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Permit . r s MASTER PERMIT PERMIT #: MST2007 -00037 COMMUNITY DEVELOPMENT DATE ISSUED: 3/20/2007 - IG 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134AD-04300 SITE ADDRESS: 10700 SW BLACK DIAMOND WAY ZONING: R-4.5 SUBDIVISION: BLACK BULL PARK LOT: 003 JURISDICTION: TIG PROJECT: PERRY Project Description: Bathroom addition. BUILDING REISSUE STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK ADD HEIGHT: FIRST: 39 sf BASEMENT: sf 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: 1 TOTAL: 39 sf 7207.00 REAR: .207.00 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER UNES: SF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER ONES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX !HP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT - SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADOL INSPECTIONS 3 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD. 500SF: 201 • 400 amp: 201 • 400 amp: 1st W/O SVC/FDR: 1 SIGN/OUT UN LT: PER HOUR: fin LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: 2 SIGNAUPANEL IN PLANT: a _ goal MANU HM/SVC/FOR: 601 - 1000 amp: 601.amps- 1000v: MINOR LABEL: 1000. amp/volt PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC/FDR>=225 A.: > 600 V NOMINAL CLS AREAISPC OCC: 0 ELECTRICAL • RESTRICTED ENERGY A SF RESIDENTIAL B. COMMERCIAL 1 13 AUDIO & 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: DATA7TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: This permit is subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable TIMOTHY PERRY OWNER laws. All work will be done in accordance with approved plans. This 10700 SW BLACK DIAMOND WAY permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 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: 503 639 - 0917 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 730.34 REQUIRED ITEMS AND REPORTS wr Issued By : Permittee Signature : ,', tw - /XL, ` 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 p •ject. Approved plans are required on the job site at the time of each Inspection. ti M1 .s:.. MASTER PERMIT r.• 1 � . - C ITY OF TIGARD A PERMIT #: MST2007 -00037 ' COMMUNITY DEVELOPMENT DATE ISSUED: 3/20/2007 ,� ARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134AD-04300 SITE ADDRESS: 10700 SW BLACK DIAMOND WAY ZONING: R - 4.5 SUBDIVISION: BLACK BULL PARK LOT: 003 JURISDICTION: TIG PROJECT: PERRY Project Description: Bathroom addition. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 39 sf BASEMENT: sf 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: 1 TOTAL: 39 51 7,207.00 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 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 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: 2 SIGNAUPANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 10004 amp /volt : 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 & 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 # 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 TIMOTHY PERRY OWNER laws. All work will be done in accordance with approved plans. This 10700 SW BLACK DIAMOND WAY permit will expire if work is not started within 180 days of issuance. or TIGARD, OR 97223 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 - 639 - 0917 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 730.34 REQUIRED ITEMS AND REPORTS i / Issued By : Permittee Signature : ,_ i .∎ /L . j iid 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 p • ject. Approved plans are required on the job site at the time of each inspection. • '� _ , r a Buildine Permit Application FOR oI FIC1. USE ONLY • J ;� a Ci}� g of Ti and FEB 15 200 o-B - /) U -7 / Perm No. .2a) 7 66 03 • 13125 SW Hall Blvd, Tigard, OR 97223 Plan Review — , A j C n I Phone: 503.639.4171 Fax: 503.598-1960 , . - 1, Date/BY , V / 5 2 Other P emtit: TI G A R D Inspection Line: 503.639.4175 ` +_, y 9 6 ( .,r Date Ready/By: / f l uris El See Attached Checklist for Internet: www.tigard- or.gov r .<r, , TT ,-,-, T r. �Noafi-. ethod /?.G�'Q j� Supplemental Information ii Ilia w� • TYPE OF WORK / REQUIRED BATA: 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 la Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 1 -and 2-family dwelling ❑ Commercial /industrial Valuation: $ r , �7 ,4Q El 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: ld /7 QD j),a, (, 4., e4` i6in j New dwelling area: ,59 square feet City/State/ZIP: `��� C i?cc � ' ?�� � Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: 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. er �4iIL_ooit Valuation: $ „( Existing building area: square feet New building area: square feet ligt-PR QPERTY OWNER , ❑ TENANT Number of stories: Name: l /mQ - �� � � Type of construction: Address: /©/ D Pc itovii/ L Occupancy groups: City / State/ZIP: 7 - 4,e4. �,e� �'7 .2J3 Existing: Phone: (503) 1pag9 op/ 7 Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: S/9-s— 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 Address: jurisdiction in which work is being performed. If the City/State/ZIP: applicant is exempt from licensing, the following reasons apply: Phone:( ) Fax::( ) E -mail: CONTRACTOR Business name: S!f/NL;, BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City / State/ZIP: Structural plan review fee (or deposit): -7� 4 Phone: ( ) 7 Fax ( ) FLS plan review fee (if applicable): O CCB lie.: Total fees due upon application: Amount received: Authorized signature: ,.''' ---.--------.'' j• c / - / ✓I /1,(r This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name. „ P97 Date:, ,5 9 7 • Fee methodology set by Tri-County Building Industry Service Board. 1:\ Building \Pamits \BUP- RES- PmnitApp doc 03/21/06 440-4613T(11 /O2JCOh1/WEB) One- and Two- Family Dwelling , • -x i `� t.*s� t 'r1 •., 3+'P,v.F `rs n ' 74 Budding Permit Application Checklist � � , � R A o 1.I l lll SI10 \ � � " . 1I � ' City of Tigard R eceived Permit No Kra• ' .:, 13125 SW Hall Blvd., Tigard, OR 97223 Date/By k:,,._. li al ® ,, Phone: 503.639.4171 Fax: 503.598.1960 A Assoc ss«amed permits = ru 24- Hour Inspection Line: 503.639.4175 ❑ Electri ❑ Plumbing ❑ Mechanical r,1 G'A' , K "IJ ■s;;ts;':?te>42t Internet: www.tigard - or.gov ❑ Other. ,p1:14 L FOLI \'G` irrel�l S41 Z4. C :. ' i }t ,. . 1 � / i fH , ri . r $ ,,,3 ip , � r .._ w . .._. _ �..„ . - .,.w.. »_.. ,..... Viii' Z '. l.. J . .. "_ D4 F - �\ 5 12.- , . f1I : ki ,w,{ .` :.,s,4: - , " l r . , r� � i ur _ , :,,I� / r .0. 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 0 ❑ ❑ 3 Verification of approved plat/lot. 0 ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ 0 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ 0 ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ Q 0 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 comer 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, 0 ❑ ❑ 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- 0 ❑ ❑ 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. 0 0 . ❑ 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 0 0 0 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 ❑ ❑ Q 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 ❑ 0 ❑ architect licensed in Ore • on and shall be shown to be • •licable to the •ro'ect under review. U R t SDI G 1 1 \ A 1 • 9 P . ' � C`b iik erli i J ss.t :V , a.i CSti P i{t i � ?7f Y R . r:" � 0 :Mt y W ;I ' ? 1�, .r Y 1 tl J ���t'''� s ( ���(� � !fi + tf4 .;, ; 7 ,��t[ y � S �L( I t , �G(� �ylyyz Z :z. . 0!i`.,.., X1 1,; 1 ..: 11sI J.tC{... F:.1;2i42P4 �lst " I:1e 11��+ ' .t V ).t 1' i - � i t)3 S, M�.Nvq.s> t9'...t, �. J�.6_:.uY, r. n:.� !' � E 1 !"C:... 'l...s�., :v'.r.'(fUr. fl Rs.+dl i�.�_, �....1: S.. � 3' 1-' •d . 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. 0 ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard 0 ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ 0 ❑ 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. I:\ BuildingTennitsU3t1P- RFSPemioApp.doc 0321/06 •i..��..r kik'. t .T t ".- a c z a i'ti( S o 'ii a k r 1 ° -- 't U 0" 1 P rectrical Permit Application o YY ,' , t r , • ' .. , " l 014 O ' I l O 'OJS Oi n � . ,:a .r �, ,.,. . N,ir:„. ,.: ..v .,.., f t.,�.4.,,,,,- ..:•c.;i • ' ri City of Tigard Received e Permit No.: � ° 13125 SW Hall Blvd. Tig OR 972� r � r- Plan Review ..,. ii ® ' Phone: 503.639.4171 Fax: 5 03.598, 19t� 9 1 5 2007 Date/By. Other Permit: Yr d t' = � In Line: 503.639.4175 Date Ready/By: Juzis: ® See Page 2 for ra. A R �u l ,, ask Internet: www.tigard- or.gov ( g i Ch-4 1 fu B ) Notified/Method: Supplemental Information TYPE 4 ' it n T zr T .. • . PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction 2 Addition/alteration/replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION . • exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural IR,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 ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E", "I -2 ", "I -3 ", I Job site address: 4:7 79 r>� , ix or more e res. Recreational Job no.: �(. °q; � /�I��/!rJ/Ci�❑ Six ormore residential units. ❑Recreatonal vehicle parks. City / State/ZIP' ❑ Health -care facilities. ❑ Supply voltage for more than 0 l oca ti ons. / / G J .eG^ V 9' 7�„2 600 volts nominal. � Suite/bldg. /apt. no.: I Project name: ❑ 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'I 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 C/0/ ` / 4 - r 4-t to Limited residential (with above family 75.00 2 / f�,j l } residential (with above sq. ft.) 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 Nam / mo o / f j — A L, ,�y 401 amps to 600 amps 160.60 2 /'1247 601 amps to 1,000 amps 240.60 2 Address: /©7e ,'(��' 4C,' / rn p,J/ Over 1,000 amps or volts 454.65 2 City/State/ZIP: D 7,,,i_.3 Temporary services or feeders installation, alteration, and /or 7 G,l relocation Phone: (5 6, 4 9- 7 977 I Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, accor• to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2 1 ' Branch circuits — new, alteration, or extension, per panel Owner signature: ��L�� , . ./..4—...../ � Date: A. Fee for branch circuits with 0 APPLICANT 1 ❑ CONTACT PERSON • above service or feeder fee, 6.65 2 each branch circuit Business name: ,S'il-h, B. Fee for branch circuits Contact name: without service or feeder fee, / 46.85 2 first branch circuit Address: Each add'I branch circuit "2... 6.65 2 Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 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: � Signal circuit(s) or limited - //! energy panel, alteration, or Address: extension. Describe: Page 2 2 City /State/ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) I Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: I Electrical Lic.: I Suprv. Lic.: Industrial plant per hour 73.75 . • ELECTRICAL PERMIT FEES • Suprv. Electrician signature, required: Subtotal: 0_1_,C,. Print name: Date: Plan review (25 %ofpermit fee): State surcharge (8% of permit fee): Authorized signature: ,,eztz-// PERMIT FEE: 6 q6 l This permit application expires if a permit is not obtained within 180 Print name: 1 i /..2 Date: days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 0 3/06 440- 4615T(11/05/COM/WFB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: I': RESIDENTIAL 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* ❑ Vacuum Systems* ❑ Other. rCOMMERCIAL WORK ONLY:, Fee for each commercial $75.00 ; system . (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentatipn ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical El Nurse Calls ❑ Outdoor Landscape Tighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations • 1:\ Building \Permits\ELC- PermitApp.doc 03/23/06 t` �- w �z GG Mechanical Permit A t l c�t .. l , � , I .0RAOFI ICyF WSW NP1 -» , 5 , 142- , ' . , , , . .1, ` 4 ,� P, City of Tigard O�� Date/By. Permit No.: 1y 5r 7 - a 3 4 4, . c v 13125 SW Hall Blvd., Ti ard, OR 97 23 A ' 1! ? g ' V Plan Review ., i Phone: 503.639.4171 Fax: 503.598 .1 A Date/By. Permit: y Ins Line: 503.639.4175 kJ.. � i� au�s. Td C , m, R I� ,y ) 1 1 Dat Ready/By: ® See Page 2 for ?'"alt ?+x O. Internet: www.tigard- or.gov 't t , — l ` fi e lO I' Not Supplemental Information T YP O WORK _ ' • COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction Ad dition/a1teration/repI acement Mechanical permit fees* are based on the value of the work performed. indicate the value (rounded to the nearest dollar) of all ❑ Demolition ' ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* (r1 and 2 family dwelling ❑ CommerciaVindustrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION:. Heating/cooling Job site address: /-, 0 tiq e /- ,ojn,dl�� �� Air conditio conditioning ho or heat p imp (requires site plan showing placement) 14.00 City /State/ZIP: 7: d()/eg ,7ac2. Fumace 100,000 BTU ( ducts/vents) 14.00 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 14.00 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. 10.00 Subdivision: Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 sir /tom //j /op hal 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 Chimney /liner /flue/vent 10.00 PROPERTY OWNER I 0 TENANT Other: 10.00 Name: 1/ 7;sD1A / ��1 6 . Environmental exhaust and ventilation s i — / / , Range hood/other kitchen Address:ID 7oa S ,C/ /7�l -e1G /4mQiv, k i equipment 10.00 City /State /ZIP: /944 / (9 . T f 7 202,S Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( fl3) & 3 0 91 '7 Fax: ( ) toilet compartments, utility rooms) 1 6.80 ❑ APPLICANT ❑ CONTACT .PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: 54/54, L Fuel t m P g Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue • Business name: S/9/N� Clothes dryer (gas) Other: Address: 'MECHANICAL PERMIT FEES *, City /State /ZIP: Subtotal 6 gv Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) . 2... � - Plan review (25% of permit fee) D CCB lic.: State surcharge (8% of permit fee) TOTAL PERMIT FEE 3° signature: This permit application expires if a permit is not obtained within 180 Authorized ���1, 9/� `��� days after it has been accepted as complete. Print name: ///97b721--Ai r , s ie /, Date: j ' /0 7 * Fee methodology set by Tri- County Building Industry Service Board 1:\ Building\Pmnits\MEC- PerntitAp 4 /06/06 440- 4617T(11 /02/COM/WEB) 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. I:\Building\Permits\MEC- PermitApp.doc 12/30/05 2 Plumbing Permit Application FOR (JFI ICl I.iSL: o:Ni 5 N.� ' /fix 7 -e, 37 City of Tigard c• dj Received Permit No.: / 1111 q 13125 SW Hall Blvd, Tigard, OR 97223 u / Plan Review Other Permit No.: Phone: 503.639.4171 Fax: 503 5 &� 91(i0� ,� �. A ":'1 Date/BY T I G A It U Inspection Line: 503.639.4173 I Date Ready/By loos: ® See Page 2 for Internet: www.tigard- or.gov,� , _.; 1,, Y � Noti Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description 1 Qty. 1 Ea. 1 Total 'Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 151._1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 0 Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION , Site utilities Job site address: /O79 SLd,5 /e t4,Trn '/ ii- Catch basin or area drain 16.60 City/State/ZIP: ''?-.-j---/4.40 � 0,4 9702.2S 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 R: ) Page 2 Storm sewer (no. linear R: ) Page 2 Subdivision: I Lot no.: Water service (no. linear R: ) 1 Page 2 Fixture or item Tax map/parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Back flow preventer Page 2 ad o/ /s/ 20 en Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 WPROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 f Ejectors/sump 16.60 Name. 72 J ��r� Expansion tank 16.60 Address:` 2 0 (J i S/IPLek � � / //tVik Fixture/sewer cap 16.60 City /State/ZIP: 16.60 Tri�� D 97 �a 3 Floor drain/floor sink/hub Phone: (5(73) ( 3 9 ii 7 Fax: ( ) Garbage disposal 16.60 • ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Business name: 24 Ice maker 16.60 L Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/Z1P: Roof drain (commercial) 16.60 Phone: Sink/basin/lavatory / 16.60 / O ( ) Fax::( ) Tub/shower/shower pan / 16.60 /6 6G E -mail: Urinal 16.60 CONTRACTOR Water closet / 16.60 /4 b Business name: ,s ,7f �' Water heater 16.60 Address: Other: Subtotal 4 9 City/State/ZIP: Minimum permit fee: $72.50 <0 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 ?Z CCB Lic.: Plumbing Lic. no.: Plan review (25 %ofpermit fee) State surcharge (8% of permit fee) S 0 Authorized signature: '4, Aida TOTAL PERMIT FEE �� Print name: /iii./ VA/ ` 9 L� r Date: ( 4 . 5 .-- /0 2 This permit application expires if a permit is not obtained within / / 180 days after it has been accepted as complete. ✓ j / *Fee methodology set by Tri-County Building Industry Service Board. I:\ Building \pennitu\PL.M- PenitApp.doc 06/26/06 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater _ 5309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: _ Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 55,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional 5100.00 or fraction thereof to and including $10,000.00. 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. Rath 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for 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 QuaatitY by (Future) Work Performed greater, except systems designed and stamped by licensed Fixture Type: R 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 ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain Comments regarding fixture work: Garbage - Domestic Disposal -Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall *Note: If the fixture work under this permit results in an Sink -Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and - Bradley fees assessed for the sewer increase must be paid before the - Commercial P - Service plumbing permit can be issued. Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal . Other Fixtures: is\ Building \Pefmits\PLM- PermitApp.doc 09/22/06 ® ON :.POSTNET TIGARD FAX NO. :506843952 ® . Fek. 19 2947 05:28PM P1 o FILE COPY —06193 FEB � � 2007 4 � - -:: .... FEB 2 3 2007 BY l l n u,ir. rovi� ;ry,t CWS File Number 07_00O55-0 1 CleanWate Serv1Ce5 Sensitive Area Pre - Screening Site Assessment Out• commitment k cleat. Jurisdiction Cl a ■ !� 1 J ' U Date J (0 / 01 Tax Map & Tax Lot - ' °farjr4 ' .' Owner Applicant 6 61 is Site Address A p0 r a ' tl apmiCompany 7' ;Vic- Address r aR CKD/.4lfc✓" &4c Proposed Activity 1 6_ ?_ At._ City State Zip d O, e 9 97, 5 Phone ) 3 99f'7 - _ Fax By submitting this form the Owner, or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering Information related to the project site. Ofllclal use only below this line Official use only below this line Official use only below this line Y N NA Y N NA E E. I J Sensitive Area'Com osite Map Stormwater Infrastructure maps Map # 1.57‘.../D LJ 1 Z QS # t-/ //8 Locally adopted studies or maps Other [11 El r Specify E i n Specify _ 41'e.,al piton) Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04 -9: ❑ Sensitive-areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. 7 3. Sensitive areas do not appear to exist on site or within 200' of the site. This pre - screening site assessment does NOT eliminate the need to evaluate and protect water quality __sensitive areas if they are subsequently discovered. This document will servo asyouur Service Provider letter as required by Resolution and Order 04 -9, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewer Comments: ' r o Pwj:) -v e ta typO ISttel ro �_e_ ✓J. ita� R eviewed By: ('`t4 - _ Date: A/ . ..,ms . . • Official use only Returned to Applicant Mail _ Fax _ _ Counter 2550 3W Hillsboro Highway 0 Hlgaboro, Oregon 97123 Date g/,1,2 / 0_7__ By Phone, (503) 681 -5100. Fax: (503) 681 -4439 0 NoAPA vatrserviccv.grg — °'^ _. I • Construction Contractors Board Peru #: M 5 ; �va7 - 009 3 7 700 Summer St NE Suite 300 Address: /D70O v 42fre.-k 7)'1}/10 1.6.4-/ b O�1"4, PO Box 14140 r c- 6,5 C Salem OR 97309 -5052 Issued by: � ' Date: 3/P-0/01 F Phone: 503- 378 -4621 p 1P,;. ' Web Address: www.ccb.state.or.us . Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed 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 licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in a appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. . I understand that I must become licensed as a construction contractor if the structure is sold or 2 r offered for sale before or on completion. ❑ 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, .I will contract with a contractor who is licensed 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. /-//lAri •�� 3A o/ i 1 e of permi plicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06 -01 -04 • Acting as You=r Own General Contractor? • INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION• RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement town existing structure, you can prevent . many.problems -by of the following responsibilities and concerns. Employer Responsibilities . You will, inmost instances, be ruled to bean "employer" and the contractors you contract with will be "employees" if you,use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from einployee wages at the time • employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503 - 378-4988. Unemployment Insurance Tax: 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 503- 947 -1488. The Oregon Business Identification Number (BIN) is a combined number .for, both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503- 945 -8091 or www .dor.state.or.usiformspay.html1 for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, . and must obtain workers' compensation insurance for your employees. if you fail to obtain workers' compensation insurance, you could be subject to penalties' and be liable for all claim costs if one of your employees is injured on the • job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503- 947 -7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from - employees' wages. - You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at I= 800 - 829 -4933 or visit their web site at www.irs.gov.; _ : . . Other R esponsibilities andAreas of Concerns . Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance 'agent-to see ifyou have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees.. _ Expertise: Make sure you have the - skills to act as ydur o vri general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503 - 378 -4621) or write the agency at PO Box 14140, Salem, OR 97309 -5052. • Property_owner.doc 06 -01 -04 CITY OF TIGARD _ BUILDING DIVISION PERMIT #: 2GO7 — 13125 SW Hall Blvd., Tigard, OR DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 M 1 b INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: /0-706 W 34 41( CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: �---/—/ OWNER : // J CC /22.y PHONE #: CONTRACTOR: PHONE #: • Inspection Request Scheduled For: Date: Pour Time: Code # Inspectio Descript Confirm # Contact # Message 3 atibuyeArk-Jce-t- 0 7a &13 o/ Corrections /Comments /Instructions: ■ir III , 1.:-.7 rui,, ex /lee- ct_%, - -4/ ----- / ,z,;&, j r�iV' -,1.. _ a-gi YC Gal _ o/: it ( ; • • f P S PARTT L APPROVAL ❑ CANCEL ❑ NO ACCESS 70e AIL =i L Fs : 1 + • DDITIONAL FEES AS ESSED 0 Inspector: If Date: Sr.) °Phone #: (503) 71 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007-00037 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/20/2007 Phone: (503) 639-4171 'sire Inspection Requests (24 Hrs.): (503) 639-4175 - INSPECTION WORKSHEET FOR DATE: 3/22/2007 TIME: 7:OOAM PAGE: 64 SITE ADDRESS: 10700 SW BLACK DIAMOND WAY CLASS OF WORK: SUBDIVISION: BLACK BULL PARK LOT #: 003 TYPE OF USE: PROJECT NAME: PERRY DESCRIPTION: Bathroom addition. OWNER: PERRY, TIMOTHY PHONE #: 503-639-0917 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 3/22/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electri CA rough-in 045227-02 503•639-0917 N' Corrections/Comments/Instructions: • • ) <:AsS El PARTIAL APPROVAL CANCEL NO ACCESS 7 FAIL ALL FO: ..4SPECTION El ADDITIONAL FEES ASSESSED -4( Inspector: 2-2 Date: hone #: (503) 718- CITY OF TIGARD ,c.� BUILDING DIVISION PERMIT !`e0e3 / x 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3 9 AD � Phone: (503) 639 -4171 4 r i;° a r � ' Inspection Requests (24 Hrs.): (503) 639 -4175 - 11. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / 0 -A 6 AO CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: ZelO 4 OWNER: ..7/ -"e'19 � PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: d Inspection Descriptio Confirm # Contact # Mes g j7/....Yi3/il/1r � Orfo /O/ C orrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL 'L F'%%.1,.:- - ' E r ' • ❑ ADDITIONAL FEES ASSESSED Inspector: • p / // Date: // Phone #: (503) 7182 CITY OF TIGARD BUILDING DIVISION - PERMIT #S 7 1- 0 -00 37 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: —5/ Phone: (503) 639 -4171 �± Inspection Requests (24 Hrs.): (503) 639 -4175 _s :� INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: to T77 z ±51 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: /� OWNER: N , /'� )" PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 0 16 9' v_ Corrections /Comments /In ructions: 3 1 C T'os- ii 1)11 / nP� f3/ , vw ✓ // o'sv.or�,c 7 L / WA GO✓ 3 zo � �t,1 rt Ps / &- i pVG44-. -" (�� av f-iov. •� ft Wiz boo 5 tc4L__ "7Po ,4./7' 7iir /VD 6 /5 )1,4- au - r f ✓ .'4-)L-_,- o „ � - a oo z c'1A -r c' Ar , A X�V67!}„- R7s / (c/L 1// - 11''7 * :-- 0/41 4x 7E�?iD2 .�- 914 en& AR.,T)/4L_ mo 1.2. ! Err :rift- /4-5 L Si * toe- ' .1 / evis roni = i ..04- Jaz- . lie' (.4) ex--14 m ar, ( 4 ' PRDv 1-c_. 6 T ,4./r'&- /P / i E i4f/ii6_ a��..._ 1 = i OVI /'oo I/61•CY RA-lf © A 4,07_,ev'Apirly . . .,_ 4WD& ?1-4-+4 ev 1 / 1 ./...PASS n PARTIA APPROVAL n CANCEL ❑ NO ACCESS FAIL n CA /' OR 1► ,, ' • 1 ITIONAL FEES ASSESSED r • Ins Inspector: /. "'y 3 � 8 p Date: Phone #: (503) 71 • CITY OF TIGARD v -D�. BUILDING DIVISION PERMIT #/ 157.24° 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: / r0� Phone: (503) 639 -4171, rl / Inspection Requests (24 Hrs.): (503) 639 -4175 '' - "'I I.. INSPECTION WORKSHEET FOR DATE: ///// TIME: PAGE: SITE ADDRESS: < DO0 � 1 /AD CLASS OF WORK: SUBDIVISION: 4.OT #: TYPE OF USE: PROJECT NAME: W DESCRIPTION: -0 -Poa h' i4; ----- OWNER: ! `/`1I 2 y PHONE #: "' CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Descriptio Confirm # Conta • . Message &PS friee1 /LPL- /1 0 5 - e --1 745-0/ -_-:.—±-z- 4. — 5" 7 o rrections /Comments /Instructions: dui e-e ‘0. / ASS n PARTIAL APPROVAL n CANCEL 1 I NO ACCESS IL ❑ CAL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED r ,, . 2#/4 D. Inspector: Date: Phone #: (503) 718- CITY OF 1°1GARD BUILDING DIVISI ®IV PERMIT #I S�` ?�v0'�©a'3 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: t �I�i ' OVA 7— Phone: (503) 639 -4171 emu° Inspection Requests (24 Hrs.): (503) 639 -4175 F' INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / ii C ci f 3 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: / ill Pef----Y v` PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Co act # Message ciQ 80 Fsax_i+) 34 Ce Le (0- 1 Corrections /Comments/ Instructions: 4 A/ 4 - 1,4^ / i 00R._ --- 7 S , 1\ z, ' 6' - / k, / is(- 7-4.4 ic.ev_i.< ,&iermr6- c91 ,vwEi- -Eff • PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS , FAIL CALL FO: - • ECTION 111 ADDITIONAL FEES ASSESSED AI AP Inspector: Date: 4/ D Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #(5 a —1)(9 7 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: * Phone: (503) 639- 4171i�l Inspection Requests (24 Hrs.): (503) 639 -4175 ,.. '.. _-. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: `D 7 Z J � 4.j P/ 1 ai CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: kr Y - y PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message d l6 9'9. Corrections /Comments /In ructions: - £! p .e E., S*601vE 3 IC Tos vkiW tst&- . .... J 3 WY l'.sv#��, 7 etWA45 T s 370 i VC3 -.- /nr Nsvil ct S u- 10053 ,4c4nl 1 t ic.__ "Po - 7 AP .4 - ' 2, 97l 0 (e /5 )lJ/4#Iki- - 1 &I v L_4 ex A94457 . Z V © r ' Z [. T 1 14 , J'L , ---.677}-LZi J / �,�jrq -u� IL/A/6- T t T 0^ tE 7)D/ l �-P)_,491( -• k'2. / Err - Jr ,+1 A-3. u j iGU' / c S Vh4V7 onf - Piss ©. FY - v✓ * . J i * ()Fa ' ' ✓ ' / e)"5trvi - l 4.04- �� G2� o R 4L-c-- Oode_ ' - -- 2rr2 eelhi APPAVti 1 A./ r6- a4_ .,- 1 A. .1-i-, . V 'WY PASS n PARTIAL APPROVA ❑ CANCEL ' n NO ACCESS FAIL U - L FO' CTIO 1 n ADDITIONAL FEES ASSESSED . 1 1 Olfw 2.4 Inspector. Date. Phone #: (503) 718- CITY OFTIGARD BUILDING DIVISION PERMIT #: MST 007- 00037 13125 SW Hall Blvd., Tigard, ard, OR 97223 DATE ISSUED: 3120/2007 Phone: (503) 639 -4171 /W+ru Ate Inspection Requests (24 Hrs.): (503) 639 -4175 1 I - INSPECTION WORKSHEET FOR DATE: 4/13/2007 TIME: 7:OOAM PAGE: 38 SITE ADDRESS: 10700 SW BLACK DIAMOND WAY CLASS OF WORK: SUBDIVISION: BLACK BULL PARK LOT #: 003 TYPE OF USE: PROJECT NAME: PERRY DESCRIPTION: Bathroom addition. OWNER: PERRY, TIMOTHY PHONE #: 503 -639 -0917 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 4/13/2007 Pour Time: Code # Inspection Description Confirm # ontact # Message 225 Postlbeam structural 046453 -02 - 503- 706 -5729 N Corrections /Comments / Instructions: ir /ix_ - , IL I/ pc 5 .-- j...„4,_) 5 e_pte_z-c..7Z ez:s K______ - le_d1 e-v c- W e 6 :(.. t,c..e-4 , - 44,sped ii/i.;7 . 7 B_ -- 1>Z /4.144_ 1 n PASS ❑ PA's IAL APPROVA ❑ CANCEL ❑ NO ACCESS FAIL II LL FOR , -,' e 1 1=1 ADDITIONAL FE S ASSESSED Inspector:- .it Date:' /- 3 2 Phone #: (503) 71 t2 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00037 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/20/2007 • Phone: (503) 639 -4171 r Inspection Requests (24 Hrs.): (503) 639 -4175 '' '�I __.. INSPECTION WORKSHEET FOR DATE: 4/13/2007 TIME: 7:OOAM PAGE: 39 SITE ADDRESS: 10700 SW BLACK DIAMOND WAY CLASS OF WORK: SUBDIVISION: BLACK BULL PARK LOT #: 003 TYPE OF USE: PROJECT NAME: PERRY DESCRIPTION: Bathroom addition. OWNER:. PERRY, TIMOTHY PHONE #: 503-639 -0917 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 4/13/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 046453 -01 503- 706 -.5729 N . Corrections /Comments/ Instructions: • ' SS ❑ PAR ' L APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL n `LL FS '•ECTION _ ' DDITIONAL FEES ASSESSED Inspector: Date - -t — Phone #: (503) / 3- 0 71 p CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007-00037 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/20/2007 Phone: (503) 639 -4171 ' t Inspection Requests (24 Hrs.): (503) 639- 4175ill INSPECTION WORKSHEET FOR DATE: 4 /6(2007 TIME: 7:04AM PAGE: 33 SITE ADDRESS: 10700 SW BLACK DIAMOND WAY CLASS OF WORK: SUBDIVISION: BLACK BULL PARK LOT #: 003 TYPE OF USE: PROJECT NAME: PERRY DESCRIPTION: Bathroom addition. OWNER: PERRY, TIMOTHY PHONE #: 503 - 6:19.0917 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 4/6/2007 Pour Time: 9:00 Code # Inspection Description Confirm # Contact # e age 205 Fooling 04610E -01 503. 633.0917 N . :0 ,0, o,, Corrections /Comments /Instructions: 0• /`J " 0 t.A.., /) /et. c...c_ ''""'"; 9 hip it)hi 2, /...--- / >4 Get.. - •'� � % 1 cif... . �i4W - 0.4' (0,),. C d.1( 170 -1 - --14- t' e-ez,44f43 kre4(7 w,,. -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS • FAIL ❑ LL FO',. ' CTION ❑ ADDITIONAL FEES ASSESSED 0 Ir Air Inspector: Date: Phone #: (503) 718 -2471 • CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00037 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/20/2007 Phone: (503) 639 -4171 u��, '� • Inspection Requests (24 Hrs.): (503) 639 -4175 . INSPECTION WORKSHEET FOR • DATE: 3/22/2007 TIME: 7:00AM PAGE: • 66 SITE ADDRESS: 10700 SW BLACK DIAMOND WAY CLASS OF WORK: SUBDIVISION: BLACK BULL. PARK LOT #: 003 • TYPE OF USE: PROJECT NAME: PERRY DESCRIPTION: Bathroorn Addition OWNER: PERRY, TIMOTHY PHONE #: 503-639-0917 • • CONTRACTOR: OWNER PHONE #: • Inspection Request Scheduled For: • Date: 3/22/2007 Pour Time: 10:00 • Code # . Inspection Description :Confirm # Contac Message 205 Footing 045227 -01 c .t=i39 -0917 N Corrections /Comments / Instructions: • et_ e— t 4_ ez.44_ a--kt L& (71K 4 - 7- 1 c, `(C /a 1 *-2,2_1/L- p 1,24,CA e9V fr _ 1 , L k a - rTcccA ' pfDiA7 LL___ ouri_ Ark-r-tin g 'ASS ,. ❑ PA'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL • ?"ALL FO' I ION ❑ ADDITION FEES ASSESSED 3 © Inspector: .� Date: hone #: (503) 718 _