Permit 1114 CITY OF TIGARD MASTER PERMIT
s • COMMUNITY DEVELOPMENT Permit #: MST2012 -00246
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012
Parcel: 1 S125DCO2000
Jurisdiction: Tigard
Site address: 7045 SW VENTURA DR
Subdivision: WASHINGTON SQUARE ESTATES Lot: 10
Project: Kelly
Project Description: Replace deck on the back of the house
BUILDING .
Floor Areas Required Setbacks Required
Stories: 2 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 I
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
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 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
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF V8 R -3 0
Owner: Contractor:
KELLY, MARGO A MCGEHEE NORTHWEST FENCE & DECK LLC Required Items and Reports (Conditions)
7045 SW VENTURA DR 10350 SW 71ST AVE
PORTLAND, OR 97223 TIGARD, OR 97223
PHONE: 503 -459 -3025 PHONE: 503 - 222 -1110
FAX: 503- 213 -6202
Total Fees: $320.63
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 nter. Those rules are s t forth in OAR
952 - 001 -0010 through A 952- 001 -0090. You may � obtain a of the rules or direct questions to OUNC by calling 503.23 987 or 1. .332 i
Issued By: Lt t, Permittee Signature:
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.
RECEIVED 4/11'' tus�r.�ta- ooa`
; C ar / el ‹ .9 - eb x12.,((2
' ` Building Permit Application ..r.„._ �
G' e,/,y Oa i%T�t+
s)eurXe� 1 Y �2
' i %L *T KI_Igtbll�itty Phone: 503- 846 -3470, Fax: 503 -846 -3993, Inspection Reque� �� k99
BU t VG DI �SIQ I� AV, Suite 350, MS 12, Hillsboro, OR 97124 www. co.washington.or.us K. o�dc_
Land Use Approval: Project # Permit #
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELUNG
❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed.
Addition/alteration/replacement ❑Other: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
13 I- and 2- family dwelling ❑ Commercial/industrial Valuation 000
Number• of bedrooms:
Q Accessory building ❑ Multi- family
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION
n Total number of floors:
Job site address: 70 L1 ' sw d ear tart ✓
City / State/ZIP: •fl q etr-d b 2 2,73 New dwelling area: square feet
OW age/carport area: square feet
Suite/bldg./apt no.: — I Project name:
Cross street/directions to job site: Covered porch area: square feet
M
Deck area: I a r square feet
Other structure area: square feet
Plan No. Reissue: Yes a No 11=11
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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
DESCRIPTION OF WORK equipment, materials, labor, overhead, and the profit for the
��
work indicated on this application.
kec ( _ -ck. CL tQ4d Eryt flirt. 1 Ioc C k o- - t(, t k L c,r„L:. • Valuation
Existing building area: square feet
13r PROPERTY OWNER I ❑ TENANT New building area: square feet
Name: M 1 t y Number of stories: o
Address: -7 Dr{(.1/4 U e-c,l.ra 0� Type of construction:
City/State/ZIP: crt, y � & Q C( 7Z&3 Occupancy groups:
Phone: ( 55 73 J - 4 e. - 3025- Fax: ( ) Existing:
ril APPLICANT n ❑ CONTACT PERSON New:
Business name: N t.) t -P.v, cc- ti (a.e c (4_ L L. L NOTICE
Contact name: (L , e.es e �co_,, All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Address: t O 3 So-) 71 s' / under ORS 701 and may be required to be licensed in the
City/State/ZIP: -h a ,,r c OR- 4'7 2-2-3 jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
Phone: (5b3) 2_0 2 1 1 1 0 I Fax: : 0 2 t 3 - 6 Zo Z apply:
E -mail: (Z ,e e- 5 .� @ •w Geo. c.¢.- Dec K • e o✓h
CONTRACTOR
Business name: p-LA) �P.1i t pL ,r__ LLB BUILDING PERMIT FEES*
Address: l p3 Sr.) S6-..) i 91- , Please refer to fee schedule
City/State/ZIP: - q �4. a a 2 q 72-23 Fees due upon application S
Phone: (So 3 Z 2_2__ I Fax: (S ,Z) 3 - 6 LO 2 Amount received S
CCB lie.: 13 6 A.( 25 8'(l : r(3 Date received:
Engineer. 5a K t.=n , i r. , 2er• , Architect:
Address: ' ' '7 S a��{ e 7 Address: This permit application expires if a permit is
not obtained within 180 days after it has
Phone :(3a3 ) 6 go -6g el? Phone :( ) been accepted as complete.
Email: k2JcVn A 7 .... • Email;
• Fee methodology set by Tri-County Building
Authorized �M / / / Industry Service Board
signature:
(� �/ 440.4613T (M)6/cOM/WEB)
Print name: .5" d. R 1 1 5�• I Date: '1 " A LF t Z I
i llq 0 ° Building Division
Development Code Provision Review
T[ G A R D Residential Projects
Building Permit No.: _ 1S .2U /o2-00 GC yto
Site Address: 10 LS'' IAA) trekl 1 LL LA De.
Project Name & Lot No.: KC1-1 /a /el
CWS Service Provider Letter
Required: Yes ❑ No ❑
Received: Yes ❑ No ❑
Routed Plans:
Original Plan Submittal Date:
1st Revision Submittal Date: ❑ Site Plan Only
2°d 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 4,1 at 503 -718-. WO or lt4 _ tigard- or.gov)
Land Use Case Ng.
❑ Zoning ' J
❑ Setbacks: MA.
Front Rear Side Street Side Garage
❑ Maximum Building Height /04 Actual Building Height
Er—Visual Clearance
• Easements
❑ Sensitive Lands Type: 0/ 6B-4-; d ' g ' G B d--/ s /lOdga' —
Notes: /
to -v 0 le —
Original Plan: Approved L!' Not Approved ❑ Date: e y`- -- / L
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)
,Z Actual Slope: l S
Notes:
Original Plan: Approved Not Approved ❑ Date: q
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
❑ Protcctcd Trees
Notes: 1\k\
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or abert@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 ■J o ❑
Date Routed to Building: .
Page 2 of 2
L
D S @ L'1 .1 Clean Water Services File Number
S E P 2 6 2012 C1eanWater Services (Z-'O D Z2
- 'Sensitive � A + rea Pre - Screening Site Assessment
RA. Jurisdiction: � 6i /Irk
2. Property Information (example 1S234AB01400) 3. Owner Information �' I
Tax lot ID(s): Name: t(V\ 6L/ b
Company:
Address: 7D 45 51.-0 IJ e,t -)-u.v Ov
Site Address: 7D ra S (r-.) Veit - pt. trct IJv City, State, Zip: T cav - d t7- '1 771 3
City, State, Zip: '1" i cy-r'4 Q R. et? 2.-Z3 Phone /Fax: 5`O 3 '-i l�i l I g 0
Nearest Cross Street: E -Mail:
4. Development Activity (check all that apply) 5. Applicant Information I/�� p
El Addition Addition to Single Family Residence (rooms, deck, garage) Name: ( eeSe_ LA ct e r v1
❑ Lot Line Adjustment ❑ Minor Land Partition Company: IVU-» I'6L.4 C._ t- 0,, ( k
❑ Residential Condominium ❑ Commercial Condominium Address: f0 9 50 S.) 7 1 51- G -2
❑ Residential Subdivision ❑ Commercial Subdivision �
CI Single Lot Commercial El Multi Lot Commercial City, State, Zip: T � � �c�
Other P. 1 G.-r: -2 0-. e ),€,L k. Phone /Fax: 567 - 2 22- - f I I a
E -Mail: R-e-e6 - @ &L-) -e...41 Ce 0 e.ck_., c owl
6. Will the project involve any off -site work? ❑ Yes 15r No ❑ Unknown
Location and description of off -site work
7. Additional comments or information that may be needed to understand your project J - U" N D;_ c
r " yptat t-e- 14.Asz6 k,� La. -,,J -e--0-)- ti= 4
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 r •2._2 , , " AAL O ■ Print/Type Title &W Vtp,(r
Signature • . , �,IC ��n/.I Date Cl- 2-( 1 2- 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.
ai
proposedtctivity does not meet the definition of develo menttr the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED. U
Reviewed by � � _ G am - Date / Z 4 1 /2 -
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax' (503) 681 -4439 • www.cleanwaterservices.org