Permit (45) 7CITY OF TIGARD
MASTER PERMIT
111 COMMUNITY DEVELOPMENT Permit#: MST2017-00291
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/14/2017
Parcel: 2S110AC00200
Jurisdiction: Tigard
Site address: 10994 SW ANNAND CT
Subdivision: ANNAND HILL SUBDIVISION Lot:
Project: Annand Heights, Lot 24
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 998 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1367 sf Garage: 440 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2365 sf Value: $291,259.65 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types . 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
Furn>=100K: 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 add'I 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 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 2365
Owner: Contractor:
ANNAND HILL LLC WINDWOOD CONSTRUCTION INC Required Items and Reports(Conditions)
BY RICHARDS,M DALE 12655 SW NORTH DAKOTA 1 Ersn Cntrl 503-639-4175
12655 SW NORTH DAKOTA ST TIGARD,OR 97223 2 Fire Rated Eaves-Both
TIGARD,OR 97223 Sides
PHONE: 503-768-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $30,444.22
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 OAR 952-001-0090. 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:<1 ,1}-1.--(e...,_ — 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.
4
. ,/^ 1 • 9
Building Permit Application ;, 4 / 7-aea
Residential Rr " FOR OFFICE USE ONLY
City of TigardReceived
114 " 13125 SW Hall Blvd.,Tigard,OR 97223 J U L 2 7 2017 Date/By: 7// 12 / Permit NoAiI7�U/1„-/yj -;,,,,../
C Phone: 503.718.2439 Fax: 503.598.1960 Plan Review ^ "!J wJ
r Date/By: VtyC� y Other Permit.CU/7 6)(-r`(t�
TIGARD Inspection Line: 503.639.4175 ( e a " "j` Date Ready/By: Juris" El See Page 2 for
Internet: www.tigard-or.gov rte" ILDii it s z 1?,Ii 3 i 0-.'.1 Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
11New 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.
Ie i-and 2-family dwelling ❑Commercial/industrial Valuation:l- a.9 1) c 9 -11
0 Accessory building 0 Multi-family
Number of bedrooms: L,
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: p
Job site address: /a 4 i �Q� 4A/IGI1�f ri)w:®) (0,,---i 6 New dwelling area: square feet
City/State/ZIP: 7�6*LP ®A-L q72. --3 Garage/carport area:LI jit) square feet
Suite/bldg./apt.no.: Project name: 417n4i,a /lCt, ATs Covered porch area: a 6 square feet)3 67
Cross street/directions to job site: /C9 7 Deck area: I square feet Q$
Other structure area: square feet—
q I
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: L RQ/L(/ iti-e0 A /5 Lot no.: 0. Permit fees*are based on the value of the work performed.
Tax map/parcel no.: V 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.
/1110 i PIZ Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY`OWNER 0,TENANT Number of stories:
Name: 4 Type of construction:
�4JC?Q,IQ CU�S� GT. �IU yp —
Address: /CUP 5- (-5-&) ,vaa p jOa-,�kd 6°V6 ree Occupancy groups:
City/State/ZIP: TA Q . Q1 2_.2.3 Existing:
Phone:Kr,3 70 L/3 7 6' Fax:(513) 5-90--7ri 6)4 New:
❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: , Al
Structural plan review fee(or deposit):
Contact name:
FLS,plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fax: :( ) Amount received:
E-mail: �/ft cj d-gr�4QMec/ ®cf/Rat/i c�j.i1'� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: kifitc1L.,Odi 4,t_5� C_ Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 46 5-5- (510 /Vet ,--A /b4, 1opei- Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review
y `!f �� ��'L2� and administrative fees): $180.00
Phone:(5'&3) .- gd _ 7s Fax:( 6713 6-fd--lac/4 State surcharge(12%of permit fee): $21.60
CCB lic.: 6-0/9 . Total fee due upon application: $201.60
Authorized signature ---, --------___ - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
int name: Date: *Fee methodology set by Tri-County Building Industry
✓: y u S 7 Service Board.
ailding\Permits\BUP-RESPermitApp.doc 02/24/2011 4404613T(11/02/COM/WEB)
.r`
1VZechanical Permit Applicatar-s,, Ir'''' FL JFFICE USE ONLY
It... --,,,t'L '---- ..r Received
City of TigardDate/By: Permit yttes7 !„/)— /
- 4 13125 SW Hall Blvd.,Tigard,OR 97223 J U L 2 7 20 i7 Plan Review ��'//� /'C/
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 DateRead B mr;5:
Internet: www.ti and-or. ov r', t t y y: a See Page 2 for
g g a ',1
Notified Method: Supplemental Information
']GYPEOF work COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
ew construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY=OF--CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
t'and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder ❑Other: Description Qty, Ea. Total
3OB SSTE�INFORMATION AND LOCATION Heating/cooling:
� �� 1 .
Air conditioning 46.75
Job site address: /0 949 �� �-�/)a s1/ /04/.'"Y Furnace 100,000 BTU(ducts/vents) � 46.75
City/State/ZIP: J., a,.. 97.2_23 Furnace 100,000+BTU(ducts/vents) 54.91
/ Heat pump 61.06
Suite/bldg./apt.no.: Project name: [*mild A,'�/ Duct work 23.32
Cross street/directions to job site: Ao f 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
/ j
Subdivision: ��n4/1 G1' ( /1 Lot no.: *2G.!(
Other: 23.32
V Other fuel appliances:
Tax map/parcel no.: Water heater ./ 23.32
-* DESCRii'T16N O,i?WORK'„ Gas fireplace/insert ..'''..-- 33.39
Flue vent for water heater or gas
/l/C{'--, <j PIS- fireplace " 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
ROP-ERTI'z,OWNER'',' ❑ TENANT Environmental exhaust and ventilation:
Name: ®fi /itfif¢uzjad 51cirhc, Range hood/other kitchen
equipment
33.39
Address: a,5-5- 56.0, 1Vdr-$h 09,4„,/,.. 5i4tc.1 Clothes der
exhaust � 33.39
City/State/ZIP: 7j ®,Z 223 Single-duct exhaust(bathrooms,
' toilet compartments,utility rooms) 5 23.32
Phone:( Fax:
�-� �d -��� '""&3) pyo =7GGG Attic/crawlspace fans 23.32
LICANT �' '.❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
50 ot $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address:
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: / /t
LV/!1 (,6l al-dcrA eS/t1(-J d9r9/n-a-!A ( 'M Barbecue
CONTRACTOR". 't/ Clothes dryer(gas)
name:Business n .=,:-
� � � ����� /'
i t�[( �d Other:
• MECHANICAL PERMIT FEES*
Address: /3,5) / AgA
at eer,5 i21ue� a Subtotal
City/State/ZIP: /, jd� 6S '' do y•- < Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.: "7.2.60.13TOTAL 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: j#3/7/q/j� Date: -�I 9/fl
'I\Rnildine\Permits\MEC PermitAoo 040`1113.doc 440-4617T(I 1/02/COM/WEB)
ilectrical Permit Ap 1 licati s.a;;-- E Rd' FOr<OFFICE USE ONLY
City of Tigard ��� t� 2017 Received
l . " 13125 SW Hall Blvd.,Tigard,OR 972223JUL Date/BPlan R : `�
Phone: 503.718.2439 Fax: 503.598.19.69-\ , 71 r-n DateBeview
Related Permit#:
TI GARD Inspection Line: 503.639.4175 t,s, Ready Date/By: Juris H See Page 2 for
Internet: www.tigard-or.gov DI ' 14 ''`"t' Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: ❑Service or feeder 400 amps or more ElBuilding over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 El Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder 0 Other: ❑Fireum .
p p ID Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
o 144II,, j El of new motor load of system
Job#: Job site addressa(j 7/?if �n 4it !r 100HP or more. ❑"A","E","1-2","1-3",
V arm/` 3
13 Six or more residential units. occupancy.
City/State/ZIP: % (�(�_ q��
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 19.-A ita A,/ f�.,. ID Hazardous locations. ❑Supply voltage for more than
N f, `v ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: /000 FEE SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: A^ngitCi /bfi)1/5 Lot#: Includes attached garage.
V 1,000 sq.ft.or less / 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft) 75.00 2
fro...) � � Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
P1OPERTY OWNER 0 TENANT
/ Services or feeders installation,alteration,and/or relocation
Name: tua.6®�coc� ats 6Ail JAL. 200 amps or less 100.70 2
Address: R ,5-s^5-S` C. i�a�i�� s -/ 201 amps to 400 amps 133.56 2
j�' 401 amps to 600 amps 200.34 2
City/State/ZIP: '7 aC72.23 601 amps to 1,000 amps 301.04 2
Phone:(It3 • 7fl0.....27/3 ?s— Fax:(i3 )370 --74,eX, Over 1,000 amps or volts 552.26 2
/ /11 �S �� rd)
6 40.44'
C ®r cc/A Temporary services or feeders installation,alteration,and/or
Email: ,,1(/l ,f�(/T/L(yl� � o relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,perpanel
LICANT 0 CONTACT PERSON p
A.Fee for branch circuits with
Business name: (5a ,e above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 0za5e J 7 ,l,L Sign or outline lighting 67.84 2
/ Signal circuit(s)or limited-energy
Address: .2.:* ,0 (54—or ei0A r1Pitpanel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: �—PZ Cz e7'2,..1-.3-5Each additional inspection over allowable in any of the above
/ � Additional inspection(1 hr min) 66.25/hr
Phone:z3) 3-71 , '7 pc Fax:(-(/3) ‘l6'—92,23 Investigation(1 hr min) 90.00/hr
Email:
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:®r.7 Electrical Lic.4.--geilif Suprv.Lic.:q5 O.S specifically listed(Vs hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal
Print name /n 5 h1 4/W Date: 1/i1//1(1 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:^ TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: c T-1•p Th4ItorAe. Date: 7 1 (71/1? days after it has been accepted as complete.
* Number of inspections allowed per permit.
t.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/] 5 440-4615T(11/05/COM/WEB
•
Electrical Permit Application—City of Tigard ,E D
Page 2—Supplemental Information
JUL 2 7 2017
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description Qty. Each Total
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
F-1 Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n H• eating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
Fl V• acuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
Fl C• lock Systems
n Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\BuildingWermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
'Plumbing Permit Applicatio•
•
D
Building Fixtures FOR OFFICE USE ONLY
City of Tigard2017 Received
- JULDate/By: Permit No.;;.-ti® 13125 SW Hall Blvd.,Tigard,OR 97223 JUS ,v! ST�'Ul?GYMS/
Plan Review
Phone: 503.718.2439 Fax: 503.598.1969,t ;lciA.RD Date/By: Other Permit No.:
Inspection Line: 503.639.4175 . ; C1tVtSi0�°1
TIGARD f ,fm..i Date Ready/By: orris: B SeePage2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® ew construction ❑Demolition For special information use checklist
Description Q . Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
��� SFR(3)bath Ate' 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /(f f 4 Y j C�f I4-A nA 1h i
q /(ac f4 Catch basin or area drain 18.76
1 Drywell,leach line,or trench drain 18.76
City/State/ZIP: ,h O fi- r2.2-.2-3` Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: // < k
b
-/1/1Gi1�l�¢ ! Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
/o 9 fib 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: iehl 11k ILi // /5 l Lot no.: -/4 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
c Clothes washer 25.02
/Vv.-) Jy Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑-PROPERTY OWNER 0 TENANT Expansion tank 12.51
,/�
Name: g/1/�/n tib 60/
-s Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: o�5-5 54D /(/1T/ _p /Z 5•( 1.�� Garbage disposal 25.02
City/State/ZIP:/ a en � Hose bib 25.02
Phone:(4-Co --27b---1--110 7S-- Fax:(�i3 -7�jQ/4.. Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ,�-0 Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: R./i/t /t �r7 erd A1-ZS N w t���jtz2/`4, Urinal 25.02
CONTRACTOR Water closet 25.02
\ Water heater 37.52
Business name: �}ar �4 At % �� Water ppiping/DWV 56.29
Address: /4,11..,0` 5 6f `1 j Other: 25.02
City/State/ZIP: (�ieeezi � j/1, �O Subtotal
Phone:(53) �3 ^ � Fax:(93) -),3 fj Gil Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
f�,� /�393satN/4
7 l/�� State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: J n /(/k ' Date: 'it 41/11 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:\Building'Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
1111111
City of Tigard
N COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A R o Building Permit Review — Residential
Building Permit #: /fjj Sj� 1?�06� f
Lt Site Address: ) 0c791.4 SW Pr n n ci n d H-T l l Ci-,
Project Name: A ( n c✓,n a, h e ic) n rs Lot #: -21
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: (V ew S ER
Verify site address/suite#exists and active in permit system.
Izf River Terrace Neighborhood: 7 No ❑ Yes,See River Terrace Review Addendum Attached
Sit Plan Elements:
Three(3)copies of site plan SE iating structures on site
/Site plan must be on 8-1/2"x 11"or 11 x 17"paper iZfFootprint of new structure(including decks)with finished
O D awn to scale(standard architect or engineer scale) floor elevations
North arrow %Utility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number /Sidewalk/driveway approach
Applicant information(name and phone number)
❑Lucau6n of wells/septic systems
L.ot dimensions and building setback dimensions g trees to be retained with drip line,and tree
❑Square footage of buildings to be demolished protection measures
XLot area,building coverage area,per tage of coverage and treet tree size,type and location
impervious area(applicable if R-7, 11,R-25&R-40) treet names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? EIY.. .c❑Noa
4 foot differential) If yes,is a storm water quality facility shown? ❑Yea ❑No
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ❑ No Received:
❑ Yes ❑ No
Public Facilities Improvement(PFI) Permit: P c_ I b - 0005D
Required: 5 Yes,applicant was notified ❑ No Applied For:
Yes ❑ No,stop intake
Land Use Case#: P 12. 2O(S -- 0 000y Sue. 2C\ S -- 0 00 \ 3
I { Zoning: � 1 Z
,IC1J Required Setbacks: Front 1 5 Rear 1 S Side 3 Street Side Garage 2 0
IJ Landscape Requirement: Z.0 %
�V`Lot Coverage Maximum: 9 0
0,0
y" Building Height: Maximum Height 3 S Actual Height 3 0
l Visual Clearance
Sensitive Lands: ❑ Yes 0 No Type
KUrban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: ('V\ AA.,:-..._. r1 i—_ Date: -7/-Li I 1 —7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: 7/ //))
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planning .Engineering 'Permit Coordinator Q Building
Workflow Sign-off: T Sign-off for Planning(include notes from planning review)
Route Application Documents: JG. Engineering: (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: �/ � a.: , Date: '``.;// /7
Engineering Review
�r-Slope at building pad:
X010
El Conditions"Met"prior to issuance of building permit
El Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Zi No
Assess Water Quantity Fee in-lieu: ❑ Yes 'fi'No
LIDA Facility on lot: ❑ Yes -Er No
❑ NOT Approved by Engineering: Date:
Notes: 11 / 7- (✓'K-- PL 4 7-0g-r---- -c-- I J
ApprovedEngineering: hi//Cry Lc Date: P� 2-)/7
PP
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved El Not Approved
Revision 3: El Approved ❑ Not Approved
Permit Coordinator Review
El 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:
DC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: 'Yes El N/A
Parks SDC: 124 Yes ❑ N/A
LIDA El Yes 1;21"'N/A
K)OK to Issue Permit Oil,
Approved by Permit Coordinator:
Date:
I:\Building\Forms\B1dgPermitRvw_RES_061417.docx
,' Cis E-5C1' //
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
a N
Transmittal Letter
T i n Et 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: /r-7-Or7 DATE isTrin�A . f .
DEPT: BUILDING DIVISION
AUG 2 3 2017
FROM: /Z/ C4f 42-/2.d.s CITY OF TIGARD
COMPANY: Gc2/®v 6 �D o d CnA/s c,7a/,/ BUILDING DIVISION
PHONE: 3 - 7/G '3 2S Car.
RE: 1D 99 V Sr t.) (9-471V4,v1) L' % -C7- 7 —
(Site Address)
(Permit Number)
(Project name or subdivision name and lot numbe4)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. Revisions: /147rd /.S
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: l S C' 2� �/�l F/A/ --t— /4°Z../9-A/S
FOR OFFICE USE ONLY
Routed to Permit Technician: Date:q- )1 Initials:
Fees Due: IN Yes ❑No Fee Description: Amount Due:
.c1-�r pl .,� ✓ v; �..- $ 48--
$
$
Special
$
Instructions:
Reprint Permit(per PE): Yes ❑No ❑ Done
Applicant Notified: e: Initials:
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc