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
_ Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: A-1114Q s "tit M S QI DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: (1(16551 20 d15 Co&Sfk rJ J-t u r AUG 2 2021
COMPANY: LILY OF TIGARD
PHONE: CC1 71 ) 3�5 .,233$ BUILDING DIVIStO : ��
EMAIL: Sf1L€5 a MOM footS CoNSkf" C.-\--tan1. cdir.
RE: r a-N D (21 d1 A✓e 1VIST2U21 — W02$-4
(Site Address) (Permit Number)
ANfc o
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: 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: LOA,
pimD.tigto t‘ ok. 0! P2),t� i l (t c.4,s LkLikcx cop_ Q '
FOR F ICE USE ONLY .!1'J _
Routed to Permit Technician: Date: 9 1 '/21 Initials:
Fees Due: El Yes ❑ No Fee Descriptio : Amount Due:
$$ ,Z5r.' c...._
Special
Instructions:
Reprint Permit(per PE): ❑ Yes ❑ No ❑ Done
A\
Applicant Notified: Date: ((S )2. ( Initials:
Building Permit Application :g —7A /21
Residential b-1 7 FOR OFFICE. USE ONLY
Received T
CityofTi and t�7/Zb/2.02A Penm[No.:T (�IZO2� Cr7O2 /
• 1312 SW Hall Blvd.,Tigard,OR 97223 J U L 1 3 2021 plan Review �' Permit:Other
• Phone: 503.718.2439 Fax: 503.5981960 DateBy:
Inspection Line: 503.639.4175 CI 1 Y OF !i t,tf i i , Date Ready/By: le I RI See Page 2 for
T I i :1 R D Internet: www.tigard-or.gov 3U i !,fl! V' r-iI9 t c`d'"". ed/Method: 1 Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
17,1 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,b overhead,an e pr frt tat, 'fitor�lt.
CATEGORY OF CONSTRUCTION work indicated on this application. j
Valuation: $ 6 16 23 a, S
le 1-and 2-family dwelling ElCommercial/industrial 7 f
O Accessory building 0 Multi-family Number of bedrooms:
ElMaster builder D Other: Number of bathrooms:
JOB SlutINFORMATION AND LOCATION Total number of floors:
Job site address: 1.37(x) b ia k a l it bre New dwelling area: square feet
City/State/ZIP: Ti(r fl - op, of 7aa 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: A^1 T t GO Covered porch area: gsquare feet
Cross street/directions to job site: GA-�Q-b J p,o se tJ t 61 Ct Deck area: la1X VJ Nft�► Y square feet
Other structure area:. tivare feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I 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.
''Cc x�� "�k Valuation: $
�tl ikkiew) cre4a t , , Al G�,n ''� GJI c-041..- Qe..1C Existing building area: square feet
, 'S-2£/c t �� �l'ei ON g 4-%4t Ay V New building area: square feet
,$I PROPERTY OWNER 0 TENANT Number of stories:
Name: TCX1, ,1 f`v j"l G O Type of construction:
Address: 13`!6,6 flp la t.5.17 A-4-e.-- Occupancy groups:
City/State/ZIP: --r—i•(rlr(2. d e., 9 7,401-3 Existing:
Phone:( ) Fax:( ) New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
LTom (Please refer to fee schedule)
Business name: �jsy RoQT6 Cori -eUC,C1 LLC
I Structural plan review fee(or deposit): 323.-7Z
Contact name: 1 -A 0 c,t L4j a;,G,H-T
FLS plan review fee(if applicable):
Address: P(5 Q>dx 7,/ Total fees due upon application:
City/State/Z1P: S.1-eS via)61,_ 02 417(yb
Amount received:
Phone:(9)3) 8Lf/ . 3ao3 Fax::( )
Un 1� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:
�j�}L£S pt , MO, estos C S"` !)C 10°,)- LOM Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: S j/h . trod 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
y and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 0317 i D Total fee due upon application: $201.60
Authorized signature: CTN., �� `� This permit application expires if a permit is not obtained
' --11 within 180 days after it has been accepted as complete.
Print name: l� (?_.c * VJ l y Date: p *Fee methodology set by Tri-County Building Industry
'� �1�IL 1 _al•Z Service Board.
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02JCOM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling 1-OR drill 1 I NI: t1Sl.l
City of Tigard Received Permit No.:
:.'I 13125 SW Hall Blvd.,Tigard,OR 97223 Ashy
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 El Electrical El Plumbing El Mechanical
TIGARD Internet: www.tigard-or.gov 0 Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ves No NIA
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity El El
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 0
9 Erosion control ❑plan ❑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 0 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 g 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 ❑ ❑
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- ❑ ❑ ❑
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 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
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 ❑
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 ❑ ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑ 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 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 0
architect licensed in Ore.on and shall be shown to be applicable to the .roect 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 ❑ ❑
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. ❑ 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 ❑
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:,Building\Permits\BUP-RESPermitApp.doc 02/2412011 440-4613T(11/02/COM/WEB)
IIICity of Tigard
~ COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Residential
TIGARD
Building Permit #: k5i 2O2-1-002e7
Site Address: 134(0S) SW 121Sr AVe
Project Name: A-1(m Lot #:
Planning Review
Proposal:op N O
2 Verify address/suite# active in Accela. al 1In River Terrace: [- o ❑ Yes, River Terrace Review Addendum
Site Ian Elements: 1l t 1Erosion Control
350pies of site plan on 8-1/2"x 11"or 11 x 17"paper R wined trees with drip line and tree protection measures
^261�yawn to scale(standard architect or engineer scale) � ootprint of new structure(including decks)and FFE
Xv rth arrow ty locations&easements (requited for new and additions)
address,project or subdivision name and lot number idewalk/driveway approach
[[[������.'' cant information(name and phone number) Location of wells/septic systems
51 Lot dimensions and building setback dimensions th- St eet tree size,type and location
EIS re footage of buildings to be demolished b/ eet names
xisting structures on site 1CJ Corner elevations (2'contours if more than 4'differenti'l)
tSp Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes ENo
I ' 0/Clean Water Syvices—Service Provider Letter (lot platted prior to 9/10/1995):
R uired: Ail Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
Water Meter F eure Unit Worksheet—Additions,Remodels and ADUs •
Required: Mg Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
SDC Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No
Public Facilities Improvement(PF]) Permit:
Required: ❑ Yes,applicant was notified No A ed For: ❑ Yes ❑ No,stop intake
EL...Land Use Case#: Zoning: p ei••S
. Required Setbacks: Front: Rear: IS Side: r Street Side: I Garage: ?—
❑wilding Height: Max. Height: 70 Actual Height: •
❑ Landscape Area: /VA % ❑ Lot Coverage Max: NA
ce ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ' um 12%of area of all street-facing facades
Garage ❑ Garage door d�widest street-facing wall ❑ Yes ❑ No,o o owing is met:
❑ Door extends no mor 5' from wall and there is a cover extending beyond garage.
❑ Door extends no more than 5'fro and ' a 2 sq ft.window above garage on 2nd floor.
❑ Garage door width is ❑ 12'or les 0%o of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ecessed entrance ❑ Wall o s 1'Roof cave ❑ Roof offset
❑ Fire es ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip, brel roof 0 Dormer
Accent siding ❑ Window trim ❑ Window recess ❑ WindowatL ❑ Balcony
isual Clearance ❑ Urban Forestry Plan
❑ Sensitive Lands: ❑ Yes ❑ No Type:
❑ Conditions met prior to issuance of building permit
N s: A47:
Approved By Planning: — , Date: 7 y 2I
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: 003/.2024
Site Plans: # 3
Building Plans: # 3
Building Permit#: [ inter building permit#above. Mr/Building
Workflow Routing: [Planning C-Engineering EPermit Coordinator
Workflow Sign-off: [r Sign-off for Planning(include notes from planning review)
Route Application Documents: [E'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
[ Juilding: original permit application,site plans,building plans, engineer and
beam calculations an. trust details,if applicable, etc.
Notes:
By Permit Technician: —/Iifi7ZM Date: Q76/1dLl
Engineering Review
aiope at building pad:
a-Conditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
L Vater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes a-No
Assess Water Quantity Fee in-lieu: ❑ Yes ErNo
LIDA Facility on lot: ❑ Yes a-No
12'ginal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:/
LT Approved by Engineering: g, 65 i4A&. Date: 7-a(,• 20 2R
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
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
eZ SDC Exemption: ❑ Received Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ,0 N/A
Tigard Trans SDC: ❑ Yes g N/A
Parks SDC: ❑ Yes 8 N/A
LIDA ❑ Yes Or N/A
OK to Issue Permit
Approved by Permit Coordinator: V l `1 _ Date: 1(21 12024
I:\Building\Forms\B1dgPermitRvw_RES_122419.docx