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Permit s.. "♦ . CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00387 In DEVELOPMENT SERVICES DATE ISSUED: 12/16/2004 c � l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12694 SW SPRINGWOOD DR PARCEL: 1S133AD-11900 SUBDIVISION: AMART SUMMER LAKE NO. 3 ZONING: R - BLOCK: LOT: 148 JURISDICTION: TIG REMARKS: Replacement of chimney chase. Fire damage repair. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: VALUE: 900.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS; 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 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: EAADD'L 500SF: 201 • 400 amp: 201 - 400 amp: 1st W /OSVCJFDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: ' 401 - 600 amp: EA ADDL BR CIR:3 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 AREAISPC 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: LANDSCAPEJIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 4 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 237.03 BEEBLE, JOHN ELAINE CORNERSTONE CONSTRUCTION This permit is subject to the regulations contained in the 12694 SW SPRINGWOOD DR .GROUP INC Tigard Municipal Code, State of OR. Specialty Codes TIGARD, OR 97223 5331 SW MACADAM AVE # 377 and er applicable laws. plans. All This permit i done in accordance PORTLAND, OR 97239 rdn 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 - 524 - 0339 Phone: 503 295 - 0108 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 Electrical Rough In Electrical Final Framing Insp Mechanical Final Exterior Sheathing Insi Final inspection Gas Fireplace Insulation lnsp :_._, - "AI . Issued By : Z Permittee Signature • _i' �_ . Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business • ay Buil Permit ittEetEdvED • FOR OFFICE USE ONLY City of Tigard Da«ea Le / 0 VV Permit No. li ,2 J/J ,l -C40.. 13125 SW Hall Blvd., Tigard, OR 97 Plan Review _ Phone: 503.639.4171 Fax: 503.598 C 1 6 2004 41111 Ili DateB : �� Other Permit: Inspection Line: 503.639.4175 ,, 5 •� Date Ready y: 0 See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGAIZD Notified/Method: Supplemental Information .. BLTILrVISION ORK 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/ or rep ace en ❑ 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: $ 700 [ ❑ Accessory building ❑ Multi- family Number of bedrooms: — 2j 0 Master builder 0 Other: Number of bathrooms: Z - - JOB SITE INFORMATION AND LOCATION,. Total number of floors: Z Job site address: 11_694 SW SPRI NVG WOOD D' . New dwelling area: .8--- square feet City/State/ZIP: / qizp e . 973 Garage/carport area: ,p— square feet Suite/bldg. /apt. no.: Project name: Covered porch area: �"- square feet Cross street/directions to job site: rje.4}.42 U �>-�� l T Deck area: ,,..9 square feet )\A -CTA 1`O S?V-.1►.1C^WCO'C D e. Other structure area: 6 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: 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. ' EF1ske M.Nfi O'- X --Nv wan F Ls,MeD Valuation: $ Existing building area: square feet NJ/PROPERTY New building area: square feet up PROPERTY OWNER ❑ TENANT - • Number of stories: Name: g_I GiL (5$a3c.,6: ■ \ Ci - N., (.1\ Q1 \h-2J Type of construction: Address: 12-4 9 S LA P SARI "J L inroop D(2 . Occupancy groups: City/State/ZIP: 71044 oz. 97 2-2 3 Existing: Phone: (tv 3) Sxzi _ r) 33 9 Fax: ( ) Er New: ❑ APPLICANT ' PERSON NOTICE - . • Business name: Gp jia 7)44- C VSP t/Gf ON dR01/P All contractors and subcontractors are required to be • Contact name: f3� Y �( 0 ' b ptl}'Y licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: r 2 al/ /14464-0 .411E . S?'E 3 ? ' jurisdiction in which work is being performed. If the City/State/ZIP: pQ/L�/- Fl�/t' 0 �72?� applicant is exempt from licensing, the following reasons apply: Phone: ( s-03 ) 2 9s - 0 (0 f, Fax: : (f3 ) v S ' / 09 6 E -mail: h - 7 a N 0 G CDYne-vs 7rva t. 1. C-41'l CONTRACTOR Business name: („012w 2S 1D . C OII S• V-a) 01■1 et o tJP 1 iili-C • BUILDING PERMIT FEES* - ' Address: •S 3 S I J M4CA -0424 / d (/E- . 2 3 7 -) Please refer to fee schedule. City/ State/ZIP: fdleT?A -r' OZ. 972;39 Fees due upon application Phone: ( 9 5' ) 2 0 /05 Fax: (5-t2,) Z95 • 1096 Amount received CCB lie.: ..# fs 7 S Q Zk y'1,. .. p y Date received: Authorized signature: it t I (e2----- This permit application expires if a permit is not obtained v within 180 days after it has been accepted as complete. Print name: , 1c g n ,,,, A.A.. Date: /24/) 0 Y . Fee methodology set by Tri-County Building Industry 1 Service Board. is tBuilding .PerrnicskBtJP- PcrmitApp.doc 12/03 440- 4613T( /02/COM/WEB) One- and Two - Family Dwelling Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard v e Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Rece Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: 24- Hour Inspection Line: 503.639.4175 i I 0 Electrical 0 Plumbing 0 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 completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings , and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore:on and shall be shown to be ap plicable to the 'ro 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- FarnilyChecklist.doc 12/03 , / 1 4 STaC f-o0 377 Electr Per mit Application 10li ()Fric Usl ()l.\ • City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ""d'4•.= 11' DateB . Other Permit: Inspection Line: 503.639.4175 - '_�_� Date Ready/By. tuns: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information E OF WORK PLAN REVIEW ❑ New construction Addition/alteration /replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location ❑Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ('l- 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 ❑Oc upant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: 1Z 694 spy s?,e{N&v/000 Ct . ❑Health care facility ❑��. Submit 2 sets of plans with any of the above. City/ State/ZIP: 7/6/1 (» 97 223 The above are not applicable to temporary construction service. Suite/bldg. /apt no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Total I •' 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. It or portion 33.40 I Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder - 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: • 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 ❑ APPLICANT I CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: COe a,,ru n) echk rivve;AdA/ 0noi IAI� . branch circuit t name: r B. Fee for branch circuits Contact Ha � �iY Q OD 1 without service or feeder fee, each branch circuit 46.85 2 Address:. 5?31 SW H ,W4D4 -" /We- 37) Each add'I branch circuit 6.65 2 City/State/ZIP:r0y2.7tsh 0 Q 7723`' Miscellaneous (service or feeder not included) 1 Pump or irrigation circle 53.40 2 Phone: (81 3 ) z95. 0 1 0 h Fax:: (Sa? )2 - i 896 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: 54)0/g Lc • Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: Investigation per hour (I hr min) 62.50 Phone: ( ) I Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: I 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 FEE Authorized signature: This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete Print name: Date: • Fee methodology set by Td- County Building Industry Service Board •• Number of inspections per penult allowed. i:\ Building \Pennits\ELC- PamitApp.doc 12/03 440.4615T(10/02/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 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:\BuildingTermits\ELC-PamitApp.doe 04/03 ii4 — ov 3 g7 Mechanical Permit Application FOR OFFICE USE ONLY City of°Tigard 4 DateBy: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Review Phone: 503.639.4171 Fax: 503.598.1960 4 N - tilt :d • ,i q ( tai Date/By: Other Permit: Inspection Line: 503.639.4175 E� Date Ready/By: kris: 10 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST 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. CATEGORY OF CONSTRUCTION Value: $ [9" 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES* For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating /cooling . Z,(? l,' Air conditioning or heat pump Job site address: 1 ' 91 - � i SPRAI,V OP_ . (requires site plan showing placement) 14.00 City/State/ZIP: n Furnace 100,000 BTU (ducts/vents) 14.00 ��CtA�2.T) �� g Z23 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: 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 • DESCRIPTION OF WORK Water heater 10.00 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 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00 Other: 10.00 Name: 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 ❑ APPLICANT ErCONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: 6:RASQ :II N CO ST'Q -v CTS trTa (AO t I MX__ Fuel piping Contact name: 'Yes d' 1 0 v $5.40 for first four; $1.00 for each additional ` `'^ 1 Furnace, etc. Address: i3t g) �4C�b� M .. S 3 Gas heat pump City/State /ZIP: pail_Tv41-N12 9. 29, 9- Wall/suspended/unit heater Phone: ( &A) 29 S' _ 0 f 0 v Fax:: (Y3) z 9 S. r Q T b Water heater " " Fireplace E -mail: �p yta.. 14 0 e,QtrNG/S 7�1't;eLk .. cow_ _Ran rJ CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: . MECHANICAL PERMIT FEES* City/State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: 11 /s-9 7S' Q State surcharge (8% of permit fee) O TOTAL PERMIT FEE Authorized signature: This p ermit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit 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. • is \Building\Permits \MEC - PermitApp.doc 12/03 2 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00387 I 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/16/2004 Phone: (503) 639 -4171 1 ill Inspection Requests (24 Hrs.): (503) 639 -4175 �: INSPECTION WORKSHEET FOR DATE: 3/10/2005 TIME: 7 :30AM PAGE: 26 SITE ADDRESS: 12694 SW SPRINGWOOD DR CLASS OF WORK: SUBDIVISION: AMART SUMMER LAKE NO. 3 LOT #: 148 TYPE OF USE: PROJECT NAME: BEEBLE DESCRIPTION: Replacement of chimney chase. Fire damage repair. 12/20/04: Added (3) branch circuits. OWNER: BEEBLE, JOHN & ELAINE, PHONE #: 503.524 -0339 CONTRACTOR: CORNERSTONE CONSTRUCTION GROUP INC PHONE #: 503 - 295 - 0108 Inspection Request Scheduled For: Date: 3!10/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 00122401 503 - 805 -6699 N Corrections /Comments / Instructions: ,e//� h , PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: ? —/ U — 0 Phone #: (503) 718- CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 6 ' INSPECTION DIVISION Business Line: .03) 639 -4171 BUP Received Date • equested - (( AM PM BUP Location a- - /L4 � . ��i�� • � � uite MEC Contact Person Ph ( q7 / a cgp - PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: �x- �c.00�S Ft�R y ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage F - -, ° � v 1 ❑ Reinspection fee of $ required before - i ins'ection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE ❑ Please call for reinspection RE: AMI ❑ Unable to inspect — no access Fire Supply Line 1 ADA /7 ' Approach/Sidewalk Date Inspector �: Ext Other: Final DO NOT REMOVE this inspection record f om e job site. PASS PART FAIL