Permit a CITY O TIGARD MASTER PERMIT
jllIl PERMIT #: MST2007 -00212
° COMMUNITY DEVELOPMENT DATE ISSUED: 1/15/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102A B -00601
SITE ADDRESS: 12075 SW LINCOLN AVE ZONING: R
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 063 JURISDICTION: TIG
PROJECT: PECK
Project Description: Construction of 348 sq ft garage. 4/14/08, ADDING (1) 590 AMP FEEDER AND (5) ADDITIONAL
BRANCH CIRCUITS.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: FIRST: sf BASEMENT: of LEFT: 5 SMOKE DETECTORS: N
TYPE OF USE: SF FLOOR LOAD: 0 SECOND: sf GARAGE: 384 of FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 5
0 sf VALUE. 14,173.44 REAR: 15
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER UNES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER UNES: 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 tNP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADDL INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: WISVC OR FDR: 6 PUMP/IRRIGATION: PER INSPECTION:
EA ADDL 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 0 SIGN/OUT UN LT: PER HOUR:
UMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC/FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ ampNolt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC/FDW =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8. STEREO: VACUUM SYSTEM: AUDIO S 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 0 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
GARRETT PECK OWNER laws. All work will be done in accordance with approved plans. This
12075 SW LINCOLN permit will expire if work is not started within 180 days of issuance, or
PORTLAND, 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: 503 260 - 0952 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 616.35
REQUIRED ITEMS AND REPORTS
Iss ed_By_: _ Permittee- Signature : -
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.
' ‘k 11 r ; i
• Mai fi ii Permit AD s io
City of Tigard CI ] 9 251 Received G
De[eie t'Q r7 Permit No.:u3/�07. . A
,114 U 13125 SW Hall Blvd., Tigard, OR 2 Plan Review Other Permit:
Phone: 503.639.4171 Fax 03.598.1 i a J 1 °" " DaWBy:
I 1 1. i\ !t I� Inspection Line: 503.639.�17� 1 v VISION SION Date ReadyBy: 1 A BI See Attached Checldist for
Internet: www.tigard -or. . � D J1 Notified . od: / //q w` t (r SaPPlemental Information
�� 1.1� /
TYPE OF WORK / REQUIRED DATA: 1- AND 2- FAMILY DWELLING
® New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, ytd� jlye prof t for the
CATEGORY OF CONSTRUCTION work indicated on this application. Li
Valuation: ,215,000'
❑ 1- and 2- family dwelling ❑ Commercial/industrial u.
® Accessory building ❑ Multi- family Number of bedrooms: 0
❑ Master builder ❑ Other: Number of bathrooms: 0
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address: 12075 SW Lincoln AVE New dwelling area: square feet
City/State/ZIP: 97223 Garage/carport area: 384 square feet
Suite/bldg. /apt. no.: Project name: Garage Addition Covered porch area: square feet
Cross street/directions to job site: Lincoln and Center Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: North Tigardville Addition I Lot no.: 601 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.
Building of garage Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Garrett Peck Type of construction:
Address: 12075 SW Lincoln AVE Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone: (503)2600952 Fax: (503)7907105 New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: Same as Property Owner 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: ( ) I Fax:: ( )
E -mail:
CONTRACTOR
Business name: Home Owner BUILDING PERMIT FEES*
Address: Same as above (Please refer to fee schedule)
Structural plan review fee (or deposit): r(,,,q 5
City/State/ZIP: - J
Phone: ( ) I Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: _ _ _ _ Total fees due upon application:
Amount received: f a s: AO
Authorized signature: This permit application expires if a permit is not obtained
I k� within 180 days after it has been accepted as complete.
Print name: �� - P , I Date: 'v I lq T • Fee methodology set by Tri-County Building Industry
t Service Board.
I1Bu PemW.v\BUP- PnmitApp.doc 0321106 440- 4613T(l1 /01/COM/WEB)
Electrical Permit A 1 t licat1o. ► OR OFFICE USE ONLY
` `� :. Rece ived �� '2--- City of Tiger i, ( BBB Da�B : D', PermitNo.: 5 �.� e 13125 SW Hall Blvd.; Ti 2 Plan Review
': C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
T I G A K D Inspection Line: 503.639.4175 OCT 19 2007 Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
U A
(,T PI aiF tQdRKL i PLAN REVIEW •
• ® New construction 0 10 / � Ci>!II 1 TION 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
❑ 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 "1 -2 ", "1 -3 ",
Job no.: Job site address: 12075 SW Lincoln AVE 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Garage Addition ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Cross street is Center and Lincoln Description I Qty. I Fee. I Total I •
New residential single or multi family dwelling unit.
Home is located on North side of Lincoln just East of Center Includes attached garage.
Subdivision: North Tigardville Addition Lot no.: 601 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Bulding Garage Limited energy, multi-family 75 00 2
g g residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Garrett Peck 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 12075 SW Lincoln AVE Over 1,000 amps or volts 454.65 2
City / State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)2600952 Fax: (503)7907105 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 2
Branch circuits — new, alteration , or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit r
Business name: B. Fee for branch circuits
without service or feeder fee, I 46.85 2
Contact name: Same as Property Owner first branch circuit
Address: Each add'1 branch circuit 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
Electric Signal circuit(s) or limited -
Business name: Viking - 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: (503) 3198667 Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: 56527 Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date
State surcharge — -- — - — Plan - review (25% of- permit fee): — -- — -- — —
(8% of permit fee):
Authorized signature: X i f tq ( TOTAL PERMIT FEE:
111 This permit application expires if a permit is not obtained within 180
Print name: C 1 o/1Al (� --CC Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: 1Bulldmg \Peroits\ELC- PenmtApp.doc 05/23/06 440- 4615Ttt1/05/COMnv®
Plumbing Permit Application .
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received t 1S _^(�, r
^ ��a1 .
Iiii
n 13125 SW Hall Blvd., Tigard, OR 97223
Date/By: Permit No.: ` ^iJy:
Pl
111 DateBy:
l Phone: 503.639.4171 Fax: 503.598.1960 a Review Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ®Se Page 2 for
T I G A K D Internet: www.tl ard -Or. ov y S
g g Notified/Method: Supplemental Information
• TYPE OF WORK FEE* SCHEDULE • .
❑ New construction ❑ Demolition For special information use checklist.
Description 1 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
❑ Master builder ❑ Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ('7()J 5 UJ L I 11 Cc,\ (4 Catch basin or area drain 16.60
City /State /ZIP: '-r' ( , �-� t 0 q - Drywell, leach line, or trench drain 16.60
Suite /bldg.lapt. no.: J Project name: tn,[ Footing drain (no. linear ft.: � Page 2
���` 1 Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
L, `\A i o t DfA4C. (' ri"-f Backwater valve 16.60
O Clothes washer 16.60
Dishwasher 16.60
5:1 PROPERTY OWNER - I ❑ TENANT Drinking • fountain 16.60
(� Ejectors /sump 16.60
Name:' CI 0%.,v.-ct PC,C, L.. • Expansion tank • 16.60
Address: 1 20 -4-5 s k.„.3 �; v . f O V, ,. Fixture /sewer cap • 16.60
City /State /ZIP: ‘.. it c\ d / .--3.-Z-2 Floor drain/floor sink/hub 16.60
Phone: 63ss ) Z bd coq � Z. Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 5c. t.. 0,..5 A ki-ov■e_ Interceptor /grease trap 16.60
Contact name: • Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: • Roof drain (commercial) 16.60
Phone: ( ) I F es:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan • 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 440 0l>J%. r S C.I ,(, 1p Water heater 16.60
Address: Other:
City/State /ZIP: •
Subtotal
Minimum permit fee: $72.50 7z' 50
Phone: ( ) Fax: ( ) • Residential backflow minimum permit fee: $36.25
T CCB Lic.: - Plumbing Lic. no.: t .Plan reJiew`(2 - 5 °70 of permiffee) - •
8 � State surcharge.(I.2°r of permit fee) � . WO
Authorized signature: __ TOTAL PERMIT FEE
Print name: %....)*
Cs 4 - a ‘r---- Date: �( t k- _W- 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.
1:1Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10/02/COM/WEB)
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 - 1' 100' 55.00 0 to 2,000 $115.00
Footing dram - 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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item 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 1 65.25 Ca as $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - and including $50,000.00.
s
p y q p per hour 72.50 • $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
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 fixture s 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"
- 4"
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
CITY OF TIGARD
°. COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
IMPORTANT PERMIT NOTICE flECE1'J0
VIKING ELECTRIC INC 1 20 8
4326 SE WOODSTOCK ;Y RD
PMB 518 �'� 1 -
PORTLAND, OR 97206 T C ��I DINISION
13
Permit #: MST2007 -00212 •
Date Issued: 1/15/2008
Parcel: 2S102AB -00601
Site Address: 12075 SW LINCOLN AVE
, Subdivision: NO. TIGARDVILLE ADDITION AMEND
Lot: 063
Jurisdiction: TIG
Zoning: R-4.5
Project Name: PECK •
Description: Cons of 348 sq ft garage.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have theappropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
GARRETT PECK VIKING ELECTRIC INC
12075 SW LINCOLN 4326 SE WOODSTOCK
PORTLAND, OR 97223 PMB 518
PORTLAND, OR 97206
Phone #: 503 - 260 - 0952 Phone #: 503 - 775 -3479
Reg #: ELE 26 -569C'
LIC 56527' -
SUP 3088S
AN t SIGNATURE, IS REQUIRED ON THIS FORM
D � N � , l l Yo gg5
Signature of Supervising Electrician Name (printed) SUP LIC #
Oct. 29. 200 � 9 : 04AM HEA THHRN No 3665 P. 1
: Et E u �U lt, ooi ioo2
R ECEIVED
OCT 2 4 2007 -, JAN 1 5 c UL j
'g°'
By CITY01- tli(;RHD can v' - er ervices B UIWINGDIVIsION •
•
. Our comiiilhncnl Is deli, • CWS HID Number
Sensitive Area Pre-Screening I o7_coyg7C l
•
Site Assessment
Jurisdiction: Net r' I 141(Afia.t!`e •e A ., i 0
• Property Information: (example 13294A001400) Owner in adorn , •
Tax lot ID(s): 1 Name: arr_
- Z% OZ C7 I Company:
AA Address: t21 -45 5k7 L_►rtro�t 1.
Site Addre - 20 — +§ Us) 1.zbu iA, Xg `r' z .i4J-.., O Q Q,� .
1'; or. I . • Phone/Fax p •115 ,/ 5o3 1 01405
Nearest Cross Street d C et. E..mall: P 11 G134421n15e - COr•A .
Development Activity: Check all that apply /Applicant Inform Uon:
Addition to Single Family Residence (moms, deck, C Name: _ S
Lot Line Adjustment ❑ Minor Lend Partltio ❑ Re a�
Residential Condominium sentiaonominium Ad dress : ,
❑ Commercial Condominium 0 Address: ���-
Residential Subdivision ❑ Commercial Subdivision ❑ •
Single Lot Commercial 0 Multi Lot Commercial ❑ PhonelFale, /
Other E -mail:
Will the project involve any offMelte work: YES ❑ NO oir Unknown ❑ Location and deeeripdon of offilte work:
Additional comments or information that ma be needed to understand your project:
w►e\¢ �
. O i A r & Z, u�vtw.• ovl et SJ` r� La/ta(i'e.� _ r o d . ■.J/ eilaxicliuu✓V
We application does N OT rspieee the need or m ng end Emelon Control Permits. Connection Pemdte, Building Permlte, Alto Development •
Permute, DEti 1200 Permit or outer permits as Issued by the Deportment or Environmental Dually, Deportment of State Lando andlor Depatment of
the Army COL AS required permits and approvals must be obtained and completed under applleshle local,•etate, and federal law.
• By sluing this roan, the Owner or Owner's authorised agent or representative. acknowledges and agrees that employees of Clean Water Services haw) authority
to enter the project site at all reasonable limes for die purpose of inspecting project silo conditions and gathering Information related to the project silo. I cer1ry
that I em familiar with thertapon Con In title d met, and to trio beat of my knowledge and belle, this information is hub. tinplate, and accurate.
Print/Type Name: , &.w v'e t & PrintlType Tide;
Signature: bate: /
FOR DISTRICT USE ONLY -
❑ Sensitive areas potentially exist on site Cr within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT
lOR TO I ANCE OF A_8E n VICEPROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on .
adjacent propenlee, a Natural Resources Assessment Report may also be required.
CI Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or
within 200' of the site. This Sensitive Area Pre- Screening Site Assessment dogs 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 07 - 20, Section 3.021. All required permits and approvals must be obtained and
completed under applicable local, State, and federal law. .
X Based on review of the submitted materials and best svgllabie Information the above referenced project will not significantly
impact the existing or potentially sensitive areas) found near the site. This Sensitive Area Pre-Screening Site Assessment
does NoT eliminate the need to evaluate and protect additional water quality sensitive areas If they are subsequently
discovered. This document will serve•as your Service Provider letter as required by Resolution and Order 01-20. Section- • •
3.02.1. All roquired permits and approvals must be obtained and completed under applicable local, state, and federal law.
❑ This Service Provider Letter Is not valid unless - CWS approved site plan(s) are attached.
•
❑ The proposed activity does not meet the definition of development or the lot wee platted after 9/0/95 ORS 92,040(2). NO SITE
ASSESSMENT 0 VIC PRO DER LETTER IS REQUIRED.
Reviewed By: bete: 70 A
2550 SW Mltlsooro Highway. Moosbon, Oregon 97123 is X
Phone (603)13814100. Fax (603) 601-443D. w,v + Aewwaaoeivleer oil . •
Wort Nor 6,9001 .
. 4441 W
•
CITY OF TIGARD • .
BUILDING DIVISION - PERMIT #: MST2007 -00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/15/2008
Phone: (503) 639 -4171 / l�l
Inspection Requests (24 Hrs.): (503) 639 -4175 �' !'i- .p�
INSPECTION WORKSHEET FOR DATE: 8/19/2008 TIME: 7:00AM PAGE 36
SITE ADDRESS: 12075 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. TIGAI DVILLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage. 4/14/08, ADDING (1) 590 AMP FEEDER AND (5) ADDITIONAL
BRANCH CIRCUITS.
OWNER: PECK, GARRETT PHONE # : 503- 260 -0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 074311 -01 503- 260.0952 N
Corrections /Comments/ Instructions:
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inENCREMIES75.11EWMIIITIA. _
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G---.• n L e Date: 1 • l e t ' el Phone #: (503) 718- 2Lf14'b
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C OF TIG ARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7 -00212
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Phone: (503) 639 -4171 aio„ ,e
115l2o i1Qfl
Inspection Requests (24 Hrs.): (503) 639 -4175 ;I'll.
INSPECTION WORKSHEET FOR DATE: 8/19/2008 TIME: 7:00AM PAGE: 35
I
I
SITE ADDRESS 12075 Em LINCOLN AVE CLASS OF WORK:
SUBDIVISION NO. 1IGARDVILLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION Construction of 348 sq ft garage. 4/14108, ADDING (1) 590 AMP FEEDER AND (5) ADDITIONAL
BRANCH CIRCUITS.
OWNER: PECK, GARRETT PHONE #: 5503260.0952
CONTRACTOR: Ow ER PHONE #:
Inspection Request Scheduled For: Date: 8/19/7008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 074311 -02 503 - 260.0952 N
Corrections/Comments/Instructions:
Qi3 N 1a a. tk• _c, 4 gi f4- L a ‘71) >Ys
n E€541 1^4k)1\) I Ni ft.6)__;
Fic\Ca , PAN4)/04
v .tie.RiA))61\i-
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C--- N O€ 1 . Date: $' I ' o Phone #: (503) 718 -00
CITY t OF TIGARD .
BUILDING DIVISION PERMIT #:
MST 2007-002'12
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /,ui,l 1/15f2000 Inspection Requests (24 Hrs.): (503) 639 -4175 _ ..
INSPECTION WORKSHEET FOR DATE: B/1817008 TIME: 7:00AM PAGE: 26
SITE ADDRESS: 12076 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage. 4/14108, ADDING (1) 590 AMP FEEDER AND (5) ADDITIONAL
BRANCH CIRCUITS.
OWNER: PECK, GARRETT PHONE #: 503- 260 -0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date 8/18/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 074258 -01 503. 260.0952 N
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL _ _ ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 6-48 -- 8 Phone #: (503) 718 -
CITY OF TIGARD " - .
BUILDING DIVISION PERMIT #: MST2007- 00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/15/2000
Phone: (503) 639 -4171 c�
Inspection Requests (24 Hrs.): (503) 639 -4175 .' . '!L
INSPECTION WORKSHEET FOR DATE: 4/16/2008 TIME: 7:00AM PAGE: 54
SITE ADDRESS: 12075 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage. 4/14/08, ADDING (1) 590 AMP FEEDER AND (5) ADDITIONAL
BRANCH CIRCUITS.
OWNER: PECK, GARRETT PHONE #: 503- 260 -0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
775 Framing 068356 -04 503 -260 -0652 N
Corrections /Comments/ Instructions:
li PASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: D ate:C� � "wog' Phone #: (503) 718 -
( )
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007- 00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/1612008
Phone: (503) 639 -4171 A.
Inspection Requests (24 Hrs.): (503) 639 -4175 `''L
INSPECTION WORKSHEET FOR DATE: 4/16/2008 TIME: 7:00AM PAGE: 57
SITE ADDRESS: 12075 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage. 4/14/08, ADDING (1) 590 AMP FEEDER AND (5) ADDITIONAL
BRANCH CIRCUITS.
OWNER: PECK, GARRETf PHONE #: 503-260- 0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
242 Interior shear walls 068356-02 503 -260 -0652 N
Corrections /Comments/ Instructions:
\
�J PASS _ ❑ PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
//6 id
Inspector: Date: / Phone #: (503) 718 -
CITY OF TIGARD
•
BUILDING DIVISION PERMIT #: MST2007 -00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/15/2008
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 J.... 'I I..
INSPECTION WORKSHEET FOR DATE: 4/16/2008 TIME: 7:00AM PAGE: 59
SITE ADDRESS: 12075 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO.IIGARDVILLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage. 4/14/08, ADDING (1) 590 AMP FEEDER AND (5) ADDITIONAL
BRANCH CIRCUITS.
OWNER: PECK, GARRETL' PHONE #: 503 -260 -0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 068356.01 503. 260.0652 N
Corrections /Comments /Instructions:
•
PASS _ ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
� Inspector: �/a Date: Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -00212
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 1/1 €d200F
Phone: (503) 639 -4171 A �
Inspection Requests (24 Hrs.): (503) 639 -4175 _ F_ —
INSPECTION WORKSHEET FOR DATE: 411112008 TIME: 7:01AM PAGE: 39
SITE ADDRESS: 12075 SW LINCOLN AVE_ CLASS OF WORK:
SUBDIVISION: NO. T IGARDVII.LE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage.
OWNER: PECK, GARRETT PHONE #: 503 -260 -0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
276 Framing 068144 -01 603-260-0952 N
Corrections/Comments/Instr
P7jC / lL �v4G/ S
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❑ PASS _ ❑ PARTIAL APPROVAL ❑ CANCEL _ ❑ NO ACCESS
Eg FAIL ECAL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / (/O Phone #: (503) 718 - YN
CITY OF TIGARD . • BUILDING DIVISION PERMIT #: MST2007- 00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/1512008
Phone: (503) 639 -4171 i��
Inspection Requests (24 Hrs.): (503) 639 -4175 ��
INSPECTION WORKSHEET FOR DATE: 4/8/2008 TIME: 7:00AM PAGE: 34
SITE ADDRESS: 12075 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 1163 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage.
OWNER: PECK, GARRE 1 PHONE #: 503 - 260 - 0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/8/20013 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 066012 -01 503 -260 -0952 N
Corrections/Comments/Instructions:
❑ _PAASS — ❑ PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS
❑SAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Al
Inspector: Date: 4 --- - e - � r Phone #: (503) 718 - "2---¢
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: MST2007 -00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/15/2601
Phone: (503) 639 -4171 ,Altb,„
Inspection Requests (24 Hrs.): (503) 639 -4175 .. li F 'I �I
■ INSPECTION WORKSHEET FOR DATE: 2/1212008 TIME: 7 : 05AM PAGE: 42
SITE ADDRESS: 12075 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. i IGARDVILLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage.
OWNER: PECK, GARRETT PHONE #: 503 - 260 -0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2/ 12/2008 Pour Time: 11:00
Code # Inspection Description Confirm # Contact # Message
205 Footing 064860-01 503-260 N
Corrections /Comments /Instructions:
/U/ 4./ 1 S "BLS,
6v1-tolv Lc/ Ar - c—,z �2iocf-- —z) 4 c,�,,,.. i—cxr- (19�r+ Try
PASS ❑ PARTIAL APPROVAL _ ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: — Date: — / ___— 08 Phone #: (503) 718 - 2- Ac4a---/
CITY OF TIGARD .
• BUILDING DIVISION PERMIT #: MST2007 -00212
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/15/2008
Phone: (503) 639 -4171 4�ry�,
Inspection Requests (24 Hrs.): (503) 639 -4175 W '' �..
INSPECTION WORKSHEET FOR DATE: 4/16/2008 TIME: 7:00AM PAGE: 55
SITE ADDRESS: 12076 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. TIGARDV1LLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage. 4/14/08, ADDING (1) 590 AMP FEEDER AND (5) ADDITIONAL
BRANCH CIRCUITS.
OWNER: PECK, GARRETT PHONE #: 503 - 260.0952
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 �0 Electrical rough -in 06835603 603-260-0652 N
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ortio
Date: 7 /��/ i Phone #: (503) 718 -
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: MST2007 -00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/15/2008
Phone: (503) 639 -4171 A �I' 'IIA
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/11/2008 TIME: 7:01AM PAGE: 40
SITE ADDRESS: 12075 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDI (ION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Construction of 348 sq ft garage.
OWNER: PECK, GARRETT PHONE #: 503-260-09u
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 EIoctiical rough -in 068139-01 503 - 260 - 0662 N
Co 'ections /Comments /Instructions:
-` , ( I 2Ip (1// 4 €)
. ! i Pbafil4 Aid / S7)DLIJ4/1 4 4f , lY 42f444 1 /
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ , NO ACCESS
r
K FAIL Al CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 101/4g
Inspector: Date: Phone #: (503) 718- V40