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Permit 11 m City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 1 0 Request for Permit Action 0A- dAi T I G,,I. ) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPernuts @tigard-or.gov FROM: ❑ Owner p Applicant ❑ Contractor fr Staff Check(/)one REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ©/NCEL/VOID PERMIT APPLICATION. R RMIT FEES (attach copy of original receipt and provide explanation below). INVOIC FEES DUE (attach case fee schedule and provide explanation below). -REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: 475TRO/'j- cooz5 y Site Address or Parcel#: /734/41 st,,) c7 Project Name: 44}0ie- t-/ Subdivision Name: `—` ✓ Lot #: ' EXPLANATION: 6 /74racr ` ..t 1 L.,;yd/ee. =%06r71,,,4/ / Ac ' '��•Ja,✓ Z t z frrx r- ttjj // /l.(r1/'r�r7/rte/ 4..4e. ?z, 7L,,J �,,,,-jZ–; -e.,er _ ,7` w.//44.),` / h '.r ,f/44:/ 7'r. Signature: c . _ Date: Vf 7 ,5. Print Name: 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 1'SI', ONL'\ Route to S s Admin: Erwg'Agi B Route to Records: Date �'© j!�� Refund Processed: Date ,I/f111.11 B .PM Invoice Processed: Date ^ ?AM B %AMIN Permit Canceled: Date -47,46n. B tr Parcel Tat Added: Date B I:\Building\Forms\RegPerrnitAction_0 2314.doc Prr . Building Permit Application vol 0 9 f S .�� Residential IOI< OI II( 1 1 ,1 11\11 City of Tigard v8 Received teiv y ��`� Permit No.: y - _ • 13125 SW Hall Blvd.,Tigard,OR 9722 ^Q'� �—1, I Phone: 503.718.2439 Fax: 503.598.19 0 +� l• . G a/ �r • Permit: i c.n h 1� Inspection Line: 503.639.4175 V3 t` 1 ,,(-Q► ,��tZ 49 /110 J S See Page 2 fnr Internet: www.tigard-or.gov Y` ��v ��y � f Supplemental Information O \\_�W to AR TYPE OF WORK 611' 0� ,/ '' QUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demoli 43M� Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 4ddition/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 ❑Commercial/industrial Valuation: $— _Qi'jU j1�i (�3T�y ❑Accessory building ❑Multi-family Number of bedrooms: �`�T ° ! El Master builder ❑Other: Number of bathrooms: / 13q1 JOB SITE INFORMATION AND LOCATION Total number of floors: t f Job site address: 1,1972frfr i5 LLI q 7 - .�' New dwelling area: ti I square feet � City/State/ZIP: -1-A red Or- 61.2-`5 Garage/carport area: l square feet Suite/bldg./apt.no.: Project name: GO A 1) 4.. /6 /1 Covered porch area: square feet Cross street/directions to job site: (,//�J'_j-C("1 19u}t f Deck area: square feet /{� Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: 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. _ a d �1 141 1 v'^ k-O `^ O e Valuation: $ 2._(n bed s/ o rn c v�l \ r ,44 rD v� Existing building area: square feet �,� New building area: square feet lT PROPERTY OWNER I ❑ TENANT Number of stories: Name: -a,l J��j i \kgut le; Type of construction: Address: ` r 7 30 5 W 9 1 C/ti Occupancy groups: City/State/ZIP: ,7a rd 0 1"- 4 7)2 3 Existing: Phone:( ) '� Fax:( ) New: APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee(or deposit): Contact name: -1!{�� ] t // e — — i� Vl FLS plan review fee(if applicable): Address: )l 3z) �5 q7 of c t / I Total fees due upon application: LC 44e,, `l g City/State/ZIP: s�a�4 ��'- � zj _ Phone:(cp3) .- 90 a) Fax::( ) Amount received: E-mail: v PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: 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. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State sticharge(12%of permit fee): $21.60 CCB lic.: C Total fee due upon application: $201.60 Aatlieri®ed signature: CROA ► 1 /// This permit application expires if a permit is not obtained CROAT.?"✓�+ within 180 days after it has been accepted as complete. '.1 name: 1).ceAyi� ( in ,A { I )7,t *Fee methodology set by Tri-County Building Industry 1 (� 444------ G r _1 Service Board. I:1Buitding\Permits\BUP-RESPerrtfitApp.doc 02/24/2011 U 440-4613T(11/02/COM/WEB) . V 0 i ® Plumbing Permit Application ,Building Fixtures 0 H 1 " C City of Tigard , "� Permit No.: /� • 13125 SW Hall Blvd.,Tigard,OR 97223 I us, Plan Review ���`-E.20445.--1.� • Phone: 503.718.2439 Fax: 503.598.19 ' l`� Plan Rev;ew Other Permit No.: P� V DateBy: T n 1;D Inspection Line: 803.63.4175 ��l` �� C�O` Date Ready/By: 7uris. HI See Page 2 for Internet: www.ti ard or. ov / Notified/Method: Supplemental Information TYPE OF WORK'�t ` Cj� FEE* SCHEDULE ❑New construction ❑ **1 ttion For s dal in ormation use checklist. Descri a tion ra�'ya E Ea. Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.71; 171-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 Accessory building SFR(3)bath 500.32 ❑ ry g ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 i 13 N 1 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 12J-3-11 S(&1 q 7 ±-n-- c...4- Catch basin or area drain 18.76 City/State/Z1P: i;CS 4(e /1 r, o 12.�3 Drywell,leach line,or trench drain 18.76 J (/Y Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: &re' b or- Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.. . Page 2 M Storm sewer(no.linear ft.: - ) I Page 2 Water service(no.linear ft 1 Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 . q IJr !r t\ c 41/ Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 I-PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51 Name: 1-4 wrera Wad j ' ),� Fixture/sewer cap 25.02 ql�/'( Floor drain/floor sink/hub 25.02 Address: I r 3 3 0 51� l ? c.,4- .-4- , ,,/ Garbage disposal 25.02 City/State/ZIP: -'I / 07 yel 6 j`, q 1?-2 3 Hose bib 25.02 Phone:(5-0 3) �i / , 1/2- Fax:( ) Ice maker 12.51 S APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: e.1 j Roof drain(commercial) 12.51 Address: .0) _A Sink/basin/lavatory MO 25.02 MO City/State/ZIP: t • • '7 , a Solar units(potable water) 62.54 Phone:(5f3 ) • . < < - Q ►O Fax::( ) Tub/shower/shower pan _ .■ 12.51 1 E-mail: Urinal 25.02 Water closet ( 25.02 2,7v 11: Water heater 37.52 Business name: Water piping/DWY 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 \+1� Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authoired signature: TOTAL PERMIT FEE Print name: if.7*c4i i. _b )f i Date: 417 4 y This permit application expires if a permit is not obtained within 180 days 7 after it has been accepted as complete. (/// *Fee methodology set by Tri-County Building Industry Service Board. MBuildiog\Pamits\W.MU-PamitApp_doc 10/01/09 440-4616T(10/02/COM/WEB) . V t.) 1 .J Mechanical Permit Application t()l t (I I . Received City of Tigard ��� Deters : Permit No.: Date/By: v `� ,� L 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review Phone: 503.718.2439 Fax: 503.5' I'AI: �� Date/By: Other Permit: T I U A R I� Inspection Line: 503.639.4175 fl 1,0 `� Date Ready/By: Juns ® See Page 2 for Internet: www.tigard-or.gov , V Notified/Method: Supplemental Information ( *I' 4� E OF WORK fc�V' 0, COMMERCIAL FEE* SCHEDULE - USE CHECKLIST 1 Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration nt performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: 'o mechanical materials,equipment,labor,overhead,and profit. Value:$ �/ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* E 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special Information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total `t'5 41A JOB SITE INFORMATION AND LOCATION Heating/cooling: -r-b- Air conditioning 46.75 Job site address: ‘ (� q-7 S� Furnace 100,000 BTU(ducts/vents) I 46.75 %j(0.15' City/State/ZIP: -T;tail or. 9 1 2-2--3 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: G re t 0 b U v ,., Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater - 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 l isoo� eithaU 5" 11'eit c)c4 S Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 G PROPERTY OWNER i/h ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Q, W d fe Range hood/other kitchen L equipment 33.39 Address: ?j 3d $ q '� C_ Clothes dryer exhaust 33.39 City/State/ZIP: Ira( ov'r, q'�,_�3 Single-duct exhaust(bathrooms, """tut C/ toilet compartments,utility rooms) I 23.32 33.101--Phone:( O ) g O .-3 67.2_ Fax:( ) Attic/crawlspace fans 23.32 'PLICANT 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: / $14.15 for first four;54.03 for each additional Contact name: • `q p g� / , Furnace,etc. Address: +e /.1 ` Gas heat pump �U S WalUsuspended/unit heater City/State/ZIP: et v- or. �� 3 Water heater Phone:(5p1) We ,(Togo ga Fax::( ) Fireplace vvv Range E-mail: Barbecue illIPIONORNIV Clothes dryer(gas) Business name: Other: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) ict.e:r%5 Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE / t This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: of • Fee methodology set by Tn County Building Industry Service Board Print name: ir t.r _. 'J Date: 1:\BuildingTenniuUME.C_PermitApp_o40/doe ' 440-4617 (11/02/COM/WEB) t. r. •Electrical Permit Application w�Q Received City of Tigard �� Date/By: Permit No.:�igeyy_ nooSy 114 • 13125 SW Hall Blvd.,Tigard,OR 9� Plan Review B Phone: 503.718.2439 Fax: 503.59 O\� Date/By: Other Permit: I 1 r:�R I Inspection Line: 503.639.4175 ♦ Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov A� y ��cLV Notified/Method: Supplemental Information E OF WORK�( O ��`t\S‘ PLAN REVIEW ❑New construction Addition/alteration/�C�Q `t' Please check all that apply(submit 2 sets of plans w/items checked below): Q 13 Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition 0 Other: AiV.. where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTIV ON exceeds 10,000 amps at 150 volts or ❑Floating buildings. [ and 2-family dwelling less to ground,or exceeds 14,000 ❑Commercial-use agricultural y g ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ` ❑Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: F`�� Job site address: 4 S t j 17 eth- C. . 100P or more. occupancy. El o Six or more residential units. El Recreational vehicle parks. City/State/ZIP: -1--s1 6 11- g 1 2-2- 3 ❑Health-care facilities. El Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: W` 1e,1 f�1 ❑Service or feeder 600 amps or more. / FEE SCHEDULE Cross street/directions to job site: C, lie �7 v r p Description I Qty. I Fee. I Total I New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 1 • 168.54 Ea.add'I 500 sq.ft.or portion 33.92 1 Tax map/parcel no.: Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) _ • Limited energy,mub fv 1„ ( 111-1 n C Ld 6 v 1-e i-c residential(with above sq. - ft.) 75.00 2 Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation gecROPERTY OWNER ! ❑ TENANT 200 amps or less 100.70 2 f/� ,,/j� 1 . ' 201 amps to 400 amps 133.56 2 Name: I a e t"1 W a f e(( 401 amps to 600 amps 200.34 2 Address: I I3?50 `5 w 97 Got amps to 1,000 amps 301.04 2• 11 Q� I Or- q I 2-3 Over 1,000 amps or volts 552.26 2 City/State/ZIP: �t ", Temporary services or feeders installation,alteration,and/or Phone:(5o23 ) 5"O ,3c7,- Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps . 125.08 . 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits—new,alteration,or extension,per panel Q-(I PLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name: each branch circuit r `.i ` 1 „ B.Fee for branch feeder circuits without Contact name: I ('/1(//'( (�C[/(„ service it feeder fee,first l 56,18 2 f � branch circuit Address: ( i,3 3v q-1 Each add'l branch circuit 3 7.42 2 City/State/ZIP: ; I Or t � G��J�� Miscellaneous(service or feeder not included) �J' 67.84 2 ( ( Each manufactured or modular Phone:(5 ) C D (� Fax: :( ) dwelling,service and/or feeder Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 Business name: Signal circuit(s)or limited-energy See panel,alteration,or extension. Page 2 2 Address: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr City/State/ZIP: Investigation(1 hr min) 66.25/hr Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%z hr min) $uprv.Electrician signature,required: ELECTRICAL PERMIT FEES 0, Subtotal: Print name: Date: Plan review(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: (Js' ii i'/ TOTAL PERMIT FEE: Print name: Date: �1 This permit application expires if a permit is not obtained within 180 Ij 7- ) /y days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\Building\Pemits\ELC_PermitApp_ELR_ .doe Rev 05/21/2013 440-4615T(11/05/COM/WEB 4 vim, - 4 Building Permit Number: ms,-,2,0/ t(-000 5� Building Permit Review Residential Projects //3 4,4 pit - /iAe- 2 4:cd2€y , -"/A`//iit` tbil Site Address: 51-J 9 7-h~' C4 . OVerify site address is valid. Project Name & Lot #: WZI (e ; I k Clean Water Services—Service Provider Letter: (lot platted prior to 9/10/1995) Required: Yes I �,I No ❑ Received: Yes ❑ No ❑ Site Plan Elements: Site plan must be on 8-1/2"x 11"or 11"x 17"paper CIThree(3)copies of site plan Drawn to scale(standard architect or engineer scale) CENorth arrow ail Map and tax lot number,site address,project or subdivision Footprint of new structure(including decks)with finished name,lot number,and zoning floor a evations r4 Applicant information(name and phone number) ,t and building setback dimensions VI ' operty corner elevations(2 foot contour lines if more than P •t area,building coverage area,percentage of coverage and 4 foot differential) rl/fk impervious area. (,Jtility locations Location of wells/septic systems. Existing structures on site Surface drainage treet names Street tree size,type and location rosion control(including drainage-way protection,silt fence gExisting trees to be retained with drip line,and tree design,location of catch basin,etc.) protection measures Planning Review ,Lt Land Use Case Number: t•-ii a EZoning: f Z - t pi Setbacks: Front 1 S Rear 15 Side 5 Street Side 0 I f Garage 0 RI Landscape Requirement: .2 0 % XLot Coverage Maximum: 8 0 ova Building Height: Maximum Height 3S- Actual Height S; nc,(c 3-6--- h Visual Clearance Nil} 1 ji Easements N f Pt pi Sensitive Lands: ❑ Yes Type l f/A jUrban Forestry Plan N)J{ Conditions Satisfied Ni/k Approved by C� a ✓t�-- Date: -17 -/y Notes: Revisions (after Building Submittal only) Reviewer Date Revision 1 Approved ❑ Not Approved ❑ Revision 2 Approved ❑ Not Approved ❑ Revision 3 Approved ❑ Not Approved ❑ I:\Building\Forms\BldgPermitRvw_RES_123013.docx Building Permit Submittal Original Plan Submittal: Date: f//7/1 y By: g Site Plans: # 3 Building Plans: # j Create Case Record#: ❑ Enter case#above for Building Permit Number. Workflow Routing: I inning [ ' gineering aie.rmit Coordinator hiding Workflow Sign-off: .i off for Planning staff,including notes from planning review(page 1) Route Application Documents: [ 'Engineering: (1) copy of permit application, (1) site plan,(1) building plan and o 'al plan review routing form. 0 Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Reviewed By: Date: Notes: Engineering Review—reviewed by: /1Z- Actual Slope: 57 ❑ Conditio Satisfcd Notes: p �.i i-. �.' .. p Approved by: Date: Revisions (after Building Submittal only) R viewer Date Revision 1 AVPrureel4 Not Approved,c dz Revision 2 Approved ❑ Not Approved ❑ Revision 3 Approved ❑ Not Approved ❑ Permit Coordinator Review ❑ Conditions Met-Prior to Issuance of Building Permit Notes: Revision Notice 1: Date Sent to Applicant: —F Ark-e--( f(' i/2-3/ Revision Notice 2: Date Sent to Applicant Revision Notice 3: Date Sent to Applicant Okay to Issue Permit- Date: I:\Building\Forms\BldgPermitRvw_RES_123013.docx 1 GZU17 / • ■•• ••••• •• •• •• •• •• ■••■••■•••.I•I•••4■1••g■••1■111••■••41•MINIIM•• RECEIVED I o SINGLE-STORY APR 17 2014 HOME ADDITION • CITY OF TIGARD I — ._6.. UILDING DIVISION • • A • I I j .<\-- EXISTING EXISTING SINGLE- • • SIDE DECK/PAT o STORY HOME • 11344 SW 97th Ct. • •• • �° EXISTING SINGLE- STORY HOME • 11330 SW 97th Ct. •• •i •••■• • • • 1 • DRIVEWAY — • I • 21-5' — EXISTING STORAGE • tv 0 1,, ./..) ._ , s ,45 • EXISTING STORAGE •I 1///60 OG = • I 'Qj, I• ••!••∎•• •• •• ••∎••∎••—••■•••—••■•••∎••∎••t■s••■•■•••■=1 CITY OF TIGARD NOTE: Approved by Planning ALL DIMENSIONS ARE APPROXIMATE. CONTRACTOR TO VERIFY ALL EXISTING DIMENSIONS. Date: 1--I17-14-I� __ SCOPE OF PROJECT Initials: 1-.TO ADD TWO BEDROOMS AND ONE BATH TO EXISTING STRUCTURE (11334 SW 97th COURT). ZONING — --- — -TOTAL LOT AREA: 31,893 Sq. Ft. -TOTAL ALLOWABLE FOOTPRINT AREA (EXISTING & PROPOSED): 80 % SETBACKS: FRONT YARD: 15' SIDES: 5' REAR YARD: 15' GARAGE FRONT: 20' /