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Permit Support Document - IIII n TiGARD City of Tigard August 1, 2013 Sage Built Homes Attn: Faith O'Billovich 16280 NW Bethany Ct. Beaverton, OR 97006 Re: Permit No. MST2013 -00111 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 12034 SW Lynn St. Project Name: Firelight Partition, Lot 2 Job No.: N/A Refund Method: ❑ Check # in the amount of $ . ® Credit card "return" receipt in the amount of $523.00. Note: Please allow 2 -5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account "deposit" receipt in the amount of $ . Comment(s): Per applicant's request as they will not be building on this lot. Refund 80% of plan review deposit, less development code revision review completed. If you have any questions please contact me at 503.718.2430. Sincerely, /C(i4 Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request forPermit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Sage Built Homes DATE: 8/1/2013 Attn: Faith O'Billovich 16280 NW Bethany Ct. REQUESTED BY: Dianna Howse Beaverton, OR 97006 TRANSACTION INFORMATION: Receipt #: 191230 Case #: MST2013 -00111 Date: 5/2/2013 Address /Parcel: 12034 SW Lynn St. Pay Method: CreditCard Project Name: Firelight Partition, Lot 2 EXPLANATION: Per applicant's request as they will not be building on this property. Refund 80% of plan review deposit. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Plan Review 230- 0000 -43106 $523.00 TOTAL REFUND: $523.00 APPROVALS: SIGNAT .S /DATE: If under $5,000 Professional Staff / 4, _ - If under $12,500 Division Manager _( If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: I Date: I o ///3 By: ed9W I: \Building \Refunds \RefundRequest.doc x 09/01/2010 06/21/2013 07:43 FAX 5034396313 CYPRESS MARKETING GROUP a001 r / C v City Tigard COMMUNITY DEVELOPMENT PARTMENTH Ifi y O f Tl nd • g DE EC .. Request Permit Action JUN 2 0 2013 q T t c; A lt» 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • = iif t l ?_� �� ify TO: CITY OF TIGARD Building Division Services Supervisor VOID 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: Fax: 503.598.1960 www.tigard - or.gov c f// ,3 X� FROM: 1=1 Owner J Applicant ❑ Contractor El City Staff (check one) ✓ REFUND OR Name: • INVOICE TO: (Business or Individual) Sole bLLUf -H n' O e S Mailing Address: \ W �K) N'` n 1 V( � -�-� \ g City /State /Zip: 11l * i J f C on& a • Phone No.: y -- N5 - C J 3? ls PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( [] /VOID PERMIT APPLICATION. ©/ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: m` .-(13- 00 Site Address or Parcel #: i 9.-03 y" S V/ L .-1 3r St 1 l ou - a, Project Name: ,. i 3 �� . Subdivision Name: Lot #: EXPLANATION: ' In C ■ _ft r1_ UC- . P t . i _ e_ � e- L __ 1 , :� / Signature: mi l/. _ i _ l r /'Ilisi L 4 Armor— Date: UI� I • - / 2 ® I � Print Name: t t 1I 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 2 -4 weeks for processing refunds. FOR OFFICE USE ONLY _ Rte to S s Admin: Date , zzfzmFErrmm Rte to Bid: Adrnin: Date , AMIN B �►•f Refund Processed Date /y�c„IE B /W% Invoice Processed: Date B Permit Canceled: Date Pj7 B ,,! Parcel Tag Added: Date By Receipt # Date Method Amount $ 1:\ Building \Forms \RegPernvtAction.doc Rev 05/25/2012 Building Permit Application V 0 1 Q r/ ///-3 Residential L -_-- ' , e ' , 7 I? fL FOR OFFICE USE ONLY City of Tigard MAY ® 2 2O 3 Received Permit No.: 1,..k 3 • -Qo(( a Date/By: 5 (� I . 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.196C0l f OF TIG RD Date/By: Other Permit: TI G A F D Inspection Line: 503.639 ( UILD rYy p� ��� ��, ^ Date Ready/By: tug See Page 2 for Internet: www.tigard or.gov to Y V 7 Notified/Method: � Supplemental Information TYPE OF WORK 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 ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $�0 7e 900 ® 1- and 2- family dwelling ❑ CommerciaUindustrial c ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: Q - JOB SITE INFORMATION AND LOCATION Total number of floors: r' d/l , su Job site address: 1 C� L� n� New dwelling area: a &8 square feet City/State /ZIP: -\ d OW Garage /carport area: �, V 0 square feet Suite/bldg. /apt. no.: `� Project name: Covered porch area: 9 O square feet Cross street/directions to job site: Deck area: ..I" square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: fi i e L. (( (-1 -r PA R ; Lot no.: A 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. Residential New Construction Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER l ❑ TENANT Number of stories: Name: Sage Built Homes LLC Type of construction: Address: 16280 NW Bethany Court Occupancy groups: City/State /ZIP: Beaverton, OR 97006 Existing: Phone: (503)502 -6623 Fax: (503)533 -5164 New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Sage Built Homes LLC Structural plan review fee (or deposit): Contact name: Katie Patterson FLS plan review fee (if applicable): Address: 16280 NW Bethany Court Total fees due upon application: City/State /ZIP: Beaverton, OR 97006 Amount received: Phone: (503) 502 -6623 Fax: : (503) 533 -5164 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E -mail: katie@sagebuilthomesllc.com Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System. Business name: Sage Built Homes Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: 16280 NW Bethany Court Solar Installation Specialty Code checklist. City/State /ZIP: Beaverton, OR 97006 Permit Fee (includes plan review $180.00 and administrative fees): Phone: (503) 502 -6623 Fax: (503) 533 -5164 State surcharge (12% of permit fee): $21.60 CCB lie.: 189330 Total fee due upon application: $201.60 Authorized signature l / S (, / /�� This permit application expires if a permit is not obtained 4,...e,,..,___..,0.-.. within 180 days after it has been accepted as complete. Print name: Katie : • rson Date: * Fee methodology set by Tri-County Building Industry 5ra� Service Board. I:\Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440 -4613T(l l /02 /COM/WEB) Mechanical Permit Application '_' ` . '1,J' 1 � FoR OFFICE LSE ONLY City of Tigard 0 2 2013 Date 51: 3 permit No.:aST av 13 -aol ( l NI v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: 1.1 G Et D Inspection Line: 503.639.4175 C O'F i "GAR Date Ready/By: luris: 121 See Page 2 for Internet: gard OV i D s p : , lG D 1V&O fV 1 Notified/Method: 11 Supplemental Information =�l V U TYPE OF WORK COMMERCIAL FEE' SCHEDULE — USE CHECKLLST Mechanical permit fees' are based on the value of the work ® New construction ❑ Addition/alteration/replacement 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* ® 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For spedal information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: 1 'a 03 51,13 Ly I A n 6 (requires site plan showing placement) 46.75 7 Furnace 100,000 BTU (ducts/vents) 46.75 City/State /ZIP: Tigard, OR 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/directions 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: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 1 23.32 a3 . Residential New Construction Gas fireplace /insert a- 33.39 6t. . 7"g Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ® PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32 Other: 23.32 Name: Sage Built Homes LLC Environmental exhaust and ventilation: Address: 16280 NW Bethany Court Range hood/other kitchen equipment 33.39 .33 3 City/State /ZIP: Beaverton, oR 97006 Clothes dryer exhaust 1 33.39 33 Al F ax: 503 533 -5164 Single-duct compartments, rtm ents (bathrooms, rooms) s, Phone: (503)502-6623 ( ) toilet compartments, utility rooms) ti 23.32 ® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans I 23.32 2.S . 3 �..- Other: 23.32 Business name: Sage Built Homes LLC Fuel piping: Contact name: Katie Patterson $14.15 for first four; $4.03 for each additional Address: 16280 NW Bethany Court Furnace, etc. Gas heat pump City/State /ZIP: Beaverton, OR 97006 Wall/suspended/unit heater Phone: (503) 502 -6623 Fax: : (503) 533 -5164 Water heater Fireplace E -mail: katie@sagebuilthomesllc.com Range CONTRACTOR Barbecue Business name: The HVAC Team Clothes dryer (gas) Other: Address: PO Box 854 MECHANICAL PERMIT FEES" City/State /ZIP: Sherwood, OR 97140 Subtotal Minimum permit fee ($90.00) Phone: (971) 322 -5013 Fax: (503) 352 -9349 Plan review (25% of permit fee) CCB lic.: ‘k 6 kk—1 O State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized si tore' This permit application expires if a permit is not obtained within 180 after it !' t days has been accepted as complete. Print name: Katie P arson Date: 6/ /3/ I • Fee methodology set by Tri County Building Industry Service Board 1:\ Building \ Permits\MEC- PermitApp.doc 03 /07/12 440.4617T(11/02/COM/WEB) Plumbing Permit Application -; I1 ! 1 -1 ','� 1 , Q Building Fixture f1►' ` 0 2 2013 FOR oFFicl: t SE ON L1 City of Tigakt 0 l r} A ( Permit NottS7 90/ 3 -co l v 13125 SW Hall Blvd., Tigard, OR 972230 i ( O a 1C D y �� 3 Iiii Plan R Z Phone: 503.718.2439 Fax: 503.598. fr( o tN , ' l Date/B Inspection Line: 503.639.4175 Other Permit No.: '� ° °�' Vr2 1 �t�' �s�' T 1 G:\ R D Date y: O ®� mental Information Internet: www.tigard or.gov Notified/Method: pp TYPE OF WORK FEE` SCHEDULE ® New construction ❑Demolition For special information use checklist Description I Qty. J Ea. i 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 El Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 1 500.32 • 3 ❑ Accessory building ❑ 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: i�o3'9 SW Ly,(\n 64- _Catch basin or area drain I I 18.76 1 Drywell, leach line, or trench drain 18.76 City/State /ZIP: Tigard, OR Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: 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 3(.D- DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 a$. O�- Residential New Construction Dishwasher l 25.02 95. O 2 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT' Expansion tank 12.51 Name: Sage Built Homes LLC Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 16280 NW Bethany Court Garbage disposal i 25.02 OS. o 1_ City/State /ZIP: Beaverton, OR 97006 Hose bib g- 25.02 5'0 . VI Phone: (503)502 -6623 Fax: (503)533 -5164 Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Sage Built Homes LLC Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Katie Patterson Roof drain (commercial) 12.51 Address: 16280 NW Bethany Court Sink/basin/lavatory 5 25.02 City/State /ZIP: Beaverton, OR 97006 Solar units (potable water) 62.54 Phone: (503) 502 -6623 Fax: : (503) 533 -5164 Tub /shower /shower pan 12.51 a,s. d 2 E -mail: katie@sagebuilthomesllc.com Urinal 25.02 Water closet 3 25.02 ',S. (:)(o CONTRACTOR Water heater i 37.52 37.s a Business name: Malmedal Plumbing Water piping/DWV 56.29 Address: PO Box 207 Other: 25.02 City/State /ZIP: Banks, OR 97106 Subtotal Phone: (503) 502 -6623 Fax: (503) 533 -5164 Minimum permit fee: $72.50 CCB Lic.: P umbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: .I, " -C�� jyk-, TOTAL PERMIT FEE Print name: Katie Pa rson I Date: 50 /, 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. 1:\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(I0/02/COM/WEB) Electrical Permit Application' , -;r �''�'. :�, tit �- 1 FOR OFFICE USE ONE) 1 - -' `� ' . -, ✓ Received 3 "� Q 1, City of Tigard I ateB : S a— ( 3 Permit No.: S - ° 13125 SW HaII Blvd., Tigard, OR 97223 MAY ®2 2 (113 f Phone: 503.718.2439 Fax: 503.598. fi 60 i �;: Other Permit: Inspection Line: 503.639.4175 1 G A R D .639 i� l (.14:. u ' ! � Ready/By: 0 See Page 2 for °�� � " 1 �r� " " ® •., . to Ready /By: Mill Supplemental Information Internet: www.tigard -0r.gov � � �0 , � � �� 1U LD'a :�G D �±� �mN 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 ® I- 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 ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ", Job no.: Job site address: !!