Permit 7
.-
l&I P� .403 -- D O
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REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ACS 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: 1 HT: 11 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: 40 psf LEFT: 5 ft RGHT: 5 ft FIR SPKL: SMOK DET:
DWELLING UNITS: 1 FRNT: 20 ft REAR: 15 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 4,950.00
Remarks: Structural renovation of existing 600 sq ft studio. Adding deck to rear of studio.
Owner: Contractor:
GABRIELA KANDZIORA GABRIEL SCOTT HOSTETLER
9360 SW EDGEWOOD PO BOX 526
TIGARD, OR 97223 CANBY, OR 97013
Phone: 503 - 639 -6097
Phone: 503 - 913 -2933
Reg #: LIC 143467
1 FEES REQUIRED INSPECTIONS
Description Date Amount Footing Insp
[BUPPLN] Pln Rv 11/20/03 $59.35 Underfloor Insulation Insp
BUILD Permit Fee 12/1/03 $148.90 Framing Insp
[BUILD] Insulation Insp
[TAX] 8% State Surchart 12/1/03 $11.91 Misc. Inspection
[BUPPLN] Addi Pin Rv 12/1/03 $37.44 Final Inspection
(additional fees not listed here)
Total $297.60
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: ----r/ I /e -__----'
Permittee C ���
Signature: J
Call 639 -4175 by 7 p.m. for an inspection the next business day
7 3 4 6 E Lci W4 - . 4 t 6 .
Building fermi ED Received , n
`/ Ow ' � � L. Building �y,/` a
Date /By: G 0- J.- / Permit No.: � �'>l/5/
Cit of Ti and NOV 2 0 2003 Planning Approval Other
y g Date/By: Permit No.:
13125 SW Hall Blvd. CITY OF TIGAR D Plan Review Other
Date /By: IO �` aJ Permit No.:
Tigard, Oregon 97223 I ( /'
-639 -4171 Fax: 5�3- $= 6 0 (VIS " ' NiM." I ' Po st- Review Land Use
Phone: 503
. .' I I Date/By: , 0 4 /03 Case No.
Internet: www.ci.tigard.or.us Contact,t UM Ju ® See Page 2 for
',�• Name/ Method: // //t 03
,., • '' � Supplemental Information
TYPE OF a RK . REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
❑ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $ 49 5
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: °, (,O 5w X66 W(.(1) $z Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: / evom, Kemorried Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.) / 1g_#
Other structure area (sq. ft.) /
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
geAkk ia1/4/ 76 0a l cv PT
L O1 . (‘- 11) 4 00 i 7 g fi d Valuation $
P�`D Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
❑ PROPERTY OWNER I ❑ TENANT Type of construction
Name: ( I5Ria,,4 KnvoZiaKA Occupancy group(s): Existing:
New:
Address: 03( 61/tJ IED6tLd
City /State /Zip: `T i ( 012 .972-Z3
Phone: 663 639 6097 Fax: NOTICE: All contractors and subcontractors are required to be
❑ APPLICANT ❑CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: Fax:
BUILDING PERMIT FEES*
E - mail: Please refer to fee schedule.
CONTRACTOR
Business Name: &A-sedge 14967gTt ell c»JST Fees due upon application S
Address: P6' 5z6
City /State /Zip: Ow:3y a< 7013 Amount received $
Phone: 53 113 293 3 Fax: 563 &f2 2273 Date received:
CCB Lic. #: 1 4 UI,b!o
Signature: Authorized Notice: This permit application expires If a permit is not obtained within
Signature: - � �� Date: / / /���G°�� 180 days after it has been accepted as complete.
C / L S r L L t *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
is \ Dsts \Permit Forms \BldgPermitApp.doc 01 /03
•
A One- and Two - Family Dwelling
A .�t,' Building Permit Application Checklist Reference no.:
City of Tigard C' of Tigard Associated permits:
`J b O Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
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.
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 O plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch asin protection, etc.
10 3 omplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
17 '' ng codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
s eet 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 applicable to the project under review.
JURISDICTIONAL SPECIFICS
f y Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
4 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (rvooicoM)
12/01/03 10:45 FAX 5038463525 CLEAN WATER SERVICES Iaj001
Nov 23 03 10:11p Gabe Hostetl _ ^ n 03 356 9333
D lIy u U P.
NOV 2 4 2003
_ F :Le Number 1 36/Q l
Clean \Mite S ervices By_ -- v I
Iv..::,,,�,: „i , kJ'. Area Pre -Screeriing Site Assessment
Jurisdiction _
Map & Tax Lot 1 y j d ADC O2ocz Owner Nrj z. - 4 .2603 S 1�ACt 4 i0240KA
Site Address
9 3(� S � (x or.t)57 _ -
Tr GHQ ( Contact ..15J t# rp — p.ts�
Proposed Activity KE F ieBfS,1I Address pa 6cAy 52_6
Bul LOlMM /WC 300 LtArt C.ri:1l/FY nie
9lnrs
Fo DEr.K. Phone 503 elf3 ..) 3
Official uSe only below this line
Y N NA Y N NA
• E D Sensitive Area Composite Map ��� Stormwater Infrastructure maps
Mai BSI t,�A QS ,f 4420
O Ei r Locally adopted studies or maps 0 0 �l Other
121 Ply Speify
Based on a review of the above information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. 03-11:
• Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER LETTER OR STORMWATER CONNECTION PERM If Sensitive Areas
exist on the site or within 200 feet on adjacent properties, a Natural Resources
Assessment Report may also be required.
IN Sensitive areas do not appear to exist on site or within 200' otf the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently discovered on your
property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REQUIRED. This FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
STORMWATER CONNECTION PERMIT.
f The proposed activity does not meet the definition of development NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIREDD.
Comments:
.ev: a :/e _ • .arrw; 4,6f J rro s'7iVe
Reviewed By: Date: � x / 3
— — — _ Retuned to Applicant
Post - it'° Fax Note 7671 Date nor Mail X Fax Courtier � /i�o3 �Paees� /
Dale 1:7A 6/03 Bye
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Co /Dept cm ^ A, )5
Phone x Phone #
503 - B /6 - 3 S j
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CITY OF TIGARD - ITE .LAN REVIEW
BUILDING PERMIT NO.: 'h iMMZT/M'
PLANNING DIVISION:
Required Setbacks: .,[Approved
Side: ❑ Not Approved
`� Street Side:
Front. e: Gara
Visual Clearance : � ' Rear: 15 Maximum Ba nce? 1 ❑ A roved ❑ Not Approved n r
b Height- feet .
CWS Service Provider Letter Required :
No
B ❑ Received
ING DEPARTMENT Date: (/ -44
Actual Slope: 3 % ti Approved
Site Ma 0 Not Approved
B L . ❑
Approved • t Ap p roved
Date: /l Z
Notes: 7 O 3
p aw cL
dick en Lties--
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/,L / BUP f ,■
Received /°I Date Re uested 3 /lv /(J �" AM PM BUP
Location 937() 2, ) Suite MEC
Contact Person / � �s'_ �i 'h ( S� 1/3' 2933 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
/Roof
SS PART FAIL
PLUMBING
Post & Beam
Under Slab
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
Anal I I 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 In spector a N 6 � Ext
Approach /Sidewalk Date 0 _0 �
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL