Permit (165) CITY OF TIGARD MASTER PERMIT
:111 ✓ "` Permit#: MST2018-00019
1COMMUNITY DEVELOPMENT Date Issued: 02/06/2018
T I t;AR f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104C602700
Jurisdiction: Tigard
Site address: 13076 SW ASCENSION DR
Subdivision: HILLSHIRE WOODS Lot: 73
Project: SCOTT
Project Description: installing new 20 x 40 sf swimming pool. No concrete or decking to surround pool.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Ri ht: 0 Detectors:
Dwelling Units: 0 Third: 0 sf g
Total: 0 sf Value: $30,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain
0 Catch Basins: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0
Drywell-Trench Drain: 0 Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 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 N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR
SF VB R-3 0
Owner: Contractor:
SCOTT,ALIZA L BLUE MOUNTAIN POOLS INC Required Items and Reports(Conditions)
13076 SW ASCENSION DR 13121 S WARNOCK RD
TIGARD,OR 97223 OREGON CITY,OR 97045
PHONE: PHONE: 503-760-4554
FAX:
Total Fees: $1,004.02
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 952-001-0090. Y may obtain a copy of the rules or direct questions to OUNC by calling 5.4.232.1987 or 1.800.332.2344.
ri;j
Issued By: �� �i��"�'‘ Permittee Signature: iA -
Call 503.639.4175 by 7:00 a.m.for the next available inspecti y�,date.
This permit card shall be kept in a conspicuous place on the job site until c1 pletion of the project.
Approved plans are required on the job site at the time of eac inspection.
Building PermitApplicatio
1-it'CEIVED
Residential
i.oR ou rjci. ISG ONI.1
City of Tigard Received n_
13125 SW Hall Blvd.,Tigard,OR 97223 $ �'I (
Date/By: // Permit N
a Phone: 503.718.2439 Fax: 503.54.4"'t 4 �g Plan Reviews
r'�,a �g '� Other Permit:
T I G A R D Inspection Line: 503.639.4175 S tP 4+ �i QJ.H I Date Ready/By: 1 kris'
Internet: www.tigard-or.gov , See Page 2 for
ILLI � OPINION
N ified Me[hod: � /1/ Supplemental Information
Yf� of
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 0 Other:
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
OC C
❑ 1-and 2-family dwelling El Commercial/industrial Valuation: $ O
❑Accessory building J
❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I 3 i to New dwelling area: square feet
icJ A�c ens �� q
City/State/ZIP: •�`v C�co-ri CI 2Z 0 1'3D- g rP Gara e/ca ort area: square feet
Suite/bldg./apt.no.: Project name:
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: l 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.
I'n3 rob.;(1(4 S•v.1� oaJ p r�,,,
n .i in h j LAV ci are'1•y G y - Valuation: $
Existing building area: square feet
(–Leek.C.- !,/V I l te44.6"/ &lire. y' q)-4 ui." Fitosoft New building area: square feet
0PROPERTY OWNER ! r
0- TENANT Number of stories:
Name:
Type of construction:
Address:
Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( )
aPc
PPLICANT New:
EA CONTACT PERSON BUILDING PERMIT FEES*
Business name: 'V o c d nv 0 J t U, ( (Please refer to fee schedule)
Contact name: ,?�'" � ) ^IN CIL%-) , Ij ICS Structural plan review fee(or deposit):
Address: 3 y S FLS plan review fee(if applicable):
� car»(ut; —
C, l C ii Y C) 12, t 7 C: `15 Total fees due upon application:
City/State/ZIP: U(Q
Phone:( j�j) -7") 5Fax::( j)'� O — —
Amount received:
E-mail: .� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
c� roof-top mounted Photo Voltaic Solar Panel System.
Business name: ;JC y 1Ae 63 G,.4
V e_ Submit two(2)sets of roof plan with connection details
Address: and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review
I $180.00 administrative fees): $180.00
Phone:( ) Fax:( )
M State surcharge(12%of permit fee): $21.60
03
CCB lic.: 95(—)
Total fee due upon application: $201.60
Authorized sig ture: ON
,� This permit application expires if a permit is not obtained
At
uJ ) (.(-571
7 k�'' r within 180 days after it has been accepted as complete.
Print name4
Date: / b-_ 18 *Fee methodology set by Tri-County Building Industry
_ Service Board.
I:\Buildin. '- •ts\BUP-RESPermitApp.doc 02/24/2011 440 4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling Folz of l R l: Lsi oy1.)
City of Tigard
Received Permit No.:
III
Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
1 Phone: 503.718.2439 Fax: 503.598.1960 ❑ Electrical 0 Plumbing 0 Mechanical
T 1 G A R D 24-Hour Inspection Line: 503.639.4175
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW
lcs \0 1/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot.
4 Fire district approval required. Name of district: • 00 0000
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc. 0 0 0
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable. 0 0 0
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non-
prescriptive path analysis provide specifications and calculations to engineering standards. 0 0 0
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
0
0
0
20 Manufactured floor/roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0
architect licensed in Ore on and shall be shown to be a licable to theproject under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above.
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0❑ 0 0
27 "Drawn to scale"indicates standard architect or engineer scale.
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0 0
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions,
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
w
Clean Water Services File Number
I
CleanWater ` ServCices 18-000375 I
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: TIGARD
2. Property information(example I S234AB01400
) 3. Owner Information
Tax lot ID(s): 2S104CB02700
Name: At ask '5Cr t}
Company:
Address: i 3O. 6 514 /Q 5Cem to,in dr
QB Site Address: 1 O`7(o Ji.� A SCen5ion dc' City, State,Zip: ftc�ito.M OR. 9734 3
City, State,Zip: Poc tc ,. eiR Si a4.3 Phone/Fax:
Nearest Cross Street:
E-Mail:
4. Development Activity (check all that apply) 5. Applicant Information
Q Addition to Single Family Residence(rooms,deck,garage) Name: Russ Slothower
Q Lot Line Adjustment Q Minor Land Partition
Residential Condominium Company: Blue Mountain Pools
Commercial Condominium
j Residential Subdivision Q Commercial Subdivision Address: 13121 S Warnock rd
Q Single Lot Commercial Q Multi Lot Commercial City, State,Zip: Oregon City OR 97045
Other In eevna) `Js.4.)•rn,on,
nos POc,I Phone/Fax: 503-997-0923
E-Mail: russ@bluemountainpools.com
6. Will the project involve any off-site work? ❑Yes Q No Q Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits,Site Development Permits,
DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of
the Army COE. All required permits and approvals must be obtained and completed under applicable local,state, and federal law.
By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority to enter
the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am
familiar with the informatio ontained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate.
Print/Type Name iISS (oTtkjwer>
Print/Type Tl
Signature �� Title OPerc�t mo nS man . Qir-'
Date I -a 5 a
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200'of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also
be required.
XBased on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive
Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This
document will serve as your Service Provider letter as required by Resolution and Order 17-05, Section 3.02.1. All required permits and approvals must be
obtained and completed under applicable local,State,and federal law.
❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially
sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality
sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 17-05,Section
3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law.
❑ This Service Provider Letter is not valid unless CWS approved site plan(s)are attached.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE
PROVIDER LETTER IS REQUIRED.
Reviewed by t % 4 �... _.`—
Date 2/5/18
Once complete, email to: SPLReviewa@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Clean Water Services File Number
CleanWater Services 18-000375
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: TIGARD
2. Property Information (example I S234A1301400) 3. Owner Information
Tax lot ID(s): 2S104CB02700 Name: At a..ci
Company:
Address: 130' 6 5(.41 5Cef inn dr
S2@ Site Address: 13.30-I S(..t.) A y.er on do City, State,Zip: j -tio,yA og97 -5
City, State,Zip: oCAtan(4 CR S111,3 Phone/Fax:
Nearest Cross Street:
E-Mail:
4. Development Activity (check all that apply) 5. Applicant Information
13 Addition to Single Family Residence(rooms,deck,garage) Name: Russ Slothower
d Lot Line Adjustment U Minor Land Partition
la Company: Blue Mountain Pools
Residential Condominium 3 Commercial Condominium
a Residential Subdivision Address:
a Commercial Subdivision 13121 S Warnock rd
CI Single Lot Commercial 13 Multi Lot Commercial City, State,Zip: Oregon City OR 97045
Other In myna `Jw.rnrr.l
Poe,( Phone/Fax:_ 503-997-0923
E-Mail: russ@bluemountainpools.corn
6. Will the project involve any off-site work? Q Yes 13 No Q Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits,Site Development Permits,
DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of
the Army COE. All required permits and approvals must be obtained and completed under applicable local,state, and federal law.
By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority to enter
the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am
familiar with the information in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate.
Print/Type Name +"1'iS`S S(5t)b J r, Print/Type Title C
Signature
pc4„. .,:364.4fte.._ Opera(t�res M�,�� fit''
Date I -as-otlb
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200'of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also
be required.
Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive
Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This
document will serve as your Service Provider letter as required by Resolution and Order 17-05, Section 3.02.1. All required permits and approvals must be
obtained and completed under applicable local,State,and federal law.
❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially
sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality
sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 17-05,Section
3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law.
❑ This Service Provider Letter is not valid unless CWS approved site plan(s)are attached.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE
PROVIDER LETTER IS REQUIRED.
Reviewed by Date 2/5/18
Once complete, email to: SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
11111 City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T I c A Iz o Building Permit Review — Residential
Building Permit #: �fjjs o1�al e(7Site Address: 13O tp sv J A-scenso-n Prkve)
-
Project Name: S' --j- Qeg hce Pot,I Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 1 Ir10 i'DUt f poo I C GtcceQ,l.1 c-1vvt_.(�Q,,,,
L,
'Verify site address/suite#exists and active in permit system.
/..z
= _1l�_�, River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Site/Plan Elements:
I'Vhree(3)copies of sitelan
P a.Existing structures on site
,Site plan must be on 8-1/2"x 11"or 11 x 17"paper qiikootprint of new structure(including decks)with finished
❑Drawn to scale(standard architect or engineer scale) floor elevations
,�,NN�orth arrow Utility locations&easements(required for new and additions)
Ly'Site address,project or subdivision name and lot number Sidewalk/driveway approach
ID'r�pplicant information(name and phone number) IIS ocation of wells/septic systems
Lot dimensions and building setback dimensions RExisting trees to be retained with drip line,and tree
1J 14. are footage of buildings to be demolished protection measures
Ade
1 .t area,building coverage area, ercentae of coverage and !Street tree size,type and location
.ervious area(applicable if R-7,R-12,R-25&R-40) ]' 1-Street names
7 operty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ❑Yes ❑No
0
4 foot differential)
If es,is a storm water .uali facili shown? ❑Yes ❑No
lean Water Service x ' * -;'(lot platted prior to 9/10/1995):
Required: y w ;�.,;t vus ssotifted ❑ No Received:
❑ Yes No
`Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notifiedNApplied
!� � o PP For: CI Yes ❑ No,stop intake
..31--Land Use Case#:
j3-/Zoning: Q_-1 C p D
t Required Setbacks: Front N f,R- RearSide Street Side
L/ �J `'j f��,<} Garage f�
Landscape Requirement: W SEP ``
Lot Coverage Maximum: D 0 %
i\Iii, l wilding Height: Maximum Height
Actual Height
tf 1I► Visual Clearance
IX-Sensitive Lands: ❑ YesNo Type
r4 -Urban Forestry Plan
0011-Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: £a_ C Date: (- 16-I Y
Revisions (after Building Submittal only) Reviewer
Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: /iC nee-
Site Plans: #
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing: LGrPlanning ( Engineering Permit Coordinator )7 Building
Workflow Sign-off: (}'Sign-off for Planning(include notes from planning review)
Route Application Documents: F"Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
wilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
By Permit Technician: ��" . , I I// i:• Date: j S., !�
Engineering Review
ope at building pad:
N Conditions "Met"prior to issuance of building permit
111 Easements (encroachments)per engineering conditions of approval and plat
III Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: El Yes No
LIDA Facility on lot: ❑ Yes No
El Final Plat Recorded:
El NOT Approved by Engineering: Date:
Notes: h7 7f/lar.4.41dzer 4.".....4,0_,Z%k,
Approved by Engineering: nth Date:
Revisions (after Building Submittal only)
Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ 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:
ADC Fees Entered: Wash Co Trans Dev Tax: es It /A
Tigard Trans SDC: ❑ Yes G N/A
Parks SDC: ❑ Yes (fi'N/A
LIDA ❑ Yes
OK to Issue Permit l� { $�
Approved by Permit Coordinator: Date: /
I:\Building\Forms\BldgPeimitRvw_RES_111617.docx