Permit Support Document Ili
City of Tigard . .t t I'VIMUNITY DliVH,OrNitiNT DUTARTMENT
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Request for Permit Action
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1 ',,, ,,r I i 13125 SW flail Blvd. • 'Tigard, Oregon 97223 • 503-718-2439 • www,tigard-9r4,,,ov
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TO: CITY OF TIGARD -,
Building Division -1 i/ - ° ,-, --
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,
13125 SW Hall Blvd.,Tigard,OR 97223 A 7* 1.
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Phone: 503,.718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: Ej Owner [ZI Applicant 0 Contractor D City Staff
ehtck(i)one
REFUND OR Name:
INVOICE TO: (Busmen or Individual) Nicholas Locke
Mailing Address: _2903se 7th aye_ _ _ ....i.i._.
City/State/Zip: Portland, Oregon ..
Phone No.: 7 75 276 4 2!)0
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
El (:ANCEL/VOID PERMIT A1)11,ICATI(..)N.
0 REFUND PERM11' FEES (attach copy of original receipt and provide explanation bi:low).
INVOICE FOR F};ES DUE (attach case Ice schedule and provide explamition .helow)
Permit #: l‘AST2020-003'27 ...ii,
Site Address or Parcel #:
Project Narnc: ,,...)rx:otriza.. ,, ..,., , 1
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Building Permit Ap licatio - 12.
Residential ECEIVElit
' FoR,;(3FFICE USE ONLY
City of Tigard DEC .� 9 2020 Received �2I�e%2Uzo W PermitNo.:P 20L0-00321
13125 SW Hall Blvd.,Tigard,OR 97 Date By:
g y��/ Plan Review
I Phone: 503.718.2439 Fax: 503.598 AQ 1 OF TIGAF1'� ate/By: Other Permit:
1 Inspection Line: 503.639.4175 BUILDING D I\)B I O ate Ready/By: Juris: 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: a Supplemental Information
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
RAddition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
r.;, „'^ ,, 4 1 work indicated on this application.
—
j'i
1 and 2-family dwelling 0 Commercial/industrial Valuation: $ 28,000
❑Accessory building 0 Multi-family Number of bedrooms: remain same
❑Master builder 0 Other: Number of bathrooms: remain same
is 4 244; 0,4„ ` Total number of floors: 2
Job site address: 10496 SW Bonanza Way New dwelling area:11 2 "'square feet Ge[�C�
City/State/ZIP: Tigard, Ore on 97223 Garage/carport area: t1 square feet ��_
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: remain same square feet
SW Bonanza & SW Riverwood Other structure area: remain sztrircdeet
qd, NI 44s - - >,
Subdivision: Cook / R IV E R V I E WESTAT E S NO. 2Lot no.: 82 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: R 2032970 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
'',P ` k work indicated on this application.
Second Story Addition to Existing 2 Story Wood Framed Valuation: $
Home. New Covered Entry. New Box Window replacing Existing building area: square feet
New building area: square feet., ' , / • „ I,. •,
a 14,40 , 1�ita'ue ,"' . --, Number of stories:
Name:Ken Dixon Type of construction:
Address: 10496 SW Bonanza Way partcygreuw: _
City/State/ZIP: Tigard, OR 97223 Existing, i
Phone:( 0 , • • Fax:( ) NOW- 1
,;I'=,", t,.
Business name: One to One Works LLC
Structural plan review fee(or deposit): i
Contact name: Nicholas I neke
FLS plan review fee(if applicable):
Address: 2903 SE 78th Ave ---1
City/State/ZIP: Portland, OR 97206 _ Total fees due upon application:
Phone:(775)276 4250 Fax::( ) Amount received:
gl'E-mail: nick@ onetooneworks.com W , , _
tir, -- Commercial and residential prescriptive installation of
't, r; n''',, ,,, . 1 �n > - < s •Z ',. roof-top mounted PhotoVoltaic Solar Panel System.
Business name: TO BID 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. _ r
City/State/ZIP: Permit Fee(includes plan review $180 00
and administrative fees): ---
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 1
CCB lie.: l Total fee due upon application: $201.60 I
Authorized signature: Y�` \ _ This permit application expires if a permit is not obtained
vvJ within 180 days after it has been accepted as complete.
Print name: Nicholas Locke Date: 1 2/4/2020 *Fee methodology set by Tri-County Banding Industry
Service Board.
I:\Building\Permits\BIJP-RESPermitApp.doc 02/24/2011 440-461 3T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR ,OFFICE 1 S1, 0\1.1
City of Tigard Received
IN Date/By: Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223
■ Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
- 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing ❑ Mechanical
I ( \l.D
Internet: www.tigard-or.gov ❑ Other:
I
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW vcs No spa
I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 ■ ri]
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ 0
3 Verification of approved plat/lot. ® 0 ❑
4 Fire district approval required. Name of district: • 0 ❑ gl
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 g]
6 Sewer permit. 0 0 E
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 ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 gj
_ basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® 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 RI 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 ® ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above •rade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- El ■ 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. 14 ■ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendruns showin• foundation elevations with cross references are acce.table.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 1=1 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 ET 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 ]2)
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 'i] ❑ 0
over 10 feet long and/or any beam/.oist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ® El El
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 K El 0
architect licensed in Ore•on and shall be shown to be as•licable to the sro.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". ►:1 ■ ■
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑
25 Buildin• .lans shall not contain red lines or ta.a-ons. "Mirrored"buildin: .lans will not be acce.ted. ❑ t 5i
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ '►.:',
27 "Drawn to scale"indicates standard architect or engineer scale. 'A ❑ 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard RI 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, co ❑ 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 fonn is required for all building additions, El ❑ 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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard and / z/ zo
11111 ' COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 G A R D Building Permit Review — Residential
Building Permit #: MST 2ow-CiO L-1
Site Address: 10495 SW Bonanza Way
Project Name: Dixon Lot #:
Planning Review
Proposal: New entry way and window modifications
X Verify address/suite# active in Accela. ® In River Terrace: ® No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: nic Erosion Control
C3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper n/CRetained trees with drip line and tree protection measures
1 f rawn to scale(standard architect or engineer scale) t ®Footprint of new structure(including decks)and FFE
®North arrow n $]Utility locations&easements(required for new and additions)
k1Site address,project or subdivision name and lot number NC Sidewalk/driveway approach
[ Applicant information(name and phone number) nia=iLocation of wells/septic systems
[kLot dimensions and building setback dimensions niCStreet tree size,type and location
n aSquare footage of buildings to be demolished ®Street names
®Existing structures on site X Corner elevations(2'contours if more than 4'differential)
NLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Ef9�❑No
g impervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? efss1❑No
11 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ® Yes,applicant was notified El No Received: El Yes ❑ No
® Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified [l No Received: ❑ Yes ❑ No
n/a] 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
ES Land Use Case#: SUB1990-00014 PD
( ) C Zoning: R-7
WRequired Setbacks: Front: 15 Rear: 15 Side: 5 Street Side: 10 Garage: 20
® Building Height: Max.Height: 35 Actual Height: no change
it Landscape Area: 20 % ® Lot Coverage Max: 80
Entrance ® Set back no more than 8'from street-facing wall in Parallel to street or offset 45 degrees or less
Windows 25'Minimum 12%of area of all street-facing facades propo fFd : ito` 17
Garage or is behind widest street-facing wall ❑ Yes ❑ No,one of the follo .
❑ Door e than 5'from wall and there is a covered porch exte garage.
❑ Door extends no more a .Does not apply, is not a ove garage on 2nd floor.
❑ Garage door width is El 12'or:modifying garage ❑ 60%or less and includes 7 of following:
❑ Covered porch El R nce Wall offset e ❑ Roof offset
❑ Fire s ' ap Siding ❑ Roof pitch ❑ Gable,hip,or gam re ormer
cent siding ❑ Window trim ❑ Window recess ❑ Window projection a
n1 Visual Clearance ntli Urban Forestry Plan
X] Sensitive Lands: C Yes ❑ No Type: low value habitat
ME Conditions met prior to issuance of building permit
Notes:
'Approved By Planning: Date: \L IN (?20
Revisions (after Building Submitta only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
I:\Building\Forms\Bl dgPennitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: al c \207C0
Site Plans: # 3
Building Plans: # 'S
Building Permit#: Qi Enter building permit# above.
Workflow Routing: Q' Planning 1 Y Engineering [ ' Permit Coordinator ' Building
Workflow Sign-off: ®' Sign-off for Planning(include notes from planning review)
Route Application Documents: 12' 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: \-\-0\\-3 U a,e-‘c e \.io C ay Date: \Z `\(D' 2G
Engineering Review
WeKlope at building pad: 2%
Conditions "Met"prior to issuance of building permit ./1 ja,
WE/asements (encroachments) per engineering conditions of approval and plat n/ti-
[ Water Quality/Quantity Facility
Assess Water Quality Fee in-lieu: ❑ Yes RI'No
Assess Water Quantity Fee in-lieu: ❑ Yes Q/No
LIDA Facility on lot: ❑ Yes 2/No
2--final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Er-Approved by Engineering: %r.G H f- 1&- ..k77 Date: i 2/rz /2020
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
QcCondi.tions "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: El
Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 11 N/A
Tigard Trans SDC: ❑ Yes ,1 N/A
Parks SDC: ❑ Yes .e' N/A
LIDA ❑ Yes X N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: 12-111 Jti..o
I:\Building\Forms\BldgPermitRvw_RES_122419.docx