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Permit
• CITY * ' � / F TIGARD MASTER PERMIT e. PERMIT #: MST2005 -00158 �I�j DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S110BB 05100 SITE ADDRESS: 14082 SW 121ST AVE ZONING: R -3.5 SUBDIVISION: ARLINGTON RIDGE LOT: 028 JURISDICTION: TIG Project Description: Family room /den addition & remodel. • BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 23 FIRST: 494 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: 5 VALUE: 100 OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 494 sf REAR: 40 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: 1 VENT FANS: 1 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 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: 9 0 - 200 amp: W /SVC OR FOR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL BR CIR: 7 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: r OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes BLACK, KENNETH A + GRETA A OREGON HOME SERVICES LLC and all other applicable laws. All work will be done in 14082 SW 121 ST AVE 4940 SE WOODSTOCK BLVD accordance with approved plans. This permit will expire TIGARD, OR 97224 PORTLAND, OR 97206 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 Phone: Phone: 503 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: LIC 147971 direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 1,604.45 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS Bolts in concrete Issued By : / _ '- „ _��� tiC.-.) Permittee Signature • 1..`4 I ! isa Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Build nm Permit App CIE I V E ® FOR,OFFIGET . :. , p. q> ONLY g , City of Tigard �p (' RDeacteeffliveyd: ,,J _It _19).- l�l,,r — Permit No.. F 13125 SW Hall Blvd., Tigard, OR 97223 MAY 0 9 200,5 Alk Plan Revi w�� a) Phone: 503.639.4171 Fax: 503.598.19 R 4 DateBy: J — / Other Permit: :I,L re �I CITY OF TIGAR Line: 503.639.4175 c2 _e Date Ready /By: �� Juris: H See Attached Checklist for Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method:) J - 1 '0 4.0 1 v- Supplemental Information 3 ?0Y - G TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all K AdditionIalteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 11- and 2- family dwelling [11 Commercial/industrial ; eve 6 � ❑ Accessory building ❑ Multi- family Number of bedrooms: t ❑ Master builder ❑ Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: - Job site address: /4084 siA) / Z( Ave_ New dwelling area: qQ square feet City/State /ZIP: —cm 9 Ca ' 7Z, Garage /carport area: 1 square feet Suite/bldg. /apt. no.: Project name: V l Covered porch area: square feet Cross street/directions to job site: f/,'ci ard f izi rr Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. . Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. s i I D ew � 1. — p / Sc - p r 1 Valuation: $ I �?Gl/� /n �ILCI Existing building area: square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: g grded,„ Type of construction: Address: / 102. .5 ) j [t Occupancy groups: City/State /ZIP: 7'I „� m e 9 Z t/ Existing: Phone: (6 ) 62,r_ /3 2e? Fax: ( ) New: g APPLICANT ❑ CONTACT PERSON NOTICE Business name: © ( � ° Q , yyls 4,L, C. All contractors and subcontractors are required to be Contact name: l4 k � ll�tAd licensed with the Oregon Construction Contractors Board "t oe under ORS 701 and may be required to be licensed in the Address: t 9'tI0 s" G cam-11-4 igtsti jurisdiction in which work is being performed. If the City/State /ZIP: p .4. , _,�[ ` r 9724 applicant is exempt from licensing, the following reasons .., ^ C1� apply: Phone: (o3) 77,z_ / 3 Fax: : (503) 77 0 E -mail: O et" a3MC_ SilGS' ` PO ! , ta°0 CONTRACTOR Business name: Q 64i-e_ BUILDING PERMIT FEES* Address: Please refer to fee schedule. City/State /ZIP: Fees due upon application Phone: ( `) Fax: ( ) 7 ? 7 / •_ __ . v " 7 Amount received • CCB lic.: J 6 — �-� t Date received: Authorized signature: 741..../......___ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Mc -ic /4 f4 an d Date: J C 9 * Fee methodology set by Tri- County Building Industry f Service Board. i:\ Bui tding\Permits\BUP- PermitApp.doc 12/03 440- 46t3T(11 /02 /COM/WEB) One- and Two - Family Dwelling ' ; . • ' • Building Permit Application Checklist_, FOR OFFICE USE;'ONLY City of Tigard Received Date/B Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 y g Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 it yj�di a 24- Hour Inspection Line: 503.639.4175 �� � 11I, ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard,or.us " °'' ❑ Other: THE,FOLLOWING ITEMS ARE REQUIRED FOR PLAN RE 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. Name of district: . ❑ ❑ ❑ 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 111 El ❑ 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 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 and 22 above. ❑ ❑ , ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be 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 and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP -RES- PermitApp.doc 2 Electrical Permit Application FOR OFFICE USE ONLY ' City of Tigard Received Permit No.. \3 ¢ .2,45 p ad /S • '� Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review V Phone: 503.639.4171 Fax: 503.598.1960 � e i ' DateB Other P Inspection Line: 503.639.4175 2:�' C'' i Date Ready/By: Jura: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information s.ear� .,�.;: - s*'3„,uc1F kr J.S ai:il; eN0.n;.- `�'t -e*.�"" a1,. 3 , .. :': : 4 r . - 'ti= tr. .r�ao s; k t ;� - ai =:* 4 ';'i r TrYPE OF€ W:ORIK = , r f r ' ' ,. #�=1 :.' a : '` 1tEY . ' i�y ,t k�.,. ,�, .,,. :'{ EI':.41�1'�c._ �.IF.. -'W� ' ms`s rS.db �� a �.''R'�1'��5 �[^ u:Y_�it+.srL4�n sc. h- .nu:3:••u iz{�i}:Hirir_ 11� .:Y.%.°..P- .b:�»dY�T,�c'�f ,.>�:#� '3v. �,� t' :: `� �','.: �......, ... : . ;. ❑ New construction a Addition /alteration/replacement Please check all that apply: ❑ Demolition ❑ Othr: EService over 225 amps, comm'l ['Hazardous location .. Demolition ,W,. � �, .r w e ^ yA' _ t _ „�,. e ❑Service over 320 amps - rating EBuildng over 10,000 sq. ft., a '�- RY O �G y OiS RUCTION , -.• ilk i- l r , ,,� d l 1 , . of 1 -and 2- family dwellings 4 or more new residential her t z.x.ti. e ' EGO �.�; - .�,t:g;t; �:�:,,: , _ ', X 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ❑Building over three stories ❑Feeders, 400 amps or more ❑ Other: structures or _ ❑Occupant load over 99 persons ❑ ' ; _ u., x--c t uuar.�rrt u ttt�as:v;ti , # ," _ �" - r." -- r _ t .€- u�„ si `' " :, .IOB a, ' 'TiGUN AMID ° 'X OG AT ON` r ' - 1 "' . ll 0 E ess/li htin plan RV park No g& 5 /2 Ave Health -care ofp ay ❑above. Job no.: Job site address: `fv / Submit 2 sets of plans with any of the above. City /State /ZIP: "1 ? ? Z Z The above are not applicable to temporary construction service • l : ^mi l ,r re ri E* iCi Ai}It7,;'.i;. . Suite/bldg. /apt. no.: Project name: Er " °` Description Qty. Fee. Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. S� Includes attached garage. pia 124.-k- - f - 121 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 1WM 7',a, x� � b4.��'fi +3 -1' q..,} �,,. 4 1.- d „ , DES .CRI PTIO, L:' Q ; �W ^ „ - y ,, a Ix Each manufactured or modular A:14 - 5 l7/ F- I g' dwelling, service and /or feeder 90.90 2 l 4 Services or feeders installation, alteration, and/or relocation 0 ' 34 - t 01 SG ; r( 7,v S'"4 200 amps or less 80.30 2 r, : m k Z vi + kry i �. 1 tia ;a:= : r 201 amps to 400 amps 106.85 2 t ;` P O ERTI''tOW1YER r a - .' Ivr i� �" TTE1IA 1V ,1T - -, r: �" �"''°'�'`'"�` 401 amps to 600 amps 160.60 2 Name: eem Elm k. 601 amps to 1,000 amps 240.60 2 Address: / ''OVZ ,S LC) 121 4te_ Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: �' � d tY f IGI.✓L� � l 7221 Temporary services or feeders installation, alteration, and/or relocation Phone: (503 ) 6 2._ 1 3 2.7 Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits- new, alteration, or extension, per panel A ' �{ °"' "t`* r :° lr' i -: - ra iTa i O tl A. Fee for branch circuits with }}�� " �,}APpLIC:�¢yS t '.;x'C�UN. •A�CPERSOr;a? =� � .. -J 'i.� -*' i3" - $ t3 'Y3. .i � .ve.�:.S6Yi. %.'s:ar�-aMw a.fa ' k:. _ In service or feeder fee, each 6.65 2 Business name: Q 1 I4s - .L branch circuit Contact name: �/ /� �d/(4 ) B. Fee for branch circuits /t/lO✓ f [Q without service or feeder fee, O ,� each branch circuit 46.85 2 Address: 4 19 1 1" 0 56 fiVeixIS Ovid E ach add'1 branch circuit 7 6.65 2 City /State /ZIP: P 91 7z66 Miscellaneous (service or feeder not included) - s /` ! Pump or irrigation circle 53.40 2 Phone: (SO3 ) l 7 7Z.. L1 3 Fax: : (c 3 ) 7741_ i / • 2 . 7741_ Sign or outline lighting 53.40 2 E -mail: oa'- t4tmeit Svcs- cap C ( Signal circuit(s) or limited- ' =; " c: " s �'. g , �` : `a ; V x t. ,' energy panel, alteration, or -' �, >. e,,-� i�� -t �CONT?�RA�IiOR" - +`� � t� �d.. -,t .,� �� a' "`. ra ", °u"a' r`.g extension. Describe: Page 2 2 C i Business name: S .'t/� tic Z a Address: tt;--�� 14,8-s-1 Each additional inspection over allowable in any of the above Po • Per inspection 62.50 ... City /State /ZIP: p (Qid�' 9 72 ?Z Investigation per hour (I hr min) 62.50 f Phone: (,p3 3 ^3 r 5 S Industrial plant per hour 73.75 x Ph )"�- Z Cj Fax: (Sts ) Z� ��_= �dr� I'RIE CCB Lie.: (3j Qrs'" Electrical Lie.: 2,(0 X 10 f L Suprv. Lie.: ( °2 - . .. 5 Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board •* Number of inspections per permit allowed. i\ Building \Pemilts\ELC - PermitApp.doc 12/03 440- 4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: : (� �? '� T N.,1; -I; -`� s` ` -`::�� �'�£- d1UJll�ri._s �.mV ��4 1'.. Ol ,�?'j, ®lt \:LJ�'y��::S`^'�^}.'� k��.T�r''.�,:�4�7�:.FdSCs Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ • Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i.\BuildmgPernms\ELC- PermitApp doc 04/03 Building Fixtures Plumbing Permit Application FOR OFFICE USE'' ONLY ' ' City of Tigard Received Permit No. '051_0/51 DatDate/13y: Per ' : 2 13125 SW Hall Blvd., Tigard, OR 97223 Review eview Phone: 503.639.4171 Fax: 503.598.1960 Awl (f � l + Plan Rev Other Permit No.: 24- Hour Inspection Line: 503.639.4175 J j 'e;. Date Ready/By: k 0 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information �ez^n - "�kw �_:=a'� =:s a;- ,;��� .Z ;,a:a', w T. =: -� Ti :,:T?.a:�a ",r�:�""°':.' ^�; : � 3�;,.�: ;= �.��.uc;..�a�iYw °,a �_ • : -^; g V 'i. « , i ", " 4Y, -ia . ;£E. �t < ^„�' ^ s .., a , ', ,6 ;; s ". *,- s =1:,.>. e,x w ..< ` ,' ,,° + , - s Yb . O - WOItKy w� ' " M, , k iD , u ,µ t FEE:, tt SGHEDULE:; .,1§ ^�'3' -'3�r� .,€' : H����. �`x✓�..�€���".F°�x �€ �' .3;���� &'.. .> .1. 4a? s "_'�i�t: °- �sa�sx. ^..., e.. '.a^ss�s�£z"..x°.::-:. _. ❑ New construction El Demolition For special information use checklist. Description Qty. Ea. Total Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) .> �..� -": _�, .-- ;�a�� ;. g ge�i X„ +a�;.:,.:.e�' ^�..�.ssaea����:.� 1; ^�'�.r; ;sv w;,^�; r �; , , :��. fi r;. <�.. , l �,..^ � - _+`' _.^ :` 1 P r : Gitfreo RI?� OF Ceil SI 'aRIlCTI®N .rt it a Zg SFR (1) bath 249.20 . i v"..' .. 'yam., v.�',;wift.: s;m,, ."rzv_ 0-,. ' -"o- =A'., „ '11,,,..' �h41 , 1 4s .1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 [11 Accessory building El Multi-family SFR (3) bath 399.00 . Each additional bath/kitchen 45.00 ❑ Master builder El Other: � _ _ Fire sprinkler ( sq. ft.) Page 2 C 6 ,, ; w f O STIaE tI F * RM m o A ND OI e3 P ON Y� ., ;v $. .':, Si ut Job site address: /4) Z . IAJ i Catch basin or area drain 16.60 City/State /ZIP: ( Il , a_ ( 7 vzj1 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: glebel Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: (_ Manholes 16.60 6 - AQ✓Cle -9 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no Absorption valve 16.60 I �• r pin ' °;" D ESCRIP TI ON diN;VOE1 ` ,444 l; :, .. ,., .M*P r. -,. _.. ,., ..� ., g, . 3; x B ackflow preventer Page 2 Add /42f �.� --Tea,( k- / Aoki Backwater valve 16.60 ii ` a k -J -t 4-1A l e l ` dates GtoS ,- _Clothes washer 16.60 Dishwasher 16.60 z , x � Drinking fountain 16.60 _ X A 4r ' s ROPERTi ] R t. i l7 iENAN =w 1 , . Il - 4 s a iv t . ' *44, � , rotm:ba� .. , . 4. .lAVVAP, Ejectors /sump 16.60 Name: > Elder Expansion tank 16.60 Address: pion. 5 1.0 121 A Fixture /sewer cap 16.60 City/State /ZIP: �� , ' Floor drain /floor sink/hub 16.60 ! � a..d . � �Z - Garbage disposal 16.60 Phone: (03 )6z4/ .. (3 249 Fax: ( ) a s � � r 01 Hose bib 16.60 Noe- � «, W .W AA ` 'E '.m a te": ?-- �GON¢T ,T PERSON `'F =. Ice maker 16.60 Business name: � t 4._lC -..