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 • COMMUNITY DEVELOPMENT DEPARTMENT
INI
III Transmittal Letter
T I tc A R.C) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Donna Bezio OCT 7 2021
COMPANY: Portland Community College CITY OF TIGARU
PHONE: 503-804-5059 IUILDING DIVISION By:____ __
EMAIL: donna.bezio@pcc.edu
RE: 12680 SW Walnut St. MST2021-00204
. (Site Address) (Permit Number)
PCC Writers House
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 3 Revisions: reduced scope of work
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: Reduced Scope of Work due to rising construction costs.
Home had accessible upgrades already.ADA kitchen now complete.Mark ups show no work in existing ADA bathroom.
No work at rear deck, No work at laundry room, No s'te improvements.4, ui w1)
FO OF ICE USE ONLY
Routed to Permit Technici : ate: Vb \� Z1 Initials:
Fees Due: ❑ Yes No Fee Desc ption. Amount Due:
, $ 12f-------- -
....)(.)1,—.) $
Special
Instructions:
Reprint Permit(per PE): ❑Yes rko ' ❑Done
pp
A licant Notified: ate: /&/2 2' [ Initials:
.
I:\Bwilding\Forms1TransmittalLetter-Revisions 073 120.doc
,3
CITY OF TIGARD MASTER PERMIT
a COMMUNITY DEVELOPMENT Permit#: MST2021-00204
T t G.A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/12/2021
Parcel: 2S104DA24500
Jurisdiction: Tigard
Site address: 12680 SW WALNUT ST
Subdivision: None Lot: None
Project: PCC Writers House
Project Description: Renovation to existing home-re-decking &rails 2 decks, removing sink in laundry, removing tub,
creating a more accessible kitchen, beam hangers in crawl space.Trade permits to be pulled
BUILDING
Floor Areas Required Setbacks Required
Stones: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 20 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 15 Smoke
Dwelling Units: 0 Third: 0 sf Right: 20 Detectors:
Total: 0 sf Value: $90,000.00 Rear: 20
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 Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Bckflw Prevntr: 0 Catch Basins: 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:
ALT SF VB R-3 0
Owner: Contractor:
PORTLAND COMMUNITY COLLEGE MINORITY CONSTRUCTION GROUP Required Items and Reports(Conditions)
ATTN PRATER,ANN T 1631 NE BROADWAY PMB 432 1 Special Inspection-
12000 SW 49TH AVE CC221 PORTLAND,OR 97232 Concrete Reinforcing Steel&
PORTLAND,OR 97219
PHONE: PHONE: 503-939-5094
FAX:
Total Fees: $1,058.25
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
OS9-nmi_onln Ihrnunl.nAR Q99-,n/'O 21non V may Main a rnm,of the.r,ileac nr riir art nooc}nne to fN INrt by roll Sin 919 10R7 nr 1 Ann 1/9 91dd
Issued By: '� t ' ` 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 --, Sf17/2I
Residential RECEIVE FOR OFFICE USE O.I.I
City of Tigard
Received S� Z MS1-202(.�Z t}
g Date/By: / //, / Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 NAY 1 7 2021 v
• Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
a �'� �r Other Permit:
Date By:
, ,t; R„ Inspection Line: 503.639.4175 CITY OF TIGARD D81e y�y: " ''�� See Page for
Internet: www.n Supplemental N ethod: _, T Information
BUILDING DIV' '�'. ,!.w�- ,
TYPE OF WORK' `tt'/ II4. 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 ❑Other: equipment,materials,labor,overhead,and the profit for the I
CATEGORY OF CONSTRUCTION work indicated on this application.
X I-and 2-family dwelling ❑Commercial/industrial Valuation: $ 90 000.00
ElAccessory building 0 Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address:12680 SW Walnut St New dwelling area: 0 square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: 0 square feet
Suite/bldg./apt.no.: Project name:PCC Writers House Covered porch area: 0 square feet
Cross street/directions to job site: SW Walnut street, gravel drive just next Deck area: 0 square feet
to SW Sevilla AVE
Other structure area: 0 square feet
r /ka i , tA _eluvrC€ Ag/ji Ilee
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Permit fees*are based on the value of the work performed.
i� ` Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: t � Arrn��S }b !t
equipment,materialsr,overhead,and the profit for the
DESCRIPTION OF WORK 90 146 S.(rr3.�-'-L1.1 work indicated on t th's application.
Renovations to an existing home e t *(01 l�/Lt(5 at-;2__cJrc5 Valuation: $ 1\[/)A
12. 0 1 5 t \I-' ((t. \o),(,Y1(if U r00 M , 0 J (Lq -i lt)t Existing building area: square feet
(11Y- f llA CIv MOCK aCer_e llc(e, 0-6, &t t'\/Ream katit13 New building area: square feet
Al PROPERTY OWNER ElTENANT C.ecuo,(-5pLe Number of stories:
Name: Donna Bezio - Portland Community College Type of construction:
Address: 9700 SW Capitol Hwy, Suite 260 Occupancy groups:
City/State/ZIP: Portland, Oregon 97219 Existing:
Phone:( 503)804-5059 Fax:( ) New:
0 APPLICANT x CONTACT PERSON BUILDING PERMIT FEES*
Business name: PCC (Please refer mfee schedule)
Structural plan review fee(or deposit):
Contact name: Donna Bezio
FLS plan review fee(if applicable):
Address: 9700 SW Capitol Hwy, Suite 260
Total fees due upon application:
City/State/ZIP: Portland, Oregon 97219
Phone:( 503).804-5059 Fax::( ) Amount received:
E-mail: donna.bezio@pcc.edu PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR : roof-top mounted PhotoVoltaic Solar Panel System.
Business name: FBD 4..1 %� , s tyl. S GyG� ��,C, Submit two(2)sets of roof plan with connection details
Address: 11,y / ��L� and fire department access,along with the 2010 Oregon
�f ►� �G(/G( �� �� Solar Installation Specialty Code checklist.
City/State/ZIP: ��,p �p 7��� Permit Fee(includes plan review $180.00
!!� v��- and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: tZ6� 5n/ /1 v.//�,Z_ Total fee due upon application: $201.60
Authorized signature: /k/�/ ®ZQ,i !U p ' This permit application expires if a permit is not obtained
/'� within 180 days after it has been accepted as complete.
)„ i Print name: , Zt 0 Date: Sf I3 *Fee methodology set by Tri-County Building Industry
V Service Board.
I:\Building\Pemuts\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
y Pcnnit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
1 I Phone: 503.718.2439 Fax: 503.598.1960 El Electrical ❑ Plumbing ❑ Mechanical
24-Hour Inspection Line: 503.639.4175
TIGARD Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ►-' 0 ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. * ❑ ❑
3 Verification of approved plat/lot. �� 0 0
4 Fire district approval required. Name of district: t:t ❑
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 LY
6 Sewer permit. 0 0
7 Water district approval. 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state K 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 ❑ ❑ I[
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-11 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 D ❑ xi
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, X 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- j,$[ 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.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. rAt 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 [X[
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 0 0 X
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 ❑ x
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 X 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 X
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ l[
for four or more appliances. �t,,�
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or KY 0 0
architect licensed in Ore ton and shall be shown to be aprlicable to the •r&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". 0 ❑ 12-
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 1 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 p❑�
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 14
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ 0 I[
Land protection measures must be drawn to scale and must include the project arborist's signature of approval.
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
on a lot of record approved prior to September 9, 1995.
:\Building\Permits1BUP-RESPermitApp.doc 02/24/2011 440 4613T(I 1/02/COM/WEB)
City of Tigard
II1" COMMUNITY DEVELOPMENT DEPARTMENT
lC
T l G a,x o Building Permit Review — Residential
Building Permit #: MST2O21-OO2O+
Site Address: 12680 SW Walnut St
Project Name: Carolyn Moore Writers House Lot #:
Pl nning Review
P posal: Interior remodel, new pavement,,rld remove/repla decking & handrails
Verify address/suite # active in Accela. On River Terrace: No ❑ Yes, River Terrace Review Addendum
Sit, Plan Elements: erosion Control
E% opies of site plan on 8-1/2"x 11"or 11 x 17"paper l2etained trees with drip line and tree protection measures
hifirirawn to scale(standard architect or engineer scale) footprint of new structure(including decks) and FFE
N. Irth arrow 11 ...Jtility locations&easements(required for new and additions)
!kite address,project or subdivision name and lot number ..,Sidewalk/driveway approach
%applicant information(name and phone number) vocation of wells/septic systems
II . dimensions and building setback dimensions rs street tree size,type and location
U..uare footage of buildings to be demolished street names
-,ring structures on site _Corner elevations(2'contours if more than 4'differential
►l t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es o
impervious area(ap licable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es o
❑ Clean Water S rvices-Service Provider Letter (lot platted prior to 9/10/1995):
Required: Yes,applicant was notified 0 No Received: ❑Yes No
II Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
II SDC Exemption for ADU applied for: ❑Yes ❑ No Received: ❑ Yes ❑ No
II Public Facilities Improvement(PFI) Permit:
Required: ❑Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
II .-and Use Case #: ❑ Zoning: R4.5
equired Setbacks: Front: 15 VBuilding Height: Max. Height:Rear:45 20 Side: 20
Actual He Streetight: Side: 15 Garage: N/A
�L
7 Landscape Area: 15 % Lot Coverage Max: 85
Entrance ; .- back no more than 8'from street-facing wall 1 t / arallel to street or offset 45 degrees or less
Windows %Minimu of area of all street-facing facades
Garage I Gara e door is 5- d widest street-facing wall ❑Yes ElNo,one of the following is met:
❑gDoor extends no in. ; an 5'fro.• • . and there is a covered porch extending beyond garage.
❑u Door extends no more tha : ' .m wall and there is a 12 sq ft.window above garage on 2°d floor.
ElGara:e door width is I or less 3 !°o or less of facade 9 60%or less and includes 7 of following:
II III Covered poi • Recessed entrance \ .11 offset 1'Roof eave _ Roof offset
I Fire s -• es I Lap Siding ❑Roof itch 5 _ able,hi.,or gambrel roof — Dormer
I cent siding Window trim U Window recess 1 Window projection ❑ Balcony
❑ Visual Cl-. .- .nce ❑ Urban Forestry,Plan
❑ Se,,-eve Lands: ❑ Yes ❑ No Type:
111 C ditions met prior to issuance of building permit
No s: ( J
Approved By Planning: _. _ Date: cj-2V/9-/
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
1:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: OSA7120. -i
Site Plans: # 3
Building Plans: # 3
1 Building Permit#: a-Enter buildin ermit#above. nn �
Workflow Routing: 'Planning engineering Permit Coordinator Ly-building
Workflow Sign-off: 'n�Si,gn-off for Planning(include notes from planning review)
E Route Application Documents: L� ngineering: (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 st details,if applicable,etc.
Notes:
By Permit Technician: i //1/ Date: Q/5A2.1
En neering Review
rnLE�Slope at building pad: e4,
L.(d' nditions "Met"prior to issuance of building permit
, asements (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 IT
LIDA Facility on lot: ❑ Yes L'_I No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes: /�
proved by Engineering: ' Date: .`_ ?___
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
\3,4
Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
0 II SDC Exemption: ❑ Received Does not a
II SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes A
Parks SDC: ❑ Yes /A
LIDA ❑ Yes N/A
OK to Issue Permit
Approved by Permit Coordinator: _ _ Date: �_&'/2-/
I:\Building\Foams\B1dgPermitRvw_RES_122419.docx