Permit 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 proiect.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
11111 "
Transmittal Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tieard-or.eov
TO: (5\1 Ae J ( DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEIVED
FROM: Allison May
MAY 2 0 2021
COMPANY: Westwood Homes LLC
CITY OF TIGARL'
PHONE: 503-713-6294 BUILDING DIVISIC I Y
EMAIL: allison@westwoodhomesllc.com
RE: 11837 SW PENNY LN MST2021-00108
(Site Address) (Permit Number)
Burt's Landing Lot 6
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
I Copies: I Description: j Copies: I Description:
Pages 2,3&4 Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. 2 Engineer's calculations.
Other(explain): y
REMARKS: bearing wall in kitchen was moved to create a larger kitchen. fL-O r// ha S
Adjacent den is now smaller and has a single door vsa double door.
Truss engineering is not affected.
Fees Due: Yew n No Fee Description: Initials: Due:_
Routed to PermiVfec_ ician: Date: 5'
ptionAmount Due:
$
'/7 IpIan t^-W:t I $
Is
Special
Instructions:
Reprint Permit (per PE): C7 Yes 1 ❑No ❑ Done n
Applicant Notified: Date: /Z7 /� i Initials:
�1
CITY OF TIGARD MASTER PERMIT
Ili • COMMUNITY DEVELOPMENT Permit*: MST2021-00108
Date Issued: 04/08/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135CC05400
Jurisdiction: Tigard
Site address: 11837 SW PENNY LN
Subdivision: BURT'S LANDING Lot: 6
Project: Burt's Landing, Lot 6
Project Description: New detached dwelling
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1246 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 22 Bathrooms: 3 Second: 1682 sf Garage: 606 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 2928 sf Value: $388,093.26 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drams' Catch Basins: 0
Bckflw Prevntr: 1
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
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr 0
Ea add'I 500 sf: 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-800 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amplvolt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Y
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2928
Owner: Contractor:
WESTWOOD HOMES LLC WESTWOOD HOMES LLC Required Items and Reports(Conditions)
12700 NW CORNELL RD 12700 NW CORNELL RD 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97229 PORTLAND,OR 97229
PHONE: PHONE: 503-330-2215
FAX: 503-342-2403
Total Fees: $40,496.54
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: }foUYV(M' De/Weffe Permittee Signature: 0wAPPl'tio-v'
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applica roll OH l( r I �Sr:oil l
City of Tigard �` C E 11/E D Date/By:
Permit No.: Z(-Ct7 l O 8
13125 SW Hall Blvd.,Tigard,OR 97223 ' plan Review
Phone: 503.718.2439 Fax: 503.598.1960 MAR 1 r ZOZt Other Permit:
Date/By.
TtG;,li[, Inspection 503.639.4175 CITY OF TIGARD DateReadyBy. 7uris: I la See Page 2for
Internet: www.tigard-or.gov Noti5ed/MeWod: Supplemental Information
BUILDING DIVISION
-- _ - Mechanical permit fees*are based on the value of the work
I]New construction ❑Addition/alteration/replacement performed Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
x% , ,,. Value:$ r
) 1-and 2-family dwelling ❑Comnrercial/industrial 0 Accessory building For spedai information use dtecklist.
❑Multi-family ❑Master builder ❑Other Description Qty. Ea. Total
Heating/cooling:
Q 'A/
l� ✓7 YV Ali conditioning 1 46.75
site address: // p..e,'Ir) (.lint, Furnace 100,000 BTU(duets/vents) ( 46.75
City/State/ZIP: Ill Tr n Ti 73 Furnace 100,000+BTU(ducts/vents) 54.91
I Heat pump 61.06
Suite/bldgJapt.no.: I Project -name:'✓/// LAneti r71, Ductwork 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: I Lot no.: T er 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater _ 23.32
- ' 4 Gas freplacefinsen 33.39
`" " `'`e "" Flue vent for water heater or gas
HVAC for new construction home fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ra -« ` pr - 1 ' e �^Nv. Environmental exhaust and ventilation: 23.32
Name: d/S�-7�, 1 �� /�/lYl.�S / , Range hood/other kitchen )
Address: /2J7nO 1/V VV C?Y J( (L Clothes 33.39
ty �/K��� ce_ g7Z2d/ Clothes dryer exhaust c 33.39
City/State/ZIP: �/n� Single-duct exhaust(bathrooms,
��A toilet compartments,utility rooms) 23.32
Phon 7i ) / ' ,2, Fax( ) Attic/crawlspace fans - 2332
Other: 23.32
•:Tre-�riut .� _` -- __ - --- -- - ., - — PrP ng
Business name: w � �y/777 l!C S it $14.15 for first four;$.4.03 for each additional
Contact name: Al] (�/t//�1/lr 1 ` / Furnace,etc. I
Address:
12/lJ O `1 ti' I��JI y €` ( 62-'6(- Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: ffr'-t 41.„/1/,4 p�0 P 47 271' Water heater
Phone e5/')_! J ew_4t 1 /IIFFaxx:J:( ) Fireplace
Email 4 i 11 , A�/t(// 1 V ( ,i Bern
'''1 ''- y, f ._.
.. �/�/. Barbecue
F.. .. .�Sw- '�„�^�-e t�:.: ��� Clothes dryer(gas)
Business name: Lakeside Heating&Cooling otter.
MECHANCa1 PERMIT PEW'
Address: 7021 SW McEwan Subtotal
City/State/ZIP: Lake Oswego, OR 97035 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503 ) 635-5253 Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 227694 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature' � days after it has been accepted as complete.
gn e V �- Fee methodology set by Tn-County Building Industry Service Board
Print name: Jason Charlton Date: 3/i 1( ` /
1:1BuitdinglPmnits\hflC PermhApp_04o113.doc 4404617T(I1/01/COOM/WFBB)
•
, ' Electrical Permit Application RECEIVE I
FOR OFFICE USE ONLY
City of Tigard
Received
. Date/By:
Permit#: Ni ST�ZF-an fro S
13125 SW Hall Blvd.,Tigard,OR 97223 MAR ZQZ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 CITY OF TI GA R G Ready Date/By: rm;r: I ® See Page 2 for
TIGARD Internet: www.tigard-or.gov BUILDING L,IViSI n Notified/Method: Supplemental Information
:
TYPE OF WORK PLAN REVIEW
®New construction 0 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 ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El and 2-family dwelling ❑ Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 El Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
l/ '37 S} / Perm. e ❑Addition mf ore.motor load of system.
Job#: Job site address: 'V �i `G 100HP or more. ❑"A",`E","1-z","1-s",
/ /} 0 Six or more residential units. occupancy.
City/State/ZIP: 9urlGl (l � � El Health-care facilities. ❑Recreational vehicle parks.
SuiteSbld /a #: J Project name: Q� � �D Li/not/dill 0 Hazardous locations. ❑Supply voltage for more than
g' J CJurT� Gl�di• "�/ ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/diimtions to job site: /// FEE SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: 4 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
(with above sq.ft.) 75.00 2
New SFR Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Westwood Homes LLC 200 amps or less 100.70 2
Address: 12700 NW Cornell Rd 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Portland,OR 97229 601 amps to 1,000 amps 301.04 2
Phone: (971)678-5018 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
El APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Same as Owner/ above service or feeder fee, 7.42 2
H'1 V'I% ' m each br an circirc
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
n/ , 7t�f/ �1nn / �� dwelling,service and/or feeder
Email:+� (�w,Qs�(/�/�Vv'�ZVI r r+e�//t�• C1 �f Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Ross Electric Inc Sign or outline lighting 67.84 2
ry Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2870 SE 75 Ave#203 panel,alteration,or extension.
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)642-2800 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:RossElectric@comcast.net Industrial plant(1 hr train) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 157891 Electrical Lic.: 34-436C Suprv.Lie.: 42325 specifically listed(Vi hr min)
ELECTRICAL PERMIT FEES
?,.Suprv.Electrician signature,required: Subtotal:
ft Print name: Stephen Ross / Date: El Plan Review Required(25%of permit fee):
/,r State surcharge(12%of permit fee):
Authorized signature; /G t ,'p,,, TOTAL PERMIT FEE:
//�/ ^ This permit application expires if a permit Is not obtained within 180
Print name: /f Date:5 P days after it has been accepted as complete.
* Number of inspections allowed per permit
1:1Buildieg\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/172015 440.4615T(11/05/COM/WEB
, ' Plumbing Permit Application
Building Fixtures hiCEIVEE rOa OFiu is I SF Ossi.1
City of Tigard MAR'17 2021 Received; PcnritN°. 512-0 (-frn6O8
111 • 13125 SW Hall Blvd.,Tigard,OR 97223 ii Rev
= Phone: 503.718.2439 Fax: 503.598.196 PLn Review
Inspection Line: 503.639.4175 CITY OF TIGARi. Date ea other PermtbSe
T 1 c,A t:L) Internet: wwtv.li aril-or. vc` r. !' Date Ready/By hide la See Page 2 for
g BUILDING DIVI I. Notified/method; Sappk...naltaformadon
TYPE OF WORK FEE* 5CHEDULE
El New construction 0 Demolition For special irf onnalion use checklist
Description 1 I Total
❑Addition/alteration/replacement 0 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 ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family
Each
(3)bath J 50032
❑Master builder additional ern' ' 25.02
❑Other: Fire sprinkler L. sq.ft) Page 2
JOO SITE INFORMATION AM) LOCATION Site utilities:
Job site address: j" I TY3 7 k/p-eF/1 m / ,,4 Catch basin orals drain 18.76
City/State/ZIP:Tigard OR eql��3 O(7f G Drywall leach line It:trench drain 18.76
) � �� � Footing drain(no.linear ft: ) Page 2
Suite/bidgJapt.no.: 1 Project name: 64,45 1,44, ; y 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.: Baekflow preventer 1 31.27
DESCRIPTION OE WORK Backwater valve 12.51
Clothes washer
t I 25.02
Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,l PROPERTY OWNER - _ .O TENANT Expansion tank 12,51
Name:Westwood Homes LLC Fixture/sewer cep 25.02
Floor drain/floor sink/hub
Address:12700 NW Cornell Road 25.02
Garbage disposal 25.02
City/State/ZIP:Portland OR 97229
Nose bib 25.02
Phone: • l/. - ' Fax:(503)342-2403 Ice maker
` 12.51
El APPLICANT' El CONTACT.PERSON as Interceptor/gree Iran 25.0202
Business name: IIIP r "*mac rcf r Pr .' . Medical gas(value:$ ) Page 2
Contact name: ' 1 Lief. t v a Primer 12.51
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 12.51
E-mail 1411 i SOng�N`ag ►'v� /d I{F�► e5"'t' I c-.60yY __ Urinal 25.02
CONTRACTOR. Water closet 25.02
Business name:HMI Mechanical Water herder 37.52
Water piping/DWV 56,29
Address:5757 SE Willow Lane
Other 25.02
City/State/ZIP:Milwaukee OR 97267 Subtotal
Phone:(503)975-9787 Fax:(503)659-2979 rf Minimum permit fee: $72.50
CCB Lic.: 178122 Plumbing Lic.no.:P6L f I i,, Plan review (25%of permit fee)
Authorized signature: , , ' 1 State surcharge(12%of permit fee)
dyy
_ � /�� TOTAL PERMIT FEL
Print name:D 'ague Date:.. 4�/�_ /_" `j This permit App&5ltafter k has been permit is not obtained within 150 days
/// e.
/ 'Fee methodologyset Tit-Coccepted an Industry
by Tit-County Building Industry Service Hoard.
I:lguikSnglPetmbs1PLMU-PemitApp_doe 10/01/09 440-46t6T00/02/COM/wna)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
C il II
T 1 c n RD Building Permit Review — Residential
0
Building Permit #: M51-2024 -DOG7,
Site Address: 11837 SW Penny Lane
Project Name: Burt's Landing Lot #: 6
ning Review
Pin
posal: New single detached house
Verify address/suite # active in Accela. n River Terra No ❑ Yes, River Terrace Review Addendum
Si Ian Elements: ro ion Control
opies of site plan on 8-1/2"x 11"or 11 x 17"paper ained trees with drip line and tree protection measures
awn to scale(standard architect or engineer scale) otprint of new structure(including decks)and FFE
orth arrow ty locations&easements(required for new and additions)
address,project or subdivision name and lot number id 1k/driveway approach
plicant information(name and phone number) ation of wells/septic systems
t dimensions and building setback dimensions eet tree size,type and location
quare footage of buildings to be demolished et names
Q :xisting structures on site omer elevations(2'contours if more than 4'diffe ntial
t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? s o
impervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es o
❑ Clean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified N Received: ❑Yes No
Water Meter Fixture Unit Worksheet-Addi • ns,Remod and ADUs
Required: 0 Yes,applicant was notified No Received: ❑ Yes lio
DC Exemptio for ADU a lied for: Yes No Received: Ye No
PP ❑
M P blic Faciliti Improvement(PH) Permit:
e uired: Yes,applicant was notified ❑No A lied For: Yes ❑ No,stop intake
and Use Case#: SUB2016-00002 Zoning: R-4.5
e uired Setbacks: Front: 20 Rear: 15Side: 5Side: N/A
q Street Garage: 20
o_scAJ tie h g Hei t: Max. Height: 30 Actual eight:
andscape r : % t Coverage Ma %
Entrance e back no more than 8' from street-facing wall Parallel to stre or offset 45 degrees or less
Windows linim ,- 12%of area of all street-facing facades
Garage Gara 1- door is behind widest street-facing wall 0 Yes No,one of the following is met:
611 Door extends no more than 5' from wall and there is a covered porch - tending beyond garage.
I D r extends no more than 5' from wall and there ' a 12 sq ft. • :ow above garage on 2"floor.
FaGara door width is I 'or less ❑ 50%or 1 s of facade 7 t%or less and includes 7 0 ollowing:
Covered porch 111 Recessed entrance t Wall offset 1'Roof eave Roof offset
Fire shingles I ..p Siding 0 Roof itch 3 Gable,x4,or gambrel roof _ Dormer
_ Accent siding 2 Window trim U Window recess U Window projection ❑ Balcony
IP
A‘ Visual Clearance Urban Foxes try an
en ..ve Lands: ❑ Yes No Type:
57 a nditions met prior to issuance of building permit a
N. es: _ 1
2 Approved By Planning: Date: �./.2y/2/
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
i3 Building\Forms\BldgPermitRvw REs I22419.docx
Building Permit Submittal
Original Submittal Date: 03/I7120)/
Site Plans: #
Building Plans: # 3
Building Permit#: Enter buildin permit# above.
Workflow Routing: I Planning [ngineering Permit Coordinator RBuilding
Workflow Sign-off: 2-Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
R.-Building:u Building: original permit application, site plans,building plans,engineer and
beam calculations and mist details,if applicable,etc.
Notes:
By Permit Technician: Date: 0325-Zl2/
Engineering Review
E S/lope at building pad: �L d
t/,onditions "Met"prior to issuance of building permit
1 asements (encroachments) per engineering conditions of approval and plat
awater Quality/Quantity Facility: ��/
Assess Water Quality Fee in-lieu: 0 Yes LEI/No
Assess Water Quantity Fee in-lieu: ❑ es rJ No
LIDA Facility on lot: Yes ❑ No
'inal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
RAP-proved by Engineering: 14 .4I$F}-2-2 Date: 3- Z S'Z!
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
P mit Coordinator Review
Co•.'lions "Met"prior to issuance of building permit
0 :pproved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
R- ,ision Notice 2: Date Sent to Applicant:
et DC Exemption: ❑ Received oes not a ly
PA SDC Fees Entered: Wash Co Trans Dev Tax:
Tigard Trans SDC: Xes ❑ N/A
Parks SDC: N es 0 N/A
LIDA Yes 0 N/A
OK to Issue Permit
Approved by Permit Coordinator: \ ,(� Date: S/2-1/ 2/
I:\Buil ding\Forms\BldgPermitRvw_RES_122419.dock
Plan# IArZAS /a-
Floors D., Large 1 00( / (,/J -(lE1/4-,I'117-(/
Bed rooms S Small l 1
we 3
LiLAV � q sa
Tub Basement R3 122`I(` )( 2 I z -_
35 1 5'Co2'
Vent 5 1st Floor 1 Z`{if 30
Water Heater I 2nd Floor I Lee i- _ L4 tt 7' ` �� - 29 i rj ?j(� o
1 ' T r
AC \i 3rd Floor V
School i R-3 Total 2g2$ ,b't _ 2 8Qj r Dci 3 ,Z
Garage CaOLP J Z
r;� ,p � o . 33
Total
S c G••% b `LL #for Elec