Permit (81) NOISI ou 9NlG1Ifl
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT °8V911 30 Al9O
I .
'Pi .
Request for Permit Action 6102 f ti NVQ'
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tiga d • vi 333w
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: E Owner ❑ Applicant X Contractor D City Staff
Check(✓)one
REFUND OR Name:
'--B, 1
a
INVOICE TO: (Business or Individual) C- A} l)a() r1 L
Mailing Address: 1.3 i a( Z, LUckA--rive-d' (A .
City/State/Zip: 0 1( Ut -76 V
Phone No.: -O3 --7&C ---(r 'S
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
hK gCANCEL/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).Alermit#: // ST 7 /�R — OE( —.-..
Site Address or Parcel#: / l 73 /S& -7 '1)C '' --cLJ
Project Name: A(2. `
Subdivision Name: „...-- / Lot#:
EXPLANATION: l (°C -, S c trlk 1-) ( o i(
Signature: �.tr'' c......_::91.._ Date: / 2/✓ /
Print Name: I"7 t- le
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. 7,:f02 •r 6 6 As"; 73 /s�, , Y3
/9.3. ,G - 7s. e _ /tri:77
Ail, yo /a9 ./,� = _
o , yz • ,- . •207• cif-
FOR OFFICE USE ONLY
Route to Sys Admin: Date i d!7 By 1.77-- Route to Records: Date 9 5 /9 By '''r
Refund Processed: Date 2-�//5, By i�'�. Invoice Processed: Date By
Permit Canceled: Date 32,/y By ..-''" Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_12051 .doc
C q
TIGARD
City of Tigard
April 4,2019
Blue Mountain Pools
13121 S Warnock Rd
Oregon City, OR 97045
•
Re: Permit No. MST2018-00315
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14173 SW 155`''Ter
Project Name: Reed
Job No.: N/A
Refund Method: ® Check#231674 in the amount of$829.94.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
0 Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request as no access from neighbor to complete the work.
Refund 80% of peunit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,d2dyre7zerde___
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
TI G n It a Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Blue Mountain Pools DATE: 3/28/2019
13121 S Warnock Rd
Oregon City, OR 97045 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 420507 Case#: MST2018-00315
Date: 11/28/2018 Address/Parcel: 14173 SW 155th Ter
Pay Method: CreditCard Project Name: Reed
EXPLANATION: Per applicant's request as no access from neighbor to complete work. Refund 80%of
permit fees.
Buildin. Permit 230-0000-43104 $625.73
12%State Surchar:e 100-0000-24001 75.09
Erosion Control Permit 640-0000-43134 129.12
TOTAL REFUND: $829.94
APPROVALS: SIGNAT ES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
tib_, ":AOR,` CCE 0` ,. i0M<�-5) 7Y ,: $. ;,`, k
Case Refund Processed: I Date: I 4�-S / B .P"r
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD MASTER PERMIT
s COMMUNITY DEVELOPMENT Permit#: MST2018-00315
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/28/2018
T r[ r+ I< [� 9 Parcel: 2S108AB05300
Jurisdiction: Tigard
Site address: 14173 SW 155TH TER
Subdivision: BRENTWOOD ESTATES Lot: 15
Project: Reed
Project Description: Construction of 624 sf in ground concrete swimming pool and spa.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors:
Total: 0 sf Value: $57,000.00 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 0 Other Units: 1
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 0 201-400 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: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR SF 0
Owner: Contractor:
REED,BRIAN M&JENNIFER A BLUE MOUNTAIN POOLS INC Required Items and Reports(Conditions)
14173 SW 155TH TER 13121 S WARNOCK RD 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97224 OREGON CITY,OR 97045
PHONE: PHONE: 503-760-4554
FAX:
Total Fees: $1,554.82
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 require you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through0090. . ou may obt.v%a co f the rules or direct questions to OUNC by calling 503.232. •8 or,p:#4.332.2344.
Issued By: • 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.
Bu 'tling Permit Application
a
Residential R E F''',� .�r
�,.* FOIZ OFFICE. CSI:0.11.1
City of Tigard Received
Date/B , P j''
13125 SW Hall Blvd.,Tigard,OR 97223 N 0 V 2 0 2 0 1 8Plan Review
1 4 _ Phone: 503.718.2439 Fax: 503.598.1 ^ Q Other Permit:
�°rt ; Date/By: �� Z'7 �a
1 I G n R D Inspection Line: ' '-,f--':'D �Detate Read/B / /0--
ry�/gy,,.tins:
rUi :. `'a ,i V; „"'_ Ready/By: /L/ /r// - ® SeePage2for
Internet: Line:g 503.639.4175 _„�_• [ified/Method: (((/// Supplemental Information
I
TYPE OF WORK REQ !' D DATA:1-AND 2-FAMILY DWELLING
grNew construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-famil dwellin Valuation: $
g ❑Commercial/industrial cL5-7, C �
Y
11Accessory building ❑Multi-family Number of bedrooms:
❑Master builder Other: poo / Number of bathrooms:
JOB SITE INFORMATION AND LOCATIOI_Vl -,4 Total number of floors:
Job site address: /4-4 7 A5S-7{{, T -ia2,4 GC- New dwelling area: square feet
City/State/ZIP: clAR / qa �; Garage/carport area: square feet
Suite/bldg./apt.no.: I � -7Project name: „w„:-...::,--_ J 17E5, DG.�/— Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area:V°�I'-4, square feet L4,2_({
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Ca6712VC7/
. oi( CA SNGj/2 61/C) e'0C)(-�GslL Valuation: $
(A.) l WI 144 / k.)Cot i L d Spm Existing building area: square feet
(A7-4 4 New building area: square feet
F.PROPERTY OWNER 0 TENANT Number of stories:
Name: g - --D Type of construction:
Address: /q/7-5 /_D-5.- T/( L� ��CG Occupancy groups:
City/State/ZIP: 774/4/2D, /�X_ g 72,2 4/
L/ `f Existing:
Phone:( ) Fax:( )
New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: 36b/c., vi v- e .tij/,/ " G S (Please refer rofeeschedule)
Contact name: Y C -i47 ro� �Y YC�G3Structural plan review fee(or deposit):
dFLS plan review fee(if applicable):
Address: 1,31 Z I S ujiclkoci4
City/State/ZIP: C)&To('A( G/ -, (31? 7D 9:5--- Total fees due upon application:
Amount received:
Phone:(5o3) 7( - 4/63-'7/ Fax::( )
E-mail: goy l- -.ua--- vAOuty 1� ►IN "3,GR364.5COPHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name: 06 liltidutl_)TA/A/ G 5- Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: / 3/2/ 5 (,tARA—)6CK Solar Installation Specialty Code checklist.
City/State/ZIP: g6 �`�o C/� (37 Permit Fee(includes plan review $180.00
C/ h76:;, ,,...5-•
and administrative fees):
Phone:(.54- 3) 76 _ Sy Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: �3 95
Total fee due upon application: $201.60
Authorized signa...-: jrAppi 0 / This permit application expires if a permit is not obtained
//'/ within 180 days after it has been accepted as complete.
Print name:STG%l ' /.. -/-{/q/I/�6.- l( Date: / 171 h/d O /E' *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist h'
H
One- and Two-Family Dwelling FOR OFFICE ISE 0y1.1
City of Tigard Date/BReceived Permit No.:
11 13125 SW Hall Blvd.,Ti ard,OR 97223 Associated Associated permits:
I Phone: 503.718.2439 Fax: 503.598.1960 ❑ Mechanical
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing
TIG A R D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les yo 1/`A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. 0 0 ❑
7 Water district approval. ❑ 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
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
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ 0 0
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 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
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- ❑ 0 0
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. ❑ 0 0
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- 0 0 0
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 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 ❑
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 ❑ 0 ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactafloorrroof truss design details. 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 ❑ 0
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 0 0 ❑
architect licensed in Ore on and shall be shown to be applicable to theproject under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 1:1 ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechnical Permit Application FOR OFFICE USE ONLY
City of Tigard FIECF-7-'/F . ceived i,
1':-'- ' '''"
sate/By:ate/By: (/ AV
r 4/tSTI\0/1-00 3/S-
II ''' 13125 SW Hall Blvd.,Tigard,OR 97223
I '
Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 NOV 2 0 2018 Date/By:
Inspection Line: 503.639.4175
TIGARD Date Ready/By: I juns. 1 ra see rage L tor
Internet: www.tigard-or.gov CIT'f' '. . '; t 71,Notified/Method: Supplemental Information
EMJILLINC. L:!,';', ,--,At
TYPE OF WORK , . , , - COMMERCIAL FEE* SCHEDULE -USEcHkeICLIST
,
Mechanical permit fees*are based on the value of the work
New construction
p Addition/alteration/replacement
0 Other: performed.Indicate the value(rounded to the nearest dollar)of all
Demolition
mechanical materials,equipment,labor,overhead,and profit.
Value.$
CATEGORY:OT:CONSTRUCTION ;), '1, ' .,..,A.:-
icrATENTIAL*SIPMENT I SYSTEMS FEE
Accessbuildi S4-
El 1-and 2-family dwelling 0 Commercial/industrial oq For special information use checklist.
0 Multi-family 0 Master builder Other:it7e, re,4 Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATI, '' .0i.3 Heating/cooling:
4 . Air conditioning 46.75
Job site address: /92 73 is,--5-- - 721-a/z/4 ca-- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7761/1-14b , C.37_.. 9.7zw4.7 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: 6.,---a-f) -12 ,)>;ii...X6--- 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
P -, 7-...4.:.:, ,,fir,- ,--- D<ige-e ,101,4.*.,,t ir,:; 1:,..:4S4.,* ,41,4744 ,,,,, FGtas fireplace/insert 33.39
water heater or gas
e •re/r- /SPA fireplace 23.32
Log lighter(gas)
23.32
Wood/pellet stove
33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
23.32
1, , .,..„1.11 PROfriiitirf.,,i ' ,-;,...4 Ad 0 i.e.hit ,,,,,t.v,,, ,,:: Other:
'.; ' -;1; ' '"--'1h '`'`' ' Environmental exhaust and ventilation:
Name: e2.,./.)0 Range hood/other kitchen
Address: /4,//734
- 4.... ---
i 53 (-7/2/2,44--c equipment
33.39
Clothes dryer exhaust
33.39
City/State/ZIP: -774,/-AD, 9R, 9-7,2L7 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
APPLICANT '''''''',.4' '1::;::' in,Inl'isrlAa PER '14:4 Other: pir:)1 AZ4LK / 23.32 7,3,62,
.;:.,:,,tv
Business name: Zlig X0u,L3-TH/N( R2n0Z.,c
i..
r--' Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: y 57-141/4/ Furnace,etc.
Gas heat pump
Address: / -3 h,q( . (A)/eRiwci< pd
- Wall/suspended/unit heater
City/State/ZIP: sOae40A( C/77 (:7/ 97 0 c<s- Water heater
/
Phone:( ) 7‘,0 ‘. Fax::( ) Fireplace
Range
E-mail: c p y ro-e. - 07-0 114 R.o‘s . cok4
Barbecue
CONT' CTOR. .c
;- ." Clothes, 4-;:' 51' Cloes dryer(gas) .-••''
4- C d 6
Business name: , f/6---; 45- /&,1,6-- Other: 3.00 t lAkaird \ it4.1
Other: O mgc:fiksacAttoiRwrms. ,,1 i„,
Address:
Subtotal S1 •43
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lie.: a 3., 5 ) 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: /A .. 0 /f * Fee methodology set by Tri-County Building Industry Service Board
Print name:577-epea,y 4p), Date:Xalrir
I:\BuildingTemits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: POnit r.
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PennitApp_040113.doc 2
City of Tigard
O COMMUNITY DEVELOPMENT DEPARTMENT
III g
T l A n Building Permit Review — Residential
Building Permit #: /45-640/7- w 3 f 5---
Site Address: 1417 3 511 I SS *, j e cr (-Q.-
Project Name: IZee4 ire-el
etr,,r7 vz_, Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Ri2.I .. 6C r Cr Poo 1 ( YEN;
•
0 Verify site address/suite# exists and active in permit system.
jei River Terrace Neighborhood: $ No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
/Three(3)copies of site plan Existing structures on site
/Site plan must be on 8-1/2"x 11"or 11 x 17"paper ZIFootprint of new structure(including decks)with finished
/Drawn to scale(standard architect or engineer scale) floor elevations
forth arrow !Utility locations&easements(required for new and additions)
Site address,project or subdivision name and lot numberSidewalk/driveway approach
fd'Applicant information(name and phone number) mon of wells/septic systems
Plot dimensions and building setback dimensions wig trees to be retained with drip line,and tree
❑Square footage of buildings to be demolished protection measures
/Lot area,building coverage area ercentage of coverage and free size,type and location
impervious area(applicable i R-7 -12,R-25&R-40) ieStreet names
gProperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced: Yes o
4 foot differential) If yes,is a storm water quality facility shown? ❑Yes,CJNo
jZi Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ❑ No Received: Yes ❑ No
7 Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notifiedNo Applied For:
pp ❑ Yes ❑ No,stop intake
an'd Use Case#:
Zoning: 1--- —1
/10 Required Setbacks: Front 64119Rear l S Side e Street Side i j Garage ZAD
,I0' Landscape Requirement:
0 Lot Coverage Maximum: g0 %
$ding Height: Maximum Height 3 S Actual Height W/P
B—Vtsu l Clearance
Sci.sitive Lands: 0 Yes 0 No Type
an orestry Plan
B Conditions "Met"prior to issuance of building permit
Notes:
fZ Approved By Planning: /VI (9'1."-- Date: t I I ? f l 6
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\BldgPennitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: • /
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: TanningEngineering rmit Coordinator uilding
Workflow Sign-off: ign-off for Planning(include notes rom planning review)
Route Application Documents: vr 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: 41 ,- ,
By Permit Technician: `6,,ail",/ Date:
iffr ,
._.../ U, w r .�_,:. .
.ti
Engineering Review
Ci Slope at building pad: /.. trY
70
Ig Conditions "Met"prior to issuance of building permit
lb Easements (encroachments)per engineering conditions of approval and plat
`Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 'S No
Assess Water Quantity Fee in-lieu: ❑ Yes Zio No
LIDA Facility on lot: ❑ Yes No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
/ Approved by Engineering: 6 R. & Date: 1/-27-413
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
0 Conditions�`Met"prior to issuance-of--bpermi
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
' - ision Notice 3: Date Sent to Applicant:
A SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes /A
Tigard Trans SDC: 0 Yes /A
Parks SDC: ❑ Yes N/A
LIDA ❑ Yes /A
OK to Issue Permit G v
Approved by Permit Coordinator: Date:
1(4 7
I:\Buiiding\Forms\BldgPermitRvw_RES 010118.docx