Permit (12) CITY OF TIGARD MASTER PERMIT
ii
2, COMMUNITY DEVELOPMENT Permit#: MST2023-00620
Date Issued: 02/05/2024
Ti cA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112CA15300
Jurisdiction: Tigard
Site address: 15569 SW BELLAGIO CT
Subdivision: BROOKSIDE SUBDIVISION Lot: 13
Project: Brookside, Lot 13
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 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!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 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 2 Fire Rated Conditions
PHONE: PHONE: 503-482-5802
FAX:
Total Fees: $22,637.97
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 requires you to follow the rules adopted by the Oregon Utili ,otification Center. Those rules are set forth in OAR
ac9_M1-nnln thrn,,nh(-)AR oc2.nni_nnonn Vnu htain a rnnu of tha nIlac nr rlirart nnactinna to(II iMC by rani ,(Y4 919 10R7 nr'I Rnn 119 914.d
Issued By: o /7 Permittee Signature: i War
Call 503.639.4175 by 7:00 a.m.for the next available inspection dal.
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.
13
Buildin2 Permit Application
i, t1;a1 ,ir
3, 7#-'' Received , / ,/ Permit Nor��'� �
City SW Tigard . Dace/By: //�
13125 Hall Blvd.,Tigard,OR 97223 `' Plau Review i�. . � `�► Other Permit: •j:Ai PZ/2A2 - `;1-1 e_-�
i Phone: 503.718.2439 Fax: 503.598.1960 '- Date/By: /�7�' „ ® Page 2 for
Inspection Line: 503.639.4175 t�3 9)' Date Ready/By: wag 2 forormatioo
l I(•11 1) Notified/Method: k 0 Stipple
Internet. www.tigard or.gov EM At
N.,w' v+ 41.t.J'P' i� r-f •) Aptk,'-- ' UM � ..
h `" h`.., 44xa.,a .. y.
New construction 0 Demolition Permitfees*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
work indicated on this application
,. "CATEGORY
an
i .OF COPiS!'1tltJCTtON`"
Valuation: $ cf`go 566 t
d 2-family dwelling 0 Commercial/ihdustrial
Number of bedrooms: 3
❑Accessory building 0 Multi-family15-
❑Master builder `
0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION N Total number of floors: 3 S 0 l
x Job site address: O/5561 55 !7,� Cr New dwelling area: 27LI square feet t OW
City/State/ZIP: —ri “) 0? 7 7 2.2' Garage/carport area: 213 square feet d 02b
Suite/bldg./apt.no.: Project name: Covered porch area: square feet Loci
Cross street/directions to job site: 7 9 714 lb UfaTopiDeck area: 1 tip square feet
Other structure area: square feet
Subdivision: .$c& Lot no.: (3 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
"?--r1 work indicated on this application.
y NS
Valuation: $
Existing building area: square feet
New building area: square feet
,f °- '"' '` " ` f Number of stories:
.2, ,.PR�3PER O P . .. 4:t mow. =a,i,,, 144 ... 'i Rf,•. t
Name: Blackwood Homes, INC Type of construction:
Address: PO Box 4188 Occupancy groups:
City/State/ZIP: Tualatin,OR 97062 Existing:
Phone:( ) z Fax ( ) New:
a, ,v eW : ''' 0Nco -e-"#. .<R B ; 1.� 1 `:9,'a,. �';t
P)El�SON^�
,_��r .`tZ�ft�aotnofedselidatlt��.14.,, ,,.`
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/Z)P:
Amount receives:
Phone:( ) iir 5i0� Fax::( ) :
Email 'p(,k(y,►pn \9 t1)1 J Cara Commercial and residential prescriptive installation of
'� y a�+, a '+� x4 M .+: q r'.e'�r `t�Kr, +�s�c=x,.
',_. ;., .i :: `= :, �, ..x . . sac i' s . 40 ' .. roof-top mounted Photovoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name: Blackwood Him. 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: and administrative fees):
Phone:(503 ) NQ"Z 590l. Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: /G q 3 01 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 Tri County Building Industry
Print name: "1'`'s' mpig , Date: �I1��, Z3 Service Board.
I:\Building\Petmits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
13
Mechanical Permit Application FOR OI F1('1•:I SE OI \
City of Tigard Received Permit No. ) l 4 9.4„
IN13125 SW Hall Blvd.,Tigard,OR 4�323 a Plan Review
Phone: 503.718.2439 _ 4 1 T Date/By: Other Permir.
'' = Juris. Pi See Page 2 for
T►GARD Inspection Line: 503.639.4175 Date Iteadyisy:
Internet: www.tigard-or.gov �-l;. Notifted/Method: Supplemental Information
r `'
" O,,.' ' `1 1� ' ' -. . r. ..)t,*:iE,I7r tL' `USE'CIi C1(1
Mechanical permit fees'are based on the value of the work
Pi New construction ❑ Addition/altet`ationkrePfa enaent; _ , performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑ Other: mechanical materials,equipment,labor.overhead,and profit
j err Value S
1-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building For special information use checklist
❑Multi-family 0 Master builder ❑ Other: Description Qty Ea. Total
-., fi j S `,,e- - .fir
" $ g *t $ .. ,,eO� ! �-` ‘, . .,. .1,--- Heating/cooling:
/ 561 SV ). fl A C4O Cr Air conditioning 46.75
Job site address: 5 p I,IJ[ 46 75
Fumace i00,000 BTU(ducts/vents)
City/State/ZIP: 7 lf,kf,4) 0 9�2.9 Furnace 100,000+BTU(ducts/vents) / 54.91 i
���"`�� �� Heat pump 61 06
SuitePoldg./apt.no.: I Project name: 23.32
(Ail
y� Duct work
Cross street/directions to job site: 71 '14 10 Nl l Tod Hydronic hot water system 23 32 —1
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: 6KdotsS o i Lot no.: 1 3 Other: 23 32
Other fuel appliances:
Tax map/parcel no.: Water heater / 23.32
: 7 15:r . ' ti4t1 a': d -®...`:. :4 ,„:', f ; � .;t; Gas fireplace/insert 33.39
/
S r f 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 I
'o' fgNT" ±� M*,, ` .; Other: 23.32
Environmental exhaust and ventilation:
Name: Blackwood Homes, INC Range hood/other kitchen / 33.39
Address: PO Box 4188 equipment
Clothes dryer exhaust / 33.39
City/State/ZIP: Tualatin, OR 97062 Single-duct exhaust(bathrooms, s
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
ra i �,
� � �'� � l � � �� CC►I�AC,1'?1'IRSON Other. 23.32
Business name: Fuel piping:
Blackwood Homes, INC S14.15 for first four;$4.03 for each additional
Contact name: PO BOX 4188 Furnace,etc. i
Address: Tualatin,OR 97062 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:(Sa ) qd 2 SiO�,_ I Fax::( ) Fireplace
t Range I
E-mail: ! di j�
�- � Clothes dryer(gas)
Barbecue
�sx"� � ����'�" '.� ��, ` .�� r5' as
A Other:
Business name 41k �JIr(Aj1 , iN .. 5 --- ,.,
Address: To gm( xq 16 Subtotal
01`10K Minimumw per%it fee($90mitfee00)
City/State/ZIP: / Plan review(25%of permit fee)
Phone:(503) (o S'S-. 702a, Fax:( ) State surcharge(12%of permit fee)
CCB lic.: i 7 t p TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: C .� _g` I * Fee methodology set by Tri-County Building Industry Service Board
Print name:Ai tt..t.Nt Date: ) /i.24 2_3
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46113T((1111/02/COM/WE
Electrical Permit Application FOR OFFICE ESE O\L\
City of Tigard Received
. DateB : E ��-� -
IIII
4 13125 SW Hall Blvd.,Tigard,OR 97223) Plan Review Related Permit#:Phone: 503.718.2439 ,,` Date/B
Inspection Line: 503.639.4175 Internet: www ti ard-o Readyotid/ e t luris: S See t 2 for
Email: TigardBuildingPermits@Tigard-or.gov Date/By:
PageSupplemental Informationf
i 1 t A i l� Nohfied/Method.
g rg�ov pPe
r
Y s-. 0� >:.; .:a { 7�. i'bRk 1 :r. :.r,4.
Please check all that apply(submit a sets of plans w/items checked):
PI New construction ❑Addition/alteration/replacement ■Service feeder ,,amps or more ■Building over three stories.
❑Demolitions ❑Other: where die available fault current
■
Marinas and boatyards.
and 2-family dwelling ['Commercial/industrial ID Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
buildings.
KVA or
ElMulti-family 0 Master builder 0 Other: ■Fire pump. ■ 1
t r , .. ■Emergency system.
0 Addition of new motor load of system.
Job#: Job site address: /c,5 1 '51A S.ttifi i4 0-I 100HP
City/State/ZW: 7IGAN) 0 occupancy.■i q 7 22y ■ ■Recreational
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
■Service or feeder 600 amps or more. 600
�� yj
Cross street/directions to job site: �C' To -Z �� = w •"` i i,, `" 3: �' ' :-.
Description I�Qty. Each � Total
New residential single-or multi-family dwelling unit.
Subdivision: SF,00 IA t. Lot#: 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
i6. * "Vz.I 4 w. t, ` +r Limited energy,residential 75.00 2
Als.s, ., D1�r ff D (with above sq.ft.)
r 1� Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ElSee Page 2
c _- ti-4 ,' ..__. -, _ Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Name: Blackwood Hurries, 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
Over 1,000 amps or volts 552.26 2
Phone:( )
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
Date: 401 amps to 599 amps 168.54 2
Owner slgnature� Branch circuits—new,alteration,or extension,per panel
, A 04.64:'';, , ._ .; ., ,.•:-of141' -lei " il' A.Fee forbranch circuits with
Business name: Sv IY L,t� -, k,(rc above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
S(/L W '( 1 v iI n`Y_` service or feeder fee,first 56.18 2
Address: branch circuit
Each add'i branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) dwelling,service and/or feeder
Email: Reconnect only 67.84 2
, �:, , 44 • ' • V r A r*Pa, `".4 i Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Business name:SUNLIGHT ELECTRIC INC i Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2804 NE 65TH AVE, SUITE D panel,alteration,or extension.
I 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: Investigation(1 hr min) 90.00/hr
071-222-5758 Fax:( )
Industrial plant(1 hr min) 78.18/hr
Email:PETER@SUNLIGHTELECTRICINC.COM Inspections for which no fee is 9000/hr
Suprv.Lic.:6652S specifically listed(Y:hr min
CCB Lic.:172549 ''::EIs _ EI S `'.-
Suprv.Electrician signature,requi "t: �,� MIIIIIIIIIIIIIIIIII Subtotal:
Print name:YEGOR EN t Date:01/25/2023FINIIII 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
wry
,r TOTAL PERMIT FEE:
Authorized signature: a This permit application expires if a permit is not obtained within 180
Date:01/25/2023 days after it has been accepted as complete.
Print name:Peter Kozarez * Number of inspections allowed per permit.
I:\Building\Permils\ELC PennitApp_ELR ERE.doc Rev 06/17Y1015
440-4 615T(11/05/COM/WEB
15
Plumbing Permit Application
Building Fixtures ..°° ,. . FOR orrlrl: I SF 0y1.1
City of Tigard Received Permit No.: F
g Date/By: /n5-7d&g3_ �„.1t:
IN • 13125 SW Hall Blvd.,Tigard,OR 97223 F, Plan Review
■ Phone: 503.718.2439 Fax: 503.59811960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
TIG.4KD ��
Internet: www.tigard-or.gov a• ,,: .` --0 Notified/Method: Supplemental Information
,.r .« s* ^.f. ;"xa �' ,- „,4i "€''t 6.3'" '.1 i cix rs' erg* s'?i3'E..i' fi b - v--',. rf,q�;`t''w .''
l'I New construction ❑Demolition For special information use checklist
Description I Qty. I En. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
-, an . r , , h a r 7 ry. 312.70
` -..�,- -�0) t.. ,- E..els.', 3c rig.,,, , r SFR(1)bath
..._. 437.78
Di 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath
SFR(3)bath 500.32
❑Accessory building 0 Multi-family• Each additional bath/kitchen / 25.02
O Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
:C rr•
`, n "',:°':i0; -. („ , I E E e- r-t,.i i i i i t 6S y,,i' 1 ;w, ;:s .Site utilities:
� I�� �� 7 'r � 4 Catch basin or area drain 18.76
Job site address: (� �T lri0 C� Drywell,leach line,or trench drain 18.76
City/State/ZIP: T 16.AQ„,) 0 K 9127-1 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 6 `t mh ro>J 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: gko0V4t0 , I Lot no.: 13 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
�, ,�. ,- s �; -.. -*�+s •.3' ' > `3.t +"' ' ti' rc /, Backwater valve 12.51
. s� .._ Clothes washer 25.02
ic K Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
� c d ° ��4�K r e! 2t� ,R i _� ,.� €� ti�r t � 'T..' Expansion tank 12.51
. ._a _ a _ ,... ,., .- _. . . ,• w ,�, �., Fixture/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
r n �';i �i ,, t;, r l j 1 ti I \.c „ �j Interceptor/grease trap 25.02
Business name: lk • C.,. ,e LA,/n jl, G... ^Medical gas(value:$ ) Page
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Si¢ tiCa� 25.02
Address: Sink/basin/lavatory
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E marl Water closet 25.02
,,
a t d FLt' ,4 61z .
�... _ �. �,.. .� Water heater 37.52
Business name: V\4, !n Q(,.v/�g Gs Water piping/DWV 56.29
Address: /60 s0 (�l FL /l�(1�UI f I NI Other: 25.02
City/State/ZIP: 0 f.,.€s)opi (Ail Subtotal
Phone:(gyp 3) 1 l L ! 1 i{ Fax:( ) Minimum permit fee: $72.50
1Y1 Plan review (25%of permit fee)
/
CCB Lic.: f0 9� Plumbing Lic.no.: p �� State surcharge(12%of permit fee)
Authorized -'- TOTAL PERMIT FEE
Si6'rlatrae: Date: l'(21 (23 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
iQrCq Trim name: �` � *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PamitApp.doy I0N1/09 440-4616T(10/02/COM/WEB)
� Building ^ ^
Division� �on
One & Two-Family� Dweffing
l[lG/\8D Fees Checklist
-^�
%n�����1I7[ I��%�K�}��1/�1�IK���: Application Date - ���|� V>�|��1K��� �]J,
Permit #: __C)y\\ ~7r` Mun #: [lo.,rs �L
\'x|uxri,m: C'`,czrJ l`.«J`: _-- - \\usconco/
UcJo (.oa: l)eck: | ���� \° Fk^,r
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Y�(� (u`Oxo) Dcck (>`,ccl"^ |')'`or \ r`
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-urou.rics l�^ |`um` (/,rcr �
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l@`/�hunc, '�� \ccc,x`rT /nvcr� u ~7
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Fz6num \'ons ~7 Gas |']nx \'eow ---------' Tom\ 6.r [|rc. \
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8ack8ov ]`rr,� --_ Uum \`oro� # 6,r |]cctricnl
DD() _____--~ {�x/ tbcplac, _____--� #|`�ue| Liles
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FEES: Description: E/oe Entered:
l)(" yn.r Kcrvv:
\n6. l`u`c/\rch: |`g S2.00 /"`er ||x|7) '
\o6o Pu,c/'\och: Sri-) S.50 (op to, | |Xl7)
hJcuz` C| Residen6a)
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Sch.xJ ("[Y: l}ixujcr: \
Tigard (]!]�� '\dn�n
]'i uzJ {'L']��
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IigurJ (]YT:
[|rcrricx| Yeonir: }`ccrmit [cc
Limited [oergy:
l�� State 8mcharr
-
N|ecb. Pczu PurortFcc
}2�� State Surcharge
P|unib6ngPeruzr Permit Fee:
12^� State Surcharge _
1ropioo [noun`L ,v/yczu-u/ P)ug
xmr Lino axa|c"�/`cc 2()22_��.d« 12/21/2/
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City of Tigard
71 a
" COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #: MST-90--3—L,Lde
Site Address: _ ,5 Sin) 13 Lc.W'1O Or erified in Accela
Project Name: '0(zoorx1 O slOCk V1SiOn Lot/Unit #:
Proposal: NW INITALki0 E.0i U<- Zone: 2 R -0
Housing Type: 0 SFR(0 Single Detached 0 Duplex 0 Triplex 0 ADU)i.Lefowhouse DCottage Cluster 0 CYU DQuad 0 Other
Required Site Plan Elements:
.Z 3Iof
site plan on max 11x17"to standard scale Strained trees, drip line/ tree protection
arrow eet and site trees shown/ labeled arJLs_•'Q
_n ' e dress, project name, lot # y i � �
eet (N/A f r SFR) tJ.FR zcZ
A cantn name es and phone # icable) >c.cl �Z
of and setback dimensions clearance triangle u"nlg'7/73 L'/
.itity locations &easements ever 12 A>
otpri of new structure and FFE Wlearly visible topo lines and property corner elevations
S' alk/driveway dimensioned
=entristurbancteri
Lot area and lot coverage percentage
Requir d Elevation Plan Elements:
(For S •• calcs needed only on street-facing) Su ry table with calculations for:
r n standard scale Twat façade area
12
uil ' g height dimensioned otal window and door area
e dimensioned-_
i2a1 ' ows and doors dimensioned
i Garage doors dimensioned
Required Floor Plan Elements:
(Not retnired 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: /S Side: Min/Max Street Side: /0 / Garage: 2,t�
I Nei 0 Max. Height: Proposed Height: �jP
Yes ❑ N/• Landscape
❑ Y- ■ /A Screening (Quad only)
N/A % Window Coverage
Y ❑ N/A Garage (SFR Only) Parking (Other Res)
Y ❑ N/A Entrance (SFR, Rowhouse, Quad only)
Yes ❑ Other building design standards (Rowhouse only)
❑ Yes Accessory Structure Standards
❑ Yes o Qualifying pre-existing unit exempt from standards (Cottage unit only)
Azrynal standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
s ❑ N/A Unit Count: 9-
Yes ❑ ows
Lot Width and Size S'
❑ Yes N/A Pathway onus/ A-Pe C6z 1�
Additional standards for Courtyard Units and Cottage Clusters only:
❑ Yes N/A Unit Area:
O Yes N/A Floor Area (per story)
❑ Yes N/A Courtyard
O Yes N/A Fence
❑ Yes ❑ N /A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes o ON/A Public Facilities Improvement (PFI) Permit:
Required: 0 Yes 0 No OA c1
Applied For: 0 Yes 0 No, stop intake Vela `i-Qtc '1�
❑ Sensitive Lands: 0 Yes 0 No
O Main Land Use Case #s: coc2. z.n- C , od, onditions met /
❑Applicant notified of land use exniratio/date: 'r12A0e. ( VW Ill , p hnHt_ t3y Vole
Approv d By Planning: `" Date: /2 (S/4.2
Notes 1,0t10U1e R(TAUke-O TO 12- porbEntin vaseeCQA raceme tb c su' rTw Patba
Revision 1: 0 Approved 0 Not Approved Date: etA,+eu.l
Revision 2: 0 Approved 0 Not Approved Date:
,Z/i
Building Permit Submittal KV
Original Submittal Date: f i tf i F/z'-i
Site Plans #: 3 '"�3 O"klt ti7 Building Plans #: 3
Building Permit #: 'Building pe/mit # entered op page 1
Workflow Routing: PI/Planning l3 Engineering O'Permit Coordinator Et/Building
Workflow Sign-off: ign-off for Planning (include notes from planning review)
Route Documents: re Engineering: (1) copy of permit application, (1) site plan, (1) building plan
an original plan review routing form.
fBuilding: original permit application, site plans, building plans, engineer and
earn calculations a trust details, if applicable, etc.
Permit Technicia /j ` Date: i 7r l r I /`Z-'S?
Notes:
Engineering Review
❑ PFI Permit:
Li
-1!".-.-tope at building pad: %
,' 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 fiNo
Assess Water Quantity Fee in-lieu: 0 Yes lNo
LIDA Facility on lot: 0 Yes ffo Add Fee: 0 Yes 0 No
inal Plat Recorded
-_
iOT App oved: Date: «/�//Z
Notes: " .0'v %/e--- o -i _ rG .Si'7 -
Approved By Engineering: Date: ///a/
Revision 1: 0 Approve ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Permit Coordinator Review
YConditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
ENG Revisions Required: i‘.1" Date notified applicant: i - Co -
4.SDC Exemption: 0 Applied for 0 Received foes not apply
yaDC Fees Entered: Wash Co Trans Dev Tax: d] Yes 0 N/A
Tigard Trans SDC: ❑ Yes 0 N/A Deferred
Parks SDC: kuYes ❑ N/A ❑ Deferred
LIDA 0 Yes RN/A
OK to Issue/Approved by Permit Coordinator: Date: `- 0 Z1
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date: