Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00586
r� DEVELOPMENT SERVICES DATE ISSUED: 12/16/2004
I I 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
SITE ADDRESS: 11945 SW 70TH AVE PARCEL: 1S136DC -04400
SUBDIVISION: FRUITLAND ACRES ZONING: C -G
BLOCK: LOT: 030 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: 5N 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: Demolition of existing 1800 sq ft residence. Septic tank to be removed. SDC credits to apply to future permits.
Owner: Contractor:
KURT DALBEY EQUITY GROUP FUND 1 JHC COMMERCIAL LLC
25115 SW PARKWAY AVE SUITE C 11125 SW BARBUR BLVD
WILSONVILLE, OR 97070 PORTLAND, OR 97219
Phone: 503 - 570 -8828
Phone: 503 - 624 -7100
Reg #: LIC 158061
FEES REQUIRED INSPECTIONS
Description Date Amount Ersn Cntrl 681 -4444
[TAX] 8% State Surchari 12/16/200 $5.00 Pump /Fill Septic Tank Insp
[ERPRMT] Erosion 12/16/2002 $26.00 Final Inspection
[ERPLN] Ero Plck -CWS 12/16/2002 $8.45
[EROSN] Ero Pick -COT 12/16/2002 $8.45
(additional fees not listed here)
Total $110.00
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 -001 Qthrough OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 3) 246 -6t•9 or 1- 800 - 332 -2344.
Issu By:
Signature: , , Signau � � 4 tA
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application FOR OFFICE USE ONLY
Received 1 �
City of Tigard Date/a : /� e
Plan Review Permit No.: ^ /,
13125 SW Hall Blvd., Tigard, OR 97223 ` - •' / .� /_/
Phone: 503.639.4171 Fax: 503.598.1960 % u i D : Other Permit:
Inspection Line: 503.639.4175 s'f I Date Ready/By: ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
. . TYPE OF WO 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
' CATEGORY OF CONSTRUCTION work indicated on this application.
K 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
' JOB SITE INFORMATION AND LOCATION . ... Total number of floors:
Job site address: t 19 Li 5 Ste) 70 t Ave New dwelling area: square feet
City/State/ZIP: Ti S „, „ 0 2 97 7-z3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: -DQe..},nvo 0,..4_ Ne‘ac/1e.. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
5 IA--) 64 t SW ,76 fii VA 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.: / 3D L rt. . YyaC� 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.
12ecMOt.e ex t S - tio�.S� i of l - -G it 1C Valuation: $
t'4Y - c4 zvt -' i 0d n ffrtcl l v-PeS Ifial fi Existing building area: square feet
New building area: square feet
(X PROPERTY OWNER - ' • I ❑ TENANT Number of stories:
Name: KLtri_ .. ct.. 1 b. y b914.4. 6 Fu'14 1 l L. 1,C- Type of construction:
Address: 2 5/is W Pc, t .b...a � �t s4„, k c Occupancy groups:
Cam(./
City/State/ZIP: , /5c r?u ://e. ° '70 70 Existing:
Phone: ( 3) 5 , _ c'Z ff Fax: (5�3) 5 70 _s- 6 °/ New:
❑ APPLICANT - �,�, PERSON ' NOTICE' . ” - -
Business name: Q St — (.gk.e. COO Su 1+ Gt ot fs ( V'tC , All contractors and subcontractors are required to be
Contact name:�{y; C k.. ��� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1 511 s t� s pi i, P y $ zi, / C� V jurisdiction in which work is being performed. If the
' pp � " r/ applicant is exempt from licensing, the following reasons
City/ State/ZIP:
T�5 ct ,& Oa- "-) Z Z apply:
Phone: (Sa3) b$ y —aG S Z Fax:: ( 5 (0 2 tf — O 1 S 7
E -mail: PT , rip (PO S kcp kf2, C6)et SK. I tt7,Lfs _ (0 AA
CONTRACTOR
Business name: e.5 p 14 t4 e49 he. S een S ( C 6) r/1 . BUILDING PERMIT FEES* '
Address: ( Z5 51_ 51_ " arbur j L V€ J l
��(( Please refer to fee schedule.
.r
City/State/ZIP: PO Cttnc� on- c )711 al
Fees due upon application
Phone: (6D) (J Z t(-) 100 Fax: (;03) (ocf t{— 5Z 95__
5 $ 0c, ( I �. /9.7./07 Amount received
CCB lic.:
Date received:
Authorized signature: �/� This permit application expires if a permit is not obtained
�• within 180 days after it has been accepted as complete.
Print name: ?q \--, z- L (� — CO I Os— Date: f /6,/ (/ . * Fee methodology set by Tri County Building Industry
Service Board.
i:\ Building \Permits \BUP- PennitApp.doc 12/03 440- 4613T(11/02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
Cit of Tigard Received
y Date/By:
Associated permits: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 A <�
24- Hour Inspection Line: 503.639.4175 I I ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.ci.tigard.or.us • ❑ Other: •
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore:on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Deyelopment Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential•dwellings
on a lot of record approved prior to September 9, 1995.
i:\Building\Permits \One- Two- FamilyChecklist.doc 12/03 •