Permit „r' v �� ®� �IV/4 _ MASTER PERMIT
�� T
;•1 • ” COMMUNITY DEVELOPMENT DATE ISSUED: D : 7/ /2008 00103
• DATE ISSUED: 7/9/2008
T'GnkD> 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
'" , - , PARCEL: 1S135DC - 01100
SITE ADDRESS: 11865 SW LINCOLN AVE ZONING: R -4.5
SUBDIVISION: TIGARDVILLE PARK LOT: 009 JURISDICTION: TIG
PROJECT: BLUNT
Project Description: Converting living room to bedroom and installing interior door.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sl BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: s/ GARAGE: s1 FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sl RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 2,000.00 REAR: 15
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: WOODSTOVES: 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/0 SVC /FDR: SIGN /OUT LIN LT: PER HOUR: CO
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: y
MANU HM /SVC /FDR: 601 • 1000 amp: 601 +amps•1000v: MINOR LABEL:
1000. amp /volt : O
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: CIO
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL . B. COMMERCIAL 0
AUDIO & STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: e
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: `O®
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: w
• This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
ROBERT BLUNT • OWNER laws. All work will be done in accordance with approved plans. This
11865 SW LINCOLN AVE permit will expire 1 work is not started within 180 days of issuance, or
TIGARD, OR 97223 1 the 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 952 - 001 -0080. You may obtain copies of these rules or direct
Phone: 503- 740 -8927 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 110.63
REQUIRED ITEMS AND REPORTS
--- , S .---- -% ,„ / ,/ - „,--'-----./ — „,././ .
�.✓ -Cr —` °' : 3 ; ; fi
Issued By :.� ' /'.,-, CS' t Permittee Signature : -
- --- " ' r"
Call 503 .639. • :00 a.m. for an inspection that bus ess day.
This permit card shall be kept in a conspicuous place on the job site until completion the project.
Approved plans are required on the job site at the time of each inspection.
f/ 5 Su() L VA/.
BuildinPerm Applicatio
• 'Kesrdential C•0\15) FOR OFFICE USE ONLY
3 City of Tigard DateB Received : ADIS Permit No.:
11 . 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 0 ^` q ' l Q�\;' 1 Date /B • • a. %t ./IyQe. Other Permit:
T I G n R D Inspection Line: 503.639.4175 , t f� Date Ready /By: Juris: Ei See Page 2 for
Internet: www.tigard- or.gov PR Notified/Method: 7 /3/of AP . Supplemental Information
((-� y p ` SON
TYPE OF WORM"' `' NG v 1v ,� REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Aiitioon Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
A ldition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
and 2- family dwelling ❑ Commercial /industrial Valuation: $ C CIC 1
❑ 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: // N, 5 . S lil/ G v Go6„/ T ✓ t. e. New dwelling area: square feet
City /State /ZIP: 7;7?).-,..1 Ct Z 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 9/071-- Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
G. /A' G.c, 'j-- ,tl t4/LG Other structure area: square feet
JJ 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.
-TtiSl /,, // A. N % N/JeC(oie deo pi( Valuation: $
Existing building area: square feet
�, New building area: square feet
I�rROPERTY OWNER ❑ TENANT Number of stories:
Name: p_ Q &lc,ey( Type of construction:
Address: /1 1526 S S,.,, z,4vcoC Alej1e. Occupancy groups:
City /State /ZIP: TSB °' 9 2 22-3 Existing:
Phone: (5,2) 7 ( - g 7 'Z 7 Fax: ( ) New:
EkAIPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: ��Yti f - 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
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail:
CONTRACTOR
Business name: k . - -
(..4/6( BUILDING PERMIT FEES*
Address: �� �1 (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP: .. —:.......,_,:,,,..,
Va�r'!'•••fee if app 1 .•e:
Phone: ( ) Fax:( )
CCB lic.: Total fees due upon application: lie)., Co?
Amount received: [ , G
Authorized signature: This permit application expires if a permit is not ob ained
within 180 days after it has been accepted as complete.
Print name: i c E/ Date: —Z7— O
Fee methodology set by Tri- County Building Industry
Service Board.
1:\Building \Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(I I/02 /COM/WEB)
Building Permit Application Checklist .
One- and Two- Family. DwellingFOR O A F ICE US ; ��'
t Received
City of Tigard Permit No.:
■Date /By:
4. i+ v 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
C Phone: 503.639.4171 Fax: 503.598.1960
TI GA`tb
24- Hour Inspection Line: 503.639.4175 ❑Electrical ❑ Plumbing ❑Mechanical
exz -:vr. a Internet: www.tigard- or.gov ❑ Other:
•
• 1. THE"FOLLO UTEMS ARE RE_ UIRED FO R P V E� " Y es, N N /"'
WING � +. ti Q S�$hF1�s.KS.I Tlt ' �!'s, , �'f'! ti'i . ,.
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ x
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- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state EK ❑ ❑
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 review cannot 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 ❑ ❑ ❑
and location. ^�
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, 1I�1" ❑ ❑
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- ❑ ❑ ❑
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 t' ❑ ❑
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 Oregon and shall be shown to be applicable to the .roject under review.
IURISD ION AL SPI CIF1CSr�`
.. _ .. 1 r y '* `' *� w _ N it . -.n
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 1 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. ❑ ❑ ❑
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 ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and accompanied by the project arborist's signature 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.
1:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11/02 /COM/WEB)
•
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
f ( I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
X I will be performing work on property I own, a residence that I reside in or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If 1 change my mind and hire a general contractor, I will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
IP —
1/4- NIIIIII
1 hz-ciA A ,
Il ; ��
Print name of permit applicant � e of permit applicant '
6 -Z7 - o '
Date
Permit #:
This form is supplied to building • F , �
permit offices by the Oregon `° ' Address:
Construction Contractors Board, 1- .:� '
as required by ORS 701.055 (6) ••�'
Issued by: Date:
This copy to issuing permit office
CITY OF TIGARD
BUILDING DIVISION PERMIT #: IrIST2008.00103
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 719/2008
Phone: (503) 639 -4171 �\7fr.
sliw Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/15/2008 TIME: 7 :OOAM PAGE: 26
SITE ADDRESS: 11865 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: 11GARDVILLE PARK LOT #: 009 TYPE OF USE:
PROJECT NAME: F3UJN r
DESCRIPTION: Converting living room to bedroom and installing interior door.
OWNER: BLUNT, ROBERT PHONE #: 603- 740 -8927
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 072646.01 503-740-8927 N
Corrections /Comments / Instructions:
989 ; ra \ - f4,5 5
(__a -3e_
Vl ae C ����' —
71 PASS n PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Dater l y ° Q Phone #: (503) 718- 2 5 2 3
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MS12008•00103
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 719/2008
Phone: (503) 639 -4171 A Ai , ^p
Inspection Requests (24 Hrs.): (503) 639 -4175 f
INSPECTION WORKSHEET FOR DATE: 7/14/20013 TIME: 7 :00AM PAGE: 37
SITE ADDRESS: 11865 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: 11GARDVILLE PARK LOT #: 009 TYPE OF USE:
PROJECT NAME: F L.1JNT
DESCRIPTION: Converting living room to bedroom and installing interior door.
OWNER: k3LUNT, ROBERT PHONE #: 603
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/1412008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
276 Framing 072553-01 103.740 -8927 N
Corrections /Comments/ Instructions:
n PASS n PARTIAL APPROVAL ❑ CANCEL : ACCESS
n FAIL CALL FOR INSPECTION Ill ADDITIONAL FEES ASSESSED
jA Inspector: Date: - 7- /4- --.6r, Phone #: (503) 718- ¢.q
:/ , : MASTER PERMIT
! � 1 0 r 4 CITY OF TI�AR
PERMIT #: MST2008 00103
v. ' COMMUNITY DEVELOPMENT DATE ISSUED: 7/9/2008
=TIG�1R 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135DC
SITE ADDRESS: 11865 SW LINCOLN AVE ZONING: R -4.5
SUBDIVISION: TIGARDVILLE PARK LOT: 009 JURISDICTION: TIG
PROJECT: BLUNT
Project Description: Converting living room to bedroom and installing interior door.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: y
TYPE OF USE: SF FLOOR LOAD: SECOND: sl GARAGE: sl FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: 51 - RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sl 2,000.00 REAR: 15
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: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: 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: P/�
EA ADO'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR: V
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL' IN PLANT:
MANU HM /SVC /FOR: 601 - 1000 amp. 601•amps- 1000v: MINOR LABEL.
1000• amp/volt : CO
PLAN REVIEW SECTION O
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY 1
A. SF RESIDENTIAL . 8. COMMERCIAL
0
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: O
BURGLAR ALARM: OTH: BOILER: HVAC, LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: a 4
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL a SYSTEMS: W
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
ROBERT BLUNT OWNER laws. All work will be done in accordance with approved plans. This
11865 SW LINCOLN AVE permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 4 the 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 952- 001 -0080. You may obtain copies of these rules or direct
Phone: 503- 740 -8927 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 110.63
REQUIRED ITEMS AND REPORTS
Issued By C� / L Permittee Signature : - _ " ` /
Call 503.639. •b - 7 :00 a.m. for an inspection that bus ess 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.