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Permit
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENTI' D- Re uest for Permit Action ,Q /S 4 , i i , 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor JR1City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) I E 010A 2 TJLe.) //,-)C., Mailing Address: I f q07 1J i 9 9 )Te.�f„-r- . u..re. 1/70 City/State/Zip: Jq 0 to t .J L2 t w/-1 4 4 CQ g a Phone No.: 3C00-025S— 7900 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): , CANCEL/VOID PERMIT APPLICATION. I REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). il INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). El REMOVE/REPLACE CONT' ' • t • PERMIT (do not cancel permit). Permit#: 1-1,5T-c9.0!5-UO 02 f D4`_____-lam=n_ Site Address or Parcel#: tca.l dw "`-c' C�Sr o1T-. Project Name: Of.I.. 0_ce_r Ee,r -Te-s 1 Lor $ Subdivision Name: CD es K 0 -OJt-i Esr#TE S Lot#: g EXPLANATION: , T.2-a Toe To . ....1131--t t T —F 2 ,.SV .,. - E. Pty,J, I lJ J o i e f__ - n Q. I0 C PNE•J t t w -i.E.-• `�t-•-6 Fl i IT er C.- ktif- fJ t-titiiL. Pub • 2z:S'c,3MiartA KnI ,� MSr20/s-Doo .2/ 'e 5 -OoSY Signature: G___.-LizikLiti---4 _ tn.-A-.{ Date: I(f l t,tis— Print /SPrint Name: f g 6, -R. A��t i S 14, l Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OI'I'ICE USE ONLY Route to Sys Admin: Date I, t4 15- ; Route to Records: Date /21e _ By ?. Refund Processed: Date ^//1¢ By ,;r%i Invoice Processed: Date/Z/jam`js B I-r Permit Canceled: Date /y//p/ c B ,,0� Parcel Tag Added: Date / By L:\Building\Forms\RegPermitAction_09 314.doc • �� City of Tigard • COMMUNITY DEVELOPMENT • • Building Division 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TIGARD INVOICE • TO: Lennar NW Inc. Customer ID: 195307 Attn: Ricky Selby . Invoice No.: INV2015-00008 11807 NE 99th St, Ste 1170 Invoice Date: 12/10/2015 Vancouver,WA 98682 Date Due: 01/10/2016 Case No. • Site Address Subdivision-Lot#.or.Project Name Amount Due MST2015-00210 6821 SW Locust St. Development Code Review Fee $88.00 for review completed prior to request to cancel permit Oak Street Estates,Lot 8 Resubmitted under MST2015-00222 Invoice Total: $88.00 ® Please see attached fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: MST2015-00210 Customer ID: 195307 Site Address: 6821 SW Locust St. Invoice No.: INV2015-00008 Project: Oak Street Estates,Lot 8 Invoice Date: 12/10/2015 Date Due: 1/10/2016 Invoice Total: $88.00 Amount Paid: $ Office Note: Route copy of receipt to Dianna Howse. Please mail payment to: City of Tigard,Building Division Attn: Dianna Howse 13125 SW Hall Blvd. Tigard, OR 97223 I:\Building\Accounting\Invoice.doc 01/14/2011 ,� CITY OF TIGARD FEE AND PAYMENT HISTORY II4 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIlGARD MST2015-00210 - 6821 SW LOCUST ST, TIGARD, OR 97223 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due DC Provision Review, SF-Ping 100-0000-43112 $88.00 $88.00 $88.00 Totals for Fees $88.00 $88.00 $0.00 $88.00 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount ' Total Payments: $0.00 Balance Due: $88.00 Buildings a /,lg/is Ls Permit Application �` ` I�9 .,,,. tesidential .► FOR OFFICE USE ONLI Cityof Tigard 01S Received - g \ 2 Date/By: i, 1 i S 677 Permit No.:in -(26 le)--_020.2 S (��t O q 13125 SW Hall Blvd.,Tigard,OR 97223 NQ V Plan Review Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 1�A� Date/By: t s----_uo/�k_ TIGARD Inspection Line: 503.639.4175 �r'�Y 0 INiSIG�w��i®Ni Date Ready/By: Juris: 0 See Page2 for Internet: www.tigard-or.gov ► lV ,7 Notified/Method: Supplemental Information gliovi 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 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1-and 2-family dwelling 12Commercial/industrial Valuation: $ 1 6'q 32O ❑Accessory building 0 Multi-family Number of bedrooms: 3 — ❑Master builder 0 Other: Number of bathrooms: 2 .. JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: 682/ SW L oC u 57- S---; New dwelling area: 2 82 2 . square feet City/State/ZIP: /l epfRb/ OR 9 722 3 Garage/carport area: 401 square feet Suite/bldg./apt.no.: Project name: Covered porch area: 5'47, square feet Cross street/directions to job site: Deck area: /9 2 square feet Other structure area: square feet /� REQUIRED DATA:COMMERCIAL-USE CHIsCKLIST r2f9K Sr6T C�__ Subdivision: ' S7-4 rr S Lot no.: 8 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. _ NSFR Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER 0 TENANT Number of stories: Name:LENNAR NW,Inc. Type of construction: Address:11807 NE 99th Street,Suite 1170 Occupancy groups: City/State/ZIP:Vancouver,WA 98682 Existing: Phone:(360)258-7900 Fax:(360)258-7901 New: • ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name:Lennar NW,Inc. (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name:Charles Webb FLS plan review fee(if applicable): Address:11807 NE 995h Street,Suite 1170 City/State/ZIP:Vancouver,WA 98672 Total fees due upon application: Phone:(360)258-7900 Fax::(360)258-7901 Amount received: E-mail:PORPermits@lennar.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name:same as above 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: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: 95345 7 Total fee due upon application: $201.60 Authorized signature: /_7415 G 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: Lk� 3/ Date: /7 f'./f ervice Board. I:1BuildinglPermits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) O) Electrical Permit ApplicatiQ \N FOR OFFICE. Se O\I.1- Pp��� Received City of Tigard Permit No: t g �G Date;By: 13125 SW Hall Bh-d.,Tigard,OR 97223 9 2,O J Plan Re�ieu = Phone: 503.718.2439 Fax: 503.598.1960 Date'By. Other Permit: i It hfy Inspection Line: 503.639.4175 SKU DateReady.'By. tans 0 See Page 2 for Internet: ssww.tigard-or.eoy i''t�' �� ®i Notifted-Methed I Supplemental Information TYPE OF WORK .���c� PLAN REVIEW ❑ New construction C]Addition/alteration/replacementI Please check all that apply(submit 2 sets or plans w,'itrms checked below): 0 Service or feeder 400 amps or more 0 Buildine over three stories ❑ Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds 14.000 0 Commercial-use agricultural 0 I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building amps for all other installations. buildings ❑ Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or ❑Emergency system. larger separately derived system JOB SITE INFORMATION AND LOCATION 0 Addition of new motor load of ❑'A", E",`t-2". 'I-3", Job no.: Job site address: // / _ 1001-1P or more occupancy. C��ZI SW GCL�lS T s--7.--- ❑Six or more residential units. 0 Recreational vehicle parks. Cifv,State/ZI e: .7r:�p/ ' [j 1 ❑Health-care facilities. 0 Supply voltage for more than ` ' 7 /x s C 2 ❑Hazardous locations. 600 volts nominal. Suiteiblde.lapt.no.: Project name: 0 Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: , Description 1 Qty. I Fee_ I Total I • ' New residential single-or multi-family dwelling unit. Includes attached garage. /' 1.000 sq.R.or less 168.54 Subdivision: Vie ,��G G! l-S �4 Z� Lot no.: 8add]500 sq.ft.or portion 33.92 I Tax map.'parcel no.: Limited energy,residential 73.00 DESCRIPTION OF WORK (with above sq.ft) Limited energy.multi-family 75.00 residential(with above sq.R.1 Renewable Energy 0 See Page 2 j Services or feeders installation,alteration,and/or relocation ft,. PROPERTY OWNER 0 TENANT . I 2200 amps or less 1 100.70 12 201 amps to 400 amps 133.56 _2 ��� Y Name: � R) , 401 amps to 600 amps 200.34 2 Address: 11801 ' Y� 9 L t e`5t. ap 601 amps to L000 amps 301 04 1 V I r V 7 y� ON et-1.000 amps or colts 1 552 26 I CityState;ZIP: al�f1e;11l1Lpq [/3P (49-60 Temporary services or feeders installation.alteration.and/or Phone:SOO ) 75.V1- 11.00/ Fax:( 1 �10 relocation ✓ 1200 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 123.08 1 2 intended for sale. lease.rent_or exchange.according to ORS 447.449.670.and 701. I401 amps to 599 amps y 168.54 Owner signature: Date: l Branch circuits-new.alteration,or extension.per panel A.APPLICANT ❑ CONTACT PERSON Fee for branch circuits withabove service or feeder fee, 7.42 2 Business name: L.r)(' fAthrYij/ 'N 1"�1 l I P' ' each branch circuit I V V l B.Fee for branch circuits without Contact name: e ha r/A, i l el,0 service or feeder fee,first V I y` V" !J 56.18 branch circuit Address: 1\), . sr1 N 1 C II _ Each add)branch circuit I 7.32 2_ n n(���t 1'Ve_/ l /�jt��j tli 1 I Miscellaneousainn ed(service r u feeder not included) C'its'State.1_lP: h` 1d I /y Il ll� ` l '(�`�- t: Each manufactured or modular I X784 2 Phone:-.50 1 '9 -1.).) "clap Fax: :(( 1) -S' _74 1 dwelling.service and.or feeder Reconnect only 67.84 E-mail: pn 'r ��(��i (�(�tr C o� Pump or intention circle 67.84 CONTRACTOR I Sign or outline lighting 67.84 _ Business name:?0. ti� Gkc�c. -. I Signal circuit(slor limited-energy I See2 11 panel,alteration.or extension. ( Paso 2 Address: tiNcy3 e s\Necceck, c - I Each additional inspection over allowable in any of the above 1 +'� Additional inspection Il hr min) 66.25'hr I Cit)'State-ZIP: ?oCAf , d- (Vf Investigation t 1 hr min) 66?5 hr Phone:(gm, u,kmoi", _-2�Q,[�f I Fay:( 1 Industrial plant(I hr min) - 78.18'hr \ '� f Inspections for which no fee is CCB Lie.:aOseAkiG Electrical Lie.: C ,o "/�101 Suprv. Lic.:5 305 S specifically listed I',:hr min) 90.00'hr ELECTRICAL PERMIT FEES Supp. Electrician signature.required:N - Subtotal: Print name: rcl_ r � ate: Plan review(25%of permit fee): LGr�� t - I State surcharge(12%of permit fee). Authorized signator �a.\ t TOTAL.PERMIT FEE: \Q--- This permit application expires if a permit is not obtained within 180 Nm pante: `��0.�� J\O�2v , Date: darn after it has been accepted as complete. • Number of inspections allowed per permit. I Ruil4ing+PermiwELC Permit pp_ELR_ERE doc Res.Or:b_Oli 440-46151111 t6T0\trWF13 Mechanical Permit Application FOR OFFICE USE ONLY 111,1 n 13125 SW Hall Blvd.,Tigard,OR 9722City of Tigard � NV4V DateReceivedy/BPermit No.: Plan Review Phone: 503.718.2439 Fax: 503.598.19 Date/By. Other Permit: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov \I 9 `l 1V3 Notified/Method: Supplemental Information N0 TYPE OF WORK t� lit1_NIA) COMMERCIAL FEE* SCHEDULE — USE CHECKLIST w,y�y e��11J�o 1` Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteratiop]( > t� performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: °°"�� mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION _ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating cooling: Air conditioning i 46.75 Job site address: 6 82 t/ 5--ii) LD Ca 5% s7✓ Furnace 100,000 BTU(ducts/vents) 1 46.75 City/State/ZIP: _Furnace 100,000+BTU(ducts/vents) _ 54.91 779 ���i�/ ©� 7Z�� 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 _C Other: 23.32 Subdivision: 2A f� 3 '-EE S>/1T�S Lot no.: 8 Other fuel