Permit At*? AirPS F.A., AtIhS / #AJs Ifil/ ///
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2001- 00255
DEVELOPMENT SERVICES DATE ISSUED: 5/18/01
--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14955 SW 79TH AVE PARCEL: 2S112BD -02200
SUBDIVISION: DURHAM ACRES ZONING: R -4.5
BLOCK: LOT: 044 JURISDICTION: TIG
REMARKS: 528 sq.ft. garage and a 50' x 3' breezeway
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 10 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 528 sf FRONT: 22 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: F1N8SMENT: sf RIGHT: 38
VALUE: $ 14,310.60
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0.00 sf REAR:
• PLUMBING
. SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: 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 ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st WIO SVC /FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 641.99
This permit is subject to the regulations contained in the
PRESTON, ROBERT J THOMPSON CONSTRUCTION, MA ARk Tigard Municipal Code, State of OR. Specialty Codes and
14955 SW 79TH AVE 8730 SW PINEBROOK all other applicable laws. All work will be done in
TIGARD, OR 97223 TIGARD, OR 97224 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg #: LIC 96435 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 - 1987.
REQUIRED INSPECTIONS
Erosion Control Insp 84 Electrical Rough In Electrical Final
Footing Insp Framing Insp Plumb Final
Foundation Insp Shear Wall Insp Final inspection
Slab Insp Exterior Sheathing Insr
Electrical Service_. —,, Rain drain Insp
Y \—
Issued B : / �} OC/,f�22�z4
' 1 Permittee Signature : l/1 �"C
�\ - ' /,.,...
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
CITYOFTIGARD MASTER PERMIT
PERMIT #: MST2001 -00255
a�y;� DEVELOPMENT SERVICES DATE ISSUED: 5/18/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14955 SW 79TH AVE PARCEL: 2S112BD -02200
SUBDIVISION: DURHAM ACRES ZONING: R -4.5
BLOCK: LOT: 044 JURISDICTION: TIG
REMARKS: 528 sq.ft. garage and a 50' x 3' breezeway
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 10 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 528 sf FRONT: 22 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 38
VALUE: $ 14,310.60
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0.00 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 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: 1 0 • 200 amp: 0 • 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 • 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR:
• LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: . INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 641.99
This permit is subject to the regulations contained in the
PRESTON, ROBERT J THOMPSON CONSTRUCTION, MARK .-
igard Municipal Code, State of OR. Specialty Codes and
14955 SW 79TH AVE 8730 SW- PINEBROOK all other applicable laws. All work will be done in
TIGARD, OR 97223 TIGARD, OR 97224 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: _ Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg #: LIC 96435 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8z Rain drain Insp
Footing lnsp Electrical Final
Electrical Service Plumb Final
Electrical Rough In Final inspection
Framing lnsp •
Issued By : ' "( �Td _ Permittee Signature :
Ili- Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business ay
PcI5t 3- -4 6 1 - b / e r
Building Permit Application C �
,� Date received: T ?S'C ( Perm,
- CO a j s 3
2,ilii � . City of Tigard
Project/appl. no.: Expire date: (`
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 ' Date issued: By: R no.:
Fax: (503) 598 Case file no.: Payment type: 3
Land use approval: 1 &2 family: Simple Complex: Z
TYI'E OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
2
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm El Other: 64r e..r QC( Sfot2ti) S7EJU1..)e,5
JOB SITE INFORMATION
Job address: l grd' . l,..) 71 e74c . Bldg. no.: Suite no.:
Lot: Block: Subdivision: I Tax map /tax lot/account no.: Z
Project name: (L'ST lvi.vw
Description and location of work on premises /special conditions: 62se , 64(geo " ..) P204 r o% - exrfiz-
Nc J5f '
OWNER . FOR SPECIAL INFORMATION, USE CHECKLIST
Name: 17oEL 164.-17t.a.) *a.:37-04 (Floodplain, septic capacity, solar, etc.)
Mailing address: /'/5153 St,..) 71a' Ow. 1 & 2 family dwelling: //
City: I6* I State:Q2 'ZIP: f ZLSf Valuation of work $ /13/ 0 ` .
Phone: 03 6Z.0 Z1(oC) (Fax: 1E-mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.) sle,tx ... 1/ 1ZC
Name: • Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.) QYt t i:C we , 232s;
Phone: Fax: E -mail: Commercial/industriallmulti- family: 9
CONTRACTOR Valuation of work $
Q tuPU� QIIR'z- ' 0 Existing bldg. area (sq. ft.)
Business name: r iJ . �1G,
Address: �7 ; p f ij P, '�/001L New bldg. area (sq. ft.)
Number of stories
City: 7T-6440 1 State: 'ZIP: 9722—y
5 79 5177 1 So3 57t Type of construction
Phone:�� Fax E - mail:
CCB no.: � 3� Occupancy group(s): Existing:
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
• ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
1 Name: '. 7 j &7Q0./ provisions of ORS 701 and may be required to be licensed in the
Address: // o 5-t S S £ . jurisdiction where work is being performed. If the applicant is
City: 6-brit state:0e 1 ZIP: 57OJ r
exempt from licensing, the following reason applies:
Contact person: •pN,.I C Plan no.: -
Phone: o , (Al Fax: E -mail: -
1 ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: $ZIP: Amount received $
Phone: I Fax: 1 E - mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied wi ,Ah er specified herein or not. / Credit card number: / /
Expires
Authorized sl a re• Date: Q / j �l Name of cardholder as shown on credit card
Print name: m "' er • I H t- 'S(t-J Cardholder signature $
Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00 /COM)
One- and Two - Family Dwelling
w, < Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard Y b ❑Electrical ❑Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR :97223 LI Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
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 0 plan 0 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 t� 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 nonuniform 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 applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. •
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6/O0 /COM)
Electrical Permit Application
Date received: Permit no.: • ' A . 741 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
•
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial 0 Multi - family 0 Tenant improvement
❑ New construction 0 Addition/alteration/replacement RI Other ' (• ' • Pare
1 JOB SITE INFORMATION
Job address: /L/ s/ ., - 4,E, , f X 11.6 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: I ( Subdivision:
Project name: P1(057n,,.) C 4+ /44A6 _ I Description and location of work on premises:
Estimated date of completion/inspection: - 2..C o t
CONTRACTOR APPLICATION \- ---".. , ; FEE SCIIED1ILE
Job no: Fee Max
Business name: o L c .�`7+QT� Description Qty. (ea.) Total no. insp
Address: New residential -single or multi - family per
dwelling unit. Includes attached garage.
City: I State: I ZIP: Service included:
Phone: I Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lie. no: Limited energy, residential 2
City /metro lic. no.: Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): a - f 4� �
ak z A,=s3- l 201 amps to 400 amps 2
Mailing address: /91„3— SL-J 7 A-t 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: T A I State:Z, I ZIP: 57z L5f Over 1000 amps or volts 2
Phone: 5 O2) jt ,o I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
'ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E Each additional branch circuit:
PLAN REVIEW' (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other-. Per inspection 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained' Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $
Expires accepted as complete. TOTAL $
Name -of cardholder as shown on credit card .
$
Cardholder signature Amount 440 -4615 (6 /00 /COM)
•
Electrical Permit Fees: Limited Energy Fees: ,
•
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total!
Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40. 1
n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 Ti Garage Door Opener
Services or Feeders - • n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 i 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
401 amps to 600 amps $160.60 2
• 601 amps to 1000 amps $240.60 • 2 n Other
Over 1000 amps or volts $454.65 2 •
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation I Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 i 2
401 amps to 600 amps $133.75 i 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits 7 Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ! ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 I n HVAC .
Miscellaneous ❑ Instrumentation •
(Service or feeder not included) ! .
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy '
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over i ❑ Medical
the allowable in any of the above •
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting* •
Fees: n Protective Signaling
Enter total of above fees $ [ ]
' I I Other
8% State Surcharge $ Number of Systems
•
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ •
Enter total of above fees $ •
❑ Trust Account #
8% State Surcharge $
i Total Balance Due • $
.
•
.
