Permit (148) CITY OF TIGARD MASTER PERMIT
IN+• COMMUNITY DEVELOPMENT Permit#: MST2018-00265
Date Issued: 03/07/2019
T"1 c ;'4 1!:I� 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD09900
Jurisdiction: Tigard
Site address: 10901 SWAN NAND HILL CT
Subdivision: ANNAND HEIGHTS Lot: 1
Project: Annand Heights, Lot 1
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 712 sf Basement 0 sf Left: 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 974 sf Garage: 349 sf Front: 15 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1686 sf Value: $217,583.90 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel 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 Temo Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 3 201-400 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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1686
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 Geo Tech Required Prior To
TIGARD,OR 97223 Pour
PHONE: 503-780-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $29,769.45
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 952-00 -0090. YAu may obtain. copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , ,'
. Permittee Signature: ---------. r
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential
FOR OFFICE ESE ONLV
City of Tigard Received�}
IN 13125 SW Hall Blvd.,Tigard,OR 97,46 Date/By: q1�u 11 SST Permit No.: c,aC�C_ S
Phone: 503.71$.2439 Fax: 508597.4'.'1. k..I ` Plan Review / J� T1
InspectionLine. 503.639.4175 Date/By. D/?i $ Other Permir.CJ tj` i�,i�t1 `
I
1 C'1 R l> , n (� Date Ready/By. ((( .runs: 21 See Page 2 for W
Internet www.tigard-or.gov SEP P 111() N. "red/Method
v / // �I� I Supplemental Information
I �I !� ,l�� Su le •
�; �* z ,
New construction Irr ..,o Ilton} 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 therofit for the
' t � � "d> "- : work indicated on this application. p
; 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ (1 I 3"--472--;3
ID Accessory building
❑Multi-family Number of bedrooms: '3
❑Master builder ❑Other: Number of bathrooms: .3
t
a.' *t. •- ' 1 x , Total number of floors: //_ �� •d0 56
Job site address: /a i' / •4) AIOn _U/ N it
(bar- New dwelling area: `P square feet /'1 Li
"7�-6 ,2
City/State/ZIP: �!
/� 0�� q 723 Garage/carport area: lif.o, square feet "7( ,,,
Suite/bldg./apt.no.: I Project name: 'J r
�.Anein C /l Covered porch area: square feet
Cross street/directions to job site: /ai tb
Deck area: 56 square feet
Other structure area: square feet
�� V ``
Subdivision: ntRli� � /i, � �?x �'°?:1° � �Q� `+�r� .� ." �- ? `'"`" :f
%:
I 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
# g j Kms, equipment,materials,labor,overhead,and the profit for the
44.a } ..b v*.�''.Y r €t.�" er'!.,,,,. .tar
ION '. '`"0 671., s �� 1
'''''''y
,, , I'-;''''''4'''''
�,, •, ' ' e'u '; , work indicated on this application.
�ek.) �P!` Valuation: $
Existing building area: square feet
�f i,* f =N'� M New building area: square feet
� ' ;f.'r `�s"° ,, x rp a 4' "it):',.'.1;
/' Number of stories:
Name: " ',�,,ODn �` °,,...ri,: �_ ¢'�, :,�O , ... eUA- �`-$ pp a����
K�r.���U /^�/�- Type of construction:
Address: /07-4T-5- �" /JJ n � /
/"d!v� �Gl-��d /{"` 6(�Y'C�l Occupancy groups:
City/State/ZIP: 7'A -23 a or 2
/ Existing:
Phone: 3 70 7 Fax (t143) 'U--WO4
New:k . ' yr r { 4
s.�, ,; - as .;. ' ' .
Business name: cfii % ' �,• r +� =v
Contact name: Structural plan review fee(or deposit):
Address: FLS plan review fee(if applicable):
City/State/ZIP: Total fees due upon application:
Phone:( ) I Fax::( ) Amount received:
(Ia./doe/0i Email: t�tJ 6;,} r", - a * s 't
' � � x t ' t +001
Commercial and residential prescriptive installation of
/� � /� r *, a rooftop mounted Photo Voltaic Solar Panel System.
Business name: VIJ/ I l lam_S 71 L Submit two(2)sets of roof plan with connection details
Address: f� �(� / 'L and fire department access,along with the 2010 Oregon
/�`"'$'r5 ( - �ir -4D'/ ..+V {! Solar Installation Specialty Code checklist.
City/State/ZIP: 15 Q Q2 9722-3 Permit Fee(includes plan review
Phone: /T`''J e-- and administrative fees): $180.00
So' -4/6 7S—
I Fax:(�3 �0—ZGd‘ State surcharge(12%of permit fee): $21.60
CCB lie.: 6"--0/96,
Total fee due upon application: $201.60
Authorized signature:' This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: _ �� Date! *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application odeuti17511.
FOR OFFICE IiSE ONLY
City of Tigardy eived
' ii 13125 SW Hall Blvd.,Tigard,OR 97223 RE®°a EIV 'By: Permit No.:
Phone: 503.718.2439 Fax 503.598.1960 n Review
T 1 c;A K n Line:
Inspection 503.639.4175 Date/By: Other Permit:
Internet: Line:gazd-or. SPP 26 20 ;Date Ready/By: hurls: ® See Page 2 for
(((( Notified/Method: Supplemental Information
■
Mechanical permit fees*are based on the value of the work
!' i ew construction 0 Addition/alteration/replacement
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
and 2-familydwelling . 1 . . ', ,�c :0;:
0 Commercial/industrial 0 Accessory building
For special information use checklist.
❑Multi-family
0 Master builder 0 Other:
Description I Qty. I Ea. I Total
- Heating/cooling:
Job site address: jU��T J 5-4/ #/ a Air conditioning 46.75
A a j a- ar Furnace 100,000 BTU(ducts/vents) . 46.75
City/State/ZIP: a. ` ' # 23 Furnace 100,000+BTU(ducts/vents) 54.91
111/
Suite/bldg./apt.no.: Project name: i L 4
L , Heat pump 61.06
Cross street/directions to job site: i Duct work 23.32
0 / 11 Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
/ Flue/vent for any of above 23.32
Subdivision: 4 nn4 Ad 4 /1Lot no.:/ Other: 23.32
Tax map/parcel no.: Other fuel appliances:
Water heater ✓ 23.32
' ..-1'.---'-'...:'"C.:::'"41fGas fireplace/insert .' 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
'— r, it Other:
23.32: "`
Environmental exhaust and ventilation:
EMIIIE �' Range hood/other kitchen
Address: rr 6 t� d�1, i laid/g.
- / L 5 equipment 33.39
f/— C{t!�dPr. fi
City/State/ZIP: �--r� Clothes dryer exhaust .� 33.39
V2 2.23 3 Single-duct exhaust(bathrooms,
Phone:( �� d , jr,7%."-- Fax:{�,3) toilet compartments,utility rooms) - 2332
-7`� Attic/crawlspace fans 23.32
Other:
>n �� , " o; � 23.32
Business name: Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
( ) Fireplace
Phone:( ) Fax::
MEW •d Ac e5/1JW Q Range
Barbecue
F J
ff.,aux .._ . Clothes dryer(gas)
Business name: - , Other:
Address: c�� ,i- 4 t : 4 i• '
3/5 ) /, , a.$ 12/c.IC,— It• Subtotal, .,, . i.. 4": :
City/State/ZIP: �tp
`AL dA - [� ,/1 af9 S Minimum permit fee($90.00)
my Phone:
( ) Plan review(25%of permit fee)
CCB lic.: State surcharge(12%of permit fee)
TOTAL PERMIT FEE
1;i2/2/
� This permit application expires if a permit is not obtained within 180
AUthoriZed Signature: days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
� � !/� �
Print name: 1 �
� 'f Date: ��j�` /�C/
I:\Building\Permits\MEC_permitApp_040 13.doc l
440-4617T(11/02/COM/WEB)
Electrical Permit Application
FOR OFFICE USE ONLI"
City of Tigard Received
gl 13125 SW HaII Blvd.,Tigard,OR 9722 V . DateB : Permit#:
Phone: 503.718.2439 Fax: 503.598.19 0 Plan Review
Inspection Line: 503.639.4175 Date/B : Related Permit#:
i 1 G,,R D " r1 Q Read DateB
Internet: www.tigard-or.gov St.P 21118 iy y_ Juris: Supplemental
See Page 2 for
Notified Method Supplemental Information
= -
z s ,R, € tew construction 0 Addition/alteraaaltr 01 I Please check all that apply
(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: ElService or feeder 400 amps or more ElBuilding over three stories.
where the available fault current 0 Marinas and boatyards.
s.
El 1 and exceeds 10,000 amps at 150 volts or 0 Floating buildings.
2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi family ❑Master builderamps for all other installations.
O -f 0 Other: 0 Fire pumpInstallation
_ �_ ; _s ,� I ,. ❑Installation of 150 KVA or
0 Emergency system. larger separately derived
Job#: Job site address O i a 4^n ewar / ❑Addition of new motor load of system.
City/State/ZIP:
l 100HP or more. ❑"A' "E' "1_2„«1.3„
�,/5 9n�3 ❑Six or more residential units. occupancy.
Suite/bldg./apt.#: �/ ❑Health-care facilities. 0 Recreational vehicle parks.
Project name:4.nm.d . A
g 0 Hazardous locations. 0 Supply voltage for more than
Cross street directions to job site: /�19 f� V 0 Service or feeder 600 amps or more 600 volts nominal
Description Qty. Each Total
Subdivision: ,/([� t New residential single-or multi-family dwelling unit.
nA, q, f /1-ed (/5 I Lot#: /
Includes attached garage. R
Tax map/parcel 4: V
1,000 sq ft.or less
168.54 4�� , , 't a, `< r,`r Q r a Ea.add'l 500 sq.ft.or portion
sm :t$?tr,, t,. , ,,^ ,l : A ,i ,`s p .r� 33.92 I
�+ /� Limited energy,residential
&f r�Pit (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
. t:f 1 ad+c' x a i �+v `, ., ,a.krRenewable Ener
/• t # gY ❑ See Page 2
Name: Wf add /`,s / JAL Services or feeders installation,alteration,and/or relocation
Address: t-O G/7N 200 amps or less
M/� �, M �[,� /� 100.70 2
/b�� sec) / - A p v/ 6 1 201 amps to 400 amps 133.56 2
City/State/ZIP: 76 ,rei 3f f72...� r� ' 401 amps to 600 amps 200.34 2
Phone: V"I7lA V'C y 601 amps to 1,000 amps 301.04
�j 22
( �r/��V 7r I Fax:�/3 )�Q ,�i Over 1,000 amps or volts 552.26 2
Email:��,e!/�e� �s N� M / `«� Temporary services or feeders installation,alteration,and/or
n
Owner installation: This installation is being madeononOproperty that I own which is not 2 cati0o amps or less
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 25.08 1
amps to 400 amps 125.08 2
Owner signature:
y, Date: 401 amps to 599 amps 168.54 2
. try?: _xarya,., isr € �`" `s" .
- R yg ',,,,,.:;,:„:5.- Branch circuits—new,alteration,or extension, er panel
Business name: ( �� A.above
sbranch or feeder
ewith
above service fedefee,
Contact name: each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit
7.42 2
Phone:( ) I Fax: :( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
2
illZritts Reconnect only 67.84
44.
Pump or irrigation circle
S fr�� /�/` 67.84 2
Business name:
ZQ��' c (�� Sign or outline lighting 67.84 2
Address: .r 4 J Oey4 J n/ Signal circuit(s)or limited-energy
`/�Lt/tri `✓ panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: ��� ,� 9,��� Each additional inspection over allowable in any of the above
Phone:(�3) 5/� 111.,"' L� I Fax:(757/5) Additional inspection(1 hr min) 66.25/hr
Email:
Y5_92;3 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
CCB L1C.:/qG7 El " Inspections for which no fee is
ectrical Llc.' m Suprv.Lic.:y
Q specificall listed(%hr mm) 90 00/hr
Suprv.Electrician signature,required: ) �� S£ ,
Print name kms` Subtotal:
Q Date: �` /b�� 0 Plan Review Required(25%of permit fee):
4
State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE:
Print name: C�f 1. 4 ` _`� /� This permit application expires if a permit is not obtained within 180
,�7 s G% I Date: 7/ ,, j * days after it has been accepted as complete.
I:\Building�Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17715 Number of inspections allowed per permit.
440-4615T(11/05/COM/WEB
Plumbing Permit Application
Building Fixtures _
City of Tigard ■ FOR OFFICE USE ONLY
I. g j A eived
` II 13125 SW Hall Blvd.,Tigard,OR 97223 Date//3y:
I Phone: 503.718.2439 Fax: 503.598.1960 rC „In Permit No.:
1.! 2 ' L U i 1 Plan Review
t i r;n R t) Inspection Line: 503.639.4175 Date/By: Other Permit No.:
lie
See PageforInternet: www.tigard-or.gov CITY OF f`GA40 tefiReeadye/tBhyo:d Supplemental Info
rmahon
/': ew construction ,
0 Demolition
For special information use checklist
ME Ea. Tl
❑Addition/alteration/replacement 0 Other: Description
New 1-2-family dwellings(includes 100 ft.for each utility co ection)
SFR(1)bath
1-and 2-family dwelling � ` 312.70
0 Commercialhndustrial SFR(2)bath _
mai
❑Accessory building 437.78
i _
0 Multi-family SFR(3)bath 500.32
❑Master builder
0 Other: Each additional bath/kitchen MEI2
—�, a ' I--..):-:•-!..?-.'. Fire sprinkler�_sq.ft.)
t ?' In IIIIII
Page age 2
Job site address: , 18.76
// / "�� � ��x � '
Catch basin or area drain
U 1 '�/ /A f ` d4
City/State/ZIP:
S. �'tL/ r�� — ..7-aDrywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: Project name: at ` //� Footing drain(no.linear ft.:_) pa e 2 —
Cross street/directions to job site: `t — Manufactured home utilities
50.03 g
10 j Manholes 18.76
Rain drain connector _
1g 76
e2
Sanitary sewer(no.linear ft.:____) Page 2
Storm sewer(no.linear ft.:_) g
Subdivision: / Page 2
Z 4, Lot no.:
Water serviceo (no.linear ft.:_) _
�� �' Page 2
Tax map/parcel no.: Fixture or item:
fY � T ;� Backflow preventer _
, � 31.27
�, '`�' i u�� -Z,�,#`�� +N.^ s��E1'A?,.,Yi g1r�t��; :ix. .41r 4� .,e a`tg'� �` � ;ai
12.51
L Clothes washer 25.02 —
Dishwasher _
Will 25.02
Drinking fountain
25.02
�,'i ,gyp .:',17Z-':::'.' 3 � � r Ejectors/sump
Name: �, / off . 4r,�,,"t . .: - Expansion tank 25.02
La� ` 12.51 -
Fixture/sewer cap _
Address: 25.02 -
i Q^��j, 3...._ Floor drain/floor sink/hub _
City/State/ZIP: ape" 25.02
Garbage disposal _
25.02 -
Phone.( 0 7S-- Hose bib
et a & (s�35`� 7000 = 125 02
251 -
_; M .. o , { � r- '. e 1502
Business name: �. w. .'�, Interceptor/grease trap 1111111 25.02
Medical gas(value:$ )
Contact name: _ Page 2
EINIII
Address: 12.51
Roof drain(commercial) _
12.51
City/State/ZIP: Sink/basin/lavatory _
25.02
Phone:( ) Solar units(potable water) 111111 62 54IMIIMIIIIIIIIIIIIIII
Tub/shower/shower pan
as . ,=>
1111210, • _
12.51a- AlZSNGt-) XQ� llGN1 25.02b r 7£ � .ra� f _* u"� t � zWater closet 25 02:�s � �'. nw � " 37 52
Business name: Oce 4,19v i
—
—
t 5629 —
Address: /v 5 i f //iv.
/i' '- Watererpiping/DWV _
�7` `! 56.29 —
5.02
City/State/ZIP: Other: _
Phone:(e/Zip: ,' - G� �a total —
7a3 ^ S� • Fax:a 3) 3Sno/ Subtotal —
CCB Lic.: !/" Minimum permit fee: $72.50
Plumbing Lic.no.: • / Plan review (25%of permit fee) —
Authorized signature: / / i/
7 //.2.
State surcharge(12%of permit fee) —
TOTAL PERMIT FEE —
Dat- 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
440-4616 T(10/02/COM/WEB)
IICity Of Tigard
7 COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD y„ Building Perm• it Review — Residential
Building Permit #: '&T QLD - (I LS.)
Site Address: 1090k SW knrland iil II C2-1-
Project
i-rProject Name: AYll'lln.vid ReA I
Lot #:
(New dwelling=subdivis �n name;Addition or Alteration=last name of owner)
Planning Review
Proposal: WC\A/ S�-12._
J Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: - No ❑ Yes,See River Terrace Review Addendum Attached
Sit Ian Elements:
ee(3)copies of site plan
sting structures on site
to plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished
D awn to scale(standard architect or engineer scale) Iffr or elevations'ty locations&easements (required for new and additions)idewalk/driveway approach
rth arrow
'te address,project or subdivision name and lot number
A•plicant information(name and phone number) j hf i •cation of wells/septic systems
IB •t dimensions and building setback dimensions 6/p
xisting trees to be retained with drip line,and tree
17..uare footage of buildings to be demolished •tection measures
L •t area,building coverage area,percentage of coverage and ej.. -et tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40)
Street names
arProperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? \, t ■No
4 foot differential) If yes,is a storm water quality facility shown? • es ❑No
- ' Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified jScr No Received:
❑ Yes ❑ No
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified tcl No Applied For:
pP CI Yes ❑ No,stop intake
,Land Use Case#: PD I2201S—D0006
1St/Zoning: R-12 L P D)
I f equired Setbacks: Front \S Rear tom' Side
3 Street Side g 2_0Garage �
Indscape Requirement:
0Lot Coverage Maximum: ,I)
:uilding Height: Maximum Height 35 j Actual Height
IL isual Clearance
I ,% g ��
nsitive Lands: ❑ Yes Ltd''No Type
WUrban Forestry Plan
tM Conditions "Met"prior to issuance of building permit
Notes:
Approved ByPlanning: 1
_ ,,. - Date: q,-16--1 c
Revisions (after Building Submittal only) Reviewer
Revision 1: ❑ Approved ❑ Not Approved Date
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: cA' '\S
Site Plans: # S
Building Plans: #
Building Permit#: Cr Enter building permit#above. Building Routing: EX Planning S Engineering S Permit Coordinator
Workflow Sign-off: D' Sign-off for Planning(include notes from planning review)
Route Application Documents: S Engineering: (1) copy of permit application, (1)site plan, (1)building plan and
original plan review routing form.
CY Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
Date: CAI i�
By Permit Technician: N '
En ineering Review
Slope at building pad: A
enditions"Met"prior to issuance of building permit
cements (encroachments)per engineering conditions of approval and plat
IBJ , ,
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes o
Assess Water Quantity Fee in-lieu: 0 Yes 1,110
/LIDA Facility on lot: 0 Yes No
Final Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:/
[ ' Approved by Engineering: &4 I:`'33''__ Date: /o•2 •/ef3
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 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:
i ZSDC Fees Entered: Wash Co Trans Dev Tax: s 0 N/A
Tigard Trans SDC: es 0 N/A
7t
OK
SDC: fd Yes
0 /A
LIDA ❑ Yespgd
OK to Issue Permit �� ��
t Coordinator: AK-Date:
Approved by Perna
I:\BuildingForms\BldgPermitRvw_RES 010118.docx