Permit (200) II ,, CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2016-00440
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/05/2016
Parcel: 1 S135DB05600
Jurisdiction: Tigard
Site address: 11400 SW 95TH AVE
Subdivision: MILLER Lot: 9
Project: Virtue
Project Description: 135 sq ft addition and 635 sq ft wrap around covered porch. Trade work under separate permits.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 135 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 2 Detectors: No
Total: 135 sf Value: $43,554.15 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
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 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:
ADD SF VB R-3 135
Owner: Contractor:
VIRTUE,LISA R REVIVE LLC Required Items and Reports(Conditions)
GALINAT,RAYMOND A 11640 SW PREAKNESS
11400 SW 95TH AVE WILSONVILLE,OR 97070
TIGARD,OR 97223
PHONE: 503-883-3873 PHONE: 971-285-0770
FAX:
Total Fees: $1,458.09
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throug . -0' -009'. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 1.
232- .: •r 00.3 2.2344.
Issued By: C°' J �' .,/�
,-'C Permittee Signature: (. z
c
u Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential F CI' �,F FOR OFFICE 1S ONLy
City of Tigard s S.4r Received /6 3i /� t PermitNo.:
111
M 13125 SW Hall Blvd.,Tigard,OR 97223 Plan R : aOflD-ex)Wo
Plan Review �r
Phone: 503.718.2439 Fax: 503.59 2016 16 DateB ; J ' 1v Other Permit:
TIG r1 R D Inspection Line: 503.639.4175tir '� Date Ready/By: r�� Ef See page 2 for
Internet: www.tigard-or.gov Notified/Method:it erZi
r O#� t 3(- q ,�r yy� Supplemental Information
TYPONMOING DIVISION REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-familydwellingValuation: -$ 1;81k.. �, S
0 Commercial/industrial /
0 Accessory building 0 Multi-family Number of bedrooms: 0
❑Master builder 0 Other: Number of bathrooms: 0
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address:11400 SW 95"'Ave New dwelling area: 135 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Virtuie/Galinat Covered porch area: 635 square feet
Cross street/directions to job site:SW Greenburg Rd Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.:5600 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:i S135DB05500 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Small addition and wrap around covered porch Valuation: $
Q Existing building area: square feet
€ Le 1'44 L-A/b�,� /i9/ 4-Ti_ `w+�/-r— New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Lisa Virtue Type of construction:
Address:11400 SW 95th Ave Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)883-3873 Fax:( ) New:
El APPLICANT DD CONTACT PERSON BUILDING PERMIT FEES*
Business name:Revive Remodeling (Please refer ro fee sc�iedrde)
Structural plan review fee(or deposit):
Contact name:Chip Duggan
FLS plan review fee(if applicable):
Address:8532 SW Saint Helens Dr.
City/State/ZIP:Wilsonville,OR 97070 Total fees due upon application:
Phone:(971)285-0770 Fax::( ) Amount received: ae/s.64
E-mail:info@reviveremodeling.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commer 'al and residential prescriptive installation of
roof-top m. ted Photo Voltaic Solar Panel System.
Business name:Revive Remodeling Submit two( . ets of roof plan with connectio' =tails
and fire departme ccess,along with -- i 0 Oregon
Address:8532 SW Saint Helens Dr. Solar Installation Specie __Code , ist.
City/State/ZIP:Wilsonville,OR 97070 Permit Fee(includes p -. ew $180.00
and a• ' .ative fees
Phone:(971)285-0770 Fax:( ) State surcharge %of permit fee): $21.60
CCB lic.:166165
To -e due upon application: $21 ...0
Authorized signature: AS.A....4 — ThiJ s pe it application expires if a permit is not obtained
0 b within 180 days after it has been accepted as complete.
Print name:Don Isaacson Date: /a/y tc` *Fee methodology set by Tri-County Building Industry
/ Service Board.
I:\Building\Petmits\BUP-RESPetmitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
Ill ■
T l c A R D Building Permit Review — Residential
Building Permit #: H e--a-i—,2__c1 (p- DC)4[.(0
Site Address: tt UJ S\j AN-Ci
Project Name: \I SAV& Wttlivl Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal:p Met Ethyl r M. Vgl V aitykod Kcal
Verify site address/suite# exists and active in permit system.
. Z River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
.Three(3)copies of site plan 14 xisting structures on site
bite plan must be on 8-1/2"x 11"or 11 x 17"paper 1I1i .otprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) oor elevations
.North arrow 0 tility locations(required for new,may apply for additions)
%ite address,project or subdivision name and lot number 11 '•cation of wells/septic systems
Or
Applicant information(name and phone number) :0 Existing trees to be retained with drip line,and tree
ribot dimensions and building setback dimensions ,i protection measures
VV Lot area,building coverage area,percentage of coverage and treet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) treet names
(4 Property corner elevations(2 foot contour lines if more than
4 foot differential)
.Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: Yes,applicant was notified ❑ No Received: ACYes ❑ No
Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified i No Applied For: ❑ Yes ❑ No,stop intake
N and Use Case#: ti//1`T
e: Zoning: ig-14.5-
13'1 Required Setbacks: Front Rear tt Side -,5- Street Side � Garage N/
v % ( `
'Landscape Requirement:
.k Lot Coverage Maximum: (s J
❑ Building Height: Maximum Height Actual Height:
Visual Clearance
.„14"."Easements
Sensitive Lands: ❑ Yes o Type
Urban Forestry Plan
IA-NoIII onditions "Met"prior to issuance of building permit NIA--
Notes:
tes:
Approved By Planning: i'ri\l 1/ ' a�' %4 Date: 1031 1(4,
Revisions (after Building Submittal w y) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPernutRvw RES 091216.docx
Building Permit Submittal //
Original Submittal Date: /0/5//i�
Site Plans: # 3
Building Plans: # '5
Building Permit#: 2 Enter building permit#above.
Workflow Routing: Com] Planning 12'Engineering Permit Coordinator .®'Building
Workflow Sign-off: 0"Sign-off for Planning(include notes from planning review)
Route Application Documents: lEngineering: (1) copy of permit application, (1) site plan, (1) building plan and
riginal plan revirouting form
zr9
Building: original
ew permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: T -a– t-c�� L-- .Ao pet.Aot.L J�L
By Permit Technician: CZ , , 1 D Date: /B/5jXo
Engineering Review
Slope at building pad:
Conditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in lieu: ❑ Yes
El No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: idf ....2:3Date: /41—(in
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
El 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:
rDC Fees Entered: Wash Co Trans Dev Tax: CI Yes �� /A
Tigard Trans SDC: ❑ Yes CTS /A
Parks SDC: ❑ Yes tZ'N/A
OK to Issue Permit
Approvedby Permit Coordinator: d/„ ate: J 1/A( '
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
RE CE
Clean Water Services File Number
OCT 31 Z016 C1eanWater Services J 16-004073
c1 A011. rea Pre-Screening Site Assessment
1. Jurisdiction: 191141TIN Cs ( I
2. Property Information (example 1S234A801400) 3. Owner Information
Tax lot ID(s): 1S135DB05600 Name: Lisa Virtue
Company:
Address: 11400 SW 95th Ave
Site Address: 11400 SW 95th Ave City, State,Zip: Tigard,OR,97223
City, State,Zip: Tigard,OR,97223 Phone/Fax:
Nearest Cross Street: SW Greenburg Rd E-Mail: lisareneevirtue@hotmail.com
4. Development Activity(check all that apply) 5. Applicant Information
Addition to Single Family Residence(rooms,deck,garage) Name: Chip Duggan
❑ Lot Line Adjustment ❑ Minor Land Partition❑ Company: Revive,LLC Residential Condominium ❑ Commercial Condominium
Address: 8532 SW Saint Helens Dr.
U Residential Subdivision ❑ Commercial Subdivision
❑ Single Lot Commercial U Multi Lot Commercial City,State,Zip: Wilsonville,OR,97070
Other Phone/Fax: 9712850770
E-Mail: info@reviveremodeling.com
6. Will the project involve any off-site work? ❑Yes Xi No U 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-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 Chip Duggan
Print/Type Title Executive
ONLINE SUBMITTAL Date 10/26/2016
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 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 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 .Gf .
Date 10/27/16
2550 SW Hillsboro Highway • Hillsboro. Oregon 97123 • Phone: (503)681-5100 • Fax: (503)681-4439 • www.cleanwaterservices.org
i
FOR OFFICE USE ONLY—SITE ADDRESS: /(4ôo &W l5 h l v
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 • COMMUNITY DEVELOPMENT DEPARTMENT
111 I Transmittal Letter
r ,,;\H D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: 1 e,"7/V-- DATE ( WEI)
DEPT: BUILDING DIVISION
FEB 1 2017
FROM: Chip D.5ri1 , CITYOk„ )G {
`J BUILDING DIVISION.
COMPANY: v \\e L L C
PHONE: q 7( 2-'S - a`776 1 By
7.---0.,b
RE: f I L{O 0 Sol RSA` 43 MST,20 r b — 0044 o
(Site Address) (Permit Number)
•
I IQ-1—U, __.-- -
(Project name or s bflivision name and t er)
ATTACHED ARE T . FOLLOWING ITE S:
Copies: Descripti? : Copies: Description:
Additie al set() of plans. Revisions:
Cross ection(s) d details. Wall bracing and/or lateral analysis.
Flo a /roof framin Basement and retaining walls.
Be calculations. Engineer's calculations.
0 ro - (explain):
REMARKS: 6. lam.„( .6 `o -
6,.„0t.,1 A's -4 . NQV P��ns <�ow nt�
[e O ,geR t1,5 -t)r '?C/oi•' `fra Wrap cc.a,yt� OovG4 . NVI �p0�7,�"(5
S oto,../ cat rC a l a/t)-L.f Ye?,',1..' #.(. l I
(e a ..K. ASI .1-ula:Qo
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: a _ j _ 1-7 Initials: '
Fees Due: 12 Yes 0 No Fee Description: Amount Due:
.� 141' pi ,,et re./ .< , $ b '
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑Yes / V No ❑ Done -
Applicant Notified: Date: 3- akr / ,1 Vf , 4i)uLL ej Initials: ”
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11400 SW 95TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2016-00440
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor