Permit Support Document Building Permit Application
Residential FOR OFFICE USE ONLY
City of Tigard RECEIVE Received q/a NW-
g ��
_ �/ Permit No.:
Date/By: (> - CrJU'
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ,3
■ Phone: 503.718.2439 Fax: 503.598.1960 MAY 9 202.? Date/By: AA- Other Permit
T I(;A R D Inspection Line: 503.639.4175 D Ready/By:/ Juris: (a See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARL otified/Method: Supplemental Information
TYPE OF WORK 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
❑Addition/alteration/replacement ❑Other: 0 6ckk / PAPa. equipment,materials,labor,overhead,and the proDt fo
CATEGORY OF CONSTRUCTION work indicated on this application. "All a`Z
❑ I-and 2-family dwelling ❑Commercial/industrial Valuation: $ j„�r,,, P(/ r
3 1 l�lGs'-� Xi7-A-J" F
❑Accessory building El Multi-familyNumber of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: III 25 s(A) I O 9 Ti. New dwelling area: square feet
City/State/ZIP: -r; a ar a 0 R 47 223 Garage/carport area: f square feet
Suite/bldg./apt.no.: V Project name: f i PrP}I rr� ,h area• > square feet
Cross street/directions to job site: 5 t) IV a Q'<t to Deck area: y square feet
\ Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 1 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.
Valuation: $
7
geck I Rd-so edve,c
rVei Z— �i //'Wei A' r r eet2?. iir<U,— Existing building area: square feet
(SSt-e ter New building area: square feet
2 PROPERTY OWNER ❑ TENANT Number of stories:
Name: CI it,,, k}u+ck eys s or'. Type of construction:
Address: ..LI 0 Z U 544 004,8 Q c Occupancy groups:
City/State/ZIP: (.4)6f L;I ►,, Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: cjq q5 C.n 1 r lC 7„, �-r—
��- Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone:( ) Fax::( )
Amount received:
E-mail: (s) C�
c
S 0` r C PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CO(lq TRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 111 Pry C 1 t j e d C of\glruet Ion 5/mod;Ces Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 2 5 I S (3 W Y 2.13 Solar Installation Specialty Code checklist.
•
Cit /State/ZIP: r ati1 fyr 4'5 Permit Fee(includes plan review
�� �,Oand administrative fees): $180.00
Phone:(Sp3 ) cob • 5 3 I')5 I Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: II 2.11 3 9 V(0 42-- 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: Q kris GO" Ili.-1Date: 1,•1„2'7 .7.3)11. *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPertnitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
}_ : Building Permit Application Checklist
k One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
y Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
■ Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing El Mechanical
n l Internet: www.tigard-or.gov
❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 ❑
6 Sewer permit. 0 . 0 ❑
7 Water district approval. 0 0 ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 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 corner elevations(if 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;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 0 ❑ El
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. 0 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 0 ❑
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 0
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 0 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 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 0 0 0
architect licensed in Ore.on and shall be shown to be applicable to the .ro•ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0
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 0 ❑
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 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 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, 0 0 0
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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
•
COMMUNITY DEVELOPMENT DEPARTMENT
ill C
Building Permit Review — Residential
� 1,11 I Ut- i ilaHB-iU
�/�
Building Permit #: V t '-}- 20Zi bb 5O BUILDING DIVISION
Site Address: / (j 4+ 5 tQ
Project Name: ZW.RjS07 Lot #:
Planning Review 1
Propos 1: PtI` Aga m
erify address/suite #active in Accela. ❑ In River Terrace: No ❑ Yes,River Terrace Review Addendum
Site P . Elements: ti, Erosion Control
l c• es of site plan on 8-1/2"x 11"or 11 x 17"paper Rei ed trees with drip line and tree protection measures
i i rawn to scale(standard architect or engineer scale) I f oo••=nt of new structure(including decks)and FFE
G • . arrow 0!tili .locations&easements (required for new and additions)
. rte ..•ress,project or subdivision name and lot number ap.dewalk/driveway approach
4 plicant information(name and phone number) ❑Location of wells/septic systems
I. •t dimensions and building setback dimensions fJN. IIStr• ee size,type and location
ft4S uare footage of buildings to be demolished •treet names
txisting ��structures on site I Corner elevations (2'contours if more than 4'differential)
1,44 4Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes ❑No 1,,/�-
im .ous area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes ❑No
Clean Water Se ' es —Service Provide Let -__C • . •d prior to 9/10/1995): —� 4�,
R ed: es,applicant was notifi VrO illPPP1 Received: ❑ Yes ❑ No
Pr-Water Meter Fixture Unit Worksheet— •..•_-•- : _•-..els and ADUs
R ' ed: ❑ Yes,applicant was notified G No �� Received: ❑ Yes ❑ No
Aril S Exemption for ADU applied for: ❑ Yes ICJ No Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified l No Applied For: ❑ Yes ❑ No,stop intake
❑Land Use Case #: ❑ Zoning: A- '{' 5—
Z RR quired Setbacks: Front: 20 Rear: /—<— Side: .5— Street Side: i-C- Garage: 2it:'
Fr-Building Height: Max. Height: Skr Actual Height: f
❑ Landscape Area: / 1 % ❑ Lot Coverage Max: A cyo
Entrance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
• - - ❑ Minimum 12%of area of all street-facing facades
Garage ❑ Gara: :-• is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
❑ Door extends n. : • an 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5 • .11 and there is a 12 sq ft.window above garage on 2nd floor.
❑ Garage door width is ❑ 12'or less ❑ 50%o : of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall o - ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable, ': or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Wino o o'ection ❑ Balcony
f ❑ Visual Clearance ❑ Urban Forestry Plan
❑ Sensitive Lands: ❑ Yes ❑ No Type:
❑ Co •tions met prior to issuance of building pe 't
No s:
Approved By Planning: Date: 2
Revisions (after Building Submittal only Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\BuildingTonns\BIdgPennitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: 5/9/.1),.
Site Plans: # 3
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing: Planning 5ir Engineering Permit Coordinator Er Building
Workflow Sign-off: [ Sign-off for Planning(include notes from planning review)
Route Application Documents: [ Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
[Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: -1 (lettl Date: g //j/01,Q
Engineering Review
lope at building pad: ar0
05 nditions "Met"prior to issuance of building permit
.r EEasements (encroachments)per engineering conditions of approval and plat
Er-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [ No
Assess Water Quantity Fee in-lieu: ❑ Yes
LIDA Facility on lot: ❑ Yes Add Fee: ❑ Yes El No
2 Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
1E Approved by Engineering: ), �S E� Date: S fa -Zv2z
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
NA-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 /2f Does not apply
.B"SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes V N/A
Tigard Trans SDC: ❑ Yes Of N/A
Parks SDC: ❑ Yes cir N/A
LIDA ❑ Yes L N/A
0 OK to Issue Permit
Approved by Permit Coordinator: 11T Date: 5/i@jfoZ4
I:\Building\Forms\BldgPermitRvw_RES_1208021.docx
RECEIVE
MAY 19 2022
CleanWater Services
CITY OF SENSITIVE AREA PRE-SCREENING SITE ASSESSM5 Tomsio l
Clean Water Services File Number 22-001506
1. Jurisdiction: Washington County
2. Property Information(example: 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Eileen Hutchinson
Carnahan's Addition to city of Tigard lot 3 Company:
1S134DB04100 Address: 11125 SW 109th Ave.
OR Site Address: 11125 SW 109th Ave. City, State,Zip: Oregon City,OR,97045
City, State,Zip: Tigard,Or,97223 Phone/fax: 503 970-5345
Nearest cross street: Email: dcschris@gmail.com
4. Development Activity(check all that apply) 4. Applicant Information
❑x Addition to single family residence(rooms,deck,garage) Name: Chris Guthrie
❑ Lot line adjustment ❑ Minor land partition Company: Diversified Construction services
❑ Residential condominium El Commercial condominium Address: 20515 HWY 213
❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Oregon City,OR,97045
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 5039705345
Other Replacing patio cover Email: dcschris@gmail.com
6. Will the project involve any off-site work? ❑yes ❑x No 0 Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project:
We have approved plans from the city of Tigard This is a existing property Patio cover is 300 sf
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 Chris Guthrie Print/type title
Signature ONLINE SUBMITTAL Date 5/18/2022
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.
CI 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 C?� Date 5/19/2022
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
locisecl 2/2020
Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p: 503.681.3600 f: 503 681 3603 • cleanwaterservices.org
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Julie Drinkwater
From: dcschris@gmail.com
Sent: Thursday, May 19, 2022 12:26 PM
To: #Building Permit Technicians
Subject: Fwd: 22-001506 11125 SW 109TH AVE SPL
Attachments: 22-001506 11125 SW 109TH AVE SPL.pdf
Categories: Julie
Caution! This message was sent from outside your organization.
Begin forwarded message:
From: SPL Review<SPLReview@cleanwaterservices.org>
Date: May 19, 2022 at 9:37:26 AM PDT
To: Chris Guthrie <dcschris@gmail.com>
Subject: 22-001506 11125 SW 109TH AVE SPL
Hello,
Clean Water Services has completed the Sensitive Area Pre-Screen review for the proposed
development at the subject property. Attached is the completed Pre-Screen form which becomes your
Service Provider Letter. Please submit the attachment to the City of Tigard. If you have any follow up
questions please do not hesitate to contact me.
Thank you,
Jessica Chaplen, EIT(she/her)I Plan Review Technician 1
Clean Water Services I Planning and Development Services
2550 SW Hillsboro Hwy I Hillsboro OR 97123
o 503.681.5100
email: chaplenj@cleanwaterservices.org
engage news I facebook I twitter
From: cwsnotify@cleanwaterservices.org<cwsnotify@cleanwaterservices.org>
Sent:Wednesday, May 18, 2022 7:16 PM
To: SPL Review<SPLReview@CleanWaterServices.org>
Subject: Pre Screen Form 5/18/2022 -Chris Guthrie
i4