Permit CITY OF TIGARD MASTER PERMIT
1 .1,1 s o COMMUNITY DEVELOPMENT Permit #: MST2012 00093
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/16/2012
T IGARD Parcel: 2S104CD01100
Jurisdiction: Tigard
Site address: 13817 SW BOXELDER ST
Subdivision: HILLSHIRE ESTATES Lot: 11
Project: Baldwin
Project Description: Replace existing deck along with 90 square foot addition.
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: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right. 0 Detectors
Total: 0 sf Value: 114,650.00 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
Fumy =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 SvcJFdr: 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:
ADD SF VB R -3 0
Owner: Contractor:
BALDWIN. RICK J & PATTI A JP QUALITY CONSTRUCTION & REMODELIF' Required Items and Reports (Conditions)
13817 SW BOXELDER ST 7608 CHAROLOIS CT
TIGARD. OR 97223 GLADSTONE. OR 97027
PHONE: 503- 998 -2944 PHONE: 503- 939 -5885
FAX:
Total Fees: $617.27
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 it work • •ended for more the 180
days. ATT 10 : regon law requires you to follow the rules adopted by the Oregon Utility Notification ter. Th••se rul-.- are set forth in OAR
952 -001- 10 through R 9 001 - 0090. -You may obtain a copy of the rules or direct questions to OUNC by calling 50 987 or I.:10.332. 44. -
Issued B • & & /'/ -06 Permittee Signature: k
Call 503.639.4175 by 7:00 a.m. for the next available Inspection . a
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 APDlicati h
v CEI
Residential "ED i oi; oi. i is ►_ t i_ o\ , Received City of Tigard MAY - 8 ?O12 ' /y TAM Pc®tNo.: 1 — 73
1111 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review is. •
R ' Phone: 503.718.2439 Fax 503. ri: FTIGARD Date/By. 40 f it1 Other Pe[mit:
TIGARD Inspection line: 503.639.4175 Daze Ready/By: lurk See Page 2 fbr
Internet, ,,,ww.tigard -or.ge„ BUILDING DIVISION Notified/Method: J ® Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Addition/aheration/replacement CI Other Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
A
G CI
1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ I LI, 6S0-
❑ 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: 138 fl b' 1? o c4 a.0 New dwelling area square feet
City / State/ZIP: ,C,b cU\ t 0(2. G 122 3 Garage/carport area square feet
Suite/bldgJapt. no.: I Project name: Covered porch area: square feet lc e
Cross street/directions to job site: Deck area - 3q 0 square feet( ?�,
CACI� mg' t-‘,116‘ O O tk pgtGW -. Other structure area square feet 7,
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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
DESCRIPTION OF WORK work indicated on this application.
— 11 Valuation: Q7cj6% -,rV . LC .
Valuation: $
1. 3t AA f\.t�� % �ctC �(' _ � � 0,1.0. iL
t 1 _ + . r � _ Existing building area: square feet
� New building area: square feet
g PROPERTY ` OW 1 � OWNER I ❑ TENANT Number of stories:
Name: R \Gp� r to �J L 1 Type of construction:
Address: i ?� O % /J� r r i JUI<<• C ' ` ''. Occupancy groups:
City/State/ZIP: } t 0 2. 12•Z 3 Existing:
Phone: (9)3) C l U — iC t:./ j4 Fax: ( ) New:
R. APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee sd ed de)
Business name: '3? ate _\ ` COn Y NI �' • ln • Structural plan review fee (or deposit):
Contact name: O 6O t� ? t CAKCA S 1 l
Address: ?6a ' G�rOkO:ts c- . FLS plan review fee (if applicable):
Vl� � CO O IL . C , O Z 1 Total fees due upon application:
City/State/ZIP: / J / Q/ .
�3 o f 3 9 51 I ( ) Amount received: ((p
Phone: Fax
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: Jasot,, g. Aey'oeu if . Cor> -‘
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted Photo Voltaic Solar Panel System.
Business name: � �.,1 tl�y Co ra ,c +on� J Submit tai. sets of roof plan with connection • ,: ' s
r
^' and fir ed , : �
.. •.t access, along with the 20 I Oregon
Address: ?6 G a O 1 o; 5 c i- Solarins - airy Cale chec . '
' State/ZIP: �71 Permit F ee (includ an ew
1'L[ . , or , 70L 7 and admini . ees): $1 80.00
City/State/ZIP:
) 939— 5 I ( Fax: ( ) State surcharge o of permit fee . $21.60
CCB lic.: ) .7 7 14 ,
To fee due upon application: $201.60
Authorized signature: 72 „....,, This permit application expires if a permit Is not obtained
■
within 180 days after it has been accepted as complete.
Print name: *3 0 N t c lAc. !)l yk r I Date: L • Fee methodology set by Tri - County Building Industry
�r0 Service Board.
Building Permit Application Checklist
One- and Two - Family Dwelling 1 • ' r . 01 r ( 0\ 1.1
11,4 City of Tigard Permit No.:
a 13125 SW Hall Blvd., Tigard, OR 97223
Associated permits:
Phone: 503.718.2439 Fan 503.598.1960
T I c' A R ti 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet www.tigard- or.gov ❑ other.
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 0 0 ❑
3 Verification of approved plat/lot ❑ 0 ❑
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 0 ❑ ❑
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 4-1. 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, connectidq details, vent size ❑ 0 0
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ 0
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, well 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. 0 ❑ ❑
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 0 ❑ ❑
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 ed ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (ie., shear wall, roof truss) shall be stamped by an engineer or ❑ 0 ❑
architect licensed in on and shall be shown to be licable to the 'ect under review.
23 Three (3) site plans are required for Item 11 above. Site plans must be 8-1/2" x 11" or 11" x 1T'.
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. ❑ 0 0
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 ❑ C []
Street Tree List
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, j] ❑ ❑
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, 0 ❑ ❑
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- RESPermitApp.doc 02 /24/2011 440- 4613T(11102/COM/WEB)
l 38 f (90 Pa)k g L-7
7- w,►J (DE-d-i.
,1 o Building Division
Development Code Provision Review
T I G A R D Residential Projects
Building Permit No: • ' `' T 9O / - £ X
CWS Service Provider Letter Received: Yes ❑ No ii N/A ❑ t om- ^ -i- 4 ;�
Routed Plans: b.
k p �� ��
Original Plan Submittal Date: f i L `� 6
1st Revision Submittal Date: ❑ Site Plan Only i F PO66-1 Pa2..t
2nd Revision Submittal Date: 0 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. ' /
Planning Review (contact `' at 503 -718 �i 1 /44 or @tigard- or.gov)
La�Use Case Flo. ' Name ____A
Et Zoning — 7 P 1) ,
Er Setbacks:
— / Front 1 3 Rear / S Side ` �� C1 Street Side / Garage '
M Maximum Building Height 3 Sr Actual Building Height —
ErVisual Clearance
EKEasements
RrSensiti - Lands Type: YL6
Notes: f
•
Original Plan: Approved Not Approved ❑ Date: qczy/2._
� PP PP
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 (:
Notes:
Original Plan: Approved Not Approved ❑ Date: 5 1 9 f i Z
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
Protected Trees
Notes:
•
Original Plan: Approved Ei Not Approved ❑ Date: 0/0
Revision .1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ ' Not Approved ❑ Date:
rt
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 Applican
Revision 2: Date Sent to App ' nt
Okay to Issue Permit: Yes N. ❑
Date Routed to Building: /
Page 2 of 2
Clean Water Services File Number
CleanWate� Services I 12- 001015
Sensitive Area Pre - Screening Site Assessment
1. Jurisdiction: Tigard
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Rick Baldwin
R2036579 Company:
Address: 13817 SW Boxelder St.
Site Address: 13817 SW Boxelder St. City, State, Zip: Tigard, Or 91223
City, State, Zip: Tigard, Or 97223 Phone/Fax: 503 - 998 -2944
Nearest Cross Street: HltlshIre Dr. E -Mail: vintagevibe @hotmail.com
4. Development Activity (check all that apply) 5. Applicant Information
ER Addition to Single Family Residence (rooms, deck, garage) Name: Jason Pickelsimer
❑ Lot Line Adjustment ❑ Minor Land Partition Company: JP Quality Construction & Remodeling
❑ Residential Condominium ❑ Commercial Condominium
Address: 7608 Charolais CT
❑ Residential Subdivision ❑ Commercial Subdivision
City, ate, zip: Gladstone, Or 97027
❑ Single Lot Commercial ❑ Multi Lot Commercial
Other Phone/Fax: 503 - 939 -5885 phone/ 1-866-823-0260 Fax
E -Mall: Jason @beyonddiy.com
6. Will the project involve any oft -site work? ❑ Yes ® No ❑ Unknown
Location and description of off -site work
7. Additional comments or information that may be needed to understand your project
Remove existing Cedar deck and replace with new IPE wood deck.
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 andlor 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 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 Jason Pickelsimer PrinVlype Title General Contractor
ONLINE SUBMITTAL Date 5/6/2012
FOR DISTRICT 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. Ii 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 avaDable information Sensitive areas do not appear to exist on site or within 200' of the site. This
Sensitive Area Pro - Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently
discovered. This document we serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. Al 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 available information the above referenced project will not significantly 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 dominant 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.
13 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 PROVIDER LETTER IS REQUIRED.
Reviewed by Date
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone (503) 681 -5100 • Fax (503) 681 -4439 • wow cleanwaterservices.org