Permit - q CITY F T I GA MASTER PERMIT
i
#: MST
COMMUNITY DEVELOPMENT DATE PERMIT 3/2
ISSUED: 7/008 208 -00093
T1G?tR[?- i
�_ 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102AB - 00912
SITE ADDRESS: 12125 SW 92ND AVE ZONING: R -7
SUBDIVISION: KIMBERLY ADDITION LOT: 012 JURISDICTION: TIG
PROJECT: LAWSON
Project Description: Relocating west kitchen wall. 8/8/08 ADDED (1) gas outlet and (1) vent.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sr LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT:
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 10,000.00 REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: / e•T WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amplvolt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
RICK LAWSON CHAMBERS CARPENTRY INC laws. All work will be done in accordance with approved plans. This
12125 SW 92ND AVE 898 NW HERTEL ST permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 HILLSBORO, OR 97124 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through 952 - 001 -0080. You may obtain copies of these rules or direct
Phone: 503 968 - 9048 Contact #: PRI 503 464 - 6567 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503- 693 -1342
Reg #: LIC 167440
TOTAL FEES: $ 418.76
REQUIRED ITEMS AND REPORTS
l —
Issued By z . Signa �� .
�'�
Call 503.639 4 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 are required on the job site at the time of each inspection.
• 4 z n CITY OF Tr AR® _ MASTER PERMIT
PERMIT #: MST2008 -00093
i
° COMMUNITY DEVELOPMENT
DATE ISSUED: 7/3/2008
.I.G.WuD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102AB - 00912
SITE ADDRESS: 12125 SW 92ND AVE ZONING: R - 7.
SUBDIVISION: KIMBERLY ADDITION LOT: 012 JURISDICTION: TIG
PROJECT: LAWSON
Project Description: Relocating west kitchen wall.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: 51 BASEMENT: s1 LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: 50 GARAGE: sl FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sl RIGHT:
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 51 0.00 REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
\
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < SHP: VENT FANS: CLOTHES DRYER:
FURN ...WOK: UNIT HEATERS: HOODS:
kl
MAX INP: btu FLOOR FURNANCES: VENTS: _ WOODSTOVES:
`ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 • 200 amp: WSVC OR iDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp 201 - 400 amp 1st WOO SVCFDR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: A01 • 600 amp EAADDL BRCIR: 1 SIGNAL/PANEL: IN PLANT:
MANU HM /SVC/FDR: 601 - 1000 amp: 601 ramps- 1000v'. MINOR LABEL: 9)
1000+ amp /volt :
PLAN REVIEW SECTION O
Reconnect only: w
> =A RES UNITS: SVC /FOR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY 1
A. SF RESIDENTIAL B. COMMERCIAL O
AUDIOS STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: O
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 5 SYSTEMS: t`
V
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
RICK LAWSON CHAMBERS CARPENTRY INC laws. All work will be done in accordance with approved plans. This
12125 SW 92ND AVE 898 NW HERTEL ST permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 HILLSBORO, OR 97124 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 001 -0010
through 952- 001 -0080. You may obtain copies of these rules or direct
Phone: 503 968 - 9048 Contact #: PRI 503 464 - 6567 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503- 693 -1342
Reg #: LIC 167440
TOTAL FEES: $ 405.10
REQUIRED ITEMS AND REPORTS
•
t / 4 .1 � /
Iss ed By : - � G., Permitt Signature : (.0„?...,,; Ife
Call 503.639.4175 by 7:00 a.m. for an inspection that busin : - ••y.
This permit card shall be kept in a conspicuous place on the job site until completion of the project. .
Approved plans are required on the job site at the time of each inspection.
q +ti CI�Y P
r COMMUNITY DEVELOPMENT PERMIT MASTER #: MST2008 ERMIT 00093
DATE ISSUED: 7/3/2008
;TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102AB - 00912
SITE ADDRESS: 12125 SW 92ND AVE ZONING: R -7
SUBDIVISION: KIMBERLY ADDITION LOT: 012 JURISDICTION: TIG
PROJECT: LAWSON
Project Description: Relocating west kitchen wall.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: s1 BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: 81 GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: TteFt sf RIGHT:
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sl „9„. REAR:
PLUMBING 4 /t, 600 1
SINKS: WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN >=100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 • 200 anp: 0 • 200 anp: WSVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp 201 • 400 amp 1st WM SVCFDR 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 . 600 amp: EAADDL BRCR: 1 SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601+anps- 1000v: MINOR LABEL:
1000. amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =226 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
RICK LAWSON CHAMBERS CARP ENTRY INC laws. All work will be done in accordance with approved plans. This
12125 SW 92ND AVE 898 NW HERTEL ST permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 HILLSBORO, OR 97124 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 001 -0010
through 952 - 001 -0080. You may obtain copies of these rules or direct
Phone: 503 968 - 9048 Contact #: PRI 503 - 464 - 6567 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503- 693 -1342
Reg #: LIC 167440
TOTAL FEES: $ 405.10
REQUIRED ITEMS AND REPORTS
Iss ed By : .4 Permiftee Signature : f� �/j!
Call 503.639.4175 by 7:00 a.m. for an inspection that busin : �. • ay.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application r, . e t^�°,' r N 7 x Fog . OFFICE USE ONL t e . r a I
S City of Tigard Received
J '� Date/By: : p (f� Permit No.: c _ . ■
111 g a 131 25 SW Hall Blvd., Tigard, OR 97223 w Plan Review
Date/By: °+ Phone: 503.639.4171 Fax: 503.598.160 Other Permit:
: :1 G ' Inspection Line: 503.639.4175 \ 1.-- Q Date Ready /By: See Page 2 for
. Internet: www.tigard or.gov d .0-." (6 1-000 Notified/Method: Mil ® Supplemental Information
TYPE OF' WORK 1 r 1.
AO � ® � COMMERCIAL FEE* SCHEDULE. — USE CHECKLIST
er $ ��S Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition /altera t(�
�. »,, performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: 504\.. - mechanical materials, equipment, labor, overhead, and profit.
• CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: Air conditioning or heat pump
l ( � Sw • �� —"� (requires site plan showing placement) 14.00
City /State /ZIP: 7 / U�
j Furnace 100,000 BTU (ducts /vents) 14.00
r Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 1 6.80 Co , art)
Other 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
_ r Gas f 10.00
Of
S v �� Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
III PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT . ❑ CON TACT. PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each a dditional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: • Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater S%' it J
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal . f L . a,
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) / 4 (p
TOTAL PERMIT FEE j i „ Ci ce
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
1:t Building \Permits\MEC- PermitApp.doc 01/19/07 440 -4617T (11 /02 /COMM'EB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:.
Total Valuation: 'Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00. _
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
•
•
1:\Building \Permits \MEC- PermitApp.doc 01/19/07 2
Jul 09 08 11:21a Leeann Greason 503 -359 -1981 p.1
� . 9 OF TIGI
-4 COMMUNITY DEVELOPMENT
T[GAYRD`; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
IMPORTANT PERMIT NOTICE
A & J ELECTRIC
PO BOX 330
FOREST GROVE, OR 97116
Permit #: MST2008 -00093
Date Issued: 7/3/2008
Parcel: 2S102AB- 00912
Site Address: 12125 SW 92ND AVE
Subdivision: KIMBERLY ADDITION
Lot: 012
Jurisdiction: TIG
Zoning: R -7
Project Name: LAWSON
Description: Relocating west kitchen wall.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical permit
to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please calf 503.7182433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
RICK LAWSON A &J ELECTRIC
12125 SW 92ND AVE PO BOX 330
TIGARD, OR 97223 FOREST GROVE, OR 97116
Phone #: 503 - 968 -9048 Phone #. 503 -359 -5891
Reg #: EE.E 34i-IC
LIC 959
SUP 4534S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X /t.d Tj't'o i1 v L'v / G 5 c y 8 S 6
Signature of Supe ising Electrician Name (printed) SUP LIC #
r
Building Permit ApplicatioL N
yr � 43� t1 -.0. . j , x 'y, fir r� • °sidebtial SS, r '� = ' FO OFFICE,' ON_L � � r e o
V r. , .♦ 1 i 1 t4•t11Fkn..k'd ! 1ril�G s..6 '1 , ,, +J Jl,:I :,„, str .. at ,
City of Tigard \` \N tv ` ® DateB �f I Permit No.: j , v: �✓ '410 ' u 13125 SW Hall Blvd., Tigard, OR 97223 J e . r o Plan Review
p ` Oth er P ermit:
Ph one: 503.639.4171 Fax: 503.598.1960 �� • @` , • L .--
® Da teB I. � J /
.
I G A R D Inspection Line: 503.639.4175 ' � ® ®`�� Date Ready /By: ..1.416
, Juris: ® See Page 2 for
,._. ,,r: Internet: www.tigard- or.gov ®� `��+' Notified/Method: AI; Of ��� '�0 Supplemental Information
TYPE 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
❑.. ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
./ 1- and 2- family dwelling ❑ Commercial /industrial �U f7 00
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /212 SW QZ = AV6- New dwelling area: square feet
City /State /ZIP: -(, D , 0 e ! 7ZZ,3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: / „� f 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION- OF WORK work indicated on this application.
'FLOCAT"F, l<i Li EST WALL Valuation: $
Existing building area: square feet
New building area: square feet
N` PROPERTY OWNER ❑ TENANT Number of stories:
Name: IVIe3e t - L Type of construction:
Address: 11 I Z f z A Occupancy groups:
City /State /ZIP: ` j
(� po2D r DR q7Z Z 3 Existing:
Phone: (51)3) ? ( 3 90 y8 Fax: ( ) New:
❑ APPLICANT . ❑ CONTACT PERSON NOTICE
Business name: . S q All contractors and subcontractors are r; quired to be
Contact name:
K licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( ) 199 16.94 .1 1
E -mail: `
CONTRACTOR 1 l , C 1 O
Business name: lv'i8E S 2MPENT�° y me BUILDING PERMIT FEES*
Address: ! �� i�7� Sr (Please reje refer to jeesehedule)
City /State /ZIP: L� Structural plan review fee (or deposit): g6
G
/L S��C`� o � 7/2 / p / 3 . / �/ Z FLS plan review fee (if applicable):
Phone: ( 503) y(p L( • (, 6-6 7 Fax: ( S'? c3 7 r p
CCB lic.: /6 7 7 y // 29/0 g Total fees due upon application: ( � Cie/
r Amount received: � l ` t (1,-k.
Authorized signature: 10 / , This permit application expires if a permit is not obtained
/ within 180 days after it has been accepted as complete.
Print name: de 0 • J , i Bt�s Date: 0/08 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(I1 /02 /COM /WEB)
Building Permit Application Checklist . -?`
6✓-ar s., k! t 176:, ri ✓r *, Eepvw...a. : 'tF7y
One- and Two- Family Dwelling .. ! , FO,a OFFICE uS ; o� . F r_=
r City of Tigard ; ,Received Permit No.:
SL v 1312 SW Hall Blvd., Tigard, OR 97223 )t F Assoated permits:
0 Phone: 503.639.4171 Fax: 503.598.1960 ' t .'•,- .
"` 24- Hour Inspection Line: 503 ❑' 7 trical - ❑ Plumbing ❑ Mechanical
l IGARD t '
- Internet: www.tigard- or.gov ❑ Ot her: (,
THklb OWING ITEMS AREhRE UIRED'FOR It VIEW , ; 'S t , , z, __ it e No r:N
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils 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 des' n and location of catch- ❑ ❑ ❑
basin protection, etc. dVpe-r SOO S - 1. CZ aso - fever, Cfrz .' t., it��
10 3 Complete sets of legible plans. Musf b drawn to scale, showing conformance to applicable local and state . . - -D ❑ ❑
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.
11 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.
12 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 grade, etc.
14 Cross section(s) 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 may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, 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- ❑ ❑ ❑
prescriptive path 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 retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Oregon and shall be shown to be as I licable to the .roject under review. • �� IU IC L SP> l --) -`
4,
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
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 trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and accompanied by the project arborist's signature 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 03/21/06 440- 4613T(11 /02 /COM/WEB)
Plumbing Permit Application
' 4 G i s -'.[ ` . Sf�Y d ]t, - : ✓ ,y - _ l- « St. 'rfie-
' Building Fixtures � .? D ' FO ' O F FICEr =
y USEONLY , �
.a � • • ' � ?F*' 3•., 4•._'.7C�Ft7,„- '�:,.x'*7Axrrfi.i '"'- '+�rY�+"'.�`;t .?? %'-
City of Tigard Received C� p�
7 :
�s g ' \ e,CEN
Date/By: / �� , ",S Permit No.: _Ala_ . --wC/ r, r at 13125 SW Hall Blvd., Tigard, 3 Plan Review
c :: C Phone: 503.639.4171 Fax: 503.598.1' , "t 16 2.0'* Date/By: Other Permit No. ,7 GO el
r Inspection Line: 503.639.4175 J orr is: Ql Se Page 2 for
Pa
‘. i C A R D ♦ IP g
:,....rtt Internet: www.tigard or.gov 0,�`'� Date Ready/By: Notified/Method: Supplemental Information
TYPE OF WW ® /► �
❑ New construction eni”M 1tl Y� ®1 FEE* SCHEDULE
IAD tt� l oht ti io l n Fors ecial information use checklist
Description Qty. Ea. Total
Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION - SFR (1) bath 249.20
r a<and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
-
Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: Catch basin or area drain 16.60
City /State /ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK • Backflow preventer Page 2
EZoCA �- A T015A! tv LL- Backwater valve 16.60
$.Clothes washer Re Lo rQ / 16.60 ( •G l
Dishwasher 16.60 lJ
Drinking fountain 16.60
ROPERTY OWNER I - 0. TENANT '
Ejectors /sump 16.60
Name: (ejCe t k'h2r -,,l L.4w54ew Expansion tank 16.60
Address: /Z I Z S 6 kJ /Z �0 Ave-. Fixture /sewer cap 16.60
City /State /ZIP: 17GA�U U. 97223 Floor drain /floor sink/hub 16.60 ,
( m e , y r 9 y8 Garbage disposal 16.60
Phone: (SD 3) / Cl F ( )
Hose bib 16.60
❑ APPLICANT . ; ❑ CONTACT PERSON
Ice maker 16.60
Business name: Q.4/vlR a J c Q � � Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 16.60
E -mail: _
ONT Urinal 16.60
CONTRACTOR -7
Water closet 16.60
Business name: i gR`1 LEI, I Q.ot.k.) tJ 4 Water heater ' 1 .. 4 .1..e 1 16.60 40,
Address: y 35 78, /\lit_ Pu 2b/ yJQ /� Other: "'�
�r Subtotal
City /State /ZIP: ,p2�Gr (a20de_ 97(/
A . - Minimum permit fee: $72.50 -� 1
Phone: (503) 3$ - 34,09 , Fax: :) 1 . L • Residential backflow minimum permit fee: $36.25 704 S v
CCB Lic.: i � 1 Lic. no.: ,511-. Z/05 It Plan review (25 % of permit fee)
Authorized signature: � 7/i (y State surcharge (12% of permit fee) .70
/
//JJ ft ` J " C TOTAL PERMIT FEE (
Print name: / /7'1 �3s Date: G�b��f3 This per t Thimit application expires if a permit is not obtained within
(a 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
:\ Building \Permits\PLMF- PermitApp.doc 12 /27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 Supplemental Information ;)
Fee Schedule:' Residential FireSuppression Systems:
Qty. " Fee (ea) T otal
Site:Utilities , - Squ • Footage: Perm Fee: -
Footing drain - 1 100' 55.00 01.o;2 ;000r ;- . $115.00
• Footing drain - each additional 100' 46.40 ; 2' to :3;600 $160.00
Sewer - ] st 100' 55.00 3,601 6'7,2001 $220.00
;; , ,_,
7,201 and greater • ' . f $309.00
Sewer - each additional 100' 46.40
• Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain• Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Qty. Fee (ea) ` Total additional $100.00 or fraction thereof, to and
Fixture or Item including $1 0,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work: Plan,Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed
greater, except systems designed and stamped by licensed
Fixture Type: 'Replace engineer.
