Permit City of Tigard, Oregon O 13125 SW Hall Blvd. ° Tigard, OR 97223 0:: ; ' F7 °.
9 2 A
Iii
,
October 24, 2008 ° S
Jim Sauble Construction LLC
23405 SW Mountain Home Rd. %1 UUU ��
Sherwood, OR 97140
Re: Permit No. MST2008 -00149
4 i
0
.�
Dear Mr. Sauble:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 14980 SW 96 Ave.
Project Name: Palmer
Job No.: N/A
Refund: ® Check #59936 in the amount of $68.78.
Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: This permit was cancelled at the plans examiner's request as a permit was not
required for this project. Refunded 100% of permit fees on check sent on an earlier date.
If you have any questions please contact me at 503.718.2430.
Sincerely,
_,,-- ) .� .j
Dianna Howse
Building Division Services Supervisor
Enc.
I: \Building\ Refunds \Administ ration \UrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
Building P • . f it • t t lic tion E X 3 1 Ce \ ' ` `
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Residential r y r �3a r an�a d ,� v x d Vi r to �r
..•' . ®\ i ',.a x,.,. lz ' � t+ rr FOR OFFICE, USE ONLY r w ; R y e
1 � 4 � ✓•' K ' V ., :T �� � � f S fi. tt * , s.
CI Of TI and ' , , eived permit No.: y
a 13125 SW Hall Blvd., Tigard, OR 9 ,°,� C', : \
, ` s Er Review I
' : -- O ;i,. Phone: 503.639.4171 Fax: 503.598` 6W� 1Z I ,� ° /gy_ Rea /B • : Juris Other Permit:
Ti ' G A.R,lS Inspection Line: 503.639.4175 tZC,� �� �` t ' a dy y ® See Page 2 for
. .. Internet: www.tigard or.gov ® �� d � 4 N'' fled Method:D Supplemental Information
- TYPE 'OF W ® a � �' , - . _ REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ De Ti io Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
$ 4ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
g 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ G j oOQ
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
. JOB SITE INFORMATION AND LOCATION Total number of floors:
A/ ob site address: t LEq $o -u 9(4 ) 4 - 4 A New dwelling area: square feet
I City /State /ZIP: -"n o� 01 /�� ��`` j„ Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Pan.. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
ty'pttili o F s , Other structure area: p Q,GH square feet 6
REQUIRED DATA: COMMERCIAL- . - . : ((
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: S 11 0 'D D • 70o > � 5 3 D 2 o Indicate the value (rounded to the nearest , and dollar) the profit of o
/ equipment, materials, labor, overhead, and the pfit for the
DESCRIPTION OF WORK ' . . . work indicated on this application.
Valuation: $
#rbb - FR.blt-1- P® it. c.41
Existing building area: square feet
New building area: square feet
PROPERTY OWNER . '❑ ,TENANT Number of stories:
ame: , ems.. PA7 A4I7 Type of construction:
Addre : Occupancy groups:
City /State/ Existing:
Phone: ( ) Fax: ( ) New:
APP LICANT ❑ CONTACT PE
• NOTICE :;, ° . .
Business name: ' .y 103/7 c.5q Lc / „� L �� All contractors and subcontractors are required to be
Contact name:
y (G�' licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail:
CONTRACTOR
Business name: „Tim SS' MA/31Z t a9r, u,ci BUILDING PERMIT FEES*
Address: ;',/ 3O.s �u3 M1" 1J 1 AZ' R, 6 . (Please refer to fee schedule)
City /State /ZIP: Si;----R, Lib D K. �7 1 G Structural plan review fee (or deposit): g ?�'
/ FLS plan review fee (if applicable):
Phone: (S-03) 5 «U - 1 LH 5 Fax: (5 , 3) 6 2 8 07 * g
CCB lic.: 5 1 Total fees due upon application: , --7t
Amount received: &g_ -7
Authorized si nature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: '" ""� o w /� Date: / 0 /, A g * Fee methodology set by Tri- County Building Industry
Service Board.
l: \Building \P its \BUP -RES PermitApp.doc 11/6/07 440- 4613T(I1/02 /COM/WEB)
Building Permit Application Checklist ,
� ', y y`i ,�,, � �' k} t , `r`FOR OFICE USE O
� F NLY k' t ,,�+
One- and Two- Family Dwelling sk
` C of Tigard Received Permit No.:
11/ a' ' - Date /By:
q 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 .Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 r <, , 0 Electrical ❑ Plumbing ❑ Mechanical
.TIAR
_ G D Internet: www.tigard or.gov , , ❑ r:
. Othe
,, �- Q IRED!FOR PLAN ?REVIEW; . }� t » aYes Noy '
I : A
�t�THE FOLLOWINGrITEMS *RRE RE U ;,:; .
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ . ❑ ❑
2 Zoning. Flood plain, solar balance points. seismic soils designation, historic district. etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ 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 ❑ ❑ ❑
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 ❑ ❑ ❑
there is more than a 4 -11. 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. ❑ ❑ ❑
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 ❑ ❑ ❑
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. ❑ ❑ ❑
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 Oregon and shall be shown to be applicable to the p roject under review.
. t . JU RISDICTIONALSPL C I I ICS . y,, ; .,; 3 /s.; ,_ . ', / ,1 . ' , , .1...', 1 , }-, � ■.: ., -, ' { ,,,*..--:,-,t. Y . tya a? ' ', t •
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. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
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 ❑ ❑ ❑
Street Tree List.
29 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.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
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.\ Buildin g\Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T( I I /02 /COM/WEB)
LITY OF TIGARD, OREGON 5 9 9 3 6
Vendor: Jim Sauble Construction LLC Check Date: 10/20/2008
Vendor No:Per00529 Vendor Acct No: Check Amount: $68.78
Invoice Number Date Description Invoice Amount
Refund- Permit 10/15/2008 MST2008- 00149/Palmer 68.78
WLCK85111C WESTERN BUSINESS FORMS & SUPPLIES 360-687 -3203 PRINTED IN U.S.A.
•
• d b r 4_;i
Community Development
Request for Permit Action
Ti I CI A R D?
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor KCit Staff
(check one)
REFUND OR Name: n r
INVOICE TO: (Business or Individual) 73 l i cx l A b'e l o .c� , L LC-
Mailing Address: 231-10 5 aW \oI t \rii n NO■Me ?A
i l k �� 1 • City /State /Zip: Y E? ' l, 0 2 Q 1 1 y 0
////t AGfilf Phone No.: CjO3 5 L A I \ t
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
E CANCEL PERMIT APPLICATION.
51 REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: M3 - V 2002 - c 0 - e `1
Site Address or Parcel #: I Hq C;6 SVJ q LQy h A\J e .
Project Name: PC' drYl P 'S'
Subdivision Name: Lot #:
EXPLANATION: ,^ J eQ k C Qs no t \ 'e c1 1 , ..
Signature: 0C�0.-k. �� OS 1.A.,1) Date: \v ' ' (___)Q')
Print Name: \---nret l e ve 11-c (s
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 811% of the land use application fee for issued permits.
d) not more than 80° /u of the building plan review fec when an application is canceled before any plan review effort has been expended.
e) not more than 80 % of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
+ Ia :m p Y E , C: .4 ' ; 0j0Mi a ✓:I }"� tl >r� r . 4 ^ i t �o- r 'y i t{ SF a F f *. t :
` ".�. iu.. , »�'' _� � IFOROFFIC U SE:'ONLZ'; , �� . r,.. x, sty ....t � ,. s�� P
Rte to S -s Admin: Date B , Rte to Bid. Admin: Date te Z ,ar Bag. •S;
Refund Processed: Date /1 /3 0,f- By air Invoice Processed: Date By
Permit Canceled: Date it ii Ai, B - Parcel Tag Added: Date By
Receipt #Of -199 Date /0/70 Method E,4 � /c__ Amount $
I: \ Building \Forms \RegPermitAction.doc Rev 07/26/07
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
14
T I GARD
October 24, 2008 .
Jim Sauble Construction LLC
23405 SW Mountain Home Rd.
Sherwood, OR 97140
Re: Permit No. MST2008 -00149
Dear Mr. Sauble:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 14980 SW 96 Ave.
Project Name: Palmer
Job No.: N/A .
Refund: ® Check #59936 in the amount of $68.78.
❑ Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: This permit was cancelled at the plans examiner's request as a permit was not
required for this project. Refunded 100% of permit fees on check sent on an earlier date.
If you have any questions please contact me at 503.718.2430.
Sincerely,
"CF4
Dianna Howse
Building Division Services Supervisor
Enc.
I:\ Building\ Refunds\ Administration \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
11 q
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Jim Sauble Construction LLC DATE: October 13, 2008
23405 SW Mountain Home Rd.
Sherwood, OR 97140 REQUESTED BY: Dianna Howse
LS
TRANSACTION INFORMATION:
Receipt #: 2008 -3492 Case #: MST2008 -00149
Date: 10/07/08 Address /Parcel: 14980 SW 96th Ave.
Pay Method: Check Project Name: Palmer
EXPLANATION: Per plans examiner's request as permit was not required for this project. Refund 100%
of plan review fee.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
[BUPPLN] Pln Rv Deposit 245- 0000 - 433000 $68.78
TOTAL REFUND: $68.78
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM '`/ ADMINISTRATION.USE ONLY
Case Refund Processed: I Date: I A D /�D B :
I: \Building \Refunds \RefundRequest.doc 05/23/07
O
l r IL � I.
1 J an IG RD 10113 /2()8 " .
! , 13125 SW Hall Blvd. 8:20: 36AM •
. I Tigard, OR 47223 503.039.4171
TIGA' •6,
Receipt Th 27200800000000003492
Date: 10/07/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MLC200S- 00498 [NIECE!' Permit Fee 245- 0000 - 431010 72.50
MLC2008 -00498 [TAX] 12% State Surcharge 100 -0000- 2070211 8.70
MST2008-00 I 49 [BUPPLN] Pln Rv Deposit 245-0000-433000 68.78
Line Item Total: $149.98
Payments:
i\Iethod Paver User ID Acct./Check No. Approval No. Flow Received Amount Paid
Check JIM SAUBLE CONSTRUCTION BTT 3797 Fax 149.98
LLC.
Payment Total: $149.98
1 +,•i••i I'.112� I , I I
IN = ° Community Development
.
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff
(check one)
REFUND OR Name: 1 Cnr IN VOICE TO: (Business or Individual) 3 im 'JC1lA b \e lc-\ . L LC
Mailing Address: 23140 W 'Mn i cArxi n V\ofne VA
V 0 1 D City /State /Zip: )VneY l A '1 i 02 q `7 1 4 0
/D /aA,f- Phone No.: 0.3 5 y L A I 15
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: m L-T Z o0 R 001 y q
Site Address or Parcel #: i yq 6 SW q 6rt h A\r e
Project Name: t''C-l' Vrfl Q r
Subdivision Name: Lot #:
EXPLANATION: 4^d J eQ k Oo QS nO ` 1T qUt i r
perms -- -
.
Signature: OC-Y.:11-1Z. y1 S )./\,b Date: \(:), ' t ' 0?
Print Name: )--nr0.1 ■ (\ Q )Q , \-9 (S
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date /0 /jy /- B i; Pir -
Refund Processed: Date /4//3 p By Invoice Processed: Date By
Permit Canceled: Date /Q / • :. Byq "- Parcel Tag Added: Date By
Receipt #er -gy9 Date /e 7 of- Method ( Q FVer__ Amount $
I:\ Building \Forms \RegPermtAction.doc Rev 07/26/07