appliances: Tax map/parcel no.: Water heater 1 23.32 DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 Flue vent for water heater or gas NSFR 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 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name:LENNAR NW,INC Range hood/other kitchen equipment 1 33.39 Address:11807 NW 99th Street,Suite 1170 Clothes dryer exhaust 1 33.39 City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 5 23.32 Phone:(360)258-7900 Fax:(360)258-7901 Attic/crawlspace fans 23.32 ® APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name:LENNAR NW,Inc $14.15 for first four;$4.03 for each additional Contact name:Charles Webb Furnace,etc. Address:11807 NW 99th Street,Suite 1170 Gas heat pump Wall/suspended/unit heater City/State/ZIP:Vancouver,WA 98682 Water heater Phone:(360)258-7900 Fax::(360)258-7901 Fireplace Range E-mail:PORPermits@Lennar.com Barbecue CONTRACTOR Clothes dryer(gas) Business name: Other: WG iD-L, G O (.t,�(N f3 I/I J C)i MECHANICAL PERMIT FEES* Address: /D 7 S W, His Td/tie CD L t1,4l ',M M ISL-;2 Jy wr Subtotal City/State/ZIP: h0 ci 7—D4 i C , `1761 6 Q Minimum permit fee($90.00) ! Plan review(25%of permit fee) Phone:(56 1 6 6 7../76)/el,ile Fax:(spa) tufa 7 9891 State surcharge(12%of permit fee) CCB lic.: 1/ 22206 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 • Ate, days after it has been accepted as complete. * Authorized signature: eel r t„„,,��rFee methodology setby Tri-County Building Industry Service Board Print name: CL//-i w/yn,U Date: 9,i6 ' 15 r:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Plumbing Permit Application Building Fixtures (ANN VY c1,: (11 i( 1 1 �r c,Nr City of Tigard Received Permit IN v 13125 SW Hall Blvd.,Tigard,OR 972 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 Plan Review ■ 015 Date/By: Other Permit No.: T I G A R D Inspection Line: 503.639.4175 0 Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov a hStb_Notified/Method: Supplemental Information TYPE OF WORK �,vY 0 V +il`� *� FEE* SCHEDULE ®New construction ❑De>.11�,,�1C•�1 For special information use checklist tt�� L Description Qty. Ea. Total ❑Addition/alteration/replacement 0 011ier: 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 ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 1 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: '" J/ Catch basin or area drain 18.76 Job site address: 6 8 2 1 .5-k) C-o eus T Sr Drywell,leach line,or trench drain 18.76 City/State/ZIP: Tj(,41RODR 9 72 23 J Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.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: OA f; S .E.. 7;,-1 7ES I Lot no.: g Fixture or item: Tax map/parcel no.: Backflow preventer 1 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 NSFR Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:LENNAR NW,Inc Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:11807 NW 99th Street,Suite 1170 Garbage disposal 1 25.02 City/State/ZIP:Vancouver,WA 98682 Hose bib 2 25.02 Phone:(360)258-7900 Fax:(360)258-7901 Ice maker 1 12.51 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:LENNAR NW,Inc Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Charles Webb Roof drain(commercial) 12.51 Address:11807 NW 99th Street,Suite 1170 Sink/basin/lavatory 5 25.02 City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54 Phone:(360)258-7900 Fax::(360)258=7901 Tub/shower/shower pan 3 12.51 E-mail:PROPermits$Lennar.com Urinal 25.02 CONTRACTOR Water closet 3 25.02 n Water heater 1 37.52 Business name: Wo L c077 !'L u m 13 fA('Cj Water piping/DWV 56.29 Address: /O 7 5 141, /41's 7D2/C 6,4.u m/ /4 /i✓!PQ ,(/per: 25.02 City/State/ZIP: /1:74u 7/2/QLL.s' e,/7 970 60 ,_i Subtotal 7.. Q89( Minimum permit fee: $72.50 lo� �"1703� Phone:(5-03) �r �X7s�ay Fax:(5;03) L CCB Lic.: `/ 2 Z7 co Plumbing Lic.no.:G‘ .-824/8 Plan review (25%of permit fee) f State surcharge(12%of permit fee) Authorized signature: 74 6 TOTAL PERMIT FEE Print name: Date: 2,/4. This permit application expires if a permit is not obtained within 180 days CG//^/� eoir/.r1.�.v after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. C1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard r COMMUNITY DEVELOPMENT DEPARTMENT ■ T 1 GR 1) Building Permit Review — Residential ABuilding Permit #: A571. /c_ ,a1 U Site Address: &E12/ `Q Leo- 4 S Project Name: C2 L -C271,- --71- E-S.2 . s Lot #: s (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: _ o/Z.Z ,ter c) `die_ [ Verify site address/suite# exists and active in permit syste . PiEver Terrace Neighborhood: ❑ Yes Ad' No V Plan Elements: ' Ttree(3)copies of site plan 0 lb.sting structures on site o plan must be on 8-1/2"x 11"or 11 x 17"paper oV,Footprint of new structure(including decks)with finished awn to scale(standard architect or engineer scale) oor elevations Orth arrow tility locations(required for new,may apply for additions) e address,project or subdivision name and lot number Pt i i cation of wells/septic systems 4licant information(name and phone number) iv.Erosion control(including drainage way protection,silt fence dimensions and building setback dimensions sign,location of catch basin,etc.) area,building coverage area,percentage of coverage and treet names pervious area(applicable if R-7,R-12,R-25&R-40) eet tree size,type and location Property corner elevations(2 foot contour lines if more than Existing trees to be retained with drip line,and tree 4 foot differential) protection measures 0 can Water Services—Service Provider Lett (lot platted prior to 9/10/1995): Required: ElY ,applicant was notified No Received: CI es CI No Public Faciliti Improvement(PFI) Permit: /Required: Yes,applicant was notified ❑ No Applied For: Yes I=1 No,stop intake ,Land Use Case#: V eao11' COOK) ®/Zoning: 4/.. J pr Setbacks: Front �D / Rear ,S— Side C Street Side s Garage �d Llj,indscape Requirement: riof Coverage Maximum: Building Height: Maximum Height 3 Actual Height c �oj If td] % isual Clearance ITAasements ciSLyE nsitive Lands: Yes 0 No Type L,'.(-) 1 1101i_ / jt2']"- rban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: _ ,A_ Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved l:\Building\Fomis\BldgPennitRvw_RES_0709I 5.docx Building Permit Submittal Original Submittal Date: ///q/g"-- Site Plans: # -3 Building Plans: # 3 Building Permit#: rtes=building permit#above. Workflow Routing. allIrining [—Eitg1 Bering �t Coordinator S—Building Workflow Sign-off: [0.►Sigtr--off for Planning(include notes from planning review) Route Application Documents: GI—Engineering (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. B-13uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: -------_____3...._ --- Date: ////)--AT Engineering Review Slope at building pad: S A 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 ❑ No LIDA Facility on lot: ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 4Z i) Date: _117Z '—_.. .5 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit El 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: Vg yes 11] N/A Tigard Trans SDC: 0 Yes N/A Parks SDC: Yes LJ N/A ❑ OK to Issue Permit - Approved by Permit Coordinator: d Date: )))24/) I:\Building\Forms\BldgPermitRvw_RES_0709I 5.docx