Permit (9) INCITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2018-00126
RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/22/2018
tt�" 9 Parcel: 1S134DB01700
Jurisdiction: Tigard
Site address: 11200 SW 115TH AVE
Subdivision: None Lot: None
Project: GELGELU
Project Description: Adding (1)312 SF shed.
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: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors:
Total: 0 sf Value: $14,068.08 Rear: 4
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
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 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: 1
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:
GELGELU,DEMETI OWNER Required Items and Reports(Conditions)
11200 SW 115TH AVE DEMETI GELGELY
TIGARD,OR 97223 11200 SW 115TH AVENUE
TIGARD,OR 97223
PHONE: PHONE:
FAX:
Total Fees: $696.69
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. _ •• •f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i, .- - `Permittee Signature:
f'411503.639.4175 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.
,
j I GGA `-1 a n
Building Permit Application
Residential FOR OFF I;SE OM .v
City of Tigard Received
Permit N%1,77„,„_,..),„2.4,
.1h . 13125 SW Hall Blvd.,Tigard,OR 97223 x Date/By: i�
Pian Reviews 46 AiA Other Permits Phone: 503.718.2439 Fax: 503.598.196 Date/By:
I I C;A R u Inspection Line: 503.639.4175 Date Ready/By: „„/t Jur s: 171 See Page 2 for
Internet: www.tigard-or.gov MAY 22 titied/Method: + i y 1 Supplemental Information
,
OF1 1\
TYPE OF WI ; !LONGr' ' DIVISION
�,n����� REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demo rtton UI v 6 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Addition/al ration/replacement 0 Other: equipment,materials,labor,overhead�nd the prpfjj fo
CATEGORY OF CONSTRUCTION work indicated on this application. ! 1 4
0 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ ,f,
Accesso buildin Number of bedrooms:
❑ ry g ❑Multi-family
❑Master builder Jul Other:
�f��T�'''_,7 Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: t, ,QO 4'W t1 New dwelling area: square feet
City/State/ZIP: �A ` pie. 1 4 2i 3) Garage/carport area: square feet
Suite/bldg./apt.no.: I,.�.-....v Pro Project name: l~� Covered porch area: square feet
IVikt
e. Cross street/directions to job site: t•V. ��,p�� ,�A�o , Deck area: , /square feet
) Liyfi, h tu/ 1,1 J��f 6 a `W 1 t1- ,/f Other structure area: tj�0� square feet�f i Z
u'l Y �1-�%=,r��"+►E"yi�, 0—` 140AV REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ;�lV 11--A5- Lot no.: two Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
ap/ cetne: r- s* it/ e/ `l! �h7It,� I kt . �`r' i/� equipment,materials labor,(rG Jr C� /� o ,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
4..7 r JJ d two 6N 9J I 1,... Valuation:Valuation: $
p eizof f"�r`�pry 1/ t ,
i 3� 1 1./A0
Existing building area: square feet
6jO i.'/M i0471/00.1.10 ` New buildir t area: square feet
xi PROPERTY OWNER 0 TENANT Number of .:ones:
Name: M*. ,t2'r,�/�.o�; L 6iL
. 4 Type of construction:
Address: 1 VD '@ w. I(4i j7'�S- . Occupancy groups:
City/State/ZIP: 1 , i *'
, l�> i. (a112
') Existing:
Phone:( ) F� _.
New:
APPLICANT la CONTACT PERSON BUILDING PERMIT FEES*
®� (Please refer to fee schedule)
Business name: r cry
r l t Structural plan review fee(or deposit):
Contact m r1 /moi Iv �
��Y�✓' et y•
FLS plan revie•v fee is a_plicato:.*
Addres U `� ` tN Total fees due upon application:
City/State/ZIP: �✓'/t'i V rf ` �A'IV bi'C11(1164*
Phone:(ii *) b I Q i'�7®,r7� Amount received:
E-mail: / ' PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
'/ ' �" S" F � rn G�`" `erki7 Commercial and residential prescriptive installation of
Q`�'/`_4/1 CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
t Business name: . i I L L Submit two(2)sets of roof plan with connection details
�"'t`1 Y and fire department access,along with the 2010 Oregon
Address: � /L,,r0 4' *W t 1�'�vo- Solar Installation Specialty Code checklist.
City/State/ZIP: J� �p , Permit Fee(includes plan review
(all ► `�n � (1100*) and administrative fees): $180.00
Q Phone: t all 1)' i �Q l -,__ e
State surcharge(12%of permit fee): $21.60
CCB lic.:
Total fee due upon application: $201.60
Authorized signature: ^ 1 This permit application expires if a permit is not obtained
�Qi. s Z 1 l within 180 days after it has been accepted as complete.
Print name:, Pi*...00,,vloriji Date: �.' ) t io W *Fee methodology set by Tri-County Building Industry
ttService Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02 4/ 01 440-4613T(11/02/COM/WEB)
1
,
Building Permit Application Checklist
One- and Two-Family Dwelling FOR orrice: I SF ore.v
City of Tigard Received Permit No.:
Associated permits:
I Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
T I C A R D Internet: www.tigard-or.gov
❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1'es NO 1/A
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
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 0 0
5 : Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. 0 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
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 ❑ ❑ ❑
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 ❑
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
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
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 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 ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑ 0
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 0 ❑ ❑
architect licensed in Ore•on and shall be shown to be a.s licable to the s 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". ❑ ❑ ❑
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. ❑ ❑ ❑
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. ❑ ❑ ❑
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.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
4
,Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Ns
� 7 j /Bea /1 Permit#:`i p...., or—itli y 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
_ Phone: 503.718.2439 Date/By: Related Permit#:
3 Email: TigardBuildingPemrits@Tigard-or.gov MAY 2 2014 Ready Date/By: ions: Et See Page 2 for
1( A R D Inspection Line: 503.639.4175 Internet: www.tl and-or. ov Notified/Method:
g g Supplemental Information
TYPE OF WORK CITYL PLAN REVIEW
❑New constructionDIVISION
Addition/alteration Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fireum
P P• 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION /�,, 0 Emergency system. larger separately derived
Job#: Job site address: I(2C� S'l�.J )(' •4.1"— ►IAC_ ❑Addition of new motor load of system.
r ' 0 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: 112 o b S Gv 164-4" +ct.{., t OR cr ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
4'e j 4- 3 G-...sr-c--,A— ,�' (with above sq.ft.) 75.00 2
yy Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
0
PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
1.yrvmes or feeders installation,alteration,and/or relocation
Name: tt ( .4 20 200 amps or less 100.70 2
Address: I f _00 S tom/ K4-1,--- 64—
201 amps to 400 amps 133.56 2
� 401 amps to 600 amps 200.34 2
I -
City/State/ZIP: 0cc/Q-4_1 601 amps to 1,000 amps 301.04 2
Phone:En i ) '( 6-zab.7_ Over 1,000 amps or volts 552.26 2
C 0"-- Temporary services or feeders installation,alteration,and/or
Email: &6 l� • relocation
Owner installation:This installM'on i be d on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
0 APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name: c �� r above service or feeder fee,
cJ each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first f 56 18 r� 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling, 67.84 2
Email: service and/or feeder
Reconnect only 67.84 2
,..' — 00. Pump or irrigation circle 67.84 2
Business name: ii t/ C 1/ I ✓ ' Sign or outline lighting 67.84 2
// �'
Address: Signal circuit(s)or limited-energy
6� t`� 7 h g .. i panel,alteration,or extension. 0 See Page 2 2
City/StateJZIP: ��� Each additional inspection over allowable in any of the above
®IC . t2 e Additional inspection(1 hr min) 66.25/hr
Phone:( )
'r 7 0 - r A--q 2 Investigation(1 hr min) 90.00/hr
Email: . K / $ f-'� n I` tv ' Industrial plant(1 hr min) 78.18/hr
L- Kt �f Inspections for which no fee is
CCB Lic.: 7 Electrical Lic.: Suprv.Lic.:
/' / Is specifically listed(V.hr min) 90.00/hr
Suprv.EIS rician si a<< h / J ELECTRICAL PERMIT FEES
P b'n aired: / Wil 41
(//J� � Subtotal:
Print name: pGZ It'G L i a nC�` k �,y I Date: 17, �� I ❑Plan Review Required(25%of permit fee):
�/ /v' ,JI State surcharge(12%of permit fee):
Authorized signature:
1 TOTAL PERMIT FEE:
I
I Print name: I i This permit application expires if a permit is not obtained within 180
I Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 10/26/2017
440-4615T(11/05/COM/WEB
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
a
T n Building Permit Review — Residential
Building Permit #: A M 3 j,2 o/8 - C-c / Z, ex,
Site Address: 2 GJ, i .. A :.1.,/ al.
Project Name:
/71:00T'A0. ��.0-17 Lot #: I iQO
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review P
Proposal: S AG g 4 ,or 1i`�`f„d
Il
01,00
L�' erify site address/suite# exists and acttiive p permit system.
67/
Terrace Neighborhood: LYNo ❑ Yes,See River Terrace Review Addendum Attached
Alie .n Elements:
I/I�,” ee(3)copies of site plan Eiisting structures on site
4,' e plan must be on 8-1/2"x 11"or 11 x 17"paper ( }Poo print of new structure(including decks)with finished
L.5/1 awn to scale(standard architect or engineer scale) iikfl..r elevations
n .rth arrow T ' ty locations&easements(required for new and additions)
1. ' e address,project or subdivision name and lot number idewalk/driveway approach
V plicant information(name and phone number) ocation of wells/septic systems
I! '
.t dimensions and building setback dimensions xisting trees to be retained with drip line,and tree
quare footage of buildings to be demolished protection measures
of area,building coverage area,percentage of coverage and Street tree size,type and location
.ervious area(applicable if R-7,R-12,R-25&R-40) 11'S-treet names
11 roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? • -ll No
4 foot differential
L ) If yes,is a storm water quality facility shown? Ii"es ■No
IV Clean Water�S�ces—Service Provider Letter(lot platted prior to 9/10/1995): E(
quired: L Yes,applicant was notified El No Received: El Yes L' No
Ei Public Facilities Improvement(PFI) Permit/
i Required: El Yes,applicant was notified M No Applied For: ❑ Yes El No,stop intake
!A,i�/�'and Use Case#: 'IAL ' oning: K-1.S
LIQ Required Setbacks: Front 2_0 Rear Li* Side '5. Street Side lc Garage Li
C_, L�ndscape Requirement: z..._E of Coverage Maximum: 80 0,0
uilding Height: Maximum Height 1 S Actual Height I L
Pi Visual Clearance
Lid'Sensitive Lands: ❑ Yes L,_� No Type
14 Urban Forestry Plan
VIA Conditions "Met"prior to issuancq of building permit ,
Notes:
A > � z1 � (-_ S i,s c. ;;1' c feet
[Approved By Planning: r r(Jj Date: Sit_ ty
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.docx
Building Permit Submittal „
Original Submittal Date:
Site Plans: #
Building Plans: #
Building Permit#: ❑ Enter building permit#above.
Workflow Routing: ❑ Planning ❑ Engineering ❑ Permit Coordinator ❑ Building
Workflow Sign-off: ❑ Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑ 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: Date:
Engineering Review
C I
XJ
, Slope at building pad: J
❑ 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 J'No
❑ Final Plat Recorded: N
❑ NOT Approved by ngineering: Date:
Notes:
,,i2"Approved by Engineering: AV VP— e Date: 7 l
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 N/A
r Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes I> N/A
LIDA ❑ Yes I N/A
OK to Issue Permit/2r 5/7-I b
A roved b Permit Coordinator: /�rd%�'t' Date:
PP Y
I:\BuildingForms\BldgPermitRvw_RES_010118.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11200 SW 115TH AVE, TIGARD, OR, 97223 September 17, 2018 at
12:43:45 PM
Record Type: Record ID:
Residential - Master Permit MST2018-00126
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor