Permit 11 ti CITY OF TIGARD MASTER PERMIT
1 COMMUNITY DEVELOPMENT Permit #: MST2012 -00082
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2012
Parcel: 2S104CCO3800
Jurisdiction: Tigard
Site address: 13944 SW HILLSHIRE DR
Subdivision: HILLSHIRE ESTATES NO.2 Lot: 144
Project: TABRIZIAN
Project Description: 930 sq. ft. second story addition. No change to exterior footprint.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 26 Bathrooms: 1 Second: 930 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 930 sf Value: $96,645.60 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains. 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell -Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 0 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
Furn > =100K: 1
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 9
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amplvolt: 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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R - 3 930
Owner: Contractor:
TABRIZIAN, BABAK LORDS CONSTRUCTION LLC Required Items and Reports (Conditions)
13944 SW HILLSHIRE DR PO BOX 969
TIGARD, OR 97223 TUALATIN, OR 97062
PHONE: PHONE: 503 -638 -5777
FAX: 503 -638 -5770
Total Fees: $3,557.96
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 don • accor a ith 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: Oreg la . _; uir- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 01 -0010 through OAR 9 -00� • '•u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 800.3 344.
Issu d By: • Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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.
Building Permit Application
Residential FOR OFFICE USE ONI.1
111 wi City of Tigard - ` � _, O�l, Received . i 1y P No.: gy /, — Al t
Date/B _
13125 SW Hall Blvd., Tigard, OR I V \� 'l, Plan Review
r?® (1 Iu 6, e her Permit:
° Phone: 503.718.2439 Fax: 503.59 ; .1' 60 Q� C c o w � DazeB : o vl l
1_ l G n l n Inspection Line: 503.639.4175 P �'�:� C � \d \ " Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov O 0��\ Notified/Method: Supplemeotallatormation
G 4�G
TYPE OF WORK» )\�� REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
ddition/alteration/replacement ❑Other: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
- and 2- family dwelling ❑ ComerciaUndustrial Valuation: $ 1
m
❑ Accessory building ❑ Multi - family Number of bedrooms: ,
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: ,
Job site address: / 5 9 w 5 LA .) ft„t;0 Q New dwelling area: 9 'a square feet
City/ State/Z1P: , oa 9 7 22. 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 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
DESCRIPTION OF WORK work indicated on this application.
930 sF l: jeA/el 111,01 Valuation: $
/4 /L10,,,, - ff el • Existing building area: square feet
" New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/ State/ZIP: ��� ,� Lt ¶ , 't iutg fisting:
Phone: ( ) Fax: ( ) New:
ti APPLICANT AEI PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: L 0/Q.Q S t^_/1%5TOZ!/c -7°,1J
Structural plan review fee (or deposit):
Contact name: - 7 - b 0 L 0205'
p FLS plan review fee (if applicable):
Address: 7 G
�� J f 6 / T fees due upon application: Y' � te 7c/ d j l
City/ State/ZIP: G A�F , ()re_ 97 0L Z
Amount received:
Phone: ( 5t3) 6 3g. —5 7 77 Fax: : ( ) -
E-mail: -11-4-f- PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR � T Commercial and residential prescriptive installation of • roof-top mounted Photo Voltaic Solar Panel System.
Business name: z_0405 c o/v55T.� ac -T70/U Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: PO tS / Q 6 7 Solar Installation Specialty Code checklist.
City /State/ZIP: ��ep ex._ 7 7O 1 Z Permit Fee (includes plan review $180.00
and administrative fees):
Phone: (5 6 9 5777 I Fax: ( $b3 ) ‘36 State surcharge (12% of permit fee): $21.60
CCB lic.: /55Q /(o //Y
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
4_ L - -D 4s I This
methodology set by Tn -County Building Industry
Print name: p Date:
Service Board.
I: \ BuildingTermits \BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(11 /02/COM/WEB)
Mechanical Permit Applicat' s ‘ %__ t OFFICE USE ONLY
City of Tigard r � Re ceived Permit No.: C Date/By: Received - '� /. / t
lig Inspect
q 13125 SW Hall Blvd., Tigard, OR 9
0 Q 'Fe '� \l, Plan Review
Phone: 503.718.2439 Fax: 503.59 ` ' 1% r 0 Date/By: Other Permit:
I i G A It D
Inspection Lin 503 l pQ Date Ready/By: June. 53 See Page 2 for
Internet: www.tigard or.gov PQ .S . \ r-V-.:. Notified/Method: Supplemental Information
TYPE OF WORKC,1` ; oOv-/' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
�,,`�r, Mechanical permit fees* are based on the value of the work
12 New construction Addition/alteratio acement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
EMI and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building For spec/cl Information use checidist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: /3 7v(/ 5L) # 4A\ (requires site plan showing placement) 46.75
City/State /ZIP: / V l ` / Furnace 100,000 BTU (ducts/vents) 46.75
/ O 7 Z 2_3 � Furnace 100,000+ BTU (ducts/vents) / 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/dirertions to job site: 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
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: I 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater I ( 23.32
1(.; X11 , / �� n_ )J Gas firepla 1 33.39
41) U/�'�{f� IP/14i( Flue vent for water heater or gas
p'a , / ' t d _ 7f— /4 e_ fireplace 23.32
/r4 1, �� Log d lighter / pelf e t stove 23.32
�� Wood/pellet ove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone:
( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
L 0 PJ0 S Lo�v 5 r t✓T/ a � Other: 23.32
Business name: � Fuel
piping:
Contact name: j) (. D,,cd 5 $14.15 for first four; $4.03 for each additional
Address: /76 96' ?I' Furnace, etc.
•
�— Gas heat pump
City /State /ZIP: '7-1441141- �.,.. p 7 d' — Wall /suspended/unit heater
Phone: (%) ) 631 Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: , 7e f �r - CL / ,7 ,*1Z-f--- Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
fig Y O 4 ! l f h 3 _ Plan review (25% p
22% of permit fee)
CCB lic.: O State surcharge (12% permit fee
TOTAL PERMIT FEE
Authorized signature:
T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Print name: 6 & L b y '-c-- 5 Date: b v , 2— • Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \Permits\MEC- PmnitApp.doc 09/09/10 440-4617T(11 /02/COM/WEB)
Mechanical Permit Applicatk - - City of Tigard 4
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\Building\Perrnits\MEC- PermitApp.doc 09/09/10 2
Plumbing Permit Applicati- 3
Building Fixtures °' � ♦ „a FO 2 OFFICE USE ONLY
4 i� - ' ' ti ',� d
City of Tigard 1 Received Permit No.:
n 13125 SW Hall Blvd., Tigard, 0 r 3• ' le*" Date/By: S7 , /� - Q(,b kr�
��
Phone: 503.718.2439 Fax: 50 9 �.196�� Plan Review Other Permit No.:
� ,, „ � r Date/By: T I G A R D Inspection Line: 503.639.4175 Q -- -:'' � ,` -. ;( '' Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov ) L 1 ° f . , ;; ,1+;- Notified/Method: Supplemental Information
TYPE OF WORK . U � " FEE* SCHEDULE
A.A. 1'vY
❑ New construction For special information use checklist
❑ Demolition
Description I Qty. I Ea. I Total
❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
a1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑Multi - family
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: /3 9 yy 4 c At.,� (,4,.? Catch basin or area drain 18.76
1:13,-/ Drywell, leach line, or trench drain 18.76
City/State /ZIP: 0 rt 9 7 Z Z3 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRI>'TION_OE_IYORK Backwater valve 12.51
Clothes washer 25.02
.11-0-N. �n 2 � //)) � ���� 'b-�` Dishwasher 25.02
}P.t+eQ • i eieCA. ` tZ/ Ltriti lea Drinking fountain 25.02
Ejectors /sump 25.02
RI PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: �� Fixture /sewer cap I 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
O- APPLICANT C a CONTACT PERSON Interceptor /grease trap 25.02
Business name: 0 Fy W5 rs-- J x 2 .) C , Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: ' O L. 6-124)s Roof drain (commercial) 12.51
Address: f 0 n emc. 919 Sink/basin/lavatory a. 25.02
City/State /ZIP: 7i , -02 97 e 6 2 Solar units (potable water) 62.54
Phone: ( 5 - 6 38 - ' 77 7 Fax: : ( ) Tub /shower /shower pan i 12.51
E -mail: Urinal 25.02
Water closet f 25.02
CONTRACTOR
Water heater ( 37.52
Business name: . /����
t ltOtt /4tr- 1/1tIA/1 r ! cooly . Water piping/DWV 56.29
Address: 385/ OW 14 or 1/ ,� Other: 25.02
City/State /ZIP: ,50,10- Subtotal
Phone: (Jo g) S'P9 -Ivoff Fax: ( ) '1
'I /141 Minimum permit fee: $72.50
CCB Lic.: /6 rd,/ Plumbing Lic. no.: 6 PO - Plan review (25% of permit fee)
7 State surcharge (12% of permit fee)
Authorized signature: / - TOTAL PERMIT FEE
/ Date: �r This permit application expires if a permit is not obtained within 180 days
Print name:
' . , ; v 2...
after it has been accepted as complete.
"Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 410- 1616T(10 /02/COM/WEB)
Jun 14 2012 3:26PM HP LASERJET FAX 503 35 60 5 1 3 p . 1
... ..
. . '
Electrical Permit Application 0 ,..,. €1,:, , ,
City of Tigard Received
Detc/Br. Permit No.yr 500/2 ... 6608 .
_______,
III 13125 SW Hall Blvd., Tived, OR 97223 Plan Review
• ' Phone: 103.718.2439 Pax; 503.396.1960 , Date/fly: Other Perrith:
tA Inspection Line; 503.639.4175 Date Ready/By: NM: - Storage 2 hr
lw
Internet www.tigard Notified/Method: Supplant met Information
ril,...„ ''3 tli,,w,""Til'effrq
h'i...9'-''.&r:11:4-.9e2::,-J-.1177,7r7ff...1y-7,',FiT,Ii-,*.F0,,,,:n-,,I.5_,-.,....;:..-._:, -.24
r,4.7-‹41i,ferrea....kh-TF.Pi'.'.1.,ffki' war2.1.,,,...,,Ate.A._ ' A .. , . ' stt.!..., .,-.. ,,,,, v ':6/1',hz.,:`:.,.:" ,c i •
0 New construction kt Addition/alteration/replacement Please cheek all that apply (iebrnIt 3 tee of ohms w/itents checked balow):
10 Serves or feadn 400 amp or mom 0 Building OM three aerie.
0 Demolition 0 Other: where the millet, hult current LI Marinas end boatyards.
scads 10,000 arup at ISO volts or 1:1FlontIng buildinp.
Orititit7,,k7ifrk"a17,116:1$.:11.Ps'4.2.1■ItilSili‘urAkVbriii'Mitteti,)26tWZ.P.,d514.43'''74:5-.34:.t.HTP.j UM Ig ground, or exceed. 14,000 CI Commeroiakse agricultinot
1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for ell other instal shone. buildings.
0 Multi-famil 0 Master builder 0 Other: CIFire pump. 0 Installation of 75 KvA or
.,, _,e,,.k,,L„,(k, ',,,Ir ' L' ' 4,- I' . . t ,, ,_' Viii i .1
"FP
. ., 0 Emergency spent larger separately derived system.
of,,A2 ;. - 4r '1,W4,. ?,,„L?..1. .a.oe t .A.thi.k. • .i.,..,1,_ r i : . . 4 0 Addition of new motor load of 0 "A". "E", "1-2", ''1.5".
lob no.: Job site address: /35YV 5c../ /./Aleak.:i 4( 100HP or mare. meaner.
0 gh, ow m reedonait wag. • 0 Recreational veW.olc pale.
City/State/ZIP: 1/ , / / Oft 9 2_2 0 Health-gam facilities, 0 Supply voltage for more titan
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt n0.: Project name: 0 Service or feeder 600 enamor mare,
Cross street/directions to Job site: Deicaintba eta. Fee. Mei •
New residential single- or multi-family dwelling unit.
Includes attached ga rage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'I 500 sq. R. &portion 33.92 I
Tax map/parcel no.: Limited energy, residential , 6 75,00 2
g . .ic t Z1',.+WK:Vi . 4 1: 1., •,.',, t...."...'
Limited energy. multi-family ' 75,00 2
LatArt tow AvitAwir f / 12w ' z - "-- residential (wilh above se. ft.)
Services or feeders Inatalletionotteretionond/or relocation _
200 amFe or Ices ■ 100.70 2
Etitilt=RPMEET:ale SiSEK4W1 -IMSrikraykal
201 amps to 400 a m p a 133.56 2
401 amps Co 600 amps 200.34 2
,. 601 empire 1.000 amp 301.04 2
Over 1.000 amps Of Vane _ 552.26 _ 2
Temporary services or feeder, in gradation, alteration, and/or
C ity/Statea1P: reloca _
Phone: ( ) Fax: ( ) 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 amp _ _ 168.54 _ -. 2
Branch dreults - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
7.42 2
each branch circuit
Business name: Z. i: .." .- et9'71,014"atC,971 B. Fee Mr branch circuits without
service or feeder fee, firm
Contact name: -ra 1- o id s branch circuit $6.18 2
- -
Each add' I branch circuit d ;e, 7'42 1
Address! PO EfA�' c 76 9 Miscellaneous (service or feeder not Included)
Each manunictured et modular •
City/State/ZIP: --7 , ow f 7e ,6 a dwelling, service and/or &oder 67.14 3
Phone: (6.1 . ) 4A? —$ Fax::( ) i Reconnect only 67.84 , 2
, Pump or irrigation circle 67.14 2
E -mail: . Sign or outline lighting 67.84 '. 2
A; .. .L 1,.,.. :.?;:.; . COT ; ;. .1+. • 'i : i.:!:4-:in Signal circuit(s) or IlmIteeknorgy
panel, alteration. or extension, _ - Par 2 , 2
Business name: RK Electric, Inc. Each additional inspection overiallowable le any r the above
Address: 24495 NW Oak Drive Additional inspection (1 hr min) 66.251 hr
Investigation (1 hr mln) 66.23/ hr
City/State/ZIP: Hillsboro, OR 97124 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 640-1344 I Fax: (303) 356 Inspections for Welt no fee is 90.00/ hr
a. elficall listed 14 hr min
CCB Lic.: 94275 Electrical Lit,: 34 I Suprv. Lie.: 4724-5 I+ 1, , :w4Riltr.E.LTE.:! . .E.724:irmai - 2: - : - ..p....4 . 6;-3.zi , ...;,!;: .
Subtotal:
Suprv. Electrician signature, required: eg, if{
Plan review (25% of permit (be):
Print name: Ron L. Kurtz Date: 67 'IS - # 2...W State surcharge (12% of permit Me):
f TOTAL HAMM FEE:
Authorized signature: (- j ,„----
This permit application expires If a permit Is act obtained nil bin LBO
c
Print name: Ron L. Kurtz Date: - /5 -/ Q.....i dap after It has teen accepted as compieta.
• Number of inspeationi allowed per vomit.
1:\lbil4nipurhAELC.PerrwlAppe60 C7/01/10 040.001M1 1/05/COM/WES
•
I N ■ ° Building Division
r i ( ; n i; r) Development Code Provision Review
Residential Projects
Building Permit No: 7kl_p --o- -) ?)-
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A
Routed Plans: /�
Original Plan Submittal Date: y //t`i) t8uf -061, /iG,L'7t aeao /1/d Ct iam 710 -tect pries
1st Revision Submittal Date: ❑ Site Plan Only
2n Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact St1 Ii at 503-718-v or @tigard- or.gov)
Land Use Case No. Name �Q►aiDa
Q Zoning 1 P D.
12 Setbacks:
Front / C Rear 1 S Side o Street Side / b Garage
a Maximum Building Height cis' Actual Building Height _ c
a Visual Clearance
Cr Easements
Er Sensitive Lands Type: Al /A
Notes:
Original Plan: Approved (3 Not Approved ❑ Date: 4( Q tit"
Revision 1: Approved ❑ . Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503- 718 -2464 or MikeW@tigard- or.gov)
Er Actual Slope: -1f - 4 "--- %
Notes:
•
Original Plan: Approved,0' Not Approved ❑ Date: 4 PT/ /Z-
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
1
City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @ tigard - or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard-or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
•
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building: •
•
•
•
•
Page 2 of 2
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