Permit CITY OF TIGARD BUILDING PERMIT
'.` COMMUNITY DEVELOPMENT Permit #: BUP2010 -00184
D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 08/10/2010
Parcel: 1 S 136DCO3600
Jurisdiction: Tigard
Site address: 7020 SW CLINTON ST
Subdivision: ISAACS SUBDIVISION Lot: 7
Project: TVF &R
Project Description: Demo of existing SFR
Owner: FEES
TVF &R Description Date Amount
20665 SW BLANTON ST. Permit Fee - Additions, Alterations, 08/10/2010 $195.38
ALOHA, OR 97007 Demolition
PHONE: 12% State Surcharge - Building 08/10/2010 $23.45
Erosion Control 08/10/2010 $26.00
Erosion Plan Review CWS 08/10/2010 $8.45
Contractor: Erosion Plan Review COT 08/10/2010 $8.45
FLYING H CONSTRUCTION CO
21100 SW OREGON ST, SUITE101
SHERWOOD, OR 97140
PHONE: 503 - 925 -1280
FAX: 503 - 678 -4221
Specifics:
Type of Use: SF
Class of Work: DEM
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $7,480
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $261.73
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
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 the 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5003.246.6699 or 1.800.332.2344.
Issued By: I Permittee Signature: ALM--c
Call 503.839.4175 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 completio f the project.
Approved plans are required on the job site at the time of each inspection.
` .C!F TIVR® T E COPY BUILDING PERMIT
3 ..:COMMUNITY DEVELOPMENT Permit ft BUP2010 -00184
Date issued: 08/10/2010
T id, A RD 13125 SW Hal Blvd:, Tigard OR 97223 503.639A171 Parcel: 1 S136DG03600
Jurisdiction: Tigard
Site address: 7020 SW CLINTON ST
Subdivision: ISAACS SUBDIVISION Lot 7
Project TVF&R
Project Description: Demo of existing SFR
Owner FEES
TVF&R Description Date Amount
20665 SW BLANTON ST. Permit Fee - Additions, Alterations, 08/10/2010
ALOHA, OR 97007 $195.38
Demolition
PHONE:. 12% State Surcharge - Building 08/10/2010 $23.45
Erosion Control 08/10/2010 $26.00
Erosion Plan Review CWS 08/10/2010 $8.45
Contractor. Er Erosion Plan Review COT 08/102010- $8.45 .
FLYING H CONSTRUCTION CO
21100 SW OREGON ST, SUITE101
SHERWOOD, OR 97140 _
• PHONE: 503-925-1280
FAX 503678 -4221
Specifics: , 4400101c/
Type of Use: SF
Class, of Work: DEM
Dwelling Units: 0
Stories: 0 Height 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $7,480
Floor Areas: / 1
Total Area: 0
Accessory Struck 0
Basement 0
Carport: 0 Pb
Covered Porch: 0
Deck: 0
Garage: 0
mezzanine :. 0
Total
$261.73 .
Required: Required items and Reports (Conditions)
• Fire Sprinkler: Parapet C1 '4i :7 rJ aoN d ( " c{`fsgty
Fie Alarm::. . `. Protected Corridors: / y/ •
Smoke Detectors: Manual Pull Stations: 8/1/
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and ati other applicable taw. AO work wiU
• 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 the 180
days. ATTENTION: Oregon Iaw requires you to follow the rules adopted by the Oregon Utility Notifiu.eliwi Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a ccipy of the rules or direr questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: A I Permittee Signature: p-,.—,
Call 503. 639.4175 by 7:00 a.m. for an inspection that business d ay.
This permit card shall be kept In a conspicuous place on the job sae until comp the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial I•()R OIII( I.. lISI. ()NI.)
II ty Tigard Received r. Permit No.:
Ci of Ti and _
a 13125 SW Hall Blvd., Tigard, OR 97223 r _
1 Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Pe ""' t:
Inspection Line: 503.639.4175 Date Ready/By: huffs. M See Page 2 for
- . : Internet: www.tigard�r.gov PP
T 1 kip . N otified/Method: Supplemental Information
- ..
. TYPE OF WORK 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 application.
® 1- and 2- family dwelling ❑ Commercial mdustrial Valuation: $
❑ Accessory building El Multi-family Number of bedrooms: 4
• ❑ Master builder ❑ Other: Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 7020 Clinton Street New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldgJapt. no.: Project name: Clinton Street House Demo Covered porch area: square feet
Cross street/directions to job site: Corner of Clinton and 70 gravel road Deck area: square feet
Take 72" to Clinton and go east to end of Clinton. The house is on the south Other structure area: square feet
of the street at the end of Clinton REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: ZTGL I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 1S136DCO3600 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.
Demolish House clear all debris from site Valuation: $7,480.00
Existing building area 1606 square feet
New building area: N/A square feet
' • ` ® PROPERTY OWNER I ❑ TENANT Number of stories: N/A
Name: Tualatin Valley Fire & Rescue Type of construction: Wood frame
Address: 20665 SW Blanton Street Occupancy groups:
City /State /ZIP: Aloha, OR 97007 Existing: Residential
Phone: (503)649 -8577 Fax: (503)591 -1435 New:
❑ APPLICANT • IN CONTACT PERSON NOTICE
Business name: Tualatin Valley Fire & Rescue All contractors and subcontractors are required to be
Contact name: Greg Perry licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be lbensed in the
Address: 20665 SW Blanton Street jurisdiction in which work is being performed. If the
City/ State/ZIP: Aloha, OR 97007 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 969-6868 Fax: : (5o ,,5q i ` /y3
E -mail: greg.perry@tvfr.com
CONTRACTOR
Business name: Flying H Construction Co. • - BUILDING PERMIT FEES*
Address: P.O. Box 2533 (Please refer to fee schedule)
Structural plan review fee (or deposit):
City / State/ZIP: Wilsonville, OR 97070
Phone: (503) 780 -4916 I Fax: (503) 679 -4221 FLS plan review fee (if applicable):
CCB lic.: 104699 Total fees due upon application:
`� Amount received:
Authorized signature: �( This permit application expires if a permit is not obtained
��!/// " °' within 180 days after it has been accepted as complete.
Print name: Greg Perry Date: 7/29/10 I • Fee methodology set by Tri -County Building Industry
C >...:ra Rnora
•
44G` • SEPTIC TANK DECOMMISSION (ABANDONMENT)
r ya For Onsite Sewage Disposal System
ry Washington County Department of Health & Human Services
""'' Environmental Health
o.'-'0,1 155 North First Avenue, MS 5, Suite 160 • Hillsboro, Oregon 97124-3072
Telephone: (503) 846 -8722
Please return completed form to Washington County Department of Health & Human Services
Environmental Health
1. 1 3( DC 0 360
Town ip Range Section Tax Lot # (s)
2. 1 u• )c 41h de I iv rrc CGS( .,r
Printed Name of Property Owner
3. The septic tank located at: 7 010 .5 t N C r +\'J`Uv. S ` --- 12 ,,r,d f e q 7z z.3
. • Address City _ State Code
Vas pumped of slud a on:
\\ Date: S 7 it 0
By Licensed Operator: 6 \Z V AL L j (B}Q J license #:
c V as baddII1 with nd or dean bank run gravel AFTER being pum 1 e
Date: Z9 /Z7 / ` O Signature of Operator:
t: Oregon Administrative Rules 340.71 185 Decommissioning of Systems
1) The owner shall decommission a system when:
a) A sewerage system becomes available and the building sewer has been connected
thereto; or
b) The source of sewage has been permanently eliminated:
2) Procedures for Decommissioning:
a) The tank(s), cesspool or seepage pit shall be pumped by a licensed sewage disposal
service to remove all seepage;
b) The tank(s), cesspool or seepage pit shall be filled with reject sand, bar run gravel or
other material approved by the Agent, or the container shall be removed and properly
disposed.
The septic tank at the address above has b m - in accordance with Oregon Administrative
Rules.
Signature of Property Owner:
WCDHHS EH Revised ARM 2007