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Permit
CITY OF TIGARD MASTER PERMIT 'g :W COMMUNITY DEVELOPMENT Permit#: MST2020-00187 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: Jul 20 2020 12:00AM Parcel: 1 S134CB06000 Jurisdiction: Tigard Site address: 12440 SW NORTH DAKOTA ST Subdivision: ANTON PARK Lot: 22 Project: Smith Project Description: Addition of 200 sf living room. All trade permits to be obtained separately. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 200 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 200 sf Value: $24,492.00 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 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 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: ADD SF VB R-3 200 Owner: Contractor: SMITH,ROBERT B SUPERIOR FRAMING AND CONTRACTING Required Items and Reports(Conditions) 12440 SW NORTH DAKOTA ST 2373 NW 185TH AVE#286 TIGARD,OR 97223 HILLSBORO,OR 97124 PHONE: PHONE: 971-226-1906 FAX: Total Fees: $1,287.43 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. You may obtaina copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By. ��/hC D[-4--J Pennittee Signature: e'er ,0G"Gf .270Al Call 503.639A175 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 ,r-t ti ,iT t I.i Residential i Oft#4F tlt I CSh.17kN11r JUN 0.i 2020 / _ / x ' City of Tigard Deday. y��®4' ' 4Q Permit Nd1S I �t�.6O cr.7 . w 13125 SW Hall Blvd.,Tigard,OR 97223 i 1'` ( ,;- -i Plan Review/, AA II^^� }}, Phone: 503.718.2439 Fax 503.598.1960:€ 1 ,` 4 Dateley: v��� ✓" f�4 Other Pieait: —� Ts A gCt Inspection Line. 503.639.4175 - `- --. . - Date Ready/By: - Anis: 65 see Page 2 for t : Internet: www.tigard-or.gov Not fied/Method: /72 2) sappicmentai Information r TYPE OF WORK notaimo DATA:I-AND 2-FA-MILY DWELLING 0 New construction ®Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all )4 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the C:4T&GORl OF CONSTRUCTION work indicated on this application. l I-and 2-family dwelling I ElCommercial/industrialConercial/industrial Valuation: $ - /i Z El Accessory building ❑Mufti-family Number of bedrooms: fl Master builder �,^ ®Other: Number of bathrooms: T JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: 12440 SW North Dakota St New dwelling area: 200 square feet City/State/ZIP: Tigard, OR 97223 _ Garage/carport area: square feet Suite/bldg./apt,no.: Project name: 12440 SW North Dakota Building Addition Covered porch area: square feet Cross street/directions to job site: Deck area: square feet SW North Dakota St& SW Tony Ct, Other structure area: square feet Enter SW North Dakota St from SW 121st Ave REQUIRED DATA:COMMERCIAL-USE CfEC'RLlST Subdivision: Anton Park Lot no.: 22 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: 6000 equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Construction of a ground level living room in the back of the existing Valuation $ home, approximately 200 SF Existing building area: square feet t AA-fie F E----t l 1-6 8,--- 6&.I ftti IJ c� ,S EP472.}i I L.`f New building area: square feet IN PROPERTY OWNER 0 TEN 4NT Number of stories: i Name: Robert B. Smith Type of construction: Address: 12440 SW North Dakota St Occupancy groups: City/State/ZIP: Tigard, OR 97223 Existing: Phone:(503)310-4661 Fax:( ) New: lill APPLICANT ® CONTACT PERSON BUILDING PL:R tr B'EEs* Business name: ---- Polo zofl esqr Structural plan review fee(or deposit): N Q , Si Contact name: Robert B, Smith FLS plan review fee(if applicable): Address: 12440 SW North Dakota St Total fees due upon application: City/State/ZIP: Tigard, OR 97223 Amount received: Phone:( 503) 310-4661 Fax::( ) l-ma l: bucksmith60 gmail.com PITOTOVOLT'AIC SOLAR PANEL SYSTEM FEES Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Pane!System. Business name: Superior Framing &Contracting, LLC Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 2373 NW 185th Ave#286 Solar Installation Specialty Code checklist. City/State/LIP: Hillsboro, OR 97124 Permit Fee(includes plan review $180.00 - ________ _____ .__ and administrative fees): Phone:( 503) 332-4045 Fax:(503) 352-4169 State surcharge(12%of permit fee): $21.60 CCB lie.: 206910 .l2)--/z_/ 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. I Print name: Robert B. Smith Date:6/1/2020 *Fee methodology set by Id-County Building Industry Service Board. l:lBuilding\Permits\BUP-RESPermitApp.dec 02/24/2011 440-4613T(I 1/02/COM/WEB) - City of Tigard ligr COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Building Permit #: PI,S T 70 20 - 00 I e 7 Site Address: 1 2-440 SW NiDI`I'Y1 Da St-- . Project Name: l+h Lot #: Planning Review Proposal: isol Q►'j'loll Verify address/suite# active in Accela. Li In River Terrace: X No ❑ Yes,River Terrace Review Addendum Site Plan Elements: ,Erosion Control 'f 3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper it.'etained trees with drip line and tree protection measures 'Drawn to scale (standard architect or engineer scale) 9 ootprint of new structure(including decks) and FEE North arrow I ,, tility locations&easements(required for new and additions) ] Site address,project or subdivision name and lot number )idewalk/driveway approach ri Applicant information(name and phone number) 'Location of wells/septic systems 0 .t dimensions and building setback dimensions MN-Street tree size,type and location A quare footage of buildings to be demolished Zu Street names .CExisting structures on site dr,omer elevations (2'contours if more than 4'differenti.yal)� �, (Rot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes JdNo impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes'No Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): Required: $-Yes,applicant was notified ❑ No Received: X Yes ❑ No Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs Required: ❑ Yes,applicant was notified At No Received: ❑ Yes E No I\-SDC Exemption for ADU applied for: ❑ Yes X No Received: ❑ Yes ❑ No 'Public Facilities Improvement(PH) Permit: Required: ❑ Yes,applicant was notified X, No Applied For: ❑ Yes ❑ No,stop intake land Use Case#: VI Zoning: 12-' Required Setbacks: Front: IS Rear: 1 N Side: S Street Side: I X. Pr Garage: 20 `$ Building Height: Max. Height: 35t Actual Height: ( 4 lk Landscape Area: 2.0 % ❑ Lot Coverage Max: SO 0/0 Entrance 11! Set bac: no m e than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows II Minim 12%of area of all street-facing facades Garage II . arage .oor is ehind widest street-facing wall ❑ Yes ❑ No,one of the following is met: .or ex nds more than 5'from wall and there is a covered porch extending beyond garage. ■ .or ex ends more than 5'from wall and there is a 12 sq ft.window above garage on 2"d floor. a, Garag- .oor idth 12'or less El50%or less of facade ❑ 60%or less and includes 7 of following: ❑ Covere port Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset E Fire s ' gles ❑ Lap Siding ❑ Roof pitch D Gable,hip,or gambrel roof ❑ Dormer E Accent iding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony -Visual Clearance *Urban Forestry Plan Sensitive Lands: ❑ Yes KNo Type: IVA-Conditions met prior to issuance of building permit Notes:Approved By Planning: L " 2jL.,— Date: (o( (W Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: tP/3/2 p Site Plans: # 3 Building Plans: # 3 Building Permit#: ci2 Enter building permit#above. Workflow Routing: ,❑- Planning [igineering Permit Coordinator ceding Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: O--Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. C uilding. original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: e Date: 6/Ati2p Engineering Review ©lope at building pad: 2`Z nditions "Met"prior to issuance of building permit el L'` Easements (encroachments)per engineering conditions of approval and plat n`C Pr.-Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Cif o Assess Water Quantity Fee in-lieu: ❑ Yes D'SIo LIDA Facility on lot: ❑ Yes g'"No L -F''inal Plat Recorded: I. I'— ❑ NOT Approved by Engineering: Date: Notes: a-Approved by Engineering: 4. ��ge.--• '. Date: el/i/p0O?1) Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ 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: 1ifiq SDC Exemption: ❑ Received Does not apply Z SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: ❑ Yes 4 N/A Parks SDC: ❑ Yes N/A LIDA ❑ Yes Ali N/A N'OK to Issue Permit Approved by Permit Coordinator: AtN") Date: (Q i« i?A0 I:\Bui Id ing\Fonns\BidgP ermit Rvw_RES_122419.docx JUN 03 2020 r" `'' . ,,.,`,770 Clean'Water Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT'f ! Clean Water Services File Number 1. Jurisdiction:City of Tigard 2. Property Information (example: 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Robert B.Smith 1 Si 34CB06000 Company: Address:12440 SW North Dakota St OR Site Address: 12440 SW North Dakota St City, State,Zip: Tigard,OR 97223 City, State, Zip:Tigard,OR 97223 Phone/fax: 503-310-4661 Nearest cross street: SW North Dakota St&SW Tony Ct Email: bucksmith60@gmail.com 4. Development Activity(check all that apply) 4. Applicant Information ID Addition to single family residence(rooms, deck, garage) Name: Same as owner ElLot line adjustment CIMinor land partition Company: ElResidential condominium 0 Commercial condominium Address: ElResidential subdivision 0 Commercial subdivision City, State,Zip: ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: Other Email: 6. Will the project involve any off-site work? ❑Yes In No 0 Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: 200 SF addition to existing structure,back of property This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits, Site Development Permits, DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document, and to the best of my knowledge and belief,this information is true,complete, and accurate. Print/type name Robert B.Smith Print/type titleOwner/Applicant Signature �h Date 5/29/2020 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also be required. ❑ Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the site. This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5, Section 3.02.1, as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local, State and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5, Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local, state and federal law. ❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed by Date Once complete,email to: SPLReview@cleanwaterservices.org • Fax: (503)681-4439 OR mail to: SPL Review, Clean Water Services,2550 SW Hillsboro Highway, Hillsboro,Oregon 97123 M,.i,. 'Office 2JJ� � I;S14h rC ig i 5bor3, C,t; ., 32123 50>.t(.€ '.:vll '_5 1,3 f)F 1.dC5El3 ;,r;