Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT VED
III a. Request Permit Action AUG 6 2W,
q 3
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.AU FWG,on
»,�CDI1/SION
TO: CITY OF TIGARD
Building Division Services Supervisor 1 D
13125 SW Hall Blvd.,Tigard,OR 97223 1'/23//3 4—
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor g City Staff
(check one)
REFUND OR Name: /
INVOICE TO: (Business or Individual) /V/�
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
•
CANCEL/VOID PERMIT APPLICATION.
` V,, El REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
I'f'e ] INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
C
Vir ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: H 4)-1--- O i - 00191
Site Address or Parcel#: 9s 3 9 c L t O g(M 6.i e.V Q.•
Project Name: .q-y r2 e-
Subdivision Name: Lot#: 11
EXPLANATION: PAT,O Co k2 i s u rJD 2 �0, , i)f_p b4 k)EL50-,D
ND f f-2 -i,-r kf 4a, Q0j Fv/L-(s 1,20.5tc11-.
Signature: I .•��--��.�.• 0' L�'�� Date: / //
Print Name: gf�!��- Tj { kl ((
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits.
d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80%of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date mina m Rte to Bld• Admin: Date l'f TAMI B Ike"
Refund Processed: Date 41; By Ara Invoice Processed: Date By
Permit Canceled: Date 9 L3//.3 By,((i. 'arcel Tag Added: Date By
Receipt# Date Method Amount$
I:\Building\Forms\RegPermitAction.doc Rev 05/25/2012
Building'Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard Received �/3 / My��l3�/Q/
Date/By: 3 Permit No.:
° 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 1 3 2013 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
,.,G n it D Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready/By: Juris: 61 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 ❑Other: equipment,materials;labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling Valuation: $ j°�O�
❑Commercial/industrial
ID 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: CIS-SC! Ski.J V ,c,n)0Q�� 0%` New dwelling area: square feet
City/State/ZIP: �� i,q- 0% Ci''1 �{ Garage/carport area: square feet
v r b
Suite/bldg./apt.no.: Project name: \f\Q_,r � S`Covered porch area � DV+square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 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.
pU
IC \\( \Y\ 0. co,VD Cover - avQs-- Valuation: $
S\e\ \ Existing building area square feet
�tlr���0� V ) New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: /AO � SaU`c-� Type of construction:
Address: "I�S"l �J �`M ^A- Occupancy roups:
City/State/ZIP:t‘ t'-A 17. 1 any \A Existing:
Phone:(5 ) c j .,',cIOa_ Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application:
Phone:( ) Fax: :( ) Amount received: '
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: b \9\,„,\._
V/ -to v-� Wfs�i Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: \ -D S l� `3'"3(4. \--, Solar Installation Specialty Code checklist. .
City/State/ZIP: J wA-Qr W 01, J gbb� � Permit Fee(includes plan review $180.00
and administrative fees): _
Phone: o) 5.--11-t_`-.:-S-51 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lie.: . q by
Total fee due upon application: $201.60
Authorized signature. - ja___ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: �S� �1\„, ` Date: j�l Service Board
I:\Building\Permits\BUP-RESPermitApp.doc 0`2/2`4/201 I 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist "'�
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
111 a 13125 SW Hall Blvd.,Tigard,OR 97223 Date/13y:
0 . Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEVIS 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, ❑ ❑ ❑
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 ❑ ❑ ❑
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 applicable to the ero'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'I'ree 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)
0 • .•
III Building Division
Development Code Provision Review
T i c n ri J Residential Projects
Building Permit No.: °1—C9`40 I- 9) -O O ( QC I •
Project/Subdivision Name: f-7)- >4V 2-`c. , Lot #:
Site Address: et S 7)C( 6-t3 t t-t6q--1( )f •
CWS Service Provider Letter:
Required:Yes ❑ No ❑
Received:Yes ❑ No ❑
Plans Routed:
Original Plan Submittal Date: ?/1 3l r 3 Routed By:
1St Revision Submittal Date: ❑ Site Plan Only Routed By:
2nd Revision Submittal Date: ❑ Site Plan Only Routed By:
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re-submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review(contact at (503) 718- or @tigard-
or.gov) n/f
Land Use CyNe N /v/4"
Zoning i.e— �4S
❑ Setbacks: /j� /
Front _an Rear l J �S'i`de Street Side / S Garage Dv
❑ Maximum Building Height: ` Actual Building Height
Visual Clearance n,/95_,Easements /Si kW/. eVe � A�Ont .. Skle,I S' pvc. ,1/0/5 G, 11 lU DL lioe j,.
❑ Sensitive Lands Type: J I_
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved 1K Not Approved ❑ Date: p-/3-/s
Revision 1: Approved ❑ Not Approved ❑ - Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13
• •
Engineering Review(contact Mike White at 503-718-2464 or MikeW @ tigard-or.gov)
Pr Actual Slope: Z
Notes:
Original Plan: Approved,Er Not Approved ❑ Date: g if 3 1 3
Revision 1: Approved ❑ Not Approved ❑. Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review(contact Albert Shields at(503) 718-2426 or albert @tigard-or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to App cant
Okay to Issue Permit: Yes No ❑
Date Routed to Building: R
1 �3 7
Page 2 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
d ive 2
City of Tigard Date Received 5//J 13 06 Permit No.: 1' r e2/ t7 '/Z."
13125 SW Hall Blvd.,Tigard,OR 97223Al;G 13 2013 Plan Review
G Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION
work indicated on this application.
❑ I-and 2-family dwelling ❑Commercial/industrial Valuation: S )`� � �
❑Accessory building El Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: q(3q SO `(,,cr,\��A,Q.,\,.■ OR` New dwelling area: square feet
City/State/ZIP: ry,\(-c (%, Cil t- .{ Garage/carport area: square feet
Suite/bldg./apt.no.: J Project name: c-� Covered porch area 311 s cl;T1square feet
Cross street/directions to job site: tJ Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rotnded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
p DESCRIPTION OF WORK work indicated on this application.
7 u•A \`(\t'_1 rk. 'Coco CpU-(`- 0\f Valuation: $
o ��� 4,, �n,�\ Existing building area square feet
�lr�d � ) New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: ./ ��v\. Saul c-' Type of construction:
Address: "1��"l S u 1��v0" -Pi . /Dc -., Occupancy groups:
City/State/ZIP:;\na 7 ( 'N Anaa-"1 Existing:
Phone:(5t;) `rte _. ..Glop._ Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:
Address: FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP: '
Phone:( ) Fax::( ) Amount received: l )
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: q Submit two(2)sets of roof plan with connection details
U �)�� ���� and fire department access,along with the 2010 Oregon
Address: 1 o 5 .C._.- S C A— <}, Solar Installation Specialty Code checklist.
City/State/ZIP: V ck,r\c_o\A-{ V)( q 63 Permit Fee(includes plan review $180.00
J and administrative fees):
Phone:(360) 5lt-t SS 1 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lic.: lik {„)::),t
Total fee due upon application: $201.60
Authorized signature- 6,&___ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
�1 *Fee methodology set by Tri-County Building Industry
Print name: �jS� �1\a, Date:��� Service Board
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)