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Permit
CITY OF TIGARD MASTER PERMIT ''_'1 i1t COMMUNITY DEVELOPMENT Permit #: MST2011 -00015 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2011 Parcel: 2S104CD05100 Jurisdiction: Tigard Site address: 13934 SW MISTLETOE DR Subdivision: HILLSHIRE ESTATES Lot: 51 Project: Brown Project Description: 268 sq ft roof structure over patio. 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: No Total: 0 sf Value: $12,000.00 Rear: 0 PLUMBING Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Urinals: Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Storm Sewer: Tubs /Showers: Garbage Disp: Water Heaters: Water Lines: Drains: Catch Basins: Bckflw Prevntr: Footing Drain: Ice Maker: Hose Bib: Backwater Value: Other Fixtures: Drywell- Trench Drain: Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers: Heat Pump: N Hoods: Other Units: Furn <100K: Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 201 -400 amp: 201 -400 amp: W/O Svc/Fdr: Mfd Home /Feeder /Svc: 401 -600 amp: 401 -600 amp: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: 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: OTR SF VB R -3 0 Owner: Contractor: BROWN, JEFFREY P & CHERYL L LANDSCAPE EAST & WEST Required Items and Reports (Conditions) 13934 SW MISTLETOE DR PO BOX 430 PORTLAND, OR 97223 CLACKAMAS, OR 97015 PHONE: PHONE: 503 - 256 -5302 FAX: 503 - 297 -6993 Total Fees: $540.51 This permit .a + « „p subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be do in accordance wi 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 da . ATTENTION: Oregon I- , re. ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9 2- 001 -0010 rough OAR • : r -0 .' ' ou may obtain a copy of the rules or direct questions to OUNC by calling 50 32.1987 or 1.800.332.2344. Is ued By: , — td i Permittee Signature: !wl — Call 503.639.4175 by 7:00 a.m. for the next available inspection da I 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 RECEIVED 1oR (II I It I I .I: Ov1.1 City of Tigard Received . Date/B : / . ism _ PermitNo./1 ,/ - 00/ IN . " 13125 SW Hall Blvd., Tigard, OR 97222p,N 11 .201 PlanRevi - Phone: 503.639.4171 Fax: 503.598.1 0 Date/B : , © m �' erPe`m`tCa' .20// - 000/ T I G A R D Inspection Line: 503.639.4175 crry OF TIGARD Date Ready : y: ®see Page 2 for Internet: www.tigard- or.gov Notified/Method: ,2 1/ J ( � Supplemental Information - a)ITII .DING DIVISION Lt; 9401; 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: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. .eSl I- and 2- family dwelling ❑ Commercial/industrial Valuation: $ f ( Q(10 ❑ 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: 139311 5 LV /14i; 1 ketae. Or, New dwelling area: square feet City/State/ZIP: r It arJ oe R7u3 Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: to f0 W ✓l Covered porch area: square feet Cross street/directions to job site: s 6u II ,416, 1 Deck area: square feet g'3. a& - - square feet ea S f ' � Kw y �je NG � Ji e,w T � jPr. � ., � � �' 0. � Other structure area: a� (<s g q /'1 15 M G G REQUIRED DATA COMMERCIAL -USE CHECKLIST Subdivision: I 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. gd t 'P 5:tYl '/�/e.. 0,ie r mac et-6.6 Valuation: S Existing building area: square feet New building area: square feet Iii PROPERTY OWNER ❑ TENANT r Number of stories: Name: A e kT a,.� C1412 ( eat Type of construction: Address: i 31 `l L( Sw /N T5tie hG p r. Occupancy groups: City/ State/ZIP: T1' p,,d U R 17213 Existing: Phone: (5t) ) 521 O eg,0 Fax: ( ) New: V APPLICANT ❑ CONTACT PERSON NOTICE Business name: L a r ct 5 (A pe E as 4- i west All contractors and subcontractors are required to be Contact name: SSW 9°i�`� licensed with the Oregon Construction Contractors Board `f J under ORS 701 and may be required to be licensed in the Address: go 8 O y 3a jurisdiction in which work is being performed. If the City/ State/ZIP: C I & E y,ng5 t U �Z j 70 (j apply: ant is exempt from licensing, the following reasons Phone: (03) Z5e 53oz, Faxx:: (5 2_97 (0993 E -mail: J aIM I ■C.$ l� (44,151.A.0 ee &1.3'T- a h- CONTRACTOR Business name: L S l t; ICAS f 1 Wcsi BUILDING PERMIT FEES* (Please refer to fee schedule) Address: fly o bic y D City/State/ZIP: CiAc ka t,,,�� j, o. s170 (j Structural plan review fee (or deposit): 4 ` s,/ FLS plan review fee (if applicable): Phone: (503) 250 530,4 _ Fax: (co)) Z97 6993 CCB lic.: ' f 577 f i Total fees due upon application: �`I f Amount air— / 4 , Sy Authorized signature: • c. y This permit application expires if a permit is not obtained C within 180 days after it has been accepted as complete. Print name: JANm; C ` , / dW 7l are/ Date: * Fee methodology set by Tri- County Building Industry / e ice Beam 7 B6- )( � I :\Building\Permits\BUP -RES PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB) %lam ,6 0/2/// • Building Division Development Code Provision Review T i n ►t ° Residential Projects Building Permit No: /`7S7 O /f - OOO /S / T /S /2E? 2u /,e.s:21 CWS Service Provider Letter Received: Yes ❑ No , N/A ❑ ' 'L /C vJ7 S4c3n, 77 J /9/3 771 Cc)S 5/' - Routed Plans: Original Plan Submittal Date: /// 1st Revision Submittal Date: l /d,l // g? ❑ Site Plan Only 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. �L Planning Review (contact 3 ( t( at 503 -718- t) V5 or @tigard- or.gov) L Use Case o. Name 1.'4 LL �& !fi Le T 5 L Zoning r - � 6-D 0 Setbacks: ront 14 Rear (S� Side Street Side /d Gara e a aximum Building Height 3‹ Actual Building Height ,i EK Clearance I ! asements ) 0 pr i�ik E Sensitive Lands Type: Notes: Original Plan: Approved ❑ Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 -718 -2464 or MikeW@tigard- or.gov) ❑ Actual Slope: l e n Notes: Original Plan: Approved gf Not Approved ❑ Date: / /6 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard- or.gov) Vi Street Trees Protected Trees Notes: ^ :t r- 14-x^1 Original Plan: Approved l/ Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @ tigard - or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes o ❑ Date Routed to Building: I // , Page 2 of 2 , h T L'J T �/� Clean Water Services File Number JAN 122011 C1eanWateer\ Services I - $)OOO 7' i - -- sitive Area Pre - Screening Site Assessment B...,..,t — , 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): 2S104C005100 Name: Jeff & Cheryl Brown Company: Address: 13934 SW Mistletoe Dr. Site Address: 13934 SW Mistletoe Dr City, State, Zip: Tigard, OR 97223 City, State, Zip: Tigard, OR 97223 Phone /Fax: 503.521.0880 Nearest Cross Street: Benchview Dr. E-m jcjdbrow @comcast.net r 4. Development Activity (check all that apply) 5. Applicant information El Addition to Single Family Residence (rooms, deck, garage) Name: Bjorn Nordqulst ❑ Lot Line Adjustment ❑ Minor Land Partition Company: Landscape East & West ❑ Residential Condominium ❑ Commercial Condominium Address: PO Box 430 ❑ Residential Subdivision ❑ Commercial Subdivision Clackamas, OR 97015 ❑ Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip: Other Phone/Fax: 503.256.5303 fax 503.297,6993 E -Mail: bjornn@landscapeeast.com 6. Will the project involve any off -site work? ❑ Yes Er No ❑ Unknown Location and description of off -site work 7. Additional comments or information that may be needed to understand your project The scope of work includes a paver patio and roof structure over a portion of the patio. 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 1 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 Nam Bjorn Nordquist Print/Type Title Sales Manager Signature /U / ! Date // /// FOR DIS RV' 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. ❑ 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 07 -20, Section 3.02.1, All required permits and pprovals 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 signficantiy 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 07 -20, Section 3,02,1. 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 • :finitlon of development or the lot was platted after 9/9/95 ORS 92.040(2), NO SITE ASSESSMENT OR SERVICE PRO VI . R LETTER iS R Q, IRED. Reviewed by/rtet. ' s/ L. Date 2550 SW Hillsboro Highway • i tilisboro, Oregon 97123 • Phone: (503) 681-5100 • Fax: (503) 681 -4439 • wvrw.cteanwaterservices.org