Permit (56) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT 'aj/� Permit MST2016-00410
T I(a A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2016
Parcel: 25111 CA00400
Jurisdiction: Tigard
Site address: 15195 SW 98TH AVE
Subdivision: ALDERBROOK FARM Lot: 10
Project: Nelson
Project Description: Second story dormer addition.Trade permits to be submitted separately. 5/21/2018: REPRINT to
add(3)exhaust fans for(3)bathrooms.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 1 First 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height 26 Bathrooms: 1 Second: 238 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: No
Total: 238 sf Value: $26,810.70 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
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Drains: 0
Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: N Vent Fans: 3 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'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
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3
238
Owner: Contractor:
NELSON,GARY&SANDRA OWNER Required Items and Reports(Conditions)
NELSON,KEVIN ERIC KEVIN NELSON
15671 SW SUMMERFIELD LN 15195 SW 98TH AVE
TIGARD,OR 97224 TIGARD,OR 97224
PHONE: 503-639-9539 PHONE:
FAX:
Total Fees: $1,531.00
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 in OAR
952-001-0010 throuR 9 -001-0.90. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 2.1987 or 1.800.332.2344.
Issued B•: �r�. Permittee Signature: /'Y+ "� �� l`/C n l
Call 503.639.4175 by 7:00 a.m.for the next available inspection 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.
AVEIMechanical Permit Appiicatio CF - l tli: 01 l it I. t 4L oNl.N
City of Tigard Received �, /� '1
Datemy: —C o?/ 1� irk 'emus No . rZ /6—eZ 9?0
13125 SW Hall Blvd.,Tigard,OR 97223 MAY 21 2 018 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
11 i .t R 1 j Inspection Line: 503.639.4175 CITY OF TIGA Iy I) Date Ready/By: Auris: $I See Page 2 for
Internet: www.tigard-or.gov 111E Notified/Method: Supplemental Information
BUILDING DIVISIO .`
TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$100.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description
Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:15195 SW 98th Ave. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard/OR/97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Nelson Duct work 23.32
Cross street/directions to job site:SW corner 98th and Sattler intersection Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
install- exhaust fans in basement and main floor bathrooms (1iYL6 t l fireplace 23.32
/7:44) 7Z) 674-/S 77"1 6 /i EX?- 'V' Log lighter(gas) 23.32
--�� Wood/pellet stove 33.39
/15.70/6, '_O®e'/ 0 Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ePROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Gary,Sandra and Kevin Nelson Range hood/other kitchen
equipment
Address:15195 SW 98th Ave 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Tigard/OR/97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 3 23.32 69.96
Phone:(503)639-9539 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:
Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: �il/6,,,JZ Other:
MECHANICAL PERMIT FEES*
Address: Subtotal 6,cie %
City/State/ZIP: Minimum permit fee($90.00) 9c , Gr--0
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) (C9,tC)
CCB lie.: TOTAL PERMIT FEE f Ca aft)
This permit application expires if a permit is not obtained within 180
�p � ��/f ,� / days after it has been accepted as complete.
Authorized signature: Kiri'"4 vl C'r`� * Fee methodology set by Tri-County Building Industry Service Board
Print name:Gary Nelson ,4%,,e>i'/ 44 NOL gel() Date:5/18/2018 .
1.1Building\Pemtits\MEC_PermitApp 040113doc 440.4617r(ItIO2/COM(WEB)
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2016 00410
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 10/27/2016
TEC '� .L7 9
Parcel: 2S 111 CA00400
Jurisdiction: Tigard
Site address: 15195 SW 98TH AVE
Subdivision: ALDERBROOK FARM Lot: 10
Project: Nelson
Project Description: Second story dormer addition. Trade permits to be submitted separately.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 26 Bathrooms: 1 Second: 238 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: No
Total: 238 sf Value: $60,000.00 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
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0
Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 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
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 238
Owner: Contractor:
NELSON,GARY&SANDRA OWNER Required Items and Reports(Conditions)
NELSON,KEVIN ERIC KEVIN NELSON
15671 SW SUMMERFIELD LN 15195 SW 98TH AVE
TIGARD,OR 97224 TIGARD,OR 97224
PHONE: 503-639-9539 PHONE: f
FAX:
Total Fees: $1,821.31
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 rth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a co of the rules or direct questions to OUNC by calling 503.232.19.800.332.2344
Issued By: r- Permittee Signature: /\-_/---'
1503.639.4175 by 7:00 a.m.for the next available inspect' ate.
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 l OR o►�rlc ►: LSI.o\Lv
City of Tigard k� Received /�
',i Date/By: /I I06
i10 Permit No.:
13125 SW Hall Blvd.,Tigard,OR 9722 .=,, , '" Plan Review
��� ���
■ Phone: 503.718.2439 Fax: 503.5 Other Permit:
1-]G A R I) Inspection Line: 503.639.4175 `t Date/By: ) J n �—
Date Ready/By: Juris: '® gee pa foor ( �
Internet: www.tigard-or.gov �y (�� Notified/Method: l�
m err I Supplemental Information
TYPE OF WORK ` ��aa
\� RE IRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑> t1,itLs `'' - 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 ""
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1-and 2-family dwellingCommercial/industrial Valuation: $ G 4 .�!',,(�
❑ ��`�''((Iv}�
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATTION2
� Total number of floors:
Job site address: ,i� s$ 1.S•10!S S\AI( t ft-1 �Je New dwelling area: 3 ca square feet
City/State/ZIP: Tot �-eS 1 0R. R 9-2 z44 Garage/carport area: S? square feet
Suite/bldg./apt.no.: Project name: Ne,10(0 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.: 2 S 11 ICA0 fir]c6 0 Indicate the value(rounded to the nearest dollar)of all
X/S�KJ equipment,materials,labor,overhead,and the profit for the
DESCRIPTIONOF WORK work indicated on this application.
(t4) GAJ Sf r 4 Pocrrier Valuation: $
eon-26%5 e 1/-•'r<o(' w21 i S 4,6% 2,x,4 110.r Existing building area: square feet
, ciG2 .-Q (N) Ma StPr Se-dr o 0m New building area: square feet
2`PROPERTY OWNER 0 TENANT Number of stories:
Name: Ji 1�
A eA5b,,► Type of construction:
Address: (S(1 c Svi St L irstie Occupancy groups:
City/State/ZIP: T.. *r.c1 Op 41226r
/ ' Existing:
Phone:( ) Fax:( )
New:
er APPLICANT
CONTACT PERSON BUILDING PERMIT FEES*
Business name: Pr- � Cd KSZCd C L ion T�.1 (Please refer to fee schedule)l PM i1 Structural plan review fee(or deposit):
Contact name:Tircg ) [le
Address: po t
O ( / FLS plan review fee(if applicable):
6� 1
City/State/ZIP: l' _ J/ �n 'f9 ^_ - Total fees due upon application: S
Phone:( )Iv_ 6!Z O /Fax::( ) Amount received:
E-mail: pi , et �� r2v�e,.., @ �2c�• C.6 L� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
r 1 CONTRAC OR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name: • Submit two(2)sets of roof plan with connection details
of- 1-1/1/Ci
� C✓
Address: and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
Phone:( ) Fax:( )
and administrative fees):
State surcharge(12%of permit fee): $21.60
CCB lic.:
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 4r_. e. Date: /rip 14. *Fee methodology set by Tri-County Building Industry
Service Board. 1- t)) kO t)
I:\Building\Permits\BUP-RESPermitApp.doc 12/24/2011 440-4613 (11/02/COM/WEB) "
1`443:
Building Permit Application Checklist
One— and Two—Family Dwelling roiz orrice, i.Si. o'l.'
City of Tigard
Received perm0Mechanical
it No.:
Date/By:
UPIC
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960echanica0
T I G A K D Internet: www.tigard-or.gov ❑ Other:
/:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW' lcs \0 1 k❑
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot.
4 Fire district approval required. Name of district: 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0
0 0
0
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ 0 ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc. 0 0 0
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 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. 0 0 0
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size
and location. 0 0 0
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- 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. 0 0
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. 0 0 0
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. 0 0 0
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 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. 0 0 0
20 Manufactured floor/roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances. 0 0 0
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 as,licable to the ,ro'ect under review.
JURISDICTIONAL 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 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. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 00 0
27 "Drawn to scale"indicates standard architect or engineer scale.
0
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. 0 0 0
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-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
r-seArke./kc'"1
Print Name of Permit Applican
ciz-7'i6
nature of Permit Applicant Date
Permit#: /15 72!)//0 064/0
Address: /57f 55- eit - zfr, :����mi%�•
7));Y
/ �i++l�ltulrav�
� r
Issued by: Date: /10-7//6 11
This Copy for Permit Offices
1111
. M
TIGARD
City of Tigard
November 14,2016
Kevin Nelson
15195 SW 98th Ave.
Tigard, OR 97224
Re:Permit No. MST2016-00410
Dear Mr. Nelson:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 15195 SW 98th Ave.
Project Name: Nelson
Job No.: N/A
Refund: ® Check#222923 in the amount of$581.91.
❑ Credit card"return"receipt in the amount of$ .
❑ Trust account"deposit" receipt in the amount of$ .
Notes: A reduction in the project valuation resulted in a reduction of permit fees and a
refund of the difference as follows: Building permit fee $328.76,plan review fee$213.70
and 12% state surcharge$39.45 for a total refund of$581.91.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
I:\Building\Refundl 5 dolialielikrchvela; arai/,ICtuegon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
1111
City of Tigard
Accela Refund Request
TIGARD
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: Kevin Nelson DATE: 11/7/2016
15195 SW 98th Ave.
Tigard, OR 97224 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 406807&407058 Case#: MST2016-00410
Date: 10/13/2016& 10/27/2016 Address/Parcel: 15195 SW 98th Ave.
Pay Method: CreditCard Project Name: Nelson
EXPLANATION: Reduction in project valuation resulted in reduction in permit fees. Refund 100%of the
difference.
`' , *�.S" .ry` Ya4
0 n -t&€ v
Buildin: Permit 230-0000-43104 $328.76
Plan Review 230-0000-43106 213.70
12%State Surchar:e 100-0000-24001 39.45
TOTAL REFUND: $581.91
APPROVALS: SIGN U DTE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
TIDE_l_VIARKzSSS`Y'EM.A:D1vtINT,STIEtAT�ICSN�I�SL�I�N>'J�
Case Refund Processed: Date: /,//d //0, By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
Building Permit Application
ResidentialI OR 01 I I( I I ',l O v l l
City of Tigard \�, Re eived re /, 13 /(Q ,f-- Permit No ).•)f/`L410
II 13125 SW Hall Blvd.,Tigard,OR 972 -ti r a Plan Review 1 l i0
.' Other Permit:
Phone: 503.718.2439 Fax: 503.5 Date/By: ��--) /4 � �1�"C�(`�C S!y�"'j)�
� �e %it i
Inspection line: 503.639.4175 1 1j Date Ready/By: 1 /l ^lo+ri�s-:�. H See Page3 for
Internet: www.tigard-or.gov 1„" ' Notified/Method:/(i (4 P:e.e Supplemental Information
TYPE OF WORK `1�`,
o�+ , ‘0 F'.�E(iuIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 D t �■�y+Ci 1 Permit fees*are based on the value of the work performed.
ISAV) Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 �* equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. ti' L C;it.C-.
Ef 1-and 2-family dwelling 0 Commercial/industrial
Valuation: e (, l .. k 4,7 p
❑Accessory building 0 Multi-family Number of bedrooms: eall
❑Master builder 0 Other: Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors: S
Job site address: New dwelling area* , square feet
�° � 'vials°1 g� °I S f�, �,re
3
i
City/State/ZIP: T 2 r—oS tog ei9 2 7 4 Garage/carport area: square feet
Suite/bldgJapt.no.: Project name: /06130f0 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.: 2 S �.1. 1 OS $ 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.
(N) eba Storm pormf r -
Valuation: S
KirLLC2 rn e... 1,111'1 i O(' W1.'(L e. t4 Pei e 1 r Existing building area:. square feet
Go Cse2 C.2 coy m.ist*, 7t�a d`'K New building area: square feet
]$PROPERTY OWNER El TENANT Number of stories:
Kaidi A Re(
Name: Sb,q 64Qy /✓ELsc'i!��771i:9. Type of construction:
Address: (S('I S W g set lfe Occupancy groups:
City/State/ZIP: T i,.4 0961128 f Existing:
Phone:(AGI 9)924:4-9y/7 Fax:( ) New:
er APPLICANT IV CONTACT PERSON BUILDING PERMIT FEES*
Business name: ' 1�C (Please refer seine+ iik)
�f d r►SZ Cd C� O rl I�G�`T��rt Structural plan review fee(or deposit):
Contact name:7it y ellem7
1! FLS plan review fee applicable):
Address: pa $Ox1 (�V�1
Total fees due upon(if application: S 3. 01
' (,)1
City/State/ZIP:
Phone:(Co�)2C JP6 1 Q Q F c . � Amount received:
Nr3E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Pias rh e�;k rev @ tisla-' C 4CONTRACR .. Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
e�''r 1/11C, Submit
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.: Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: '.:: Date: 11-1114 *Service Board.Fee gYset by Tri County Building Industry
I:\Building\Permits\BUP-RESPennitApp.doc'02/24/2011 440.4613 I/02/COM/WEB) `n� !�
ArJ
1
CITY OF TIGARD MASTER PERMIT
114 I COMMUNITY DEVELOPMENT Permit#: MST2016-00410
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2016
(` '`�i`D9 Parcel: 2S111CA00400
Jurisdiction: Tigard
Site address: 15195 SW 98TH AVE
Subdivision: ALDERBROOK FARM Lot: 10
Project: Nelson
Project Description: Second story dormer addition.Trade permits to be submitted separately.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left 0 Parking Spaces: 0
Height: 26 Bathrooms: 1 Second: 238 sf Garage: 0 sf Front 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: No
Total: 238 sf Value: $60,000.00 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
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temo 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
801-1000 amp: 0 601+amp-1000v: 0
10001-amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener. N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 238
Owner: Contractor: •
NELSON,GARY&SANDRA OWNER Required Items and Reports(Conditions)
NELSON,KEVIN ERIC KEVIN NELSON
15671 SW SUMMERFIELD LN 15195 SW 98TH AVE
TIGARD,OR 97224 TIGARD,OR 97224
PHONE: 503-639-9539 PHONE:
FAX: #7........"4"----*"...---
Total Fees: $1,821.31
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 rth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 .800.332.2344
Issued By: Permittee Signature:
1603.639.4175 by 7:00 a.m.for the next available inspec ate.
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.
1
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325(2))
This statement is required for residential building,electrical, mechanical,and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
F-eviA Ai ellS:V-1
Print Name of Permit Applican
• nature of Pe it Applicant Date
Permit#: /1572/b--etc-)4lO .l,�
Address: /5715— (4/ gar "lfzrt_ 0s 7'..T'`
s .
1' " f, •y•,i'f
Issued by: e`� Date: /d4-7//6
�t"�
This Copy for Permit Offices
Building Permit Application Checklist
One- and Two-Family Dwelling 1 O i< <O i i i( I ( ',i (1\1 v
City of Tigard Received
ll rate/R : Permit No.:
III 13125 SW Hall Blvd.,Tigard,OR 97223 Associated Permits:
= Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov 0 Other:
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 A
3 Verification of approved plat/lot. 0 0
4 Fire district approval required. Name of district: • [] H , R
5 Spic system permit or authorization for remodel. Existing system capacity . ❑
6 Sewer permit. 0 0
7 Water district approval. 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. [� ❑
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 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. ❑ (� []
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 licable to the ro'ect under review.
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. ❑ ❑ Ei26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. Q ❑
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 U 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-RESPetmitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
_ � Transmittal a smittal Letter /
is n k n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.ti rd-or.gov
DTO: 'ECE
I Q
E
( p-yw DATE ' 'CEIVED:
CITYJUL 18 2017DEPT: BUILDING DIVISION BUILDINO`DIGIISRIODNFROM:
COMPANY: PCP/ -i- .- G
PHONE: b3-2 ?0 "---62/2Cl� ryl
1_ l
C'_
RE: /S-/c $ SL+/ l r it 157" i 4/")
(Site Address) 1 ( ermit umber
_�
c7Srh Ave_ IVi.LSr
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING I 14► S:
Copies: Description: Copies: Description:
Additional set(s) of plans. . 3 Revisions: Pormor /Oc4M opt)
Cross section(s)and . ' ails. Wall bracing and/or lateral analysis.
2 Floor/roof framing. a_ Basement and retaining walls.
iL Beam calculatio :. Engineer's calculations.
Other(explain):
REMARKS: 4r)sfci vs .4d"e•ss Por..sr Co rile-42—f6i4C -+.
f en
15e'M /live_ p/arc ) o,,vr PAd.Keelr— 4.,l;i4t/ IiNC../ t�-/,*11r r Amit•
4 5,,a7- 07;v35 (-- •P ( r- ea - n,= G-A4-. ri S� i. �TraarCms
.
FOR OFFICE USE ONLY
Routed to Permit Technici, Date: 7. )3-)) Initials:
Fees Due. Yes E "o Fee Description: IP _ -•
1J4 . 1D) c-,..‘ r-v : $ 9p
$( ) .
$
Special
Instructions: -
Reprint Permit(per PE): ❑ Yes r4 No one
plicant Notified: Date: 7/Ao/I7 ----- ayrre,m,,k- itial6De.b
I:\Building\Fonns\TransmittalLetter-Revisions 061316.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15195 SW 98TH AVE, TIGARD, OR, 97224 January 14, 2019 at
9:26:28 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00410
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - NoCofO
Comments:
Plumbing corrections on separate plumbing permit.
Violation Summary:
Inspector Contractor