Permit CITY OF TIGARD MASTER PERMIT
1111 II COMMUNITY DEVELOPMENT Permit#: MST2016-00089
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/24/2016
Parcel: 2S 109BA05800
Jurisdiction: Tigard
Site address: 13736 SW MISTLETOE DR
Subdivision: HILLSHIRE SUMMIT NO.2 Lot: 44
Project: Debban
Project Description: In-ground swimming pool with safety 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
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: No
Total: 0 sf Value: $30,000.00 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 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:
OTR SF U 0
Owner: Contractor:
DEBBAN,BRENT M&DEBORAH H BLUE MOUNTAIN POOLS INC Required Items and Reports(Conditions)
13736 SW MISTLETOE DR 13121 S WARNOCK RD 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97224 OREGON CITY,OR 97045
PHONE: PHONE: 503-760-4554
FAX:
Total Fees: $997.02
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 ma •• ••y oft - -- - - t questions to OUNC by calling `•x.232.1987 or 1.800.332.2344.
Issued By: ���.��— Permittee t• • • . ` A Irl —
Call 51afr[i•�° 7:00 a.m.for the next available inspecti.f ate.
This permit card shall be kept in a conspicuous place on the job site until c pletion of the project.
Approved plans are required on the job site at the time of eac• inspection.
Building Permit Application,
Residential ikt4CElli till/ FOR OFFICE USE ONLY
City of Tigard Received
IN1 (', j(�1 Date:Bv: m i� Permit No.:H , <—ezb r
13135 SW Hall Blvd.,Tigard,OR 9\4AR v Plan Revie%
S Phone: 503.718.2439 Fax: 503.598.1960 `� L 121 Other Permit
TIGARD Inspection Line: 503.639.4175 ti I' '014 tit,ARO D.t R ady'By: Juris: El See Paget for
Internet: www.tigard-or.gov Notified.Method: .5--/ fop Supplemental Information
BUILDING DIVISION rttirmylakLek Pu-s3 S-
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
al 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
0 Addition/alteration/replacement 0 Other: equipment,materials.labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 0,000
ElAccessory building ❑Multi-family Number of bedrooms:
ElMaster builder 0 Other:I n9cU CyJr. 5u1,rnrsvn Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
_ Po
Job site address: i 3' 31-0 5w M -2t.t �c. New dwelling area: square feet
City/State/ZIP: ( c.•\(•C, 6 Z glaa`I Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 1br✓bb011 Covered porch area: 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.
Tax mapiparcel 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.
Valuation: S
-l-n3co,..)nc. -,_,o.y-r1mtv5 I Ls j 5c,Ye* covet'
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT E ' CONTACT PERSON BUILDING PERMIT FEES*
,�
(Please refer to fee schedule)
Business name: �l„,c /1 Lc, 1--i-
JJ i-ci;t•, pee:
Structural plan review fee(or deposit):
Contact name: Il)`l� t6-60 w,Rr-
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP: 2 20,
Phone:(t13 ) t Gcf7_ c9a3 Fax: :( ) Amount received. 88
E-mail n PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
����5 b� U�l co n�A, { c Co Commercial and residential prescriptive installation of
CONTRACTOR roof-top m.-I ted Photo Voltaic Solar Panel Syst .
Submit two(2) s of roof plan with con ton details
Business name: -2)woe ,A;\w 6t�th pc015
CC and fire department. cess,along wi e 2010 Oregon
sAddress: 131,\ , C.,cy,oCK ccs Solar Installation Speck .,Code-Checklist.
Permit Fee(include ..-I review
City/State/ZIP: C _ ,�,n ZcCA y �' q 7u—(5 and ad nistrative s): 5180.00
Phone:(531) -7c,(� - L. 6 .-04_4 ( Fax:en) 5C3 1(OO--3G69. State surch ,e(12%ofpermit fee): S2I.60
CCB lic.: C
� 54 otal fee due upon application: 5201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: R - �Ip�h d C J e(� Date: 6 rt j b *Fee methodology set by Tri-County Building Industry
lx<� �/ ' Service Board.
I: Building Pennits'BUP-RESPermitApp.doc 02,24/2011 440-4613T(11 02/COM,WEB)
City of Tigard RECEIVED
■
COMMUNITY DEVELOPMENT DEPARTMENT MAR 1'0 2016
T 1 G A R D Building Permit Review — Residential CITY OF TIGARD
BUILDING nwiclnni
Building Permit #: H 4-7'r:9-c ((. -oC0 g
Site Address: 13136 SW Kt s*\e-be. tf•
Project Name: pebban Lot #:
(New dwelling= subdivision name;.Addition or,Alteration= last name of owner)
Planning Review
Proposal: AA 1 I 01A 1 9.01 w' 'AAVIW Lett=oi•..-' Oa Saf:t Co '
Ierify site address/suite# exists and active in permit system.
ig. River Terrace Neighborhood: No ❑ Yes, See Ri'verTenrace Review Addendum Attached
S4e Plan Elements: �f
VD�C�ree (3) copies of site plan
J .xisting structures on site
pLV to plan must be on 8-1/2"x 11"or 11 x 17"paper LrJ Footprint of new structure(including decks)with finished
rawn to scale (standard architect or engineer scale) floor elevations
orth arrow -El-Utility locations(required for new,may apply for additions)
LAS e address,project or subdivision name and lot number ocation of wells/septic systems
plicant information (name and phone number) (Erosion control(including drainage-way protection,silt fence
gLot dimensions and building setback dimensions esign,location of catch basin,etc.)
-BLot area,building coverage area,percentage of coverage and T1LI Street names
1pervious area (applicable if R-7,R-12,R-25&R-40) ''Street tree size,type and location
C Property corner elevations(2 foot contour lines if more than $Existing trees to be retained with drip line,and tree
4 foot differential) protection measures
•B- Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: E Yes,applicant was notified 2r No Received: ❑ Yes ❑ No
$ Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified TS No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#:
V Zoning: R--/
G;iSetbacks: Front 15 Rear 1 S Side S Street Side — Garage 2.3
/
andscape Requirement: 2O °'o
Lot Coverage Maximum: g 0
-1Et"Building Height: Maximum Height Actual Height
- Visual Clearance
-EfrEasements
'4E1-Sensitive Lands: ❑ Yes g No Type
Urban Forestry Plan
$Conditions "Met"prior to issuance of building permit
Notes:
•
Approved By Planning: Yt—rl m 1PnraGl� Date:
3 10 1 b
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved E Not Approved
I:\Building\Fonns\BldgPermitRvw_RES_012116.docx
Building Permit Submittal
Original Submittal Date: I 11 o 1
' 1 I4
Site Plans: # 3
Building Plans: # 3
Building Permit#: LJ Enter building permit# above.
Workflow Routing: 2-Planning i ngineering ❑iP rcnit Coordinator R" Building
Workflow Sign-off: Com]" Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
9riginal plan review routing form.
d Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes: f)
By Permit Technician: ij ). � 2yuLiDate: (=> /dXfo
Ingineering Review
Slope at building pad:
Conditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: itlG _____P Date: 3--4y--��
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 "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
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:
C Fees Entered: Wash Co Trans Dev Tax: ❑ Yes /A
Tigard Trans SDC: ❑ Yes EN/A
Parks SDC: ❑ Yes /A
1:70K to Issue Permit _
3//3/ 6
Approved by Permit Coordinator: r / Date:
1:ABuilding\Fonns\BldgPennitRvw_RES_0121 16.docx