Permit CITY OF TIGARD MASTER PERMIT
e.
' COMMUNITY DEVELOPMENT Permit#: MST2017-00142
TIGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/02/2017
Parcel: 25104AD03504
Jurisdiction: Tigard
Site address: 12800 SW WALNUT ST
Subdivision: None Lot: None
Project: CULWELL
Project Description: 864 sq. ft. garage addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left 5 Parking Spaces: 0
Height 24 Bathrooms: 0 Second: 0 sf Garage: 864 sf Front: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right 5 Detectors: No
Total: 0 sf Value: $38,560.32 Rear: 15
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
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 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 add9 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 0
Owner: Contractor:
CULWELL,LESLIE D AND SIEVES HOME IMPROVEMENT Required Items and Reports(Conditions)
DIANNA L 16485 SE SUNNYSIDE RD 1 Ersn Cntrl 503-639-4175
12800 SW WALNUT HAPPY VALLEY,OR 97015
TIGARD,OR 97223
PHONE: PHONE: 503-358-4778
FAX:
Total Fees: $1,182.07
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 through OAR 952-001-0090. •u may• _ opy of the rules or direct questions to OUNC by calling 503.232.1987 or 1. 0.33 44.
Issued By: i'/.. ...-..�CG_ —mit_ .Permittee Signature:
mall 503.639.4175 by 7:00 a.m.for the next available inspectio 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
uoR ouiici: t:S1:0 1.1
City of Tigard VE, Received
��� Date/B : 7 /7 Jr, Permit No.: j 7_
;Ph . 13125 SW Hall Blvd.,Tigard,OR 97
I Pl. R-:
Phone: 503.718.2439 Fax: 503.598.1960 p 1 Z 701 Date/B : I 11/1=1:11111 Other Permit:
1 GA K D Inspection Line: 503.639.4175d-or.gh�R Date Ready/By: �I►7Lf//I" � 61 See Page 2 for
Internet: www.tigard-or.govOf N Notified/Method: M Supplemental lnformation
AINIG
TYPE OF 1.D REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 'gl Other: C—A icily_ equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
D 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ ,., 3 Q J 6!0
12 Accessory building ❑Multi-family Number of bedrooms: !sr t�nV v O
It❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: id,800 Sw writ' , S v. New dwelling area: n square feet
City/State/ZIP: 1 ioyl rcj d R 9 73 Garage/carport area: 0i.t square feet
Suite/bldg./apt.no.: Project name: Cuj ,j I ( ,c)tac t n/1JJ't,. Covered porch area: / square feet
Cross street/directions to job site: 1 3 r W �NJ 4a �,).4 fzJ, Deck area: square feet
i
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.: a �t'�J 5C y 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.
R 6�.Jl P--)c'I cb C fa f ter '_. -i-4 h OCLS Valuation: $
J Existing building area: square feet
New building area: square feet
"Er PROPERTY OWNER 0 TENANT Number of stories:
Name: L L_s co I `It Type of construction:
Address: 61 800 s vu 1A.1 ,i�1 fj, � .� Occupancy groups:
City/State/ZIP: Tic.,'...i, (,, 6 / 9 7. ,c
Existing:
Phone:( ) Fax:( )
New:
0 APPLICANT
0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
S t QV IMf,t `M Structural plan review fee(or deposit):
Contact name: S.4gv` C)ZC
FLS plan review fee(if applicable):
Address: /t 1/(KE .SE. _Sv.,Nr.�tc)Z (c)
Total fees due upon application:
City/State/ZIP:
ti Art/ thilie-y CZ (7cLS
Phone:603 ) 3_S Y til 7 X Fax::( ) Amount received:
E-mail: . 4? `O&c K yah CC.CC)1,1PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: s t� {� ��in,_ — !n` Submit two(2)sets of roof plan with connection details
L(t'1 3 V and fire department access,along with the 2010 Oregon
Address: I C y 8S, `SC_ ScNtki_ ,.0 r), Solar Installation Specialty Code checklist.
City/State/ZIP: Ail n 7 k 4/(7 Cie 2,0 tt C Permit Fee(includes plan review $180.00
// and administrative fees):
Phone:(5c ) 3 55-y 7 75 Fax:( )
CCB lic.: State surcharge(12%of permit fee): $21.60
I53S:6t / a7/tcl1
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: .TE- ti a Qc C k Date: *Fee methodology set by Tri-County Building Industry
t Service Board.
I:\Building\Permits\BUP-RESPetmitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One— and Two—Family Dwelling FoR oii icl: L si 011
of Tigard Received Permit No.:
Cityg ss
A 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
TIG A K D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les 1O "i_'
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 0
3 Verification of approved plat/lot. 0 ❑ 0
4 Fire district approval required. Name of district: • 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity0 a
0Q
66 Sewer permit. ❑ El 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ El
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
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
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, El 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- El 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. El ❑ 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
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
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 El 0 El
for four or more appliances. 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 a 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". CI 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
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
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 ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval. CI El 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)
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
1111111
T I G A R D Building Permit Review — Residential
Building Permit #: h51- /' 7 -Cid J/-7
Site Address: , '
Project Name: Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: ' r -
❑,� ^Verify site address/suite#exists and active in permit system.
,River Terrace Neighborhood: in No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
,OThree(3)copies of site plan „DExisting structures on site
❑Site plan must be on 8-1/2"x 11"or 11 x 17"paper }Footprint of new structure(including decks)with finished
rawn to scale(standardrehitect or engineer scale) floor elevations
❑North arrow t UUtility locations (required for new,may apply for additions)
ElSite address,project or subdivision name and lot number t aLocation of wells/septic systems
OApplicant information(name and phone number) L,LlExisting trees to be retained with drip line,and tree
OLot dimensions and building setback dimensions protection measures
;[]Lot area,building coverage area,percentage of coverage and aStreet tree size,type and location
"`impervious area(applicable if R-7,R-12,R-25&R-40) InStreet names
,❑Property corner elevations(2 foot contour lines if more than
4 foot differential)
-❑ .Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified El No Received: ❑, Yes ❑ No
❑ Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified .11 No Applied For: ❑ Yes ❑ No,stop intake
❑ Land Use Case#:
0 Zoning:
,Z Required Setbacks: Front ° Rear Side °' Street Side j ` '; Garage
ID Landscape Requirement: .•
/moo
:❑ Lot Coverage Maximum:
.i"-Building Height s Maximum Height Actual Height 11-1
.:d Visual Clearance
ID Easements
,❑ Sensitive Lands: ❑ Yes 0 No Type
9. Urban Forestry Plan! ,
Conditions "Met"prior to issuance of building permit °•
Notes:
Approved By Planning: 4.e.,1,4-. Date: `' 11
( V1Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw REs 091216.docx
Building Permit Submittal
Original Submittal Date: Y/i 7//7
Site Plans: #
Building Plans: #
Building Permit#: nter building permit above. �_
Workflow Routing: Planning ngineering Permit Coordinator LJ tiutiding
Workflow Sign-offLJ�Sign-off for Planning(include notes from planning review)
Route Application Documents: []- gineering: (1) copy of permit application, (1) site plan, (1) building plan and
orial plan review routing form.
L_ wilding: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: #4f-ft44-,- �s Date: fit` 7 I
Engineering Review
lope at building pad: 4:Pr
❑ Conditions "Met"p rior 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: 42 Date: y-j9'.--,/7
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
LI 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:
i'qDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 1b4/A
Tigard Trans SDC: ❑ Yes Koh /A
Parks SDC: ❑ Yes C'eN/A
K to Issue Permit
Approved by Permit Coordinator: Date: J 9
q-------
I:\BuildineForms\131dgPermitRvw_RES_091216.docx
Building Permit Application
Residential �/ t o I o i i t ►: t ')I O y l.1
•Cl of Tigard
f'" E Received �+f (�
`J b ��i/, Date/By; 9i7/�7 Permit No.:/, rs- 0/7'i)/la
: 4 13125 SW Hall Blvd.,Tigard,OR 9 V Plan Review [ __c
8 Phone: 503.718.2439 Fax: 503.598.1960 A % % \1 Date/By: Other Permit:
1 1,,n E 11 Inspection Line: 503.639.4175 APR + Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Of
��GA Notified/Method: ��'T.(, Supplemental Information
90
` },r�'$�. 'tt'�'� tr9 tP a w >".1:: -s',5- ii v#F,..
fix, ''' •.� is -. :.-s ,�. Y"�V .'.. �. x x '•' '' , .� !:: es-c44:91.10-!. ' ",5`'�'' _' ay= ',7 4:'''''
❑New construction 0 Demolition Permit fees*are based on the value of the work`performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement ID Other: G-A 101,,e„ equipment,materials,labor,overhead,and the profit for the
#,a
n R,4 , j ,,x i l k?i � � work indicated on this application.
,, �r , ,_t , €.r ar. - . , .,'r�' � '`��'"S, ani
0 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ j ��
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
s , -;-,,t-,,,,,..,,,,', i„,4,-;,.:0-::. ?4,1 r, ± '*14 014. .l C 1 f; ` Total number of floors:
_. �-,r_ ,..�. s. Sg . tisja�.. .,, -... em_ �-..��-✓v_a s ,�.:
Job site address: I13 8�0 �W 1/Jd�1 s�� New dwelling area: square feet
City/State/ZIP: T i-.tiel rd OR 9 707023 Garage/caiport area: 8 , square feet
Suite/bldg./apt.no.: 1 Project name: CUlwc,II tQS;jG-rfe ,i/id Ei , Covered porch area: square feet
Cross street/directions to job site: I[),)S-r• T6 w A I JL.k-/ 46 Aa d feS Deck area: square feet
Other structure area: square feet
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no a �, p� � Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
r- - � � �' - . _, x work indicated on this a..lication.
Valuation: $
Fl c)ci A-hocSA+.fie_ ' -4-0 hMISC.-
Existing
SC. Existing building area: square feet
New building area: square feet
' � '�' d � s " $ Number of stories:
Name: L e.s C U y .e�� ` Type of construction:
Address: IBJ.$00 Sw vudt(No4_ s 1. Occupancy groups:
City/State/ZIP: --r;,,,,,(c) O( 9 12013 Existing:
Phone:( ) Fax:( )
New:
+i`" ��'�`s -3�'`�� �'� t �^ )1'-'''l
�, �' ��, s t- ,r�•-� �.� fir, r ,.� ,�
t'-4; dam ,:::: ,,,. x .� p1 :1-- . t4i ".',, a� � # �� :Ati
Business name: _Si- -ie$ II, -,040,rQ')"e tru ,<._ _ � 3 . os 1� � .^
Structural plan review fee(or deposit):
Contact name: .S 4.e'Q Qt0(
Address: 16 Y gs s( SorwiS ice_ r� FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP: ilty y .MIl el 022 776I _
Phone:60a Q ) asy t,7 78 Fax::( ) Amount received
Email �eOec c� pt�i oo.Cd ril �W,fA . -1 1_ -'IT ,.
m;; Commercial and residential prescriptive installation of
c-,= _,- tit _
CO. : r -� ,. t * - = roof-top mounted Photovoltaic Solar Panel System.
Business name: S.)2�2S o Submit two(2)sets of roof plan with connection details
N M e y i f 0 V and fire department access,along with the 2010 Oregon
Address: 6 y 8S .S ,SONi^/Ys. (�, Solar Installation S•ecial Code checklist.
City/State/ZIP: Altp y VA/lel at / 970 LS Permit Fee(includes plan review $180.00
/ / and administrative fees
Phone:(SOS ) 3.S -y 773' Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: ,gs4266 Total fee due upon application: $201.60
Authorized signature: 77-----.7 _ 4-' This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: *Fee methodology set by Tri-County Building Industry
T�V; �e C Date: Service Board.
I:\Building\Permits\BUP-RESPermitApp,doc 02/24/2011 440-4613T(11/02/COM/WEB)