Permit 'City of Tigard, Oregon o 13125 SW Hall Blvd. • Tigard, OR 97223
4T }AR ® 1
April 21, 2008
Varnes
10825 SW Fairhaven Way
Tigard, OR 97223
•
Re: Permit No. BUP2008 -00074
Dear Mr. Varnes:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: , 10825 SW Fairhaven Way
Project Name: Varnes
Job No.: N /Ax
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $56.00.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as the permit was not required (header not replaced). Refund
80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
1: \ Building \ Refunds \ Administration \LtrRefund- CancelPermicdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
I
City of Tigard
T 1 GA RD 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: Alfred Vames DATE: 4/21/08
10825 SW Fairhaven Way
Tigard, OR 97223 REQUESTED BY: Dianna Howsc
TRANSACTION INFORMATION:
Receipt #: 2008 -830 Case #: BUP2008 -00074
Date: 3/13/08 Address /Parcel: 10825 SW Fairhaven Way
Pay Method: CreditCard Project Name: Vames
EXPLANATION: Per applicant's request as permit was not required (did not replace header). Refund
80% of permit fees.
REFUND: IN FORMATI ON:: .
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
[BUILD] Permit Fee 245- 0000 - 432000 $50.00
[TAX] 12% State Surcharge 100- 0000 - 207020 6.00
TOTAL REFUND: $56.00
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager
"//' 9 -2 /- 08
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM: :ADMINISTRATIONUSE:ONLY
Case Refund Processed: I Date: - I ja 1 a e By: I <t
I:\ Building \Refunds \RefundRequest.doc 05/23/07
Community Development
Request for Permit Action RErt VE TIGARD
APR 15 2008
•
TO: CITY OF TIGARD CITY OF TI(3AAD
Building Division Services Coordinator BUILDING DfVISICN
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ES City Staff
(check one)
REFUND OR Name: /
INVOICE TO: (Business or Individual) �/L
Mailing Address: ��
V 0 1 1 City/State /Zip:
Y/ ° C Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
j' 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 #: E k_C ogoo g - co n a/6
Site Address or Parcel #: /3600 c PF /G L 141W/
Project Name:
Subdivision Name: A1/19" Lot #: Aj/j (-
EXPLANATION: _ i T L'2 E./9 Tn /A) & ` r 4 eD - 72 #d T,g 5
/97 L iC/�it/ 7716 eri /94 / &977
__
Signature: , / e _L_L Date: .9 /5 t
Print Name: ' 86$1 E #D19-1-7' SA
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 g B frwirm Rte to Bldg Admin: Date /,2✓ p P B /. -'
. Refund Processed: Date it/ //9- By Invoice Processed: Date By
Permit Canceled: Date $0,2 0, By.657 Parcel Tag Added: Date By
Receipt # Date Method Amount $
.1:\ Building \Forms \RegPermitAction.doc Rev 07/26/07
Community Development
TIGARD Request for Permit Action O
`( '1 Z0N
TO: CITY OF TIGARD
Building Division Services Coordinator C °.��' � � � �' m �I •
13125 S Hall Blvd., Tigard, OR 97223 IBU91b �W L L s �l
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) 4 \ 121v F_ s
Mailing Address: I F 2 S S ha-111_441) A y
VOID City/State /Zip: T /Ga► -�`Z �) q 7 7.23
"/ /�� 4 /9 " -- Phone No.: Se) 7 lo22 — 6 3 /
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
Ce, CANCEL PERMIT APPLICATION.
ral 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 #: P g - <c 79
Site Address or Parcel #: /O g e9 5 d� 1 , 1� �/ ex 609Y
Project Name: V4-2 IJE 5
Subdivision Name: Lot #: xi//j-
EXPLANATION: #6,1/1 4j* &.
Signature: 4221 Date: L 1 1 -- , 7 -e
Print Name: 4- L Y iq.1
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.
c) 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 S s Admin: Date '1 /7 Ord Ejr9J Rte to Bld • Admin: Date m0, - B
Refund Processed: Date 72/ OP By f' Invoice Processed: Date By
Permit Canceled: Date y aw,(� h• By (. Parcel Tag Added: Date By
f
Receipt # J! Date ,Vi/01,f Method C. Amount $ /76 • ( 3
I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07 _ _ _
C ITY OF TIGARD BUILDING PERMIT
!pi II
PERMIT #: BUP2008 -00074
COMMUNITY DEVELOPMENT DATE ISSUED: 3/13/2008
TI GARD . 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103DD - 00420
SITE ADDRESS: 10825 SW FAIRHAVEN WAY ZONING: R -3.5
SUBDIVISION: FAIRHAVEN COURT LOT: 013 JURISDICTION: TIG
PROJECT: VARNES
Project Description: Installing sliding door in place of window.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS. REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,000.00 .
Owner: Contractor:
AL VARNES OWNER
10825 SW FAIRHAVEN WAY
TIGARD, OR 97223
Phone: 503 - 620 - 5231 Contact #:
Reg #:
FEES
Description Date Amount
REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 3/13/2008 $62.50
[BUPPL■] Pln Rv 3/13/2008 $40.63
[TAX] 12% State Surch 3/13/2008 $7.50
Total $110.63
•
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 than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: i . ', _Permittee Signature: ``""— _ (,f..,....)
K -
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 FOR OFFICE USE ONLY
City of Tigard (�� Dat Received eB y: 3 3 it (3 Permit No.: y P��� C�0 I
:� • 13125 SW Hall Blvd., Tigard, OR . tiS Plan Review
Phone: 503.639.4171 Fax: 503. ”8. O% Date/By: Other Permit:
f I G A R D Inspection Line: 503.639 AA p0 1 3 2 4 Date Ready/13y: Juris: ® See Page 2 for
Internet: www.tigard or.gov \V► ARo Notified/Method: Supplemental Information
TYPE OF Of
� �G D,. - - REQUIRED DATA:1- AND 2- FAMILY DWELLING
❑ New construction ino ition 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: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ A
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: k in fS 7.....S 6 W rat P - 4 Pv6/J /AAA" - New dwelling area: square feet
City /State /ZIP: - J7 G A/2,0 1'7 L 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: 3/i a ‘ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 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
DESCRIPTION OF WORK work indicated on this application.
Su.) 1 i C.(-1 /r •i 1) 0 t,J (VG w) G.- In-4- N 61A.) SC../ r-/A/C' Valuation: $
IPOp (L-- ("( FA Pk ( P. • ° vh • SF� 6u is 2 + 31 4 Sr 6 Existing building area: square feet
New building area: square feet
' ❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: 4 L. \41/2,(J(,( Typc of construction:
Address: / - l3<)u C Occupancy groups:
City/State /ZIP: Existing:
Phone: ( a3) (, • . O .. ( t , 3 ) Fax: (S03) (., -Z,t - 51.0 New:
❑ APPLICANT . ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: 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 followg follow reasons
apply: (Da. 5U
Phone: ( ) I Fax:: ( ) 71(9 . 4;3
E -mail: 1, 50
CONTRACTOR _ //0 • 4 3
Business name: AI Varner BUILDING PERMIT FEES*
Address: I 10825 SW Fairhaven Way (Please refer to fee schedule)
City /State/ZIP:
1 igard, OR 97223 Structural plan review fee (or deposit):
C 503 620 - 5231 FLS plan review fee (if applicable):
Phone: ( ) Project name: 3/2008
CCB lie.: Total fees due upon application: HO ,. G
Amount received: //V , 6
Authorized signature: This permit application expires if a permit is not obtained
(� / /' f/21 41......------ within 180 days after it has been accepted as complete.
Print name: - A— t`, VAR"( 6 Date: 3/( 3. i * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02/COM/WEB)
i \ r1 .
Building Permit Application Checklist
•
One- and Two - Family Dwelling FOR OFFICE USE ONLY •
City of Tigard Received
Permit No.:
1 11 1 Date/By: 1 3125 SW H all Blvd., Tigard, OR 97223 Associated permits:
C Phone: 503.639.4171 Fax: 503.598.1960
T I G A k D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard- or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I 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 0 •❑ ❑
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 -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. ❑ ❑ ❑
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 a, a licable to the . ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Five (5) 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 accompanied by 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: Building \Permits\BUP- RES- PemtitApp.doc 03/21/06 440-4613T( I I /02/COM/WEB)
City of Tigard, Oregrn '• 13125 SW Hall Blvd. • Tigard, OR 97223 •
-1
TIGARD
April 21, 2008
Alfred Varnes
10825 SW Fairhaven Way
Tigard, OR 97223
Re: Permit No. BUP2008 -00074
Dear Mr. Varnes:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 10825 SW Fairhaven Way
Project Name: Varnes
Job No.: N /Ax
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $56.00.
• ❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as the permit was not required (header not replaced). Refund
80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
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
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: Alfred Varnes DATE: 4/21/08
10825 SW Fairhaven Way
Tigard, OR 97223 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 2008 -830 Case #: BUP2008 -00074
Date: 3/13/08 Address /Parcel: 10825 SW Fairhaven Way
Pay Method: CreditCard Project Name: Varnes
EXPLANATION: Per applicant's request as permit was not required (did not replace header). Refund
80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount
[BUILD] Permit Fee 245- 0000 - 432000 $50.00
[TAX] 12% State Surcharge 100 - 0000 - 207020 6.00
TOTAL REFUND: $56.00
APPROVALS:
If under $500 Professional Staff 2 If under $7,500 Division Manager /_
J / 9 — / - 08
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 / obi /O e F' By: I S
I:\ Building \Refunds \RefundRequest.doc 05/23/07
,' CITY OF TIGARD 4/21/2008 -
.. _ 1 131?; SW Hall Blvd.
v I I :37:3 4r \Nl
'.r, Tigard, OR 97223 503.639.4171
TIGARD
Refund Receipt #: 27200800000000001325 X6
Date: 04/21/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
BUP2008 -00074 Reversal - [BUILD] Permit Fee 245- 0000 - 432000 (50.00)
BUP2008 -00074 Reversal - [TAX] 12% State Sur 100- 0000 - 207020 (6.00)
Line Item Total: ($56.00)
Refund: -
N•lethod Payer User II) Acct. /Check No. Approval No. Flow Received Amount Paid
Credit Reversal ALFRED VARNES 05599B In Person (56.00)
Refund Total: ($56.00)
U J
o
i t
°' 0
Pets • p a r: a�i o it;
t o a C o Ix v x
3 8 x r
� � o v W C s o cJ
N � s — y . r � y w ki t C� . 6.
V • :7 y U gU .-, fx e, 0 .\ a
. a I
Q H 2 w •• c ' s \ a'
al
x a
rRoxio.rpn I of
pr CITY OF TIGARD 4/17/2008 -
1312; SW Hall Blvd. 2:52:23 PM
Tigard, OR 97223 5113.639.4171
TIGARD
Receipt #: 27200800000000000830
Date: 03/13/2008
Line Items:
Case No Trau Code Description Revenue Account No Amount Paid
BUP200S -00074 [BUILD] Permit Fee 245 -0000- 432000 62.50
BUP2008 -00074 [BUPPLN] Pin Rv 245- 0000 - 433000 40.63
BUP2008 -00074 [TAX] 12% State Surcharge 100 -0000- 207020 7.50
Line Item Total: $110.63
Payments:
Method Payer User ID Acct. /Check No. Approval No. Flow Received Amount Paid
CreditCard ALFRED VARNES BTT 05599B In Person 110.63
Payment Total: $110.63
•
cRccciptrpi Page I oil