Permit CITY O TIGARD BUILDING PERMIT
A: PERMIT #: BUP2004 -00235
DEVELOPMENT SERVICES DATE ISSUED: 5/26/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12905 SW 121ST AVE PARCEL: 2S1036C -01700
SUBDIVISION: CANOGA PARK ZONING: R -4.5
BLOCK: LOT: 001 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: 5N : 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: $ 1,200.00
Remarks: Fence over 6ft.
Owner: Contractor:
BECKER, GORDON S AND OWNER
MARJORIE K
12905 SW 121ST AVENUE
TIGARD, OR 97223
rnone.
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Footing Insp
[BUILD] Permit Fee 5/21/2004 $62.50 Final Inspection
[TAX] 8% State Surchari 5/21/2004 $5.00
[BUPPLN] Pin Rv 5/21/2004 $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 (50- .699 or 1- 800 - 332 -2344.
Issued , , � .
Permit tee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
5
Building Permit application 2 l FOR OFFICE USE ONLY
City of Tigard L I V i�. Date/By: Received e�� PeraritNo J ' IL `1 U(l • U(/p�3
13125 SW Hall Blvd., Tigard, OR 97223 / V Plan Review / / f /
Phone: 503.639.4171 Fax: 503.598.196 Q I 2 1 1 Date/B : - a Other Permit:
Inspection Line: 503.639.4175 20u. J `' Date Ready/By: Jaris: . ® See Attached Checklist for
Internet: www.ci.tigard.or.us oF Notified/Method. 11 (.j Supplemental Information
_ /r-"R I
TYPE OF WORK REQUIRED DATA: 1- AND 2- F.kNIILY 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: _ w . (. .. equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION
work indicated on this application.
❑ 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ /V dd
El Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder t Qther: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /..e/'03 S W e I it . f. /1-11-C.- New dwelling area: square feet
City / State/ZIP: _ ar / D K. ` 2 2_3 Garage/carport area: square feet
Suite/bldg. /apt. no.: -.7 Project name: Fe of e , 4.- G fr Covered porch area: square feet
Cross street/directions to job site: /t/, At c r --hef Q f /z /rT 1 4.,/c- Deck area: square feet
ti Ai , e t s1 Other structure area: square feet .
R DATA: COMMER = 4
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: $
f-- f) r7 i L) z /' L� •S i ,✓ . ? l f
t , . , r' et IA a F112(.t L /
Existing building area: square feet
New building area: square feet
;4
t'. ` s // - ( TENANT Number of stories:
Name: Go NCO rA 1.._ Ma ..- 0 /-- eCK v'' Type of construction:
Address: z $d .S S/ V►/ . jai ,-,` � e Occupancy groups:
City/State/ZIP: - ex !`o? / 0 ►e_ '1 72-2.3 Existing:
Phone: (503) go .. 40 0 Fax: ( ) New:
tannwlik, , 147, - : --
. ' ` a M s.N ,CONTACT - PERSON
,.,� . a ..� NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
t'Z r •' �� under ORS 701 and may be required to be licensed in the
Address: 1 2 q 0 S - T vl/ _ i2- f �-(' A- vc jurisdiction in which work is being performed. If the
City/ State/ZIP: applicant is exempt from licensing, the following reasons
� q r , 0 7 2 Z3 apply:
Phone: ($ o3') S'ci 0 _ 717)0 Fax: : ( ) c;).- ST
E -mail: bC Z Z be � _t__,, L, n ,.,.) ,_,, co l .
CONTRACTOR 5 ry e ,
Business name: i i L , k L L..
BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City/State/ZIP:
Phone: ( ) Fax: ( ) Fees due upon application
CCB lic.: 1 Amount received
Date received:
X Authorized signature: / This permit application expires if a permit is not obtained
✓✓11 within 180 days after it has been accepted as complete.
Print name: ‘d ,do v? J e e e t c ,,,,, h Date: S / //O / * Fee methodology set by Tri -County Building Industry
Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11/02 /COM/WEB)
One- and Two - Family Dwelling ' , ,
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 Art N�lioNU \i /ii ❑ Electrical ❑Plumbing ❑Mechanical
24- Hour Inspection Line: 503.639.4175 ,_
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. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ CI
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 ❑ ❑ ❑
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 ❑ ❑ ❑
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 Ore:on and shall be shown to be applicable to the project 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 ". ❑ ❑ ❑
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 tree protection measures as required by conditions 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.
i:\Building\Permits \One - Two - FamilyChecklist.doc 12/03
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CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: vt f iii.
PLANNING DIVISION: .,
Required Setbks: 'I Approved ❑ Not Approved
Side: J Street Side:
Front. Garage: ear:
Visual Clearance: gl,Approved ❑ Not Approved
Maximum Building Height feet
CWS Service ovider Letter Required: ❑ Yes 0 No
A/ p
❑ Rece ivF .
ENGINEERING DEPARTMENT:
Actual Slope: %o ❑ Approved ❑ Not Approved
Site Plan: ❑ Approved ❑ Not Approved
By: Date:
Notes:
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #:U2ooy- cx� S
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 �r��M��Ip�i8 1" ii
Inspection Requests (24 Hrs.): (503) 639 -4175 'I —
INSPECTION WORKSHEET FOR DATE: 3/ TIME: PAGE: 1
SITB ADDRESS: IZ9 JZ/ ST AVL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 /ZS/ Pour Time:
Code # Inspection Description Confirm # Contact # Message
Z11 F67Vci:: ov&Z 6 nlA- sbs gc$-/-9oa/ d
Corrections/Comments/Instructions:
Or
/
PASS 7 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL mfALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718 - 26 L4/9
_i___Iin°
CITY OF TIGARD 24 -Hour
BUILDING Inspectioh Lines (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171
MST
BUP
9 4' ' Date Requested S 2 8- 0 AM PM BUP
Location / 2 9'0 2 / Sf Suite MEC
Contact Person ijdY? Ph PLM
Contractor Ph ( ) SWR
BUIJQG Tenant/Owner ELC
(Footing ELC
i- oundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: " --.7
Post & Beam /
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall �- p v(�
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
F' •
PART FAIL
P u ' = ING
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 El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please - II for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line �t I C �-
ADA Approach/Sidewalk Date I Z ! 0 ■ Insp ector �� L . _ �, \'�1` -'� Ext
Other:
Final DO NOT REMOVE this inspection reco I rom the job site.
PASS PART FAIL