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Permit . _ _ - CITY OF TIGARD MASTER PERMIT .` COMMUNITY DEVELOPMENT Permit #: MST2011 -00086 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/26/2011 Parcel: 25111 BD00305 Jurisdiction: Tigard Site address: 9840 SW INEZ ST Subdivision: PEMBROOK HEIGHTS Lot: 5 Project: SULLIVAN Project Description: 528 sf. accessory structure. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left 0 Parking Spaces: 0 Height: 11 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: $20,623.68 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 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'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 Ecompasing: N Other: N Other Description: g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB U 0 Owner: Contractor: WNTERBOTTOM, LISA M LIVING TRUS OWNER Required Items and Reports (Conditions) BY WINTERBOTTOM, LISA TR & 1 Ersn Cntrl 503 - 681 - 4444 SULLIVAN, JOHN R TR TIGARD, OR 97224 PHONE: 503 - 431 -6919 PHONE: FAX: Total Fees: $696.80 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 Notif is enter. Those rules are set forth in OAR 952- 001 -0010 through 9 You may obtain a copy of the rules or direct questions to OUNC ••IIin! i` : or 1.800.332.2344. Issued By: "t " " - - _ Permittee Signature J Call 503.639.4175 by 7:00 a.m. for the next available inspection .ate. " This permit card shall be kept in a conspicuous place on the job site until comp etion of the pro • ct. Approved plans are required on the job site at the time of each ins.-•ction. Building Permit - Application q ' d Residential -- -- - -- FOR OFFICE USE-ONLY __ - \c p\\ Received City of Tigard 1� 'L Date /13 1 9 �� Permit No.: . T / .t ss nn P lan ived III ° 13125 SW Hall Blvd., Tigard, OR 97223 P`� '! 2 Phone: 503.718.2439 Fax: 503.598.1960\u` .o e ,,' �9 DateB : ( k ; Other Permit: T G A It D Inspection Line: 503.639.4175 I T* e�'� Date ' ea.) : , : ® See Page 2 for Internet: www.tigard - or.gov C' o� Notified/Method: "T : ii Supplemental Information ne \ \ \ - S1()444.- (,,J t ' i CA/ TYPE OF WO .REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ Demolition Permit fees* are based on the value of the work performed. ❑ New construction Indicate the value (rounded to the nearest dollar) of all A Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 6,43,1.22), ® 1� and 2- family dwelling El Commercial /industrial L f 1 �� � ▪ Accessory building El Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address: 98 lib S (• (,j f 2 57 New dwelling area: square feet City/State /ZIP: T G f q, 2 0 o f 9722(-1 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area square feet Cross street/directions to job site: /0(31 i- Deck area: square feet Other structure area: S``2 8 square feet • REQUIRED,DATA: COMMERCIA - 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. S 14 Of XI Q COQ ERG e LA L( A 2 c I -Z - r - 67c H C Valuation: $ Existing building area square feet To C ,� -r s I D F OF \, \ o New building area: square feet El PROPERTY OWNER ❑ TENANT Number of stories: Name: J 6\A S u t L l J f ^/ Type of construction: Address: C) , j 0 S c,), (t ) (F S ' Occupancy groups: City /State /ZIP: T( Ae� 1 �r Y 9 7 2 2 — Existing: • Phone: (S b3 ) I. 3i ^ (,o 1 9 Fax: ( ) / New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: (Pleaserefertofeeschedule) 'r Structural plan review fee (or deposit): Contact name: 1 � „n FLS plan review fee (if applicable): Address: t C ` " ° Total fees due upon application: City /State : 1 " Amount received: Q ‹h-One: (c03) L H / - 67 p c Fax:: ( ) . -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: ( C..Y` Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City /State /ZIP: Permit Fee (includes plan review $180.00 and administrative fees): Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60 CCB lic.: 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: J 6 N , S' L L 1 U • nJ Date: 1 Li ' (70.1( * Fee methodology set by Tri -County Building Industry Service Board C\ Building \Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(I 1 /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No.: IN v 1 3125 SW Hall Blvd., Tigard, OR 97223 Date/By: C , ._ Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TIGARD 24 Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical 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. ❑ ❑ ❑ 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. El ❑ El 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 1 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state CI ❑ CI 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. 1 (1 ite /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, ❑ ❑ El 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- ❑ ❑ ❑ 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. d, 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ 12 ❑ 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 ❑ ❑ ❑ s ystem s, see item 22 , "Engineer's calculations." 19 B eam 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. a 20 Manufactured floor /roof truss design details. ❑ El ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ El ❑ for four or more appliances. 1 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 as e licable to the iro'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 ". ❑ ❑ ❑ 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. El ❑ ❑ 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. 1:\Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11/02/COM /WEB) Building Division .14 ... Development Code Provision Review TIcARD Residential Projects Building Permit No: //J _. i (1) :t- CWS Service Provider Letter Received: Yes M No ❑ N/A ❑ Routed Plans: Original Plan Submittal Date: 5 7 19/1 / 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 (/) 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 al ong left only if approved. 4'ishe_, " Planning Review (contact 1 �-� WV:4 -✓� at 503 -718- L`�s2 or /B f- @tigard- or.gov) Land Use Case No. Name f�E. w. b ( /!(,l S�i.�r ()J(,o) I "Zoning g - .5 pi Setbacks: 4< Front Lv * Rear 5 Side S Street Side / 1/4 Garage 2 t Er Maximum Building Height I S Actual Building Height / Y �z Er visual Clearance Easements [D/Sensitive Lands Type: /10 N �- Notes: 1 Lie s 5 1tucTt.c%4 O n _y Original Plan: Approved EP"' Not Approved ❑ Date: .S/ f' j// 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: 7 Notes: Original Plan: Approved,( Not Approved ❑ Date: 51 6!i Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City borist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) 1; treet Trees Protected Trees Notes: Original Plan: Approved El Not Approved ❑ Date: 5 01 /00i) 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 i o •. . Date Routed to Building: / • Page 2 of 2 • D n _ I(- Oo 2v Z_ Services Clean Water Services File Number CleanWai IJ er. - MAY 20 1 itive Area Pre- Screening Site Assessment f 1. sdktion: l C, �(Z OF � k • 2. Property information (example 1S234AB01400) 3. Owner lidomration MAY 1 9 2011 T a x l o t iD(s): Z S 11% F a d es 0 ° 305- Name:. 0\ ■J S kn t_ t tp •J � P1 Company t ra,r f�A lU Address: 9 ® f d S L) w E ' Site Address: '26' Y n • • s 1 ".1 4 s City. State, zip: c, H Kn. 0 2 ",47 C lV � 1i�N City. State, zip: ?'t l A&Q O R `1 ? 2 2 -i Phone/Fax: CO 1 I - In 9• t 9 * 's Nearest Gross Street JOC) � E- Mait: C'CdQ4 ' „I.t - ' oW� 4. Development Activity (chedk all that apply) 6. Applicant infonnaton Addition to Single Family Residence (rooms, deck, garage) Name: —\ cabin/ Svt t L I W3"' Q Lot Line Adjustment © Minor Land Partition Company: ® Residential Condominium 0 Commercial Condominium Ad dreS 406 L © Residential Subcivision j Commercial Subdivision Cit © Single Lot Commercial i' Multi Lot Commercial ' gy p' Other w ne tc S N e e ^ 2" >( ' o' A'( ?47cf n Phone/Fax: " 'V' t uvr■ s` ) SEw E != C OPIN CC E -Mali: 6. Will the project involve any off -site work? DiYes El No © Unknown • Location and description of off -site work 7. Additional comments or information that may be needed to understand your project • 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 Qtralitys Department of Slate Lands andtorDaparfinentof 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, des and agrees that employees of Clean Water Services have author0y to enter the prat site at all reasonable times for the purpose of inspecting project site comfit's and gathering hnformafon relied to the project site I certify that i am : : i : vdth the Information c o r t f a k d In this docuinent and tothe testof my imowtedge and betet this information b tee, complete, and aasrrce. Print/Ty 11•111 +r . is 'gpe S vA (L L✓n! I Printli Title Signature V l 1� Date ( in./Y -1 • 7 n t FOR DIST CT USE ONLY ❑ Sensitive areas pate:Maly odstan sib or within 200 site. 7tEAPPUCANT MUST PERFORM ASUEASSESSMBffPRIORTO[SSUANCEOFA ERVICE PROVIDER LETTER IfSanslllveAteac exist on the sib erwithin 200 faeton emijomat properties, aNabualResoumesAssessmentReport also be required. Based an review ofter stdtrrdted netertets wittiest tavaila le information Sarsithe areas do not appear test an se orwithb 200' of the site. Ms SensDveArea PreS'aeening Site A ht does NOTWimhnatethe need to evaluate and protect water quality sensitive areas if they are subsequently discovered. This doctmentadi serve as your Sendce Provider letter as required by Resolution and Order07-20, Section 3.02.1. All required pemdts and • approvals must be obtained and completed under applicable local, State, and federal law. ❑ Based on review of the outwitted materials end beat wobble Information the above nisanoedprojecuwE notskytilkently tr +act the ndsttng orpeternitaity sensitive area(s)iound near Mesta ThlsSahstliue ea Pre-Screening SiteAssessmatedwer NOTelim the need tlo evaluate and protect ed water qua* seu eareas ifFrey are subsequentlydbcovwed This doaanehtwfllserve as your Semite Proves Mkt as requited by ResohMou and Order 07-20, Section 3.02.1. All required permits and 11pp: ovals must be obtained and completed under applicable lad, state and federal law. ❑ This Service Provider Letter Is notvaild unless CWS approved site plants) are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after a /95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDE ' LETTER IS • _ o UIRED. Reviewed by AKA A Date 5/I 2 G J I111• W - lira : - • Fa!_aii€ �' S(.i " Pis . +s.) 31 1, ;0- • f (53_, • • Information Notice to Owners About t `___ ; ' C onstruction Responsibilities .:' i r -% (ORS 701.055 (5)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503- 378 -4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503 - 947 -1488. • Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503 - 945 -8091 or go to http: / /www.oregon.gov /DOR /BUS /docs /211- 055.pdf for the appropriate forms. • 'Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503 - 947 -7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their website at www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough -in and finish trades. CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052 Telephone: 503 - 378 -4621 — Fax: 503 - 373 -2007 Website Address: www.oreaon.gov /ccb f /property_owner adopted 12 -04 -07 This Copy for Permit Applicant Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. 0 I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Prin Name of Permit Applicant s ■ 9 , Sign :ture of Pe it Applicant Date Permit #: r at3 ! Address: l to �� T ,-A -- rfbg rdi de 9? nF Issued by: Q • l -- Date: ' /��� This Copy for Permit Offices