Permit q CITY OF TIGARD BUILDING PERMIT
'-! 'I '. COMMUNITY DEVELOPMENT Permit#: BUP2020-00096
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/30/2020
Parcel: 1 S135DA00700
Jurisdiction: Tigard
Site address: 11260 SW HALL BLVD
Project: FULLERTON Subdivision: METZGER ACRE TRACTS Lot: 16
Project Description: Demolition of a 1,210 sq.ft.house on sewer and a 625 sq.ft.detached garage. UPON FINAL INSPECTION,
DEMO CREDITS FOR SDC FEES WILL APPLY.
Contractor: DAN RIEHL EXCAVATING Owner: RALPH FULLERTON
24801 SE HOFFMEISTER 11260 SW HALL BLVD
DAMASCUS, OR 97089 TIGARD, OR 97223
PHONE: 503-658-8180 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 04/15/2020 $332.27
Demolition
Occupancy Grp: Occupancy Load: Erosion Control w/Development 04/15/2020 $80.70
Dwelling Units: 0 Info Process/Archiving-Sm$0.50(up to 04/15/2020 $0.50
Stories: 0 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: 0
Value: $17,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $413.47
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet: 1 Ersn Cntrl 503-639-4175
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
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 OAR 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.
Issued By: Permittee Signature: r - '
••_Call 503.639.4175 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
Residential ! ECEIVED FOR OFFICE USE ONLY
Received
. City of Tigard MAR 3 0 2020 Date/By: �/J/ 17/ ! T Permit No.: ({,1p ,c1...avety
!PI • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / '�t�J s I!V
Phone: 503.718.2439 Fax: 503.598.19TY OF TIGARD Date/By: N* Other Permit.
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: kris: laSee Page 2 for
Internet: www.tigard-or.gov Notified/Method: /j) n Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction Xbemolition 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: $
VI-and 2-family dwelling 0 Commercial/industrial
ElAccessory building ❑Multi-family Number of bedrooms: I '
❑Master builder ❑Other: Number of bathrooms: ��s b
JOB SITE INFORMATION ND LOCATION ( � Total number of floors: pa'�5
Job site address: \\.__Q Ub 1 '�� -\ V ( New dwelling area: // 7(p square feet
City/State/ZIP: `6-, (-)L�� 11V ,'\ Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: rN / Covered porch area: square feet
Cross street/directions
to job site: T Deck area: square feet
0-it)S SE;fl/i/r.6" i'fl0�/�E7Z t E77' 7.Z /n 2——llt2e .P 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
t DESCRIPTION OF WORK work indicated on this application.
"t- 2,- 'tr CN Od Valuation: $ /71 604,
ky� 1
�� \, Existing building area: square feet
--dA ' Je_r per 7, . c_ri ilf- New building area: square feet
Name:�OPER\TY OWNER ? ElANT Number of stories:
" \ ' ""- L�'{ \ Type of construction:
Address: \\ Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
'PPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: k \Y k(IrA U�� y1n � � reviewe refer tofee schedule)
le)
"\v t Structural plan fee(or deposit):
Contact name:
t�L rI FLS plan review fee(if applicable):
Address - . a `i/y\
City/State/ZIP:1 .,no�_ � C\`1 Total fees due upon application:
f� 1 Amount received:
Phone.Cc 4F I?5 gjg� Fax:: SS"I. I5
E-mail: 1 �_ `' (---(7,
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
�� ? ��7 �� Commercial and residential prescriptive installation of
LONAACTOR roof-top mounted PhotoVoltaic Solar Panel System.
/\ Submit two(2)sets of roof plan with connection details
Business name: Thf✓ Y�'L � G` L ` and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
)
CCB lic.: ( 3 t n Total fee due upon application: $201.60
1
Authorized signs This permit application expires if a permit is not obtained
' I
f within 180 days after it has been accepted as complete.
Print name: Date: 'yy `` *Fee methodology set by Tri-County Building Industry
�/� �S'� (� Service Board.
1:\Building\Permits1BUP-RESPern itApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE 1 'l. ONl.l
City of Tigard d Received
III Date : : Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
' Phone: 503.718.2439 Fax: 503.598.1960
TIGARD 24-Hour Inspection Line: 503.639.4175 0 Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOVt INC; I"1'EMS ARE RI.QUIRED FOR PLAN REVIEW Yes No \ k
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 0
3 Verification of approved plat/lot. _ ❑ 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
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 ❑permit required. Include drainage-way protection,silt fence design and location of catch- 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, ❑ ❑ ❑
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 ❑
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
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 floor/roof truss design details. ❑ 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 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 Oregon and shall be shown to be applicable to the project 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 0 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ 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, ❑ ❑ ❑
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(I 1/02/COM/WEB)
City of Tigard
7111 ■ ill COMMUNITY DEVELOPMENT DEPARTMENT
c n i D Building Permit Review — Residential
Building Permit #: 94Pp2O 'CCU
Site Address: MOO 6W fiall iNvd
Project Name: Flit I let`tpn Lot #:
Planning Review
Proposal: Deja0 haj
® Verify address/suite# active in Accela. X. In River Terrace: No 0 Yes,River Terrace Review Addendum
Si,Plan Elements: rosion Control 00--Ea u 10-ZZ
413 copies of site plan on 8-1/2"x 11"or 11 x 17"paper 11 etained trees with drip line and tree protection measures
1rawn to scale(standard architect or engineer scale) botprint of new structure(including decks)and FFE
orth arrowtility locations&easements(required for new and additions)
Itiite address,project or subdivision name and lot number ro idewalk/driveway approach
L I pplicant information(name and phone number) f, .cation of wells/septic systems
t. .t dimensions and building setback dimensions PAgtreet tree size,type and location
)Ftgquare footage of buildings to be demolished treet names
' xisting structures on site Corner elevations(2'contours if more than 4'differential)
Af6t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? [� e��No
pervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? /�I/ 11 No
lean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): pp -��
Required: XYes,applicant was notified E No Received: X Yes No , ui <V
4 Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs ttha fie 6-"Ti
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
Anc SDC Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No
Er Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified 'No Applied For: ❑ Yes ❑ No,stop intake
'Land Use Case#: tKZoning: R— (Z—
!i 'equired Setbacks: Front: Rear: Side: Street Side: Garage:
'!.'�1 uilding Height: Max. Height: Actual Height
111 andscape Area: % ❑ Lot Coverage Max:
Entrance IMI Set back no ore than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ■I Minim 1 %of area of all street-facing facades
Garage II ara do is behind widest street-facing wall ❑ Yes El No,one of the following is met:
❑ Poo exte , no more than 5'from wall and there is a covered porch extending beyond garage.
le l oo exte . n. more than 5'from wall and there is a 12 sq ft.window above garage on 2°d floor.
• Garage d r wi s ❑ 12'or less CI50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Coy red '.orch ❑ Recessed entrance ❑ Wall offset 0 1'Roof eave ❑ Roof offset
❑ Fires ' :les El Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess Cl Window projection ❑ Balcony
Visual Clearance 11921-Urban Forestry Plan
Sensitive Lands: ❑ Yes �j No Type:
IA Conditions met prior to issuance of building permit
Notes:
*Approved By Planning:(...
C ,m/1� Date: ���I�
Revisions (after Building Submittal only Reviewer Date
Revision it 0 Approved ❑ Not C�
Approved
, /� , 917 e �,j,
� t��y
Revision 2: El Approved 0 Not Approved
I:\BuildingTonns\BldgPemutRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: _ /
Site Plans: #
Building Plans: L,�
Building Permit#: am, 'nes�ter building ermit#above. �
Workflow Routing: CI�Planning Bering hJ/flemut Coordinator ❑
Workflow Sign-off: ❑ Sign-off for lanntng(inc u e 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: (/Yi Y 3/3 0/ v 5 . 4 v
By Permit Technician: Date: yi//1s/�
Engineering Review
❑ Slope at building pad:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approv plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes 0 No
Assess Water Quantity Fee in-lieu: 0 0 No
LIDA Facility on lot: Yes ❑ No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
❑ Approve y Engineering: Date:
Revisi (after Building Submittal only) Reviewer Date
evision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 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:
• SDC Exemption: ❑ Received Does not apply
• SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 14 N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
LIDA ❑ Yes N/A
pOK to Issue Permit /� -
Approved by Permit Coordinator: f�J Date: +1 14(W
I:\Building\Fonns\BldgPermitRvw_RES_122419.docx
vsx V ^A R 1Lira L
'Y *A C1eanWate� Services
SENSITIVE AREA PRE-SCREE4KiAt2PTE ASSESSMENT
3i .,i,;, LA uIpl afl\.Water Services File Number 20-001129
1. Jurisdiction: Tigard
2. Property Information (example: 15234AB01400) 3. Owner Information
Tax lot ID(s): 1 S135DA00700 Name: Ralph Fullerton
Company:
Address: 2351 NW Westover,#704
OR Site Address: 11260 SW Hall Blvd City, State,Zip: Portland, OR, 97210
City, State,Zip: Tigard, OR, 97223 Phone/fax: 5038162403
Nearest cross street: SW Pfeifle St Email: rwfthird@msn.com
4. Applicant Information
4. Development Activity(check all that apply)
❑ Addition to single family residence(rooms, deck, garage) Name: Lisa Riehl
❑ Lot line adjustment 0 Minor land partition Company: Dan Riehl Excavating, Inc
❑ Residential condominium 0 Commercial condominium Address: 24801 SE Hoffmeister Road
❑ Residential subdivision ❑ Commercial subdivision City, State, Zip: Damascus, OR, 97089
❑ Single lot commercial 0 Multi lot commercial Phone/fax: 5036588180/5036584585
Other Residential Demolition Email: riehldan@yahoo.com
6. Will the project involve any off-site work? Dyes 0 No 0 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 Lisa Riehl Print/type title Sec/Treas
Signature ONLINE SUBMITTAL Date 4/15/2020
FOR DISTRICT USE ONLY
0 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 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.
X 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 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 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_ j `lw,1..,el sr�•---- Date 4/28/202n
Once complete,email to: SPLReviewq cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Revised 2/2020
Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p:503.681.3600 f: 503.681.3603 • cleanwaterservices.org