11225 SW NORTH DAKOTA STREET IS VIONVO HiHON MS SZZ
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11225 SW NORTH DAKOTA ST
CITY OF TIGARDBUILDING PERMIT
RMT 0:
DEVELOPMENT SERVICES DATEEISSU�ED: 5/2/2005 -00187
1 LL 13125 SW Hall Blvd.,Tigard,OR 97223 503.639-4171 PARCEL: 1S134DB-00400
SITE ADDRESS: 11225 SW NORTH DAKOTA ST ZONING: R-4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Demolition of 1200 sq ft home and 120 sq ft out building. Septic tank is to be removed. SDC credits to
apply to future construction.
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: 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: 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: ,
Owner: Contractor:
VINCE BIGGI OLSON BROTHERS EXCAVATING, INC
17660 SW KRAMIEN RD 4515 NW SILVER LEAF DR
NEWBURG, OR 97132 PORTLAND, OR 97229
Phone:
Phone: 503-531-0529
FEES Reg#: LIC 69865
Descript;-ln Date Amount REQUIRED ITEMS AND REPORTS
(BUILD] Permit Fee 5/2/2005 $62.50 Ersn Cntrl 681-4444
[TAX]9%State Surcharl 5/2/2005 $5.00
IFRPRMT] Erosion 5/2/2005 $26.00
IFRPLN] Fro Pick-CWS 52/2005 $8.45
(additional fees not listed here)
Total $110.40
IL
22
H 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
w 952-001- rough OAR 952-001-0100. You may obtain a copy of these rules or irect questions to OUNC by
W callin 03-246-6 1- 0-332-7344.
J
Issu d By: Permittee Signature:
Call 503-639.4175 by 7:00 a.m.for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans ane required on the job site at the time of each inspection.
Building Permit Application
Cit of Tigard Received
y g Date/By: Permit No.: -z"/
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review -- f.�l�
Phone. 503.639.4171 Fax: 503.598.1960 Date/Ely: Other Permit:
—Checklis
Inspection Line: 503.639..us Dote Ready/ByNotified/Method:
-- 1 TS,pl AentalId formatio for
Internet: www.ci.tigard.or.us Notifted/hfethod: ��S-opplementallnformatlon
TYPE. OF WORK P-EQUIRED DATA:I-AND 2-FAMILY DWELLING
❑New construction ❑Demolition ^� Permit fees*are based on the value of the work perfortned.
-- Indicate the value(roun(led to the nearest dollar)of all
❑Addition/alteration/replacers ❑Other: equipment,materials,I bor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
E] I-and 2-family dwelling C]Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Numbe-of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: `�,�C� "law New dwelling atea: A — square feet
Ci State/ZiP: r "Cop1'0,-,t7 & 9 -7 Garage/caiport area: square feet
Suite/hldg./apt.no.: Project name: �^V/„]P �1 e� Covered porch area: square feet
Cross street/directions to job site: _ Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees•are based on the value of the work performed.
Tax snap/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.
Valuation: S
Existing building area: square feet
New building area square feet
'Cl PROPERTY OWNER ❑ TENANT Number of stories-
Name: , u Type of constructio.:
Address: A Occupane, groups: �—
City/State/ZIP: — v Existing:
Phone ( (o Fax (S� Z� - New: —
❑ PPLICANT ❑ CONTACT PERSON
-- ------__-- -- NOTICE
Business name: _ —,_ — _ All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
CL Ad':ess: jurisdiction in which work is being performed.If the
City/State/ZIP:
applicant is exempt fro%i licensing,the following reasons
apply.cc — —
Phone:( ) Fax::( ) — -
E-mail:
m CONTRACTOR —— -
W Business name: —
BUILDING PERMIT FEES*
'J Address: —
Please refer to fee schedule.
City/State/ZIP: �
Phone:( ) Fax: Fees due upon application
( ) -
�- Amount received
CCB lic.:
-" ---- Date received:
Authorized signature: This permit application expires If a permit Is not obtained
within ISO days after It has been accepter+Rs complete.
Print name: _ Date: • Fee methodology set by Tri-County Building Industry
Service Board.
ia7ui1dmg\Permi12tBUP PermilApp.dm 12/03 440-4613T(11/02/C0WVEB)
One- and Two-Family Dwelling
Building Permit Application Checklist
City of Tigard Received Permit No.:
Uate/D
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.639.4171 Fax 503.598.1960
24-Hour inspection Line: 503.639.4175 ❑ ElecMcal ❑ Plumbing ❑ Mechanical
internet, www.ci.tigard.or.us ❑ Other:
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zonin . Flood plain,solar balance points,_seismic soils designation,histori:district,etc. _
3 Verification of approved plat/lot.
4 hire distrle )roval required. Name of district:
5_Septic SI permit or authorization for remodel. Existing_s stem capacity _❑ _
6 Sewer permit. ❑
7 Water district approval. �u _ _ _ El
8Soils 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 catc 1- [
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.
i 1 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. _
2 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&�ad1 etc_
14 Cross sect()n(A)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 maybe required to clearly portray
construction. Show details of all wall and roof sheathing,rooting,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-
prescript iveaP th 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 retalninf;walls. Provide cross sections and details showing placement of rebar. For engineered
stems,see item 22,"Et,¢ine-.r's calculations."
19 Beam calculations. Provi�-t vo sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any b-arn/joist carrying a_non-_uniform load.
IL 20 Manufactured floor/roof trus.,design details.
lX 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required
F for four or more appliances_
W 22 Engineer's calculallons. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an^ngineer or
architect licensed in Oregon and shall be shown to be applicable to the Droiect under review.
m 23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1/2"x i 1"or 11"x 17".
7 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. _
W 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 rotection 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.
1:\Building\Permits\BUP-RES-PermitApp.doc 2
CITY OF TIGARD
BUILDING DIVISION PERMIT 0: [iUf°:roto,�o1rn
13125 SW Hall Blvd.,Tigard, OR 97,223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1002006 TIME: 7-01AMI PAGE: %O
oITE ADDRESS: 11225 SW NOR rH DAKOI•A SI- CLASS OF WORK:
SUBDIVISION: LOT#: TYPE OF USE:
PROJECT NAME: ';1 ONFCHASF SUBDIVISION
DESCRIPTION: Demolition of 1200 sq It hone and 120 sq ft out bui ng. Septict o be removed. S[)t,'cmd is
In apply to future.con6truction.
OWNER: ISIC;(;I, V1I4(:F PHONE #:
CONTRACTOR: 01 SON RRO I-FIFRS FXCAVAi ING, INC PHONE 0:
Inspection Request Scheduled For: Date: 1/ >( Pour Time:
lel
Code # Inspection Description Confirm # Contact #
)'c4 IMA irwpoNction 0).! jatt;01 !AW-320.27 Z N
/y '�
Corrections/Comments/Instructions: c,/`� "" 4e
4�' 6.4,e —Ca V G�/�O�
N lJ
is
�-?�° �geje'
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
)(FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: — :.w,<,. l l� Phone #: (503) 718- �7�
1
Jan 26 06 02:13p Roundstone Construction 503-526-2084 p.2
n 169 PO4 APIs 19 '95 14:17
a Arc OF oueooN
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WATER SUPPLY WELL REPORTSKYLE� DRILLING, ,1 VVL'LL ID O L ins_
(es f•qM ed by 0"53 7.705) C'�, I SI C.
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(3) DRILL METHOD: _ (10)STATIC WATER LEVEL:I
I_JRolary -
>a.__� b•iow tend aurbo•. std
Mr _)RoYry Low I tAua•r An"an pre•,Wt* b OW sa terse"ft Oita
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kItPROPOS@0 USE.
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ntermet (._I'Maotion L�Lrveelocw QDI►a•r F>41A..—_... '._ 10__--- ..Ellugtled F .. 6v4t,.
(!)IORE HOLE CONSTRUCTION: - ----
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MOLL SEAL Amount
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Ora vim PMe444 horn (1 to >! 81ta of ArevN ��•!S!, - .. .._.__. .. ...
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3,01 Tele/prpe
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(! ELL TESTS: mum testing time Is 1 hourn'entM ""f'
thlewoIsIMowwwa ' Oregon` elof44"won nomwomon
)WMinimum 7)WE Mini , at•ndtnde MeteriaM"W and MWare1e11M r"ortea above nr•into W*a peel r/my
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0. _ _yl nil of wet oil H c ( --- -- -
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I accept room*M MT Por the eonetructIm aherawn. or awl0enmem wrrk
y .� -._-.1-...___...__ ___:._. .. ... .. .. _ _. ... •_—_- peAorn,ee en IA1e well fwr�a the eone•.whon nelee npentq eEove •e.tetter
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Vacs•weta enatyste aor»7 Mree By wham ...._. - _ oonebud+ort atenrtert0u Thhl
r•pOrt Y krR to t he frral al my rnKllAed�e sne e+elet
Ula any etrala conprer water not 10118311V101 urrJrlff krtewee ;•T'oo IAiln -•�-- � Nunber ' Z
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aprhofersll ___ Skyles DrIll1np.Inc,
ORIOMAL-WATE.g RESOURCE&bFPAgTMENT FIRST COPY CONSTRUCTOR RECOND COPY-CUSTOMER �' -
Jan 26 06 02:13p Roundetone Construction 503-526-2084 p.3
n 169 P03 APR 18 '95 14:16
Date Poatrnarfied_ O "ItC " H, b /j A 7
Dade Hknd-110v:ered
DateRuidn CK{lcti Tt oc.'ll l i OWRD Receipt
- ----- Dere Pee Received i
START CARD
NOTICE OF BEGINNING OF WELL CON&MUCTM
*required by ORS 537.762)
nis form must be completed and the original mailed or delivered to the Water Rolourcea
deepening Salem OR 97301-1271 for all new consbu ction,conversion,alteration,deep 8 and abaodtmmortts. This fit'7 h 25 Snrogr �NP.Suite A,
s original must be moiled or
delivered before a checks
is s payable d. A S at fee shall acoompauy the origiml for all new well cOnStrvetion,vtmve Sion,and
deepenings (make checks payable kr the Water Resources Department). In addidoN the conumi dor shall provide a legible copy of thin
followin��muxltoda:()bq rob i+v`mnil no later 1tlusri thneee(1 Raen r a i owe or cotnmenoarnan o w b
�"Y ed or absstdo�et�wore c of the
delivery,during regular ottioe hours before work is commenced or c t 1 by firma
le ' to O by FAX before wort is commenced. If rnethod(c)is used,a
gtb copy of the start card shall also be availed or delivered to the region 1 Office no later than the day work is cartxrteocal, The
Water Resoun.es Commission hes authority,to impose civil ponalties 1br failure b submit the required f 125 fee with the start cant,for
failure b su'butil tide 3125 fee in a timely manner,and for fr<ilure to timely submit start ranch.
Owna's rsruand mailing addres:.� cc v rz ^ I, .r� :•.�Home
_ 0(4v— rs, ,,.
�•:c ,.�
Pitons:
Work / -- --
Type of work: Fee ❑ New Construction No Fee ❑ Alteration R
Required: ( eMlrlRteosrditlaa)
e9 ❑ Conversion Required: ® Abrrdeumeat Orlg.Stsu#
❑ Deepenlnit Orifi.Start
GaNo.., t•.,:._
Card No. rd
Proposed Commencement Date: "I'
nxistins or Proposed Wt;1 Depth: .F Diameter: 33"-_ Original Well I.D.Label Number: J(Jr•.+ ,
Usc: ® Domestic u Community(Public system) [] Industrial [] Irrigation —y
❑ Thermal ❑ Injection ❑ Monitoring (]Othei
PmnAIR��Viu�i94fltion: ----
County+'4 ,-,} f .,. �. Township / e t w
1---- �n8 Section _7-r t sx Lot ••
_ North ne South Rad er Wal --
114 ' 1,/4 � ��e
j QL Latitude _ Longitude
-86eet Address'of wfll,if not assigned,nearmt address.
of this form and the ' rtstation provider)is Occttrste to the beat of our knowledge.
OwnedAgent Name Bonded Weser 8� lMoeilar Will Cau,,nzbr Name
J ed
Due alanCo
e►pa:y afta*nod..
rJWKRR PLEASC NOTE:This is not a water right appoesdon. The owner Is responsible for obtaining■water right tlrran`h
W the Water Resources Department.it requlred. The Oregon Health Divisloa requires plans to be submitted aind approved prior
J to canomcdon If the well Is to be aseel as a public system.
ADDMONAL IMPORTANT INF(IRMATION ON BACK.
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