Permit ?„i +" aq r `� O TI ^ ARD _ MASTER PERMIT
PERMIT #: MST2008 -00058
COMMUNITY DEVELOPMENT DATE ISSUED: 8/11/2008 •
T i "CARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639
";`` " '' PARCEL: 25111 BD -02100
SITE ADDRESS: 09755 SW PEMBROOK ST ZONING: R -3.5
SUBDIVISION: CLOUD CAP LOT: 003 JURISDICTION: TIG
PROJECT: SAARINEN
Project Description: Addition. 90 sq. ft. entryway and split level remodel.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 15 FIRST: 90 sf BASEMENT: 51 LEFT: 5 SMOKE DETECTORS: y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 51 FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: 51 RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 90 sf 15,000.00 REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILICMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000• amp/volt :
PLAN REVIEW SECTION
2
Reconnect only: 2
> =4 RES UNITS: SVC /FOR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
0
AUDIO & STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: Lite
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS:
O
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR: Specialty Codes and all other applicable
ANNETTE SAARINEN OWNER laws. All work will be done in accordance with approved plans. This
EASTON, WILLIAM J permit will expire if work is not started within 180 days of issuance, or
9755 SW PEMBROOK ST a the work is suspended for more than 180 days. ATTENTION: .
TIGARD, OR 97224 Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 001 -0010
through 952- 001 -0080. You may obtain copies of these rules or direct
Phone: 503- 639 -3921 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 554.29
REQUIRED ITEMS AND REPORTS
�\ /
Iss d By : ) .. . _ 1 -0 Permittee Signature ��� -rte
-„-- 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.
,
..r q CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2008 -00058
COMMUNITY DEVELOPMENT DATE ISSUED: 8/11/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 BD - 02100
SITE ADDRESS: 09755 SW PEMBROOK ST ZONING: R -3.5
SUBDIVISION: CLOUD CAP LOT: 003 JURISDICTION: TIG
PROJECT: SAARINEN
Project Description: Addition. 90 sq. ft. entryway and split level remodel.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 15 FIRST: g0 of BASEMENT: at LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: of GARAGE: at FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 5
VALUE: 1 5,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 90 at REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER UNES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOOOSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: tat W/O SVC/FDR: 1 SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HWSVC/FDR: 601 - 1000 amp: 601•amps- 1000v: MINOR LABEL:
1000* ampNolt :
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 8. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: 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
ANNETTE SAARINEN OWNER laws. All work will be done in accordance with approved plans. This
EASTON, WILLIAM J permit will expire if work is not started within 180 days of issuance, or
9755 SW PEMBROOK ST if the work is suspended for more than 180 days. ATTENTION:
TIGARD, OR 97224 Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through 952- 001 -0080. You may obtain copies of these rules or direct
Phone: 503 639 - 3921 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 554.29
REQUIRED ITEMS AND REPORTS
A AP /
Ass d BY : ���i i / : Permittee Signatu'PPZ,_ , . '`_ - ,
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.
Ilvild IA'IrA pli�aho St"
. Residential R ECENED FOR OFFICE USE ONLY
City of Tigard Dateed `
o O Q U ,...—.. ' ermit No.: / r ' J/ O rMJ - -`�`� V
III
• 13125 SW Hall Blvd., Tigard, OR 97223 Y 0 6 2 O Plan Review
II �� Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 , I Date/By: Mp Q'' 5-- (3, $'
Inspection Line: 503.639.4175 P►
m Ready/By: �� ®pplemental See Pa e 2 for
ation
t T I G A R D Internet: www.tigard �', °V �` • tifi
to Ready/By: " / -frV r - — �` Su Information
BUILDING 5r1(.4 writ" 1 el —
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, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1- and 2- family dwelling ❑ Commercial/industrial
Valuation: $ IS,t:xO
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: t�7 ' s,v ,� A , b 61 New dwelling area: square feet 70
City /State /ZIP: ( la., i ...4 , 7 a, .....1/41 Garage /carport area: square feet
Suite/bldg. /apt. no.: J � roject name: D r t n ei e t/J7 Covered porch area: square feet
Cross street/directions to job site: 7 �_ Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lou D c..- Ala Lot no.: 3 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: ,2 S' g i 165 b r) 1 Oo ! c� 9 Indicate the value (rounded to the nearest dollar) of all
l equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
��oA� �� 1, � 7g-Y 1�t� Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: A n r1,j C5tA r/ h-e-iN Type of construction:
Address: l 7g Ski Pekm b /' Si— Occupancy groups: • '
City/State/ZIP: `�c a 0 et �.2y Existing:
Phone: C --) Fax: ( b / q / p t New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 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
Business name: /F� I ) �2 � BUILDING PERMIT FEES*
Address: ��V (Please refer to fee schedule) 3., City /State /ZIP: Structural plan review fee (or deposit): l i V •
FLS plan review fee (if applicable): -
Phone: ( ) I Fax: ( )
CCB lic.: Total fees due upon application: / 3 a.. /
Amount received: / 3
Authorized signature / / I � .`4" This permit application expires if a permit is not obtaidded
within 180 days after it has been accepted as complete.
Print name: Amete, r i /j,eFh Date:c 64 c od ► Fee methodology set by Tri -County Building Industry
Service Board.
1: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(I1 /02/COM/WEB)
Building Permit Application Checklist .'
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Received
City of Tigard Date/By:
No.:
74 13125 SW Hall Blvd., Tigard, O 97223 Associated permits:
0 Phone: 503.639.4171 Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
l' I G A R D
Internet: www.tigard- or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
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.
3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ 0 ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
4 y JD 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.
✓ a) Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
~ and location.
-- 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
— 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation. .
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Oregon and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
W. 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. ❑ ❑ ❑
2 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
�' 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and accompanied by the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\ Building \Permiu\BUP- RES- PermitApp.doc 03 /21/06 440- 4613T(II /02/COM/WEB)
Bee trica1' Permit Application CE 1 FOR OFFICE USE ONLY
• City of Tigard Received
Q Date/By: . 576 p t # 3 /7 - f Permit No.: /JS7 � , —T
7f
13125 SW Hall Blvd., Tigard, OR 97223 O 6 Plan Review
Date B :
Phone: 503.639.4171 Fax: 503.598.1960 VIP( Other Permit:
Inspection Line: 503.639 GAR at Ready/By: lads: - RI See Page 2 for
T I 6 A K D
Internet: www.tigard or.gov C Q ' F /; D `V 1 �Q t e d /Method: Supplemental Information
TYPE OF WORK Bu1Lv� PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
ig 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ",
Job no.: I Job site address: Q 55 5;,) Pa1'Ie €c. ! 5 1001-11 or more. occupancy.
(� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - rimieil 04 et T 1. y ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 1elNeN °gray ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Glut R Description I Q•y. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 6LCI,1D `rte Lot no.: 3 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: 02 S / I MEM – 15.21 OD / Rt503 39 7 Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft) 75.00 2
Limited energy, multi - family 75.00 2
eVTRy r l, 'R C tppi. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
p PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 106.85 2
Name: j�,� 401 amps to 600 amps 160.60 2
�" N E'C( SPA444.14sNi 601 amps to 1,000 amps 240.60 2
Address: 8765 &(A) Pp/464:ot S I Over 1,000 amps or volts 454.65 2
City/State /ZIP: 6 � , 042_ Ct� ]av Temporary services or feeders installation, alteration, and/or
1 p relocation
Phone: (r ) coat 3R 1f I Fax: (SU3) • 4' ( to'- 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, I , rent, or each e, 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: ...4......, Date: D 106/2QS� A. Fee for branch circuits with
g APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits p 1
Contact name: without service or feeder fee, 46.85 2
fWµ%T� wj first branch circuit
Address: Each add'I 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: /JO/4Z Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: SEI- _ 4-5 14 13vE 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: ( ) I Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: .: Industrial plant per hour 73.75
A ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: N ► Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440-46t5T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard ' . •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: •
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
p Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
• • '
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in or a residence that I will
reside in. HI hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
A Vi iltst Saarinee)
Print name of permit applicant Signature of permit applicant
Date
Permit #:,4
This form is supplied to building,
permit offices by the Oregon ��• Address: _ Gt/.
r rr
Construction Contractors Board, ��` '
as required by ORS 701.055 (6)
Issued by: 77- Date: —5/7714
This copy to issuing permit office
J ,.4 ,r,; :Ili:. : e 1' i f / . i4,., ,,
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/ / I ADDITION I
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a, DRIVE -WAY
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.'4.'. N 88'26' E _ 1314
, CURB I /
28' -8" 9' ` I2' -4"
N \ 9.41' 50' 12' ,* 18" MIN.
12" MIN.
SW PEMBROOK ST.
g
/ / s
SITE PL4N
24 PEMBROOK ST
LOT 3 CLOUD CAP
OREGON
COUNTY 1 II _ 201-0"
PARCEL 8503391 I
TAX LOT 2SIII13D -02100
CITY OF TIGARD = SITE PLAN REVIEW
BUILDING PERMIT NO.: t15 0. — -
a
PLANNING DIVISION: ❑Not Approved Setb�ks:
Side: ,5 Street Side: -X-- Rear: �..�. --•-
Front. G rage: _LW._ ot Approved
Visual Clearance: ( Approved ❑ Not
Maximum Building Height ..142. feet
CWS Service Provider Letter Required: ❑ Yes ❑ No
_ Date: 510&
ENGINEERING I PARTMENT: Not Approved
Actual Slope: L_ 0 Approved ❑ No roved
Approved C3 of
B te PI
B Date: 8 .
,-„✓
Notes: Y
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING P RMIT NO:
� . Approved 0 Not Approved
Strce Trees: Approved No pp iv
B: b
Protected ted «� d Date: ;. 4
Not:s: