Permit r U CITY OF TIGARD MASTER PERMIT
111111 -
I COMMUNITY DEVELOPMENT Permit#: MST2015-00158
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/19/2015
Parcel: 1 S134CD05600
Jurisdiction: Tigard
Site address: 11735 SW SUMMER CREST DR
Subdivision: BURLWOOD NO.3 Lot: 16
Project: MCCLENAHAN
Project Description: 525 sq. ft. Detached garage addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 15 Bathrooms: 0 Second: 0 sf Garage: 525 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors: No
Total: 0 sf Value: $22,748.25 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 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: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvpes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
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'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:
NEW SF VB 0
Owner: Contractor:
MCCLENAHAN,DEREK J&WHITNEY J OWNER Required Items and Reports(Conditions)
11735 SW SUMMERCREST PL DEREK MCCLENAHAN 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97223 11735 SW SUMMER CREST DR
TIGARD,OR 97223
PHONE: PHONE 503-332-5338
FAX:
Total Fees: $927.34
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through•AR 90090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued 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 ON
LI
City of Tigard RECEIVEP Received Permit No..Date/B : I MINIM
i∎ I•
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie •-
Phone: 503.718.2439 Fax: wiwygin Other Permit:
Date/B
I 1,.;\R 0 Inspection Line: 503.639.4175 AUG 2 7 2015 Date Ready/By:
Internet: www.tigard-or.gov Notified/Method: -/JJr. I Supplemental Se e Page 2 lnfor formation
CITY 1 t' 1'1(�AK)
TYPE OF "M141 fliNG DIVISION 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.
❑ 1-and 2-family dwelling ❑Commercial/industrial Valuation: -f h $ a. 7 i j 3,5-64,
(Accessory building ❑Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address: I i?35-• 5 . 5,..);,� 2._ ("a-Es; ,L?, New dwelling area: WA square feet
City/State/ZIP: ��AQi) O 97-2a3 Garage/carport area: N/A square feet 52s
Suite/bldg./apt.no.: I Project name: /l lcL 4AN /e,,p r- Covered porch area: square feet.
Cross street/directions to job site: --r--, FAQ -�.� `�' [ 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: j 3,4c r j- 0 5 6000 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
OF '77-1E 00"EclT/ 1 A`- (5 Der-ACHED. Existing building area: square feet
/// New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: 1�erii__ AA e CZ r.n,A onv- Type of construction:
Address: I 1-73s-- 5 c„,..„ 5,1„,,,, /e__ ( z j `b2. Occupancy groups:
City/State/ZIP: --T--/tj..A21), , Q 2._ i 9?Z23 Existing:
Phone:(5-03) 33z, -!., 3 3,. Fax:( ) Nev‘:
pf APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name: .:_ ( E A S 1C)ke
FLS plan review fee(if applicable):
Address:
City/State/ZIP: 1 ) J a
`I Total fees due upon application
Phone:( ) QOLA-e Fax::( ) Amount received:
E-mail: 'r626k e Pv�G CLE NCI/) 1..�‘J�p C'0 � PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
( Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: JN t Y� 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.
Permit Fee(includes plan review
City/State/ZIP: and administrative fees): $180.00
Phone:( ) Fax:( )
State surcharge(12%of permit fee): $21.60
. CCB lie.: e^----- Total fee due upon application: $201.60
Authorized signatu"?e: 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
Print name: l C�L��AH�N Date: �.2 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
111 City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 Dateciat L'
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits
TIGARD
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing 0 Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. Sec 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, ❑ ❑ ❑
1 . v 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 ap p licable to the •ro'ect under review.
