Permit q CITY OF TIGARD MASTER PERMIT
II I :' COMMUNITY DEVELOPMENT Permit #: MST2011 -00158
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/16/2011
Parcel: 1 S 135DC07000
Jurisdiction: Tigard
Site address: 11675 SW 91ST AVE
Subdivision: CHARBEN Lot: 9
Project: DRENNAN
Project Description: 520 sq ft accessory structure.
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 Seconds 0 sf Garage 0 sf Front. 0 Smoke
Dwelling Units 0 Third 0 sf Right 0 Detectors
Total 0 sf Value $20,311.00 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
Drywell- Trench Drain' 0 Other Fixtures 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 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:
ALT SF VB R -3 0
Owner: Contractor:
DRENNAN, JOHN W OWNER Required Items and Reports (Conditions)
BURNETT, JOHN FREDERICK 1 Ersn Cntrl 503 - 681 -4444
PO BOX 23603
TIGARD, OR 97281
PHONE PHONE
FAX
Total Fees: $775.80
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 Notification Center Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules • • erect questions to OUNC by calling 503 2 1987 1 800 332 2344.
Issued By:- Permittee Signature: ' Lh (1 ) , - )Aa2/j c/'L`
Call 503. • 3 , .141* :00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion f the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application e
FOR,OFFICE ONLY° •
City of Tigard �O �� DateB Received , Q D Permit No
13125 SW Hall Blvd., Tigard, OR 97 % P lan Review 1I/ Yak . ,.∎ !— 004, Ill• S -
Phone. 503.718 2439 Fax. 503.598.1960 C C ,AG` " � 5 � ' Date /B �a r& L+ e t Other Permit
TI,GARD Inspection Line: 503.639.4175 O i 0 Date Ready/By , funs IA See Page 2 for
Internet www.tigard -or gov C l `C1 `1
Notified/Method E Supplemental Information
SO V )1 • t
TYPE OF WOR
V REQUIRED DATA: 1- AND 2- FAMILY DWELLING
■ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value ( romded 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.
❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 1 31 I
Rj 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: //6 75 5. Lif/, 97 A sr �I v E * New dwelling area: square feet
City /State /ZIP: T!O /T $f b o i n T72.23 Garage /carport area: square feet
I
Suite/bldg. /apt. no.: Project name: Covered porch area square feet
Cross street/directions to ob site: ^ , 5T
I !Y � co /7N�R �� � a12GeNt3f/ =ll4 Deck area: ,� v square feet
Other structure area: �/. square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision I Lot no : Permit fees* are based on the value of the work performed.
/ / T Indicate the value (rounded to the nearest dollar) of all
Tax ma p / p arcel no. .� / DO D equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
'oN$ r,g f/or/ma. o'1qGG - A U L / ll1Ai 6r Valuation: $
Existing building area square feet
New building area: square feet
121 PROPERTY OWNER ❑ TENANT Number of stories:
Name: JOHN IA/ .IJe v.' A-A( Type of construction:
Address: 1 / 6 7 S t�/ V e Occupancy groups:
City /State /ZIP: 7 /c'AIt Q � 37223 Existing:
i
Phone: (.5 ( 3 5 q 2 Fax: ( New:
ril APPLICANT MI CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: TpH � � r� N/ViQN licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be 1censed in the
Address: `/ el, 75- s i L✓, q 1 Cr A. ye .- . jurisdiction in which work is being performed. If the
City /State /ZIP: / T/ 6 A R %/ Or', q 7 2.23 apply ant is exempt from licensing, the following reasons
Phone: (soy 6 3 9 - S 71 2. Fax:: ( )
E -mail: t i drenna A 8e I)is.v. co/ I
CONTRACTOR BUILDING PERMIT FEES*
Business name: 5Ayl1�� (Please refer to fee schedule)
/1 675' S, w �1 5r4 V . Permit fee
Address: f
State surcharge (12% of permit fee):
City /State /ZIP: (/GAR i UI' . 6 17 2..2 3 FLS plan review (40% of permit fee):
Phone: (So3) 6 39 - 57 9 2 Fax: ( ) (Due upon application)
CCB lie.: //'' ll 1 Total permit fees:
Authorized signature: W, I i e. �„ Amount received:
This permit application expires if a permit is not obtained
Print name: To M N 144 .beENNA N Date: within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I \B°Jdmg\Perm,ts\FPS- PermitApp doc 02/01/2011 440- 4613T(11/02/COM/WEB) ,i4)65-5-Z
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group •
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm •
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review (40% of permit fee): $ •
TOTAL: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
•
I \ Building \Permits \FPS - PermitApp.doc 02 /01/2011 2
'' Building Division
Development Code Provision Review
TIGARD Residential Projects
Building Permit No: H6'TAO/ i —co /5g
CWS Service Provider Letter Received: Yes yl No ❑ N/A ❑
Routed Plans: q,
Original Plan Submittal Date: / /7 /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 along left only if approved. ( c // ,
Planning Review (contact at 503- 718 -a J 1 or - 1 -'4NI.i @ tigard- or.gov)
Land Use Case No. Name D2E .I. /
Zoning - .
0' Setbacks:
Front c0 Rear tc, Side Street Side f 5--- ` Gar
El Maximum Building Height f< Actual Building Height ��
P sual Clearance
12 Uasements
'R! Sensitive Lands Type: 0 /
Notes:
Original Plan: Approved LX Not Approved ❑ Date: ( 03/t t
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: S
Notes:
Original Plan: Approved Not Approved ❑ Date: 1 9 //4-/i1
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)
S treet Trees
P rotected Trees
Notes:
Original Plan: Approved Not Approved ❑ Date: .
Revision 1: Approved ❑ Not Approved ❑ Date: / f
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 " No ❑
Date Routed to Building: :/ ,
Page 2 of 2
SE P 0 8 2 011 Clean Water Services File Number
B ; • ; �M C1eanWate Services Ilk- - 2 --
v -Sensitive Area Pre - Screening Site Assessment
.RECEI D
1. Jurisdiction: City of Tigard
2. Property Information (example 1S234AB01400) 3. Owner information lT
Tax lot ID(s): 1 S135DC - 07000 Name: John W. Drennan
Company: Homeowner S UI pSEP [ N' 1 li t 3 D
Address: 1 1675 SW 91st Ave. I ON
Site Address: 11675 SW 91st Ave, City, State d Oregon 97223
City, State, Zip: Tigard, Oregon 97223 Rhone /Fax[ 503 -639 -5792
Nearest Cross Street Greenburg Rd. E - Mail: j rennan8 @msn.com l
_ 1
4. Development Activity (check all that apply) B. Applicant information
❑ Addition to Single Family Residence (rooms, deck, garage) Name: John W. Drennan
❑ Lot Line Adjustment ❑ Minor Land Partition Company: Homeowner
❑ Residential Condominium ❑ Commercial Condominium 11675 SW 91st Ave.
❑ Residential Subdivision Address
❑ C ommercial Subdivision , Ti ard Oregon 97223
U Single Lot Commercial la Multi Lot Commercial City, Stabs, Zip: 9 9
Other Detached Accessory Building Phone /Fax: 503 - 639 - 5792
E -Mail: ldrennan8 @msn.com
8. WIiI the project involve any off -site work? ❑ Yes kti No ❑ Unknown
Location and description of off -site work
7. Additional comments or information that may be needed to understand your project
This is a 520 sq. ft. Accessory building. The use is for storage. (Vt' Pty rYt6„Nk AA9 ,OL,QCi2t
This application does NOT replace Grading and Erosion Control Penults, 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 zed agent or representative, acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times forthe purpose of inspecting project site e9nditons 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 Jo. W. Print/Type Title Homeowner
Signature /X , (-4-efellecon Data 9- 8-2011
FOR DISTRIC USE ONLY
[] Sensitive areas potentially exist on site or within 200' of the eke. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER. If Sensitive Areas artist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report
may also be required.
1st 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
approvals must be obtained and completed under applicable local, State, and federal law
❑ Based on review of the submitted materials and best evadable information the above referenced project will not significantly impact the existing or potentially
sensitive areas) 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. The 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 end federal law.
la 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 PROVID . R ER IS _EQUI -•. D. e
Reviewed by r L 'S.r r I % 4-4.---' Date q / /(
err 0 cvYI .I i ia1•• ∎ -, , • ., iN Gdr ^. ", c urs ) in .. :.0"1, UE. 1 -`'1 rQ • r ,501, y , . .r..A ^.a ..,tie r.4, is ;,,,•n∎a
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 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
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 a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
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.
Dfiiv VI/ bP A/A/A Ar
Print Name of Permit Applicant
I). ic - Zo /(
Sign ure of Permit Applicant Date
Permit #: /' I Y — kJ // t5tFe •
Address: // S // It Art ° - ���\\V4
d I 3
Issued by: . f _ Date �j /6// C • ` •
This Copy for Permit Offices
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard
= Building Division
T IGARD
TRANSMITTAL LETTER
TO: - /1/ /\/.-ZSpn/ DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
SEP 0 9 2011
FROM: `, O h-iN (4/ i EA/,VA ,v CITY OF TIGARD
BUILDING DIVISION
COMPANY: fOA f--r,uiAIt1 `�' -
PHONE: 503- 639 -3-?q.2._ By � !��/
RE: //‘ 75 s‘,J 97 '' /15 ,c2o / 56/ci
(Site Address) (Permit Number)
Zit ��vAi/lA/
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: • Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS:
FOR O FIC F, USE ONLY
Routed to Permit Technician Date: ( (� fi / (i Initial``
Fees Due: ❑ Yes ❑t -go Fee Description: Amount Due:
$
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
1.\ Budding\ Forms\ TransmittalLetter- Revisions.doc 02/08/2011
RECEIVED
SEP 07 2011
CITY OF TIGARD
BUILDING DIVISION
EL. 98.5'
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---..
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EL. 97.5'
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STRUCTURE
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SCALE I" - 201 - 0"