Permit ,,11
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2022-00101
Date Issued: 04/26/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AD05000
Jurisdiction: Tigard
Site address: 12840 SW 129TH PL
Subdivision: 2004-003 PARTITION PLAT Lot: 1
Project: LAMANNA, R C TRUST
Project Description: Remove 996 sq ft of existing home. 352 sq ft of foundation to remain. New addition permit to
follow. Separate permits for plumbing and sewer.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $7,000.00 Rear: 0
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
Bckflw 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
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!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 0
Owner: Contractor:
LAMANNA,R C TRUST 360 HOUSES REDO Required Items and Reports(Conditions)
5448 SW CHAMPION PL 3155 SW 199TH TER
PORTLAND,OR 97225 ALOHA,OR 97003
PHONE: PHONE: 503-863-9709
FAX:
Total Fees: $300.06
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 wor. ' suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Thos- rules are set forth in OAR
ac9-nni_nMn thrnnnh('AI Qc9-M1-MQn Vnu maw nhtain a rnni_nf tha ndae nr rlirart ni lactinne to f11 INR by Tallinn cin't 919 1QA7 nr 1 Ann 9 91.
Issued By: P€Tmittee Signature:
.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 proj=
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential RECEIVE , FOR OFFICE USE ONLY
City of Tigard APR 12 2022 � 11/ /01 k4 Permit No.: t��f' o: --cicol
1 _- 13125 SW Hall Blvd.,Tigard,OR 97223 Tian Review i/�
Inspection n 503.718.2439
503.63Fax: 503.598.1960CITY OF TIGARD DateRcady/By. '� 2� other
Jur ern . Seepagezfor
Ti c A rz D BUILDING DIVISION Notified/method: L/ � Supplemental Information
Internet: www.figard-or.gov 4,44 �/"'
l ,ry %
TYPE OF WORK REQUII&D DATA:I-AND 2-FAMILY DWELLING
❑New construction ._ nexuul:r;pn Permit fees*are based on the value of the work performed.
Addition/alteration(replacement ❑Other. Indicate the value(rounded to the nearest dollar)of all
aaa��_ equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ 2 , C =-
CIind
❑ 1-and 2-family dwelling Commercial astrial t✓r
❑Accessory building ❑Multi-family Number of bedrooms:
El Master builder ❑Other. Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
1 Job site address: 12840 SW 129th Place New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site:I„129th Place and SW Walnut Place Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 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.
Remove approximatley 996 SqFt of the existing structure.352 Sq Ft to remain. Valuation: S
Secure,clean and prepair property for new addition to existing structure. Existing building area: square feet
Permit is for demolition only,plans for new addition to follow. New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Richard LaMantia Trust Type of construction:
Address:5448 SW Champion Place Occupancygroups:gr ups:
City/State/ZIP: Portland,OR 97225 Existing:
Phone:( 503 )746-3142 Fax:( ) New:
I21APPLICANT g CONTACT PERSON BUILDING PERMIT FEES*
Business name:SD Hutchinson LLC (Please rejwto fee„r..ro
z,)
Contact name: Scot Hutchinson Structural plan review fee(or deposit):
Address: 7325 NE Imbrie Dr.#133 FLS plan review fee(if applicable):
City/State/ZIP: Hillsboro,OR 97124 Total fees due upon application:
503 956 9772Amount received:
Phone:( ) Fax::( )
E-mail: sdhutchca@gmail.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Cotumrercral and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 360 Houses Submit two(2)sets of roof plan with connection details
3163 SW 199th Terrace and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Beaverton,OR 97003 Permit Fee(includes plan review
and administrative fees): 5180.00
Phone:( 503 ) 863-9709 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 211096
......:. ..
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.
jp�� *Fee methodology set by Tri-County Building Industry
{ Print name: lm4 /rU (jl..1 Jn. Date: Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
I
City of Tigard
Ililr COMMUNITY DEVELOPMENT DEPARTMENT
a
Building Permit Review — Residential
TIGARD
Building Permit #: H Sf2,O22. 00 le I
Site Address: PAL/0 SW 12-6r
Project Name: ,,a f-1 VI 6< k 1 ftrtti-i li7 Lot #:
Planning Review n n a v v AH i
Proposal: (i 01 a ead-i (r'
rlit)Verify address/suite #active in Accela. ❑ In River Terrace: +'i' No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: Wrosion Control
p3 copies of site plan on 8-1/2"x 11" or 11 x 17"paper i l4 +i t++'s-9 ++ + +ter
Drawn to scale(standard architect or engineer scale) rule(including decks)and FFE
North arrow (—ITS+t t u_ ae_ / �tur d fnr ne and arl •t+nnc).
ASite address,project or subdivision name and lot number g-Siciewalk-741fivewity-apprertelit-
XIApplicant information(name and phone number)
JLot dimensions and building setback dimensions ❑Sti..
Square footage of buildings to be demolished l treet names
rz� ' • ( i s i mare
xisting structures on site ' +ham„ 4'rhff «: t�
Q�at-area g o rarer ara r a t g�f ev a �a >1,000 sf of impervious area created or replaced? ❑Yes No
i+ czinns ar a(anr,lirahlP if R 7 R 1 R 5 8 R d[ll_ _ L1 r i 1
� '-�, , s x�et:e�-��c�lit�-€ae�i•4�s13e�::;,�--���
rClean Water Services —Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
t. Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
�0.k SDC Exemption for ADU applied for: ❑ Yes r AZ No Received: ❑ Yes ❑ No
L Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified g)No Applied For: El Yes ❑ No,stop intake
~stand Use CRse-#. Zoning: a_ 4. 5
p Required Setbacks: Front: 2—o ` Rear: (S + Side: S 1 Street Side: 15` Garage: —an t
g etg t: l eight
B—�anzl % El Lot coverage Max: % 1
I
c iil4o Min l2% F of ill rr r F G a
a
Garage arage door is behind widest street-facing wall ❑ Yes ❑ No,one of the is met:
❑ Doo ds no more than 5'from wall and there is a covered porch g beyond garage.
❑ Door extends no m an 5'from wall and there is a fi.window above garage on 2°a floor.
❑ Garage door width is ❑ 12'or less 5 ° ess of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Reces rance a offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ap Siding ❑ Roof pitch `G-a-131 'yor gambrel roof ❑ Dormer
❑ A • ng ❑ Window trim ❑ Window recess ❑ Window pro' tion ❑ Balcony
-El Vi,ual Clcarzrrz . '❑ Urban Forestry Plan
F Sensitive Lands: ❑ Yes 3No Type:
Conditions tuec plies tcriz-n-u4lice-of buildg permit
Notes:
f Approved By Planning: Date: `f l( 20 2 2
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Fonus\BldgPennitRvw RES_122419.docx
Building Permit Submittal
Original Submittal Date: /,?�
Site Plans: # ,'-
Building Plans: #
Building Permit#: 0 Enter building permit#above.
Workflow Routing: 0 Planning ❑ Engineering Q`Permit Coordinator Ef Building
Workflow Sign-off: [t Sign-off for Planning(include notes from planning review)
Route Application Documents: Ef Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
E Building original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
' e
By Permit Technician: , .
Date: fm-Au.
Engineering Review
D 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 P. o
LIDA Facility on lot: ❑ Yes ❑ No Add Fee: ❑ Yes ❑ No
❑ Final Plat Recorded:
❑ NOT Approved by Engineeri. :. Date:
Notes:
❑ Approved b ngineering: Date:
Revision fter Building Submittal only) Reviewer Date
' : sion 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
OcConditions "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 'Does not apply
2rSDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes e N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
LIDA ❑ Yes p N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: ig12OZV
I:\Building\Forms\BldgPemutRvw RES_1208021.docx
Clean Water Services
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT RECEIVED
Clean Water Services File Number 122-000942 A� 7~
1. Jurisdiction: Washington County Li I Y Oi- I GARG
BUILDING DIVISION
2, Property Information(example: 15234AB01400) 3. Owner Information
Tax lot ID(s): Name: Richard"Marina
2S104AD05000 Richard LaManna Trust
Company:
Address: 5448 SW Champion Place
OR Site Address: 12840 SW 129th Place City,State,Zip: Portland,OR,97225
City,State,Zip- Tigard,OR,97223 Phone/fax: 503-746-3142
Nearest cross street: Email: richardiamanna@gmail.com
4. Development Activity(check all that apply) 4. Applicant information
f } Addition to single family residence(rooms,deck,garage) Name. Scot D.Hutchinson
Company: SO Hutchinson LLC
❑ Lot line adjustment ❑ Minor land partition
[3Residential condominium IDCommercial condominium Address: 7325 NE lmbrie Dr.ur133
❑ Residential subdivision ID Commercial subdivision City,State,L p H;tlsboro,oR,97124
❑ Single lot commercial ❑ Multi lot commercial Phone/fax. 503-956-9772
Other Email. sdhutchco@gmail.com
6. Will the project involve any off-site work? ❑Yes a No 0 Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project
The existing septic tank will be de-commissioned and will be hooked up to the city sewer system.
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 Scot D.Hutchinson Print/type title Okvner
Signature ONLINE SUBMITTAL Date 3/2512°22
..........
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.
Ii 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.
y/
Reviewed by �---"496 _ Date 3/2822
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
Main:Office 4 25,50 SW Hi lsbo o Highway hr Sbcr, 0rego,97123;;; .3.1.8:..* JO ,. 6.03.68.1.36(1) ctearwatemervices.or9