Permit (11) INCITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2023-00619
Date Issued: 02/05/2024
T E CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112CA15900
Jurisdiction: Tigard
Site address: 15590 SW BELLAGIO CT
Subdivision: BROOKSIDE SUBDIVISION Lot: 19
Project: Brookside, Lot 19
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: 706 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 34 Bathrooms: 4 Second: 1033 sf Garage: 304 sf Front: 15 Smoke Yes
Dwelling Units: 1 Third: 1052 sf Right: 5 Detectors:
Total: 2791 sf Value: $489,732.87 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
Other Fixtures: 1
Drywell-Trench Drain: 0
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!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 SFA VB R-3 2791
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: $22,885.90
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility otification Center. Those rules are set forth in OAR
ori9-nn1-nn1 n thrni,nh nAP oc ..nnl-nnan Yni I rank/nhtain a rnnk/of tha nJoc nr rlirart ni iactinnc to ni ii'JC h,ra 3 9'49 1QR7 nr 1 Rem'3Q9 9341
Issued By: - e,..4 Permittee Signature:
all 503.639.4175 by 7:00 a.m.for the next available inspection ••te.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
7
Building Permit Application
I O► I I( I 1 S1 ON 1
City of Tigard ,� '4( I% ', a di /).- i 75 _ Permit No:f$'i�i}yv�3 ( 17
13125 SW Hall Blvd.,Tigard,OR 97223 `� Plan Review �q/�� ether permit:^ �,- r1�
8 Phone: 503.718.2439 Fax: 503.598.1960 DECRate/By: i 2� r Ca Y ' r `' V 0 T 5
Inspection Line: 503.639.4175 D 1 '` 2ULbate Ready/By: �11�e�i�� ® See Page 2 for
I I(�A F I) Notified/Method: 1 • I �1 tJi • I SapPkmental Information
Internet: www.tigard-or.gov
ar srkRo 4 ,.' I i k ik . „
r -, '' -4* +' x4,' ,, , ;,. -..--;0 " t .s,:`iF '�'_' at°i x i it r ,, ?fi.fo Y• t,',, rim "a Ni,` a:i"
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
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
(-a
` ." � CATEGORY°oF`:GOI�TS')C'kiJCTi()N°':�"
Valuation: 43
$ Ltgl -;�t
and 2-family dwelling 0 Commercialihdustrial
\. Number of bedrooms: 3
❑Accessory building 0 Multi-family
Number of bathrooms: y
❑Master builder 0 Other:
JOB SITE I R1V�ATI NFO $ Total number of floors: 3 3'09 5
. . �ON AND LOCATION
Job site address: /c590 5 W- UtL C-10 <: New dwelling area: 2-79 1 square feet Los
City/State/ZIP: r c,i) 0 77 2-24 Garage/carport area: 3 Oil - square feet �,033
`�—
Suite/bldg./apt.no.: -Project name: Covered porch area: f ��� square feet —70(a
Cross street/directions to job site: -7 9 ID L.4 l VrJ , ,,Deck area: " square feet
Other structure area: square feet
. Q 1*7. O _ ' 1; MIST
t
Subdivision: $ko I Lot no.: /9 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
; - ‘l ..
,„� '411 ` ' = ,.. }X * ,1y work indicated on this implication.
NSr^ ^ cT /,zKA.e," ct .,e1)►(/ Valuation: $
Existing building area: square feet
New building area: square feet
i1PRQJ'E�RTY O% _ a a 0 ,��4-1.4 Number of stories:
Name: Blackwood Norms; INC Type of construction:
Address: PO Box 4188 Occupancy groups:
City/State/ZIP: Tualatin,OR 97062 Existing:
Phone:( ) Fax ( ) New
. 1„R, n ,:x�- .ri; ±mw§ r=*k r w'^�.kP< S' :3;x iT-n , : ,' ..:
*' x.:t 1 - �� ' & c s f fki .l rIioti #4 .4e t',4 N5,oi 4 i i# "9 e�',
,r ,
Business name: Structural plan review fee(or deposit):
Contact name: Blackwood Homes, INC PO Box 4188 FLS plan review fee(if applicable):
Address: Tualatin,OR 97062 Total fees due upon application:
City/State/ZIP:
Phone ( ) 4 1 TA SgO1 Fax::( ) Amount received:
,, a "r' R .1;" ` 4
Email ,9 01, ,1 kh d � N Care Commercial and residential prescriptive installation of
"'. v ' r
• � • k�„ ;; rryx�,�g.,, roof-top mounted Photovoltaic 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.
Tualatin,OR 97062 Permit Fee(includes plan review $180.00
City/State/ZIP: t, and administrative fees):
Phone:(Sd3 ) 1 2 5 v0Z Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: !b 93 0 1 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.
Date: l I/..7 I Z 3 I "Fee methodology set by Tri County Building Industry
Print name: A Service Board.
1:\Building\Pemuts\BUP-RESPemvtApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
` /
Mechanical Permit Application FOR OFFICE t SF;ONLi
City of Tigard „� ,�
13125 SW Hall Blvd.,Tigard,OR 97223 fir n Review
'. • Phone: 503.718.2439 5""�' Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready By: ions See Page 2 for
TIGARD Internet: www.tigard-or.gov DEC 1 "i 202.E Notified/Method: Supplemental Information
. . , lea ; W ,ir ii-i14 a I i' `
� - t Mix r °..
New construction ❑Addition✓alteration/rrplace ent Mechanical permit fees•ere based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑ Other: mechanical materials,equipment,labor,overhead.and profit.
' , t GY14 ' value $
1-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building
For special information use checklist.
0 Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
1,'T A ,. I. a yyy ' ° z 4 p 04040, °. `. ,... ,,.. 1'; Heating/cooling:
Job site address: /5590 5 vI b(u.4C.-(,0 G7--- Air conditioning / 46.75
Furnace 100,000 BTU(ductslvents) t 46 75
City/State/ZIP: Tu f4, 0 9123.9 Furnace 100,000+BTU(ducts vents) 54.91
Suite/bldg./apt.no.: I Project name: Heat pump 61 06 I
Duct work 23.32
Cross street/directions to job site: 7 9 j'4 1p LAI 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: EK(IOKS‘o(v I Lot no.: /I Other: 23 32
Other fuel appliances:
Tax map/parcel no.:
Water heater 1 23.32
. .. . ' b a.':* Gas fireplace/insert 33.39
Sr^ 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/flue/vent 23 32
y At T'1'fx 4, 1 Other: 23 32
Environmental exhaust and ventilation:
Name: Blackwood Homes, INC Range hood/other kitchen
Address: PO Box 4188 equipment 1 33 39 1
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
' .,.. .... . tt <.f Cp AC",f:=J'EYRSON' Other 23.32
Business name: I,,., Fuel piping:
Rlackwood Homes, INC $14.15 for first four;S4.03 for each additional
Contact name: PO BOX 4188 Furnace,etc. f
Address: Tualatin, OR 97062 Gas heat pump
City/State/ZIP: Wall/suspended/unit heater '
Water heater
Phone:(64) y(2 S$01_ Fax::( ) Fireplace
E-mail:• • , , , 1 , a tAik Range f l
Barbecue
y :M g_ Clothes dryer(gas)
Alf( ct,, ft to j / /A L then:
Business name:
To $QX xq I/
Address: U t0 Subtotal
City/State/ZIP: 0 G01a C.N r a Minimum permit fee($90 00)
Plan review(25%of permit fee)
Phone:(503) 6SS. 0 2.2, Fax:( ) State surcharge(12%of permit fee)
CCB lic.: ( 1 \ 6 , 31 1I /�/ TOTAL PERMIT FEE
1 �J" This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: e��"'_
--•.e,� • Fee methodology set by Tri•County Building Industry Service Board
Print name: U_yN Date: 1 //21 2 3
I:\Building\Permits\\BUP-RESPermitApp.doc 02/24/2011 440-46113T((I 11/02/COM/WE
Electrical Permit Application FoR OFFICE USE ONLY /7
City of Tigard - •
`Date�sea v ,
IN
It g
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review a
111 Phone: 503.718.2439 D E C 1 ,! 202;/ DatelB
Related Permit#:
Email: TigardBuildingPennits@Tigard-or.gov Ready Date/By: Jris: ® See Page 2 for
i I :1 R D lemental information
Inspection Line: 503.639 4175 Internet: www tm ard-or ov Notified/Method: Supp
IT 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 0 Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
.A Zr1ON <_: : =' M , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-family dwelling 0 Commercial/industrial ElAccessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi family ❑Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
x "w . ,, " � ss 4,3 '", ' §^ 't 0 Emergency system. larger separately derived
p 0 Addition of new motor load of system.
Job#: Job site address: /.�0. 51 .1 <D.CL#&10 ( . 100HP or more. ❑«A„ «E„ <`I-2""1-3„
rn,� ❑Six or more residential units. occupancy.
City/State/ZIP: �'�T�J O� 1 a �y 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldgP Project t.#: Pro ect name: ElHazardous locations. 0 Supply voltage for more than
1 ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 70111 Tb (Alp :%" ,,,. s": # ;,,tl *„ r „ 's y-'y
Description Qty. Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Skotta01. Lot#: Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 5 33.92 1
.+ ;; D I 'I: , _, ,,.. Limited energy,residential 75.00 2
\
r v Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
_ s r � � Renewable Energy ❑ See Page 2
<�_ ,! 00.. .. m _ter_ -. , ,- Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 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 stgnature4 Date: 401 amps to 599 amps 168.54 2
x ;. . Branch circuits—new,alteration,or extension,per panel
, p tc.�NT ::. i„.. :° w. it. - A.Fee for branch circuits with
Business name: , � above service or feeder fee, 7.42 2
s v) ("t(a`� ` r�I r�L each branch circuit
Contact name: B.Fee for branch circuits without
Sot t tul _t service or feeder fee,first 56.18 2
Address: Y 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
' • +;' <z °a_, x` 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 El See Page 2 2
Address:2804 NE 65TH AVE, SUITE D panel,alteration,or extension.
j 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:071-222-5758 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:PETER@SUNLIGHTELECTRICINC.COM Inspsctionsal 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 SY:hr min w
Suprv.Electrician signature,requi : Subtotal:
Print name:YEGOR , ..EN Date:01/25/2023 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: ' f 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.
I:\Building\Permits\ELC PermitApp ELR_ERE.doc Rev 06/17/2015 440.4615T(11/05/COM/WEB
Plumbing Permit Application / /
Building Fixtures 1 OR OFFICE 1;SE oyLv
City of Tigard 17-CEIVPD
EVieW tNo13125 SW Hall Blvd.,Tigard,OR 9•2237
I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I GAR!) Inspection Line: 503.639.4175 L s ' 1 .Y 2O2 a, Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
r y .
r 1 "' 7,,.' °`E!,;I rQ 1.,, i 8..0, / t T *2 �t^ '-," .4 i. ••••-..z, z. 7rl • "`. f.t f t k _sx.. -,-
'191 r,i t r" For special information use checklist
L'J New construction ■ Ddrnbtlt € 1 l � l P f
Description I Qty. I Ea. ( Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
AM r s a a f a- ''',I-,;,',",;',..1,,,- r ,` . 3`- SFR 1 bath 312.70
,t !,!} -) c ' t ) .e ( )
DI 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath / 500.32
0 Accessory building 0 Multi-family•
Each additional bath/kitchen / 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
1 a • . :*`t. 'g.;# ': g i't.i';',''ZI'0;i?t e _r e j ,: -, :?.i1 M Site utilities:
Job site address: /56-90 S v4 1.t LUMAI CACatch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: T 16-A&fl 0 t 9� 91 2-2-q 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: 1 ill ( f(/pJ 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: gh0 t0i_. I Lot no.: C 7 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
t .- .v., < 7•r , t" • 4 s ,"'�"' • '',-" r:4.37. Backwater valve 12.51
r��6: 1 Clothes washer 25.02
__
r K Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
( Expansion tank 12.51
r... Fixture/sewer cap 25.02
Name: Blackwood Homos, INC Floor drain/floor sink/hub 25.02
Address: PO Box 4188 Garbage disposal 25.02 1
City/State/ZIP: Tualatin, OR 97062 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
b. ';, z `11.�--`J r c: r w 1. F ` Interceptor/grease trap 25.02
,._.-:0- ::.-..,'.'...--Business name: u • G, j win��A(� Medical gas(value:$ ) Page 2
l Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sid 6titv.1 Sink/basin/lavatory 25.02
City/State/Z1P: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
37.52
Business name: V\! l(' IP /�g�G. Water piping/DWV 56.29
Address: //_O so RI
F� ` 'Wtill Other: 25.02
City/State/ZIP: 0� 4 (Ail Subtotal
Phone:(SO'?) ill. 9 2 q 14 Fax:( ) Minimum permit fee: $72.50
I J n Plan review (25%of permit fee)
CCB Lic.: /66,99 Plumbing Lic.no.: t"gs (12%
- State surcharge of permit fee)
Authorizei { TOTAL PERMIT FEE
signature:
Date: f 1 [2,7/2) This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
Pn name: /i a�" �Q r *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)
s
14 III
Building Division
One & Two-Family Dwelling �� C
TIGARD Fees Checklist
PERMIT INFORMATION: Application Date - FEE VERSION 1J1 r 7.4Z
% 7i
,S�
Permit #: rr\ 2 ?� f
a b Plan #:
kl Doi- Floors: 3
Valuation: Covered Porch: _ Basement
Bedrooms: 3 Deck: �2.., 1s` Hoot —70ca
WC (toilets) Lk Deck Cover: 2°' Floor 3.'-
Lavatories 5 Patio Cover ------ 3rd Floor 1 j D-
Tub/shower 3 Accessory Struct. -- R-3 Total 21 41
1 s7Adk-- Water Heater 1 /0 Elec Garage 3D`4
Exhaust Vents 7 Gas Flue Vents ------ Total for Elec. ' o95
Backflow Prey. 4 / Heat Pump AC ) # for Electrical S
BBQ ------_, Gas Fireplace #Fuel Lines
2 c_ * .__ wc,4
FEES: Description: Fee Apples: Fee Entered:
DC Prov Revw: Planning �J
Info Proc/Arch: Lg$2.00 (over 11x17)
Info Proc/Arch: Sm $.50 (up to 11x17) X----„,
Metro CET: Residential t3se
School CET: District:
Tigard CET: Admin
Tigard CET: ODHCS
Tigard CET: AH
Electrical Permit: Permit Fee:
Limited Energy:
12% State Surcharge
Mech. Permit: Permit Fee: C.
12% State Surcharge 4.7
Plumbing Permit: Permit Fee:
12% State Surcharge
Erosion Control: w/Permit - Ping
1:ABuilding\Fonns\ResPlanCheckFees_Dec2022_AA.doc 12/21/22
Page 1
City of Tigard
71 q i
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #: ►en,ST 'Z4-3"'(>'( l9
Site Address: Ic if S I;3 13aLIMC, CJ- erified in Accela
Project Name: (Z(); __ r visv0fl Lot/Unit #: n Lci
Proposal: N t-V) t0� OC Zone: R4 121(2+t-0
Housing Type: ❑ SFR(❑Single Detached ❑ Duplex❑Triplex❑ADU owhouse❑Cottage Cluster❑CYU ❑Quad ❑Other
Reqyired Site Plan Elements:
2 3 c e of site plan on max 11x17"
rC] a to standard scale ained trees, drip line / tree protection ` ,
arrow Street and site trees shown / labeled 6r1cosC -C
' e a dress, project name, lot # YyJZ
eet n es (N/A for SFR)
�/
A cant name and phone # icable) (1-6Y11 ,\-- I. jY
of and setback dimensions
ility locations &easements P-01
otpri f new structure and FFE leariy visible topo lines and property corner elevations
S' alk/driveway dimensioned '2-/O,i
of area and lot coverage percentage rosion control
Requir n d Elevation Plan Elements:
(For S • calcs needed only on street-facing) Su ary table with calculations for:
r to standard scale Thal façade area
uil g height dimensioned ,H'fotal window and door area
fade dimensioned
tti� ows and doors dimensioned
Garage doors dimensioned
Required Floor Plan Elements:
(Not re,puired for SFR) ❑ S mary table that includes
a 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: is Rear: 1S Side: Min/Max Street Side: /0 / Garage:
l I
Hei 0 Max. Height: Proposed Height: Li
Yes ❑ N/ Landscape
❑ Y /A Screening (Quad only)
Y N/A 0/0Window Coverage
Y 0 N/A Garage (SFR Only) Parking (Other Res)
Y,e(-❑ N/A Entrance (SFR, Rowhouse, Quad only)
Yes 0 Other building design standards (Rowhouse only)
❑ Yes N Accessory Structure Standards
❑ Yes o Qualifying pre-existing unit exempt from standards (Cottage unit only)
A 1 " nal standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
s 0 N/A Unit Count: '9-
ieti
Yes 0 ► • Lot Width and Size
❑ Yes • N/A Pathway 61A01 pQ v_0..,�,,, S / 0141
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
/V r r2043
O Yes 0 N /A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995) Fx
❑ Yes o ❑N/A Public Facilities Improvement (PFI) Permit: f
Required: ❑ Yes 0 No u3 , ( .
�
Applied For: 0 Yes 0 No, stop intake kezp rats q'ti'E'
O Sensitive Lands: 0 Yes 0 No
O Main Land Use Case #s: 1Z2—2. - C-- onditions met
Z
❑ c Applicant notified of land use expiration dat • 112 O f4 N 3y OW C, I p F-,nc,L By ///i"��t$
Approv d By, Planning: �� ----� Date: /2/I sK/23
Notes IANi'D Ujil /p-A u*eO TO LOT- / V ae>112 a(xi CY) i .Sv i3 M i r i o o i2. 'rt 33 Kiz.`n ,!
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Building Permit Submittal
Original Submittal Date: t 11,1/1 ?��a
Site Plans #: 3
Building Plans #: ;I)
Building Permit #: 1uilding pert,it # entered op-page 1
Workflow Routing: lanning g Engineering [Permit Coordinator Building
Workflow Sign-off: (Si Plgn-off for Planning (include notes from planning review)
Route Documents: Engineering: (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.
J
Permit Technician: r�' Date: a f'� 7-3
Notes:, (141 Y(,d,)I I um( �L 1-iu, gope lA U2C f pL,C 04 tivv
Engineering Review
❑ PFI Permit:
CfIope at building pad: ok
'"Conditions met prior to issuance of permit
fa'Easements (encroachments) per engineering conditions of approval and plat
®'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes W,No
Assess Water Quantity Fee in-lieu: 0 Yes C'No
LIDA Facility on lot: 0 Yes KNo Add Fee: 0 Yes 0 No
I inal Plat Recorded 4kNOT Approved: !f7vi' 4 4o k P{74/ S/ G Date: -/ /
/
Notes:Approved By Engineering: Date: ///m�2 9
Revision 1: 0 Approved 0 Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Permit Coordinator Review
❑ Conditions met prior to permit issuance
O Approved, NOT Released: Date notified applicant:
NG Revisions Required: Date notified applicant: A-O �-
.SDC Exemption: ❑ Applied for ❑ Received 'I(Does not apply
vpSDC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: Yes 0 N/A G Deferred
Parks SDC: Yes ❑ N/A E Deferred
LIDA ❑ Yews` C/A \
94OK to Issue/Approved by Permit Coordinator: IA9 Date: 1' ) a ZLr.
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date: