Permit ,, CITY OF TIGARD MASTER PERMIT
` 12 COMMUNITY DEVELOPMENT Permit #: MST2011 -00089
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/23/2011
Parcel: 1 S134DC09600
Jurisdiction: Tigard
Site address: 11545 SW CORNELL PL
Subdivision: TIGARD PARK Lot: 12
Project: BRYANT
Project Description: 430 sf. patio cover.
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: 0 sf Value: $4,000.00 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'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
Ecom asin N
Other: N Other Description: p g'
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
BRYANT, DONNA J & ROSS A OWNER Required Items and Reports (Conditions)
11545 SW CORNELL PL
TIGARD, OR 97223
PHONE: PHONE:
FAX:
Total Fees: $313.13
This p it is issued subject - the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be ne in accordance with appr•ved pl -• . his permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
d s. ATTENTION: Oregon law r =e res you • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 2- 001 -0010 t lough OAR 952 -001 %1: 0. Y•u •btain a copy of the rules or direct questions to OUNC by calling 503.23 987 or 1.80 2.2344.
I sued By: - = .4 � A Permittee Signature: , A� �. .(
'
Call 503.639.4175 by :00 a.m. for the next available inspectio 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
Residential ®� FOR OFFICE USE ONLY.
City of Tigard ,, _ " ,4 R Date ed II :pi, Permit No.. 4,- a 13125 SW Hall Blvd., Tigard, O � � Plan Review
11, Phone: 503.718.2439 Fax: 503. • : � t�� Other Permit:
.� ' � 'Q i' � V Date/B ���
Inspection Line: 503.639.4175 Q I " , \N _` \-- Date Ready :9: H See Page 2 for
T I G A R D Internet: www.tigard- or.gov 0 C, Noti - i ethod: i , � {� I - Supplemental Information
TYPE OF WOR 1/17. ` ,UI • ' D 2- FAMILY DWELLING : `
® New construction ❑ Demolition Permit 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.
'till- and 2- family dwelling ❑ Commercial /industrial Valuation: $2400 � D9 = �yd
® 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: 11545 SW Cornell PI New dwelling area: square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered Deck Covered porch area: 430 square feet
Cross street/directions to job site: SW Tigard St. Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST`
Subdivision: Tigard Park I Lot no.: 012 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 4218 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.
In summer of 2008, added roof /cover to existing backyard desk area. Valuation: $
Existing building area: square feet
New building area: square feet
. . ® PROPERTY OWNER - , 0-TENANT Number of stories:
Name: Ross Bryant Type of construction:
Address: 11545 SW Cornell PI. • Occupancy groups:
City/State /ZIP: Tigard, OR 97223 Existing:
Phone: (971)227 -5676 Fax: ( ) New:
... ®, APPLICANT: , : . ` ' Z. CONTACT PERSON ; .. . BUILDING PERMIT FEES* . `"
(Please refer to' fee schedule)
Business name:
Structural plan review fee (or deposit):
Contact name: Ross Bryant
Address: 11545 SW Cornell PI. FLS plan review fee (if applicable):
City/State /ZIP: Tigard, OR 97223 — Total fees due upon application: Ar7, 45'
Phone: (971) 227 -5676 Fax: : ( ) Amount received:
PHOTOVOLTAIC. SOLAR PANEL SYSTEM4'EES *
E -mail: rdhln @yahoo.com -
. - Commercial and residential prescriptive installation of
CONTRACTOR e _ . , , - , _. . roof -top mounted Photo Voltaic Solar Panel System.
Business name: Ok1/rr,r- Submit two (2) sets of roof plan with connection details
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.: Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ' �� � 5-j____,=-;,. � -/ * Fee methodology set by Tri County Building Industry
l 4 , J�� Date: Service Board.
I: \ BuildingWermits \BUP- RESPennitApp.doc 02/ 24/2011 440- 4613T(11/02 /COM/WEB)
/ /' -0,v
Clean Water Services File Number
C1eanWateer Services 11- 0 02332
Sensitive Area Pre - Screening Site Assessment
1. Jurisdiction: Wasiaingtonceunty Tigard
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Ross Bryant
Tigard Park Subdivision: Lot # 012 Company:
Address: 11545 SW Cornell PI.
Site Address: 11545 SW Cornell PI. City, State, Zip: Tigard, OR 97223
City, State, Zip: Tigard, Oregon 97223 Phone /Fax: 971- 227 -5676
Nearest Cross Street: Sw Tigard St. E -Mail: rdhln @yahoo.com
4. Development Activity (check all that apply) 5. Applicant Information
FA Addition to Single Family Residence (rooms, deck, garage) Name: Ross Bryant
❑ Lot Line Adjustment ❑ Minor Land Partition Company:
❑ Residential Condominium ❑ Commercial Condominium
Address:
❑ Residential Subdivision ❑ Commercial Subdivision
[I Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip:
Other Phone /Fax: 971- 227 -5676
Added cover /roof to existing deck. E -Mail: rdhln @yahoo.com
6. Will the project involve any off -site work? ❑ Yes in No ❑ Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
I have applied for a work permit. They asked me to submit a Service Provider letter.
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 andlor 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 Ross Bryant Print/Type Title
ONLINE SUBMITTAL Date 5/25/2011
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.
• 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 07 -20, Section 3.02.1. 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 serve as your Service Provider letter 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, 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.
f 5/31/2011
Reviewed by Art Date
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • www.cleanwaterservices.org
e Building Division
Development Code Provision Review
TrcAaD Residential Projects
Building Permit No: i
CWS Service Provider Letter Received: Yes ❑ No N/A ❑
Routed Plans:
Original Plan Submittal Date: 57I
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (/) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
• Planning Review (contact 1 . 1'16 -. 1 • tJ ? _ _rvy at 503 -718- Z'ISL or 4risrre, @ tigard- or.gov)
Lanj, Use Case No. Name 7 qu, rg Pa s.IL
Zoning R - y• .S •l
F1' Setbacks:
Front 10 Rear / S Side S Street Side IS Garage
12 ' ( Maximum Building Height 3 O Actual Building Height Y Ga fier c t44» �I
V isual Clearance
LIB Easements NO T TO Scale.,
MrSensitive Lends Type: NO e- // •
Notes: ..rn dine' t S 8 0 1 S PRA-. Cit AAC ,
Original Plan: Approved L►3 Not Approved ❑ Date: 6 7 26 4/
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
/1 Actual Slope: I 0
Notes:
Original Plan: Approved--Er
pproved- Not Approved ❑ Date: S
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date: -
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
0/Street Trees
Protected Trees
Notes: _ ,S`3/410//
Original Plan: Approved Lid Not Approved ❑ Date: $'3 7.2o'i
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes No ■
Date Routed to Building:
Page 2 of 2