Permit (83) CITY OF TIGARD MASTER PERMIT
IN u
'' COMMUNITY DEVELOPMENT Permit#: MST2015 00304
Date Issued: 08/15/2016
T JIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2515/20/6 500
Jurisdiction: TIGARD
Site address: 8240 SW NORFOLK LN
Subdivision: HOGGAN'S PARK Lot: 6
Project: Hoggans Park, Lot 9
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1170 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 1611 sf Garage: 526 sf Front: 15 Smoke Yes
Dwelling Units: 1
Third: 0 sf Right: 5 Detectors:
Total: 2781 sf Value: $339,256.72 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0
Drywell-Trench Drain: 0 Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2781
Owner: Contractor:
WESTWOOD HOMES LLC WESTWOOD HOMES LLC Required Items and Reports(Conditions)
12700 NW CORNELL RD 12700 NW CORNELL RD 1 Ersn Cntrl 503-639-4175
PORTLAND,OR 97229 PORTLAND,OR 97229
PHONE: PHONE: 503-330-2215
FAX: 503-342-2403
Total Fees: $24,071.92
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
bed in accordanc- ith approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspend for more the 180
d s. ATTENTION: Oreg• law requires you to follow the rules adopted by the Oregon Utility Notification Center/ Those rules - e set forth in OAR
52-001-0010 through OAR 9, -001-••• :/You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19or 1 1..332.234'.
Issued By: 1 _, / ./- i� ..,..4..... . Permittee Signature: / ' ' -
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the projec
Approved plans are required on the job site at the time of each inspection.
for 9
Building Permit Application i
Residential FOR OFFICE FSE ON Ll
Received Permit No.:
City of Tigard Date/B : t/ ,— ? ', a',
NI 13125 SW Hall Blvd.,Tigard,OR Plan ReViewit
J Other Permit: '�%J 1
lig _ Phone: 503.718.2439 Fax: 503 ^ 1� Date/B : � � -,,�page 2 for
T I G A R D
Inspection Line: 503.639.4175 k® Date Ready/By: Mill ", ge 2l Information
Internet: www.tigard-or.gov c ' l Gick� Notified/Method: pple
TYPE OF r* Q`�e�\ REQUIRED DATA:1-ASID 2-FAMILY DWELLING
New construction v o7i`tion Permit fees*are based on the value of the work performed.
® Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
.
® Valuation j3 r
1-and 2-family dwelling 0 Commercial/industrial risk$ 27377,-6,a2 `-jt
Number of bedrooms: a
❑Accessory building 0 Multi-family
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: L 3 3 O 7
Job site address: �`',(:7'1,'') 1Li/ 464-rile I c o<,
New dwelling area: l 7 s( square feet
City/State/ZIP:IT_) , ,,/ l l j, f.}r'C? Garage/carport area: 521 square feet
f Coveredporch area: f 7square feet f
Suite/bldg./apt.no.:' Project name: j -(„ 14 r —" 1 q 1 6
i
Cross street/directions to job site: Deck area: square feet 1 110
Other structure area: = square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: n e C~C,-< fin /( Lot no.: i Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no> equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
New Single Family Construction
Existing building area: square feet
New building area: square feet
l PROPERTY OWNER 0 TENANT Number of stories:
Name:Westwood Homes LLC Type of construction:
Address:12700 NW Cornell Rd Occupancy groups:
City/State/ZIP:Portland,OR 97229 Existing:
Phone:(971)678-5018 Fax:( ) New:
E( APPLICANT 0 CONTACT PERSON, BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Westwood Homes LLC Structural plan review fee(or deposit):
Contact name:Matt Fricke
FLS plan review fee(if applicable):
Address: 12700 NW Cornell Rd
Total fees due upon application:
City/State/ZIP:Portland,OR 97229
Amount received:
Phone:(971)678-5018 Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:Matt@Westwoodhomesllc.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name:Westwood Homes LLC
and fire department access,along with the 2010 Oregon
Address: 12700 NE Cornell Rd Solar Installation Specialty Code checklist.