Previous Capped ' Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic .
Drinking Fountain ISOmetriC. or Riser Diagram
Eye Wash El Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
•
3 „
- 4"
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal - Commercial .
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) •
Rec. Vehicle Dump Station
Shower -Gang
-Stall
'Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase. of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 12/27/06
Electrical Permit Application FOR OFFICE USE ONLY
h City of Tigard �� DateBea :Aral Permit No.: s _ I.
• �a "
■ 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
' � Q . Phone: 503.639.4171 Fax: 503. r LOO� Q Dat : Other Permit: g��) (jet
Inspection Line: 503.639 Date Ready/By: _furls: ® See Page 2 for
Internet: www.tigard- or.gov �\ - 6P
�` �,' ified/Method: Supplemental Information
c,
TYPE OF WORK O PLAN REVIEW
❑ New construction ❑ Addition/alteration(1 13C Please check all that apply (submit 2 sets of plans w /items checked below):
V `'_ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 4 where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTR exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
A
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: c �p/
I00HP or more. occupancy.
�Z Z- � S L j go., ,tvC ❑ Six or more residential units. ❑ Recreational vehicle parks.
Ci /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
ty ! �� �72 rD 1 e 7 2 2 3 ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: L Avsd1..1 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty 1 Fee. 1 Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add] 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
'Re_ °CAT El, lel •r tO AL.C. residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: �It 401 amps to 600 amps 160.60 2
�� � -'�t'` �`� 601 amps to 1,000 amps 240.60 2
Address: 1 Z t 'Z.. S S t✓ 9 Z w4Gr Over 1,000 amps or volts 454.65 2
�
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: '
�1 G.o,c,,L.> 042 9, relocation
Phone: ( X31 ,(p 8 (it) Li 8 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This instal ation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, leas r- /exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
,� Branch circuits – new, alteration, or extension, • er panel
Owner signature: `%, /i Date: A. Fee for branch circuits with
❑ • ' ` LICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits •
Contact name: without service or feeder fee, 46.85 f 2
first branch circuit
Address: Each add'l branch circuit 6.65 • I� 2
Miscellaneous (service or feeder not included) e
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: _ Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: A al : I — GL I ` - ( rc-1 ( ' - _ . Signal circuit(s) or t i o n d-
energy panel, alteration, or
Address: v, ! J Q A 530 extension. Describe: Page 2 2
City/State /ZIP: Q . s CD,w () E OE ? 71 //„ Each additional inspection over allowable in any of the above
a ! �f Per inspection 62.50
Phone: („05) 38 9 5-a / r , 'ax: ( b3) 35 -/ 8� Investigation perhour(1 hr min) 62.50
CCB Lic.: 9 6 9 Electrical Lic.: 3� /C___ Suprv. Lic.: 4/6 5 Industrial plant per hour 73.75
i ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7 /i //t / % / /D Subtotal: 5?1,5U
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): W 42_
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC - PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard '
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
P PRESIDENTIAL: WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- Pe`mitApp.doc 03/23/06
.2 CITY OF TIGARD
' ° COMMUNITY DEVELOPMENT
TIGA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
RE C E \$J ED ED
Plumbing Signature Form RA- 0 2N
CITY O F TIGARD
BUILDING DIVISION
IMPORTANT PERMIT NOTICE °�e �,
:7 li 11111G
JERRY LEE BROWN 43578 NW Purdin Road
43578 NW PURDINO RD orest Grove. OR 97116
FOREST GROVE, OR 97116 (503) 357-3600 ° CCB #150256
Permit #: MST2008 -00093
Date Issued: 7/3/2008
Parcel: 2S 102AB -00912
Site Address: 12125 SW 92ND AVE
Subdivision: KIMBERLY ADDITION
Lot: 012
Jurisdiction: R -7
Zoning: TIG
Project Name: LAWSON
Description: Relocating west kitchen wall.
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing
Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be author until this completed form is received
OWNER: PLUMBING CONTRACTOR:
RICK LAWSON JERRY LEE BROWN
12125 SW 92ND AVE 43578 NW PURDINO RD
TIGARD, OR 97223 FOREST GROVE, OR 97116
Phone #: 503 - 968 -9048 Phone #: 503 - 357 -3600
Reg #: LIC 167440
. LIC 959
LIC 150256
PLM 34 -405PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X / l/✓.. a A. _i ��.. _ e v v� 0t L)
Sign.: ure of �� ed P lug Name (printed)
CITY OF TIGARD
BUILDING DIVISION ,„ PERMIT #: MST200f3 00093
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/312008
Phone: (503) 639- 4171Ail �
Inspection Requests (24 Hrs.): (503) 639 -4175 'I�
INSPECTION WORKSHEET FOR DATE: 8/8/2000 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 12125 SW 92ND AVE CLASS OF WORK:
SUBDIVISION KIMBERLY ADDITION LOT #: 012 TYPE OF USE:
PROJECT NAME: LAVCON
DESCRIPTION: Relocating west kitchen wall. .
OWNER: I AWSON, RICK PHONE #: 503 -968 -9048
CONTRACTOR: CHAMBERS CARPENTRY INC PHONE #: 503-4M-6567
Inspection Request Scheduled For: Date 8/812008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 20 Electrical rough -in 073960 01 503 -3691 -5891 Y ilivl
Corrections /Comments /Instructions:
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0 ►' 1 XC' LL FOR INSPECTION
,,,I`` AIL n ADDITIONAL FEES ASSESSED
' Date: qf 0 (�(1
Inspector: PI' Date: ` l 0
Phone #: (503) 718-
/<\\/,,/ . <, i 1 A N--.7-'-j1 1 I _.1 I 1
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i HALL BLVD
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MRT2008 0009 3
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 71312008
Phone: (503) 639 -4171 Zit 111/4
Inspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 817!2008 TIME: 7 :01AM PAGE: 28
SITE ADDRESS: 1212 SW 92ND AVE CLASS OF WORK:
SUBDIVISION: l(IMF3ERL.1` ADDITION LOT #: 012 TYPE OF USE:
PROJECT NAME: LAWSON
DESCRIPTION:
Relocating west kitchen wall.
OWNER: I.AM ON, RICK PHONE # 503-968-9048 CONTRACTOR: CHAMBERS CARPENTRY INC PHONE # 503-446567
Inspection Request Scheduled For: Date: 817/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
-
120 Electrical rough -in 073870.01 503 -359 -51381 ' Y
Corrections /Comments /Instructions:
ML 7, ki
C Okfq. Z-►n•E ® L�, -1 s40- (3F Sit4'. 4
v•1®E. SLR) - 4Anf�L. RuiaG ,A
CZ�z `1 J CAL_
Id ' a_SZ N 1 ' t! W 4 ! -; 1,4 . ° ; v ±.1 - e
o, p Q i `
0\L cA ' L5 A-
•
❑ PASS ❑ PARTIAL APPROVAL El CANCEL NO ACCESS
A FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: q• • I) Phone #: (503) 718- 240.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ,T2003 Cttl(3u3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/312008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 6394175
� ..
INSPECTION WORKSHEET FOR DATE: 8/13/2008 TIME: 7:OOAIvt PAGE: f8
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 12125 SW 92ND AVE LOT #: TYPE OF USE:
PROJECT NAME: KIMBERLY ADDITION 012
LAWSON
DESCRIPTION:
Relocating west kitchen wall. 8/6108 ADDED (1) gas outlet and (1) vent.
