Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2003 -00359 SSUED: 6/13/03
- �, L�I � DEVELOPMENT SERVICES DATE I
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S104AD -03801
SITE ADDRESS: 12630 SW WALNUT
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
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: 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:
Remarks: Demo 1314 sf. residence. Dwelling is on sewer (SEWER CREDIT APPLIES).
All debris is to be removed.
Owner: Contractor:
NANCY SMITH OWNER
12630 SW WALNUT
TIGARD, OR 97223
Phone: 503 - 692 -5436
Phone: 503 - 692 -5436
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 6/13/03 $62.50
[TAX] 8% State Tax 6/13/03 $5.00
[ERPRMT] Erosion 6/13/03 $26.00
[ERPLN] Ero Plck -USA 6/13/03 $8.45
(additional fees not listed here)
Total $110.40
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.
Issued By: ( ; a,
Permittee
Signature: /
Call 639 -4175 by 7 p.m. for an inspection the next business day
.,- ...mo
/ B��flle�'ing Per _ l , p FOR OFFICE USE ONLY
l Received . Building 2�3.OI �
Date/B - to 1 Permit No iji
City of Tigard
Planning Approval Other
^1q Date /B Permit No.
13125 SW Hall Blvd. 3k�� � �� Plan Review Other -
Tigard, Oregon 97223 fTIGAB* Date/B Permit No.:
Phone: 503- 639 -4171 Fax ���� °I 9 �'' "'%'' M r
I Post - Review Land Use
' DateB : Case No.
Internet: www.ci.tigard.or.us . Contact / Jp 1 p6. ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Su i 1 lemental Information
TYPE OF WORK / REQUIRED DATA:
❑ New construction Demolition 1 & 2 FAMILY DWELLING
❑ Addition /alteration/replacement LJ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, matenals, labor,
overhead and profit for the work indicated on this application
Accessory Building ❑ Multi- Family //�
III Builder ❑ Other: Valuation $ L� t O� •
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: /24230 i () (4)4LN617 C7 Total number of floors
New dwelling area (sq. ft.) 11�/.../ri-.......
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: SAv/"'Anci o Am,vev F RINK Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
kt)es7 ® / z4c ra on/ A14 ‘, i7 Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: �+�o Lot #:
Tax map /parcel #: 2 ‘5 O n a Z. Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, matenals, labor,
�, overhead and profit for the work indicated on this application.
2:74r eGir;o / of aw-WA 4 /41/.56
T rJ epta /ma �
y e � e Valuation $
/'� Existing building area (sq. ft.)
�1 JC� fQ �T /fBGtF New building area (sq. ft.)
Number of stories
PROPERTY OWNER I ❑ TENANT Type of construction
ame: A/A-WC j / , 'x/14 5/4 07,9 Occupancy group(s): Newtng:
Address: / 260 C9 Ski ktl4LA/Qr
City /State /Zip: % 02 972,7„.3
Phone: 503 (p9Z -.5 3A. Fax: CcO3) a z®- 3 NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
'APPLICANT . ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: 3e jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: Fax:
E -mail: Y5 r,;-1, 3qi 7 i{- . (lo I , C � BUILDING PERMIT FEES*
Please refer to fee schedule.
CONTRACTOR
Business Name: 0/j ail Fees due upon application $
Address:
City /State /Zip: Amount received $
Phone: Fax: Date received:
CCB Lic. #:
Authorized ji Notice: This permit application expires if a permit is not obtained within
Signature: Date: 0 31 3 180 days after it has been accepted as complete.
/ Y 4A/C / J, —SP i -77—/ *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
T 1/
t:\Dsts\Petmit Fomtis\BldgPermttApp.doc 01/03 � (T ��U r � 1 � 0 4 -
47
. 111
,� Plan Submittal Requirement Matrix -
'� i Commercial & Multi- Family
City of Tigard New, Additions or Alterations
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(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 \PlanSubMatrix.doc 04/03
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 / : , : * -4175
MST
INSPECTI9N DIVISION Business Line: (5v *f 4171
BUP 3 — 00 35s7
Received Date Requested 7- 3 � pt AM PM BUP
Location (D-(030 uLt Suite MEC
•
Contact Person Ph ( ) '20 3 - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing (0 9 5 6
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: V3 \ 4 \_ SIT
Post & Beam �/�
Shear Anchors •
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: Other: l •
4 PART FAIL ® : o
BING
4 -
Post & Beam . Fr-
`
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
Approach /Sidewalk Date 7/V43 T Inspector `^ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL