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Permit v 0 1 0 City of Tigard • COMMUNITY DEVELOPMENTDEPARTMENT g I _ III Request for Permit Action 0//, 1 :c i,ARC) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermit@tigard-or.gov FROM: ❑ Owner 1E1 Applicant ❑ Contractor ❑ City Staff Check(V)one REFUND OR Name: INVOICE TO: (Business or Individual) S#_ g,.. 01 c. (.,4---c AA. 44...G. . Mailing G- Mailing Address: 'fZ A 6,-L-,...-1( Cl- (--,-,4c l e a City/State/Zip: 4.--k Oc•..,fb /e1X/e17q 7055 Phone No.: 3—°3 387— 7577 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): . CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ►ge INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: r i5- 6 4r 2 f ( / çj 9' Site Address or Parcel #: jZ Q 7S l 1./,...., c%� 0. Subdivision Name: Sert.%1-� U,1.-. M , L.1„,- Lot #: 30 EXPLANATION: C....4 ,e ,� rie e4. r.e..,4— A,` a”. (a /-- 4e1/%) fr_ el'll/.7i- ivcirib-ee-/')si A4/6 --taco 7Jy /3 7:. f.rej2o? 7 r‘,,,—00/0 7 Signature: v Date: 1/4/76 Print Name: Refund Policy 1. The city's Community Development Director,Building()fficial or(1itc Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 800 of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. .Ul refunds will be returned to the original pacer in the form of a check via ES postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE UST ONLY Route to Sys Admin: Date By i Route to Records: Date 4/!o / By 447 Refund Processed: Date B: 4 j Invoice Processed: Date y 6 je By IP' • Permit Canceled: Date ' G// By art. arcel Tag Added: Date By I:ABuilding\Forms\Rcyl'e mit.Action_(92314.doc City of Tigard • COMMUNITY DEVELOPMENT Building Division 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TIGARD INVOICE TO: Stone Bridge Homes NW,LLC Customer ID: 173318 4230 Galewood St, Suite 100 Invoice No.: INV2016-00012 Lake Oswego, OR 97035 Invoice Date: 04/06/2016 Date Due: 05/06/2016 Case No. Site Address Subdivision-Lot#or Project Name Amount Due MST2015-00060 12078 SW Turnagain Dr. Southview Heights,Lot 30 $753.25 Plan review fees due for plan review completed prior to receiving request to cancel permit(resubmitted under MST2016-00134). Invoice Total: $753.25 ® Please see attached fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: MST2015-00060 Customer ID: 173318 Site Address: 12078 SW Turnagain Dr. Invoice No.: INV2016-00012 Project: Southview Heights,Lot 30 Invoice Date: 04/06/2016 Date Due: 05/06/2016 Invoice Total: $753.25 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 I:\Building\Accounting\Invoice.doc 01/14/2011 CITY OF TIGARD RECEIPT 111111 2 r 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 401236 - 12/28/2015 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2015-00281 Plan Review 230-0000-43106 $750.00 Total: $750.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 43032 BTAGGART 12/28/2015 $750.00 Payor: Stone Bridge Homes NW, LLC Total Payments: $750.00 Balance Due: $23,869.74 Page 1 of 1 iik9k/ ' Building Permit Application V 0 1 0 L//o/fk paw}'v it F"Q" Residential RECD- k6 f FOR OFFICE USE ONLY Cl of Tigard - ' Received „ WAWA' Permit �/'n �/ /J fi `J g Date/By: `2 k J `1.„,�� S/d`0/�l/al�Cr7/ I w 13125 SW Hall Blvd.,Tigard,OR 97223 D`C 2 2015 Plan Review t 2 1 L / ���0/���sJA� Phone: 503.718.2439 Fax: 503.598.1960 DateBy: 1 Other Per 142 Inspection Line: 503.639.4175 GR(-y #, r Date Ready/By: o� oris: 10 See Page 2 for T I G A R D �, l i( t 14I Zi0 Off” Internet: www.tigard-or.gov r..