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Permit Support Document a • T GARD> City of Tigard October 18, 2012 Everett Custom Homes 735 SW 158 Ave., Ste. 180 Beaverton, OR 97006 Re: Permit No. MST2012 -00020 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11455 SW 96 Ave. Project Name: Everett Terrace, Lot 11 Job No.: Refund Method: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $431.31. 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): Lot purchased by another developer and new building plans were submitted. Refund 80% of plan review paid for original plan review that was not completed. If you have any questions please contact me at 503.718.2430. Sincerely, /691*7 Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Everett Custom Homes DATE: 10/2/2012 735 SW 158c Ave., Ste. 1S0 Beaverton, OR 97006 REQUESTED BY: Dianna Howse DEB TRANSACTION INFORMATION: Receipt #: 185533 Case #: MST2012 -00020 Date: 2/16/2012 Address /Parcel: 11455 SW 96th Ave. Pay Method: CreditCard Project Name: Everett Terrace, Lot 11 EXPLANATION: Lot purchased by another developer and new building plans were submitted. Refund 80% of plan review paid for original plan review that was not completed. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Plan Review Fee 230- 0000 -43106 $431.31 TOTAL REFUND: $431.31 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager � /` _ If under $25,500 Department Manager l` /�'�f /�;�::��CGC If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTE AD INISTRATION USE O _ Case Refund Processed: I Date: /, By: I \Buddin \Refunds\ RcfundRe .09/01/2010 cC/ City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ill 0 i Request Permit Action 1 it q / /zA ,1 - r IC; A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor N City Staff (check one) REFUND OR Name: / INVOICE TO: (Business or Individual) J S•Q —•----- OA. ( oki6.6 Mailing Address: 735" � ,t v 15g � }t)Ir %t-6. / 'o City/State /Zip: --. 6g,40€2.7 - 6,0 / 9 706C,0 Phone No.: 53 7 5D' Le 214 Q V/ c_- MM' -S PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( = V • ID PERMIT APPLICATION. /+• i M t P ' RMIT FEES (attach copy of original receipt and provide explanation below). 1 i! • 'DICE FOR FEES DUE (attach case fee schedule and provide explanation below). A REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: 1 ao I a. - OOOaO °� .0 2. gofa-6062 -'S' Site Address or Parcel #: 1145S ' -i t> 9ir Plpe Project Name: f e)tAf,i1 <-, 44- / Lbi /1 Subdivision Name: Et 2�71 "/ kit_A -e_ L Lot #: /( EXPLANATION: Low A-`a. r - D t FF ,JT Oc.,..3 ,1/4.)ec e... NE.4J PLA -r f lu 1 t ►`1 4rp , o 1 1 c9-0I gs -ooa 0. 61,eaola -60 Signature: . -- .CLL 4� Date: C ( I Print Name: ~ �fp ) //) t - 41- 1--/Sfx..1 Refund Policy I. The Director or Building Official may authonze the refund of a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended c) not more than 80% of the land use application fee for Issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80 of the building permit fee for issued permits pnor to any inspection requests. 2 Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2 -4 weeks for processing refunds. FOR OFFICE USE ONLY (03$, 3f Rte to Sys Admtn: Date 9 ig /2- B , .W Rte to Bldg Admtn: Date& /b /2— By P%. /V , pa Refund Processed: Dat% /b / . B i/I Invoice Processed: Date By Permit Canceled: Date /, /(� // z By !# arcel Tag Added: Date By � t, - Receipt # Date Method Amount $ Rer -tt//k 1: \Building \ Forms \RegPermrtActron doe Rev 05/25/2012 A"' ✓A) h,17,06, Buildiig Permit Application V 0 1 g . /6/(f/(2.-- �� Residential �� FOR OFFICE USE ONLY Recei City of Tigard U�;��� DuteBea DateB 011 /It Permi[ No : N f , • 13125 SW Hall Blvd., Tigard, OR Plan Review Phone: 503.718.2439 Fax: 503.598.196Q. 6` 2012 Other Perrrut. �� TI G A R D Inspection Line' 503.639.4175 V� `j " Date Ready/13y. Juns• ® See Page 2 for Internet' www.tigard- or.gov , �3 Notified/Method Supplemental Information C�,' N d ov19 I TYPE Ot 1�'Jd;r'l. ' -' 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. ® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $125,280 ❑ Accessory building ❑ Multi - family Number of bedrooms: 3 ❑ Master builder 1:1 Other: Number of bathrooms: 2 JOB SITE INFORMATION AND LOCATION Total number of floors: 3 Job site address: \1 L 95 SW 96th New dwelling area: 1860 square feet City /State/ZIP: Tigard, OR 97224 Garage/carport area: 228 square feet Suite/bldg. /apt. no.: Project name: Everett Terrace Covered porch area: square feet Cross street/directions to job site: Greenburg and 96th Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Everett Terrace 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. new single family residence Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Everett Custom Homes Type of construction: Address: 735 SW 158 Ave Suite 180 Occupancy groups: City / State/ZIP: Beaverton, OR 97006 Existing: Phone: (503)750 -6268 Fax: ( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: Emerio Design (Please refer JO fee schedule) Structural plan review fee (or deposit): Contact name: Neil Fernando Address: 6107 SW Murray Blvd #147 FLS plan review fee (if applicable): City / State/ZIP: Beaverton, OR 97008 Total fees due upon application: Phone: (503) 515 -5528 Fax: : ( ) Amount received: 1635, n E -mail: neil @emeriodesign.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive insta ation of roof -top mounted Photo Voltaic Solar P. • System. Business name: Everett Custom Homes Submit two (2) sets o , 'of plan w• • connection details and fire department acce ale • g with the 2010 Oregon Address: 735 SW 158' Suite 180 Solar Installation Special . *de checklist. City /State/ZIP: Beaverton, OR 97006 Permit Fee (in ides pla eview $180.00 a • dministrative . Phone: (503) 750 -6268 Fax: ( ) State surcharge (12% of permit fee : $21.60 CCB lie.: 189447 , A / / Total fee due upon application: $201.60 Authorized signature: / 111 ' / / This permit application expires if a permit is not obtained ( _ within 180 days after it has been accepted as complete. Print name: 1....3 (� jr (� -lf�� Date: 2 I LS l 2 * Fee methodology set by Tri- County Building Industry Service Board. I.\ Building \Permits \BUP- RESPermitApp doe 02/24/2011 4404613T(11 /02/COM/WEB) ' Plumbing Permit Application , b 8 ��� ,� . Building Fixtures a ,, LEI FOR OFFICE USE ONLY Recet�ed City of Tigard , z -, A 20 Rec /i u0 A A Perms No. )191:90-a--6094/2 1111 - a 13125 SW Hall Blvd.. Tigard OK 97223 `y Plan Review Phone: 503 7i8.2439 Fax. 503.598 r* 0 , V Date /By Other Permit No.. �la.��, v T I G A R D Inspection Line: 503 639.5175 4 rt 'i n"Gnn�j IR, r'? Ae`t� Date Ready /By. to r See Page 2 for Internet: www.tigard- or.gov - ",( - ��M � t ©�V/1G��iv N I 8 Supplemental Infurmatinn . TYPE OF WORK 1 1 V FEE* SCHEDULE -: ® New construction ❑Demolition For special information use checklist. Descnption l Qty. I Ea. ) Total ❑ Add)uonlalteration/replacement ❑ Other. New 1.2-family dwellings (includes 100 ft for each utility connection( CATEGORY OF CONSTRUCTION - _ = SFR (1 !bath 312.70 ® I- and 2- family dwelling I ❑ Commercial /industrial SFR (2) bath t 437.78 SFR (3) bath 50032 ❑ Accessory building I ❑ Multi - family Each additional bath/kitchen 25 03 ❑ Master builder I ❑ Other: Fire spnnkler L sq. ft.) Page 2 ` t JOB SITE INFORMATION AND LOCATION Site utilities: Job site address. 4 t. 4 h1 W 96th Catch basin or area drain 18.76 Drywell, leach line, or trench drain 1 5.76 City / State/ZIP: Tigard. OR 97224 ! Footing drain (no linear ft.• ,) Page 2 Suite/bldg. /apt. no.. I Project name: Everett Terrace Manufactured home utilities 50.01 Cross street/directions to job site: Greenburg and 96th Manholes 18.76 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 Everett Terrace Lot no.: \ 1 _ Fixture or item: Tax map /parcel no.: Baekflow preventer 31 27 Backwater valve 12.51 . - - - DESCRIPTION OF WORK - • - I Clothes washer 25 0 New single family residence Dishwasher 25 02 Drinking fountain I 25 02 Ejectors/sump 25.022 - ® PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.03 Name: Everett Custom Homes Floor drain/floor sink/hub 25 02 Address: 735 SW 158 Suite 180 Garbage disposal 25.02 City / State/ZiP: Beaverton, OR 97006 Hose bib 2 5.02 Phone. (503)750 -6268 Fax: ( ) ice maker 12 51 ® APPLICANT - r . ❑ CONTACT PERSON - interceptor /grease trap 25.02 Medical gas (value: S _ } Page 2 Business name: Emerio Design Primer 12.51 Contact name Neil Fernando Roof drain (commercial) 12.51 Address: 6107 SW Murray Blvd #147 Sink/basin/lavatory '5.02 - City /State/ZIP: Beaverton, OR 97008 Solar units (potable water) 62.54 Phone: (5031 515 -5528 Fax: : ( 1 Tub /shower /shower pan 12.51 Urinal 25 02 E-mail neil @emeriodesign.com Water closet 2 225.02 - CONTRACTOR . - - 37.52 Water heater Business name: Wolcott Plumbing Water piping/DWV 56 29 Address: 1075 W HistoricColumbia River Hwy Other. I 25 02 City/State/ZIP: Troutdale, OR 97060 Subtotal Phone: (503) 667-1781 Fax (503) 667 -9891 Minimum permit fee: 572.50 Plan review (25cr of permit fee) CCB Lie.: 112220 Plumbing Lie no.. 26 -824PB State surcharge (12% of permit fee) Authorized signature: aka TOTAL PERMIT FEE _ / This permit application expires it a permit is not obtained within 180 day, Print name. DENNIS L DUNNING Date: / / //l 0/� after it has been accepted as complete. "Fee methodology set by TO Building industry Service Board. t•VnuddmgtltrmoTI 41tt PcrmitApp.doc Win Mg Sitl.4uttTIi Mr'JCUM.'WI -ni . . . . . Mechanical Permit Applicati .. FOR OFFICF. USE ONLY .. . . . ... ... . . _ City of Tigard TL,'Nz.,"iii.VIED ..— - irm mile, Pertrdt No.: I 1 --,- ,,, I II ----- 7 13125SW Halt Blvd., Tigard, OR 97223 ' ' . Phone: 503.718.2439 Fax: 503.598.1960 - EHEMESIIIIRIC.:. Permic exP_AotA- ,. Inspection Line: 503.639 5 A17 - R T c 2012 , TIGARo Date Ready/By: iii 0 See Page 2 for Internet: www.figard Notified/Method: Supplemental Information C: Tr Y OF TRGARD TYP,E 00 Wolifer \ d SION .-..:. : :•., .. FEE* SCHEDULE ...13SE CHECICLIST Mechanical permit fees* are based on the value of the work (gi New construction El Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all 0 Demolition 0 Other: mechanical materials. equipmenL labor. overhead. and profit. Value: S . !,=,>'...: . ' op.'it*IsraucnoN.: -:,•.;:•:•:::: . • ,'•',,' .-:*.SIDENTiAlAdUIPMENT i8ysivipmEs.': 1:0 I- and 2 dwelling 0 Commercial/industrial G Accessory building For special information use checkfin. 1:3 Multi-family I:1 Master builder I:I Other: Description I Qty. I Ea. I Total • .;:::....i...::::' ripOtiNiAnoN AriO VparioN '..-:!:,..*[:. : :: -3 Heating/cooling: ' Air conditioning Job site address: 1 V 96th (requires she plan allowing placement) , 46.75 Furnace 100.000 BTU (duds/veins) I 46.75 City/State/Z.1P: Tigard, OR 97224 Furnace 100.000+ BTU tducts/vento 54.91 Suite/bldg./apt. no.: Project name: Everett Terrace Lot Heat pump (requires sae plan showing placement) 61.06 Cross street/directions to job site: Greenberg and 96th Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 1332 Unit heaters (fuel not electric). in-wall, in-duct, suspended. etc. 415.75 Subdivision: Everett Terrace Lot no.: \ 1 . Flue/vent for any of above 23.32 Other 23.32 Tax map/parcel no.: Other fuel appliances: .. .."DF.s04ittioN bi.*0.4:::::;.::...:.:;,.y;,::::' :. . 1. ,:".: , . Water h 2332 e Gas fireplace 33.39 new sine Way resIdent•e Flue Wilt for water heater or gas VAC.. . fireplace - 23 32 Log lighter (gas) 23.32 . Wood/pellet stove 33.39 Wood fireplace/insert 2332 '140pERTY .:.". I '..' . -' . : : :..0.:tiii:Norr • - .. i Chimney/liner/flue/vent 2332 Other: 2332 . Name: Everett Custom Homes Environmental exhaust and ventilation: Address: 735 SW 158' Ave Range hood/other kitchen equipment 1 _ 3339 , City/State/ZIP: Beaverton, OR 97006 Clothes dryer exhaust I 33.39 Single-duct exhaust (bathrooms, , 1, c_ Phone: (503)750-6268 Fax: ( ) toilet compartments, utility rooms) "I 7 -) 23.32 .. EZI .4 .:..:.)..;, . : , ::: ;,:?:,E1.:cONTlidriI,ERSON ..:;:,: Attickrawlspace fans 23.3' Other. W 4 _ I I 23.32 Business name: Emerio Design Fuel piping: Contact name: Nell Fernando $14.15 for first four: S4.03 for each additional Address: 6107 SW Murray Blvd #147 Furnace, etc. t Gas heat pump City/Suite/ZIP; Beaverton, OR 97008 Wall/suspended/unit heater Phone: ('503) 515.5528 I Fax: : ( ) Water heater I Fireplace l E-mail: nell@eineriodesign.oam Range I. ' , . • ::: • : 11 • ......'' XiI4TRA•iCrt5i!::::.:: :',...•:.7 :..-::...'ii,=:.::J .: Barbecue Business name: Pyramid Heating Clothes drier (gas) . Other Address: 9409 NE Colfax 'MRCHAMCAL PERMIT FEE0 1 •:!.: . City/State/ZIP: Portland, OR 97220 Subtotal Minimum permit fee ($90.00) Phone: (503) 786-9522 I Fax: (505)184, 3 4 32 Plan review (25% of permit fee) - CCB lie.: 59382 State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature: ,ApAdd c314.1ri"ERn This permit application expires if a pent* Is net obtained within 1111 days after a has been accepted as eompkte. I Print name: Ap y 1 %) -(.Y' I Date: 2/ 1( z . Re methodology in by Tri-County oitding Industry Service hoard labullalagUtmlimMt.C.PosnitAnp.clue 09509/15 440 (I I Al2/COMPNE11) . Electrical Permit A p p l i c a t i o n F t if; 1.11T1t. I . I. i \ 1 . \ 1 4 ............... - City of Tigard I FC1',. , n R 'c ei ' d , .pirmairgilt,, femit No.: ti*TP0, -11,449 ' 111125 SW Hall Blvd , Tipird, 0 . tfr:r; ." L pg`113 r '. h n o, evoto Other Permit: 5i0e.,9.04). 6re, air . . Phone: 503,718.2439 Fax: 503.598p60. ate/B: : Inspection Lint : 503.639.4175 Eb 1 8 2012 13ate Ready/9 , 8 E See Pogo 2 tor 1_1 imemrt: www lieatd-or,gev Notified/NT r i i i-a. 1 1.11 5 1 , ! ..,.. atm' information . Is / ' • I ' ■ n 'TYPE ' e r • .,: ..:....:...:..., .. -....; '.. New construction 0 Ad tint alteration/re-placement Please clICK 211 Mat apply (submit I sett ot plass worems erceseahot 0 Service or feeder 400 amps or tram 0 Building met three stories. 0 Demolition D Other: wbere the available emilt curvem 0 Marinas and bnlayardS. I .. .... :•.: . . : . '• • . . ..;• . CATEGORY CONSTRUCT161 ;';'/...'..'. ...'.....! . >:',„.. ciceedA 10 °Tic' c't 13 v°1 or CI IRAK, ins binlehnea ' leas In ground. or exceeds 14.000 0 C,omnszeial agricultural 0 1 - 11114.1 2 dwelling 0 Commertiul/industrial CI Accessory building mops ice all other installations buildings [I Multi-family D Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KW or 3-.:.,7!"