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Permit
p.s ,n 6 — i (\.-A-citiz.6 - a-8 r o 9 CITY OF TIGARD MASTER PERMIT • COMMUNITY DEVELOPMENT Permit #: MST2004 -00259 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2004 Parcel: 25111 BC04900 Jurisdiction: TIG Site address: 10205 SW MURDOCK ST Subdivision: Lot: Project: MITCHELL & GALICH PARTITION Project Description: 1,560 square foot addition. 8/8/05 add AC unit. 11/8/06: Added 100 ft. of sewer. 7/28/09 Permit reinstated for 30 days for final inspections. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 786 sf Basement: sf Left: 5 Parking Spaces: 2 Height: 21 Bathrooms: 1 Second: 405 sf Garage: sf Front: 20 Smoke Dwelling Units: Third: sf Right: 5 Detectors: Yes Total: sf Value: $110,000.00 Rear: 15 PLUMBING Sinks: Water Closets: 1 Washing Mach: Laundry Trays: Rain Drain: Catch Basins: Lavatories: 1 Dishwashers: Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: • Tubs /Showers: 2 Garbage Disp: Water Heaters: 1 Water Lines: Drains: 1 Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: Heat Pump: N Hoods: Other Units: 1 Fum<100K: Vents: 1 Woodstoves: Gas Outlets: 3 Fum > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 1 0-200 amp: W/ Svc or Fdr: 12 Ea add'I 500 sf: 20 1 -400 amp: 201 -400 amp: 1st WO Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add! Br Cir: 601 -1000 amp: 601 +amp- 1000v: • 1000 +amp /volt: ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: • Owner: Contractor: Required Items and ,Reports (Conditions) MICHAEL MITCHELL SPECIALTY HEATING & COOLING 10205 SW MURDOCK ST 1601 SE RIVER RD TIGARD, OR 97224 HILLSBORO, OR 97123 PHONE: 503- 708 -8313 PHONE: 503- 640 -3607 FAX: 503 -681 -0793 Total Fees: $2,124.34 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 2- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. tSL c^— Issued By: •L\ Perm ittee Signature: �� 1 d ' Q 9 C lI I D ` � I i / - • / MASTER PERMIT CITY OF TIGARD ��� �' � , PE RMIT #: MST2004 -00259 q DEVELOPMENT SERVICES DAT ISSUED 10/7/2004 ' --° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 10205 SW MURDOCK ST PARCEL: 25111 BC -02500 SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R - 3.5 BLOCK: LOT: 023 JURISDICTION: TIG REMARKS: 1,560 square foot addition. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 21 FIRST: 786 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 405 sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELUNG UNITS: T RB sf RIGHT: 5 VALUE: 110.000.00 OCCUPANCY GRP: R3 BORM: 2 BATH: 1 TOTAL: 1.191 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: • LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER UNES: SF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 2 GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: V VENT FANS: 1 CLOTHES DRYER: FURN > =100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 3 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADDL INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 1 0 . 200 amp: W/SVC OR FDR: 00 PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: • 201 • 400 amp: 1st W/O SVC/FCR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 . 600 amp: EA ADDL BR CIR: 0.00 SIGNAL/PANEL: IN PLANT: MANU HWSVC /FDR: 601 - 1000 amp: 601 +amps- 1000y:. MINOR LABEL: " X at 1000+ amDNolt PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL 0 AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL: O GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: ' Owner: Contractor: TOTAL FEES: $ 1,839.82 MICHAEL MITCHELL OWNER This permit is subject to the regulations contained in the SW MURDOCK ST Tigard Municipal Code, State of OR. Specialty Codes 10205 10205 SW OR 97224 and 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. Phone: 503 708 - 8313 Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg u: rules are set forth in OAR 952 -001 -0010 through 952- 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. . REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Plumb Final Foundation Insp PLM /Underfloor Framing Insp Insulation Insp Final inspection Post/Beam Structural Mechanical Insp Shear Wall Insp Rain drain Insp Post/Beam Mechanical Plumb Top Out Exterior Sheathing Inst Electrical Final • Underfl 'nsulatiQn Electrical Service Gas Line Insp Mechanical Final / / k / / / Issue By : = l � i � � > L Permittee Signature : , L.� Call (503) 639 -4175 by 7:00 p.m. for an inspection needed e next busi • s day s A-) p A/c 5 6 AI:, . • CITY OF TIGARD , RMIT DEVELOPMENT SERVICES D s UED: 10/7/2004 AA II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 25111 BC -02500 SITE ADDRESS: 10205 SW MURDOCK ST ZONING: R - 3.5 SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 023 JURISDICTION: TIG Project Description: 1,560 square foot addition. 8/8/05 add AC unit. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 21 FIRST: 786 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 405 sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: TNR sf RIGHT: 5 VALUE: 110,000.00 OCCUPANCY GRP: R3 BDRM: 2 BATH: 1 TOTAL: 1,191 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHA FUEL TYPES FURN < 100K: BOIUCMP < 3 P: 1 VENT FANS: 1 CLOTHES DRYER: ■ FURN > =100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 3 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER • TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 1 0 • 200 amp: W/SVC OR FDR: 12 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVOFDR: 0 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 0 SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC 0CC: 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: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes MICHAEL MITCHELL OWNER and all other applicable laws. All work will be done in 10205 SW MUR DOCK ST accordance with approved plans. This permit will expire TIGARD, OR 97224 if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules Phone: 503 Phone: adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 1,854.94 1 -800- 332 -2344. REQUIRED ITEMS AND REPORTS Issued By : ' iS i 1i 4_ . 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. t CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00259 r; DEVELOPMENT SERVICES DATE ISSUED: 10/7/2004 ' i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 10205 SW MURDOCK ST PARCEL: 25111 BC -02500 SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R - 3.5 BLOCK: LOT: 023 JURISDICTION: TIG REMARKS: 1,560 square foot addition. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 21 FIRST: 786 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 405 sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THR sf RIGHT: 5 VALUE: 110 OCCUPANCY GRP: R3 BDRM: 2 BATH: 1 TOTAL: 1.191 sf REAR: 15 PLUMBING ' SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: FURN > =100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 3 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: W/SVC OR FOR: oo PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVOFDR: CO SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: 0 SIGNAL/PANEL: IN PLANT: MANU HWSVC /FDR: 601 • 1000 amp: 601 +amps•1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC /FDR> =225 A.: 5 600 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: $ 1,839.82 This permit is subject to the regulations contained in the MICHAEL MITCHELL OWNER Tigard Municipal Code, State of OR. Specialty Codes 10205 SW MURDOCK ST and all other applicable laws. All work will be done in TIGARD, OR 97224 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. Phone: 503 708 - 8313 Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Plumb Final Foundation Insp PLM /Underfloor Framing lnsp Insulation Insp Final inspection Post/Beam Structural Mechanical Insp Shear Wall Insp Rain drain Insp Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins[ Electrical Final Underf•- ' . - 'on Electrical Service Gas Line Insp Mechanical Final / / / Issue. By : .-' / • iL 1 o. L Permittee Signature : i_ • ' i Call (503) 639 -4175 by 7:00 p.m. for an inspection needed e next busi • - s day -... ,, , • ., , - 1. ..,,--,‘Ni . , : -D . Building Permit Application FOR OFFICE USE ONLY City of Tigard 0 1 20 A Received Off ej Date/B : / Permit No.: Wr o ,, 13125 SW Hall Blvd., Tigard, OR 97223 C, --...? Plan Review Phone: 503.639.4171 Fax: 503.598.1960 '`J , 84.N.10100w, Date/B : • .f- - 0 Other Permit: Inspection Line: 503.639.4175 - r‘Gg l -ast - ci II Date Ready/By: / 4A y ,04-1_. . 0 See Attached Checklist for / ‘ - ---" -- Internet: www.ci.tigard.or.us GVE 0 DIVIbl`j Notified/Method: . : , _ 41 401 Supplemental Information 10 1231°‘ ,.s..s;,..:,1:i:Liy.,:' ,,psi...t,. . ....,;,,r.,_.,.. K.fuy. ''f,.:41:7.t ..,:...(42..:f :::..i,'.: z.. ;;; • ,,;.. ,-: . ..z. ■2 . . .. 1.N.-,.. ....,,V1:=.•,, w . ''' 'OF 'WORK -. "'F t' REQUIREDIDATA -V AD :NLI 'qA:5•j w, ' -5 .;:•‘-t , :::':: , . '!,':-:, T4'n '0.;,:: ,--- .iEAMLY DWELLING .:.-.-:-• 0 New construction 0 Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all X Addition/alteration/replacement El Other: equipment, materials, labor, overhead, and the profit for the le:~., .1. ,- .CA . T-EGORI( OF CONSTRUCTION nrl,' i ..: ''''!'' `' 1::: work indicated on this application. ,.''' ,,' e.:?' h'7'1.'''''.."1:A ,:, !',',.,' :':' ..r. •, •,,,:....',- 1 i X 1- and 2-family dwelling 0 Commercial/industrial Valuation: $ 0 1 ct Number of bedrooms: 2 El Accessory building 12 Multi-family 0 Master builder 0 Other: Number of bathrooms: • : : . , '':. A.W..,:•..F:5' 10BifglieiN:FORVAIIOW :: . Total number of floors: t 1 /e Job site address: 1 0 a C) 5 6. W. %.-1 U F--- C.:>(...,c..14..... S New dwelling area: I 5 e ttls feet City/State/ZIP: 'I" I ec ^17,....(=> 1 (2) IL, g_6% c t•-.1 Ci 1 2 2. 4- Garage/carport area: square feet Suite/bldg./apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: C c. tz—na le_ ft., ;\"1. ( CD 3 R .D Deck area: square feet • ... ''' • w. 1-1 •) l' C 0 c... vcs i-r.. Other structure area: square feet REQUIRED'D'ATA:;COMMERCIALAJSECHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map/parcel no.: 2_ S %i i BC-. "T t... 2. 5 c, equipment, materials, labor, overhead, and the profit for the •:::..,,_';,':,,'. i'q:: ': .'',':.,- TIESCRIP TION:p OF wowc - work indicated on this application. Valuation: $ 1 t> C> i 1 CD1■1 t•-•1 diQ I v..) F i.... oo s...._ -1-- - r 5 L rt—.. L. Existing building area: square feet ".