Permit (88) CITY OF TIGARD MASTER PERMIT
'
:
COMMUNITY DEVELOPMENT . Permit#: MST2018-00357
`' , Date Issued: 02/14/2019
T i C;A R I3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ay! ' i* Parcel: 1 514/2019 700
::, �' �1
� Jurisdiction: Tigard
Site address: 9504 SW 74TH AVE
Subdivision: GERRITZ PARTITION •t: 2
Project: Gerrtiz Partition, Lot 2
Project Description: New SF. DEMO CREDITS FOR TRANSPORTATION AND PARKS APPLIED FROM
BUP2017-00281. 9/19/18: REPRINT to add(1)laundry tray.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1169 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 22 Bathrooms: 3 Second: 1390 sf Garage: 450 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 2559 sf Value: $324,623.55 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 3 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: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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: 5 201-400 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 2559
Owner: Contractor:
JOHN GERRITZ ENTERPRISES INC GERRITZ CUSTOM HOMES Required Items and Reports(Conditions)
____
515 NW SALTZMAN RD PMB 800 333 S STATE ST SUITE V-146 t ffrsn Cntrt - -4173 •
PORTLAND,OR 97229 LAKE OSWEGO,OR 97034
PHONE: 503-320-7280 PHONE: 503-320-7280
FAX:
Total Fees: $9,325.54
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 . les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-0 090. ou may,. -in a co. of the les or direct questions to OUNC by calling 3.232.1987 or 1.800.332.2344.
Issued By: 'e ,4 /--- Permittee Signature: 17L-1 IA--- ._9Q-,7-Pc•e -
all 503.639.4175 by 7:00 a.m.for the next available inspectio ate.
This permit card shall be kept in a conspicuous place on the job site until co letion of the project.
Approved plans are required on the job site at the time of each spection.
Plumbing Permit Application 0' S-7
Building Fixtures FOR OFl1c'l USE OyLV
City of Tigard ,-.. Received
Date/By: Permit No.:
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
': ae Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
TirARn Inspection Line: 503.639.4175 Date Ready/By: Juris 0 See Page2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
( New construction 0 Demolition For special information use checklist
Description 1 Qty. .1 Ea. 1 Total
El Addition/alteration/replacement ❑Other: .' New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION° ' ." `-`A ,iii
s bath 312.70
(I I-and 2-family dwelling 0 Commercial/industri 44 1 ØkL (2)bath 437.78
❑Accessory building 0 Multi-family ! ,.'�>. A R(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler(-sq.ft.) Page 2
YOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: SO 4 s(a 3 s? (.4'4' Catch basin or area drain 18.76
Dtywell,leach Iine,or trench drain 18.76
City/State/ZIP:
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
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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORTL Backwater valve 12.51
1 y Clothes washer 25.02
!` i D 3 CC. t&'FC V,C 41 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER ' 0 TEN*NT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 'x 25.02 9.560.D.
_
City/State/ZIP: Solar units(potable water) 6254
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal _ 25.02
,
Water closet 25.02
CONTRACTOR'
Water heater 37.52
Business name: Ak\C/r)c• t Water pipinglDW V 56.29
Address: ` {, ccx �• �y ltVm it,/Cie, t ,,-J v Other: I 25.02
City/StatelZ.IP: Vx7a4,ey-'kv"-\ ()gm IS 1y.-)4Z' Subtotal
Phone:( C "')_ --) !3 Fax:( ) Minimum permit fee: $72.50
CCB t.ic.: ; C1 7 1 Plumbing Lic:no.: p 6 Plan review(25%of permit fee)
�r State surcharge(12%of permit fee)
Authorized signature:'"---r- C�,,,,.-_---- TOTAL PERMIT FEE
i 11Print name: Date: ,_ This permit application expires if a permit is not obtained within 180 days
`Tq k-' 1�1 { !,�Cx h i after it has been accepted as complete.
f .Fee methodology set by Tri-County Building Industry Service Board.
