Permit CITY OF TIGARD MASTER PERMIT
I'1 I • COMMUNITY DEVELOPMENT Permit#: MST2020-00164
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/09/2020
Parcel: 1 S 135AD07700
Jurisdiction: Tigard
Site address: 8803 SW THORN ST
Subdivision: GRAHAM ACRES Lot: 5
Project: Thornwood, Lot 5
Project Description: New SFA
BUILDING
Floor Areas Required Setbacks Required
Stones: 3 Bedrooms: 3 First: 436 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 33 Bathrooms: 4 Second: 653 sf Garage: 240 sf Front 15 Smoke
Dwelling Units: 1 Third: 699 sf Right 5
Detectors: Yes
Total: 1788 sf Value: $230,653.68 Rear. 15
PLUMBING
Sinks: 1 Water Closets: 4 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: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes 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 SrvclFeeders 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 SFA VB R-3 1788
Owner: Contractor:
THORNWOOD HOLDING CO LLC SCHMIDT EXCAVATING INC Required Items and Reports(Conditions)
16615 SW MAPLE CIR 514 DAYTON AVE 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97034 NEWBERG,OR 97132
PHONE: PHONE: 503-538-3587
FAX:
Total Fees: $25,585.17
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 2-00 090. ou may obtain copy the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: G
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.
. ,i
.[iu.tiWing.Permit Application i ;— 1 . IBC-�.fo ' if 5, v �j'.%
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Building Permit Application Checklist
One-and Two-Family Dwelling ", ..
City of Tigard ' '
a i at 5 S.:'flsli tihd.Iarsn},U1t'37:23 ! �" ' .-...�
. PItOtle 3.714 20' fat .Fiat So'S OW { -. r.a 'relix
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a ° '_l-t+rlSfta.pcxtcun Urx W3634 4175 I il..a+scat [y" !'1G.aaitt L '_:•.:.
Immo. waves tst;arJ-cr V4 d a WI"
11:4'il'Hiliz' ifoLLowric,aysisViturQtARED 1 ,
i 1 I oust n..aetionz e0utpdeicrt, lttteow.,;ahea?aw atieli`t((IS t in{'urt.,r'tl Si.d.h�. : . Li _W.../"..m.
2 tonint. Maul l gleam .u(ta balaa.a gonna atomicsoils dos! action.historic clunict,etc .. i t a _
3 Verification of.F3proaell piatlnt i
Fire district at rnsol r tilted. ,Niemen? ,.,that s t
5 S tics sisal aerinit Of authnraxa tton for reruailti t't rite➢,ss'ec-na es 5aoty WI ill ' i
6 Sesser sermir { i I_
7 SS a ter distinct a roaat. ;
S Sorts re art, "u't,si.".M.Fri ora«.ira1 applicable sting alai signal=.are ru rile or will,apphca Lion e. '
9 4.raairttcontrol igplan {permit matted. In loftdrainage-wasprote,,,.n,siltfens ae'r',ss and location ofcatch- 0
brain.:--rection,(tc.
10 Complete sets of legible plans. Musa he drui3, to scads,showing con fo,mancc to applicable local and mak°
buifding codes Lateral design dotal&and u*aa+,:cttons,mist lie Itic'rporated trio the plans or an a aegis's full-sir
shtci 4144-4414d is the plans WO€ruS8 refcrenci,;stooge➢plan inea Lion and dcmais. Pfa.,rexien cattpta>)be convict 0
bo .tr ht worbtitams extit
1) Site/plot plan drawn to state. litre plan mum show lot and building setback dramostotas,property corner olevatons(it" :
theft is mare than a 4.11 elevation,'i',•entail,ptI n'zttt,shills co''.1 'Imes at 2-ft intermit:),is),location ureasements
i andQrivc.S,,,,fosnprtntofstructure(,➢eluding dodo(:Mention afueti.Jmtiesystem utility localisms; ncoan
indicator„lot tea,gurgling coverage area,par" itngt of cos omeei im eiriuus area mewling.Strtinures bn sail➢aryl
star race dramege,
12 Foundation plan. Shuts dimensions,anchor tmki,an} hold-doom s and rein,ercmg pads,connection details,eau xa
and location
i3 1-lour plena, Shaw all dimensiou,,room iden,itica€ion window size,lose,iianor smoke tragetar;a,tiv°gaert�.ater Pa II III
furnace ventilation tarts,Mouthing livnairs.taco/net;old-Lcgs 30 lashes Awe grade.or
14 Cross section(s)and details. Shots all traming•,n amber sizes end spacing such as floor beams,heatiers,.loists,sob-
well austtrucaion,roof arnontetion.Mom than one c1's5'C1tin may be required to clearly t as-
cviuuuetion Shots daunt s of all%eat and roof s[tcmthing,roofing,root slope,ceiling height,siding naat.:rsa1 (riot tags
and Saunsiatian,ogle$.,g'trc.Lice s'stssrrutti.n,thermal vtsutation.ores
15 Elevation roiaw . Pra)4iik elevations fur new ccrestaaetson,tn;ntttaa:n of two le e'au'fur additions,,,' t r4 neditis. ,�
Extent)r
terror elevatict'rs muss reflect the-aattol grad:if the chmsge in grade it greater titan lb ar Cog at goading envelope.
• Full-size sliest addendunt. mwme foundation elevaturns still ixnss refertnees are acc€:mint
ib Stall bracing,(prescriptive peel(tadtur lateral annlvxis plans. Mum.indicate details and lac,',.,",;tat non.
testa rase icing anal roe"idm so etileatanis slid matculuti0ns to en„ineaing st<nrdards.
17 1loortruof framing. Prom&plans for all floor anof a iwe nblies„indicating greases suing,spacing:end smiting
torettions,. ShOtt'attic ventailation.
ig tlaseincnt and retaining wails. Praasrde moss sc ski tit'and dctai,a showing pt;seentc tit ri meat For enginec'r.tt r Li
as+tuna,s,;IlEra 22,".r- nacr s calculations:" )
I9 ileum tlte 0',c t,e t!aev on�Ilona.
am5Priattl:..o sets➢soctvrcalculations
causing s on nos;Ii run to de dear velum rot ell bears and multiple twists • U
oad
20 Manufactured flaortrnoPtr
ims deg sndetails, t' I
? care cum fiance,
miltt.y the pas--.''pti'u path or provide calculations. fi gas-piping erlosmaii r is required rt. a
for milt or more a fiauta's
22 Engineer's calculations, When requited co psorided,ti e.,shear wall,rod tam)strait be grmsgrmat!ge oo mow;of .i J ,-„-
rchumct Base rd Sn fsreacr1 and shalt he simian to he atralisabia to the mincerwoks-scam" I 1
.IUURISDI TlON,.t S J CiF ,'CS . `s r s).l a' c,c. ,, _ 1 ii is
23 1-Puree i36Salep3"..r.art revir 4furti'.. di ,*tc '3.1.t7 1 gr.:zi. . .. t e•1e t i ig.i•,-,, ! ' - a 1 `l
23 Ito i21 sets curb ae a ts^r vilest for luaa,'(a" I'' 20 atnd 22 e+hos c. ? • (u
23 ksuild Mall
on r inns all not coma on roil less a,t to '-visa `hlirrt.red"buat.lisa„.lists will nut tic,t:.„aril Irelialkilitili
?b "Reserved"bttiidrnn, until nausi lass'a'iieria isudanrd mt,fw£'emit., S steps lk.....nx.sa€cc^s locums.''
37 iMison iascater"indicates stsndaad architect or engineer scale. reWillail
28 Sits plan to include tree size„Wiwioar dill moor per s ppeos ed project street tree pion airs,calla,and' 1,,oil igard
~ 7u,,-,free I:..in
29 Site plait to mchide nom and goo protection me., totes as required by condoinrii of approval, I rim(setuitaiv..i;sp imea„ ,
and torectron measures most he drawn to scale and most indite thenrojee€.,lac-let's sr;.-alum of ail.-oral
sea A Clam Warm Seroaces'.yensbisvdreb.Pte-So ebbing.SrteAssn➢etion±;tsrequiNdIns all budding;ddi!ii s, ;.
€nclud6f46,do fb.p666660 wsets rover non-sgetarotas sulfa i and riceessmra structures to evlimig retizr➢bill distil laps
sinaiofof record approvederroruaScpufrober 1995
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Mechanical Permit Applfeatian t V . ..r. '
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City of Tigard APR 30 2020 'c-'- ..._ .,,2Q'F1 /bH
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I t
Plumbing Permit ApplicAtinri'
) Building Fixtures APR 3 0 2020 tok ()I[III 1,1 emx
Ili City of Tigard /7tofiYt4) P'"11-1-CT..7-eP-o-OW(0 9
. , . 11125 SW 1-91.11 Blvd_Ttped.OR 97/2) R,
: $ 000A5 7a)79b 7.454 Fat 501 548 1)60
hove-van fam 503 639 4175 1.4 id Ass.Psto/tor
LAGAR 1.)at4f-raftp0),
thttittill S1444f itgard-or gen ; No0nret4effmr ALSO:mm.1 lArzoossos
.. 1
TYPE OF%Oki( FEE'SCRCDULE
F spraerl Jaferortroron Ate rhfanst.
9 New L5050001050 a 00M000011
or
''DRAcipitosi I Q5). i Ea 1 Totag
0 AdtharOahersomereplfew)mert a Other New 1)2-family dwellings tioemdes IGO 0...fer each unite emeleeme)
CATEGORY Of comucmo ISFR)1)hate 31/70
0 1-and 2,festally derail% 1 0 Coramereisliredustetg SFR 0.)Nth
SFR(4)huh 437 78
509 32 ...
0 Accessory building emAz.4..Ay
Eaehuldammil hadttachen 25 02
0 Mama bulder 0 Other Fee aprmaler(_ sq ft.) rage 2
JOB SITE.INFORMATION AND LOCATION SIB Milifies;
Job site addre:se Isoa 1-14orm s-r i Catch balm or ilrat dram 18 76
. I Herm&Itch hilt,pi-irerch dram IS 76
CktliStaveZIF 1ttbeto orx "7 1 Foohng 44un Ole hour ii _j Noe 2
$.14.41414'apt no P"4-ci"mc 1114,4))/LaJWCO Mae,tset WiNi fame i..),IltkS 50 03
Cross strtelldmrcuear topt sat IStarAs50s. 1876 ,
plA u, 84v 2) Porn dram ttorsect0S •
1S 16
Soneary srwca(ea Mute(1 1 Page 2
Storm sewer(an Imear r1 ____) Past 2
Water terrier fro I meat ft ) Page 2
Suhdp.isioe-7.7.10/Z41‘401:70)en 4.0(Abt. 1,0)pa 5 Fame:or item
.0151 3SA06-11 00 122204 043 Batkiloo,presto:0o 11 27 •
Batkwater rah< 1/51
DESCRIPTION Of WORX
Closh5S Assiser 25 01
liELA) (40tYtt Dtshwarhef 15 in
°oaken faustuon 25 02
Emetarsistung 25 02
II PROPERTY OWNER 1:1 TENANT expansm4 mak )2 51
.1) Newry's...were:1p 2501
N31"/`4004404,000 got-011-4 LL(.. Flea dramifteet sorkfhub 23 02
Addr"s/4446 lerliaar (tfiCIX Gssbige 44;4)1.31 2502
Cif)/Statcar LA lele titti€60 rt- 9/03/ Host bib 2,3 T. — -
Meer 403) -7V/ /98/ 1 Fax.( ) ter maker 12 31
EI APPLICANT lit CONTACT PERSON intectptorlreAse trap 25 02
ries °3Me SLit inrAirt aesibilfilti6 i t'd Memel gas Lvati.r..S ) Page 2
Pruner 12,51
Contact name #14.43trj etoff ArtAxpite
Roof&am ftommreval) 12 5/
Add'es3 514 DN./TON) 4VE ..,....A s...,Arvs.s.os.a.s.,,, 2502 ,.
Ce5PSOLt47./0 . .S6/41 unto foteler water) 62 54
IDA
Phone(50 6069 FfitV i ) lubiehm)4Wshourr pea 12 51
Urmal
E-matl tste)06ce cloy+ai I_Loy 25 02
vl
Vista t.),asei 25 02.
CONTRACTOR.'"'"
, Sktoor lower 5131
9054m:sr name.Edward Mullen Plumbing —5.0.0ms opmg.1.0.10V 5.0 9
Address 1601 SE River Rd 0047 2502
C0y1SiairiZIP Hillsboro.OR 97123 stistolai
Phone(503-640-0113 1 rne (503440-4483 Mvnimon ptnnO fec S72 50
rtwar prtme fee)
CC13 Ife 926)39 PILirbmg LK.no 34-260P3 Plan v.f75%af
SInet Itotharst A i 2%of perm a ter)
Authorized sIgnater TOTAL PERM LI)EC
i Ph0)mane Jeremy CiaCe DLit This wows spohsAisso fzi pm if•pst,fit xxl..ta 4baskinca*aka,18£8 aliayl
stles 0{11119 htta oosepos5 as sou Om,
5res noOssiAse on AA Troroors II,al'ol$Itaisen,SCNKAt Lossi
1 4i.rldons41..4.09-‘1U-h,...4.N1 4.,,,14:=*)Tri, ilis)-14:nr.wcaroweze.
I , .
Plumbing Permit Application -City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ay. Peieeil Tani Square Footage:,,., Permit Fee:
Footing drain"1'IW- - 500J ago 2000 Sh2,C0
Footing dram=each additional 100' 37.52 2;001 to 3(20 Slbu 69
Seep-In h W' 61i4 1;601 ho 7�Cq =SDJ 20
7.201 tad amen 5127 54
Sewer-each adibnWl I00' 17 52
Waco Sercux>In 1011 _ 62 51 Medical Gas Systems:
Warr Service'each h1J4anal 100' 37:32
Ssocm A Rain Drain-rat 100' 6j.$4 Valuation:SI OOIo S5,00 Permit Fee:
lUG 00 Minimum fee ST_Xl
Storm t Run Drain-each additional 100' 3752 $5.00100 m 510/000M7 S1150 kc the fast S5.0t0 CO and SI S2 f '
Other Inspections or Fees ay rafrq Tani and ngSI 00 oo tractron 0e ref,W
Impxnan ofesulmg tom blig Wan 510.001 W to 525.000.00 5105.50 fit the lira S10,0:000 and SI it for
whM ro lee rs speitscady indicated 90 Wrhr each additions/SI00 Won fruxi,ou thereof,to
(minimum dNrge-Ire howl W including S25,00000
•
huw pront outside of noon..]busmen 90 03thr S25.001001u 55(40700 CO S379 50 for the fun S25,000 00 and 51 45 for
hat(eammun charge-1Ixsural each additional$I00 CO or fncnon sheieof,io
Reinspenen feet 9000415 *cad including S50,00000 _.
Addrteael plan reatcw or refine s 9000R,r S50,00100 and up 5742 00 for the rust 550,000 CO arid SI 20 for
(minimum Chagc-Ire faun]
each additional 5100 CO or fraction thereof
Subtotal:
Commercial Fixture Work:
Are yoe capping,adding or replacing flstures? If`yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer trey, Plan Review for Plumbing Installations
Qauny by Fixture Thee Plan review is required for any of the following,
Fuer.Type far Urpcer Pkese check all that apply.
Were Performed: Capped Aaata Mbew
ite 2'and
BaplistrplFon 0 greater escents(stemAny new commtnts1 sudesignedilding iand stainth water prd b ec nfcd
Bath -TuvShower e g >
-lacuaJV:Tidpod tagineer_
. -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Co.'Warn
t r Tall asM defined in OA'91o•78b0040.
CutpduerWater.Aspuaiw 0 Medical gas and vacuum systems for health care faeilRrzs,
D snvra'Srr •Cecrar,eresal 0 Any mulripurpoat fire sprinkle!Totem..
0 Any complex structure as defined in OAR91 S-280-0040,
,DCIPCAK
Walking Fouraain
Ere wash Submit 2 sets of plans will any attar*bane.
Floes(Taminnk: ,
r _ Isometric or Riser Diagram
IJ Isometric or riser diagram is required for new buildings
-tar wash Oran I that meet the qualifications above.