JI.RISUI('TIONAI. 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"buildingplans will not be accepted. ❑ ❑ ❑
26 "Reversed"buildingpplans 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.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB)
REllEIV
Property Owner Statement
Regarding Construction Responsibilities AUG 2 7 2015
Oregon Law requires residential construction permit applicants who are not Iicensec14 h the rlCARD
Construction Contractors Board to sign the following statement before a building permit can be !VISION
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-
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.
t f�� prk
Print Name of Permit Applicant
5----
Signature Signature of Permit .. • Date
Permit#: -S/ /5"-- 0O45
Address: //2,..3-5' Set/ _cam t-167z
Issued by: Date: /0,1.5
This Copy for Permit Offices
r=
Clean Water Services File Number
Cleat V'1'atcr Services
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: fiejten-Getintr-'/ c
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): .' !)L 05-600 Name: •T E4k /l)icC r_1714Aefethl
Company:
Address: 0.135-
/13 51%.1 C,zES r C',Q
Q$ Site Address: City, State,Zip: -1 /'./-',e U .BIZ , cy 77
City,State,Zip: Phone/Fax: 'C3 332 - e
Nearest Cross Street: E-Mail: rivZE=r,f (,t�.xwwr4 r[. /Cr,,wJ,CO
4. Development Activity(check all that apply) 5. Applicant Information
•
./.3( Addition to Single Family Residence(rooms,deck,garage) Name:
o Lot Line Adjustment o Minor Land Partition Company: ) )
o Residential Condominium o Commercial Condominium Address `
o Residential Subdivision o Commercial Subdivision �' 9
o Single Lot Commercial o Multi Lot Commercial City,State,Zip: _7 1 _" - �T
Other Phone/Fax:
E-Mail:
6. Will the project involve any off-site work? o Yes y No o Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
This application does NOT-replace Grachng and Erosion Control Permits,Connection Permits, Building Permits, Site Development Permits,
DBJ1200-C Permit or other permits as issued by the Department of Environmental Cuality, Department of State Lands and/or Department of
the Army CCE Al required permits and approvals must be obtained and completed under applicable local, state, and federal law.
Bi sigi ng tti s Tom{the Canner or Omen's aithoriae i agent cr rgxesataliioe aknovJalyS ad agses tld erpioyees°M em Vl a S mass here aahority to eta
theprojed sites al reasonabietirres for thepurpoeeof inspelirgprciect steoaYitionsaid gahaing irtan>tico related to theprojed site I oetfythzt Ian
fariliaviththeirtc ratoncortanedinthisdoorrat,atItothebestor ykrovJecyadbdiet,Illsir&irr icnistn.e ccn lde ad aurae
Print/Type Name 7 AUK(�Gy,atAnt--i Print/Type Title
Signature '�L_''/1: � Date -Z7
FOR DISTRICT USE ONLY
o (estineaeespatetidlyedsimsteorwittin2)0'dthesite T1-E APPLICANT MUST P A SITE PSS6A ENT PRIOR TO ISSUANCE CFA
SERVICE PRCM DER LETTER If Sarsti ve krers exist on the sheer wtti n 370 fest co 4a:e l properties,a Natrd F anew A snBn1 F tpat nw al so
laeregired
b" Pawl onrai eNoftheabrrittedrreteidsad best akildleinfomlicoarsitiveaE cb r cb not weartoedsitonsitecrviittin200'dthesiteilisSensitive
Nee Re Sassi ng Ste Assessrriat does NOT(JIM rete the need to eel We aid prated wda Oily ty a nd ti roe aegis if they ae sbeequetl y ci 9:cmrect Tti s
doarnErt van sane as you'Sawoe RtMth later a5 rap red by F l of ili 0n ad Chia 07-2), Section 3021. All regi red per nits aid ap royal s must be
cbtaned ad=Tidal under applidde loaf,Stag and Wad lay
o IItsedonrai mot the%twittedrrtfaids aid t a altieirfomrtienthe doche refaaned project wllrntsgificatyirrpect the adstingcrpdeialy
se t eaels)found rea the jte ifis arritheA03 ReSrrerirgSteAssaaralrice NOTdinirrdetheneedtoe dueteadprotectatitiordmeter("Lefty
seretiieaas if they aeabsequatlyci edThisdaarnatwll sinnersyarSetiiceRonidalateasregiredbyFbsolcfionadC rde07-27,Section
3.021. All regiref parrits and Tpro is met beobtaned ad convicted under applicabielocd,stateaxl faded lay
o This Service Provider Letter is not valid unless ONS approved site plan(s)are attached.
