Permit CITY OF TIGARD MASTER PERMIT
III o COMMUNITY DEVELOPMENT Permit #: MST2010 -00163
T I GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2010
Parcel: 2S 111 CB01307
Jurisdiction: Tigard
Site address: 10450 SW DELMONTE DR
Subdivision: DEL MONTE SUBDIVISION NO.2 Lot: 14
Project: Bekooy
Project Description: 790 SF garage addition with covered porch.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 15 Bathrooms: 0 Second: 0 sf Garage: 790 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes
Total: sf Value: $35,691.00 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 6
Ea add 500 sf: 0 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 8 Stereo: N 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)
BEKOOY, CHRIS OWNER 1 MST Ersn Cntrl 503 - 681 -4444
10450 SW DELMONTE DR
TIGARD, OR 97224
PHONE: PHONE:
FAX:
Total Fees: $1,296.60
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes =n• - II pplicable 1:. All work will
be don • acco an th approved plans. This permit will expire if work is not started within 180 days of issuanc • rf / suspenor more the 180
da . ATTENTION: Oregon w re• ires you to follow the rules adopted by the Oregon Utility Notification • - _ . • -e rules set forth in OAR
2- 001 -0010 through OAR 952 -1 • • 10 You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 • • •• • • 9 • 0.332.2 .
Issued By: _ • • - 0 10. / / / Permittee Signature:
Building Permit Application
Residential rc li rlrrlcl: ust: c►N1.Y
cd City of Tigard g�
IN O '\ Q Da l e a f�' Permit No , ST; , to ( . •
° 1 125 SW Hall Blvd., Tigard, OR q 1 � ' - .
� �,
3
Phone: 503.639.4171 g Fax: 503.598.196 j3 P �Q Date/13 : i� �
N 1
G Q e , Plan Review �. Other Permit:
I• I t; A a i Inspection Line: 503.639.4175 � �\ S � Date Ready/By: O ® See Page 2 for
• Internet: www.tigard or.gov Q � \I\ ,tifi EN Supplemental Information
TYPE OF W :i\i " REQUIRED DATA: 1- AND 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
NCAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
j
1 -and 2- family dwelling ❑ Commercial/industrial Valuation! ( 1 t S industrial ) )-0, i °i
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: i p Lis 5 (.3 17� ( �p, 'Or- - New dwelling area: square feet
City /State /ZIP: -1-7/4 0 „/ , Q iz a 7 ....1.4 Garage /carport area: '7 et p square feet
Suite/bldg. /apt. no.: Project name: 3 e. L n G- -„ , ,, Q Covered porch area: - 3 �� square feet
Cross street/directions to job site: 1 03 J r " Deck area: square feet
_- l \ Other structure area: square feet V ---
M , • REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: ;2 \ - �
. . rt no.: Permit fees* are based on the value of the work performed.
Y'�N' ,r y Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: S °l equipment, materials, labor, overhead, and the profit for the
r DESC OF WORK work indicated on this application.
�,p.. t,, Q Cd�aa L At - + i O+i Valuation: $
Existing building area: square feet
New building area: square feet
af PROPERTY OWNER I ❑ TENANT Number of stories:
Name: c L r : s 3-e k oa � Type of construction:
Address: S64. € Occupancy groups:
City /State /ZIP: Existing:
Phone: ( 5 ) -3 f g .. g 5 3 S Fax: (503) LY3 1 - 3 L 3 New:
['APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: Sa r v1 t 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: (h r i s Sc koo 1 , GO w1
CONTRACTOR
Business name: Qi.A.) BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application , C.: ,� airL Amount received: L, 5 6L/
Authorized signature: This permit application expires if a pe mit is not obtained
within 180 days after it has been accepted as complete.
Print name: y 13L t7J Date: q A / lei • Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\BUP -RES PermitApp.doc 10/01/09 440 -4613T(11 /02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling FOIL c)l l Icl: usl: (:)NI
14 City of Tigard Received Date/By: Permit No.:
n 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960
I I �: A K I) 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.tigard - or.gov ❑ Other:
'III F. FOLLO\V'NG ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore .on and shall be shown to be applicable to the •ro'ect under review.
- IUf.ISDICTIO\IAL. SPECIFICS
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1:\ Building \ Permits \BUP- RES- PermitApp.doc 03 /21/06 440- 4613T(l1 /02/COM/WEB)
•
Electrical Permit Application l c)l2 Orrici.: lisi: oNI.1
City of Tigard 5 Da � y , Permit No.: fh Sri (v r
13125 SW Hall Blvd., Tigard, 0' : = • : +3 ' `
C l @ Pl an R e vi ew
.� Phone: 503.639.4171 Fax: 503.7_ i 6 i' . Date/B : Other Permit:
1
Inspection Line: 503.639.4175 1. Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard 0 �® Notified/Method: -/ -i....6) Supplemental Information
TYPE OF WORK () ��1 G t% PLAN REVIEW
❑ New construction MAddition/alteratar RitlealeS1 Please check all that apply (submit a sets of plans w /items checked below):
❑ Demolition ❑Other: S?0 ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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
j -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 ", "1 -2 ", "I -3 ",
Job no.: Job site address: / 100HP or more. occupancy.
c7 45 0 6 W Del . l ,1 cyi4e i - ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -F-„ . , �� Q .-a1.1 ❑ Health -care facilities. ❑ Supply voltage for more than
O V ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ( Project name: 3 k ODj Gnu 5 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 1 Q 3 ri Description I Qty. I Fee. 1 Total 1
v New residential single- or multi- family dwelling unit.
Includes attached garage.
•
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less ! 100.70 [03. 2
OPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name:
/ 401 amps to 600 amps 200.34 2
f L t - : .' g - f - 0 (j 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
ty relocation
Phone: (5 3 I ' - g S 3 S Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation i eing made on property that I own which is not
intended for sale, lease, rent q)! ge, ing to ORS 447, 449, 670, and 70 . 401 amps to 599 amps 168.54 2
� Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: i71 t I t.7 A. Fee for branch circuits with
42-- APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: •1.. vbA e branch circuit
Each add'I branch circuit I (c., I 7.42 1. ~ -a
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone:( )
Fax :: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Ot /'� pU(�� panel, alteration, or extension. Page 2 2
V� Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) I Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: , , 22
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): ( 7_A3
TOTAL PERMIT FEE: 1 6 z . 6 .5
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:\ Building \Pennits\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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*
❑ Other:
COMMERCIAL WORK ONLY:
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*
El 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:\ Building \Permite\ELC- PermitApp.doc 07/01/10
•. �.�.STaaro 001103
,
Clean Water Services File Number
0 1 . 1 U V E no -... ..1.k: Sernices 1 /0- o o. a a-D ]
a
I . n piji • , ! . r i- Ice : � ing Site Asses .,i i i�]ED
. 1. Jurisdiction: Tigard S E f 2 2 2 0162 ? 9 70 \ 0
2. Property Information (exerrip/e IS - . 4A801400) . Owner Information pR1)
Tax lot ID(s): 25'111a:301307 'Y _• Name: Chris Bekooy „ OF Tl N1SlO
Company; 03 0)11%1G 1) \ .
Address . -areas 42e1 onteDr
Site Address: 10450 SW Del Monte Dr City, State, Zip: Tigard, OR 97224
City, State, Zip: Tigard, OR 97224 Phone/Fax: 503- 319 -9635 / 603- 431 -2363 `., •
Nearest Cross Street 103rd E -Mail: chris@ bekooy.com
4. Development Activity (check all that apply) 5. Applicant Informadon
® Addition to Single Family Residence (moms, deck, garage) Name: Chris Bekooy
I] Lot Una Adjustment ❑ Minor Land Partition Company: •
❑ Residential Condominium ❑ Commercial Condominium Address: 10 450 SW Del Monte Dr
❑ Residential Subdivision ❑ Commercial Subdivision •.
C3 Single Lot Commercial la Multi Lot Commerdal Cam, State, gyp: Tigard, OR 97224
Other, Phone/Fax: 503-315-5535 / 603 - 431 - 2363
E - Mail: chrlsalrbekooy.com .
6. Will the project involve any off -site work ❑ Yes ® No ❑ Unknown
Location and description of of .site work
7. Additional comments or Information that may be needed to understand your project
This application does NOT replace Grading and Erosion Control Permits, connection Permits, Building Penmib, Site Development Pennib, DEQ
1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army
COE All required permits and approvals must be obtained and completed under applicable local, state, and federal lava
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of C lean Water Services have authority
to enter the project sitte at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify
that I am remftei with the information this document, and to the boat of my imawlcdge and belief, this information is true, complete, and accurate.
Print/ type Name Chris B PrintlType Title
Signature Date 9 -21 -2010 •
FOR DISTRICT IA ,- .
0 Sensitive areas potentially etdst on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE CFA •
SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report
may also be required.
n Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site. This
' Sensitive Area PreArgeening Site Assessment does NOT eliminate the need to evaluate end protect water quality conclave areas if they are subsequently
discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local, State, and federal law
❑ Based en review of the submitted materials end best ardiFable information the above referenced project well not significantly Impact the wasting or potentiaty
sensitive area(s) found near the sae. This SensitiveArea Pre-Screening SileAssessment does NOT criminate the need to evaluate and protect additional water
quality sensitive areas if they are subsequently discovered. This document v/li I serve as your Service Provider letter as required by Resolution and Order
OT-20, section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law.
❑ Thls Service Provider Letter is not valid unless CWS approved site plans) are attached.
❑ The proposed1 uudivily dues not meet the definition of development or the lot was platted after 919/95 ORS 92.040(2). NO SITE ASSESS I ENT OR
' SERVICE PROVI ER LETTER IS, EP 17 O.
Reviewed by /.A 4...-...4—'—di - -- - Date ' e ` P
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Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I will
• reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and 1 hereby certify that the information on this homeowner statement is true and accurate.
C_ h r + - S ge_ leOfy
Print Name of e it plicant �/
A., /0
Sigh o e it Applicant Date
Permit #: 1 U'' U0 63
Address: I d .$ a u.. ~ .
Issued by: ( . ] Date: q/� 1 10 i "
This Copy for Permit Offices
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: /n5 k) UU Lf�3
PLANNING DIVISION:
Required Setbacks: }g Approved ❑ Not Approved
Side: 4 Street Side:
Front. Garage: ....;,2_. Rear: _L
Visual Clearance: or Approved ❑ Not Approved
1 Maximum Building Height aQ. feet ,/
CS yule° Prov'der Letter Required: Er Yes ❑
i \V J�
fizz ❑ Re •r ived
1 i t � : ei-eilVie,/ 7 Date: VD /0
ENGINEERING DEPARTMENT:
Actual lope: % Approved ❑ Not Approved
Site P a : El LI of trued
By: 4 Date: 7 l
Notes:
CITY 0 TIGARD - SITE PLAN
BUILDING PERMIT NO: REVIEW
y1_,�' :0- 1G3 6i Street Trees: V Protected Trees: Approved Not Appm d
Svc p* Art oved ❑ Nit A *proved
mac: Date: 9 i
0