Permit CITY TIGARD MASTER PERMIT
�l DEVELOPMENT SERVICES DATE ISSUED: 7/24 /0003 00392
�- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16090 SW KING CHARLES AVE PARCEL: 2S115BB - 04100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
REMARKS: Enclose existing front porch with new bay window and relocate front door.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT:
VALUE: 4,620.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 1 00 SIGNAL /PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
5=4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 215.73
LYNDA DU CHENE OWNER This permit is subject to the regulations contained in the
L Tigard Municipal Code, State of OR. Specialty Codes and
16090 YND DU KING CHARLES
KING CITY, KING 9 CHARLES all other applicable laws. All work will be done in
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 639 - 7877 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 -001 -0010 through 952 - 001 -0080. You
Reg #: may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Framing Insp
Foundation Insp Exterior Sheathing Insl
Underfloor insulation Insulation Insp
Crawl Drain /Backwater Electrical Final
Electrical Rough In Final inspection , .
Issue By : i ~ 1 ot � Permittee Signature : ....,
Call (503) •39 -4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Application FOR OFFICE USE ONLY
Received 7 Building t/ I—
Date /B ( t73 Permit No.: 60 37
City of Tigard Planning Approval Other
Date/B : Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/B : Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 - ''�/ 101i Post- Review Land Use
Date/B : Case No.
Internet: www.ci.tigard.or.us � ti ■ - I Contact ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Su Iemental Information
i .'_ �
TYPE TOF WORK :: :1M .. ..: �` I r REQUIRED DATA ::
111 New construction El Demolition , 1 & 2,F MI D WE LL ING , , ..
[ Addition/alteration/replacement ❑ Other:
, . T � :' ..,. Note: Permit fees* are based on the total value of the work performed. Indicate
.,. �s : -,. �, . � CATEGORY�QFCONSTRUCTION., m �¢ ;� ,
a, 1 & 2- Family dwelling ❑ Commercial/Industrial Miam the value (rounded to the nearest dollar) of all equipment, materials, labor,
Inl
overhead and profit for the work indicated on this application.
Accessory Building El Multi- Family ��
❑ Master Builder ❑ Other: Valuation $ 6
- O r - _ � : No of bedrooms: No of baths:
4
�, JOB SIT_gE I / N / FO RM.A TION and LOGATIO �..
Job site address: / 4 a go . jam( ef Total number of floors
Illew dwelling area (sq. ft.)
Suite #: I Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: Covered porch area (sq. ft.) £' ($ � U
Cross street/Directions to job site: ^ Deck area (sq. ft.)
91 4..) c.), /i4 • /! �_ ` � � /�) Other structure area (sq. ft.)
� C� t-� - / I- , ,, R T �
C OM M ERCI A L USEICHECKLIST ,
Subdivision: `t. _ I Lot #: j,'f
Tax map/ parcel #: q
pP �l hLll) Note: Permit fees* are based on the total value of the work performed. Indicate
; ' . �,,, , ;x "; :DESC ,,TiION' QF :W�OR g i < .. <- the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
6 27"1. ' 1 -- GL..... i 4 i2cfL6e. cation $
� �i_ e Existing w building building ldin re a area (sq. ft.) ft.)
9�` �1i � � - . � .:� -.� _�. � dew bui are
r Number of stories
PROPERTY OWNER Z AV IT : A'N1 4 �` ` , i,' i, .,, Type of construction
Name: Lt_ G(cQ�.Gp� Occupancy group(s): Existing:
U,, D ?� 6 c) New:
Address: j �
City /State /Zip' s Al � Zn7a.
Phone{ - p,3 / a _.;?: 7 4P-1 ' g 9.—q
NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
A'PPIiICANT : ,5 . ❑ eO A0 I E RSOI�I MT A provisions of ORS 701 and may be required to be licensed in the
Business Name:��e� jurisdiction where work is being performed. If the applicant is exempt
Contact Name: r/ from licensing, the following reason applies:
Address: •
City /State /Zip:
Phone: Fax: , B RnIIT EE *,1 ,;
E -mail: :` e e ` ' h d u
. „PE F 4 5 +
� �.� � � �, Please r f r �to fee sc " e l �
. ��� _ ,u` ,-o ,- : � _ A� � q�. ...� �_ - I. ._...:
i, i'� ,;�� :.; ,. � a -a; ; CONTRA�CT�OR� �-..��. �;;�:��'� a �� � ...- � �� _
Business Name: 0'°V'e/ Fees due upon application $ Address: l '
City /State /Zip: h Q G Amount received $ •
Phone: Fa Date received:
CCB Lit. #:
Authorized "''' _ Notice:- This permit application expires if a permit is not obtained within
/L��
Signature: - .f _ AA / 7 ( 180 days after it has been accepted as complete.
/{ ; L < , e_ C g e i *Fee methodology set by Tri- County Building Industry Service Board.
// (Please print name)
i:\Dsts\Permit Forms \BldgPermitApp.doc 01/03
One- and Two - Family Dwelling
' ' Permit Application '
4 #40
AA Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard
City of Tigard D Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
• I Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. X�['
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist. •
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and \ ,
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height siding material, footings.and 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 & 22 above.
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. x
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ?Cy--
27 "Drawn to scale" indicates standard architect or engineer scale. •
28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. x
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6 /00 /COM)
Electrical FOR OFFICE USE ONLY
ctrical Permit Application
R ece i ved , Electrical
Date/By: 7 �Y" c c 2 Permit No.: gaS rAx1J—OO5/ g
g-
City of Ti and Planning Approval Sign
Y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, , Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
// / u I Date /By: Case No.:
Internet: www.ci.tigard.or.us �. I Contact J El See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 ' Name /Method: Supplemental Information.
°. ,, ; 6 : ' , s; AN fi,. W,01WE rbF , Pt.10 :AtVIEW (P "as OOli al ff t ifiPIY) :.. ; s _ .. #.
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
ii. ,' a; l ,CATEGORY OF CONSTRUCTION;< I & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: 0 gr ss g g plan ❑ Other:
E e /li htin p
- Submit sets of plans with any of the above.
, _ „4 JOB,$001NEQ- 0fAMO.N and LIOCATION , , x
The above are not applicable to temporary construction service FEE
y Job site address: i or Pi .5 / fi � _ SCI I ULE =. -- _. . ,.. , . 4 ";
Suite #: Bldg. /Apt. #: ' _ Number of inspections per permit allowed
x. Name: p�. < p ....-
Description Qty I Fee (ea.) Total
New residential - single or multi- family per •
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
4 Tax map /parcel #: Each manufactured home or modular dwelling
.a _ � service and/or feeder 90.90 2
a � ^` , � „p„ DESCRIPTION`OFiwoR -+.,. .�. - Fv Services or feeders - installation,
alteration or relocation:
20 0 amps or less 80.30 2
2 01 amps to 400 amps 106.85 2
4 01 amps to 600 amps 160.60 2
s
" 601 am to 1000 am 240.60 2
/ PR ®REI2T1' QWNER; ❑ TEN_ANT „_:: ftz
t O ver 1000 amps or volts 454.65 2
N -6/�,C - e-- Reconnect only 66.85 2
Address: (P v 9,e _S )GC l Temporary services or feeders - installation,
9-7-2-1-P alteration, or relocation:
City /State /Zip: /2 7 200 amps or less 66.85 1
33
Phone j 3� -7�� -, 9y 7 9 / • 201 amps to 400 amps 100.30 2
� 401 to 600 amps 133.75 2
A'P,PLICL T"M. ..: n . C.ONTAC T"PERSON;. <" ,,; " „ax Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of y
service or feeder fee, first branch circuit d 46.85 44 g5 / 2
Phone: Fax: Each additional branch circuit 4 b (r ,' S 2
E-mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
�..1 °�__. 1=- • _ � '� Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: & ��e �/� Description:
Address: v`
Each additional inspection over the allowable in any of the above:
City /State /Zip: Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
n
fit Electrical Permit,Fees35,% 847,1 ` .. s E::, .::
Supervising electrician Subtotal $ 5,5d3
signature required: Plan Review (25% of Permit Fee) $
Print_Name: Lic. #: State Surcharge (8% of Permit Fee) $ ” -4
TOTAL PERMIT FEE $ ,S7' 7 g
Authorized --# 7;41;25 Notice: This permit application expires if a permit is not obtained
Signature : i C ale! 180 days after it.has been accepted as complete.
*Fee methodology set.by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Fortes \ElePermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
F - 7 Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
Permit #: 6)D; -o039
Address: / /i9 A.° k C4/1/21i5
Issued by: , _, ' it ,� ' ' Date: 74
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
• cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and.initial boxes 1 and 2, and either box 3A or 3B:
I I own, reside in, or will reside in the completed structure.
i'•
NO I understand that I must register as a construction contractor if the structure is sold or offered for sale
' before or upon completion.
3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
ix
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
_(:_- , 0.2. e"2...-e--a--
(Signature ft of permit applicant) - (Date) -
(White copy to issuing agency permit file,
pink copy to applicant)
' ^
information Notice t* Property Owners
'bout Construction Respons`b'U`t^es
Note: This f Notice to Property Owners about Construction Responsibilities
was developed by the Con /rrmhonCootroc/orx.Bo/oz//nuocordonuowith()}S'70lO55(5).
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 areas concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not rcgis\ercd with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the fOl lowing:
Oregon's withholding tax law: Asan employer, yoummM withhold income taxes from employee wages a1the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091.
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all em ployees. For more information, call the Oregon Employment Department at 378-3 524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compensation insurance for your employees. Ifyou fail to obtain workers' compensation insurance, you may
be subject to penalties and will bc liable for uUchimcosts if one o[your employees in injured ondhrj b.Forcunrcinfbrmuhoo,
call the Vorkers Compensation Division at the Department of Consumer and Business Services at 945-7888.
•
U.S. internal Revenue Serviee As an employer, you must ■vithhold federal income tax from employees' wages. You will be
liable forthetaxpayment even if you didn't actually withhold the tax. For more information, call the internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project. youurencnponyih|cfhrrcuo|vingonyfai|ure
that may be brought to your attention through inspections.
•
Liability and property damage insurance: Contact your insurance agent to see i f you have adequate insurance coveragefor
accidents and om issions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must bc
re-done.
Time to supervise employees: Make st{re vdu have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work ofroUgh-in and finish
trades, and to notify building offIcials at the appropriate times so they can perform the required inspections.
if you have additional questions. write or call the Construction Contractors Board (P0 Box l4|4CL Salem, OR97JO;-5052,
503/378'4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
pmp*wo.pmv
, .
)141/ KING CITY
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
■11 Phone: (503) 639 -4082 • FAX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: - '
located at: - /// IS LS .......6L/_ 1 ct &,4 c2
King City Representative
I DSTS'i:CINST DOC
-
CITY OF TIGARD . 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 - S — 0029 a._
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested 3- /69 AM PM BUP
Location / (.' 0 ?? D l'<► rt,S t L-e,- -, leS ) 4 vc Suite MEC
Contact Person Ai n d 5 Ph ( ) 3 — n97 7 PLM
. Contractor Ph ( ) SWR
BUILDING . ,Tenant/Owner ELC
° ELC
Foundation Access °
Ftg Drain �., ELR
Crawl Drain
Slab Inspection Notes: " cJ/ 1 SIT
Post & Beam js, �ec Y 7)eA`S r, ,6 - vs)—
Ext Sr ea h /Sh Anchrs A� G � v im.' kwr _/ 04- d o cy -
Ext Sheath /Shear �Y
Int Sheath/Shear
Framing
Insulation
------ d \AS\ N S 01 - n- - O (o ! fJ ') 4
Drywall Nailing
Firewall t
Fire Sprinkler
Fire Alarm \A% )- ; -- , ki 1. c elA A
Susp'd Ceiling
Roof
Oer:
PART FAIL
PLUMBING a _: °
Post & Beam
Under Slab
Rough -In C. C
Water Service
Sanitary Sewer
Rain Drains j VI
Catch Basin / Manhole
Storm Drain
Shower Pan
• Other:
Final
t°1
PASS PART FAIL
.MECHANICAL''' -
Post& Beam
•
Rough -In
Gas Line
Smoke Dampers
• Final
P • •. FAIL
1 - EC.TRICAL. �� (.-I) V\C IA - ) 1\
Rough -In
UG /Slab
Low Voltage
Fi Alarm
ina ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line `�' !/ —
ADA
Approach /Sidewalk Dat -C� /
— Inspector - , - t
Other:
Final DO NOT. REMOVE this inspection record f om the job site. .
PASS PART FAIL
r-