Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00317
L Ali SERVICES DATE ISSUED: 7/7/2005
44 . 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S10366 -08500
SITE ADDRESS: 12425 SW 122ND AVE ZONING: R -4.5
SUBDIVISION: LAKE TERRACE LOT: 012 JURISDICTION: TIG
Project Description: Deck addition.
REISSUE: � FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: 40 psf LEFT: 5 ft RGHT: 5 ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: 15 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 4,648.00
Owner: Contractor:
VIRGINIA YOUNG OWNER
12425 SW 122ND AV
TIGARD, OR 97223
Phone: 503 - 590 -1988
Phone: 503 - 475 -3180
Reg #:
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surchari 7/7/2005 $7.30
[BUILD] Permit Fee 7/7/2005 $91.30
[CDCBLD] CDC Bld Re 7/7/2005 $42.00
[LRPF] LR Planning Sur 7/7/2005 $6.00
(additional fees not listed here)
Total $297.25
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 than 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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: � �j1) ����
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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 Aprdi ationm- \ 9 FOR OFFICE USE ONLY . -
y " '''"
City of Tigard �oo � DateDate/By Date/By Received ?aO Permit No.: M Al . 00 /
O
13125 SW Hall Blvd., Tigard, OR 97223 0.- C Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 OF t Gp`, i''r '�,i� +' f `a' DateB . 7- 7 -- 0 5 Other Permit:
Inspection Line: 503.639.4175 CV" NI - n a' Date Ready/By: �� ® See Attached Checklist for
Internet: www.ci.tigard.or.us V��p1NG 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.
ID 1 -and 2- family dwelling 0 Commercial/industrial Valuation: $
Ce
• ❑ Accessory building ❑ Multi- family Number of bedrooms: t4 6 t'l
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION . Total number of floors:
Job site address: /V T. 6 l,
`- [
New dwelling area: square feet
City /State /ZIP: - 7 / 1 l 5 /2(9 L! k q ` 2 , 2 2 Garage /carport area: square feet
r you/1(4-
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street /directions to job site: Deck area: ) quare 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
DESCRIPT�IOONN OF� WORK w ork indicated on this application.
/ ,t' � _) (0 . NP a . __Lit T A / r Va luation: $
° �� :7 c / 7 , p Existing building area: square feet
/ (/� / New building area: square feet
❑ PROPERTY OWNER ` ❑ TENANT Number of stories:
Name: V / K q ) f lI 60 C /C� lrt r? Type of construction: •
Address: 1 'z-- yc .13 ,� 6,2_ � ` — ct Occupancy groups:
• City /State /ZIP: ---fr/ � �0 /4_49 927 23 Existing:
Phone:) S �O /7ff Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
. under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) Fax::( )
E -mail:
• - CONTRACTOR,
Business name: - -
Address: aii/p -
BUILDING PERMIT FEES*
a xtie (. Please refer to fee schedule.
City /State /ZIP: .
Fees due upon application
Phone: ( ) Fax: ( )
• Amount received
CCB lic.:
Date received:
Authorized signature: This permit application expires if a permit is not obtained
...MO within 180 days after it has been accepted as complete.
Print name: C'A/'�' Date. 4`� * Fee methodology set by Tri County Building Industry
Service Board.
• i:\ Building \Permits \BUP- PernitApp.doc 12/03 440-461 3T( I 1 /02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received
g Date/By. Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 'j'lH �N��!%'I1`''� CI Electrical CI Plumbing CI Mechanical
24- Hour Inspection Line: 503.639.4175 1; -
Internet: www.ci.tigard.or.us ❑ Other.
THE FOLLOWING ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ _
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire 'district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ _
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ 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 ❑ ❑ ❑
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, ❑ ❑ ❑
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. ❑ ❑ ❑
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 ❑ ❑ ❑
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 ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
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. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
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 .2 'licable to the .ro'ect under review.
.IURISDIC"I ZONAL SPECIFICS
23 Five (5) 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. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
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 tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
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:\Buil ding \Permits\BUP- RES- PermitApp.doc 2
Jul. 6. 2005 11:09AM CLEAN WATER SERVICES 503 6814439 No.7872 P. 2
RECEIVED
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TY OF TIGARD
Approved UILDING DIVISION
Clean Water Services
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Jul. 6. 2005 11:08AM CLEAN WATER SERVICES 503 6814439 No.7872 P. 1
CleanWater Services JUL 0 (3 2005
)„ t, , , „ ,,, CITY OF TIGARD
BUILDING DIVISION
July 6, 2005
John and Virginia Young
12425 SW 122 Avenue
Tigard, OR 97223
(503) 590 -1988
RE: 25103E31308500 Deck addition CWS File# 05 002876
Clean Water Services has received your Sensitive Area Certification for the
above referenced site. District staff has reviewed the submitted materials
including site conditions and the description of your project. Staff concurs that
the above referenced project will not significantly impact the existing Sensitive
Areas found near the site. The vegetated corridor width for sensitive areas within
the project site shall be a minimum of 50 feet wide, as measured horizontally
from the delineated boundary of the sensitive area. For vegetated corridors 50
feet wide, the first 10 feet closest to the sensitive area shall be equal to or better
than a "good" corridor condition as defined in Section 3.02.7, Table 3.2.
Enhancement/restoration to be completed by July 30th, 2005. Should final
development plans differ significantly from those submitted for review by the
District, the applicant shall provide updated drawings, and if necessary, obtain a
revised Service Provider Letter. In light of this result, this document will serve as
your Service Provider letter as required by Resolution and Order 04 -9, Section
3.02.1. All required permits and approvals must be obtained and completed
under applicable local, state, and federal law.
This letter does NOT eliminate the need to protect Sensitive Areas if they are
subsequently identified on your site.
If you h. ny questions, please feel free to call me at 503 - 681 -3603
le aae
r ron ental Plar evie Post-it" Fax Note 7671 °A"' 11 o la9aes a
( 03) 681 -3613 - To Vir t ut.5 From prkiGlL C
Go /Dept. Co. CW S
Pnone phone
Fax TL4 -0V IL Fax*
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2550 SW Hillsboro Highway . Hillsboro, Oregon 97123
Phone: (503) 681 -3600 • Fax: (5f3 6fit_1fnz • - _ -
•
Jul. 6. 2005 10:42AM CLEAN WATER SERVICES 503 6814439 No.7870 P. 1/2
'10tI;1; ► 11 tt I,s RECEIVED
JUN 3 0 Z005 JUL 0 6 2005 � 4 , 10 P6^ File Number CI OF TIGARD
CCleanWater \ Servi - — - - - -- - $ " BI ill DING DIVISION
0111 cu,uu,itcncnt .S ica . Sensitive Area Pre - Screening Site Assessment
,-� Jurisdiction 1GPt Q.10 Date -
• Map & Tax Lot 3, EBO '5 Owner MaTilr in- yai 1G
Contact fi q
Site Address / ` 1 . ' � TA h ! Company
Address /Z ! tt
Proposed Activity arro I fa C ity State Zip 71213 •
r C' Phone .C.);?? Cj� -- / Iger
Fax — j -()$ ?A'
Official use only below this line
Y N NA Y N NA
rr ❑ Sensitive Area Composite Map n ❑ Stormwater Infrastructure maps
Map # 0�5� W' GL- I I QS # L 9 a l Th
❑ ,cam' Locally adopted studies or maps Other
l 1 l� Specify ' Specify { Q q �iaQ
Based on a review of the above information and the requirements of Clean Water Services
Design and Construction Standards Resolution and Order No. 04 - 9:
Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER. If Sensitive Areas exist on the site or within 200 feet on adjacent
properties, a Natural Resources Assessment Report may also be required.
❑ Sensitive areas do not appear to exist on site or within 200' of the site. This 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
04 -9, Section 3.02.1. All required permits and approvals must be obtained and
completed under applicable local, state, and federal law.
❑ The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
Reviewed By: 1\(.061 S C44 Date: - I (0 03
6 --
Post -it°° Fax Note 7671 oan aes' geb 0).. Returned to 9pplicant
' iL :li _. _ , �'
Mail Fax ✓ Counter
coioept. • i e co. jjj f 7 Date id ,PLOD" _ ByC7�.
Phone Y Phon..
�� r • e3 I 8'11°
CITY OF TIGARD - •
BUILDING DIVISION PERMIT #: BUP2005 00317
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/7/2005
Phone: (503) 639 -4171
Ak � IN
Inspection Requests (24 Hrs.): (503) 639 -4175 ''! I..
INSPECTION WORKSHEET FOR DATE: 9/2/2006 TIME: 7:07AM PAGE: 84
SITE ADDRESS: 12425 SW 122ND AVE CLASS OF WORK:
SUBDIVISION: LAKE TERRACE. LOT #: 012 TYPE OF USE:
PROJECT NAME: YOUNG
DESCRIPTION: Deck addition.
OWNER: YOUNG, VIRGINIA PHONE #: 503 - 590 -1988
CONTRACTOR: OWNER PHONE #: 503 - 475 -3180
Inspection Request Scheduled For: ; Date: 9/2/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 014822 -01 603-690-1988 N
Corrections /Comments/ Instructions:
i
PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL n ALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: g--2/-t9--. Phone #: (503) 718-