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Permit v 14 CITY OF TIGARD ,., , MASTER PERMIT 1. ` COMMUNITY DEVELOPMENT RV° /7 • Permit#: MST2016 00145 Date Issued: 06/08/2016 T t OA1 D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S115AD00100 Jurisdiction: Tigard Site address: 10512 SW TUALATIN DR Subdivision: WILLOW-BROOK-FARM Lot: 32 Project: HATTON Project Description: 4/18/17, REPRINTED to revise permit;scope of work is for a 442 sf 2-stQry addition for master _bath, pantry&loft area. Mechanical, electrical&plumbing work under separate permits. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 277 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 28 Bathrooms: 1 Second: 165 sf Garage: 0 sf Front: 0 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors. Total: 442 sf Value: $61,926.50 Rear: 15 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 Storm Sewer: 0 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 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+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 442 Owner: Contractor: HATTON,FLOYD W&BARBARA W OWNER Required Items and Reports(Conditions) 10512 SW TUALATIN DR FLOYD&BARBARA HATTON 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 10512 SW TUALATIN DR TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $2,010.85 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 - - •- -- 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. AT NTION: Ore••n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-.010 through OAR'52-e. -0 i90. You may obtain a copy of the rules or direct questions to OUNC by callin .232.1987 or 1.800.332.2344. Issued B`: A1 ... 11LIGA_=�� Permittee SignatuC e_�i' �� /� Call 503.639.4175 by 7:00 a.m.for the next available inspection te. This permit card shall be kept in a conspicuous place on the job site until c pletion 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 , Dewy, ii a �(p - PamitNo.:trtsATgaft�- /ur- 13125 SW Hall B1vd.,Tigard,OR 97223VPlan Review I fit! �i I' 8 Phone: 503.718.2439 Fax: 503.598.1 M Date 4 l,l i 4 ) Permit: i,,.,i<n Inspection Line: 503.639.4175 Y Date Ready/By: ice- ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: 51:14 1(.(g/�jt "fie, I Supplemental Information 1tirl-' ebt ;Lit- ID L v TYPE OF WOR P� y (iP.3� REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑ s � �` ��� Permit fees*are based on the value of the work performed. '�` � Indicate the value(rounded to the nearest dollar)of all 1Addition/alteration/replacement ❑ 5!�'�',@C5 equipment,materials,labor,overhead,and the profit for the .. CATEGORY OF CO • VON work indicated on this application. Valuation: $ ID 0'00 and 2-family dwelling 0 Commercial/industrial 11'"' 1 t..1 0 Accessory building 0 Multi-family Number of bedrooms: 0 Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 4t 9A. /2 Job site address: / 1251rU o f yATI}I OR- New dwelling area: 49.6...--. square feet City/State/ZIP: "rtjat7p OR cil a Z+ Garage/carport area: square feet Suite/bldgJapt.no.: Project name:/4 h-e-r0 J (2 J V-61„)(41:, C eredporch /square feet Cross street/directions to job site: t Deck area: �' 6 0 square feet . square feet se REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. tIndicate the value(rounded to the nearest dollar)of all ti Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the /y 'n DESCRIPTION OF WORK work indicated on this application. e/ ,7 Valuation: $ --1. i 4 It P t iv l N Existing building area: square feet New building area: square feet J PROPERTY OWNER ❑ TENANT Number of stories: Name: f ,(�� s �.� , _{-.li,A-r- 11,) Type of construction: Address: /�' \\ 1 1 Occupancy groups: l City/State/ZIP: Existing: Phone:( ) Fax:( ) New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* I� Business name: 1 t V z1t (Pleeserefertofeeschedule) 1�w1 � Structural plan review fee(or deposit): 1, Contact name: ssot4(J wi 0. FLS plan review fee(if applicable): Address: eDa l vet g,h - =112-?_ 1 Total fees due upon application: 4/1001 ,51 City/State/ZIP: �q �, I Phone:( -'li d-1556 I `� Fax .—4 - Amount received: •E-mail: ilLuJ 6 is G�l.l�-t-U c� L�eR �l 1 L GAJ Wt PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CO roof-top mounted PhotoVoltaic Solar Panel System. Business name: (' 0 LoNom. 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 surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signator �ti / �� Thin permit application expires If a permit is not obtained \IA.A i/ within 180 days after it has been accepted as complete. "See methodology set by Tri County Building IndustryPrint name: ci U;_4(.. j op_•— Date: 4.,g_...-,' Service Board. \I:1Building\Pennits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 114 Transmittal Letter r c;,\Ez i 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: i-4 DAT ' . _..�.:l: y • DEPT: BUILDING DIVISION 'I /: FROM: FJoyo' hi tyclih CITY OF TIGARD BUILDING DIVISION COMPANY: PHONE: SO3 —Zq0 J-- q/Z gi RE: /05/2- ,540Tua/a.-/-iia Pr, nar,✓ 1-15f0-0/Ce -60/i/6- (Site Address) f i (Permit Number) NO,#Oh R-€ i -eh c-e (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. Revisions: rn s1 2.O J —(10/y$- Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. 6 Engineer's calculations. Other(explain): REMARKS: 73cse. are eh j h e-e Y i r a GG. h o T. /77 - 2-C'/c. --00/yS FOR OFFICE USE ONLY Routed to Permit Technician: Date: 4 - c- I - Initials: ..)' Fees Due: ti Yes ❑No Fee Description: Amount Due: 1-f I I-Jr pi v... rcjI , — $ 90 C -,/� Ariz- 4i E l—es -- $ 42-A67-770/4 $ Special Instructions: Reprint Permit(per PE): Yes [NoDone Applicant Notified: '/oSp Date: //�/ 7 JJ tials: 3'y VM IBuilding\Forms\TransmittalLetter-Revisions_061316.doc CITY OF TIGARD MASTER PERMIT 11 ' COMMUNITY DEVELOPMENT Permit#: MST2016-00145 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/08/2016 T t t.;A t<.D9 Parcel: 2S115AD00100 Jurisdiction: Tigard Site address: 10512 SW TUALATIN DR Subdivision: WILLOW-BROOK-FARM Lot: 32 Project: HATTON Project Description: 395 sq.ft. addition. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 395 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 23 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 395 sf Value: $40,000.00 Rear: 15 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 Storm Sewer: 0 Drains: 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 Fu rn>=100 K: 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+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 395 Owner: Contractor: HATTON,FLOYD W&BARBARA W OWNER Required Items and Reports(Conditions) 10512 SW TUALATIN DR FLOYD&BARBARA HATTON 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97224 10512 SW TUALATIN DR TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $1,802.17 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those - are set forth in OAR 952-001-0010 through R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 .2344. r'�j� Issued By: cl' --' Permittee Signature: /_1r- d, e N' 1 �'� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential Received City of Tigard -, Dec43 : /� l(P Permit No.:rile r /(0��/il • 13125 SW Hall Blvd.,Tigard,OR 97223 .- Plan Review t C� 0 Phone: 503.718.2439 Fax: 503.598.1 ii:Vis Date/By: 4 1 jf to * iwther Permit: 1 i ,,,r u Inspection Line: 503.639.4175 Date Ready/By: 111 Jude: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: 5pi.ilice/ "�e, ( Supplemental Information 1$ fl-' tFc^Rt 7d V (L.4 TYPE OF WORI�?� 1 } REQUIRED DATA:1-AND 2-FAMILY DWELLING II`;11.1`` 0 New construction 0 Dc � >' -' Permit fees*are based on the value of the work performed. N 1- Indicate the value(rounded to the nearest dollar)of all ❑ 6��o equipment,materials,labor,overhead,and the profit for the 7AdditioalalteraUonkeplacement CATEGORY OF COON work indicated on this application. and 2-family dwelling ❑Commercial/industrial Valuation: $ ! G©' ) 0 Accessory building 0 Multi-family Number of bedrooms: �`' 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 10 ' 12 'XI 1 Oftlidrci}I C2 New dwelling area: ;3 CJ 6- square feet City/State/ZIP: "r p pR c:1._1 Zf.i Garage/carport area: square feet Suite/bldg./apt.no.: Project name:.J-rt-o l 1 1�� � Covered porch area: square feet Cross street/dtrections to job site: t 1" Deck area: s 6 0 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. lTax 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. -‘..__._S'S �)D t 4 /1 Valuation: $ M /�Y� ` Existing building area: square feet k gr New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: 1 Name: f�(� g Q,.k12.27 Type of construction` . Address: /' 6 I�,"1`l ' Occupancy groups: 1\ City/State/ZIP:l� Existing: Phone:( ) Fax:( ) New: APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Pleadule) rQ Pe-6i111•1 �� '� fe nej(or rojepose it: Business name: �W �'�t�'�(�� Structural plan review fee(or deposit): Contact name: (J �1 id 1- ) ij -Address: �1 eD�t` an FLS plan review fee(if applicable): `' 1 Total fees due upon application: 4/10 51 City/State/ZIP: ,f) )) '12Z9 �` -1 t 'S Phone:( ) CAI Fax::(.---) --, Amount received: •E-mail: ��a Y` GIeI,i�U���G�R , t GO W l� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* 11 CO Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: ( D Lk)N 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 surcharge(12%of permit fee): $21.60 CCB lic.: \ Total fee due upon application: $201.60 Authorized si tut � A"r /k4 �� This permit application expires if a permit is not obtained • within 180 days after it has been accepted as complete. Print name: � 1 Date: q,...-- "Fee methodology set by Tri-County Building Industry 0 1�'� �" ` Service Board. \I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) r 1 City of Tigard r COMMUNITY DEVELOPMENT DEPARTMENT . a T 1 c,n li D Building Permit Review — Residential Building Permit #: fit) 4—06/I-r S Site Address: j D 51 a 5 k) 'Ta a.(arii n Dr . Project Name: 14e ---on Lot #: (New dwelling= subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: 3 15 szA. -C{ . add;-4;u,-) (pi ,.`._5 d e C---(C) 41) a 1Sr9(t ;Um ( 1 KVerify site address/suite# exists and active in permit system. 5rRiver Terrace Neighborhood: eNo ❑ Yes, See River Terrace Review Addendum Attached Site Plan Elements: Di•Three(3) copies of site plan !-<.'sting structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper 14 9otprint of new structure(including decks)with finished RISrawn to scale (standard architect or engineer scale) floor elevations [5,-(Korth arrow ,Cltility locations (required for new,may apply for additions) ite address,project or subdivision name and lot number giocation of wells/septic systems . Applicant information (name and phone number) ,Erosion control(including drainage-way protection, silt fence 0Lot dimensions and building setback dimensions , design,location of catch basin,etc.) of area,building coverage area,percentage of coverage and E15treet names •(� U� . pervious area(applicable if R-7,R-12,R-25&R-40) t.reet tree size,type and location -V P •perty corner elevations (2 foot contour lines if more than Existing trees to be retained with drip line,and tree 101 footilifferential) protection measures XC can Water Services—Service Provider Letter (lot platted prior to 9/10/1995): 'equired: krYes,applicant was notified ❑ No Received: ❑ Yes No /Ii1 Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified X No Applied For: E Yes ❑ No,stop intake gl- Land Use Case#: N(/A wZoning: p- 4 ,5 IP NI Setbacks: Front --- Rear 1 5 Side 5 Street Side — Garage Landscape Requirement: 0/0 Lot Coverage Maximum: 0/0 Building Height: Maximum Height 30 Actual Height a Visual Clearance xEasements Sensitive Lands: ❑ Yes xNo Type 1.4s,�k -iicwcie(a'ic-, 1 rlo Urban Forestry Plan 54c52.p S(a PC S- .VConditions "Met"prior to issuance of building permit Notes: Approved By Planning: £it p/ a ( j tt .- Date: 4-1,2 "/(0 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\Building\Forms\BldgPennitRvw_RES_012116.docx r 7 Building Permit Submittal Original Submittal Date: q/6. Site Plans: # Building Plans: # 3 Building Permit#: tenter building permit#above. Workflow Routing: Planning 14"Engineering Coordinator g Workflow Sign-off: -off for Planning(include notes from planning review) Route Application Documents: ngineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. El—tit-11111g: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: —� Date: 4/424. Engineering Review Slope at building pad: Conditions "Met"prior to issuance of building 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 No LIDA Facility on lot: [Ti Yes No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: A Date: LAM/X Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved • Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit IApproved,NOT Released: ( &1 CG.v#/'lb� / Date: `f - /4 -1(to N/_otes: Ni el- C(itJi SPL , Applic4riT noTiff_e� a st.L'i-i i 41- Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: L` SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes L:gi N/A Tigard Trans SDC: ❑ Yes [Xi N/A Parks SDC: ❑ Yes 71 N/A VOK to Issue Permit Approved by Permit Coordinator: Date: 5 'i1-Ile 1:\Bui Iding\Fonns\B1dgPennitRvw_RES_012116.docx • t 72_ 54.) TTal4fih Or ‘161‘) 'i0 Clean Water Services File Number \ 1 v C1eanWate\" Services 16-001845 T1 %�` 0� 1C�O�OINb`Nnsitive Area Pre-Screening Site Assessment g 1. Jurisd� 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Floyd Hatton Company: Address: 10512 SW Tualatin Drive Site Address: 10512 SW Tualatin Drive City, State,Zip: Tigard,Oregon,97224 City, State,Zip: Tigard,Oregon,97224 Phone/Fax: 503-209-4128(cell phone) Nearest Cross Street: SW River Drive E-Mail: FHatton78@comcast.net 4. Development Activity(check all that apply) 5. Applicant Information 11) Addition to Single Family Residence(rooms,deck,garage) Name: Floyd Hatton ❑ Lot Line Adjustment ❑ Minor Land Partition Company: Li Residential Condominium ❑ Commercial Condominium Residential Subdivision Address: 10512 SW Tualatin Drive ❑ ❑ Commercial Subdivision IJ Single Lot Commercial LI Multi Lot Commercial City, State,Zip: Tigard,Oregon,97224 Other Phone/Fax: 503-209-4128(cell phone) E-Mail: FHatton78@comcast.net 6. Will the project involve any off-site work? ❑Yes KI No ❑Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project I think the site plan shows all the info,but if you have any questions,call me at 503-209-4128. Thanks! This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality,Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate. Print/Type Name Floyd Hatton Print/Type Title ONLINE SUBMITTAL Date 5/17/2016 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200'of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also be required. ❑ Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 07-20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,State,and federal law. Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 07-20,Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law. his Service Provider Letter is not valid unless 1 CWS approved site plan(s)are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9195 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed by _ t.et-'°ar' 6f1,4, ei—"� Date 05/17/16 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone:(503)681-5100 • Fax (503)681-4439 • www.cleanwaterservices.org Property Owner Statement RECEIVED Regarding Construction Responsibilities APR 1 9 2016 Oregon Law requires residential construction permit applicants who are not licensed with Y OF T IGGARD Construction Contractors Board to sign the following statement before a building permi ING DIVISION 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: 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 all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or C j 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. % /t���! iJ t+ o . Print Ng-of of Permit Applicant Signature of Perm,t Applicant Date V Permit# �S�' a0/(o e_ s-- Address /05/a SkJTItg1-4T7•V +�°` y ~ •, / I '/' I Issued by " Date 5V11124----- This Copy for Permit Offices 1 City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT 1111I Building Permit Review — Residential IlO,1RI) Building Permit #: 7)/1577M/6-06/'rc Site Address: J &51 a 6 k) --rt ad et_4i,i br. Project Name: 4e-0-on Lot #: (New dwelling=subdivision name;addition or alteration=last name of owner) Planning Review Proposal: 3 15 stk., f4 , o�dd;-4i u Cp i &s d e L(c) r(-a t 3y (( trs *el1 tndme . `I C Verify site address/suite#exists and active in permit system. L$'River Terrace Neighborhood: ,No 0 Yes,See Rimer Terrace Review Addendum Attached 1 Site Plan Elements: RThree(3)copies of site plan ��.. ; 'sting structures on site `site plan must bg on 8-1/2"x 11"or 11 x 17"paper ,'/ .otprint of new structure(including decks)with finished lrawn to scale(standard architect or engineer scale) floor elevations ortarrow > h ,i2ftility locations(required for new,may apply for additions) .Site address,project or subdivision name and lot number ,Location of wells/septic systems .'Applicant information(name andhone number)) Erosion control(including drainage-way protection,silt eiNtit dimensions and building setback dimensions design,location of catch basin,etc.) t area,building coverage area,percentage of coverage and P9Street names pervious area(applicable if R-7> R-25 84 R-40) /LtJ R-12, ,�,� Ret tree size,type and location -I`G� P"•perty corner elevations(2 foot contour lines if more than ' Existing trees to be retained with drip line,and tree tll •_ foot 'fferential protection measures can Water Services-Service Provider Letter(lot platted prior to 9/10/1995): equired: trYes,applicant was notified ❑ No Received: PP O Yes 1K,No 1 Io Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified Xi No Applied For: ❑ Yes ❑ No,stop intake 71- Land Use Case#: If/A CV' zoning: p--14 ,5 g ,lii Setbacks: Front Rear 1 5 Side 5 Street Side — Garage ZLandscape Requirement: Lot Coverage Maximum: Building Height: Maximum Height 30 Actual Height 6 Visual CIearance Easements )21 Sensitive Lands: ❑ Yes pl No Type ©ta-d 4-At -c[o;rcIp(Gt;,, n a Urban Forestry Plan 5462p SfaeeJ- Conditions"Met"prior to issuance of building permit Notes: • Approved By Planning: CAL4,4 a (1f4.tA,L-- Date: 4-/a2 "/(gyp Revisions (after Building Submittal only) Reviewer Date Revision 1: A Approved ❑ Not Approved 44(9-1":„((g-1„:„ 1/"- °/9 ( (, 1/° ( (, -1 Revision 2: ❑ Approved ❑ Not Approved Revision 3: 0 Approved 0 Not Approved l:\Building\Forms\BldgPermitRvw_RES_012116.docx I Building Permit Submittal Original Submittal Date:` Site Plans: # Building Plans: # 3 Building Permit#: nter building permit#above. Workflow Routing: (� P-la-nning neering rrtut Coordinator g Workflow Sign-off: L,T�J'S_t�g�i-off for Planning(include notes from planning review) Route Application Documents: IJ'iEn veering: (1) copy of permit application,(1)site plan,(1)building plan and original plan review routing form. 1 C -Btu?dmg: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: 1` � By G -�,, ,/ Date: 4//a4� Permit Technician: � - Engineering Review I Slope at building pad: Conditions"Met"prior to issuance of building permit Easements (encroachments)per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes No 1 Assess Water Quantity Fee in-lieu: 0 Yes No LIDA Facility on lot: 0 Yes No 0 NOT Approved by Engineering: Date: 1 S Notes: Approved by Engineering: �� p Date: / / i Revisions(after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: 0 Approved 0 Not Approved • Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review tConditions"Met"prior to issuance of building permit 4 I Approved,NOT Released: 6/".4.44-2 ,_ e4.4-,,,,,,-. Date: `i - 14--`(o i9 Notes: fvi C(AI•S SPL _ 4pi;Ca/t f no l 'el tJ SLIhrn i 1 ( ,,,, Revisions (after Building Submittal only) 4� Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: Z q SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes (Xi N/A 1/" Tigard Trans SDC: 0 Yes [X N/A ✓/ Parks SDC: 0 Yes ft N/A j/fOK to Issue Permit ' Approved by Permit Coordinator: Cay Clm) Date: 5 -11-!a I:\Building\Forms\B1dgPermitRvw_RES 012116.decx ei Gy l; "4---- , Building Permit Application Residential City of Tigard Received Date ii / i 4p - Permit No.:14,6r 201/(o 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1 Com! p'arJ "cym(S� •• I Phone: 503.718.2439 Fax: 503.598.1 CVNN Daffy. 4 );l1 L ) ether Permit: �i, I. Inspection Line: 503.639.4175 Date Ready/By: lurk ! B see Pane 2 for Internet: www.tigatd-or,gov Notified/Method: 5:p:ht./7 �Pi I Supplemental Information �q 1-1\ ObPOr`�t1 , fl (\ TYPE OF W007.1.112‘R !� <<x .� u� REQUIRED DATA:I-AND 2-FAMILY DWELLING 0New construction �;�� ti .. Permit fees*are based on the value of the work performed. J 1\ S' �,�� Indicate the value(rounded to the nearest dollar)of all 7,MdmoalahoMuOe/raplacement ❑ rp t+ equipment,materials,labor,overhead,and the profit for the CATEGORY OF COhl l8go;Y.1 work indicated on this application. and 2-familydwellingValuation: $ " 0 CommerciaUinduatrial L0 CO 1,1 ❑Accessory building 0 Multi-family Number of bedrooms: 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: y Job site address: �� � 1 � TO�t_Aar"'K ' /12 New dwelling area: ' ". square feet r 3.LJr�� •V k/ r city/stat/ZIP: -t-� ,Q p 4� �"�2.Z $e/ t area square feet Suite/bldgJapt.no.: T'f Project name: 4 F TTO� !�r7r'T (j C. �� square feet Cross street/directions to job site: Deck area: �' 6 0 square feet square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. t• Tax map/parcel no.: — Indicate the value(rounded to the nearest dollar)of all f� (� equipment,materials,labor,overhead,and the profit for the %; I° DESCRIPTION OF WORK work indicated on this application. '-1' -o/d .iia =!Oa,L /;I. % Valuation: S \ Existing building area: square feet New building area: square feet Qj PROPERTY OWNER ❑ TENANT Number of stories: Name: rt,0,..(t2 jp Type of construction: Occupancy groups: City/StatAddress:e/ZIP:C-/ Existing: Phone:( ) Fax:( ) New: / APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* r� Business name: p w Q/I t d? A' P� c.te. `'� review toles deposit): ` ` "_'(f" Structural plan fee(or deposit): Contact name: '}-}(,i 1y'(:0S,Z..k.l 41.4 r} FLS plan review fee(if N,:1 Address: 5(_ Tg��t`tzm,c,: l Total fees applicable): (Mee City/State/ZIP: ✓ • '� due upon application: I,��,J ,5-3 I Phone:( p� 111221 Fax::(.---9 Amount received: `'` Lk E-mail: 1PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES• ,. 4 U ri r G�(t -'e4 o� 1f 1�lLti l G p YI.( Commercial and residential prescriptive installation of C /�!) roof-top mounted PhotoVoltaic Solar Panel System. Business name: ( t) l"I,-,o-) Submit two(2)sets of roof plan with connection details l �F• and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review S180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: Total fee due upon application: $201.60 Authorized signaturp iteT/ This permit application expires If a permit is not obtained within 180 days after It has been accepted as complete. Print name: --lr'0(.{t • L (/� '-Date: 4„��t( "Fee methodology set by I'll-Candy Building Industry , �'�`M' I�1yr_"' Service Board. \I:\Building\Permits\BUP-RESPemtitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) FOR OFFICE USE ONLY–SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT : _ Transmittal Letter T i c;,n lz n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.t. ard-or.gov TO: kyle) DAT CEIVED: DEPT: BUILDING DIVISION RECEIVED / AUG 9 2017 FROM: /O 0/ a- of , CITY OF TIGARD COMPANY: BUILDING DIVISION PHONE: 1/4503 - 2_01 - y/Z g By:ff-1• RE: 10672- SC1 TiAk-/cd-ill Dr . /i1f ZOA- -- 00PLC' (Site Address) (Permit Number) ri (Project name or subdivision name and Is j mber) ATTACHED ARE THE FOLLOWIN P E (1 Copies: Description: ` Copies: Description: Additional set(s)o t'an. Revisions: Cross section(s) and •e : s.oy \ Wall bracingand/or lateral eral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): 3 God i e j 40 64.e l S I9- pia.r REMARKS: / co i) -roafi ,7pi�. 1 -Prdb.) Gri j,r,4903,o0J'e pfo-h.s 014,9 VC9d d<</< - C72 / Copc. pro oje "W.I.) de-Oki-JD )ah hcw alccfc J 9 / cr i �1 'Deck Devi h trio% FOR OFFICE USE ONLY Routed to Permit 'echnician: Date: g- 17 - )-7 Initials: I) Fees Due: fK Y s ❑No Fee Description: Amount Due: • 1 1-J pJ4h r--. ,,, $40 $ $ Specia; rip,,J) $ S- �. Instructions: �j', '15 -50 Reprint Permit(per PE): ►, Yes ❑No — i mne Applicant Notified: i ate: Sratiot//7 Initials: 4?` I:\Building\Forms\TransmittalLetter-Revisions—061316.doc 1