Permit CITY OF TI GARD BUILDING PERMIT
PERMIT #: BUP2003 -00638
l DEVELOPMENT SERVICES DATE ISSUED: 5/21/2004
All 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 07565 SW HERMOSO WAY PARCEL: 2S101A6 01502
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 022 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: NR S: NR E: NR W: NR
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: N S: N E: N W: N
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: 2 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:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: 1
VALUE: $ 18,500.00
Remarks: Convert existing house into offices.Occupancy Change R -3 to B. No additional Parks SDC required as office will
have only two employees.
Owner: Contractor:
BERNT JACOBSEN EVERGREEN PACIFIC INC
4248 GALEWOOD ST 5664 CARMAN DR
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 -3358
Phone: 503 - 892 -9301
Phone: 636 -5165
Reg #: LIC 41521
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[BUPPLN] Phi Rv 11/3/2003 $146.71 Plumbing Permit Required
[FLS] FLS Pln Rv 11/3/2003 $90 28 Framing dsp
Gyp Board Insp
[BUILD] Permit Fee 7/31/2003 $225.70 Final Inspection
[TAX] 8% State Surchari 7/31/2003 $18.06
(additional fees not listed here)
Total $3,352.65
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 uspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the egon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 - 0100 ou may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 1- 800 - 332 -4 '.
Issued By: 4 1
Permittee 7,/, —
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
5"4t- $w 1/01170/01 Wfrit •
Building Permit Application FOR OFFICE USE ONLY f '
Received //nn Building
Date /By: 1,1
Received / ai Permit No.'t�U 1 9 — 0066
Cit of Ti and Planning Appro al Other
Y g Date /By: Permit No. iV r aC)C, - 6 7 0Y (:)
13 125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: /1 1 131./)3 Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 �1 Post - Review [and Use
.� I ( Date /By: Case No. 1,05;6009 Internet: www.ci.tigard.or.us Contact Raayat.2 Vita Juris. • ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: II/?443 -49 (/ Supplemental Information
r /2// e a t d 4
'",t : +�. y .. .�e�... . '- k^ � �i.s, ""1:.1..3 +' i "4. �.s ,; k^:. -s ',..1;4,1f7;,„1'
'` • .. TYPE OFNWORK:' . =i =-� ` . r /... 3. .e M
_ �-�.. �`� +� .,' � REQUIRED`DATA;'
El New construction ❑ Demolition t ' i "
ri 1 & 2`FAMIL-Y %DWELLING
' Addition/alteration/replacement ❑ Other: -
.' _,,..'... a : ,' :ICATEGORVCOF; CONSTRUCSTION' :'` :P Note: Permit fees* are based on the total value of the work performed. indicate
El & 2- Family dwelling jaCommercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this ap -. i n.
El Accessory Building ❑ Multi- Family
❑ Master Builder El Other: Valuation
'_*�, ' 1: s - JOB SITE( INFORMATION4n&LOCATION.,,.' ;` t`'` No. of bedrooms: 4 > No. of baths:
Job site address: - 7 per . .45311W6117( Total number of floors
J New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: \/4-7,, i.) 2.// a'---/- Covered porch area (sq. ft. j
Cross street/Directions to job site: Deck area (sq. ft.)
/ � Cr 4(4/ Other structure >e (sq. ) 0..1SS.-,
: ,, z, ,,,,,.� - .4:,;.; .;xREQU iDiDATA�; „ },_. , . ,
1 .
COMM USE CH ECKLIST ,
Subdivision: Lot #: °"
Tax map /parcel #:"2 /e9/ f-p —'l4vc Note: Permit fees* are based on the total value of the work perfo Indicate
,' :: ,, �' • ' r . ._ " :..;.r the value (rounded to the nearest dollar) of all equipment, material- -
:�f.._ : =, _�.: - ;'�DE$GRIPTL O N OF DWOR K�;':� --� �,. � .?���� • :or,
77 overhead and profit for the work indicated on this application.
/ )t Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.) 04
Number of stories Z
;- PROPERTY. OWN ER,. • 1 :' , ='.i ®`TENANT'sr .. ° . *- ',• , ... iv Type of construction VP
Name: r4 J -- dAte.t. 73 Occupancy group(s): Existing: 45
Address: New:
City/State/Zip: j1
Phone � � - g3j q ax: itt,4- • NOTICE: All contractors and subcontractors are required to be
�� licensed with the Oregon Construction Contractors Board under
`Q ICA:
P . NT - , c 'A❑. T CONTAC PERSON s''; provisions of ORS 701 and may be required to be licensed in the
Business Name://6 Oft:" jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 1j� /� ,rp f,�// from licensing, the following reason applies:
7-
Address: 9 4//t-e/,--C /74 7 -
City /State /Zi . y -'? )..--/
Phone{ O Fax : Q;9 ® . «, -- ,_ . "
E -mail: � °; MI
PER :;. ��' �f�`` ��;`��. >a - .:.., ,,, : ; ..-
a ;; °:,` °, , .h yI; lease 'refeirtorfee
, ,,
a . :CONTRACTOR k t, :.v.
Busin Name:t! Fees due upon application S
Address: f S� 2 � C i .
City /State /Zip ei / - f 7 Amount received $
Phone` � p Fa a. 6-57 Date received:
CCB Lic. #: - 2 _
Authorized
g i i i / / j / �. e: /
Signature: / O' Notice: This permit application expires if a permit is not obtained within
/ /� 180 days after it has been accepted as complete.
�
�j it i Al /) U *Fee methodology: set.by Tri- County Building Industry Service Board.
(Please print name) ��� ,/ r
i:\Dsts\Permit Forms \B1dgPermitApp.doc 01/03 O pJ l \ c t � � cbb / f /
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One- and Two - Family Dwelling
° ° Permit Application Checklist Building Permit Application Chkli Reference no.:
Associated permits:
City ofTigard Cl of Tigard `J � ❑ 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 0 plan 0 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 fooi,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
23 Five (5) site plans are required Item 11 above. Site plans must be 8 -1/2" I1" or 11" it 17 ".
24 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 (6 /00 /COM)
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busin:ss Line: (503) 639 -4171 MST
BUPA -00 635
Received 24te Requested �� ' 1 M PM BUP
ff nn
Location W uite MEC
Contact Person P- c5h ( ) PLM
Contractor Ph ( ) SWR
BUILDIN Tenant/Owner ELC
oomg
ELC
Foundation
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 ' I ' qp,
Othe • '
PART FAIL
g Ii!J
& 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
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call '• r reinsp- tion RE: El Unable to inspect — no access
Fire Supply Line
ADA l ' f / � ®� I / •
Approach /Sidewalk Date v Inspect° � � I∎ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILSING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171 - BUP D —C C ; '
Received Date Requested /d — / 3 AM PM BUP
Location 7.S Ca ,c---- 1 `�"" Suite -' re MEC
Contact Person . .�-t 1 0 Ph ( ) �� 9 l -' t 4 PLM
Contractor Ph ( ) ,, ( SWR
BUK6IN Tenant /Owner `�4 --e�I LA-? �� r.rOJ ELC
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT ����� 3 �
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation j�. �t / /� '&
Drywall Nailing U
Firewall th:519--
Fire Sprinkler
Fire Alarm ( c : . T j — �lj
Susp'd Ceiling �
Roof �US R ��v �
Other:
QV. 4-7-4 ► '4� RA( C, 1T` �(k�" ` f_� D , 'ASS PART
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan �•4 —'
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.
PART FAIL
Please call f r reinspection RE: Unable to inspect – no access
ire Supply Line * A
ADA �
P
Approach/Sidewalk Date /
V v Inspector 40�'f r ' Ext
Other
DO NOT REMOVE this inspection record from the job site.
11 :,:,. PART FAIL