Permit I CITY OF TIGARD MASTER PERMIT
N ' COMMUNITY DEVELOPMENT Permit#: MST2020-00154
Date Issued: 06/05/2020
T 1 c,A tt l-a 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1346D00300
Jurisdiction: Tigard
Site address: 11455 SW HAZELWOOD LOOP
Subdivision: ENGLEWOOD NO.2 Lot: 91
Project: Ingle
Project Description: Replace existing 160 sf deck in same location with new material and staircase.
BUILDING
Floor Areas Reaulred 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: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors:
Total: 0 sf Value: $12,000.00 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 Rain 0 Storm Sewer: 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 Tvoes 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 SrvclFeeders 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
Ecompasing: N
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR SF VB R-3 0
Owner: Contractor:
INGLE,TIMOTHY VIS DESIGN Required Items and Reports(Conditions)
VILLENAVE,ROCHELLE ANNE 15221 NE 12TH WAY
11455 SW HAZELWOOD LOOP VANCOUVER,WA 98684
TIGARD,OR 97223
PHONE: PHONE: 503-858-7315
FAX:
Total Fees: $559.51
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 OAR 952-001-0090.0, _You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198798 oar 1.800.332.2344. _ /
Issued 'L t d, ` Permittee Signature: G'A/ .9- 4/C 97 ,1J
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.
I
Building Permit Application t;Kkee., -w fr
Residential RECEIVES FOR OF ICF: 151. U\I 1
Received 1 2e1 .„-_,OD Permit No./.1_5 x ,00 i5 of
City of Tigard y DateBy:
13125 SW Hall Blvd.,Tigard,OR. 97223 MAY 11 2020 Plan Rev ew�Y 2�� I :l p her Penn it'
e Phone: 503.718.2439 Fax: 503.598.1960 DateBBy:
11, \i,1, Inspection Line: 503.639.4175 CITY OF TIGARD DateReady/B : ...r , ]aris. ® See Page 2for
NC. DIVI,41oN,1 fied/M od: %i!!GG//JI[[_ Supplemental Information
Internet: www.tigard-or.gov f3�JI�DI � ��G'��6
TYPE OF WORK 6 ` REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0 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: $12,000.00
® I-and 2-family dwelling 0 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:11455 SW HAZELWOOD LOOP New dwelling area: square feet
City/State/ZIP:TIGARD OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:TIM INGLE Covered porch area: square feet
Cross street/directions to job site: Deck area: 160' square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:W269811 I Lot no.: Permit fees*are based on the value of the work performed.
Tax ma ! arcel no.:1 S134BD00300 Indicate the value(rounded to the nearest dollar)of all
P P equipment,materials,labor,overhead,and the profit for the
t r r¢DESCRIPTION OF WORK work indicated on this application.
REPLACE EXISTING DECK IN SAME LOCATION WITH NEW MATERILA AND Valuation: $
STIARCASE Existing building area: square feet
New building area: square feet
.1 NI 0 PROPERTY OWNER 0 TENANT Number of stories:
Name: NGLE Type of construction:
Address: 11455 SW HAZELWOOD LOOP Occupancy groups:
City/State/ZIP:TIGARD OR 97224 Existing:
Phone:(503) Fax:( ) New:
�. APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:SIMPL HOME DESIGNS (Please refer to fee schedule)
Structural plan review fee(or deposit): /(,(,,_Sy
Contact name:MIKE MONTGOMERY
FLS plan review fee(if applicable):
Address:5531 SW BUDDINGTON ST
Total fees due upon application:
City/State/ZIP:PORTLAND OR 97219 -
Phone:(503)515.6495 :(5
Fax:
719-4825 — Amount received:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES"_
I<<r r2 f Commercial and residential prescriptive installation of
CONTRACTOR o 6 I L roof-top mounted Photo Voltaic Solar Panel System.
Business name:VIS DESIGN LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:14782 SW FERN STREET Solar Installation Specially Code checklist.
City/State/ZIP:TIGARD OR 97223 Permit Fee(includes plan review
and administrative fees):
Phone:(503)858-7315 Fax:(503) State surcharge(12%of permit fee): I
CCB lic.:208978 at `U Total fee due upon application:
Authorized signature:
This permit application expires If a permit is not obtained
within days after it has been accepted as complete.
Print name:MIKE MONTGO Y" .05/11/20 *Fee methodology set by Tri-County Building Industry
Service Boo ard.
1:\Building\Permits\BIlP-RESPermitApp.doc 02/24/2011 44 6I3T(ll./02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USA: O\t.\
City of Tigard Received
g DateB : Pei it No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
a Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing ❑ Mechanical
T GAKI) Internet: www.tigard-or.gov ® Other: E DECK REPLACED
THE FOLLOWING ITl',\I'' '121, Rl?QI IRED'FOR HAN REVIEW Yeti 41 N.-v
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. • • U
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ® ❑
3 Verification of approved plat/lot. 0 ® ❑
4 Fire district approval required. Name of district: ❑ ® ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ CI 0
6 Sewer permit. 0 El
7 Water district approval. ® 0 ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0
El
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state fEl 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 ® ❑ ❑
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 ® ❑ ❑
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- ® ❑ ❑
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. ❑ ❑ El
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 ❑ El
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 ❑ ►��
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 Cl
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 ❑ ❑
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 ❑
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 [� ❑
architect licensed in Ore on and shall be shown to be a licable to the m'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".
24 Two(2)sets each are required for Items 16, 19,20 and 22 above.
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ Cl
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. (J ❑ 121
27 "Drawn to scale"indicates standard architect or engineer scale. 0 ❑ ►��
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ►��
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 ❑ El
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
'PI6
N. COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
a
Building Permit #: MS 7 2 .2-0 —00 /S y
Site Address: ( 1455 Sw -1-4a•zeivvaD4l t-ln,P
Project Name: TN (,e Lot #:
Planning Review �J
Proposal: New Gee_ # ytlrs
L% Verify address/suite#active in Accela. 8-In River Terrace: igk No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: NNErosion Control
1k copies of site plan on 8-1/2"x 11"or 11 x 17"paper Detained trees with drip line and tree protection measures
brawn to scale(standard architect or engineer scale) ,'Footprint of new structure(including decks)and FFE
%North arrowNA-utility locations&easements(required for new and additions)
Ni8ite address,project or subdivision name and lot number Sidewalk/driveway approach
'Applicant information(name and phone number) Vocation of wells/septic systems
Aitr.ot dimensions and building setback dimensions Rettreet tree size,type and location
Kfrquare footage of buildings to be demolished Xtreet names
`Existing structures on site $Comer elevations(2'contours if more than 4'differential)
ili4oat area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? EYes IgNo
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes No
X Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: 4'Yes,applicant was notified ❑ No Received: "CYes ❑ No
,Ig* Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
.1K SDC Exemption for ADU applied for: es ❑ No Received: ❑ Yes ❑ No
Public Facilities Improvement (PH) Permit:
Required: ❑ Yes,applicant was notified X No Applied For: ❑ Yes ❑ No,stop intake
ITA-Land Use Case#: V.. Zoning: R-4,S''
0 Required Setbacks: Front: 20 Rear: I S Side: 5 Street Side: IS Garage: t'/P-
X Building Height: Max. Height: 50 Actual Height: ±- I S
IVA-Landscape Area: % a .ot Coverage Max:
Entrance Set ac no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows I 12%of area of all street-facing facades
Garage a g door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
oor extends no more than 5' from wall and there is a covered porch extending beyond garage.
El oor ext ds no more than 5' from wall and there is a 12 sq ft.window above garage on 2" floor.
❑ Gara e door if..:th is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covere.IIT. ❑ Recessed entrance ❑ Wall offset 0 1'Roof eave ❑ Roof offset
❑ Fire s 'gle ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
VA-Visual Clearance Trban Forestry Plan
.Ikr-Sensitive Lands: 0 Yes Nr.No Type:
''+`► Conditions met prior to issuance of building permit
Notes:
0 Approved By Planning: Date: 5II212.0
Revisions (after Building Submittal only Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: s/WJ
Site Plans: # 3
Building Plans: # 3
Building Permit#: —Enter building permit#above.
Workflow Routing: L7-Planning ❑ Engineering ❑ Permit Coordinator v ding
Workflow Sign-off: -Sign-off for Planning(include notes from planning review)
Route Application Documents: i gineering: (1) copy of permit application, (1) site plan, (1) building plan and
opal plan review routing form.
'f� Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: "`lll� acar✓ Date: ,7/2/2d
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
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes: \\7:
❑ Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of buildi • permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submitt. only)
Revision Notice 1: Dat- ent to Applicant:
Revision Notice 2: D. e Sent to Applicant:
❑ SDC Exemption: ■ Received ❑ Does not apply
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
LIDA ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
1:\Building\Forms\BldgPermitRvw_RES_122419.docx
RECEIVED
- r
MAY 1 1 2020
CleanWater Services,CITY OF TIGARD Service Provider Letter
() 3111 3
1 , , i UILDING DIVISION
Submission Date: May 04,2020 Confirmation#: 411
Applicant Name: SIMPL HOME DESIGNS CWS File#: 20-001159
Contact Email: mikem@ezpermits.biz Review Type: Partner City Plan Review
Contact Phone: (503)515-6495 Ground Disturbance: 50
Primary Address: 11455 SW Hazelwood LOOP New Impervious Area: 0
Tigard,OR 97223
Primary Jurisdiction: Tigard Mod.Impervious Area: 0
Affected Tax Lots: 15134B000300 Development Activity: SFR Addition
Project Description: replacing wooden deck with like wooden deck.;;Sfd Addition
FOR DISTRICT USE ONLY
❑ 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 theabove referenced projectwill 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 yourService 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 orthe lot was platted after 9/9/95 ORS 92.040(2).
NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
❑ NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed By:LDRToolReview Date:May 05, 2020
The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the Tualatin
River Watershed.Our partners include municipalities,environmental organizations,and developers large and small.
Contact Us*2550 SW Hillsboro Highway*Hillsboro,Oregon 97123
phone:503-681-5100•email:splreview@cleanwaterservices.org*website:www.cleanwaterservices.org/permits-development