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Permit
CITY OF TIGARD BUILDING PERMIT PERMIT #: BUP2004 -00322 f i l l DEVELOPMENT SERVICES DATE ISSUED: 7/22/2004 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15100 SW 89TH PL PARCEL: 2S111AD -12100 SUBDIVISION: SCHECKLA PARK ESTATES ZONING: R -4.5 BLOCK: LOT: 038 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: 1 HT: 10 ft GARAGE: sf OCCU SEP. RATED: BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED FLOOR LOAD: 40 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: $ 3,000.00 . Remarks: Change pitch of roof Owner: Contractor: ROGOZ, MAREK+ BARBARA OWNER 15100 SW 89TH PL TIGARD, OR 97224 Phone: 503 - 620 -4130 Phone: Reg #: FEES REQUIRED INSPECTIONS Description Date Amount Framing lnsp [BUPPLN] Pln Rv 7/7/2004 $46.87 Insulation lnsp [BUILD] Permit Fee 7/22/2004 $72.10 Final Inspection [TAX] 8% State Surchari 7/22/2004 $5.77 Total $124.74 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-II e • .ugh OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by calli•. (503)246 -66•• or 1- 800 - 332 -23 Iss . ed By: 1 / 1 14 Permittee Signature: ( t Call 639 -4175 by 7 p.m. for an inspection the next business day Permit #: &U.-PC) Gir:).?'P'` ' ' Add DO • AA) O ( � G t Is ed by: ate: 7/8 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: l u I 1. I own, reside in, or will reside in the completed structure. bk 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. Ei 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 aye 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 of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. &. 'R'''I 6. - 4 - ra2.2 —o 14 (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) Building Perniit FOR OFFICE USE ONLY 4_ City of Tigard C E I V E D Received i Dates : �! j. �, , �,� _ _ 13125 SW Hall Blvd., Tigard, OR 7 Plan Review Phone: 503.639,4171 Fax: 503.598.1960 ". Dates : Other Permit: Inspection Line: 503.639.4175 H I� 7 [ 20 111. — Date Ready/By: Juris ® See Attached Checklist for Internet: www.ci.tigard.or.us �j U` Notified/Method: Supplemental Information a"< N ,.< _ .,t- . , _ ° , 4° J ' #4ss. y fi „ ,� .,�). > ' x ' , V1 LING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all '"1 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ; ; k , i )6, ' ,; work indicated on this application. Valuation: $ 2, 1 -and 2- family dwelling ❑ Commercial/industrial .y., J. (9.42 ° --- ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: Total number of floors: Job site address: ioo SW $9 p L New dwelling area: square feet City/State /ZIP: 1 'L ‘,13,- ? o 1,R, 4, 2 `,2 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: &O 0 F — fir.-- Jy t ) F L to' U Covered porch area: square feet Cross street/directions to job site: j PIT L Tr tL r 'l r l — Deck area: square feet Other structure area: RQooF square feet e\/ S005f TA, COMME $lam, E= CHE.CKL-IST Subdivision: I 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 f - r ` �r i i 4 I< o ,o" ' y ' : , e N- -- �` ' pP work indi on this application. �©,O F R c �1 p L (t . J Valuation: $ Existing building area: square feet New building area: square feet ; �: ` _ »�... e a i°= c � M., : Number of stories: Name: i'l A-izyfac d Z 1A y,,pj Avail- Cro'Z., Type of construction: Address: 1 100 S 8 0 VL Occupancy groups: City/State/ZIP: 'r 16-A- v,.., ©(A. on ZZ LI Existing: Phone: 0 - p"►j) G zia 0 Fax: ( ) New: _ :- � ." ,:mss `� % - Business name: 5 — L P All contractors and subcontractors are required to be Contact name: N ilk-4),AF i,i, s - 1b v.,V7vl4v.N 1 VLO C}- 2/ licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 1 ,C t 0 0 St.-1 Ft t)t, jurisdiction in which work is being performed. If the City/State/ZIP: T 1. - A-v 9 Q e- °ii L2 L1 applicant is exempt from licensing, the following reasons _` apply: Phone: ('O tj') 6 a..O 1 ( ( 50 ( Fax: : ( ) E -mail: ��x W 7� Business name: S E L F t � R � P - Address: .< Please refer to fee schedule. City/State/ZIP: j � / Phone: ( ) Fax: Fees due upon application L116 • g —1 ( ) CCB lic.: Amount received 1 16 , p 7 Date received: —7 — 7 —6 Li p Authorized signature: This permit application expires if a permit is not obtained / within 180 days after it has been accepted as complete. Print name: i •-c • 4 _ 0 cc • Date: 0 6 0 ( ch 0 * Fee methodology set by Tri-County Building Industry Service Board. J/(�jr�/ i:\Building \Permits \BUP- PernitApp.doc 12/03 440- 4613T(1 i /02/COM/WEB) 77 ..g / One- and Two - Family Dwelling Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard n ) Date/By: d Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 I' ✓ — Y Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 24 l�, r //' "�� p ❑ Electrical ❑Plumbing O Mechanical 24- Hour Inspection Line: 503.639.4175 Y/ ✓� ^ , , � , Internet: www.ci.tigard.or.us 1 1 I � 7 ❑ Other: f� l 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, roofmg, 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. ❑ 0 ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development 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 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION - DIVISION Business Line: (503) 639 -4171 MST BUPA q -0d3 Z Received Date Requested ( — AM PM BUP Location %.' /On s PL- Suite MEC Contact Person Ph ( ) PLM Contrr Ph ( ) SWR €DJ!1G Tenant/ ce a, d "l 1 0 ELC Foo ing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: ( SIT Post & Beam / �^ Shear Anchors V ,� Ext Sheath/Shear '� Int Sheath/Shear 4/ 4 A-eS o, 6-L G2! C�,¢ ' Framing l' Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling / Roof O Other: •J ■ *ART FAIL PLUMBING 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, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA 2 ?—� ji S Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL