Permit "iTER RE'f�MIT.
I .;TwI : F RI I T : P�.� . . , n M ; ` ,36- 0.1.?,7,
. C OMMUNITY: DEVELOPMENT DEPARTMENT=; - DATE : -S iJE:D ' i / Zi T rc�.C� '
•' 1312`S • :SW' Hall • Blvd, Tigard, Oregon 97223.81'99 (503) 639- 4171 ; " - .' 9 Rc L -a IS I � YA I5 I �
SITE ADDRESS. 107 -� S W PONDEROSA ' -- 'L _
• `SUBDI'V,ISION, BLACK BULL FART!. - '- • -,v - . ' ZONING: R-:-4,=:,5
- Reaarks: ADDITION 216' SO, FT • - •
REISSUE ' STORIES.' '` 1 • FLOOR =AREAS - -- ' - -- - f I' n T :
_ BASEMENT.:.. 0 �, . RE_JIRED- SETBACKS- ,RE�U.REI`- ,
' , ,, NOM ;:'ADD
- 'HEIGHT. : :.�... : :: 15 FIRST. :•:, 216 s''f '•GARAGE:: , .'' ' •0` sf - LEFT,'. ...:..'..: 0: 'sat DETECTRS: „<• Y
- ._
'TYPE OF lUSE.. :SF .•FI ODR „LOATz:... : 40 ' SECOND„: . . ',�•°;. 0. f , . ; FRONT.. . ' - - 0 - ;PARKING •' ES: . "g. .
=TYPE CT GONST. :5N ,Di,ELLIP,S I F1NBS ;0, sf ... RIGHT ,. ' .0. F
CCC PANCY,';6RP k3' ',BORii : :O •BATH: 1 ' ' TOTAL.-- =--- -: - , •216 - sf - - VALUE.. $ : ',13'!67 "REAR' ' ,16 . '
- . --
----- - - - - -- - - - -. _ P1_1ft1Bi N6 - - -- W { , , - —.77-7-L.
SINKS :..:. -. -- ..: , 0', • WATER; CLOSETS 1. • l41S 1L C MTh 0 ' - ,- LAUNDRY: - TRAYS. r 0 ' riiiPi :;RAIN-- ft: 0 TRiW'S...: - :. .. .-0
•.'LA'VATORIES'' -- ; 2 -• .DISHY S}iERS.. 0' "FLOOR .`4: 0 SEWER LINE :• 0' SF 'RAIN DRAINS: .0 ' ,:CATCH BASINS... _ 0 -•
I TUB /sl;ui7ER 2 • 6ARBh'EE DISP..: ' 0 WATER i'.EATERS .0', • • WATER- LINE, -ft: '0, -, BCItFLW'PREVNTR: 4' GREASE TRAPS..: -,
.. - . • - , OTi*ER F[XTL =RC=S: 0 ,
- FUEL TYPES ' ---- - FU: ; ;• -100K .. 0 'BOIL /C F'` ( 3HP: - 0 'VENT' FANS ; . 6 CL CiT 5 DRYERS: ° ,0 • -_ `' -
- - _ FJ RN ? = 100; ' :.: '0 - _UNIT HEATERS... `0 - HOODS. .. ...... '0: - OTHER• UNITS.'•: :. 0 ' - 1 - '
✓ N'AX •IN.P.. ' '0 FLOOR FIURNACES 0 VENTS . 0 ' 610DDSTOV €S 0 , ' Gf S• OUTtLETS. ^ 2r :
-- - -- - -' - - -- - ----- - - -_ -- - ELECTRICAL . - -.. -_ ,-- -- -� '' - "77 _T =-
' - RESIDENTIAL UNIT - SERVICE /FEEDER --- - =TEN4- ERVC /FEET ERS -- - -- BRANCH •CIRC�JITS = = - - '.- NISCELLAAECY - - - - r - A D D' L INSPECTIONS--
• '• 10000 SF OR L 0 '- • : 0 ' '-,h'',0- anp.. 0 0- - 200 aap..-: 0'< . W /SVC OR FDR..: - : 0 P NPIIRR ?6ATION :' 0 • ER, INSPECTION; 6 •
• =n r aw- L Fet.i7r i iii , t p : - t x r ' r - a a P , . = - - - - [@i, - - gF : -F - ist - ifyir O l l y 1 : ; ;m " - , S :.0 -, TER R . .:.;:. - - ,
- • UNITED' ENE_RSY. -: -0 401,'°„ '6 sap.. ;r0 ' 401, - 60'„' cop.: -0 . EA ADDL. BR CIA: 3 , ' -- SIBN L/P B.;....: B IN, PLANT....:.: -0' ;
' NAN 1. 1 /SVC /FDR: 0. - 601': _'10e 'sop..,: ,0' . 601 4 -l0 0 Vi- 0: ; . , , i&INNT;`LABE •10:, 0 ': . -• - _ .
