Permit . V 9 i I ;211A
•. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT C , •�*
`-I
Request for Permit Action JUL 2 8 2021
;`I'ltC \RDT 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or, v OFTIGARD
' f 1'''DIVISION
TO: GITY OF TIGARD
Building Division
13125 SW Kali Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 T gardBuildingPerrnits@tigard-or.gov,`
FROM: ❑ Owner ❑ Applicant ["Contractor ❑ City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) G•),Fc entiamN GIDA.) -6,1 c47 OA/ L...LC
Mailing Address: (L� 7 D5 f7 �t lf
•
City/State/Zip: S (`t nnCI a R 5-7 / CT v
Phone No.: SO 3 1 �j 4 to(Q q/J
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
:fin • CANCEL/VOID PERMIT APPLICATION.
LI REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR PEES DUE(attach case fee schedule andrr�� provide explanation below).
Permit#: r S+ 7,(72.) D(.D2-8 (0
Site Address or Parcel#: ( 5 (Q 39 `j{y,) F t/-th pi aft'l 7 722 '
Project Name: ;17.)u 1SC_6P t
Subdivision Name: Lot#:
EXPLANATION: _.I-.1 I t�ev-, 1 !,1 f+ ,,,•,,,vcJ 10 ei-5 cd-Yv i)v 0.
/VO / t\.h .^ /)r.37.1 /- 2' Cf4-4,- -- 4y
CO i /17e-r--?'b de d ,
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Signature: A.,.., Date: 7-
Print Name: 0...1v p c7 (,0 ic,a..e ma i 1 A.)
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
i!/O',% /S—C4,C ZS,
. FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date ./Q 2.,/ By 2t
Refund Processed: Date ..At///9- By 4)O Invoice Processed: Date By
Permit Canceled: Date ,f/J J 7i By d Parcel Tag_Added: Date By
I:\Building\Forms\ItegPermitAction_1205I8.doc
Dianna Ornelas
From: Wiedemann Construction <wiedemannconstruction@gmail.com>
Sent: Wednesday,July 28, 2021 10:37 AM
To: #Building Permit Technicians
Subject: Request for Permit Action - Cancel/Refund
Attachments: Tom Richfield cancel permit app.pdf
Caution!This message was sent from outside your organization.
Good morning,
Please see attached request for cancellation of permit M5T2021-00286. The job has been cancelled. A
refund is requested.
Thank you,
J%vwW
Wiedemann Construction, LLC
503-784-6691
CCB #213315
1
V 0 Dr
Building Permit Application ! 4-6 -7 13
2-
Residential RECEIVES FOR OFFICE USE ONIA
City of Tigard DReceived - / Permit No.:
14 q 13125 SW Hall Blvd.,Tigard,OR 97223 Platn Review��� �Z r Mar202���6
JUL 0 2021
_ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
i I G A R D Inspection Line: 503.639.4175 CITY OFTIG
ARD Date Ready/By: Juris. Ed See Page 2 for
Internet: www.tigard-or.gov Notified/Method: ' . Supplemental Information
BUILDING DIVISION _ -�
TYPE OF WORK 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
2/Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
[x I-and 2-family dwelling ❑Commercial/industrial Valuation: $ ZO i b 0 p
❑Accessory building 0 Multi-family
Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 5 4 Ste; Bei-rh pi New dwelling area: square feet
City/State/ZIP: ( , (xa,, ( o 9'7 -72-9 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: lava puck) . to(.0-7 square feet
Cross street/directions to job site: (.--41( 4, Do,`.G)ki Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
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
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: ZO.)000
t.
r -a ?: _ Existing building area: square feet
E��7 New building area: square feet
0'PROPERTY OWNER 0 TENANT Number of stories:
Name: to p kl ,�tw J,}Ca IJ Type of construction: ,g,,,,,D ,�,u e_f
Address: I c) ( 34 tom: c Lithpi Occupancy groups:
City/State/ZIP: l, t 0 2 9 7 2 Z y Existing:
Phone:( ) Fax:( ) New:
[APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee
Business name: t e.C6 n,�AJ 4schedule)
COJl�rj t�(a L� Structural plan review fee(or deposit):
24/c(4
Contact name: J 1 yvl I i ette4.1utAjjj FLS plan review fee(if applicable):
Address: /Li 57 0 i1 D
1- I At c C
p Total fees due upon application:
City/State/ZIP: 5Le tr it.),'„ p iz, 9 71 -1 o
Phone:(5 63) -mil (f(Q c I Fax::( )
Amount received:
�f PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: h'.e IE.a('iiko-s-,K i 1-"-`.J -tt ifI(cI'1 6?. ViikC:t1 - ( t:i'+1
Commercial and residential prescriptive installation of
CONTRACTOR Cam,, t. roof-top mounted Photo Voltaic Solar Panel System.
Business name: W 1 eajzo izt.),0 COY cam. ,ti o� L L L Submit two(2)sets of roof plan with connection details
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):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.:2,1 5�i ij 1 T Total fee due upon application: $201.60
Authorized signature: J ,r This permit application expires if a permit is not obtained
��//�ll/// �/ within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: .Aa w 1Q 64wiui ) Date: 7-7-1011 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
City of Tigard
1,1 COMMUNITY DEVELOPMENT DEPARTMENT
a
T 1 c a RD Building Permit Review — Residential
Building Permit #: P(STZ021-002 E36
Site Address: 15634 SW 84th Place
Project Name: Duncan Deck Cover Lot #:
Planning Review
Proposal: New deck cover
® Verify address/suite#active in Accela. ® In River Terrace: lie No ❑ Yes, River Terrace Review Addendum
Site Plan Elements: rlaErosion Control
IN3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper rEiRetained trees with drip line and tree protection measures
$]Drawn to scale(standard architect or engineer scale) 113Footprint of new structure(including decks)and FFh
kNorth arrow naUtility locations&easements(required for new and additions)
5il Site address,project or subdivision name and lot number nllSidewalk/driveway approach
]Applicant information(name and phone number) Location of wells/septic systems
®Lot dimensions and building setback dimensions • aStreet tree size,type and location
riaSquare footage of buildings to be demolished lE Street names
®Existing structures on site rfaComer elevations(2'contours if more than 4'differential)
11 Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? AD
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? L1Yes ❑No
® Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: X Yes,applicant was notified ❑ No Received: ❑ Yes IN No
[E Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
0 SDC Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No
® Public Facilities Improvement (PFI) Permit
Required: ❑ Yes,applicant was notified ® No Applied For: ❑ Yes ❑ No,stop intake
f Land Use Case#: ® Zoning: RA 2
l] Required Setbacks: Front: na Rear: 15 Side: 5 Street Side: na Garage: na
J Building Height. Max.Height: 30 Actual Height: 19
11 Landscape Area: % na Lot Coverage Max:
- • ' e ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees o - -
Windows No - „ 12%of area of all street-facing facades
Garage ❑ Garage door ._ ' - dest street-facing wall ❑ Yes 0 ., .-e of the following is met:
❑ Door extends no more - -- - - - - - _ . el porch extending beyond garage.
❑ Door extends no more th Does not apply. ;a 12 sq ft.window above garage on 2°d floor.
❑ Garage door width is • • less Li 50%or less o 60%or less and includes 7 of following:
❑ • .. c ❑ Recessed entrance ❑ Wall offset ❑ 1 ❑ Roof offset
■ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roo er
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ B c
MI Visual Clearance naUrban Forestry Plan r
® Sensitive Lands: ❑ Yes ® No Type:
a Conditions met prior to issuance of building permit t
Notes: O
IC Approved By Planning: / i1..M Ofv1et'L Date: 7/13/2021
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved r
Revision 2: ❑ Approved ❑ Not Approved d
r
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
l
Building Permit Submittal
Original Submittal Date: O 73/2Cr2/
Site Plans: # 3
Building Plans: # 3
Building Permit#: 'Enter building permit#above.
Workflow Routing: CrPlanning [ Engineering C'-Permit Coordinator C—Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: Z, Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
cr'Building: original permit application,site plans,building plans,engineer and
beam calculations an st details,if applicable,etc.
Notes:
By Permit Technician: Date: D7/,Zd.0.2/
Engineering Review
Slope at building pad: 2 a
C-Conditions "Met"prior to issuance of building permit f/'&
Er--Easements (encroachments)per engineering conditions of approval and plat rllk
CVWater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [No
Assess Water Quantity Fee in-lieu: ❑ Yes [No
LIDA Facility on lot: ❑ Yes CNo
'Final Plat Recorded: M/.
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: nt44/ dr1C""- / Date: 7/2-1 fiat/
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
latConditions"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 7 Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes VI N/A
LIDA ❑ Yes Z N/A
/ OK to Issue Permit
Approved by Permit Coordinator: Date: 1 (21 I 202A
I:\Building\Forms\Bl dgPermitRvw_RES_122419.docx