OWNER: LAW30N, RICK PHONE #: 503968 9048
CONTRACTOR: CHAMBERS CARPENTRY INC PHONE #: 5033464 -6567
Inspection Request Scheduled For: Date: Pour Time:
811312008
Code # Inspection Description Confirm # Contact # Message
610 Gas line 074127 -02 503.936 -1097 N
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL FOR_INSPECTION El ADDITIONAL FEES ASSESSED
A Inspector: Date: l? g Phone #: (503) 718- ____I,Z'
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MS7 200.00093
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7
Phone: (503) 639 -4171 �;' �I�Ir
Inspection Requests (24 Hrs.): (503) 639 -4175 ��� _.,
INSPECTION WORKSHEET FOR DATE: 8/13/2008 TIME: 7 :00AMI PAGE: 19
SITE ADDRESS: 12125 SW 92ND AVF CLASS OF WORK:
SUBDIVISION: KIMBERLY ADDITION LOT #: 012 TYPE OF USE:
PROJECT NAME: LAWSON
DESCRIPTION: Relocating west k tc:hen wall. 8/8/08 ADDED (1) gas outl €.t and (1) vent.
OWNER: LAW1 RICK PHONE #: 503,968 - 9048
CONTRACTOR: CHAMBERS CARPFNTR'Y INC PHONE #: 503 - 464 -6561
Inspection Request Scheduled For: Date: 8/13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 Mechanical rough -in 074127 -01 503 -938 -0917 N
Corrections/Comments/Instructions:
•
�' P. ASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED .
Inspector:
A D ate: o -1 — o a Phone #: (503) 718- •
....-
•
CITY OF TIGARD
BUILDING DIVISION A PERMIT #: MS - 12008-00093
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3/2008
Phone: (503) 639- 4171 Wi�l+�
Inspection Requests (24 Hrs.): (503) 639 -4175 .. `:_
INSPECTION WORKSHEET FOR DATE: 8/ &2008 TIME: 7 :O3AM PAGE
SITE ADDRESS: 12125 /9f�lD AVE CLASS OF WORK:
SUBDIVISION: KIMBERLY ADDITION LOT # : 012
TYPE OF USE:
PROJECT NAME: LAWSON
DESCRIPTION: Relocating west kitchen wall.
OWNER: LAWSON, RICK PHONE #: 503.966.9048
CONTRACTOR: CHAMBERS CARPENTRY INC PHONE #: 503 - 464 -6567
Inspection Request Scheduled For: Date: 8/6/21708 Pour Time:
Code # Inspection Description Confirm # Contact # Message
X75 Framing 073794 503 -464 -6557 N
Corrections /Comments /Instructions: 471
la% /1/ .!---ec-7-22-1 C/4-1- 011t&vi--- CA-y f -- 777/ Qv
❑ PASS 1 " PARTIAL APPROVAL ❑ C ANCEL El NO ACCESS
❑ FAIL CALL FOR INSPECTION n A DDITIONAL FEES ASSESSED
Inspector: Date:8 - 6 -� 8 Phone #: (503) 718- 14, � ,_____-
CITY OF TIGARD
BUILDING DIVISION A . PERMIT #: MST2008.00093
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3/2008
Phone: (503) 639 -4171 iji
Inspection Requests (24 Hrs.): (503) 639 -4175 ...:411- `__..
INSPECTION WORKSHEET FOR DATE: 7/8/2000 TIME: 7:OOAM PAGE: 47
SITE ADDRESS: 12125 SW 92ND AVE CLASS OF WORK:
SUBDIVISION: KIMBERLY ADDITION LOT #:. 012 TYPE OF USE:
PROJECT NAME: L.AWSON
DESCRIPTION: Relocating west kitchen wall.
OWNER: LAWSON, RICK PHONE #: 503. 968 -9048
CONTRACTOR: CHAMBERS CARPENTRY INC PHONE #: 503- 464 -Ea?
Inspection Request Scheduled For: Date: 7/8/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
225 Post /beam structural 072314.01 503-709-4433 N
Corrections/Comments/Instructions:
"r1/ (- P. -Qo vi, V-4: c.J/°i"o -r Loia.. -pc.. C- - 4iezty/ z ��y2..-
•.._ - b.400 . 7A 7 122002 5"p /� 5 i e 44./A -' i
1
r PASS (l PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ' n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: - ege Phone #: (503) 718 ----------
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2008 -00093
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3/20013
Phone: (503) 639-4171 �" '0 ,, ,
Inspection Requests (24 Hrs.): (503) 639-4175
p'I_I..
INSPECTION WORKSHEET FOR DATE: 7/8/2008 TIME: 7:OOAM PAGE: 46
SITE ADDRESS: 12125 SW 92ND AVE CLASS OF WORK:
SUBDIVISION: KIMBERLY ADDITION LOT #: 012 TYPE OF USE:
PROJECT NAME: LAWSON
DESCRIPTION: Relocating west kitchen wall.
OWNER: LAWSON, RICK PHONE #: 503 968 -90418
CONTRACTOR: CHAMBERS CARPENTRY INC PHONE #: 503464 -6567
Inspection Request Scheduled For: Date: 7/8/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 072310 -02 503 -709 -4433 Y
Corrections /Comments /Instructions:
''K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
(l FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 \ \1�--..._ Date: 7) f ) (a Phone #: (503) 718-
CITY OF TIGARD
v 5/27/2010
13125
503.639.4171 , 4 -
SW Hall Blvd., Tigard OR 97223 7:18:4�yy -+M
TIGARD Activity Listing
Case #: MST2008 -00098
Project Name: WILSON
Site Address: 14114 SW BENCHVIEW TERR
CODE DESCRIPTION DATE DONE DISP DONE BY NOTES
(Descending Order)
205 Footing 07/24/2008 PASS KBS 073155 -01 - 503 - 524 -8303 - VM - Y
210 Foundation walls 07/24/2008 PASS KBS 073156 -01 - 503 - 524 -8303 - VM - N
305 Plumbing underslab 08/04/2008 PASS JW 073671 -01 - 503 - 524 -8303 - VM - N
220 Slab 08/08/2008 PASS KBS 073950 -01 - 503 - 476 -5612 - VM - N
315 Post/beam plumbing 08/15/2008 PASS Chip Barnett 074271 -01 - 503 - 524 -8303 - VM - N
605 Post/beam mechanical 08/15/2008 PASS Chip Barnett 074273 -01 - 503 - 524 -8303 - VM - N
225 Post/beam structural 08/15/2008 PASS Chip Barnett 074275 -01 - 503 - 524 -8303 - VM - N
615 Mechanical rough -in 10/02/2008 PART KBS 076225 -02 - 503 - 524 -8303 - VM - N - 180
275 Framing 10/02/2008 FAIL KBS 076225 -04 - 503 - 524 -8303 -- VM - N - 180
320 Plumbing rough -in 10/02/2008 PASS JW 076225 -01 - 503 - 524 -8303 - VM - N
225 Post/beam structural 10/02/2008 PASS KBS 076225 -03 - 503 - 524 -8303 - VM - N
120 Electrical rough -in 10/03/2008 FAIL Gary Noble 076271 -01 - 503 - 524 -8303 - VM - N -180
120 Electrical rough -in 10/06/2008 PASS Gary Noble 076323 -01 - 503 - 524 -8303 - VM - Y
230 Underfloor insulation 10/10/2008 PASS KBS 076562 -02 - 503 - 524 -8303 - VM - N
280 Insulation 10/10/2008 PASS KBS 076562 -01 - 503 - 524 -8303 - VM - N
275 Framing 10/10/2008 PASS KBS
235 Shear walls /anchors 10/13/2008 PASS KBS 076629 -01 - 503 - 524 -8303 - VM - N
242 Interior shear walls 10/13/2008 PASS KBS
322 Shower pan 11/03/2008 PASS JW 077567 -01 - 503 -524 -8303 - VM - N
610 Gas Line 12/10/2008 PASS Chip Barnett 078934 -01 - 503 -524 -8303 - VM - Y
699 Mechanical final 03/03/2010 PASS Rick Bolen Habitable mechanical
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