118uildmg\Pevnuts\Pi.Mu-PermrtApp dos 10/01/09 440-4610T(10/02/COMIWEB)
II CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2018-00357
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/14/2019
T I` '' I`1) g Parcel: 1S125DB12700
Jurisdiction: Tigard
Site address: 9504 SW 74TH AVE
Subdivision: GERRITZ PARTITION Lot: 2
Project: Gerrtiz Partition, Lot 2
Project Description: New SF. DEMO CREDITS FOR TRANSPORTATION AND PARKS APPLIED FROM
BUP2017-00281.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1169 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 22 Bathrooms: 3 Second: 1390 sf Garage: 450 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2559 sf Value: $324,623.55 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 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
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y 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: 5
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'l 500 sf: 5 201-400 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 2559
Owner: Contractor:
JOHN GERRITZ ENTERPRISES INC GERRITZ CUSTOM HOMES Required Items and Reports(Conditions)
515 NW SALTZMAN RD PMB 800 333 S STATE ST SUITE V-146 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97229 LAKE OSWEGO,OR 97034
PHONE: 503-320-7280 PHONE: 503-320-7280
FAX:
Total Fees: $9,297.52
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090.ou may obtai a copy of th=rules or direct questions to OUNC by calling 5`03.232.1987 or 1.800.332.2344.
Issued By: V- Permittee Signature: ; '---)17W
Call 503.639.4175 by 7:00 a.m.for the next available inspection d e.
This permit card shall be kept in a conspicuous place on the job site until com 'tion of the project.
Approved plans are required on the job site at the time of each inspection.
` Building Permit Application
Residential RE cEivEDFOR o► r►c 1. l ie o\►.)
City of Tigard RecDate/By:
y: ' ` \ Permit No. .V\5421—C
13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: �a �� �� F V
,1111111 jj� Plan Review
Phone: 503.718.2439 Fax: 503.598.19614 F 2018 Date/By: Id 149 4 ($ Other Permit Q)is_i\_..^1 t -
1 1 G:1 R D Inspection Line: 503.639.4175 Date Ready/By: � / s: ® See Page 2 for J.J of OO(l��
Internet: www.tigard-or.gov CITY OF T I G A R D ,otified/Method: / - Supplemental Information
s E i t r Al
. 'TYE f • M • print.. e:
®New construction 0 Demolition ' Q0 4 J4lit*4**Sivr 2:-.,,,
,
❑Addition/alteration/replacement 0 Other: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
C•A` • OR•Y"OFCONSTRUCTION , .'..,-.:1-..- equipment,materials,labor,overhead,and the profit for the
1-and 2-famil dwellin work indicated on this application.
® y g ❑Commercial/industrial
❑Accessory building 0 Multi-family Valuation: JV�J ��3
❑Master builder 0 Other: Number of bedrooms: 4
SITE INPOlittottutION ANtvLS A Number of bathrooms: x1-3
Job site address:9504 SW 74th Ave. Total number of floors: 24;1
City/State/ZIP:Tigard Or.97223 New dwelling area: 2559 square feet CS16
Suite/bldg./apt.no.: Project name:Gerritz P.PF12017-00261 Garage/carport area: `450square feet ,((cc)
!
Cross street/directions to job site:Taylors Ferryto74th down to 9504 Covered porch area: k/ square feet
Deck area: square feet
Other structure area: square feet
Subdivision: l Lot no.:2
Tax map/parcel no.: Permit fees*are based on the value of the work performed.
BION Indicate the value(rounded to the nearest dollar)of all
- . '... .. .-. equipment,materials,labor,overhead,and the profit for the
New single familyHomeN�`� , .2s f.r. S 0xrork indicated on this application.
. .'.- t -r Valuation: $
/‘' 79/)1:-/CZ") 7 ,"6--7.,Z r -
i("(0) Existing building area: square feet
;�4 PE
New building area: square feet
Name:John Gerritz Enterpriese,Inc. Number of stories:
Address:333 S.State St.Ste.V-146 Type of construction:
City/State/ZIP:Lake Oswego,Or.97034 Occupancy groups:
Existing:
Phone:(503)320-7280 Fax:( )
r$ .s. .--",:-„,".f1,,'"',--.1,,„", .. ,4 CO,..1' ' � New:
r ..;.'1.,,,,...i.;',...::::,::`;,--u. ., ,,r,. ., .. , ' ,'"1
ING� 11,,tT
Business name:John Gerritz Enterprises,Inc. � � ,
Contact name:John Gerritz Structural plan review fee(or deposit):
Address:333 S.State St.Ste V-146 FLS plan review fee(if applicable):
City/State/ZIP:Lake Osewgo Or.97034 Total fees due upon application:
Phone:(503)320-7280 Fax::( ) Amount received:
E-mail:johng@roundstoneproperties.com PR
I.. t , Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:John Gerritz Enterprieses,Inc. Submit two(2)sets of roof plan with connection details
Address:333 S.State St. Ste V-146 and fire department access,along with the 2010 Oregon
— Solar Installation Specialty Code checklist.
