Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00214
I. DEVELOPMENT SERVICES DATE ISSUED: 5/9/02
,ya� ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 .
SITE ADDRESS: 11765 SW WALNUT ST PARCEL: 2S103BA -00600
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
REMARKS: Const. of detached garage. path 1
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 12 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 528 sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 12
VALUE: $ 12,566 40
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 00 sf REAR: 99
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 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
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 695.51
E DRAKE OWNER This permit is subject to the regulations contained in the
GEORGE Tigard Municipal Code, State of OR. Specialty Codes and
11765 SW
OR W WALNUT LNUT all other applicable laws. All work will be done in
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg #: 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
Erosion Control Insp 8 Framing Insp
Footing Insp Rain drain Insp
Foundation Insp Electrical Final
Electrical Service Plumb Final
Electrical Rough In Final inspection
Issued By : 4_ 0.4.1 .. t '1 Permittee Signature 6Z/
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
•
• id d s l q- 7-6- o z- g l
Building Permit Application /
-
� Date received: %3 /0i Permitno.:J167gjd� _ 1 4
�r.:, n City of Tigard //
Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, ' .. 4, OR 97223
Phone: (503) 639 - 4171 Date issued: By: AN Receipt no.:
Fax: (503) 598 - 1960 /4/2 f Q Case file no : Payment type:
' — l &2 family: Simple Complex:
-
Land us- aIproval. � � . - j' 1 , y p p
TYPE OF PERMIT
7 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION •.
Job address: //76,5 5G!! WALA/ (4 7 57. Bldg. no.: Suite no.:
Lot: 'Block: (Subdivision: 'Tax map /tax lot/account no.: 251 03 5A — D b (o 00 ,
Project name: PR f£ES /DENc•g — Z.cz c- - ' C7A)'A- ,4DP /7 /0.v /�
Description and location of work on premises/special conditions: ..5" g 5/ ) 5/A sfo r y / W o o d 7';at vhf Cu 4rJr74
LOc$7 /0A/ : AlE ® g x /l7 /R/6 N0 LSE //v /9A 7 CA" ) //9"2
OWNER - FOR SPECIAL INFORMATION, USE CHECKLIST 4--.'
Name: C7 (o,t?Gj VRAKE (Floodplain, septic capacity, solar, etc.)
address: / / 7 C 5 5 to WA4UlU7 ST. 1 & 2 family dwelling: `
Mailing �
City: 7/ &,9 -iep State: DEC I ZIP: 9 7 Z 2 3 Valuation of work 5Z a 5f x 2 % •3•30-f= $ / i 5 -- 6 ,
Phone: 503 - 5 2 /. / 567 I Fax: N A I E -mail: 9 d rA k e II o 3 @, No. of bedrooms/baths ,
Owner's representative: 5 i},1.."¢ Ccro /.con, Total number of floors f. ^
Phone: Fax: E -mail: New dwelling area (sq. ft.) ■
Garage/carport area (sq. ft.) 52 8 ^�
Name: 5 ?E Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: !State: 'ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR Valuation of work / $
Existing bldg. arca (sq. ft.) ....
Business name: /J' W lEtZ.. New bldg. area (sq. ft.)
Address:
City: 'State: 'ZIP: Number of stories
Phone: I Fax: 1E-mail: Type of construction ....
CCB no.: Occupancy group(s : Existin_:
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 5,10-ft 0.T j ,— provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: I State: 'ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: .54144e a7 oNxtr Contact person: Fees due upon application $
Address: Date received:
City: (State: (ZIP: Amount received $
Phone: I Fax: 1E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied with whether s crfied erein or not. Credit card number. Expires /
Authorized signature: Date: / 2 0 /02 Name of cardholder as shown on credit card
Print name: o ✓� Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after itthas been accepted as complete. 440.4613 (6/00/COM)
•PLo R •Eu I oq . -
• One- and Two - Family Dwelling J
• • • • • Checklist Reference no.:
� Building Permit Application Checklist
Associated permits:
City of Tigard City f Tigard y g 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other:
'Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE . FOLLOWING 'ITEMS ARE REQUIRED FOR. PLAN. REVIEW , . ' ;.Yes . No :.N/A
Z I Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
7 4 Fire district approval required.
464 5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
A, a 7 Water district approval.
NA 8 Soils report. Must carry original applicable stamp and signature on file or with application.
✓ 9 Erosion control c$ plan 0 permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
0 V10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable lecal 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.
CI
✓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.
•
V12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
113 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.
114 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.
VI 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.
2 2 - 116 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.
x/17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
a8 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
2 Z 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.
z ?,g Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
NA for four or more appliances.
7 y . Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
J URISDICTIONAL SPECIFICS '
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted.
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 must include street tree size, type & location per City of Tigard Street Tree List booklet.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6 /00 /COM)
. ,, .‘,
•
- .44 Electrical Permit Application
Date received:
Permit no. i/kbf, . co
:.f 1 City of Tigard Project/appl. no.: Expire date:
Ciryn(Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
. TY PE OF PERMIT '
•
fll;l 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement ❑ Other: 0 Partial
. JOB SITE INFORMATION '
Job address: / /7(o 5 5&/ LJAC.NU7 .5T. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision: ' C - 2 - 5 103 5 A - oa to o o
Project name: D,Q4,rg I Description and location of work on premises: 1'ET4CHEP laR.e.c –
Estimated date of completion/inspection: ,Ju c- y .
CONTRACTOR APPLICATION FEE SCHEDULE . • .
Job no: Q 1A 1 'N 6 - Fee Max
Business name: Description — Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: dwelling unit. Includes attached garage.
City: I State: I ZIP: Service included:
Phone: I Fax: I E -mail: 1000 sq. ft. or less I 4
Each additional 500 sq. ft or portion thereof
CCB no.: I Elec. bus. lic. no: Limited energy, residential 2
City /metro lie. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER .. 200 amps or less / 2
Name (print): oXG,E 22.i1.<---E 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: // 7Co 5 jw W A uT 3 T 601 amps to 1000 amps 2
City: 7-/ H 4 D I State: V.< I ZIP: 91Z23 Over 1000 amps or volts 2
Phone: 5D"3 •/567 I Fax: — I E -mail: 9 d vo, ke I/ 03 . vo / Reconnect only l
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation,
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: 2 Date: y Zo 0 C 401 to 600 amps 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circutt(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stones ❑ Feeders. 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)
[A
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:.. .
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
. 1000 sq ft. or less I $145 15 4 n Audio and Stereo Systems
Each additional 500 sq. ft or
portion thereof $33 40 1 n Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90 90 2 El
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
/
200 amps or less I $80.30 2 r --,
201 amps to 400 amps $106.85 2 I I Vacuum Systems
401 amps to 600 amps $160 60 2 El amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2
Reconnect only $66 85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
•
Over 600 amps to 1000 volts.
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits '
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6 65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service -
El Alarm Installation
or feeder fee.
First branch circuit $46.85 I � I I
Each additional branch circuit $6.65 I HVAC
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ n ' Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
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Permit #: 1`W T X - — OO �i
pF
Address:
111 (o \A) 6 S. \A/ALA
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N • .rnrir + Z 1
`. •= Issued by:43 ' _ 10 ate: 9 -O 2
59
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:
,7 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.
n 3A. My general contractor is
I (Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construc ion Responsibilities on the reverse side of this f rm.
,e_ j 9 oz-
_
( gnature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
IIRVOrrmation Notice to Property Owners
About Construction Responsibilities
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
ERB' LOVER REGPONSDF lLlTlES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer', you must comply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945 -8091. .
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources
at 378 -3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and rifust
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 94.5 -7888.
U.S. Internal Revenue- Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1- 800 -829 -1040.
OTHEFe RESPONSllc /LAMS AND AREAS OF CONCERN:
Code compliance: As the pern holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re -done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish
trades, and to notify building officials at the appropriate limes so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 141-40, Salem, OR 97309 -5052,
503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop- own.pm4
1 /94
CleanWater Services
Oni cmniitmcnl Is cic,ii
May 6, 2002
George & Linda Drake
11765 SW Walnut St.
Tigard, OR 97223
Re: Addition to single family residence and garage located at 11765 SW
Wlanut St., Tigard, OR
CWS file 1973 (Tax map 2S103BA, Tax lot 00600)
Clean Water Services has received your Sensitive Areas Certification Form for
the above referenced site. Staff has reviewed the Sensitive Areas Certification
Form and concurs that the sensitive area found during the pre- screen appears to
be piped. In light of this result, this document will serve as your Service Provider
letter as required by Resolution and Order 00 -7, Section 3.02.1, and your
Stormwater Connection authorization from Clean Water Services as required by
Ordinance 27, Section 4.B. All required permits and approvals must be obtained
and completed under applicable local, state, and federal law.
This concurrence letter does NOT eliminate the need to protect sensitive areas if
they are subsequently identified on your site.
If you have any questions, please feel free to call me at 503 - 846 -3613.
- Sincerely,
.1)66/A ge/6
Heidi Berg
Site Assessment Coordinator
\ \mo_serv_04 \eng$ \Development Svcs\SP 00 -7 \Concurrence Letters\2SI03BA00600 - sens area piped.doc
155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124
Phone: (503) 846 -8621 • Fax: (503) 846 -3525 • www.cleanwaterservices.org
CIT TIGARD _ , 24- Hour' -- . _ J , -r�., -- \ ---�
BUILDING 1 � �,� Inspection Line: (5031639 -4175 - MST a b o - Li
INSPECTION'bIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested �T'' AM PM BUP
Location • 11 (0 5 't%l o % _c / .4.. Suite _ MEC
Contact Person t h ( ) S IS .a I PLM
Contractor • Ph ( ) SWR
BUILDING. , Tenant/Owner ELC (R — O 0 q LI C I
Footing
Foundation ELC
Access:
Ftg Drain ; O m go _ ELR
Crawl Drain
Slab t' Inspection Notes: _. SIT
Post & Beam O 0_ .. - , , .
Shear Anchors i ___ / i
Ext Sheath/Shear O 11 Al -, $7,21W7 . &' 4 .I'
Int Sheath/Shear i
., Framing
Insulation
< Drywall Nailing
Firewall
Fire Sprinkler
c' Fire Alarm
c Susp'd•Ceiling
' Roof
Other: ir
l _ he' fl$ PART FAIL ,
P • BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
ASS PART FAIL
ANICAL
Post & Beam
< Rough -In
Gas Line
( ' Smoke Dampers
S Final
• PASS PART FAIL
ELECTRICAL `-
Service e
Rough-In - y ;r_t
UG/Slab
Low Voltage 1p
Fire a� Alarm/ \ A`71
�� PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd..
SITE fl Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA S_ 2 _ 0
Approach/Sidewalk Dat Inspector • / Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL