Permit ,
CITY OF TIGARD MASTER PERMIT
.. :' COMMUNITY DEVELOPMENT Permit #: MST2013 -00063
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 • Date Issued: 05/09/2013
Parcel: 2S 109AD00100
Jurisdiction: Tigard
Site address: 12585 SW BULL MOUNTAIN RD
Subdivision: BLUE RIDGE Lot: 1
Project: Islas
Project Description: Deck repair and addition
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
Total 0 sf Value $16,683 12 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
Tubs /Showers: 0 Garbage Disp 0 Water Heaters 0 Water Lines 0 Drains 0 Catch Basins 0
Bckfiw Prevntr 0
Footing Dram 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
Fum <100K: 0 Vents 0 Woodstoves 0 Gas Outlets 0
Fum > =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! 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 AO
Other: N Other Descnption Ecompasing N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
VILLALOBOS, SERGIO ISLAS OWNER Required Items and Reports (Conditions)
12585 SW BULL MOUNTAIN RD ;
TIGARD, OR 97224 ,
PHONE PHONE
FAX:
Total Fees: $607.37
r 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 - - , • •. •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 /01 -0010 hrough 0 • - 9 .1 %.90 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1.800.332 2344
Iss . ed By: / ' `` — Permittee Signature: ' [O . ill
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.
w
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
<4 I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this hom eowner statement is true and accurate.
2 SL QS
Print Name of Permit Applicant
3
Signature of PermitAppli>;;ant Date
Permit #: M5 ol013- coo (Q
Address: 1 A5`fi dl.�7 � T►J� !��������1ii /�;�;
,.,
aly�a�E
" Issued Date: 5 -5//,;
This Copy for Permit Offices
Building Permit ApplicatiRECEIVED
Residential Folc OI. FICI? 1•sl{ ON I,1
City of Tigard MAR 18 2013�Bed 5. m �6-� „O`O ��
i Penult No
13125 S \V Hall Blvd., Tigard, OR 97223 Plan Review �ii��Q�r
Phone: 503 718.2439 Fax: 503.5y9 71C � d pr► DatefB hat
�� Other Permit
Inspection Line 503.639.4175 v 1�J/�� ��tlnl�fLLW! Date ReadyBy 6— Q s ® See Page 2 for
TI GARD Internet: www.tigard- or.gov BUILDING DIVISION Noufied 7 / Supplemental Information
TYPE OF WORK REQUIOD DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work perfonned
Indicate the value (rounded to the nearest dollar) of all
j Addition/alteration /replacement ❑ Other: equipment. materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION
work Indicated on this application
Valuation: ()083 1 s� °r
1- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building ❑ Multi- family
Number of bedrooms:
❑ Master builder ❑ Other Number of bathrooms:
JOB SITE INFORMATION Jl AND LOCATION Total number of floors:
Job site address: / 2585 < u� fiC�(it ,Th el / New dwelling area• square feet
City /State /Z[P: -TT 6 l or 9�'L2 4 Garage /carport area. square feet
Suite/bldg. /apt. no.: 1 Project name I Covered porch area: square feet
Cross street/directions to lob site: l S 9' 12 6 Deck area: square feet8 &
/ Other structure area. square feet
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 10 the nearest dollar) of aal
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New t
Dep' � Valuation S
1/ Y Existing building area square feet
New building area: square feel
Names PROPERTY OWNER I 0 TENANT Number of stories:
frn ) �OS Type of construction:
Address:) 2S 5_ S S• w (6 , i / �- ! ✓/ p ( g d Occupancy groups -
City /State /ZIP: 776, r • r 9 L Z„ (1 Existin
X 0 3 ) —� y 3 g.
Phone �j Fax' ( ) New.
APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee (or deposit):
Contact name: Sam e
4 bove FLS plan review fee (if applicable):
Address:
City /State /ZIP: Total fees due upon application: e
Phone: ( ) I Fax • ( ) Amount received: '
^L
E -mail PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES"
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted Photovoltaic Solar Panel System.
Business name: (-) to C2._ 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: ( ) I Fax ( )
State surcharge (12% of permit fee): $21.60
CCB tic : Total fee due upon application: $201.60
Authorized signature- 6 % � - `J (' _ _ (� This permit application expires if a permit is not obtained
��, (�✓
within 180 days after it has been accepted as complete.
* Fee methodology set by Trn -County Building Industry
Print name: - I Date Service Board.
1:\ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(11 /02/COM/WEB)
_ ° Building Division
Development Code Provision Review
TIGARD Residential Projects
Building Permit No.: H�F c9) Z —000L
Project /Subdivision Name: 151 ---Pr , Lot #:
Site Address: /S 6u.) IluLLL NTN) W D
CWS Service Provider Letter:
Required: Yes Tai- No ❑
Received: Yes - No ❑
Plans Routed:
Original Plan Submittal Date: 3 11 113 Routed BylLi-P.
1St Revision Submittal Date: ❑ Site Plan Only Routed By:
2nd Revision Submittal Date: ❑ Site Plan Only Routed By:
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 g left only if approved.
Planning Review (contact Armes v- T (2. at (503) 718 - 2i-I' 2.7 or aLlneS - @tigard-
or.gov)
Land Use Case No. T U� g'Z n,
Zoning 1R ----I d
0' Setbackss ,S Side Street Side \
i 5 � .‘
Front 1 Rear 17 Garage
U Maximum Building Height: "FG 1 Actual Building Height P■) I .A.-
❑ Visual Clearance -N / pr
❑ Easements
( "ensitive Lands Type: Ni DNS
❑ Street Trees -ill A-
❑ Protected Trees- N) A
Notes:
Original Plan: Approved GY Not Approved ❑ Date: .3 11111 �J
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
Er Actual Slope: /
Notes:
Original Plan: Approved Not Approved ❑ Date: 3 f 3
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 Applic
Okay to Issue Permit: Yes No ❑
Date Routed to Building:
Page2of2
I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13
1
Clean Water Services File Number
+�� I �j
FEB 2�� 2017 C1eanWater \r Servi ces (-0004t 3
Sensitive Area Pre-Screening Site Assessment
11. t a (
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(a): Name: Sergio Islas
12585 SW BULL MOUNTAIN RD Company: Homeowner
Address: 9727 N. Portsmouth Ave
Site Address: 12585 SW BULL MOUNTAIN RD City, State, Zip: Portland, Or. 97203
City, State, Zip: TIGARD, OR. 97224 Phone /Fax: 503 7017793
Nearest Cross Street: SW 126th E -Mail: margarltahemande:1261 @yahoo.com
4. Development Activity (check all that apply) 6. Applicant Information
IA Addition to Single Family Residence (rooms, deck, garage) Name: ed spencer
❑ Lot Line Adjustment ❑ Minor Lend Partition Company: endpoint design
❑ Residential Condominium ❑ Commercial Condominium Address: 4036 ne sandy bv. # 203
❑ Residential Subdivision ❑ Commercial Subdivision ortland or 97212
(3 Single Lot Commercial 1.3 Multi Lot Commercial City, State, Zip: P
Other Phone/Fax; 503 460 9313
E -Mall: ed @endpolntdesign.com
6. Will the protect Involve any off -site work? ❑ Yes ■n No ❑ Unknown
Location and description of off -site work
7. Additional comments or Information that may be needed to understand your project
repair & replace. a few footings & small slab. exist deck 708 sq ft/new deck 138 sq ft. /total 846
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 Owners 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 condllions 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 b true, =plate, and accurate.
Print/ type Name ed spencer Print/Type Tltle designer
ONLINE SUBMITTAL Date 2/20/2013
FOR DISTRICT USE ONLY
❑ ensitive 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 fest 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 intonation the above referenced project wtil not signficantiy impact the existing or potentially
sensitive area(s) found near the site. This SensiliveArea Pre-Screening Ste 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 302.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law
❑ Thle 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 9/9195 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVI +E: LETTER iS REQ I • .
Reviewed by ��►i_✓� iA►/_ _ , Date 0 Z Z 7
2550 9. 1h IIsboin Higlxv�5 Hillsboro Oregon 97123 Phone (503) 051-5,1 (503) ( vo ti clezir aferserwces:orq
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