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Permit CITY OF TIGARD MASTER PERMIT 0 .,: 1 DEVELOPMENT SERVICES PERMIT • MST97 -0530 � •�- 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: UED: 1e/08/97 PARCEL: 251O4AD -02800 SITE ADDRESS...:12949 SW WALNUT ST SUBDIVISION ZONING: R -4.5 BLOCK LOT • JURISDICTION: URB Remarks: Addition to SFD BUILDING REISSUE: STORIES • 2 FLOOR AREAS BASEMENT...: 0 sf REQUIRED SETBACKS— REQUIRED- - CLASS OF WORK.:ADD MIGHT • 20 FIRST • 840 sf GARAGE • 333 sf LEFT : 0 SMOKE DETECTRS: Y TYPE OF USE...:SF FLOOR LOAD • 40 SECOND...: 0 sf FRONT : 20 PARKINS SPACES: 0 TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT : 0 OCCUPANCY 6RP.:R3 BORA: 2 BATH: 1 TOTAL------: 840 sf VALUE..$: 62083 REAR • 99 PLUMBING SINKS • 0 WATER CLOSETS.: 1 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0 LAVATORIES • 2 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 1 CATCH BASINS..: 0 TUB /SHOWERS...: 2 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0 OTHER FIXTURES: 0 - ' MECHANICAL FUEL TYPES FURN (180( ..: 8 BOIL /CMP ( 3HP: 0 VENT FANS • 1 CLOTHES DRYERS: 0 GAS FURN ) =100K ..: 0 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 0 MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS • 3 WOODBINES • 0 GAS OUTLETS...: 0 ELECTRICAL - - RESIDENTIAL UNIT— — SERVICE /FEEDDER— —TEMP SRVC /FEEDERS— — BRANCH CIRCUITS — — MISCELLANEOUS— - -ADD'L INSPECTIONS- 1m SF OR LESS: 0 0 - 200 alp..: 1 0 - 200 alp..: 0 W /SVC OR FOR..: 0 PUMP /IRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 500SF.: 8 281 - 400 alp..: 0 201 - 488 alp..: 0 1st W/O SVC /FDR: 0 SIGN /OUT LIN LT: 0 PER HOUR • 0 LIMITED ENERGY.: 0 401 - 600 alp..: 0 401 - 608 alp..: 0 EA ADDL BR CIR: 0 SIGNAL /P(4EL...: 0 IN PLANT • 0 MANF HM/SVC /FDR: 0 601 - 1'..• amp.: 0 601 +amps -1m v: 0 MINOR LABEL -10: 0 1000+ amp /volt.: 0 - — PLAN REVIEW SECTION ---- -- Reconnect only.: 0 )=4 RES UNITS..: SVC /FDR)=225 A.: ) 600 V NOMINAL: CLS AREA /SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM • INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM..: 0TH: .. BOILER • HVAC LAND5CRPE /IRRI6: PROTECTIVE SIGNL: GARAGE OPENER..: CLOCK • INSTRUMENTATION: MEDICAL OTHR: .. HVAC DATA /TELE H ' ' . : NURSE CALLS TOTAL 0 SYSTEMS: 0 Owner: Contractor: TOTAL FEES:$ 901.65 HAD PHAN • OWNER This permit is subject to the regulations contained in the 12949 SW WALNUT Tigard Municipal Code, State of Ore. Specialty Codes and all TIGARD OR other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is Phone 4: Phone 0: not started within 180 days of issuance, or if the work is Reg B..: mi.1'.1 suspended for more than 180 days. ATTENTION: Oregon law ---- — - requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 -0010 through OAR 952- 081 -0088. You may obtain copies of these rules or direct questions to OUNC by calling -1987. REQUIRED INSPECTIONS Erosion Control Crawl Drain /Back Electrical Rough Gas Line Insp Water Line Insp Plumb Final Footing Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service In Building Final Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp Post /Beam Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final Post /Beam Me - lectrical Servi Fireplace Insp Rain drain Insp Mecha ' Fi Issued • y: •, 1 iV A d . .17 1 Permittee Signature: W . 'D � _ . ��//.i/j + + + + + ++ +++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + ++ + + + ++ + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day • Plan Check # �`— ! R CITY OF Residential Building Permit Application Recd By O 13125 SW HALL BLVD. New Construction Additions or Alterations Date Recd /0 — q TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. i Z 0 39 -.?".` V 503 - 639 -4171 Date to DST / -4 / - 1 i F 503- 684 -7297 Permit #/✓* T9n - - OS`SO Print or Type Called / Z'f7p II /6 Incomplete or illegible applications will not be accepted /lia- Name of Project Name Job 7,C D 2 77 7 .-- X: 41- / -50/x/ A/C.-(/Y Mailing Address ' Address S ite Address / � © 6 / 2 �T 5 � ���/ City/State Zip I Phone i Name L9'0D OTC 72' 777,4) // P/ N ame ' Owner Mailing Address /214/ SGV cdAr v6e City/State' Zip Pone Engineer Mailing Address 77 0E. 97 - -345 City/State Zip Phone General Name Contractor q Describe work New 0 Addition Alteration 0 Repair 0 Mailing Address to be done: Prior to permit 2 ,_5," � � Additional Description of Work: ,4/04)/ 77 - issuance, a copy City Zip Phone Z ,6.P/J, t�r � des 0 - .R..0 of all licenses P t4 /0,,Q. -- 71..0,655 - 6- OR* PROJECT are required if Oregon Const.'Cont. Board Exp. Date expired in COT Lic.# V ALUATION Ste " � i < Urt t database v Mechanical Name „,, CONSTRUCTION ONLY: Sub- /, -- ` i J Sq. Ft. House Sq. Ft. Garage Contractor Mailing Address : 33_3 Prior to permit Corner Lot YES NO Flag Lot YES NO issuance, a copy City/State Zip Phone (check one) (check one) of all licenses Restricted Audio /Stereo Burglar are required if Oregon Const. Cont. Board Exp. Date Energy System Alarm expired in COT Lic.# database Installation Garage Door HVAC Plumbing Name ,i - # - -- Opener Systems Sub- ! (check all that Other. Contractor Mailing Address apply) Will the electrical subcontractor wire for all YES NO restricted energy installations? Prior to permit City/State Zip Phone Has the Subdivision Plat recorded? Nr YES NO issuance, a copy of all licenses are Oregon Const. Cont. Board Exp. Date required if Lic.# Reissue of MST #: Solar Compliance expired in COT (Calculation Attached) database Plumbing Lic. # Exp. Date I hearby acknowledge that I have read this application, that the information given is correct, that I am the owner or authorized Name agent of the owner, and that plans submitted are in compliance / r with Oregon State laws. Electrical / , Is- a-oi ; rture i of w er /Age Date Sub- Mailing Address �,.0 � � 12 -/ i / q 7 tact Na a Phone'# City/State Zip Phone Contractor � 6 �ip Z/ Con �. ® P” so $ A / V4-O)•h 771-5638 Prior to permit FOR OF CE USE ONLY: issuance, a copy - - - - � 072 x'/ J S SA { 2--Plat #: J� Map� �^ of all licenses are Oregon Const. Cont. Board Exp. Date / ('7 1 O Z � required if Lic.# _ Z Setbacks: t / �� Zone: Solar: expired in COT � - (�ti database Electrical Lic. # Exp. Date En tee proval: Planning Approval: TIF: I:SFREM.DOC (DST) 4/97 Permit #: q 7- OJ 5 o OF O �` • Address: /A9 ( 19 ' gtO z0/cC. AJ 7 ,.. * F � `, 0 A d dress 1 " . • YtY11YY� „ . Z , Issued b Date: / 2- 'g_ 7 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. ;� i 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 1 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 W 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 Construction Responsibilities on the reverse side of this form. d o I /i a/pg -- l��G' 8- (Signature of pe • applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) - I�1ffo matia�u 1�otuce to properly 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. EMPLOYER RESPONS lLlTDE$: • 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 must 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 945 -7888. U.S. Internal l evenue 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 I - 800 -829 -1040. • , •THE( F- ;ESPONV=39LmES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. . - 1Liabilit;y 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 he 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 genera] 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 Box 14140, 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 CITY OF TIGARD BUILDING INSPECTION DIVISION MST c i - -DS 30 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 • BUP Date Reequested ,, n �, —'21 l AM PM BLD I Location I 2 -f 6 1 I/v[1 ,11AA . Suite MEC Contact Person ( Ph c2)-1-3;q5 J 1-3 ;q5 PLM Contractor Ph SWR �^ BUILDING Tenant/Owner EL (Q - (D( () 7 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof • Misc: Final )4 /_ P ASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL • Post & Beam Rough In • Gas Line Smoke Dampers Final ' 4 , PASS PART FAIL ECT Service Rough In UG /Slab Low Voltage Fire Alarm • • SS !'ART FAIL • S = Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date i20 Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site CITY OF TIGARD BUILDING INSPECTION DIVISION MST ?7- oS�a 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 Q BUP Date Requested 7 Z� < 9 AM PM BLD Location 1 2 —1 Suite / MEC Contact Person LO Ph S 2 Lfr3. I S PLM Contractor Ph SWR 011ILD1 Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling . Roof Misc: ASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains 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 Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ] Please call fo reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Other Date Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection re rd from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST G� -7,Ds30 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested ,' n ,M7, —,Z Q L -` 1 AM PM BLD Location 1 2-9 �a-ei IF Suite ! MEC Contact Person f) Ph SZ J r 3 ;LI5 PLM Contractor Ph SWR 'gyp BUILDING Tenant/Owner ELC D r b ( C Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: / Final / 4 — Q s- - PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL LErfR1CAb Service Rough In UG /Slab Low Voltage Fire Alarm ART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk 7 0 — Other Dat Inspe Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. 01.'23/98 13:39 V503 684 7297 CITY OF TIc ;ARD Q001/001 CI TY O F TIGARD Electrical Permit Application Plan Ch _ i 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Recd _ Phone (503) 639 -4171, x304 Date to P.E. • Print or Type Data to DST Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit# LC�- o��,�C Fax (503) 684 -7297 Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development I Number of Inspections per permit allowed - • Name (or name cf business) _. -_ Service included: Items Cost Sum Address u� /� � �+' 4a. Residential - per unit City/State/Zip / /�/J _ _ AO 1000 sq ft or I4st 2 Each additional 500 sq. it or $110.00 4 portion thereof $25.00 1 - Commercial ❑ Residential ® miteU E nergy $25.00 Each Manuf'd Home or Modular . , Dwet:Irg Service or Feeder _ $68.00 . , 2 2a. Contractor installation only: (Attach copy of all cur • nt is - nses) 4b. Services or Feeders Electrical Contractor f - , -' J - . �/ G Installation, alteration, or relocation Address . 13 Z _ L G • .-� 200 amps jr lee $60 00 2 20 1 amps to 400 amps 580.00 . 2 City 1/�. _- rc State o f Zip�Z _ 401 amps to 600 amps $120.00 2 - Phone No. n_5 / L _ _ 601 amps to 1000 amps $180 00 - - 2 I Job No. -T Over 1000 amps or volts $340.00 2 Elec Cont. Lice No . 3= 2 e Exp.Date_ .o- /- 9f Reconnect on 'y __ $50 00 2 I ' OR State CCB Reg. No. -e/ 3 Exp.Date_S'ZZ -�p 4c. Temporary Services or Feeders f COT Business T stns No. E .Date Installation, alteration, of reiacr• on 200 amps or less $50.00 - 2 Signature of Supr 201 amps to 400 amps 575 00 2 - r - -- 401 amps to 600 amps S100 00 • 2 - p Over 600 amps to 1000 volts. ° Licen No _I Z V I - / - _Exp.Date / - see "b" above. Phone Nr sZ 4d. Branch Circuits New, alteration or extension per panel 2b. For owner installations: a) The lee for branch circuits with purchase of service or Print Owner's Name feeder fee Address Each branch •orrc�it $5.00 _ • 2 b) The fee for branch circuits i City. State Zip . without purchase of po Phone No. _ service or feeder fee. • First branch circuit / $ 35 00 - 2 The installation is being made on property I own which Is not Each additional branch circuit _ $5 00 ,2-.) 2 intended for sale, lease or rent. 3.e- Miscellaneous Service or feeder not included) Owners Signatt:i e Each pump or irriaaticn circle $40.00 2 Each sign or outline lighting $40.00 2 3. Plan Rev section (if required):* Signal circuit(s) a limited everg panel, aaeration or extension $40.00 2 Miner! abels (10) 5100.00 Please check appropriate item and enter fee in section 58. 4 or more residental units in one structure 4f. Each additional Inspection over Service and feeder 225 amps or more the allowable in any of the above _ System over 600 volts nominal Ter inspection _ _ S35 00 Classified area or structure containing special occupancy Per Hour S55 as dascrtbed in N E C Chapter 5 In Planl $55.00 0 * Submit 2 sets of plans with application where any of the above apply. 5. Fees: / 0 Not required for temporary construction services. I 5a. Enter total of above fees $ °� 5'i• Sacharge (.05 X total fees; $ NOTICE Subtotal $ Sb. Enter 25% of line 5a for PERMITS i3ECOME VOiD IF WORK OR CONSTRUCTION AUTHORIZED IS Fier :ieview if required (Se:.3) $ NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ - c IS SUSPENDED OR ABANDONED FOR A PERIOD OF 130 DAYS A T ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account # /' 63 . 3 Total balance Due , i',OSTS\ELC95.PPF no 9 i /