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Permit 4 CITY OF TIGARD MASTER PERMIT 11 Jg COMMUNITY DEVELOPMENT Permit #: MST2012 -00032 T I GA RID 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/20/2012 Parcel: 2S 112 BA03000 Jurisdiction: Tigard Site address: 14090 SW 80TH CT Subdivision: WAVERLY MEADOWS Lot: 24 Project: Marsh • Project Description: 364 square foot addition. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 364 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 22 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 364 sf Value: $37,091.60 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell -Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 Furn <100K:• 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 0 201-400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 2 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 364 Owner: Contractor: MARSH, STERLING E WILLIAM JAMES MONTOYA Required Items and Reports (Conditions) 14090 SW 80TH COURT 4918 MADRONA ST TIGARD, OR 97224 LAKE OSWEGO, OR 97035 -4236 PHONE: 503 -639 -7739 PHONE: 503 - 381 -3545 FAX: Total Fees: $1,728.08 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 - -- • : ith approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is susp :. = _ • for more the 180 days. ' ENTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rule. are set forth in OAR 952-011-0010 through OAR 952-0: r' 9'. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.. :.; oor 322334 Is-. ed By: • / - � G �, �� Permittee Signature: `(/"� �� 4 Call 503.639.4175 by 7:00 a.m. for the next available inspectlo date. This permit card shall be kept Ina conspicuous place on the Job site until completio .f the project Approved plans are required on the Job site at the time of each Imp: . I Building Permit Application RECEIVED Residential R+- CEI • ED FoR OFFICE USE ONLY City of Tigard FEB 2 4 2012 Received t mil' Date /By: - , 7 /5 , / Permit No.: Mr/64210 K 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review . �^"_/ ' • Phone: 503.718.2439 Fax: 503.598.196Q� TY OF TIG Date /B : A,& Other Permit: l I G A K D Inspection Line: 503.639.4175 LII� Date Ready :y: Jura: ® See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notified /Method: 314, a err TX-6 Supplemental Information eta 4.✓'v' L-r � M. TYPE OF WORK REQUIRED DATA: I- 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: $ d71.0.11 /� 1- and 2- family dwelling ❑ Commercial /industrial ' �J El Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: / yo f'o S , �� ' e fr New dwelling area: t f square feet City/State /ZIP: T d✓� I Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: /"I/1 &5 t / 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: I 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. nc `f � l � e 4 oe Valuation: $ K �t Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: ter' 4 a Type of construction: Address: /11080 j 10% Pa e -, Occupancy groups: City/State /ZIP: 7, ` a l / Qg, 7z24 Existing: Phone: ( ) , 0.7_11_361 Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee (or deposit): • Contact name: FLS plan review fee (if applicable): Address: City/State /ZIP: Total fees due upon application: Phone: ( ) Fax:: ( ) Amount received: ifAy6 .0 E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof -top mounted PhotoVoltaic Solar Panel System. Business name: JIM /140.kin p /k Submit two (2) sets of roof plan with connection details Address: L4 S w t tea- and fire departmen access, with the 2010 Oregon l 51 t Solar Installation Specialty Code checklist. City/State /ZIP: La Kr 09 4)4 �) P7a 3$ Permit Fee (includes plan review $180.00 and administrative fees): Phone: ( ).93-354_35q1 I Fax: ( ) State surcharge (12% of permit fee): $21.60 CCB lie.: 1P3r/ /-? / *ii-- .:=7 4 7 1 f 0- 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. * Fee methodology set by Tri-County Building Indusuy Print name: /(/I �D�I�O�a Date: yt I� Service Board. 1:\ Building \Permits \BUP -R ESPetmitApp.doc 02/24/2011 4404613T(I 1 /02 /COM /WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City Tigard Received `� g Date /By: Permit No.: III • 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: l.I G ` D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ''es No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. I I Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations.. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and /or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore:on and shall be shown to be applicable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x II" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings j on a lot of record approved prior to September 9, 1995. I:\ Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440 -4613T(I I /02 /COM /WEB) I Electrical Permit Application • k etved / li Pli City of Tigard �1 �t ma y. a �e f Permit No.: l���Ia �V 3� Other Permit: • 13125 SW Hall Blvd., Tigard, OR 97`223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 MAR n Plan Re : T I G R D Inspection Line: 503.639.4175 20 Date Ready/By: Sufis: ® See Page 2 for Internet: www.tigard - or.gov FEB X 2 201 Notified/Method: Supplemental Information TYPE OFCVROU X1'4 _ ' D PLAN REVIEW ❑ New construction ❑ Addition18tWtili i tsW . A 1m Please check all that apply (submit / sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION 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 JOB SITE GYFOILrWTION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: I Job site address: I T &TD ' ' 1 " C-Oth et t 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: r y , � �n �/ -7 ❑ Health -care facilities. ❑ Supply voltage for more than ty 1 �! 6(4 ! / 2 Z' ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: I Project name: Ai/445H ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 I Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family I TIN-) 72:2 t- K(ST/'i'V 6 f'U '(f� residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 _ 2 Name: rER IN h ltlAeiK 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 • Address: ,4010 S CO, j J e /., Over 1,000 amps or volts 552.26 2 ��e r Temporary services or feeders installation, alteration, and/or City /State /ZIP: L ddC ( relocation Phone: ( ) SD 6 3q...7.7-1 Fax: ( ) 200 amps or less 59.36 I 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701. `, /.� Branch circuits — new, alteration, or extension, per panel wner signature: Date: 16 . 2OI A. Fee for branch circuits with ❑ APPLIC I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first / 56.18 2 Contact name: branch circuit l Each add'I branch circuit / 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular City/State /ZIP: 67 84 2 dwelling, service and/or feeder Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR /i Signal circuit(s) or limited energy Business name: ac:30, t / L► panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is specifically listed (V2 hr min) 90.00 / hr CCB Lie.: Electrical Lie.: Suprv. Lie.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: - Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: - This permit application expires if a permit is not obtained within 180 Print name: Date: • days after it has been accepted as complete. Number of inspections allowed per permit. I:\ Building \PermitstELC- PermitApp.dac 07/01/10 4404615T(I I /05 /COM/WEB N'lechiical Permit AupatrE FOR OFACE USE ONLY City of Tigard Received G 1�1/itg Permit No.: 11111 n 13125 SW Hall Blvd., Tigard, OR 97223 q Plan Review C Phone: 503.718.2439 Fax: 503.598.196(F 2 4 2012 Date/ Ely: Other Permit: T I G A R D Inspection Line: 503.639 Date Ready/By: lolls: M See Page 2 for Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: 114 0 tt° 5w. 'Net, (requires site plan showing placement) 46.75 n N ` 'l Furnace 100,000 BTU (ducts/vents) 46.75 City /State /ZIP: �l ∎z i/�C t /} '�Z. 2 ' t Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: 1 Project name: N H Rex, Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work Q 23.32 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 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 y1 ! ` � e- Gas fireplace 33.39 14 D 1 io) To NOuS L t0 ciuut Flue vent for water heater or gas /t h r A �f- T_ ©pM fireplace 23.32 1p JCL tT 1 t� Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 • ❑ PROPERTY OWNER I ❑ TENANT - Chimney/liner/flue/vent 23.32 Other: _ 23.32 Name: si-Gizu jj6o M 4K Environmental exhaust and ventilation: Range hood/other kitchen • Address: NO i0 ajr(�(), % .01:14. 