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Permit
CITY OF TIGARD BUILDING PERMIT PERMIT #: BUP2003 -00322 t DEVELOPMENT SERVICES DATE ISSUED: 6/4/03 ,l- '`J I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11514 SW TWIN PARK PL PARCEL: 1S134DC -09300 SUBDIVISION: TIGARD PARK ZONING: R -4.5 BLOCK: LOT: 009 JURISDICTION: TIG REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: dl\ 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: 5 ft RGHT: 5 ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: 20 ft REAR: 15 ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 1,500.00 Remarks: Construction of splash deck for above ground pool. Owner: Contractor: FREDERICKSON, ANDREW J /CATHY + OWNER FREDERICKSON, EVELYN ELIZABETH 11514 SW TWIN PARK PLACE TIGARD, OR 97223 Phone: Phone: Reg #: FEES REQUIRED INSPECTIONS Description Date Amount Final Inspection [BUILD] Permit Fee 6/4/03 $62.50 [TAX] 8% State Tax 6/4/03 $5.00 [BUPPLN] Pln Rv 6/4/03 $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 -0 thrckigh OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by calling 03) 246 -669• or 1- 800 - 332 -2344. kee A/1 k Issue By: ' Pe rm ittee Signature: Call 639 -4175 by 7 p.m. for an inspection the next business day • I ! r Building Permit Application Flt-: a LSI•: _ Date received: /n05 C ity of Tigard Permit no.: g 'i 4" _ ,5 . A :! �- "� Project/appl. no.: 4 - xp . - date: C' o Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 f 8 Phone: (503) 639 -4171 Date issued: I B4, t , ' ceipt no.: Fax: (503) 598 -1960 1 Case file no.: Payment type: Land use approval: // 1&2 family: simple Complex: \ INPE OF 1'ER;,IIT 0 1 & 2 family dwelling or accessory CI Commercial/industrial O Multi- family 0 New construction ❑ Demolition ❑ Addition/alteration/replacement 0 Tenant improvement ❑ Fire sprinkler /alarm ❑ Other. . JOB SITE INFO12N1:\TION Job address: //53/ �,(J ��..g Bldg. no.: Suite no.: Lot: I Block: Subdivision: I Tax map/tax lot/account no.: Project name: Description and location of work on premises/special conditions: !_ _ ■ _ � _ . - l . ."%o /g OWNI :It FOR SI'E(:IAI INI ORi,I; TI ON. USE (:'11E(:I:L,IST Name: .�(/ �PD(/e /Gk•S/JA(J ( Iluudpl :lin,scpticcapacit�,.allar,cu.) Mailing ad s: //5 7 y s �� 1:.`,.. � 1:.`,.. e .. e 0 I & 2 family dwelling: City: G`�A.?) / � State: ( 9 gZ IP: 7727_ 3 Valuation of work $ /S Phone; 5'75 2 3 1 Fax : 3 57 E- mail:T5C_AIA40 m •o. of Owner's representative: - / 7 Total number of floors Phone:ib .-, i - $ Fax: E -mail: New dwelling area (sq. ft.) APPLICANT Garage/cafport area (sq. ft.) Name: r 411pYc Covered porch area (sq. ft.) Mailing address: Deck area (sq. ft.) 8 � City: State: ZIP: Other structure area (sq. ft.) I Phone: Fax: E — mail: CommerclalllndustriaUmultl family: CONTR:k(;1.012 Valuation of work $ Existing bldg. area (sq. ft.) Business name: l 00 / New bldg. area (sq. ft.) Address: City: I State: I ZIP. Number of stories Type of construction Phone: I Fax: I E -mail: CCB no.: Occupancy group(s): Existing: New: City/metro lic. no.: Notice: All contractors and subcontractors are required to be :,R('II ITE(:•FIDFSI(;N I :12 licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to be licensed in the Address: jurisdiction where work is being performed. If the applicant is City: State: I ZIP: exempt from licensing, the following reason applies: Contact person: I Plan no.: Phone: Fax: E -mail: EN(:IiN'EI_R OI'FICI: UST: ONLY Name: Contact person: • Fees due upon application $ Address: Date received: • City: IState: 'ZIP: Amount received $ Phone: I Fax: I E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this 0 Visa CI MasterCard work will be complied with w e 'fled herein or not. Credit card number: Expires $ Authorized signature' ate: /�D -3 Name of cardholder as shown on credit card Print name: �N�.r) q/ • / � 1 o/S'- - -i l'/l'S7l Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 5 .. D 440 -4613 (6■2oM) •--&ulLb 1/43T Pau PPL -tJ ,1 TIC 5• °" loS•'3 Permit #: 661 j �o?DO 3 - d10 5 P/2.- o Addre • W //V AO Pc- • J� / G3 Is.ued by: t _ i , .AA r Date: /`�/ 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: ` dll. I own, reside in, or will reside in the completed structure. ( PrAf 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale 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 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 Construction Responsibilities on the reverse side of this form. ier �yo ` (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) :e_)) 'L Pc7 c[f�rpy DM.7nrsTs .Pole• This Information Aotic,- to Property Owners about Constructi Responsibilities was developed by the Construction Contractors Board in accordance 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 follow ing responsibilities and areas of concern. I; you hire persons not registered \\ith the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement ofa residential structure, you \sill, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon'swoCCI:C'2o]ding 7-z acs: As an employer, you must withhold income taxes from employee gages at the time employees are paid. You w ill 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. i✓ rzemra]oyanenc iiaosuraaee pax: 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 Department at 378- 3524. Wor_sars° coy Lpens tia t insyr27oce.: As an employ cr. you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. !f you fail to obtain workers' compensation insurance, you may be subject to penalties and w ill be liable for all claim costs if one ofy our employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Seri ices at 945 -7888. J.S. ➢ul Revenue Service: As an employer. you must withhold federal income tax from employees' wages. You will be liable for the tax payment even ifyou didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1- 800 -829 -1040. 0TM zR ]°3C SP oOL`GSG o GLGT GAS AGu® AREAS OF COGJC RN Code co[7, 1 o. - ,nep: As the permit holder for this project. you are responsible for resoly ing any failure to meet code requirements that may be brought to your attention through inspections. iLozH]ty are properly tr age iiasue'aace: Contact your insurance agent to see ifyou ha■ e adequate insurance co‘ erage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures. fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. IEupsrlase: Make sure you have the expertise to act as your own general contractor, to coordinate the work ofrough -in and finish trades. and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions. write or call the Construction Contractors Board (PO Box 14140, Salem. OR 97309 -5052, 503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop -own pm 1/94 LEGEND 67c S INITIAL POINT, 2'x36' GALVANIZED IRON PIPE OVER A 5/8' IRO J e IRON ROD D PLASTIC CAP INSCRIBED c. INC IN PLS 2008 SET INSIDE, 6 BELOW GROUND & S FOUND MONUMENTS AS NOTED S 5/8'x30' IRON ROD WITH PLASTIC CAP INSCRIBED 'LDC, INC.PLS 2008 ", SET S 5/8"x30' IRON ROD WITH PLASTIC CAF INSCRIBED 'LDC, INC.PLS 2008 ",TO BE ,ONUMENTED PER ORS 92.070(2). ' D DATA PER SURVEY NO. 22,324 631.88 (631 96) NOTE: IRON SET 1.00' SOUTH ON LINE S88'14'18 "E 5/8" Imo. 0.29' N. / — 42.54. 223.42 S8E 7.83' 85.00' 3- J ll E C E D �y E© 7 4' 106.; 6 00 7 in ° 16 /7 4 sq. ft. 8,300 sq. ft. 5 '- JUN 04 2003 W • ,500 sq. ft. 3 7,500 sq. 1 /^ N . CITY OF TIGARD ° , to ' ►� 0 � o ) B DIVISION °I N �,I o N/ • ;�Io •)/ � f co �� a 630. Q3 .' e_', � - 0,00, 0, �� j 4' S" 'P . N C ) �" S88'04 59 E 4 4T� �, qZ l 3z j?. / �,DcP v° 3 102.00' S 7 ;' � BNDY I 8 ° ' 15 — E . S 88 E w 7,501 sq. ft. • o 7,500 sq. ft. o /�p0' �Q 4) � � N Pi 10. 0' � N 108.67 ° 122.99' i 1r c S 88'1613 E • 0 S 8 E J J I •O —1 Z V / ( � 121.5 l w 110.15' r� -1 o cn ... J � . �, 40 , is - f- ' -- • o 14 — 1 � Z IAA • ~ a • 7,861 4 , 1/4,r. ' q . o g 7,551 sq. ft. ,3 bti U Q f 13.82 • 0 e , ,,,,i, NN • M S 88'16'13" El zl S 88'16'13' E N 3 f In Q 132.99' t 133.27' ti w a. 3 6 0 � o 10 0 . � / 3 °0 3 c r r o ° 7,501 sq. ft. N • M N r , 7,514 sq. ft. v6i o N 6 N Sri to Z N 88'16'13" W c ° n . S 8816'13' E r) N , 133.08' 133.27' N 0- ' 25 25 t ° Il °�. o0 12 25 25 ro in 8,C06 sq. ft. N °' I M CD 8,613 sq. ft. � 118.22' N 118.22' '6, 71.YPI- moo' AnanoNAL DEDICATION _ 1' NON- VEHICU AR ACCE:. N8£ ".6'13 "W BASIS OF BEARINGS 632.48' S 8E E 316.51' S f . • i 6'13 :T N 6S•16,13" V, CO. RD. N0. 916 632.51' (632.56) (PER CS 20.267) CITY OF ;:TIGARD 24 -Hour BUILDING Inspection Line: (50 9 -4175' INSPECTION DIVISION Business Line: (5' ' r • 171 MST Received Date Requested /6 2- AM PM BUP Location `.�� .�) P p - �� Suite MEC ,3 PLM p --- ' ( %) 6 Z� — 0 O Contact Person Wit' i � L :4 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing q ` • Insulation V Drywall Nailing Fire wall Fire Sprinkler 1} Fire Alarm Susp'd Ceiling Roof Other: 41 �� PART FAIL PL 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE D Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA \� L Ext � Approach/Sidewalk Date t CD ' Inspector �. � � , Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL