Permit MASTER PERMIT
'6 C i' U ®F T I G A R D PERMIT #: MST2007 -00041
COMMUNITY DEVELOPMENT DATE ISSUED: 3/13/2007
,,TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103DA -00500
SITE ADDRESS: 13180 SW WATKINS AVE ZONING: R -4.5
SUBDIVISION: DERRY DELL LOT: 005 JURISDICTION: TIG
PROJECT: MIGUES
Project Description: Addition.
BUILDING
REISSUE: CUSTOM STORIES. 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK ADD HEIGHT. 11 FIRST: 676 sf BASEMENT sf LEFT 5 SMOKE DETECTORS Y
TYPE OF USE. SF FLOOR LOAD 50 SECOND sf GARAGE sf FRONT: PARKING SPACES 2
TYPE OF CONST 5N DWELLING UNITS THIRD sf RIGHT. 5
VALUE 62 40
OCCUPANCY GRP. R3 BDRM BATH TOTAL. 676 sf 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 1 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 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 2 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 8 STEREO VACUUM SYSTEM AUDIO 8 STEREO FIRE ALARM INTERCOM /PAGING. OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH BOILER. HVAC LANDSCAPE/IRRIG. PROTECTIVE SIGNL:
GARAGE OPENER. CLOCK INSTRUMENTATION MEDICAL' OTHR
HVAC. DATANTELE COMM: NURSE CALLS: TOTAL # 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
RON & DEBORAH MIGUES DALE EICKHOFF SR laws All work will be done in accordance with approved plans This
13180 SW WATKINS AVE 11115 SW 114TH PL permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 TIGARD, OR 97223 if the work is 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 952 -001 -0080 You may obtain copies of these rules or direct
Phone: Contact #: PRI 503 784 - 2017 questions to OUNC by calling 503 246 6699 or 1 800 332 2344
FAX 503- 968 -7978
Reg #: LIC 58902
TOTAL FEES: $ 1,131.76
REQUIRED ITEMS AND REPORTS
Issued By : �1/ J Permittee Signature : ,. 7,‘„,0���y 7
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.
f' - i - ' V:' _ I 0 -CAD
Plumbing Permit Application colt Orrlcr. 1 SI: ONLY
City of Tigard e = i 200 y 3 /4 prl P ermit N. -- - - -
,� _� �..
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fad 5g3j593.1 1(1• j A „ i it° Date/BI, Other Permit No..
1 ion Line: 503.639.4175
TIC'. :� 1. t) Int et: www.ti d-or. fl lip = 1rTC r;."-IT �( �� Date Ready/By )�w 10 See Page 2 for
> Notified/Method: Supplem Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
,,,,,,,,// Description I Qty I Ea. I Total
L7Addition /alteration/rep :cement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CA GORY OF CONSTRUCTION SFR (I) bath 249.20
C)and 2 -famly dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMAT 4 N AND LOCATION Site utilities
Job site address: /3/ VD 5 IA/ .. k i f i . e . Catch basin or area drain 16.60
City /State/ZIP: 'T'; 2 d i d c e (y y 3 Drywell, leach line, or trench drain I 1660
Suite/bldg./apt. no.: I Project name: Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street /directions to job site (,tJ r #" it . Pd/'
Manholes 16.60
Rain drain connector 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
Tax map/parcel no.:
Future or item
Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
I- W Po „ r" Y 17 r 0 - ; Nt Backwater valve 16.60
Clothes washer 16.60
D • washer 16.60
❑ PROPERTY OWNER I ❑ TENANT Drink •: fountain - - - 16.60
,�1 E3edors/ +' ' \ � 16.60
Name: R o ;t/ i. Q c Q B 1 /,/f t v e S Ex sion to 4--- ,_. s 16.60
Address: / 3 / f 0 S W. (,,,, r/'C t i4, f Fi4re/sewer on - - \ 16.60
City /State/ZIP: `T; 74.1 ccl 0/ e 1, a, �.t Fl.. drain/floor s' ■ : 16.60
Phone: (S'o3 ) 7 9 t/ ` 2 0/ 7 Fax: ( ) : - ge disposal V�4 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose ib 16.60
Ice mak 16.60
Business name: p r L. co N s rr, vc.7 %d� _ Interceptor/ se trap ( 60
Contact name: A f., L E (;€ / p .. f Medical gas (value $� ) Page 2
Address: / (< / 6" s. iv. /Iv PA a c - Primer 16.60
City /State/ZIP: ; , m , 4 9) ,/� 13 e). R oof drain ! e (commercial) 16.60
Phone: Sink/basin/lavatory 16.60
(coy ) 7 �6y " 1 O / 7 I Fa x :: ( �) 968 - 7 9, Tub/shower/shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet ..60
Business name. E .vx m 1).1•=4, ( t - ; �,,JC Water heater 16..0
Address770 `t' 0 141 Other:
City/State/ZIP: , \ \S bo�.•e 0u.. g1(
Subtotal
(5' ) �p 2...t{?_, Fax: Minimum permit fee: $72.50
Phone:
j , ig ' ( 3) b�% k 2 Resid ential backflow minimum permit fee: $36.25
CCB Lic.: rj 2 L\ O Plumbing Lic no. :'3t • - 4'A ? g Plan review (25% of permit fee)
S / 4,/ e 1 State surcharge (8% of permit fee)
Authorized signature: -]/I /Q% TOTAL PERMIT FEE .2y. 3o
Print name: )C , , , L aft US I Date: 3.--4 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 .\Bu.Iding\Pamib\PLM -Perm itAppdoc 06/26/06 4404616T(I0/02/COM/W ®) .
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof; to and
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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
QaaodtY by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780-0040.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink -2" that meet the qualifications above.
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
-Commercial
-Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures: 1
i,\&dldmg\Permite\PLM- PennitApp doc 09/22/06 ■
BuildinE Permit Application FOR OFFICE LSE ONLY
City of Tigard i1, Received ; 0 ? , i
° 13125 SW Hall Blvd., Tigard, OR 97223 plan Review /
Phone: 503.639.4171 Fax: 503 598.1960 / DaWB / 3 - 1 - v 7 Other Permit
f 1 G n It D Inspection Line: 503.639.4175 Date Ready/By" Juns ® See Attached Checklist for
Internet www.tigard- or.gov Notified /Method Supplemental Information
JI I Y v' �, ar a.
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed.
Addition/alteration/replacement ❑ Other: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. L i6 2 $O
dwelling Valuation.
1 -and 2-family
Y g ❑Commercial /industrial
❑ 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: /1/ 10 5, , /.4)q r /C +QS New dwelling area: square feet
City /State/ZIP: Tif / (� 9 1 .� g Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: 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.
0 6 a 6 Jet fit O Valuation: s
Existing building area. square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: £ T 7 >( 1A,-e ,S i 1 o'. , �. �.CbU ( S1� �/ Type of construction:
Address • �J� Occupancy groups:
City / State/ZIP: Existing
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: p, L , C o a , /✓ c• , o /V All contractors and subcontractors are required to be
Contact name D A h c �� c �� y f► /x licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address• /1/ f , s-- J r (/) //a Pt jurisdiction in which work is being performed. If the
City / State/ZIP: -t d / applicant exempt from licensing, the following reasons
apply:
Phone: (.5 ) 7 q' ` O / 7 Fax: . ( 0 1 ) 76 f-2 /r ? f
E -mail:
CONTRACTOR
Business name:
BUILDING PERMIT FEES*
Address C �( /n „ (Please refer tofee schedule)
City /State/ZIP:
J j' 4 �Y Structural plan review fee (or deposit)•
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: J 1"!d 57 Total fees due upon application:
Authorized signature: IN
Amount received:
fZ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name p . [ ) G `, 0 7171 I Date: / —0-2 ' Fee methodology set by Tri -County Building Industry
Service Board.
r VituddingTemam\BUP- RFS- PmnnApp doc 03/71/06 440-4613T(I I/02/COM/WEB)
One- and Two-Family Dwelling
Building Permit Application Checklist ` r'�Y . I of oI I Ic util "tJi�l �
City of Tigard rseca ved
H v
Date/By
No .
13125 SW Hall Blvd., Tigard, OR 97223
Associated
Phone: 503.639.4171 Fax 503.598.1960 parrots
24- Hour Inspection Line" 503.639 4175 ❑ Eleancal 0 Numbing ❑ Mechamcal
7I` Internet: www.tigard- or.gov ❑ Other
IlL OLLOWVING I`i'i Ii\i , Rl QU:iRI D 'F',0 WI' N'R EV iENN °ti 1v C1 "O N ,��{
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • •
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 0 0 ❑
3 Verification of approved plat/lot. ❑ 0 ❑
4 Fire district approval required. Name of district: . ❑ ❑ 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ 0
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- ❑ 0 ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state 5 ❑ ❑
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 Eij ❑ ❑
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 151 0 0
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, 119 ❑ ❑
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- C' ❑ ❑
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- ® 0 ❑
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 ® ❑ 0
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 0 0 ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ 0 ❑
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 ❑ 0 ❑
architect licensed in Ore:. and shall be shown to be . • 'licable to the • o'ect under review.
4 � }:I UR1S DIC I ION' \L'" S P [ C II {r
� �5. i , ICS < t �r jj+'' l.u. R. �.t1 « I....`_.. • 1F G. 4 itx.,- �� ` VA S (� xr a +7 Y s ty
e � 4.. tea' �!� �' � �. ��."rNa t�v tom'' ;� ��� }4t t?` r '`f - s � 4 �....�. . • lr
23 Five (5) site plans are required for Item I I 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. 0 ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. 0 ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ 0 0
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.
1 \Bwtd'mgTemra\BUP- rtES- PunitApp d« 03/21/06
$ ,?. SS g.
Electrical Permit App ■ • ; FOR OFFICE U SL ON
, E 1 V , 11 ' . , � , .
City of Tigard Received Permit No � j ' A
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• C ' Phone: 503.639.4171 Fax: 503.5 0 Dy�B Other Permit. TI GA•RD
Inspection Line: 503.639.4175 I IN O �oo� Date Ready/By. tads ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method. Supplemental Information
TYPO I1k3 PLAN REVIEW • ,
❑ New construction ❑ A
r ,te 4 � a . • � 9 9 r � Please check all that apply (submit 2 sets of plans whtems checked below).
ott>IAl '�fa e Tr
❑ 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
❑ 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
❑ Emergency system. larger separately denved system
JOB SITE INFORMATION AND LOCATION ❑ Addinon of new motor load of ❑ "A ", "E ", "I -2 ", "I - ",
Job no.: 1 Job site address: /&/.9 I OOHP or more. occupancy
O . 5 . IV • L' T iC / ❑ SIX or more residential umts. ❑ Recreational vehicle parks.
❑ H -care facilities. ❑ Supply voltage for more than
/
City/State/ZIP: 7- yQ , / N 9 ?� 3 600 volts nominal.
13 Hazardous locations
Suite/bldg. /apt no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qa• I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. fl. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. 0 )
Limited energy, multi - family 75.00 2
3 residential (with above sq 0 )
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
Name: Q i v - 5c 401 amps to 600 amps 160.60 2
r r v P S 601 amps to 1,000 amps 240.60 2
Address: / r VO , s u ta n, 7 -- k - i‘4 , 5 , Over 1,000 amps or volts 454.65 2
City/ State/ZIP: 7" d Q� �? 2 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT. I . ' ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B Fee for branch circuits
without service or feeder fee, 3 1 46.85 y(.
Contact name: first branch circuit
Address: Each add'I branch circuit 2. 6.65 13. 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: Pump or irrigation circle 53.40 2
CONTRACTOR '' ' ' Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: 14 u D t-v50 0.) S SST f i:. ( t4-y EA..Gt,1Vt co Z.J C.— energy panel, alteration, or
t, f 3s S t� 1 R , . ( , extension. Describe Page 2 2
Address: ( U
City/ State/ZIP a L 04.1 ta7 e e•-• Each additional inspection over allowable in any of the above
O Fax: Per inspection 62.50
Phone:
( S o) b R / • c 1 O 7 I ( ) f � 4 (^ 7 O 7 Investigation per hour (I hr min) 62.50
CCB Lic.: ct I y i v Electrical Lic.: 31 - ( L.Suprv. Lie.: 377 O 5 Industrial plant per hour - 73.75
`1 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: t A ( - _ _ Subtotal: Q.
Print name: �V =L W `a -vSt� r� Date: i I I 9 /c, 7 —
Plan review (25% of permit fee):
� .� `7 ` ( State surcharge (8 /o of permit fee): g. 7
Authorized signature: TOTAL PERMIT FEE: e • C I r)
Print name: Date: This permit application expires if a permit is not obtained w ithin FRO
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I \Bwlding\Pamrts\ELC- PamitApp doc 05/23/06 440-4615T(11/05/COM/WEB
i
Electrical Permit Application - City of Tigard T •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL.WORK ONLY: 7, • •
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 ONLY: - ' _.� i , •
Fee for each commercial $75.00 "
system
(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
El Instrumentation
❑ l Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling •
El Other -
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Buildmg\Pennos ELC- PamoApp doc 03/23/06
•
• B- 23;007 01:54P FROM: TO:5036814439 P:1/2
■
■
iv .
D !� i'�i Ir
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■
L I FEB 2 3 2007 I J,
.. CWS File !slumber I 0 7 oOO5?7
CleanWater Services - L.
Our Commitment is clear. Sensitive Area Pre-Screening Site Assessment
Jurisdiction _ 7164-RD Date 2 - j - O�_
Tax Map & Tax Lot* A'/ 03 04 OUSOO Owner R - e d ,7, a 111, a ei
Applicant Di,t.w L-.`icf, P f
Site Address / 3 1 $ 0 . S .•v• a-"o j"/ci v5• Company _ 0, c t. c .-er . r.- . ,
'fit & rd "t' ?, 25 Address till 3 i, w HIV 1-4 Pi-e'c. e
Proposed Activity _ City State Zip IV, ,i ,^ A pi 97 . 2 2 3
_ e l el 1 7 a' Phone 6-0 3 - 7 Ste( - e 1 7 _
Fax 9 4 5 ' - 21 SI —
_
By submitting this form the Owner, or Owner's authorized agent or representative, acknowledges
and agrees that employees of Clean Water Services have authority to enter the project site at all
reasonable times for the purpose of inspecting project site conditions and gathering information
related to the project site.
Official use only below this line _
Mel.l use only below this line Official use only below this line
Y N NA Y N NA
Ir ^ 7 Sensitive Area Composite Map Stormwater Infrastructure maps
Map # _ 25N M 1 E QS# 4q// 8
-1 I � I Locally adopted studies or maps . I Other
L S I I J u Specify /term- //0" te5
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:
LI 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. If
Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural
Resources Assessment Report may also be required.
E l 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. This document will serve as your
Service Provider letter as required by Resolution and Order 04-9, Section 3.02.1. All
required permits and approvals must be obtained and completed under applicable local,
state, and federal law.
n The proposed activity does not meet the definition of development NO SITE ASSESSMENT
OR SERVICE PROVIDER LETTER IS REQUIRED.
Reviewer Comments:
ktse- oh e✓iew o i S:T - , - • !-r. , .ltdfo
- / - A-. Po 'Ner _ . ;' ; jQCrrfl i. O TCNT 4 ,
• ,v e., o�k h e. th 'e•
Reviewed By: I. I. - Date; _4420Z_________
Official use only
Post -it® Fax Note 7671 Date 3/ 0 7 Ipaogeste
Returned to Applicant
To From /7 k 1 - 5w ,, /64, Mail _ Fax A( Counter _
Co. /Dept y , /t Co. 2I ) C Date -/O ) _ By
• O( (�JwSTY ✓el�oK ( J
Phone # Phone #5 , 65/ _ I /O
Fax # 5703. 5 69' 99 ! Fax # J
. CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . ' _
INSPECTION WORKSHEET FOR DATE: 5/16/2007 TIME: 7:00AM PAGE: 53
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 -784 -2017
Inspection Request Scheduled For: Date: 5/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 048369-01 503- 784 -2017 Y
Corrections/Comments/Instructions:
0414 /Lc. 1 1"1
u��Y
6
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: S ,F' Date: S /G —0> Phone #: (503) 718- "2-4-4-5"
CITY OF TIGARD -
BUILDING DIVISION . . #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171 � au� q� i l l
Inspection Requests (24 Hrs.): (503) 639 -4175 .' �__..
INSPECTION WORKSHEET FOR DATE: 5/15/2007 TIME: 7:00AM PAGE: 13
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 YPE OF USE:
PROJECT NAME: MIGUES DESCRIPTION: Addition. / 4'.
OWNER: MOUES, RON & DEBORAH IS < ~ � T PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 -7B4 -2017
I ,
r .
.>.
Inspection Request Scheduled For: Date: EdIc I Pour Time:
Code # Inspection Description Confirm # Contact # Messag
199 Electrical final 048315 -01 603 -307 -3885
Corrections /Comments /Instructions:
PASS ❑ PARTI . L APPROV' ❑ CANCEL ❑ NO ACCESS
❑ FAIL - '''L FOR N� • '• ❑ ADDITIONAL FEES ASSESSED
/ s � � X-- #: .21
Inspector: Date: Phone #. (503) 718-
CITY OF TIGARD,
BUILDING DIVISION PERMIT #: MSf2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171 Ake
Inspection Requests (24 Hrs.): (503) 639 -4175 ill..
INSPECTION WORKSHEET FOR DATE: 4/16/2007 TIME: 7:00AM PAGE: 4
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 -784 -2017
• Inspection Request Scheduled For: Date: 4/1612007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 ' Electrical rough -in 046559 -01 503-307-3885 N
Corrections /Comments /Instructions:
•
•
•
•
•
•
•
7 1) c / a7, a•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ AIL ❑ CAL FOR INSPECTION ❑ ADDIT( AL FEES ASSESSED lie •
Inspector: Date: #: (503) 718 -
•
•
CITY OF TIGARD.
BUILDING DIVISION PERMIT #: MS12007- 00041 •
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/1312007
Phone: (503) 639 -4171 M eru fit
Inspection Requests (24 Hrs.): (503) 639-4175 III
INSPECTION WORKSHEET FOR DATE: 4/19/2007 TIME: 7:01AM PAGE: 30
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 006 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 - 7842017
Inspection Request Scheduled For: Date: 4/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
280 Insulation 046793-01 503-784-2017 N
Corrections /Comments /Instructions:
•
•
ASS ❑ PARTIAL APPROVAL 111 CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: Date: 4--1 9 -off Phone #: (503) 718-
' CITY OF TIGARD.
BUILDING DIVISION PERMIT #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/1312007
Phone: (503) 639 -4171 �w4Y
Inspection Requests (24 Hrs.): (503) 639 -4175 W °7I t ..
INSPECTION WORKSHEET FOR DATE: 4/19/2007 TIME: 7:01AM PAGE: 31
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES. RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 -784 -2017
Inspection Request Scheduled For: Date: 4/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
230 Underfloor insulation 046792 -01 503.784 -2017 Y
Corrections /Comments /Instructions:
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 4 - /'? -v Phone #: (503) 718- �`,f-
CITY OF TI.GARD
BUILDING DIVISION PERMIT #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175
WORKSHEET FOR DATE: 4/17/2007 TIME: 7:01AM PAGE: 38
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
' SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #: •
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 -7134 -2017
•
Inspection Request Scheduled For: Date: 4/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 046606-01 503- 784 -2017 N
Corrections /Comments /Instructions:
•
•
•
•
N"fir
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ¢ 1 ? li Phone #: (503) 718- Z��.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/12/2007 TIME: 7:00AM PAGE: 42
SITE' ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK: '
SUBDIVISION: DERRY DELL LOT #: 005 • TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #:
CONTRACTOR: • DALE EICKHOFF SR PHONE #: 503.704 -2017
Inspection Request Scheduled For: Date: 4/12/2007 Pour Time
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 046385.01 503 - 784 -2017 Y
Corrections /Comments /Instructions:
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: Date: 4-- /2- 0? Phone #: (503) 718 - �-¢`�
CITY OF TIGARD.,
BUILDING DIVISION PERMIT #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171 �pirl�lr
Inspection Requests (24 Hrs.): (503) 639 -4175
•
INSPECTION WORKSHEET FOR DATE: 4/10/2007 TIME: 7:00AM PAGE: 13
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: !VOGUES, RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503.784 -2017
Inspection Request Scheduled For: Date: • Pour Time:
p q 4/10/2007
Code # Inspection Description Confirm # Contact # Message
235 Shear walls/anchors 046272 -01 503 -784 -2017 N
•
Corrections /Comments /Instructions: •
•
•
•
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - Date: ¢ - /O— 07 Phone #: (503) 718 - z_..4-Q�b
CITY OF TIGARD.
BUILDING DIVISION PERMIT #: MST2007-00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171 !a.
Inspection Requests (24 Hrs.): (503) 639 -4175 '. D1
INSPECTION WORKSHEET FOR DATE: 4/10/2007 TIME: 7:00AM PAGE: ' 12
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 -7134 -2017
Inspection Request Scheduled For: Date: 4/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 046272 -02 503 -784 -2017 N
Corrections /Comments / Instructions:
#;- LbPr/Ie°L' E 4.//4 -J Z- / 'a)
te r"
❑ PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • Date: 4 -- /0 - e27 Phone #: (503) 718- 7
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007- 00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171 Art
Inspection Requests (24 Hrs.): (503) 639 -4175
•
INSPECTION WORKSHEET FOR DATE: 3/23/2007 TIME: 7:03AM PAGE: 17
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503-7642017
. Inspection Request Scheduled For: Date: 3/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
310 Crawl drain 045318.01 503-784.-2017 N
Corrections /Comments /Instructions:
•
•
\.
F4: • S ❑ PARTIAL APPROVAL \ ❑ CANCEL ❑ NO ACCESS'
❑ FAIL ❑ CALL FOR INSPECTION \ ❑ ADDITIONAL FEES ASSESSED
Inspector: ii/1 � " _ \ Date: I Phone #: (503) 718 -
CITY OF TICARD. •
BUILDING DIVISION , PERMIT #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 31/3/2007
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175 "'I I..
INSPECTION WORKSHEET FOR DATE: 3/23/2007 TIME: 7:03AM PAGE: 16
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: ['AGUES
DESCRIPTION: Addition.
OWNER: !AGUES, RON 2 DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 - 2017
Inspection Request Scheduled For: Date: 3/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
225 Post/beam structural 045318 -02 503 -784 -2017 N
Corrections /Comments /Instructions:
•
•
!� PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - Date: 3- 2 - e 2 Phone #: (503) 718- ? . 1-1
CITY OF TIGARD.
BUILDING DIVISION PERMIT #: MST2007- 000'l1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639- 41714pggi�
Inspection Requests (24 Hrs.): (503) 639 -4175 _' . °:_..
INSPECTION WORKSHEET FOR DATE: 3/21/2007 TIME: 7:02AM PAGE: 13
SITE ADDRESS: 13180 SW WATKINS AVE_ CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES. RCN & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503.784 -2017
Inspection Request Scheduled For: Date: 3/21/2007 Pour Time: ,10:00
Code # Inspection Description Confirm # Contact # Message
205 Footing 045188 -01 503-784 -2017 N
Corrections /Comments /Instructions:
1 xicidevz- 601. 5.Z6 5}90 j
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
(l FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,� Date: 3- 2/ -07 Phone #: (503) 718 - 2,4-4S
• CITY OF TIGARD, • •
BUILDING DIVISION PERMIT #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639 -4171 Al A,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/20/2007 TIME: 7:00AM PAGE: 57
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 006 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 50
Inspection Request Scheduled For: Date: 3/20/2007 Pour Time: 12:00
Code # Inspection Description Confirm # Contact # Message
210 Foundation walls 045070 -02 503.789 -2017 N
Corrections /Comments /Instructions:
❑ PAS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 3 -ZO -a Phone #: (503) 718- Zq..4 - sue
1' CITY OF TI.GARD. •
BUILDING DIVISION PERMIT #: MST2007 -00041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 31/312007
Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 '.. lit
INSPECTION WORKSHEET FOR DATE: 3/20/2007 TIME: 7:00AM PAGE: 58
SITE ADDRESS: 13180 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: MIGUES
DESCRIPTION: Addition.
OWNER: MIGUES, RON & DEBORAH PHONE #:
CONTRACTOR: DALE EICKHOFF SR PHONE #: 503 -784-2017
Inspection Request Scheduled For: Date: 3/20/2007 Pour Time: 12:00
Code # Inspection Description Confirm # Contact # Message
205 Footing 045070-01 503-784-2017 N
Corrections /Comments /Instructions:
0 0 AA. -W- - 7 - ?,54 - may
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 / Date: 3 - 2ei — n >, Phone #: (503) 718 - 2,6 �_
•