Permit (78) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019-00013
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/04/2019
-i-FG_ A I=.f7 9 Parcel: 2S112BD13300
Jurisdiction: Tigard
Site address: 7744 SW CORNUTT ST
Subdivision: ELDERBERRY RIDGE Lot: 29
Project: Elderberry Ridge, Lot 29
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1179 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1447 sf Garage: 379 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2626 sf Value: $329,165.90 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 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: Y 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 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!500 sf: 4 201-400 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 2626
Owner: Contractor:
RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions)
17933 NW EVERGREEN PL STE 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175
370 BEAVERTON,OR 97006
BEAVERTON,OR 97006
PHONE: 503-645-0986 PHONE: 503-645-0986
FAX: 503-690-2942
Total Fees: $32,199.68
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a,• -II 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, • f work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce Those rules are set forth in OAR
952-001-0010 through OA' ¶52-001-009x. You m obtain a y of the rules or direct questions to OUNC by calling 503.232.1;•7 or 1.800.332.2344.
` 1
Issued By: zeiL Permittee Signature: T
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.
Buil�ihin2 Permit Application b) ('
�
eSldentlal ,mu FOR OFFICE I;SE ON1.1'
City of Tigard � � ' et�ea
`J gDate/By: n Permit No.
13125 SW Hall Blvd.,Tigard,OR 97223 t r�1 S ��' \�'�_ ,"�
an Review
11111 111 Phone: 503.718.2439 Fax: 503.598.19601ateBy: ai4 Other Permits] ,Ct- 4.
TIG,F Il Inspection Line: 503.639.4175 �^�_ _ , t eady/By: ,,Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITY Li 14� d/Method: `'. /� Supplemental Information
x II \JG DIVISION
0:5:: u. � � ''44 4� '? 0 1 �t _ 3 x 6�e °t s3 a o '
::::c onstruction ❑Demolition 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 0 Other: equipment,materials,labor,overhead,and the profit for the
` ' r t F' . t , work indicated on this application.
�� :r� �j2°I �1�
✓ 1-and 2-familydwelling
Valuation: $
❑ g 0 Commercial/industrial t
❑Accessory building ❑Multi-family Number of bedrooms: 4
0 Master builder ❑Other: Number of bathrooms: 3
..` i4 '..',.'..4"`::;!1:, s " ' ' Total number of floors: 2 , , J
lob site address: 7744 SW Cornutt Ln New dwelling area: 2626 square feet -")
/iff[J
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 379 square feet L I" 9
_'l1_l
Suite/bldg./apt.no.: Project name: Elderberry Ridge Covered porch area square feet 1
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave Deck area: square feet
Other structure area: square feet
s ' r llw., t U it l'ST
Subdivision: Elderberry Ridge Lot no.: 029 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
' ' t t ,` -4r i}* „3.7,k',,,,,5-' work indicated on this application.
" ,;,c. ,k, =t,. �'.*: ' a' 51, 5*-; b3, ., . .4ztr' ,P tt,•".'a aim. ::«.,.s x 'y pP
Construction of SFR Valuation: $
Existing building area: square feet
New building area: square feet
✓ t ' t'. t Number of stories:
Name: Riverside Homes, LLC Type of construction:
Address: 17933 NW Evergreen Pl., Ste 370 Occupancy groups:
City/State/ZIP: Beaverton, OR 97007 Existing:
Phone:( 503)645-0986 Fax ( ) New:
Y N g
ll1 .
Business name: Riverside Homes, LLC gy M '(or r it): '
Structural plan review fee(or deposit):
Contact name: Wes Boisvert
FLS plan review fee(if applicable):
Address: 17933 NW Evergreen Pl., Ste 370
City/State/ZIP: Beaverton, OR 97007
Total fees due upon application:
Phone:(503)645-0986 Fax::( ) Amount received:
E-mail: i1f • �
wboisvert@riversidehome.com '
a Commercial and residential prescriptive installation of
e • .- _ �,..-: f;-' :):;:'''''''''''1'447:* ', �- ti,_.`,., roof-top mounted Photovoltaic Solar Panel System.
Business name: Riverside Homes, LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 17933 NW Evergreen Pl., Ste 370 Solar Installation Specialty Code checklist.
City/State/ZIP: Beaverton, OR 97007 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( 503)645-0986 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lig.: 189148 Total fee due upon application: $201.60
Authorized signature: i'L L" /.2a,i-:;,71- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
pal; .-''.-44titit,-Ri t * y set by Tri-f minty Building Inrinctry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
A
Mechanical Permit Ap lication _ (1)14OI FILE USI ()()NIANl
illCity of Tigard $ I Received
Permit No.
DateBy: \q_ Gt
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 2 Date/By:Plan Review Other Permit:
.��� � 2�1�
1 1(7 A It l) Inspection Line: 503.639.4175 Date Ready/By: Juris: Ed See Page 2 for
Internet: www.tigard-or.gov CATY OF CIGAR. Notified/Method: Supplemental Information
- CATY •; I0 .
- 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
O Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
'rt
Value:
�f�t s,.1a, `. . t�. :ng},x } } �",.:).'",11„.64,4,„,.tu . .. . �;z v.a .te �x,1.C,
`#� 1t F
«�x p i li a '�� '
❑✓ 1-and 2-family dwelling 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:
Air conditioning 1 46.75 46.75
Job site address: 7744 SW Cornutt Ln Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP: Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name: Elderberry Ridge Duct work 23.32
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave 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: Elderberry Ridge [ Lot no.: 029 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
,,,--41...A i F ; $#� ! Gas fireplace/insert 1 33.39 33.39
"" '"'"''' ' Flue vent for water heater or gas
Construction of SFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
6 n e Other: 23.32
"'{ R 4 4 4 I' P , �
`<a s x°' - - _- - Environmental exhaust and ventilation:
Name: Riverside Homes, LLC Range
hood/other kitchenequip1 33.39 33.39
Address: 17933 NW Evergreen Pl., Ste 370 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP: Beaverton, OR 97007 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32 93.28
Phone:(503 )645-0986 Fax:( ) Attic/crawlspace fans 23.32
' m. , $Iv � 4❑YY. zs_;�7_ 1a ,� .,,f.,::..,,',4„:3.1
,f., ,wt: .1 Other: 23.32
Fuel piping:
Business name: Riverside Homes, LLC
$14.15 for first four;$4.03 for each additional
Contact name: Wes Boisvert Furnace,etc. 1 14.15
Gas heat pump
Address: 17933 NW Evergreen Pl., Ste 370 Wall/suspended/unit heater
City/State/ZIP: Beaverton, OR 97007 Water heater 1 14.15
Phone:(503 X45-0986 I Fax: :( ) Fireplace 1 14.15
Range 1 . 14.15
E-mail: wboisvert@riversidehome.com Barbecue
Cs } J.-, Clothes dryer(gas)
Business name: Pro Heating & Cooling Other:
Address: 2095 NW Alocleck Rd.#1103 Subtotal
City/State/ZIP: Hillsboro, OR 97124 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 971)205-4989 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 209001 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. LA!(�,e1, « * Fee methodology set by Tri-County Building industry Service Board
Print name: Nikki Pruett Date: 1/29/19
I.\Building\Permits\MEC PermitApp_040I13.doc 440.4617T(11/02/COM/WEB)
Electrical Permit Application RECEIVE FOR OFFICE USE 011.1"�"'1 Received
City of Tigard Permit a
DateBy: 1ST \"C—(.i} l J��
'A 13125 SW Hall Blvd.,Tigard,OR 97223 a Plan Review
III
■ Phone: 503.718.2439 Fax: 503.598.1960 ') 1 Date/By: Related Permit#:
Inspection Line: 503.639.4175 s". Ready Date/By: 7nris: ® See Page 2 for
T 1 G A R D Internet: www.tigard-or.gov i f OF I " t� Notified/Method: Supplemental Information
is i • is
c.f
ElNew construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
A,.. , *t, A x w' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
E✓ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
14 ''Jpj; =pp t A 1 t t - +a
" A t, ' ❑Emergency system. larger separately derived
MI M<: ?f s stem.
w
Job#: Job site address: 7744 SW Comutt Ln ❑100HP or more.motor load oof Y
❑..A,> "E" ..1.2,, "1-3",
City/State/ZIP: Tigard, OR 97224 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: Elderberry Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Bonita Rd & SW 76th Ave W: . "
Description I Qty. I Each I Total .I *
New residential single-or multi-family dwelling unit.
Subdivision: Elderberry Ridge I Lot#: 029 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92 1
, ` t Limited energy,residential
Construction of SFR (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
',''''.::4.-.-
Renewable Energy 0 See Page 2
Wry
,. El '';'1::;:21:i::
¢
.t .A ,.. ._. .J. ' ...• m., Services or feeders installation,alteration,and/or relocation
Name: Riverside Homes, LLC 200 amps or less 100.70 2
Address: 17933 NW Evergreen Pl., Ste 370 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Beaver-ton, OR 97007 601 amps to 1,000 amps 301.04 2
Phone:(503)645-0986 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 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
i - _ --. .- T r k Branch circuits—new,alteration,or extension,per panel
,. :.,:::,';44a Q_t a's. A e ,
�.' _ .n -�G.�„ _ ., *�� _` A.Fee for branch circuits with
Business name: Riverside Homes, LLC above service or feeder fee,
7.42 2
each branch circuit
Contact name: Wes Boisvert B.Fee for branch circuits without
service or feeder fee,first
Address: 17933 NW Evergreen Pl., Ste 370 branch circuit 56.18 2
City/State/ZIP: Beaverton, OR 97007 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)645-0986 I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: wboisvert@riversidehome.com Reconnect only 67.84 2
t.? A Pump or irrigation circle i 67.84 2
Business name: Sunlight Electric Inc Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy 0 See Page 2 2
2804 N E 65th Ave. St. D panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Vancouver, WA 98661
Additional inspection(1 hr min) 66.25/hr
Phone:(360) 518-7589 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.: 172549 Electrical Lic.: C230 Suprv.Lic.: s ecificall listed 'i4 hr min
; . ii*: 4" '.'4;44 del ..:z
Suprv.Electrician signature,required: 7 _ Subtotal:
Print name: Chester Garrett I Date: 1/29/19 0 Plan Review Required(25%of permit fee):
/� State surcharge(12%of permit fee):
Authorized signature:L/4 , �� u vim` TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Nikki Pruett ' Date: 1129119 days atter it tuts been accepted as complete.
* Number of inspections allowed per permit.
C\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description Ni i Qty. Each Total (*
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
✓❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s cificall listed 1/2 hr min
COMMERCIAL W '° : f ;, .PERMIT,FEES
Subtotal(Enter on Page 1): 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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
C\Building\Permits\ELC_PernntApp_ELR_ERE.doe Rev 06/17/2015
Plumbing Permit Application
Building Fixtures a rolz OFFICF. USE O\LY
Received , ^,Tic\^ y +-
City of Tigard Date/By: Permit No. l 1
INii, 13125 SW Hall Blvd.,Tigard,OR 97223 j AN 2 9 z019 Plan Review
I Phone: 503.718.2439 Fax: 503.598.19 Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD Grist I` l lw H1? Date Ready/ y: him
® See Page 2 for
Internet: www.tigard-or.gov ,` `
i tl! t Notified/Method: Supplemental Information
gtta4+b- 7 f1,. ..reg a A#:.c, w..; ^H' „.r++:- �4f. . Nu 3£t�' ' "'.. S :,.,',w- ",,tmw- e b im'#;h 77,'
t x
z�.�yHb.••*w2 *vA.'-:^NA' `a�+R+tS..abX'F' %i#: `".n„�,.y�..,:'"� M.tsCu ^3mxi�!r�� .�e.e+»assPri :..XW :...�i.trsmat..� .N � Jetir^�fle�'e•.�e++kk
2 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CAT �. 4 y 1 , a, A--# = SFR(1)bath 312.70
ll 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building 0 Multi-family -
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
;-...:•:••44.=•-,•.1..,;.:::->:,;,:;....::,...'•':•-• t 6 .-t e - Site utllltles:
,,. f• i , , - , §v .
Job site address: 7744 SW Cornutt Ln Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/zIP: Tigard, OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: Elderberry Ridge Manufactured home utilities 50.03
Cross street/directions to job site: SW Bonita Rd &SW 76th Ave Manholes 18.76
Rain drain connector 1 18.76
Sanitary sewer(no.linear ft.:_) Page 2
- Storm sewer(no.linear ft.:_) Page 2
. Water service(no.linear ft.:_) Page 2
Subdivision: Elderberry Ridge 1 Lot no.: 029 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
r: 1tI si,lioT JiF"'WORK. " x pl , '' Backwater valve 12.51
'1644:11i4-:"4"', *.""`"' '''''''"'Yr"'''''''' Clothes washer 1 25.02
Construction of SFR
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
1'7,1 'j °� t ,l E ; 41t Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Riverside Homes, LLC
-- Floor drain/floor sink/hub 25.02
Address: 17933 NW Evergreen Pl., Ste 370
Garbage disposal 1 25.02
City/State/ZIP: Beaverton, OR 97007 Hose bib 2 25.02
Phone:(503)645-0986 Fax:( ) Ice maker 1 12.51
A " 0 i f s 4,,s ,f , Interceptor/grease trap 25.02
'' D • N
Business name: Riverside Homes, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Wes Boisvert
Roof drain(commercial) 12.51
Address: 17933 NW Evergreen Pl., Ste 370 Sink/basin/lavatory 6 25.02
City/State/ZIP: Beaverton, OR 97007 Solar units(potable water) 62.54
Phone:(503)645-0986 Fax: :( ) Tub/shower/shower pan 4 12.51
Urinal 25.02
E-mail: wboisvert@riversidehome.com
,_.w.,.74-41.azF R r l+ ,� �uw +� ?0..er .red
Water closet 3 25.02
'•'••4•411,'''•n ' •5.o xz. . . r t<x: Water heater 1 37.52
Business name: H & H Mechanical Water piping/DWV 56.29
Address: 5757 SE Willow Ln Other: 25.02
City/State/ZIP: Milwaukie, OR 97267 Subtotal
Phone:( 503 975-9787 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 178122 Plumbing Lie.no.: PB414 Plan review (25%of permit fee)
i - State surcharge(12%of permit fee)
Authorized signature: y 6 ,,,_, TOTAL PERMIT FEE
Print name: Nikki Pruett Date: 1/29/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Irl-County tsulldmg Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
IIICity of Tigard
4 COMMUNITY DEVELOPMENT DEPARTMENT
l c AR ) Building Permit Review — Residential
Building Permit #: (\s-n�kg_(.5o f
Site Address: `7 714 5\4 O rn c,1-+ L n
Project Name: E I cif r-be rr16 G?i of GJ e 2::::‘Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 1Jei ) &P R.
izi Verify site address/suite#exists and active in permit system.
VRiver Terrace Neighborhood: 0 No 0 Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
❑Three(3)copies of site plan Et✓xtsttng structures on site
❑Site plan must on 8-1/2"x 11"or 11 x 17"paper , Footprint of new structure(including decks)with finished
❑Drawn to scale(standard architect or engineer scale) floor elevations
ONorth arrow %Utility locations&easements(required for new and additions)
❑Site address,project or subdivision name and lot number
number) Sidewalk/driveway approach
❑Applicant information(name and
phone urrofwells/septic systems
OLot dimensions and building setback dimensions
�-_____�_�_ g trees to be retained with drip line,and tree
age of buildings to be demolished protection measures
❑Lot area,building coverage area,percentage of coverage and %Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40)
❑Property comer elevations(2 foot contour lines if more than >1,000 sf names
impervious area created or replaced? es ❑No
4 foot differential) If yes,is a storm water quality facility shown? ❑Y�, ❑No (V
ill
0 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
cifRequired: 0 Yes,applicant was notified C"No Received: ❑ Yes 0 No
Public Facilities Improvement(PFI)Permit:
Required: 0 Yes,applicant was notified 0 No Applied For:���?�`� y (701
,L� Yes 0 No,stop intake
/ZI Land Use Case#: D ( 2--01 b— 0 000 9 gV G 2.0110 - O 00 O-1
Zoning: R _
Required Setbacks: Front I S Rear I S Side S Street Side I 0 Garage 20
.i Landscape Requirement 2,0 %
1i Lot Coverage Maximum: 8 0 % C
V( Building Height Maximum Height 5 Actual Height ZS
Visual Clearance
El Sensitive Lands: 0 Yes V No Type
JZI Urban Forestry Plan
Vi Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: 0.4L0/\/.., V'_- _ _- Date: V Z9 j I 9
Revisions (after Building Submittal only) Reviewer
Revision 1: 0 Approved 0 Not Approved Date
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\BuildingWorms\BldgPermitRvw RES_061417.docx
Building Permit Submittal
Original Submittal Date: #i \. el \‘
Site Plans:
Building Plans: # 3
Building Permit#: E_1' LamEnter building permit#above. �/
Workflow Routing: L/ Planning EVEngineering Permit Coordinator t.� Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: Q/Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
12/
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: (-�^ \\
By Permit Technician: ' --A-2 .),...._. Date: 1 5`
CA
En 'neering Review
i
�lvpe at building pad: 'i
/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: 0 Yes 0 No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot: 0 Yes 0 No
❑ Final Plat Recorded:
CINOT Approved by Engineering: Date:
Notes:
/Approved Approved by Engineering:
"apr►— Date:
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
L ❑ 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
Sion Notice 3:2SDC Fees Entered: Date Sent to Applicant: /
Wash Co Trans Dev Tax: e /Yes 0 N/A
Tigard Trans SDC: L9' ❑ N/A
Parks SDC: Yes ❑ N
LIDA ❑ Yes /A
OK to Issue Permit / /i�
Approved by Permit Coordinator:
/ , Date:
I:\BuildingWorms\BldgPermitRvvvRES 010118.docx