Permit !N ...• CITY OF TIGARD MASTER PERMIT PERMIT #: MST2007 -00092
COMMUNITY DEVELOPMENT DATE ISSUED: 6/27/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134DD-01200
SITE ADDRESS: 11675 SW TIEDEMAN AVE ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: PENA
Project Description: 112 sq ft kitchen addition
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: ` i . sf BASEMENT: et LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: st RIGHT: 5
VALUE: 1 0,348.80
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: WASHING MACH: . LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS AMYL 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: 7 SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ ampNolt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: 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
JOEL PENA BATEMAN CONSTRUCTION INC laws. All work will be done in accordance with approved plans. This
11675 SW TIEDEMAN 4991 SW NEVADA CT. permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 PORTLAND, OR 97219 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: 971 - 222 - 7131 Contact #: PRI 503 452 - 2380 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503- 768 -4986
Reg #: LIC 111019
TOTAL FEES: $ 487.77
REQUIRED ITEMS AND REPORTS
A.4 I
IP'XI (
Issu d By : f, , Permittee Signature : , /��� /`
/ •■-■
Call 503.639.4175 by 7:00 a.m. for an inspection that bus! -ss day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
14 ' `JO 4 CITY MASTER PERMIT
I �rj 1'
l , ° COMMUNITY DEVELOPMENT PERMIT #: MST2007 - 00092
D ATE ISSUED: 6/27/2007
TI GA RD: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134DD-01200
SITE ADDRESS: 11675 SW TIEDEMAN AVE ZONING: R
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: PENA
Project Description: 112 sq ft kitchen addition
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS . REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BORM: BATH: TOTAL: 0 sf 10,348.80 REAR: 15
PLUMBING
SINK WATER CLOSETS: WASHING MACH: ' LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE D P: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN >=100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADM. INSPECTIONS
1000 SF OR LESS: 0 • 200 amp: 0 • 200 amp: W/SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADM_ 500SF: 201 • 400 amp: 201 - 400 amp: 1st W/O SVC/FDR 1 SIGN/OUT UN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: 7 SIGNAL/PANEL: IN PLANT:
MANU HM/SVC/FDR: 601 - 1000 amp: 601+amps- 1000v: MINOR LABEL:
1000. amp/volt :
PLAN REVIEW SECTION
Reconnect only: NI
>4 RES UNITS: SVC/FOR> -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: tfiS
BURGLAR ALARM: OTH: BOILER: HVAC: LNDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS: 13
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
JOEL PENA BATEMAN CONSTRUCTION INC laws. All work will be done in accordance with approved plans. This
11675 SW TIEDEMAN 4991 SW NEVADA CT. permit will expire if work is not started within 180 days of issuance. or
TIGARD. OR 97223 PORTLAND, OR 97219 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: 971 - 222 - 7131 Contact #: PRI 503 452 - 2380 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503- 768 -4986
Reg #: L1C 111019
TOTAL FEES: $ 487.77
REQUIRED ITEMS AND REPORTS
Issu-d By : _' i' A ' Permittee Signature : , / �� , `
Call 503.639.4175 by 7:00 a.m. for an inspection that bus' • =ss day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
' Building Permit Application .
Residential FOR OFFICE USE ONLY •
R ECE VED Recei n ��
City of Tigard I V F Date/B ved /+ D7 Permit No.: 5r 7
y:
13125 S W Hall Blvd., Tigard, OR 9722 Plan Review / _� \ f \ Q 1 Other Permit:
Phone: 503.639.4171 Fax 503.598.1960 Plan Re : U( lJ ill /
Inspection Line: 503.639.4175 MAY 2 4 2001 Date Read .h S See Page 2 for
T I G AR D Notified/Method: I Supplemental Info
Internet: www.tigard-or.gov CITY G .�.�GQRD (P�z (s} S[
TYP OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
(V; Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION
work indicated on this a /Q ! J 241 b CQ
Valuation: $
I- and 2- family dwelling ❑ Commercial /industrial
❑ 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: //('75 • 5 ) - 4-067— New dwelling area: -r) quare feet / /02.
City /State /ZIP: i 7767/+ ®Q 972:2-3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: f/7 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
6 7e8a7t1 de) 46- 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.
/4129 Valuation: $
/ � X e /� / TZ /fa'71J Rd, MR 0Ui f T7On.1
C' Existing building area: square feet
. New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: 6 Z 7 / 06. 7 ,) , 4 Type of construction:
Address: / / 675 v() )7 A�? l ) "ie Occupancy groups:
City /State /ZIP: 776 0 R., 9 Existing:
Phone: ( q7 /) 22Z 7, 3 / Fax: ( ) New:
` I _ [ APPLICANT ❑CONTACT PERSON NOTICE
/ ` Business name: 0�[� p6�/ -} All contractors and subcontractors are required to be
N Contact name: X45-79 uAt/er— licensed with th e Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
NI Address: / / L [ 73 . 52„ .. ) ���r��c ' /� ) A.06---- jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /Z1P: 7761 e az f 7223
apply:
Phone: (17/) 2 , 2 ,7__ 2 , 2 ,7__ 7/3) Fax:: ( )
rr I 'J
(A) E -mail:
vV CONTRACTOR
I
1 Business name: e0,0,7--00c,-70/1) ,/A) c BUILDING PERMIT FEES*
(ti Address: y 1 ? / 6 /0. / "Pp/1 G (Please refer to fee schedule)
Structural plan review fee (or deposit):
n � 3
l
",l City/State/ZIP: 1104 D a ° 1 - 702 9
Phone: (S. 3) L/S2_ 3g Fax: ( ; 5031 76 9 — y.9 g ,6 FLS plan review fee (if applicable):
CCB lie.: j/l O / q q Total fees due upon application:
' Amount received: 90,
Authorized signature: / 1111. / ' This permit application expires if a permit is not obtained
,� � J within 180 days after it has been accepted as complete.
Print name: c /�GYG / � - �5 /f7 Date: '— —
/6 07 * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits \BUP -RES PermitApp.doc 02/23/07 440 -4613T(11 /02 /COM/WEB)
N
l
Building Permit Application Checklist
One- and Two - Family Dwelling FOR OFFICE USE ONLY
City of Tigard ` Received Permit No :
• 13125 SW Hall Blvd., Tigard, OR 97223 Alr■ Dated t
' Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
T I G A R D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ID Mechanical
Internet: www.tigard - or.gov ❑ 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- ❑ ❑ ❑
'n protection, etc.
10 } 3 omplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
ui ing codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
I sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
ht violations exist.
11 1 Site/ o f plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
th 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
I surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, , ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations." .
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Oregon and shall be shown to be as e licable to the sroject under review.
JURISDICTIONAL SPECIFICS
3 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
'26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include 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\BUP- RES- PermitApp.doc 03/21/06 440 -4613T(I 1/02 /COM/WEB)
' Plumbing Permit Application
RECEI
� FOR OFFICE USE ONLY
City of Tigard 66 Received e /� 0- , Permit No.: )*/���
07 -9V-
- a 13125 SW Hall Blvd., Tigard, OR 97223 MAY 2 4 2007
Plan Review Other Permit No.:
lig
Phone: 503.639.4171 Fax: 503.598.1960 ��, r 1 F . s Date Date Inspection Line: 503.639. c+- ° ,i l ly, ARD
Date Read B t o ®See Pa e 2 for
T I G n R D ard -or. ov p I"o y y
Internet: www.ti B
g g BUILCIitC LJI1/ISIONNotilled/Method: G Supplemental Inf o rm ation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I 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
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ‘t 4A5 rJ W ' v ‘ 3 D.E. VON AVG. Catch basin or area drain 16.60
City/State /ZIP: T I GAR v OR. 92,23 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: ' lE NA Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: r Manufactured home utilities 110.00
cY s� � UT `I .' Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
uodivision: Lot no.: Water service (no. lir�'Par ft :.,__ t.'F,ge 2 1
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
�/ DESCRIPTION OF WORK Backflow preventer Page 2
1\ I c C \. \E„N P OD \I' 6111 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: 770 El ENIA Expansion tank 16.60
Address: 11 GIG 5 4 -1-' G. ) E t :4 Fixture /sewer cap 16.60
City/State /ZIP: -. Q , t 0 c -1'\ 2-2-3 Floor drain/floor sink/hub 16.60
Phone: (t ) 3.22 ... -- +%31 Fax: (5 ) 1 131 - 3,113 Garbage disposal I 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: R of drain (commercial) 16.60
Phone: Sin asin/lavatory \ 16.60
( ) Fax: )
u /shower /shower pan 16.60
E -mail:
Water Urinal 16.60
CONTRACTOR Water closet 16.60
�+ „.. I_ mo . t- . a
Business name: ' T 1 - 2�� Water heater 16.60
Address: `.=,/ to ,r7 5` W il--A/ Al 57 _ Other:
( Subtotal
City /State/ZIP: 77 9 7 a - Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: // Dg Y5 / /3"S /Qf( Plumbing Lic. no.: 4.8 Plan review (25% of permit fee)
Authorized signature: / -7 / /, g State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name, 6.4. Date: 5/14//6 - This permit application expires if a permit is not obtained within
Y 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1.\ Building \ Permits \PLM- PermitApp.doc 12/27/06 440-4616T(I0/02/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 - l' 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 $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, adding or replacing futures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all ihat apply. '
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
-Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub /S i/Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system. .