Permit Fee(includes plan review $180.00
City/State/ZIP:Portland,OR 97229 and administrative fees):
Phone:(971)678-5018 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 195597Total fee due upon application: $201.60
e
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:Matt Fricke Date: V f."I 1 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
Received Permit No.:
'pity of Tigard
Date/By:
14 a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.59 ,ND Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: .tuns: ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov I J Notified/Method: Supplemental Information.
QEC $ d
TYPE OF WORK1CaPF� wr
COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
�'` (� 50" Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alt �Ciplt, �t performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: tyU11tLF mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other:
Description Qty. Ea. Total
Heating/cooling:
JOB SITE INFORMATION AND LOCATION Air conditioning I 46.75
Job site address: ?', 2,,9 51 1, fkr f ci k ((,/i^ ? Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard OR Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: 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
Subdivision: �n C' / Lot no.: tt
Other: 23.32
//
,O`w, i?)r,� I_ Other fuel appliances:
Tax map/parcel no Water heater I 23.32
DESCRIPTION OF WORK Gas fireplace/insert ( 33.39
Flue vent for water heater or gas
new SFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
►,i PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name:Westwood Homes LLC Range hood/other kitchen
equipment 33.39
Address:12700 NW Cornell Road _Clothes dryer exhaust I 33.39
Single-duct exhaust(bathrooms,
City/State/ZIP:Portland��yOR 97229 toilet compartments,utility rooms) it 23.32
Phone: 111/-C:71-93 f Fax:(503)342-2403 _Attic/crawlspace fans 23.32
E APPLICANT_ 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Westwood Homes LLC $14.15 for first four;$4.03 for each additional
Contact name:.met Fr'tre, Furnace,etc.
Gas heat pump
Address: 12700 NW Cornell Road Wall/suspended/unit heater
City/State/ZIP:Portland OR 97229 Water heater
Ili_6 yl-C Fax::(503-)342-2403 Fireplace
Phone: IQ1Range
E-mail:ft4 a4westwoodhomesllc.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:Central Air MECHANICAL PERMIT FEES*
Address:PO Box 433 Subtotal
Minimum permit fee($90.00)
City/State/ZIP:Clackamas,OR 97015 Plan review(25%of permit fee)
Phone:(503)656-1908 Fax:(503)650-3898 State surcharge(12%of permit fee)
TOTAL
lic.: 178624 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
r
Print name:Jon Montgo Date: 712 /16(5
1:\Building\Permits\MEC_PermitAPP_040i13.doc 440-4617T(i1/02/COM/WEB)
I
Electrical Permit Application FOR OFFICE I SE 0\I.1
L City of TigardRecei
ved
Date Permit#:
II • 13125 SW Hall Blvd.,Tigard,OR 97aN Plan Review
I Phone: 503.718.2439 Fax: 503.598? w 1 o1C3 Date/By: Related Penn it#:
Inspection Line: 503.639.4175 %[ g .- Ready Date/By: Juris: 0 See Page 2 for
1 I G A R D Internet: www.tigard-or.gov q-1, ry Notified/Method: Supplemental Information
TYPE OF WORK 0% �, t \o PLAN REVIEW
®New construction 0 Addition/alteratioca.>�p1 °` Please check all that apply(submit 2 sets of plans w/items checked):
\�`I 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: `" where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
` ❑
Job#: Job site address ��, t
'i 7 t`� ,, f'����,�-f,(K („7„'a' 100HP or more.
❑Six or more residential units. occupancy.
() ' ,., ❑Recreational vehicle parks.
City/State/ZIP: '�` ��G � �/��, /�'l,l�'-� ( ❑Health-care facilities.
/ / 0 Supply voltage for more than
Suite/bldg./apt.#: /
Project name: ❑Hazardous locations.
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: ?r* t. 170 K Lot#: t Includes attached garage.
/:,/
/f?j. �' 1,000 sq.ft.or less i168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft.or portion S- 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
New SFR Limited energy,multi-family
75.00 2
residential(with above sq.ft.)IS
Renewable Energy ❑ See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Westwood Homes LLC 200 amps or less 100.70 2
201 amps to 400 amps I 133.56 2
Address: 12700 NW Cornell Rd 401 amps to 600 amps 200.34 2
City/State/ZIP:Portland,OR 97229 601 amps to 1,000 amps 301.04 2
Phone:(971)678-5018 ,. Fax:( ) Over 1,000 amps or volts 552.26 2
� L( Temporary services or feeders installation,alteration,and/or
Email:� '��( Vii`"=' � ?•>141,o-< „E l i(% 2 p=�. ;. r)'',-.
: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less I 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
la APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name:Same as Owner above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Ross Electric Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2870 SE 75th Ave#203 panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Hillsboro,OR 97123 Additional inspection(1 hr min) 66.25/hr
Phone:(503)642-2800 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:RossElectrie@eomeast.net Inspections for which no fee is
specifically listed('A hr min) 90.00/hr
CCB Lic.: 157891 Electrical Lic.: 34-436C Suprv.Lic.: 42325 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Stephen Ross Date: 0 Plan Review Required(25%of permit fee):
r/ State surcharge(12%of permit fee):
f TOTAL PERMIT FEE:
Authorized signature:��i I 1 1J
This permit application expires if a permit is not obtained within 180
/
days after it has been accepted as complete.
Print name: Date: `Lr L.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard ® Received
vedBy: Permit No.:
III0 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
S Phone: 503.718.2439 Fax: 503.598. \I q Other Permit No.:
�Q\� Date/By:
T t G A R D Inspection Line: 503.639.4175 ate Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov �- ed/Method: Supplemental Information
TYPE OF WORK ((;'� tic'AQ`���\ � FEE* SCHEDULE
0 Dem% ON� For special information use checklist
0 New constructioni
��jj `�- Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
O 1-and 2-family dwellingSFR(2)bath 437.78
❑Commercial/industrial
SFR(3)bath i 500.32
0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
�y i.Y
Job site address: d tCatch basin or area drain 18.76
; <.,-/ Ab( f";t" /1)141
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard OR Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: 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: r~ ?rl! C ,'k" Lot no.: 1 Fixture or item:
Backflow preventer ( 31.27
Tax map/parcel no..
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer ( 25.02
new SFR Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
e: PROPERTY OWNER ( 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Westwood Homes LLC
Floor drain/floor sink/hub 25.02
Address:12700 NW Cornell Road Garbage disposal ( 25.02
City/State/ZIP:Portland OR 97229 Hose bib 2.- 25.02
Phone: all-f- 61-1-coif Fax:(503)342-2403 Ice maker 12.51
r41 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
1 / yd u 5 j Medical gas(value:$ ) Page 2
Business name: �nlY�(, /�CIC � 4� Primer 12.51
Contact name:(14i *TT Frl c ke, Roof drain(commercial) 12.51
Address: 5 t pie ,si r Sink/basin/lavatory f-( 25.02
City/State/ZIP:e/ Solar units(potable water) 62.54
Phone:6 ( )e-K- i5 Fax::( ) Tub/shower/shower pan L. 12.51
Urinal 25.02
E-mailMiegwestwoodhomeslIc.com
Water closet 25.02
CONTRACTOR Water heater ( 37.52
Business name:H&H Mechanical Water piping/DWV 56.29
Address:5757 SE Willow Lane Other: 25.02
City/State/ZIP:Milwaukie OR 97267 Subtotal
Phone:(503)975-9787 Fax:(503)659-2979 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:178122 / r'Plumbing Lie.no.: State surcharge(12%of permit fee)
Authorized signature: i s , ,/ - / TOTAL PERMIT FEE
rte" '! . -7/ -- ,
G
Print name:Dusti ague Date: a(161 fuir> 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.
1:\Building\Permits\PLMU-PermitAwdoc 10/01/09 440-4616T(10/02/COM/WEB)
%I City of Tigard
q COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c n Building Permit Review — Residential
Building Permit #: Pi>r,20 i f-cam 3 Olt
Site Address: g „3,0 Nor /4 L
Project Name: fj Lot #: 7
(New g= subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: ARWO ce-
/Verify site address/suite# exists and active in permit syste7.
ORiver Terrace Neighborhood: ❑ Yes lIQ No
Sit/Plan Elements:
tree(3) copies of site plan 10 i'isting structures on site
o plan must be on 8-1/2"x 11"or 11 x 17"paper ft Footprint of new structure(including decks)with finished
Vawn to scale(standard architect or engineer scale) fl r elevations
e rth arrow Utility locations (required for new,may apply for additions)
address,project or subdivision name and lot number 0 I ation of wells/septic systems
. .plicant information(name and phone number) '/. rosion control(including drainage-way protection, silt fence
74 t dimensions and building setback dimensions d ign,location of catch basin,etc.)
Lot area,building coverage area,percentage of coverage and Veet names
impervious area (applicable if R-7,R-12,R-25&R-40) Street tree size,type and location
' O r perty corner elevations (2 foot contour lines if more than 0 isting trees to be retained with drip line,and tree
4 foot differential) protection measures
! I lean Water Services—Service Provider Lette of platted prior to 9/10/1995):
i
equired: ❑ Yes,applicant was notified LIQ/ No Received: ❑ Yes ❑ No
ublic Facilitie mprovement(PFI) Permit:
Lequired: Yes,applicant was notified E No Applied For: es ❑ No,stop intake
and Use Case#: '.S4' jc `/'1— �?
4oning: tie" L
etbacks: Front /5" Rear /S Side Street Side / Garage o2 C
V andscape Requirement:
Pir je
of Coverage Maximum: e
V Building Height: Maximum Height 36-' Actual Height r . /'
fdiu�sual Clearance
Id I ;asements
OA ensitive Lands: ❑ Yes Vlo Type
III, Urban Forestry Plan
❑ Conditions "Met"prior to issuance of building permit �J
Notes: Gn s rne.cSli. 4 /14.0? pc oi c- I•SS' C..%44.2nKY
»I� �Y► f'1/
liS
Approved By Planning 9-[[� - ;� - Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\B1dgPennitRvw_RES_070915.docx
Building Permit Submittal
Original Submittal Date: V-441 S'
Site Plans: # 3
Building Plans: #
Building Permit#: ,,� �i �ii building permit#above.
Workflow Routing: Lf—Tri ❑ Engineering ❑ Permit Coordinator ❑ Building
Workflow Sign-off: -off for Planning(include notes from planning review)
Route Application Documents: E -engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original Ian review routing form.
uilding: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: --,� eS. ,; '�' Date: it, � �� `;�
Engineering Review
re Slope at building pad: .2 "
conditions "Met"prior to issuance of building permit
7Easements (encroachments)per engineering conditions of approval and plat
/Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes I No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approver by ngineering: Date:
Notes: ,r _ ,,,,„/�. .,_._- .�' �// al . .
Approved by Engineering: egfL Date: z. y .-1,.y;�
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?q /
Approved,NOT Released: ` w,�., Date: 1/+I/
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:
WSDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: ❑ Yes p3ON/A VParks SDC: [ Yes El N/A
OK to Issue Permit
, (0.0
Approved by Permit Coordinator: Date:
//
I:\Building\Fonns\BldgPennitRvw RES_070915.docx
Albert Shields
From: Albert Shields
Sent: Monday, January 04, 2016 3:50 PM
To: 'Matt Fricke'
Subject: MST2015-00301, -00304,
Matt, Conditions of Approval required before building permit issuance remain Not Met. I'll mark MST2015-00301 and
MST2015-00304 "Approved but Not Released." Please let me know when the conditions are met.
Albert Shields
City o1 Tigard
Permits/Projects
Coordinator
`' 'A A bert4 tgard-oo. ov
1,505, 7:8-2426 ,-,
(503)624-3681 9`•:
13125 SW tall Bivro,
Tigard,OR 97223
1