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Permit MASTER PERMIT ,097 = --- 11-7-t------ Air, • . CI TY OF Ti A R D PERMIT #: MST2003 -00131 w , DEVELOPMENT SERVICES DATE ISSUED: 4/28/2003 . 13126 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 , SITE ADDRESS: 11220 SW 82ND AVE PARCEL: 1S136CB-02200 SUBDIVISION: RANCH VALLEY ZONING: R - 4.5. BLOCK: LOT: 093 JURISDICTION: TIG REMARKS: Adding 440 SF to existing house. 0/05,, PERMIT FOR 30 DAYS. . BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD • HEIGHT: 12 FIRST: 440 sf BASEMENT: sf .LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf - GARAGE: sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf 'RIGHT: 5 VALUE: • 4065600 OCCUPANCY GRP: R3 BDRM: BATH: , . TOTAL: 440 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: • TRAPS: LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: 'SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIX TURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: • VENT FANS: 2 CLOTHES DRYER: '. FURN > =100K: • • UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: . ELECTRICAL ' RESIDENTIAL UNIT ' SERVICE FEEDER TEMP SRVC /FEEDERS ' BRANCH CIRCUITS MISCELLANEOUS ADD 'L INSPECTIONS 1000 SF OR LESS: 0 - 200amp: 0 - 200amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: . EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR: _, { .. LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1.00 • SIGNAL/PANEL: IN PLANT: ' MANU HM /SVC /FDR: 601 -1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : ' • PLAN REVIEW SECTION Reconnect only: » 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: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: . GARAGE OPENER: CLOCK: INSTRUMENTATION: - MEDICAL: OTHR: HVAC: • DATA/TELE COMM: NURSE CALLS: TOTAL #SYSTEMS: Miner Contractor: TOTAL FEES: $ 1,166.28 This permit is subject to the regulations contained in the BRYAN S. HADDIX OWNER Tigard Municipal Code, State of OR. Specialty Codes and 11220 SW 82ND AVE • all other applicable laws. All work will be done in TIGARD, OR 97223 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: 503- 684 -2697 Phone: 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 Reg #: . obtain copies of these rules or direct questions to OUNC by • ca lling (503) 246 -1987. REQUIRED ITEMS AND REPORTS . Footing lnsp Crawl Drain /Backwater Electrical Rough In' . Low. Voltage Electrical Final Foundation lnsp PLM /Underfloor Framing Insp - Insulation lnsp Mechanical Final • Post/Beam Structural Mechanical Insp Framing Insp Insulation lnsp • Plumb Final Post/Beam Mechanical Plumb Top Out Shear Wall Insp Insulation Insp Final inspection Underfloor insulation Electrical Rough In Exterior Sheathing Insp Rain drain Insp . Issued y : 1�____- Permittee Signature f / /./ • - Call (503) 639 -4175 by 7:00 p.m. for an inspection needed th : next business day I , ` ::T:: 03OO131 CITY O F T I GA R D 1,i DEVELOPMENT SERVICES DATE ISSUED: 4/28/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 11220 SW 82ND AVE PARCEL: 1S136CB -02200 SUBDIVISION: RANCH VALLEY ZONING: R - 4.5 BLOCK: LOT: 003 JURISDICTION: TIG REMARKS: Adding 440 SF to existing house. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 FIRST: 440 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD. sf RIGHT: 5 VALUE: 40,656.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 440 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 2 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 2 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 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 1.00 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: $ 1,041.28 This permit is subject to the regulations contained in the HADDIX, BRYAN S OWNER Tigard Municipal Code, State of OR. Specialty Codes and 11220 SW 82ND AVE all other applicable laws. All work will be done in TIGARD, OR 97223 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: Oregon law requires you to follow rules adopted by the Phone: Phone: Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Framing Insp Electrical Final Foundation lnsp PLM /Underfloor Shear Wall lnsp Mechanical Final Post/Beam Structural Mechanical Insp Exterior Sheathing Insi Plumb Final Post/Bea v' .• nical Plumb Top Out Insulation Insp Final inspection Und- oor insulation Electrical Rough In Rain drain lnsp : , V R� u�� 1 /A / Iss d By : , ' '�� ' i 1 _ �. L 1 . Permittee Signaturef- .� � % � - 4. — Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne business day /O 1'r5 a Building Permit Application r FOR OFFICE USE ONLY Received y/ Building � RECEIVE DateBy: f j�/ 3 �� Permit No.y,�G /�V3 '0 /a/ City of Ti and D Planning Appr Other y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 APR 0 2 2003 Date /By: Permit No.: Phone: 503- 639 -4171 F +? 1 ,� \i Post- Review Land Use TI !., - � � � Date /By: y /ZS /O3 Case No. Internet: www.ci.tigard.or. '' nJ Contact Juris.: ® See Page 2 for 24 -hour Inspection Request D3'=6 PJIYISION Name/Method: V-PMIL- . Supplemental Information i & – og TYPE OF WORK . REQUIRED DATA: ❑ New construction ❑ Demolition • 1 & 2 FAMILY DWELLING ® Addition/alteration/replacement ❑ Other: • • CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate © I & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family ❑ Master Builder ❑ Other: Valuation $ 4 /19 / 6. oa JOB SITE INFORMATION and LOCATION . No. of bedrooms: No. of baths: Job site address: D Total number of floors 1 220 .� 82 Avg_ New dwelling area (sq. ft.) 4410., 91R Pr Suite. #: Bldg. /Apt. #: Garage/carport area (sq. ft.) Project Name: H INPO I)) Covered porch area (sq. ft.) Cross street/Directions to job site: yo Noc 13auM D Deck area (sq. ft.) 014 HALL Tb PRAFFLL Go RIUNT76 oxi to Other structure area (sq. ft.) • Si PE. or Rono, (c' 17a1.0• 82"tn To rH 1fOa Do-I . "MX PICOT l 1220 OW 51Na REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: QA u d..I-4 VALLEY Lot #: 3 Tax map /parcel #: /5/36,C8 "�o2 00 Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, . overhead and profit for the work indicated on this application. kip(' i - ri o hi Dr X TA ItS — r.R SErl d- I3Pl7 4 Tb $C CLATAgaR or ausnivA 14ouSE. Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories a PROPERTY OWNER I ❑ TENANT Type of construction - Name: ORVA u H A D DI X Occupancy group(s): Existing: New: Address: 11220 su..) C2ND Av. City /State /Zip: Tt6A RD DR (71223 Phone: (503) 6234-26:R7 Fax: NOTICE: All contractors and subcontractors are required to be ❑ APPLICANT ❑CONTACT PERSON licensed with the Oregon Construction Contractors Board under 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: from licensing, the following reason applies: Address: �y- City /State /Zip: . Phone: Fax: . .. BUILDING PERMIT FEES* - : E -mail: • Please refer to fee schedule. CONTRACTOR Business Name: F WIZ l x T I LL OF Fees due upon application $ Address: - 11l k1 C©xirRA c roK City /State /Zip: Amount received $ Phone: Fax: Date received: CCB Lic. #: Authorized + Notice: This permit application expires if a permit is not obtained within J Signature: / i �J1 / /. /, /a/. Date: 4 // 180 days after it has been accepted as complete. VA1' 5 r /-A A0170( *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms\BldgPermitApp.doc 01/03 1 , , , One- and Two - Family Dwelling ; Building Permit Application Checklist Reference no.: ryofTigard Associated permits: City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ 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 reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. R 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 Erosio 1 • ' 1 1 ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch -basin protec ;on, etc. ' 10 3 Complet ets of legible plans. Must be drawn to scale, showing conformance to applicable local and state buildi e:'l Lateral design details and connections must be incorporated into the plans or on a separate full -size .hed to the plans with cross references between plan location and details. Plan review cannot be completed i copyrigh ''olations exist. ' Sit�e/plot p : ; drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if '1. - ' - ore 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); I s; utility locations; direction indicator;ir• acaa; impeuzicus•a existing structures on site; afiel-stiffase4saimage, 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists • over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS 23 F lans are required for Item 11 above. Site plans m st be 8 -1/2" x 11" or 11" x 17 ". 24 Two sets each are required for Items 16, 19, 20 & 22 above. —'/-- 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List. 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 (6/00 /COM) Elec Permit Application FOR OFFICE USE ONLY • a R ece i ve d E lectrical Date/By: Permit No./ V — 0 City f Ti and Planning Approval Sign y 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- Review Land Use Sat Ilahle I ,I Date /By: Case No.: Internet: www.ci.tigard.or.us e . ' Contac Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental. Information. TYPE OF WORK - _. PLAN REVIEW (Please check all that apply) • ❑ New construction , ❑ Demolition ❑ Service over 225 amps- - ❑ Health -care facility commercia ❑ Hazardous location Addition/alteration/replacement ❑Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet, CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in . ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park • ❑ Master Builder ❑ Other: ❑ Egress/lighting plan - ❑ Other: • JOB; SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above: The above are not applicable to temporary construction service. Job site address: 11220 $u.) 432ND R vg , - FEE* SCHEDULE ° - Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: .4 A (]l7 )X Description Qty Fee (ea.) Total New residential- single or multi- family per 1 Cross street/Directions to job site: dwelling unit. Includes attached garage. Service included: . - 1000 sq. ft. or less 14515 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Lot # Limited energy, residential 75.00 2 Subdivision: : Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90 :90 2 Services or feeders - installation, - alteration or relocation: • ' 200 amps or less 80.30 2 • 201 amps to 400 amps 106.85 2 • 401 amps to 600 amps - 160.60 2 El:PROPERTY OWNER I ❑ TENANT • 601 amps to 1000 amps • 240.60 2 Over 1000 amps or volts 454.65 .2 Name: IjgYAN 1-1 A ODI - Reconnect only 66.85 - 2 Address: 1122o sty 82N AVE. Temporary services or feeders - installation, . alteration,-or relocation: City /State /Zip: -r7 A RD OR . c37223 ~ 200 amps or less 66.85 _ ' 1 Fax: 201 amps to 400 amps 100.30 2 Phone��a3)' �p$�} 2�G7 401 to 600 amps 133.75 2 ❑ APPLICANT ° . . El CONTACT PERSON • • Branch circuits - new, alteration, or Name: extension per panel: - A. Fee for branch circuits with purchase of Address: _ service or feeder fee, each branch circuit - 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 1 2 Phone: Fax: - Each additional branch circuit 6.65 l 2 E -mail: Misc.(Service or feeder not included): CONTRACTOR Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: • . Signal circuit(s) or a limited energy panel, • . • alteration, or extension Page 2 2 Business Name: , Doi,,) J R WI L/_ 8 E - Description: Address: T'-y e1/2N I'?ZAC K_ - . Each additional inspection over the allowable in any of the above: City /State /Zip: Per inspection per hour (min. I hour) 62.50 • Phone: Fax: . Investigation-fee: Other: CCB Lic. #: Lic. #: Electrical- Permit Fees* - . Supervising electrician Subtotal $ 52, 5t7 signature required: • Plan Review (25% of Permit Fee) $ Print Name: Lic. #: - State Surcharge (8% of Permit Fee) $ . TOTAL PERMIT FEE $ Authorized - Notice: This permit application expires if a permit is not obtained within Signature: is - =�J // 74,/,La Date: 4 / / / t3 . 180 days after it has been accepted as complete. . *Fee methodology set.by.Tri -County Building Industry Service Board. 113q 4 AJ s, I- (Please print name) - - i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03 , • Electrical Permit Application •- City of Tigard-:., Page-2 - Supplemental Information _ LIMITEDSEN PERMI F _ • RESIDENTIAL WORK ONLY Fee for all systems -' • $75.00. Check Type of Work Involved: • • - _ - r n ' _ Audio and Stereo Systems - , . , • El Burglar Alarm; D . ' Garage Door Opener *. _ .. ` I I ' Heating Ventilation and Air Conditioning System t • � Vacuum Systems • Other COMMERCIAL WORK ONLY Fee for each', system $75.00,' (SEE OAR 918- 260 -260) :. _ ' Check Type of Work Involved:' " 7 _ • 0 A udio and Stereo Systems 0 -Boiler Controls '. .. , - . , ontrols , n Clock Systems - - . ❑ Data. Telecommunication Installation ; 0 Fire Alarin•nstallation • ' • , ❑ HVAC • -, ri Instrumentation V ❑ Intercom and.Paging Systems . . - Landscape Irrigation Control - ; ' e Medical - _ Nurse Calls` � • Outdoor Landscape Lighting • - ' n Protective Signaling 1 ' n Other `- . - Number of Systems * No licenses; are required, Licenses are required for all - ' other installations , - • ' t , i:\ Dst s\ PermitForms\ElcPermitAppPg2.doe 91/03 - Mechanical Permit Application ' FOR OFFICE USE ONLY eceve Mechanical Date/By: Permit No.: 1sT- 3n/y3— 00 /''/ City of Tigard Planning Approval Building g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 A Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use # Vi Internet: www.ci.tigard.or.us , Date/By: Case No.: Contact Juris.: ® See Page 2 for 24 - hour Inspection Request: 503 639 - 4175 ` ""° '' Name/Method: Supplemental Information. .TYPE OF WORK COMMERCIAL FEE* SCHEDULE - .USE CHECKLIST _.'; u, ; , ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work • © Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit. Ni 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family z, RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description I Qty I Fee(ea) I Total ❑ Master Builder ❑ Other: - Heating/Cooling • JOB SITE INFORMATION and LOCATION - Furnace - add - air conditioning ** 14.00 Job site address: I 1220 5 raw Ada- . Gas heat pump . 14.00 'Suite #: 1 Bldg. /Apt. #: Duct work 14.00 Project Name: {a DP) x Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: Go MORTI 4 0 A! . (for radiator or hydronic system) ' 14.00 14 A1-1..- Fgefl W To prw7;t.c.. TNJ g DIJ Unit heaters (fuel, not electric) • PHA'r•Ft� to .62N 0E,P 7Th- /togs (in wall, in -duct, suspended, etc.) • 14.00 patv,1! ON Rrt or I5 /1920 5u) 5 AP' -4 Flue /vent (for any of above) - 10:00 Subdivision: A UM IJAr�EV Lot #: 3 Repair units 12.15 R Other Fuel Appliances . -. • Tax map /parcel. #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 Aoo / r/oar ep i10a -Imo_ iWEn 4- 13A -f7-1 Flue vent (water heater /gas fireplace) 10.00 _ Log lighter (gas) 10.00 l 'S� eiNgV �Eg. )s— i-)Ini5 - Wood/Pellet stove 10.00 ' Wood fireplace /insert • 10.00 ' Chimney/liner /flue /vent 10.00 ® PROPERTY OWNER 1 1 ❑ TENANT - Other: ' 10.00 Name: gRypill 1-{A00 Environmental Exhaust & Ventilation ) Range h ood/other kitchen equipment • 10.00 Address: ;11•22c 51,0 R'2A HO, Clothes dryer exhaust 10.00 ' • City /State /Zip: T7i 4RD 1 9R. ( 31 2 . 23 Single duct exhaust Phone:6193) A54 - ZR 1 Fax: (bathrooms, toilet compartments, ❑ APPLICANT ❑ CONTACT PERSON . utility rooms) 6.80 Name: Attic /crawl space fans 10.00 Other: 10.00 Address: Fuel Piping City/State/Zip: • * *($5.40 for first 4, $1.00 each additional) • Phone: I Fax: Furnace, etc. ** Gas heat pump ** • E-mail: ** Wa lUsuspended/unit heater - CONTRACTOR Water heater ** - Business Name: Q r- 1 N R iU /1 . Fireplace ** Range ** Address: f rZ 77f (�t�/U/ e_T iK BBQ ** City /State /Zip: Clothes dryer (gas) ** Phone: Fax: • Other: - - ** CCB Lie. #: Total: Mechanical Permit Fees* Authorized ' j 3 Subtotal: $ • Signature: .A.r■v /i iv Date: 4 Minimum Permit Fee $72.50 $ - /diti J am- ', App p Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: ' This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit For s\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard. Page 2 - Supplemental Information, Commercial Fee Schedule: • Total Valuation:. Permit Fee: ,- . . $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 , • $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction . thereof, to and including $10,000.00. . $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and , $1.54 for each additional $100.00 or fraction thereof, to and including , $25,000.00. • $25,001.00 to $50,000.00 • $379.50 for the first $25,000.00 and , $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. . $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or • fraction thereof. - Assumed Valuations Per Appliance: , Value Total • Description: Qty (Ea) Amount , • Furnace to 100,000 BTU, including • 955 ducts & vents - ' Furnace > 100,000 BTU including ducts 1,170 • & vents Floor furnace including vent 955 • Suspended heater, wall heater or floor 955 • mounted heater • . Vent not included in appliance permit 445 Repair units • 805 < 3 hp; absorb. unit, 955 to 100k BTU . - 3 -15 hp; absorb. unit, • 1,700 . ' • 1Olk to 500k BTU . • 15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU ' 30 -50 hp; absorb. unit, 3,400 , . 1 -1.75 mil. BTU . >50 hp; absorb. unit, . 5,725 . >1.75 mil. BTU Air handling unit to 10,000 cfm 656 . ' Air handling unit >10,000 cfm 1,170 . Non- portable evaporate cooler 656 • • • • Vent fan connected to a single duct 446 • Vent system not included in appliance • 656 . permit . Hood served by mechanical exhaust 656 Domestic incinerator 1,170 ' Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 , inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL $ , VALUATION: . . . . , ALUATION: , i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 Building Fixtures . Plumbing Permit Application Rec eived FOR OFFICE USE ONLY Plumbing • Date/By: Permit No.:'/l157app3 -0015 ) City Of Tigard Planning Approval Sewer 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 - Review Land Use �ruu�� Internet: www.ci.tigard.or.us ' , i,�, �.��� Date/By: Case No.: Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 `" "" ' Name /Method: Supplemental Information. TYPE OF WORK FEE *'SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea) 1 Total IM Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION ,. (includes 100 ft. for each utility connection) SFR (1) bath • 249.20 2 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: l 1220 , t,U i2 ND AVE. , ' Site Utilities Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 ' ADP) X Drywell/leach line/trench drain 16.60 Project Name: Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: {i3e RTh o#' I.1Ast Manufactured home utilities 110.00 Ronk c q tal R Ols P iafair. i La .-; ON 12 Manholes 16.60 ' 3 KO IJ SE_ o Jj Kt U Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: , RAik.1e.44 If AL.L.44 Lot #: 6 Storm sewer (no. linear ft.) Page 2 Water service (no. linear ft.) Page 2 Tax map /parcel #: Fixture or Item; DESCRIPTION OF WORK Absorption valve 16.60 ADD in OA) D F i3 4 (33A i 1"1 TO 5 Backflow preventer Page 2 ac)KPPEK or )401.4v__ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 `.t PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 - Name: 6 6 VAIU 1-t l r-t Do) x Expansion tank 16.60 Address: i o. 6 v ,u 0 A1/t, Fixture /sewer cap • 16.60 City /State /Zip: 77G/�RD oft 97a l-3 Floor drain/floor sink/hub 16.60 Y Garbage disposal 16.60 Phone: tO03) 6 ( 64 • 2Gq7 Fax: Hose bib 16.60 . ❑ APPLICANT . ❑ CONTACT PERSON Ice maker 16.60 Name: Ott) JUG W it t'_ f f 4917 -gMzg Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) • 16.60 Phone: Fax: Sink/basin/lavatory -2 16.60 • E -mail: , Tub /shower /shower pan I . 16.60 ' CONTRACTOR Urinal . 16.60 Business Name: 0w�),zg 77 oz --774. Water closet 1 16.60 Water heater 16.60 Address: ( & Other: City /State /Zip: Other: Phone: Fax: • . -Plumbing Permit Fees*" . Subtotal $ CCB Lic. #: Plumb. Lic.#: Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 Signature: . ,,��/' /l // LL/. Date: i�� Plan Review (25% of Permit Fee) $ 4/EM Aril p 1 State Surcharge (8% of Permit Fee) $ (Please print ame) TOTAL PERMIT FEE ' $ 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. i:\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 Qty. Fee (ea) Total Square 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' 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 additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 *. Quantity by (Fixture) Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Existing 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 *Note: If the fixture work under this permit results in an Garbage - Domestic 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: i:\Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03 Permit #: MsT (-O0 `00 t 31 Addres • su) ' , n) D Issu: • by: �_. !, Date: tABA.J S 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: N/ 1. I own, reside in, or will reside in the completed structure. 5 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. ri 3A. My general contractor is (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 X 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. Property Owners about Construction Responsibilities on the reverse side of this form. Aga- (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) • Information Notice to Prtperty Owners About Construction Responsibilities • . .This Information Notice' to Property Owners about Construction Responsibilities was by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent manyproblems by being aware of the following responsibilities and areas of concern. • EMPLOYER RESPONSIBILITIES: 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 most instances, be ruled 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: Asan employer, you Must withhold income taxes from employee wages at the time employees are paid. You will be liable for'the tax payments even if you don't actiial ly withhold the tax from - your employees. For more information. call the Oregon Dept.'ofRevenueat 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 Employment Department at 378 - 3524. . Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance tor'your employees. I fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs i f one ofyour employees is injured on the job. For more information, call the Workers' Compensation at the Department Of Consumer and Business Services at 94'5-7888. - U.S. Internal 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 tax. For more information, call the Internal Revenue Service at 1- 800 -829 -1040: - OTHER RESPONSIBILITIES' AND -AREAS OF CONCERN: • 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 ifyouhave adequate insurance coverage for accidents. and emissions 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 tirnes the'Y can perform' the required inspections. • If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052, 503/3,78 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop- own.pm4 1/94 • riv3?" 3 ©o / 3/ r:P:0 3 2003 \-)I RECEIVED CleanWater \ Services APR 16 200 File Our commitment is clear. By - I Nally F TIGARp Sensitive Area Pre - Screen ib i i{snt Jurisdiction l 0,1 Date y -.3 -0 3 Map & Tax Lot (J )S 30 e, a x'00 Owner � A I4&C • Site Address 112 - )-p S �U r Q flue 741;C) SQ.) S n c Hie. co, 177 2 3 Contact - G r) , v ? 3 Proposed Activity v' fi Address A , crw Phone Gey a(ot 7. Official use only below this line ❑ Y N f A Y N —NA( - El Sensitive Area Composite Map ❑ ❑ Stormwater Infrastructure maps Map # 1 T QS # (k 'a-2–' Y N N Y N 7 ❑ ri Locally adopted studies or maps ❑ ❑ `/ Other 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. 00 -7: ❑ 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 Assessment 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. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: _ / -- ) \7 _ . ,---P 0 G. I/J VGA ' A/ ZOO Reviewed By:` --- 1 / � j Date: R / 31d Th Returned to Applicant Mail Fax Counter 155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Date By Phone: (503) 846 -8621 • Fax: (503) 846 -3525 www.cleanwaterservices.org CITY OF TIGARD -'-s 1'1'l S BUILDING DIVISION PERMIT #:a0 63-0 3 - 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: Phone: (503) 639 -4171 At Inspection Requests (24 Hrs.): (503) 639 -4175 ...'�: 'IL INSPECTION WORKSHEET FOR DATE: 3- g TIME: PAGE: SITE ADDRESS: /(7 2_,.6 Fa 4 CLASS OF WORK: — SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: _ OWNER: PHONE #: CONTRACTOR: 6j1; PHONE #: 6t( _ 2 ( ci 7 Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 6 l ii )7te-lia-e. 1 Corrections /Comments / Instructions: ;~ 4/w.Xi-Le c �� A_- /A z Cl- I�,7 - - F . , V, .,d . • a . PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑/ L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: �� -� Phone #: (503) 718- CITY OF TIGARD 24 -Hour BUILDING —• Inspection Line! (503) =539 -4175 - 4251 0 06( ' ( INSPECTION DIVISION Business L : (503) 639 - 4171 BUP Received Da Requested � ° 5 - AM PM BUP Location // d� Date Aif' Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/CO G r 4-Y' 'G—'^ D T — a' , 9 7 ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: - SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear r �" Framing h l.�1 `- - L/C. r- Insulation M � �� Drywall Nailing Firewall Sh Z. e3 !AL 5 ---� Fire Sprinkler Fire Alarm Susp'd Ceiling _ Roof 10`f Other: _ Final PASS PART FAIL PLUMBING ® /C,_ , "�C c �SGL�7`F Post & Beam � � ` 6 e� Under Slab G1 l�L �tG Rough -In F D Water Service _ -♦ Sanitary Sewer t- �v b7� Rain Drains Catch Basin / Manhole Storm Drain • Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PAS�PART FAIL Service Rough -In UG/Slab � Low Voltag / r e Fire Alarm F Reinspection fee of $ required. before next,,'- -- section. Pay at City Hall, 13125 SW Hall Blvd. AS PART FAIL SITE 111 Please call for reinspection RE: Unable to inspect - no access Fire Supply Line e" ADA Approach/Sidewalk Da Inspector Ext Other: Final DO NOT REMOVE this inspection record fro , b site. PASS PART FAIL CITY OF TIGARD. 24-Hour • BUILDING Inspection Lime 503)- 639 -4175 INSPECTION DIVISION - Business (503) 639 -4171 MST 0j 3 L BUP Received 5 al Date Requested / Y AM PM BUP Location / / 2- 2-0 k2 1 ( 4 Suite MEC Contact Person 954( _et, Ph ( ) Z6 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC. A ccess: Ftg Drain ELR Crawl Drain • Slab Inspection Notes: SIT Post & Beam Shear Anchors . Ext Sheath/Shear Int Sheath/Shear =� Framin nsulation> fti1 DrywafFNailing • �' ` • ' — - Firewall Fire Sprinkler Fire Alarm . Susp'd Ceiling • Roof Other: PART FAIL FAIL RING - Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain - Shower Pan • Other: - 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall B • - PASS PART FAIL SITE 0 Please call for reinspection RE: y Un. • - • nspect — no access Fire Supply Line ADA Approach/Sidewalk Date 2 � 6- Ins , A ' Ext P Other: Final DO NOT REMOVE this inspection r ord from the job site. PASS PART FAIL • • CITY OF TIGARD z 24 -Hour • • BUILDING Inspection Lin (503).639 -4175 MST 3 — DO /c3/ INSPECTION DIVISION - Business/I�ne: (503) 639 -4171 BUP Received Date Requested °°" AM PM BUP Location / I 2-6 ?? 'rld (1 Suite c/ MEC Contact Person Ph ( ) Co 8' ! - ze 9 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC • Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear _ Int Sheath/Shear � C, /s t' Framin. �-T— Drywall ' N a iling • ST � Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam • Under Slab Rough -In Water Service Sanitary Sewer • Rain Drains Catch Basin / Manhole Storm Drain Shower Pan • Other: 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE o inspect – no access Fire Supply Line /� ADA Dat V Inspector Ext Approach/Sidewalk Other: Final - . . DO NOT MOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD _ 24 -Hour • BUILDING Inspection Lin(503) 639 -4175 MST 3-6o / 3/ INSPECTION DIVISION - Business Li . (503) 639 -4171 BUP Received Date Requested ° ? f AM PM BUP Location // Prt" Suite // MEC Contact Person Ph ( ) 6' FY— 26 q7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access. Ftg Drain r. GM c , 72 ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear h , / Int Framnath/Shear e` _. L,' 4 41r - / _ �i�.L �1 5 u atio t i j rywall Nailing — Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling. • Roof Other: Final 00 P ASS PART PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspecti RE: Unable to ' ess Fire Supply Line ADA Date • v Inspecto .... A Ext PP A roach/Sidewalk Other: Final DO NOT REMOVE this inspection cord from the job site. • PASS PART FAIL CITY OF TIGARD 24 -Hour. • BUILDING Inspection Line: (503) 639 -4175 3 - 6 0 'INSPECTION DIVISION - Business Line: (503) 639 -4171 MST BUP Received Date Requested / Z AM PM - BUP Location I I /eld / -tt., Suite MEC Contact Person Ph ( ) kg- v1 co 7 7 . PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing - .. Foundation ELC Ftg Drain Access: � �f - ELR Crawl Drain Slab Inspection Notes: _ - • SIT Post & Beam Shear Anchors Ext Sheath/Shear • Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler • / O. — ' • Fire Alarm Susp'd Ceiling Roof - Other: Final PASS PART FAIL PLUMBING • Post & Beam Under Slab. Rough -In Water Service Sanitary Sewer • Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line - Smoke Dampers Final PASS. PART FAIL ELECTRICAL Servi - g -In lab Low Voltage . Fire Alarm Fi Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ASS PART FAIL SITE 111 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Date ( --01-( Inspector L T C Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record fr m the site. • PASS PART FAIL CITY OF TIGARD • _ 24 -Hour BUILDING • Inspection Line:. (503) 639 -4175 00/ 4220 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received I% (/ / )ate Requested / l2 O.( AM PM BUP Location f / 2 Z "? ' A-e) Suite MEC Contact Person Cl� Ph ( ) A 2 Q PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Drain ELR Crawl Drain Slab Inspect,. ,' Notes: Q SIT Post & Beam ,a 1 �fil�C. yQ�ill� Shear Anchors Ext Sheath/Shear /Le wdd Int Sheath/Shear • • Framing Insulation • Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam • Under Slab ough -In ervice Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fi PART FAIL CHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Inspector / Ext Other: Final DO OT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING - Inspection Line: • (503) 639 -4175 ; ' MST `3 , 00 13 INSPECTION DIVISION Business Line: (503) 639 -4171 - BUP Received Date Requested 1 ° - 3 AM PM BUP Location , 1(2-1-0 8a AlJ —' Suite MEC Contact Person Ph ( ) PLM .Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC 1 Footing 6 0T - 2- Co q7 Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam 6 111 C Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation r , , • ,. L 10 s 0 1 l - Drywall Nailing y � � � �� ' V Firewall 2- - S \N L t >V �'\ W 1 c 9V , S V Fire Sprinkler Fire Alarm CSI , 1 ic - (A t i 6" 1 I V Susp'd Ceiling (� \ r `��f ) 1 �• Roof 3 1<i4 V l D L )j' c' D (&))1 Other: 2 1 OM- m -\ Final � V °" � • �� �Cu 1 J . -- PASS PART FAIL . PLUMBING Post & Beam Under Slab NI/". Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: _ Final _ PASS • PART FAIL MECHANICAL - • Post & Beam Rough -In Gas Line ') �� , Fox Smoke Dampers f Final PASS PART FAIL ELECTRICAL Service gn =ln ■ ct Voltage 'Vd k l Low Voltage Fire Alarm Final . ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART SITE ❑ Please call for reinspection RE: Unable to inspect - no access Fire Supply Line // ADAoach/Sidewalk Date / 2 3 ` 6 �" Inspector ice•+.. _ II L Ext Approach/Sidewalk Other: L Final DO NOT REMOVE this inspection record fro the j site. PASS PA RT FAIL • • ( 5 - d ) - 7/g- 2____vK‘ ,______ ,_ /I CITY OF TIGARD • 24 -Hour • BUILDING • Inspection Line:. (503) 639 -4175 MST 3 -co / 3( INSPECTION DIVISION - Business Line: (503) 639 -4171 BUP Received Date Requested /6 - 2 7 AM PM BUP Location /(Z 2-D 8 a ' A-0-e - Suite MEC Contact Person Ph ( ) le i' ((' a6 ?! I PLM Contractor Ph ( ) SWR BUILDING .. Tenant/Owner ELC Footing ELC Foundation • Access: Ftg Drain 0 F / - Q -, ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear • Int Sheath/Shear Framing, Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL • PLUMBING t Post & Beam . Under Slab Rough -In Water Service Sanitary Sewer ain Dr '' Catch Basin / Manhole Storm Drain Shower Pan Other: • - F i - • 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 Reinspection fee of $ - , --,required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line ADA Date lv /Z 7 Id 3 Inspector Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the job site. PASS . PART FAIL . CITY OF TIGARD 24 -Hour BUILDING Inspection Liner (503) 639 -4175 3- Q( 3/ INSPECTION DIVISION - Business Line: (503) 639 -4171 2— � BUP Received / Date Requested 07 AM PM BUP Location / / 2-2-0 R? A-22 A ' " ` Suite MEC Contact Person � —*�� Ph ( ) � 9 'FY PLM Contractor Ph ( ) SWR BUILDI Tenant/Owner ELC F ooting Foundation ELC A ccess: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shea Sheath/S • r InSh- :r ra. t' �...._ 7171, -7 �' C ,► rg rLtcQ 9 -L- • 3 ,�; P- r -�••- a ion Drywall Nailing c c eler-5 ` Firewall Fire Sprinkler Fire Alarm 11.\1;) r,�-,w9 Susp'd Ceiling'` run.= • Roof Other: Fi PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: • 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 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection. RE: El Unable to inspect - no access Fire Supply Line ADA • Approach/Sidewalk Date I L? - 1 Inspector �� , 3V �u ��`� Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD. : 24 -Hour BUILDING Inspection Line:. (503)'639 -4175 MST 3^ 06 / 3 / INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 6 AM PM BUP Location l 4-1e) A. Suite / MEC Contact Person // C Ph ( ) bS' Y °?b'/ 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: n it SIT SIT Post & Beam P 1.�� 7 " Shear Anc , • InT eath/She. i V e4os a ge,-"! e pee— , Drywall Nai g aM1 GG - may Firewall Fire Sprinkler Fire Alarm Susp'd Ceili f" ) // Roof 'Other: Fin. _ y,, i74 .`l OBl- . p 1 w� // (G. 41h.n � 4 4ap PART 0 Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: 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 El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 111 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line �� Ent Approach/Sidewalk Date s ' � 7 '6 Inspector ADA _ Other: • Final DO NOT REMOVE this Inspection record from the job. site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 539 -4175 MST 3 �� ` 31 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested S AM PM BUP Location l 1 L Z D c?' a 'J i #t -2_ Suite MEC Contact Person Ph ( ) '- • 4 '°Z6. 7 7 PLM Contractor Ph ( ► SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR �. awI Drain Slab Inspection Notes: a s e - SIT ost &Be ` ar Anchors Ext Sheath/Shear Int Sheath/Shear ( a /� Q c � \/ y�- O`-✓ ✓ t c ) Framing � Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PART FAIL ING Posr Ben ' nder Slab' - Roug - n` Water Service Sanitary Sewer Rain Drains Catch Basin /Manhole - • �. Storm Drain Shower Pan - Other: Fi / A SS PART FAIL M L ost & Beam Rough -In Gas Line Smoke Dampers F 1 A S . PART FAIL CTRICAL Service . J Rough -In UG /Slab . Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW E - PASS PART FAIL SITE L Please call for reinspection RE: Unable to inspect —� Fire Supply Line Q ADA D ate cJ A/ D 3 Inspector E" Approach /Sidewalk Other: Final DO NOT REMOVE this inspection record from the Job site./ —PASS PART FAIL l • CITY OF TIGARD A 24 -Hour • BUILDING - Inspection Line:' (503) 639 -4175 MST 3-0013/ INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received 'f Sri Date Requested 7 A AM PM BUP Location ���0 �� � � Suite MEC Contact Person /n.." Ph ( ) c 'I V a( 7 PLM Contractor Ph ( ) SWR Tenant/Owner ELC H'R ELC n Access: -Ftg- Bral'n ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing • Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: PART FAIL • I Post & Beam • Under Slab - Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain • �. Shower Pan Other: , Final _ I PASS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line Smoke Dampers " Final PASS PART FAIL I" ELECTRICAL Service Rough -In • UG /Slab Low Voltage - Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd -. PASS PART FAIL SITE 0 Please call for reinspection RE: ❑ Unable to inspect - no acces: Fire Supply Line ADA Approach/Sidewalk Date - —�� Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. • PASS PART FAIL CITY OF TIGARD 24 -Hour / BUILDING Inspection Line: (50 . 75 : r MST ° e -0 0 / 3( INSPECTION DIVISION Business Line: (51. -=-- 1 �y� BUP • Received Date Requested Z - Z AM �� 7 F PM BUP Location / / Z 2-0 E-„ `46f _, Suite_ MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/ 6),8 - 2- 7 ELC Footing Foundation ELC Access: Ftg Drain CAM 40P ELR Crawl Drain Slab Inspection Notes: _ SIT Post & Beam ( - r, _ 6-6, Shear Anchors �` _ 1c Ext Sheath/Shear /f �! -�=/ hit Sheath/Shear ` / ,, ` vv v. ` Framing Insulation X )) �1��' ,�' "v' ,?/06/." b d / Drywall Nailing \ ?/1 G Firewall L \ \';') � dt/t --," Fire Sprinkler ( '� Fire Alarm c \/ " v " J )_VL— 1 b E' - 3 e • Susp'd Ceiling Roof I Other: ' ._ it - 'SS PAR PLUMBING` Post 1 6 &Beam � \ (f Under Slab L� /A ` ��'� - �� � - , 11..... - • Rough -In (i' (•.'(r� / ti �/� ' Water Service(. S L. - - -.�. hA ' r L - Sanitary Sewer( 1 51,4^ ) �elp--1A._---- � Rain Drains (i.) 40' - ■ Catch Basin / Manhole Storm Drain � Shower Pan �`� I (Ot: Other: SASS PART 0 MECHANICAL Post & Beam Rough -In Gas Line ��‘..) Q \.S Sm • . - Dampers �I(' P , - S PART FAIL LECTRICAL S- •ice Roug n UG /Slab Low Volt - Fire Al • m AS ASS PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City . Hall, 13125 SW Hall Blvd. 1 SITE E Please call for reinspection RE: 0 Unable to inspect - no access Fire Supply Line Vb /� ^ �/ I'�,- ADA Date d 2 Inspector �'``/ ` " — Ext ApproachlSidewalk the:: -- h,ner+ ox ellnn_r®cnrd_frnmn_fhss_lnh_alfo r CITY OF TIGARD s1- BUILDING DIVISION PERMIT #: 6-2) ^ 003) 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 I, Inspection. Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: � TIME: PAGE: SITE ADDRESS: 1 1 i v 4 A" CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: . PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: 6i��� ,o PHONE #: (0c c..( .IQ, Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message pt. Corrections /Comments /Instructions: • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 3 / /L5 Date: 01‘ Phone #: (503) 718- • l (00 - -- -- --- - -- - . _- 140 . W a _ FRUIT TREES i 1 G i ( ACM& - " I lip ! I S - 0 PHONE 'L 9 DRIVEWAY do * -AEQVET�IRVAID ELLCTRl_CLLr_ _BOOK UP 10 1 " — 141 EXISTING 1 -1OUSE 1240 5Q. FT: . -0--4- 20' 65' C4ERRY . 22 ' 35' 02 ___ __- 1-- A001 -nom PINE 20 / U M . ,103 T i GARDEN SHED I 02. - . . --