Permit ;....: CITY OF TIGARD MASTER PERMIT
!; 0 Permit #: MST2009 -00206
COMMU NITY DEVELOPMENT
T G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/18/2009
[
Parcel: 2S109AC06100
Jurisdiction: Tigard
Site address: 13292 SW NICOLE LN
Subdivision: Lot: 0
Project: Wilson Ridge II
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1360 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 22.5 Bathrooms: 3 Second: 1652 sf Garage: 690 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $337,097.00 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Catch Basins: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0
Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Drains: 100
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum > =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: 4 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: Y HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
STONE BRIDGE HOMES NW LLC STONE BRIDGE HOMES NW LLC 1 MST Ersn Cntrl 503 - 681 - 4444
16869 SW 65TH AVE., #505 16869 SW 65TH AVE # 505
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035
PHONE: 503- 387 -7577 PHONE: 503 -387 -7577
FAX: 503 - 387 -7615
Total Fees: $17,210.74
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. ATTE! •i.: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 I 10 through • R 9 .1-01'0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
I / C '�
Issued =y: 1.. _ if . 4 Permittee Signature:
- r
Building Permit Application FOR OFFICOFFICE USE ONLY R Cit of Tigard Received
Date : / a/ Q ,%1,-- Permit No/LIs7:2Q09.... ,.
° 13125 SW Hall Blvd., Tigard, OR 97223 n Plan Review
. OCT / 't, i ter ermt
Phone: 503.639.4171 Fax: 503.598.1960 OCT is .. � � Date /By: � �• �3
p • C11 p�,1 Oh P i �S'cyeaov 9 d
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Attached Checklist for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: t 1 • E, a/ ' 77‘...:- Supplemental Information
BUILDING' DIVISION Lin a i. m #
TYPE OF WORK REQUIRED DATA: 1- D 2- FAMILY DWELLING
® New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1 -and 2- family dwelling El Valuation: ' .37, oc Commercial/industrial v t
❑ Accessory building ❑ Multi- family Number of bedrooms: 9
❑ Master builder ❑ Other: Number of bathrooms: ........-03-- 3
JOB SITE INFORMATION AND LOCATION Total number of floors: a
S W N 1 ��
Job site address: d
�55Ci1 1 aA � New dwelling area: 3 p i 2 square feet
L
City/State /ZIP: Tigard, OR 97223 Garage /carport area: trio 96 square feet
Suite/bldg. /apt. no.: Project name: Wilson Ridge II Covered porch area: ( 7 square feet
Cross street /directions to job site: SW Bull Mountain Rd. & SW 133 Ave. Deck area: square feet
Other structure area: 'Qf square feet
REQUIRED'DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Wilson Ridge 1I Lot no.: 9 2 q - 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
. DESCRIPTION OF WORK . work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Stone Bridge Homes NW, LLC Type of construction:
Address: 16869 SW 65 Ave., #505 Occupancy groups:
City/State /ZIP: Lake Oswego, OR 97035 Existing:
Phone: (503)387 -7577 Fax: (503)387 -7615 New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: Stone Bridge Homes NW, LLC All contractors and subcontractors are required to be
Contact name: Vicki Elix licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16869 SW 65 Ave., #505 jurisdiction in which work is being performed. If the
City /State /ZIP: Lake Oswego, OR 97035 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 387 -7577 Fax: : (503) 387 -7615
E -mail: vcki @dmhholdingsco.com
CONTRACTOR
Business name: Stone Bridge Homes NW, LLC BUILDING PERMIT FEES*
Address: 16869 SW 65"' Ave., #505 (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP: Lake Oswego, OR 97035
Phone: (503) 387 -7577 Fax: (503) 387 -7615 FLS plan review fee (if applicable):
CCB lie.: 1/133 'a Total fees due upon application:
/ Amount received:
Authorized signature: OV This permit application expires if a permit is not obtained
1 within 180 days after it has been accepted as complete.
hiiih, _-----1 °rint name Jiirki -Flitc A - 41 a f.• E^ I Date: � t I ;.,1I GPI f , * Fee methodology set by Tri- County Building Industry
Service Board.
gildin \ Permits \BUP- I'ermitApp.dac 03/21/06 440- 4613T(11/02/COM /WEB)
Plumbing Permit Application
Building Fixtures 1 FOR OFFICE USE ONLY
�
City of Tigard Received
Date/By: Permit No.:MST i n (C) \.,204,7
111 to 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C • Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Date/By:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: kris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental lnformation
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family - SFR (3) bath x 500.32 ��j(j s2 ....
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I a � l 2. Syr/ N irn t e. Lan Catch basin or area drain 18.76
City/State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: I Project name: Wilson Ridge 11 Manufactured home utilities 50.03
Cross street/directions to job site: SW Bull Mountain & SW 133rd Avenue 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: Wilson Ridge 11 I Lot no.: 21 Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve ]2.5]
Clothes washer / 25.02
Dishwasher / 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER
1 ❑ TENANT Expansion tank 12.51
Name: Stone Bridge Homes Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16869 SW 65 Avenue #505
Garbage disposal 1 25.02
City /State /ZIP: Lake Oswego, OR 97035 Hose bib 2 25.02
Phone: (503)387 - 7577 Fax: (503)387 - 7615 Ice maker / 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: SEE ABOVE Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Gayland Forsberg
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory I /() /1 g 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 3 12.51
E -mail: gayland @stonebridgehomesnw.com Urinal 25.02
CONTRACTOR Water closet 3 25.02
Water heater / 37.52
Business name: Legacy Plumbing Water piping/DWV 56.29
Address: 8985 Hazelvern Way Other: 25.02
City/State /ZIP: Portland, OR 97223 Subtotal X(,X) , j2.
Phone: (503) 816 - 8887 Fax: (503) 297 - 4587
Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 173318 Plumbing Lic. no.: 26 -517PB
g-��/J State surcharge (12% of permit fee) 6 0.0
Authorized signature: ^.7g #22 - / -`J TOTAL PERMIT FEE 8(06 • 3L,„
Print name: Matt Nelson Date: 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:\ auil ding\Permits\PLMU- PermitApp.doc 10/01/09 440 -4616T(10 /02 /COM/WEB)
Mechanical Permit Application 0 , ':1 , ; 1 '.: 1 1 . :( ry
;` �4�Flh K O I fa(.l 11tiF O\I 1�
City of Tigard Date/By Permit No.: i . e . r�
ii ,,,- q 13125 SW Hall Blvd., Tigard, OR 97223 as —'
0 _ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
,:1C� i n;�t Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
® New construction ❑ Addition/alteration/replacement Mechanical permit fees* arc 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.
CATEGORY OF CONSTRUCTION Value: $
® 1- 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
�/�Q n SVV �{' ' Air conditioning
Job site address:
I l� 1 Ql S Y V N i� k Lane, (requires site plan showing placement) 46.75
City/State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts /vents) 1 46.75 IC,. 7S
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: I Project name: Wilson Ridge II Heat pump 61.06
Cross street/directions to job site: SW Bull Mountain & SW 133 Avenue Duct work 23.32
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: Wilson Ridge 1I Lot no.: ge' Other: 23.32
Tax map /parcel no.: Other fuel appliances _
DESCRIPTION OF WORK Water heater 1 23.32 W3.3 L
Gas fireplace / 33.39 7j�j . - 59
Flue vent for water heater or gas ... . .,
fireplace 23.32 , I
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
® PROPERTY OWNER ❑ TENANT
Other: 23.32
Name: Stone Bridge Homes Environmental exhaust and ventilation
Address: 16869 SW 65th Avenue #505 Range hood/other kitchen ;
33.39 3 3 .
equipment
.f�
City/State /ZIP: Lake Oswego, OR 97035 Clothes dryer exhaust / 33.39 3 3. i9
Single -duct exhaust (bathrooms, (�
Phone: (503)387 - 7577 Fax: (503)387 - 7615 toilet compartments, utility rooms) & 23.32 13 e—
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: SEE ABOVE
Fuel piping
Contact name: Gayland Forsberg $14.15 for first four; $4.03 for each additional
Furnace, etc. / 11 , 15
Address:
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater /
Fireplace 1
E -mail: Range t
CONTRACTOR Barbecue
Business name: Comfort Zone Clothes dryer (gas)
Other:
Address: 1032 NW Corporate Drive MECHANICAL PERMIT FEES* _
City/State /ZIP: Troutdale, OR 97060 Subtotal .3 a‘l . ?j L
Phone: (503) 667 - 5595 Fax: (503) 491 - 8252 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: 110091 State surcharge (12% of permit fee) 3(1 90
TOTAL PERMIT FEE
signature: This permit application expires if a permit is not obtained mum tou
Authorized Si
,� w days after it has been accepted as complete.
Print name: David Heldstab Date: • Fee methodology set by Tri-County Building Industry Service Board
1:\ Building \PermiuU4EC- PennitApp.doc 10/01109 440 -4617T (1I /02 /COM/WEB)
,. .
Electrical Permit Application ', I OI O1 I 1 i U ti BI • } �� n`"'` i * ;isi`► ^ i.. iIc!�' l O
f i ..,.,, i a {+j,o �, i r ( �{ � 'F
It r `J g Tigard, Plan Review - • = 00
' ' Cl of Ti and Received Permit No . 1
13125 SW Hall Blvd., Ti ard, OR 97223
t,' ' 11 Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
'' -''` l ' Ins ection Line: 503.639.4175 Date Read B Ju ris:
'T I G'A K D' P Ready /By: ® See Page 2 for
- Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
® New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
0 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", ' 1 -3 ",
Job no.: i 1 Job site address: 13 W Ni c,014, 100HP or more. occupancy.
S le, La °� 0 or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Wilson Ridge 1I ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW Bull Mountain & SW 133rd Avenue Description 1 Qty. I Fee. l Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Wilson Ridge 11 Lot no.: r79 1,000 sq. ft. or less 1 168.54 I ( 4
Ea. add'l 500 sq. ft. or portion 1 33.92 (7. 8 j � 1
Tax map /parcel no.:
Limited energy, residential p
DESCRIPTION OF WORK (with above sq. ft.) ( 67.84 (07 C3 1 2
Limited energy, multi - family
67.84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or Icss / 100.70 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Stone Bridge Homes 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 16869 SW 65th Avenue #505 Over 1,000 amps or volts 552.26 2
City/State /ZIP: Lake Oswego, OR 97035 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)387 -7577 Fax: (503)387 -7615 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT
1 0 CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: SEE ABOVE B. Fee for branch circuits
Contact name: Gayland Forsberg without service or feeder fee 56.18 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail: gayland @stonebridgehomesnw.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: City Electric Signal circuit(s) or limited -
energy panel, alteration, or
Address: 55568 SW Schaltenbrand Lane extension. Describe: Page 2 2
City/State /ZIP: Sherwood, OR 97140 Each additional inspection over allowable in any of the above
Per
Phone: (971) 404 -1714 Fax: (503) 625 - 3052 Investigation 66.25
gattion per hour (I hr min) 66.25
CCB Lic.: 42422 Electrical Lic.: 26 - 289C Suprv. Lic.: 35925 Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: r'"2_,...) Subtotal: 309. 2 -Z
Print name: Chuck Friesen Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): - 6( O . I
Authorized signature: TOTAL PERMIT FEE: 3 () . 7
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 46t5T(11/05 /COM/WEB
OBE: 1376,
S TONE LLD GE T.;
:* Alillill faQMFS z■W 'i.Y.c • LOT: 29 ?;
16969 W ! Bath AvE.. f606 DATE: 10/1.4/2009 #'
(609)987 7677 G ' ° s s a o x 7 085 PROPERTY:WILSON— RIDGE —II I
CITY: TIGARD • i
SCALE: 1 " =20'
. '
LEGEND ,
PLAN No.: 17F `'
STREET TREES OPTION -1 ELEVATION
! fi 0 '{ -5 ADEMASTER NONEYLOCUST j
- GLEDITSIA TRIACANTI4OS INERMIS-
13292 SW NICOLE LANE ;'
I `I
• 3 592 •
594 _ _ t'i
�`� Approach'. (• o ) I '� o )
• .' 1 E..; •.. .. •
EL m594' : ' Y ?, M , jEL •591'
;ii •$riv�nuay . — — — — — — 8 � 1 PILE
1'594 ". 'a.,• - - - 594' 'o- `s ,, ii
in
30' S
13' • 12
1;9 v ii
5'_e 5'_0' .
bin , - 3 ea rga . 0 ,t
.. PPE. 594
, 594' Im 1 8'10' a, q
' co v
588
4 b f'!. 4
21/1 bath
n PPE. 5948'
594
40'
i
592' y 588 •
4 • IIII 4' I
•PATIO <3
it i
1
in in
E L ■592'
(DE "588'
60.01 ryi
I 592 590 588 !
hh i
' OT C � : EP,AG C
v ,
1 LOT AREA: 5,132 SQ. FT.
1 BUILDING AREA: 2,210 SQ. FT.
I PERCENTAGE: 44.2% t,
:
NOTES: 1.
ALL GRADE AND PROPERTY LINES ARE ESTIMATES OF CURRENT LOCATIONS. '
ALL DIMENSIONS AND SQUARE FOOTAGE ARE APPROXIMATE FIGURES.
1 ALL RETAINING WALL HEIGHTS AND LOCATIONS ARE ESTIMATES.
I THEY MAY VARY AND BE SUBJECT TO CHANGE.
SIDE SETBACKS ARE 5' OR 1/3 THE BUILDING HEIGHT FOR THAT SIDE, LOT * '29 ,
WHICHEVER IS GREATER. 5,132 a' ft.
DRIVEWAY MAY DIFFER DUE TO LOCATION OF UTILITY BOXES, T
STREETLIGHTS AND OTHER SITE CONDITIONS.
.. L,;,....: : : :: .....:17,IZI3?;',A;AIW,1 ..2.11,'i.t!,Z;;.Li.:ii 1:: : :: .:,;., ,,, ,.„7,; : ; ,:lF +.=3:1: 1`t11::......,:wrs. - ..tiS=2 11.1 :1301 ZiZ 1I;.r...sT. , r %Ah.'.' AVA:2 :a 111:i6i 6 % e,,..S:;.r.air,:B lii. :aY; o3 a i.' "',
° CITY OF TIGARD • SITE PLAN REVIEW
BUILDING PERMIT NO.: /7570200 9 - a(),0 6
PLANNING DIVISION:
Required Setbacks: or " Approved ❑ Not Approved
Side: S Street Side:
Fron . G' age: Rear: is
Not Approved 0 '.�i >.:a► Clearance: lal Ap�rwed ❑ � pA'
` num Building Height 2.. feet
f _ WS Service Provider Letter Required: ❑ Yes ❑ No
p ❑ Rec eived
fig: 4' ..J t6 Date: e0
ENGINEERING EPARTMENT:
Actual Slope: % Approved ❑ Not Approved
Site PIn: Approved ❑ of pproved
B (d,,, Date: 0 2 CI
Notes: 4 ( uAv----
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO:/ - a ' — 00 ad ,
Street Trees: ,..,/App roved ❑ Not Approved
�
Protected Trees:ff S Approyed
Date: 0 , ? ■ of ' pp roved
�� ((Mix b
B. ,
Notes: