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Permit w } CITY OF TIGARD BUILDING PERMIT PERMIT #: BUP2005 -00313 � ; DEVELOPMENT SERVICES D ATE ISSUED: 6/30/2005 ..� I- ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103BB -08500 SITE ADDRESS: 12425 SW 122ND AVE ZONING: R -4.5 SUBDIVISION: LAKE TERRACE LOT: 012 JURISDICTION: TIG Project Description: New header for picture window. REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT 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: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 2,000.00 Owner: Contractor: YOUNG, JOHN G VIRGINIA F OWNER 12425 SW 122ND AV TIGARD, OR 97223 Phone: 503 - 590 -1988 Phone: 503 - 475 -3180 FEES Reg #: Description Date Amount REQUIRED ITEMS AND REPORTS [BUILD] Permit Fee 6/30/2005 $62.50 [BUPPLN] Pln Rv 6/30/2005 $40.63 [TAX] 8% State Surcharl 6/30/2005 $5.00 Total $108.13 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: lI Permittee Signature: _ � _ �� / /` J Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the • oje . Approved plans are required on the job site at the time of each inspection. Building Permit Applicatio E D 1OR Oi t 1(I 1 �I ( YI 1 Received - City of Tigard � Date/B - -ate -� Permit Na. —0 13125 SW Hall Blvd., Tigard, OR'9TL Plan Review Phone: 503.639.4171 Fax: 503.598.1960 T n 0 2005 D _ A. _ . • -- 65 — Other Permit: Inspection Line: 503.639.4175 S j i'� 3 .4 'i I„ Date Ready/By: ® See Attached CheckIist for Internet: www.ci.tigard.or.us TIGACA Notified/Method / Supplemental Information BYYP C;F WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. ` ,_f' 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. .1- and 2 -family dwelling ❑ Commercial /industrial Valuation: ......., `,; 0 0 . 0 o ❑ 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: 422 Ya Cap 1 m d New dwelling area: square feet City /State/ZIP: --1 / 9' W! Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: )1MG. Covered porch area: square feet Cross street /directions to job site: /.,„2,�, 6e)(1.1 J f Deck area: square feet 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.: 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. .e.P ) Lj C? // 0 1( (k/ 016 q Valuation: $ I q.pado S Existing building area: square feet New building area: square feet PROPERTY OWNER I ❑ TENANT Number of stories: Name 0 I / , h n / r ��� Type of construction: Address: / (f ..r/ E r /,,D., Occupancy groups: City /State /ZIP: 1 © gii p ( 0(......) 9 72.2 3 Existing: Phon).?) S — 7? 4 ■ Fax -C(A — ( ()3 9 New: 5 �( � C J ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City /State /ZIP: apply: Phone:( ) Fax::( ) E -mail: CONTRACTOR Business name: BUILDING PERMIT FEES* Address: • Please refer to fee schedule. City /State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lic.: Date received: / /� Authorized signature > p a . �1.� (lv ����l s ( This permit application expires if a permit is not obtained � within 180 days after it has been accepted as complete. Print name: V ` r6. /iv / nun , I Date / %O/ 6) * Fee methodology set by Tri- County Building Industry ((( l Service Board. i1Building ,Pernits\BUP- PernitApp.dce 12/03 440- 4613T(11 /02/COM/WEB) One- and Two - Family Dwelling Buildint Permit Application Checklist 1.0R 01 Fl( I. I SF ()NIA Ci}. of Ti and Received `J g Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Associated Phone: 503.639.4171 Fax: 503.598.1960 Assoiated permits: 24- Hour Inspection Line: 503.639.4175 ,Il ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us ❑ Other. 1 IIL FOLLOWW'I \(; ITL1iS .kRL REQUIRE]) FOR l'LA\ REvlL\V ' No "' 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: . ❑ El ❑ 5 Septic system permit or authorization for remodel. Existing system capacity El ❑ ❑ 6 Sewer permit. ❑ El ❑ 7 Water district approval. CI ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. - ❑ El ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ 0 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. 1 1 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- El El El 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 ❑ ❑ El 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 0 ❑ ❑ architect licensed in Ore on and shall be shown to be licable to the ro'ect under review. 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 Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. El ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ 0 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. 1:\ Building \ Permits \BUP- RES- PermitApp.doc 2 Permit #: U( oZO 5 O tS 3 ) 3 Address: 12.'1,Z5 �� L 1,2,2, Q.'L-- Issued by: Date: ti "3 Q 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: ''. 1:7‹ . , 1. I own, reside in, or will reside in the completed structure. r\' 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 W 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. /7 5---- ignature of pe pplicant) (Date) (W a e copy to issuing agency permit file, pink copy to applicant) ~-~ Information Notice to Property Owners About Construction Responsibilities Note: This InfOrmation Information Votic to Property Owners about (onxn'/ati/o �eax�oo/bd3�v was developed /x' the Construction Contractors Board i/ accordance with ORS 70lvjj(5,1 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 RESPONSIBILITIES: If you hire persons not registered 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 s ill he employees. As the employer, you must comply with the following: Oregon'swithholding tax law: Asnn employer, you must withhold income taxes from employee wages a1 the nmc are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more inforITlatioll. call the oregon Dept. of Revenue at 945-8091 Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more infhrrnatiou, call the Oregon Employment Department a1]78'35Z4. Workers' compensation insurance: As an employer, you are subject to the Orceon \orkers' Compensation Law, and must obtain workers' compensation insurance (or your employees. If you fail to obtain workers' compensation insurance, you may bcxuhirntiopcou|hrsonJwU|hc|iaWohoruUduimcostni[mneo[)ovrunp\uycosiai 'urcdon/bcjob.Purnoorcinfbnnotimo. call the Workers' Compensation Division at the Department Department ofConsumer 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 if you didn't actually withhold the tax. FormopciuKouuhon.uJ|rhe}u{e,na}Rcvcnue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: /\s the permit holder for this project, youuncrcsponsih|efbrrcso|riugunytui|unc1onocctcodcreqxinmanrx that may be brought to your attention through inspections. Liability and property 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 he re-done. Time to supervise employee : Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have theexpertise 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 (P() Box \4l40, Salem, ORV73OY'5052. 5O]/378'462|). The Board is located at 700 Summer St. NE Suite 300, in Salem. ymp'nx".pm CITY ... ... ............ ( ): .... oaf Approved . el 940iCk. cbel-"Th. Conditionally A oproved . 1 For only the wQ6( as dec ...... ............ • ' III iliiiiHsJob: _....tiAddreAilss-__A :1,.....___. 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