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Permit (169) CITY OF TIGARD MASTER PERMIT `Ilk .' COMMUNITY DEVELOPMENT Permit#: MST2019-00115 TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2019 Parcel: 2S 102 B B00300 Jurisdiction: Tigard Site address: 10080 SW KATHERINE ST Subdivision: NORTH TIGARDVILLE ADDITION,AMENDE Lot: 22 Project: PHOU Project Description: Converting carport into garage, repairing kitchen wall, installing new front door, installing sliding door, modifying roof, new deck, reframing closet, framing covered porch, and new siding. 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: 35 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Total: 0 sf Value: $11,950.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 1 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: 1 Garbage Disp: 0 Water Heaters: 1 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: 1 Natural Gas Heat Pump: Y Hoods: 1 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: 1 0-200 amp: 0 W/Svc or Fdr: 15 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: ALT SF 0 Owner: Contractor: PHOU,LYNN OWNER Required Items and Reports(Conditions) ANG,CHOUNG LYNN RHOU 12070 SW 119TH AVE 12070 SW 119TH TIGARD,OR 97223 TIGARD,OR 97223 PHONE: 503-828-7502 PHONE: 503-825-7502 FAX: Total Fees: $1,339.32 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 aremesetts forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232,1987 or 1.800.332.234 �> �.� Issued By: ,....fPermittee Signature: Cal . 9.4175 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 RECEIVED Residential I:OR Oi 1 I I til OyI l APR 0 32019 Received City of Tigard Date/By: 1 ? S ! *59;40/5 0`! 14 • 13125 SW Hall Blvd.,Tigard,OR 97223 ITY OF TIGARD Plan Review ■ Q 9 Other Permit: Phone: 503.718.2439 Fax: 503.598.1 Date/By: j Inspection Line: 503.639.4175 ILDING DIVISION Date ReadyBy. ` 1uas: Fl See Page 2 for 1 R,ARte hr Internet: www.tigard-or.gov tified/Metho Supplemental Information TYPE OF WORK QUIRED DATA:I-AND 2-FAMILY DWELLING 0 New construction 0 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: <-ebrrIC0,1 equipment,materials,labor,overhead,a ,the rop fit f the CATEGORY OF CONSTRUCTION work indicated on this application......,05,g:.Y� qi"��7.) -and 2-family dwelling 0 Commercial/industrialValuation: $ ❑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: t u O 3 0 LO-4,0'10,0____S.i- New dwelling area: j square feet City/State/ZIP: -T-‘ 0,1* i 0 01-1'7 U Garage/carport area: 'a>square feet Suite/bldg./apt.no.: .Project name: Covered porch area: square feet Cross street/directions to job site: 5w t/1 Q_5) Siisj , y 1 ArdS'�" Deck area: t square feet 7'1j 1( Other structure area: 01-64,1‘). { square feet..fz,.;)t, ,:,,j,,,_ 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 DESCRIPTION OF WORK work indicated on this application. �' i Valuation: $ -Li N 3 'AAi !.-0-f ,, �, tx5 J 1 Existing building area: square feet l� -c}�?1V vi i v,_ < t> e,?,)/QTY I , (0,v f?a1i`D v1 J J- i a New building area: square feet Er PROI RTY OWNER ' 6 ❑ TENANT Number of stories: Name: LL y\ti r \),\.-.42)30,.._ Type of construction: Address: 12O 1 0 S`W 1(q f 1--+ Atice, Occupancy groups: City/State/ZIP:i 9,-j, 0p.... I/tt 3 Existing: Phone:(So') ) i,',CZ 1 sol, Fax:( ) New: [r APPLICANT D CONTACT PERSON B!JILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee(or deposit): Contact name: /-.)‘11.1 0., a,,tLr FLS plan review fee(if applicable): Address: t 3 0j w .t,� A 1 22 Total fees due upon application: City/State/ZIP: 1t lnl-) Io(Z Phone:(L (5Z ) $Z' =1 SO2 Fax::( ) Amount received: E-mail: C � ca) Q mai 1 - cow► PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* -" r1 J CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: 06,4)0 Cr 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: tl,`A __ c'\ This permit application expires if a permit is not obtained `��_" within 180 days after it has been accepted as complete. Print name: L *Fee methodology set by Tri-County Building Industry G N 7 � .�� Date: 1-,_ _`� Service Board. I:1Building\Pennits\BUP-RESPennitApp.doc 02/24/2011 440_(-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling IOOR Oil 1( 1 t'' l: 011.1 City of Tigard Received Permit No.: 1111‘ 13125 SW Hall Blvd.,Tigard,OR 97223 Dated C Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: lic,AHI> 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical Internet: www.tigard-or.gov ❑ Other: THE FOLLOW'ING ITEMS ARE REQUIRED FOR PLAN REVIEW 1e 10 V/,1 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 3 Verification of approved plat/lot. 0 ❑ 4 Fire district approval required. Name of district: N'' [V 0 5 Septic system permit or authorization for remodel. Existing system capacity . 0 17.k 0 6 Sewer permit. 0 Cld 0 7 Water district approval. 0 [V 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 Er 0 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 B7 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 Pr 0 0 there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements 1 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 V 0 0 and location. .,/ 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, U 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- EV 0 ❑ l 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. Ud 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 prescriptive path analysis provide specifications and calculations to engineering standards. 0 0 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 0 0 Ltd' systems,see item 22,"Engineer's calculations." L Id 0 0 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. 0 0 Il/,_. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 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 `-b' 0 0 architect licensed in Ore.on and shall be shown to be a.,licable to the .ro'ect under review. JURISDICTION.-U. 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". I11 0 0 24 Two(2)sets each are required for Items 16,19,20 and 22 above. C 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 1P 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. A 0 0 27 "Drawn to scale"indicates standard architect or engineer scale. N _..0 0 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard P 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 tr..— 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 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) Mechanical Permit Application rolt oiF1cE Fsi ONLI • Cl of Tigard 0\1E0 ReceivedBPermit No.: 13125lig Is ,SW Hall Blvd.,Tigard,OR 972 Date/By. Ciirol /1 ©d el y II g Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: Date/By: Tic,A R I) Inspection Line: 503.639.4175 ��R 1Ct a Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov �. yly Notified/Method: Supplemental Information GRO ITY Y'yi N1S . ... . •. TYPE OF ,' tiJ COMMERCIAL FEE* SCHEDULE - USE HECKLIST' Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATE, ,, nOF CONSTRUCTION .. .„ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* BI-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.a ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total :10R SITE INFORMATION A1' OCATION 1,. Heating/cooling: �v��n� Air conditioning 46.75 Job site address: 1 OQ ;0 .r 11 J[i /'(�,S- -' Furnace 100,000 BTU(ducts/vents) 46.75 i City/State/ZIP: t 9 `C) o L g 1 2 2 3 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump I 61.06 Suite/bldg./apt.no.: Project name: p 141/4,L Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 , Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Oth Subdivision: Lot no.: er' 23.32 Other fuel appliances: Tax map/parcel no.: Water heater _ _ 23.32 ,x* '*= ), e, Gas fireplace/insert 33.39 RFCItiPIlON tf WORK,• Flue vent for water heater or gas 400(1 rP IaL4244w -jm jAii f ri'I`J:s! - ) 11 fireplace Log lighter(gas) 23.32 23.32 41W �C '1.>.5 �arA /l� �-= Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 T Other: 23.32 '4".;a,$ .. .. PROPER : IVIMI A •. ti TENANT - ,. •r .,... Environmental exhaust and ventilation: Name: (_td N l pt,e Range hood/other kitchen ., n equipment 1 33.39 Address: teL 07 o SW it yam' 4v ._ Clothes dryer exhaust _ ( 33.39 City/State/ZII': -T 1It 7 �y Single-duct exhaust(bathrooms, � � Q toilet compartments,utility rooms) 23.32 Phone:(S) ) 3 f —75 S U- Fax:( ) A Attic/crawlspace fans 23.32 ;- PPUCANT 1 " fly ,CONTACTN Other: 23.32 Fuel piping: Business name: .J . ..4.1)"1" $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Gas heat pump Address: Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Other: Business name: C•(fi -t/ MECHANICAL PERMIT FEES* Address: Subtotal _ City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) -- Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FE This permit application expires if a permit is not ob ined within 180 Q, u As-- days after it has been accepted as complete. Authorized signature: �� " „- p 1'V • Fee methodology set by Tri-County Building Industry Service Board Print name: Ly N in ?tt b (A Date: L.f.- fat 1:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 s"lwwf rl['t11 Pc merit AnnllcntIOf REcENEMIIIIIIIIMIEMMEIIIIIIIII City of Tigard tg' nets it •IA %j 1 rr ��JtY—r Jil � 11115 SIV 11011 illvd..71104 OR 97123 2[� 2 9 plea Review Retired remake.a �, 501,711/439 APS 1>rteTr: hila-7 -e:. 7�,'' men t. Sit ---1e,.:far Feud: 7ipni►luthebnet"l+twite�Oltgad crt,�tty ewopkre,u,ieternenes I" pu4kctaM►Line: 503.639.4175 Internet DIVu re,or wnxtC PLAN R6YIEW it AdditiOnAdieration/rcl+l tacancrbt 'Meese desk all tht.pply(tulimn Z sets erpte.wroeer eluded)- . New eonsbvnlon O Stroke or feeder 400 saps or news 0 ituitdiee over dies stork,. I chef: where the available kali eleven! O Minims mei boatyards. CATEGORY be,CONSTRUCTION ■ (>wrtnnlition err at w O exceed.10,000 erISO'ohs oe t'loethir bundler. buildingless aan pound.or emcee 14.000 0 Commerciet•use esriceui (]1•and 2.0unlly dwelling 0 ComnurclaVindustriai 0 Accessory Napa for all other hntaMbas. building,. (]Fin pump. O trotatwbmat ISO KVA« • Multi-Candi 0 Master builder ❑Other. O emergency'Went beaersepent/derived JOE SITE INFORMATION AND LOCATION O Addition or new mots bed of0 syste"E".-t.2-,-i-r. Jm. Frifob she addrC$E %0 0130 V,, INV II AL S•1' IOOf1P or inert OSix«mereanldemlelunlit. eco wlxi. r O lkaeb•care facilities. O Recreational ve hick parts ' for more the atsaiSatn+Zir:"i;1, 1 d 22053 O rdnrdow locations. O Supply se ( Project Atone: T Q ko►OtJ1 O Strikee«feeder 600 amps«more. 600monied volts � PEE SCHEDULE Cross street/directions to Job sits 1 on. I Orb 1 Teter 1 • . New residential single-or multi-family dwelling unit. N: Includes attacked arise. a Subdivision: Lot I,000sq A or Ices �� N: Fa.add'1300 sq.R or patio : -© Tax tttp/,. -.1 OIG RK • `•4 Limited wave residential 75.00 •`". tq�CR117ibNi p/O whh above A. III -© r i r ► PG- Limited stagy.multi-Amity 7300 / Q, • R i... - ' residential with above ..R. �. / Renewable En + • r .,': , .,• a,TENANT:;: :` Services or feeders Installed* atteratlo orelocation ► i ;1�rROr6R7Y OWNER EA , ,: 200 sops or less I1 boo bo NO= (.t �'{h �l ��•Q u 201 imps to 400 amps 13336 2 Address: {1010 slit)RA ill 401 amps to600amps 20034 a 2 are stn 1• a J , P Ci 3 t 2.3 601 naps to 1,000 amps P' t 0 Over 1.000 amps or volts 55126 , 2 Phcnac(503)B i S 1 402 Temporary services or feeders iastaladon,alteration,and/or 1- �a?1�71�wvI ,1•)-01411 relocation Entail: . C�adon= lin tit f 59.36 I Owner IostaUadoa• is t ad is being made on property that 1 own which is not 200 amps ortab )25.08 2 Intended for sole,ltd rent,or=change,according to ORS 447,449,670,and 701. 201 amps to 400 amps 168.54 2 Data 401 amps to 399 amps Owns signature: Brandt circuits-new.alteration,or estensios paid .crArru ..'` . . .,,1...---:,•:,-...-0 CONR'ACr:! .N . . A.Foe roc brand circuits with O ' CAFrCj i - above service or feeder fen; (5- 7.42 ')• 2 Business nMtc _ - !e ., each branch circuit B.Fee the branch dreuits without I Cattail namrti r ,, `, ►M savke«fexrda Eery Arlt 3618 Pt Address: 2‘,i 5. -. � (N 1 NCS Eschmdd 1 bnutch circuit dreuit 7.42 _El Ciiy/State ZIP: , L'y q It)N 1 s Miscellaneous(service or feeder not lnelad Exch mawfactured or modular b7.84 2 ?hat G3) c�1_J - �I b dwellin service and/or feeder Ftmllil: t o .e..... .. LA. Reconnect only 67.84 • , %' CONTRACTOR 3'.,' . ... Pump er intaijoa circle, 11 67.84 jiff Business nota.. _,-4/i Sign or outline lighting 67.84 Signal eireuit(s)or litnited-awry Atlttttxs i \ panel,abandon,or extension. 0 see 2 El ty 9 f 17fl ss- Each additional las, .on over allowable in a of the above !S 15Wdllr: �.. /` ,,,,• .,Air .Additional inspection(i hr aim) 66.25/hr � Phone:tri) t; t Investigation(1 ler aim) 90,06/hr _• itj Q industrial plant(1 Iv min) : 78.18J Er �, Email. Jk ' r .e l ti C...tZ�l.t� WEA\- r"itW� inspogiols which oo fee is 90.00/hr • CLU Lk.: l ; ,b Eloctriai Lf1, '(�` -f Suprv.Lic.: � ..-Aa listed K hr min Supwr.inetiddlas lri'r! • k + T r }„7el!'i ELECTRICAL SubtoMIT tEES al: ;� • / - Print giant-'r�.J i a _ a, 4) Date: %s +r I O Phan Review R triad %of - ' fee Authorized signature: , State surcharge(12%ofpamitfee): Z. S • TOTAL)-?mer FEE: .2 31.4-1-s-4,---- Pricer aro. This permit spp sada espi es Ire per.ft Y eel ebedaed maces 150 1)atC{ days sits?k baa baa aotapted sm eewpkre C' "d"�—" • Number of inspections allowed papaya INaea�attaedYlJL_t♦rwrtM_Ra_t�Sbt POI 10144017 Me lairntimeO..ryV6p Scanned by CamScanner Plumbing Permit Application Building Fixtures roR Mil(1- 1_SI 011.1 City Of Tigard Received ` , }� �� Permit No.: )) 1114 u 13125 SW Hall Blvd.,Tigard,OR 9723. ,�� Date/By: rr ��- � � 'y����� { Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: ) ,(, ,,RD. Inspection Line: 503.639.4175APR a y Date Ready/By: -Juris: ® See Page 2 for 7� Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK f TY OF TIGARD FEE* SCHEDULE ❑New construction 51)1169ANG DI !S!ON Forspecial in ormation use checklist. Description Qty. Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-famil y dwellin SFR(2)bath 437.78 g ❑Commercial/industrial ❑Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION ICON AND LOCATION Site utilities: Job site address: L l)o SD -tnTr`�J S+ Catch basin or area drain 18.76`' D 01-7,7_2 Drywell,leach line,or trench drain 18.76 City/State/ZIP: lJl f� Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: .VManufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 f CRI ION OF WORK Backwater valve 12.51 b,v4 n w i ,'n Clothes washer I 25.02 ,1.57.4,),„1 'C ct4tr Dh-Q ) (W V\Q(ii C(OOPS'WC^(Zr) Dishwasher 25.02 Vl� / Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: .4 0--1 4't Y O u Fixture/sewer cap 25.02 1� -1 -ft, nn`, °o nn Floor drain/floor sink/hub 25.02 Address: \/!;a 1 0 S LV I i-Y`�`-C- �r C) Garbage disposal 25.02 City/State/ZIP: `7 1 t l/t J 0 . ('t-)223 Hose bib 25.02 Phone:( 5 ) n "1 Fax: `L�=�S Q Z ( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 rt I a bc1J( Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 1 12.51 1).5 E-mail: Urinal 25.02 CONTRACTOR 7 Water closet 25.02 Water heater ‘ 37.52 3 7.5:1 Business 2 BuscielA Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal `7�t Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: 4 7�Q Li) State surcharge(12%of permit fee) 7 O I Authorized signature: ` TOTAL PERMIT FEE Wil.vd(4,2 Print name: /1./ZSN� )-" ),1� (iL.4 Date: r t h j, q This permit application expires if a permit is not obtained within 180 days � after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 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 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 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. vi k c tit Print Name of Permit Applicant �7 0,2 L., Signature of Permit Applicant Date Permit#: /�)$ 1'v� - 0vv615- •1 ?,111,?, Address: fad 5 11G;.'y ' j24- ���ms; • Issued by: Date: Y/, 1//i This Copy for Permit Offices Clean Water Services File Number CleanWaterr Services 19-000977 Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: Tigard 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): 2S102BB00300 Name: Lynn Yi Phou Company: Address: 10080 Katherine street Site Address: 10080 Katherine street City, State,Zip: tigard,oregon,97223 City,State,Zip: tigard,oregon,97223 Phone/Fax: 5038287502 Nearest Cross Street: sw tigard st E-Mail: choungang@gmail.com 4. Development Activity(check all that apply) 5. Applicant Information • Addition to Single Family Residence(room- deck, arage) Name: Lynn Yi Phou ❑ Lot Line Adjustment ❑ Minor Lan. 'a ition Company: Li Residential Condominium ❑ Commercial Condominium Address: 12070 SW 119th Ave ❑ Residential Subdivision ❑ Commercial Subdivision e;.,0l0 I„+r,,,.,,.,o,,.i.,, ❑ Multi Lot Commercial City, State,Zip: Tigard,OR,97223 Other Phone/Fax: 5038287502 E-Mail: choungang@gmail.com 6. Will the project involve any off-site work? Yes ❑No ❑Unknown Location and description of off-site work working on a deck 7. Additional comments or information that may be needed to understand your project 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 Lynn Yi Phou Print/Type Title ONLINE SUBMITTAL Date 3/26/2019 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 17-05, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,State,and federal law. U 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. U This Service Provider Letter is not valid unless CWS approved site plan(s)are attached. U The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed byDate 3/29/19 2`>50 SW Hillshoro Highw.ry • Hillsboro. Oregon 97123 • Phone_(503)621-5100 • Fax (5(3)681-4439 • www-cleanwnterservices-orq City of Tigard q COMMUNITY DEVELOPMENT DEPARTMENT e T l c a R o Building Permit Review — Residential Building Permit #: fl5��/y— O)«S Site Address: toogo S'./ _,,,,14„,-',,,, .0. Project Name: 1°I ,i Lit.tt Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review i- ``��� + r i N P�royos al: T+f-Pry*64 e.\ ,.1(IV A �I1 j it1 �ri61 �+j fk r nti.,J tI LI t r�i1t rJ ���Aw�") G L 1- An take- r^�Fi i1 r j ily [12 Veriaddress suite#active in Accela. `L�f In River Terrace: [ No ❑ Yes, 7 fy / River Terrace Review Addendum Site lan Elements: rosion Control Pies of site plan on 8-1/2"x 11"or 11 x 17"paper etained trees with drip line and tree protection measures Lid'D :wn to scale(standard architect or engineer scale) fi. .otprint of new structure(including decks)and FEE P .rth arrow e :..tylocations&easements-(required for new and additions) ■' e address,project or subdivision name and lot number WI idewalk/driveway approach 9 pplicant information(name and phone number) 'd'Location of wells/septic systems 475 pt dimensions and building setback dimensions eet tree size,type and location :��,'b re footage of buildings to be demolished C , eet names Li :xtsting structures on site V orner elevations(2'contours if more than 4'differential) pot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes C Io •pervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes ❑No i/ Clean Water yervices—Service Provider Letter(lot platted prior to 9/10/1995): Required: ' Yes,applicant was notified ❑ No Received: [t/ Yes l.! No AA'Public Facilities Improvement(PFI)Permit: Required: ❑ Yes,applicant was notified No AppliedieFor: ❑ Yes CI No,stop intake 6 .nd Use Case#: Lit( "Zoning: )1 Ut equired Setbacks: Front: 3� Rear: V Side: Street Side: Garage: Nor �'�,,r : • ding Height: Max.Height: 4 Actual Height: IA J `, Landscape Area: 2.9 % 1t Lot Coverage Max: ntrance • Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows 1'Minimum 12%of area of all street-facing facades Garage VA'Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met: ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage. ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor. Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer ❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony sual Clearance Til Urban Fores an try nsitive Lands: ❑ Yes Of No Type: 0,/' Conditions met prior toissuanceof buildingpermit ^� L + y �,..„)es: pU �!2( M n1�J1 W C e ail [S ) . (-o 4'ri^^ti� �'4� il�t� :..�1� Il4 �J t ist+''• V.4 1, Ltd' Approved By Planning: A Date: 1-71-1 q Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPermitRvw_RES_022819.docx Building Permit Submittal Original Submittal Date: l/ 31/GJ Site Plans: # Building Plans: ai Building Permit#: er building�permi�t#above. _ Workflow Routing: ,,,,__,,����arming L—ngitieering ermit Coordinator Cr'Suildtng Workflow Sign-off: Cr`Sign-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. [ —li'uilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: i By Permit Technician: �i't,„,�— - Date: 4-gA _......‘.. Engineering Review CVSlope at building pad: ,7„ 0 Q-Conditions "Met"prior to issuance of building permit Q'Easements (encroachments)per engineering conditions of approval and plat [VWater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes [ 'No Assess Water Quantity Fee in-lieu: ❑ Yes Y.-No LIDA Facility on lot: ❑ Yes LV No 2 Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: R"Approved by Engineering: ena 64-f... Date: i/•--/O • 201 `' 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 11 gilding 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: ..CX—SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes CWN/A Tigard Trans SDC: ❑ Yes ck N/A Parks SDC: ❑ Yes CEr N/A 1 LIDA ❑ Yes gi'"N/A OK to Issue Permit Approved by Permit Coordinator: G f( Date: 14110/l (C1 I:\Building\Forms\BldgPermitRvw_RES_022819.docx