Permit Building Permit Application ?
Residential RECEIVED
Cityof Tigard Received 3 Permit NA ��7„
g JUL�UL fi o 202..i Date/BY "/ t I'-lS 1 W 20�nOs35,
Il 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 43
Phone: 503.718.2439 Fax: 503.598.196cITY OF TIGARD Date By: ( //e a A Other Permit:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: / 4D Jens ® See Page2for
Internet: www.tigard-or.gov Notified/Method: fglill Supplemental Information
M
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY 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
ki,Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
.. CATEGORY OF CONSTRUCTION
1-and 2-family dwelling 0 Commercial/industrial Valuation: $ Q 2S/qD
O Accessory building El Multi-familyNumber of bedrooms: �j 000 y
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 7 1-1-1 O s',,-) CA-E.�p_Y pp. I v E._ New dwelling area: square feet
City/State/ZIP: Ti caAIZD., 0 °t-T 12._3
Garage/carport area: square feet
Suite/bldg./apt.no.: — Project name: Si\6,1.1... pE6)c 4 CovE te, C oveered a: 143 Z square feet
Cross street/directions to job site: SOVTN 4F =N'1"Eft$r'-T)orQ OF Deck area:`j1/�l) y 3 z . squarefeet
/may pa-I V I- z�' '7S Pc-A - -- s— Other structupe are e�: )2 qv square feet
✓ S CAA t (2O1/I/�.�'7Z. L6 Z. /e-t=�il-f� REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: /2.e LL J 6 HI L L-S No, 2. Lot no.: go Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Z S O 1 C. 01600 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
l•4D DESCRIPTION OF WORK work indicated on this application.
PE'PLAGE FKtSTIIJC� DELK . ADP NEW DE,_K Valuation: $
t."iTN' -c9VEle 4321 Existing building area: square feet
New building area: square feet
jil.PROPERTY OWNER 0 TENANT Number of stories:
Name: Jo N ptT N A1J s Yh A Lc- Type of construction:
Address: '7 N 7 p S W C H F.Rl--y 1)R l V I- Occupancy groups:
City/State/ZIP: 1 I G AA D r 0 R. '1 Z'2-2 3 Existing:
Phone:(5o g) S HO - g 21 C. Fax:( ) New:
4 APPLICANT gl,CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Contact name: t✓L Structural plan review fee(or deposit): 2z 'r b%�
�OtNATF}A►J S✓I'1A
Address: "j y-p S w C(f ER ft-y bR t J G- FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP: T14AILD OR a12z3
Amount received:
Phone:(S03) Imo g 2 t G. Fax: :( )
E-mail: s 4(t O S yr�a t I co,,,,,
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
✓ Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 13u 1 LT [3y t-}t're(C 0 L.....,JLJ E 12 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 lic.: Total fee due upon application: $201.60
Authorized signaturecsLA This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: J pjVA^r i4#..j S yvl 4.t".. Date: 7. Is, 20 Lv "Fee methodology set by Tri-County Building Industry
Service Board.
t:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB)
Property Owner Statement RECEIVED
Regarding Construction Responsibilities JUL 2 0 2020
Oregon Law requires residential construction permit applicants who are not licensed with thL'OF TIGARD
Construction Contractors Board to sign the following statement before a building permit cail4G DIVISION
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
X, I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Nk`Ri-MJ c0114LL
Print Name of Pe • " p. ' ant
r
7. 20 . Zo
Si re of Per . .. .nt Date
Permit#: MST w?O — ( O7 rJ
"l��c� sw CfVn� Dt- F �
Address: a 41
Fe a7c s,l 0
TOal'd, OR o1-1223 ,V z
Issued by: Date: G" " 2
This Copy for Permit Offices
RECEIVED
cisra.2c+ --C9C7 S" AUG 042020
CITY OF TIGARD C1eanWater\Services
BUILDING DIVISION
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT
Clean Water Services File Number 20-001897
1. Jurisdiction: Tigard
2. Property Information(example: 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Jonathan Small
2s101dc01600 Company:
Address: 7470 SW Cherry Drive
OR Site Address: 7470 SW Cherry Drive City, State,Zip: Tigard, OR, 97223
City, State,Zip: Tigard, OR, 97223 Phone/fax: 5038408216
Nearest cross street: 75th Place Email: small.logs@gmail.com
4. Development Activity(check all that apply) 4. Applicant Information
® Addition to single family residence(rooms, deck, garage) Name: Jonathan Small
❑ Lot line adjustment 0 Minor land partition Company:
❑ Residential condominium D Commercial condominium Address: 7470 SW Cherry Drive
❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Tigard, OR, 97223
0 Single lot commercial D Multi lot commercial Phone/fax: 5038408216
Other Email: small.logs@gmail.com
6. Will the project involve any off-site work? ❑Yes ❑ No 0 Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project:
There is an existing deck of 240 sq feet that is going to be rebuilt. Another deck will be added of 432 sqft with cover
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 Jonathan Small Print/type title
Signature ONLINE SUBMITTAL Date 7/16/2020
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.
I 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 riot 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 ��s s 06.24411.11.14,1, Date 08/04/2020
Once cofriplete,email to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
R[.vi 2'2020
Main Office • 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cieanwaterservices.org
City of Tigard
el COMMUNITY DEVELOPMENT DEPARTMENT
■
TIGARD Building Permit Review — Residential
Building Permit #: MS T Zp 2 CO y 3 S
Site Address: —] 4ii) LSW Chorvu\ 11)(1Vf)
Project Name: SIy1G1 t t (ACC Lot #:
Planning Review
Proposal: Dew_
JVerify address/suite# active in Accela. 'i—In River Terrace: ' No ❑ Yes,Ri'verTerrace Review Addendum
Site Plan Elements: KLAYasion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper etained trees with drip line and tree protection measures
Drawn to scale (standard architect or engineer scale)oxth arrow Footprint of new structure (including decks) and FFE
Utility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number idewalk/driveway approach
Xkkpplicant information(name and phone number) Fro .cation of wells/septic systems
Lot dimensions and building setback dimensions Li'treet tree size,type and location
V square footage of buildings to be demolished Street names
i ',fisting structures on site 'omer elevations (2'contours if more than 4'differential
Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes] No
,impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes XX'[[II'`''"TTTo
,*'Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: XYes,applicant was notified ❑ No Received: ❑ Yes No •
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified _No Received: ❑ Yes E No
filkSDC Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No
11"-Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified XNo Applied For: ❑ Yes ❑ No,stop intake
NtkLand Use Case#: Zoning: R- 3•S—
Re uired Setbacks: Front: Side: 1 20 q Rear: 5 Street Side: Garage:
Building Height: Max. Height: 3D` Actual Height: 12
Landscape Area: % 104cLot Coverage Max:
Entrance • Set .-ck o more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows \I N' ' 12%of area of all street-facing facades
Garage • Ga .ge oor is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
• D or e I`: ds no more than 5'from wall and there is a covered porch extending beyond garage.
V D ore- ds no more than 5'from wall and there is a 12 sq ft.window above garage on 2"d floor.
II Garage oor I . • is 0 12'or less ❑ 50%or less of facade El 60%or less and includes 7 of following:
❑ C ver p..ch ❑ Recessed entrance ❑ Wall offset 0 1'Roof eave ❑ Roof offset
❑ F'IIe s.' gle 0 Lap Siding ❑ Roof pitch CI Gable,hip,or gambrel roof CI Dormer
❑ Adcent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
li Visual Clearance VOrtrrban Forestry Plan
Sensitive Lands: ❑ Yes No Type:
PO(Conditions met prior to issuance of building permit
Notes:
. Approved By Planning: Date: 1 I21 IV°
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
1:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: 7/Z/ZD
Site Plans: #
Building Plans: # ..3
Building Permit#: ®'Enter building permit# above.
Workflow Routing: E Planning Engineering Permit Coordinator Q—Btilding
Workflow Sign-off: lg.-Sign-off for Planning(include notes from planning review)
Route Application Documents: B-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Or Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: �v,Q �•rf. Date: 7/3�Ze
Engineering Review
lope at building pad: /0 7
N--Conditions "Met"prior to issuance of building permit
Er-Easements (encroachments) per engineering conditions of approval and plat "`14
Eater Quality/Quantity Facility: Et-
Assess Water Quality Fee in-lieu: ❑ Yes Et No
Assess Water Quantity Fee in-lieu: El Yes ( o
LIDA Facility on lot: CIYes C-No
�/
E anal Plat Recorded: w1`
❑ NOT Approved by Engineering: Date:
Notes:
Ct<Approved by Engineering: 77;t4,1//±5, Date: 8/6/zogo
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:
SDC Exemption: ❑ Received K.Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 14 N/A
,{
Tigard Trans SDC: ❑ Yes tl N/A
Parks SDC: ❑ Yes N/A
LIDA ❑ Yes 44 N/A
OK to Issue Permit
Approved by Permit Coordinator: ., lam" . Date: 7110 (tj
1:\Building'Forms\BldgPermitRvw_RES_122419.docx
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