Permit A - CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00434
.11i; DEVELOPMENT SERVICES DATE ISSUED: 9/10/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136CB -05400
SITE ADDRESS: 11020 SW 83RD AVE
SUBDIVISION: STEVE + HUGHIE'S PLACE ZONING: R -4.5
BLOCK: LOT: 026 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK : sf N: S: E: W:
OCCUPANCY GRP: 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: $ 500.00
Remarks: Replace existing front deck.
Owner: Contractor:
LAFFERRIERE, GERARDO + BEATRIZ
11020 SW 83RD AVE
TIGARD, OR 97223
Phone:
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 9/10/2004 $62.50
[TAX] 8% State Surchari 9/10/2004 $5.00
[BUPPLN] Pln Rv 9/10/2004 $40.63
Total $108.13
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: _
Permittee
Signature: 2
Call 639 -4175 by 7 p.m. for an inspection the next business day
c b eNeN) Building Permit Avalon n FOR OFFICE USE ONLY
City oo Received
of Tigard 1 Q Permit No.'7.
r' _ �yt
`J g C p Date/By: . 6 I/V �/ s
13125 SW Hall Blvd., Tigard, OR 97223 J 14 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 1 'a 1/4.0% � ( � j t_ ✓ `' 4 ■ �Il�` f� Date/By: Other Permit:
Inspection Line: 503.639.4175 1 OUIVI ` w • U • ' I ,, Date Ready/By: furls: ® See Attached Checklist for
Internet: www.ci.tigard.or.us eg yy o Notified/Method: - 1 ( 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 CONST RUCTION work indicated on this application.
dwelling a. Valuation: $ 5 0
1- and 2-family g ❑ Commercial/industrial
El Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
• - JOB SITE INFORMATION AND LOCATION i 4 s ; Total number of floors:
Job site address: 1 O . o Si p '3 rd A LA, New dwelling area: square feet
City/State/ZIP: Ti (r-A-41 312 y° 72 2 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: FRoN T PDiz tit 9- Covered porch area: square feet
Cross street/directions to job site: $ 3 a S44. 1"e_ Deck area: square feet
Other structure area: square feet
REQUIRED DATA COMMERCIA 4ISE' 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.
Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: G,e tr. AFFi:11 I 1L1g Type of construction:
Address: �1 p 20 S W 3 rd 1 Occupancy groups:
City/State /ZIP: 'n ( A-A.9 p 2 9 7 . 2 3 Existing:
Phone: (55 3) 470 .-1 1 4 v Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: 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: d w L, BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: (
Amount received
CCB lic.:
Date 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: Date: * Fee methodology set by Tri -County Building Industry
Service Board.
i: \ Building \Pmnits \BUP- PermitApp.doc 12/03 440- 4613T(I1 /02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist I FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Dated t
Phone: 503.639.4171 Fax: 503.598.1960 Owae.t ,
Associated permits:
C:1 Electrical ❑ Plumbing ❑ Mechanical
24- Hour Inspection Line: 503.639.4175 „41.
Internet: www.ci.tigard.or.us ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. El ❑ ❑
4 Fire district a • s royal re • uired. Name of district: ❑ ❑ El
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. El ❑ El
7 Water district approval. ❑ ❑ El
8 Soils report. Must carry original applicable stamp and signature on file or with application. El El El
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ El ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
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, ❑ ❑ ❑
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 ❑ El ❑
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. El ❑ El
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 Ore:on and shall be shown to be applicable to the .ro under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ El El
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. ❑ El El
26 `Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. El ❑ El
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ El
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ El
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. El ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ El ❑
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.
i:\Building\Permits \One- Two - FamilyChecklist.doc 12/03
•
Permit # d C00 rO V3 ` 7
OF
c Address: \ \ 42_6 S Li)
.' Issued Date: q Oc( 1859
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors. Board to sign the
following statement before a building permit 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 1 and 2, and either box 3A or 3B:
1. I own, reside in, or will reside in the completed structure.
I I 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
I ' 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 Contractors Board.
OR
n 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. 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.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about onstruction Responsibilities on the reverse side of this form.
) 14c 1 64 '
ignature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
• _ , . . •
. .
• Information Notice to Property Owners
1
About Construction Responsibilities . .
. . .
Note: This Information Notice to Property Owners about Construction Responsibilities
. .
I
was developed by the Construction Contractors Board in accordan :e with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent, many problems by being aware of the following responsibilities and u of concern. .
EMPLOYER RESPONSIBILITIE . .
If you hire persons not registered with the Construction Contractors Board to do ki.bor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be i to be au i employer and the people
you hire will be employees. As the employer, you must comply with the following:
• - 1
I
Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091.
1
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call.the Oregon Employment Division at the Department of Human_Resources
at 378-3524.
. _ .
. ; .
Workers' compensation insurance: As an employer, you are subject to the Oregon N
orkers' Compensation Law, and must
j
obtain workers' compensation insurance for your employees. If you fail to obtain wo kers' compensation insurance, you may
■
be subject to penalties and will be liable for all claiinco if one of your employees iS injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income t4from employees'Avages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more inforrnation, call the Internal Revenue Service
at 1-800-829-1040. • _ , . . . .
. •
OTHER RESPONSIBILITIES AND AREAS OF ;ONCERN:
I
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections. .
Liability and property damage insurance: Contact your insurance agent to see if you have ad insurance coverage for
accident. and omissions such as falling tools, paint overspray, water damage from pipe punetures, fire, or work that must be
re-done. . . .
. , .
Time to supervise employees: Make sure you have sufficient time to supervise you employees.
Expertise: Make sure you have the expertise to act as yOur own general contractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times so they can perform the inspections.
. „ .
, .
If you have additional questions, write or call the Construction Contractors Board (O Bo 14140; Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-ow n . pm4
t 194 . .
CITY OF TIGARD 24 -Hour - _
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received =iii Date Requested
4)"/".7 AM PM BUP
Location `/Z 1 `3 Suite MEC
_Contact Person Ph ( 4P7 )0 ll.D PLM
Contractor Ph ( ) SWR
Tenant/Owner ELC
s Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post -& Beam -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing 4 c4 kwU
tiolNailing '
Firewall
Fire Sprinkler
Fire Alarm •
Susp'd Ceiling
Roof
Other:
PART FAIL
P I MBING
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 LI Reinspection fee of $ required before next i spection. 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
IL
Approach/Sidewalk Date • ✓ ( Inspector 1 I lk* Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation - 42 0
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
a ; /e-'-r:L____Alet__
w h = �
��_ - In it A.M. P.M. Entry:
Address: 7 / / U _ . • _`_l_ ""
Tenant: Ste:j4/ MST:
BUP:
Con /Own: 6 , MEC:
/
19 U � 4 7 4- 3 0 ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
— MAMMY ZC_ / -
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nspector: C` 4,40.421 R-fc( Date: 7 ?
APPROVED DISAPPROVED /CALL FOR REINSP. 40 CO