Permit Support Document (21) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT REt-tCi
Request for Permit Action
q QEF' 1 4 2011
Ti G A R f) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 w.tigar
TO: CITY OF TIGARD `
Building Division /2.o,//7 074
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: wner ErApplicant .Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) /G///,/ e:.--)06 6 co/v_s-7--i-z- , o/J
Mailing Address: / l S 3 sc, ND %
City/State/Zip: %/C D/i_ 9 7,7-23
Phone No.: —SSU 3 — 7,g(> ,.- '73 7S
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: 9 _. 3/2 dor' 3 Q.0 -rkiX:v`2I/7 'e,C,� 7?
Site Address or Parcel#: //�/ .7 / il-
Project Name: ,ify7/94A IC( /6A
Subdivision Name: / / ,rl MA/ Ale/ A Lot#:
EXPLANATION: e`�a eq,�f,� 2.044 A5
- S- e2/j 7 — W 3
fek//'. a20/7 a
1
Signature: Date: r/y//?
Print Name: / ,,,,01WYj
-
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
/91G[, -i'r` /4-, rice m: --
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date // 6. /7 By E
Refund Processed: Date Ai/ By r^ Invoice Processed: Date By
Permit Canceled: Date 9 /7 TkatV Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_ 231 .doc
r
Building Permit Application
�
,, Residential �tii '- FOR OFFICE USE ONLY
City g Date/By: / � 0 i Permit NA S7 /)/,•'/
Ci of Tigard1/720//7 'sr.ir /`�� C
- ° 13125 SW Hall Blvd.,Tigard,OR 97221(s" T `x
o fl
Plan Review Other Permit: ]]
Phone: 503.718.2439 Fax: 503.598.1Fa Date/B : • Z� �, L �i G/)7,00_4
TIGARD Inspection Line: 503.639.4175 Date Ready/By i / Juris p See Page 2 for
Internet: www.tigard-or.gov tified/Method: // / • Supplemental Information
AUG 10 20 17 �r�s1 ��
TYPE OF,WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑) �OF TIGA � Permit fees*are based on the value of the work performed.
'New construction li ion
r DIVISION Indicate the value(rounded to the nearest dollar)of all
I
❑Addition/alteration/replacement 'til r: �„� equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. Dp
e_and 2-family dwelling 11Commercial/industrial Valuation: / $ c2j)$1 36,43
❑Accessory building ❑Multi-family Number of bedrooms: 3 !,O''
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: / Db2H
Job site address:`f w--7 Qt) /IAAQnC ,, (Oa r'1 New dwelling area: ' /t�y square feet/( 0
City/State/ZIP: ` :7-6 4-243 0� ;� 9 72,x3 Garage/carport area: s Q square feet (G�
Suite/bldg./apt.no.: Project name: /n n4nd Ile("
A Covered porch area: square feet
Cross street/directions to job site: Sff% 1-_ADeck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: fl/)RQ,c/ I. e<,/_ /5 Lot no.:/3 Permit fees*are based on the value of the work performed.
x/ Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
#1111- 1 c1�r P12Valuation: $
Existing building area: square feet
New building area: square feet
❑,PROPERTY OWNER 0 TENANT Number of stories:
Name: ttiptip a , Type of construction:
�art�Q,p eU�st� GT. rl1 _
Address: )1901.4 -'5 ' 54'J /1)0/2/11 /ako eit-rel Occupancy groups:
City/State/ZIP: 7/ a ed en 2.2-3 Existing:
Phone:(<63 70 7C Fax:(5-243) tS yU--7f D4 New:
Li APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: ,/,,, (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application:
Phone:( ) Fax::( ) Amount received:
E-mail: a �i o�t5,i� (5,c,,fit Cc j/.1(p PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
cv/n CAVO-er
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: i th,,)ail 4„_s� L Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 424 55,(5'-to /J#? -1kh iO[t, /iz- O' Y'{ Solar Installation Specialty Code checklist.
City/State/ZIP: 7/5
e,,,r 9'7223 , Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(5- 3) gd _Li5 7S" Fax:( 6 '3 6-9c)-Zad‘ State surcharge(12%of permit fee): $21.60
CCB lic.: 7 Total fee due upon application: $201.60
Authorized signature: - �_ _- _-- --__ __ - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: .:i _ 5" Date: i , *Fee methodology set by Tri-County Building Industry
Service Board.
•
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
Mechanical Permit Applicat)40 FOR OFFICE USE ONLY
"'� Received
'City of Tigard Permit No./i
13125 SW Hall Blvd.,Tigard,OR 97223 ' EIV 1-By. 1�.
_ Other Permit.
