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Permit c/l - o ./ �a- - u� �'d -e ms � - A CITY OF IGARD MASTER PE'RM'IT PERMIT #: MST2004 -00093 ,e mpir ii, DEVE Hall B d. lv , E N a d, O ERVI CES 39 -4171 DATE ISSUED: 3/25/2004 • SITE ADDRESS: 12435 SW 122ND AVE PARCEL: 2S103BB -08600 SUBDIVISION: LAKE TERRACE ZONING: R - 4.5 BLOCK: LOT: 013 JURISDICTION: TIG REMARKS: Remodel, adding 713 sq.ft. not changing the footprint BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 135 sf BASEMENT: 578 sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 578 sf GARAGE: sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 128,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 713 sf REAR: 15 PLUMBING SINKS: 2 WATER CLOSETS: 2 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 1 0 • 200 amp: W /SVC OR FDR: 00 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 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 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: Owner: Contractor: TOTAL FEES: $ 1,977.25 This permit is subject to the regulations contained in the JACK PAULSON PACIFIC CASCADE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes 12435 SW 122ND 1015 MOLALLA AVENUE and all other applicable laws. All work will be done in TIGARD, OR 97223 OREGON CITY, OR 97045 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 - 579 - 2596 Phone: 503 656 - 0920 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 83425 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS . Grading Inspection Post/Beam Structural PLM /Underfloor Framing Insp Insulation Insp Final inspection Footing Insp Post/Beam Structural Mechanical Insp Shear Wall Insp Rain drain Insp Footing Insp Post/Beam Mechanical Plumb Top Out Shear Wall Insp Electrical Final Foundation Insp Underfloor insulation Electrical Service Exterior Sheathing Ins Mechanical Final Foundation Insp Crawl Drain /Backwater Electrical Rough In Exterior Sheathing Ins Plumb Final / Issue By : ` ��`-r- Permittee Signature :. j' / /id Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the n: • busi -ss day i f , N 1 • . ,.. . .. . ;M ASTER PERMIT • N GARD • f ERMIT # MST20 4 0OO., _ �� /,, � _ r - . DEVELOPMENT SERVICES DATE i s s uED: 3/25/04 CIA 9 � -- ' "'r' °° I ' t 13125 S.W Hall Blvd .,Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS 1`2435 SW 122ND AVE PARCEL: 2S1,03BB- 08600. SU.BDIVISION: LAKE TERRACE ZONING: R -4.:5 • BLOCK: • LOT: 013 JURISDICTION; TIG REMARKS: Remodel, adding 7'13 sq:ft. 'not changing the footprint • BUILDING ' REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED • CLASS OF WORK: ADD - „ HEIGHT: FIRST: 135 sf .BASEMENT:, 1578 sf LEFT: 5 SMOKE DETECTORS: Y' TYPE OF USE: SF FLOOR. LOAD: 40. SECOND: - 578 sf GARAGE: sf FRONT: '15 PARKING,,SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THko: sf RIGHT: 5 VALUE: 128 ' OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 713 sf ,000.00 REAR: 15 PLUMBING SIN S 2\ WATER CLOSET 2\ WASHING MACH: LAUNDRY TRAYS: RAIN D' . TRAPS: ---- SIN . S?. S: 3 DISHWASHER: '1 FLOOR:DRAINS: SEWER LINES: SF RAIN D• • INS 1 CATCH BASINS: • TUB /SHOWERS: '1 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PRE R:. GREASE TRAPS: ;OTHERFIXTURES: MECHANICAL , „, ` , . FUEL'TYPES R N 100K: 'r BOIL/CMP< 3HP: V NT,FANS: l ' 5 CLOTHES DRYER: „ GAS FURN 'UNIT HEATERS: HOODS: 1 OTHERUNITS'. MAX;INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GASOUTLETS: ELECTRICAL . RESIDENTIAL UNIT S RVICE,EE€DE1 ” ' TEMP'SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'LINSPECTIONS • 1000 SF OR'LESS: 0: 20.0 amp '1• 0 200 amp: W /SVC OR FD R: 00 PUMP /IRRIGATION: PER. INSPECTION: ■ EA AMYL 500SF: 2!: - amp: 201 -. 400 amp: 1st W /0'SVC/FDR. • SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 %amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVCIFDR: 601 - 1000:amp: 601 +anmps - 1000x: MINOR LABEL: 1000 +amp /volt : . - - PLAN REVIEW,,SECTION Reconnect only: - - - > =4?RES UNITS: SVC /FDR> =225. A.: > 600 V NOMINAL: CLS ARENSPC 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 6 SYSTEMS: - - contractor: TOTAL FEES : $ 1,914.75 Owner: This_ permit:is, subject to theregulations contained in the JACK PAULSON- PACIFIC CA SCADE HOMES INC Tigard Municipal Code, Stateof OR. Specialty Codes and 12435 SW' 122ND 1015 MOLALLA AVENU,E, all' Other applicable laws. All work will be done in. TIGARD, OR 97223 OREGON CITY, OR 97045 , accordance with approved plans. This permit will expire if work is not started Within:180 days of issuance, or the v ork:is suspended forinore'than 180 days. ATTENTION:• Oregon law - requires you to follow rules adopted by the Phone: 503 579 -2596 Phone: 503 656 -0920 .O regon Utility Notification' Center. Those rules are set • .forth in OAR•952- 001 -0010 through 952- 001 -0080. You Reg 8:, LIC 83425< may. obtain copies of these rules or direct,questions't0' OUNG by calling (503) 246-1987. '' . t - i REQUIRED INSPECTIONS Grading Inspection Underfloor'insulation ElectricatSeryice Insulation;lnsp Final inspection Foot'ng Insp Crawl Drain /Backwater Electrical'Rough In Rain drain' In Foundation Insp PLM /Underfloor Framing Insp Electrical Final . Post/Beam Structural Mechanical Insp Shear Wall 'Insp Mechanical Final Post/Beam. Mechanical Plumb Top Out Exterior Sheathing Ins Plumb Final 1 f B — 0 /74 - t _ Permit'tee Signature : ' „.. / 4' , Issued y / ! Call (503) 39 -4175 by 7 :00 m.for an inspection needed the xt;bUsiness day ( ) y p.m. p CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00093 �I�j DEVELOPMENT P EN TSERVICES o 639 - 4171 DATE ISSUED: 3/25/04 SITE ADDRESS: 12435 SW 122ND AVE PARCEL: 2S103BB -08600 SUBDIVISION: LAKE TERRACE ZONING: R -4.5 BLOCK: LOT: 013 JURISDICTION: TIG REMARKS: Remodel, adding 713 sq.ft. not changing the footprint BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 135 sf BASEMENT: 578 sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 578 sf GARAGE: sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 128,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 713 sf REAR: 15 PLUMBING SINKS: 2 WATER CLOSETS: 2 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: oo PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HM/SVC /FDR: 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 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: Owner: Contractor: TOTAL FEES: $ 1,914.75 CASCADE HOMES INC This permit is subject to the regulations contained in the JACK PAULSON PACIFIC 12435 S W 122ND 1015 FI C A S A D AVENUE Tigard Municipal Code, State of OR. Specialty Codes and TIGARD, OR 97223 OREGON CITY, OR 97045 all other applicable laws. All work will be done i accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: 503 579 - 2596 Phone: 503 - 656 - 0920 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 83425 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Grading Inspection Underfloor insulation Electrical Service Insulation Insp Final inspection Footing Insp Crawl Drain /Backwater Electrical Rough In Rain drain Insp Foundation Insp PLM /Underfloor Framing Insp Electrical Final Post/Beam Structural Mechanical Insp Shear Wall Insp Mechanical Final Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Plumb Final Issued By : /dt .• = Permittee Signature : Call (503) .39-4175 by 7:00 p.m. for an inspection needed the(h xt business day B� � it iinQ PePIi11 FOR OFFICE-USE ;ONLY � ?� D Received Permit No Q 13125 SW Hall Blvd., Ti City of Tigard Date ."'SAi 11 S aoa �t Tigard, OR 7 C) 2004 Plan R evie ! g � (� 3 —G Other Permit: Phone: 503.639.4171 Fax: 503. 6 �"Np . . Date/B : �V 3 - � Inspection Line: 503.639.4175 t`' _ Date Ready/By: Juris. ® See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION - - `.-th" 1'u °y �h:�`< w1 +'q!'✓1t ,,. L,e �:ii kL ,�"'.- :• ri1;'.+a3, .� , �i7 _ '.t.' ' tN :','ilit'1: F_'.S',L^'. :'�:,h�'_. .4`.q R r... .,, ^.. il�� ':rli�� e,.;1,i• y( :! °.nm�• � ' : s =l,:''.1'; :1 `Ar '' 'r lk -ik'd' i 41,,.- ,.', t�F i, n't, t;" y � ;''° ��W �`': °i �, fi:' . ��," �DA ANl) 2a FAM Iti Y' DWE LING• i.. '.;Pn�'d r, ,..a� „ �.„�:::?4taly,!i =: -,,•`� , :�._- 'a� °� ,_s ;;s; ,'�':u u A�., 4 • i. h�; �'radC.,REQI:III2L''�D _ - .. _ 3 ^-kA U, .1 „' g , = ° t , X PE OF WORK,, ; r, a? a ,:,dw „- ,. {_�.,, .. , ��n4;,' 2a3 ''�i6'��c�d�.'»("�'.i.gk�..u°a � "yl�s.�?,•� • 3.'; c: �+ a .�*'s� � a�h� '.�.s,E'�'a, :!�4^� :_ ,.� �.'� �.7e .�'. a • w ., �m_ . -� - . � - . ,, - , ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all 0 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead,.and the profit for the ;, .;,,r <x;v., r.;,:: =;r= ,,; '' , ;r• „ ,r:, ,r a,a ^y .1, a:: work indicated on this application. ' ; ",4: ' . t ' �, ,„ CATit OF' CONSTRUCTii ¶ : it ps1 t” ;a'�"=Wt,' K ei X "4,., °?r -, tg' , .r r � °�4a„ V, re:. t t . ?� . ; ?