Permit (81) CITY OF TIGARD MASTER PERMIT
II . ' COMMUNITY DEVELOPMENT Permit#: MST2019-00014
T I GA f<'.0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/04/2019
Parcel: 2S112BD13400
Jurisdiction: Tigard
Site address: 7722 SW CORNUTT ST
Subdivision: ELDERBERRY RIDGE Lot: 30
Project: Elderberry Ridge, Lot 30
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1352 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1533 sf Garage: 491 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2885 sf Value: $365,198.05 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
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: 1
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 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 2885
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PL STE 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
370 BEAVERTON,OR 97006
BEAVERTON,OR 97006
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $32,877.76
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Code -,d 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 issuanc: • 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. - Those rules are set forth in OAR
952-001-0010 through OAR •01-0090. You m-, obtain a copy• the rules or.'rect questions to OUNC by calling 503.232.1•: or 1.800.332.2344.
Issued By: �/...4.0 :A '//r7 Permittee Signature: A
Call 603.639.4175 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.
( oy 3ô
Building Permit Application
iResiiential 1'OR OFFICE ESE ONLY'
Received of Tigard 4, DateBy:
)l 1 i Sc� m Permit No. - 6\q- t Ur
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 9N 2 Date/By: '[ sit Other Permr' 7�}�q--
Inspection Line: 503.639.4175 '' Date Ready/By: runs: ® See Page 2 for
TIG.\RII 4t g
Internet: www.tigard-or.gov CITYO9.f(- r red/Method: 4/0 Supplemental Information
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t, Yq' �. «" , '� ,-:'' $,t ' a, c 40154'4.4:1'1.::47;:*:*"
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.t ..� x[,+�.�.��1'w..�tea ` � ���s. x.�.. . �� F �-v .. � l- .m-4,�.. �:* �.'.
El New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
;, ' ��`a work indicated on this application. ((��
s, t:'t� J" / l� ,
;' � a �' s. tet,. 3(4
❑✓ 1-and 2-family dwelling 0 Commercial/industrial
Valuation: $
o Accessory building 0 Multi-family Number of bedrooms: 5
I=1 Master builder El Other:
Number of bathrooms: 3
. s ma•x � Total number of floors: 2 32S7� t l a . a o si.
Job site address: 7722 SW Cornutt Ln New dwelling area: 2885 square feet t 533
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 491 square feet `3SD___
Suite/bldg./apt.no.: Project name: Elderberry Ridge Covered porch area: square feet
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave Deck area: square feet
Other structure area: square feet
x art r[ r 7 t,1 9 fir �! 1 ; ,r 'T '.�"�"
Subdivision: Elderber Rid.e Lot no.: 030 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
f a;.. r eur, a mak,.+ . • .: : u3 4"a ,r s
kr '' ? , '' work indicated on this application.
Construction of SFR Valuation: $
Existing building area: square feet
New building area: square feet
t
g _ fi .r. Number of stories:. . ; l
Name: Riverside Homes, LLC Type of construction:
Address: 17933 NW Ever.reen Pl., Ste 370 Occupancy groups:
City/State/ZIP: Beaverton, OR 97007 Existing:
Phone:( 503)645-0986 Fax:( )
.,.
New:
x�. T , . ,# 4 ,,,,7:&!:::41,,,f-1.:*:ln •irk R � tMi
'�. r° ' ` a k{: + "5 y
Business name: Riverside Homes, LLC
Structural plan review fee(or deposit):
Contact name: Wes Boisvert
FLS plan review fee(if applicable):
Address: 17933 NW Evergreen Pl., Ste 370
/
Total fees due upon application:
City/State/ZIP:ty ZIP: Beaverton, OR 97007
Fax::
Amount received:
Phone:
(503)645-0986 ( )
E-mail: wboisvert@riversidehome.com
Commercial and residential prescriptive installation of
�7 :.: / � . <, zr� �� roof-top mounted Photovoltaic Solar Panel System.
Business name: Riverside Homes, LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 17933 NW Evergreen Pl., Ste 370 Solar Installation Specialty Code checklist.
City/State/ZIP: Beaverton, OR 97007 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)645-0986 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lie.: 189148 Total fee due upon application: $201.60
Authorized signature:, 1 This permit application expires if a permit is not obtained
----- within 180 days after it has been accepted as complete.
Print name: 1/29/2019 *Fee methodology set by Tri-County Building Industry
Nikki Pruett Date: Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application F()R OFF!CI. l SF()11.1
- City of Tigard Received Permit No.MS-T
11111 IR 13125 SW Hall Blvd.,Tigard,OR 9722):4'
ECF IVED Plan Review
: I Phone: 503.718.2439 Fax: 503.598.19 0 4 ''''' Date/By: Other Permit:
I(-i/ - -
.\u t, Inspection Line: 503.639.4175
JAN 2 9 Z019 Date Ready/By: runs: See Page 2 for
1 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
......,.....-- , . _
' ''''''''' '*'- '4:**1.44(1e*"''-''''''''' *'•-11'''' ' - Mechanical permit fees*are based on the value of the work
a New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
0 Demolition Ell Other:
4.. ... Value:$
- •cxf.4••••z till"!•7'.--.7Y1..n7 ::' '''''':'',''i: `t-I.It SP1:'`0';;P''''''' ..;'‘."3:Al'fiV.: ..:.''''' '4Z
El 1-and 2-family dwelling DI Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder .y, Other: Description I Qty. I Ea. I Total
4,,,,,,••••,•-,...,,,.•...•,•_,.••,t. . ,:i.:C.., Heating/cooling:
' - ''''*"'11"-fi '41$'",`Ilk.''.I.'''s '0', '''"'" T.., ,t-..-..-:•I'''.
''''''''.4 ' ' ,..1,-AII/tS '.%'e..!......‘,.44,....,' ." ,'.,,N,,',".;.,• e ."''', ' '' '''''''' ''. Air conditioning 1 46.75 46.75
Job site address: 7722 SW Cornutt Ln Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP: Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Elderberry Ridge Heat pump
Duct work 61.06
23.32
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Elderberry Ridge 1 Lot no.: 030
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
4.:--•• - 'i• •".• *••••'••••f.-_•••:', "1:* Gas fireplace/insert 1 33.39 33.39
"•;• ,;*.a*' • • '$.--.7* •!.1411:*** : ** *:t.;.7*. '* 1 , . '•1'•.i.,•iri4k mr''''';;: for water
Flue vent heater or gas
Construction of SFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
''''''•:**1 ."`'`•' 5'' '*'-'i' . ' 'IN''*ill' ' '''''' 7 Zi'e.4'.** ' " ' * ',AY.. • z';''' ,".' "."."i",' Environmental exhaust and ventilation:
,.... . . .. • , .• .•,,..:-...,
Name: Riverside Homes, LLC Range hood/other kitchen
equipment 1 33.39 33.39
Address: 17933 NW Evergreen Pl., Ste 370 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Beaverton, OR 97007 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 6 23.32 139.92
Phone:(503 )645-0986 Fax:( ) .., Attic/crawlspace fans 23.32
4,,'6,,•=r's:24•••t Other:
'''...i i i• :',*,7'S-Alli.'.'1*:'4.IN ''''-i.;i i't,-.;:-,i,::4' 4,0: ,,,
', 'AY 17'''' ti 0'1..2::LiekeRr''',::,...:1;;#:,:!-:-:',2'.:::1.;1',:.-.-.,zr,g,„w'41w...!-, , -,-**"'.'''''''' ' '"*.--• ' - Fuel piping: 23.32
Business name: Riverside Homes, LLC
$14.15 for first four;$4.03 for each additional
Contact name: Wes Boisvert Furnace,etc. 1 14.15
Address: 17933 NW Evergreen Pl., Ste 370 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Beaverton, OR 97007 Water heater 1 14.15
Phone:(503 )645-0986 I Fax::( ) Fireplace 1 14.15
Range 1 14.15
E-mail: wboisvert@riversidehome.com Barbecue
--,•••,7z,••:.•,„ - •••.,-.,r•.,6„:„,,,,r,, :,,,-,,.,f.,.•-•.„.•71-1..?;:-••fi,,,•••...•...,;,,::.-.t.1.•„..„,,.• fi.,,,,,,,r,c21.1,-salit••;: :E -.4,75:1474;1511m44/1„tf'4111.1 Clothes dryer(gas)
Other:
Business name: Pro Heating & Cooling --- :„rL.-z-T,...ttr---- r-. :. : --''''"7"'"7"""''1'''
";vii,....;evi::77.., wo.4"iiiir.,,,,46-' --. ‘.. • •••
Address: 2095 NW Alocleck Rd.#1103 Subtotal
City/State/ZIP: Hillsboro, OR 97124 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 971) 205-4989 Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 209001 TOTAL PERMIT FEE
I jr )
This permit application expires if a permit is not obtained within 180
, -.,
days after it has been accepted as complete.
Authorized signature:(,/ilLfri,6 ,...(.4-6-4- * Fee methodology set by Tri-County Building Industry Service Board
Print name: Nikki Pruett Date: 1/29/2019
I\BuddingTermds\MEC_PermitApp_040113 doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application—, � E FOR OFFICE ISE ONLY
a�
City of Tigard ReceivedDate/B : .
i 'I 13125 SW Hall Blvd.,Tigard,OR 97223 INN 2 9 2Q1� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 r Date/B : Related Permit#:
Inspection Line: 503.639.4175 �'r Read Juris:
TIGAR[} � i�� ��" t Y Date/By: ® SeePage2for
Internet www.tigard-or.gov 1 4 IliS1 Notified/Method:
1, d6 Su mental Information
,t
,, e
9 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
. , , where the available fa1t current Marinasand boatyards.
❑Demolition ❑Othe :
::,?xh., , . 4 , " g T r ( a ,
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
✓ 1-and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 0 0Accessory building
0 Multi-family 0 Master builderamps for all other installations. buildings.
0 Other: 0 Fire pump. 0 Installation of 150 KVA or
' n , B St ' i i 1 1' 1 i,.q '''',4":".,.! _ ❑Emergency system. larger separately derived
7722 SW Cornutt Ln ❑Additionofnewmotorloadof system.
Job#: Job site address: l0OHP or more. ❑"A",``E",'°1-2^, °t-3",
occupancy.
City/State/ZIP: Tigard, OR 97224 ❑Six or more residential units. 0 Recreational vehicle ar
❑Health-care facilities. parks.
Suite/bldg./apt.#: I Project name: Elderberry Ridge 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: SW Bonita Rd &SW 76th Ave ' , • <i't ,-:.
Description I Qty. ��Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Elderberry Ridge 1 Lot#: 030 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.fl.or portion 33.92 1
s t`.1. ° ?, ,v Limited energy,residential 75.00 2
Construction of SFR (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
,-„,,,-„,12 mss a, .rr ; 119 t '' ' • , ,;
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen PI., Ste 370 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Beaverton, OR 97007 601 amps to 1,000 amps 301.04 2
Phone:(503)645-0986 1 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
trAP 'i C 1}.' --t e k,i Branch circuits—new,alteration,or extension,per panel
• A.Fee for branch circuits with
Business name: Riverside Homes, LLC above service or feeder fee,
7.42 2
each branch circuit
Contact name: Wes Boisvert B.Fee for branch circuits without
Address: 17933 NW Evergreen PI., Ste 370 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Beaverton, OR 97007 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)645-0986 f Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: wboisvert@riversidehome.com Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: Sunlight Electric Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 2804 NE 65th Ave. St. D
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Vancouver, WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360) 518-7589 Fax:( ) 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 Lie.: 172549 Electrical Lie.: C230 Suprv.Lie.: s.ecificall listed '/zlir min
Suprv.Electrician signature,required: /n1/4.0 _ L Subtotal:
Print name: Chester Garrett I Date: 1/29/2019 0 Plan Review Required(25%of permit fee):
/f
State surcharge(12%of permit fee):
Authorized si ature TOTAL PERMIT FEE:
gn i V� G /
This permit application expires if a permit is not obtained within 180
Print name: Nikki PI B- - - -i
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page,2`—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description Qty I Each r,;.,Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems: I
Check Type of Work Involved: 5 kva or less 100.70 2
5.01to15kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
✓❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s}ecificall listed '/z hr min
, # c w �#` OVAL P
I ;
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): I
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Ap lication
BuildingFixtures C �E E
Folz OFFICE I. ONE)
Cl of TigardjAN Received
1111 13125 SW Hall Blvd.,Tigard,OR 97223 ` 1 Date/By: Permit No.�C,-1 `(` r(3Sli 1
• 11 10 Phone: 503.718.2439 Fax: 503. .190 1" Date/By:Plan Review Other Permit No.: �'l
Inspection Line: 503.639.4175 ° ' i��%"^
T I( AILD BUILDING
i LD I N O $VISION Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov i7�J 1, k lsP Notified/Method: Supplemental Information
.•,.
0 New construction 0 Demolition For special information use checklist
Description 1 Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
d -1
,x AV . t T 4,°.'fie f £.. SFR(1)bath 312.70
IE 1-and 2-familydwellingSFR(2)bath 437.78
0 Commercial/industrial
❑Accessory building 0 Multi-family SFR(3)bath 1 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB' tl 7 '` ," t -*$ s° • Site utilities:
Job site address: 7722 SW Cornutt Ln Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Elderberry Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Bonita Rd &SW 76th Ave Manholes 18.76
Rain drain connector 1 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Elderberry Ridge 1 Lot no.: 030 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
I. t • , t. .L; s Backwater valve 12.51
:71.417, .' '-A' t t a �4 s� lt '` •�, Clothes washer 1 25.02
�, .s � .v
Construction of SFR
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
, ti,. . a:
rYg •s tr .-,-..,:•-,-. y° � , '�• ' ,', ,'
-,-.4,....,, Expansion tank 12.51
Name: Riverside Homes, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen PI., Ste 370 Garbage disposal 1 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 2 25.02
Phone:(503)645-0986 Fax:( ) Ice maker 1 12.51
Y, APP UCA1 1 ~• t a ti aInterceptor/grease trap 25.02,
Business name: Riverside Homes, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Wes Boisvert
Roof drain(commercial) 12.51
Address:
17933 NW Evergreen PI., Ste 370 Sink/basin/lavatory 6 25.02
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax::( ) Tub/shower/shower pan 3 12.51
E-mail: wboisvert@riversidehome.com Urinal 25.02
to a5 � Water closet 3 25.02
..14a1044044.4.4". Water heater 1 37.52
Business name: H & H Mecanical WaterP�tPing/DWV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Phone:( 503 975-9787 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 178122 Plumbing Lie.no.: PB414 Plan review (25%of permit fee)
J/ State surcharge(12%of permit fee)
Authorized signature:�.y=� ��, TOTAL PERMIT FEE
if
Print name: Nikki Pruett Date: 1/29/2019 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Pee methodology set by Tti-County Rulldmg industry service Board.
L•\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
, COMMUNITY DEVELOPMENT DEPARTMENT
1111
TIGA
R 1) Building Permit Review — Residential
---,,,,...,...,,Lk-
Building ..x - ,-,77'I....":21:.'_..2�,Lra: : -. .- t- . .v. ., .:-- ,,
ng Permit #: �l`(�ST \G_ TAU
Site Address: 77 2.2 Sw Corny++ Lo-
Project
r)Project Name: GI au b.O.,r,-1.1 i i d 9 e Lot #: ?O
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: New Sc.-(
Verify site address/suite#exists and active in permit system.
Gir River Terrace Neighborhood I2'No 0 Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
?Three(3)copies of site plan
IgExisting-structures on site
Site plan must be on 8-1/2"x 11"or 11 x 17"paper
Footprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
North arrow Utility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number ,ZSidewalk/driveway approach
Applicant information(name and phone number)
Lot dimensions and building setback dimensions on-bf wells/septic systems
,lExisting trees to be retained with drip line,and tree
[ Squaie footage of buildings to be demolished protection measures
)ZJLot area,building coverage area,percentage of coverage and JZStreet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) gStreet names
'Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? [ryes ❑N)
4 foot differential) If yes,is a storm water duality facility shown? DYes ❑No
N/A
0 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified /E-' No Received: ❑ Yes ❑ No
I`'' Public Facilities Improvement(PFI)Permit: I cr 2-0`-1 - 0001 i
Required: 0 Yes,applicant was notified ❑ No Applied For:
Yes ❑ No,stop intake
;21 Land Use Case#: at220!(a - OQQ Qq , S V(3 2,01(0- Q000l
VZoning: 2 -7
Required Setbacks: Front 1 5 Rear 1 s Side 5 Street Side ) 0 Garage 2....0Landscape Requirement 2_4
Y" Lot Coverage Maximum: —
yi Building Height Maximum Height 3 s Actual Height
AVisual Clearance
/in Sensitive Lands: 0 Yes 0 No Type
Urban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
/4E] Approved By Planning: !r) ::: 1, .....--` Date: 1) ZG / 19
Revisions (after Building Submittal only) Reviewer
Revision 1: 0 Approved 0 Not Approved Date
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw_RES 061417.docx
Building Permit Submittal
Original Submittal Date: 0 \ >e, \ 1 CA
Site Plans: # T
Building Plans: # 3
Building Permit#: [2/Enter building permit#above. f
Workflow Routing: 'Planning [2/Engineering C" El Permit Coordinator Building
Workflow Sign-off: 1;2(Sign-off
YSign-off for Planning(include notes from planning review)
Route Application Documents: I/ Engineering: (1) copy of permit application, (1)site plan, (1)building plan and
original plan review routing form.
CY Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: '. .---P4—k_A_,.._
Date: i Ilyk\ \ex
Engineering Review
d
Slope at building pad: J
2' 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 0 No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot 0 Yes 0 No
❑ Final Plat Recorded:
❑ NOT Approvedb Engineering: Date:
Y �' ��
Notes:
d� A roved byEngineering:
Date: d '
PP
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
O Conditions"Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant
Revision Notice 2: Date Sent to Applicant
Revision Notice 3: Date Sent to Applicant:
DC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: E Y s 0 N/A
Parks SDC: PM Yes 0/A
LIDA 0 Yes IfP" N/A
bC11(to Issue Permit .
Approved by Permit Coordinator: Date:2 /6° //is
I:\BuildineForms\BldgPermitRvwRES 010118.docx
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
7722 SW CORNUTT ST, TIGARD, OR, 97224 September 11 , 2019 at
10:53:26 AM
Record Type: Record ID:
Residential - Master Permit MST2019-00014
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Final erosion control approved.
Moisture content form received.
Moisture barrier form received.
High efficiency lighting form received.
Insulation certification verified.
Duct seal test report received/verified.
C of 0 left on counter.
Violation Summary:
Inspector Contractor