Permit •
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CITY TIGARD PERMIT #: BUP2004 -00467
.-' SW ll& DEVEL R V ACES 639 -4171 DATE ISSUED: 9/30/2004
SITE ADDRESS: 075 SW BEVE- „L-T- -� PARCEL: 2S101AB -02100
SUBDIVISION: ,BEVELAND — ,4 4/ �' �,, / ZONING: MUE
BLOCK: 7 i! S",� �- 4 � �”" L T: 003 JURISDICTION: TIG
REISS FL OOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM 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:
Remarks: Demo existing 1200 sq ft house, sewer is to be capped. SDC credits to apply to new construction.
Owner: Contractor:
ZIMMLER DEVELOPMENT CAMROCK EXCAVATION
14915 SW 72ND AVE SUITE 200 PO BOX 1228
TIGARD, OR 97223 BORING, OR 97009
Phone: 5003 - 598 -3440
Phone: 503 - 665 -0560
Reg #: LIC 141879
FEES REQUIRED INSPECTIONS
Description Date Amount Ersn Cntrl 681 -4444
[BUILD] Permit Fee 9/30/2004 $62.50 Cap Sewer Line Insp
[TAX] 8% State Surchaq 9/30/2004 $5.00 Final Inspection
[ERPRMT] Erosion 9/30/2004 $26.00
[ERPLN] Ero Plck -CWS . 9/30/2004 $8.45
(additional fees not listed here)
Total $110.40
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 3) 246-6.'9 or 1- 800 - 332 -2344.
Issu d By: ,t im '. --I - Cad - — 441 ( - - - V - 4 - - -(____'
Permittee
Signature: �� - _:;�� %�
/ r
Cali 6 9-4175 by 7 p.m. for an inspection the next business day
I
Building Permit Application FOR OFFICE USE ONLY
Received
9 City of Tigard DaDate/By: % Q Permit No JA,oS� o 4 .4
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / Ak o,1,4x Date/B Other Permit.
Line: 503.639.4175 1 � Date Ready/By: Q See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: En Supplemental Information
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❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
s ,;'.'.r'-k�. `,`$�' •z : ° °:�:'^'.`%z`a.- �k�>4s F:! ".ic ;".", ;» *- �; -r; a:
f work indicated on this application.
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-4,41-P.!. = , ^ �sq'e, �C.i'. : " ; tea '-.:- ,1 rzh.. x s _ :c...4,
Valuation: $
❑ 1 - and 2- family dwelling ❑ Commercial/industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
Mir wit i w. � ^^�.;...< �,., ,. .,,. ' .. Total number of floors:
° '" . JOB SITE I NFQ * TIO IV;te4N 1) `L O' ATI'O
';
Job site address: b-E. J L C.A- ,,,S7-. New dwelling area: square feet
City/State /ZIP: 7 / z 7 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
EAQU1R IIATAc CiOMMER JUJSE
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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
'
} 41411 k f`,�AESGRIPTIO O1V4'ORKl-, l 4 work indicated on this application.
/WO t, 5 E 1-----1-----",7 Y' d , 70l OI-) acto ER_ Valuation: $
Existing building area: square feet
New building area: square feet
' • �> �P'ROPERTY ®WNER i r = .- ^T gilt - 4 $ ° Number of stories:
/Name: 7 / ' 017)7 �1Z J O ? er n Type of construction:
(Address: /y 9 6 7y,� si, Occupancy groups:
,City/State /ZIP: 7) — 6 - 1 /9 i> L.9 , 7 0_z_ 3 Existing:
Phone: () 5 e Fax: ( )
New:
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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
City/State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
� xr �' a -ro ,°rz- ';�E*3 'Y� ,'r� d'* use ,a^ ' , W s
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daRtP,CTOR * a M
Business name: - e,, /`�Ot✓ » r7 , A.tt Agri *wovt'�� � �,
BLI G'� PERMFTAFF�E *° =tk�' ^
Address: �'' ���` s..:, a;. �: r,. �.:: ���_�.- �� ^� ` ...
Po S O.. /ZZ
Please refer to fee schedule.
City/State /ZIP: g / -( N 6.7 v■ 9 70 D Fees due upon application
Phone: (S ZS 6„6,s--- c: Fax: (so ? 6,6 v y,� �'(,— Amount received
CCB lic.: / 2 7 1 / 8 7
• Date received:
Authori signa .. // This permit application expires if a permit is not obtained
ig 4111
within 180 days after it has been accepted as complete.
Print name: 51L1a iJ Pei let-e/2., ; - Date: lf' . Q.. p `-1 * Fee methodology set by Tri -County Building Industry
Service Board. h ( , /4 C{
• iABuilding 12/03 440- 4613T(1l /02 /COM/WEB) .11
One- and Two - Family Dwelling .
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 Gi %� i ��t; I A 24- Hour Inspection Line: 503.639.4175 ...41, 411 ❑ Electrical 0 Plumbing 0 Mechanical
Internet: www.ci.tigard.or.us -'' ❑ Other:
THE FOLLOWING ITEMS. ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I 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 IN ❑ ❑
building codes. Lateral design details and connections must be incorporated ihto 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 ap to the .roject 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. ❑ ❑ ❑
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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( 5 ORVALL T. CADE JOB INVOICE
BYER'S SEPTIC TANK SERVICE, INC.
P.O. BOX 549 Wants 7: 30 - .8: AM
OREGON CITY, OREGON 97045 CUSTOMERS ORDER NO. DATE ORDERED
(503) 656 -3326 10 -21 -04
•
•
ORDER TAKEN BY DATE PROMISED 0 A.M.
BILL TO Grace 10 -22 0 P.M.
PHONE
ADDRESS
MECHANIC
Camrock Exc.
T t CITY
HE -�
1 �
\ ' A -P ' I ,� I JOB NAME AN SW Beveland St. / Tual. 0
L Vl/ !-� I � J.l R DAY WORK
DESCRIPTION OF W RK 0 CONTRACT
��� orb Scott 971 - 235 -1306 D EXTRA
�ctP Zoo4 - 00
74- I-�(o`�
jZ c - oa
OUANT• DESCRIPTION OF MATERIAL USED PRICE AMOUNT
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P P 9 -
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HOURS BOR AMOUNT
TOTAL
MECHANICS ® MATERIALS
HELPERS TOTAL
LABOR
j t
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
• SIGNATURE DATE COMPLETED
TOTAL
_ a.....c41-6
je-e_.- 7 1 7
-11 57 CiLL&J
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) •r 75
' INSPECTION DIVISION Business Line: (503 f ►. MST
BUP
Received Date Requested � 2
R AM / PM BUP • 0 0 1 (:) g6. 7
Location S . ' , 1 .. -_ _ __ ,/ Suite MEC
I llW
Contact Person Ph ( ) 76 a- 9,5=3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT ___3.27,2„.._e_ Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Li 7 ,� ,
/ 4. 4 jvv 1/4 : ,._\)___ -_ ,I '-‘-% 4: ... \/ Insulation � � j
Drywall Nailing �' ��
Firewall ,...,/\ \ if
�^ 9
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof a
Other: 4 / ! AI 0
carr PART , y. ! ► / J
PLUMBING ��� ./. !Ali A 4� A .1 J , L1 / ^ r
Post & Beam r r
Under Slab MAIIIIPMEMIL4 1 �1u//. L , iu . t r.
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 E Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line / �
ADA 10 2�
Approach/Sidewalk Date ( Inspector T Ext
Other:
Final DO NOT REM VE this inspection record from the job site.
PASS PART FAIL
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