Permit _ CITY OF TIGARD MASTER PERMIT
s` COMMUNITY DEVELOPMENT Permit#: MST2021-00281
Date Issued: 09/14/2021
T I i ;, I.! 17 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S111 DC00600
Jurisdiction: Tigard
Site address: 15760 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 453
Project: Potechin
Project Description: Remove 168 sq ft cover and build new 288 sq ft patio cover.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
0 0 sf Front: 15 Smoke
Height: Bathrooms: 0 Second: 0 sf Garage:
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors:
Total: 0 sf Value: $6,955.20 Rear: 10
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 Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Bckfiw Prevntr: 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
Fum<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 addi 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 0
Owner: Contractor:
POTECHIN,MARJORIE TRUST RICK'S CUSTOM FENCING&DECKING INC Required Items and Reports(Conditions)
15760 SW ALDERBROOK CIR 4543 SW TV HWY#A
PORTLAND,OR 97224 HILLSBORO,OR 97183
PHONE: PHONE: 503-640-5434
FAX:
Total Fees: $435.40
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
Gc'_nn111n1n fhrni inh CIA 9-nnl-nnOn ',nil r nhtain a,�wmo f the n dine nr.1 nt ni,aefinne fn ill Mr.h,,reeinn Sill 9 1QA7 nr 1 Ann TA99 94ad
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Issued By: �if��Permittee Signature: eC GG/94CCi3 fir,
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 lob site at the time of each inspection.
BAildina Permit Application
ResidentialRECEIVEDll)It ()Ilit I I til:(1\1
City• of Tigard Received y�ppl Rio />/��G�
g JULs n r Date(Bv: T k—/.2/ bit lny-gir Sl /` 02O
13125 SW Hall Blvd.,Tigard,OR 97223 L ZD2'' Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Dat&By. 7/01 ct i AtielotttrOther Permit
T I G A at U Inspection Line: 503.639.4175 CITY OF TIGARG Date Ready/By: Jude. ® See Page 2 for
Internet: www.tigard-or.gov 31�IL-�ING DIVISION� ohfiedlMethod: �jZ / Supplemental Information
TYPE OF WORK 17 REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
IgiAddition/aiteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
9' 1-and 2-family dwellingValuation: S W t JO V
0 CommerciaUindustrial
Number of bedrooms:
❑Accessory building 0 Multi-family
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION1, ( Total number of floors:
Job site address: t h ri Shiy7 n� derbr o Me_ C r• New dwelling area: square feet
City/State/ZIP: Ti1 l pl and r V 12. "1�4.� Garage/carport area: square feet
Suite/bidg.iapt.no.: 1 Project name: ptkednin Covered porch area: 1 'K square feet
Cross street/directions to job site: Deck area: square feet
I AS SW
0 "AZGld1bu) Ulf. Other structure area: square feet
{l1IQS t�W N• I& LYDDF' br• REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
hS^l1 G Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: 1 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
112.ErnpV,e t41soi 4 cover huild ntu) 'LSIsai r + Valuation: s
GDY er Existing building area: square feet
New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: Har brie Votechiy\ Type of construction:
Address: 1Wb silt) pttderbrook Ciir. Occupancy groups:
City/State/ZIP:1ch U RYd'1t t) . 1 R _'2 i-i Existing:
Phone:(6r bt)D�++—ap"ID Fax:( ) New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
r 1, p /+1I�t (Please refer la fee sell
MulBusiness name: �Gp�kit3 GVS �ilil �IYIrd E Der,[—ihq Structural plan review fee(or deposit): L
Contact name: S l to 2 tG J� FLS plan review fee(if applicable):
Address: uu 3 1 � TTV 1) tJJ �t
City/State/ZIP:
jrnItSIJDrD iOl lZW hb Total fees due upon application:
tt pion, �j' ' l Amount received:
Phone:(R3,)pion,' w Q-J ci Fax::( )
eve.rui-tedge (3 Yic>✓sfencino)-corn PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:St
Commercial and residential prescriptive installation of
CONTRACTOR ^ roof-top mounted PhotoVoltaie Solar Panel System.
Business name:Ri c�S CVS� d'DYn Fen nod C De L�i Aq Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 1.1t11 SE J 1l Solar Installation Specialty Code checklist.
City/State/Z1P: K1ttS(hprp l DR ai�� i
Permit Fee(includes plan review $180 00
and administrative fees):
Phone:(5DS)OtCl2_- Vil-01 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: DD In( /!1 /////{A Total fee due upon application: $201.60
Authorized signature: �J7/^� —7�,—fg----- This permit application expires if a permit is not obtained
����iii(((JJJIIt///vvv ✓✓✓ttt /// within 180 days after it has been accepted as complete.
Siu e 19.4k.\n 1 5\� Date: ' • ^ ^ t *Fee methodology set by Tri-County Building Industry
Print name: [ d �^• (, (• Service Board.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling rc,lz 01-1,1( I. t SF oyi.'
City of Tigard ••.
Received
Permit No.:
S50 Hall Blvd.,Tigard OR 972238.19 Associated permits:
2 Phone: 503.7182439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Tll;hltI) Internet: www.tigardor.gov 0 Other:
fHE FO11.O\\ INI, l Ili\lti :ARF REQi`IRi I) FOR PL1\ RI'111 11 ,`•, ' I I
• 1
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. E • •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ 0
3 Verification of approved plat/lot.
4 Fire district approval required. Name of district: • ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 ❑
6 Sewer permit. ❑ CC 0
7 Water district approval ❑ U. 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0
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 Cfi 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.
1 I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0" 0 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,tot 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 f ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 21 ❑ 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- ET 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. EY 0 El
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. 0 0
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non-
Er 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 Er 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 ❑ a
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 2 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load. 0
20 Manufactured floor/roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0
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 wr ❑ 0
architect licensed in Ore:on and shall be shown to be +..licable to the .ro'ect under review.
.0 ititil)I( I ION .l'I:( iI i(
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". r
24 Two(2)sets each are required for Items 16, 19,20 and 22 above.
re ❑
25 Building plans shall not contain d lines or tapc-ons. "Mirrored"building plans will not be accepted. D ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0
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, D ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0
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 approvedgrior to September 9,1995.
1:1Building\Permits&BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
nLULIVI®
SEP 01 2021
CITY Ors
TIGARD
C1eanWater Services Service Provider letter 'ILDINGDIVISION
Our commitment is clew
/V S ! vj/
Submission Date: Aug 31,2021 Confirmation it: 631
Applicant Name: RICK'S CUSTOM FENCING CWS File B: 21-002218
Contact Email: admin.hillsboro@ricksfencing.c Review Type: Partner City Plan Review
om
Contact Phone: (503)992-6871 Ground Disturbance: 10
Primary Address: 15760 5W Alderbrook CIR New Impervious Area: 288
Tigard,OR 97224
Primary Jurisdiction: Tigard Mod. Impervious Area: 0
Affected Tax Lots: 25111DC00600 Development Activity: SFR Addition
Project Description: Digging 3 footings for patio cover support.Patio cover will be 288 SF;Sfd Addition
FOR DISTRICT USE ONLY
® 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
protectwaterqualitysensitive 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.Thisdocumentwill 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 meetthe definition of development or the lot was platted after 9/9/95 ORS 92.040(2).
NO SITE ASSESSMENTOR SERVICE PROVIDER LETTER IS REQUIRED.
❑ NO SITE ASSESSMENTOR SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed By: LDRToolReview Date:August 31,2021
The CWS Development Services group is here to review your project In the most effective and efficient way,while protecting the Tualatin River Watershed.Our
partners Include municipalities,environmental organizations,and developers large and small.
Contact Us*2550 SW Hillsboro Highway*Hillsboro,Oregon 97123
phone:503-681-5100*email:splreview@cleanwaterservices.org*website:www.cleanwaterservices.org/permits-development
CleanWate� Services
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT
Clean Water Services File Number 21-002218
1. Jurisdiction: Tigard
2. Property Information(example: 15234AB01400) 3. Owner Information
Tax lot ID(s): _ Name: Marjorie Potechin
2SI11 DC00600 Company:
Address: 15760 SW Alderbrook Cir
OR Site Address: 15760 SW Alderbrook Cir City, State,Zip: Tigard, Oregon, 97224
City, State,Zip: Tigard, Oregon, 97224 Phone/fax: 6613090040
Nearest cross street: SW Oak Meadow Ln Email:
4. Development Activity(check all that apply) 4. Applicant Information
❑X Addition to single family residence(rooms,deck, garage) Name: Jazzmin Ragland
❑ Lot line adjustment 0 Minor land partition Company: Rick's Custom Fencing and Decking
❑ Residential condominium D Commercial condominium Address: 4543 SE Tv Hwy
❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Hillsboro, Oregon,97123
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 5039926871
Other Email: Admin.Hillsboro@ricksfencing.com
6. Will the project involve any off-site work? ❑Yes 0 No 0 Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project:
Digging 3 footings for patio cover support
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 Jazzmin Ragland Print/type title Administrative Assistant
Signature ONLINE SUBMITTAL Date 8/17/2021
FOR DISTRICT USE ONLY
O 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
LDR TOOL Date 8.31.21
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 RF„ arczo
Main Office • 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • p:503.681.3600 f:503.681.3603 • cleanwaterservices.org
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