� 33o Orr t ,.., + Notified/Method: Supplemental Information twit\ t i )t ss ,A -!,,,, z,;10:;;,,,4,-:4:;,-,,,,4xrQF WQRi£ rt V 4 i 2 FAMI l YDWELL1N ®New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicatt,the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,- aterials,labor,overhead,and the profit for the ,, TE � F"© �� O Y % i work indicated on Misapplication.WCfa , ® I-and 2-family dwelling ❑Commercial/industrial Valuation36 -744.4.,---it 4, b li 1�$ 0 Accessory building EIMulti-familyNumber of bedrooms: ❑Master builder ❑Other: Number of bathrooms: w ,:i 4FQ y t 4Total number of floors: 2.. fi✓% +.ate m., , a. A � /, -„G, .e , ,,, e ,d, T . ,,ziiza Job site address: 11.01 f+`i +:1u IQ Fe-N.64PM N m. New dwelling area: 301 P square feet3 it 7 ci City/State/ZIP:Tigard,OR 97224 Garage/carport area: 4(9 square feet Suite/bldg./apt.no.: Project name:Southview Heights Covered porch ar square feet j 617 Cross street/directions to job site:SW 122""Ave&SW Beef Bend Rd Deck area: 3Z '3 CO square feet',c Other structure area: square feet I --'--.74‘,--,'•1,:# E off; .4 R „ �� � „ ' Subdivision:Southview Heights Lot no.: ' O 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 FfirlWa,„ `` i SOF +L , work indicated on this application. Valuation: $ new,single family residence Existing building area: square feet New building area: square feet „�, � c' k'.'' fes' - } a: T3 E iT t 6-ii ti ,5iw-❑ TENA v0tzi • Number of stories: t . Name:Stone Bridge Homes NW,LLC Type of construction: Address:4230 Galewood St,Suite 100 Occupancy groups: City/State/ZIP:Lake Oswego,OR 97035 Existing: Phone:(503)387.7577 Fax:(503)387.7615 New: ,sem -_r , ikeri,i r5. .'r _76 G R kz Business name:same as above Structural plan review fee(or deposit): Contact name:Deirdre Britt FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Amount received: Phone:( ) Fax: :( ) PHO VOLTAI SOLAR'PANEL SYSTEM FEES*: „ E-mail:dbritt@stonebridgehomesnw.com �' Commercial and residential prescriptive installation of CONTRACTOR , roof-top mounted Photo Voltaic Solar Panel System. Business name:same as above Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/1_IP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: 173318 Total fee due upon application: $201.60 Authorized signature: ....-c .----t-A%' This permit application expires if a permit is not obtained \ __.. within 180 days after it has been accepted as complete. Print name: -DEAF:.�j k'+.,i; 13Rj,('j”' Date: )2.I'2,1/1 Gj "Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB) r . � i VOID Electrical Permit Applicat d ` %.---, ---u -- FOR OFFICE USE ONLY • (` ,� , Received City of Tigard 7 1, 9 9 2015 line/By Penuit No[Af702,0/`�00.2f / N 13125 SW Hall Blvd., Tigard,OR 9723- Plan' Review !/ /�"' J 1 '� Phone: 503.718.2439 Fax 50309,31 q 6 Q - Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 ' r Date Ready/By lien IPJ See Page 2 for Internet: www.tigard-or.gov i.. ,.•,, ,:,,,i`s„,,t`1 Notifiedeth /Mod: Supplemental Information � 5 =-Wri'•i?ti}1rQRk Y' 1 s Please cheek all that apply(submit 2 sets of plans whims checked below): ®New construction ❑Addition/alteration/replacement ❑Service or feeder 400 amps or mote ❑Building over three stories. ❑Demolition ❑Other: where the available fault runcnl ❑Marinas and boatyards. "elf -4, � iii '.. `1R€�y ij ' exceeds 10,000 amps at I50 volts or ❑Floating buildings. ,< t f•-- I•�ara,e 3„,..,..,„t ,,,,�.; ,s. ;, :,',� "t .,, less to ground,or exceeds 14,000 ❑Commercial-use agricultural ® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building amps for all other installations. buildings. 0 Multi-family ❑Master builder ❑Other: 0 Fire pump, 0 Installation of 150 KVA or -_ s - e m 11 ,i r q,�, _ 0 Emergency system. larger separately derived system, r , ,.,•:, k "�." s..''':',,,d r .1 ( ,�.''',,,' r, �.'.f new load - I- r �? P, <h- - � ,.,.,,, ❑Addition of tc ❑ ,A., ..F„..I 2.,., 3„ Job no.: I ttil Job site address: 1201 t SVJ U A-I g DR_ loot 113 or more, occupancy, ,/ 0 Six or more residential units. 0 Recreational vehicle parks. City/State/l.1P:Tigard,OR 97224 ❑Health-care facilities, 0 Supply voltage for more than _... ❑Hazardous locations. 600 volts nominal Suite/bldg./apt.no.: IProject name:Southview Heights 0 Service or feeder 600 amps or more. Cross street/directions to job site:SW 122"Ave&SW Beef Bend Rd Description 1 Q,y ' leer. 1 raid a, New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision:Southview Heights I Lot no.: 30 1,000 sq ft.or less 168-54 4 -''VV Ea,31.1'1 500 sq,fi,or portion 33.92 Tax map/parcel no.: Limited energy,residential 75,00 2 rtl ' ., ' l 4 r ( '- x , v (with above sq.ft.) j Limited energy,multi-tinnily 75,00 2 new,single family residence residential(with above sq.1L) Renewable Energy ❑ See Page 2 " ' - Services or feeders installation,alteration,and/or relocation "° 200 amps or less 100.70 2 201 amps to 400 amps 133"56 2 Name:Stone Bridge Homes NW,LLC 401 amps to600amps 20034 2^ Address:4230 Galewood St,Suite 100 601 amps to 1,000 amps 301,04 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP:Lake Oswego,OR 97035 Temporary services or feeders installation,alteration,and/or Phone:(503)387.7577 I Fax:(503)387.7615 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,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 • 2 Owner signature: Date: __ Branch circuits-new,alteration,or extension,per panel lr. t• 8 q lL y + "'r '„ A.Fee for branch circuits with v above •service or feeder fee, 7.42 2 Business name:same as above each branch circuit B.Fee for branch circuits without Contact name:Deirdre Britt service or feeder tee,first 56.18 2 branch circuit Address: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) City/State/ZIP: Each manufactured or modular 67,84 Phone:( ) Fax: :( dwellin service and/or feeder Reconnect only 67,84 2 E-mail:dbritt(dlstonebridgehomesnw•coo Pump or irrigation circle 67,84 2 0I, a f 0: ,rm9i4'Il2 ,...E I# +, ' ' •,`ti sk '4' , Sign or outline lighting 67,84 2 Business name:City Electric Signal cilcuit(s)or limited- nergy Sec ___ panel,alteration,or extension Page 2 Address:55568 SW Schaltenbrand Ln Each additional inspection over allowable in any of the above Additional inspection(I Its min) tie 25/hr CityiState/ZIP:Sherwood,OR 97140 Investigation(I hr nun) 66.25-hr Phone:(971)404.1714 Fax:(503)625.3052 Industrial plant(1 hr min) 78 I S/hr ------ __—_. -_.- ---_—_. Inspections for which no Ice is e CCB Lic,: 42422 1 Electrical Lie.: 26-289C Suprv. Lie: 35925 specilically listed W.:hr min) 1 mull• h; - ---_ ELECTRICAL. PERMIT FEES e_,..,-- -._—.-- Suprv. Electrician signature. required: Subtotal ' ( Maunvren (25 d permit leer.~ Print mime: (hucl. Friesen I Date:111 State surcharge(I2 0 of pet mt lee): Atilhorized signature: (1IAl.PLRIb11l TI'i:' � .. Thi.pctnnt ytl hcthun c�pite tl t punul I+mol uhl.tincel tt irhin earl I t int name-. I�nle' d.t�;.tllet J ha.befit.t n'eplul.tc corn plebe. Nuntha nl insliraums allowed p5 permit '.Ii„I.: .. t,;il.,.l l.e' 1'.• t, �-� I I.k i s. I.,.. te:, i:'i:-r,11 i ,:.l:.I il-!'-i['(1?.I.\t:l n I / '4 nIn LI tri' t .r ; 4 '';'" Mechanical Permit Applicayttit:t ,- , .,, - , 1 FOR OFFICE USE ONLY • City of Tiga rd Received Ilatc/Ily N01.5:2;20/f,60,211-7 I I " 13125 SW I tall Blvd.,Tigard,OR 97223 D7C 2 2 2015 Plan Review Permit Phone: 503,718..2439 Fax: 503,598.1960 Datelly. Oilier Permii: TIGARD Inspection Line: 503.639.4175 (';r r‘,, t_„,,, j , . ' , Date Ready/By: loos El See Page 2 for Internet: www.tigard-or.gov .... Notified/MethodSupplemental Information n)Ple oi: Avngic COMMERCIAL FEE* SCHEDULE- USE C1JECKUST 1, Mechanical permit fees*are based on the value of the work El New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 1=1 Demolition 111 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ Ih , ,,I ,„I;34thiOji:iilltiiiit 'z''''' Ei I-and 2-family dwelling III Commercial/industrial III Accessory building For special information use checklist. Ill Multi-family 0 Master builder ci Other: Description Qty. Fa Total ''.',.i4g"":"V-Liffi: 41,40.AY'-A'ifil411,4r4I-26;411We'41;t4V,v,A4',cir -",4:0-','''' ''-'44)';SI: . - • , ... ' I Air conditioning 46.75 I Job site address: )2074) StAi T RA A("A N PR • Furnace 100,000 BTU(ducts/vents) 1 , 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: I Project name:Southview Heights . Duet work 23.32 .._ Cross street/directions to job site:SW 122"Ave&SW Beef Bend Rd 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 Flue/vent for any of above 23.32 Other: 23.32 1 Subdivision:Southview heights Lot no.: 3h - Other fuel appliances: Tax map/parcel no.: Water heater 23.32 i Gas tireplace/insert , 33,39 Flue vent for water heater or gas 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 1 , -,,----- 0, --- -.-.- • -vp,,,--,-- eiv.40..-.• ,1....k.,.A.,...,,,,,,,.4 -.,k*,114,,,*. Other: ottetowAbe-- --gutt,it.Y-4):'--- fita- m'A"''''''''''' '''''''*' 23.32 - 1 #. -.`,,,q-- '-''''' ''',',/t- ' ',1"-st----'-'---- ' --•• ---".,-,,,-+-'-'-'11--- Environmental exhaust and ventilation: Name:Stone Bridge Ilomes NW,LLC Range hood/other kitchen — — _equipment_ 33.39 Address:4230 Calewood St,Suite 100 Clothes dryer exhaust 33,39 City/State/ZIP: Lake Oswego,OR 97035 Single-duct exhaust(bathrooms, - toilet compartments,utility rooms) 23.32 Phone:(503)387.7577 Fax:(503)387.7615 Attic/crawlspace fans .. 23.32 1:-a-,s,-fr7.51:,,tz;l4,-.7i..-t5r.,,,rt./ Other: 23.32 { Fuel piping: Business name:same as above S(4,15 for first four;54.03 for each additional i Contact name: Deirdre Britt Furnace,etc. .., (las heat pump Address: Wall/suspended/unit heater City/Stale/ZIP: Water heater _ t . t , Phone:( ) Fax::( ) Fireplace --- - Range. E-mail:dbritt(a)stonebridgehomesnw.com i 13arhecue 1 CONITtACT012Clothes dryer(gas) , 1 , , • I 1 Business mime:COther: omfort Zone NI E'ClIANICAL PERMITFEES* -"[-Y. -'' Address: 1(132 NW Corporate 1)i- Subtotal , .., City/State/ZIP.Troutdale,OR 971160 MI111111E1111 pel mil fee(500.00) Plan review(25%Of period lee) ' I Phinie:(503)667 I Fax:(503)491.8252 Slatesurcharge(12%of permit lee) . , „..... ... . ......,„, ....,........ . , l'Cll lic.: 1141091 TO FAL VE1011.1 FEE iith.Perinit aPPIICatOMe;ciiirCs il a permit is not obtained within 1-44- tin),a her it has been accepiell As COMpie IC. ,'----m----> AO 1101.1/Cti'.Ignaillre: A ,--:.,_ ._.---,- ---"L''"-- - l cc niciliottitine So by 1 thr0.10) Itoddine Intlithiy Service!thud l't int name Da k id Ileldslab I Date: 1 , . .. : . , ,,,i J:r ,. • V 0 I 0 I lumbin2 Permit Applicati4ri; , i, : ' V , t„.. • Building Fixtures Fon OFFICE USE ONLY C 7 C 2 2 2015 Received �(�J City of Tigard Pemit N !SP4/5"O0 / n 13125 SW Hall Blvd.,Tigard;OR Tri! 3 ,I s , , Da1cJl3y: III 0 , t- Plan Review Other Permit No.; ' Phone: 503.718.2439 Fax: 501�91i,1'60 w,I Dalc/fay: T1GARI) Inspection Line: 503,639.4175 Date RcaayiNy. Joris: 0 See Page 2 for Internet: www.tigard-or,gov Notified/Method: Supplemental Information 4.1' TYPE OF1.`►YO FEE* S9 ED17 >~ .#1ks440 El New construction onstr rtiolrJtY ti> EI Demolition For special information use checklist. Add Description I Qty. I Ea, I Total t/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) r. , i �'8 t ''0 � ' 4 � SPR(I)bath 312.70 I SFR(2)bath , ® 1-and 2-family dwelling IDCommercial/industrial , SFR(3)bath 500.32 ❑Accessory building ❑Multi-family - Each additional bath/kitchen 25.02 0 Master builder 0 Other: Firesprinkler sq.ft. Page ' r F d , :r t � „'r'''..!(, tt � S Site utilities: Catch basin or area drain 18.7 6Jobsto address: IVO-It $W TtUz.4 t&Ail4 DR Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97224 Footing drain(no,linear It: ) Page 2 Suite/bldg./apt.no.: I Project name:Southview Heights Manufactured home utilities 50.03 Cross street/directions to job site:SW 122"1 Ave&SW Beef Bend Rd Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision:Southview Heights I Lot no.: 30 Fixture or itcm: Tax map/parcel no.: Backflow preventer 31.27 ;� � w .:r r Backwater valve 12.51 Clothes washer 25.02 new,single family residence Dishwasher 25.02 ~ Drinking fountain25.02 Ejectors/sump 25.02 r �', '' ExExpansion tank 12.51 ?. ..�W�' ...� Vi' i�° d�... �., A :- ,.. ?94 re „� � n Name:Stone Bridge Homes NW,LLC Fixture/sewer cap 25-02 Floor drain/Floor sink/huh 25.02 Address:4230 Galewood St,Suite 100 Garbage disposal 25.02 City/State/ZiP:Lake Oswego,OR 97035 Hose bib 25.02 Phone:(503)387.7577 Fax:(503)387.7615 Ice maker 12.51 f E-I ®< !,.' f <.._ � t :�a-;g�i, , nlerceptor/grease trap 25.02 yds', f , . .„, k,^.. � r . h Business name:same as above Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Deirdre Britt - Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 ti-mail dhrittta)stoncbridgchomesnw.com Urinal 25.02 NWater closet 25.02 ~OrRACTOR � fr. Water healer 37.52 Business name: Max Plumbing ,._._._._ _. . - --._-- Wider pipinJl)W V 56.29 Address:PO Box 5597 Other: 25,02 ('iiv/Slate//.I P: 1leavertun,OR 97006 Subtotal Phone:(971)275.0198h;15:( ) Minimum permit lee: $72 50 12(0541'2''' ��� Plan redo, ( 5 ul permit Ice) (�('B Lie.: Plumbing I is no.: 1 �' -- \t re,,,,,..h.„(12,of perms' Ice) Atnhorvul signature. ` } /'e.--+ 1 �,,...CL �G I c)111 PI-10\11'1. 1 1 1 .. - l ........... -fins perunl application expires t ,per nut,s not obtained mi Rhin ISO days Pi n;une:.lason Iltrr'ncr I I)ntc: alley it has been ackcpicil as cumniere. "FCc mahudrdogs 5,9 M In-Comas I3mldntc Indu>ais Sc:s ice 13naid Vlyl;lirr•.1'.r;nu•,I'I AHI-Fenno 4plutnc Id:iA^ 41.=i0,t,1;Iann:I ),I.W1'il 7 /6. City of Tigard vIII COMMUNITY DEVELOPMENT DEPARTMENTr .....„ , ,, , - T I G A R D Building Permit Review — Residential Building Permit #: e_sro21L5 -- m,21/ Site Address: 120'1% SW U r n P,_ Lx ,r) D f D . Project Name: j bh V i eve Bei/!"4-5 Lot #: 30 (New dwelling=subdivision am ,-\ddon or.Alteration= last name of owner) Planning Review Proposal: t e,w S P Verify site address/suite# exists and active in permit system. River Terrace Neighborhood: ❑ Yes No Sit Plan Elements: hree (3) copies of site plansting structures on site pite plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished rawn to scale (standard architect or engineer scale) poor elevations orth arrow LJ Utility locations (required for new,may apply for additions) 'te address,project or subdivision name and lot number cation of wells/septic systems EVAplicant information (name and phone number) rosion control(including drainage-way protection, silt fence t dimensions and building setback dimensions design,location of catch basin,etc.) 21t)Lot area,building coverage area,percentage of coverage and street names pervious area (applicable if R-7,R-12,R-25&R-40) Street tree size,type and location L:1Property corner elevations (2 foot contour lines if more than ' ❑Existing trees to be retained with drip line,and tree 4 foot differential) protection measures Igt Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): equired: II Yes,applicant was notified VC,No Received: ❑ Yes E No N(ItPublic Facilities Improvement(PFI) Permit: equired: ❑ Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake LJ Land Use Case #: sU i3 — 2 6 0 0Cil. Voning: Retbacks: Front 15 Rear 1 S Side S Street Side — Garage 10' MC/Landscape Requirement: '2.0 % M Lot Coverage Maximum: $o 1 *Building Height: Maximum Height 35 Actual Height r%'., 32 ,mydisual Clearance 'asements ensitive Lands: ❑ Yes Ng No Type Urban Forestry Plan LSA Conditions "Met"prior to issuance of building permit Notes: ` IV � Approved By Planning: /6 1 i m Lei\l�(b ath) Date: 12 22415 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\Building\Fonns\BldgPennitRvw_RES_070915.docx Building Permit Submittal Original Submittal Date: /ca/2.2/Z5— Site Plans: # / Building Plans: # 7 Building Permit#: L7 Enter building permit#above. Workflow Routing: Ek-Planning 111- Engineering 111--'ermit Coordinator Building Workflow Sign-off: 0' 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: 4/4%1X/ Date: /aX23/--5 Engineering Review Slope at building pad: Conditions "Met"prior to issuance of building permit Easements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes No ❑ NOT Approved by Eng' eering: Date: Notes: . ,i.• i • /--I1 _- I� ./� - Approved by Engineering: 42. p Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved Cl Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: yes ❑ N/A Tigard Trans SDC: ❑ Yes ,W N/A Parks SDC: 12f Yes ❑ N/A 7 OK to Issue Permit Approved by Permit Coordinator: Date: /-0 45/i c 1:ABuilding\Fonns\BldgPennitRvw_RES_0709I 5.docx