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 submitti%- information for plan review responses and revisions.
This form and the information it EN ovides helps the review process and response to your pr9ject.
711City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
_ Transmittal Letter
I , ,k„, 13125 SW Hall Blvd. • Tigard, Oregon 97223 . 503.718.2439 • www.tittard-or.t;ov
DATE t)
DEPT: BUILDING DIVISION iihtirC
,SAP 1 1 2(122
FROM: CtS WTLt#-R-no1C Gi 'r l ' fEGARD
COMPANY: ? tort-ttK OR'Git 'be.INNTKIA S I LLt. BUIL CNG DIVIS:CM
By: a�i y
PHONE: i'a'b •341. 6SO l f,
EMAIL: C.M IcCTbS L.L-CNv. • Corm
RE: 15 1'( 54,.3 Itworoa L .
. Msr act%- ooti:)
(Site Address) (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
i Copies: Description: _ Copies: Description:
Additional set(s)of plans. 1 Revisions: IMRSILtil. b?Tl CirkM4M 5.
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: bw or#40oat-41m vE2.104i•4.1.. MoolPY 14. oktsr d- bPTN.
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PytD Lk c cfr 0.E- -b01LI . 5TE wAct-t'tl _T�"''1 •.:40 urbtt1to al'tttEr._Az L-
FopOF ICE USE ONLY _ .
Routed to Pm 1 c hntc tan: Date:_ l Initials:_�_ ___ --
Fees Due: Yes E] No Fee I)escriptio t: Amount Due:
$- till pl.444._._.Ce-44.t.P___ Cilir l_e _. $ ____HS--.1._____-_-1
Special
Instructions:
Reprint Permit(per PE): irly_i__s _._ I Nu _-.
Applicant Notified: r Dale: 17;7)py Initials: 71.
ipi ,� CITY OF TIGARD MASTER PERMIT
1; ' COMMUNITY DEVELOPMENT Permit#: MST2021-00283
Date Issued: 08/02/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112CA06800
Jurisdiction: Tigard
Site address: 15374 SW THURSTON LN
Subdivision: ASHFORD OAKS Lot: 22
Project: Dana
Project Description: Fire damage repair of roof framing/sheathing and external sheathing, siding and interior finishes
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $76,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!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:
DANA,MARC R&KRISTEN L KENNEDY RESTORATION Required Items and Reports(Conditions)
15374 SW THURSTON LN 13909 NE AIRPORT WAY
TIGARD,OR 97224 PORTLAND,OR 97230
PHONE: PHONE: 503-234-0509
FAX:
Total Fees: $1,744.66
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
oc9-nn1-nnln thrn,in AP 0c9 -anon vn,, av nhtain a rnnv of tha nJuc nr dirt ni inetinne to(ll i i( by Tallinn cn4 919 1 QR7 nr 1 Ann 499 91a4
Issued By: � Permittee Signature: 4f
' 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.
¢YxYYxNdd{xtdli/.
Building Permit Application 8_7 212
Residential FOR OFFICE. t'SH:ONLY
RECEIVE: Received o z r u Ms i�ozr oo
Cityof Tigard Permit No.:
JUN 12 2021 valeta
r 13125 SW Hall Blvd.,Tigard,OR 97223Plan Review / '
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 7 ��' itor
Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF"�`IG Date Ready/By: //l 0 See Page 2 for
Internet: www.tigard-or.gov SUP DING r r No' ed/Method: Supplemental Information
TYPE OF WORK REQUIRED DAT•:I-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 0 Other: equipment,materials,labor,overhead,and the profit for the
Oa CATEGORY OF CONSTRUCTION work indicated on this application.
2-family1- Valuation: $ 4,1 es 0 b
14 and dwelling ❑Commercial/industrial
0 Accessory building El Multi-familyNumber of bedrooms:
0 Master builder Number of bathrooms: r
❑Other:
JOB SITE INFORMATION AND LOCATION l otal number of floors: Z.,
Job site address: 153-1'i •b .3 TIAvK S'h14 LN . New dwelling area: square feet
City State/Z_IP: '['t S W-k ID t O lb.-re Cl a N 11 L.2.4 Garage/carport arca: .r square feet
Suite/bldg./apt.no.: Project name: Oet h et Covered porch area: /- square feet
Cross street directions to job site: Deck area: square feet
Other structure arca: square feet
l REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
rr11LIC 1)hwM4Cm. 12-R.100%0 l_ 01= 2 F Ftt-APA"Or /3WE-s+11►I
A t'i ltrk-11- A-- b t{�FtRi t Mlr I S 1 101 Mir Ot tJ e, i IS "ettl uK. Existing building area: square feet
F t13 is - New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City;State/ZIP: Existing:
Phone:( ) Fax:( ) New:
® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: pRe,vs,C—W-rt' rbe.„A`Mktcvt gtitVei"AS I LIE.
Structural plan review fee(or deposit): Al.Va
Contact name: Cic} -tSCb P(dt-{-vL gIV,S 1-0..l.-e bl�
FLS plan review fee(if applicable):
Address: 2..a$b 10,4 CA-0 t-k.tt..JLS e,LV tD• lb to
City/State/ZIP: a �,tpv,t,r-hg," �t,� i-Cpo� Total fees due upon application:
Phone:(-501)) 3 y I • 41,ez,ei I Fax: :( ) Amount received:
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: C1 tS Q4p$L.LC N trJ•C '4'1
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 4G1f.N1J,,b`? eSrb�p,t�0 H Submit two(2)sets of roof plan with connection details
and lire department access,along with the 2010 Oregon
Address: Ivi.b el 1„kn_ Al 'OkT y I IN't Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
City State/ZIP: ?tot-rt.-NOD 1 D (t.E( o N `t 7 L)C and administrative fees): $180.00
Phone:(50)) t3y •OSo°) Fax:( )
State surcharge(12%of permit fee): S21.60
CCB lie.: '+by b'L 77,4 ? Total fee due upon application: $201.60
Authorized signature: _ 41/ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: e,1priLt 514 R.51 L104-e V 1[ Date: .2( *Fee methodology set by Tri-County Building Industry
1' 6 Service Board.
L\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613'1'(11/02/COM/WE13)
Building Permit Application Checklist
One- and Two-Family Dwelling rOR OFHl( t: t SH U\l.1
Cit of Ti and Received
INy ' Date/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223
e Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical ❑ Plumbing ❑ Mechanical
I I G A IZ D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 cs yi, y, k
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. ❑ 0 ESt
3 Verification of approved plat/lot. ❑ 0
4 Fire district approval required. Name of district: • 0 0
5 Septic system permit or authorization for remodel. Existing system capacity El
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 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state TE1 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 ❑ 0 0
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 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 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- ® 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. 0 ❑ 29
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- (S 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 ® ❑ 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 21
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 gl 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 ❑ IN
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required El 0 0
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
architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17".
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ 0 0
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, 0 ❑ 0
and 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 ❑ 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.
I:\Bui lding\Permits\BUP-RESPermitApp.doc 02/24/201 1 440-4613T(11/02/COM/WEB)
City of Tigard
v COMMUNITY DEVELOPMENT DEPARTMENT
ill 11
TIGARD Building Permit Review — Residential
Building Permit #: 146r2O21 -. 002 83
Site Address: _1 S3-4y Sli TttuesmJ (,N•
Project Name: 04/2 4 Lot #:
Planning Review
Proposal: 94A) g.2eAkt. ,fib- PA'A(sR) OJT Clt> JJ(i 11 c, f iirtt
erify address/suite#active in Accela. J"-In River Terrace: .IJ No ❑ Yes, River Terrace Review Addendum
ite Plan Elements: ❑Erosion Control
03 copie • Ian on 8-1/2"x 11"or 11 x 17"paper ❑Retained trees with drip line and tree protection measures
❑Drawn to scale(standar • ct or engineer scale) ❑Footprint of new structure(including decks) and FFE
❑North arrow ❑Utility locations&easements (required for new and additions)
❑Site address,project or subdivision name and lot num ❑Sidewalk/driveway approach
❑Applicant information(name and phone number) o • of wells/septic systems
❑Lot dimensions and building setback dimensions ❑Street tree size, nd location
❑Square footage of buildings to be demolished ❑Street names
❑Existing structures on site ❑Corner elevations(2'contours if more 4'differential)
❑Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replace . Yes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes ❑No
!�J Clean Water ervices—Service Provider Letter (lot platted prior to 9/10/1995):
Iequired: Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
Water Meter F. ture Unit Worksheet—Additions,Remodels and ADUs
Required: Yes,applicant was notified ❑ No �/ Received: ❑ Yes ❑ No
gry,SDC Exemption for ADU applied for: ❑ Yes 1G( No Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified 'No Applied For: ❑ Yes ❑ No,stop intake
❑ and Use Case#: Zoning: P'7
•n Required Setbacks: Front: /c Rear: /0 Side: S Street Side: /3 Garage: 2.0
❑ Building Height: Max. Height: Actual Height:
❑ Landscape Area: % ❑ Lot Coverage Max: 0/0
' ance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windo'•. ❑ Minimum 12%of area of all street-facing facades
Garage ❑ . :- door is behind widest street-facing wall ❑ Yes ❑ No,o s- . e following is met:
❑ Door e no more than 5'from wall and there is a covered .• extending beyond garage.
❑ Door extends no m. - •an 5'from wall and there• . sq ft.window above garage on 2"d floor.
❑ Garage door width is ❑ 12'or less ■ t' • or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Rece -. entrance LI all offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles G ap Siding ❑ Roof pitch V. able,hip,or gambrel roof ❑ Dormer
❑ Ac -- st.' g ❑ Window trim ❑ Window recess • • dow projection ❑ Balcony
❑ Visual C -. ce ❑ Urban Forestry Plan
❑ - sitive Lands: ❑ Yes ❑ No Type:
❑ Conditions met prior to issuance of building permit
Not . jQ (J Yi Tn cY• ao r-
Approved By Planning: Date: 7/'/LA
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
1:\Building\Fonns\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: # 3"
Building Plans: ,#,/,3
Building Permit#: E r nter building permit#above.
Workflow Routing: Planning ❑ Engineering• ❑ Permit Coordinator Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: ®'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
VBuilding: original permit application, site plans,building plans,engineer and
beam calculations and st details,if applicable,etc.
Notes:
By Permit Technician: Date: '//c/204
Engineering Review
Slope at building pad: ,7" "
'onditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 2--No
Assess Water Quantity Fee in-lieu: ❑ Yes Erne.
�� LIDA Facility on lot: ❑ Yes LS No
1Z Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Er-Approved by Engineering: 14. lrt5�� te_ Date: 7-"D-24'3
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
V{i"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 7f 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: Date: 1 122) I 2,0?i1
1:\Building\Forms\BidgPermitRvw_RES_I 22419.docx