Permit (37) CITY OF TIGARD MASTER PERMIT
III Permit#: MST2018-00155
': COMMUNITY DEVELOPMENT
Date Issued: 06/07/2018
-f-LC,AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104BC01200
Jurisdiction: Tigard
Site address: 14504 SW FERN ST
Subdivision: HILLSHIRE HOLLOW Lot: G
Project: Kaufer
Project Description: Installing new in ground fiberglass pool and concrete deck.
BUILDING
Floor Areas
Required Setbacks Required
sf Left: 0 Parking Spaces: 0
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 oke
Dwelling Units: 0
Height 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front 0 DetSmoke
Third: 0 sf Right: 0
rs:
Total: 0 sf Value: $40,000.00 Rear: 0
PLUMBING
Washin Mach: 0 Laundry Trays: 0
Rain Drain: 0 Urinals: 0
Sinks: 0 Water Closets: 0 g SF Rain Storm Sewer 0
Floor Drains: 0 Sewer Lines: 0 0
Lavatories: 0 Dishwashers: 0 Drains: Catch Basins: 0
Water Heaters: 0 Water Lines: 0 gckflw Preens: 0
Tubs/Showers: 0 Garbage Disp: 0 Backwater Value: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 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
0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
1000 sf or less: 0 W/O Svc/Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 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
All N
Audio&Stereo: N
HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N Ecompasin l:
Other N Other Description:
BUILDING INFO
Occu anc Group: Square Feet:
Class of Work: Type of Use: Type of Constr: P y
SF VB
U 0
OTR
Owner: Contractor: Required Items and Reports(Conditions)
KAUFER,GREGORY A REVOCABLE TRIPREMIER POOLS&SPAS OF OREGON 1 Geo Tech Report Required
TRUER,VALERIE J REVOCABLE WILSONVIO BOX LE,OR 97070 Prior To Pour
TRUSST
14504 SW FERN ST
TIGARD,OR 97223
PHONE: 503-997-6983
PHONE: 503-855-4117
FAX:
Total Fees: $1,500.07
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 do ted b not
startedhOregonthin Utiliays ty Notification Nstifif issuance,
ss ace, or Center. if work Those suspended for more
the 180
AR
days. ATTENTION: Oregon law requires you to follow to- P YX0.e3 rule44.
952-001-0010 through OAR 952-001-0090. You may obtain •copy of the rul- or direct questions to OUNC by calli s�
,_. .._
Ade
ittee Signature:
Issued B / "...--41.
�i/—��� —�
Arr
C 0 .•39.4175 by 7:00 a.m.for the next near •le inspection
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 R I Foi 0..„ cl: I;SI:ON Ll
City Of Tigard 3 Received Permit No.
g MAY 1 2Q1 Date/B : i, ' / � // _/ W s
III13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
� Other Permit:
■ Phone: 503.718.2439 Fax: 503.59 . r ) Date/B : 1
Inspection Line: 503.639.4175 � 6 ./ Date Ready/By: Juris: ® See Page 2 for
I 1 GA K D 4C3 DIVISION Notified/Method: Supplemental Information
Internet: www.tigard-or.gov BUILDING I
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
rzr New construction El 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.
Valuation: $ +),000
❑ 1-and 2-family dwelling El Commercial/industrial
❑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: 14 spy. 6N fvP� . T= New dwelling area: square feet
City/State/ZIP: —rib IaQ.D 02 ' 7Z23 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: •' ! Covered porch area: square feet
Cross street/directions to job site: Deck area:4' to0._ //:orr) 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.
Valuation: $
,,,�� /0:&--72,7/7-5- /ACL I.4.L-_.2) Existing building area: square feet
3 New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: &Q.0(11 le...ArtIrri, Type of construction:
Address: 4504- I.n) it •e-5;' Occupancy groups:
City/State/ZIP: I-1 t,aQ,c 0 CZ- 4I1ZZ') Existing:
Phone:(: ,3 ) 'II-bi g3, Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: y tl L i;r0 0 ' Structural plan review fee(or deposit):
Contact name: VACS iA .AI,
11 J FLS plan review fee(if applicable):
Address: il(St) 51.3 Pt0a3I 51/41 CD ()
Total fees due upon application:
City/State/ZIP: l/J)t Sot- J I t,Lt3 02_ '107 l3 4 0 Amount received:
Phone:(503 ) ,b55-,..1-117 F :( -;104-4,)—G13/
E-mail: ZIA.)0‘i%tJ C vt 45_t:0 N1 CA — PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name:
1
tLM I PSL rot.I S and fire department access,along with the 2010 Oregon
Address: 91r.. E u1/4.) Qi an11 -.41_. (, , so t;Z (a. Solar Installation Specialty Code checklist.
0
City/State/ZIP: 011-50N.) til LAC, t O(L 10-7 Permit Fee(includes plan review $180.01
�} i and administrative fees):
Phone:(303)555-4I 1_7 fes:406 )4-4-0-(/ State surcharge(12%of permit fee): $21.60-
CCB lic.: p(� 174-.3e3 1113/I'1 " Total fee due upon application: $201.60"'
I This permit application expires if a permit is not obtained ,
Authorized signature: V�f1��
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: 124 cv_Lr1c y J Date: ;_i!r_it Service Board.
L\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFF1(E I.SE O'I.v
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223
Date Permit No.:
Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
T 1 C'A K D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e yo 1/;1
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: , 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. ❑ 0 ❑
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 ❑
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
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 ❑ 0 0
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 ❑ ❑ 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 0 0
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- ❑ 0 ❑
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 EIevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ 0 0
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- 0 0 0
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 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0
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 ❑ ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 p
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 0 0 0
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". 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ..g
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 d
A Street Tree List.
I29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ 0 0
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, 0 0 0
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)
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
III
Building Permit Review — Residential
TIGARD
Building Permit #: Ats TAM Y. - 0 1 S—S"
Site Address: 11S1 S ",/ porn .c4-
Project Name: PA Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 1\1(4 ^,i PrP k`+riicoJ eu-.(
V LJ Verify site address/suite#exists and active)permit system.
River Terrace Neighborhood: IV No ❑ Yes,See River Terrace Review Addendum Attached
V›tte Plan Elements:
.'I, , :sting structures on site
ee(3)copies of site plan
P. i - plan must be on 8-1/2"x 11"or 11 x 17"paper 4110 ootprint of new structure(including decks)with finished
1r prawn to scale(standard architect or engineer scale) fl••r elevations
74► orth arrow ref tility locations&easements(required for new and additions)
IM Si - address,project or subdivision name and lot number �l_,sidewalk/driveway approach
D; k.plicant information(name and phone number) !! ocation of wells/septic systems $i„ 44 + 6(' '^ art,'
ot dimensions and building setback dimensions 11I” xisting trees to be retained with drip line,and tree
Vf71;quare footage of buildings to be demolished • .rotection measures
i,!1; .t area,building coverage area,percentage of coverage and 'i4. eet tree size,type and location
�� .pervious area(applicable if R-7,R-12,R-25&R-40) t%
t t names
L•I roperty corner elevations(2 foot contour lines if more than* ,000 sf of impervious area created or replaced? ''s E No,\,
dot differential) If yes,is a storm water quality facility shown? esj /
Clean Water Syrvices—Service Provider Letter(lot platted prior to 9/10/1995):
/ equired: Yes,applicant was notified ❑ No Received: }C7 Yes o
Public Facilities Improvement(PFI) Permit,,:_ 4 I1/ 7 i
Required: CI Yes,applicant was notified LVG No Applied For: ❑ Yes ❑ No,stop intake
and Use Case#:
Li
rZoning:
1/ 1L� equired Setbacks: Front 0 /� Rear Cj Side S Street Side s Garage 0andscape Requirement: Z.(;1
t Coverage Maximum:
Building
Building Height:,)A3
WiFMaximum Heighteght �Z k �j{ T� ,
Actual Hi
/ isual Clearance
V 'Lid Sensitive Lands: Lt"/Yes CI No No Type God S),,1.-,"--0,,11- 1-k(. kl 4rt t iW
Urban Forestry Plan
gi Conditi s "M jt" rior to iss ante of building permit
Notes:'K 0{1 ti„L r _ Iw pr ti idam,of icc✓v L SI.
I.
etr
11"
L'16
Approved By Pla7nning: Date: g-31-1:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES 061417.docx
Building Permit Submittal _
Original Submittal Date: 51Q//ir
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning p•Engineering *Permit Coordinator Building
Workflow Sign-off: 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
original plan review routing form.
C''Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: '�1i�c, i Date: 1?)//r-
Engineering Review
�ope at building pad: 2%
2--Conditions "Met"prior to issuance of building permit
2"-Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 2—No
Assess Water Quantity Fee in-lieu: ❑ Yes 2r-No
� LIDA Facility on lot: I�s El No
LG F/inal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 4,14 KS 14412- Date: 4. -7.-/g
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:
DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
LIDA AYes ❑ N/A
A OK to Issue Permit
Approved by Permit Coordinator: Af-wl �eDate: 411A___
I:\Building\Forms\BldgPermitRvw RES_010118.docx
,,
Clean Water Services File Number
CleanWater Services 18-001761
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: Tigard RECEIVED
2. Property Information(example 1S234AB01400) 3. Owner Information
Tax lot ID(s): 2S104BC01200 Name: Greg Kaufer JUN 7 ?Oif
Company: ��T OF TIGARD
Address: 14504 SW Fern St. g O1 F! a1"�a[
Site Address: 14504 SW Fern St. City, State,Zip: Tigard,ORaU1LDTG DIVISION
City, State,Zip: Tigard,OR,97223 Phone/Fax: (503)997-0983
Nearest Cross Street: Ascension E-Mail: kaufer.plumbline@gmail.com
4. Development Activity(check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence(rooms,deck,garage) Name: Rick Wolpin
❑ Lot Line Adjustment ❑ Minor Land Partition Company: Premier Pools&Spas of Oregon
• Li Residential Condominium ❑ Commercial Condominium Address: 9150 SW Pioneer Ct.Suite G
L3 Residential Subdivision ID Commercial Subdivision
❑ Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Wilsonville,OR,97070
Other Phone/Fax: 4084406934
New in-ground fiberglass Swimming pool E-Mail: rwolpin@ppas.com
6. Will the project involve any off-site work? ❑Yes 1 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 Rick Wolpin Print/Type Title Vice President of Sales
ONLINE SUBMITTAL Date 6/1/2018
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 17-05, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local,State,and federal law.
XBased 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 Date 6/5/18
2550`,`,^)[ H ghway • Hd•sboro.Oregon 97123 • PI erte (503 r'3'-5100 • 931 443J • Jraterservices orq
•
r '
Designer:Vitally• 5.
Address:9150 SW Pioneer ct ste-G
City:WMsoMe
00/s & Spas :oR 97070
Phare:503.855.4117
Cel:503.943.9673
Enrol:vItallys#DDas.comn
Alternate Contact:
• License ft:ORCCB-174389
Customer Name:Greg Kaufer
Address:14504 SW Fern St
City:Portland
State/Zip:OR,97223
Phone:
Cell:503.997.0983
Email:kaufer.olumbline@gmai.com.
Alternate Contact:
Job 4:Kaufer Pool
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Scale:1/37" ft_