Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00099
�
Al i DEVELOPMENT SERVICES DATE ISSUED: 3/23/04
k `""' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
.44 SITE ADDRESS: 13235 SW 76TH AVE PARCEL: 2S101 DB 00613
SUBDIVISION: ROLLING HILLS ZONING: R - 3.5
BLOCK: LOT: 018 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ACS 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: 1 HT: 12 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: 15 ft REAR: 15 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 12,830.40
Remarks: 528 sq.ft. accessory structure (no electrical )
Owner: Contractor:
DAN MARSHALL OWNER
13235 SW 76TH AVE
TIGARD, OR 97223
Phone: 503 - 624 -7466
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Ersn Cntrl 681 - 4444
[BUPPLN] Pln RN 3/11/04 $109.27 Footing Insp
BUILD Permit Fee 3 /23/04 $168.10 Foundation Insp
[BUILD] Framing Insp
[TAX] 8% State Surcharl 3/23/04 $13.45 Misc. Inspection
[CDCPLN] CDC Pln ReN 3/23/04 $40.00 Final Inspection
(additional fees not listed here)
Total $373.72
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: 7 t/ / ,
Pe rm ittee
Signature: � / /,..
Call 639 -4175 by 7 p.m. for an inspection the next business day
Sent by: • )gers Machinery Co. -Corp. 5036390111; 04/11/03 8 :584M; JetFax #737;Page 2/3
04/11/ 03 09:45 FAX 5035981960 CITY OF TIGARD X002
yy p OR.OFFLCE USE ONLY Blill[11II 7 • Permit An 8 1><eatloII DateiBy: ��' Building a°p�� � O 7
•
• Date/By: l� Permit No. o
•
Planning Approval Other
City of Tigard . Date/B : ^ ; .1 y h� Pe No.:
13125 SW Hall Blvd. Plan Review Other
Date/By: rmit y: Pe No.:
Tigard, Oregon 97223 �,, Post -Rcvi Land Use
Phone: 503-639-4171 Fax 503 - 598 -1960 e �l' 1 '1 Date/By: " Case No.
Internet: www.ci.tigard.or•us - " Contact J Juris.: 01 See Page 2 for
Ins ection R cst: 503 - 639 - 4175 Name /Metho T i Su lemental Information
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I gi n: . !.I . .r'::,,1 !ii', r : hd , 11l
D emolition I . :r : " ' 'P "`� ,,. I ;.r! f1 I' L ,.. ?: .:
New construction ID ' ..... � , � ':'_ . �
WI
Addition/alteration/r - placement ❑ Other:
b �+� : + on the total value of work performed. Indicate
•:01 r of 1'" '::I Note: Permit fees are based
�1:;:. °: ;? `•i'i I 11 a.: l'1�!` " materials
,,labor,
' '' '' 'i the value (rounded to the nearest dollar) of all equipment, materi ,. labor,
1 & 2- Family dwelling ColnrnereiaUIndustrial overhead and profit for the work indicated on this application.
Accessor�Eluldin• Multi - Family 5,-3 K �4 .30 $ ( Z 1 p 4O
Master Builder 111 Other: V aluation
� No. of bedrooms: No- of baths:-�—
'�.. ' ";;'r�,t oitv�iy'tl y T'' .� Total number of floors (
Job site address: �, a2 S. W.. - 7 , -rM New dwelling area (sq. ft.)
Suite #: /t 4- 1 Bldg. /Apt. #: /V�/} Garage/carport area (sq. ft.)..... %
Project Nam e:gi,Tt3uc� N& / Covered porch area (sq. ft
Cross street/Directions to job site: SW VAR 6S cie 7(0 i Deck area (sq. fl..)
Other structure area (sq. ft.)
�t
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Subdivision: �t- i)l. 1/46- 1-1 .'i'1 I Lj. S Lot #:
Tax map/same. #: Note: Permit fees" are based on the total value of the work performed. Indicate
y ,,,, yN N �, I t it :: e' (rounded to the nearest dollar) of all equipment, materials, labor,
;I ... s��:I�.I ., :1 Y:I,' r CU!YIIT' • d dQJtu�l:j N,kli!;1' ,. I;a , : the work �.:�• , over h ea d value an profit for the ork indicated on this application '
Valuation $
Existing building arca (sq. ft)
New building area (sq. ft.) 4/6_
N/ [.1 Number of stories
:0 ia. _ in `� 'F' trr 5 ',+j `1 F4"'; -. r ,. ^ ,,, i,!" T of construction
1 s 1�
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i. ryligiesi -k��__ Occupancy group(s):
ame: New:
Address: 13,S"'" ao °z,%„ A(F
Cil� /State/Zip-'fl &AIQ4 - q 7' 7,7
licensing, the following reason applies: NOTICE: All contractors and subcontractors are required to be
P pne: (� a � 7 .:� Fes- ,,.., licensed with the Oregon Construction Contractors Board under
;- r . r,, ,, ..,., Fl;l • U mil t...0 . .:I•... , . . c.. .L,l. ":: ",i.1::
t ' ,� :,, s Na i, I U �li ... � provisions of ORS 701 and may be required to be licensed in the
usme Name: _ jurisdiction wherc work is being performed. If the applicant is exempt
� Contact Name :
°S - D � - - 4 � from .�.�L -�'• 41 .._ �.� -_ .:�w�i . -'15-1 •
Address: V , ._ .
C.) City /State/Zp. ,
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phone: :.,;�;��' pr . -' ..� �a�� ai ;►`� G • p � I tu.1!•'�;�� v, ,. t�; ,
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?Z� Fees due upon application ®LN RI/ $ /O9 off-7
4 Business Name: p��6f�2 C,�, Ti�i�
c-3-. Address: Amount received $
City /State/Zip:
Phone: I Fax: Date received:
CCB Lic. #: 4 i , i
r Authorized jliffNi Z / Notice: 1 his permit applicadon expires If a permit is not obtained within
y,, Signature: Daze=d 180 days after it has been accepted as complete
\ / /fir willJVi - -
°Fee methodology act by Trt- County Building Industry service Board.
U (Please print name) •
EE -27 2004 06:58 AM 5036396282 P.01
: 1
CleanWater Services ; I` �
7004 \
� File Number I q053 11
Phone: (503) 846.3553 Chuck Buckalle
155 Fax: (503) 846.3525
155 N First Avenue, Suite 270 Construction Inspectio '3y
Hillsboro, Oregon 97124 Sensltive Area Pre . Screening Site Assessment
buckaliewtecleanwaterse .or
JurlsdlctIor A � Date
Map & Tax Lot z ) 0/04(3 00 Owner * Al ., ;..
Site Address , ,� s (-WO
- 1 1 6 4 11..0 Q 4 (? Contact
Proposed Activity e, eu06-- Address 716.11,Qpf
Phone
Official use only below this line •
Y N NA Y N NA
71 n Sensitive Area Composite Map ❑ ❑ Stormwater Infrastructure maps
Map # a 511.<)/9) QS # 4 /4eZ
❑ ❑ Locally adopted studies or maps
❑ Other
Specify Specify
Based on a review of the above information .and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. M
❑ 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.
IQ 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 Sy: � Date: O t/
•
Returned to Applicant
C : a ir Mailer Fax Counter
Date 3/t� <> 9 ter
155 N Flret Avenue, Sulte 270 o Hillebera, Oregon 97124
Phone: (503) 840 -8821 o Fax: (503) 848.3525 o www.c[QJOwAtclfscry(co.oru
Permit #: 13 Uea ao q —ooU g
Address: (, 3s scti.2 76 'KV
Issued by: Clint Date: ,3 /,,,7 a /6,t
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
V1 1. I own, reside in, or will reside in the completed structure.
11 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
4N. 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name oft.. • i tractor.
I hereby cell> that the . bove • • ormation i correct and that I have read and do understand the Information
Notice to r'rop • rty O • ne %ction :po : ilities on the reverse side of this form.
... ..6- " "i°9-
����'r(S': / /rS . p scant (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
. . .
Information Notice to Property Owners
About Construction Respons^b^
Note: This Information Notice to Property Owners aboui Construction ibilities
was developed by the Construction Contructors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESP•VISMILITIES:
If you hire persons not regstered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire wfll be ernpoyees. As the ernployer. you rnust cornply with the foliowing:
Oregon's withholding tax law: As an etnployer, you must withhold income taxes from employee wages atthe time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. o[ Revenue ut945-809\.
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all ernployees. For more inforrnation caH the Oregon Ernpoyrnent Department ut378'3524.
Workers' compensation inmormnue: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compensation insurance for your employees. lfyou fail to obtain workers compensation insurance, you may
be subject to penalties and will be liable for al I claim costs if one of your employees is injured outhojob. For more inforrnation.
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment even ifyou didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-1040.
*MIER RESPONSBBL0TIES ;;LND AREAS •F CONCErt!M:
Code cornpliance: As the permit holder for this project, youurcrcyponoih|e6orrcso|viugunyfui|ure/omcetcudcreguircments
that rnay be brought to your attention through inspections.
Liability and property damage iiisurance: Contact your insurance agentto see if you have adequate insurance coverage for
ucuidentaundomissionauuuhuofu|iingtoo|s,yVintovnmpruy.vvotcrdumuge . from pipe puncrurcs. fire, or work that rnust be
re-done.
Time to supervise employees: Make sure you have sufficienttiine to supervise your eiriployees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coord inate the work of rough- in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
Ifyou have additional questions. write or caiI the Construction Contractors Board (P0 Box 14140. Salem, 0R 97309-5052,
503/378-4621). The Board is Iocated at 700 Sumrner St. NE Suite 3OO
prop-own.pm4
CITY OF TIGARD 24 -Hour
BILDING Inspection Line: (5 639 - 4175
INSPECTION DIVISION Business Line: 03) 639 -4171 MST T;
BuP o Gb ( "1 - 606
Received / Date Requested "2:7R-- AM PM BUP
Location ! 3 3 76 Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
ILD • Tenant/Owner O—G'LL ,P. (o v3 — ( 9c9 —d ELC
Foundation ELC
Access: �/ )1$ Tit .- crlt
Ftg Drain r�— ELR
Crawl Drain L 4
Slab Inspection Notes: . 5 0 1_ 2.— SIT
Post & Beam
Shear Anchors 1 1 de.5s D/4
x heath /S
Int S eam -- n ar CA) d' e/Qic, \ l
Framing
Insulation
Drywall Nailing r
Firewall ,,
Fire Sprinkler 1. b c o °� _ F:.. = ', ►y0J►
Fire Alarm - 7 C ,,
Susp'd Ceiling ��� r.r 1. .6' {
Roof
• • -r:
PASS •ART FAIL
• • BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
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, 1 25 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: / • Unable to in ect — no access
Fire Supply Line
ADA Date �� Inspector Exit-- Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record fromthe Job site.
PASS PART FAIL