Permit (83) �, CITY OF TIGARD MASTER PERMIT
''- COMMUNITY DEVELOPMENT
Permit#: MST2019 00065
-T 6GARLD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/25/2019
Parcel: 2S 110AD 10300
Jurisdiction: Tigard
Site address: 10933 SW ANNAND HILL CT
Subdivision: ANNAND HEIGHTS Lot: 5
Project: Annand Heights, Lot 5
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 706 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 27 Bathrooms: 3 Second: 1100 sf Garage: 380 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 1806 sf Value: $233,279.70 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 RainStorm Sewer: 100
0
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: 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
11
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 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 1806
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
PHONE: 503-780-4375 PHONE: 503-625-6526
FAX: 590-7606
Total Fees: $30,111.96
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 952-001-0090. You may obtain a c•• - • - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344,
Issued By: -.---.07-..i-_, -, -_ nature: I `-- !/I -.L�.
C. 0�- 9.4175 by 7:00 a.m.for the next available inspec date.
This permit card shall be kept in a conspicuous place en the job of the-project.
Approved plans are required on the job site at the time of each inspection.
•
Building Permit Application •
ResidentialFOR OFFICE USE ONLY
City of Tigard RECEIVED ReceivedDate/By: Os '101 permit No.IX\� 1 �
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ��Y�r�
C Phone: 503.718.2439 Fax: 503.598.1960 FEB 2 7 2019 Date/By. y el OtherPermia�Cke,‘
TIGARD Inspection Line: 503.639.4175 Date Ready/By: uris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD N. e fied/Meth,.._ 7,"/ Supplemental Information
BUILDING DIVISION 4,6A / 66 ,k4.,
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
f 'New construction 0 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.
��� Valuation: $ of - 1
h _and 2-family dwelling 0 Commercial/industrial /
❑Accessory building ElMulti-familyNumber of bedrooms: ,3
0 Master builder 0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: Q, Z1 B(49
Job site address: /U f)- jtv /A/lQM1 U //�/ l G4/-71 _ New dwelling area: { 6, square feet ( (65
City/State/ZIP: 7:7 44-4,10Q 41:777q 7� --3 Garage/carport area:/ 0 square feet 7 0(47
Suite/bldg./apt.no.: Project name: nn non/ IlCV A Covered porch area: square feet
Cross street/directions to job site: /99.0 Deck area: $-7) ' square feet
Other structure area: jam' square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: A/IQ tid /leo f j IS Lot no.: 5— Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Ai4p
) 5 d Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name:
D kre-9040 cansri-14GT.rivyu „1-7/1"--- _ Type of construction:
Address: 494'S'- ' 5A.) /i}aa Dealt) tc, '' -ri / Occupancy groups:
City/State/ZIP: ma✓„, ?3 Existing:
Phone:(�3 70_�7C Fax:(5-2B) ,5:9() 7J 6)4 New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: sirieStructural 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::( )
0_11 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: l n Mfl4Nft Dines/L/112 (f AL 'Co" Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: t.(j �'-OV at.5 74„irkL Submit two(2)sets of roof plan with connection details
�+ and fire department access,along with the 2010 Oregon
Address: /R-65 5 JI.J /V09- p i4 1)4- V 1- Solar Installation Specialty Code checklist.
City/State/ZIP: 7iG q�223 Permit Fee(includes plan review $180.00
y and administrative fees):
z
Phone:(5r3) Ld _Lf 7s Fax:( 6v3i 6-9V-7a0,G State surcharge(12%of permit fee): $21.60
CCB lie.: 6-0/96, Total fee due upon application: $201.60
Authorized signature: _� � -
This permit application expires if a permit is not obtained
���—�— - - _ within 180 days after it has been accepted as complete.
- *Feeloetl..,dology set by Tri-County Building Industry
Print name: s Date: Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(Il/02/COM/WEB) I
Mechanical Permit Application FOR FICE USE ONLY
City of Tigard RECEIVED ReceDateive ved
Permit No. —cc.C,1_ CILCI C�
�1.� —�
- " 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review 111
Phone: 503.718.2439 Fax: 503.598.1960 7 t1 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 FEB 2U19 Date Ready/By: luris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
gi k a p VISIQN COMMERCIAL FEE* SCHEDULE "USECHECK �IST
...'"-e:
sa �. . ..w.' ,.___..,,,
Mechanical permit fees*are based on the value of the work
ew construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
/❑Demolition D Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEG{0 2I'OF"CONSTRUCTION' RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
21.-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
�§$OR S)<TE I1�TJN OR11��;'L1ON ,%1�TD LOC,A"TION.'
�� Heating/cooling:
conditioning 46.75
Job site address: /6-?5, j-& J9-A4 G' /.41//Qti r.../ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: �� Furnace 100,000+BTU(ducts/vents) 54.91
y r `o 9-n.23 Furnace
pump 61.06
Suite/bldg./apt.no.: Project name: [�n � v� /G/� Duct work 23.32
/�
Cross street/directions to job site: /D r,,,�/ Hydronic hot water system 23.32
1r 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: Mv14,. /./.t/y(/ Other: 23.32
Yr' f'� Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater ./ 23.32
Gas t fireplace/insert ..0""-.... 33.39
4"" ,, Y , Eg ; DESC iIPiIION F.:WORK Flue vent for water heater or gas
/licit-,f �/I- fireplace 23.32
V Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
''' ' ,3''''-% NER'._; 0 TENANT Environmental exhaust and ventilation:
Name: ®4 3/�C�iUdad &t 571 j1 G Range hood/other kitchen
Vl,a6,1/4,---,-
6,5 �� 5 A equipment 33.39
Address: i�J /yd./it), Are/ Clothes �dryer exhaust 33.39
To 0,.� 9
City/State/ZIP: .72,2,3 Single-duct exhaust(bathrooms,
Q toilet compartments,utility rooms) 0 23.32
Phone:( 5'03 .26d -4/37t Fax:cz3) 'Q -7,r 0G Attic/crawlspace fans 23.32
r1PYLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
(,(0,.e $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address: Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail tt)//7 diu-ocrd mesh/_ )C! 1, tot®J t ((/ /.n Barbecue
CpTj �
CTO ",_' V Clothes dryer(gas)
�5� (k-/1 Other:
Business name: Fi / MECHANICAL PERMIT FEES*
Address: /3i /5v fes / /C�GIDt4,5 2/c..v '` A.. Subtotal
City/State/ZIP: �d� far h c" 0n a�'y's Minimum permit fee($90.00)
"�f 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: methodologyby y s Industry* Fee set Tri-Count Bulildin Indus Service oBoard
Print name: /03cr q// ,e/) Date: /)-7/1 e
I\Buildine\Permits\MEC PermitAno 040 13 doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application* Ft JFFICE USE ONLY
City of Tigard Received1:21IUMMIll II
e 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : .C
Phone: 503.718.2439 Fax: 503.598.196 1 `� -1^ Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris 0 See Page 2 for
TIGARD Internet: www.tigard-or.gov FEB 2 7 2019 Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW '
C OF TIGARD Please check all that apply plans )
New construction ❑Addition/alterationA U DIVISION y(submit 2 sets of w/items checked):
D Demolition ❑Other:
0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 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.
0 Multi-family 0 Master builder D Other: ❑Fireum
p p. 0 Installation of]50 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site addres G 9 77 11^n qA 1 /J / ❑Addition of new motor load of system.
(�17I{ f�1/�/ IOOHP or more. ❑"A„ "E» "1-2„ "1-3„
City/State/ZIP: /�r
0 Six or more residential units. occupancy.
To
5aid C��` 9--a.7..3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: x! Project name: AnaA,d iict,_A# 0 Hazardous locations. 0 Supply voltage for more than
//
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: /00I FEE SCHEDULE
>• VV Description I Qty. I Each I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: /n�^nqn, lit?),(7/5 Lot#: >5' Includes attached garage.
r lJ l 1,000 sq.ft.or less / 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
��f SF� (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
"PROPERTY'OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: tuf weds 6As th� lnl/, 200 amps or less 100.70 2
Address: y-t��,"''(((��i6665S sk co Or p (T G/i 6 4 201 amps to 400 amps 133.56 2
�j[ 70 f72.23
7 1 401 amps to 61,0 amps 301.04 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( • 7 t _L/3 71' Fax:(5v3 )550 -241.4 Over 1,000 amps or volts 552.26 2
�J sec /u� 6 4 �Cdrh Temporary services or feeders installation,alteration,and/or
Email: p/- �S 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 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: aalyLe.
above service or feeder fee,
7.42 2
each branch circuit
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 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
,, , 1 CONTRACTOR, Pump or irrigation circle 67.84 2
Business name: itrt/It)Uu-gt F�.rd.r/L. Sign or outline lighting 67.84 2
�Li / Signal circuit(s)or limited-energy
Address: .0�/ le/CPAri /2® panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: (i(� /�jl c�'�v`,��j Each additional inspection over allowable in any of the above
c Additional inspection(1 hr min) 66.25/hr
Phone: 3) s// .�'7 1 j Fax:(5-(1 ) 'i''-97..13 Investigation(1 hr min) 90.00/hr
IIndustrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is
CCB Lic.:/q ,7 Electrical Lic.:6--gea Suprv.Lic.:1/5OS specifically listed(''/hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name jn 5 k 4 Date: %)7/(: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:
Ai TOTAL PERMIT FEE:
This permit application expires if a permit isnot obtained within 1&R__
Print name: C A ri q ma -Ae. Date: 2- 7hf days after it has been accepted as complete.
J * Number of inspections allowed per permit.
I'Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/] 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
Fee for all residential systems combined: $75.00 Description 1 Qty. I Each I Total j'*
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
Garage Door Opener* 50.01 to 100 kva 552.26 2
>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:
❑ 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
specifically listed(V2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* 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
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
E Protective Signaling
❑ 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
III
Plumbing Permit Application •
Building Fixtures
IREC'EIVED FOR OFFICE USE ONLY
City of Tigard Received
I/ 41 13125 SW Hall Blvd.,Tigard,OR 97223 FEB 27 2019 Date/By: Permit No.nca---ayk_CkI,C)ISS
Plan Review
: 2 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARD
TIGARD Date Ready/By: Juris' 21 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
ticoRK .. - ' . . .. 'FiEE.;,.sciinititl
ew construction D Demolition For special information use checklist
,
_ Description Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
. , .... -
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
/Err-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 4. --'' 500.32
0 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: /i 35,5 41 AtA rig Ad A,i/614.4 Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 77 1--A- ) O/Z- --- 1"-2 -2--3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:/9.:Niariciligeo k A
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
43 9 tit' 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: /971 na 11,1 A/1/5 Lot no.: c Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK -
. .
Clothes washer 25.02
NV') 51-71 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0
u-PROPERTY OWNER ,: 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: plinatlivre aci e'aitS 71-p, ,_,
Floor drain/floor sink/hub 25.02
Address: /9, ç-g $& itiorrth- i9 6_k/...... 5-,41.6.--i
Garbage disposal 25.02
City/State/ZIP: 7i,-/j at-el az e7-7.2-.... .3 Hose bib 25.02
Phone:(4-03 7 0-i-ro 7,sFax:(fe,3,54-, -Z,044- Ice maker 12.51
0.APPLICANT '- 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: 5644
Medical gas(value:$ ) Page 2
to
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
Urinal 25.02
E-mail: kJ iftdav 6711/4)/71--eS/V La" ,-47/1-a 1/16f'
.. ., , . . vWater closet 25.02
CONTRACTOR Water heater 37.52
Business name: pc, /-A/L / fit A-6(.. ib Water piping/DWV 56.29
Address: /6,//62 6- 44 fi 71-0") Pa/ Other: 25.02
City/State/ZIP: 61,--06yi e-- % ,40,- e)-1 3'20,5- Subtotal
-
Phone:(5-&3) 70_3 J Fax:O3) "7,.a6dift Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: iz.,2 /3? Plumbing Lic.no.:3,S-- OPA
State surcharge(12%of permit fee)
Authorized signature: 20.., 4 - 7/1 ii- ) TOTAL PERMIT FEE
Print name: i cZ) s
tuki jr-- Date: D../2,3 1/9 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.
1ABuilding\Permits\PLMU-PermitApp doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
i
71
Building Permit Review — Residential
Building Permit #: MS- - r q_ ��'0;Q( Q.j
Site Address: /(.)93 Q ) r`- a( /•, >/
allr
Project Name: 6'r Lot #:
(New dwelling=subdivisiot(ne;Addition or Alteration=last name of owner)
Planning Review ✓✓✓✓✓✓
Proposal: C ) C)--le)
V Verify site address/suite#exists and actio in permit system.
110 'Over Terrace Neighborhood: \No 0 Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
iL • ee(3)copies of site plan dilt. ;sting structures on site
t,Sia plan must be on 8-1/2"x 11"or 11 x 17"paper I► ootprint of new structure(including decks)with finished
wn to scale(standard architect or engineer scale) i-.r elevations
.rth arrow A U: 'ty locations&easements(required for new and additions)
Z Site address,project or subdivision name and lot number I Sid-walk/driveway approach
V3pplicant information(name and phone number) al;, ation of wells/septic systems
ILJLot dimensions and building setback dimensions iv •:sting trees to be retained with driline,and tree
kV !`,care footage of buildings to be demolished protection measures P
7 .t area,building coverage area,percentage of coverage and t �.'eet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) VA Street names
'U' Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created
4 foot differential) P or replaced? IJYes ❑ o
If yes,is a storm water quality facility shown?1,1PPYes 48/No
lean Water Services—Service Provider Letttte/(lot platted prior to 9/10/1995):
equired: ❑ yes,applicant was notified pd No Received: 0 Yes 0 No
Public Facilities Improvement(PFI)Permit: /Yes
quired: Yes,applicant was notified ❑ No Applied For: ❑ No,stop intake
Ed Use Case#: AVQ�?i _ )��0 )
ning: X _1 7
[i2 equired Setbacks: Front `�\�" Rear Side " Street Side
r._(Landscape/� / �� 4./.3Garage
Requirement %
of Coverage Maximum: --53-F)
VA Building Height: Maximum Height 1 Actual Height ..2.e�(
11 isual Clearance
/Yesf/ ensitive Lands: 0 No Type N94 chy £
rban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes.
Approved By Planning:
`! Date: <,,.2
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:\BuildineForms\BldgPermitRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: .. 1a7)-119
Site Plans: #
Building Plans: # .
Building Permit#: if Enter building permit#above.
Workflow Routing: E Planning DiEngineering CrPermit Coordinator Er Building
Workflow Sign-off: ign-off for Planning(include notes from planning review)
Route Application Documents: re 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: Date a 1,n-1 t
Engineering Review
E Slope at building pad: 2 5%
Conditions"Met"prior to issuance of building permit
g'"Easements (encroachments)per engineering conditions of approval and plat
[J"Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes B.-NO
Assess Water Quantity Fee in-lieu: 0 Yes CT-No
LIDA Facility on lot: 0 Yes ErNo
Er-Final Plat Recorded:
❑ NOT Approved Date:
PP b Y Engineering:��
Notes: Ce.,,,,G
ra+A degt,.As AVM hof it Gair /€2.746.-eds 65-740 e.7)
Approved by Engineering: - g g . 2 ' Date: 2• Z7. 19
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
- ❑ Conditionet"prior to issuance of buildingpermit
❑ 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:
gaDC Fees Entered: Wash Co Trans Dev Tax: es 0 N/A
Tigard Trans SDC: Y ❑ N/A
7OK
Parks SDC es ❑ N/LIRA ❑ Yes /A to Issue Permit Z .Z 4toi
Approved by Permit Coordinator:
41f(-1-:ate: 1
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.
741 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
r ,,z i13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: R4 SG!') DATE RECEIVED:
DEPT: BUILDING DIVISION 7 ".,
M 1 n
FROM: ] C l _:
COMPANY: A
PHONE: `7 16 2 CP
RE: /0 9 33 m ' /" __,,,,,7:,2Qee,e--,,,,te-f-
(Site Address) ( ermit Number) /1/1a0 i,_ezzro
4
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: /1 7L1i s S' '—` 7` l 1r' //e)/(2)
rovi'2e- Ar,ei,
Routed to Permit Technician: D : W ' 1 - Initials: "'
Fees Due: ❑ Yes Zi No L- Fee Descripti i n: Amount Due:
Nyt NS- E)...,-- z/-- Ss( 2(1---
Special
Instructions:
Reprint Permit(per PE): ❑ Yes r N ❑ Done
Applicant Notified: -- Date: 3 1 /27 2 Initials:
I:\Building\Forms\TransmittalLetter-Revisions 061316.floc