i:\dsts\forms\elc- fees.doc 10/09/00
CITY OF TIGARD
13125 S.W. HALL BLVD.:'- RECEIVED
TIGARD, OR 97223
MAY 2 4 2001
IMPORTANT PERMIT NOTICE - ,w i,j,f,,,,,
�ml�u>rtN , ,
WILLAMETTE ELECTRIC INC r Don0-- a� /
PO BOX 230547
OR 97281
Electrical Signature Form
Permit #: MST2001 -00255
Date Issued: 5/18/01
— Parcel: 2S 12BD- 02200 — —
Site Address: 14955 SW 79TH AVE
Subdivision: DURHAM ACRES
Block: Lot: 044
Jurisdiction: TIG
Zoning: R
Remarks: 528 sq.ft. garage and a 50' x 3' breezeway
Your company has been indicated as the electrical contractor for the permit indicated above: In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
PRESTON, ROBERT J WILLAMETTE ELECTRIC INC
14955 SW 79TH AVE PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone #: Phone #: 624 - 3631
Reg #: uc 75059
SUP 1965S
ELE 34 -283C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X 4/
Signature of Sup-rvisi► ec rician
If you have any questions, please call (503) 639 -4171, ext. # 310
CITY OF BUILDING INSPECTION DIVISION
MST .0)
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested � D' AM PM BLD
Location / `f q S 7 _ Suite MEC
Contact Person }'Yl(�1�<— Ph 3i 2 S 7/5 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: v f�
Slab ! 7 -- `� - �L SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: / PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
•
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ) Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date / t o / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE ,this inspection record from the job site.
•
v
CITY OF TIGARD BUI DING INSPECTION DIVISION - MST 1'
24 -Hour Inspection Line: 75 Business Line: 639-4
i BUP
Date Requested 1 ( - 0 AM PM BLD
Location / `7 9 ) ,S - 6 ---- 7 9 - f4 MEC
Contact Person ir 0J\, , Ph 3 / a S 715 PLM
Contractor C ��>� � �- cv�i' ( l C.---- SWR
BUILDING Tenant/Owner r� 4-75 -2 ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing _
Insulation ,fa t I , ,
Drywall Nailing –_-=- : L2 1 C ii
Firewall - 7
Fire Sprinkler 61- -/ ; e / All i ti_ _ _ Fire Alarm /
Susp'd Ceiling / ',2 Cep
Roof GJ /�J — P . / . � r C�(�
Misc: / � �
Final � ? Z_VICJ/ C ._A • PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains G' fr) -- e2 7 - p
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In /
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL ` i
Service
Rough In
UG /Slab
Low Voltage
. Fire Alarm
PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk ,� � �
Other Date / C — ,i(2 -----0/ Inspector _ 41.1._---, • Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
X91 Y OF TIGARD LDING INSPECTION DIVISIC'
MST �J� iUaS S
24 -Hour Inspection Line• 4175 Business Line: 639 -4 r?1
BUP
Date Requested -// AM PM BLD
Location / (115 5 4-- 79'm Ay/ Suite MEC
Contact Person Ph £i 2 r 3 7 / PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling a
Roof ti ( e 1 r D 0 - �1 cY
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
TO Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post-& Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
C ELECT)
Service
Rough In �/
UG /Slab
Low Voltage '
Fi -
4 ' ART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: / [ ] Unable to inspect - no ac
ADA
Approach /Sidewalk Date / — / ! — l� Inspector ∎ 1 �� Ext I
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION, MST �-U
-24 -Hour Inspection Line: 6, 4175 Business Line: 639 -. .1
BUP
Date Requested 1 / — AM PM BLD
Location /9- ' ite MEC
Contact Person Ph — 347 , , S - 7/ LS PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing A/ E.--/7 6 LE, crpC4/ 4
Insulation
Drywall Nailing �� �� � y �Dr � O t-
Firewall
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling
Roof
Misc:.
S PART < 1--
. PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
• Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
. PASS .PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect no access
ADA
Approach /Sidewalk
Date
Other // 4 / Inspector Ext
Final
PASS PART FAIL DO. NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUP' DING INSPECTION DIVISION'
MST ® / d.5
24 -Hour Inspection Line: 63;, -175 Business Line: 639 -41 -r
BUP
Date Requested / / —� AM PM BLD
Location / L , �S 7 7' " Suite MEC
Contact Person ! Ph 3/ Z S 7 /c PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: f/4 LOS FPS
Foundation �7
Ftg Drain -5644, ✓'� - q 2 1JlS-
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING.
Post &Beam
Under Slab
Top Out
Water Service
San' - -wer
11
PART FAIL
'ANICAL
Post & Beam
•
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ . required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
1
Approach /Sidewalk
Other Date / / ' 6-0/ Inspector , n l / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
r...1 7--
_
CITY•OF TIGARD IVI.LDING INSPECTION DIVISIC MST
'l / u
24 Hour.lnspection Line: E 4175 Business Line: 639 - 4171
C BUP
Date Requested / - `� AM PM BLD
Location / 7 y 5) 5`'' 79 -A 4Z-A Suite MEC
--
Contact Person Ph 3 / Z 5 / PLM
Contractor Ph SWR
BUILDING Tenant/Owner pi/4 S! c4(d 1f, S ef � ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear _
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm J a
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL ! lr�
r� g'ai'n Beam go �IA�Qr o� / ` R / _ v�'i � ' w �v"-r�''.v‘ a /` t+�
OS Beam
Under Slab tv t ans -
Top Out
Water Service
Sanitary Sewer
41,M.Drairits
Final
PASS 4 FAIL
MECHANICAL
Post & Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date ®/ In spector 7 "J / 1, -��q Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1
CITY TIGARD BOLDING INSPECTION DIVISIC -
24 -Hour Inspection Line: E 4175 Business Line: 639-4171 MST D-06/ — 4:440
BUP
Date Requested 7 I AM L—PM BLD
Location / - 95 ` ��j / - J' � Suite MEC
Contact Person 0 CizJ1 Ph 3/ ---S') / ` S PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
, Ftg Drain
Crawl Drain Inspection Notes: M SGT
Slab F' < ' ` a'�'L�� SIT
Post & Beam
Ext Sheath /Shear vvv
Int Sheath /Shear
Framing / ��/�, _ 6N 6 , - 6 4c. ' ■C (Ai L `
Insulation
Drywall Nailing e 114 4. 'o d 2 4-25'0 () j= �to�,ct— ",(5 a / /se �
Firewall
Fire Sprinkler A-rig. r oNe a i' 04-•
Fire Alarm
. Susp'd Ceiling
Roof
Misc:
Fina
• FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line •
Smoke Dampers
Final •
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
. Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date g – Z Ll Q/ Inspector Ext
Final
PASS PART FAIL • DO NOT REMOVE this inspection record from the job site.
- OF TIGARD BUILDING INSPECTION DIVISIC •
24 - . Hour' Inspection Line: 6 4175 Business Line: 639-4171 MST G( Gtiv r Z��
BUP
-62p Date Requested 60/(4 AM PM BLD
Location 2 Ara Suite MEC
Contact Person Ph . 50— PLM
Contractor Ph SWR
(,BU G - Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT -
Post & Beam
Cif heath /Shea)
Int a h /Shear
a /. THE - ," ArPygA #4 /5 A/O Coy lAleGTev rP 'ME TOP PL »rE,
D ation 1 "E 5 , ∎ 5 MO5? $ E Nhlte0 10 THE TOP Pt . Re e. r 5 Ty,
Drywall Nailing . 4,
Fire Sp � 7D BLGIG,rr7
Fire Sprinkler d 5 � E Anal --e �E ,
Fire Alarm
Susp'd Ceiling C� N t� /1 G7.ifil- V741 f C- 6
Roof
Misc:
a
PASS PART 40217
•LUhi' NG
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL /
Post & Beam
Rough In V
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
. Service
Rough In
UG /Slab
Low Voltage
. Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date C9/157/ O,/ Inspector W 1A.) S7EA C7 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
`GI(OF TIGARD BUILDING INSPECTION DIVISIC r�
MST
24 -Hour Inspection Line: 6. 4175 Business Line: 639 -4171
BUP
Date Requested ) '' 3 b AM PM BLD
Location / 9) S Sw 7 f Suite MEC
—.-
Contact Person Ph J/ Z _ 5 5 PLM
Contractor Ph SWR
�,BUJJ nING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
oun FPS
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing - / /' S - i1 Lc AZ ao ', j• ' /9 S u... 1 44 so 4..4e1 - /oar
Insulation
Drywall Nailing 4= 47
Firewall
Fire Sprinkler •
Fire Alarm
Susp'd Ceilin•
Roof
Mis •
F' al
'A = PART FAIL
PLU BING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam - •
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
. UG /Slab
Low Voltage
Fire Alarm .
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Q — o / Inspector f
Date Ext
Other = 3
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
- -µ� Ci Y°OFi1GARD BUILDING INSPECTION DIVISIC'" MST
24-Hour Inspection Line: 6 4175 Business Line: 639 -4 . /1
BUP
Date Requested AM PM `/ BLD
Location / (f S) 5 `• J 7f 4e Suite MEC
Contact Person Ph 3( Z - 5 7 /O PLM
Contractor Ph SWR
UILDl Tenant/Owner ELC
Retaining Wall ELR
• iTrTSi
ndation
Access: FPS
• Ftg Drain SGN
Crawl Drain Inspection Notes: .
Slab . SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
-
Roof
Misc:
— PART FAIL
I ' BING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART . FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date ( Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
`1