City/State/ZIP:Lake Oswego,Or.97034 Permit Fee(includes plan review $180.00
Phone:(503)320-7280 Fax:( ) and administrative fees):
CCB tic.:43494 State surcharge(12%of permit fee): $21.60
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
d , 12/24i1 within 180 days after it has been accepted as complete.
f .
f:uilding\Permits\BUP-RESPermitAp i• 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applic j': _,; ' Received
City of Tigardy: p `
13125 SW Hall Blvd.,Tigard,OR 9722 , $, plan Review .--tii Phone: 503.718.2439 Fax: 503.598.1 I I I c.uDala'Byr Other Permit!,W 1 ,s,C1
i . , Inspection Line: 503.639.4175 Date Ready/By: iui: ISI See Page 2 for
Internet: www.figard-or gov C ITY014 1 i A D Notified/method: Supplemental Information
IJ ILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHECKLIST
Mechanical permit fees*are based on the value of the work
tagNew construction 0 Addition/alteration,/replacement performed,Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/smuts vas,
mi I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
Multi-family 0 Master builder 0 Other: Description Qty. I La. Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
• Air conditioning k 46.75
Job site address: '"4 $�."(,LI tj LJ 17 t� q/ . Furnace 100,000 BTU(ductsivents) I 46.75
City/State/ZIP: ri. y-c/ 0/1_ q-, 2, 5. Furnace 100,000+BTU Num/vents) 54.91
Beat pump 61.06
Suite/bldgfapt.no.: Project name: Ge f{i 4-L- xy fiir, . Duct work , t 23.32
Cross street/directions to job site: `1".` LA,1.', Fib.r✓u '7'v /7 y ks T[}. Hydrmtic hot water system 23.32
DV Residential boiler(radiator or
ci Sb q hydropic) , 23.32
Unit heaters(fuel-type.not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: i Lot no.: Other 23,32
'M+ Z �"(� �' i Other fuel appliances:
map/parcel i s j J 9 a LiWater heater 23.32
Taxm elno.: 3��p
DESCRIPTION OF WORK Gas fireplace/insert 33,39
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
ANT Other: 23.32
twrPROPERTY OWNER 'VTEN
Environmental exhaust and ventiiadon:
Name: a tx v. G >:C i'II_ G,tiokLba S.. Range hood/other kitchen y
equipment { 33.39
Address: -333 S, S f A it .51. Si Y-1 W t.. Clothes dryer exhaust k 33.39
)� Single-duct exhaust(bathrooms,
+rt W ! x d _7 03 toilet corm:artrrtents,utility monis) �
City/State/ZIP: 23.32
Phone:(ej(7 -5' o - -72soFax:( ) Anic/crawlspace fans 23.32
0 APPLICANT �y 0 CONTA&'PERSON Other. _23.32
r�p m e h J ! .,z- Fuel piping:
Business name: SI4,13 for first four;54.03 for each additional
Contact name: -56 j.y el G e.Y t i 4 7/ Furnace,etc. l
Gas heat pump
Address: Walt/suspended/unit heater
City/StateJZIP: Water heater t
Phone:( ) Fax::( ) Fireplace
Range t
E-mail: Barbecue t
CONTRACTOR Clothes Myer(gas)
OtheBusiness name: .(k {-(p-,4'T"zv CC:0,xr _
MECHANICAL PERMIT FEES*
Address:Q QC( jJ C( r-!}\( ST: Subtotal
Minimum permit fee(540.04)
City/State/ZIP: -i t 2(�
Plan review(25%of permit fee)
Phone:(5c)- -166 C152-Z.- I Fax:(.5M)136-3C-f A z State surcharge(12°%°of permit fee)
CCB lic.:
pt 3 s 2 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: / 1"1„...„ * Fee methodology set by Tri-County Building industry Service Board
Print name: 5"6 ►, vet GE"r; Date: /4'!4, f
1:Building•,Peno ts'MEC_ App 040113 dor 440-46171111 x02 COM WEB) I
-RECEIVE
ECEIVE 'r
Electrical Permit ADDlicatioi11 illi: (H E I( l' I ' ()NI
City ojTigard -��F'� § Recei ed
IIIi13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review - - _ {'��
- Phone: 503.718.2439 Fax: 503.598. i�/ Date/By: Related Pesnit s ` 'V li��
Inspection Line: 503.639.4175 9 7t 01� t l(x.A 1)Ready Da emy: la See Page 2 for
I ' i!r? Internet: www.tigard-or.gov HI 111
,11Is ; rp1 Yp 1 Sp/44k ifed/Methad: Supplemental Information
TYPE OF WORK PLAN REVIEW _
V New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans Whams checked):
CIService or feeder 400 amps or more 0 Building over dwee stories.
❑Demolition ❑Other
where the available fault current 0 Marines and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
'( I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building loss to groundor exceeds 14.000 0 Commercial-use agricultural
❑Multi-family 0 Master builder 0 Other amps fora!!other installations. tdigs
❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION oi ❑EaletlencY system. larger separately derived
pJ c r�Liu
y� 0 Addition of new motor load of system.
Job#: Job site a�lress:
15C)'L3 J w / i /� 10OHPormore. 0-A","E"."1-2","1.3•
City/State/ZIP: `I 1 5 a.,/ 0( 01-1-L-2..-3 ❑six or more residies. units. occupancy.
❑Halth�are facilities. 17 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Ge--fy.gi'-L Pcalit 1,.:,,. 0 Hazardous locations. 0 soils nominal-
Cross more than
0 Service or feeder 600 amps or arose
street/directions to job site: Prov,,Loys, t'Lwy ..to -79 it- FEE SCHEDULE
I oeeriwtsa 1 0tv. I Each 1 Tawe I •
New residential single-or multi-family dwelling unit.
Subdivision: G t.".4-v-'s4-7-, eaklrki Vito-, Lot#: 2 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: --AstyriW 1 3 IVO Es.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
e,LI 1 v►rJi,la ren-. ;i..?
.? IA t"'`. Limited energy,multi-family .
residential(with above sq.ft.) 75.00 2
Renewable Energy Cl See Page 2
(PROPERTY'OWNER ❑ TENANT .
G Services or feeders installation,alteration,and/or relocation
Name: S 01.‘w V e.r`r)4 2 w 6Yp'Yr ier, �1K 200 amps or less 100.70 2
Address: 333 s. S-Li C s/. sir- : v— j LI L. 201 amps to 400 amps 133.56 2
1 401 amps to 600 amps 200.34 3
City/State/ZIP: l..t,of a C'�s w r 6 O'. °r'')o3y 601 ampsto 1.000 amps 301.04 2
Phone:(901 -3.2 p- g-O Fax:( --)----` Over 1,000 amps or volts 552.26 2
(� Temporary services or feeders installation,alteration,and/or
Email: i off.y 5 prJ 'f'ouw(AS4'O w(5'�1...... v -v ca f'Y.S, Co""" relocation
Owner inssttallationc 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 ( 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 5 (in c 014 -„„_ above service or feeder fee, 7.4_' 2
each branch circuit
Contact name: ..-S.sVr\et r, hr... C.,e `('f) 4 . B.Fee for branch circuits widsow
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Phone:( �jb�) Fax Miscellaneous(service or feeder not included)
3 a o- '')21% ( ) 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: Elite Electric Group,LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 6150 NE 92nd Dr.#104 panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Portland,OR 97220 Additional inspection(I hr min) 66.25/hr
Phone:( 503 432-8845 Fax:(888)901-7914 Investigation(I hr min) 90.00/hr
Email: office(d eliteelectricpdx.com Industrial plant(I hr min) 78.181 hr
Inspections for which no fee is WOW
hr
CCB Lic.: 191274 Electrical Lic.:C639 Suprv.Lic.: 5762S specifically listed('h hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print Warne: . /.�, - Date: //-,/ —/Q''' O Plan Review Required(25%of permit fee):
....
7CY
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
4—>
This permit application expires if a permit is not obtained within Lao
Print name: 110NA G N T r,z Date: 1/— (1-/8' days atter it has been accepted as complete.
• Number of inspections allowed per neurit.
i:lBuildinglPermmitsslELC PermuApp ELR ERE.doc Rev 06/17/2015 44044615T11MA1S/COM/WEB
plumbing Permit Applicatio - ,�CEWEJ'
IVE .
�'
City of Tigard i ;< Received
13125 SW Nall Blvd.,Tigard,OR 97223 ,) c
-
Phone: 503.7182439 Fax: 503.59 Plan Review
Phone:
Inspection Line: 503.639.4175 kit g, Dat gay: cher Permit No,m��-' 'CA .-CVS-S-4
1 i,. r;! kik i I Cft 0 nate Ready/Br any VI See Page 2 for I
Internet: www.tigard-or.E OF VI U L JNiG DIVJA I `NNamed/Method: Suppteme tatl ,Wee
t3 } �* ULE
5/New construction 0 Demolition For special irrfonua ion use checklist
0 Addition/alteration/replacement 0 Other Description Qty. ( Ea I Total
New 1-2-family dwelllags(includes 100 It for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
411-and 2-family dwelling 0 Com nercial/lndustrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen
0 Master builder 0 Other., 25.02
Fire sprinkler( sq.ft.) Paget
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ',(i J } ,N ,i.., Catch bay or area theta 18.76
City/State/ZIP:" 0let e-lp.1.1`t Drywell,leach lune,of trench dam 18.76
Suite/bldg./apt.no.: Project name: g.r s z 3. ./1,-.... Footing drain(no.linear ft.:__.) Page 2
} eG.i . Manufactured home utilities 50.03
Cross street/directions to job site: -fl t ,-s Fly To r7. 4.- Manholes
It,
£1 S'uC [ 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear it.:,_,_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: �t Water service(no.linear R.: ) 2
;7 Q:�r 4> T t,,.. " av,k I Lot no.: Fixture or item:
Tax map/parcel no.: i 5 i as h y i.,t5..±. -mix, Backflow preventer 31.27
J-
DESCRIPTION OF WORK / Backwater valve 12.51
(N Got-e S i r.r 5 Lt;; FOO iv*i L✓r V/ve Clothes washer 25.02
Dishwasher 25.02
Drinking fowttain 25.02
Ejectors/stunp 25.02
[
CVPROPERTY OWNER
1 0 TENANT Expansion tank
12.51
t
Name: ".;0'1u. CVZ"(1' 't .IOC, Fnttmrtsewearcap 25,02
Address: 3`33- 5. S-4-0.4e. S iI. 3Te: V, /t4L Floor drain/floor sink/hub25.02
City/State/SIP: Gage disposal 25.02
ai..„he 0-Ld a c,(0 C I "?O Sr/ Hose bib 25.02
Phone:( ^ ) 114 " ), i3 ;! Fax:( "`T Ice maker 12.51
tAPPLICANT C'CONTACT PERSON Interceptor'/grease trap 2102
Business name: 3 Py vy( C-0660 Medical gas(value:$ ) Page 2
Contact name: S 4y
, N,r GC.•`r{f T7_ Primer 12.51
Address: hoof drain(conumtiai) 12.51
&O./basin/lavatory 25.02
city/State/ZIP: Solar units(potable water) 6234
Phone:( ) I Fax::( ) Tubishower/showerpan 12.51
E-mail: s�',h,,,,i 1 69 Yc u S 11"-v•0v-rsre:r`�'t br. a=il:'-- Urinal 25.02
CONTRACTOR Water ckmset 2502
Business name: allscope plumbing and construction, HUWaterheater 37.52
Waterpiping/DWV 56.29
Address: 18859 SW Butternut St Other:
25.02
City/State/ZIP: beaverton or 97078 Subtotal
Phone:(503)-927-0713 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 197728 Plumbing Lic*no.: pb 1249 Plan review (2596 of permit fee)
Authorized signature: f &z� aeA it-
TOTAL
a sueeharge(i296 ERMITt fee)
/ e PERMIT FEE
Print name: timothy a h Ilenbach jr Date: TWspermitappucadoncaptive iiapermit isnot drtainedwithini88days
10/16/18 after it bas been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board.
t:lBnitdinePamitslPLAV-PmnttApp.doe 10/01/09 4404btenuravcohowEB)
City of f Tigard
11111 ' COMMUNITY DEVELOPMENT DEPARTMENT
T 1 A Building Permit Review — Residential
Building Permit #: -c. 1k - C`k., ;?`i -1-
Site Address: Cy 272 '9 41) Ate_
Project Name: !R—)kbvt_ Lot #: 2
(Ne dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: /.46 a? e
NJ Verify site address/suite# exists and acteio p rmtt system.
❑ River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Site 'Ian Elements:
i►, P ee(3)copies of site plan V °'•;sting structures on site
V Sp1an must be on 8-1/2"x 11"or 11 x 17"paper it ootprint of new structure(including decks)with finished
U4j,i0 wn to scale(standard architect or engineer scale) II..r elevations
arrow
WjtV ,V . 'ty locations&easements(required for new and additions)
jt address,project or subdivision name and lot number I Sid walk/driveway approach
Vi licant information(name and phone number) •1 :A.cation of wells/septic systems
dimensions and building setback dimensions14 iG Existing trees to be retained with drip line,and tree
uare footage of buildings to be demolished
tection measures
area,building coverage area,percentage of coverage and 1/JS et tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) treet names /
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? 62 Si ❑No
4 foot differential) If yes,is a storm water quality facility shown? gl Yes ❑No
4 1V', lean Water Services—Service Provider Letttte of platted prior to 9/10/1995):
quired: El Yes,applicant was notified lld No Received: ❑ Yes ❑ No
V Public Facilitie provement(PFI)Permit:
R quired: applicant was notified ❑ No Applied For: Zes ❑ No,stop intake
V5 and Use Case#: ,2_�) _ 0000 14 Hing: 11, s—
Re uired Setbacks: Front
q .._2,0 Rear /c--- Side c"—" Street Side Ki'4 Garage ,2
dscape Requirement:
IV of Coverage Maximum:
ra Building Height: Maximum Height 3C) Actual Height 2Q
‘ isual Clearance
III k,ensitive Lands: ❑ Yes 0 No Type
E4 than Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: A_____—_— __4:t_
Date: _ r
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\BuildinglForms\BldgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: \ ` U\\�
Site Plans: #
Building Plans: #
Building Permit#: Er.Enter building permit#above.
Workflow Routing: Planning Engineering R Permit Coordinator ErBuilding
Workflow Sign-off: [3/Sign-off for Planning(include notes from planning review)
Route Application Documents: E/Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Br Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: � �A,_,,
Date: a\ is
Engineering Review
Ic�ope at building pad: ,S, t/o
onditions"Met"prior to issuance of building permit
asements (encroachments)per engineering conditions of approval and plat
WaterQtY
uali /Quantity Facility: '
Assess Water Quality Fee in-lieu: ❑ Yes o
Assess Water Quantity Fee in-lieu: ❑ No
ZLIDA Facility on lot: Yes 0 No
ing Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:��
13" Approved by Engineering: /,���/ Date: /,2/..26t/g'
Revisions (after Building Submittal . $ y) 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- let"prior to issuance of building,permit
0 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
*SDC Fees Entered: Wash Co Trans Dev Tax: XYes 0 N/A
Tigard Trans SDC: AYes 0 N/A
Parks SDC: , Yes 0 N/A
LIDA OsYes V. N/A
ikOK to Issue Permit
Approved by Permit Coordinator: „,d Date: f\ac,J a
I:\Building\Forms\BldgPermitRvwRES 010118.docx
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9504 SW 74TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00357
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Ac installed.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9504 SW 74TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00357
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
No power to gas cooktop.
No gas at gas cooktop.
Seal condensate drain at foundation vent left side of house. R408
Seal line set penetration thru foundation wall and provide listing From manufacturer for
line set covered unprotected below grade.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9504 SW 74TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00357
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Water pressure exceeds 80 psi. 608.2
Provide pry to reduce water pressure to 80 psi maximum.
Finish sealing at base of upper level main bath tub. 407.2
Strainer in master tub missing. 404
Provide permit for laundry tray installed not on permit.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9504 SW 74TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00357
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Sleeve in foundation for previous line set location not sealed water tight as noted on
previous mechanical final inspection.
Ceiling penetrations for HVAC around furnace plenum not sealed as noted on previous
mechanical final inspection.
Provide fall prevention devices at upper level front bedroom windows measured 23 3/4"
to net clear opening of windows, both bedrooms. R312
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9504 SW 74TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00357
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Sleeve in foundation for previous line set location not sealed water tight as noted on
previous mechanical final inspection.
Ceiling penetrations for HVAC around furnace plenum not sealed as noted on previous
mechanical final inspection.
Provide fall prevention devices at upper level front bedroom windows measured 23 3/4"
to net clear opening of windows, both bedrooms. R312
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9504 SW 74TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00357
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Corrections from previous plumbing inspection complete.
PRV installed, water pressure 30 psi at garage hose bib.
Violation Summary:
Inspector Contractor