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Permit pp li..!. CITY O F TIGARD MASTER PERMIT CITY PERMIT #: MST2007 -00070 COMMUNITY DEVELOPMENT fv DATE ISSUED: 5/10/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102DB - 01600 SITE ADDRESS: 09340 SW HILL ST ZONING: R - 4.5 SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: TROMP VAN HOLST Project Description: 198sf addition. I BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 195 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: 195 sf 18,018.00 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: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /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: 6014-amps-1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FOR> =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: I BURGLAR ALARM: 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 Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable JOHANNA TROMP VAN HOLST OWNER laws. All work will be done in accordance with approved plans. This 9340 SW HILL CT 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: 503 684 - 8986 Contact #: questions to OUNC by calling 503 246.6699 or 1.800.332 2344 Reg #: TOTAL FEES: $ 501.21 REQUIRED ITEMS AND REPORTS n Issued By : ' / �,G4 g— `----- / Permittee Signature • - ,� - o v 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. Building Permit Application Residential FOR OFFICE USE ONLY City of Tigard ® Date /B : Received rd& D�Q - 7e ) �— :]' Permit No.: M55,00 _ Al 13125 SW Hall Blvd., Tigard, OR 9722 CE!V Plan Review (` '- ' • Phone: 503.639.4171 Fax: 503.598.1960 p ❑ Date/By. '�(. O-7 ■ Other Permit: T l CARD Inspection Line: 503.639 A 1 R Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard -ocgov CITYOFT 2007 Notified/Method: Supplemental Information TYPE OF ��HICB� DI VISI O REQUIRED DATA: 1- AND 2-FAMILY DWELLING ING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ∎_:'Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the . CATEGORY OF CONSTRUCTION CTION work indicated on this application. zi 1- and 2 -famil dwelling Valuation: $ I B 000; y g ❑Commercial /industrial r ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE. INFORMATION AND LOCATION • • Total number of floors: Job site address: ` 3 Lt O S . \', \\ s'4c. , New dwelling area: \ c\ s" square feet City /State /ZIP: ' '\ S.,,r, Q CA "'tr3 Garage /carport area: square feet Project Suite/bldg. /apt. no.: Project name: k k ', �,,,_ Covered porch area: square feet Cross street/directions to job site: Deck area: square feet \A C'\ t. p Q w., c.„_ c- c� — Q '� c.- r cam. is \\ \ \ \ S'- . Other structure area: square feet _ _ REQUIRED DATA: COMMERCIAL-USE CHECKLIST Subdivision: - 1 C r �� ,,,` 3 ._,,,t no.: j n. b 00 Permit fees* are baseu on the value of the wotic pet :ared. , � Tax map /parcel no.: S \ .. — \ Iv O O 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. S. t ) Z K \ O c y,', \ (-^ .N s Crw��. Valuation: $ Existing building area: square feet . New building area: square feet ,gPPROPERTY OWNER ❑ TENANT Number of stories: Name: • ■\,,,.c�,b --. , �c.� Ni., c O� . V c.,..,� �c,,e� Type of construction: ' Address: \ 3 O .S . \-3 \--Vx "\ .S . Occupancy.groups: City /State /ZIP: c \ 0 C C k ' 2 3 Existing: Phone: ( 3) t g - g `\ ' �j Fax: ( ) New: ❑ APPLICANT . ❑ CONTACT 'PERSON NOTICE Business name: b ..0 .� L. f All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board 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: C3 . �c--. • 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 —e�� -" "� C� � This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print namea „� v'; . oti -., ci , ` Date: .. 3 1 0 "'1 * Fee methodology set by Tri -County Building Industry Service Board. I:\Building \Permits \BUP -RES PermitApp.doc 02/23/07 440- 4613T(I 1 /02 /COM /WEB) Building Permit Application Checklist , One- and Two - Family Dwelling . FOR OFFICE'- USE ONLY City of Tigard Received Permit No.. III C Associated v 13125 SW Hall Blvd., Tigard, OR 97223 Phon 503.639.4171 Fax: 503.598.1960 Associated permits: 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical TIGARD Internet: www.tigard-or.gov 0 Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN - REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ Cl 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 ❑ ❑ ❑ 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. 1:\ Building \ Permits \BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11/02 /COM/WEB) Electrical Permit Applicatio roll orH lcl `(ash o� lv T • t Cl and g V of Ti E�E� E T = r R eceDae,iB / ved /7t' . Permit No.:M y f 1000 " 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review 5 p p Phone: 503.639.4171 Fax: 503.598.1° , l. t 7 4 2001 Date/B . Other Permit: T I G Alt o Inspection Line: 503.639.4175 Date Ready/By: Juris: 53 See Page 2 for • Internet: www.tigard - or.gov CITY OF Notified/Method Supplemental Information TYPE OFe ING ®IViseN PLAN REVIEW - ❑ New construction OAddition/alteration/replacement 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 12n 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 ", "l -2 ", "l -3 ", Job no.: Job site address: /� IOOHP or more. occupancy. �` S yi �� ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: ' �� C ❑ Health -care facilities. ❑ Supply voltage for more than �l• q �I ` l2L 3 ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: ,•a •tS eOf,! 414("4 J /�;4 a . / ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: 0 r r 4 Description I Qty I Fee. I Total I ' New residential single- or multi - family dwelling unit. 1 1/441/ °•, '� Q 4: 44-•• Q Apt pa..Oi 4'd 66' a Includes attached garage. no 1,000 sq. ft. or less 145.15 4 Subdivision: 6,4,4 A 644 1 0 4 4 ( Lot no. /0--g Ea. add'l 500 sq. ft. or portion 33.40 I Tax map /parcel no.: s 1 Z 3 .. o 1 6 0 0 Limited energy, residential D ESCRIPTION OF WORK (w ith above sq. ft.) 75.00 2 f t i G / ©v fe A. f Q L energy, multi -family 75.00 2 f/ k e J O �+ G�, L{ Q� r f i O ti residential (with above sq. ft.) ` 6 44 e�' k Gh $ �.e Gf - 1 — 'd ^� t� Services or feeders installation, alteration, and /or relocation / O v(, 200 amps or less 80.30 2 9 PROPERTY OWNER • l ❑ TENANT . , 201 amps to 400 amps 106.85 2 Name ,� �� 1 .. 401 amps to 600 amps 160.60 2 0��� h n C� .� C V ��. R v fi 601 amps to 1,000 amps 240.60 2 Address: q3 4 d s Al L. f 1 1 s A.... Over 1,000 amps or volts 454.65 2 City /State /ZIP: / -1-- .....< O a .1 / `2 2.. Z 3 Temporary services or feeders installation, alteration, and /or relocation Phone: (sty 3) 63 I"i. gl g ( 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 599 amps 133.75 I 2 -- --- --- `� ..: Branch circuits — new, alteration, or extension, per panel • Owner si gn atur ate: ` 3 - O I A. Fee for branch circuits with ❑ APPLICANT ❑ 'CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: 0 ,;,t,), 2r B. Fee for branch circuits Contact name: without service or feeder fee, I 46.85 2 first branch circuit • Address: Each add'l branch circuit f 6.65 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: V w 14 er energy panel, a 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 (I hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL. PERMIT FEES - Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of permit fee): State surcharge (8% of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. Number of inspections allowed per permit. 1:\ Building \Permits\ELC - PermitApp.doc 05/23 /06 440- 4615TO1/05/COM /WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: . RESIDENTIAL. WORK ONLY: f Fee for all residential systems combined $75.00 Check Type of Work Involved: El Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* El Vacuum Systems* ❑ Other: . f COMMERCIAL WORK' ONLY: Fee for each commercial $75.00 system (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 El Intercom and Paging Systems E l Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations L' Building \Pefmits\ELC- PermitApp.doc 03/23/06 Construction Contractors Board Permit #: MS26b3 —0 0070 700 Summer St NE Suite 300 Address: 13 5 (,O.) 141 1] ,ilet s' PO Box 14140 , Salem OR 97309 -5052 ". " r Issued by 11 Date: O Phone: 503 - 378 -4621 \ i Web Address: www.ccb.state.or.us Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) 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. 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. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: &El 1. I own, reside in, or will reside in the completed structure. �� ❑ 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. ❑ 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR A 7 10 3B. I will be my own general contractor. 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 hereby certify that the above information is correct and that I have read and do understand the Information Notice to. Property Owners about Construction Responsibilities on the reverse side of this form. (Signature of permit applicant) ate) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06 -01 -04 Acfl 41 Ytu ' General Col tr4 etor7 _ . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer ' espnsthllftes You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (BIN) is a combined number for. both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/forrnspay.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. _ If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site at www.irs.gov. • Other ,Resp nsibilities a t d .Areas of Co: eer s Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. • Expertise: Make sure you have the skills to act as Your own general cOntractOr, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. . . . Property_owner.doc 06-01-04 i Ir `- 1 ±: n i APR 0 4 2007 i I RECEIVED l L, - 7, APR 2 3 2007 CITYOFTIGARIDcws File Number Q 7-00(11 '' Clea3Water \` ServicILDINGDt8 Our commitment is clear. Sensitive Area Pre - Screening Site Assessment Jurisdiction T I CARD Date L\- 3 - 2.o C "-( Tax Map & Tax Lot 2-S i 2.. Z> - Of boo Owner �O Vs, - `Tco .;t.r\ACA 10 `} in R C 1 b o o) Applicant O..s:� €-c Site Address y 3'-' S .� r\'. \\ S . Company �\ c''c-� °C2� Address ( ‘3tiO S. z \\ \\■&-4.• Proposed Activity I, \, �,_&6.,,N' cn--., City State Zip b \ sc.-,4 O 2, Si D.,2 Cor .)- ,'t3 / G>.i' Phone - C) - - '`-t• Ect g Iv . Fax By submitting this form the Owner, or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. Official use only below this line Official use only below this line Official use only below this line Y N NA Y N NA NI I 11 I Sen Area Composite Map I ( St r w t Hz0 Infrastructure maps I I • I IN Locally adopted studies or maps Other Specify ® C Specify pa /floret Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04 -9: ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. Sensitive areas do not appear to exist on site or within 200' of the site. This pre - screening site assessment does NOT eliminate the need to evaluate and protect water quality • sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 04 -9, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. . ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewer Comments: .. ma c / o ; ow a fl e a ev;ti / 0 4y o T7 o e1 • ' eT i -. • 4ve.4 0; N oc,,r 7 s.'7 Reviewed By: f ' Date: ' �f f /0va 7 1 Official use only Returned to Applicant Mail . Fax _ Counter 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 Date via/6 7 By Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • www.c.leanwaterservices.oro I ' Y a . A. 4t1k' ‘.. . -' #4 - N7.' ./ ib**** 4 4 * ti • J \ 47 eip < ' .--,,, ; , , ,,,,,, .. \ . . ..„. . ,, ts ,. . -Nk,,,,,,,::,,,-.,_, , ., „,.„.,,.7 \ ,. „,,,,„,, . ,--•\,,,, y_-\- \ /.,<, y ., -- ,, \ ) , , , . . ,,, , / ' ' ' - ', , , - *N>) ” /2 / ' , • . \ <. ' j \ Illille:$100,/ 4 1k1, 41 , e44 4 1.' s:?>'i i til * 4 ‘ . . ,, \.. , , ote. / :, , . ....., ,, ,... \ \„„... /:// AB 44 '14% .. \ „, ■ *fir► •..: i ��► ---- a awl Its II 40A ■ to . im ill 42 au al .,„<// 0.--- Ana llk A mid es , ai _,,,,,, _, ...........,\ s , \ , ..,0,,..._.\\,,,, \‘..,..\ III ,.:,,,,, / „,I i \\:., \ \ \ 1 _ ,., .., , ., //,\ \ , ,. \_,,,.,/7, \ \\.. 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Date: t ,, . ii o • . . , i ' 1 ' ' CITY OF TIGARD BUILDING DIVISION PERMIT #: MS7 2007 -00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6!•1012/07 Phone: (503) 639 -4171 _� A 0111 i(I+ Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 11/13/2008 TIME: 7:00AM PAGE: 15 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOIST DESCRIPTION: 19Osf addition T OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 603 -684-8986 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/13/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 078030 -01 603- 1360.1668 N Corrections /Comments/ Instructions: As �� 4 P rdvt) cia.4,5 (. tf-,.,..0..., PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: . Date: , v Gc Phone #: (503) 718 2Y/73 CITY OF TIGARD ' BUILDING DIVISION PERMIT #: MST2007-00070 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1012007 Phone: (503) 639 -4171 � Omn, �, a4 @iyi Inspection Requests (24 Hrs.): (503) 639 -4175 .n `__.. INSPECTION WORKSHEET FOR DATE: 6/3/2008 TIME: 7:00AM PAGE: 31 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 198sf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503 - 684 -8986 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 613/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 070687 -01 503 - 860.1668 N Corrections /Comments /Instructions: PASS Ell PART ' L APPROVAL El CANCEL ❑ NO ACCESS • , FAIL ❑ 1' L FOR I!b; •N ❑ ADDITION FEE ASSESSED , 9, A - . Inspector: Date: Phone #: (503) 71/ CITY OF TIGARD BUILDING DIVISION PERMIT #: MST7007- 00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: EIiO /2007 Phone: (503) 639 -4171 � Inspection Requests (24 Hrs.): (503) 639 -4175 �' INSPECTION WORKSHEET FOR DATE: 1/11/2008 TIME: 7 :01AM PAGE: 71 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 198sf addition;. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503 -6B4 -89135 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1/11/ 2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 139 Electrical final 062954 -01 503- 850.1568 N Corrections /Comments /Instructions: PASS n PARTIAL APPROVAL ►I CANCEL n NO ACCESS ❑ FAIL n CALL FOR INSPECTION '--- . , ITION EES ASSESSED Inspector: G • ►y . �' Date: t - 1 1. " 61 Phone #: (503) 718- liffb CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10/2007 Phone: (503) 639 -4171 �mny Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/13/2007 TIME: 7:01AM PAGE: 12 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 198sf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503. 68489136 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 8/13/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 053869 -01 503 - 860 -1668 N Corrections /Comments /Instructions: • vt.1% es rA PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS ` FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED • Inspector: ��r ��g L Date: D • j 3 ' a'1 Phone #: (503) 718- 1 • • r t ` i • , r 01,144-G6t--- CITY OF TIGARD 4 -r- , BUILDING DIVISION PERMIT #: MST2007 -00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10/2007 Phone: (503) 639 -4171 .o I Inspection Requests (24 Hrs.): (503) 639 -4175 '.! ''! L INSPECTION WORKSHEET FOR DATE: 7/30/2007 TIME: 7:02AM PAGE: 10 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 191:3sf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503 - 684 -8986 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 7/30/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 052990 -02 503- 860.1668 N Corrections /Comments /Instructions: VVIIIIIMN - 2 Pny t'ob " kce 1/4,4ittlitm/ g bd, yitttt/,,A415;( ifi det 3) 3p4r,P .ormA4 1,d);/te-c toc4N aff),Aft-eS e yte.fm-P2cc - ❑ PASS n PARTIAL APPROVAL ❑ CANCEL F I NO ACCESS X FAIL [XI CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED it hi)/ 01 Vi lo `.i Date: Phone #: (503) 718 VyO CITY OF TIGARD ` BUILDING DIVISION PERMIT #: MST2007 -00070 'A 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10/2007 Phone: (503) 639 -4171 *84410111+\ I Inspection Requests (24 Hrs.): (503) 639 -4175 ,,,,f INSPECTION WORKSHEET FOR DATE: 1/22/3008 TIME: 7.01Af PAGE: 43 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 19(1s€ addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503.€;84 -89N CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1/22J20013 Pour Time: Code # Inspection Description Confirm # Contact # Message MO In uIaaion 063613-01 503 - 860.1668 N Corrections /Comments /Instructions: ��/ PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS ❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: . /" Date: / Z -----c. Phone #: (503) 718- /-- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00070 .4k 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5110/2007 Phone: (503) 639-4171 v. q�mllj�l� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/16/2007 TIME: 7:00AM PAGE: 51 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 198sf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503- 684 -8986 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 8/:512007 Pour Time: Code # Inspection Description Confirm # Contact # Message 240 Exterior sheathing 054109 -01 503-860-1668 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL I I CANCEL n NO ACCESS FAIL e t CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Date: -- - — 0 ? Phone #: (503) 718 - &j • CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10/2007 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/15/2007 TIME: 7:00AM PAGE: 12 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 198sf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503 -684 -8986 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/15/2007 Pour Time: Code # Inspection Description 'Confirm # Contact # Message 275 • Framing 0540048 -01 503-860-1668 h! 235 3/Mf ., C orrections/Comments/Instructions: . 6A -N& - Is 14.f/ /1j.47\Cj &a. XrJ ✓2r/ �5' • A • PASS ❑ PARTIAL APPROVAL n CANCEL I I NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: g' Vic — - 67 Phone #: (503) 718 ,---feS CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5//0/2007 / Phone: (503) 639 -4171 A 14114Al Inspection Requests (24 Hrs.): (503) 639 -417 I L. INSPECTION WORKSHEET FOR DATE: 7/30/2007 TIME: 7:02AM PAGE: 11 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 19Bsf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503 - 6848996 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 7/30/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 276 Framing 052990 -01 503 -860 -1660 N Corrections /Comments/ Instructions: 4/ D7 PAS n PARTIAL APPROVAL CANCEL NO ACCESS AIL I f. CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ‘5 Inspector: Date: 7-.7e'-‘ Phone #: (503) 718- Z3 CITY OF TIGARD 6:11444 BUILDING DIVISION PERMIT #: MST2007 -00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10/2007 Phone: (503) 639 -4171 / �nibf ���U��' I It Inspection Requests (24 Hrs.): (503) 639 -4175 .�'!�+r ''' �... INSPECTION WORKSHEET FOR DATE: 6/26/2007 TIME: 7:00AM PAGE: 30 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOIST DESCRIPTION: 198sf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503 - 684 -B986 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6126/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 225 Postlbeam structural 060943-02 ' 503 -860 -16613 N Corrections /Comments /Instructions: KPASS I I PARTIAL APPROVAL (l CANCEL LJ NO ACCESS FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: I� Date: � Phone #: (503) 718 A7f� /al ccH o CITY OF TIGARD \ BUILDING DIVISION PERMIT #: MST2007 -00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10/2007 Phone: (503) 639 -4171 /tea's Inspection Requests (24 Hrs.): (503) 639 -4175 _�I,,Li.'� INSPECTION WORKSHEET FOR DATE: 6/26/2007 TIME: 7:00AM PAGE: 31 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 198sf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503- 684 -8986 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/26/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 230 Underfloor insulation 050943 -01 503- 660 -1668 N Corrections /Comments /Instructions: )( PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS ❑ FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: Date: '"L CP ld 7 Phone #: (503) 718 - r r _ , CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00070 . , 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10/2007 Phone: (503) 639 -4171 / Oi�nrAti vAIil Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/7/2007 TIME: 7:00AM PAGE: 59 SITE ADDRESS: 09340 SW HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 198sf addition. OWNER: TROMP VAN HOLST, JOHANNA PHONE #: 503 - 634 -8986 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/7/2007 Pour Time: 9 :00 . Code # Inspection Description Confirm # Contact # Message 205 Footing 049751 -01 503- 860.1668 N Corrections /Comments/ Instructions: • • • PASS PARTIAL APPROVAL I I CANCEL I I NO ACCESS n FAIL I. I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED A Inspector: Date:(r 7- Phone #: (503) 718- s. CITY OF TIGARD BUILDING DIVISION PERMIT #: a /dp7 - Wd7o 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: ( /S7 £7 TIME: 17,44 L'4 PAGE: SITE ADDRESS: �3 1-4-i CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: yt'r l ic-r PHONE #: 1 Q �! CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: t1// Le Pour Time: Code # I pection Description n # Contact # Message Corrections/Comments/Instructions: iaV G L- , Z azel L AG• 4 ^ - 1� 4 '' �T� E!i �f 1��5. !�l� .0 � Lp, <l�aG✓iv . PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 71 Date: Phone #: (503) 718 - 7.4-4 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00070 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10/2007 Phone: (503) 639- 4171�4i� I . Inspection Requests (24 Hrs.): (503) 639 -4175 „T ''L. INSPECTION WORKSHEET FOR DATE: 6/21/2007 TIME: 7:03AM PAGE: 46 SITE ADDRESS: 0310 HILL ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TROMP VAN HOLST DESCRIPTION: 198sf addition, OWNER: TROMP VAN HOLST, JIOHANNA PHONE #: 503.6a4 -6386 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/21/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 315 Post/beam plumbing 050646 -01 503 -860 1668 N Corrections /Comments /Instructions: — P / '% PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS ❑ FAIL I I CALL FOR INSPECTION � ADDITIONAL FEES ASSESSED Ins ector: 1t (JJ�� �' Date: 9 / _ Phone #: 503 718 -' P i�V � � )