Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2020-00134
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/07/2020
Parcel: 2S102AB00601
Jurisdiction: Tigard
Site address: 12075 SW LINCOLN AVE
Subdivision: NORTH TIGARDVILLE ADDITION,AMENDE Lot: 63
Project: Ruggiero
Project Description: Convert upper level storage closet into a bathroom. Water meter not required to be upsized. ALL
TRADE PERMITS TO BE OBTAINED SEPARATELY.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $28,000.00 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
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
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 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:
ALT SF VB R-3 0
Owner: Contractor:
RUGGIERO,RYAN C&NICOLE S ROBERT J DOMZALSKI Required Items and Reports(Conditions)
12075 SW LINCOLN AVE 8933 SW WOLDS DR
PORTLAND,OR 97223 BEAVERTON,OR 97007
PHONE: PHONE: 503-349-6332
FAX: 503-746-4459
Total Fees: $872.51
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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
-tV_,i.-—--2
Issued By: mittee Signature: �� -�.
C 9.4175 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 /�S
Residential CFN U FOR OFFICE CAE O.L\
City of Tigard ae wed / if /a PermitN y r, a, do ..oafs
: " 13125 SW Hall Blvd.,Tigard,OR 9722 nR 1 y 2Q20 Plan Review G��p21� in
Phone: 503.718.2439 Fax: 503.598.1y960 ' F Date/B : J f^'v_ Other Permit:
te Ready/By:
See Page 2 for
T I GARDInspection: www.tigard-or.gov75 D 1 1 v`'1. '1� p hl Notified/MetMd: 7 ®elemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
O New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
O Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
ClTr Y OF CONSTRUCTION work indicated on this application.
' Valuation:28,000.00 $
2 1-and 2-family dwelling 0 Commercial/industrial
l 0 Accessory building 0 Multi-family Number of bedrooms:
2 0 Master builder ❑Other: Number of bathrooms:1
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12075 SW Lincoln Ave. New dwelling area: square feet
City/State/ZIP: Tigard, Oregon 97223 Garage/carportarea: square feet
Suite/bldg./aptno.: Projectname:Ryan & Nicole Ruggiero 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 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.
Upper Level Bathroom/ Shed DormText Valuation: $
f 5/0, / To .2 t�,6 7rM�, Existing building area: square feet
e /1'7 / / _/1 icAsjzz- itf0/ 2is.--6 '.6 470 New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name: Ryan & Nicole Ruggiero q 1 u. *< . PkimeoT Type of construction:
Address:12075 SW Lincoln Ave. Occupancy groups:'
City/State/ZIP: Tigard, Or. 97223 Existing:
Phone:(541 )521-8891 Fax:( ) New:
d APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Structural plan review fee(or deposit): 3/ ,,5 „,
Contact name: Ay).V> I:AM-kW,\
FLS plan review fee(if applicable):
Address: `.)(l i\„ * KI)34I
Total fees due upon application:
City/State/ZIP:
Phone:(5O)) - 653 _ Fax::( ) Amount received
E-mail: d,e,,v,,j„C,11%,Ge
OCR ' ��� PHOTOVOLTAIC SOLAR PANEL SYSI EM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Rob Domzalski Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 15385 SW Thames Ln. Solar Installation Specialty Code checklist.
cityistate/zIP:Tigard, Or. 97224 Permit Fee(includes plan review $18000
and administrative fees):
Phone:(503) 349-6332 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.:79617 Total fee due upon application: $201.60
Authorized signature: RiAti This permit application expires if a permit is not obtained
' P 11 ' t within 180 days after it bas been accepted as complete.
Print name:ROb Domzalski 1 1 Date:April 13, 2020 *Fee methodology set byTri-County Building Industry
Service Board
1:1Buildmg\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
al
T I G A R D Building Permit Review — Residential
Building Permit #: /ftS7-.29--o - QO/ 3 /
Site Address: I Z0'15 SW Llln Cowl A-v2,
Project Name: �S1-sro Lot #:
Planning Review JJ
Proposal: tffeetraU9N Cghve(} S-+�r C,Cc1t e- %lkvl A9 2G ,1D—v---
Pr Verify address/suite#active in Accela. MI In River Terrace: No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: Arosion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper nr4Retained trees with drip line and tree protection measures
brawn to scale(standard architect or engineer scale) AO/Footprint of new structure(including decks)and HIE
. forth arrow Utility locations&easements(required for new and additions)
.Site address,project or subdivision name and lot number /Sidewalk/driveway approach
.Applicant information(name and phone number) Mbocation of wells/septic systems
„IstLot dimensions and building setback dimensions NOIotreet tree size,type and location
/ quare footage of buildings to be demolished XStreet names
Existing structures on site WCorner elevations (2'contours if more than 4'differential)
(t Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes YiNo
1 impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes No
Pit Clean Wat r`,ervices—Service Provider ed prior to 9/10 95): s774_ „vT4"n402 i✓�2f'
Required: ►`, •es,applicant was notified o D ec 've . No 40
12(Water Met-'Fixture Unit Worksheet—A • • , emodels and ADUs
Required: EYes,applicant was notified ❑ No Received: ❑ Yes No
171.SDC DEGE2�/fiL applied for: ❑ Yes X No Received: ❑ Yes 0 No
Public Facilities Improvement(PFI) Permit:
Required: 0 Yes,applicant was notified X1 No Applied For: 0 Yes ❑ No,stop intake
f\rtrLand Use Case#: ik Zoning: Iz--+C
Required Setbacks: Front:2O Rear: LS Side: 5 Street Side: ►rtk- Garage: 223' —Na
11,Building Height: Max.Height: 20 Actual Height: IQ 0—61Aarl e/ �/�
i1 "" 0 f
-Landscape Area: % -Lot Coverage Max: % _ �U] V
Entrance 11 .et back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ►t,A,,',. urn 12%of area of all street-facing facades— N erk-6n
Garage !i a .ge oor is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
11 oor tends no more than 5'from wall and there is a covered porch extending beyond garage.
11 oo t ds no more than 5'from wall and there is a 12 sq ft.window above garage on 2"d floor.
17 G. . e d or 'dth is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch 0 Gable,hip,or gambrel roof 0 Dormer
❑ Accent siding ❑ Window trim 0 Window recess ❑ Window projection ❑ Balcony
-Visual Clearance "Urban Forestry Plan LOW
I^J�"
Sensitive Lands: , ( Yes LOW
. No Type: \f t�ldt I &t Hai ("
O!=' Conditions met prior to issuance of building permit
Notes:
Approved By Planning: V Date: 44 120[W
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: y/S/20
Site Plans: # '3
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing: eI Planning 0 Engineering - 0 Permit Coordinator wilding
Workflow Sign-off: 2--gin-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. ,
❑ Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: fyy/2,0
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: 0 Yes ❑ No
Assess Water Quantity Fee in-lieu: 0 Yes ❑ No
LIDA Facility on lot: 0 Yes 0 No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
❑ Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not . roved
Revision 2: 0 Approved 0 No pproved
Permit Coordinator Review
❑ Conditions"Met"prior to issu. ce of building permit
❑ Approved,NOT Rele •ed: Date:
Notes:
Revisions (after B • •ing Submittal only)
Revision Noti 1: Date Sent to Applicant:
Revision N•.ce 2: Date Sent to Applicant:
❑ SDC E . .ption: ❑ Received 0 Does not apply
❑ SD ees Entered: Wash Co Trans Dev Tax: ❑ Yes 0 N/A
Tigard Trans SDC: ❑ Yes 0 N/A
Parks SDC: 0 Yes 0 N/A
LIDA 0 Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\B1dgPennitRvw_RES_122419.docx
RECEIVED
APR 2 9 2020 CleanWater Services
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT
Clean Water Services File Number
1. Jurisdiction:City of Tigard
2. Property Information(example: 1 S234AB01400) 3. Owner Information
Tax lot ID(s): Name:Ryan and Nicole Ruggiero
2S102AB00601 Company:
Address:12o75 sw unc° Ave
OR Site Address: City,State,Zip: Tigard,OR 97223
City, State,zip:12075 SW Lincoln Ave,Tigard 97223 Phone/fax: 541 521 8891
Nearest cross street: SW Center Email: rcruggiero@gmal.com
4. Development Activity(check ail that apply) 4. Applicant Information
El Addition to single family residence(rooms, deck, garage) Name:sameabove as
CILot line adjustment ElMinor land partition Company:
0 Residential condominium ❑ Commercial condominium Address:
0 Residential subdivision ❑ Commercial subdivision City,State,Zip:
❑ Single lot commercial ❑ Multi lot commercial Phone/fax:
Other remodel of existing closet to bathroom(no footprint change) Email:
6. Will the project involve any off-site work? ❑Yes ■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 Ryan Ruggiero Print/type title homeowner
Signature 'tan Rg9gieio Date Apnl20.2020
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.
0 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 19-5,Section
3.02.1,as amended by Resolution and Order 19-22.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 sense as your Service
Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.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 PLANS)ARE ATTACHED.
154 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 11EQUIRED.
Reviewed by J %Y" Date 4/29/2020
Once complete,email to:SPLReviewecieanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway,Hillsboro, Oregon 97123
Main Office • 2550 SW Hillsboro Fiighway • Hillsboro,Oregon 97123 • p:503.681.3600 f:503:E381.3603 • cleanwater:services.orrl
/7S7,26r o - Gb/34J 9-otr2.5t5, - 341- 032-
Water Meter Fixture Unit Worksheet for Additions/Remodels/ADU -D
Please complete the following information: APR t '6'6
Customer Name: latii jvvN- N 'Jv i 0 k izip_ov i I{/W l ��; :,GPP?
Service Address: Street/Suite#: I2O 74 5'W (.4 1,-,to I v\- 'L gU1LD1 N J VIA G D1vIS1
City: Ti ! State: ar- Zip: 17 2 Z'
Phone Number: 7141 DZI V P 1 I Email: rc,v-vei 0)i•eMp (? , 1-r-M I . 0len
Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add.
Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at
total. the proposed total.
Fixture Unit Current Point Current Proposed Point Proposed
Quantity Value Total Addition Value Total
Bar sink x 1 = x 1 =
Bidet x 1 = x 1 —
Clothes washer 1 x 4 = 4 x 4 =
Dishwasher I x 1.5 = I,5 x 1.5 =
Hose bib x 2.5 = x 2.5 =
Hose bib,each 7, x 1 = 2 x I =
Kitchen sink I x 1.5 = 1.5 x 1.5 =
Laundry sink I x 1.5 = I, x 1.5 =
Lavatory 7, x 1 = 2 1 x 1 = I
Water closet, 1.6 GPF Z x 2.5 = 5 I x 2.5 = 2.5
Bathtub/whirlpool x 4 = x 4 =
% Shower stall x 2 = I x 2 = y
Bath/shower combo 1 x 4 = t{ x 4 --
Current Points: 21 • 5 Proposed Increase: c• 5
Current Points+Proposed Increase= 11 =New Total Points =Required Meter Size
Meter Sizes: 1 to 30 points—5/8" 30.5 to 37 points=3/d' 37.5 and over points= 1"
/7,L`t, 4t 055055 — 000
New Meter Size Needed for New Total Points: N A Cost: $ N-Pk (see page 1)
il
Current Meter Size per Utility Billing: 5ie9 Cost: $ N fl (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $ N/a
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
FOR OFFICE USE ONLY
G.Current Meter Size Confirmed with UB 'S err L- F-t -d z` l( y/ -7/�°
Signature of UB Representative Date < /a
1:/Building/Forms/WaterMeters_070119 Add.doCx Page 2
• A7s- i.2o - oo/3 y
Julie Drinkwater
From: #Building Permit Technicians
Sent: Monday, April 27, 2020 9:08 AM
To: Julie Drinkwater
Subject: FW: MST2020-00134 - Ruggiero - 12075 SW Lincoln Ave
Importance: High
Hi Julie,
Please print this email from UB and put it with the permit packet. I believe it is on the desk there with the plans to go
out to Allyson.
Thank you!
Dianna
From: UB Online<UBOnlinepay@tigard-or.gov>
Sent: Monday, April 27, 2020 8:46 AM
To: Dianna Ornelas<Dianna@tigard-or.gov>; Rob Domzalski<domzalski7986@comcast.net>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: MST2020-00134- Ruggiero- 12075 SW Lincoln Ave
Good Morning,
The current fixture meter count is incorrect and should be 23. It looks like the hose bibs were put in as the additional
instead of one hose bib as 2.5 and the add'l bib as 1. Fortunately, that does not change the required meter size.
Current meter size is 5/8 inch and according to the worksheet there is no meter size increase needed.
Kind Regards,
Jill
Jill
III ' City of Tigard -Utility Billing
• Senior Accounting Asst
I u,A I.1)
(888)826-7211 Payments
(503)718-2460 U6 Main
jaIbi@tigard-or gov
{503)718-2494
13125 SW Hall Blvd.
Tigard,OR 97223
From: Dianna Ornelas<Dianna@tigard-or.gov>
Sent: Friday, April 24, 2020 11:48 AM
To: Rob Domzalski<domzalski7986@comcast.net>
Cc: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>; UB Online<UBOnlinepay@tigard-or.gov>
Subject: MST2020-00134- Ruggiero - 12075 SW Lincoln Ave
Hello Rob,
This permit has been created and the plan review submittal fee due is$316.56.
1
A
The fees can be paid online at https://aca.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number MST2020-00134 under the Building tab.
Once the payment is received the plans will be routed offsite for building review. Due to the increased permit activity
and remote working conditions, please expect delays. The permit technicians will contact you as soon as the permit is
ready to issue with the balance due.
Please note that we received the water meter fixture unit worksheet however the signature was missing on the
form. I have copied our Utility Billing division to approve and sign the form and return to the permit technicians as
this is required prior to permit issuance.
Thank you.
Dianna L. Ornelas (Howse)
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
2