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Permit ~CITY OF TIGARD MASTER PERMIT PERMIT #: MST2008 -00160 COMMUNITY DEVELOPMENT DATE ISSUED: 2/24/2009 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2 S 103 D D - 00405 SITE ADDRESS: 10765 SW FAIRHAVEN ST ZONING: R -3.5 SUBDIVISION: FAIRHAVEN COURT LOT: 001 JURISDICTION: TIG PROJECT: HULQUIST Project Description: Converting carport to garage. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: 2,136 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 2,136 sf 15,000.00 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: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: NAT FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 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 FOR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 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 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL S SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable MARY ANN HULQUIST OWNER laws. All work will be done in accordance with approved plans. This 10765 SW FAIRHAVEN ST permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503- 639 -5168 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 651.72 REQUIRED ITEMS AND REPORTS Issued By : a , ; `, ` 1 ► ► Permittee Signature : hf.E, , GV t-,__.,_/ i1 Call 503.639.4175 by 7:00 a.m. for an inspection that business 04. 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. B+a ldiit Appl Residential FOR OFFICE USE ONLY 1114 City of Tigard e DateB /ji1�, ,j Permit No.: Zola 1V '"'01160 • 13125 SW Hall Blvd., Tigazd, OR 97223 Plan Review i M� Other Permit: Phone: 503.639.4171 Fax: 503.598.19 r� Date/B : TI G A R D Inspection Line: 503.639 �t! oo� Dale Ready /: 7 0 See Page 2 for Internet: www.tigard- or.gov 1 f/ Notifie 62 /6 Supplemental In 1 P Cji,(P ` 1 7- - n 4/1/ 14 TYPE OF WOR �� REQUIREDDAT 1- AND 2- FAMILY DWELLING ❑ New construction ❑ D�f�� V G4 Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all El Addition/alteration/replacement ❑ O% ' equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. El 1- and 2- family dwelling El Commercial /industrial Valuation: $ /l- � ❑ Accessory building El Multi-family Number of bedrooms: ID Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /0 7 �05 �,cvr r R ,, e �i4(/ei/ Zr, City /State /ZIP: 7- 6_40e46 I ]ve__ 7 .7 Z Z.— 3�/ Garage /carport area: square feet Suite/bldg. /apt. no.: f Project name: 14 iiu1 a u c S} Covered porch area: square feet Cross street/directions to job site: [Xli4T7' S _T, Deck area: square feet �,¢G / ,i 4, _ n C¢l,¢ 7`2/,t/.S - , 7i> /2-0/ Other structure area: square feet 4- y - e�/ rcie -- (/ 6 v Z F,4 /ee</Adi'esl/ REQUIRED DATA: COMMERCIAL-USE CHECKLIST Subdivision: F vE.& CBC9(`( Lot no.: D t Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. C low/ / XI gi4-/'�BJZT 77/ ( ,.'-'-e-- Valuation: $ Existing building area: square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: in 4441 ,44/ A/ /4 '� g 0 6 7 Type of construction: Address: /Q ? 67 ,, . 4 (l .4 vex/ „S Occupancy groups: / City /State /ZIP: ! (4� OR,. 7 . 6 ZZ 3 - /8 Existing: Phone: (53), 3q___6 (6 r Fax: ( ) New: kif APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: S m under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: CONTRACTOR Business name: dutAt ti/ BUILDING PERMIT FEES* Address: (Please refer to fee schedule City/State /ZIP: Structural plan review fee (or deposit): Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: Total fees due upon application: Amount received: Authorized signature: ICe e14Uy1dr 41#r/jit)i This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: '_ / / , /�� . c� Date: t * Fee methodology set by Tri- County Building Industry ' f/ 7 [�� Service Board. I: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist One- and Two- Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No.: 1 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: _ Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: TIGARD 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard- or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ _ ❑ CI 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 ❑ ❑ ❑ 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 ❑ El ❑ 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 Ore. on and shall be shown to be applicable to the .ro'ect under review. it RISDIC I IONAI_ SPECIFICS 23 Three (3) 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 trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature 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. 1:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440.4613T(11/02 /COM/WEB) 11) PC1 /LJ✓A-r.--G AIM! , Mechanical Permit Application �' Rece • FOR OFFICE USE ONLY of Tigard CI ` Date/By: /0 ' �U 0377- Permit No.: /iff lv )( ... �) /job ' • 13125 SW Hall Blvd., Tigard, OR 97. VI Plan Review � v< <KJ Phone: 503.639.4171 Fax: 503.598. dI r Date/By: Other Permit: II G A R I) Inspection Line: 503.639 ; "' Q D at e Ready/By: orris: 0 See Page 2 for Internet: www.tigard- or.gov N! O I1 ��C, Not 'r1 Supplemental Information TYPE OF WORIC► A , % A COMMERCIAL FEE* SCHEDULE — USE CHECKLIST El New construction ❑ Addition /alteratio l$ 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. CATEGORY OF CONSTRUCTION Value: $ 1- and 2-family dwelling C /industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES* y g ❑ ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: • Description Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job Air conditioning or heat pump ob site address: �O ��p �j _ s ti.) ',.1../ j t1 V± 4" 7" (requires site plan showing placement) 14.00 City /State /ZIP: 77 4 4 , t , € - 97 2_2-5 Furnace 100,000 BTU (ducts /vents) ( 14.00 1 $ Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: �,¢7�/ /Vs ��- Duct work 10.00 / / / Hydronic hot water system 14.00 y�. l �i G / // J i ... 7` 4I ,g7`e/ i/5 -. 2- 7` - Residential boiler (radiator or 01 AV Or/f/ /� / / /.Kl Unit heaters 14.00 7 C � O Unit heaters (fuel -type, not electric), F 4- f C "y , „ e ,Z „:""2e - in -wall, in -duct, suspended, etc. 14.00 Subdivision r �? Lot no.: Flue /vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel applia es �� DESCRIPTION OF WORK Water heater 6d l0 f!•`� e wr Gas fireplace 10.00 fire � 4/7 � ��T �v jQ/'C�/ Z J FI t for water heater or gas --- J ek � e" Log lighter (gas) 10.00 e 10.00 r °� f C./.- Log J Wood/pellet stove 10.00 Wood fireplace /insert 10.00 IV PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00 Other: 10.00 Name: /17.414,1 /4/V A v / s Environmental exhaust and ventilation Address: /e 7 1 6 5-- C) . / 2. / 2 v � ' / L � Range 10.00 e hood/other kitchen r.7 - it/ �/ equipment City /State /ZIP: Clothes dryer exhaust 10.00 �% / 0 �� Z Single -duct exhaust (bathrooms, Phone: (. l3) 6 3 �- ..6-7,6 4 Fax: ( ) toilet compartments, utility rooms) 6.80 1 APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: 6'.9/71.____ $5.40 for first four; $1.00 for each additional Furnace, etc. Address: Gas heat pump City/State /ZIP: Wall/suspended/unit heater Phone: ( ) Fax :: ( ) Water heater . p (Ip Fireplace E -mail: Range CONTRACTOR Barbecue 4 , ' Clothes dryer (gas) Business name: v /�' Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Phone: ( ) F ax: ( ) Minimum permit fee ($72:50) 7Z j Plan review (25% of permit fee) CCB lie.: State surcharge (12% of permit fee) p,.--K) r TOTAL PERMIT FEE I , in. 80 e � This permit application expires if a permit is not obtained within 180 Authorized signatur �( days after it has been accepted as complete. Print nameta_.(41 ‘.... , � %� /yv'c' /Q Date: . 11._ , 7 _ Or ' Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits\MEC- Perm�App.doc 01/19/07 // 440- 4617T(11 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $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 01/19/07 2 Plumbing Permit Application ‘Ae FOR , �e© Buildin Fixtures OFFICE USE ONLY City of Tigard 7 ` Received p ermit No.: Vj5,� �y / 111 � 13125 SW Hall Blvd., Tigard, OR 97223 \� +' ... !I / / / /�f ��- /! � P U ` /"'� ■ Phone: 503.639.4171 Fax: 503.598.1960 v 'C` Vp ` rP /g ew ((( ( Other Permit No.: Inspection Line: 503.639.4175 CA 1 \ 0 AAV'� at Juris: 0 See Pa e 2 for TIC K D Internet: www.ti ard -or. ov R y o g g g 033 Notified Method: T S upplemental Information TYPE OF WORK v FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 /: 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: # SOS .-Z `i4, / _ ♦ t. t Catch basin or area drain 16.60 City/State/ZIP: -7 V i 02 9-2 2 S Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: %/,Q< 4" -S �-^ Manholes 16.60 � e �,� G/ /r / G /o 77) , /4)", /A/s o2 7> Rain drain connector 16.60 �i I d / te- `, , Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Page 2. Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 61'/0la `'/.7/ d - / 'i7 --f p7 6-A2 c' ` e_ Backwater valve 16.60 /vta�4 ler AA^ tr. Clothes washer 16.60 L Dishwasher 16.60 RI PROPERTY OWNER ( ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: ' i ��..„ _ a` J % Expansion tank 16.60 Address: /0 7 6 , s - . ce j 7L---;4/,e ‘,/_e,(/- s= 7 Fixture /sewer cap 16.60 City/State /ZIP: 'Z' ` f e ye_ �7Z�$ Floor drain/floor sink/hub 16.60 Phone: (671) ) 15 C -S /&, Fax: ( ) Garbage disposal I 16.60 $� APPLICANT ❑ CONTACT PERSON Hose bib 16.60 \ Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: .. ..7 2 .7 Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: ` m 4, -0"Ve / Water heater f 16.60 i6.6,,, Address: Other: Subtotal City /State /ZIP: Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 S;1? .20 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: / , State surcharge (12% of permit fee) C 058 A , ■ v �� TOTAL PERMIT FEE Print name: Jj .,.� ", i f U * 41 / t, 7- Date: /_ f 7 . , , This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1:\Building\Permits\PLM - PermitApp.doc 1 2/27/06 440- 4616T(10 /02 /COMJWEB) l - 78 Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1s 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 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. Commercial Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 12/27/06 leo �G/ , Electrical Permit Application FOR OFFICE USE ONLY City of Tigard , .d �► Permit No.: • 13125 SW Hall Blvd., Tigard, OR 97223 an Rv Phone: 503.639.4171 Fax: 503.598.1960 EC DateBy: Other Permit: TI G A R U Inspection Line: 503.639.4175 \' ry 9(' Date Ready/By: Jc 's B See Page 2 for Internet: www.tigard - or.gov N0 V 1 t Notified/Method: Supplemental Information TYPE OF WORK � • OVTIGAR� PLAN REVIEW ❑ New construction ❑ Addition alteration /r ► ( rN 1‘ F I O N Please check all that apply (submit 2 sets of plans w /items checked below): • ( ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural t$ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "l - ", / �-- , /,, ,, / z4-, 100HP or more. occupancy. Job no.: Job site address: t/0 fd 01 /9 £ i 1 � yPU i ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: 17‘.....4 �,1/�5 O C C 7ZZ 3_ s.1 ❑Health -care facilities. ❑ 600volts nominal. for more than / 7 ❑ Hazardous locations. Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. //� FEE SCHEDULE Cross street/directions to job site: ,'` A /s 67- /�� 1 l Ec i j Description I Qty. I Fee. 1 Total I • / New residential single- or multi- family dwelling unit. l ✓ei .re 4J t¢TE 4/5 # �e, 4444 7b' ,1_,: 4 v 9; Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 g ' Limited energy, multi - family eA J ✓ . 7/1/, dg-ter :fre (C4� le residential (with above sq. ft.) 75.00 2 LL / Services or feeders installation, alteration, and/or relocation I / . 4' 6> b C/ i t.,> f 200 amps or less 80.30 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: mm44 ,N /1 g.vLQ v/ 6_-T 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: /0 6,6 e (, Fig - i t ,4xi Ve/i/ fr, Over 1,000 amps or volts 454.65 2 City /State /ZIP: -7"/ 1 4 q izz 3 _ 3 , i / Temporary services or feeders installation, alteration, and/or /i`s O relocation Phone: (, j ) / .3 f_...676 y 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, le se, rent, or exchange, acco In to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signatu iyf/ Date:l� �7 � � A. Fee for branch circuits with ❑ APPLI ❑ CONTACT PERSON above service or feeder fee, each branch circuit 6.65 2 Business name: B. Fee for branch circuits Contact name: without service or feeder fee, / 46.85 t 2 first branch circuit Address: Each add'I branch circuit / 6.65 G Gj 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: D t) �,e /2___ Signal panel, e r t i o n , energy panel, alteration, or Address: extension. Describe: Page 2 2 City /State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75 _ ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: '3 , '5 O Print name: w ./ Date: //,../7 f/ Plan review (25% of permit fee): (J State surcharge (12% of permit fee): 42-- Authorized signature: TOTAL PERMIT FEE: ,R7--- This permit application expires if a permit is not obtained within 180 Print name: In / ,Q � / /J Date: //..--- i 7 _ Q days after it has been accepted as complete. ""� ! " 1 * Number of inspections allowed per permit. I\ Buildin g\Permits.ELC- PermitApp.doe 05/23/06 440- 4615T(11/05/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: \Building\Permits\ELC- PermitApp.doc 03/23/06 Information Notice to Property Owners About Construction Responsibilities Statement Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. [ORS 701.055 (4)] This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box and complete the following statement: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I have read and understand the Information Notice to Property Owners about Construction Responsibilities contained on these two pages and I hereby certify that the information checked and completed above is correct and accurate. ,....„, ,• 101,/, A 4,7 / Pr name o permit appl Signatur f perm appl //— / 4i Date This form is supplied to building Permit #: aor�5"G�I�GL� Y Oregon �"' Construction Contractors Board, . permit � v 770 C ( 5 4/. J ` el;/AA'r s° ermit offices by the Ore on 4 =- 1 . , Address: -�/, ~ r, ` 5 - p I' as required by ORS 701.055 (6) +".y i �— a� r// 4 7/�-3 Issued by: .7 Date: This copy to issuing permit office This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. BUILDING DIVISION TIGARD TRANSMITTAL LETTER TO: �7) 7, J if i -) DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED DEC, 11•'2008 FROM: c So . I t y►� iP�-�c.� �2� / CITY DIVISION BUILDING NG DIVISION COMPANY: 0 8v,E, PHONE: 3- ?O7 ` 75-c;761 By:J RE: /2/s u c UC 1166 (Site Address) �� ber) (Project nam or su 'v ision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: I Description: 1 Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. / Floor /roof framing. - rg.>s 5 . Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): t'c>,Li REMARKS: FOR QF FI E USE ONLY Routed to Permit Technicians Date: Z rr C � Initia Fees Due: Yes o Fee Description: Amo ue: Special Instructions: Reprint Permit (per PE): ❑ Yes TiC O ❑ Done Applicant Notified: • Date: Initials: I :\Building\ Forms \TransmittalLetter - Revisions.doc 4/4/07 `�oTOnro� Ti �`� z mbil Permit Ap1ic . • wP 3 ,....it .4 Washington County Phone: 503 -:4.., -NA ax: 503- 846 -3993, Inspection Request: 503- 846 -3699 155 N. 1 AV, Suite 350 u _ , ' illsboro, OR 97124 •..• ••:ee.washington.or.us *RECO4 Current Ph • • .: _ • pproval: Project # Permit # 1(yIF�TZCO CU(n3 TYPE OF WORK FEE * SCHEDULE ❑ New construction • ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total IRTAddition/alteration/replacement ❑Other: R EC EI VE ew 1- 2 family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION R (1) bath 339.00 ,tE'1- and 2- family dwelling ❑ CommercialIindus r� 2 CC SFR (2) bath 435.00 u` J 2- SFR 3 u J bath 530.00 ID Accessory building ❑ Multi - family ( ) ❑ Master builder 0 Other: CITY OF TIGARD Each additional bath/kitchen 93.00 Fire sprinkler ( # sq. ft.) By Sq. ft. JOB SITE , INFORMATION AND LOCATIOI$UILDING DIVISIO V Site utilities Job site address: I (y ks (k) tl\hniQv- Catch basin or area drain 15.50 City/State /ZIP: s t ( r d /3 Drywell, leach line, or trench drain 15.50 Suite/bldg. /apt. no.: l Project name: \Au k Footing Drain (each 100'increment) 45.00 Cross street/directions to job site: ` Manufactured home utilities 103.00 . Manholes 15.50 Rain drain connector 15.50 Sanitary sewer (each 100 ft.): # of ft. 45.00 Subdivision: Lot no.: Septic Connection 32.00 Tax map /parcel no.: Storm sewer (each 100 ft.): # of ft. 45.00 DESCRIPTION OF WORK . Water service (1,5} 100 ft.): I ,E6 CO E 5.0 Fixture or item CO(1V Q,cr- ' .+ ciir 4-0 g irQ Q e • Absorption Valve 15.50 J 4 U v _ _ Backflow preventor 15.50 Backwater valve 15.50 Clothes washer 15.50 0 PROPERTY OWNER .Q- TE NAN T Dishwasher 15.50 Drinking fountain 15.50 Name: Ejectors/sump 15.50 Address: Expansion tank 15.50 City/State/ZIP: Fixture /sewer cap 15.50 Phone: ( ) Fax: ( ) Floor drain/floor sink/hub 15.50 ❑ APPLICANT Garbage disposal ❑ COAI TAG'F- PER3QN 16.4k t Business name: Hose bib 15.50 Hydroponic piping system 15.50 Contact name: Ice maker 15.50 Address: Interceptor /grease trap 15.50 City /State /ZIP: Medical gas (value: $ ) By Value Phone: ( ) Fax: : ( ) Primer (s) 15.50 Residential Re -pipe: 3600 sq.ft/less 93.00 E -mail: _ Residential Re -pipe: 3601 sq.ft/more 139.00 CONTRACTOR Roof drain (Commercial) 15.50 Business name: /4 'a. 114 6- 1-I r:)!U i C 46._ I L L C ; Sink/basin/lavatory 15.50 Address: 5 ) 5 ,) se - i i . LL C ,�; LAi .. Tub /shower /shower pan 15.50 1 City/State /ZIP: ("772.6 ' Urinal 15.50 K. Phone: (5 cc; ) ) 5 7 CI "? Fax: (y �, '') 4.S7 .- ' :f 7") Water closet ° 15.50 Water heater I it?. _RI . (00 CCB lie.: 1 7?i 1`� Z_ Lic. no.: iii .1/41 Other: Authorized signature: �- ° / .� Subtotal �1--- „. , / Minimum permit fee L .72.50 Print name: ,/lvzi.. ` y (L, r/ .6`' r Date: ..' Plan review (65% of permit fee) $ This permit application expires If a permit is not obtained within 180 days after it has been State surcharge (12% of permit fee) $ 08•'0 accepted as complete. * Fee methodology set by Tri -County Building Industry Service TOTAL PERMIT FEE $ n Board. 440 -4616T (6/19/C8) �G1ON „ et !,„ T't�ro Elec - -' ' ermit • .: '• IOII Current Planning Washington C' ', . 1' AV, Suite 350, MS 12, Hillsboro, OR 97124, Approval o mot' Phon - ; -: - 3470, Fax: 503 ' ' Project # M.8Z ZOO ES •6(5100 s i ection Re ' uests: 503- 846 -3699 www.co.w. ; • , . on.or.us TY OF WORK FLAN `REVIEW El New construction i, ` Addition/alteration/replacement ❑ Other: e heck all that apply: ice or feeder 400 amps ❑ Hazardous locations or more where the available ❑ service or feeder 600 amps or more CATEGORY OF CQNSTRUCTION FE' f 109 fault current exceeds ❑ Building over three stories 7 411- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory bidding 10,000 amps at 150 volts or ❑ Marinas and boatyards Multi- family ❑Master builder OF TI I, ' RD less to ground, or exceeds ❑ Floating buildings ❑ Other: (�; 4,000 amps for all other BUILDING DI I 1 0 ' iltstallations. ❑ Commercial -use agricultural . JOB SITE ' INFORMATION AND 'LOCATION buildings ❑ Fire pump Job no.: I Job address: ( �5 j3 - haven ❑ Emergency system ❑ Installation i derives ` KVA or larger system City/State /ZIP: - im (` n el i.� L Q ❑ Addition of new motor load of 100HP or more ❑ y. q -2," "1-3" occupancy } Suite/bldg. /apt. no.: Project name: ❑ Six or more residential units ❑ Recreational vehicle parks L �,� ❑ Supply voltage for more than Cross street/directions to job site: 1 ❑Health -care facilities 600 volts nominal FEE StiHEDUL E 7 7 Description I Qty. I Fee Total * Subdivision: I Lot no.: Residential single- or muyN family slling unit Includes>atitachoil.garage.:';. 4r,, ,,.4: . . Tax map /parcel no.: 1,000 sq. ft. or less 153.00 4 DESCRIPTION OE :WORK Ea. add'l 500 sq. ft. or portion 43.00 • Limited energy, residential 61.00 2 Q 1 v Q Vkt In 4 .t I a .- - 5li . E' f -€. with above s.. ft. Limited energy, multi- family 6700 2 residential (with above . ft.) PROPERTY OWNER SeryICes or fee I,ers installation, alteration,' and/or J'el Name: 200 amps or less 92.00 2 201 amps to 400 amps 122.00 2 Address: 401 amps to 600 amps 184.00 2 601 amps to 1,000 amps 275.00 2 City /State /ZIP: Over 1,000 amps or volts 514.00 2 Phone: ( ) l Fax ( ) "Tempi►r+u � - orf+e.deri in ; � : retocatit►n . r .. . Owner installation: This installation is being made on residential or farm property owned by me or a member of 200 amps or less 79.50 2 my immediate family. This property is not intended for sale, exchange or rent. (ORS 479.540(1) and 479.560(1). 201 amps to 400 amps 110.00 2 Owner signature: Date: 401 amps to 599 amps 153.00 2 `� OA41� .. I .. K; CONTACT . . pt . Br 4'+4 Rif4 east; alteration; .or eatteeaon p 'pa . A. Fee for branch circuits with Business name: above service or feeder fee, 8.75 each branch circuit 2 Contact name: B. Fee for branch circuits 4 46 without service or feeder Address: fee, first branch circuit 2 City/State /ZIP: Each add'l branch circuit 1 4405 ( Phone: ( ) I Fax: Mlscellait e..:oi7Teedoi• no tfil<eludet'1) ., . ( ) Each manufactured or modular 104.00 2 E-mail: dwelling, service, and/or feeder Reconnect only 79.50 1 ' CONTRACTOR Pump or irrigation circle 61.00 2 Business name: ( t �r y � + &v �C c . ✓ ; C 4 j cr re x. i � Sign or outline l 61.00 2 Signal circuit(s) or limited- Address: /0( � a x (3 / 5 . pc,.. .T ���-f, � energy panel, , City/State /ZIP: -� I- e, 7 s� q a e s Phone: (j ,;, j . i= , f . g - 5'''' S .� .3 - Fax: ( t',. t 6— C' sci ?e-6— , ; Per inspection 90.00 E -mail: CCB lic. no.: l r j'i- Investigation fee (See compliance) metro Other: ___— ELEGTRIGAL PERMrr 'FEES Subtotal Ale .5 . - Plan review (25% of permit fee) t Authorized t . State surcharge (12% of permit fee) b •4G signature: 1 ' ' :". "- . Y �� TOTAL PERMIT FEE - -� This permit application expires if a permit is not obtained Print name:�l j • > Date: 2 within 180 days after it has been accepted as complete fl r r� *Number of inspections allowed per permit. Revision 6/08 • — 123' — — LOT 16,359 SF I MAIN FOOT PRINT 2136SF LOT COVERAGE 13% !, I RECEIVED ' " P9 o I NOV 1 7 '2008 I CITY OF TIGARD I BUILDING DIVISION • 42' -0" 69'-4" —I 1' -8" • - EXISTING HOME ' I N 1f ,= • -I r, a _141 EXTG GARAGE t URTY '� O O 251 SF II r i — k /!! � HATCHING REPRESENTS 43' -0" 4' -2" 18' -10" 'ROPOSED GARAGE ADDITION i I DRIVEWAY 193SF N I — — — — — I 123 4 CURB 4 c D7 FAIRHAVEN ST (: 1.v NOTE: LOT IS LEVEL Contractor: Site Address: Scale: BY OWNER 10765 SW FAIRHAVEN ST 1"=20' D MARY- ANN HULQUIST TIGARD, OR 97223 Date: 09/09/08 CITY OF TIGARD . SITE PLAN REVIEW �� BUILDING PERMIT NO: : e W /[J j -- Street Trees: ifi Approved ❑ Not Approved Protected es: E Approved ❑ No Approved BY: 1,(1d IP-rr Date: /rig 00 Notes: 1 I See CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.: a ,,p1 _ PLANNING DIVISION: _y,d, Required Setbacks: a Approved Side: ,S ❑ Not Approve(: Street Side: ( Front, JO Garage: w Rear: IS ""seal Clearance: D Approved "laximum Building ❑Not Approved g Height. 3y feet ::Vv S Service Provider Letter Required: ❑ Yes ❑ No / ❑ Received . . 4 _ e Date: I ( o. �NGi EERING :PARTMENT: Actual Slope: % X Approved ❑ Not Approved Site Plan: . B d � Approved 0 Not Approved .. / :./„., Date: — ,..., Notes: CITY OF TIGARD /1 7 g- 0 J i1 C) BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 �NP�ypiipi�l / � Inspection Requests (24 Hrs.): (503) 639 -4175 9.1'• . :_.. • INSPECTION WORKSHEET FOR DATE: 1 1/( b' 7 TIME: PAGE: SITE ADDRESS: / J7 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: 7 — 7S-20 CONTRACTOR: PHONE #: P /J 5 Inspection Request Scheduled For: Date: Pour Time: I Code # Inspection Descri tion Confirm # Contact # ( pl y )/(1/-( g t r vt�► � „ ` f_. v 0 //4/ Corrections /Comments / Instructio: PASS (l PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: ( " V Date: / Phone #: (503) v � Ins p � ) 718- CITY OF TIGARD 4 FYr rY BUILDING DIVISION PERMIT #: mST zoo O 'O O 13125 SW Hail Blvd., Tigard, OR 97223 ,:: DATE ISSUED: Phone: (503) 639 -4171 Aar/ .„ „.C Inspection Requests (24 Hrs.): (503) 639 -4175- ° `__.. INSPECTION WORKSHEET FOR DATE: 61101 Q TIME: PAGE: SITE ADDRESS: 6165° 5 W r A ICZ \\q V C! CLASS OF WORK: SUBDIVISION: LOT #: "TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: • PHONE #: CONTRACTOR: PHONE #: • • Inspection.Request Scheduled For: Date: 61 01 0 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 P L..ir ; N� � r� �A� 19q �. �` i coL ' Corrections /Comments /Instructions: c.V\i'Dt � � 0 I N L c. 1 e N PPN' ... 5 19 . oCF Fc- 1 R.LN I D L-1 s l Vin, w H 1 • PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ►n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: . t B �—C Date: 6 ICI Phone #: (503) 718- 2- �- 1 CITY OF TIGARD , <t) 4 BUILDING DIVISION /7 V PERMIT #: p T2O0h3 -00160 13125 SW Hall Blvd., Tigard, OR 97223 / DA E IS ` " 12009 Phone: (503) 639 -4171 V Inspe Requests (24 Hrs.): (503) 639 -4175 ;IL, I ��� �� INSPECTION WORKSHEET FOR DATE: 2/26/2009 TIME: 7 :03AM PAGE: 15 SITE ADDRESS: 10765 SW FAIRHAVEN ST CLASS OF WORK: IA SUBDIVISION: FAIRHAVEN COURT LOT #: 001 TYPE OF USE4 • PROJECT NAME: HULOUIST �� DESCRIPTION: Comforting carport to garage. • `�I OWNER: HULOUIST, MARY ANN / PHONE #: 503 - 639.5160 CONTRACTOR: OWNER PHONE #: t 1 Inspection Request Scheduled For: Date: 2/26/2009 Doe Pour Time: .1too oe Code # Inspection Description Confirm # Contact # Mes uti 206 FO�)t.irt 080851 -01 503 -807 -7520 Y Corrections/Comments/Instructions: ( _ - 4Ccs5 ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: / Phone #: (503) 718-