Permit (33) VCity of Tigard •anCOMMUNITY DEVELOPMENT DEPARTMENT 0 I
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III MI g 7/0/�7 .
Re uest for Permit Action /
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TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 At„z.za&J 4% i L:• a.j
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TO: CITY OF TIGARD
Building Division 1 i.�N 2 2 017
13125 SW Hall Blvd.,Tigard, OR 97223 CITY OF TIGARD
Phone: 503-718-2439 Fax: 503-598-1960 TigardB •;• fittOttvi§ros Qv
FROM: ❑ Owner ❑ Applicant X Contractor ❑ City Staff
Check(V)one
REFUND OR Name:
INVOICE TO: (Business or Individual) a pc.) RA55 '6.-64,,, S a,c.S 11,LJ 5 5�LL
Mailing Address: U , g,y 3 345 Col-,S�
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City/State/Zip: C[ec-CiGG%zvt, 1 og 9 7 O 15
Phone No.: ? `] I - 3---1 5 - q--1(9:7
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
T-- CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: I 1 1 7 J 00 i 6
Site Address or Parcel#: 9/5L, I/et-Do 13 L 61--
Project
flProject Name: '2)09-IL Ci ePa''j C-_
1
Subdivision Name: Lot#:
EXPLANATION: (jS f0-yta-,/ 1i1rt4 C.1.42ca- Le /m('
Signature: - / / ' . . .I...i_i, Date: 62/9e// 7
Print Name: ,5 j.44 RQICS 2 USS 6- L L
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. `/Yr, .3_3 - 90, d1023<P-2
/J , 4,5 - /O � , ��
FOR OFFICE USE ONLY
Route to Sys Admin: Date (p g /7 1 V Route to Records: Date.' Z //- B :j
Refund Processed: Date ' b /7 Byu nvoice Processed: Date By
Permit Canceled: Date 7 0 /, By ; ', Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092 14.doc
.14 C w
TIGARD
City of Tigard
July 26, 2017
S &S Russell Construction
Attn: Sharon Russell
PO Box 3395
Clackamas, OR 97015
Re: Permit No. MSt2017-00152
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9150 SW McDonal St.
Project Name: Burke
Job No.: N/A
Refund Method: ® Check#225434 in the amount of$106.92.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request as the job was cancelled. Refund 80% of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
4 -'4-! , -
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
11111
= City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use,development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable)must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: S&S Russell Construction DATE: 7/6/2017
Attn: Sharon Russell
PO Box 3395 REQUESTED BY: Dianna Howse
Clackamas, OR 97015
TRANSACTION INFORMATION:
Receipt#: 410444 Case#: MST2017-00152
Date: 5/8/2017 Address/Parcel: 9150 SW McDonald St.
Pay Method: CreditCard Project Name: Burke
EXPLANATION: Per applicant's request as job was cancelled. Refund 80%of permit fees.
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Buildin. Permit 230-0000-43104 $95.46
12%State Surchar•e 100-0000-24001 11.46
TOTAL REFUND: $106.92
APPROVALS: SIGI•110 D• TE:
If under$5,000 Professional Staff 4
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
j p s ]fit 1tAV }
Case Refund Processed: I Date: _2/2i/et— I By:
I.\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
11111 14 13125 SW Hail Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: BURKE
Site Address: 9150 SW MCDONALD ST
Receipt Number: 415907 - 03/02/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2017-00152 $-106.92
Total: $-106.92
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 225434 DHOWSE 03/02/2018 $-106.92
Payor: S&S Russell Construction
Total Payments: $-106.92
Balance Due: $106.92
Page 1 of 1
CITY OF TIGARD RECEIPT
>i 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T[ :. AR.I7
Receipt Number: 410444 - 05/08/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2017-00152 Building Permit-Additions,Alterations, 230-0000-43104 $119.33
Demolition
MST2017-00152 12%State Surcharge-Building 100-0000-24001 $14.32
MST2017-00152 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $0.50
11x17)
Total: $134.15
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 508373 BTAGGART 05/08/2017 $134.15
Payor: Sharon Russell/S&S Russell Construction
Total Payments: $134.15
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2017-00152
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/08/2017
T[C1R Parcel: 2S111AB00500
Jurisdiction: Tigard
Site address: 9150 SW MCDONALD ST
Subdivision: ELROSE TERRACE Lot: 1
Project: BURKE
Project Description: Seismic upgrade.
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: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $3,000.00 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 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 add9 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:
ALT SF VB R-3 0
Owner: Contractor:
BURKE,PATRICK M&AGATHA L S&S RUSSELL CONSTRUCTION LLC Required Items and Reports(Conditions)
9150 SW MCDONALD ST PO BOX 3395
TIGARD,OR 97224 CLACKAMAS,OR 97015
PHONE: PHONE: 971-275-4727
FAX:
Total Fees: $211.71
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 rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. • ay ob�of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.,
.
Issued By: i y .�� Permittee Signature: —P Gf
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. i
Building Permit Application
Residential Folz(nil( I sl: 0y1.v
City of Tigard itE(� Received Permit iii 13125 SW Hall Blvd.,Ti ard,OR 97223 `�/ Date/B : •ms7(JjJ�
g Plan ReviewLi. ,1
Ill Phone: 503.718.2439 Fax: 503.598.1960 Date/By: I Other Permit:
l 1 G A R D Inspection Line: 503.639.4175A [j 1 Date Ready/By: / Jur s: I H See Page 2 for
Internet: www.tigard-or.gov �" CINotified/Method: 7 /7 e� ./ Supplemental Information
rit TY OF TIGARD 1t,�1
TYPE OF WOfill REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction .k.i.&DWG DIVISION Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
?rddition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTIONwork indicated on this application.
and 2-family dwelling 0 Commercial/industrial Valuationtc �� $ 3 t!
❑Accessory building 0 Multi-family Number of bedrooms:
1.3 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: q `56 so) C ed 6-,f,
New dwelling area: square feet
City/State/ZIP: ----re-:A,. a„d , 0 g 2„ 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Ll Project name: 6.4„.4,4,,_ 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: 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.
Valuation: $
J �� n Existing building area: square feet
/' New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: 'J '(J(__ �t,t,.t' Type of construction:
Gz% l c
Address: q /5-o 5 p ✓v!G { Occupancy groups:
City/State/ZIP: utia t O % 7,2,..)_. Existing:
Phone:( ) i./ Fax:( )
New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(PBusiness name: S 4- S S�G1 (Ili GL�i review refer("Vacosit):ted
Structural plan fee(or deposit):
Contact name: 1/LC Uh 2L.L.1 5 sp CZ
FLS plan review fee(if applicable):
Address: ,). 0, Zax .33rprJ-
Total fees due upon application: /7 7
G
City/State/ZIP: 63 61_0 i 0 i2 q 7o/5
ct 7l ) 5^ L/ ( ) Amount received: 7'� c--7
Phone:( r� 7 Fax:: V
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
5 1 C-varl (C-2i 5 S Y(J 5 5e-/( CET 7 3I-YU c f j O91 c�?�' Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: < + " (1 j4_,S ) 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 lie.: j 7 5 J,
/ Total fee due upon application: $201.60
Authorized signature* .401 % l2te,/j % � This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1T/gOij /W S5 GL. Date: c— *Fee methodology set by Tri-County Building Industry
J L` / �// / 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 wiz multi. t;sl. ()NIA
City of Tigard Received
Permit No.:, 111 13125 SW Hall Blvd., ard,OR 97223 Associated
permits:
C Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
1 t' R Internet: www.tigard-or.gov
❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1( y° 1,:'
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 • in
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. 0 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 0 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 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 0 0 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 ❑ 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 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 0 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. 0 0 0
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 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 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0
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 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
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 0 0
architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review.
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. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
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, 0 0 0
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)