Permit (3) IN CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2023-00097
Date Issued: 06/08/2023
T f 6 A R p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112CA14500
Jurisdiction: Tigard
Site address: 7750 SW LAYTON LN
Subdivision: BROOKSIDE SUBDIVISION Lot: 5
Project: Brookside, Lot 5
Project Description: New detached dwelling. NO FINAL INSPECTION UNTIL DEFERRED SDC FEES HAVE BEEN
PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 816 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 27 Bathrooms: 3 Second: 1147 sf Garage: 385 sf Front: 10 Smoke Yes
Dwelling Units: 1 Third: 507 sf Right: 5 Detectors:
Total: 2470 sf Value: $396,427.25 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 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: 0
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: 4
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!500 sf: 4 201-400 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 VB R-3 2470
Owner: Contractor:
BLACKWOOD HOMES INC BLACKWOOD HOMES Required Items and Reports(Conditions)
Po BOX 4188 Po BOX 4188 1 Ersn Cntrl 503-639-4175
TUALATIN,OR 97062 TUALATIN,OR 97062
PHONE: PHONE: 503-482-5802
FAX:
Total Fees: $23,817.54
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
Q59_nn1_(N111 thrn f5F,7 AR QF9_nni_n n V may nhtain a rnnu of tha mloe nr dirt nnactinnc to(11 IN(:by rain cm 929 10R7 nr 1 Rnn 449 92dd
Issued By: . Permittee Signature: �. \ /�
Call 503. 9.4175 by 7:00 a.m.for the next available inspectio Ida\.
This permit card sha a 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.
Building Permit Application (S5
I OR 0111(.1. 1 SI:ONl.l
Cityof Tigard RECEIVED Received 'j/ / I .. o 7.7
g Date./By: J
13125 SW Hall Blvd.,Tigard,OR 97223 J Plan Review Z,477
2 ��P�
• a Phone: 503.718.2439 Fax: 503.598.19(MAR 2 2 2023 Date/By: vJ A d 't` 1116 it —..6260%2.
F I G A R I) Inspection Line: 503.639.4175 Date Ready/By Juns: See Page 2 for
Supplemental www.tigard-or.gov Notified/Method: I I,,3 �p•Jg Supplemental Information
CITY OF TIGARD Nil") NhfRA ti•
TYPE OF APING DIVISION REQUIRED DATA:I-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
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
il
and 2-family dwelling
CATEGORY OF CONSTRUCTION❑Commercial/industrial work indicated on this application.
Valuation: $ 3 9 lo, 2-7 -
o Accessory building 0 Multi-family Number of bedrooms: 3
0 Master builder 0 Other: Number of bathrooms:3
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 29
Job site address: I SQ SW (haipl UV New dwelling area: 2.t'.7O square feet (1 q i
City/State/ZIP: 7 7(4.14.0 0 9...1 2,2 t
I Garage/carport area: 3/Q square feet
Suite/bldg./apt.no.: Project name: Covered porch area: an square feet
Cross street/directions to job site: -7 9 1 14 ID Litlj tQ i Deck area: a square feet
t Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: .®kjo l Lot no.: 6 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.
/• ,S Valuation: $
� Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: Blackwood Homes; INC Type of construction:
Address: PO Box 4188 Occupancy groups:
City/State/ZIP: Tualatin, OR 97062 Existing:
Phone:( ) Fax:( ) New:
Off APPLICANT 0 CONTACT PERSON BUILDING"PERMIT FEES*
(Please refer to fee schedule
Business name: Structural plan review fee(or deposit):
Contact name: Blackwood Homes, INC
PO BOA 4188 FLS plan review fee(if applicable):
Address: TI I I
atin OR 97062 Total fees due upon application:
City/State/ZIP:
, 'j Amount received:
Phone:(5`1�) K I ��, Fax: :( )
E-mail: bl IXLA II,ytioj 0 0. rti ok.i i (f`N PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
"� 1` `--" Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
Blackwood Homes, INC and fire department access,along with the 2010 Oregon
Address: PO Box 4188 Solar Installation Specialty Code checklist.
City/State/ZIP:
Tualatin, OR 97062 Permit Fee(includes plan review S I80.00
and administrative fees):
Phone:(603 ) L1r2 5901_ Fax:( ) State surcharge(12%of permit fee): $21.60
_CCB lic.: I493 t, 1 t' Total fee due upon application: $201.60
Authorized signature: 4t,
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:A o'9' 144 _ a >Date: 3 I.23 *Fee methodology set by Tri-County Building Industry
Service Board.
I:ABuilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4y3,1123
1i y 3T(ll1/02/COM/WEB)
5s C
Mechanical Permit Applica44( CEIVE� hOROFFI('h.L SI'.O\L.l
City of Tigard CCVV Date/By. MS1 6 S' O oqi
Permit No:
y
13125 SW Hall Blvd.,Tigard,OR 97223��� .y Plan Review I
' II Phone: 503.718.2439 ''YYII L 2023 Dan Rev Othzr Permit
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris t td See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
ax : avAom _ ,q TYPE OF".'WORK' 1- ' '' ' COMMERCIAL FEE"SCHEDULE USE CHECKLIST
New construction ❑ Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
p performed Indicate the value(rounded to the nearest dollar)of all 1
❑Demolition ❑ Other: mechanical materials.equipment.labor.overhead.and profit
s .cATECORY OF CONSTRUCTION Value S I
IITFrNTIt1E I QIJ#PtMPL— T'l YSTEMS i~EI S'.
1-and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other: Description Qt) Fa Total j
fil 74`SITE`>INiffoiiMATION AND LOCATION Heating/cooling:
Job site address: �1
—7-7So Sv4 a c
Air conditioning 46 75
'V Furnace 100.000 BTU(ducts s eats) -b 75
City/State/ZIP: / �p� I
t3 ��lttl�"Y 9?2zy Furnace 100,000+BTU(ducts resin 51 )I 1
Suite/bldg./apt.no.: Project name: Heat pump (-,1 "t, '
CI
Duct work 23 32 i 1
Cross street/directions to job site: 7 / ill IV Lki TONI Hydronic hot water system i
123. _
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: gKtbKSkoft,. 23 32
Lot no: Other: i �- I
Other fuel appliances:
Tax map/parcel no.: 1
} Water heater 23.32
t ..,. K l5,5;. DESCRIP_TION.:OFr WORK Gas fireplace/insert 33.39
A 5 r-K Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23 32
Wood/pellet stove 33-39
Wood fireplace/insert 23.32
Chimney/liner/tlue'sent 1 23 3-
* *S.:00TY',.OWINER ❑ TENANT Other I 23
32
Name: Environmental exhaust and ventilation:
Blackwood Homes, INC Range hood/other kitchen
Address: PO Box 4188 equipment I 33 39 j
Tualatin, OR 97062 Clothes dryer exhaust 33 39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone ( ) Fax ( ) toilet compartments,utility,rooms) 23-32
Attic/crawlspace fans 23.32
Fa ?A SIr3W,PLjC NT--`.' a 0 CONTACT PERSON Other:
- - 23 32
Business name: INCFuel piping:
Blackwood Homes, NC S14.I5 for first four;S4.03 for each additional
Contact name: PO Box 4188 Furnace,etc I
Address: Tualatin, OR 97062 Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:(SId) yI'2 5401_.. Fax: :( ) Fireplace
E-mail: 6 r Range
Barbecue
, ttA ''` `' Clothes dryer(gas) I
�.. Other:
Business name: 4I K. Q J r(A� / ii\j G MECF[ANiCAL PERMIT FEES*
Address: To so)( .,q 1t Subtotal
City/State/ZIP: 0 r—WJr Ck1 , 0KN Minimum permit fee($90 00) i
Plan revierr(25%of permit fee)
Phone:( Fax:
Q3) ���- 0.7.� ( ) State surcharge(12%of permit fee) —{
CCB lie.: ��\ W TOTAL.PERMIT FEE
tv This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
--- -__.` " Fee methodology set by Tri-Counts Building Indusnr Sen_ice Board
Print name: _.V,I\ Date: 1 .1212.E
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WI:
SS
Electrical Permit Applicatiou. FOR OFFICE. USEE� W�%ONLY�
City of Tigard ECEIVE[ Date/B d Perm it#: ►1 8,,O1G1
� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 MAR 2 3 2023 Date By: Related Permit#:
Email: TigardBuildingPennits@Tigard-or.gov Ready Date/By: lens: 1Z1 See Page 2 for
I 1 G,1 I:1) inspection Line: 503.639.4175 Intencirvdoilarizoir,gov Notified/Method: Supplemental Information
tjAHD
-: : - TYPE"Of 43knicDING DIVISION 1 wy- `.j ew construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current ID Marinas and boatyards.
CATEGORY
O'F'CONSTRUCTIONEl
exceeds 10.000 amps at 150 volts or 0 Floating buildings.
1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building Tess to ground,or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
vv JOB.`SITE INFORMA ION AND LOCATION 0 Emergency system. larger separately derived
-7-7 S0 S LA`�4 L V 0 Addition of new motor load of ❑system.
Job#: Job site address: I OOHP or more. "1-3",
�p�� q 0 Six or more residential units. occupancy.
City/State/ZIP: �I�it"J 0 Recreational vehicle parks.
1 �i ❑Health-care facilities.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. ❑Supply voltage for more than
1 ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 701 Ili. TD LA.4T0 FEE SCHEDULE
Description I Qtv. I Each 1 Total I
New residential single-or multi-family dwelling unit.
Subdivision: SSOO I.Qt, Lot#: S includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq ft.or portion 33.92 1
DESCfiIPTION OF WORK . Limited energy,residential 75.00 2
Al s r (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
� '� - TENANT Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Name: Blackwood Homes, INC
Address: 201 amps to 400 amps 133.56 2
PO Box 4188 401 amps to 600 amps 200.34 2
City/State/ZIP: Tualatin, OR 97062 601 amps to 1,000 amps 301.04 2
Phone:( ) 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 signatur Date: 401 amps to 599 amps 168.54 2
APPLICANT El CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: S fi LAW-- kiLc& above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
5 /SELO� 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:( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
- - Pump or irrigation circle 67.84 2
Business�name:SUNLIGHT ELECTRIC INC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2804 NE 65TH AVE, SUITE D panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:VANCOUVER, WA 98661 Additional inspection(1 hr min) 66.25/hr
Phone:971-222-5758 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:PETER@SUNLIGHTELECTRICINC.COM Inspectionsal frnt(1 whichhr no) 78.18/hr
Inspections for no fee is 90.00/hr
CCB Lic.:172549 Electrical 2 Suprv.Lic.:6652S specifically listed Liz hr min
)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,requir : Subtotal:
Print name:YEGOR . •EN Date:01/25/2023 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
r TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name:Peter Kozarez Date:01/25/2023 days after it has been accepted as complete.
Number of inspections allowed per pennit.
l:\Building\Pcrmits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 440-4615T(II/05/COM/WEB
Plumbing Permit Application .iS
! Building Fixtures ������ FOR OFFICE USE: ONLY.
RECEIVED Received O� ( 4�IVA1
City of Tigard Permit No.: ,"` Lu uUU�,
i 13125 SW Hall Blvd.,Tigard,OR 9727�33.p Date/By:
Pl. I Phone: 503.718.2439 Fax: 503.598.1x161M 2 3 2023 Date/By:an Review Other Permit No.:
Inspection Line: 503 639 4175 Date Ready/By: lures: See Page 2 for
TIGARll y y g
Internet: www.tigard-or.gov. CITY DE.TGAflD Notified/Method: Supplemental Information
I z
.7 f'., E-b `;w LD Nt D j{VI .w,K ....FEES S e I x e
New construction ❑ Demolition For special information use checklist
Description I Qty. Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
i-',',, l ``� ... �. . -4Y,c s �� 1 i>I[j .„?. `sr SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
Wr ..w,Fr.4. C, p� .Hry
r a >`II) l(eC *-
N - ' Site utilities:
Job site address: 1-75() S\pi LAi lnr Catch basin or area drain 18.76
City/State/ZIP: n p t� p `Q, Drywell,leach line,or trench drain 18.76
1G r IQ i) O . / Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 701 um f0 iJ Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
D Water service(no.linear ft.:_) Page 2
Subdivision: A900V,St0f-- Lot no.: S Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
s .,- Backwater valve 12.51
� p Clothes washer 25.02
1� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
11 - .; s, t = _tt = * Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Blackwood Homes, INC Floor drain/floor sink/hub 25.02
Address: PO BOX 4188 Garbage disposal 25.02
City/State/ZIP: Tualatin, OR 97062 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
:'`k4,.,,,, : 4 ( kt �4. 5`s *"1t •`-,❑ :co mcr d } Interceptor/grease trap 25.02
Business name: i 1 u 1, G tp LA/r\j fr,i(, Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Si( 6c ii►'1 Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
> w x Water closet 25.02
t _.f x -s*. ... s�r� --"t• r , :� Water heater 37.52
Business name: \A, /^r. Q(.AJ a 1 VJ(,.. Water piping/DWV 56.29
Address: l b o So ( 1 FL. i h\ Other: 25.02
City/State/ZIP: 0 ii (Apt Subtotal
Phone:(SO�) 112, A c Li Fax:( )2 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: /6 (Q 99 Plumbing Lic.no.: P g c
State surcharge(12%of permit fee)
Autitorized TOTAL PERMIT FEE
signature: This permit application expires if a permit is not obtained within 180 days
Date: r I3 �3after it has been accepted as complete.
I�Print name: �4i7 *Fee methodology set by Tri-County Building Industry Service Board.
L\Building\Permits\PLMU-PetmitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
III ' COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #: —d0d L7
Site Address: '7 7 S o S W (Atyi'on Lin • I/Verified in Accela
Project Name: g hnOK S i h.— Net., Dt t, , SFR Lot/Unit #: I.,0 'X
Proposal: / Wt.) De-cc�"fOt S r K Zone: R.<S^ O
Housing Type: to SFR(MSingle Detached 0 Duplex❑Triplex❑ADU)0 Rowhouse❑Cottage Cluster 0 CYU ❑Quad ❑Other
Refired Site Plan Elements:
cl 3 c9pies of site plan on max 11x17"
g Drawn to standard scale ,
'North arrow Street and site trees shown/ labeled
LcSite address, project name, lot #
',Street names (14/A for SFR)
T/pplicant name and phone # )
Lot and setback dimensions + +6ff-ElearanCe-tri L 1Q..
Mr/Utility locations &easements
/Footprint of new structure and FFE L°1 Property corner elevations
® Sidewalk/driveway dimensioned 01,LIDA (>1,000 sf disturbance)
P(Lot area and lot coverage percentage 6,f Erosion control
Required Elevation Plan Elements:
(For SFR: calcs needed only on street-facing) Sujnmary table with calculations for:
Mr/Drawn to standard scale ,Total facade area
�uilding height dimensioned Total window and door area
Façade dimensioned
endows and doors dimensioned
Ldl Garage doors dimensioned
Required Floor Plan Elements:
(Not equired for SFR) El Sum i I includes
ach story dimensioned 0 Total f area
Each story floor area calculated ❑ F r area per story
Planning Review
The following standards have been met:
/ • 1
Setbacks /Front: IC) Rear: I S Side: S Min/Max Street Side: I ,0 / N A Garage: ao
Height ('Max./ Height: ,S Proposed Height: 41, ' /!
/Yes 0 N/A Landscape - S710 l4t-c0,4. pot°kt9
Eyes I 'N/A Screening (Quad only)
g Yes ❑ N/A % Window Coverage fk
V(Yes ❑ N/A Garage (SFR Only) Parking (Other Res)- I b' w1d'Fh,1 I/ •F e +n+
dYes ❑ /A Entrance (SFR, Rowhouse, Quad only)
❑ Yes re N A Other buildin design standards (Rowhouse only) f
es ❑ N/A ccessor Structure an ar s
•
Yes No Qualifying pre-exis ' unit exempt from standards (Cottage unit only)
Ad i ' I standards fo rtyard Units, Cottage Clusters, Rowhouses,and Quads:
❑ Yes ❑ N/A • ount:
❑ Yes Lot • and Size
es ❑ N/A Pathway
A ' nal standards for Co d Units and Cottage Clusters only:
❑ Yes ❑ Unit Ar •
❑ Yes 0 N/A Area (per story)
❑ Yes Court
es 0 N/A Fence
❑ Yes EllZJ No /A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
hiYes ❑ No ®'N/A Public Facilities Improvement (PFI) Permit:
Required: s 0 No
/ Applied For: Yes ❑/No, stop intake /glad-7-e�}-
f( Sensitive Lands: 0 Yes :r No
lrplain Land Use Case #s: V 2c71 - 0000 6 ❑ Conditions met
Applicant notified of land u e pira io da • / I /2A 2-
Approv By Planning: Date: /2-1a mac».3
Notes v -of , a- d 6 6C w/ kneS.
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date: 7/2,2—/ii
Site Plans #: 3
Building Plans #: 3
Building Permit #: 1TBuilding permit # entered on page 1
Workflow Routing: manning-IE-Erigineering -0 Pcr-mit Coordinator Building
Workflow Sign-off: ,e-Sign-off for Planning (include notes from planning review)
Route Documents: 1ngineering: (1) copy of permit application, (1) site plan, (1) building plan
and original plan review routing form.
'in-Building: original permit application, site plans, building plans, engineer and
beam calculate ns and tr st details, if applicable, etc. /�
Permit Technician: Date: ! 2 /273
Notes:
Engineering Review
0 PFI Permit: r
Pr/Slope at building pad: Z 4 ok
////6? "conditions met prior to issuance of permit
E sements (encroachments) per engineering conditions of approval and plat
Hater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes ❑ No
Assess Water Quantity Fee in-lieu: 0 Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No Add Fee: ❑ Yes 0 No
ki nal Plat Recorded
❑ NOT Approved: Date:
Notes: i_
Approved By Engineering: Date: Z,:ei/2 3
Revision 1: ❑ Approved Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
Permit Coordinator Review
,,i/
Conditions met prior to permit issuance
Approved, NOT Released: _ Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
0lw�►C - -mption: 0 Applied for 0 Receivedoes not apply
Aril:,'C Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A ❑ Deferred
Parks SDC: Yes 0 N/A 0 Deferred
LIDA ❑ Yes Pl/A•
1
K to Issue/Approved by Permit Coordinator: �� f k� Date: �� ` L) :.3
Revision 1: 0 Approved ❑ Not Approved �� Date:
Revision 2: 0 Approved 0 Not Approved _ Date: