Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2015-00274
s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/21/2016
Parcel: 1 S136AA14000
Jurisdiction: TIGARD
Site address: 10183 SW 67TH AVE
Subdivision: OAK STREET ESTATES Lot: 35
Project: Oak Street Estates, Lot 35
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Reauired
Stories: 2 Bedrooms: 3 First: 1692 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 905 sf Garage: 417 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: 2597 sf Value: $314,976.33 Rear: 15
PLUMBING
Sinks: 1 WaterClosets: 3 WashingMach: 1 Laundry Trays: 0 Rain rain: 1Urinals: 0
Lavatories: 4 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 Prevntr: 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 Tvoes Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum-100K: 0
ELECTRICAL
Residential Unit Service Feeder Temo Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mid 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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2597
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: $23,608.90
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. Thos are set forth in OAR
952-001-0010 throu OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5 .232.1987 or 1 32.234
Issued By: F7 — Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspe ion date.
This permit card shall be kept Ina conspicuous place on the job site until corniiLlation of the roject.
Approved plans are required on the job site at the time of each inspec i
Building Permit Application
Residential RECEIVES FOR OFFICE USE ONLI'
City of Tigard Received �� f PemiitNo / �0�`
n 13125 SW Hall Blvd.,Tigard,OR 97223 D E C 2 2 2 015 Plan Date/By:
Review 4
Phone: 503.718.2439 Fax: 503.59 Dale/By:
Other Permit�GL/j�p�Q� BOaa
Y 0� FiGAH Ready/By: ® See Page 2for
a Inspection Line: 503.639.4175 BUILDING .�`t i 1 E � Date Read B orris
Internet: www.tigard-or.gov ` l�h� Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
C_ATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling ❑Commercial/industrial Valuation: ) l—k a
❑Accessory building ❑Multi-family Number of bedrooms: 3
❑Master builder ❑Other: Number of bathrooms4
JOB SHE INFORMATION AND LOCATION Total number of floors:
Job site address: U i g3 S W G 77/w 14!IG New dwelling area: 2 S 7 square feet3
City/State/ZIP: CI RD j 0/? 9720-3 Garage/carport area: 4,) 7 square feet
Suite/bldg./apt.no.: Project name: Covered porch area: go / square feet p
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 04irs _ 7- G s A T:S Lot no.: 3 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 991h 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. lease refer to fee schedule
Structural plan review fee(or deposit):
Contact name:Charles Webb
Address:11807 NE 991h 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.
includes plan review
City/State/ZIP: Permit Fee( p $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 7 3 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: C I� _ 3 Date: 2 *Fee methodology set by Tri-County Building Industry
Service Board.
1:\3uilding\Permits\BUP-RESPermitApp.doc 02/24/2011 4404613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling r i FOR OFFICE USE ONLY
City of TigardRecived
13125 SW Hall Blvd.,Tigard,OR 97223 11 E_C 2 23 2 015 Datee/By: —P.-.t A1Sr,20/_5re0-?,,Z:K
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 CITY 0 0 Electrical [I Plumbing El Mechanical
Internet: www.tigard-or.gov B, El Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ LLJJ I ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. El ❑ El
3 Verification of approved plat/lot. El 1:1 1 El
4 Fire district approval required. Name of district: E] ❑ I El
5 Septic system permit or authorization for remodel. Existing system capacity 11 ❑ 1 El 1
6 Sewer permit. El El I El
7 Water district approval. 1:1 El El
8 Soils report. Must carry original applicable stamp and signature on file or with application. El 1:1 El
9 Erosion control El plan El permit required. Include drainage-way protection,silt fence design and location of catch- El El El
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state El 1-1
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
c9pyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property comer elevations(if 1:1 El
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 ff El El
and location. _7'=— El
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater,
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- E] E]
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.. El E71
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- 1:1 El
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 Z L1 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered EJ El
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 Z El El
over 10 feet long and/or any beam/joist carrying a non-uniform load. –q'
20 Manufactured floor/roof truss design details. = Q
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required El El
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 Oregon and shall be shown to be
_�licable to the project under review.
JURISDICTIONAL 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". 111 El
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ E] Q
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. El El ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ E] E]
27 "Drawn to scale"indicates standard architect or engineer scale. El El El
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, El 1--] 1:1
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
EJ El
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwelli ❑
on a lot of record approved prior to September 9, 1995.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions,
ngs
I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 4404613T(11/02/COM/WEB)
i
Mechanical Permit ApplicatioiPj ` i: ? $" FOR OFFICE USE ONLI'
���^/�
City of Tigard ReceivedPermit No DOo`V
DateBy:
a 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 a 2 5 L J
plan Rev
iew
Other Permit:
Inspection Line: 503.639.4175 Date/By:
Internet: www.tigazd-Or.gOv a p ( Date Ready/By: J
Page 2 for
e` Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
// Air conditioning r 46.75
Job site address:
10163 s W (D Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP: CD
Z 3 Furnace 100,000+BTU(ducts/vents) 54.91
Heat ump 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
Subdivision: �� �� L -- �� Lot no.: Other: 23.32Other 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 ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:LENNAR NW,INC Range hood/other kitchen
equipment 1 33.39
Address:11807 NW 991' 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 ❑ 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 99"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: G 6 L G a"-7- L4 M)3 Other:(i MECHANICAL PERMIT FEES*
Address: 107591-564).816 G & 1>L` N/ Subtotal
City/State/ZIP: NO Uri)AC G G C!70 6.0 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(5'01 6 6 7 -f 7C�1 G�- 3f Fax.(5State�� 2li�! f State surcharge(12%of permit fee)
CCB lic.: U A 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: � * Fee methodology set,by Tri-County Building Industry Service Board
Print name: , Date: 9,16 ,
IABui1ding\PermitsVvlEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application
- �C 2 .�i 20115 Received 'A
City of Tigard Date,B : Permit No.:
13125 SW Hall Blvd..Tigard,ORl 7114 7; r7,f Plan Review
C Phone: 503.718.2439 Fax: 501698A.W. Q 1, Date/By: Other Permit
Inspection Line: 503.639.4175`-` " j Date ReadyfBy: orris 0 See Page 2 for
Internet: wivw.tieard-or.gov NotifiediMethod: Supplemental information
TYPE OF WORKPLAN REVEW
❑New construction ❑Addition/alteration/replacement Please check all Otat apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accesson'building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived systom
JOB ME.INFORMATION AND LOCATION' ❑Addition of new motor load of ❑"A-,-E-,-1-2".-•1-3-,
Job no.: Job site address: G S S 7 // L- I OOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks-
CityiState/Zllz: ❑Health-care facilities. ❑Supply voltage for more than
s G G 5 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Q13. I Fee. -I Tow
New residential single-or multi-family dwelling unit
Includes attached garage.
Subdivision: -- Lot no.' 1.000 sq,ft.or less 168-54 4
OAP,- 55 v -- � : Ea add'1500 sq.ft.or portion 33.92 1
Tax map/parcel no.:
Limited energy,residential 75.00 2
DESCRFMOtN OF WORK (with above sq.fE.
Limited energy,multi-family
75.00
residential with above sq.ft.) -
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
PROPERTY OWNER ❑ TE.*WNT. 200 amps or less 100.70 _
201 amps to 400 amps 133.56 2
Hume: Y 401 amps to 600 amps 200-34 2
Address: 601 amps to 1.000 amps 301.04 2
Over 1.000 amps or volts 552.26 2
C itn'Statei21p: noh I k 1AATemporary services or feeders installation,alteration,and/or
Phone: 00 ) �j— j v® Fax:( )` 51b' 1101 relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that 1 own which is not tot amps to 40o amps 125.05
intended for sale,lease,rent,or exchange.according to ORS 447.449.670.and 701. 401 amps to 599 amps 165.54 ! 2
Owner signature: Date: Branch circuits-new,alteratioe,or extension,per panel
APPLICANT ❑CONTACT,PERSON' A.Fee for branch circuits rrirh
above service or feeder fee. 7 40
Business name: t each branch circuit 2
B.Fee for branch circuits wirhoui
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: (MIN V Each add']branch circuit 1 17.42 2
Cilli/State;21P: Miscellaneous service or feeder not included
LZ c:7 Foch manufactured or modular 67,84
Phone:( U) Fad; : �-1 dwelling,service andior feeder
6 Reconnect only 67.84 2
E-mailNIRix,rMifs-Czcorn Pump or irrigation circle 67.84
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Iy G�C Signal circuit(s)or limited-energy See
net,alteration_or extension. Page 2 2
:address: 1bL\0--,5 � .>� � Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25,'hr
Cit\.Stalc/ZIP: Investigation i 1 hr min) 66.25 hr
Phone:(qil Industrial plant(I hr min) 78.18-hr
Inspections for which no fee is 90.00'hr
CCB Lic.: (a Electrical Lic.: C- ,9 Suprv. Lic.: �� s ecificalh,listed(4:hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: G r K' ate: Plan review(25%of permit fee):
State surcharge(12oio of permit fee):
Authorized signatur . VO\CJ 'J e TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: n-9- 0`o5e� C Date: days after it has been accepted as complete.
' Number of inspections allowed per permit-
1ftuildincPcrmirsELC Prnnfc4pp_ELR ERE doe Rev 05C6_013 44046151'111'05'C0StIWEB
i
Plumbing Permit AppliLea
-
Building Fixtures `-C 2 _S' •
20",5 R ceived FOR OONLY
FFICE USE
City of Tigard Date/By: Permit No/"/57,_;2�/5_-00.2 7f
q 13125 SW Hall Blvd.,Tigard,
OR(912p: - v Plan Review
Phone: 503.718.2439 Fax: 50 .,�.9 8.19,66 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Juris: See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Fnpplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction El Demolition For special information use checklist
Description I Qty. I Ea. I Total
n Addition/alteration/replacement El Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
E I-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
El Accessory building Multi-family SFR(3)bath 1 500.32
Each additional bath/kitchen 25.02
n Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /6) /8 3 Catch basin or area drain 18.76
---�-Aep Drywell,leach line,or trench drain 18.76
City/State/ZIP: ; 22
7 .?
Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: froject 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.: rage
Storm sewer(no.linear ft.:_) Page
Subdivision: 0 Water service(no.linear ft.: Page 2
.4 j_,_ 5"r1&_:EF T Z__ ;,,'I;rE_5 Lot no.: 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 991 Street,Suite 1170 Garbage disposal 1 25.02
City/State/Z[P:Vancouver,WA 98682 Hose bib 2 25.02
Phone:(360)258-7900 Fax:(360)258-7901 Ice maker 1 12.51
E APPLICANT El 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$Lennar.com Urinal 25.02
Water closet 3 25.02
n
Water heater 1 37.52
Business name: WdLCp77' joLum131,41(' 56.29
)7 Water piping/DWV
Address: /075- WM57.ORIC ev4u W A4 ml 1?i r: 25.02
City/State/ZIP: -
,7,_ep,w 7_19,4 70 1�0 Subtotal
Phone:(5d-3)1;6 7-l7$ k7 Fa.:(5_o3) ,//7- _9 Iff Minimum permit fee: $72.50
CCB Lie.: Z Go Plumbing Lie.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Cl Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLNW-PermitApp.doc 10/01/09 440-4616T(10/02/C0NVWEB)
City of Tigard
alCOMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Residential
Building Permit #: / .s%a0/5- ? 7y
Site Address: loles `5:'lF) �j re
Project Name: 0� 3i &� 4:bLILI Lot #:
(New dwelling=subdivision name;:Addition or Alteration=last name of owner)
Planning Reviews�--��--
Proposal: Axeeo -�.��e
Verify site address/suite#exists and active in permit syste
ever Terrace Neighborhood: El Yes ;No
V;V�IPlan Elements:
.ee
(3)copies of site plan isting structures on site
. e 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) fL-or elevations
rth arrow 2/utility locations (required for new,may apply for additions)
IIS e address,project or subdivision name and lot number cation of wells/septic systems
plicant information (name and phone number) Erosion control(including drainage-way protection, silt fence
Ut dimensions and building setback dimensions sign,location of catch basin,etc.)
t area,building coverage area,percentage of coverage and
V eet names
pervious area (applicable if R-7,R-12,R-25&R-40) treet tree size,type and location
Property corner elevations (2 foot contour lines if more than sting trees to be retained with drip line,and tree
4 foot differential protection measures
t�yl lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
�equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
Public FacilVyes,
Improvement (PFI) Permit:
equired: applicant was notified ❑ No Applied For: /Yes ❑ No,stop intake
and Use Case#:
oning: Je-
L1J Setbacks: Front a(J Rear S' Side C Street Side Garage
�L andscape Requirement: °o
of Coverage Maximum: %
BuildingHeight: Maximum
Height Actual Height
%fr_asements
Visual Clearance
ensitive Lands: ElYes VIN 0 Type
Forestry rban Plan
Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: Date: S
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
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Building Permit Submittal
Original Submittal Date: /,1 •2
Site Plans: #
Building Plans: #
Building Permit#: 9-Enter building permit#above.
Workflow Routing: [Planning 9-,Vngineering Permit Coordinator l"Building
Workflow Sign-off: ZSign-off for Planning(include notes from planning review)
Route Application Documents: [Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
C?Bfuilding: 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: 1
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: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
le
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:
Fees Entered: Wash Co Trans Dev Tax: Yes El N/A
�&SDC
Tigard Trans SDC: ❑ Yes g'N/A
Parks SDC: 5&Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: GAY �Date-: 3� S
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