Permit A, CI'T'Y OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00402
�fl�, DEVELOPMENT SERVICES DATE ISSUED: 8/24/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S133DD 11400
SITE ADDRESS: 11847 SW 125TH CT
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 ZONING: R -4.5
BLOCK: LOT: 151 JURISDICTION: TIG
REISSUE:'‹ FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: A� f` _ FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: / 70 sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: /6 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: 40 psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:Y
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 6,000.00
Remarks: In -fill 2nd floor of 2 -story greatroom.
Owner: Contractor:
ROBERTS, JOHN C REMODELING + MAINTENANCE SVCS
11847 SW 125TH CT PO BOX 231061
TIGARD, OR 97223 TIGARD, OR 97281
Phone:
Phone: 503 - 330 -7267
Reg #: LIC 66997
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 8/18/2004 $100.90
[TAX] 8% State Surchari 8/18/2004 $8.07
[BUPPLN] Pln Rv 8/18/2004 $65.59
Total $174.56
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.
0
L._ 31,!�'� i � � � _ l
Issue By:
Permittee `
Signature:. _, s 11/ M/
Call 639 -4175 by 7 p.m. for an inspection the next business day
f .
Building Permit i k∎ " D FOR OFFICE USE ONLY
City of Tigard , � Q *4 Date/By Received irk 1. ! 1 Permit No.:(J 2 (4 T D .944�—W M O
v
13125 SW Hall Blvd., Tigard, OR 97223 \ Plan Review )
Phone: 503.639.4171 Fax: 503.598.19 c �'1GA /r � m r , lil�;i'Nr1i` '^i ' i I Date/By: y: if dy K4V Other Permit:
Inspection Line: 503.639.4175 -'1 G w1�j1��,„ _ y -'1 Date Ready/By: G I Juris, ® See Attached Checklist for
Internet: www.ci.tigard.or.us ' o \NG Notified/Method: p/a Supplemental Information
�' ; W' � j ;','7,:,-,A'''-iii.,.::,', FA: J, I E 1."ivn i DWEL
❑ 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
" 1 £� l,V 4 work indicated on t his application.
� l ® PP
-and 2- family dwelling ❑ Commercial/industrial Valuation: $ AC-4
❑ Accessory building 1:1 Multi - family
Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
'g Total number of floors:
. _ x �� _ - .° -sus mot .. , ,',� a'�.,�.a, s ... �3� _
Job site address: % I. By 4, 5u1 1 2 1 - c'T New dwelling area: square feet
City/State /ZIP: -• ( 6 p g... .1 OR, ° 9-Z2.3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: 2^ P Lc. e.4(... r'.) : ` ` Covered porch area: square feet
Cross street/directions to job site: end's r F tNLCdh 1AtS Deck area: square feet
r""1 'A P ► 2 , S 0 •.114 F O A M V.1R L . ..L t A 12T' Other structure area: 1$ O square feet
r &i F' Y/`OYY1 - YAU'tS "! I A• 1301.1 ,. li DAtI.`'r t •COMMR C i4 I :;k4;.'61. EcI<LIST.
Subdivision: V N��Q, a .... S vrn,,,.,C�al,.2 , Lot no.: JS \ 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
work indicated on this application.
1'J` e-\ Z -S C 6 .6 2 -C- p�Q_00'(1(� CC�A' Valuation: $
1
' FA . M t L� (] CI AN <1gs T /A 0-2--s Existing building area: square feet
u � New building area: square feet
- > e` .. , . > -. t . qtr. � t ,. it ;: Number of stories:
Name: 6u16,3 \ cji G. �S Type of construction:
Address: I L9Lfq- S(.),) t 21- C, \ Occupancy groups:
City/State /ZIP: T vs A6-1_ C CZ, (=I - I-ZZR, Existing:
Phone: Gt. ) 'E 612o C.0 k k Fax: SG? ) 2 13 6'-1 43 New:
'Ate i ' k i Xa . ( . y ; " e 6 t ,; ° k ° hgx�s a" ,� V: r:1. g '`..: z v t w 7 ,_
Business name: IJ j, , All contractors and subcontractors are required to be
Contact name: pl„ \� �Ve a GZ c� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1 \',(.. '} Ste) I2J I c...7 jurisdiction in which work is being performed. If the
City/State/ZIP: r \ �Gl..: O6c c1'422 3 applicant is exempt from licensing, the following reasons
apply:
Phone:
(5 tL`1, -61ZO cal` Fax: :fsc.,3) Z►� G . ly3
E -mail: v ( . A60,,v .d21 (
. .
i % .- • , %i p: �3i, • vQhs� %Q..S • B[7I11,DIlVG rEkM1T FEES*
Address: CJ (gait 2.." 1 is G.
Please ease refer to fee schedule.
City/State/ZIP: T1 c., ACi.-> Ca, cl') 2 k
Phone: Fees due upon application
�3) 130 .- a16 �. I Fax: �v) c � yO CCB lic.: GGcl 4, 0 V Amount received
Date received:
Authorized signatI. - • --", This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ^ - b t. 1 (,ZLAC - 6 - (1 - Date: 8 i 1 vJ° `i * Fee methodology set by Tri- County Building Industry
Service Board.
is\ Building \Permits\BUP- PermitApp.doc 12/03 440.4613T(11/02/COM/WEB)
Building Division
i��j Plan Submittal Requirement Matrix
` Commercial & Multi - Family - New, Additions or Alterations
City of Tigard
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue)
* For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i: \ Building \Forms \COM- PlanSubReq.doc 12/24/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP ° - � f — d 6) 44'
Received Date Requested ' AM PM BUP
Location l I 0 Li 1 ! 0 , S -1/4(4 " It Suite MEC
Contact Person Ph (C1 fp) g 1 PLM
Contractor Ph ( ) SWR
ILDI Tenant/Owner ELC Z 6 d' - 6 C)4 4 /
Foo
Foundation Acces ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT �- / l
Post & Beam �— a3
Shear Anchors Q I
Ext Sheath/Shear L% I C !
Int Sheath/Shear "2 Lo � N _ / I r• 1
Framing 7
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
S PART FAIL
- 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
PA FAIL
LEC IC
Service I '
Rough -In 6.V
UG/Slab
Low Voltage
Fir arm
dri fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /
ADA �a Q , 1 /
Approach /Sidewalk Date / 7f Inspecto �
. •. d" Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL