Loading...
Permit CITY OF TIGARD MASTER PERMIT ' 11111 ' ' ' COMMUNITY DEVELOPMENT Permits: MST2022-00131 Date Issued: 05/19/2022 'FIG A R I-) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S1346D13200 Jurisdiction: Tigard Site address: 12074 SW SUMMERBROOK LN Subdivision: SUMMERBROOK SUBDIVISION Lot: 15 Project: Trommels Project Description: 56 sq. ft. shed attached to dwelling. Already built. BUILDING Floor Areas Required Setbacks Required Stories: Bedrooms: First: sf Basement: sf Left: 5 Parking Spaces: Height: Bathrooms: Second: sf Garage: sf Front: 20 Smoke Dwelling Units: Third: sf Right: 5 Detectors: Total: sf Value: $2,871.68 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Math: 0 Laundry Trays: 0 Rain Drain: 1 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 Dwell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers: Heat Pump: N Hoods: Other Units: Fum<100K: Vents: Woodstoves: Gas Outlets: Furn>=100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 D-200 amp: 0 W/Svc or Fdc 9 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 Owner: Contractor: TROMMELS, ROBERT STEPHEN OWNER Required Items and Reports(Conditions) WONG,PIK YUNG 12074 SW SUMMERBROOK LN TIGARD,OR 97223 PHONE: PHONE: FAX: Total Fees: $546.69 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 ox9_nn1_nn1n lhrnn nap 059_f1 A Vnu(mn/aw nhlain a nnnv of*ha ndoe nr rlirart rn,aafinna 1n(ll INC'.by rallinn 5(�t' 9g 1OR7 r 1 ennf 9qo 91.44 // Issued By: �NU/1 X11 Permittee Signature: tl �� 7�-�-^-- --- C 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 lob she at the time of each inspection. r ..---47- ildine Permit .application f Residential pp q / FOR OFFICE I. ONLY Cih' ofTigard .RECEI ?lED 4'-ri ',',7-, i. _ ;, — - I 1_5 SW 1laU Bkd..1ipard()R vt,�i 1 FiFiii irZZ f ins.,ratmt. Phone: w;.'IttZ W lax: Sn3.3471.14Mt1A( 1 aM/A histwetiait Line: St0•114.8I'S (Saar Ruhr Br �l iuw 0 s.r Pap 2 gee h.t¢rnet: wlaw.ti�ird+ar.tur waw4 ik. ,1 /'t �, J suppk.rrd ldra uatfu■ ���j CITY Or ',hi r ,�; PLIILDING L.,irSiGr — --- � � TYPE Of WORK . REQUIRED DATA:1.APO 2.iAMILY DWELLING `,�w construction 0 Demolition lies•are based on Itt:is Iur ai au work performed Indicate the salve(rounded to the nearest.uteri of all A ,.,:divan aheraioo'replacrtnent 0 Other equipment.mutcruls.Libor.us eau ad.and the profit fui tit) CATEGORY OW coN TW/CTIRN Work indicated on Om application. 21 ig 71 i (i� I ___� __ __ Valuation: ,li ^ 0 I and 2-6mih•dwelling ❑Cummercial industrial Number of bedrooms b ❑ Accasor}buildirr []Math-farm I. Nmnbrsofbathnxms' 'b ❑Master builds 0 tJtir: -- JOR SITE INFORpI.►?ION AND LOCATION Taut number of float: 1 1oh site ad.bes> 1 2,6'j 9 4 y✓ 3d,r04,t[1t br661C L.vt New dwelling area: square Ioet a C,ryte�carport area: squire fat citeatmemP: 7'i�.�. C�K g7223 q Suse bldg.apt.no.: -1 Project sum. TyU P^Yh I?i lS Covered porch arm square fett Cross street Jimtivas to job sue: (L‘ '• typ ps iM1/4 Sv.r✓itno,•'"C' is, Doak area: square feet . Other structure area stp square feet IRQVIIIID liATAtt� Su6divisiun: IAt can.: )rJ Permit fees*are based on the satuc of the work performed Indicate the value'rounded to the nearest AilLr1 trial! Tax map parcel n : equipment. nnteruls,Libor overhead,and the profit fur the I work ndi:med on this application. DtRClIFTIDN O/ N'OR1t — Valuation: $ IV 'Xi/ v Ice..1�� a'ek Ch.5.1 S d•K Q- k$Y2 1-y- -/ ,L_ _ ,iy,y Existing building area: square feet 0 (�!.<ll/L elS !/'tS l�04 L 1 fJV� l3 r`�jlt[l�rc�' — --.-__ New busking area: square fat PROt4:R1'1 Ott SLR a TE.YANtT '.a..,- RO brook- 5 Tro K49.1 at 4f AMMO:/1,07y $w SL>,Hswtv*b ea-'R Lh Occupancy groups: (rt):Stoical P:-IT, OK Cl1'L23 _ Existing: Ph.r.. tre,i, I }thy-g-Z-.17 I av . New d APPLICANT O CONVTAC1 P)-at,t).v iE11if.M111G►ERIiii T1e1:1s Business name: sfN A S /r'7/V C, Structural plan review fee Ior depia.al. C'uatact name: j ILS plan review fee III applwable l Addnesa: Total fees due upon application City StateZIP: A,m.ant rccen ed Phone: I t Fax: :I I - ---- i PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES 11 G-mail: C urnmercul aid res&.krgWl presaripuSC irslalL*Lcc or t:OfRRACro& f ruolaup mtianted Pbs sVoltai:Solar Panel S}stmr it Std+tnt two 121 s is of roof plan w n ith co o:li.n details Business tome: ri t c>teml' and tire department accent,alaiu sixth the 2010 lb.•g..ol .Arian:sec Soho.fortullanort SPeeart?l'(..40 chcekluu. Ci1v S1aleZIP Permit Fee{includes planretie-n- SIfsLL(Ml and administrative tees}: Phone: I I Fax:t I State surcharge i 12 of permut far.. S2L(OU ('CB lir.: Tow! r:: ,:.... .curt application: I S2uLru r� -- Aushurtzesl silauture: a �L I hi.prriwrt appahAtbin rsplrrs N a pernsu is not uMdned GI��GG/II�'��^^^^ wllhui IMa Bus a11rr II has been as aepled n orinplete. +ns j 'Ioe mcthodolup}set h} in-Count)Buutduip titduar} I Print name �c/b '`S ro't'N'..t., Date: y/�'2UZ'L sssstec Bard. 1:'Building TomuHt.'P-REStermitApp.doc 41224.MII 440-4dl.:)tll'U2CtM WE.Hi • , !:Metrical Permit Application REC����� City of Tigard duk nt y:y.i till Ilan Bltd.. t, W.Olt 91.1rip N,,`` P.:a IL�itw R la: P.tr l- r Phone MI 'In.2it9 Fax: 5t1;.591t.14M1 MA 1 1 7�2� f�.k Bx. --. Inspection I_+Dn. 511i.659A175 Rcoh Dqr lh r• V. Yqe 2 Iv.-._._..__- TIGARD wki;ntxkdut NI. I.alla W lal ..ntaiw sa blla ate%IWtrd Alta. -<xa -_ -. __ .. 11Tk of MOAK - ! ... PLAN KIN it:1F 1s�I ❑New construction Addition alteration replacement ".-.'.is.s ill w qqP,uuatw ia le w[biro Jkd Ji 0 su%ice ei kc.kt WO.tqto or mire Q au.11alp n n tisct twits 11:[-:l. I l .r. ❑all't.l: when dam nsikloc Laub cuttrat ❑Bremer.u.d 1.1t1yaJ. I .S.f L4 Uk1 Of- lt/\5.1 kit I ION atccsrb If *.imp al 15u tuns. Qf 44allu hu.Jmp _ - bt.w mama..curd.lalkat QC..mr.a r :uw l- c arrsuhal ❑ 1•and 2•lamtly duelling ❑t ommc.lal industrial Li Accessory building wart 1..Allah.,e.Wklo+ro nw:drrtr. 1 QMulb•faintly © Masterbuilder 0OtheY: O ham r• o' ❑IuWl.htttcubISuk.'..tat JOS MIN DIFINNWIALION AM LOCATION - 0 Earrirtal..tits rt112...potato'''.Jana! ., ---' O.oddl..t of ota isakt twit at ty.Win. Job dt*rD Job sae address: vt'o7 9 s s✓ 1-u.r+irt dll'Urea 11C Lib( I5A1111.at snow .� .A Dun a xt ne rata.kalis wait uuquxrt Cdy,State'Z/P'. f r� v�tyr 0 A 4-2'& Qrkeils-cam 4ciyrileg Q knreslimsl',hark Fmk,. tionott..a ls.lw+ro. Q wcgh tallot fa mew hue Suuebhtg.:apt.Y: Project runic T'yrpe+tr.itZf .>n1,..Ian,tuui Q4t.c[.rL•cdxwv.m5..wnpr. Ctusa SUCH directions to job sac: 111 list iL Ili".,k.. 5-1.1,1r.WN'LtLIte.0 4t FEE SCHEDULE 14.,r1ae .,.,, Lai I.W i 7 ties[aside 11WU atal¢le-or emirs InuulS itarIhlii;sill_ Subdivision Lot Y- asikiki at tubed',mat . ---------. . 41 :, .y I1..n tie 1M.5i i a t.* Tax mop parcel i'. Ea Wall 500.4.n an balloon It.42 1 1 mtWCRWI1ON OF NOlY I-attain!gimp,.made-bur ?S.UU mutt ablve.4 n.r C l.imilad ulnry.mule-Wml. ?5-W ' Irs.drnur.wA dwnc ay.n • - i Renrwabit!rosin ❑ See Pate 2 !i PkG1'E:k'11 ()in NI k 1 ❑ 'moan. - st+vlcn ar[seders kinallatlaa,alteration*.tanker ^^ relacstk_u ._a "JnA11.uu +"Af� J i^O M."' g,t" !IN.n4 t :a ` 11;<+:1+ i�7� 21,-.. !111�u4 1 lit,.con. 1 !I. ' Addy, r.411y 7ln/ sUnilhnrtrbrex\CLV _._ din,a o g l -hit.u•..1n ' ZfA,tl 2 City.StdeZIP `-r'f'bfd- ©`t • T/ 7 13 Nil..na I.•1.121111 s.atr. 11•1 ul _ , Phone: -51.VN grin ti p c.'1`77 +` ! ow.Idt.1.•.avu a%vit. 1522h 2 1 _.,__. -__.. -..__ .. lempsrart serrkes or feeders installation.allerar Wa.and'or d Resit rob •GtfV' 'ruy1,...tofSt 5 eh.Ni I,- • Love sefocana• ()alter inntallatieC.alias installation I..I'_tit I.1.:.1. .1 I 11. - d I ...I 1 I.I I:. I'.. ..Liu lea 1 54L1.6 I t mten cal for sale.Ivent.or :Inge..a [mine to GRS 447..U'.c 70.and 7ul 2111 gulp.ItsNYl Naps 125.0e 2 4 Owner stenalure: ..____ Date: $j///Z6z2 4111 antik to 55.4talpa i--- I61.53 Brame!drains-new,alteration.or Ii15 Sir.Dar panel 0 AlrLiCANT CONTACT l A.fee 61I CRI.uji ensmI,et'lb ` A ,tt.*C..Y1..t VI kg*ta:fcc. ]{ w1 2 cods Busancss name; ��P t 3 codsla.wh c+ItWI d Contact name: II Tee Lax bralJm ureuas a'N.ur: tett lit ue foodet fit.Gel 56.Ih 124.111T Leh win bunch.u.ud ?.12 - City state ZIP stlicliaaeaus sienna ar feeder ant Unlade!, +. Phone:i. I 1 Taz I I FAA utru.ta.Iuit.1w a '.iufal a,x.xl - - - ' _-.- Jwtliu.c arS ke mail ktdtt Falull: noonsieei nut) 6/.Al CONTRACTOR 14r5p.r ulgquuua ilk ts'xt - 'Siun hi utahur Itglaa_y ^7.Al 2 Austness name: --_--_-- ---- -... Ikpial.u.uiaiw hasrtd•ruc.pt 0 see rare2 Address: pail.•.IIH Iran,w cilrilkel Lai additional Inspection nits aMwable In all%ea nee abase Coy State ZIP .xdy Gariana.pc.ts,.a 1i lu ddrul ,.-,25 In Phone i 1 I fax:i I laaatrit I In mall ••.1111 'I. A hdasi.u11.Wn i 1 hi mu.' 't IA it. 3 _ mail: _ br.ra.huts.I..Mllab lu fat is ~ .r,,lal as CCB Lie.: �-I Electrical Lie.: Supcv.Lie.: „o.iuuut load t'.la Ina" 61.ZCI ICAL MIABI FEU Sups.Electrician sinnaiure.required: Nulw.wl 3 b Zr. -. .O Plan Kr. Rcqured t25'ooI mute ieet Pent Warne: Dale. - Sale sulaharfe tit"...I penile left. • 1(11.U.1'l-R\t11 Ilk Authortre.d signature: Thum►.'ra n •il appe. ..a tp 1 ai a .11 a peruJl it l*binaural**sib'.Ina Pent Mande. I Daly ) dais al Its n hall lcrnicupld us.attp►4r. • ]unho,.1 411.c.1..1ra As:,..rJ tit prune I U.W ?a.a•ati' rots a.Sor tan CRE4.. Rs.Iai'NIS aa.d.i1t.,t1 i1SIle.IlSEP Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONLY • City of Tigard Received Date/By: Permit No.: 41 13125 SW Hall Blvd.,Tigard,OR 97223 i i ltzt plan Review Phone: 503.718.2439 Fax: 503.598.1960W( 1 1. Date/By: Other Permit No.: Inspection Line: 503.639.4175 1 r D Date Ready/By. furls: ® See Page 2 for TIGAIID Internet: www.tigard-or.gov "•j('r !1!�Y,GARD pP NotifiedlMethod: Supplemental information TYPE OF WORI€3UILDING DNl�1UN FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Catch basin or area drain 18.76 Job site address: /207 S 4 w." c w rn.arf hi-aoie Z.Pt Drywell,leach line,or trench drain 18.76 City/State/ZIP: T:.1,4.,;{ CIS 9 7 z 23 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: r✓o et le, Manufactured home utilities 50.03 Cross street/directions to job site: 1 Z I Sf /t✓2 h rtQ 4 to Ht�r 41f&loe k20 Manho1es 18.76 Rain drain connector ( 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: / " Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK p I, Clothes washer 25.02 /y)44/ Ti::,,` S t, e t et*sd-y i ddIt ox iii ikq Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 '' i,-.f 2ROPERTY OWNER ._ 0 TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: KO4Lel- `; Tr'0.f.fr+9a 1S Floor drain/floor sink/hub 25.02 Address: /Z 01 ei < t/ SCAN/Hf OK 6 rot he- L el_ Garbage disposal 25.02 City/State/ZIP: '--.' . A ®K ei 7 2.'2?, Hose bib 25.02 Phone:(;'s,7) �,-�. ', c"'-, 1--7 Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: • Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: be„uhe.t. Waterpiping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: // TOTAL PERMIT FEE II �+ Date: s^!) This permit application expires if a permit is not obtained within 180 days Print name: �f1 t1 EX `-/- S r,f,_,...y 4f O - 1/11.0 4 L after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1tBelding\Permits\PLMUI-PermitApp.doc 10/01/09 440-4616T(10/02/COMIWEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1" 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $23320 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to P and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the fast$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure Drive Taro as defined in OAR918-780-0040. Cuspidor Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram -4" ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-foodthat meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lev/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Pennits\PLMF_PemiitApp.doc 08/04/2011 2 City of Tigard IIr COMMUNITY DEVELOPMENT DEPARTMENT , 1 A lz n Building Permit Review — Residential Building Permit #: /1157-ai —er063 I Site Address: t?iO j 4 'v /riftbuiC ro�v Project Name: i tti A 4-4-achett 51,% Lot #: t j Planning Review LL �k � Proposal: -CCCk Skid4 QU `-C - 1ett e Verify address/suite#active in Accela. ❑ In River Terracb: gr No 0 Yes,River Terrace Review Addendum Site Plan Elements: .rosion Control W13 copies of site plan on 8-1/2"x 11"or 11 x 17"paper riORetained trees with drip line and tree protection measures Drawn to scale(standard architect or engineer scale) XFootprint of new structure(including decks)and FFE &North arrow gilitility locations&easements(required for new and additions) PSite address,project or subdivision name and lot number eaDSidewalk/driveway approach pApplicant information(name and phone number) 01,ectsiet.of v Hof pti „y„t...,.a Lot dimensions and building setback dimensions astreet tree size,type and location igs u./b.,de,..olisked pi,Street names iff [xisting structures on site r c (9' tni re if mnre than 4' coaar:.l) ©La} eaT-lauilding,..rn +a,se=_ p rrentaoe of rrn�erav�nd >1 imp-. rr urn) If yes st lrev� • nv_�aJo �7 Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ein.No Received: ❑ Yes ❑ No rl Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs Required: ❑ Yes,applicant was notified 70 No Received: ❑ Yes E No E3 SDCTarrrptioa for fiHU appltcd-fu.. C3 Y XI No Received: ❑ Yes ❑ No Public Facilities Improvement (PFI) Permit: Required: E Yes,applicant was notified At No Applied For: ❑ Yes ❑ No,stop intake E}-Luid t se Caste #. Co Zoning: 2 — 4c Required Setbacks: Front '2-4 t Rear: Lc7` Side: ' Street Side: ( 5' Garage: ZO Max. Height: '301 Actual Height: 'lc c�tct64 E3Landscape Area: j0/4 % xi Lot Coverage Max: A.Vik �""�" " E c � 'e uo:Wore tb .n 8'frost Street facing w-all Windo C� Mi 1 %of ax of s$ ❑ Garage door is behind widest street-facing wall E Yes ❑ No,one of the fo i a met: Boor ds no more than 5'from wall and there is a covered porch exten ' eyond garage. ❑ Door extends no m 5'from wall and there is a 12 s ow above garage on 2.d floor. ❑ Garage door width is ❑ 12'or less ° s o facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Re ranee ffset ❑ 1'Roof eave ❑ Roof offset ❑ Fire shin le Lap Siding ❑ Roof pitch El a , or gambrel roof ❑ Dormer ❑ ent siding El Window trim ❑ Window recess ❑ Window jeetien El EI—Vistral Clearance res an 0 Seneitivc Landes Type: D C"otfdti:1ons met prior to issuance of buildirgpermit - Notes: Approved By Planning: ,4 2%4/( Ait t Date: i I Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved I:1Building\Fonns\BldgPemvtRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: S`7jf. Site Plans: # Building Plans: # Building Permit#: nn r building permit#above. Workflow Routing. FR4 arming ngineering SST' it Coordinator Q—BTl 'ding Workflow Sign-off: [sign-off for Planning(include notes from planning review) Route Application Documents: eering: (1) copy of permit application, (1) site plan, (1) building plan and orjginal plan review routing form. L`_'1'Building. original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: `.. Date: S"/`/ , Engineering Review Pi Slope at building pad: 02 4 PJ Conditions "Met"prior to issuance of building permit n Easements (encroachments)per engineering conditions of approval and plat it f&' R"Water Quality/Quantity Facility: / Assess Water Quality Fee in-lieu: D Yes LJ No Assess Water Quantity Fee in-lieu: ❑ Yes � o LIDA Facility on lot: ❑ Yes L"T No Add Fee: ❑ Yes El No Er Final Plat Recorded: h(a' ❑ NOT Approved by Engineering: Date: Notes: IY,Approved by Engineering: Trrvrf 8),ii cey Date: 5JI -)ZO - Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved ``th Permit,�...��__ Coordinator Review 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: tlZr SDC Exemption: ❑ Received e.ar Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes jorN/A Tigard Trans SDC: ❑ Yes /N/A Parks SDC: ❑ Yes 'N/A LIDA ❑ Yes /N/A OK to Issue Permit Approved by Permit Coordinator: A V' Date: 5 (1tol?,67/2- I:\Building\Fornis\B1dgPerniltRvw_RES_1208021.docx Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the 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 yI 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. ho„prn,ti YZiS Print Name of Permit Applicant // l S //// Z O Z Z Signature of Permit Applicant Date Permit#: /11S7-P689--00131 Address: 4117 y 3i.J $ ✓ i ii Ln, ) Gt7 .r:�.+urv� Issued by: Date: 54citaa. [_ This Copy for Permit Offices 47-7:4.Yerf4,4k Information Notice to Owners About • y Construction Responsibilities (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.ciov. 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 Website Address: ww 'oregon.gov/ccb f/property_owner adopted 9-2016 This Copy for Permit