Permit Support Document 171 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action V 0 1
1 1 G A p n 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov /6/29 ,�
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1.0: 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 10 City Staff
Check(1)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):
4 CANCEL/VOID PERMIT APPLICATION.
5 -IFHtdD PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: M6v20 /4-000 /gy
Site Address or Parcel#: %I/0 6LA) K2_.1-u)/A-JCeo *
Project Name: 4 5P ,0 1-o L-i-e--
Subdivision Name: Q Lot#:
EXPLANATION: AZ-DA1 ,) IJ£LSa.31 FM') r?l't`6 -PtZti,T' / tT 7// - De7/54
�4A.scfit �•liD �e 1Q -lips Pf /TT Hs7p4 'o/s�. , o
Ow1,3 f.L W4- !) clehIsar9TE. Pear-ors, Pc4A,s e ,4-f/,1z,2. i,35l ci oe5 64-,73 Ab .
Signature: _ .0. _, Date: to/.Zg/c.!
Print Name: -a eAg/f_ A---/J/17145/"..1
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
I OR 01 DICE USE ONLY
Route to S s Admin: Date/O�'f12.EMI ,, Route to Records: Date // AT B _.
Refund-Processed: Date/p/79//•f By --,f. 1. 41 Invoice Processed: Date By
Permit Canceled: Date jp/29//51 By b. Parcel Tag Added: Date By
I:\Building\Forms\RegPetmitAction_I 2314.doc
V 0 1 n ielZ9i
Building Permit Application / /
Residential RECEIVED FOR OFFICE USE ONLI
City of Tigard Received / j, 1/�j 5! �!i O�`�
Re
Date/By: C ,,1 �� `'�/ Permit No.: OL 7 L
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
1!lh a Phone: 503.718.2439 Fax: 503.598.141 2 1 2014 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: 7uris. H See Page 2 for
Internet: www.tigard-or.gov CITY OF T1GAR1.0 Notified/Method: Supplemental Information
TYPE c REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
•DA Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
�`' CATEGORY OF CONSTRUCTION work indicated on this application.
1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 2,0) O °
❑Accessory building ❑Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: G 6LI 0 5 td "frn3v)LII S r New dwelling area: square feet
City/State/ZIP: '�`r wy 0 le— 9 223 Garage/carport area: 6;5 square feet
Suite/bldg./apt.no.: "� Project name: j 1e,t/ M Of W ,p Covered porch area square feet
Cross street/directions to job site: �J 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(rotnded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
C, aQ �-. �� �{(4.46/11 n Valuation: $
1��k/t" /1"--e ` '7i ce - Existing building area square feet
Fifer,'e4 L -6c Doti 4 etibf2 5ite 4- e Df4if f j New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: T SfeM L-0 L._LC Type of construction:
Address: PO t,,,?c z--54 3 0 Occupancy groups:
City/State/ZIP: f a r t q 7 it 8 Existing:
Phone:5.3 ) 50 5 5(.9L-(7 Fax:( ) New:
y APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: pc3(.€Vl I, L(�L
i Structural plan review fee(or deposit):
Contact name: 9 c d 'Fixr r(1.. FLS plan review fee(if applicable):
Address: 5 Givv%.L
Total fees due upon application:
City/State/ZIP: Amount received: 4Z
` h ,(
Phone: ) CNA,
Fax::(
)
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: YY` d T--1).4-r-__ E. GCct)goldhf, "kit
Comm: ial and residential prescriptive installation of
CONTRACTOR roof-top m$ ted Photo Voltaic Solar Panel Sys •- .
Business name: 111,-- I ct.,4 . Mewl 1.---14 Submit two(2 - of roof plan with con s= on details
and fire department •• -ss,along w'. i e 2010 Oregon
Address: ( ly 0 iOf I s itf(Y el al - 3 t2 Solar Installation Specia -, -•-• checklist.
Permit Fee(incl • plan re
City/State/ZIP: � ,(j ()5 N�°(o 1 QR- 7 0 5 a • .tministrative fees): $180.00
Phone:(gyp? ) 12(7 ",\ 1 0 ! Fax:( ) State arge(12%of permit fee): $2 .60
CCB lic.: 1 8 9 1 le Total fee due upon appication: $201.60
Authorized signature: PA This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: (N✓(61 1„,rr-,.._ Date:Via l 2i{ i ( *Fee methodology set by Tri-County Building Industry
Service Board
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY"
Received
City of Tigard Received Permit Na
1114 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
a Phone: 503.718.2439 Fax: 503.598.1960
TIGARD
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les 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 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-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 Ore on and shall be shown to be a licable to the project under review.
23 Three(3)site plans are required for Item II 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"buildingplans 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. ❑ ❑ Cl
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.
L\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)