Permit
a CITY OF TIGARD MASTER PERMIT
sz COMMUNITY DEVELOPMENT Permit#: MST2010-00010
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/19/2010
Parcel: 2S104AD05700
Jurisdiction: TIGARD
Site address: 12884 SW SEVILLA AVE
Subdivision: WALNUT CROSSING Lot: 4
Project: Walnut Crossing
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 1169 sf Basement: 0 sf Left: 5 Parking Spaces: 2
Height: 24 Bathrooms: 3 Second: 1496 sf Garage: 681 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $299,978.62 Rear: 15
PLUMBING
Sinks: 2 Water Closets: 3 Washing Mach: 1 Laundry Trays: Rain Drain: 0 Catch Basins: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0
Drains: 1
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Bckflw Prevntr 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 5
Furn-100K: 1
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: 5 20 1-400 amp: 0 201-400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401-600 amp: 0 401-600 amp: 0 Ea add'I Br Cir:
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:
Owner: Contractor: Required Items and Reports (Conditions)
PAHLISCH HOMES PAHLISCH HOMES INC D
63088 NE 18TH ST SUITE 100 63088 NE 18TH ST #10040L-
BEND, OR 97701 BEND, OR 97701
PHONE: 541-385-6762 PHONE: 541-385-6762
FAX:
Total Fees: $16,178.21
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. A ION: r on equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1-0010 through OA 52-001 10 ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 800.332.2344.
Is ued By: Perm ittee Signature:
y
Building Permit Applicatio>l EC E ! VE
Residential FOR OFFICF USE- ONLY
City of Tigard JAN 14 2010 DateB / D Permit No.:
me 13125 SW Hall Blvd., Tigard, OR 97 OF TIGARD Pian Review
Phone: 503.639.4171 Fax: 503.59 A0 DateB : Other Perm t: sfoew0 Inspection Line: 503.639.4175 UILDING DIVISION Date Ready/By: lu' . ® See Page 2 for
Internet: www.tigard-or.gov NotifediMethod:Q_ 1 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.
® I -and 2-family dwelling ❑ Commercial/industrial Valuation: $299,977
❑ Accessory building ❑ Multi-family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: I
Job site address: 12884 Sevilla Ave New dwelling area: 2665 square feet
City/State/ZIP: Tigard, Oregon 97223 Garage/carport area: 681 square feet
Suite/bldg./apt. no.: Project name: Walnut Crossing Covered porch area: 66 square feet
Cross street/directions to job site: Walnut & Sevilla Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL-USE CHECKLIST
Subdivision: Walnut Crossing Lot no.: 4 Permit fees* are based on the value of the work performed.
Tax map/parcel no.: 2SI04AD05700 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.
Construct new single family home on lot. Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Pahlisch Homes Type of construction:
Address: 63088 NE 181", STE 100 Occupancy groups:
City/State/ZIP: Bend, OR 97701 Existing:
Phone: (541)385-6762 Fax: (541)385-6742 New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Pahlisch Homes All contractors and subcontractors are required to be
Contact name: Jason Spence licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 63088 NE 18th, STE 100 jurisdiction in which work is being performed. If the
City/State/ZIP: Bend, OR 97701 applicant is exempt from licensing, the following reasons
apply:
Phone: (541)385-6762x101 Fax: (541)385-6742
E-mail: jasons@pahlischhomes.com- 1 U GLOQIII~Gj
CONTRACTOR
Business name: Pahlisch Homes BUILDING PERMIT FEES*
Address: 63088 NE 181h, STE 100 leosereerto eeschedule
City/State/ZIP: Bend, Oregon 97701 Structural plan review fee (or deposit): $750.00
Phone: (541) 385-6762 Fax: (541) 385-6742 FLS plan review fee (if applicable):
CCB Gc.: 42067 Total fees due upon application: $750.00
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Speam
ESL FDat;: 1.12.10 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RES PermitApp.doc 10/01/09 44440-44613T(11/02/COM/WEB)
9 NQV k
Mechanical Permit Applica9tC'.~IV
FOR OF FICE USE ON LY
City of Tigard Received Permit No.:
IAN 14 2010 Date/By: ~f gyp- i r
" 13125 SW Hall Blvd., Tigard, OR 9722
Plan Review
. Other Permit: 40
Phone: 503.639.4171 Fax: 503.598 Date/By:
Inspection Line: 503.639.4175 dNY OF TIGARD
Date Ready/By: s:
Internet: www.tigard-or.gov (
BUILDING DIVISION Notified/Method: Su See Page ll for
pplementallntormation
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
® New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value ofthe work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
® 1-and 2-family dwelling El Commercial/industrial E] Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other: Description Qty.
Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 12884 Sevilla Ave Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: Tigard OR 97223 Furnace 100,000 BTU (ducts/vents) i 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: Walnut Crossing Heat pump 61.06
Cross street/directions to job site: Walnut St. & Sevilla Ave Duct work 23.32
H dronic hot waters stem 23.32
Residential boiler (radiator or
h dronic 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75
Subdivision: Walnut Crossing Lot no.: 4 Flue/vent for an of above 23.32
Other: 23.32
Tax map/parcel no.: 2SI04AD05700 Other fuel appliances
DESCRIPTION OF WORK Water heater 1 23.32 ?3 32
Gas fireplace 1 33.39
Install new service for new residential single family home Flue vent for water heater or gas
fireplace 23.32 1
Lo lighter as 23.32
Wood/ pellet stove 33.39
Wood fire lace/insert 23.32
® PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Pahlisch Homes Environmental exhaust and ventilation
Address: 63088 NE 18th Range hood/other kitchen
equipment 1 33.39 33.39
City/State/ZIP: Bend, OR 97701 Clothes dryer exhaust 1 33.39 33.39
Single-duct exhaust (bathrooms,
Phone: (541)3856762 Fax. (541)3B56742 toilet compartments, utility rooms 5 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawls ace fans 23.32
Other: 23.32
Business name: Pahlisch Homes
Fuel piping
Contact name: Jason Spence $14.15 for first four; $4.03 for each additional fQ
Address: 63088 NE 18th Furnace etc. 1 14.15 tv
Gas heat um
City/State/ZIP: Bend, OR 97701 Wall/suspended/unit heater
Phone: (541) 3856762x101 Fax:: (541) 3856742 Water heater 1
Fireplace I
E-mail: jasons@pahlischhomes.com Range 1
CONTRACTOR Barbecue 1
Business name: Pahlisch Homes Clothes dryer as
Other:
Address: 63088 NE 18'h MECHANICAL PERMIT FEES*
City/State/ZIP: Bend/ OR / 97701 Subtotal ?j ~j•
Minimum permit fee ($90.00)
Phone: (541) 3856762 Fax: (541) 3856742 Plan review (25%ofpetmit fee)
CCB lie.: 42067 State surcharge (12% of permit fee) 3~ •cJ
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Jason Spence Date: 1.12.10 * Fee methodology set by Tri-County Building Industry Service Board
1:\Building\Pe its\MEC-Pe itApp.doc 10/01/09 440-4617T (I 1/02/COM/WEB)
Electrical Permit ApRI
City of Tigard j 14 2010 D Received ' Permit No.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503dMY- OF TIGARD Dat : Other Permit
Inspection Line: 503.639.4175~' tLDI~G DIVISION Date Ready/By: J~ 13 See Page 2 for
Internet: www.tigard-or.gov B/~I NotiSed(Method: Supplemental Information
OF WV„fN*•tX
® New construction ❑ Addition/alteration/replacement Please check all that apply (submit I, sets of plans w/uems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: when the available fault current ❑ Marinas and boatyards.
i e d K AT1~+Cifl1tX .Cfb CONS 1~i1J IYfl1+I : r ` ; r' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
® 1- and 2-family dwelling ❑ Commercial industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
Emergency system. larger separately derived system.
g { JO '`.IYYR~1+lTryr. Ai~TD.1+aCAT1QN'
❑ Addition of new motor load of ❑ "A", "E', '1.2',-1-3",
Job no.: Job site address: 12884 Sevilla Ave 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: Project name: Walnut Crossing ❑ Service or feeder 600 amps or more.
FIFE St ULE
Cross street/directions to job site: Walnut St & Sevilla Ave. uesc son Fee Tots
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Walnut Crossing Lot no.: 4
1,000 sq. ft. or less 1 r67.84 8.54 168.54 4
Tax map/parcel no.: 2SI04AD05700 Ea. add'1500 sq. ft. or portion 5 .'91(0 9.
° Limited energy, residential 1 67.84 2
or 1~Vfll2K with shave t . ft.
Install new service for single famil residence Limited energy, multi-family 7.84 2
Y residential with above s q. ft.
Services or feeders installation alteration and/or relocation
lt~ 200 amps or less 100.70 2
P1iflFEitTY OWNI T NWANT ' < . • 201 amps to 400 amps 133.56 2
Name: Pahlisch Homes 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 63088 NE 18th Over 1,000 amps or volts 552.26 2
City/State/ZIP: Bend, OR 97701 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (541)385-6762 Fax: (541)385-6742 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2
Branch circuits - new, alteration or a tension er anel
Owner signature: Date: A. Fee for branch circuits with
APPLICA , [ •CONTACI';Ps „SAN above service or feeder fee, 7.42 2
each branch circuit
Business name: Pahlisch Homes B. Fee for branch circuits
Contact name: Jason Spence without service or feeder fee,
first branch circuit 56.18 2
Address: 63088 NE 18th Each add'I branch circuit 7.42 2
Miscellaneous service or feeder not included
City/State/ZIP: Bend, OR 97701 Each manufactured or modular dwelling, service and/or feeder 67.84 2
Phone: (541) 385-6762x101 Fax:: (541) 385-6742 Reconnect only 67.84 2
E-mail: jasons@pahlischhomes.com Pump or irrigation circle 67.84 2
1 r~r 4 aCQ1VTBT flJ' a ; Sign or outline lighting 67.84 2
Signal circuit(s) or limited-
Business name: MW Electric w energy panel, alteration, or
Address: 29889 HWY 34 SW extension. Describe: Page 2 2
City/State/ZIP: ALBANY, OREGON 97321 Each additional inspection over allowable in an of the above
Per inspection 66.25
Phone: (841) 754.6171 I Fax: (541) 754.1872 Investigation per hour (l hr min) 66.25
CCB Lie.: 67362 Electrical Lie.: 2-61 C Suprv. Lie.: ~~7y S Industrial plant per hour 78.18
4 " . >~E CAL P 4
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: VER Date: 1.12.10
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 9 rj
This permit application expires if a permit is not obtained within x80
1 1 Print name: MICHAEL WEAVER Date: 1.12.10 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\.-. in 1EI°C-P--pp.doe 10/01/09 440461ST(II/05/COMM2E6
Plumbing Permit Application
Building Fixtures
City of Tigard Received Permit N
Fo~D O
V 13125 SW Hall Blvd., Tigard, OR 9722-1 -
Phone: 503.639.4171 Pax: 503.598.1960 Ilan Review Other Pen+ut No..
Date;l3v: _
Inspection line: 503 639.4175 Date Ready/};y: - - -huiK ® Set Page 2 for
Internet: www.tigard-or.gov Notiticd7vleihtxt
Supplemental Information
T'O'PE OF WORK FEE,* SCHEDULE
New construction E] Demolition Fors ecial infurination use checklist.
Description ~T- Ea. Total
❑ Addition/alteration/replaceinent ❑ Other: New 1- 2-family dwellinl!s (includes 100 11. fix each utility conne_ct_ic;)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® I -and 2-fmtily dwelling ❑ Commercial/industrial SIR (2) bath 437.78
p Accessory building ❑Molti-family SFR (3) bath 1 500.32 500.32
-
Lach additional bath/kiichen 25.02
Muster builder ❑ Other: Fire sprinkler ( sq. fl.) - Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: -
Job site address: 12884 Sevilla Ave Calch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/Zll': Bend, OR 97223
_ h'cwting drain (no. linear H.: Page 2
SuiteJbldg./apt. no.: Project name W
: (Tossing Manufactured home utilities - 50.03
Cross street/direc-tions to job site: Walnut & Sevilla Ave. Manholes 18.76
Rain drain amncc-tor - 18 76
Sanitary sewer (no, linear III.: - Page 2 -
_ ---y Storm sewer (no, linear V. Page 2
Water service (no. linear IL I'age 2 ~
Subdivision: Walnut Crossing Lot no.: 4
Fixture or item:
"has map/parcel no.: 2SI04AD05700 Backilow preventer 31.27
DESCREPTION OF WORK Backwater valve 12.51
Clothes washer _ 25.02
Install new work in new single family residence Dishwasher - 25.02
Drinking fountain 25.02
I-jcctors./sump 25.02
12.51
® PROPERTY OWNER Q TENANT Fxpansiontank
Namr. Pahliseh Homes - Fixture/sewer cal, 25.02 - - Fltxir drain/ o,or sink/hub 25.02
Address: 63088 NE: 181"- - - `
Garbage disposal _ 25,02
City/State/ZIP: Bend, OR 97701 Flose bib 25.02
-Phone: (541)3856762 - Fax: (541)3856742 - Ice maker - - - 12.51
-
CR APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
llusiness name: Pahliseh Homes Medical gas (value: S - _ Pagc 2
Primer 12.51
Contact name: Jason Spence - -
Roof drain(annmcrcial) 12.51
Address: 63088 NF. I8" --~e -
0, _
SinkMasin/Iavatnry
City/Suite/'Lill: Bend, OR 97701 Solar units (potable water) 62.5.3
Phone: (541) 3856762%101 - Fax:: (541) 3856742 Tub/shower/shower pan--- 12.51
IN mail: jasons(a)pahlischhomes com 1lrinal 25.02
Water clout 25.02
CONTRACTOR
Water heater 17.52
.
Business name: LIPPOLD PLUMBING WaterpipingI)WV - .-.----56.29
Address: 25430 SF; SUNSHINE: VALLFY RD Other: 25.02
City/Statci/-"[P: DANIASCAS, OREGON 97089 - - - Subtotal 500.32
Phone: (971) 404.7012 Faz:4E~ Minimum pcnnit fay : S72.50
Plan review (25%of permit fee) 125.08
CCB Lie: 189042 Plumbing Lic, no.: -
- rr State surcharge (12°i of permit fee) 60.04
Authorized signau '1'0"1'Al_ PERMI l' TF 685.44
- pD 11+is permit application eipires if., permit is not obtained sithin 0111 days
Print name: Z?A L. L A S L Zl T t~L _ - rate: 1.12.10
after it has been accepted as complete.
"fee methodology set by Tri-County Ridding Industry Ncn•ice Board
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L Buyer Date Buyer Date Scale 1:1
Lot Sq. Ft. =6314 sq. ft.
Foot Print Sq. Ft.= 1919 sq. ft. Subdivision: Walnut Crossing
% Lot Coverage = 30.39% ~J Lot#: 4
Total Impervious Surface= 2481 sq. ft. Rd111.ch~Lg Tomes Address: 12884 Sevilla Ave, Tigard, OR
PLANT SCHEDULE
63088 NE 18TH STREET, SUITE 100 Plan Name: Stonecreek 2car
ueoPeAN BEND, OREGON 97701 Date:
Q 1.12.10 II
AMUS PH: (541) 385-6762 FAQ:: (541) 385-6742 Scale:l =20
® XYCARPA
DRIVEWAY, WALK, AND PATIO [,M MS :IRIS FOR RIiPIRISNCIS ONLY AND NC)'1' IN'1'ENDI'.D TO RE'I'IIE IS\ACI' DISPICI'ION UF'I'Ilii SINAI. PRODUCT
' IS.l'ACT UTILITY CONNECTIONS AT RHSIDENCL: MAY VARY PFa RUIEDI R'S DISM.'XION
VlAbT
Oregon Residential Specialty Code N1107.2
HIGH- EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: t 0 -000 Jurisdiction: T,
Site Address: I ? $ Std ��
Subdivision/Lot #: j 0_ (56..461 L L J
and /or
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: Date: 7/ 2 Vp
Ow er /General Contractor /Authorized Agent
Print Name:
•
•
ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
1:\ Building\ Forms\ RES- 1- IighEfficiencyLighting.doc 07/01/08
•
,47:1;'"
PERMIT NO /, ®CtO /
CleanWater Services
?u commitment It clew. LOT
EROSION CONTROL INSPECTION REPORT
DATE ,7/. 2.4 INSPECTOR/ j ,,,, /� (7,,,
O WNER/PERMITEE 4 ( „ �
i
SITE ADDRESS S �' /a1
APPROVED
FINAL INSPECTION
THIS SITE MEETS THE POST - CONSTRUCTION
EROSION CONTROL REQUIREMENTS SET
FORTH IN CLEAN WATER SERVICES
RESOLUTION AND ORDER
NOTE: IF POST - CONSTRUCTION EROSION CONTROL MEASURES ARE STILL BEING
EMPLOYED ON THIS -SITE TO MEET CRITERIA FOR AN APPROVED FINAL INSPECTION,
THE MEASURE(S) MUST REMAIN IN PLACE UNTIL LANDSCAPING IS COMPLETE
OR PERMANENT GROUND COVER IS ESTABLISHED.
A COPY OF THE FINAL EROSION CONTROL=INSPECTION REPORT MUST BE
FORWARDED TO THE NEW OWNER, AT WHICH TIME NEW OWNER ASSUMES
THE RESPONSIBILITY FOR MAINTENANCE, REPAIR AND REMOVAL.
OTHER
THANK YOU FOR YOUR COOPERATION!
INSPECTOR •
STREET TREE CERTIFICATION
1, ,Owner/At for
LEASE PRINT) (PERMITHOLDER)
Do hereby certify that thefollowing location meets
City of Tigard and Washington County
land use and development standards for street tree installation.
ADDRESS: — )Oo 1
SUBDIVISION: LOT:
SIGNATURE: DATE: 7 / l/
(0 W'NBR/AGENT)
RECEIVED BY: DATE:
(CITY OF TIGARD)
1:\Buildtng\Forms\Stcc(FreeCerci0caie 01
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.
1 1111 BUILDING DIVISION
a (i1.Sk 2-U \0 . O
TIGARJ TRANSMITTAL LETTER
a
TO: i `_ DATE RECEIVED:
DEPT: B . DING DIVISION RECEIVED
F EB 16 2010
CITY O F TIGARD
FROM: BUILDINGDIVISIO_N'
COM ANY: -„A CL�LC
PHONE:./ 5`1 / 3 g 5 4P7 4a. x /0/
RE: l V 3 -t) .t)LL, 1 % 1 57 - ) /0— L5040/ d h-c V
(Site Address) (Permit/Case Number) Projec ( name or sub ivision name and lot nurpber)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: 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. 1C Engineer's calculations.
Other (explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
$
$
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I: \Building\ Forms \TransmittalLetter - Revisions.doc 4/4/07