� / C IOOHP or more. occupancy. �� V 1 (n 1� v� ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: r El Health-care facilities. ❑ Supply voltage for more than ty \ l/C(� I ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE_ Cross street/directions to job site: Description I Qty. i Fee. I Total I 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 DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family 75.00 2 Residential New Construction residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less (. 100.70 i W , 70 2 ® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: Sage Built Homes LLC 401 amps to 600 amps 20034 2 601 amps to 1,000 amps 301.04 2 Address: 16280 NW Bethany Court Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP: Beaverton, OR 97006 relocation Phone: (503)502 -6623 Fax: (503)533 -5164 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 166.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: Sage Built Homes LLC B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: Katie Patterson branch circuit Each add'l branch circuit 7.42 2 Address: 16280 NW Bethany Court Miscellaneous (service or feeder not included) City/State/ZIP: Beaverton, OR 97006 Each manufactured or modular 6784 2 tY + dwelling, service and/or feeder Phone: (503) 502 - 6623 Fax: : (503) 533 - 5164 Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E mail: katie@sagebuilthomesllc.com Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: Ross Electric panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 2870 SE 75 #203 Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: Investigation (I hr min) 66.25! hr ity/State /ZIP: Hllsboro, OR 97123 Industrial plant (1 hr min) 78.18/ hr Phone: 503 642 -2800 F ax: 503 642 -5815 I nspections for which no fee is Phone: ( 503) ( ) 90.00/ hr specifically listed (%: hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Subtotal: Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: e. This permit application expires if a permit is not obtained within 180 • days after it has been accepted as complete. Print name: Katie P er on / Date: 07/ • Number of inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 44 461 /05 /COWWEB Building Division V 0 0 Development Code Provision Review TI G A R Residential Projects Building Permit No.: S 1 -00 I l / Project /Subdivision Name: r'= l eLI6 f-F i PA-2-17770/0 , Lot #: Site Address: /a0 3 `f 1.1 S 1 CWS Service Provider Letter: Required: Yes ❑ No ❑ Received: Yes ❑ No ❑ Plans Routed: JJ Original Plan Submittal Date: ./-- / a3 Routed By: 1St Revision Submittal Date: ❑ Site Plan Only Routed By: 2nd Revision Submittal Date: ❑ Site Plan Only Routed By: 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 'f approved. ' / Planning Review (contact at (503) 718- p7��1() or hie @tigard- or. ov g ) Land Use case N . d t 4 Zoning � E / Setbacks: Front �� Rear / 5 Side 7 Street Side ` G age la Maximum Building Height: °J (, Actual Building Height 0' Visual Clearance 0" asements Sensitive Lands Type: 4;,, 12 treet Trees 1° � ("Protected Trees t' Notes: C 1II ��?//s P 2 l �� � caN j 2 i� 1 Original Plan: Approved ❑ Not Approved M Date: 7 6 - 13 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13 Engineering Review (contact'Mike White at 503 - 718 -2464 or MikeW @tigard- or.gov) Actual Slope: Notes: gam.) LOk VI-4- 5- Ala tref12 - 5-E.vt .ek-. IS c-C (-441-172.S - 9 favi-duz heaVC Fir£ LCD C4 7= ' 671-j L 5"l b f eaff LB Original Plan: • Approved ❑ Not Approved Date: s 1 /// 2 " Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at (503) 718 -2426 or albeit @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 4 /4)1..3 Date Routed to Building: • (i • i � • ;i Page 2 of 2 I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev.' 01 /16/13