....1.1 , s. :'• 1 jai II‘R (Sr :="l'i::: ; . ; •....; : ....; .,,. . ORINNIION AND LOCATION:::?. i ......,.. : • ::. • .. in . . LI bun wit town larger scparazly derived sylicm. I., Addition of aaw molar load of 0 - 1.r, - i .r. Job nu.: I Job site address: I 195 sw 9614 100HP or more. occupancy. CI Six or mom residential units. 1] km-mai:mai velum penal. City/State/ZIP; Tigard, OR 9'7224 0 1 facilities 0 Supply vohage for more 'ism — 1:1Hruradous locations. 600 volts comitol. &lite/bldg./apt. no.: I Project name: Everett Terrace ' 0 Service or feeder 000 amps cn more. : ;:....:.:... .: . .... : ::1/11E.§CREDULE -::' '. .: Cross street/directions Iti joh site: Greenburg and 96th Doodad= . . ) Qty. I Vet I Vaal i I New residential aingle- or multi-fondly dwelling ult. Includes attached garage. SulXliviSion: Everett Terrace Lot no.: 1.1,__ 1.000 sq. ft. or kris I6&54 4 Ea. addl 500 sq. ft. orportion 33.92 1 Tax map/parcel no.: - Limited energy. nesichanial 75.00 1 .''; • • ' '. ' ''. E''i ..!' ',' ' ''' ''' . DESCRIFITON. WORRT:•;!:-: , (with above so. ft.) Limited energy, multifamily 75110 2 New single family residence residential (with above so. ft.) . ) Services Or feeders installation. alteration. and/or relocation 200 amps or kat 100.70 2 ., . I ,',.. • .. 7 ' , r11 i1gitiffERI*0* ,.....',:.1 . 3; MI amps to 400 amps (33.56 2 ,.. ., 401 amps to 600 amps 200.34 2 Name: Everett Custom Homes 601 amps to 1.000 amps 301.04 2 ... — . Address: 735 SW 158 Aye Om 1.000 amps or volts 552.26 ' 2 Tentpurary services or feeders Installation, alteration, and/o City/State/Z1P: Beaverton, OR 97006 relocation . . Phone: (503)750 I Fax: ( ) 203 amps or less 59.36 I Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 1 25.08 1 ... intended for stile, !case, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or ortension, per panel Owner signature: Date: A. Fre for branch circuits with APPLICANT .,;::, ..,,,,...!..,..,..: 0 : coraAct ,p kiksoN . z. ..... : .. . ", ; above millet or fee& fee, 742 2 ..- • ....., • • • • . . ,, ',. . cad, branch circuit Business name: Eanerio Design B. Fee for branch circuits without ..... — service or (eetirr fce, first sfi. ill 2 Contact name: Neil Fernando branch circuit , Each add') branch dram 1 7.42 I 1 2 Address: 6107 SW Murray Blvd #147 Miscellaneous (service or feeder not Included) . — act' rosiattactured or modular City/State/LP: Beaverton, OR 97008 67.84 3 &vanilla, =vice and/or feeder Vhone: (503) 515.5528 Fax : ( ) Reconnect only 67.84 , 2 Pomp or inigation oink 67.84 2 E- mai k n ell @ erncriodesignec om Sign or outline lighting 67.84 2 ','"' • ' :. , • : • ', ,. - . ' 7 . : : .•• .; .. CONT'itACTOR '' ' ....: .. :. : .. : • .'.‘ .' %:". . ' '''' 1 ■ ... 7 '''''';'''':' Signal on:mitts) or limited Business name: Wright 1 Electric panel. alteration, or extension. . Page 2 2 Each additional trileetion over allowable in any of the above Address; 5618 SE 135 Ave Additional inspection (I hr mill) Invesligelion (I hr min) 666.25/ hr hr Ci ty/State/ZIP: Portland, OR 97236 - Industrial plant (1 hr min) 78.18/ hr PhOttet (503) 760-8522 Fax (503) 762 Inspections for which no fee is 90.00/ hr specifically listed Oh hr min) _ Cal Lic.: 162368 Electrical Lic.: 3-332C Stun'. Lic.: 3398$ ''.•'..;;I:i ' ELECI'RICAL.PERMIT'IRIS .. ' ...'':',.....t..'... Suprv. Electrician signature, required: Cs.....1. 1 4144/ Subtotal: — - Plan review (2591i of permit fee): Print name: Dennis Welch 1 Onte: Sine surehtur (12% of permit fce): ' TOTAL PERMIT FEE Authorized signature; This permit application expires Ira permit Is not obtained within 180 days after it has been accepted as complete. Print it arric --- Date: • Number of inspections allowed per Fermi Mee ildiegTenaleAELC.PamitApp.duc 0710U1D 40-4615Th1/05/COMMEN !p q Building Division � r' f Development Code Provision Review T I G A R D Residential Projects Building Permit No: N 5 1 a O/ jZ -ono ?c CWS Service Provider Letter Received: Yes ❑ No ❑ N/A 0 0 Routed Plans: � Original Plan Submittal Date: • I 19" 151 Revision Submittal Date: :J1t1 /9— ❑ Sitefirenly, 9 A.) 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 (✓) 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. . 4. • Planning Review (contact i tYt.-ed PA-ea/ "r., at 503-718-Zia. or ` @tigard - or.gov) Land Use Case No. s b 7.41) Name £ v e.r.i ' E Zoning - ( Ca- Setbacks: ,r Front 1 5 Rear 15 Side 7" Street Side (i0 Garage 2.a Y Maximum Building Height 3 5 Actual Building Height 3/ OP Visual Clearance Q0- Easements Q' Sensitive Lands Type: P(o' Not s: , �..r,�y s Lt. S�e br..el< - Y 0- a.djw r��.4.�. h&ASA-s.6.1 4 (7 2_ (2.) 5 * d a yo i b• a4 ate_ 3 - o k a s 44-. re) ,rn..oa#•.t (3444h0 4' rw. 11141.4.4- - , 3 bL.,,,,,p ow./. eked. Original Plan: Approved V Not Approved Date: Z ( 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: 5 Notes: Original Plan: Approved -17r Not Approved ❑ Date: 7. / I j I � Revision 1: Approved ❑ Not Approved ❑ Date: 111 Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 r City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov) E{IStreet Trees IE Protected Trees / f' J ( / � I - L Notes: 1."-J " /' ete a -t r 7'L \f--'' / ' �) +r.� , SY ' c 4"-- ) () C L.1 / •F- c' I -J f 9Wn- - Original Plan: Approved ❑ Not Approved L7 Date: 2 - a - I 1 Revision 1: Approved ❑ Not Approved e Date: 5"iY' (s.6. ..e, p -,34. , w) II-) 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 Applicant Okay to Issue Permit: Yes O. No Id 2 - /Z� - ! , , , Date Routed to Building: / . Page 2 of 2 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. a City of Tigard Building Division TIGARD TRANSMITTAL LETTER TO: I DATE RECEIVED: DEPT: - BUILDING DIVISION RECEIVED MAY 10 701? FROM: \ _ CITY OFTIGAItD • DIVISION COMPANY: I�� • 4 ,. A i L PHONE: By,. RE: (Site A ress) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: I Description: I 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: b-i 1, 4 5 at1 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: 1•\Buildmg\ Forms \TransmivalLetter - Revisions.doc 02/08/2011 0 i U cT PER ENGINEERING 1 A I •. J`i ;; I •' : ,: •...' : ':. APPROVAL (TYP) APPROVAL 20' STORM & SAIETARY� LOT 10 N.. ••.:. ' .. .,. ,. . � SEWER EASES LENT 1 ... ••. ... • • .' I.:':: •. . ._A 1 I'' 1---11 E ]OS II N C PROPOSED Lg PDE l ca X ' I :. . • v� 1 '1 I a I I 1 . . I ':..' StDUIENT o a• • >i . .. ... 3 . : . '..TREE PROlEC71DNI _ - i SERVICE _ � _ _ _ tJ67o' ��_ _ _ I $y,• I SA ligi.... ' : �.> > n, ' X ( 1 X X— %— % —X —x —x 4 X -X -% -% X X X - X %� I -1 e ' „v 4 1 n x I PROPOSED FOOTING II"C". I I � I "i : ...10:::. I I � �ss>t DOR NECTION : • •. •:. _ I s • :: :: ` :• 1. . L '.�:: : . '.: ' . i EJOS112 TREE I x I EEtx ,n PROPOSED STORY : PRbPDSi ti ' .•. : .: t . : , , • . Ica •• ' ` 1 N 1D RELA4N (TYP )7n" LOT 11 aEAENOUT BO' MIN : DRI • . - � .. I $:. '. - .H• Z•; I': .': 1 d' ' 1 SD. - r F u O YATCHM7H LOT 12 - � I - - 1 L'. r .4 _ _ ., x — �� - - - -x - x- x- x x - x - x�-r „ _i I •.•....l . 40 taS — — — aRDPOSED TREE aER I 1 :. : I : . ' : ' . 1 1 ca WNREODOR PROPOSED 21 1 PROPOSED PLANTER ENGINEERING APPROVAL (Tw) " '� - f L • _ : ..: I. 21' X 175' 1 . Oe ': ) 1 \ S 1 E1MSDNNG STORY stow THROUGH PIAMTER �' . r.. ':.::• I :::. � LOT 12 I .. i. ,� •: .. Nl Z,,;• • ' I 1 CE l7h 1 $ i 1 N ED m SITE - - SCALE 1' = 20'