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Permit - 8 • r i A CITY O F TIGARD MASTER PERMIT PERMIT #: MST2003 -00234 DEVELOPMENT SERVICES DATE ISSUED: 6/18/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13705 SW 118TH CT PARCEL: 2S103CD - 08000 SUBDIVISION: CREEKSIDE PARK ZONING: R -4.5 BLOCK: LOT: 010 JURISDICTION: TIG REMARKS: Add 296 square foot media room to rear of house. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: DWELLING UNITS: THIRD: sf RIGHT: VALUE: 27,350.40 OCCUPANCY GRP: BDRM: BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 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: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 705.11 This permit is subject to the regulations contained in the SCHIEBOLD, HANS + SHARON R MCCONNELL & SON CONSTRUCTIOTigard Municipal Code, State of OR. Specialty Codes and 13705 SW 118TH CT 16038 SW BRIDLE HILLS DRIVE all other applicable laws. All work will be done in TIGARD, OR 97223 BEAVERTON, OR 97007 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: 503 - 591 - 8788 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 63571 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Exterior Sheathing Insl Mechanical Final Foundation Insp Mechanical Insp Insulation Insp Plumb Final Post/Beam Structural Electrical Rough In Rain drain Insp Final inspection Post/Bea 1 i ■ - anicai Framing Insp Roof Nailing Uri. - oor insulation Shear Wall Insp Electrical Final jr - Iss d By : , .%!,.- / J,/ , Permittee Signature : t ��2� /h r 2 1 %`9 ' Call (503) 699 -4175 by 7:00 p.m. for an inspection needed t e next busine s day Building Permit t UCation y FOR OFFICE USE ONLY Received 2 Planning Approval Building 2�/ ✓ E I V i / Date /By: 03 Permit No.: Other �j�. Hj3 ao;3 ` City of Tigard �� Date/By: Permit No.: 13125 SW Hall Blvd. 'JUN lan Review Other Tigard, Oregon 97223 N O �� 2„ Date/By: M A 1/ `` l' 03 Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 D , ' , , o ' il h '' Post- Review Land Use �U/to � I Date/By: ' e Internet: www.ci.tigard.or.us G ©lv . -�_� Contact 4 '.. ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: / Supplemental Information TYPE OF WORK i I VI: �: .6-. n New construction 111 Demolition ` ci� i , ; " ; TG N ote: Permit fees are based on the total value of the work performed. j Addition/alteration /replacement III Other: �� CATEGORY OF CONSTRUCTION * p formed. Indicate wil 1 & 2- Family dwelling ❑ Commercial/Industrial Miami 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 g � , <t) III Master Builder 111 O Other: Valuation $ G 4 du JOB SITE INFORMATION and LOCATION No of bedrooms: No of baths: Job site address: /3 `7 '1,v li 8 r4 G j Total number of floors �� < New dwelling area (sq. ft.) Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) Project Name: i s- ,5C/CJ b zyd Covered porch area (sq. ft.) Cross street/Directions to job site: e, Deck area (sq. ft.) $ Q(a -it 0.0 l I Other structure area (sq. ft.) • 0 G /urn, Subdivision: kft 5704 /0 Lot #: (0 4 Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate ' ,, w ,' r the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. Valuation S Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ■ PROPERTY OWNER TEN ' f ks' ,. Type of construction Name: if ipu_ . ALd) 1 4444 Occupancy group(s): Existing: New: Address: /) 4 70.5 .r tai / /,/ c,� . City /State /Zip: 77‘4_,Q OA p7/7.7 Phone:p C 2 , tax: NOTICE: All contractors and subcontractors are required to be (p S Za licensed with the Oregon Construction Contractors Board under 0 APPLICANT ❑ CONTACT PERSON 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: City /State /Zip: Phone: Fax: ' E-mail Business Name: . )L ti �� � /t -r �f�JS //L(�Cll� due upon application $ Address: 4'035 ,c&/ ffmt{'vLL. m aS Ae.-- ount received $ y � ��'f� V f� �,� � R'lfa0 � Phon j 1 0 � -� Fax(j p375'�7� ��C Date received: CCB et' Authorizes pjliMi / Notic e: This permit application expires if a permit is not obtained within Signature I . ate: i''' O 180 d ays a it has been accepted as complete. i C AI-coop/6i( *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 One- and Two - Family Dwelling ° ��- B u ldin Permit A lication Checklist Reference no.: Building PP ryofTigard Associated permits: City 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. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch -basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a 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 revi- . JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. _ _ 25 Building plans shall not contain red lines or tape -ons. "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) Mechanical Permit Application ' t;OR OFFICE USE ONLY UU Received l- �5 Permit No.: Date/By: .: r — CC� 93 c` By: �-[�� Permit N. Planning Approval Building City of Tigard 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 �"�(' Date/By: No.: Internet: www.ci.tigard.or.us . 4, I.' Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 W Name/Method: Supplemental Information. TYPE OF WORK COMMERCIAL FEE* SCHEDULE - 'USE CHECKLIST ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work A 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. ' 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule , ,161 Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description Qty I Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00 Job site address: j 3 ? ?s` ft() I I F ii,-_7 / yk rye Gas heat pump 14.00 Suite #: .--. Bldg. /Apt. #: — Duct work / 14.00 G t�/ Hydronic hot water system 14.00 Project Name: 1.4;,/ $ if Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 f �iti . �'/,tr /`go F L ot #: / Repair units 12.15 Subdivision: Other Fuel Appliances Tax may /parcel #: 5 C-3 Water heater 10.00 :' DESC RI PTION OF WORK Gas fireplace 10.00 �e V mix hi ziLu /T .] n Flue vent (water heater /gas fireplace) 10.00 V Log lighter (gas) 10.00 Q y£ 4() /)1 ,1-49( / " Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 0-PROPERTY -OWNER 1 0 TENANT . .._ A Other: 10.00 Name: I' Enviro Exhaust '& Ventilation K17 cGl c am Range hood/other kitchen equipment 10.00 Address: /3 )� sW /`,Z Gs Clothes dryer exhaust 10.00 City /State /Zip: j I6 f7/z. 3 Single duct exhaust Phone: l }1- I� . 7 Fax: (bathrooms, toilet compartments, p APPLTCA>`IT CONTACT PERSON _' =. utility rooms) 6.80 C � A��Y Y Attic /crawl space fans _ 10.00 Name� ,�v(c .0 js���(Jl �lfp Other: 10.00 Address: /I‘e) 3g S"(, 6e, ,0LR At & T p,Q. Fuel Piping City /State /Zip: o,v fL/a 01 7 7 * *($5.40 for first 4, $1.00 each additional) Phone: .17 l C Fax: s �E Furnace, etc. ** `` y l Gas heat pump E -mail C i 6 i. C c9%t Wall /suspended/unit heater ** CONTRACTOR Water heater ** Business Name: 3 j.�f�9 i /i4 t l co ,4,1.1u Fireplace ** Address: /3` ' ^� y' ,y S� Range ** 6 / s IfA C/ �� BBQ City/State/Zip: ,/ f) ,� Clothes dryer (gas) ** Phone: '9 69- q ' 7.5- Fax: Other: ** CCB Lic. #: Total: �� Mechanical Permit Fees* Authorized � Subtotal: $ Signature: Date Minimum Permit Fee $72.50 $ ) 6 0 tAi Plan Review Fee (25% of Permit Fee) $ (Please " pr i n tn 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 Forms\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 101k 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: is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 06/03/2003 04:'20 5036425815 ROSS ELECTRIC PAGE 01 �� F��i�!�� � Received �>~,dk {i~E+'�'1( ' 1 ".4I ��1< - .... Elects , W Electrical Perm 2 Electrical ! t ze'll• ' J. 6 3 Permit Vo : N" , � - , xa3(- r ia rn•oq, ., rpr v ft , -. "� ' Sign City of Tigard L Date/BY Permit No.: , 13125 SW Hall Blvd. Plan Review Other Date'Bv Permit No.: Tigard, Oregon 97223 Pose Review - Land Use Phone: 503 - 639 -4171 Fax: 503 -598 -1960 hib Date/By. CaiteNo: Internet: www.ci.tigard.or.us See hulk: IN See 2 for =�� Concoct 24 -hour Inspection Request: 503 -•639 -4175 Name/Metbod: I Supplemental information. t , T"^t;, - t �'"""' t �y�II�1 � ryry t' �� "" ... >, r :l.�.' �y,�,�. x gy p. 7fi II, i ' a i y l�j�"I� j , . . . 1 ::), I �'� , i '1!111 k 5 ,t , .It t�i 0 "..T. � .; .:.,f.:.4AKan .�: -. °1 l -. w: : -1 5. �}l ). , P &. 11' �ih�t.;ifll.:ih f ,M,`u fthis's�M. - �, ; ���117�1.r.Yn� � I i, +. Y I �- ' New construction ■ Demolition ■ Service over 225 amp - 1 Health -cart facility commercial 0 Hazardous location to Add&t1Dn/alterehOnlr .lacement li Other in SCrvicc over 320 amps -rating of ❑ Building over 10,000 square fcct, r: i � ..'''''Y >�.,'� iw �r+. lc� I !r ,? ,a 1 & 2 family dwellings four or more residential units in 11E4 1 & 2- Family dwelling �rt'�r`t7� ,..s': „i!,I, Iryi:l, �,. .: r.. r �,. ..:... s. •>....:.i . � ■ Commercial/Industrial © System aver 600 volts nominal one structure p Building over three stories 0 Feeders, 400 amps or more Accessory Building I � Multi- Falcon C] Occupant load over 99 persons 0 Manufactured structures or RV park 1r • Master Builder `U Other: D Ernes/lighting plan ❑ Other, - -- Submit sets of plans with any of the above. 1 , j,iw u r- r ? ; x ".„. - ! L' i''',~: : ,: :i::,c! .6. *s :L_' r �: The above are not a kabk to „ coostractloa service. Job site address: 4 1$ -- LT �� . . 5�S`�q`��e�.'��1'�"'l Iii I .= *�u11' . 4r ,1!. .- ._.. TrV.:: 1;':: W,,,t.i.r 'I Suite #: • Bid:. /A +t. #: Number of in.. ectioes • er ■ ermit allowed Project Name: 5 SC-tCd c)(,1) Description Qty Fee ma.) Total ���” ,�, New residential- single or multi - family per t Cross street�lrectlons to 1ph site: /ft/ r � 'f'/ Suter /'v dwelling unit xoeiedee attached garage. 7769e-P ° / C' -" /-1 ,r 4:7 6A/M6 C Service included: 7 4 i r 1000 an. ft or len 145.15 a (i. e+ / v /l $ G / f e / — < Gl f C 4 Each additional 500 s • . ft. or portion thereof I 33:40 l Limitedencr•, tesldeatial 75.00 Ell SLr1?dtiv"isi9,I : ca -7 L , Lot #• t Limited . w A non residential 13.00 1111111111111111131 f r . 9 X rrlS s; s arse / r ,a ; > > 5 > hull or modular dwelling 90.90 e in Services or feeders - installation, alteration m relocation: r_______ 200 amps or less 80.30 t 2 j 201 amps to 400 amps" -- 106.85 Mil I i 401 amps to 600 amps _ _ 160.60 rr^ -- - r , TM 77 '`' 66 1 - am- to woo ,= 240.60 _� Ill ft ,I „ i. L . I s :: — w — .--- ». ,_ 1 1' ��! 4 ; ' . Over 1000 am., or volts 454.65 • ( Name: S G 1 Reconnect on • 66.55 I`rhBT r.. -ay Address: f 3 1 Temporary services or feeders - installation, alteration, or relocation: . J fl, a,9 _ 4 200 am r or leas 66 -85 1 Fax 201 •s to 400: • 100.30 2 Phone Ls 401 to 600 amps 133.75 2 ,K , ._ a , 1 ..: 7, *, ,.,_ ,, �, - 4 ,.�1s.:. '.> - �- .f_r..eti:... F �3 Brunch circuits - new, alteration, or Name: /1 TZAW extension per panel: A. Fee for branch circuits with purchase of' Addy - Ss: , , , A l, ;: 1 i " —, A service or feeder 1f each branch circuit 6.65 2 ��� Iv I B . Fee for branch circuits without purchase of X5 Cit /State. /Z!. 5: I, ,4 1 ! 7 t> service or tbeder f fast branch circuit 4 6.85 4r ' 2 ' • i one: rf' Fax. . S, - . '"&? Each additional branch circuit i 6.65 IIM 2 E-mail: f ■ 7 , 1 i Misc,(Sc vice or feeder not included): - , , p�t F �[ Each . orirri circle 53.40 II ��IIII,,,:: .. .__.. .,.. ...,,,c., •-.' — 2 '!:1 : 1I�Siri c' ° ' 4.' Each „ or°talkiel:htln• M. 53.40 Job No: _. Signal ' circuit(s) or a limited energy panel, i uallle33 Name: $ 5 e �� alteration, or extension 2 • ,_ Description: Address: a3 kg) 5 w b r4,k1_ G Ci /State /Zi 1 Each additional inspection over the allowable in arty of the above: ty p • � Ct Per inspection per horn (min. 1 hour) 62.50 ini all Phone: to y Z., 2.v CD _ Fax: 40 5f/ investigation fee: GCB Lic. #: J/ Ilir a I Lic_ #: s5344154V G Other: -�- ill �i�,'i'i: A,ci 'J Per Oli ,c . , • S :).. , ,i .i il :. , t , 1,r '414EI Supervising electric -.0 i Subtotal =0 si y s ature re . uired: Ai f' C 2v •�" Plan Review (25% of Permit Fee) Print Name: lifarArnr 5 Lic. #: R,3 State Surch :, :e 8% of Pentnit lee S .2. TOTAL "PERMIT FEE S 5 . r Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: _ 180 days after it bet bccn accepted as complete. "Fee methndoingy set by Tri- County Building industry Service Board. G'°\1 :°) " • 0 1 \c , � JUN 0 6 2003 C1eanNat Services File Number 3t/ our commitment is clear Sensitive Area Pre- Screening Site Assessment • • """" ; , Jurisdiction Date , ✓,. ;�,r�f'; . - Map & Tax Lot • mil 03d- O 03000 Owner �•� /`, ' Site Address f,3VS" / 0 7 ' 4 Cr c Contact ,!. %'. ; u�' • f / 5 Y Ad dress r,; Proposed Activity -;77, , � .� 1,, ��'�'�,, - � f .4)4 1 . d �` x� �, r ' 11" r 1.7-1 � , i ,,Phone (` f3) Official use only below this line Y N NA Y N NA _ Sensitive Area Composite Map U n Stormwater Infrastructure maps Map# 2j /4),4 QS# 1917 Y N NA Y N NA n Di ; 5.I Locally adopted studies or maps n n u 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. I Ki 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 ony_our property. _NO_. FURTHER SITE OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. 7 The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: 6 44 o o h nevi eta r ? Site t ei a. •.d A 00A. a. er Pa./ /44 T r Prof rh P t.'rc- Reviewed By: Date: V WO Returned to Applicant Mail X Fax Counter 155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Date 6//o/c) By - Phone: (503) 846 - 8621 • Fax: (503) 846 - 3525 www,cleanwaterservices.org CITY OF TIGARD 24 -Hour BUILDING Inspection Line ' ► .39-4175 MST 0 1,,�� '� t ° 2 41 INSPECTION DIVISION Business Line (5 1 •39 - 71 �ti/� BUP Received Date Re ueste r 1 T �— AM PM BUP Location r 3 7 e5 / � 0 y " � ' �h Suite MEC Contact Person Ph ( ) 5 — 035 PLM Contractor Ph ( ) SWR BUILDING Tenant/0 1 r ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: yvv l _ SIT Post & Beam V2--OnnA Q—` Shear Anchors J V /'� Ext Sheath/Shear Int Sheath/Shear ✓V �� l �.'"`- • Framing _ Insulation p cQ \ „ � �" Drywall Nailing �'` 4 ��' I v` Firewall 2✓ - r`�� W\ 1 Fire Sprinkler Fire Alarm Susp'd Ceiling �1 2 M l a Roof _ (12J Ai PART FAIL P ING Pest & Beam 1.11 Un • er Slab Rough -In Water Service Sanitary Sewer 41 (iv—A-- � Q C K (3)- Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Sm • e Dampers ark 0 \ PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final fl 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 ADA 1 A � Approach/Sidewalk Date ` `/ �/ Inspector V (� Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Lin . x§139 -4175 MST 3 'd 6 °\-- 3 `T INSPECTION DIVISION Business Line: (5 63 1 BUP Received 2 Date Requested 0 ' AM PM BUP Location /3 7o.< l / ( f / Suite MEC Contact Person Ph ( ) .3 - 8 7 88 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: 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 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 Fi - • larm F ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SI El Please call fo • reinspect .n RE: El Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date or... Inspe Ext Other: Final DO NOT REMOVE this inspection recor from t - Job site. PASS PART FAIL