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Permit
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 s COMMUNITY DEVELOPMENT DEPARTMENT st Transmittal Letter api 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: LL`( t-4 }G,' 14 -r i DATE RECEIVED: DEPT: BUILDING DIVISION i 1 t L,1:2 I V t.L) AUG 4 2020 FROM: .1:24(14v, c CITY OF TIGARD :� �," BUILDING DIVISION y�,� COMPANY: Owlets vesvt,#15 PHONE: <' jO',) '013(P By: RE: . 80 SW- 11(o4" Plate f�l`„ r o2—o - t2a"I (Site ress) ( ermrt Number) �Gt (~L5 lel (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: A set(s)of plans.(No) Rryisians1 Revisions: Cross section(s) and details. es Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: QfvwA. s *rf 3G1ro tomees6 -t70.0 c `dr.!✓�°Fble.-Glovdrd") Hey(t'm+ . on 146i4 •}'. 7'�/A 'if 1 � Gf rt s�atu, �1G,#bs e l 4 ehlym cyn 6.snGls fJ) a e4 tterMi. # Ilk4;ks a iaol6,etGtxl%t (1 -sii4)./ .dust. rwitA A rim 4 reo vt$ FOPO FILE USE ONLY Routed to P it Technician: Date: (,o �Zo Initials: Fees Due:Pit E No Fee Desc tion:: Amount Due: 1/7_, Dl%.n revc.t- $ S Special Instructions: Reprint Permit(per PE): ❑Yes ► No U Done Applicant Notified: Date: Initials: I-\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 rr CITY OF TIGARD MASTER PERMIT 2 ' ' COMMUNITY DEVELOPMENT Permit#: MST2020-00221 Date Issued: Aug 21 2020 12:00AM TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S103CD02600 Jurisdiction: Tigard Site address: 13780 SW 116TH PL Subdivision: HOLLYTREE Lot: 6 Project: Schelsky Project Description: 196 sf addition of family room and remodel of master bathroom and closet. TRADE PERMITS TO BE OBTAINED SEPARATELY. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 196 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 196 sf Value: $24,002.16 Rear: 15 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: 1 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 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!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3 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: ADD SF VB R-3 196 Owner: Contractor: SCHELSKY,MURIEL A TRUST SLS CUSTOM HOMES INC Required Items and Reports(Conditions) 21550 SW 75TH AVE PO BOX 1093 TUALATIN,OR 97062 TUALATIN,OR 97062 PHONE: PHONE: 503-691-9878 FAX: 503-692-7983 Total Fees: $1,683.77 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 0 952-001-00 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. � Issued By: !� 7�"� Permittee Signature: a� /—.3G/ ��D V 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 1/7/00 Residential RECEIVED FOR OFFICE USE ONI.Y City of Tigard Received: [ Permit No.1 S r.Z , a, 13125 SW Hall Blvd.,Tigard,OR 97223 JUL 0 7 2020 Plan Review ✓�L] / ,iMrk other Permit: 1 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : sp CITY OF TIGARD TIGARD Inspection Line: 503.639.4175 Date Ready/By: Ann/ Ions. ® See Page 2 for Internet: www.tigard-or.gov - of ninIC ni\ACIC11• Notified/Method:C 4 Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING El New construction Ill Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Igl Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and 7tb[�a profit for the CATEGORY OF CONSTRUCTION work indicated on this application. rt 7/ 00P— II 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 4-- El Accessory building El Multi-familyNumber of bedrooms: Lxt J Z 3 El Master builder El Other: Number of bathrooms: act JOB SITE INFORMATION AND LOCATION Total number of floors: .l r / Job site address: ra 3-'1 $0 P.0. t'' P` New dwelling area: i Q Le square feet City/State/ZIP: �rt,,u,,9 e2 ci'1 1. --3 Garage/carport area: L' LT square feet Suite/bldg./apt.no.: Project name: Sc{�d�t`i Covered porch area: square feet e __ Cross eet/directions to job site: c Cn i✓ 1,s K' Deck area: 0 square feet Of t -6'"o E�'-76 C EOS S E7Ztlf[_E P/Le-I146-tit --Cr/ , Other structure area: 0i square feet 9' p • /✓5 id/9-7-6-X. ME 77-, 4JD G�* A/,/ 4/ QUIRED DATA:COMMERCIAL-USE CHECKLIST 1 Subdivision: Lot no.: '�8 Permit fees*are based on the value of the work performed. Tax map/parcel no.: a S \ b 3 C. ©Q 'J-4 o e) livt_c,L lag-1 5-'1`t d 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. L�O.5ta0 rinrn,i,, ,L.,,,.� i� ,rani Z StiW��,:i 1 c�a-� Valuation: $ Existing building area: square feet New building area: square feet 71 PROPERTY OWNER 0 TENANT Number of stories: Name: Le t-> S (.lv.t.J e..-1 Type of construction: Address: 2\ S$' S i '1 S %- Occupancy groups: City/State/ZIP: -T,, '— 02 Ci 1 o to.-- Existing: Phone:( ) Fax:( ) New: APPLICANT 0 nCONTACT PERSON BUILDING PERMIT FEES* Business name: 5(„s cAx.s ui.. 000,44 f t- 12. t / rr) (Please refer to fee schedule)'-- 5{ Structural plan review fee(or deposit): 9 , f Contact name: JkeAJ c Sk-irx(-)),.� Address: �p Ct 3 FLS plan review fee(if applicable): City/State/ZIP: c„t. o,- c\'(,o L`� Total fees due upon application: Phone:(50 7 ) (,A,1- 'la' Fax::( .03) (a 9.2.—Z`. e J Amount received: E-mail: O I\yc-e Uc Ste$ Nam:-t), Cc PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: S L} c.....).i-NA's \, ,rc 1 -vvw.0,)e( I a(--- Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Ro (o w 9 Solar Installation Specialty Code checklist. City/State/ZIP: - prc,,a-n r• �L q.), L- Permit Fee(includes plan review $180 00 �3 ) and administrative fees): Phone:( 1 °L�' 1 d' Fax:( 'O3) 1,°t) `I l8 3 State surcharge(12%of permit fee): $21.60 CCB lic.: '?L 1 l Total fee due upon application: $201.60 Authorized signature This permit application expires if a permit is not obtained t / - within 180 days after it has been accepted as complete. Print name: TG-V C Y Date: 1/i 11, *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPertnitApp.doc 02/24/2011 4404613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling I OR OFFICE 1 S1.. (lyl.' City of Tig ard d Received .� ll DateBy: Permit No.: ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: I Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical I !GARD Internet: www.tigard-ocgov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW yes No Ni 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. Cl ❑ ■ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ 0 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: 1 U F LA— 0 ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity 0 0 [J( 6 Sewer permit. ❑ ❑ ❑' 7 Water district approval. ❑ ❑ Et 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 El' 9 Erosion control ®plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ 0 basin protection,etc. o ra s .k< f'v•-' 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state E( ❑ ❑ 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 61 ❑ ❑ 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 size [r ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ 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- c. ❑ ❑ 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. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. Eif 0 0 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. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- [ 0 0 prescriptive path analysis provide specifications and calculations to engineering standards. / 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing (_el 0 ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ [' 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 [v] ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 0 27 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required [r]' ❑ ❑ 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 QY architect licensed in Ore:on and shall be shown to be a s.licable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". !I 0 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. E ❑ 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. (f ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ E( and protection measures must be drawn to scale and must include the project arborist's signature of approval. D 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 ❑ !� ❑ '" including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings {r3� 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) Electrical Permit Application RECEIVE • FOR OFFICE USE ONLY City ofTigard JUL 0 7 2020 Received IN . y Permit ri:M Z4 ST 0 '00 ZZ-! 't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGAR D te/By: Related Permit 0: inspection Line: 503.639.4175 BUILDING DIVISI a Lady Date/Hy: tuns: I lig See Paget for TICARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction dditionialteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demoliti0ri '❑Other: ❑Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION" exceeds 10,000 amps at 150 volts or 0 Floating buildings. _Di_Di=and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural snips for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or 1 JOB SITE INFORMATION AND LOCATION '''r��'11y _ ❑Emergency system. larger separately derived Job#! Job site address�� > '{{I . f/ 0 Addition of new motor load of system. 1 -' ! f,�'' '1 ( 100HP or more. ❑"A""E„ ,•t_2„ •'I.3„ fff 1 El or more residential units. occupancy. City/State/ZIP: }/ L l Z q _ ❑Recreational vehicle parks. P t f f r 1 1 ❑Health-cure facilities. Suite/bldg./apt.#: ',.✓ Project name: r t f 1 ❑Hazardous locations. 0 Supply voltage for more than '� IDService or feeder 600 amps or more. 600 volts nominal, Cross street/directions to job site: FEE.SCHEDULE .. Description I vn. 1. ...Each I Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1 y 75.00 2 Pi nY' I DESCRIPTION OF WORK Limited energy,residential '° rr)r`YI (with above sq.ft.) [JLf Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 0 PROPERTY OWNER `'❑ TENANT' - - Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 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 0 APPLICANT -1------ff CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee far branch circuits wrtlr Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: B.Fee for branch circuits n'ithoui _ ` 00 Address: service or feeder fee,first 56.18 le 2 branch circuit City/State/ZIP: Each add'l branch circuit Z, 7.42 ILL 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR i - Pump or irrigation circle 67.84 2 Business name: (tj t15 F,let- 1, { l n'il ./'Y Sign or outline lighting 67.84 2 -{r -y �-- r r l� Signal circuit(s)or lexitedcnergy 0 See Page 2 2 Address: I1 lt} �{1�7j4._ �t p �J panel,alteration,or extension. � Each additional inspection over allowable in any of the above City/State/ZIP: I ci r �, Additional inspection(1 hr min) 66.25/Iv Phone: t ) 1 Fax:( ) Investigation(1 hr min) 90,00/hr Industrial plant(1 hr min) 78,18/ltr Email: `j"I v� r e. re c e (e(tr 1 C , (- y v-) Inspections for which no fee is 90,00/hr CCBLic.: I- l_ L Electrical Lic.: 9-f52 Suprv.Lie.: ID'j specifically listed(Vsshrmin) ELECTRICAL.PERMIT FEES Suprv.Electrician signature,required ] V i C Subtotal: 1 I d°L Print name: d Date-''7� ['Plan Review Required(25%of permit fee): I Slate surcharge(12%of permit fee): R S' . `2.,, Authorized signature: :ice TOTAL PERMIT FEE: k 30 --"`- This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has bees accepted as complete. * Number of inspections allowed per permit. 1:1Buitding\Pennbs\ELC_PenmusApp ELR_ERE.doc Res'06/17/2015 4404615T(11/05/COMAVED - Plumbing Permit Application ECEIVED Building Fixtures FOR OFFICE 1'SF oNI.Y JUL 07 ZUZO ReceivedIIIr�� z -0a ZZ1 City of Tigard PlatenRe • 13125 SW Hall Blvd.,Tigard,OR 972 ITY OF TIGARD Pia Review Permit Noll SrD = Phone: 503.718.2439 Fax: 503.59 Other Permit No.: Inspection Line: 503.639.4175 �CDING DIVISION Date/By: TIGARD Date Ready/By: lurk ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total 0-Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connectio CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 lig 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 El Accessory building SFR(3)bath 500.32 ❑Multi-family Each additional bath/Idtchen 25.02 ❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: \ 71 L'(9 5 j \ -11-5- Catch basin or area drain 18.76 f� 0 Drywell,leach line,or trench drain 18.76 City/State/ZIP: t C\- 2'J IQ q*, 2.2 3 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: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 tt�errr� t G �J�� (gyp Clothes washer 25.02 c oc:1 N(. �\-10W ` \ rT V ' ° 'STP Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$_) Page 2 Primer 12.51 Contact name: ----- 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 /7 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR j LN U P L )t S, Water heater 37.52 Business name: 1 Si, ater piping/DWV 56.29 Address: \S \L-{S S W \ \,©) s t Other 25.02 City/State/ZIP: `L?(av io)N ' O . I L 1© Subtotal Phone:(541 21-4.- 130 Fax:( ) Minimum permit fee: $72.50 CCB Lie.: y 4` Plumbing Lic.no.: 15 (/) Plan review (25%of permit fee) �- State surcharge(12%of permit fee) Authorized signature. ____-3-- TOTAL PERMIT FEE r^ !iI^2 This permit application expires if a permit is not obtained within 180 days Print name:� � Date: lY�� after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. IiBuilding\Permits 1PLMU-PermitApp.doc I0101/09 440-4616T(10/02/COM/WEB) City of Tigard 71 Gn COMMUNITY DEVELOPMENT DEPARTMENT T 1 G nRD Building Permit Review — Residential oh Building Permit #: /1ST 7 7-0 — 6072-1 Site Address: /3 .ej a() //(ram A Project Name: gdfigq®jjy __ Lot #: Planning Review fj�7 z Pr I I osal: �dl� _ 7fl rRz.-- cil- l►A Verify address/suite# active in Accela. 1, "River Terra e: V No ❑ Yes, River Terrace Review Addendum Sit 1an Elements: V r•sion Control Vi,3./bpies of site plan on 8-1/2"x 11"or 11 x 17"paper P1 ' ained trees with drip line and tree protection measures TKI 1�2awn to scale(standard architect or engineer scale) IF, ootprint of new structure (including decks)and F1-± W,J,( rth arrow \1%J'ty locations&easements (required for new and additions) address,project or subdivision name and lot number 1P idewalk/driveway approach .licant information (name and phone number) 11 ,1 ation of wells/septic systems ►. . dimensions and building setback dimensions tit io-et tree size,type and location iY If are footage of buildings to be demolished eet names T. xisting structures on site Comer elevations(2'contours if more than 4'differential) Oct area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes impervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility showni Yes o ❑ Clean Water S *ces-Service Provider Letter (lot platted prior to 9/10/1995): Required: Yes,applicant was notified ❑ No Received: ❑ Yes No ❑ Water Meter F. ture Unit Worksheet-Ad s7 Retnpdels and ADUs Required: Yes,applicant was notifie No Received: El Yes No rf/t' Q �� BY .DC Exemption for applied for: es�d No Received: ❑ Yes ❑ No NCT- yc1+i ht Public Facilities Improvement (PH) Permit: Ar f Required: ❑ Yes,applicant was notified la Noplied For. p❑ Yese El No,stop intake \""' and Use Case#: ` M Zoning: G�-_4I S equired Setbacks: Front: / Rear: /� Side: �- Street Side: - Garage: 49 NJ Building Height: Max. Height: .'v Actual Height: i 2± Landscape Area: % of Coverage Max: Entrance t back no more than 8'from street-facing wall ❑ Parallel to stree ar 6ffset 45 degrees or less Windows El Minim %of area of all street-facing facades Garage El Garage door is be ' 'dest street-facing wall 11 es ❑ No,one of the following is met: ❑ Door extends no more ' from wall a ere is a covered porch extending beyond garage. El Door extends no more than 5'f and there is a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is ❑ ' r less El 50%o -of facade El 60%or less and includes 7 of following: ❑ Covered ❑ Recessed entrance ❑ Wall o ❑ 1'Roof cave El Roof offset ❑ • gles ❑ Lap Siding ❑ Roof pitch ❑ Gable, mbrel roof ❑ Dormer Accent siding ❑ Window trim ❑ Window recess ❑ Window 'ection ❑ Balcony Visual Clearance urban Forestry an 'Qlaensitive Lands: ❑ Yes l ' No Type: ?�/onditions met prior to issuance of building permit Not Approved By Planning: Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved L\Building\Fonns\BldgPermitRvw RES 122419.docx Building Permit Submittal Original Submittal Date: 7`7/20 Site Plans: # 3 Building Plans: # ^j Building Permit#: ...2 Inter building permit# above. Workflow Routing: Planning Engineering ''Permit Coordinator .ZI-Buuilding Workflow Sign-off: ['Sign-off for Planning(include notes from planning review) Route Application Documents: O'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. ilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: ,. 2/)i /t4-' Date: 7/i5/Ze Engineering Review [ Slope at building pad: 2.9,, D'Conditions "Met"prior to issuance of building permit a 4- Easements (encroachments) per engineering conditions of approval and plat —I CJ --Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ErNo Assess Water Quantity Fee in-lieu: ❑ Yes LNo LIDA Facility on lot: ❑ Yes 0-No Final Plat Recorded: M l� ❑ NOT Approved by Engineering: Date: Notes: D.-Approved by Engineering: T� �,? -._-, Date: 7/24/2.020 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review NIA 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: SDC Exemption: ❑ Received . Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: ❑ Yes VI N/A Parks SDC: ❑ Yes . N/A LIDA ❑ Yes 7 N/A OK to Issue Permit Approved by Permit Coordinator: 11 Pk, Date: 1 I Z1[20 I:\Building\Forms\BldgPermitRvw_RES_122419.docx RECEIVED A U G 21 262 r Clean Water Services Flie Number CITY OF TIGA CleanWater\``Services f 20-001887 BUILDING DIV1� Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: !t 6.444 2. Property Information(example 1S234AB01400) 3. Owner Info eon Tax lot ID(s): 6.S iv 3 CPO �,te.pp Name: Son,1rGk Company: Address: RE SlteAddress: (a,113O W 1(,te-° City,State,Zip: City,State,Zip: • -L 40µd pa- t( t 3.a.; Phone/Fax: Nearest Cross Street: E-Mail: 4. Development Activity(check all Mal apply) B. Applicant information 1tl Addition to Single Family Residence(rooms,deck,garage) Name: Sot U t S4i' 'L E ❑ Lot Line Adjustment ❑ Minor Land Partition Company: S to..* C wsrer++ gor►t ❑ Residential Condominium ❑ Commercial Condominium ❑ Residential Subdivision Address:{ t 0�3 ❑ Commercial Subdivision ❑ Single Lot Commercial ❑ Multi Lot Commercial City State,Zip:"rtAANI-+x'1 o 11/4- 91ot.7— Olher PhonelFax: 4°3 G`V it -R Y'11P/4.13 (,e)2,7 jr E-Mail: S4-tVe s/7 ILJl(oMWar f ' 6. WEI the project Involve any off-elte work? ❑Yes fri.No ❑Unknown Location and description o1 of-site work 7. Additional comments or Information that may be needed to understand your project t-XF'C04 tea Jr Se" R.. 1 Zinn/ Mef -ro l2t This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Pernik, DEQ 1200-C Permit or other permits as Issued by the Department of Environmental QealDy,Department of Stele Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local;slate,and federal law. By signing this form,the Owner or Owners authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times far the purpose of inspecting project site conditions and gathering Information related to the project site. I certify that I are familiar with the Information contained__ In this dot mart,and to the best of my imowledge and belief,this Information is true,complete,end accurate. Print/Type me S+t l' I34- Printlfype Title 9^u Signature Data 4/X41 /Ao"..• 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, X 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 19-5, Section 3.02.1,as amended by Resolution and Order 19-22.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 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and • approvals must be obtained and completed under applicable local,state and federal law. X THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS f_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 .Caa , Date 7/22/2020 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 Revised 2/2020 Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p:503.681.3600 f:503.681.3603 • cleanwaterservices.org 7_... -_ 15 D.00 1 ... .. ......-... .,._ _ ---7-- - . , ADp►TIoN 1 • Mt*At 4 0.0�� •,„. — . — • f�X [S�' �4SicleAce 03flI 6�K �s.�R'� \O` 43/ unrt. M -" Fl.rs�"<-- 0 Nis / 00 EXIGi, \M � • P.O. Box1093 5.*f \ :t Tu ALATIN, ORCWSF g www:slshomes.Com Clean Water Approved Bermes • \._ FOR NVIRONMENTAL REVIEW SY—��Q----_Date Z SPL ATTACHMENT____j _OF • 4-5.1 7 CT"LPT PLAk 5.W. I 1&11' F'( ce •• ,,,oe ( 6 LE. Iu: c.c') j NDPTH ' • LEN4(MurIEL. SGHELsksr II 1 ao s-w. III&it, PI iI rd/Or. 11Z2, Lina Smith From: Lina Smith Sent: Thursday, July 9, 2020 12:51 PM To: 'office@slshomes.com' Cc: #Building Permit Technicians Subject: Schelsky home addition at 13780 SW 116th PI Hi Steve, Just signed off for my department (Planning/Zoning) on your building permit submittal for the Schelsky home addition at 13780 SW 116th PI. I will forward your submittal to the Building Division for review, but before they can issue the permit, you'I6need to submit the following: oeigll',A service provider letter from Clean Water Services (CWS). Please follow the instructions on their website. If you op'for 81 have any questions, please contact CWS directly: https://www.cleanwaterservices.org/permits- development/step-by-step-process/environmental-review/ t� • A water meter fixture unit worksheet: https://www.tigard- tVe or.gov/document center/UtilityBilling/Water MeterWorksheet-Additions Remodels ADUs.pdf. If you have any PS to questions about this, please contact the Building Division at 503-718-2439 or tigardbuildingpermits@tigard- ��0 �,� kS or.gov. f �rhank you, Lina Smith Assistant Planner City of Tigard I Community Development 13125 SW Hall Blvd.Tigard, OR 97223 E-mail: LinaCS(a tgard-or.gov 1