77 Phone: 503.718.2439 Fax: 503.598.1960 a
T 1 GARD Inspection Line: 503.639.4175 Date Ready/By. ions- 0 See Page 2 for
Internet: www.tigard-or.govA,,G 1 n 20
{? Notified/Method: Supplemental Information
TYPE:OF NirORKCIiy OF TIGARD COMMERCIAL FEE* SCHEDULE -USE C:HECKLIST
Mechanical permit fees*are based on the value of the work
et-ew construction ❑Addition/alteratic �� E `
DIVISION performed.Indicate the value(rounded to the nearest dollar)of all
El Demolition El Other: ,i9 mechanical materials,equipment,labor,overhead,and profit.
Value:$
- ' CATEGORY OF CONSTRUCTION.
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
Heating/cooling:
JOB SITE INFORMATION AND LOCATION
Air conditioning 46.75
Job site address: ) /�j/7,5(,� , 1 fG /n /ow t-1 Furnace 100,000 BTU(ducts/vents) ,� 46.75
City/State/ZIP: `a� (1Z 9-n23 Furnace 100,000+BTU(ducts/vents) 54.91
7--,--,"
`` Heat pump 61.06
Suite/bldg./apt.no.: Project name: [44,w,,,,/ ./G%' Duct work 23.32
Cross street/directions to job site: .� (� Hydronic hot water system 23.32
0�� 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
Other 23.32
Subdivision: /9„,,n4 VV/y h 15 Lot no.:/�
_/ Other fuel appliances:
Tax map/parcel no.: Water heater o0 23.32
4 '.DESCRIPTION,OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
//j .J <SP"— fireplace 23.32
/i/ Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
ROPERTY OWNER 0,:TENANT Environmental exhaust and ventilation:
Name: /f-chU6,:yd 4.571 �1 G Range hood/other kitchen
jD o S 1 Cleqothes dryer
33.39
Address: a 6 5"5' 6'� /1),,,-/..11t>'i Clothes dryer exhaust � 33.39
Single-duct exhaust(bathrooms, '
City/State/ZIP: �j�G �,r� (���,3 �
/ toilet compartments,utility rooms) 23.32
Phone:( 5.-03 76 d -g3-7,‘" Fax:.3) 0 .-7000 Attic/crawlspace fans 1 23.32
, PLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: 5o An
e. $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater
Fax: Fireplace
F
Phone:( ) ( ) Range
E-mail: tu/ll oI dl ft,tS/VG,,,d9cg/1'La A ((/M Barbecue
CONTRACTOR VClothes dryer(gas)
/Ar Other:
Business name: .F/rr/ (i L ° MEt7HANICAI PERMIT FEES*
Address: /3• /5-6) 7/ Atilt 43 �ILt/ a-• Subtotal
City/State/ZIP: � d/l. ,,, y 6 J Minimum permit fee($90.00)
s Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: -2,2.6;3TOTAL 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: 113-rel q/ Date: F//7/7
I:\Building\Permits\MEC_PermitApp_040 13 doc 440--4617T(I 1/02/COM/WEB)
1
Electrical Permit Application 0 FOR OFFICE USE ONLY
Received .- �.�
City of Tigard Rsateiv :
. a 13125 SW Hall Blvd.,Tigard,OR 97223 '" ENE Related Permit#:
EPhone: 503.718.2439 Fax: 503.598.196 , i
Inspection Line: 503.639.4175 Ready Date/By: Sufis- 10 See Page 2 for
TI GA R DNotified/Ivlethod Supplemental Information
Internet www tigard-or.gov AUGi f1
TYPE OF WORK u t`0 20 ' PLAN,REVIEW
Please check all that apply(submit 2 sets of plans w/items checked):
New construction ❑Addition/alteratione.it TIGARD�1 amps0Building
❑Service or feeder 400 or moreover three stories.
0 Demolition 0 Other: �]q� where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONS' > 1 DIVISION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
' less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION .
0 Emergency systemlarger separately derived
em.
yst
s st
0 Addition of new motor load of system.
Job#: I Job site address: �
9/7 ^/I q,i� m 100HP or more. ❑
_/ )2.2 0 Six more residential amts.
occupancy.
di
City/State/ZIP: 0 Health-care facilities. 0 Recreational vehicle parks.
0 Supply voltage for more than
Project name: / ( 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.#: j k A/ta I / /t ❑Service or feeder 600 amps or more.
Cross street/directions to job site: /0G t FEE SCHEDULE
Vi Description I Qty. I Each I Total
s
New residential single-or multi-family dwelling unit.
Subdivision: Alin QItGf
_Q Alio it 15 I Lot#: /3 Includes attached garage.
1,000 sq.ft.or less / 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion .2., 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.) /
�/�f �'�� Limited energy,multi-family 75.00
/- residential(with above sq.ft.)
Renewable Energy 0 See Page 2
'P1rOPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
:mac rIc f ,[_ / 200 amps or less 100.70 2
Name: lo i� (,(f/lip/TSL fr'Z-� G �y� 201 amps to 400 amps ]33.56 2
Address: p(��S �j co Afd,141 p�a?-LC�� t'"'-� 401 amps to 600 amps 200.34 2
City/State/ZIP: �-rote// Q.72y 601 amps to 1,000 amps 301.04 2
v ���/ Over 1,000 amps or volts 552.26 2
Phone: ( 7f1a-.17/3 7S— I Fax:(65 i3 ) 0 ",(o[�
®
/ Temporary services or feeders installation,alteration,and/or
Email: hel /e„ttefd iii ,ylveS J�u-� 6.0-64 .caen relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1159.36 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 2
Owner signature: Date:
401 amps to 599 amps 168.54
Branch circuits-new,alteration,or extension,per panel
. CONTACT PERSON LICANT I 0 A.Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: (j each branch circuit
Contact name: / B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
Each add'1 branch circuit 7.42 2
City/State/ZIP: 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
Sign or outline lighting 67.84 2
5D
Business name: ��t/ }(tic$C ,��Z��!/L
�� Signal circuit(s)or limited-energy 0 See Page 2 2
Address: .��/ 5'c. O(�11 rte panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: D4f---Ht„d t ,T-1,1-.3-5 Additional inspection(1 hr mm) 66.25/hr
Phone: 3 S .6
7(j Fax:l522) ‘5.1b_92:73 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: Inspections for which no fee is 90.00/hr
/16,72_4I oS specifically listed(V2 hr mm)
CCB Lic.: Electrical Lic.�9f� ! Suprv.Lic.:� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name I Date: 67// ❑Plan Review Required(25%of permit fee):
jib 5 Al-)4 � State surcharge(12%of permit fee):
Auth —
�,: _�- TOTAL PERMIT FEE:
lZed Signature: This permit application expires if a permit is not obtained within 180
Print
Date: 1`///2 days after it has been accepted as complete.
Print name: T t �(t /1 e4 * Number of inspections allowed per permit.
440-4615T 11/05/COM/WEB
1:\Building�Permits\ELC_PermitApp_ELR_ERE.doc Rev 06!171Y875 �
--,------mm..mm......m7.n1m1I1IIIIIIIIIIIlIIIIIIIIIII_, olo _
Plumbing Permit ApplicatU ',,,,,,,,„!
y
fl,uilding Fixtures iur . , FOR OFFICE USE ONLY
City of Tigard fty w a i . Received
:111
" 13125 SW Hall Blvd.,Tigard,OR 972
Plan Review
Date/By: Permit N�/` /� may,
Phone: 503.718.2439 Fax: 503.598.1960
J" ' /� Y/�2�
TIGARD Inspection Line: 503.639.4175l�f,U ��1� Date/By. Other Permit No.:
AInternet: www.tigard-or.gov Date Ready/By: luris: I H See Page 2 for
Notified/Method Supplemental Information
TYPE OF WORKCI /OF TIGA FEE* SCHEDULE
"012ew constructions 1 }�
A S. For special information use checklist
❑Addition/alteration/re lacementDescription
P 0 Other: Qty. Ea. Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
and 2-family dwelling 0 Commercial/industrial SFR(2)bath A/"' 437.78
ElAccessory building 0 Multi-family SFR(3)bath o 500.32
ED Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: // / 7 i , -,1 ng _l_1 (4
/14 / Catch basin or area drain 18.76
City/State/ZIP: (�/ / IL-1 �2��� �'� Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: Project name: }// Footing drain(no.linear ft.: ) Page 2
/)i-t 7G/I TC! it A Manufactured home utilities es 50
Cross street/directions to job site: .76
Manholes
18.76
/0 9 0 Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: / Water service(no.linear ft.: ) Page 2
�71/lG/1.1 // /L I Lot no.: Fixture or item:
Tax map/parcel no.: t�/ Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12.51
_ Clothes washer 25.02
J�J 5E2 Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT' Expansion tank 12.51
Name: kll,�t�/CW ffC�' Bart-5 71--pC
Fixture/sewer cap 25.02
�s&) NOT/ , 10 5-4)-6.-1 Floor drain/floor sink/hub 25.02
Address: /9 /
City/State/ZIP: 7 a- / Garbage disposal 25.02
Phone:( Hose bib 25.02
(/ . 7� Fax:(ce 3 S`:7-?o/Q‘ Ice maker
0 APPLICANT 15.01
CONTACT PERSON Interceptor/grease trap 25.02
Business name:
�j� �p Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address: Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:
Solar units(potable water) 62.54
Phone:( ) I Fax: :( ) Tub/shower/shower pan 12.51
E-mail. pM� �J��' l� 1�J//1 tS/l!W Urinal
�/f itai'4eG,� 25.02
CONTRACTOR v Water closet 25.02
Business name: pQr-/A fA4�4 ;, ZO Water heater 37.52
s. '� Water piping/DWV 56.29
Address: /4,AV c" jt' l J Q_/
/'�/ Other: 25.02
City/State/ZIP: 500.4 y�0/1 del f7(/
�v/ Subtotal
Phone:(5,-- 3) QJ,
7023 gg 7
Fax:6-e3) �U�' Minimum permit fee: $72.50
CCB Lic.: /i� i_347 Plumbing Lic,no.: 5�O1Dks
Plan review (25%of permit fee)
Authorized signature: 7///�e State surcharge(12%of permit fee)
/C TOTAL PERMIT FEE
Print name: _�l� C.kL Dater/�/,/, This permit application expires if a permit is not obtained within 180 days
5F/R s�� 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(70/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
Ill I
T l c A R o Building Permit Review — Residential
�M,
Building Permit #: "45 7---,O,0 O( ,S,Z�
Site Address: tiel 11 so/ Amod 1,4' Cou if—
Project Name: Atinand 14Lot #: 13
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: i?vJ c / i-,Pilhvle '�' .r,\ar k.Ge
. Verify site address/suite# exists and active in permit system.
-tic.River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
.Three(3)copies of site plan existing structures on site
n.ite plan must be on 8-1/2"x 11"or 11 x 17"paper .if ootprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
North arrow -TJtility locations&easements(required for new and additions)
ite address,project or subdivision name and lot number Sidewalk/driveway approach
,,Applicant information(name and phone number) VS,Location of wells/septic systems
Lot dimensions and building setback dimensions Fxisting trees to be retained with drip line,and tree
N n.quare footage of buildings to be demolished protection measures
ri Lot area,building coverage area,percentage of coverage and Xreet tree size,type and location
impervious area(applicable if R-76.:-.A,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? ❑Yes ❑No
4 foot differential) If yes,is a storm water quality facility shown? ❑Yes ❑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:
Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#: F b H2O IS- DWO
Zoning: j2-12- (j7c))
14 Required Setbacks: Front (S Rear i5 Side 'i Street Side r\/A- Garage 2O1
.E. Landscape Requirement:
Lot Coverage Maximum: SC) %
1
Building Height: Maximum Height Actual Height 2'
13- Visual Clearance
;21–Sensitive Lands: Yes ❑ No Type $4o-ee19 s 1 )p .S
Urban Forestry Plan ` Vit``
Conditions "Met"prior to issua ce of building permit
Notes: Cp( c i911,V'� 00 lsc Me 5")/1911( IOC ►►L
Approved By Planning: . �A � Date: 101(7
Revisions (after Building Submi atf lonly) Review
D to
Revision 1: U* Approved El Not Approved - g/-//�
Revision 2: ❑ Approved El Not Approved
Revision 3: El Approved El Not Approved
I:\BuildingTorms\BldgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: 17/6/7 7
Site Plans: #
Building Plans: #
Building Permit#: 7-Enter building permit#above.
Workflow Routing: Planning Engineering 'Permit Coordinator yBuilding
Workflow Sign-off: Sign-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.
Building: original permit application,site plans,building plans,engineer and
/
beam calculations and trust details,if applicable,etc.
Notes: -
By Permit Technician:
` I /
Date: 72/9//7
Engineering Review
Slope at building pad: W
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
,Er Water Quality/Quantity Facility: �/
Assess Water Quality Fee in-lieu: ❑ Yes SCJ No
Assess Water Quantity Fee in-lieu: ❑ Yes 2 No
LIDA Facility on lot: ❑ Yes -2"- o
❑ NOT Approved by Engineering: Date:
Notes: -7
Approved by Engineering: li�. Date: 8 L6 </
Revisions (after Building Submittal only) Reviewer D e
Revision 1: Approved ❑ Not Approved 1�., I 1
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:
C Fees Entered: Wash Co Trans Dev Tax: :......"Ves
es ❑ N/A
Tigard Trans SDC: es ❑ N/A
Parks SDC: ❑ N/A
LIDA ❑ Yes /A
OK to Issue Permit �///C07/7---
.1121/3----
I:
(p// ti- -
(65pproved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
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
i 111 la
111 Transmittal Letter
I ;G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
/ te AUG222017
FROM: ?6G��'' /�� CE Y OF: ,
(.Ni c. �ti-✓` BL; i_ s"�. ' DIVISION
COMPANY: ` 1
ARE:PHONE: ‘1- 3" 70d 4/;2 5 By/A—
RE:
tr(Site Address) f? 5� / a (/p tgrmitki `� c�oz,
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
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: /VC's s/4 p/4I Ai /L0-'e— "-it'll
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑No Fee Description: Amount Due:
$
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes ❑No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc