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Permit F \ , ,� , CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00179 iliI DEVELOPMENT SERVICES DATE ISSUED: 6/24/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15070 SW 81ST AVE PARCEL: 2S112CB -12700 SUBDIVISION: PP1991 -017 ZONING: R - 4.5 BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: Placement of 1,760 sq ft manufactured home as addition to existing single family home. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 FIRST: 1,760 sf BASEMENT: sf LEFT: 5 - SMOKE DETECTORS: Y TYPE OF USE: SFM FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THR a sf RIGHT: 5 VALUE: 13 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 1,760 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: 100 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 - 200 amp: 0 0 - 200 amp: 1 W /SVC OR FDR: oc PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1 1st W/O SVC/FCR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,054.16 This permit is subject to the regulations contained in the CORBIN, GARY SAND TERRIE METRO HOMES INC Tigard Municipal Code, State of OR. Specialty Codes 13950 SW BONNIE BRAE COURT 31175 SW COUNTRY VIEW LP and all other applicable laws. All work will be done in BEAVERTON, OR 97005 WILSONVILLE, OR 97070 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: Phone: 694 - 2608 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 78182 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Underfloor insulation Shear Wall lnsp Electrical Final Footing Insp Crawl Drain /Backwater Exterior Sheathing Insi Plumb Final Foundation lnsp Electrical Service Insulation lnsp Final inspection MFG Home Footing SE Electrical Rough In Rain drain Insp Post/Beam Structural Framing Insp Water Line Insp Issued B : d4.1 ot.-/G Permittee Signature I/11r !„. Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b • siness day Building Permit Application FOR OFFICE USE ONLY Received Buildin D ate /By: Permit No.:,/i?Sretpc — LYE 171 Ci" of Ti and Planning Approval Other ,1 g Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: - Phone: 503- 639 -4171 Fax 503 -598 -1960 .. , ' " Post - Rev Land Use 61 Date/By: Case No. Internet: www.ci.tigard.or.us '` Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: , Supplemental Information ;'v".:: "' �: t' T . TYP.E .) _, h� ; y aS ay f A i t j .:X t.,� : '"t fk-A { S -1- Y 3 ...,... �,r�., � ,.,.+s . -... _ .., � r � h ° s ti a ' '. -,,t l" ` 1 D V r � LL'Q � [IIItED DAhTA t` - � ; �, , ❑ New construction ❑Demolition ; 0, x ?a: „ 1 & 2 F AMI L Y DWELLING . � , ,, , Addition/alteration /replacement ❑ Other: s , " ., , >..CATEGORY,OFF :CONSTRUCTION;.; ' r Note: Permit fees* are based on the total value of the work performed. Indicate 1 & 2- Family dwelling ❑ COnllriermialylndustrlal the value (rounded to the nearest dollar) of all equipment, materials, labor, Di overhead and profit for the work indicated on this application. Accessory Building ❑ Multi- Family III Master Builder ❑ Other: Valuation $ { • a s w ' .< 0B°SITE INFORIVIATIONiiind,LOCATION „ , c,; No. of bedrooms: No. of baths: Job site address: /5 SW j l �`'� g')5) /iv e 01� ' Total number of floors 5 New dwelling area (sq. ft.) Suite #: Bldg. /Apt.4: Garage /carport area (sq. ft.) • Project Name: Covered porch area (sq. ft.) Cross street/Direction to job site: Deck area (sq. ft.) t„/ail ajtd.. Koss Other structure area (sq ft.) l7, - 2_(.5 5 00,,,.:,t Res 4- 0 g/ 5 f co/ e �. � . - , .. a ;a. •'w § r * "x �y.r y 4 aZ t� , i3 - ' t �1 REQ -UIRED d DA " TA t f mg r ; gist ctrl cl �tr ,. . -* i , a COMMERCIAL ` US E`CHECICLIST ;, w ' S ubdivision: Lot #: a ._. .� -s» � � s: , � _ �• ,1 , .. U,x : r , t_c .a._ _ .. u _ . _ . Tax map /parcel #: 'Z S 1 / Z c:-.13 — (2. ? OC Note: Permit fees* are based on the total value of the work performed. Indicate ^ " t ._ '' 4 R r "' DESCRIPTION.,OF WORK ';`_`.... ° W i ., , . „ the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ✓ilautt-tcc s a►'ed k'(o`ke dt r ro-1 to Valuation $ • /. �✓tj �(� ` .Se Existing building area (sq. ft.) t sl New building area (sq. ft.) Number of stories I P..ROPERTY OWNER. ..i4 ' TEN 'ANV' i�. s, i . } ,~a' Type of construction . Name: G. r f .- s , � , Occupancy group(s): Existing: V New: Address: 1 5 0 70 6/5 r ii ✓ e_ City /State /Zip: f t ' ..I OK , 9 7 2 -Zv NOTICE: All contractors and subcontractors are required to be Phone: 5 zo 1 7 97 3 Fax: 03 (070 -- C)g� Z J licensed with the Oregon Construction Contractors Board under • t 'v 5 Fs '_.C ON T A CTP ER SO N' �• provisions of ORS 701 and may be required to be licensed in the Business Name: jurisdiction where work is being performed. If the applicant is exempt Contact Name: Garr 5, Goof from licensing, the following reason applies: , - Address: 15 7o 5i& ) 8575 /tve City /State /Zip: j t, g �r� c) c?--- Phone: 5 2_0 i -7? 7 3 Fax: 503 X70-0$9 Z. DING x : ,. , ' B LL U P iFEE ' * ivy ! t E-mail: ERMIT cS5 c b -t t/P� / ©'7 • 1e , P e a s e r fe t fe hedul , Business Name: Metr it-(o 0-2 eS 1 Fees due upon application $ Address: 31175 2(. C.,t.$ry Ili Le City /State /Zip: 1_0 fScit ttJ(r 470 ?D Amount received $ Phone: - D3 41.-/- 2./.60 Fax: 503 (05- Z S3 Date received: • CCB Lic. #: 7'/ L_ Authorized Notice: This permit application expires if a permit is not obtained within ` Signature: Date: 9Z—y/5)-r- 180 days after it has been accepted as complete, *Fee methodology set by Tri- County Building Industry Service Board. • (Please print name) is \Dsts \Permit Forms \BldgPermitApp.doc 01/03 Plumbing Permit Application FOR OFFICE USE ONLY Received Plumbing Date /By: Permit No.: City f Tigard Planning Approval Sewer y g aC Date /By: Permit No.: 13125 SW Hall Blvd. Plan Revi Other Tigard, Oregon 97223 Date /By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use Date /By: Case No.: Internet: www.ci.tigard.or.us ' Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503-639-4175 Name /Method: Supplemental Information. ' ' TYPE OF WORK .; : Y` . ,. . , . FEE *,SCHEDULE' (for special information use •checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) 1 Total ® Addition/alteration/replacement ❑ Other: N ew I y Sc., 2-family dwellings •: (includes 100`ft. each utility connect . .. I'', ' . CATEGORYOF.CONSTRUCTION., • SFR (l) bath 249.20 IR 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 Accessory Building ❑ Multi - Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 • JOB'SITE` INFORMATION and.LOCATION • , Fire sprinkler - sq. ft.: Page 2 _ . Job site address: )So ?o 50 8 ( 5t e , rt � ! o ,,, '- 