Permit CITY O F T1 GA R D MASTER PERMIT
PERMIT #: MST2005 -00371
c 4 DEVELOPMENT SERVICES DATE ISSUED: 11/2/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 SI34CB -02100
SITE ADDRESS: 12175 SW SUMMER CREST DR ZONING: R - 4.5
SUBDIVISION: SUMMER HILLS PARK LOT: 018 JURISDICTION: TIG
Project Description: Replacement for permit 1982 #3983. This will be for final approval of "as built" addition.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF • FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: DWELLING UNITS: Mill sf RIGHT:
VALUE: 0
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: W00DSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVaFDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amp6- 1000x. MINOR LABEL:
1000+ amp/volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
HALLBERG, ROBERT E OWNER and all other applicable laws. All work will be done in
CATHERINE accordance with approved plans. This permit will expire
12175 SW SUMMERCREST DR if work is not started within 180 days of issuance, or if the
TIGARD, OR 97223 work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules
Phone: 503 - 349 - 1230 Phone: adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
952- 001 -0080. You may obtain copies of these rules or
Reg #: direct questions to OUNC by calling 503 -246 -6699 or
TOTAL FEES: $ 250.00 1 -800- 332 -2344.
• REQUIRED ITEMS AND REPORTS
,,/
Issued By : � L»� G 1 ■ Permittee Signature �I �/�+��...si /�
►—
Call 503-6394175 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.
•
•
• Buildine Permit Application + FOR OFFICE USE ONLY
City of Tigard
CC E® Received
Date/B (� n • Permit No.: • � r P'T , ° /I �� - ��
C V
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1M1 2 7 '� % i t.
p 200 ;E' I-. Date Ready/By.
Inspection Line: 503.639.4175 J —1 • _ ' _ � Date t ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method ? I Supplemental Information
CITY OF TIGARD
BUI j lINOWO5+EQN 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: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this applicatio
❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ /Ot
•
❑ 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: l2/ 7• 5',0 /r !,- >
, s v . (7re [� ()p New New dwelling area: square feet
• City /State /ZIP: / T, A Q r d D JeJed." p 9 7 A 7 Garage /carport area: square feet
Suite/bldg. /apt. no.: (' Project name: '\0t> Jeri Q dAe ?/ 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.
n . �I►
4- tiVlImo' i uw ..R..� X I v-� RI 3, pu al 85 . Valuation: $
Existing building area: square feet
New building area: • square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: p L 49' , r '�"' 4 N e. „ / 1/4 a z r .Q Type of construction:
Address: d, 81,49e /' � /
'V 5$ N. Piz (f1 4' P.O. / 3 7 Occupancy groups:
City/State/ZIP: ,v eta t y & 44f J 1 1 e. 9 7 / 3 Existing:
Phone: 605 31/ 9,.../ ( Fax 'o3 )5 ./q I New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: 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
applicant is exempt from licensing, the following reasons
City /State/ZIP: apply:
Phone:( ) I Fax::( )
E -mail:
CONTRACTOR
Business name: Oce_W EIL
BUILDING PERMIT FEES*
• Address:
Please refer to fee schedule.
City /State /ZIP: pp
Phone: ( ) Fax: Fees due upon application a5b•
( )
CCB lic.: Amount received
Date received:
Authorized signatur ='r �� � / / This permit application expires if a permit is not obtained
/ •
within 180 days after it has been accepted as complete.
Print name: 6 e . / fir E / Date: D ..., 7 .... 6 5- • Fee methodology set by Tri- County Building Industry
(� CJ �/ Service Board.
i:\ Building \PenniIa\BUP- PermiWpp.doc 12/03 440- 4613T(11 /07/COM/Wat)
One- and Two - Family Dwelling
: uildine Permit Application Checklist FOR OFFICE USE ONLY
•' of Tigard Received
g Date/By Permit No.:
13 5 SW Hall Blvd., Tigard, OR 97223
Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 /ia
24- Ho. r Inspection Line: 503.639.4175 I I ❑Electrical ❑Plum ng 0 Mechanical
Internet: www.ci.tigard.or.us ❑ Other.
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1'cs No N/A
1 Land u actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. ' ood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification if approved platflot. _ ❑ ❑ ❑
4 Fire district a : • royal required. Name of district: . ❑ El ❑
5 Septic system • - it or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district app • val. ❑ ❑ ❑
8 Soils report. Must . original applicable stamp and signature on file or with applicatio ❑ ❑ ❑
9 Erosion control ❑ plan • permit required. Include drainage -way protection, silt fence . esign and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible • fans. Must be drawn to scale, showing conformance to .pplicable local and state ❑ ❑ ❑
building codes. Lateral design s - tails and connections must be incorporated into the • ans or on a separate full -size
sheet attached to the plans with cr• s references between plan location and details. ' an review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The p1. ust show lot and building setback di nsions; property corner elevations (if ❑ ❑ ❑
there is more than a 4-ft. elevation differen.'a1, plan must show contour lines at -ft. intervals); location of easements
and driveway; footprint of structure (includin decks); location of wells /septi • systems; utility locations; direction
indicator; lot area; building coverage area; perce .ge of coverage; impervi • s area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any - old -downs ane einforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window si location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 3! inches above grade, etc.
14 Cross section(s) and details. Show all framing - member sizes . d spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cro . section may be required to clearly portray
construction. Show details of all wall and roof sheathing, r• • mg, • • f slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insul.,i on, etc.
15 Elevation views. Provide elevations for new constructio,, minimum o o elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the c -ange in grade is - ater than four foot at building envelope.
Full -size sheet addendums showing foundation eleva ens with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral alysis plans. Must indica'. details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications . d calculations to engineering sk dards.
17 Floor /roof framing. Provide plans for all floo /roof assemblies, indicating membe izing, spacing, and bearing _ ❑ ❑ 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide c •ss sections and details showing placement o - bar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calcul
19 Beam calculations. Provide two sets df calculations using current code design values for all be. s and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beaotst carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Iderftify the prescriptive path or provide calculations. A gas- piping schemati • 's 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 engin . r ❑ ❑ ❑
architect licensed in Ore on and shall be shown to be licable to the ro'ect under review.
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x I I" 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. ❑ 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
CITY OF TIGARD , _
BUILDING DIVISION PERMIT #: MST2005 -00371
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/2/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ' ° 'I I..
INSPECTION WORKSHEET FOR DATE: 11/3/2005 TIME: 7:06AM PAGE: 1
IZ/
SITE ADDRESS: 12175 SW SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: SUMMER HILLS PARK LOT #: 018 TYPE OF USE:
PROJECT NAME: HALLBERG
DESCRIPTION: Replacement for permit 1902 #3983. This will be for final approval of "as built" addition.
OWNER: HALLBERG, ROBERT E, PHONE #: 503 -349 -1230
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 : inai inspection 020265.01 603-349-1230 N
Corrections/Comments/Instructions:
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i PASS IN • ° oy IAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL II r AL e R INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` ■_ --■ 0111111111 ' Date: / 4, 5 -- Phone 4, 5 -- Phone 3 Phone #: (503) 718 -