Permit IN CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2014-00100
Tr GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/03/2014
Parcel: 2S104AC08400
Jurisdiction: Tigard
Site address: 12568 SW 131ST AVE
Subdivision: MORNING HILL NO.9 Lot: 227
Project: LEWIS
Project Description: Replacing existing patio cover.
BUILDING
Floor Areas Required Setbacks Required
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
Detectors
Dwelling Units: 0 Third: 0 sf Right: 0
No
Total: 0 sf Value: $22,000.00 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
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tunes 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%Ink- 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 at: 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:
LEWIS,PEGGY L REVOCABLE LIVING FRITZ CAMPBELL REMODELING Required Items and Reports(Conditions)
12568 SW 131 AVE 12568 SW 131ST AVE
TIGARD,OR 97223 TIGARD,OR 97223
PHONE PHONE: 503-888-8776
FAX:
Total Fees: $740.23 /
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law, • 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 , ore the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C' ter. Those - _- are s' orth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy o rules uect questions to OUNC by calling 503. .1987 o,1.80.. 32. 44.
P"—
Issued B '- /-
Permittee Signature: I� ✓/;A
Ca11 7:00 a.m.for the next available inspection . e.
This permit card sha . • onspicuous place on the job site until corn letion of the roject
Approved plans are required on the job site at the time of each in..: ion.
Building Permit Application
Residential FOR OFF ( F. 1;SE ONLI
Raseived
City of Tigard Permit No.:
INI iii
• 13125 SW Hall Blvd.,Tigard,OR 9722 �� � �I "4`� ��
Phone: 503.718.2439 Fax: 503.598.19 �% a: , r Other Permit:
iMIBIIJ
Inspection Line: 503.639.4175 \\\\1� a Ready : curls: ® See Page 2 for
T A Internet: www.tigard-or.gov Jv \� , ` ed/Method:�� f� ' Supplemental Information
5 cj Fr,t2
TYPE OF WORK G N REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction El Demolitioi Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
(E/Addition/alteration/replacement ❑Other: _ equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
,�,/ Valuation: $
tE l-and 2-family dwelling ❑Commercial/industrial ,4 0o
❑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: 42i-4.,13 ..f-,0 /3, S i 4,,£ New dwelling area: square feet
City/State/ZIP: '7"6 A 2/)/ .m qr7 a a 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: ,[buy,.0:.--4,,-,e-z„) go rib Covered porch area il 7.,5' square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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.
/e6 LAC %Ai G� �EcAA,4A i,r ) Ariz) Lida c/6/L Valuation: S
Existing building area square feet
New building area: square feet
PROPERTY OWNER II l❑ TENANT Number of stories:
Name: TOM >�it)r/t✓L.t� f /c�(�s y �G 6/0/.s Type of construction:
Address: /,95'4,13 ‘54,41 /3/57 X s/.6"• Occupancy groups:
City/State/ZIP: 2.-/z A/ j) Q 97:29.3 Existing:
Phone:(503') 45,52.,f — 9y a 3 Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please relymlesscliedul i
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
City/state/ZIP: Total fees due upon application:
Phone:( ) Fax::( ) Amount received:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: "...lire,f z ZAAfi d�[4 ,e6Aft) 'e L/�4 Submit two(2)sets of roof plan with connection details
U and fire department access,along with the 2010 Oregon
Address: X619 ,U6 %.5-4,2 A;Q ,i/G . Solar Installation Specialty Code checklist.
l Permit Fee(includes plan review
City/State/ZIP: �0� zA Q/ Q� �/7 )/ 3 and administrative fees): $180.00
Phone:(obvj) Bg$ 9 '. rj, Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: A30 e/+SS 3/30 115-- Total fee due upon appication: $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: �� Z ate: t *Fee methodology set by Tri-County Building Industry
Al 4 O L L 4," 7 Service Board.
L\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 4404613T(I 1/02/COM/WEB)
„ I.
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLI
Received
IN City of Tigard Date
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits
Phone: 503.718.2439 Fax: 503.598.1960
1 G A R D 24-Hour Inspection Line: 503.639.4175 13 Electrical ❑ Plumbing ❑ Mechanical
Internet www.tigard-or gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 'vs NI o v/
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. _ ❑ ❑ ❑
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
,_p. ri_ht violations exist.
WWI e/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑
ere 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 ❑ ❑ ❑
'52-f .chitect 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 1 F'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. ❑ ❑ ❑
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.
I:1BuildingPermits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
S -
1111 City of Tigard
■
COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: M Si- iii -op l co
Site Address: 1o2.s- -e sGv /S/%1-L / s/eq4 Cg
Project Name: Zew.i.c Ay/0 (o.,- Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Now pc( 10 !o v?
,LI- Verify site address/suite #exists and active in permit system.
Site Plan Elements:
�
e (3)copies of site plan xisting structures on site
ite plan must kg on 8-1/2"x 11"or 11 x 17"paper footprint of new structure(including decks)with finished
[ a°n to scale (standard architect or engineer scale) floor elevations Caw 0
M,� oorth arrow ❑Utility locations(required for new,may a ply for additions)
L75.tt address,project or subdivision name and lot number ration of wells/septic systems //
L�7�1licant information(name and phone number) ❑Erosion control(including drainage-way protection,silt fence
L7Lot dimensions and building setback dimensions �desi ,location of catch basin,etc.)
L�J
❑Lot area,building coverage area,percentage of coverage and <eet names AA
impervious area(applicable if R-7,R-12,R-25&R-40) L1J3Street tree size,type and location/ .0
❑Poperty corner elevations(2 foot contour lines if more than [Existing trees to be retained with drip line,and tree
4 foot differential) protection measures Alit
Clean Water Se ices—Service Provider Letter: (lot platted prior to 9/10/1995): ,l€colek( 'kV itf,/,fr
Required: LJ Yes ❑ No Received: X Yes No
❑ Land Use Case #: //M
0�Zoning: ZS-
In�d�S tbacks: Front /S' Rear /sue' Side J c Street Side 6U' Garage .20
2'Landscape Requirement:
LK of Coverage Maximum: / a
Building Height: Maximum Height `7 Actual Height
El V dual Clearance,/t//
L'd' Easements
❑ Sensitive Lands: ❑ Yes ❑ No Type
❑ Urban Forestry Plan AA-
O Conditions Met 44.
Notes: N04 Gws SP‘ -
Approved By Planning: III/ALA A Date: i i
Revisions (after Building Submittal onll I Reviewer Date/7/�
Revision 1: ❑ Approved L�YNot Approved '
Revision 2: '1 Approved ❑ Not Approved -kV- (P 21.2
Revision 3: ❑ Approved ❑ Not Approved
I:\Bui lding\Forms\BI dgPerm itRvw_RES_042914.docx
Building Permit Submittal ,
Original Submittal Date: 6/ //�(
Site Plans: # 3 (`
Building Plans: # 3
Building Permit#: El Enter building permit# above.
Workflow Routing: Planning engineering rrmit Coordinator R— ding
Workflow Sign-off: a- ii-off for Planning(include notes from planning review)
Route Application Documents: p---Pngineering: (1) copy of permit application, (1) site plan, (1) building plan and
ornal plan review routing form.
[ ' uilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ;/ _ Date: /g4/'y
Engineering Review
❑ Actual Slope:
❑ Conditions Met
Notes: /V a 5-n/Cpt41 l�1 r J1(y 1 SJ v■45,
Approved by Engineering: Date: b • 171
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions Mct-Prior to Issuance of Building Permit
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
:11111K to Issue Permit
Approved by Permit Coordinator: Al/ A Date: Z7-2-6'/./-
I:\Bui I ding\Forms\BldgPermitRvw_RES_042914.docx
Clean Water Services File Number
C1eanWaterr Services 14-001709
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: Tigard
2. Property Information (example 1 S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Peggy Lewis and Thomas Enfield
25104AC08500 Company:
_ Address: 12568 SW 131st Avenue
Site Address: 12568 SW 131st Avenue City,State,Zip: Tigard,OR 97223
City,State,Zip: Tigard,OR 97223 Phone/Fax: 503 524-9423
Nearest Cross Street: SW Walnut E-Mail:
4. Development Activity(check all that apply) 5. Applicant Information
Addition to Single Family Residence(rooms,deck,garage) Name: Peggy Lewis and Thomas Enfield
3 Lot Line Adjustment 3 Minor Land Partition Company:
Residential Condominium .3 Commercial Condominium
Address: 12568 SW 131st Avenue
] Residential Subdivision ] Commercial Subdivision
] Single Lot Commercial ] Multi Lot Commercial City, State,Zip: Tigard,OR 97223
Other Phone/Fax: 503 524-9423
Replacing existing patio cover E-Mail: fritzcamp @earthlink.net
6. Will the project involve any off-site work? ]Yes XI No ']Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
We want to replace our rotted patio cover. We will not be increasing the non-permeable portion of
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 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 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 lam 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 Peggy Lewis and Thomas Enfield Print/Type Title
ONLINE SUBMITTAL Date 6/18/2014
FOR DISTRICT USE ONLY
U 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.
U 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.
lJ 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 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.
j 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 9/9195 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by (242-e. 176; Date 06/25/14
2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone:(503)681-5100 • Fax:(503)681-4439 • www.cleanwaterservices.org