Permit - CITY OF TIGARD PERMIT
PERMIT #: MST2001 -00102
j DEVELOPMENT SERVICES DATE ISSUED: 3/6/01
„�f l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11435 SW 92ND AVE PARCEL: 1S135DB -04700
SUBDIVISION: DOGWOOD RIDGE ZONING: R -4.5
BLOCK: LOT: 007 JURISDICTION: TIG
REMARKS: Convert carport to garage
BUILDING
REISSUE: YES STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: 12 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 418 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: DWELLING UNITS: FINBSMENT: sf RIGHT: 5
VALUE: $ 8,000.00
OCCUPANCY GRP: BDRM: BATH: TOTAL: 0.00 sf REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 • 200 amp: 0 • 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 • 1000 amp: 601 +amps•1000v: MINOR LABEL:
1000+ amp /volt
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: . NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 187.48 .
WES GAVETT OWNER This permit is subject to the regulations contained in the
Tigard Municipal Code, State of OR. Specialty Codes and
11435 SW 92ND AVE all other applicable laws. All work will be done in
TIGARD, OR 97223 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg #: forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Rain drain Insp glialaila
Footing /Foundation Dn Electrical Final
Electrical Service Building Final
Electrical Rough In
Framing In e
Issued - i e4 �v . ,t Permittee Signature : G
y U�� ' '!°c'� g
Call (5 639 -4175 by 7:00 p.m. for an inspection needed the next b mess day
Building Permit Ap
‘1' 0.- cation
\ Da r eceived:3l - p_. ( h i Permit'd9!'I oi. �
10"
.4, .411 City of Tigard 0 X0® Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd Tig . d 97223 q
Phone: (503) 639 -4171 D �����Q0�- . Date issued: By: Receipt no.:
Fax: (503) 598 -1960 M �U� \� Case file no.: Payment type:
Land use approval: f\'� 1 &2 family: Simple Complex:
TYPE OF PERMIT
e :<1 . & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
, ddition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: 1 1 51.E q 2 ND AV Bldg. no.: Suite no.:
Lot: 00 Block: Subdivision: Do wood ' ►'. ' e.. Tax map /tax lot/account no.:
Project name:
• Description and location of work on premises/special conditions: Co V1 1: e Cat/ pc, v4 - 4 - o se vase .
A of o1 -I- e
- e e c. -l-ir 1 Cct GI rC u i I-S
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: I\ e. rY a 1„d W cS (_ J e-. l.-1 (Flood plain, septic capacity, solar, etc.)
Mailing address: 1 3 5 51.._, 92ND AN 1& 2 family dwelling:
0 e
State:0 ►a_ ZIP: 9 23 Valuation of work $ i l 000 —
Phone: -`�03 7 . 24 -71 , 4, Fax: E -mail: WGo ve.. .a ,co No. of bedrooms/baths
Owners representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.) CM Il / fs
Name: K. t? y r r? W e i 2.14 Covered porch area (sq. ft.)
Mailing address: C. vn e_ 0-J olj ve__ • Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industriallmulti- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
Business name: . 0 to / ,je,
New bldg. area (sq. ft.)
Address:
City: State: ZIP: Number of stories
Type of construction
Phone: Fax: E -mail: •
Occupancy group(s): Existing:
CCB no.: New:
City /metro lic. no.: • Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
CAD NIn7 provisions of ORS 701 and may be required to be licensed in the
Name:
Address: 9 5 (DS w ( 9 -Pk jurisdiction where work is, being performed. If the applicant is
City: o r -1 I a State: OR (L ZIP: 9'1 • 'Z 3 exempt from licensing, the following reason applies:
Contact person: Plan no.: 0 �
Phone: Fax: E -mail:
ENGINEER
Name: C ."`""''"' 5 gsso �I, es Contact person: Fees due upon application $
Address: 30- s I-{., 44-1_ PI oolZ Date received: .
City: ' b I-1 c t. o1 State: 0 2 ZIP: 91223 Amount received $
Phone: t6o3 22S• -3841& Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied with, whether specified herein or not. Credit card number:. Expires /
Authorized signature: .-12,...4...n �iJCr U e-it Date: 3 '� 0 I Name of cardholder as shown on credit card
Print name: K�r lc/ G v2'H $
C ardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00/COM)
One- and Two - Family Dwelling
•
4 . , 11 �.,
Building Permit Application Checklist Reference no.: .
Associated permits:
City of Tigard City f Ti and
ty b ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
1
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.
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 Oregon and shall be shown to be applicable to the project 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) ketseach aie required for Items 16, 19, 20 & 22 above.
25 Buildirig,plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted. _
27
28 .
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6/00/COM)
. 1J
Permit #: M o 1-I1 6d /O
• F ��
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� . � � Address: •
s by: ■ _ .t�I�' Date: g /(0
�
Issue
�85
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:
IJ 1. I own, reside in, or will reside in the completed structure.
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
I I (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
�( 3B. I will be my own general contractor.
�� VV 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.
`e.e■(.< g/62 /
(Signat re of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
ErMormaUon MoVce o Prroperty Owneve
Censt nosponsilbMes
Note: This information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are :noting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problerni by being aware of the following responsibilities and areas of concern.
EMPLOYER H23PON',49EIUTilES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement or a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon's wi okiog tax !Ioniyz As an employer, you must withhold income taxes •frorriemployee wages at the 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. of Revenue at 945-8091.
Unemplayrient. insurance "na7.: As on employer, you are required to pay a tax 'for unemployment insurance purposes on the
wages of all employees. For inure information, call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
Wayike Trs' corngwisation imsocznee As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers conipensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and Wi he liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Cc:inapens.ntion. Division at the Deprrtment of Consumer and Business Services at 945-7888.
U.S. Thfnlerniail SCI:6;c : As Otemployer, yon must withhold federal income tax from employees' wages. You will be
liable for the tax pay:nent even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at I-800-829-1040.
CD7Y.nn RESPONSOUTES NO AREAS OF CONCERH°.
Code cornpiiiance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
LiaMity and prmIrty damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for .
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own .prn4
.1/94
CITY OF TIGARD 24 - Hour
BUILDING ;■ Inspection Line: (503) 639 -4175 MST d D--
INSPECTION DIVISION Business Line: (503) 639 -4171
_ BUP
Received Date Requested 1- / AM PM BUP
Location // L 13 3 / 7 ,2 '17d 4-i- Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) /l SWR
BUILDING Tenan /5 i� a 44--- g'v ELC
Footing ELC
Foundation Access: /� / M �-
Ftg Drain V 0 1 06 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors �' J� - -- - -_ _. • _
Ext Sheath/Shear F - - - 2 /�-'� � �" T' �/ .3��°� <• R 1
Int Sheath/Shear
Framing
Insulation 6 t a ^ `
Drywall Nailing VROV-1-01(
NO
Firewall
Fire Sprinkler
Fire Alarm t Pl e P (4N Et---
Susp'd Ceiling
Roof
,, Otr :
Other:
'ASS PART FAIL 1) PLO1GIBING ' \ I 1\)0R... LA •;' --
Post & Beam
Under Slab --- Rough -In * 5 ‘ ,(A c
Water Service
Sanitary Sewer
Rain Drains
Basin / Catch ei4� tZzo�,
tc WI��N�,
Storm Drain Q
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
J Fire Alarm
A S PART FAIL Reinspection fee of $ required before next inspection: Pay at City Hall, 13125 SW Hall Blvd.
SITE ' : Ei Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
A D
Approach /Sidewalk Date / Inspector Ext
Other:,
Final DO N T REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST n e 5e) C�
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 2 -2"'C--
S AM PM BUP
Location l / if 3 / md Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ! 1 02./Li- 6 q - 7 (J ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing •
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling 6.//
Roof
Other:
Final
P _ • FAIL
PL MB
• -am
Under Slab
Rough -In
Water Service
Sanitary Sewer it
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
ter .PART FAIL
M - ANICAL
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
Approach/Sidewalk Date i = pector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL