Permit Fliiirt4' CITY OF TIGARD MASTER PERMIT
`a COMMUNITY DEVELOPMENT Permit #: MST2010 00123
�0 . ` Date Issued: 07/30/2010
gT t CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 134 DB06000
Jurisdiction: Tigard
Site address: 11027 SW 110TH PL
Subdivision: JEFFREY ESTATES Lot: 19
Project: Bailey
Project Description: Replace existing deck cover, approximately 360 sq ft.
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: sf Value: $9,950.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr: 0
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
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir:
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:
Owner: Contractor: Required Items and Reports (Conditions)
BAILEY, JOHN M & SHAWNIE H LARSON CUSTOM HOMES INC
11027 SW 110TH AVE 17850 SW PHEASANT LN
TIGARD, OR 97223 BEAVERTON, OR 97006
PHONE: 503- 968 -0256 PHONE: 503- 643 -0704
FAX:
Total Fees: $451.67
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 iss ance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Noti icatio Center. Those rul s are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. Yo ..play obtain : . --.1Agilatiki questions to OUNC by calling 50 .6699 or 1.800.3 . 344.
Issued By.-/ T G Permittee Signature:
/ �
Building Permit Application `�� u' •
fi
Residential
. -I OIt OI .TI( Irlitil O \l 1
IN City of Tigard JUL 2 7 2 0 1 0 Received � � 0 �� Permit No.: / / dto /o - /
13125 SW Hall Blvd., Tigard, OR 9722 �, - q �, y , plan Review 1 II
C Phone: 503.639.4171 Fax: 503.598.1960 t - "r . GAR,, `l' DateB : roman 10 Other Permit:
U lf: 'o
r I t n RI) Inspection Line: 503.639.4175 1 �l n� �; D I 1 f I, - t Date ReadyBy: y :
g g � ' `Notified/Method: / 3 0 ®See Page 2 for
0 ` luris p Supplemental Information
Internet: www.ti azd -or. ov
/ 3)_ pdtitt t JI91 w
/ TYPE OF WORK - . REQUIRED DATA: 1- AND 2- FAMILY DWELLING
I!!! I ew construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation of 9 ��
1 -and 2- family dwelling ❑ Commercial /industrial i
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: k 1177 7 S LI mit', pL New dwelling area: square feet
City /State /ZIP: -jc 6,
, plL 17 ZZ3 6i- / / E t / Garage /carport area: 4.--3.2_ square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
(_DESCRH'TIONOF ^.WORK_ work indicated on this application.
-ZN . 1 , vim K Cc _ Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY" -OWNER - . 1 - ❑ TENANT ' Number of stories:
Name: — ,r St.4446 kueI Type of construction:
Address: it 07L 7 q fi , � tP it 1 Occupancy groups:
City /State /ZIP: `7 C u A2 al 7 ZZ) Existing:
Phone: (fU q b F5 -- 0 75b Fax: ( ) New:
-- PPLICANT; - ❑ CONTACT PERSON NOTICE =
Business name: (.l'titjj,,,) GA)" 1-1o,'i ES All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) Fax::( )
E -mail:
CONTRACTOR;
Business name: LAR>.,3 a vt>,,, 43 ,,,,.... m f � BUILDING PERMIT. FEES*
Address: 11615 4\ S fw . t j, (Please refer to fee schedu/e� •
City /State /ZIP: Structural plan review fee (or deposit):
Phone: (SIJ %) IZ. 177 l/ Fax: (SU'S) GIr2 - 13 3 FLS plan review fee (if applicable):
CCB lic.: 37 4 w Total fees due upon ap �7
Amount received: 1 %4 .7 /
Authorized signature: 4 This permit application expires if a permit is not ��
obtained
�A' 1w within 180 days after it has been accepted as complete.
1 �
Print name: V � Date: 7_ 27- zoi 0 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits\BUP -RES PermitApp.doc 10/01/09 440 -4613T(11 /02 /COM/WEB)
Building Permit Application Checklist
z i oR > ol I icy: US l ; o
One- and Two - Family Dwelling . i
City of Tigard Received permit No.:
I lk i Date/By:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
0 Phone: 503.639.4171 Fax: 503.598.1960
I I c:i 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard - or.gov ❑ Other:
'i I IE 4'6 11 LO\VVINc I; 1 \1 AR QUiiiru ;FOIL :'PI X r Ni :izf :Vi'rW ' i ‘ t, Ntt , /*
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
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 . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ 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 . ❑ ❑ ❑
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 ❑ ❑ ❑
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, ❑ ❑ ❑
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..-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. ❑ ❑ ❑
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- ❑ ❑ ❑
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 ❑. - ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
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 ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
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 ❑ ❑ ❑
architect licensed in Ore:on and shall be shown to be applicable to the .ro'ect under review.
F'JURISD VI - IONAI: SPI-.6II ICS -._.- .._. -,•',.,,,.''',' -. `
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑. ❑
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, ❑ ❑ ❑
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: \ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(II /02/COM/WEB)
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PLAM�I ISJO! . 3
Reg . d : . 84A pproved� 0 Not Approved • ,!�
Side: Street Side: P!> >' y
Front. Garage: = Rear. `V 7 �
Visual Clearance: [Ap�p 0 Not Appnorod Z. 0131 Maximum Building Height•.L feet
CWS Service Provider Letter Required: ❑ Yes No °s- wa
IT 1
yy ❑ Received
B i a . Date: i / /i 0
ENGINEERING DEPA TMENT:
Actual S pe: % Approved 0 Not Approved - k
- $ 5 . i
Site Pl Approved 13 at pproved
Br: Date: 7 to ._
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I of I 7/27/2010 9:55 AM