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Permit (86) CITY OF TIGARD MASTER PERMIT Permit#: MST2017-00334 p SII.. COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/19/2017 �t 'T" Parcel: 2S106DA00300 Jurisdiction: Tigard Site address: 13347 SW 169TH AVE Subdivision: RIVER TERRACE EAST Lot: 3 Project: River Terrace East, Lot 3 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 97 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 562 sf Garage: 456 sf Front: 8 Smoke Dwelling Units: 1 Third: 562 sf Right: 0 Detectors: Yes Total: 1221 sf Value: $163,653.44 Rear: 5 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 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: 2 201-400 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 SFA VB R-3 1221 Owner: Contractor: ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) BY FORSUM,MICHAEL 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175 7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660 STE 1 SCOTTSDALE,AZ 85258 PHONE: 602-494-4031 PHONE: 360-695-7700 FAX: Total Fees: $23,947.66 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 2-001-0090. 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 Permittee Signature: G�/�✓�G`Cc�l/� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. //l/ 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. Building Permit Application „Orr 3 #0:74:6041€n0$1 ,.. L_ .� FOR OFFICE USE O\Ll' Ci of Tigard AUG 2 2 2017 Dateivy�: _43 f= /`7 / AA `J g /2 � / Permit Nor"STi1U i 2_00334f: 334f w. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review • r Other Permit: ,A '�, ���) 1111 1 Phone: 503.718.2439 Fax: 503.59�1�6�0 i -,,,,.t,.. .1 Date/By: �:".1� •�� S�YC_O��/l� W��3 T 7 G A l;D Inspection Line: 503.639.4175 B U d Lr ^�4 z i,< a� 1 , �v Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov Notified/Method:�c?/V/(7 Supplemental Information &/7�� (G.- /Alt C c 1.c. � ` 0 New construction El Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all El Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the f „ i work indicated on this application. Valuation: $ �-f' 1-and 2-family dwelling 0 Commercial/industrial •+�1 EI Accessory building !r Multi-family Number of bedrooms: 2, I�g3� �J 3 ❑Master builder ❑Other: Number of bathrooms: 2 a b s , 1 f ; l t , _ t, ,, -, Total number of floors: L� 1 6' 7 7 Job site address: / -7_ I 0 & C., New dwelling area: l 221 I square feet City/State/ZIP:Tigard,OR 97224 Garage/carport area: '45(0 square feet‘CZ. Suite/bldg./apt.no.: Project name:River Terrace East ,7 Covered porch area: square feet v 6 a Cross street/directions to job site: Deck area: square feet(h'7 I 4...,14.. cov./area: . R -, O er structure area: 7 square feet -i � 1' € K O leiT. sem ' I\ ` Subdivision:River Terrace East Lot no.: Permit fees*are based on the value of the work performed. ry Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the .,__,,,,:,:i!'ve'ititilfil's i Y work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet re � ' ... ,' • Number of stories:' ' tom ,,, A, � : M Name:ADVL Land Holdings,LLC Type of construction: Address:7600 E Doubletree Ranch Road Occupancy groups: City/State/ZIP:Scottsdale,AZ 85258 Existing: Phone:(602)694-4031 Fax:( ) New: I s ..",r1512;.44-474'•-•64M4.1 ar ;: �, n L, Business name:Polygon WLH,LLC Structural plan review fee(or deposit): Contact name:Nichole Thorpe FLS plan review fee(if applicable): Address: p LA k oil. .. _ _ . Total fees due upon application: City/State/ZIP:Vancouver WA 98661 Amount received: Phone:(360)695-7700 Fax::( ) E-mail:Nichole Thorpe ._, uM i Commercial and residential prescriptive installation of f s' roof-top mounted Photovoltaic Solar Panel System. Business name: I Submit two(2)sets of roof plan with connection details '� k l and fire department access,along with the 2010 Oregon Address: `� ,�t )3 Ed W -`S- 1 , kii,.. e.. 5 ) Solar Installation Specialty Code checklist. City/State/ZIP:Vancouver WA 9866 Permit Fee(includes plan review $180.00 and administrative fees): Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60 CCB lic.:207247 Total fee due upon application: $201.60 Authorized signature: / i / -/ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Nichole Thorpe Date:06/16/2017 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COMIWEB) . . , 9 1 , Mechanical Permit Application°‘,/ 0 2 LL1 I FOR OFFICE USE ONLY City of TigardPermit Nyortic 27e,,7...(ye 3:3 q .1111 R 13125 SW Hall Blvd.,Tigard,OR,..9t4 v„:... ....„, .,,, ,i,,,, Drhaate/Br,w / I Phone: 503.718.2439 Fax 503.5i$8,160 •, *'• ' •, . twgy, Other Permit TIGARD ; Date Ready/By: Inspection Line: 503.639.4175 . /Wit 1 El See Page 2 for - Internet www.tigard-or.gov Notified/Method: Supplemental Information '''' '' '• '1:14,10:§7.- '''''T—; :;:.•::ots-•E•-fy....-••• 41'4',lit,.W.713Wg,„4•1:"P.A.,:ff_W, - "a12%_14.ilt.4-iiiiiikblificti,W4WW,AlatiM:1,1 —' -'------- - --- -'--—---P-'--'-- '--'--'-:-----'--- '- '- ' ---- -4- -2 Mechanical permit fees*are based on the value of the work El New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ ireilVaa''214.0.14ke#14WERKOK-0A4,- ---St*O§fig4.**?:!4j.;;Z:74::.. ...pvklibm--mikviosi-eihiN-yi-.71Em-.-g--i.agi,,rr::e.1 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For spedal information use checklist '11(Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total ---,..,-:.,,•,,..-...--..-----, ..1.--••;„.,,-.--:-.-+--- -,-,44, ,,:,:40.12;-,-...;i4c,f.g,-,.- Heating/cooling: ck$41.-*i*Xj54-1..1.2744PAIM9W9491WIRJA:1,W19,•*-1-ate-L-44.1;42•KiTrP7•2. Air conditionm. g 1 46.75 46.75 Job site address: /33 III S\N) kuortil f\.,,tes, Furnace 100,000 BTU(duets/vents) 1 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt no.: Project name:River Terrace East Duct work 2332 _ Cross street/directions to job site: Hydronic hot water system • 2332 Residential boiler(radiator or hydronic) 2332 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 1 23.32 Other. 2332 Subdivision:River Terrace East Lot no.:3 . _ Other fuel appliances: Tax map/parcel no.: Water heater 2332 -• — — ' - " - •""",-L,..4,14eloREAI 4: ,;..;12•..=f.::?:01,;.::,-1 Gas fireplacermsert 1 3339 DESCRIPTION 9F.'7941Ci., , -:, -v.-..v. , ,..0 :1 Flue vent for water heater or gas P1S17,701)'": OC) 3V fireplace 2332 - Log lighter(gas) 2332 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 2332 - •• if.,:tre ..-.,:::..4.7"'..-.--.. ..42.,4„,.Ti-z44,-",,:•„:,; Other: 23.32 AWrilgt*I.i.g14744*4141t.:14:-7.:•'-:f;•';',A44".'"US2.t ..'''''A-L3'W.Lrqf.'40';-::: "-t1.11a;"k! Environmental exhaust and ventilation: Name:ADVL Land Holdings,LLC Range hood/other kitchen equipment I 33.39 Address:7600£Doubletree Ranch Road Clothes dryer exhaust t 3339 City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) ii. 2332 Phone:(602)694-4031 Fax( ) Anicicrawlspace fans 2332 .; Other';.-,3'•; :r*Vi-irilafg:04-4k4. 4,1?..n.:1''.;:17.;i:r11:::i:Er coPl • 2332 Business name:William Lyon Homes,Inc. Fuel piping: $14.15 for first four;$4.03 for each additional , Contact name:WI CVI 0‘.e"11A0n2e Furnace,etc. 1 Address: n )2\natAA/1/4)Oti t - - au:A-<- 510 Gas heat ptunp Wall/suspended/unit heater City/State/72P:Vancouver,WA 98660 Water heater Phone:(360)695-7700 Fax :(360)693-4442 Fireplace 1 Range 1 E-mail:10 I cAnoy, 7TWOvvrf....1.41uncrIrontles • (AI Barbecue F:c. -4":::" -i-,.?-:-:7:P-:-i.:•!, --;i:,4,-;,;471:* 14::,..a4rf Clothes dryer(gas) zi;i•-....,N7".741.-At:4?.'.•ei,"- •;::! ikee !• :':,.... , .• . •• -,-14 4. : '..s,,r -,•-s•-:,et-- -_,., 1- 47 Business name:pn v,e...60, kyv\ : 1, afft:17,-.!7.:,?::::.:....., .1. ntstAtrg.i4i..:,..',21 7 Address: 10 C‘S-- •Pi\(),10 Dr suAkc, ktn Subtotal , City/State/ZIP: kkASVArD i?(), (i Vij)I lvfmimum permit fee($90.00) Plan review(25%of permit fee) Phcme: )Ly_o_ skgek-L, Far 6115) Ott\I.. sns- Stath surcharge(12%of pemtit fee) CO3 lic.:101 001 TOTAL PERMIT tett This permit application expires if a permit is not obtained within 180 days after it has beet accepted as complete. Authorized signature: .n„.....4.,„6- ,,,„-- . Fee methodology set by Tri-Connty Building Industry Service Board Print name:Wi,44„1,---ii twp,L, Date: Electrical Permit Avplication ,.,-',,1 G ‘..' 2011 FOR OFFICE USE ONLY ,.. - - City ofrigard 4,111h 13125 SW Hall Blvd,Tigard,OR-972M ,•.4, -- 4. .,.4 ; 7-1',, pi, cw ' Phone: 503318.2439 Pax: 503.598.90 ' '4 Tiate/B . Related Permit ik Inspection Line: 503.639.4175. Ready Datedly: Iodic lill See Page 2 for T I GLARE: inizatet.1ww.tigard_or.gov Notified/Method; Supplemental Information ---7);'-j.'--7,-;=-7;34.C.'''j-ff'''''''';:r•S'-c7.-:':''.-='%-i--ie--Iz 'Sjt,3-',V..11kll:. ;Zar :'',.'*•-'-'5''r V.---'?--z-T'.:I.K:',-;= i&I-V,',..,±,',IA11-1'.',IV.:-P-q,'...t14-.1"WATOV4,-.6:-.r-=t-e-i-4:ig ---, .031, El New construction 0 Addition/alterationtreplar-ement Please check all that apply(submit 2 sets of plans writers decked): ['Service or feeder 400 amps or more 0 Building over three abides. 0 Demolition D Other: . where the available Emit current 0 IZazinas and boatyards. {,4.:: 411-c),OPF-.7-----:- - f-,-;-.-- exceeds 10,000 amps at 150 volts or 1:IFloating buildings. i.,.-and 2-family dwelling 0 Commerciallindtistrial. 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. . buildings.• 41,14 Multi-family -- 0 Master builder 0 Other 0 Fire pump. 13 Installation of ISO KVA.or' 1--P.X. ':;*,;:g4tk57:,W,-.: Ezid7rfne?Inotor bad of yoularger separately derived system Job#: Job site addres13311 7 \.,,,. \I partil pat, 10,011P or more. 0"A",'V,'I-r, 0 Six ormore residential units. occupany. City/State/ZIP:Tigard,OR 97224 °Hadar-care&citifies. 0 Recreational vehicle parks. SuitelbldgJapt.#: 1 Project name:giVe/r.1-e--1Ar)1 c-g ECtcf" E9Hazar&service orusfeediwatiermssoo.amps or more. CI SuPP6a°v°17:341tagl'nunaLf°"mre Ilan Cross street/directions to job site: 1)acriptii. I Qtr. Serb I Total I * , New residential single-or multi-family dwelling unit. SubdiYisi°11: l'U-4-er -Ft-trate- 'Ett54-- Lot#1 3Includes attached garage. ' — I.000 eq.ft.or less I 168.54 4 Tax map/parcel#: Ea.add'1500 sq.ft.or portion i 33.92. 1 Limited energy,residential 5 7 (with.above sq.ft.) 7 .00 , Limited energy,muld-ilunity 75.00 2 residential(with above sq.ft) Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2 Address:7600 E Doubletree Ranch Road 201 amps to 400 amps 133.56 2 401 amps to 601)amps 200_34 2 City/StatarZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 301.04 2 Phone:(602)694-4031 I Fax( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: .. relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I 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 ABrZehfoertentin:-.ne7,,atratlen,or extension,per panel Business name:William Lyon Homes,Inc. above servote.or"eclat fee, 742 2 each itujt Contact name: hitch olf,Th pB.Fee for branch circuits vithout service or feeder fee,first Address: 103 Poi.)athAi-#04 St su;tk-t, SID branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98660 4 Each sal branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 • ' ' Fax::(360)693-4442 Each manufactured or modular 67.84 2 dwelling,service and/or feeder RTnriii;;1 I a 6. 4,a ofg,i_ pi .4•p, PC !at Reconnect only 67.84 2 ;1--Iff.;_:7;,T,_4".-;:„.rly..-e.,. .,,•::::: :7- 1.4.A.,;;4(5R-0,K„':,. .0-2:,;7,!-f_,,,,,.-7.z.-:,- ---m---.J.-'_,,,,',---.2,--1-4...;-4---7:_?- 7,‘ Pump or irrigation circle 67.84 2 Business name:Gamer Electric Washington,LLC ' Signor outline lighting 67.84 2 Signal circuit(s)or limited-energy Address:k Li D2_ \lailk,ut i 'v.e k.1.1.10i dit-\-e, \U Panel,alteration,or extension. " ose rage A Each aderfional Inspection over allowable in any of the above2 City/State/ZIP:'Pik t taitt4 ID 1 t)j)k. CeS1 t 1 Additional inspection(I hr min) 66.25/1m Phone;(253)320-1657 I Fax:( ) Investigation(I br min) 90.00/hr Indust:dal plant(I brad* ' 78.18/In- Rmsrli•bdaniels@g,vrensa.com Inspections for which no fee is CCB Lic.: C1158 Electrical Lie.: 208174 Suprv.Lin: 4496S specifically listed(t4 blink) ; 90.00/hr Suprv.Electrician signature,required:Mr:=2:113,e4±.--- , . Subtotal: Print name: Joan?Albert •• • Date: 4/26/2016 0 Pin Review Requir'ed(25%ofpemnit 4f"--- ---"-- - ._—:" State surcharge(12%of permit fee):. ..,_ ':.',..., Authorized signature; - TOTAL PERMIT FEE: This permit application expires ifs permttle not obtained within I80 Print name: Bill Daniels Date: 4/26/2,016 days after It has been accepted as complete. * Numberofinspections allowed per permit_ kip.AllullifirelomminlacjerratcApp SLR BREA=Rev osninois 440-46IST(11/05/COLMB Plumbing!Permit Application N J v 0 1017 Building Fixtures t City of Tigard :11 :,i ;, BamitNo �j °/2..c1033`r IN • 13125 SW Hall Blvd.,Tigard,OR 972 Pian_ Phone: 503.71$.2439 FaX 503.598.1960 i OtberPerinit No T t G t,k D Inspection Line: 503.639.4175 Data aeady/By; suds: BI See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplementer Inferennioa -.i�ur •i E•� TIA.617i*�0 ; 4. .1_•�-a'[y : �4 ;.tr :i0•:tFrai+.;:litigViG �L :� _ i5y..-•z .-n .. ... .. ai'....v ®No v construction - ❑Demolition Y For special Information use checklist `description { Qty. ]_ Ea. 1 Toed ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 IL for each utility connection) •r-V. '"'• ....-Z. !; _C,4`I i• ,` Yi'arFaii 'eiib:I5;A:-.ti:;:.?.1.a t_•;A:::._: SFR(1)bath 3I2.70 ' 1-and 2-family daveliing .. ❑CommSFR(2)bath • 437.79 ' ••SFR(3)bath- l ' 500.32 i - ❑Accessory building j Multi-Oily Each addttlonal badi/kitcliea 25.02 ❑Master builder. 0 Other Fire spritdderl__sqft.). Page 2 t -' :1";W:4.* `I O i13U `. T'1 ... Site utilities: _ lob site address: ✓391' SVv I ,cith pc,fpi Catch basin or area drain . 18.76 . Cityf5tate(LIP:Tigard,OR 97224 Drywoll,leach line, 18.76 ' trench drain • _ Footing drain(no.linear R.: 1 Page 2 `Suite/bldg./apt.no.: I Project name: gtww r Tfir1 re.Ecx 4- Manufactured home utilities 50.03 Cross street/directions to job site: 1 Manholes 18.76: - Rain drain connector 18.76 Sanitary sewer(no.linear ft,:_) Page 2 i Storm sewer(no.linear IL: 1 Page 2 • 'Water service(no.linear It: ) ' Page 2 - Subdivision: (24J ,r- TP v _ &oS.- Lot no:,3 _ e Fixture or item: Tax map/parcel no.: Backflow pre+venter 1 3I.27 ' r'`#. I1F�SCR1P1ut5t[1H�Wo r.: ., Backwater valve 1 12.51 • . Clothes wisher 25.02 Dishwasher 25.02 Drinling fountain 25.02 Ejectors/sump - 25.02 M1 .5,:' .;" -ll ';6 f.,??,; ••` i'C''i N i °� mansion tank 12.51 Name:ADPL Land Holdings;LLC Fuun elsrrovercap 2 25.02 Address:7600E Doubletree Ranch Road Floor draint800r sink/bub 25.02 Garbage disposal 25.02 City/Statc/ZIP Scottsdale,AZ 85258 Hose bib ' 25.02 ' . Phone:(602)694.4031 Fax:( ) IIx maker 12.51 • . .:.x`'- : 4 c.`,., •, : •: 'X • 1: 1 Interco tor/grease trap 25.02 Business name:William Lyon Homes,Inc Medical gas(vane S ) Page 2 Contact name: Primer - 12.51 . +-� \G1f1 t 2. 1 � _ Roof drain(comms tial) 12.51 Address:'16 2)11 O `',�� )r� �o • - Sin k/basintiavatory 25.02 City/State/ZIP:Vancouver,WA 98660 - Solar units(potable water) . 62.54 ' Phone:(360)695-7700 - Fax::(360)693-4442 Tub/shower/shinverpan 12.51 B-mail Urinal I 25.02 - ...,+-�.yz.I 1,..-.:, s •;fi - .q.,.. . - ,,,. . .,� wow closet 25.02 1 . .-•icy--'. ;sFP:..•.• .''•. -'. s,:3t;••d.T'ju Ci` -•s - . "„ • :-... ‘ Water:heater 37.52 , Business name:Affiance Plumbing LLC WatexpipiitgfDWVI k 5619 Address:146 W Historic Columbia River Hwy ! Outer; 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Piton=(503)492-3490 Fax:(503)912-6438 Minimum pe h fed $7230 I Plan review(25%of permit fee) • CCB Lk.: Plumbing Lie.no.:PB732 ' State-surcharge(12%of permit fee) , Authorized signature: /.. ,/ TOTAL PERMIT FEE Print name:Robert Dishmd<n Dater 5f23f2016 This peradtappacelienexpires ire p m ria ailrcbtained within 180 dos atter bias been ae asxomplete. *Fee methodology srtiy Tri-County Building tedaauy Service Board 1.1Builiring1PermheaPaILLPencliApproc 10153/09 440-4616T(291621GOIWWE6) City of Tigard IN ' COMMUNITY DEVELOPMENT DEPARTMENT C T lD Building Permit Review — Residential Building Permit #: ST)0/ _ 00 3 3 L J Site Address: / z 2' - /(19-4/_ f -e_ Project Name: ' .p - 0 _ , Lot #: (New dwelling=sub. vision name;Addition or Alteration=last name of owner) Planning Review / l Proposal: /tJ i-) S'% /1- & n'/ �L ('it Ind 4erify site address/suite#exists and active in permit s tem. River Terrace Neighborhood: ❑ No V Yes,See River Terrace Review Addendum Attached SiVPlan Elements: �ree(3)copies of site plan 0 e.sting structures on site e plan must be on 8-1/2"x 11"or 11 x 17"paper ►7, ootprint of new structure(including decks)with finished idir awn to scale(standard architect or engineer scale) oor elevations Vpilorth arrow " 'i'ty locations&easements(required for new and additions) pfe address,project or subdivision name and lot number Vi Sidewalk/driveway approach plicant information(name and phone number) 1. 'anon of wells/septic systems Lot dimensions and building setback dimensions tial, sting trees to be retained with drip line,and tree ICJ Sli are footage of buildings to be demolished •rotection measures A Lot area,building coverage area,percentage of coverage and J treet tree size,type and location pervious area(applicable if R-7,R-12,R-25&R-40) Street names Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? Zes ❑N 4 foot differential) If yes,is a storm water .uality facility sho ? , ❑Yees's ydl�o n 1 can Water Services—Service Provider Lett (lot platted prior to 9/10/1995):41ffI, ii..) r its,...c 'equired: ❑ Y ,applicant was notified No Received: ❑ Yes ❑ No r4 Public Faciliti s Improvement(PFI) Permit: PFi of L.a_� / / Required: Yes,applicant was notified CI No Applied For: [Ill Yes CI No,stop intake /C'tom / nd Use Case#: 1 PC�o/iP—&cl ot))tp(knQ_614, -/Y)o-cy7L, .�e_.—0/S' )1)'7 c,,Yog g— 2 ORequired Setbacks: Front Rear Side t � Street Side 3/ 9(Garage 0 andscape Requirement: c2( Pi of Coverage Maximum: rid Or. ulding Height: Maximum Height Actual Height Visual Clearance k It 11 ensitive Lands: ❑ Yes Lld No Type ►L Urban Forestry Plan ❑ Conditions "Met" rior to issuance of building permit Notes: (ij7Sbt4$ _c--kl/ k /hp 'ny-' 4 /4- /. __cGkzy1e, _ Approved By Planning: - • ' Date: /meg J -- Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved l:\Building\Forms\BldgPennitRvw RES_061417.docx Building Permit Submittal .. Original Submittal Date: 22L//, Site Plans: # Building Plans: # Building Permit#: Enter building permit#above. Workflow Routing: Planning fr Engineering 1=?Permit Coordinator Building 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. l Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: / ' By Permit Technician: Date: R.0),te// / En ineering Review o Slope at building pad: b 10 ❑ 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 Ll No Assess Water Quantity Fee in-lieu: ❑ Yes Er No LIDA Facility on lot: ❑ Yes J2-No ❑ NOT Approved by Engineering: Date: Notes: /n^ ( f Approved by Engineering: U �. 1,1Z-42, LA-9 ! Date: '( l s/ 17 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 proved,NOT Released: Date: 4/r(i 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: 7 SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: Yes ❑ N/A LIDA ❑ Yes N/A OK to Issue Permit Approved by Permit Coordinator: Date: fc)-1)-')//k7- 1:\Building\Forms\BldgPermitRvw_RES 061417.docx City of Tigard IIIICOMMUNITY DEVELOPMENT DEPARTMENT 2 TIGARD River Terrace Building Permit Review Addendum Building Permit #: Site Address: 7gS --. a) /7q /-e_ Project Name: Plivi-- �--e a6-e v-� Lot #: 3 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review of River Terrace Plan Distri<t Design Standards (18.660.070.1.): Is the project subject to the plan district design standards? I1"Yes ❑ No 1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional element required for lots with over 60 ft. of street frontage shall be provided every 30 ft. Balcony w/access 2 Window Projection Vertical Wall Offset a Porch min. 5 deep ft. de min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer ivI rIE 2. Eyes bn the street: a minimum off112%of ea h street facing facade must include windows or entrance doors. Percentage Shown: --7,72 72--; �/ n / �^, ,g�-, /6 / 0 3. )yintrances:At least one entrance must meet both of the folio g standards: ] Max. 8 ft. setback from longe street- facing wall pa Parallel to street,angle no more than 45° from street, or open onto porch Entrance opens to a porch: Yes ❑ No If yes,all the following apply: 2,S sq.ft. min. ne street facing entry �/ ft.max.roof above floor of porch virs ft. depth min. 1LJ 30%min.porch roof coverage 4. etailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades: Covered porch min. 5 ft.wide x 5 ft. deep' ❑ Recessed entry area min. 5 ft.wide x 2 ft. deep ❑mall offset min. 16 inches � ❑pormer min.4 ft.wide `,' 'f{Roof eave min. 12 inch projectionoof offset min. of 2 ft. O Roof shingles either tile or wood I! Gable,hip or gambrel roof design 1 ❑ oof pitch oriented south min. 500 sq. ft. ❑ . .rizontal lap siding min. 3-7 inches wide Accent siding min. 40%of street facade` 1/. Window trim min.2 1/2"wide by 5/8"deepa" 0 Window recess min. 3 inches for all street facing 0 Bay window min. 5 ft.wide by 2 ft. deep ❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35%or less of street facade 5. Garages and Carports:May face the front or side lot line on a corner lot. Setbacks: No closer to front or side lot line,than longest street-facing wall. ❑ Yes No. If No (Check one): ❑ IYiay extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch. cjMay extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story above the garage that faces the street with a min. area of 12 sq.ft. W : (Check one) 12-foot-wide garage door ❑ 40%max. of street facade ❑ 50%max. of street facade with 7 detailed design elements Notes: 7,Z Approved By Planning: Date ____94:' I:\Building\Forms\BldgPermitRvw_RES_RT_062216.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 111 Transmittal Letter T l G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Tom H. DATE RECEIVED: DEPT: BUILDING DIVISION FROM: Nichole Thorpe NOV 1 . 2017 COMPANY: Polygon Northwest a " PHONE: 360-989-40204 �� RE: 13367,13359 3347,13341 SW 169TH (Site Address) (Pernu�um er River Terrace East jgagFa. Loft 3 M51-zoti-d 033q (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: 0 Additional set(s) of plans. 3 Revisions: Bulletin, Plan Sets 0 Cross section(s) and details. 0 Wall bracing and/or lateral analysis. 0 Floor/roof framing. 0 Basement and retaining walls. 0 Beam calculations. 0 Engineer's calculations. 0 Other(explain): REMARKS: Please pay fees owed with Trust Account. Adding 3rd Bathroom Option FOR OFFICE USE ONLY Routed to Permit Technician: Date: )'Z._ ) 4 - J 7 Initials: 1 Fees Due: ® Yes ❑No Fee Description: Amount Due: I Pr P) �� rev: ,,,, $$ gQ ✓' Special Instructions: Reprint Permit(per PE): N-tiYes ❑No ❑ Done Applicant Notified:/U1(efi'L c Date: ,42//i /j 7 Initials: .,_....... I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13347 SW 169TH AVE, BEAVERTON, OR, 97007 October 25, 2018 at 11 :42:05 AM Record Type: Record ID: Residential - Master Permit MST2017-00334 Inspection Type: Inspector: 199 Electrical final Jeremy Burrows Result: PASS Comments: Corrections completed. No A/C Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13347 SW 169TH AVE, BEAVERTON, OR, 97007 October 26, 2018 at 8:51 :20 AM Record Type: Record ID: Residential - Master Permit MST2017-00334 Inspection Type: Inspector: 699 Mechanical final Jeremy Burrows Result: PASS Comments: Corrections completed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13347 SW 169TH AVE, BEAVERTON, OR, 97007 October 26, 2018 at 8:51 :36 AM Record Type: Record ID: Residential - Master Permit MST2017-00334 Inspection Type: Inspector: 299 Final inspection Jeremy Burrows Result: PASS - CofO Comments: Final erosion control passed Moisture content form received Moisture barrier acknowledgement form received High efficiency lighting form received Insulation certification verified Blower door and/or duct seal test certificate received C of 0 left on counter. Violation Summary: Inspector Contractor Plumbing Permit Application . ; ; 'a , , ' t Building Fixtures FOR OFFICE I_iSE ONLY Received 31 of Tigard " w Pennit N '>'" 13125 SW Hall Blvd.,Tigard,OR 97223 F.i i. �i ' ( '` Date/By: : /C.� i, Si' �� C���/ Plan Review l A ' Phone: 503.718.2439 Fax: 503.598.1960 r /Date/By: j"if J c' .'e6, Other Permit No.: T I G A RD Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov •"-Notified/Method: Supplemental Information TYPE OF WO '''1'-'3:-'14.'s''''' ~.. FEE* SCHEDULE ®New construction ❑Demolition For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION '-- " SFR(1)bath 312.70 ® I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ['Multi-family Each additional bath/kitchen 25.02 ❑Master builder ID Other: Fire sprinkler(1,221 sq.ft.) t}j4 Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 13347 SW 169TH Ave Catch basin or area drain 18.76 City/State/ZIP: Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:River Terrace East Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.:3 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESC RIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Multipurpose Fire Sprinkler System Dishwasher 25.02 Permit# MSvZ0f7-00334 Drinking fountain 25.02 Ejectors/sump 25.02 e4 PROPERTY' OWNER 0 TENANT Expansion tank 12.51 Name:Polygon Northwest Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:703 Broadway St.Suite 510 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 ►i APPLICANT ❑ CONTACT PERSON- - Interceptor/grease trap 25.02 Business name:Alliance Plumbing,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Gavin Thomes Roof drain(commercial) 12.51 Address: 146 W Historic Columbia River Hwy Sink/basin/lavatory 25.02 City/State/ZIP:Troutdale,OR 97060 Solar units(potable water) 62.54 Phone:(503)492-3490 Fax::(503)912-6438 Tub/shower/shower pan 12.51 E-mail:Gavin@AlliancePlumbing.net Urinal 25.02 `'CONTRACTOR Water closet 25.02 Water heater 37.52 Business name:Alliance Plumbing,LLC Water piping/DWV 56.29 Address: 146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.: 184601 Plumbing Lic.no.:PB732 may, State surcharge(12%of permit fee) Authorized signature: ,C.--...7 J /L___►/ TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Gavin Thomes Date:2/5/2018 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1-\Building\Permits\PLMU-Permit App.doc 10/01/09 440-4616T(I0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Ttilit es Qty. Fee( _ Total Square.Footage: Permit Fee: Footing drain-l'100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 Sewer-1st 100' 62.54 -- 3,601 to 7,200 $233.20 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Ins echo l or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to hand including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge 1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Other Fixtures: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantity'by Fixture Type Fixture Type far Replate/ Plan Review for Plumbl> Ig Installations Work Performed: Capped Added Relocate Baptistry/Font Plan review is required for any of the following. Bath Tub/Shower Please check all that apply. Jacuzzi/Whirlpool Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain Any multipurpose fire sprinkler system. Eye Wash ❑ Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3" Submit 2 sets of plans with any of the above. -4,, Car Wash Drain -- Isometric or Riser Diagram Garbage -Domestic-non-food Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lay -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-Clothes Water Extractor *Note: If the fixture work under this permit results in an Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the https://allianceplumbing-my.sharepoint.com/personal/gavin_allianceplum15�1ng_net/Documents/Documents/Fire Sprinklers/RT/City of Tigard Permit.doc Electrical Permit A1�plication. r? e.a s " �'t ..�., 9 ,(titi 01=1.1c 1�,t sig,()NI ) ' 1 W Hall Tigard,OR 97223 I U L 2 �3 2 018 Leer Pftevw7 f S-/l/�/ Permit 5-7a /y)J�t�L/ Phone: 503.718.2439 Fax: 503.598.}�t" -sir `.; ` y ?P"„ Dually: v Related Permit it: r1v`,tik7 Inspection line: 503.639,417$ `�'I t:.;;;,...7,,,t s M t Internet www.tigard-or.gov j,‘•-":,' 1 i!,El '-11 s�`$NNottf i s S Ste Pent t Information , ��,� , �== men nforma n ,..:.'3,, b�,f ii's}. �N , ZB,35;°.`. r,b y:;', + ti '-‘4:1/41-,L';`'',.I h• ,. '! 5 °,0- tart , leer ,77 l: New constructionY •. np° 0 Other ? 1 , ��Service Or feeder 400 amps or mare 0Building over three 0 Addition/alteration/replacement lacement � _ 1 � lease check all that IMPLY(submit 2 sets of plans whtems checked): j 0 Demolition scan 'es. where the available fault current 0 Marinas and boatyards. � 1:"v .f `O 4':.?,r;Si,x, - "', exceeds 10,000 ampsat 130 volts or 0 1 and 2-familydwelling 0 floating hal-use a. 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural Other: amps thrall other installations. buildings. gQMulh family 0 Master builder ID Fire p P- 0 Installation of 150 KVA or 'f y �F fi i„4 g i b.. c 't , ` V 0 Emergency system, larger separately derived Job#: Job site address: 1 3 314,1- o Addition ofnew motor load of system. St It,cT %.kvE. tooiipormore. ©"A. °E" "1.2„••I,3,. City/State/ZIP: 1`z 001 ❑Six or more residential units, occupancy. Suite/bldg./apt.#: Project na niT T_ ❑Health-care facilities. ❑Recreational vehicle pinks. J '�' 1`l V��L , ❑Hazardous locations, 0 Supply voltage for more than Cross street/directions to job site: 1a4fx�.S } & o� Q" "t of Seeder aoo amps or more. valla nominal. Destription Qrs. 1 Each Teat 1•'; Subdivision: n New residential single-or multi-family dwelling unit. t ai r et1-titALikc,E 1 Lot#: 3 Includes attached garage. Tax map/parcel# 8 1,000 sq. .or less 68.54 4 Sq.A.or portion 1 33.92, 1 � FF Limited energy,residential Co (,'�12,�C y ����� (with above sq.A.) 75.00 2 Limited energy,multi-family residential(with above sq.A.) 75.00 2 �� ,j` Y?-, pstt �' s-7%,; Renewable Enerigy O See Pa e 2 Services or feeders installation,Bration,and/or relocation Name. AbV L 1-ftm4,6 1-bl'Aita.s , LLr, it-is 200 amps or less 100.70 2 O p f-. l,`� E 'TILES'TILES, 1�! e4F 201 amps to 400 amps 133.56 2 Address: City/State/ZIP: �,p b/� 40l amps to 600 amps 200.34 S "`E.)A.2_ 2 8 6 60 601 amps to 1.000 amps 301.04 2 Phone(602) (,q A4-L403 I Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or 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 � M, _�< ." � . = I .. ,'' ...������s t :r l:ftrE5jt,lit:,;(;, sem. . Branctc cSrcuits—new,slteratiaa,or extension,per panel " �' � �" A.Fcc for blanch circuits wiUi Business name: .LtG,O0,y 45 MSS r 401_14 1 LI above service or feeder fee, � j i• each branch circuit 7.42 2 Contactname:' f'O y`,a IJ 1e...1 A7.4/4,0i B.Fee Ibr branch circuits without service or feederfee,first 56.18Address: l O(\ fns T 1311+ 3 (^ G-T. branch circuit V�e DJ tr 'W ih. 9 S/ _Lc 0 Each add''branch circuit 7.42 1 2 Photic �O Miscellaneous(service or feeder not included) (5b3) 51 . - (A16 Q. ! Fax::( ) Each manufactured or modular Email: �M . 1 0.n O • O , dwelling,.service and/or feeder 67.84 2 z._'`%fi „"'="'_ r „ y v d...} , R.._ .C01� Reconnect only 67.84 2 � �� ' Pu feel Pump or gallon circle 67.84 Business name:Three Phase Electric Sign or outline lighting 67.84 2 Address:11490 SE Jennifer St Signal ciscttit(s)or limited energy Panel.alteration,or extension. 0 See Page:! 2 Each additional inspection over allowable in any of the above City/State/ZIP:Clackamas,OR 97015 Additional inspection(I hr min) 6625/hr Phone:(503)908-8058 I Fax:(503)762-1823 Investigation(1 hr iron) 90.00/hr Email:permits@threephaseelectric.com Industrial plant(I hr min) 78.18/hr CCB Lie: 162368 1 Electrical Lie.: 3-332C 1 Suprv,Gie.: 3398S Inspections for which no fee is 90.00/hr Meal! limed hrmin Suprv.Electrician signature,required: �- 7 n .' `° ::♦; Su , y 4. Subtotal: Print name: Dennis Welch Date: 0 Plan Review Required(25%of permit fee): Slate surcharge(12%of permit fee): Authorized signaat TOTAL PERMIT FEE: Print name: Gail Evans1. This permit application expires if a permit is not obtained'within 180 Date: I days after it has been accepted as complete. I B°adr i e+rnps`EF ,PamitA Ei R_i dcc Rev b t7 X113 * Number of inspection,allowed per permit. p-- O 440.46 isTT I 1 D5%COM1WII,B