Permit (243) 111111 CITY OF TIGARD MASTER PERMIT
111:' COMMUNITY DEVELOPMENT Permit#: MST2018-00175
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/09/2018
T[Cai `L 9 Parcel: 2S104CC04100
Jurisdiction: Tigard
Site address: 13922 SW HILLSHIRE DR
Subdivision: HILLSHIRE ESTATES NO.2 Lot: 147
Project: SOMMERVILLE
Project Description: 288 sq. ft. In ground swimming pool with safety cover.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: First: sf Basement: sf Left: Parking Spaces: 0
Height: Bathrooms: Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: 0 sf Right:
Detectors: No
Total: 0 sf Value: $30,000.00 Rear:
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Urinals:
Lavatories: Dishwashers: Floor Drains: 0 Sewer Lines: SF Rain Storm Sewer:
Drains: 0
Tubs/Showers: Garbage Disp: Water Heaters: Water Lines: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: Hose Bib: Backwater Value:
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Natural Gas 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 VB R-3 0
Owner: Contractor:
SOMMERVILLE,JEANINE A BLUE MOUNTAIN POOLS INC Required Items and Reports(Conditions)
13922 SW HILLSHIRE DR 13121 S WARNOCK RD 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97223 OREGON CITY,OR 97045
PHONE: PHONE: 503-760-4554
FAX:
Total Fees: $908.52
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 - -.-_ . by the Oregon Utility Notification -nter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You m twin a cop of the rules or dire questions to OUNC by calling 50 32. •87•f1.8•,.332.2344.
.--fIssued By: Signature: / \ Iv/�,/44 �
Call -,:°..7. 1v175 by 7:00 a.m.for the next available'inspection date.
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
FOR Of'1 1<:E f SE ON IA
City of TigardRECEIVED Date/Received s "
' , �, Permit No.: ,..
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review, w l y t
I Phone: 503.718.2439 Fax: 503.598.1960 JUN
R (� ) i U Date/B : NE i Other Permit:
T I G A R D Inspection Line: 503.639.4175 JUN 1. " O i(, Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov yy ®,{` �p ,� Notified/Method: En
Supplemental Information
cA
TYPE 0 ' 1 i r b ING DIVISION REQUIRED DATA:1-AND 2-FAMILY DWELLING
[' New construction ❑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.
Valuation: $ ,X__0 c..
0 1-and 2-family dwelling I=1Commercial/industrial
ElAccessory building ElMulti-familyNumber of bedrooms:
Master builder Other: r�N < Number of bathrooms:
❑ .:-(� . ek) rte `_t
JOB SITE INFORMATION AND LOCATIN Total number of floors:
Job site address: l3Ci 3S 3 k i 0,\\31,.\,,,....e C 5. New dwelling area: square feet
City/State/ZIP: --(L. G(ci 6j Q, on aa 3 Garage/carport area: square feet
Suite/bldg./apt.no.: v Project name: (, ),)„,teryzili'i LK,_ Covered porch area: square feet
Cross street/directions to job site: �J Deck area: square feet
5cr✓6( c /)f,)v I' 2'l Lc /fr./c / GS 11 .,„/_, /��1'v� Other stru rree area: /56 square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel 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: $
J/— v
h ok:l'l 0 S w.'. • wWvlk or) rte'C.i L / Scl1lt`f(`c.v Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: T�v,WL l 1k- Type of construction:
Address: V Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
APPLICANT a CONTACT PERSON NOTICE
Business name: � '
>a ,_,44Q,..,;(6 G-t ", t All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: L C\YY- under ORS 701 and may be required to be licensed in the
Address: aL c..�,y�Or��� 6,01 jurisdiction in which work is being performed.If the
City/State/ZIP: ) applicant is exempt from licensing,the following reasons
C C �c fl C��y C�l� �17�y apply:
PP Y:
Phone:(Gj(j3) 7(,.;C5 1-1 56C( Fax::( --1 . Lir
E-mail: I (r., N k•;,LdnC:•L:tAl c,..t✓\ 15:�L io'\
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: 5c.t vvt� C\5 RbQ\Q Permit fee: I , Fr
Address: i d
State surcharge(12%of permit fee):
City/State/ZIP:
o o permt
Phone:( ) � Fax:( ) (Due upon application submittal)
CCB lie.: 027.Pt c 6 Total permit fees:
Amount received:
Authorized signatuA-0)16-- ---------,..., This permit application expires if a permit is not obtained
Print name: �� ` Date: ( ' within 180 days after it has been accepted as complete.
\,•.s. J 6 8 tixc k_-.'t -- — t 9 , " * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Budding\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COMWEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete A,B, C D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler(Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A,B &C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review(40% of permit fee): $
TOTAL: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
I
T I G A R D Building Permit Review — Residential
Building Permit #: irisTRe i y_do/7
Site Address: 4 ' T2,2_ GUd \illi h( e, p I-Iv&
Project Name: SDmrmeirV 111.6- 170D Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: N?W fns y po c 1
Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: X No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
.:Three(3)copies of site plan `Existing structures on site
Waite plan must be on 8-1/2"x 11"or 11 x 17"paper4/Footprint of new structure(including decks)with finished
D`
I rawn to scale(standard architect or engineer scale) floor elevations
�'i orth arrow FIA tility locations&easements (required for new and additions)
nbite address,project or subdivision name and lot number , iig •@ ewalk/driveway approach
► plicant information(name and phone number) location of wells/septic systems
of dimensions and building setback dimensions AgExisting trees to be retained with drip line,and tree
N r,4!.quare footage of buildings to be demolished protection measures
of area,building coverage area,percentage of coverage and /1J1 Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) ('Wtreet names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ❑]YYeess] To
""'4 foot differential) If yes,is a storm water quality facility shown? it i. 11❑No
IR'Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: Yes,applicant was notified ❑ No Received: Yes/ 144.? ,-.1
Public Facilities Improvement(PFI) Permit: 7/1/4- 6:1
Required: E Yes,applicant was notified . No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#: K/,
itgr Zoning: R`-1 C.Pu)
I^J, Required Setbacks: Front 1/ Rear ( Side C l Street Side N/P .Garage
'y1 Landscape Requirement:
Lot Coverage Maximum: 8)
0/0
N Building Height: Maximum Height Actual Height
I:: isual Clearance
Ja'Sensitive Lands: ❑ Yes (No Type
14V1 Urban Forestry Plan
II 4 onditions "Met"prior to issuance of building permit
•tes:
Approved By Planning: it-�Q� Date: (.0Clc l` �
Revisions (after Building Submittal only Reviewer ` Date
Revision 1: ❑ 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: 6 /47 if
Site Plans: # 3
Building Plans: # 3
Building Permit#: nter building permit above.
Workflow Routing: arming Engineeringrmit Coordinator EL-13thilding
Workflow Sign-off: d=off for Planning(include notes from planning review)
Route Application Documents: Q.-efig veering: (1) copy of permit application, (1) site plan, (1) building plan and
origal plan review routing form.
OV Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
� ' `-� Date: /t
By Permit Technician: �, �7j .',
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 No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: ,lZ Date:
Revisions (after Building Submittal only) eviewer 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 ..I N/A
Tigard Trans SDC: ❑ Yes L N/A
Parks SDC: ❑ Yes ..,..N N/A
LIDA ❑ Yes N/A
OK to Issue Permit
Approved by Permit Coordinator: Dater(224 245 N loThruo 0/7`4,914--i
I:\Building\Forms\BldgPermitRvw_RES 061417.docx