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Permit I I MASTER PERMIT „ CITY OF TIGARD V.0411 11111I a COMMUNITY DEVELOPMENT Permit#: MST2015-00125 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/22/2015 Parcel: 2S103DD00413 Jurisdiction: Tigard Site address: 10860 SW FAIRHAVEN ST Subdivision: FAIRHAVEN COURT Lot: 5 Project: BAUER Project Description: 168 sq. ft. kitchen addition. 12/15/15, REPRINTED to add (1)200 amp panel and(1)bar sink. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 168 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 168 sf Value: $18,925.20 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn>=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: 3 Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 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 Other: N Other Description. Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 168 Owner: Contractor: BAUER,CLAYTON 0&DIANE E OWNER Required Items and Reports(Conditions) 10860 SW FAIRHAVEN ST 10860 SW FAIRHAVEN ST TIGARD,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-720-9643 FAX: Total Fees: $1,354.64 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 A . egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. `Those rules are set forth in OAR 952- -0010 through OA 952-090. You may obtain a copy of the rules or direct questions to OUNC by callin 3.232.1�9,8o7f �cr .800.332.2344. Is ued By: � �Permittee Signatur0` !/ .-e-Cn__,CZ 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. W CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00125 T it;ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/22/2015 Parcel: 2S103DD00413 Jurisdiction: Tigard Site address: 10860 SW FAIRHAVEN ST Subdivision: FAIRHAVEN COURT Lot: 5 Project: BAUER Project Description: 168 sq. ft. kitchen addition. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 168 sf Basement: 0 sf Left 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 168 sf Value: $18,925.20 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 - Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders 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: 3 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 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 Other N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 168 Owner: Contractor: BAUER,CLAYTON D&DIANE E OWNER Required Items and Reports(Conditions) 10860 SW FAIRHAVEN ST 10860 SW FAIRHAVEN ST TIGARD,OR 97223 TIGARD,OR 97223 PHONE PHONE: 503-720-9643 FAX: Total Fees: $1,223.44 I 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.FNTIfN_ Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- -0010 through 9 1- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or,1.800.332.2344. Is ued By: Permittee Signature: �1� � 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. 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 701.325 (2)) This statement is required for residential building, electrical, mechanical,and plumbing per mits. 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 a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I w ill 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 I hereby certify that the information on this homeowner statement is true and accurate. _ GLu e v Print Name of Permit Applicant b)CL L1I/L Signature of Permit Applicant Date Permit#: Aisr o/5'- QQ/a •T� Address: /DoP4' s-4-0 FI/RAM/En/ Issugd by: A 4 Date: II/ ‘1144.-1.: This Copy for Permit Offices Building Permit Application x Residential C1AVI 1-014 Oil I( I I ',I ()NI l City of Tigard permit No: �r a S Date/B r 13125 SW Hall Blvd.,Tigard,OR 97223 C Plan Review' • ' Phone: 503.718.2439 Fax: 503.598.1960 S iO\J Date/B : i,=ry other Permit: 1 1 ti\It D Inspection Line: 503.639.4175 3th- Date Ready'.' Juris: 18 See Page 2 for Internet: www.tigard-or.gov CriV OF I„(lk otified/Method: Supplemental Information TYPE OF WORIB,r�ILDINGDIUVIS ° 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 (IAAddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. iv 1-and 2-family dwelling Valuation: ¢ �' y g ❑Commercial/industrial L B �iZ S .` ❑Accessory building ❑Multi-family Number of bedrooms: (11 Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /0740 50 j/n JAI auoi 5't/• New dwelling area: M6Ao square feet City/State/ZIP: 77 boa el , 7, 3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: ti tl” Covered porch area: square feet Cross street/directions to job site: Deck area: square feet 79(,u a' ally i-X iPU 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. )ern. MALI Jr/Voch` Valuation: $ / Existing building area: square feet New building area: square feet PROPERTY OWNER I ❑ TENANT Number of stories: Name: $a en 4. efs 4Th 4. e, Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: ❑ APPLICANT RI CONTACT PERSON BUILDING PERMIT FEES* Please refer so fee schedule) Business name: f X.I.! e �� • �' * It/d CA Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: lis`� SW eits 6/ 54 7 Ode., City/State/ZIP: r' . Q 5772 23 Total fees due upon application: 7 R Amount received: Phone:(b yr.('04-0 I Fax::( ) 447 / �s• ,� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: C /h/J/!L� Commercial and residential prescriptive installation of `, CONTRACTOR / l- roof-top mounted PhotoVoltaic Solar Panel System. Business name: / d144Ve/2 — t-'/ l4? R.(ut7 Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: f!�+T,4R IR �'7 Z L 3 Permit Fee(includes plan review S 180.00 SSY E and administrative fees):Phone:(5 3) 720_ 96 Y� Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: N4 ed_–..--..S-0 • To tal fee due upon application: $201.60 Authorized signature:// ✓� * This permit application expires if a permit is not obtained ``,�C 6�1.� within 180 days after it has been accepted as complete. Print name: e4,,,,,,,_ Date: ? ..--) "Fee methodology set by Tri County Building Industry Service Board. I:\Building\Permits'BUP-RESPennitApp.doc 02/24/2011 440-46131(11/02/COM/WEB) Electrical Permit Application �IV FOR OFFICE t SE ONI,1 City of Tigard C�� D B� Permit#: III a 13125 SW Hall Blvd.,Tigard,OR Plan Review Phone: 503.718.2439 Fax: 503.598.1960 p r°\ Date/13 : Related Permit#: Inspection Line: 503.639.4175 \\\ II yy�y Ready Date/By: Juris: ® See Page 2 for TIGARD Internet: www.tigard-or.gov ) u��`1) Notified/Method: Supplemental Information TYPE OF WOiR� i V�rr*(.�A�1�4�� PLAN REVIEW ❑New construction ❑Addition/alteratt2fat( Me?tt Please check all that apply(submit 2 sets of plans w/items checked): t�UU\��jJ ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial El Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 1 ool-IP or more. City/State/ZIP: 0 Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I • New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy ❑ See Page 2 1 ❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: N6∎Cl.v.e ,i, l! lQ" 4-'0„` 0,_U.. - 200 amps or less _ I 1 100.70 1 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 t intended for sale,lease,rent,or exchan e,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: (),l,OIJVAQ, I5((Adli.l'L Date: 7.� .-.-015 401 amps to 599 amps 168.54 2 ❑ APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first ( 56.18 2 branch circuit City/State/ZIP: Each add'l branch circuit Z 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: er2t/n/Eg. Sign or outline lighting 67.84 2 circuit(s)or limited-energy Address: panel, alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr mm) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(Vs hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signatur : � TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: ,t0 c_� days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB • . 1 r 4 Mechanical Permit Application wiz OFFICI: 1 SE ONLY City of Tigard * ILA A- Date/By: Permit No,: Y • 13125 SW Hall Blvd.,Tigard,OR 97223 Ji Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 L Q 2015 Date Ready/By: Juris: @ See Page 2 for 0—Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WOR IP p 0V � �i*�(� COMMERCIAL FEE* SCHEDULE — USE CHECKLIST q(� �1�T A I"� Mechanical permit fees*are based on the value of the work ❑New construction ❑Addition/alterati ftbhq 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 ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: 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 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 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 Chimney/liner/flue/vent 23.32 ❑ PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment _ / 33.39 Address: Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range / E-mail: Barbecue CONTRACTOR Clothes dryer(gas) teAr Other: Business name: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lie.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. k/ki Authorized signature: /� • Fee methodology set by Tri-County Building Industry Service Board A_Print nam ._ Date: 6_i5 I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) • • Plumbing Permit Application Building Fixtures X8i tl 1(1R OFFICE USE ONI.I Received City of Tigard kkti� G Date/By: Permit No.. 13125 SW Hall Blvd.,Tigard,OR 97223 n r10 Plan Review Phone: 503.718.2439 Fax: 503.598.19,68 C L Date/By: Other Permit No. Inspection Line: 503.639.4175 wv �� Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov AIv l!G Off} Notified/Method: Supplemental Information TYPE OF WORI�'1�Y`V�1rl1�]�S1 ♦ FEE* SCHEDULE ❑New construction [ Gon For special information use checklist Description I Qty. I 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 ❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 Accessory building SFR(3)bath 500.32 11) ry 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: Catch basin or area drain 18.76 • Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear ft.: ) Page 2 Suite/bldgJapt.no.: I 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 ( Drinking fountain 25.02 �� Ejectors/sump 25.02 (J PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: 499(1 � 1" D,Ar/� 0i �1_ .`.,/) Fixture/sewer cap 25.02 Address: G!7_�,kl,+v''7�-�$� a /1./g/1.41/191)t1Le v`--' Floor ge disposal sink/hub 25.02 (� Garbage disposal 25.02 City/State/ZIP: '7/6, ' p D�_ ' 7?-?-3 Hose bib 25.02 Phone:(5Q33) G� �1t�2 ' ' Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 ` City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: //; y�N,/ /aft tA16? _ - Water piping/DWV 56.29 Address: l D/`(,O $� f//2 '4(/C?l STS Other: 25.02 City/State/ZIP: 7A2 D / 02• ( 7 a.p,...`3 Subtotal / Phone:(43) & -2 o Q Fax:( ) Minimum permit fee: $72.50 CCB Lic.: / Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE iejr- This permit application expires if a permit is not obtained within 180 days Print name: �i 1 Tb/� 2j q.t..t 1L_- Date:7-G./5 after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-Permit App.doe 10/01/09 440-46167(10/02/COM/WEB) L_ . . City of Tigard 11111 COMMUNITY DEVELOPMENT DEPARTMENT ■ TIGAR l Building Permit Review — Residential Building Permit #: S7,.b1s COQ 125'" Site Address: log 6O 34() irA-ve,2 ��.�L Project Name: CSS/lie.r- Astieb7, Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: E(,, kik Le.. nCc)L f1. Verify site address/suite#exists and active in permit syste . ►I!A ' .ver Terrace Neighborhood: ❑ Yes LNo Sit Plan Elements: J h ree(3)copies of site plan 'sting structures on site } e plan must kg on 8-1/2"x 11"or 11 x 17"paper [ Footprint of new structure(including decks)with finished WliO awn to scale (standard architect or engineer scale) floor elevations orth arrow ►t/ .4. 'ty locations(required for new,may apply for additions) rNi . e address,project or subdivision name and lot number J i•cation of wells/septic systems {a. .plicant information(name and phone number) v) .osion control(including drainage-way protection,silt fence I' ,t dimensions and building setback dimensions d=sign,location of catch basin,etc.) fr. .t area,building coverage area,percentage of coverage and ►P treet names impervious area(applicable if R-7,R-12,R-25&R-40) ed: eet tree size,type and location aj operty corner elevations(2 foot contour lines if more than !/ ....sting trees to be retained with drip line,and tree 4 foot differential) protection measures [G J Clean Wate,r.S ices—Service Provider Letter(lot platted prior to 9/10/1995): Required: Ig Yes,applicant was notified ❑ No Received: ❑ Yes t2/No 'Public Facilities Improvement(PFI)Permit: / �,��// Required: ❑ Yes,applicant was notified No Applied For ❑ Yes ❑ No,stop intake /'tiCGand Use Case#: �/ oning: e 3.c- ur etbacks: Front c7 Rear /, '""" Side 5 Street Side ad Garage c:Qo ,'4andscape Requirement: 91 • •t Coverage Maximum: �} % It Building Height: Maximum Height ...DU Actual Height / isual Clearance r 14' asements ,�,� !1/ nsitive Lands: ❑ Yes fa N o Type APP9Urban Forestry Plan Ni nditions"Met"prior to issuance of building permit Notes: Approved By Planning: . Date: e is- Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPermitRvw_RES_070I 15.docx Building Permit Submittal Original Submittal Date: Yet. Site Plans: # _5_ Building Plans: # 3 Building Permit#: building permit# ove. �-- Workflow Routing. Erna ' g ngineering Pern 15' ut Coordinator ding Workflow Sign-off: ■ Sign-o for Planning(include notes from planning review) Route Application Documents: ngineering. (1) copy of permit application, (1) site plan, (1)building plan and on • Ian review routing form. uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: c .------- � Date: 77(//j r Engineering Review ,a" Slope at building pad: 27° ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes No Assess Water Quantity Fee in-lieu: ❑ Yes ,,E'No LIDA Facility on lot: ❑ Yes otErNo ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: !"t.l kA.- tom.' . Date: yi/S Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved, NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: OK to Issue Permit Approved by Permit Coordinator: �jL�+ _ Date: /�li..5 l 1:\Building\F'orms\BldgPermitRvw_RES_0701 15.docx