Permit ,
CI OF TIGARD
PERMIT #: BUP2004 -00213
- .0#4 DEVEL Tigard, I CES 1639 -4171 DATE ISSUED: 5/11/2004
SITE ADDRESS: 10327 SW PICK'S WY PARCEL: 2S1146B -18500
SUBDIVISION: RIVERVIEW ESTATES ZONING: R -7
BLOCK: LOT: 031 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: NONE : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: 5 ft RGHT: 5 ft FIR SPKL: SMOK DET:
DWELLING UNITS: 1 FRNT: 15 ft REAR: 15 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 4,764.20
Remarks: 287 square foot awning
Owner: Contractor:
LARSEN, STEVEN C + NORTHWEST FINISH LTD
KAREN L TRS 1417 NE 76TH
10327 SW PICKS WAY SUITE F
TIGARD OR 97224 VANCOUVER, WA 98665
one
Phone: 360 - 699 -0562
Reg #: MET 4971
FEES LIC REQMJi1�6INSPECTIONS
Description Date Amount Footing Insp
[TAX] 8% State Surcharl 5/11/2004 $7.30 Final Inspection
[BUILD] Permit Fee 5/11/2004 $91.30
[BUPPLN] Pin Rv 5/11/2004 $59.35
Total $157.95
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 -Os ; • • • h OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling .13) 246 -6699 'r 1-800-332 • • . `
1� �� 1 ,
Issue By: 1�9_ L �
�lL •
Permittee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
.
Building Permit App • ,. D n- FOR OFFICE USE ONLY
Received I 1
City of Tigard �® Date/B : 5ff / Permit No.: a.
13125 SW Hall Blvd. r ' 7223
t= oy Plan Review
Phone: 503.639.41 03.598.1 66 � 'i' Date1B : Other Permit:
Line: 50.4175 - \) 2 Q „_!_ A I I Date Ready/By: El See Attached Checklist for
Internet: www.ci.tigard:or.u�'\P \G,{� \ O N Notified/Method: I Supplemental Information
J \ . cAvi ' 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
K Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead; and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1:3 1 - -and 2- family dwelling ❑ Commercial/industrial Valuation: $ L/ 7611
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder �.,'' er:
I4 O \O n - Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /00:21,9,7 sw ice` S WqA...-' New dwelling area: square feet
City/State/ZIP: -n G A - , D 2 0 2 7 ( _ / q Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: L t1 ✓r 1KS - Covered porch area: square feet
Cross •street/directions•to job site: Deck area: square feet
Other structure areaS7 square feet
REQUIRED DATA: COMMERCIAL -USE 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.
i Valuation: $
`5` i ^ _ t t �� . Existing building area: square feet
. Zj%( -P • '`i New. building area: square feet
0 OWNER ❑ TENANT Number of stories:
Name: G 1.A vs __ y Type of construction:
Address: /(3a,7 3t des Loci, . Occupancy groups:
City/State/ZIP:q t5 ( ®V. q 72,ari Existing:
• PhoneL{ ' )• Copo r it( Fax:•( )• New:
- APPLICANT ❑ CONTACT PERSON NOTICE
Business. name: A s ,44. /vesk L'tv All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
I under ORS 701 and may be required to be licensed in the
Address: / L/ ` 7 i„/, 76 ' x `'` $ 4 . F jurisdiction in which work is being performed. If the
City / State/ZIP: JQ J.� 1 LA 364 applicant is exempt from licensing, the following reasons
apply:
Phone: (36C>) 6 f'65 CzR I Fax: : (3b0 04' -6 47C.- .
E -mail:
CONTRACTOR
Business name: Ab9A critic LT) BUILDING PERMIT FEES*
Address: t [ 17 )/ 6 7t r- Please refer to fee schedule
city/ State/ZIP: va_ncawe r, �4
`�-� Fees due upon application
`1
Phone: 06a) 6` ' a5�� Fax: (3(,()) 611.C4 _
L
„,„0001111 Amount received
CCB •lia �
: 6
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: /e .i ce Sepdp r.c.! r, ' Date: f� a , y • Fee methodology set by Tri - County Building Industry
Service Board.
is\ Building \Permits\BUP- PermitApp.doc 12/03 440- 4613T(11 /07/COM/WEB)
May. 6. 2004 2 :39PM CLEAN WATER SERVICES 503 6814439 No.1379 P. 1
APr•19 14 I:12PM ULAN WAIkH SLKiV1US NUJ 1141:1M5 no ILOO P. c/2
•
``� 1 ' U. t VJ . 0 �� 1 ' Re Number yx
Q‘ , V Se ' WR 2 9 2iO4 U
wA , � dnmit,ncnt is eleer. 1l 3a nsi Area Pre - Screening Site Assessment
\ ` F. \s\`.''
6 Map & Tax Lot _ _ / A `. Cc Owner
Site Address : .. t t�'1 t
ti, ast_ Contact 1911r-1n g i ,. h 1 .
Proposed Activity , - Let -% _ Address
tau7 n, 7fe s
4.10 v+a,c , cu•er nC t d 'S
Phone �o- 6g -dst
: mac.
o!f c d use o 7fybekiw ads lira .
Y N NA Y_ N NA •
f;4 ri TT Sensitive Area Composite Map n Stormwat�er Infrastructure maps
L'I Ma # • Z - U ❑ L21 QS # 1I
U ❑ rm . Locally adopted Imo! l J studies or maps ❑ Other
�1t Specify Specify - era b/ ,.a..,
Eased on a review of the above information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. 04-9:
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT . •
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas
exist on the site or within 200 feet on adjacent properties, a Natural Resources
Assessment Report may also be required.
Sensitive erects do not appear to exist on site or within 200' of the site. This pre-
. screening site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently discovered on your
property, NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
STORMWATER CONNECTION PERMIT.
❑ roposed activity does not meet the definition of development. NO SITE
-
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments: , , -
Reviewed By /.fir _ Date - elOt
Returned to Applicant
Post- it. Fax Note 7671 Date 6 , 4si ■ / Mail Fax,k Cm:W r
To Ro h4/54.6, //ay. Dale.gfel ,Sy
c° NA) 60 co.
Phone,H ,lq,p Phone 0 3 .. eel— 360 cc .
Fax # :0 - a /, 6#Se Fax a c7yJ
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28' / 30' -6" �f
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(E) DRIVEWAY �. 'e'S'
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CITY OF T1GARD - SITE PILAII REVIEW P to
tri
BUILDING PERMIT NO.: bu.-V _ppa4 5 C3...'40 00 t,
T PLANNING DIVISION: R -7 pp rg
Required ,Setbacks: 0 A proved ❑ Not Approved
N Siri 2: d
Street Sic / rri
E Frog . Gar�Le: AO_ Rear: /5- G n
o Visua`. C'I;,�ra: =:e: iv /�}►�' A,�pra�ed 0 Not Approved , ` � 1
,L
f Maximum Buii ing Height. b 3S feet
-Jo
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WS S e �P ovid . Letter R =squired 5 Yes ❑ No
0 T a-= . rn
/ � ❑ Received v r- C rn
r I-, o
B) Gt . C atn4-,Q� Dat : :: S - // - o N p o
ENGINE 'G DEPARTMENT: 0 Z Z0 '� a
Actual Slope: _% ❑ Approved 0 Nct Approved y
Site Plan: ❑ Approved ❑ Not Approved 0
c2 By:
Date: z
Notes :' pet4 ca_ ® / cn ..e -,ned, €44 .../ X. M
CITY OF TIGA,RD.- 24 -Hour .
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST ,,!!
643 BUP
Recei�r €d Date Requeste AM PM BUP
Location 03*- S7 A) ` ' SW Suite MEC
Contact Person Ph ( ) (2Q c G —OSZDa PLM
Contractor Ph ( ) SWR
UILD 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
Final
S PART 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 ❑ 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 ` � O�
Approach/Sidewalk Dat Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL