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Permit ° 1 2-v 1rb J� ,A ,,, ,,,, 4 pA �c -mss , , . CITY bF TIGARD MASTER PERMIT ! COMMUNITY DEVELOPMENT Permit #: MST2009 -00171 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009 Parcel: 2S108AB05200 Jurisdiction: TIGARD Site address: 14139 SW 155TH TER Subdivision: BRENTWOOD ESTATES Lot: 14 Project: Brentwood Estates Project Description: New SF with accessory dwelling unit. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms 4 First: 1834 sf Basement: 0 sf Left: 5 Parking Spaces' 0 Height: 27 Bathrooms: 4 Second: 2309 sf Garage: 783 sf Front: 15 Smoke Dwelling Units: 2 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $457,435.00 Rear: 15 PLUMBING Sinks: 3 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Catch Basins: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0 Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 1 Gas Outlets: 5 Furn > =100K: 1 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: 8 20 1 -400 amp. 0 201 -400 amp. 0 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add Br Cir: 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 Ecom asin Y Other: N Other Description: p g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) BRENTWOOD HOMES - JOHN BRENTWOOD HOMES NOFFZ 15170 SWFINIS LN 15170 SWFINIS LN TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503 - 407 -1101 PHONE: 503 - 407 -1101 FAX: Total Fees: $19,571.73 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. ATT ' • 1 : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -6.10 through OAR ' 2 -00 -• 10. You may obtain a copy of the rules or direct questions to OUNC .. .246.6699 or 1 800 332.2344 Issued = : \ • ^, Permittee Signa • • : C ", CITY OF TIGARD MASTER PERMIT 2 _- COMMUNITY DEVELOPMENT Permit #: MST2009 -00171 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009 Parcel: 2S108AB01201 Jurisdiction: TIGARD Site address: 14139 SW 155TH TER Subdivision: Lot: Project: Brentwood Estates Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1834 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 27 Bathrooms' 4 Second: 2309 sf Garage: 783 sf Front: 15 Smoke Dwelling Units: 2 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $457,435.00 Rear: 15 PLUMBING Sinks: 3 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Catch Basins. 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0 Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 1 Gas Outlets: 5 Furn > =100K. 1 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 addl 500 sf: 8 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add Br Cir: 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 Ecompasing: Y Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) BRENTWOOD HOMES - JOHN BRENTWOOD HOMES NOFFZ 15170 SW FINIS LN 15170 SW FINIS LN TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503- 407 -1101 PHONE: 503 - 407 -1101 FAX: Total Fees: $20,491.73 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: W V\ t (`Z 0 AI tAil Permittee Signature: — �' � • Bu ilding Permit Application w • � 7 Res 1 ' go tio ,d de FOR I FO USE ONLY City of Tigard DateB �� 1 Permit No.:�L � 11 13125 SW Hall Blvd., Tigard, OR 97223 AU G 1 2009 plan Revie _ 1- ° :: - Phone: 503.639.4171 Fax: 503.598.1960 Date/By: tko �a� � � Other Permit: e y} TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/ y: / o C Q� 1u -' ® See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method :( /4/ e l C Supplemental Information 1 0/74 i I , - .;.... �. . ... ....... = �� 'I'YPE '�OF-W4RK � � �;;' : %RE = UIRED DAT AND 2- FAiGilli�'DWEIJI�Ti�IG ® New construction Pe rmit fees* are base. in the value of the work performed. ❑ Demolition P Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ^ _ °:1, :- <: •.. , €,, i< work indicated on this application. 4,,, ORY;'OF, CO,, JCTI0, ` , >c, " =� ® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ J 7 3 ❑ Accessory building ❑ Multi - family Number of bedrooms: 4 ❑ Master builder ❑ Other: Number of bathrooms: 4 `,: Z _`. JOB SITE.'INPORMATIUN :A1S'IN OCAT101�' 7 ini; ;:�� Total number of floors: 2 t �;. Job site address: 14139 SW 155 Ter New dwelling area: 4143 square feet 1 22 1 3 t ( City /State /ZIP: Tigard Oregon 97224 Garage /carport area: 783 s quar e fee i z Q I .!1 Suite/bldg. /apt. no.: Project name � ��(�i 6 S Covered porch area: 204 square feet 9 , � 1' Cross street/directions to job site: Bull Mountain Road to 5` Terrace Deck area: square feet Other structure area: square feet °REQUIRED DATA COMMERCIAL SU E'CHECKLIS ',:_' Subdivision: Brentwood Estates Lot no.: 14 Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the ' .a s ~ w g , *wig: . D -W : :'> t work indicated on this application. u Valuation: $ • Existing building area: square feet r— New building area: square feet :er PROPERTY, �.• <.:. ®: ` OWNER'�ryMr- ", =' � �;.: ❑ %TENANT , ;��; Number of stories: Nance: Brentwood Homes John Noffz, President Type of construction: Address: 15170 Sw Finis Lane Occupancy groups: City /State /ZIP: Tigard Oregon, 97224 Existing: Phone: (503)407 -1101 Fax: ( ) New: P. , - ::aT s> A P. -- - i F�P E R ❑ C ' C ONTACT S O N r ; >' _ �� , :�- •. .�> . �:. �� r,� NOTICE Business name: All contractors and subcontractors are required to be ` Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: - jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E- mail: ' .'.: Business name: Brentwood Homes - t° * -s - -sd '° ,BUILDI stnP RVIIT FE t \, y am , ^, ;.' 't 4i, Address: 15170 SW Finis Lane -,: " "!`' " ° " : "` ^ `% ( Please, refer, tofeesch , t , City /State /ZIP: Tigard Oregon, 97224 Structural plan review fee (or deposit): # 7 eo s Phone: (503) 407-1101 Fax: ( ) FLS plan review fee (if applicable): CCB lie.: 18115 Total fees due upon application: 0 750 / Amount received: 7 • � Authorized signature: / / This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: J n 0 Noffz, Jr Date: 08/18/09 * Fee methodology set by Tri -County Building Industry Service Board. l: \Building \Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(1 I /02 /COM /WEB) ,. Electrical Permit Application. p FOR OFFICE USE ONLY City of Tigard Er r -vt ut-t Received Permit No.: m ived , gi 6 , mg q 13125 SW Hall Blvd., Ti Tigard, OR 97223 A %, 20 Plan Review i ,)' 99..1.,Y3 M ' Phone: 503.639.4171 Fax: 503.598.1ggy ..- - Date/B : Other Permit: , a. Date Ready/By: Juris. See Page 2 for Inspection Line: 503.639.4175 ei .1 CIOIGO ,1 Notified/Method: Supplemental Information TIGARD Internet: www.tigard-or.gov r I, •-' .....„1. tICION t ;m spx„mitx weilAft , W= , - , -v'n' , ,VWv4 New construction 0 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below): [s] 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. Migg :rt$R exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground, or exceeds 14,000 0 Commercial-use agricultural El 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. 0 Multi-family El Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or CI Emergency system. larger separately derived system. i i 1911 0 Addition of new motor load of 0 "A", "E", "1-2", "1-3", Job no.: Job site address: 14139 SW 155 Terrace 1001-11' or more. occupancy. 0 Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: Tiagrd Oregon, 97224 ClHealth-care facilities. 0 Supply voltage for more than 0 Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: LOt 14 BWE 0 Service or feeder 600 amps or more. IFS 111.U' 4:000W2KP . ,, ;Filr,': Cross street/directions to job site: Bull Mountain Road and 155 Terrace Description I Qty. I Fee. I Total f . New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Brentwood Estates Lot no.: 14 1,000 sq. ft. or less fit" t i 145.15 rya, 4 Ea. add'l 500 sq. ft. or portion 7 33.40 g3540 1 Tax map/parcel no.: Limited energy, residential IkArtna,;',5,;Wireitrt 15k5:Witi(e400#0741416 (with above sq. ft.) 75.00 71t' 2 Limited energy, multi-family 75.00 2 residential (with above sq ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 • 2 doi A W 201 amps to 400 amps X 106.85 2 Name: Brentwood Homes John Noffz 401 amps 10 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 15170 Sw Finis Lane Over 1,000 amps or volts 454.65 2 City/State/ZIP: Tigard Oregon, 97224 Temporary services or feeders installation, alteration, and/or relocation Phone: (50.)407-1101 Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits – new, alteration, or extension, l er panel Owner signature: Date: A. Fee for branch circuits with Ara, fe01,1,:tlile,:: j slaw oxoxixotofrk4s,, above service or feeder fee, 6.65 2 each branch circuit Business name: . B. Fee for branch circuits without service or feeder fee, Contact name: 46.85 2 first branch circuit Address: Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 66.85 . 2 E Pump or irrigation circle 53.40 2 ::,.:;W•C ';lljiiG:' ti.,...:"Elk ''.'''.':' Si or outline lighting 53.40 ,, 2 Signal circuit(s) or limited- • Business name: Kodiak Electric energy panel, alteration, or I Address: 8486 sunnyside road extension. Describe: Page 2 * If 2 City/State/ZIP: Salem Oregon 97306 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 881-1259 N, Fax: (503-) 391-2611 Investigation per hour (1 hr min) 62.50 CCB Lic.: 161998 0 \ Electrical Lic.: 24-528C Suprv. Lic.: 5113S Industrial plant per hour 73.75 !Ka :M-StiatetliteNtIg00 "• Suprv. Electrician signature, required: Subtotal: Plan review (25% of permit fee): Print name: Randy Seiber Date: 08/1809 State surcharge (12% of permit fee): ...– Authorized signature ..„.....„.... ti TOTAL PERMIT FEE: permit application This expires if a permit is not obtained within 180 Print name: rDate: days after it has been accepted as complete. * Number of inspections allowed per permit. I: \Building \ Permits\ ELC-PermitAppdoc 05/23/06 440-46! 5T( I 1/05/COM/WEB Plumbing Permit Application • Building Fixtures FOR OFFICE USE ONLY Cl of Ti aCd Received A g 111 . V 1 3122 g / Date/By: I D ' I Permit No.: M op i -2/ . 5 SW H all Blvd., Tigard, O 7223 Plan Review Phone: 503.639.4171 Fax: 503.59. j J 0 o o Q Date/By: Other Permit No.: 44.4.1 , 1 �j TIGARD Inspection Line: 503.639.4175 M (J J DateReadyBy: Juris. ® See Page 2 for Internet: www.tigard or.gov Notified/Method. Supplemental Information `. 1 : S' � ' FE HED -L . :T =XPE' OE�'V4�O C U E.,. ,, a,. ., �... � ate. ^.. ® New construction 0 J ❑ emolttiOni°"1� For special information use checklist. Description I Qty. Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) T _ -P- - Mat "'"' * :: ' „_ ' CATEGORY . OF F- CO NSTR TIQN ".' ° °° (1 bath 24 >�` N s.,, �, ..... ... �:�3,,.....E•• >,�..r:., ,,.., ,..�a� ' ...,: _= ��' ' "•':� .. SFR ) b 9.20 ® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building • ❑ Multi - family SFR (3) bath I 399.00 Each additional bath/kitchen I 45.00 ❑ Master builder ❑ Other: ,, ::a ,., .t<..: Fire sprinkler ( sq. ft.) Page 2 ' �' \ `' v '`JOB SI T ; . I N RM ATI , �" -'" °' E FO QN „ < r1ND LOM , , Y, .. __.. a .:,. .�. �.,.,...,Y:....: , .�„ z. � _v�� S u tiliti es Job site address: 14139 SW 155 Terrace Catch basin or area drain 16.60 City /State /Z1P: Tigard Oregon 97224 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _ ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Bull Mountain Road to 155 Terrace Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _ ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Brentwood Estates I Lot no.: 14 Water service (no. linear ft.: _ ) Page 2 Fixture or item Tax map /parcel no.: `�. „�;: �_ � ,«b. ,,ESC - ,a• ^..;, ., Absorption valve 16.60 �.;;, e ;',:v... . SD RI P.. TION OF .WORK• s % � -_ _�.�w %;��'�•a >.... ,., ,,,. ,. , �,.:,� �- E<.�� - . r''',:,` . , ''`� "'E Backflow preventer Page 2 Backwater valve 16.60 Clothes washer ' . 16.60 Dishwasher 16.60 16.60 PRO � d ,W N, E R ' - -` ; s , '” " '; ': .T ... 1, aaz... . �, , :. ,.. ..:.., >,,,,..... ,. .,�., \•.. ......� l'"-- . ., >,,,,, > '',` >.. r ..� Ejectors /sump 16.60 Name: Brentwood Homes Expansion tank 16.60 Address: 15170 SW Finis Lane Fixture /sewer cap 16.60 City /State /ZIP: Tigard Oregon, 97224 Floor drain /floor sink/hub 16.60 Phone: (503)407 - 1101 Fax: ( ) Garbage disposal 4 16.60 • 4 APPLI ANT 4e-4%'4,, a.,.,;, _ ❑� G ..... � � _ ®' P ; ;, - Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan A 16.60 E -mail: Urinal 0 16.60 ON:TRA R�:': =`.. �: `C CTtO .,. • � .. ry".:. .. x. _. M�,, . Water closet # 16.60 Business name: Craftwork Plumbing Water heater / r 16.60 Address: 7737 SW Cirrus Dr Other: City /State /ZIP: Beaverton Oregon, 97007 Subtotal Minimum permit fee: $72.50 Phone: (503) 644 - 8698 Fax: (503 - 644 - 5989 Residential backflow minimum permit fee: $36.25 CCB Lie.: 79666 Plumbing Li no.: 20 - 148PB Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: �•r/' l TOTAL PERMIT FEE Print name: Pete Pollard Date: 08/18/09 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'J'ermits\PLMF- PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB) , . . . ..., • Mechanical Permit Application „ FOR OFFICE USE ONLY .. ' . ° W I \ l i C „, i 2 tY 5s of H T ai i iv \ILI) I - Date/By: , . 1 Received ew 0, . 0 t Plan Revi Date/By: 0 MIA Permit No.: Irrpoo52....- ex ,/ 71 m Phone: 503.639.4171 Fax: 503.598160 9k 2009 Other Permit: Inspection Line: 503.639.4175 I-WU i v TIGARD Date Ready/By: Juris. Ed See Page 2 for Internet: www.tigard-or.gov CM( OF TIGARD NotifiecUMethod Supplemental Information 4 - FE IAL- E l tqSelEDU& L ' •'..: : - ' -,..,,--4.,.,,,,,.4•0,:,.- .,...,,,, - 1,: ..:: -.•,' c ...„ - '. .....,.e. Mechanical permit fees* are based on the value of the work IZ New construction 0 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. wiymtAg-,2v,” Value: $ ' :- Z 1- and 2-family dwelling 0 Commercial/industrial El Accessory building For special information use checklist. El Multi-family 0 Master builder P Other: Description Qty. Ea. Total - tiiileiNUari*V4Ntis:4 - 4,iiiqmp 1-yoc8p.oN,'„ .,-, Heating/cooling 6 Air conditioning or heat pump Job site address: 14139 Sw 155 Terrace (requires site plan showing placement) 2 14.00 City/State/ZIP: Tigard Oregon 97224 Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 2 17.90 Suite/bldg./apt. no.: Project name: C. Gas heat pump 14.00 Cross street/directions to job site: Bull Mountain Road to 155 Terrace Duct work 2 10.00 Hydronic hot water system _ 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel-type, not electric), in-wall, in-duct, suspended, etc. _ 14.00 Flue/vent for any of above 2 6.80 Subdivision: Brentwood Estates Lot no.: 14 Other: 10.00 Tax map/parcel no.: Other fuel appliances 15hTekti*fickkoPIW:diikOligai77nne:SW1. Water heater 2 10.00 Gas fireplace 1 10.00 Flue vent for water heater or gas fireplace 3 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 _ Chimney/liner/flue/vent 10.00 W'':;:- . SkiiiTittiffitKAli.: te07-4WEjlito,'kWaViatifl. : b Other: 10.00 Name: Brentwood Homes Environmental exhaust and ventilation Range hood/other kitchen Address: 15170 SW Finis Lane equipment 1 10.00 City/State/ZIP: Tigard oregon, 97224 Clothes dryer exhaust 1 10.00 Single-duct exhaust (bathrooms, Phone: (503)407-1101 Fax: ( ) toilet compartments, utility rooms) 4 6.80 41 gg' : ,' '-TNI-7:A Attic/crawlspace fans 10.00 .,.....,:..,..--2. ' -"'-- :''..;Y:- '' 4,11 Other: _ 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Furnace, etc. 1 Address: Gas heat pump 1 City/State/ZIP: Wall/suspended/unit heater Phone: ( ) Fax: : ( ) Water heater 2 Fireplace 1 E-mail: Range 1 7, Barbecue 1 Clothes dryer (gas) Business name: Rumbolt Heating Other: Address: PO Box 397 1.a.ligittqMNICAkffRMITk.f.."<-4:.:1150 City/State/ZIP: Beaver creek oregon, 97004 Subtotal Minimum permit fee ($72.50) Phone: (503) 656-0475 Fax: (503-) 632-8669 Plan review (25% of permit fee) CCB lic.: 172897 t \k(t \13 fri ehe0 . ' State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature: N- / 0 4 , days after it This permit application expires if a permit is not obtained within 180 has been accepted as complete. Print name: j ,J A/4 e ,, e. .. Date: g _ i e „.....e> y * Fee methodology set by Tri-County Building Industry Service Board 1. \BuildingWermits VvIEC-PermitApp.doc 01/19/07 440-4617T (11/02/COIWWEB) 'Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: >ag,MNTIAL W ON:L ieir77iir6% Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* tA Other: Qa,to e q3 3 Iv\ .wcoM-1VIERCIIAL Wo1 oNL:I'.Y. :q ; Fee for each commercial $75.00 system (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 I:\BuildingWermits\ELC- PermitApp.doc 03/23/06 �.(� r '" III Building Division One & Two- Family Dwelling rrcniiD Fees Checklist P. INFORMAT,IO■:.. :. - "' .- Permit #: 1T aC�O -- Oa \ I Plan #: Date: 9/ oai / 2_Go R Site Address: \L41 su j 1 r ' - \ - -C' ((ac Q. Parcel #: Subdivision: Lot #: 19 5L Zoning: Jurisdiction: Setbacks: Front: i S -- Rear: l -, Left: jt— Right: S Class of Work: (F Stories: First Floor:, I Ci 51 Type of Use: Height: -2: Second Floor: '3pq I Construction: V (3 Floor Load: Third Floor: Occupancy Group: Dwelling Units: a Bonus Room: Valuation: Bedrooms: 4 Total Floors: 4- - 3 Bathrooms: Li Basement: Decks: ,..Garage: — 7 2 3 i'' Porches: -2 2 Other: 4? 2 FEES:.. .D ; 'Fee . Amount:: _. Amount Paid: ":- Balance: D;ue. ':, ��.. Plan Check: Building: Extra Set: Permit: Building: Tax: Metro CET: School CET: Mechanical Tax: Plumbing: Tax: Electrical: Tax: Low Voltage: Tax: CDC: CDC Ping. Rev.: CDC LRP Fee: SDC: Parks: TIF Res.: TIF MT: Erosion Permit: Erosion CWS: Erosion COT: Water Quality: Water Quantity: SUB TOTAL: Sewer: Permit: Inspection: SUB - TOTAL: TOTAL MST & SWR: I:\ Building \Forms \ResPlanCheckFees.doc 01/19/07 Page 1 PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment /systems) Description I Qty. 1 Fee(ea.) I Total Description Qty Fee(ea.) Total New l -& 2- family dwellings :.. Heating/Cooling . _ (includes 100 ft. for each utility connection) Air conditioning or heat pump* i 14.00 SFR (1) bath 249.20 Furnace 100,000 BTU (ducts /vents) 14.00 SFR (2) bath 350.00 Furnace 100,000+ BTU (ducts /vents) Z 17.90 SFR (3) bath 1 399.00 I Gas heat pump 14.00 Each additional bath/kitchen 1 45.00 1 Duct work ". 10.00 Rain Drain, single famil dwelling 65.25 Hydronic hot water system 14.00 Fire sprinkler - sq. ft. 0 to 2,000 115.00 Residential boiler Fire sprinkler - sq. ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14.00 Fire sprinkler - sq. ft. 3,601 to 7,200 220.00 Unit heaters (fuel, not electric) Fire sprinkler - sq. ft. 7,200 and greater 309.00 (in wall, in -duct, suspended, etc.) 14.00 . • • ' . • . _ Site Utilities . . • . . ' Flue /vent (for any of above) 6.80 Catch basin/area drain 16.60 Repair units 12.15 • Drywell /leach line /trench drain 16.60 Other Fuel Appliances Footing drain - 1 100' 55.00 Water heater 1 10.00 Footing drain - each additional 100' 46.40 Gas fireplace r 10.00 Manufactured home utilities 110.00 Flue vent (water heater /gas fireplace) * 10.00 Log lighter (gas) 10.00 Manholes 16.60 Wood/Pellet stove 10.00 Rain drain connector 16.60 • Wood fireplace /insert ( 10.00 Sanitary sewer - l 100' b 55.00 -I- Chimney /liner /flue /vent 10.00 Sanitary sewer - each additional 100' 46.40 Other: 10.00 Storm sewer - 1st 100' 1 55.00 --t-- Environmental Exhaust & Ventilation Storm sewer - each additional 100' 46.40 Range hood /other kitchen equipment ( 10.00 Water service - •1 100' ( 55.00 .1- Water service - each additional 100' 46.40 Clothes dryer exhaust 10.00 • Fixture.iir Item . - Single duct exhaust i Absorption valve 16.60 (bathrooms, toilet compartments, Backflow preventer 27.55 utility rooms) 6.80 Backwater valve 16.60 Attic /crawl space fans 10.00 Clothes washer I 16.60 Other: 10.00 Dishwasher 1 16.60 Fuel Piping * *($5.40 for first 4, $1.00 each additional) Drinking fountain 16.60 Furnace, etc. , 4 ** Ejectors /sump 16.60 Gas heat pump ** Expansion tank 16.60 Wall /suspended /unit heater ** Fixture /sewer cap 16.60 Water heater ** Floor drain /floor sink/hub 16.60 Fireplace ** Garbage disposal 1 16.60 Range r ** Hose bib Z 16.60 BBQ ** Ice maker 1 16.60 Clothes dryer (gas) ** Interceptor /grease trap 16.60 Other: * * Primer 16.60 Total: Roof drain (commercial) 16.60 Mechanical Permit Fees Sink/basin/lavatory3./1 /6 1, Q 16.60 Subtotal: $ Tub /shower /shower pan I 16.60 Minimum Permit Fee $72.50 $ Urinal • 16.60 Plan Review Fee (25% of Permit Fee) $ Water closet 4, 16.60 State Surcharge (12% of Permit Fee) $ Water heater t 16.60 TOTAL PERMIT FEE $ Other: Other: • Plumbing Permit - Fees.. ELECTRICAL FEES (residential single- or multi - family) Subtotal $ Description Qty. Fee Total _ Insp Minimum Permit Fee $72.50 $ 1,000 sq. ft. or less ( 145.15 4 Plan Review (25% of Permit Fee) '$ Ea. add'l 500 sq. ft. or portion ,0 33.40 1 State Surcharge (12% of Permit Fee) $ Limited energy, residential 75.00 2 TOTAL PERMIT FEE $ Each manufactured or modular dwelling, service and /or feeder 90.90 2 • Electrical Permit Fees • Subtotal: $ Plan review (25% of permit fee) $ State surcharge (12% of permit fee) $ TOTAL PERMIT FEE $ I: \Building\ Forms \ResPlanCheckFees.doc 01 /19/07 / Page 2 kit 2E . 'LZ‘ City of Tigard, Oregon 0 13125 SW Hall Blvd. 0 Tigard, OR 9722 A 03f0 ,.*1 ®a nti Friday, December 11, 2009 31P, s S 'K Mr. John O. Noffz, Jr. 15170 SW Finis Ln. Tigard, OR 97223 RE Transportation Development Tax ( "1'DT) Refund. Our Permit No. MST2009 -00178 /4//3/ SW 45 ,9-v . Dear John: At the time the above building permit was issued you paid a Transportation Development Tax ('1'DT) fee of $4,599.00. Effective December 1, 2009, Washington County approved a Temporary Discount on '1DT charges and has made that discount retroactive to July 1, 2009. The enclosed receipt for a credit to your credit card represents a refund to you of the difference between your original '1'DT payment for your project and the new Temporary Discount charge. The amount of the credit refund is $920.00. Please call m t 503-718-2' 26 if you have any questions. / Albert hiel.. Peiinits /Projects Coordinator 503 - 718 -2426 Phone: 503.639.4171 0 Fax: 503.684.7297 0 www.tigard - or.gov 0 TTY Relay: 503.684.2772 4tsi 2oc.)9.-co /7 City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: John O. Noffz Jr. DATE: 12/10/09 15170 SW Finis Ln. Tigard, OR 97223 REQUESTED BY: Dianna Howse AMS TRANSACTION INFORMATION: Receipt #: 175540 Case #: MST2009 -00171 Date: 10/07/09 Address /Parcel: 14139 SW 155th Ave. Pay Method: CreditCard Project Name: Brentwood Estates EXPLANATION: Refund amount discounted for TDT per Washington County. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund EXample: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount TDT - Transportation Development Tax 4050000 -43320 $920.00 TOTAL REFUND: $920.00 APPROVALS: If under $500u Professional Staff If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Refund Request Reviewed: Date: o By: Case Refund Processed: Date: ?'t s ,. By: • I: \Building \Refunds \RefundRequest.doc 04/13/09 psi 20A'- ()[ .„, �- _t: , a d w Community Development . ` v: Nr Request for Permit Action T c TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: n Owner n Applicant n Contractor . City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) / LE/ e pe� 4 ive o' i ��p-vArm .... Mailing Address: or ' City /State /Zip: it Phone No.: II PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): • CANCEL PERMIT APPLICATION. e REFUND PERMIT FEES (attach receipt, if available). H INVOICE FOR FEES DUE (attach case fee schedule and explain below). n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). --�� / Pertnit #: �i�e✓°- se ��e 41-G 't2 Lis Site Address or Parcel #: N Project Name: ,f, Subdivision Name: iv Lot #: EXPLANATION: 47X. z ® Z Re.,-/AAI- / �I/56>0d2 77o,Nr- " /i9y (1 -- ,7 --- -4-/ - 73y / e9v> /i4 0l 14460 7 17 c ''' Se vosi / gnature: 'a G2.7M g -, ,--11.-" ems 0 9 a. rr ec °772 -7 / � e2 . Signature: ,�� ate: '7 . / i _ ."- tlam% e7 Print Name: , Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80 of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has :been expended. e) not more than 80 of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. � � � !�c �:.,�� f x h�cr ,5., rw-r I � ma's' r� �' � �'F �- t ai' � iti'tir .t' i"+" S ¢ -1 °z c �+� ti fi�^�rfv z r , 4x r FOR OFFICE USE ONLY,- "' r?{ 4�.� i ... _�nx1 .L :M. -{ .�.� y..��x Hi ,.. .��/C - , - _... .._, �..Y ._.... ._ .».. -,_ _._.. ,_ .. .� �i�i'2. �js ��w� -�.. x.�'�r, !r't� �. X 4"3. y?h.�1r -..Si lSi Rte to S s Admin: Date B' Rte to Bld• Admin: Date a�� #M Refund Processed: Date / ; ,• B • ;; A voice Processed: Date B Permit Canceled: Date xi f 9- By Parcel Tag Added: Date By Receipt # Date Method Amount $ I:\ Building \Forms \RegPennitAction.doc Rev 07/26/07 (;- Oregon Residential Specialty Code 8318.2 if In5T2 i GOI`l MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, V o Z-, /) es,Fz__ , am the general contractor or the owner- builder at the following address: Site Address: / Lit � 7 S(.,,‘. /SS l� City: ..... /:d O 77224' Permit #: A / 2e - Oa /7/ Subdivision/Lot #: 13s a.. - rte,. ESr�„TS le.i � ( 7 / and /or Map and Tax Lot #: • To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. • [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the general contractor that all moisture - sensitive wood framing members used in construction have a moisture content of not more than 19 - percent by dry weight of dry framing members. Signature: - Date: �// `� General Contractor or wner-B I; \ Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08 Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: M 200? - D o / ?, Jurisdiction: e> Site Address: / W.? S lS5 �� L G 7 . Subdivision/Lot #: and/or Map and Tax Lot #: eT - l Y By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2) Signature: � Date: 0 w ner /General Con iac1. A rrtze A Print Name: r7 O /0 o � ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty'percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. 1: \Bui lding\ Forms \RES- HighEfficiencyLighting.doc 07/01/08 STREET TREE CERTIFICATION _ _ I, o tL A)oF , Owner /Agent for J0LL ° 1171Z2443.- (PLEASE PRINT) (PERMIT HOLDER) Do hereby certify that the follo`ving location meets City of Tigard land use and :development standards for tree Installation. \ �!� / 2 6 0 1 ADDRESS: /Ws? St-%- O(� %7 2 z. `f SUBDIVISION: « ,,I wd�"Sfi��G LOT: /,y SIGNATURE: 9,-e-- v DATE: / / //,) (04YlNER /AGENT) RECEIVED BY: DATE: (C1 Y OF TIGARD) I:\ Building \ Forms \Streetl'reeCertiticatc 01 /19/07 CITY OF TIGARD RECEIPT V a 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 176271 - 12/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2009 -00171 $- 920.00 Total: $- 920.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 671912 DHOWSE 12/11/2009 $- 920.00 Payor: John 0 Noffz Jr Total Payments: $- 920.00 Balance Due: $920.00 • Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD j) r . • • .A. % i Receipt Number: 175540 - 10/07/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2009 -00171 Building Permit 2300000 -43104 $2,311.70 MST2009 -00171 12% State Surcharge - Mechanical 1003100 -24001 $15.49 MST2009 -00171 CDC Plan Review, RES 1003100 -43112 $46.00 MST2009 -00171 CDC Plan Review, RES - LRP 1003100 -43117 $6.00 MST2009 -00171 12% State Surcharge - Building 1003100 -24001 $277.40 MST2009 -00171 Metro Const. Excise Tax - Residential 2300000 -24011 $548.92 Use MST2009 -00171 Tig -Tual School CET - Residential 2300000 -24102 $4,143.00 ..—.. MST2009 -00171 TDT - Transportation Development Tax 4050000 -43320 $4,599.00 --_... MST2009 -00171 Erosion Control 1003100 -22002 $136.00 MST2009 -00171 Erosion Plan Review CWS 1003100 -22003 $44.20 MST2009 -00171 Erosion Plan Review COT 2300000 -43102 $44.20 MST2009 -00171 Water Quantity - Res 5200000 -43122 $275.00 MST2009 -00171 Permit Fee - Elect (per dwelling unit) 2200000 -43103 $412.35 MST2009 -00171 Limited Energy 2200000 -43103 $75.00 MST2009 -00171 12% State Surcharge - Electrical 1003100 -24001 $58.48 MST2009 -00171 Air Conditioning or Heat Pump 2300000 -43102 $14.00 MST2009 -00171 Furnaces >= 100K BTU 2300000 -43102 $17.90 MST2009 -00171 Water Heater 2300000 -43102 $10.00 MST2009 -00171 Gas Fireplace 2300000 -43102 $10.00 MST2009 -00171 Wood Fireplace /Insert 2300000 -43102 $10.00 MST2009 -00171 Range Hood /Other Kitchen 2300000 -43102 $10.00 MST2009 -00171 Clothes Dryer Exhaust 2300000 -43102 $10.00 MST2009 -00171 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 $40.80 Utility Rooms) MST2009 -00171 Fuel Piping 2300000 -43102 $6.40 MST2009 -00171 SFR - Baths 2300000 -43101 $444.00 MST2009 -00171 12% State Surcharge - Plumbing 1003100 -24001 $53.28 MST2009 -00171 Plan Review 2300000 -43106 $752.61 ' Total: $14,371.73 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT • Credit Card 671912 LSELLERS 10/07/2009 $14,371.73 Payor: John 0 Noffz Jr Total Payments: $14,371.73 Balance Due: $0.00 Page 1 of 1 I 4NLE RE 11 D 6WFACE GRADS Al TK !CE CS MOAN TO CORMS. AHD DIRECT EWA= DRASAGE MKT PROM M EOM M SNOW TO OPOI YARD AMA - CAMPO • EA i a NI CESS RT O O CONTROL S1C! Al • /e o; 001011 IE + MEMO MIL CRY STMDARO• AND PTO TOR SHEEP BRADS ECEIVE 6• AABS STOW CEN LS RE01 R I POOTN GRAN TOM MAIONtY FlaICTION AT 6D! wn PRAPRAM EA0ESINT A6 TEE m TE 6 Pw:T'+o6E0 NOISE CL TYPE.LL PRDPORY LEE 1 ME KETSE A CTS L EE I ro EA De@ SEPENT R MNIARY S — 11 M lEAREAR !@@!T DER 0*1. COD OCT 01 2009 , MEL MOE CITY OF TIGARD - - _,_ a 1,2: E ' — BUILDING DIVISION T -'- - -- I % — I Y.. EIITRT WKCO1*CTtil I / i .14.1 / III cel1E®ONMllen+r MIRY DP 4I ! I � Ai ...0, .• oa6TEn awe LSE SEW OE 4 OM wiser 1 0.---__ ; ` V- i•CO,RI.DItl.GEMIK PER -------- A � ff �� ..,, �� - �� , CRY 01111-.NiRn IRE ' l AI PROBES C NN WOO PDL IMPOSED A06 I I mid CO ICIE SLM 0113E 1*11140*14E!® 6OL BEM OR APPTEDNO 00114011010.440..1* �d FILL m TO DRAM MAT M eillDWl N ®a[ 1 "MICA. . "MICA. l#a'6[R LSE i \ I ROAR IANTARY AND 6EEER E.A6RlR � LSE ' _ 1 I � I 1_41 i l i s) ; L-- --1 � t L i1 n `� i 1 J II 6 �I L I -�--1 I - Q 10• 1 1 I j OOl1E MRY�DIEI,E I. I . ABE • SIR C TE Y C EM Q *ACTED I \ 1044041056110 E ro BRAN D� I � -/ IYSM • AMOONTo 11E DY. R.a� r1ELOG rR OD.E SMELT POE CRY 6TMOAIOO AIO RECURESENTs \ .■..., ... 26f2 I I J .-' L___ - 1 ill I - -- - _ - -- _ - A.._. .....,,,._. -� - _ - - ( L.i� _ O. OiA 7A C 7 K M 1 mk �• � 11V T IITA .W / MR CRY 0 01 6100100 6 »O IEEO. ES1M TTTR.LL PR01•ERIT LSE 1111111010. FlCPO6ED BUILDING PEISE11* AS GWEN PR7.OE SAC COMM WIEILIE MSTALLED TTPEJL.!EN MEMO SETBACK LEM 34 SRL EMOS MSSNO ARAM Mon 11C 45011E Pl OMErIY Al EOM IC E>QOTIE WEN MIER PE! =wry nil CM PLANNING STANDARDS 6TNDA/m6 ASO PECORISENTE !EWES MINED SWAGE !RAGE AT M SCE OP WON TO CON1EX AND DIM= 60FAOE DRANK& AWAY 116111 M MOUE Y &MN TO OPEN YARD AREA - CAPERS ALL MATED 500100E SKIM M NECEMART TO 004100. STORM MINTS BRENTWOOD ESTATES 6 FOR MEMO BRACE LOT 9.4 von mum PST *!i, Da j 4'`1 4 J STOS SOWS PEST M OPOMP LOT COMPLE E 24.11% 000110010 LOT COTMOE Iraq . -z— {,j, -0- tcl.,_ /Li.L.s.,21) 4‘,._ /14 7\r- - : 1 ft. CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.: ' o - �� 4 PLANNING DIVISION: L � Required Sett�l;s; Approved ❑ Not A Side: - § C/�'�1' Front. c►reet Side: •[_O Approved /.� bile% Visual Cleara,�� "� e. —� Rear: (� Maximum B 1 . , ,i i „t ❑Not Approved CW$ Service Prc;,� •.` ; . � - Y - ''� der Letter r:: ed; ❑ yes 0 N ' t3 :.��. rr -- r Received ENGINEERI t , �T . /V a-(v • Actual � 2 M t; ctul SI A to ala pe % Ap (.t ed ❑ Not Approved B ; a lApproved ❑ N . t A, proved Notes: Date: /D Z G CITY ,_,___X4-fvj-e-e)--t4rt--..„ r-26 OF TLGARD - BITS PLAN gVILW 1 BUILDING PERMIT N �� ; A ppro ve,- A ❑ Not Approved Street Trees: prroved of prro ved Protested a � Date: 10 ` `� By : Notes: 1