Permitr
CITY OF TIGARD MASTER PERMIT
I. COMMUNITY DEVELOPMENT Permit#: MST2021-00475
Date Issued: 12/06/2021
T(GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S 136AA10800
Jurisdiction: Tigard
Site address: 10186 SW 69TH AVE
Subdivision: OAK STREET ESTATES Lot: 3
Project: Caldwell
Project Description: Turn bonus area into bedroom; add floor to open to below area (86 sf)to be used as a loft. Trade
permits to be pulled separately.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 1 First: 0 sf Basement 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 86 sf Garage: 0 sf Front: 0 Smoke
Yes
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 86 sf Value: $11,229.88 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
Bckflw Prevntr: 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>=100 K: 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 86
Owner: Contractor:
CALDWELL,TRICIA&RYAN OWNER Required Items and Reports(Conditions)
MILLER,BRIDGET
10186 SW 69TH AVE
TIGARD,OR 97223
PHONE: PHONE
FAX:
Total Fees: $743.61
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
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Issued By: HOLM VO4 1 6 We9e' Permittee Signature: 0 'A
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
rah,„.,„,„„,„„_____ ,.. .,,
RECEIVEDla
Building Permit Application
Residential NOV 2 2021 FOR OFFICE USE ONLY
City of Tigard CITY OF TIGARD RDateeiv B y // OZ / , %z .ermitNo Msr20`.1,00 f✓
13125 SW Hall Blvd.,Tigard,OR 97�'}�� Plan
' I Phone: 503.718.2439 Fax: 503.59s�bLDING DIVISION Date/By: 1Z 2 A LI Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: kris, Ed See Page 2 for
Internet: www.tigard-or.gov otified/Metho . / / Supplemental Information
•
TYPE OF WORK R I UIRE I DATA:l-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. V$
Valuation: $ '']]]- .L7
w I-and 2-family dwelling ❑Commercial/industrial \\ "
❑Accessory building ❑Multi-family Number of bedrooms: 74
❑Master builder ❑Other: Number of bathrooms. J
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
1 Job site address: 10186 SW 69th Avenue New dwelling area: 86 square feet
fs/ City/State/ZIP: Tigard OR 97223 Garage/carport area: square feet
f✓' Suite/bldg./apt.no.: Project name: Playroom Remodel Covered porch area: square feet
Cross street/directions to job site: Locust&69th Ave Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Oak Crest Lot no: 3 Permit fees*are based on the value of the work performed.
fax 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.
Turn bonus area into bedroom;add floor to open to below area valuation: $
to be used as a loft Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name: Ryan Caldwell Type of construction:
Address: 10186 SW 69th Avenue Occupancy groups:
City/State/ZIP: Tigard OR 97223 Existing:
Phone:(503)816-0062 Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to,*schedule)
Business name:
Structural plan review fee(or deposit): WO
Contact name: Ryan Caldwell
FLS plan review fee(if applicable):
Address: 10186 SW 69th Avenue
City/State/ZIP:/State/ZIP: Total fees due upon application:
y Tigard OR 97223
Amount received:
Phone:(503)816-0062 Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: rtcaldwell@gmail.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 06 fvi 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 lic.: Total fee due upon application: $201.60
Authorized signature: — t This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Caldwell Date: 11/1/2021 *Fee methodology set by Tri-County Building Industry
RyanService Board.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE 1.SE oNL
Cityof Tigard Received
• g Date/By Permit No
11 13125 SW Hall Blvd.,Tigard,OR 97223
I Phone: 503.718.2439 Fax: 503.598.1960 Associated pemtits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing ❑ Mechanical
TIGARD
Internet www.tigard-or.gov ❑ Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
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 ❑ ❑ ❑
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 ❑ ❑ ❑
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, 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. ❑ ❑ ❑
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- ❑ ❑ ❑
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 ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 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 ❑ ❑ ❑
over 10 feet long and/or any beam/joist 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 ❑ ❑ ❑
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 ❑ ❑ ❑
architect licensed in Ore_on and shall be shown to be as ulicable to the uro 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". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
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. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
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, ❑ ❑ ❑
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)
FOR OFFICE USE ONLY—SITE ADDRESS: //1/_� d��—6
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
T I GA R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Alyson Armstrong DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Ryan Caldwell NOV 15 2021
COMPANY: LITY OF TIGARL)
BUILDING DIVISIt
PHONE: 503-816-0062
EMAIL: rtcaldwell@gmail.com
RE: 10186 SW 69th Avenue Tigard, OR 97223 MST2021-00475
• (Site Address) (Permit Number)
Oak Crest Lot 3
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
.3 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: As requested, an enlarged set of A-1 plans so that the font can be read more easily
FO O FICE USE ONLY
Routed to Permit Technic.' : D 6 12 I 'Z� Initials: trtr
Fees Due: ❑ Yes I Vl No Fee Descripti n: Amount Dug
J � $
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes o ❑ Done) 7
Applicant Notified: Date: [, /',L( Initials:
RECEIVED
Property Owner Statement NOV 2 2O2'
Regarding Construction Responsibilities CITY OFTIGARD
Oregon Law requires residential construction permit applicants who are not licensed with theUIL DING DIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own. reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
X I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Ryan Caldwell
Print Name of Permit Applicant
Cie November 2, 2021
Signatur of Permit Applicant Date
Permit#: {�15TC� ____ 41 J__ o
— -----
----
7'ramX e \�
Address: kO`KO �•) Cww� �V�—
Issued by: Date: V2A(AZ1 _ g9
This Copy for Permit Offices
Information Notice to Owners About
' �'-'1 '- Construction Responsibilities
r_� . (ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure,can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance:As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140,Salem,OR 97309-5052
Telephone: 503-378-4621 —Fax: 503-373-2007
WebsiteAddress:www.oregon.gov/ccb
f/property owner adopted 9-2016 This Copy for Permit