Permit IA
`° CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00123
u DEVELOPMENT SERVICES DATE ISSUED: 4/9/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135CC -00100
SITE ADDRESS: 10200 SW TIGARD ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT 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: 0.00 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: ',Roo
Remarks: Removing wall and installing a window
Owner: Contractor:
ROGER DAY OWNER
10200 SW TIGARD
TIGARD, OR 97223
Phone: 503 - 670 -1704 Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Framing Insp
PRMT CTR 4/9/01 $62.50 27200100000 Insulation Insp
Final Inspection
5PCT CTR 4/9/01 $5.00 27200100000
PLCK CTR 4/9/01 $40.63 27200100000
• Total $108.13
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 -1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246 -1987.
Permitee
Signature: 74(
Issued By: L...--eiry �_,e0
Ca10639 -4175 by 7 p.m. P .m. for an inspection the next business day
rn-
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Building Permit Application
Date received: 1 1-- 1 1--d l Permit no .
„I'I!• City of Tigard
J.a o�i� 3
City of Tigard
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Project/appl.no.: Expire date:
Phone: (503) 639 -4171 Date issued: By: l Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
•
4 OD 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
. Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
J OB SITE INFORMATION
Job address: 6,2 o 1.--e- Bldg. no.: Suite no.:
Lot: Block: Subdivisi s • . Tax map /tax lot/account no.:
Project name: .
Description and location of work on premises/special conditions: /lie.; wa to
41 P P P� �n�n_ v �� .�5A///ryLj w. a:.v
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
IMEMNIEWAIIIIMMI
(Iloodplain, septic capacity, solar, etc.)
4
Mailing add O2# , s 1 & 2 family dwelling: p
D
S te: O ZIP: y' Valuation of work $
Phone:f, Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: oc /'-
Covered porch area (sq. ft.)
Mailing addre : • _ g gMIENNIMIFSIIIIM Deck area (sq. ft.)
ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR Valuation of work $
Business name:
Existing bldg. area (sq. ft.)
Address:
New bldg. area (sq. ft.)
Number of stories
City: State: ZIP: Type of construction
Phone: Fax: E -mail:
CCB no.:
Occupancy group(s): Existing:
New:
City /metro lie. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP:
exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied with, hether specifi -' T � • in or not. Credit card number: / /
Authorized signature: _..,411L41, _..,411L41, Date: ( C� /y
Expires
/ t/ Name of cardholder as shown on credit card
Print name: P c $
/ Q ` Cardholder signature Amount
Notice: This permit application expires i a permit is not obtained within 180 days after it has been accepted as complete. 440-46l3 (6ro0/COM)
SITE PERMIT CHECK LIST
Commercial and Multi - Family: Complete ENTIRE form.
Residential: Complete SHADED areas only.
• Excavation Volume: cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density) cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other
Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
Utilities (Complete all that apply)
Storm Sewer: Linear Ft.
Sanitary Sewer: Linear Ft.
Fresh Water: Linear Ft.
Catch Basins: #
Clean Outs: #
'.Pl'ans Required: ;.See "Application /Plans 'Submittal Requirements attached:'' : �.-
The,.following`must accompany this'application _ . r -
Sit&PlanY.witf Vicinity Map;: Parking:_°(including ADA) and ;..
showing ADA compliance � Lighting ' Plan and details: k; , =_ .. _ :Landscaping
.3Erosio Plan and details - = Retainin'g Structures :;N <;
mo ;Site;Utility- -'Plan and details: required);�
,(showing to approved
system): f "s .:
is \dsts \forms\sitechecklist.doc 10/05/00