Permit Support Document r City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
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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 :4 „ \1,2../ i�
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13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerr&is� fil
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FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
E` 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#: 00005—
Site Address or Parcel#: U4,2.0Z2 gfit)
Project Name: /414G74”. P/ r>,T. SS-
Subdivision Name: Lot#: —
EXPLANATION: A y a -4-,1 5����. �> �' `�f c,„/to
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Signature:
Print Name: Uu//T (1111
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 /aft /4 By ''ll Route to Records: Date If /g B 4g
Refund Processed: Date il/ 4 By, ¢yC. Invoice Processed: Date By
Permit Canceled: Date P/ I/t 9B ,/"' =arcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_1 51 .doc
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Manufactured Dwelling .0 . : ',
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Placement Permit Application FOR OFFICE USE ONLY
City of Tigard Received ^ 1'
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: w l lq /1 Peer: �_(y�- f,�—
Plan Review /' }J�t/ t/(/G O e
11111 I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: �"" (/'
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: 'oris: See Plan Submittal
Internet: www.tigard-or.gov Notified/Method: I Requirements
JOB SITE INFORMATION OWNER INFORMATION
Site Address: } ZQ 1 c ,�c. -c tco,0 Name:
Park Name: (--NC.1 IA ZS t I �fl Ll^ Address:
Subdivision&Lot#: 5 y (�1.- (ice)GD IS k k 13 `t gra
Directions}� ` to inspection site: City: tA� - o�3�A�d I Statedp_ I ZIPq a
�W`f \ l �C'��s�^l hN o � Phone:q(3 c "1 iI , I Fax: -I
Is property inside city limits? I Yes 0 No E-mail: fVic [C...„, , Cjoi.1^tj7 ___uJ Vit 1 ec,,, ,
LOCAL GOVERNMENT APPROVALS
Zoning Sanitation
Signature: Signature:
Jurisdiction: Jurisdiction:
Date: Date:
MANUFACTURED DWELLING PLACEMENT PERMIT FEES
Cost(each) No.of Sum
(1) Installation/re-inspection Items
(a) Placement(includes placement,electrical feeder,30'of water/sewer connection). $ 275.50 $
(b) State surcharge at 12%(of placement fee only). $ 33.06 $
(b) Re-inspection(includes inspection and 12%state surcharge)- $ 100.80 $
Placement permit to be obtained only by homeowner,or Oregon-licensed manufactured dwelling installer.
(2) Electrical
(a) Service and/or feeder(new service installation or alteration/relocation of existing service). $ See Electrical Permit Application
Electrical service permit to be obtained only by homeowner performing work or signing supervisor of Oregon-licensed electrical contractor
performing work.
(3) Plumbing
(a) New water service(for services over 30 lineal feet)- $ See Plumbing Permit Application
(b) New sanitation/storm sewer or rain drain(for services over 30 lineal feet). $ See Plumbing Permit Application
Plumbing permit to be obtained only by homeowner performing work or Oregon-licensed plumbing contractor performing work.
(4) Miscellaneous fees
(a) Administrative fee(State of Oregon). $ 30.00 $
(b) System development fees(sewer connection,storm water,parks development&traffic impact). $ See Permit&System Development Fees
SUB-TOTAL $
Name: j Name:
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Address:
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City: � � I State:c� I ZIP: �'Z�" City: f �� C f I State,r I ZIP: } —
Phone: Q 3 x: Phone:ct l� 4 3 . ‘ I Fax: 7
CCB No.: MDI No.: E-Mail:
SKIRTING CONTRACTOR
Name: -7, I hereby certify that the information above is true and correct
1 )? AACG N CO N:'S i k0C,CA.f•N P k All work to be performed shall ,' • accordance with all
JPt*I i governing laws and rule
Address: LIG ' N /l L4 SI f SS:1-: l j
City: " State: ZIP: /6 -(c-/?
Phone: 50,s '-7T G� 1i//' Fax: Authonzed ig .• re Date
CCB No.: / l lMDI/LSI No.: Print Name: Het
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I:\Building\Pennits\SFM-PermitApp.doc 10/16/2014
Building Permit Application
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Plan Submittal Requirements
TIGARD Manufactured Dwelling
1. SITE PLAN-Three (3) copies, fully dimensional and drawn to scale,labeled with:
A. ❑ map&tax lot# ❑ subdivision name ❑ subdivision lot# ❑ site address
❑ zoning ❑ applicant name ❑ phone number
Size requirement: 8-1/2"x 11",to a maximum 11"x 17".
All details listed below shall be incorporated into the site plan:
B. North arrow.
C. "Drawn to scale"indicates standard architect or engineer scale.
D. Footprint of structure,including accessory structures,garage,carport and decks shall reflect actual building
dimensions,including retaining walls.
E. Finished floor elevations,all levels.
F. Garage finished floor elevation.
G. Corner lot elevations. If more than 4 feet elevation differential,plan must show contour lines at 2-foot intervals.
H. Location of all cuts and fills on the lot.
I. Driveway corner elevations.
J. Zoning setbacks (front,side and rear).
K. The location of all public and private easements.
L. The location,termination,and all invert elevations of all drainage piping(sanitary and storm) showing all
elevations necessary to show positive gravity flow to the approved drainage device (i.e.peepholes, storm lateral,
sanitary lateral).
M. Residential driveways,sidewalks will be shown on site plans and will be in accordance with the City of Tigard
standards. Driveway cuts shall not be permitted within 30 feet of intersecting right-of-way lines,nor within 6 feet
of property lines. Weep holes/drain pipes will be installed 6 feet from adjoining property lines. Multiple
driveways on individual parcels of land must have 30 feet of separation;joint-use driveways require a formal
agreement.
N. Show all erosion control devices proposed for site. Contact Clean Water Services (CWS) at 503-681-5113 for
assistance.
0. Show location of existing facilities and new or relocated structures (utilities,well/septic systems,mailboxes,
power poles,water meter,light pole,stop sign,etc.).
P. Indicate property slope directions.
Q. Existing and finished contours when slope in any direction exceeds 20% (additional requirements may apply-see
grading policy).
R. Site plan to include tree size,type and location per approved project street tree plan (if applicable),and City of
Tigard Street Tree List.
S. Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,
driplines,and protection measures must be drawn to scale and must include the project arborist's signature of
approval.
2. BUILDING PLANS-Three (3) full sets for illustrating the manufactured dwelling foundation or basement
construction (no redlines or tape-ons accepted).
Size requirement: up to 24"x 36"maximum, folded into eighths (9"x 12")with the plans inside. No rolled,
reversed or mirrored plans will be accepted.
All details listed below shall be incorporated into the building plans:
A. Scale (architectural or engineering only).
B. Cross sections of the manufactured dwelling foundation or basement(every set of plans shall contain a
minimum of two cross sections at mid-point of each direction).
C. Exterior elevation (all views shall be shown).
D. Basement wall,foundation and retaining wall sections.
E. Documentation by manufacturer indicating that manufactured dwelling roof can support over-framing of
garage roof.
F. Driveway construction.
I:\Building\Permits\SFM-PermitApp.doc 10/16/2014