Permit City of Tigard • COMMUNITY DEVELOPMENT IEPARTNIEN'I'kiF 0
�4
II a
Request for Permit Action
11,,,,...) 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 ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Polygon Homes WLH LLC
Mailing Address: 703 Broadway St., Ste 510
City/State/Zip: Vancouver, WA 98660
Phone No.: 360-695-7700
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
VI CANCEL/VOID PERMIT APPLICATION.
❑ 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#: MST2019-00453 I SwS2O — 00 3Z2
Site Address or Parcel #: 14320 SW 165th Ave
Project Name: Polygon at Roshak Ridge
Subdivision Name: Polygon at Roshak Ridge Lot#: 172
EXPLANATION: Plan renamed and updated
Signature: %9CL W.-822/..42- Date: 1/6/2021
Print Name: TonjkMorris
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE L1SE ONLY
Route to Sys Admin: Date By Route to Records: Date j By '7
Refund Processed: Date By Invoice Processed: Date 2.4 Byfil
Permit Canceled: Date 1/Ja/1,i By kW Parcel Tag Added: Date By
I:ABuilding\Forms\RcgPermitAction_205 doc
' Building Permit Application LV \....,_
Residential u-- r-( � ,, -8 FOR OFFICE USE o1\L1
Received / p M8r26/9-ODyf✓c3
City of Tigard 1 Receive /L'I�' I Permit No.
:IN
13125 SW Hall Blvd.,Tigard,OR 9722 e �Y 2 6 , ./j q�
• C Phone: 503.718.2439 Fax: 503.598.1`.. n.,� Date/By:Review J�� �45 A 4 Other Pern>gieR24/1_CO 32L
T 1 G A R D Inspection Line: 503.639.4175 CITY Or' I!(. r ' ) Date Ready/By: hris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
T i PE 'C1riii '17REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF I aNSTRII .. f t work indicated on this application.
Valuation: $ L3 )3QL-1
® 1-and 2-family dwelling ElCommercial/industrial
0 Accessory building 0 Multi-family Number of bedrooms:N
ElMaster builder 0 Other: Number of bathrooms:/3
JOB SITE INFORMATION AND LOCATION ° - Total number of floors: l l
Job site address: 1 I'J) c� I t Q S-�/� Q�, New dwelling area: 3�2-] square feet ,Q3 I„
City/State/ZIP:Tigard,OR 97224 I "�J�� Garage/carport area:tp--pl square feet \ 5°i
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge 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:Polygon at Roshak Ridge Lot no.: 11 d_" 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
work indicated on this application.
lication.
DESCRIPTION OF WORK
New SF Valuation: $
Existing building area: square feet
New building area: square feet
ISI PROPERTY OWNER 0 TENANT Number of stories:
Name:Polygon WLH LLC Type of construction:
Address:703 Broadway Street Ste 510 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442 New:
, E APPLICANT,,: - ,: , - El CONTACT PERSON BUILDING PERMIT FEES*
(Pleare refer feeBusiness name:Polygon WLH LLC
Structural plan review fee orodeposit)u7e#
Contact name:Amanda Gavin
FLS plan review fee(if applicable):
Address:703 Broadway St.Ste 510
City/State/ZIP:Vancouver WA 98660 Total fees due upon application:
Phone:(360)695-7700 Fax::(360)693-4442 Amount received:
E-mail:permitsubmittals@polygonhomes.com /PHOTOVOLTAIC SOL'RPANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247 I Total fee due upon application: $201.60
Authorized si =as�at.... i This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Amanda avin Date: a� i� *Fee methodology set by Tri-County Building Industry
t Service Board.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicati ,, FOR OFFICE USE ONLY
City of Tigard w ! L.,F Received Date/By: Permit No.:M� 2���av n 5
- 3
q 13125 SW Hall Blvd.,Tigard,OR 97223 t�-
Phone: 503.718.2439 Fax: 503.598.1960 I-E8 2 6 2019 Plan Date/By:Review
ew Other Permit:
TIGARD Inspection Line: 503.639.4175 f�` r ��y Date ReadyBy: runs: ® See Page 2 for
Internet: www.tigard-or.gov CITY O r. !kii\HE) Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE'OF ORlf yy CO RCIAL FEE* SCHEDULEUSE C>J CKLI '.
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONNIRUCTION RESIDENl IA L EQUIPMENT 1" YS I E14IS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
,. SOB SITEINFORMATION AND LOCATION Heating/cooling:
Vr 25 � s _ _w 1,`IL(Vl � 1 Air conditioning 46.75
Job site address: 1 i Furnace 100,000 BTU(ducts/vents) l 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge 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:Polygon at Roshak Ridge Lot no.: (-7?_-- Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
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
Other: 23.32
® PROPERTY OWNER 0 TENANT
Environmental exhaust and ventilation:
Name:Polygon WLH LLC Range hood/other kitchen
1
equipment 33.39
Address:703 Broadway St.Ste 510 Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver WA 9860 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:(360)693-4442 Attic/crawlspace fans 23.32
® APPLICAN " y,r.. ❑:'C(?N FAC`I r Other: 23.32
Fuel piping:
Business name:Polygon WLH LLC
$14.15 for first four;$4.03 for each additional
Contact name:Amanda Gavin Furnace,etc.
Address:703 Broadway St.Ste 510 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:TBD Other:
44ii41tCHANICALPRMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.: 4 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Authorized sit' alr , * Fee methodology set by Tri-County Building Industry Service Board
Print name:Aman•: Gavin Date: 61a !al
I\Building\Permits\MEC_PermitApp_040113.doc 44 7T(I1/0/COM/WEB)
.4.
Eiectri'al Permit Application, r FOR OFFICE CSE ONLY
�,R,` U Received g�2019- G� 53
ih - City of Tigard Date/By: Permit#:
• 13125 SW Hall Blvd.,Tigard,OR 97223 C pp
Phone: 503.718.2439 Fax: 503.598.1940E 2 6 2019 Date/By:Review
Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Surfs: ® See Page 2 for
TIGARD, Internet: www.tigard-or.gov GI I V Ur 9 Kiii.; -19 Notified/Method: Supplemental Information
-Na visioj PLAN REVIEW
m
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stones.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION S , exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to Bound,or exceeds 14,000 ❑Commercial-use agricultural
ngs.
❑Multi-family 0 Master builder 0 Other: 0 amps forum all other installations. Inbustallation Pump. ❑Installation of 150 KVA or
JOE SITE INFORMATION'AND LOCATION `, 0 Emergency system. larger separately derived
I) t
Job#: Job site address: LLI 22�V , � 1 to c-'� ❑Additioo of ore.motor load of system.
l / U JJ 1 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Polygon at Roshak 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: FEE-; DBE
Description I Qty. I Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: l Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 1 33.92 1
DESCRIPTION OF WO Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
• 13 PROPERTY OWNER, t; 0 TENANT - - , Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH LLC 200 amps or less 100.70 2
Address:703 Broadway St.Ste 510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:(360)693-4442 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
'APPLICANT ❑ CONTACT PERSON ; ` ;
Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Polygon WLH LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name:Amanda Gavin B.Fee for branch circuits without
service or feeder fee,first
Address:703 Broadway St.Ste 510 branch circuit 56.18 2
City/State/ZIP:Vancouver WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(630)693-4442 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:permitsubmittals@polygonhomes.com Reconnect only 67.84 2
,_ CONT Ae1* , .'';.':;;':;%,"'/,,;...,, ,,;.„-",,,,,,,,,,,,:„ '''''''''-4-?-"g°14 Pump or irrigation circle 67.84 2
Business name:TBD Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy See Page 2 2
Address: panel,alteration,or extension. 0 g
City/State/ZIP: —
Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) 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 Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(4 hr min)
' ELECTRICAL PERMIT FE „', '
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signatur •
This permit application expires if a permit is not obtained within 180
Print name: Amanda G in Date: days after it has been accepted as complete.
: Number of inspections allowed per permit.
I:\BuildingTermits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 4 0-4615T(11/ /COM/WEB
Plumbing Permit Application
Building Fixtures k ,,, 't,‘,;Fr: FOR OFFICE USE ONLY
City of Tigard Received
EB 2 +
q 13125 SW Hall Blvd.,Tigard,OR 97223F 6 0 9 Date/By: Permit No.:
/�19'0 0 453
Plan Review
-
Phone: 503.718.2439 Fax: 503.598.196 Other Permit No.:
d DateBy:
Inspection Line: 503.639.4175 s4 Y Ur i ( H L) Date Read B Juris: ® See Page 2 for
TIGARD Internet: www.ti and-or. ov 9 1 4N �'SS��z1I y yg
g g "���C..�a�i4.-� ����a�E�,�r? Notified/Method: Supplemental Information
`TYPE OF WOK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description I Qty. Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath I 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1,1.1 3e.1 V S UI.J (O I f C.�' Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 l Drywell,leach line,or trench drain 18.76
Footing dram(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge 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:Polygon at Roshak Ridge Lot no.: 1,1 Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27
.DESCRIPTION OF"WORK
Backwater valve 1 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER i ❑ TENANT , Expansion tank 12.51
Name:Polygon WLH LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:(360)693-4442 Ice maker 12.51
63 APPLICANT ,_� ❑ CONTACT:PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Amanda Gavin
Roof drain(commercial) 12.51
Address:703 Broadway St.Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR
t "' ' 1: ''''s Water heater 37.52
Business name:TBD Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signat TOTAL PERMIT FEE
Print name:Amanda avin Date: �� /1 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.dor 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
III ■
T l c n a n Building Permit Review — Residential
Building Permit #: J4 8 j 2O 19- 0Oy-53
Site Address: 113.2 w 1.6S Ar i
Project Name: POLYGON AT ROSHAK RIDGE Lot #: I ?"2-
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Pro osal: NEW Si*
Sfln�i ' J�7 0. PLAN SET# 17-(?g,
IC' Verify address/suite#active in Accela. ® In River Terrace: ❑ No ® Yes, River Terrace Review Addendum
Site Plan Elements: Lll'. ,sion Control
!iJ 3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper 40,Fined trees with drip line and tree protection measures
li1155 wn to scale(standard architect or engineer scale) ��Ffootprint of new structure(including decks) and FFE
Q3�1 rth arrow I[i4.Ut' locations&easements (required for new and additions)
C( address,project or subdivision name and lot number idewalk/driveway approach
V .plicant information(name and phone number) kitcation of wells/septic systems
L:4 .t dimensions and building setback dimensions Q5t et tree size,type and location
I ird'.uare footage of buildings to be demolished IVSfty.et names
�,hi Existing structures on siteer elevations(2'contours if more than 4'differential)
114ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? .Yes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑YNo
® Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified II NoReceived: ❑ Yes ❑ No ArtiLA)k
® Public Facilities Improvement(PFI) Permit: L04 C/),(
Required: . Yes,applicant was notified ❑ No Applied For: . Yes h ❑ No,stop intake
® nd Use Case#: PDR2015-00002/ SUB2015-00004 Ly'ed Zoning: f'�'5 PU
quired Setbacks: Front: 12/8 Rear: 1 S Side: 3 Street Side: Garage: id
LCd Building Height: Max. Height: 3° Actual Height: Z1"
Landscape Area: % kLot Coverage Max:
Li', 'Entrance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ❑ Minimum 12%of area of all street-facing facades
(-_ Garage ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
I ` ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
q� ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor.
❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
4.......z, ❑ Accent siding Window trim ❑ Window recess ❑ Window projection ❑ Balcony
Kl sual Clearance lfd Urban Forestry P n
R3 Sensitive Lands: ❑ Yes 2 No Type:
® Conditions met prior to issuance of building permit
No Conditions to be met prio to buil 'ng permit issuance
lid Approved By Planning: Date: I t.-Zvi'
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: a2/26/19
Site Plans: # 3
Building Plans: # 3
Building Permit#: [Enter building permit#above.
Workflow Routing: 0'Planning [ Engineering Er Permit Coordinator 'Building
Workflow Sign-off: R' Sign-off for Planning(include notes from planning review)
Route Application Documents: l Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
Er Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: l.Vi l0/!9
Engineering Review
QrSlope at building pad: (3 g
E Conditions "Met"prior to issuance of building permit iv/A
Q"-Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Q//No
Assess Water Quantity Fee in-lieu: CI Yes D o
LIDA Facility on lot: ❑ Yes E1 No
EFinal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
24pproved by Engineering: T Date: /24l114019
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
V
DC Fees Entered: Wash Co Trans Dev Tax: LYYes ❑ N/A
Tigard Trans SDC: Wi Yes ❑ N/A
Parks SDC: es ❑ /A
LIDA ❑ Yes Kr N/A
K to Issue Permit
Approved byPermit Coordinator: �� f Date:' f //
PP „J
I:\Building\Forms\BldgPermitRvw_RES_D22819.docx