Permit Building Permit Application�, - / , -
t
Residential I(lR 01,I ICF I SI Oy1 1
City of Tigard :FP 2 D 2020 p...` ;,'ed la / 2o2v %'! Permit Na.:,�STZOZv 285
• 13125 SW Hall Blvd.,Tigard,OR 97223 . ,, Plan R v:
1. f . Plan Reviewk2�,j n ��/5�
II C Phone: 503.718.2439 Fax: 543.598.1960 1 , i") Other PC1ntit 020 _
y Date/Bv:
TIC.1 R D Inspection Line: 503.639.4175 i f�l{ ( sa, I C)k Date Ready/BY: nisi_ ®See Pape 2 for
Internet: www.tigard-or.gov Notified/Method: ( Supplementallnfornsaon
TYPE OF WORK REQUIRED 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
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
„re._and 2-family dwelling 0 Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms: i
❑Master builder 0 Other: Number of bathrooms: 2) '2,...
JOB SITE INFORMATION AND LOCATION
Total number of floors: '2,
Job site address: L72 (j_JIJ. ( ) New dwelling area: ' "�0 square feet
City/State/ZIP: Gara e/c ort area: square
,/ qi g P feet
d Suite/bldg./apt.no.: J,1 7 Project name3""�f4-ri J Covered porch area: [�� square feet
.04 Cross street/directions to job site: 4� Deck area: V square feet
Other structure area: square feet
een
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 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
DESCRIPTION OF WORK work indicated on this application
Valuation: $
t-7,4e, � G 4 A-16—. Existing building area: square feet
r- New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: 4- (t Type of construction:
Address. 1 CI j Li Occupancy groups:
City/State/ZIP:T i al„ "TZ2.t. u
---{{ Existing:
Phone:t I1 �'7 Fax:( ) New:
5f APPLIC El CONTACT PERSON BUILDING PERMIT FEES*
/ (Please refer le fee eche:Alej
Business name:
Structural plan review fee(or deposit):
Contact name: Q� l
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
-- PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:i), Y-c t.i hi al t ii �.G., e t,A,Lei i / , cc ' '.-
J Commercial and residential prescriptive installation of
CONTRACTOR
y�/+ roof-top mounted Photo Voltaic Solar Panel System.
Business name: 1& Y A.4yiiijjSubmittwosetsroofplanwithconnectiondetails
C 1 and fire department access,along with the 2010 Oregon
Address:'•! ,V �)(,f '4 C : f '-: - i�ei Solar Installation Specialty Code checklist.
City/State/ZIP: �iM� q Permit Fee(includes plan review
_ 1 t�Y -`riy2 .I 11�p� and administrative fees): $180.00
Phone: IIsyp'? tiK
Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: - - ajj
Total fee due upon application: $201.60
Authorized signature: a
This permit application expires if a permit is not obtained
within 180 days after it has been aorepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: 13-1—tteTZT
Service Board.
I:\Building\Pernrits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(l 1/02/COM/WEB)
Mechanical Permit Application / FOR OFFICE; USE ONLY
' , o Cityof Tigard
Received Permit No.:
11„, ■ 13125 SW Hall Blvd.,Tigard,OR 97223 2By:Plan Re
4 20 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/Hy, Other Permit:
Inspection Line: 503.639.4175 . �
T I G A I:1� � JJ �. Date ReadyJBy: � 6a See Page 2 for
Internet: www.ti d-or. ov ' r @ e�i i t..d E
S� 8 ,; Notified/Method: SupplementalInformation
.7 l'ylr. c ! I 11) ,1,
TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
Mechanical permit fees*are based on the value of the work
y:SiNew construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 1
0 Demolition 0 Other mechanical materials,equipment,labor,overhead,and profit. _
Value:$
CATEGORY OF CONSTRUCTION
-
I l-and 2-family dwellingRESIDENTIAL EQUIPMENT!SYSTEMS FEES*
y 0 Commercial/industrial ❑Accessory building
For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
r JOB SITE INFORMATION AND LOCATION ‘1/
Heating/cooling:Job site site address: `1 ® 24 ', � J Air conditioning 46.75
-Z- �'']f � Furnace 100,000 BTU(ducts/vents) l; 46.75
City/State/ZIP:71 I- rz , C 1' • '"' Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: "�-�-..�_ Heat pump I 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic l 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.:
1 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
11► ( l /�� �M y I A • 2 ' fireplace 23.32
Log lighter(gas l 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32 .
Chimney/liner/fue/vent 23.32
• Other: 23.32
T PROPERTY 0 0 TENANT Environmental exhaust and ventilation:
Name: ..d I.l�,s 4 .. /. Range hood/other kitchen
rr�� equipment I 33.39
Address. A ��Rr• �1 �� Clothes dryer exhaust ` 33.39
City/State/Zl': 0111 . Single-ductexhaust(bathmoms,
toilet compartments,utility rooms) + 23.32
Phone:(60) istip-7 Fax:( ) Attic/crawlspace fans 23.32
T. APPLICANT 0 CONTACT PERSON Other: —__ 23.32
Fuel piping:
Business name: --------
$14.15 for first four:$4.03 for each additional
Contact name: A IL_ falgllr�` , Furnace.etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
E-mail: age '
Barbecue
CONTRACTOR I Clothes dryer(gas)
Business name: _ f tA 11LI>lf� all Other:
MECHANICAL PERMIT FEES*
Address: dig, 1 AMR
t, 1t Subtotal
.1 �. 14f . 4 Minimum permit fee($90.00)City/State/ZIP:
Phone: �ry Plan review(25%of permit fee)
✓) (� Fax:( ) State surcharge(12%"of permit fee)
CCB lie.: go � • TOTAL PERMIT FEE
This permit application expires if a permit is not obtained"Nthia 100
....--
days after It has been accepted as complete.
Authorized signature: Aril " Fee methodology set by Tri-County Building Industry Service Board
F��� rr-. .�
iat name: r �.__ Date: '�--Di— I
1:\Buildmg0Permits1MEC_ermitApp_040113.doc 440-4617T(11/02/COM/w&B)
1 'l RECEIVED
� xi /7_, . JUN 2 2 2021
City of Tigard • COMMUNITY DEVELOPMET4T DEPARTMENT
IN Action
OF TIGARD
Request for Permit Action BUILDING DIVISION
> > ,,h f;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: c. Owner ❑ Applicant 0 Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Betaine'R or Individual) -F re-G`-e t2f'4 `t_,
Mailing Address: 1 -'-.\- 'per w q Q'Tl-t- A\-\./�
City/State/Zip: ► 1 -15 C,4. e'1-72-2 4-
Phone No.: (.. )._
1. �-
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (✓):
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#: 6:-, t hi,o NI i:tO --0O-
Site Address or Parcel#: e't`772 G..774 'tA) view i c12,tciNC / 'Ti6r A- '11Z
Project Name: TR L AeTvAC -i elm At(..4
Subdivision Name: Lot#:
EXPLANATION: P l-A 'E G- L._ ok"l-t— p Ft 1 Ciacrl0
r11-41 s �2(=z3" 6 cr,
Signature: - Date: - Z - 2�2 1
Print Name: P �� ti°rl L L
_—
Mond Policy
L The dty's Community Development Director,Budding 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.
I OP ( l 1 It I I -,I t)''d.
Route to tiys Adam: Lame By Route to Records: Date 9 /4 2,e BY KJ dr
Refund Processed: Date'V/1- By Invoice Processed: Date By
Permit Canceled: Date 9//pJ By'e l Parcel Tag Added: Date By
1:\Building\Farms\RegPermitAction_f2O5t oc
. Electrical Permit Application IIIIIIIIIIEZMIEIIIIIIIIIII
- City of Tigard Date/By:
13125 SW Hall Blvd., Received
Tigard,OR 97223 Plan Review
Permit#:
illPhone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: ]urh: la See Page 2 for
1.1(-' \` 1) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
)4
®.New construction ❑Addition/alteration/replacement acemen Addi /alteration/replt Please check all that apply(submit l sets of plans w/tems checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Al-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION,`AND LOCATION 0 Emergency system. larger separately derived
Job site addresst rill .3 Y v Y +N V �i' C.�...� 0 Addition mf oew motor load of system.
Job#: 111 100HP or more. ❑•`A„ ••E",»1_2>•»t_3„
City/State/ZIP: �j 0 Six or more residential units. occupancy.
ty . ❑Recreational vehicle parks.
���/�.. �tli' -i�� 0Health-care facilities.
Suite/bldg./apt.#: 1 Project name: I I (A/ (t^.) / 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 SCHEDULE
Description 1 pt\. I Each 1 Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 3 168.54 4
Tax map/parcel#: Ea.add'!500 sq.ft.or portion % 33.92 1
41\1
DESCRIPTION OF WORK Limited energy,residential
v 1 •
(with above sq.E.) 75.00 2
�_� Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Enercv 0 See Page 2
fi( PROPERTY OWNERI I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: - S'�. WN./L 1-Tr/'1fli� 200 amps or less 100.70 2
Address: tifq !v461,t,r G(1 201 amps to 4�amps 133.56 2
'+ 401 amps to 6�amps — 200.34 Z
City/State , J' �C 2 . 601 amps to 1,000 amps 301.04 2
Phone: ) 1 - 1..�' 7x:( ) Over 1,000 amps or volts 552.26 2
/� Li,....
V _ r ,, ( Temporary services or feeders installation,alteration,and/or
Email:'i of ��L ai 1� �( Mk L., •ly" relocation
Owner installation This instal ati is be g 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
�y Branch circuits-new,alteration,or extension,per panel
'yi APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name: above service or feeder fee,
// � each branch circuit 7.42 2
Contact name: l� PVCD - " ' ,/t 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
i ( CONTRACTOR Pump or irrigation circle 67.84 2
Business nameyt-t-., Gr} b Gi � INCr*...1 "-
_ Sign or outline lighting 67.84 2
p
.)'` i i1"vt�L� f i' pnne circuit(s)or extension.idioergy 0 See Page 2 2
Address: panel,alteration,or
Ci IState/ZIP: �j f�j Each additional inspection over allowable in any of the above
ty - ✓tJ Additional inspection(1 hr min) 66.25/hr
Phone:W�t ) . � 7, Fax:( ) Investigation(1 hr min) 90.00/hr
Email: �'// ' ff�� Industrial plant(1 hr min) 78.18/hr
+ Inspections for which no fee is
CCB Lie.: t''l 12 1 Electrical Lic.: 3 Suprv.Lic.:If X, n[ S specifically listed eh hr min) 90.00/hr
CCAAYY ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
iPrint name: r,iay-n.4 Date: 7— 1 — ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: /�' _t��r TOTAL PERMIT FEE:
j `"``�-"����""""'�''������''�� This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
t * Number of inspections allowed per permit.
I:\Budd®g\Permrta\FLC_PemutApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COMIWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description h. Each Total J *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
• Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
[A Garage
to 100 kva 552.26 2
Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
pf Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n 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 (r6,25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Y2 hr mina
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter
Fee for each commercial system: $75.00 _
y —*�Number of inspections allowed per permit.
Page]):
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
l �
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
(J Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:1Buildmg\Permits\ELC_PermitApp ELR_ERE.doc Rev 0611712015
Plumbing Permit Appliratil>[>i ` 1 .-.
Site•Utilities
City of Tigard S F r� 2 2020 Received
III Permit No.: _
t 13125 SW Hall Blvd.,Tigard,OR 97223 ( ;"' p:' Date/By:
'�'
i (211�. t m Plan Review
Phone. 503.718.2439 Fax 503.598.1960 l ,, � icy Other Permit No.:
Inspection Line: 503.639.4175 ,,e s: a t 1 1
-
I 1( '.is I) Date Ready/By: Jerk 10 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
iiiNew construction ❑Demolition For special information use checklist
Description 1 QtY. J Ea. -1 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
jit 1-and 2-familySFR(2)bath 437.78
dwelling 0 Commercial/industrial SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB Stn. INFORMATION AND LOCATION Site utilities:
Job site address: (/7M< ) Catch basin or area drain 18.76
City/State/ZIP:`'''�''� h Y7 Dt'yweli,leach line,or trench drain 18.76
l r1 C) Footing drain(no.linear ft.:_) Page 2
SuitefbldgJapt.no.: ject name: i VAJ(,,,�,. h o
J Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
'
Sanitary sewer(no.linear ft.:_J Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture ar item:
Tax map/parcel no.: Backflow prevents 31.27
___.-__
DESCRIPTION OF WORK Backwater valve 12.51
tjet CJ)Yi4yu,L*1oyL �- Clothes washer I 25.02
v S•F•1'}- • Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
!i PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:- ry 4--
Fixture/sewer cap 25.02
l
� T-` Floor drain/floor sink/hub 25.02
Address: / 0
e Garbage disposal t 25.02
City/State/Z i an,, • Hose bib 2 25.02
r Phone: ) �j I Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25,02
Medical gas(value:$ ) Page 2
Business name:
--- Primer 12.51
Contact name: n .�"
�{1�-1 1. ,! Roof drain(commercial) 12.51
Address: Sink/basin/lavatory -1 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02 i
Water heater 37.52
Business name: JJ �a11 I Water piping/DWV 56.29
Address: (�y,� f f t 4 Other: 25.02
City/State/ZIP: !�.01_, Je-` � Subtotal
) Fax:( ) Minimum permit fee: $72.50
Phone: 1 e
�} - Plan review (25%of permit fee)
'
CCB Lie.: �-1 J Plumbing Lic.no.:
mow.- Slate surcharge(12%of permit fee)Authorized signature: TOTAL PERMIT FEE
Print ram t�j j"'�j _ Date: T permit application expires if a permit is not obtained within 11i0 days
lase c._rsr after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
IABwilding\Pemits\PLMU-PermitApp.doc 10/01/09 4404616T(10/02/COM/WEB)
City of Tigard
71 .
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A RD Building Permit Review — Residential
e.
---- M ST2°2.0 d Z� 5
Building Permit #: -.
Site Address: �+ g1'.) 1//�
Project Name: 7 r�j l�" Lot #:
Planning Review -- 'Prop al: �i ; r''
Verify address/suite# active in Accela. J River Terrace: No ❑ Yes,River Terrace Review Addendum
Sit7Plan Elements: • Control
3 ..pies of site plan on 8-1/2"x 11"or 11 x 17"paper tained trees with drip line and tree protection measures
►. D • to scale(standard architect or engineer scale) ..tprint of new structure(including decks)and FFE
Wirth arrow t! ;'tr locations&easemefits(required for new and additions)
1Q5 address,project or subdivision name and lot number ti Sidewalk/driveway approach
4 plicant information(name and phone number) 4 t;cation of wells/septic systems
t Lot dimensions and building setback dimensions ®`. et tree size,type and location
Iiii!t►`t*tare footage of buildings to be demolished .A treet names
• ring structures on site '• `other elevations(2'contours if more than 4'diffe tial)
I TO.t area,building coverage area,percentage of coverage and 1�,000 sf of impervious area created or replaced? In'IYes ❑I e
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown?` Yes No
0?6ean Water Services—Service Provider Lett 91(lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified ict No Received: ❑ Yes 0 No
rater Meter ture Unit Worksheet—Addit$ns,Remodels and ADUs
Required: Yes,applicant was notified No / Received: 0 Yes L? No
11, :DC Exemption for ADU applied for. 0 Yes l2f N' o Received: 0 Yes 0 No
V Public Facil{tip mprovement(PFT)Permit
aired: Yes,applicant was notified ❑ No A!.lied For: Yes 0 No,stop intake
1el Use Case#: -SO80/ / COr' -t nba ��0I Zoning. -c
equired Setbacks: Fronti1 'a' Rear: IS— Side: � Street Side: Garage: ()
IQ Building Height: Max.Height 5 Actual Height e 2c., S^'
h`1)t. andscape a: % .ot Coverage
Entrance Ql t back no more than 8'from street-faring wall X'arallel to street or offset 45 degrees or less
Windows um 12%of area of all street-facing facades
Garage D[I Garage door is behind widest street-facing wall Yes 0 No,one of the following is met:
Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from w and there is a 12 sq ft.window above garage on 2.d floor.
Garage door width is 0 12'or less 50%or less of facade 0 60%or less and includes 7 of following.
O Covered porch 0 Recessed entrance 0 Wall offset 0 1'Roof eave 0 Roof offset
O Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof 0 Dormer
O Accent siding 0 Window trim 0 Window recess 0 Window projection 0 Balcony
\CVisual Clearance 0 Urban Forestry Flan
Sensitive Lands: 0 Yes No Type: __
❑ Condition- et prior to 'ssuance of b t ding permit Pt h
Notes: -d 'i, •g _4�1 r p n irroj Ut
ec't Per
[-1X Approved By Planning: C-6191' Date: Sept. 2nd, 2020 t0/24)0
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
1:\Building Worms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: 029/202O
Site Plans: # c.3
Building Plans: # 3
Building Permit#: [ "Enter building permit#above.
Workflow Routing. Q1Pianning J-Engineering [ Permit Coordinator riZ--Building
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.
CBuilding. original permit application,site plans,building plans,engineer and
beam calculations an st details,if applicable,etc.
Notes:
By Permit Technician: Date: /OA,,OZU
Engineering Review
lope at building pad: 47 `-1-,) $ ativAT- 1
1:2 �u `{ ;
�'Conditions"Met"prior to issuance of building permit c d,t tors S at
Imo' Casements (encroachments)per engineering conditions of approval and platl 4�
'` '� f
la-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [ No
Assess Water Quantity Fee in-lief}: ❑ Yes � o
LIDA Facility on lot: 1 ) L► 11 a Yes ❑ No
®'Final Plat Recorded: I
7 NOT Approved by Engineering: 14,E•v s} L. Date: LDivo J ,�
Notes: rry t*)r LI pA► 51z4-21 a •ic t N. r AR—.
co IAA❑ Approved by Engineering: Date:
Revisions(after Building Submittal only) Reviewer Date
Revision 1: El Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Permit Coordinator Review
Conditions"Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes: (AM 01 Epp A tD`zip 20
Revisions(after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant e _
-L5 SDC Exemption: ❑ Received ,r2;Does not apply
.SDC Fees Entered: Wash Co Trans Dev Tax: . Yes 0 N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: _ Date:
I:\Building\Forms\BldgPennitRvw_RES_122419.docx