0 equipment 33.39 City /State /ZIP: 1 TeX t 0A, c(72Z'1 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( )5-03, . 7-7-M Fax: ( ) toilet compartments, utility rooms) 23.32 • ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Other: 23.32 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional_ Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater . Phone: ( ) Fax: : ( ) Water heater , E -mail: Fireplace Range CONTRACTOR Barbecue Business name: TI AO Aj'fj OO Clothes dryer (gas) , Other: a Address: 1.( if g G ) � r e t ip}Dpe/(J A- 47\ MECHANICAL PERMIT FEES* City /State /ZIP: E 0 560660, c Subtotal Phone: ( ) 38 /. 35q ‘ Fax: ( ) Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB tic.: if S(q /? State surcharge (12% of permit fee) v 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. l, Print name: f�tj44 OW fe ya I Date: L��(Z Fee methodology set by Tri County Building Industry Service Board 1:I Building \Permits\MEC- PermitApp.doc 09/09/10 440-4617T (I 1/02/COM/WEB) Mechanical Permit Application - City of Tigard . . Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: ,• Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • 1 • I:\ Building \Permits\MEC -Pei nitApp.doc 09/09/10 2 REcE D Property Owner Statement CI MAR 1 6 2012 Regarding Construction Responsibilit N G D GAI Oregon Law requires residential construction permit applicants who are not licensed with the 1 VISIO Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing per mits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I V l I will be performing work on property I own, a residence that I reside in, or a residence that I w ill reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office - issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. S-fe rfi'nj ( 'A Print Name of Permit Applicant / /arcJ 2 / 2- Signature of it Applicant Date Permit #: litSroaa '090 / —Oa/ Address: / 1 � W 80 Cr r ' �i ' ' ��' > � \ 14. Issued by: Date: [_i" This Copy for Permit Offices //are o c) Eroe - t - e,z...- : . iii Building Division Development Code Provision Review fIc,ARI) Residential Projects Building Permit No: H g 6 T �1 2 - co0 3 CWS Service Provider Letter Received: Yes ❑ No j N/A ❑ `�"/" �w� G Routed Plans: �°/ Original Plan Submittal Date: a 424 / y v / /� Pt Revision Submittal Date: ' �gl / �" ❑ Site Plan Only (91 z '`� O/"' ` � 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (1) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact SO tagli at 503-718-A4Si or ti d or. ov @> g ) Land Use Case Nn � . Name S e ❑ Zoning L ❑ Setbacks: ,Front �� Rear ` 6".- Side Street Side /v Garage oaf/ ❑ Maximum Building Height as- Actual Building Height ;21- El Visual Clearance Easements 13r Sensitive Lands Type: Notes: Original Plan: Approved V Not Approved ❑ Date: 31q112,- Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) ,Actual Slope: Notes: • Original Plan: Approved Not Approved ❑ Date: 3 9 /1-- Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard- or.gov) Er Trees Q Protected Trees Notes: Original.Plan: Approved Cam. Not Approved ❑ Date: velpa. . Revision 1:' ; , Approved. 0 Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard- or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: • Revision 1: • Date Sent to Applicant Revision 2: Date Sent to Appli t • Okay to Issue Permit: Yes No ❑ Date Routed to Building: ` • • e • • Page 2 of 2 y _ 1 ' . _ _ . , _, .. , RECEIVED . _ ._ .. . _ . MAR 8 2012 . • CITY OF TIGA D . - - _ _ - BUILDING DIVISION . • . . . v ,_ - _ . . ( a % do, _ .. _ _ _ . . . _ _ . . . , , _ . . . . _, . _ . . . ,,.. . . . . . . . . , . _ . . _ . . 1 . • _._ _ . __ . _ . _ . . .. . , . .. . . • , .. _ . , . . I . . . •• __ . , . __ ... _ . ._ . _ ,, _ , _ , . , , _ __ . . _ . 1 . . . .. . , . , . . _ _ , ,„ 0 , . . _ _ . _ . . . \ - - 12; .* _ . ___ _ , - \ II. i TJ \ .. . CO -- 1 \ \ \te °` - -- - - N. ti it \ 3 Q - - . ► ; '1 ,v�'� `1 2'41,1. \ _ a l ?Ptb r it - . _ . _ i 1 � ', '11 - -- I. 1 � ' 1 ---- \ 1 ' ex , Cr -ems X, �T`evl t� ( � h vg in �`� = h. \,. , c c . 9 -.2? . ` - / V . • .