� 4 , L L I nterceptor /grease trap 16.60 Contact name: ` M ' k 0.... 0.... /« Medical gas (value: $ ) Page 2 Address: q l'L3 S L ` b l ®] Primer 16.60 City/State /ZIP: 16a,,d de_ 9 ?zoa. Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan ` 16.60 E -mail: Urinal 16.60 a GONTRACd?OI2` 52 4 r) Zf {i, '� � ��,�' 1 ` ° �s ,��.K �� ... ,��«� =.,;.r.;�,. -� :i��.� �� ,?��. �`�-�� Water closet 16.60 Business name: � e_ ik ?Lou g / / Water heater / 16.60 Address: 7/ 'BpX 00gigt (99/ 8, Other: City/State /ZIP: '� 1 . a ! 9'7Zvp Subtotal Minimum permit fee: $72.50 Phone: ( 5a) Zqi/_ /909 Fax: (503 24 'i.- 1 Zs' Residential backflow minimum permit fee: $36.25 CCB Lie.: 5' Z 3 8. Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: 74,..6"2 (7 State surcharge (8% of permit fee) J c /-' j TOTAL PERMIT FEE Print name: � �,^ // c4 Date: S'7" This permit application expires if a permit is not obtained within • '�Y I ! C ( 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Pemtits\PLMF- PermitApp.doc 12/03 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard . Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression System s: vow a S PPLAtAitie `e f K M i.0 : m. <. e �e a� Toeai q Footage p erm t e e 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" ;s".. >, ; ; r- > = " 'V'alation ° P� 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 � pct k" ;e^' "� 'tX . ° t ` ^'�` , F C eo-' ea additional $100.00 or fraction thereof, to and F1XtnreOrIgte121 x i '� Y, *. ' Q Y �", ofal including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees " 3" Quantity by(F(xture) W.orkerformed� Ftxture e'' " � ,' 0 a Replace . s = N e�v Moveatng � c P p Comments regarding fixture work: 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" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. • Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\ Building \Pemuts\PLM- PermitApp.doc 3/03 M P Application FOR OFFICE US E ONLY Received City f Tigard PermitNo 1312 SW Hall Blvd., Tigard, OR 97223 Date/ By: ,,2a6) OCR! IP Plan Review , Phone: 503.639.4171 Fax: 503.598.1960 h I� ' lh� DateB Other Permit: Inspection Line: 503.639.4175 c it 4 � 1 Y Internet: www.ci.tigard.or.us ,ea . - Date Ready/By: Juris: S See Page 2 for g Notifieed/d/Met Method: Supplemental Information .� '<aE;"�,� g . �' �. a. �:.:<>,° �_ s;....L�,;.�c.'r. �,Pu.,°,"ssMS =- '1iy.:�q�.,.. , i =g n .:,*;:?' . " - �;t�nroS .:kza��;' i .�.gc.:�,: ;•.s,..=��i: .,� �:,,, _ '° =, `ee:` <TtYPE OFWORKT_ ^:GO IERC?;L�kEE * CH1;,,04.'''4i3SE:CIIEGI ISST �1 -. - �.,-., s,a��..��,.,ar.�,�a..rS.�.z,. �.:,'�a:,k?��,��,�.'�« k r.� x�"��°n:- = _ s.- _ti:'�„�.^i g����M:, "... i.Nw:�e�:�ati�n�;�*x:..�se� - -'"� .. - _ . ❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. �.,^ - 3s,'�, - n..' .'? �v^r�' �_;,.�= a�z„ �*�t �€�*�� , .�.:..R: ;.;��-sr. ,k. � .��:'-- °:�" Value: $ ,:d, .. .CA ; EGOR Y , o COt STRU s ° ,. .1,v. 7 , • P r IV,L NTAltEQUIPIV NI,I' SA'STEMS �1- and 2- family dwelling I] Commercial /industrial ill Accessory building ''� ` °` Multi M builder For special information use checklist. 111 y ❑ ❑Other: Description Qty. Ea. Total rrr k ,s s A- ,,mss.,. JOB •INFO ATTON AI ,ID OC AT IO N,, A ': , 12 Heating/cooling s.w.�z ate:.�. . ,.,R.a.._ „�.i �,.w;$.� x. �raz"i Job site address: i lZ iv S� /� Air conditioning or heat pump r !t �° (requires site plan showing placement) 14.00 City /State /ZIP: '...ri�„ `!'/4 r 9 Furnace 100,000 BTU (ducts /vents) 14.00 Suite/bldg. /apt. no.: Project name: shk Furnace 100,000+ BTU (ducts /vents) 17.90 Gas heat pump 14.00 Cross street/directions to job site: Duct work a.. 14.00 //'�� q] - Hydronic hot water system 14.00 C'C`aQ.& 121 �� Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: Lot no.: Flue /vent for any of above 10.00 • Other: 10.00 Tax map /parcel no.: Other fuel appliances ' 'g . W �__° P, Water heater 10.00 ,,, .,,t __.„ .: Y. i . - DESCl2IPT.zON OFWORK - •Ot a vk.r 'x ` L Gas fireplace 10.00 NCLu Duct (l 1.01 - Jo 1 ketA i I s' Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 wrv, %�;�;;�;.rw =�� : ����- ��.�;x ass' �M -- ; ,:' -- c �- :�:�:; Chimney/liner/flue/vent 10.00 x r " a OPEI2TY O WNSE R 4,, ..,,'* 0.r ®rTENANT < ' '. Y s... o- , .v M , k.4' r:. 4 -w„ wl �� ,._ itr. � Other: 10.00 Name: iz« FILI+G�°� Environmental exhaust and ventilation A Range hood /other kitchen Address: gore_ St4t1 121 Ate equipment 10.00 • City/State /ZIP: -rill j C 7 Z2 ti Clothes dryer exhaust 10.00 f Single -duct exhaust (bathrooms, Phone: (5:1 ) 6 24 (3x4 Fax: ( ) toilet compartments, utility rooms) l 6.80 : r 04,,ol 4ppeLia, "" ,' N' , i qON '?A T ERSON µ Attic /crawlspace fans 10.00 ! Other: 10.00 Business name: 0,„,:. Gl,l I ��+�1+,5 e...z.0 Fuel piping Contact name: 4.3:- g $5.40 for first four; $1.00 for each additional Address: dliettin S alfaciviadir A Furnace, etc. Gas heat pump City/State /ZIP: P ( a 7200 Wall /suspended /unit heater "� r Phone: (53 7 .-{ 66 3 Fax: : (5C ) 77 t{F3p Water heater ,(_ ���// f Fireplace E -mail: Otr (4 Svcs' . A CO7NA Range l %t4.. ', . 7' ;; ,F t2"` . __ f� a'S<`,wE'..�.a:.v i°wn" . i 'p $` . _ . t � x-- , , , "..r . ,*- - b:,,,.' CONS ,ittCTO .z _ �� " rz a L -� ` , :. _ Barbecue Business name: 4 6 'oiA x 4`, __ , 66r,� Clothes dryer (gas) Address: ' Other: 7z 2 ° t ..„ a ° ,' s �s =r, Rr .;,a, :mss,.,,_ r- f . C . (,(Ju y t� -, '. IGIE:CHt4NI�AL`,PE < FEES �,;' ;° � `-; City/State /ZIP: iTattA4t121 k r `1 706 0 Subtotal Phone: (5>J3) .5.02. - 6573 Fax: (5c 6, ?s--, s--, G Z64 Minimum permit fee ($72.5 Plan review (25% of permit fee) ) CCB lie.: I5` ( ??6' s . State surcharge (8% of permit fee) / TOTAL PERMIT FEE This permit application e Authorized signature: 74 "/ expires if a permit is not obtained within 180 da ys after it y �/ has been accepted as complete. ` Print name: i4 , 110„,".„( Date: .6 /,/ * Fee methodology set by Tri- County Building Industry Service Board \ \ ME i:\ Building Permits C- PermitApp.doc 12/03 440 -4617T (11 /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: if s Tota Valuation ; ``p ;, a Kgrznit Fee: g N l%1. _b , $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • • i:\ Building \Permits\MEC- PermitApp.doc 12/03 2 i F CleanWater Services C) coniruitin nt i< Heir. June 2, 2005 Mark Hylland Oregon Home Services 4940 SE Woodstock Blvd Portland, OR 97206 RE: Addition to single family residence located at14082 SW 121 Ave., Tigard, OR CWS file 05- 001896 (Tax map 2S110BB, Tax lot 05100) Clean Water Services has received your Sensitive Area Certification for the above referenced site. District staff has reviewed the submitted materials including site conditions and the description of yourproject (See attached site plan). Staff concurs that the above referenced project will not sigiificantly impact the existing Sensitive Areas found near the site. In light of this result, this document will serve as your Service Provider letter as required by Resolution and Order 04-9, Section 3.02.1. AO required permits and approvals must be obtained and completed under applicable local, state, and federal law. This letter does NOT elminate the need to protect Sensitive Areas if they are subsequently identified on your site. If you have any questions, please feel free to call me at 503 -681 -3605. Sincerely, Chuck Buckallew Environmental Plan Review Site plan attached E: \Development Svcs \SP 00 -7 \Form Documents \Concur with cert - no impact to water quality 04 -9.doc 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 Phone: (503) 681 -3600 • Fax: (503) 681 -3603 • www.CleanWaterServices.org CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE SQUIRES ELECTRIC PO BOX 16851 PORTLAND, OR 97292 Electrical Signature Form Permit #: MST2005- 00 Date Issued: Parcel: 2S 110 B B -05100 Site Address: 14082 SW 121ST AVE Subdivision: ARLINGTON RIDGE Block: Lot: 028 Jurisdiction: TIG Zoning: R -3.5 Remarks: Family room /den addition & remodel. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: BLACK, KENNETH A + GRETA A SQUIRES ELECTRIC 14082 SW 121ST AVE PO BOX 16851 TIGARD, OR 97224. PORTLAND, OR 97292 Phone #: Phone #: 503 - 252 -1609 Reg #: LIC 135085 ELE 26 -1101C SUP 4882S AN INK SIGNATURE IS REQUIRED ON THS,FORM x - fig, -� • S. . ur- of / Kervising Electrician If you have any questions, please call 503.718.2433. • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST0,a9 ' eel-C INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested M BUP Location ! E / Z/ `. Suite MEC • Contact ---aor All ( ) !' —L a,. !._ %4t l! -7 - 1 .0 c PLM Contractor +'>t V _ ) '� �Z - — ZoO7 S WR . ,1 nn rr DINT Tenant/Owner C �l�'I, Footing ARAI w Foundation Access: L iI • i ' Ftg Drain LR r r Crawl Drain Slab Inspection otes: SI 4:t/t/ Post & Beam Shear Anchors ,/ nchors _ _ _ Ext Sheath/Shear tv��i�'� hit Sheath/Shear OR' LEA - it,"--- Framing ' 1 Insulation Drywall Nailing Firewall i/ e-- J A- Fire Sprinkler — Fire Alarm _ �� �� f `��- Susp'd Ceiling .02 ` Roof -I ' / - _J O ler• �, FAIL e.1.17' An P dw '7 ,------ '&21a. Under Slab s 'I1@'C &rw AS, 4,0� pk ,,e, •-e— Rough-In . - �/ /✓ - (- �© /4 ��H Water Service ' ML ' Sanitary Sewer /it,./v� /✓ Q� "t 8-G , Rain Drains Catch Basin / Manhole ,41111,- L a , „„ - f ® Storm Drain Shower Pan 6G _ O 'S ator -Cpi.,� , • • . ...-- - if- ei-ld AOC 0 71 A, 07 — PART FAIL .�� ip _ Post &Beam 2 � v � < /a Rough -In c� y Gas Line ---- Cy / .< 'VD Y0LDile -/4• Smoke Damp- s PASS FAIL i. - I Rough -In � _ 1i 7 � _ UG /Slab Low Voltage .......1 Fir Alarm ,0/ /4/V6- /94 4 - -S Final Reinspection fee of $ required before next ins p-: ART FAIL p q p = on. Pay at Hall, 1 125 SW Hall Blvd. SITE _ ❑ Please call for . • inspe •on RE: ' Unabl : . inspect - no acc s Fire Supply Line 4 ADA Approach/Sidewalk Date j� 3 Inspector .4'., / Ext Other: WA- Final D • NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2006- 001613 ,A. , 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 - Inspection Requests (24 Hrs.): (503) 639 -4175 '_ INSPECTION WORKSHEET FOR DATE: 11/3/2006 TIME: 7 :06AM PAGE: 70 a 17/ SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. 11/2/06: Added low voltage for Audio /Stereo. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 - 7714663 Inspection Request Scheduled For: Date: 11/3/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 020178 -01 603-252-/609 N Corrections /Comments /Instructions: ! 'Or - - I '0 C-' G c Z- r = :)"J S __) o 'LC dP Cci a e e. Cci7 ' 1 F - - - ..k. ■ ■LaAs.- --- - a- ACIA 1 ,...e ..A., I r, , , 4 . .4 I wffi r L. , fi ifim , . . . . „ , = i r, n PASS n PARTIAL APPROV ' ANCEL ❑ NO ACCESS FAIL n C L FOR , w,.. - TION n ADDITION FE ASSESSED .f Inspector: / / Date: 3 i Phone #: (503) 718 X4 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 001513 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 : mod ul Inspection Requests (24 Hrs.): (503) 639 -4175 J4 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 65 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503.772 -4663 Inspection Request Scheduled For: Date: 10/31/2005 Pour Time: Code # Inspection. Description Confirm # Contact # Message 199 Electrical final 019785 -01 503 252-1609 N Corrections/Comments/Instructions: _4�, • _ ' 40 ' ' O b--- air - •*0 _ A) 1 a •I r • ' ■ jam,. ' z , sib [( PASS KI -ARTIAL APPROVAL n CANCEL n NO ACCESS I►/ FAIL IP CA 6R INSPECTION n ADDITIONAL FEES ASSESSED Inspector: -- ate: /O ` �/. ° Phone #: (503) 718- _ y.. CITY OF TIGARD , i; . BUILDING DIVISION PERMIT #: MST2005 -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 / �wmrolo�� I�F i l h l Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/11/2005 TIME: 7:09AM PAGE: 40 1 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 - 772 -4663 Inspection Request Scheduled For: Date: 8/11/2005 Pour Time: Code # Inspection Description Confirm # . Contact # Message 120 Electrical rough -in 013342 -01 503- 793.5747 N Corrections /Comments /Instructions: C6 8 A1N \10%--"T 'Na a ' b' fo(L A, vbip -N,D ;a • 5�5 -.•) P,J c ca2c,vC 1 A b6rti0(I QA(Ledv1V o NFL el c.-- _ b c AN - SCI cf ta `gyp q ccztst■ q KL,L ("tANeA es Gz,eiv j (3 - r_- -s . . 3 �- I t �-c� N j 1 2 acne__ wQ�s , 4 ,, X 0 cz. iL`a A ❑ PASS A PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS _ FAIL El CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED Inspector: NC 1 Date: '3I III O 2�t�� Phone #: (503) 718 - CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MS1 —& / S INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / A M BUP �[ Location / r o �2� ��7 / / 2 / s Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing _ Insulation , \ /�r `L 3 O J ` Drywall Nailing Firewall Fire Sprinkler if �� " 3 Fire Alarm Susp'd Ceiling Roof Other: ,may Final 1Y .2 — 6 FAIL d ✓ � S 06 } PLUMBING ✓ �2 � Under Slab O? /S –. 77 - 6 1 - 1E.r) Rough -In Water Service /// ‘L,/ Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Ot - • PASS PART FAIL HANICAL 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 inspectio ity Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for r-'nspectior "E: __ Unable to inspect – no acc s Fire Supply Line ADA // 3 e '! / Approach /Sidewalk Date Inspe Other: Final DO OT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200 00168 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639- 4171P�iii�l�� • Inspection Requests (24 Hrs.): (503) 639 -4175 =� :_.. INSPECTION WORKSHEET FOR DATE: 11/3/2005 TIME: 7:06AM PAGE: 51 SITE ADDRESS: 14062 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE • LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. 11/2105: Added low voltage for Audio/Stereo. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503-772-4663 Inspection Request Scheduled For: Date: 11/3/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 020225.02 503.772 -4663 N Corrections /Comments /Instructions: a lq X 00 (9 0 0 CTT6 f. ;r‹),A,Az-7-‹ Y . 1 0 i . 4- . --(-L- z' Q . 0-,----- t O/ 3\/0 S (c 9 v - r 4-io,,;ii- r. c -.,,:: \ -is- S' K ciA ---,P\ ..-6 ke__ k- �,,,e ‹ k -� / ' ,, ti p- ,,,..__.A__- 4i k ,, • 7/..' Os ❑ PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS e'FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: \_ (-^\ Date: /3/0 V-- Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 !�Ip�rugy�j�l Inspection Requests (24 Hrs.): (503) 639 -4175 ,_.._.11k INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 62 SITE ADDRESS: 14082 SW 121ST AVE • CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 -772 -4663 Inspection Request Scheduled For: Date: 10/31/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 019793 -02 503 772 -4663 N Corrections /Comments/ Instructions: • PL 1 Z — oc 7'/ T J 4 s 1-1.0) Ptho Ms = '1--- 6161, (=vim / 0/ r3M * /Z 01. G n PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS Z FAIL • A FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED . Inspector rate: /0:S • Phone #: (503) 718- CITY OF TIGARD \ _ BUILDING DIVISION PERMIT #: MST200S -0015B 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 �omn,elm�i)f�l,i Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/9/2005 TIME: 7 PAGE: 80 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family roam /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 - 772 -4663 Inspection Request Scheduled For: Date: 8/9/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 013140 -01 971 -645 -9273 Y Corrections /Comments /Instructions: wit I`�•�'- i ■EASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NQ ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: , / ! Phone #: (503) 718 - r CITY OF TIGARD BUILDING DIVISION #: IdfS'T24(fxa 0015e (6_______. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 A �l Inspection Requests (24 Hrs.): (503) 639 -4175 �.__e.. INSPECTION WORKSHEET FOR - DATE: 11/3/20055 TIME: 7:06AM PAGE: 49 SITE ADDRESS: 14082 SW 121ST AVE_ CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. 11/2/05: Added low voltage for Audio /Stereo. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 - 772-4663 Inspection Request Scheduled For: , Date: 11/3/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 020225 -03 503. 772.4663 N Co ections /Comment /Instructions: C 10I -1/6 s (CA9 ). et i ciJ e.ANA ■ - r,,,1 LQ fl „_____,. ..cl..e,zikA eie.)-- {4\„.0,_...L__,,, vs-s-v_ \ . 4 t v __,e,I_-e_s .e t . -- Oki _ 1' N 0 0.e c ''• A , t.A..;1 ,,. (?_9_ce.,t,.., Jic A,., ,aQ cz b - e---( 22 - - --02_ 4 \ -- \ -- k---tr , -( 4 1A.__ C_,,, --(.1-- -__A c_u,...-, ‹.) P `+'L . ( -,„I pLrt,v.c- - c_v- ----(--- s - 1." ,. L__: --\ - k - c_e____ a v2:2___ ''' /2.- . iP../1 ■;JZ. 4 el_ H 7�o _ - 003q UV\ 0 ' ' ` S - 2Y- . 1 ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS VI FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 00156 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 tnv r i � Inspection Requests (24 Hrs.): (503) 639 -4175 ____La- . ''I I INSPECTION WORKSHEET FOR DATE: 11/3/2005 TIME: 7:06AM PAGE: 53 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. 11/2/05: Added low voltage for Audio/Stereo. • OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503. 772-4663 Inspection Request Scheduled For: Date: 11/3/2005 Pour Time: . Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 0202255 -01 503-772-4663 N Corr ctions /Com ents /Instructions: � (L1 2 , 6 - q J . b / / yac E ,_ . 160 [ PASS ❑ PARTIAL APPROVAL y CANCEL I I NO ACCESS FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED • •ecto . .ate: 'hone • . 503) 71: 10/31/05 MON 11:10 FAX 503 684 0954 CARLSON TESTING 120 0 2 b � ,, _ Main Office .- Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave_, NE P.O. Eox 7918 a Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708 artson Testing, Inc. Phone (503) 684 -3460 Phone (503) 589 -1252 ,Phone (541) 330 -9155 FAX (503) 684 -0954 FAX (503) 589 -1309 FAX (541) 330 -9163 & Special Inspection FINAL SUMMARY LETTER ° n• . October 31, 2005" • - T0509364.CTI , - City of Tigard p . / - - o 13125 SW Hall Blvd., - ' . Tigar I, OR 97223 -8199 - - • -A a Attn: Building Department 0 Re: # Residence © 14082 SW 121 Street , - 14082 SW 121 Street — Tigard, OR' __ - •Permit #: MST2005 -00158 • .° e p " Dear Sir or Madam: a This lsato certify in accordance with Section 1701 of the Uniform Building Code, Title 24, we have performed special inspection of the following item(s) per our inspection reports only: Installation of Adhesive Anchors - s _ .n q / - 9 a -O All inspections and tests were performed and reported according to the requirements of Project Documents and, to the best of our'knowledge, the work was in conformance -with the,approved plans and specifications, approved change orders and applicable workmanship provisions of theQState Building Code and Standards, as well as the structural engineer's design changes, approvals and verbal instructions. 4 Our reports pertain to the material tested /inspected only. Information contained herein is not to be reproduced, except in full, without prior authorization from this office. - a .. a If there are any further questions regarding this matter, pleas d o not hesitate to contact this office. Respectfully s bmitted, ' C -',.- +N f rST1NG,l C - .... - a , • o Douglas W. ch o Chief Executive Officer — • mbw • - 0 tl o cc , Oregon Homes Services LLC -- Greg Braxwell A G Rolin Consultants —Adam Rolin ,: - CAD Monkey;Lt.:C —Trent Jorgensen - ' r a , �v i � .. ! /. A - 0 G ` • l CITY OF TIGARD BUILDING DIVISION PERMIT #: IvMST2005^0015B 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 /�mam�4Niy�g ... Inspection Requests (24 Hrs.): (503) 639 -4175 ' ...... INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 61 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503-772-4663 Inspection Request Scheduled For: Date: 10/31/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 019793 -03 503772-4663 N C•rrections /Comments /Instructions: ..) - , ( or- .1.__. r d dam. L , - 7t 6 4 `J e__: &t/ - 657 :1 -51. - /A a) S11 ,4 c - e-__- � --' .°— k., P `___ _e____ .rth_s_m___ft_c _401• 7._: 1C-14- r i v WC__ pL- ✓"t fro (,---7 "lam to ,i- _._..- ❑ PASS Er PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS g FAIL - FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date:/0 °F'7 a \, Phone #: (503) 718- I CITY OF TIGARD �` BUILDING DIVISION PERMIT #: MST2005 -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 4" Inspection Requests (24 Hrs.): (503) 639 -4175 �&J' L . INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 63 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503- 772 -4663 Inspection Request Scheduled For: Date: 10/31/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 019793 -01 503772 -4663 N Corrections /Comments / Instructions: PASS d PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL % ' FOR INSPECTION ❑ - ADDITIONAL FEES ASSESSED Inspect. Date: �� J �� Phone #: (503) 718 - CITY OF TIGARD V • BUILDING DIVISION PERMIT #: T 0 5 -0016 8 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 / -4111111" M Inspection Requests (24 Hrs.): (503) 639 -4175 .. INSPECTION WORKSHEET FOR DATE: 8/18/2006 TIME: 7:06AM PAGE: 87 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC - PHONE #: 503.772 -4663 Inspection Request Scheduled For: Date: 8/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 280 Insulation 013802 -01 971 -645 -9273 V AK Corrections/Comments/Instructions: K_PASS ' ' ' IAL APPROVAL CANCEL n NO ACCESS n FAIL 'ALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Date: 8 0 C #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006 00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/16/2006 TIME: 7 :06AM PAGE: 33 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK • DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503-772-4663 Inspection Request Scheduled For: Date: 8/16/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 013624 -02 971 -6445 -9273 Y Corrections/Comments/Instructions: , p (12( 10 PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , Date: tF 7 6— Q 5-- Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006.00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2006 Phone: (503) 639 -4171 /i d�IP uy�r�IjII l Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/16/2005 TIME: 7:05AM PAGE: 34 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 -772 -4663 Inspection Request Scheduled For: Date: 0/16/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 615 Mechanical rough -in 013624 -01 971 -645-9273 N Corrections /Comments /Instructions: '�/ /-S7' o ,� v�� �/`�L. A 5'v %O Sil L � .c4S'v 2,4174 �(.J ��' 4 L i,7 ❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS (l FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: glL0----0S Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005.00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 �m���Npuypiip�l� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/15/2005 TIME: 7:06AM PAGE: 54 SITE ADDRESS: 14082 SW 121 ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 -772 -4663 Inspection Request Scheduled For: Date: 8/15/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 242 Interior shear walls 013534 -01 971 - 645.9273 Y Corrections /Comments /Instructions: • PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 1 FAIL C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED �' ,U 718- Inspector: Date: ,�.5 P #: 503 �S � ) 718 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200500159 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/0/2005 Phone: (503) 639 -4171 lAmau�p�u N� jj\ Inspection Requests (24 Hrs.): (503) 639 - 4175 °`-.�., INSPECTION WORKSHEET FOR DATE: 8/15/2005 TIME: 7:05AM PAGE: 53 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 -772 -4663 Inspection Request Scheduled For: Date: 8/15/2005 Pour Time: Code # Inspection Description Confirm #. Contact # Message 275 Framing 013534 -02 971 - 645.9273 Y Corrections /Comments /Instructions: C�`s tiA.iJ J 2- f O'YS e v LG A/2.¢ Z41..4J 1�/ ,rl , 7� i/ co G /149/x- i '' J• G GS ci 6re� f"L"r ( � atiA9/4J /7/5 /-4 t1/L/ n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS AIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: -15-- °=Phone #: (503) 718- CITY OF TIGARD- .■ BUILDING DIVISION PERMIT #: MST200S -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2006 Phone: (503) 639 -4171 /niue/gp ii l It Inspection Requests (24 Hrs.): (503) 639 -4175 ° ° °__.. INSPECTION WORKSHEET FOR DATE: 8/12/2005 TIME: 7 :06AM PAGE: 45 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503-772-4663 Inspection Request Scheduled For: Date: 8t122006 Pour Time: Code # Inspection Description Confirm # Contact # Message 240 Exterior sheathing 013467-02 971 - 645-9273 Y Corrections /Comments /Instructions: • • FA PASS %Y ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ol FOR INSPECTION 111 ADDITIONAL FEES ASSESSED v. Inspector te: 0 ' / - C2 7Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -0016Q 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 - Phone: (503) 639 -4171 Alkow Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/12/2006 TIME: 7 :06AM PAGE: 44 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503. 772 -4663 Inspection Request Scheduled For: Date: 8/12/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 242 Interior shear walls 013457-03 971-64.5-9273 Y Corrections /Comments /Instructions: • 1■r6z -- r ❑ PASS • PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS A FAIL r, CA OR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: L D ate : e J 2 L hone #: (503) 718- �. s CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 - mnu%�il� Inspection Requests (24 Hrs.): (503) 639 -4175 �' AL INSPECTION WORKSHEET FOR DATE: 8/12/2005 TIME: 7 :06AM PAGE: 47 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel, OWNER: BLACK, KENNETH A + GRETA A, - PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 5503.772 -4663 Inspection Request Scheduled For: Date: 8/12/2006 Pour Time: Code # Inspection Description Confirm # • Contact # Message 615 Mechanical rough -in 013457 -01 971 -645 -9273 N Corrections /Comments /Instructions: FL r TD Ft kt1,0). 2 C , . /ib e Q ' Alev S i i - 7V .0 Pi v' t-- v LT et-t ❑ PASS ,iii PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL MI CA OR INSPECTION ❑ ADDITIONAL FEES ASSESSED Ins ector: is Phone #: (503) 718 - P ) • CITY OF TIGARD BUILDING DIVISION - PERMIT #: MST2005.00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2006 Phone: (503) 639 -4171 :AllIm'IPII / l1: Inspection Requests (24 Hrs.): (503) 639 -4175 —_,t41 __.. INSPECTION WORKSHEET FOR DATE: 8/9/2005 TIME: 7 :05AM PAGE: 79 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 5 772 -4663 Inspection Request Scheduled For: Date: 8/9/2006 Pour Time: Code # Inspection Description Confirm# Contact # Message 615 Mechanical rough -in 013141 -01 971 -645 -9273 Y Corrections /Comments /Instructions: ' / / z l -z L 6 1 • El PAS " ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: //4 Date: --- Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION ) - PERMIT #: MST2005 -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 h c t . Inspection Requests (24 Hrs.): (503) 639 -4175 .414- 111., INSPECTION WORKSHEET FOR DATE: 7/28/2005 TIME: 7:08AM PAGE: 55 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 5 772 -L663 Inspection Request Scheduled For: Date: 7/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 235 Shear walls/anchors 012292-01 50317 -6309 N Corrections /Comments/ Instructions: � A'PI -n) ' A-_?S 4 S / '( 4t7? ■ �.c.�. cilirliLC L r — l' /4-0-r ----- 1/LS'c'l7 `' - r�A - • —7 �iS'Zi7.2, l-.jf J'2 -----;- 1t'i 6--ct.! - 41 ❑ PAS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS AIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , Date: 7- 26- Phone #: (503) 718- CITY OF TIGARD • BUILDING DIVISION PERMIT #: MST2005.00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 802005 Phone: (503) 639 -4171 i Inspection Requests (24 Hrs.): (503) 639 -4175 � INSPECTION WORKSHEET FOR DATE: 7/28/2005 TIME: 7:08AM PAGE: 54 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 - 772 -4553 Inspection Request Scheduled For: Date: 7/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 240 Exterior sheathing 012292-02 503. 317 -6309 N Corrections/Comments/Instructions: - .1 5 i'1 > L Gy /1 GL IJi LGf��ti' /C/G Z 5 • n PA n PARTIAL APPROVAL El CANCEL ❑ NO ACCESS FAIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED i A,/ Inspector: Date: 7 -- 2. --a, Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006.00i 8 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 610/2005 Phone: (503) 639 -4171 �A jjr / 1 0 1 ,� yl 1\ Inspection Requests (24 Hrs.): (503) 639 -4175 ' . INSPECTION WORKSHEET FOR DATE: 7/28/2005 TIME: 7:00AM PAGE: 53 SITE ADDRESS: 1408 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 026 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503-772-4663 Inspection Request Scheduled For: Date: 7/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 242 Interior shear walls 012292 -03 503 -317 -6309 N Corrections/Comments/Instructions: �f%r A- £4 ALL z.c , /007 . n PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS IL CALL FOR INSPECTION ❑ADDITIONAL FEES ASSESSED Inspector: Date: ° i p �- 0,z—d� Phone #: (503) 718- CITY OF TIGARD Cale - / zj f� , BUILDING DIVISION PERMIT #: MST2005 -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 �/ iidl�l���i, , ,,.t\ r Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/17/2005 TIME: 7:11AM PAGE: 75 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503- 7714663 i Inspection Request Scheduled For: - Date: 6/17/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message ' 225 Post/beam structural 009534 -01 503.317 -6309 N Corrections/Comments/Instructions: Al(4 6.1,0V vkl. i ILIAIV• C p_A/ L i -- 4 ' , l ( 1 • K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 6-i-i-6S- Inspector: Date: Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005.00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 anne° n i � "\\ Inspection Requests (24 Hrs.): (503) 639 -4175 f 'Ii INSPECTION WORKSHEET FOR DATE: 6/13/2005 TIME: 7:08AM PAGE: 10 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: - SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK • DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503- 772 -4663 Inspection Request Scheduled For: Date: 6/13/2005 Pour Time: 11:00 Code # Inspection Description Confirm # Contact # Message 210 Foundation walls 009101 -02 503- 452 -5388 N Co•rections /Comments/ Instructions:. { j . e—.e — \ p : T ) --■' Arlifarr, - — ( 0 - ,‘ . ^ :.J-- -.9% _ ed / . Z___e_e_...f ..sv\ a • ri Li- • ' mac! -.6 . bk. . � � r i ❑ PASS 1',1 PARTIAL APPROVAL ❑ CANCEL , ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 10 / 11 AS Phone #: (503) 718 CITY OF TIGARD BUILDING DIVISION A - PERMIT #: MST2005 -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 : mr- u1I;�1911 li Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/13/2005 TIME: 7:08AM PAGE: 11 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition &.remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503- 772 -4663 Inspection Request Scheduled For: Date: 6/13/2005 Pour Time: 11:00 Code # Inspection Description Confirm # Contact # Message 205 Footing 009101 -01 .503-452 -5388 N Corrections /Comments /Instructions: - ‘ '1A kt2Ca V _ 7 t.i .�. n PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED !� Inspector: Date: ( Phone #: (503) 718- CITY OF TIGARD B ILDING DIVI - PE IT #: U SI ON RM MSr2005.00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 /m iIh Inspection Requests (24 Hrs.): (503) 639 -4175 ° __.. INSPECTION WORKSHEET FOR DATE: 6/13/2005 TIME: 7:08AM PAGE: 9 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. • OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 - 772 - 4663 Inspection Request Scheduled For: Date: 6/13/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 215 Footing drain C � 009101 -03 503452 -5388 N r D C S Corrections /Comments /Instructions: CA- 0 - x . tJ - - e_ (atC9 � L.).► G rt7 LA/■' • 6 I CO AN PASS ❑ PARTIAL APPROVAL ' CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: V(_; Date: V� 3 / 6 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005- 00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8 /2005 Phone: (503) 639 -4171 rn,7a Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/9/2005 TIME: 7:09AM PAGE: 94 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC , PHONE #: 503 -772 -4663 Inspection Request Scheduled For: Date: 6/9/2005 Pour Time: 2:00 Code # Inspection Description Confirm # Contact # Message 205 Footing 008798 -01 503 - 577 -5914 N Corrections /Comments /Instructions: vl /L) •0 • ❑ PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS AIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: -- Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -00158 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/0/2005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/9/2005 TIME: 7:09AM PAGE: 93 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503 - 772 -4663 • Inspection Request Scheduled For: Date: 6/9/2005 Pour Time: 2 :00 Code # Inspection Description Confirm # • Contact # Message 210 Foundation walls 008798 -02 503 -577 -5914 N Corrections /Comments/ Instructions: • ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL •. ' ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: / _ Date: Phone #: (503) 718- ' Oct 18 05 01:56p AG Rol in Cons 503 6 63564 p . 1 4 AG ROLIN CONSUETI Nq , _ AO ....... 11 300 SE LINNY LANE, BORING, OR 97009 . ,. (503) 663-9960 FAX (503) 663-5647 . • AGROLIN@AOLCOM A STRUCTURAL DESIGN, ENGINEERING & CONSULTING • FAX COVER SHEET DATE: / ° d'e--- NUMBER OF PAGES: i (INCLUDING COVER SHEET) - , - TO: 6—rey AT: Z/". i --C6 S PROJECT: g/,,,,-,k 4Ire-47 I JOB NUMBER: S 4 a FAX #: 77 1 c --- 41 CC: - . FROM: 4ia TV) • ................ ,,.......... COMMENTS. - Permit #: .. # 0 5 61- a ‘ i 4/ '/ 7 el Ile a il di--bAr (2--) a c2 e ad),-,h,-) eetA f 4 ..) 1 i l ro j 4/ w --) - & 4 7(oa r?t 14 e ,,,,ec ,..-.. P ' • A - cV K • /,-‘ . , ::/G-' r- .„: • 4, ''.•,- Nef" 19, + \>, 1 ExPlam 12-31-20 Aitaimitieumn mammnolimmomm Main Office Salem Office Bend Office k'' , P.O. Box 23814 060 Hudson Ave., NE P.O. Box 7918 • Tigard, Oregon 97281 • Salem, OR 97301 Bend, OR 97708 Carlson Testing Inc• Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 FAX (503) 684 -0954 FAX (503) 589 1309 FAX (541) 330 -9163 Special Inspection (FINAL SUMMARY LETTER October 31, 2005 T0509364.CTI City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 -8199 Attn: Building Department Re: Residence @ 14082 SW 121 Street 14082 SW 121 Street – Tigard, OR Permit: #: :00158 — '� Dear Sir or Madam: This is to certify that in accordance with Section 1701 of the Uniform Building Code, Title 24, we have performed special inspection of the following item(s) per our inspection reports only: Installation of Adhesive Anchors All inspections and tests were performed and reported according to the requirements of Project Documents and, to the best of our knowledge, the work was in conformance with the approved plans and specifications, approved change orders and applicable workmanship provisions of the State Building Code and Standards, as well as the structural engineer's design changes, approvals and verbal instructions. Our reports pertain to the material tested /inspected only. Information contained herein is not to be reproduced, except in full, without prior authorization from this office. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully . bmitted, C ' ° *IV c STING, I C Douglas W. ch Chief Executive Officer mbw cc: Oregon Homes Services LLC – Greg Braxwell A G Rolin Consultants – Adam Rolin CAD Monkey LLC – Trent Jorgensen Main Office Salem Office Bend Office • P.O. Box 23814 060 Hudson Ave., NE P.O. Box 7918 Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708 Carts on Testing Inc. nc • Phone (503) 684 -3460 Phone (503) 589-1252 Phone (541) 330-9155 FAX (503) 684 -0954 FAX (503) 589 1309 FAX (541) 330 -9163 October 31, 2005 T0509364. CTI Permit No. MST2005 -00158 FIELD INSPECTION REPORT DATES COVERED: October 11, 2005 PROJECT: Residence @ 14082 SW 121 Street ADDRESS: 14082 SW 121 St Street — Tigard, OR INSPECTOR: J. King, COP #729 10- 11 -05: CTI representative observed the installation of 5/8" threaded rods into cleaned, proper diameter holes at (12) locations for HTT16, using Simpson Set Pac, ICBO #5279, Batch #'s: 139194EE and 293780EE, expiration dated 6/06 and 9/06. Installation conforms with approved plans /engineer (for 2 locations with 8 ' /z" depth) and OR, ICBO requirements. *'* CHECK ONE BOX ONLY *** YES NO 1. This is a preliminary inspection only. — OR — ❑ 2. The work inspected conforms to acceptance criteria listed above. If "No," the portions of the work that are non - conforming items are clearly stated above and will be added to the NCL. Remaining portions of the work, which are not preliminary in nature, are to be considered as ® ❑ conforming. Our reports pertain to the material tested /inspected only. Information contained herein is not to be reproduced, except in full, without prior authorization from this office. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CA SO TESTIN C Douglas W. Leach Chief Executive Officer JK/mbw cc: Oregon Home Services LLC — Greg Braxwell City of Tigard Building Dept A G Rolin Consultants — Adam Rolin Cad Monkey LLC — Trent Jorgensen