Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT
Permit#: MST2023-00364
Date Issued: 12/18/2023
T f G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DC20600
Jurisdiction: Tigard
Site address: 13864 SW 172ND AVE
Subdivision: RIVERSIDE AT SCHOLLS MEADOW Lot: 43
Project: Riverside at Scholls Meadow, Lot 43
Project Description: New detached dwelling.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1006 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 22 Bathrooms: 3 Second: 1286 sf Garage: 390 sf Front: 12 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2292 sf Value: $409,539.24 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 1
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 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'I 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 2292
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
15350 SW SEQUOIA PKWY STE 320 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97224 BEAVERTON,OR 97006 2 (2)layers of 2x fire blocking
at area indicated
PHONE PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $49,857.17
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< ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oc9-nn1_nMn fhr h nAR OF9-nM-nnon V Main m rnrn,of 4he nilec nr Him'''.n„eefinne+n ni iMt`by nnllinn Frr 979 10527 nr 1 Ann'110 01.14
i/��/A ' sIssued By: '`/',/�_�'J Permittee Signature: %��� Ifrf �Q ��Call 503 39.4175 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 job site at the time of each inspection.
Building Permit ApplicationREC-. EIV
Residential ,
JUL :2 21123 Received /) �n 3�
INCity of Tigard Date/By: � � �p ::tl::m
u 131SWHall BlvdTi ardOR97223 •
g Plan ReviewGFTIGARD Date/Bit:M� U��S
Y
1 [G A 1:1) Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Y iur�:p ® See Page 2 f
Internet: www.tigard-or.gov Notified/Method: t N • A 0 -1 kc I• Supplemental Information
Y .W . i� 1.�u * Z IN.rr n frrs, C.•
II
{' Eric ,N fi, `x.> !v 41, 6i t .A 1- 12r� ,IvE.` a " - ro .
ID 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
=- , •, , = T „Y.-Pr,CONST U N work indicated on this application. )'1.(
❑✓ 1-and 2-family dwelling 0 Commercial/industrial
Valuation: $
ElAccessory building El Multi-familyNumber of bedrooms: 4
❑Master builder ❑Other: Number of bathrooms:.2- 3 @�.�
r " 1 SITE y w 414" '1 Total number of floors: 2
Job site address: 13864 SW 172nd Ave New dwelling area: 2292 square feet J °P.—‘8—(
City/State/ZIP: Tigard/OR/97140 Garage/carport area: 390 square feet r CDC
Suite/bldg./apt.no.: Project name: Riverside at Scholls Meadow Covered porch area: square feet
Cross street/directions to job site: Roy Rogers &Jean Louise Rd Deck area: square feet
Other structure area: square feet
1CNU, DATA'COlptER ..x CIS
Subdivision: Riverside at Scholls Meadow Lot no.: 43 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: WCTM 2S106DC20700 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
'-1„ RIpTiON Oj p '• work indicated on this application.
Construction of single family detached residence Valuation: $
Existing building area: square feet
New building area: square feet
' ❑✓ ,PRO, T ;O - r: `t .TENAN Number of stories:
Name: Riverside Homes Type of construction:
Address: 15350 SW Sequoia Pkwy, Suite 320 Occupancy groups:
City/State/ZIP: Portland, OR 97224 Existing:
Phone:(971) 371-1310 Fax:( ) New:
0 APPLICANT A � 4 , • BUILDINGSPERMIT
Business name: Riverside Homes �4 v, :_4, - ' (Please ref .tofeeschedule) , ,,,.,, �u,1�'
— Structural plan review fee(or deposit):
Contact name: Jennifer Doty FLS plan review fee(if applicable):
Address: 15350 SW Sequoia Pkwy, Suite 320
Total fees due upon application:
City/State/ZIP: Portland, OR 97224
Amount received:
Phone:(971 ) 371-1310 Fax::( )
PHOTOVOLTAIC SO LAR le'ANEL SYSTEM FEES*
E-mail: jdoty@riversidehome.com
.z, ,, . < Commercial and residential prescriptive installation of
.' CONTRACTOR
s,� roof-top mounted Photovoltaic Solar Panel System.
Business name: Riverside Homes Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 15350 SW Sequoia Pkwy, Suite 320 Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, OR 97224 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( 971) 371-1310 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 189148 Total fee due upon application: $201.60
Authorized signature: . mil _, This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: Jennifer Doty Date: 7/17/23 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE FSE oNi.Y
City of Tig
ard d Received
- g Date/By: Permit No.:
ill 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
AGAR[)
24-Hour Inspection Line: 503.639.4175 0 Electrical El Plumbing El Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW hes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ® ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ® ❑ ❑
3 Verification of approved plat/lot. ❑ ❑
4 Fire district approval required. Name of district: Tualtin Valley Fire&Rescue ® 0 0
•
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑
6 Sewer permit. ® 0 0
7 Water district approval. ® 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ® 0 0
9 Erosion control ig plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ® 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® ❑ 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ® ❑ 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ® ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ® ❑ ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. IN 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ® ❑ 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ® 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ® ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ® ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ® ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑
architect licensed in Ore:on and shall be shown to be a$•licable to the •ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ® ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ® ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ® ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ® ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ El
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9,1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
,,
Mechanical Permit Applicatton 1 FOR OFFICE USE ON1,1'
City of Tigard Received
Permit No.: % A . 111 ii
Date/By:
111 - -'''',l•1 g 13125 SW Hall Blvd.,TiTigard,OR 97223 ,.. _,,.:‘,) Plan Review
: 11 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 ,- - -, Date Ready/By: Jun s: 0 See Page 2 for
Internet: www.tigard-or.gov . 1 Notified/Method: Supplemental Information
W ''''l'g .1 44A, C:.4:'•rit. ";:Seilii:ai'-iTAIr;11:t4.c ligelC41§714.Mechanical pemnt fees*are based on the value of the work
a New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition Ei Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
tATEGORY,„,..ii... ',4 ''' , -44‘,,,F:',* '-",' ,,,,,,„, ' - - .,,. 4,...- ,-,-,-,",--,- •31,4',-,,;," FEEs,,,,2*.:`,.Xf.:*e
fA.i„rcONS'FRV" • ,',
El 1-1-and 2-family dwelling 0 Commercial/industrial El Accessory building For special information use checklist
0 Multi-family El Master builder 0 Other: Description Qty. Ea. Total
,,,,,,... ini,,,- Heating/cooling:
,fIli iNfA:i‘!:' '''1, ' :"'-' '''''' '' t Air conditioning 1 46.75 46.75
Job site address: 13864 SW 172nd Ave Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP: Tigard/OR/97140 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Riverside at Scholls Meadow Duct work 23.32
Cross street/directions to job site: Roy Rogers&Jean Louise Rd 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
Other: 23.32
Subdivision: Riverside at Scholls Meadow Lot no.: 43
Other fuel appliances:
Tax map/parcel no.: WCTM 2S106DC20700 Water heater 1 23.32 23.32
icRI! ON 'OF Gas fireplace/insert 1 33.39 33.39
Flue vent for water heater or gas
Construction of single family detached residence 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
i''''i'; re*-::'''';'41.''..1%-'' . - '''-'''''''' ,,---',' El-" . ,,i, .4•?1,-- Environmental exhaust and ventilation:
Name: Riverside Homes Range hood/other kitchen
equipment 1 33.39 33.39
Address: 15350 SW Sequoia Pkwy, Suite 320 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Portland, OR 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32 116.6
Phone:(971 )371-1310 Fax:( ) Attic/crawlspace fans 23.32
-,,,,,m -, ' .„ -..,.., ,r1,,,,,,,, ,';;;5.4;;.;;;,;„ ,,,;I: Other: 23.32
, .sf-J11.11,„ , ,„'4, ";<''''' ':.';'"' 1....1 '..''' '' : ''''''''; Fuel piping:
Business name: Riverside Homes
$14.15 for first four;$4.03 for each additional
Contact name: Jennifer Doty Furnace,etc. 1
Address: 15350 SW Sequoia Pkwy, Suite 320 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Portland, OR 97224 Water heater 1
Phone:(971 )371-1310 Fax::( ) Fireplace 1
Range 1
E-mail: jdoty@riversidehome.conn ,., Barbecue
boNTRAiiint :,,,,., -
,,,i/V0,± ,A,,Vs. Clothes dryer(gas)
Other:
Business name: Proheating & Cooling
Address: 2123 2123 NE Aloclek Dr, Suite 1209 Subtotal
Minimum permit fee($90.00)
City/State/ZIP: Hillsboro/OR//97124
Plan review(25%of permit fee)
Phone:( 971)205-4989 Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: , I
.,....... ----..
,, days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name: Jennifer Doty Date: 7/17/23
1:)13uilding\Permits\MEC_PemitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Famil Fee Schedule:
Total Valu on: a k ee
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
E
Electrical Permit Application FOR OFFICE USE ONI,v
City of Tigard!PiDateived 1,1 Aft t A
r 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2439 Fax: 503.598.1960 Date/B :Plan Review
E`'``" Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: kris: EI See Page 2 for
T I GA R D Internet: www.tigard-or.gov ';Notified/Method: Supplemental Information
';' TYPE O I L 1, #?iYA PLAN VIE`v lit;
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
i . � TEGORY OF CONS1 , ON , � V,>
exceeds I0,000 amps at 150 volts or El Floating buildings.
1-and 2 famil dwellin less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ y g ❑Commercial/industrial ❑Accessory building
Multi-familyMaster builder Other: amps for all other installations. buildings.
❑ ❑ ❑ ❑Fire pump. ❑Installation of 150 KVA or
-. EIT ,INFORMATIOI * G CATION €,; '" x ' ❑Emergency system. larger separately derived
system.
Job#: Job Site address: ❑Addition of new motor load of
13864 SW 172nd Ave 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: Tigard/OR/97140 ❑Six or more residential units. occupancy.
g El Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Riverside at Scholls Meadow ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Roy Rogers&Jean Louise Rd '' .E': ;`.FEE;•t I'4 _`
Description Qty. Each Total *
New residential single-or multi-family dwelling unit.
Subdivision: Riverside at Scholls Meadow Lot#: 43 Includes attached garage.
1,000 sq.ft.or less 1
Tax map/parcel#: WCTM 2S106DC20700
Ea.add'l 500 sq.ft.or portion . 4
33.92 1
.„ x n 'TION F;WO 3.„ y , Limited energy,residential 75.00 2
Construction of single family detached residence (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
r Renewable Energy ❑ See Page 2
PRO ' ` Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes 200 amps or less 100.70 2
Address: 15350 SW Sequoia Pkwy, Suite 320 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Portland, OR 97224 601 amps to 1,000 amps 301.04 2
Phone:(971 ) 371-1310 Fax:( ) 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 signature: ��-yy Date: 401 amps to 599 amps 168.54 2
II* �`€1__I CONTA oN ;., Branch circuits—new,alteration,or extension,per panel
...r. '`` `' �' 0:4017 ` '" •� ,. �` A.Fee for branch circuits with
Business name: Riverside Homes above service or feeder fee, 7.42 2
each branch circuit
Contact name: Jennifer Doty B.Fee for branch circuits without
seAddress: 15350 SW Sequoia Pkwy, Suite 320 branche it feederitfee,first
branch circuit 56.18 2
City/State/ZIP: Portland, OR 97224 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(971 ) 371-1310 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: jdoty@riversidehome.com Reconnect only 67.84 2
CTOR "
�.- r�� ;A : Pump or irrigation circle 67.84 2
Business name: Sunlight Electric Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy CI See Page 2 2
2804 NE 65th Ave, Ste. D panel,alteration,or extension.
City/State/ZIP: Vancouver/WA/98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360) 518-7589 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: yegor@sunlightelectricinc.com Industrial plant(lhrmin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 172549 Electrical Lic.: C230o Suprv.Lic.: 6652S specifically listed(1z hr min)
Suprv.Electrician signature,required:/L///?2' Exp 10/01/25 EL : CAL PERMIT FEES.
Subtotal:
Print name: Sunlight Electric Date: 7/17/23 El Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
1 TOTAL PERMIT FEE:
Authorized signature: .�_: --•.-_
This permit application expires if a permit is not obtained within 180
Print name: Jennifer Doty Date: 7/17/23 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
4ritivDescription Qty. Each I Total I *.
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:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%x hr min)
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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application
Building Fixtures FOI4 OFFICE USE ONL1
Cityof Tigard Received ,(t(�^n t r,t .t,^, /t
II - ll , DateBy: Permit No.: 1V,s 1' u(J �v"vA{•�,
I13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review DateBy: Other Permit No.:
Inspection Line: 503.639.4175
T 1 C A P.D Date Ready/By: Tuns. ® See Page 2 for
Internet www.tigard-or.gov Notified/Method: Supplemental
o
['New construction ElDemolition For special information use checklist.
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
,: rz ,I A a a ,y ONSTRU t °. SFR(1)bath 312.70
❑✓ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32 500.32
0 Accessory building El Multi-familyEach additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
4911 S x ORM*1 t ,1 r Site utilities:
Job site address: 13864 SW 172nd Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard/OR/97140
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Riverside at Scholls Meadow Manufactured home utilities 50.03
Cross street/directions to job site: Roy Rogers &Jean Louise Rd Manholes 18.76
Rain drain connector 1 18.76 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Riverside at Scholls Meadow I Lot no.: 43 Fixture or item:
Tax map/parcel no.: WCTM 2S106DC20700 Backflow preventer 31.27
e j j ` - . ''...1-..6' Backwater valve 12.51
Construction of single family detached residence cl°then washer 1 25.02 25.02
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,i ✓ p tl . . .'i N Expansion tank 12.51
Name: Riverside Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15350 SW Sequoia Pkwy, Suite 320 Garbage disposal 1 25.02 25.02
City/State/ZIP: Portland, OR 97224 Hose bib 2 25.02 50.04
Phone:(971 ) 371-1310 Fax:( ) Ice maker 1 12.51 12.51
a;+4,P U*QNtAcT Interceptor/grease trap 25.02
Business name: Riverside Homes Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Jennifer Doty
Roof drain(commercial) 12.51
Address: 15350 SW Sequoia Pkwy, Suite 320 Sink/basin/lavatory 6 25.02 150.12
City/State/ZIP: Portland, OR 97224 Solar units(potable water) 62.54
Phone:(971 ) 371-1310 Fax::( ) Tub/shower/shower pan 3 12.51 37.53
E-mail: jdoty@riversidehome.com Urinal 25.02
Water closet 3 25.02 75.06
a '' - - ' i "' ., ..44 Water heater 1 37.52 37.52
Business name: H & H Mechanical Water g/1 in DWV 56.29
P P
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie/OR/97267 Subtotal
Phone:(503)975-9787 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:178122 Plumbing Lic.no.: PB414
State surcharge(12%of permit fee)
Authorized signature: u:
TOTAL PERMIT FEE
Print name: Jennifer Doty Date: 7/17/23 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMil-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Is
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential
Fire Su
n Systems:
Sq1< ,1 a Site Utiltip ees .. .r...
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems'
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
� , { � dfa1 each additional$100.00 or fraction thereof,to
e1 In 9 e° 1'F and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type .. .,..
Fixture Type for Replace Plan review is required for any of the following.
Work Performed: Capped ?{e1ocate Please check all that apply.
Baptistry/Font
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial El Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
etrik `r Dia > 1
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\npruett\Downloads\PLMF_PermitApp.doc 2
Plumbing Permit Application
Buildin Fixtures ��
g FoR OF IC:F. USE ONLY
City of Tigard Received
Date/By: Ni /� 3f% q Permit No.:`� n
41 Ill13125 SW Hall Blvd.,Tigard,OR 97223 1` W U�. 11 1�'lS1"w7A•OCZtA i
Phone: 503.718.2439 Fax: 503.598.1960 ) Plan Review
Date/By: Other Permit No.:
T t G A R D Inspection Line: 503.639.4175 Date Ready/By: .. runs: See Page 2 for
Internet: www.tigard-or.gov y o'
Notified Method: Supplemental Information
,... - $' TY 4,,,,,, 4 '9-'t NR ` 1 t"I' .l.014- ...y" Dal' + ;tr..
a+aec+ '�`N
❑✓ New construction ElDemolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
= 4. A _e t R C TRC1 4: SFR(1)bath 312.70
El1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building El Multi-familySFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
El Fire sprinkler( sq.ft.) Page 2
JOi M4 I t JOI+1 114'
�= � � �TNFOR Olki T
� � Site utilities:
Job site address: 13864 SW 172nd Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain' 18.76
City/State/ZIP: Tigard/OR/97140
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: Riverside at Scholls Meadow Manufactured home utilities 50.03
Cross street/directions to job site: Roy Rogers&Jean Louise Rd Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Riverside at Scholls Meadow 1 Lot no.: 43 Fixture or item:
Tax map/parcel no.: WCTM 2S106DC20700 Backflowpreventer 1 31.27 31.27
�° ES ' �xQF.W¢
Backwater valve 12.51
�� ' ' "" Clothes washer 25.02
Construction of single family detached residence
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t-)PR ERT`V o • R , ® - Expansion tank 12.51
Name: Riverside Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15350 SW Sequoia Pkwy, Suite 320
Garbage disposal 25.02
City/State/ZIP: Portland, OR 97224 Hose bib 25.02
Phone:(971 ) 371-1310 Fax:( ) Ice maker 12.51
f � � ✓ A C � " NTr of ®� x Interceptor/grease trap 25.02
Business name: Riverside Homes Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Jennifer Doty
Roof drain(commercial) 12.51
Address: 15350 SW Sequoia Pkwy, Suite 320 Sink/basin/lavatory 25.02
City/State/ZIP: Portland, OR 97224 Solar units(potable water) 62.54
Phone:(971 ) 371-1310 Fax::( ) Tub/shower/shower pan 12.51
E-mail: jdoty@riversidehome.com Urinal 25.02
. .. �4, ,. .. ,, �` t RAc'J'-R ..,r m , V r Water closeteat 25.02
x_ Water heater 37.52
Business name: Truscapes
Water piping/DWV 56.29
Address: 7800 NE Walker Road Other: 25.02
City/State/ZIP: Hillsboro/OR/97124 Subtotal
Phone:(503)531-9216 Fax:( ) Minimum permit fee: $72.50 Al_23
CCB Lic.: Plumbing Lic.no.: LCB #7962 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 10
Authorized signature: 2u -,
'""` TOTAL PERMIT FEE
Print name: Jennifer Doty Date: 7/17/23 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMu-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems
It� �tllltie8 Qty, Fee oaf, Arly ,. !
Footing dram-1' 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater S327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
rs.,- - 'total each each additional$100.00 or fraction thereof,to
Qther tspetons. e� ) and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantiy by Fixture Type $(f ,}' -; '1
Fixture Type for Replace/ Plan review is required for any of the following.
WorkIerfotined: Capped .x Adde Relocate
Baptistry/Font Please check all that apply.
ElAny new commercial building with water service 2"and
Bath -Tub/Shower
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
y
Car Wash Drain Aso etric`or Rl<ser Ufa`
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\npruett\Downloads\PLMF_PermitApp.doc 2
III Building Division
One & Two-Family Dwelling
TIGARD Fees Checklist
PERMIT INFORMATION: Application Date FEE VERSION ) ( �
l
Permit#: 5/2Z)7--°7/ Lf Plan #: 21q)
! +d., Floors:
Boah
Valuation: .1A Covered Porch: �' Basement
Bedrooms: 1-1
) Deck: 1st Floor D0r
P
WC (toilets) Deck Cover: �— 2nd Floor t �
!;-6Co
Lavatories L( Patio Cover ,.-- ----- 3rd Floor
Tub/shower 3 Accessory Struct. _ R-3 Total p q
.D.
Laundry Tray �S Water Heater l r as Elec Garage 3� 0
Exhaust Vents I Gas Flue Vents _.----- Total for Elec.
ZC..P'6Z--
Backflow Prey. Furna / Heat Pump AC # for ElectricalLi
BBQ Gas Fireplace #Fuel Lines i
—T
FEES: Description: Fee Applies: Fee Entered:
DC Prov Revw: Planning ✓/''
Info Proc/Arch: Lg$2.00 (over 11x17) I Le
Info Proc/Arch: Sm$.50 (up to 11x17) 4 (P
Metro CET: Residential Use
School CET: District:
Tigard CET: Admin
Tigard CET: ODHCS t -'
Tigard CET: AH L .
Electrical Permit: Permit Fee:
Limited Energy:
12% State Surcharge t'
Mech. Permit: Permit Fee:
I.
12% State Surcharge
Plumbing Permit: Permit Fee: ✓
12% State Surcharge `‹/
Erosion Control: w/Permit- Ping
I:\Building\Forms\ResPlanCheckFees_Dec2022_AA.doc 12/21/22
Page 1
City of Tigard
II COMMUNITY DEVELOPMENT DEPARTMENT
11,11
Building Permit Review - Residential
TIGARD �r n�
Building Permit #: M`lJ�ti3'Ut13LQ
Site Address: 13864 SW 172nd Ave g Verified in Accela
Project Name: Riverside Homes at River Terrace Scholls MeadowLot/unit #: 43
Proposal: New Single Detached SFR Zone: RES-C
Housing Type: tgi SFR(111 Single Detached 0 Duplex 0 Triplex 0 ADU)0 Rowhouse❑Cottage Cluster 0 CYU ❑Quad 0 Other
Required Site Plan Elements:
f'3 copies of site plan on max 11x17"
'Drawn to standard scale -5itetairred-trees;dripiti•rrettree-prataction
{4 North arrow 0 Street and site trees shown / labeled
O Site address, project name, lot # ❑Table ealeclatirf g#-ree eenepy e -n'iattrrity-
O Street names (N/A for SFR)
0 Applicant name and phone # L I-Caust.yard-CPr* ngle_rWneosioned.ifapplicable)
O Lot and setback dimensions 0 Vision clearance triangle
e-Existir►g-st wes-&square-footege--- 0 Utility locations &easements
O Footprint of new structure and FFE 0 Property corner elevations
O Sidewalk/driveway dimensioned L, L!BA (-1,C!!A �r JI i.U1 6aii�c)
O Lot area and lot coverage percentage 0 Erosion control
Required Elevation Plan Elements:
(For SFR: calcs needed only on street-facing) Summary table with calculations for:
O Drawn to standard scale El Total façade area
O Building height dimensioned 0 Total window and door area
O Facade dimensioned
O Windows and doors dimensioned
d Garage doors dimensioned
Requir n Elements:
(Not required for SFR) 0 Summary table that includes
O Each story dimensioned or area
O Each story floor area calculated ❑ Floor area per
Planning Review
The following standards have been met:
Setbacks 0 Front: 8/12 Rear: 10/15 Side: 3' Min/Max Street Side: 8' / Garage: 20'
Height 0 Max. Height: 35' Proposed Height: 22'
O Yes 0 N/A Landscape
0 Yes 0 N/A Screening (Quad only)
f'Yes 0 N/A % Window Coverage 15%
O Yes 0 N/A Garage (SFR Only) Parking (Other Res) 59%, 7 facade elements provided.
O Yes 0 N/A Entrance (SFR, Rowhouse, Quad only)
❑ Yes 0 N/A Other building design standards (Rowhouse only)
0 Yes 0 N/A Accessory Structure Standards
0 Yes le No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
❑ Yes 0 N/A Unit Count:
0 Yes 0 N/A Lot Width and Size
❑ Yes 0 N/A Pathway
Additional standards for Courtyard Units and Cottage Clusters only:
0 Yes,0 N/A Unit Area:
❑ Yes 0 N/A Floor Area (per story)
❑ Yes 0 N/A Courtyard
O Yes 0 N/A Fence
❑ Yes ❑ No 1ZiN/A 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 0 No, stop intake
O Sensitive Lands: 0 Yes ❑ No
❑ Main Land Use Case #s: PDR2021-00001 0 Conditions met
o Applicant notified of land use - . •ir.tion date: suhroi all y 8/5/24, o of o by 8/5/26
Approved By Planning: Date: // i 7/2-6/ 3
Notes
Revision 1: 0 Approl ❑ Not Approved Date:
Revision 2: 0 Appr•,ed ❑ Not Approved Date:
Building Permit Submittal Original Submittal Date: 100 I S40'l/3
Site Plans #:
Building Plans #: 3
Building Permit #: l "Building permit # entered on page 1
Workflow Routing: 'Planning'Engineering ID1Dernnit Coordinator building
Workflow Sign-off: 'Sign-off for Planning (include notes from planning review)
Route Documents: t "Engineering: (1) copy of permit application, (1) site plan, (1) building plan
anyl original plan review routing form.
p'Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.
Permit Technician: jekf 0 U 41 Date: •\\ 11 3
Notes:
Engineering Review
❑ PPFI Permit:
V Slope at building pad: 2-.)
'Conditions met prior to issuance of permit
(Easements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes IVAo
Assess Water Quantity Fee in-lieu: 0 Yeso
LIDA Facility on lot: 0 Yes 174-1Io Add Fee: 0 Yes 0 No
❑ Final Plat Recorded
O NOT Approved: Date:
Notes: -
Approved By Engineering: Date: ig7z�_S
Revision 1: 0 Approve ❑ Not Approved Date:
Revision 2: ❑ Approved 0 Not Approved Date:
Permit Coordinator Review
yConditions met prior to permit issuance
�❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
j', `SDC Exemption: 0 Applied for ❑ Received hoes not apply
UU 1 SDC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: Yes 0 N/A 0 Deferred
Parks SDC: Yes ❑ N/A ❑ Deferred
LIDA Yes ) N/A
K to Issue/Approved by Permit Coordinator: t\- �1` � Date: .` 23
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date: