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Permit 0 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENAI 0A Request for Permit Action /is 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.�v TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner Q Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) 1 S C L// / Mailing Address: 52'�R-5 Q E�,A ID OW-S P2p S rt E- I City/State/Zip: �-A, �� , oso F- QQ i Q tz q,7 035 Phone No.: Co J -7 - SY Q , - PLEASE-TAKE ACTION FOR THE ITEMS) CHECKED (✓): CANCjVO D PERMIT APPLICATION. UND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: �S— f . Site Address or Parcel#: ' SU3 �b A PW q P DR T1 GAP-0 ( Q R Pro)ect Name: As Subdivision Name: AS Lot #: 9 EXPLANATION: C N A N C E Q L A rSS€72-F' AIS 720/5- -1�9O o2 I/7� Signature: Date: l 1 t 5 Print Name: NL E (A ( A U 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 B Route to Records: Date Z—V ,L_C B Refund Processed: Date Alll B Invoice Processed: Date B Permit Canceled: Date/y 2 y /s B Parcel Tag Added: Date B I:\Building\Forms\Req PemutAction_092314.doc City of Tigard • COMMUNITY DEVELOPMENT Building Division 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.ti arg dor.gov INVOICE TO: JTSC,LLC Customer ID: 200237 Attn: Janelle Guiao Invoice No.: INV2015-00010 5285 Meadows Rd., Ste. 171 Invoice Date: 12/24/2015 Lake Oswego, OR 97035 Date Due: 1/24/2016 Case No. Site Address Subdivision-Lot#or Project Name Amount Due MST2015-00122 13408 SW Barnum Dr. Ashwood,Lot 9 $520.47 Plan review fees due for plan review completed prior to request to cancel permit(resubmitted under MST2015-00247). Invoice Total: $520.47 ® Please see attached fee schedule for description of fees due. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (Detach and return this portion with payment.) Case No.: MST2015-00122 Customer ID: 200237 Site Address: 13408 SW Barnum Dr. Invoice No.: INV2015-00010 Project: Ashwood,Lot 9 Invoice Date: 12/24/2015 Date Due: 1/24/2016 Invoice Total: $520.47 Amount Paid: $ Office Note: Route copy of receipt to Dianna Howse Please mail payment to: City of Tigard, Building Division Attn: Dianna Howse 13125 SW Hall Blvd. Tigard, OR 97223 l:\Building\Accounting\Invoice.doc 01/14/2011 CITY OF TIGARD FEE AND PAYMENT HISTORY 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 MST2015-00122 - 13408 SW BARNUM DR, TIGARD, OR 97223 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Plan Review 230-0000-43106 $751.34 $751.34 $750.00 7/1/15 Check 201492 $1.34 Plan Review 230-0000-43106 $433.13 $433.13 $433.13 DC Provision Review, SF-Ping 100-0000-43112 $75.00 $75.00 $75.00 DC Provision Review, SF-LRP 100-0000-43117 $11.00 $11.00 $11.00 Totals for Fees $1,270.47 $1,270.47 $750.00 $520.47 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 201492 Check 271 JTSC LLC 07/01/2015 $750.00 Total Payments: $750.00 Balance Due: $520.47 Ruildin Permit Application U 1 U /Z iW�/--f . Residential GENE + Received Ci of Tigard � Permit No. City g Date/By: I� 1 13125 SW Hall Blvd.,'figard,OR O 2015 Plan Re r —{ Other Permit Phone: 503.718.2439 Fax: 503.E 196 DateB : "�S J !G O Inspection Line: 503.639.4175 Date Ready/By: Juris 0 See Page 2 for Internet: www.tigard-or.gov CITY OFTIGARt) Notified/Method: 3v S Supplemental Information fill DING DIVISION ® 1 ! TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® I-and 2-family dwelling ❑Commercial/industrial Valuation3iS- 739 1 1-7-$ ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 91y0g S WV�App 1Z New dwelling area:'1S13 quare feet3 g City/State/ZIP:Tigard,OR 97223 Garage/carport area: (o � . square feet Suite/bldg./apt.no.: Project name:Ashwood Covered porch area: —21%_ square feet 1170 Cross street/directions to job site: Deck area: j square feet j0 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. New single family residence Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: LF 4,LLC Type of construction: Address:5285 Meadows Rd Stell 171 Occupancy groups: City/State/ZIP: Lake Oswego,OR 97035 Existing: Phone:(503)657-3402 Fax:( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name:JTSC,LLC Plea-reerto feeselredule Structural plan review fee(or deposit): Contact name:JohnWyland Address:5285 Meadows Rd Ste. 171 FLS plan review fee(if applicable): City/State/ZIP: Lake Oswego,OR 97035 Total fees due upon application: Phone:(503)209-7555 Fax::( ) Amount received: E-mail:jwyland@jtsmitheo.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name:JTSC,LLC Sub�fiire two(2)sets of roof plan with connection and a ment access,along with Oregon Address:5285 Meadows Rd.Ste 171 Solanstallation cialry Cecklist. City/State/ZIP:Lake Oswego,OR 97035 Permit Fee(inc Qn review $180.00 administrative Phone:(503)657-3402Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.:200237 Total fee due upon application: 201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name:John V1 gland Date: Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 4404613T(II/02/COM/WEB) .:u CE I V E 11,ly, City of Tigard Dale/B B.e� � Perini;No.: "'^1;.• Fet 13125 SW[lull Blvd.,Tigard,Oft 97223 flan Review n a o ) Other Permit: I tune: 503.710.2439 Pax: 503.59f�yi 0 q O 2015 Date/D - -- o1C>15--pod j ~, ® Inspection Line: 503.639.4175 eeDD Date Ready/Dy. iuri� 0 See Plrge 2 for Internet: www.tigard-orgoV Notified/Method: Supplemental Information .: ._,._- _' .e-;._--._.-..:,-ee.�sit=xay6,ti4•- - Y .'t; f:%tvs-..-.t-,- M:.. ""y3.=e�,le= '�sr= _y';.. - s -^`>4,ii e_:qu•.. ":F� -_ - l...n.- ..1Pa"3:• :is ws�k=m..xn.�r:w .g�.:;;,w:i�,..j. ,1sYl ,PLAN,. ;FE �t - ,.,<ns; ®`NCW Construction ` ❑Additl` I ,., Please check all that apply(submit 2 sets ol'plans•w/iten)s checked below): ❑Service or f'eeden 100 amps or more ❑Building over three stories. ❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards. exceeds 10 000 mn)s at 150 volts or 0 Floating b .:M - - `'CST,• '4 --.a:'. ,::,.. _ ¢¢ stn, G'LORI';.OTkG(3.,5Tl2lJC�7'IONk' �a°g[:�;.;�,'+;'•, - ;,sk::.¢ - - .n.7;5,,.;.,".$ .tit,;- - - a,:t r,0..,,s.. - - k<.;:.-.r w:.r,-- <� _;f,.�,.jt.;a,•n:`.5:-;.�=-: - T'�'-,_.�„- a'"'_-�",�`",� .''`.` " :`"';" '•":":` less to ground,or exceeds I•1,000 ❑Commercial-use agrictilt ural ® I-and 2-family clwelling ❑Commercial/industrial ❑Accessory building amps for all other ins;allauons. buildings. ❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation oft50 ICVA or ❑Emergency system. larger separately derived system. ^'4•�`'.'Se`�"a,„5--;;5�,_- �`-_?' .y J, :-fit T��mt _ u.'{.a.L..>,�a �„ ❑Addition of ac%%motor load of ❑ '1 ,1 3" Job no.: Job site address: Jby0rAW QA�N� pR 1001-1P or more. occupancy. S ❑Six or more residential units. ❑Recreational vehicle parks. City/State/Z[P:Tigard,OR 97223 ❑1lealth-care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name �S{�WQOD S�( ❑Service or feeder 600 amps por more.�� r■ + X"i',la''�y-`y'[[.,,P2 `itYraFY�tyi;� Y '�L4uJSt:l'1_L`'Dl'�2`.',E'? x'i'\,••.''•4•sxf';;aF_h5�a�:,c;)i- ° �� - Cross sh'e'et/directions to Job site: Ueseri roan µtv. I Fce. I Total New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 163.54 4 Tax map/parcel I,a.add']500 sq.ft.or portion 3 33.92 I no.. Limited energy,residential F..:,S, „ly:zt SFr,;' �• :::,- 75.00 ? ([vit;above s ft.)iLcu Limned energy,mule-fainly 75.OU � Electrical for new single family residence residential(with above sc.ft.) ReiuewatileilLi er 0:S&Ti:i'a-2 Services or Feeders installation,alteration,aitd/m•relocation ,.':uslti4°',.'•'ice - - y,:r»• - _ . _ _ - -- - '- - •.'I'?ir.':°_ - 200' 0 ;- am s or less 10.70 >a. ':P• ..:#�. ,tip:. tV•IY�R;:s,;,. - �, '1'1.1V:4:NT'.:'ir. 'I 201 amps to 400 amps 133.56 2 Name: L� `t / LLC 401 amps to 600 amps 200.34 2 Address:5255 Meadows Road Suite 171 601 amps to 1,000 amps 301.04 2 Over 1,000 an)ps or volts 552.26 2 City/State/ZIP: Lake Oswego,OR 97035 "Temporary services or feeders installation,alteration,and/or Phone:(503)657-3402 Fax:( ) relocation 200 amps or less 59.36 1 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,(case,rent,or exchange.according to ORS 447,449,670,and 701. +' 401 apps to 599 amps 163.54 2 Owner signature: Date: Branch circuits-new,alteration,or extension,pcr unel .3"• w2'"" „'? max--- „_ - U w,3:•_ A.Fee for branch circuits milt a)i 's'API'•LIC•tt1VT=_3'?;a,,.ra t : ;,: 4. .,:....,:. Business 1.,,-,:,,,tra:gr ,: ,: ir' .a3 s'..._,_ ❑'GONTAGI, i'ERSON-.,y:, I -'._ - -,.:.:�;r.t."'-:c�,,,s.'_:-.._<-:.-,.-:, above service or feeder fee, JTSC,LLC each branch circuit 7.42 2 B.Fee for branch circuits wirhotrr Contact nam V3 t�N WV LA N (D service or feeder fee,first 56.18 branch circuit Address:5285 Meadows Road Suite 171 Each add'I branch circuit 7.42 2 City/State/ZIP: Lake Oswego,OR 97035 111iscellancous(service or feeder not included) Each manufactured or modular I bout: (503) 20Ci -75155 w Fa.: :( ) delling,service and/or feeder 67.84 2 Reconnect only 67.84 2 E-mail: , Oy,JeAnck 0- +sm l hC C 0 m Pump or irrigation circle 67.84 2 1.•vac;ln;- n3:F.� - -- -,.,Y.'xh.�, - _--- -- - - _ ?:r•° r,-_, M _ =-- - Sign or outline lighting 67.81 2 Business name: � �� J Signal circuit(s)or liminal-crier y See ! ' -panel,alteration,or extension. Page ge 2 2 Address: -G/,?�� j11j(�e((/(�( d H-L e, 1 Each additional inspection over allowable in anyof the above 7 I Additional inspection(1 hi min) 66.25/hr City/state/ZIP: l`j, ( YLJ U/1 / Investigation(I hr min) 66.25!hr Phone:(�03) � Fax: Industrial plant(1 hr min) 78.18/hr - Inspections for which no fee is CC13 Lic.. /al!5GI Electrical Lie.: � upr J �?(� specifically listed(%hr min) 90.00/hr - �' ��I:I,C�'11RIC4•I -R�'Idg1�,F>✓)r$�:=.�-;, Suprv. Electrician signature,required: ¢; '; Subtotal: .- Print Warne: Date: Plan review(25a o of permit tee): - State Surcharge(12%offiermit fee): Authorized signature: ;;; < TOTAL PERMIT FEE: Print ) rf DfltC: This permit npplicatiun expires ifit pertnit is not obtained within 130 1 CIttI Itatnc: t •�LL� /f -� �- days after it has been accepted us complete. itiumber of msp�ctmns altowcd per per!nn I Anuilding:Prr:ai!c•E?LC' PcnnilApp_EL.R.L-•ItE d,)c Rt,05/21120!! -1,10-16I5TI1110iX0NVWr.*B Mechanical Permit Application Ll F(O�R OFFICE USE ONLY City of Tigard RECEIVE Receiv Date/B d d /j Permit No.:Ml r /a a- n 13125 SW Hall Blvd.,Tigard,OR 97223 �� Plan Review p C Phone: 503.718.2439 Fax: 503.598.1960 Other Permit a� SCO f JUN 3 0 2 015 Date/By: Inspection Line: 503.639.4175 Date Ready/By. Juris: H See Page 2 for Internet: www.tigard-or.gov CITY OFT IGARDI Notified/Method: Supplemental Information TYPE OF W(%U1LD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES- 1- EES- 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: �3y0 s SW 2)ml4uM OR Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: -r I A R 1) o R q I a13 Furnace 100,000+BTU(ducts/vents) 54.91 Heat ump 61.06 Suite/bldg./apt.no.: Project name:Ashwood Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or h dronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas Mechanical for new single family residence fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ® PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: LF 4,LLC Range hood/other kitchen equipment , 33.39 Address:5285 Meadows Rd Ste 171 Clothes dryer exhaust 33.39 City/State/ZIP: Lake Oswego,OR 97035 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(503)657-3402 Fax:( ) Attic/crawlspace fans 23.32 ® APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name:JTSC,LLC Fuel piping: $14.15 for first four;$4.03 for each additional Contact name:JohnWyland Furnace,etc. Address:5285 Meadows Rd Ste. 171 Gas heat pump Wall/suspended/unit heater City/State/ZIP: Lake Oswego,OR 97035 Water heater 1 Phone:(503)209-7555 Fax: :( ) Fireplace 1 Range E-mail:jwyland@jtsmitheo.com Barbecue CONTRACTOR Clothes dryer(gas) Business name:Integrity Air,LLC Other: MECHANICAL PERMIT FEES* Address:7301 SW Kable Ln Ste 500 Subtotal City/State/ZIP:Portland,OR 97224 Minimum permit fee($90.00) Phone:(503)572-3594 Fax: Plan review(25%of permit fee) ( ) State surcharge(12%of permit fee) CCB lic.:203869 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name:John Wyland Date: 1:\Building\PermitsWlEC_PermitApp_040113A 4444617T (i I/02/COMMEB) Plumbing Permit Application 25�� Building Fixtures E%.'EITEP . OFFICE City of Tigard Received / nd Permit No.: a 13125 SW Hall Blvd.,Tigard,OR ��3 Date/By: (O 5 C O 215 Plan Review Phone: 503.718.2439 Fax: 5038 190 Date/By: Other Permit N161A))e�ls�OQQ Inspection Line: 503.639.4175 /� Date Ready/By: luris-ToSee Page 2 for Internet: www.tigard-or.gov ` VV EGARt p Notified/Method: Supplemental Information TYPE G p(Vi FEE* SCHEDULE ®New construction ❑Demolition For special information use checklist Description I Qty. I Ea. 7 Total ❑Addition/alteration/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 ❑Commercial/industrial SFR(2)bath 437.78 Accessory building SFR(3)bath 500.32 ❑ ry g ❑Multi-family Each additional bath/kitchen 25.02 ❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 13L10% St,J BARNNM OR Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name:ASHWOOD Manufactured home utilities 50.03 Cross street/directions to job site: 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: Lot no.: Q Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Plumbing for newsingle famiy residence Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER [j TENANT Expansion tank 12.51 Name: LF 4,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:5285 Meadows Rd Ste 171 Garbage disposal 25.02 City/State/ZIP: Lake Oswego,OR 97035 Hose bib Z 25.02 Phone:(503)657-3402 Fax:( ) Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name:JTSC,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:John Wyland Roof drain(commercial) 12.51 Address:5285 Meadows Rd.Ste 171 Sink/basin/lavatory 25.02 City/State/ZIP: Lake Oswego,OR 97035 Solar units(potable water) 62.54 Phone:(503)209-7555 Fax: :( ) Tub/shower/shower pan 12.51 E-mail:jwyland@jtsmitheo.com Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name:The Mullen Co.dba Edward Mullen Plumbing Waterg/I te DWV 56.29 p p Address: 1601 SE River Rd Other: 25.02 City/State/ZIP: Hillsboro,OR 97123 Subtotal Phone:(503)640-0113 Fax:( ) Minimum permit fee: $72.50 CCB Lic.:92689 Plumbing Lic.no.: � r �P Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:John Wyland Date: 90 S 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 Industry Service Board. ]:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/C0M/WEB) City of Tigard ' t COMMUNITY DEVELOPMENT DEPARTMENT 4 � o Building Permit Review — Residential Building Permit #: HtiOb Site Address: 1.3 408 �r- Project Name: In Lot #: _ (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: CZ Verify site address/suite# exists and active in permit syste 9�iver Terrace Plan District: Yes LI No Sit Ian Elements: ree(3)copies of site plan sting structures on site If4S e plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure (including decks)with finished awn to scale (standard architect or engineer scale) or elevations rth arrow 21utility locations (required for new,may apply for additions) yCe address,project or subdivision name and lot number ✓ cation of wells/septic systems plicant information(name and phone number) Erosion control (including drainage-way protection, silt fence t dimensions and building setback dimensions sign,location of catch basin,etc.) of area,building coverage area,percentage of coverage andSfreet names pervious area (applicable if R-7,R-12,R-25&R-40) ,7steeet tree size,type and location Property corner elevations (2 foot contour lines if more than IldExisting trees to be retained with drip line,and tree 4 foot differential nrntertinn measures N*A:Iean Water Services—Service Provider Lette�(lot platted prior to 9/10/1995: equired: ❑ Yes,applicant was notified 9,d' No Received: ❑ Yes ❑ No L'J Public Facili s Improvement (PFI) Permit: equired: LTJ Yes,applicant was notified ❑ No Applied For: V/yes ❑ No,stop intake nd Use Case#: �S C-7) L� r oning: —etbacks: Front �c Rear �s Side Street Side Garage � ,/� dscape Requirement: /y/A % of Coverage Maximum: I%Ll. % P uilding Height: Maximum Height Actual Height visual Clearance easements ^/ Vensitive Lands: El Yes Ind' No Type Urban Forestry Plan ❑ Conditions "Met"prior to issuance of buil g permit Notes: _Xr sS �' Approved By Planning: -J Date: ) S^ Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\B u i l d in g\F o rm s\B I d gPerm i tR vw_RE S_031015.d o c x Building Permit Submittal Original Submittal Date: I'VI Site Plans: # _ Building Plans: # _ Building Permit#: CkEnter building permit#above. �� Workflow Routing: 2-Planning engineering ermit Coordinator Lr Building Workflow Sign-off: B"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 original 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: a I Date: Enmoineering Review ;>C, ope at building pad: � Vnditions "Met"prior to issuance of building permit E& ements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes D-50— Assess Water Quantity Fee in-lieu: ElYes L NNo LIDA Facility on lot: El Yes ffl No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: Date: 7 ',4 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit 11 Approved,NOT Released: Chi►-. t�� Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: OK to Issue Permit Approved by Permit Coordinator: G (/� Date: I:\B u it ding\Forms\B IdgPermitRvw_RES_031015.docx FOR OFFICE USE ONLY-SITE ADDRESS: 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. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tijzard-or.gov TO: �,i �`f O� �t C� av,� DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVE FRON!1 _ �la�►��L�_ _ �_1 a. U JUL 2 2 2015 COMPANY: T 5 M r T H co {APA ( CS WYOFTYGA RD PHONE: JOS, CGS " m ,03- BUILDING BiYi� RE: 1;40`d Sul e?ARNU H OR -11 GAPQ r 0R, DIST a01 J' 001 O.'-1 (SiteAddress) ernit Number) ASi-1WOOD'CSJA-TlES LOT ct (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: I 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. 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): =E1 s I No ❑ Done Applicant Notified:T6A&I b I Date: 6- Initials: I:\Building\Forrns\Transmittal Letter-Revisions.doc 05/25/2012