Permit pr CITY OF TIGARD p R® BUILDING PERMIT
V H PERMIT #: BUP2007 -00330
COMMUNITY DEVELOPMENT DATE ISSUED: 7/6/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 109DA -11600
SITE ADDRESS: 12989 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 105 JURISDICTION: TIG
PROJECT: WIZNEROWICZ
Project Description: Addition of storage loft in garage.
REISSUE: oil— FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: AE:T FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: 144 sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 144 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
GARAGE: sf OCCU SEP. RATED:
STOR: HT: ft
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: $ 3,499.00
Owner: Contractor:
CHERYL WIZNEROWICZ LOSLI FENCE & DECK INC
12989 SW BLACK WALNUT ST 547 SE 73RD
TIGARD, OR 97224 HILLSBORO, OR 97124
Phone: 503 - 598 -0958 Contact #: PRI 503 - 250 -3452
Reg #: LIC 171559
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUPPLN] Pln Rv 6/20/2007 $40.63
[BUILD] Permit Fee 7/6/2007 $81.70
[TAX] 8% State Surcha 7/6/2007 $6.54
[ BUPPLN] Addl Pln Rv 7/6/2007 $12.48
Total $141.35
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 .tility- Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy
of t se rules or d rd ectTes ons_to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu d By: K_ (e/ !I Permittee Signature: 1� 4 . __ `
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 project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application REC Efl J EI FOR OFFICE USE 0N"L1'
CH of Ta and Reserved Per mit No.: : /
tY g JUN 2 0 2 Date/B : i w SL-A) „ Zoo — to ,n
1,
q 13125 SW Hall Blvd., Tigard, OR 97223
-
Phone: 503.639.4171 Fax: 503.598.196(D ITY of TIGARD DatePlan BRevy: iew 2 .9. cn �Q) Other Permit:
T i GA R D Inspection Line: 503.639.4175 BUILDING D nS@r�1 Date ReadyBy: funs: ei See Attached Checklist for
ww
Internet: w.tigard- or.gov iY Vlt7 N otifiedlMethod: "11 Supplemental Information
TYPE OF WORK ,-,, REQUI RED .DATA:r1- AND�2=FAMILYaDWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
. I4 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
- - , ; CATEGORY; OF CONSTRUC FION� ` - ' -5, work indicated on this application. � �{ C7
; e Valuation: $ I5 "
g1- and 2- family dwelling ❑ Commercial/industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder gl Other: -al N, Total number of floors: p L 1- Number of bathrooms:
IOB SITE N7OND LOCAT O
vim. , �i� _�k „_, �, ^�s ._ -. � IEORMATIN ,;. a aA .-. .. ..w ...a, i _ .. i
Job site address: 1 z ci Rci S tit/ (2 (lC k ok i u -(- 3+ New dwelling area: square feet
City/State/ZIP: fl f � r 1 O, q 7 2217 Garage/carport area: square feet
Suite/bldgiapt. no.: Project name: . l Ent- p t i ct Covered porch area: square feet
Cross street/directions to job site: , g m a k s tti I Min • I e ' J - Deck area: square feet
on Graf- 1' -Ac1d, r1C of Sif'n l - Rid e S�, l eFt- on Other structure area: i1/ sgaeet t• /4
Oak Vu ( Ie� T rrct' /11 e ; r lC 1, O h 610, V IA.t I 1. ±- S+ : RE „GOMME RCIAL-U
Subdivision: `�u 1')'1 ni I`1- K 1(1,3 Lot no.: I Permit fees* are based on te 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
il
DESCRIPTION ,OF• WORD°^ , :: y ,,, : . , , x , - work indicated on this application.
3 r q above__ .sh area. Valuation: $
"�D Q J I Cf� i n C C1 rGlg . � <>` 1
�J J Existing building area: square feet
New building area: square feet
_ PROPER ,O I ❑ TENANT - . Number of stories:
Name: C e r I ..,c 1 I i z v crow 1C- 7 Type of construction:
Address: I q 9 ` s w ra c MI
Yl txI - 51-- . Occupancy groups:
City/State/ZIP: — 1 — 1 q r- (/ 1011 9 7 22 ii Existing:
Phone: ( 503 5 r t _()q -g Fax: ( ) New:
' APPLICANT r . . ' ❑ CONTACT `PERSON' - - .
NO
Business name: All contractors and subcontractors are required to be
Contact name: ex- I 9 , n u3 ', c 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: k • Cs
Phone: ( ) l Fax: : ( ) 53 ■ \
E -mail:
CONTRACTOR
Business name: il; if -- BUIL
LOS I i Fenc Dec�.k I nc . DING PE
�� - ''` ” (Please ieferf jee schedule ' � =,
Address: rd
City/State/ZIP: H 012 9,124 Structural plan review fee (or deposit): yo t 3
( FLS plan review fee (if applicable):
Phone: (50' 1
3 250 -3 152 Fax: ( )
CCB lic.: 17 1 557 Total fees due upon application:
Amount received: �/� , 6,3
Authorized signature: 1,04,0 L iti This permit application expires if a permit is not obtained
` within 180 days after it has been accepted as complete.
Print name: �
Cl1 e ry / n e r n w i r, z Date: 6/1 9 /26z1-7 Fee methodology set by Tri-County Building Industry
Service Board.
7-''s- - ' CITY_OF TIGARD .
BUILDING DIVISION PERMIT #: BUP2007- 00330
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2007
Phone: (503) 639 -4171 j
Inspection Requests (24 Hrs.): (503) 639 -4175 `, J' � ..
INSPECTION WORKSHEET FOR DATE: 8/23/2007 TIME: 7:00Alvi PAGE: 41
SITE ADDRESS: 12989 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 105 TYPE OF USE:
PROJECT NAME: WIZNEROWICZ
DESCRIPTION: Addition of storage loft in garage.
OWNER: WIZNEROWICZ, CHERYL PHONE #: 503.598 -0958
CONTRACTOR: LOSLI FENCE & DECK INC PHONE #: 503 -250 -3452
Inspection Request Scheduled For: Date: 8/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
290 Final inspection 054513 -01 503- 588 -0958 N
Corrections /Comments /Instructions:
l ' ASS ❑ PARTIAL APPROVAL n CANCEL NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date:g Phone #: (503) 718- -alep---
CITY -OF TIGARD
A
BUILDING PERMIT #: BUP2007- 00330
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 716/2007
Phone: (503) 639-4171 ti
Inspection Requests (24 Hrs.): (503) 639 -4175 �' <f �l
INSPECTION WORKSHEET FOR DATE: 8/17/2007 TIME: 7:01AM PAGE: 61
SITE ADDRESS: 12989 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 105 TYPE OF USE:
PROJECT NAME: WIZNEROWCZ
DESCRIPTION: Addition of storage loft in garage.
OWNER: W1ZNEROWCZ, CHERYL PHONE #: 503 -598 -0958
CONTRACTOR: LOSLI FENCE & DECK INC PHONE #: 503.250 -:452
Inspection Request Scheduled For: Date: 8/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 054188.01 503 - 598.0958 N
Corrections /Comments /Instructions:
q e . ...) ./",±71e-o-i- 4 e"diezq./ . -- jr:-:-. .,rtiepte ..Al--
•
❑ PA Li PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector:. Date: 9- 2 — c� 7 Phone #: (503) 718- r-c-C
CITY- OF TIGARD
BUILDING bIVISION PERMIT #: BUP2007 -00°30
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/612007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 c'
INSPECTION WORKSHEET FOR DATE: 8/5/2007 TIME: 7:00AM PAGE: 19
SITE ADDRESS: 12989 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 105 TYPE OF USE:
PROJECT NAME: WIZNEROWICZ
DESCRIPTION: Addition of storage loft in garage.
OWNER: WIZNEROWICZ, CHERYL PHONE #: 503-598-0958
CONTRACTOR: LOSLI FENCE & DECK INC PHONE #: 503- 250 -3452
Inspection Request Scheduled For: Date: 8/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
276 Framing 053703-01 503-250-3152 N
Corrections/Comments/Instructions:
A/
•
A SS S n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
n FAIL n C F' ' I ,4•11 ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date.' l Phone #: (503) 7 _2/C