Permit t +- CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00262
I DEVELOPMENT SERVICES DATE ISSUED: 6/4/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15180 SW 133RD AVE PARCEL: 2S109DA -02300
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: URB
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: R1 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: Demolition of 3200 square foot residence. Septic tank is to be pumped & filled. SDC credits to apply to future
construction.
Owner: Contractor:
VENTURE PROPERTIES NORTHWEST EARTHMOVERS INC
4230 GALEWOOD STE 100 PO BOX 1467
LAKE OSWEGO, OR 97035 TUALATIN, OR 97062
Phone: 503 - 387 -7600
Phone:
Reg #: LIC 62761
FEES REQUIRED INSPECTIONS
Description Date Amount Ersn Cntrl 681 -4444
[UBUILD] Permit Fee 6/4/2004 $62.50 Pump/Fill Septic Tank Insp
Final Inspection
[UTAX] 8% State Surchz 6/4/2004 $5.00
Total $67.50
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 B • 6-ga4/t/a—ki
Permittee
Signature: X
Call 639 -4175 by 7 p.m. for an inspection the next business day
Buildine Permit Application i FOR OFFICE USE ONLY •- •
Cl of Tigard Received 1 ! v ' Permit No -
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �■ y Date/By: Oth -- 't: .
Inspection Line: 503.639.4175 [ �� _ Date Ready/By: Fr 1` rea See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: r upplementalInformation
Wtm -RM S : r;:Y. . �.o-E, .se.'GUF`�'a { .� �' ', a "f �.•" .�.1 'v 4'S� a.� � 'x^»... i
fi i � + "^. .., : f,g-al i uW . OoRft . A :.. :. _ �ft - t; ; . <, . 111 �; R Q,U DikcKz A I D2 FA -tgv ft D,WEI'.I:ING
❑ 'New construction a 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
::;. rp ; '= ;' : ^';cx >.r T � :: : ; .t, f �: v� A - : z F4 -T i work indicated on this application.
` . 3 � i ,I' ' . CAT0 R GONSTR CTIOrN a;l .,` AVA1=:' ,' '," ,.g ` PP
a1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 2k•.M. gIGO"
❑ Accessory building ❑ Multi - family Number of bedrooms: 14
❑ Master builder ❑ Other: Number of bathrooms: Z
.5 `i'.� ' - "JOB S ORMQT AND''OCATION Total number of floors: Z
Job site address: \,6 1 .3Q ,__6(...3 171-3C1 g area: : 7A)) square feet
City/State /ZIP: Tigard, OR 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: — Project name: Summit Ridge Covered porch area: square feet
Cross street/directions to job site: West on Bull Mountain south _ Deck area: square feet
on 133rd East on Southern end of 133rd , Other structure area: square feet
: I,2EQU-M DATA COIyIll %ERCIAE- .CISEE •
Subdivision: N/A Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 3 I 0 G — idicate the value (rounded to the nearest dollar) of all
-• 0 = .uipment, materials, labor, overhead, and the profit for the
4 ,: Z 0, AATE'SVViAM : . $ D RIP,TI k�i pF WORI{ ate ' , ' A t work indicated on this application.
Valuation: $
Remova of 'house t4[L
.4 , ! � ' Existing building area: square feet
New building area: square feet
.0 €?'".' -�' ?y 4;' sus :'.sraa; °�:°�'- ';::�, ° "tsc.8,. 7�::,',`..- -- Y �.-:: r�;,:.:.s:_:K,;. °, >" :'
., �tPROPERT C OWNER :��, ®. GENANT Number of stories:
Name: Venture Properties The of construction:
Address: 4230 Galewood, Suite 100 Occupancy groups:
City/State /ZIP: Lake Oswego, OR 97035 Existing:
Phone: ( ) 503- .387 -7600 Fax: ( ) 503-387-7U7 New:
'�� '" 4 4 , ' APP.LIt ANT 1 :16 > ,, C. ,' ... =� , k >
:� C = � � ON T . GT . PE`RS,Ol�'�- �° �> � � �� � 't ' �� > r . ; �.'� �` � ; �
�. ��; :x ': fib . _ < „_ t : �N �A . � x ; r F i i`• °` ' � ' .„ ,z - 1 6 01 L k, ” _ .
Business name: Same as Above All contractors and,subcontractors are required to be
Contact name: Jim Delmore licensed with the Oregon Construction Contractors Board
under ORS 701 and maybe 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: ( ) 503 - 866 -4839 Fax:: ( )
E -mail: jimd@donmorissettehomes.com
:. i`�8"" -` '�i �� � �.� ..� :,fir' -.��. - �°`�m ^" - � � ' �'S c. b� '"s,'""'€�z
=7 rt`g ,F COI�ITRA' kta : k r I t _ p ' tk
Business name: NEI `'t ; .
- BUI - - i PERMI'T FEES *c:
Address: 16850 SW Boones Ferry Please refer to fee schedule.
City/State /ZIP: Tualatin, OR 97062
Fees due upon application
Phone:( ) 503 - 624 -0363 Fax:( ) 503 - 639 -1634
Amount received
CCBIic.: 62761
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: 1m Delmore Date: 3 June 04 * Fee methodology set by Tri -County Building Industry
Service Board. k n1�^ 1
i:\Building\Pemvts \BLIP- PermitApp.doc 12/03 440- 4613T(1 t /02/COM/WEB) v- ,....3, (j'
'C'et (&� C4 •% ,......62404W.7&&461
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY _~
City of Tigard Received Permit No..
13125 SW Hall Blvd., Tigard, OR 97223 Date ia t
Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 // 4 111 , 1 1 i
24- Hour Inspection Line: 503.639.4175 A. OA 11 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us • ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED, FOR PLAN REVIEW Yes No N/A
I 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 ❑ ❑ ❑
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 Oregon 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 24 -Hour
BL;LDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171 2 //�
Received Date Requested 2- � ` PM BUP
Location t'S 8( Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling Roof .17 „tp ^l! 0 r eft
Oth : r•►` ' r
• SS PART FAIL
PLU I. = 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please cal for rein section RE: ❑ Unable to inspect - no access
Fire Supply Line } ADA ! Approach /Sidewalk Date � Inspector Ark Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•
, 11/22/2004 11:25 NORTHWEST EARTHMOVERS 5036243681 NO.136 ?012
fax transmission
{ NORTHWEST E.4RTHMOVERS, INC. {
PO 130X 1407 /j
TUAL AT1N, OR 97062 f roa►Nwaa► I 9 l«ovwasaaai
Phone: (503) 624 -0363 r •, M +`
Fax: (503) 639 -1634
Date: 11/22!2004 Time: 11:24 AM
TO; City of Tigard FROM:
Attn: Dan Nelson Jeff Dickson
Fax it: 503-4624-3681
Project: summit Ridge
# at Pages (including this form) : 4
message:
Demo Permits: BUP 2004 - 00260
BUP 2004 - 00261
BUP 2004 - 00262
Attached are the documents provided by Aloha Sanitary Service for the cleaning of the septic tanks for
the above referenced demo permits. After the tanks were cleaned they were removed and hauled to
an approved dumpsite.
If you have any further questions or need any other documentation please let me know.
Thanks,
Jeff Dickson
CC: File
Hard Copy To Follow By Mail : Yes No
11/19/2004 8:5S NORTHWEST EARTHMOVERS -> 5036243681 N0.13 D02
' ' No 03 0* 02: 1Sp Kel 1. Morgan 503-844-7598 p.2
...____
•
. . . ,
.
N VOICE NC. 7
A 1 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 • •N .• 4
P a .
503-644-2797 • 503-648-6254 * 503-639-5188 -
1 NAME: I
M eadq-4tir /Z ,--- /9R - ii'&1/W 4 ted I
1 I ADDRESS:
erry: STATE: ZIP: _ ......._____
HOmE:
WORK: CELL:
JOB SITE: /
r' 77 6 i'' it It P-Ntt,
P.0.#: 7 7 17/7
PAID BY CHARGE CHECK LI CASH U CREDIT CARD U
f -
DATE 6) 9, z i.. 1 _ ? ...6 0 q DRIVER ( o ii 6 AMOUNT
1 0(1
, a .'" PUMP SEPTIC TANK
• 7S d ----
,
, INSPECTION FEE
LI SERVICE CALL
2JI LABOR, LOCATING, DIGGING, BACKFILL
___. _
L
• _. .
i TOTAL 1 $ :7 c - rcf ..)...
.• ..... .',.• _ ' . ,, - . 1.:.• - .- .'.': -::-.'- .:..' 7'7.: .:..:- •• ' j
,. .
- REMARKS - -
TYPE OF TANK: STEEL LI CONCRETE D PLASTIC•U HOMEMADE LI
il HORIZONTAL 1 U VERTI • U REC - NGLEIZI 0 OTHER
I SIZE OF TANK: 350 a 500 0150 In : • • 0 1250 0 1500 0 2000 0 3000 0
1
LID LOCATION: INLET Li UTL al MIDDLE 0 ENTIRE TOP D
1 TANK CONDITION: Goa) 0 .
• IR Li POOR C:3
' ! FITTINGS: BAFFLES U CONCRET: E3 CAST IRON C PLASTIC D
• NEEDS NEW LID? YEs U SIZE
GROUND COVER OvFR TANK
COMMENTS ON CONDITION OF DRAIN FIELD ETC, '
----_______...•__________
SIGNED BY //
,.............._,... _ _____,.