Permit (10) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2023-00618
Date Issued: 02/05/2024
[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112CA15800
Jurisdiction: Tigard
Site address: 15574 SW BELLAGIO CT
Subdivision: BROOKSIDE SUBDIVISION Lot: 18
Project: Brookside, Lot 18
Project Description: New attached dwelling. NO FINAL INSPECTION UNTIL DEFERRED SDC FEES HAVE BEEN
PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 651 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 34 Bathrooms: 4 Second: 1028 sf Garage: 273
g sf Front: 15 Smoke
Dwelling Units: 1 Third: 1064 sf Right: 5 Detectors: Yes
Total: 2743 sf Value: $480,568.95 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 2 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: 3 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: 1
Other Fixture Units: Bar sink
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 7 Clothes Dryers: 2
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
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: 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
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SFA VB R-3 2743
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: $22,723.97
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 requir 9 you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oc9-nni nnin thrnnnh fIAR oc9-nni_nnon Vnn ,,nhtain ate' nv of tha nilac nr rlirart ni iactinnc to(ll imr.h,Tallinn 919 1 og7 nr 1 RIM R39 91d4
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection da e.
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.
/ 0
Building Permit Application
a '` ���� IUROil1( 1 t �1. a\il
a C�I,RI, RE.^
`.! Received Permit No.:
City of Tigard Date/By: ,),1 I,K i3 4.77.—_" fl S7 ,13...0067,1 F
13125 SW Hall Blvd.,Tigard,OR 97223 1 Plan Review Other Permit: h ,
(; 1 s 2�2 Date/By: 12l > , fir, •t/1
Phone: 503.718.2439 Fax: 503.598.1960�� J,�; Si See Page 2 for
Inspection Line: 503.639.4175 Date Ready/By:
l 16 A 1 t) p CITE OF TIGAR� tified/Method t I �� J — Supplemental Information
Internet: www.tigard-or.gov ItAG DIVISION
0 Demolition Permit fees*are based on the value of the work performed.
New constructionIndicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
c 7
' , -,: "CATEGORY'OF jcolc itijaio - „
a
COO` ��C`/['e.yr�� r C
Valuation:i $ TJnd 2-family dwelling 0 Commercial/ihdustrial work indicated on this application
Number of bedrooms: 3
❑Accessory building 0 Multi-family
Other:
Number of bathrooms:
❑Master builder ❑ 3 ,C)0
®�
JOB-SITE:INFORMATION AND',LOCATION- Total number of floors: Co
Job site address: /5 S 7 Li $v 4 gt u4-t o G 7 New dwelling area: 2.7 46 square feet k deg
City/State/ZIP: rJ (1,,to O 9 74 Garage/carport area: 273 square feet t O2,,
Suite/bldg./apt.no.: -Project name: Covered porch area: ' square feet 1/4J95
Cross street/directions to job site: 7 9 714 ' LA-1 I Vry Deck area: Lt,t , square feet
Other structure area: square feet
REQUIREkD T Q ., _ ,
Subdivision: g fWNh�` - I Lot no.: i 0 Permit fees*are based on the value of the work performed.
1 c 1/1/CAA
n r n I Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no J 1 l lJl'I � equipment,materials,labor,overhead,and the profit for the
7 v g work indicated on this application.
Valuation: $
"5r .. c. �' dA-Je4k o 1
Existing building area: square feet
New building area: square feet
x wrtzrzv r r i't` t r CA .
i4,-'-' . Number of stories:
>'ROPER7Y,QWNER , .£ ...�'1, t�e...a* �t `, ,.;
Name: Blackwood Homes, INC Type of construction:
Address: PO Box 4188 Occupancy groups:
City/State/ZIP: Tualatin,OR 97062 Existing:
Phone:( ) Fax ( ) New:
,. �',ors a^rd �"= r�i - ..a«: r rtca i f R+ �; w �. k�' -.,,,,e d'r .� .lr �.q..
.: 4.. ' C , 41 d e:10(�Au, ,,,SONt. ,*, „ )
asp � �. .felt irflie ak) #: S 4
Business name: Structural plan review fee(or deposit):
Contact name: Blackwood Homes, INC
PO BOA 4188 FLS plan review fee(if applicable):
Address: Tualatin,OR 97062 Total fees due upon application:
City/State/ZIP: I Amount received:
Phone:(ScR.) '�f P. Sii1 0y Fax:.( ) „'` 'i 3}I t C�'n i , I•• _ .._*,
E-mail 'a( Commercial and residential prescriptive tive installation of
Teti: '` + .w'4'*� ..A. ,.. 7P�- c - P
,.. , t� :„ ,,e e, s �:,-,,-. roof-top mounted Photovoltaic Solar Panel System.
°'~ ,:-..;:;A, Submit two(2)sets of roof plan with connection details
Business name: Blackwood Homes, INC and fire department access,along with the 2010 Oregon
Address: PO Box 4188 Solar Installation Specialty Code checklist.
Tualatin OR 97062 Permit Fee(includes plan review $180.00
City/State/ZIP: p and administrative fees):
Phone:(6JO ) yr2 590L Fax:( ) State surcharge(12%of permit fee): $21.60
CCB tic.: g 93 0+ Total fee due upon application: $201.60
This permit application expires if a permit is not obtained
Authorized signature: within 180 days after it has been accepted as complete.
Fee methodology set by Tn-County Building Industry
Print name: ANAM Date: I 2 7��3 I *Service Board.
I:\Building\Perntits\BUP-RESPerrnitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicat• t
City of Tigard Date/By: j). ) / ;', ,,: T Pertmt No.: S�-- , ,,,I=
g 13125 SW Hall Blvd.,Tigard,OR 97223 d Plan Review/ �✓
Lt. I ^/ `� Other Permit
1 Phone: 503.718.2439 V t, i! �OL Date/By:
TIGARD Inspection Line: 503.639.4175 Date ReadyBy: Juns: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: _J-7,6. Supplemental Information
DIVISION
.v': , ' * . sa r ;IX "i .1 l ` 'f 0 .• � ro — Sfti KLIST
.. .,ry. z"a*. r.��.. w�W=° .� as , .�.
Mechanical permit fees•are based on the value of the work
Pi New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
q a ® ,. Value
'ems - .v....n,.., .✓ .,.. .A ,, :6,, .,. s' ..— x f � ,„ e x a . �ac,t'at Qatar �^f m�F° r �
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
'a ,7s) ti "e ' o y, pj A.I c . 1OlY Heating/cooling:
/�s 7'{ Svc S t Air conditioning j 46.75
Job site address: �r10
Furnace 100,000 BTU(ducts!vents) i 46 75
City/State/ZIP: 'rap) 0. 9129 Furnace 100,000+BTU(ductsivents) 54.91
Suite/bldg./apt.no.: L Project name: Heat pump 61 06
Duct work 23 32
Cross street/directions to job site: 7 9 i 10tm rod 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: Ktlol,SVE.,, I Lot no.: /8' Other: 23 32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
, � P�� e „,.„, w �- ' Gas fireplace/insert 33.39
�,r S r., Flue vent for water heater or gas
/V 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.i a a t s I . 1, 23.32
Environmental exhaust and ventilation:
Name: Blackwood Homes, INC Range hood/other kitchen 33-y
Address: PO Box 4188 equipment
Tualatin, OR 97062 Clothes dryer exhaust y 33 39
City/State/ZIP: Single-duct exhaust(bathrooms, 104
toilet compartments,utility rooms) 1 23.32
Phone:( ) Fax ( ) Attic/crawlspace fans 23.32
W °..G t 3N .AVi PERSbN, a Other: 23.32
Fuel
Business name: piping:
Blackwood Homes, INC SI4.15 for first four;54.03 for each additional
Contact name: PO BOX 4188 Furnace,etc. !
Address: Tualatin, OR 97062 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater /
Phone:(5l ) go. sox_ Fax::( ) Fireplace
I
E-mail: & , ,; , 6, f f Range
Ott � Barbecue
;hi�
'•,ten l . ir. .b = w,. _ ', Clothes dryer(gas)
•'k +tu_ , / t/vG Other.
Business name: ,L11 V t�
Address: Lb SOx ;.c I!, Subtotal
0 t� ,v G� O� Minimumw per%it fee fe0e)
City/State/ZIP: , Plan review(25%of permit fee)
Phone:(5U3) (OS'S- 0 2Z Fax:( ) State surcharge(12%of permit fee)
CCB lic.: u \ V \ 1q TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within Iso
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: t1 NjQ Date: 1 /124 23
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46113T((lll/02/COM/WI
Electrical Permit Application FOR OFFICE. USE O\l.l
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223UPI � � ,) an Review
i Phone: 503.718.2439 Date/B : Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: ice: 65 See Page 2 for
1 1 t'`�1`1) Inspection Line: 503.639.4175 Internet: ww#Efi 'ardior oi02"• Notified/Method: Supplemental information
..,, ke.... 057;.% .- &...�7 -OW. ..f,�.i.• i _r��2. �' ,..`� '�,=x• ..ers'i. �:...N ,".... .,., ' k` .,� �' w,
New construction 0 Addition/alteration/mai:410A! I`l Ru Please check all that apply(submit 2 sets of plans w/items checked):
Q1 41; gy' GI� IICN ❑Service or feeder 400 amps or more ❑Building over three stories.
DDemolition ❑Other: J where the available fault current 0 Marinas and boatyards.
:, y� I exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑installation of 150 KVA or
-' , .. s` + i R 0 Emergency system. larger separately derived
,, . . . s f � 1 ram- fix, o of newmotorload of system.Pa Y
/Sc7L/ SW 6'fii 'I v` CT ❑Additi n oa
Job#: Job site address: 0 1. 100HP or more. ❑"A","E","1-z", I-3",
0 Six or more residential units. occupancy.
City/State/ZIP: �)(y (� 0 9,�y 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: '7q 1"1} To LAIToiJ ..:?�. " > - . .. .,.. , '1, _:y ,
Description -,, ._ I QtY• Each I Total 1 *
New residential single-or multi-family dwelling unit.
Subdivision: g Q11..a0 , Lot#: ! r Includes attached garage.
1,000 sq.ft.or less / 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion q 33.92 1
,_, Ai . '_ _..., ,.:, < .. . , + Limited energy,residential
Alsr f F. (with above sq.ft.) i 75.00 2
r�J 1' Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
fir,* , ,, Renewable Energy ❑ See Page 2
2: t_�> O� tt .2•,-P+�" 4 . ' z-- - Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less ..4-- 100.70 2
Blackwood Humes, INC 201 amps to 400 amps 133.56 2
Address: 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
• Branch circuits—new,alteration,or extension,per panel
"�` �p���"T � �' � �°� ������`l��`"' A.Fee for branch circuits with
Business name: S V 14V'1� �I 4L above service or feeder fee,
v each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: SR, toG,0 Y" service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
,.2 f.. .,� ; .,. .. . • .> 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, SUITED panel,alteration,or extension.
I Each additional inspection over allowable in any of the above
City/State/ZIP:VANCOUVER, WA 98661 Additional inspection(Ihrmin) 66.25/hr
Phone:971-222-5758 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial f hr min) 78.18/hr
Inspections
Email:PETER@SUNLIGHTELECTRICINC.COM for rw which no fee is 90.00/hr
CCB Lic.:172549 Electrical • 2 Suprv.Lie.:6652S specifically listed(Y:hr min _v
Suprv.Electrician signature,requi : Subtotal:
Print name:YEGOR , . .EN f Date:01/25/2023 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: itr 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 permit.
1:\Building\Pennits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Plumbing Permit Application l r
Building Fixtures � E .E [SI oyLv•
Received
City Oi Tigard ; telly: Permit No.:instea 3-L >4l k'
IIII13125 SW Hall Blvd.,Tigard,OR 97223 (}4-'(.„
e - Ian Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A It In Inspection Line: 503.639.4175C ' �r)Read/B Juris: ® See Page 2 for
Internet: www.tigard-or.govI ����� ethod: Supplemental Information
,s " F t- �E .- �a r w-0 y a,-4c I'itd «
' {construction,..c,ey w �e.o+. �. S ,' , ��§ "„ � sy •_ •`ry_f`.a. . '4x. .•
L'J New ❑Demolition 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)
y '1 r c c) 2 t 'is v C€i "6 `dz ' SFR(1)bath 312.70
Pi 1-and 2-family dwelling IDCommercial/industrial SFR(2)bath 437.78
SFR(3)bath / 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen / 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
4 "` re •At ;toys°4i t t< t,t n (`i'i;i'C, s l`; '�c. a ',.„�' Site utilities:
Job site address: l J s 7y s W Lc �a C - Catch basin or area drain 18.76
City/State/ZIP: ���,��� OI� f�'��j„t� Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: l Project name: Manufactured home utilities 50.03
Cross street/directions to job site: _]l ill It (mro� 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: g,koo to-i- I. Lot no.: `�'/ Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
T�,=, = s = Backwater valve 12.51
25.02
!_ Clothes washer
r K Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
#rt , .Ri `77, a , R C r- x:! s, a t Expansion tank 12.51
Fixttre/sewer cap 25.02
Name: 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
; ` o f 11� = Interc tor/ ease tra
�� �s t�t�F t Via$ G�� r�t�t r�u^� �}s�r el) � P 25.02
Business name: ik • G W je(,,J m girt r� Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: S i 4 tit 01 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
Water closet 25.02
k
. Water heater 37.52
Business name: 1'\a, (` P L i f l\gv4( i Water piping/DWV 56.29
Address: /60 so rZ l FL. W A v Other: 25.02
� u� 1 City/State/ZIP: ( >J Subtotal
Phone:(,O 3) 11 9 9 q Fax:( ) Minimum permit fee: $72.50
CCB Lic.: /61(p 99 Plumbing Lic.no.: t"g Plan review (25%of permit fee)
State surcharge(12%of permit fee)
"Authorized c- .- TOTAL PERMIT FEE
signature: Date: f Z'�I,�3 This permit application expires if a permit is not obtained within 180 days
i after it has been accepted as complete.
Print name: 0 4 11,1Dr *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PamitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
f
a wilding Division
IN
One & Two Family Dwelling LinTICARD Fees Checklist -
PERMIT INFORMATION: Application Date - FEE VERSION 1 1 Y 7Ol
Permit #: mS-r W„_06 Le ( (6 Plan #:Door L Vs._ Floors:
Valuation: Covered Porch: _ Basement
Bedrooms: Deck: tibb 1" Floor US
WC (toilets) 9 Deck Cover: ----- 2nd Floor 1 o V
Lavatories S Patio Cover 3rd Floor t o/
Tub/shower � Accessory Struct. R-3 Total a
Water Heater ( / Gas / Elec Garage -7 3
Exhaust Vents 7 Gas Flue Vents Total for Elec. 2�\
1 ,
Fu
Backflow Prey. rnace Heat Pump AC � J 1# for Electrical
BBQ ------ Gas Fireplace _ -- #Fuel Lines 3
FEES: Description: Fee App ' s: Fee Entered:
DC Prov Revw: Planning
Info Proc/Arch: Lg$2.00 (over 11x17) '21 t?lv.\- 1 1'..?� ��
Info Proc/Arch: Sm $.50 (up to 11x17) Ca - " �
Metro CET: Residential Use p
School CET: District: \c��
Tigard CET: Admin
Tigard CET: ODHCS
Tigard CET: AH
Electrical Permit: Permit Fee:
Limited Energy:
12% State Surchargerz
Mech. Permit: Permit Fee:
12% State Surcharge ✓
Plumbing Permit: Permit Fee: /
12% State Surcharge
Erosion Control: w/Permit - Ping
1:ABuilding\Forms\ResPlanCheckFees_Dec2022_gA.doc 12/21/22
Pagc 1
City of Tigard
II$ eCOMMUNITY DEVELOPMENT DEPARTMENT 11
• Building Permit Review - Residential
TIGARD
Building Permit #: /11 S7l 20.1-3--OOG-1
Site Address: Ic 1 -t S Ii. U A( 1 ? CX erified in Accela
Project Name: `c(2„01:7.-C10e- S�`,`u--',`,V`iSr�� Lot/Unit #:
Proposal: Nai 1�o to ,-K- Zone: t 2 Qi'I
Housing Type: 0 SFR(0 Single Detached 0 Duplex 0 Triplex 0 ADUk..glouse❑Cottage Cluster 0 CYU ❑Quad 0 Other
Revd Site Plan Elements:
/ 3 c e f site plan on max 11x17"
A a to standard scale ained trees, drip line/ tree protection
arrow Street and site trees shown / labeled CWC-LUQ-
• • e a dress, project name, lot # y �1�
• eet n es (N/A for SFR) ` UDR
0Cw- - I0 dimensionPd (if applicable)
1
A cant name and phone # � ,_�-- - 9 Pf� )
of and setback dimensions e.= """=�"` • 'g " C72/P
. � - ti ocations &easements >
otpri f new structure and FFE learly visible topo lines and property corner elevations
S' alk/driveway dimensioned ❑ L i .4 1,006 sf distar•berrrce)
of area and lot coverage percentage IPM,Ei-osion control
Requir d Elevation Plan Elements:
(For S • calcs needed only on street-facing) Su ry table with calculations for:
r n to standard scale façade area
uil g height dimensioned 2'Total window and door area
Cade dimensioned
l21\ • ows and doors dimensioned
i Garage doors dimensioned
Required Floor Plan Elements:
(Not rewired for SFR) ❑ S mary table that includes
story dimensioned T floor area
ach story floor area calculated loor area per story
Planning Review
The following standards have been met:
Setbacks 0 Front: IC Rear: IS Side: S— Min/Max Street Side: /0 / Garage: 2.0
I
Hei 0 Max. Height: _ Proposed Height: SN
Yes ❑ N/ Landscape
❑ Y /A Screening (Quad only)
N/A % Window Coverage
Y 0 N/A Garage (SFR Only) Parking (Other Res)
❑ N/A Entrance (SFR, Rowhouse, Quad only)
Yes 0 lI Other building design standards (Rowhouse only)
❑ Yes N Accessory Structure Standards
O Yes o Qualifying pre-existing unit exempt from standards (Cottage unit only)
A i - nal standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
s ❑ N/A Unit Count: 9-
Yes ❑ Lot Width and Size
❑ Yes N/A Pathway 0yi4 fIN roa970ti1 ,i t. 00/ ` LA()cr)
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
O Yes N/A Fence
❑ Yes 0 N /A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995) 1
❑ Yes o ON/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes 0 No W1,/ /acdr-
Applied For: 0 Yes 0 No, stop intake �lT"�'" I TIC
❑ Sensitive Lands: 0 Yes 0 No_❑ Main Land Use Case #s: 2.c Z — � onditions met
❑Applicant notified of land use expiration date: 1 a - iy / - nt,L 'B - fl/i4-/e2
Approv d By Planning: Date: (2/f /Z
Notes bUrbU)C PirraCIA-eO TO LOr . Qcvo (i29iet(t14,-) ft 13e- Sjornirr a 'I h KeNta
Revision 1: ❑ Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Building Permit Submittal
Original Submittal Date: I Z/tu/-7n7 3
Site Plans #: ?�
Building Plans #: 3
Building Permit #: 4ui1ding permit # entered 9h page 1
Workflow Routing: Planning Engineering of Permit Coordinator CQ Building
Workflow Sign-off: 1,ign-offg for Planning (include notes from planning review)
Route Documents: ngineering: (1) copy of permit application, (1) site plan, (1) building plan
a d original plan review routing form.
Building: original permit application, site plans, building plans, engineer and
eam calculations an trust details, if applicable, etc. /
Permit echnicia Date: ;". l"t ( Z�
• ,
Notes: �'t.L plan Y UJtlI Lua6 raw � ta, -4�i z1/J t
fix Piimi dIwA± rA - Pt P P .
Engineering Review
❑ PFI Permit:
Slope at building pad:
[onditions met prior to issuance of permit
r.'Easements (encroachments) per engineering conditions of approval and plat
I<Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes 4Vo
Assess Water Quantity Fee in-lieu: 0 Yes WIN°
LIDA Facility on lot: 0 Yes no Add Fee: 0 Yes 0 No
❑ Final Plat Recorded
fJ NOT Approved: Date: 1420 3
Notes: //'fit- G .77:- 7 % ��i
Approved By Engineering: Date: 0e0/2
Revision 1: 0 Approved 0 Not Approved Date: `
Revision 2: 0 Approved ❑ Not Approved Date:
Permit Coordinator Review
onditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
•` NG Revisions Required: Date notified applicant: 1 - (ft •Z 4
r.
r��►C Exemption: 0 Applied for 0 Receivedoes not apply
■ DC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes 0 N/A Deferred
Parks SDC: Yes 0 N/A Deferred
LIDA Yes \pA/A
•� ,OK to Issue/Approved by Permit Coordinator: . C? Date: , lb L`4
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date: