Permit (2) CITY OF TIGARD MASTER PERMIT
' ' COMMUNITY DEVELOPMENT Permit#: MST2023-00455
T I[;A h p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2023
Parcel: 2S112CC05900
Jurisdiction: Tigard
Site address: 15954 SW 81ST CT
Subdivision: BOND PARK NO.4 Lot: 87
Project: Haas
Project Description: Interior remodel,including removal of a wall,add structural beam.Trade permits to be pulled
separately.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $7,650.00 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
Footing 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!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 0
Owner: Contractor:
MORTENSEN,JENNIFER A REVIVE LLC Required Items and Reports(Conditions)
15954 SW 81ST CT 8532 SW ST HELENS DR STE 210
TIGARD,OR 97224 WILSONVILLE,OR 97070
PHONE PHONE: 971-285-0770
FAX:
Total Fees: $357.83
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. Th- rules are set forth in OAR
oc9-nM-nnln Ihrn hh P oc',nni-nnon Vn a�dnhfa'n a nnnu of the,r,,i nr riirn 4 n, tinnc In Al Mtn by nalllliinn Ff-Z-�9-1QR7 nr 1 PA '0 9'UA
Issued By: / r..-/ ••--y f �w13i� / Jlt�� Permittee Signature:— ' l G--C.At✓
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.
Building Permit Application
Residential RECEIVED
City of Tigard Received i DateB : 1 �� Permit No.: M 11/ldZ '141/
13125 SW Hall Blvd.,Tigard,OR 97223 SEP ' 7 2023 Plan ReviewQ ItI 4-Lk- A Av
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: l J 11 i Other Permit:
1 l, 1 K r) Inspection Line: 503.639.4175 Date Rea B . Fa See Page 4 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Metitod���` �� » Supplemental Information
BUILDING DIVISION � 4t( r4 176ifl
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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.
All-and 2-family dwelling lid Commercial/industrial Valuation: $ 1660.0-0
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder ElOther: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 15'5[1 5 Go O'I.'1-} (.t7I-t.trT. New dwelling area: square feet
City/State/ZIP: '�i j�J Q,a )k q-� aa.y Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: N Qc Covered porch area: square feet
Cross street/directions to job site: S L)`DI.J_tf t1x.rM 1Z,A 4-o S t.,0--re.A4u.e Deck area: square feet
}"U S LO BoI\ 5A-- - -o 5(J % I u C Cat.,.(-4- Other structure area: Z square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Q Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: 2 J 1 C C�o51(�0 equipment,materials,labor,overhead,and the profit for the
r (DESCRIPTION OF WORK work indicated on this application.
(et. Re ye C _ tL Wa pn 1 Valuation: $
of C1 6�` (T>- K��.%
t f„� 5r ri 0 (_ Existing building area: square feet
�` I u/11 tCl�L4 New building area: square feet
a PROPERTY OWNER 0 TENANT Number of stories:
Name: CT e.){c N(Las Type of construction:
Address: ` 5 9 5(+ 5'(A) I.S*Cout_r . Occupancy groups:
City/State/ZIP:'-15a rd 0(Z R 7 aaC Existing:
Phone:(5o3) Fax:( )
']�— % ��2 New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: e'R e.0 ;V e "Res-YY,0�ei` t' -. es(e( review refer*rift
Structural plan fee(or deposit):
Contact name: 0 r S 0.Q C55o>'
Q ^ . FLS plan review fee(if applicable):
Address: Q'S 3;., SW z�. �4e_L S Dr. S }'e. Zlv
City/State/ZIP: kS�rU , tl.e 0 YL q.-1 070 Total fees due upon application:
Phone: Gr Fax::( ) Amount received:
( 1�()n2�5 �, U PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:--t^ to Co 3 -D eu:vAZ-f'e.rv.Ode1i A* F o COI
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: l�ex)' v..e '}Z�m d e l t r.� .Des h Submit two(2)sets of roof plan with connection details
CC ff and fire department access,along with the 2010 Oregon
Address: 5 3 2 5 up54.. .4,-e.LQ,\SLuc. S e. 21 1 Solar Installation Specially Code checklist.
City/State/ZIP: S t) U t (l e 6 g c'- 70
Permit Fee(includes plan review $180.00
and administrative fees):
Phone:('f 7O 215 . 0'170 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: C25 Total fee due upon application: $201.60
Authorized signature: / � ��'it , This permit application expires if a permit is not obtained
(c within 180 days after it has been accepted as complete.
*
Print name: Date: Fee methodology set by Tri-County Building Industry
Do h L S c ac Son 9/7/ZO Z 3 Service Board.
I:\Building\Pennits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(11/02/COM/WEB)
City of Tigard
C
" COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
y0\4�'/ v A/ '(b
� /�P�Az
Building Permit #:
Site Address: 1 5 q 5 4' 7`W__ g 1 s - ,'Verified in Accela
Project Name: HAAS, ,K i r'�`CJI 9(te I Lot/Unit #:
Proposal: S^4CT'allol K-441 iiQyviatte k Zone: $— b
Housing Type: Pir SFR folKSingle Detached ❑ Duplex❑Triplex❑ADU) ❑ Rowhouse ❑Cottage Cluster❑CYU ❑Quad ❑Other
Required Site Plan Elements:
,3 ies of site plan on max 11x17"
prawn to standard scale
Le North arrow
S ite address, project name, lot # •
'treet names •(N/A fui SFRj'
Applicant name and phone # •
Ealf of aid reek-dimensions
Lr1 Existing structures &square footage
n Fn tnri t of node_ e and rFE' -Er-Property-comer-efevertietts-
0 Erosiuii Luuuul
RRgaiiced-E tion Plan Elements:
(For SFR: calcs nee e et-facing) Summary table wit calculations for:
❑ Drawn to standard scale 0 gade area
❑ Building height dimensioned indow and door area
❑ Fagade dimensions
❑ Windo oors dimensioned
rage doors dimensioned
---Itoc ' d Floor Plan Elements:
(Not required or •-cludes
❑ Each story dimens' ❑ o
❑ E oor area calculated ❑ Floor area per story
Planning Review
1 The following standards have been met: r ,
°.•�. Setbacks MFront: 1 O Rear: t S • Side: S Min/Max Street Side: 1 / Garage: ai•
d
N/A,'
Height 40 Max. Height: 3,S Proposed Height:
❑Yes,le N/A Landscape
❑Yes 0 N/A Screening (Quad only)
❑Yes V N/A % Window Coverage
❑Yes SN/A Garage (SFR Only) Parking (Other Res)
❑Yes) 'N/A Entrance (SFR, Rowhouse, Quad only)
❑Yes'N/A Other building design standards (Rowhouse only)
❑ Yes,(N/A Accessory Structure Standards
❑Yes,No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses,and Quads:
❑ Yes N/A Unit Count:
❑ Yes N/A Lot Width and Size
❑Yes N/A Pathway
Additi nal standards for Courtyard Units and Cottage Clusters only:
❑ Yes N/A Unit Area:
❑ Yes N/A Floor Area (per story)
❑Yes N/A Courtyard
0 Yes N/A Fence
D Yes ❑ No/N/A Clean Water Services - Service Provider Letter(lot platted prior to 9/10/1995)
❑ Yes ❑ No/N/A Public Facilities Improvement (PFI) Permit:
Required: 0 Yes 0 No
Applied For: 0 Yes 0 No, stop intake
Sensitive Lands: 0 Yes No
❑ Conditions met
Approved By PI nning: Date: 6117/2-02-'5
Notes A. fAX.P.Or v a I:c.41C Ibt•1• .- S w+OtS
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: ❑ Approved 0 Not Approved Date:
Building Permit Submittal I
Original Submittal Date: CI 11 L2f)Z3
Site Plans #:
Building Plans #:
Building Permit #: 1;]/Building permit # entered on page 1 �
Workflow Routing: I "Planning 0 Engineering hermit Coordinator LN- uilding
Workflow Sign-off: lW ign-off for Planning (include notes from planning review)
Route Documents: P eering: (1) copy of permit application, (1) site plan, (1) building plan
anfd original plan review routing form.
er Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.
-fC/
Permit Technician: r U 4 " �" Date: �7�2fJ7i�
Notes:
Engineering Review
❑ P •- it:
❑ Slope at bui •ad:
❑ Conditions met prior t •o ance of permit
❑ Easements (encroachments) pe ; ineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee-in-lieu: 0 '- 0 No
Assess Water Quantity Fee in-lieu: 0 Yes . •
LIDA Facility on lot: ❑ Yes •o Fee: 0 Yes 0 No
❑ Final Plat Recorded
❑ NOT Approved: Date.
Notes:
Approved B gineering: Date:
• -vision 1: 0 Approved ❑ Not Approved Date:
Revision 2: ❑ Approved 0 Not Approved Date:
Permit Coordinator Review
❑ Co '•ns met prior to permit issuance
❑ Approved, - Released: Date notified applicant:
❑ ENG Revisions Req • Date notified applicant:
❑ SDC Exemption: 0 Applied for • Received 0 Does no --:
❑ SDC Fees Entered: Wash Co Trans Dev Tax' • 'es ❑ N/A
Tigard Trans ' . ❑ Yes 0 N/A ❑ Deferred
Parks -% : 0 Yes ■ • 0 Deferred
DA ❑Yes ❑ N/A
❑ OK to Is - Approved by Permit Coordinator: Da -
•evision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date: