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Permit (151) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT w Request for Permit Action 1 q D TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-oorr.gca'v' 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 City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) '7��x ///4ti E S"OL GG �7�AL Mailing Address: ///P 7 :? -d o4J d/O J C7 City/State/Zip: E*T- G--(A1 ..J , e 2 70 Phone No.: 6 3 " '/..SS '-S 10-6 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): 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). Permit#: �`' 57 2cd / 9 De 3 7-0— Site Address or Parcel #: /4/3 7O Szt) A-7/S .6 Project Name: C Q 8 y Subdivision Name: Lot#: EXPLANATION: A/6 .e)U 9n OF /' ?Lti t r}Print Date: id/3//mil Print Name: eye..., -" 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 /61 3 '( By rilml ' •.to to Records: Date (p 7 j By 4/ Refund Processed: Date/e5 s /? B„ Invoice Processed: Date By Permit Canceled: Date /�/3/ B i .. arcel Tag Added: Date By I:\Building\Forms\RegPermitAction_12g51 Kdoc CITY OF TIGARD MASTER PERMIT .-- COMMUNITY DEVELOPMENT Permit#: MST2019-00372 TIARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/23/2019 Parcel: 2S104CC05900 Jurisdiction: Tigard Site address: 14370 SW MISTLETOE DR Subdivision: HILLSHIRE WOODS Lot: 3 Project: SCOBY Project Description: Removing cedar roofing and installing new sheathing for a DaVinci shake roof system. 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: $38,500.00 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 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 Ecompasing: N Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 0 Owner: Contractor: SCOBY,JILL _____ APEX HOME SOLUTIONS Required Items and Reports(Conditions) r 14370 SW MISTLETOE DR 1118 MEADOWVIEW CT TIGARD,OR 97223 WEST LINN,OR 97068 PHONE: PHONE: 503-455-5900 FAX: Total Fees: $1,082.57 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 • OAR 952-001-0010 through OAR 952-001-0090. . is.. .ama copy o - es or direct questions to OUNC by calling 503. 32.1987 or 1.800.332.2344. Issued By ,-4Sri � Permittee Signature: -_ II 503.639.4175 by 7:00 a.m.for the next available ins section 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 RECEIVE ► O►2 o i 1 ►( 1: l S l:Z 1 III Cl Of TI and eived y) Tigard a.to/By: chic, 6127- Plan �T- ii c,` '� 13125 SW Hall Blvd.,Tigard,OR 97223 �/J/ S- Plan Revie�`y Phone: 503.718.2439 Fax: 503.598.1960 �,�� �)O Date/By: SII ' ' ' Other Permit: I i G n K D Inspection Line: 503.639.4175 �'�i Date Ready/By: / / u is: Fa See Page 2 for Internet www.tigard-or.gov V I '' o l iGA o ed/Method: (/ �!/ Cj `d��fs Supplemental Information !Jtt nuyG. IlltSl 6 _"TYPE �' VVbRK m REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 N7 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 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 3 `� - al and 2-family dwelling 0 Commercial/industrial �y 5 , ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: i yam"1 b S> yv1 S�kr toe_ 0?"-- New dwelling area: square feet City/State/ZIP: T i c -C..) f QNts I C►-7Z7-3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: 1 \` S(,tr'b' Covered porch area: square feet Cross street/directions to job site: (S,;y\ f`/\b. r pp.'-... (�u(,� 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. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CoESCRIPTION OF WORK work indicated on this application. ),J citac_r_ '(-,,c, �.,_.., . ht-1C/1.,-A.- w,'r'� 11 pm. fm- c�✓x. Valuation: $ V l - 7-rS} - ?n1( n.4., . r/b 61%\n(,0 4-o Rx).,✓ryv,+ Existing building area: square feet — New building area: square feet 191 OPERTY OWNER 0 TENANT Number of stories: Name: ,j \\ St.,okcai Type of construction: Address: 11.4- SI.0 v";54-4-R-+4-e- 'Der- Occupancy groups: City/State/ZIP: 1; Q,` 01'/7-Z3 Existing: - Phone:( '.j j ) -1 Ln -'1 I 0 Fax:( ) — New: 0/APPLICANT EKKONTACT PERSON BUILDING PERMIT FEES* — Business name: Q, 3, )r,�Q„ a (Please refer to fee schedule) Un5 Structural plan review fee(or deposit): Contact name: Lc",-,tv..--• ( c e n S FLS plan review fee(if applicable): Address: )11( r,,,,,,c."Kx,oi%',Zv\.) e; V'i- q Total fees due upon application: f 3 t:S 3c City/State/ZIP: p pp wt.�a- t�-,r,r� � Cly. �_`�'f7tX°' - — Antdurtt iebeived'__ Phone:(az 4t4Z ,=----i--9 Fax..( ) E-mail: , PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* LA,,A,,, tart hw'-,tspdt ,c.. - Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: S(rr.�e., P AJ.7., 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.: a ..)..\-{111 Total fee due upon application: $201.60 J Authorized signature: .....1.---,.../� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Ll„iv JJJ)/U..) �,..51 is Date: 1—,7" i CI *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Pernuts\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling I O R O l l l( r. 1 0\1 l City of Tigard Receiv d Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: _ Phone: 503.718.2439 Fax: 503.598.1960 IN24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical 1 G ii D Internet: www.tigard-or.gov ❑ Other: TILE FOLLOWING ITE11S :ARE REQUIRED FOR PLAN REVIEW 't's yo v'v 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 8 0 • 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 3 Verification of approved plat/lot. . 0 0 . A 4 Fire district approval required. Name of district: 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 0 7 Water district approval. 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 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 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 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 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 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 I,licable to the .ro'ect under review. JURISDICTIONAL L 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". 0 0 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. A A2Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. H 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 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) a t . TIGARD City of Tigard October 11, 2019 Apex Home Solutions 1118 Meadowview St West Linn, OR 97068 Re: Permit No. MST2019-00372 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 14370 SW Mistletoe Dr Project Name: Scoby Job No.: N/A Refund Method: ® Check#233528 in the amount of$1,082.57. ❑ Credit card"return" receipt in the amount of$ 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 not required for residential re-roof project. Refund 100% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 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 III City of Tigard T[G A RD 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: Apex Home Solutions DATE: 10/4/2019 1118 Meadowview St West Linn, OR 97068 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 425888,425970,425972 Case#: MST2019-00372 Date: 9/18/2019, 9/23/2019 Address/Parcel: 14370 SW Mistletoe Dr Pay Method: CreditCard Project Name: Scoby EXPLANATION: Per was not required for residential reroof. Refund 100%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Building Permit Fee 230-0000-43104 $608.23 12%State Surcharge 100-0000-24001 72.99 Plan Review 230-0000-43106 395.35 Info Process/Archive Fee 230-0000-43135 6.00 TOTAL REFUND: $1,082.57 APPROVALS: SIGNAT RES/DATE: 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: ,: ..� ;� ,;:)_/ By: ,:..!` ;'' I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT II - I 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TfGA it.D Project Name: SCOBY Site Address: 14370 SW MISTLETOE DR Fu_�� Receipt Number: 436102 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00372 $-395.35 Total: $-395.35 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 233528 DHOWSE 08/27/2021 $-395.35 Payor: Apex Home Solutions Total Payments: $-395.35 Balance Due: $395.35 CITY OF TIGARD RECEIPT i g • 13125 SW Hall Blvd.,Tigard OR 97223 - - 503.639.4171 T I(;.A R.JD Project Name: SCOBY Site Address: 14370 SW MISTLETOE DR Q/2-/tf-/ Receipt Number: 425888 - 09/18/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00372 Plan Review 230-0000-43106 /D d go $395.35-ec-- Total: $395.35 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 00923G BTAGGART 09/18/2019 $395.35 Payor: Landon Coggins/Apex Home Solutions Total Payments: $395.35 Balance Due: $0.00 Page 1 of 1 IN CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: SCOBY Site Address: 14370 SW MISTLETOE DR - A_Ai6 Receipt Number: 436103 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00372 $-395.35 Total: $-395.35 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 233528 DHOWSE 08/27/2021 $-395.35 Payor: Apex Home Solutions Total Payments: $-395.35 Balance Due: $790.70 Panes 1 of 1 CITY OF TIGARD1111 RECEIPT .i> 13125 SW Hall Blvd.,Tigard OR 97223 - 503.639.4171 TIGARD Project Name: SCOBY Site Address: 14370 SW MISTLETOE DR vi /6-/A/4 (— Receipt Number: 425970 - 09/23/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00372 Building Permit-Additions,Alterations, 230-0000-43104 /Gf'D 76 $395.35 4-- Demolition Total: $395.35 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 07842G BTAGGART 09/23/2019 $395.35 Payor: Landon Goggins/Apex Home Solutions Total Payments: $395.35 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD RECEIPT :1111 * 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 -WARD Project Name: SCOBY Site Address: 14370 SW MISTLETOE DR Receipt Number: 436104 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00372 $-291.87 Total: $-291.87 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 233528 DHOWSE 08/27/2021 $-291.87 Payor: Apex Home Solutions Total Payments: $-291.87 Balance Due: $1,082.57 Page 1 of 1 111111 CITY OF TIGARD RECEIPT .. 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: SCOBY Site Address: 14370 SW MISTLETOE DR Dk/ �/ ,11/41/-g L_. Receipt Number: 425972 - 09/23/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00372 Building Permit-Additions,Alterations, 230-0000-43104 (Iry C7e $212.88 <`J Demolition MST2019-00372 12%State Surcharge-Building 100-0000-24001 it $72.99 4---- MST2019-00372 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 ri $6.00 ,÷- 11x17) Total: $291.87 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 06833G BTAGGART 09/23/2019 $291.87 Payor: Landon Coggins/Apex Home Solutions Total Payments: $291.87 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD FEE AND PAYMENT HISTORY lig 2 - q 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD MST2019-00372 - 14370 SW MISTLETOE DR, TIGARD, OR 97223 SCOBY Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due 12%State Surcharge-Building 100-0000-24001 $72.99 $72.99 $72.99 9/23/2019 Credit Card 425972 $0.00 Building Permit-Additions,Alterations, 230-0000-43104 $608.23 $608.23 $395.35 9/23/2019 Credit Card 425970 $0.00 Demolition $212.88 9/23/2019 Credit Card 425972 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $6.00 $6.00 $6.00 9/23/2019 Credit Card 425972 $0.00 11x17) Plan Review 230-0000-43106 $395.35 $395.35 $395.35 9/18/2019 Credit Card 425888 $0.00 Totals for Fees $1,082.57 $1,082.57 $1,082.57 $0.00 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 425972 Credit Card Landon Coggins ins/Apex 09/23/2019 P $291.87 Home Solutions 425970 Credit Card Landon Coggins/Apex 09/23/2019 $395.35 Home Solutions 425888 Credit Card Landon Coggins ins/Apex 09/18/2019 p $395.35 Home Solutions Total Payments: $1,082.57 Balance Due: $0.00