Permit il CITY OF TIGARDIII s ' BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2021-00032
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/24/2021
Parcel: 1S135AD02300
Jurisdiction: Tigard
Site address: 10915 SW HALL BLVD 19
Project: Billy Maxine LLC Subdivision: METZGER ACRE TRACTS Lot: 6
Project Description: Upgrade 460 sq ft existing attic floor.
Contractor: OWNER Owner: BILLYE MAXINE LLC,THE
13500 SW PACIFIC HWY#499
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: MF
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 02/14/2021 $827.34
Demolition
Occupancy Grp: B Occupancy Load: 5 12%State Surcharge-Building 02/14/2021 $99.28
Dwelling Units: 0 Plan Review 01/27/2021 $146.77
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 02/14/2021 $103.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 02/14/2021 $330.94
Value: $62,095 Info Process/Archiving-Lg$2.00(over 02/14/2021 $2.00
11x17)
Info Process/Archiving-Sm$0.50(up to 02/14/2021 $0.50
Floor Areas: 11x17)
Tigard CET-Non-Residential-Admin 02/14/2021 $24.84
Total Area: 0 Tigard CET-Non-Residential-AH 02/14/2021 $596.12
Accessory Struct: 0 Plan Review 02/14/2021 $391.00
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,521.79
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
,. 6:::
Issued By: Permittee Signature: -C..- / ,,��
,,z...„6„..srd..,
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 71, _g
-Residential- t,e1'1'ry ti; FOR OFFICE USE ONLI'
City of Tigard !II'
d /� 7 Permit No. DZ/ 2
JL.IVEV DateBy:Receive t% 2{ ZQZ� �LLj _a�� J�
II u 13125 SW Hall Blvd.,Tigard,OR Plan Review/ �
e Phone: 503.718.2439 Fax: 503.598.1960 DateBy: ^ , Other Permit:
f l t,n R 11 Inspection Line: 503.639.4175 JAN 1 9 202� Date Ready/By: / Juris: ETSee Page 2 for
Internet: www.tigard-or.gov NN 'fie // •/ Supplemental Information
TYPE OF W/ E,,G . 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
ZAddition aIteratic replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this a lication.
Valuation: &
�tuily-dwolling ❑Commercial/industrial i
0 Accessory building [ vIulti-family Number of bedrooms:
✓ 60k 0 q r. 9 0
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: i G t j i `a cj'v i t-N A i_t_,. *6 L--s ,- New dwelling area: square feet
City/State/ZIP: •T i LI lZ, t> t C) it_ c i' - Ci `7 2.2 --j Garage/carport area: square feet
Suite/bldg./apt.no.: . i 9 Project name:/s. r 7 E.Covered porch area: square feet
Cross street/directions to job site: Q ,1.L• ,hc if y-1nl E I,i..{.. Deck area: square feet
J"-" F-i /-k L-i,_._ ?y i._"w' V.7. f ' ;r:, `T Other structure area: square feet
v'v.. ,_,1 C..:, .&:.,L.L. rz. C.C..' t,,,-i 11.- T REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I-1 1 ...T Z L.1 p s'z..L Z, --f- A.(.-1-< Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: j { ?,`a (7 v a .C"� equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
L. 'P'C:1 i2 A-s " 'E.).z.1 J i.t,i is.7 is-r-T-t c:--. I"i.._ L-1:C,,i=2.. Valuation: $
�t , r Existing building area: square feet
`-'Y-° c>(2, .7 (: i—j. r 12., i�.i/ t Li'rr'• t. L-. -)
.t=r-- tom 441.11 1..... i iE- L.4-1,'1*,-'it e New building area: square feet
X PROPERTY OWNER 0 TENANT Number of stories:
Name: G t l..L.-- I`^'1 i',..> t El 1_k__c Type of construction:
Address: i v i. el'•y-,i "p/�c., t c 1 (._. t-t„`,;•,,e xi. 4.Cj c-1 Occupancy groups:
City/State/ZIP: •-T- t L:.), rL'1> 1 G cLaa LZ t-I ci 1 2_ -5 Existing:
Phone:( ) Fax:( ) New:
,,'APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name j0,H t� T> l�.t,� t.�A 4i11 T� (Please refer rojeeosit):schedule)
L` ti C- i �' - Structural plan review fee(or deposit): ,/ 6,7 '
Contact name: - C,l,t...4 4,.„4 /�t�1 I� /�t' •&y-- r FLS plan review fee(if applicable):
Address: _a i r€e4-G. �zi.`v L.ii-I?, /�..,,.. `7 co,i ..
Total fees due upon application:
City/State/ZIP: C_7 i..i g 12.rr�4 t�� 1 tZ iz L7 v1`.A CI 1 i (:%
Amount received:
Phone:(' L=:#) G v t 1 Fax::( )
E-mail: �" PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
i'" 0r� `"' 1 - Commercial and residential prescriptive installation of
;', '`• ` : CrtiV i vv( 2.._ roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
(5 I t t_7 ( A X t^' e �� - and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
r In:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
r'
" -At!'''' ` ::7,6/t.127 t 07-/i7 Total fee due upon application: $201.60
* -A 1 prized St ' : it`: #/ This permit application expires if a permit is not obtained
lb. within 180 days after it has been accepted as complete.
�, t.a► tV `> ja *Fee methodology set by Tri-County Building Industry
Print name:
r..3 t`,.r *-+1. e: i / J 5/ a i Service Board.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB), t ! n y
INc ada.. t'lltru&Ary, ry c.�,(t_Ett1 . CAA-. f-- Aitii _ .'�`f t,-lAJ �z rj Pt `t`( "' /� DELI �Cle
RECEIVED
Property Owner Statement FEB 2 3 20
Regarding Construction Responsibilities 21
g g p CITY OF TIGARG
Oregon Law requires residential construction permit applicants who are not licenseeAtellhe DIVISION
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
j 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.
/1/17 gerAreP, /71,9
Print Name of Permit Applicant
2. _2.02-. z1
Signature of Permit Applicant Date
1� v ZD Z/ nou 3
$fePermit#: ---. . ..
/ofif Jw �42 id// ,
Address:: �r h���`*\L�qi:3`,
/7
Issued by: „9,0144477, Date: gi-a0-/
Thic rnnv fnr Parma.flffit
•
Dianna Ornelas
From: #Building Permit Technicians
Sent: Monday, February 22, 2021 5:54 PM
To: PAM BENSON
Subject: RE: BUP2021-00032 receipt no 432925 02/14/2020 10915 SW Hall Blvd
Attachments: OwnersConstructionResponsibilities.pdf
Hi Pam,
Thank you for the information.
As the owner performing the work,we will need you to complete Page 2 of the attached owner responsibility form and
return to TigardBuildlingPermits@tigard-or.gov so that we can issue the permit.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard ( Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: PAM BENSON <pam.benson@yahoo.com>
Sent: Friday, February 19,2021 9:18 PM
To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Re: BUP2021-00032 receipt no 432925 02/14/2020 10915 SW Hall Blvd
Caution!This message was sent from outside your organization.
This is a free standing building that I live in. I am the sole owner of Billye maxine Ilc/. Thank you
Pam
On Friday, February 19, 2021, 09:05:36 AM PST, #Building Permit Technicians <tigardbuildingpermits(cDtigard-or.gov>
wrote:
Hello Pam,
Thank you for the information.
If this is a rental unit in property that you own, we need you to complete and return the attached form to
TigardBuildingPermits(a�tigard-or.gov before we can issue the permit.
Thank you.
1
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: PAM BENSON <pam.bensonayahoo.com>
Sent: Thursday, February 18, 2021 8:53 PM
To: #Building Permit Technicians <TigardBuildingPermits(c�tigard-or.gov>
Subject: Re: BUP2021-00032 receipt no 432925 02/14/2020 10915 SW Hall Blvd
I am the sole owner of the Billye Maxine LLC. Do you need to see any LLC Papers?
On Thursday, February 18, 2021, 06:24:13 PM PST, #Building Permit Technicians<tigardbuildingpermits(c�tiqard-or.qov>
wrote:
Hello Pam,
I need further clarification.
Is this an apartment building or a condominium unit? The tax assessor information shows Billye Maxine LLC as the owner
of this property. Are you part of Billye Maxine LLC?
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
2
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: PAM BENSON <pam.bensonyahoo.com>
Sent: Thursday, February 18, 2021 5:50 PM
To: #Building Permit Technicians <TigardBuildingPermits(cr�tigard-or.gov>
Subject: Re: BUP2021-00032 receipt no 432925 02/14/2020 10915 SW Hall Blvd
I will be my own contractor. I am the owner. John Annand is the architect and will be helping me
along the way.
On Tuesday, February 16, 2021, 06:10:14 PM PST, #Building Permit Technicians <tigardbuildingpermits a(�tigard-or.gov>
wrote:
Hello Pam,
Thank you for the payment.
We are still waiting for the contractor information to add to the permit before we can issue it. Please email this information
at your earliest convenience.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
3
•
From: PAM BENSON <pam.benson(c�vahoo.com>
Sent: Sunday, February 14, 2021 7:14 PM
To: #Building Permit Technicians <TigardBuildingPermits(a�tigard-or.gov>; PAM BENSON <pam.benson(a�vahoo.com>;
John D. Annand Jr<archida2(a.aol.com>
Subject: BUP2021-00032 receipt no 432925 02/14/2020 10915 SW Hall Blvd
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
4
City of Tigard
p COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Commercial - No Land Use
Building Permit #: BUP2.13Z\- oc3Z_
Site Address: (Qq IS-- SUO ttALL 1'.LV() Suite/Bldg#: ( 1
Project Name: soi.)
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: 11)6 W11'10016 % (ns ut,Am61 1b pdp 1b gu(20?(-OOo32
Existing Business Activity: /'^
Proposed_ Business Activity: /V H
to Verify site address/suite# exists and active in permit system
Z ver Terrace Neighborhood: ❑ Yes Gr No
ning:
muted Use: ,2' Yes El No ❑ Spec Space
VI
firm no land use required.
� � iness License:
{w
Exists: ❑ Yes ❑ No, applicant was provided a business license application
Notes:
Approved by Planning: —'� Date: "1/ 'f//
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: #
Building Permit#: ❑ Enter building permit#above.
Workflow Routing: ❑ Planning ❑ Permit Coordinator ❑ Building
Workflow Sign-off: ❑ Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑ Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date:
1:\Building\Fonns\BldgPennitRvw_COM_NoLandUse_111819.docx
errrl� _
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:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_l 11819.docx
T
RECEIVED
SEP 1 3 2021
JD'OF TlGARD
;I IILDING DIVISION
September 9th, 2021
To: Building Division Tigard Building Permit
Please see attached Building permit BUP2021-00032.The permit was approved 02/24/2021.
I was not aware to apply for window, insulation and drywall permits at the same time.
I have completed the Building Permit application for two windows; insulation and sheetrock.
I have included the architect drawings for the den/studio.
Please let me know if I need to do anything else to get the permits.
Thank you,
Pam Benson
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.
Ili City of Tigard ' COMMUNITY DEVELOPMENT DEPARTMENT
fi
Transmittal Letter
i I G A it t) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: ?/Vir7 c.?1/4/4 ,i SEP 1 3 2021
COMPANY: CITY OF TIGARLD
BUILDING DIVISIO „
PHONE: ,Sd3 //3 /Y 27,r-i--
EMAIL: /�/pin. G/2JOh .0 /PA/v s"�j
RE: /o9/r -r /,//-D L L 2 L.,„/ l`` ELP 2C21- OO( 2
(Site Address) / j l+ Z Z 3(Permit Number)
f9bvsr
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: r Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain): /
REMARKS: 7Gt�� c'-' `i � ) ,� (/�/�. 'd[,
--/-v /✓6/ .7-o 27 U Z 4 Z / — pow ,? 2
7c/m. j--- %o�/.., vd✓c .' Z - 2f`'2/
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: `�/jQ// 1 Initials/4A✓
Fees Due: [I] Yes 60 Fee Description: Amount Dut:
$
$
$
Special
Instructions:
Reprint Permit(per PE): [] Yes n No n Done _
Applicant Notified: Date: Initials: