Permit (2) ' i 0 I
r City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT' 3 /
I
`i ■ Request for PermitAc
tion
T i . A R I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD RECEIVED
Building Division MAR 9 2020
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@ta OGARD
FROM: X Owner ❑ Applicant ❑ Contractor ❑ C TUJ iNG DIVISION
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) 5 t /� /`{l v,Me. C�('l
V �'vn S
Mailing Address: /3307 Si" /cLt'4 PL
City/State/Zip: •7'i' 5c4...).4., ot 7 oZ-13
Phone No.: 3-0-z,> (? ? a' ,< 70/q
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
4 REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: c ,trav C3 ---- 000O 41
Site Address or Parcel #: /o Y 73 S 1PCtric s-.II.
Project Name: ) I. 6- !y r°cf)S
Subdivision Name: Lot#:
EXPLANATION: 0 r 1,,,L C l$....-.cA4c<,( irC 41 e. 6.,0 i^K S L f
.;dL &' Of' ILA- Aecla<
Signature: /1---.----
Date: 7--?- Zo2 c.�
Print Name: 5rc C A. afcc,—
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date „_sl f By J.� Route to Records: Date 49/7/7—/ By �i
Refund Processed: Date 3 /�'Zo By,,,PXY Invoice Processed: Date / By
Permit Canceled: Date 3/.1/74) By, Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_120518.doc
TIGARD
City of Tigard
April 3, 2020
J &E Home Solutions
13301 SW 128th P1
Tigard, OR 97223
Re: Permit No. SIT2020-00004
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10475 SW Park St
Project Name: J &E Home Solutions LLC
Job No.: N/A
Refund Method: ® Check#235133 in the amount of$322.80.
❑ Credit card"return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$
Comment(s): Per applicant's request as driveway was eliminated from scope of work
and erosion control no longer needed. Refund 100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Ornelas
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
a
City of Tigard
T I G A lz Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: J&E Home Solutions DATE: 3/20/2020
13301 SW 128th P1
Tigard, OR 97223 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 428320 Case#: SIT2020-00004
Date: 2/24/2020 Address/Parcel: 10475 SW Park St
Pay Method: Check Project Name: J&E Home Solutions LLC
EXPLANATION: Per applicant's request as driveway was eliminated from scope of work and erosion
control no longer needed. Refund 100%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Erosion Control 640-0000-43134 $322.80
TOTAL REFUND: $322.80
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff 'C/ �✓ e.._�s
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: q/3y�r By: (0
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
ill CITY OF TIGARD RECEIPT
I, 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: J&E HOME SOLUTIONS LLC
Site Address: 10475 SW PARK ST
Receipt Number: 436215 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
S1T2020-00004 $-322.80
Total: $-322.80
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 235133 DHOWSE 09/03/2021 $-322.80
Payor: J&E Home Solutions
Total Payments: $-322.80
Balance Due: $322.80
Page 1 of 1
,p4
f .
CITY OF TIGARD RECEIPT
* • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T[C=;ART_
Project Name: J&E HOME SOLUTIONS LLC
Site Address: 10475 SW PARK ST C 5 i
Mt
Receipt Number: 428320 - 02/24/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SIT2020-00004 Erosion Control Only 640-0000-43134 $322.80 4--
SIT2020-00004 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $1.00
11x17)
Total: $323.80
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 0503 BTAGGART 02/24/2020 $323.80
Payor: J&E Home Solutions
Total Payments: $323.80
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2020-00004
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/24/2020
Parcel: 2S102CB06801
Jurisdiction: Tigard
Site address: 10475 SW PARK ST
Project: J&E HOME SOLUTIONS LLC Subdivision: 1992-092 PARTITION PLAT Lot: 1
Project Description: Erosion control only for a 1,588 sq.ft.driveway to a new detached garage.
Contractor: ABM STRUCTURES LLC Owner: J&E HOME SOLUTIONS LLC
19897 SW 68TH AVE 13301 SW 128TH PL
TUALATIN, OR TIGARD, OR 97223
PHONE: 503-956-4332 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control Only 02/24/2020 $322 80
Info Process/Archiving-Sm$0.50 (up to 02/24/2020 S1.00
Type of Use: SF 11x17)
Class of Work: OTR
Project Valuation: $5,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading: Yes
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $323.80
Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
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- You may obtain a copy of the rules
or direct questions to 0 NC by calling 503.2 or 1.800.332.2344.
Issued By: ermittee Signature:
c- 'L
Call 503.639. 5 by 7:00 a.m.for the next available inspec i ate.
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
1
Site Work ^: i . $4.( =( ='* ' FOR OFFICE USE ONLY
City Of Tigard
Received
CCpp 2 4 20ZU DateB : aIq :�
Ili • 13125 SW Hall Blvd.,Tigard,OR 9�2II3� y
.. Plan Review
Phone: 503.718.2439 Fax: 503.5 600 ,- li.."` PS) Date/B : Other Permit: Al._'
fT .�Ir
T I t \R I) Inspection Line: 503.639.4175 A.i I I , t t`t,t--.,ni.�, Date Ready/By: ® El ee Page 2 for
Internet: www.tigard-or.gov ' -r,IL xti1��'I; DItsf 1(7)1`.,!` Notified/Method: �jM Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $5-aJ� �-
❑ 1-and 2-family dwelling ❑Commercial/industrial i
❑Accessory building El Multi-familyNumber of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
IN
Job site address: I 0 IA 7 5 S P`Ip R.L New dwelling area: square feet
City/State/ZIP: '- rrG 412,Q g'7 22 '3 Garage/carport area: square feet
Suite/bldg./apt.no.: aged name: • Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
_ / L Nth .1 Existing building area: square feet
�!v r.
New building area: square feet
Pi(PROPERTY OWNER 0 TENANT Number of stories:
Name: cT Ze E. Ho M E S Oi- (7-1-.oNs Type of construction:
Address: I % 3 0 4 Sw 1 ea r<n nL . Occupancy groups:
City/State/ZIP: ,r G ft-K J // b Q 9-` 22' Existing:
Phone:(SO) TSt$S - 7 0 I Li Fak:( ) New:
APPLICANT 0 CONTACT PERSON NOTICE
Business name: Dk . f-,..L l-..y A., .., _ All contractors and subcontractors are required to be
Contact name: f,j;�L KEL e � j licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 9 g i ^f w 2.0 11 A ia- tk1-f 2 jurisdiction in which work is being performed.If the
City/State/ZIP: eo g. n.{V p D 2 01^7 2 d di
is exempt from licensing,the following reasons
I apply:
Phone:(225) 244-5(MD Fax::( )
E-mail:
CONTRACTOR
Business name: i-13 Ai icj'R,(ft 1142 c 5 r L.(i C'. BUILDING PERMIT FEES*
Address: (Please refer to fee schedak)
Structural plan review fee(or deposit):
City/State/ZIP:
Phone:( ) Fax:( ) FLS plan review fee(if applicable): Cal
Total fees due upon application: 3/3 60
CCB lic.: 22. 5
Amount received:
Authorized signatur : l / This permit application expires if a permit is not obtained
C/// within 180 days after it has been accepted as complete.
Print name: L. W W . 14.a LL6Q '24 20 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Petmits\SIT-PertnitApp.doc 08/02/2016 4404613T(I1/02/COM/WEB)
4
City of Tigard: Site Work Permit Checklist
Page 2-Supplemental Information
Commercial,Multi-Family and One-and Two-Family Dwellings:
No permit is required if fill is less than 50 yards (5 dump truck loads), or less than 3 feet deep and will
not be supporting a structure. If a building will be constructed on the fill, it must be engineered fill. If
fill is in a flood plain,drainage way, or wetland,the applicant must apply for a sensitive lands review
(SLR).
Please complete all items below, unless otherwise noted.
Excavation Volume: cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) cu.yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90%of maximum density) cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
Site Utilities Plumbing Work:
Complete the Plumbing Permit Application for site utilities plumbing work.
Plans Required: See"Site Work Permit Application -Plan Submittal Requirements"attached.
The following must accompany this application:
❑ Site Plan with Vicinity Map showing ADA ❑ *Parking(including ADA)and Lighting
compliance Plan
❑ Grading Plan and details ❑ *Landscaping Plan
❑ Erosion Control Plan and details ❑ Soils Report(if required)
❑ Retaining Structures
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans Valuation: Permit Fee:
(New,Additions or Required at $.0o to$500.00 $51.09 minimum permit fee
Alterations) Submittal $500.01 to$2,000.00 $51.09 for the first$500.00 and
$2.69 for each additional$100 or fraction
Commercial 3 thereof,to and including$2,000.00.
$2,000.01 to$25,000.00 $91.44 for the first$2,000.00 and
Multi-Family R-1 Occupancy 3 $10.76 for each additional$1,000 or
fraction thereof,to and including
$25,000.00.
One-&Two-Family Dwelling 3 $25,000.01 to$50,000.00 $338.92 for the first$25,000.00 and
$8.06 for each additional$1,000.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 to$100,000.00 $540.42 for the first$50,000.00 and
$5.38 for each additional$1,000.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and over $809.42 for the first$100,000.00 and
$4.49 for each additional$1,000.00 or
fraction thereof.
1:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2
a ..
11111 Site Work Permit Application
Plan Submittal Requirements
T I G A it D Commercial,Multi-Family and One- &Two-Family Dwellings
A site work permit is required for all commercial projects including new buildings,additions,
accessory buildings larger than 120 square feet,modular structures and multi-family R-1
occupancies. A site work permit is required for excavation, fill,grading,paving, retaining walls,
fire hydrants and fire department access on private property for work on individual lots not
covered under the subdivision development.
Note: A separate "plumbing"permit for site utility plumbing work is required for sanitary
sewer, storm sewer and potable water systems on private property. Please see the Site
Utilities - Plumbing Permit Application for plan submittal requirements.
1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic
location labeled with:
A. ❑ map &tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ applicant phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads (drawn to scale)with project location.
2. BUILDING PLAN submittal requirement: Three (3) complete sets, Civil only.
All details listed below shall be incorporated into the plans:
A. Site plan showing:
1) Required parking spaces and driveways.
2) A route, accessible to persons with disability,leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible
route.
4) Curb ramps along the accessible route,curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
2) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant.
3) Size of underground water service for the sprinkler system.
E. Erosion control plan complying with the requirements of the Clean Water Services
(CWS) agency showing
1) Silt fence locations.
2) Bio-filter bags/other approved barrier material surrounding catch basins.
I:\Building\Pemvts\SIT-PermitApp.doc 08/02/2016 3
' a
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to ensure compliance with CWS standards.
F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
A. Soils (geotechnical) report. A soils report is required for new buildings and additions
to contain the following:
1) The report shall address the potential of soil liquefaction and instability (OSSC
Sec. 1804.2).
2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1).
3) Foundation and lateral pressures exceeding 1,500 lb./sq. ft. (OSSC Sec. 1805).
B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
1:\Building\Permits\S1T-PemritApp.doc 08/02/2016 4
City of Tigard
71i COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Residential
. .a_
Building Permit #: S-_--:7 r1_C Ly
Site Address: 11Tt'1 S S`a/ Pr1..rt- !"
- Project Name: Lot #:
PlanningrProposal:
Review \ ,\ cc� CV) lw,r r'vw�- U�aM . k 1 dtfi �� 30 bF
- Prol�osaL• �J_n�1� a '}{/', ^ � ^j
Verify address/suite #active in Accela. In River Terrace: No ❑ Yes,River Terrace Review Addendum
an Elements: ? .sion Control
e .pies of site plan on 8-1/2"x 11"or 11 x 17"paper it 'etained trees with drip line and tree protection measures
II.• .wn to scale(standard architect or engineer scale) " ootprint of new structure(including decks)and FFE
s .rth arrow o . "ty locations&easements(required for new and additions)
C ' - address,project or subdivision name and lot number Ikidewalk/driveway approach
E s .plicant information(name and phone number) Jl .cation of wells/septic systems
`Lot dimensions and building setback dimensions IV.;..eet tree size,type and location
rif. re footage of buildings to be demolished I'', -et names
LldExtsting structures on site `i orner elevations(2'contours if more than 4'differ tial)
aot area,building coverage area,percentage of coverage and ->1,000 sf of impervious area created or replaced? Il Yes ❑N
IIf' pervious area(applicable if R-7,R-12,R-25&R-40)
yes,is a storm water quality facility shown? ❑Ycl
ILI Clean Water Sces—Service Provider Letter(lot platted prior to 9/10/1995):aired: Q/Yes,applicant was notified ❑ No
�
Received: L1l Yes [ d
Water Meter tore Unit Worksheet—Additions,Remodels and ADUs
Required: Yes,applicant was notified ❑ No Received: 0 Yes No
-^WSDC Exemption for ADU applied for: 0 Yes 0 No Received: 0 Yes 0 No
AA-Public Facilities Improvement(PFI)Permit:
Required: 0 Yes,applicant was notified 0 No A plied For: 0 Yes 0 No,stop intake
rid Use Case#: Zoning 1 - •
E i,equired Setbacks: Front: 7..) Rear: IS Side: S Street Side: LA Garage: Zo
I /Building Height: Max. Height: 30 Actual Height: IL
fa Landscape rea: % -Lot Coverage Maxim
Entrance back no more than 8'from street-facing wall VParallel to street or offset 45 degrees or less
Windows Minrnum i 12%of area of all street-facing facades (g,11 S
Garage 0-Garage door is behind widest street-facing wall 0 Yes ❑ No,one of the following is met:
❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
0 Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2ad floor.
O.Garage door width is 0 12'or less 0 50%or less of facade 0 60%or less and includes 7 of following:
❑ Covered porch 0 Recessed entrance 0 Wall offset 0 1'Roof eave ❑ Roof offset
O Fire shingles 0 Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof 0 Dormer
❑ Accent siding r,�❑ Window trim ❑ Window recess ❑ Window projection 0 Balcony
rV sual Clearance 'I Urban Forestry,Plan
I.V. Sensitive Lands: 0 Yes L�'No Type:
KA-Conditions met prior to issuance of building permit
Notes:
Approved By Planning: Date: A/P-4120
Revisions(after Building Submittal on y) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: J./I/1 /
Site Plans: # SA
Building Plans: # d2
Building Permit#: ❑ Enter building permit#above.
Workflow Routing. inning I l F g for SalZelialg
Workflow Sign-off: f for Planning(include notes from planning review)
Route Application Documents: n ' e . (1) c f pe a 1 an,
rigin ew rou g form.
EhEirtilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: Fre 5.an) ('Vd / <Jrvt-c L1 C✓; /l J/r�J,Y� x / e� `r1s /17S —
By Permit Technician: v Date:
Engineering Review
❑ Slope at building pad:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
O Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes 0 No
Assess Water Quantity Fee in-lieu: 0 Yes ❑ N.
LIDA Facility on lot: 0 Yes ❑ o
❑ Final Plat Recorded:
O NOT Approved by Engineering: Date:
Notes:
❑ Approved by Engineering: Date:
Revisions (after Building Submittal o ) Reviewer Date
Revision 1: ❑ Approved I Not Approved
Revision 2: 0 Approved 0 Not Approved
Permit Coordinator ' view
❑ Conditions "Met"pri. to issuance of building permit
❑ Approved,NO Released: Date:
Notes:
Revisions (a -r Building Submittal only)
Revisio otice 1: Date Sent to Applicant:
Revis'6 Notice 2: Date Sent to Applicant:
❑ S►, Exemption: 0 Received ❑ Does not apply
O DC Fees Entered: Wash Co Trans Dev Tax: 0 Yes 0 N/A
Tigard Trans SDC: ❑ Yes 0 N/A
Parks SDC: 0 Yes ❑ N/A
LIDA 0 Yes 0 N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:1Building\Fonns\BldgPermitRvw_RES_122419.docx
City of Tigard
COMMUNITY DEVE].OPMENT DEPARTMENT
lig e
TIGARD Building Permit Review — Residential
Building Permit #: 57--T .;.r-Ct )
Site Address: 10M S &i,r p,r-t. &if
- Project Name: Lot #:
Planning Review en, (t)r1 CAO n tv-o 1 t 1 , S I.1-L 1/4.&./0 rld.._
- Proposal: At - ,
Verify address/suite# active in Accela. In River Terrace: No D Yes, River Terrace Review Addendum
o ' an Elements: `mot .sion Control
.pies of site plan on 8-1/2"x 11"or 11 x 17"paper C etained trees with drip line and tree protection measures
II • .wn to scale(standard architect or engineer scale) %' ootprint of new structure(including decks)and FFE
P .rth arrow !•r . -ty locations&easements(required for new and additions)
C address,project or subdivision name and lot number 7.I.idewalk/driveway approach
L. . .plicant information(name and phone number) Jt .cation of wells/septic systems
L Lot dimensions and building setback dimensions •t.. eet tree size,type and location
A4 aare footage of buildings to be demolished I'. -et names
gat
structures on site ed orner elevations(2'contours if more than 4'dif e tial)/
Otot area,building coverage area,percentage of coverage and - >1,000 sf of impervious ar- • -.-. re'laced? F.Yes 121 N.
impervious area(applicable if R-7,R-12,R-25&R-40)
rid Clean Water Se/ices-Service Provider Letter(lot platted prior to 9/10/1995):
utred: Des,applicant was notified ❑ No Received: Ieces
Water Meter Fjixture Unit Worksheet-Additions,Remodels and ADUs /
Required: G Yes,applicant was notified ❑ No Received: 0 Yes [a1/No
— SDC Exemption for ADU applied for. ❑ Yes ❑ No Received: ❑ Yes 0 No
Public Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified ❑ No A plied For: 0 Yes ❑ No,stop intake
and Use Case#: Zoning. (Z`1'1 A
I� �equired Setbacks: Front: 2) Rear. IS Side: .S.. Street Side: Lk Garage: 24
lL Building Height: Max. Height: 30 Actual Height: 1 L
K'Landscape % p-Lot Coverage Mary
Entrance back no more than 8' from street-facing wall 4d Parallel to street or offset 45 degrees or less
Windows Minimum 12%of area of all street-facing facades t 8r'Ts/
Garage `[ -Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
r t 0 Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2°a floor.
VA-Garage door width is 0 12'or less 0 50%or less of facade ❑ 60%or less and includes 7 of following:
0 Covered porch 0 Recessed entrance 0 Wall offset 0 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ I.ap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
O Accent siding ❑ Window trim 0 Window recess ❑ Window projection ❑ Balcony
,�, Isual Clearance (Urban Forestry Plan
IN Sensitive Lands: ❑ Yes [ "No Type:
KA-Conditions met prior to issuance of building permit
Notes: j
X Approved By Planning: Date: a( 12D
Revisions (after Building Submittal on y) An Reviewer Date
Revision 1: Z Approved ❑ Not Approved ! v l tY: ^V^ V V . 3 / 3 / L-
Revision 2: 0 Approved ❑ Not Approved
l:\Building\Forms\Bldgl'ermitRtiw_RES_I22419.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: # 4
Building Permit#: ❑ Enterbuilding permit#above.
Workflow Routing. ,L] EnQ ®n i for [ dasg
Workflow Sign-off: f for Planning(include notes from planning review)
Route Application Documents: e . (1) c f a 1 ' pan,
rigin ew rou g form.
ding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: FP? S:LG,I cirNPrv/ c)M-+j . `i�LG u, /l 4K i/rti.Yr.a�' t�nrl�i /1 JSj
By Permit Technician: v ' 7 Date:
Engineering Review
O Slope at building pad:
❑ 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 ❑ N.
LIDA Facility on lot: 0 Yes ❑ o
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
❑ Approved by Engineering: Date:
Revisions(after Building Submittal o. ) Reviewer Date
Revision 1: 0 Approved 4 Not Approved
Revision 2: ❑ Approved 0 Not Approved
Permit Coordinator ' view
❑ Conditions"Met"pri. to issuance of building permit
❑ Approved,NO Released: Date:
Notes:
Revisions ( r Building Submittal only)
Revisi. once 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
O S►C Exemption: 0 Received ❑ Does not apply
❑ DC Fees Entered: Wash Co Trans Dev Tax: 0 Yes 0 N/A
Tigard Trans SDC: 0 Yes 0 N/A
Parks SDC: 0 Yes 0 N/A
LIDA ❑ Yes 0 N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
1:1Bwlding\Forms\BldgPermitRvw_RES_122419.docx