+;�' i' `;.M ` a, x n r: ,k >.'' "sunr Valuation: $ / as- / 0-0-0 K1 1- and 2- family dwelling ❑ Commercial /industrial Number of bedrooms: ❑ Accessory building ❑ Multi- family 111 Master builder ❑ Other: Number of bathrooms: , «'a f ' ' t Total number of floors: 14, t ,t' 1 t � JOI3 1S ITEtIN FO RMA TIO NAN, LOCA omit i 1 , 1 „ b, ,, N ,.I ; ,i Job site address: /, v ?� s / L L0 z New dwelling area: - 7( 3 square feet City/State /ZIP: I/4? A1^i 0, 9 ?. z 2 7 Garage /carport area: square feet Suite/bldg. /apt. no.: �/ '' / Project name: Covered porch area: square feet Cross street/directions to job site: r >4i l A d( / / 7 Z h Deck area: square feet ; I. , _ Other structure area: square feet f REQ ED D ATA ` C IIS -- 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 .;. ; g ,. ,prT� „ «+ ':..vi' ;: r".- .,'::..., '.":..:;^. ,',��3s..,,`r'. - : °;i: + .d:a :";.�aS 'a;'^',: i,,�$ °' ' PM. ,; `. , `,• „_ ,3. EttWi, ' t;; work indicated on this application ,„ �n t �,;,: •, 't , ,: ",, »DESCRIPTION : tOFF: WORK„ i;,,n ,rr�4- .,,.,'°j.e.t`',' ,_ A`, ,;. ft ., �' ��,�,��- � �.,: sas , t3`.• , ;� .�. .,t„ �§ � �:_.:.^�+�zr.�ee =s.'„ � � a.: , �, .. ,.ate „=�; �, ., ...,° , ,.��,s>� ,... „�.:'v �,. as �a3� .w / Valuation: $ Existing building area: square feet New building area: square feet g414 "�?rr:aft r °.:� -* z� >xih..:,i 3?';a�,z, c n * , a.a.y ;v� -.a;;; :' ; - a% ,�3: ° 'hHI�„ :, = "'', ^; _ - v: -- 71x €'t:,�` ikii a - l'. a „,a a, i' *1",< 4 ' PROPER Y OW irgf ' �� 4 : "' '� ® TENANT• X4P Number of stories: . Name: . 1, /Ole% il 'L Type of construction: . Address: ,/ 7 (( 7 �� (62 )2 2i A ✓Le . Occupancy groups: City/State/ZIP: - < ,q r. U q 7Z Z. y Existing: • Phone: ( 7) c 27 t7 • Fax: ( New: .t.. .. .i s v-. s;�:;„ ? "':°3f, r rs ;•. t,� ; . ,, , ^,'^to "..p,, .m, .'.:: :s: ''R° - � e , r ; ,.k^'3`i�� .,Sri> ^aiFu ? s3;: , .z', . , i''" . . '. .PSIN . Q ° , rd ' Li ,. s^ CON;TACT:PERSON; . `51' .. ' , T 1 ',.,r V � = y „.,'., �� >.,,;x;a� .�'. ,x �� ” �.�, .:�,: -�� . � ,�� :..�: ,,. .,. . e,= .� , .r.s. , x : t- .:,,.�.,,4d : �.�.�= ''NOTICE ;',.,.• �. .,. ��xk,; ��: �frr;-.:„'.'.: �'° ?raas��., �.', ken�sr' a�._. ',�,sr:;�,'�•�+��'�t�:t�- ..�.�4 �r^x>°ac�, �f�7tTs �,.�:, .,. , �r:.e�sr �¢; ?n::.. � .� °H�'r:�"`=` a`- Business name: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: under ORS 701 and may be required to be licensed in the Address: jurisdiction in'which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: a pply ; Phone: ( ) Fax:: ( ) E -mail: s �: "!'"r=' - " .y-'"2 °'kla`St,sr`�; Uzi' vrcd�3rs !'�,'33,` &.� :'s;'; »� "s; `zY" ^r » *`�;,' � a�. i = ;' t' . ` a rz , a� ' ' tCONTRA'GT r ,v r a ; t , Business name: L.PT �� ^ _ 4 �je, D I` { r [ i 5 �v 11,19,M.G3'PER , 7,:F'EES L v9 -�� :3in.:llr ,l ' rw'ST.'a., .-,�. _., -., •_ .'Xk; air -:, <_.. ::"4�'.. Address: JC /� (�� -A ot I l Fees due upon application IV Please refer to fee schedule. p City/State /ZIP: (kale)# e.i. - r L- f Old 9 7O`f eL 5S / Phone: l S .p O ?9Q Fax: ( ) ¢ Amount received CCB lie.: 8 0Q6-- 6/ / 2 / Date received: �1 r�v7j,b ( Authorized signature c 4 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. i:\Building \Permits \BUP- PernvtApp.doc 12/03 440- 4613T(I I /02 /COM/WEB) One- and Two - Family Dwelling BuildtnR Permit Application Checklist FOR OFFICE USE ONLY City of Tigard n�ceBya Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 A ssociated permits: Phone: 503.639.4171 Fax: 503.598.1960 - "h' " ('i � ❑ Electrical ❑Plumbing ❑Mechanical 24- Hour Inspection Line: 503.639.4175 A Internet: www.ci.tigard.or.us ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 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 design and location of catch- ❑ ❑ ❑ protection, etc. 10 3 omplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ' state ❑ ❑ ❑ ng 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 • . • ' olations exist. 11 Site /plot plai drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ 4 there • .. ^ - than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements : driveway; footprint of structure (including decks); I t lit?}-}eeatie 6.0direction •... _ ;...;.,.�.,,. • - • - _ - existing structures on site; and indicator; l - .--..- .:- _ - . _ _ . _ _ _ .. - _ 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 Ore:on and shall be shown to be a..licable to the •ro'ect under review. JU- RISDICTIONAL_SPECIFICS 2 Five 5 site .lans . re required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 w. ' c 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 tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions;' ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 Electrical Permit Application FOR OFFICE USE ONLY a . ' ' Received City of Tigard DateB Permit No.: Tigard, OR 97223 g // 13125 SW Hall Blvd., Ti Phone: 503.639.4171 Fax: 503.598.1960 - �� ' Date/B Plan Review Permit : Other Permit: Inspection Line: 503.639.4175 ' id/�1 e` Date Ready/By: Juris. El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information ,. .. k .. a te. a� q - .''' s,.. �- :•', z- � : h �. • ,7 _ �, zv- a ..&sz�. Tl O W O R K . , t = ti a' } g t k , .., ' PLAN REVIEW � >� " ,_,: ❑ New construction N Addition /alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l Hazardous location �,� _� P e ` � ['Service over 320 amps – rating ❑ Buildn over 10,000 sq. ft., i:. ,r r CA OF C aNSTRIJ CT ION ' ,> of 1- and 2- family dwellings 4 or more new residential 1- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi family ❑ Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more DOccupant load over 99 persons ['Manufactured structures or t %fkv ` JOB` ITE AN LOCATION. y. ,p , ❑Egress /lighting plan RV park Job no.: Job site address: �Z � .1f f f )21 ii. i � �� ie ❑Health -care facility ❑Other: _ Submit 2 sets of plans with any of the above. City /State /ZIP: I �! ' c 9 2-L 7 The above are not applicable to temporary construction service Suite/bldg. /apt. no.: Project name: iSS t '' ': aari EE SCHEDULE ;_, " _ s = _ ** Description Qty. Fee. Total - �� - Cross street/directions to job site: 41/4/7 ,) /4G New residential single - or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less i 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 3 33.40 l Tax map /parcel no.: Limited energy, residential 75.00 2 _ Limited energy, non - residential 75.00 2 : � , ; " 4; ,, "DESCRIPTION OFpWO RK� sat,' y ; � s - !kiwi ,'�, Each manufactured or modular Re /7). / „tea:” dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less i 80.30 2 i x -'7''' � s t 400 am Ps 106.85 2 . ' - ,.,,,, ERT..'i�OWN t, . -, TENA , "� A' 201 am P P z� . ,. .� _ .. :t.. <, t 401 amps to 600 amps 160.60 2 Name: , 5 � A ,�� / 1 1 ,� ( 601 amps to 1,000 amps 240.60 2 Address: /Z y � f r s /2,Z, ,,-`l Ale Over 1,000 amps or volts 454.65 2 / �� /C n Reconnect only 66.85 2 (4 City /State /ZIP: ,• (d ?Z Z 3 Temporary services or feeders installation, alteration, and/or / relocation Phone: 0 5 ) 11 9�, 21 s ! 6 Fax: ( ) r 200 amps or less 66.85 1 Owner installation: This installation is bein • me on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent i' r • inch • ge, ,c s (ding to ORS 447, 449, 670, a d 70I. - 401 amps to 600 amps 133.75 2 Owner signature: �� . :J 1 — Date: ) Branch circuits – new, alteration, or extension, per panel ' ❑ `API? ridroi , v i avvmrdtiztmzftfk Ole: w ; m A. Fee for branch circuits with service or feeder fee, each © 6.65 2 Business name: branch circuit / B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - ..-,4, ri ' N f `VW CON I 4C,T f � w. a . J ,,.�, a ' . ' energy panel, alteration, or E extension. Describe: Page 2 2 Business name: Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP:. Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax ( ) Industrial plant per hour 73.75 MISTOR ;CTRICAL PERMTI' E?EES* . b CCB Lic.: Electrical Lie.: Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: !1 Date: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: ` ( This permit application expires if a permit is not obtained within 1.80 / � days after it has been accepted as complete Print name: / Date: ' Fee methodology set by Tri- County Building Industry Service Board l `• Number of inspections per permit allowed. i.\ Building \Permits'ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM/WE8 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: tial DEN'JCIAI. WORK Q1 4 ,. ;.F A.. , 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: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: . ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC -PermitApp.doc 04/03 Mechanical Permit Application FOR OFFICE USE ONLY' Received CI>l)' of Tigard Date/By: Permit No.: Y 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 * rt'1`,la Date/By: Other Permit: Inspection Line: 503.639.4175 ,�:� , I I D ate R ea d y /By: Ju I3 See Page 2 for ,LR1 W Internet: www.Ci.tigard.or.us Notified/Method: Supplemental Information I r > ,;z .x"�� ."' � ,f�'Jt_i�`�I- E�"a'ff,`�Ss >.,$�s q� ..�. «� .�'�,"'� l;'$,4�:,.,�� z 1'�:., -gin '�, " . t , :,. ` , ws- ` °; �" a. - .. �.t ,�..,. ='r _;° la ,1 ' __ MNIERGIAI:akFEE *.,; SC•HED.ULE6 ECKLIST �'F` <'a 1 $:��,xJ:$x:t,.. � :<* �,�,.�'�'.�t�c�. =;��ilt Yp•E, mod, ��;. :� ° #, 3.;C0 .,n ,. . � r= .,,..,a... x'y:, f .,t;.y..3: v T.:...; , „, <, ,,, ,; ,,:, ,w.a s, :« < a. . ,. ,,, Mechanical permit fees* are based on the value of the work ❑ New construction 0 Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. s[ +ss:: ;t �;y:. ,�:7 lkl x,, ,e.�aci+ �:,: ',ham`- 33Ki :t' f .`' "r 4:";k ?e Value: $ 6 Kilfi414 t om`AI it tiVa`a - CA=TE;GURY OEi,,COIVSTRiJCTION ? } :, z, r , &,,� Yit .•;f, ; i P• ,m J . •�. -.r, -, ; •:••• .:,, , • RESI , 'E QUI PME N T' /'SYST R I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total . ?; "4NT�F:4 !1 "=Zi - , iei ;v 3S { i ° . dR''lL:f:�r: ��: # i ,a s :`; = .:fi �_; s• ?JOB ,SI ,V SAND LOG;AE,,, , =. ��i; - ;,, Heating/c <; ^ ,a ooling �� z� ,w. >mt„,.��:r�;re�.:xx•: <�r.Mrs EU °.��srt• �:w �. ° pp�a�m. ti., �- ar+.u..,aas;z�.,,'`.,;,;,,. irk ,�f��: � - s: /L Y 3 l �� y �'e- g conditioning or Tres se heat plan showing ) Job site address: Ai re wires site Ian placement) 14.00 City/State /ZIP: T - 4 re, nk 9 ? 7 3 Furnace 100,000 BTU (ducts /vents) 14.00 f/ Fumace 100,000+ BTU (ducts /vents) 790 ' Suite/bldg. /apt. no.: t Project name: Gas heat pump g/ 1 40 Cross street/directions to job site: �� ( �/ /1/ Duct work l .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 Flue /vent for any of above 10.00 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances ? it A . .:, 1 • . , ,r ,. t : ..... t I f i f 3 a e ..- :.: �r, H�deig ..- r. F , l ,�a; Im, ,,; r- Water heater 10.00 i.. , , t t ai r . t ae & OF r WORK �' ,'� . ` .u.aLt = ` , [,ia,,.,,Y'y r,,.,, e'aa 2�,raw m,xc,rc,� ,a�>aa a... ,c am s��..,.€ � Gas fireplace 10.00 A IM) ci(i/ 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 , `R ° 4» ,, r 'l o. . a... .,. Vr• -- ,.. ,J ,�.;�;., , ;i <, V i i;,�, :, . Chimney /liner /flue /vent 10.00 t t ,, . F - 1 , PROPERTY. O '! - 3 . a q»q{ c TENANT t rz sg 4 trWl.a '��? ..... ��,��=�w�.�.- ,�.,,,. . .�,..- >°.,i..�,,� ,_.> „� °� �a, � W Other: 10.00 Name: .. tv ( h f , . , f Environmental exhaust and ventilation �/ , Range hood /other kitchen Address: /2 : ) / Z ,��►► /L �ve , equipment / 7 10.00 City/State/ZIP: 7 T ' ) a rce vi 72 2 f C lothes dryer exhaust 10.00 � Single -duct exhaust (bathrooms, f f 7 j • ( ) p ,., Za 6 Phone: Fax: ( ) ' toilet compartments, utility rooms) 6.80 ,. „ , tom � ,. s' °ij n tp € F _, .•r =< �.: 3 " >i it Attic /crawlspace fans 10.00 � . ' ® PPLICANT , � 0 R . i ts- . ,-: , . CQN;T AC,T�PERSONy .:, ,.w.. Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Furnace, etc. Address: Gas heat pump ■ City/State /ZIP: Wall /suspended /unit heater ' • Phone: ( ) Fax: : ( ) Water heater Fireplace ■ E -mail: ' Range - / ,_,,' ,. °. ",,"*r :`Y ,°, -vo x:^a::..:aa '" 'i,`s; "' 4, ,i tr ' ' . i . ° ;14 .;° ,^ ; „k • . ,.. tt';: y ;; t-°-1';F , l gp . ...�_ : tF' Barbecue Business name: aLL E- /2— Clothes 'dryer (gas) Other: Address ” MECH : PPERMIT FEES*' °. City/State /ZIP: Subtotal Minimum permit fee ($72.50) Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lie.: i State surcharge (8, % of permit fee) � TOTAL PERMIT FEE! ) Authorized signature: t- l/ r' T his permit application expires if a permit is not obtained within 180 / days after it has been accepted as complete. Print name: 1 Date: * Fee methodology set by Tri- County Building Industry Service Board i:\Building \Permits \b1EC - PermitApp doe 12/03 440- 4617T(I 1/02 /COIN WEB) • Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: 't'a4` �f , 1 . 0 , ; s.: = A;Vw< `Total =$`�aluatronL4, '; ' ,� 4 , 4 4 p ermit 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. • iMuilding \Permits\Iv1EC- PermitApp.doc 12/03 2 Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY City of Tigard Received Permit No.: Y Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Alk Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 I Date Ready /By: Juris l See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information '.Y ' ;,. k •t .�Y,.rt .1 .:h: .S'�. ii' Gt;tt - +.' c r .itn : .4 4 x01: ,I•� 7''rr' �rf �k: -,a :vt .. } .4 ", ' °'1`y.• .rte` ._;, „ w,� d `ii� k'=e��K. 'P` �� : ;�;� N;.s 1�:.� - r;' ]t V. . E'EE- , SCIIEDLiIE' , . :;x.. a .% = '-`,,, +4. ;_ °'t' '>.TYP'E� ffai ;Y'w::�.:rAi °: .,..!: 1 1:.",„",ifi,i'�.-,u,.,.r,l.)_., Vi u. t '. - �..ar_,>w= ��' g9ir.` v" utde •:F3C:r °''�u� ='`i;�_mq =?.'`^. - u.gcte,u ...Y € ^..•ql;,"d, a'anr '� -'9 �rT�'Ji'.S�inf"' ,= L'F.;;!, 't7 u8�rm��b .. :..:u ,r .. t rA ..IJ.�. ,ir n __.v .r „:''i': ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total '] Addition/alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection) � y 0, +. c; rr .. r .. :f'. d? €:.yr li''' �. s ,�x. 1.. i 4 i lls',., ! ' .-3` {' , v } _ �, � , < i; *" ^ 't r yJ " ':'s'' 3 SFR (1) bath 249.20 ',1. * ; - %:1 : v. -G 'fr :4 61tAc 1 _ a!,;'' aCATECORl"'OF.'r;CUNSTRUGT I , i, r. >1. . .. �t4: cssatr..z •r,rs .�� ,:= ,eta,. 0'31 a ^r tfi °. e ua ,, tE 1 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: q; ,, ,� :: t .ti. , .ti A ,: ex. -.. s;'r.'� ;" Fire sprinkler ( sq. ft.) Page 2 x F � t F I � W � rSITE lINF �'�AND LOCATION , M l� i ii , '� 1 'i t ;t. ., .wzt v, , A :ge A4x.t..e,.. 4, v.. .3au.: Yr. cfu6;4,,,, c.N4t,,ht -: i...�.. .i , d a , A41.il is t Site utilities Job site address: /. y3 ' f6,..) /2 ' ' ' A if Catch basin or area drain 16.60 City/State/ZIP: 7 -,o ,.. g ??7Z3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: , I Project name: Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: 114;,0 / ' p.41 Manufactured home utilities 1 10.00 / 4 01/ / 2 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: " "?i'l : >�dn S , =d t vT,: € > 'x::° .: {z. , . +'<;.x„ - �r:,; -s; .;a.. "f 'i: �,' >; -.. -. �,.; Absorption valve 16.60 ` ,:fr r 1 ; , ; . .:'4't i + . .:VDESCRIP <TIOIy D OElVdri f = :'O, , , i` , 3: - ?,lir- '-':;...:'l �:� �Ar in„r�•.z7sn:Uxaa.�x2etf., ,tie, �.��.�,w�, : .� =,�V i a g - ,.�* ,.fi Backflow preventer Paget Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ,,,_ �,a. ,n =s . ,x : :,:- aa. ,� < «.t t P' - .' , +a Drinking fountain 16.60 �, . ' . rvR , t < �� = • "j ' ; u s ? "' "` i 'rz'' .1 ej 'x. " `° - _',. "g .!.�,"�,4,' ; � 1 r;1,- CI` OWN ,a. V,r ,. . ' , ng... - , TE z .:r E�- ,,�Us.€.�,r_� ,,.•� AA- t r,_B= �.� / L. 'r ?,.ax o_�� a .. r<:... ::�t . Ejectors /sump 16.60 Name: , �� if 4'i p /, ,4 ... (d Expansion tank 16.60 Address: /2y f )' < /Z Z r� ,oiJ((.. Fixture /sewer cap 16.60 City/ State/ZIP: c� -Z� p6 ' 44 � X 9 Z1Z Floor drain /floor sink/hub 16.60 � ' Phone: ? Fax: ( ) Garbage disposal 16.60 �p t ':- .0 , r,,r, i01, ,, x l ;, , , ''.. : 1 ,. : - -,,: „�E +, =, r_ , as , ;, Hose bib 16.60 `��41 ! l-AC PPLIANT 'x s ` �`"- r " ;® CONTACTz '� ,a 1 5t'a¢ ,ta, a ,c.,�..t : -s , .t �q x,.54 sue "_ ��t., r r.,.r€ ..� -_ � :, , _a `. 1 I maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) - Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin /lavatory Z, 16.60 Tub /shower /shower pan 7., 16.60 E -mail: Urinal 16.60 is =� - 's ° ;�'�� s4a r .6,;tt=cerad><u- "`- .sa:�H�lz ^.. .. �. �� et � x ip ,1I ;�: x`^r? "'P,: l3.r$;;i'l U'�`.,. E . 'g,�'.`,. ,3. - , • N .F r., : , :r `;'1';p , !`... , i •li , 4 k ; • � �t -grj, tig41 : rt: �? '` a ' ;'' { » CONTRACTO •, ;'7 �r , ,.a r5': a,i'2��,.....,�,a „_ �xr , y�a��e,+'. �asxx� - „,� .'�s.: �� i;,e;:�:,�� Fes, =4 , ^ y� , xk,�.r , .4,:, s: Water closet 16.60 Business name: Cw (- E Water heater 16.60 Address: Other: / tw 4t1L6 ik .e ,4, )h., City/State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: j,9 i Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: i Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. is\ Building \ Permits \PLMF- PermitApp.doc 12/03 440 -4616T( 10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ,. N" •.':k, , :.3r " ^:; " �^ 5: 'F' - "LE r' „' ��f��,E.'�:xz n:h. .?:,d«.''i �1;:"` .v�. ,;;�"il? :1 :v: `�"' '�'ru ^ "'k s..t .. ^3 * ' .,t„ey.a^ s¢ , t.:, Fee,, ea T o t a t ^.:' e ' „a �'� r _ , - ., Q Yt''t�1 v : ( §):' 44 "' u :f. °�:' 0 S><te�Util>Lt><es , � � ° . q .- ._._ g _ , - ......___.., ..._,..»d.. .._ ..... <....- s�c�.. �:.a�°,ti�k z: d._ac; - x" ,.qtr -.e c _S� +t S in_ "n- .. ..S�.r'��<��31 sx- 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 - Ist 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service -1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 FJ 1„,�, E , y . „�,.; ' xt „^," Rr'�(l^n , Storm & Rain Drain - 1st 100' 55.00 ::° s �,:« 3 r; F;' � , . :,a, t ^,;, x f ,'s �., $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 u a a dditional 100.00 or fraction thereof, to and ��::�s�4:, { r .,�,�,,.,�,f1�� 1�„ -' Qty. Fees(ea) 1 � =�'I'otal'��i $ !'ll%tue or Iteltl . eam.agit fw:aris, 3; t:? ct + 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. 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: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . F� t " `¢ x' ,µ W ` > 1 v Aliu"ant ef - 7(Eiztu ;i);�W.. a o erfaimed ' , �.k ype it . -'`rs'f'74,- °� a �r s d s rz k s - - s t "'3 ; FuctUre "zTy e t �M 14�1t�t l v ell �YY k: r k RCp aCC� s- { '4, °' � & t ' �l ew1 M ea Exis P a Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3 „ -4 „ Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an • -Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station • plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bommercial Isometric or riser diagram is required if fixture quantity Service total is >9 . • Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 3/03 MAR 1 0 2004 File Number yo / Clean ate Servrie Oi r rattatn►tnaent is clear, Sensiti - Pre- Screening Site Assessment Jurisdiction ' i__^ ,? �� Date ;;�/ `i' O Map & Tax Lot Mr .2:5gl i !�1 k 38 1 4 'bc,v� Owner T�r / E Xi� ,R'c4,5d Site Address /,t /3S S.w.. / 22 ,e' Al/ 01: 2. 6 1 7Z Contact /2'f 7 5" f Proposed Activity n ri".e;,;r rt.Atv 41 ; ,1 /,i X Address Ta 1, 4 OR_ (. 2 Z Z j() (10 ∎ tiff ,a 't -t fir rfth rn tJZxi!1,i7 2217. -fr' OsiV Official use only below this line Y N NA Y N NA Et Sensitive Area Composite Map Stormwater Infrastructure maps ❑ .. ❑ Map # 2,,5'1 t 4 ❑ ❑ ❑ QS # Ll 3 1 ❑ ❑ Locally adopted studies or maps n ❑ ❑ Other Specify Specify' a. 002 c,,t Pt, Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No L J 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 LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. 11 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 on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. a The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: // ✓✓ A n No /PAc&p e;o Ac.d uSe. !Yo n ;b4.i1eryiuo5 G.✓PCt. 1 /��S h•r ri- a r Thp th' dy /2 e 49,14Ywt Reviewed By: �' �--- Date: 3/i ./d Returned to Applicant Mail )( Fax Counter Date 3// ?/n By" 155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Phone: (503) 846 -8621 • Fax: (503) 846 -3525 • www.cleanwaterservices.orr • Permit #: V4.. el— OOQ ? ?j Address: 455 &AD I aat4 koE, Issue by: • C.. Date: e/d Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered 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 registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ,/ I 1. I own, reside in, or will reside in the completed structure. FA F A 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. W 3A. My general contractor is No- i C CleaC ort) L Pb 1 l tJC'o S '3 Li _a_5' (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. • If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered 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 1 have read and do understand the Information Notice to Property Owners abo t Construction Responsibilities on the reverse side of this form. 3 5/ ( Signature of permit applicant) e) (White copy to issuing agency permit file, pink copy to applicant) Information Noti c to Property Owners About Construction Responsibilities Note: This Information Iijornzation !voice to Property ()wners about Construction ReAponsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax Law: As an employer, you must withhold income taxes from employee 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 Oregon Dept. of Revenue at 945-8091. 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 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lfvou fail to obtain workers' compensation insurance, you may be subject to penalties and will he liable for all claim costs ifoocn[ your employees is injured outhe joh.Fu,morcinforma1inn, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from emplovees' wages. You will be liable for the tax even ifyou didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code cmmuplimmoe:Aa the permit holder for this project, ynuxrcncsponsiNuforrcsnivinguoy failure to meet code requirements that may be brought to your attention through inspections. Liability and propeItY.damage insurance: Contact your insurance agent to see ifyou have adequate insurance coverage for accidents and omissions such xnfx|}ingtools, paint overspray. water damage from pipe punctures, fire. or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Make sure yo have the thee.xpertise to t as your as vour general contractor. to coordinate the work ofrough- in and finish trades, and t6 notify building ppropriate times so they can perform the required inspections. If you have additional pestions. write orcall the Construction Contractors Board (P0 Box 14140, Salem, OR 97309-5052, 503/3704021). TlucRoord is located at 700 Summer St. NE Suite 300. in Salem. • BUILDING W Hall Blvd., Tigard, DIVISION 4" , PERMIT #: MST2004 -00093 13125 , OR 97223 / 6 DAT ISSUED: 3/25/2004 Phone,. (503) 639 4171 %!��u �� 1I ° 1 "I i _ --., = — Inspection, Requests (24 Hrs:) (50 3) 3) 639 -4175 " :_.., � -(f �' INSPECTION WORKSHEET FOR DATE: 2/11/2009 - -- TIME 7 O0AM PAGE: 18 , SITE ADDRESS:, 12436 SW 122ND AVE ` ' CLASS OF WORK: SUBDIVISION? LAKE TERRACE LOT .#: 013 TYPE OF USE: - PROJECT NAME: PAULSON .. DESCRIPTION: Remodel, adding 713 sq.ft. not changing the'footprint OWNER:' PAULSON, JACK.' PHONE . #: " 503-679-2596 CONTRACTOR: PACIFIC CASCADE HOMES INC „ PHONE #: 603-.65E4920 "Inspection Request Scheduled For: Date: 211 112009 Pour Time: . Code # - ikispeCtion Description Confirm. # Contact # . Message 399 / Plumhinq,l'inaI Oft04 0i 503 - 616.2588 N Corrections /Comments / Y / .1A-t e / c . CIA / 4 \-jj-2 I _. ` , • • � _ ' : ❑ PARTIAL APPROVAL - . ❑ CANCEL: ❑ NO ACCESS ® FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED C Inspector: A Date: 1 VO Phone #: (503) 718 p-4.-.)-Lte . . _ .. .. . . Cirif OFTIGARD - • _ " , ,' := Ai IP -----,„ BUILDING DIVISION PERMIT #: . MST2004-00093 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3 Phone: (503) 639-4171 MIA I ifi 1 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FO I4 PAGE: DATE TIME 7:00Aivi 9 . - SITE ADDRESS: 12435 SW 122ND AVE CLASS OF WORK: SUBDIVISION: LAKE TERRACE LOT #: 0 TYPE OF USE: PROJECT NAME: PAULSON DESCRIPTION: Romcdol, adding 713 sq.ft. not changing the footprint . . • OWNER: PAULSON, JACK PHONE #: 503-579-2696 CONTRACTOR: PACIFIC CASCADE HOMES INC PHONE #: 503 Inspection Request 5cbeduled For: Date: 8/12/2008 Pour Time: • Code # Inspection 'Description . Confirm # Contact # Message . . 39.$ Plumbing final 074075-01 ' 503-616-2588 W Corrections/Comments/Instructions: ---...4-- \ VACe,t i f_cv-e4ACe,/,,,, A 1--k<3r K 1 `r3 10 r 1 AA- ' Acr.e.,( S e , IV\67\74■ p -1/4 CS e- tre 1-, Rt__,<I_ S c e, ‘ '(' 1 -0:._..; .;,,, Fr 4 . A.„,/ b,..-\-- c „ y r.t - t..7:cl. .., ■ . ....1 . 1-k I 1 mcSc,, - ' 'C_,:. 4 La j Co c).... 7 pn 4.-ce,,,,, \,„ .A. 7 %---)_.%, \, . AA t.,-- ‘-'" ( - 1,1% i .14-x, R ,:c - C-ccLt c_fc e,. A__ -.....,k3 . • , n' ' lt ., 1 / 4 \ ow t,.../ (A.-A1 00 -A-,f, „..c. Lo-,,,, Sec, \ ,c-,,,--\--..-c w 'cm, -1 it cp- (t -a. 11=1 oo LArk_c)t. ' .. v (7\ 1 __ , - D. 776 Q- 1 4— ai_iir c,c ye/L.-Jr , LIA./ -. 1 ' POrr io _Le_ T N 17eLt v i—i-i kh, \ (-"a ( 4I\ Ln k (1 ‘Jt‹, Clr (),, . _ I PASS III , PARTIAL APPROVAL D CANCEL . NO ACCESS 6 FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES.ASSESSED Inspector: (1 ) h. iv' Date: riv \. cicr : Phone #: (503) 718- i T CITY OF TIGARD b . , , • • BUILDING DIVISION PERMIT #: I+�ST2004 00003 13125 SW Hall Blvd., Tigard OR 97223 DATE ISSUED: 3/25/2004 Phone: (503) 639 -4171 411111111\ Inspection Requests (24 Hrs.): (503) 639 -4175 / V INSPECTION WORKSHEET FOR DATE: 3/25/2005 TIME: 7:07AM PAGE: 47 SITE ADDRESS: 12435 SW 122ND AVE CLASS OF WORK: SUBDIVISION: LAKE TERRACE LOT #: 013 TYPE OF USE: PROJECT NAME: PAULSON DESCRIPTION: Remodel, adding 713 sq.fti not changing the footprint OWNER: PAULSON, JACK PHONE #: 503 - 579-2506 CONTRACTOR: PACIFIC CASCADE HOMES INC PHONE #: 503 - 656 -0920 Inspection Request Scheduled For: Date: 3/25/2005 Pour Time: Code # Inspection Descriptio Confirm # Contact # Message 320 Plumbing rough -in 0 002851 -02 503- 579-2586 N tions/Comments/Instru tions: - Corr tions ' �,,� {-- 3 /2 / (n 2s] — \ S ,i/J_ v `y, • PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED '16\ � Date: Phone #: 503) 718- ' Inspector: ( ) ' ® ice., .. ` 1 CITY QF TIG•AI�lD" . • { BUILDING DIVISION ' �; PERMIT #: MST2004 00093 I . i 1Tigard, 31`25 (W Hall Blvd: , OR 97223 I \-- • DATE :ISSUED': 3/25/20 • Phone. 503 639 41 ia,, ii Iti �� A Inspection Requests (24 ,Hrs.): (503) 639 =4t75 INSPECTION WORKSHEET FOR DATE := 3/21/2005' TIME 7 :1OAM PAGE: 34 SITE ADDRESS: 12435 SW122ND''AVE CLASS'OFWORKK ' 'SUBDIVISION: ' LAKE TERRACE ' LOT # 013 TYPE OF USE :' PROJECT NAME: PAULSON DESCRI .Remodel, adding 713 sq.ft. not changing, the,footprint . ' OWNER PAULSON, JACK - • PHONE #c, 503- 579 -2596 !, : CONTRACTOR: PACIFIC CASCADE HOMES INC , . PHONE #: 503 - 656.0920! ., • `Inspection Request- Scheduled 'For Date: ' 3121/2005 . our Time Code # Inspection Description Confiiln # Contact # Message 320 Plumbing,rough -in - 002315 -01 60M792696 - 1 Corrections/Comments/Instructions: • • . • j 1 • . .. I i ' . 41 , - e. l`A/,Libao / <1Kil , 0 PASS 0 PARTIAL-' APPROVAL ❑ CANCEL • Q N a ACCESS FAIL, • ,n CALL FOR. INSPECTION 0 ADDITIONAL FEES ASSESSED - Inspector: t j 1 . Date: , 3 )/ : Phone ' #: (503) 718- - r , /CITY OF TIGARD -" BUILDING DIVISION � D ATE ESS U ED: 3t2al2 C)C14y 0t)3 IV ' 13125. SW Hall Blvd., Tigard, OR 97223 • Phone: (503) 639 -4171 - 0/0!�i ' ( , f'7,--:-,-.` f �i Inspection Requests (24 Hrs.): (5,03) 639 -4175 % � - INSPECTION WORKSHEET FOR DATE 91/4/2007 TIME 7 :00AM PAGE:.. 13 SITE ADDRESS: 12435 SW W 122ND AVE CLASS OF WORK: SUBDIVISION: LAKE TERRACE LOT #: • 013 TYPE; OF'USE:: PROJECT NAME: PAULSON DESCRIPTION: Remodel, adding 713 sq.ft. not changing the footprint • OWNER: PAULSON, JACK PHONE #: 503-579-2596 CONTRACTOR: PACIFIC CASCADE HOMES I NG' PHONE #: 503-656.0920 Inspection Request Scheduled For: Date:' 3/14/2007: Pour Time: Code # Inspection Description Confirm # " ` Contact # Message .• 200 Insulation , 055744-01 503 250E N Corrections/ on meats /Instructions:; ,• D-/zo‘ lac . '6U - \4 c ' ` " VJ' . • n PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS 'FAIL. n CALL FOR INSPECTION n ADDITIONAL FEES .ASSESSED Inspector: �`�_- - Date: / P # :. X 503 ) 718 - 21), /'/ CITY-, OF TIGAR - Bu LDING ®nn$i N A, PERMIT #: MST2004 00093 13125 SW Hall Blvd., Tigard, OR 97223 . •DATE ISSUED: '312512004 •Phone: (503).639- 41'71 ,u�1�lpub�l� _ ,, Inspection 'Requests,'(24 Hrs.): (503) .639- 41 . _.. INSPECTION WORKSHEET FOR ",DATE: • , •&2412007 TIME: 7:00AM PAGE: 21 a SITEADDRESS: 12435 SW' 122ND AVE CL OF WORK: • • SUBDIVISION: LAKE'TERR'ACE LOT #: 013 TYPE OF USE: PROJECT -NAME: PAULSON " DESCRIPTION: R :model, adding 713 sq.ft. .not changing the footprint •. t OV NER. <. PAULSON, JACK . . PHONE #: 503 - 679-2596 CONTRACTOR: PACIFIC CASCADE HOMES INC PHONE #: 503 - 656-0920 Inspection RequestScheduled. For: Date: 5/24/2007 Pour Time: • Code _# Inspection Description . Confirm # Contact # • Message ,. 120 • ec rival' rough -in (4 99Q • 50 3 - 679-2506` . N - r -:!' • Corrections ° /Comments/ Instructions: . : ' ' C 411? D l'f/igi '.4f -- ' . ' ' ' P ASS I I PA ° IAL APPROVAL n CANCEL NO ACCESS ' n F AIL ;ALL FO'''; P CTION N ® 9 ION :L FEES 'SSESSED Inspector: • v _ � �� Date: - _ P hone #: (503) 718 „ CITY. OF'TIGARD 0 . . - , .a1,+ PERMIT #: 9 BUILDING DIVISION I ST2004 000g3 ISSUED:; 13125 8'W Hall Blvd - Tigard, OR 97223 DATE 3/ 26f2 004 Phone: (503) 639-4171 . 44i�e "� � ' Inspection Requests (24 Hrs.): (503) 639 -4175 - .z- a�i -� �) �- ' INSPECTION "WORKSHEET FOR DATE: 12Y11/2006 TIME: 7 :00AM PAGE 35 SITE ADDRESS: 12435 SW 122ND AVE CLASS OF WORK: SUBDIVISION: LAKE TERRACE LOT #: 013 TYPE OF USE: PROJECT NAME: PAULSON . ' DESCRIPTION: _Resin del, adding 713 sq.ft. not changing the footprint OWNER PAULSON, JACK PHONE #: 60:5791696 CONTRACTOR:' PACIFIC CASCADE HOMES INC PHONE # :' 593 -856 -0920. . Inspection Request Scheduled For: Date: 12/111200 Pour T me: Code # Inspection Description Confirm # Contact # ' Message 280 Insulation 040870401 503- 579.2,96 N Corrections /Comments /Instructions: P ASS PARTIAL .APPROVAL ❑ CANCEL ❑ NO AC ❑ ' � CESS Er FAIL , ❑ CALL FOR INSPECTION n ADDITIONAL FEES,ASSESSEb Inspector:. _ Date: / _ Phone #: (503) 718: CITY OF TIGAR"D • it? BUILDING DIVISION 'PERMIT MST2004 00093 13125 SW Hall Blvd:, Tigard,, OR 9:7223. DATE ISSUED: 3/25/2004 'Phone: (503)'639- 41,71 0 ,111110 . Inspection Requests, (24 Hrs.): (503) 639 - 4175 • : INSPECTION WORKSHEET FOR DATE: 11/16/2006 TIME: 7;DDAhtt PAGE: 65 'SITE ADDRESS': 124 5:SW 122ND AVE CLASS'OF WORK: SUBDIVISION LAKE TERRACE. LOT #: 0:13. TYPE OF USE: PROJECT NAME: PAULSDN DESCRIPTION: Remodel, adding 713 sq:fL not changing ' the footprint OWNER: PAULSON, JACK PHONE #: 503-57%2596 CONTRACTOR: pACIFIC'CASCADE HONES INC Q ±, V ; A (,. � :. PHONE #: 503-656-0920 Inspection Request Scheduled For': Date: 11/16/2006. Pour Time: `Code # * Inspection Description Confirm: # Contact- # Message - 120 Electrical rough-in 0391 101 . 503- 579.2596 N Corrections /Comments /Instructions: t „A‘rt Ro S l oL U . - • 1 PASS APARTIAL APPROVAL. ❑ CANCEL: 0 •NO ACCESS FAIL n " CALL-.. FOR INSPECTION I .I ADDITIONAL FEES' ASSESSED:- Inspector: p�,�` LL Inspector: @\1 Date: 11 1 t) U - Phone , #: (503) 71£3.-'2\t"\., CITY OF TIGARD 0 .. ��} BUILDING L ®� DIVISION ... _ : - PERMIT #: 7--- 13125'' Hall Blvd:; Tigard OR; 97223 DATE ISSUED: Phone: (503) 639 -4171 /�iuiitadp�p�'P�i lt,- Inspection? Requests (24 Hrs:) (503) 639 - 41'75 __° .iI, INSPECTION,WORKSHEET.FOR DATE: .- TIME - PAGE: SITE ADDRESS: 1 2-1 1 22- `s'-' CLASS OF WORK: SUBDIVISION: LOT #: TYRE OF USE: . -, . PROJECT NAME: • ° DESCRIPTION: ' ' ' OWNER: s - PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time:. Code # • Inspection Description Confirm # , Contact # Message ' , W - 'L C74 z Corrections /Comments /Instructions: , • • r. PASS n' PARTIAL APPROVAL n.CANCEL , Q NO ACCESS :FAIL n. CALL FOR INSPECTION ,n ADDITIONAL FEES ASSESSED A . Inspector: , Date: /4 ' --r' Phone #: (503) 718` CITY OF TIGARD BUILDING DIVISION - . PERMIT# MSr2004 -00093 13125 SW Hall Blvd., Tigard, 312.,J20 , OR 97223 DATE ISSUED: r 04 9 • Phone (503);:639:4171 l/�� iiat 1 Inspection Requests (-24 Hrs :) (503). 639 -4175 .� I'i • INSPECTION WORKSHEET FOR DATE: 9/20 /2005 • TIME 7:07A PAGE: 53 SITE ADDRESS: 12435 sw 122ND AVE CLASS ,OF WORK: SUBDIVISION: LOT; #:, TYPE OF USE: LAKE TERRACE 013 PROJECT NAME • PAULSON DESCRIPTION:. Remodel, adding 713 FAA. ,not changing the footprint • OWNER: PAULSON,JACK PHONE#: 503.579 =2596 CONTRACTOR: PACIFIC CASCADE HOMES INC PHONE #: 503 - 656.0920 Inspection Request Scheduled For: Date: 9/20/2005 Pour Time: ' Code # Inspection Description Confirm # Cbntact # Message • 280 Irtsulaiion 016128 -01° 503-579-2596 N ` Corrections /Comments /Instructions: • • • • • • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL - ❑ NO ACCESS • El 'FAIL .ALL FOR INSPECTION ❑ ADDITIONAL FEES: ASSESSED. • 4 D a te: 9 —�- pS Phone #: (503). 71`8 - Inspector: , • " ,. _ � • CITY OF TIGAR BUILDING DIVISION PERMIT MST2004000 3' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/25/200q Phone: (503) 639- 4171 �rf ii�ttfij Inspection - Requests ,(24 Hrs.) (503) 639 - 4 INSPECTION 'WORKSHEET 'FOR DATE: 9/8/2005 TIME: 7 :O9AM PAGE: • 16, SITE ADDRESS: 12435 SW 122ND AVE CLASS OF WORK: SUBDIVISION: :LAKE TERRACE LOT #: 013 TYPE,OF USE: PROJECT NAME: 'PAUL` SON ' DESCRIPTION: Remodel., adding 713 aq.ft. not changing the footprint OWNER:. P AULSON, JACK PHONE #: 503- 579.2596 CONTRACTOR: PACIFIC CASCADE i=iOMES,INC` PHONE #: 503- 666.0920 Inspection Request Scheduled For: Date: 1 8f200 Pour Time Code # Inspection Description Confirm # - Contact #" 'Messa9e „ 275 Framing 015186.01 503-679-2596 N Corrections/Comments/Instructions: • • • • • • c ❑ PARTIAL APPROVAL, ❑ CANCEL 1 1 NO ACCESS FAIL, . CALL FOR INSPECTION . ❑ ADDITIONAL FEES ASSESSED , • Inspector: "Date 9 = -0 Phone # (503) 71'8- • CITY of T G 'RD 0 . ..• . BUILDING DIVISION` _ PERMIT #: „ NiST2004..000g - - 13125 SW Hall Blvd., Tigard,, OR. 97223 DATE ISSUED: 3125/2004 . Phone: (503),639 4171 vvl ` � i lrl . Inspection Requests (24 Hrs:): (503) 639-41k' // 75 ' • , 'l1.:'' II INSPECTION WORKSHEET FOR' DATE: ' 'W3012005 TIME: 7 :14AM • PAGE: 46 SITE ADDRESS 12435.51 122ND AVE' CLASS OF WORK:. SUBDIVISION: LAKE TERRACE • LOT #: 01.3 TYPE OF USE: PROJECT NAME: PAULSON DESCRIPTION: Remodel, adding 713 sgft.:not changing the (ootprint. , OWNER: PAULSON, JACK - PHONE # ,. 503- 579.2596 CONTRACTOR: PACIFIC CASCADE INC: . PHONE #: 603 - 65&0920 , Inspection Request "Scheduled For:. - Date: :8130/2005 -• Pour Time: Code # inspection. Description Confirm # Contact # Message ,. 275 Frarning 01458401 503- 579-2596 . .h1 C''orrections /Comment's Instructions:' 0 45-,4 .a ' C ...4' z... ABC' !At .W ).5.6 _ 1 -" -57 4/Geg't "..c. • A LAC L - 3 - se .0 Z--4-i < S ,' 1rr C r' /• c- . • ii2UUi S 4�4,4:�7 : 4,,o ('rte ./ v' � 7 r ?46c /4Tom// 7 1` 47 . ` ° - i x' '' Z - ;ems te r. - / 14 4 • • pA ❑ PARTIAL APPROVAL • CANCEL • , • ;n NO ACCESS • .. PAIL ' 1 --- ❑ 'ALL ;FOR INSPECTION = ADDITIONAL FEES ASSESSED ,:./ . Inspector: � . . Date: 6 — .30-- - 0,) . Phone #:: (503) 718 - " CITY OF TIGARD • BUILDING 'DIVISION - r. . PERMIT #: M ST2004001 3 13125 SW Hall Blvd,, Tigard, OR 97223 DATE' • I SSUED`.. 3/25/20 Phone: (503) 6 394 171 ,'" , ig161�114 1 `,, , Inspection Requests (24 Hrs.) (503) 639 " n��,ei4N�yli INSPECTION WORKSHEET FOR DATE: 8/9/2005 TIME 7;0SAM . PAGE: „ 33 SITE ADDRESS' 12435,SW122ND AVE CLASS OF WORK: , ' - SUBDIVISION: LOT. #, TYPE OF USE: LRiKE 013 PROJECT NAME: ' PAULSON ' • ; DESCRIPTION: : Remodel, adding, 71'3 sq.ft. not changing the footprint PHONE #: 503.579.2596 OWNER: , OW , PAULSON, JACK • ` - - .. „ : CONTRACTOR; PACIFIC CASCADE HOMES INC. ;' . PHONE # :. • 503 - 656 -0920 • Inspection Request Scheduled. For:, Dater 8/9/2005 Pour Time: 2. Code # Inspection Description Confirm # "s Contact - #' Message 275 . Flaming 013169 -02 • 503-579 -2596 N , Corrections /Comments /Instructions: • ' ,001 - .7 , El PAS ❑; NO ACCES ❑ PARTIAL APPROVAL � �� ❑ CANCEL � � • ACCESS • -AIL' ❑,, ALL FOR. INSPECTION -Q' ADDITION FEES ASSESSED . QQ ' . • Inspector: f " ' Date. C� hone #; (503) 71,8 CIT—Y—OFTIGARD . BUILDING DIVISION - • ' PERMIT # M,T2QQ 00093 13125 `SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/2' J2004 Phone :' (503) "639 4171 -.....1'.71/1111j...1.7-'' � Inspection Requests (24 ,Hrs.:) (503): 639 -4175 INSPECTION WORKSHEET FOR. _ DATE: 8/9/2005 TIME 7 :OSAM • PAGE: SITE ADDRESS: 12436 SW 1'22ND AVE CLASS 'OFWORK: SUBDIVISION: LAKE TERRACE LOT # 013 TYPE OF USE: PROJECT NAME: PAUL SONY DESCRIPTION: Remodel, "adding 713 sq.ft. not changing the footprint OWNER ` PAULSON', JACK N � f PHONE #: 5t73 575 5 6 • CONTRACTOR: PACIFIC CASCADE HOMES INC, PHONE #. ..503.656.0920 Inspection Request, Scheduled For Date: 8/9f200 Pour Time: Code # Inspection Description - Confirm . #`' Contact; #. Message . . • 110 Electrical rough -in - .0131 69 -01 . ' 603- 57942696 Corrections /Comments' ; € /Iristructions i • e'a- f`n • • 341,PASS n PARTIAL APPROVAL n CANCEL Q NO ACCESS. ❑ FAIL E CALL FOR INSPECTION. • 0 ADDITIONAL FEES ASSESSED P 6" , 1`11'66 2N II Ins actor:; Date 'S 9 Phon #: (503) 71'8- - CITY OF CARD jh .. IL®INC DIVISION • - PERMIT.# MST2201:14-91 f�9 ' . 13125 SW Hall Blvd:, Tigard OR ..972231' " DATE ISSUED; 3/25/ 004. Phone:, (503) 639'4171 �i�� llfiy�cifll6��ll'� , - Inspection Requests (24 Hrs (503) 639-4.175 _ ,W; INSPECTION WORKSHEET FOR . • DATE:: 8/4/2006.. • TIME:, 7 PAGE: 75 SITE ADDRESS: 12435 SW 122hlD AVE • . - CLASS OF WORK: SUBDIVISION: 'LAKE TERRACE • ,LOT #; 013; TYPE OF USE PROJECT NAME: PAULSON DESCRIPTION:, Remodel, adding 713 sq :ft. not clanging the footprint, OWNER: PAULSON,, JACK PHONE' #': 503- 579.2596 CONTRACTOR: PACIFIC CASCADE HOMES INC PHONE #>: 503 - 656-0920 i, Inspection • Request -Scheduled ; For Date : _ 8/4/2005 Pour Time: Code # Inspection Description Contact. # Message 120 Electricals ®ugh -in 12741 =01 503 579. 2596:. V' ' Corrections /Comments /Instr,_uctions : ® ' 2 ; R A' ..41e, w '.ti yr 1 N • b ,, 6 • (SC' : T N J C. -x `t ,\ j . . 's&R 'Zc‘,...s, - mus - T . q-... ,.,,) ' vz, 1..ts.py . O _ de x-;:c-S-vbt Ofi L'i, \-\ . _ . __ . . . sz7.1) r‘.4 - .%i.,Th.. 1 / 74040, :Nsfiks3, r...4 4,:t- vc, 0 , , , • Q PASS 0 PARTIAL APPROVAL ,LI CANCEL • O ,NO ,ACCESS FAIL CALL FOR INSPECTION ' ] ADDITIONAL FEES 'A'SSESSED 0. E- Inspector: Dater 1 23"A "•�- _ Phone # (503) 718- �{ • \ CITY OF TIGARD BUILDING DIVISION PERMIT 4 .*: MST2004 -00093 -. 13125 SW Hall Blvd., Tigard, OR 97223` DATE ISSUED: 3/2 2004 Phone: (503) 639-4171 * `, Inspection Requests (24 Hrs.): (503) 639=41.75;! ..,�, • INSPECTION WORKSHEET FOR `' . DATE: 0/412006 • TIME ' 7 :013AM, PAGE` 74 1 , SITE ADDRESS: 1 SW 122ND AVE CLASS OF WORK: SUBDIVISION: ;LAKE TERRACE 'LOT #: 013 TYPE OF USE PROJECT NAME: PAULSON; DESCRIPTION: Remodel, adding 713 "eq.ft. not changing -the footprint OWNER: . P`AULSON, JACK PHONE #: • 503 - 579.2595 = CONTRACTOR PACIFIC CASCADE HOMES INC PHONE # : 503056.0920 Inspection :Request Scheduled:' For-: Date: 8/4/2005' Pour Time:. Code # Inspection Description Confirm # Contact'' # Message 610 Gas line .012791 -02 503-579 -2596 N Corrections/ Cornrnents/ Instructions: CI 77 . • • 1 • • Er PASS • ❑ PARTIAL APPROVAL 0 CANCEL • :0 NO ACCESS FAIL CALL FOR INSPECTION Q ADDITIONAL FEES ASSESSED Inspector: Date: -8 :3 Phone # (503) 718- • CITY OF TIGARD BUILDING DIVISION w • PERMIT # MST2004 -00093 • 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2 I2® Phone: (503).639- 4171 �a� illi�ll�i�p��, _ 'Inspection Requests '(24:Hrs,): (503) 639 .., • INSPECTION WORKSHEET FOR DATE`. 513/2006 TIME: 7 :14Atvi PAGE:. . 26 SITE ADDRESS: 12436 SW 122ND AVE CLASS OF WORK: SUBDIVISION: 'LAKE TERRACE LOT. #: 01 3 'TYPE.OF'USE: • PROJECT NAME: PAULSOh! I DESCRIPTION; Remodel, adding 713 stilt, not changing the footprint • OWNER:_ .PAULSON,. JACK ' PHONE #: 603679-2596 .CONTRACTOR: PACIFIC CASCADE HOMES INC PHONE #• 503666 -692a • - Inspection Request Scheduled For: Date: 6/;12005 Pour Time • Code # Inspection Description . ' Confirm # Contact # Message • 615' Mechanical rough '.005962 -01 503-579 -2596 N • Corrections/Comments/Instructions: • • • • • • • PASS PARTIAL; APPROVAL Q CANCEL ❑ NO ACCESS • 0 FAIL " • CALL INSPECTION E ADDITIONAL FEES ASSESSED • • Inspector: 'Date: Phone #': (503) 718 C ITY •O F`Y IGA'R D , . - 24 -Hour _ ' . - - BUILDING Inspection; Line:. ( 503) 6_ • 4175 s .., MS p yi boy- 'INSPECTION DIVISION Business Line: (5!, „'` 639 - 4171 = - ._ - . BUP • Received ,Date Requested / _ _ AM PM” - BUP - - Location r j A _ _ /AR ' -- Suite - - MEC.' - Contact Person _ - - �` • Phi( ) ' - PLM Contractor Ph ( - )._ _ SWR - BUILDING. :Tenant/Owner _ -. _ . EL C. .Footing . ELC .. Foundatign cACCes f , �` {' fr y . Ftg Dram . � `` _ �� u e . ., ELR_ - , Crawl ,Drain: . , - S �.. r e i . ,. . i k . ,, " •.. , Slab Lnspeet on Notes SIT • - :. Post & Beam..~ ' ' - . • ' :,Shear Anchor Ext Sheath/ ear _ kit Sheath/ ear ammg Insulatio _ _ __ - — - Drywalls ; ailing - Firewait, _ °. • .. fire 1 rm ,rinkler Fire _ - -Sus Ceiling : - R f: O er - Fnal' - . PASS PAR PLUMIBI,NG FAIL _ P & Beam _ Under Slab. - . - _ -- • Rough -In • Mater Service - -- , - - _ . • Sanitary Sewer` ' _ :Rain • Catch Basin / Manhole _ Storm Drairi; Shower Pan'-` `Other: - .. - - • 'Final . PASS PA FAIL - ' • " • N1 CHANICAL M ' • Post & Bea m' Rough -]n . - - - - , . _ • Gas Line Smoke; Dampers- - - _ .Final' _ .- PASS • PART FAIL _ _ • ELECTRICAL ;J :, ;Service . , . - - Rough In • UG /Slat - - - • LOW-Voltage , . FireAlarm - . Final< Reins , ection fee of -$ • - re ui'red before next =ins ection. Pa at.Ci Hall, 13125SW Hall Blvd: PASS PART FAIL, p _ q p Y' ty ; _ , . ` 2 , E • Please call for`reinspection RE - 0 Unable to inspect — no access Fire Supply Line, .ADA . Approach/Sidewalk_ ®ate / - 3 o . inspector _ Other:, -.- - Final, • D®_ NOT REMOVE this Inspection record ' the job site.•. - ' . - PASS PART FAIL • CIT OF TIGAR'D ' _ - - 24 -Hour ` - _ -- - Y` . - = . BUILDING : Inspection Liner (503)'639 = 41 - KIST -)- U � DUO INSPECTION DIVISION, • - ` Bus Line.- (503) 639 -4171 _ -- . - - BUP Rece / � Date Requested � � °- 9 YAM PM BUP Location_ -/ 3S - . l? '-\ -' - :Suite , • MEC- _ . Contact Person _ 9 Ph ( ) , 5-797 =-751.6 PLM :Contractor. - - Ph ( ) ` SWR - BUILDING u :' Tenant/Owner . ELC, K Footing -- ELC . Foundation 7 , �. �'� l% Z a - . Access t Ftg Drain - . A i x 5 T o �� , " � �, o EL R Crawl Drain sl M ,. : : ' ' ' - , .: ,+ .g , ' W ? a„. .:, « .. zi. � a b - I nspec tes: - . ,, z Post &Beam -'l7 -- .I f _ l' 'SIT Shear Anchors, ,1 C) Sheath/ . nt,Sheath/Shear - �' - Framing.. _ Insulation _ _ _ _ . Drywal N aili n l g - - - Firewall - Fire Sprinkler ` Fire Alarm .. :Susp'd Ceiling ;Roof: - Other :. - - . Final .ASS ART FAIL , _ - • _ PLUMBE Id0511 'S � . -1 Post &Beam - ' . _ Under.Slab . :;Rough -ln S • -Water Service- - - Sanitary Sewer - _ Rain,Drains - Catch Basin / Manhole Storm 'Drain . : Shower Pa n - " Other Final - _ .. - ;PASS PART FAIL. . MECHANICAL` . - Post; & Bea_ _m' ' Rough -In. = - . - -- Gas Line .Smoke Dampers • - Final - PASS- PART' FAIL „ELECTR Service _ .. ,: . Rough -ln - • • , L G /Slab Low Voltage. - - _ FireAlarm- Final Reins ection fee of _$, -- required before next ins ection Pa at City Hall, 13125•SW Hall Blvd. - PASS PART FAIL P . - '' P Y ty SITES 2 - t L A' ° ❑ Please'callrfor,;reinspection RE: - Q Unable to inspect — no-access Fire Supply Line 'ADA D Ls� 4 —e I Ext - _ `Approach/Sidewalk- _ - . _. Other: - - - 'Final - 'DO NOT REMOVE this :inspection: record :from the Job. site- - - - . i PASS. PART FAIL 'CITE( OF TIGARD ' - 24 =Hour ' BUILDING Inspection Line: (503) 639 -4175 � dp _oc�7 `INSPECTION DIVISION - Business Line: (503) 639=4171 ' MST ) BUP .Received :Date Requested - • /i AM - PM; BUP Location , __ i a " 3- /e? Suite M EC • Contact Person Owi ® " Ph ( ) PLM; Contractor J Ph ( .) 5 7 C Off- SWR BIJILDING ¢ ra ; ; Tenant/Owner ELC - Footing ELC., Foundation _ f '„ �' h Ftg Drain Access Fir �r ;� """ " w • R` rawl Drain C '. r -k z° l ' ,� �1 - EL . . axix �xa. �finw �� mom, �a -..d 'Slab = I nspection Notes: - `SIT - "ost' & :earn - ear r ' nc ors E-xt Sheath/Shear - Int Sheath /Shear; Framing. _ - - - - ; lrisulation: - Drywall Nailing • • - 'Firewall -Fire Sprinkler - • 'Fire Alarm - -Susp'd Ceiling, :Roof , " `:Other :.. .,PA PART FAIL MBINGW.'? _ ;Post & -Beam - - 'Under Slab .- • - 'Rough -ln ' Water Service - Sanitary Sewer - Rain Drains Catch :Basin l Manhole' . ._ • . ;Storm Drain • - +Shower`Pan - 'other: _ ;Final . PASS PART FAIL ; MECHANIC'AL I - . . . Post & Beam • - . Rough -ln - _ _ _ Gas Line !.Smoke Dampers • _ _ • Final - - PASS` PART FAIL - . - _ ELECTRICAL 14.- - . ■Service Rough -In U.G /Slab = • . . - LowVoltage .. ... . Fire' Alarm' . Final Rein§ ection"'fee:of $ - : - • • :required before;next;ins a tion. -Pa at Ci ;13125 SW Hall -Blvd. Q p q P . y' tY Hall; PASS PART F A` • IL . qSirrENTitai44,7 4.13iii:44 Q, Please, call for reinspection RE: Unable to-inspect - no access . Fire Supply Line - Ap - ®fit® / �7 d f ._ Inspect °r • ,,.. .': _ _ • ;Approach /Sidewalk, J (Other: I -Final - - DO NOT °REMOVE this inspection record frog the: job. site: - PASS PART' , FAIL . . CITY OF TIGARD. -- -- 24-Hour BUILDING 110, inspeCtion Line:, r; 03) 639-4175 , 0 m sr 4900 4- / - 0 0 F 3 INSPECTION DIVISION .- -:— Business Li no: ;1503) 64974171 . . • BUP /: — - 1 : - 1 . . Received - Date Requested - - - - _. AM ..PM Bup . Location - . - .- - , - _ • - .- - - .,'_ 1 1 _ - Suite MEd . . :Contact Person ' - 1) 4--<.A-erea - -,:e" ') cS76-,676 PL cobtractor - , SWR . . I BUILDING v t -;° , : , "'. 7 :: -' -; -, Tenant/Owner E LC - . - oo ing _ , . _ ! ' - ELC •1 PAO:Tc,6"644i4 Tyq5...i).:itt• ,- .4V-. tj'-' '''', Ftg Drain _ - ''''''''''',,°:-, ELR ,. Crawl. Drain Post & Beam Inspection Notes: P,..."`-. A 4._ i 6 iN t 11 ). z 6 ,-, L f SIT : I \--) V ' ----) • - 'Shear Anchors JA"l'i 'oriq ie /6 i'f1 - S . riDe1 ici ■ 1 L Ext-Sheath/Shear ., - - - ‘-' - ' ' - .. I n e g 4ttilS 119 r . Aff „........... : , i) ,. iv. ,, v , r ...,..„,.... 7 - A.z „ .. . c .,...„- T - 0(...4...4 — c --..„. insUlation ,Drywall Nailing - '..) Pir c '''‘ i it '' '--' ' ' eie--4 4. ------ --- --'s - - 5 Firewall - if 1/4/1, L:-.^ A 6 • - ' Fire Sprinkler ' ' , . - ,Fire Alarm v ' _41 - 3 Susp'd : _ _... .... • of AMINE1111 ,.., -- • Oiling - '7 ' : • , ‘, .-- i ) Ve ' - ,S 17 c oKAi'4, °. . . . . Pv P - g o 1 e-5 _ ,1-4..._4_._ 1-1,7M, ,S77 A1 -- el f .. " .• ) ( PRT FAIL " 1 S 7 , . pk opisow,y Ht--1-12. _ hs "It= .014 eL-- 5 Post & Beam - .'Under Slab •- - - Rough-An . ' - ' Water Service , - . _ . - : _ Sarlitary Sewer - '' •Rain - - . -- Catch-BaSin-/ Manhole ' ':- - ' Storm Drain . Shower Pan • - , • , Other: Final :PASS PART FAIL . . . tlECITANICA'124 • , - , ' • Post & - Beam -. Rough-ln . . Gas Line ' . - • Smoke Dampers - . Final PASS 'PART FAIL 'fELECTRICALf.li:VM. . ' • . -- . Service . - - ' . _ Rough-ln . . _ UG/Slab - Low Voltage . . ' , _ _ - Fire Alarm - . PASS PART FAIL Fteinspection fee of$ . - requiredbefore. next inspe•Ction. Payat Dity:Hall 1,3125SW,Hall Blvd: .- - ' • i• ' sITE'pon'r,R2ergilvit 0 Please'Callbr reinspection RE: - ' - ' • 0 Unable to inspect- . . . Fire,Supply Line , ',,!? ..,--) 0 . Date ' ,. • ADA ' , /Z...., - ..___ _ . APProadh/SideWalk: , inspector, - - - - Ext „ Other: , . - .Final . . " . 0 ` . DO NOT REMOVEthilts: Inspection record r 'the Job_Site.; • . - . _ PASS PART FAIL • CITY OF TIGARD - 24 -Hour - BUILDING, •, Inspection Line: (503) 639- .r t'. ' MST INSPECTION `DIVISION D0 ' q — .D . -)dc7.3 — . Business Line:. (503,•.S'� -4171 ; BUP _ Received = - • - Date : Requested FT Z 3 AM PM .BUP :- Location 3 S ova A t Suite ; MEC Contact Person .,,e gi . s Ph (' ) Eq q- 7 W-3/ PL M Contractor - - Ph ( ) - • SWR • 'BUILDING ` t '•`' Tenant/Owner _ - ELC Footing ELC - Foundation - ' , Access: � P ,. - Ftg Drain ELR Crawl Drain Slab Inspection Notes: _ SIT • Post &" Beam - ; She eath/She- r' - r I nt Sheath/ . = ' 1•' �► ,0 ' Aril" r- mg lab Insulation Drywall ! ailin ' — Firewall Fire Sprinkler - ,, Fire Alarm ren � .; C eek 4-,`No uT S Susp'd Ceiling p ' • t e , 8''/ ' 1- 17. z Cr, ;Cc , "4 7----7.1 A u3.L_Y .Other, • PART FAIL i P. e v e1NG k n • A-LSa y Vi •r . r4-04-. Post & Beam c3 i -1 :v. op-1 7- /A =-7 _i S , ,Z-Z , �� , 1-u -(.:--- S c. Under °Slab 1 � l K ✓� Rough -tn it Water Service C" T 7 - f - c Z. P 9 L-eo f G--i o- D (' Sanitary Sewer • &I/e\----7A16- z-- S' 6/< _ t A- It 'P- 5 . Rain Drains _ - Catch Basin;. /`Manhole i ' ...— „ �,, l� Aes �C � j Storm Drain — Shower Pan " Other: Final. „ PASS PART FAIL ' MECHANICAL : V Post & Beam Rough -ln. - Gas Line Smoke Dampers Final . . PASS PART 'FAIL , . ELECTR c., `y e Service Rough -In - ' UG /Slab Low Voltage . Fire Alarm - Final 0 Reinspection'fee =of$'• - : required before next.'inspection ,Pay'at City:Hall, 13125 SW Hall Blvd. PASS' PART FAIL . :SITE . , s , . ❑ 'Please ' call for RE: 0 Unable to inspect – .no_access Fire Supply Line ADA Approach /Sidewalk Date. ' -� , i ;sped ®r' _ _ - � . IExxt. O - „ Final , DO . NOT "REMOVE this insg e ctiew red '• + d 'rent the Job,, site - - .. PASS PART FAIL CITY OF TIGAtiD -- 24-Hour t , . . BUILDING . Ins ( p ection Line: 5 03� � _, 5 . MST ao-o9 ' Dd°T 3 639 -° INSPECTION DIVISION Business Line: 150,0e"1-4171 : Date. Requested AM BUP Received 9 - M PM _- BUP. Location, . wR.R ' - = Suite • MEC_ Contact Person � • Ph'( ). 3'4'gl 7S'31- ' . PLM Contractor Ph ( • - • SWR - `BUILDING Ten_ ant /Owner, ELC: Footing, Foundation. s:- . -. ELC .. - Ftg Drain Acces ELR Crawl Drain'. Slab Inspection Notes: SIT . - Post & Beam • Sh . xt Sheath/Sliear ; _ - . . t Sheath/She. , Framing 2a Si L.) fts ® Sr e 4if -A Insulation / � - • D all N ilin . ' _ _ Firewall - Fire Sprinkler pgss. - 6-7.--- 1; .�= ` V�S 1-0 7'L 7,. Fire Alarm = �', O •B►?�® _ , /� . two .°�r1 - e - • � Susp'd ,Gelling / ,� ® , Roof a ,.: i, d . � O ther: s Final -.;. S / J ('= rg PASS PART FAIL - - /i � - PLUMBING " _ _ . A s o • .. _ x _ e; _42111 pis. _ r d r' . - ; - Post, &• Beam T B t.7 Under Slab � r .: � _= - .� _ - Rough,ln - Al r =©,f Cr' _ Water Services ST�Tu �. . Sanitary "Sewer - '' i /,' Rain Drains Catch Basin / Manhole ,x� e ® , r it Storm Drain Shower Pan en-6 ._ w 5 L4) .t. Other: • Final . PASS' PART' FAIL MECHANICAL l . ice- ; - - C--1---,0 S, • Post -& • Beam p Rough-In - _. l7 Gas:. Line _ - Smoke: Dampers' .- _. Final _ PASS PART •FAIL . ELECTRICAL • . _ • Service Rough -In - - - • UG /Slab . Low Voltage '' '. Fire Alarm Final Reins _ ection fee of-$ required before next inspection.' Pay at City Hall, 13125 SW Hall .Blvd -. PASS PART F AIL � ' '" • P, Please call for reinspection RE: _ [7 Unable inspect – no ,-access Unable : `SITE • .A. :� � ' ,„ ❑ - Fire Supply Line - . ADA Approach /Sidewalk ®ef ® � f _ ` _ lelspect® t Other: Final .DO NOT;REMOVE 6. peetio ire ,!, rd' from the job site: - PASS_ PART FAIL , , ... CITY OF TIGARD . — 24-Hour. - - BUILDING 0 Int Line: (5O3 )6394175 w ink MST g ° 6 ° q 3 INSPECTION DIVISION Business Line: (503) 639 - , . . . - BUP . / • -, , /' Received Date' Requested CO' - dal .r AM. PM • BUP - Location — _ - __Leli_a(,,8----Suite - MEC' L (-__, 0 -) i Contact Person AQ-2./4A-J•frI.A-J---' 0 ( ) , 3 -I 7 0 ,.7( PLM - Contractor Ph ( ) SWR - BUILDING '. Tenant/Owner ELC Footing , • . ELC Foundation • - AcceSs: . •"' - - - ,.- • ---:-" ' '''' . '' - - - '', ` ,„,- - ,, - ',-', Ftg Dram ELR . . Crawl Drain Slab Inspection NOteS: SIT - _ - 4tost & Bea ,, . Shear ' richors , , ' Ext Sheath/Shear - • • ' • I . - Framing - Insulation • Drywall Nailing ' _ Firewall Fire Sprinkler 1. Fire Alarm . . . Susp'd Ceiling • - Roof . 1 Other!' i 2-6-•L‘..-==. - FAIL - . 4411 'ART . - , , NGf Post & Beam , .. 1 Under Slab . Rough-In - Water Service Sanitary Sewer , . Rain Drain's • - - Catch Basin /-Manhole - _ . Storm Drain - • • . . -, - Shower Pan • Other:' . ., Final PASS PART FAIL - '11(iECHANICXC Post-& Beam . Rough-In Gas Line Smoke Dampers - . - ' . , Final PASS PART FAIL . . ELECTRICALV Service Rough-ln , . - UG/Slab . , . • Low Voltage . • Fire Alarm . • " • Final Li PART FAIL Reinspection fee of $ ' required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ... PASS SITE:;':!;:'r':':itVTW'q El' Pleasezali ion RE; . . _..---ae Ill Unable-to inspect — o access. .Fire Supply Line , • -. ,. Date .." Z a Inspe Approach/Sidewalk. Other: . _ , . Fihal - .. .. ' ' 'DO NOT REMOVIE'this Inspection' record•from tile jobsite.; - • . .• - PASS PART FAIL . CITY OF TIGAR® 2 4 Hour BUILDING Inspection Line: (503).639 - 4175: n d604 O INSPECTION: DIVISION Business Line :(503)639 - 417,1. • - BUP . Received Date Requested ° ( AM / /� .P BUP q . Location - t--( / • ; rl. •Suitte MEC ' Person ; _ . Ph ( ) . ' 7 K9 -'.: . PLM Contractor. : , Ph ( ) SWR . ; _ BUILDING s. : Tenant/Owner ELC Footing :ELC . .. . e Access: - r - Ftg- ® rain „ ` �e� E LR Crawl Drain rai - Th w - Slab - Inspection Notes:' - SIT • Post &Beam l' °' . SFear At! chors '' ExtrSheath %Shear ";Int Sheath /Shear `„ .,' . Framing . - / F v. ---,...„ 7 71,•-_-.-.... .Insulation Drywall Nailing - Firewall Fire Sprinkler Fire.Alarm - - Susp'd Ceiling - Roof ' - ot' ' Fjaal ,. - + PASS ' PART FAIL. 4:-.!._ ® BING i.., •41461" • Post '&; Beam _ ' Under Slab . _ - _ - _ Rough -In . • `'Water Service . Sanitary,:Sewer . . . Rain Drains _ 'Catch Basin 1 Manhole ' Storm :Drain: Shower . Pan -' . Other: - _ Final ; PASS . PART •:FAIL = MECHANICAL,. N, .',7=-1',1 • Post•& Beam Rough =ln , 'Gas Line- Smoke.Dampers ':Final ' PASS PART • FAIL ` • ELECTRICAL 7e , - 'Service, „ Rough -ln - 'UG /Slab .. Low Voltage Fire_Alarm Final .0 Reinspection fee of'$ - - required; before next inspection: Pay at City Hall,'13125 SW: Hall Blvd. P PART FAIL, - :SITE¢. f i . f 'w A5 Q Please call for reinspection RE: ❑ Unable to inspect - no access - Fire SUpplytine c ,° ADA . L.0"/ C . `,/ A roach /Sidew Date / Inspector Eitt - PP alk Other:- •,Final ' ` DO NOT REMOVE thlls Inspection record - from thejob Site. PASS PART FAIL - ' \� CITY OFTIGARD •247Hour Li ne: ... . , BUILDING , : Inspection. (503) 639-4175- .., mst _ _. Adoq—eo 6 _3 :INSPECTION DIVISION Susineis Line: (503)639-4171 BUP . - • " .6 —t. keceived, Date Requested AM PM- BUP a ila" ' A --( - )- - -- ' • Location _ /a W.3:s• JO _ . ,, . S u i te MEC Contact Person -- /2.-,' O2_ . Ph( ) r78 PLM Contractor - - - - - Ph ( ) SWR . . : :- : . - Tenant/Owner . _ _ - - ELC . . .. . - Foo 6 . ■ ELC ,.. , . ... . •. . ■iiririggr Access: , „,,',-:„,;-' ,.. -,. .,..', ..i ,: ., : -,- -;”' -:, ,', .-- ELR 7 g; D rain - . Crawl brain Slab Inspection Notes:, * /4 : 0 "CD S IT • - . r ' Post & Ream] Shear Anchors Ext Sheath/Shear • IntSheath/Shdar . Framing 0 0 ,,..... , Insulation - . ` • . . . . Drywall Nailing , . Firewall , FireSprinkler - - _ - Fire Alarm - . . S Ceiling . Roof' Other: . Final' AS PART FAIL MBING . , • . Post & Beam - Under. Slab - • • RRough-In . n - - . WaterService _ , Service ' Sanitary'Sevver - - _ . . 'Rain Drains • . . Catch Basin / Manhole - Storm brain - - - _ • Shower Pan Other: . . Final • . • PASS PART FAIL _ , 5IiitCHANICALL'',2,;V"?..,-; , Post & Beam • Rough-In -- _ _ _ Gas. Line . _ , Smoke Dampers Firfai , ., • .PASS PART FAIL , E LECTR ICA L:' ,. ., Service, , Rough-In . • • - UG/Slab _ Low Voltage _ _ Fire Alarm , •Final -. , i Li PART FAIL Reinpoation tee of$ - ' ' • required .befOre nod inspection.' Pay at city Hail, 1:3125 SW Hall Blvd. PAss ' . ' , Pleasecall for reinspection FIE; ' • 0 Unable to inspect .— no access "Fire Supply tine . , . I ADA ' o --- /'(r --- 0 - ' • E Dattr . e _ Inspector - APProach/SideWalk ,it- . Other: - ' ' • Final - ' - ' • DO NOT gglIVIOVEithis,iiiitpeiitiOh reacird - from - th _ e Job:Site, . • PASS PART FAIL, TY BOF 40 - 4 - Hour. _ CI �'Iea/4RD- 2 DING Inspection Line (503 175 1 MS ' _ � T INSPECTION DIVISION. " Business tine: (5' ) '..4! - - BUP Received j 1 - Date Requested c g AM PM BU P Location 14.. -1 ? v Arrre'„ Suite MEC _ . Contact'Person K1 okrw,. 0 9 1 , , e 4 - . 7 o O, -- ao7 / _ PLM Contractor h ( = y)' 7 ZCl to SWR ,18141 . 1 Tenant/Owner ; - - ELC ooti Foundation ELC - ; Acc e s s r;� k� `° Ftg" Dram ELR :Crawl Drain" Slab Inspection Notes: SIT Post & Beam . ShearAnchors , • • Ext Sheath /Shear - - Int Sheath /Shear Framing, Insulation • _ • • 'Drywall Nailing Firewall Fire Sprinkler ®B,, ®e� :��1 P 1 - Fire. Alarm Susp d Ceiling: vl ,� , ` l ��-v�. r- .. Other:. - - •r- - - , _ A A : r? 1 /y ite PASS , FAIL P;LUIVIB J t • ' ' \ j....6 j\--C-4___." Post & Beam" - . Under Slab a ,f+ Rough - ' -Water: Service, .. " Sanitary Sewer' Rain Drains. - Catch. Basin, /';Manhole - - Storm Drain• - • Shower -Pan. _ ' Other:' - • Final , PASS PART _FAIL TMMEtHANICio►L "'V' `r p Post-& Beam Rough -ln • ' Gas Line Smoke Dampers . Final • PASS PART FAIL "ELECTRICALL ` ..: - Service • Rough -In UG /Slab - Low'Voltage . 'r Fire Alarm , Final ❑ Reinspection -fee of $ required be next inspection. Pay at City Hall, 13125 SW : all B d. PASS PART FAIL •"SITE $,,z,y , x _ ;:i • 0 'Pleases llxfor reinspection RE: -- 0- Unable spect - no access Fire Supply Line . ADA Approach/Sidewalk Date .Ilnpe s oP Ext Other: _ - - , - •Final ° , - - DO NOTREMOVE thlit `inspection record from, the,]ob sit®.. .. PASS PART ;FAIL _, 1/2 3/2008 Case Activity Listing 2.21.22PM EL Case #: MST2004 -00093 .�t A ned Donee. IJ dated „ 1 r m s ton. _ ,.,.. ., .Date.l _ _ Date 2 . ..., � . 3. .. � �:,.: r � � � � ��. _...,..�,,� P. . � �. � ,. Hold... � D ts , � , T• B B N ��. MSTA005 Application received 3/22/2004 None DONE JMT 3/22/2004 BLD MSTA010 Check for prcl. 3/22/2004 None DONE BLD 3/22/2004 CWS letter received restrict. BLD MST2120 Electrical rough -in 8/3/2005 8/4/2005 8/4/2005 None FAIL GN 8/4/2005 012791 -01 — 503 -579 -2596 — VM - STI Y —180 III MST2610 Gas line 8/3/2005 8/4/2005 8/4/2005 None PASS KBS 8/4/2005 012791 -02 — 503- 579 -2596 — VM - STI N MST2120 Electrical rough -in 8/8/2005 8/9/2005 8/9/2005 None PASS GN 8/9/2005 013169 -01 — 503- 579 -2596 — VM - STI Y MST2275 Framing 8/8/2005 8/9/2005 8/9/2005 None FAIL KBS 8/9/2005 013169 -02 — 503 -579 -2596 — VM - STI N MST2275 Framing 8/29/2005 8/30/2005 8/30/2005 None FAIL KBS 8/30/2005 014584 -01 — 503 -579 -2596 — VM STI N — 1 80 MST2275 Framing 9/7/2005 9/8/2005 9/8/2005 None PASS KBS 9/8/2005 015185 -01 -- 503 - 579 -2596 — Val STI N MST2280 Insulation 9/19/2005 9/20/2005 9/20/2005 None PASS KBS 9/20/2005 016128 -01 — 503 -579 - 2596 VM - STI N MST2285 Drywall nailing 10/4/2005 None PASS KBS 10/4/2005 # - see inspection notes. KBS MST1530 Permit expired by 7/10/2006 None DONE HAP 7/10/2006 limitation HAP Page 1 of 4 CaseActivity.:rpt 1/23/2008 - Case Activity Listing 2:21:23PM 'ACCEL Case #: MST2004 -00093 Asst ned zF = D one u U daf Achv�t , .. , s ton Date >,1,� -� - . -.. _ - 2 . -: �, �Date:3 �„ �� _ = � 3 ... , . Y � ,. _P __ , .�. „=Yx ._ -.._ , .._ _ •... -. Hold . � e:. Des � x To- �, � B < Notes 70 MST1520 Mail expiration notice 8/1/2006 None DONE JMT 7/12/2006 $250 due for bld /plm /elc /mec finals JMT MST1470 Return to "I” status 8/4/2006 None DONE DER 8/4/2006 Proof of reciept showing work has BLD been in progress. Per Brian /Hap return to issued status. MST2120 Electrical rough -in 11/15/2006 11/16/2006 11/16/2006 None PART GN 11/16/2006 039841 -01 -- 503 -579 -2596 — VM - GN N • MST2280 Insulation 12/8/2006 12/11/2006 12/11/2006 None PART KBS 12/11/2006 040870 -01 — 503- 579 - 2596— VM - STI N -180 MST2120 Electrical rough -in 5/23/2007 5/24/2007 5/24/2007 None PASS AMS 5/24/2007 048998 -01 — 503- 579 -2596 — VM - STI N MST2275 Framing 5/24/2007 5/25/2007 5/24/2007 None PASS AMS 5/24/2007 049080 -01 — 503 -579 -2596 — VM - STI N MST2280 Insulation 9/13/2007 9/14/2007 9/14/2007 None PART RB 9/14/2007 055744 -01 503 -616 -2588 VM - STI N --160 MSTA012 Plans routed to Plans 3/22/2004 None DONE BLD 3/22/2004 per Mark's request, also submitt Examiner BLD the original plans for review MSTA026 Plans 3/23/2004 None DONE MAV 3/23/2004 checked/approved by MAV PE MSTA030 Reviewed plans 3/23/2004 None DONE MAV 3/23/2004 routed to PT MAV MSTA705 Footing Insp 6/8/2004 None PART RB 6/8/2004 Footing for front porch. RB Page 2 of 4 CaseActivity..rpt 1/23/2008 Case Activity Listing 2:21:23PM' q‘i- Case #: MST2004 -00093 T.. Asst ned D n 3 E.. k o e U - dated Actrvrt. t .Descri twn .� v . _ .. .. D , ! s.� _ ..�, �:.•�,, a , _ , � °,;, -„ To MSTA706 Foundation lnsp 6/21/2004 None PASS RB 6/22/2004 Front of structure RB MSTA7I0 Post/Beam Structural 12/7/2004 None PASS KBS 12/7/2004 KBS MSTA726 Shear Wall Insp 8/16/2004 None FAIL CB 8/16/2004 not ready CB MSTA727 Exterior Sheathing 8/16/2004 None FAIL CB 8/16/2004 Insp CB MSTA032 Post- review 3/24/2004 None DONE JMT 3/24/2004 completed JMT MSTA080 (F) Ready to issue 3/24/2004 None DONE JMT 3/24/2004 GET OWNERS RESP FORM JMT SIGNED. LEFT MESSAGE WITH ANSWERING SERVICE MSTA092 (F) Issue combination 3/25/2004 None DONE JMT 3/25/2004 permit RCP MSTA705 Footing Insp 6/18/2004 None PASS KBS 6/18/2004 KBS • MSTA706 Foundation Insp 6/18/2004 None PASS KBS 6/18/2004 KBS MSTA710 Post /Beam Structural 6/24/2004 None PASS AMS 6/24/2004 Front porch only. AMS MSTA726 Shear Wall Insp 8/23/2004 None PASS CB 8/23/2004 CB Page 3 of 4 CaseActivity.. 1/23/2008 Case Activity Listing 2:21:23PM CCEL _. Case #: MST2004 -00093 � . -_; . �. �,. ,... _..._,.._ ._ �.r. ��- rr, , Assigned Don e Updated •,x Date 2- . Date�3 -� ., ... m y;. Acttv�ty Descr► tton. �, .., �•Date, . -;� .. � _. �.. }._ _ .,_�- ��_ Hold Des MSTA727 Exterior Sheathing 8/23/2004 None PASS CB 8/23/2004 Insp CB MSTA705 Footing lnsp 12/2/2004 None PASS CB 12/2/2004 CB MSTA706 Foundation Insp 12/2/2004 None PASS CB 12/2/2004 CB MSTA726 Shear Wall Insp 12/29/2004 None PASS KBS 12/29/2004 KBS MST2320 Plumbing rough -in 3/20/2005 3/21/2005 3/21/2005 None PASS MRS 3/21/2005 002315 -01 — 503 -579 -2596 — VM - STI N MST2320 Plumbing rough -in 3/22/2005 3/23/2005 3/23/2005 None PART MRS 3/23/2005 002496 -01 — 503- 579 -2596 — VM - STI N —144 MST2320 Plumbing rough -in 3/24/2005 3/25/2005 3 /25/2005 None PASS RB 3/25/2005 002851 -02 — 503 -579 -2596 — VM - STI N MST2615 Mechanical rough -in 5/2/2005 5/3/2005 5/3/2005 None PASS KBS 5/3/2005 005962 -01 - 503 -579 -2596 — V)� STI N MST2610 Gas line 7/25/2005 7/26/2005 7/26/2005 None CANC CB 7/26/2005 012112 -01 — 503 -579 -2596 — VM - STI N —180 Page 4 of 4 CaseActivity..rpt