Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00326
- - . �� I DEVELOPMENT SERVICES DATE ISSUED: 7/11/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S136DD -05400
SITE ADDRESS: 06780 SW CLINTON ST ZONING: ?
. SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 013 JURISDICTION: TIG
Project Description: Demo 800 sq ft house, septic tank is to be removed. Possible SDC fees for future development.
REISSUE: FLOOR 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: : sf N: S: E: W:
OCCUPANCY GRP: 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:
Owner: Contractor:
PACIFIC NORTHWEST PROPERTIES DAN OBRIST EXCAVATION INC
JO BECKETT 6431 SE JENNE RD
9665 SW ALLEN RBLVD pS5TE 115 PORTLAND, OR 97236
R N F �hone RTO 5o3O626 9 35QQ
Phone: 503 - 667 -4042
FEES Reg #: LIC 105618
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 7/11/2005 $62.50 12Ob &Jr ) I--
[TAX] 8% State Surcharl 7/11/2005 $5.00 50 _ /98/-- 1/09
[ERPRMT] Erosion Cool 7/11/2005 $26.00
[ERPLN] Erosn Pln Rv ( 7/11/2005 $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 -01 -:: • through OAR 952 - 001 -0100. You may obtain a copy of these rul- :. • :ct questions to 0 1 C by
calli g 503 - 246 -.69 f 1 0- 332 -2344.
Issu = • By: _ Permittee Signature: A -••••,,," Xi
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 FOR OFFICE USE ONLY .
City of Tigard TN
Date/By: ) �4V Permit No.: / i I_/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
//
Phone: 1 AB D Other Permit:
Inspection Line: 503.639.4175 i Date Ready/By: P "' ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: & Supplemental Information
. . . TYPE OF WORK • . REQUIRED DATA: 1 -AND 2- FAMILY DWELLING
❑ New construction emolition 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
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1-- and 2- family dwelling ID m
Comercial /industrial Valuation: $
El Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
. JOB SITE INFORMATION AND LOCATION. Total number of floors:
• Job site address: tc; 7 ?e i S GL),,--74.v.-7 New dwelling area: square feet
City /State /ZIP: 7-7? 5 R ,-- t0'-"- Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: / .r/ e 01- ri y , Covered porch area: square feet
Cross street /directions to job site: 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.
,� c y
i &iy✓l f7 / /c!' 4-5 't-"l° Valuation: S
SP)O 7J Existing building area: square feet
New building area: square feet
. ' ' ' .'. 6•P'" .ROPERTY OWNER' ❑, TENANT - Number of stories:
Name: Type of construction: • L °.)
Address: Occupancy groups: j�
City /State /ZIP: Existing: *n �
Existin /�'
Phone: ( ) Fax:( ) New:
• - . ❑ APPLICANT ❑ CONTACT PERSON - NOTICE
• Business name: / 4 -e_ /( G Atro/A i e 4,74 7�. � � All contractors and subcontractors are required to be
Contact name: ��C• /`� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
4,./
Address: -,4 A_Li46.n /4( sr/L( sr / jurisdiction in which work is being performed. If the
Ei� applicant is exempt from licensing, the following reasons
City /State /ZIP:
e Cr 65 apply:
Phone: ( 52,3) ( g So tP Fax:: ( ) 7/-122 //
E -mail:
CONTRACTOR
Business name:
tL "h ', �}AC BUILDING PERMIT FEES*
Address: / , r ,/,,,, h Please refer to fee schedule.
City /State /ZIP: N! 74, r q / �✓- Fees due upon application
Phone: ( ) 667- / 54.51,,y9__ Fax: ( ) Gl 3 S G6
CCB lic.: / 5� Amount received
Date received:
Authorized signature: Y This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
" Print name: /l� mod Ll ,`(' � Date: * Fee methodology set by Tri- County Building Industry
Service Board.
I \ Building \Permits \BUP- PermitApp.doc 12/03 440 -4613T(I I /02/COM/WEB)
•
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
Date/By.
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 _41,11192.4111 '� ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.ci.tigard.or.us ❑ 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
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 Ore •on and shall be shown to be . • .licable to the •ro'ect 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.
1:u Building \ Perm its \BUP- RES- PermitApp.doc 2
...,- V
"fi
t'. CITY OF TIGARD
ti Approved .
�
, Conditionally Approved - ,,,, [ is
a For only the work d scribed In;
el P 140 41 A60 - — 003 ?l
Seeletter to: Follow -,...[ ]:
\ 7
t Attach ' [ ];
�o ess - 7ga
B y Date:,
i
I
,07/28/2005 16:25 5036673566 DAN OBRIST EXCAV PAGE 02
• 4 07/2a/2005 12:43 50328836E PAGE 01/01
Date 07126/06
Scheduled 07128/05
work Order # teO28690
River City Environmental, Inc. Complete industrial
P.O. Box 30097 ' 5O3- 252 -6144 waste Removal
Parkland, Oregoi] pR CCB# 147355 WA CCB# RIVERCE981BT Septic Tank Cleaning
97294 Sump Line Cleaing
an Ohrist Excavation Site information
6431 SE Jenne Rd
Portland, OR 97236
6780 SW Clinton, Tigard
503 - 793 -351
Description Units
Pump To Fill Septic) /, 0 at 2.50. (:3
Instructions: Driver Notes
Vacant Demolition
503 -938 -1723 call when you have a tiime of arrival
River City Environmental, Inc. is in no way responsible for damage to ttis septic tank or Oda on the system.
Terms: Net 10 days. 1.6% par month will be charged on pest due accounts. (48% per annum).
Terms and Conditions The Right to Lien
The customer agrees to pay all Invoices arising out of pumping services, and any other special services herein within 10 days.
The customer agrees to pay such extra and overtime charges as may be Invoiced from time to time for services rendered, over and above the
normal servicing schedule, on behaif of to customer.
The customer agrees to assume responsibility damage to Customer's real or personal property arising from pumping services which take place
on customer's premises, where the drivers and vehicles of River City Environmental have been instructed to enter.
This includes, but is not limited to driveways, trees, power lines or poles and building structures.
If River City Environmental, Inc. Ends It necessary to add liquid to the tank on iobslte, customer will be charged for the additional gallonage resulting
from these condidtions.
Customer agrees to reimburse fiver City Environmental, Inc, for all reasonable attorney's fees court costs and other expense incurred by said
company to enforce collection or to serve their rights under this agreement,
Customer abrees lo the above conditions. !Redeemable in Multnomah County
Work Authorized by Date , �y ! /
Driver Signature Date / /C2(4
Time
"pi 4'; A1111111111
CITY ,OF TIGARD
BUILDING DIVISION PERMIT #: BUP200S -00326
13125 SW Hall Blvd., Tigard, OR 97223' DATE ISSUED: 7/11/2005
Phone: (503) 639 -4171
*Ilifyiti?\
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 7/29/2005 TIME: 7:07AIvt PAGE: 105
SITE ADDRESS: 06700 SW CLINTON ST CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 013 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Demo 800 sq ft house, septic tank is to be removed. Possible SDC fees for future development.
OWNER: PACIFIC NORTHWEST PROPERTIES, PHONE #: 503 - 626-3500
CONTRACTOR: DAN OBRIST EXCAVATION INC PHONE #: 503.667 -4042
Inspection Request Scheduled For: Date: 7/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 012393 -02 503-936-1723 N
Corrections /Comments /Instructions:
;
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ! CAL FOR INSPECTION ❑ ADDITIO AL F ' S ASSESSED
hit J✓
Inspector: l
Ins Da te: "`� Phone #: 503
p iv ' � ) 718 -