Permit •
All MASTER PERMIT
PERMIT #: MST2003 -00354
_,I,L'W D EVELOPMENT SERVICES DATE ISSUED: 8/11/03
13125 SW Hall Blvd.; Tigard; OR 97223 (503) 639-4171
SITE ADDRESS: 13156 SW WINTERLAKE CT PARCEL: 1S133DB -04800
SUBDIVISION: BRITTANY SQUARE NO. 4 ZONING: R - 12
BLOCK: LOT: 076 JURISDICTION: TIG
REMARKS: 2 -story addition
BUILDING
' REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 21 FIRST: 181 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF - FLOOR LOAD: 40 SECOND: 250 sf GARAGE: sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5
VALUE: 39.824 40
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 431 sf REAR: 12
PLUMBING
SINKS: 0 WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 2 CATCH BASINS: _
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 0 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: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EAADDL BR CIR: 100 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: 0TH: BOILER: HVAC: LANDSCAPE/1RRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: ' MEDICAL: OTHR:
HVAC: DATA/TELE COMM: , NURSE CALLS: TOTAL B SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 860
CARL COX SCOTTCO BLDG + DESIGN This permit is subject to the regulations contained In the
13156 SW WINTER LAKE DR 11640 SW 135TH AVE Tigard Municipal Code, State OR. Specialty Codes and
. TIGARD, OR 97223 TIGARD, OR 97223 all other applicable laws. All /o d
rk,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: '
Oregon law requires you to follow rules adopted by the
Phone: 503 - 590 - 5185 Phone: 646 - 6771 Oregon Utility Notification Center. Those rules are set
forth in OAR 952- 001 -0010 through 952 - 001 -0080. You
Reg a: LIC 00049670 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS •
Footing lnsp Plumb Top Out Insulation lnsp Final Inspection
• Foundation Insp Electrical Rough In Rain drain Insp
Post/Beam Structural Framing Insp Roof Nailing
Underfloor insulation Shear Wall Insp Electrical Final
Crawl Drain /Backwater Exterior Sheathing Ins[ Plumb Final
Issued By : •/ Kr" ,40 / Permittee Signature l / L I ��
Call (503) 639 -4175 by 7:00 p.m. for an inspection nee.e. h Isine ss day
1 i fir, y '' /ly y 1 M I '' V
Building Permi Application OFFICE USE ONLY .
I �I�{ City of Tigard Date received 7 63 Permit no M�e»5 fo) >-�,3S o
r , E ® Project /appl no.: -x e date: .
Address: 13125 SW Hall Blvd, Tigard, OR' 99 2
City of Tigard n^
Phone (503) 639 -4171 Date issued • B • �J Receipt no.:
Fax: (503) 598 -1960 JUL 0 9 2003 U.) Case file no.: Payment type
Land use approval: CITY OF TIGARD I &2 family. Simple Complex
Dl ul numG DIVlb U r
s TYPE OF PERMIT e.
.l A ❑ I & 2 family dwelling or accessory D CommerciaI /industrial ❑ Multi- family ❑ New construction U Demolition
1 1 i j .Addition /alteration /replacement U Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
I ' JOB SITE INFORMATION
I
- Job address: f 3 / 5 6.., \A z W, ∎4 4- e - La ke D Bldg. no.: Suite no.:
-; Lot - & Block• 1 Subdivision: Sr I Ay 5 9 ( 44 re #. `f' Tax map /tax lot /account no.: 15 ) 33 D
Pro name:
Description and location of work on premises /special conditions:
C o
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Flood lain septic ca acit solar, etc.) F'
,� Mailing address: 13 ( 5 /v 5 0 ij//J f—e 00" I & 2 family dwelling: 2
1 City: `— State:0� TIP: ZZ Valuation of work sass S �0 L1G�_-
Phone:5119 - 5/,)535 Fax: E -mail: No. of bedrooms /baths ...Wr { —(
Owner's representative • Total number of floors Z.
Phone I ax: E -mail: New dwelling area (sq. ft ) 9�1 S E
APPLICANT Garage /carport area (sq ft.) .. . ... .....
a
Covered porch area ft.)
Name: 0 P ( 1
1 ,� Mailing address• Deck area (sq. fl.) __
City• State: ZIP: Other structure area (sq ft.) . 144' S
,-Z Phone: Fax: E -mail: Commercial /industrial /multi- family:
1 CONTRACTOR ` : Valuation of work sass .. S
i� ` /(�l .L Existing bldg. area (sq. It ) .. .
`� Business name: q��j New bld area (sq. It.)
( • exJ / 3 V.,—
., .J
� Address:/ o I City: 4 y � State: at ZIP 97Z 3 lype of of stories . .
" fype of construction
Phone: _ &��7. Fax._ E -mail.
1 1 CCI3 no - Occupancy eroup(s)• Existing.
4 ,- -o
New
t y /metro lie no : ,
i V a.. Notice: All contractors and subcontractuls.irc required w be
"�' ARCHITECT /DESIGNER .: ;t licensed with the Oregon Construction Contractors Board under
Name: Provisions of ORS 701 and may be required to be licensed in Ih(
'' r ` Address:
• City
Jurisdiction where work is being performed If the applicant is
Slate I /_IP exempt from licensing, the roll e, reason applies
Contact person: P lan no. —
''�� Phone. Fax E-mail:
op ENGINEE OF USE ONLY
Name: Contact person: Fees due upon application S '� ' • `.
( � Address: Date received:
City • State: ZIP • Amount received . . ... . ..... .... S
Phone. Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all Junuhcuon. accept Lie hI Land. please Lall jumdieuon tin more uilimnauon
attached checklist. All provisions of laws and ordinances governing this a VI.,i U Masteicatd
work will be complied with, 'let - spec iii herein or not Cicdn Laud number 1 /
I•.\Pirc.
Authorized signatur . I� /��' Date 17q/9,3 Name ni Lardh older a..ho,rn on uedn Laud
• . S
11 11anie:
7 SCUT Cardholder signature Amount
Nntu•r• Thl■ nrrmu ;Innitriu%n i•rIvr ,: if aI nrrm,t is nil nhtainr(l Iv1thin IXil rtavc :Ii) r ii ha. hr•r•n :u•rrnu•rl a. rrtmnlrli• 44(1.41,11 (1,/(1114('1
1p ,, Electrical Permit Application OFFIC USE ONLY
Date received: 7 y' d'3 Permit no.: frfgje v 3 _403
t�.�If I City of Tigard Project /appl. no.: Ex ire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: B Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family 0 Tenant improvement
0 New construction Allkddition /alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: /3 /5t S) (4 Lake o Bldg. no.: Suite no.: Tax map /tax lot /account no.:
Lot: /...-( Block: Subdivision: 8,- S.qt GC2 ve tA t
Project name: Description andlocatio'h of work on premises:
Estimated date of completion /inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Ma)
Description Qty. (ea.) Total no. in
Business name' ,4-1.. TIC t'�LE>:TIZcL �,) L Newresidential- singleormulti- family per
Address: 4.11;35 ack &mei /d ,q..6 , dwellingunit .lncludesattachedgarage.
City: Ke r cEeti- State' t ZIP' 91-30 30 Serviceincluded:
Phone:l� ,3 _ F,Fax:03_ q E-mail: • 1 000 sq. ft or less 4
CCB no.: , i - o 271 Elec. bus. lie. no'.\ +121 C.••
Each additional 500 e ft of portion thereof
Limited energy, residential 2
City /metro lic. no.: / -3/ • /0 —/ —0 3 Limited energy, non - residential 2
/ /' A' /(L Each ntanutactured home or modular dwelling
Signattue 0 5 ervuin electrician (i ed) Date .7- 9 Service and/or feedei 2
Sup. elect. name (punt) /0-1 -0`4 License po. gn, .. Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less _ 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address
601 amps to 1000 amps 2
City: State ZIP: Over 1000 amps oi volts 2
Phone: Fax: E -mail: Reconnect only I
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 ,alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee lin blanch cucuits with purchase of
Address: service or feeder tee. each branch circuit 2
City: !State: I ZIP: 13 I-ce fbi hi anch circuits without purchase /�
Phone. Fax E-mail: of service oi feeder Ice. lust branch cucuit 4' 2
Each additional branch cucuu.
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
U Service over 225 amps - commercial U Health-ewe facility Each pump ot Irrigation circle 2
U Service ovei 320 amps- rating of I&2 U Hazardous location Each sign ot outline lighting 2
flintily dwellings U 131'1ldntg over 10.000 situate feet tixu of Signal cucutt(s) or a limited enet gy panel.
U System ovei 600 volts nominal mote residential units in one suucture alteration. oi extension* 2
U Building over three stories U Feeders, 400 snips or more "Description
U Occupant load over 99 persons U Manutacnned stnicnues of RV pink Each additional inspection over the allowable in any of the above:
U Egress /lighting plan U Other: Per inspection I I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee ... S
Not all pnisdicnons accept credit cards. please call jurisdiction for more mionnanon Notice• This permit application
U Visa U MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit cord number / / within 180 clays after it has been State surcharge (8 %) ....S
i'-`ptres TOTAL ..S
accepted as complete.
Name of cardholder as shown on credit card
S
Cardholder signature Amount 4411 - 45 I5 t6 /00ff't
' r,, , ' . F
e`
Plumb Permit App OFFICE USE ONLY
Date received: 7 /`' 63 Permit no.: IN 35
t ���-, City of Tigard
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Sewer permit no.: Building permit no.:
City of Tigard Phone: (503) 639 -417 I Project /appl. no.: 're date:
Fax: (503) 598 -1960 Date issued: By Receipt no.:
. Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ I & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction A Addition /alteration /replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION -.1.
FEE SCHEDULE (for special information use checklist)
Job address: //**( 5 , , y . / e t'e Description Qty. Fee(ea.) Tot:
Bldg. no.: Suite no.: New I- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot /account no.: / j- / 33, e SFR (I) bath
Lot: 76 . Block: Subdivision:B t SFR (2) bath
Project name: SFR (3) bath
City /county: 77 f ,.d , I ZIP: 7-ZZ 3 Each additional bath /kitchen'
Description and loc tion of work on premises: Site utilities:
`J'iz/e 47 !^ f (4Q5 fn /n. at l Catch basin /area drain
Est. date of completion /inspection: Drywells /leach line /trench drain
Footing drain (no. lin. ft.)
.. - PLUMBING CONTRACTOR __ Manufactured home utilities
Business name: r 7/4'mb /it? Manholes
Address: 7495 M /64 ii -/-+ Rain drain connector
City: Ve I State: Oa IZIP: T 7.pD6 Sanitary sewer (no. lin. ft.)
Phone.. (4/3 Fax 437- 11991 E -mail: Storm sewer (no. lin. ft.)
CCB no.: Plumb. bus. reg. no: 0/7 pg Water service (no. lin. ft.)
City/metro lie. no.: _31 _ 0 L Fixture or item:
y i5 3o�5 . /C�� 4 ° ITT Absorption valve
Contractor's representative signature: rte
Print name: a i D ate: , _ o3 Back flow preventer
y Backwater valve
• ' • ,''^ , CONTACT PERSON IV
Basins /lavatory
Name: ' 'e 5,074-74-,_ . Clothes washer
Address: //49 s /3J-A Dishwasher
City: 7-4 I StateO.2 IZ q{2 �3 Ejectors/sump
um ptains)
Ej /sump
Phone923.. , ` 1 Fax524 -1' r/ E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): Floor drains /floor sinks /hub
Garbage disposal
Mailing address: Hose bibb
City: !State: IZIP: Ice maker
Phone: IFax: 1E-mail: Interceptor /grease trap
Owner installation /residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs /shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: State: ZIP: Other:
Phone: Fax: E -mail: Total
Minimum fee S
Not all jurisdictions accept credit cards. please call jurisdiction for more iniim- mation Notice: This permit application
❑ Visa ❑ MasterCard Plan review (at %) S
cxpiies if a permit is not obtained
Credit card number. / / State surcharge (8 %) .... S
fl.pires within 180 da tiller it has been TOTAL $
Name of cardholder as shown on credit card accepted as complete.
S
Cardholder signature Amount
nnn_nr, , iaainiri
07/18/03 08:57 FAX 5038463525 CLEAN RATER SERVICES 0001
. _ 07/16/2803 13:13 583524775 SC.OTT00 BLDG. & DES. PAGE El:
•
Fit Number
CeanWate S erviG �fl Lg/
p
Our eommi nient i clear. UL 21 a �sitive Area Pre - Screening
MTV OF TIGARD
BUILDING DIVISION
Jurisdiction / / G Gt' vd Date 7// dl 3
Map & Tax Lot Jg / S r� ,a. 400 0 Owner Ca-/ COX
Site Address
tom , v kP 7. Contact S�4i!' Sloes
• Proposed Activity 7-7 bA —) p • Address // /3S
/7 t � _ z-co ale
• Phone
roix 6 5 77S
Y N NA Y N NA
T - 1 Sensitive Area Composite Map n Stem Infrastructure maps
` I Map# /S/we, ' QS# y2/6
H ® Locally adopted studies or maps I I Other
Specify 1_ t 1� � Spec
Based on a review of the above information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No..00 -7:
11 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 LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas
exist on the site or within 200 feet on adjacent properties, a Wtural Resources
Assessment Report may also be required.
ItSZI 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 on your
property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
.. STORMWATER CONNECTION PERMIT. - .
• The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
�.. on • e :e e 1 _ - W 2 - • /0 ,e
/ / /r ' ees w , , r _ . . P.. 1 • - e• -
Reviewed By: Date: ' AVG •
•
Returned to Applicant
•
Post -ite Fax Note 7671 11328 7 - /9//) li a 9 5 ► / Ma Fax K Counter
Date ' J'/ 4 _
,15 r,c Fns'
5e, rr F li c�,f /,3•ef h l/ i ! �� d 3 B} `
Co./Dept. Co. ink 5
Phone a Ptrone # , - 03 3SS7
Fax #5-03...5214_ 7 751 Fax -
' CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 - 3 s-(
INSPECTION DIVISION . Business Line: (503) 639 -4171
�./ BUP
Received Date Requested / - • / AM PM BUP
Location / 3 (S (, C .L_4 l .�o Suite MEC
Contact Person Ph ( ) 07 3 i PLM
Contractor Ph ( ) sa ( 1 — 77'7 SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: C O ,/YA c3 ® ELR
Crawl Drain
Slab Inspection Notes- SIT
Post & Beam 1 °f? P
Shear Anchors ,, - —rxr 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:
- 'ASS PART FAIL
CHA _
P. :eam
Rough -In
Gas Line
Sm• e Dampers
PART FAIL
RICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
.tom PART FAIL
SITE El Please call for reinspection RE: Ir. Unable to inspect – no access
Fire Supply Line �(
ADA L/
Approach/Sidewalk Date/ / Q Inspector , _ . X11 c--•'"7/jct
Other:
Final DO NOT REMOVE this Inspection record fro the Job site.
PASS PART FAIL
i", _1- wmk-,1p
1
CITY OF TIGARD ' % /
BUILDING DIVISION PERMIT #: MST2003-00354
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/11/2003
Phone: (503) 639 -4171 &a
Inspection Requests (24 Hrs.): (503) 639 -4175 el P
INSPECTION WORKSHEET FOR DATE: 4/5/2005 TIME: 7:09AM PAGE: 8
SITE ADDRESS: 13156 SW WNTERLAKE CT CLASS OF WORK:
SUBDIVISION: BRITTANY SQUARE NO. 4 LOT #: 076 TYPE OF USE:
PROJECT NAME: COX
DESCRIPTION: 2 - story addition 4 - - 05 This permit is reinstated for purpose of "Final Inspection" for a period of 30
days. per Hap Wat14ns. till May 4, 2005.
OWNER: COX, CARL PHONE #: 503 - 590.5185
CONTRACTOR: SCOTTCO BLDG + DESIGN PHONE #: 646 -6771
Inspection Request Scheduled For: Date: 4/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message /
299 Final inspection 003750 -01 503. 690.5185 N V
Correctio1 /Comments /Inst ctions:
w
4.6
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ir / Date: G -- U--- Phone Phone #: (503) 718-