10415 SW HILLVIEW STREET 0
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CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : BUP96--0Lub
13125 SW Hell Blvd.Tigard,Oregon 07223.9199 (503)839.4111 DATE ISSUED: 05/30/96
PARCEL: 2S 102CC--1,`d@00
SITE ADDRESS. . . : 10415 1:�W HILL. V i EW ST
SUBDIVISION. . . . : TONYc PLACE L ON 1 NG:R-3. :,
BLOCK. . « . . . . . . . . t_i) .. . . . . . . . . . . . . :4
RE ISSUE t FLOOR AREAS- -- - _._._.._-_ EaXTE FtIOR WALL C0N8TRUCT'ION-
CI._ASS OF WORK. :NE W � FIRST. . . . t 0 s f Ns S1 E: W:
a
TYPE OF: USE. . . a SF SECOND. . . : 0 5 P PROTECT OPEN I NGS,----- -'TYPE OF CONST. :5N . . . : 0 s f Ni S: E: We
OCCUPANCY GRP- :R3 TOTAL-____1__: Ih s f ROOF= CONST: FIRE RET"' :
OCCUPANCY LOAD: 0 BASEMENT. : 0 sf AREA SEP. RATED:
STOR. : 0 HT: 43 ft GARAGr. . . : lr s OCCU SEP. RATED:
BSMT?: MEZZ?: REUD SETBAC;KS-____.-.._.- REQUIRED-------
FLUOR LOAD. . . . . 0 p s f I._C•.:1=T:35 ft RGHT 1 35 ft FIR SPKL: SMOK DET. . :
DWELLING UNI-r6: 0 FRNT: 0 ft REARe35 ft FIR AL.RM: HNDI':.'P' ACC:
13EDRMS: 0 BATHS: 0 IMP SURFACE: 0 PRO CORK: PARKING: 0
VALUE. $ :
�¢��
RemBuild a 4.5 fort t.i11 halm radio tower that is attached to the residence.
ArkisI IMO'TMY VAN DEN BOS type amoi.tnt by date recpt
10415 SW HIL.LVJEW STREET' PRMT $ j25. 00 JMH 05/30/96 96•-27990
PLC:K t 16. 25 JMH 05/:0/96 96--27990
I I ';AR)_7 ,JR 97223 5PCT $ 1. 25 JMH 05/ 1/9S 96--27990
11hone #: 464-0709
I_:ontrar_tar:
OWNER - _
1,Hone #: $ 422. 550 TOTAL
fgeq #. . a 13125
_.__ ___...._.-• REQUIRED INSPECTIONS ---
This permit is issued subject to the regulations r .tamed :n the Foot ing Insp
Tigard Municipal Code, State of Ch-e. Specialty odes and all other F'i na i i n r pest i on -,.•.__ ____ ______. _
applicable laws. All work will be done in acr.rdance with --
approved plans. This permit will expire if work is not started _ -•-------- -----
within 18P days of issuance, or if work is suspended for more ---
than 180 days.
.._..
I lerm it t:e e S i g n��t u n e:
\Y
. / ....�_W_..._...,._..
( Call for inspection - 639-4175
Residential Buildin,_Rermit Application i
City of Tigard �
13 11 25 .SIN Hall Blvd.
Tigard. OR 97223
(503) 639-4171 C c l i e,1
Jobsite Address• 10415 SW 11illvi ew St.
Subdivision,. Tony' s 1'on ' T;ace Lot # I Office Use Onq
`•`. �' Planck/Rec #
Valuation* '-
Cor►+c: Lot? Y - N-- ------- Permit #
Reissue of
Flag Lot? y = N =
-- -- Map & Tl- #
I`
Owner: Timothy R. Van Den Bos4
_ — Approvals Required
Address: 10415 SW lii.11yiei, St. Planning
Tigard, OR 97223 d
— Engineering
Phone: (503) 684-6339
Other
Contractor: S,im _
Items Reclulred
,.address: S ibcontractors
-- -- — -- - Truss Details
Phone _---�— -`—_— —_ Other
Contractor's License #
(attach ropy of current Oregon license)
Contact Name & Phone. Tim Van Den Leos 464-,0709 (work)
985-3510 or
Subcontractors: Architect/Engineer: John R. Thomas 697-8123
Plumbing: _ _ Address: 314 Salter
Mechanical: _ Gaston, OR 97119
(attach copy of current OR Contractor's License)
Phone: 15(13) 985-3510 or (503) 697-8123
Install Amateur Radio Tower attached to West wall of residence.
JOB DESCRIPTION:
63I
503- 8 y-
Appli(-s nature & Phone number
Received by. �_' .�_.-� Date Received: ��
N\V,9RDC^.MUFIPRFSAF'0
Permit # Account Description A-gmlo�un! Atnt. Pd. Bal. Due
u1��G 204 Bldg. Permit (BUILD) �,/.,3 GID 0 , 67/ 04e
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg: Ld2Z`
Plumb:
Mech:
Plan Check (PLANCK) 4o< )
Bldg: �.
Plumb:
Mech:
Sower Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF FIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
I!istitutional TIF (TIF-IS)
G'.;ce TIF (TIF-O)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FI.S)
Erosion Cntrl Perrult (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: so1
•sem:- �.-
Address: )/V t �.
Issued by:� nate: as 3_0_5!i
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: (h•egurt Lu►t,, ORS -01.055(-1), requires resicicr,lipl con,vlruclionnernril apL)li-
cont.i ta'ho are not registered v0th the construction Contraclors Board to sign the
P.11oit'ing vicitenmetit he%re a huilding permit can he issued, 7'his.vi(ifemerlt i.v i-t,gillred
,lar residential huildiug, electrical, mechanical, and plunrhink permits. Licensed
architect and engineer applicants, exempt_horn registration under ORS 701.010(7),
need not s•uhrnil this state"Ient. This statement will befiled~pith the permit.
Fill in the appropriate blanks and initial boxes 1 and 2. and either box 3A or 313:
Ft
1. l own, reside in,or will reside in the completed structure.
(771 2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
UU 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 he
registered with the Construction Contractors Board.
OR
311. 1 will he in omi general contractor.
�--� I1•I hire subcontractors, l \%ill hire only subcontractors registered with the Construction cmitr:lctors
Board. If i change my mind and hire a general contractor. I %trill contract Nsith a contractor ��In is
registered with the CCR and Will immediately notify the office issuing this building permit of tin
name of the contractor.
I hereby certify that the above informati,111 is c►rrcct and that I have read and do understand the Information
Notice to Property Owner• almilf t Ilesimnsihilities on the reverse side of this form.
-�
(Date)
)
(tiignaturr�,I perntit appli�;uit t
(II hire coht.to i.e.vrting agcorca hertnit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
( 'ole- 1/it N 111/`11,P114I/it)I) Notll.'f' !t1 1'1(pol'II (hI'Ii,e ", t111(!lit Ims'll'm lit Rck/) of/,tlhlhllt'h
fl'it's den'If vf-(11,1'/hr (',ill s'lIIft i1nY7 ('n►firth AWS /i,)in't/m(I,, ,)I-,A:illiit'ilh ( />S 7(11.')5~(tit.
oil arc act IIg.,as. UoklI (1\N'11c,liitr,icim'it, .i'I,ii lit:t IIIL', ILRIIt'!,I'III;II": I `,Ill",I'if llfit lImproACIll cIIIItI ill)(",I'III Ig41111:1111,C,
y(fit can pre vcI,i many IlrtlblenI' b) hcinl: aware ill 11C 14 11 illi rc,l1(1n"ill)lit ics and areas of co-curn.
EMPLOYER RESPONSIBILITIES:
if Noo hilt, peisons not rcil,iACrCd N\llll the ( iilll.li'IICIIuIi ( nlllt, lioard (t) do lahol III Ci111,1111 1111 Cq ar.51St,11, in tlly
i;oll!;trticllt)rl ill II11PIoN elliclll of a rv',i fcnt�'ll),lructtirc, Noll N Ill, in mil,,( Ill>,t111Ce",,fie 1'ulcil it')huall Cillploy r alld flit; ilc'01'11C
%oii lure•will he cmpl,-,vee:,.. ;1�:the crn1,111\.r. r1u rntl�;t<l'1tnp1�'\villi the f'�,llt,yvill �.
Orrl~un'stvitl►holdingta%late: A'iit)clnllltt-'cr,\oll11111"t withhold incometnv't-Ii'ornC1111111) cev. 1p.e.,a(tlie IIm:cmplttac •,
Ire[)aid. \ otl N%iII he II:1IIle II'r the 1;1y 1111��nlent.,avid 11 volt(it 111,11 actllit II ttiiill hoIll the tax (tom vaur vnlplo\cc. ! it rllolc
iIIIli rnlilt ion,call tlc l)rcl.• )If Ikllt.o Rc\ell lie,it 94.,~-8091.
Unemployment Iilstlranl'e 191: As;111 l'I11(1t,1\ef, v,Hi;Ile 11:111111e11 It,pa.% ,1 ;'Y: iril'L1IwIll f11+1N 1111.111 III'+lW1111.C I)II111otiL'.1111 111C
wage,;of all c111OIuNCcs. V(it'more fit formation,cal!the.t)rcgon Lnlploymcnt Department at 178.35-2•4.
N orkers'compensation insimince: ;1 111 enl,llo\cr. ou arc"1111Ject to the Orcg,m V orkw,'I.ompt v,ation I at\,;,nd muNt
llhtaill NN ofkef"C,'IIIPell`;itliIII i11:1111;1111.C )t 1(it II t1i11111iNCt."., iI \ull fiiI toobtain�\llrkvI`S'i,oil 11l41150t1tit1111tii1r lm,c.',; Ll lit;I
he StlhiCO 10 11011,116Vs WId\v Ill hu li;llllt.lilt ('111 l.Imill 11 otivol mil cliqlIoN cc-s i.,,itliflICLI 011 thCj0b 1 01'111111c111101`111 IL111,
call I 11 Wt irkerti'CL)111pell;NI It if I)iv kiot1 111 the i)cliarlment of•C'r nmfillvr and Ifiv,iilc,44 sen,ice s nt(',1e 7998.
Ii,`. InternalRei c•nueSvr\ice: )1,,lit crnplo-\er.y(lit nmsl\%Ithholdlydcra1111(:orilclax 1romC111111(,+,ILA""tNlic,. 'it\%I he
Ilahlc lilt the Iay 11at 111c,1l 1 l if iI ytill didn't i1cllially\N ithhold the I;tv I iir more inf'lirlruttion,01111 the lmornal li.0 Cnuc 5CIA it c
8011-929:1040
OTHER REQOPONSIBILiTIES AND AREAS OF CONCERN:
Codevolliplis>Ince: `,�Ihcpermithcldolorthi'•;fl1tltrt.v01Adl,W"llunwlhic1,11ri, .,oklilt!ilmt,111111001nl'Otiod'. I� i.ltiisi.lurnt.
Ill:( 1111.\ 110 hruu�tllt to\( m,attention throuIg11 insl,crti(1n;.
Lnahilit\ and property ilamage itmjrancvt 1. olll,i;t Nom Ir1,tltam t.';wt,w i,' II I';I felt llllalt.'iTYII': IICk'i:1 16 t I Out:for
at.Lldoll',and olll isSiolls SIIC11 a4 Iidl ling 11$ok. pafill o1 l'i'tilll";ll, tl atet ilalll,a}kaffil) 1`:t)c 111111,1llt-C,, tII':, )I-N01 111;11 111,1~1 111:
iC-(luI1C
Time to supero ire employ vs-s: 11:11-1, ,1$1 -u hm t, ,Ilt'f w I,lil i!111k: i . 'Ilrcl1.i'.,.' ,,,llI nitll
�,Xrlertise: �illkl'�;IIfC\t,l.l IlayC illi_'Cyt1t'tl I'�C II ;It :I',`.+!IIi t 1i 1!i'l'lll'I;I i• �v:.11 Ill i,�I-I��� i„�11)I'UIIt'1110,i('1 k� i �� '11'I, !I I.;I';t(I'il,li
trt dO.Aih1 to iil,tif\ hlriidintx i+ti;ci lt.if Ihr npllrnh;'i1 i limy;w 1 ih,,\ 'Iri 11i'r}v 1111 thi rvgijlr,•1 i'lLZr('(1'',11a,
If y71)11 have add itiollaI q1)k*"tlt)11b. m ltl'111 loll Il1e t 1111"tlllcllul'11 1111111iA,11 1°t,a1,I Wk ) 11i
>01'178-4621 1. 'I he 11111tH is 1tltalted ill ;(Ill "imlllnet til, \1 1 mic .1011, m
(,rntl.nv,n pill I
I t)1
FILE COPY
TYY
CITY OF TIGARD
February 25, 1999 OREGON
Timothy Vandenbos
10415 SW Hill View St.
Tigard, OR 97223
Re: Permit BIJP96-0288 issued for a ham radio tower at 10415 SW Hill View St.
Dear Timothy Vandenbos:
Our .-ecords indicate that the required inspections for the permit BUP96-0288 have not
been completed and approved as required by Section 113 of the State of Oregon One and
Two Family Dwelling Specialty Code.
Please call within 30 days and schedule an inspection of the work for which permit
BUP96-0288 was ir.sued. You can leave a message requesting an inspection on our 24-
hour inspection request line at 639-4175. If you prefer you can call me directly at 639-
4171 extension 414. 1 am often away from my desk so please leave a detailed message
and I will return your call at soon as possible.
Sincerely,
Warren Jackson
Building Inspector
13126 SW Hall Blvd., Tlgard, OR 97223(503)639-4171 TDD(503)684-2772
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TO REORDER CALL MOSES BUSINESS FORMS.INC •(503)242-0864 y��5sz '"p d'"' W k
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Line: 639-4171 MST
BUP
Date RequeSLed �_. AM� PM _. BLD
Location Suite MEC y c
Contact Person Ph _ PLM _
Contractor Ph ��,�"/— /� 1 �c'�.SWIR _
BUILDING Tenant/Owner f I'l-lefZ_EI.0 j
Retaining Wall ELR
Footing --------_—
Foundation NOT REQUESTED FPS — —__
Fig Drain FOUND DURING RESEARCH SGN
Crawl Drain
Slab NO INSPECTION(S) FOUND IN FILE SIT
Post& Beam pl X05 —
Ext Sheath/Shear H y )/A N n�
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing _
Firewall ,�_
Fire Sprinkler - ,o —fC.�
Fire Alarm
Susp'd Ceilinq / r ti r- 1�
Roof /
Misc: h S L �q �t9 r" A �ro d ,
)
Final
PASS PART FAIL (D v
PLUMBING
Post& Beam
Under Slab
Top Gut
Water Service Q L1
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL _�;l`
MECHANICAL / _ 5// Z/
Post&& 6earnz1
Rough In
Gas Line --- -- �- v"
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL --
Service
Rough In -
UG/Slab
Low Voltage
Fire Alarm
Final - -- ---- - -__
PASS PART FAIL ------ --
SITE
Backfill/Grading -- ----_ — -
Sanitary Sewer
Storm Drain ( Reinspection fee of a required before next Inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( 1 Please call for reinspection RE: _�-�_--_____ 1j�Unable to Inspect- no access
ADA
Ather n/Siaawalk Date / Inspector_ ��'VU'r�. Ext
IFin i _
Final �
CACC, r7A r:T •#/\T ♦�:_ ..,.,_..a7__ _._ _ .- .._ a •• - ••