- len+ agp /volt.,: C,. . ---- _:. --,
_._ _ - ---- -
- - _ .FLAN REVIEW SECTION '-- ��_. __ .
_- �_..----- _
- Rec.'.
e_onnect oily°: :.0 )=4.RES.UNITS..: _ SVC /FDR) =225 A.' :'• ) - ,600 V'NCNIN^A `' .. CIS - ARE(d /OC CCC:
' - - ---- : - ---- ` ELECTRICAL - RESTRICTED ENERGY ' - _ 4.----- • — - -- - -=. - .
• A. Sr: •RESIDENTIAL -- - - - -- . B: ; mE - fiCIAL --- . - - -' - --- �_ - - - - -- -- i _ ' ' _ --
i�'UDi•0 & ST REED.,: "Jk',C,U11T SYSTEI..1 ' dE - T -TNTERCCN /F`r�STN&':• ITTDOUR.LNDSC Ld - '
,' '
fiUBiO-� STE i.tO:.: -' EIRE -ALARM:. ,
' BURGLAR,= iLARN:. E}T'rl: • •' 'BOILER - - NVAC W4DSE E IRRIG.: - PROTECTIVE _
• GARAGE OPENER.. - .' ., CLOCK.'.. '_ - INSTRLNENTATION: NEDICAL;,'.,: .r..,a : ' ; °�; OTHR: .
HVAC. - DATAI ELE -COi t , - NURSE 'CALLS..:..'. - TOTAL -# SYSTEMS: B
J'i3n'ei ; - - -- ,7 raCt or : = . ' -------- •- - - -- ' =TOTAL' FEES :$ '224.91 - -
. 'RAY.FA:,R' ' OWNER -
10705 Si' PONDEROSA PL - _ ' , ' ' '-- '
TI6ARTi.C►R 97223 - _ . _ •
Phone,t. 6B4 . f one fr _ . , , - '
Reg ft.
•
,This p rnit is issued subjec to the regulations contained Tin 'the Tigard Code, ,State. of Or=e :' - Specialty:' Code's,' and all other- < - ,.- -
• 'appiicabie'laies.,•; All '6'k :zili' be -done in CC D?d,ifCe. w ,
ith approved plans. This if .wiI1.e;'pire ,it - work is' not'started -'
, ,,days,of: issuance, , or i�r,: wor^k' s.,,suspended` for gore : than' 180 •days: ' . ... ,. _ . .
• '- _: -.----e-'---7--------7-7-7--77- _ -- REQUIRED 'INSPECTIONS - - -, .. -_--- ,- -- -- - -- - -'
.'.Footing Insp = . Plupb Top Out A'luab' Final- - '
. Foundation Iiisp Fraong- •
isp , '- Building Final' • _ , . .
ost /Beaa S`ruct . ' Insulation :I Erosion Contrail
:P
' Crawl Train' ' . Gyp' aea; �d'Insp ,, -, . - ■ .
'PLg /Under-fioar Rain.,drain Insp ` "
.. ..
rtee , �ipn'�1;ure.. , ;off: - Ifilar w , ' :I s ■le .Y '� � 1• - 4 ' ft,- •
Call' i a'r� iris ''.•, ,� ' ,2 . • I;:
ec.tr- o'rI, £ 9�- -4`175'
,.' ' ' I ■ r. . ' ' s .-F 9 G. _ „1,3. . - it', - ;, - .'.= ! ,. ,'';,'. .1 - " ; • -.. • • ' •' .. - - -'" ' ' ", '
,`o g0 3-17 _6/1..
Residential Building Permit Application
City bf Tigard q&
• 13125 SW Hall Blvd. 1,�' ��
c5" Q/
Tigard, OR 97223 V'L2-
(503) 639 -4171
Jobsite Address: tb'1o5 Std Po/Q0ei205/4 PL
AIL
Office Use Only E.
Subdivision: LAX RN-ELK.. Lot # Z �
Contact Date % / ::.: Initials
Valuation: �3 �� Result
New Construction Only: (Squar Footage) Planck/Rec # 7j- Cog
Permit # nnsf 9(- o /37
House: X arage: Reissue of .- :
Map & T #; 51 WIIP- 540o.
Corner Lot? Y N Flag Lot? Y N Zone F.5
C. U1) LC�A e , .. Plat # ii,(ti - bra : POLO(
Owner: .f�'r'� e___
Approvals Required . -
Address:►'rb'N„�- t J f
:Planning tbcks 69 � J
g. ea Q��;.;. Solar P�
Engineering . .....
Phone: w
Contractor: -- J J • / -- Items Required
/� Subcontractors 1 / 411
Address: C / ((�} V� 0 Truss Details .
Other
Notes . .
Phone: (
I
Contractor's License # (, N .
(attach copy of current Oregon license)
Contact Name:
Contact Phone: ( )
Subcontractors: / Architect/Engineer:
r� �
Plumbing: e1 V UI1A. V Address:
,
(attat;h copy of current OR Contractor's License)
Phone: ( )
JOB DESCRIPTION: L�I..ILLA -� �- Z.G1 . t -i nv lM 2 -tD?M 4 knci.st d1d
l ( co 3) (oal ft ��
Applicant Signature n , -�'�"" Applicant Phone number
Received by: f,7^ '"l- a Date Received: I/ --1 5� /
H Uopmldsb ,ecepp
•
Permit * Account Description Amount Amt. Pd. Bat. Due
Bldg. Permit (BUILD) /(J q. S u u
Plumb. Permit (PLUMB) 4) , L
Mech. Permit (MECH)
•
State Tax (TAX) 4 1 ,4 0 7. tie
Bldg: 5.1 3
Plumb: • L >
Mech:
Plan Check (PLANCK) 7- 73 1/.`6 .°`_ ,
Bldg: 7,93 •
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TiF (TIF -MT)
Commercial TIF (TIE -C)
Industrial TIE (TiF -I)
Institutional TIF (TIF-IS)
Office TIF (TIF -0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion PlancIJUSA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: } � J ' i
1
■ Permit #: ! f' T 9( 0/ 7
O F �
� R; 6 70S 501 I il DS/# "-- -
�� �, Address:
ic "r te; % Issued by: 411.1i �!...
/1 % , 0 k (� �
: . Date: O
/:g
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.
Er Fillinthe 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 I X 2 . I understand that I must register as a construction contractor if the structure is sold or offered for sale
�� '"' II before or upon completion.
El 3A. My general contractor is . J 9 7
(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 Owner a ',tut Construction Responsibilities on the reverse side of t I is form.
. � i i
(Signature o permit applicant) ( ate)
(White copy to issuing agency permit file,
pink copy to applicant)
Enforrmation Notice to Prropc r 2y twn rs
About Construction Responsibilities
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 70
If you arc 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 YER RESP•NSIBOLITDES:
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.
J.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.
OTHER RESPONISIB000TBES AND r REAS 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.
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 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 NOTICE
Inspection Line 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL.
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out n - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins
Other: I
Date: :) /t - .3 ! l (o A.M. P.M. Entry:
Address: / U 7 0.S A �YGdri -.l GLa-ex-__■
Tenant: Ste: MST: `'14' 0/ 37
BUP:
Con /Own: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
1i�G�S vAAizo 9 r'
-77 "-L.-Ls-
4-"V
?"7/,i rS2 ctc: - r2
1 �G.rt�L,g7 \/b!/7 S -Y .S
In pector: Date: 3 44,6.
APPROVED DISAPPROVED /CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -417
Footing Rain Drain Cover /Service FINAL:
oundatios Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: •
Date: [ l g / (p A.M. P.M. Entry:
Address: l U 705
c� / (p
Tenant: � p Ste: MST: / O 137
Con /Own: L
-i'0 SV MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
1) e e/Aarl„ ✓
fl�i S S,Zu G7L.e4: ,00.�v,�, �� ?dL4% r,
C �y 4.,
Inspector: AO. • • \ Date:
_AFP'Re '-ED -. DISAPPROVED /CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
4
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
Plbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in .. Bd -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 572_3 (? (, A.M. P.M. Entry:
Address: / 0 7 as Perdu 6 -4-6L. r
Tenant: Ste: MST: '7((, D /37
BUP:
Con /Own: (p g4-( --as? c( MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
a r Coale- �ti i --�4_ 1, / Le C Z
A."- I
Inspector: 4 • Date: 7Z8/j‘..
APPROVED DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
lbg.Un ab Plbg. Top 0 Insulation - Elect.
East/Beam Stru ec . Rough -1 Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk R�gtrts�
Other: _
Date: J / //4 ( , A.M. P.M. Entry:
Address: / D 7 t
Tenant: Ste: ms-r5 6 0/ 37
BUP:
Con / wr . _, 1' &P 15S -8syy
MEC:
PLM:
ELC
4E FOLLOWING CORRECTIONS ARE REQUIRE ELR: :
(..- °Y. ' 3-s- " °/- ' 4 7 477
e._ . L. I( .i1. T * ± 4
_ fig
/ / �/ /�
.�. .. +�� v _
®- .. _Al
III° • 4/.J
a ,/
o ____. _if._ . ,,_,,, .._.__. .: e.e.....Ate•
(::-.4.— /2,o.
Inspector: '/ Date: 6t- 7
APPROVED // DISAPPROVED /CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain over /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Bea ech. Shear /Sheath 44211:1 -Mech.
PIbg.Un Ir /Slab (Plbg. Tor 7 Insulation - Elect.
Pos Bea Struct. (Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: `` `
Date: 5i2_ I 9 $, A.M. P.M. Entry:
Address: /0 D C je61 O/1. —a - ff—
Tenant: Ste: MST: (�6, Q / 37
/ p p BUP:
® n /Own: 6.0 "I "-Q s!1 MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
® - 1r �(/
.ft- t -," / .��
( .
— i ✓.
3 ..Ittt_d____z:=1. ,. 7 ,..... p.t....04.4_, L 1 H - .2.6_
In�spe�ct r: ./41 Date: 5 2 ' 0 / e
APPROVED DISAPPROVED /CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION DIVISION MST ?6'00/ 37
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested l l� ' Z Q - q 9 AM PM BLD
Location / b7OS POVI Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation C bm yb t) in Sp. • , Hy 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:
• in.n.
°ART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
. PART FAIL
'ECH
Post & -eam
Rough In
Gas Line
Smoke Dampers
n -''
d /•ART FAIL
Rough In
UG /Slab
Low Voltage
F TryA RT re Alarm
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
Date ate Inspector nspe Ext
E x
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.