Garpage -Ddnearlc now rood
Disposal ,Tamsc se food rdara.°
-Ccmn,u.iel toad rrItecd
•Indumal(rod misted
Ice Mach raef g Drams Comments regarding fixture work:
0.1 Separawr leas Swum)`Re.siearele Damr S W tan
Shower -Cana
-Stall
Sink d4vt0ar narreodreiaLed
,Bradles
Com'SersA)1,1 fiend reemmC .
',. •Scr.icc •Note; If the fixture work under this permit results in an
Ssnmminr Poo]Felice increase of sewer EDUI,a sewer permit will be Issued and
I wssna-narrs - fees assessed for the sewer increase must be paid before the
f Wares Enmctw -
Wares Ctoan•Ta,lp plumbing permit can be issued.
Urinal
Other Futures '
Li➢uildinglPermitslPLMP PermitAppdue 08iO4/201I
City of Tigard
IIICOMMUNITY DEVELOPMENT DEPARTMENT
II
TIGARD Building Permit Review — Residential
Building Permit #: /`7ST p pQ/co t/
Site Address: 0003 SW -Onorh $t(e -4
Project Name: ThorrljGod IJ}e6titoNS Lot #: 5
Planning Review
Proposal: A-tn{ i& l lhlt- Sfi
IRL Verify address/suite# active in Accela. V.. In River Terrace: 1l No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: ''Erosion Control
V.3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper Retained trees with drip line and tree protection measures
%Drawn to scale (standard architect or engineer scale) rKFootprint of new structure(including decks) and FFE
$INorth arrow KJtility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number Sidewalk/driveway approach
Applicant information(name and phone number) ( Location of wells/septic systems
'.Lot dimensions and building setback dimensions treet tree size,type and location
re quare footage of buildings to be demolished treet names
n xisting structures on site .Corner elevations (2'contours if more than 4'differential)
7 i Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? KYes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? , Yes ❑No
IClean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
' Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified 0 No Received: ❑ Yes ❑ No
1'A}SDC Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No
vf Public Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified Igi No Applied For: El Yes ❑ No, stop intake
V. Land Use Case#: PD .2.0 0- DCO O RI Zoning: Q—1-2—
U Required Setbacks: Front _IS Rear: 15 Side: S Street Side: N/Pr Garage: 20
U' Building Height: Max. Height: 55 Actual Height: 35
Landscape Area: 20 % ISI Lot Coverage Max: E3D
Entrance i• Set ba . no ore than 8'from street-facing wall ElParallel to street or offset 45 degrees or less
Windows II Minim 12 °of are of all street-facing facades
Garage II aragi doo is behin 'dest street-facing wall Alp 119 ❑ No,one of the following is met:
■ I oor tends ore than 5' from wall a a cove ed porch extending beyond garage.
• I oo extends o m re than 5' and th a window above garage on 2"floor.
II Garage d r widths 2'bless or lUs o facade ❑ 60%or less and includes 7 of following:
❑ Co red por h ❑ ecessed e ce ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ F. shingle ❑ p Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof 0 Dormer
❑ A ent si ' g ❑ dow trim 0 Window recess ❑ Window projection ❑ Balcony
Visual Clearance .8C Urban Forestry Plan
JR"Sensitive Lands: 0 Yes . 'No Type:
sr Conditions met prior to issuance of building permit
Notes:
K. Approved By Planning: P9101
Date: S I S 120
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: /� 2Q
Site Plans: # ,J^'
Building Plans: # ..:3
Building Permit#: E—Enter building permit#above.
Workflow Routing: -Planning Err gineering trmit Coordinator -Building
Workflow Sign-off: 2-Sign-off for Planning(include notes from planning review)
Route Application Documents: [Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
,p riginal 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: -q762 .t Date: ,S7/G:72_0
Engineering Review
Cr/S.-lope at building pad: 2 2
L Conditions "Met"prior to issuance of building permit
We Easements (encroachments)per engineering conditions of approval and plat
Q'Vater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑, Yes ❑ No
/ LIDA Facility on lot: { ,/Yes D No
12 Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:�
[ Approved by Engineering: Date:
Revisions (after Building Submittal only Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
sgr 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:
SDC Exemption: ❑ Received Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: T� OJ`/d/'` Date: 5 J 11120
1:\Building\FormslBldgPermitRvw_RES_122419.docx