Permit CITY OF TIGARD MASTER PERMIT
C • - COMMUNITY DEVELOPMENT Permit #: MST2012 -00152
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/19/2012
Parcel: 2S103CB02601
Jurisdiction: Tigard
Site address: 12185 SW MARION ST
Subdivision: WILLAMETTE NO.2 Lot: 30
Project: Delano
Project Description: Construction of 24' x 22' accessory pole building. Per CWS, no erosion control required as just
excavating for the posts.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 12 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors: No
Total: 0 sf Value: $9,000.00 Rear: 5
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
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 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
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =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 8, 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:
DELANO, NELLIE M 8, GARY W OWNER Required Items and Reports (Conditions)
12185 SW MARION ST 1 Ersn Cntrl 503 - 639 -4175
TIGARD, OR 97223
PHONE: 503- 590 -1652 PHONE:
FAX:
Total Fees: $467.24
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 ne in acco • _ = 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
ys. ATTENTION: Ore.- la . s wires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
52 -001 -0010 through OAR 9 v:- 001 - u may obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I ued By: ,i■- ha i . � �i ; .I Permittee Signature: W
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Application
Residential - -- �, a I c)K OFFICI: US 1... ON
City of Tigard Date/By: � -�= �
' 1-161 /5"A �
�� , - � :: y: � a� � // / P erm it No.:
• 13125 SW Hall Blvd., Tigard, OR 97223 r� Plan Review
8 Phone: 503.718.2439 Fax: 503.598.196 U N 1 Z O Z Date/By: �� 111 Other Permit:
• i �, �, n
I Line: 503.639.4175
Internet: Date Ready/By: mss
Supplemental See Page l for
rnet r.gov �• t +i ;, Notified/Method:� J /Z� Supplememtal Information
B__ Nu L a'i�pU�!
TYPE OF � t REQUIRE DATA: 1- AND 2- FAMILY DWELLING
New construction ❑ Demolition Permit fees* are based on the value of the work performed.
v. Indicate the value (rounded to the nearest dollar) of all
Addition /alteration/replacement ®tether: 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: $ ! a
`kt Accessory building ❑ Multi - family Number of bedrooms: el
1 ❑ Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: r
- 7.
ob site address: a , t $ S s w M av t (ug, S -/- ►. 4- r New dwelling area: square feet
t /ZIP: \ S Q,, - 0 (i -cc 0., 4 7 ')-1- 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: J Project name: l dn., V Covered porch area square feet
Cross street/directions to job site: Deck area: feet
f a �' GC V` I its/1 Other structure area: 5'a4 square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
1 1 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.
L S d � y S �I d Valuation: $
Existing building area square feet
, i New building al a: square feet
Ly'PROPERTY OWNER I 1\ ❑ TENANT Number of storie :
Nam e: (5 .. y N4/(1:4 0 -. (6„,,a IJ Type of constru cfio .
Address: t -.). \ gS S I,,.) M a,tr t c:-. SA' - Occupancy groups: •
City /State /ZIP:
'T � a t� � eP / � q a�- 3 Existing:
Phone: (9)3) S IO- / to - ").. Fax: ( ) New:
[�]� PLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
N l ! Structural plan review fee (or deposit):
Contact name: / \ f - .i �,C ( -
Address: FLS plan review fee (if applicable):
Total fees due upon application:
Oj^City /State /ZIP: $$
�� Amount received: !3f'p
Phone: ( ) : ( )
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Fax: Co • ercial and residential prescriptive installation of
I
roof -top •∎ounted Photo Voltaic Solar P. • System.
B usiness name: 06t-)A) E 2 Submit two sets of roof plan with - a nnection details
and fire dep. .. t access, alon: . th the 2010 Oregon
ti Address: Solar Installation Sp' . .,l C..e checklist.
c City /State /ZIP: Permit Fee (include- • anreview $180.00
I and ad • 'strati - . es):
Phone: ( ) Fax: ( ) State surcharge % of permit fee): $21.60
CCB lie.: (L.J......e.....1-2-: Total fee due upon application: $201.60
Authorized signature: l� --"2Y — This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: A 1 _ , / 1/ / V I Date: /a-S /a -10/2_I * Service me Bodardogy set by Tri-County Building Industry
I:1Building\Permiits\BUP- RESPermitApp.doc 02/24/2011 440 -4613T(I I /02 /COM/WEB)
Building Permit Application Checklist
One- and Two - Family Dwelling Foli OFFICE USE OiNI.I
City of Tigard . . - Received
Permit No.:
q 1 3125 SW Hall Blvd., Tigard, OR 97223
Associated
III 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
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • p.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ E9'
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 -
apacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
-
7 Water district approval. CI CI CI
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 ❑ ❑
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 I 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 -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, ❑ ❑ ❑
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. ❑ ❑ ISI----
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 ❑ ❑ [lam
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 Er ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ I '
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 t3 ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. IB ❑ t - •
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or a ❑ ❑
architect licensed in Ore on and shall be shown to be a licable to the ro'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 17 ". ❑ ❑ _
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. IB' ❑ ❑
-
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. Q' CI CI
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. E " ❑ ❑ —
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ CI CI
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.
