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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2000 -00465 DEVELOPMENT SERVICES DATE ISSUED: 10/23/00 " W 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14560 SW 92ND AVE PARCEL: 2S111AC -01400 SUBDIVISION: PINEBROOK TERRACE . ZONING: R -4.5 BLOCK: LOT: 055 JURISDICTION: TIG REMARKS: Porch addition BUILDING REISSUE; STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLP,SS OF • 51 HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: . P'[1' E OF .sE: p 9 9 FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: DWELLING UNITS: FINBSMENT: sf RIGHT: VALUE: $ 2,604.00 OCCUPANCY GRP: BDRM: BATH: TOTAL: 0.00 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 1 TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: ' OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 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 10004:-SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM /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: $ 614.36 This permit is subject to the regulations contained in the ESCRIVA, DONNA JEAN OWNER Tigard Municipal Code, State of OR. Specialty Codes and 14560 SW 92ND AVE . all other applicable laws. All work will be done in 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 #: 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 Footing lnsp Final inspection Slab lnsp Framing lnsp Rain drain lnsp Plumb Final i �� / ��_ ,ti►' . Issued By : X 46.. � _ t1 Permitte Signature `�+r? %s_ .. *) / ° all (503) 639 -4175 by 7:00 p.m. for an inspection needed the n:*siness day I .,s • • •1 A MASTER PERMIT \ PERMIT #: MST2C^0 - 00465 ,-"A t ° DEVELOPMENT SERVICES DATE ISSUED: 10/23/00 r , t 1 - 1 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14560 SW 92ND AVE • PARCEL: 2S111AC -01400 SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5 BLOCK: LOT: 055 JURISDICTION: TIG REMARKS: Porch addition BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: DWELLING UNITS: FINBSMENT: sf RIGHT: VALUE: $ 2,604.00 OCCUPANCY GRP: BDRM: BATH: TOTAL: 0.00 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 1 TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 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'LINSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: -1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNALJPANEL: 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: Il , ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL i ' 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: p HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 614.36 0 This permit is subject to the regulations contained in the ESCRIVA, DONNA JEAN OWNER Tigard Municipal Code, State of OR. Specialty Codes and 14560 SW 92ND AVE all other applicable laws. All work will be done in • 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: CP Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: forth in OAR 952 -001 -0010 through 952 - 001 -0080. You II may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. 0 REQUIRED INSPECTIONS - Footing lnsp Final inspection Slab lnsp 0 Framing lnsp Rain drain Insp Plumb Final . Xi ., - Zvi ��� &fe Issued By : � E� Permittee Si gnature `s ;i L�I� ."--7 .r , all (503) 639 -4175 by 7:00 p.m. for an inspection needed the n -, :*siness day V% Permit #: / ;1M 06 965 0 �% Address: /4/5 0 �a 41'1/�` � � � Issued by: z A ii. Date: /0 /Z,, /6 ) /859 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: Vik 1. I own, reside in, or will reside in the completed structure. 44"2. I understand that I must register as a construction contractor if the structure is sold or offered for sale r ' before or upon completion. n 3A. My general contractor is I I (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 iGti 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 P I pe , !; ; AP Ira Construc i n Responsibilities on the reverse side of this form. i i � � ,...CI _ I /me. i 4/ ' I6/11/70 igarlikr, a of • permit applicant) (Date) Or (White copy to issuing agency permit file, pink copy to applicant) 111ftrmaUon hIcAce props i y 0\. ne r About Cm 1r1strruio oon C• c spolne6[ Mor s Note: This Information Notice to Property Owners about Construction Responsibilities was developed 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 