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Permit CITY OF TIGARD MASTER PERMIT IN ': . COMMUNITY DEVELOPMENT Permit#: MST2020-00227 13125 SW Hall Blvd.,Ti Date Issued: Aug 21 2020 12:00AM TfC:r1R13 and OR 97223 503.718.2439 9 Parcel: 2S111AD05500 Jurisdiction: Tigard Site address: 8750 SW PINEBROOK ST Subdivision: PINEBROOK TERRACE Lot: 78 Project: Smith Project Description: 825 sf 2-story addition consisting of(3)bedrooms and sauna. TRADE PERMITS TO BE OBTAINED SEPARATELY. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 390 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 21 Bathrooms: 0 Second: 428 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 818 sf Value: $100,172.28 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: 0 Garbage Dist): 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 Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders 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: ADD SF VB R-3 818 Owner: Contractor: SMITH,NICHOLAS I OWNER Required Items and Reports(Conditions) 8750 SW PINEBROOK ST TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $4,325.46 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 throu AR 952-000011/�/D4/�. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19873. 2. or 1.800.332.2344. / Issued By: . C%��YL1. ..-t � (� ' Permittee Signature: .t/ "T7-f�G/G'�—"7C�N 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. r 4 Building Permit ApplicationRECEIVED . Residential JUL- 14 2020 F'Oit lil•I R t: 1 4i tlsl- City of Tigard CITY OF TIGARD I D 7 SS 2c� .CQ p fw IN r • 13125 SW EIa11 Blvd_Tigard,OR 9 `tN0 t I ST 20 20"�0�.27 a Phone 503.7182439 Fax: 503.598.] ILDING DIVISION 1eW 6/3aAA, other Pamir r 1 G A it i) Inspection Line: 503.639.4175 Date Ready/By:: {, 1/ no loos le e See Pane 2 for Internet: www.tigard-or.gov NauSed/Method: /L(, ,()( Supplemental inrormatioa 6d'1 V, h1; 7C I TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELL!NC ❑New construction 0 Demolition Permit fees*are based on the value of the work pc:funned. -I Indicate the value(rounded to the nearest dollar)of all (Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the Of CATEGORY OF CONSTRUCTION work indicated on this application. I C) �. t 1-and 2-family dwelling ❑Commerciallindusttial Valuation: $ _._� Pv1 _ ,f_ ry 0 Accessory building 0 Multi-family Number of bedrooms: i"" ❑Master builder ❑Other: Number of bathrooms: 0 04 ien-a - - JOB SITE INFORMATION AND LOCATION Total number of floors: is 18 2 lob site address: 8750 SW Pinebrooktree New dwelling area: % — square feet 928 City/State/ZIP: Tigard Oregon 97224 Garagdoarportarea: square feet SI0 Suite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: Hall to Pinebrook Deck area: square feet e t/,J _. .e._ Pa/V S/4/G / 7, structure�1 .,,' 1��M Other area: square feet C W S S VI C.€` P i'�U e'I L 2-- i— rKI GL D :REQUIRED DATA:COMMERCIAL-USE,t:RECKc,ISI� 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 S equipment,materials,labor,overhead,and the profit for the .54 .5 DESCRIPTION OF WORK work indicated on this application. rtiall addition to existin structure. Adding bedrooms 2 down Valuation: $ an one ups airs. De--- P r-t i rS 11 OE Existing building area: square feet 6 i7TAy,Ni Ft> S Ertl-4_6 r j - .41) , New building area: square feet 21 PROPERTY OWNER [j TEN ANT Number of stories: Name: Nick Smith Type of construction: Address: 8750 SW Pinebrook Street Occupancy groups: City/State/ZIP: Tigard Oregon 97224 Existing: Phone:(503) 310-3439 Fax:( ) New: 0 APPLICANT 0 CONTACT PERSON BIRI,DING PERMIT FEES* Business name: axe refn to fee ackeda teI Structural plan review fee(or deposit): /: 7 7t/ Contact name: `c' Address: FLS plan review fee(if applicable): City/State/ZIP: Total fees due upon application Phone:( ) Fax::( ) Amount received: E-mail: -- PBOTOVOLTAIC SOLAR PANEL SY$'I'E14IFEES* CONTR CTOR Commercial and residential prescriptive installation of - roof-top mounted Photo Voltaic Solar Panel System. Business name: NONE I am doing the work myself. Submit two(2)sets of roof plan with connection details Address: E7�� /J and fire department access,along with the 2010 Oregon /�-- Solar Installation Specialty Code drecidist. City/State/ZIP: Permit Fee(includes plan review $180.00 Phone: and administrative fees): ( ) Fax ( ) State surcharge 12%of CCB he,: haTB ( permit fee): $21.60 Total fee due upon application: S201.60 Authorized signature: i This permit application expires pp If a permit is not obtained Nick Smith j *�l Feemethodology n 180 gy ses t by Tri Coter it has up yBuildinndindstry complete. Print Hama '1" -r " Date:7-13-2Q by ty g industry Service Board. I:\Building\Permits1BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COMIWEB) 1 t Dianna Ornelas From: Nick Smith <nicksemail.new@gmail.com> Sent: Thursday, July 23, 2020 8:39 PM To: Dianna Ornelas Subject: Re: MST2020-00227 - Smith - 8750 SW Pinebrook St Caution!This message was sent from outside your organization. Allow sender I Block sender This is great news! I believe th valuation of the project would be around $95,000 iYl were paying to have it done. There is no equipment as I have an existing furnace-and there is nothing tti ri -usually expensive like kitchens or bathrooms. I am doing this myself and I have budgeted $42,500 to complete the work. Let me know when I can pay and I'll get that taken care of. Thank you! On Thu,Jul 23, 2020 at 7:16 PM Dianna Ornelas<Dianna(altigard-or.gov>wrote: Hi Nick, This permit has been approved by planning, however the permit application is missing the project valuation amount which determines the plan review submittal fee due. Please let me know what the project valuation is which includes all equipment, materials, labor, overhead and the profit for the scope of work. In other words, the cost of what a licensed contractor would bid for the job. Once I have this amount, I will email you plan review submittal fee due and instructions to pay the fees online. Thank you. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd l Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits 1 RECEi VED Property Owner Statement AUG 21 2020 Regarding Construction Responsibilities $tY pNGDIVSON Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building,electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or x I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Nick Smith Print Name of Permit Applicant S 8/21/2020 Signature of Permit Applicant Date Permit#: /`'I S 72-0 Zp GYJ 7 o f Address: f 7..S O ;ft Issued by: " Date: e7Li/ = This Copy for Permit Offices Information Notice to Owners About `I= Construction Responsibilities (ORS 701.325 (3)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number(BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to http://www.oregon.ctov/DOR/BUS/docs/211-055.odf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503-947-7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance:As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309-5052 Telephone: 503-378-4621 —Fax: 503-373-2007 Website Address:www.oregon.gov/ccb f/property_owner adopted 9-23-08 This Copy for Permit Applicant RECEIVE® ' ? S 7 -00;a 2 r 5O $AAJ :oi/v 2cdve__ CleanWater Services AUG 14 2020 Service Provider Letter Our commitment is cic,i ATY OF TIGARD BUILDING DIVISION Submission Date: Aug 13,2020 Confirmation#: 479 Applicant Name: SMITH, NICHOLAS I CWS File#: 20-002149 Contact Email: Review Type: Partner City Plan Review Contact Phone: Ground Disturbance: 384 Primary Address: 8750 SW Pinebrook ST New Impervious Area: 384 Tigard,OR 97224 Primary Jurisdiction: Tigard Mod. Impervious Area: 0 Affected Tax Lots: 25111AD05500 Development Activity: SFR Addition Project Description: adding 384 sf of additional living space to the back of the house;;Sfd Addition FOR DISTRICT USE ONLY ❑ 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. ❑ 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. ❑ NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed By: LDRToolReview Date:August 13,2020 The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the Tualatin River Watershed. Our partners include municipalities,environmental organizations,and developers large and small. Contact Us*2550 SW Hillsboro Highway*Hillsboro,Oregon 97123 phone:503-681-5100*email:splreview@cleanwaterservices.org*website:www.cleanwaterservices.org/permits-development Clean Water Services - Pre-Screen Report(Approval Pending) Submission Date: 8/13/2020 Confirmation U: 479 Applicant Name: Nick Smit Review Type: Partner City Plan Review Contact Email: nick.psu@gmail.com Ground Disturbance: 384 Sq. Ft. Contact Phone: 503-310-3439 New Impervious Area: 384 Sq. Ft. Primary Address: 8750 SW PINEBROOK ST Mod. Impervious Area: 0 Sq. Ft. Primary Jurisdiction: Tigard Development Activity: Single-Family Dwelling Addition Affected Tax Lots: 2S111AD05500 INSTRUCTIONS:Additional CWS reviews or permits ARE required. Refer to the table for Next Steps. Permit or Review Required Next Steps Environmental Site Assessment Yes Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT Review MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER.Submit a site assessment to CWS for review. Water Quality Treatment Review TBD Contact city(primary jurisdiction) responsible for land use review and permit and Stormwater Inspection issuance. Erosion Control Inspection Permit TBD Contact city(primary jurisdiction) responsible for land use review and permit issuance. Erosion Control Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit with Site Plan issuance. Line Tap Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Disconnection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Connection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Connection Permit with Plumbing TBD Contact city(primary jurisdiction)responsible for land use review and permit Plan issuance. Easement Review TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the Tualatin River Watershed.Our partners include municipalities,environmental organizations,and developers large and small. Contact Us*2550 SW Hillsboro Highway*Hillsboro,Oregon 97123 phone:503-681-5100*email:spl review@cleanwaterservices.org*website:www.cleanwaterservices.org/permits-development r 'l• C1eanWater Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number 1. Jurisdiction: Tigard 2. Property Information(example: 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Nick Smith Company: Owner Address: 8750 SW Pinebrook Street OR Site Address: 8750 SW Pinebrook Street City, State,Zip: Tigard, Oregon , 97224 City, State,Zip: Tigard, Oregon, 97224 Phone/fax: 5033103439 Nearest cross street: Hall Email: nick.psu@gmail.com 4. Development Activity(check all that apply) 4. Applicant Information I Addition to single family residence(rooms, deck,garage) Name: Nick Smith ❑ Lot line adjustment 0 Minor land partition Company: Owner ❑ Residential condominium 0 Commercial condominium Address: 8750 SW Pinebrook Street ❑ Residential subdivision 0 Commercial subdivision City,State,Zip: Tigard, Oregon , 97224 ❑ Single lot commercial 0 Multi lot commercial Phone/fax: 5033103439 Other Backyard addition to house in southeast corner. Email: nick.psu@gmail.com 6. Will the project involve any off-site work? ❑Yes 0 No 0 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 contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate. Print/type name Nick Smith Print/type title Signature ONLINE SUBMITTAL Date 7/20/2020 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. O 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. ❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED. D 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 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 nevsc 2/2020 Main Office • 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • p: 503.681.3600 f:503.681.3603 • cleanwaterservices.org 7 Building Permit ApplieationRECEIVED ,/t� Residential JUL 14 2020 FOR OFFICE I SI:TINL1 ��ZZ/ City of Tigard y� CITY OF TIGARD I Dateray: 7 23 10 420 PermtNa. +�,,, " 13125 SW Hall Blvd.,Tigard,Oil 9�., Ptanitcvtcw / �ST�Zl7 - - •• Phone: 503.718.2439 Fax: 503.598.1f1W11LDINGDTVISION natdsy: Other Pemut: riCr.4ttCr Inspection Line: 503.639.4175 Date Ready/By: aril: ® Sea Page 2foe 1. Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:T-AND 2-FAMILY DWELLING 0 New construction 0 Demolition Permit fees'are based on the value of the work performed. �}1 Indicate the value(rounded to the nearest dollar)of all l=1 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. elj I2f1-and 2-family dwelling ❑Comereial/indusuia] Valuation: S 9J/Number of bedrooms: 3 �yt v m 0 Accessory building 0 Multi-family _ 0 ❑Master builder ❑Other: Number of bathrooms: 77w 40 - JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: 8750 SW Pinebrook Street New dwelling area: tF Z S square feet City/State/ZIP: Tigard Oregon 97224 Garage/carport urea: square feet Suitelbidg./apt.no.: Project name: Covered porch area: square feet ~Cross street/directions to job site: Hall to Pinebrook Deck area: square feet /� Other structure area: square feet G � SS r VI C€- f- �� G�-• (.1 JS ..E � "-- Jt�L t t) a REQUIRED DATA:COMMERCIAL—USE TIFIECKLLST Subdivision: Lot no.: Permit fees'are based on the value of the work performed. Tax map/parcel no-: SVC1 Indicate the value(rounded to the nearest dollar)of all equipment materials,labor,overhead,and the profit for the s,Qt 4' Se ' DESCRIPTION OF WORK work indicated on this application. gnirill addition to existin structure. Adding bedrooms 2 down Valuation: $ +T °and one upstairs. S `"lam ` ®Ir (- 1 To ai Existing building area: square feet = 6 e7Tei-.I N Et S p r.7--4-61 4)D . New building area: square feet • Of PROPERTY OWNER ❑ TENANT Number of stories: Name: Nick Smith Type of construction: Address: 8750 SW Pinebrook Street Occupancy groups: City/State/ZIP: Tigard Oregon 97224 Existing: Phone:(503) 310-3439 Fax:( ) New: • ❑ APPLICANT 0 CONTACT PERSON . BUILD/NC-PERMIT FEES Business name: MRearereferto fee rchednl851 • - ' Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: City/State/ZIP; Total fees due upon application: - Amount received: Phone:( ) Fax:: ( ) � PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: //�� 1Ht NI Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photovoltaic Solar Panel System Business name: NONE I am doing the work myself. Submit two(2)sets of roof plan with connection details ', J and fire department access,along with the 2010 Oregon Address W iJ . /2—. Solar Installation Specialty Code checklist. CitylSYate2IP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fa: -(---- ) State surcharge(12%ofpermit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name; Nick Smith s Date: 7-13-20 -'Fee methodology set by Tri-County Building Industry Service Board. I:1BuildinglPermits\BUP-RESPennitApp.doc 02/24/2011 440-46 13T(1 1/02/COM/WEB) City of Tigard IIII ® COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Residential Building Permit #: MS S T 20 20 - 00 .-a-7 Site Address: E3`15D SW Pine brag I- 5-i--, Project Name: BM (i"h Lot #: Planning Review Proposal: M4(tan gVerify address/suite# active in Accela. 0 In River Terrace: 34 No ❑ Yes,River Terrace Review Addendum Site Plan Elements: (Erosion Control .V copies of site plan on 8-1/2"x 11"or 11 x 17"paper NARetained trees with drip line and tree protection measures 5rawn to scale(standard architect or engineer scale) ootprint of new structure(including decks) anal) ,North arrow . Utility locations&easements (required for new and additions) Site address,project or subdivision name and lot number I .idewalk/driveway approach Applicant information(name and phone number) 50 ocation of wells/septic systems Lot dimensions and building setback dimensions Ntreet tree size,type and location WSquare footage of buildings to be demolished ►:..treet names xisting structures on site 0 orner elevations(2'contours if more than 4'differential) Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes ATo impervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑YesVo x-Clean Water Services —Service Provider Letter(lot platted prior to 9/10/1995): Required: ] 'Yes,applicant was notified ❑ No Received: El Yes No 1E(Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs ��Required: ❑ Yes,applicant was notified �No Received: El Yes El No N SDC Exemption for ADU applied for: El Yes ❑ No Received: ❑ Yes ❑ No XPublic Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake t Land Use Case#: 't Zoning: -q-. ' Required Setbacks: Front: - Rear: 5 Side: 5 Street Side: VWl Z 2cDA- Garage _ Building Height: Max. Height: '30 Actual Height: ±2 t andscape Area: % .ot Coverage Max: En ranee 103et back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows Minimum 12%of area of all street-facing facades Garage Gar ge d or is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met: D r c tends no more than 5'from wall and there is a covered porch extending beyond garage. D or : -rids no more than 5' from wall and there is a 12 sq ft.window above garage on 2"d floor. Gar e oo 'i is ID or less ❑ 50%or less of facade El 60%or less and includes 7 of following: ❑ C ve ed p..,ch El Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer El Accent siding ❑ Window trim El Window recess ❑ Window projection ❑ Balcony Visual Clearance KA Urban Forestry Plan �� "� tom. '1[ Sensitive Lands: Yes ❑ No Type: vt).CO`('iN eo j moa. ►t/itb aitus Conditions met prior to issuance of building permit J/ Notes: /� � ' j�� Approved By Planning: TIOJ I A v Date: �I Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved 1:1Building\Fonns\BldgPennitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: 7//v/'Zo Site Plans: # 3 Building Plans: # 3 Building Permit#: gYEnter building permit#above. Workflow Routing: R Planning ‘.II--Engineering E—Permit Coordinator 42-13uilding Workflow Sign-off: 2"Sign-off for Planning(include notes from planning review) Route Application Documents: [.a- 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: G—c:, ( to Date: 7/23`?-0 Engineering Review 'Slope at building pad: 2� R'Conditions "Met"prior to issuance of building permit 'a_ 5-"Easements (encroachments)per engineering conditions of approval and platst/� l 'Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes R No Assess Water Quantity Fee in-lieu: ❑ Yes R''No LIDA Facility on lot: ❑ Yes E No Final Plat Recorded:K/ems ❑ NOT Approved by Engineering: Date: Notes: 2.---Approved by Engineering: /..4....../cd--4Date: 7/Z-7koeo Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review onditions "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 i N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes N/A LIDA ❑ Yes N/A OK to Issue Permit Approved by Permit Coordinator: 19e‘aiL Date: —7 J2-( I1 I:\Building\Forms\BldgPermitRvw_RES_122419.docx