Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021-00077
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/25/2021
Parcel: 2S108DB05700
Jurisdiction: Tigard
Site address: 15372 SW SEINE DR
Subdivision: POLYGON AT BULL MOUNTAIN Lot: 55
Project: Coiling
Project Description: New 126 sf deck(12'x10'-6")
BUILDING
Floor Areas Required Setbacks Reauired
Stories: 2 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: $3,070.62 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
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bcktlw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywall-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 addl 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:
ALT SF VE R-3 0
Owner: Contractor:
COLLING,BRIAN&KIRSTEN STANLEY DEWAYNE MOORE Required Items and Reports(Conditions)
15372 SW SEINE DR 6107 SW MURRAY BLVD#263
TIGARD,OR 97224 BEAVERTON,OR 97008
PHONE: PHONE: 503-522-0047
FAX:
Total Fees: $373.79
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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:`\--0\k \)(..kince W - Permittee Signature: on ctc) )1 t LCt t\
Call 503.639.4175 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.
Building Permit Application
Residential FOR OFFICE USE ONLY
City of Tigard RECEIVED Received O 2/ Pit No.
;� • 13125 SW Hall Blvd.,Tigard,OR 97223 Plate 3 C' I�ST��� f77
S Phone: 503.718.2439 Fax 503.598.1960 MAR 0 1 2021 3 / Zr Other Permit.
Da[eBy:
numin Inspection Line: 503.639.4175 Date Ready/By: ..-a A. huffs: E See Page Z for
Internet: www.tigard-or.gov CITY OF TIGARG NotiF Methor / Supplemental Information
B DIN DMSIO'. 1
TYPE. OF WOW( REQUIRED DATA:1-AND 2-FAMILY DWELLING
(jf New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead and the profit 0,
for the
CATEGORY OF CONSTRUCTION work indicated on this application. 6610 Z
Valuation: S j
1-and 2-family dwelling ❑Commercial/industrial 1 -' L,
v 0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 53 i Z 3 L.1 Se i ilk, +J f, New dwelling area: square feet
City/State/ZIP: 'rI c,A Cot J o f1' 1 12 Li Garage/carport area: square feet
Suite/bldg./apt.no.: U Project name:
'� -I Covered porch area: square feet
>
/ni t
Cross street/directions to job site: 15 Om Deck area: ( 2(4 ✓ square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: 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.:
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
t t " Valuation: S
Rio t Icl ncL- 12 x IC -(E DeGk-
Existing building area: square feet
New building area: square feet
[5(PROPERTY OWNER 0 TENANT Number of stories:
Name: briar) Cr Ilifled Type of construction:
Address: 15372_ .SW 5e.li1Q. Dr.
City/State/ZIP: -Ft f pl, 0. QZ22-9
Phone:(5o3) 70 2245 Fax:( )
0 APPLICANT IX CONTACT PERSON
Business name: *54an Mc01c2 Coos NC:-4-1081 J �ff _
Contact name: }a✓1 MQO(Q- fir` -
Address: &A 0-7 (SO /YIt)frety 1vd •c /� l* Z�3 '� Z� _ 3 0-7 0,
City/State/ZIP: FjeCx�(t2f ) O r?DO6 �/ `'J-7 x I
Phone:(503) 522- 0 047 Fax::( )
E-mail: I tin ►t'TL,QfQ di CS ,GO Yl L.
CONTRACTOR
Business name: 5-1-Q n M00(k_ CO)-1S Iq-I.r J Or-
Address: ( I 01 51....) ynv t l ay I?7)Vd• # 2.0
City/State/ZIP: $p_,sipA--}on, de R-t C0 8 oo
Phone:(99 33) .522—OOt-t7 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lie.: (oS$a 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:
A n Q,ID f •Fee methodology set by Tri-County Building Industry
�� rVl Date: /A /Z 1 Service Board.
I:\Building\Pernits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One— and Two—Family Dwelling FOR OFFICE USE ONLY
IMIICity of Tigard Date/By. Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax 503.598.1960 Received
24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing ❑ Mechanical
TIGARD Internet: www.ligard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW vC1 ', N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ • rd
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. Cl 0 Gii
3 Verification of approved plat/lot. E ❑
4 Fire district approval required. Name of district ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑
6 Sewer permit. Ed
0/17 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch-
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state IW 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 comer elevations(if ® ❑ 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 ® ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 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
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. IN ❑ 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 ❑ El
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 ❑
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 13 0 [ZI
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 an
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 031
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.c.,shear wall,roof truss)shall be stamped by an engineer or ® 0 ❑
architect licensed in Ore on and shall be shown to be a it icable to the ect 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 1T'.
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0
25 Building plans shall not contain red lines or tape-ons. `Mirrored"building plans will not be accepted. 0 ❑ E 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 ❑ M
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
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:\Building1Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard 3//e>21
r COMMUNITY DEVELOPMENT DEPARTMENT
C
T1cARD Building Permit Review Residential
Building Permit #: N1 Sr202/ -eve77 1
Site Address: / - 2 _c7 j b r:
Project Name: l C Lot #:
Planning Review Pr' .osah• kVX.) c4G/C 61 r"ac' ?A-Q
Verify address/suite# active in Accela. In River Terrace: ❑ No qQ Yes, Rile?'Terrace Review Addendum """
Sit/Plan Elements: Erosion Control
)copies of site plan on 8-1/2"x 11"or 11 x 17"paper 12 Retained trees with drip line and tree protection measures
�rawn to scale (standard architect or engineer scale) ootprint of new structure(including decks) and FFE
forth arrow ytility locations&easements(required for new and additions) I
t to address,project or subdivision name and lot number NJS . walk/driveway approach
vi
plicant information(name and phone number) 'iV•.cation of wells/septic systems
•
dimensions and building setback dimensions •$treet tree size,type and location
►V: .uare footage of buildings to be demolished reet names
IL E ling structures on site Corner elevations(2'contours if more than 4'differential)
of area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes /'o
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: ❑ Yes ❑ No
Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs
\ Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
SDC Exemption for ADU applied for: ❑ Yes ❑ No Received: CI Yes ❑ No
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes/ ❑ No,stop intake
and Use Case #: , l / ❑ Zoning: — `7 // /�
,Required Setbacks: Front: N Rear: /s Side: Street Side: / Garage: " /
'IQ Building Height: Max. Height: g0 Actual.Height: ��
LI ands cape Area: % El Lot Coverage Max:
Entrance 911 Set back no more than 8'from street-facing wall \Parallel to street or . -t 45 degrees or less
CI Minim..-- 2%of area of all street-facing facades
Garage ❑ Garage door is be'i. • dest street-facing wall ❑ -: ❑ No,one of the following is met:
❑ Door extends no more i .• 'from wall and ere-. . covered porch extending beyond garage.
❑ Door extends no more than 5'from ... a ere is a 12 sq ft.window above garage on 2"floor.
❑ Garage door width is ❑ 12'or less at 50%or - • facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ ':--ssed entrance ❑ Wall offse ■ I'Roof cave ❑ Roof offset
❑ Fire shingles ■ Lap Siding ❑ Roof pitch ❑ Gable,hip, . ...t brel roof ❑ Dormer
❑ Acc-• 1.' g ❑ Window trim ❑ Window recess ❑ Window pro.- ,.on ❑ Balcony
❑ Visual Clear, • - ❑ Urban Forestry Plan
❑ Se. : e Lands: ❑ Yes ❑ No Type:
-1 i Conditions met prior to issuance of building permit
Approved By Planning: '-- '' Date: f Z/
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: D 3'Ol -2 02/
Site Plans: # 3
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing: Planning ['Engineering lPermit Coordinator Building
Workflow Sign-off: [ 'Sign-off for Planning(include notes from planning review)
Route Application Documents: P.Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
2/Building: original permit application, site plans,building plans, engineer and
beam calculations a, . trust details,if applicable, etc.
Notes:
By Permit Technician: , ir; / Date: D9Q3-Z Z'
Engineering Review
❑ Slope at building pad:
❑ 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 ❑ No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
fQ Approved by Engineering: Date: __S. 0
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved E Not Approved
Revision 2: ❑ Approved E 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:
SDC Exemption: ❑ Received Vt.Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: 0 Yes N/A
LIDA ❑ Yes {S N/A
J. OK to Issue Permit
Approved by Permit Coordinator: kfk--- Date: *12,6ii
1:\Building 1 Forms\BldgPermitRvw_RES_122419.docx