Permit C ITY OF TIGARD SITE WORK PERMIT
#6111/ a DEVELOPMENT SERVICES PERMIT # : SIT2005 -00021
s W 13125 S Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED : 9/19/2005
PARCEL : 2S102BB -02600
SITE ADDRESS: 10100 SW MOLLY CT ZONING : R -4.5
SUBDIVISION: MOORE'S MEADOWS LOT: 007 JURISDICTION : TIG
Project Description: Retaining wall.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: SF GRADING ?: VALUE: 5,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
• ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
JODY BLAKELY Description Date Amount
10100 SW MOLLY CT [BUILD] Prmt Fee -Valu 9/19/2005 $91.30
TIGARD, OR 97223 [TAX] Valu 8% State Surcharg 9/19/2005 $7.30
[BUPPLN] Pln Rv -Valu 9/19/2005 $59.35
Phone: 503 - 209 -2207 Total $157.95
Contractor:
OWNER •
•
Phone:
REQUIRED ITEMS AND REPORTS
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. 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 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 copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: ; Permittee Signature:
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 Applica jp ENt:I' FOR OFFICE. USE ONLY
City of Tigard 1Ftv. eB — a Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 2: Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � E P 1 e ( 1 7 0� '' ; ; �� Other Permit:
�m7
Inspection Line: 503.639.4175 4.- J 'I Date Ready/By. ® See Attached Checldist for
Internet: www.ci.tigard.or.us FTIC71 ' " ' Notified/Method Supplemental Information
CITY NiSiO .
PING D
TYP F WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ 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: /E77 14 / / 4 ( ,L, equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ I OO 0
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ,Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
• Job site address: /o/a2 S,/ /..4044.,y C? New dwelling area: square feet
City /State/ZIP: -- 7 -- 25,42,..p pA 97 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: grATA. 4/ , Covered porch area: square feet
Cross street/directions to job site: 5 ) ( / e 4 / g „) t. JA(Ali/T Deck area: square feet
714UD .01,4050A-1 ST Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: /-iZ / - leAPO Lt) I Lot no.: 7 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.
leerA2N/j t �1 Valuation: $
�7 /V Existing building area: square feet
New building area: square feet
jgr PROPERTY OWNER I ❑ TENANT Number of stories:
Name: 701,1)d $I.AKELY Type of construction:
Address: i 0 j QO Std ma-L. L c.-/- Occupancy groups:
City / State/ZIP: AAv OR— c7 22-3 Existing:
Phone: (503) 7.0 - 27.07 Fax: 603) 5913 - a 390 New:
ig[ APPLICANT o ld CONTACT PERSON NOTICE
Business name: u/ All contractors and subcontractors are required to be
Contact name: "�pD+� gil� [�`, licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: f 0/ ) ) f) /fi(dj i, C jurisdiction in which work is being performed. If the
City /State/ZIP: /T4i7 0,e_ 87223 applicant is exempt from licensing, the following reasons
apply:
Phone: (Sff3 209 -1 - 7 I Fax: : (503) 5 - C-
E -mail: J ad/ bjA by a jJr tit CO AA.
CONTRACTOR
Business name: / BUILDING PERMIT FEES*
Address: Please refer to fee schedule.
• City /State/ZIP:
I Fees due upon application , 3-7,3"
9
Phone:( ) • Fax:( )
Amount received
CCB lic.:
Date received:
Authorized signature: C_.Z, This permit application expires if a permit is not obtained
L within 180 days after it has been accepted as complete.
T
Print name: `iQ'� cQY & AY-ELY • I D ate: 1/3/05 • Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Permits\BUP- PennitApp.doc 12/03 4404613 T(11/02/COM/WEB)
•
One- and Two - Family Dwelling
Building Permit Application Checklist I•olz OFFICE i Si.; ON1,1
City of Tigard Received
Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 ay.
Asso+
Phone: 503.639.4171 Fax: 503.598.1960 y . „ �ed permits:
24- Hour Inspection Line: 503.639.4175 1/e oi a
O Electrical O Plumbing O Mechanical
Internet: www.ci.tigard.or.us '� 0 Other.
I'I - I L FOLLO\VING ITEMS ARE REQUIRED FOR PLAN REVIEW W 1cs 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- 0 0 0
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local . and state 0 ❑ ❑
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 revie►gcannot 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 0 ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ 0
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- El ❑ ❑
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 0 ❑ ❑
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 o'ect under review.
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or I I" 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. ❑ ❑ 0
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 ❑ 0 ❑
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\BUP- RES- PermitApp.doc 2
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GA,f(/14 \ TY :, , , . RD - SITE PLAN REVIEW
r5Pc lLi BU ii ' P 0'1' 'O.: ( i -- OUP
T . PLANNING DIVISION:
•
Required Setbacks - 0 Ap. • - ❑ Not Approved
Side: _ Street Side: •
Front. . Garage: Rear:
Visual Clearance: fVk D Approved ❑ Not Approved
Maximum Building Heigh feet
S cale 1 - 20' C DVS Service Provider tter Required: ❑ Yes El
❑ Re ived
Lot 7 Moore's Meadows Subdivis'an G (Y 4 `gP Date: ' s
ENGINEERiN DEPARTMENT
10100 SW Molly Ct. Actual Slope: _% roved ❑ Not Approved
Site P . 4 pproved Not Approv d
B_ \ y - Date: L C2
Notes;
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: SIT2005 -00021
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2005
Phone: (503) 639 -4171 • :�� y9 It
Inspection Requests (24 Hrs.): (503) 639 -4175 - '` :_..
INSPECTION WORKSHEET FOR DATE: 10/26/2005 TIME: 7:07AM PAGE: 9
t,,i,¢L Av to 6 f -1-n1r
SITE ADDRESS: 10100 SW MOLLY CT CLASS OF WORK:
SUBDIVISION: MOORE'S MEADOWS LOT #: 007 TYPE OF USE:
PROJECT NAME: BLAKELY
DESCRIPTION: Retaining wall.
OWNER: BLAKELY, JODY PHONE #: 503 - 209-2207
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/26/2005 Pour Time: 2:00
Code # Inspection Description Confirm # Contact #
205 Footing 019410 -01 503 - 209.2207 ? 4-CK
P47-1 o
Corrections/Comments/Instructions:
F07 6-1 $ S. t:941 k/4 -1 FoA , e7 1—i'v A-1( 1/4-1-CS
!n /�/ -7 ! . "" c L S Yc Lam./ l_ L., 77 - !rL/ /&/6/
IA/ - e C Cary! c Z 0-r Pca i Gib i C -6, i %Z V 4- _
G cit./61 i v VimiD
3 fE'c Si e A( -/V S P L 7 tZ '\1 - " J CL —( I I'
.?
t=om i/1 �.- �' - )■/ ��:I �� .
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
12 FAIL r CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 _ s Date: ! (2 . '2 .`7S Phone #: (503) 718 -
CITY. OF TIGARD .
BUILDING DIVISION' PERMIT #: SIT2005 -00021
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .._'
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 7:16AM PAGE: 14
SITE ADDRESS: 10100 SW MOLLY CT CLASS OF WORK:
SUBDIVISION: MOORE'S MEADOWS LOT #: 007 TYPE OF USE:
PROJECT NAME: BLAKELY
DESCRIPTION: Retaining wall.
OWNER: BLAKELY, JODY PHONE #: 503- 209 -2207
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/27/2005 Pour Time: 2:00
Code # Inspection Description Confirm # Contact # Message
205 Footing 019540 -01 503- 209.2207 N
Corrections /Comments /Instructions:
PASS ,ARTIAL APPROVAL El CANCEL 111 NO ACCESS
FAIL I/ ,LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . — AMP Date: / v, � �' Phone #: (503) 718 -
III
CITY OF.TIGARD _
BUILDIN DI PERMIT #: SIT2005 -00021
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9
Phone: (503) 639 -4171 4*v II�
Inspection Requests (24 Hrs.): (503) 639 -4175 _ A .! I..
INSPECTION WORKSHEET FOR DATE: 12/6/2005 TIME: 7:02AM PAGE: 15
SITE ADDRESS: 10100 SW MOLLY CT CLASS OF WORK:
SUBDIVISION: MOORE'S MEADOWS LOT #: 007 TYPE OF USE:
PROJECT NAME: BLAKELY
DESCRIPTION: Retaining wall.
OWNER: BLAKELY, JODY PHONE #: 503 - 209-2207
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12 / 6 /2 0 0 5 Pour Time: 2:00
Code # Inspection Description Confirm # Contact # Message
210 Foundation walls 023011 -01 503 - 209-2207 N
Corrections /Comments /Instructions:
titiwirwtiri'Av
2 A∎.
v _ ,..._
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FE S ASSESSED
Inspector: Date: . / ei :'hone #: (503) 718-
CITY OF. TIGARD , . -- -
BUILDING DIVISION PERMIT #: SIT2005r00021
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/200ft
Phone: (503) 639 -4171 " +�h ;7l�l
Inspection Requests (24 Hrs.): (503) 639 -4175 F :_..
INSPECTION WORKSHEET FOR DATE: 5/17/2006 TIME: 7:06AM PAGE: 3
SITE ADDRESS: 10100 SW MOLLY CT CLASS OF WORK:
SUBDIVISION: MOORE'S MEADOWS LOT #: 007 TYPE OF USE:
PROJECT NAME: F31.AKELY
DESCRIPTION: Retaining wall.
OWNER: BLAKELY, JODY PHONE #: 503209 -2207
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/17 /2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
21.5 rooting drain 030052 -01 503109.2207 Y
Corrections/Comments/Instructions:
j
`. ) CEO • ‘A iF - Tr/rod mi 471oiv ♦ F /n,....,. c�".� —re -mil ..., �.�►i.-.c
❑ PASS ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL, FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 5=/7- - Phone #: (503) 718- 2
CITY OF TIGARD -1-0 MoltI
BUILDING DIVISION - PERMIT #: `,$11-200:5-00021 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: �i /19 /200.''i
Phone: (503) 639 -4171 u 11
Inspection Requests (24 Hrs.): (503) 639 -4175 W "'III
INSPECTION WORKSHEET FOR DATE: 51/0/2006 TIME: 7:01AM PAGE: 4
SITE ADDRESS: 10100 SW MOLLY CT CLASS OF WORK:
SUBDIVISION: MOORE'S MEADOWS LOT :. 007 TYPE OF USE:
PROJECT NAME: C31..AKELY
DESCRIPTION: Retaining wall.
OWNER: E1'I_AKELY, JODY PHONE #: 603 -209 2207
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/10/2006 Pour Time:
Code # IPspect o Desc ription Confirm # Contact # Message
215 ( Footing drain 03013701 6103 - 709 -2207 N
- - drain
WI 7•!x'7/ .
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CA LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /� %� Date: 6. /r/01 Phone #: (503) 718- 7
CITY- OF_,TIGARD
BUILDING DIVISION PERMIT #: SIT2005"00021
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2005
Phone: (503) 639 -4171 ��.., IC
Inspection Requests (24 Hrs.): (503) 639 -4175 -_..
INSPECTION WORKSHEET FOR DATE: 2/12/2007 TIME: 7:05AM PAGE: 6
SITE ADDRESS: 10100 SW MOLLY CT CLASS OF WORK:
SUBDIVISION: MOORE'S MEADOWS LOT #: 007 TYPE OF USE:
PROJECT NAME: BLAKELY
DESCRIPTION: Retaining wall.
OWNER: BLAKELY, JODY PHONE #: 503-209-2207
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 043283 -01 503-209-2207 Y
Corrections /Comments /Instructions:
1 A J .
e • V' 1
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ AD_DITI NAL F S ASSESSED
Inspector: s i r Date: Z t2L T 7Phone #: (503) 718 - c e