Permit CITY OF TIGARD MASTER PERMIT
-' COMMUNITY DEVELOPMENT741
Permit#: MST2017-00439
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/27/2017
Parcel: 2S103CC00700
Jurisdiction: Tigard
Site address: 12075 SW ROSE VISTA DR
Subdivision: COLONIAL VIEW Lot: 2
Project: SMART
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 2714 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1291 sf Garage: 960 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: 4005 sf Value: $510,192.40 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Drains: 0
Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 1 Gas Outlets: 6
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 8 201-400 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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB
R-3 4005
Owner: Contractor:
SMART,DAVID&JERI THE HOLLMAN COMPANY Required Items and Reports(Conditions)
14051 SW 155TH TER 3161 SW RIVERFRONT TER 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97224 WILSONVILLE,OR 97070
PHONE: PHONE: 503-780-4058
FAX:
Total Fees: $35,388.37
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 0 952-001-009. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i Permittee Signature: ___....../..--- ><"
Call 503.639.4175 by 7:00 a.m.for the next available inspection dat•
This permit card shall be kept in a conspicuous place on the job site until co tion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential
City of Tigard IIECFIVFmewed qQQ i 7 Permit No. --i(__l s�1111
• 13125 SW Hall Blvd.,Tigard,OR 97223IIIIIIIIIIMIIIIIIIIMIIIIIIIIIIII
Date/By' V/ Or✓d ` j/
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review )- -f Other Permit: ;Q _
r t t a i [� Inspection Line: 503.639.4175 N -V 8 2 0 1 7 Date Read/B": r,a;g: I`` �� for
Internet www.tigard-or.gov t � rified/Method:, ( /71 J Supplemental Information
/�' ® See Page 2
5-1
(Ir
e ° J 3 .� / J i
i'... ,., ieu - * - % # .s�1,. ` 100. tit ,;z, ,r T 1. >dI)2 �� . ' s t^
►,1 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
} ►'1„t �s�, g work indicated on this application.
dwelling 0 Commercial/industrial Valuation: `� $1"7"5"40" J
® 1-and 2-family / o`
❑Accessory building 0 Multi-family Number of bedrooms: 4
❑Master builder 0 Other: Number of bathrooms: 3
ciii:
rs,...vtriAMARAna P ► r° ,i a i da t x; Total number of floors: 2 e QO C- "79 by
Job site address:12075 SW Rose Vista Dr New dwelling area: —3694 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 960 square feet
Suite/bldg./apt.no.: Project name:Pelser Residence Covered porch area: 1 16 square feet'a 9 j
Cross street/directions to job site:SW 121°to Rose Vista Dr. " area: t+� � �¢tguae feeta7 ,�-
cv‘t
Other structure area o��+.square feet
/�t15r}}�} ,tom ,- 30 6'' r ��tt $.R
Yi}Q -i �is41{ - 1 I.x�1 :4
'r i5 nn!..,�9t� ��+E.�Xrv.� o-w. L ...,,.;" .x. :: $#+rv.z*y
Subdivision: 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
equipment,materials,labor,overhead,and the profit for the
. , ,.fi ' ' a ' ta work indicated on this application.' s u, - *.� „�.. . . ;< cif, ..:,_,+r .tw , . s . :a«
A new home Valuation: $
Se f✓LGA �jr v d,d C tk - 11'e `v-t- Existing building area: square feet
rre-e New building area: square feet
5 � 7 �rVaa � w '" ar : dtim 4 t ct
Number of stories:^ z
Name:Dave and Jeri Smart Type of construction:
Address:14051 155"'Terrace Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:(503)504-4997 Fax ( )
�, New
. ,. x n.a...�.. ,. 3...w„ sa ..�..,... _., ,„,,r1 ..,n'v.-, .t.,, nfia, . ilifi
m r at.,� .r 3.
Business name:The Hollman Company �'� s.b .,„ ,.
Structural plan review fee(or deposit):
Contact name:Rafe Veenker
Address:3161 SW Riverfront Terrace FLS plan review fee(if applicable):
City/State/ZIP:Wilsonville,OR 97070 Total fees due upon application:
Phone:(503)701-3265 Fax::( ) Amount received:
:} , 'E-mail: t
Rafe@hollmanco.com .
Commercial and residential prescriptive installation of
'' VA AJZI . .110ft ri 3,.,. . ..,< , "M.i ,m-` ,,..,m ,. �:W:'z ,. ,- roof-top mounted Photo Voltaic Solar Panel System.
Business name:Same as above 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:( ) Fax:( ) State surcharge arg (12%of permit fee): $21.60
CCB lic.:1586
Total fee due upon application: $201.60
Authorized signature: e ` This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Rafe Veenker Date:11/8/2017 *Fee methodology set by Tri County Building Industry
Service Board.
I:\Building\PermitskBlJP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
Mechanical Permit Application roll()Hi( I. ISI 011.1
,City of Tigard " , r Received
:� _ 13125 SW Hall Blvd.,Tigard,OR 9722Ctl ri r DateBy: Permit No.:
r
_ Phone: 503.718.2439 Fax: 503.598.19 Plan Review
Inspection Line: 503.639.4175 t,..A Date/By: Other Permit:
Til A k t Date Ready/By:
Internet: www.tigard-or.gov t�� y y Juris: H See Page 2 for
QNotified/Method: Supplemental Information
s �
; f:AO t'3 LS � -: `tib
.� n.-. . A' .0 ,.e54: zit ..�ai.,...'.^.:r .,,. t , � � . -1 ,'1e r,. ,..per x b .lei $e' value 3A�s`� h�'�,r"n,K'
& .• 1 Mechanics[permit fees*are based on to theof the work
®New construction 0 Addition/alteratiore� `lY'1` performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: ,. mechanical materials,equipment,labor,overhead,and profit.
x Value:$
' .. ,. v.� .5.,,.., <3P- "� .,:,.�.t _. «„tet, .r�,.��� "� 7:x a��it �' pIt�31 �p �,a � � 4
® 1-and 2-family dwelling ❑Commercial/industrial �" � ' . � io "1 �l
rrr
0 Accessory building � �For special informationuse checklist u ��
❑Multi family 0 Master builder
0 Other: Description I Qty. I Ea. I Total
Heating/cooling:
Job site address:12075 SW Rose Vista Dr. Air conditioning 1 46.75
Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name:Smart Residence Heat pump 61.06
Duct work 23.32
Cross street/directions to job site:SW 121”to Rose Vista Dr.
Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. . 46.75
Flue/vent for any of above 23.32
Subdivision: I Lot no.: Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
Water heater 1 23.32
t` t o "
-.;: .� � , .'. ,MP. . . . , Gas fireplace/insert 1 33.39
A New Home �� '',MVP;
"V` Flue vent for water heater or gas
fireplace 1 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
x4i4xP � t�,� � a li Other: 23.32
Name:Dave and Jeri Smart Environmental exhaust and ventilation:
Range hood/other kitchen
Address:14051 ISSm Terrace equipment 1 33.39
Clothes dryer exhaust 1 33.39
City/State/ZIP:Tigard,OR 97224 Single-duct exhaust(bathrooms,
Phone:(503)504-4997 toilet compartments,utility rooms) 3 23.32
(
., .., ) Attic/crawlspace fans
23.32
4Mats . it a�
Other: 23.32
Business name:The Hollman Company Fuel piping:
Contact name:Rafe Veenker
$14.15 for first four;$4.03 for each additional
Furnace,etc. 1
Address:3161 SW Riverfront Terrace Gas heat pump
City/State/ZIP:Wilsonville,OR 97070 Wall/suspended/unit heater
Water heater 1
Phone:(503)701-3265 I Fax::( ) Fireplace 2
E-mail:Rafe@hollmanco.com Range 1
Barbecue 1
ry r, .�i'. � „,, , . 6. , .., .,. .i v Clothes dryer(gas)
Business name:Woodward Heating Other:
Address:552 Main St 1�_ 1
Subtotal
City/State/ZIP:Aumsville,OR 97325 Minimum permit fee($90.00)
Fax:( ) Plan review(25%of permit fee)
Phone:(503)448-4328 I
CCB iia:153836
State surcharge(12%of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized Signature: days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name:Rafe Veen= Date:11/8/2017
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application --,-1-,71‘1,. l� ,q,
City of Tigard i Y .< eived
Iii 'i 13125 SW Hall Blvd.,Tigard,OR 97223 - ') p ate/By: Permit#:
L Plan Review "ii: Ji 7 u`t 3`)
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
I �, It l� Inspection Line: 503.639.4175 � �` Ready Date/By: furs:
Internet: www tiand-or. ov ® See Page 2 for
g g0 I,e. Supplemental Information
®New constructioni ,b <-.
0 Addrtion/alteration/re it K ? �, Please check all that apply(submit 2 sets of plans w/items checked)
0 Demolitionl-�t-�� ``
0Other: .�S�,-- ❑Service or feeder 400 amps or more 0 Building over three stones.
where the available fault current 0 Marinas and boatyards.
" < i' a i `!:' d • ^` „w ig .. .4 an $0,a 00 exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-famil amps for all other installations. buildings.
Y ❑Master builder ❑Other: 0 Fire Pump.•
❑installation of 150 KVA or
`3` i i,i ; t ` w
❑Emergency system, larger separately derived
Job#: 1 Job site address:12075 SW Rose Vista Dr. 0 Addition of new motor load of system.
100HP or more. 0"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97723 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:Smart Residence 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 121'r to Rose Vista Dr. r ,,,;
?*fi41 4.
Description " Qty. ' .:
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Fee for all residential systems combined: $75.00 Desaription < f Qty :l Each I Total I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
® Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva
301.04 2
® Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
Heating,Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
® Vacuum Systems* >100 ha-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
0 Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/ 1
Inspections for which no fee is
specifically listed %Z hr min) 90.00/hr
9 �
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
(SEE OAR 918-309-0000) ` Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
O Boiler Controls
O Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
O HVAC
O Instrumentation
❑ Intercom and Paging Systems
O Landscape Irrigation Control*
O Medical
O Nurse Calls
❑ Outdoor Landscape Lighting*
O Protective Signaling
O Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I:1Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015
Plumbing Permit Application ae
Building Fixtures �� a` `
a `.t' '' '"' FOR OEFICE USE ONLY
City of Tigard ,,; Received
n 13125 SW Nall Blvd.,Tigard,OR 972237 Date/By: Permit Na.: -_ Y it 3G
,r f^�S t/V t 7'cam /
2• Phone: 503.718.2439 Fax: 503.598.1960 ,` U' PlattReview
TIGARD
Inspection Line: 503.639.4 i 75 1v � thy: Other Permit No.:
Internet: www.tigard-or.gov
z as i N y bn tads Qi See Page 2 far
eRead
ethod: Supplemental information
TYPE OF WORK r
FEE. ScxEnUi,>;
®New construction ->
❑ a-, mow- Fors ecial iu oollia use checklist. _
0 Other:
0 Addition/alteration/replacementDescription Qty, En. Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath
437.78
❑Accessory building 0 Multi-family SFR(3)bath 1 500.32
Each additional bath/kitchen 25.02
0 Master builder ❑Other
Fire sprinkler( sq.IL) Page 2
JOB SITE INFORM,tTION`AND LOCATION Site utilities:
Job site address:12075 SW Rose Vista Dr Catch basin or arca drain 1 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: , Project name:Smart Residence Footing drain(no.linear ft.:^) 2
Manufactured home utilities Page50. 2
3
Cross street/directions to job site:SW 121r'to Rose Vista Dr Manholes
18.76
Rain drain connector I 18.76
Sanitary sewer(no.linear it: I Page 2
Storm sewer(no.linear ft.:LO) 1 Page 2
Subdivision: Water service(no.linear ft.:41) 1 Page 2
Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
_ ... DESCIOPTION OF'WORKi. �ackwatervalve 12.51
A New Home Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 75.02
Ejectors/sump
®-PROYE RTY OWNER 75.02
_I=. [�TENANT _,- Expansion tank
12.51
Name:Dave and Jeri Smart F xtumJsewer cap 25.02
Address:14051 155i°Terrace Floor drain/floor sink/hub 25.07
City/State/ZIP:Tigard,OR 97224 Garbage disposal 25.02
Hose bib 25.02
Phone;(503)504-4997 Fax ( ) Ice maker
_® ' 12.51
..r® APP.LICANT _ CONTACT PERSON Interceptor/grease trap 25.02
2
Business name:The Hallman Company Medical gas(value:S ) page
Contact name:Rafe Veenker Primer 12.51
Address:3161 SW Riverfront Terrace Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Wilsonville,OR 97070 Solar units(potable water)
I 62.54
Phone:(503)701-3265 Fax::( ) Tub/shower/shower pan 12.51
E-mail:Rafe@hollmanco.com Urinal 25.02
CONTRACTOR- = Water closet 25.02
_-
Business name:EK Plumbing Water heater 37 52
Water piping/DWV 56.29
Address:508 SW 1"St
Other. 25.07
City/State/ZiP:Battle Ground,WA 98604
Subtotal
Phone:(360)687-4648 I Fax:( ) Minimum permit fee: 572.50
CCB Lie.:129363 Plumbing Lie.no.:37-430PB Plan review (25%of permit fee)
Authorized signature:i��� ei ,‘J State surcharge(12%ofpermit fee)
` 6�(_ TOTAL PERMIT FEE
Print name:Michael EK Date•11/6/2017 1 This permit application expires if a permit is not abtnined within 180 days
over it has been accepted as rnmplNe.
'Fee methodology set by Tel-County Building industry Service Board.
1:1Bu1klingTermhs1PLMU-PermitApp.doe l0101/09 44O-16167(t0/02/COMAVCB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utt lities Qty Fee(ea) Total
SquaieFootage Permit Fee
Footing drain-1 M 100' 1 50.03 0 to 2.000
Footing drain-each additional 100' 5121.90
37,82 2.001 to 3.600 $164.69
Sewer-ism 100' 1 62.54 3,601 to 7.200 $233.20
Sewer-each additional 100' 377.201 and greater $327.54
.52
Water Service-1st 100' 1 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
Storm&Rain Drain-1st 100' 1 62.54 VaIual on Pernut Fee
$1.00 to$5.000.00 Minimum fee S72S0
Storm&Rain Drain each additional 100' 37.52 55,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
hIc ' QFee(ca) Total OternspetionsorFees` ty each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.40.
S 10,001.00 to$25,000.00 $148.50 for the first 510,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including 525.000.00.
hours(minimum charge n r 2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
Reinspection Fees 90.00/hr eachincluding
00000 or fraction thereof,to
Additional plan review for revisions and ineiudine$50.000.00.
90.00/hr 550,001.00 and up $742.00 for the first S50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
` Qutintity by Fixture Tyne
FlxtureTppeior - wed Plain Reviewfor Plun%bing=In"staliations..
3Vork Performed cuppea„` n�taea - tteloentc.. Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2”and
Jacuzzi/1Vhirlpaal greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain
0 Any complex structure as defined in OAR918-780-0040.
Eye Nash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
;74Car Wash Drain T$Onletrle•Or'hili Y})lakT'v;m-
Garbage Domestic-non-food -❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice MachiRefrig.Drains
Oil Separator(Gas Station) Comments regarding future work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
_ Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet , fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
C:\Users\Rafe\Documents\Documents\0-CLIENTS(Build)\Dave&Jeri iiiart\Permits\PLMF PermitApp.doc
Clean Water Services File Number
C1eanWater Services 17-003769
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: Tigard
2. Property Information(example 1S234A801400) 3. Owner Information
Tax lot ID(s): 2S103CC00700 Name: Dave&Jeri Smart
Company:
Address: 14051 155th Terrace
Site Address: 12075 SW Rose Vista Dr City, State,Zip: Tigard,OR,97224
City, State,Zip: Tigard,OR,97223 Phone/Fax: 503-504-4997
Nearest Cross Street: 121St E Mail: smartsticher@yahoo.com
4. Development Activity(check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence(rooms,deck,garage) Name: Rafe Veenker
❑ Lot Line Adjustment ❑ Minor Land Partition Company: The Holtman Company
❑ Residential Condominium ❑ Commercial Condominium Address: 3161 SW Riverfront Terrace
❑ Residential Subdivision ❑ Commercial Subdivision
❑ Single Lot Commercial ❑ Multi Lot Commercial City,State,Zip: Wilsonville,OR,97070
Other Phone/Fax: 503-701-3265
A new home E-Mail: Rafe@hollmanco.com
6. Will the project involve any off-site work? ❑Yes l No ❑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 Rafe Veenker Print/Type Title Rep
ONLINE SUBMITTAL Date 11/16/2017
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.
XBased 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 17-05, 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 L Date 11/22/17
2550 SW Hillsboro Highway • Hillsboro. Oregon 97123 • Phone: (503)681-5100 • Fax (503)681-4439 • www.cleanwaterservices.ore
City of Tigard
l1111 COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A RD Building Permit Review — Residential
Building Permit #:
Site Address: / _ c)«_.) etiz<-P V/
2r've_
Project Name:
`-71- -CT---k_ Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 2t.)
Verify fy site address/suite#exists and actio permit system.
❑ River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Sit lan Elements:
ree(3)copies of site plan .
ite plan must be on 8-1/2"x 11"or 11 x 17"paper + sting structures on site
ooraven to scale(standard architect or engineer c le)12
ore leva eleof lig vations structure(including decks)with finished
Orth arrow
IV e address,project or subdivision name and lot number 3/, ty locations&easements(required for new and additions)
Vr idewalk/driveway approach
.plicant information(name and phone number) ation of wells/septic systems
of dimensions and building setback dimensions ':
�- xisting trees to be retained with drip line,and tree
I/ •uare footage of
► buildings to be demolished protection measures
w a+t area,building coverage area,percentage of coverage and t.J -et tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) 1+treet names
IllProperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? 1i4es No
4 foot differential)
If yes,is a storm water quality facility shown? Wes ONO
❑ Clean Water ervices—Service Provider Letter(lot platted prior to 9/10/1995):
Required: Yes,applicant was notified ❑ No Received:
LI ublic Facilities Improvement(PFI) Permit: 1:1 Yes o
Required: ❑ Yes,applicant was notified V No Applied For:
❑ Yes ❑ No,stop intake
rvkand Use Case#:
oning:
Required Setbacks: / y c-
Front 2ReartS Side , Street Side "J�
0 Garage t,2 0
Kandscape Requirement: 0/0
• tot Coverage Maximum:
ht
�� Building Height: Maximum Hei l
g � Actual Height 140 //
.. isual Clearance
►w S�nsitive Lands: /Yes ❑ NoT /
an Forestry Plan ype1 _�'`�/lam' c�1 X11
`editions "Met"prior to issuance of buildingpe 't
:15) --/-
n/ �
Notes: p
Approved By Planning:
Wr Date: g
Revisions (after Building Submittal only)
Revision 1: ❑ Approved ❑ Not Approved Reviewer Date
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPernutRvw RES_061417.docx
Building Permit Submittal
Original Submittal Date: /
//� 1 7
Site Plans: # J
Building Plans: #
Building Permit#: me .building permit#above. -
Workflow Routing: anning _gineering [}1 �rmit Coordinator Lu ding
Workflow Sign-off: �-4-off for Planning(include notes from planning review)
Route Application Documents: [Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
ding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician:
---� Date: //41/i 7
� i,�
Engineering Review
lope at building pad: 12
❑ Conditions "Met"prior to issuance of building permit
O Easements (encroachments)per engineering conditions of approval and plat
,Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes .21--/No
Assess Water Quantity Fee in-lieu: Yes ❑ No
LIDA Facility on lot: ,Yes 0 No
Date:
0 NOT Approved by Engineering:
Notes: c�
//J�/ i 1_ 14). Date: t 17
Approved by Engineering: �!'L l�
Revisions (after Building Submittal only)
Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
O Conditions "Met"prior to issuance of building permit
O 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:
jet Fees Entered: Wash Co Trans Dev Tax: 0' es 0 N/A
Tigard Trans SDC: ►i Yes 0 N/A
Parks SDC: Yes 0 N/A
LIDA Yes 0 N/A
OK to Issue Permit
/ l3)i�
Approved by Permit Coordinator:
Date.
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12075 SW ROSE VISTA DR, TIGARD, OR, 97223 October 26, 2018 at
10:49:14 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00439
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12075 SW ROSE VISTA DR, TIGARD, OR, 97223 November 13, 2018 at
11 :09:56 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00439
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12075 SW ROSE VISTA DR, TIGARD, OR, 97223 November 29, 2018 at
11 :35:28 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00439
Inspection Type: Inspector:
299 Final inspection Jeremy Burrows
Result:
PASS - CofO
Comments:
Final erosion control passed
Street tree certificate received
Moisture content form received
Moisture barrier acknowledgement form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor