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Permit (10) it ,, CITY OF TIGARD MASTER PERMIT 'ri ■. ' COMMUNITY DEVELOPMENT Permit#: MST2016-00217 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2016 T[t''" R.L? 9 Parcel: 1 S136AB05300 Jurisdiction: Tigard Site address: 10420 SW 72ND AVE Subdivision: 1993-089 PARTITION PLAT Lot: 2 Project: Garrison Project Description: 520 sf accessory structure. No electrical at this time. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 15 Bathrooms: 0 Second: 0 sf Garage: sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No Total: 0 sf Value: $15,000.00 Rear: 5 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: 0Catch 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 addl 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: ACS SF VB U 0 Owner: Contractor: GARRISON,ROLAND K AND OWNER Required Items and Reports(Conditions) GOWAN,VIVIAN J ROLAND GARRISON 1 Ersn Cntrl 503-639-4175 10420 SW 72ND AVE 10420 SW 72ND AVE PORTLAND,OR 97223 TIGARD,OR 97223 PHONE: 503-312-0403 PHONE: 503-312-0403 FAX: Total Fees: $710.97 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 enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtai the rules or direct questions to OUNC by calling 503/•2.1987 or 1.800.332.2344. Issued By: �� �� Permittee Signature: a 03.639.4175 by 7:00 a.m.for the next available inspection, .te. 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. Building Permit Application Residential Rr#EI\/E , FOR OFFICE USE ONE) City of Tigard ��I �/ FOR .11/ 1 jr,,,,, O/ 00' Date/B Permit No.: r(J 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 b 2016 Plan Review I Phone: 503.718.2439 Fax: 503.598.1960 Date/B : • �I1 Other Permit: I I t,-\ .I) Inspection Line: 503.639.4175 tai'FQF TIGARD Date Ready/By: 4 G al Juris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIV'SIO Notified/Method: small Supplemental Information " TYPE OF WORK LJ 11 V 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 0 Other: equipment,materials,labor,overhead,and the profit for the a,. CATEGORY OF CONSTRUCTION work indicated on this application. 0 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ /�4 'i&° yAccessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: . -.JOB�`.SITE INFORMATiON AND LOCATION ' Total number of floors: Job site address: / b V-z,c) , (�(J 7 z 1,--42_ New dwelling area: square feet City/State/ZIP: Q t0 /2 i) 7 7Z 7 ?� Garage/carport area: 5 square feet / Cri1 i—S//CO Suite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet ®V? --7 "7 h'. n Pa J'J Qr Other structure area: square feet L (/ REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: D Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF'3-WORK / work indicated on this application. /1/ 41 -� (// /4./S 9 //7`���4 Ch ,pr'O/h Ohl Valuation: $ Ac ��l� /,,/�� Existing building area: square feet (, c, .0 \ r 9 New building area: square feet PROPERTY OWNER' 0 TENANT Number of stories: Name: 40 /4'14 1 66?rf /7 ah Type of construction: Address: /0 4 z0 i2 7 H ji e e Occupancy groups: City/State/ZIP: 77ugr--6/ 9 7 2,, Z ? Existing: Phone:(c03) 3 //2-- ©(f Q 3 Fax:( ) New: eel APPLICANT ❑,CONTACT PERSON BUILDINGPERMIT'FEES* (Please refer to eisehedule) Business name: e9 W ii_P /--- Structural plan review fee(or deposit): Contact name: C�Q/11 -f' 9 L ,0f 1 FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: 1l l 6•'442Amount received: Phone:( ) Fax::( ) E-mail: PHOTOVOLTAIC:SOLAR PANEL SYSTEM FEES* • Commerci- and residential prescriptive installation of CONTRACTOR roof-top mount 'hotoVoltaic Solar Panel S em. Business name: h' (f / ft� Pt-- Submit two(2)sets o .of plan with con - tion details l ' and fire department access, : ong wit e 2010 Oregon Address: Solar Installation Specialty Co, •-cklist. City/State/ZIP: Permit Fee(includes pl.. evil- $180.00 and admini • .tive fees): Phone:( ) Fax:( ) State surcharge /o of permit fee): $21.60 CCB lic.: Tot. "ee 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. C *Fee methodology set by Tri-County Building Industry / Print name: 0 / ak, # CG,r ,/,cU Date: / `f `"(7�,G Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-44613T(11//02/COM/WEB) City of Tigard li11 ■ COMMUNITY DEVELOPMENT DEPARTMENT 111 T I G A R D Building Permit Review — Residential Building Permit #: 1"( 'o2b l 6—OO oll 7 Site Address: /Q 4.?6 SA) ; 2/L1 , , Project Name: (207)24r/72S On Alce..cse� ,Sj1uc7re Lot #: (New dwelling=subdivision name;Ad�4. n or Alteration=last name of owner) Planning Review JJ Proposal: 4)-e-11/ � �—- U '-P -477/ QC CEs S iur7:2 fi-e Verify site address/suite# exists and activ permit system. 0 'ver Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached Sile Plan Elements: Vtree(3)copies of site plan sting structures on site e plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished 10 awn to scale(standard architect or engineer scale) floor elevations IP: .rth arrowility locations(required for new,may apply for additions) i/.,Stt' e address,project or subdivision name and lot number t.cation of wells/septic systems pplicant information(name and phone number) ih Erosion control(including drainage-way protection,silt fence t dimensions and building setback dimensions sign, location of catch basin,etc.) 0(area,building coverage area,percentage of coverage and [VSSdetreet names spervious area(applicable if R-7,R-12,R-25&R-40) •,:�; eet tree size,type and location Property corner elevations(2 foot contour lines if more than 1d:0 sting trees to be retained with drip line,and tree 4 foot differential) protection measures t /Required: CI No Received: L�Yes No Public Facilities Improvement(PFI) Permit: / Gly/f&R T Required: ❑ Yes,applicant was notified V No Applied For: ❑ Yes ❑ No,stop intake 1 J '' and Use Case#: r.!41/Zoning: P-7- V. Setbacks: Front NM Rear 5 Side S Street Side Am Garage A A— Landsca e Requirement:uirement: ( p 9 of Coverage Maximum: 0/0 Building Height: Maximum Height /'S-- Actual Height /3 Visual Clearance Easements ' Sensitive Lands: ❑ Yes ❑ No Type Urban Forestry Plan Conditions "Met"prior to issuance of building permit otes: Approved By Planning: .''�- G Date: ---/e.2•5--//4 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved El Not Approved I:\Building\Forms\BldgPermitRvw_RES_0121 1 6.docx Building Permit Submittal Original Submittal Date: 5 l J o Site Plans: # Building Plans: # 3 Building Permit#: [ Enter building permit#above. Workflow Routing: C7"Planning .0" Engineering 2-Permit Coordinator Re-Building Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: 1'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Q aQyg Date: 51,94;47 Engineering Review ❑ Slope at building pad: (// Cl Conditions "Met"prior to issuance of building permit 2 Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: El Yes [ No Assess Water Quantity Fee in-lieu: ❑ Yes ErNo LIDA Facility on lot: ❑ Yes ErNo ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: Date: - 11. Revisions (after Building Submittal only) Reviewer Date Revision 1: El Approved ❑ Not Approved Revision 2: ❑ Approved El Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: 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: C Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes N/A K to Issue Permit Approved by Permit Coordinator: Date: <4/,710 1::\Building\Forms\BldgPermitRvw_RES_O 12116.docx 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 permits. 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 all su "contractors who work on the structure must be licensed with the Construction ContractoreBoard. r I will be performing work on property I own, a residence that I reside in, or a residence that I will 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 homeowner statement is true and accurate. lea9i-ge‘i Print Name of Permit Applica t 572e76 S •na re of `ermitApplica Dia Permit#: 1"kl acics-OOol.(7 Address: Logao 79" A-1)f- ✓L c z a---)-3 � cow i2� � This Copy for Permit Offices Clean Water Services File Number RECEIVED C1eanWateer Services 16-002034 JUN 9 2016 Sensitive Area Pre-Screening Site Assessment CITY OF T IGARD $WWlMIMGIDMSOON 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): 1S136AB05300 Name: Roland Garrison 10420 SW 72ND AVE Company: n/a Address: 10420 SW 72nd Avenue Site Address: 10420 SW City, State,Zip: Tigard,OR,97223 City, State,Zip: Tigard,OR,97223 Phone/Fax: 503-312-0403 Nearest Cross Street: Oak E-Mail: r.garrisonl@comcast.net 4. Development Activity (check all that apply) 5. Applicant Information Addition to Single Family Residence(rooms,deck,garage) Name: Roland Garrison ❑ Lot Line Adjustment ❑ Minor Land PartitionCompany: n/a ❑ Residential Condominium ❑ Commercial Condominium Address: 10420 SW 72nd Avenue ❑ Residential Subdivision ❑ Commercial Subdivision [ISingle Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Tigard,OR,97223 Other Phone/Fax: 503-312-0403 Misc.structure(shop)with no services 20X26 E-Mail: r.garrisonl@comcast.net 6. Will the project involve any off-site work? ❑Yes id No ❑Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project This building will have a French drain underneath,and is not at risk for runoff off-site. 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 Roland Garrison Print/Type Title ONLINE SUBMITTAL Date 6/8/2016 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200'of the site. THE APPLICANT MUST PERFORM A SIE 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. Reviewed by e..„4.,..e Date 6/9/16 2550 SW Hillsboro Highway • Hillsboro. Oregon 97123 • Phone: (503)681-5100 • Fax (503)681-4439 • www.cleanwaterservices.org } } } (/I , \ # 'cit., {. . . • 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 10420 SW 72ND AVE, TIGARD, OR, 97223 Residential - Master Permit 205 Footing Scheduled MST2016-00217 Jeff Grove Talked with contractor. No footings required on the job Inspection canceled Violation Summary: Inspector Contractor