Permit (60) i IA
114 CITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT Permit#: MST2016-00308
TfA.R 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2016
Parcel: 2S104CD10200
Jurisdiction: Tigard
Site address: 13611 SW TRACY PL
Subdivision: HILLSHIRE ESTATES NO.2 Lot: 101
Project: Cerbone
Project Description: Remodel of existing 1st floor bathroom to improve accessibility. This permit is for structural only-
all 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: 1 Third: 0 sf Right: 0 Detectors: No
Total: 0 sf Value: $40,000.00 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
0 Storm Sewer 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains:
Bckflw Prevntr: 0 Catch Basins: 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'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:Y Square Feet:
NEW SF VB
R-3 0
Owner: Contractor:
CERBONE,ROBERT REVOCABLE LIVINCROBERT J DOMZALSKI Required Items and Reports(Conditions)
13611 SW TRACY PL 8933 SW WOLDS DR
TIGARD,OR 97223 BEAVERTON,OR 97007
PHONE: PHONE: 503-349-6332
FAX: 503-746-4459
Total Fees: $1,098.07
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 t - - adopted by the Oregon Utility Notificati Center. Those rules are set forth in OAR
952-001-0010 throu•• e_, R 952-001-0090. You may obtain a opy of the rule-or direct questions to OUNC by calling 32.1987 or 1.800.332.2344.
Issued By: rI' -.i,_ —.� ermittee Signature:
.'.
-.. 9.4175 by 7:00 a.m.for the next available inspec on 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 roll oiiicl I si":O\l"\
Cityof Tigard 2 Received / ,� ,(,� / ��fj
g 2� Date/B x / �� Permit Nr"/5���(O ODJ�c Z7
13125 SW Hall Blvd.,Tigard,OR 97223 n I G16 Plan Review I
Phone: 503.718.2439 Fax: 503.598.1960 NU Date/B : l. OtherPermit:
Ti G A R D Inspection Line: 503.639.4175 �F TIGARD Date Ready/By: luris. la See Page 2 for
Internet: www.tigard-or.gov CITY `t1S O Notified/Method: p IS Supplemental Information
DIV
BUILDING f�7 (8,Fzena j _
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 ❑Commercial/industrial
Valuation: $ 14OI dela
❑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: 13 ,IA S 1..j-'f'r.a_y ?[at w New dwelling area: square feet
City/State/ZIP: "f al 0 1�- 1 17 2 3 Q Garage/carport area: square feet
Suite/bldg./apt.no.: � Project name: Cp >L5""14. h o. Covered porch area: square feet
Cross street/directions to job site: 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
„Li r
DESCRIPTION OF WORK \ work indicated on this application.
z_Qwta 6- ,.
t G ,l$111 10 4.-E' L0"o4N Ci.i�Fu,C'c Valuation: $
Existing building area: square feet
1M pr eve �C- ,l; tit 1. — � ri-t, ON L Y —
1�.-c. Tl2f{-rz c. - n 6I= ar-t t r-€1 . $1 ti Li New building area: square feet
d PROPERTY OWNER 0';TENANT of Numberof stories:
Name: a ,,i... c.e.....,,, Grid... Type of construction:
Address: Ls6it su-1 '.- . ij PtQcc_
Occupancy groups:
City/State/ZIP:—r;3„.„...4_. 0 9 7 7'4 1 Existing:
Phone:(503) S 1 - q S00 Fax:( )
New:
0 APPLICANT 0 CONTACT PERSON BUILDINGPERMIT FEES*
(Please refer to fee schedule)
Business name: c' _ uw:+ _e -IyhG
ry Structural plan review fee(or deposit): /70.R , sy
Contact name: —r;,,,,.... Le,c S
IFLS plan review fee(if applicable):
Address: c(4 O sar ALd ••P-.V' Si-Vt1.—
T
Total fees due upon application:
City/State/ZIP: Po.v,-i-a-'^r4 0-a_ Cl/2(9
1 Amount received: ®� , 5/
Phone:(6:3) 230,. 12,9 3 I Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail 1
��� �bw1ll�tv✓1,. r�• Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: 12414 lw+pate s Submit two(2)sets of roof plan with connection details
�_t and fire department access,along with the 2010 Oregon
Address: 2.119) Jtj uotorisDive Solar Installation Specialty Code checklist.
City/State/ZIP: Be?VQit hDr- p0`�' Permit Fee(includes plan review
I and administrative fees): $180.00
Phone:(j)3) 2,41, 4?J22 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: •']C'c,17 7 , 42/f
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtain,
within 180 days after it has been accepted as comp!'
*Fee methodology set by Tri-County Building Indust,-
Print name: 041,4(Ae Loor4pks Date:o$',p2. to U4 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling rolz orrlcE i.si. ()NIA
City of Tigard1111q Date/BReceived
Permit No.:
13125 SW Hall Blvd.,Ti ard,OR 97223 Y
g Associated permits:
3 Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
T[G A K D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l cs 'O y/°'
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • U
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: CI ❑ 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ CI
6 Sewer permit. 0 0 ❑
7 Water district approval. ❑ ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 ❑
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 ❑ 0 ❑
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 0 ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 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 0 ❑ ❑
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 ❑ ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ 0 ❑
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 a 9 ilicable to the s 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". ❑ ❑ ❑
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. ❑ ❑ 0
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 0 ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
kABuiand protection measures must be drawn to scale and must include the project arborist's signature of approval.
A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ CI
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.
lding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13611 SW TRACY PL, TIGARD, OR, 97223 May 18, 2017 at 9:25:48 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00308
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Work not started on this permit at this time.
Inspection scheduled in error.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13611 SW TRACY PL, TIGARD, OR, 97223 May 18, 2017 at 9:24:53 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00308
Inspection Type: Inspector:
299 Final inspection David Young
Result:
CNCL
Comments:
Work not started on this permit at this time.
Inspection scheduled in error.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13611 SW TRACY PL, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2016-00308
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor