Permit Support Document (127) trtir
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Request for Permit Action 36-p ,
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TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • t ig 4or.goP1
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TO: CITY OF TIGARD I0' ?# sY ,
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Building Division
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13125 SW Hall Blvd.,Tigard,OR 97223 lr c° -
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: '1 Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) ,�/ ,4 ..A4//9-A/ /2/2
Mailing Address: (
,,3//,.._5-0 S c'(J t1/'4-C-OZ /so-A/ s z_�A/
City/State/Zip: Oa" G/ti°A,t o- 97 0 C ,
Phone No.: (G.�a,% - 575 - '.9 3_3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
2 CANC /VOID PERMIT APPLICATION.
r/ ND PERMIT FEES (attach copy of original receipt and provide explanation below).
III INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: v-I 57--0-o I e40 -OO 3? 2--
Site Address or Parcel#: 1 1 5 90 `c3e,u IN__o y--i t Tri- r4(.)
Project Name: 42\#9-PP
Subdivision Name: Lot#:
t 1r 1-
EXPLANATION: C Acc /^ (rojc/ . . ' excSr--e•.ccs J
ZSignature: d Date: 9-2 1 ` //
Print Name: 0 f-i 01/4A__r 9
airRefund 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 .'(gMEM,, Route to Records: Date /" B 4/7
Refund Processed: Date /j/7// B 4•=7 Invoice Processed: Date By
Permit Canceled: Date ///7/ . By 4*-' " arcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_09231 .doc
II
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TIGARD
City of Tigard
November 14,2016
Brian Rapp
31650 SW Willow Island Ln.
West Linn, OR 97068
Re: Permit No. MST2016-00372
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11590 SW Lomita Ave
Project Name: Rapp
Job No.: N/A
Refund Method: ® Check#222934 in the amount of$62.05.
❑ Credit card"return"receipt in the amount of$ .
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$ .
Comment(s): Per applicant's request as job was cancelled. Refund 80% of plan review
submittal fee as plan review had not commenced prior to cancellation request.
If you have any questions please contact me at 503.718.2430.
Sincerely,
_____/6: zez47:_c_
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
II " City of Tigard
TIGARD Accela Refund Request
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: Brian Rapp DATE: 11/7/2016
31650 SW Willow Island Ln
West Linn, OR 97068 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 406332 Case#: MST2016-00372
Date: 9/22/2016 Address/Parcel: 11590 SW Lomita Ave
Pay Method: CreditCard Project Name: Rapp
EXPLANATION: Per applicant's request as job was cancelled. Refund 80%of plan review fee as request
was submitted prior to plan review completed.
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Plan Review 230-0000-43106 $62.05
TOTAL REFUND: $62.05
APPROVALS: SIGN T S DATE:
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
'FOR TIDEMARK°SY•STEMADMINISTRATION-USE
Case Refund Processed: Date: /�/�/4, By: „ ;v Y
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
Building Permit Application
Residential I. orrice I SI ON I.1
11111 City of Tigard ti 1 ',ece�s� ,_ , _am. No.:
13125 SW Hall Blvd.,Tigard,OR 97223 k _ J Plan Review
Phone: 503.7182439 Fax: 503.598.1960 Date/B : Other Permit:
1 I G AR') Inspection Line: 503.639.4175 2 Date Ready/By: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: / Supplemental Information
TYPE OF WORIC F 1 O i 1GARD REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0*APING' DIVISION 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 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwelling 0 Commercial/industrial Valuation: $2500
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:11590SW Lomita Ave 1 I 6630 11.SC1Z New dwelling area: square feet
City/State/ZIP:Tigard/OR/97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Back Fence Covered porch area: square feet
Cross street/directions to job site:SW 90`s Ave Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Lomita Terrace Lot no.:10 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:1S135DD03611 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.
Replace old fence with an 8 ft cedar fence with pressure treated posts along the Valuation: $
back property line Existing building area: square feet
New building area: square feet
® PROPERTY OWNER, 0 TENANT Number of stories:
Name:Brian Rapp Type of construction:
Address:31650 SW Willow Island Lane Occupancy groups:
City/State/ZIP:West Linn/OR/97068 Existing:
Phone:(631)455 9233 Fax:( ) New:
i+ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer le fee schedule)
Business name: Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application: t.-77, Z
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:ZRIOS Construction LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:775 NW Autumncreek Way Apt K111 Solar Installation Specialty Code checklist.
City/State/ZIP:Beaverton/OR/97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:201707
Total fee due upon application: $201.60
Authorized signature: ie...,.....,_ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1.l` Date: �� Z2 I l *Fee methodology set by Tri-County Building Industry
1 L1 Service Board.
I:\Building\Permits\BUP-RESPenni kpp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
III e
TIGARD Building Permit Review — Residential
Building Permit #: /1/57,20/6", (505 7
Site Address: [ c 9L) SW 1/01,01-71 kt je'
Project Name: � at Lot #:
(New elllng=subdivision name;Addition or Alteration=last name of owner)
Planning Review v ch
la''4`' / Yp�tQ' &is"hYtj (o • �f' wJ () l`h' - l� cJ_
r JJGG = r
Sirrn e Lor&h.
..Verify site address/suite# exists and active in permit system.
X.Itiver Terrace Neighborhood: No El Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
d hree(3)copies of site plan ❑E 's ' g structures on site
iRSite plan must be on 8-1/2"x 11"or 11 x 17"paper o ' of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) o ele ' ns
►! orth arrow ❑U ' ' locations (required for new,may apply for additions)
N. ite address,project or subdivision name and lot number ❑Tif alio of wells/septic systems
A
U pplicant information(name and phone number) DEM—kin tr o be retained with drip line,and tree
!1I-dimensions and building setback dimensions protec on m asures
N►r:. .t area,building coverage area,percentage of coverage and ❑Street tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) Street names
(0l operty corner elevations(2 foot contour lines if more than
4 foot differential)
‘5c-Clean Water Services—Service Provider Letter of platted prior to 9/10/1995):
l 'Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
\Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was no bified 4No Applied For: ❑ Yes ❑ No,stop intake
El Land Use Case#:
°ning: Lt_S—
❑ Required Setbacks: Front Rear Side Street Side Garage
❑ Landscape Requirement: %
❑ Lot Coverage Maximum:
❑ Building Height: Maximum Height Actual Height
❑ Visual Clearance
❑ Easements
❑ Sensitive Lands: ❑ Yes XNo Type
❑ Urban Forestry Plan
❑ Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: I91 . , j Am Date: 3_11_.Z: (.(✓
Revisions (after Building Submittal! ly) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPennitRvw RES 091216.docx
Building Permit Submittal
Original Submittal Date: 4/94-i
Site Plans: # 3
Building Plans: # I__
Building Permit#: ZEE r building permit above. �
Workflow Routing: Planning LYr;nglneering g.--15e-;mit Coordinator 1�'t3utlding
Workflow Sign-off: off for Planning(include notes from planning review)
Route Application Documents: [ ngineering: (1) copy of permit application, (1) site plan, (1) building plan and
o nal plan review routing form.
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: :�_,0'f,,.. Date: 9bgl/,
Engineering Review
Slope at building pad:
Conditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 1Z-J, Date: ,p --,„e
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 01-0. /A
Tigard Trans SDC: ❑ Yes ►l, N/A
Parks SDC: ❑ Yes 1g N/A
7OK to Issue Permit
Approved by Permit Coordinator: Date: 9/.= V/ L
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
FOOTINGS
All post footings shall bear in solid ground. Bearing conditions shall be verified in the
field by the City during the footing inspection, prior to placement of concrete. Do not
construct footings over utility lines. Call 811 for utility locates before you dig.
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