I: \Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11 /02/COM/WEB)
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.
or
•
l
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.
l 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.
Go v O etcktuo
Print Nan of Permit Applicant
C✓ (De - 6 -ZF(-
' Signatu e f Permit Applicant Date
Permit #: MS - DOSS
� ` gyp- [� , .4.
Address: °Z 7f 5 5-W N, i 1 p Sit • ; rj ' *
Dealt/lb d a- 97293 '
Issued by: _ Date: 7//9// f`i
This Copy for Permit Offices
/A/85 Meaos eT
111111 o ° B uilding Division
Development Code Provision Review
T i c n ti Residential Projects
Building Permit No: M `a l 5o (9. -6D / 5A
CWS Service Provider Letter Received: Yes?IgE No ❑ N/A ❑
Routed Plans: , �� ,
Original Plan Submittal Date: /7"
15t 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 (fie, tt CO21 AC-S at 503 - 718 - c:14-3 or atoll ` @ tigard- or.gov)
Land Use Case No. Name
Pg Zoning 4 5
❑ Setbacks:
Front de ' Rear S Side 5 Street Side — Garage
❑ Maximum Building Height 15' Actual Building Height la '
pi Visual Clearance
J . Easements
g Sensitive Lands Type: N/ A
Notes: CCC2.55Dvi .S }uti
Original Plan: Approved Ill Not Approved ❑ Date: to - a 7 - I .
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: J `
Notes:
Original Plan: Approved ..Er Not Approved ❑ Date: Z
Revision 1: Approved ❑ Not Approved ❑ Date: (i ----4-..- .
Revision 2: Approved ❑ ' Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
L
•
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard- or.gov)
Street Trees
Protected Trees
Notes:
Original Plan: Approved E( Not Approved ❑ Date: G - at -aola•
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 No ❑
Date Routed to Building:
•
Page 2 of 2
/ D
s�� JUN 2) 2012
Clean Water Services File Number
\ { CITY®F
JUN 2 5 2012 J CleanWater \ �b:soii,f I I " 15 11
By
Sensitive Area Pre-Screening 'Site Assessment
y
1. Jurisdicton:1 tgarU
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): 2S103CB02661" 21e01 Name: Gary and Nellie Delano
Willamette NO 2, Lot 30, Acres .37 Company: •
• Address: 12185 SW Marion Street
Site Address: 12185 SW Marion Street City, State, Zip: Tigard, Oregon 97223
City, State, Zip: Tigard, Oregon 97223 Phone/Fax: 503 - 5904652
Nearest Cross Street: 121 st E - M a il : ndelano@frontier.com
4. Development Activity (check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence (rooms, deck, garage) Name: Gary and Nellie Delano
❑ Lot Line Adjustment ❑ Minor Land Partition Company:
❑ Residential Condominium ❑ Commercial Condominium Address: 12185 SW Marion Street
❑ Residential Subdivision ❑ Commercial Subdivision , Ti arc Oregon 97223
❑ Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip: 9 re9
Other accessory building Phone/Fax: 503-5904652
E -Mail: ndelan0@frontier.com
•
6. Will the project involve any off -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
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, admowtedges and agrees that employees of Clean Water Senrioes have authority
to enter the project site at all reasonable limes 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 Gary and Nellie Delano Print/Type Title owners
Signature � �7�;A! I ' Date 06/25/2012
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. 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 ate. 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
: 1. provals must be obtained and completed under applicable local, State, and federal law.
• Y. 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 SiteAssessment 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 definition of development or the lot was platted after 919/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVID ; LETTER IS REQUI • E ' .
Reviewed by / = ,� _ _ _ Date . 10
2550 SW Hillsboro Highway • Hillsboro . Oregon 97123 • Phone: (503) 681 -5100 • Fax (503) 651 -4439 • ve'f. clean valerservices.org