Permit Z r1 PIO .
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00178
i I DEVELOPMENT SERVICES DATE ISSUED: 4/21/04
F�� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14665 SW 79TH AVE PARCEL: 2S112BD 02800
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS 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: R3 TOTAL AREA: 0 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:
Remarks: Demo existing approx. 900sf house. House is on septic (NO SEWER CREDITS)
Septic tank to be pumped, filled and inspected. All debris to be removed.
Owner: Contractor:
MATRIX DEVELOPMENT RON'S SPIDERHOE SERVICES
6900 SW HAINES STREET 16232 S NEIBUR RD.
PLAZA 2, SUITE 200 OREGON CITY, OR 97045
TIGARD, OR 97223
Phone: 620 -80810
Phone: 620 -8080
Reg #: 6tf3- 639 - 829452
FEES REQUIRED INSPECTIONS
Description Date Amount Ersn Cntrl 681 -4444
[BUILD] Permit Fee 4/21/04 $62.50 Pump /Fill Septic Tank Insp
[TAX] 8% State Surchart 4/21/04 $5.00 Final Inspection
Final Inspection
[ERPRMT] Erosion 4/21/04 $26.00
[ERPLN] Ero Plck -USA 4/21/04 $8.45
(additional fees not listed here)
Total $110.40
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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: „,,jet
Pe mi ittee
Signature: / 4 , cd.„._____
Call 639 -4175 by 7 p.m. for an inspection the next business day
r
Site -Work ,
•
Building Permit Application FOR OFFICE USE ONLY
• Received / Permit I ° 0A v _ � U/ A
City of Tigard DateB : D '`/ ermit No.: 0
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 //�mrmNp ' , i A\ DateB : Other Pernut:
.-a i
Inspection Line: 503.639.4175 gpv0 1 Date Ready /By: I= ® See Page 2 for
�1•J J
Internet: www.ci.tigard,or.us Notified/Method: Supplemental Information
�. $ . te 1w ? v* :M 'x K , - W s , , 1 - , i , s '` ' `, t� $ - 4 t t ' e'i ," / �1 n t Y2- FAMILY DWELLING
` „. -.
:rte , . 11&_ W”: TYPE OF W ORK ,, t 1§ Id ' „ TtEQUIREDDATA Al ,
''�:"�A3 - EIS'. i��" �s�i: �: f�i*',.' �E4.: �+.". irSm�'.' �; �. r`.:. , 1��i l` �: 1' i3�9hSt��,'* t�s'^+' e,�.'.n�arF�i,ras.d� -�.rv•, . »...'?'d�!'k,�s.s i��.,,,,E, ,..a�'`Rd m�,.....yr� . ax;* �.: �; sK: ,., f;,:.._, �., �Yt.,%»,,.. tv,. �.:,. k,..P..�'f? ��; <a � x 3.�.:::..:.: -��3. _.1 ,.
❑ 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
�, x, rrl r1 , I�� ar n �o s" ' work indicated on this application.
"r qe �F k1 nE °. aigi a�R µCATEGORY C ONSiiitaION tt lag a �
Valuation: $
❑ 1- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
c �' '� '1� =`° I
` aP • T IO ' z a€ Lx #Int a r Total number of floors.
S i x ilk , `a 61i " S TE, I NFORMA RON AN D� LOCATION. { % r 7i 'w , , - *Z 1
Job site address: 1 4 (p (p 5 51,0 - 011.1-1 New dwelling area: square feet
City/State /ZIP: Ts bA itp , 011, 91 221-1 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: $0IV% -i0 *14 114 Deck area: square feet
Other structure area: square feet
2 REQUIR USE CHECKLIST
, Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: 2. 5112, Pz:D 2'1 OZD equipment, materials, labor, overhead, and the profit for the
S al c r ' 4S %+o7, A l S> -SC T S,v'��' N 0 O r b '�saXe' k s - R' € s ..-
t4 sf � ;t r DESCRII'TION OF WORK - 1 '',# V , work indicated on this application.
r°"+, u: u45�£ ,. .:_ �. „ „u & : � xh ._ -... � ;k�aaas.a3a�.:,- ._.:, a.,o-'Y. k,.R� °„ + =;': ._.4:.
Valuation: $
dr r,nolitbor, 0f exigfiny kerne
Existing building area: square feet
New building area: square feet
�` I " w a a - ,� - .ate. +cis. „v� T v '
� i PROP ERTY . OWNER , �', '' � HI FEN iT „ f t Number of stories:
Name: 0•4ATQIX DevELOpM ENT 0.01 P • Type of construction:
Address: 1 5 5 S W ( T1•1 AveN u E # 100 Occupancy groups:
City/State /ZIP: poQ-RAN D OIL 'x7223 - . Existing:
Phone: ( 5 (020 - $o e o Fax: (903) 59 a - B90O New:
4t »,, �r,k'„ F^' .z"�kr r = 1.. ,
jl r Y 4 1 r' .�'a � , : . : 'S �., , .;'� Ott 1 F z3 O xs.. , E -r ' ,- x 4. =fi
ik W,� tai :a ., .. ,,. t, ,PI CANT F 'ggi' ,. O . « M 4 .,. + C ONT ,t— ° igrt, o 5 � s ' , } `1
l NOTICE ' z r o r r� J ,. :
Business name: M ATR he D '/ EL0 pm ENT COR.P• All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: CAL” 16 8Rev.. N under ORS 701 and may be required to be licensed in the
Address: 121 55 VJ 109114 A1( EN tAE #V 100 jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State /ZIP: Po # N D o It_ 9 1223 apply: �\
Phone: (503 ) 62p- t010 1 es'1 222 Fax:: ( 913 ) ii $ - 89oe,
E C. l3Q2/.1N Lp t.E 61ENQ1 -toM ES GOM
v miti - , � „ € 1 CONTR A � '' . ;= W . ., � ,, H ,
Business name: Y GCS t 1 Jk ^ LD ' E
`
bZ O t. S '3P 1 1] ER N OE Set E rr BUILDING P RMIT :
, ' FEES K ° z , ,
...h_ Z4 . €.z ., ✓„ :asst . -fi a ti. '. ,. ,c a
Address: ((p 2 2 5. N C 1 BlA R - r2-1) • f Please refer to fee schedule.
City/State /ZIP: 0 Re co E '' C IT ? Ok 9 —I 0 4 5 Fees due upon application
Phone: ( 5p3) (p 3 q 2 q1 Fax: ( ) Amount received
CCB lic.: 1 I
Date received:
Authorized This permit application expires if a permit is not obtained
' fit within 180 days after it has been accepted as complete.
Print name: ,444 f C 1 rs 7rtp.A/,j Date: - - i - 0 * Fee methodology set by Tri- County Building Industry
Service Board.
i:\Building\Permits \SIT- PermitApp.doc 12/03 440- 4613T(II /02/COM /WEB)
City of Tigard: Site Work Permit Checklist
Page 2 - Supplemental Information
Commercial, Multi- Family and One- and Two - Family Dwellings:
No permit is required if fill is less than 50 yards (5 dump truck loads), or less than 3 feet deep
and will not be supporting a structure. If a building will be constructed on the fill, it must be
engineered fill. If fill is in a flood plain, drainage way, or wetland, the applicant must apply
for a sensitive lands review (SLR).
Please complete all items below, unless otherwise noted.
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.
.� ..� , .�k €a t , '" � ' law' t gg ° VUI ' 's"" 3 ` �"t,a ` .. .,r l cx, C;. r ! -:
'�.�.�...: _za-' :, x, �, ,.. x�`z�. �o�. .'* ���� ��.?�`�' rr.:€�...�.. '`:.� �.`�' � 5'gf x�,.,..t... �a .. M Ll.
Site Utilities Plumbing Work:
Complete the Plumbing Permit Application for site utilities plumbing work.
Plans Required: See "Site Work Permit Application - Plan Submittal Requirements"
attached. The following must accompany this application:
❑ Site Plan with Vicinity Map showing ❑ *Parking (including ADA) and
ADA compliance Lighting Plan
❑ Grading Plan and details ❑ *Landscaping Plan
❑ Erosion Control Plan and details ❑ Soils Report (if required)
❑ Retaining Structures
*Does not apply to One- and Two - family dwellings.
14 ofPlans=�
T ` gTYPE;OF SUBMITT t : �, � � Requitred at
% (Includes` New, Additions or Alterations) y �Subm ttal
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
i:\Building\Forms \SIT - Checklist.doc 12/29/03
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S89'07'l7 "E 309.27' •
SCALE: ' "= 30' .. • . • • { _ : _
CITY OF TIGARD 24 -Hour
•
BUILDING - Inspection Line: (503) 639 -41175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST - 7
BUP 04 ! g
Received Date Requested / ` J AM PM BUP
Location / `7 4 79 Suite MEC
Contact Person Ph ( — Foto PLM
Contractor Ph a SWR
11LDIN Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam A44 /-(-C
Shear Anchors /'
Ext Sheath /Shear O _p2
Int Sheath /Shear
Framing 46/5.5rZ t i - - L u l 4t S
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Othe /� A/n �,
Other: d i' /w
( PA BART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
• Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam •
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL.
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect - no access
•
Fire Supply Line
ADA /„../A
Approach/Sidewalk Date // —r ¢— Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL