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Permit Support Document City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT�� 0 1 0 'PI N FFFF , . Request for Permit Action //,/ie TIGARD 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 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor I—taff "°* Check(1)one 4: REFUND OR Name: 1d INVOICE TO: (Business or Individual) ICA/1/ /1-4/4/44.44 `1 Mailing Address: 21 (,-r 40 Le City/State/Zip: Si1#�VW.,Vr( i c„)/e., q 7/N0 Phone No.: C 5-01) 750•-' I n j PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): [Lam' NCEL/VOID PERMIT APPLICATION. FUND PERMIT FEES (attach copy of original receipt and provide explanation below). 4. ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). -; Permit#: /)),S7-12 )/E<—00 ,j 1s Site Address or Parcel#: /01.0 3 ) gL ) i.)Nf:4I A/ Project Name: ,4^/VQ bra "ol/t,,r ) ,j Subdivision Name: g,m Ser Ltr44,fi L Lot#: ' EXPLANATION: C --i-c.ed .4►-0- ,kv Ivor A,r i, ediNvrhy S /t ei AkezA, i`rd ;:. 4'd e4 ,� . - r ,kra , id t h., 134rA,-i'll it; 0 Signature: i ��_ � _s, Date: f -�r� Print Name: e►P44..td :& , ,e4 ' J Refund Policy ,�J 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 USE ONLY Route to Sys Admin: Date 11 s-h e By z.„--f--, Route to Records: Date„1./...'7/../? By 40-4...rRefund Processed: Date S AO f By ;11,1- Invoice Processed: Date By Permit Canceled: Date-5/4/7/1-"" By i`" Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 1c • •. TIGARD City of Tigard 6/1/2018 John Annand II 21640 SW Lebeau Rd Sherwood, OR 97140 Re: Permit No. MST2018-00119 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 12030 SW Lincoln Ave. . Project Name: Annand Properties Job No.: N/A Refund Method: =/ Check#228637 in the amount of$87.45. ❑ Credit card "return" receipt in the amount of$ 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): Permit was created in error as porch canopy is less than 200 sf and does not require a building permit. Refund 100% of plan review fees paid. If you have any questions please contact me at 503.718.2430. Sincerel , 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 r Building Permit Application V 0 I r .5//f if <f)flie--' Residential r olr c)II ISE s1. O11.1 City of Tigard ,ECEIVE ► .eceived Date/By: /24 �r� 13125 SW Hall Blvd.,Tigard,OR 97223 1 i 3 air- �.J Permit No.: / 621 4.e 71), 11 , IIPlan Review f1 Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: 1 1G r.,R t1 Inspection Line: 503.639.4175 APR 2.4 1018 DateDa Reay.dy/By: Juns: 65 See Page 2 for Internet: www.tigard-or.gov Notified/Method: y Supplemental Information CITY®F TIwt" TYPE OF WO "DesiON REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction 0 Iron Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ►, • .li do i,,,Iteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 1-and 2-family dwelling 0 Commercial/indusal Valuation: $ ' Commercial/industrial ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 2 0 5 Co %` L. 1 N C©L..s..A ,ca,N. £.LL U New dwelling area: square feet City/State/ZIP: "1"I (4.04.%t� I>. ) rLilE 4,1 c N.9,, ass 3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: 1V7Z.3 i"L..,OE.3t. r 1x_®‘,.._1 T' Covered porch area: square feet pa.f2,.,p c.A w.1 la i�`lf Cross street/directions to job site: Deck area: square feet G,Wt. LI A?G.cs L. t.., :AL' E.F.i t.) E.. Other structure area: square feet r Wil. q I s r p ft. 'S`ist e..q R" gr-b..1 %4.-9 R-ej, REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 14,i"..1 ia,g,tZ_L•..1, iti., ® ®.1-1-10K1 Lot no.:a Permit fees*are based on the value of the work performed. Tax map/parcel no.: Z S t e A e, Q Q q 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: $ ip.� fT r_-.t,�gC. G lir....c�e T »s=tC3 ft.—. G p....1© VP."."( deb.. a W ® (to Co 'S 4) ,, f '.i.• 1�b C t=" Au,ICLtE Existing building area: square feet �f ) New building area: square feet ,�y.PROPERTY OWNER 0 TENANT Number of stories: Name:A$..I 0.....1 A,,1....11 p. F'12.tfs LP`E. "-) £cJ, I 1--L L L C Type of construction: Address: 2_l Ca.4-c1 S 10../. E.b tz....4„,, ?+.0 . Occupancy groups: City/State/ZIP:* S t-1 ff.,t2...Wt7d t>j p It....E.ckp Li Existing: 4 ' r i4 Phone:(503 -1 S f� I fb 1 5 Fax:( ) New: I X APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please Business name:j b N e•.1 p, N t`I t.l{i• 1•...1 C.1A+.R-.15 refer rfee schedule) Contact name: J Q. 1,.1 AN. NJ!� Structural plan review fee(or deposit): FLS plan review fee(if applicable): Address: a 1 (ta q-o ,w. or,_'la,1E,^.U [L.c)dab.1:› City/State/ZIP: , ,l ��p®� ) Q �sit_4,14,p..4q.7 144.3 Total fees due upon application: Amount received: Phone: (5t , - b 1 A Ls Fax::( ) E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* (�I.. l�".Vt fi d cl.. 2.c. . o. . c-or'-Ir CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic 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 surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print namS1.4ba, (js.) ..Date: 4- [(.5/€6. *Fee methodology set by Tri-County Building Industry © q � Service Board. I:\Building\Permi'1ts1BBUP R SPe�rmit,�"pp'.doc 02/24 (1p1 10 6 3T(11/02/COM/WEB) 1 City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT ■ T I G A R D Building Permit Review — Residential Building Permit #: "s-7Ajj—e f/i/� Site Address: tLO SO S I L�nt.l1i s Project Name: 5PR 4ciet+d/� Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: 4,,,a.^.4 441\11-- erify site address/suite#exists and activin permit system. [l River Terrace Neighborhood: a No ❑ Yes,See River Terrace Review Addendum Attached Si lan Elements: LI Th ee(3)copies of site plan Existing structures on site - elan must be on 8-1/2"x 11"or 11 x 17"paperotprint of new structure(including decks)with finished Oki rawn to scale(standard architect or engineer scale) I am elevations n orth arrow i►i U ty locations&easements(required for new and additions) Vie address,project or subdivision name and lot number !sidewalk/driveway approach I!Ap elicant information(name and phone number) b, ocation of wells/septic systems i at dimensions and building setback dimensions -es to be retained with drip line,and tree quare footage of buildings to be demolished rotection measures building�coverae ea,percentage of cov- erage and t et tree size,type and location rvtous area applicable if R-7,R-12,R-25&R-40) l treeet names t'`I\ roperty comer elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ■Yes 1►. o 4 foot differential) If es,is a storm water e uality facili shown? ❑Y.. o 4 Clean Water ervices—Service Provider Letter(lot platted prior to 9/10/1995): Required: Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake 11.'! and Use Case#: • Zoning: equired Setbacks: Front IS Rear B' Side 5 Street Side IA Garage 21 E L.ndscape Requirement: 11 of Coverage Maximum: go 0/0 , :uilding Height: Maximum Height art Actual Height TD %A Visual Clearance J� • Sensitive Lands: ❑ Yes ❑ No Type ItTA Urban Forestry Plan `Conditions "Met"prior to issuance of building permit Notes: pproved By Planning: Date: ! _41*,_ 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_061417.docx Building Permit Submittal Original Submittal Date: y j 10K Site Plans: # Building Plans: # Building Permit#: [ —Ener building pe #above. j Workflow Routing: L-$i Hing Engineering 1�1'ermit Coordinator ceding Workflow Sign-off: [+" -off for Planning(include notes from planning review) Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. [ Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: . � �� Date: 0tiji 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: ❑ Yes ❑ No ❑ Final Plat Recorded: E l NOT Approved by Engineering: Date: Notes: ❑ Approved by Engineering: Date: 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 _ ❑ Approved,NOT Released: Date: Notes: 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: ❑ SDC Fees Entered: Wash Co Trans Dev Tax: El Yes ❑ N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes El N/A LIDA El Yes ❑ N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_RES_010118.docx