Permit CITY OF TIGARD MASTER PERMIT
Iliq 11. II
COMMUNITY DEVELOPMENT Permit#: MST2014-00057
7 tGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/01/2014
Parcel: 1S134DC12300
Jurisdiction: Tigard
Site address: 11455 SW GALLO AVE
Subdivision: CASCADIAN PLACE Lot: 12
Project: Burgess
Project Description: New roof over existing deck and new door in existing wall
BUILDING
Floor Areas Required Setbacks Reauired
Stories: 0 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: $15,000.00 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
Drywall-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 Circu4s_
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea addl 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: Ecompas ng N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
BURGESS,LA DONNA&SCOTT MARK DECOURCEY Required Items and Reports(Conditions)
11455 SW GALLO AVE 3218 SE 170TH AVE
TIGARD,OR 97223 PORTLAND,OR 97236
PHONE PHONE: 503-572-2035
FAX:
Total Fees: $626.77
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 ac e 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 NTION: Or on law requires you to follow the rules adopted by the Oregon Utility Notification Ce• - . -•se rules are set forth in OAR
952-0 -0010 through OAR -0090. You may obtain as copy of the rules or direct questions to OUNC by calling 50 32. -' • 1.800.'32.2344.
Iss ed By: K........„ �%r�(.ciL4 1��/� Permittee Signature: calling 50
�l `-- --
Call 503.639.4175 by 7:00 a.m.for the next available inspe •on date. l./
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 Applicatiquj
Residential I ()IZ ()1 I R I I ',I (t\11
1111 " City of Tigard APR 2 2 2014 oe� ea iff fi_, Permit No.: 1"7„, `
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi
Phone: 503.718.2439 Fax: 503.>L T F TIGARD Date/B : ��i, i la Other Permit:
I It.,1 RD Inspection Line: 503.639.4175 Date Ready/B : d,p luris: 65 See Page 2 for
Internet www.tigard-or.gov BUILDING DIVISION Note. ethod: / Supplemental Information
r� d,0 /0l 74/.4--
TYPE OF WORK / REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0 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.
rgi 1-and 2-family dwelling Valuation: $
❑Commercial/industrial i
❑Accessory building ❑Multi-family Number of bedrooms: /5 CoQ
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I j 4/ 5 5 S W es/-1-0 A t...)`r--- , New dwelling area: square feet
City/State/ZIP: -'T` 1.6 A iZ,Q , D 9 7 2.2 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Covered porch area square feet
Cross street/directions to job site: Deck ammo.T2,_00 F ii 6 5- square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: C.A. 5 v 1 vi)(-4, c C1[ l Lot no.: I 2, 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.: (v 5 5---- C 3 15134 DG I2-5o 0 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
1--Ac t,, n-o o(= Qv n
-)c% 5-r- I'1--s.c,e, DEC-to Valuation: $
NE- G —o moo i'1y �x1•
5-1 { ,rN� �i�i, Existing building area square feet
Cl
New building area: square feet
PROPERTY OWNER { ❑ TENANT Number of stories:
Name: 5 L0 ? AND LA QD l---■ N A (3 c?C2-6 E5 5 Type of construction:
Address: I I1--t 6 5 5 LA-) G A/44.3 i4t.)e_ Occupancy groups:
City/State/ZIP: .-1- I C. V (-{J / D (Z , 9'7 2_2 3 Existing:
Phone:( ) Fax:( ) New:
kis APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: t'� RR. Q CO() lx-G E.- / v��a��� �1
J Structural plan review fee(or deposit):
Contact name:
3 ( / 5 � i '7D Tu FLS plan review fee(if applicable):
Address:
-
ty Qo (4�i_-^ n c) 2 r Q �3 ` Total fees due upon application:
City/State/ZIP: V 7 V I 1 ? fp -�jin6
Phone:(5 3 *j 7 2 - ____ 5- Fax::( ) Amount received: 7� j ,
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mown PhotoVoltaic Solar Panel System.
�` ,/1 �,` Q E CO U (L��' / Submit two(2)set. • roof plan with conne •. details
Business name: Y t (r
and fire department acc -, along wi • . e 2010 Oregon
Address: '43 7-.L ' `j ( 10`r l4 Solar Installation Specialty ecklist.
Permit Fee(inclu•, pl. •view
City/State/ZIP: Pp T L.tA t-4 0/ 0 f2.-, °1 ?2 and inistrative $180.00
Phone:(c-03 �6' 7� 94:73- �j� Fax:( ) State su arge(12%of permit fee): $21.60
!
CCB lic.: 3 v� q( 6 ` l Total fee due upon application: _ $201.60
Authorized signature: This permit application expires if a permit is no obtained
IAA_ within 180 days after it has been accepted as complete.
Print name: VI l A ( 4 0 C D,j (��/ Date: y ),.9_-- f i'7 *Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received 1 p,,,,,i
11111
13125 SW Hall Blvd.,Tigard,OR 97223 Dated t
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD
24-Hour Inspection Line: 503.639.4175 1:1 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. ❑ ❑ ❑
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. ❑ ❑ ❑
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.
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-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. ❑ ❑ ❑
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 ❑ ❑ ❑
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 ❑ ❑ ❑
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 ❑ ❑ ❑
architect licensed in Ore Ion and shall be shown to be a,,licable to the ,ro'ect under review.
.I('RISUICTIONAL SPECIFIC'S
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"buildingplans will not be accepted. ❑ ❑ ❑ -
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. El ❑ ❑
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.
I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
F
Building Permit Number: 116Tc30 it/- oc05-7
;' . ' Building Permit Review
Residential Projects
I IGARD
■
Sl Address: UUL55 SW �A UlO Av ,
.Verify site address is valid.
Project Name & Lot #: De,COU'Rak_. i Lc IQ
Clean Water Services—Service Provider Letter: (lot platted prior to 9/10/1995)
Required: Yes ❑ No 0 Received: Yes ❑ No ❑
Site lan Elements:
l itete plan must be on 8-1/2"x 11"or 11"x 17"paper Ly'i'hree(3)copies of site plan
li5 wn to scale(standard architect or engineer scale) [ !(j arrow
p and tax lot number,site address,project or subdivision L�J'Footprint of new structure(including decks)with finished
name,lot number,and zoning floor elevations
licant information(name and phone number) Land building setback dimensions
a P r o p e r t y corner elevations(2 f o o t contour lines if more than [ t t area,building coverage area,percentage of coverage and
4 foot differential) impervious area.
alf1Vlity locations Location of wells/septic systems.
Ifxi ling structures on site E 'urface drainage
IESe re5e names e t tree size,type and location
erosion control(including drainage-way protection,silt fence l xisting trees to be retained with drip line,and tree
design,location of catch basin,etc.) protection measures
Planning Review
R T ind Use Case Number: 5 U B ZooZ —C COD Z
EI--*Zoning: R LA•S
E 1 tbacks:
Front 2.0 Rear l 5 Side IS Street Side IS Garage 20
C,��`Landscape Requirement: IN)/ A %
L�LOt Coverage Maximum: 1s I Pc
' Building Height: Maximum Height SO Actual Height ±l9
I isual Clearance
[I Egsements
LRy'Se sitive Lands: ❑ Yes Type
L`_I"Urban Forestry Plan
Cl4onditions Satisfied
Approved by: 1'�n Y ill 1 Date: L .22 L1
Notes: U
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
1:1Buildingworms\BldgPermitRvw_RES_123013.docx
Building Permit Submittal ��
Original Plan Submittal: Date: %',/9 g I y B y
Site Plans: # 3
Building Plans: # '5
Create Case Record#: El.-Enter case#above for Building Permit Number.
Workflow Routing: i lanning Engineering �7-ermit Coordinator wilding
Workflow Sign-off: �ign-off for Planning staff,including notes from planning review(page 1)
Route Application Documents: Engineering: (1) copy of permit application, (1)site plan, (1) building plan and
,�/original plan review routing form.
1G Building. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Reviewed By: _ /L ' Date: (1/j-/y
Notes:
Engineering Review–reviewed by: n)
Ac pal Slope: 1!o
', Conditions Sa fled
Notes: /o E/11 Co t,N 6'ekZ UJ C 1 SS Vt .S
Approved by: Date: y,2y, 41
Revisions(after Building Submittal only) Reviewer Date
Revision 1 Approved El Not Approved ❑
Revision 2 Approved El Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
Permit Coordinator Review
nditions Met-Prior to Issuance of Building Permit
Notes:
Revision Notice 1: Date Sent to Applicant: _
Revision Notice 2: Date Sent to Appli .nt
Revision Notice 3: Date Sent to A.e;can /
Okay to Issue Permit- �� Date: 2--3
1:1BuildinglFor ms\BldgPermitRvw_RES_123013.docx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11455 SW GALLO AVE, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
PASS
MST2014-00057
Jeff Grove
Violation Summary:
Inspector Contractor