Permit CITY OF TIGARD MASTER PERMIT
= rr COMMUNITY DEVELOPMENT Perfirl MST2015-00273
s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2016
Parcel: 1 S136AA13900
Jurisdiction: TIGARD
Site address: 10211 SW 67TH AVE
Subdivision: OAK STREET ESTATES Lot: 34
Project: Oak Street Estates, Lot 34
Project Description: New SF
BUILDING
Floor Araw Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1384 sf Basement. 0 sf Left: 5 Parking Spaces: 0
Height. 23 Bathrooms: 3 Second: 1508 sf Garage: 494 of Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total. 2892 sf Value: $351,999.56 Rear: 15
PLUMBING
Sinks. 1 Water Closets'. 3 Washing a : 1 Laundry Trays. 0 Rain rain: 1 nnas:
Lavatories. 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines'. 100 SF RainStorm Sewer: 100
0
Tubs/Showers. 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevnlr: 0
Footing Drain: 0 Ice Maker. 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0 Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods'. 1 Other Units: 0
Furn<1001: 1 Vents'. 0 Woodstoves'. 0 Gas Outlets: 4
Fum>=1001: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp', 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea addl 500 sf: 4 201-400 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 SecurityAlarm: N Vaccuum System: N Garage Opener: N All '
Other: N Other Description', Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr.. Occupancy Group: Square Feet:
NEW SF VB R-3 2692
Owner: Contractor:
LENNAR NORTHWEST INC LENNAR NORTHWEST INC Required Items and Reports(Conditions)
11870 NE 99TH ST,STE 1170 11807 NE 99TH STREET SUITE 1170 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: PHONE: 360-216-6423
FAX: 360-258-7901
Total Fees: $24,312.80
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 u nded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi tion Center T utas are sal forth in OAR
952-001-0010 through O 9�:'
u may obtain a copy of the rules or direct questions to OUNC by calling 50 32. or 1 0 .332. 344
Issued By: { Permittee Signature:
Call 603.639.4176 by 7:00 a.m.for the nett available Inapecdonate.
This permit card shall be kept In a conspicuous place on the job site until comp on of a project
Approved plans are required on the job site at the time of each inspection.
Building Permit Application RECEIVED
Residential DEC 2 2 2015 FOR OFFICE USE ONLI
ReceivedCI
City Tigard CITY
OF TK ARO i Date/By 12-1,23 IS Permit13125
C • Phone: W Hall
8. 4 9 Tigard,03, 9722VPILDINU GIVISIO PDI Beview l
Phone: 503.718.2439 Fax: 503.598.1 Other Pe
Inspection Line: 503.639.4175 Date Ready/By: Judi ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: I 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.
— _
® 1-and 2-family dwelling ❑CommValuation:ercial/industrial ,3 $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 'L
Job site address: lopll (. New dwelling area: 2 oY Z square feet _7
City/State/ZIP: C qgo OR 72 e.—? Garage/carport area: 4 4- $quare feet
Suite/bldg./apt.no.: Project name: Covered porch area: 222 square feet 0
Cross street/directions to job site: Deck area: square feet 1,39
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: — -T '.S 74 r-5 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.
NSFR Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:LENNAR NW,Inc. Type of construction:
Address:11807 NE 991"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 reef to fee schedule
Structural plan review fee(or deposit):
Contact name:Charles Webb
Address:11807 NE 99"Street,Suite 1170 FLS plan review fee(if applicable):
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.
Permit Fee(includes plan review
City/State/ZIP: $180.00
and administrative fees):
Phone:( ) Fax:( )
Stale surcharge(12%of permit Cee): $21.60
CCB he.: /'95&0 7 Total fee due upon application: $201.60
Authorized signature: /_ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: /e J7- Date:Sl=L l3 f Z _! 5 'Fee methodology set by Tri-County Building Industry
y 7 Service Board.
t —r
I:\BuildingTermits\BUP-RESPermitApp.doe 02/24/2011 4404613T(I 1/02/COM/WEB)
Electrical Permit ApplicatibV E D
City of Tigard DEC 2 2 2015 2ce.Bevd Perm it No �JT�p/sOO27-S
13125 SW Hall Blvd..Tigard,OR 97223 a -n Plan R;7iety
Phone: 503.718.2339 Fax 56P>4 ifi )i- r��:�•n� Dam'B Other Permit'
Inspection Linc: 503.639.417 �' - -,�a J�'J1 NLN Dam RradS:,By 7tuns 0 Set Pagei for
Internet: vitt W.tigard-orgov ,"'`"• Notified%hed: Supplemental Information
TYPE OF WORK PLAN REVIEW - !,
';ew construction r pleau check all out apply isubmit 2 sits of plans W/hems checked beloa):
❑ ❑AdditiorJalteratiom rzplacement _
0 Service or feeder 400 amps or more ❑Building over three smites. ,
❑ Demolition ❑Other: where the available fault wren ❑Mannas and boatyard:.
CATEGORY OF CONSTRUCTION exceeds 10.000ampsat 150 volmor ❑Floating buildings.
les,to ground,or exceeds 14.000 ❑Commercial-ustagnculsuml
❑ I-and family dwelling E]CommerciaUindus-Uial ❑Accesson building amps for all other installations. buildings
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately dmxed system
, JOB SfTE LNFORMATION AND LOCATION r� ❑Addition ofnew motor load of 0-A-,-E-,-1-2-.-1.3".
Job no.: Jobsite address: )OZ ! W (D ! 7}/ ��/[: Iixormoeore. nccrearem
❑Six ar mor<residmtiel units. ❑Recreational vehicle packs.
CirwStale/Zle: �2 �i �J ❑Health-care Facilities. ❑Supply mlmge for more than
L---i ❑Hazardous locannns. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more
F'EE-SCHEDULE-
Cross streeUdirections tojob site: t i non I Qtr. I Fee I Tow
New residential single-or multi-family dwelling unit.
/'� Includes attached garage.
Subdivision: Oq - S� __— _ Lol no.: 3¢ 1,000 sq.ft,or less { 168.13 S
Ea.add'1500 sq,h,or portion 4 33.92 1
Tax map.'parcel no.:
Limited energy,residential 7500
DESCRIPTION.OF WORK (With above .
.it) 2
Limited energy.multi-family 7500
residential(with above sq.fL)
Renewable Energy Ene ❑ Set Pa e 2
Services or feeden installation,alteration,and/or relocation
PROPERTY OW74EIX TENANT 1200 amps or less IDOJO _
t 201 amps to 400 amps 133.56 2
Name: Y 301 amps to 600 amps 200.33
Address: �� ,� 601 amps to 1.000 amps 301.04 2
Over LOW ampsor..It 552.26 2
Cin'lStalo'ZIP: aTemporary services or feeders installation,alteration,and/or
Phone:ao 1�— q ()o Fax:(X)052� -1-101 relocation
200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08
intended for sale,lease,rent,or exchange.according to ORS 447,449.670.and 701 401 amps to 599 amps 168.54 1 1 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
APPLICANT - ❑.CONTACT PERSON: A.Fee for brunch eimuits with
above service or feeder fee. 7,42
Business name: W. t each branch circuit
B.Fre for branch circuits nithoxt
Contact name: service or feeder fee,first 56.18 x
'l branch circuit -
Address: r N 'U't ' i I Each add I branch circuit 7.42 ?
C'it_v'S[a[a'7_IP: htisatlianeous service or feeder not included
1' Exch manufactured or modular
Phone:( ) - Foe : �-7
dwellm ,semice amf or feeder 67.84 ?
Reconnect only 67.84 ?
E-mail:/' rptn Pump or imeation circle 67.83 _
.CONTRACTOR Sign or outline lighting 67.84
,
Business name: W� 1-+- TG�Gkr
Signal circuigs)orhmited-eoerev Sce
Anel,alteration.or extension. Paee 2
Address: RA()-:5 3& - Each additional inspection over allowable in any of the above
`, Additional inspection(I hr mm) 66.25:hr
Citdstaw ZIP: oCkNa Imesogetiomll hrmin) 66.25A hr
Phone( i7 1 S-3 Fax:( I Industrial plant(I In min) 78.18 hr
�y inspections for which no fee is 90W hr
CCB Lic.: l6 Electrical Lie.: �` 10 Supry Lie.: 05 5 s eoficalh listed l'•rhrrrm)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ Subtotal:
Print name: `s Ej r Kr ate: Plan review(2596 of permit fee):
�t 1 — State surcharge(12%0 of permit fee)'.
Authorized signatur . - '-',, C TOTAL PERMIT FEE:
�r-��' ` 1 This permit application expires its prms u enot obtained within 180
Pnn(n:afltt: Y� Q�Q V�\O�eJ C- Daft: docs cher irha Lyra acttpttd as complete.
� • Number o(nupaminns allowed per permir.
I ItuildU�Pamnrf:LC Pertnhapp_aLa FAEdw Ra-0vJ{ml: Hu-+6131p bG5C0\EWER
Mechanical Permit Applicatii7ECEI V E-
City of TigardR it015 Date By Permit No. ` 0 73
GEC 2 2 2
• 13125 SW Hall Blvd.,Tigard,OR 97223 ��^'�// Q
Plao Review
Phone: 503.7182439 Fax: 503.598.19 . _ -(�f�n.:.'4!-� Date/By: Other Permit:
Inspection Line: 503.639.4175Date Ready/By.Bvl� Y r'J ® See Page 2 for
p - lads:
Internet: www.tlgard-or.gov vP�.-i� a -- - Notified/Melhod: Supplemental Information
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
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`
® I-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
// �y Air conditioning ` 46.75
Job site address: `lf Z!/ S w (0 7n� f/L. Furnace 100,000 BTU(ducts/vents) I 46.75
City/State/ZIP: `Tl'9.e> Q 4 722 3 Furnace 100,000+BTU(ducts/vents) 54.91
Heat um 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: H dronic hot water system 23.32
Residential boiler(radiator or
h dronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: QpN s CSG E - C=ST/�TE Lot no.: �L1
Other: 23.32
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( as) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other23.32
E PROPERTY OWNER ❑ TENANF :
Environmental exhaust and ventilation:
Name:LENNAR NW,INC Range hood/other kitchen
equipment 1 33.39
Address:11807 NW 991M1 Street,Suite 1170 Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,mill rooms) 5 23.32
Phone:(360)258-7900 Fax:(360)258-7901 Attic/crawls ace fans 23.32
E APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:LENNAR NW,Inc Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Charles Webb Furnace,etc.
Address: 11807 NW 991M1 Street,Suite 1170 Gas heat pump
Wall/suspended/unit heater
City/State/71P:Vancouver,WA 98682 Water heater
Phone:(360)258-7900 _7F (360)258-7901 Fireplace
Range
E-mail:PORPcrmits@Lennar.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Other:
G LCO% % LU A.1 / C �7 MECHANICAL PERMIT FEES`
Address: 2j.- 1R 57'O L 91 T//Z-52 Subtotal
City/State/ZIP: 48-v RLC 0,9 7 rJQ O Minimum permit fee($90.00)
//�� > p Plan review(25%of permit fee)
Phone:(501 667 /;7&/N 3B Fax:(spa ) l� / _ ` State surcharge(12%of permit fee)
CCB lie.: 2 2 2 U G TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: n ' Fee methodology set by Tri-County Building Industry Service Board
Print name: f��- d wM4'a Dale:
LlHuilding)PemiitsUNEC PeimitApp_N0113.doc 4404617TfOMVCOPo B)
PlumbinePermit Applica (; _ 1)
Building Fixtures DEClq
C 2 2 2 15 7D.te/By:
���
City of Tigard Permit No
• 13125 SW Hall Blvd.,Tigard,01i7G?�.3 ) >.'?
■ Phone: 503.718.2439 Fax: e9 449x0. Other Permit NoInspectionLine: 503.639.417 E"'-• jun, ® SeePaget for
Internet www.tigard-or.gov : Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition Forspecial information use checklist
Description Ea. Total
ElAddition/al[eration/replacement EI r: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commerciallindusurial SFA(2)bath 437.78
El Accessory buildingSFA(3)bath 1 500.32
Multi-fatnily
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: Q s G- Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: D 1 6P 4 '7
Footing drain(no.linear ft. Page 2
Suite/bldg./apt.no.: I Project time: Manufactured home utilities 50.03
Cross street/directions tojob site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear If.: Page 2
Stone sewer(no.linear It.:_) Page 2
Water service(no.linear 0.:_) Page 2
Subdivision: s�' r- --s j9 ES Lot no.: g4- 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 ❑ TENANT Expansion tank 12.51
Name:LENNAR NW,Inc Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:11807 NW 99"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 ❑ 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 99"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
Water closet 3 25.02
CONTRACTOR
�7
Water heater 1 37.52
Business name: L Ctl7% PLG[M �� Water piping/DWV 56.29
-6
Address: U 75- 17D ev/-a'm/3/// Ir/f r: 25.02
City/State/ZIP: .PD 77,4 r Subtotal
Phone:(524 3)66 7^�7B Minimum panni[fee: $72.50
CCB Lic.: 2 r7 Plumbing Lic.no.: _ jj Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: 12 TOTAL PERMIT FEE
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.
I Buildmg�Permi1,TLW P11.nAppdac 10/01/09 440-4616T(10/0V(70 m
V
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
s
Building Permit Review — Residential
Building Permit #: /t9 S Tap/S— (.6Qa*73
Site Address: -1310 &O A A/
Project Name: 4-:;bLA9 Lot #: 341
(New dwelling=subdivision name;addition or Alteration=last name of owner)
Planning Review
Proposal: .Nem S�
nId/�Ve� rify site address/suite# exists and active in permit syste
{�kver T errace Neighborhood: ❑ Yes (�Nct
Siff Plan Elements:
Vree(3) copies of site plan 'sting structures on site
Pe plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure (including decks)with finished
rawn to scale (standard architect or engineer scale) "oor elevations
C,t��rth arrow ,,,,,���/pppU,,,tility locations(required for new,may aPPly for additions)
ye address,project or subdivision name and lot number cation of wells/septic s)stems
dGlicant information (name and phone number) rosion control (including drainage-way protection, silt fence
Xp
,krl,ott dimensions and building setback dimensions clesign,location of catch basin,etc.)
04Sdt area,building coverage area,percentage of coverage and eet names
P.,mpervious area (applicable if R-7,R-12,R-25&R-40) treet tree size,t)pe and location
roperty corner elevations (2 foot contour lines if more than �Wtisting trees to be retained with drip fine,and tree
4 foot differentialprotection measures
lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
�equired: ❑ Yes,apphcant was notified No Received: 11Yes ❑ No
LyJ Pubhc Facilities Improvement (PFI) Permit.
equired: Yes,applicant was notified ❑ No applied For: Yes ❑ No, stop wake
and Use Case #: S�//QO/4-- oay/
orung: �' S
L1] Setbacks: Front a(j Rear S Side S Street Side /57 Garagc
Landscape Requirement: °S�
-or Coverage Maximum: "o
Building Height: Maximum Height 30 Actual I leight 4�?
isual Clearance
Easements
lensitiveLands: ❑ Yes VIN o Type
Crban Forestry Plan
onditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: Date: CR S
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Bui Iding\Fonns\BldgPennitRvw_RES_070915.doex
Building Permit Submittal
Original Submittal Date: GS
Site Plans: #
Building Plans: # �'57--
Building Permit#: Enter building permit#above.
Workflow Routing: B'Planning E Engineering E3- ermit Coordinator C9'8uilding
Workflow Sign-off Sign-off for Planning(include notes from planning review)
Route Application Documents: 2Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
[?'Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date:
Engineering Review
Slope at building pad:
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-Leu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: /?� _
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:
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: ❑ Yes N;7N/A
Parks SDC: Yes ❑ N/A
OK to Issue Permit /--
//Approved by Permit Coordinator:
1\.Building`.Forms\BldgPennitRvw_RES_070915Sdocx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10211 SW 67TH AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - C of O
MST2015-00273
Chip Barnett
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10211 SW 67TH AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - C of O
MST2015-00273
Chip Barnett
Violation Summary:
Inspector Contractor