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Permit
CITY OF TIGARD MASTER PERMIT 11111 s. COMMUNITY DEVELOPMENT Permit#: MST2021-00116 Date Issued: 06/16/2021 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135CC05700 Jurisdiction: Tigard Site address: 11803 SW PENNY LN Subdivision: BURT'S LANDING Lot: 9 Project: Burt's Landing, Lot 9 Project Description: New detached dwelling BUILDING Floor Areas Required Setbacks Required Stones: 2 Bedrooms: 4 First: 1170 sf Basement 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 3 Second: 1611 sf Garage: 526 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2781 sf Value: $365,967.06 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: 1 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 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 2781 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: $39,841.59 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: F(O VcavtiDe4Wee Permittee Signature: 0 Ili Appluat'Lo-vl 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. Now Building Permit Application + 2.1 g Residential RECEIVED FOR OFFICE USE ONLY City of Tigard Received D?/�� ��� �fj �S�r'^�/DO//� Date/By: 7 Permit No.: Jew 13125 SW Hall Blvd.,Tigard,OR 97223 NAR O 8 ND Plan Review p' = Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 7 / OtherPennitsSW/ 021 00077 Inspection Line: 503.639.4175Date Ready/By: Juris: TIGARD p CITY OFTIGARD Y Y� � ® SeePage2for Internet: www.tigard-or.gov tified/Method: / Supplemental Information BUILDING DIVISION TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. O‘42 ® 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ �5� (07 0 Accessory building ❑Multi-family Number of bedrooms: 0 Master builder 0 Other: Number of bathrooms:_- 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2._ . 3 3 0 7 Job site address: // '1S P n �k,� New dwelling area: 27�/ square feet i co ( City/State/ZIP: �j 4 Y Q�1 0 A- 073 Garage/carport area:5'24 square feet I I 0 Suite/bldg./apt.no.: Project name: g(/J' (�rtf/ 1 Covered porch area:,? square feet Cross street/directions to job site: // Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.:I Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. New SFR Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER 0 TENANT Number of stories: Name:Same as applicant Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name:Westwood Homes LLC (Please refer to fee schedule) Structural plan review fee(or deposit): ;; ;�.3¢ Contact name::A 1 IA-s m. ryt fA41 J FLS plan review fee(if applicable): Address: 12700 NW Cornell Rd Total fees due upon application: City/State/ZIP:Portland,OR,97229 Phone:50- — lI3-0ZGlt Fax: :( ) Amount received: E-mail: 41 U soie�i�/,IJJ,Sl'{'f Qv�f orr,S j . . �'OrrPHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR _ roof-top mounted Photo Voltaic Solar Panel System. Business name: wes-hN/b-o4 Hays L_LG Submit two(2)sets of roof plan with connection details 'V/ and fire department access,along with the 2010 Oregon Address: 127 0 0 IV Y e0 rite I ( ed Solar Installation Specialty Code checklist. City/State/ZIP: Po rf( 0( © 2 17 22_ I Permit Fee(includes plan review and administrative fees): $180.00 Phone:503) 71-j—42 2 Gr q Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: 195597 Total fee due upon application: $201.60 Authorized signature: `te.„(L6 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. /r/ *Fee methodology set by Tri-County Building Industry Print name: t Date:3 Service Board. I:\Building\Pern its\BUP-RESPermitApp. 02/24/201 I 440-4613T(11/02/COM/W EB) Mechanical Permit Applicat CE�VE Reserved FOR OFFICE ISE O\I.1 City of Tigard Daffy Permit No.: ,(4 s72d2_/-GV l/6 :14 13125 SW Hall Blvd.,Tigard,OR 97223 LIAR 0 8 O7 Plan Review • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: T i i,[) Inspection Line: 503.639.4175 CITY OF TIGAHEi Date Ready/By: Jug: 6/See Page 2 for Internet: www.tigard-or.gov Notified/Method. Supplemental Information BUILDING DIVISION, TYPE OF W ., t; COMMERCIAL FEE* SC1IEDf.JLE-USE Ch ECKLLST Mechanical permit fees°are based on the value of the work ❑X New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all El Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit Value:$ CATEGORY OF CONSTRUCTION Ci'ION - RES OENTt Et)) 'lti iEN`1"/SYSTEMS FEES* ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist 0 Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total JOB SITE LRPOR MATION AND LOCATION Heating/cooling: Air conditioning I 46.75 Job site address: // b _co) pen r)y L Furnace 100,000 BTU(ducts/vents) ' 46.75 , City/State/ZIP: ' rjl,`"(' D�2- 14 fn. ,ZZ 3 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: 6(/Y¢-s 1 Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: i 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 HVAC for new construction home fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 `Wood fireplace/insert 23.32 Chinmey/liner/flue/vent 23.32 Other: 23.32 r 0 TENANT Environmental exhaust and ventilation: Name: WI S 1 w 0 od /-1-on/ e j /`(. Range hood/other kitchen �� equipment 33.39 Address:`1700 /A/VV/ CeY14/1/ ,e �"' Clothes dryer exhaust I. 33.39 City/State/ZIP:po I �1�Z G./ r� " �1 Single-duct exhaust(ballrooms,' / toilet compartments,utility rooms) 23.32 Phone. ) 7/3 �2)==:7 Fax:( ) Attic/crawlspace fans 23.32 ' "` 0`:" Other 23.32 0 APPLICANT s f � Business name:tio.QGj-T'fi j0oC tome S //G Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: /4-l (, 6-0` ) rn.et,t, Furnace,etc Address: ` 2—-7 Q U &KJ Ci Yj/i'// Gas heat pump WaWsuspended/unit heater City/State/ZIP: O/ /1 1 o kid j / �f 7 Z Z 7 Water heater Phone:r ( 5-7/3 -&Z 4(a Fax::( ) Fireplace Range E-mail:Al U 6-100 4~/�was--him ad h oma-//c.Cci h't,_ Barbecue CONTRACTOR Clothes dryer(gas) — Other: Business name: Lakeside Heating& Cooling MECHANICAL FEES* 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 fce) CCB lie.: 227694 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 * Fee methodology set by Tri-County Building Industry Service Board Print name: Jason Charlton Date: 3 ?/?t)2y 1'Uluilding\Permits\MEC PennitApp 040113.doc 440-4617T(11!lI/02/COM/WEB) Electrical Permit ApplicationR l.Olz OFFICE1 SF:ONLY ' •������� Received / City of Tigard Date/B : Permit#:Ms p o2/".40//to ill a 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 0 8 2071 Plan Review ■ Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: T 1 G A R D Inspection Line: 503.639.4175 CITY OF rIGA �: Ready Date/By: Ju 66 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WOILDINIG DIVISIOI PLAN REVIEW ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more ❑Building over three stories. DDemolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: l J 103 CJ W rer n ii1 I�, ❑Addition um of new motor load of system. J ((���' 100HP or more. ❑"A","E","1-2","]-3", City/State/ZIP: /; y/j� o �] 2 ❑Six or more residential units. occupancy. 9€2../ v'/ yr q / 2'7 3 ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: f' 4di 0 Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: C, Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'1 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential New SFR (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 ® PROPERTY OWNER ❑ 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 ® APPLICANT 0 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, each branch circuit 7.42 2 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 dwelling,service and/or feeder 67.84 2 Email: 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 Signal circuit(s)or limited-energy Address:2870 SE 75th Ave#203 panel,alteration,or extension. 0 See Page 2 2 Each additional inspection over allowable in any of the above City/State/ZIP:Hillsboro,OR 97123 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 min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 157891 Electrical Lic.: 34-436C Suprv. Lic.: 42325 specifically listed(A hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Stephen Ross Date: ❑Plan Review Required(25%of permit fee): /.+ State surcharge(12%of permit fee): ,."-i4 - TOTAL PERMIT FEE: Authorized signature: > "' / This permit application expires if a permit is not obtained within 180 Print name: / / Date.'✓/ M/ I days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Plumbing_Permit Application Building Fixtures RECEIVED 1 0„ OFI R is I SF; o11_, City of Tigard , Received 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 0 8 202: a ° Permit xo.:/firs dZ(6D/1/� ' Plan Review = Phone: 503.718.2439 Fax: 503.598.1960 a, Other Permit No.: �_l�, 1,e) Inspection Line: 503.639.4175 CITY OF TIGARG aate Iur1r H See Page 2 for Internet: www.tigard-or.gov a 8 SappheWalInformation TYPE OF WORK' FEE* SCHEDULE ®New construction ■ Demolition For special i i ormation use checklist Description I Qty. ] Ea. I Total ❑Addition/alteration/replacement ■ New 1-2-family dwellia_. (includes 100 it for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 0 1-and 2-family dwelling ■Commercial/industrial SFR(2)bath 437.78 Accessory building ■ SFR(3)bath l 50032 ❑Master builder ■ Each additional bath/kitchen 25.02 Fire sprinkler(.-__sq.ft.) Page 2 JOB SITE INFORMATION AM) LOCATION Site nullities: Job site address: ;1 i k,��%, ,2,1 10 Catch basin or area drain 18.76 City/State/ZIP:Tigard OR '72, -3 Drywel),leach line,or trench drain 18.76 gap /1vr �/12I Footing dur (no linear ft.ie ) Page 2 Strite/bid J t.no.: Project name: I 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 It.: ) Page 2 Subdivision: Lot no.: Fixture or ftem: Tax map/parcel no.: 1 25.02 Dishwasher I 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ME of • ■ Expansion tank 12.51 Name:Westwood Homes LLC Fixture/sewer tap 25.02 Floor drain/floor sink/hub 25.02 Address: 12700 NW Cornell Road Garbage disposal r 25.02 City/Stale/ZIP:Portland 1 • 97229 Nose bib 1 25.02 Phone: Fax:(503)342-2403 Ice maker 12.51 0 ■ CONTACT PERSONInterceptor/grease trap 25.02 Business name: Medical gas(value:S ) Page 2 Contact name: Primer 12.51 Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 Ci Solar units(potable water) 62.54 Tub/shower/shower pan 3 12.51 Urinal 25.02 IIIIIIIIIIIIIIIIPfmne: Water closet 3 25.02 Water heater f 37.52 Business name:14&11 Mechanical Water piping/DWV 56.29 Address:5757 SE Willow Lane Other 25.02 City/State/ZIP:Milwaukie OR 97267 Subtotal Phone:(503)975-9787 Fax:(503)659-2979 Minimum permit fee: 572.50 CCB Lie.: 178122 V--- Plumbing Lie.no.:65L71'if Plan review (25%of permit fee) ME State surcharge(12%of permit fee) Authorized signature: ' -i2 ! ��� TOTAL PERMIT FEE Print name:Dus ' 'ague Date:13/83)/2 / 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. t nBuadingWe mils1PI.MU-PmniiApp.dot 10/01/09 440-4616r(boo2/COM/WEB) City of Tigard IIICOMMUNITY DEVELOPMENT DEPARTMENT T1cARD Building Permit Review — Residential 0 Building Permit #: MSr201,l-001/(. Site Address: 11803 SW Penny Lane Project Name: Burt's Landing Lot #: 9 Planning Review Pr Pr New single detached house Verify address/suite #active in Accela. n River Terr : No ❑ Yes, River Terrace Review Addendum S4.9431an Elements: r ion Control 143 opies of site plan on 8-1/2"x 11"or 11 x 17"paper aired trees with drip line and tree protection measures rawn to scale(standard architect or engineer scale) otprint of new structure(including decks)and FFE rth arrow ty locations&easements(required for new and additions) e address,project or subdivision name and lot number id alk/driveway approach plicant information(name and phone number) anon of wells/septic systems iot dimensions and building setback dimensions et tree size,type and location square footage of buildings to be demolished eet names ..„1xisting structures on site orner elevations(2'contours if more than 4'diffe ntial l,ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? 7' s o impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? M es o Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑Yes,applicant was notified ❑No Received: ❑Yes ❑No ❑ Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: ❑Yes,applicant was notified No Received: ❑Yes No ❑ DC Exem do for ADU applied for: IJ Yes ❑ No Received: 1::]Yes LI No p P blic Faciliti s Improvement(PFI) Permit: equired: Yes,applicant was notified ❑No plied For: Yes ❑No,stop intake and Use Case#: SUB2016-00002 Zoning: R-4.5 e uired Setbacks: Front: 20 Rear: 15 Side: 5 Street Side: 15 Garage: 20 q 'ding Height: Max. Height: 30 Actual Height: ��J' andscape ' r;.: % AKA Coverage Max• 0,0 Entrance % .et back no more than 8'from street-facing wall Par el to street or offset 45 degrees or less Windows 7 ,i' ' urn 12%of area of all street-facing facades Garage 7 Garat- door is behind widest street-facing wall Yes ❑ No,one of the following is met: I Door extends no more than 5'from wall a I d there is a covered porch extending beyond garage. I Door extends no more than 5'from w and there is a 12 sq ft.window above garage on 2nd floor. J Gara a door width is 1_, 12'or less 7 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 itch ❑ Gable,hi ,or gambrel roof Dormer Accent sidingWindow trim U Window recess U Window projection ❑Balcony i 0ual Clearance IJ Urban Fores an Ev, sitive Lands: El Yes 1J No Type: 3 Co Lions met prior to issuance of building permit No s: Approved By Planning: INN-- Date: g .gi Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPennitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: d /V 8/202./ Site Plans: # 3 Building Plans: # 3 Building Permit#: [ Enter building2errmit# above. �_ Workflow Routing: (❑'Planning I'F,ngineering U P ermit Coordinator ErBuilding Workflow Sign-off: 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. Er-Building: original permit application, site plans,building plans,engineer and beam calculations and st details,if applicable,etc. Notes: By Permit Technician: Date: 193/0 41.92/ Engineering Review n�lope at building pad: ��b l onditions "Met"prior to issuance of building permit a--Easements (encroachments) per engineering conditions of approval and plat Iater Quality/Quantity Facility: �—�� Assess Water Quality Fee in-lieu: ClU Yes No Assess Water Quantity Fee in-lieu: ❑ Yes JNo LIDA Facility on lot: Yes ❑ No ❑Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: proved by Engineering: K ,F t 5vk Date: 3- S I -Zan, Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved P rmit Coordinator Review Conditions "Met"prior to issuance of building permit P. Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: 6,,,DC Exemption: ❑ Received oes not a ly 11 SDC Fees Entered: Wash Co Trans Dev Tax: es U N/A Tigard Trans SDC: rs ❑ N/A Parks SDC: rzYes ❑ N/A LIDA V Yes ❑NIA _ OK to Issue Permit Approved by Permit Coordinator: --Date: Aii/.2_ I:\Building\Forms\BldgPermitRvw RES_122419.docx