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Permit ,, Il s CITY OF TIGARD MASTER PERMIT a #: ST COMMUNITY DEVELOPMENT DATE ISS D: M /20/12009 2009 -00002 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2 S 103C D -04400 SITE ADDRESS: 13530 SW 121ST AVE ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: BROWN Project Description: Convert 170 sq. ft. garage to habitable space. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BORN: BATH: TOTAL: 0 sf 16,461 10 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 2 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM /SVCIFDR: 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 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: 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 BROWN, MICHAEL J + MASTERCRAFT ENTERPRISES INC laws. All work will be done in accordance with approved plans. This RIES, JUNITA M 11440 SW LANEWOOD ST permit will expire if work is not started within 180 days of issuance, or 13530 SW 121ST AVE PORTLAND, OR 97225 if the work is suspended for more than 180 days. ATTENTION: TIGARD, OR 97223 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: Contact #: PRI 503 849 - 4644 questions to OUNC by calling 503.246.6699 or 1.800.332.2344. FAX 503- 643 -701 Reg #: LIC 56602 TOTAL FEES: $ 626.79 REQUIRED ITEMS AND REPORTS Issu d By : 1 - , � / 1 ` / L I/ i /77%. P ermittee Signature : j r / %, ; /�. - - Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential RECEIVE I FOR OFFICE USE ONLY . City of Tigard Received Date/B 2 '�9 _,II PermitNo.: V 1 2Ovi.0 lb 002 • 13125 SW Hall Blvd., Tigard, OR 97223 JAN 12 2009 Plan Review ,�, II I if' Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 Date/B : � (�� TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: kris : B See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISIO ' otified/Method: ( ' ) Supplemental Information TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. '(and 2-family dwelling Valuation: --ROPY:WM y g ❑ Commercial /industrial (6 61 tO $ ❑ 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: / 3 3 ) 4.4./, /Z/ -TA,fg New dwelling area: / square feet City/State /ZIP: 77# fl D2 4? 70--2- Garage/carport area: / square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: S iST 4_/172 "1 / ■4•7 �� M7 g-d57n6DsZ._ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone: ( ) Fax: ( ) New ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: .; _ All contractors and subcontractors are required to be „ �" ^ 9 licensed with the Oregon Construction Contractors Board Contact name: Yi 4,6_ under ORS 701 and may be required to be licensed in the Address: //4/L/ .S -(,4}, S0— jurisdiction in which work is being performed. If the City/ State/ZIP: 42-12._ ( 7 zas - applicant is exempt from licensing, the following reasons apply: Phone: (S ) 6L/, — yo/ yy Fax: : (sue) 6,4/.3 74 // E-mail: nie4,. ...e. g... k pn1. A. . CONTRACTOR Business name: 7 BUILDING PERMIT FEES* (Please refer lo fee schedule) Address: / /GiG./U S G!/r k „,,07....0-44) City/State /ZIP: P p2 q 1. Z Z 5 Structural plan review fee (or deposit): Phone: ,.... 8 , g _ / s G y y Fax: ( 593) o 4 /3 —70// FLS plan review fee (if applicable): CCB lie.: ��� `Z_ ( , / ( uplican ' Amount on recei : Authorized signature: permit Total applica due tion expires if a permit is not obtained J / within 180 days after it has been accepted as complete. Print name: / jith. /'r { - *P Date: / /2-- 0 `j * Fee methodology set by Tri -County Building Industry Service Board. I:\Building\Pennits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02/COM/WEB) , l Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No � - 1312 SW Hall Blvd., Tigard, OR 9722 Associated II Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: 1 I G A R D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ 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- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore. on and shall be shown to be ap plicable to the .ro'ect under review. .11. RISI)IC I'IONAL SPECIFICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1.\ Building \Permits\BUP- RES- PernitApp.doc 03/21/06 440.4613T(11/02/COM/WEB) ` Mechanical Permit Applicatio9 Q \J D FOR OFFICE USE ONLY City of Tigard Received Permit No.: �C���i � j � ET 13125 SW Hall Blvd., Tigard, OR 97223 A N 1 2 2009 Plan Review v �� Phone: 503.639.4171 Fax: 503.598.19 H Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 � I! i .�/ OF'f TIGARD Date Ready/13y: Juris: 0 See Page 2 for Internet: www.tigard- or.gov t Date ethod: Supplemental Information BUILDING DIVISIO TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ '7-° 1 -and 2- family dwelling ❑ Commercial/industrial 0 Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES* For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling / / r- / 2 - 3 Air conditioning or heat pump 5:30 Job site address: / 3 i �j� (requires site plan showing placement) 14.00 - City/State /ZIP: /G,At - j . 02 1 77: Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 ' Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: I of no.: Flue/vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 � ^ Gas fireplace 10.00 /1 >YS�tti$L /N 1S p!b'r 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 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00 Other: 10.00 Name: Environmental exhaust and ventilation Address: Range hood/other kitchen equipment 10.00 City/State/ZIP: Clothes dryer exhaust I 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) - 6.80 PLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: t 10.00 Business name: ,,..,..„-', Fuel PIPS Contact name: . / 1 „.e...„ $5.40 for first four; $1.00 for each additional Address: // Z_/yp (A,,, 1,4171/ S-7--, D S Furnace, etc. Gas heat pump City/State/ZIP: ) O2 q 7 7.--Z-7 Wall/suspended/unit heater Phone: (, 03) g4f9 96 :9 y Fax: : ( 6 !I 3 -7D / / Water heater I, Fireplace E -mail: »7( Je.e/J ( V 2- �iJ A] '!-- Range CONTRACTOR Barbecue Business name: � 7 L �/ -) j- SAS Clothes dryer (gas) Other: Address: //9 L/D S u4 4,1.N ' � MECHANICAL PERMIT FEES* City/State /ZIP: 7==b�- - 4)2 77 Z2 • Subtotal Minimum permit fee ($72.50) 7Z. Phone: (5/23) Q t/ f— 96 Y 1 Fax: (5 to Y3 7/7 // Plan review (25% of permit fee) CCB lic.: ' 6, ? State surcharge (12% of permit fee) a. -7c) TOTAL PERMIT FEE Et ,2o Authorized signatur • /J This permit application expires if a permit is not obtained within 180 �/ , days after it has been accepted as complete. Print name: .\ � Date: /--/ z — o / * Fee methodology set by Fri-County Building Industry Service Board I :\ Building \Permits\MEC- PermitApp.doc 01 /19/07 440 -4617T (11 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I: \ Building \Permits\MEC- PermitApp. 01/19/07 2 Plumbing Permit Application Site Utilities RECEIVE I FOR OFFICE USE ONLY �) C City of Tigard R eceived Permit No.: C/` _o2- ■ lig 13125 SW Hall Blvd., Tigard, OR 97223 JAN 1 2 2009 DateBy: 5 � U G?X> I Plan Review Other Permit No.: Inspection Phone: 503.639.4171 Fax: 503.598.1960 DateBy: TIGARD Iion Line: 503.639.4175 Date Ready/By: Juris 0 See Page 2 for �1TY O F TIG Internet: www.tigard- or.gov Supplementallnformatioa TYPE OF WORK DIVI$IDP� n fied/Method: FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. ] Total jition/alteration/replacement ❑ Other: New 1- 2-family dwellings ngs (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 and 2- family dwelling El Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: / ‘, 5 --- 3-1 . .7 5_ AL / Zj /47.40- ' Catch basin or area drain 16.60 City/State/ZIP: 1 / 44 4) / D £ 9 7 z ,- z .,- Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: , Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: _ ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 - 2f / fE %,0$z- / e Backwater valve 16.60 � Clothes washer / 16.60 ,� Dishwasher 16.60 ,, 10 PROPERTY OWNER 0 TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: /xe- j7494/jf/ Expansion tank 16.60 Address: /35 s„ W 10, / Pi /yam Fixture /sewer cap 16.60 City/State /Z1P: ... 724 7 4e47 9 J 2-7j3 Floor drain/floor sink/hub 16.60 (5 3 5 - 2 ? � 5 ,� Phone: � Fax: ( ) Garbage disposal 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: Roof drain (commercial) 16.60 Sink/basin/lavatory o /C3 // 16.60 Phone: ( ) I Fax: ( ) Tub /shower /shower pan ( 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet ( 16.60 Business name: {\' Water heater / 16.60 `�J Address: a ( ' VV 1 E Z _ Other: / City/State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 c Z , CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) K State surcharge (12% of permit fee) , ( Authorized signature: 0lIJ/1.ari& TOTAL PERMIT FEE . , Dint name: M % Q.e , „ z ga w ate: 1•••• - ell 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. 1 \Building\Permits\PLMU- PermitApp.doc 12 /27/06 440- 4616T(10/02ICOM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qtr. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 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 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees*. ❑ Any new commercial building with water service 2" and Quantity_ by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain Garbage -Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar /Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: I:\Building\Permits\PLMU- PermitApp.doc 2 Electrical Permit Application RECEIVED FOR OFFICE USE ONLY City of Tigard 1.2 2009 Received Permit No.: M L�r�Q/y7( � O Date/By: a w i . 09 9 I N 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 OF Tic, • , I Date/By Other Permit: T I G A R D Inspection Line: 503.639 C rr 1 ate ReadyBy: Juris: 0 See Page 2 for Internet: www.tigard- or.gov B1J1LD NG DNISt Noti f ied/Method: Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction Xdition /alteration /replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural El 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", 100HP or more. occupancy. Job no.: Job site address: 3s--30 S S ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: n� q ❑ Health -care facilities. ❑ Supply voltage for more than t /(n/s J / ©� ! Z ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 x( /11 / erc - $Z 67 /•U 6/S T ‘7092-.14 0 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 I PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: K� :II? iv/ 7 W 7' ��� 401 amps to 600 amps 160.60 2 / /// 601 amps to 1,000 amps 240.60 2 Address: ✓�30 5 (� Z . s r 4.41r. Over 1,000 amps or volts 454.65 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or Ci T,-,,,,,,,,,t, 0 e 9 7 relocation Phone: ('3) S2 _ ( g 2 7 Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: C Et ec G / L' L. C Signal circuit(s) or limited - energy panel, alteration, or Address: 33 , Q � W / 61 . S■ N 1 v 'v k , extension. Describe: Page 2 2 City/State /ZIP: liE- 4 /S'D 0/ 1 ' 7 00 6 Each additional inspection over allowable in any of the above to Per inspection 62.50 Phone: (q7 / ) S' 70 yl2 9 Fax: ( 1 I l �t Investigation per hour (1 hr min) 62.50 CCB Lic.:/ / 3 3'3Q Electrical Lic.: 4_ �2$ ` ,. Suprv. Lie.: J O D S�$'' Industrial plant per hour 73.75 l f0(I /a' ELECTRICAL PERMIT FEES Suprv. Electrician signature, required. Subtotal: 4_(,,,,P Print name: i C K /v l 1 A , 5 4..�- Date: ( . / _ O Plan review (25% of permit fee): ''''ff State surcharge (12% of permit fee): 4 5. C , Authorized sign...0 -: TOTAL PERMIT FEE: .5 , Ak-s D ate: / _ This permit application expires if a permit is not obtained within 180 Print name: �` cK M TA sA 1 / D days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits'ELC- PermitApp.doc 05/23/06 440- 46t5T(11/05 /COM/WEB .11. 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: ❑ Audio and Stereo Systems* n Burglar Alarm I I Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ D ata Telecommunication Installation n F ire 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 03/23/06 i OCSVB D Property Owner Statement JAN 13 2 009 Regarding Construction Responsibilities c to Oregon Law requires residential construction permit applicants who are not licensed with theB Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: N Atei r o,,x3 _ 2 C () &ti Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. M . L UW 1J Print Name of Permit Applicant - --EV\/&(-(i)(1/ f/......1 - 2, -- 0 1 Sign ture of Permit Applicant Date Permit #: H -ary) Cca9.2 /1 , Address: l3J dui la/ !�Ji.- s;- :" Z' ---17-Q,4-4:b � rurr�:: A .1 Al 9 zza 3 ' , ; f Issu W 4-1,- ..** ed by: Date: • ii This Copy for Permit Offices CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2009 -00002 13125 SW Hall Blvd., Tigard, OR 97223 {�' DATE ISSUED: (/ ;1017009 Phone: (503) 639 -4171 � Sr a � am �I, A I Inspection Requests (24 Hrs.): (503) 639 -4175 ; !ai 1 . INSPECTION WORKSHEET FOR DATE: 2/24/2009 TIME: 7 ;0()AM PAGE: 1 SITE ADDRESS: 130;30 S/ 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Convert 170 sq. ft. garage to habitable space. OWNER: BROWN. MICHAEL & JUNITA PHONE #: CONTRACTOR: ivMASTERCRAFT ENTERPRISES INC PHONE #: 503.849 -4644 4 Inspection Request Scheduled For: Date: 2724/2009 Pour Time: Code # Inspection Description Confirm # Contact # Mes g W 299 Final inspection 080798 -04 50:3- B49-4644 Y /" Corrections /Comments/ Instructions: N , U3 ni PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS (l FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: G I NN?) L- Date: 212341 (' Phone #: (503) 718 - ,n, CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2009-00002 00002 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2012009 Phone: (503) 639- 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 A A ' 'I �.. INSPECTION WORKSHEET FOR DATE: 2/24/2009 TIME: 7 :00AM PAGE: 2 SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Convert 170 sq. ft. garage to habitable space. OWNER: BROWN, MICHAEL & JUNITA PHONE #: CONTRACTOR: IviASTERCRAFT ENTERPRISES INC PHONE #: 503 - 849 -4644 Inspection Request Scheduled For: Date: 2/24120p9 Pour Time: Code # Inspection Description Confirm # Contact # \sage 199 Electrical final 080798 -03 503 - 849.4644 Y Corrections /Comments /Instructions: Am ■ N i c,ZC, Yw i+A . q•-, 6 5 PA SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: �Th Y QO Date:1 1"4 ( A Phone #: (503) 718 -1 CITY OF TIGARD " BUILDING DIVISION #: MST2009 -00002 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1l2Opo08 Phone: (503) 639 -4171 a Insp ction Requests (24 Hrs.): (503) 639 -4175 _.. INSPECTION WORKSHEET FOR DATE: 1128/7009 TIME: 7 :01AM PAGE: 2 SITE ADDRESS: 135530 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Convert 170 sq. ft. garage to habitable space. OWNER: BROWN, MICHAEL ,1 +, PHONE #: CONTRACTOR: MASTERCRAFT ENTERPRISES INC PHONE #: 5n849-4644 Inspection Request Scheduled For: Date: 1/28/2009 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 080086-03 503 - 849-4614 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I Inspector: ■ Date: / � ! - 9 Phone #: (503) 718- CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2009 -00002 k 0 Ci - ' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/20 /2003 Phone: (503) 639 -4171 /a i wdo lt l l l , Inspection Requests (24 Hrs.): (503) 639 -4175 IC , • INSPECTION WORKSHEET FOR DATE: 2/2412009 TIME: 7:00AM PAGE: 3 SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Convect 170 sq. ft. garage to habitable space. OWNER: DROWN, MICHAEL & JUNITA PHONE #: CONTRACTOR: MASTERCRAFT ENTERPRISES INC PHONE #: 503.849-4€44 71 ir Inspection Request Scheduled For: Date: 2/24f2009 Pour Time: n Code # Inspection Description Confirm # Contact # Mes g 1(�� 399 Plumbing final 080798 -02 503.64 Y Corrections /Comme /Instructions: 9 s I A/IL--4- g /0-17 a- ' PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ci Inspector: c/Z._ Dater // Phone #: (503) 718 -" T — ! CITY OF TIGARD • BUILDING DIVISION PERMIT #: MST 7009-00002 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2012009 Phone: (503) 639- 4171 °� Inspection Requests (24 Hrs.): (503) 639 -4175 ��': _.. INSPECTION WORKSHEET FOR DATE: 1128/2009 TIME: 7:01Am PAGE: 4 6. IZr SITE ADDRESS: 13630 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BRowl'1 DESCRIPTION: Convert 170 sq. ft. garage to habitable space. OWNER: BROWN, MICHAEL J +, PHONE #: CONTRACTOR: MASTERCRAFT ENTERPRISES INC PHONE #: 603-049-46414 Inspection Request Scheduled For: Date: 1/2812809 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 080086 -01 603-849-4644 N Corrections /Comments/ Instructions: _________ t ■,4-1 \ / --7-7__---_, e, , ` v P� - PARTIAL APPROVAL , CANCEL 1 I NO ACCESS • FAIL /1 . CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ..g A Inspector: Date: © Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION #: M; T 009 00002 13125 SW Hall Blvd., Tigard, OR 97223 i of DATE ISSUED: //012009 Phone: (503) 639 -4171 lip AimegiplipdiI Inspection Requests (24 Hrs.): (503) 639 -4175 4. =`:_.. 6 INSPECTION WORKSHEET FOR DATE: 1/21/2009 TIME: 7.0{ jAm PAGE: 21 SITE ADDRESS: 13530 S'w 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Convert 170 sq. ft. garage to habitable space. OWNER: BROWN, MICHAEL J +, PHONE #: CONTRACTOR: MASTERCRAFT ENTERPRISES INC PHONE #: 503.849 -4644 Inspection Request Scheduled For: Date: 1/21/2009 Pour Time: �� Code # Inspection Description Confirm # Contact # Mes �i/U"� 305 Piumbing underslab 079873..01 5034349 -4644 Y frilA" Corrections /Comments /Instructions: 0 W- 3_ 6 ) I �� L.Au ) w/ (:__ / 0 ) , u‘t,s - ()_ ) (e. f _,. 7-- . c.) , ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS �/ ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Z, 1 / Phone #: (503) 718- J Inspector: Date: P ( ) CITY OF TIGARD 1 BUILDING DIVISION PERMIT #: MST2009 (�O002 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1120/2009 Phone: (503) 639 -4171 Ili \ Inspection Requests (24 Hrs.): (503) 639 -4175 Jowl � :_.. ! Z Z INSPECTION WORKSHEET FOR DATE: 2/24/2009 TIME: 7 :00AM PAGE: 4 SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Cowed. 170 sq. ft.. garage to habitable spare. OWNER: BROWN, MICHAEL & JUNITA PHONE #: CONTRACTOR: MASTERCRAFT ENTERPRISES INC PHONE #: 503. 949.4644 7/ 7 Inspection Request Scheduled For: Date: 2124/2009 Pour Time: v i Code # Inspection Description Confirm # Contact # Mes ag • _. A 699 Mechanical Sinai 080798 -01 503-849-4644 Y � Corrections /Comments/ Instructions: PASS n PARTIAL APPROVAL ❑ CANCEL El NO ACCESS n F IL ❑ CALL FOR INSPECTION 1 I ADDITIONAL FEES ASSESSED Inspector: 1 / / \'4 Date: )/ >q/a 5 Phone #: (503) 718 - ,j CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2009-00002 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1120/2009 Phone: (503) 639-4171 A ,... /r i i i i. Inspection Requests (24 Hrs.): (503) 639-4175 _: o l INSPECTION WORKSHEET FOR DATE: 1/29/2009 TIME: 7 PAGE: 13 SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: COnYeri 170 sq. ft. garage to habitable space. OWNER: BROWN, MICHAEL J +, PHONE #: CONTRACTOR: MASTERCR AFT ENTERPRISES INC PHONE #: 503-8419-41644 Inspection Request Scheduled For: Date: 1(29/2009 Pour Time: Code # Inspection Description e . • Contact # Message 280 Insulation 080122-01 .03-849-4644 \ Y •■••••, Corrections/Comments/Instructions: - IL- Z.1 t".14 LL 0 PASS PARTIAL APPROVAL CANCEL fl CALL FOR INSPECTION El I I ADDITIONAL FEES ASSESSED pi NO ACCESS ) fl Inspector: G N6eLle Date: 1 °./ Phone #: (503) 718- lqqb CITY OF TIGARD BUILDING DIVISION PERMIT #: MS`T 009 Of' ►fktl2 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/20/2009 Phone: (503) 639 -4171 427 0�il Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 1/28/2009 TIME: 7.0'1AM PAGE: 3 SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Convert 170 sq. ft.. garage to habitable space. OWNER: BROWN, MICHAEL ,.I +, PHONE #: CONTRACTOR: MASTERCRAFT ENTERPRISES INC PHONE #: 503- 849.4EA4 Inspection Request Scheduled For: Date: 1/28/2009 Pour Time: Code # Inspection Description Confirm # Contact # Message 6Th Mechanical rough -in 080086 -02 503 -849 -4644 N Corrections /Comments/ Instructions: 6/ K(/// f/ V6 - //---_. iA / F.4 PAS' I PARTIAL APPROVAL El CANCEL El NO ACCESS • FAIL n CALL FOR INSPECTION ❑ ADDITIONAL F ES ASSESSED Inspector: A 1.A _ Date: 1 Le 0 Phone #: (503) 718- ZA CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2O()9.00002 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/20/2009 Phone: (503) 639 -4171 --,,' '�I Inspection Requests (24 Hrs.): (503) 639 -4175 . 1_.. INSPECTION WORKSHEET FOR DATE: 1/28/009 TIME: 7:01AM PAGE: 1 SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Convert. 170 sq. ft. garage to habitable space. OWNER: BROWN, MICHAEL J +, PHONE #: CONTRACTOR: MASTERCRAFT ENTERPRISES INC PHONE #: 503 - 849 -4544 Inspection Request Scheduled For: Date: •1/28/2009 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 080086-04 513 -049 -4644 Y Corrections /Comments /Instructions: 0 ?---- 77) ._. J)--/4-37C; 0 k,../ nii-- r.,- _4, / (,-4-C_____ A-P fogi:/-6 ❑ PASS in, ' PARTIAL APPR• ' ❑ CANCEL ❑ NO ACCESS _ FAIL � ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / c---...._ rb °I Inspector: yr. — Date: Phone #: (503) 718 - za _ . CITY OF TIGARD f . i BUILDING DIVISION i P MIT #: ') o 000rp 13125 SW Hall Blvd., Tigard, OR 97223 1' M 1/27/2 . .?) a 09 fr. ' Phone: (503) 639-4171 / Inspection Requests (24 Hrs.): (503) 639-4175 \\ I--) INSPECTION WORKSHEET FOR DATE: 1121/2009 TIME: 7 PAGE: 20 SITE ADDRESS: 13530 "SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BROWN DESCRIPTION: Convert 170 sq. ft. garage to habitable space. OWNER: BROWN, MICHAEL J +, PHONE #: CONTRACTOR: MASTERCRAFT ENTERPRISES INC PHONE #: 503-849-4644 Inspection Request Scheduled For: Date: •/21/2009 Pour Time: 12:00 Code # Inspection Description Confirm # Contact # M es ..., , 6e,4- 220 Slab 079873-02 503-849-4644 Corrections/Comments/Instructions: 0 ?q 2? — 0 2_ ,. c/Nss El PARTIAL APPROVAL ID CANCEL 0 NO ACCESS FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED fii liv / - tM Inspector: Date: Phone #: (503) 718