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Permit CITY OF TIGARD MASTER PERMIT 1111 4 COMMUNITY DEVELOPMENT Perm it #: MST2011 -00157 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09/23/2011 Parcel: 2S109AA03500 Jurisdiction: Tigard Site address: 12930 SW WILMINGTON LN Subdivision: WILMINGTON HEIGHTS Lot: 9 Project: BOSZE Project Description: Replacing deck. BUILDING Floor Areas Required Setbacks Required Stories 0 Bedrooms 0 First 0 sf Basement 0 sf Let 5 Parking Spaces 0 Height 0 Bathrooms 0 Second 0 sf Garage 0 sf Front 15 Smoke Dwelling Units 0 Third 0 sf Right 5 Detectors' Total 0 sf Value $15,000 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 Storm Sewer. 0 Drains 0 Tubs /Showers 0 Garbage Disp 0 Water Heaters 0 Water Lines 0 Catch Basins 0 Bckflw Prevntr' 0 Footing Drain 0 Ice Maker 0 Hose Bib 0 Backwater Value. 0 Drywell- Trench Drain 0 Other Fixtures 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 Other N Other Description Ecompasing N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF 0 Owner: Contractor: BOSZE, JENNIFER A WALTER BROS CONSTRUCTION LLC Required Items and Reports (Conditions) 12930 SVV WILMINGTON LN DBA PDX DECK & FENCE TIGARD, OR 97224 11795 SW TUALATIN RD #67 TUALATIN, OR 97062 PHONE 503- 539 -1196 PHONE 503- 332 -5076 FAX 503- 855 -3572 Total Fees: $619.27 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952- 001 -0010 thr�•AR 952 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.199 87 or 1 800 332 2344 , A Issued B Y �i_ i Permittee Si g nature; ' Ca 03 • < 9 .175 by 7:00 a.m. for the next available inspection date. • This permit card sh . : - ept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application FOR OFFICE USE ONLY 1 ' - City of Tigard ��� DateB �� �� Permit No fr 1 S ' 13125 SW Hall Blvd , Tigard, OR 97 Plan Review Phone 503 718 2439 Fax 503.598. Ta t L 01\ DateB ' H G'$_• Other Permit T I G ARD Inspection Line. 503 4175 0� L Date Ready/By / , / � / Tr-6 / J See Page 2 for Internet. www.tigard -or gov C.')-? �Q ,on Nottfi d/Method / / �� Supplemental Information TYPE OF WOT �,� C j � REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Ofition 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. l- and 2- family dwelling ❑ Commercial /industrial Valuation. $ J! t ��� b . ❑ 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: /2'33a 514J /1/)1/7);4,A. , in New dwelling area: square feet City /State /ZIP: 1 04 171.4-1-i Garage /carport area: square feet Suite/bldg. /apt. no. Project name: RA c '7, Covered porch area square feet r Cross street/directions to job site: Deck area: 416 L/ square 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 (romded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ �� � �. 1 e elate d d.I.k- Existing building area square feet r � New building area: square feet la PROPERTY OWNER ❑ TENANT Number of stories: Name: j) ell ?Ilk d D67_ e , Type of construction: Address: 1 2 G, 30 W j 1 rnjg9`y,‘ i- • Occupancy groups: City /State /ZIP: � I I ei d ®l- q7 z 2Y Existing: Phone: (4 5-31..0 (, Fax: ( ) New: Rt APPLICANT ❑ CONTACT PERSON NOTICE Business name: kc I k„ - 13 y ( 4_ pig A Vox pckie 2 cc n 2,e All contractors and subcontractors are required to be Contact name: r,� /k� licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be Icensed in the Address: 1 / 7c S 5 t, ra l rt V 6-7 jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City /State /ZIP: Mei /c al-)N 7.(2- 9 7067-- apply: Phone: ( 5-03) ' 32 - /� 6-0 76 I Fax' 5 3 ( ) 6'S5 -3)2.. E - mail: Je'f' `V' Qt site e C f'C el ex • 4u rn CONTRACTOR BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: /jt Permit fee: Address: /� 1 State surcharge (12% of permit fee): City /State /ZIP: FLS plan review (40 %ofpermit fee): Phone: ( ) rn Fax: ( ) (Due upon application.) CCB lic.: a g 5 Total permit fees: Authorized signature: 0 ' Amount received: This permit application expires if a permit is not obtained Print name: tie 1� �' /,6 l Date: 9 j •1 ) 1 1 within 180 days after it has been accepted as complete. v� t * Fee methodology set by Tri- County Building Industry Service Board. i \Buddding\Permits\FPS- PermiApp doc 02/01/2011 440- 4613T(11/02 /COM/WEB) d 1 14' t City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: 1.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition El 1 -10 heads: No plan review required. El Alteration El 11+ heads: Plan review required. El Repair Number of sprinkler heads: Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler El Wet El Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I - Hood Fire Suppression System Hood Project Valuation: $ C.) Fire Alarm Submittal shall Battery Calculations El Yes include: Individual Component El Yes Cut Sheets Fire Alarm Project Valuation: $ D.) Residential Sprinkler (Stand Alone System) Square Footage: Permit Fee: 0 to 2,000 $198.75 2,001 to 3,600 $246.45 3,601 to 7,200 $310.05 7,201 and greater $404.39 Sprinkler Project Square Footage: sq. ft. Fire Protection Permit Fees Project valuation subtotal (see A, B & C above): $ Permit fee based on project valuation (see fee schedule): $ Permit fee based on square footage (see D above): $ State Surcharge (12% of permit fee): $ FLS Plan Review (40% of permit fee): $ TOTAL: $ Plan review requires a completed application and three (3) sets of plans at submittal. Plan review fees are required at submittal. I \ Building \Pcrrmts \FPS- PermitApp doc 02/01/2011 2 Building Division Development Code Provision Review TIGARD Residential Projects Building Permit No: in 57 (94.) 1 1- -00 CWS Service Provider Letter Received: Yes [No ❑ N/A ❑ Routed Plans: Original Plan Submittal Date: 1/7/i 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 J ' el FbO/a( at 5O3-7l8-/I- or 06 1 @tigard - or.gov) Land Use Case o . ` Name Zoning 1 7 ❑ Setbacks: Front 1 ) Rear /5" Side .S Street Side /0 Garage 0 ❑ Maximum Building Height 33 Actual Building Height ❑ Visual Clearance 0" Easements / / EI / Sensitive Lands Type: /( Notes: Original Plan: Approved ©/ Not Approved ❑ Date: q - 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) Actual Slope: Z Notes: Original Plan: Approved Not Approved ❑ Date: 9 (3 /l 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) / Street Trees Protected Trees Notes: Original Plan: Approved 13 Not Approved ❑ Date: Y/ ),,1/ 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 Ap cant Okay to Issue Permit: Yes No ❑ Date Routed to Building: r Page 2 of 2 - 1\ \)v1 2 5 7 \\ ---- �\\� Clean Water Services File Number gy - CleanWate S ervices I 1 - 00 3 -4-I I Sensitive Area Pre- Screening Site Assessment 1. Jurisdiction: Tigard 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): 2 -Ste/ ,}A() 3 . Name: Jennifer Bosze Company: Address: 12930 SW Wilmington Ln Site Address: 12930 SW Wilmington Ln City, State, Zip: Tigard, OR 97224 City, State, Zip: Tigard, OR 97224 Phone /Fax: 503.539.1196 Nearest Cross Street: Greenfield E- Mail: jenbosze @gmail.com 4. Development Activity (check all that apply) 5. Applicant Information W Addition to Single Family Residence (rooms, deck, garage) Name; Jennifer Bosze ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: 12930 SW Wilmington Ln I] Residential Subdivision 1:1 Commercial Subdivision 1:1 Single Lot Commercial ID Multi Lot Commercial City, State, Zip: Tigard, OR 97224 Other Phone /Fax: 503.539.1196 replacement deck E -Mail: jenbosze @gmail.com 6. Will the project involve any off - site work? ❑ Yes Z4 No ❑ Unknown Location and description of off - site work 7. Additional comments or Information that may be needed to understand your project I am rebuilding an existing deck structure. 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 Jennifer Bosze Print/Type Title ONLINE SUBMITTAL Date 8/25/2011 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. ❑ is Service Provider Letter Is not valid unless CWS approved site plan(s) are attached. T h e proposed activity does not meet the definition of development or the lot was platted after 919195 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDE ETTER IS REQU) ED. Reviewed by CPL -q- Date 3 (/ t , 2550 SW Hillsboro Highway • Hillsboro. Oregon 97123 • . Phone: (503) 68I -5;100 Fax: (503). -'h439 • vnwi.cleanwaterse vices.org ADDENDUM \A/ L/vI ■ NGTON --) I G H TS L07 A* 9 g. .2 ' 35I :?. , 1-- CONSL TON ARK\ , Ilk brinispouTS \n 1 (") . P• \ • S i)...•_ _ _ _ _ _ ........ - - a Ac rc gs . 0,, A .....\ \;''' .;•\'' T - 1 cr‘ . 4 . 1- - s-U I I A i 1 R ci ,s 1 1 4 Fec-e - 1 _..i (--) IN li) I - - -- -------- . l E i N 2, I (ACK Nial/MINEi .-4 — . 41011111.7 ; ---- 3 . 4 --(j,i1.773.7-31.11:1 f - ,. ..- - • - 0 • a 't -4 e/ • • ■ ;I . - -' • .... , . . -------------- s I 5 ' F %-i 0 ,---, / 71 1 4 I - , w. W I LH I N 6-17'o&) .. , • _ fv \ k vC3 --- Z, L.° - r 41 9 ( r- i . I _-,-.. This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. „ City of Tigard 14 - Buildin g Division i' I GARD (----- TRANSMITTAL LETTER TO: Ik DATE RECEIVED: DEPT: Irf ING DIVISION RECEIVED 11�� J'' J / SEP232011 FROM: WA t tti✓ bV5 6P14�ac /to 4 CITY OF TIGARD BUILDING DIVISIO COMPANY: \AAa- ply)( Dery tam _6- PHONE: 5`05. 3_ Co-% By RE: Z� �b S/"- i / 1 itnTh ite Address) (Permit Number) 5L Ot — (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: X Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and /or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: ' FOR OFFICE USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes ❑ No Fee Description: Amount Due: $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: 1 \BuddmgWorms \TransmittalLetter- Revisions doc 02/08/2011