Permit CITY OF TIGARD MASTER PERMIT
1 $ COMMUNITY DEVELOPMENT Permit #: MST2011 -00025
T I C; A R. 0 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/07/2011
Parcel: 2S103DA05500
Jurisdiction: Tigard
Site address: 13465 SW 107TH AVE
Subdivision: Lot: 0
Project: Hurley
Project Description: 162 sq ft addition to existing detached garage.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 162 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: No
Total: 0 sf Value: $10,000.00 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 Storm Sewer: 0
Drains: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell- Trench Drain: 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 add'I 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
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ACS SF VB R -3 0
Owner: Contractor:
HURLEY, DENNIS & DANA JIM SAUBLE CONSTRUCTION LLC Required Items and Reports (Conditions)
13465 SW 107TH AVE 23405 SW MOUNTAIN HOME RD ,
TIGARD, OR 97223 SHERWOOD, OR 97140
/
PHONE: 503 - 698 -6659 PHONE: 503 - 544 -1415
FAX:
Total Fees: $480.67
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 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 r. Those rules are set in OAR
952- 001 -0010 thro • ' 952- 001 -0090. You m' • • • - o• - . rect questions to OUNC by calling 50 32.19: or 1.800.332. 34;e
1 /
Issue•'- - _ ......- ./ / / t Permittee Signature: ,1 < / /A� .�
1 : 39.4175 by 7:00 a.m. for the next available inspectio date.
This permit ca ' 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 1 EK/ % A
Residential FOR OFFICE l "I ONLY
City of Tigard D / // ,• Permit No.: az j/ e 6 ~`
• 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 natPlan Review 4 ,24/ ( other Permit:
T I G n I u Inspection Line: 503.639.4175 Date Ready/By. / Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: ,ot /¢ / Supplemental Information
1 4i1 W
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.
❑ I- and 2- family dwelling ❑ Commercial/industrial Valuation: $ /Q I QQ D
® 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: 13465 SW 107 Ave New dwelling area: square feet
City/State/ZIP: Tigard, Or Garage/carport area: 162 square feet
Suite/bldg. /apt. no.: Project name: Detached Garage Addition Covered porch area: square feet
Cross street/directions to job site: Park St. & 107 Ave Deck area: square feet
Westward on Park St. off 99W to 107 Ave. Turn left onto 107 Ave, proceede Other structure area: square feet
one block to the end. Site is on the right. REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: N/A I Lot no.: 5500 Permit fees" are based on the value of the work performed.
Tax map /parcel no.: 2S13DA -05500 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.
9X18 ft addition to existing 18x20 ft detached garage. Valuation: $
Remove and reconstruct roof of 18x20 existing garage to match the new addition Existing building area: 360 square feet
New building area: 162 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Dennis and Dana Hurley Type of construction:
Address: 13465 SW 107 Ave Occupancy groups:
City/State/ZIP: Tigard, Or. 97223
Existing:
Phone: (503)698.6659 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: Dennis Hurley licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13465 SW 107 Ave jurisdiction in which work is being performed. If the
City/ State/ZIP: Tigard, Or. 97223 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 968.6659 Fax: : ( )
E -mail: dndhurky @frontier.com
CONTRACTOR
Business name: Jim Sauble Contractor / Handyman BUILDING PERMIT FEES*
Address: 23405 SW Mtn. Home Rd. (Please refer W se es)
Structural plan review fee (or deposit):
City/ State/ZIP: Sherwood, Or. 97140
FLS plan review fee (if applicable):
Phone: (503) 628.0748 Fax: ( )
CCB lic.: 163459 4f // Total fees due upon application: 1/4/4. 7 7
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Dennis Hurley Date:
* 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)
. a/ A- Dt4---
' Building Division PLM f
Development Code Provision Review
r c n x o Residential Projects
Building Permit No: h .1 D / I" DOD 02 S
CWS Service Provider Letter Received: Yes ❑ No N/A ❑ a/WA eol-w/ .lt0 -/
- ,.,a,� /.
Routed Plans:
Original Plan Submittal Date: o'Z /�/ 1/
1st Revision Submittal Date: ❑ 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 (1) 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.
Planning Review (contact ST+ L �Z2fN�4h at 503 718 t` or / /s� G @tigard- or.gov)
Land Use Case No. 0/0 Name / `9
EK'Zoning � • 3.5
GYS'etbacks:
Front WA Rear 5 Side S Street Side 4* G age 26
CYMaximum Building Height is Actual Building Height 7 'a.
B" Visual Clearance
la Easements
l;r Sensitive Lands Type: N1 • N G
Notes:
Original Plan: Approved Er Not Approved ❑ Date: 2/l/
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:
Notes:
1
Original Plan: Approved ' Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date: 4 1-72(-
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
1
City borist Review (c ontact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
t reet Trees
Protected Trees
Notes:
/
Original Plan: Approved o Not Approved ❑ Date: 2/L
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 A plicant
Okay to Issue Permit: Yes No •
Date Routed to Building: lZ
Page 2 of 2
02/12/ 2011 04:56 5036280748 SAUBLE PAGE 01/01
Feb. 3. 2011 8:35A No, 0152 P. 1
tl
I ir FEt 0 ?01i Clean Water Services File Number
CleanWate Services I II- 00 02-co
rte= n,s aitive Area Pre-Screening Slte Assessment
1. JLIisdIction: Washington County
2. Peewit Worts atian (example 1S234ABO1400) 3. Owner Information
Taos tot [D(e>3: 2S103DA05500 Name: Dennis Hurley
Company:
Addreept 13485 SW 107th Ave
Site Address; 13466 SW 147th Ave Clt mete, Zip: Tigard, OR 97223
City. Stara, Zip: Tigard, OR 97223 Pharts/Fax: 583- 3134269
Nearest Cross Street: E - Neil:
4, DeveloptnentAathrity (amok ell that apply) O. Applicant Information
• Addition to Single Family Residence (rooms, deck, garage) H ama; Jim Sauble
Lot Line Adjuetrnent C] Minor Land Psrttion Company: Jim Sauble Construction
U Residential Condominium d Commercial Condominium Address: 23405 SW Mtn Home Reed
❑ Residential Subdvision ❑ Commercial Subdivision
Single Lot Commardel ❑ multi Lot Commercial city, State, Zip: Sherwood, OR 87140
Other Phone/Far 603 -544 - 14151 603-828 -0748
E -Mail •
6. Will the project Involve any off -site work? ❑ Yes No ❑ Unknown
Location and description of oft; - site work •
7_ Additiknei comments or Information that may be needed to understand your project
ADDING 9 X 18 TO EXISTING SHED
This application does NOT replace erecting and Erosion Control Permits, Cennecttan Permits, Eddins Permits, Site Development Pelmets, nee
1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Departrtaernt of the Army
COE. All required permits and approvals must be obtained and completed under applicable local, elate, and federal law,
By signing this form, the Owner or C» er'a with mired agent or re veeentelve, acknowledges end agrees net employees of t Lean Water Servles nava authority
to enter the pinject site at all reasonable Canes for the purpose of fnepecting Prolect silo Conditions and gathering iformalion related to the pro)oct site. I °elfy
Ihai I an larnilar with the lsfonnalion contained in This document and to the best of my knowledge and belief, this information is too, complete, end ammo.
Printilype Name Jim Bauble Prgrt/Type Title
Signature DMb Feb 2, 2011
FOR DISTRICT USE ONLY
.I Sensitive areas Medially exist on site or wither 200' of the sae. THE APPLiCANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SEIWICE PitoViuER LETTER, It Sensitive Areas exist an the site or within 200 feet on adjacent pi a Natural Resowcee Asaeesment Reedit
may also be required.
Based on review of the submitted materiels end beat available Information Canallfve areas do not appear to midst on site or wizen 200' of the site, Thh
VV �sitiveArea PreSoeenine S e Assessment does NOT etknlnate the need to evaluate and prat water quality sensitive areas it they ere subsequently
discovered. This document will serve es your Service Provider latter as required by ResoJUtlon and Order 07 Section 3.02.1. All required permits and
approvals must be obtained end completed under applicable local, State, and federal law.
fj Based on review of the submitted materials and best avaiable kifamratdon Ore above referenced project viii not slgnlncantly Impact the exlsttg of potentially
sensilee area(s) found nee' the site. ids SensilveArea tie- Saeenag Silo Assessment does NOT eliminate the need to evaluate and protect additional water
quality sensiive areas it Meyers subsequently discovered. This doamrent will ewve as your Service Provider fetter as required by Resolution and Order
07-20, Section 3.02 All required permits and approvals nnrst be otnetred end completed under applicable local, slate and federal law
Q This Service Provider Letter to not valid unless CWS approved site plants) are etched.
f] The proposed activity dose not meet the definition of development or the lot was platted after e/8195 ORS 92.044(2}. NO SITE ASS6SSME14T OR
SERVICE PROVID - LETTER IS REA O.
Reviewed by Air .9.46,1 . . Date 1
:5E23t41- 1ets -�H_I, r- H11_bc•0 ;a; - - . _ • _ _ . 'a
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