Permit . ....,. ,
'• C ITY OF TIGARD BUILDING PERMIT
A PERMIT #: BUP2004 00271
A 1'w DEVELOPMENT SERVICES DATE ISSUED: 6/11/2004
. EiA 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S1116D -00314
SITE ADDRESS: 09880 SW PEMBROOK ST
SUBDIVISION: PEMBROOK HEIGHTS ZONING: R -3.5
BLOCK: LOT: 004 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: 40 psf LEFT: 5 ft RGHT: 5 ft FIR SPKL: SMOK DET:
DWELLING UNITS: 1 FRNT: 20 ft REAR: 15 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 4,980.00
Remarks: Remove & replace deck, adding stairs.
Owner: Contractor:
LUNESKI, ROBERT DAVID /JO AN NE DECKING NW
9880 SW PEMBROOK ST 5775 WILLOW LANE
TIGARD, OR 97224 LAKE OSWEGO, OR 97035
Phone:
Phone: 503 - 697 -9288
Reg #: LIC 44911
FEES REQUIRED INSPECTIONS
Description Date Amount Footing Insp
[BUILD] Permit Fee 6/11/2004 $91.30 Framing Insp
[TAX] 8% State Surcharl 6/11/2004 $7.30 Final Inspection
[BUPPLN] Pin Rv 6/11/2004 $59.35
[CDCPLN] CDC Pln Rel 6/11/2004 $40.00
Total $197.95
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 ough OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling ( ) 246 -669 •r 1- 800 - 332 -2344.
Issued
At
Permittee
Signature: T V
� J �
Call 639-4175 by 7 p.m. for an inspection the next business day
•
, RECEOVE® A rr f£ u rttt a t
Building Permit Application �'7, � .. Y •; ,
�. pp rw � , � � d t ;FOROFFICE>'1J$E � ONLY yy ; ;' ' , ; w - �`
City of Tigard i�ifltl 1 2004
6 TY OF ReceiDateB ���
ved /_�� Permit N (Q No.: L,C I(J5 _ ,„,g7 13125 SW Hall Blvd., Tigard, OR 972 TI Plan Review
Phone: 503.639.4171 Fax: 503.59 DIVISI�,GARD � r � DateB Other Permit:
( 1
Inspection Line: 503.639.4175 ILDING ' s' -
l . Date Ready/By: ®See Attached Checklist for
:
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
.n
TYPE OF .WORK y D DATA: 1 AN2 D - FAMILY DWELLING
'RE,QUIRE
❑ 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
. , = , CATE OF CO work indicated on thts p non.
? k application.
TA 1- and 2-family dwelling aluation: $ — % 9g )
y g ❑ Co Commercial /industrial I
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORM ATION AND LOC Total number of floors: •
Job site address: "t g O S1,,) y2 .v b r 4rcs 1( ! New dwelling area: square feet
City/State /ZIP: 1— c,,, I. q 1 ZZ (I- Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Lil IN S k ! Covered porch area: square feet
Cross street/directions to job site: Deck area: �2 1 ° 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.: Indicate the value (rounded to the nearest dollar) of all
/ equipment, materials, labor, overhead, and the profit for the
s• - :-. DESCRIPTION:OF- WORK , _: /' . , work indicated on this application.
. -H4 vv,` ,, el e _. (> 4 . /� 1t '
ce. --C/k. 5 L 1 j / Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY .OWNER t ` ® TENANT !`` Number of stories:
Name: L Type of construction:
Address: a O Q S GU Y�
�t.I1 rpa K . 5 I- Occupancy groups:
City/ State/ZIP: ,-.4... Existin g:
Phone: (y ( q I . Fax: ( ) New:
h ® 'APPLICANT ,, 'r t, `' t ❑ CONTA'CT PERSON
Business name: 2 l < G 1( Al 11./ All contractors and subcontractors are required to be
J � licensed with the Oregon Construction Contractors Board
Contact name: /` 1 1 1 <% 1 1/ L4 v ei y under ORS 701 and may be required to be licensed in the
Address: t r "7-7 S W , // i L 41,1 { - jurisdiction in which work is being performed. If the
City/State /ZIP: Col k O (O
applicant is exempt from licensing, the following reasons
/" 4 _ l / -7 i apply:
Phone: ( j� ? ) ( 4 9a s Fax: : ( ) q ! — ( q 2 q
E -mail:
s k 1 ,, CONTRACTOR+
Business name: : ,- ;BUILDING PERMIT FEES
! z '�� Ot S I
Address: I Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
CCB lic.: zf' -1 9 / Amount received
Date received:
Authorized signature: 4-✓I J /' This permit application expires if a permit is not obtained
f / � within 180 days after it has been accepted as complete.
7
Print name: , � G Date: W — ` I V 11 * Fee methodology set by Tri- County Building Industry
///��l t Service Board.
1:\Building \Permits \BUP- PemutApp.doc 12/03 440- 4613T(11 /02 /COMJWEB)
. . .
A Building Division
I r t l iI Plan Submittal Requirement Matrix
c =--• Commercial & Multi - Family - New, Additions or Alterations
City of Tigard
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue)
* For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i:\ Building \Forms \COM- PlanSubReq.doc 12/24/03
File Number
CITY OF TIGARD, OREGON
Sensitive Area Pre - Screening Site Assessment
Community Development
Shaping A Better Community
Jurisdiction `I r c 44,1 • Date
Map & Tax Lot / — p Owner Tt Lh 5-6 1c i
Site Address , & b v S'ti pEQalrirrro.
vc - • Contact 2
Li 1/71 j q.
Proposed Activity �„ re( / te c _ Address -7 s i 2 ' ((
r a w L y
C 0E4. J Phone h6j (yo 7 ® 1
Official use only below this line
Y N NA Y N NA
❑ ❑ ❑ Sensitive Area Composite Map ❑ ❑ ❑ Stormwater Infrastructure maps
P QS #
• ❑ ❑ ❑ Locally adopted studies or maps ❑ ❑ ❑ Other CEIV ED
Specify Specify ��
Based on a review of the above information and the requirements of Clean Water IGgRD
Services Design and Construction Standards Resolution and Order No. 04 -9: CITY OF T
BUILDING DIVISI
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas
exist on the site or within 200 feet on adjacent properties, a Natural Resources
Assessment Report may also be required.
gl Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently discovered on your
property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
" REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
• STORMWATER CONNECTION PERMIT.
❑ The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
Reviewed By: Date:
Returned to Applicant
Mail Fax Counter
Date By
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123
Phone: (503) 681 -3605 • Fax: (503) 681 -4439 • www.cleanwaterservices.org
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: • 1 639 -4175
INSPECTION DIVISION Business Line: 5 i • '-,171 MST
7 BUPa� �r 4 7 — do °z - 71
Received Date Requested /l 1 7 A M l'� PM BUP
Location Suite MEC
Contact Person .— l 2."l ./N• Ph ( ) 6 O 9 7 — 9, ce' PLM
Contract Ph ( ) SWR
B ILD Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab e 11,5 Inspection Notes: SIT
Post & Beam
Shear Anchors Gj
Ext Sheath/Shear
Int Sheath/Shea __C 4,0 Q,r<ts OLJ' .$-
O
v
Framing
Insulation C.-4-\
Drywall Nailing Y` ✓1�c.� O � " " " C� ' s T S
Firewall j� � l 5, - D c 5 - ` � S C7,) < <O. - C S
Fire Sprinkler
Fire Alarm p a ) c
Susp'd Ceilin 1 n ix ,
Roof V
Other:
3 C t , � - S-e. cif e a-(j-
__ PART FAIL _
'fi :ING 4 L It r . -1 1 N ri
Post r l abm
Under t ` ^ t3 --�/ti S I i
nder Slab �� -
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: 5/2*------;;i5L/
Final
PASS PART FAIL i
MECHANICAL
Post & Beam
Rough -In C14 '/
Gas Line �.
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
//ti) /a
ADA ` L/ VC:
Approach/Sidewalk Date 1 Inspector Ext
•
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL