Permit (112) CITY OF TIGARD MASTER PERMIT
' 1 COMMUNITY DEVELOPMENT Permit#: MST2023-00476
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/09/2023
Parcel: 2S108DC28200
Jurisdiction: Tigard
Site address: 15444 SW MISSOURI AVE
Subdivision: CROSSING AT BULL MOUNTAIN Lot: 137
Project: River Terrace Crossing, Lot 137
Project Description: New detached dwelling w/140sf patio cover.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 1204 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1323 sf Garage: 580 sf Front: 12 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2527 sf Value: $468,615.75 Rear: 10
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 Drains: 0 Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Bckflw Prevntr: 1
Drywell-Trench Drain: 0 Other Fixtures: 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: 2
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvcfFeeders 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 Y
Other: N - Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF V B R-3 2527
Owner: Contractor:
PACIFIC LIFESTYLE HOMES INC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
11815 NE 99TH ST STE 1200 11815 NE 99TH ST#1200
VANCOUVER,WA 98686 VANCOUVER,WA 98682
PHONE: PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $51,308.45
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 in OAR
Qc _nn1_nnln ihrnunh CIAR oc9_nnl_nnQn VVro,m a n inn,of tha nine nr rlirant nuaeHnne In CA INC M,naIllnn 5ti 919 100a '1 7 nr 1 an0 19 7'4 rr
Issued By:�f�� .-- . j5, -�- Permittee Signature: 4� —�`'t
�/�/ 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 lob site at the time of each Inspection.
'4
Building Permit Application
Residential FOR OFFICE USE ONLY
CI of Tigard Received Permit No.: T
`J g CEIVED Received
! ' r�� ��! L�
13125 SW Hall Blvd.,Tigard,OR Plan Review
. �� 23 , - j- Other Permit: e��tJle-o2o�3ex)�31d,
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 1
l' G A R U Inspection Line: 503.639.4175 S E P 18 2023 Date Ready/By: Lotto Juns See Page 2 fur
Internet: www.tigard-or.gov otified/Method: �� W- Np '�� Supplemental Information
;, e r'("4 '.r ) "(kr t u REQUIRED ,1-t AND 2-FAMILYDWELLING
_
+ ». a
New construction ❑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 ❑Other: equipment,materials,labor,overhead,and the Wrofit for the
kT' GORN OF CONSTRUCTION '_ work indicated on this application. 1 1%.Q, L 5 5
and 2-family dwelling ❑Commercial/industrial Valuation: �5300;000
❑Accessory building 0 Multi-family Number of bedrooms: 3
❑Master builder 0 Other: Number of bathrooms: 3
IOB SITE INFORMATION AND?LOCATION Total number of floors: 2 ) 61
Job site address: 15444 SW Missouri Ave New dwelling area: 2527 square feet I 3
City/State/ZIP:Tigard,OR Garage/carport area: 580 square feet 204
Suite/bldg./apt.no.: Project name: River Terrace Crossing Covered porch area: 74 square feet
Cross street/directions to job site: Covered Patio area: 140 square feet
Other structure area: square feet
ss 1ERCLAL-LSE CHECKLIST
Subdivision:River Terrace Crossing Lot no.: 137 Permit fees*are based on the value of the work performed.
Tax map/parcel no2510RUC2R200 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.
New SFR Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name. Pacific Lifestyle Homes Type of construction:
Address:11815 NE 99th Street,Suite 1200 Occupancy groups:
City/State/ZIP:Vancouver,WA 98682 Existing:
Phone:(360)573-8081 Pax: New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES'
(Please refer to fee schedule)
Business name: Pacific Lifestyle I tomes
Structural plan review fee(or deposit)
Contact name:Permit Coordinator-Kellie Franklin
FLS plan review fee(if applicable):
Address: 11815 NE 99th Street,Suite 1200
City/State/ZIP:Vancouver,WA 98682 Total fees due upon application:
Amount received.
Phone:(360)213-0809 F'ax::
E-mail: perm its;a huildplh.atm P_HOTOVOLTAIC SOLAR PANE I S\STENI FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Same Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:Same Solar Installation Specialty Code checklist.
City/State/ZIP:Same Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB tic.: 173524 Total fee due upon application: $201.60
Authorized signature: � This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name.Kellie Franklin Date:9/142023 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
v 13125 SW Hall Blvd.,Tigard,OR 97 CEDate Date/By:y: �� ,, a�r
Plan Review IMIEMI
Phone: 503.718.2439 Fax: 503.598. 1V Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: 3uris: H See Page 2 for
Internet: www.tigard-or.gov SAP t 202 Notified/Method: Supplemental Information
TYPE OF WOR r + COMMERCIAL.FEE*SCHEDULE` UST CHECKLIST fw..
1.,:,"` Mechanical permit tees'are based on the value of the wolk
®New construction ❑Addition/alterationireplabemedtt performed.Indicate the value(rounded to the nearest dollar)of all
El Demolition El Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL ' )" ENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder D Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: 15444 SW Missouri Ave. Furnace 100,000 BTU(ducts/vents) I 46.75
City/State/ZIP:Tigard,OR Furnace 100,000+BTU(duets/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:River Terrace Crossing 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:River Terrace Crossing Lot no.:137
Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2S108DC28200 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
New SFR 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: 23.32
® PROPERTY OWNER ❑ TENANT
Environmental exhaust and ventilation:
Name: Pacific Lifestyle homes Range hood/other kitchen
-- - - - _-_-- - equipment 1 33.39
Address:11815 NE 99th St.,Suite 1200 Clothes dryer exhaust 1 33 39
City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32
Phone:(360)573-8081 Fax ( ) Attic/crawlspace fans 23.32
® APPLICANT ® .CONTACT PERSON Other: 23.32
Business name:Pacific Lifestyle homes Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Permit Coordinator-Kellie Franklin Furnace,etc. 1
Address: 11815 NE 99th Street,Suite 1200 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater
Phone:(360)213-0809 Fax::( ) Fireplace
Range I
E-mail: permits@buildplh.coln Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name. Wolcott Plumbing
Address: 1075 West Historic Columbia River HWY Subtotal
City/State/ZIP:Troutdale,OR 97060 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)667-1781 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:112220 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 LQ. f4A��ya * Fee methodology set by Tri-County Building Industry Service Board
Print name:Kellie Franklin Date:9/14/2023
1-..\Building\PermitaIEC PermicApp 040113.doc 440.4617f(1 I/02/COM/WEB)
na
Electrical Permit Application FOR OFFICE USE ONLY
City Of Tigard RECEIVE L eceivad
Date/By: Permit#. PI ST�-2) 13_o / 14
13125 SW Hall Blvd.,Tigard,OR 97223 SEP 2023 plan Review v r 'L
Phone: 503.718.2439 Fax: 503.598.1960 RelatedPemut#:
DateBy
D Inspection Line: 503 639 4175 Ready DateBy orris: RI See Page 2 for
T I G A RP. Internet: www.tigard-or.gov -rQl i V OF r�C�ARD Notified/Method Supplemental Information
TYPE OF WOR-f�et :0aii,14.10l " PLAN REVIEWodilt
®New construction ❑Addition/alteration/replacement Please check all that apply(subma 2 sets of plans wiirems checked)..
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑Marinas and boatyards.
,.. CATEGORY OF CQr I;-.?.:-S;S:i ::§ ,g p '' exceeds 10,000 amps at 150 volts or El Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations, buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
.::.1' t ,' , ; g'''s w s d ( g • ❑Emergency system, larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:15444 SW Missouri Ave. IOOHP or more. ❑"A","E","t-z","I-3",
❑Six or more residential utuls. occupancy.
City/State/ZIP:Tigard, OR ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:River Terrace Crossing ❑Hazardous locations. ❑Supply voltage fur mo a Than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Otn 1 Each 1 Ea.] 1 *
New residential single-or multi-family dwelling unit.
Subdivision:River Terrace Crossing Lot#: 137 Includes attached garage.
Tax map/parcel#:2S 108DC28200 1,000 sq.ft.or less 3 168.54 4
y,a „a•t.�. a Ea.add'1500 sq.ft.or portion 1 33.92 1
A, F DESCRIPTION OF W1;3 ; z i 1:7:7¢ Limited energy,residential 75.00 2
New SFR (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
El PROPERTY OWNER i,I" `[] TENANT Renewable Energy 0 See Page 2
_ Services or feeders installation,alteration,and/or relocation
Name:Pacific Lifestyle Homes 200 amps or less 100.70 2
Address:11815 NE 99th St., Suite 1200 201 amps to 400 amps 1 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver, WA 98682 601 amps to 1,000 amps 301.04 2
Phone:(360 )573-8081 Fax:( ) Over 1,000 amps or volts 552.26 2
Email:permit$@buildplh.Com Temporary services or feeders installation,alteration,and/or
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 16854 2
t "i -`®iAPPLICANT 1 23 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Pacific Lifestyle Homes above service or feeder fee, 7.42
each branch circuit _
Contact name:Kellie Franklin B.Fee for branch circuits without
Address:11815 NE 99th St., Suite 1200 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver, WA 98682 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360-213-0809 Fax: :( Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:permits@buildplh.com Reconnect only 67.84 2
"r i CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2890 SE Brookwood Ave. 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)648-4552 Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr
Email:permits@garnerelectric.com Industrial plant Q hr min) 78.18/hr
Inspections for which no fee is 9000/hr
CCB Lic.: 121159 Electrical Lie.,: 34-3305C Suprv. Lic.: 3707-S pecifically listed(v,hr min)
Suprv.Electrician signature,required: I"rLl�c ELECTRICAL PERMITSubtotal
o FEES
41�-- Subtotal:
Print name: Charles Garner Date: 9/14/2023 ❑Plan Review Required(25%of permit fee):
State surcharge(12%ofpennit fee):
Authorized signature: a ac e TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within Is0
Print name: Brittany Burian Date 9/14/2023 Jays aver it has been accepted as complete.
Number of inspections allowed per permit.
1.1Building\Permits\ELC PeratitApp ELR ERE.doc Rev 06/17/2015 440-4615T(I I/05/COM/WEB
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received Pe ,I 4/_1 r DO(t7
II
4 13125 SW Hall Blvd.,Tigard,OR 97223 f C,T l 0 2023 Pan Review
_" Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
TIGARD Inspection Line. 503.639.4175 CITY OF TIGARD Date Ready/By: Juris ® See Page 2 for
Internet www.tigard or gov DI
VISION. Supplemental r rlemental Information
a
TYPE OF WORK p �� FEE* SCHEDUL,F,
®New construction ❑ Demolition I For special information use checklist
2331. Description I Qty. I Ea. Total
0 Addition/alteration/replacement 0 Other: - New 1-2-family dwellings(includes 100 ft.for each utility connection)
n ,,g ilma y
CATEGORY OF iCMS1ItUCI'Ifl 11'ri ls" 3}(;1, SFR(1)bath 312.70
® I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 1 500.32
Each additional bath/kitchen 25.02
❑ Master builder 0 Other:
Fire sprinkler sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15444 SW Missouri Ave. Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: l Project name:River Terrace Crossing 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:River Terrace Crossing I Lot no.: 137 Fixture or item:
Tax map/parcel no.: 2S108DC28200 Backflow preventer I 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New SFR
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
el PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Pacific Lifestyle Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11815 NE 99th Street,Suite 1200
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98682 Hose bib 25.02
Phone:(360)213-0809 Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pacific Lifestyle Homes Medical gas(value $ ) Page 2
Primer 12.51
Contact name:Permit Coordinator-Kellie Franklin
Roof drain(commercial) 12.51
Address: 11815 NE 99'h Street,Suite 1200 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 6254
Phone:(360)213-0809 Fax::( ) Tub/shower/shower pan 12.51
E-mail:permits@buildplh.com Urinal 25.02
hg•,t�s,Al+ n: Water closet 25.02
Water heater 37.52
Business name:Malmedal Enterprises Inc Water piping DWV 56.29
Address:PO Box 207 Other: 25.02
City/State/ZIP:Banks,OR 97105 Subtotal
Phone:(503)324-0759 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 102535 Plumbing Tic.no.: Plan review (25%of permit fee)
vZ7 p8 State surcharge(12%of permit fee)
/E
Authorized signature: P4�2J4,at, 7/I/2.10 TOTAL PERMIT FEE
Print name:Kellie Franklin 10/30/2023 This permit application expires if a permit is not obtained within 180 days
Date: after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
i\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
:1 ' COMMUNITY DEVELOPMENT DEPARTMENT
N
Building Permit Review - Residential
IIGARD
.�
Building Permit #: 1l1'YrO`Da.3-004(-7(47
Site Address: ISqV4q tJ 1'y1L Tit)Ql Aye erified in Accela
Project Name: R1W12-. 1 212ACc Q,QCSS)NC7 Lot/unit#: i" 3
Proposal: N '5/ill‘Le TOPtHel> SAP Zone: (465--g
Housing Type: S' FR Single Detached ❑ Duplex❑Triplex❑ADU) ❑ Rowhouse ❑Cottage Cluster 0 CYU ❑Quad ❑Other
Requ' d Site Plan Elements:
3 c es site plan on max 11x17"
euelerro standard scale
arrow treet and site trees shown / labeled
t ress, project name, lot # p anoov at maturity
6,05'
ee ames (N/A for SFR)
licant name and phone # )
Lot a setback dimensions
, n chru�fi„-ec 8� ya CalIZ .tans ' ' ocations &easements
F tp ' of new structure and FFE ropert orner elevations
S' walk/driveway dimensioned )
of area and lot coverage percentage rosion control
quired Elevation Plan Elements:
(For : calcs needed only on street-facing) Summary table with ions for:
❑ Dra to standard scale 0 Total fas ea
❑ Buildin eight dimensioned ❑ T indow and door area
0 Facade dim •oned
El Windows and doo imensioned
❑ Garage doors dimension
Required Floor PI ements:
(Not required FR) Summary table that includes
0 story dimensioned ❑ I floor area
Each story floor area calculated ❑ Floor a er story
Planning Review
The following standards have been met: , /
Setbacks ❑ Front: a em Rear: la Side: 3 Min/Max Street Side: g� / Garage: zv
Height 0 Max. Height: 'S5 ' Proposed Height: 2y '— 014 9
❑Yes N/A Landscape
❑Yes N/A Screening (Quad only)
❑ Yes N/A % Window Coverage
El Yes N/A Garage (SFR Only) Parking (Other Res)
❑Yes N/A Entrance (SFR, Rowhouse, Quad only)
❑ Yes N/A Other building design standards (Rowhouse only)
❑Yes N/A Accessory Structure Standards
❑Yes No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
❑ Yes N/A Unit Count:
❑ Yes E N/A Lot Width and Size
0 Yes N/A Pathway
Additional standards for Courtyard Units and Cottage Clusters only:
❑Yes N/A Unit Area:
❑Yes N/A Floor Area (per story)
❑Yes N/A Courtyard
0 Yes N/A Fence
imm
❑ Yes 0 No..216 Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ No ON/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes ❑ No, stop intake
Sensitive Lands: ❑ Yes Ig-Pd6
❑ Main Land Use Case #s: 'PD(2ZCAF'-CCODIO/PIN2Dta-CcC�S ❑ Conditions met
❑Applicant notified of land use expirat' date: 3/22/oD26
Approved By Planning: Date: CiAgirS
Notes gf fp cies160 55>`1ooklOS /wipe. tmal.e. . ain DI) • &2MAts° 1'Cni1*me srAnr7AlQOS ,JeW. AP0a9 Arrelt 2ot6
Revision 1: 0 Approved 0 Not Approved Date: Oitevl POi2
Revision 2: El Approved ❑ Not Approved Date: VAS
d
Building Permit Submittal
Original Submittal Date: gI I% I1013
Site Plans #:
Building Plans #:
Building Permit #: 6/Building permit # entered on page 1
Workflow Routing: "Planning M'Engineering LA'Permit Coordinator by$uilding
Workflow Sign-off: ign-off for Planning (include notes from planning review)
Route Documents: L'Engineering: (1) copy of permit application, (1) site plan, (1) building plan
aDd original plan review routing form.
LS Building: original permit application, site plans, building plans, engineer and
I,, _U/C�r beam_ calculations and trust details, if applicable, etc.
Permit Technician: I'' —/ n V -' Date: A 1117.!747'3
Notes:
Engineering Review
❑ PSI Permit:
Slope at building pad: .c2 %
&I-Conditions met prior to issuance of permit
('Easements (encroachments) per engineering conditions of approval and plat
12-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes -, l No
Assess Water Quantity Fee in-lieu: 0 Yes 1E'No
LIDA Facility on lot: 0 Yes fE'No Add Fee: ❑ Yes ❑ No
Final Plat Recorded
❑ NOT Approved: Date:
Notes:
Approved By Engineering: Date: or/2 3
Revision 1: ❑ Approved of Approved _ Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
ENG Revisions Required: _4Date notified applicant:
1 [ DC Exemption: ❑ Applied for ❑ Received s not apply
rDC Fees Entered: Wash Co Trans Dev Tax: \U Yes ❑ N/A
t/ Tigard Trans SDC: Yes ❑ N/A Deferred
Parks SDC: Yes ❑ N/A E Deferred
LIDA ❑ Yes TN/A
to Issue/Approved by Permit Coordinator: 0.O(d Date: _ l` jig 7i�
Revision 1: ❑ Approved ❑ Not Approved _ Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
IIIIC Building Division
One & Two-Family Dwelling
T i c n tiD Fees Checklist
PERMIT INFORMATION: _ _ Application Date - FEE VERSION 3,..)14i 2.02
( c
Permit #: ,cs��Z,3_ ao 77 r _ Plan #: �5?-7 l pd Floors:
Valuation: 4168, 615. 75 Covered Porch: �t Basement
Bedrooms: 3 Deck: IL
Covered 1"Floor I D-bli
WC (toilets) 2 Deck Cover: 2"d Floor S Z3
Lavatories g Patio Cover l ( 0 3`d Floor
Tub/shower Accessory Struct. _ R-3 Total a5-7
Laundry Tray ---___. Water Heater /` j� Garage CQ?
Exhaust Vents 5 Gas Flue Vents Total for Elec. 310-7
Backflow Prey. ci Furn
� ace J Heat Pump CAC # for Electrical 5
BBQ Gas Fireplace #Fuel Lines Z.
FEES: Description: Fee Ap 1i : Fee Entered:
DC Prov Revw: Planning
Info Proc/Arch: Lg$2.00 (over 11x17)
Info Proc/Arch: Sm$.50 (up to 11x17) (eO
Metro CET: Residential Use ``ee
School CET: District: �, ✓
Tigard CET: Admin ,
Tigard CET: ODHCS ✓y/
Tigard CET: AH
Electrical Permit: Permit Fee: ✓
Limited Energy: ✓
12% State Surcharge ✓
Mech. Permit: Permit Fee:
12% State Surcharge
Plumbing Permit: Permit Fee: ✓
12% State Surcharge ✓
Erosion Control: w/Permit - Ping
1,7
I:\Building\Fonns\ResPlanCheckFees_Dec2022_AA.doc 12/21/22
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