Permit (3) CITY OF TIGARD MASTER PERMIT
r Permit#: MST2018-00356
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2019
TIGARD Parcel: 2S104AB09000
Jurisdiction: Tigard
Site address: 12400 SW 131ST AVE
Subdivision: MORNING HILL NO.6 Lot: 119
Project: GISMONDI
Project Description: Replacing the existing 372 sq.ft.deck.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors:
Total: 0 sf Value: $8,890.80 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 RainStorm Sewer: 0
0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywall-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 add'I 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:
ALT SF VB R-3 0
Owner: Contractor:
GISMONDI,MICHAEL E JR LIVING TR STANLEY DEWAYNE MOORE Required Items and Reports(Conditions)
BY GISMONDI,MICHAEL E JR& 6107 SW MURRAY BLVD#263
GISMONDI,BERNARD TRS BEAVERTON,OR 97008
24046 AMES ST
TAYLOR,MI 48180
PHONE: PHONE: 503-522-0047
FAX:
Total Fees: $581.72
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 issu, ce, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio Center. Those rules are set forth in OAR
952-001-0010 throug •'-.952-001-0090. You may obtai opy of the rules or direr questions to OUNC by calling 503. .1987 or. .-00.332.2344.
'MINIssued By: r - `-- �-i�_ Permittee Signature: AMa Now � �
Call 5,, ��4175 by 7:00 a.m.for the next available inspection d e.
This permit card shall be kept in a conspicuous place on the job site until com.etion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential , q^3 FOR 0141(11 ESE O\I.1
Cl of TigardIVE 1 Received
`� g DateBy: ��/ its( 1.477....._— Permit No.: ,s ye j S� r p t,3
1111 g .1 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Q''� t%C� O'LC
Phone: 503.718.2439 Fax: 503.598.1960 ITT(( s Date/By: �Z ( C� n' Other Permit:
T 1 G A R U Inspection Line: 503.639.4175 Lir__i "" " .2U i Date Ready/By: / Juris: H See Page 2 for
Internet: www.tigard-or.gov CITY
fied/Method• / - // •7 I Supplemental Information
TYPE OF RAILG DI ISiO REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 1:1 Demolition wt� 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 dwellingValuation: $ �O t $q a
0 Commercial/industrial
1:1Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: )2.1-100 v i. 1 3 I A v&" New dwelling area: square feet
City/State/ZIP: ` It), ,}<--el, 0R, C-7 Z2-j Garage/carport area: square feet
Suite/bldg./apt.no.: 0 Project name: 6,S 6 j d' ' cJL Covered porch area: square feet
Cross street/directions to job site: ci I au}- ill- ! L ,ileo rQ ri-- Deck area: 3 )L square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: l 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 aplm ication.
.2.0c C t bac .
I _ as2clt Sink. 'C-4 p r 1 n 1---
Valuation: $ ` 7
Existing building area: square feet
New building area: square feet
KPROPERTY OWNER 0 TENANT Number of stories:
Name: 4I 7icho_ , ,./),Lon C l a Type of construction:
Address: 1jL. b St,0 I-2,b.+- a:0SL Occupancy groups:
City/State/ZIP: i w,--,4 , 0g— f r1' 3 Existing:
Phone:t*, ) ":3,.ii—24/57 Fax:( )//CO JZ-i New:
El APPLICANT X CONTACT PERSON BUILDING PERMIT FEES*
1j (Please refer to fee schedule)
Business name: 1�3ifiE..- , cr..si.fi-C•T)c�,7
Structural plan review fee(or deposit):
Contact name: j- `,-1 NI,Qt3,1
FLS plan review fee(if applicable):
Address: (01 0-7 Sk,+.i ` '.. (I u v tri 4 J 3 f
y� f A Total fees due upon application:O ] e--V
City/State/ZIP: dJ..C'c„,) -}Oft/,--- . G3-7�°�C 5 / /w`
:. � Amount received:
Phone:
(5 .-i) .72L.-ci'tj7 Fax::( kteet
E-mail: 5 4-q,,1 A ravorp eE;k ,'4.) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: ,J .civi Moo, Cor/5,,)y-14... et l Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: (p 1 ) ) 5. KA t ri IVC) • D.,;.5 Solar Installation Specialty Code checklist.
City/State/ZIP: j?jl tii,j e k CvZ. c[Z Gig Permit Fee(includes plan review $180.00
1 and administrative fees):
Phone:(S..c 3) T22.-00,17 Fax:( ) 4.01-e_
State surcharge(12%of permit fee): $21.60
CCB lic.: /i',15 2 y
Total fee due upon application: $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: K 00 i�- Date: *Fee methodology set by Tri-County Building Industry
Sty Service Board.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling mit orrlci. CSI, oyl.l
City of Tigard d Received Permit No.:
INg Date/By:
r 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
s Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
T t G n R D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les 10 1',k
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • il
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 0
6 Sewer permit. 0 0 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 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 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 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 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 0 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 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 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 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floortroof 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 0
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. 0 0 0
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 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 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)
CE Clean Water Services File Number
DEC 2 6 Z018 C1eanWater Services
FyIrtqfprelMotPre-Screening Site Assessment
1. Jurisdiction: fj4 1N{; DIVISION
2. Property Information (example 1S234AB01400) 3. Owner Information !
Tax lot ID(s): Name: J _.r,rl l w f t',-' ' i-`1,1
Company:
sr
Address: l ZLI OC S) i',1
OR Site Address: j2c4oc -‘ i 5t 5e� otvv City, State,Zip: 1 1 0-1-'01, C)+Z-, ell 223
City, State,Zip: Tj,r4, Da'_ 9.1222, Phone/Fax: 5O3-3itI-2'191
Nearest Cross Street: J rx i'i t4 f- E-Mail: .. -.vi wr, 4--h &) G Pw1 c—c,s4-. rtaz.+-
4. Development Activity(check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence(rooms,deck,garage) Name: S t4'1 M c D r ,
❑ Lot Line Adjustment ❑ Minor Land Partition Company: )I c c rt ( _i -I-'tAz-- i(•,'1 •
❑ Residential Condominium ❑ Commercial Condominium Address: 6 t o"7 5/,,1 Mu frqi r3/,x4 214,5
❑ Residential Subdivision ❑ Commercial Subdivision r
la Single Lot Commercial la Multi Lot Commercial City, State,Zip: j3e ie{ h, Qf2 cj7(>a
Phone/Fa 5 -c 52-2-
Other 12pplc�e rk.r.lt ESArvtr i r~in�- 1
E-Mail: ,D t't'lec`r'.--e e c_kS.,4:G,41
6. Will the project involve any off-site work? ❑Yes 4No ❑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 y
)4.Q1-p:V
+ t`
Print/Type Title 4~ -��'5`
Signature .-_�_—• Date 1C ._ t
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
f�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 17-05,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 � L�LPP Date l0/J1e
Once complete, email to: SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Revised 6/2017
City of`Tigard
11 C
4 COMMUNITY DEVELOPMENT DEPARTMENT
T c A R D Building Permit Review — Residential
Building Permit #: zksr oZO(7' 6 `-----
Site Address: 422-166 S7f() /,- /c4/- -P
Project Name: (3 Oill?' G
e_pivo cerx pr1.7L" Lot #:
(New dwelling=subdivision name;Addition or 4flteration=last name of owner)
Planning Review
Proposal: Eioni,,,/-C el r K., (r) 4)1. rze.'jr-- d
!�ori
LTJ Verify site address/suite#exists and active ' ermit system.
0 River Terrace Neighborhood: y
No ❑ Yes,See River Terrace Review Addendum Attached
Sit lan Elements: ��
Three(3)copies of site plan xisting structures on site
VS. - plan must be on 8-1/2"x 11"or 11 x 17"paper ❑Footprint of new structure(including decks)with finished
11: b rawn to scale(standard architect or engineer scale) floor elevations
lg North arrow V, ty locations&easements(required for new and additions)
litate address,project or subdivision name and lot number !C A e, alk/driveway approach
V plicant information(name and phone number) pl , t.ation of wells/septic systems
l21,ot dimensions and building setback dimensions sting trees to be retained with dri
are footage of buildings to be demolished'(€)
protection measures P line,and tree
b•t area,building coverage area,percentage of coverage and PI .-et tree size,type and location
itipervious area(applicable if R-7,R-12,R-25&R-40) ►Street names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced?
4 .ot differential) p d. ElYes.,<;,,If es,is a storm water •uali facili shown? ❑Yes Mo
IN Clean Water S rvices—Service Provider Letter(lot platted prior to 9/10/1995):
Required: II Yes,applicant was notified ❑ No Received:
Yes ❑ No
ublic Facilities Improvement(PFI)Permit
Required: ❑ Yes,applicant was notified No Applied For:
PP 0 Yes ❑ No,stop intake
,! . d Use Case#:
i go ring. C
.
(equired Setbacks: Front le- Rear T Side Street et SideImo 'W
age p\-fr
dscape Requirement: %
Coverage Maximum: ---0-5 % J /ier Building Height: Maximum Height ( i Actual
Height ./i
1 i sual Clearance ��
Sensitive Lands: b�J Yes ❑ No Type
. yl rban Forestry Plan i C '1 GUP f/ .,,,,L_
IN nditions "Met"prior to issuance of building permit V�� 0-60 71
Notes:
❑ Approved By Planning:
:._._ -----÷7/---_ Date: /�.
Revisions (after Building Submittal only) Reviewer
Revision 1: 0 Approved ❑ Not Approved Date
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
i:\BuildineFoims\BldgPermitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: _ if
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planning engineering tPermit Coordinator Building
Workflow Sign-off: Sign-off for Pla ntng(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.
tff-Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
ByPermit Technician: 4";
/ `�r�
; r/f. Date: !oZ/A 4(//1--
Engineering Review
Er Slope at building pad: (07c5
Er Conditions"Met"prior to issuance of building permit
[?] Easements (encroachments)per engineering conditions of approval and plat
IZI Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes No
Assess Water Quantity Fee in-lieu: 0 Yes No
LIDA Facility on lot: 0 Yes No
Er/Final Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:VApproved
by Engineering: g R,• 15.11..:. Date: 12 • z l• l8
Revisions (after Building Submittal only)
' Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
NIAConditions"Met"prior to issuance of building-permit
0 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:
SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes N/A
Tigard Trans SDC: 0 Yes N/A
Parks SDC: 0 Yes N/A
LIDA 0 Yes N/A
0 OK to Issue Permit fJ
Approved byPermit Coordinator: ACMf.Jvt— Date: 2,1 31)1`�
PP AO
I:\Building\Forms\BldgPermitRvw_RES 010118.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12400 SW 131ST AVE, TIGARD, OR, 97223 February 25, 2019 at
11 :51 :33 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00356
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - NoCofO
Comments:
Decks and guardrails ok.
Safety terminal installed at lower handrail.
Violation Summary:
Inspector Contractor