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Permit Building Permit Application Residential RECEIVED City of Tigard 7 Received b 1 7 /7 ' /�� n itih 7 511, A U G 1 O / Date/By: Permit No.: - O r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review = Phone: 503.718.2439 Fax: 503.598 Y OF TIGARD Other Permit:.WQ,1017 lU OM g TIGARD Inspection Line: 503.639.4175 Date Ready/By: Jw�. ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING El 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 ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ IN I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building 0 Multi-family Number of bedrooms: (h�� ?j ❑Master builder 0 Other: Number of bathrooms: 344it a-- (r t.i c JOB SITE INFORMATION AND LOCATION Total number of floors: +tw (2-) Job site address: /37c(c Lo Abl2vo,IN ii . -:) New dwelling area: /4/-1,19 square feet City/State/ZIP: '-11 ath CA,, 0\1 2Z_'5 Garage/carport area: 7...2 5 square feet Suite/bldg./apt.no.: Project name: Covered porch area: 9 70 square feet Cross street/directions to job site: --6 4U C p,t) -re tz e- Deck area: ' 6 square feet Other structure area: square feet EX P I R E D i/c'J z- = cl Ka o REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:S rl(1.l j E.< 0. N©i /S s-Ct no.: 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. Com r Ini.l.kCi t D o a-(- ScAl eAt Vo--m (rob1)e lout( o A l6 'piles- Valuation: Existing building area: $ �I ��1_ square feet3 C � Q New building area: square feet 0 PROPERTY OWNER 0 TENANT Number of stories: Name: 36tRq k Pa-rQ(,LD t 4 t L so W Type of construction: Address: 1"i 114 S Lo I30 v j,c.to Te pZ Occupancy groups: City/State/ZIP: ��` 17 0a,Gta t)2, q 72,Z 7 Existing: Phone:( ��) "C'7 1Eaait( 1 ) 3 ' j0D New: P0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer Business name: (�t ,,SOIN Lt�vl t6Z' t -r to fee schedule) Structural plan review feee((or deposit): Contact name: Z GtU(4D FLS plan review fee(if applicable): Address: l t(1 f- 6u) Bes-0A0 G w 'Te ty �l ,u2a 6&. 9 72 Total fees due upon application: 1. vv City/State/ZIP: /,� Zlor I Amount received: 7SQ• Phone:( , ) j(P-SZO id, Fax::( ) E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* 1 2 (,w LI �'� C�1� �'+' Commercial and residential prescriptive installation CONTRACTOR D roof-top ounted Photo Voltaic Solar Panel S m. Business name: Submit two sets of roof plan with c ection details and fire departm access,alot tth the 2010 Oregon Address: Solar Installation Spect ode checklist. City/State/ZIP: Permit Fee(i des plan • xv $180.00 administrative fees): Phone:( ) Fax:( ) State rcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signatur • ''' f ,Q.,...„ This permit application expires if a permit is not obtained GI) within 180 days after it has been accepted as complete. Print name: tij� Date: 8-G�_ D i 7 *Fee methodology set by Tri-County Building Industry Service oard. 00 L\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) 750' Cn - AA City of Tigard IIIM COMMUNITY DEVELOPMENT DEPARTMENT I T1cARD Building Permit Review — Residential Building Permit #: N '3Tc,/-o I-7 — 66 3 a-7 Site Address: f s 2--/ c2,0 i,,eA v-p,eJ noc,c_ Project Name: 7�/AM Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: ie 1 0 c j L Verify site address/suite# exists and activ in permit system. ❑ River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached Sit Plan Elements: (l ree(3)copies of site plan . 15:�sting structures on site ye plan must be on 8-1/2"x 11"or 11 x 17"paper 1V.Footprint of new structure(including decks)with finished awn to scale(standard architect or engineer scale) poor elevationsorth arrow tility locations&easements(required for new and additions) 'e address,project or subdivision name and lot number 1►,Sidewalk/driveway approach pplicant information(name and phone number) I ,'cation of wells/septic systems Lot dimensions and building setback dimensions ko 1, 'sting trees to be retained with drip line,and tree IveA Il''uare footage of buildings to be demolished .rotection measures 10 14•t area,building coverage area,percentage of coverage and eet tree size,type and location /impervious area(applicable if R-7,R-12,R-25&R-40) 1Y1 Street names Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? s CI No 4 foot differential) If yes,is a storm water quality facility shown? Yes CI No ❑ Clean Water rvices—Service Provider Letter (lot platted prior to 9/10/1995): Required: Yes,applicant was notified ❑ No Received: ❑ Yes [' No 0Kublic Facilities Improvement (PFI) Permit: 7 Required: ❑ Yes,applicant was notified M No Applied For: ❑ Yes ❑ No,stop intake ItitEand Use Case#: oning: e—21 i 0 FrontRear Side Street Side 4 Garage VJ Regtured Setbacks: cQO l� � g „..2 e,-) k*andscape Requirement: i of Coverage Maximum: IA Building Height: Maximum Height ) Actual Height , ..2.-7- lkisual Clearance Sensitive Lands: I Yes ❑ No Type n S'/Oltza c ban Forestry Plan onditions "Met"prior to issuance of building permit otes: _elaiE Approved By Planning: ---�_ ,jt Date: Revisions (after Bu. ing Submittal only) Reviewer , ate Revision 1: Approved ❑ Not Approved , Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_061417.docx Building Permit Submittal Original Submittal Date: g(/7! /7 Site Plans: # 3 Building Plans: # 3 Building Permit#: O'Enter building permit#above. � Workflow Routing: a-Planning Engineering IQ Permit Coordinator Building Workflow Sign-off: a Sign-off for Planning(include notes from planning review) Route Application Documents: 2-Engineering: (1) copy of permit application, (1) site plan, (1)building plan and original plan review routing form. Building: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: Date: g /7 En veering Review ((�� pe at building pad: at /o E 5 onditions "Met"prior to issuance of building permit Pf/ IPE61411760 Fog .cf /7M 4/4/6 2d-ectAISTRIAcTro d R asements (encroachments) per engineering conditions of approval and platy P°Ssi/3L6 Lh # r QE�I tG�t/ Water Quality/Quantity Facility: Sh4i..l 4 G L AS64464-17. ow PLO r'''UP Assess Water Quality Fee in-lieu: ❑ Yes No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: l2rYes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: Date: g/#9..S7 7 Revisions (after Building Submittal on eviewer 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 7:3Approved,NOT Released: to 4/2`r/ Notes: 72.: g ,(ni..,1(ed-t-u. 'r ii-v-ite_4,a.4.,44 a Revisions (after Building Submittal only) �j ��/� Revision Notice 1: Date Sent to Applicant: p, . /9'" , 1U4 91 5T I ON-- Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: DC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: 95 Yes ❑ N/A Parks SDC: Yes ❑ N/A LIDA elYes ❑ N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: I:\Building\Forms\BIdgPennitRvw_RES_06141'7.docx