• I> 1> 1AT i (!) A..1 CZ0 cz. ---; I 5 ex.e3 el , tz rr". New building area: square feet PROPERTY- WNER::! - - ..!,, , ...,,,-:,-- 00 TENANT , : : ,-...',....,-, -,i--, Number of stories: Name: I I C i /A... E. L t — i I '''r C 1.4 E. LL. Type of construction: Address: i C) ac 5 5 .‘...i. (---t 4...) (LCC.. K-. ''' Occupancy groups: City/State/ZIP: "T"' 1 c It_c::) c) tz.-tr_6 0 N5 or" a2.4. Existing: Phone: (aCji, 1 c - E I% Fax: ( ) New: iic !i,Lig i iki4. r fO:3;.!: . ;:.I ,".'i;,:.:*A6isi,ktiiii60;gr.RMY ;,....,-., •"';) 4 '?"i'" 14 •' 6 •'''''' L '''''''''' ''''''' '''''''' ''• ' . ' - n '''' " . '4.::::',:•::.:.:0...:A•;' 5 2.::'•:' ':. "...• : ' -' : • Business name: .=::■ V--M., 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: ( ) I Fax: E-mail: CONTRACTOR i-o ...::•';.:: 1•• ,;:.'Z ..''2-.;E.„.1 ••::',i: ir:tr.'; .1'`:;• P Pi : ‘...''..: ';.i N: fie ';' ,: ;.- -1- ;-,--,,: ,,, .'-,:i- ,:, 0 , 14:wI-:::‘ ,,!;•:-.4,:.;t r • Business name: (=> a....." V .... ic ........ , . ; :' 4 ''''V' , '.P - "j' 4 x:iiiilf'iLi5ii■rdt;i r iiiiUrtii -, 5 • Address: Please refer to fee schedule. City/State/ZIP: od Fees due upon application -0V50 ' Phone: ( ) I Fax: ( ) - Amount received CCB lie.: Date received: Authorized signature: A , / / This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Ati e 41 r , Date: V1/7-4 * Fee methodology set by Tri-County Building Industry Service Board. i: \Building\ Permits\ BUP-PennitApp doc 12/03 440-4613T(11/02/COM/WEB) One- and Two - Family Dwelling • • . Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 ssBy: A Phone: 503.639.4171 Fax: 503.598.1960 Assoociated permits: 24- Hour Inspection Line: 503.639.4175 L I I l ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us ❑ 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. ❑ ❑ ❑ 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 combleted 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 Ore! on and shall be shown to be applicable to the .ro•ect under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits\One-Two-FamilyChecklist.doc 12/03 • B Fixtures . . b -� E i E V . Plumbing Permit Application . FOR OFFICE USE ONLY q ; , }y g ��� 0 � `°� Received } �5r0�}T -Qoas9 Ci of Ti an d Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Phone: 503.639.4171 Fax: 503.598.1960 Plan Review CI3V OF TIG/i,��, � ; + Other Permit No.: 24- Hour Inspection Line: 503.639.4175 BUILDING D,,,.4. ,.I DatDate/By: 1 I Jnri:: Date Ready/By: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information ,..:. :........ ... .. .: . .. f1'Y , ,.:,.. :r .. .. - •` . :` - e E S .. .. . .a: ..:.. . . _. , , :_ ..: ...: =t :... r .... ... ...................z, , + , :a ....,... : .. ... . ... -. _ ,.. _ . < ...... .e.. ir ... .. ... ❑ New construction ❑ Demolition For special information use checklist Description I Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) .:. .. _.. � .... :.. ....mow i3':r..::: • ^•?:::.:,,., . ': �*TV.: +:4:.: °.._ \'.t•�:. �. .t �; . : � :. . • • - 'ICATEGORY ..OF�:.C � °r;`� i ° � -t �'�" � SFR (1) bath 249.20 . 3., �s.:i .:. ^Wid..:��',:. ......... �...::'.::.:- .':...:�!.•r _Y.S "..��.QC:`„ -. ....."`R_._.. i.U::.� : . ❑ 1 - and 2- family dwelling ❑ Cotnmercial/industrial SFR (2) bath 350.00 ❑ Accessory building ID Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: : :,.;.. ;:..:•::, <_. _ ;� <.:;,•,;,•,.:_= Fire sprinkler ( sq. ft.) Page 2 ;•, _:aa:,.. '. 40B; SITF RMATIcni. :AND LUCATIODI,` _ ' ; : " *'::` - ,..::_- : >..5� ;. � :.. :: „. „::,,.. <:..:..- ..•:�:. .. .... »_ .. � <., ....< ..... . ..':: �I: >._ .." .- Site utilities Job site address: , Q 7.0 ,s SIA) / V/L,DOC,C Catch basin or area drain . 16.60 City/ State/ZIP: /f 64015 OA. 4 7z-z- Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: /o 3 ~d in VA bee,...--- Manufactured home utilities 1 10.00 • Manholes 16.60 Rain drain connector R 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 Fixture or item Tax map /parcel no.: Absorption valve .. , : :DESCRI io;v :o;F:;wol it f rr , . ....:. :.: =:-• ,- �... -:- �:•:..,.,. <. : , .'.<'w'` ._.....':<.... w preventer . �.. ,. ...x :..:, �...., , : ,,�;::: ••.;• �':�!i. .. .. <.... . Backflo nter Pa e 2 p e e sr:" Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 : ; ::;.: Dri f oun t a i n 16.60 .3" .fe: '.h :! T.... wNER:= = 'El\A1V `�Y:ROEER O -] ......:........>... ......,..�...,- ...,,......,.::: ..., ,,. :' �_......._ ..- .................. a.,.......- ............ tors su .... .. .. ..... ......... .... u.;.;......_ � ...:.,:.. ^ :;.:. :- i ;. a ° ; ' Ejec / mp 16.60 Name: m f e frkf[_ Tr) /TeiG'EL(„_ Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City/ State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 isr c ::;:?,:r:: ?.?s` a . `s.v CA ,:•..:_ :.; •..:..�.: ::.::::•Sa: . 4 ?' ,!..1',1;•;,-;.i-..' , +• 4. ; ; Hose bib 16.60 :�i= :: EEIN:f li',1..•. •, .1 ® '.COIVTA : FE t RS'ON :`d:, ?. : ;• ...:: - ° �• "`--� �� • "•• Ice maker 16.60 Business name: 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 Fax:: ( ) Sink/basin/lavatory I 16.60 Tub /shower /shower pan a 16.60 E -mail: Urinal 16.60 � . . . .. .. .....:. . :...... •::-.... . . . .. ...•.; •.� .... , . .. . Water closet 1 16.60 Business name: 00,1A/Ef__ Water heater I 16.60 Address: Other: City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbin • Lic. P ..: Plan review (25% of permit fee) PEA • %� State surcharge (8% of permit fee) Authorized signature: 11 , TOTAL PERMIT FEE Print name: ' (ci /,t In i alga-. Date: y 7 74f)• 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. i:IBuildinglPermits\PLMF- PermitApp.doc 12/03 440- 4616T(IO /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ,:.. ee: ea � otal Site.U,t><1><ttes':: :,. � ty; >.t.;��(." � =� ��- �,5 uare�F' ootae������::�;. Footing drain - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 :- •- ; .,,,:........:..::..._ ;... Valuation::??; x Permi • 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 y:i. =: r::,:•.,:: :: additional $100.00 or fraction thereof, to and :_` r.Qty;� `Feef(e'a):!'. ; Total':' .......... including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 '$379.50 for the•first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees t:FiiitureT' e: `::,•, -, :rte'; _ ; >Reptace.:' " s� "i• '>5 ; - {: ? °y .'.4146,4 ;'Ca ed':' Comments regarding fixture work: :: . : . ; - .. : .-°,'C, , �; ., % :.,: ea � .�..'�'_.�_ , 1Vew`R•` '��r.: ,.. .. .,_., g` ,_PP g arg Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall . . • • -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" - 3" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity Service total is >9. Swimming Pool Filter Washer - Clothes • Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal • Other Fixtures: • i:\Building\Pern its\PLM- PermitApp.doc 3/03 Mechanical Permit Applicatioit'U FOR OFFICE USE ONLY City of Tigard Mj ✓ REEiew d ` , / L _ Permit No.: tt / y • 13125 SW Hall Blvd., Tigard, O223 r• `�a i �6 Phone: 503.639.4171 Fax: 503.598 � Q as;l� (r\ P Date/By: O Permit: �, Inspection Line: 503.639.4175 1 .11 j I Date Ready/By: kris. El See Page 2 for Internet: www.ci.tigard.or.us G`� OF 1. 1GPS Notified/Method: Supplemental Information w: . r.tNI -a DI V : .. , � ,:�:' �::^ , :• , :.; E. : OF., WORK: _- . ;:.. ......,..;r:., �. ... _ [ - :,,.... ...:.:.... , . .:.,. ,. ;CONiMERC'I °AIr�:;FE S CHED U L•E� " ST Mechanical permit fees* are based on the value of the work ❑ New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. T :..- .:�,... :x,:.14, Value: ..r�.,i:u.� .�'� >:tc:, . gin.,.: �^c:<• '.Y �;�..�. :; .• . . . CATEGORY ..M.- OS .: x.Yc... .B.� , ,.... F . , ... _.x .a..,x. ��. � N n; mss:: - ^• 'i!:+ .a;:i' h .::.::_............ :a:i v :: • :... . ...: ... .. ...... .. .. . " :.... 'RESIDENTI )QU SYSTEMS FEES* ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total , i • ;: '' 3 , J OBt • : SITE: = NF-ORMATION LOC - ' = ' : ` - r , z, : ' ` : : : Job site address: /0 2-0 SW MilocPoc L Sf Air conditioning or heat pump (requires site plan showing placement) 14.00 City/State/ZIP: i/ at 77ZZ Furnace 100,000 BTU (ducts /vents) 14.00 • Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts /vents) / 17.90 Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances < #.. _. �•:3„ ,�, -.: ' .. - " - Water heater 10.00 •.,�_ ..:..... _. = DESC RIPTI01!i ,` QF W Q l2 K : ?, '� ',i • Gas fireplace 10.00 Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 .:-y;;.: , . ..",.... ,:':: c: r< :.,:..:::.::,...::: : :r::. -�:; . . ,.. ::e ::..:. Chimney/liner /flue /vent 10.00 ROPERTY OW'NER::' : ..:: : : . :.: : :::..::,. .: >..,. > a ..P ,. 1'E Pltt s lT i"� ; � ; = ..�.. ..:,..• , .... .,.....,.�... ,. ® .:(<, ::;:•:,:::.: .._........ .. r 1000 Name: / 1Cloyie,„ train!, Environmental exhaust and ventilation Address: Range hood /other kitchen equipment 10.00 City/State /ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) / 6.80 :,..- t;# ': > "" " ' -'t" ace fans 10.00 Attic/crawlspace - ® r?ARE'L1Ce1Nfi ;` " :�' , ��' >. xi ' � f :CONTP►CT�� ' ;P'ERSOPI. = :r: 4 P ....-a .�._::..:� ^s.••.. -... _ .. �.:. !!..w. rte.... ...i 3•:l.1'.Yw < -.:. ew::Y:u>... -2�x�. .. . .._at.l xi T S: >.:: � -.': ,. .., . Business name: Other: 10.00 Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State/ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range .y,.. : �: ., " . r,,.., ,. :3 = . . . i . .. - - . 6 . ' : Barbecue .'t' . ..:_:7.�5.' =.n ....... _ � . .. . x _ . - pis A:... rh'..m x. ,_:c...:, . .... .. . . .. .. = '.:..S:�li; .s ...:e r! :1_, : •R Ig• '•.: N— Clothes dryer (gas) Business name: OG/ Other: Address: _..,,::. ':.:.,.; ":: ........ .._ ........ t ....... , .,...:r :.... - ;] pjEGHALVIC ?I:iPER1VIIT::FEES City/State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: / C Gfj / affix.-- Date: V 740 • Fee methodology set by Tri- County Building Industry Service Board is\ Building \Pemtits\MEC- PemtitApp.doe 12/03 440 OWWEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: tTotal�Valu'ation: ;.Pe'-rrit =.Fee. $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or . . . • fraction thereof, to and including _ , $50,000.00. • $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • • i:\Building'Permits\MEC- PermitApp.doc 12/03 2 - Electrical Permit Applicatiioo FOR OFFICE USE ONLY l • City of Tigard S �� Dar Permit No. Mgr; „ oa�s9 13125 SW Hall Blvd., Tigard, OR 97223 r� r Plan Review Phone: 503.639.4171 Fax: 503.598.1960 SEP 07 �","y4y�, +„ ''? l l ' I � Date/B : Other Permit: Inspection Line: 503.639.4175 :.�.. Date Ready/By: Juna: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information rlw OF TIGARD �d,� .C_` .'!�,.,'.Y '�� {'1Gi ° !_, yy pv� y .�+ _.�:• .:a3•rrP.'�.Yaii >� Yi:...Pa : ^3 w4- .6'•.s u ;> .}].'_ ..TC1..y K SB y fp - ..1 :: � !d. - �'1. - c+'v!� Y J'.., tsT: "':..t,�.d" `, `5:f.�.Yl I(•P�T:r `.i:`'`.'. .' ti, L TL3 6 ` -k y . r a.., SY.PJ`:. V p :�4 <._M, .c, ,•ir. ;3•c; .r.: '• •l .'4. py�c taa'+ }�. f . . � > h "F - ... .' ,2 � .�'':�N.ts.�. -4` ,:',.,9i .J?:T :2' -... .. 1 ��:1�Ci,'. [ •.... �R�. '. . FOY� >Y + +.,•:J•:...j.,��'..'.v..R o:a•.F. 1:1:;�Y!e..?,►i� .. � , _�4 ^. fq ''�Fr .:.- ...- a.: >- .t.....:_, , ::J ... .:.... ..... _. .. ....,. :. . _ . -. . ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location ;, ..,; - :. it ::: _: <, Q; . ;,. �r.$ car a .r � : u , . ;::, >;:.'. , ,..µ ..' Y �:r:::::.... ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., : a ..r a? ", .U ` . , RT tI =IUNZy� -v *` ;;. • •. r: r .: l+�• ^'II'Z� �AD�:"i y.U�i 4� .l. C fi =.;Ri ..X.` " i.l:!: . -.: _.. S.Y 1✓i::f�3r r�':... ?' ,l. RJ:;� of 1 - and 2 - family dwellings 4 or more new residential ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ❑ Other: ['Building over three stories ['Feeders, 400 amps or more g =�, „ - Wr.t: '..` > s :u y�„ r.:... . =:,•s .. �;.,..:: , , ..:. , a� :; ;: Other: �yM4:, c ; ,y:' . persons red structures or ['Occupant load over 99 a ['Manufactured •ea rii „a:' ig a +1~> I .Cd O `. A$1a1Vl ; :,, <t rM ,` rd4�.. .r, r :grii,x# > *x: , ,, , k '..;s :;_ - :„,„„, ;wr:.,4.r..,�r.,,�,:..._- .; •. RV park Egress/lighting plan Job no.: Job site address: i o2 0 g N.eNt ['Health-care facility ❑Other: M u C..,(-- V.'s Submit 2 sets of plans with any of the above. City/State /ZIP: T he above are not applicable to temporary construction service. "t t cAk �Q o tL �c_, �� 224 : : Suite/bldg. /apt. no.: Project name: r =:1,,xM. R ' . rr D ` =. : Description I Qty. Fee. Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 • t Tax map /parcel no.: Limited energy, residential 75.00 2 ;15 ,,sM.: ; ca,.:�.• : • r ..:� -,.. ;,,.. . .�:y s = {;: era: * .� , , . , .' �.,.: Each manufactured or modular Limited energy, non-residential 75.00 2 d "'• "ii rO PT UY!I**S? ' Ott- °' i;fi; - ,c '"" �' ' "" ',"' t' +� � 7..,..::r..,.:....:: �:...:?�.:'nf^ c '.�. � .. �3��: � �;$i.��' ;.v , �,�fi71::.: .;�s�r dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less / 80.30 2 ;: �:.{ ;. :14 -:n: ;:z:. .:,.: .,_ �'...., 's-:.:`.' ; t~ •::: ;� A ; ; , :: �:-: � :�•-.: ' ; ,rM1 (iIi: . 4, 201 amps to 400 amps 106.85 2 , a t ,� '.� ; �: � , c s'' ��I'I�'^.OX ��� .. .�. • •�, :.f:� :-,.:J,,•; '' &PF� ' .'` � n.;r.�"��� -:; ti;i:.,.: -.:s.; 1._ _. .. _ ...:.�. - •. -'::s.'� .�:� :. r <. z.-r.,.� a�.xy�. ".,_ n 1, a:+z .. :.'arixr3. 401 amps to 600 amps 160.60 2 Name: 1..1 1 G W . E L. M (-r C.,. N E L.L. 601 amps to 1,000 amps 240.60 2 Address: 1 t7 Z. • .:"./ . l .---( 1/4) 0._ 0 pC.t'L Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: "r' (e �g_p J tL�4�1�1 Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel *';� � "�' %k � ' °: tK� <' •_ '"�`' '� "' A. Fee for branch circuits with fn r. ,4 , ice I:I AI+I : a. � '.�. , l . 1V CT : , .. :.:...,a:. `: :.. .'_ _ 3.: _ :. ".... 'cscs,.s „= ....,nom �.. :.r:.�., - .,: service or feeder f each - " - a? a fee, e Business name: branch circuit ) z 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'l branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Pax:: ( ) Pump or irrigation circle 53.40 2 • Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - �1: } ;.� • t * : ��,f, dr"` k `" i ``a an e1, alteration, or }�, '�'��.�� ��u*�'�5' °'?':"T e� �°R��•T, >,. ''� J,� +�i�;��, :.:sr.y ` =u's.`'�, y'hr. energy P k75 �. rid' iii'_ 7 ..iaa .dE :: 3.._ k? aES.. Sa° i sv :.,�md +c.MV.,� �:[ extension. Describe: Page 2 2 Business name: 176 IU Eje--- Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 Y�'.,704 M':YY;y'. aro.`.,: -7'A I'':' y` pF,.+'-"1°7:`;,I*'I.'+"i;aikaa ::.: ..::r.. . CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) TOTAL PERMIT FE Authorized signature: g This permit application expires i a permit is no t obtained within 180 days after it has been accepted as complete Print name: M f �,�'yJ Date: / 7 ' / � • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed is\ Building \Permits\ELC- Pem:itApp.doe 12/03 0 -461 T(10 /02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: Na. '.O. �. .J. Q . 1 ,® °' l• 7*. !' T ea a s }" "3Ir:' C�}',: .Si:' ._. -�. ..�...- .- . -.e_. .. r.. >:..iG.0 -i. +•r......�. .��:�. .- SaYi'.�fFW..VrcT' Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems • ❑ Boiler Controls . . • ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: • *No licenses are required. Licenses are required • for all other installations . . i:\ Building \Permits\ELC- PemtitApp.doc 04/03 � 4 V Permit #: � � l ii — 00 .2-5 of � V, % � �, 0 1-t Address: 16a �u) WU�Z>Dc% \ � pF�\ S\O : N Issued by: 4 �/ Date: / . . 59 G \ � p \NG p\ / 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: ..- 1. I own, reside in, or will reside in the completed structure. 2. 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 P 3B. I will be my own general contractor. 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 . bout Construy 1 n Responsibilities on the reverse side of this form. / / / / /./ri.L ' ' I AA/ : ignature of pe 't applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) • ,. ' Jill FAFi , 'j aln M Fir © Note: This information Notice to Property Owners about Construction Responsibilities was de'eloped by t,le Construction Contractors Board in accordance with ORS 701.055(5). if you are acting as :lour 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 of concern. !.f you hire pe;':;ori—: :iot reg isif"ed with the Coostructier. Contractors Board to do labor ii'. constructing or assisting in the construction or improvemcr of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire wi:. be employees. A., the employer, you most comply with the following: C.") -eE;_ .'s .. : :' _,. °r..: ' • As an employer, you must withhok: income taxes from employee wages at the time employees are paid. N.(o i w- i. liable r the t= 7: payments eve...! if you don't actually withhold the tax from your employees. For more information, call the Oregon _wept. of Revenue at 945 -8091. As an cmpiove;, you are required to pay a tax for unemployment insurance purposes on the wages of ra' etr.oloyees. ^L" 1:'.':c in :-. n-aticn, call the Oregen Er-.ployment Di vision. at the Department of Human Resources at 378 -3524. ;' :......... ' ?e :_..,...__'Y!:.,_.,. .. __ ce As an erylo■er, you are s' :bject to the Oregon Workers' Compensation Law, and'mu t obialcf wo_kr's' car. r,:is ,Uri • C(' o yo,= en :_,icy'ccs. If you C,ail to compensation insurance:, you may he subject :a penaitks '.:e i :a`.:'. :'. for e emir• one of yu+'remployees 's inured on the job. For more intern lati:iI, call the Wor; :ers' Carnpe. : the of Consumes and 13usiness Services to 945 -7888. �J.�. im'tec i AL e r,picy er, you must withhold federal income tax from employees' wages. You will be liable for the lax pay'iv.ent et yot, dtda't actually . ‘,;!tiriliold the tax. For more information, call the internal Revenue Service at I -800- 829 -1040. ,. :. 0h %: ht Comae :n pa_l.ce, As the permit. holder for this project, you are responsible, for resolving any failure to meet code requirements that may be brought to your atteihtion through inspections. ,!•L' :YL:. t an! pra: :e ty the r,g ;tTsu cunt^.: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint o"erspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise erep Make sure you have sufficient time to supervise your employees. iExpci_ k-i:se: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -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 •(PO $ox 1`4i'4(•?f-Saieirh, OR.97309 -5052, 503/378 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1 /94 N RECEIVED JUN 1 1 File Number 4140 Glear�Wate� Services SEP 0 7 2004. Our commitment is cleat. 13y Sensitive Area e- Screening Site Assessment / CITY OF TIGARD Jurisdiction ° t c' A" ' o Date t _/Ju,,.c eons BUILDING DIVISION Map & Tax Lot 25ddt SCOZ SOO pwner fivet,f .mfmftEC� Site Address 40...o• Sal AuhL k.1G IbRrt�. Og_ Q 7 z7.-g Contact _Moo-Ara - / i/D »ia6 Proposed Activity Address /o• 0 ,Sc(J r7ow x sr- 6¢ E - ))kllf"J Phone SO 7k - V t y' Official use only below this line Y N NA Y N NA Sensitive Area Composite Map ((--�� r-�-}} Stormwater Infrastructure maps � ❑ r Sensitive_ zwiW -A ❑ U 71�J QS# 15dG'j • ❑ ,c7 Locally adopted studies or maps ®❑ ❑ Other Specify _ Specify 20/5Z AEZLIAL 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 LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. El 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 on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: E0 d►.) 1?-swi Cw OF S tTf ?ow <IK,7 310q -rtiF l i ? o r o S c Q . ?tad E r + t t_ r ✓ r - y r S, A,1, FiC.1 t'f r rocs 'rte F 'Parer .Tt Pt .t� s ►- S e - Reviewed By: ,A,/ Date: 6 - 16 - 0 4- f Returned to Applicant Mail>< Fax Counter, Date 6- 16- OLt By lA 2550 SW Hillsboro FGghway • Hillsboro, Oregon 97123 Phone: (503) 681 -3805 • Fax: (503) 681 -4439. w'vw.clenuIwulczscr%iccs,ol6 . . Ono,(1 _ . , • _ . . - - _ SCALE DliAWING 1. (1.. I ■:• . • • I I Cr.rtcr.!pt s 111C. • so •Ifnd v. .1 ' el+ I.•• %GI ,C0.0,0 • c � Building Permi - r f . � + ; �� FOR OFFICE USE ONLY City g of Tigard Received O ff �i4 DateB / Q Permit No -: 146r �'� R��' 13125 SW Hall Blvd., Tigard, O 3 2a Plan Review Phone: 503.639.4171 Fax: 503.�eg96 �i,,�;hrti l'\ Date/B : Other Permit: Inspection Line: 503.639.4175 1GAR ' �.i !J...I I I Date Ready/By: ® See Attached Checklist for Internet: www.ci.tigard.or.us WY ..,• S . `/ • • Notified/Method: Supplemental Information yy ..r«'. . g w+a' d; :r : «` ` _ tj D 1- G Di J�5 � 9:5 < y, 'a_ ?: :' ' ?n `ii, ;: 'C r •G :3 , tih a - z' 3;. 'f fi: t. r ''• `v - {:R",?• : :+�;._ • : ' ; g .:. S . S i:.:. •r�' 3 - ;et•� - bae.ib'�e =u-., "-'- E «V y' r' r L :� a:.,� . -?:-. r r . - yip t . .. 0.1:1 . Sr +4- r O _ -. rtw E Q ..,r r2= Aly 1IL1;D:W L: . : .c�::�S...s_.r -- �C.+'K.:' , sa,.•o - aa'>'� --t':. * r . <_.-'� ."''y •":� ',� V .... ac ., 2'A, t= 3r"�'v' a; 'z .'.'i^ f�': 3i:tuiirrs:� &..tdu "fl. r. . 4 ,.r,. .. ❑ New construction ❑ Demolition Permit fees *, are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all I R;Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the � -' m:4 ;ui ' u_r..i; J {µ x ,s�,, " .t;,•.. 7-- ,�;a:x =fi�:�. "•�`i'a?:ek. 1 -xrsr:;�.x..::- r x+ �r�`§�'•°a r ' �,,�:,;Yt. work indicated on this application. - r� 7. ., x ,. :•:: ,�' fit:`;, , � r` t? ''��'1 -•�' ;r`' ;v, fi'o( `PE °3QE' r a L �C: I . fit:,', .•__- �' - p , �.,. r • °� '•.1. A� .'." } i3' „ � ...;s, ,, : a; :.•� :�` ..irr:,, sk: �>,:; �.,<^ . ^:N.� r, , ::._ -. c:° ��r� :�'�4:',y�x::;.a:�i3�_'�•�i;:S Valuation: g El $ i j 0 . �� ® « ,gip 1 - and 2- family dwelling Commercial/industrial ❑ Accessory building El Multi-family Number of bedrooms L ❑ Master builder ❑ Other: Number of bathrooms: P �� . ...y4 �it"� ?�':?E`ir; :e- '�a.5�ta;: S <��:4T •rK':�c� "_� "T'E;kii.J:BF -a'v x E}ir'.s .q ~Jp81STfE ZN£Q I�IC71!1" QCATiO Total number of floors: �'t%a+T:),.::a[ i` �. et:^ �' �= i2. 2�."+,"{ ti: �.. r6?�3'r.Se=.�.•','2...::�:.' .. :XY+}- >.�i': § ^. :n .^i. •.:. m,_' i . + .:..l:.r.�..�. � ��` Job site address: i 0 a 5 `J : W, v-di tV [ Pez,L 14, •'"i'”: New dwelling area: 1 43 square feet City/ State/ZIP: 7" 1 4, %2 p j C j SL. 5—lst CL) j• c •[ 2 . 4. Garage/carport area: square feet Suite/bldg. /apt. no.: i Project name: Covered porch area: square feet Cross street/directions to job site: C C. g_. NI ilr:.. 1'- 5 , N04'..• i CD -3 rLD Deck area: square feet .e...%) . ` 4 .. . % 4 . .. r" v I C> V CO i4.... . t' Other structure area: square feet i x t n .t 'a RN. `. eqt:_:. J g.t W CKLIST. Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax Tax map /parcel no.: 2 `� l j i (r "'�" Z equipment, materials, labor, overhead, and the profit for the map/parcel .: iJ ._ . "; ^. 5 � _ .. yHS t - � r.R " ' -fix „_ 7;4 :>( , ^r• . �� ••:�`° . a ; 's3 t, .; l i k - "3 ' :t ; :t•�,r: '`•::.: : . : ` I.e` "',•..; r n ^ , , " ;, S • r..a �DESCRRTI T `'` r S VO : r - _ :.,: t . ' ' � - :,: work indicated on this application. :-.X.1 .r. •..i":: :047 t7 . <. 1 5 _ _.:..;n•:::,.,..i ..•..teri m .•.> w •n ;' ; ; ; : .•' ;`•.}"..: 1.. .' . s2/ pp • / h . L> L> 1 •'T" i L`r� M i s i v.) 1= L uc) �. ÷ Valuation: $ Existing building area: square feet I a f' S tz 'C; New building area: square feet tF'/aYU3:v' 3: :}�5 '�¢;'�Pas --� .`:^i:::n:�:;y,a:a: t•�,•.q ,- �:';��- _- s:;�.�..:.. y��- �€'.�?�r• a ;;vs r,,�t_ x �,`:n.�. d -: �Ar'VT.�r�;;f�+j7*� Number of stories: ..., .;�,,., r.r'c- ...a•3i,:ik:: w+4�' • �: : ,�;i':�n � .. `:��j!s.'•�':wrR:.;,.gy'x;f vaum '�.., a. :a ••: .3:.. Name: }^ i C. fri /A, E. L, M i 1- 014 E. i...L_ Type of construction: Address: i p 2. c..., S 5 . Irv, I•I •.i itik>v 1 "1"1 Occupancy groups: City/State/ZIP: ° T" i V4/ IL.0 i © re.-.W_ e 0 KI a 1 224. Existing: Phone: (i365, - 7 oil a, i Fax: ( ) �: :. r * New: v.. J°;P' ?.[ ; .F . _ -t- ;3- .rg64. �... , �r�r ✓'.� *yr.'n. 't:^ 4Y:. p ^s - .•^'•+ r :�t - ai'h- s�';. ��: °.�:.. `' �c.sx a.-.� .'.. �''� O ' '(.�'�.R •s' �til .:.,±; :,•Ifi: � x §: , > o: . c r r .!x. a>- #;.,:;M'.c: te r, ?a e a:: e?4 °RS'ON 6 -.� w , t `'?iAs',. `t ,...-,. : ,;. ;%, :.t ...,.... , - ..... '. ..six+s�":;'�.$- ;Otis, scar .. -+i= ai�:.F;is_�.3:v5i3�''k�r. , Business name: N e—it , All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State/ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: ?i. � }:;���i�`"r��'n, ^-`;��C'� : `4x:<�ti�'t °d:- .Il '{,k "3!5 > "5t,� s'`iic;'t_ ?.'i:.it ..� �.,;• ,�••:;'•- .!�'� " ":•S'� v -<t ?3� :N 'i" X ' : :itiT 'C' .^ -..1' °n ip 1. ;.;s*zy" . ........ �}. " ' F ". >+r. fF1 2/'.i ,�d hn.". �f_' ;!: { :i. �: g yva ;i �i.,-J? . ^;4:. 11TIiAGT.C1R.rs r - :e: - Y c; y:'' , `4' 4 ,s �,..:!',� �#'i < .. x3•. f•'-_.'!- 1� .:t.'A.'rf..•F..,.:53�•`:�Z .- ...- t, d• r.+.`". �... �:•Xil..'Yj.�.t5�n:- u..t¢••:r• sr::,.. ?$...l�..Z.. '�`r ' Business name: O �I.1 &,..75 c,�n, `r:s a:r'y'^t" .� � t9'.lii °s • � NC E .s+•H''EE ;w� •..;,..�i. Address: Please refer to fee schedule. City / State/ZIP: J 5-0 • ed Phone: ( ) Fax: Fees due upon application y �' CCB lic.: • Amount received J , . /` Date received: Authorized signature: "(�tia'"t. / / .--/ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: i e - 14_ /ril r tr��L Date: 9 J ZO ` Fee methodology set by Tri -County Building Industry . Service Board. iABuilding \permits \BUP- PermitApp.doc 12/03 440- 4613T(1I /02/COM/WEB) Case Activity Listing 1/23/2008 CCEL/- Case #: MST2004 -00259 2:24:50PM . Assigned Done - - Updated Activity Description Date 1 : Date 2 Date 3 Hold Disp ' To By By Notes MSTA005 Application received 9/7/2004 None DONE DEB 9/7/2004 Owner did not bring in copy of CWS ' BLD letter, but has it at home. He will bring it in. MSTA008 Permit Created 9/7/2004 None DONE DEB 9/7/2004 BLD MST2l 15 Electrical service 8/1/2005 8/2/2005 8/1/2005 None CNCL STI 8/1/2005 012615 -01 — 503- 708 -8313 — VM - STI N • MST1290 Reprint permit 8/8/2005 None DONE BB 8/8/2005 BLD MST2120 Electrical rough -in 9/1/2005 9/2/2005 9/2/2005 None PASS GN 9/2/2005 014884 -01 — 503-598-0686 VM - STI Y MST2275 Framing 9/8/2005 9/9/2005 9/9/2005 None 0 q/' `f ( c CB 9/9/2005 015296 -01 -- 503 -598 -0686 — VM - STI N —180 MST2699 Mechanical final 9/13/2005 9/14/2005 9/14/2005 None FAIL �,F KBS 9/14/2005 015656 -01 — 503 -598 -0686 — VM - STI N —150 MST2275 Framing 9/13/2005 9/14/2005 9/14/2005 None PASS KBS 9/14/2005 015656 -02 — 503 -598 -0686 V1' STI N MST2610 Gas line 9/13/2005 9/14/2005 9/14/2005 None / &/5/ KBS 9/14/2005 015656 -03 — 503 -598 -0686 VM - STI N —150 MST2280 Insulation 9/16/2005 9/16/2005 9/16/2005 None PASS AMS 9/16/2005 015932 -01 — 503 -598 -0086 — VM - ' STI N MST2610 Gas line 10/4/2005 10/5/2005 10/5/2005 None PASS RB 10/5/2005 017478 -01 — 503 -598 -0686 — VM - STI N Page 1 of 4 CaseActivity..rpt Case Activity Listing 1/23/2008 CCEL Case #: MST2004 -00259 2:24:50PM Assigned - _ Done Updated Activity Description Date 1 Date 2 Date 3 Hold Disp • To By By Notes MST2610 Gas line 12/27/2005 12/28/2005 12/28/2005 None PASS JM 12/28/2005 024097 - 01 — 503 - 598 - 0686 — VM - JM Y -180 MST1290 Reprint permit 11/8/2006 None DONE DER 11/8/2006 BLD MST2399 Plumbing final 4/16/2007 4/17/2007 4/17/2007 None PASS JW 4/17/2007 046595 - 01 -- 503 620 - 3203 VM - STI N MSTA010 Check for prcl. 9/7/2004 None DONE DEB 9/7/2004 restrict. BLD MSTA012 Plans routed to Plans 9/7/2004 None DONE DEB 9/7/2004 Examiner BLD MSTA018 Revisions rec'd/routed 10/4/2004 None DONE DEB 10/4/2004 (3) sets of revised shear wall plans & to PE BLD (2) sets of engineering. MSTA026 Plans 10/5/2004 None DONE MAV 10/5/2004 checked/approved by MAV PE MSTA030 Reviewed plans 10/5/2004 None DONE MAV 10/5/2004 routed to PT MAV MSTA706 Foundation Insp 10/21/2004 None 4 ( 5/72/0 y KBS 10/21/2004 KBS MSTA710 Post/Beam Structural 11/18/2004 None PASS KBS 11/18/2004 KBS MSTA711 Post/Beam 11/12/2004 None PASS RB 11/12/2004 Mechanical RB Page 2 of 4 CaseActivity..rpt 1/23/2008 Case Activity Listing 2:24:SOPM CCEL Case #: MST2004 -00259 Assigned Done . Updated Activity Description Date 1 Date 2 Date 3 Hold 1'... To By By Notes MSTA713 Crawl 11/17/2004 None tOk /a4 MRS 11/17/2004 need a crawl drain Drain/Backwater p MRS valve - MSTA717 PLM/Underfloor 11/16/2004 None PASS - MRS 11/16/2004 MRS MSTA722 Plumb Top Out 2/22/2005 None PASS MRS 2/22/2005 MRS MSTA726 Shear Wall Insp 1/4/2005 None Z,10 KBS 1/4/2005 KBS MSTA032 Post - review 10/6/2004 None DONE DLH 10/6/2004 CWS Service Provide Letter received completed DLH 9/7/04. MSTA035 ELC signature on 10/6/2004 None DONE DLH 10/6/2004 application DLH MSTA036 PLM signature on 10/6/2004 None DONE DLH 10/6/2004 application DLH MSTA080 '( F) Ready to issue 10/6/2004 None DONE DLH 10/6/2004 Left message with Michael's v -m ? DLH 2:30 PM. MSTA092 (F) Issue combination 10/7/2004 None DONE DEB 10/7/2004 permit BLD MSTA705 Footing Insp 10/22/2004 None PASS KBS 10/22/2004 KBS MSTA706 Foundation Insp 10/22/2004 None PASS KBS 10/22/2004 KBS Page 3 of 4 CaseActivity..rpt - Case Activity Listing 1/23 /2008 CCEL. Case #: MST2004 -00259 2:24:50PM 4 Assigned Done Updated Activity Description Date 1 Date 2 _ Date 3. Hold Disp To By - By Notes MSTA711 Post/Beam 11/16/2004 None PASS MRS 11/16/2004 Mechanical MRS MSTA713 Crawl 11/18/2004 None PASS MRS 11/18/2004 Drain/Backwater MRS valve MSTA726 Shear Wall Insp 1/21/2005 None PASS KBS 1/21/2005 KBS MSTA727 Exterior Sheathing 1/21/2005 None PASS KBS 1/21/2005 Insp KBS MST2505 Sanitary sewer 7/10/2005 7/1 1/2005 7/11/2005 None PASS MRS 7/11/2005 011158 -01 -- 503 -598 -0686 — VM - STI Y Page 4 of 4 CaseActivity ..rpt CITY OF TICAR.D BUILDING DIVISION PERMIT #: MST2004 -00259 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/7/2004 Phone: (503) 639 -4171 „�'ty � iI I IK\ I n spection Requests (24 Hrs.): (503) 639 -4175 , -_' ` INSPECTION WORKSHEET FOR DATE: 7/11/2005 TIME: 7:07AM PAGE: 8 SITE ADDRESS: 10205 SW MURDOCK ST CLASS OF WORK: SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 023 TYPE OF USE: PROJECT NAME: MITCHELL DESCRIPTION: 1,560 square foot addition. OWNER: MITCHELL, MICHAEL PHONE #: 503 - 708-8313 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 7/11/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 011158 -01 503.598 -0686 Y Corrections /Comments /Instructions: if / i t �' C /1 r .... i 2 --- i P ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: /�� Date: ( A Phone #: (503) 718- CITY OF TIGARD 'BUILDING DIVISION PERMIT #: MST2004 00259 ' 13125 SW Hall Tigard, OR 97223 DATE ISSUED: 10/7/200 Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 `'II INSPECTION WORKSHEET FOR DATE: 4/17/2007 TIME: 7:01AM PAGE: 45 SITE ADDRESS: 10205 SW MURDOCK ST CLASS OF WORK: SUBDIVISION: MITCHELL - GALICH PARTITION LOT #: 001 TYPE OF USE: PROJECT NAME: MITCHELL DESCRIPTION: 1,560 square foot addition. 8/8/05 add AC unit. 11/8106: Added 100 ft. of sewer. OWNER: MITCHELL, MICHAEL PHONE #: 503 - 708 -8313 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 4/17/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 046595 -01 503-620-3203 N Corrections /Comments /Instructions: # w 7 AI- �f / 2a ►= PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: ( -)/T - 77 - 67 Phone #: (503) 718-