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3„ that meet the qualifications above.
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang - •
-Stall
Sink Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes •
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i.\Building\Permits\PLM- PermitApp.doc 12/27/06
' Electrical Permit Applicati �P ��, FOR OFFICE USE ONLY
yr �: a r
City of Tigar _ °� —� Date/By: 7 a 7 V 5 To 7_ O DO q2
ia► .sy '+- Per No.: /
• 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
C • • Phone: 503.639.4171 Fax: 503.598.1IMI 2 4 200j DateBy: Other Permit:
T I G A R D Inspection Line: 503.639 CM /. �. : , �_ Date Ready /By: orris: ry ID See Page 2 for
Internet: www.tigard- or.gov a : I ••' Notified/Method: / CO Supplemental Information
TYPE OF WOR ":',::',',1014:
PLAN REVIEW
❑ New construction Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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
g I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3 ",
1 OOHP or more. occupancy.
Job no.: Job site address: // 675 sc „, r - 1'7'17✓ A-t'E , ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: �p ❑ Health -care facilities. ❑ Supply voltage for more than
ty � ' t F"L� �� t 72 3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: / gN4 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ..ieer-s,--4.9 BUzG— ed . Description I Qty. I Fee. I Total I •
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 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
'/ Limited energy, multi - family 75.00 2
K. / rz./ -/ ) 419.0 l ? 7C, /l.J residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: i y - -G Pe-AM- 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: // 67 s' c,.) T7ijZ 12' , "Q ,---- Over 1,000 amps or volts 454.65 2
City/State /ZIP: n 6-"flel° v2 972713 Temporary services or feeders installation, alteration, and/or
relocation
Phone: Ss7l —Z Fax ( ) 20 amps or les -
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, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, a er panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact n ��gZ_ P57/1/4 r ,,��..��, // /¢ without service or feeder fee, /
first branch circuit 46.85 2
Address: `/6 7 ,5 5 1J l �Q 4h0 er-- Each add'I branch circuit 7 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: 776A-040 Q ie, 9 - 72Z- 3 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ('q7) 222._ 7, ,3 J Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
•
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name:
Tflg 4066' ,z6'' Z energy panel, alteration, or
Address: 5280 6 - 6 ,.. ) C47' e71/ , , extension. Describe: Page 2 2
City/State /ZIP: ll ie ef..... 97,4Z/ Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 3) ,29 Z •— 4'7 o 2,' Fax: (6'63) e1 ' t -' Li 72 __e Investigation per hour (1 hr min) 62.50
CCB Lic.: /3,8 ,-09 Electrical Lic.: C /g Suprv. Lie.: l// / 3 5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: ��iG ) 6 ✓ Date: s.r)z - d Plan review (25% of permit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
1: 1Building 'Permits\ELC- PermitAppdoe 05/23/06 440-4615T( I I /05/COM/WEB /J,
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
O 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 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ,ST2007.O1i;;32
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: €127/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ,L�I�i •
INSPECTION WORKSHEET FOR DATE: 2/13/2008 TIME: 7:01AM PAGE: EA
SITE ADDRESS: 116Th SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971 -222 -7131
CONTRACTOR: E3ATEMAN CONSTRUCTION INC PHONE #: 503.452 -2380
Inspection Request Scheduled For: Date: 2/13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
339 Plumbing final 064848.01 5€ 3- 616 -€i770 N
Corrections /Comments/ Instructions:
_ 1
4 P I It PARTIAL APPROVAL ❑ CANCEL ` NO ACCESS
• FAIL - VI CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
___4
L.---
Inspector: Date: 0 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 . ''�_I:.
INSPECTION WORKSHEET FOR DATE: 8/7/2007 TIME: 7:03AM PAGE: 24
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971 -222 -7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503.452.2300
Inspection Request Scheduled For: Date: 8/7 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 053549.01 503 - 516 -5770 N
Corrections /Comments /Instructions:
J PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL U CALL FOR INSPECTION ( 1 ADDITIONAL FEES ASSESSED
Inspector: 6 Date: ,g1 71 t 7 Phone #: (503) 718-
Jul 16 07 10:03a Sam Zern 503- 579 -8134 p.1
r tYl CITY OF TIGARD AA -T2j -C) — 00 69Z .
COMMUNITY DEVELOPMENT
y1GARDi 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
MT TABOR PLUMBING
12165 SW ANN PL.
TIGARD, OR 97223
Permit #: MST2007 - 00092
Date issued: 6/27/2007
Parcel: 1 S134DD -01200
Site Address: 11675 SW TIEDEMAN AVE
Subdivision:
Lot:
Jurisdiction: R
Zoning: TIG
Project Name: PENA
Description: 112 sq ft kitchen addition
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.7 18.2433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
JOEL PENA MT TABOR PLUMBING
11675 SW TIEDEMAN 12165 SW ANN PL.
TIGARD, OR 97223 TIGARD, OR 97223
Phone #: 971 - 222 -7131 Phone #: 503 -579 -8134
Reg #: LTC 111019
LIC 138509
LIC 110945
PLM 34 -358PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X zcJ
Signature Authorized Plunlber Name (printed)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MS I rtlt)7 00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: U27/2007
Phone: (503) 639 -4171 j � l
Inspection Requests (24 Hrs.): (503) 639 -4175 Na " __..
INSPECTION WORKSHEET FOR DATE: )J13/200 TIME: 7:01AM PAGE: 63
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971- 222 -7131
CONTRACTOR: f3ATEMAN CONSTRUCTION INC PHONE #: 603- 452 -2380
Inspection Request Scheduled For: Date: 2/13/20081 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 06484 8-02 603.516.5770 N
Corrections /Comments/ Instructions:
1 rej PASS IN PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL 11 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
/
Inspector: - Date: Z.-/V Phone #: (503) 718 264/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2007
Phone:'(503) 639 -4171 .A
ICI
Inspection Requests (24 Hrs.): (503) 639 -4175 "::_...
INSPECTION WORKSHEET FOR DATE: 8/10/2007 TIME: 7:OOAM PAGE: 3
SITE ADDRESS: 11675 SWTIEDEMAN AVE CLASS F WORK:
SUBDIVISION: LOT #: T E OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971 - 22.2.7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503452 -2380
Inspection Request Scheduled For: Date: 8/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Eledrical rough -in 053809 -01 503- 421 -4879 N
Corrections /Comments /Instructions:
r 3& ---- -/.4 - . -7 .---
,--/: --(V 144 51)/APCcet_. .--- — 7)1 a_ P C---
i/ed94 7a
off - - �. -
ASS ❑ P. •TIAL APPRO . ❑ CANCEL n NO ACCESS
n FAIL 4( ALL FO : "E ION n ADDITION FEES ASSESSED
■ Inspector: Date: U Phone #: (503) 7T8-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MS'T10Q7 -Ot 01t2
13125 SW Hall Blvd., Tigard, OR 97223 Al Ili DATE ISSUED: 6{ 2712007
Phone: (503) 639 -4171 qur If I
Inspection Requests (24 Hrs.): (503) 639 -4175 ...':
INSPECTION WORKSHEET FOR DATE: 9/27/2007 TIME: 7:OOAM PAGE: 50
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971 -222 -7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503452 -2380
Inspection Request Scheduled For: Date: 9/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
280 Insulation 0564558.01 503. 516 -5770 N
Corrections /Comments /Instructions: .
0 5 f GuG,-- 020YC- ( S Z7 6.r' 5(7 , .(M 1*
1" S Pt - CVO - AA U.01 4.- - STdd 2K- 640��- z S i % v...�
•
N it'I D ' : ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
f" FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 9- 77 —D 2 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007-OOO92
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: &27 /20(ri
Phone: (503) 639 -4171 Etv
Inspection Requests (24 Hrs.): (503) 639 -4175 � I F'I....
INSPECTION WORKSHEET FOR DATE: 8/2312007 TIME: 7:O0AM PAGE: 47
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971 222 - 7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503- 452-2380
•
Inspection Request Scheduled For: Date: 8/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 054807 -01 503.516 -5770 N
•
Corrections /Comments/ Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
------'
Inspector: Date: � e . --a - - Phone #: (503) 718 - 4
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007- 00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 J ° i
INSPECTION WORKSHEET FOR DATE: 8/20/2007 TIME: 7:O2AM PAGE: 20
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 q ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971 -222 -7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503. 462.2380
Inspection Request Scheduled For: • Date: 8/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 054319.01 503 -516 -5770 N
Corrections /Comments /Instructions:
Cam) - TVerz- A 6 VV4-
rn l'tai Cogrer2o l G' iei / ,vc /'eras✓ * > A' S'7174 =A.te¢
•
PASS ARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION 1 I ADDITIONAL FEES ASSESSED i
Inspector:, Date: a Z &_--b ? Phone #: (503) 718- %
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007- 00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE'ISSUED: 6127/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/17/2007 TIME: 7:01AM PAGE: 21
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 371 -2217131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503 -4:52 -2380
Inspection Request Scheduled For: Date: 8/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 054235-02 503 - 516.5770 N
Corrections /Comments/ Instructions:
3 c j 7 -TV P 7z7 62e. t S' 7 Y 'a•4-7 a-146/ Zo U�
/RJR 1-L - 7'"PO ( ad/V57 A 50 4 6 - 77V 7'X
s l 6466/ t A 1.4-e
( C/7
n PASS __. 1 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
AIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: Date: I5 — l'7err7 Phone #: (503) 718-
CI ■ Y OF ■ IGA■ D
BUILDING DIVISION PERMIT #: MST2007 -00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6127/2007
Phone: (503) 639 -4171 !°
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/17/2007 TIME: 7 :01AM PAGE: 22
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971 -222 -7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503-462 -2380
Inspection Request Scheduled For: Date: 8/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 064235.01 503 - 51505770 N
Corrections /Comments / Instructions:
PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - Dater — t 7--d7 Phone #: (503) 718 - 2_
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: MST2007- 00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2007
Phone: (503) 639 -4171 '1 tl tl?�
Inspection Requests (24 Hrs.): (503) 639 -4175 ' `'I_L.
INSPECTION WORKSHEET FOR DATE: 7/17/2007 TIME: 7:03AM PAGE: 79
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971 - 222 - 7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503- 4512380
Inspection Request Scheduled For: Date: 7/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
225 Post/beam structural 052074 -01 503-516-5770 Y
Corrections/Comments/Instructions:
f 47, /4, \i - rS « / ' y 44}44
•
n PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
;st
Inspector: Date: 7-/ ?- d2 Phone #: (503) 718- �'S
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007- 00032
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 �': .r,�
INSPECTION WORKSHEET FOR DATE: 7/6/2007 TIME: 7:06AM PAGE:
SITE ADDRESS: 11675 SWTIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971- 222 -7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503- 452 -2330
Inspection Request Scheduled For: Date: 7/6/2007 Pour Time: 2:00
Code # Inspection Description Confirm # Contact # Message
210 Foundation walls 051567-02 503 -516 -5770 N
Corrections/Comments/Instructions:
ij ,s(/O 7 .ci. Iii &'TS i /1.6S' LL.ed7 - % S ,,.- , , ,Ca9 -
1 4047;:c , & -/
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector . Date: 7-6 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: MST2007 -00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/6/2007 TIME: 7:06AM PAGE: 2
SITE ADDRESS: 11675 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PENA
DESCRIPTION: 112 sq ft kitchen addition
OWNER: PENA, JOEL PHONE #: 971- 222 -7131
CONTRACTOR: BATEMAN CONSTRUCTION INC PHONE #: 503 - 462.2380
Inspection Request Scheduled For: Date: 7/6/2007 Pour Time: 2: 00
Code # Inspection Description Confirm # Contact # Message
205 Footing 051567 -01 503-516-5770 N
•
Corrections /Comments /Instructions: ,
tF/ /r/57L71-L c e -cc' L— - i
•
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-