'Site^Utilities. , Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Drywell /leach line /trench drain 16.60 Footing drain (no. linear ft.) . Page 2 Cross street/Dire to job site: Manufactured home utilities '110.00 ' l co Act t 1'eof �� n 5 �- Manholes 16.60 00W 1•1 Ye 0;5 Rain drain connector 16.60 915t ex qa I o$S Sanitary sewer (no. linear ft.) Page 2 • Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: 5 11 2 cl3 " [ 2 Water service (no. linear ft.) Page 2 DESCRIPTION OF WORK."' °.', Fixture or.Item . �! Absorption valve 16.60 cOnV1ec r � try, - cS sew' '-" tocdt ✓ .4.4 J oi t's•.-tS Backflow preventer Page 2 f O (1a..r1.1c$Ir,.v`�ct fr t? 4S A 4't ckciel tt o 1 Backwater valve 16.60 7n -PX t 5 Ir � h o i.1,$ e Clothes washer 16.60 l Dishwasher 16.60 Drinking fountain 16.60 kg:PROPERTY OWNER •. '. �1 '0 TENANT,- - . . • Ejectors /sump 16.60 Name: G i 5, C r b r ti Expansion tank 16.60 Address: )5(:)20 St) 910 /hie Fixture /sewer cap 16.60 City /State /Zip: w c�v- e5J2 ci ? ZZ�/ Floor drain/floor sink/hub 16.60 ) Garbage disposal 16.60 Phone: go3 201- 7173 Fax: 9o3 6,70-08r2- Hose bib 16.60 :.'APPLICANT . • • ❑ CONTACT PERSON' Ice maker 16.60 Name: G,y 5, e,,rbl h Interceptor /grease trap 16.60 Address: 15o 7o Sl $1sf d'tle Medical gas - value: $ Page 2 City /State /Zip: 734 r 972 Z Primer 16.60 Roof drain (commercial) 16.60 Phone: 5b> Zo/ -79 73 Fax: 5 C7O O 1 "t Sink/basin/lavatory 16.60 E -mail: qqc. -b,.. @ Ver t z e t , 4e/ Tub /shower /shower pan 16.60 'CONTRACTOR • Urinal 16.60 Business Name: • 0 u ' f. Y2 Water closet 16.60 Water heater 16.60 Address: Other: . City /State /Zip: Other: Phone: Fax: ':•,' Plumbing Permit'Fees * : , . . • Subtotal $ j/ O °' • CCB Lic. #: Plumb. Lic. #: Minimum Permit Fee $72.50 $ Authorized r % f ` 6 /zy� Residential Backflow Minimum Fee $36.25 a Signature: . Date: Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ <3 U (Please print name) TOTAL PERMIT FEE S Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri- County Building Industry Service Board. is \Dsts \Permit Forms \PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: 'Residential Fire Suppression Systems: ; Site Utilities Qt Fee:(Ca) '`Total S ware Footage: Permit Fee: Footing drain 1' 100' 55.00 0 to 2,000 $115 ".00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 • Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' f 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 otal additional $100.00 or fraction thereof, to and =.Fixture or, Item i';. Qty _Fee (ea), , .T, . 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 specially requested inspections - per hour 72.50 and including $50,000.00. 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. • Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. `i `Quantity by'(Fixtu�e) Work;P.erformed+ Comments regarding fixture work: Ftxture�'Type '�, v: a Replace,` d 4■e■ Moved = Ezlstiog- capped: • - Baptistry/Font Bath -Tub /Shower • - Jacuzzi /Whirlpool - Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator - Dishwasher - Commercial _ - Domestic Drinking Fountain - Eye Wash _ Floor Drain/sink - 2" 3" • - -4 „ Car Wash Drain Garbage Domestic '`Note: If the fixture work under this permit results in an Disposal - Commercial increase of sewer EDUs, a sewer permit will-be issued and - Industrial !fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial • - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: is \Dsts \Permit Forms \PlmPermitAppPg2.doc 01/03 CCGE Electrical Permit Applic o'n FOR OFI'I(•I LSE ()Nil' City of Tigard N ` 1 100 Received D ,/ Permit No.: ` j 1 fl - oar ?9 13125 SW Hall Blvd., Tigard, OR 97223 P a n Re 7 b Ja Plan Review Phone: 503.639.4171 Fax: 503.598.1960 P ~' • , � C; Other Permit: - CIG rif t''• Date/By: inspection Line: 501639.4175 VT DI , - ' A i Date Ready/By: hob: El See Page 2 for Internet: www.ci.tigard.or.us B UILDING Notified/Method: Supplemeatal Information '7� . i +1 �'SeF u �`n y .'' - .ut5tia c� r , "r rrr . { .� + r . ' g >.t r: { 5 u3+ l'•'••1: / ' �5 .. 'll 3 s . { • `i-'# E Eo 4FE3t= ?i _. 9 b 1 i �f ri` ik ; e _ g Ftl:i' >r si. r r P r r .. "� ... x ; :''I•.'''c -�rl; ] � '•[j ,. t.. -'.- • New construction ► i 'Addition/alteration /replacement 'lease check'alt that apply: ❑ Other' IN Service over 225 amps, comm' I ❑Hazardous location El Demolition II Service over 320 amps - rating ❑Buildng over 10,000 sq. 11., , :-= I,�N ' enrc i {t f F t�t I . 771. 9.,•. 6 . 7 r i � 1 . 1 �. ' 41. t • x71 I :.': t `s.. r,. . i,.,:, r,�s,t .. x .. • I .._, ,. ,,... -r • , ,74 ..k .,.. ,. "a 'i ko • a •• , 1 .:,.t of 1 -and 2- family dwellings 4 or more new residential i I - and 2- family dwelling ❑ Commercial /industrial 0 Accessory building u System over 600 volts nominal units in one structure Multi family El Master builder II Building over three stories ❑Feeders, 400 amps or more ❑ Other: .14, ;oi:: ac `�`M ?� yAf Y {tr { p�.q' ' ^f, v t s: , , 1111 Occupant load over 99 persons OManufactured structures or L ,i v.: 7 . [.r'. \ Lt ( '}17ft.(11. ; f' .' ' i; . : ;; . 1 44 .0:i: x lkf- 4 •';., . ark y r t, r I a ,,.4 u � i� PIV kn s' �' i, • t Ig Egress/lighting plan RV part Job no.: q , e Job site address: 5(.. -To sIU S!5.^r II Health -care facility ❑Other: � submit _L sets of plane with any of the above. City /State /ZIP: 1i (1 f l "f'0 t [ l9' ., e above are not applicable to temporary construction service. Suite/bldg./apt. no.: J Project name: ;1: _ ..li�ia''•r`r stl`ki IT IS b: L•l.nfM1. •exemption Qty. Fee. Total Cross street /directions to job site: ew residential single- or multi- family dwelling unit. I eludes attached garage. 1 000 sq. ft. or less 145.15 4 Subdivision: I Lot no.: z :. add'! 500 sq. R. or portion 33.40 1 Tax map /parcel no.: irnited energy, residential 75.00 2 a E 1p, wFq 3 nrar+./ : t , r� GYr i r t r r. 'mired energy, non-residential 75.00 2 ,.. :.. ''x "hlf= i . 1 5 /4, 2, tisNAilt / � • u '� y :zht..Lif. . t • }\ � 1 ,. r F ' t , each manufactured or modular �("51 �� _ n � d Iling, service and/or feeder 90.90 2 - 1 1 . lei, . . 'ErRvICC S rvlces or feeders installation, alteration, and /or relocation (I) AMP aJe, CAS 4u/ PD2 a- (,t) &. a/44047 5 210 amps or less V[,, 80.30 �. U 2 , ,.. , r #o ?: rF •,-.M.: t ,h,: L ll i ES `ia-f lr ,R» t R� 1 , ° 21 1 amps to 400 amps ' / 106.85 2 • . s v • rt y , t ,u ,., u+ T 1:x42{ P'LCA4i � a A �y , t 411 amps to 600 amps 160.60 2 Name: G-i CT i"�� co � , 1 V 611 amps to 1,000 amps 240.60 2 Address: Mbl D 5tIN eti 1 6 ever 1,000 amps or volts 454.65 2 ■ onnect only 66.85 2 City /State /ZIP: 11 1,,A fi � 012 • • mporary services or feeders installation, alteration, and /or Phone: ( ) I Fax: ( ) r ocadon 240 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 600 amps 1 i 133.75 2 Owner signature: Date ,,� ) �J l� Branch circuits- new, alteration, or extension per anal a t a i 9E t1E / � p yFi it t `infIL r y�� fig? '+3 j � r rti v. P P r..�.; r b�'.., t u, :. I ��u,,iu�..Es .� " n i r' lI� • �s %$�tiwi' �� Iti,� 93ia�'�a":�r��,�s - i tielil u r�' A . Fe for branch circu with service or feeder fee, eac 6.65 2 Business name: I branch circuit Contact name: BI Fee for branch circuits without service or feeder fee, 46.85 2 Address: I each branch circuit Each add'1 branch circuit 6.65 2 City /State/ZIP: M iscellaneous (service or feeder not included) Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2 Si or outline lighting 53.40 2 E -mail: , ��: ,y;:, ...:� ... �...... _ T & T EIectrical LLC Si al circuit(s) or limited - •. -, _ : `•.,�. tza €� " i ' , .:�a��; efgy Panel, alteration, or Business name: 4120 SE International Wa y tension. Describe: Page 2 2 Suite A - 105 Address: Mitwaulae, OR 97222 Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZIP: In estigation per hour (I hr min) 62.50 Phone (5 O , ) L 52' 1 lo IO I Fax: (5) ea (pi 2.. In. 4,1 .1: r r . r 73.75 V. nYn:,>.• -; by IMliFIL�eid CCB Lie.: ISo 1 , I Electrical Lic.: 2i4, iip6c1 Suprv, Lic.: /1.1 b 1 S g' Subtotal Suprv. Electrician signature, required: (� �'►��1i /� Plan review (25% of permit fee) Print name: T ,lift A. K LI m ,1 7 V � , ' � � r �i D a t e: a� /' � Stale surcharge (8% of permit fee) 1 I f �1 ^ I 7 ' 6 TOTAL PERMIT FEE Q Authorized signature: 7 {d� 1 This permit application expires if a permit It not obtained within ISO Print name: �i� i` •• Dam: Lji/ / / I days after 11 has been accepted as complete l� IFee methodology set by Tri County Building Industry Service Board " INumber of inspections per permit allowed. i:' Building \PermitaLC- PermitApp.doc 12107 4d( 4615T(10/02 /COM/WEB 1 1 I i t ' c l 2 I 9LZS3EOS 0 11:131N133 111 2 : t , T tr00Z L T '- C Manufactured Dwelling OFFICE USE ONLY Permit Application , ` ��� �� Date receive t , a� Permit no.: 1 l�Jf�/�177 .4,14 M � �� � City of Tigard � ' Project/appl. no.: Expire date: City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 pp'' O ')004 Date issued: By: Receipt no.: 98 Phone: (503) 639 -4171, Fax: (503) 54700 L i.tigard.or. Case file no.: Payment type: Internet address: www.c �`ITY O F TIGARD Health dept.: DEQ: Land use approval: Bull LING DIVISIOh+ TYPE OF PERMIT ❑ Owner installed g Contractor installed ❑ Repair ❑ New ❑ Addition/alteration ❑ Replacement: Same location ❑ Yes ❑ No JOB SITE INFORMATION Job address: ►5070 5w gist- y iv e Space no.: Manufactured dwelling park: Address: City: --' e c State: N . ZIP: Ct 7z-zy Tax map /tax lot no. /account no.: 7, S I ( . Glf3 — l2Too Lot I Block: Subdivision: Base flood elevation: p t Elevation certificate: Descripti n of work on premises: 52 to 0,4 ad Wn n etAUS:.ctt,i reek t N.te ow c C A. � H 'tb S t , e x 15�',:t he tSL' • OWNER MANUFACTURED HOME INFORMATION Name: Go.,✓ S S. ( .,, Address: i 5-050 s co l'j 5f - /like_ Concrete stringers /slab under home: A Yes ❑ No . City: r, q ,al I State: O)Q I ZIP: q 7 ZZy ❑ Single g Double ❑Triple • Phone: s-o 3_301-797 31 Fax:5E3 67 o p9:IZE -mail: Owner representative: Valuation $ • 3 ) 247 Square feet 17 60 Phone: Fax: E -mail: (dwelling and set up only, does not include other permits) SET UP /INSTALLATION CONTRACTOR ADDITIONAL PERMITS (if required) Name: SSrt -tautit Hoe — 3&SoH i L%. 1 ( ❑ Mechanical Permit no.: Address: /600 :VA A (Ia.' t fiiie ❑ plumbing Permit no.: City: LJoactlos.cev1 I State: (A I ZIP: 9 70'7/ Phone: 03 5 `i g( - yq y yI Fax: ( E -mail: ❑ Electrical Permit no.: CCB license no.: TA - kv 'City/Metro license no.: ❑ Foundation Permit no.: MDI license no.: /?D. /65'. ❑Garage Permit no.: SKIRTING CONTRACTOR ❑ Carport Permit no.: Name: /iefro HO"eS Tri C- ❑ Cabana Permit no.: Address: 31/75 5 Country V) eu) E-p. City: 1 fo „ iU[ I/Q I State: OR I ZIP: Vag) ❑ Ramada . Permit no.: Contact person: M 4 ) h ( ft. I Phone: 503 61 .9 — tog ❑ Awning Permit no.: CCB license no.: 7 $'(s Z City /Metro license no.: ❑Alterations Permit no.: Skirting license no.: MDULSI license no.: +147-MI71 APPLICANT ❑ Other Permit no.: Name: 6: , 5, cog • Notice: Manufactured dwelling installers must have an Oregon Address: Y !S'070 5W w/ / /� ✓P ` MDI and Construction Contractors Board license under provi- City: ri Q ,, Stater° ZIP: R ? LZ / sions of ORS 701 and may be required to be licensed in the Phone: 52 3 Z ,,t _ 5 Fax:$7,3 670 D Sht E -mail: jurisdiction where work is being performed, or the appliant is I hereby certify I have read and examined this application and know the same exempt from licensing for the following reason: to be true and correct. All provisions of laws and ordinances governing this type of ork will be complied with whether specified herein or not.. S /z6 / O pplicant's signature Date Set up fee $ State surcharge $ Notice: This permit application expires if a permit is not obtained within State fee $ 180 days after it has been accepted as complete. TOTAL $ 440 -4624 (8/00 /COM) Permit #: WLST a-c / -- 6197 7-F ( :-45 �F „ t Address: iS ` O 0 5 91ST - 4 `'' ""T 24 Date: °�`d97° ,.. 89� Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: p - A 1. I own, reside in, or will reside in the completed structure. ri 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. F 3A. My general contractor is PiP / 140 v'5 .Z C— ' 7 fir 1 Y a- (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Proper y wners a ut Construction Responsibilities on the reverse side of this form. r (S gnature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) • Ifidormetoui Go occe ©Props y O® To ,Note.-. This Information Notice to Property Owners about Construction Responsibilities ' developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contracto to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLO FF R RE POvSOBEL E If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in nose instances, be rulcd to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax law: As an e.mployer, you must withhod income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945 -8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Em 3loyment Division at the Department of Human Resources at 378 -3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of) our employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Co:isumer and Business Services at 945 -7888. U.S. Ilnternai Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tr x. For more information, call the Internal Revenue Service at 1- 800 - 829 -1040. OTHER RESPOlS0 3lLlTlC S AND AREAS OF CC©ICERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accident3 and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052, 503/378 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop- own .pm4 1 /94 Jury 7. 2004 10 :18AM' CLEAN WATER SERVICES 503 69144:39 Nc 17'�� �i F. 1 v iu� O11 I li, 1:C.'"' „ J ., \I Li ." (1,' F il e Nu mber r" ---7'33)(1 ; , CearnWate Services l MAY z s zoo4 �� S puc cammihrnenl is clear. Sensitive Area Pre creening Site Assessment Jurisdiction CA), CY `kG, -) Date — C Map & Tax Lot 25112e is i Z vo Owner G� C -0 -b Site Address i Sn 1t Sys S(41 /hie. j 1e C r i w T,�rs�,�.� O' 572ZY Contact I sb o Su.) 1 f 4, e Proposed Activity �a ,r, �, � T ecrs 1 Address vi e-d OR. 1722-V ? a s p rtz.k, ReSpd..qe it Phone ';oS Zo - ?F 7 3 a:. PoScbiE �i¢X a3 la7o -d8gz, - Official use only below this rine `— Y N NA Y N NA 0 el ❑ Sensitive Area Composite Map ❑ D Stormwat infrastructure maps Map # ZS t 0 ./.°4 QS* 1 /62. 0 ❑ © Local( adopted studies or maps ❑ ❑ Other U Specify Specify Based on a review of the above information and the requirements of Clean Water • Services Design and Construction Standards Resolution and Order No. 04 -9: ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Asaessrnent Report may also be required. Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect Water quality sensitive areas If they are subsequently discovered on your property, NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ri The proposed activity does not meet the definition of development, NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: Reviewed By: Date: Returned to Applicant Mai! JG Cuurrler Date - $��i -�- %• 2550 SW Hillsboro Highway a Hillsboro, Oiegon 07123 Phono: (503) 661.3645 • Far: (503) 601-4439 • www.eleanwntorserviv qr RECE IV E D J 0 8 2004 CIT OF TIG A R D BUILDING DIVISION CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST °C 6/" O ( 2_ INSPECTION DIVISION Business Lire: (503) 639 -4171 - a. BUP Received Date Requested f� - - 1 l AM PM BUP Location / "D 7 0 3I 2- _ Suite _ MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/0'r -_:;.dP > ' a��9n 1,- . --- ELC Footing M[::�, =.4v.a ..il,:i = Foundation ELC Access: Ftg Drain - ELR N Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors 1wQ:� _ ., - Ext Sheath/Shear Int Sheath/Shear / "� _ 4. } scs. v,e t ` ► rc . ss. d:.i ., 1/ Framing Insulation O l a I I d Drywall Nailing ' " 1 `t" '��� / ��� / ��" �� Firewall LOLO, /14-09--<± 4. 2, Y-40 - , J `1 C Fire Sprinkler Fire Alarm l Susp'd Ceiling �'6`� � �� 1 - J D14.1-\10\-1 ,, I Roof &;' \1c \���� PN 0 VV Ot er: ( A - .PART FAIL ^� 1 1 , ( I PL ' BI , 1 �C �e :;o* Y� " ('A��`'1 )-11 1—L kAdriQ Post & Under Slabm RD D \'1 G ( i -� .NQs I Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan 4 6 0 1-r: c.... (---.- • , RT FAIL ANICAL 1� Post & Beam �°� Rough -In Gas Line Smoke Dampers Final PASS _ PART FAIL L Service Rough -In UG /Slab Low Voltage Fire • larm ► ="�' Ei Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. '• PART FAIL SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line / / ADA /4, Q Approach/Sidewalk Dat ! r Inspect � = i� Ext Other: Final DO NOT REMOVE this inspection record from he job site. PASS PART FAIL .A l /', / -