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Permit (188) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT : = Request for Permit Action 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 ,ity Staff Check(✓)one REFUND OR Name: PiZ 0 COt--/ / "i "'"' S 71.,.Vi c INVOICE TO: (Business or Individual) ./'U E_ !moo 774 Mailing Address: 4= 033 6 /5- .4-f�>✓. /.,=- ,2 3 ., City/State/Zip: SE- 6J.4- 9,/,.2. / Phone No.: 0 — ..S-p CO L/ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANC VOID PERMIT APPLICATION. qr.—REFUND P IT FEES (attach copy of original receipt and provide explanation below). 7NVZ510E FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: , f7 2-d/7 -p )/�� Site Address or Parcel #: //0 75 S 4..) --' l Project Name: Subdivision Name: Lot #: EXPLANATION: /f c.l�-u C7-70/,.l Or✓ /'/-O.?�Z.-T i/4 it"1-r7 0'I /`=/ o/-1 'V /0 2, o 0 v 7 z) <t' Ili, '/.- ,Ps- 2- -' _e_7 /'‘../ 07/ 7Z/a/1'70-'67J / D/ en'-1 re—E/I Ezd / .,,t1-- -oki,J -tL,/f Z.c JC: D, W/ �,/,33 ,c /. Signature: �'�i�'w r Date: /0 I A3/j Print Name: Agt (- _ n/i , G- - / 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date , Z.V>, B ` Refund Processed: Date lef f3/ 9 By .0 Invoice Processed: Date By Permit Canceled: Date /✓ ,4._ $ -. Parcel Tag Added: Date By I:\Building\Forms\RcgPermitAction_1 518.doc 7 - . TIGARD City of Tigard October 11, 2019 Pro Corn Home Services 2033 6th Ave, #236 Seattle, WA 98121 Re: Permit No. MST2019-00183 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 11075 SW Errol St Project Name: Pierce Job No.: N/A Refund: ® Check#233581 in the amount of$313.81. ❑ Credit card "return" receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: A reduction in the project valuation from $103,000 to $41,812.85 resulted in a reduction of plan review fees. Refund difference of$313.81. If you have any questions,please contact me at 503.718.2430. Sincerel , Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • lard, Oregon 97223 • 503.639.4171 I:\Building\Refunds\Administr T r e nd-0 y. 0 7 � e ay: 5 .� 4. //2 • www.tigard-or.gov 41111111111111111111.1 City of Tigard T(GARD 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: Pro Com Home Services DATE: 10/4/2019 2033 6th Ave #236 Seattle, WA 98121 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 423374 Case#: MST2019-00183 Date: 5/8/2019 Address/Parcel: 11075 SW Errol St Pay Method: CreditCard Project Name: Pierce EXPLANATION: A reduction in the project valuation resulted in a reduction of plan review fees. Refund difference of$313.81. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Plan Review 230-0000-43106 $313.81 TOTAL REFUND: $313.81 APPROVALS: SIGNATU E D TE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: P/D 7/.3/ By: -'. C I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 4 13125 SW Hall Blvd.,Tigard OR 97223 III 503.639.4171 TIGARD Project Name: Pierce Site Address: 11075 SW ERROL ST Receipt Number: 436100 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00183 $-313.81 Total: $-313.81 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 233581 DHOWSE 08/27/2021 $-313.81 Payor: Pro Corn Home Services Total Payments: $-313.81 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD RECEIPT III13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TECAId.D Project Name: Pierce Site Address: 11075 SW ERROL ST ' /241 /k/ L Receipt Number: 423374 - 05/08/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00183 Plan Review 230-0000-43106 $730.65 Total: $730.65 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6837G JDRINKWATER 05/08/2019 $730.65 Payor: Joe Rotta Total Payments: $730.65 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD71 FEE AND PAYMENT HISTORY 1 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TI,C,'AFR.I? MST2019-00183 - 11075 SW ERROL ST, TIGARD, OR 97223 Pierce Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due 12% State Surcharge-Building 100-0000-24001 $76.95 $76.95 $76.95 5/20/2019 Credit Card 423585 $0.00 Building Misc Fund (copies/prints) 230-0000-45319 $12.00 $12.00 $12.00 7/18/2019 Credit Card 424773 $0.00 Building Permit-Additions,Alterations, 230-0000-43104 $641.29 $641.29 $641.29 5/20/2019 Credit Card 423585 $0.00 Demolition DC Provision Review, SF-Ping 1 00-0000-431 1 2 $98.00 $98.00 $98.00 5/20/2019 Credit Card 423585 $0.00 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $10.50 $10.50 $10.50 5/20/2019 Credit Card 423585 $0.00 11x17) Investigation Building 12% State 100-0000-24001 $10.80 $10.80 $10.80 9/30/2019 Credit Card 426137 $0.00 Surcharge Investigation Fee 230-0000-43102 $90.00 $90.00 $90.00 8/24/2019 Credit Card 425432 $0.00 Investigation Fee 230-0000-43104 $90.00 $90.00 $90.00 9/30/2019 Credit Card 426137 $0.00 Investigation Fee 230-0000-43102 $90.00 $90.00 $90.00 9/30/2019 Credit Card 426137 $0.00 Investigation Mechanical 12%State 100-0000-24001 $10.80 $10.80 $10.80 8/24/2019 Credit Card 425432 $0.00 Surcharge Investigation Mechanical 12%State 100-0000-24001 $10.80 $10.80 $10.80 9/30/2019 Credit Card 426137 $0.00 Surcharge Plan Review 230-0000-43106 $730.65 $730.65 $730.65 5/8/2019 Credit Card 423374 $0.00 Plan Review 230-0000-43106 $-313.81 $0.00 Tig-Tual School CET-Residential 230-0000-24102 458.90 $458.90 $458.90 5/20/2019 Credit Card 423585 $0.00 Totals for Fees $2,016.88 $2,330.69 $2,330.69 $-313.81 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 425432 Credit Card anonymous 08/24/2019 $100.80 424773 Credit Card Joseph Rotta 07/18/2019 $12.00 423585 Credit Card Joe Rotta, Pro.Com 05/20/2019 $1,285.64 426137 Credit Card Shane Berney/Pro.com 09/30/2019 $201.60 423374 Credit Card Joe Rotta 05/08/2019 $730.65 Total Payments: $2,330.69 Balance Due: $0.00 .Building Permit Application U C : r�1 Residential �? ^ Q MAY 8 `019 EEiew ' t, 0`,_�` R3 ! 13125SWHallBlvdTigard,OR 97223 I / , 1 0 P i Phone: 503.718.2439 Fax: 503.598.1(�( r I' s•. r•!,,3 Date/B : rj i Other Permit: LQi ii 1Y.li'f1 �+. 1 1 G n R l� Inspection Line: 503.639.4175 Date Ready/By: / Jur s H see Page 2 for Internet: www.tigard-or.gov Notified/Meth : ( f? Supplemental Information TYPE OF WORK • errs*are based on the value of the work performed.Indicate nearest dollar)of all equipment,materials,labor,overhead,and the ❑New construction ❑Demolition on this application. Q El Addition/alteration/replacement ❑Other: ti I I U t D- CATEGORY.OF CONSTRUCTION Valuation: $ -211777 D 1-and 2-family dwelling ElCommercial/industrial Number of bedrooms: ❑Accessory buildingNumber of bathrooms: ❑Multi-family ElMaster builder ❑Other: Total number of floors: JOB SITE INFORMATION AND LOCATION New dwelling area: 353 square feet Job site address: 11075 SW Errol Garage/carport area: square feet City/State/ZIP:97223 Covered porch area: square feet Suite/bldg./apt.no.: I Project name:Pierce Residence Addition Deck area: square feet Cross street/directions to job site: Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CH Permit fees*are based on the value of the work performed.Indicat nearest dollar)of all equipment,materials,labor,overhead,and the Subdivision:Echo Heights I Lot no.: on this application. Tax map/parcel no.:W259156 Valuation: $ DESCRIPTION OF WORK ,�. �2� I �D AL J�jx � Existing building area: square feet L,,. c '\_ New building area: square feet 0,1( ? i OM '1 O 5(1( Number of stories : Type of construction: ❑ PROPERTY OWNER I ❑ TENANT (� , ��/ /Jr r Occupancy groups: Name: Y i!� /- Address: Existing: City/State/ZIP: New: Phone: BUILDING PERMIT FEES* ( ) Fax:( ) (Please refer to fee schedule) zi APPLICANT R CONTACT PERSON Structural plan review fee(or deposit): Business name: 1:12 Q . COM f g' S�''?,i,rf C c FLS plan review fee(if applicable): Contact name: O 0 - Total fees due upon application: Address: Zo3,3 v e `A+ ) .4:t2..S Amount received: City/State/LIP: S, `‘ -l (Z l PHOTOVOLTAIC SOLAR PANEL SYSTEM Phone: � � —d0 I Fax::( ) Commercial and residential prescriptive installation of E-mail: jV� 0 v f ul/ ' 1 P P roof-top mounted Photovoltaic Solar Panel System. Submit two(2)sets of roof plan with connection details CONTRACTOR and fire department access,along with the 2010 Oregon Business name: S.4,iyi .q S ty Solar Installation Specialty Code checklist. Permit Fee(includes plan review Address: and administrative fees): City/State/ZIP: State surcharge(12%of permit fee): Phone:( ) Fa ( ) Total fee due upon application: CCB lie.: 224 225 /4 7 This permit application expires if a permit is not obtained ii within 180 days after it has been accepted as complete. Authorized signature: *Fee methodology set by Tri-County Building Industry Service Board. Print name: OE I- T1-A G/Ci Date:5_ —'q REQUIRED DATA: 1-AND 2-FAMILY DWELLING I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2019-00183 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/20/2019 Ti 9 Parcel: 2S103ACO2800 Jurisdiction: Tigard Site address: 11075 SW ERROL ST Subdivision: None Lot: None Project: Pierce Project Description: Converting existing bedroom to a bathroom and adjoining addition of 353 sf to include bedroom and closet for a master suite. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 353 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 12 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 353 sf Value: $41,812.85 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: ALT SF 353 Owner: Contractor: PIERCE,DARREN F REVOCABLE LIVIN PRO COM HOME SERVICES Required Items and Reports(Conditions) PIERCE,AMY J REVOCABLE 2033 6TH AVENUE STE 236 LIVING TRUS SEATTLE,WA 98121 11075 SW ERROL ST TIGARD,OR 97223 PHONE: PHONE: 206-429-8327 FAX: Total Fees: $2,016.29 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 Notificatio Center. Those rules are set forth in OAR 952-001-0010 thr••• OA' • -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 32.1987 or 1.800.332.2i 4 / 11,11rsp Issued B,. ,r Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. Pl / „^ This permit card shall be kept in a conspicuous place on the job site until completion of the projectt.—�(/,' — 42v4 Approved plans arg required on the job site at the time of each Inspertion_ „Building Permit Application ' ` ° Residential ��, �{ 2019 City of Tigard Received sr— O15 reel't3 DateB • 13125 SW Hall Blvd.,Tigard,OR 97223E Plan Review ' li _ Phone: 503.718.2439 Fax: 503.598.1 60 Date/By: A?iI4- Other Permit: r, T t G R D Inspection Line: 503.639.4175 Date ReadyBy: / Jur s: H See Page 2 for Internet: www.tigard-or.gov NotiSed Meth /�� Supplemental Information TYPE OF WORK ermit ees*are based on the value of the work performed.Indicate the nearest dollar)of all equipment,materials,labor,overhead,and the pro ❑N New construction ❑Demolition on this application. (�Addition/alteration/replacement ❑Other: 4 I � v t CATEGORY OF CONSTRUCTION Valuation: $..-14147777)17. ®1-and 2-family dwelling ElCommercial/industrial Number of bedrooms: El Accessorybuilding g ❑Multi-family Number of bathrooms: ❑Master builder ❑Other: Total number of floors: I JOB SITE INFORMATION AND LOCATION New dwelling area: 353 square feet Job site address:11075 SW Errol Garage/carport area: square feet City/State/ZIP:97223 Covered porch area: square feet Suite/bldg./apt.no.: I Project name:Pierce Residence Addition Deck area: square feet Cross street/directions to job site: Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECI Permit fees*are based on the value of the work performed.Indicate the nearest dollar)of all equipment,materials,labor,overhead,and the pro Subdivision:Echo Heights I Lot no.: on this application. Tax map/parcel no.:W259156 Valuation: $ DESCRIPTION OF WORK Existing building area: square feet c i p-0, --1-- 6k1 G b L 15)so New building area: square feet �” ''V – MNumber of stories: Type of construction: 0 PROPERTY OWNER I n 0 TENANT Name: DARE M { 4� /� Occupancy groups: Address: `�q T Existing: City/State/ZIP: New: Fax: BUILDING PERMIT FEES* Phone: ( ) ( ) (Please refer to fee schedule) MAPPLICANT �=® CONTACT PERSON Structural plan review fee(or deposit): Business name: 1:3)20 . CVM FLS plan review fee(if applicable): Contact name: f.170£ 6 c..1.77-121-- Total fees due upon application: Address: 2,033o33 ~ 4 UE $f2! Amount received: City/State/ZIP: e,/4T a ligi 1 c5(Z ( PHOTOVOLTAIC SOLAR PANEL SYSTEM FE Phone:( 2) Dil —06%7 I Fax: :( ) Commercial and residential prescriptive installation of roof-topmounted PhotoVoltaic Solar Panel System. E-mail: //..,,g (� �M y V , Submit two(2)sets of roof plan with connection details CONTRACTOR and fire department access,along with the 2010 Oregon Business name: S�fj1 A C "7 Itil.t Solar Installation Specialty Code checklist. Permit Fee(includes plan review Address: and administrative fees): City/State/ZIP: State surcharge(12%of permit fee): Phone:( ) Fa ( ) Total fee due upon application: CCB lie.: 2 24' 225 /477)-1 C 7 1 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: *Fee methodology set by Tri-County Building Industry 4,:„- Service Board. Print name: C) 019A Gj ---Date:5.-g -1q REQUIRED DATA:1-AND 2-FAMILY DWELLING I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) • . Building Permit Application Checklist One- and Two-Family Dwelling Cityof Tigard Received g Date/By: Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 _ Phone: 503.718.2439 Fax: 503.598.1960 Associated perniits: i 1 C`AR D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing 111Mechanical Internet: www.tigard-or.gov 0 Other: 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ N 3 Verification of approved plat/lot. 0 ❑ 4 Fire district approval required. Name of district: • ❑ 0 H 5 Septic system permit or authorization for remodel. Existing system capacity . 6 Sewer permit. ❑ 0 ❑ 7 Water district approval. ❑ • ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 9 Erosion control 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of ❑ ❑ ❑ catch-basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state I ❑ ❑ 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 Eg ❑ El 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 ® ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® ❑ ❑ 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- ® ❑ ❑ 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. ® El ❑ 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- ® ❑ ❑ 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 ® ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. El Alk 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 licable to theproject 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. ❑ El 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. R 0 ID 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. El 27 "Drawn to scale"indicates standard architect or engineer scale. 0 ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ Cl ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ El 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 I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) 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) City of Tigard IIII u COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R D Building Permit Review — Residential M Building Permit #: 44ST�a M- G0C�� Site Address: #07c— Cu) . i / -,g7— Project Name: Piet -j ',/,717:;:a_e /9,44-AOLot #: (New dwelling=subdivision name;Aon or Alteration last name of owner) Planning Review knIA-L__Prozpai sal: •9/r11'/Un-- CMY r -exit.h. ' LJ Verify address/suite#active in Accela. n River Terr ce: 4:1 o ❑ Yes,River Terrace Review Addendum Sit lan Elements: .sion Control 4Copies of site plan on 8-1/2"x 11"or 11 x 17"paper I1,)tained trees with drip line and tree protection measures rawn to scale(standard architect or engineer scale) N. .otprint of new structure(including decks)and FEE rth arrow IT .• 'ty locations&easements(required for new and additions) IaS address,project or subdivision name and lot number n i.ewalk/driveway approach 'plicant information(name and phone number) PI+ . tion: of wells/septic systems IQLo dimensions and building setback dimensions it.�'-et tree size,type and location .. . uare footage of buildings to be demolished 1't --t names II: •.ting structures on site al R er elevations(2'contours if more than 4'differentia,_l)/ 111 At area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes• LNN ervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes Deo Clean Water S *ces—Service Provider Letter(lot platted prior to 9/10/1995): Required: Yes,applicant was notified ❑ No Received: ❑ Yes /No 01(iblic Facilities Improvement(PFI) Permit: Required:aired: ❑ y r1 lie For: Yes,applicant was notified Ll� No ❑ Yes ❑ No,stopintake q PP Pp 41 nd Use Case#: Zoning: ,1�1t C qG t equired Setbacks: Front: Rear: Side: Street Si e: r Garage: 1614)( M Building Height: Max. Height: 3O Actual Height: , N °Landscape Area: % }fit Coverage Max: Entrance ■ Set back no more than 8'from street-facing wall ❑ Parallel to street or of ' degrees or less Windows ❑ trii .... 12%of area of all street-facing facades Garage ❑ Garage door is .e - .'cleat street-facing wall N) ❑ Y-. • No,one of the following is met: ❑ Door extends no more . ' rorn wall and ther- • covered porch extending beyond garage. ❑ Door extends no more than 5'from wa i. there is a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is ❑ 12'or -. ■ 50%or less o :-..e ❑ 60%or less and includes 7 of following: ❑ Covered porch P 'ecessed entrance ❑ Wall offset • ' •.f eave ❑ Roof offset ❑ Fire s '•: - ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gam. •.f ❑ Dormer ��yy ■ -ccent siding �❑ indow trim ❑ Window recess 121 Window projection L. =, cony �1'isual Clearance Wrban Forestryryan 1,411, ensitive Lands: CILid Yes ' No Type: IV onditions met prior to issuance of building permit dpproved �By Planning: . ' Date: _4_01/__ __ 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_022819.docx Building Permit Submittal 7 Original Submittal Date: i Site Plans: # Building Plans: # Building Permit#: . Enter building permit#above. Workflow Routing: R " lanning /F-Engineeringrmit Coordinator Building Workflow Sign-off: ► Sign-off for Pfanning(include notes from planning review) Route Application Documents: 1"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: i By Permit Technician: ` , cidlariglile-a, Date: / / En ineering Review DI ope at building pad: ?} Conditions "Met"prior to issuance of building permit NJ//} Easements (encroachments)per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes il.No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes No re Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: C?1 Approved by Engineering: 0gc- Date: 5. /3. /ff Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved El 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: ❑ Yes N/A Tigard Trans SDC: CI N/A Parks SDC: ❑ Yes Er N/A LIDA ❑ Yes IX-N/A OK to Issue Permit Approved by Permit Coordinator: AT1/4/1° Date: 5 ( 13 k C' I:\Building\Forms\BldgPermitRvw_RES_022819.docx