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Permit v 0 I D RECEIVED ,/2,- -did JUN 2 `2 2021 1,1City of Tigard • COMMUNITY DEVELO MINT DEPARTMENT .� GI TIGARD Request for Permit Action BUILDINGTY 0� DIVISION l , ^ 1:n 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www,tigard-or,g►ov t _ TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR. 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigatriBuildingPertnits@tigard-or.gov FROM: Ei. Owner ❑ Applicant ❑ Contractor ❑ City Staff Cheek(✓)one REFUND OR Name: INVOICE TO: (B"iOesa c to dindual) 6&-..G7° V t2 ,—L Mailing Address: l -' �..Z. = J mil. A\-'4l� City/State/Zip: ► 1 F I5 e,1-7`2-2.4- Phone No.: (....."- _,..) !v- t � 0-7- PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 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#: LA.,.-mot t�l io •— 1. S 7,o 2r -cto,2,k40 Site Address or Parcel#: Gl`772 4 G 774 v) V it✓'W ctcz,R/AcC f -rter-pcx,A l.ZZ Project Name: `i'1240,w SAC.(-f G-� Al)CA Subdivision Name: Lot#: EXPLANATION: P �/� 4C c L A—r, r41P Pt 1 C 1 on Fro Tn--1 is \•- 2aT5 cr, 0. Signature: Date: 6, - 2 Z - Z-Q Z I Print Name: P -s7 1�- fsi 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 34 weeks for processing refund requests. 1 tilt O1 l It! l >E t a" 1; haute m hys r`idmui: Date By Route to Records: Date ''� ,#J Refund Processed: Date^/ eg By ./ei Invoice Processed: Date By Permit Canceled: Date /1/ By ✓ i Parcel Tag Added: Date By l:\Bui1ding\Pomp ttegPeenitAction_ 5t8.doc Building Permit Application —6\ *m� Residential FOR OFFICE USE ONLY City of Tigard SEE 2 9 2020 Received loll b ZOZO -%7 Permit No.;MSt OO2 p 13125 SW Hall Blvd.,Tigard Plan Review OR 97223 . -g- •• - C Phone: 503.718.2439 Fax: 503;398.190 F 1 M i.) Date/B.:.: Other Permits ���—��57 T I G AR.D Inspection Line: 503.639.4175 l 1J I N 3 DIVISION hate Ready/Ry: 7 i� la See Page 2 for Internet: www.tigard-or.gov Notified/Method; _y Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING IFNew 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: $ i; I-and 2-family dwelling ElCommercial/industrial ❑Accessory building 0 Multi-family Number of bedrooms: El builder ❑Other: Number of bathrooms: ' JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: •,` ie ' i �� �/ , New dwelling area: t Ot V square feet City/State/ZIP: i A- r J Strjal Garage/carport area: square feet Suite/bldg./apt.no.: s Project name: )/I I J _ — Covered porch area: ` 0 square feet —` Cross street/directions to job site: lt�� �-�' Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot 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. �j� ,•, ,— ., a r Valuation: $ ►tom.' NA Sari atsnr►VP )!!Man .. Existing building area: square feet New building area: square feet ►•, PROPERTY OWNER 0 TENANT Number of stories: Name �l .All Or. + Type of construction: Address. i yl t # MEN r Occupancy groups: City/State/ZIP: Ai Ail, AllillnIER Existing: Phone: iI ) jL *Ar New: r! APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: � . ` A, Structural plan review fee(or deposit): Contact name: aft. L I► FLS plan review fee(if applicable): Address: �.._ Total fees due upon application: City/State/ZIP: Phone:( ) Amount received: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: +. r • J r, t'I �' � Commercial and residential prescriptive installation of C s ' ' CTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: 1� � l Submit two(2)sets of roof plan with connection details --- '`' ��� and fire department access,along with the 2010 Oregon Address: Solar Installation Specials-Code checklist. �� t Permit Fee(includes plan review City/State/ZIP: at ,diair VA I ' D I and administrative fees): $180.00 Phone:( do) r ( M ___ Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: ` r al, �� Thls permit application expires if a permit is not obtained _ within 180 days after it has been accepted as complete. Print name: ��� ^ Date: ins yip, *Fee methodology set by Tri-County Building Industry .e . �i.��i`%11 E� Service Board. I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) , Mechanical Permit Applicatwd--" '' -- City of Tigard ,'( iJ D"" 2 2 2020 Recatceived ,By: Permit No.: III f 0 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �' Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: Inspection Line: 503.639.4175 -. r ��^`i t Date By. l l i�^,R D p f u t$ i , l' i 4 k o l C�i,, Date Ready/By: furs. ® See Page 2 for Internet: www.tigard-or.gov' -- Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST New constructionMechanical permit fees*are based on the value of the work 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* Xf1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist ❑Multi-family ❑Master builder 0 Other: Description 1—Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: .�( Air conditioning 146.75 Job site address: i Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZTP:—("!A C • -11; Furnace 100,000+BTU(ducts/vents) 54.91 I 1 l f ; � Heat pump 61.06 Suite/bldg./apt,no.: Project name: t i M Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit beaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 ---- ----- Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 __K (�' �yy� "� Flue vent for water heater or gas Y —i d1I._112 Ii, 1 ,'+f . ' • 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: PROPERTY OWNER 0 TENANT - 23.32 - Environmental exhaust and ventilation: Name: r /' mm Range hood/other kitchen equipment Address: S\ nv,vv 33.39 �t , - Clothes dryer exhaust 1 33.39 City/State'ZIP:j`' 4 al • O1" 'Z Single-duct exhaust(bathrooms, ry 1 VE" ` toilet compartments,utility rooms) L. 23.32 Phone: ) 5 . g Fax:( ) Attic/crawlspace fans 23.32 g APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: S14.15 for first four3$4.03 for each additional Contact name: �i, S L.-. Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace E-mail: Range V Barbecue CONTRACTOR Clothes dryer(gas) Other: Business name: Y MECHANICAL PERMIT FEES* Address: -- Subtotal City/State/ZIP: r- Minimum permit fee($90.00) rf • Platt review(25%of permit fee) Phone: ) -'�'�• 3�1 Fax:( ) State surcharge(12%of permit fee) CCB lie.: .2.1). j,3 - 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: A '^- • Fee methodology set by Tri-County Building Industry Service Board Print name: J� f , � Date: itl y- 1 I:Buildiug\Pcsm \M itsEC_term"MitApp_040113.doe ,l�' 440-4617T(11/02/COMIWEB) Electrical Permit Application City of Tigard ReceivedDatelBy: Permit#: IN 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 3 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: runs: IN See Page 2 for 1 i 6 'RI) Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW I ®,New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 1 j❑Demolition ❑Other: 0 Service OT where the availableer currenamps OT t 0 Building over threey stories. ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. Al-and 2-family dwelling ❑Commerciallindustrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or ,,... . JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived f I Job q ', 9,2-. Job site address 4l� , V V ' f Y Si„ t t..� , 0 Addition moew motor load of system. I OOHP or more. ❑"A"...E,,,"I 2>,"1-3" ❑Six or more residential units. occupancy. City/State/ZIP: 1 i CuRecreational vehicle s. 1 t1 t �� '1 � ❑Health-care facilities. ❑ P Suite/bldg./apt.#: 1 Project name: tr/,-!1� D Hazardous locations. 0 Supply voltage for more than [U.. ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE I Description I Q . I Each I Total I • New residential single-or multi-family dwelling unit Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less a ) 168.54 4 Tax map/parcel#: Ea.add'1500 sq.ft.or portion 1 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 UN c j.�„ S (with above sq.ft.) �l r u "V' �' • (L Limited energy,multi-family 75.00 2 ......_. residential(with above sq.ft.) PROPERTY OWNER j © T Renewable Energy ❑ See Page 2 /� Services or feeders installation,alteration,and/or relocation Name: 4.. ! 1 v-.A, L.. 200 amps or less 100.70 2 Address: sU Y 1,ff A 1,c'�/'r/ 201 amps to 400 amps 133.56 2 t `� �Y ) Ltj t�7 - t 401 amps to 600 amps 200.34 2 City/Stae IP✓1�it t�l [—�i 601 to 1,000 L ''J 1 amps amps 301.04 2 Phone:O"` 1) Gy 1 — V 1 Fax:( ) Over 1,000 amps or volts 552.26 2 l 4,.... f • Temporary services or feeders installation,alteration,and/orEmail: ll-4i [S aI►V relocation Owner nstallation +This' insati 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 Branch circuits—new,alteration,or extension,per panel APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 j n l ( each branch circuit Contact name: I p '}"fit-. 40-y B.Fee for branch circuits without J a K/' i 'JJ 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: } Sign or outline lighting 67.84 2 �-P�' C �. ��� fJ j 1' Signal circuit(s)or limited-energy Address: • panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Saiet& I i t', . 36 r/j Each additional inspection over allowable in any of the above ! Investigation Additional inspection(1 hr min) 66.25/hr Phone ) 4G Fax:( ) (1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr +� _ Sist Inspections for which no fee is CCB Lie.: 1`11 ' Electrical Lie.: ij „) Suprv.Lie.:)J Sspecifically listed eh lu min) 90,00/hr /1✓ ELECTRICAL PERMIT FEES Suprv.Electrician signature,-,required:e Subtotal: IPrint name: ,i� i„\—7tr i-•i 4 Date: 7--e, -2 7 D Plan Review Required(25%of permit fee): LOLL t`tt��r !! �i State surcharge(12%of permit fee): Authorized signature:• i�'+ TOTAL PERMIT FEE: L/�' This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. t:lnuildagWermits\Ftf_PemtitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(]1Po5/COM/WEB Electrical Permit Application—City of Tigard Page 2-Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE combined: $75.00 Description won Q . Each ( Total I Fee for all residential systems Renewable electrical energy systems:'' Check Type of Work Involved: 5 kva or less W` 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: ❑ Burglar Alarm 25.01 to 50 kva I 301.04 2 50.01 to 100 kva 552.26 2 Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 pi Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: l ❑ Other: Each additional inspection is 66.25/hr 1 chanted at an hourly(1 hr min) Inspections for which no fee is specifically listed CAhr min) 90.00/hr ELECTRICAL PERMIT FEES COMMERCIAL WORK ONLY: subtotal(Enter on Page 1): Fee for each commercial system: $75.00 �+ Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems n Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ — �__ Other: Total number of commercial systems: 1 __ *No licenses are required. Licenses are required for all other installations 1:1Building\Permits\ELC_Per milApp_ELR_ERE.doc Rev 06/17/2015 a Plumbing Permit Application ..^ti i\I .D Site Utilities IIIIIIIIIIIMZMIIIZMIIIIIII c,EP 2 3 2020 Cityof Tigard Received INIll , Date/By: Permit No. ll 13125 SW Hall Blvd.,Tigard,OR 97223 r!(3AR D plan Review ■ Phone: 503.718.2439 Fax: 503.598.1960 . • Other Permit No.: DateBy: Inspection Line: 503.639.4175 '- S y 1ti 0 ..)e' Ready/By: .ions 1 ®See Page 2 for IIGARDDate Internet: www.tigard-or.gov NotifiediMerhod: 1 Supplemental Information TYPE OF WORK FEE* SCHEDULE XNew construction ❑Demolition ! For special information use checklist Description 1 Qty. I Ea. I Total ❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(l)bath 1 312.70 1-and 2-family dwelling �- ❑Commercial/industrial _ SFR(2)bath 437.78 El Accessory buildingSFR(3)bath 500.32 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other. i'ire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: Catch basin or area drain 18.76 Dtywell,leach line,or trench drain 18.76 City/State/ZIP: ,/fir' "- ' y 1''�`2).A Ty- Footing drain(no.linear ft.: } Page 2 Suite/bldg./apt.no.: Project name: 1Y141 LA.__ 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: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 � r. Clothes washer 1 25.02 �j' � Dishwasher i 25.02 Drinking fountain 25.02 ~ Ejectors/sump 25.02 PROPERTY OWNER 0 TENANT Expansion tank 12.51 r�; � :$ _ 1 Floor drain floor sinklhub 25.Garbage disposal ' 25.02 CitylState/ZIP:"'i`�' .� �J_ IC ` Hose bib 25.02 Phone:66) rt. <' i//"'{'✓ttt�"� Fax:( ) Ice maker 12.51 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 5J 171 _ Primer 12.51 Contact name: 1'11r'{`+T_( Roof drain(commercial) 12.51 Address: Sink/basin/lavatory IX. 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan , 12.51 E-mail: Urinal 25.02 Water closet 1 25.02 CONTRACTOR Water heater i 37.52 Business name: Water piping/DWV 56.29 Address: tip idi VI Y Other: 25.02 City/State/ZIP: -"i tr 4 4'1J) Subtotal Phone: La/'- ` Minimum permit fee: $72.50 ' '] i t Fax:( ) CCB Lic.: l n ������ Plumbing Lie.no.: Plan review (2S%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print nam : Date � acceptedafter it has been as complete. t�1 *Fee methodology set by Tri-County Building industry Service Board. 1.\Buildi°g1Pcmits\PLMU-PcrmitApp.duc 10/01/09 440.4616T(10/02/COM/WFB) City of Tigard III s gli COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R D Building Permit Review — Residential Building Permit #: Alifilliftgigor ,-- & - MST-2. )20— 001 (P Site Address: ()3„ 1n + 999,2 g1c) Vlett) c2,0e__ Project Name: -.oiif Lot #: Planning Review Pro sal: 101 nrs w.t — t •6 Otilni Q'Verify address/suite# active in Accela. IA ver Terrace: No ❑ Yes,River Terrace Review Addendum Siy•Plan Elements: fit=. Control 44 3 ..pies of site plan on 8-1/2"x 11"or 11 x 17"paper 1t;tamed trees with drip line and tree protection measures I. 6 to scale(standard architect or engineer scale) ,1`r, •.tprint of new structure(including decks)and FFE n.Vkcrth arrow I! •'tv locations&easements(required for new and additions) IZ' address,project or subdivision name and lot number &&Sidewalk/d.riveway approach .plicant information(name and phone number) ,t, !;cation of wells/septic systems it Lot dimensions and building setback dimensions Xl". et tree size,type and location 111 are footage of buildings to be demolished :s treet names 1 • Ling structures on site ffyn Corner elevations(2'contours if more than 4'ctietial) k 'Irk t area,building coverage area,percentage of coverage and ,000 sf of impervious area created or replaced? Yes ❑I impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown?ljtrYes VNo tear Water Services—Service Provider Lett (lot platted prior to 9/10/1995): Required: 0 Yes,applicant was notified iNo Received: ❑ Yes El No water Met xture Unit Worksheet—Additydns,Remodels and ADUs l Required: • Yes,applicant was notified No Received: ❑ Yes No i1 °.:DC Exemption for ADU applied for Cl Yes l�No Received: ❑ Yes ❑ No r Public Facilitiifmprovement(PFI)Permit (�tined: V Yes,applicant was notified ❑ No A.'lied For. Yes 0 No,stop intake 5,,eq d Use Case#: S��i1 0l y'� �j V ;•,0,4 Zoning: -� !rJ equired Setbacks: Front �e7 Rear: ide: S Street Side: &)/7 F Garage: %.9----e IG Building Height Max.Height r� Actual Height e2cv S' Ma ndscape % t" {of Coverage Entrance back no more than 8'from street-facing wall 'El Parallel to street or offset 45 degrees or less Windows niimum 12%of area of all street-facing facades Garage 60 Garage door is behind widest street-facing wall Yes ❑ No,one of the following is met: Door extends no more than 5'from wall and there is a covered porch extending beyond garage. O Door extends no more than 5'from w and there is a 12 sq ft.window above garage on 2°4 floor. Garage door width is 0 12'or less 506/0 or less of facade 0 60%or less and includes 7 of following: ❑ Covered porch 0 Recessed entrance ❑ Wall offset 0 1'Roof eave ❑ Roof offset ❑ Fire shingles Cl Lap Siding 0 Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer O Accent siding ❑ Window trim ❑ Window recess ❑ Window projection 0 Balcony \usual Clearance 0 Urban Forestr ylan Oft ensitive Lands: ❑ Yes V No Type: ❑ Condition et prior to}' suance o£b 'iding permit Prior to iermit issuance, applicant needs to complete a PFI to switch Notes: vy..pe _'.Dad• �trl g� r„ roc 49.eo driveway and street trees. SC ® Approved By Planning: Q""`- /1 Date: Sept. 2nd, 2020 Revisions(after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved 0 Not Approved I:1Building\FormslBldgPeamitRvw RES_122419.docx Building Permit Submittal Original Submittal Date: f /372o2O Site Plans: # .5 Building Plans: # 3 Building Permit#: lir Enter building permit#above. Workflow Routing a-Planning Ca'Engineering [ Permit coordinator Ed-Building Workflow Sign-off: (,YSign-off for Planning(include notes`rrom plaiuung review) Route Application Documents: Engineering. (1)copy of permit a$ication,(1)site plan, (1) building plan and original plan review routing form [l2 Building original permit application,site plans,building plans,engineer and beam calculations and txu t details,if applicable,etc. Notes: y, By Permit Technician: Date: JO/J(,./102,0 Engineering Review ❑ e at building pad: g A.-a—Conditions"Met"prior to issuance of building permit W I a 7- ���r ~ast 1 (y4,4 -s I:I Easements (encroachments)per engineering conditions of approval and plat 2-Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes a1.lo Assess Water Quantity Fee in-lieu: ❑ Yes Er No LIDA Facility on lot P'*'x f L l bA [a--Yes ❑ No ❑ Final Plat Recorded: &NOT Approved by Engineering: 6/44e Date: /d)).-, .a,gb Notes: 4} , j l.0 Lib?, DM s, -t Plvi, 4)` - ige1- /utr cL 4✓L Akt jp t Fesct- (1-4tJEw (Pc.,a--rwcu.c H . T-A.1 J L ❑ Approved by Engineering: E"-"--" "-``1'+ Date: Revisions(after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: ❑ Approved 0 Not Approved Permit Coordinator Review Conditions"Met"prior to issuance of building permit 0 Approved,NOT Released: _ Date: Notes: 441 t(.pt2 (4pp ICit Vlt `(v 120('X) Revisions(after Building Submittal only) Revision Notice 1: Date Sent to Applicant Revision Notice 2: Date Sent to Applicant SDC Exemption: ❑ Received Does not apply ,,,,Qp/r SDC Fees Entered: Wash Co Trans Dev Tax: l Yes 0 N/A Tigard Trans SDC: g Yes 0 N/A 9��� 5 Parks SDC: t" Yes ❑ N/A Llp{t t-`'",P1 cO LIDA ❑ Yes g N/A' �A(�/ ❑ OK to Issue Permit Approved by Permit Coordinator: Date: 1:\Building\Forms\BldgPermitRvw_RES_122419.docx