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Permit CITY OF TIGARD MASTER PERMIT 11 1 COMMUNITY DEVELOPMENT Permit#: MST2020-00207 Date Issued: Aug 3 2020 12:00AM TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1036B06500 Jurisdiction: Tigard Slte address: 12195 SW 121ST AVE Subdivision: None Lot: None Project: Wolf Project Description: New shed dormer above detached garage. 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 Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Total: 0 sf Value: $7,500.00 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 Storm Sewer: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 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 Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 0 Owner: Contractor: RABAU,MARLA S LEVCOR LLC Required Items and Reports(Conditions) WOLF,KEITH S 12573 SW WINTERLAKE DR 12140 SW KATHERINE ST TIGARD,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-502-0323 FAX: Total Fees: $356.83 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 0 952-001-009�. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. e). Issued By: . •-frig --- - 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 project. Approved plans are required on the job site at the time of each inspection. Building Permit Application z to / ZD Residential , Received. City of Tigard JUN 13 2020 Data e 7/7�zd 4?0 Permtx 2e20-®D•to 7 " 13125 SW Hall Blvd.,Tigard,OR 97223rri plan Review ' /I Q/��� Phone: 503.718.2439 Fax: 503.598.1960 I f' ° f ateBy: I�/ZAZ.O / !r'I Other Perm,t: T I G A R D Inspection Line: 503.639.4175 Y s 'I �, Date ReadyBy: 111 lea H See Page 2 for Internet: www.tigard-or.gov - otified/Method: Supplemental Information + TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING �` a ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all rAddition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. E I-and 2-family dwelling ❑Commercial/industrial Valuation: $ c,, ElAccessory building 0 Multi-family Number of bedrooms: ElMaster builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 14 1 S -j 21 ,L' New dwelling area: square feet City/State/ZIP:Tigkrif r t 1 ��Z`� g carpo square Gaza e/ rt area: s 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: 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. ri �1 e- e➢ `. r/�`'re, I re.,. ijCd,: Valuation: $ Existing building area: square feet New building area: square feet la PROPERTY OWNER 0 TENANT Number of stories: Name: K/,/ Type of construction: Address: g�� AW- Ar ("),16 Occupancy groups: City/State/ZIP: p Existing: Phone:��.3 0(/D gj(p!�5/07 Fax:( ) New: ❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: NIK. , __ Gp 1 Structural plan review fee(or deposit): 2 , tire, Contact name: l�V,/�t v./ FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP:Phone E-mail: d/ #�1s CJ 6 Z- ' (�7 '3 Fax: :( ) Amount received: /L� y C-5 -�_ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* �i �j Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. ,��t p Submit two(2)sets of roof plan with connection details Business name: �V t�T/10`AI/ t� and fire department access,along with the 2010 Oregon Address: eql vv � 1 � Solar installation Specialty Code checklist. dy P • 1 Z� Permit Fee(includes plan review $180.00 C' lState/L�P: � 7 3and administrative fees): /1 Phone: 1M75/7, Fax:( ) State surcharge(12%of permit fee): $21.60 I CCB lie.: "l b lip/A) Total fee due upon application: $201.60 f Authorized signature: This permit application expires if a permit is not obtained i within 180 days after it has been accepted as complete. Print name:M I� Date:/ J 0 *Fee methodology set by Tri-County Building Industry 1I /���' iif" 111�� Service Board. 1:113uilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) City of Tigard III ■ COMMUNITY DEVELOPMENT DEPARTMENT T1cARD Building Permit Review - Residential Building Permit #: h 5 T ZO Z© — 0 O ZO 7 Site Address: 121 Gj S SA1 t 21 SA— P\V-t' Project Name: petioA{,{ LU b t,F Lot #: Planning Review • Proposal: i)Of Mg Ott7v`P, O)& 1ft1eof 16011& -no Sl-ie pia), rent)IrecP 4"Verify address/suite # active in Accela. R._In River Terrace: X, No ❑ Yes,River Terrace Review Addendum Site Plan Elem nts: KtAgrosion Control Vt3 c pies o si e plan on 8-1/2"x 11"or 11 x 17"paper 117ic8etained trees with drip line and tree protection measures XDr to e(stir, dard architect or engineer scale) 143-Footprint of new structure(including decks) and FFE Xi Noarro I 'Utility locations&easements (required for new and additions) Sit ad s , ro 1 'r subdivision name and lot number Sidewalk/driveway approach N'Ap licant m o ation(name and phone number) Wocation of wells/septic systems Ite o dimensions and building setback dimensions 'VA-Street tree size,type and location Iquare footage of buildings to be demolished gStreet names kgxisting structures on site AComer elevations(2'contours if more than 4'differential) Trot area,building coverage area,percentage of coverage and > 000 sf of impervious area created or replaced? o Ott area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? IC e No Er Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No .Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs Required: E Yes,applicant was notified No Received: ❑ Yes ❑ No NiPISDC Exemption for ADU applied for: ❑ Yes ❑ No Received: E Yes ❑ No ,rPublic Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified Ig(No Applied For: ❑ gYes ❑ No,stop intake istkLand Use Case #: r- Zoning: R-- I.S .Required Setbacks: Front:NI pr Rear: S Side: S Street Side: N j Pt Garage: 2321 Kl Building Height: Max. Height: t S Actual Height: t S. C RO L , Landscape Area: % Lot Coverage Max: Entrance II Set back no mor than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows 11 Minim 12% f area of all street-facing facades Garage 11 'arage oor is e ' . widest street-facing wall 0 Yes ❑ No,one of the following is met ■ D or e ends , more than 5'from wall and there is a covered porch extending beyond garage. • D or tends • more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor. II Garat- oo width 11 'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following: ❑ Cov ed por h II' Recessed entrance 0 Wall offset ❑ i'Roof eave ❑ Roof offset ❑ Fir shingle ❑ ap Siding 0 Roof pitch ❑ Gable,hip,or gambrel roof 0 Dormer O Ac ent siding 0 Window trim ❑ Window recess 0 Window projection 0 Balcony WA-Visual Clearance -Urban Forestry Plan Sensitive Lands: 0 Yes 18r No Type: (Conditions met prior to issuance of building permit Notes: At-Approved By Planning: Date: (o'ZZ PIO Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw RES 122419.docx Building Permit Submittal Original Submittal Date: Y t e Site Plans: # Building Plans: # 3 Building Permit#: LE' Enter building permit# above. Workflow Routing: Er Planning ❑ Engineering ❑ Permit Coordinator 42-11uilding Workflow Sign-off: t2-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. wilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: � / ljjy�/Q�J Date: 7/7/24:9 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 ❑ Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: ❑ Approved by Engineering: t Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Ap ove. Revision 2: ❑ Approved 0 Not Appro ed Permit Coordinator Review ❑ Conditions "Met"prior to issuance of . ' ding permit ❑ Approved, NOT Released: Date: Notes: Revisions (after Building Su t ittal only) Revision Notice 1: bate Sent to Applicant: Revision Notice 2: Date Sent to Applicant ❑ SDC Exemption: ❑ Received ❑ Does not apply ❑ SDC Fees Entere.. Wash Co Trans Dev Tax: ❑ Yes 0 N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes 0 N/A LIDA 0 Yes ❑ N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: I:\Building\Forms\B IdgPermitRv w_RES_122419.docx