exist_'ng structure, you can prevent many problems by being aware of the following responsibilities and areas of concern, EMPLOYER RCSPORSIS5L` u ES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in ',be 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: As an 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 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 Employment 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 Fnust 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 your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -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. *THEIR r ESPc•MMILITOI S AND AREAS OF COf 9CERN: 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 accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must he 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, Saleni,'OR 97309 -5052, 503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop- own.pm4 1 /94 pST / p l L - v U . Building Permit Application ,� Date received: 0- /-e70) Permit no.:il 1 2000_./ " " 4 i' II. City of Tigard City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 f Project/appl. no.: Expire date: Phone: (503) 639 - 4171 Date issued: By: Receipt no.: N Fax: 503 598-1960 w Fax: ( 503) 5 10 Case file no.: Payment type: Land use approval: 1 &2 family: Simple Complex: TYPE OF PERMIT - . ' 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition i± • ddition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: - ...- JOB SITE INFORM ATION >, Job address: / C) Six) " Z, 4. 17L' Bldg -noc. — - - Suite- no--.` _Lot: : .. -Tax-inapItax — Project name: . Description and location of work on premises/special conditions: - Y OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: CU Fr yG,4 y6 — C� /MM eZL , . . (Floodplain, septic capacity, solar, etc) .. Mailing address: /r 5700 5&) 2 A l/e` 1 & 2 family dwelling: _ ' / City: 7 ,q- 2 L State:Oe ZIP: 97Z 1 Valuation of work $ a y. Phone: 67-0 - /t / /S' Fax: E -mail: No. of bedrooms/baths `_' —, Owner's representative: Total number of floors Phone: Fax: E -mail: New dwelling area (sq. ft.) APPLICANT'S: - Garage/carport area (sq. ft) c -'..."\—"-- IMENASSINEREMI Covered porch area (sq. ft.) i' g 5 PA/ r' Mailing address: J /57a4 5 4- ve Deck area (sq. ft.) ~ ---- --` -�•___- City: 'T/6- -/y /� State:a/a ZIP: q 22- 4/ Other structure area (sq. ft.) Phone: b7a /4//5 Fax: E-mail: Commercial/industrial /multi- family: CONTRACTOR Valuation of work $ Business name: d (�Nj te/ Existing bldg. area ( tJ Address: New bldg. area (sq. ft.) '''-,... Number of stories ... City: State: ZIP: Type of construction .., Phone: Fax: E -mail: CCB no.: Occupancy group('s : Existing: New: City /metro lic. no.: Notice: All contractors and subcontractors are required to be , . 4 ` ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under • Name: provisions of ORS 701 and may be required to be licensed in the Ad. jurisdiction where work is being performed. If the applicant is � ZIP: exempt from licensing, the following reason applies: OA) A.,0'77.... Contact person: Plan no.: A.,0'77...._ Phon:: Fax: E -mail: ENGINEER Name: _ Contact.persot Fees due upon application $ Address: Date received: City: �-° ` ZIP: Amount received $ Phone: - --- Fax: Errill Please refer to fee schedule. I hereby certify I have read and examiner is application and the \ Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All p • 'si• s : a / ' ..s ordinances • • ':. ingthis \O Visa ` O'M terCard - work will be compli - . , - e r - 41- d herein a • . Credit cardmumber: \\ . / / i D ` O \ Expires Authorized sig /� Date fo i 0. Name of cardholdeaas_shown on credit card Print name: t r r ' ' ' ` ' - LI' .— l2 i Cardholder signature $ Amount Noti : This permit app ica o n expires if a permit is not obtained within 180 days after it has been accepted as complete 440 -4613 (6ro0/COM) Pti :=" "' - /. -- -30 — ---- 7 / gzi/7 C f Plumbing Permit Application Date received: N I ( —O Permit no. : f11 /""),~00Cli / a x e d':. I ja City of Tigard �.� �•, Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: G • TYPE OF. PERMIT ❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement 0 New construction 0 Addition /alteration/replacement 0 Food service 0 Other: JOB SITE INFORMATION - FEE SCHEDULE (for special information use checklist) NI Job address: / c/S 0 5W 9 A,. I g" 4 ✓g". Description Qty. Fee(ea.) Total N ew 1- and 2- family dwellings only: no.. -- �Sutte rto.: (includes 100 ft. for each utility connection) \T ap lot/accouTi nom ` SFR (1) bath - - Lot:- - - -- - - 4B1ock: , I Subdivislo .:.- -. -- - - SFR (2) bath • o' •. • e: - • SFR (3) bath City /county: w,o, S µ,,, 6.r I ZIP: 9' ?Z z / Each additional bath/kitchen Description and location of work on premises: Site utilities: a: 02 c 11 if- ?/7 v AJ Catch basin /area drain Est. date of completion/inspection: Drywells/leach line/trench drain Footing drain (no. lin. ft.) PLUMBING CONTRACTOR • Manufactured home utilities Business name: (' (N Ci Manholes Address: ct A - Rain drain conneor • 1 • City: I State: I ZIP: - "•Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: . Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: _Water service (no. lin. ft.) City /metro lie. no.: Fixture or item: Contractors representative signature: Absorption valve Back flow preventer Print name: Date: Backwater valve •' CONTACT PERSON Basins/lavatory C//,. C-� ism .A-1--7 eLL Clothes washer Name: C Dishwasher Address: /t/•-�v Se.J 92 /4--✓ Drinking fountain(s) . City: 776_,.q../2 1) I State: I ZIP: 97.224/ Ejectors/sump Phone: ,v / /s Fax: E -mail: Expansion tank OWNER Fixture/sewer cap ' Floor drains/floor sinks/hub Name (print): CZ.,./ TF ,1,4;2 4 r-t .mot -s<LC.- Garbage disposal Mailing address: /t/ra,O s' 92 A a ' Hose bibb City: 7%G —.A_ I State: 01 I ZIP:g; Z 2 V Ice maker Phone: 6o 7o /y /3 F. . I E -mail: Interceptor /grease trap Owner installation/re • e - ma' : e ance only: e actual installation Primer(s) will be ` deb i , c . . : ce and rep . r e by my regular Roof drain (commercial) emp . - o - • - t, II :. - -• , AVAla II • r OR • e 7. 04n• Sink(s), basin(s), lays(s) , d_ Date: /6 )! Sump • `ENGINEER Tubs/shower /shower pan ?..T ame: Urinal �--.... Water closet �� �� Water heater City: I ZIP: Other: Phone: I Fax: I E -mail: Total I 7'201) of all jurisdictions accept credit cards, please call jurisdiction for more informations Minimum fee $ Notice: This permit application - Visa 0 MasterCaz expires if a permit is not obtained Plan review (at %) $ it card •num[x�r'. State surcharge (8 %) .... $ taa ' s within 180 days after it has been Name of cardholder as shown o�catd accepted as complete. TOTAL $ $ Cardholder signature Amount / 440-4616 (6/l)0/COM) ■ • 7. '/3 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested �- AM PM BLD Location /-{ j &eo S 4' 9 2- Ai 4 Suite MEC Contact Person Ph ' 7 0 /V /. PLM Contractor Ph SWR 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 fww I nsulation 4tfa r Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: nal "ezey d BART FAIL CO LUMBING CJ 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 7� =a Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGAFiD BUILDING INSPECTION DIVISION MST 1.�� " ;e e ) �� 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 2.%" Z-y AM PM BLD • • Location / 4 ' - o 5 Suite MEC Contact Person Ph '7U /(/' /5 PLM Contractor Ph SWR UILD - -- 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 fi ei/'� �avA.'t��2�iCr- / Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm - Susp'd Ceiling Roof Misc: Pow. $: Final PASS PART FAI 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 Z Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. L MST — Master Permit Inspection Description Date Passed By Notes Grading Footing /Setback Foundation walls Slab Footing drain Waterproof basement walls Plumbing underslab Crawl drain Post/beam plumbing Post/beam mechanical Underfloor insulation Post/beam structural Shear walls /anchors Exterior sheathing Plumbing top -out Gas line & test — Mechanical rough -in Electrical rough -in Electrical service Low voltage Sprinkler rough -in Backflow preventer Roof nailing Firewall Framing MFG -Home set -up Insulation Drywall nailing Masonry /Reinforcement Rain drain Sanitary sewer Water service Pump /fill septic tank Approach /sidewalk Grading final Mechanical final Plumbing final Electrical final Final inspection G% _ - o t Special Reports • SWR - Sewer Permit Inspection Description Date Passed By Notes Sanitary sewer Final inspection INSPECTION RECORD — MST (MASTER) PERMITS