Permit V ` CITY O F TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00267
i k DEVELOPMENT SERVICES DATE ISSUED: 8/6/2004
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14925 SW 100TH AVE PARCEL: 2S11106 -02601
SUBDIVISION: MURDOCK HILL ZONING: R -3.5
BLOCK: LOT: 007 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: 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: 1 FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 18,000.00
Remarks: Installation of 16' x 36' in- ground vinyl -lined swimming pool.
Owner: Contractor:
WINSTON, MARK DAVID ROBERTS CONSTRUCTION
14925 SW 100TH AVE. 20593 S NURSERY LN
TIGARD, OR 97224 OREGON CITY, OR 97045
Phone: 503 - 624 -1633
Phone: 503 - 780 -6157
Reg #: LIC 19843
FEES REQUIRED INSPECTIONS
Description Date Amount Ersn Cntrl 681 -4444
[BUPPLN] Pln Rv 6/7/2004 $140.47 Footing lnsp
[FLS] FLS Pln Rv 6/7/2004 $86.44 Framing Insp
Final Inspection
[BUILD] Permit Fee 6/9/2004 $86.44
[BUILD] Permit Fee 8/6/2004 $129.66
(additional fees not listed here)
Total $456.76
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:
Permittee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
�
Building Permit Applicat ion IVED / FOR OFFICE USE ONLY
City of Tigard 1004 Date/By: d CO 0 `fe Permit No.% f „,y-00.24 7
13125 SW Hall Blvd., Tigard, OR 97223 J UN , ,
/ /Wa1r„ Plan Review
Phone: 503.639.4171 Fax: 503.598.1 :Will �� Date/B : Other Permit:
Inspection Line: 503.639.4175 Y O �IGAHD ■ y, •' I ` Date Ready/By: Juris 0 See Attached Checklist for
Internet: www.ci.tigard.or.us BUILDING DIVISI • Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING Q
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. O
Indicate the value (rounded to the nearest dollar) of all "-.....
❑ Addition/alteration/replacement Nr Other: <4.,,111,,1”. d , > I equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTIONS work indicated on this application. a „
Valuation: $ ' ,,� c� Fl
N. 1- and 2- family dwelling ❑ Commercial /industrial U C
❑ Accessory building ED Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ILIct Z r7"- .` New dwelling area: square feet I
City/State /ZIP: 1 1 (t4) (n ✓ C1-724 Garage /carport area: square feet i
Suite/bldg. /apt. no.: Project name: Covered porch area: square fegt •
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet Q
REQUIRED DATA COMMERCIAL -USE CHECKLIST 1
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all '�
Tax map /parcel no.: ( )
equipment, materials, labor, overhead, and the profit for the
x ' DESCRIPTION OF WORK , . a ' work indicated on this application. �1
16 )(Q ` —K itrC ao.1`0 ` J 1 N J I Ci ki (D3 1 ? Valua $
1 Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT .441,7..1 Number of stories:
Name: vviAt c A ?so Z S/4-4/v I10 1 V S r j Type of construction:
Address: ( L` [i r S S iii! I oo et 14-4 L, Occupancy groups:
City/State/ZIP: ,q- ` f cr t , q -1 g A Existing:
Phone: (3'S) to Z L . (( Fax: ( ) New:
> APPLICANT * , ❑ CONTACT PERSON ; ,.` ° , E I E
Business name: t*,� 0
-7� . N�
v i� i 0 j` e.4lii-� C 6" 4,, ap,,., (le_ All contractors and subcontractors are required to be
Contact name: w licensed with the Oregon Construction Contractors Board
M / -� under ORS 701 and may be required to be licensed in the
Address: 10S .. 1 v-
J 25E- (4 .J 1 jurisdiction in which work is being performed. If the
_ applicant is exempt from licensing, the following reasons
City/State /ZIP: - e zr� C,e 1-11 o f Ct-)0gS apply:
Phone: (s-as ) 6 (D)._ i Z t-i Fax:: ( )
E -mail:
CONTRACTOR
A,, '
Business name: ),A 1 7 c4 S (1 Zb�1 Coon DA LLC.
4 � 6 s =Bi)ILDIIVG PERMIT FEES*
Address: r OS93 5 , /esi -7 1.--/
Please refer to fee schedule.
City/State/ZIP: 0 /LEC,:� � � D2
/ 9 v� Fees due upon application
C . ien�e: (b ) - 1 FeD —Cot f —7 F ax: ( )
CCB lie.: ,Q Amount received
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: lu i i 0 � ' Date: * Fee methodology set by Tri- County Building Industry
Service Board. /!�/j V
i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11/02/COM/WEB) ?4, V'
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,r
A Building Division
G ��m ° "' N�hp�d�t�Iti • Plan Submittal Requirement Matrix
Commercial & Multi - Family - New, Additions or Alterations
City of Tigard
''•r`' iiiA €� Ia �S e ? ! 6 % i I 1 i d 1i� ' : � i,y
Demolition Permit 2
(site plan required showing location and square
• footage of all buildings to be demolished)
1 r
'' Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing (building fixtures) 2
M •
Electrical . 2
•
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue)
* For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i:\Building \Forms \COM- P1anSubReq.doc 12/24/03
CleanWater Services
Our commitment is clear.
RECEIVED
August 3, 2004 AUG 0 6 2004
CITY OF TIGARD
BUILDING DIVISION
David Roberts
20593 S Nursery Ln.
Oregon City, OR 97045 -9749
RE: In- ground pool located at 14925 SW 100 Ave., Tigard, OR
CWS file 4396 (Tax map 2S111 CB, Tax lot 02601)
Clean Water Services has received your Sensitive Area Certification for the
above referenced site. District staff has reviewed the submitted materials
including site conditions and the description of your project(see attached site
plan). Staff concurs that the above referenced project will not sigiificantly impact
the existing Sensitive Areas found near the site. In light of this result, this
document will serve as your Service Provider letter as requited by Resolution
and Order 04-9, Section 3.02.1, and your Stormwater Connection Permit
authorization from Clean Water Services as required by Ordinance 27, Section
4.B. All required permits and approvals must be obtained and completed under
applicable local, state, and federal law.
This letter does NOT elminate the need to protect Sensitive Areas if they are
subsequently identified on your site.
If you have any questions, plea feel free to call me at 503 -681 -3605.
Sincerely,
s �
Chuck Buckallew
Environmental Plan Review
Site plan attached
E: \Development Svcs \SP 00 -7 \Concurrence Letters\2S11 1CB02601 - no impact to water quality 04 -9.doc
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123
Phone: (503) 681 -3600 • Fax: (503) 681 -3603 • www.CleanWaterServices.org
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CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: aJoZpo y 40 ,26 7
PLANNING DIV!SON:
Required Setbacks: ❑ Approved ❑ Not Approved
Side: Street Side:
Front. Garage: Rear:
Visual ClearanceMr ❑ Approved ❑ Not Approved
Maximum Building Height• feet
CWS Service Provider Letter Required: El Yes ❑ No
/, ve
13 ): ��� �• l-� ❑ Recei
Date: 6 - 8 -0 '
ENGINEE ING DEPWMENT:
Actual SI s pe: 0 /o ,: Approved ❑ Not Approved
Site Pia' • l: Approved �] of pproved
B : j Date: 6 d
Notes:
to �( -enet c't 0 CL Crt
loOnta.k. 41.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
_Al
INSPECTION DIVISION Busin - s Li - : 03) 639 -4171 MST
BUP l
Received Date Requested . ' AM PM BUPv /g —Ce9/Z• Location Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
ALDINC) Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation / SGEBT ARV f5 Drywall Nailing vv
Firewall CO/
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Ot
la, PART FAIL
- I BING
Post & Beam /„
Under Slab
Rough -In
Water Service 74 1
Sanitary Sewer
Rain Drains
Catch Basin / Manhole /1141
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 El Reinspection fee of $ required befor: ext inspection. Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for r: spectio' RE: / 411 Unable to inspect — no access
Fire Supply Line
ADA
/L '
Approach /Sidewalk Date Ins ct
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL