Permit q CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2014-00136
T t G A Fit E) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/26/2014
Parcel: 2S103BB07600
Jurisdiction: Tigard
Site address: 12502 SW 123RD AVE
Subdivision: LAKE TERRACE Lot: 4
Project: Evans
Project Description: Replace existing 500 sq ft deck.
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: $10,000.00 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 Tvoes 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 Srvc/Feeders 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 All
Other N Other Description: 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:
EVANS,DALE F JOANN THREE RIVERS CUSTOM DECKS INC Required Items and Reports(Conditions)
12502 SW 123RD AVE 23885 S MOUNTAIN TERRACE
TIGARD,OR 97223 BEAVERCREEK,OR 97004
PHONE: PHONE: 503-632-8777
FAX: 503-632-8770
Total Fees: $503.17
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 through OAR 952-001-0090. You may obtain o y of the rules or direct questions to OUNC by calling 5' ' 1987 or 1.800. .2.2344.
Issued By: G Permittee Signature: A'�
all 503.639.4175 by 7:00 a.m.for the next available inspectio •ate.
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.
1 f
Building Permit Application
Residential RECEIVEDI (1 z O I I l(l I ti ()NI 1
City of Tigard DteiB ved: ��Ap /yl Permit No.: S
M9
/ -€90/3 ,
111 I Ill
13125 SW Hall Blvd.,Tigard,OR 97223 QUG 21 2014 Plan Re
Phone: 503.718.2439 Fax: 503.598.1960 Date/B ��( .nun, Other Permit:
1 I ,A R D Inspection Line: 503.639.4175 TM Q Date Ready :y: 4-,,,A i ta See Page 2 for
Internet: www.tigard-or.gov ��' TIGARD Notified/Method: Z7i / �g y� Supplemental Information
f3UILDAntwisioN&i.:tfhve-6.-
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.
and 2-family dwelling El Commercial/industrial Valuation: $ /0 1 Oc
❑Accessory building ❑Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 41 50 /2 4 New dwelling area: square feet
City/State/ZIP: / / ol- OWS Garage/carport area: square feet
,
Suite/bldg./apt.no.: Project name Covered porch area square feet
Cross street/directions to job site: /0/4"4/ Deck area: 6—pc 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.: 'LS�(�?j t'?�'-j(y�yp 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.
Reirite��� yr C Valuation: $
G f Existing building area square feet
New building area: square feet
PROPERTY/OWNER ❑ TENANT Number of stories:
Name: ,�/,t J ri tiles rs Type of construction:
Address: �"_!�/(I,/L—CV MS S� Occupancy groups:iit
City/State/ZIP: l"'r`' Existin '
g�
Phone:( ) Fax:( ) New:
(J°L APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: Ta,GG�% D'u s ` view refer de osit):/c I�f �J Jam, Structural plan review fee(or deposit):Contact name: J ,144IV
FLS plan review fee(if applicable):
Address: 2 l g"•S t(,(6,04 wow/ 1.
City/State/ZIP: 477004 Total fees due upon application: 7 /
r� Amount received: /V6 .
Phone:(,193) 07 • / Fax: :( )
Z���� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: fill�r� 4( e �,3, 1
CONTRAC R Comm• • and residential prescriptive installation r
roof-top moun :. ' otoVoltaic Solar Panel S .
Business name: Submit two(2)sets o :P f plan with co' •ction details
Address: /`f'rC I&.5 ,PPuceltwr' and fire department access, . r n: •i the 2010 Oregon
Solar Installation Special .,• hecklist.
Permit Fee(i es plan revt-
City/State/ZIP: administrative fees): $180.00
Phone:( ) Fax:( ) o
Sta urcharge(12%of permit fee): $21.60
CCB lic.: 'en,
Total fee due upon appication: .1.60
Authorized signaturr This permit application expires if a permit is not obtaine•
within 180 days after it has been accepted as complete.
Print name: DEAJAHS 4 ,J Date: '�/?(/4._ "Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
. •
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONL1
City of Tigard Received
71 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By
• Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
T I G A h O 24-Hour Inspection Line: 503.639.4175 CI Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other
THE FOLLOWING ITEMS 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 Lon and shall be shown to be :e.licable to the .ro'ect under review.
.II, RISI)I( "I'IO\:AI, SPECIFICS
23 Three(3)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 trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature 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:\Building\Permits\BUP-RESPerrnitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
., a
City of Tigard
71 r COMMUNITY DEVELOPMENT DEPARTMENT
N .
T I G A R D Building Permit Review — Residential
,
Building Permit #: 115T6o/4-O6 / 36
Site Address: t2502- ‹SW 12 31-41 AVG
Project Name: kiAlis. Eo . ReplacGIVIO* Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Rep lac& txi s-hr ctec*-
.r Verify site address/suite #exists and active in permit system.
Site Plan Elements:
Three(3)copies of site plan .xisting structures on site
,ite plan must he on 8-1/2"x 11"or 11 x 17"paper .OFootprint of new structure(including decks)with finished
rawn to scale(standard architect or engineer scale) floor elevations
North arrow ...Z.J 1ility locations(required for new,may apply for additions)
,ite address,project or subdivision name and lot number Location of wells/septic systems
pplicant information(name and phone number) ygrosion control(including drainage-way protection, silt fence
Lot dimensions and building setback dimensions design,location of catch basin,etc.)
fdfot area,building coverage area,percentage of coverage and treet names
impervious area(applicable if R-7,R-12,R-25&R-40) iZtreet tree size,type and location
p'I'roperty corner elevations(2 foot contour lines if more than ,Existing trees to be retained with drip line,and tree
4 foot differential) protection measures
Clean Water Services-Service Provider Letter: (lot platted prior to 9/10/1995):
Required: 2Yes ❑ No Received: ❑ Yes 2'No
R'Luiand Use Case#: LA TejYr7l.Ge.--
E ning: R Lt•S
R Setbacks: Front 2.0 Rear 15 . Side 5 Street Side 'J IA- Garage 1.4/A
andscape Requirement: Nips, % `
/.ot Coverage Maximum: N/A %
Vywilding Height: Maximum Height D Actual Height (V ii{-
isual Clearance
2'E...a sements
� �/
' S nsitive Lands: ❑ Yes L�J No Type
rban Forestry Plan
LC'Conditions Met
Notes:
Approved By Planning: A1'6U Date: g.14 . itA
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_042914.docx
y �
Building Permit Submits I
Original Submittal Date: g P-1/9
Site Plans: #
Building Plans: # 3
Building Permit#: ter building petit#above.
Workflow Routing: ! ".Planning 0 Engineering ErPermit Coordinator 1XBuilding
Workflow Sign-off: .Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
o giinal plan review routing form.
%V Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: , , ��" L CGci5
By Permit Technician: ' Date: 'Y /
Engineering Review
❑ Actual Slope:
❑ Conditions Met
Notes: /k)4 4M v 4. . 1 g
Approved by Engineering:--` Date: ,53,z/.. ..y
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
NAP / Conditions Met-Prior to Issuance of Building Permit
!Notes: es Pc 17k v't v-■■ ''-i e - s
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
OK to Issue Permit
Approved by Permit Coordinator: a . ems,t,(y Date: 0/0 d 7/(
I:\B u i l d ing\Forms\B I dgPermitRvw_RES_042914.docx
Clean Water Services File Number
Clean Wate\\ Services 14-002542
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: /�
2. Property Information(example 1S234AB01400) 3. Owner Information
Tax lot ID(s): 2' /O3 4 &7 74POU Name: 'actit I tJC A7
Company:
Address: /2502- 5c 7 123 A-V •
Site Address: / 502. 51.-) i23e-43 AVF City,State,Zip:`Tbtb, ( C72.23
city,State,Zip: �b4 -h! Ore- /7223 Phone/Fax: ' 73, 590. (p/ '0
Nearest Cross Street: I IL-A/UD E-Mail: leAI 4(-7/gt-t',. Cr44lLr4�jj,,J1
i
4. Developent Activity(check all that apply) 6, Applica Information /
❑
Addition to Single Family Residence(rooms,deck,garage) Name: / Al/e7--) "--100-1,41A,0 Lot Line Adjustment CI Minor Lend Partition Company:�f-/ et Ct .TVN((,l
)Q'4s
❑ Residential Condominium D Commercial Condominium c
❑ Residential Subdivision Address Z�J�I � J /(</(/C/r(/j,�//� .+Q,
❑ Commercial Subdivision
❑ Single Lot Commercial ❑ Multi Lot Commercial City,State,Zip:J?? / ,e QO 17(A24
Other 4y M T-A/07— Phone/Fax: .�• (o32. t"./
A-1)nrn oni. E-Malt DEe'4By3iI zs.c1iV(
' _ I
6. WIII the project Involve any off-site work? 0 Yes ANo ❑Unknown
Location:and description of off-site work
7. Additional comments or Information that may be needed to understand your project
This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ
1200.0 Permit or other permits as issued by the Department of Environmental Quality,Department of State Lands and/or Department of the Army
COE, All reg9lred 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 limes for the purpose of Inspecting project site conditions and gathering information related to the project site. I certify
that I am remili r 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_AI 1(/A i/ " 14/{/,(/ Print/Type Title Ofd-TIQ�t/S N114.416.6-2--
Signature LI - Date 5.2_/. 14-"
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. II 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 Pm-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,
El Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially
sensitive areas)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 subsequenlly 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,stale and federal law.
❑Thls Service Provider Letter is not valid unless CWS approved site plans)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.
Reviewed by r �+ir�<<r f�<th•l r s� Date 09/16/14
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12502 SW 123RD AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - No C of O
December 17, 2014 at 1:39:19
PM
MST2014-00136
David Young
Replacement of existing deck and railing, at prior existing location.
Violation Summary:
Inspector Contractor