Permit „CITY � OF TIGARD MASTER PERMIT
PERMIT #: MST2005 00167
t1
DEVELOPMENT SERVICES DATE ISSUED: 5/27/2005
r��� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
Azta PARCEL: 25101 DB -00614
SITE ADDRESS: 13275 SW 76TH AVE ZONING: R - 3.5
SUBDIVISION: ROLLING HILLS LOT: 019 JURISDICTION: TIG
Project Description: Garage addition
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 12 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 0 SECOND: sf GARAGE: 440 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: 5
VALUE: 22,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf a REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: 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 ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200amp: I 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/FCR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 3 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:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Munidpal Code, State of OR. Specialty Codes
FREZZA, CONRAD NICHOLAS + APRI OWNER and all other applicable laws. All work will be done in
13275 SW 76TH AVE accordance with approved plans. This permit will expire
TIGARD, OR 97223 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
Phone: Phone: 503 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
Reg #: direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 560.43 1 -800- 332 -2344.
REQUIRED ITEMS AND REPORTS
Issued By : A. , /ir ,ice _ 1, Permittee Signature : • AP- Af//2
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.
Buildind' Permit APinigr FOR OFFICE list: ONLY
City of Tigard Received u� -- � i 4)5%o d
•J g Date/By ` `' Permi T i
13125 SW Hall Blvd., Tigard, OR 97223 n� Plan Review
Phone: 503.639.4171 Fax: 503.598.19 1 2005 At hry�pCi i\ Date/By: Datey: rAA v - O S
Inspection Other Permit:
p _ Ready /By: kris: ® See Attached Checklist for
Line: 503.639.41 C ❑ Date Read B
Internet: www.ci.tigard.or.us CITY OF T I O �At ,L Notified/MethodJ� 0 lu
�- �7� Supplemental Information
BUILDING DIVISION z� 'V.Iss9A.2.
TYPE OF WORK ` f1EQUIRED 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.
❑ 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ r).-- a .0 no
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ICI Other: (a , SL,;, Au:.6o„, Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: i �,,)_ 71 S t..J - 1 to At aJ e> New dwelling area: square feet
City/State /ZIP: -r t J as - O{-L. cj - oi; oZ 3 Garage /carport area: IN O square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: '7 6 , 0 a4 K. S Deck area: square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL - USE CHECKLIST
Subdivision: I), n l l t jul V'i 11 5 Lot no.: I ei 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.: 6, „:„t✓l, tr equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
y (n� Valuation: $
t at Existing building area: square feet
New building area: square feet
R PROPERTY OWNER ❑ TENANT Number of stories:
Name: C ✓ .,` r ark d•. et ,-)r1 ( -i` C ,-- Type of construction:
Address: l") a Q'S SL) '7 1; 1 J (.42. Occupancy groups:
City/State/ZIP: l cu --3,_ 0 ._ q 7a a 3 Existing:
•
Phone: ( 5 )3) E, . 0 -- j 4.-c; Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: C..0 ��� t f n I � � � licensed with the Oregon Construction Contractors Board
`t under ORS 701 and may be required to be licensed in the
Address: V3 1 S L) '7 6 "ik- ALA u P , jurisdiction in which work is being performed.. - If the
/State /ZIP: applicant is exempt from licensing, the following reasons
Cit
y -- i y dLecst OR- C( 7 -a- apply:
Phone: ('rc ) io _� c - j 6 �1 Fax:: ( )
E -mail:
CONTRACTOR
Business name: '
BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City/State/ZIP: / 6 .� �}
Fees due upon application �
Phone: ( ) Fax: ( )
Amount received
CCB hc.:
Date received:
Authorized signature: CYO --) rjl This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 4p 61 I L ; f'-� �. y Date: y j I � /f * Fee methodology set by Tri -County Building Industry
9 Service Board.
. 05/17/2005 11 : 34 LEUPOLD8STEVENS - 95035981960
FROM : ID ' S ELECTRIC I NC -,-,.. IV E a NO. : 503 662 3122 re
i' . \ - RECtl Y • - I b .1- e_& . ,, NO . : 392 D002
El't,-;.^4-nizarPern___AtAPSIVIAM 4.114 (11 1 it 1 E , •I liNi % , • :
City of Tigard le( 1 7 NOS Ittsudivort
Osidlir P `i
cimit 14 "V \5"17:7 GOY - ao 4 f
0125 SW 1-tall Blvd, 'Nook OR 97223 IGAR ; ,.• ., (mar Porrnit•
Phone: 39. Pak 5060....,-1-TY OF T
Ito Divis ,. Pil
ftil blai - dy ;17-- Pay:
. .!''4 ,,,, veJ..,
httopatioo Litio: 501639.4175 "iimi 1 Ell a --- e ----
503.64171 : 503. .
(1 Pilo itar .
BUILD' -.G d" ' ' -- Notif ettod. soppleutontai istronpaion . .
• townies: www.c..,:tigarcl.or.w; - rr ,..,,-,,,,rp.1.. . .e: 17- • -, • . , Jrrr7
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D New construction ..:.• ' g t liOnhtiterkitiOnirePitt=lea TIMM Lilo& etii that apply:
CiSOrvioe over 225 nun* conurel
CI Dettlolition El Haaardous looltiOn
f 0 Other: ' • . Elsorvico nvcr 120 rug* -- Wang DimindAs ow ikatO ar4.11...
..'..„..,-„,„;40,:Pv ,I;iii„:17.,.:::::14, ,...; ‘ .:„ . . . 7 :1 ,v 8 j p ,... - .•••• .., 1 h . k . ‘..., • .: . 4' o 1 and 2-cooraly dwollinrco 4 or mum utsw rosidoritinl .
. [Sown evor 600 voLta nominal . • units in 011a VEMCUM: •
'.! 1- and 2 dwelling 0 Commercial/industrial 12 Acr.tsory building
. . El ovio threo 0.06 ot DPI:odors, 400 totp or moro
1:) Midti-fatnily .0 Master Wilda 0 odur. V oar
Do k o;,,ax 99 pattonit 1:11AutufitCturiscl atrocturpa Or
%,7,F.J : "7 tr...,.,i-"'"ILITA"a.=-717:.Aini.' :.1" :"*......:':' Ditst.rtiotiorsplazi Rk.
!c:• ',; . , , ' • ' k" • ' " ...4 ' ' i ' ' ' ' . Elftcalth-cato facility
Job no.: .10b site arldress: 4-- SG-J ?A 1:A " V
sJ. sabmit z mai of plans with any alba aboVO,
CitY/Sta ./.17/./e->aP OAV. • ito above aro not * applicable 10 tirtpoosry onannution egrvioe.
ala...?.... . " " '777-777.774'7777-77" el " tibkiiiita:* -1. 4
Suite/144./apt. no.: reject _
,
. .,-- 1
emwstreetkiirection to job site
s - L..)/eV . eterve. Near . irtaiderstial simile- or venhi dwelling unit.
i .7) ....
...... - hwilidas satuchod ,- e-, __,
I.= Nif it. te iwo 145.1 . 4
, -., ..
LOt nO.r/ If.4. lultil 500 sq. fl. or portion 33.40 I
SubditritliC111: .
i h .-- _ ..„,. Linitni 5 Mk/. rosixt"onil 75.00 2
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. ir s.
Tax rrutp/pare-col r-n ,.e 4' . - . , .,
e. ''' 4 ; Limited MIR, norrroaidatiall 75.Q0
11
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- ';:i*:'..1 .F.':'.:..i;r■,.1W, dr4
dwolligtp, wryly:. attEllnr or _ 90.90 _
• 1 * e l l e Z I - • 2&.--.1V42 . "5"4') ft - . .11.e' ,1e /927/711 tinrairza or taatora 10141144 011crotlos, miter tralota4lan .
. 2.00 anr or loat R0.10 2
' -
' 106,85 2
7 ,."'"7-777:75Wfi,.;40•64411, •.;:-:.:••••:,: ',•;i'• ;:•,. ‘;• :!.;;.1...' - %Ie. Notfr...f • - A•.,.,:r, ;7, - f -1 ---.."
160,60 2
lqatue; ? gi, "...-,, , .7 --- El
61 Lunt* to 1,000 ._ - _ 2 T -
, 4 �.-
Address: ,,, 76' 6 ,,,j 2 a. Ifizi_______ . Over 1,000 arte or V0118 454.65
----, Roconnor4,5t________ 66.1Z5 2
• AAA...
C ity/Statear: ■•-r," ; 4: ___„2 3 _______ L aervloon ur fowlers installation, talc-Fuqua, ttildior
ehl eo )6.-10 - 6-.60 c) (Fax:
200 anyo or lefai 66.135 ' i
,
Cfmn.VInstallotleat: ThitL installation is being ramie 011 propaty that I own which iti ilot . ..21_. 400 itnipzi 100.30
itite for Adcd sate, 1 ,,, . , occhange, accorcling to ORS 447, 449, 6 • an= 7 . 401 iimpi to 600 amps. 133.75 2
Owner signatury r.i.\ A , I, __ Oak p a
: r C" .
4 „r_l_ eseta cades - oew, alteration, or catanaitot,_rr• pond. ' '
' "" - ' 1 ' . . ' • . ' . " '' - ' '" ''''. • A - Ftgl for branch 1... 02 .-- =4kitit
'init 4 •:'' 1Z • . • .- o .,,.: 4,A0 1 ,,;, ; ,. ; . 11
wince or ihr4cr fon, otich 6.6 2
Business name: hnuich come ... .
0- ltoo for branch &mita
Contact name withow porviLv Or %oda GA, 111 46.85 ../.4
--- ---------,, each broach carcalt ,
Address: ' s: Rseb add:1 brunch circuit EN 6 • ; 2
,, -.-----.... ---- .
• City/StutdiiP: , IVIhicanurous (serviez or cantle vita lockahol . ,...
. . - Pump of irrisafion circle_ 51.40 2 _
Phone: ( ) - Film; : ( ) sip or ontlina Ughtios 51.40 . 2
_
., _._
E-mail: . • .„,, ., Signal circuiL(a)or hinitial
'fl'•:7777-70777-77q777:77777-777TFT:i64.10 L a; ..,. 'ff 411 c ( *.Park 6 . 1 ' liti Page 2 2
flusiness name: • i . .
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5,91119,Arir ' .--
Each tultittionalln9ection War alkolr4hie hi • of the obtrva
Addr Od, -7 e • ' _. : .."41 hejfd-Zita-
Par ilismct ....,, 62,50
• .
City/Stztta .11); " d'af _ 14 1-1- - - .... .1 tivootigatton par hour (1 Itr min) 62.50
•:, -_.------ Industrial phart por hour 73.75
c Phona:L40) e" 0 , _..... , • . Fax: (
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......,c,q.,;,:.....„,,,!,,,s,: • 1 :',. .. ., =%...-•.;:::4;46---
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CC I3 1.,ica--:60 ' Elccilical Lica V -4 Suprv. Lic.: ...„ -,<-. .
..-----. Mao wi (25% orp.it Yee) -------
, " Suprv. Eledrieinn signature, required : 1 . , d . -
-
Prult ' .--, -.L._ . 'z. . ."" - Slain aoraharge (a% Or puma fa) . .t.,7
.1-ir
TurAt, PERMIT mut 7,;?.. /if
AutharieA signature: To. oiins ami a;41.1igTh - r - iiilaii omais is nat *WINN! withilt 1$0
.......----------.--- days otter it Inu hum actypoti lal caaaptiaa
Print name: £)A1 Fed o wl
ate: * igyjaky Sot 4'1'144:aunty Ihniaina outtouy 3erviac Board
...------ *° Nuinbar of' immotaapt par mom tillotaxl.
.,-.----__-_---------------
i .
05/25/2005 10:50 LEUPOLD &STEVENS -> 95035981960 N0.402 D002
503 846 3525
os,Vav 25 . 2305010:0' AID. WATER SERVICE-S 503 6814439 tic • 71 10 P • 1001
t
C_ {, \q \1-', \
e �. zu5 \ lj . Number bs- boano7 1 11 Clean a � Sezv�C ,., -. ea Pre Screening Site Assessment
Ot� cornsritmn.
t is c1c6c. A
JUrjsdiiction ►�jd`c'S. Date 5/1"7/o
Mao & Tax Lot 655 S Owner C.494_1� ws1 R i �r0 -
Lfl� l `i Contact L.e.-
site Address t , a. s 6t..., - oe,„we, Company
Y► ��- OR- q Address i 3 6U 10, e_
Proposed Activity , , Ci State Zip c� bit_ q 3
Proiso - .� . - , (.> a' s b
Phone So
Fax _5 - S . of erg-
- -- Oft1cJ®J use only below this line
Y
Y N NA N NA
0�11 n Sensitive Area Map Stormwater Infrastructure maps
l J I ` Asap # , tc) ❑ ❑ as # _ u'AI AA
❑ ❑ El L-
Locally adopted studies or maps r1 I u 1 Other
Specify _ - 1 4!� Specify _______
Based on a review of the above information oln an t h e equi en l of Clean Water Services
Design and Construction Standards
❑ Sensitive areas potentially exist on site or within 200' of the site- THE APPLICANT
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER. If Sensitive Areas exist an the site or within 200 feet on adjacent
properties, a Natural Resource$ Assessment Report may also be required.
VI Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening srto assessment does NOT eliminate the need to evaluate and protect
water quality sensitive area if they are subsequently discovered. This document
will serve as your Service Provider letter as required Resolution obtained Order
04-9, Section 3.021. Ali required permits and app
completed under applicable local, state, and federal law.
❑ The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED
Comments:
_�"" �/ / Date: 27.2 f/0 5
Reviewed By: C %>��'
Post4t- Fax Note 7671 Date /205 pages t �a w f Returned to Applicant
.
From Maid' _ Fax I taunter
TO Da - Lr,��z e /wok ekti��+a� Dated .; — y -
ooJDCD� c o . e�lJ' ,
Phone 0 Phone 11 60,5 • 66 I • s700 aa
, Fax # <.n7. S2). L iPA1
1-4't* j
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST200S -00 I67
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/27/2005
Phone: (503) 639 -4171 4 u4Pili
Inspection Requests (24 Hrs.): (503) 639- 4175�I �.�
INSPECTION WORKSHEET FOR DATE: 10/19/2005 TIME: 7:03AM PAGE: 81
SITE ADDRESS: 13276 SW 75TH AVE CLASS OF WORK:
SUBDIVISION: ROLLING HILLS LOT #: 019 TYPE OF USE:
PROJECT NAME: FREZZA
DESCRIPTION: Garage addition. 7/29/05: Added (1) feeder.
OWNER: FRF77A, CONRAD NICHOLAS + APRIL, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 018623-01 503-781-7330 Corrections /Comments /Instructions: PRA
( ; cob
/
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL F•R INSPECTION ❑ ADDITI NAL FEES ASSESSED ( ) Date: ( 0((e O n e #: 503 71-
Inspector:
CITY - OF TIGARD nti
BUILDING DIVISION - A PERMIT #: at)D5 – 4 / G 7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 !�n����'
Inspection Requests (24 Hrs.): (503) 639 -4175 ,„_II- __ ..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /3 7$ 7' ` / z. -` - CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: r
CONTRACTOR: k PHONE #: Opp— 7 330
Inspection Request Scheduled For: Date: • Pour Time:
Code # Inspection Description Confirm # Contact # Message
qq
Corrections/Comments/Instructions:
. A, PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector: � � ""' Date: 101 � C Phone #: (503) 718 - Zy4b
i