Permit (75) Buird 1i2 Permit Application EXPIRED 3/ -Ji
Residential RECEIVED ,.(Hz 0,.-,.,(.,.i i s i.: (o,t,
Received
City of Tigard , 'n' 3 / Permit No.:��jr�/5-06 /7 n
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit:
1 1 t \r i) Inspection Line: 503.639.4175 CT�'Y OF TIGARD Date Ready/By: Juris: El 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.
Valuation: $ SC9ch0
❑ 1-and 2-family dwelling ElCommercial/industrial /
0 Accessory building El Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ?Cl/,S ,t/ P�S l /4/1:70k New dwelling area: square feet
City/State/ZIP: --7--1,2„,/ ? L22 L Garage/carport area: square feet
Suite/bldg./apt.no.:d Project name: A/ ,- Oe S J H ELF J Covered porch area square feet
Cross street/directions to job site: Deck area: LI 2 g 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.
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.
Valuation: $
t t 4-1 61,---1 I / t' SCC-q4 On Existing building area square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: 'L&'I1 01-e f,F•• Type of construction:
Address: 99/5- S L.4_, P 6r-c,a, , S Occupancy groups:
City/State/ZIP: -1-15a-r4 QO 972,^1, Existing:
Phone:(5j 3) g J 6 _ Li y Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer tofeeschedul)
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 mo•• ed Photo Voltaic Solar Panel Syste .
Business name: d 11- Submit two(2)se • roof plan with co s, on details
and fire department acce., • on:_ : the 2010 Oregon
Address: Solar Installation Special •• ecklist.
City/State/ZIP: Permit Fee(in es planrevr $180.00
administrative fees):
Phone:( ) Fax:( ) State su arge(12%of permit fee): $21.60
CCB lie.: Total fee due upon application: $ i 1.60
K----------
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: GS2i -o.ij Date:
*Fee methodology set by Tri-County Building Industry
ZS'( Service Board
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
r -
Building Permit Application Checklist ' .., -
One- and Two-Family Dwelling I OR (>FFI( l: ISE 0\I.1
Received
City of Tigard Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
I I .AI:I)
24-Hour Inspection Line: 503.639.4175 El Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov 0 Other:
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
3 Verification of approved plat/lot. ❑ ❑ 0
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. ❑ 0 0
7 Water district approval. 0 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
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-fl.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, 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
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- 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 ❑ ❑ ❑
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 ❑ 0 ❑
architect licensed in Ore.on and shall be shown to be a•.licable to the 'ro'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". 0 0 ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑ ❑
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 Tree 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.
A Clean Water Services'Sensitive Area Pre-ScreeningSite Assessment form is required for all buildingadditions, ❑ ❑ ❑
9
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.
L\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
s
' Building Division
Development Code Provision Review
TI C;n ii Residential Projects
Building Permit No.: V3 1 I — OC>17 '
Project/Subdivision Name: N1,1.F I , Lot #:
Site Address: ci 9 t S `aw P r�-,2vo ti,
CWS Service Provider Letter:
Required:Yes 0 No
Received:Yes ❑ No Fg-
Plans Routed:
Original Plan Submittal Date: `)/24/3 Routed By:
1St Revision Submittal Date: 0 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 ATVS VOAAC2, at(503) 718-2-42-7 or S K ti d-
or.gov)
Land Use Case No.
Zoning� T2-7.S-
13
13 etbacks: t I �t
Front Rear 1S Side .S Street Side 20 Garage
Erlyaximum Building Height: 3d Actual Building Height N'Pc
LY Visual Clearance N/Pr
❑ yasements
N' Sensitive Lands Type: N 0 Nt
D Street Trees NI A-
0,
0, Protected Trees tJ/q-
Notes:
Original Plan: Approved Not Approved ❑ Date: 1 12.1113
Revision 1: Approved 0 Not Approved 0 Date:
Revision 2: Approved ❑ Not Approved 0 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)
...Er Actual Slope: 7
Notes:
Original Plan: Approved Not Approved 0 Date: 7 1/ 3
Revision 1: Approved 0 Not Approved 0 Date:
Revision 2: Approved 0 Not Approved 0 Date:
Permit Coordinator Review(contact Albert Shields at(503) 718-2426 or albert@tigard-or.gov)
0 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 Appli nt
Okay to Issue Permit: Yes No 0
Date Routed to Building: ^
Page 2 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13
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 per mits.
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:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II 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 w ill
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 horn eowner statement is true and accurate.
0/7 eA_F
Print Name of Permit Applicant
SigMature of PermitA Applicant pp Date
Permit#: M S( a0 I J-C l O
Address: '19 zauD •
.;
lb; ti._ s`
Issued by: Date:
This Copy for Permit Offices
b