Permit (169) , „-
Ili CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2018-00335
T i i;A ti I3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2019
Parcel: 2S 110AD 10400
Jurisdiction: Tigard
Site address: 10941 SW ANNAND HILL CT
Subdivision: ANNAND HEIGHTS Lot: 6
Project: Annand Heights, Lot 6
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories. 2 Bedrooms: 4 First: 770 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1114 sf Garage: 392 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Yes
Total: 1884 sf Value: $243,092.40 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: 0
Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Tema Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'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
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1884
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 Report Required
TIGARD,OR 97223 Prior To Pour
3 1 Hour Fire Rated Eaves
PHONE: PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $30,336.73
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 52-001-0090. You may obtain copy of the r s or direct questions to OUNC by calling 503.232.1987 or 1.800 332 2344
' fr. ....
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 aro required on the job site at the time of each inspection.
I • •
Building Permit Application •
Residential ,"r FOR OFFICE USE ONLY
City of Tigard .11 Received ' �7 G�� �
DateBy: 27//8 l/r� Permit Np s j 4 S.',O
. a 13125 SW Hall Blvd.,Tigard,OR 97
= Plan Review
Phone: 503.718.2439 Fax: 503.598. •60 C 'sVil0'6 DateBy: 1Z it I� Other Permit. /��y���Q 7
TICARD Inspection Line: 503.639.4175 1 Date Ready/By. L / /� Juris: p Pee Page 2 for
Internet: www.tigard-or.gov ® l , kiit') NotVed/Metho ` , Supplemental Information
TYPE OF.WO iri ?idGiwiI. REQUIRED I ATA:1-AND 2-FAMILY DWELLING
XNew construction n Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement El Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1-and 2-family dwelling 0 Commercial/industrial Valuation: $ . L16l�
El Accessory building El Multi-family Number of bedrooms: ; fl �
El Master builder El Other: Number of bathrooms: �/
JOB SITE INFORMATION AND LOCATION Total number of floors: - _ ( - 2---)C0
Job site address: ",.- 9' ����Q� 14AAanG/ H!;I lo4,-'l New dwelling area: /�'/? square feet 1 ' 14
City/State/ZIP: .7, 6,q-//_f) 0, 9 7 _ '3 Garage/carport area: 3l(�f 7:),_ square feet 7 7()M
Suite/bldg./apt.no.: Project name: `Q,n,, /jC A j Covered porch area: d square feet
Cross street/directions to job site: .f� /
d Q`� Deck area: 61:) square feet
Other structure area: square feet
REQUIRED DATA.COMMERCIAL-USE CHECKLIST
Subdivision: ^nu A" ii/e<y A /5 I Lot no.: �0 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/�� OFf WORK work indicated on this application.
hick) j'P!L Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER. 0 TENANT Number of stories:
Name: tupt.,0 4c904 COILSr T. tiIJ "— Type of construction:
Address: /02'4 S'-5— gam.) Oa Da-k40 d6''t.T.G$ Occupancy groups:
City/State/ZIP: 7f a re ?-.23 Existing:
Phone:(�3 7gi L7 5 Fax:(6-e43) 3/U'7d4 New:
❑';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:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
E-mail: wiAC/IA-1011 Wa aM d5N ita ®r4 At all r C'o� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: kJ/Ad/4,v(Ai ac cc 1k� Submit two(2)sets of roof plan with connection details
�� and fire department access,along with the 2010 Oregon
Address: A.—G s—S /140- 1--h /A-k j, ( * tS7L Solar Installation Specialty Code checklist.
City/State/ZIP: 7/5 aid 2 Permit Fee(includes plan review
® 2 and administrative fees): $180.00
Phone:(5- 3) gd _4-ta 75- Fax:( 6-03 6"9i '-7ad` State surcharge(12%of permit fee): $21.60
CCB lic.: 6-0/96- Total fee due upon application: $201.60
Authorized signature: ---- ---.—. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
sr
" . f ,22 r✓ , D a e: Ifridf ,J Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FC JFFICE USE ONLY
City of Tigard Received
la) Date/By: Permit No.:
•IN 13125 SW Hall Blvd.,Tigard,OR 9722 . y
Plan Review
Date/By:503.718.2439 Fax: 503.598.19 Other Permit:
TI GA R D Inspection Line: 503.639.4175 t r„� Date Ready/By: Surfs: H See Page 2 for
Internet: www.tigard-or.gov `�� (.'r Notified/Method: Supplemental Information
, G NikID
:*e, " a E4 400. * ..COMM., RCIAT FEE* SCHEDiJLE-,iISE,(:IiECI I,IST
4"4"4" "4"`""'' ''' '"` ""'' '' x:' '''''':''''''''''''''.:4'1'' ' �" �, Mechanical permit fees*are based on the value of the work
ew construction 0 Addition/alteratioreNl .� performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
"CATEGcORY OF;.CONSTRUCTIO,N RESIDENTIAL EQTIIPMENT/SS STEMS FEES*
,j09i.and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
iB OR14Ji'TIoN,:.Ai4p I;oCAT3ON. Heating/cooling:
BS
Air conditioning 46.75
Job site address: O L1 f 5i ,in a / /1 pi
. ' Furnace 100,000 BTU(ducts/vents) ,.*"'". 46.75
City/State/ZIP: J,,'are,/ ®,c 9--72.2-3 Furnace 100,000+BTU(ducts/vents) 54.91
v Heat pump 61.06
Suite/bldg./apt.no.: Project name: n '-ADuct work 23.32
Cross street/directions to job site: jo f r 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: ,�y h 76 Lot no.: Other: 23.32
�n�/id (/ Other fuel appliances:
Tax map/parcel no.: Water heater ✓ 23.32
,., s_ yDE .,ti 61 Weide,, . Gas fireplace/insert .e 33.39
Flue vent for water heater or gas
f <P-1---� fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
ROPERTY OWNER' ❑ 'TENANT
., Environmental exhaust and ventilation:
Name: 6/1 y/,j, (J0/ 4(571 c. Range hood/other kitchen -
6,S /yeti-014i
Nd �� 10 5 othment 33.39
Address: t5J r 'tfi Clothes dryer exhaust .� 33.39
City/State/ZIP: 7-,,,,,,,,,/ ®,, �2?..3 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32
Phone:( 5-03 7Fax:"(i 3) g fC -7 ( Attic/crawlspace fans 23.32
j AAPI. IC2t.NT '.,❑ CONTACT PERSON. Other: 23.32
Fuel piping:
Business name: 60 Ate
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
_, Range
E-mail til.�ll du'dorik0"eS/l/W(Cn1.(,Et A ((/A Barbecue
`"CONTRA)CTOR".; ''�. Clothes dryer(gas)
Other:
Business name: -F,,--5/ C.4-l MECHANICAL PERMIT FEES*
Address: /3/50 //ac i ,.4,5 f2/c. C/. /p. Subtotal
City/State/ZIP: tf k 6S O Qn y < J Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: '72 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: / * Fee methodology set by Tri-County Building Industry Service Board
Print name: 7/�� r et// /) Date:(/�-![_(it. /rte,
I\1 ,ildin¢\Permits\MEC PermitAso 040 440-461 T7 (I 1/02/COM/WEB)
Electrical Permit Application• Fl JFFICE USE ONLY
City of TigardIIIIM Permit#:
1111
a 13125 SW Hall Blvd.,Tigard,OR 97223 ; lL Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 `�~.. 'a -
SEIIIIIIII
Inspection Line: 503.639.4175 ;�>tCli Ready Date/By: Juris ll See Page 2 for
T I G A RP Internet: www.tigard-or.gov 'i: Notified/Method: Supplemental Information
TYPE OF WORK EC V d�6� PLAN REVIEW
New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
�''II" +�,, 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: ,r • where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCT`I'�q exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ❑Commercial/industri `. ccessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
�� �� r` �� 0Addition of new motor load of system
Job#: Job site address: A^A 4.4 6141001-IP or more. ❑"A",
City/State/ZIP: % /�r. �y 2�3 0 Six or more residential units. occupancy.
C��`' 7r ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: nA ,#,d f.�j'L 1# 0 Hazardous locations. 0 Supply voltage for more than
Pi "� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: �jy0 t� FEE SCHEDULE-
V Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: /�Anan, #161 15 Lot#: 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
f/e.f 5FZ (with above sq.ft.) i 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PIrOPERTY OWNER, I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: (' 1( utaeyc &As in,thDIL 200 amps or less 100.70 2
Address: p. $ct �!0 ex_i t b' " 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 70
glee,/ V72.2-3 601 amps to 1,000 amps 301.04 2
Phone:( 7�i 0.__1/3 7 Fax:(6v3 )57a ---741-4 Over 1,000 amps or volts 552.26 2
/ ' Temporary services or feeders installation,alteration,and/or
Email: �erd/Ll,�,R-CS /VU ( 6 IAC I CiJ�� 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
ICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Vq.n'ie. above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR.., Pump or irrigation circle 67.84 2
Business name: 42a tA4,gt k7c. ,1'?L Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ID See Page 2 2
Address: Ca.a OOA panel,alteration,or extension.
��l rrr,�
City/State/ZIP: � .t yZ�j Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:V3) 5-/9 v7 pi Fax:45--1/3) ‘fb _f2„13 Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:®[[/7 ..4 ElectricalLic.:L—Ne Suprv.Lic.:YZOS specifically listed(/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name /,n`5ih 4 AV Date: /�U�/A., 0 Plan Review Required(25%of permit fee):
'y S State surcharge(12%of permit fee):
Authorized signature ,,,,e'
" ~ �- TOTAL PERMIT FEE:
-�� ,--,.- This permit applic9tion expires if a permit is not obtained within 180
Print name: C r1•D Th 4 jI Date: j,1,p/IC6 days after it has been accepted as complete.
* Number of inspections allowed per permit.
i'Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/11.'5 440-4615T(11/05/COM/WEB
• •
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description *
Fee for all residential systems combined: $75.00 Qty. Each Total Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
E Audio and Stereo Systems* 15.01 to25 kva 200.34 2
Wind generation systems in excess of 25 kva:
[1 Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
H Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
[1 V• acuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
(-1 O• ther: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n B• oiler Controls
E Clock Systems
E Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n N• urse Calls
[1 O• utdoor Landscape Lighting*
❑ Protective Signaling
[l Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE-doc Rev 06/17/2015
1p
P1Umbing Permit Applicatio •
Building Fixtures FOR OFFICE USE ONLY` Received
City of Tigard Permit No.:
III . Date/By:Re
■ 13125 SW Halt Blvd.,Tigard,OR 972 0.,
Phone: 503.718.2439 Fax: 503.598. '60 Plan Review
DateBy: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 t ( � Date Ready/By: Juris: Ef See Page 2 for
Internet www.tigard-or.gov 1� � �St9'lNotified/Method Supplemental Information
...oa tp"Afo' s R�l.'
•1"T' EOR��RK_ {� �..;.. .:;FEE*:.SCHEDULE ,.; ',
ew construction ❑Deal G � For special information use checklist
Description Qty. Ea. Total
0 Addition/alteration/replacement 0 rt er: 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 437.78
���°°°����- SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: -
Job site address:/e
v pe//(5 cu /i- ng ii(04Catch basin or area drain 18.76
Fell(
` ( Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7-1-6 lit,i) O' ' r-73_.2.-3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: _Anand ifieo A-/5 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
l®9 0 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: M(6 AI i/ A/15 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
n Clothes washer 25.02
NV.) 5 12 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER 0 TENANT, Expansion tank 12.51
Name: pilin/ l dr 1 lois- p c_, Fixture/sewer cap 25.02
Address: / '5&D /Wr/j_X) `z 5-04-1.6.-.1
Floor drain/floor sink/hub 25.02
y 7,-,f
r f/9"Q. 7 arr.,/
� en
Garbage disposal 25.02
City/State/ZIP: Hossee bib 25.02
Phone:( --/--120 7S-- Fax:(f-e 3 S-99 -76Ot Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: 50/4Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: ptirl `(/ a d M-z5'N w (��__„„,„.42,./C<c� Urinal 25.02
.0
Water closet 25.02
CONTRACTOR
e Water heater 37.52
Business name: par-FA/Id' it / �� WaterPP t m WV 56.29
Address: /4,//() 6' 64 `1 IfivA /20 Other: 25.02
City/State/ZIP: (coil. ,1,1 "7(/ - Subtotal
Phone:(&'3) g-3 ^ -6 Fax:53) 7,atieil Minimum permit fee: $72.50
CCB Lic.: ii‘.2 /39 S
Plumbing Lic.no.: ��>>""p/J Plan review (25%of permit fee)
3State surcharge(12%of permit fee)
Authorized signature: 77/7il{> TOTAL PERMIT FEE
Print name: cD, n kJ/J.,7( Date:7,77/0/ This permit application expires if a permit is not obtained within 180 days
after it has been a"apra•t it cw splete-
"Fee methodology set by Tri-County Building Industry Service Board.
\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/VEB)
City of°Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
e
r c n :n Building Permit Review — Residential
Building Permit #: /7s7—.2O
Site Address: /0 g1/7 . GO 46e47707//,//C
Project Name: 4nno J ( - Lot #:
(New dwelling=subdivision nate;Addition or Alteration=last name of owner)
Planning Review
Proposal: A/p t v CFR
12Ierify site address/suite# exists and active in permit system.
0-River Terrace Neighborhood: ENo ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
ree(3)copies of site plan LJExisting structures on site
EKie plan must be on 8-1/2"x 11"or 11 x 17"paper sprint of new structure(including decks)with finished
21 5 awn to scale(standard architect or engineer scale) �floorr elevations
B'1QOr arrow rCJUt jiffy-locations&easements(required for new and additions)
ite ddress,project or subdivision name and lot number Sidewalk/driveway approach
4�Applicant information(name and phone number) $Location of wells/septic systems
Lot dimensions and building setback dimensions sting trees to be retained with drip line,and tree
'❑Square footage of buildings to be demolished protection measures
.ot area,building coverage area,percentage of coverage and -El-greet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) 'treet names
roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? Iafes ONO
4 foot differential) If yes,is a storm water quality facility shown? -EYes ❑No 07
-Er-Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified I No Received: ❑ Yes ❑ No
Public Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified I (No Applied For: ❑ Yes ❑ No,stop intake
2 Land Use Case#: ?D) 'PO6—6 O03
0' Zoning: F - (a
0-Required Setbacks: Front f 5' _ Rear jL Side Street Side 7 Garage ' O
[ p Requirement:e Re uirement: %
De-Lot Coverage Maximum: 16
.P.--Building Height: Maximum Height 3S Actual Height
B-Visual Clearance
.0-Sensitive Lands: 0"-V.
Q Yes ❑ No Type
Iff-iirban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
D-Approved By Planning: d_.17 Date: a/%
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved El Not Approved
I:\Building\Forms\BldgPennitRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: /Z//o///
Site Plans: # 3
Building Plans: # -3
Building Permit#: • Enter building permit#above.
Workflow Routing. Planning Ingineering 'ermit Coordinator uilding
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: C 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: -tem Date: /-`/€/d
Engineering Review I�
lope at building pad: b
❑ Conditions "Met"prior to issuance of building permit
0 Easements (encroachments)per engineering conditions of approval and plat
Vater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes -0"No
Assess Water Quantity Fee in-lieu: ❑ Yes ,Et No
LIDA Facility on lot: El Yes ,r2`No
,B'Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
„la-Approved by Engineering: hi,i v tv Date: ) / Z /f
Revisions (after Building Submittal only) Reviewer D✓✓✓ate
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-permtt
❑ 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:
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: 'Yes ❑ N/A
Parks SDC: 14 Yes ❑ N/A
LIDA ❑ Yes X N/A
'IKOK to Issue Permit
Approved by Permit Coordinator: Atlitij
(4'42h—
Date: J 2I (7 I I g
I:\Building\Forms\BldgPermitRvw_RES_010118.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
II Transmittal a smittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard—000r.gov
TO: [' � c),,,,_474,,--1--- DATE RECEIVED:c, ,
DEPT: BUILDING DIVISION tECEIVED
SEP 11 2019
FROM: N,, -- CITY OF TIGARD
++,, BUILDING DIVISION
COMPANY: ','.cc(.v,,c,9 C?'� l.n�;%�l c r,
PHONE: 0_3,v3 ?,\. i — 6\17 By:
RE: I C )-1.( 'LC C,-\v)p =" (-1-qA C + kAT ?at-- 35'5"--
(Site Address) (Permit Number)
(Project name or subdivisioame and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions: ,Is.;