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Permit (20) CITY OF TIGARD MASTER PERMIT IN ... . COMMUNITY DEVELOPMENT Permit#: MST2016-00375 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/06/2016 t 9 Parcel: 2S 104AA00300 Jurisdiction: Tigard Site address: 12665 SW 127TH AVE Subdivision: BELLWOOD Lot: 52 Project: Cromwell Project Description: New 14'x 20'detached accessory structure BUILDING Floor Areas Required Setbacks Required, Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 15 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No Total: 0 sf Value: $12,000.00 Rear: 15 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 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 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: 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: CROMWELL,SAMUEL T TUFF SHED Required Items and Reports(Conditions) MARGARET A 2950 SE 73RD AVE 12665 SW 127TH HILLBORO,OR 97123 TIGARD,OR 97223 PHONE: PHONE: 503-848-6088 FAX: Total Fees: $562.01 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. Oregon law requires you to follow the rules adopted by the Oregon Utility Notification pC ose rules are set forth in OAR 952- 1-0010 through R/ - 1-0090. You��may obtain a copy of the rules or direct questions to OUNC by calling 503 ,e...-:•,, �-1`8l 332,2344. Iss ed By: . _(' l _I4 ...-4-X p Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspecti•n e. 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 Ric -F ErResidential `' � IK 1I( 101 t S1:O\Ll City of Tigard SEP 2 6 2016 Received Permit No.: ►,J 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie• ,7�T�� X37 ' s Phone: 503.718.2439 Fax: 503.598.1269T); p r x Date/13 : ' - - Other Permit Inspection Line: 503.639.4175 a l : l t Date Read/B _ luri�: TIGARI) Readyy: i M See Page 2 fur Internet: www.tigard-or.gov Tnr,T)iN(' ?'6i `it Notified/Method: !() S , , 11 Supplemental Information P� eiri1.2( S T1- 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 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: $12,000 ►Z� Accessory buildingNumber of bedrooms: 0 0 Multi-family ❑Master builder 0 Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address:12665 SW 127th Ave New dwelling area: square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name:Cromwell Covered porch area: square feet Cross street/directions to job site:SW 128th AVE&SW 127th Ave Deck area: square feet Other structure area: 280 square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Bull Mtn Lot no.:52 Permit fees*are based on the value of the work performed. Tax map/parcel no.:R479306 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. New 14'X20'Detached Accessa7 Building Valuation: $ Existing building area: square feet New building area: square feet 0 PROPERTY OWNER 0 TENANT Number of stories: Name:Margaret Ann&Samuel Cromwell Type of construction: Address:12665 SW 17th Ave Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:( ) Fax:( ) New: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name:Permit-It,LLC (Please refer tofee schedule) Structural plan review fee(or deposit): Contact name:Scott Earl FLS plan review fee(if applicable): Address:33714 SE 20th Street Total fees due upon application: City/State/ZIP:Washougal,WA �� Amount received: Phone:(360)326-8870 Fax::(360)998-3228 E-mail:scott@permit-it.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR ercial and residential prescriptive installa', of roof-t ounted Photo Voltaic Solar Pane .'stem. Business name:Tuff Shed,Inc. Submit two ets of roof plan with t ection details and fire departmen —ess,alone-•'tth the 2010 Oregon Address:6500 NE Halsey St Solar Installation Specti e '.de checklist. City/State/ZIP:Portland,OR 97213 Permit Fee(in .les p ._'review $180.00 .i: administrative s): Phone:(503)288-8833 Fax:( )CCB lic.:105914State charge(12%of petmitapplication:fee): $21.60 it.T../ N / V' Totai fee de upon $201.60 Authorized Signa This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Scott Ea Date:9/12/16 *Fee methodology set by Tri County Building Industry Service Board. 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) RECEIVED City of Tigard Er 2 6 za?6 COMMUNITY DEVELOPMENT DEPARTMENT e 111 SIT 'OTC! I) Building Permit Review — Residential T1GARD DUI .► GDIV IO Building Permit #: H 67---ao!Co-a) 37 5- Site Site Address: 1 Z ko S Sv'/ t 2 i''h ei v-L Project Name: C, ►m wt41 Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N'eAif 1.1 X 2,0 ,q)- ct IVerify site address/suite#exists and active in permit system. River Terrace Neighborhood: gr No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: $Three(3)copies of site plan /Existing structures on site /Site plan must be on 8-1/2"x 11"or 11 x 17"paper 'Footprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations `North arrow Q44titlity locations(required for new,may apply for additions) Site address,project or subdivision name and lot number [ vcatieu of wells/septic systems Applicant information(name and phone number) B£Listing trees to be retained with drip line,and tree ?Lot dimensions and building setback dimensions protection measures area,building coverage area,percentage of coverage and -0Sue&tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) Street names /Property corner elevations(2 foot contour lines if more than 4 foot differential) Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): Required: J Yes,applicant was notified ❑ No Received: ❑ Yes A No ti.S v'f /0 Wit. .,i;—Public Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes El No,stop intake 0 Land Use Case#: N/A , i Zoning: 41 ,S/21 Required Setbacks: Front '7..../0 Rear I S Side S Street Side ) 5 Garage , ,E Landscape Requirement: 8-"Lot Coverage Maximum: -------'% y� Building Height: Maximum Height V Actual Height I I ` El Visual Clearance g—Easements u-Sensitive Lands: ❑ Yes ❑ No Type ❑ Urban Forestry Plan Com-Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: Al 0 v1, a i C7Gi52-PAA Date: q,`Z Cv/l Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: El Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_091216.docx Building Permit Submittal // Original Submittal Date: 9/26///o Site Plans: # '5 Building Plans: # nj Building Permit#: 2' Enter building permit#above. Workflow Routing: 0 Planning _12-Engineering JPermit Coordinator Building Workflow Sign-off: Et Sign-off for Planning(include notes from planning review) Route Application Documents: ❑i Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: CA.iI 0_,O Date: 9/.. // Engineering Engineering 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 I No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 421 Z Date:-! 1/4 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: MAI C Fees Entered: • Wash Co Trans Dev Tax: ❑ Yes P! /A Tigard Trans SDC: Cl Yes ► N/A Parks SDC: ❑ Yes 6. N/A OK 7wto Issue Permit //t- I: Approved b Permit Coordinator: 41" Date: 7PP Y\Building\Forms\B1dgPennitRvw_RES_091216.docx Clean Water Services File Number \� 16-003750 CleanWate Services Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: Tigard 2. Property Information (example 1 S234AB01400) 3. Owner Information Tax lot ID(s): 2S104AA00300 Name: Margaret Ann Cromwell&Samuel Cromwell R4733OG Company: Address: 12665 SW 127th Ave. Site Address: 12665 SW 127th Ave. City, State,Zip: Tigard,OR,97223 City, State,Zip: Tigard,OR,97223 Phone/Fax: (503)419-7930 Nearest Cross Street: SW 127th Ave&SW 128th Ave E-Mail: N/A 4. Development Activity (check all that apply) 5. Applicant Information ❑ Addition to Single Family Residence(rooms,deck,garage) Name: Scott Earl ❑ Lot Line Adjustment ❑ Minor Land Partition Company: Permit-It. LLC ❑ Residential Condominium ❑ Commercial Condominium Address: 33714 SE 20th Street ❑ Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial City, State,Zip: Washougal,WA,98671 g ❑ Multi Lot Commercial Other Phone/Fax: 360-977-0446 280 SF Shed E-Mail: scott@permit-it.com 6. Will the project involve any off-site work? ❑Yes d 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 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 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 Scott Earl Print/Type Title President/CEO ONLINE SUBMITTAL Date 10/5/2016 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 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. ❑ 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. ❑ 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 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed by �.,� ,/1 ,._,.,t •- --" .�.. .. . ,. Date 10/5/16 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone:(503)681-5100 • Fax. (503)681-4439 • wwwcleanwaterservices org FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 14 II Transmittal Letter T I G A D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: t e€riga - DATE RECEIVED: DEPT: BUILDING DIVISION 1`" -. FROM: Nathan Wormer COMPANY: Tuff Shed PHONE: 503-288-8833 FC RE: 12665 SW 127th Ave, Tigard, OR 97223 MST2016-00375 (Site Address) (Permit Number) Cromwell-New 14x20 detached access. cture (Project name or subdivision name and lot numb- ATTACHED ARE THE FOLLOWING IT .. .: Copies:.,,,. De cripti©*r, 4 ; Copies: Description: Additional set(s) of •lans. 2 Revisions: Foundation Cross section(s) . d details. Wall bracing and/or lateral analysis. Floor/roof frami 'g. Basement and retaining walls. Beam calculat f'ns. Engineer's calculations. Other(explai ' : 1( :MARKS: New detail sowing anchorage to concrete foundation replacing e concre e peer FOR OF:FICk USE ONLY Routed to Permit Technician: Date: 3 — 7 - ' Initials: Fees Due Yes ❑No Fee Description: Amount Due: .S r $ `jam J`1 Plc" r��y evJ $ $ Special Instructions: Reprint Permit(per PE): ❑ Yes , "No ❑ Done Applicant Notified:// 77-4,;,9,1,/ Date: :3/9//7 Initials<;4-4/----- I: ( ---- I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012