o The proposed alivity does not meet the ddiriti on of daetcprnet or the Id vas platted after 9/9/96 CFB 9204(X2). N3SITEA,S1 ABVTO R SErMCE
FFCMC6R LETTER IS
Reviewed by Date A J2f 12D
Once complete,email to:SPLReview @cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Reused 2/2015
,► ,: Information Notice to Owners About
( ) Ci` -
onstruction Responsibilities
4,y (ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure,can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an em ployer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Em ployment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to
http://www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 503-947-7815.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
700 Summer St NE,Suite 300, PO Box 14140, Salem,OR 97309-5052
Telephone:503-378-4621 —Fax: 503-373-2007
Website Address:www.oregon.gov/ccb
f/property_owner adopted 9-23-08 This Copy for Permit Applicant
City of Tigard
I
• COMMUNITY DEVELOPMENT DEPARTMENT
TI G AR n Building Permit Review — Residential
Building Permit #: /1-)57;40/5-= j/5--8'
Site Address: 11 1.35 Sw S t.c.w,►-ne r- C re j I- jr
Project Name: M C.,(,) o h G In Lot #:
(New dwelling= subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 6-/-h l 4 Q e- , -�v °1,ec l- /!15 A-e 5 L
Verify site address/suite#exists and active in permit syste
❑ River Terrace Neighborhood: ❑ Yes ,0 No
Site Plan Elements:
,Three(3)copies of site plan kiExisting structures on site
Site plan must be on 8-1/2"x 11"or 11 x 17"paperotprint of new structure(including decks)with finished
rawn to scale (standard architect or engineer scale) floor elevations
rth arrow Nt2tftility locations(required for new,may apply for additions)
ite address,project or subdivision name and lot number )0,12-Location of wells/septic systems
Applicant information(name and phone number) rosion control(including drainage-way protection,silt fence
, Lot dimensions and building setback dimensions design,location of catch basin,etc.)
/U A- ❑Lot area,building coverage area,percentage of coverage and r, 42Street names
impervious area(applicable if R-7,R-12,R-25&R-40) 1Z'11•' r et tree size,type and location /Vfi-
roperty corner elevations(2 foot contour lines if more than sting trees to be retained with drip line,and tree
4 foot differential) protection measures p}/`
'Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ZYes,applicant was notified ❑ No Received: "Yes ❑ No
, Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified 12-1\10 Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#: N I
Zoning: Q- 11. S-
Setbacks: Front Rear S' ( Side c I Street Side Garage
,-Ei"Landscape Requirement: A_
Lot Coverage Maximum: hit} % ,
Building Height: Maximum Height /5 Actual Height I 5 r
Visual Clearance
/a-Easements Al
,...a-Sensitive Lands: ❑ Yes No Type
-2'Urban Forestry Plan /L► lac-
Conditions "Met"prior to issuance of building permit /V rt
Notes:
Approved By Planning: ^ ei, a . e,w✓u2'� Date: 8 -4j`_lS
Revisions (after Building Submittal only) _� Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPennitRvw_RES_070915.docx
f —
Building Permit Submittal
Original Submittal Date: ge j
Site Plans: #
Building Plans:
Building Permit#: nter building permit#above.
Workflow Routing: [t�� %� n��ning —ngineering [�l�rmit Coordinator wilding
Workflow Sign-off: E -5iign-otf for Planning(include notes from planning review)
Route Application Documents: gineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
airrlding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: __' ���r Date: /�- ��
En gi ring Review
.I Sat building pad:
.416-e---at
"Met"prior to issuance of building permit
- ments (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 ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date: A .�3f__4
Notes:
Approved by Engineering: Z cP Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
li 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:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
rel to Issue Permit
Approved by Permit Coordinator: il, ' Date: .0 / 7 51
1:\Building\Forms\BldgPermit Rvw_RES_0709 I 5.docx
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11735 SW SUMMER CREST DR, TIGARD, OR,
97223
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
PASS- NoCofO
Comments:
No electrical at this time.
Violation Summary:
Tel: 503.718.2439
Inspection Date:
November 21, 2016 at
11:45:50 AM
Record ID:
MST2015-00158
Inspector:
Mark VanDomelen
Inspector Contractor