Permit (49) CITY OF TIGARD MASTER PERMIT
11 1t : COMMUNITY DEVELOPMENT Permit#: MST2017-00252
13125 SW Hall Blvd.,Ti Date Issued: 07/11/2017
T[[�ttR. and OR 97223 503.718.2439 9
Parcel: 1S134CD10300
Jurisdiction: Tigard
Site address: 11670 SW 116TH AVE
Subdivision: BURLWOOD NO.4 Lot: 4
Project: Warrick/Paris
Project Description: Construction of 360 SF accessory structure.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors:
Total: 0 sf Value: $4,095.00 Rear: 5
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 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:
ACS SF VB
R-3 0
Owner: Contractor:
WARRICK,WILLIAM CONGER Required Items and Reports(Conditions)
PARIS,KRISTEN DIANE
11670 SW 116TH AVE
TIGARD,OR 97223
PHONE: 971-235-4480 PHONE:
FAX:
Total Fees: $359.06
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 O:R 952-001-0090. You may obtain o the ru es irect questions to OUNC by calling 503.2 2.1987 or 1.800.332.2 44.
Issued By:
Permittee Signature: 4/L ,�` ,1
Ca 0 . 175 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.
Building Permit Application
Residential RECEIVED
City of Tigard Received /-
g Date/By: f-!Plan
I 1 Permit No.:MSI l - a 5
13125 SW Hall Blvd.,Tigard,OR 9' 2 7 2017 Plan Review-7
1111 I Phone: 503.718.2439 Fax: 503.598.1960 Date/By. G—i/ Other Permit:
T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ^ /f /7frh,ris: 10 See Page 2 for
Internet: www.tigard-or.gov Nnt++ /Method: /� Supplemental Information
BUILDING DIVISION ,, �
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
a New construction ❑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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ . 00
❑ 1-and 2-family dwelling 0 Commercial/industrial 7 0 �s
eid 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: /)4/Q 5.hi j/ti, hi.19-2/ New dwelling area: square feet
City/State/ZIP: rl ql 223 tot �PA-ats Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 1:41 -lr /!J GL l Lir U Covered porch area: square feet
Cross street/directions to job site: / Deck area: square feet
cliii i;614/77D / alp+-'y I`'(, 11, AV Other structure area:3 #O SQ quare feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 1 6 1 3i/el) I U b Q d 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.
/t/S Jiftli Ste-e --/ A ph,/ 1.ia-e— 2 fihi
Valuation: $
A10 e 724.44 -- l /1/0 fitiA4 // j _ Existing building area: square feet
/age — Site,- 616g-- ,1,k) New building area: square feet
PROPERTY OWNER
0 TENANT Number of stories:
Name: ` IQ s `/ lAial —
)
J/ Type of construction:
Address: //if `76) ///6 Py Ai/ Occupancy groups:
City/State/ZIP: n M`-rff� Q '3 7 2 2 3 Existing:
''
Phone:(97/) .35` 't'� .('S l' 315_ 9c-/6
New:
0 APPLICANT 0 CONTACT PERSON
BUILDING PF_.RMIT FEES*
Business name: (Please refer to fee schedule)
Contact name: -
Structural plan review fee(or deposit):
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application: yy
Phone: ( ) Amount received: t#97. 31
( ) Fax::
E-mail: PHOTOVOLTAIC SOLAR PANEL'SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: ()U/$4/672' Submit two(2)sets of roof plan with connection details
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 lie.:
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: kg../..S i&J n (9 r I S Date: , 67 7g-i 7 *Fee methodology set by Tri-County Building Industry
Service Board. /
P It
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) 'i 3 -
Building Permit Application Checklist
One- and Two-Family Dwelling roll of iici: t si: Oy.l.l
City of Tigard Received d
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Rev
Associated
permits:
= Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
TIC n R D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 c yO y 1
I Land use actions completed. See jurisdiction criteria for concurrent reviews. • I •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • ❑ ❑ 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0
6 Sewer permit. El 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 ❑ 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
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
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
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.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 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 a licable to theproject 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. ❑ ❑ 0
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 ❑
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 ❑
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, ❑ 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-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
:.71 'I COMMUNITY DEVELOPMENT DEPARTMENT
I
T1cARD Building Permit Review — Residential
Building Permit #: i'1151—a;. 1'7—050,;-5"-?—
Site
Go;- - —
Site Address: (I(-7o SW tt6T NE-
Project
&Project Name: M W04 r\•.c.,l,~ Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review ` "(
Proposal: n2a,`7 C�C�',�5 �►(`� tjt,�� 18\\k(
M Verify site address/suite#exists and active in permit system.
,Z River Terrace Neighborhood: A No ❑ Yes,See River Terrace Review Addendum Attached
Sit, 'Plan Elements:Di JJ
,_Three(3)copies of site plan LJ xisting structures on site
Id Site plan must be on 8-1/2"x 11"or 11 x 17"paper IiCJFootprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scab., ) 2.0 floor elevations
CJdorth arrow 15 tility locations&easements(required for new and additions)
d .ite address,project or subdivision name and lot number �pst.idewalk/driveway approach
`P'pplicant information(name and phone number) NGF:+ •cation of wells/septic systems
21Lot dimensions and building setback dimensions ►''xisting trees to be retained with drip line,and tree
0quare footage of buildings to be demolished protection measures
NLot area,building coverage area,percentage of coverage and I! . eet tree size,type and location
(impervious area(applicable if R-7,R-12,R-25&R-40) N Street names
roperty corner elevations(2 foot contour lines if more than >1,000 sf o impervious area created or replaced? ElYesAiNo
4 foot differential) If yes,is a storm water quality facility shown? ,❑Y
l Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified X1 No Received: ❑ Yes ❑ No
gifilt Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
AO/Land Use Case#:
D Zoning:
Required Setbacks: Front Rear Side Street Side Garage
1461 Landscape Requirement: \ %
11 Lot Coverage Maximum: \ % is yt
Building Height: Maximum �Height
$ Cj (-7") Actual Height 9 i
1)IS Visual Clearance - Sc v1 6%-4,11:APPy
1JiSensitive Lands: CIYes CINo Type
Urban Forestry Plan
Conditions "Met" rior to issuance of building g permit
Notes:
Approved By Planning: �fpyv,' .-E,, Date: IL-2._1117.
Revisions (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 061417.doex
Building Permit Submittal
Original Submittal Date: (Q o,77 7
Site Plans: #
Building Plans: #
Building Permit#: CYt nter building permit#above.
Workflow Routing: a Planning ��r r.ngineering Ll Permit Coordinator Building
Workflow Sign-off: a Sign-off for Planning(include notes from planning review)
Route Application Documents: ,r Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original 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: C w _.a., Date: 4/1_74`
Engineering Review
'tit- Slope at building pad: //
pfConditions "Met"prior to issuance of building permit
tii Easements (encroachments)per engineering conditions of approval and plat
el 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: Date: 7/4//7
Revisions (after Building Submitta 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:
C Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
LIDA ❑ Yes N/A
FVOK to Issue Permit
Approved by Permit Coordinator:
Date: G/"
I:\Building\Forms\B1dgPermitRvw_RES_061417.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11670 SW 116TH AVE, TIGARD, OR, 97223 August 28, 2017 at 9:30:35
AM
Record Type: Record ID:
Residential - Master Permit MST2017-00252
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - NoCofO
Comments:
Final inspection ok per approved plans.
No electrical installed at this time.
Violation Summary:
Inspector Contractor