Permit CITY OF TIGARD MASTER PERMIT
"7 4-'p COMMUNITY DEVELOPMENT Permit#: MST2023-00280
Date Issued: 06/29/2023
T I C A 0,,D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S112BD05000
Jurisdiction: Tigard
Site address: 7947 SW LEISER LN
Subdivision: LEISER PARK Lot: 14
Project: Mathis
Project Description: Infill 107 sq ft on second floor and adding a wall to split(1)bedroom into(2).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: 107 sf Garage: 0 sf Front: 0 Smoke Yes
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 107 sf Value: 53.500.00 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
Fooling Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 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>=100K: 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+amplvolt: 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-3 107
Owner: Contractor:
MATHIS,SATARA&AUSTIN OWNER Required Items and Reports(Conditions)
7947 SW LEISER LN
TIGARD,OR 97224
PHONE: PHONE:
FAX
Total Fees: $397.28
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: gon law r ' s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oso_nn+-nntn rhrn.inh o n1_nn nn ,r nhrain a nnn„of+ha nn„n nr,rrar+nu,achnnc rn ni ruin h,,nanjnn Sna oao 1 7 nr t arm azo'lee
Issued By: Z v. ' Permittee Signature: j/(N—/}I/p7�r»
�
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 site at the time of each Inspection.
Building Permit A Vpplication� ����� /E®
Residential FOR OFFICE USE ONLI
1c
City of Tigard �'., i 4 2023Received if:t '' / t Permit No.: 14St: 23—er0rEt
11 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /- � 3 n/1
_ Phone: 503.718.2439 Fax: 503 59g.1960 T''OF TIGARD Date/By: t(!/ J �f� Other Permit:
I11, \I2D Inspection Line: so3.639.a175 BUILDING DIVISION DfiReddyBy: ��J IA A. Jura: 10Se ge4for
Internet: www.tigard-or.gov NNotified/Methad: �� Q J Supplemental Information
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
I]Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
■ 1-and 2-familydwellingValuation: $3500
❑ ❑Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms: 4 t
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Op Job site address: 7`1 1 ! ysj L,61��- 1.400.y� New dwelling area: square feet
City/State/ZIP: TiTM-), OIL , C 12241 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: `jI,o� 11--)— i-1. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Sir R-or.,1 t11k-3 L4 t ti PRSZv<.. Lot no.: il., 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.
<200sqft addition of second story floor infil above primary Valuation: $
house entry. Existing building area: square feet
New building area: square feet
l] PROPERTY OWNER ❑ TENANT Number of stories:
Name:Austin and Satara Mathis Type of construction:
Address:7947 SW Leiser Lane Occupancy groups:
City/State/ZIP:Tigard, Or, 97224 Existing:
Phone:( ) Fax:( ) New:
I] APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer tojeeschedule)
Business name:2one Design Group
Structural plan review fee(or deposit):
Contact name:Kaeli Nolte
FLS plan review fee(if applicable):
Address:427 N Going St Total fees due upon application:
City/state/zlP:portland, Or, 97217
Amount received:
Phone:(503 )5832165 Fax: ( )
-05 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:knolte@zone-us.com
d - - Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: OWna y - %(!\V\2 a C.,, abod o, . 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.
Y Permit Fee(includes plan review
Ci /State/ZIP: $180.00
ty and administrative fees):
6 Phone:( ) Fax:( )� State surcharge(12%ofpermit fee): $21.60
CCB lic.: Total fee due upon application: $201.60
J Authorized signature: Kaeli Nolte Digitally signed by Kaeli Nolte This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Knell Nolte Date:6/14/23 *Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLI
City of Tigard Received
--'a 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
t 1
Phone: 503.718.2439 Fax: 503.598.1960 Associated pe i s:
24-Hour Inspection Line: 503.639.4175 0 Electrical ❑ Plumbing 0 Mechanical
TIGARD Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 1111 El
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. n I
3 Verification of approved plat/lot. n n []
4 Fire district approval required. Name of district: • n n n
5 Septic system permit or authorization for remodel. Existing system capacity r n
6 Sewer permit. n
7 Water district approval. n n n
8 Soils report. Must carry original applicable stamp and signature on file or with application. n n E 1
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- 0 D
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑f ❑ 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 U U U
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 Q
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, U U U
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- Q ❑ ❑
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. U 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- ❑ • ✓❑
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 p 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑✓
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 ❑ ❑ p
architect licensed in Ore:on and shall be shown to be applicable to the .ro'ect under review.
.II RISI)IC DICTION kl. SPECIFIC'S
23 Three(3)site plans are required for Item 11 above. Site .lans must be 8-1/2"x 11"or 11"x 17". 1FI.11....
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ r4
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. n ❑_ n
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. n n n
27 "Drawn to scale"indicates standard architect or engineer scale. 8 e
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard J
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:1Building\Permits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(11/02/COM/WEB)
City of Tigard
II " COMMUNITY DEVELOPMENT DEPARTMENT
e
Building Permit Review - Residential
TIGARD
Building Permit #: 1 •t\-ul( 3. 3- CG 3 ) /
Site Address: -7 9 47 5\-1 `C'Si r t P1 Verified in Accela
Project Name: ,5'14n SFR Setonk 02/ MIS. Lot/Unit #:�d n�(No...)Proposal: r 1-oOS^1 M SQCO 5t0t"/ of pcS�'^q WU92, zone: t'�'eS-
Housing Type: SFR( Single Detached CI ❑Triplex CI ❑ Rowhouse ❑JCottage Cluster❑CYU ❑Quad ❑Other
Required Site Plan Elements:
126 cwies of site plan on max 11x17"
Er/Drawn to standard scale
North arrow •
It Site address, project name, lot #
'Street names (.N/A fur SFR)
'Applicant name and phone #
B-L-et-anrl <ethark climaP long -El Visiuii Clem al ire trit i1C—
IiExisting structures &square footage eats
ootprint of new structure and FFE Property corner elevations
Cdc.Sidewalk/driveway dimensioned
Lot area and I
d Elevation Plan Elements:
(For SFR: ca cs ni on street-facing) Summary to cu ations for:
❑ Drawn to standard scale a al facade area
❑ Building height dimensions Total window and door area
❑ Facade dimensio
❑ Windo doors dimensioned
❑ age doors dimensioned
Required Floor Plan Elements:
"(-Not-re for SFR) ❑ Surn� mary thble that includes
El Each story dimen red- na
❑ Total floor area
❑ Each s rea calculated area per story
Planning Review
The followingg tandards have been met:
Setbacks L'-1//Front: IC Rear: I s Side: C Min/Max Street Side: I S / Garage: a-o
Height gyMax. Height: -;f' Proposed Height:
❑ Yes N/A Landscape
❑ Yes N/A Screening (Quad only)
❑ Yes N/A % Window Coverage 00 '1/
El Yes N/A Garage (SFR Only) Parking (Other Res) p O(qiole
❑ Yes N/A Entrance (SFR, Rowhouse, Quad only)
❑ Yes N/A Other building design standards (Rowhouse only)
❑ Yes N/A Accessory Structure Standards
El Yes No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Atli ' I standards for Co Units, Cottage Clusters, Rowhouses,and Quads:
El Yes ❑ N/A unt:
❑ Y /A Lot Width a • e
Yes ❑ N/A Pathway
A ' ional standards for Courtyard Units and Cottage Clusters only:
❑ Yes Unit Area:
❑ Yes ❑ N/A ea (per story)
❑ Yes ❑ Courtya
s 0 N/A Fence
❑ Yes ❑ No E /A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ No A/A Public Facilities Improv9ment (PFI) Permit:
Required: ❑ Yes INo
Applied For: ❑ Yes ❑ No, stop intake
Sensitive Lands: ❑ Yes I /No
❑ Conditions met
L A. 4ea»t notified of-Famed ion date:
Approved By planning: Date: 6 / 14/'a-0D 3.3
Notes No 141A 3e Petr++4. Fair in %'f LAI MCI PO 54 tU.--S etiecq`IL
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date: (p /I yt2 3
Site Plans #:
Building Plans #:
Building Permit #: Ehr Building permit # entered on page 1
Workflow Routing: aPlanning ❑ Engineering ❑ Permit Coordinator building
Workflow Sign-off: ign ff for Planning (include notes from planning review)
Route Documents: ❑ Enering: (1) copy of permit application, (1) site plan, (1) building plan
and///original plan review routing form.
0-Building: original permit application, site plans, building plans, engineer and
v beam calculations and trust details, if applicable, etc.
Permit Technician:„ � Y. M dukt, Date: b f Ua (I-'C1I
Notes: AA 1,OY/
Engineering Review
❑ PFI Permit:
❑ Slope at building pad:
0 Conditions met prior to issuance of permit
❑ Easements (encroachments) per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ,yl-N`o
LIDA Facility on lot: ❑ Yes- `" ❑ No Add Fee: ❑ Yes ❑ No
•
❑ Final Plat Recorded
❑ NOT Approved: Date:
Notes:
Approved By_Engineering: Date:
9Rei lion 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
❑ Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
❑ SDC Exemption: ❑ Applied for ❑ Received El Does not-apply
❑ SDC Fees Entered: Wash Co Trans Dev Tax: C Yes ❑ N/A
Tigard Trans SDC: ❑ Yes 0 N/A 0 Deferred
Parks SDC: ❑ Yes ❑ N/A ❑ Deferred
LIDA ❑ Yes ❑ N/A
❑ OK to Issue/Approved by Permit Coordinator: Date:
Revision 1: ❑ Approved ❑ Not Approved Date:
`'-Revision 2: El Approved ❑ Not Approved Date:
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:
17\ I own, reside in, or will lesidg`in the completed structure and my general contractor is:
SO`�dkrcL 4v`a S
p
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
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.
Sa. cor c N1,Olk:\fl 15
Print Name of Permit Applicant
G/ 9/2.-1 ?
Signature of Permit Applicant Date
Permit#: MS1'W U (VIM
Address: 1"1A1
q
Issued by: �Qlnq Date: 141Vill,Q'L3 "i°
This Copy for Permit Offices
7� > Information Notice to Owners About
Construction Responsibilities
r. i (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, call 503-945-8091 or go to
http://www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms.
• 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 503-947-7815.
• 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, call the IRS at 1-800-829-4933 or visit their website at 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
Website Address:www.oregon.gov/ccb
f/property_owner adopted 9-23-08 This Copy for Permit Applicant