Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2003 -00516
0 DEVELOPMENT SERVICES DATE ISSUED: 8/28/03
13125 SW Hall Blvd.. Tigar O R 97223 (503) 639 -4171 PARCEL: 1S136DA-00200
SITE ADDRESS: 10995 SW 68TH PKWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: 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: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE:
Remarks: Demo 1,260 sq.ft. single family residence, 390 sq.ft. carport, 1,080 sq.ft. shop and 15x20 pool. Sewer to be capped
& inspected. All debris to be removed
Owner: Contractor:
DONALD POLLOCK DARRYL N. ANDERSON
1834 SW 58TH AVE 15910 SE CLAY STREET
PORTLAND, OR 97233
Phone: 503 - 292 -3975
Phone: 503 - 256 -5514
Reg #: LIC 84451
FEES REQUIRED INSPECTIONS
Description Date Amount Sewer Insp (CA- ppE o)
[BUILD] Permit Fee 8/28/03 $62.50 Final Inspection
[TAX] 8% State Tax 8/28/03 $5.00
[ERPRMT] Erosion 8/28/03 $26.00
[ERPLN] Ero Plck -USA 8/28/03 $8.45
(additional fees not listed here)
Total $110.40
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 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: _ " 1/
Permittee f /
Signature: .
Call 639 -4175 by 7 p.m. for an inspection the next business day
05/12/2003 15:36 FAX 5035981960 CITY OF TIGARD 2)002
Buildinglernitit Application -,.•• •‘ .,.,: :4-owoFFicu. liSE ON1..Y.'' ' ..'' ...." " ' •
Received / I • ?i d., Building ir
L paiesy:8128/ 0 3 Permit No. a ag3- ot._ ec,
City of Tigard Planning Approval
Date/By: Other •
Permit No.:
13125 SW Hall Blvd. A Plan Review Other
Tigard, Oregon 97223 Date/B : Permit No.: —
Phone: 503-639-4171 Fax: 503-598-1960 ./,-:`7,1463;ii.,•.) Post Land Use
.. . A jj, n ,,,,,i, , . Date,!&_, Case No. ,.
Internet: www.Ci.tigard.or.uit ions.: t. See Page r
24-hour Inspection Request: 503-6394175 Narnc/Idethod suppicmcntai Information
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'..4..;:. T.:...,"!: CAI:FA* ' i" t •• • v N.: ',.. ." • Note: Permit fees* are based on the total value of the work performed. tndicatt
O 1 8c2-Farnil dwellin:. 1K; COMMerC181/IndllStrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
I overhead and profit for the work indicated on this appiication.
111 Access o Buildin: ilk:,! Multi-Family_ -
• Master Builder El Other Valuation $ i 4 PP°
ismastaiM73,11 ,4 i-j :e No. of bedroornsa_ No of baths: Z t
Job site address:1 097 .5 44 ,"; diatal• ro Total number of floors —&--.
New dwelling area (sq. ft.) il 4,2_4, ail')
Suite #: Bid : ./ • .t.#: Garage/carport area (sq. ft.)..12-4sraft ' "594
Project Name; Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
OLV Other 61711ChITC area (sq. ft.)... /.Y.2)..(..... OtO
5Y ple•eikeft
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Subdivision: Lot #: -::. .
Tax ma Llo arcel #: • Note: Permit fees* are bated on the total value of' the work performed. Indic res (4. 1 .. o the valac (rounded to the nearest dollar) of all oloipment, ntaterials, labor,
_,„„„ overhead and profit for the work indicated en this appltcadon.
j:j en• oi.„Lr I 0 #1,.. 0 fir ,>_,..... A e .
- - Ai vaivatior . s
a7,1 . Existing building area (sq. ft)
- r P .
i New building area (sq. ft)
I Number of stories
- , . .
riSM., .,..3, I Type of construction
r■ I Occupancy group(s): Existing:
Name: _15_0./y. i. )2 .- 2-1-c•
Address: ; if• Pt/ . IP—(
Ci /State/Zig: - . ,, ,
__A .____ NOTICE: All contractors and subcontractors are required to be
Phone: - -
Fax -2. 2 y ; 42 licensed with the Otegon Construction Contractors Board under
Ette7, : provisions of ORS 701 and may be required to be licensed in the .
Business Name: _5/ L VA t., ,F,..- v jurisdiction where work is being performed. lithe applicant is exempt
Contact Name: p, c '
pgeG k from licensing, the following reason applies:
Address: /9
Cl /Stateai . : , 0 ,.., r A'S- — 7 2- ______ —
Phon . go Z - . - v F; .•..i. ... - thr, - .01:,,i.:;oreFi t .. F..40: . ..:).,.:,7-.t.Y::: al
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Business Name: , /"/ '., , , , '.. , , Fees due upon application. $
Address: ; A
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Cit /State/Zi,: Amount received • $
• PPIT1,1 r i , ,
—
Phon . 0, a -q , t Fax: Date received: I (:: Fib 3 I I 0- Lio
CCB ic. - : ;
Authorized 01100121Pr Node.: 'nits permit application expires if a permit Is not obtained *thin
Signature: 4111 r,.. ./ / . / Date: L : 0 5 , 40days atter it bin been accepted as complete.
"
DaveplA .,‘i- ar 11.- .
_— 'Fee anithadolou sat by Tri.County Building Industry Service Board.
e., (Please print name)
iNDstakPermit FormaNBIdgPermitApp.doe 01/03
/ 5 / 3 6' li tj 2—,)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -41
INSPECTION DIVISION Business Line: 1503) 639 -4171 MST
C 3— oo61b
Received Date Requested / — a- ' AM PM BUP
Location /Oq 95" ®/oot Suite MEC
Contact Person eA S Ph ( ) 292— 397.5 PLM
Contractor Ph ( ) SWR
63 Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: c' - SIT
Post & Beam V P ) 7 - ;p
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation yg
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
S PART FAIL
elita [AGING /
cam
Under Slab
Rough -In .i
Water Service
Sanitary Sewer
Rain Drains
Catch Basin /Manhole
Storm Drain
Shower Pan
so •
PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
. -••- ••-• - - - - '
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