Permit a CITY OF TIGARD MASTER PERMIT
.14 COMMUNITY DEVELOPMENT Permit #: MST2010 -00148
T I GAR. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2010
Parcel: 2S104CD02200
Jurisdiction: Tigard
Site address: 13714 SW HILLSHIRE DR
Subdivision: HILLSHIRE ESTATES Lot: 22
Project: Loop
Project Description: Remove and replace existing deck.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: No
Total: sf Value: $12,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvciFeeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add9 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add! Br Cir:
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
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BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
LOOP, CURTIS A AND CAROL M WALTER BROS CONSTRUCTION LLC
13714 SW HILLSHIRE DR 11795 SW TUALATIN RD #8
TIGARD, OR 97223 • TUALATIN, OR 97062
PHONE: 503- 579 -6297 PHONE: 503- 332 -5076
FAX: 503- 855 -3572
Total Fees: $526.51
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 dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 throw - - 952 - 001 -0100. You m. = • r ' 1 irect questions to OUNC by calling 503 6.6 9 1.800.332.2344.
L_/ _ "T //�/
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Issued. . Permittee Signature: b �J —
i
Building Permit Application V �_ EAVF
Residential p Q I FOR OFFICE USE ONLY AIMIPI City of Tigard � - : ` . ;. ^ ._: Received e ,, . �l 41?
Permit No.: y o + e r 9/ 0
q 13125 SW Hall Blvd., Tigard, OR 97223 II II Plan Review �, G
C Phone: 503.639.4171 Fax: 503.598.1 G 2 6 2010 010 DateB : �'' " / - �� other Permit: imlig
T I C. n RD Inspection Line: 503.639.4175 _ Date Ready : y: Juris: ® See Page 2 for
Internet: www.tigard CITY C t - ; OA D Notified/Method: Supplemental Information
TYPE OF WORK 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
,..,�/ Valuation: $ , 000 111 t- and 2- family dwelling ❑ 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: 13 7I SUU 1 i // 4; p,/ New dwelling area: square feet
City/State/ZIP: f i % o 1- 2 2- 3 Garage/carport area: square feet
Suite/bldgJapt. no.: Project name: pi r - &, Id Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet I-12V
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
irtolOve ft eloo e x;r1:n5 dpi.k Valuation: $
Existing building area: square feet
New building area: square feet
lX PROPERTY OWNER ❑ TENANT Number of stories:
Name: e liar I o C P Type of construction:
Address: 13 I i t 5L) k- \1 s 6 i rt'_ A./. Occupancy groups:
City/State/ZIP: 'CI 9C ref OP- 123 Existing:
Phone: ( 5 3) 5-7q_ 6�% 7 Fax: ( ) New:
❑ APPLICANT )6 CONTACT PERSON NOTICE
Business name: W a \67 b ro (4, AillULti(�.n All contractors and subcontractors are required to be
Contact name: 1 el-4 wok( licensed with the Oregon Construction Contractors Board
V under ORS 701 and may be required to be licensed in the
Address: (17i5 i,,) 'f 2 (6(4, ad b J jurisdiction in which work is being performed. If the
City/State/ZIP: fait (G �7yt o 9 X06 _
applicant is exempt from licensing, the following reasons
apply:
Phone: ( 53) 332 - ;---Q 7 / Fax: : ( O3) , 53 75 7
E -mail: , e, '2( 0 vaXM x., LLB M
CONTRACTOR
Business name: W Q t k 13 ,. 5 to N 54 M BUILDING PERMIT FEES*
Address: 1174c S T(A 1 G R D i 7 Structural (Please refer to fee schedule)
City/ State/ZIP: ,L ral plan review fee (or deposit):
T t&a (G �, ' l � �� 6 F LS plan review fee (if applicable):
V Phone: ( 5-0-5) 33 2 _ S 07(o Fax: ( )
CCB lic.: v,)„ S s Total fees due upon application:
/� Amount received: 1 .51
Authorized signature: V / / /i( i This permit application expires if a permit is not obtained
v� / within 180 days after it has been accepted as complete.
Print name: , C Q l Date: g 12 5 /() • Fee methodology set by Tri-County Building Industry
Service Boafd.
I :\Building\Permits\BUP -RES PermitApp.doc 10/01/09 440- 4613T(1 I /02/COM/WEB)
Aug 2. Sep. 14. 2010 6 . 03 PM iter 503-85 l' P . 2 •
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RECEIVED C
LU • SEP 2C
Ili CI an Water Services File Number
AUG 3 1 Z010 Ce anWW�e r S � . tic D IN I
�g -I GDNI I � l dd?�Za —!
By .�. Se - itive Area Pre - Screening Site Assessment
1. Jurisdiction: 1 L 0 >,` g�v`
2, Property Information (example 1S234AB01400) 3. Owner Information
Tax tot ID(s) _ a S (Q 4 (C �J ( 2 200 _ Name: G•Q-ry j /00P
Company:
Address: / 3 7I
Site Address: i 3/ 1 N Shy ,h ;1 13hrrj 4 r City, State. Zip: T 9 r1 O /Z. 9 7 4
City, State, Zip: • 7 et 2 97 4./.. 3 Phone /Fax: Sd 3 - f79- 62 97
Nearest Cross Street: E -Mail:
4_ Development Activity (check all that apply) 5. Applicant information
" 'w
g Addition to Single Family Residence (rooms, deck, garage) Name: V ova t
l Lot Line Adjustment d Minor Land Partition Company: taia (rdf / W - Len W -
CI Residential Condominium Q Commercial Condominium
CI Residential Subdivision Address: )) 7R S SW Tji(rs�4 e o #(, 7
0 Comrnercia! Subdlvlslon
o Single Lot Commercial 0 Multi Lot Commercial City, State, Zip: QM,9 Q!2 7/j
Other aIat n a ree(ot.a d a4:4L. Phone/Fax: 5'43- 337 ^5 1 4 76, 03-8 3' 3S7 Z
E -Mail: Je. ..,,i,J4 0[O.++r:vff./lei
B. Will the project involve any off-site work? 0 Yes No f] 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 Pemtlts, Site Development Permits, DEQ
1200.0 Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army
COE. Alt required permits and approvals must be obtained and completed under applicable local, slate, and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges aid agrees that employees of Clean Water Services have authority
to enter the project site al all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. 1 certify
that I am familiar with the information con wined In this dorum t, and to the best of my knowledge and tellef, this information Is true, c =irate.
and lrate.
Print/Type Name (r / i w Print/Type Tide i vr/ke n inteh
Signature ! , Date c 3 10
FOR DISTRICT USE ONLY
Q Sensitive areas potentially ex on site or within 200' of the site. THE APPLICANT MUST PERFORM ASITE ASSESSMENT PRiOR TO ISSUANCE OFA
, _SERVICE PROVIDER LETTER. If Sens,tiveAreas 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 eubmitled materials and Beal 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 Missive as your Service Provider fetter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local, Slate, and federal law.
( Based on review of the submitted materials and best available information the above referenced project villl rot significantly impact the exis or potentially
sensitive area(s) found near the site. This SertsireArea Pre•Screentng SueAssesanen:does NOT el the need lo evaluate and protect additional water
quality sensitive areas ii They are subsequently discovered. This documentwll serve as your Service Provider letter as required by Resolution and Order
07 -20, Section 3.02,1. M 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 ptan(s) are attached.
❑ The proposed activity does not meet the definition of development or the lot was plated after 919195 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER 1S RE s VIREO. `
Reviewed by --J� Date 1 (g 1 _
ee e Sef Hillsboro Homer e r ? Hillsboro Order n 97123 - PiloiIC: (50J) 58 -5100 - Fax: (5O :1) G6l -4434 • \ .'. /.dc.o ltiv2ler i ivi;,i::;.
FMAt lJte Pm-scrtaA
Ai got- t -T ft
Sep. 14. 2010 6:03PM No. 0374 P. 1
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CleanWater Services
FACSIMILE TRANSMISSION
To: b F X n Date: Ti(E1 !o
Fax Number: c33 - 3 11(00
From: rL (A i 2ctL Phone Number: 533- - 3LS
Fax Number: _,CZa3 - (oil '/ '/ 3
We are sending a total of 2 , pages, including this cover sheet.
Comments:
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2550 SW Hillsboro Highway Hillsboro, Oregon 97123
Phone: (503) 681 -3600 Fax (503) 681 -3603 www.CleanWaterSeit'ices -org Cleanwater Services
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CITY OF TIGARD - SITE PLAN REVIEW ,sa,
BUILDING PERMIT NO.: rP . o! D — 06 /
PLANNING DIVISION:
Required Setbacs: 9Approved ❑ Not Approved
41 Side: Street Side: v
Front. r u<nr:
Visual Clearance- Of • :F,; „� <. r t t Ni Approved
Maximum Build t-f<. ' 3 'ett
CWS Service Provider �.���. Rr� ..:, ❑ No
$ '
m t.. wit.p.:2: aa..� t . L:. ived
B . ' I Uate• ff.3Ihh!)
ENGINEERING D PARTMEN
Actual S : ti% 1E1 Approved ❑ Not Approved
Site Plan (Approved 0 of pproved.
By, Date: a I 0
Notes:
CITY Of TIGARD - SITE PLAN NMI*
�1,tij,OING PERMIT NO:
Street Trees:
F ❑ Not Approved
Protected Tress: 7 , Approved ❑ N ed
SY: fO4G11 Date: ; up
Notes: q
T ,u re 1 Ce p, /r
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