, FOR OhFICt: CSI•:(LN Ll' Ci}�, of Tigard Received ��ilrT� �" "ZY-b2, , `J g 1;) 2j Date/B : Liv . i 11‘ 13125 SW Hall Blvd.,Tigard,OR 973 a'' Plan Review I Phone: 503.718.2439 Fax: 503.59$.1960 Date/B Other Permit 1 _n 1Z 1 Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov tt , v`N Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 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/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. t,and 2-family dwelling ❑Commercial/industrial Valuation: $ ❑Accessory building ElMulti-familyNumber of bedrooms: 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: I. '1 c't 1t9 S u 7 •3 AA. 5,n4_ New dwelling area: square feet City/State/ZIP: I I'3 `t,A a d 1Z 7 3-2_2`( Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. r Valuation: $ ✓`}•<%\rte l�� r-'C /Z���,,� � /J c�'�'kr-.3 3✓-t 1 hV-J 62 `cI•�)C . t� ('4Se 'Lek "L 7i t). Existing building area: square feet n -t c:. e)„ i e•ut , C.;4__ New building area: square feet -.n PROPERTY OWNER ❑ TENANT Number of stories: Name: /1/{••4 I.e.IL .4.... k„`f. l ce,,,k (—,,,^e_j Ac& Type of construction: Address: /Li C1 /0 3 ,e„) &�7.n,-,(. A''L Occupancy groups: City/State/Z1P: -1-- „,7,, ,� a /Z S. 2_2_ `( Existing: Phone:(.ct 8.4, 7_3 1 0 Fax:( ) New: 0 APPLICANT ❑ CONTACT PERSON _;'BUILDING PERMIT FEES* (Please refer to fee schedul) Business name: A/4 Contact name: Structural plan review fee(or deposit): a�a r� �at ” FLS plan review fee(if applicable): Address: 1 K , 2._0 .•S v..: . f...-t ,h..f-_ Total fees due upon application: City/State/ZIP: T s ,...r.4 d ,1 5 j-z Z ./ , Phone:(�l) s-L 5 7 3/t0 Fax::( )\ Amount received: r� l /► t PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: C c.4) CCR 6,-t.t`'c,S4- , e.`t-- Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: ?( , i ar Submit two(2)sets of roof plan with connection details C/ and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: 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: 144 d'i-4. f'f,'Q_c4L,/\„. Date: 11( ZZ 120/C�, *Fee methodology set by Tri-County Building Industry ( Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling roR orrlCE t SE oyI.v City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 Received 1111 Asso I Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: Permit No.: 71GARD 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e yo y/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 ■ ■ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. 0 0 0 4 Fire district approval required. Name of district: . 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0 6 Sewer permit. 0 0 0 7 Water district approval. 0 0 ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 ❑ 0 building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ 0 there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 0 0 furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ 0 floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. _ 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ 0 ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 ❑ 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ 0 for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore.on and shall be shown to be as slicable to the •ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 ❑ ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:ABuilding\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB) ,. * rte Property Owner Statement Regarding Construction Responsibilities . Oregon Law requires residential construction permit applicants who are not licensed`w ith the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building,electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: /1I4cL J k `4 e,1 I c 'eCl 4 e&'-\ Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. it'(4 4-C,L fr✓ e G 1 ate,✓\ Print Nameof P mit Applicant 11/7 7--/ 2 a f A Signature of ermit Applicant Date Permit#: r025 J—ota/B�‘V Sr . Address: i�,,Z(J 54; 7,3 `` /�4cez 42 ??- ( ;:" : �/ s Issued by: � Date: �/ f4. This Copy for Permit Offices I CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2018-00298 T[GARB D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/15/2018 Parcel: 2S112BC05200 Jurisdiction: Tigard Site address: 14920 SW 83RD AVE Subdivision: LA MANCHA ESTATES Lot: 5 Project: FRIEDMAN Project Description: Garage conversion to habitable space with (2)bedrooms and(1)bathroom. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 2 First: 420 sf Basement: 0 sf Left 0 Parking Spaces: 0 Height: Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 420 sf Value: $49,749.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 6 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 420 Owner: Contractor: FRIEDMAN,MITCH DAVID FRANK SILVA CONSTRUCTION Required Items and Reports(Conditions) 14920 SW 83RD AVE 11320 SW CAPITOL HWY TIGARD,OR 97224 PORLAND,OR 97219 PHONE: PHONE: 503-380-7756 FAX: Total Fees: $2,191.33 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 wolk_iss not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow t u es adopted by Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throu AR 952-001-0090. Vof the rules or direct quesions to OUNC by calling 503.232.1987 .800.3 .2344. e Issued By 6��� 7 ermittee Signature: Call 50 .4 5 y 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. 3 . ]Building Permit Application .. Residential FOR OFFICE l SE ONL\ f Received City of Tigard a '= Date/By: �t l/,5 /i /j�-- Permit No. 57- /?`– boZel(�' 1 - ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / fi (rr'G'� Phone: 503.718.2439 Fax: 503.598.1960 () T b 1018 Date/By: I i,fi 100 N Other Permit: Ti G A R D Inspection Line: 503.639.4175 t 2 Date Ready/By: ( Juris: [a See Page 2 for Internet: www.tigard-or.gov a k a.,, N 'fied/Method: ` / 1r Il - Supplemental Information CITY S F 7 l'lRiir b =gar ILDING IVt Oi ` TYPE OF WORK REQUIRED DATA:1-AND 2-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 lit Addition/alteration/reP Addition/alteration/replacement 0 Other: equipment,ment materials,labor,overhead, the profit 2i,the CATEGORY OF CONSTRUCTION work indicated on this application., 7 9 [1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 0 Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /49 2C ✓ g New dwelling area: 4 Zb square feet City/State/ZIP: 7 c f,) k" 7 p- Garage/carport area: „14/42 square feet —s Suite/bldg./apt.no.: ( Project name: rn,,erizMdr/ Covered porch area: . square feet Cross street/directions to job site: Deck area: 3► square feet 4A' C'(/i- Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indi ate the value(rounded to the nearest dollar)of all equip' ent,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work in: cated on this application. Valuation: $ Existing buildin. . ea: .quare feet New building area: square feet Sk PROPERTY OWNER 0 TENANTNumber of stories: /p T e of constructs. : �' C.124...' /�JZ't' Name: L •c.--1Jrr.!` YP Address: J `? Occupancy L.. ps: City/State/ZIP: T.1 '. ''' ( 7 i9 " Ex':'ing: Phone:(„03, 386 .9 .75%,- Fax:( ) New: t:APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) �;s Business name: Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: !'f ii.,/.(,7 City/State/ZIP: Phone:( ) Fes;;( ) Amount received: E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* /'�? Commercial and residential prescriptive installation of 314� �, � � �T roof-top mounted PhotoVoltaic Solar Panel System. Business name: j ji, .. . /, ",,s N we tx ,. �e Submit two(2)sets of roof plan with connection details ` �''/°'!" iand fire department access,along with the 2010 Oregon Address: // , C i) I ("` .- 10(1 0(1 i > Solar Installation Specialty Code checklist. • Permit Fee(includes plan review City/State/ZIP: ifland administrative fees): $180.04 Phone:003) e 6 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: c e ' , A 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: f -{ ' i Date: `� *Fee methodology set by Tri-County Building Industry i 'it �Ld � Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONI.I' Received Ci}�, of Ti and Permit No.: `J g Date/By: ,r .. '1 4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: Date/By: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: 10 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information '£ '"'s ' CQMMERCIAL FEE* SCHEDULE L.'USE C!LECI I..ISI' --;: TYPE:SQ�`��'VQRK tis:� s..a° ' . . '' Mechanical permit fees*are based on the value of the work 0 New 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: CAI' .-., OF CONSTRUCTION RESID , EQUIPMENT I SYSTEMS FEES}y ,', ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total r Heating/cooling: 4 JOB S�, URMATION -LOCATION c: t .:" x. Air conditioning 46.75 Job site address: /sok) 1„t,lJU3- Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: ''J''� / �j Furnace 100,000+BTU(ducts/vents) 54.91 r rf� 1 � � Heat pump 61.06 Suite/bldg./apt.no.: ✓ Project name: t;-l.l1/4, ,u4—,, Duct work 23.32 Cross street/directions to job site: 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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 mo DESC 1,,,,...;;W,,® � ORIIl : Gas fireplace/insert 33.39 , , r„ '" '` Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 a1„1 u Other: 23.32 . . '°_ . ;+ . 7su¢ .''r .j TENANT '.:" - ''-�" " Environmental exhaust and ventilation: Name: nf7<2,11 T , Range hood/other kitchen �J equipment 33.39 Address: 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 ,:..0 OpLicAt1 " +i,- CONTACT PE ch s Other: 23.32 Fuel piping: Business name: /,( ,•," I=��, .f S /Xi �' 3 t a,C`� $14.15 for first four;$4.03 for each additional Contact name: ,/l/i 1 , ' �-1,,V %, Furnace,etc. ,��...,�1;� ,.jam, � c�,... / '' Gas heat pump Address: f 13 y i ,e� Wall/suspended/unit heater City/State/ZIP: C1,r.� a 6 �"9 fit' Water heater / 1 Fireplace (5).`5) -34?-e, -7 7'�t, Fax::( ) Fir lace Range E-mail: Barbecue :„...„0:77,,:2:.,-,1;;;; Y.°1- Clothes dryer(gas) Other Business name: / ft; IM 17 Address: ..... T 2. c".-- X C/X Subtotal City/State/ZIP: l l f�4..._ 7 ? ,� Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( � � �� ( 7 Fax: i v/v3 � y �� State surcharge(12%of permit fee) CCB lic.: / C3 6 ,'� � 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: �/ft l.- I2, 1 * Fee methodology set by Tri-County Building Industry Service Board Print name: �'N 'l3 '71-2 Date: !/57/ a I:\Building\Permits\MEC PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PennitApp_040113.doc 2 , Electrical Permit ApplicationR „ FOR 01;1.1( L I Si.ON l.1 Ci o Tigard ' � Received 13125rS Hall Blvd.,Tigard,OR 97223 N O V 15 Date/By' Permit#: ���/Non D Plan Review 0 IC Phone: 503.718.2439 Date/By: Related Permit#: Email: TigardBuildingPermits@Tigard- +,• �� Ready Date/By: I I G A R p Jaris: Ed See Page 2 for Inspection Line 503 639 4175 In-,�• t.i \,,qi r r r i4 6§ Notified/Method: Supplemental Information •k i t .w. r =?.' "2*,. x r,...-., '.•ys Wg,O Who fi, 'i.,i ," a. Q3_c.ki,F'.v.A,c `rr.?'. ws21l. A . "'rk, k'p :': ' s�, .e ❑New construction IA Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. .5:43A:::1' -a :1:'::, , '.:. CATEGORY,"OF CO,StitA 3'I 014_ -'?v ;ice r„` '` exceeds 10,000 amps at 150 volts or 0 Floating buildings. V1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or , ` gl:W vsf,1 Z4OBtST E,INF© VIA'i0 €Ali x 0 ,an4 , 0 Emergency system' larger separately derived stem. 0 Addition of new motor load of system. Job#: Job site address: ' )(1. 20 SA/ 83Mtool->P or more. ❑"A","E","i-2","1-3 , City/State/ZIP: / .4,0 7;„7 f6 ❑Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. 0 Hazardous locations. 0 Supply voltage for more than Suite/bldg./apt.#: Project name: ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: "` 5 FEES SGHE 4'-- r - a Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel# s Ea.add'1500 sq.ft.or portion 33.92 1 ,, ( I ESCRI ONO RKY) ; ,„ Limited energy,residential il /����, ��`�H ` �' (with above sq.ft.) 75.00 2 �� tJr"1 `'"'i I �� Limited energy,multi-family 75.00 2 residential(with above sq.ft.) '4 '''''''''-`1: Renewable Energy 0 See Page 2xxx L WttJ ® i l 'rflnr .® '17 "` ri , Services or feeders installation,alteration,and/or relocation Name: „,Fs+7_)-jv f j f I'p& 200 amps or less 100.70 2 Address: Jeff (..5. 0 < `~S t 201 amps to 400 amps 133.56 2 /J �i Q 401 amps to 600 amps 200.34 2 City/State/ZIP: 7 rt.,�if1`�B �i*� ! ,off j 601 amps to 1,000 amps 301.04 2 Phone:(i253) 39 b ,4 , ,r+-'6, Over 1,000 amps or volts 552.26 2 Email: E•7 / Temporary services or feeders installation,alteration,and/or relocation f), Owner installation:This i r stallatio - -ing made on property that I own which is not 200 amps or less 59.36. 1 intended for sale,lease,ren or exc ange according to ORS 447,449,670, . • 701. 201 amps to 400 amps 125.08 2 Owner signature: ,y i, r Date: mm 4 401 amps to 599 amps 168.54 2 �, k o;: ., , , Branch circuits—new,alteration,or extension,per panel " t�CElNl �' ` '"r "( '.,CO "°".` '" o a''''' -* A.Fee for branch circuits with i Business name: above service or feeder fee, each branch circuit 7'42 2 Contact name: B.Fee for branch circuits without service or feeder fee,first Address: branch circuit 56.18 2 City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone: ( ) Each manufactured or modular Email: dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 -,, *. CONTRACTOR ., a t •tfA ,.r- f- ,;'; Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy El See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(I hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr mm) ELECTRICAL;PERMIT,FEE_S.' Suprv.Electrician signature,required: Subtotal: Print name: Date: 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: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp ELR ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB t Electrical Permit Application °EiVED ►OR OFF1( 1; t Sl. o\I.\ City of Tigard Received 3' Pla R 111111 PIN 11 13125 SW Hall Blvd.,Tigard,OR 97223 ���'j (t 4, Plan Review L am, r Phone: 503.718.2439 Date/B : Related Permit#: Email: TigardBuildingPetmits@Tigard- a Ready Date/By: Juris: See Page 2 for rlc;nl:n ' E AGAR Inspection Line: 503.639.4175 h] e TR,1M iymnic Notified/Method: Supplemental Information TYPE OF,WORK PLAN=REVIEW, ❑New construction J Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. ❑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. V1-and 2-familydwellingCommercial/industrial less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑ El building 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 Job#: Job site address: 1( 0 Addition of new motor load of system. T 20 ch/ 83,0 100HP or more. ❑"A" "E" "1-2» "1-3» City/State/ZIP: �// La ❑Six or more residential units. occupancy. �- l 9 �7f'f`� El Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I... Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential ODj� j� (with above sq.ft.) 75.00 2 � '� � 7i� "' Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 [r PROPERTY;OWNER , 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 1 Addre • ���� �� Aj���'s=�' 201 amps to 400 amps 133.56 2 Address: / z 6 � tf e r34� 401 amps to 600 amps 200.34 2 City/State/ZIP: j• o �? • �"f 601 amps to 1,000 amps 301.04 2 Phone:0'33) ? 6 - .?.. ..5-C, 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 t el Owner signature: Date: 401 amps to 599 amps 168.54 2 ( (..„9/37..,APPLICANT Branch circuits—new,alteration,or extension,per panel � _ ❑ CONTACTERSON A.Fee for branch circuits with ' Business name: j.—/ 5 l v,, �� 1 `) !1.,� ii above service or feeder fee, f 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('/hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 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: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB Plumbing Permit Application Building Fixtures -RECFOR OFFICE LSE o\Ll 4' 1 City of Tigard -':.eceived 111111 41 1 13125 SW Hall Blvd.,Tigard,OR 97223 y p S rig�m t+.I;0tlg II Phone: 503.718.2439 Fax: 503.598.1960 0 L T 2 e Plan Review Permit No.: 1_ Date/B Date/By: Other Permit No.: Inspection Line: 503.639.4175 T I G A R D � 9f���� y �,g Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov CITY (J€ E t.MH I I.Notified/Method: Supplemental Information TYPE OF WORBUILI IN(3 DIM".N' y' - FEE* SCHEDULE 0 New construction 0 Demolition For special information use checklist. Description I Qty. Ea. Total Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OE CONSTRUCTION SFR(1)bath 312.70 0..1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/ltitchen 25.02 0 Other: Fire sprinkler a P � ( sq.ft.) Page 2 JOB;SITS INFORMATION AND LOCATION Site utilities: Job site address: /VI c 0 ,5"�" E1t,�/ Catch basin or area drain 18.76 +''�! Drywell,leach line,or trench drain 18.76 City/State/ZIP: 711,110 7 f Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: A,6142,nk, Manholes 18.76 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: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 . FTI. 12.51E CIONOV � Backwater valve max, ilP,. . ,,:,z., ,�,,. .. , =dryClothes washer 25.02Aju .8 i,V �" „*4 . �1Z et' Dishwasher 25.02Al AO/) te3,4 TN if/-) 4 37 11f- \ - �/ Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWR 0 TENANT , Expansion tank 12.51 Fixture/sewer cap 25.02 Name: i / L FA t alai Floor drain/floorsink/hub 25.02 Address: /0-`Z a t°` tJ Garbage disposal 25.02 City/State/ZIP: `17g -1 V Hose bib 25.02 Phone:( ) l 1 Fax ( ) Ice maker 12.51 APPLICANT 'f 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 C Pine' 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 f 12.51 E-mail: Urinal 25.02 CONTRACTORS Water closet I 25.02 "" - Water heater 37.52 Business name: Cy1 . 1,74.1.4v/ lL+M ti .4✓ Water iP iD WV 56.29 Address: 5 ✓1jFy7 ? i, Other: 25.02 City/State/ZIP: iy -4„ />7.r Subtotal Phone:(� 7/) 7' -17,,111 Fax:( ) Minimum permit fee: $72.50 CCB Lic.: / Plan review (25%of permit fee) 3C)6,3 Plumbing Lic.no.: Put/36 State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: a[.- : 'f dl � This permit application expires if a permit is not obtained within 180 days IJ't �i:Wl _ after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 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. 11111 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter r r;;\R l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: / -7/ c47DATE ' ; , . .,; r i _'''. DEPT: BUIL ING DIVISION NOV 08 2101 FROM: /u ,5/ COMPANY: 1 7?. 4XA 51 Z U c / BUILIIiNG :1\,,IS I', PHONE: .' ,y ,- ; 2 c1- g" L L L cr.. RE: /c(l 2 $t.,-( 0,40 ??22f "%v--- /71--0 ,61 (Site Address) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. Revisions: 3 Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. 3 Beam calculations. Engineer's calculations. Other(explain): REMARKS: FOOF 'ICE USE ONLY Routed to P e cian: Date: 1 `3 Initials: -- Fees Due: g�i No Fee Des pti : Amount Due: $1/ po z Pan c0*A a L- $ Ls- $ $ Special Instructions: Reprint Permit(per PE): ❑ Yeso ❑ Done (7_ Applicant Notified: Date: f C/l"(//, Initials: I:\Building\Forms\TransmittalLetter-Revisions 061316.doc City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14920 SW 83RD AVE, TIGARD, OR, 97224 March 18, 2019 at 9:09:47 AM Record Type: Record ID: Residential - Master Permit MST2018-00298 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: No access for inspection, no one home. 9:00 am Does not appear from exterior to be ready for mechanical final inspection, electrical not done at this time. No message left with inspection request. Violation Summary: Inspector Contractor NI Electrical Permit Applicationri. � . FOR OFFICE 1 SE O\i,l i City of Tigard 0i Received Date/By: ir,, 0,777/7Z,4111 ..rm i r"-ea„. ,� 13125 SW Hall Blvd.,Tigard,OR 97223 P an Review 13 Phone: 503.718.2439 Fax: 503.598.1960 DBy. Related Permit#: Inspection Line: 503.639.4175- Ready Date/By: Juris ® See Page 2 for T I G A R DInternet: www.tigard-or.gov �1 �� ��r Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW 0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. 0 Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION # 0 Emergency system, larger separately derived Job#: I Job site address:14920 SW 83rd Ave 1fA Il Addition of new motor load of system. ;n 1 OOHP or more. ❑"A",`B","1-2","1-3", City/State/ZIP:Tigard,OR 97224 ,'y5 P Six or more residential units. occupancy. "oft. Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name:silva �I CI Hazardous locations. 0 Supply voltage for more than iP" ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I ' New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential Garage remodel-update wiring,finish trim work �(Gy� (with above sq.ft.) 75.00 2 re-C.- Al`C)-17 '`-- Limited energy,multi-family ^ � �(� ,b/ /�p�� residential(with above sq.ft.) 75.00 2 �"u✓� �l�'/►�� r/f/i� _ � �C� ` I/"'�� Renewable Energy ❑ See Page 2 0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name:Freidman 200 amps or less 100.70 2 Address:14920 SW 83'Ave 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Tigard,OR 97224 601 amps to 1,000 amps 301.04 2 Phone:( ) I 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 0 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first 1 56.18 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit 7 7.42 51.94 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Spark Dr(F-Body Speed,He) Sign or outline lighting 67.84 2 Address:29101 SE 2212 Signal circuit(s)or limited-energy Ci See Page 2 2 Hwy panel,alteration,or extension. City/State/ZIP:Boring,OR 97009 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)386-1316 Fax:( ) Investigation(I hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email:permits@sparkdr.us Inspections for which no fee is90.00/ hr CCB Lic.: 219224 Electrical Lic.: C1368 Suprv.Lic.: 6284S specifically listed(%hr min) ELECTRICAL PERMIT FEES Sr.El Ian signature,required-7 — '-- Subtotal: 108.12 Print name: George V Michels V Date: 2/25/19 ❑Plan Review Required(25%of permit fee): ''-- State surcharge(12%of permit fee): 12.97 , �.e�gnature: —�— i_ TOTAL PERMIT FEE: 121.09 This permit application expires if a permit is not obtained within 180 Print name: Wynette Webber Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits'ELCPermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB ;i a City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT UPIal = Request for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: Owner ❑ Applicant jzi.,Contractor ❑ City Staff Check(✓)one `� , REFUND OR Name: r'''17 ,14`" U/ INVOICE TO: (Business or Individual) 5/ /. `-' l:- M £ -7/11" - Mailing Address: 1/3 2 k $ (1 274 5j Z /1 U-/ City/State/Zip: , ).c 4 7 I D/' Phone No.: 5- r- 3 g V —r PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 4 CANCEL/VOID PERMIT APPLICATION. 4 Ply REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: j (5T 6/ — 06 / 5 Site Address or Parcel#: /V, 2c $ Project Name: ,' o5,/,./(1.1.-c I g k. c 247 t:,.f` e Subdivision Name: Lot#: • EXPLANATION: - A 1..> � l CAI .fes'/ �;1/ ..1.... ,c, I 'Id / / —L i — — i o Signature: ,--6�t Date: Print Name: y j,-fir= ,*t,4A-0, Refund Policy ! 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date By Route to Records: Date By Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_120518.doc City of Tigard Tel: 503.718.2439 Location: Inspection Date: 14920 SW 83RD AVE, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2018-00298 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard Tel: 503.718.2439 Location: Inspection Date: 14920 SW 83RD AVE, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2018-00298 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Not ready for final inspection. Light fixtures not installed, boxes not safed off. Outlet in laundry not done. All devise covers missing. Violation Summary: Inspector Contractor City of Tigard Tel: 503.718.2439 Location: Inspection Date: 14920 SW 83RD AVE, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2018-00298 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: permitted branch circuits for garage conversion ok. Violation Summary: Inspector Contractor City of Tigard Tel: 503.718.2439 Location: Inspection Date: 14920 SW 83RD AVE, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2018-00298 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Provide approved plumbing final inspection prior to building final inspection. No final inspection done at this time. Violation Summary: Inspector Contractor