Permit Support Document V CH D . RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
_IN18 q
Re uest for Permit Action MAR 2 9 ?U22
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.ugard oC.Vv°ETIGARD
°' 1U I^ V' //SION
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ® Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) KARUNA Adhikari
Mailing Address: 16654 SW Birdsong St
City/State/Zip: Beaverton,OR
Phone No.: 8147775104
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑x CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: MST2022-00074
Site Address or Parcel #: 16654 SW Birdsong st. Beaverton OR 97007
Project Name: 7-8 foot fence on top of retaining wall.
Subdivision Name: Lot#:
EXPLANATION: Fence height reduced to 7 ft
Signature: V%' Date:03/29/2022
Print Name: KARUNA ADHIKARI
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date 3 Zq U. By tij Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date M1117iit. By VW Parcel Tag Added: Date By
l:\Building\Forms\RegPermitAction_12 51 ..doc
Building Permit Application
Residential C „OR oI Fit,: t,si ()
NIA.
NIA.
RE
CEIVE
City of Tigard Received ��� �PI
s Date/B '
Permit No.:
III • 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 21 2022 Plan Review
e Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
TI R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method Supplemental Information
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
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
ElI-and 2-family dwelling ElCommercial/industrial Valuation: S 300
El Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16654 SW Birdsong St New dwelling area: square feet
City/State/ZIP: Beaverton, OR, 97007 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: fence installation Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: Fence 113 square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 220 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.
Fence on the top of 2ft retation wall. Fence is 7-8 ft tall. valuation: $
The fence poles have poper concrete base. Existing building area: square feet
New building area: square feet
iir PROPERTY OWNER 0 TENANT Number of stories:
Name: Karuna Adhikari Type of construction:
Address: 16654 SW Birdsong st Occupancy groups:
City/State/ZIP: Beaverton, OR,97007 Existing:
Phone:(540)3556644 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* '"
(Please refer wise schedule)
Business name: Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
Rig brnther constuction LI C and fire department access,along with the 2010 Oregon
Address: 19750 SW pike st Solar Installation Specialty Code checklist.
y Aloha, OR, 97078 Permit Fee(includes plan review
City/State/ZIP: and administrative fees): $180.00
Phone:(971)7068631 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 22044 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date:2/23/2022 *Fee methodology set by Tri-County Building Industry
Karuna A hikari Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
.
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONI.1
City of Tigard Received Permit No.:
ihila 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
: R Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical Cl Plumbing ❑ Mechanical
TIGARD
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/.1
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ■ •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: ❑ 0 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0
6 Sewer permit. 0 ❑ 0
7 Water district approval. 0 0 ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ 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 ❑ ❑ 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 ❑ 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 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- 0 0 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. 0 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 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 0 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 0 , ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 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 a's licable to the 8 ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item I I above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ 0 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 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 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 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 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 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)
DECEIVED
MAR 2 12011 Clean Water\ Services
SENSITIVE AREA PRE-SCREENING SITE A$
Clean Water Services File Number 22-000565 —_
1. Jurisdiction: Washington County
2. Property Information(example: 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Jwala Adhikari
2S106DA18100 Company:
Address: 16654 SW Birdsong St
OR Site Address: 16654 SW Birdsong St City, State,Zip: Beaverton, OR, 97007
City, State,Zip: Beaverton, OR, 97007 Phone/fax: 8147775104
Nearest cross street: SW River Terrace BLVD and SW Birdsong St Email: jwaladhr@gmail.com
4. Development Activity(check all that apply) 4. Applicant Information
❑ Addition to single family residence(rooms,deck,garage) Name: Jwala Adhikari
❑ Lot line adjustment 0 Minor land partition Company:
❑ Residential condominium ElCommercial condominium Address: 16654 SW Birdsong St
❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Beaverton, OR, 97007
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 8147775104
Other 4 ft backyard retention wall&Fence Email: jwaladhr@gmail.com
6. Will the project involve any off-site work? ❑Yes ❑ No 0 Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project:
This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits,Site
Development Permits, DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality,
Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and
completed under applicable local,state,and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water
Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering
information related to the project site. I certify that I am familiar with the information contained in this document, and to the best of my
knowledge and belief, this information is true, complete,and accurate.
Print/type name Jwala Adhikari Print/type title
Signature ONLINE SUBMITTAL Date 2/9/2022
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO
ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural
Resources Assessment Report may also be required.
❑ Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the
site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if
they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section
3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable
local,State and federal law.
❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the
existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to
evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service
Provider Letter as required by Resolution and Order 19-5, Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and
approvals must be obtained and completed under applicable local,state and federal law.
❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED.
® The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT
OR SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by At rl{� A.�►'✓rt 1 1 1— Date 2/22/2022
Once complete, email to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Hevis,d 2/2020
Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cleanwaterservices.org
RECEIVED
a on WIPP a Q610105 MAR 2 12022
a::Ua.a Pe set RAN�16654 SW&Nve St Man a Ste M•a.
New lima,NM,10,10331:sa:39 PI
CITY OF TIGARD
Site plan for 2/9/22 submittal lUILDING DIVISION
free,:lwala Mani Adhikari<iwaladhr@gmail.com>
Sent:Thursday,February 10,2022 1:31 PM
To:Permits<Permits@CleanWaterServices.org>
Cc:Bhuntu Q cadhikarikaruna90@gmail.com>
Subject:16654 SW Birdsong St Plan of Ste attached
Address:16654 SW Birdsong St,Beaverton OR 97007
PLan of site attachedCP
1.
Fence
r RI temr::n wall 411 might
• Property address:16654 SW Birdsong St,
Beaverton OR 97007
• 4ft retention wall and fence on the top of it
per city of Tigard guidelines
• Home backyard faces Wetland
• All work inside property line
• City of Tigard recommended to contact the
CWS
T
I -
-1 Willa
RECEIVED
MAR 2 12022
Project Plan:Side wooden Fence wall for Address 16654 SW Birdsong St, Beaverton OR 97007. GI7Y OF TIGAHIL
Designed by professional licensed contractor. iUIL.DING DIVISIOvv
1) Size of the east side wooden fence wall: 7 to 8 ft Tall, -15 ft wide with four of 4x4x8 ft inch
poles support that are 2 ft deep into the base
2) Fence rests on 3 ft tall concrete retention wall with four 4x4x8 ft fence poles that are 2 ft deep
into the base
3) Retention Wall Footing dimension: 2 ft wide, ^' 15 ft length, 9 inch high
4) Fence Wind load:-2000 lb
Wind pressure 18 psf
Wind Load -2000 lb