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14480 SW 103`" AVE.
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T I GA^KD BUILDING PERMIT
PERMIT#: BUP2002-0006
DEVELOPMENT SERVICES DATE ISSUED: 2/25/02
13125 SW Hall Blvd..Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S111 B(;-00900
SITE ADDRESS: 14480 SVA' 103RD AVE
SUBGiVISION: TIGARDVILLE HEIGHTS ZONING: R-3.5
BLOCK: LOT: 019 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL. CONSTRUCTION
CLADS OF WORK: DEM 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?: REUD SETBACKS,_ _ __ _ REQUIRED
FLOOR LOPED: psf LEFT: ft RGHT: it FIR SPKL.: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE:
Remarks: Demolition of(1)single family residence of 2,664 square feet and (1)carport of 684 square feet and (1) shed of
L 820 square feet. Septic tank is to be either removed or pumped, filled and inspected. All debris is to be removed
Owner: Contractor:
CALVIN PRESBYTERIAN CHURCH ROBERT GRAY PARTNERS INU
10445 SW CANTERBURY LANE PO BOX 1000
TIGARD, OR 97224 SHERWOOD, OR 97140
Phone: 503-639-3273 Phone: 692-4675
Reg #: LIC 000654
_ FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Erosior Control Insp 846-8
PRMT CTR 2/25/02 $62.50 27200200000 _ Pump'1:01 Sepf!c Tank Insp
Fir, iction
5PCT CTR 2/25/02 $5.00 27200200000
EROS CTR 2/25102 $26.00 27200200000
ERPC CTR 2/25/02 $8.45 27200200000
(additional fees not listed here)
Total $110.40
This permit is issued subject to the regulations contained in loe 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-U01-1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503)246-6699 or 1-800-332-2344.
Permittee
y l ,
Signature: / •( y J l l
issued By: _ I ',•�, �
Cali 6394175 by 7 p.m. for an inspection the next business day
Building Permit Application
City of Tigard D�Lrived: °�/?/L, Permit no.: U Q9 ooZ- }7
City u(l•fgnrrl
Address: 1:3125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: Expiled.te:
Phone: (503) 639-4171 Date issued: By: J Receipt no.;
Fax: (503) 598-1960 Case file ne.. Payment type:
Land use approval: 1&2 family:Simple Complex:
7U I &2 family dwelling or accessory U Commercialhridustrial U Multi-family U New construction M Demolition
U AdditioNalteration/replacement U Tenant improvement U fire sprinkler/alarm U Other:
J6841TE INFORMATION
Jobaddress: 14480 SW 103rd Avenue Bldg.no.: Suite no.:
Lot: Block: Subdivision: 1 Tax map/tax lot/account no.: 2 S 1 l 1 BC 9 0 0
Project name: CUP 2001-00002 --
Description and location of work on premises/special conditions: Dc'rrlo i i s h Ll)__ single family
_
residence and ( 2 ) detached one-story �5F)cds
t
Name: Calvin Presbyterian Church
Mailingaddress: 10445 Canterbury Lane I K 2 Tamil) dwelling:
City: Tigard -- —
State;OR '[P:97224 Valuation of work........................................ $_
Phone: -3 273 1 Fax: IS mail: No.of bedrooms/baths.................................
wnersrepr:sentative: Ray Beyer Total number of floors......................I..........
Phone: 639-3273
Fax: Fi mail: New dwelling area(sq. ft.) ..........................
Garage/carport ansa(sq. ft.).........................
Name: Calvin Presb, terian Church Covered porch area(sq,ft.) ...... . ................
Mailing address: 10445 SW Canterbury bane Deck arra(sq,ft.)........................................
City: Tigard- State: OR iIP:97224 Other siructurcarea(sq. Ii.)......................... _
Phone:639-3273 FT,_r G-—ma il: Commerclal/industrial/multi-iamiiv
Valuation of work.......... ... ............. ........... $
Business name: Robert Gray PartnersExisting bldg,arca(sq. ft.) ......... ..............
New bldg.area(sq. ft.) .......................... .....
Address: P.O. Box i OOO --------.--
City: Sherwood State: OR ZIP: 9 714 0 Number of stories....... .. ............ I I......
Phone:6 9 2-4 6 7 5 Fnx:6 9 2-9 2 9 Gmai1: Type of construction....................................
CCH no.: 654 24 Occupancy group(s): Existing:
Cityhnctrolic.no.: Tigard: 7678 , Mofrn: 1888New. -__-
Notice:All contractors and subcontractors are required to he
licensed with the Oregon Construction Contractors Berard uncle
Name: Russell L. Leach provisions of URS 701 and may he required to he licensed in the
Address: P.O. Box 1016 jurisdic tion where work is being performed. If the applicant is
Cit : erwoo Slate: OR Z,III: 9;140 exempt from licensing,the following reason applies:
Co ntact person: ra .9 Plan no,: — -- -- --- —
Phone: 692-4675 Fax: 692-929 1 E-mail: — -- --- --
Name: Sisul Fny• 1contact person:Ton Sisul Fees due upon a plit.unm . _... $ —
Address: 375 Portland Ave. Date received:
City: Gladstone State• OR 'ZIP: 97037 _ Amount received
Phone: 657-018 8 IF: E-mail: Please refer to fee schedule.
1 herehy certify I have read and examined this application and the! Not all pnimboita,q weeps credit'cads.please call iuriMlictlon lot nxxe inGxmaaon.
attached checklist. All provisions of laws and ordinances governing this U visa U MasleWanl
work will be coTplied i(}l, whether,s cified herein or not. credo card numhn
--- I.spires
A uthorfzed signature: .- Dale: ,�; � --Fame of cardhol r as shown on credit rod -
Print name: - (i^_ t_- �� -- --- -s
Cardholder signature Amount
Notice:Phis permit application expires ira pemtit is not obtained within I,J days after it has been accepted as complete, raldnt tenxvroMl
I Co n nerc ial Ilan Submittal
ae(juirement Matrix
City of Tigard
TYPE OF SUBMITTAL ` of Plans
(Includes New, Additions o Alterations) Required at
Submittal
Site Work
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building 1*
Fire Protection System 3**
Mechanical 2
Plumbing - Building Fixtures 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans. After
plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
*For over-the-counter commercial tenant improvements, submit 2 sets of plans.
**"New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i:w9ts\form9\coM-matdx.dcc 9/24/01
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