11369 SW 91ST COURT ADDRESS:
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iArecords\rnicrotlrn\targetsV.)uilding.doc
CITY OF TI ' ARS
BIJILDrNG PERMIT
PERMIT 4t. . . . . . . : DUB 1)5—0 12",L'16
COMMUNITY DEVELOPMENT DEPARTMENT DA'rE ISSUED: 06/16/95
13125 SW Hall Blvd.Tigard,Orogor 97223.8199 (503)039.4171 1
PARCEL: 1S1,35DB12200
.ITL r4DDRES'_,,, 11369 SW 91ST CT
_�JBDIVISJDN. . . . : ZONING:
BLOCK. . . . . . . . . . : LOT. . . . .0 . . . . . .
REISSUE: FLOOR EXTERIOR WALL C0,43TRUCTION -
CLASS OF WORK. :ADD FIRST— . ; s N: S: E: W:
TYPE or-, USE. . -fir-r bECOND. . . : Sf PRc"rECT OPENINGS?
'TYPE OF CONST . :c_JN TF i I RD. . . . : Sr N. S: E: W:
OCCUPANCY GRP. . R3 TOTAL— 0 5'F ROOF CONST: FIRE RET'? .
OCCU,,',,ANCY LOAD: BASEMr-,*.NT. : s AREA SEP. RATED:
STOR. : 1 HT. . 1— ft GAPAGE. . . : sf Or.C1J SEP. RATE)..
BSMT" : 1ylEzZ?: REDD SETBACKS- RE.QUI
FLOOR LOAD. ., . . :60 psf LEFT: Ft RGHT. ft FIR SPKI... G)M 0 1-1, Dr T.
DWELLING UNITS% F RNT-, ft REAR: ft FIR AL RM: HND ICP ACC,
BEORMS: BATHS.-. IMP 13)URFACE, PRO CORR. PARKING:
VALUE. s - 1000
Rrniar'ks : r X 10 PATIO CCIVER
O,,qner-: FEEE,
IVI IZATT type aniol.tnt by (J-it e i-ecpt
11369 SW 91 PRMT 1, 25. 00 JD 06/16/95 95--266886
P 1...C K $ 16. 25 SW 06/15/05 1)5 .-266845
TIGARD OR 97223 13PCT $ 1. 25 JD 06/16/95 95-26666(,
PI-IC)TIC, #: ('39L308
Cor,tt-ac_,tt)r,:
OWNER
r:`Ilcine ft: $ 4.2. 50. TOTAL
Reg t�. . . OL0000
------- REQUIRED INSPECTIONIE'
This permit is issued subject to the regulations contained i -he Fr-aming Irisp
Tigard M,:nicipal Code, of Ore. Specialty Codes ;od all other Firal Irisr)ecLtic)n
applicable laws. All i.,rk will be done i- a._,-rdance with
approved plans, This oersit will expire if wurx is not started
within 180 days of issuance, or if worP, is suspended for more
than 180 days.
Per-mittee [3)iqTia 1_tt-e :
IS,
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Call fnr inspection 639--4175
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4i 1 Address:
( � z
Issued by:C
Date:
Statement: Information Notice to Property Owners
About Construction Responsibili.ties
Note: O)•egon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construct:on Contractors Board to sign the
following statement before a building pe.,mit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statemEnt. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
a1. I own, reside in. or will reside in the completed structure.
LJ 2. I understand that I must register as a construction contractor if the structure is sold or offered �.;r sale
u before or upon completion.
3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contract-rs Board.
OR
j� '9. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
NBoard. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
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w I hereby certify that the above information is correct and that I have read.end do understand the:afm Ovation
Not:ce to Property Owners about Construction Responsibilities on the reverse side of this form.
(Si�,'ure of perrfiit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Residential Building Permit Application
City of Tigard \
13175 SW Hall Blvd. ys 1i2 "'�j
Tigard, OR 97223
(503) 639-4171
Jobsite Address:
;P Lot Ufflce Use Cnly
Valuation: i 7�,[`1 _ ���lr� U• �'� Planck/Rec. #_ 1/0 ~ 150
#
Corner Lot? Y � Permit if —
Flag Lot? Y N
Reissue of
Map & TL#
owner. A;+provals Required
Addres*// Z_Y 1 �/ _ Planning
z=` -r" �re �� ►–� Engineering _
Phone: — Other
Contractor:
Items Required
i Address: � __ Subcontractors
Truss Detdds
Phone: � - _ Other
Contractor's L cense #
(attach copy of current Oregon license)
Contact Name ; Phone:
Subcontractors: Arch itectlEngineer:
a �
Plumbing: _ , ,�) (� Address:
v:
r �
Mechanical:
.~- (attach copy of current OR Contractor's License)
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�- Phone:
C ll
JOB DESr.PIPTION: Zif
---t�r—* 6)6 9P —
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Applicant SignatureP one// 'number '
Received by. 7L V)�A 110, Date Received: ( j
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Permit S Account-Description Amount Amt. Pd. Bal. Dtii.-
O L.vE Bldg. Permit (BUIL'J) ) ✓ ` `'
Pki:mb. Permit (PLUMB)
Miech. Permit (MEC,4) _
State Tax (TAX) �' 1" ' -- J`2
Bldg: Z
Plumb:
Mech:
Z5-
_
Plan Check (eL. NCK)
Bldg: el l_
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) --
Residential TIF (YIF-R)
Mass Transit TIF (1-IF-MT) —
Commercial TIF (TIF-C)
Industrial TIF
Institutional TIF (TIF-IS)
t Mce TIF (TIF-O) �---
Water Glu.lity (WQUAL)
a -
;` Water Quantity (WQUANT)
Fire Life Safely (FLS)
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Erosion Cntrl Permit (ERPRMT) _
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LL; Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROS') G ~
TOTALS: j� �' ` Z )
CITY OF TIGARD
BUILDING DIVISION
RESIDENTIAL PLANS SUBMITTAL
APPLICANT NAME: PLAN CHECK #
ADDRESS: PHONE #
DATE RECEIVED: RECEIVED BY:
CHECKLIST (All items must be in packet before Alar► vAli be reviewed)
YES NO N/A
1. [ ] [ ] ( ] 3 FULL SETS OF BUILDING PLANS (No red line revisions
or tape-ons).
2. [ ] ( ] [ ] 5 SITE PLANS(including tax lot and tax map number,easements,
erosion control provisions, floor elevation of garage and main
floor, set backs, drive-way location, north arrow, scale, location
and termination of rain drains,all property corner elevations,and
contours if over 15% grade).
3. ( ] [ ] [ ] BUILDING PLANS SHALL REFLECT TOPOGRAPHY OF LOT
(if house is designed for a flat lot and the lot is not flat, revised
drawings are required. No red lines accepted).
4. [ ] [ ] [ ] REVISION TO PLANS MUST BE FOLLOWED THROUGH
FRCA,1 ROOF TO FOUNDATION (detailed sections may be
different from the originals as a result of your changes These
portions of the structure that are affected by the change need to
be reflected on the plans. No red lines will be accepted).
�t
5. ( ] [ ] [ ] FLOOR PLAN(S)
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6. [ j [ ] [ ] FLOCR FR-\NiING
r�
" i. [ ] [ ] [ j TRUSS !OISTS (engineering, details and layouts)
8. [ ] [ 1 [ ] ROOF FRA,10ING PLAN (all hips and valley supports ire Icated
and detailed).
— OVER —
YES NO N/A
9. [ ] [ ) f ] ROOF TRUSSES (engineering, details and layouts)
10. [ ] [ ] [ ] COMPLPE CROSS SEC?ION(S)
11. [ } [ ] ( } ALL 4 ELEVATIONS ARE SHOWN - 3 ELEVATIONS FOR
ADDITIONS AND REMODELS
12. [ } [ ] i } BASEMENT WALL, FOUNDATION AND RETAINING WALL
SECTIONS (wiil need engineering if walls are 8 ft. high or
higher)
1'. [ ] O O WALL BRACING (structure must meet table R-402.10, revised
alternate method 93-7, or a lateral design shall be provided)
14. !' ] ( ] [ 1 ALL DETAILS REQUIRED BY NO. 13 ABOVE SMALL BE
INCORPORATED INTO THE PLAiiN1S. No attachments are
al lo,+ved.
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15. [ ) [ ] [ } BEAM CALCULATIONS (all beams over 10 h. in length or any
beam that supports a point load).
16. ( ] [ ] ( ] ENERGY CODE PATH IDENT0ED
DO NOT MAKE CORRECTIO10S IN RFD
NOTE: A tree removal permit :hall be required for cutting of all trees that are 6" or
larger in diameter at 4 feet above. grade. Permit application f(-,,-ms are
available from the Planning Division. Two copies of a site plan showing the
location of the trees and proposed building are requit�,d with the application.
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 6399-41,.75 Business Phone: 639-4171
Inspection: �Z�
Footing v Susp. Ceiling Spink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Oil Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line Idg.
Plbg. Underfloor Rain Drain Framing ) / -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
[�^te Requested: -� Z/ �� �5 Time: 4M PM
Aidress:_r / /�i 1 w2-;t L
Builder: Permit #: /
THE FOI LOWING CORRECTIONS ARE REOU;RED
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Ins ctor: ` l �- �, �^' �'— Date: � r
GPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
C,i T Y oF RUT'r-I i,'V OF r-,AYt4ENT RECF I V-T Nn. 95---,,4,6AFi'
GHRCK PHOUN'T 2t.6.
N(IME o I7_ATT, U. G. CAGH AMOUNT . 0. 00
ADDRVl-3T, a IMTT, 5HIR[ FY PAYMENT 06/16
11.369 f� 3W q1�:T C'T SIi.1N
T I CAIRD CIR
PURt-'I:OT OF F'A MFNT nMOL.IN"i PAID PURPOSE nF F'AYMk:W AMOUNT PA
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SUILDINC-3 PERM SUIVII-Ki-0i'M .._... 00 ,T. Nt.lILD PE"FZ.... � .�.. __ .. .... .._...__
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TOTAL AMOUN"C F'r1I Ii
CITY OF 'f CfyrRD RN.1" I OF PAYMF.NY RE:C'•E IIT NO. :c�;4 -c��. u
I:HEI;14 AMOUNT s i
NAME s T i AI Y O V. G. CASH F'a IOUNT a 0. LAO
pIJDPESS a 11369 SW 91ST ('.OLIRT F'ICIYMFNT DATE. QA(, 1`",Asa"';
TfGnR0j OP, 9(JPf)IVTSION a
F::,URPOBF OF Pfl'rMFNT AMOUNI PAT.n PUPt=OGI: OF F'FIYMF'NT AMOUNT P. iC)
fsl_ghl F'.MFCFi FE 6—• ,OP 16. 25
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