Permit CITY OF ' TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00251
.J I DEVELOPMENT SERVICES DATE ISSUED: 5/28/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S1036C -02700
SITE ADDRESS: 12120 SW ALBERTA AVE
SUBDIVISION: CANOGA PARK ZONING: R -4.5
BLOCK: LOT: 001 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: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,000.00
Remarks: 8' fence and access gate.
Owner: Contractor:
BUCHHOLZ, KARL PAUL JR OWNER
CAROL LOU
12120 SW ALBERTA
TIAonRD e OR 97223
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Footing Insp
[BUILD] Permit Fee 5/28/2004 $62.50 Final Inspection
[TAX] 8% State Surchari 5/28/2004 $5.00
[BUPPLN] Pin Rv 5/28/2004 $40.63
[CDCPLN] CDC Pln Rey 5/28/2004 $40.00
Total $148.13
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- throAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 03) 246 -6699 1- 800 - 332 -2344.
Issu d By: / °
Permi n
Signature: /g
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application . FOR OFFICE USE ONLY
City of Tigard Received
Date/B : PT
/ leMIIMI Permit No.: ;MO ■ 0,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 .43,00 • Date/B : Other Permit:
Inspection Line: 503.639.4175 ,s 41 / 1, ei il Date Ready/By: El See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: WM Supplemental Information
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El New construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
. 0 Addition/alteration/replacement P Other: equipment, materials, labor, overhead, and the profit for the
. e4'.,•:°'''*sfqAyp'f,KM,BSIIWarraNF6r,t";Nein,i(' Mratganagl,M,=. 44 work indicated on this application.
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1- and 2-family dwelling 0 Commercial/industrial Valuation: CO
Number of bedrooms:
111 Accessory building El Multi-family
Number of bathrooms:
CI Master builder . I=1 Other:
qOIP.4111* lAtataritikkAgiroSagl. :KEriti. 4 1 0..-t , ..„ PP Total number of floors:
;#ir-;::. , .-.7..r. , &.N..ma•i.4` :4 - .-.2.7., ,_37....
Job site address: i2120 %...) AV()-e-Aci t‘ New dwelling area: square feet
City/State/ZIP: '—
1 , z; z1 .0A-e1 0 '2 cl 722 3 Garage/carport area: square feet
Suite/bldg./apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: • square feet
7'itiaadif371M
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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
11ixtgatiovifoilionvowouxutitntglaff work indicated on this application.
Valuation: $
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Existing building area: square feet
New building area: square feet
. 1.,7g,45 7 441-raltliTitatitirdrAfer,M4**■ AziamvxwoRititwAvir.=T4,.,404,7g Number of stories:
-teaa"....0•W„,„, ,,,,-.40,4.40*IA ?,:itlei,`:::e. :, :i'w.d .....;,...P.O: ..':
Name: il‘ii-e_ ni Ak\ko\ 7-- Type of construction:
Address: 17_ I 2_. 0 ....J -A\\Q-a-C\ c ok ('-k-- Occupancy groups:
City/State/ZIP: -- , o A ef 722. 3 Existing:
Phone: (1 ) S-2 I 7 6 C I Ea44,-(----)' New:
'P.
at3f rog,441.,
. .... . _ -....,,,...„1-:
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: , .4
tVIP
, t-igi,..*.altV. t.‘3.0 eitrAitt,F.
Business name:
z7
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Address:
Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.:
I 1
Date.received:
Authorized signature: .7LIMIIHIP 10111BAL... This permit application expires if a permit is not obtained
_ .
- , within 180 days after it has been accepted as complete.
.• .
Print name: / \i / . 4e_ 1 0 c. , N •-.. Date: * Fee methodology set by Tri-County Building Industry
Service Board.
i: BuildingTermits \ BUP-PermitApp.cloc 12/03 440-4613T(11/02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
Rece ived
City of Tigard Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 //s s:I 1,;+ °'l\
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: ww.ci.tigard.or.us W
w ❑ Other:
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
_ 6 6 '_ ht violations exist. .
11 " Site /pl • t plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
they" . 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 .roject under review.
JURISDICTIONAL SPECIFICS
r 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. ❑ ❑ ❑
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
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CITY OF TIGA D - SITE PLAN REVIEW / \
B IILDING PERMIT NO : " \ / \ /
P ANNING DIVISION: %■., \ / •
Re uired Setbacks: ` +I Approved ❑ Not Appr �„ f / /
C) Side: Stree /De: • N / \
O. Front. fare: Rear: Q. 0 N / N
O. ual Clearance: :; ,improved ❑ Not Appr a \ / \/
Qg1; ximum Building Heig tQ] feet • N /
C S Service Provider L =tter Required: ❑ Yes EN �/ N /
6 (- • -er- • i CIL B coo, S do tr 4 ❑ Received 7 / //\ 13 • . I . 4 ♦1 _.it. Date: 5 �v - f ,op
E GINEERI' G DEPAR MENT: 0 7, )`i
A•tua) Slope: _% • Approved ❑ Not Approved `
Si' Plan: • Approved ❑ Not Approved
By: Date:
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) : 39 -V.
INSPECTION DIVISION Business Line: (503) 639 -- 71 MST
Received Date Re e 1/ J I AM PM BUP
Location / a- I 3-6 Suite MEC
Contact Person Ph ( ) PLM
Contra Ph ( ) SWR
ILDI Tenant/Owner 101 - ELC
Footing 906 ( ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: n - 1 SIT
Post & Beam
.c'�Q�i2
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Sus•'. Ceiling
Ro lam-'
Oth- :
PART FAIL b d • - BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole .y
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 ❑ Please call for reinspection RE: ® Unable to inspect — no access
Fire Supply Line
ADA tq
Approach/Sidewalk Date I l /L Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL