Permit (184) CITY OF TIGARD MASTER PERMIT
'"� Permit#: MST2018-00240
. COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2018
Tf Ci AR 9 Parcel: 2S1146608900
Jurisdiction: Tigard
Site address: 16264 SW 104TH AVE
Subdivision: SWANSON'S GLEN Lot: 30
Project: Lange
Project Description: Extending first and second floor 8 ft in the rear. Adding covered deck patio 12 ft off of the house
in the rear. Owner will do mechanical,electrical, and plumbing work, but will submit those
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 459 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: Yes
Total: 459 sf Value: $60,964.95 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 Rain0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 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: 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 N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 459
Owner: Contractor:
LANGE,NIXON OWNER Required Items and Reports(Conditions)
16264 SW 104TH AVE NIXON LANGE
TIGARD,OR 97224 16264 SW 104TH AVENUE
TIGARD,OR 97224
PHONE: 971-333-1170 PHONE: 971-333-1170
FAX:
Total Fees: $1,994.33
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. Tho e, es are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a -- •f the rules or direct questions to OUNC by calling 5,0,.232.1987 5 232.1987 or 1.80 :33 .2344.
Issued By: ittee Signature: J1 6,\ ~ f -
09 03.639.4175 by 7:00 a.m.for ther next avai ble inspection date. \ ./
This permit card shall be kept in a conspicuous place on the job site until c mpletion of a project.
Approved plans are required on the job site at the time of each inspection.
i �` Building Permit Application ,_
wry
Residential Q FOR OFFICE USE ONLY
City of Tigard AUG U L��O Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: 7 ,/,„_/„..,„
PtT�.�!(��UaL/�
_ (` Plan Review 1 ( OPhone: 503.718.2439 Fax: 503.598.190 Date/By: Other Permit:
Ins ection Line: 503.639.4175 Date Ready/By: _ Juris: ® See Page 2 for
1IGARD p
Internet: www.tigard-or.gov Notified/Method: Supplemental Supplemental Information
TYPE OF WORK ' ` REQUIRED DATA I-AND FANHLl4*MEI LING
❑New construction D 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. 1 G}ti
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 9
ElAccessory building 0 Multi-family Number of bedrooms:
0 Master builder El Other:
Number of bathrooms: /2
JOB SITE INFORMATION AND:LOCATION Total number of floors: 2
Job site address:16264 SW 104th Ave New dwelling area: Jl1Lv/tsquare feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 0 squarelfeet
Suite/bldg./apt.no.: Project name: Covered porch area: , 76luare feet
Cross street/directions to job site: 104th and Durham Rd Deck area: square feet
South on 104th avenue to house on the left Other structure area: 0 square feet
REQUIRED BATA::COMMEI C1AL-USE CHECKLIST
Subdivision:Swanson's Glen i Lot no.:30 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 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.
Extend 1"and 2'floor of house 8'in the rear Valuation: $
Add covered deck patio 12'off the house in the rear Existing building area: square feet
* . 11?. -4—‘11-t%:"1-4 Q L "41.Q, New building area: square feet
�+ _"OPERTY OWNER - 0�Cet 'sN'ss1�VA�lY - Number of stories:
Name:Nixon Lange Type of construction:
Address: 16264 SW 104th Ave Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:(971)333-1170 Fax:( )
New:
►a APPLICANT 0 CONTACT PERSON BUILDING pump'ctS.
Business name: f1'Iaereleitreehedt+Ye ..t ;
Structural plan review fee(or deposit):
Contact name:Nixon Lange
FLS plan review fee(if applicable):
Address:16264 SW 104th Ave
City/State/ZIP:Tigard,OR 97224 Total fees due upon application:
Phone:(971)333-1170 Fax::( ) Amount received:
E-mail:nglange3@gmail.com PHOTOVOLTAIC SOLAR PANEL FEES*
CUNTItt1C 'UR , Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Nixon Lange fG7�Z G�j n4 r( Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:16264 SW 104th Ave Solar Installation Specialty Code checklist.
City/State/ZIP:Tigard,OR 97224 Permit Fee(includes plan review $180.00
•
and administrative fees):
Phone:(971)333-1170 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: f
/ Total fee due upon application: $201.60
l
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: '6-2 -c•- 1`3 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.oc 02/24/2011 440-4613T(11/02/COM/WEB)
i "Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Cityof TigarReceived
r. llandOR 97223, 11III permits:
Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing 0 Mechanical
"(AGAR()
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ El
3 Verification of approved plat/lot. ❑ ❑ El
4 Fire district approval required. Name of district: • ❑ ❑
El
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ El
6 Sewer permit. ❑ ❑
El
7 Water district approval. ❑ ❑
El
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ Eg
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ El
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® 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 ❑
and location.
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 ❑
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
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 ® ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 El
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. I4 ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ El
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 ® ❑ ❑
architect licensed in Ore:on and shall be shown to be a..licable to the .roject 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. ® ❑ 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ El
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, ❑ ❑ El
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
Iiii a COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A- D Building Permit Review — Residential
Building Permit #: /14 ST,,t <>/g- e)..?iv()
Site Address: fl)2(D4 SW I 01.4.h Ave.
Project Name: .t✓ �a thanLot #:
(New dwell' =subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Cj . HQ L.n
"Verify site address/suite# exists and active in permit system.
,River Terrace Neighborhood: ›CNo rS.Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
liChree(3)copies of site plan >Existing structures on site
kite plan must be on 8-1/2"x 11"or 11 x 17"paper X'ootprint of new structure(including decks)with finished
>Drawn to scale(standard architect or engineer scale) floor elevations
Qorth arrow kAlJtility locations&easements (required for new and additions)
to address,project or subdivision name and lot numbertt6tdewalk/driveway approach
›ItApplicant information(name and phone number):RI
NALocation of wells/septic systems
jilLot dimensions and building setback dimensions tigxisting trees to be retained with drip line,and tree
7A quare footage of buildings to be demolished protection measures
V.1 of area,building coverage area,percentage of coverage and f€treet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) NCtreet names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? Y No
No foot differential) If yes,is a storm water quality facility shown? No
'6if Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified X No Received: ❑ Yes ❑ No
rg Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified IX No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#:
51 Zoning: 12-12—LPD)
Required Setbacks: Front NA.- Rear ts' Side S ' Street Side im. Garage Nr
R Landscape Requirement: SO % I
Lot Coverage Maximum: SQ
',Building Height: Maximum Height 3G Actual Height ±2.4
NR-Visual Clearance
A Sensitive Lands: 0 Yes No Type
"-Pt Urban Forestry Plan
(JA- Conditions "Met"prior to issuance of building permit
Notes:
A Approved By Planning: Date: 13 2,e3 S
Revisions (after BuildingSubmittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Buildinfforms\BldgpemutRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: �,2Pio-
Site Plans: #
Building Plans: # 5
Building Permit#: cifEnter building permit#above.
Workflow Routing: ! Planning ra Engineering Permit Coordinator }5`--BuildingWorkflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: L'f1 Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
"Z Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
,,c(ifyrel
By Permit Technician:
Date: /(
Engineering Review
❑ ope at building pad: ��
M
Ile
onditions "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 LNo
em/
Assess Water Quantity Fee in-lieu: ❑ Yes [ No
LIDA Facility on lot: ❑ Yes Pr-No
VFinal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 40,1s �:e.--A k/ Date: 4:/_.svg
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
0 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:
iiiliSDC Fees Entered: Wash Co Trans Dev Tax: :�:�' es N/A
Tigard Trans SDC: ! Yes 4'N/A
Parks SDC: Yes N/A
LIDA tJ Yes `PN/A.1•7- /
OK to Issue Permit /Iffier
Approved by Permit Coordinator: Date: 6 !�
I:\Building\Forms\B1dgPern itRvw_RES_010118.docx
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.
III m City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
1 c,A 1:i 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: 41 Iil SDK1 DATE . 19qiNI ',f:a.r'
DEPT: BUILDING DIVISION SEP 1 8 2018
CITY OF F IGAhO
� 9 8UILD!NG DIVISION
N
FROM: f v ixoA Ia t It-
COMPANY: ---
J
PHONE: ql i- 33 3- / (7 0 By:42:L
RE: /pz(oy 3J (0(1+L' AVe-
ir57--leinbeirt-( )o'ulf�(Site Address)
LAS 4c( (:4oc\
(Project a or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Z- Revisions: R5x-s 3 7 - / S 4 et
Cross section(s) and details. Wall bracingand/or la eral kal sis. ^ -�
Y (l�t GS
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: Z. 51,4_4_4, w res ptv‘S-t-S 4. s r o
2 r✓G--1 i- S 0u
3 - n 1 rek!s ('Zc. ,P�c 9
1
FO OF ICE USE ONLY
Routed to P echnician: Date: g l a1 Q� Initials: /*-
Routed
Due: Yes ❑No Fee Des 'pti n: Amount Due:
$
l ' 1, v{\ �"„c�V; $ `fS d
P $
$
Special
Instructions:
Reprint Permit(per PE : ElYes v No _ [ Done
Applicant Notified: �� Date: �(k)f i� Initials: frj----
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
16264 SW 104TH AVE, TIGARD, OR, 97224 August 26, 2019 at
9:04:13 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00240
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor